Experiences in Implementing a New Ambulatory Care Clinical Support Structure

The COVID-19 pandemic provided the opportunity to explore and reimagine our organizations practice leadership model. We were seeing turnover in all roles which highlighted the need to make an effective and efficient leadership structure change as an important focus for our future success. The purpose of the structure evaluation and implementation was to provide the following: 1) provide effective and efficient leadership, direction and oversight of all practice activities; 2) drive increased employee and provider engagement through lean management; 3) drive excellent patient experience as the organization shifts to new care models and pathways; 4) simplify leadership “layers” at the practice level and apply a consistent model of practice leadership across all service lines; 5) define core accountabilities for leadership team members; and 6) ensure that the work of the practice leadership team is unencumbered with tasks that should be completed by centralized teams or existing organizational departments.
Therefore, in 2021, our organization reimagined our ambulatory care support structure for our clinical staff to align with our support structure we had in place for our administrative employees. In doing so, we implemented new roles within our leadership team that serve as senior directors of clinical operations and clinical managers (number of clinical managers is dependent upon number of practices in service line) for each of our service lines. The senior director of clinical operations works collaboratively in a team leadership model with other service line leadership to include our directors of operations, program directors, vice-president, and medical director to ensure patient access to services and quality of care. The clinical directors are responsible for cross-continuum oversight in their respective service line across the organization to ensure safe, efficient, evidence-based care is being provided while following regulatory requirements. In addition, the clinical director serves as a clinical leadership resource, coach, and mentor to clinical staff across the service line by encouraging professional growth and development. Modeling the behavior we wish to see in our clinical staff, the clinical director maintains professional affiliations to keep abreast of latest trends in field of expertise and are required to have a master's degree and obtain nurse executive certification when eligible. The clinical director, along with the clinical managers, ensures that appropriate clinical standards and practices are developed and implemented as a result of research and non-research findings.
In less than a year of implementation of the leadership structure change, the clinical directors have had a positive impact in identifying variations in clinical practice across the organization and implemented or refined standard work. Relationships established within the practices with the clinical staff have proven to be beneficial, and we look forward to our next employee engagement scores. The traditional leadership team has welcomed and embraced the new leadership team approach, identifying the value clinical leadership and oversight has provided thus far in reducing variation. We are excited for the opportunities and journey that this new, emerging model of leadership will take us.