title: Engaging Frontline Staff in Performance Improvement: The American Organization of Nurse Executives Implementation of Transforming Care at the Bedside Collaborative.
abstract: BACKGROUND
  Process improvement stresses the importance of engaging frontline staff in implementing new processes and methods. Yet questions remain on how to incorporate these activities into the workday of hospital staff or how to create and maintain its commitment. In a 15-month American Organization of Nurse Executives collaborative involving frontline medical/surgical staff from 67 hospitals, Transforming Care at the Bedside (TCAB) was evaluated to assess whether participating units successfully implemented recommended change processes, engaged staff, implemented innovations, and generated support from hospital leadership and staff.
  
  
  METHODS
  In a mixed-methods analysis, multiple data sources, including leader surveys, unit staff surveys, administrative data, time study data, and collaborative documents were used.
  
  
  RESULTS
  All units reported establishing unit-based teams, of which >90% succeeded in conducting tests of change, with unit staff selecting topics and making decisions on adoption. Fifty-five percent of unit staff reported participating in unit meetings, and 64%, in tests of change. Unit managers reported substantial increase in staff support for the initiative. An average 36 tests of change were conducted per unit, with 46% of tested innovations sustained, and 20% spread to other units. Some 95% of managers and 97% of chief nursing officers believed that the program had made unit staff more likely to initiate change. Among staff, 83% would encourage adoption of the initiative.
  
  
  CONCLUSIONS
  Given the strong positive assessment of TCAB, evidence of substantial engagement of staff in the work, and the high volume of innovations tested, implemented, and sustained, TCAB appears to be a productive model for organizing and implementing a program of frontline-led improvement.
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Needleman
authors.forename: Marjorie L
authors.initials: ML
authors.lastname: Pearson
authors.forename: Valda V
authors.initials: VV
authors.lastname: Upenieks
authors.forename: Tracy
authors.initials: T
authors.lastname: Yee
authors.forename: Joelle
authors.initials: J
authors.lastname: Wolstein
authors.forename: Melissa
authors.initials: M
authors.lastname: Parkerton
mesh_terms: D003299:Cooperative Behavior; D006801:Humans; D007857:Leadership; D009718:Nurse Administrators; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D015279:Organizational Culture; D005791:Patient Care / Q000592:standards*; D017064:Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration*; D014481:United States