Lean Daily Management and Transparency: Powerful tools for cultural change in healthcare

August 21, 2015
Hand hygiene, patient satisfaction, hospice comfort — these are just a few of the many priorities of a top-run healthcare organization. Providing the very best care involves a large and diverse array of goals, leaving many medical centers struggling to get a handle on all of them.

“The goal is to empower everyone in our organization to become focused problem-solvers,”
Greater Baltimore Medical Center has implemented a solution popularized by Toyota and Boeing — one that’s paying off handsomely. Launched in the spring of 2013, Lean Daily Management (LDM) works as an umbrella to ensure that every area of the hospital’s operations are constantly improving through smart oversight and input from front-line staff and patients.

“It’s a way to more closely engage our staff in ongoing problem-solving around our quadruple aim of providing the best health outcomes and best care experience to our patients with the least waste in an environment that provides more joy to our staff,” said GBMC project manager Lisa Griffee.

LDM helps key areas of the medical center focus on things most important to them and that are also aligned with GBMC’s overall goals. These priorities run a broad gamut from hand hygiene and infection control to patient satisfaction and hospice comfort. Every morning (weekends and holidays included), the hospital’s executive leadership splits off into teams and makes rounds to its assigned units. At each stop, the executives convene with at least one unit representative to review data, share successes and discuss any barriers that may be preventing staff from achieving its collective goals.

For example, one survey of GBMC patients captured perspectives on eight key topics including communication with doctors, responsiveness of staff, pain management and discharge procedures. This data became the Patient Experience Overall Hospital Rating metric, one of a number of metrics that make up the LDM program.

GBMC uses the feedback to improve work procedures and enhance the patient experience. When nurse-to-patient communication was identified as an area that needed improvement, a plan was put in place that included communication training for all staff (not just nurses). Additionally, a new system was put into place for nurses to go on hourly “rounds” to talk with patients about their questions or needs.

“The goal is to empower everyone in our organization to become focused problem-solvers,” Griffee said.

To Griffee, the program represents an important cultural shift. “It has transformed how executives and many different employees interact with each other,” she said. “The appreciation and collaboration of everyone focused on achieving our vision of ‘to every patient, every time, we will provide the care that we would want for our own loved ones,’ has allowed us to continually improve our goals at a more rapid pace.”

From an initial group of four departments, LDM has expanded to include 30 different areas. All of the medical center’s inpatient and surgical units have their own posted LDM boards and the medical center has included key service providers like environmental services and transportation in the program. In addition, there are several boards dedicated to metrics that apply directly to physicians.

Transparency is another major goal at GBMC.

GBMC’s patient safety and quality measures are overseen by a quality committee that includes board members, physicians, nurses, patients and family members. The committee’s findings are the first item presented at every GBMC board meeting to ensure there is always enough time for discussion of any arising issues.

“GBMC believes that transparency is critical to success because it drives accountability and demonstrates to our patients and the community that we are honest and open with them about their hospital,” said Carolyn Candiello, vice president of Quality and Patient Safety.

It wasn’t easy deciding to publish all of the collected data on the company website (, whether the data showed improvement or not. But Candiello said they’ve been very pleased with the results. Since adding the information to the website in 2013, GBMC has seen significant improvement in many key areas.

All hospitals have at least some quality data available online, but GBMC’s published data is much more comprehensive and up-to-date. “By posting our data every month, we provide the most current information. In fact, as soon as our board quality committee has seen the data, we publish it,” Candiello said.

Candiello cited hospice care as a good example of the benefits of transparency. Generally very little public data is available for those seeking hospice care for themselves or family members. But this is one of the areas for which GBMC provides information online.

“GBMC is proud that we are able to get 98 percent of our hospice patients comfortable within 24 hours,” Candiello said. “The national metric is that comfort is achieved in 48 hours. I’m not aware of any other way consumers could get that information.”

Because data on hospital quality can be confusing at times, GBMC provides both online video and text to explain the figures, along with other resources patients can use, for example, to discuss procedures with their doctors.

“If they are having knee surgery, they should know what their surgeon's infection rate is and understand how to prevent complications,” Candiello said. “Patients who are informed about their healthcare and have an open relationship with their care team are likely to have better outcomes.”

- Julia Clerk, Tribune Content Solutions
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