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Transforming Care at Mass General

Stefancyk, Amanda L. MSN, MBA, RN

AJN The American Journal of Nursing: September 2008 - Volume 108 - Issue 9 - p 71–72
doi: 10.1097/01.NAJ.0000334978.12855.59
DEPARTMENT: Transforming Care at the Bedside

Introducing TCAB at a Massachusetts hospital.

Amanda L. Stefancyk is nursing director of a general medical unit at Massachusetts General Hospital in Boston.

She also coordinates Transforming Care at the Bedside:

Editor's note: Recognizing that medical–surgical units are among the busiest and most challenging areas of many hospitals, the Robert Wood Johnson Foundation sought to find ways to retain bedside nurses by empowering them to make the changes needed to improve care and teamwork on the unit. It developed and funded an initiative called Transforming Care at the Bedside (TCAB—pronounced "tee-cab"). The Institute for Healthcare Improvement led the first phase of this work with 10 hospitals that had agreed to test a new role for nurses and other team members who are on the front line of care.

TCAB focuses on making improvements in four areas:

  • the safety and reliability of patient care
  • team vitality and teamwork
  • patient- and family-centered care
  • adding value to care processes (for example, by increasing the time that nurses spend in direct contact with patients)

These aims are achieved by providing frontline staff with the authority and tools needed to make such changes. For example, staff members engage in brainstorming exercises called "snorkels" and "deep dives" to identify barriers and possible solutions. Using the plan–do–study–act, or PDSA, method, staff members test, evaluate, and tweak their ideas as needed and then spread their use.

Taking off from the success of the initial 10 hospitals, the American Organization of Nurse Executives is leading a second phase of TCAB that involves more than 60 hospitals. Additional TCAB initiatives are expected from the Robert Wood Johnson Foundation. A virtual TCAB learning center (see, provides more information about TCAB as well as guides and tools that others can use to transform care in hospitals and other settings. Additional information and resources are available at

© 2008 Lippincott Williams & Wilkins, Inc.