4 ways frontline managers can drive sustained outcomes improvement

To create and sustain meaningful improvement within healthcare, hospital leaders should enlist their frontline managers in four key strategies, according to a new paper from the Institute for Healthcare Improvement (IHI).

The IHI based its conclusions on collaboration with 10 major healthcare systems throughout the United States and Canada, including Washington state’s Virginia Mason Health System, Wisconsin’s ThedaCare and Maryland’s Greater Baltimore Medical Center. The four major strategies hospital leaders should undertake include:

Selecting a pilot unit within the system: Several factors should go into making this choice, including low staff turnover, good management practices already in place to build on, and the presence of a “champion” within it to promote participation and build enthusiasm.

Begin not at the managerial level, but with the charge nurse: Numerous organizations that the IHI collaborated with emphasized that the charge nurse, rather than the nurse manager, is the real leader in frontline operations. Intermountain, for example, began by standardizing and clarifying the charge nurse’s role; the alternative, when roles are not clearly defined, may leave unit managers scrambling to perform what are traditionally the charge nurse’s duties, such as frontline huddles, patient rounding and coaching frontline workers.

Build momentum by setting realistic early goals: The first priorities for the pilot unit should be easily accomplished in the short term, such as implementing daily huddles for medication administration. Such “early wins” will improve staff engagement, according to the IHI’s collaborators. The Gallup Business Journal recommended a similar strategy in 2014, FierceHealthcare previously reported.

Work to engender both trust and urgency within the system: For example, Denver Health established two top organizational goals: cutting patient falls and improving patient experience scores. Intermountain, meanwhile, focused on implementing work through the lens of its Transforming Care at the Bedside program. Such initiatives “can gain a sense of urgency by targeting acute problems that are widely recognized by staff,” the report states. “Over time, observable success on acknowledged problems in the pilot unit can build widespread support for the initiative.”

- download the paper (.pdf, registration may be required)