TCAB  HOW TOPointsforSuccessfulEnculturationofTCABonyourunit….

Southern Maine Medical CenterBiddeford Maine 

5th largesthealthcareproviderinMaine

LargesthealthcareproviderinYorkCounty

150‐bedlicensedcommunityhospital

MS3:32bedmedsurg/oncologyunit

RN’s:43,CNA’s:21

RN/Ptratio’s:4‐5days;5‐6nights

AveragedailyCensus:23

BeganTCABMarch2009

So we’re from the “other” Portland….

ErinBradford,RN,BSN:ms3.eab@smmc.org

MindyMondoux,RN,BSN:ms3.mmm@smmc.org

Our TCAB Journey

RN’sspendingmajorityoftimeDocumenting Multi‐step

processtospeakwith

MD’s

Staffworkingsingularly,

poorawareness&teamwork

Hiding &Hunting forequipment

Gopheringforsupplies

Nolunchbreaks

CNA’sworkingalone

Assignmentssplitbetween

wings

MS3 Before TCAB

What Happened?

TCABtraining

SNORKELS

PDSA,testsofchange

PortablephonestocallMD’s

PODsystem

2CNA’seachPOD

SafetyHuddles

Assigned/BuddyIntentionalRounding

EquipmentParkingSpots

Eliminatednon‐valueaddedtasks

CoveringlunchbreakswithineachPOD

NewDocumentationScreens

Suppliestothebedside

PatientWhiteboards

EstablishedUnitCouncil

First StepsMS3 Original Aim Statements

• Measure:Fallwithinjuryrate

1.ReducefallswithinjurytoZERObyDecember31st 2009

(SafeandReliableCare)

• Measure:TimeMotionStudy

2.IncreaseNursestimeatthebedsideby25%byDecember31st 2009(ValueaddedCare/PatientCenteredCare)

• Measure:PatientSatisfactionscores

3.IncreasePatientSatisfaction(willingtorecommendedSMMC)to80%HCHAPS

and96%withAvatarby12/31/09(PatientCenteredCare)

• Measure:TCABTeamVitalitySurvey

4.IncreaseTeamVitalityby20%by12/31/10(TeamVitality/Teamwork)

Snorkel!

TCAB LingoTestofChange=Initiative=Innovation=ProcessImprovementProject

PDSA=Processandstructuretoguideyourtestofchange

Snorkel=Brainstormingsessiontogenerateideasfortestsofchange

Measure=Methodyouwillusetojudgethevalueofyourtestofchange.Canbequalitativeorquantitativedata:

StaffSurveys,PatientSatisfactionResults,TimeMotionstudies,fallrates,etc

RingofKnowledge=SmallcardhighlightingatestofchangeyouwishtosharewithyourcolleaguesatTCABface‐to–facemeetings.Everyonecollectsthemasawayto“stealshamelessly”

Storyboard=PosterpresentationforTCABface‐to‐facemeetings

Project How To:

StaffGeneratedIdea

PDSA

AssignProjectLeader

EducatedStaffonChange

SettimeforEndoftest

EvaluateStafffeedback

MeasureOutcome

Adopt,AdaptorAbandon

Meetings

Meetingsweeklyatfirst

Thenbi‐weekly

Nowmonthly

Callinsystem

Things You’ll Need:

Facilitator,scribe

Agenda

Meetingminuteswithactionplans

AssignaleadertoeachtestofchangeandPDSA

Timeforstafftoattend

Setmeetingdate&time

Bribewithfood

Our Unit Council:

Keeping Everyone in the LoopYou will need MULTIPLE 

ways to inform your staff of changes….

Emails

StaffMeetings

Posters

Flyersthroughoutyourunit

Bulletinboards

Postitsonlockers

UpdatesonPaystubs

Newsletters

FacetoFaceCommunication

MandatoryEducationalInservices

Our Biggest Success….BulletinBoardintheBathroom!

Quick WinsGopheringList

“Whatwouldyoueliminatefromyourday?”

CommentBox

VotingPosters

Badgecardwithfrequentlyusedphonenumbers

“Whatmakesagoodday,whatmakesabadday?”

Expectations&OwnershipDocument

PeerInterviews

QuietZone’sforMedicationPreparation

DischargeFollowupPhoneCalls

Stumbles in the Road

Poorstaffing

HighCensus

Poormeetingattendance

Non‐compliancefromstaff

BurntoutTCABers

Staying on TrackPositivepeople!

Administration&ManagerSupport

CelebrateSuccess

Haveparties,giveprizes,staffrecognition

OffsiteRetreats

Leadbyexample

PostDataResults,PDSA’s

Don’tbeafraidtoAbandon

Protected“ProjectTime”

Recruiting the “T‐CRABS”Engagethemwithsimpletasks:posters,bulletinboards

TurnComplaintsintoactionplans

Alwaysbringitbacktopatientcare….

Moststaffarehappytohelpandbeinvolved,theyjustneedaninvitation

TCABisanopportunitytoimproveyourworkenvironment,improvepatientcareandincreasejobsatisfactionthroughYOUR ideas.Noideawillgoun‐noticed,everyonewillbeinvolved.Wewilltryeverythingbecauseyouhavethebestideastoimproveourunit.

NewSystem:Ideas

generatedfromthe“bottom”

OldSystem:Ideasforcedfromthe“top”

Lessons LearnedTCABisnotanyONEthing.Itisaphilosophy,aculture,awayoflife.

Don’texpectMiraclesovernight

Changetakestime,culturechangetakesevenlonger

There is nothing wrong with change, if it is in the right direction-Winston Churchill

The key to change... is to let go of fear.” –Roseanne Cash

To improve is to change. To be perfect is to change often. — Winston Churchill

Be the change you want to see in the world.-— Mahatma Gandhi

It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change. -Clarence Darrow