Where Leadership and Design Meet — The Center for Innovation at SJH

IN CONVERSATION WITH JEN RICKER

Addressing issues ranging from narcotics accountability to nurse burnout, CCU3 Nurse Manager Jennifer Ricker is embracing human-centered design and shares how it has elevated her daily practice as a clinical leader.

Jen’s synergy of design and leadership go hand in hand to address complex healthcare challenges. By putting people at the center of her decision-making process, she exemplifies how human-centered design can be a strategic tool that transforms healthcare experiences, one empathetic solution at a time.

The CFI team spoke to Jen about her experiences using design, including how it helped strengthen interdisciplinary communication, contributing to driving down hospital-inquired infection. Read our conversation with Jen below.

Q: How did you start your career in healthcare?
I’ve been at St. Joseph’s for 14 years. I started my career as a paramedic, and did that for about 8 years. When I decided to go into nursing, I wanted the gnarliest nursing job I could find so I went to SICU. I found surgical traumas to be really interesting.

Overtime, I got a lot of experience working on projects and presenting. I helped open up Seton South, the new step-down unit. That’s where I got my love for project management and honing my leadership skills. My boss Tan invited me to apply for my current role. Shortly after that, COVID hit. I got 9 months under my belt and all of a sudden, we had this massive catastrophic emergency - that was interesting foray into management. Right before that, I got my foray into innovation through a design sprint, which was shut down due to COVID.

Jen presenting her unit’s whiteboards used as a tool to collaboratively track quality metrics.

Q: When did you first learn about design?

In 2019, I was invited to participate in the hospital’s first design sprint. I started learning the tools of innovation there. My group, specifically, was looking at telehealth. Right before COVID! All of it is kind of funny. It was wishful thinking --insurmountable. We were thinking why would anyone want to use telehealth. Some of the foreshadowing was hysterical. COVID hit and our group was disbanded.

Q: When did you first start applying design to your practice?

I interfaced with the former Innovation Director on supporting frontline nurses with housing during COVID. During that time, he was working on developing a micro-sprint, a way to complete a design sprint quickly. Time became really important during COVID because there were so many crises every moment of everyday.

Q: Tell us more about using the design micro-sprint. How did the outcome strengthen your unit’s workflow?

I wanted to try the micro-sprint in CCU3. There was a problem space around rethinking interdisciplinary rounding. Interdisciplinary rounding is when all the different players come together to talk through a patient’s needs. We had to meet the needs of the patients and physicians without making the nurses feel like their time was being wasted.

Jen participating in a design workshop with guest visitors from Beebe Health.

During huddles, we wanted to ensure everyone’s voice was being heard and their time was respected. We started brainstorming, and came up with a huddle that’s evolved and still use today — 3 years later.

Now my assistant manager or I meet with the physicians first thing in the morning to have a high-level briefing about every single patient for the day. We were able to really open up communication, and get the right information to the right people. We recreated the huddle in a way that is purposeful for the workflow of the unit and respectful of the nurses’ time, and frankly, it doesn’t involve them so we were able to take it off of their plate.

COVID showed us time is really precious in a hospital environment. We don’t always have to the time to go through every step of the design process, but we can we quickly figure out what a problem is, talk to people, brainstorm and iterate. It created a fast but meaningful way towards innovation

Q: The huddle has supported some huge quality outcomes. Can you share those with us?

That huddle really strengthened our relationship with the interdisciplinary team and to make sure physicians were on the same board as us. We had a huge push to drive down hospital-acquired infection. To date, it’s been over a year without infection on both sides. It’s really huge in the ICU. The huddle was the way we made sure we communicated with physicians on what we needed, when we changed our plans, and how we take things out causing infection. From a quality standpoint, we use it as a forum to strengthen these quality metrics.

Q: Now you’re using design very regularly in your daily practice. You recently used to work on narcotics accountability. Can you share more about that work?

We were getting reports bringing to light some bad practice that ultimately doesn’t support nurses and puts the organization in a bad position. With narcotics, the really important thing, is you have to administer exactly what the order is– and ensure every little bit of the narcotic file is accounted for. The report brought to life, sometimes, we rush and don’t do all the steps to clearly outline what happened to the medication. We specifically identified our biggest area of weakness is when we have an emergency. We have to get the narcotics out immediately, and we will ask someone other than the nurse to pull it, which creates all these other issues.

Q: Which design tools did you use to help address narcotics accountability?

We wanted to see where exactly the problem was happening. From my experience working with CFI, I decided to journey map. We mapped out the process step by step, identified the key players, and noted the problem areas. I led this and I had a resource nurse, two bedside nurses, our APN and educator weigh in. When we came out of the whole thing what we realized was the problem wasn’t the narcotics. The problem is our communication.

Members of Jen’s team gathered to discuss and build the journey map for the narcotics accountability project. The team used color-coded sticky notes to map out key stakeholders, tension points, and key steps.

We developed a ‘how might we’ problem statement. We ultimately said, ‘How might we optimize team communication during emergencies to promote safety and narcotic accountability?’ Our running solution is early identification of roles and standardization of expectations for roles. We need to ensure the right people are doing the right things and that medication is getting to the right hands. If we can do that, we can slow down these moments of stress that cause our system to break down.

Our next steps are to test this out a bit. We are going to invite the physicians, pharmacists, nurses to create a mock emergency scenario to figure out how we can slow down these moments.

Q: What does a human-centered design approach add to your nursing team and work culture?

During the narcotics project, one of the bedside nurses kept saying my opinion doesn’t really matter. What I said to him was, ‘You’re just the right person to ask about. I want to know what this looks like from your perspective. Your opinion does matter here.’ I went to the Critical Nurse Conference and one of the tenets of healthy work environment is this idea of true collaboration. Innovation has this opportunity to really even the playing field, especially in decision-making in a hospital setting.

Q: What are possible hesitations, or challenges you foresee with nurses or hospital employees adapting human-centered design practices?

Nurses believe in evidence-based practice. It’s our foundation – that’s how we know we are doing the right thing. Innovation can feel outside of our comfort zone for nurses. Both things go hand in hand. I’m finding the more touchpoints I have with the Innovation team and learning human-centered design, it feels natural to use in my daily practice and increases my confidence in using the tools. The practice is hard to describe. It’s hard for some people to grab onto because it’s not concrete but when you start playing with the tools it becomes intuitive.

Q: What can human-centered design and a culture of innovation bring to SJH?

This is really timely for hospital systems. Hospital systems are really strained from different avenues and we can’t sustain doing the same things that we are doing. We need ways to leverage creativity and to think outside of the box. That’s one of the reasons I have invited you guys to be part of the unit.

Q: What has it been like working with the CFI team?

It’s so much fun working with you all. I have learned so much and our collaboration has evolved. Teams have the option to access a whole bunch of services from CFI. Your roles vary from teachers, consultants to partners, which is neat because you can tailor it to the needs of the team and project.