Why staff buy-in isn't enough: Lessons learned from helping staff to own and improve their practice

Purpose:
Ask for staff buy-in, they can refuse to buy your product. Help them build the product, and they own it. To develop ownership for nursing practice, we gave Unit Practice Councils (UPCs) authority for scope of nursing practice, and coached them in governance and quality improvement methods.

Significance:
Staff who own their practice are accountable for it. Coaching staff to use authority, improve practice using evidence, and share decisions with peers and managers is a complex but essential effort often overlooked in adoption of shared governance. This effort has paid off in our organization.

Strategy and Implementation:
To strengthen shared governance, nurse managers and UPC members developed a scope of authority for UPCs based on results from completion of the Decisional Involvement Scale. The scope includes standards for and improving nursing practice. The nurse researcher facilitates UPC development: a 3-hour UPC orientation, toolkit on governance principles and improvement methods, attends UPC meetings to coach use of toolkit and negotiation skills, and help align UPC aims with strategic imperatives. Staff dialogues with UPC members throughout development of initiatives: e.g., communication network matching staff to UPC members, speed huddles to solicit suggestions, process evaluation posters scored by staff, participation in small tests of change. UPC members and staff meet one-on-one for final education before go-live. Everyone is actively prompted to participate in developing an initiative, so everyone owns the results, implementation goes smoothly, and staff hold each other accountable.

Evaluation:
Successes include hourly rounding, care teams, SBAR handoff, and standardized bedside report, providing structure for improving outcomes. Poster sessions at biannual meetings create friendly competition and pride. Scores on Nurse Practice Council Effectiveness Scale indicate high satisfaction.

Implications for Practice:
Deming said workers doing the work know how the work could be improved. By helping to drive improvement efforts rather than just provide input, UPCs/staff own the work, negating the need for buy-in. They can do this when given authority for their practice and coached in the required skills.