Leading the Health Care Enterprise
Leading the health care enterprise seems new and overwhelming with awesome responsibilities. However, nurse leaders have been navigating the complexities of large multiple systems in health care for more than 50 years, most of my nursing career lifetime. Nurse leaders, serving as the captain of the health care ship, have steered the system into new and sometimes turbulent waters throughout the world. What circumnavigates the challenges, which are so daunting in today's health care world, are the high seas of government-enforced rules and regulations and databases with intimidating information technology requirements to achieve financial reimbursement for patient care services rendered. For without financial wherewithal, no health care organization could sustain and maintain operations, and some, especially in rural areas, have fallen by the wayside.
As this issue explores the significant role of nurse leaders in shaping and transforming health care systems, 2 outstanding shakers and movers of the Nursing Administration Quarterly (NAQ) editorial board are guest co-editors for "Leading the Health Care Enterprise." Carol Bradley, MSN, RN, CENP, senior vice president and system chief nursing officer (CNO) for the Legacy Health System, a 6-hospital integrated health care delivery system serving Portland, Oregon, and southwest Washington, initiated the idea for this issue. Carol is well known for her innovative leadership as a patient care executive, instilling a strong patient care ethic into organizations she has led. Before joining Legacy, she served in a variety of senior nursing executive positions in large health care systems including the not-for profit, for-profit, and public hospital sectors. She was also the regional vice president and editor for the California edition of NurseWeek and the principal/owner of a consulting practice focused on workforce planning, work environment improvement, and designing recruitment and retention solutions for the nursing profession.
Carol has been actively involved with nursing policy and legislative issues in the nursing profession, serving as the president of both the Association of California Nurse Leaders and the American Organization of Nurse Executives. She is also a trustee of the Commission on Graduate Foreign Nursing Schools, serving as the president in 2010, and is frequently asked to represent patient care executives and nursing issues within a variety of national and international forums.
Joining Carol as guest issue co-editor is Joyce Batcheller, DNP, RN, NEA-BC, FAAN, senior vice president and System CNO/dean of the Seton Clinical Academy for Education and Research for the Seton Healthcare Family, the largest hospital system in central Texas. In her system CNO role, Joyce coordinates, nursing practice, education, research, and informatics and resource management across a complex and geographically dispersed system. She led the development of Seton's mature, 17-year-old shared governance structure, which has resulted 9 of Seton's hospitals designated by the American Nurses Credentialing Center-4 Magnet and 5 Pathway to Excellence.
As the system CNO, Joyce led the strategic planning for the spread of Transforming Care at the Bedside, which has resulted in practice efficiencies, decreased work intensity, and improved nurse retention and nurse time at the bedside. In addition, she has led other significant improvements such as patient-lift equipment, new beds and mattresses to avoid pressure ulcers, wireless phones for clinicians, a nursing business intelligence system, a staffing and scheduling system based on patient acuity, and a nurse residency program. Joyce was inducted into the American Academy of Nursing in 2010.
With the editorial leadership of these 2 innovative systemwide nurse executives, NAQ brings you the latest in health care systemwide initiatives. What constitutes a system and why is this so significant in improving the health of people and communities? The cost of health care continues to escalate at alarming rates and is more costly in the United States than in 12 other industrialized countries. Does a systemwide enterprise result in cost savings, and is care improved or does patient care quality diminish with quantity?
In the early 1980s, I had the privilege of working with the Virginia Mason Consortium, when I was the CNO for the Virginia Mason Hospital in Seattle, Washington. We had 12 rural hospitals that were connected to Virginia Mason Consortium for medical, nursing, and other patient care consulting services. I do believe that there was definitely improvement in the health care of people and the communities on the Olympic Peninsula extending to Canada and Oregon. Perhaps, there was resulting cost savings, but at least it was an early example of integrating services and an innovative approach to improving the quality of care through shared resources.
In today's world of health care enterprises, which are increasing in consolidation, nurse leaders have an amazing opportunity to create multiple services that enhance patient care and provide significant opportunities for the profession of nursing. The greatest challenge is to ensure that patient care remains at the center of the organization's mission. Excellence in patient care is significantly enhanced through the utilization of advanced practice registered nurses, who are essential to providing cost-effective transitional service from acute care hospital-based care to evidence-based transitional care in hospices, home health care, assisted living, rehabilitation, and other out-of-hospital services. It makes no difference where you are practicing as a nurse leader; think out of the box, be an innovator, and create whatever your community needs to provide illness prevention services and health promotion as part of the health care system enterprise.
Know yourself, have an open mind to explore new vistas, develop a knowledge base and new learning opportunities, be true to yourself, and don't be afraid of making mistakes along the way to creating new health care enterprises. If you don't do anything, you can't make mistakes. DO IT!!
-Barbara J. Brown, EdD, RN, CNAA, FNAP,
FAAN
Editor-in-Chief
Nursing Administration Quarterly