Lean Daily Management (LDM):

Same Mission, New Look

AI (Artificial Intelligence) concept.

Lean Daily Management, a four year- old initiative at SBH that engages senior and front line staff in problem solving, is back after a year-long COVID-19 hiatus. Only, at least for now, LDM has a somewhat different look.

Once again, the program starts at 9 a.m. every weekday morning, with senior executives meeting – virtually from their own offices instead of in the President/CEO’s office – to update graphs that examine how the hospital performed over the past 24 hours in terms of Better Health, Better Care, Least Waste and More Joy. On daily metric charts, units fill out their charts in green when a goal is reached and red when they fall short. The emphasis remains not on where the institution or individual units are now, but where they need to be. As such, the team places a particular emphasis on the Pareto charts that document the reason(s) for fallouts and their cumulative effect.

Senior management no longer breaks into groups of four or five to take the “gemba walk” to meet face-to-face with front line staff in their respective units. Instead, senior executives rotate with eight paired daily. Each duo pays virtual visits to five different hospital units. As in the past, management gives front line workers on these 20 units a brief overview of how the institution did in these four categories over the past 24 hours, before giving them the chance to grade their own performance in each category. Staff mentions any “barriers” or “shout outs.” This day they also answer a single multiple choice question on Planetree. Best bet: choose “all of the above” as the answer, which most do. Sitting in the “control room,” an office cubicle outside administration, one can view on the computer screen selected virtual meetings. This may include, say, Rob Church, senior vice president/chief nursing officer, and Sam Cooks, vice president/director of IT, discussing with the lab such issues as the low percentage of prescriptions presently filled at the outpatient pharmacy. Or Maureen Eisner, vice/president director of the patient experience, and Dr. Jacqueline Witter, vice president/director of nursing quality and informatics, speaking to a nurse in mother/baby on staffing concerns. Coordination among the executives and front line staff, perhaps regarding estimated time of a meeting or which executive should go to what meeting, is handled here in the control room.

At 9:43 every morning, the unit meetings end and the entire executive team – comprised off all of SBH’s senior officers – regroup to discuss what they learned. They reserve each Wednesday morning for discussions of those barriers identified.

“The way we’re now doing LDM is conducive to the times and it’s very efficient,” says Dr. Dan Lombardi, senior vice president, chief academic and quality officer. “But, at the same time, we’re missing out on those pieces that you can only get in-person.” He says that it took considerable trial and error to get this point, with most of the time spent identifying and learning the most appropriate technologies. He is unsure what changes will remain once the pandemic ends.

“LDM has been a great tool to help us see what’s going on within the organization,” he says. “Taking a pause worked well in allowing us to observe what we were doing well and what we needed to do better. It was a good opportunity for us to refocus.”

SBH was the first, and may be the only hospital in the New York metropolitan area, to use LDM. In the past years, Dr. Lombardi says that LDM is responsible for SBH achieving considerable improvement in a number of metrics. These range from better handwashing to a reduction in overhead pages, from better patient/family education to a reduction in missing medication.