Getting patients home efficiently is more than a metric — it is a key part of safe, timely and patient-centered care. A clinical nurse leader, or CNL, and assistant unit director, or AUD, on the Rush medical observation unit built a tool to reduce discharge order-to-exit times and boost staff engagement by celebrating nurses who meet the unit’s 90-minute discharge goal. The tool titled the GOALBall Machine turned a discharge goal into something visible, engaging and motivating.
Before the project began, the unit’s average discharge order to patient exit time was 130 minutes, well above the 90-minute goal. While staff understood the importance of timely discharges, engagement around this metric was limited. The team wanted a new, low-cost approach — one that would recognize effort, build teamwork and connect actions to broader patient-flow goals.
Launched in June 2024, the GOALBall Machine is a simple paper display that resembles a gumball machine. Each time a nurse discharged a patient within 90 minutes of the discharge order, they wrote their name and date on a paper “GOALball” and placed it on the display. Over time, the board filled with colorful reminders of success.
Behind the scenes, the CNL verified discharge times in the electronic health record to ensure accuracy, while the AUD coordinated the rollout and helped personalize monthly prizes based on staff preferences. Recognition, including monthly shout-outs and small celebrations, keeping motivation and friendly competition high without adding cost or complexity.
The GOALBall Machine also encouraged collaboration. Nurses worked more closely with providers, case management and transport teams to ensure patients were ready to leave promptly.
Meaningful Results
The results were meaningful and sustained. After the GOALBall Machine was introduced, the average discharge order-to-exit time improved to 112 minutes by Nov. 2025, a 14 percent reduction that saved about 18 minutes per patient. These improvements were sustained for 18 months, demonstrating that this creative improvement drives measurable and lasting improvement.
Today, the GOALBall Machine remains active on the unit, with ongoing data collection to support continued improvement.
The GOALBall Machine shows how shared leadership and creative thinking can turn routine data into motivation — supporting patient flow, strengthening accountability, teamwork and advancing nursing excellence.