By: Felicity Pino, Shelly Hammer, and John Toussaint, MD
Many organizations have developed a daily management that includes stand-up huddles, a huddle board where key metrics are reviewed, and where staff ideas for improvement are captured. Some have also begun using daily status sheets where managers meet with front line staff to understand barriers to daily work processes so that anything in the way of great care can be addressed and staff can do their best work. But as we look beyond the front line to the VP and senior VP level the standard work for huddles and executive management is less consistent and therefore, less effective. For the last two years Children’s Mercy has worked hard to create the same rigor at the top level of the organization as at the front line. We report here on those results.
Children’s Mercy (CM), a 300+ bed Children’s hospital with 8,000 staff in Kansas City, has been on an accelerated journey of organizational excellence for the last few years. When Paul Kempinski was named CEO July 2018, he turbo-charged the learning journey. His primary focus was on employee and patient safety. He set out to build a safety system that could help get Children’s Mercy to zero harm.
In order to reach this goal, he realized there needed to be transparency regarding every injury or near miss. CM has a robust frontline management system in place which includes daily huddles in over 300 tiered areas. Although a spoken intent of huddles is safety, there were still safety concerns going unvoiced during frontline daily huddles. As a result, there were days when zero problems were escalated, and no one on the executive team really knew if frontline safety problems were even being captured.
The improvement team was asked to do an assessment. The first step was to understand why problems were not being escalated. They found that problems and the barriers to solving problems were getting stuck somewhere between the frontline department and the senior executive team. In other words, there was no place for problems to be escalated to and no effective system to visibly highlight these problems for executives. So, in March 2019, the executive team worked with the improvement team to design an executive management team huddle. The first attempt included a huddle board and an agreed upon time to have the huddle. But many of the executives didn’t see how the huddle would help with escalating safety problems. And in fact, the data showed it wasn’t working (fig.2). There was need for improvement.
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