Building a Working Professional Governance Council in the Cardiac Device Clinic
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EP LAB DIGEST. 2026;26(9):10-13.
Evan Robertson, BSN, RN, CCDS, Advanced Cardiac Device Nurse1; Amy Tucker, MSN, RN, CCDS, Nurse Manager1; Amanda Sowell, MSN, RN, CCDS, Registered Nurse Supervisor1; Jennifer Graham, MSN, RN, NE-BC, CPHQ, Director of Electrophysiology1; Kathy Shaffer, DNP, APRN, AGCNS-BC, NE-BC, C-ONQS, FCNS, Director of Nursing-Ambulatory Care2; Caroline Swanger, MSN, RN, AMB-BC, Ambulatory President of Nursing Staff2
1Atrium Health Sanger Heart & Vascular Institute, Charlotte, North Carolina; 2Atrium Health, Charlotte, North Carolina
Background and Rationale
For many patients with cardiac implantable electronic devices (CIEDs), the relationship with the device clinic is long term. Pacemakers, implantable cardioverter-defibrillators (ICDs), loop recorders, and other implantable devices require regular follow-up throughout the life of the device and, in many cases, the life of the patient. Management of these complex devices extends beyond technical oversight and intersects with patient access, clinician education, and day-to-day problem solving. As patients live longer with CIEDs, device clinic operations become increasingly complex and require more precise workflows.
The Atrium Health Cardiovascular Device Management team oversees more than 21,000 active CIED patients and includes nearly 50 nurses, technicians, and administrative teammates. In 2024, the team reviewed the results of a safety and workplace culture survey that articulated a concern shared across the department: a need for a structured pathway to share ideas and to directly contribute to process improvement.
That need was easy to recognize in daily practice. In a busy clinic, valuable ideas can remain unspoken without a trusted mechanism for bringing them forward. Before the council was established, many teammates were already identifying problems and refining workflows, but much of that work occurred in silos. The council’s value was not in creating new processes from scratch; rather, it provided a structured forum for sharing existing efforts and moving them forward more consistently.
What is Professional Governance?
At its core, professional governance is the structural framework that aligns clinical practice with accountability and decision-making authority at the point of care, ensuring clinicians maintain ownership of practice and outcomes.1 It provides teammates with a structured platform to raise concerns, evaluate workflows, and help shape decisions that affect patient care and the work environment. In a specialty clinic, such a platform is essential because the individuals performing the work each day are often the first to recognize where a process is breaking down.
Although professional governance is often associated with nursing, ambulatory leadership intentionally included all teammate roles within the clinic. This inclusive approach was especially important in the device clinic, where nurses, device technicians, and administrative teammates work side by side and often observe different aspects of the same process. By including all roles, the council became more representative of how care is delivered and helped keep discussions grounded in the full reality of an interprofessional device clinic practice.
Structure of Professional Governance at Atrium Health
At Atrium Health, the ambulatory governance model connects specialty councils with operational and executive leadership. In practical terms, concerns identified within the clinic have a clearer pathway for escalation, and decisions made at higher levels can be communicated back to teammates in a more organized manner. This structure is particularly important in the device clinic, where effective care delivery depends on coordination. Remote monitoring, alert review, scheduling, patient education, documentation, and communication with providers frequently overlap. The council provided the team with a dedicated forum to discuss these issues, prioritize areas requiring attention, and maintain momentum on projects.
Adoption of Professional Governance in the Device Clinic
As with most practice changes, adoption was not immediate. From the teammate perspective, the main question was simple: would professional governance meaningfully benefit the clinic, or would it simply add another meeting to an already full schedule? Building buy-in required demonstrating that the council would focus on existing problems as a group rather than relying on individuals to solve problems independently. Sharing the workplace survey results helped position the council not as an administrative initiative, but as a direct response to needs that teammates had already identified.
Early Priorities and Implementation Strategy
Once the council was established, it was important to focus on issues teammates immediately recognized as relevant. Early discussions centered on workflow consistency, communication related to protocol changes, onboarding, and opportunities to strengthen evidence-based practice. These targeted initiatives helped establish the council’s credibility among teammates.
Representation across all teammate roles was a priority from the beginning. Device clinic work is shared across nurses, device technicians, and administrative teammates, so the council needed to reflect that reality. Including perspectives from all roles enriched discussions and helped identify opportunities for improvement issues across the full spectrum of device clinic practice, including remote monitoring, in-person evaluation, patient education, scheduling, and communication with providers.
Additionally, the council required a structured framework for its work. In practice, regular meetings, clear follow-up, and visible project ownership proved to be as important as the project ideas themselves. In a high-volume device clinic, where urgent tasks can easily divert attention from process improvement, consistently scheduled meetings allowed for dedicated time to focus on improvement initiatives and observe their impact over time.
Operational and Professional Impact
From a clinical standpoint, the practical value of professional governance becomes more apparent as patient volume and acuity increase. Device clinics are being asked to manage increasing numbers of transmissions with actionable alerts, patient messages, follow-up needs, and documentation while still maintaining timely response and technical accuracy. The council provided a more organized structure for evaluating and improving workflows and efficiencies in real time.
One of the most important changes has been greater visibility. Many team members were already doing thoughtful improvement work before the council was established, but that work was not always visible across the clinic. Once there was a forum to share those efforts and connect them to broader priorities, useful ideas spread more consistently.
That shift has carried over into patient care. In CIED management, details often determine whether care feels coordinated or fragmented. Clear follow-up, consistent communication, and reliable workflows shape the patient experience in practical ways. Many improvements begin with a small issue that continues to resurface, such as a bottleneck, a gap in education, or a process that varies depending on who handles it.
For example, one obstacle the team experienced was the availability in electrophysiology (EP) provider schedules for surgical consultations when devices reached the elective replacement indicator (ERI). Scheduling patients approaching ERI for presurgical consultations, rather than waiting until ERI is reached, has reduced the likelihood that generator change-out consultations are delayed until scheduling becomes urgent. Similarly, tracking antitachycardia pacing (ATP) and shock events with a defined pathway for earlier specialist evaluation has made ventricular tachycardia (VT) management more consistent across the practice. Having a structure to work through these issues has made it easier to translate day-to-day observations into changes that benefit both patients and teammates.
A Working Council
After nearly a year of council work, the impact of professional governance can already be seen in several aspects of the clinic.
Current council initiatives include reducing alert burden by reviewing and reprograming alerts for the patients who generate the highest volume of transmissions and streamlining VT therapy follow-up through tracking of ATP and shock events and the creation of a pathway for earlier specialist evaluation. Another initiative focuses on improving cardiac resynchronization therapy (CRT) optimization through earlier identification of suboptimal responders, targeted device reprogramming, and referral for additional heart failure follow-up when appropriate. The council has also supported a short educational series during biweekly staff meetings, incorporating pre- and post-session assessments to reinforce learning.
These projects illustrate the potential of professional governance within a device clinic. Efforts have focused on challenges that affect patient safety, clinic flow, access, and continuity of care. Although several efforts remain ongoing, many have already been incorporated into routine workflows, reflecting the team’s confidence in the value of professional governance. Data collection continues as these processes mature. Ongoing evaluation of workflows will be important to ensure that they continue to improve patient outcomes and clinic efficiency over time.
Lessons Learned
One of the most important lessons learned through this professional governance work was the need to establish collaboration and transparency early. Teammates were more willing to participate once the purpose of the council was clearly defined and there was a reliable process for communicating updates back to the team. In a clinic where improvement efforts had often occurred behind the scenes, that transparency helped build trust from the start.
Leadership support was also important, although not because leaders needed to direct the work. Rather, leaders were most effective when they removed barriers, connected projects with available resources, and helped maintain momentum. Teammates needed the autonomy to lead improvement efforts, but they also needed confidence that those efforts were supported and had a clear path forward.
Ultimately, sustainability depended on the council’s ability to empower teammates to influence meaningful change. Regularly sharing project updates helped demonstrate the impact of improvement efforts in practice, and recognizing participation as a meaningful professional contribution helped ensure the work remained relevant and sustainable over time.
Future Directions for the Cardiac Device Clinic
The need for professional governance in CIED management is likely to grow. Device clinics are caring for larger patient populations, working with increasingly sophisticated technology, and relying more heavily on remote monitoring. Patients also expect timely communication and clear follow-up. From the clinic perspective, meeting these demands takes more than technical expertise. It requires a clinic structure that supports ongoing learning, evaluation, and adaptation, and the council has provided one approach to meeting that need.
Looking ahead, the council can support several priorities that are directly relevant to CIED management, including refinement of remote monitoring workflows, improved standardization of education, development of specialty-specific competency pathways, and stronger use of data to guide quality improvement. Future safety and workplace culture surveys will help determine whether the council continues to feel useful to teammates and whether its work is having the intended impact on clinic practice.
For leaders and clinicians in CIED management, the takeaway is clear: those closest to the daily work often identify the clearest opportunities for improvement. In a device clinic, where technical accuracy, communication, access, and workflow all directly affect patient care, that perspective should intentionally be built into the clinic structure. This experience suggests that giving all teammates a structured platform to lead process improvement can strengthen both the team and the clinic’s ability to adapt to changing demands in healthcare and improve patient outcomes.
Disclosures: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest, and have no conflicts of interest to report.
