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.
"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."
Alexandra Wilson Pecci is an editor for HealthLeaders.
