Dr Sharon Pappas, chief nurse executive (CNE) of Emory Healthcare, crystallized today's leadership challenge: the healthcare vortex consisting of patients and those who care for them rotating around an axis line, which is our changing delivery system.1 She made the case that nursing creates value by focusing on improving the quality of care and thus the outcomes measures by which organizations will be reimbursed leading to success or failure. As the proportion of Medicare patients in acute care hospitals' performance-based reimbursement grows, it will be necessary to design a "quadruple aim" enterprise focused on population health, improving the patient experience while reducing costs. Healthcare leaders need to leverage a workforce engaged in meaningful work to disrupt the status quo. Nurse leaders can quantify the values of nursing by understanding cost avoidance associated with innovative care delivery models. Dr Pappas is optimistic that the science of nursing administration will be advanced through both statistically significant and the operationally relevant improvements in patient outcomes. Real leaders hunger for the responsibility to make a difference.
What's Next? A Nurse Executive's Perspective
Dr Linda Everett, former executive vice president and CNE at Indiana Health, identified 5 critical megatrends to follow in a rapidly shifting healthcare paradigm. Megatrend 1 is the impact of globalization on the healthcare system along with shifting reimbursement and a need for rapid process improvement. Megatrend 2 involves the treatment possibilities with nanotechnology and other digital devices. Megatrend 3 is envisioning healthcare as a complex adaptive system. Megatrend 4 includes changes we will see with the impact of baby boomer preferences on the healthcare delivery system, and the millennials as a growing part of the nursing workforce. The final megatrend is the importance that high-touch care will play in a high-tech environment. Nurses will play a key role in leading change in healthcare, and lifelong learning will be essential.
The Evidence Linking Patient Experience to Patient Outcomes
Christy Dempsey, chief nursing officer (CNO) for Press Ganey Associates, Inc, presented a data-driven perspective of the nursing work environment and its influence within the healthcare system vortex. Data integration and cross-domain analytics (ie, patient experience outcomes, value-based purchasing, and nursing sensitive indicators) are enabling nurse leaders to understand more holistically and more precisely the impact of the nursing work environment on overall health system performance. Dempsey stressed the importance of shifting from a patient satisfaction paradigm to one that captures the full patient and caregiver experience. Press Ganey's Compassionate Connected Care Model explains how the patient experience is shaped by culture (ie, teamwork), operational efficiency, clinical excellence, and caring behaviors.2 Moreover, these same elements shape how caregivers experience care. Nurses want to work in environments that support teamwork and safe, high-quality care and provide resources and strong leadership and, most importantly, where they feel they belong. Patient and nurse perceptions of care quality are both enhanced by higher-quality work environments, and better care of nurses results in better care for patients.
Engaging Patients and Families
Effectively engaging patients and families in their care is challenging nurse leaders. Dr Karen Drenkard, CNO, GetWellNetwork, presented the Interactive Care Model as a strategy for meeting our patients "where they are," which is difficult because our healthcare systems are not designed to allow patients to be full partners in their care.3 Emerging evidence indicates that outcomes may be improved when patients are involved in their care. Patients want health providers to treat them as equal partners in an open and inclusive manner. The Person Engagement Index4 is a newly developed tool being used to assess a patient's capacity for engagement and facilitate the cocreation of a care plan with the patient, not for the patient. Nurse leaders must be risk takers and change agents to develop innovative ways to engage patients in their care. To become the norm of healthcare delivery, the innovations must demonstrate improved quality and cost outcomes for patient engagement.
Innovative Healthcare Delivery Model
In 1991, when the cost of health insurance threatened the financial stability of his company, Harris Rosen, president and chief operating officer of Rosen Hotel & Resorts, made the decision to self-insure and bring healthcare in-house via the Rosen Medical Center. Mr Rosen and his copresenters, Ashley Bacot, risk manager, and Kenneth Aldridge, RN, director of Health Services, shared with attendees the innovative, nurse-led program offered to all associates and their families. At a cost of $14.75 weekly ($48.25 for family coverage), associates are provided disease management, preventive services, and dental coverage. Copays for primary care are minimal ($5), and hospital admission carries a $750 copay regardless of severity of diagnosis. Sick at work[horizontal ellipsis] associates don't clock out and receive a same-day appointment, and free transportation is provided. Care is coordinated by an in-house staff of nurses and physicians. The savings have been considerable (estimated $250 million). More important to Mr Rosen, he has provided "superior service and care to the people who matter the most"-his associates.
Reflections on Quantum Leadership
To close the 2016 International Nursing Administration Research Conference, Leah Curtain reminded us of our essential humanity and how our strength as leaders lies in our own humility developed through spirituality, science, humor, and deep respect for our fellowmen. Dr Curtain inspired us to mold and sustain a spirit of caring by evoking the best in people, guiding them to make decisions based on what is best for patients and communities. She eloquently detailed though scientific concepts the interconnectedness of our universe and how a shift in how we see the world, understand relationships, and make commitments is key to breathing life into people and organizations. Her parting words left us feeling refreshed and energized:
* Know you can do it! Believe it!
* Evoke higher nature-we are all connected.
* If you change the way you look at things, the things you look at change.
* Rely on your own inner resources-coalescing around something worthy of human effort.
* Develop deep trust and respect for those with whom you work.
* Learn to be flexible and adapt to new situations.
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