Start small, test, then if it works, go big

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Start small, test, then if it works, go big

< 1 minute read

St. Rose iterates on different ideas and solutions on a small scale until the idea is tested and reliable.

The Issue

When we first began the program, we really had no idea where to even begin. We didn’t have the resources to implement new EMRs or hire new staff like many other hospitals were doing, so we felt stuck.


St. Rose is a non-profit hospital in Hayward, CA. It has 217 beds and serves a diverse, low-income population including Spanish, Hindi, and Tagalog speakers. Their transitions program began in 2012 and is influenced by Project RED.

What We Tried

Our program coordinator was a big believer in small tests of change and our hospital is small enough that we have the ability to experiment with many of our processes. Our whole program has been developed through a series of small tests of change. We try something, see if it works, modify if needed, then when it has proven useful, we go big.

Our red notebooks, for example, started as just the leftovers from our marketing department. They had a couple hundred extra notebooks that they were going to throw out, so we took them and gave them to patients to write down their questions for their care team. Patients loved them and kept using them even after they were discharged. When we noticed that they often asked us for the medical record number to give to the primary care physician, we added that information to the front sheet of their notebook when we first gave it to them. Once we saw that the system worked well, we ordered a thousand more notebooks and have been using them ever since.

We followed the same process with pillboxes and a risk assessment form. We tried a version of pillboxes with a few patients, modified it based on how well it worked, and ultimately stopped using them because we concluded they weren’t that helpful. However, with the risk assessment form we kept iterating and modifying it and still use it today.


Testing ideas at a small scale lets us make the best use of our available resources, i.e. people, time, and money. We can test many ideas, refine the better ones, and only implement the best ones. Starting small has been the key to our success at St. Rose.

Organizational Background

Organization Name: St. Rose Hospital

Location: St Rose Hospital, Calaroga Avenue, Hayward, CA, United States

Organization Type: Hospital