Transforming Care at the Bedside How-to Guide: Increasing Nurses' Time in Direct Patient Care

Institute for Healthcare Improvement (in collaboration with the Robert Wood Johnson Foundation)
Cambridge, Massachusetts, USA
How to cite this document:
Rutherford P, Bartley A, Miller D, et al. Transforming Care at the Bedside How-to Guide: Increasing Nurses’ Time in Direct Patient Care. 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).
One of the most exciting combinations of changes that have been developed within TCAB is the ability to remove hassles and waste from processes on medical-surgical units so that nurses and other clinicians can spend more value-added time caring for patients. This How-to Guide builds on relevant research and published literature and integrates what staff in TCAB hospitals have learned as they strive to significantly increase nursing time in direct patient care, which contributes to patient safety, better outcomes for patients, and greater staff satisfaction with the work environment to support their professional practice.
This How-to Guide is divided into four sections:
  • Section One describes the importance of increasing nurses’ time in direct patient care and the ways in which TCAB has adopted strategies from lean management and the Toyota Production System to remove waste from key processes on medical and surgical units.
  • Section Two outlines how to get started and two methodologies for measuring nurses’ time in direct patient care.
  • Section Three highlights key TCAB strategies to increase nurses’ time in direct patient care, including specific changes that have been tested and implemented on a variety of medical-surgical units and can be adapted to any unit or hospital setting.
  • Section Four presents three case studies of hospitals that have implemented many of the changes proposed in this guide.

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