Institute for Healthcare Improvement: Learning and Innovation Community: Transforming 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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Transforming 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 hospital care - medical and surgical units - areas where most patients receive care during a typical hospital stay.

The challenge of providing safe, reliable, efficient, timely and patient-centered care in medical and surgical units is compounded by increasing acuity levels of patients, shorter patient stays, and 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. In many hospitals the work environment on medical and surgical units is chaotic and inefficient, contributing to high nursing turnover rates.

Hospitals cannot meet the current challenges on medical and surgical units by fine-tuning the status quo or exhorting staff to work more diligently — they must establish new models of care. In such a demanding and fast-changing care setting, effective inter-professional teamwork and collaboration are of utmost importance for the transformation of bedside care on medical and surgical units. Promising new models for transforming care on medical and surgical units have emerged through a collaboration of the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI), called Transforming Care at the Bedside, which formed the basis for this Learning and Innovation Community.

Launched in 2003, Transforming Care at the Bedside (TCAB), a national program of RWJF and IHI, engaged leaders at all levels of the organization to:

Improve the quality 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

TCAB is not a traditional quality improvement program; one primary characteristic that sets it apart is its focus on engaging frontline staff and unit managers to develop innovations and exemplary care models on medical/surgical units to dramatically improve outcomes for patients and staff alike. Currently, hundreds of hospitals across the US and internationally are implementing TCAB strategies and changes on medical and surgical units.

Aims

Reduce hospital-acquired pressure ulcers to zero
Reduce patient injury from falls (moderate or higher) to 1 (or less) per 10,000 patient days
Increase staff vitality and reduce annual voluntary turnover by 50%
Reduce readmissions within 30 days to 5% or less
95% of patients will definitely recommend the hospital
Increase nurses’ time at the bedside to 60% or greater