When the Robert Wood Johnson Foundation announced four Maine hospitals were among the 16 facilities in the nation to participate in the first two cohorts of the Aligning Forces for Quality: Transforming Care at the Bedside Co-llaborative (TCAB Collaborative), Rosemary C. Henry, MS, RN, vice president of nursing/chief nursing officer at St. Mary's Regional Medical Center, Lewiston, ME, wasn't surprised.

"When the 'call' for grant participation came to hospitals and health systems across the country, the Maine Aligning Forces for Quality played a strategic role in our selection success because they identified the state of Maine as a healthcare community," she said. "So when each Maine hospital submitted proposals to be part of the initiative, we were recognized as part of a health community, not individual hospitals seeking participation in the project.

"This strategy places a critical mass of Maine hospitals in the front of the pack leading healthcare improvement across our state and across the country."

Changing Med/Surg Cultures

Pat Camire, MSN, RN, NEA-BC, vice president for nursing and clinical services/chief nursing officer at Southern Maine Medical Center in Biddeford, explained why nurse leaders and clinicians are excited about the collaborative.

"TCAB provides us with the tools needed to change the culture within the nursing unit, since it empowers nurses at the bedside to identify issues and make decisions regarding how to improve those issues that are directly related to patient care," Camire said. "It gives nurses at the bedside permission to become assertive and confident in their ability to make clinical changes that reflect excellence in patient care and also heightens other hospital departments' response to requests from nursing staff under the umbrella of TCAB."

TCAB encompasses four focus areas:

• patient-centered care;

• value-added processes;

• safe and reliable care; and

• vitality and teamwork.

"The initiative is primarily dedicated to the med/surg units, in part because med/surg units tend to be the areas where most of our patients are admitted, and it has historically been a specialty that has not been recognized," Camire said. "The TCAB initiative has given the med/surg nurses the attention they deserve in recognizing their ability to be successful agents for change within the hospital setting."

A Different Perspective

For Jennifer Fogel, RN, manager of nursing systems at Eastern Maine Medical Center, Bangor, TCAB came along at just the right time.

"We have been implementing change in nursing care and systems for a long time, with a great emphasis since 2000," she said. "Our efforts have resulted in a lot of changes in terms of electronic documentation, patient satisfaction and other key issues. We love TCAB because you do reach a point where you're looking for more ways to get your messages across to staff as you introduce improvements."

Since Eastern Maine Medical Center's parent healthcare system, Eastern Maine Healthcare System, has a goal of being the best rural healthcare system in the state by 2012, Fogel and her colleagues have been looking closely at patient safety with a goal of zero preventable errors.

"The TCAB initiative allowed us to choose issues, and we chose four: falls, pressure ulcers, nosocomial infections, and increasing nursing time at the bedside," she said. "These issues are not new and they're not unique to our health system, but TCAB gives us the tools to look at them in a different way. If someone has already achieved something good, why should we try to re-invent the wheel?"