Improving Hospital Performance Metrics in 10-Minutes a Day

ESO Staff

Rotating shift schedules can sometimes work against a hospital staff tasked with providing high quality care and patient safety for long hours at a time, with team members they may not know well. From physicians to nurses all the way to facilities and cleaning staff, each team member plays a part in ensuring that patients are safe and satisfied. If you are working with a new staff member for the first time, or don’t have much time to interact with specialized providers – like nutritionists, for example – it may be more challenging to establish a rapport and function with an optimized working relationship.

The Team-Start Process

So how can a hospital staff fast forward that getting-to-know-you phase with a special emphasis on patient safety? One hospital in The Netherlands instituted a simple and easy 10-minute procedure that has yielded excellent results in the three years since they begun. The Rotterdam Eye Hospital, the largest provider of ophthalmic care in The Netherlands, created a simple card game, conducted at the start of each shift during a brief, staff-wide “huddle.” During the short meeting, two staff members would draw a card from a special deck of cards that featured questions or tasks focused on patient safety.

Step 1: Self Assess

Inspired by seeing an airline staff conduct a quick pre-flight huddle, the hospital card game creators asked themselves why a health care staff couldn’t have a similar pre-shift meeting to ensure everyone knows each other and is properly focused. Upon returning to their home facility, the creators outlined their own “team-start” procedure, which begins with each team member giving him or herself a color rating that reflects their current mental state. The choices are

  • Green (“I’m good”),
  • Orange (“I’m okay but I have a few things I’m concerned about”)
  • Red (“I’m under stress”).

The creators explained that there is no need to explain the cause for your rating, but it is important to share with the team members because it can impact the entire team and affect how you should be treated during the shift.

Step 2: Prepare for the Day

After this brief time for introductions, the team leader takes a moment to ask if there is anything in particular the team needs to know to work more effectively together that shift, such as, “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?” These questions ensure that all team members are mentally prepared and on the same page for the day or night to come.

Step 3: Integrate Education

Finally, two team members are selected to draw a card from the specialized deck of cards. The deck of card includes two types of topics – either a patient safety question to be answered during the meeting, or a task to be conducted during the shift and shared back at the next day’s meeting. Since the meeting ideally includes as many staff members working on the shift as possible – including cleaning staff and any office members – it creates the ideal opportunity for all staff to better learn and understand the value of patient safety standards.

Included questions might be, “List the five steps in hand hygiene,” or “State the most common errors that can occur when medication is prepared.” An observation task might be: “Observe your colleagues and decide who contributes most to the working atmosphere,” or “Observe your colleagues and report back on how well they follow hand-hygiene procedures.”

When conducted with a positive learning-focused attitude, the card game promotes communication and motivates all team members to focus on high standards of patient care during the shift, and understand the role each plays. Additionally, the questions allow all staff members to better understand the reasoning behind certain procedures and open the channels for communication. For example, a cleaning staff member may share that he or she is consistently finding medication left in a patient’s bed, alerting the nursing staff to the fact that the patient has not been taking it as they believed.


The hospital has seen significant improvements in metrics since they established this simple “team-start” process in 2015. It reports that its 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.

Pro Tips for Healthcare Leaders

Game creators stress a few important reminders for other hospitals wanting to institute a similar card game:

  • Create a game that is customized for your facility, staff, and specialties. Focus on the particular areas of improvement most needed for your situation, and be sure to update the cards on a monthly basis.
  • Commit to your team-start every shift, every day. The game will only yield great results if it is conducted with consistency.
  • Require everyone on the team to participate. Knowing that you may be selected at any given time, regardless of your job function, encourages everyone to be engaged and aware of standards and job performance. No one should be excluded from participation or expectations.


According to the game creators, taking into account the emotional needs and full perspective of those delivering care is a key element in improving team performance across the board. Taking a few minutes to proactively focus on team needs and ensure all are aligned can make each shift more enjoyable and effective, benefiting patients and caregivers alike.

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