Visual Management Board Implementation to Enhance High Reliability at a Large VA Health Care System
Background: The US Department of Veterans Affairs (VA) is committed to embodying principles of high reliability organizations and Lean management culture. The practice of making problems readily known to team members and leadership is called visual management, an important tool in the journey to becoming a high reliability organization. Visual management boards (VMBs), or huddle boards, can foster transparency, teamwork, and employee empowerment.
Observations: A variety of health care teams at the Lieutenant Colonel Charles S. Kettles VA Medical Center within the VA Ann Arbor Healthcare System (VAAAHS) created and instituted VMBs. This article highlights the implementation in a large, diverse outpatient cardiology clinic. The incorporation of a VMB into the daily huddle of the outpatient cardiology clinic team led to increased problem identification among staff and leadership and fostered teamwork as issues were addressed. Feedback from teams across the VAAAHS noted how the boards were helpful in prioritizing areas for improvement, fostering teamwork, and increasing staff engagement, empowerment, and satisfaction.
Conclusions: A VMB is a simple, inexpensive, yet potentially powerful tool to bring together diverse health care teams to identify problems in the workplace, engage staff in developing solutions, and enhance communication with leadership. Implementation of VMBs at the VAAAHS may serve as a model for other VA health care systems for the incorporation of visual management into daily workplace culture.
Discussion
VMBs are common in health care and are implemented to promote the core principlesof Lean thinking and HROs, including visual management and daily accountability. The goals of a visual management tool are to make problems visible and document their management. A VMB can serve as a focal point for team discussion and a physical space to track each problem through its initial identification, understanding of root causes, consideration of potential solutions, and recording of intervention results.
A VMB can foster a culture of safety, leadership commitment, and continuous process improvement when designed and implemented to reflect team needs. VMBs can empower staff members to share work concerns and openly promote engagement. As a central place for discussion between staff and leaders, VMBs can also foster teamwork and communication. The daily huddle provides a safe, productive working environment by ensuring that lines of communication are open among all team members, regardless of role or leadership designation.
Limitations
This article focused on the implementation of 1 type of visual management tool. It provides an in-depth discussion of the development, implementation, and experience with a VMB at multiple clinics of a single section in 1 health care system. These reported experiences may not represent other VA facilities. Perceptions of the impact and usefulness of the VMB were mostly anecdotal. Further evaluation of the VMB implementation experience and utility at other VA health care systems would provide additional insight into the optimal implementation of VMBs.
Conclusions
Through increased transparency, empowerment, and communication, VMBs are an important tool in the visual management tool belt for organizations committed to HROs and Lean management. Given the successful institution of VMBs at the VAAAHS, the description of our experience may aid other VA systems for the incorporation of visual management into the daily culture of their respective health care teams.
