increase performance and problem solving effectiveness · honsha™ experience you can lean on 1...

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honsha™ experience you can Lean on

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Increase Performance and Problem Solving Effectiveness

–TIERED HUDDLES

Bob Plummer and Matt Wehr

March 2018


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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

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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?


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Kaizen Leadership System Purpose

• To support the work of our front line resulting in meeting the expectations of our patients

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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!”

Main Elements



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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


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Keys to Process MetricsEnable rapid problem

identificationby front line.

Enable rapid problemresponse

by management.

(Stop & Notify) (Sense & Response)

Make it normal for the flow of service to be continuous.Reduce or eliminate stagnation.



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Leader’s Role in Problem Solving

2. Model and teach everyday problem solving. Tools: 8-step problem solving and Problem Solving Worksheet

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

3. Coach team to be fire preventers. Everyone, everywhere, solving problems every day. Prioritize time in your Leader Standard Work. Tool: Problem Register

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How did we do yesterday?

Is there anything we

need help with?

What’s our plan for today?

Three Key Questions


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Roll up

Unit Level boards

Clinic board

Organization-wide boardSenior

Management

Middle Management

Front lines

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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

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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


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Visual Controls

• Purpose: – Find problems.

– Achieve goals.

• Alignment of goals, outcomes, processes, and problem solving

Days since last

HAC:

55

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Daily Accountability: Tiered Huddles and Checks

• Find problems by reviewing process and outcome measures


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Problem Escalation Example

• 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, Escalate

Director

• If a supply can’t be found in 5 min, ESCALATE to RSN

• 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

• 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

Manager

Staff

• Within 15 min, contact Central Supply (3-xxxx)• If no delivery within 1 hour, ESCALATE to ANM

Supervisor

Unit Manager

Clinics Manager

CEO

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From Compliance To Engagement

Compliance

Involvement

Enthusiasm

Engagement

Discretionary ActionMinimal Action


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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

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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.


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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, non-judgmental

Trust & Respect

Empower, motivate, encourage

Model Leader behavior

HUDDLE LEADERS…

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Manager: Amy Chapman v27 (2/10/14)

Manager Standard Work – 3 North/ South

Date: _______________________________

Start of Shift R/G Mid Shift R/G End of Shift R/G

0730-0800 Start of Day – Review Calendar & Plan

1200 Mid Shift Huddle (ANM/RSN)

1600-1700 DMS Communication/ Quick Hits/ Problem Solving/ Escalation F/U

0800 – 0830 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:

3 NORTH:

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 RN @rounds RN @rounds Complaints Escalations Escalations Care Concerns R/G

Other Issues

1230-1330 Lunch

Standard Work Checks 1330-1500 Meetings/ Project Work

Reset Visibility Boards HAC Assignments Done 1500-1530 Gemba Walk (S, E, N, Tx Room, Office) Meals/Breaks Assigned Gemba Viz Board R/G D/C Nav Board Escalation F/U 0830 Office Work- Manager Time

Process Check Issues (NPSG, HAC)

Quantros Reviewed & Assigned Review Andon Tracker Productivity Grid Reviewed Review Outcomes STP 0900 Leadership Team Daily Huddle

TO DO:

1000 Peds Manager Daily Huddle

1030-1200 Gemba Time/ Andon Responses

Bedside Rounding

Email/ voicemail/ Project work

Standard Work for Unit Managers Example

Gemba Rounds

Unit Rounds & Response

ProblemSolvingMorning

Huddles

Problem capture



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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


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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



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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


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Questions and Answers

Bob Plummer, [email protected]

Matt Wehr, [email protected]


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