A discussion of approaches to transforming care: contemporary strategies to improve patient safety

Abstract

Aim: This article presents a discussion of three contemporary approaches to transforming care: Transforming Care at the Bedside, Releasing Time to Care: the Productive Ward and the work of the Studer Group. Background: International studies of adverse events in hospitals have highlighted the need to focus on patient safety. The case for transformational change was identified and recently several approaches have been developed to effect this change. Despite limited evaluation, these approaches have spread and have been adopted outside their country of origin and contextual settings. Data sources: Medline and CINAHL databases were searched for the years 1999– 2009. Search terms included derivatives of ‘transformation’ combined with ‘care’, ‘nursing’, ‘patient safety’, ‘Transforming Care at the Bedside’, ‘the Productive Ward’ and ‘Studer Group’. Discussion: A comparison of the three approaches revealed similarities including: the foci of the approaches; interventions employed; and the outcomes measured. Key differences identified are the implementation models used, spread strategies and sustainability of the approaches. The approaches appear to be complementary and a hybrid of the approaches such as a blend of a top-down and bottom-up leadership strategy may offer more sustainable behavioural change. Implications for nursing: These approaches transform the way nurses do their work, how they work with others and how they view the care they provide to promote patient safety. Conclusion. All the approaches involve the implementation of multiple interventions occurring simultaneously to affect improvements in patient safety. The approaches are complementary and a hybrid approach may offer more sustainable outcomes.