Ten Reasons Why Redesigning Nursing Care Delivery is Hard

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Many health systems have prioritized piloting a team-based nursing care delivery redesign project as part of their 2024 strategic plan. Medical-surgical units are often selected as high-priority because they are challenging from both a recruitment and retention standpoint. Nurse leaders often find they need help with how to get started with a pilot. One asked my opinion about having a hackathon to jump-start their efforts.

Large-scale internal hackathons have become popular over the past decade to tap into creative ideas and crowdsource innovation. Based on my work with organizations, I recommended that there are better approaches than a hackathon.

To solve a problem like care delivery redesign, you have to know it intimately. While the fresh perspectives of a broader range of employees can be constructive and valuable in some redesign aspects, a hackathon will not produce a final design. You need to have the right stakeholders at the table. Redesigning care delivery is hard for the following ten reasons:

1. Redesigning nursing care delivery is a major cultural shift in how nurses think about their work.
2. Nurse leaders must champion the redesign efforts, and many, at this point, don’t.
3. Care redesign is not one size fits all – it is very complex and the design might look different even within units in the same hospital.
4. The labor markets in different geographical locations are very different and recruitment for new roles might be accessible in some areas and difficult in others.
5. The scope of practice of team members such as LPNs/LVNs, EMTs, PCTS, and CNAs varies widely from state to state.
6. Redesigning care delivery is a significant change project requiring nurse leaders to have expertise in change management.
7. Successful organizations will go through many iterations in the design process.
8. Redesigning care delivery requires an ongoing commitment on the part of executive leaders.
9. Nurses graduating today need to prepare to assume team leadership roles where they supervise and delegate care.
10. A teamwork infrastructure needed to support a new care delivery model is absent today in many healthcare settings.

The good news is that even though redesign is complex, it is achievable. As part of an AONL subgroup, we recently conducted focus groups with nurse managers leading team-based units. These managers confirmed the challenges cited above but many had successfully tackled them. They cautioned that success does not happen overnight – their units turned the corner at the 6-12 month point. Experienced skilled nurse leader champions are essential. Ongoing communication is crucial. Role clarity is a key success factor. They found some things in their initial pilot design worked well but others did not. Some outcomes were achieved but not all were. There were also some unexpected wins (better teamwork, higher patient satisfaction and a solid plan to grow your own workforce).

When you commit to care delivery redesign – it is a major commitment. You will likely find as these leaders have that best practices that seem to work in some health systems don’t always work in others. If you wait for solid evidence on care redesign, you may wait a very long time and it still might have limited usefulness. Their advice is to build a sense of urgency in the workforce, begin your redesign and be prepared to pivot when you need to.

© emergingrnleader.com 2023

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