Accelerate Hospital Process Improvements with Front Line Drivers

Accelerate Hospital Process Improvements with Front Line Drivers

Imagine taking a cross country road trip, but instead of GPS, your only guide is a road atlas printed twenty years ago. Sure, you could still get where you’re going, but you’d probably take a few wrong turns or encounter changes in the landscape. You’d reach your destination, but it would take you longer, be more expensive, and you’d be much more frustrated.

Healthcare is full of organizations driving to improve patient outcomes and experience while also managing expenses. They are doing so with the guidance of minimal data, and even that is often from delayed reporting systems. The dynamics of infrastructure, regulatory requirements, governing bodies, stakeholders and patients are incredibly complex, with multiple strategies needed to make process improvements. For healthcare leaders, it is difficult to know the impact of today’s improvement attempts when a month might pass without published results.

What if a hospital leader–from the C-suite to the charge nurse on the unit, to the environmental services technician in the patient room–could predict the outcome of monthly results on a daily or weekly basis and course-correct in real time to improve outcomes? Metaphorically, what if you were given an updated map before you missed your exit?

Front Line Drivers (FLDs) are a powerful tool that can be used across your organization, from radiology to the operating room, environmental services to supply chain, to cut through the complexity by showing real-time results that provoke real-time changes. FLDs are actions that front line employees can take to influence or impact a key performance indicator (KPI). It’s like how a driver might use the speed of travel and number of stops to know (and adjust) if the car will reach the destination when expected. These are actionable daily activities, tied to KPIs, that allow your team to dial in and give you the power to predict your outcomes.

For example, turnaround time for testing in radiology has significant impact on emergency department throughput. This dependency often strains the relationship between ED employees and their radiology peers, further hindering the flow of information. Using a tier 1 huddle board in CT, the radiology team could discuss daily the number of delayed tests and cite barriers that prevented each test from starting on time.

At each huddle, this information would be entered on a *tracking sheet on the huddle board. This is not an extra workload a leader performs alone in an office, but a hands-on exercise that happens with, and most importantly, in front of the team.

After a week (sometimes even a few days) the Pareto principle shows which barrier has caused the majority of delays. Managers would have enough visibility to the most common barriers to then lead front line employees in a discussion about solutions.

With data in hand and emotion out of the equation, radiology can now approach the ED with tactical suggestions. In one Texas hospital utilizing the FLD/huddle process, the radiology team found most test delays were caused when patients were tied up with ED nurses at the scheduled departure time for testing. After presenting their findings to the ED staff, they collaboratively developed a practice they named the “Texas Two-Step,” wherein the ED staff would step aside, shifting focus to other tasks and allowing radiology to step in. By engaging the ED in the why behind the issue, they were able to strengthen the relationship, decrease the number of tests with delayed starts, improve turn-around of results to physicians for decisioning, and ultimately decrease patients’ length of stay.

It’s empowering for employees to know that their individual actions have a direct impact on organizational success. FLDs empower employees to navigate the challenges ahead of them with clarity so they can keep on the road toward exceptional patient care. When employee engagement improves, patient experience and outcome metrics improve, leading the way for transparency and data driven decisions to become the norm.


*If you’d like a copy of the tracking sheet described above, or if your organization needs help with process improvement, please email

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