CSTS Staff EmpowermentCSTS Staff Empowerment

Christine A. Goeschel ScD MPA MPS RN

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Learning ObjectivesLearning Objectives

• To understand the importance of empowering front line staff

• To consider the regulatory and accreditation expectations that support patient focused decision making by all members of the clinical team

• To explore techniques that help front line staff when challenged by hierarchical structures or power gradients

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What We KnowWhat We Know

• Change involves technical challenges– Evidence– Measurement– Analysis

• Change involves adaptive challenges– How to Engage nurses, physicians, executives– Competing priorities– Organization hierarchies– How to hardwire practice changes

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What Have We Learned So Far?What Have We Learned So Far?

• Work involves technical problems– Evidence– Measurement

• Adaptive problems– Engagement of nurses, physicians, others clinical

and administrative staff– CUSP– Daily goals– Competing priorities

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Improve Patient Safety Improve Patient Safety Culture: Create TrustCulture: Create Trust

• Caring

– Keep Patients your North Star

– Commit that preventable harm is not tenable

– Tell your own Josie Story

• Competent

– Learn from mistakes

– Implement teamwork tools (CUSP)

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Ensure Patients ReliablyEnsure Patients ReliablyReceive EvidenceReceive Evidence

Pronovost: Health Services Research 2006

  Senior TeamStaff

leaders leaders

Engage How does this make the world a better place?

Educate What do we need to do?

ExecuteWhat keeps me from doing it?How can we do it with my resources and culture?

Evaluate How do we know we improved safety?

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Placing Value on Staff Placing Value on Staff EmpowermentEmpowerment

Keep patient as north star ~ Harm is not tenable

• Support decision to speak up– Must feel competent – Must feel it is safe– Must feel it will work

• Transparency when harm occurs– At patient level– At provider level– At organization level

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Strategies for Staff Empowerment

• Policy Level (only helpful if enforced)

• Examples:

• Code of conduct

• Require nurses to assist with central line placement

• Require adherence to checklist

• Policy to deal with disruptive behavior

• Require surgery briefing and debriefing

• Require written report when handoffs occur

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Strategies for Nurse Empowerment

• Practice Level

– Licensure

– Nurse Practice Act

– Magnet Nursing

– Collaborative Practice Models

• Infection Preventionists

• Attending Physicians

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Structures that Support Empowered Staff

• Performance Level

– Orientation /Skill Building

– Annual Competency Assessment

– Recognition/Reward

• clinical ladder (nurses)

• compensated time (physician staff)

• ???Perfusionists, techs, therapists, etc

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• Use tools to practice empowerment in safe space– Participates in patient rounds– Daily Goals with non-physician read back– Learn from Defects– Participate in M&M

• Address disruptive behavior quickly

Strategies for Empowering Clinical Staff

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• In conflict, keep focus on patient as north star

• Remind staff that teams make wise decisions with diverse and independent input– Do not play man down

Strategies for Strategies for Empowering Clinical StaffEmpowering Clinical Staff

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Action PlanAction Plan

• Project leaders meet with CSTS teams

• Discuss what policies/procedures exist to support empowerment

• What procedures may be needed?

• Create strategy to involve frontline staff across the care continuum in this project : use the 4Es

• Discuss what tools you can use to enhance empowerment