Background/significance: Historically, the neurosurgery clinic utilized a physician-centric leadership model. In 2017, the neurosurgeons proposed a staffing model change to allow each provider to have a designated RN scribe to assist with order entry. Members of the clinical team (to include RNs, LPNs, and MAs) had concerns regarding several clinic processes, but had no formal forum for discussion. In an attempt to provide that forum, and a newer collaborative approach, the clinical care team (CCT) was initiated.

Purpose: The team was created leveraging a shared leadership model to directly impact and improve clinical quality, elevate nursing practice, increase caregiver satisfaction, and empower clinical staff to meaningfully engage with physician colleagues.

Methods: The CCT utilizes a congressional shared leadership approach, with all clinical staff encouraged to participate in weekly meetings. Through defined procedures, the CCT reviews performance improvement ideas, with collaboration to solution.

In 2017, CCT embarked on their initial large-scale clinical process improvement change. They reviewed the physician-proposed staffing model change and developed the discharge nurse model. This updated model supported improved clinic efficiency, financial stewardship, and provider and caregiver satisfaction. To realize these improvements, the designated discharge nurse took accountability of several key functions. After the provider had examined the patient, the discharge nurse reviewed and transcribed physician orders, per written physician order sheet; discussed the referral process and location options with the patient; added patient education information to the after-visit summary (AVS); and scheduled necessary follow-up appointments for the patient. Once printed, the nurse reviewed the AVS with the patient, including important phone numbers listed. The patient-focused approach to care was well received by the patients.

As the CCT matured, the members completed other clinic performance initiatives. Upcoming standout performance improvement topics for 2019 include MyChart activation sign-up, medication reconciliation optimization, rooming efficiency, and standardization of workflows.

Results: The CCT-developed discharge nurse model resulted $88,548 in savings through staffing optimization. CCT leveraged clinical resources to allow staff to work to their scope of practice. This model change also resulted in 23% improvement in caregiver satisfaction in the areas of teamwork, empowerment, and safety, and a 9.8% improvement in provider engagement scores related to quality and clinical staff competency.

Conclusions: The change from the physician-centric to a shared leadership model has created dramatic improvements in the clinic. The CCT provided team members a forum with decisional voice for process change in the clinic. In addition to improved satisfaction, empowering staff and providers to engage in the CCT has resulted in many quality and outcome improvements.

Katrina Marmo MSN, RN, ONC

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