The clinical voice is sometimes overshadowed by other “voices” that are slowly making an entry into clinical processes. I was struck recently by the fact that electronic health records dictated the workflow in one recent incident. In another situation a patient education/entertainment system was a driving force in workflow. Creating an organizational structure to accommodate these types of changes in workflow design and operations is key to maintaining a seamless patient care delivery process.

Delivery of care has many facets. Nurse leaders are challenged to manage competing priorities while creating optimal healing environments at the same time. Ultimately, it is the responsibility of clinical leadership to drive patient care. To set a framework for clinical operations, you must consider quality, service, and financial performance. Here are some potential strategies:

• Establish a Clinical Operations Work Group to filter competing priorities. The group should identify guiding principles that align with your organization’s mission statement, goals and strategic plan. The added expertise of specialty team members from other support services such as LEAN, IT and Biomed allows inter-professional decisions that can improve decision outcomes. A core clinical group is also invaluable in establishing, maintaining, and aligning with executive leadership.
• Categorize requests for changes to workflow into groups (new technology, best practices, new standards, policies, etc.). Characteristics of these requests should be identified based on quality, service and financial performance. The “Framework for Vetting Requests” below can serve as a guide during these discussions.
• Once a potential value adding request has been identified, create a project plan and pilot program for that particular process. Create a score card for end users to evaluate and provide feedback to the group. Use this feedback to optimize process and communicate the project to your staff.
• Once a process has been accepted, communicate and roll it out to the staff. After implementation, include a feedback loop for continual improvement.

As healthcare continues to respond to the ACA, CMS, and other market conditions, managing and prioritizing changes will be critical to the success of healthcare systems. Nurse leaders need to create ways to strategically vet and organize this process. Many organizations have already put considerable effort into managing competing priorities with positive outcomes, but continuous improvements will be required.

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