A triad leadership model — which often unites a nurse, physician and quality or administrative leader — is gaining traction among health systems as they work to streamline operations and improve outcomes amid an increasingly complex healthcare environment.
West Orange, N.J.-based RWJBarnabas Health implemented triad leadership in late 2022 to enhance collaboration among its nurse, physician and quality leaders, recognizing the need for stronger teamwork during strategic planning of the system's safety and quality initiatives, according to Andy Anderson, MD, the system's executive vice president and chief medical and quality officer.
This model is applied at both the system-level — with Dr. Anderson partnering with Executive Vice President and Chief Nursing Officer Nancy Holecek, MAS, MHA, BSN, RN, FNAP, and Amy Cotton, DNP, APRN, senior vice president of quality and safety — as well as across the executive teams at RWJBarnabas' 12 hospitals.
The model allows for team-based brainstorming and decision-making, helping leaders work toward the system's common goals in a more cohesive way. It also provides greater clarity for leaders and a shared sense of accountability for outcomes. These efforts align with the system's high-reliability culture, which emphasizes daily safety huddles, outcome transparency and a collaborative environment focused on continuous improvement.
For systemwide quality improvement projects, a nurse, physician and quality leader from three different hospitals are selected to lead initiatives. These leaders meet monthly and ensure that other CMOs, CNOs and quality leaders are engaged in the initiative, according to Dr. Anderson.
"Having those three leaders at the table as equal partners, as a triad team … It's really powerful because it's team-based. It brings ideas forward that may not have emerged when those three individual types of leaders are not together, and then it helps ensure that the different constituencies are just working together on the different initiatives," he said.
The model has broken down numerous siloes across RWJBarnabas and aligns with efforts to standardize quality and safety practices systemwide. Last year, the system launched an initiative to lower central-line associated bloodstream infections by educating staff members on best practices and standardizing the types of central lines and dressings kits used. The system relied on a triad leadership model to oversee change management efforts at each hospital, achieving a 40% reduction in monthly infections. The model has also been used to oversee improvement efforts for Clostridium difficile, pressure injuries and now mortality.
When transitioning to a triad model, Dr. Anderson emphasized the importance of system- and hospital-level leaders serving as role models to ensure a smooth adoption. For instance, CNOs and CMOs at each hospital often round together, engaging with patients and staff to reinforce the leadership approach.
"That type of model is powerful, because your physicians and nurses see their two leaders together, walking the walk together, coordinating and collaborating," he said. "It creates better synergy, better teamwork and better communication. … So it's just kind of naturally taken hold and really progressed in a good way over the past couple of years."