Visual management ensures continuous improvement in patient care
The essence or heart of every Lean practice is continuous improvement. It is a process consisting of operating philosophies and methods that creates a maximum value for patients by reducing waste and waits while emphasizing the respect for the patients’ needs, staff involvement and continuous improvement. Visual management is a Lean methodology focusing on the principle that every member of the team should be able to communicate clearly what is going on in their unit/department at any given time. The clinical RNs at New York-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC) were inspired in 2016 to create standard work utilizing visual management to assure continuous improvement.
This was demonstrated throughout NYP/CUIMC with unit-based daily huddles, roll-out of standard visibility walls, and improved understanding of data at the unit level. These innovative initiatives, rolled-out in 2016, were honed on each unit during 2017. NYP/CUIMC clinical registered nurses (RNs) decided in 2017 to take the next step and hold each other accountable to the standard of work they created on their units. The introduction of the Kamishibai Board was the next step in the journey to continuous improvement.
Kamishibai is a form of storytelling using visual boards that originated in Japanese Buddhist temples and is an integral part of Lean methodologies. This visual management tool is used to complete audits on standard work processes. Kamishibai boards provide a visual checklist to ensure nurses hold each other to the established standard of care. For example, if the clinical RNs state they will complete unit rounds daily to check on the patients’ skin integrity, this is listed on the Kamishibai board with an area to indicate who is responsible and when this was completed. This permits clinical RNs to easily observe progress with standard work and identify problems or gaps requiring resolution.
The clinical RNs also hold nurse leaders accountable via the Kamishibai board. The nurse leader indicates when they will complete rounds on the board and are responsible to indicate completion. The clinical RNs can easily see the progress nurse leaders are making and provide ‘gentle reminders’ to complete their daily rounds. This tool has increased nurse leaders’ presence at the “Gemba”, where the work is actually being done, and improved RN satisfaction. The clinical RNs on the CCU inspired and influenced other units to adopt the Kamishibai boards. This innovative tool has facilitated in improving the quality of patient care throughout the medical center. — Nicole M. Hartman, DNP, RN, MBA, NEA-BC, Magnet Program Director,
NewYork-Presbyterian-Columbia