“Huddles, not just another meeting;” I wrote that when we started our twice a week IT leadership huddle in April. How true! And as of three weeks ago, we have another leadership huddle experiment in progress – the daily hospital leadership huddle. It is part of our developing lean Daily Management System.
Our Acting CEO and COO for the University of Michigan Hospitals and Health Centers, Tony Denton, runs the daily huddle. As Tony said in his initial communication, “The purpose of the leadership huddle is for senior leaders to have daily awareness of issues that may impede our ability to provide service. The leadership huddle is the “top tier” of a daily management system designed to surface issues and problems, assign leads for pro-active problem-solving efforts, examine trends and track progress. It is a key aspect of developing a more effective Michigan Operating System. If successful, we expect to see continuous improvement in our safety, quality, timeliness and financial results, and enhanced ability to deliver ideal patient and family care experiences through the engagement of our people.”
The value of these leadership huddles was clear the first week. We are surfacing daily issues that need attention. But more importantly, we are surfacing long standing problems that have not been previously reported, or been given adequate attention, even though they impact patient care and safety.
The range of issues covered includes everything from direct patient care, to facilities, to equipment, to supplies, to employee safety. We’ve covered communication about direct admits, flu vaccine availability, linen delivery to a particular unit, and lighting at an offsite employee parking lot.
It is no surprise that there are issues raised just about every day that require the attention of the IT team. It could be a workflow in our EHR that not everyone is following that has led to a patient safety incident, reports of system slowness, or isolated phone issues.
If the issue has been already reported, I track it through to resolution. If the problem has not yet been reported, I investigate the specifics and engage the right leader from IT as soon as possible. Yes, the follow-up can seem scattered, redundant, or time-consuming. But that is all part of the learning curve. I raised this at our last PDCA Friday (plan-do-check-act) when we discussed how the huddles are working so far.
Given the dependency on IT, the frequency of issues for my staff will continue. One of my goals is to ensure we have timely and efficient resolution on all huddle issues. And we need to coordinate this new process with our standard process of reporting all IT problems through our central IT service desk.
So how does the 20 minute huddle work?
- At the start, we do “10 second follow-ups” on previously reported issues.
- Then we do the roll call, starting with a report out from each of the two daily patient safety huddles – one in the children and women’s hospital and the other in the adult hospital and cardiovascular center. Their standard reports first cover capacity – how many available beds, are we taking transfers, etc.
- Then we hear any issues from those huddles that are significant enough to need senior leadership attention.
- We then call on each senior leader for any new issues or broad informational items.
We don’t problem solve but we do problem identification and determine if the issue needs follow-up, who owns it and when they will report back. Real-time problem solving that day and accountability are critical to this working.
All issues are recorded in a daily huddle summary and are sent out later in the day.
We all try to be at the huddle in person whenever we can, but there is a call-in option for those, like me, who are not based on the hospital campus. Those who are out of town are expected to send an alternate.
There are huddle ground rules: Put your phone on vibrate and put away other electronic tools. Keep reports short and to the point – 30 seconds or less. Report only if there is something to escalate to this group. It’s ok to have nothing to report.
At my twice a week IT leadership huddles, we review any open issues in progress for us from the hospital huddles. This is in addition to our usual review of IT issues which follows the framework of safety, quality, timeliness, financial and people.
Are we huddled out? No. Are we tripping over each other at times in tracking down problems? Yes. But are we surfacing and solving problems to better serve our patients – absolutely yes!
See the Michigan Quality System website to learn about our health system’s lean journey: http://www.med.umich.edu/mqs/
See the UM Virtual Lean Resource Center to learn more about lean: www.med.umich.edu/i/quality/tools/lean_assist.html
Visit the Lean Enterprise Institute for resources to transform your company: http://www.lean.org/