PIT BOSS Pit crews focus on improving different aspects of your facility and help build teamwork throughout the staff. Here are members of the Certification Pit Crew at Shands Hospital at the University of Florida Health System.

If your nurses complain about not having enough autonomy and say in how your facility is run, here's an idea that will give them the authority to implement real change — all while cutting down on the number of meetings you must preside over. Create "pit crews," small groups of staff members who focus on improving a specific aspect of your facility. We have 9 pit crews in place at our hospital. Follow our lead or develop groups that would work best for your needs.

• Party Pit Crew decreases daily stress and increases teamwork and camaraderie. This group recently planned our holiday party for more than 100 guests from the department and organized last month's bowling outing.
• Certification Pit Crew promotes nurse certification, which includes providing educational resources, notifying staff of exam dates and organizing review classes. The review sessions and pre-test they recently coordinated encouraged our staff to get certified, built their confidence and ultimately led to an all-time high of 39% of our nurses achieving certification.
• Environmental Pit Crew improves the organization of equipment and supplies to optimize the efficiency of patient care and workplace comfort for patients and staff. This group recently decorated windows and walls with large glossy landscape pictures of local springs. They're currently working on redesigning the supply room and revamping anesthesia crash carts to make supplies more accessible during emergencies.
• IT Pit Crew improves the accuracy and efficiency of electronic charting and acts as a resource for nurse training. They recently worked on the department's flow sheets to improve patient charting, suggested upgrades to current electronic forms and worked with IT to make the appropriate changes.
• Peds Patrol Pit Crew provides resources for staff on all topics related to the care of children and improves the organization of pediatric supplies in the PACU. They've developed a newsletter to keep staff constantly updated and recently redesigned a pediatric supply cart to ensure needed supplies are always at the ready and easy to find.

• Education Pit Crew provides staff with resources and updates on new equipment, policies and procedures, and safety checklists. They're currently working with anesthesia to provide weekly in-services for the nursing staff.
• Patient Safety and Infection Control Pit Crew created a form that staff fill out if they want leadership to address potential safety concerns that haven't yet resulted in a reportable event. The department's safety officer meets weekly with the anesthesia medical director to review and address issues raised by the crew.
• Efficiency Pit Crew facilitates patient flow throughout the perioperative area. They recently came up with the idea to have a staffer serve as "trail boss," who helps transport patients and informs staff along the way about their condition and special needs.
• Patient Satisfaction and Quality Improvement Pit Crew ensures patient needs are met and quality assurance goals are attained. The group recently addressed concerns about our ability to get patients into the OR on time. They obtained data and made changes based on their findings that have reduced wait times and improved patient satisfaction scores according to recent surveys.

Making it work
One staff member serves as the pit crew's driver. She leads the team, communicates with the surgical manager (me, at our hospital), and helps implement the ideas her team develops. Leadership skills, a desire to be mentored and a sincere interest in making change happen are important attributes for drivers to have. If you think someone would make a great driver for a particular crew, suggest she volunteer to run it.

The drivers recruit their own 5-to-7-member crew. People tend to migrate toward what they're good at and their areas of interest, so it's relatively easy to find fits for most members of your team while creating a crew.

Every staff has its overachievers, middle-of-the-road types and Steady Eddies who want to perform their regular duties without going above and beyond. The long-term goal is to have every staff member serve on at least 1 crew each year. Participation shouldn't be required, but consider making sitting on a crew a yearly goal that's part of annual performance evaluations. If a few staffers complain that none of the crews fit their interests or personalities, don't hesitate to develop one that does.

Make it a priority to schedule an hour or so away from bedside nursing each month so pit crews can meet. Also structure time during the regular workday for a crew to complete special projects they propose, such as redesigning the supply room. Giving them time to meet and implement change is key to making this system's success.

You'll be rewarded with a staff who appreciates making meaningful contributions to the accomplishments of your facility. Working on a pit crew gives them ownership in the changes they suggest, which means the improvements are easier to make and more likely to stick.