Managing Through a Pandemic: A Daily Management System for COVID-19 Response and Recovery.

Area of Science:

• Healthcare Management
• Quality Improvement
• Organizational Resilience

Background:

• Lean daily management systems (DMS), originating in manufacturing, are evidence-based quality improvement tools.
• While studied in specific units, Lean DMS have not been examined as a comprehensive system for crisis response in healthcare.
• The COVID-19 pandemic presented an unprecedented challenge for U.S. hospitals and health systems.

Purpose of the Study:

• To explore the implementation and impact of Lean daily management systems (DMS) in U.S. hospitals during the COVID-19 pandemic.
• To understand how DMS facilitated rapid response and contributed to recovery efforts.
• To identify lessons learned for future crisis management and organizational resilience.

Main Methods:

• Qualitative interviews were conducted with 46 leaders and frontline staff across four U.S. hospitals and health systems.
• A semistructured interview guide focused on DMS implementation and its use during the COVID-19 pandemic.
• Deductive qualitative analysis was used to identify themes related to DMS facilitation of system response.

Main Results:

• Lean DMS facilitated rapid communication through tiered huddles and established standard work for redeployed staff.
• The pandemic increased DMS visibility, improved leadership communication, strengthened accountability, and empowered frontline staff.
• Key lessons for recovery include expanding telehealth, utilizing incident command systems, and coordinating resources for potential shortages.

Conclusions:

• Lean DMS proved to be a robust system enabling swift organizational response to unpredictable events like the COVID-19 pandemic.
• DMS practices, such as tiered huddles and standard work, support organizational resilience by enhancing sense-making, awareness, and coordination.
• The Lean DMS framework can be applied to various challenging situations to maintain high standards of care and ensure preparedness.