Improving Patient Outcomes: The Effects of Staff Participation and Collaboration in Healthcare Delivery
Executive Summary — Health-care organizations have a well-documented, industry-wide need to improve their processes. To that aim, the Institute of Medicine has made at least 2 recommendations that focus on front-line staff—physicians, nurses, and respiratory therapists. The first recommendation states that front-line staff should be involved in unit decision-making and the design of work processes and workflow (participation). The second emphasizes respectful interactions among front-line staff, including information-sharing and coordinating activities to achieve organizational goals (collaboration). This study provides preliminary supporting evidence for the Institute of Medicine's recommendations to use a dual, front-line strategy of participation and collaboration to improve patient outcomes. Key concepts include:
- Shared decision-making and respectful collaboration are vital to enabling improvement in health-care organizations.
- Front-line staff participation in process improvement can solve a common problem: lack of commitment from health-care professionals to implement new practices.
- Units with more collaboration—as measured by staff perception and use of collaborative work practices—experienced greater improvement in risk-adjusted mortality among patients.
- Participation in process improvement may be an effective strategy for other service organizations that face staff resistance to new routines.
Front-line staff possess an immense amount of functional and experiential knowledge from which their organizations can learn. This paper examines two distinct processes for leveraging front-line staff knowledge in organizational learning—participation and collaboration. Participation describes front-line staff sharing decision-making authority with hierarchical superiors (e.g., managers). Collaboration refers to front-line staff respectfully working together by sharing information and coordinating activities to achieve a goal. Using a sample of hospital intensive care units, we found beneficial effects of front-line staff participation and collaboration on organizational performance, as measured by improvement in risk-adjusted unit mortality. However, the positive effects had contingencies. Participation's effect was contingent on the type of participation. Participation in daily unit management had no effect on unit mortality, while participation in process improvement was positively related to improvement in unit mortality. The positive relationship between collaboration and improvement in mortality was greater for units with larger staff sizes. The implications of these findings for organizational learning, process improvement and human resource management are discussed.