logo
  • Nonprofit News
  • Management
    • Boards and Governance
    • Communication
      • Framing & Narratives
    • Ethics
    • Financial Management
    • Grassroots Fundraising Journal
    • Leadership
    • Technology
  • Philanthropy
    • Corporate Social Responsibility
    • Donor-Advised Funds
    • Foundations
    • Impact Investing
    • Research
    • Workplace Giving
  • Policy
    • Education
    • Healthcare
    • Housing
    • Government
    • Taxes
  • Economic Justice
    • About
    • Economy Remix
    • Economy Webinars
    • Community Benefits
    • Economic Democracy
    • Environmental Justice
    • Fair Finance
    • Housing Rights
    • Land Justice
    • Poor People’s Rights
    • Tax Fairness
  • Racial Equity
  • Social Movements
    • Community Development
    • Community Organizing
    • Culture Change
    • Education
    • Environment
    • Gender Equality
    • Immigrant Rights
    • Indigenous Rights
    • Labor
    • LGBTQ+
    • Racial Justice
    • Youth Activism
  • About Us
  • Log in
  • CONTENT TYPES
  • Featured Articles
  • Webinars
    • Free Webinars
    • Premium On-Demand Webinars
  • Tiny Spark Podcast
  • Magazine
    • Magazine
    • Leading Edge Membership
Donate
Hospitals, Management

Leadership Lesson for Nonprofits: Empowering Hospital Staff More Broadly Brings Better Health Outcomes

Steve Dubb
June 5, 2018
Share11
Tweet4
Email
Share
Photo By: U.S. Navy photo by Mass Communication Specialist 2nd Class Joshua Fulton

May 31, 2018; New York Times

It should come as no surprise that hospital culture impacts the quality of care received, but that does not make changing that culture to deliver better care easy, notes Dr. Pauline Chen in the New York Times. Of course, at NPQ, we have noted the importance of organizational culture in many areas—including addressing equity, diversity, and inclusion. These lessons, it turns out, are also highly applicable in delivering quality health care.

In particular, Chen observes, new research indicates that one key strategy for improving hospital care is to empower the entire medical team (i.e., nurses, technicians, and administrators, as well as clinicians) to have a say in medical decisions, rather than relying solely on MDs. For example, Chen writes that, “Heart attack patients who are treated at hospitals where nurses feel powerless and senior management is only sporadically involved in patient care tend to fare more poorly than patients hospitalized at institutions where nurses are asked regularly for their input and chief executives hold regular meetings with clinicians to review patient results.”

One way to implement such changes systemically involves getting hospitals to create what researchers call a “guiding coalition.” This involves, Chen explains, having “a group of more than a dozen staff members, ranging from high-ranking administrators to clinicians, nurses and technicians from across the entire institution. The coalition members participate in regular workshops, discussions and national forums on ways hospitals might improve, then help their respective hospital translate newfound ideas and information into clinical practice.”

This approach was piloted by a group of 10 hospitals, which formed the Leadership Saves Lives (LSL) collaborative. “To assess the clinical effect of the intervention, the researchers decided to look at heart attack patients, individuals whose care depends on the staff in several departments in a hospital,” Chen says. The full study results are available here. The research team included public health and medical researchers from Vassar, Yale, Columbia, and the Mayo Clinic.

Chen writes that, “The researchers found that all 10 hospitals changed significantly, but six hospitals experienced particularly profound cultural transformations.” At the six hospitals that showed the most favorable results, one key was an institutional shift from a frame of “because I said so” to one of “focusing on the why’s.” Also important was empowering medical teams to treat patients as individuals rather than following the same clinical protocols for all patients in a given class. As Chen explains, “Instead of accepting that every heart attack patient had to undergo certain testing or take specific drugs because the chief of the department or administrator had previously established such clinical protocols…it became more important to provide the data that proved such rituals were actually helpful.”

Nurses and technicians in these high-performing hospitals said they felt that they were newly empowered to voice opinions in “more of an equal role, no matter what position you are.” By contrast, at the four lower-performing hospitals, there remained “persistent expectation of deference to authority” as well as a work environment where staff remained, in the words of one staff member, “so squarely in the box that we can’t even see the edge.”

Chen gives one example of how empowering technicians led to better health outcomes:

One hospital in the study, for example, had been struggling for years with poor outcomes because patients often had long wait times between the onset of heart attack symptoms and the initiation of appropriate in-hospital care. Many of the hospital’s administrators and clinicians assumed that little could be done because of their rural location. But the hospital’s EKG technicians knew of a new and relatively inexpensive transmitter that could immediately relay EKG results to the hospital.

“But the EKG technicians never felt empowered to speak up,” recounted Dr. Elizabeth H. Bradley, president and professor of science, technology and society at Vassar College.

In Great Britain, Dr. Patrick Geoghegan, professor of mental health and social care at Anglia Ruskin University, is spearheading a similar program in the National Health Service. “You can have all of the best policies, procedures and strategies, but if the hospital’s organizational culture is not receptive, then you will fail,” Geoghegan observes.

Bradley, who was part of the research team, notes that if more hospitals held regular meetings that bring together hospital staff from all disciplines “in a psychologically comfortable and trusting place to speak the truth and to have meaningful conversations,” then these relationships and the cultural changes they inspire will “drive the sustainability of your improvements.”

“It takes bringing people together and redefining leadership as a role that anyone at any level can take,” Bradley notes. “We think we just need to get the best doctor,” Bradley adds, “but witnessing how staff treat each other is a pretty strong signal for how they will treat and care for you.”—Steve Dubb

Share11
Tweet4
Email
Share

About The Author
Steve Dubb

Steve Dubb is a senior editor at NPQ, where he directs NPQ’s economic justice program, including NPQ’s Economy Remix column. Steve has worked with cooperatives and nonprofits for over two decades, including twelve years at The Democracy Collaborative and three years as executive director of NASCO (North American Students of Cooperation). In his work, Steve has authored, co-authored and edited numerous reports; participated in and facilitated learning cohorts; designed community building strategies; and helped build the field of community wealth building. Steve is the lead author of Building Wealth: The Asset-Based Approach to Solving Social and Economic Problems (Aspen 2005) and coauthor (with Rita Hodges) of The Road Half Traveled: University Engagement at a Crossroads, published by MSU Press in 2012. In 2016, Steve curated and authored Conversations on Community Wealth Building, a collection of interviews of community builders that Steve had conducted over the previous decade.

Related
“Bright Spots” Report a Goldmine for Nonprofits about Successful Fundraising at the Grassroots
By Ruth McCambridge
September 11, 2020
Bloomberg Equity Initiative’s First Investment is $100 Million Gift
By Ruth McCambridge
September 4, 2020
Developing Human Capital: Moving from Extraction to Reciprocity in Our Organizational Relationships
By Jeanne Bell
February 13, 2020
American Hospital Association Keeps Mum on Aggressive Debt Collection
By Karen Kahn
January 9, 2020
Lancet Editor: Protesting Climate Change Is a Doctor’s Duty
By Julie Euber
November 4, 2019
Study Finds 45 Percent of Patients who Qualify for Charity Care Are Billed Anyway
By Steve Dubb
October 15, 2019

Upcoming Webinars

Group Created with Sketch.
January 21, 2 pm ET

Remaking the Economy

Health, Racial Disparities, and Economic Justice

other posts by The Author
Out of View, Exiting Administration Wields Its Axe at the...
By Steve Dubb
January 15, 2021
Feds Fix Some PPP Flaws but Ignore Old Shortcomings
By Steve Dubb
January 13, 2021
The Long Road to Cultural Representation: Two New...
By Steve Dubb
January 12, 2021
CYNDI SUAREZ
The Nonprofit Racial Leadership Gap: Flipping the Lens
Powerful Interests Seek to Make Puerto Rico the Hong Kong of the...
Moving Beyond the Privilege of White Tears
logo
Donate
  • <