Date of Award


Document Type

Open Access Dissertation


College of Nursing


Nursing Practice

First Advisor

Ronda Hughes


Background: Changes in the delivery of healthcare services in the United States have been driven by cost containment over the last 20 years. To have a thriving organization within the current healthcare environment, nurses and physicians need to closely collaborate. As healthcare organizations prepare for the value-based era, new leadership models need to be implemented. This project addressed collaboration between nurse and physician leaders with a focused communication strategy to improve team performance, engagement, and quality outcomes in the acute care setting.

Method: A quality improvement project was designed to improve communication between front line team members and the dyad leadership team. The dyad leaders conducted weekly rounds with front line staff using a standardized lean quality improvement tool that supported leaders in improving engagement, coaching, and accountability, thereby improving patient outcomes. Pre- and post-intervention leadership capabilities self-assessment was completed by the dyad leaders. Team members completed a post-intervention engagement question. Data were analyzed using descriptive statistics and control charts.

Results: The results indicated that the physician leaders performed some independent coaching but required increased nurse leader support due to underdeveloped relationships with team members and inexperience with coaching. Physician leaders reported beginning levels of leadership competencies and understanding of organizational culture compared to nurse leaders. Despite necessary interdependence, both physicians and nurses have limited insight into one another’s unique roles. All team members in all three unit reported either strongly agree or always with dyad leader engagement. Team members reported an increased awareness of expectations, self-confidence, and skill level.

Conclusion: Dyad leaders need ongoing concurrent professional development to lead and build high performing teams and improve patient outcomes. Dyad leadership models can be instrumental in improving collaboration, communication, and clinical outcomes.

Implications: Joint (dyad) leader rounding should include: concurrent standardized education, weekly rounding, real-time coaching, standardized change process, and empowerment to hold individuals accountable. Dyad leaders must effectively communicate goals and expectations to promote engagement and accountability. Dyad leaders should continuously collaborate, build relationships with key stake holders, and facilitate interprofessional communication to improved outcomes for patients


© 2017, Lisa James