Registed Nurses' Association of Ontario

Improving Organized Care through Leadership and Management

Suzanne Lynch Braithwaite
Belleville Nurse Practitioner Led Clinic

The overall learning goal for this fellowship was to develop the leadership knowledge, skills, and expertise required to support program management, review, and evaluation within a rural, interprofessional, primary care team.

Month 1: Learning new knowledge

I would describe the first month of the fellowship as a time of learning new knowledge. In the first week, I participated in the RNAO Designing and Delivering Effective Education Programs (DDEEP). During this week, I was actively trying to absorb the new knowledge, and brainstorming ways I could use this new knowledge to improve programs at our clinic. The days were long, and the nights were even longer as I organized the information from the day and prepared it to share with the BNPLC team.

When I returned from the week long workshop I was quickly throttled into completing activities to meet my first learning objective: project management. This learning objective was designed to provide me with a systematic approach to managing large projects; the fellowship. This learning objective posed the largest learning curve for me. I found myself immersed in literature from the business and organizational sectors and learning terms such as project dashboard and project brief.

Eventually I became lost in this new world. However, with the support of my mentor I found myself back on track with a wealth of knowledge to apply to the fellowship project. Although my first learning objective required me to step furthest outside of my zone of comfort, it proved to produce some of the most beneficial learning outcomes and products of the fellowship. Outcomes included the fellowship website, project management dashboard and calendar, and a theoretical framework for project management that will guide future project at the BNPLC.

Month 2: Collaborating

I would describe the second month of my fellowship as a time to collaborate with team members and community partners to learn and understand how to apply my new knowledge in practice. During this time I used the transformational leadership model to guide my collaboration and consultation.
I met with program coordinators from various local primary care organizations to gain insight into their own triumphs in organized care. I had the opportunity to explore how their organization uses leadership and management to improve organized care and patient health outcomes. Each organization offered a unique perspective and approach. I was able to easily compare and contrast the various processes across the organizations as well as their patient and provider experience outcomes. I was able to identify themes among the organizations and compare those themes to their leadership styles.

After gathering all of this information I organized the new knowledge into a format to present to the BNPLC team. Using the transformational leadership model, I worked with the team to review the information from site visits as well as information from the literature. We were able to pick and choose recommendations from the literature, and processes that are currently used at local primary care organizations, to develop a hybrid program management process that aligns with the mission and vision of the BNPLC, meets the needs of the providers, and supports organized care programs at the BNPLC.

Using an experience-based design approach, (Bate & Robert, 2006) the team came up with an outline of their vision of a “perfect program management framework/process”. The experience-based design invites the users of the proposed process to develop the process themselves. The role of the facilitator in this process is to guide the discussion, encouraging participants to brainstorm the “perfect” experience. The facilitator/designer then takes the information and develops a prototype. The BNPLC developed the following statement “The Belleville Nurse Practitioner Led Clinic needs an organized care management framework that optimizes care because we want better outcomes”. This statement has been used to guide the remainder of the fellowship and will continue to guide program management at the BNPLC as we continue to grow.

Month 3: Making it all happen

The final month of the fellowship was the busiest. During this time I worked with the BNPLC team to make our dreams into a reality. I had high standards to meet as I had encouraged the team to dream big and envision the “perfect” experience. I developed a prototype to share with the team and get feedback. After receiving feedback, I went back to the drawing board and re-vamped any necessary components to meet the needs of the BNPLC team. This process of team engagement and transformational leadership contributed to successful and meaningful fellowship outcomes. The provider driven approach empowers providers and enhances buy-in.

At times I felt frustrated with the back and forth nature of the final month of the fellowship as it took the control out of my hands and placed it in the hands of the entire team. It required a significant amount more time, energy, and resources and I went back to the drawing board each time. It can be difficult to elicit so much feedback and to take the feedback honestly and genuinely. To really understand the needs of others. However, it is obvious that this process results in a richer more meaningful outcome.

During this time I struggled to meet the needs of the team while at the same time keeping within the fellowship timelines. It was difficult to cut activities short for the sake of time; however, the project management framework that guided the fellowship activities kept me on track. I understood that it was important to close the project on time, and to ensure the project details were not left unfinished. At this time I also worked closely with my mentor and the BNPLC team to look forward and clearly develop a plan to sustain the fellowship activities far beyond the completion date. The sustainability plan helped me to rest assured that the ongoing activities would not be left to dissipate.


This fellowship provided me with a unique opportunity to learn new knowledge and develop new skills in a practical, hands on setting. I had the opportunity to address an immediate need within my organization by capitalizing on the strengths within the organization, evaluating opportunities for improvements, and building on my individual learning. The structured approach I took supported me to critically evaluate and reflect on my learning needs and identify areas for new knowledge growth in the future.

The improvements and outcomes produced by the fellowship includes a comprehensive system to manage the complexities of health conditions, patient needs, and provider/organizational characteristics. This system will alleviate redundant work, reduce deviation from evidence based practice, and enhance patient health outcomes and provider experience. The fellowship also provided me with the capacity for leadership management that extends far beyond the duration and limits of the fellowship. It has provided me with a range of leadership and organizational management skills that can be transferred to other sectors including political action, health system reform, knowledge creation, and knowledge translation.

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