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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1042 — Leveraging Frontline Expertise: How Senior Managers Empower and Support Frontline Staff in Identifying and Addressing Improvement Opportunities

Lead/Presenter: Marlena Shin, COIN - Bedford/Boston
All Authors: Shin MH (CHOIR, VA Boston ) Engle RL (CHOIR, VA Boston) Rivard PE (CHOIR, VA Boston) Singer S (CHOIR, VA Boston) Holmes S (CHOIR, VA Boston) Easley S (CHOIR, VA Boston) Riendeau RP (CHOIR, VA Boston) Shwartz M (CHOIR, VA Boston)

Essential elements of work system improvement are empowerment and support of frontline staff (FLS) in identifying improvement needs and opportunities. This is often hampered by substantial gaps between perceptions held by FLS and those held by senior managers (SM). Leveraging Frontline Expertise (LFLE), a structured program for promoting quality/safety improvement, focuses on these essential elements and gaps. LFLE spurs SM engagement with FLS to identify and solve work system challenges. This paper compared perceptions between FLS and SM about LFLE implementation.

The paper is part of a larger mixed methods implementation study at VA Medical Centers. Applying an analytic framework, we compared qualitative data collected through semi-structured interviews with SM and FLS and through web-based feedback forms with open-ended response items from FLS in specific units implementing LFLE.

Overall, both FLS and SM felt LFLE contributed to staff support and empowerment. Both groups appreciated the opportunity to engage each other in dialogue about work system challenges and ways to address those challenges. However, while many improvements were implemented through LFLE, FLS at some sites felt that LFLE had not prompted enough action. FLS reported preference for more timely and in-depth engagement with SM. In particular, FLS would have preferred more consistent, thorough communication and feedback about actions taken (or not) on the work system challenges they had identified. SM, on the other hand, felt challenged to actively listen to FLS identify issues while not disagreeing or jumping to resolutions too quickly. Also, contrary to FLS perceptions, SM typically felt that sufficient feedback had been provided to FLS on actions taken.

SM and FLS agreed that, through LFLE, they engaged in productive dialogue about improvement needs and opportunities. However, our study identified lingering and potentially problematic gaps in perception between SM and FLS.

Through LFLE, SM and FLS collaborated to identify and address challenges with patient care structures and processes, thereby improving care to Veterans. Continuing to empower and support FLS in accelerating innovation and work system improvement is critical in the VA. SM need to anticipate perceptual gaps and actively seek to forge a shared understanding through programs like LFLE.