Improving infant mortality rates

Front-line staff possess immense functional and experiential knowledge from which their organizations can benefit. This premise has led to widespread promotion of collaboration - among front-line staff and between staff and managers - as a strategy to integrate front-line staff knowledge for performance improvement. Collaboration refers to individuals working together to achieve a common goal via information-sharing, joint decision-making, and coordination of activities. In contrast to prior work, we distinguish forms of collaboration by three organizational goals - unit management, routine production, and process improvement, and examine whether collaboration for these different goals has different effects on performance. This paper reports on a longitudinal study of 23 neonatal intensive care units (NICUs) in a structured, quality improvement program. We test the relationship between collaboration within the NICU and improvement in patient outcomes, as measured by risk-adjusted infant mortality (n=1061). The effects of collaboration vary by goal. Collaboration in unit management increases the chance of mortality, while collaboration in routine production and in process improvement are associated with a reduced chance of mortality. The implications of these findings for research on organizational learning, human resource management and operations management are discussed.