New ways to support patients and staff at East Madison Hospital

When nurse manager Kristen Stine, MS, RN, ACNS-BC, was thinking about ways to improve patient care and employee morale on the 4th floor Medical Surgical Unit at East Madison Hospital, she knew exactly what to do: Empower the nurses to help move the needle.

5-minute huddle leads to big changes

As part of UW Health Way leader training, Kristen learned about PICK huddles and brought the idea to the unit council in Summer 2021.

“PICK stands for possible, implement, challenge or kibosh, and the huddles provide an opportunity for frontline staff to impact their practice and their unit, and to really own the process,” she said.

Unit council leader Kelli Susee, ADN, RN, played an active role in implementing and championing the huddles on the unit, which gained traction and results in 2022.

Anyone who works on the unit is welcome to submit an idea card that describes a problem or opportunity, the idea for improvement, expected benefits and results, and the stakeholders (including patients and families) who should be consulted for feedback or to implement the change.

Ideas are reviewed at the PICK huddle held every Friday at 7 a.m. to allow both night and day shift staff to participate. Each huddle is led by a unit council member and decisions by huddle participants are based on the level of effort/resources needed and the expected impact. Suggestions requiring low effort with high impact easily fall under “implement.”

Those defined as “possible” require little effort but are low impact while “challenge” means high effort and high impact. Recommendations under “kibosh” typically fall outside the nursing council’s scope.

Ideas from the PICK huddle that have been implemented include working with Post-Anesthesia Care Unit nurses to improve medication management for patients who are transferred to the unit after surgery; using secure chat to improve communication efficiency with colleagues from imaging to schedule appointments for patients; and moving intravenous fluids from central supply to the pharmacy so they are easier to access.

Some ideas such as making a public announcement about the end of visiting hours were easier to implement. Updating the phone list took a great amount of time but both Kelli and Kristen said it was well worth the effort.

In addition to vetting ideas for patient care improvement, PICK huddles have also become a space to share recognition such as positive patient feedback, DAISY Award nominations for nurses, Sunshine Award nominations for nursing assistants, Hi-5s from colleagues and colleagues’ birthdays.

“PICK huddles are a constructive place to give feedback. It’s a great outlet for people to voice their concerns, and staff and providers can see the great work that’s being done because we post a list of what’s been completed,” Kelli said. “It was a big transition, but everyone really embraces the huddle now and it’s just so much fun. It seems like this should be on every unit.”

PICK huddles (possible, implement, challenge or kibosh) provide an opportunity for frontline staff to impact their practice and own the process, according to nurse manager Kristen Stine. The unit council introduced the huddles on the Medical Surgical Unit at East Madison Hospital, which gained traction in 2022.

Care team leader rounding improves satisfaction

Elevating the role of care team leaders (CTLs) on the 4th floor Medical Surgical Unit at East Madison Hospital has had an exceptionally positive impact on patients and employees.

“I want to empower people at the bedside to make decisions in the moment and be proactive. This impacts quality outcomes and patient satisfaction, as well as staff satisfaction,” said Kristen. “We are a growing hospital, so this was also a way to start succession planning and build leadership skills to ensure that staff members have opportunities to grow professionally when they’re ready.”

The hiring of a house supervisor a year ago to maintain the inpatient nursing operations of the hospital meant that CTLs such as Eden Larson, BSN, RN-BC, had more time for patients and staff. CTLs on the unit now round on patients each shift, something Eden says has made a world of difference.

“CTL rounding with the patients is a great way for us to support our nurses. They can see that we’re more available to them, and it’s a positive change for patients,” Eden said. “When a patient who’s had a dissatisfying experience can feel that they’ve been heard, it changes their outlook on their stay. And the nurse doesn’t have to feel alone when they have another person who can talk to the patient, really listen to them and address their concerns.”

Eden and Kristen feel a renewed sense of teamwork on the unit. “People really enjoy coming to work and say this is their work family,” Eden said. “Medical surgical nursing is not easy and most people don’t stay in this field for very long. I’ve been here for six years and I just love the people I work with. Morale has improved over the last year. People smile a lot.”

CTLs on the unit worked with the nurse manager and clinical nurse specialist to develop a standard set of questions for rounding based on patient satisfaction metrics. Since they began rounding in July 2022, there has been a dramatic increase in their top box scores:

  • General hospital satisfaction rating increased from the 86th to the 93rd percentile
  • “Staff worked together to care for you” rating increased from the 74th to the 92nd percentile
  • “Response to complaints” rating increased from the 88th to 92nd percentile.

When asked about the increase in the scores, Eden said, “I think it was a little unbelievable. I initially thought it was wrong, and that it had to be a different unit.”

Kristen said, “It’s a validation that we’re doing something right and it just keeps pushing us forward.”

As a way to elevate the role of the care team leader (CTL), CTLs began rounding on the Medical Surgical Unit at East Madison Hospital. CTL Eden Larson, BSN, RN-BC (pictured with a patient), says the support CTLs provide has been a great satisfier for nurses and patients alike.

Check out more stories featuring the great work of our nurses in the 2022 Nursing Annual Report (pdf).