Nurse-Executive Team Leadership Demonstration Project


The purpose of this unique project is to use evidence‐based methods to improve leadership competencies and the culture of interdisciplinary executive team management in order to improve the rate of adoption of leadership, quality, and patient safety best practices. Improvements in organizational performance will be measured using a balanced scorecard of process and outcome measures including quality and patient safety (Q/PS) indicators. The project emphasizes the role and responsibility of nurse leaders for leading quality and patient safety initiatives in relationship to other members of the management team.

The initial phase of this study was supported by The Robert Wood Johnson Foundation. The impetus for the study was the recognition that the role of the Chief Nurse Officer as part of the senior leadership team in complex healthcare organizations is pivotal if quality and safety outcomes are to be achieved in patient care, yet may be undervalued and/or underutilized. This project was executed within a selected sample of hospitals within the NCHL LENS. On‐site interviews were conducted with executives and nurse leaders from eight hospitals, representing five health systems operating in six states (California, Iowa, Michigan, Missouri, Texas, and New York). Approximately 30‐40 people were interviewed using a uniform interview protocol at each site, representing Board leadership, senior executive team and physician leadership, nursing management, and staff nurses.

The following highlights the qualitative findings from these on‐site interviews:

  •   Wide variance in levels of sophistication and extent of infrastructure to execute Q/PS initiatives
    •   While senior administrative leadership is fully committed, physician engagement in Q/PS initiatives is variable
      •   Nursing staff are actively engaged in numerous Q/PS initiatives to the extent that some noted the process was a distraction from patient care. As one CEO noted, “Right now, there are so many goals. We need to strategize where we want to leverage ourselves: it gets embraced on the senior side, foggy in the middle, then when it gets to the staff level, they’re overwhelmed.”
        •   Personal and organizational characteristics that fostered team effectiveness and accomplishment of Q/PS goals included: stability of team leadership over a period of years; a collaborative relationship among team members; strong CEO leadership; clarity and focus on Q/PS priorities; employee engagement and support for the focus; physician involvement; and sufficient institutional resources to support Q/PS efforts
          •   There is very little work intentionally targeted toward optimizing senior leadership team effectiveness

            From the qualitative data analysis, several key components emerged that are hypothesized to enhance organizational effectiveness in Q/PS initiatives. Phase II of the project, entitled Improving Senior Leadership Team Effectiveness in Quality and Patient Safety, will include the design and implementation of team‐ and practice‐based learning at the executive level and individual coaching in order to (1) develop the abilities/competencies of the CNO and senior team, (2) expand the capacity of the organization, senior team, and CNO, and (3) improve prioritization and accountability for quality and safety outcomes.

              The study’s principal investigators are Joanne Disch, PhD, RN, University of Minnesota, and Scott DeRue, PhD, University of Michigan. A nationally recognized advisory council of academic and practitioner thought leaders in organizational development and nursing leadership are serving as advisors to the research team.

            For more information about this demonstration project contact Melanie Standish at