Bringing Frontline Staff to the Forefront of Quality and Safety Improvement


For this post, the Department of Quality and Safety asked one of our team members, Casey McGrath, RN, MSN, senior director of Clinical Quality Improvement, to discuss Brigham Health’s latest project to engage frontline staff in hospital-wide quality improvement and patient safety initiatives.

As a large academic medical center, our employees pride themselves on having innovative ideas. On a daily basis you can hear chatter amongst staff across the hospital as they discuss “light-bulb moments” about new ideas on how best to care for a patient, identify opportunities to improve our workflow and processes, and one of the latest new research projects.

It is well-established in patient safety research that these frontline staff members, those who are responsible for caring for patients at the bedside, are key to identifying hazards in the workplace and proposing the best ways to eliminate them.1 However, it can be challenging to translate the ideas of frontline staff into action. This problem is not specific to Brigham Health; it is something large academic medical centers and hospitals face throughout the country. Recognizing this problem, many academic medical centers have created unit-based team (UBT) structures, allowing frontline staff to be closely involved in continuous patient safety and quality improvement.1,2 This past summer, Brigham Health began the process of launching our own UBT system across our inpatient floors. As part of the UBT model, frontline staff are paired with members of hospital administration and other key stakeholders with the goal of having staff feel empowered to ensure their voices are heard and they are engaged in changes and improvements in the work they do every day to care for patients.

Our UBTs meet weekly and focus on key hospital patient safety and quality improvement initiatives (e.g. catheter-associated urinary tract infections, central line-associated bloodstream infections, hand hygiene, patient satisfaction) as well as local quality, safety and operational metrics. The team reviews data, discusses concerns and identifies and implements improvement initiatives. Currently, BWH has seven active UBTs and is working on expanding to other inpatient units throughout the hospital. By providing units with a standardized structure for identifying concerns, improving performance and sharing ideas, as well as administrative support to assist with designing and implementing improvement initiatives at the frontlines of care, we hope to turn these “light-bulb moments” into reality so that the Brigham and its staff can continue to provide the safest and highest-quality care to patients and their loved ones.


  1. Pottenger, BC., Davis, RO., Miller, J., Allen, L., Sawyer, M., Pronovost, PJ. Comprehensive Unit-based Safety Program (CUSP) to Improve Patient Experience: How a Hospital Enhanced Care Transitions and Discharge Processes. Quality Management in Health Care. 2016 October/December.
  2. Kim CS., King E., Stein J., Robinson E., Salameh M., O’Leary K. Unit-based Interprofessional Leadership Models in Six US hospitals. Journal of Hospital Medicine. 2014 May.