Transforming Care at the Bedside How-to Guide: Spreading Innovations to Improve Care on Medical and Surgical Units

Institute for Healthcare Improvement (in collaboration with the Robert Wood Johnson Foundation)
Cambridge, Massachusetts, USA
How to cite this document:
Schall MW, Chappell C, Nielsen GA, et al. Transforming Care at the Bedside How-to Guide: Spreading Innovations to Improve Care on Medical and Surgical Units. Cambridge, MA: Institute for Healthcare Improvement; 2008. Available at
Launched in 2003, Transforming Care at the Bedside (TCAB) is a national program of the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI).
The full power of Transforming Care at the Bedside to empower front-line staff and bring about high-leverage changes to improve care at the bedside is fully realized only when effective and proven practices are spread across an entire hospital or health system. The capacity of an organization to spread new practices is closely linked to its ability to sustain gains achieved through the implementation of these new practices. “Sustaining the gains” requires that an organization ensures that new practices and behaviors become a permanent part of its “way of doing business.”
By describing the experience of TCAB hospitals within a larger conceptual framework for spread, this guide captures lessons learned to date about effective strategies for spreading TCAB practices, which may allow other organizations to spread effective and proven practices more easily.
This How-to Guide is divided into four sections:
  • Section One provides an overview of the key components needed to sustain and spread improvements, including the IHI Framework for Spread.
  • Section Two outlines a practical step-by-step sequence of activities to lay the foundation for spread, create a plan for spread, and implement and refine the plan for spread. Section Two also includes real-world examples from TCAB hospitals and tips about best practices for achieving spread and sustainability.
  • Section Three includes two case studies.
  • Section Four provides tips and tools from TCAB hospitals.

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