Managing of Daily Improvement (MDI) Through Daily Huddles: Creating Culture and Engaged Problem Solving Nurse Coordinator Staff At City of Hope Department of Hematology & Hematopoietic Cell Transplant (HEM/HCT)

Background: Transplant nurse coordinators at City of Hope work daily to manage patient schedules, collaborate care coordination, provide patient education and achieve patient expectations through complexities of daily challenges.  Employees create “work-arounds” instead of solving problems. As any work place, problems in the daily work are opportunities for improvement.  At COH, there has not been a standard problem solving methodology. In many cases, improvements are implemented but are not consistently sustained. Not all staff members participate in project improvement projects. Solved problems, or “work-arounds,” are not documented and tracked. COH recognized the need to create a culture of continuous improvement. COH needed to advance to daily problem solving and information sharing activities in the HEM/HCT department and as well as throughout COH Medical Center.

Purpose: To create a process of daily problem solving and information sharing activities. The staff is fully engaged with; finding, prioritizing, assigning, and solving problems in progress until completion.  To develop a place for staff to share information and to promote diversity & inclusion by encouraging all team members to share ideas with each other.

Intervention: A pilot of Managing Daily Improvement (MDI) through daily huddles at the “huddle central” board was implemented in the department. Through the Accelerating City of Hope Excellence (ACE) team, management and key personnel were given education on an MDI tool: “huddle central.” Standard work on conducting the huddle was created. Management and key personnel then educated staff on standard work which includes filling out “Improvement Opportunity” cards to identify challenges the staff have.

Discussion: Through the ACE initiative, several key areas were selected to pilot MDI. HEM/HCT Nurse Coordinator area was one of first 4 areas selected. The focus is on practical problem solving to improve communication and promote a culture of continuous improvement. It establishes a daily discipline of finding, prioritizing, assigning, and solving problems until completion.  Staff are encouraged and empowered to solve problems in teams.  It is a place for staff to share key information about their daily work with each other. The huddle metric targets were: 1) solved 4 problems per month; 2) are held 90% of the time; and 3) 75% of staff attends daily. Since May, the problems solved per month averaged 6.75; huddles held per month averaged 95%; and staff daily attendance averaged 68%. Some examples of solutions were: improvement of pre-transplant class patient attendance; improvement of communication and disseminating information to other department; and improving timely turnaround of physician orders for signature. We will continue to monitor the metrics established, improve the daily huddle attendance and number of problems solved.