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Daily ManagementJulie FryOctober 2014

Today’s Objectives (Minor) Understand how Daily Managementfits in with VM organizational managementframework (Major) Identify the 5 elements of DailyManagement (Major) Understand how Daily Managementprinciples can support your leaders and teammembers 2012 Virginia Mason Medical Center 2014 Virginia Mason2

The Virginia Mason Production SystemWe adopted the Toyota Production Systemphilosophies and practices and applied them tohealth care because health care was so lacking inan effective management approach that wouldproduce: Customer first Highest quality Obsession with safety Highest staff engagement A successful economic enterprise 2014 Virginia Mason

Traditional Health Care Management System? DC Comics 2014 Virginia Mason

World-Class ManagementThe World-Class Management System is a leadershipsystem that provides focus, direction, alignment, and amethod of management for daily workThisOr This5 2014 Virginia Mason

World-Class ManagementThe World-Class Management System is a leadershipsystem that provides focus, direction, alignment, and amethod of management for daily workManagementby PolicyProvides focus and directionDailyManagementManages daily work 2014 Virginia nagementAligns across the organizationtoward full customer satisfaction

Management by PolicyAligning Vision with ResourcesLong Term Vision5 year PlansAnnual GoalsKPO PrioritiesClinic PrioritiesSection PrioritiesClinic Focus Areas:Our Work in 2014 Develop and implement a "know you" template in our electronicmedical record (EMR) Be present with our patients; demonstrate thatwe know them and care Standard touch point behavior (Milkshake) TBD Contribute to my team's excellent phone service performance Treat every call, every message as our patient Work to resolve patients needs in one call Measure and improve message lead timeBE THERE Simplify scheduling "rules", share best scheduling practices, andreduce appointment types Just say yes! Offer patients care when, where andhow it is desired Design and test innovative care delivery models Increase patient enrollment in MyVirginiaMason Engage patients in using MyVirginiaMason toimprove their health and well-being Pilot patient direct scheduling Identify new ways to engage patients to use the portal Know and explain how Virginia Mason is present for patientswithin my communitySHARE Help us grow! Champion our locations, servicesand quality to provide our patients what they needPREPARE Implement new workflows using our electronicmedical record (EMR) Schedule patients for follow-up appointments before they leave myclinic Successfully implement our ambulatory computerized providerorder entry (ACPOE) system 2014 Virginia Mason Give patients the specific information they need to navigate nextsteps in their careHow do I contribute tothese goals?

Management By Policy, or Hoshin KanriReflectionACTCheck andReview Compare performance toplan Occurs at all companylevels EnvironmentalScanning SWOT Review 5 YearPlans A3ENGAGEMENTPLAN“Catchball” Idea exchange Feedback, engagement Identify resources / roles Set measurement criteriaDeploymentSTUDY Production plan Understanding/ awareness Develop strategies for entire organization departments individualsDOAdapted from elements of World Class Management, Management by Policy8 2014 Virginia Mason

Check and Review Cycle regular checks and reviews are critical determines current status of goal achievement conducted regularly (e.g., daily, monthly, quarterly) includes intensive, objective study of data joint problem-solving, planning, and follow-up may berequired 2014 Virginia Mason

Cross-Functional ManagementA management system for implementingbreakthrough improvements that is alwaysfocused on the elements of full customersatisfaction10 2014 Virginia Mason

Cross-Functional Management Achieving full customer satisfaction requiresintegrated cross-functional management, teamsworking together, not at cross purposes Top leadership must integrate the organizationinto a close-working system All functions must work together to achieveoptimum quality, delivery, cost and service(QDCS) “The ‘horizontal weave’ must be stronger thanthe ‘vertical weave’” Kaoru Ishikawa11 2014 Virginia Mason

Cross Functional ManagementOrthopedic Value StreamClinicExperienceInpatientCare 2014 Virginia MasonPeriopFlowFollow UpCare

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Daily ManagementRepetitive daily activities and behaviors that leadersengage in to ensure customer demand is met andidentify abnormal conditions: Know at a glance status of daily workDailyManagement Completing planned work Understand status of upstream and downstreamprocesses Standard work being followed Know when to take action and what action to take Engaging Staff 2014 Virginia Mason

The Leader’s Primary MissionAs a leader you have 2 jobs:1. RUN your business2. IMPROVE your businessDaily managementis HOW you dothis 15 2014 Virginia Mason

The FIVE Principle Elements of Daily ManagementVisual ControlsCreate linkedvisual systemsthat drive actionDisciplineLeadersconsistentlyverify the healthof processesand systemsRoot CauseAnalysisAsking “why” andusing data andanalysis to attackproblems 2014 Virginia MasonDailyAccountabilityProcessEstablish roundingprocess at alllevelsLeaderStandard WorkLeaders routinelycomplete keyactivities necessaryto run and improvetheir business16

DemandIn order to run your business, you have toKNOW your business.Start with understanding your demand A metric that reflects your departmental objective – one that tells youwhether you’re meeting your day-to-day customer requirements.(e.g., 22 patients per day per MD, or Ortho surgery schedule 5 total hips on Tue, L9 requires 5 empty beds. etc) A metric that reflects the health of your departmental processes.(e.g. 48 hour post discharge phone call for all medical patients)NOTE: Be sure you are looking at process measures versus outcomemeasures (e.g. how is your staff currently handling the demand of phone callsversus what do the phone stats show on the analytics report retrospectively?)17 2014 Virginia Mason

SupplyNow that you have identified your demand, what is yoursupply (what resources do you need to meet demand)?Hospital example: Daily staffing and types of staffing needs (RNs, PCTs,MAs, MDs, RTs, etc) Room availability? Special equipment?18 2014 Virginia Mason

Visual ControlProduction BoardsUnderstand your business Key business function to meet customer demand Daily/weekly demand (plan). (Pts., files, checks, etc.) Capacity (FTEs, rooms, machines)Make it visual Determine best metric-should be process not outcome Frequency to measure (daily, weekly) Visual display of plan versus actual Communicates key expectations with simple visual displaysMake it easy (at a glance) Standards are clear (quantifiable activity) Abnormal conditions are visible Improvement opportunities are apparent19 2014 Virginia Mason

Visual Control Starting Point20 2014 Virginia Mason

Visual ControlProduction Boards CardiologyCTSNumber of patientsbeing seen today,should have this manycharge slips21 2014 Virginia Mason

PhlebotomyAM Draw Production Board –team assignments and teamleadersDaily schedule 2014 Virginia Mason

Daily ect for People 2014 Virginia Mason

Quick and Dirty 2014 Virginia Mason24

Visual ControlsPatients can see status 2014 Virginia Mason

Visual ControlsHere’s an example of how insurancepayment closure understands their business dailyVisual signal for helpStaff member can see& re-assign to help 2014 Virginia Mason

Responding to abnormalities 2014 Virginia Mason27

Daily Accountability1. VisualControlsCreate linkedvisual systemsthat drive action5. DisciplineLeadersconsistentlyverify thehealth ofprocessesand systems2. DailyAccountabilityProcessEstablishrounding processat all levels4. Root CauseAnalysisAsking “why”and using dataand analysis toattackproblems3. LeaderStandardWorkLeaders routinelycomplete keyactivitiesnecessary to runand improve theirbusiness 2012 Virginia Mason Medical Center 2014 Virginia Mason28

Daily Accountability ConceptsHuddles “Go see. Ask why. Show respect.” (Mr. Cho,Chairman TMC)Regular checks on the production boardsProcess to follow up on the stories told by the visualcontrolsLeaders hold people accountable for completingtheir assigned tasksGenba RoundsVisibility of all levels of leadership involvement29 2014 Virginia Mason

HuddleHuddles with Standard Agenda Demand: expected vs. current Capacity: availability of staff, beds, appointments, etc. Identify and trend abnormalities/assign improvement workas needed Develop plan to address any variances Performance from the previous day to be recognized oraddressed/improved (e.g., quality measure such as phonestats, outstanding WIP, etc.)Agenda*Staffing*Demand*Capacity*Yesterday’s Performance*New Issues30 2014 Virginia Mason

Team HuddleDaily Accountability ProcessBuild the foundation with genba walks and a routine for huddles. Team leader huddle with team at start of shift at a minimumonce per dayRUN my business:- Standard agenda/checklist- Staffing and rotation- Updates regarding performance from the previous day- Takes place at the production board- Review today’s plan – note issues- No longer than 15 minutes; standing up31 2014 Virginia Mason

Genba Round Team leader huddle with team Supervisor huddle on genba with team leaders (daily)RUN my business:Review production boardsSafety, Service, Quality, CostIMPROVE my business:Review issues from previous day – trendabnormalitiesTask assignment (red dot, green dot)From the trending of production issues, visual board depictswho is assigned, due date, and on task (green) or off (red).32 2014 Virginia Mason

Genba Round Team leader huddle with team Supervisor huddle on genba with team leaders (daily) Supervisor huddle on genba with manager (weekly)LeadershipReview issues, trends, abnormalitiesConducts Root Cause AnalysisCreate/review action plans33 2014 Virginia Mason

Genba Round Team leader huddle with team Supervisor huddle on genba with team leaders (daily) Supervisor huddle on genba with manager (weekly) Manager genba walk with directors/executives (monthly/quarterly)RUN/IMPROVE my business:- Starts at production board- Review issues, abnormalities, trends- Opportunity to discuss and make a plan for issues that cannot be solved locally.34 2014 Virginia Mason

Daily Huddle BarriersBarriers to daily huddles include: 24/7 operationPhone work (can’t remove everyone at same time)Staggered start timesStaff work from homeSome ideas our staff have leveraged: Videotape Sharing of huddle leadership Cascading huddles 2012 Virginia Mason Medical Center 2014 Virginia Mason35

Leader Standard Work1. VisualControlsCreate linkedvisual systemsthat drive action5. DisciplineLeadersconsistentlyverify thehealth ofprocessesand systems2. DailyAccountabilityProcessEstablishrounding processat all levels4. Root CauseAnalysisAsking “why”and using dataand analysis toattackproblems3. LeaderStandardWorkLeaders routinelycomplete keyactivitiesnecessary to runand improve theirbusiness 2012 Virginia Mason Medical Center 2014 Virginia Mason36

Standard Work for LeadersStandard work for leaders specifies the actions to betaken each day to focus on the processes in eachleader’s area of responsibility.Clinic Supervisor Daily List 2014 Virginia MasonDirector Daily List

Critical ElementsEssential Assigned Work for Each Site LeaderFrequencyDaily Weekly MonthlyReview Financials & Report Variances (information/reportspecific)Document & Follow Up on Issues/ConcernsxxDocument & Follow Up on Patient Alerts & DefectsxReview and Updated Kaizen PlanOperational Rounding (Leader rounding, Service rounding,etc.)Conduct Purposeful Genba Observations supported by VMPStoolsApplause RecognitionxxxxSweep Staff Readiness: Performance Evals, FFD, etc.xReview Press Ganeyx38 2014 Virginia Mason