When a nurse comes to Jackie with an idea, her response is always the same:  "Did you put that in KaiNexus?"

That's it. No form to fill out. No meeting to schedule. No waiting to see if it goes anywhere. Just a question that tells staff exactly what's expected and gives Jackie the visibility to make sure the idea doesn't die.

Jackie became the nurse manager of the ICU at Mary Greeley Medical Center in September 2024. In the twelve months that followed, her 30-person team logged 57 completed improvements in KaiNexus. Twenty-one came in the last three months alone. On the day they presented their work to colleagues across the hospital, 14 improvements were active, and 7 more were awaiting assignment. One of her nurses thought of another idea in the middle of her presentation, and guess where it went?

Yep, into KaiNexus.

Ron Smith, Mary Greeley's Performance Excellence Director, opened the session with this: "We really haven't seen the success in any department like we've seen with the ICU recently." At an organization that has been running continuous improvement since 2013 and won the Malcolm Baldrige National Quality Award in 2019, that's not a small statement.

Why a High-Performing ICU Team Still Needed a Better System

Jackie walked into a high-performing unit. Experienced staff. Strong culture. People who genuinely relied on each other. Her director's advice was to hire great people and get out of their way.

She took that seriously. But she understood it differently from most leaders. A high-performing team still needs somewhere to put its ideas. Without a system, those ideas stay informal. A frustration gets mentioned at the end of a shift, someone nods, and three months later, the same frustration comes up again.

Getting out of the way meant building the infrastructure first, not assuming it was already there.

The Four Leadership Behaviors That Drove ICU Improvement Culture

Jackie didn't launch an initiative or announce a program. She made four specific changes to how she leads.

Every new hire submits at least one improvement in their first 90 days. She tells them this at their first meeting together. New hires are the freshest eyes on every process they touch. Treating that as an asset rather than something to be socialized out of them turns onboarding into a source of improvement.

When staff bring her an idea, her first response is always the same question. It keeps ideas from staying informal. It also means that when an idea feels familiar, she can search KaiNexus across the entire organization to see if another department has already solved it. Often, one has.

Highly effective ratings on annual reviews go only to staff who have completed an improvement. Improvement is part of the job description. The review process says so.

She brings Whitney Johnston, their KaiNexus partner, to department meetings to report out engagement data: who has submitted recently, and who has been most active. The data is visible to the whole room, making the competitive element real and intentional. After every meeting, Jackie would go back to her computer and watch new submissions come in.

Real Examples: Frontline Staff Improvement Ideas That Stuck

They don't look like improvement projects, but things that were bothering people.

Brenda, an ICU nurse, had spent months walking past the kitchen to retrieve a mug from a closet on the other end of the unit, then walking back to fill it. She submitted the idea. Within a week, the mugs were in the kitchen. That quick win changed how she thought about the system. She went on to design a family brochure for the ICU with everything visitors always asked about: visiting hours, the cafeteria, and what to expect. Housekeeping puts it in every patient room. She brought it to the patient experience council. The ER built its own version. Brenda looked at theirs, found things she wanted to improve, and revised hers. One submission. Three units.

Cat, the charge RN, found that the oral care kits the unit had been ordering were being discontinued. Rather than sourcing a replacement, she looked at what was already in stock and worked with stores to order the components individually. The result: $8.65 saved per patient per day.

Eva redesigned the signage outside comfort care and palliative patient rooms after noticing it was often covered by open doors and unfamiliar to float staff and lab techs from other units. The new sign uses plain language, explains what it means, and sits where all staff already know to look. For patients in the final stage of their care, anyone walking into that room without context can disrupt something that took careful work to create.

None of these required a fishbone diagram.

What 57 Completed Improvements Actually Mean for a Care Team

Ron closed the presentation with the observation that explains it: people resist being changed, but they don't resist the change they're involved in.

When staff have a system where ideas have somewhere to land, a manager who follows through, and visibility to see their work recognized, the ideas come. KaiNexus gave Jackie the infrastructure to manage all of it. To see what was moving. To close what was complete. To find what another department had already figured out.

Mary Greeley has been building this culture since 2013. Jackie's ICU is what it looks like when a unit-level leader fully takes it on.

If your team has ideas that aren't making it into the system, or improvements that stall before they close, that's the problem KaiNexus is built to solve. See it in action.