Spreading Daily Management
There is an old adage - How do you eat an elephant? One bite at a time.
The same principle can be applied when it comes to thinking about spreading Daily Management. Daily Management is many things. It is a framework to align and organize daily work to achieve strategic goals and address operational needs. It is a mechanism to cascade those goals to the front line staff and translate them into priorities for local improvement. It is an incubator for staff development and coaching. And it is a whiteboard full of information.
It is exhilarating to see the first time a team really “gets it” after introducing Daily Management because you see their engaged body language as you hear the escalation of issues and understanding of performance. In this moment, you can feel the energy of empowerment to solve problems. This experiential adrenaline rush leads to an immediate conclusion – we need this everywhere, in all departments, as soon as possible!
Speaking from experience, it is imperative to temper that urge. Daily Management is complex and requires a thoughtful and measured roll out plan in order to sustain over time. Here are some key considerations about how to spread Daily Management after successful implementation in a model cell or pilot unit.
Go Beyond the Board
At first glance Daily Management is most closely associated with the Daily Management Board (DMB). The DMB is the physical manifestation of the system, utilizing visual management and anchoring huddles with standard work. But the DMB is like an onion and it is critical to go beyond the board and peel back those layers to understand the intention of each element. What are the components of your Daily Management System? What is the purpose of each? What principles do they support and what behaviors do they require? Taking the time to answer these questions will help you set a steady pace for spread because it will guide you in where to spread. What departments have the most stable leadership? What is the capacity of your continuous improvement (CI) team to support the spread to ensure the understanding of the principles and behaviors behind the whiteboard? It is crucial for those involved to not just learn the system but understand the why behind it.
Create Milestones
Characterizing Daily Management as a system implies that there are multiple elements. It can be overwhelming to implement all of those elements at once. How can you examine your system at high level and break it down into smaller phases? At Mount Sinai Morningside we created four phases- Preparation & Set Up, Communication Huddle, Key Performance Indicators, and Improvement Huddle. When spreading Daily Management into a new department you are not spreading “the system” as a whole, but simply the first phase, and then the next and the next. It’s helpful to define milestones within each of your phases as well. Imagine toll gates between the phases and ask yourself what is required before you move from one phase to the next? These milestones are your roadmap for spreading Daily Management in a way that will sustain.
Link to Leadership
Successful spread of Daily Management requires support from Executive Leadership. As you identify the next department to implement a DMB also consider- who is their Executive Sponsor? What is that Sponsor’s understanding of their role? How will they set expectations and support the department? It is valuable to schedule time in gemba with the Sponsor, the department leader, and the CI coach. Additionally, when you go to gemba ensure that you bring your milestones. Where is the team? Where did you expect them to be? What are they learning? What are their barriers? We have found that an engaged Sponsor results in an engaged Manager and an engaged team. The CI team alone cannot drive this engagement. Also, it is important to look at the layers of leadership from that Executive Sponsor down to the front line. For example, a Chief Nursing Officer to a Director to a Nurse Manager to an Assistant Nurse Manager to a Charge Nurse. Are you engaging every level? Do they all have the same understanding of the big goal (Daily Management) and the immediate goal (milestones of current phase)? When each layer is in alignment you ensure a successful, sustainable spread.
If you are interested in Mount Sinai Morningside’s unique approach please, click here to learn more about our Catalysis Pre-Summit Workshop "Prioritize Your Process: Tactics to Improve, Spread, and Sustain Daily Management."
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Migdalia Otero-Terry says:
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