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November 28, 2014
8:56
Nurs Admin Q Vol. 39, No. 1, pp. 14–17 c 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright
The Case for Nursing Leaders on Hospital Boards Cathy Siegel Weiss, JD, BA; John D. Pettker, LLB At Children’s Hospital Los Angeles (CHLA), the participation of our chief nursing officer (CNO) as a voting member on our governing board has been crucial to effective functioning in several areas, particularly those that impact the safety and quality of our patient care services, as well as our entire organization’s financial and operational efficiency. As a voting member of our Board of Trustees and 2 standing committees, our CNO has a voice that carries authority and credibility, serving as a conduit between her Trustee colleagues and the nursing troops she leads, who constitute more than half of CHLA employees. Our CNO communicates to the board our nurses’ concerns and perspective and in return conveys to nurses the information necessary to implement the board’s policies and strategic decisions. As we consider how to ensure CHLA’s future as a premier pediatric academic medical center, we understand that the results of the board’s work would be impaired if it did not take into account the responsibilities and challenges faced by nurses. We would miss a vital contributor if our CNO was not involved in the hospital’s governance at the highest levels. Key words: governance, health care, leadership, nursing
A BOARD ROLE FOR THE CHIEF NURSING OFFICER Over the past 10 years, Children’s Hospital Los Angeles (CHLA) has taken giant steps forward in formulating and achieving strategic objectives to improve its in-patient facilities, teamwork and spirit of its patient care providers, the quality and safety of its patient care services, and its financial and operational efficiencies. Would improvement in these areas been achieved without including our chief nursing officer (CNO) as a voting member of our governing board? Perhaps. But there is no question that our CNO’s active participation on our hospital’s governing board has been, and continues to be, integral to the formulation of well-targeted and achievable goals
Author Affiliations: Children’s Hospital Los Angeles, California. The authors declare no conflict of interest. Correspondence: Cathy Siegel Weiss, JD, BA, Children’s Hospital Los Angeles, 6550 Sunset Blvd, Los Angeles, CA 90027 ([email protected]). DOI: 10.1097/NAQ.0000000000000069
that elevate our entire organization’s quest for excellence. In 2008, CHLA’s Board of Trustees amended the hospital’s bylaws to include the CNO as an ex officio (by right of office) voting member of the governing board. Prior to our CNO’s inclusion as a board member, she had attended board meetings in an advisory, nonvoting capacity as a member of the hospital’s Executive Leadership Team. We have a large Board of Trustees, consisting of almost 70 members, to include the multiple competencies and diversity in thought leaders we need to support our mission. A large part of our board’s work is accomplished through its standing committees, and our CNO now serves on 2 of the most important of these as a voting member: the board’s Executive Committee, which has the powers of the full board, except with respect to a limited number of extraordinary actions, and the board’s Safety and Quality Committee. Children’s Hospital Los Angeles is a freestanding pediatric academic medical center widely acknowledged as one of the top children’s hospitals in the nation, and board
14 Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
LWW/NAQ
NAQ-D-14-00033
November 28, 2014
8:56
Nursing Leaders on Hospital Boards governance plays an essential role in maintaining that status. In February 2009, the American Hospital Association’s Center for Healthcare Governance set forth a job description for the board of a freestanding hospital that reads as follows: The board sets policies, makes decisions and oversees organizational performance within the context and scope of its role and authority in discharging the following responsibilities: • Select, support, evaluate, and compensate the CEO • Develop organization vision and mission • Provide sound financial oversight • Ensure availability and effective allocation of resources • Approve and monitor the quality and performance of hospital programs/services • Engage in goal setting and strategic planning • Assure legal and regulatory compliance • Build and sustain relationships with key internal and external partners, including the medical staff • Strengthen board effectiveness • Identify and respond to stakeholder needs and advocate on their behalf • Assess and demonstrate the health care organization’s benefit to the community and other stakeholders.1(p35)
We believe that CNOs contribute to every responsibility enumerated earlier and that CNO input at the board level is critical to effective functioning in several key areas. This is particularly true of those that touch on the safety, quality, teamwork, and efficiency in the delivery of patient care services. More than half of CHLA’s employees are nurses. Nurses have a tremendous impact on health care quality and cost. From their “in the trenches” vantage point, they have a unique perspective on the delivery of health care, the needs and expectations of our patients and their families, and the overall operating success of the hospital. Our CNO is their leader. On our governing board, she is a vital conduit in a 2-way process: conveying nursing perspectives and concerns to the board while communicating to our nurse employees. From the very top of our organization, she conveys information that is necessary to implement
15
the board’s policies and strategic decisions at the bedside. From our perspective, a hospital’s CNO cannot adequately fulfill these functions as a “backbencher” at meetings of the full board or its standing committees. To be truly effective in board and committee deliberations, the CNO needs to have a vote as well as a voice; she or he needs to be empowered. As a voting member of our Board of Trustees and standing committees, our CNO has a voice that carries added weight, authority, and credibility, with both Trustee colleagues and the nursing employees. AN OPERATIONS LEADER WHO ADDS TO BOARD KNOWLEDGE The nurse executive has played a vital role as a board member in formulating and implementing our strategic objectives. In July 2011, CHLA opened the doors of its state-ofthe-art, 317-bed in-patient care facility, which represented the boldest financial project ever undertaken by our governing board in the hospital’s history. Construction of this new facility was the first strategic step—the brickand-mortar phase—to achieving transformational, systematic change in how CHLA delivers health care services to its patients. It was a 10-year project from design phase through move-in day. At its inception, our CNO, along with a select group of other senior hospital executives, was designated to serve on the team charged with planning and orchestrating the project. One of her principal responsibilities was to elicit, understand, and communicate to stakeholders the design criteria essential to meet the evolving needs of our patients, their families, our physicians, our nurses, and the entire CHLA team. The goal was to create a technologically advanced, clinically efficient, and familycentered environment. The last 3 years of this project, at which time our CNO had become a voting member of our Board of Trustees and its Executive Committee, proved to be “crunch time” for the board in fulfilling its oversight and decision-making functions.
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
LWW/NAQ
16
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November 28, 2014
8:56
NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2015
During this time, her participation in the board’s deliberations, in which she shared her unique perspective as to what elements of the project were essential to support our mission, as distinguished from those that might be nice additions, was extraordinarily helpful to the board in making very difficult “trade-off” decisions. These enabled us to successfully complete the project on time and within our budgetary constraints. BOARD EDUCATION FROM A TRUSTEE WITH OPERATIONS EXPERTISE While changing the physical plant of a significant component of our campus was a first step to transforming our organization, other changes were also needed. We were challenged to address market forces driving health care reform at both the national and state levels and to transform the cultural environment at CHLA to further improve teamwork and develop human resources. Along with other management and physician board members, our CNO was instrumental in educating our board on the need to be out in front of the organizational angst that was bound to arise when making major changes. No one within our organization knew more about how our nurse employees would be affected by, and react to, change, nor was anyone else better equipped to advise the board on these matters. On another front, the nurse executive serves on the board Safety and Quality Committee, which is charged with oversight of credentialing, accreditation, safety, and quality across the institution. She continually contributes a unique focus on the challenges facing nurses in our very complex environment. She is a strong and unyielding proponent of safety and quality improvements, keeping a laser focus on the role of nursing. She has provided key leadership on a number of initiatives involving nursing practice, pharmacy issues, and continuing education, all of which are designed to prevent medication errors. She is a
fierce advocate for a just environment, where acknowledgement of errors in a nonpunitive setting and a transparent analysis (along with concomitant accountability) are the rule. Her leadership has supported the organization’s adoption of this approach, which is key to the pursuit of the safest and highest-quality care. Children’s Hospital Los Angeles has achieved and been designated as a Magnet facility, which is evidence of the important roles nursing and nursing leadership play in the organization. Our Magnet designation reflects the talent, quality, and passion of our nurses and the housewide commitment to the highest standards of professionalism. Achieving Magnet status is first and foremost not only about excellence in nursing but also about an institution’s culture, the value it places on nurses, and the support nurses receive from the governing board as well as from physicians and administrators. The Magnet application process requires an extraordinary commitment of time, talent, and resources across the institution. Our CNO was pivotal in successfully advocating for and leading the Magnet process and in educating our board about why the Magnet process warranted the resources allocated to it. Among a board’s many fiduciary duties is the duty to ensure the future well-being of the institution that it serves. At this moment in the history of health care, that is a significant challenge—a challenge our board has embraced with the strong leadership and support of our nursing leader. With our CNO’s active participation, we have engaged consultants with whom she and other leaders work to identify and implement opportunities for improved and enhanced clinical documentation and clinical operations. These opportunities require active and positive engagement from nurses. We have seen firsthand how important the CNO is in leading these efforts, which at times place higher than normal demands on our nursing staff.
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
LWW/NAQ
NAQ-D-14-00033
November 28, 2014
8:56
Nursing Leaders on Hospital Boards A BOARD MEMBER WHO ADDS VALUE FOR STRATEGIC PLANNING In addition to addressing clinical documentation and clinical operations, our board, like many other similarly situated bodies, is engaged in a strategic planning process. This process will ultimately map out the vision for our hospital for the next decade. We think it would be shortsighted to engage in this process without the active participation of our senior nursing leader at the board level. As we consider all of the issues confronting our institution, and the various means for ensuring its future as a premier pediatric academic medical center, we feel that there would be a risk of missing crucial elements if our CNO was not integrally
17
involved. We understand that the strategic planning process would be incomplete if it did not take into account the roles, responsibilities, and challenges faced by nurses. Involving the nurse executive in the strategic planning process at the board level provides key input. The promise implicit in having a CNO serve as a voting member of a hospital’s governing board is 2-fold. The CNO represents a health care organization’s crucial constituency—nurses. In addition, an experienced, talented nurse executive actively contributes wisdom, knowledge, and experience to the board’s deliberations as it fulfills its fiduciary duties. At CHLA, we have been fortunate to benefit from the full realization of that promise.
REFERENCE 1. Center for Healthcare Governance. CompetencyBased Governance: A Foundation for Board and
Organizational Effectiveness. Chicago, IL: Center for Healthcare Governance; 2009:36, appendix 2.
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
NAQ-D-14-00033
November 28, 2014
8:56
Nurs Admin Q Vol. 39, No. 1, pp. 14–17 c 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright
The Case for Nursing Leaders on Hospital Boards Cathy Siegel Weiss, JD, BA; John D. Pettker, LLB At Children’s Hospital Los Angeles (CHLA), the participation of our chief nursing officer (CNO) as a voting member on our governing board has been crucial to effective functioning in several areas, particularly those that impact the safety and quality of our patient care services, as well as our entire organization’s financial and operational efficiency. As a voting member of our Board of Trustees and 2 standing committees, our CNO has a voice that carries authority and credibility, serving as a conduit between her Trustee colleagues and the nursing troops she leads, who constitute more than half of CHLA employees. Our CNO communicates to the board our nurses’ concerns and perspective and in return conveys to nurses the information necessary to implement the board’s policies and strategic decisions. As we consider how to ensure CHLA’s future as a premier pediatric academic medical center, we understand that the results of the board’s work would be impaired if it did not take into account the responsibilities and challenges faced by nurses. We would miss a vital contributor if our CNO was not involved in the hospital’s governance at the highest levels. Key words: governance, health care, leadership, nursing
A BOARD ROLE FOR THE CHIEF NURSING OFFICER Over the past 10 years, Children’s Hospital Los Angeles (CHLA) has taken giant steps forward in formulating and achieving strategic objectives to improve its in-patient facilities, teamwork and spirit of its patient care providers, the quality and safety of its patient care services, and its financial and operational efficiencies. Would improvement in these areas been achieved without including our chief nursing officer (CNO) as a voting member of our governing board? Perhaps. But there is no question that our CNO’s active participation on our hospital’s governing board has been, and continues to be, integral to the formulation of well-targeted and achievable goals
Author Affiliations: Children’s Hospital Los Angeles, California. The authors declare no conflict of interest. Correspondence: Cathy Siegel Weiss, JD, BA, Children’s Hospital Los Angeles, 6550 Sunset Blvd, Los Angeles, CA 90027 ([email protected]). DOI: 10.1097/NAQ.0000000000000069
that elevate our entire organization’s quest for excellence. In 2008, CHLA’s Board of Trustees amended the hospital’s bylaws to include the CNO as an ex officio (by right of office) voting member of the governing board. Prior to our CNO’s inclusion as a board member, she had attended board meetings in an advisory, nonvoting capacity as a member of the hospital’s Executive Leadership Team. We have a large Board of Trustees, consisting of almost 70 members, to include the multiple competencies and diversity in thought leaders we need to support our mission. A large part of our board’s work is accomplished through its standing committees, and our CNO now serves on 2 of the most important of these as a voting member: the board’s Executive Committee, which has the powers of the full board, except with respect to a limited number of extraordinary actions, and the board’s Safety and Quality Committee. Children’s Hospital Los Angeles is a freestanding pediatric academic medical center widely acknowledged as one of the top children’s hospitals in the nation, and board
14 Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
LWW/NAQ
NAQ-D-14-00033
November 28, 2014
8:56
Nursing Leaders on Hospital Boards governance plays an essential role in maintaining that status. In February 2009, the American Hospital Association’s Center for Healthcare Governance set forth a job description for the board of a freestanding hospital that reads as follows: The board sets policies, makes decisions and oversees organizational performance within the context and scope of its role and authority in discharging the following responsibilities: • Select, support, evaluate, and compensate the CEO • Develop organization vision and mission • Provide sound financial oversight • Ensure availability and effective allocation of resources • Approve and monitor the quality and performance of hospital programs/services • Engage in goal setting and strategic planning • Assure legal and regulatory compliance • Build and sustain relationships with key internal and external partners, including the medical staff • Strengthen board effectiveness • Identify and respond to stakeholder needs and advocate on their behalf • Assess and demonstrate the health care organization’s benefit to the community and other stakeholders.1(p35)
We believe that CNOs contribute to every responsibility enumerated earlier and that CNO input at the board level is critical to effective functioning in several key areas. This is particularly true of those that touch on the safety, quality, teamwork, and efficiency in the delivery of patient care services. More than half of CHLA’s employees are nurses. Nurses have a tremendous impact on health care quality and cost. From their “in the trenches” vantage point, they have a unique perspective on the delivery of health care, the needs and expectations of our patients and their families, and the overall operating success of the hospital. Our CNO is their leader. On our governing board, she is a vital conduit in a 2-way process: conveying nursing perspectives and concerns to the board while communicating to our nurse employees. From the very top of our organization, she conveys information that is necessary to implement
15
the board’s policies and strategic decisions at the bedside. From our perspective, a hospital’s CNO cannot adequately fulfill these functions as a “backbencher” at meetings of the full board or its standing committees. To be truly effective in board and committee deliberations, the CNO needs to have a vote as well as a voice; she or he needs to be empowered. As a voting member of our Board of Trustees and standing committees, our CNO has a voice that carries added weight, authority, and credibility, with both Trustee colleagues and the nursing employees. AN OPERATIONS LEADER WHO ADDS TO BOARD KNOWLEDGE The nurse executive has played a vital role as a board member in formulating and implementing our strategic objectives. In July 2011, CHLA opened the doors of its state-ofthe-art, 317-bed in-patient care facility, which represented the boldest financial project ever undertaken by our governing board in the hospital’s history. Construction of this new facility was the first strategic step—the brickand-mortar phase—to achieving transformational, systematic change in how CHLA delivers health care services to its patients. It was a 10-year project from design phase through move-in day. At its inception, our CNO, along with a select group of other senior hospital executives, was designated to serve on the team charged with planning and orchestrating the project. One of her principal responsibilities was to elicit, understand, and communicate to stakeholders the design criteria essential to meet the evolving needs of our patients, their families, our physicians, our nurses, and the entire CHLA team. The goal was to create a technologically advanced, clinically efficient, and familycentered environment. The last 3 years of this project, at which time our CNO had become a voting member of our Board of Trustees and its Executive Committee, proved to be “crunch time” for the board in fulfilling its oversight and decision-making functions.
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
LWW/NAQ
16
NAQ-D-14-00033
November 28, 2014
8:56
NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2015
During this time, her participation in the board’s deliberations, in which she shared her unique perspective as to what elements of the project were essential to support our mission, as distinguished from those that might be nice additions, was extraordinarily helpful to the board in making very difficult “trade-off” decisions. These enabled us to successfully complete the project on time and within our budgetary constraints. BOARD EDUCATION FROM A TRUSTEE WITH OPERATIONS EXPERTISE While changing the physical plant of a significant component of our campus was a first step to transforming our organization, other changes were also needed. We were challenged to address market forces driving health care reform at both the national and state levels and to transform the cultural environment at CHLA to further improve teamwork and develop human resources. Along with other management and physician board members, our CNO was instrumental in educating our board on the need to be out in front of the organizational angst that was bound to arise when making major changes. No one within our organization knew more about how our nurse employees would be affected by, and react to, change, nor was anyone else better equipped to advise the board on these matters. On another front, the nurse executive serves on the board Safety and Quality Committee, which is charged with oversight of credentialing, accreditation, safety, and quality across the institution. She continually contributes a unique focus on the challenges facing nurses in our very complex environment. She is a strong and unyielding proponent of safety and quality improvements, keeping a laser focus on the role of nursing. She has provided key leadership on a number of initiatives involving nursing practice, pharmacy issues, and continuing education, all of which are designed to prevent medication errors. She is a
fierce advocate for a just environment, where acknowledgement of errors in a nonpunitive setting and a transparent analysis (along with concomitant accountability) are the rule. Her leadership has supported the organization’s adoption of this approach, which is key to the pursuit of the safest and highest-quality care. Children’s Hospital Los Angeles has achieved and been designated as a Magnet facility, which is evidence of the important roles nursing and nursing leadership play in the organization. Our Magnet designation reflects the talent, quality, and passion of our nurses and the housewide commitment to the highest standards of professionalism. Achieving Magnet status is first and foremost not only about excellence in nursing but also about an institution’s culture, the value it places on nurses, and the support nurses receive from the governing board as well as from physicians and administrators. The Magnet application process requires an extraordinary commitment of time, talent, and resources across the institution. Our CNO was pivotal in successfully advocating for and leading the Magnet process and in educating our board about why the Magnet process warranted the resources allocated to it. Among a board’s many fiduciary duties is the duty to ensure the future well-being of the institution that it serves. At this moment in the history of health care, that is a significant challenge—a challenge our board has embraced with the strong leadership and support of our nursing leader. With our CNO’s active participation, we have engaged consultants with whom she and other leaders work to identify and implement opportunities for improved and enhanced clinical documentation and clinical operations. These opportunities require active and positive engagement from nurses. We have seen firsthand how important the CNO is in leading these efforts, which at times place higher than normal demands on our nursing staff.
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
LWW/NAQ
NAQ-D-14-00033
November 28, 2014
8:56
Nursing Leaders on Hospital Boards A BOARD MEMBER WHO ADDS VALUE FOR STRATEGIC PLANNING In addition to addressing clinical documentation and clinical operations, our board, like many other similarly situated bodies, is engaged in a strategic planning process. This process will ultimately map out the vision for our hospital for the next decade. We think it would be shortsighted to engage in this process without the active participation of our senior nursing leader at the board level. As we consider all of the issues confronting our institution, and the various means for ensuring its future as a premier pediatric academic medical center, we feel that there would be a risk of missing crucial elements if our CNO was not integrally
17
involved. We understand that the strategic planning process would be incomplete if it did not take into account the roles, responsibilities, and challenges faced by nurses. Involving the nurse executive in the strategic planning process at the board level provides key input. The promise implicit in having a CNO serve as a voting member of a hospital’s governing board is 2-fold. The CNO represents a health care organization’s crucial constituency—nurses. In addition, an experienced, talented nurse executive actively contributes wisdom, knowledge, and experience to the board’s deliberations as it fulfills its fiduciary duties. At CHLA, we have been fortunate to benefit from the full realization of that promise.
REFERENCE 1. Center for Healthcare Governance. CompetencyBased Governance: A Foundation for Board and
Organizational Effectiveness. Chicago, IL: Center for Healthcare Governance; 2009:36, appendix 2.
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
