The top leaders at hospitals involved in the Transforming Care at the Bedside (TCAB) initiative have nothing but praise for it. In the words of Charles J. Barnett, president and CEO of the Seton Family of Hospitals in Austin, Texas, one of the three initial participants in TCAB, "It has been a remarkable experience."
Thomas M. Priselac, president and CEO of Sinai Medical Center in Los Angeles and chairman of the American Hospital Association, said, "TCAB has been one of our most successful organizational initiatives. At its essence, TCAB appeals to the interest of everyone who works in hospitals to take care of patients both more effectively and more efficiently. It is a way to advance an organization's vision around patient satisfaction and employee satisfaction."
Barnett noted that it's not difficult to ask nurses to engage in activities that have the potential for improving the care they deliver. "The response I've gotten from nurses is 'Well, of course! That's what we're here to do: to care for our patients and to continue to find ways to improve care,'" he said.
Barnett added, "From my perspective as CEO, one of the ways to improve patient care is to have the best nurses providing the best nursing care." But, he acknowledged, "It's not just staff nurses. You need excellent nursing leadership. You need a medical staff supportive of excellence in nursing and willing to work with nurses as colleagues. You need an administration committed to supporting nurses and other clinical professionals. And you need a board willing to state publicly that excellence in nursing is one of the organization's most important strategic objectives."
Priselac agreed. "Leadership matters at all levels. At the executive level, there first needs to be agreement on the organization's goals for quality, safety, patient satisfaction, and financial results. Those in executive roles-the chief executive officer, chief operating officer, chief nursing officer, and chief medical officer-need to see TCAB as a viable strategy to achieve the organization's objectives. But I firmly believe that it's the level managers who hold the key to success, because they sit at the intersection of the institution and its goals and the folks who are doing the work. Finally, both physicians and nurses who do the work on a day basis must view TCAB as an important driver of success for their organization," he said.
In Priselac's opinion, TCAB brings to the forefront the leadership capabilities on each unit. "Anything that helps an organization identify where and how management needs to be strengthened is good for the overall health of the organization," he said.
To illustrate the importance of leadership on the unit level, Priselac observed, "TCAB has been spread throughout all units of my hospital-and we're a large organization, almost 1,000 beds. Many units were excited about getting involved in TCAB. Where there was trepidation, the staff weren't clear that this was a new way of operating, as opposed to a project of the month. Once they understood that this was a way we want to conduct our operations on an ongoing basis, that TCAB was not just a 'flavor of the month,' their concerns went away."
Laurie Lewis
freelance medical writer, New York City