Understanding TCAB's Four Focus Areas

    • June 4, 2008

1. Safe and Reliable Care (Reliability)

Care for hospitalized patients is safe, reliable, effective and equitable.

Safe and reliable care hinges on a culture of safety where people are not just encouraged to work toward change, but to take action whenever necessary. A hospital is able to improve safety only when the leadership is visibly committed to change and when staff is empowered to openly share safety information. Organizations that do not have such an open culture often find staff members unwilling to report adverse events or unsafe conditions because of concerns of reprisal.

Because of their proximity to patients and the direct care they provide, nurses and other frontline staff are uniquely capable of identifying and implementing process improvements that could result in safer, more reliable care.

Tip: Examples of safe and reliable care include: reducing medication errors and adverse drug events, establishing rapid response teams and preventing inpatient falls.

2. Vitality and Teamwork (Vitality)
Effective care teams continually strive for excellence when they work in a joyful and supportive environment that nurtures professional training and career development.

Vitality can be facilitated by formal and informal leadership. Team vitality starts when teams are allowed to work on issues relevant to their success. Effective teams work together and get great results. The mindset of effective teams is that they must act in ways that make excellent work possible, sustainable and satisfying. They are always looking for ways to improve their work. Teams with strong vitality strive to reduce or eliminate blame, name-calling, cynicism, conflict and apathy. Developing a process for improving care and teamwork greatly increases team vitality by improving how the team acts and interacts.

Tip: Examples of vitality and teamwork include: optimizing communication among team members, engaging frontline staff, personal and team recognition and incorporating management and professional development programs for staff.

3. Patient-Centered Care (Patient Centeredness)
Truly patient-centered care on medical and surgical units honors the whole person and family, respects individual values and choices and ensures continuity of care. Patients will say, "They give me exactly the help I want and need exactly when I want and need it."

Patient- and family-centered care is essential to cultivating a partnership at the bedside in making decisions, healing relationships and facilitating interactions between the individual patient/professional. A key aspect of patient- and family-centered care includes health care practitioners listening to and honoring patient and family perspectives and choices, including beliefs and cultural backgrounds. Sharing complete, unbiased information between health care providers and patients and families should be affirming and useful. Encouraging patients and families to participate in care and decision-making is important.

Because patients and their families spend most of their time with nurses and other frontline staff—and often express their preferences, expectations and frustration with them—nurses are in a great position to help ensure that the care a hospital provides is as patient-centered as possible.

Tip: Examples of patient-centered care include: involvement in the discharge process, adjusting medications to the patient's schedule, sitting for a few minutes with each patient at each shift, being pain free and having daily information regarding plan of care, schedule of tests and prognosis.

4. Value-Added Processes (Lean)
All care processes are free of waste and promote continuous flow.

Developing lean operations requires distinguishing value-added and nonvalue-added steps in every process. Commitment to a lean organization must begin with leadership and become a part of a culture that is receptive to and rewarding of lean ideas. Staff should be involved in helping to redesign processes to improve flow and reduce waste.

Because nurses and other frontline staff spend so much time in activities that take away from the amount of time they have to spend in direct patient care, they are well suited to identify processes that increase leanness in a unit.

Tip: Examples of value-added processes include: application of lean strategies such as space redesign and having all needed equipment at the bedside at all times. Also, use of cell phones to reach staff where they are.