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Patient Safety in Action: Huddles around Whiteboards Help Airmen See the Big Picture

Lt. Col. Laura Lewis points to the whiteboard as she speaks with Maj. Jill Hibbert about action items on the leadership daily management board. The 61st Medical Squadron at the Los Angeles Air Force Base discuss uses the boards to track information shared during huddles to improve visibility and accountability. Chief Nurse Lt. Col. Laura Lewis (left) with the 61st Medical Squadron at the Los Angeles Air Force Base discusses action items on the leadership daily management board with Maj. Jill Hibbert. The boards are used to track information shared during huddles to improve visibility and accountability. (U.S. Air Force photo by Sarah VanHoy)

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Daily huddles are a leading practice in military treatment facilities and some healthcare teams are supplementing these brief conversations with visual aids. Air Force MTFs use a structured whiteboard, called management boards, to track the plan for the day, any issues or concerns, kudos, and wins to provide a framework for facilitating discussions and improving accountability.

These boards are part of a larger Continuous Process Improvement Management System the Air Force Medical Service instituted. Daily management boards are used by frontline staff during daily huddles and leadership management boards are used to track concerns that have been raised by frontline staff for their action.

“As teams got involved with the boards, it became part of their regular day,” said Beth Kohsin, director of the CPI Program Office at the Air Force Medical Operations Agency. “It’s not an addition to their daily tasks, it’s what makes a difference in their day. That’s what we wanted; to make a difference for their team and leadership.”

The CPI Management System embodies two AFMS Trusted Care, or high reliability, guiding principles: “Focus on the Frontline Operations and the People Who Do the Work,” and “Every Airman, Every Day a Problem Solver.” In less than a year since adopting the management boards, leaders have a better understanding of frontline operations and teams have a shared mental model. 

“We’re seeing frontline staff who are feeling more connected to their immediate frontline leaders and senior leaders because the leaders are actually coming to them, to listen to their huddles, understand their issues and help,” Kohsin said. “An MTF staff member told me they felt good when an issue they brought up was added to the leadership board because they realized the leaders were serious about helping them resolve their issue.” 

At Los Angeles Air Force Base’s 61st Medical Squadron, the management boards played a role in helping leaders monitor quality checks for bacteria of pharmaceutical equipment that adds water to powdered prescriptions. The team was alerted to instances of bacteria found in an Army MTF’s Fillmaster equipment.

Informational graphic depicting the management board

The pharmacy and aerospace bio teams at the Los Angeles Air Force Base added the issue to their management boards and began to track results of their Fillmaster checks over the next several hours. Without the board, the issue would have been handled by e-mail or phone calls and could have easily fallen off the radar or experienced a delay in being investigated. With the management board, the entire team had visibility and accountability to ensure something was being done about this potential patient safety risk.

Lt. Col. Laura Lewis, chief nurse with the 61st Medical Squadron was a co-champion behind the daily management board launch at the Los Angeles Air Force Base. The 61st MDS was one of the few groups to pilot the management boards. Lewis said the accountability and visibility of end-results were attractive to her team. 

“We currently have 11 daily management boards and one leadership management board. Other sections are seeing the value and now want to have a board for their team too. It speaks volumes to the success of this tool,” Lewis said. 

The management board templates are based on empirical evidence from six Air Force MTFs. AFMOA worked with teams in the field to identify the elements they wanted in a visual management board system. Teams can, and do, modify the board template to fit their needs. The teams at Los Angeles Air Force Base’s 61st Medical Squadron added a section called “New Additional Information” to track details about concerns that need more information before resolving.

“In talking with people out in the field and now at leadership levels, I’m very excited that people are seeing how it makes a difference in their day,” Kohsin said.  

Col. Michael Higgins, vice commander at AFMOA, says that when teams force themselves to be disciplined to write something down, whether it’s a concern or a win, in a place where everyone can see, then the whole team can work out a plan for the day. 

"Our goal toward Zero Harm is paramount. We can only achieve this with a visible, measurable, and demonstrable commitment to high reliability principles and processes. Our structured communication through standard work and management boards is just one example on how we do that."

-Col. Michael Higgins, vice commander, Air Force Medical Operations Agency


“We are asking leaders all the way down to frontline staff caring for patients to have a standard for work and reduce variance in support our patient safety zero harm goal,” Higgins said. “To get there, we have to mirror that discipline in how we go about having conversations. It is absolutely fundamental for us to have a coordinated process on how we communicate up and down, and across the organization. The management boards force us to spend deliberate time with the right people, synergize efforts and get help early.”

Higgins says leaders must have buy-in, demonstrate, teach and be part of the process to evolve thinking. He also advises leaders to visit huddles and look at the daily management boards in different sections with a coaching mindset, not a problem-solving mindset because it’s up to the teams to work through those problems.

“The use of these management boards is just one part of our high reliability initiative, but a very important part that all MTFs can benefit from,” Higgins said. “It’s a critical connected piece to a systems approach that without it, the system would be disconnected.”

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