October 5, 2026
Host
Welcome to At the Bedside, a Covenant Medical Center podcast about better handoffs, better conversations, and better care. I'm your host, Charon, and today we're talking about what it takes to make bedside shift report stick in real clinical work. We'll look at the system around the nurse. We'll keep it practical and honest.
Guest
This series explores how bedside shift report can strengthen communication, support teamwork, and bring patients and families into the conversation about their care. We're looking at the implementation side now, not just the bedside behaviors. Implementation is where good ideas meet real life. That's the focus of this episode.
Host
Because better care happens when we work together. And that means the system around the nurse has to work, too. We have talked about what frontline nurses do. We have talked about what charge nurses observe and coach. But there is another question. What has to happen around those nurses for bedside shift report to actually stick? That's the implementation question. It's about making the practice dependable. It's about the conditions that make good practice possible.
Guest
That is the implementation question. A good idea does not become reliable practice simply because a tool exists or because education occurred. It has to survive contact with real clinical work. Reliability comes from the workflow, not the wish. And that takes intentional design.
Host
So the implementation plan cannot be: send an email, attach a checklist, and hope for the best? That would be convenient. It would also miss the hard part. The hard part is the human system. We need a better plan than hope.
Guest
Which is helping people make the practice work in the real clinical environment. That's the hard part. It requires listening, adjusting, and supporting. It takes patience and persistence.
Host
Our project uses several supports: Epic, the Best Care Board, a QR code, and a bedside checklist, so why is that not enough? Tools alone don't change behavior. So what's missing?
Guest
Because availability and adoption are different things. The project literature includes examples where nurses found digital handoff tools useful, while consistent use still remained a challenge. A tool can be present and still not be part of the workflow. Adoption is a social and clinical process. The missing piece is often the workflow.
Host
So something can be easier to use without necessarily becoming the way people work. That's the gap we're trying to close. That's a crucial distinction.
Guest
Exactly. That is why implementation has to look beyond whether we built the tool. We need to understand whether the workflow supports clinical thinking, communication, and the people using it. If the workflow doesn't fit, the tool becomes another task. And another task can become another workaround. And that's why we observe.
Host
So a better tool still depends on how it is used in practice. Practice is the test. Observation tells the truth.
Guest
Exactly. Technology supports nursing work. Nursing judgment and human interaction still drive the work. The tool is not the practice. The practice is the conversation. The bedside is the real classroom.
Host
Here is the frontline version: “Leadership found another best practice. We will do it for a few weeks, somebody will audit it, and then the next initiative will show up.” That skepticism is real. It comes from experience. That's the elephant in the room.
Guest
That is uncomfortable to hear, which probably means we should hear it. Leaders cannot dismiss that history if they want to build trust. Trust is earned in the follow-through. We should name it and address it.
Host
Because nurses remember what happened the last time somebody promised the new process would make work easier. Memory is part of the implementation environment. It's a credibility issue.
Guest
Exactly. Leaders cannot ask for trust while dismissing the experience that created skepticism. Trust is built by listening and by following through. It is also built by explaining decisions. Credibility is built one decision at a time.
Host
So what does leadership do with that? How do they respond? So what's the first step?
Guest
Invite nurses into the work. Listen to what is functioning and what is not. Be transparent about what can change and what needs to remain consistent. Then show that feedback produces learning. Shared decision-making instead of implementation by announcement. That is how ownership grows. Start by asking, not telling.
Host
Shared decision-making instead of implementation by announcement. That's a different posture. That's a shift in leadership style.
Guest
Yes. The goal is nursing ownership, not temporary compliance. Ownership lasts after the audit ends. Compliance often ends when the audit does. It's a shift from control to ownership.
Host
If frontline feedback can shape the workflow, what should remain stable? What are the non-negotiables? So what stays fixed?
Guest
The core purpose of the handoff. The CMC policy expects interactive communication, an opportunity for questions, pertinent and current information, minimized interruptions, verification when appropriate, and access to relevant historical information. S-bar is encouraged as a standardized communication approach. These are the functions we protect. The purpose stays fixed; the process can adapt.
Host
And at the bedside? What does that look like? And the patient stays central.
Guest
The AHRQ checklist adds behaviors such as introducing nursing staff, inviting the patient and family to participate, accessing the medical record, conducting the verbal S-bar in understandable language, reviewing safety and tasks, and identifying patient and family needs, concerns, and goals. These behaviors keep the patient in the conversation. Always.
Host
So adaptation does not mean every core behavior becomes optional. It means we adjust how we do them. So we protect the core.
Guest
Correct. We can learn how to make the workflow fit the environment while protecting the functions that make the handoff meaningful. The core functions stay; the details can flex. That is the balance. And we learn the rest.
Host
What should leaders be listening for during implementation? What signals matter? What are the signals of trouble?
Guest
Repeated friction. Where are nurses leaving the workflow to find information? What information is outdated or poorly prioritized? Where does the process interrupt rather than support the clinical conversation? What keeps the patient from having a meaningful opportunity to participate? These are the questions that reveal the real workflow. Friction is the signal.
Host
In other words, a workaround can be data. It can tell us something. So we follow the friction.
Guest
Exactly. A workaround can tell us where intended workflow and real workflow have separated. It's a signal, not just a violation. We should study it, not just correct it. It leads to the real problem.
Host
And the response should not automatically be, “The nurse did it wrong.” That's a blame reflex. And we resist blame.
Guest
Correct. Sometimes the nurse needs coaching. Sometimes the process needs coaching. That line is worth repeating. It keeps us honest. Blame stops learning.
Host
That line may be worth keeping. It reframes the problem. That's a good rule.
Guest
Sometimes the nurse needs coaching. Sometimes the process needs coaching. Both can be true. It's a rule for improvement.
Host
The literature also talks about electronic information. What should implementation leaders keep in mind? What are the pitfalls? So what about the digital tools?
Guest
Electronic records can make information available, but nurses still have to identify what matters for the patient in front of them. The literature synthesis identifies fragmented displays, irrelevant content, outdated information, weak prioritization, and inconsistent updating as practical barriers reported across studies. These barriers are common and they are solvable. They should serve the conversation.
Host
Which sounds familiar to anyone who has ever clicked through a chart thinking, “I know the information is in here somewhere.” We've all been there. That's the test.
Guest
That may be one of the more universal experiences in modern healthcare. The digital tool should reduce that search, not add to it. It should support the conversation, not replace it. And the test is at the bedside.
Host
So how should we judge the digital part of this project? What's the standard? So how do we measure success?
Guest
By whether it helps nurses prepare for and carry out the clinical conversation. A digital feature is useful when it supports clinical thinking and communication. Its existence alone does not prove adoption or reliability. The test is whether it helps at the bedside. By whether it helps nurses and patients.
Host
What should leaders watch for when they evaluate the patient side of BSR? How do we know it's real? What about patient participation?
Guest
Do not reduce participation to whether nurses entered the room. The evidence distinguishes bedside location from a genuine opportunity for the patient to contribute. Presence is not the same as participation. It must be genuine, not just physical.
Host
And contribution can look different from patient to patient. It's personal. So we look for real engagement.
Guest
Yes. A patient may ask a question, clarify information, correct something, identify a priority, or simply listen. The patient’s preference and circumstances matter. Participation is not a performance. It is an invitation. And we respect each patient's way of engaging.
Host
What about priorities submitted digitally? How do we handle those? What about digital priorities?
Guest
That creates another implementation question. Did the nursing team merely receive the priority, or did someone acknowledge and address it during the subsequent bedside shift report exchange? Those are not the same thing. Receiving is not addressing. They need a human response.
Host
So the measure has to connect the digital input back to human interaction. That's the link. So we close the loop.
Guest
Exactly. Otherwise we are just counting clicks, not caring for patients. The human response is the point. Closing the loop is care.
Host
Where does Wei’s Convergent Care Theory fit at this level? How does it guide implementation? Where does the theory come in?
Guest
This may be where the theory becomes especially useful. Convergent Care Theory describes organizational care, collaborative care, person-centered precision care, and self-care, grounded in a culture of caring. It gives us a map for the whole system. It gives us a shared language.
Host
It also identifies competence, compassion, accountability, trusting, sharing, and engaging as facilitators that help stakeholders work together. Translate that for implementation. What do these look like in practice? So we can talk about the whole system.
Guest
Competence means preparing people to perform the practice. Accountability means following through. Trusting means staff can speak honestly about what is not working. Sharing means information moves both directions. Engaging means nurses and patients are participants rather than passive recipients. Compassion reminds us that implementation is happening to people who are already doing demanding clinical work. These facilitators are the culture we build. And the whole person.
Host
And self-care matters because the workforce is part of the system, not separate from it. People are not machines. Including the nurse.
Guest
Exactly. The theory explicitly includes both patients’ and healthcare providers’ self-care. A caring culture considers the people giving the care as well as those receiving it. That is a radical and practical idea. Yes, including the nurse.
Host
Let’s make this uncomfortable again. How does a leader know whether we are really listening to frontline staff? What's the evidence? So how do we know we're listening?
Guest
One practical test is whether feedback can influence the implementation conversation. If every concern receives the same answer, “Just follow the process,” then we are gathering feedback without learning from it. Listening means something has to change. By what changes after we listen.
Host
That is the kind of thing that makes people stop giving feedback. Silence is a symptom. That's the proof.
Guest
Right. A suggestion box is not shared decision-making if the box is actually a shredder. Feedback has to have a path to action. Action is the proof.
Host
There is the bitter truth with a little humor. We need both. So we need action.
Guest
And the alternative is straightforward: listen, evaluate the concern, protect the essential clinical functions, change what reasonably needs changing, and explain the decision. That is respectful implementation. And we need to explain the action.
Host
Even when the answer is no. Especially when the answer is no. Even when it's no.
Guest
Especially then. Transparency matters. People can accept a no if they understand why. Especially when it's no.
Host
There is a leadership message underneath all of this. It's about belief in the staff. So what's the leadership message?
Guest
There is. The project is built on confidence in Covenant nurses and charge nurses, not on the assumption that frontline nursing lacks commitment. That confidence shapes every decision. It's belief in the staff.
Host
As Daniel Ron-ick, Chief Nursing Officer at Covenant Medical Center, has said: “I believe in the nurses at Covenant.” That is a short line, but it changes how implementation should feel. It sets the tone. And that belief must be visible.
Guest
It should. If we believe in nurses, then their clinical judgment, experience, and feedback have to matter as we build reliable practice. Belief has to show up in the process. Visible in the decisions we make.
Host
Let's talk about training. What does good training look like for bedside shift report?
Guest
Good training is not a one-time event. It is ongoing, practical, and connected to the real workflow. It includes practice, feedback, and reinforcement.
Host
So it's more than a module in a learning management system.
Guest
Much more. It has to reach the bedside. It has to involve the people who do the work. And it has to be supported after the training ends.
Host
What about observation? How should leaders observe without policing?
Guest
Observation should be learning, not surveillance. The goal is to see how the workflow actually functions. Then you can identify where support is needed.
Host
So the observer is a partner, not a judge.
Guest
Exactly. That changes the conversation. It makes it safe to talk about what is not working. And that is how you get real data.
Host
What about the culture piece? How do we build a culture that treats adaptation as learning?
Guest
It starts with leadership language. When leaders say, “We learned from that,” instead of “Who failed?”, the culture shifts. Adaptation becomes normal, not a sign of failure.
Host
So the words we use matter.
Guest
They do. They shape whether people speak up. And speaking up is how implementation improves.
Host
Let's talk about workflow fit. How do we know if the workflow fits?
Guest
We know it fits when it supports the clinical conversation instead of interrupting it. It fits when nurses can use it without leaving the bedside. It fits when patients can participate naturally.
Host
So fit is about flow, not just features.
Guest
Exactly. A feature can be useful and still not fit. Fit is about how it works in the moment. It is about timing, sequence, and human attention.
Host
What about the digital support? How do we keep it from becoming a distraction?
Guest
We design it to support the conversation, not replace it. We keep the screen secondary to the patient. And we make sure the information is current, relevant, and easy to find.
Host
So what is the leader's role in all of this? Always.
Guest
The leader's role is to create the conditions for the work to succeed. That means resources, time, training, and psychological safety. It means listening to feedback and acting on it. It means protecting the core purpose while allowing the process to adapt. And support!
Host
So what should the implementation team carry forward? What are the takeaways?
Guest
Protect the core purpose. Observe actual practice. Treat frontline feedback as implementation data. Separate the presence of a tool from reliable adoption. And keep patient participation connected to the conversation, not merely the location. These are the anchors.
Host
And when something does not work? What then?
Guest
Learn from it. Sometimes the nurse needs coaching. Sometimes the process needs coaching. Adaptation is learning, not failure.
Host
Competence. Compassion. Accountability. Trusting. Sharing. Engaging. These are the culture words.
Guest
A caring culture where people work together. That is the goal.
Host
Better handoffs. That's where we start.
Guest
Better conversations. That's how we get there.
Host
Better care. That's the outcome we want.
Guest
We’ll meet you At the Bedside. Thank you for listening.