Staff Empowerment Research Articles

Culture Change Practice in U.S. Nursing Homes: Prevalence and Variation by State Medicaid Reimbursement Policies

To estimate the prevalence of culture change practice in U.S. nursing homes (NHs) and examine how state Medicaid policies may be associated with this prevalence. In 2009/2010, we conducted a survey of a stratified proportionate random sample of NH directors of nursing (DONs) and administrators (NHAs) at 4,149 U.S. NHs; contact was achieved with 3,695. Cooperation rates were 62.6% for NHAs and 61.5% for DONs. Questions focused on NH (physical) environment, resident-centered care, and staff empowerment domains. Domain scores were created and validated, in part, using qualitative interviews from 64 NHAs. Other NH covariate data were from Medicare/Medicaid surveys (Online Survey, Certification and Reporting), aggregated resident assessments (Minimum Data Set), and Medicare claims. Medicaid policies studied were a state's average NH reimbursement rate and pay-for-performance (P4P) reimbursement (including and not including culture change performance measures). Multivariate generalized ordered logit regressions were used. Eighty-five percent of DONs reported some culture change implementation. Controlling for NH attributes, a $10 higher Medicaid rate was associated with higher NH environment scores. Compared with NHs in non-P4P states, NHs in states with P4P including culture change performance measures had twice the likelihood of superior culture change scores across all domains, and NHs in other P4P states had superior physical environment and staff empowerment scores. Qualitative interviews supported the validity of survey results. Changes in Medicaid reimbursement policies may be a promising strategy for increasing culture change practice implementation. Future research examining NH culture change practice implementation pre-post P4P policy changes is recommended.

Effects of person-centered care on residents and staff in aged-care facilities: a systematic review

BackgroundSeveral residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff.MethodsWe searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling) including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes.ResultsThe search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies) that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4). The studies in this review incorporated a range of different outcome measures (ie, dependent variables) to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents’ levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses’ sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an increased risk of falls. The findings from this review need to be interpreted cautiously due to limitations in study designs and the potential for confounding bias.ConclusionTypically, person-centered interventions are multifactorial, comprising: elements of environmental enhancement; opportunities for social stimulation and interaction; leadership and management changes; staffing models focused on staff empowerment; and assigning residents to the same care staff and an individualized philosophy of care. The complexity of the interventions and range of outcomes examined makes it difficult to form accurate conclusions about the impact of person-centered care interventions adopted and implemented in aged-care facilities. The few negative consequences of the introduction of person-centered care models suggest that the introduction of person-centered care is not always incorporated within a wider “hierarchy of needs” structure, where safety and physiological need are met before moving onto higher level needs. Further research is necessary to establish the effectiveness of these elements of person-centered care, either singly or in combination.

Leadership from the bottom up

A number of recent policy initiatives have sought to improve the quality of dementia care in residential and nursing homes. Drawing on current literature and themes identified from in-depth interviews with four managers working in these settings, this paper discusses the potential for different styles of leadership in developing a suitable organisational culture in which quality dementia care might develop and thrive. It argues that alongside valuable strategic imperatives coming from the UK National Dementia Strategy (DH, 2009), there is a corresponding need for more ‘bottom-up’ approaches within dementia care settings themselves through the empowerment of staff. It argues that this would enable more participatory approaches to organisational development. The paper specifically discusses the concepts of both ‘climate’ and ‘culture’ in institutional care for older people and how these features can be enhanced to support a more person-centered approach. Particular emphasis is given to the significance of leading a culture of learning, which we view as crucial to any transformation process.

Health Care Worker Perspectives Inform Optimization of Patient Panel-Support Tools: A Qualitative Study

Electronic decision-support systems appear to enhance care, but improving both tools and work practices may optimize outcomes. Using qualitative methods, the authors' aim was to evaluate perspectives about using the Patient Panel-Support Tool (PST) to better understand health care workers' attitudes toward, and adoption and use of, a decision-support tool. In-depth interviews were conducted to elicit participant perspectives about the PST-an electronic tool implemented in 2006 at Kaiser Permanente Northwest. The PST identifies "care gaps" and recommendations in screening, medication use, risk-factor control, and immunizations for primary care panel patients. Primary care physician (PCP) teams were already grouped (based on performance pre- and post-PST introduction) into lower, improving, and higher percent-of-care-needs met. Participants were PCPs (n=21), medical assistants (n=11), and quality and other health care managers (n=20); total n=52. Results revealed that the most commonly cited benefit of the PST was increased in-depth knowledge of patient panels, and empowerment of staff to do quality improvement. Barriers to PST use included insufficient time, competing demands, suboptimal staffing, tool navigation, documentation, and data issues. Facilitators were strong team staff roles, leadership/training for tool implementation, and dedicated time for tool use. Higher performing PCPs and their assistants more often described a detailed team approach to using the PST. In conclusion, PCP teams and managers provided important perspectives that could help optimize use of panel-support tools to improve future outcomes. Improvements are needed in tool function and navigation; training; staff accountability and role clarification; and panel management time.

Addressing distress in head and neck cancer patients: A quality improvement project.

43 Background: To better address the emotional needs of cancer patients by improving mental health care in Head and Neck Cancer (HNC) Medical oncology at Norris Cotton Cancer Center, Lebanon, NH, through implementing an evidence-based process for identifying and managing psychological distress. Methods: Using quality improvement methods, mental health care in HNC Medical Oncology was evaluated and revised November 2010 through April 2012. In January 2011, a two-component intervention was put into routine care including 1) the validated National Comprehensive Cancer Network (NCCN) distress thermometer (DT) and 2) a treatment decision algorithm. A licensed nursing assistant administered the DT and providers reviewed results as part of the clinical exam. Heightened distress was defined as a score of ≥ 4. Screening processes were improved through Plan-Do-Study-Act (PDSA) cycles. Results: Prior to January 2011, identification of distress was based on provider’s clinical assessment. Of 104 patients seen between November 2010 and January 2011, 25% (26) were diagnosed with psychological problems. Cause-effect diagraming suggested that lack of a formalized process for distress assessment contributed to missed diagnoses. Providers were unfamiliar with mental health resources. As reported in Psycho-Oncology 21(Suppl. 1): 51(2012) after implementing process changes, bi-weekly distress screening rates rose from 0% to 38% between January and July 2011. With additional PDSA cycles, these rates increased to 74% between October 2011 and April 2012. Similar to proposed benchmarks, 84% (47) of newly diagnosed patients (56) were assessed for distress. Furthermore, of 138 unique patients seen, 71% (98) were screened for distress and 47% (46) of these had heightened distress. Providers addressed the needs of all those identified. Improvement was attributed to the empowerment of staff and participation of senior leadership. Barriers included a heavy reliance on the presence of trained staff. Conclusions: Quality improvement methods can be applied to the cancer setting in order to create systems of care, which more reliably identify and address distress. Teams, however, must be invested in the work and receive support from senior leadership.

Hospital network performance: A survey of hospital stakeholders’ perspectives

Hospital networks are an emerging organizational form designed to face the new challenges of public health systems. Although the benefits introduced by network models in terms of rationalization of resources are known, evidence about stakeholders’ perspectives on hospital network performance from the literature is scanty. Using the Competing Values Framework of organizational effectiveness and its subsequent adaptation by Minvielle et al., we conducted in 2009 a survey in five hospitals of an Italian network for oncological care to examine and compare the views on hospital network performance of internal stakeholders (physicians, nurses and the administrative staff). 329 questionnaires exploring stakeholders’ perspectives were completed, with a response rate of 65.8%. Using exploratory factor analysis of the 66 items of the questionnaire, we identified 4 factors, i.e. Centrality of relationships, Quality of care, Attractiveness/Reputation and Staff empowerment and Protection of workers’ rights. 42 items were retained in the analysis. Factor scores proved to be high (mean score>8 on a 10-item scale), except for Attractiveness/Reputation (mean score 6.79), indicating that stakeholders attach a higher importance to relational and health care aspects. Comparison of factor scores among stakeholders did not reveal significant differences, suggesting a broadly shared view on hospital network performance.

Improving Job Satisfaction in an Ambulatory Care Setting and OR: Promoting a Culture of Zero Tolerance, Mutual Respect and Staff Empowerment

Effective multidisciplinary communication is vital to provide safe quality care. It was noted that there was bullying and disruptive behavior present within the OR and the Pre op areas, across disciplines. Employee job satisfaction scores were low.

القيادة التحويلية لدى القادة الأكاديميين في الجامعات الأردنية الرسمية وعلاقتها بتمكين أعضاء هيئة التدريس

This study aimed to investigate the level of practicing transformational leadership among academic leaders in official Jordanian universities, and its relationship with teaching staff empowerment. To achieve the study aim, a questionnaire was used to measure the transformational leadership of the academic leaders and the job empowerment of teaching staff. The study sample consists of (288) academic leaders in University of Jordan, Yarmouk University and Mu'tah University, and (773) teaching staff members were selected randomly in the mentioned universities, representing (30%) of the total number. The study findings revealed that academic leaders in official Jordanian universities have higher degree of transformational leadership. Findings also revealed that there is a significant positive relationship on (≥ 0.01) between leaders practicing transformational leadership and teaching staff members job empowerment. The study suggests to generalize its results, spread it in higher education institutes, performing training courses for leaders and teaching staff members. The study also recommends performing similar survey studies on other populations to verify the possibility of results generalization. هدفت هذه الدراسة إلى معرفة درجة ممارسة القادة الأكاديميين في الجامعات الأردنية الرسمية القيادة التحويلية وعلاقتها بتمكين أعضاء هيئة التدريس ولتحقيق هدف الدراسة، تم استخدام الاستبانة وأجريت الدراسة على عينة تكونت من جميع القادة الأكاديميين في الجامعة الأردنية وجامعة اليرموك جامعة مؤتة، بواقع (288) قائداً و(773) عضو هيئة تدريس في الجامعة الأردنية، وجامعة اليرموك، وجامعة مؤتة، تم اختيارهم بطريقة عشوائية ممثلة بنسبة (30%) واشتملت الدراسة على متغير مستقل هو درجة ممارسة القادة الأكاديميين القيادة التحويلية في الجامعات الأردنية الرسمية، ومتغير تابع هو درجة ممارسة أعضاء هيئة التدريس للتمكين الوظيفي، بالإضافة إلى متغير وسيط وهو مكان العمل. وتم تحليل بيانات الأداة من خلال استخدام البرنامج الإحصائي (SPSS) وكشفت نتائج الدراسة عن درجة توافر عالية للقيادة التحويلية لدى القادة الأكاديميين في الجامعات الأردنية الرسمية، ودرجة توافر متوسطة لممارسة أعضاء هيئة التدريس للتمكين الوظيفي، كما وأظهرت النتائج وجود علاقة ارتباطية إيجابية ذات دلالة إحصائية عند مستوى (0.01 ≥) بين ممارسة القادة الأكاديميين للقيادة التحويلية وبين التمكين الوظيفي لأعضاء هيئة التدريس. واقترحت الدراسة مجموعة توصيات من أهمها تعميم نتائج الدراسة على جميع المعنيين في مؤسسات التعليم العالي، وعقد دورات تدريبية لأعضاء هيئة التدريس وللقادة، لشرح وتوضيح التمكين الوظيفي وفوائده، وتشجيع جميع العاملين على المشاركة في عمليات التدريب.

Professional development, values and strategy – the means for building strong libraries for the future!

The library and information sector is undergoing massive change. In a changing world we must create environments that promote strong development to ensure a viable future and a library that provides benefits to all our customers. Professional development is an essential component of this environment. It must be in line with the organization’s strategy and values. Changes in customer expectations, behavior and technological development make it even more important to form the library’s identity and prioritize our activities. Values, strategy and professional development go hand in hand with the development process. Staff participation in the development process produces a climate that is creative and a means of ensuring success in the future. At the Swedish University of Agricultural Sciences University Library we have worked with professional development, strategy and values as well as the concepts of staff empowerment and leadership. This effort has included all staff members and the results have been excellent.

Relationship Between Organizational Culture Type and Empowering Staff in Manufacturing Companies of Iran

The main purpose of this study was relationship between the type of organizational culture and staff empowerment in Productive Corporations in Iran. The research type was descriptive. The sampling was purposeful and 30 companies between 157 were selected. Two questionnaires (ODQ) and empowerment were completed by staffs. They were analyzed by Ancova the results showed that there is a meaningful relation between type of organizational culture and staff empowerment and its dimensions (being merit, effective, independency, job being meaningful and trust between staffs).

Securing executive buy-in for preventative risk management – lessons from water safety plans

Appropriate implementation of water safety plans (WSPs) offers an important opportunity to engage in and promote preventative risk management within water utilities. To ensure success, the whole organization, especially executive management, need to be advocates. Illustrated by four case studies, we discuss the influence of organisational culture on buy-in and commitment to WSPs. Despite an internal desire to undertake risk management, aspects of organisational culture prevented these from reaching full potential. Enabling cultural features included: enthusiastic management; past incidents; accountability; insufficient regulations; image; learning and continual improvement cultures; stakeholder relationships; and empowerment of staff. Blocking features included: lack of awareness and recognition; complacency; poor internal relationships; competing priorities; lack of resources and skills; contrasting internal cultures and a lack of near miss reporting. Benefits of WSP implementation and how management are committed are also discussed. We offer some suggestions to those wishing to generate executive buy-in such as: understanding reasons for hesitance; demonstrate benefits; avoiding complacency; highlight building blocks of WSPs and recognising the value of using the WSP approach to inform sound investment planning. We urge water utilities to consider the influence of organisational culture on the success and sustainability of WSP adoption, and to better understand how effective leadership can mould culture to support implementation.

The Checklist Manifesto

The Checklist Manifesto

LMS transitioning to Moodle: A surprising case of successful, emergent change management

<blockquote>During 2009-10 the University of Ballarat implemented the open-source learning management system (LMS) <em>Moodle</em>alongside its existing legacy LMS, <em>Blackboard</em>. While previous IT implementations have been troublesome at the university, notably the student information and finance management systems in 2008-09, the <em>Moodle</em> implementation appears to have been a success. This article reviews the key factors in the implementation and points to several features which have made it a success. The success factors may be suitable for consideration by other organisations which are implementing change, particularly as several appear to run counter to the traditional conceptions of change and project management. This case study points to the importance of trust and empowerment of high quality LMS staff, who are focussed on the end-user rather than the technical side, to implement the project in an 'organic', emergent process. Given that the managerialist project management model, which appears to put more faith in systematic procedures than the staff who have to implement them, is more typical of many LMS and IT implementations, this case study revealed a surprising and refreshing level of approval for valuing staff expertise over 'tick box' adherence to technical checklists.</blockquote>

Job satisfaction and career commitment among Alzheimer's care providers: addressing turnover and improving staff empowerment.

This study investigated the relation between job satisfaction and career commitment among 262 Alzheimer's care staff working in long-term and community-based care settings. It was anticipated that the results would suggest whether career commitment could be enhanced to positively influence job satisfaction, and conversely, if improvements in job satisfaction might contribute to a deepened sense of vocational empowerment. Participants attended dementia-specific training and completed 2 short work-related questionnaires that measured job satisfaction and career commitment. The results of stepwise regression revealed interrelations between the 2 constructs. Congruence appeared to be reciprocal with respect to the overall scale scores and the intrinsic job satisfaction measure. Unexpected relations appeared in analyses of the extrinsic job satisfaction measure and the career planning subscale. Results are indicative of the fundamental distinction between job satisfaction and career commitment. Implications for efforts to reduce turnover and improve staff empowerment are also considered.

The Synergy Professional Practice Model and Its Patient Characteristics Tool: A Staff Empowerment Strategy

Nurse leaders can positively influence practice environments through a number of empowerment strategies, among them professional practice models. These models encompass the philosophy, structures and processes that support nurses' control over their practice and their voice within healthcare organizations. Nurse-driven professional practice models can serve as a framework for collaborative decision-making among nursing and other staff. This paper describes a provincewide pilot project in which eight nurse-led project teams in four healthcare sectors worked with the synergy professional practice model and its patient characteristics tool. The teams learned how the model and tool can be used to classify patients' acuity levels and make staffing assignments based on a "best fit" between patient needs and staff competencies. The patient characteristics tool scores patients' acuities on eight characteristics such as stability, vulnerability and resource availability. This tool can be used to make real-time patient assessments. Other potential applications for the model and tool are presented, such as care planning, team-building and determining appropriate staffing levels. Our pilot project evidence suggests that the synergy model and its patient characteristics tool may be an empowerment strategy that nursing leaders can use to enhance their practice environments.

Central Line–Associated Bloodstream Infections in Neonatal Intensive Care: Changing the Mental Model from Inevitability to Preventability

Previously considered unavoidable complications of hospital care (reflecting an "entitlement" mental model), health care-associated infections are now considered as medical errors and cause significant preventable morbidity and mortality in neonates. Prevention of such infections, particularly central line-associated bloodstream infections (CLABSI), should be an important patient safety priority for all neonatal intensive care units (NICUs). An important first step is to promote a mental model of CLABSIs as preventable complications of care. Other general strategies are (1) promoting an organizational culture of safety and empowerment of staff; (2) hand hygiene; (3) avoiding overcrowding and understaffing; (4) using breast milk for enteral feedings; and (5) involving families in infection prevention efforts. Specific strategies to prevent CLABSI are (1) insertion practices: insertion of all central vascular catheters under strict sterile conditions with the aid of a checklist; (2) maintenance practices: ensuring that entries into the lumen of the vascular catheter always occur under aseptic conditions, minimizing catheter disconnections, and replacement of intravenous infusion sets at recommended intervals; (3) removal of all central lines as soon as possible. Participation in national or statewide quality improvement collaboratives is an emerging trend in neonatology that can enhance CLABSI prevention efforts by NICUs.

An empowerment framework for nursing leadership development: supporting evidence

This article is a report on a descriptive study of nurse leaders' perspectives of the outcomes of a formal leadership programme. Effective nurse leaders are necessary to address complex issues associated with healthcare systems reforms. Little is known about the types of leadership development programmes that most effectively prepare nurse leaders for healthcare challenges. When nurse leaders use structural and psychological empowerment strategies, the results are safer work environments and better nurse outcomes. The leadership development programme associated with this study is based on a unifying theoretical empowerment framework to empower nurse leaders and enable them to empower others. Twenty seven front-line and mid-level nurse leaders with variable years of experience were interviewed for 1 year after participating in a formal leadership development programme. Data were gathered in 2008-2009 from four programme cohorts. Four researchers independently developed code categories and themes using qualitative content analysis. Evidence of leadership development programme empowerment included nurse leader reports of increased self-confidence with respect to carrying out their roles and responsibilities; positive changes in their leadership styles; and perceptions of staff recognition of positive stylistic changes. Regardless of years of experience, mid-level leaders had a broader appreciation of practice environment issues than front-line leaders. Time for reflection was valuable to all participants, and front-line leaders, in particular, appreciated the time to discuss nurse-specific issues with their colleagues. This study provides evidence that a theoretical empowerment framework and strategies can empower nurse leaders, potentially resulting in staff empowerment.

Enhancing Shared Governance for Interdisciplinary Practice

Cincinnati Children's Hospital Medical Center has a strong history of embracing staff empowerment and shared decision making. Shared governance for nursing was implemented in 1989; a separate allied health structure was created in 1999. The two operated in parallel with few occasions for interface, and with little collaboration. With the beginning of the medical center's efforts to pursue perfect patient care in 2002, there was a marked increase in the frequency of interprofessional initiatives and collaborations in the organization. By 2005, this increase in collaborative practice precipitated discussions questioning the purpose and efficiency of two separate structures. Over the next two years, planning ensued to merge these structures to better reflect the current interprofessional reality. The enhanced shared governance structure at Cincinnati Children's was launched in 2008. Each discipline now governs its own practice, but as patient care issues overlap, there is a structure in place to resolve patient issues that cross disciplines. The new Patient Care Governance Council includes physician and family representatives.

Pilot Health Promoting Hospital in rural South Africa: evidence-based approach to systematic hospital transformation

This project aimed at transforming a rural District Hospital in the Limpopo Province of South Africa into a Health Promoting Hospital according to standards developed by WHO-Europe. The intervention used a diagnostic approach and baseline needs assessment of hospital staff, patients, and their relatives to identify health education and promotion needs. Activities included empowerment training and skills development, implementation of health education and promotion activities, and the integration of health-promoting standards and values in the hospital structure and culture. The project indicated applicability of the model in a resource-limited setting, based on staff empowerment, local leadership, and stakeholder engagement.

Basic requirements for implementation of total quality management in Centers of Emergency Medical Services in Iran according EFQM model

Basic requirements for implementation of total quality management in Centers of Emergency Medical Services in Iran acc ording EFQM model Abedsaeedi, Z 1 . (PhD); Mozafari,M 2 .*((PhD); Pazargadi,M. 3 (PhD); Alavi majd, H. 4 (PhD) 1. Assistant Professor, Dept of Medical Surgical, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. PhD Student, Dept of Nursing, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Lecturer, Ilam University of Medical Sciences, Ilam, Iran 3. Associate Professor, Dept. of Management, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4. Associate Professor, Dept. of Biostatistics. Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Abstract Background and aim Successful implementation of TQM requires a committed leadership, customer – based approaches, process management, efficient communication, knowledge management, empowerment and involvement of staff and an organizational culture for continuous quality improvement. The aim of this study was to assess basic requirements for implementation TQM in Centers of Emergency Medical Services in Iran acc ording EFQM model. Materials and methods In this descriptive study, all of operational and official stations of Medical Emergency services in Ilam, Bushehr, Mazandaran, Ardebil, West Azerbaijan and Yazd province, one half of operational stations in city of Tehran, Sistan–Baluchestan, Khorasan-razavi and Isfahan, were included. All senior managers and personnel of these centers and a random sample of 3246 customers who have received care during the last 6 months were selected. By using a 189 –item’s rating scale and 4 questionnaires; leadership style, job and patients satisfaction and state of organizational empowering, according to 5 enabler criteria, from EFQM model was assessed. Validity of instruments by measuring content validity and reliability by internal consistency and test-retest confirmed. Descriptive and inferential statistics used for analyzing data. Findings The overall mean score was 168.4±34.6 out of 500; therefore, the selected divisions were labeled as drifters organizations which were in early stage of quality improvement road. In comparison, the Tehran, Isfahan and Khorasan-razavi centers with more score labeled as improver’s organizations. At the entire, leadership criterion obtained minimum (26.6%) and people criterion obtained maximum (39%) mean scores. Conclusion Results showed that enabler criteria of the EMS centers in Iran need to reinforcement. It is essential enhancing the knowledge and attitude of managers and personnel about quality improvement principles . Additionally, establishing the management by process, creating customer focused approach and culture of continuous improvement, empowering employees and constituting quality circles are appropriate interventions that should be considered Keywords: European Foundation for Quality Management (EFQM), Total Quality Management (TQM), Center for Management of Accidents and Emergencies, Emergency System, Enabler criteria. * Corresponding Author: Mosayeb, Mozafari. Dept of Nursing. Faculty of Nursing & Midwifery, Ilam University of Medical Sciences, Ilam, Iran, Banganjab. E-mail: Mozafaric@yahoo.com