Rural Oregon Hospitals Implement Frontline Caregiver Program

"The last thing I want to do is try and micromanage great ideas, and this has just been a huge win for us," Francis says of TCAB. "I think it's invigorating for [the staff] because it gives them the latitude to do what they think is right."

Oregon's TCAB program is funded by the Robert Wood Johnson Foundation, as part of its Aligning Forces for Quality initiative, and facilitated by the Oregon Association of Hospitals and Health Systems, which sought out hospitals to participate.

Diane Waldo, director of quality and clinical services for the Oregon Association of Hospitals and Health Systems, says rural hospitals that participate in the program can expect the same benefits as urban hospitals, such as improved patient and nurse satisfaction. But TCAB also offers rural hospitals a boost in nurse recruitment and retention.

"Overall, rural hospitals can probably benefit the most from the business case perspective," she said in an email to HealthLeaders, "[by] not having to address/recruit hard-to-fill nursing positions while struggling to provide optimal quality care."

Francis views programs like TCAB as a way out of a common bind for rural hospitals: their tendency to "contract and hunker down" and reject innovative, risk-taking ideas because of a belief that they should cover only the basics of healthcare.

"I think it's vital that as rural healthcare administrators we have to look at opportunities like" TCAB, he says. Although he acknowledges that not every risk will pay off, he believes "intelligent, well-though-out, viable, and worthwhile risk-taking is incredibly important for rural healthcare leaders."

"This is an opportunity that was afforded rural hospitals through our hospital association," he says. "I just applaud the innovation and the risk-taking nature, and the ability to not just try and maintain the status quo but to really look at improving healthcare delivery in rural markets. And I think that's very critical for the survival of rural hospitals."