Innovative Care Delivery Models in Action

How Two Nursing Leaders Led the Transformation of Their Care Models to Improve Patient Care and Nurse Satisfaction

In a recent webinar, Aya Healthcare invited nursing thought leader, Dr. Bonnie Clipper, to moderate a discussion with two nursing leaders: Kathy Howell, Chief Nursing Executive of UCHealth, and Ashleigh Gerhardt, VP of Network Operations and Emergency Services of HonorHealth. They shared valuable insights and lessons they learned from redesigning their care delivery models through team nursing initiatives and virtual care programs.

Watch the full webinar on demand or continue reading to discover some of the innovative care delivery models they implemented in their own health systems.

Expanding Care Team Capabilities with a Skill Mix Framework

With the increased strain on resources brought by the COVID-19 pandemic, many health systems are finding creative strategies to increase the speed and accuracy of care delivery even with reduced resources and headcounts. Experimenting with different skill mixes is one way to improve and supplement service delivery with a broader range of practitioner types while still allowing nurses to practice at the top of their scope.

“We’ve implemented quite a few new support roles to allow our nurses to practice at the top of their scope. One is a patient technology technician, which is a role that takes all the technology concerns off our frontline nurses in acute care settings. Our teams have shared that it’s a revolutionary, game changing addition — yesterday a nurse told me they wouldn’t work in a unit without this role.”

Kathy Howell, Chief Nursing Executive of UCHealth

Here are a few ways that Howell and Gerhardt made strategic changes to their skill mix to expand the utilization, capacity and capability of their care teams:

• Offloading Non-Essential Tasks: Howell introduced a new role, patient technology technician, that provides onsite clinical and technical real-time support and offloads tech maintenance tasks from nurses in acute care settings.
• Integrating Paramedics into Trauma Teams: Gerhardt’s team, in partnership with their local EMS medical directors, began integrating advanced paramedics into their ED teams to work alongside nurses and fill various roles such as patient screening and monitoring.

Improving Bandwidth and Efficiency with Virtual Nursing Programs

Implementing a virtual nursing care model can help increase bandwidth and efficiency, especially in the midst of a nursing shortage. Virtual nurses can monitor and care for patients remotely, as well as support nurses who are on site at the bedside. Data shows virtual nurses can help decrease nurse turnover, patient falls, length of stay, readmission, and ICU transfers. Virtual care nurses can assist with:

• Patient screening and admissions
• Wound care (in collaboration with onsite wound care techs)
• Remote monitoring for patient deterioration
• Medication verification

Both Howell and Gerhardt found success with implementing virtual nursing programs. Howell saw a 38% improvement in nurse productivity and a sharp decline in the time elapsed between initial patient consults and clinician visits. Nurses also identified high-risk patients quicker and improved the overall quality of care. On the other hand, Gerhardt’s virtual nurse program helped enhance patient safety, streamline admission and discharge processes and increase overall patient and nurse satisfaction.

“The goal of our virtual nursing program is all about driving home great care and keeping safety top of mind… we needed to find a creative way to interact with patients while improving the speed and accuracy of care delivery.”

Ashleigh Gerhardt, VP of Network Operations and Emergency Services of HonorHealth

Tips for Navigating Care Transformation

Successfully implementing any type of organizational change requires concerted efforts across all levels of a health system’s hierarchy — you need to buy in not only at the leadership level but also at the individual level. Here’s how UCHealth and HonorHealth updated their care models and integrated new roles into existing team dynamics:

• Communicate Early and Often: Communication is key when driving organizational change. Leaders, directors, chief nurses, and other executives should spend ample time with frontline staff to communicate changes, answer questions, and explain the rationale behind any new initiatives. Any changes should be communicated across multiple channels — there’s no such thing as overcommunication in these situations.
• Give Frontline Staff a Seat at the Table: Offering frontline staff an opportunity to weigh in on new initiatives can help foster team champions, get teamwide buy-in, and provide valuable perspectives that can drive future program improvements.
• Use Metrics to Inform Decision Making: Both quantitative and qualitative data should inform decision-making and program design for new or updated care models. Use pre- and post-program data to compare metrics around productivity, patient and nurse satisfaction, and more.
• Start Small, Start Quietly: Pilot initiatives are an effective way to test out new care models before integrating them into the wider health system. By rolling out small, experimental initiatives, you can monitor the impact on metrics, collect feedback, and take a more iterative approach.

Dr. Clipper also shared some words of advice, encouraging webinar attendees to, “Start small, do something. It doesn’t have to be perfect; it’s just a matter of getting started in this new space. We’re in a period of disruption in healthcare right now. You can’t make things worse — you can only make them better. Now is the perfect opportunity to transform, learn and iterate along the way.”