Increase Performance and Problem Solving Effectiveness. Bob Plummer and Matt Wehr March Learning Objectives

Transcription

1 Increase Performance and Problem Solving Effectiveness TIERED HUDDLES Bob Plummer and Matt Wehr March Learning Objectives Kaizen Leadership purpose Clarify the functions of tiered huddles Define Leadership support of tiered huddles Develop standardized work for huddles Discuss what types of things to measure to improve huddles 2 1

2 3 Honsha Serves a Diverse Array of Industries 4 2

3 Your Current State What does leadership mean to you? How do we lead? What are we doing every day? How/when do we find problems? What do we do with problems we find? 5 Kaizen Leadership System Purpose To support the work of our front line resulting in meeting the expectations of our patients 6 3

4 Main Elements 1. Standard and Stable Processes Standards are visible, instructed, owned by someone, able to be followed by all. 2. Visual Controls/Management Expected versus actual performance is evident for processes, outcomes, and problem solving. 3. Daily Accountability Process: Tiered Daily, stand-up, brief meetings in gemba at visibility boards to confirm team has resources for a successful day. 4. Standard Work for Leaders Standards are checked Visual controls are checked Andon (immediate problem) response Performs daily accountability process checks We get what we inspect! 7 Tiered Huddles An overarching structure and system that manages inter-relationships between weekly meetings at every level of an organization Short, focused conversations by natural work group members to check work status, surface problems, take countermeasures, and plan the day s work 8 4

5 Keys to Process Metrics Enable rapid problem identification by front line. (Stop & Notify) Enable rapid problem response by management. (Sense & Response) Make it normal for the flow of service to be continuous. Reduce or eliminate stagnation. 9 Leader s Role in Problem Solving 1. Provide standards for your team to know what to track, when to solve, notify or escalate. Define what a pre-problem looks like. Tools: process metrics, graph, chart, table, flow board 2. Model and teach everyday problem solving. Tools: 8-step problem solving and Problem Solving Worksheet 3. Coach team to be fire preventers. Everyone, everywhere, solving problems every day. Prioritize time in your Leader Standard Work. Tool: Problem Register 10 5

6 Three Key Questions How did we do yesterday? What s our plan for today? Is there anything we need help with? 11 Roll up Organization Senior -wide board Management Middle Management Clinic board Front lines Unit Level boards 12 6

7 13 Visual management & Tiered accountability Organization Level Scorecard Driven Board Clinic Level Huddle Board Unit Level Huddle Board Tiered accountability occurs when the outcome metrics from a lower level board appear or are related to metrics at the up level board 14 7

8 Tiered Huddles Build the team through open and shared communication Support the team members Share work status, ideas, and other information across the team, Clinic and organization Quickly surface problems and potential problems Align the team s efforts for the day 15 Visual Controls Days since last HAC: 55 Purpose: Find problems. Achieve goals. Alignment of goals, outcomes, processes, and problem solving 16 8

9 Daily Accountability: Tiered Huddles and Checks Find problems by reviewing process and outcome measures 17 Problem Escalation Example Staff If a supply can t be found in 5 min, ESCALATE to RSN Supervisor Within 15 min, contact Central Supply (3-xxxx) If no delivery within 1 hour, ESCALATE to ANM Unit Manager Within 30 min, contact: Day Shift: (Name of contact person - (xxx) xxx-xxxx) Night/Weekend Shift: (Name of contact person - (xxx) xxx-xxxx) If issue is not resolved within 1 hour, ESCALATE to Manager Manager Clinics Manager Director CEO Within 30 min, contact: Day Shift: (Name of contact person - (xxx-xxxx) Night/Weekend Shift: Nursing Supervisor If issue is not resolved within 1 hour, ESCALATE to Director Within 30 min, contact: Day Shift: (Name of contact person - (xxx) xxx-xxxx) Night/Weekend Shift: N/A If issue is not resolved within 1 hour, Escalate18 9

10 From Compliance To Engagement Engagement Enthusiasm Involvement Compliance Minimal Action Discretionary Action 19 Standardized Work for Leaders Maintain the integrity of the standardized processes. Monitor visual controls (focus on gaps: problems) Establish accountability (tier to tier checks) Acknowledge and respond when notified Find problems Surface problems Solve problems 20 10

11 Leadership Responsibility Provisions: Manpower Process Workload Outcomes: Quality Service Level / Output Cost / Efficiency In most management systems, managers typically only monitor outcomes. Kaizen Leadership Systems require that Leaders engage and coach in manpower development, process adherence and patient flow. 21 HUDDLE LEADERS Courage / Humility / Kaizen Are Good Facilitators Seek to Understand Practice active listening Align Resources Don t problem solve during Huddle: - save for Gemba Focus on process not person Are non-blaming, nonjudgmental Trust & Respect Empower, motivate, encourage Model Leader behavior 22 11

12 Standard Work for Unit Managers Example Morning Huddles Unit Rounds & Response Manager: Amy Chapman v27 (2/10/14) Start of Day Review Calendar & Plan Manager Standard Work 3 North/ South Date: Start of Shift R/G Mid Shift R/G End of Shift R/G Mid Shift Huddle (ANM/RSN) DMS Communication/ Quick Hits/ Problem Solving/ Escalation F/U RSN/ Mgr Huddle/ Environment Checks 1700 Sign Out with Units 3 NORTH 3 SOUTH 3 NORTH R/G 3 SOUTH R/G NOTES HPPD USA SW Check USA SW Check 3 SOUTH: Floats/ sick/ A day RSN SW Check RSN SW Check Occupancy HAC Assignments HAC Assignments Discharges (#) Viz Board Magnets Viz Board Magnets Admits (#) D/C Nav Board D/C Nav Board RN procedures TDD TDD Care conference Goals Goals Harm Complaints Escalations Escalations Care Concerns R/G Other Issues Lunch 3 NORTH: Standard Work Checks Meetings/ Project Work Reset Visibility Boards HAC Assignments Done Gemba Walk (S, E, N, Tx Room, Office) Meals/Breaks Assigned Gemba Viz Board R/G D/C Nav Board Escalation F/U Gemba Rounds 0830 Process Check Issues (NPSG, HAC) Office Work- Manager Time Quantros Reviewed & Assigned Review Andon Tracker Productivity Grid Reviewed Review Outcomes STP 0900 TO DO: Leadership Team Daily Huddle 1000 Peds Manager Daily Huddle Gemba Time/ Andon Responses Bedside Rounding / voic / Project work Problem Solving Problem capture 23 Huddle Meetings Purpose Discuss the previous day s work and issues, the current day s expectations, any issues affecting today s performance, team member concerns, etc Attendees The Natural Work Group/Team Timing At tier 1 Daily, 5-10 minutes in duration At tier 2 Updated daily; Meetings either daily or weekly At tier 3 Updated daily; Meetings either weekly or monthly 24 12

13 Key Huddle Critical Features Connected tiers from front line units to site level managers to regional managers Standard roles assigned on a rotating basis Standard agenda/schedule Focused discussion based on visual information 25 Review Review the principles and characteristics of Kaizen Leadership systems Clarify the functions of tiered huddles Define Leadership support of tiered huddles Design and build your department s Visual Boards Develop standardized work for huddles Conduct huddles at all levels Discuss what types of things to measure to improve huddles 26 13

14 27 Questions and Answers Bob Plummer, Matt Wehr, 28 14

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