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Increasing value-adding patient care by applying a modified TCAB program

Tuula Antinaho (Department of Nursing Science, University of Eastern Finland, Kuopio, Finland and Central Finland Health Care District, Jyväskylä, Finland)
Tuula Kivinen (Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland)
Hannele Turunen (Department of Nursing Science, University of Eastern Finland, Kuopio, Finland)
Pirjo Partanen (Department of Nursing Science, University of Eastern Finland, Kuopio, Finland)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 12 September 2017

Issue publication date: 19 October 2017

436

Abstract

Purpose

The purpose of this study is to evaluate a development process aimed at increasing registered nurses’ (RNs) working time use in value-adding patient care by applying a modified Transforming Care at the Bedside (TCAB) program at inpatient units of two tertiary hospitals.

Design/methodology/approach

Basic data for the development process were collected on RNs’ working time use via external observation in 2011 (RNs = 113). Nursing work was redesigned and implemented by 12 multi-professional teams during 2012-2013. The development process was evaluated by repeating the collection of RNs’ working time use data in 2013 (RNs = 95) and by analyzing the memos of the development teams via deductive content analysis (N = 64).

Findings

RNs’ working time use showed statistically significant increases in value-adding care and direct patient care but decreases in non-value-added work and miscellaneous work. Changes in the nursing work model, division of labor and the nursing work environment all affected RNs’ working time use.

Practical implications

The development process progressed distinctively in each unit, as shown by the results of the development work. Clinical RNs had key roles as innovators and change agents, yet the engagement of nursing managers was most essential for the success of the development work.

Originality/value

Even minor changes in nurses’ daily work profile can have considerable effects on RNs’ work. The TCAB program was shown to be a useful method in developing RNs’ work also in psychiatric units.

Keywords

Acknowledgements

The authors wish to thank the RNs and their managers in the Central Finland Health Care District and the Päijät-Häme Social and Health Care Group for their willingness to participate in this study. Special thanks to Biostatistician MSc Tuomas Selander from Kuopio University Hospital’s Science Service Center for his guidance in the statistical data processing. The university committee on research ethics granted ethical approval for the study (IRB No 3/2012). Consent to carry out the research was obtained from the participating hospitals. RNs and other participating professionals were informed of the study and its voluntary nature.

Citation

Antinaho, T., Kivinen, T., Turunen, H. and Partanen, P. (2017), "Increasing value-adding patient care by applying a modified TCAB program", Leadership in Health Services, Vol. 30 No. 4, pp. 411-427. https://doi.org/10.1108/LHS-11-2016-0061

Publisher

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Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

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