Institute for Healthcare Improvement: Learning and Innovation Community: Taking Action to Transform Care at the Bedside

Available through the IMPACT network or on a direct-enroll basis, IHI’s most intensive front-line improvement work happens in Learning and Innovation Communities. These are collaborative change laboratories in which teams from a wide variety of organizations work with each other and IHI faculty to rapidly test and implement meaningful, sustainable change within a specific topic area.

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Download a brief description of this Community.

Taking Action to Transform Care at the Bedside is available either through membership in IMPACT or through direct enrollment in the Community. Learn more about the IMPACT network.

The Challenge

The Solution

The Institute of Medicine’s report, To Err Is Human, documented wide-scale quality problems in the nation’s health care system, including up to 98,000 hospital patient deaths each year due to medical errors. Since this landmark report was released, many organizations have launched initiatives to redesign care, but few have focused on the backbone of these organizations — medical/surgical units — areas where most patients receive care during a typical hospital stay.

The challenge of providing safe, reliable, efficient, and patient-centered care in medical/surgical units is compounded by increasing acuity levels of patients (MedPAC, 2001),[1] complex diagnoses, shorter average patient stays, and ever-increasing technological complexity. Adding to these stressors is an ever-expanding range of new therapies for clinicians to incorporate into their practices, increasing diversity of the patient population, and mounting paperwork.[2] In such a demanding and fast-changing care setting, teamwork and team continuity are crucial. Yet medical/surgical units tend to have high rates of staff turnover.

[1] MedPAC. 2001. Report to the Congress: Medicare Payment Policy. Available at: www.MedPAC.gov

[2] Greiner A, Knebel E. 2003. Health Professions Education: A Bridge to Quality. Institute of Medicine.

Ideal care in medical/surgical units is reliably safe and error-free, responsive to patient needs and preferences, rewarding and satisfying to staff, and highly efficient. Hospitals cannot meet the current challenge by fine-tuning the status quo or exhorting staff to work more diligently, they must establish new models of care.

Promising new models for care of medical/surgical patients are emerging from a collaboration of The Robert Wood Johnson Foundation and IHI, entitled Transforming Care at the Bedside, and form the basis for this Learning and Innovation Community. The four main themes are: Safety and Reliability; Care Team Vitality; Patient-Centered Care; and Increased Value. Although these categories serve as a framework for organizing and focusing the work, they are in fact highly interdependent. Working in one area can produce positive change in another. IHI believes that by working in all four categories simultaneously, care teams will produce truly transformative results.

Areas of Focus

This community targets the following areas:

Making care safe and effective: Examples include reducing medication errors and adverse drug events, establishing Rapid Response Teams, and preventing inpatient falls.

Promoting care team effectiveness and vitality: Examples include optimizing communication among team members, engaging front-line staff, and incorporating talent management and professional development programs for staff.

Supporting and involving patients and families: Examples include support and involvement of patients and families and creating patient-centered healing environments.

Increasing the value of care and care processes: Examples include reducing waste through application of “lean” approaches, and improving work environments through space redesign.

Aims

Participants will be asked to test changes aimed at achieving ambitious goals, such as:

Reducing adverse events to less than 1 per 1,000 patient days
Reducing falls to less than 1 per 1,000 discharges on the unit
Creating a retention-focused culture with a staff turnover rate of less than 5% annually
Increasing caregiver time at the bedside to greater than 75% of their time; significantly increase value-added activities
Improving patient willingness to recommend the unit to 100% “top box” responses
Enhancing patient satisfaction with communication and care coordination to “top box” responses
Increasing clinical care reliability to 98% for top diagnosis or condition on unit
Increasing staff satisfaction