The Goal: Involve nurses and other frontline staff in continually identifying areas for improvement in the quality or patient-centeredness of care, and design and test new procedures to potentially address these challenges.
Why It's Important: A fundamental concept of TCAB is the engagement of frontline nurses and others in the process of generating ideas for improvement. While good ideas from other organizations may create a spark for testing changes, the key processes of care in an individual setting must be adapted for them to become part of the culture and natural practice on a given unit.
How It's Done: The "deep dive" and "snorkel" exercises are valuable sources of ideas that are generated from frontline staff. These exercises are generally conducted at the launch of the TCAB process. It is critical that regular opportunities exist for ongoing input from frontline staff about new ideas for improvement. Often the habits and patterns of work on a unit are passed from experienced nurses to novice nurses. Some of these common practices may represent "work-arounds" to address either long-standing problems or archaic processes.
1. Frontline teams should meet weekly to brainstorm and generate new ideas through:
- Brainstorming or "Snorkel" exercises.
- Adapting strategies from other industries.
- Adapting "best practices" from other hospitals or conferences.
- Conducting site visits at other hospitals.
2. Provide opportunities to redesign work processes to identify and drive out waste and enhance safe, reliable and patient-centered care.
- Methods to enhance regular generation of new ideas include incorporating storytelling into staff meetings, creating a culture in which reporting of near-misses is encouraged for the purposes of learning, and incorporating brainstorming ideas into regular staff meetings. The balance between adapting and implementing proven strategies with the need to enhance vitality through staff-generated ideas is a characteristic of a successful TCAB unit.
- Identifying the biggest complaints often leads to creative new solutions and ideas. Asking frontline staff about some of the biggest challenges they face each workday, then looking for ways to address them, quickly engages staff in problem-solving issues they are most invested in changing.
- Successful sites regularly involve new people in these meetings (including new hires and students) and ensure the group is seen as open to new perspectives. New participants help to generate some of the best new ideas.
- Underscore that this process is not an additional task, but offers a new and different way to improve care processes. TCAB is a proven way that frontline nurses can position themselves as the drivers of quality improvement—rather than having to implement the ideas of others. Nurses who have participated have enjoyed the opportunity to learn and make improvements together.