by Amy Wilson

Healthcare is changing rapidly and care delivery team structures across the U.S. hold an undeniable responsibility to adapt to these changes. Other industries allow members throughout their organization to encourage the identification of barriers, discovering underlying issues, propose solutions, and shift outmoded processes. Implementing this type of shared leadership in healthcare can empower care providers to pivot in a direction based on collaboration which fosters growth towards meaningful solutions. This type of dynamic collaborative thinking led to the development of a Nursing Transformation Unit with the intention of closely listening to nurses to improve their workplace efficiency and satisfaction.

The work to develop a transformational model for nurses to thrive and share ideas began last year with thorough research and began first with listening. To spread the word about this innovative pilot unit at Ascension, the nursing leadership set up nursing town hall meetings at each of our hospital facilities in Tennessee with intentional, thoughtful listening to the nurses working to serve our patients each day in different facilities and their respective units. The learnings were enlightening and presented an imperative opportunity for improvements that would foster growth and continued care excellence. One of the main takeaways was the current burden faced by nurses who care for patients in fast-paced, high-stress environments which emphasized how the nursing care model has not changed despite the many improvements in the healthcare environment.

This compelled our nursing leadership team to restructure the recruitment and hiring process by using behavioral based interview questions, which were created and modified through a concerted effort with the nurse leadership and HR for an improved, more thorough selection process. Due to the nature of the unit – fast-paced change and nimbleness – the interview questions provided direction around which candidates should be selected for the unit with a validation measurement tool based on skills and expertise. Following the selection of exceptional candidates for the implementation of the new unit, the new team members were required to attend orientation sessions to equip our staff with process design techniques and organization development tools that would be brought to life in the new space.

Through the development of our Nursing Transformation Unit, we strategically recruited 22 new staff members – a mix of 15 nurses and 7 nursing technicians – placed throughout our 17 medical surgical rooms. Since launching the unit in October 2018, our team has trialed 29 variations of interventions based on the barriers indicated by the bedside care team during orientation based on what works well in the clinical space and what needs to be changed.

The teams in the pilot were divided into different work streams selected based upon paint points identified during our orientation and training: Interdisciplinary Team, Informatics and Technology Team, and the Workflow Team. Each staff member then volunteered to take part in one of the three teams based on their skill or where they felt most passionate about contributing to the change process. Each two-week period, we selected interventions of focus, in which each team member then takes ownership of the tasks – flattening the leadership hierarchy. The team member was responsible for collecting data to assess whether the intervention was successful or would need further iterations. Management continually equipped the team with the necessary resources to accomplish these tasks, as well as coach the team to remain aligned with the ultimate vision of the pilot.

Culture was a huge component of these changes. One of the greatest byproducts of the unit has been the ability to encourage nurses to ask the “why” question around a broken process and come up with solutions on their own. We provide access for the staff to engage with interdisciplinary staff members to understand all perspectives of existing protocols. By doing so, our staff can be creative with their solutions and test minimal viable products. This provides the staff with the ability to see small increments of change and take leadership in the transformative process.

In world of rapid changes based on digital innovation, a key component that we had to address based on research, we acted quickly to take full advantage of health technology and empower our nurses for the best care delivery possible. To bridge the gap between familiar technology and healthcare, our units were equipped with Amazon devices in each patient room to test voice-activated technology in the acute care setting. One of the main use cases is to provide video education to patients. We’ve created a video to welcome a new patient to Saint Thomas, provide orientation to their room environment, as well as provide brief education around the Amazon devices that are in their rooms so that patients are better connected to a convenient, seamless care experience.

Through thoughtful listening to understand, empowering leadership and implementing solutions, not only did our team become educated on the nuances of the profession, but it also sparked the question of: how do we equip our nursing staff with the right tools to build a healthy community and a healthy self in a high-stressed environment? This work is not something that will ever be complete, but it will certainly continue to transform the way healthcare is delivered while improving the healthcare experience and care outcomes.

Amy WilsonAmy Wilson, BSN, MSN, is chief nursing officer for Ascension Saint Thomas. For more information on the health system and services, go online to