Ambulatory Staffing Support Care Model: A Quality Improvement Project Using an Innovative Process to Address Outpatient Clinic Staffing Deficits

Ensuring optimal staffing levels in the ambulatory care settings within a hospital housing over 150 outpatient clinics presents a myriad of intricate challenges. These challenges stem from the sheer diversity of clinics, the specialized skill sets required for staff, and the ever-fluctuating staffing needs due to a multitude of factors, including regular shift management, absences due to illness or family medical leave (FMLA), and shifts in clinic structures. To tackle these complexities and fortify support for clinics grappling with staff shortages, this quality improvement project endeavored to introduce an innovative staffing care model that can effectively address outpatient staffing deficiencies, and revitalize the existing float team ambulatory care nurse cohort, known as the ambulatory clinical resource team (A-CRT). This project will allow the learner to delve into the intricacies of using an expert nursing team to support the diverse challenges in ambulatory care staffing.

Our investigation involved posing six critical questions, touching upon aspects like shift management, clinic complexity, and the expertise of the A-CRT staff. This inquiry led to a transformative overhaul of our care model and gave rise to four pivotal initiatives aimed at bolstering the provision of care in outpatient ambulatory care clinics. These initiatives encompass an enhanced orientation process, specialized training geared towards supporting a select number of clinics with daily staffing needs (DAYS program), the implementation of a proactive system to predict and prepare for future staffing needs (MONTHS program), and the establishment of standardized terminology to define the concept of "critical staffing needs" through a shared tool.

The novel care model, notably the DAYS and MONTHS programs, has produced a remarkable upswing in the support provided to outpatient clinics. Furthermore, it has helped identify and create an “RN in-basket support” role for clinics who use the electric medical record (EMR) system to communicate with families using MyChart. The Capacity tool has fundamentally reshaped our approach to redistributing staff to areas with acute staffing needs, ensuring a more efficient and responsive allocation of resources.

Future endeavors will entail optimizing the size of the A-CRT RN cohorts to align with outpatient clinic DAYS and MONTHS staffing needs, completing the integration of clinic schedules into a centralized software program, and conducting regular reviews of best staffing practices with clinic managers to assess support needs. This transformative approach to clinic staffing is poised to significantly enhance the support provided to ambulatory care settings and further the success of the new care model.