Red light, yellow light, green light, GO!

A few years ago, the Neonatal Intensive Care Unit (NICU) at my former hospital came up with what I thought was a brilliant initiative focused on nursing staff wellbeing.  Basically, at the end of every shift, each nurse would place a colored ball (red, yellow, or green) into a jar by the main desk.  The red-colored ball indicated that the shift was very stressful, while the green-colored ball indicated that the shift was not stressful at all (the yellow-colored ball signaled that the shift was somewhere in the middle of those two extremes).  The unit leadership collected and counted all of the colored balls to get an idea of how stressful the shift had been for the unit as a whole, which they then used to retrospectively look at other key factors, such as the unit census (total number of patients), acuity (how critically ill all of the patients were during that shift), and staffing levels (how many nurses were working that shift, how many patients each nurse had been assigned, etc).  

Admittedly, the system that the NICU leadership had created provided a good retrospective view of the shift, but it could not have been used to adjust staffing levels or increase the number of manager check-ins and leadership rounds during that actual shift.  I filed away the NICU's initiative as something to consider for the future, but to be honest, the retrospective nature of the system of colored balls limited its widespread application to other inpatient units.  

I was reminded of this same NICU initiative after recently coming across a blog post about using a similar system during leadership check-ins (see Chad Dickerson's blog post, "The magic of the personal check-in: Red, yellow, green").  Here, meeting participants kick off every meeting (whether a 1:1 meeting or group meeting) by stating at the outset how they are feeling at that particular moment.  As Dickerson writes, "Red means you are having trouble focusing, you're extremely distracted, and/or you're feeling distressed.  Green means you are feeling good, focused, relaxed, and ready for any discussion.  Yellow is somewhere in between."

Dickerson explains why this simple "trick" works so well, stating, "The reason that the red/yellow/green exercise is so powerful is that it can quickly create a space of psychological safety that helps teams do better work.  It's also quick and simple.  You don't need to hire expensive consultants or take personality tests or get a special certification."

Participants don't have to explain why they are feeling Red, Yellow, or Green.  Rather, just by stating how they are doing at a particular moment in time creates a sense of authenticity, vulnerability, and humility, which in turn helps build psychological safety and engenders mutual trust.  There is perhaps no better way to build trust within a group or team than by individual members being vulnerable and honest.  

Incidentally, Dickerson references a Harvard Business Review article ("How One Hospital Improved Patient Safety in 10 Minutes a Day").  The article was written by Roel van der Heijde and Dirk Deichmann and presents a very similar initiative developed by leaders at Rotterdam Eye Hospital.  Prior to the start of every shift, team members would "huddle" together and rate his or her own mood as red, orange, or green.  The team leader then asks if there is anything that the team needs to know to work more effectively together that shift.  Lastly, the team leader assigns two staff members to each draw a card.  One card has a safety-related quiz (e.g. "What are the five steps in hand hygiene?"), while the other card asks the person to observe something during the shift and share his or her findings during the next day's team huddle.  Of particular interest, Rotterdam Eye Hospital claims that this routine has resulted in an improved safety culture, improved patient safety performance, and increased staff engagement and wellbeing!

What I particularly like about all of these similar initiatives is that they are so simple and easy to use.  As Dickerson suggests, they do not require specialized certification or training and can be easily implemented.  Incidentally, I am feeling particularly "green" today!  Now it's time to go!