An Organizational Commitment to Diversity, Equity, Inclusion, and Justice: A Multipronged Strategic Approach.

Cedars-Sinai is a sixth continuous Magnet organization in Southern California that embodies inclusive leadership in support of diversity, equity, inclusion, and justice (DEIJ) principles. The organization adheres to a strategic model prioritizing staff sense of belonging, empowerment, engagement, curiosity, and creativity. Employing inclusive leadership, we have implemented strong programs of professional development and continuous learning, innovation, and research. This leadership and these programs have fostered a culture of inquiry, support evidence-driven practice, quality improvement, and staff engagement. Our organization is committed to creating a caring and healing environment that promotes performance. We believe in practicing loving-kindness toward ourselves and others as a core value. Executive leadership support has been a key element in our successful implementation of DEIJ strategies, including employee resource groups, Shared Leadership Councils, transition to practice programs, health equity research, and innovative solutions. These strategies have been shown to yield a significant return on investment.

Capitalizing on an Existing Shared Governance Structure in Developing Leadership Succession Planning.

This evidence-based project in a large academic medical center presents the integration of a succession-planning framework into existing shared leadership councils to fill open formal leadership positions. The framework included assessment, planning, and outcome evaluation of 3 strategic interventions: 1) leadership development, 2) experiential learning, and 3) mentoring. Benefits included improved self-perception as a leader, improved leadership competency, increased talent bench strength, and 32 internal promotions of frontline staff to formal leadership positions within 1 year.

Realigning Shared Governance With Magnet® and the Organization's Operating System to Achieve Clinical Excellence.

In 2012, an academic medical center successfully overhauled a 15-year-old shared governance to align 6 house-wide and 30 unit-based councils with the new Magnet Recognition Program® and the organization's operating system, using the processes of LEAN methodology. The redesign improved cross-council communication structures, facilitated effective shared decision-making processes, increased staff engagement, and improved clinical outcomes. The innovative structural and process elements of the new model are replicable in other health institutions.

Characterizing the relationship between coronavirus disease 2019 (COVID-19) and central-line-associated bloodstream infection (CLABSI) and assessing the impact of a nursing-focused CLABSI reduction intervention during the COVID-19 pandemic.

OBJECTIVE: To examine the impact of SARS-CoV-2 infection on CLABSI rate and characterize the patients who developed a CLABSI. We also examined the impact of a CLABSI-reduction quality-improvement project in patients with and without COVID-19. DESIGN: Retrospective cohort analysis. SETTING: Academic 889-bed tertiary-care teaching hospital in urban Los Angeles. PATIENTS OR PARTICIPANTS: Inpatients 18 years and older with CLABSI as defined by the National Healthcare Safety Network (NHSN). INTERVENTION(S): CLABSI rate and patient characteristics were analyzed for 2 cohorts during the pandemic era (March 2020-August 2021): COVID-19 CLABSI patients and non-COVID-19 CLABSI patients, based on diagnosis of COVID-19 during admission. Secondary analyses were non-COVID-19 CLABSI rate versus a historical control period (2019), ICU CLABSI rate in COVID-19 versus non-COVID-19 patients, and CLABSI rates before and after a quality- improvement initiative. RESULTS: The rate of COVID-19 CLABSI was significantly higher than non-COVID-19 CLABSI. We did not detect a difference between the non-COVID-19 CLABSI rate and the historical control. COVID-19 CLABSIs occurred predominantly in the ICU, and the ICU COVID-19 CLABSI rate was significantly higher than the ICU non-COVID-19 CLABSI rate. A hospital-wide quality-improvement initiative reduced the rate of non-COVID-19 CLABSI but not COVID-19 CLABSI. CONCLUSIONS: Patients hospitalized for COVID-19 have a significantly higher CLABSI rate, particularly in the ICU setting. Reasons for this increase are likely multifactorial, including both patient-specific and process-related issues. Focused quality-improvement efforts were effective in reducing CLABSI rates in non-COVID-19 patients but were less effective in COVID-19 patients.