AONE TCAB in Phoenix

The AONE TCAB Learning Community of 32 hospitals met face-to-face in Phoenix, Arizona yesterday and today.  For those of us coming from places where there was snow on the ground (and a lot of it!), Phoenix’s sunshine was a beautiful respite from the cold and it rejuvenated and energized all 170 attendees.  This was the second face-to-face meeting for this group of hospitals and this agenda was quite different from the first meeting, where the teams  took in a lot of new information from outside experts.  Yesterday and today, the information that was shared came from the teams themselves, all of whom brought story boards on one of their innovations, as well as small cards with information about their innovations that they shared with and collected from each other.  Also, fifteen of the teams were randomly selected in advance of the meeting to do oral presentations about one of their innovations. 

In addition to all of the information that the teams shared with each other, we were joined yesterday by Phil Authier, RN, MPH, Partner/COO of EdgeWork Institute, for a 3 hour workshop on concepts of culture transformation.  The teams were engaged by Phil’s interactive presentation as he offered a variety of perspectives on changing individual and organizational culture through work in caring using engagement, presence, beliefs and intent. 

The teams also completed the Thomas Killman conflict mode exercise that showed them how they handled conflict.  Were they competitive or compromising?  Were they accomodating or avoiding?  Pam Thompson led the teams through a discussion of the variety of modes and what each meant and in which situations they would be useful.  The teams also discussed their results among themselves in their own teams in order to get to know each other better and how each handled conflict. 

The teams also had a chance to do a small group exercise called the speed huddle, which is based on the speed dating concept.  The teams broke out into small groups and within the small groups, they had 5 tables to visit, with each table having a different discussion topic about team vitality for the group to discuss for 6 minutes.  After 6 minutes, the teams switched tables and moved on to the next topic.  During each session at each topic table, one person wrote down the ideas that were generated by that group and AONE will be compiling the results of all the ideas to share with the teams.  We weren’t sure how this exercise would work with such a large group, but it turned out great and the teams had a lot of fun.  

Thanks to all the teams for their excellent story boards and a big thanks to the 15 teams who did some fantastic oral presentations!  It is always exciting to see and hear the progress the teams are making, and the ideas and tools with which they leave Phoenix today will come in very handy as they rejoin their colleagues at home and continue the innovation work of TCAB.

AONE TCAB Blog from Chicago – Day 2

So,  here I am at the end of another long but truly satisfying day of non-stop action, conversation, questions and learning.  We started the morning checking in with all of the teams to tie up any lingering questions they had from the previous day.  Then, it was on to rapid cycle tests of change and the Plan/Do/Study/Act (PDSA) process, which is another fundamental part of TCAB.  Barbara Farrell shared her expertise with the teams and led them through the different steps, asking them to take their design challenge from the day before and practice going through a rapid cycle test of that design challenge.  After going through the exercises, we had some teams come up and report on how they would rapidly test these innovations and design challenges – rapidly being the key word.  The idea with TCAB is that you don’t take your idea to a committee or to a group who will belabor all of the pros and cons and perhaps never take action.  Instead, you propose it to the team and you start small: one nurse, one patient, one shift.   It was clear from the excellent presentations that the teams definitely “got it” — they understood the concept and the process.  By the way, did you know that there is such a thing as glow-in-the-dark markers?   Well, one of the teams is going to be purchasing these as part of one of their tests of change, and wow – I know what is on every single one of the teams’ to-do lists right now:  FIGURE OUT WHERE TO BUY GLOW-IN-THE-DARK MARKERS ASAP.

After a break, Cindy Liberi from UPMC’s Center for Quality Improvement and Innovation spoke to the group about creating high level change using the 5S method.  The 5S method helps to identify waste in your work environment and there are 5 steps that Cindy described:  Sort – identifying what you want to keep and what needs to go; Set in Order – “a place for everything and everything in its place”; Shine – this is a nice way of saying “make it clean and spotless” so yes, it does involve a dust rag and some Pledge (or any other favorite cleaning/dusting agent); Standardize – making sure that everyone knows where exactly things belong and labeling spots for all items; and Sustain – keeping things clean and orderly not just for the day or the week but constantly and consistently and having staff take ownership of the work and the processes.  For TCAB, these 5S changes could apply to one of the main things that nurses tend to identify as an area needing change: hunting and gathering for supplies.  If this is an issue on your unit, the 5S methodology seems like a great way to address it.  Plus, did you know that you can use “5S” as a verb?  For example: The nurses on the night shift 5S’d the nursing station last night and now I can’t find anything!! 

Jill Fuller, CNO and interim CEO of Prairie Lakes Healthcare System in Watertown, South Dakota kicked off the afternoon with a look at what she and her team of nurses have been discussing over the last few years regarding the future and that we will not have enough nurses to care for patients.  So, what would happen if there was only 1 nurse left standing in the hospital?  Jill had some great ideas of what her team has dreamed about but also, she shared what she and her team have implemented that has impacted the care of patients and is paving the path to what their future will eventually look like.   Jill also spent some time with us talking about what she and the TCAB team have put in place in order to increase time in direct patient care.   If you’ve never heard Jill speak, she is a provacateur extraordinaire and it was great to have her push some buttons, so to speak, and push at some of our barriers when thinking about the future of nursing care.

Becky Pomrenke and Barb Farrell finished the afternoon with presentations about interventions for pressure ulcer prevention and preventing harm from falls.  Becky and her TCAB team at USA Medical Center have a very detailed program in place and they continue to test new ideas and seek better ways of preventing and caring for those patients at risk of or who have developed pressure ulcers. 

Pam Thompson closed the day with a look back at some of the themes that she discussed on Monday morning to connect the many tools and pieces of information they had received yesterday and today.  Pam asked that they return to their hospitals not as rockets, who go up fast and then come down crashing and burning, but as the Space Shuttle, re-entering the earth’s atmosphere with a flight plan and a definitive landing place.   

Congratulations to the new 32 AONE TCAB teams who made it through an information and action-paced two days with us.  And a huge thanks to all of our presenters who made TCAB come to life for these teams and gave them so many excellent tools for their journey.

AONE TCAB Blog from Chicago, IL – All aboard!

Day one of our two-day kick-off and training meeting with 32 hospital teams from all over the United States has come to a close, and what a day it was!  We started our meeting this morning with a presentation from AONE’s CEO, Pamela Thompson, who gave our more than 200 hospital staff attendees an excellent overview of TCAB and how it aligns with the AONE strategic mission and vision.   Maureen White, Senior Vice President and Chief Nurse Executive of the North Shore – Long Island Jewish Health System, followed Pam and gave an excellent overview of her hospitals’ experiences with TCAB and how TCAB has become part of their health system’s strategic plan.  Her personal anecdotes made everyone laugh and assured them that though TCAB may still be a “great unknown”, with perseverance and hard work comes success.    A favorite set of quotes from Maureen’s presentation when talking about the need for vision and action and “not standing still” were:  “Vision without action is hallucination.” and  ”Action without vision is chaos.”   So, with TCAB, there has to be both – vision AND action, which lead to innovation and transformation.

For the rest of the day, the teams learned the “snorkel” process for identifying innovations.  They worked with their hospital teams and identified challenges and brainstormed “wild and crazy” ideas that could put their plans into action.   The room was abuzz with energy and conversation  and anyone could see that the team members were really into the whole process and seemed to be enjoying the freedom to create and think and work together.   The snorkel was expertly led by Barb Farrell, AONE Director of Quality & Innovation and she promised more of the same for tomorrow when the teams will learn the ins and outs of rapid cycle tests of change.

The day’s work concluded with an overview of the data collection that will be required as part of this TCAB journey. Becky Pomrenke, a staff nurse from the University of South Alabama Medical Center in Mobile, which was one of the AONE TCAB hospitals part of the AONE RWJF project, was able to allay firsthand some of the anxieties the teams had about the data and measurment requirements, so we are really glad that Becky will be with us again tomorrow to share more about her hospital’s experiences.

One of the highlights of the day for me was seeing how many teams continued their TCAB conversations long after the meeting ended, including during our end-of-the day reception.  Thanks for a great day everyone!