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Abstract

Background: The Transforming Care at the Bedside (TCAB) project engages frontline health care providers as the leaders of change and improvement efforts in their work environment. This study explored how health care providers and managers from three TCAB units in a university-affi liated health care center perceived the development of their change capacities following their involvement in this program. Method: This descriptive, qualitative study involved focus groups and individual interviews. Results: Participants learned to work as a team and to expand their outlook. They had access to processes and tools to learn new skills. New relationships also developed among the various players, and they shared new roles, which enabled them to translate the desired changes into action and make the results visible. Conclusion: The study showed the TCAB program helps develop health care providers’ and managers’ change capacities.

As the nursing shortage escalates, improving the efficiency of the nurse’s workflow is becoming increasingly important. According to Runy (2008), the best way to address this issue is to ask nurses about the efficiency challenges they confront in their work environment, create work environments that facilitate communication and teamwork, and minimize wasteful work. The pace of rising care expenditures is not sustainable and demands an improvement in the network’s performance and the reestablishment of balance in public finances (Government of Quebec, 2010). Within this context, strategies must be identified for optimizing effective practices and eliminating waste to reduce costs within a reasonable period of time (Grossmeier, Terry, Cipriotti, & Burtaine, 2010; McGhan et al., 2009). One such strategy developed by the Institute of Healthcare Improvement (2014) is the Transforming Care at the Bedside (TCAB) program. TCAB engages frontline staff in leading process improvement efforts aimed at enhancing value-added work processes, patient outcomes, and work environments (Hassmiller & Bolton, 2009). Through TCAB, nurses develop core skills that enable them to change the work they perform (Thompson, 2009). Despite evidence supporting thevalue added by the TCAB program, little evidence exists about managers’ and health care providers’ perceptions regarding the development of their change capacities.

BACKGROUND

Initiated in 2003, the TCAB program was developed through a partnership between the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement (2014). The TCAB program was created to promote changes originating at the point of care as well as to engage frontline staff in developing innovations and changes directly aimed at improving work processes and patient care. The framework underlining the TCAB project is largely based on Rogers’ theory of innovation (1962, 2003), which suggests that the diffusion of an innovation is influenced by four elements: the innovation itself, the communication channels, the time required for the innovation–decision process, and the social system. Also according to Rogers’ theory of innovation, the adoption process occurs through five stages: first exposure to innovation (knowledge), increasing interest in the innovation (persuasion), acceptance or rejection of the innovation (decision), implementation and test of the innovation, and a final decision (confirmation). Thus, the TCAB project engages frontline staff in the development and spreading of innovations that will provide improvement to work processes and patient care. Since 2003, more than 81 hospitals throughout the United States have been involved in the TCAB program, and the program has spread to other countries as well (Needleman & Hassmiller, 2009), including Canada. The TCAB program has five foundational elements where change is targeted (Institute of Healthcare Improvement, 2014): ● Safe and reliable care. ● Vitality and teamwork. ● Patient-centered care. ● Value-added work processes. ● Transformational leadership. The aim of the TCAB program is to encourage frontline staff and hospital leaders to initiate changes that will lead to improvements in these five domains. The TCAB program has been found to facilitate positive results for a variety of reasons. It creates a work culture that promotes improved performance and value-added activities (Bolton & Aronow, 2009). It further encourages frontline staff to use their knowledge and experience as well as to work as teams to identify, implement, and test changes that will likely lead to improvements. Reviews of hospitals and nursing units participating in the TCAB program showed that a large number of innovations were suggested, adopted, and spread, resulting in patient care improvements and high vitality and teamwork among staff (Needleman et al., 2009; Pearson et al., 2009). The TCAB program represents a powerful mechanism for improving the human capital of a health care organization (Dearmon et al., 2013). The TCAB program encourages frontline staff to adopt new roles and new responsibilities, allowing them to become the drivers of change in their units. The hope is that by encouraging nurses and managers to identify, implement, and test changes that could improve their work practices and environments, they will intrinsically accept and eventually spread these changes. As suggested by Mintzberg, Ahlstrand, and Lampel (1998), changes must occur in an organization’s culture, its modes of functioning, and long-term competencies. These are the elements that should be improved first to initiate and sustain change. Thus, to facilitate changes, an organization should move from a culture of “change management” to a culture of “capacities for change” (Rondeau, 2008). Rondeau (2008) described changes in organizations as a learning or evolution process, which suggests that to develop change capacities, all members of an organization must have access to the competencies, tools, and resources that make changes possible. It is important to explore change capacities as they contribute to an organization’s ability to successfully implement and sustain change. Research in this area can generate new evidence contributing to an understanding of how best to transform work processes (Dearmon et al., 2013). The aim of this study was to describe managers’ and health care providers’ perceptions of the development of their change capacities with the TCAB program in a university-affiliated health care organization.

 

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