“One of the things we noticed is it’s important that we articulate to our caregivers how important their opinions are while balancing that with the need to create efficiencies that do not further add costs to the organization or to healthcare as a whole,” Michelle Hereford, RN, the system’s chief nursing executive, told Becker’s. “… They do have a lot of solutions that perhaps were not entertained in the past.”
One program that has emerged from conversations with staff is its Care Team of Tomorrow. University Hospitals piloted the program in 2022 and 2023, and following its expansion across all UH inpatient medical-surgical units, the program has improved patient experience, employee engagement, retention and recruitment of registered nurses and other professionals, according to Ms. Hereford.
In a conversation with Becker’s, Ms. Hereford and Ashley Carlucci, DNP, RN, chief nursing officer for the UH East Market, discussed the program’s effects and challenges as well as the six new roles introduced in the model to enhance patient-centered care.
Addressing workforce shortages
Ms. Hereford noted that the initiative aimed to engage employees in developing solutions for workforce shortages and inefficiencies that led to frustration and turnover. “It’s the engagement of our caregivers that led to this model, which was designed to keep our patients at the center of what we do,” she said.
To achieve this goal, UH collected feedback through various methods, including a survey of 17,000 respondents and discussions with a smaller group of about 100 employees from different disciplines.
“This was not just nurses,” Dr. Carlucci said. “This was every single person in our organization that touches a patient. They got in a room and said, ‘OK, this is what’s working, and this is what’s not,’ and dreamed big: ‘If I was the patient, how would I want to be communicated to, and what am I missing as a patient?'”
The evolution of the Care Team model
Through this process, nine roles were created. Dr. Carlucci noted that while the pilot phase saw high engagement and innovation, teams faced challenges with consistency as they rapidly adapted. Leadership later helped refine the process, reinforcing the original role designs and ultimately narrowing the nine roles to six for a successful systemwide implementation.
The six roles of the Care Team of Tomorrow are:
1. Patient experience ambassador
- Created to focus on patient communication and experience.
- “We wanted a role that somewhat made it a concierge experience for every single patient — welcoming them to the unit, welcoming them to the care team, speaking with their family, making sure that they had all their questions answered,” Dr. Carlucci said. “And that was all they did. They communicated all day long with the patient and the family to ensure that they understood everything that was happening for them.”
2. Nurse coordinator
- The only licensed nursing role among the six, responsible for keeping team members organized and informed, and ensuring frequent huddles.
- “They would know if one area was struggling, and if they were a little bit behind on their tasks, they would be able to pull from another area to send them some help right away,” Dr. Carlucci said. “Instead of waiting until the end of the shift and realizing that things weren’t completed yet.”
3. Multi-skilled technician
- Trained to assist with basic clinical tasks that do not require a nursing license, such as drawing lab work and setting up telemetry or taking vital signs.
- “It not only helped the nursing team out, but it also helped with the engagement of a group of individuals that felt like they didn’t have [career] pathways before,” Dr. Carlucci said.
4. Personal hygiene expert
- Focuses on patient hygiene and comfort, ensuring patients are up in the morning, have their teeth brushed and feel comfortable.
- “Things that just make you feel better as you’re sitting there in a patient bed,” Dr. Carlucci noted.
5. Mobility aid
- Assists patients with walking and mobility, and engages in conversations with patients.
- “It was a dual role of both patient satisfaction and getting our patients moving,” Dr. Carlucci said. “And that was their primary responsibility. That’s all they did. So when they were done with one patient, they would then go to the next patient and walk with them, and then they’d go to the next patient and walk with them. And so when they were done with the whole unit, they’d start over again and again. It was a fantastic role, not only [in terms of reducing] length of stay but also for our patient experience, too.”
6. Equipment specialist
- Ensures medical equipment is available and operational in patient rooms.
- “We wanted to create a role that, one, knew about all the equipment in the unit, and two, made sure that the patient’s room was ready with everything that the nurse needed when a patient arrived,” Dr. Carlucci said.
Measuring success and future expansion
UH tracks the initiative’s success through multiple patient care, operational and staff engagement metrics, such as reduction in patient falls, length of stay, and proactive versus reactive equipment maintenance. The health system provides real-time feedback to employees to ensure continuous improvement.
“This work is ongoing,” Ms. Hereford said. “We firmly believe that our caregivers’ feedback matters. One of the notices we received prompted several employees to highlight the need for a similar approach in our emergency department, and we’re actively expanding this model.”
While the initiative has faced challenges, Ms. Hereford emphasized the importance of engaging employees and balancing their input with the need for efficiency. “How we have those conversations and how we engage with our caregivers really made a difference here,” she said. “So I will ask other health systems — engage your people. They want to be involved.”
Dr. Carlucci expressed similar sentiment, advising other health systems to act. “We’ve talked about care model redesign for decades,” she said. “The key is actually going, asking, listening, and breaking down those barriers. My advice is: Come up with a timeline, go do it, ask, and implement it.”
