Transforming Care at the Bedside

Lessons from Phase II

The Program Being Evaluated

Transforming Care at the Bedside (TCAB) is a multiphase program of the Robert Wood Johnson Foundation. For this initiative the Foundation has partnered with the Institute for Healthcare Improvement for all three phases and with the Association of Nurse Executives for phase three. The goal of this initiative is to empower front-line nurses and other staff to develop, test and implement changes that will dramatically improve care on hospital medical/surgical units. The fundamental tenet of TCAB is that improvements in the nurse work environment will positively affect the quality of patient care.

TCAB is currently in its third phase. Phase one began in three hospitals, phase two spread to 13 hospitals and it is now being implemented in 78 hospitals.

About the Evaluation

The evaluation is led by Jack Needleman, Ph.D., of the UCLA School of Public Health. This evaluation has two components to assess the different phases of the TCAB program.

Earlier evaluation work provided both outcome and process information on TCAB to inform the planning of the demonstration phase. Evaluators:

  • Collected data from participating sites to measure improvement in quality-of-care outcomes that are sensitive to nursing service;
  • Provided a qualitative exploration of the facilitators and barriers to achieving change and testing TCAB innovations;
  • Conducted in-depth case studies at a limited number of sites to explore the role that an institution's culture and/or leadership will play in the creation and dissemination of innovations.

The current evaluation will examine similar themes along with the outcomes of the three learning and dissemination strategies developed within this authorization. The three strategies represent different interventions to spread the TCAB process, including an ongoing learning community for 10 of the TCAB II pilot hospitals and a Web-based resource center.

Summary of Methods

The evaluation team has developed a standardized measurement plan that will be implemented within each strategy, and will provide the Foundation with information about the ability to spread the TCAB process using differing levels of intensity.

Knowledge and Impact

In a report to RWJF, the evaluation team reported that

  • The small number or participating hospitals limited the ability of the evaluators to say whether the program improved patient care.
  • The program was successful in engaging front-line staff in developing, testing and implementing changes to improve processes on nursing units. It also appeared to lead to greater retention and attraction of nursing staff.
  • The work of testing and evaluating innovations spread beyond the original nursing units participating in the program to other parts of the participating hospitals.