Open Forum

Looking for some ideas on how other ambulatory clinics are structuring the leadership/oversight at the clinic level -- we are looking at how our clinics are "run" - we have multiple locations and have utilized different models and not felt like any of them were the right "fit" or maybe we have not had the right people... what positions do you have for oversight / accountability (clinic vs. office manager, medical director, etc) what type of qualifications - who reports to who ... just wondering what other clinics are doing and what is working well. if anyone has a basic org chart or model, they would be willing to share I would love to hear about what's worked for your sites. Thanks!! 

For reference - we have providers, RNs, MAs, CHWs, FD and admin staff, care coordinators/referral. 

Thanks in advance! 

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Keri Urquhart MPH BSN RN
Covenant Community Care- FQHC
Detroit MI

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Hi Keri,

Working with a few different styles, it really comes down to who you have in the clinical leadership positions. 

At your sites, what is the typical amount of staff?

I do recommend having your Clinic Manager be an RN as they can supervise both the back office and front office. Limiting to one Manager (rather than a clinical and office manager) also removes any difference in managerial personalities so that all staff receive the same type of leadership, support, and direction. 

Do you have site Medical Directors who would work directly with your chosen manager position as a dyad relationship? SMD supervises the providers and the Clinic Manager supervises all others. I find this to be exceptionally successful as most providers do better with their managerial needs with another peer. 

Let me know if I can provide any more insight, hope this helps start the conversation!

Sincerely,

Brianna

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Brianna Rivera, MSN, RN
Founder & CEO
Rivera Healthcare Consulting
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We have nurse managers in most of our clinics that partner with the practice manager (non-nurse). The PM has overall responsibility for operations of the clinic. The PM, Nurse Manager and Medical Director then form a triad to ensure outcomes are being met that align with our enterprise/ambulatory goals. We also have a supervisor (PSC, Sr) in many of the clinics that support administrative and front desk personnel. This person also reports to the PM. The PMs then report up to an operations director (non-nurse). The directors report to the Chief of Ambulatory (also not a nurse) but is my partner in the ambulatory triad along with an ambulatory Chief Medical Officer.   All nurses in ambulatory have a dotted line to me (CNO). Hope this helps.  Happy to discuss if that would help.    

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Patricia Hughes DNP RN NE-BC
UK HealthCare
Lexington KY
(859) 323-4413
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Good Morning,
Some of our practices have nurse manager but most have non clinical manager. Some practices have a nurse clinical lead to support the non-clinical manager. There is a significant difference with how the practice runs daily when have the combination of clinical and non-clinical support.
Regards,
Terri Seamans, RN, BSN, BC
NLH Mercy Hospital


Original Message:
Sent: 10/10/2024 4:03:00 PM
From: Patricia Hughes
Subject: RE: Clinic Leadership Structure

We have nurse managers in most of our clinics that partner with the practice manager (non-nurse). The PM has overall responsibility for operations of the clinic. The PM, Nurse Manager and Medical Director then form a triad to ensure outcomes are being met that align with our enterprise/ambulatory goals. We also have a supervisor (PSC, Sr) in many of the clinics that support administrative and front desk personnel. This person also reports to the PM. The PMs then report up to an operations director (non-nurse). The directors report to the Chief of Ambulatory (also not a nurse) but is my partner in the ambulatory triad along with an ambulatory Chief Medical Officer.   All nurses in ambulatory have a dotted line to me (CNO). Hope this helps.  Happy to discuss if that would help.    

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Patricia Hughes DNP RN NE-BC
UK HealthCare
Lexington KY
(859) 323-4413
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Our leadership is restructuring right now as we have had a lot of clinic locations where there was not a clinical leader paired with an operational leader. 

We have an RN supervisor for all the nurses in the region and most of our operational managers are also regional (covers multiple clinic and cannot always help with the day to day at each clinica location). 

They are adding a "Clinical Lead" position in each clinic. The preference is that this is an RN based in that clinic and they are the first line go to for any needs within that specific site. They also have their eyes on all the environment of care concerns every day at their clinic. Their direct support person being their regional manager. 

They also added my position as a clinical practice leader to support the operational leaders. I am an ambulatory clinical nurse specialist for the practice and support quality/safety/and evidence-based practice in our clinics. 

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Kristie Hills
Clinical Nurse Specialist
Spokane WA
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