Background: Joint leadership- modeled by physician-nurse dyad unit leaders has been a successful leadership structure at our organization for years. Advanced practice providers (APPs) have grown significantly in numbers over the past 10 years and have become critical members of our inpatient healthcare teams. They represent a stable and engaged workforce. In 2016, the nurse-physician dyad expanded to a nurse-physician-APP triad. This triad model utilizes interprofessional collaboration to achieve measurable goals, which are tracked and trended on unit-based quality dashboards.
Purpose: This initiative expanded an existing, effective unit dyad leadership model to a triad model that included advanced practice providers.
Description: The natural progression of APP inclusion at our hospital resulted in the creation of the first nurse-physician-APP triad leadership team. Senior leadership and physicians have actively created an environment where APPs are valued, trusted and opinions respected. As a result, APPs have become increasingly instrumental to daily hospital operations.The triad model was formally implemented in June 2017 and subsequently adopted by other inpatient units. The dissemination of the triad model has supported the continued professional development of APPs, enhanced APP and physician alignment with the nursing department, and advanced the strategic goals of the organization. One inpatient medical triad improved patient flow by increasing discharge before noon rates resulting in improved patient satisfaction and reduced ED overcrowding by 26%. The inpatient surgical triad implemented same day discharges for 120 of 161 planned total joint replacement (TJR) patients, reducing length of stay and associated costs with no readmissions. They then collaborated with the perioperative triad to pilot same day discharge for TJR patients directly from the post-operative care unit (PACU). 75% of the identified patients (n=120) have successfully been recovered and discharged from the PACU without subsequent operative related readmissions.Senior organizational leaders, including the CMO and CNO, use the larger dyad/triad forum to drive innovation and best practice and to collect first hand feedback on organizational challenges. Current work includes: sepsis quality indicators, reduction in HACs, increased participation in workplace safety, and creation of a culture of high reliability.
Conclusions: The formalization and integration of the nurse-physician-advanced practice provider triad leadership model has successfully leveraged the existing knowledge, skill, and engagement of APP, nurse and physician leaders to advance patient outcomes.