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Each year, Baptist Hospital delivers more than 7,000 new babies in Nashville, but the way key decisions were made was decidedly old school … until now.

With the beginning of the new fiscal year on July 1, Baptist Hospital has rolled out a co-manager model that takes a team-oriented, frontline approach to operations. Prior to the rollout, the department had been managed in a traditional manner by a nursing director and several nursing managers who oversaw labor and delivery.

“In the past, we were a very hierarchical structure with many layers of approval,” explained Pam Clayton, director of nursing for Women’s Health at Baptist, who serves as nurse executive in the new model. “We didn’t give nurses the true ability to be decision-makers.”

She added that in the new structure, each member of the team brings different talents to the table but with the same end goal for their patients. Clayton said the integrated leadership model is more outcome oriented than the previous operational mode.

Cornelia “Connie” Graves, MD, director of perinatal services for the hospital, has been named physician executive in the organizational team. She and Clayton, along with consultant Donna Helfferich, are responsible for formulating strategy and providing direction as it relates to programs, clinical services and operations for obstetrics.

“In obstetrics, physicians and nurses have had a long history of co-management,” Graves said. “This model we’ve developed is taking what’s really being done and giving it a more formal structure so what we believe is the physician and nurse will see each other more as equals, and each person is vested in seeing the patient has a good outcome.”

She added, “Our goal is to take Baptist to the next level not only in Middle Tennessee but nationally in how we deliver healthcare to women. We feel like in this new century, there has to be a new model, a better model.”

Graves and Clayton are charged with overseeing three primary areas of care — the Ante/Intrapartum Center, High Risk Neonatal Center and Maternal Newborn Center. However, within each of these focus areas, teams of clinical leaders made up of physicians and nurses share around-the-clock responsibility and accountability for performance outcomes. With the accountability comes the power to make decisions regarding daily operations, care coordination, quality, staffing, training, education and professional development, communication and financial parameters.

“Our physicians are excited about this new approach, and I think it will further solidify a better overall experience for patients, staff and physicians and position us as an innovator when many obstetrics programs across the country are still using a silo or vertical model,” noted Graves.

A key side benefit to the new structure is a renewed enthusiasm among nurses to take on leadership positions.

“In the past, people would just grimace at the thought of becoming a nurse leader because we just put so much on that position … the span of control was just unmanageable,” said Clayton, who added that already 14 staff nurses representing all three of the clinical centers have shown an interest in taking on an expanded role. “They were excited about the opportunities in this new model and about leadership in general.”

Clayton noted that with the ongoing nursing shortage and increasing age of current nurse managers, it is important to attract a new generation of nursing leadership. The same also holds true for physician leaders. Both Graves and Clayton said it is imperative to have strong nursing and physician succession plans in place.

To create the new operational model, which builds off of established principles and management theory but was customized to meet the specific needs at Baptist, hospital officials hired Donna Helfferich, an independent consultant with Sandra Shelley & Associates out of the Chicago area. A registered nurse, Helfferich has a clinical and administrative background in women’s health.

“Integrated leadership is more about teamwork than individual performance,” she said. “It’s the antithesis of hierarchy.”

In a traditional “chain-of-command” format, an executive who is typically far removed from the affected work area hands down a decision.

This transformational leadership concept brings those on the frontline, who have the hands-on knowledge of how to best accomplish tasks, into the decision-making loop. Helfferich pointed out that when staff is involved in addressing operational issues, the outcome is much more likely to be a workable, sustainable solution.

“It’s about ownership … when people own something, they take care of it,” Helfferich pointed out. “The staff has to buy it, or they won’t do it. We’ve missed the boat on that so many times.”

The new structure is solely focused on operations. Medical governance continues to be led by the chief and vice-chief of obstetrics, along with medical obstetrics committees. However, the new operational teams are expected to work collaboratively with the department’s governance and hospital’s overall administration.



August 2008

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