Adopting a High Performance Management System Utilizing a Lean Visual Management Tool to Sustain Improvements

Saturday, 29 July 2017: 9:30 AM

Louise C. Rudden, MScN1
Melody Hicks, BScN2
Stephanie Lappan-Gracon, MN2
Yogini Walli, MN, BScN2
Irene Koo, MHA3
Rose Rivard, CPA4
(1)Paediatric Medicine, Hospital For Sick Children, Toronto, Toronto, ON, Canada
(2)Ambulatory Department, Hospital For Sick Children, Toronto, Toronto, ON, Canada
(3)Ambulatory, Hospital For Sick Children, Toronto, Toronto, ON, Canada
(4)Department of Dentistry, Hospital For Sick Children, Toronto, Toronto, ON, Canada

After the implementation of a LEAN Daily Continuous Improvement Program (DCIP) in a Large Pediatric ambulatory portfolio the momentum for process improvement accelerated and great successes were achieved. However, after a period of time ideas for improvement began to decrease. Managers resorted to look for solutions to sustain and maintain the improvement. As healthcare evolves so do the increasing demands on manager responsibilities limiting their ability to not only find solutions but act on them.

In an effort to support managers and leaders in sustaining improvement, a High Performance Management System (HPMS) was adopted using a LEAN visual management tool called an Obeya, translates as “big room” in Japanese. A HPMS is an organizational framework that defines standard work for each tier of management and the integrated hierarchy that reinforces, supports, and improves work at all levels. Its theory is grounded in the Juran Trilogy (Quality Planning, Quality Control, and Quality Improvement). A HPMS enables a culture of transparency that encourages and sustains improvement.

The Obeya aids in visualizing priority projects within the portfolio and a visual map of how each project is directly aligned with the organizational strategy and goals to achieve key performance metric targets.


Using a visual management tool has allowed managers and leaders to quickly visualize their progress on many important initiatives and move projects along at a more efficient pace. Some of the early outcomes experienced by managers who have piloted this framework include increased focus, collaboration, and efficiency.The Obeya allows managers to “see together, learn together, act together”.


Defining management standard work enables managers to reduce variation and achieve outcomes more efficiently. This framework will aid in eliminating non value added/non managerial work in a manager’s schedule supporting them to find and implement solutions that sustain improvement both at a departmental and organizational level. As a framework its adaptability to all tiers of management in an organization will really drive the strategic agenda for organizations.