Oregon Hospitals Using the “Transforming Care at the Bedside” Program


Here is an article from HealthLeaders Media about the Transforming Care at the Bedside  program: “Rural Oregon Hospitals Implement Frontline Caregiver Program.” TCAB is a program that's similar to the UK NHS program called Releasing Time to Care  where nurses are taught how to analyze and improve their own work.

Eight hospitals in Oregon are implementing this programmatic approach to Lean-based improvement, engaging nurses and front-line staff.  Similar to the approaches in our upcoming book  Healthcare Kaizen, “Although [TCAB] aims to improve patient care, it also helps increase nursing satisfaction and a feeling of ownership among staff.”

Also from the article:

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.

As with Kaizen, engaging staff in improvement certainly improves morale, which leads to other improvements. Masaaki Imai wrote in his seminal 1986 book KAIZEN  that the primary focus should be staff enthusiasm and engagement. Other approaches to improvement typically focus on ROI, or Return on Investment.

Again from the article:

Although the program aims to improve patient care, it also helps increase nursing satisfaction and a feeling of ownership among staff, which [CEO at  Mid-Columbia Medical Center] Duane  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.”

Francis rightfully emphasizes that he, as CEO, doesn't micromanage improvement ideas in the hospitals. TCAB (and Lean and Kaizen) require the full engagement of nurses and other staff. They can fix things. They can redesign processes, given basic Lean training along with some time to make improvements happen.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


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