1. CSTS Staff Empowerment Christine A. Goeschel ScD MPA MPS RN

2. Slide 2 Learning 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

3. Slide 3 What 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

4. Slide 4 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

5. Slide 5 Improve Patient Safety Culture: Create Trust Improve Patient Safety Culture: 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)

6. Slide 6 Ensure Patients Reliably Receive Evidence Pronovost: Health Services Research 2006 SeniorTeam Staff leaders Engage How does this make the world a better place? Educate What do we need to do? Execute What keeps me from doing it? How can we do it with my resources and culture? Evaluate How do we know we improved safety?

7. Slide 7 Placing Value on Staff Empowerment 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

8. Slide 8 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

9. Slide 9 Strategies for Nurse Empowerment Practice Level – Licensure – Nurse Practice Act – Magnet Nursing – Collaborative Practice Models Infection Preventionists Attending Physicians

10. Slide 10 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

11. Slide 11 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

12. Slide 12 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 Empowering Clinical Staff

13. Slide 13 Action 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