Lesley Wright on visual control

• in the car - to see the status of the fuel, oil, speed;

• at the garage - to see the quantity and cost of the petrol we purchase;

• in the home - to see the water level in the kettle;

• at the airport - to see the flight departure gate and status;

• in business - to see fluctuations in the market at the stock exchange.

But how many of us would approach a major crossroads and drive at full speed if the traffic lights were not working? Visual control gives us knowledge and certainty and makes our lives safer.

In a Lean organisation, the status of virtually every process should be visible to all, taking the form of a picture, a chart, or a shadow board, which should be designed for simplicity rather than complexity to give impact. Visual controls placed close to the processes allow everyone involved to have the knowledge and use it, just like traffic lights. Walking away from the process to access a computer screen takes staff away from the workplace. When information is available only to a few people, then only the few take responsibility for the process.

The purpose of visual control is to reflect actual performance against expected performance. Hand-made visual controls, placed close to the process, allow information to be updated easily, give timely information and enable everyone to take responsibility for performance and react to it immediately.

When you walk into a Lean environment, good visual control tells you straight away:

• what the process is;

• if it is safe;

• if the resources are being used effectively;

It also eliminates the need to depend on one person's knowledge.

Consider the information we need to manage the service to ensure timely delivery, high quality and safety. Ask yourself: what was the demand on the service yesterday or an hour ago, compared to the capacity we have to meet it now? Is there something missing that could compromise patient safety: for example, a defibrillator in emergency care or a drug on an anaesthetic trolley? On the wards, how many patients should be discharged tomorrow? When are scans booked? Have take-home drugs been ordered? What are the standard algorithms for pathology testing? How many defects were identified in the process and what was their root cause? Do staff returning from leave or sickness understand where changes have been made?

Good visual control will answer all these questions without having to ask anyone.

Does your healthcare environment give you the message, "this is how are we doing, this is how to make it safer, these are the issues that arose yesterday and this is where we are in trying to address them"?

Visual control not only provides us with the knowledge to make our lives safer, but those of our patients, too.