Transforming Care at the Bedside (TCAB)

You are here:

Transforming Care at the Bedside (TCAB)

What is TCAB?

Transforming Care at the Bedside (TCAB) is a national program that was developed by the Robert Wood Johnson Foundation (RWJF) and the Institute for Healthcare Improvement (IHI). The program goal is to engage front-line hospital nurses and leaders at all levels of the organization to:

Improve the quality and safety of patient care on medical and surgical units.
Increase the vitality and retention of nurses.
Engage and improve the patient's and family members' experience of care.
Improve the effectiveness of the entire care team.

The current TCAB initiative is based on the experience and widespread success of the 117 original TCAB hospitals who participated in the pilot program. Since 2008, TCAB has been offered to hospitals through Aligning Forces for Quality (AF4Q), a national program of the Robert Wood Johnson Foundation. The AF4Q TCAB Collaborative is an initiative that engages nurses and frontline staff to improve the quality and safety of patient care on hospital units. It brings together those who get care, give care, and pay for care to improve the quality of health care in entire communities.

Why Should My Hospital Participate in TCAB?

Hospitals that have implemented TCAB consistently report positive outcomes on the participating units, such as decreased falls and pressure ulcers, increased time spent by nurses in direct patient care, and increased patient and nursing satisfaction. The return on investment for TCAB hospitals has been shown to be well worth their input of resources, and tends to yield increasingly larger dividends as the initiative continues.

The Business Case for TCAB

The equation for net income is simple: Total Revenues – Total Expenses = Net Income. The results of TCAB affect both revenues and expenses in ways that are favorable to a hospital’s bottom line (by increasing revenues and decreasing expenses). Here are some ways that TCAB affects hospital revenues:

TCAB outcomes

Impact on Revenue

Higher patient satisfaction

Happy patients = loyal customers who will return for subsequent visits when they need health care.

Data on patient satisfaction and quality of care are becoming more available to consumers and the consumption of health services based on this information is increasing.

Higher job satisfaction for hospital staff (especially nurses)

The TCAB environment makes it easier to recruit great staff members who will provide the kind of care that will attract customers (patients), which grows the hospital’s business and market share. Nurses and physicians want to work in an environment where employee morale is high, and patients want to receive care from clinicians who genuinely love their work.

Higher staff satisfaction not only reduces turnover, but helps hospitals to recruit the best nurses, physicians, and other staff members. This gives the hospital a competitive advantage.

Reducing Waste

Finding places to trim expenses is often difficult, but TCAB makes it simpler by reducing waste and increasing quality and efficiency through its processes.

TCAB outcomes

Impact on Expenses

Decreased nurse turnover

A conservative estimate of turnover cost at a New York hospital was over $53,000 per nurse (this estimate includes expenses related to training, orientations, sign-on bonuses, etc.).1

The pre-TCAB nurse turnover rate at the same New York hospital was 7 FTEs per year. After implementing TCAB, the hospital had only 1 RN turnover during the course of 18 months. This saved them the cost of 9.5 FTE turnovers, or approximately $507,452 over that 1.5 year period.1

Decreased incidence of pressure ulcers

Decreased expenses resulting from hospital-acquired pressure ulcers. In 2007, the average cost per case in which pressure ulcers were listed as a secondary diagnosis was estimated by the CMS to be $43,180 per hospital stay.1

Decreased liabilities resulting from lawsuits for preventable pressure ulcers.

1 Source: Brian Banas, MBA, RN, Chief Operating Officer at Medina Memorial Hospital, New York. The Business Case for TCAB at Medina Memorial Hospital. March 2011.

Most importantly, TCAB doesn’t waste time and money on ineffective strategies. Rapid-cycle tests of change (a signature element of the TCAB process) permits the front-line staff to move quickly to figure out what works and what doesn’t work. Since these tests of change start out on the smallest scale possible, “failed” tests do not impose heavy risks or costs, but rather serve as opportunities to learn from the results and make modifications for the next tests of change. Ultimately, TCAB outcomes such as increased patient and staff satisfaction are not just “feel-good” concepts- they translate directly into dollars, and are key components to your hospital’s future success.

Oregon Hospitals Participating in TCAB

Harney District Hospital
Lake District Hospital
Mercy Medical Center
Mid Columbia Medical Center
Providence St. Vincent Medical Center *5 teams!*
Rogue Valley Medical Center *2 teams!*
Tillamook Hospital

Contact Information

Diane Waldo, MBA, BSN, RN, CPHQ, CPHRM, LNCC
Oregon TCAB Regional Clinical Leader
E-mail: diane.waldo@oahhs.org
Office: 503-479-6016
Cell: 503-333-8577