Daily Management SystemsLane F. Donnelly MD

Nemours Children’s Hospital

Culture “Sum of people’s

habits as to how they get their work done” Often focus of

discussion “need a culture of

improvement / safety”

Culture But to create a culture of improvement,

you cannot focus on culture, you need to focus on your DMS To change culture, you need to change

your DMS – change the expectations of how your leaders lead and how daily escalation and solving of problems occurs

Daily Management Systems

Daily Management Systems Designed so that problems are

quickly identified Front-line staff are empowered to fix

the problems that they can Problems that the front line

employees cannot fix are escalated and counter-measures created quickly

Key Elements to DMS

Leadership Standard Work Visual Controls Daily Accountability Process Discipline

Mann D. Creating a Lean Culture – Tools to Sustain Lean Conversions, 2nd Ed, 2010

Tiered Huddle Structure 1st – Front line Drive accountability for front line

problems Problem escalation to higher tiers

Clinic Huddles

Peri-Operative Huddle

OutpatientHuddle

Hospitalists / Inpatient Units

Huddles

Integrated Huddle

ORHuddle

EmergencyHuddle

Materials - IT - Laboratory - Facilities - Radiology - Pharmacy - Facilities/Security -Family Centered Care - Rehab - Respiratory - Infusion Center - Construction

Critical CareHuddle

Patient Flow Huddle

Short (10 – 15 minutes) Standing Occur between 7AM – 9:30AM At site of care Front of visual board Front line associates / leaders Standard Work: Scripting

Huddles

Approach

Metrics / Goals

Today’s Readiness Assessment

Problem Accountability

Metrics / Goals Quality & Safety Patient / Family

Experience Delivery Cost Engaged

Associates

Today’s Readiness Assessment

MESA Methods Equipment Supplies Associates

Problem Accountability “Quick Hits” Complex Issues

–Owner–Team–Report back date–Counter measure

No scheduled meetings 7 - 10:30 am NCH leaders attend huddles Observe operations (Gemba) during

this time

NCH Leadership Standard Work

Traditional Management Over-sight highly variable and leader

dependent (calls) Management style shifts significantly

with change in person DMS – designed not to be dependent

on a particular person – more predictable / reliable over time

Roles of Leaders

Make sure systems run as designed (maintenance Kaisen)

Continuously improve those systems (Improvement Kaisen)

NCH – Opened October 22, 2013

Integration Huddle started June 2012 Data tracked February 2013

Issues 252 Complex issues (28/month) Sept - 21, Oct - 63, Nov – 73 After opening: flow (41), supplies (17),

facilities (16), & IT (15) Mean time to resolution = 19.1 days

–(0 – 125 days) > 10 days (n = 9): IT (5), flow (2)

Huddle Audits

DMS Rapidly identify and escalate

problems Team-building Leader inter-changeability Much improve coordination Elimination of the rumor-mill