Promoting positive culture change in nursing faculties: Getting to maybe through liberating structures.

Organizations are complex with cultures that influence excellence, commitment and job satisfaction. In nursing schools, faculty are required to succeed within the performance driven culture of academic scholarship alongside the organizational culture that influences the work environment. The purpose of this article is to describe the process that a School of Nursing engaged in using complexity science and liberating structures to shift a perceived unhealthy organizational culture to a healthier one.

Healthcare Quality Improvement Requires Many Approaches.

It is a pleasure to respond to the commentaries and we thank the authors for the thought, time and effort they so obviously put into their writing. We are excited that documenting our experience has resulted in such a wide range of opinion.

Five years of Experience using Front-Line Ownership to Improve Healthcare Quality and Safety.

Front-line ownership (FLO) is a complexity science-based approach to leading change initiatives that is built upon a foundation of Positive Deviance and the use of Liberating Structures to engage others. In this paper, we outline the use of FLO in four successful patient safety or quality improvement projects in four countries. While the underlying principles guiding the use of FLO were the same for each of these projects, project goals, the types of roles involved and how the projects evolved, spread and were sustained, varied considerably between settings.

Front-line ownership: generating a cure mindset for patient safety.

Great advances have been made in standardization and human factors engineering that have reduced variability and increased reliability in healthcare. As important as these advances are, the authors believe there is another important but largely ignored layer to the safety story in healthcare that has prevented us from progressing. In the field of infection prevention and control (IPAC), despite great attempts over several decades to improve compliance with hand hygiene, surveillance, environmental cleaning, isolation protocols and other control measures, very significant challenges remain.

Healthcare culture and the challenge of preventing healthcare-associated infections.

Consider the following story: A patient in a teaching hospital is about to be examined by a resident physician. When asked by the patient to wash his hands, the resident refuses, saying he has done so recently. The staff physician then enters the room and the patient speaks of his disappointment regarding the actions of the resident.