Implementation of a participatory management model: analysis from a political perspective.

AIM: To analyse experiences of managers and nursing staff in the implementation of participatory management, specifically processes of decision-making, communication and power in a Canadian hospital. BACKGROUND: Implementing a Participatory Management Model involves change because it is focused on the needs of patients and encourages decentralisation of power and shared decisions. METHODS: The study design is qualitative using observational sessions and content analysis for data analysis. We used Bolman and Deal's four-frame theoretical framework to interpret our findings. RESULTS: Participatory management led to advances in care, because it allowed for more dialogue and shared decision making. However, the biggest challenge has been that all major changes are still being decided centrally by the provincial executive board. CONCLUSIONS: Managers and directors are facing difficulties related to this change process, such as the resistance to change by some employees and limited input to decision-making affecting their areas of responsibility; however, they and their teams are working to utilise the values and principles underlying participatory management in their daily work practices. IMPLICATIONS FOR NURSING MANAGEMENT: Innovative management models encourage accountability, increased motivation and satisfaction of nursing staff, and improve the quality of care.

Development of an evidence-based specialty support surface decision tool.

Advancing technology, an aging population, increasing attention to appropriate resource use, and growing concerns about patient safety and professional liability combine to complicate support surface choice. Cognizant of these factors, staff in a 600-bed tertiary care hospital in a large urban center in western Canada decided to evaluate an existing specialty support surface decision tool and update the instrument based on current published literature (no older than 3 years), expert opinion, and results of pilot testing. Elements included in the existing tool were the patient's Braden Score, mobility/activity indicators, and identification of existing skin breakdown. The tool allowed considerable latitude in decision-making based on other clinical factors and established professional practices and had not been formally evaluated. The revised tool addressed relevant assessment criteria such as risk category, patient weight, presence of existing skin breakdown/number of ulcers, flap surgery, pulmonary complications, palliative care, positioning, and Braden score, as well as oversight of support service choice. Although the incidence of nosocomial pressure ulcers did not change significantly during the trial period, costs incurred for support surface use decreased 26% overall, underscoring the need for improved guidelines for support surface selection.

Thinking ecologically for safer healthcare: a summer research student partnership.

As leaders for nursing education, nursing research, healthcare administration and patient safety, we asked one another: How do we use our collective resources to build health system capacity for clinically based research training and safer healthcare? Drawing on knowledge from the field of ecological restoration, which is the study and repair of damaged ecosystems, we partnered the Safer Systems research program of the Faculty of Nursing, University of Alberta, with Capital Health's Royal Alexandra Hospital (RAH), the Caritas Health Group, the Canadian Patient Safety Institute (CPSI) and several funding agencies to provide hands-on training in clinical research, infection control and patient safety policy development for nursing students during the summer months. As we plan ahead, our student and staff evaluations show that together, we can make concrete, vital contributions to student education, nursing research, evidence-informed practice, clinical quality improvement and national policy. We are using what we have learned to continually expand the range of undergraduate, graduate and post-doctoral clinical learning opportunities in healthcare safety that are available year round. Our shared goal is to support current and future nurses in leading the way for safer healthcare systems and the safest possible healthcare.