Fostering a culture of collaboration

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Patient safety is a top priority for everyone at Michigan Medicine, and the Daily Management System — or DMS — helps keep quality and safety an integral part of everyday conversations.

DMS engages unit-level staff across multiple disciplines in daily reviews of the “state of the unit.” These reviews enable employees to raise issues — ranging from patient and staff safety concerns to equipment, supply or IT-related problems — share “kudos” with team members, and discuss quality and safety metrics connected to their unit, such as hospital acquired conditions and hand hygiene compliance.

The quick, 15-minute interactions help foster a culture of collaboration, real-time problem solving and continuous improvement across the unit — while also ensuring the team is prepared to best care for each patient.

Over the past year, all 43 inpatient care units at Michigan Medicine have implemented DMS reviews, joining more than 80 percent of the organization’s ambulatory care units that also engage in daily huddles.

“Our unit had been holding daily safety huddles prior to adopting DMS, but we’ve found that the visual board and DMS review system have provided structure for our meetings and really increased team attendance,” said Nicole Figueroa, RN, clinical nursing director for the child and adolescent psychiatric unit. “We now use our huddles to ensure that everyone on the unit is aware of how we’re doing on all safety measures, and to make sure that all staff are aware of any patient-related issues that arise overnight. Since the patients on our unit are mobile, it’s important that everyone know of any potential issues around patient interaction that could affect the team.”

The DMS process also provides an opportunity for units to select which metrics for the visual board are most important to them.

“Historically, patient falls have been an issue on our unit, so it’s great that our DMS board allows us to have real-time data on patient falls to share with the entire team,” said Jennifer Kelley, MSN, RN, clinical nurse specialist on 12W at C.S. Mott Children’s Hospital. “Everyone on the team has shown a renewed commitment to finding processes or procedures to help keep our patients from falling when being transferred on or off the unit.”

Empowering employees

The DMS review process also encourages greater employee engagement by providing a platform where staff members can offer ideas to address important issues and/or prevent reoccurrence.

“I have definitely seen an increase in the confidence level of the staff on our unit and a greater willingness to speak up and bring attention to issues or problems they are having,” said Kelly Gawne, RN, clinical nursing director for the inpatient acute rehabilitation unit (6A). “Using the board as a guide, we have an open discussion — which includes everything from patient-related problems to issues with equipment or technology. Just the other day we were able to get a piece of equipment fixed in a matter of hours because someone brought it to the huddle and we were able to follow up on it immediately.”

Other teams also reported a similar impact following the adoption of the DMS daily review process.

“We have noticed a huge improvement in team members’ willingness to offer solutions to existing problems or suggestions on how we can improve care,” said Kimberly Monroe, M.D., M.S., medical director, 12W/12E in Mott. “Recently, one staff member noticed a change in a medication from a created order set that would have adversely affected a large number of our patients. We quickly addressed the concern and minimized any potential impact on our patients.”

The boards — and the conversations they drive — ensure staff members within each unit are on the same page.

“We use our DMS reviews as a time to provide news and unit-level updates, as well as any organization-wide initiatives that are relevant to our employees,” said Cinda Loik, RN, BSN, MBA, clinical nursing director for the inpatient neurosurgery unit (4A). “A lot of our huddles turn into a Q&A discussion, but we also utilize our time to look over our quality and safety metrics.”

“We started our DMS review in January and that same month we hit our highest ever hand hygiene compliance percentage,” Loik continued. “Does DMS deserve all the credit? Not necessarily, but I certainly think our daily reviews have helped make a positive impact on our employees and on our patients.”