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Increase Performance and Problem Solving Effectiveness

–TIERED HUDDLES

Bob Plummer and Matt Wehr

March 2018

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

Honsha Serves a Diverse Array of Industries

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?

Kaizen Leadership System Purpose

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

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

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

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.

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

How did we do yesterday?

Is there anything we

need help with?

What’s our plan for today?

Three Key Questions

Roll up

Unit Level boards

Clinic board

Organization-wide boardSenior

Management

Middle Management

Front lines

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

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

Visual Controls

• Purpose: – Find problems.

– Achieve goals.

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

Days since last

Daily Accountability: Tiered Huddles and Checks

• Find problems by reviewing process and outcome measures

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

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

Supervisor

Unit Manager

Clinics Manager

From Compliance To Engagement

Compliance

Involvement

Enthusiasm

Engagement

Discretionary ActionMinimal Action

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

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.

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…

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

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

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

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

Questions and Answers

Bob Plummer, b.plummer@honsha.org

Matt Wehr, m.wehr@honsha.org

Increase Performance and Problem Solving Effectiveness · honsha™ experience you can Lean on 1...

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