Spreading Innovations in Health Care

The spread of quality innovations is being encouraged by the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI) in their national Transforming Care at the Bedside program (TCAB). Launched in 2003, TCAB is a multiphase, national initiative to improve the work environment on hospital medical-surgical units, and thereby increase the quality of patient care and nurse engagement.

During TCAB, participating hospitals are coached on how to identify, develop, test and share prototype strategies to improve the quality of care. Staff at the participating hospitals test a number of changes in the way they organize and provide care, and many of the innovations are subsequently adopted as usual practice.

Before asking a larger group of hospitals to adopt TCAB strategies that have previously been found promising, RWJF decided to look at dissemination efforts within the three major hospital systems with the longest-running TCAB experience. The premise was that these systems—considered to be leaders in nursing quality improvement—could help identify the possibilities and challenges of spreading health care innovation to other units, hospitals and health systems. In particular, evaluators wanted to understand whether some of the most successful program innovations could be spread and replicated directly, and if the larger TCAB processes that helped front-line staff identify and test these changes could be spread as well.

The evaluation process showed that TCAB innovations—and the TCAB process itself—can be effectively replicated. Results signaled that large health systems can successfully transmit quality improvement changes to diverse hospitals or units within their systems. With a carefully planned, coordinated and implemented process, all three organizations effectively spread their quality improvement interventions, sometimes employing and transferring the larger TCAB processes for identifying and implementing changes.