10
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WINTER 2018
WINTER 2018
|
11
NEW INITIATIVES
T
he diplomas and certificates that
once lined a wall of Dr. David
Perlstein’s office are gone, replaced by
four rows of paper charts, three deep,
displayed in plastic pouches that have
been mounted atop a large whiteboard.
This is the just one of the signs, both
tangible and intangible, that show SBH’s
commitment to the process known as
Lean Daily Management.
SBH’s President/CEO was first
introduced to Lean Daily Management,
or LDM, while sitting on the Clinical
Leadership Committee of the American
Hospital Association. A fellow
committee member, Dr. John Chessare,
the CEO of Greater Baltimore Medical
Center, had spoken enthusiastically
about an initiative his hospital had
launched several years before to more
closely engage staff – from front line
workers to senior management – in
ongoing problem solving.
“Sometime later, when I was in
the Baltimore area at a pediatrics
conference, I called John and asked if
he would mind if I came over to see the
program he had been talking about,”
says Dr. Perlstein. “I walked the hospital
that day with John and his team and was
sold. I thought, ‘We have to do this.’”
He liked that the entire organization
was focused on singular changes. “You
would have front line staff, managers,
executives all focused on the same
global issues, with the specificity of
those issues driven by each of the
individual areas,” he says.
At Greater Baltimore Medical Center,
he saw, for example, radiology staff
focused on such issues as patient
scheduling and canceled testing. “They
would have a nurse manager reporting
with other front line staff about issues
based on best health outcomes, best
care experience, lowest cost and most
staff satisfaction (the four elements of
the Quadruple Aim),” says Dr. Perlstein.
“The charts displayed in each unit,
where they tracked their measures by
filling in either in green or red or blue
depending on whether or not they met
their goals, were all very low tech. The
engagement, however, was phenomenal;
people really took it seriously and they
took it personally when they failed.”
LDM: A DEFINITION
LDM is defined as the disciplined,
daily process of gathering data and
assessing performance metrics. The
process is intended to drive appropriate
behaviors and countermeasures that
create a culture of seeing and solving an
organization’s key problems.
A solution used by such global
organizations as Toyota and Boeing,
LDM empowers workers to become
focused problem-solvers – beginning
with those working on the front line.
Front line staff is engaged in selecting,
reviewing, presenting and problem
solving. Managers make sure data is
SBH Takes the Lead in Process Known as
LEAN DAILY MANAGEMENT
By Steven Clark
collected, analyzed and ready to present.
Executives coach in problem solving
and removing barriers.
“When I came back and presented it to
our team, they said, ‘Boy, this is what we
have really been looking for to get the
executives out of the executive suite and
into the units, while at the same time
engaging and empowering our front line
staff and focusing on improvement,’” says
Dr. Perlstein. “Up until now, most of the
improvement we had done was top down
and this was a way to reverse it.”
It wasn’t long afterwards that Dr. Dan
Lombardi, Associate Medical Director and
Patient Safety Officer, and Dr. AnnMarie
McDonald, Senior Vice President,
Chief Quality Officer, drove down to
Baltimore to see LDM in action. They
too came away impressed, anxious to
start the program here.
LDM AT SBH
Today, more than six months after
launching its pilot program on two
patient floors in April, LDM is practiced
at SBH on 10 units in the hospital
(patient floors and mother/baby, as
well as the emergency department,
radiology, pharmacy, and laboratory)
– with plans soon to add the ICU,
operating room, ambulatory care, and
endoscopy suite. Just last month, Dr.
Lombardi, Dr. McDonald and staff
nurses, along with key implementers
from Greater Baltimore Medical Center,
introduced the program to more than
a dozen enthusiastic representatives
of area hospitals at a meeting of the
Greater New York Hospital Association.
SBH is the first hospital in the New York
metropolitan area to incorporate LDM.
“LDM gets us closer to becoming a
highly reliable organization,” says
Dr. Lombardi. “It’s not just 20 executives
trying to do quality improvement and
improve the process. Now, you have
every front line staff worker asked to
look at these measures and come up
with ways to improve them. We’re
looking at what may be dysfunctional in
a unit, where there are areas to improve
upon and where employees may say, “I
do this every day, but in a sense it’s not as
effective or as streamlined as it could be.”
LDM begins daily at 9 a.m. sharp
when senior management meets briefly
in Dr. Perlstein’s office. Here, they
update the charts that hang from the
large whiteboard and discuss how the
hospital performed over the past 24
hours when it comes to Better Health,
Better Care, Least Waste and More
Joy. On the daily metric charts they
fill in green if goals are reached 100
percent and red if they are not (or blue
if measurement is premature), update
the monthly run sheet accordingly,
highlight the key factors on the Pareto
chart, and list next steps on the action
plan. Senior executives then split into
separate groups to interface with the
different units. Here, they are greeted by
front line staff, who stand before charts
that offer a snapshot of their own unit’s
goals and expectations.
“IT’S NOT JUST 20 EXECUTIVES
TRYING TO DO QUALITY
IMPROVEMENT AND IMPROVE
THE PROCESS. NOW, YOU
HAVE EVERY FRONT LINE
STAFF WORKER ASKED TO
LOOK AT THESE MEASURES
AND COME UP WITH WAYS TO
IMPROVE THEM.”
