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.
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.
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”)?
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:
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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