SUCCESSFUL EXECUTIVE LEADERSHIP requires skills and competencies to lead others into new frontiers, regardless of the role. The chief nurse executive (CNE) and the chief information officer (CIO) are 2 senior leaders charged with leading others through a chaotic period in health care. These roles intersect at a critical point, leveraging different but key leadership skills to deliver results. It has been a time-honored code that a nurse is not a CIO. But times are changing!
The movement from the CNE role to the CIO role is a journey in boundary-spanning leadership for the creation of direction, alignment, and commitment across group boundaries in quest of a higher vision or goal.1 CNEs and CIOs are seeking new levels of collaboration to drive innovation as they address mission critical problems and transform organizations to thrive. A CIO with a nursing background encourages the nursing workforce and information technology experts to think beyond their professional boundaries to realize the results they can achieve together.
It is a challenge for clinicians to move to the CIO role. In 2013, I made that transition after spending over a decade as a CNE, followed by tenure as a senior nursing informaticist (aka chief nursing informatics officer). In the Fall of 2013, I became the first nurse in our organization to achieve a senior leadership role beyond the traditional nursing umbrella. What has become evident is that strong leadership skills are required to succeed at each and every organizational level. Chief Nurse Executives, also called Chief Nursing Officers (CNO) in many organizations, and CIOs need the same competencies. These skills provide the foundation for success:
1. Strategic visioning: "Leaders" do not lead others without first developing, crafting, sharing, and selling a vision. Without a vision, there is little chance of bringing about organizational change. Teams work effectively when their collective work is aligned by a vision. A vision defines what the future will hold. It inspires action, while aligning with the future work of the organization in a consistent manner. The CNE sets the vision for nursing services, including a plan for how Nursing will lead as a discipline in the provision of patient care. The CIO sets the vision for leveraging information management in the improvement of health care services through use of data and technology. Both leaders set the vision for meeting the needs of a complex system and the provision of safe quality care to patients. Both executive leaders take a vision and create a reality.
2. Strategic Frameworks: Leaders improve systems on the basis of theoretical frameworks to gain a fundamental understanding of patterns and opportunities for system improvements. Chief nurse executives build their patient care delivery models on the basis of scientific principles, as well as theoretical frameworks. Among those frameworks is patient safety. Fundamental to patient safety programs are performance and process improvement models such as Lean engineering methods. Lean is a management system and philosophy to improve the quality of care by reducing errors and eliminating waste.2 Safety in Health Information Technology (HIT) is based on understanding the characteristics of a sociotechnical system. System-level failures are deemed unforeseen combinations of system component failures. These components include people, technology (hardware/software), processes or workflows, organizational policies and procedures, and external environment or cultural influences.3 The understanding and design of HIT systems in health care to reduce errors is a fundamental framework to providing a safe infrastructure to patient care settings. The sociotechnical model provides the conceptual framework to address challenges inherent in studying HIT. Strategies for improvement are based on sound theoretical models, regardless of the discipline. A strong leader leverages these frameworks to improve business processes and outcomes.
3. Collaboration/Empowerment: Nursing has been rich in tradition of empowerment models including (but not limited to) shared governance. This model is based on building point of service systems through councils and teams reallocating the power in the organization to those who do the work of health care: the bedside clinicians.4 In this framework, a learning organization is empowered to achieve value as defined by the business.
In HIT, an industry standard framework has been developed on the basis of a service life cycle in information technology service management. This framework, titled Information Technology Infrastructure Library, provides a model to design, develop, and implement information technology as a valuable service provider to the business.
To bridge the philosophies of shared governance and Information Technology Infrastructure Library, a new empowerment model has been developed at the University of Kentucky. Its purpose is to engage information technology employees as owners in their work and to focus on service delivery. Branded as collaborative transformation, this model has become the organization's design for shared decision making and accountability to change our culture, deliver organizational goals, and achieve the mission of a world class HIT in meeting the business needs. Teams have been formed to engage employees who own decisions regarding their own work processes (Figure).
4. Branding/Identity: To be successful as a leader, you must brand yourself as a cultural change agent. Your purpose must never be about a personal achievement but for the good of the team and organization. A strong personal brand is what you are known for and is determined by how you present yourself and how you handle decision making. You must be authentic, consistent with your core values, decisive, and be "present." Authenticity allows you to transcend disciplines by focusing on collaboration across the industry. This is important in any leadership position and is transferrable from the CNE to the CIO role.
5. Influence: As highlighted in the American Nurses Association Scope and Standards in Practice and Education,5 the essence of leadership is provision of direction, guidance, and influence to accomplish common goals. Leadership occurs at all levels within an organization, but the senior leader of a specific domain, such as nursing or information technology, must be able to direct, guide, and influence others to achieve a common goal.
Executive leadership is purposeful. As a health care leader, you are the architect for the bridge between patient care and technology. Constructing a collaborative vision is the most significant crosswalk between nursing and information technology. In nursing, the vision is centered on the patient or the health care consumer. It involves striving toward optimal care for every patient, every time. In information technology, the laser focus is on support of the frontline clinician so that he or she has the tools required to provide that care. This means improving the information systems supporting these individuals-for every clinician, all the time.
Leading at different levels in different settings is difficult work. One key success factor is a level of technical competency. To lead nursing, you must be grounded in the nursing process and the scope and standards of nursing practice. To lead information technology, you must have enough technical savvy to be deemed a subject matter expert in a field of computer or information science.
Nurses are the largest users of health information technology today. A nurse leading information technology and sitting at the executive table promotes our competence as a discipline. Making the transition from CNE to CIO is possible because of leadership skills and frameworks attained in the CNE role. Grounded in theoretical underpinnings, a nurse leader is capable of succeeding in this transition because of core competencies as leaders.
Are you interested in a role outside of traditional nursing leadership? Could the CIO position be right for you? Reinvent yourself. Take a risk. But most of all LEAD.
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