Determinants of successful frontline process improvement

Senior manager participation is a key success driver for process improvement programs. To increase their participation, we designed an intervention in which senior managers worked with frontline staff to identify and solve safety-related problems over an 18-month period. On average, the 20 randomly selected treatment hospitals identified 17.3 problems per work area and solved 9.1 of these. However, their readmission rates and percentage increase in nurses' perceptions of safety improvement were no better than 48 control hospitals'. Thus, we investigated drivers of successful program implementation within the set of treatment hospitals. We found that managers from hospitals with low and high perceived improvement identified similar numbers of problems. However, high perceived improvement hospitals took action on more problems. We found no benefit from selecting problems with the highest benefit-to-cost ratios because there was a flat landscape for problems' benefit-to-cost ratios. Thus, for safety improvement in hospitals, allocating resources to search for and select high benefit/cost problems appears to be of limited benefit versus allocating resources to take action on known problems. This approach also aligns with how managers actually selected problems for resolution efforts: problems that were easy to solve were more likely to be selected.