Singer Sara J, Rivard Peter E, Hayes Jennifer E, Shokeen Priti, Gaba David, Rosen Amy
Department of Health Policy and Management, Harvard School of Public Health, Boston, USA.
Jt Comm J Qual Patient Saf. 2013 Aug;39(8):349-60. doi: 10.1016/s1553-7250(13)39049-7.
Leveraging Frontline Expertise (LFLE) is a patient safety intervention for engaging senior managers with the work-systems challenges faced by frontline workers and ensuring follow-up and accountability for systemic change. A study was conducted to assess the ability to refine, implement, and demonstrate the effectiveness of LFLE, which was designed for and tested in private-sector hospitals, in a Department of Veterans Affairs medical center (VAMC), typically a more hierarchical setting.
LFLE was pilot tested in an urban, East coast-based VAMC, which implemented LFLE in its emergency department and operating room, with the medical/surgical ward and ICU serving as controls. A 20-month multimethod evaluation involved interviews, observation, data-tracking forms, and surveys to measure participant perceptions of the program, operational benchmarks of effectiveness, and longitudinal change in safety climate.
Implementation showed fidelity to program design. Participating units identified 22 improvement opportunities, 16 (73%) of which were fully or partially resolved. Senior managers' attitudes toward LFLE were more positive than those of frontline staff, whose attitudes were mixed. Perceptions of safety climate deteriorated during the study period in the implementation units relative to controls.
LFLE can be implemented in the VA, yield work-system improvements, and increase alignment of improvement aims and actions across hierarchical levels. Yet the results also warn against dangers inherent in adapting improvement programs to new settings. Findings suggest the need for active listening and learning from frontline staff by senior managers and trust building across hierarchical
利用一线专业知识（LFLE）是一项患者安全干预措施，旨在让高级管理人员参与应对一线工作人员所面临的工作系统挑战，并确保对系统性变革进行跟进和问责。本研究旨在评估LFLE在退伍军人事务部医疗中心（VAMC）（通常是一个层级性更强的机构）完善、实施及证明其有效性的能力，该措施是为私立医院设计并在私立医院进行过测试的。
LFLE在位于东海岸城市的一家VAMC进行了试点测试，该中心在其急诊科和手术室实施了LFLE，将内科/外科病房和重症监护室作为对照。一项为期20个月的多方法评估包括访谈、观察、数据跟踪表和调查，以衡量参与者对该项目的看法、有效性的操作基准以及安全氛围的纵向变化。
实施过程显示出与项目设计的一致性。参与单位确定了22个改进机会，其中16个（73%）已全部或部分得到解决。高级管理人员对LFLE的态度比一线工作人员更为积极，一线工作人员的态度则褒贬不一。与对照组相比，在研究期间，实施单位的安全氛围认知有所恶化。
LFLE可以在退伍军人事务部实施，带来工作系统的改进，并提高不同层级改进目标和行动的一致性。然而，结果也警示了在将改进项目应用于新环境时存在的固有风险。研究结果表明，高级管理人员需要积极倾听一线工作人员的意见并向他们学习，以及在不同层级间建立信任。
