A productive healthcare organization needs an integrated teamwork and engaged physician leadership to successfully manage costs and improve quality. Lean daily management (LDM) is considered an effective tool for achieving cultural change, with better physician engagement to take ownership of operational performance. We report 6 month experiences from the implementation of LDM and daily executives’ Gemba walks in medical inpatient units.
In order to fulfill the vision “To every patient, every time, we will provide the care that we would want for our own loved ones”, the hospital initiated a quadruple aim of better health outcomes, better care experience, less waste/lower cost and more joy to care‐providers from April 2013. A strategic plan was devised with application of LDM in form of Pareto‐chart. At morning, each day, the hospital executives walked in each “medical units” (Gemba walks) to monitor daily performance. In allocated units, a team led by a hospitalist or a medical resident presented a dashboard (Pareto chart) with issues including safety, quality, cost, and efficiency relevant to the aims. Performance on each metric was reviewed relative to a reasonable target. If the daily targets were missed, the team discussed reasons (the 5 whys’), with a focus on identifying the primary cause, and determined how it could have been prevented. Six month outcomes in various metrics are presented compared to prior year’s available results.
|Metrics||2012 (1 year)||April‐October 2013 (6 months)|
|Better Health||Verbal Hand‐offs to PCPs||30‐40%||100%||90% attempt rates 50‐70% success rates|
|Discharge summaries completed in <48 hrs.||30%||100%||95%|
|Serious patient safety events||20||0||5|
|Reporting of near misses, great catches, and lower level safety events||30‐40%||100%||65%|
|Hand hygiene compliance||70%||100%||95%|
|Better Care||Patient satisfaction score||86%||99%||90%|
|Least Waste||Average ER waiting times||6 hours||<3 hours||3.5 hours|
|Compliance to time‐limit of 90 minutes from ‘ER routing slip’ to ‘admission orders’||70%||100%||95%|
|Stable patients discharged before 1 pm||74%||100%||90%|
|Placement waiting time for medically stable patients to nursing facilities||1.5 days||0 days||1.2 days|
|Early morning specialists’ consults for patients admitted overnight with potential same‐day discharge||25%||100%||45%|
|More Joy||Review of appropriate clinical guidelines for each new admission||Unavailable||100%||80%|
|Physician satisfaction score||66%||99%||87%|
When implemented with full management support, LDM and daily Gemba walks could improve patients’ quality‐care metrics in inpatient units. These also directly enhanced physicians’ participation in patient care, sense of ownership and satisfaction.
To cite this abstract:Subedi B. The Effect of Lean Daily Management and Gemba Walks in Quality‐Care Metrics. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 139. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/the-effect-of-lean-daily-management-and-gemba-walks-in-qualitycare-metrics/. Accessed April 8, 2020.