Frontline Dyad Approach to Maximize Frontline Engagement in Improvement and Minimize Resource Use

Resar R, Romanoff N, Majka A, Kautz J, Kashiwagi D, Luther K. The Frontline Dyad Approach: An IHI Designed Methodology to Maximize Frontline Engagement in Improvement and Minimize Resource Use. Cambridge, MA: Institute for Healthcare Improvement; March 2012.

Why, with all the effort to improve safety at the front lines of care, has little or no measurable change in safety outcomes been achieved? Experts posit that the failure to see more improvement relates to the sheer number of frontline defects occurring in the attempt to deliver reliable care to our patients — defects that are neither recognized nor changed. 

This paper details the Frontline Dyad Approach — developed by the Institute for Healthcare Improvement (IHI) staff and key faculty, working collaboratively with Cedars-Sinai Medical Center and Mayo Clinic — to engage frontline staff in identifying and correcting small defects that have become normalized deviations, in the belief that elimination of these safety issues will have a dramatic effect on reducing organizational adverse events. 

The Frontline Dyad Approach begins with a conversation with frontline staff to identify potential defects in care processes. The term "dyad" stems from the concept that the defects identified using this method are relatively simple, regularly occurring, and can be solved by a small team of two (hence, “dyad”) frontline staff. The dyad approach encourages small-scale testing with the smallest working group (frontline dyad) and, because of the very important scoping function, provides improvement with minimal resource use in a very short timeframe (within 30 days or less).


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