Sandra Hearn Reading Jessie’s post is very similar to what I found when I reported exactly one year ago. I “heard” and recognized the need for additional levels of staff to limit the overwhelming administrative requirements placed on our clinical support staff. I first shared my expectations with my 5 nurse managers with the promise that I would critically look at the functions across the organization and the staff who fell under my purview. I found the need to hire additional clinical secretaries with defined PDs and separate a lot of blurred functions that crossed over to business assistants, medical records and nursing duties. All changes were made with input from staff themselves who performed the work with time studies so I can have data linked with financial impact to go to Senior Leader Team (CFO/HR) for additional staff. Another area similar to Jessie was having assistant nurse managers and assistant center managers added to our staffing mix. when it comes to accountability, this comes from leadership and HR to enforce it at every level. Having clear goals and ability to run reports and track met outcomes is key. I also teach team accountability so peers can hold each other accountable- some on board and others not so much but that’s where training comes in. we have a designated multi-disciplinary team working on how to best manage uncontrolled diabetics who were pumped up at the beginning to get started but then team lost steam, another director and I set up a coaching time and for the past 2 month they’ve been meeting bi-weekly to focus on goals and reporting out. they now establish setting bi weekly goals to meet as a team.