Partners Advancing Clinical Excellence: Building Professional Councils for Quality Improvement at Six Community Hospitals

Engaging bedside clinicians, especially nurses, is essential for the success of sustainable process improvement programs and thus for improving the quality of health care. Studies have shown that properly implemented professional councils can be effective in engaging and empowering bedside clinicians to create lasting and meaningful improvements. This case study describes a 5-year program to implement and operate staff-led councils to lead evidence-based practice (EBP) quality improvement initiatives at 6 community hospitals. The outcomes presented in this case study demonstrate that staff-led councils have the potential to improve patient safety and quality of care as evidenced by observed reductions in ventilator-associated pneumonias, central line-associated bloodstream infections, and mortality from acute myocardial infarction and severe sepsis. The U.S. health care system has been characterized as expensive and inefficient, with widespread opportunities for improving quality. Two Institute of Medicine (IOM) reports-To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century-highlight the issues of patient safety and quality of care, reporting that as many as 98,000 patients die each year as the result of medical errors (Hughes & Clancy, 2009; IOM (U.S.) Committee on Quality of Health Care in America, 2001; Kohn, Corrigan, & Donaldson, 2000; Needleman & Hassmiller, 2009; Page & IOM (U.S.) Committee on the Work Environment for Nurses and Patient Safety, 2004). Engaging nursing personnel, the largest component of the health care workforce, in patient safety and health care quality improvement programs is critical (Draper, Felland, Liebhaber, & Melichar, 2008; Hughes & Clancy, 2009; Needleman & Hassmiller, 2009; Page & IOM (U.S.) Committee on the Work Environment for Nurses and Patient Safety, 2004). In response, we undertook a program to engage nursing personnel in patient safety and quality improvement by fostering staffnurse empowerment to drive change through a program of staff-led councils. Rosabeth Moss Kanter's model of structural empowerment, widely used in nursing research, states that employees are empowered when they have access to information, resources, support for their work, and opportunities for growth and development (Kanter, 1993; Manojlovich, 2007). Studies have shown the impact of nurse empowerment on job satisfaction, commitment to the organization, and improvement in patient outcomes (Laschinger, 2008; Manojlovich, 2007; Richardson & Storr, 2010). The model of staff-led councils originated in nursing and has evolved into a framework that guides development and supports interdisciplinary professional practice integrated at the point of care. This model provides an infrastructure that supports value-based, relationship-based, and integrated evidence-based practice (EBP) throughout the organization (Grigsby, Westmoreland, & Shiparski, 2002). Properly trained staff-led councils can be effective in empowering nurses to correct existing processes contributing to medical errors, identify opportunities for improving quality of care, and adopt new practices (Frankel, Gandhi, & Bates, 2003). These councils should be empowered, autonomous, and should have a structure that ensures that those processes related to EBP are sustained (Porter-O'Grady, 2003). By focusing on capacity building and developing accountability of staff, organizations can demonstrate the value-added benefit of nursing councils to improve organizational outcomes (Anthony, 2004). The organizational structure and decision-making approach that an organization maintains, such as nursing councils, can result in a workplace that is desirable, satisfying, and produces excellent outcomes (Clarke, 2006; Draper et al., 2008; Laschinger, 2008). In the fall of 2006, Sutter Health, with the support of a matching grant from the Gordon and Betty Moore Foundation, initiated the Partners Advancing Clinical Excellence (PACE) program at six San Francisco Bay Area community hospitals. …