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Rural Oregon Hospitals Implement Frontline Caregiver Program

 |  By Alexandra Wilson Pecci  
   September 28, 2011

Duane Francis knew he had to give a frontline caregiver program a shot when his chief nursing officer first brought it to his attention.

"It was right in our wheelhouse," says Francis, CEO at Mid-Columbia Medical Center in The Dalles in sparsely populated central Oregon. "I loved how simple it was and how direct and immediate and effective I thought it could be."

Now Mid-Columbia Medical Center is one of eight hospitals in the state that have worked with the Oregon Association of Hospitals and Health Systems to implement the Transforming Care at the Bedside (TCAB) program over the past few months. TCAB is a nurse-led hospital improvement program from the Robert Wood Johnson Foundation that engages frontline staff in improving patient care over an 18-month period.

Mid-Columbia's nursing staff launched the program by brainstorming ideas for process improvement, then voting on and prioritizing the best ideas. Since implementing the program in July, the staff has focused on patient days without falls, created an information board in the breakroom highlighting current pressure ulcers, initiated bedside handoffs during shift changes, and used lean methodology to reorganize three storerooms.

Although the program aims to improve patient care, it also helps increase nursing satisfaction and a feeling of ownership among staff, which Francis views as equally important.

TCAB "has been such a morale enhancer because of that ownership component," he says. "You have nursing staff coming up with the ideas; you have your colleagues that are endorsing it…it wasn't any edict that came from on high."

Responsibility for the program is squarely on the nursing team's shoulders, which works well for Francis, who says he encourages his executive team to act like "mini-CEOs" in running their own departments.

Francis describes his role in Transforming Care at the Bedside as "being supportive and critically involved" by evaluating whether the hospital is achieving the program's aims, while leaving the implementation to the staff.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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