Lean Daily Management: A Tool for Engagement and Cultural Change

You know that your organization needs a reliable primary care base, an integrated specialist network, and engaged physician leadership to successfully manage costs and improve quality. So once you have purchased the most strategic physician groups and aligned with your referral base, you are prepared, right?

Maybe not. Many organizations are not realizing their expected ROI because they have been unable to get physicians to take ownership of operational performance or see themselves as members of the broader organization.

Lean daily management (LDM) offers an effective tool for achieving the necessary cultural change and physician engagement. The LDM process promotes physicians ownership of their operational performance, creates a no-fault culture, and reinforces continual improvement efforts. Physicians often respond well to its transparent, data-oriented nature.

The process is deceptively simple. At the end of each day, a team (composed of all operational stakeholders) gathers for a 5-minute discussion to review a dashboard with four categories: safety, quality, cost, and efficiency. This dashboard is intended to measure the team’s performance on specific metrics. To help focus and prioritize its improvement efforts, the team should place only one metric in each category.

The discussion is led by a physician (not management), and everyone who is able to attend should be required to do so. By involving everyone, from clinical to administrative staff, LDM reinforces the team-based culture that is critical to successful cost and quality management.

Performance on each metric is reviewed relative to a reasonable target that is aligned with the organization’s objectives, thereby helping team members understand what level of performance is acceptable and reinforcing work expectations.

If the daily target was missed, the team discusses why, with a focus on identifying the primary cause, and determines how it could have been prevented. In the search for the primary cause, it is important to examine systematic issues and not place blame on individuals. This is the moment when cultural change happens: The group must allow all perspectives to be voiced, come to consensus as a team, and take ownership of systems and processes.

At the end of the day, the team is accountable to itself for implementing any proposed improvements. Management should reinforce this by attending LDM, ensuring that the team focuses on system and process issues (again, not individuals), and providing financial resources when the team has demonstrated a clear and reasonable need.

When implemented with full management support, LDM is one of the most powerful tools for cultural change that exists in Lean or Six Sigma. It is deceptively easy to implement and may be the physician engagement tool you have been looking for.

This post was initially featured, June 17, 2013, on the hfm Healthcare Finance Blog.

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