Creating a Common Nursing Vision and Strategic Priorities across a System
CASE STUDY 7-1 Creating a Common Nursing Vision and Strategic Priorities across a System
Joyce Young XYZ Health System (HS) is one of the largest health systems in the United States, and it is continuing to grow. The health system comprises more than 56,000 full-time equivalent employees, which includes more than 11,000 active physicians (3,400 employed physicians and residents) and more than 16,000 registered nurses (RNs) practicing in 47 hospitals across 10 states. A shared mission and common values connect these 47 diverse hospitals. Additionally, XYZ HS understands the importance of a shared vision to bring leaders together in strategy and the pursuit of transformational change.
Creating a common nursing vision to determine and drive strategy across a large, diverse health system is clearly a challenge but is worthy of undertaking. The XYZ HS nursing leaders recognized the power of leveraging the talent bank of 47 diverse hospitals and nursing leaders toward a common vision and strategies; in fact, they saw this as critical to leading change and preparing for a reformed future of healthcare delivery.
The leaders recognized that success in this endeavor required essential keys steps, beginning with awareness or understanding of the pivotal role of nursing. Only with awareness and understanding can an effective strategy be determined. Awareness Events of the past decade, and certainly since the Patient Protection and Affordable Care Act was signed into law on March 23, 2010, have fueled interest within the healthcare industry and in the nursing profession in understanding what a reformed healthcare delivery system looks like and how to position the industry and profession for success.
In the IOM and Robert Wood Johnson Foundation report The Future of Nursing: Leading Change, Advancing Heath (IOM, 2010), it was noted that the U.S. healthcare industry is fraught with fragmentation as well as barriers to care and the ability to provide cost-effective, high-quality care. The report said the solutions may reside in a transformed nursing profession. The report outlined recommendations directing not only nursing leaders but also policy makers, payers, licensing bodies, and other healthcare leaders to align the industry and care delivery system with the current era of reform.
Similarly, the Advisory Board Company’s report Perfecting the Patient Care Services Strategic Plan (2012) wove nursing innovation strategy throughout the five core components of service, quality, finance, people, and growth. The universal theme in these reports clearly points to the pivotal role that nursing must play in designing the future of health care.
In a seminal speech given at the Institute for Healthcare Improvement national forum, Berwick articulated what he called “the moral test” (Berwick, 2011). Berwick spoke to the impending changes that the healthcare industry is facing and stated, “This is the threshold we have now come to, but not yet crossed; the threshold from the care we have to the care we need…. Our vision is for healthcare that is just, safe, infinitely humane, and that takes only its fair share of our wealth” (2011, p. 11).
The vision Berwick spoke of was embraced by the XYZ HS nursing leaders. This vision became the impetus for unifying the XYZ HS nursing leaders’ commitment to a system-wide strategic focus and transformational change. In an industry bombarded with high-velocity change, focus was quickly identified as the next key to success in this important strategic work. Focus Given the size and complexity of XYZ HS, along with the pace of change in the industry, the need for focus could not be understated.
For XYZ HS, the ability to focus was fostered through the commitment of dedicated time (over several months) and to a clear understanding of the current state. Focus enables the ability to identify what is most important. An appreciative inquiry approach was used to integrate feedback and information that had been gathered over a dedicated time period (Tagnesi, Dumont, Rawlinson, & Byrd, 2009).
The numerous nurse leaders from the 47 diverse hospitals were then divided into three small work groups. In the spirit of shared leadership, each work group was tasked with identifying and proposing three to five strategic goals. The resulting 9 to 15 proposed strategic goals were then taken back to the full group for voting. The voting results served as the basis for determining three system-wide strategic nursing priorities. Guided by a vision of health care that is just, safe, and infinitely humane, the three strategic priorities promoted the pivotal role of nursing. The size and scope of nursing leaders from 47 diverse hospitals across 10 states leveraged the profession in leading change and readiness for a reformed future of healthcare delivery.
Focus ensured the appropriate strategic goal selection and prioritization; this set the direction for the work required to execute the strategy. Commitment and accountability round out the keys to success in creating a common nursing vision and strategic priorities across a system. The XYZ HS leaders understood that it was through commitment and accountability that they would get where they desired to go. Accountable, empowered work teams were created to execute each strategic priority. Milestones were identified along with due dates, metrics, and reporting requirements. The process described in this case exemplar was grounded in the shared leadership principles of partnership, equity, commitment, and accountability.
One year later, progress is encouraging and the journey continues. Thanks to a common vision, thoughtfully determined strategic priorities, and empowered, accountable, highly committed leaders, the XYZ HS is successfully positioned to meet the challenges of the future. Case Study Questions 1. What lessons are learned from reviewing the strategic plan and progress made in XYZ HS? 2. What factors were most significant in driving 47 diverse hospital nursing leaders toward a common vision and strategic priorities? 3. Of the key steps articulated, which do you think was most important? 4. Are there other steps that you would advise employing in this process? 5. How does size and scope help or hinder strategic success?