Frontline Leadership
While INLP deployed interprofessional leadership across departments, the primary profession focused on for leading quality improvement efforts and change were RNs. INLP identified RNs as a valuable and underutilized resource as organizational change agents.
Nurses typically:
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Work closest to the patients' bedside
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Are charged with implementing most processes
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Have valuable insight into what’s working... and what’s not
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Know how and why “work arounds” happen

Implementing the Improvement Infrastructure
As discussed in detail in the Core Curriculum section, INLP projects were implemented through a variety of modes, including on-site engagement, off-site trainings, and through embedded improvement projects in the hospital environment. Four areas that INLP focused on to develop the leadership skills of frontline nurses engaged in the program included: Process redesign, data management, communication strategies, and change management.
Data Management
Data management was an integral part of the change process, as it allowed team members to continually make sure that they were headed in the right direction. Details about the types of data collected, and processes for collection can be found in the Data Collection section of Section II. However, key topics included in the leadership curriculum included:
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Proper coding for data collection
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Data collection processes (i.e., bundle elements)
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Statistical analysis (e.g., run charts)
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Data reporting
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Using data to validate tests of change
Communications
Particularly during the spread portion of INLP projects, gaining buy-in for new workflows throughout participating hospitals was critical to each project's success. This required gaining support interprofessionally, and across departments. Due to the challenge of implementing unified improve processes, INLP developed a formal communication strategy, and incorporated training on goal-based communication strategies into the off-site trainings. To guide participating hospitals in developing a comprehensive communication plan, INLP provided the following four-step process:
"Step 1. Identify all key audiences and stakeholders, including individuals, committees, and departments.
Step 2. Brainstorm all potential objections to and reasons for noncompliance with the medication administration project. For example, one frequent objection concerned the failure to ap- preciate the problems posed by interrupting the nurse who was attempting to administer the medication. Because the first med- ication administration project had already proven effective on two units within each hospital, the potential reasons for not wanting to implement the project tended to focus less on the approach’s efficacy and more on why the approach might not work in a specific unit or with specific patients.
Step 3. Group stakeholders on the basis of their expected objections and potential reasons for noncompliance. In some cases, the grouping of stakeholders was obvious. For example, at one hospital, during the first project the team had already en- countered resistance from intensive care unit (ICU) nurses who did not think that they needed to implement the intervention because (1) the unit is smaller and requires less travel distance be- tween activities, allowing the nurses to focus more on work at hand, and (2) each nurse is assigned only to one or two patients at a time, obviating the need for checking two forms of identification for their patients.
Step 4. Identify potential communication strategies (for example, one-on-one conversations, poster boards) to overcome the objections." [1]
Based on these four steps, a communication plan was developed by each team, with hospital-specific strategies created for specific stakeholder groups. A sample strategic communications message map can be found at the top right of this page. Lastly, the topic of "branding" was addressed, and each hospital create a tagline to facilitate consistent messaging, and promote program awareness. Program taglines were translated into logos, and incorporated across message mediums.
For the Medication Administration program, examples taglines included:
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“Pass it Right”, and
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“Your Safety is Our Priority.”
Additional example of communications strategies are below.
Change Management
Change management can be described as "an approach to transitioning individuals, teams, and organizations to a desired future state." [2] Whether on a singular hospital unit, or attempting to produce change organization-wide, there are many challenges to bringing about change. In order to address this topic, multiple aspects of managing change were addressed in the INLP core curriculum, including:
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Organizational influence
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Executive engagement
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Policies & procedures
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Team building
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Peer sharing and adoption of innovation
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Implementing workflow changes
Example of Work Flow Changes:
![]() Medication Admin PosterThis poster was another communication method used to educate, and remind staff about a new tool being used on the unit - a red light was used as a tool to remind staff that medication administration was happening | ![]() EGDT Time PosterThis poster was used by one participating hospital as a visual aid to walk clinicians through necessary EGDT bundle requirements | ![]() Sepsis FlowchartDeveloping a high-level flowchart of sepsis during an off-site session |
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![]() Sepsis Screening ToolExample of a sepsis screening tool, developed by UCSF | ![]() Sepsis Screening Tool | ![]() NICU identificationNICU nurses now check 3 forms of ID |
![]() Med Pass ZoneWarning tape used to mark off med admin zone | ![]() Med Admin Vest.pngThis bright yellow vest was worn by nurses during med pass time, as a visual cue to other staff to minimize disruptions |
Process Redesign
Process redesign was an integral part of the INLP change process. In order to address system inadequacies, new tools and workflows were developed to support and lead to the desired outcomes (improved medication administration accuracy, and a reduction in sepsis mortalities). This included:
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Identifying successful innovations
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Making process changes
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Developing tools
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Identifying work flow changes needed
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Identifying tests of change
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Rapid cycle testing
Check out some of the process innovations developed by INLP participants below...
References
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Kliger, Julie. "Https://innovations.ahrq.gov/perspectives/sustaining-and-spreading-quality-improvement." AHRQ Healthcare Innovations Exchange. AHRQ, 01 Aug. 2012.
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Kotter, J. (July 12, 2011). "Change Management vs. Change Leadership -- What's the Difference?". Forbes online.
![]() Fight Sepsis T-shirtT-shirt designed by San Francisco General Hospital to raise awareness about the sepsis improvement project | ![]() Medication Admin "Roadshow"Educational "roadshow" to raise issue and project awareness | ![]() "Pass It Right" Logo |
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![]() Stakeholder AnalysisExample of a Stakeholder Analysis | ![]() Message MappingMap of stakeholders, and target messaging regarding the sepsis project |
Problem: Timing of resident rounding was leading to unacceptable interruptions of nurses during medication administration.
Response: Members from Unit Team worked with physicians to adjust rounding schedules. Unit Team members met with chiefs of staff to explain purpose and approach to reducing medication errors.
Problem: Patients who are identified as septic require a lactate lab drawn as soon as possible. However, turn-around times for results can take up to an hour.
Solution: Unit Team and Steering Committee members lobbied Laboratory Services to place point-of-care testing machinery to run lab on unit, thus reducing time to results significantly (usually under 20 minutes).
Additional strategic communication topics included in the Core Curriculum included:
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Goal-based communications
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Promotion & Awareness
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Communications Program Development
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Presentation training
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Stakeholder analysis

