At a division meeting, providers filled a whiteboard with 36 sticky notes — each one a frustration slowing them down. A broken light. A missing drink in the lounge. A fridge too small for a clinical team.

These were the pebbles in their shoes, and the division of emergency medicine at Children’s Wisconsin had just launched a new practice to remove them.

Project Pebble helped increase provider engagement from the 54th to 71st percentile in 12 months.

A measurable gap

Project Pebble was born from a simple observation: the person who experiences a problem and the person with the resources to fix it are rarely the same.

That gap — between frontline experience and institutional resources — is where provider frustration lives. And frustration, left unaddressed, erodes the engagement and well-being that pediatric care depends on.

Division Administrator Andrew Schuette encountered this gap years earlier as an administrative fellow at another hospital.

One morning, he attended a vice president leadership huddle. That afternoon, he worked alongside the food and nutrition team delivering meals to patients on the trauma floor. The contrast was striking — the bedside problems were invisible in the boardroom.

He committed to closing that gap.

At Children’s Wisconsin, the opportunity was measurable. While the division of emergency medicine’s overall engagement sat at the 54th percentile, the question “Do I have the tools and materials to do my job?" registered at just the 28th percentile.

Something specific was getting in the way.

Starting small, building trust

Schuette and Division Chief Amy Drendel, DO, brought the question directly to providers, distributing sticky notes and asking a simple question: what is the pebble in your shoe?

The whiteboard filled fast.

The team applied an impact matrix to sort each of the 36 pebbles by effort and impact, deliberately targeting easy wins first to build momentum. Fixing office lighting. Stocking Diet Mountain Dew in the provider lounge.

These were small fixes, but they sent a clear signal: Leadership was listening, and things were changing.

The harder pebbles required partnerships and more creative problem-solving. The nursing team was already working on many of the same issues, but no one had communicated this to the division. By inviting nursing leadership to share their progress, the clinical teams eliminated duplicated effort.

Refrigerator space became one of the most tangible wins. With over 100 team members sharing a single fridge, providers had no reliable place to store food during long shifts. The division and nursing leadership partnered with facilities to secure funding. It required electrical rewiring and sustained advocacy, but providers now have a place to store a meal.

Other resolved pebbles improved the clinical experience: provider stools in every room, a call room cleaning schedule, on-time learner starts, improved ED room cleaning, and more.

Leadership could not solve every problem, but it could demonstrate that every pebble was worth taking seriously.

Results that speak

At the end of the first year:

• Twenty pebbles were resolved.
• Engagement climbed to the 71st percentile.
• The “tools and materials” question rose from the 28th to the 46th percentile, an 18-point gain.

In 2025, the division ran a second round with Suzanne Seo, MD, serving as clinical lead and discovered something unexpected. Providers surfaced entirely new pebbles. Removing the first layer of friction revealed the next.

This reframed the entire initiative: Project Pebble is not a one-time fix. It is an ongoing practice, built on consistent habits: Soliciting pebbles at huddles, closing the loop individually with every provider who raises an issue, and sharing results transparently so trust compounds over time.

Project Pebble is expanding to critical care, genetics, nephrology, and more. The gap between those who experience problems and those who can solve them is not unique to any one division. It exists across every unit, every team, every specialty.

The pebbles will always be there. Removing them is what makes the difference.