The seven model areas represent a cross section of the Cleveland Clinic in terms of clinical processes, administrative processes and sophistication. Now that the original hypothesis has been proven, the CI group is working in a variety of model areas and other ways with other departments and areas where managers want their teams to become better at solving problems and delivering on their core purpose.
The framework for creating a CI culture could speed up the organization-wide transformation. For example, in recent months when outpatient phlebotomy had a strong mandate to improve performance, the initial impulse was to jump into the traditional project-based approach with the CI department doing some time studies, drawing a process map, and so on. But then they looked at all of the variables in the process and realized that volumes and other factors would always be in a state of flux.
Caregivers in the area needed to be able to respond to and address any future issues on their own. So instead they started by asking the more basic questions embedded in the cultural transformation model. Does everyone know what matters most to the Cleveland Clinic and what they need to deliver?
Does everyone know how they are doing, and if they are winning or losing today? By starting with those questions, communicating the expectations, and tracking hour-by-hour performance, they made some dramatic improvements in a very short period of time. Yerian, MD, Joseph A. Seestadt, Erron R. Gomez and Kandice K. Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. Article by Chet Marchwinski.
Article by David Verble. Friend's Email Address. Your Name. Your Email Address. Send Email. Any time a clear gap like this exists, there is the opportunity to further clarify that gap and study countermeasures in the form of an A3. To get to a tipping point, we have to develop enough capability in enough people and reach enough different parts of the organization. Leave a Comment Cancel reply Your email address will not be published. Related books. Explore topics Problem Solving.
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Non-necessary Non-necessary. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website. Share this Article Like this article? Email it to a friend! This volume presents what I believe is a compelling method of daily management for a relatively small manufacturing business — fewer than employees with only two production facilities.
Toyota provides an alternative example, using the same basic methods in a very large manufacturing business with , employees all over the world.
This organization is surely the global leader in daily management and continuous improvement targeted to support top-level hoshin objectives, as I described from direct observation in my previous Lean Post The Cascade of Hoshin. But what about large businesses in service industries that I believe might gain even more benefit from daily management? I have seen many examples of daily huddles at the front lines in financial services, fast food and restaurants, healthcare, etc.
Until recently I had not seen anything that felt like a robust and sustainable process that created the foundation for improvement. Full disclosure. I have never had any relationship with the Cleveland Clinic and I received no fee for my visit. I did ask the Clinic to pay my expenses. Significant focus on projects using lean methods, varying degrees of senior management enthusiasm and engagement, and modest sustainable results.
Four years ago, Lisa and Nate decided to take a more robust approach and focus on implementing systems and building capability where every caregiver was capable, empowered, and expected to make improvements every day. You can read more about their shift here. Last year, Lisa and Nate, along with executive leaders Dr. Ed Sabanegh, President, Main Campus and Regional Hospitals , decided to take a much more systematic approach by building a daily management system that spans the organization and would expose and elevate information every morning through six levels of management, from the nurse at the bedside to the CEO.
It was to be a mighty escalator my phrase, not theirs of operational information, including successes, challenges, opportunities to improve, and countermeasures that in typical healthcare organizations are not visible above their level of occurrence and whose resolution, even when flagged promptly, is usually delegated horizontally to staff for attention over extended periods.
Hence, challenges persist, and too many remain unresolved. So there is a healthy urgency to link daily management, targeted kaizen , and focused hoshin for organizational survival. A typical day looks like this: The first huddles begin at 7 am with every manager meeting with his or her team ie, nurse manager with bedside nurses on an inpatient unit. This leads to a later meeting typically around 8am of the managers with their director, the meeting of all directors with the hospital chief nursing officer for the nursing teams or operating officer for operational functions , the meeting with the leaders of the hospital, the meeting of leaders from each of the 12 hospitals and the executive clinical leaders, and the 11 am meeting with the CEO, clinical leaders, and other members of the operations council including the executive leaders of the major functions from Quality and Patient Experience to IT, HR and Operations.
The key to making the escalator useful is to determine actual performance the preceding day at every level and flag abnormal or unacceptable performance at that level. These issues are written by the line manager on the right side of the dry-erase management boards for special attention and rapid countermeasures.
If line managers at each level cannot respond to problems quickly, their reports will soon conclude that the whole exercise is only about drawing up problem lists — a bad tendency of bureaucracies in general and many visual management systems in particular. And they will lose interest. Once issues are flagged, the question becomes whether they can be resolved by managers in that unit or whether they need to be shared with adjacent units.
For example, I observed at the second level meeting that the managers described challenges within their individual units — which may be related to patient needs, staffing, and equipment, among others — and asked the other units if they could help, with a bit of coaching from the director the unit managers reported to. Decisions to make the day better for patients and caregivers were made in just a few minutes with no back and forth e-mail or additional meetings required.
There is a second type of issue that can only be addressed by elevating escalating it to a higher level huddle for discussion and resolution. And a few ride the escalator all the way to the top for a rapid decision. Specifically, we focus on patient safety and quality issues, caregiver safety issues, and providing access to care for our patients. Here is what we discovered and acted on:. These are a few of the most critical factors that we have discovered to be important with tiered daily huddles.
What about you? Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. Article by Toshiko Narusawa and John Shook. Friend's Email Address. Your Name. Your Email Address. Send Email. While the benefits of this practice are well known, the challenge we saw is that across an entire hospital there are many more problems to be solved than can be shared in 15 minutes.
By creating smaller huddles typically people , we create an environment where individuals are much more likely to openly discuss problems within their team than in a large group with multiple levels of leadership. Additionally these small huddles have an expectation that every attendee shares information daily; this expectation builds in responsibility and accountability for every leader.
Tiers ensure the information flows in a logical way throughout the organization, and that problem solving occurs in all teams at all levels of the organization. Tiers provide a way for the manager to develop team members and illuminate problems that were previously trapped, remaining with those closest to the work who had no clear, consistent venue to share it. In order for the huddles to be connected in an effective and logical way, they needed standardization. We put into place a standard framework — including a standard way we identify and review performance inclusive of the definition of the metrics, a standard way to investigate different types of problems not all are the same , and a standard way for the tiering to function in different locations.
This standardization created shared expectations, enabled rapid dissemination and served as the basis for continual PDCA.
So when people ask me if they need tiered huddles, I respond with a few questions: How are problems surfaced by those closest to the work?
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