Daily Management System Improving Quality and Promoting Patient Safety: An Evidence-Based Practice Initiative

The 2015 report from the Joint Commission emphasizes the importance of expanding evidence-based initiatives to improve care quality and safety in acute care hospitals across the USA. In addition, the Institute of Medicine report also highlights the urgency for acute care hospitals to improve patient safety. This is currently being enhanced by evidence-based quality improvement initiatives which facilitate effective teamwork and collaboration among caregivers. Daily Management System (DMS), a data driven process and a subsystem of Lean/Breakthrough is one such initiative. It has been successfully implemented in most acute care facilities in New York City’s Health and Hospital Corporation since 2014. The goal, of this evidence-based quality improvement initiative, is to promote high quality safe care through team building and problem solving. DMS also sustains continuous improvement, aligned with planned organizational goals. In order to achieve these goals and transform health care into highly functional systems, nursing leaders such as nurse practitioners are strategically positioned to be actively involved in quality improvement initiatives. DMS organizes collection of real-time process focused data or metric on a visual control board. This visual control board allows team members to become actively engaged and buy-in on processes. The interdisciplinary team members meet or huddle for at least ten minutes each day to review steps in the process. Front-line team members are able to see their contributions to this process in real time. The author participated in a nurse practitioner led metric process during 2014 which involved daily collection of real time data involving patients being monitored on telemetry. All data from this metric were recorded and later analyzed and reviewed with senior executive stakeholders. Root cause analysis was conducted, allowing real causes of problems encountered with the process to be identified, analyzed and fixed. New changes to system were authorized by senior executive stakeholders. These changes resulted in significant improvement in telemetry monitoring, with decreased health care cost for patients and the organization. In addition, daily huddles or briefs have eliminated silos by promoting team dynamics, and improved communication among interdisciplinary care providers. The format of daily huddles is standardized with clearly defined components consisting of metrics-goal review, daily readiness assessment, quality improvement problem and accountability reporting. In summary, DMS is a proven evidence-based quality improvement initiative, which focuses on team building, making errors visible, building quality, decreasing cost and constantly addressing problems; thereby resulting in a safer environment for patients and their families. In order to meet the standards of the Joint Commission and the Institute of Medicine in maintaining patient safety, Nurse practitioners and other nursing leaders are integral to the success of this initiative, as they are strategically positioned to lead and maintain DMS in their health care organizations.