title: Empowering Sustained Patient Safety: The Benefits of Combining Top-down and Bottom-up Approaches.
abstract: 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.
authors.affiliation: Tippie College of Business (Dr Stewart), College of Nursing (Ms Manges), and College of Public Health (Dr Ward), The University of Iowa, Iowa City.
authors.forename: Greg L
authors.initials: GL
authors.lastname: Stewart
authors.forename: Kirstin A
authors.initials: KA
authors.lastname: Manges
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
mesh_terms: D006739:Hospital Administration; D006801:Humans; D007857:Leadership; D009936:Organizational Innovation; D009937:Organizational Objectives; D061214:Patient Safety; D011209:Power, Psychological