Building the High-Value Care Team

Strategies for Delivering Cost-Effective, Coordinated Care

Three near-universal strategies to address care team inefficiencies and increase care team value.

Building the High-Value Care Team

Nurse leaders are under pressure to deliver care team value—which means they're torn between cutting costs and providing high-quality nursing care. But to build a high-value care team, they must focus on both.

This study identifies three inefficiencies that plague care teams and includes strategies to achieve the right balance between dollars spent on staffing and quality.

Traditional strategies no longer enough

Most traditional efforts to drive care team value have focused on just one side of the value equation—either inputs (for example, hours per patient day or salaries) or outputs (for example, high-quality patient care or strong performance on nurse-sensitive indicators).

It's time to change the conversation. Nurse leaders looking to build a high-value care team must take a balanced approach, providing the highest possible quality care for every dollar spent on staffing. And the time is right: with nearly one million nurses reaching retirement age in the next 10-15 years, nurse leaders have a unique chance to carry out these changes.

Three near-universal opportunities for increasing care team value

But where are your biggest opportunities to drive value? There are three inefficiencies that plague nearly all care teams.

  1. First, there is overreliance on bedside RNs to complete work that support staff or other non-RN care team members can safely accomplish. Nurse leaders should ensure all care team members are working at the top of their license—and then consider changing the proportion of bedside RNs or trading a bedside nursing position for an expert RN role.
  2. Second, uncoordinated interprofessional care often leads to duplicative efforts and wasted resources. The most effective organizations closely align all care teams' goals and workstreams, encouraging real-time collaboration whenever possible.
  3. Finally, many organizations deploy a "one-size-fits-none" care team, an approach that usually fails to meet high-risk patient needs and may over-serve low-risk patients. We've outlined a five-step process to help hospital leaders scale care team staffing to patient need.

Three paths to value—and the moves to get there

To help you fight these inefficiencies, we've identified three critical paths to greater care team value—and provided detailed guidance to help you implement them at your organization.

Change the Nursing Skill Mix

    • Achieve top-of-license nursing practice
    • Right-size the proportion of RNs in the skill mix
    • Trade a nursing position for an expert RN role

Align Interprofessional Goals and Work

    • Give all care team members the same set of goals
    • Transfer work to specialized team members
    • Gather physicians and staff at the bedside at the same time
    • Keep teams as consistent as possible

Deploy the Minimum Core Team and Selectively Scale Up Support

    • Select a patient population of focus
    • Identify patients needing additional support
    • Define the core and expanded care teams
    • Layer additional support onto the core team
    • Regularly reassess patient need for support
    • Case study: St. Charles Health System
    • Case study: Massachusetts General Hospital

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Three paths to a high-value care team