Empowering health care improvement: an operational model

The shift from compliance to continuous improvement requires a bridge--empowerment--that enables the creation of an environment in which employees can contribute the full range of their expertise in service to the organization. Leaders are responsible for creating this empowering environment.

An operational model that describes the nine aspects of empowerment (for example, mission and values, access to information, avenues of influence) can serve as a template for leaders to use to promote an atmosphere of empowerment in their organizations.

The authors adapted this model as a survey instrument to uncover some hospital success stories that demonstrate several aspects of empowerment in action. The survey was administered at two hospitals. CASE STUDY 1: At Beth Israel Hospital (Boston, Mass), Nutrition Services rated the "mission and vision" aspect of empowerment in their department at an average of 3.5 out of a possible 4.0. The department attributes this high rating to their focus on specific goals that reinforce the larger mission and vision of the hospital as a whole. These goals form the basis for annual employee evaluations. For example, a 1992 patient-focused goal was to provide nutrition counseling and education. The department approached this goal by developing a daily format ("Eat Smart") for the daily hospital cafeteria menu that provided nutritional information. The rationale was to educate employees, who could then bring back information to their patients. Alignment of the department's efforts with the larger mission of the hospital enabled Nutrition Services to extend its influence beyond departmental and professional boundaries. Implementation of other plans at the hospital demonstrate a sustained process of vision development on the part of the executive leadership. CASE STUDY 2: At Robert Wood Johnson University Hospital (New Brunswick, NJ), Support Services gave the "environment of trust and respect" aspect an average rating of 3.7. The key to this success story lies in the upgraded role of the housekeepers as "hosts." The "Pro-Act" restructuring model for patient care delivery creates and upgrades positions to relieve nurses of their task loads. The three nursing services that participated in the survey gave their highest rating to the "access to the education and training" aspect of empowerment. The high quality of professional excellence is supported by tuition reimbursement, incentives for credentials, the extern program and scholarships provided to attract outstanding nursing students to their staff and encouragement of nursing staff at all levels for publication, presentations, and poster sessions.

These case studies demonstrate how leaders created an environment in which collective learning has become a way of doing business. Given the multifaceted nature of the empowerment model, some may wonder where to begin to focus leadership efforts. It is important to emphasize that the constellation of empowerment aspects constitutes an integral system; the full potential for empowerment arises from synergy among all nine aspects.