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In a laboratory setting with fast-paced changes and heavy demands on staff, day-to-day communication across departments is challenging, yet paramount to resource sharing and real-time problem solving. Children’s Mercy Hospital Kansas City (CMH) has implemented system-wide lean practices focused on clinical and operational excellence. Our laboratory mission, or True North, is to produce clinically relevant laboratory results and information to assist in the diagnosis, treatment and prognosis of patients in a timely manner, by: �� Reducing Errors – Pre-analytical, Analytical & Post-analytical �� Making encounters with the laboratory extraordinary �� Reducing turnaround times �� Maximizing employee engagement and productivity �� Reducing waste The first phase of the CMH Daily Management System (DMS) was to implement daily huddle and metrics boards. Each individual department would align unit-level readiness and quality metrics to the institution’s True North foundational elements and report on the following daily readiness objectives: 1. MESS: Methods, Equipment, Supplies, and Staffing (displayed as green or red) 2. Situation Awareness Notifications (abnormalities that need special attention that day) 3. Recognition (employees who go above and beyond contributions from previous day) 4. Announcements (department or institutional changes taking place that day) 5. Daily Workload (reported in patient volumes and previous day test volume) 6. Quick Hits and Big Issues (problem solving: QH completed within 3 days/check-in dates for each) A multi-tiered system would include huddle boards from individual department levels (i.e. Chemistry, Microbiology, or satellite department), one overall for the lab (pictured below), and the hospital as a whole. Each tier would report up to the next tier daily at the same time. Huddles are kept to five minutes or less.


DMS allows departments to identify MESS red/green thresholds that affect patient care. All information should be displayed in a simple, clear format where any employee walking by would understand how patient care is being delivered for that day. All huddle boards are dry erase for easy documentation and use red/green magnets to identify abnormalities “at a glance.” Huddles take place at the beginning of each shift with all stakeholders present to ensure clear communication between staffing changes. Departments are required to first determine what MESS levels would be considered abnormal (red). This requires breaking down testing platforms, staffing matrices and supply and inventory par volumes to ensure continual and efficient patient care. Any downtime, critical staffing level, or backorder that can cause delays in testing should be reported red for the day. Methods are department goals that are critical for care management and can be measured as they progress. This can include mandatory education for staffing or employee vaccination compliance. Problem solving is a daily occurrence. These issues are documented as “Quick Hits” (being completed within the department in three days or less) or “Big Issues” (taking additional time, resources, and possibly external departments). Each problem is assigned to a lead and given a due date to report back. Progress is reviewed during huddles and documented using Harvey Balls showing progress. These sheets can be used to show inspectors documentation of issues resolved in the department. Every department is required to identify situations that could cause delays in patient care. This can include, but is not limited to, IT downtime, courier delays, weather concerns, construction, or surges in patient volume. This information is followed up with Announcements and Employee Recognition. Metrics provide visual content to continual improvement. Metrics are also included in daily reporting, focusing on Safety, Employees, Quality, Delivery of Services, and Stewardship or Resources. These metrics must be measurable, contribute to improved patient care, employee engagement, operational and clinical excellence. These metrics should be department specific, timely, and patient centered.

Larger health systems often have satellite facilities in different geographical locations than the main hospital. Timely communication of department readiness across a health system is vital to ensure continual patient care when distance can affect distribution of additional resources. Telecommunications allows for huddles to take place online where information can be shared in real time. This allows for administration to allocate additional resources quickly, when necessary. CMH uses Polycom RealPresence to video conference huddles at the Tier 2 Laboratory Management huddle, as well as the hospital Tier 3 level. WebEx and Skype are other options for teleconferencing.


The Daily Management System has allowed for improved communication between shift exchange and departments throughout the hospital. The standardized process empowers frontline employees to identify abnormalities in staffing and equipment, resolution of issues, and efficiencies in process improvement. This bottom-up approach aligns with the True North mission allowing employees to become engaged and more solution-driven. Health systems with multiple satellite locations are able to connect via telecommunication technology, allowing for real-time reporting and deployment of resources. This ensures optimal utilization of resources that can be reallocated based on volume drivers within the department. Aligning department readiness and metrics with patient outcomes daily helps build a highly reliable organization focused on continuous improvement. In this continuously changing healthcare environment, institutions must become more efficient with limited resources, focused on clinical improvement, and empowering staff to discourage burnout. DMS is an effective lean tool for organizations wanting to break down silos, improve communication between departments, and strive towards clinical and operational excellence.

MeSH Keywords

Laboratories/organization & administration; Total Quality Management; Decision Making, Organizational; Communication; Models, Organizational; Capacity Building;




Health and Medical Administration | Pathology


Special Acknowledgements: I would like to thank the following individuals for their participation in the planning and implementation of the DMS program at Children’s Mercy Hospital Kansas City: Felicity Pino, Toni Sheffer, Christina Vasquez, Deb Faller, Barbara Mouron, Diane Burford, Randah Althahabi , Marinda Cooper, Joshua Bradley, Steven Buckley, Trang C. Nguyen, Clint Frazee, Megan Gripka, Lindsey Dodds, Jeannie Ray, Julie Kenward, Dr. Uttam Garg PhD, Dr Eugenio Taboada MD

Implementing Daily Management System Huddle Boards to Improve Communication Across Satellite Laboratories