AONE TCAB Meeting May 16-18, 2011

The city of Minneapolis welcomed 28 AONE TCAB hospital teams last week with sunshine and weather in the mid-60’s – lovely! It was the fourth and final face-to-face meeting for the AONE TCAB hospital teams, who have been on the TCAB journey with us since August 2009. Two hospitals from this AONE TCAB cohort, Abbott Northwestern and Gillette Children’s Specialty Healthcare, opened their doors to us and hosted wonderful site visits for the group on Monday afternoon, the 16th. Both of the TCAB units at these hospitals welcomed us and gave us some behind-the-scenes opportunities to see some newly opened and even some soon-to-be-opened areas. It was a great afternoon for everyone. Thank you to Abbott and Gillette for being such gracious hosts!

At this meeting, we had an array of phenomenal presenters who shared their expertise with the teams. Claudia Perez from the Seton Family of Hospitals in Austin spoke about spread and sustainability of TCAB. Maureen White, Chief Nurse and Senior VP at North Shore-Long Island Jewish Health System in New York, offered an excellent perspective about connecting the work of TCAB with the future of health care and the IOM Report on the Future of Nursing. Rosemary Gibson, author and consultant from Arlington, VA spoke about linking the work of TCAB with the concepts of patient safety and just culture. The nurse managers, who met as a small group on May 18, heard from Deborah Washington, director of patient care and diversity at Massachusetts General Hospital, about the critical importance of diversity and TCAB leadership.

They also participated in a session with Debra Gerardi, RN, JD, MPH, on resolving conflict using engagement and self-nurturing. AONE is truly fortunate to have such a cadre of experts who challenged the teams to think beyond their TCAB unit to some of the larger issues confronting all health care professionals.

Not only was this the final meeting of this AONE TCAB cohort that began in August of 2009, but it was the last meeting where AONE would be using the “TCAB” name. As many of you know, AONE has developed its own program, based on the principles and processes of TCAB, called the Center for Care Innovation and Transformation or C-C-I-T for short, and we have 47 new hospitals enrolled. Applications for the 2012 cohorts will be available Fall 2011 at http://www.aone.org/.

Future Patient Care Delivery Committee: Care Complexity

Concerned about increased patient care safety issues in your workplace? Have you seen a rise in medication errors without an obvious cause? Wondering how you’ll improve productivity and patient outcomes in your newly formed ACO? Have you thought about the science behind that all-too-familiar term “multitasking”?

Complexity Science is a current attempt to understand and explain the behavior and dynamics of systems composed of many interacting elements. Complexity Science studies adaptive systems that contain components in a constant state of change with outcomes that are not totally predictable. This is in contrast to linear methods where change can be measured and predicted. Our nursing practice is both predictable and unpredictable. Dr. Atul Gawande gives a very generalized analogy in his book, The Checklist Manifesto. He says a simple process equates to a recipe. A complicated process, he states, would be one with many linear processes or recipes or checklists added together, like sending a rocket to the moon. A complex process, he describes, is like raising a child -- no recipe is the same for each child!

This is sounding more and more like nursing’s work as our staff are faced with competing goals and priorities, stressful demands, technical challenges, facility design flaws, operational failures, etc. In what ways can we, as nurse leaders, understand the work and design environments of care, respectful of the complex work nurses perform? Many of you have “interruption-free zones” that outline when and where distractions and interruptions are not acceptable. Other examples I’ve heard are: decreasing non-value added services; increasing visual scanning capabilities; and increasing access to timely information. These are all great examples of practice complexity acknowledgement and change at the point of service. What else is happening out there to stimulate innovation and creativity for others related to nursing’s cognitive work and complex practice?

At the AONE 44th Annual Meeting and Exposition last month, Patricia Ebright and Mary C. Sitterding presented their analysis on complexity and how they are studying it through a Cognitive Practice of Nursing model. They would benefit from descriptive feedback on their methodology. Also, the AONE Future Patient Care Delivery Committee encourages you to give us feedback on activities presently occurring in the field.

If you’re looking for additional resources, check out AONE’s 2011 Toolkit for Future Care Delivery with examples to get you and your staff involved in future change.