Engaging Front-Line Staff to Improve Quality and Safety in Hospitals

1. Engaging Front-Line Staff to Improve Quality and Safety in Hospitals Peter Lazes, Cornell University, ILR School Donna Sullivan Havens, University of North Carolina School of Nursing at Chapel Hill, NC Pete Carlson, Cornell University, ILR School Sloan Industry Studies Conference

2. Terms • Front-line staff • Levels of involvement

3. Assumptions • Involving front-line staff can be important in improving quality and efficiencies • Involving front-line staff may play an important role in sustaining and spreading improvements

4. Research Questions • To what extent are hospitals involving front-line staff in improvement activities? • How are they involved in these activities? • What kind of results are they getting?

5. Research Design • Phase I: Screening hospitals using phone interview to identify promising sites for case studies • Phase II: In-depth case studies

6. Site Selection Criteria • Baldridge Awards • Labor-Management Partnerships • Lean and 6 Sigma • Magnet Hospitals • Pursuing Perfection • Transforming Care at the Bedside

7. Research Process • Careful selection of sites • Phone interviews with the person most familiar with their quality improvement activities • 41 hospitals met criteria • 31 sites participated • 27 interviews completed

8. Current findings • Disconnect between the story we got from the person we interviewed and what we knew about the particular hospital.

9. Current Findings (continued) 2. There was a disconnect between how the respondent rated the hospital for the level of front-line staff involvement and how we would have rated them based on what they had told us

10. Current Findings (continued) 3. The improvement efforts described were mainly driven by external pressures

11. Current Findings (continued) 4. In several cases, unions were actively partnering with management

12. Reflections • We are not sure whether we spoke to the most appropriate person • There is a strong likelihood that there are significant silos between quality activities and meeting the needs of patients

13. Reflections (continued) • How are hospitals going about balancing working on external measures and responding to patient care issues?

14. Next Phase • Additional phone interviews to identify sites with the most extensive front-line staff involvement • Conduct 4 to 6 case studies