Date of Award


Document Type

Open Access Dissertation


Moore School of Business


Business Administration

First Advisor

Timothy Fry

Second Advisor

Marco Habermann


Hospitals in the U.S. are under increasing pressure to reduce costs, streamline delivery of care, and increase value to patients (Young, 2012). In the operations management literature, Lean process improvement has been shown to be a valuable tool to reduce waste in healthcare (Womack, 2005). Lean process improvement involves, among other things, transitioning authority to frontline staff actually providing the value (De Treville & Antonakis, 2006; Liker, 2004). Similarly, Womack (2005) states that Lean process improvement is used to reshape healthcare processes for the delivery of patient care in order to increase value. On the other hand, Rubrich (2004) notes that many Lean projects fail due to poor leadership support and lack of employee empowerment and autonomy. Therefore, the goal of this dissertation is to examine employee empowerment in healthcare. Specifically, this dissertation examines employee empowerment in respiratory care. The field of respiratory care has an accepted approach to empowerment known as "Assess and Treat" programs whereby respiratory therapists are given the authority to change patient treatment plans using physician-approved decision-making protocols. This Assess and Treat program is a type of structural empowerment where frontline respiratory therapists are designated greater formal authority over patient care. Implications for hospital unit outcomes as well as the multi-level effects on frontline respiratory therapists are examined.


© 2014, Ashley Y. Metcalf