How One Hospital Improved Patient Safety in 10 Minutes a Day

Most modern health care improvements seem to involve expensive technology and an uncomfortable amount of change management. But clinical and nonclinical staff at the Rotterdam Eye Hospital have improved patient care and raised staff morale at a very modest cost: 10 minutes a day and a special deck of cards.

Members of the hospital’s design thinking team were inspired by something they saw when they boarded a KLM Airline flight: During a pre-flight huddle of the cabin crew, team members introduced each other and then asked each other two questions on flight safety.

When they got back to Rotterdam Eye Hospital, the managers asked themselves why couldn’t they add a similar feature to their own “team-start” huddles? After all, in some ways, the situations were similar: A group whose members may not have worked together before must form a close-knit team quickly and execute their duties in a way that meets the organization’s guidelines to the letter.

To test the idea, hospital managers developed a special patient-safety card game that encouraged coworkers to work together more easily and reinforced their knowledge of core safety and patient care principles. (One of us, Roel, designed and ran the initiative; the other, Dirk, studied it.

Now, a number of other hospitals and long-term care organizations in the Netherlands have started playing the card game too. In 2016 and 2017, a nursing home and a rehabilitation center from Zorgpartners Midden Holland near Rotterdam also adopted the “team-start” huddle and card game and have seen similar improvements in patient care and staff morale.

Here’s how it works:

At the start of every shift, the team members get together for a brief “team-start.” Each team member rates his or her own mood as green (I’m good), orange (I’m okay but I have a few things I’m concerned about) or red (I’m under stress). The rest of the team doesn’t need to know that you’re under stress because you’re having a dispute with your landlord or you are worried about your ill toddler. How you feel, however, is important because it affects how you should be treated.

Next, the team leader asks if there is anything in particular the team needs to know to work more effectively together that shift: For example, “Is there a delay in public transport so we can expect patients to be late for their appointments?,” or “Is there a patient with some kind of special need coming in?”

Sharing the answers or results generated by the card questions and activities with the group ensures that the insights stick.

That’s it.

This routine might not sound like the makings of a significant advance, but Rotterdam Eye Hospital has experienced some significant improvements in service quality since it introduced the card game in 2015. First, the hospital’s performance on its patient-safety audits has risen, and caregiver job satisfaction has improved substantially, moving from 8.0 to 9.2 on a 10-point scale after staff began playing the game. The nursing home and rehabilitation center reported similar results.

The staffers have observed a variety of other gains as well. For instance, the game has encouraged team members to get to know each other better, and patients are reassured when team members are familiar with each other. (We conducted interviews with staff members in the hospital, nursing home, and rehabilitation center, and conducted an informal survey after the initial exercise.)

“The main advantage for me is that I know who I am working with today. Now I know their names and how they are doing,” one doctor said.

Other staff members gained a deeper understanding of the reasons behind certain protocols. “I now understand the importance of some patient safety measures more, and now I know how I contribute to them,” one cleaning person from the rehabilitation center said.

Finally, everyone gained a deeper understanding of the significance of their own job — not always easy in a centralized organization. “I now feel part of the caregiver team,” one nutrition assistant said. “I know now I am not only providing food but am part of making a patient feel safe.”

The game has also encouraged more sharing between members of the staff, particularly between people who often don’t have very many occasions to talk to each other such as cleaning people and doctors. One case in point: A question from the card game about what someone should do if he or she found medicine lying around prompted a cleaning person to mention that she kept finding pills in a patient’s bed, alerting the doctor to the fact that the patient was not taking the prescribed medicine.

Rotterdam Eye Hospital has also introduced the game to other members of the World Association of Eye Hospitals in the United Kingdom, Australia, and Singapore.

Although the game is not expensive to run, it does require management to do the following:

Design the particular card game you need. The card game must be tailor-made for your own culture and focused on your current challenges. A hospital, for example, might stress medication safety and hand hygiene, while a nursing home might focus on understanding the vulnerabilities of the elderly and end-of-life care. Each patient experience card game consists of at least six themes.

Make a commitment to the game. It won’t work if teams play only some of the time.

Require everyone on the team to participate. The game works because everyone knows that he or she is in the same boat and may be put on the spot tomorrow. And we mean everyone — not only the inpatient and outpatient teams but even people in HR and Finance.

We sometimes act as if health care organizations are big machines. But the fact is that the quality of health care depends ultimately on the collective performance of many small teams. The “team-start” huddle and patient experience card game suggests that performance can improve once we take into account the full perspective and emotional needs of the people who are actually delivering that care. The game is a great first step toward building that awareness.