At a large rural academic medical center within a 36-bed inpatient-medicine unit, we were struggling to increase employee engagement through traditional strategies. While leader standard rounding, leadership stability, and organizational efforts were in place, we were unable to move out of tier 3 as showcased in our 2017 employee engagement survey. There was a need to identify and create an approach to engagement that was reliable, consistent, and conveyed without significant burden. Through a systematic approach, we aimed to empower all staff working within the microsystem to be problem solvers. With that goal, we created and IDEA board aimed at increasing overall engagement and microsystem ownership.
The IDEA board launched in February 2018, taking into account sustainability fostered by our approach of leader standard work. All staff members can place an idea on the board with no idea being “too simple.” Each month, ideas are reviewed by our practice area council (shared governance) who then decide on each idea’s overall complexity, impact, and effort required to expedite progress. Based on this, the team, including the submitter “owner,” gather resources needed to help facilitate idea advancement. Then in a systematic way, we evaluate the idea’s progress utilizing four categories. They are 1) to do, 2) doing, 3) done, and 4) brainstorming. We use the brainstorming category as something which is not achievable for one reason or another that month, but is something that we are considering for the future. By displaying the idea’s progression visually in our conference room, all staff are able to see the evolution of their or the team’s ideas.
Most often ideas align with either our academic mission (educational needs), financial stewardship, quality, practice, staff engagement, or basic workflow on the unit. Without real guidance, the team has gravitated towards our strategic goals, which is significant, as strategic goals can often feel removed from clinicians at the bedside, despite the efforts of other interventions.
The implementation of the IDEA board at the microsystem level allowed for profound empowerment amongst the team, directly influencing employee engagement. This model has allowed for individual and team commitment to their space, culture, safety, and clinical outcomes. Since 2018, we have seen a drastic increase in idea submission, leading to a unit-based goal for FY20 in which each team member must submit at least one idea. With a department of 70 FTEs, this has contributed to countless improvements and innovations. Significant to mention, we have also moved from a tier 3 with an overall engagement rate of 3.56 in 2017 to tier 1 with an overall engagement rating of 4.15 in 2019. In addition, we achieved a leader index of 96 out of 100, a statistic that was not available in 2017. Given the structure of the IDEA board, we expect it will continue to self-sustain as we make rapid tests of change and improvements. Through these efforts, staff continue to feel their voice is heard and that the work they do matters. While some of the ideas may seem small, their impact is huge.