Caregivers always are looking for ways to improve the quality of care their patients receive, but achieving results often can be difficult.

UAB Hospital is one of 32 in the United States participating in a two-year project to identify, develop and disseminate a set of practical, easy-to-use tools to help redesign and improve health-care delivery processes. Faye Williams, right, is the nurse manager on W9N and leader of the project for UAB.
The challenge of providing safe, reliable, efficient, timely, patient-centered care in medical and surgical units is compounded by shorter patient stays and complex technologies. Adding to the stress is an ever-expanding range of new therapies for clinicians to incorporate, greater patient diversity and mounting paperwork. In many hospitals the chaotic, inefficient work environment on medical and surgical units contributes to high nursing-turnover rates.

UAB Hospital is one of 32 in the United States participating in a two-year project to identify, develop and disseminate a set of practical, easy-to-use tools to help redesign and improve health-care delivery processes.

The American Organization of Nurse Executives (AONE) is sponsoring Trans-forming Care at the Bedside (TCAB) with a $1.5 million grant from the Robert Wood Johnson Foundation.

Velinda Block, chief nursing officer, worked with other UAB nursing leaders to submit an application for the grant. The W9N hematology-oncology unit is UAB Hospital’s pilot unit for the grant. The group’s focus is to improve health care in four areas: safety and reliability, joyful and supportive work environments, patient-centered care and value-added work. Faye Williams, the nurse manager on W9N, is the leader of this project for UAB.

Williams recently spoke to the UAB Reporter about the progress made and the goal of the project from UAB’s perspective.

Q. How does TCAB differ from other quality-improvement programs?
A. This initiative is designed to help nursing staff have quick wins. There is a slogan that asks, “What can you do by next Tuesday?” It encourages the staff to generate ideas quickly and test them, knowing that there’s always work to be done. The general length of time is six weeks versus several months for traditional quality improvement projects.

Q. What is staff response to setting the pace for this project?
A. Overwhelming at first, but exciting. They have felt more ownership in the unit and have seen their ideas lead to very positive changes. The key is sustainability, which requires a strong team that’s willing to own the process and see it through.

Q. Where are the staff particularly interested in developing innovative solutions?
A. The greatest areas of interest are staff communication and patient safety. We continually monitor data such as falls, patient satisfaction and medication errors. The staff would like to implement electronic white boards at both the nurses’ station and in the patient’s room to help improve communication. That has not yet become a reality, but we are in the beginning phase of implementing Vitals Link. It is a device that will feed the patient’s vital signs directing into the IMPACT/Cerner system at the time this data is obtained. This provides quicker feedback to all those involved in the patient’s care.

Q. How are the innovations tested?
A. They use the PDCA method (Plan, Do, Check, Act). They also use a method called “Adopt, Adapt, Abandon.” After ideas are generated and a plan is formed, they quickly test their ideas. Data is gathered via survey from other staff members pre- and post-implementation. Initiatives are accepted, modified or abandoned all together.

Q. If successful, how are the innovations implemented?
A. Successful initiatives are implemented through staff education. This also will include physicians and patients if necessary. New processes are communicated, often requiring a culture change for staff.

Q. How important is teamwork and collaboration?
A. Effective teamwork and collaboration are essential to transforming care at the bedside. We must have everyone’s help to make a safer environment for our patients.

Q. Does TCAB appeal to nurses?
A. I think the appeal is that staff have the opportunity to make a difference in the way they care for patients. These initiatives come from them, not the nurse manager or director. They are able to see positive changes, such as a safer environment and increased patient satisfaction and know that they are the reason that the change occurred.