Transforming Care at the Bedside (TCAB) was a national initiative developed by the Robert Wood Johnson Foundation in collaboration with IHI that ran from 2003 through 2008 and had three phases.
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
Over the course of several years, participating hospitals tested, refined, and implemented change ideas within each of the four categories, 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. IHI believes that it is only by working in all four categories simultaneously that care teams can produce truly transforming results.
Key Phases of Work
TCAB was developed over the course of several phases and continues on in many forms today.
Phase I: Prototyping Phase
In the summer of 2003, RWJF and IHI recruited three innovative hospitals to serve as prototypes for what would eventually become a larger effort. These three sites — Seton Northwest Hospital in Austin, Texas, part of the Ascension Health System; UPMC Shadyside, part of the University of Pittsburgh Medical Center (UPMC) in Pittsburgh, Pennsylvania; and Kaiser Foundation Hospital in Roseville, California, part of Kaiser Permanente — developed and rapidly tested ideas to determine the viability of a process for transforming care on medical-surgical units.
Phases II - III: Pilot Testing Phase
On the strength of the promising results achieved by the three prototype hospitals, an expanded pilot phase was launched in June 2004, with 13 sites varied both in terms of geography and demography. The hospitals received technical assistance from IHI faculty, which included individuals skilled in quality improvement, innovation, change management, transformational learning, and the change strategies to dramatically improve performance in the five TCAB themes:
- Transformational Leadership
- Safe and Reliable Care
- Vitality and Teamwork
- Patient-Centered Care
- Value-Added Care Processes
Phase III of TCAB launched in September 2007, with ten of the 13 pilot organizations continuing:
- Cedars Sinai Medical Center (Los Angeles, CA)
- Children’s Memorial Hospital (Chicago, IL)
- James A. Haley VA Hospital (Tampa, FL)
- Kaiser Permanente (Sacramento, CA)
- North Shore-Long Island Jewish Health System (Great Neck, NY)
- Prairie Lakes Healthcare System (Watertown, SD)
- Seton Healthcare (Austin, TX)
- Thedacare (Appleton, WI)
- UPMC Shadyside (Pittsburgh, PA)
- University of Texas MD Anderson Cancer Center (Houston, TX)
The ten Phase III hospitals went on to create and test new concepts, develop exemplary care models on medical and surgical units, demonstrate institutional commitment to the program, and pledge resources to support and sustain these innovations.
Since 2008, a number of hospital teams across the United States have joined these ten initial participants in applying TCAB principles and processes to dramatically improve the quality of patient care on medical and surgical units. These include more than 70 hospitals in IHI’s IMPACT Network’s Learning and Innovation Community on Transforming Care at the Bedside, 67 hospitals in the American Organization of Nurse Executives (AONE) TCAB program, as well as individual hospitals and health systems that have downloaded TCAB “How-to Guides,” tools, and resources to launch their own medical-surgical transformation. For more information please visit the Materials section.
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