The Effect of Transforming Care at the Bedside Initiative on Healthcare Teams’ Work Environments

Abstract

TCAB is an intervention that allows healthcare teams to implement change to improve patients' and families' outcomes. Ongoing energy should focus on how to improve communication among all members of the team and ensure their support.

Systematic review of interventions to improve nurses’ work environments

“…Despite the specific intervention intent to address nurse autonomy, Aitken et al's (2011) use of participatory approach and Meraviglia et al's (2009) accreditation process failed to improve this outcome. No change was similarly observed from two other studies that measured nurse autonomy (Gardner et al, 2009;Lavoie-Tremblay et al, 2014).…”

“…The above studies were implemented for 21 months (Lavoie‐Tremblay et al., 2014) and 4 years (Van Bogaert et al., 2017) which could have contributed to the exhaustion and exposed the evaluation to history effect. Despite the lack of reports of higher workload in Lavoie‐Tremblay's study (2014), the study observed difficulty among their participants and credited this to the intervention's bottom‐up approach and described difficulty in implementation of their planned changes due to competing priorities and imposed organizational changes throughout the almost 2 years of intervention. Likewise, the Productive Ward Program (Van Bogaert et al., 2017) underscores the effect of exhaustion of study participants, where highly statistically significant increase in nurse reported workload and poorer quality of care between T1 and T3, which the authors attributed to staff budget reduction and concurrent accreditation processes running between T2 and T3 creating competing priorities.…”

“…Long interventions periods may have contributed to additional workload to participants. The above studies were implemented for 21 months (Lavoie-Tremblay et al, 2014) and 4 years (Van Bogaert et al, 2017) which could have contributed to the exhaustion and exposed the evaluation to history effect. Despite the lack of reports of higher workload in Lavoie-Tremblay's study (2014), the study observed difficulty among their participants and credited this to the intervention's bottom-up approach and described dif- Eight studies were able to demonstrate that the combination of critical components of the intervention strategy, conceptual focus, and implementation design is effective in improving outcomes.…”

Effective Strategies to Spread Redesigning Care Processes Among Healthcare Teams

“…It gives the TCAB team other perspectives and enables it to jointly identify areas of improvement and test new ideas. For changes to be effective in practice, the perspectives of both healthcare providers and patients should be considered, and patients should be committed to the change (Lavoie‐Tremblay, O'Connor, Harripaul, Biron, Ritchie, Cyr, et al., ).…”

An evaluation of National Health Service England's Care Maker Programme: A mixed‐methods analysis

“…Internationally, a prominent example of change driven by individuals is seen in the TCAB initiative in the USA, which seeks to impact upon patient care by encouraging effectiveness, efficiency, transformational leadership and teamwork (Robert Wood Johnson Foundation, ). Evaluation revealed improvements in patient safety (Robert Wood Johnson Foundation, ) and improvements in communication, not only between healthcare professionals themselves but also in their interactions with patients (Lavoie‐Tremblay et al., ). Securing the necessary resources, including staffing, and adequate preplanning were seen as critical factors in the potential success of such initiatives (Osman & Nolan, ).…”