Category Archives: Transforming Care at the Bedside
In 2003, the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation launched Transforming Care at the Bedside (TCAB), a nationwide, nurse-focused effort to improve health care delivery. TCAB recognized that nurses often hold the key to making hospital care more effective, patient-centered and efficient. David Harrington, RN, BSN, CMSRN, has been a nurse at Providence St. Vincent Medical Center since 2006 and a TCAB leader there for two years. Erin Hochstein, RN, BSN, PCCN has been a staff nurse at Providence since 2010 and a TCAB leader for two years. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
As nurses, we are with our patients and their families during some of the most pivotal moments in their lives, which is a true honor. Yet, with the ever-increasing demands of health care, the responsibilities of nurses have become greater, pulling us away from the bedside. To curb this trend we were given the opportunity, at Providence St. Vincent Medical Center, to adopt Transforming Care at the Bedside (TCAB), a program that gives bedside staff the chance to streamline care and improve patient outcomes.
By allowing us direct input on our workflow, we have the opportunity to develop rapid tests of change that we implement over the course of one shift. This adjustment in practice empowers frontline nurses to be catalysts of change for patient care, permitting us creative liberty in finding solutions to practice and system issues we face on a daily basis.
The Providence St. Vincent TCAB team began its journey in 2010 by visiting Prairie Lakes Hospital in Watertown, South Dakota, one of the original TCAB pilot sites, as part of an innovation grant provided by Providence Health & Services. Nurse representatives from three medical-surgical units along with hospital leaders were introduced to TCAB in action. As newly appointed TCAB leaders, we returned from the trip feeling motivated, inspired, and ready for change.
For more than four decades, the grantmaking of the Robert Wood Johnson Foundation (RWJF) has advanced the nursing profession, supporting nurses in their efforts to improve care and strengthening nurses’ role in shaping the future of the nation’s health care system. The latest issue of Charting Nursing’s Future, RWJF’s periodic series of issue briefs, tracks the Foundation’s growing commitment to nursing.
The brief examines RWJF’s impact in five distinct areas:
- Expanding roles for nurses;
- Building educational capacity;
- Demonstrating nurses' contributions to quality and safety;
- Creating leaders for the 21st century; and
- Bridging gaps in research and data.
Among the two dozen past and present programs highlighted in the brief:
- Expanding roles. In the mid-1970s, RWJF played a critical role in the emergence and acceptance of nurse practitioners (NPs), supporting demonstration projects in rural areas of California, Alabama, Tennessee and New England. Subsequently, RWJF’s Nurse Faculty Fellowship Program helped create an intellectual home for primary care nursing, leading to the creation of master’s degree NP programs across the nation.
Human Capital News Roundup: Screening for prostate cancer, organ donation, bariatric surgery, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) scholars, fellows and grantees. Some recent examples:
In an op-ed in the New York Times, Andrea L. Campbell, PhD, writes about how health care reform could benefit her sister-in-law, now a quadriplegic after a car accident. “As a scholar of social policy at [the Massachusetts Institute of Technology], I teach students how the system works,” she writes. “Now I am learning, in real time.” Campbell is an alumna and a member of the National Advisory Committee of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program, and the recipient of an RWJF Investigator Award in Health Policy Research. The Washington Post Wonk Blog and Esquire’s Politics Blog also picked up on Campbell’s story.
Medical News Today is among the outlets to report on a study led by an alumnus of the RWJF Clinical Scholars program, Danil V. Makarov, MD, MHS (a 2008-2010 U.S. Department of Veterans Affairs Clinical Scholar). A large share of patients diagnosed with prostate cancer are sent for unnecessary imaging, the researchers found, which could compromise the care they receive, delaying their ultimate treatment, and could also run up the costs associated with diagnosing and treating their cancers. Read more about the study.
Susan Bakewell-Sachs, PhD, RN, PNP-BC, program director of the New Jersey Nursing Initiative (NJNI), spoke to The Record (Hackensack, N.J.) about a report in the New England Journal of Medicine that finds the country’s nursing shortage may have temporarily eased. She also discussed nursing education in New Jersey. “What I tell students is they should be thinking of a career trajectory that includes an education projection path,” she said. “Anyone who has other people’s lives in their hands must be a lifelong learner.” NJNI is a program of RWJF and the New Jersey Chamber of Commerce Foundation.
Oregon Public Broadcasting reports on the success of an RWJF initiative—Transforming Care at the Bedside—in the state. The program encourages nurses and other frontline workers to suggest and implement ideas to make their hospitals safer. A recent survey by the Oregon Association of Hospitals and Health Systems found that over the last 10 months, there was a "10-percent increase in better access to supplies and equipment among staff; a 12-percent improvement in communication on the wards; and a 16-percent increase in nurses who say their ideas seem to count."
By Lori Melichar, Ph.D., M.A.
Senior Program Officer, Research and Evaluation, Robert Wood Johnson Foundation
I recently attended a National League for Nursing meeting of top nursing researchers, educators and leaders. Among the purposes of the meeting was to identify gaps in and opportunities to create knowledge to improve nursing education.
While meeting participants discussed several exciting efforts currently underway to improve nursing education, journal editors attending lamented the fact that most of the published research on nursing education innovations is based on single-site studies, making it unlikely to convince faculty to adopt new models of education or change core curriculum. The editors, educators and researchers agreed that research linking teaching methods and curricular content to patient outcomes would bolster efforts to transform patient care in the U.S. Evidence in this area is crucial because curricula are packed, faculty are overworked, change takes effort, and students don't always know what's best for them.
Producing more rigorous evidence is a strategy I often support as a member of the department of research and evaluation at the Robert Wood Johnson Foundation (RWJF). The Research Initiative component of the Campaign for Action, along with the Foundation's Evaluating Innovations in Nursing Education Program, will seek funding for studies of educational innovation over the next couple of years. It occurred to me that a strategy that might be more successful in the goal of quickly transforming nursing education falls out of the Foundation's flagship nursing program, Transforming Care at the Bedside (TCAB).
I was a part of the team from RWJF and the Institute for Healthcare Improvement (IHI) that developed the TCAB program that taught front-line nurses and their managers the skills and methods of continuous quality improvement, and inspired and empowered them to make changes to transform care at the bedside. The idea was that, though evidence should always be considered when it exists, there are things one can try to improve outcomes that matter, without first proving effectiveness.