Nurses Offer Solutions for Improvement

A new approach to the suggestion box

Terri Murray, MSN, RN, NE-BC, is a nurse manager for three cardiovascular stepdown units with more than 120 nursing caregivers at Cleveland Clinic’s main campus. While the three units work as one team, it can be challenging to communicate ideas and receive feedback from everyone. “We work seven days a week, 24 hours a day,” says Murray. “It’s hard to get the whole group’s consensus and get more ideas for improvement from the broad spectrum of our entire team.”

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To make sure everyone’s voice was heard, the units’ Shared Governance Council opted for a conventional method – a suggestion card and box. While that may not seem like a novel approach, the council added a twist to traditional suggestion cards, then incorporated them into the units’ Kaizen continuous improvement practice to ensure follow-through on good ideas.

Gathering and considering ideas for improvement

The cardiovascular stepdown units began using conventional suggestion cards in early 2016. “It only took a month or two to figure out it wasn’t really effective,” says Murray. “People often wrote in blanket statements without their names or possible solutions.” For instance, a card might complain that nurses on the night shift never have certain supplies, but not provide an idea to fix the issue.

“The Shared Governance Council realized that team members often have the best solutions, and they should come up with them and be proud of them,” says Murray. So the council revamped the cards, creating suggestion/solution cards. The front of the cards feature the word “team” in bold letters and say that nurses are “appreciated, invited, heard, connected, included and part of solutions.” The back includes three lines for a suggestion, three lines for a possible solution and space for the nurse’s name.

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The units get about 20 suggestions a month, which are reviewed by the Shared Governance Council and, if applicable, moved through the Kaizen process. “The council considers what we want to target and what it will require,” says Murray. The process helps them put solutions in place: Can the idea be implemented right away (a “just do it” idea in Kaizen terminology), does it require more root cause analysis, or will it need a structured problem-solving approach (Kaizen’s “A3 methodology”)?

Putting ideas into practice

In the past year, many of the suggestions and solutions presented by nurses in the cardiovascular stepdown units have been carried out. Here are a few:

  • Shift switching practice – It was often hard for nurses to find someone to take their shift when something came up and they were unable to work. A team of nurses suggested creating a closed Facebook page where nurses could post messages asking for someone to fill in or swap with them. The idea was an immediate success. “There’s not a line of people outside my door telling me they need a day off and can’t find a replacement,” says Murray. “To see them make changes on their own is exciting to me.” She says nurses successfully find a colleague to switch shifts with them nearly all the time now.
  • Handwashing initiative – The cardiovascular stepdown units wanted to increase handwashing compliance. They began utilizing internal audits, holding one another accountable. The units increased their overall compliance to the 80th percentile, well above the average nurse adherence rate of 63 percent, according to the World Health Organization. They continue to stress hand hygiene, working to raise compliance rates even higher.
  • Community giving projects – Many nurses expressed an interest in working together on philanthropic projects, so a committee was formed to organize quarterly events. For one of their projects, nurses put together more than 100 bags of toiletries for Laura’s Home, a women’s crisis center in Cleveland.
  • Specialty certifications – The cardiovascular stepdown Shared Governance Council is currently working on an A3 project to increase the number of nurses with specialty certifications.

Through the suggestion/solution cards, nurses have been empowered to identify areas for improvement and offer solutions. “The reason the cards are working is because we encourage everyone to be part of the solution. We want all of our nurses to feel heard and included,” says Murray. “It’s a success because nurses are seeing their solutions come to life.”

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