How Baylor Scott & White Health restructured its care team model to prepare for the Covid-19 surge

This past week, I spoke with leaders at Baylor Scott & White Health (BSWH) about how they’re redeploying staff to achieve efficient, team-based staffing in response to this pandemic. Many organizations are moving towards team-based staffing, but during our conversation, I was struck by BSWH’s collaborative yet structured approach. From the beginning, leaders involved various clinical stakeholders and relied on a consistent design process to help with staff acceptance and readiness, as well as worked to standardize changes across service lines. My hope is BSWH’s approach and insights will assist you when making staffing decisions in the coming days or weeks.

BSWH’s approach to team-based staffing

Across the system, RNs from low volume areas are being redeployed to serve as ‘surge nurses’ in clinical areas predicted to be hardest hit, starting with the ICU. Rather than attempt to rapidly train more ICU RNs, a group of leaders, educators, clinical specialists, and staff created a team-based staffing model with an ICU RN as team lead, supported by a redeployed RN, RT, and PCT. This approach was subsequently replicated by key stakeholders for other areas, including ED, acute care, and dialysis.

To ensure success with team-based staffing, BSWH developed frameworks for each team, which are shared below. These outline the roles of RNs and ancillary care team members—providing clarity about who does what. All roles were carefully created to reflect complementary team structures, reflecting scope of practice for each practitioner. Leaders at BSWH also emphasized that this level of detail is essential to maximize collective staff safety, effectiveness, and efficiency. To help remind staff of role expectations, these frameworks are posted on patient doors as visual reminders.

Beyond role clarity, BSWH leaders took additional steps to support staff with role transitions and team-based care. What follows are key insights from these leaders regarding their process to help assist you with effectively redeploying clinicians into surge staffing models.

  1. Clearly explain the “why” behind moving to team-based care. This is not about repurposing RNs to become ICU nurses; this is about utilizing the entire workforce to support each other, optimizing the skills of ICU clinicians and highly trained acute care staff with other staff that can serve in various support roles.

  2. Team-based roles must be consistent with scope of practice, both licensed and ancillary. You’ll need to consider the skill sets required for clinical areas. But when it comes to defining roles, look at scope of practice to ensure all staff are confident of role decisions when moving to an unfamiliar environment.

  3. Assess and support RN learning needs. Redeployed staff receive training based on their new role and current learning needs. BSWH used skills assessment tools already available for clinical areas and self-assessments conducted by staff, and developed targeted learning plans based on assessment findings. When applying this to your organization, consider the following:
    • Support for learning is not a one size fits all solution. You’ll need to consider both years of experience and home unit to identify learning gaps, as well as the unit or service area that you are attempting to consistently place the redeployed nurse. For example, step down or ambulatory nurses may need to brush up on or learn very different skills than peri-operative staff.

    • Look beyond clinical skills. Staff may not inherently understand how to function in a team-based model. A review of delegation, communication, and team-based behaviors for all involved employees will be needed, including staff on receiving units.
  4. Provide upfront opportunities for redeployed RNs to become part of their new unit’s culture. This was vital to BSWH’s success in rolling out the team-based approach to staffing. Leaders are taking the following steps:
    • Redeployed RNs are assigned to one unit or area for a period of 6-8 weeks, which helps staff see themselves as part of the unit rather than working in a ‘float’ position.

    • Provide a detailed orientation of ‘home’ units for redeployed staff so they know the logistics, layout, equipment, and standing processes before their first shift.

    • Pilot the model in advance of the surge to ensure redeployed staff have at least one shift to become familiar with the unit, spend time with the team, and practice their new role. Likewise, using pilots will cultivate receiving staff support for the model.

    • Provide a permanent mentor or preceptor for each redeployed RN, and make an effort to coordinate staff schedules to align with preceptor assignments.

One of BSWH’s core values is “we are in it together,” which leaders believe has been key to overwhelming support for these new models of care. Additionally, leaders trust that the deliberate processes followed to create team-based staffing models, train redeployed staff, and prospectively socialize staff into new unit cultures has solidly prepared them for what lies ahead.

The Nursing Executive Center wishes to thank the following BSWH leaders for their willingness to share this outstanding work with colleagues across the country during this unprecedented time:

  • Remy Tolentino, MSN, RN, NEA-BC, Vice President, Nursing Workforce & Leadership Development, Baylor Scott & White Health
  • Karen Zwerneman, MSN, RN, NEA-BC, Director, Nursing Leadership Development, Baylor Scott & White Health
  • Susan Smith, DNP, APRN, ACNS-BC, Adult Health Clinical Nurse Specialist in the Critical Care Department, Baylor University Medical Center, Dallas
  • Scott Williams, MSN, RN, NE-BC, Director of Nursing, Baylor Scott & White Medical Center at Irving
  • Leslie Gembol, DNP, RN, NEA-BC, Chief Nursing Office, Temple Region
  • Kate Williams, DNP, RN, NPD-BC, Director Center of Nursing Education Innovation & Practice, Temple Region
  • Kris Powell, MSN, RN, CEN, NEA-BC, FAEN, Director of Emergency Services, Baylor Scott & White Health - North Texas Division

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This is a summary document to provide leadership insights. Our entire team is available to be a thought partner with you. Email us with any questions you may have, but if you would like to schedule a call with either myself or someone from our research team, please reach out.

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