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In a time of tremendous change in health care, our focus has become “What can we do better with what we already have?” Supplies and resources may always be restricted, but there is one resource that will never be limited: knowledge.

Every individual has a wealth of knowledge and experience. The true challenge lies in how to distribute knowledge that already exists. This is where the concept of “liberating structures” comes into play.

Liberating structures are a variety of communication frameworks that allow for energized knowledge sharing and problem solving. These frameworks empower innovation. Liberating structures have been used in many disciplines to discover the best solutions: business, accounting and marketing. However, their use in health care has been limited, with only a few published studies using these techniques.

Prevention of patient falls is an ongoing and complex challenge in acute-care settings. According to a 2013 study by Choi and Boyle, “Falls are one of the most commonly occurring adverse events among hospitalized patients, with about 30 percent of falls resulting in injury, disability, or death.” Fall prevention is a “nurse-sensitive indicator,” which in means that falls are influenced by and indicate the quality of the nursing care provided to the patient.

Hospitals across the country continually work to prevent falls and find it is a complex challenge. Liberating structures techniques are thought to be effective in complex situations and were applied to fall prevention in a recent study to enhance patient safety at Providence St. Patrick Hospital.

A widely used health care term, “best practice,” means providing care that consistently leads to the best results. Nurses and other team members routinely seek to use proven best practices in their care, which is essential to keep patients safe while in the hospital. At the same time, nurses at the bedside have developed techniques all along to keep patients safe.

To unearth some of these best practices and helpful techniques from nursing experience, the researchers selected two liberating structure techniques: discovery and action dialogue, and TRIZ. These were two of 35 options developed and described by Henri Lipmanowicz and Keith McCandless, the pioneers of liberating structures.

The technique of discovery and action dialogue consists of seven questions that build upon one another. This technique is used to help a group explore solutions to a problem while uncovering that some individuals find better solutions than others. These “better solutions” are behaviors or practices are known as “positive deviance.” In other words, the results deviate from the expected norm in a positive direction.

By creating an environment where health care providers can openly discuss and brainstorm a problem, discovery and action dialogue helps to unearth these positive deviant behaviors or practices that may then be replicable throughout the health care setting – therefore improving practice and enhancing patient safety and care.

The second liberating structure, TRIZ, is a technique that consists of only three questions. This technique asks group members to create the opposite outcome of what they actually want. This technique was a favorite of both the researchers and the participants. The first question was, “Within your normal daily activities, how would you ensure a patient is going to fall?” Laughter commonly followed this question along with many creative responses. The second question was, “Is there anything we are doing that resembles these activities?” This really got the group members thinking.

The participants responded, “I think we unintentionally do all of these things,” stimulated true self-reflection. After allowing time for reflection and sharing, the researchers asked each group, “How are we going to stop these activities, or what is our first move?” It was at this time that many nurses shared their best-practice techniques and fostered new ideas and solutions.

The results of this study are still being analyzed, but it is apparent that this project was successful in discovering nurses’ knowledge and creating an environment for nurses to share, motivate and challenge one another to achieve the best for their patients. The nursing research scholars hope to see liberating structures techniques more commonly used in health care in the future.

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Hope Ballew and Lauren Swanson are registered nurses and clinical nurses at Providence St. Patrick Hospital.

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