Structural Empowerment Through Shared Leadership Led to Improved Staff Satisfaction, Patient Satisfaction, and Patient Outcomes

Abstract: Structural empowerment is one of the major components of the ANCC’s Magnet Recognition Program model (ANCC, 2008). Structural empowerment in an organization with Magnet status is exemplified by nurses involved in shared governance and engaged in shared decision making on structures and processes that results to staff satisfaction (Clavelle & O’Grady, 2013). A review of the evidence have shown that structural empowerment is associated with organizational commitment (Yang, Liu, Huang, & Zhu, 2013; Yang, Liu, Chen, & Pan, 2014), improved professional practice environment, and job  satisfaction (Armstrong & Laschinger, 2006; Spence Laschinger, 2008; Spence Laschinger et al., 2003; Spence Laschinger, Finegan, & Wilk, 2011; Spence Laschinger, Nosko, Wilk, & Finegan, 2014; Yang, et. al., 2013, Yang, et.al., 2014). The benefits of Shared Governance has been well documented, yet formal communication tools to ensure timely, comprehensive, and participative decision-making within this process, is often lacking. With the successful redesign of our SG structure to align with Magnet Recognition Program ® Model and the organization’s Lean operating system, we developed complimentary communication structures designed to increase shared decision making capabilities of the organization. We also adapted the Lean methodology and continuous process improvement to achieve council goals based on the strategic plan. A comprehensive literature review of Lean implementation in health care have shown cost efficiency, increased productivity, patient and staff safety, and improved quality of care (D’Andreamatteo, Ianni, Lega, & Sargiacomo, 2015). This presentation details the communication development process and the associated measured outcomes.

Methods: Two workgroups comprised of nurses from all levels of care and inter-professional groups were formed. The first workgroup diagrammed the current state to identify gaps and develop countermeasures to ensure bidirectional council communication. A future state workflow was designed to define unit-based issues and referred to house-wide councils. The steering committee and Coordinating Council met to refine the process and design communication tools. An Action Request Form (ARF) was developed in addition to a routing process. Action requests were reviewed to prioritize council discussion. The second workgroup focused on measuring and monitoring outcomes based on the strategic plan to achieve the triad of clinical excellence: staff satisfaction, patient satisfaction, and patient outcomes. We used the A3 tool, a problem solving approach and continuous process improvement. Quarterly council goal monitoring using the plan-do-check-act were conducted. We also celebrated small wins to encourage, motivate, and engage the frontline staff.

Results: Between April 2014 and November 2015, 600 ARFs were submitted by the clinical staff. A thematic analysis shows that 70% of these are related to management accountability issues, and 30% are clinical practice focused. Resolution of the ARF has been achieved in 76% of submission in a mean time of 58 days after submission. RN satisfaction scores showed 100% on all Magnet job satisfaction scales. Council developed goals aligned with the strategic plan and have shown improvement on the triad of clinical excellence such as: increased certification rates, increased patient satisfaction, and improved patient outcomes on decreasing falls, decreasing catheter-related urinary tract infection, and decrease in workplace injury.

Conclusion: Due to the success of the SG and ARF communication tools, council agendas are now action-orientated and have improved staff satisfaction, patient satisfaction, and patient outcomes. We believe this innovative workflow enhanced shared leadership and be a replicable model for other health institutions.