TCAB: What’s Your Hospital Doing to Improve Care?

November 2009 report cover

What makes a “good hospital”? A patient might have the best surgeon in the world; but as any nurse will tell you, that patient will die unless the surgeon has a top-notch nursing staff to ensure that the patient is well prepared for the surgery and well supported during the recovery period. Too many hospitals have lost their understanding of what’s essential to ensure great clinical and financial outcomes.  In such hospitals, nurses aren’t included in decision making, have little local authority, are penalized for identifying factors that lead to poor care, and can’t claim excellent team relationships.

The American Nurses Credentialing Center’s Magnet Recognition Program has helped to identify the factors that lead to excellence in nursing care, granting Magnet status to hospitals that provide such excellence. Now an initiative known as Transforming Care at the Bedside (TCAB) has provided the framework and tools for empowering bedside nurses to become  agents for change. TCAB nurses work with other health care team members to improve care processes and effectiveness, focusing on four areas:  the safety and reliability of care, teamwork and job satisfaction, patient and family satisfaction, and “value-added care.” (Increasing the amount of time  nurses can spend with patients by decreasing the time they must spend charting or hunting for supplies would be one example of adding value to care.)

In November AJN is publishing a special report, Transforming Care At the Bedside: Paving the Way for Change, with the support of a grant from the Robert Wood Johnson Foundation (RWJF); it’s available online now. The Institute for Healthcare Improvement (IHI) led the initial development of TCAB;  in our report’s lead article, the IHI’s Pat Rutherford and colleagues describe TCAB and its impact on some key indicators. UCLA School of Public Health professor Jack Needleman and colleagues evaluate several pilot programs, presenting data from surveys and interviews with front-line nursing staff, nurse administrators, and hospital quality improvement personnel. Other articles offer lots of case examples of staff-led changes from TCAB units and facilities. And there’s more: you’ll find articles that discuss the business case for TCAB; address the critical role of leadership development for nurses; discuss how nursing education fits in; and offer perspectives from CEOs, trustees, and physicians.

TCAB is being spread through the American Organization of Nurse Executives (AONE) and by hospitals that have heard about the work and are committed to participating in transformational change. It requires that hospital executives support front-line staff in leading rapid-cycle change, support staff education in using TCAB tools—and perhaps most important—embrace, daily, a new way of operating. TCAB is not a one-time project.

AJN has also published a series of 12 articles by Massachusetts General Hospital nurse Amanda Stefancyk, describing her unit’s experience with TCAB. That series is available here.

If you’re a staff nurse or nurse manager, think about proposing that your unit pilot TCAB. You can find all you need to get started at RWJF’s TCAB site. We also need to share the new AJN report with trustees, members of the “C-suite” (CEOs, COOs, CNOs, CFOs) and policymakers.And all of us can create demand for hospital support for excellence in nursing care by asking, on job interviews and when choosing a hospital to work in or seek care in: “Is this a TCAB hospital?”