Transforming Care at the Bedside How-to Guide: Engaging Front-Line Staff in Innovation and Quality Improvement

Institute for Healthcare Improvement (in collaboration with the Robert Wood Johnson Foundation)
Cambridge, Massachusetts, USA
How to cite this document:
Rutherford P, Phillips J, Coughlan P, Lee B, Moen R, Peck C, Taylor J. Transforming Care at the Bedside How-to Guide: Engaging Front-Line Staff in Innovation and Quality Improvement. 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).
When IHI and RWJF began the journey to transform care at the bedside on medical-surgical units, the challenge was great. Front-line staff was exhausted and dispirited by the increasing workloads, inefficient work processes, and negative work environment. Nurses were leaving not only the unit, but the nursing profession. Yet, within the first year of TCAB, it became clear that by giving front-line staff the skills and permission to innovate and make improvements in their work, new energy and passion were building on the unit. Staff felt empowered as they contributed directly to making their work and the lives of their patients better.
By sharing the lessons of the TCAB hospitals, this guide provides an opportunity for other hospitals to learn and experience the value of engaging front-line staff in innovation and quality improvement.
The How-to Guide is divided into four sections:
  • Section One describes the three key improvement strategies used in TCAB for building improvement capability and engaging front-line staff in innovation on medical and surgical units.
  • Section Two outlines a sequence of steps to build front-line staff’s capability in innovation and quality improvement to transform care at the bedside.
  • Section Three includes five case studies describing how hospital staff are implementing TCAB principles and processes.
  • Section Four presents practical tips from TCAB participants, sample templates, and references to web tools and other resources.

[NOTE: The document is a large file and may take a few minutes to download.]

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