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

Terms Front-line staff Levels of involvement

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

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?

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

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

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

Current findings 1.Disconnect between the story we got from the person we interviewed and what we knew about the particular hospital.

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

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

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

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

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

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