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How Healthcare Staff Can Impact Quality

From the Disputing Blog of Karl Bayer, Victoria VanBuren, and Holly Hayes.

Our good friend, Don Philbin, sent us this link to a Harvard Business School article about “Turning Employees Into Problem Solvers” in healthcare.

The article looks specifically at incident-reporting systems in hospitals and, rightly so, suggests that any system used to report and track incidents in healthcare should contribute to the implementation of actions to correct for those incidents resulting in higher quality care. The paper is authored by Julia Adler-Milstein, an HBS doctoral candidate in the Health Policy Management program; Sara J. Singer, assistant professor at the Harvard School of Public Health and Harvard Medical School; and HBS professor Michael W. Toffel.

The team’s working paper, “Speaking Up Constructively: Managerial Practices that Elicit Solutions from Front-Line Employees,” considers data on nearly 7,500 incidents from a single hospital to determine whether two types of managerial actions increase the frequency with which frontline workers speak up by reporting incidents and do so constructively by including solutions in their incident reports.

The authors looked at “patient-safety information campaigns.” Undertaking a campaign to encourage staff members to speak up about incidents increased the frequency of reporting by five percent. When staff were asked to share a solution to the problem the frequency of shared solutions tripled. In addition, there was a significant increase in reporting when unit managers actively engaged in problem solving. Staff were more likely to share solutions when their managers were more proactive in resolving the underlying problem. Another finding: the campaign worked great for a limited time period, after which staff appeared to “shut down” and the frequency in responses slowed. The authors ask, “At what point do people shut off?”

The team’s database offers additional information to consider that was not examined in the working paper, Toffel says. Other questions to answer include: What types of responses to incidents are most effective? When should behavioral corrections be implemented? When should technological corrections be made?

“I’m excited to look at this data longitudinally,” says Singer. “Ideally, one would hope that an incident gets reported and that a solution is implemented so that the incident doesn’t recur. We can look at whether this happens over time. Knowing this will make a significant contribution to improving patient safety, because a lot of hospitals rely on these reporting systems and promote their use, if only to fulfill accreditation requirements.

“The real question remains, are they serving the intended purpose? It could be that very little happens with these reports in terms of the long-term learning that you would hope to see.”

Says Adler-Milstein, “We could also determine if the same type of incident is occurring in a given unit over time, even when it is being reported. That would then make it possible to focus on how particular units resolve their problems.”

Identifying pockets of excellence would enable more qualitative research to determine what exactly a unit is doing to achieve its success—and to identify how those practices could be codified and adopted elsewhere.

“Health care started out with largely independent practitioners and a limited body of knowledge,” says Adler-Milstein. “Given the changes that have occurred recently, technological and otherwise, health care hasn’t caught up quickly enough with the new practice methods that accompany this very different, modern-day model. I hope we will get there eventually, but right now there is a lag.”

Drilling down to discover when frontline employees speak up most constructively, and how to translate this into problem solving, should help bridge that gap.

In terms of staff speaking up constructively and helping problem solve, we posted here about a Mass General study that indicated physicians are reluctant to report impaired or incompetent colleagues.

We suggest that organizations that develop the capacity of staff and physicians to engage in healthy conflict in the workplace may move closer to achieving improved patient care. We welcome your comments on this topic.


Holly Hayes

Holly Hayes Bovio received a Masters in Health Administration (MHA) from Duke University and her undergraduate degree from Southern Methodist University. She holds a certificate in mediation from Texas State.  Holly brings a strong hospital operations background to healthcare mediations including a focus on clinical quality.  Holly managed her own consulting… MORE >

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