Imagine an organization where:

  • The most precious resource is maximized to its fullest capacity.
  • LeanHealthcare_VisualManagement27RSThe leader’s role is to coach, to teach and to mentor that most precious resource to achieve results that were thought impossible.
  • The precious resource is excited to come to work and is trained and empowered to make decisions.

Now imagine this scenario expanded to all of your precious resources – your staff.  You have the proverbial army of problem solvers.  Thousands of employees pulling the rope all together in the same direction.

It is not a dream or a fantasy.  It is happening in the healthcare world right now – accomplished by a Lean Healthcare system, based on Lean fundamentals and reinforced with a Lean Management Systems philosophy as the foundation and direction.

Wow!

So how does this actually happen?  How does this dream become reality?

It starts with a leadership team.  It starts with their vision.  It starts with their belief that this concept can work and their understanding of the leaders’ key roles for success.

The leaders provide the vision and the guidance, and just as important, the fundamental building block that is an active, engaged staff.

We train in healthcare perhaps like no other industry.  But the training, and the direction that goes with it, has never equaled a fully engaged staff.  We know we cannot train our way to an army of problem solvers.  It may work for a while, but the flavor of the month does not sustain.  Oh sure, there will always be high achievers and budding superstars that hustle and do wonders with new tools and bits of knowledge and expertise.  But it doesn’t sustain for the masses.

Why?

Try as we might, we never found the happy medium where we can trust in and engage the staff on a daily basis with the information they need.  This is where Lean healthcare methodology and Lean Management Systems become vital to success, specifically through a visual management system.

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There have been many articles and blogs written about the power of visual management and visual management boards.  But my message is just a little bit different.  How many times have your walked the units, gone to the gemba and looked at the various forms of communication boards?  How many times have you shook your head in bewilderment at data that is months old and obviously not in use by the staff?  Or boards that have papers everywhere with no rhyme or reason.

I have worked with a hospital that has made tremendous strides in implementing Lean and engaging its workforce.  Their visual management system is not only based on the visual management board, but also on the visual management board process.  The board and process is based on consistency of purpose and content.  What goes on the board and where does it go?  This engaged organization formed a visual management board team from multiple departments, both clinical and non-clinical, and empowered that team with a senior staff leader.  The team started with a Kaizen event and followed with many improvement iterations.  This organization now has approximately one hundred functioning Visual Management boards, or “Huddle Boards.”  The design and content are not mine and are not the senior staff’s.  They are owned by the workforce who trialed the boards and made the changes.

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LeanHealthcare_VisualManagement15RSAre the huddle boards working?  For the past two years, virtually every unit in the hospital has been begging for them.  But to get a board, you have to go through a prescribed process of being coached, mentored, trained and certified before your board will be installed.  I am not sure I have seen all 100 boards but, every one I have seen is exactly the same. Remember what I said about consistency of design and purpose.

And of course if you have a huddle board, you must have huddles.  Again, theirs are standardized.  In fact there is standard work on how the huddle should function.  I credit three parts to the huddles and huddle boards that made them different than any I have seen elsewhere:

  1. Plan of the day – This is information that is driven by the staff that attends the huddle. What do they want to hear that lets them know what the status of the unit is for that day?  What do they need to reflect on from yesterday or the previous shift that may drive action today? Who needs help?  Who can provide it?  It varies of course from department to department, but it is always what is important to the staff.  The folks we are trying to engage.
  1. Pick chart – This is an area for employee suggestions and improvements. Very systematic and very process driven.  Ideas are put on the board by the staff and reviewed in the daily huddle.  They are categorized by difficulty to implement and impact on the unit.  The ideas are subsequently assigned volunteer ownership for further problem solving and or implementation of the many just-do-its.  Some ideas may be outside the span of control or scope of the department to implement. These are moved to a parking lot, from which the leadership has the responsibility to evaluate the idea and potentially take it to the next level.
  1. Recognition area – Individual, team or organizational. Birthdays and employment anniversaries.  Shout outs and thank you’s.  Patient and leadership comments.  Again, the key is what the staff wants to discuss in this section.

The other main section of the board is the problem solving area with statistical history, problem-solving A3’s and leading indicators tracked daily.  This area is focused on the unit’s problems and opportunities but always driven by the strategic priorities of the organization to ensure they are working on the right things.  This is the toughest part to implement but has tremendous impact as it occurs.  Because it is focused on the unit’s problems and daily leading indicators that are behavior based, the problems are live and able to be discussed daily.

The first three sections get the staff involved and active.  Then the problem solving manifests itself.

Huddles are usually eight to twelve minutes.  They stick to the schedule and make sure the huddle starts on time.  One of the first boards was at an ambulatory site and the wonderfully engaged manager would walk the floor imploring “huddle in five minutes” when the board was just beginning.  But very quickly, there was no more imploring.  The staff is there.  On time, every day, in the narrow, dimly lit hallway which was the best space they had for their board.  The nursing staff, the housekeeping staff, the laboratory representative, the physicians.  The folks that make it work.  Huddling to discuss how they are going to do a better job of taking care of their patients.

The process is repeated daily throughout the organization at all boards, ranging from Environmental Services, Emergency Departments, Radiology, Special Police, Adult Care, Infant Care, Cardiology, IT, Home Care, Human Resources, and many others.

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LeanHealthcare_VisualManagement26RSCommunicating.  Growing.  Solving problems.  Sustaining.

It is working.  Metrics are being moved.  Quality, Satisfaction and Service are improving.  Costs are going down and revenues are increasing.  Some units are saving many thousands of dollars.

Why is it working?  Because it is developed and owned by the fundamental building block of the organization – the staff.  The people that do the work.  They huddle at the boards because the information they share and receive is meaningful and helps them do a better job with less stress that day.  They huddle because they feel empowered to solve their own problems.  They huddle because it feels good to recognize someone and say thanks for a job well done.  They huddle because it is theirs.


Steve Taninecz, Director for Lean Healthcare and Process Improvement at HPPToday’s blog was written by Steve Taninecz, director at HPP.

Steve has 40 years of experience in manufacturing and healthcare organizations.  Steve’s work in the healthcare field began as an educator, trainer and coach for the Pittsburgh Regional Health Initiative, then as part of a New England for-profit health system overseeing, counseling and coaching culture change to the hospital system’s leadership for the successful implementation of lean.  Steve holds a Bachelor’s Degree from Youngstown State University in Industrial Management and a Master’s Degree in Organization Leadership from Geneva College.

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