AHRQ Safety Program For Long-Term Care: HAIs/CAUTI Module 3: Staff Empowerment

2 Objectives Cite staff empowerment concepts Discuss how staff empowerment contributes to a culture of resident safety, leading to improved outcomes and quality of life Illustrate three ways to increase staff empowerment Explain how to address and overcome challenges to staff empowerment Staff Empowerment

3 What Is Staff Empowerment? “Belief that one has control over decision making”¹ Staff Empowerment

4 Organizational Factors for Staff Empowerment²¯⁴ Structures for advancement opportunities Awareness of staff contributions Access to resources, information, and support Staff Empowerment

5 Staff Empowerment Assessment Tools³, ⁵ HHS Report - Measuring Long-Term Care Work: A Guide to Selected Instruments to Examine Direct Care Worker Experiences and Outcomes Conditions for Work Effectiveness Questionnaire Perception of Empowerment Instrument (PEI) Psychological Empowerment Instrument Yeatts and Cready Dimensions of Empowerment Measure Staff Empowerment

6 Psychological Empowerment Instrument⁵ Sample questions for measuring competence: How strongly do you agree or disagree with these statements? 1.I am confident about my ability to do my job. 2.I am self-assured about my capability to perform my work. 3.I have mastered the skills necessary for my job. Staff Empowerment

7 Why is Staff Empowerment Important?⁵, ⁶ Higher staff satisfaction Lower turnover Improved quality of care for residents Staff Empowerment

8 Relationship Between Resident Quality of Life and Staff Empowerment⁷ Staff Empowerment Increased job satisfaction and lower job turnover Increased resident satisfaction and perception of care Higher quality of care overall

9 Importance of Empowering Nursing Staff ⁴, ⁷ Frontline providers Increased flow of information Resident advocates Staff Empowerment

10 Characteristics of an Empowered Frontline Staff Curiosity Interest in improvement Knowledge of nursing home resources and infrastructure Staff Empowerment

11 Curiosity Understand changes and the reasoning behind them Increase their knowledge about clinical care areas Have numerous opportunities to learn about how the organization operates and how resources are allocated Staff Empowerment

12 Interest in Improvement Understand how to apply and be actively involved in implementing best practices at an individual resident level Understand how best practices can be implemented and supported at a unit and facility level Staff Empowerment

13 Knowledge of Nursing Home Resources and Infrastructure Assessment of organizational processes Evaluation of practice interventions Active participation in continuous assessment and evaluation Staff Empowerment

14 What Builds Staff Empowerment? Leader support and teams Communication and information sharing Positive reinforcement Confidence Just Culture Staff Empowerment

15 An Empowered Team Staff Empowerment

16 Leader Support and Teams², ⁴ Teamwork Resources – Channels for advancement or growth in the organization – Opportunity for increases in knowledge and skill – Ability to participate in task forces or committees Staff Empowerment

17 Teamwork and Support Staff Empowerment

18 Communication and Information Sharing³ Encourage two-way communication between management and staff Provide a clear venue for all staff to share their achievements Create procedures for staff to safely share concerns Staff Empowerment

19 Open Communication Staff Empowerment

20 Positive Reinforcement³ Recognize staff and their contributions Celebrate success Use Learning From Defects tool Staff Empowerment

21 Positive Reinforcement Staff Empowerment

22 Confidence⁹ Collaborative trust and confidence Psychological safety – Invite input from all team members – Encourage team members to contribute – Promote active listening and learning from each other – Ensure all team members are accessible – Acknowledge the limits of current knowledge Staff Empowerment

23 Collaborative Trust and Confidence Staff Empowerment

24 Just Culture⁸, ⁹ Mission, values, and expectations System design Managing behavioral choices Learning systems Accountability and justice – Philosophy for response to error Staff Empowerment

25 A Just Culture Staff Empowerment

26 Barriers to Staff Empowerment¹⁰ Lack of senior leader support Lack of resources Poor teamwork and support Stagnation and loss of momentum for change Staff turnover Punitive response to error Staff Empowerment

27 Key Concepts Review Empowerment of frontline staff contributes to lower staff turnover and high job satisfaction, which increase resident satisfaction and safety Key factors influencing an empowered staff – Structures for advancement opportunities – Awareness of staff contributions – Access to resources, information, and support Staff Empowerment

28 References 1.Parker L, Price R. Empowered managers and empowered workers: The effects of managerial support and managerial perceived control on workers' sense of control over decision making. Human Relations. 1994;7(8): Brannon D, Mor V. Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. The Gerontologist. 2005;45(3): Bowers N, Nolet K, Roberts E, et al. Implementing Change in Long-Term Care: A Practical Guide to Transformation. University of Wisconsin–Madison, School of Nursing; chments_1_and_2.pdf. chments_1_and_2.pdf 4.Cready C, Yeatts D, Gosdin M, et al. CNA empowerment: Effects On Job Performance And Work Attitudes. Journal of Gerontological Nursing. 2008;34(3): Literature/2007/Nov/Consequences-of-Empowered-CNA-Teams-in-Nursing- Home-Settings--A-Longitudinal-Assessment.aspx. Literature/2007/Nov/Consequences-of-Empowered-CNA-Teams-in-Nursing- Home-Settings--A-Longitudinal-Assessment.aspx 5.Harris-Kojetin L, Brannon D, Barry T, et al. Measuring Long-Term Care Work: A Guide to Selected Instruments To Examine Direct Care Worker Experiences and Outcomes. Washington, D.C.: U.S. Department of Health & Human Services, U.S. Department of Labor; Staff Empowerment

29 References 6.Kolus K. Mather Pavilion – Staff Empowerment Yields Quality Improvement. Long-Term Living. 2010;59(9): Hamann DJ. Does Empowering Resident Families or Nursing Home Employees in Decision Making Improve Service Quality? Journal of Applied Gerontology. 2014;33(5): Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; content/uploads/flipbooks/healthcare/healthcare.htmlhttps://store.justculture.org/wp- content/uploads/flipbooks/healthcare/healthcare.html 9.CUSP Toolkit. Rockville, MD: Agency for Healthcare Research and Quality; December tools/cusptoolkit/toolkit/index.html. tools/cusptoolkit/toolkit/index.html 10.TeamSTEPPS Long-Term Care Toolkit. Rockville, MD. Agency for Healthcare Research and Quality; October tools/teamstepps/longtermcare/scenarios/index.html. tools/teamstepps/longtermcare/scenarios/index.html 11.Pronovost PJ, Berenholtz SM, Goeschel CA, et al. Creating high reliability in health care organizations. Health Services Research. 2006;41(4Pt2): Staff Empowerment