Transforming Care at the Bedside by Empowering Nurses

    • June 28, 2012

At Seton Family Hospitals in Austin, nurses used to spend significant time away from patients while searching for the scattered supplies they needed to provide care. Today, as the result of an inexpensive redesign of the supply areas, including shelving units and a labeling system to show exactly where needed supplies are located, nurses are spending less time “hunting and gathering” and more time providing patient care. This is all because of an innovative program that gives nurses more input in decisions about how to improve hospital systems.

Despite the pivotal role nurses have played in patient care for decades, it wasn’t until 2003 that a national effort began capitalizing on nurses’ strengths and experience to improve the delivery of health care. That year, the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF) launched Transforming Care at the Bedside (TCAB), a nationwide, nurse-focused effort to improve health care delivery. TCAB recognized that nurses, the largest group of health care professionals, are often patients’ last line of defense against medical errors, are a lifeline for family caregivers, and in many ways hold the key to making hospital care more effective, patient-centered and efficient.

TCAB’s overall goal was to make inpatient care safer, more reliable and more patient-centered—and in places like Seton Family Hospitals, it did. There and at other TCAB hospitals, nurses and other staff lead efforts to improve the quality and efficiency of care. Research shows that 70 to 90 percent of errors in hospitals are a result of badly designed systems of care. If the systems were improved, the thinking went, the quality of care would also improve.

In the first phase of the project, IHI and RWJF recruited three innovative hospitals that agreed to test TCAB in their medical-surgical units. At the time, 35 to 40 percent of unexpected hospital deaths occurred on medical-surgical units. The participating hospitals—Seton Northwest Hospital in Austin, Texas; University of Pittsburgh Medical Center Shadyside; and Kaiser Foundation Hospital in Roseville, Calif.—created nurse-led teams that identified needed changes, suggested and tested solutions, and then decided whether and how to implement the innovations. They served as laboratories for change, and the experiment was successful.

The success of TCAB in those first three hospitals led to a second phase of the program, which involved 13 additional sites that received technical assistance to implement and test TCAB. Nurses and other front-line staff at the sites created and tested new concepts, developing exemplary care models at their institutions. Each participating hospital was required to demonstrate institutional commitment to the program by pledging resources to support and sustain the innovations developed and implemented through TCAB.

Across the country, and around the world, and hospitals continue to implement TCAB. Both IHI and the American Organization of Nurse Executives (AONE) are providing courses to help hospitals and other organizations implement the program. In addition, the RWJF Aligning Forces for Quality program included TCAB among its major initiatives and helped many hospitals learn how to implement it.

The lessons learned and the breakthroughs made in the first two phases of TCAB are now available to any hospital or health system interested in the program. The RWJF website offers toolkits and other resources to help hospitals implement this groundbreaking and successful program, including information on how to plan to become a TCAB hospital.

“It seems intuitive that the people who provide the most direct care to patients should help make decisions about how that care is delivered, but nurses needed to be empowered to make their voices heard,” said Susan B. Hassmiller, PhD, RN, FAAN, RWJF senior adviser for nursing. “And now there’s really no going back. Today, hospitals across the country are using this nurse-led, evidence-based approach to providing safer and more reliable patient-centered care. Hospitals participating in TCAB report better clinical outcomes, increased time spent by nurses on direct care, reduced nurse turnover, and lower costs. That means patients do better. Now, it’s not just the patients who listen to nurses. More and more, it’s decision-makers in our health care system. And we’re all better off for it.”

During this, its 40th year, the Robert Wood Johnson Foundation is saluting the programs it supports that have made a difference to the nation’s health and health care, including Transforming Care at the Bedside.