Overcoming Barriers to Collaborative Team Practice: A System Approach.

All healthcare systems are challenged to provide sufficient access to appropriate care for the individuals and communities they serve. Among the commonly discussed interventions in an era of clinical shortages is the establishment of team-based care, where team members can practice at the top of their license. This solution ensures that talent and ability are amplified. However, this vision has been thwarted by several barriers. Recognizing that complex causes prevent team-based care, CommonSpirit Health leadership has embarked on a multifaceted implementation of tactics to mitigate the barriers. The strategy addresses issues ranging from regulations, laws, and payment practices to a lack of knowledge and understanding between professions. A combination of solutions, rather than discrete tactics, holds the key to the system's strategy. The complement of actions put in place at CommonSpirit Health has included new executive roles, dyad leadership models, shared multidisciplinary education, targeted advocacy, best practice playbooks, and the flexibility to individualize local models as part of the journey to a more effective and efficient model of care.

Nurses on Boards: Still a Challenge for Health Care Organizations.

Multiple articles have explained the benefits of nurses as hospital board members. The Nurses on Boards Coalition has been working for several years to increase the number of nurse board members. Yet, the percentage of hospital and health care board positions filled by nurses has been decreasing. This article shares what all nurse leaders can do to increase the visibility of nurses as competent, valuable voices at the board table.

Always a Nurse: A Profession for a Lifetime.

A single career in nursing may encompass numerous and very different positions. Nurses are aware they can select from a variety of specialties, as they choose to learn additional skills or pursue new opportunities. Today's nurses use their intelligence, experience, and holistic concern for all people in more diverse arenas than ever before. This article is followed by a series of first-person accounts of jobs that may not, on first consideration, look like nursing roles. These professionals have not left nursing. They have carried their healing energy, grounding in the nursing process, as well as a desire to improve the well-being of others with them, because they are nurses.

Bringing the right players to the table.

Finance and clinical leaders should ensure that the appropriate stakeholders are part of planning the "how" of change. Clinicians should be included in strategy and decision making. Inclusion can help leaders make decisions that best serve patients.

Understanding the business of employed physician practices.

Health system leaders should understand issues related to finance, compliance, human resources, quality, and safety in their employed physician practices to better support the success of these practices. New business and payment models are driving operational changes in physician offices. Catholic Health Initiatives (CHI) has added new system roles and responsibilities to oversee physician practices.

Addressing staffing shortages in an era of reform.

Health system leaders should understand that physician and nursing shortages threaten a hospital's ability to offer high-quality care. Integrated delivery systems should project their workforce needs for both the near term and long term. Catholic Health Initiatives (CHI) is using two new models of care that deploy staff in new ways.

Population health management: a "start small" strategy.

Catholic Health Initiatives (CHI) is piloting population health management for a test population that comprises CHI employees and their families. CHI is using a medical home model to coordinate care. The system anticipates a reduction in its employee healthcare costs of 10 to 14 percent.

Integration requires new roles and responsibilities.

Accountable care organizations and population health management may require changes to the healthcare team, including new job descriptions. Catholic Health Initiatives (CHI) has added new leaders to focus on population health. CHI has standardized job descriptions for upper management to reflect a focus on primary care.

Hospital-physician partnerships: a fairy tale?

To work together more effectively, clinical and finance leaders should: Recognize the cultural causes of tension, Conduct honest conversations to help build trust, Acknowledge their own blind spots to understanding.

Shared governance: one way to engage employed physicians.

To work better with employed physicians, finance leaders should: Understand classic management theories on what motivates employees. Learn from shared governance models with nurses at Magnet hospitals. Apply best practices in management to all employees, not just physicians.

The call for innovation.

To help promote innovation in health care, nursing and finance leaders can: Begin by asking the "why" and "why not" questions. Earmark dollars for experimental care models. Advocate for eliminating legal and regulatory barriers that prevent innovation.

A new customer service partnership for hospitals and physicians.

To promote better customer service, clinical and finance leaders should work as partners to: Make customer service as important a goal as clinical quality. Educate staff on better communication with patients and families. Perform a root-cause analysis to identify problem trends.

The case for nursing leadership development.

Nursing and finance leaders can support their organizations' goals and strategies by: Recognizing the business case for management competence, specifically in how supervisors affect employee satisfaction and turnover. Gaining business acumen, specifically in competencies such as human resource management and understanding of healthcare financing. Promoting management and leadership development, starting with charge nurses and moving up through the ranks of nursing management.