Nurse practitioners and physician assistants supported by one dynamic organization

May 19, 2022  //  FOUND IN: Strategy & Leadership,
The new APP directors. Top row: Andrea Kline and Stan Mukundi. Middle: Brian Downie and Nicole Speck. Bottom: Shahrzad Patterson and Paul Ranella.

Nurse practitioners (NPs) and physician assistants (PAs) are highly valued team members who partner closely with physicians to provide a high level of patient care across Michigan Medicine — but opportunities existed to better support these growing professions within the organization.

The resulting APP leadership structure will be redesigned to provide consistent representation, align reporting structures, enhance consistency of practice, coordinate and support best practices and encourage career advancement among this team of professionals.

While in many health systems, the term “APP” includes other APRN (advanced practice nurse practitioner) roles such as certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs) and clinical nurse specialists (CNS), the executive sponsors at Michigan Medicine chose to focus on building a leadership structure for NPs and PAs, in recognition of the similar challenges and opportunities faced by both professions within our health system. 

“In the past, NPs and PAs had variable representation across operating segments, departments and units which contributed to confusion with reporting relationships, and at times inconsistent training, performance management and recognition,” said Chief Medical Officer Jeffrey S. Desmond, M.D. “This restructuring project will bring these professionals together into one dynamic, disciplined organization which will follow a service line structure, and focus on both inpatient and outpatient care.” 

After several months of design work, the project has reached an important milestone. A multi-disciplinary team, led by six APP directors, has kicked off work to implement the structure while clarifying and aligning roles such as APP managers, finalizing reporting structures and developing leadership tools and standards.

“We benchmarked against other similar health systems and spent time defining a realistic span of control for APP directors and the best scope of practice for APPs,” said Chief Nurse Executive Nancy May, D.N.P., R.N., AMB-BC, NEA-BC, FAAN.

“This structure has undergone a lot of revisions and we recognize that it’s not perfect, but we believe it is a great starting point to support our APP teams,” she said.

The implementation team will use a phased approach, with work already beginning. A tentative timeline is listed below:

Congratulations to the new APP directors:

Service Line Grouping A (C&W, Primary Care, Diagnostics & Clinical Info. Management, ED and Post Acute)

  • Shahrzad Patterson (PA)
  • Andrea Kline (NP)

Service Line Grouping B (ADTU & Infusion, Ambulatory Procedures, Cancer, CMC/PM&R and Med Specialties)

  • Brian Downie (PA)
  • Nicole Speck (NP)

Service Line Grouping C (CVC, Neurosciences and Surgical Specialties)

  • Stanley Mukundi (PA)
  • Paul Ranella (NP)

For additional information about the new structure, visit this APP Organizational Structure website

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