Nursing Leadership Case Study 8-1 Paper

Case Study 8-1

Positioning for Positions Everest Health System is located in the Midwest and is the largest healthcare system in the region, with three large acute care hospitals, a mental health hospital, two smaller community hospitals, and a rehabilitation hospital. Nursing Leadership Case Study 8-1 Paper. In addition to the inpatient facilities, the corporate structure of Everest Health System owns a physician group with 10 outpatient clinics distributed over the large metropolitan area of nearly 3.2 million people. Everest also contracts with an independent group of physicians who are recognized as “Everest physicians” and share in negotiated group insurance rates for inpatient and outpatients services. In addition, Everest has an outpatient sports medicine and rehabilitation center, an outpatient MRI diagnostic center, two outpatient surgical centers, a cancer center, and a standalone infusion therapy center. The three large acute care hospitals are all Magnet designated, and two are recognized with the Planetree designation as well.

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All of the chief executive officers (CEOs) of the inpatient and outpatient centers report to an executive vice president for patient care, and the chief operating officers (COOs) and chief nursing officers (CNOs) report to the CEOs at their respective facilities. Being a progressive healthcare system, the executive VP for patient care desires to develop an Institute for Nursing Excellence, an idea that also appeals to the executive for philanthropy because there is a potential donor who might be willing to fund the new institute. An outside consultant has been hired to facilitate the development of the new institute. It is decided that the membership of the newly formed institute will consist of the CNOs and the directors of research and development for each of the inpatient facilities who report to each of the CNOs.

During the first few months, the consultant facilitates the meetings. The group spends considerable time and process to identify what they consider to be the characteristics of an Institute for Nursing Excellence. Using this as a foundation, they developed a mission and vision statement and created a professional practice model that would serve as a conceptual model that could be used to articulate the purpose, mission, and vision of the institute internally and externally. After these foundational documents were developed, they decided to focus on meeting the recommendations of the Institute of Medicine’s Future of Nursing report and look for opportunities to improve measures of nursing quality across the system. After 8 months of meetings, the CNOs met privately and decided to lead the meetings themselves and terminate the services of the consultant. One of the CNOs of the larger acute care hospitals volunteered to be the leader of the group.

Over the next year, the group worked on developing a strategic plan with measures for expected deliverables for quality, research, education, and nurse-sensitive indicators. The CNO leader also developed a job description for a director for the institute that was approved by the full membership. The position description was written to indicate that a doctorate in nursing was strongly preferred and that the applicant should have previous experience in a nursing leadership positions. There was considerable discussion about the title of the position, with several options considered such as director, vice president, and executive vice president. Nursing Leadership Case Study 8-1 Paper

Another area of consideration was the reporting structure for the new position. Several concerns were raised among the members, but these were not openly discussed in the meetings. Some of the CNOs were concerned that if the new position reported to the executive VP of patient services, the position might evolve into a chief nurse executive (CNE) position for the entire healthcare system and that they might be required to report to this person in the future instead of the hospital CEO. The CNOs indicated they don’t want this new person to “interfere in the operations of their hospitals” and “tell them how to run their business.” The directors of research and development also were concerned that they too might be required to report to this new centralized position; some of the directors prefer to report at the entity level rather than the system level. There was significant discussion about the new person reporting to. During the first few months, the consultant facilitates the meetings. The group spends considerable time and process to identify what they consider to be the characteristics of an Institute for Nursing Excellence. Using this as a foundation, they developed a mission and vision statement and created a professional practice model that would serve as a conceptual model that could be used to articulate the purpose, mission, and vision of the institute internally and externally. After these foundational documents were developed, they decided to focus on meeting the recommendations of the Institute of Medicine’s Future of Nursing report and look for opportunities to improve measures of nursing quality across the system. After 8 months of meetings, the CNOs met privately and decided to lead the meetings themselves and terminate the services of the consultant. One of the CNOs of the larger acute care hospitals volunteered to be the leader of the group.

After several months of discussing the pros and cons of reporting structures, titles, and lev-els of authority for the new position, the job description was written to place the position one level below the CNOs with wording that the person would report to the entire CNO group. The position was viewed by the CNOs to be at an equal level of the directors of research and development. The position was then posted for recruitment.

A few applications were received, but they were reviewed first by the CNOs in their regular CNO meetings before they were shared with the entire institute membership. Applicants who seemed appropriate were interviewed by phone by the CNOs and then vetted to the entire institute membership for a second phone interview or a face-to-face interview. It soon became apparent that most applicants with strong leadership experience were uneasy about a position that reported to a “group” instead of to one individual, and because most applicants had been CNOs or directors of nursing schools, they were not satisfied with the title “director” instead of “vice president.” Months of debate ensued with no resolution to the reporting structure, title for the position, or selection of applicants willing to take such a position.

Because the new position remained unfilled for more than 18 months, the “interim director” position was rotated among the CNOs, but the directors of research and development were not considered in the rotation. With months of tenure in the interim director role, the lead CNO was in the spotlight for interviews and collateral materials developed to showcase the Institute for Nursing Excellence. This led to some of the CNOs voicing concern that the interim director CNO was “taking all the credit” personally for the institute’s accomplishments without sharing the recognition and awards among all of the CNOs. Nursing Leadership Case Study 8-1 Paper

Over months of meetings, evidence of nursing excellence (publications, research, certifications, and newly earned degrees) were collected from each respective entity by one of the directors for research and development and published in a document highlighting nursing excellence at Everest Health System. The funding received from the major donor was used to provide nursing scholarships, and the group met to develop the application process, selection criteria, and the selection process. The money was distributed in scholarships for applicants bridging the as-sociate degree to baccalaureate, the baccalaureate to master’s, and the master’s to doctorate. The institute membership seemed to work well together when given a specific task to accomplish.

The directors of research and development talked among themselves and voiced concerns that they felt that the institute had lost its vision and that the CNOs were controlling the work of the institute without recognizing the contributions or value that the directors brought to the institute. As issues were discussed at the institute meetings, any observer could see rolling of eyes and other nonverbal expressions of discontent among the members. Some members were meeting outside of the institute meeting to analyze what they believed was the “true agenda” of some of the CNOs. Some members expressed that they believed that decisions were made from a fear perspective: fear that hiring a real leader for the institute at the vice president or executive VP level might compromise the CNOs’ power or disrupt the existing CNO reporting structure.

Communication among the group was guarded; positions on issues were calculated; and there was little transparency in expressing real feelings about important issues. When there was an application from and interview of a nationally known nursing leader for the position, the group began to speak of elevating the position to a VP level, but the reporting structure remained with the position reporting to the institute CNO leader. The applicant subsequently rescinded his application, and he stated that “he perceived that the group was not working well together and he was not willing to take a position at a director level that reports to a group as contrasted to an individuals

Questions

What is your perception of the forces that may be at play among the institute members?
What might you do as an institute member to facilitate a higher performance among the group?
What might be the risks, gains, and personal vulnerabilities in trying to redirect the group?
How might outcomes be different if there was more vulnerability and transparency among members?
What would be your vision of what could be done to create an exemplar Institute for Nursing Excellence?
If you were a CNO, using the six stages of the cycle of vulnerability, what might you do to try to facilitate change in the group dynamics?
How might collective mindfulness help the group to achieve the original vision for the institute? Nursing Leadership Case Study 8-1 Paper