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, and I'm glad you're here. Let's get started.
Guest
This series explores how bedside shift report can strengthen communication, support teamwork, and bring patients and families into the conversation about their care. It's a practice that touches every part of the day, and it matters.
Host
Because better care happens when we work together, and that simple idea is the heart of this work. It shows up in every handoff.
Guest
We have talked about bedside practice, coaching, and implementation. Now we get to the question that decides whether any of it lasts long after the launch energy fades. That is the real test. Sustainability!
Host
What happens when the project is no longer new, the launch is over, and bedside shift report has to survive ordinary clinical work? That's the real test, and it's where sustainability begins.
Guest
So when does the project end, in your view? I mean, when is it safe to stop calling it a project and just call it practice?
Host
Ideally, the project becomes less visible because the practice becomes more normal. It stops being an initiative and starts being just how we hand off. It becomes part of the rhythm of the unit.
Guest
That sounds simple. It is probably not, and anyone who has lived through a change effort knows why. The gap between simple and easy is often wide.
Host
It is not. Sustainability requires attention, feedback, and leadership long after the first education session. It asks for a different kind of commitment. That commitment has to be built into the culture.
Guest
Frontline nurses know the pattern. New initiative. New checklist. New audit. Then six months later everybody is wondering whether we are still doing it, or whether it quietly disappeared. That pattern is exhausting, and it erodes trust.
Host
That is exactly why sustainability deserves its own conversation. It is not just an administrative footnote. It is about whether the change has a life of its own.
Guest
What should success look like when we are trying to sustain this practice? What would make you say, yes, this is holding?
Host
A practice that is understood, usable, expected, coached, and increasingly owned by the people doing the work. That is the target. That ownership is the goal, not just compliance.
Guest
So the aim is not to keep saying, 'Remember the bedside shift report project.' The aim is for safe bedside handoff to become how the work is done. It becomes ordinary, and that is a compliment.
Host
Right. The aim is for safe bedside handoff to become how the work is done, not a special event we schedule. It should feel like the natural next step.
Guest
Sustainability cannot mean freezing the workflow forever. That would make the practice brittle. A practice that cannot adapt will not survive.
Host
Correct. We protect the essential functions while learning how the workflow performs in the real environment. It has to flex without losing its core. We protect the purpose and let the details evolve.
Guest
Which functions stay protected when everything else is changing? Which parts are non-negotiable for safe care?
Host
Interactive communication. Current and pertinent information. An opportunity for questions. Safety verification when appropriate. A standardized handoff structure such as S-bar. And a meaningful opportunity for the patient and family to participate. Those are the elements we keep coming back to.
Guest
The practice can mature without losing its purpose. We can change the details while keeping the reason we started. The reason is the anchor, even when the form changes.
Host
Exactly. Reliable does not have to mean rigid. It means dependable in the ways that matter most. Dependable is better than perfect on the best day.
Guest
Here is where people get nervous. The word sustainability is usually followed by the word audit. And nobody wants another layer of watching. That fear is real, and we should not dismiss it.
Host
And nobody wakes up hoping for one more spreadsheet. We have enough of those already. We already have plenty of tabs open.
Guest
Then why measure at all if it makes people nervous? What makes measurement worth the effort?
Host
Because measurement can tell us whether the practice is occurring, where it is drifting, and where the team needs support. It can be a flashlight, not a hammer. It should illuminate, not intimidate.
Guest
But measurement can also become a compliance exercise. That is the risk we have to name. We have to watch for that drift toward box-checking.
Host
Yes. A number should start a conversation, not replace one. The moment it replaces conversation, we lose the learning. Conversation is where the real data lives.
Guest
So if the number drops, are we fixing the practice or fixing the spreadsheet? That is the question that keeps people up at night. That tension is worth naming out loud.
Host
We ask what changed. Did the workflow become harder? Did staffing or patient needs expose a weakness? Is coaching inconsistent? Are the measures capturing the practice we actually care about? Those questions matter more than the raw number. Those questions turn a number into a narrative.
Guest
Measurement becomes useful when it helps the team understand the work. It should feed curiosity, not fear. It should point us toward the next useful conversation.
Host
Exactly. That is the shift we need to keep making. That shift is how learning becomes culture.
Guest
The literature gives us a reason not to treat sustainment as an afterthought. It is part of the intervention, not something we bolt on at the end. Sustainment is a design requirement, not a cleanup task.
Host
A 2024 bedside-report quality improvement project reported increased compliance during the pilot and at both nine-month and twelve-month sustainment periods after implementing a standardized safety-focused bedside report approach. That gives us a longer view. That is a powerful argument for staying curious over time.
Guest
What does that add to our conversation about keeping this practice alive? How should that evidence shape our expectations?
Host
It shows why we should look beyond launch-day performance. The question is whether practice remains dependable after implementation moves into routine operations. Launch-day numbers can be misleading if we stop there.
Guest
Our broader evidence review also keeps returning to education, staff buy-in, coaching, standardization, and the difficulty of sustaining bedside report. Those themes keep showing up. Those themes are not surprises; they are patterns.
Host
Which means sustainability is part of the evidence problem, not an administrative detail. It belongs in the science of improvement. It deserves the same rigor as any other clinical improvement.
Guest
Does the charge nurse role change once implementation matures and the project team steps back? How does that role evolve from launch to long-term?
Host
The emphasis changes. Early on, coaching may be more visible. Over time, the charge nurse can help notice drift, reinforce expectations, and bring recurring barriers back into the improvement conversation. It becomes less about checking and more about supporting. That shift from checker to coach is crucial for sustainability.
Guest
That is different from policing every handoff. It is a shift from surveillance to stewardship. Stewardship builds ownership; surveillance builds resistance.
Host
Very different. Observation should help the team learn where the practice is strong and where support is needed. It should build confidence, not fear. Confidence grows when people feel supported, not watched.
Guest
Because nobody wants a charge nurse hiding behind the door with a clipboard. That kind of watching can sour even a good practice. That image alone can make people defensive.
Host
That would probably make bedside report memorable for the wrong reason. We want it memorable for the conversation, not the clipboard. The clipboard should not be the star of the show.
Guest
Coaching stays close to the work without turning the work into surveillance. That balance is everything. It keeps the humanity in the process.
Host
That is the balance. It keeps trust alive while keeping the practice honest. Trust and honesty have to travel together.
Guest
Eventually, every process drifts. That is not a moral failure; it is a normal system response. Drift is not a verdict; it is a signal.
Host
And drift should trigger curiosity about the system, not an automatic assumption that people stopped caring. We have to ask better questions. Curiosity is a more productive starting point than blame.
Guest
What should leaders ask first when they notice drift? What question opens the most learning?
Host
What is getting in the way? What changed in the environment? Is the workflow still clinically useful? Are people clear about the essential elements? Those questions open the door to learning. Those questions keep the focus on the system, not the person.
Guest
That brings us back to the Episode 3 idea that workarounds can be data. They tell us something about the design. Workarounds often point to a smarter way forward.
Host
Exactly. Sometimes a deviation signals a coaching need. Sometimes it exposes a design problem. Sustainability depends on knowing the difference. That is where the real work lives. That discernment is a leadership skill worth building.
Guest
The goal is learning without slowly negotiating away the core practice. We adapt the strategy, not the purpose. We can change the how without losing the why.
Host
Yes. Adapt the implementation strategy when needed, while protecting the clinical purpose. That is how a practice stays both alive and faithful. It is a balancing act, but a necessary one.
Guest
How does Wei's Convergent Care Theory help us think about sustainability in this context?
Host
Sustainability depends on the same caring relationships that support implementation: competence, compassion, accountability, trusting, sharing, and engaging. Those are not soft ideas; they are the infrastructure. They hold the practice together.
Guest
Accountability without trust sounds like enforcement. And enforcement alone rarely sustains anything. Trust is the soil where change grows.
Host
And trust without accountability can leave practice unreliable. Convergent Care gives us a way to hold those ideas together within organizational care, collaborative care, person-centered precision care, and self-care. It keeps the whole picture in view. That is a holistic way to think about sustainment.
Guest
The theory also keeps the workforce inside the care system rather than treating staff as an unlimited implementation resource. That matters for sustainability. People are not a renewable resource.
Host
Exactly. Sustainable practice has to consider the people providing the care as well as the people receiving it. Both are part of the equation. You cannot sustain care if you burn out the caregivers.
Guest
At some point, leadership has to know whether ownership has shifted to the clinical team. That is the real handoff. The practice has to belong to the people doing it.
Host
One sign is that nurses can explain why the practice matters, identify barriers honestly, coach one another, and participate in improving the workflow. When that happens, the practice has roots. Roots make it resilient.
Guest
What happens when the project team steps back and the spotlight moves elsewhere?
Host
The clinical team should still know what good practice looks like, how concerns are raised, and how learning gets back into the process. That is the sign of a living practice. It breathes on its own.
Guest
If everything collapses the minute the project team leaves, we did not sustain anything. We just borrowed success for a while. That is not good enough for our patients.
Host
That is a fair test. Sustainability means capability remains in the system, not just in a few champions. Champions are great, but systems outlast individuals.
Guest
There is a leadership statement we have used throughout this series. It has anchored the conversation from the beginning. It reminds us why this work matters.
Host
As Daniel Hronek, Chief Nursing Officer at Covenant Medical Center, has said: 'I believe in the nurses at Covenant.' That belief is not a slogan; it is a commitment. It is a foundation for action.
Guest
In a sustainability conversation, that belief carries responsibility. It means we trust nurses with the work of carrying the practice forward. Trust is not a lack of standards; it is a different way of holding them.
Host
It does. If we believe in nurses, then lasting change cannot depend only on reminders from leaders or the project team. Nurses need meaningful ownership, useful feedback, and a voice in how reliable practice develops. That is what makes change stick. It is about partnership, not policing.
Guest
Belief becomes visible when people are trusted to help carry the practice forward. Trust is the engine of sustainability. It powers the daily choices.
Host
And when leaders continue to listen after the launch is over. Listening is a form of maintenance. It keeps the practice connected to reality.
Guest
So what does making change stick actually require from all of us?
Host
Protect what matters. Measure to learn. Coach without turning observation into punishment. Treat drift and workarounds as information. Adapt thoughtfully. Keep patients in the conversation. And keep nurses in the improvement process. That is the recipe. It is simple to say and hard to live.
Guest
Then maybe the best sign of success is that people stop calling it a project. It just becomes the way we care for each other and our patients. It becomes normal, and normal is powerful.
Host
Because it has become dependable practice. Not extraordinary, just expected. That is the quiet victory of sustainability.
Guest
Not frozen. Not forgotten. Still learning. That is the sweet spot. It is a living practice, not a monument.
Host
That is sustainable change. It lives in the people, not in the project plan. It survives because it belongs to the team.
Guest
Better handoffs. That is where it all starts. Every safe handoff is a small promise kept.
Host
Better conversations. That is how we keep it going. Conversation is the heartbeat of teamwork.
Guest
Better care. That is the outcome we never stop pursuing. It is why we do all of this.
Host
We'll meet you At the Bedside. Thank you for listening, and let's keep making the practice last. Stay curious, stay committed, and keep the conversation going. As we wrap up this episode, I want to leave you with a few practical thoughts. Sustainability is not a phase that comes after implementation. It is the work of making the practice part of daily life. It means asking honest questions when things drift. It means listening to the people closest to the bedside. It means measuring what matters and using those measures to learn, not to punish. It means coaching with respect and expecting reliability without rigidity. It means remembering that patients and families are part of the conversation. It means keeping nurses in the improvement process. It means acknowledging that the workforce is not an unlimited resource. It means building a culture where trust and accountability grow together. That is the kind of culture that can sustain bedside shift report long after the launch energy fades. It is not easy. It requires attention, humility, and persistence. But it is possible. Every shift, every handoff, every conversation is a chance to strengthen the practice. So let's protect what matters. Let's measure to learn. Let's coach without surveillance. Let's treat drift as information. Let's adapt thoughtfully. Let's keep patients at the center. Let's keep nurses empowered. And let's remember that the goal is not to keep a project alive forever. The goal is to build a practice that can keep learning after the project is gone. That is sustainable change. That is better handoffs. That is better conversations. That is better care. Thank you for joining us At the Bedside. We'll see you next time. It is chosen every day by leaders who listen, by charge nurses who coach, by nurses who speak up, and by teams who learn together. It is chosen when someone notices a drift and asks what changed instead of who dropped the ball. It is chosen when a number drops and the first response is curiosity, not blame. It is chosen when a patient is included in the conversation and when a family member feels informed. That is how a practice becomes part of the culture. That is how a project becomes a habit. That is how a habit becomes a standard. And that is how a standard becomes safe, reliable, compassionate care. So let's keep choosing it. Let's keep learning. Let's keep improving. And let's meet again At the Bedside. And keep going now.