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Rad Idea: Pebbles: A Strategy For Team Engagment

By Mario Pistilli


In the March 2020 issue of ICE magazine, I wrote about the concept of a flowing stream as an allegory for leadership and that in our leadership journey there are pebbles and sometimes boulders that block our stream. The pebbles in our way impede us from achieving our best results. For a technologist those pebbles may take the form of equipment needs, staffing needs or process improvement needs. It is the accumulation of these pebbles, rocks and boulders that lead to frustration and reduced engagement.

Sometimes they led to the acceptance that “it’s just the way things are around here.” One of the other team member concerns that often shows up on surveys is around the desire of employees to have a voice and a say in decisions. Staff members want to be heard and can add tremendous value to decisions. To combine these two concepts, we instituted a “Pebbles List” and a monthly “Pebbles Meeting” for each department at Children’s Hospital Los Angeles (CHLA).

The “Pebbles List” is a spreadsheet we developed in which we elicited answers from staff to the following question: “What are all the things (pebbles) in the way that slow you down or prevent you from doing your best?” We had these conversations repeatedly – either one-on-one or in groups. Also, many ideas came from working side by side with our teams and seeing what they went through on a daily basis. The (pebbles) issues fell into some broader categories by which we organized our list: equipment, staffing, IS, roles and workflows. The spreadsheet also contained a column to list the specific issue: who was responsible, status and due date. We learned some very interesting things from staff in each of these categories. Under equipment, for example, the staff said we don’t have a wheelchair compatible scale in radiology and must hunt for one when it is needed. I asked why nobody said anything previously and they said that they thought we couldn’t get one. This was an easy one and we ordered the scale right away. Of course, staffing is a more complex issue to solve. You likely cannot just add full-time employees (FTEs) but not everything is always really about FTEs. We learned some of the pebbles were around having the right staff allocated at the right places and times. So, we instituted three-times-a-day staffing huddle to reallocate staff where it is needed based on how the day is going. This item was also an opportunity to openly communicate with teams regarding the constraints and difficulties in finding candidates. 

The “Pebbles Meeting” was attended by any staff that could rotate in and out and was a chance for staff to get updated on the status of items as well as contribute potential new items. The meetings turned into a great mechanism to help hold me and my managers accountable to work on items as we knew we would be reporting out to staff on progress. We decided as a group during the meetings what should make it to the list for us to work on and did not put one-time things or personal staff issues on the list but only those things that were frequent and had a wide impact. Items that did not fit that were best dealt with on an individual basis. Some of the more complex issues, such as department staff scheduling issues, were given to volunteer staff workgroups to find their own solutions with their leader. For example, the radiology staff was unsatisfied with the call schedule and a group was given the task of devising a method for call scheduling. The workgroup members did an amazing job of finding their own solution.

The “Pebbles” concept turned into a great way for us to communicate more effectively, be accountable, solve problems and improve engagement. The list is visible to everyone, and it has seemed to energize some and show that they really do have a voice. The meetings show that we really can remove some of the obstacles in the way of providing the best care. •

Mario Pistilli is the administrative director, imaging services at Children’s Hospital Los Angeles. 

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