Ten innovative hospitals* graduated from the Transforming Care at the Bedside (TCAB) pilot program on May 13 after five years of engaging frontline nurses to improve the quality and safety of patient care on medical and surgical units and increase the vitality and retention of nurses. And now, hospitals throughout the United States have the opportunity to implement TCAB at their facility.
Whenever Susan Hassmiller, R.N., Ph.D., F.A.A.N., leader of the Human Capital team at the Robert Wood Johnson Foundation (RWJF), speaks about the Transforming Care at the Bedside (TCAB) program, nurses line up to hand her their business cards and request to become a TCAB hospital.
"There is enormous demand from hospitals to start TCAB," Hassmiller says. "Nurses are unbelievably appreciative of TCAB. It gives them hope by offering them a mechanism to make their work environment better."
TCAB, a national partnership between RWJF and the Institute for Healthcare Improvement (IHI), is a unique model in the U.S. that engages nurses and the frontline staff that they work with to improve the quality and safety of patient care on medical and surgical units; increase the vitality and retention of nurses; engage and improve the patient's and family members' care experience; and improve the effectiveness of the entire care team.
Research shows that improving the practice environment of nurses and frontline staff is a critical strategy for improving patient care, achieving safety and quality goals, retaining nurses and advancing best practices in care delivery models.
TCAB enables frontline nurses to do just that by getting them to brainstorm new ideas to improve patient care on their floor, test them, and if proven beneficial, implement and spread their innovations. Examples of successful innovations include using red, yellow and green status boards to assess nurses' workloads; redesigning physical space to enhance efficiency and safety; and using PDAs to sample where nurses spend their time. (See profile on Children's Memorial Hospital's TCAB experience.)
Now, Hassmiller will no longer have to turn away nurses who want to participate in TCAB—RWJF has launched a TCAB Virtual Resource Center. The site will provide tools to help nurses fully implement TCAB, as well as video clips, best practices and innovations, "how to" manuals and personal stories from nurses on how to best engage frontline staff.
The launch of the TCAB Virtual Resource Center marks a milestone for the program—the end of the pilot program and the beginning of widespread adoption. On May 13, the 10 original hospitals that participated in the five-year pilot program attended a graduation celebration at RWJF, where they participated in a learning session, received plaques and pledged to continue to spread TCAB.
The pilot hospitals "will continue to be the innovative and lead hospitals in the country," Hassmiller says. "That designation will not go away now that the pilot program is over. They will continue to work and mentor other hospitals."
RWJF and IHI handed out a "re-commitment letter" to the hospitals during the ceremony. The letter asks them to commit to continuing to serve as leaders working to improve, sustain and spread the improvements in care at the bedside across their organization or health care system and assist other hospitals nationwide in implementing TCAB.
Many of the pilot hospitals are disseminating their work through journal articles. For example, nurses at the University of Pittsburgh Medical Center Shadyside published an article in the April 2008 Journal of Nursing Administration on methods to transport TCAB to the outpatient setting.
The Foundation and IHI are depending on the pilot hospitals to help the more than 200 hospitals that have already begun their own TCAB journeys. Ardent enthusiasm from nurses participating in the pilot program led RWJF to award nearly $1 million to the American Organization of Nurse Executives (AONE) in early 2007 to work with 50 hospitals nationwide to share lessons from the TCAB pilot. Due to the excitement and caliber of the applications received, AONE invited 68 hospitals to participate. Pamela Thompson, R.N., F.A.A.N., chief executive officer of AONE, was one of four co-authors of an article published in the March/April 2008 issue of Journal of Healthcare Management (link to the abstract) on chief nursing officer retention.
RWJF has funded several articles that will aid with TCAB adoption. Barbara Mackoff, Ed.D., and Pamela Klauer Triolo, R.N., F.A.A.N., published results from a national qualitative study in the Journal of Nursing Administration in March and April 2008 exploring why mid-level nurse managers stay. Ann Hendrich, R.N., M.S.N., F.A.A.N. and Marilyn Chow, D.N.Sc., R.N., F.A.A.N. will publish a study in the summer 2008 Permanente Journal that examines how nurses spend their time in hospitals to determine the factors that prevent nurses from spending more time at the bedside.
IHI also offers a learning and innovation community for hospitals to join to implement TCAB. The learning and innovations community is described on the IHI Web site. A number of hospitals in Europe have implemented TCAB, and now nurses from as far away as New Zealand and Saudi Arabia have expressed interest in becoming TCAB hospitals.
John Lumpkin, M.D., M.P.H., RWJF Health Care Group leader, summed up the impact of TCAB at the graduation ceremony: "Five years ago when we started this journey, we believed that we could solve an important problem, but little did we know that with the leadership of 10 innovation leaders that we had started on a path that will help transform health care," he said.
*The "TCAB 10" hospitals are: 1) Cedars Sinai Medical Center in Los Angeles 2) Children's Memorial Hospital in Chicago 3) James A. Haley VA Medical Center in Tampa, Fla. 4) Kaiser Foundation Hospital in Roseville, Calif. 5) North Shore-Long Island Jewish Health System in N.Y. 6) Prairie Lakes Healthcare System in Watertown, S.D. 7) Seton Healthcare Network in Austin, Texas 8) ThedaCare in Appleton, Wis. 9) The University of Texas/MD Anderson Cancer Center in Houston and 10) the University of Pittsburgh Medical Center.