Background: Lean management tools have proven effective in achieving high reliability in health care. Local Problem: Unstructured leader rounds, decentralized prevention bundle repositories, and unfavorable patient experience outcomes prompted leaders on a thoracic and cardiovascular surgery unit to find other methods to address these issues and positively impact outcomes. Methods: Nurse sensitive indicator prevention bundles, root cause analysis tools, and best practices were used to develop Kamishibai Cards (K-Cards) for each measure targeted. Interventions: K-Cards were implemented to standardize processes, engage patients in their care, and promote staff identification of barriers and solutions. Results: Nurse-sensitive indicators and patient experience metrics were positively impacted by Kamishibai Rounding. K-Cards promote a state of continuous improvement, which supports sustainability of evidencebased practice and best practices that were implemented. Conclusions: K-Cards use high-reliability principles to standardize nursing practice to promote quality outcomes.