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Successful implementation of shared leadership empowers the front line staff to accept ownership of the department driving them to strive to make changes in the care environment that improve patient care. This article describes how one emergency department implemented a shared leadership governing structure to empower the staff to become problem solvers and change agents. Preliminary data collected supports the premise that shared leadership and decision making positively affects the care environment. Implementation of Shared Leadership: A Strategy to Improve Outcomes Introduction SST.
Lake’s emergency department has had an extended history of poor staff oral, large turnover rates (staff and management), low patient satisfaction scores, and a negative image within our hospital and the community. One strategy other SUccessfUl hospitals are using to overcome these obstacles is to empower the staff to become problem solvers and change agents by implementation of a shared leadership governance structure. This structure allows many decisions to be made at the point of care by the staff members performing the care.
Research suggests that implementation of shared leadership will improve the patient care environment and appears remission to re-vitality the emergency department (Ellis ; Gates, 2005). Implementation of shared leadership is a journey with many challenges. Complete implementation demonstrates promise to improve patient outcomes and satisfaction as well as retention of nursing personnel (Armstrong ; Leeching, 2006). This journey will be without challenge and difficulty, but by keeping the product within our line of vision, success will occur.
Problem Statement with Rationale The implementation of shared leadership and decision-making, a technique that places decision making at the front line staff level, allows for rapid changes and improvements to be made within the patient care environment. Implementation of changes that are staff driven will improve staff satisfaction by reducing redundancies and delays in care. The improvement in the care delivery environment will result in the emergency department being a desired place to work and receive care.
Analyzing the results from this change in leadership style, expect to see a reduction in staff turnover, improvement in patient satisfaction scores and an increased market share secondary to an improved image of the department. Literature Review Shared leadership fosters a positive work environment that is vital to attract ND retain nursing staff while improving patient outcomes (Pennies, 2003; Brady-Schwartz, 2005: Kowalski, Beauty, Kurd, Leafed, ; Hook, 2007). Moore and Hutchison (2007) define shared leadership as staff having a voice and being involved in decision-making.
By empowering staff, employees increase their feelings of respect and trust in management. All of these qualities lead to improvement in the work environment and that has a positive effect on patient outcomes. Engaged staff stay employed at an institution further elevating the positive effects on the care environment. Pennies and Skittering (2008) identify hat challenges will occur within the shared leadership journey but will be “embraced by frontline nurses who are inspired to identify and make differences in their complex adaptive healthcare environment” (p. 27). Project Summary Early in 2009, the emergency room leadership team developed a plan to deliver patient centered care, develop standardized processes, and to use data to drive change. A review of research suggested that implementing a shared leadership governing structure would best meet the needs of our department. The development of a professional practice model demonstrating how the hared leadership committees relate to each other was first on the agenda.
The next step was to recruit staff members to chair the shared leadership councils and physician leaders to champion the work. Several frontline staff members were recommended to lead the committees and they voluntarily accepted the new roles. The staff members accepting these roles did not receive a salary increase or a reduction in other duties assigned to them. The committees include members from all aspects of the care environment including registered nurses, technicians, secretaries, and physicians.
Allowing all the staff to have a ice has been vital to our success. An emergency room nurse and a facilitator are assigned to lead each team and they are responsible to set meeting dates, develop an agenda, and lead meetings designed to evaluate process and implement change. Crucial components to successful meetings include an action item agenda and the completion of assignments from prior meetings. An average of 40 staff hours of meetings are held a month in which staff bring concerns and plan change.
Education regarding the practical application of performance improvement techniques and lean technology has helped the staff identify problems. Each staff member goes away from the meeting with a job to accomplish. By allowing staff to develop the changes, gaining “buy-in” has been easier to accomplish. The teams have implemented many changes that have improved our care environment. After each meeting, an evaluation is completed assessing if the meeting stayed on task and if all goals for the meeting we accomplished.
Before the initial meetings, a set of goals and boundaries was assigned to each committee. Each of the committees have all led performance improvement initiatives identified by staff that place the patient in the center of he care environment and eliminates non-value added steps related to their care. Implementation of a variety of best practices including rapid rooming of patients, standardization of processes, development of an individualized orientation and competency verification system, and improvement of communication within the department have occurred.
Building policies to meet practice and making the right thing to do the easiest thing to do is an important evaluation before implementing any change. Brief meetings are held daily at the “point of care” when change is occurring and each change is evaluated for effectiveness fore final implementation occurs. Our quality improvement program is best characterized by “What is in it for the patient? ” and “How can we make care more efficient to deliver?. My job in this transformation has been to facilitate all of the committees and ensure that things are progressing and staying on task.
One strategy used to keep the momentum is the email sent out after every meeting listing assignments and who is accountable to complete the task. Engagement of the entire emergency room team (including physicians, nurses, and technicians) has been vital to our success. In the beginning, the management team had faculty maintaining excitement within the staff and now has difficulty keeping up with requests for change from the staff. For the first time in history at SST. Lake’s, our department is being recognized as a best practice department and others are trying to duplicate our success.
Other departments within the hospital are requesting that the emergency room staff attend their personnel meetings to explain what shared leadership is and what it has done for our work environment. The emergency department staff will be presenting their story at the Iowa Health System Nursing Practice Council and the Iowa Health System Leadership Symposium in April 2010. Allowing staff to present their story helps motivate them, further advance projects, and gives them pride in their accomplishments.
Conclusion Implementation of the shared leadership concept in the emergency department has re-vitality and energize our department. The project is now approximately 70% of the way complete, with many challenges yet to tackle. The quality improvement projects we have completed in the past year have stabilized our department and exceeded our early expectations. Staff satisfaction scores are improved and we have had a 0% RAN turnover rate since our work began. We have realized an increase in our volume resulting in a 3% increase in the all city-market-share.
Despite this increase in volume, we have been able to keep our median length of stay low and to continue to get the patients to see the physicians in a rapid manner. Without the changes in process, this would not have been possible. The most exciting change has been the increase in our Press Gamey patient satisfaction score. The overall mean has increased from 82. 6 to 86. 4. With the largest improvement in the “likelihood of recommending’ section. For years, the emergency department was chastised for having the lowest score n the Iowa Health System and now is being congratulated for having the largest increase within the health system.
Our journey to excellence has elevated staff by showing them that their hard work is driving care, improving outcomes, and increasing patient satisfaction.