Empowering Sustained Patient Safety: The Benefits of Combining Top-down and Bottom-up Approaches

J Nurs Care Qual. 2015 Jul-Sep;30(3):240-6. doi: 10.1097/NCQ.0000000000000103.


Implementation of TeamSTEPPS for improving patient safety is examined via descriptive qualitative analysis of semistructured interviews with 21 informants at 12 hospitals. Implementation approaches fit 3 strategies: top-down, bottom-up, and combination. The top-down approach failed to develop enough commitment to spread implementation. The bottom-up approach was unable to marshal the resources necessary to spread implementation. Combining top-down and bottom-up processes best facilitated the implementation and spread of the TeamSTEPPS safety initiative.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Hospital Administration*
  • Humans
  • Leadership*
  • Organizational Innovation
  • Organizational Objectives
  • Patient Safety*
  • Power, Psychological*