System- and Unit-Level Care Quality Outcome Improvements After Integrating Clinical Nurse Leaders Into Frontline Care Delivery.

Miriam Bender, Elizabeth A Murphy, Maricela Cruz, Hernando Ombao

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


OBJECTIVE:This study determined whether 1 health system's frontline nursing model redesign to integrate clinical nurse leaders (CNLs) improved care quality and outcome score consistency. METHODS:Interrupted time-series design was used to measure patient satisfaction with 7 metrics before and after formally integrating CNLs into a Michigan healthcare system. Analysis generated estimates of quality outcome: a) change point; b) level change; and c) variance, pre-post implementation. RESULTS:The lowest-performing unit showed significant increases in quality scores, but there were no significant increases at the hospital level. Quality metric consistency increased significantly for every indicator at the hospital and unit level. CONCLUSIONS:To our knowledge, this is the 1st study quantifying quality outcome consistency before and after nursing care delivery redesign with CNLs. The significant improvement suggests the CNL care model is associated with production of stable clinical microsystem practices that help to reduce clinical variability, thus improving care quality.
Original languageEnglish (US)
Pages (from-to)315-322
Number of pages8
JournalThe Journal of nursing administration
Issue number6
StatePublished - May 25 2019

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