Friday, April 12, 2013

What is a Pareto Chart and a Gemba Walk And How Will They Help GBMC Reach Our Goals?

The GBMC HealthCare system is working hard to redesign our systems to achieve our  Quadruple Aim and to ensure that every patient is cared for the way we’d want our own family members cared for.

We’ve been using LEAN tools to help us get to our goals, and this week we have had a team working on the design of Lean Daily Management (LDM).

LDM is a tool to get our people on a daily basis to be reviewing their performance and finding and removing impediments to reaching their goals.  This week a Team has been working with our consultant Neil Crockett of Next Level Partners to help us get LDM started in a disciplined way. 

Every morning the team calculates how well they did on their chosen key indicators from the day before.   For example, the process may be teaching patients about their medication, hand hygiene compliance, the percentage of patients leaving the Emergency Department within our time goal, or the percentage of occupied rooms cleaned the previous day.

If the goals are not achieved, the team documents the reasons why, which are essentially the system failures. Knowledge about the system failures is then used by the team to redesign their system.  It has been shown that organizations that do this is in a standardized way make a lot more progress than organizations that don’t. 

The success rate is displayed on a LDM board on the unit or in the department and that is coupled with a Pareto Chart where team members can document the reasons for the failures and see what needs to be worked on and changed.

Another key component of LDM is the senior team gemba walk. Every morning, at a prescribed time, members of the senior team go to visit the team at their LDM board. A team representative tells the senior execs how they did the day before and what the reasons were if they did not reach their daily goals. The senior execs hear if there are any barriers that the execs need to remove so that the team can get their work done.  
Kim Vohrer, RN, Clinical Partner, reviews the Unit 38 LDM board during a gemba walk.

Helping facilitate the LDM project is Lisa Griffee, project manager from MIS.  Our initial units or departments where we are rolling this out include Physical Therapy / Occupational Therapy (Sandy Sofinowski), Unit 35 (Kathy Bull), Unit 38 (Kimberly Vohrer), Residents (Dr. Paul Foster, Dr. Rameet Thapa), Hospitalists (Dr. Chris Greenawalt, Dr. Rekha Motagi, Dr. Fred Chan) and Emergency Department (Stephanie Topscher & Dr. Jeff Sternlicht). Also supporting the efforts are Cate O'Connor-Devlin, Jill Wheeler and Justine Kellar from Nursing Leadership and Performance Improvement Masters Lisa Griffee, Cheryl Vankuren, Shannon Baumler and Julie Gabriele.

I am very excited about using LDM as a way for us to improve faster. This week, I was surprised to learn how often nurses don’t have the medications they need for their patients.

I look forward to using this tool in a disciplined fashion in all departments and on all units to help us achieve our vision. Thanks to everyone as we learn how to do this together!


  1. At LDM I did not see pharmacy was on the team. It would of help all team members are included in the LDM to give their input to improve over all patient care.

  2. Thanks, Anonymous. The Team this week was just to get lean daily management format setup. It has only been rolled out to a small number of units and departments. We will eventually roll it out to all units and departments. I hear you volunteering the Pharmacy to be in the next wave! Thanks.

  3. Just want to congratulate the entire GBMC organization on your bold step in this direction of disciplined daily routine in your work! Although initially disruptive (as with any change), many high quality organizations like yourselves are finding this is a great enabler to "providing the care that we would want for our own loved ones." Again, congratulations!!

  4. I want to thank the teams and the GBMC leadership,for showing me the tools I am learning in my nursing masters program, at work at the facility where I am employed! I have to turn in a paper this evening on the use of The Pareto chart! Way to go GBMC senior team, for walking the walk, not just talking! Conratulations to the participating units, and staff, I know doing extra when you already have so much to do, is a trial, but helping your patients is always the goal!


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