Releasing Time to Care at Squamish General Hospital & Richmond Hospital

This award was formally named “Getting Better”. Our Excellence in Quality category names changed in 2020 to reflect the updates to our BC Health Quality Matrix. Visit our Categories and Criteria page to find out more.

Since April 2012 Squamish General Hospital and three nursing units from Richmond Hospital have been implementing a program called Releasing Time to Care™ to improve the reliability, safety and efficiency of care delivered to patients. The program has six goals:

1. Improve teamwork among staff
2. Decrease interruptions and work flow inefficiencies
3. Improve direct patient care time
4. Improve patient satisfaction
5. Decrease patient adverse events and infection rates
6. Demonstrate financial efficiency

Releasing Time to Care™ (RT2C) is a rigorously tested quality improvement program that has shown international success for empowering staff to build measurement and to drive change into their everyday work. It is a structured framework that uses Lean principles and puts patients and providers at the centre of the changes that are needed to transform a culture.

Ward Leaders were identified among frontline staff and dedicated one day per week to champion the program’s implementation. They established a “Knowing How We’re Doing” board to create a focal point where staff could directly track measures and discuss improvement ideas and actions, and promoted the use of simple visual management tools including safety crosses and measles charts for staff to mark incident-occurring or incident-free days and to identify location of clusters of the incidences they were tracking. Staff bring up improvement ideas during daily team huddles and dot-voting surveys capture responses to action ideas.

Since implementing RT2C, two of Richmond Hospital’s nursing units have shown a 29% average decrease in patient falls. A “well organized ward” (WOW) model led to activities in decluttering, relocating supplies and equipment which reduced waste and edited redundant nursing processes. Collectively, the various WOWs that each unit undertook have led to 663 hours nursing time saved per year which translates to 55 extra nursing shifts. Even meal tray delivery times were shifted to allow patients more time to finish their meals, resulting in better nourishment and less food waste.

Bedside whiteboards are available for every patient and help patients and families stay up-to date with their care and be involved as much as possible. Average patient satisfaction survey results on one Richmond Hospital nursing unit increased by 4% to 44% in four dimensions. At Squamish General Hospital, patients report increased satisfaction with receiving information about medications for home, participating with decisions around their own care and being treated with dignity and respect.

The success has prompted Vancouver Coastal Health to develop an improvement system encompassing both Lean and RT2C methodologies to continue to spread the great work across the organization.

The RT2C team has developed an in-house basic training day for new Ward Leaders and developed a site tour package that showcases the work of the RT2C units. The tour sees a steady stream of monthly visitors from various sectors of health care. It has also been included in the observership program for the UBC chapter of the Institute for Healthcare Improvement Open School.