Ehman, Jeffrey R.

ABSTRACT Background: Successful use of nurse practitioner (NP) and physician assistant (PA) care models is vital to delivering optimal patient care, maintaining financial stability, and reducing staff burnout and turnover. Local Problem: A large cardiovascular surgery practice experienced substantial growth, leading to an obsolete NP and PA care model. Consequently, workplace satisfaction scores were reduced, and the NP and PA turnover rate in 2018 was unacceptably high. Methods: A multidisciplinary redesign team was formed to address gaps in the care model through a quality-improvement initiative. The team analyzed current workflows, collected external and internal survey data, conducted patient tracers, and observed staff. Seventeen collaborative care models were proposed by frontline staff members and presented to their peers for feedback. This feedback was used to select the best aspects of the proposed models to create a new model. Interventions: The updated care model consisted of several key changes, which included reducing NP- and PA-to-patient ratios, eliminating redundant tasks, shifting from location-based to surgical team–based coverage, ensuring top-of-scope practice, developing specialty service lines, and separating inpatient and outpatient practices. Results: After implementation of the new care model, NP and PA turnover rates decreased from baseline by an average of approximately 74% per year. Departmental work culture scores concomitantly increased from 68% to 85% after implementation of the new care model. Conclusions: Adapting care models in conjunction with departmental growth is crucial to enhancing staff satisfaction and reducing burnout.

Strategic projects in large healthcare organisations are often highly complex and dynamic, and they require a team of skilled business professionals to execute them. Examples of difficult, costly and extended project executions have been shared in the literature. Successful project execution involves many critical facets. One facet that continues to be of marked interest is effective resourcing of strategic projects. This paper focuses on describing a staffing approach used at Mayo Clinic (Rochester, Minnesota) to facilitate successful, agile and sustainable execution, with desired outcomes. In 2016, Management Engineering & Consulting (ME&C) began exploring a collaborative staffing model that partnered management engineers with project managers (PMs) to drive strategic, multisite projects. This ongoing collaboration model was evaluated from multiple perspectives, including project outcomes, timeliness, client and staff satisfaction and opportunities for innovation. Data and feedback on the model were collected with historical reports, surveys and focus groups with stakeholders, leaders, PMs and management engineers. The feedback and data indicated that the collaborative staffing strategy and model have further optimised service delivery, enabled professional staff to work at the highest level of their competency and dynamically blended knowledge, expertise and skills to achieve better and more sustainable overall project outcomes.