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Care Redesign: A Higher-Quality, Lower-Cost Model for Acute Care

Rudisill, Pamela T. DNP, RN, NEA-BC, FAAN; Callis, Carlene BS, MHA; Hardin, Sonya R. PhD, RN, CCRN, NP-C; Dienemann, Jacqueline PhD, RN, NEA-BC, FAAN; Samuelson, Melissa DNP, RN, NEA, BC

JONA: The Journal of Nursing Administration: July/August 2014 - Volume 44 - Issue 7/8 - p 388–394
doi: 10.1097/NNA.0000000000000088

OBJECTIVE: The aims of this study were to design, pilot, and evaluate a care team model of shared accountability on medical-surgical units.

BACKGROUND: American healthcare systems must optimize professional nursing services and support staff due to economic constraints, evolving Federal regulations and increased nurse capabilities.

METHODS: A redesigned model of RN-led teams with shared accountability was piloted on 3 medical/surgical units in sample hospitals for 6 months. Nursing staff were trained for all functions within their scope of practice and provided education and support for implementation.

RESULTS: Clinical outcomes and patient experience scores improved with the exception of falls. Nurse satisfaction demonstrated statistically significant improvement. Cost outcomes resulted in reduced total salary dollars per day, and case mix–adjusted length of stay decreased by 0.38.

CONCLUSION: Innovative changes in nursing care delivery can maintain clinical quality and nurse and patient satisfaction while decreasing costs.

Author Affiliations: Senior Vice President and Chief Nursing Officer (Dr Rudisill), Community Health Systems, Franklin; and Assistant Vice President Strategic Resource Group, Vice President Strategic Planning American Group (Ms Callis), HCA, Nashville, Tennessee; Professor (Dr Hardin), College of Nursing, East Carolina University, Greenville, North Carolina; and Professor Emeritus (Dr Dienemann), School of Nursing, UNC Charlotte and Nurse Researcher Carolinas Medical Center University, North Carolina; and Chief Nursing Executive (Dr Samuelson), Poplar Bluff Regional Medical Center, Missouri.

Community Health Systems is a registered trade name of Community Health Systems Professional Services Corporation.

The authors declare no conflicts of interest.

Correspondence: Dr Rudisill, Community Health Systems, 4000 Meridian Blvd, Franklin, TN 37067 ( or

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins