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AHRQ Safety Program For Long-Term Care: HAIs/CAUTI
Module 3: Staff Empowerment
2Staff Empowerment
Objectives
• Cite staff empowerment concepts
• Discuss how staff empowerment contributes to a culture of resident safety, leading to improved outcomes and quality of life
• Illustrate three ways to increase staff empowerment
• Explain how to address and overcome challenges to staff empowerment
3
What Is Staff Empowerment?
“Belief that one has control over decision making”¹
Staff Empowerment
4Staff Empowerment
Organizational Factors for Staff Empowerment²¯⁴
• Structures for advancement opportunities
• Awareness of staff contributions
• Access to resources, information, and support
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Staff Empowerment Assessment Tools³,⁵
HHS Report - Measuring Long-Term Care Work: A Guide to Selected Instruments to Examine Direct Care Worker Experiences and Outcomes• Conditions for Work Effectiveness
Questionnaire
• Perception of Empowerment Instrument (PEI)
• Psychological Empowerment Instrument
• Yeatts and Cready Dimensions of Empowerment Measure
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Psychological Empowerment Instrument⁵
Sample questions for measuring competence:
How strongly do you agree or disagree with these statements?
1. I am confident about my ability to do my job.
2. I am self-assured about my capability to perform my work.
3. I have mastered the skills necessary for my job.
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Why is Staff Empowerment Important?⁵,⁶
• Higher staff satisfaction
• Lower turnover
• Improved quality of care for residents
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Relationship Between Resident Quality of Life and Staff Empowerment⁷
Staff Empowerment
Increased job satisfaction and lower job turnover
Increased resident satisfaction and
perception of care
Higher quality of care overall
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Importance of Empowering Nursing Staff ⁴,⁷
• Frontline providers
• Increased flow of information
• Resident advocates
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Characteristics of an Empowered Frontline Staff
• Curiosity
• Interest in improvement
• Knowledge of nursing home resources and infrastructure
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Curiosity
• Understand changes and the reasoning behind them
• Increase their knowledge about clinical care areas
• Have numerous opportunities to learn about how the organization operates and how resources are allocated
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Interest in Improvement
• Understand how to apply and be actively involved in implementing best practices at an individual resident level
• Understand how best practices can be implemented and supported at a unit and facility level
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Knowledge of Nursing Home Resources and Infrastructure
• Assessment of organizational processes
• Evaluation of practice interventions
• Active participation in continuous assessment and evaluation
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What Builds Staff Empowerment?
• Leader support and teams
• Communication and information sharing
• Positive reinforcement
• Confidence
• Just Culture
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Leader Support and Teams²,⁴
• Teamwork
• Resources
– Channels for advancement or growth in the organization
– Opportunity for increases in knowledge and skill
– Ability to participate in task forces or committees
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Communication and Information Sharing³
• Encourage two-way communication between management and staff
• Provide a clear venue for all staff to share their achievements
• Create procedures for staff to safely share concerns
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Positive Reinforcement³
• Recognize staff and their contributions
• Celebrate success
• Use Learning From Defects tool
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Confidence⁹
• Collaborative trust and confidence
• Psychological safety
– Invite input from all team members
– Encourage team members to contribute
– Promote active listening and learning from each other
– Ensure all team members are accessible
– Acknowledge the limits of current knowledge
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Just Culture⁸,⁹
• Mission, values, and expectations
• System design
• Managing behavioral choices
• Learning systems
• Accountability and justice
– Philosophy for response to error
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Barriers to Staff Empowerment¹⁰
• Lack of senior leader support
• Lack of resources
• Poor teamwork and support
• Stagnation and loss of momentum for change
• Staff turnover
• Punitive response to error
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Key Concepts Review
• Empowerment of frontline staff contributes to lower staff turnover and high job satisfaction, which increase resident satisfaction and safety
• Key factors influencing an empowered staff
– Structures for advancement opportunities
– Awareness of staff contributions
– Access to resources, information, and support
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References
1. Parker L, Price R. Empowered managers and empowered workers: The effects of managerial support and managerial perceived control on workers' sense of control over decision making. Human Relations. 1994;7(8):911-928.
2. Brannon D, Mor V. Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. The Gerontologist. 2005;45(3):309-317.
3. Bowers N, Nolet K, Roberts E, et al. Implementing Change in Long-Term Care: A Practical Guide to Transformation. University of Wisconsin–Madison, School of Nursing; 2007. https://www.nhqualitycampaign.org/files/Implementation_Manual_Part_1_Attachments_1_and_2.pdf.
4. Cready C, Yeatts D, Gosdin M, et al. CNA empowerment: Effects On Job Performance And Work Attitudes. Journal of Gerontological Nursing. 2008;34(3):26-35. http://www.commonwealthfund.org/Publications/In-the-Literature/2007/Nov/Consequences-of-Empowered-CNA-Teams-in-Nursing-Home-Settings--A-Longitudinal-Assessment.aspx.
5. Harris-Kojetin L, Brannon D, Barry T, et al. Measuring Long-Term Care Work: A Guide to Selected Instruments To Examine Direct Care Worker Experiences and Outcomes. Washington, D.C.: U.S. Department of Health & Human Services, U.S. Department of Labor; 2005. http://aspe.hhs.gov/daltcp/reports/dcwguide.htm#empowerment.
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References
6. Kolus K. Mather Pavilion – Staff Empowerment Yields Quality Improvement. Long-Term Living. 2010;59(9):20. http://matherlifeways.com/wp-content/uploads/2012/05/FINAL.pdf.
7. Hamann DJ. Does Empowering Resident Families or Nursing Home Employees in Decision Making Improve Service Quality? Journal of Applied Gerontology. 2014;33(5):603-23
8. Griffith S. Just Culture, Healthcare Services Overview. Outcome Engineering; 2012. https://store.justculture.org/wp-content/uploads/flipbooks/healthcare/healthcare.html
9. CUSP Toolkit. Rockville, MD: Agency for Healthcare Research and Quality; December 2012. http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/toolkit/index.html.
10. TeamSTEPPS Long-Term Care Toolkit. Rockville, MD. Agency for Healthcare Research and Quality; October 2012. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/scenarios/index.html.
11. Pronovost PJ, Berenholtz SM, Goeschel CA, et al. Creating high reliability in health care organizations. Health Services Research. 2006;41(4Pt2):1599-617.
