Leadership Guide to Patient Safety

The Goal

Convince hospital executives to fully support efforts led by nurses and other frontline staff to increase the quality and patient-centeredness of care—while also increasing job satisfaction and retention.

Why It's Important

All transformation requires leaders who are engaged and supportive. Many improvements can occur within an individual unit, but at some point capital costs or interdepartmental issues will require support from senior leaders. Once a unit leader or staff nurse generates unit-level interest for improving quality and transforming care, he or she can begin to gather information to win the backing of organizational leaders.

How It's Done

Understanding how TCAB activities can affect core measures like safety indicators and staff turnover rates help sell TCAB to management.

1. Begin a discussion with senior leadership about engaging frontline staff in improving the quality of the care experience for patients and staff. Highlight that the program can positively affect core measures important to management.

Measures to consider for discussion include:

  • staff turnover rates
  • safety indicators
  • comparative scores on key quality measures relevant to the unit population
  • patient satisfaction scores.

Some hospitals have found it helpful to provide hospital data on turnover and preventable errors. Focusing on how TCAB can help reduce errors, improve retention and increase the time nurses spend at the bedside has been most convincing to administrators.

Initial push-back from leadership often is that a new initiative would involve additional cost. Since TCAB involves small tests of change, these small improvements: build confidence in staff that change is possible, help serve as the tool of empowerment itself, and take little to no money to make the improvement.

Another initial concern frequently expressed by leadership is that there is not enough time to allot for frontline nurses to participate in these activities, and the hospital cannot afford to be involved in another quality improvement program. TCAB hospitals emphasize that the initiative doesn't require much added time, but is a technique to adopt to make current work and meetings far more productive. The TCAB process provides a systematic, empowering approach to solving challenges that nurses are already facing and trying to address.

Tip: Show leadership how the most popular small innovations have been adopted by other hospitals and that cost is minimal. (For successful interventions, see Section 4, Chapter 2: Innovations That Work)

TIP: Getting the support of the most senior nurses early has proven to be key in making the program a success and leads to support from other nurse leaders. Approach the senior nurse as a first priority.

2. Emphasize that the program can measure the impact of improved processes of care on both quality and cost of care.

Many of the process redesign elements of TCAB, including the application of “lean” techniques, result in waste reductions which can be quantified as cost savings and improved efficiencies for nursing time.

3. Align the potential outcomes of TCAB to the organization's strategic vision to focus the support of leaders.

Linking TCAB to the hospital's mission connects the unit-level transformation activities to the overall vision of the organization. Many TCAB hospitals have a frontline nurse (along with his/her nurse manager) present their progress directly to members of the hospital's senior-most leadership. Seizing opportunities to report on how TCAB is creating solutions to problems earned support from the leadership and energized frontline staff. At many TCAB hospitals, stories first told by staff nurses became the success stories most often repeated by administrators, because they illustrated the changes being made and showed how staff vitality was improving.

Video Series

Engaging Staff and Senior Leadership

June 2008. Paul Hanson, CEO, Prairie Lakes Health Care System, talks about his experiences with engaging staff and senior leadership to fully support efforts led by nurses and other frontline staff to increase the quality and patient-centeredness of care—while also increasing job satisfaction and retention.

See more RWJF videos

Most Requested