Transforming Care at the Bedside

An Ambulatory Model for Improving the Patient Experience

A program called Transforming Care at the Bedside (TCAB) is adapted for implementation in an ambulatory setting with considerable success. Many of the initiatives introduced made a significant difference to patient satisfaction and patient experience at this cancer center in Pittsburgh.

In 2003, the Institute of Health Care Improvement and the Robert Wood Johnson Foundation launched Transforming Care at the Bedside, a nationwide effort to improve health care delivery. In this article, the authors describe the University of Pittsburgh Medical Center Hillman Cancer Center's adaptation of the program to the outpatient setting. The process begins with a series of prioritizing and brainstorming sessions for frontline staff led by a team that included a nonbiased facilitator trained in TCAB methods, executive leaders, and middle-level managers. The group identified 165 issues and suggestions, many of which were rapidly tested for care delivery improvements.

Key improvements in the first six months of TCAB:

  • Reductions in patient wait times.
  • Increase in patient and staff satisfaction by 30 percentiles.
  • Shortened turnaround for laboratory results.
  • Improvement of visitors' first impressions through new signage and a concierge program.

The implementation evaluation revealed that staff involvement, ownership and accountability are critical elements in the success of TCAB initiatives. Moreover, the creation of task forces helped move forward a broad array of care delivery improvements. Plans are now under way to spread many of the initiatives to other University of Pittsburgh Medical Center cancer facilities.