Daily management systems in medicine.

"Lean" (continuous improvement) organizations make use of daily management systems (DMS) that are designed so that problems can be quickly identified, front-line staff are empowered to fix the problems that they can, and problems that the front-line staff cannot fix are escalated and countermeasures created quickly. Key components of a DMS include leadership standard work, visual controls, and a daily accountability process, as well as discipline involving each of these three components. The author's organization recently had the opportunity to open a new, nonreplacement hospital, allowing the incorporation of continuous improvement principles into the hospital's design and operations. One high-priority task was the creation of a DMS, which was structured as a tiered "huddle" system. All of the front-line clinical areas, as well as all clinical and nonclinical ancillary support areas, conduct morning huddles. Problems identified at these huddles and needing escalation are then brought to a patient flow huddle and an integrated huddle. All of these huddles occur daily and have a standard format with three clearly defined components: metrics-goal review, daily readiness assessment, and problem accountability reporting. The huddles also provide a daily opportunity to see and converse with the people with whom one needs to discuss certain issues. The process of bringing people together for these huddles can contribute significantly to team formation, coordination of efforts, and development of a culture of trust.