At one time in my career, I veered slightly away from the classic nursing management track. I accepted a position reporting to a system chief strategy officer. The skills required were the same as those of a chief nursing officer, but the experiences were new and different. I was tasked with leading a multidisciplinary project team charged with building a new, innovative, technology-enhanced, team-based outpatient center. It was a multifaceted, complex job, with a myriad of new challenges every day.

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I spent hours with architects, city and county planners, and business associates who were building the outdoor shopping center where the clinic would be located. It was interesting to be part of a project that involved retail shops, restaurants, and a theater. It was challenging to negotiate how we could meet local government building regulations while teaching myself to use project management software. It was educational to learn about parking space planning and traffic mitigation. It was invigorating to be part of the team planning our marketing strategy. It was rewarding to develop new patient flow designs and a customer service culture, while leading a team across clinical departments, which had traditionally operated in silos. It was also the least stressful job I ever had.

This project was less stressful to manage because the daily problems, once solved, stayed solved. What made it less frustrating than typical health care leadership work was something I didn't analyze until years later. That's when I realized that the power behind that team's ability to overcome barriers, even when we initially disagreed, was our alignment around what we all perceived to be a greater good.

The health care professionals who took part in that project were aligned around the shared goal to build an outpatient center that would delight customers, while providing a wonderful place for caregivers to work. Our business partners were aligned with us around developing a destination site for customers where shopping, entertainment, and health care needs could all be met. The city and county officials were aligned with us to provide something that was much desired by the community. Even the project management software could be called aligned, in that it was a tool that arranged and scheduled the various tasks and parts of the project in the order they needed to be accomplished.

Sometimes I fantasize about how much we could accomplish in the next era of health care if that kind of alignment was our norm. This will require overcoming the historic fragmentation that has grown out of competition for limited resources, payment methodologies, professional chauvinism, professional protectionism, and (sometimes) conflicting objectives of payers, regulators, and providers. What if we could come together to align everything, we do around one dominant goal (superseding all others): to provide the best whole system for provision of curative and wellness services to consumers, communities, and populations?

Guest editors Pat Yoder-Wise, Maria Shirey, and Ray Perryman have put together a collection of articles that support the concept of a health care system configured around our most important stakeholders: the users of health care. I hope that reading this issue will fortify your determination to increase patient (or consumer)-centered alignment in the organizations you influence. Nursing leaders can, and should be, at the forefront of the movement to decrease fragmented care.

Thanks for Choosing to Lead,

-Kathleen D. Sanford, DBA, RN, FACHE

Editor-in-Chief

Nursing Administration Quarterly