title: Clinical team leaders provide added heft in driving improvements, moving the ED culture toward a patient-centered approach.
abstract: Anticipating a more competitive marketplace when the Accountable Care Act is fully implemented next year, ED administrators at Truman Medical Center Lakewood in Kansas City, MO, have taken steps to re-engineer outdated practices and infuse the department with a patient-focused culture. To get staff on board, the ED director appointed several clinical team leaders (CTL) from the nursing staff. Infused with a combination of managerial and administrative responsibilities, the CTLs have reinforced a flurry of new practices and policies on a 24/7 basis, and key metrics are on the rise. The CTLs were created through the re-allocation of existing full-time positions within the ED. There was no need to take on additional staff, although the ED director solicited staff input when deciding which of the staff nurses were best suited for the CTL positions. Since the CTL positions were created in 2011, the ED has implemented immediate bedding, bedside triage, hourly rounding, bedside shift reports, and a number of other improvements. The ED's left-without-being-seen rate has been more than halved, from 10% to 4.6%, and the arrival-to-leave time has been slashed by more than 100 minutes, even while volume is on the increase.
mesh_terms: D004059:Diffusion of Innovation; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D008923:Missouri; D019982:Organizational Case Studies; D015279:Organizational Culture; D010348:Patient Care Team; D018802:Patient-Centered Care; D058996:Quality Improvement