Transforming Care At The Bedside Research Articles

Improving patient handover: A narrative review.

The clinical handover process has been directly associated with patient safety. Improving patient handover can improve patients' safety and ultimate outcomes; therefore, this review was conducted to examine the literature available on interventions that make handovers more effective. MEDLINE (EBSCO) was searched for interventions that improve the efficacy of clinical handovers. Studies were excluded if they were irrelevant, not published in peer-reviewed journals, not published in English, or were based on animal studies. A total of 1087 publications were retrieved and sorted by relevance. The eligibility of the articles was determined by reading through the titles and abstracts then full texts, and reference searching. Six studies were selected for this literature review. A number of handover interventions were explored. One intervention was changing the handover location to patients' bedside; Bradley et al. found that bedside handovers decreased handover time and patient adverse events. Another intervention was providing education on handovers which Sand-Jecklin et al. associated with reductions in adverse events. Moreover, Lee et al. used simulation-based education and found that it significantly improved nurses' knowledge, performance competence, and self-efficacy. Another intervention was the transforming care at the bedside (TCAB) framework which incorporated multidimensional strategies and emphasized handover as part of patient centeredness; these strategies improved patient safety, yet the results cannot be attributed solely to handover modifications. Meanwhile, Hada et al. implemented a mixture of interventions and found that they improved patient safety and reduced adverse events. The interventions explored were bedside handovers, providing education and simulation-based education on handovers, emphasizing patient centeredness as part of TCAB strategies, and implementing a mixture of interventions. All interventions reduced adverse events, although some improvements were not significant. Due to the limited evidence available to support the efficacy of the interventions on improving clinical handovers, the results remain inconclusive.

Transforming Nursing Care at Patients' Bedside in Low Resource Settings: A Study of Four Hospitals in Southern Nigeria

As the largest group of health care professionals, nurses are in a nodal position to ensure achievement of healthcare goals. Transforming Care at the Bedside (TCAB) is a global initiative whereby nurses implement innovative practices for patient satisfaction. However, the initiative has not been the focus of studies in Nigeria. This study examined TCAB practices among nurses in four hospitals in Southern Nigeria; and determined the effectiveness of capacity building on selected TCAB activities and outcomes. Triangulation (observation, descriptive and quasi-experimental) design was used to collect data from 224 randomly selected nurses working in medical and surgical units of four hospitals in two States of Southern Nigeria. Validated Observation checklist and two validated researcher-developed Questionnaires were utilized to collect data. The Intervention involved capacity building on 21 TCAB activities in four core areas: safe and reliable care; vitality and teamwork; patient-centred care; value-added care processes. The study followed ethical processes. Data were analysed using descriptive and inferential statistics on SPSS 20. After capacity building, nurses' practice of most TCAB activities improved significantly (p≤0.05), except for work redesign, and improving the work environment. Nurses also spent significantly more time on value-added activities and less time on non-value-added activities after the intervention. Practice of TCAB activities was significantly associated with patient and family satisfaction, nurses' satisfaction, patients' wellbeing, nurse: patient interactions and quality of care (p <0.001). Nurses in the four hospitals implemented many TCAB activities, and this significantly increased nurse: patient interactions, patient wellbeing and satisfaction in the hospitals studied. The TCAB initiative is therefore feasible and relevant in low resource settings like Nigeria.

Variables Associated With Nurse-Reported Quality Improvement Participation

Lack of staff engagement in quality improvement (QI) is a persistent challenge in improving quality in health care. In this study, we examined variables associated with nurse-reported participation in QI using data from over 500 registered nurses employed in US hospitals. Of the 16 studied variables, based on the adjusted multivariate regression analysis, the following were positively associated (p

Increasing value-adding patient care by applying a modified TCAB program

PurposeThe purpose of this study is to evaluate a development process aimed at increasing registered nurses’ (RNs) working time use in value-adding patient care by applying a modified Transforming Care at the Bedside (TCAB) program at inpatient units of two tertiary hospitals.Design/methodology/approachBasic data for the development process were collected on RNs’ working time use via external observation in 2011 (RNs = 113). Nursing work was redesigned and implemented by 12 multi-professional teams during 2012-2013. The development process was evaluated by repeating the collection of RNs’ working time use data in 2013 (RNs = 95) and by analyzing the memos of the development teams via deductive content analysis (N = 64).FindingsRNs’ working time use showed statistically significant increases in value-adding care and direct patient care but decreases in non-value-added work and miscellaneous work. Changes in the nursing work model, division of labor and the nursing work environment all affected RNs’ working time use.Practical implicationsThe development process progressed distinctively in each unit, as shown by the results of the development work. Clinical RNs had key roles as innovators and change agents, yet the engagement of nursing managers was most essential for the success of the development work.Originality/valueEven minor changes in nurses’ daily work profile can have considerable effects on RNs’ work. The TCAB program was shown to be a useful method in developing RNs’ work also in psychiatric units.

The Effects of the Transforming Care at the Bedside Program on Perceived Team Effectiveness and Patient Outcomes.

The objective of the study was to document the impact of Transforming Care at the Bedside (TCAB) program on health care team's effectiveness, patient safety, and patient experience. A pretest and posttest (team effectiveness) and a time-series study design (patient experience and safety) were used. The intervention (the TCAB program) was implemented in 8 units in a multihospital academic health science center in Montreal, Quebec, Canada. The impact of TCAB interventions was measured using the Team Effectiveness (TCAB teams, n = 50), and Clostridium difficile-associated diarrhea and vancomycin-resistant Enterobacter rates (patient safety) and Hospital Consumer Assessment of Healthcare Providers and Systems (patient experience; n = 551 patients). The intervention was composed of 4 learning modules, each lasting 12 to 15 weeks of workshops held at the start of each module, combined with hands-on learning 1 day per week. Transforming Care at the Bedside teams also selected 1 key safety indicator to improve throughout the initiative. Pretest and posttest differences indicate improvement on the 5 team effectiveness subscales. Improvement in vancomycin-resistant Enterococcus rate was also detected. No significant improvement was detected for patient experience. These findings call to attention the need to support ongoing quality improvement competency development among frontline teams.

Teaching nursing students to provide effective heart failure patient education using a peer teaching strategy

Background/objective : Prelicensure nursing students possess minimal knowledge, skills, and confidence to provide effective, patient-centered transitional heart failure (HF) education to patients. This article evaluates a unique educational intervention designed to prepare nursing students to be more effective HF patient educators upon graduation. Methods : A pretest, posttest design and survey was used to evaluate a three-hour educational program. This program was offered to three different groups of students between Fall 2013 and Spring 2016. Eighteen fourth-semester students trained as peer teachers helped present program content to 66 second-semester Accelerated Bachelor of Science (ABS) nursing students. Resources from the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation Transforming Care at the Bedside (TCAB) materials were used as the curricular guide. The program consisted of a HF didactic session, case study, role-play, and simulation activities. Results : Second-semester students demonstrated improvement in identifying essential elements of HF patient education, from 45.8% to 86%, and the ability to perform Teach-back increased from 43% to 86% ( p < .001). Confidence in patient education skills and Teach-Back technique increased from 17% to 94% ( p < .001). Conclusions : Using fourth-semester peer teachers to facilitate education provides an effective and satisfying way for the second semester students to practice new techniques through role-play. The HF peer teaching program is highly adaptable to prepare prelicensure nursing students to educate patients and families on a wide variety of chronic illnesses across the healthcare continuum.

Engaging Frontline Staff in Performance Improvement: The American Organization of Nurse Executives Implementation of Transforming Care at the Bedside Collaborative

Process improvement stresses the importance of engaging frontline staff in implementing new processes and methods. Yet questions remain on how to incorporate these activities into the workday of hospital staff or how to create and maintain its commitment. In a 15-month American Organization of Nurse Executives collaborative involving frontline medical/surgical staff from 67 hospitals, Transforming Care at the Bedside (TCAB) was evaluated to assess whether participating units successfully implemented recommended change processes, engaged staff, implemented innovations, and generated support from hospital leadership and staff. In a mixed-methods analysis, multiple data sources, including leader surveys, unit staff surveys, administrative data, time study data, and collaborative documents were used. All units reported establishing unit-based teams, of which >90% succeeded in conducting tests of change, with unit staff selecting topics and making decisions on adoption. Fifty-five percent of unit staff reported participating in unit meetings, and 64%, in tests of change. Unit managers reported substantial increase in staff support for the initiative. An average 36 tests of change were conducted per unit, with 46% of tested innovations sustained, and 20% spread to other units. Some 95% of managers and 97% of chief nursing officers believed that the program had made unit staff more likely to initiate change. Among staff, 83% would encourage adoption of the initiative. Given the strong positive assessment of TCAB, evidence of substantial engagement of staff in the work, and the high volume of innovations tested, implemented, and sustained, TCAB appears to be a productive model for organizing and implementing a program of frontline-led improvement.

To Our Readers

Process improvement stresses the importance of engaging frontline staff in implementing new processes and methods. Yet questions remain on how to incorporate these activities into the workday of hospital staff or how to create and maintain its commitment. In a 15-month American Organization of Nurse Executives collaborative involving frontline medical/surgical staff from 67 hospitals, Transforming Care at the Bedside (TCAB) was evaluated to assess whether participating units successfully implemented recommended change processes, engaged staff, implemented innovations, and generated support from hospital leadership and staff.In a mixed-methods analysis, multiple data sources, including leader surveys, unit staff surveys, administrative data, time study data, and collaborative documents were used.All units reported establishing unit-based teams, of which > 90% succeeded in conducting tests of change, with unit staff selecting topics and making decisions on adoption. Fifty-five percent of unit staff reported participating in unit meetings, and 64%, in tests of change. Unit managers reported substantial increase in staff support for the initiative. An average 36 tests of change were conducted per unit, with 46% of tested innovations sustained, and 20% spread to other units. Some 95% of managers and 97% of chief nursing officers believed that the program had made unit staff more likely to initiate change. Among staff, 83% would encourage adoption of the initiative.Given the strong positive assessment of TCAB, evidence of substantial engagement of staff in the work, and the high volume of innovations tested, implemented, and sustained, TCAB appears to be a productive model for organizing and implementing a program of frontline-led improvement.

Facilitating Nurses' Engagement in Hospital Quality Improvement: The New Jersey Hospital Association's Implementation of Transforming Care at the Bedside.

Transforming Care at the Bedside (TCAB) is a program designed by the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement to engage frontline staff in change processes to improve the work environment and patient care on nursing units. Originally designed and piloted in a small number of hospitals, TCAB is being disseminated through large-scale quality improvement (QI) collaboratives facilitated by professional organizations, such the New Jersey Hospital Association's Institute for Quality and Patient Safety (NJHA). This article presents the results of an evaluation of the NJHA dissemination effort. The evaluation team used an observational mixed-method evaluation design and multiple data sources to assess implementation of TCAB by nursing units in these facilities. The results show that most of the participating units successfully implemented the TCAB improvement processes. Nursing teamwork and three nursing-sensitive outcomes improved significantly over the course of TCAB, and TCAB unit managers attributed important improvements to their unit's participation. These findings suggest that TCAB is a viable mechanism for engaging frontline nursing staff in valuable QI activities. Other hospitals interested in furthering the culture and capacity for QI among frontline nursing unit staff should consider a TCAB collaborative for achieving these goals.

Effective Strategies to Spread Redesigning Care Processes Among Healthcare Teams.

The purpose of this study was to describe how spread strategies facilitate the successful implementation of the Transforming Care at the Bedside (TCAB) program and their impact on healthcare workers and patients in a major Canadian healthcare organization. This study used a qualitative and descriptive design with focus groups and individual interviews held in May 2014. Participants included managers and healthcare providers from eight TCAB units in a university health center in Quebec, Canada. The sample was composed of 43 individuals. The data were analyzed using NVivo according to the method proposed by Miles and Huberman. The first two themes that emerged from the analysis are related to context (organizational transition requiring many changes) and spread strategies for the TCAB program (senior management support, release time and facilitation, rotation of team members, learning from previous TCAB teams, and engaging patients). The last theme that emerged from the analysis is the impact on healthcare professionals (providing front-line staff and managers with the training they need to make changes, team leadership, and increasing receptivity to hearing patients' and families' needs and requests). This study describes the perspectives of managers and team members to provide a better understanding of how spread strategies can facilitate the successful implementation of the TCAB program in a Canadian healthcare organization. Spread strategies facilitate the implementation of changes to improve the quality and safety of care provided to patients.

Part 1: Evidence-based facility design using Transforming Care at the Bedside principles.

An academic hospital used Transforming Care at the Bedside (TCAB) principles as the framework for generating evidence-based recommendations for the design of an expansion of the current hospital. The interdisciplinary team used the table of evidence-based data to advocate for a patient- and family-centered, safe, and positive work environment. A nurse project manager acted as liaison between the TCAB design team, architects, and facilities and design consultants. Part 2 of this series describes project evaluation outcomes.

Transforming Care at the Bedside: managers' and health care providers' perceptions of their change capacities.

The Transforming Care at the Bedside (TCAB) project engages frontline health care providers as the leaders of change and improvement efforts in their work environment. This study explored how health care providers and managers from three TCAB units in a university-affiliated health care center perceived the development of their change capacities following their involvement in this program. This descriptive, qualitative study involved focus groups and individual interviews. Participants learned to work as a team and to expand their outlook. They had access to processes and tools to learn new skills. New relationships also developed among the various players, and they shared new roles, which enabled them to translate the desired changes into action and make the results visible. The study showed the TCAB program helps develop health care providers' and managers' change capacities.

CE: Original research: the perceptions of health care team members about engaging patients in care redesign.

This study sought to explore the perceptions of health care workers about engaging patients as partners on care redesign teams under a program called Transforming Care at the Bedside (TCAB), and to examine the facilitating factors, barriers, and effects of such engagement. This descriptive, qualitative study collected data through focus groups and individual interviews. Participants included health care providers and managers from five units at three hospitals in a university-affiliated health care center in Canada. A total of nine focus groups and 13 individual interviews were conducted in April 2012, 18 months after the TCAB program began in September 2010. Content analysis was used to analyze the qualitative data. Health care providers and managers benefited from engaging patients in the decision-making process because the patients brought a new point of view. Involving the patients exposed team members to valuable information that they hadn't previously thought about during decision making. Health care teams stand to benefit from engaging patients in the change process. Patients contribute a different point of view, and this helps to ensure that the changes proposed and implemented address their needs.

Improving The Effectiveness Of Human Resources Practices Through Transforming Care At The Bedside

In 2010, in an effort to increase patient involvement in decision-making about health care redesign, a Quebec university health care organization implemented the Transforming Care at the Bedside (TCAB). This article presents the results from a qualitative study exploring health professionals’ perceptions of TCAB and the effect on turnover and overtime. This descriptive, qualitative study utilized focus groups, individual interviews, and a review of administrative documents for data collection. Participants included hospital workers from five units implementing TCAB. The data generated by the interviews and focus groups were analyzed using NVivo with the method proposed by Miles and Huberman (1994). During the first year of implementation of TCAB, the team noted the importance of taking time to see the effects of the changes and thereby facilitate the involvement of other team members. A number of TCAB team members also cited communication as a facilitating element for informing team members of changes. According to the participants, the TCAB strategies that were implemented have had a positive impact on practice and on the work environment, and turnover showed an improvement. There was no change in absenteeism. TCAB has the potential to impact not only nurses’ work, but interprofessional team work as well, through changes that involve everyone. Future research should focus on how to support team members to reduce resistance to change and increase social support in order to implement and sustain changes.

The Effect of Transforming Care at the Bedside Initiative on Healthcare Teams’ Work Environments

Different initiatives have been implemented in healthcare organizations to improve efficiency, such as transforming care at the bedside (TCAB). However, there are important gaps in understanding the effect of TCAB on healthcare teams' work environments. The specific aim of the study is to describe findings regarding the TCAB initiative effects on healthcare teams' work environments. A pretest and posttest study design was used for this study. The TCAB initiative was implemented in fall 2010 in a university health center in Montreal, Canada. The sample consisted of healthcare workers from four different care units. Statistically significant improvement was observed with the communicating specific information subscale from the measure of processes of care variable, and a significant difference was found between the support from colleagues variable, which was higher at baseline than postprogram. The differences for psychological demand, decisional latitude, and effort-reward were not significant. TCAB is an intervention that allows healthcare teams to implement change to improve patients' and families' outcomes. Ongoing energy should focus on how to improve communication among all members of the team and ensure their support.

Critical evaluation of transforming care at the bedside application in a multi-model nursing practice: A reflective review

It will soon be a decade since Transforming Care at the Bedside (TCAB) initiated by the Institute of Healthcare Improvement (IHI) was introduced. This noble idea has had great successes and led to improvements in patient safety. Some institutions have successfully implemented and realized the benefits. We have conducted a reflective review of the possible challenges that may hinder other institutions from successfully implementing this initiative and suggest some action plans that may deliver a better result. Our review broadly examines the main nursing models in relation to patient care quality improvement, that is American and British models and we base our arguments on our experiences in Australia, the United Kingdom, Ireland and in Saudi Arabia. Where the latter’s healthcare practices are a prototype of the American model, mainly because in America, the healthcare is primarily private and has to often cope with care related litigation, contrary to Saudi Arabia where the government offers free healthcare to all its citizens and also, the citizens have the privilege of opting to seek care in other organizational facilities in which they are eligible. Our review points out that, though all other aforementioned countries have taken steps to incorporate TCAB, it is a new initiative being introduced into one of Saudi Arabia’s top healthcare organizations. Being participants in this organization which has recently moved to “implementing” TCAB, our study is focused on reviewing the systems readiness in implementing this initiative, with special focus on system structure and planning. We also discuss how achievement of success in implementing TCAB and all other quality improvement projects require system and needs analysis and thorough preparedness of all relevant players. The discussion will carefully consider and deliberate on TCAB’s core agendas but can be extrapolated to all other safety and quality projects undertaken within a healthcare system.

A trinity of engagement transforms care at UPMC Shadyside's 6 Main

AbstractAt 6 Main, part of the University of Pittsburgh Medical Center, the evolution from a struggling patient care unit to a high‐functioning patient care team was led by a thoughtful partnership involving the unit director, her staff, and an improvement specialist trained in the use of Transforming Care at the Bedside (TCAB) tools. Motivated to achieve total patient safety, they worked together to transform the culture of a nursing unit so that those closest to the patients are empowered to initiate and lead improvement efforts. The results of this transformation are reflected in higher patient satisfaction scores that stem from enhanced communication with nurses, greater responsiveness of hospital staff, and a safer and more pleasant hospital environment. © 2012 Wiley Periodicals, Inc.

Maureen White, MBA, RN, NEA-BC

Maureen White, MBA, RN, NEA-BC

Transforming Care at the Bedside (TCAB): Enhancing Direct Care and Value-added Care

The purpose of this study was to examine the effectiveness of a Transforming Care at the Bedside initiative from a unit perspective. Improving patient outcomes and nurses' work environments are the goals of Transforming Care at the Bedside. Transforming Care at the Bedside creates programs of change originating at the point of care and directly promoting engagement of nurses to transform work processes and quality of care on medical-surgical units. This descriptive comparative study draws on multiple data sources from two nursing units: a Transforming Care at the Bedside unit where staff tested, adopted and implemented improvement ideas, and a control unit where staff continued traditional practices. Change theory provided the framework for the study. Direct care and value-added care increased on Transforming Care at the Bedside unit compared with the control unit. Transforming Care at the Bedside unit decreased in incidental overtime. Nurses reported that the process challenged old ways of thinking and increased nursing innovations. Hourly rounding, bedside reporting and the use of pain boards were seen as positive innovations. Evidence supported the value-added dimension of the Transforming Care at the Bedside process at the unit level. Nurses recognized the significance of their input into processes of change. Transformational leadership and frontline projects provide a vehicle for innovation through application of human capital.

Do Lean Practices Lead to More Time at the Bedside?

The aim of this review is to evaluate the application of value-added processes in healthcare, with an emphasis on their effects on bedside nursing. Literature relevant to Lean methodology and inpatient care was reviewed, excluding all research related to other service lines (i.e., surgical services, emergency services, laboratory, radiology, etc.). Increased value is also an important tenet of transforming care at the bedside (TCAB), an initiative launched by the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF). Therefore, articles concerning TCAB were also included in this review. A systematic study of the literature revealed varied applications of Lean principles in practice, ranging from the implementation of a single tool, to full organizational restructuring. All articles reviewed reported positive results, although the majority lacked strong supporting evidence for claims of improvement. Even though there is some indication that the application of Lean principles to nursing processes is successful in improving specific outcomes, the authors cannot conclude that the implementation of Lean methodology or TCAB greatly influences direct patient care, or increases time spent at the bedside.