There has always been a distinction between providing the best practice vs.  common practice for health care providers and their organizations, and in order to bridge that gap, it is vital that innovations and new ideas can be spread quickly.  Pockets of excellence exist in our healthcare systems, but sometimes, awareness of the best ideas and practices often remain unknoo others (Schall, 2008.)

Transforming Care at the Bedside, or TCAB, is a national program that utilizes top management at all levels of the healthcare organization, building on the skills of front-line nurses and other healthcare workers on the team to enhance the level of quality as well as safety of patient care on medical and surgical units; in addition, it is designed to increase the motivation level and retention of nurses, and involve patients and their families so that their experiences with the healthcare system will result in more positive results. Another goal is to increase the effectiveness of the entire care-providing group of staff (Rutherford, 2009.)

One of the most important aspects of a hospital’s decision to implement a TCAB program is the involvement of front-line nursing staff, as a way to maximize the efforts to implement quality improvement methods.  These programs can include a variety of components but one of the most important issues that maximizes the chances of success is considered to be support of the staff.  Since in the past there were significant holes in comprehending the best ways to involve staff nurses in change procedures, TCAB was meant to help to fill in these gaps by providing support and training for both staff nurses and managers.  The goal is to empower them so that they are able to identify areas that need to change, evaluate work processes, test out new processes, and make decisions about which ones should be continued (Parkerton, 2009.)

There are several unique aspects of the TCAB framework that differ from other types of quality improvement strategies. For example:

• Instead of coming from hospital leaders or the quality improvement portion of the hospital staff, TCAB utilizes staff that are usually on the front lines as well as unit managers. This way, the nurses who are most familiar with the patients and their families deliver those services in a more personal manner.
• TCAB aims to develop changes that will transform the organization. The staff in charge as well as the nursing staff continually challenge themselves by examining critically their assumptions, experiences, and by including the families of their patients and the patients themselves in their decision-making, the patients become partners with the staff rather than simply being on the receiving end of care as passive participants.
• Finally the TCAB process is not static in that it continually encourages new learning, discoveries, and improvements. New ideas are tested in an effort to improve processes.

At the Robert Woods Johnson Foundation, there are serious efforts to spread and share TCAB methods with other units and hospitals. The hospitals that opt to become involved in switching over to TCAB practices are coached on how to identify, develop, test, and share prototypical means designed to improve the quality of care. Those staff at the participating hospitals try out various changes in the ways in which they organize and provide care and many of their changes and innovations are later adopted as standard practice (Pearson, 2008.) Each organization takes a different approach when it comes to how much latitude to give to the frontline nurses in making decisions about the nature of the innovations to be utilized and tested. Some hospitals use a top-down approach to create a predetermined innovation that was originally developed at the grassroots level, and others use a bottom-up approach to distribute the TCAB changes (Pearson, 2008.)

An example of an implementation of a TCAB program involved one of the original pilot sites, the medical-surgical unit at Seton Northwest Hospital in Austin, Texas. Over a five-year period, the TCAB model spread to more than 21 units across the hospital network. At that hospital, the chief nursing officer felt very strongly about making the change to that model, and so it became a priority among the hospital’ s organizational goals. Their method for spreading TCAB from the pilot site to other sites within that system depended heavily on the TCAB spread team, which included the chief nursing officer, two day-to-day nurse leaders, a senior project coordinator, various clerical support staff and a coach who met with the spread team every few months (Perez, 2009.)

Seton Northwest Hospital’s success in utilizing, adopting and spreading TCAB had a great deal in common with the other hospital units that have tended to have a successful outcome. The hospitals had certain qualities in common: their unit leaders and staff were extremely involved in the process of change, each unit had at least one TCAB strong proponent who acted as an instructor who taught the frontline staff the program’s techniques for identifying and following through with changes; staff members then shared what they had learned with other unit representatives in meetings that were scheduled on a monthly or quarterly basis. (Perez, 2009.) It seems clear that a crucial component in the success or lack thereof in implementing TCAB is providing enough support and encouragement to the staff so that they develop a sense of enthusiasm and pride in their contributions to significant improvements in patient care. Some hospitals have even implemented virtual meetings to allow staffs from other hospitals to both participate in providing and receiving feedback about their programs while saving time by cutting out travel time that is much needed to use for direct service to patients.