With so much care being delivered in hospital medical/surgical units, and with an estimated 35 to 40 percent of unexpected hospital deaths occurring on such units, The Robert Wood Johnson Foundation (RWJF) and IHI agreed to work together to create, test, and implement changes that will dramatically improve care on medical/surgical units, and improve staff satisfaction as well.
In 2003, through an initiative called Transforming Care at the Bedside (TCAB), RWJF and IHI created a framework for change on medical/surgical units built around improvements in four main categories:
- Safe and Reliable Care
- Vitality and Teamwork
- Patient-Centered Care
- Value-Added Care Processes
TCAB is now in its fifth year, and the 10 participating hospitals are testing, refining, and implementing change ideas within each category, many with very promising early results. Examples include the following:
- Use of Rapid Response Teams to “rescue” patients before a crisis occurs
- Specific communication models that support consistent and clear communication among caregivers
- Professional support programs such as preceptorships and educational opportunities
- Liberalized diet plans and meal schedules for patients
- Redesigned workspace that enhances efficiency and reduces waste
Many changes cannot be strictly categorized, but produce positive change in one or more categories. RWJF and IHI believe that it is only by working in all four categories simultaneously that care teams can produce truly transforming results.
