Q. What is Transforming Care at the Bedside (TCAB)?
A. TCAB is a successful quality improvement program initially developed and led by the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI). The American Organization of Nurse Executives (AONE) is now involved with implementing TCAB in 68 hospitals. The program engages frontline staff in hospitals, along with leaders at all levels of the organization to:
- Improve the reliability and safety of patient care on medical and surgical units.
- Increase the vitality and retention of nurses.
- Engage and improve the patient's and family members' experience of care.
- Improve the effectiveness of the entire care team.
Q. What are the goals of TCAB?
A. The goals of TCAB are to increase the time nurses spend in direct patient care to 70 percent; to improve quality, reliability and safety of patient care; to create patient-centered care; and to improve nurse retention by improving workforce vitality. By achieving these goals, clinical outcomes such as reducing falls, reducing codes, and reducing readmission rates should also be affected.
Q. What quality issues does TCAB address?
A. TCAB encourages the redesign of work processes on medical/surgical units to achieve better clinical outcomes and quality of patient care such as reducing decubiti, reducing adverse events and reducing codes. Overall patient satisfaction and improved retention of nursing staff are important indicators of success.
Q. A lot of initiatives address quality of care. What makes this approach different?
A. TCAB takes a unique approach to addressing quality of care issues by supporting nurses and other frontline staff to develop their own interventions, design new processes and adapt ideas from staff that improve care. This is a bottom-up, team-based approach to achieving quality rather than a top-down approach.
Q. How do hospitals test innovations?
A. Teams of frontline staff quickly test innovations, so that the TCAB team generates innovative ideas they test quickly for feasibility. The team generates quantitative and qualitative data to determine if the idea should be adopted, adapted or abandoned.
Q. If innovations are successful, how are they implemented?
A. When the TCAB team assesses a change to be an improvement—whether it improves the work environment, patient safety, patient care, or reduces waste—the improvement is fully implemented on the pilot unit and evaluated to ensure that it is sustainable over time. When documented results show the intervention to be sustainable, TCAB units spread the intervention to other hospital units, allowing each additional unit to adapt the changes to their unique circumstances.
Q. How do hospitals measure outcomes and report success?
A. Topline results are important for evaluating the success of interventions, and TCAB teams routinely review the results of the tests to assess the effectiveness of interventions. Trending data for key outcome measures are tracked over time to assess the overall effect of all of the changes toward the desired outcomes and goals of the project.
Q. How does TCAB help to retain nurses and reduce turnover?
A. TCAB involves nurses in the work of redesigning processes that allow them to spend more time with their patients. Engaged nurses who spend more time with patients are less apt to want to leave their jobs.
Q. Why does TCAB appeal to nurses?
A. Nurses on TCAB units are empowered to lead efforts to develop innovations and actively make changes they can test and implement to improve their environment, patient safety and patient-centered care. The nurses share in decisions and create an environment where the multidisciplinary care team serves the patient and family. This process creates a cadre of motivated nurse leaders who are “decision-makers” rather than simply “implementers.”
Q. What are some of the results of TCAB?
A. A select sampling of results include:
- Nine TCAB hospital units involved in the pilot phase of the program have gone five successive months or more without a full resuscitation code.
- Three TCAB pilot units have gone six successive months without moderate or severe harm from falls.
- Average turnover rates for RNs and advanced practice nurses on the TCAB pilot units at all TCAB sites dropped from 5.8 percent to 3.4 percent over three years (58% decrease).
- The percentage of time registered nurses spent in direct patient care at TCAB hospitals increased from approximately 40 percent to more than 50 percent over two years.
Q. What are some of the most successful TCAB innovations?
A. Some of the most successful innovations include developing systems to reduce falls by indicating which patients are at high-risk for falls, creating rapid response teams to effectively intervene when a patient's condition deteriorates, and relocating supplies, equipment and medication in or closer to patient rooms to help nurses spend more time with the patients.
Q. Can TCAB be implemented in units other than medical/surgical units?
A. Although originally conceived to improve clinical outcomes and nurse retention on medical/surgical units, most hospitals in the TCAB initiative have spread the program to almost every other unit in the hospital. Two hospitals have even spread the TCAB program to their outpatient service departments.
- 6 Section 6: Additional Resources
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