Developing solutions from the ground up

3 minute read

Developing solutions from the ground up

< 1 minute read

Anyone on Peninsula Circle of Care transitions team can write concerns and suggest solutions on a public board that’s reviewed every other week.

The Issue

Transitions is such a new field that there are no best practices, really. We are constantly trying new approaches and running small tests of change. As a program manager, I can be a little separated from the day-to-day challenges that our staff face. Staff can also often feel intimidated to bring up any concerns they have in our team meetings. I wanted to create a forum where they could feel comfortable voicing their concerns and take ownership for solving them.


Mills Peninsula is a non-profit hospital in Burlingame, CA that has partnered with the Palo Alto Medical Foundation and Peninsula Family Services to develop the Peninsula Circle of Care program. The hospital has 241 beds and serves a primarily elderly population (average age of 81) living alone with 90% on Medicare. Peninsula Circle of Care, their transitions program, began in 2012 and is influenced by the Care Transitions Program and a community based model.

What We Tried

We implemented a 4-blocker, which is a Lean process-improvement tool. It’s essentially a board divided into four sections: “suggestions,” “analysis,” “let’s try it,” and “parking lot.” Anyone can put thoughts into the suggestions section and every two weeks we review the board as a team. We discuss each of the new issues and decide who will take ownership of the issue to do the analysis. Whoever does the analysis then brings back suggestions and we either try them out or put them in the parking lot.


It’s a great way to get everyone involved in the development of our transitions program. The questions, concerns, and suggestions are all coming directly from the staff and we have open conversations about each of them. We can also see progress being made as concerns get analyzed and turned into ideas that we try and ultimately implement if they’re successful.

The biggest impact of this process is that it empowers our staff. The board is always public, so they can add issues at any point—and, seeing their peers voice concerns gives them the confidence to speak up as well. Since everyone is involved in discussing the concerns and developing solutions for them, it’s easy to spread new practices. We have since implemented 200+ changes.


It may take weeks before staff feel comfortable expressing their ideas for improvement. Keep encouraging them to post up ideas. Once they see their ideas are being addressed, they are likely to post more ideas.

Organizational Background

Organization Name: Mills Peninsula Hospital

Location: 1501 Trousdale Drive, Burlingame, CA 94010, United States

Organization Type: Hospital