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Pam Cipriano: In value-based care, nurses are ready to lead

By | July 14 th,  2015 | care coordination, finance, Pam Cipriano, chief nursing officer, nurses, Blog, nursing, value-based care, American Nurses Association, executive leadership, quality, Top 25 Women in Healthcare | 3 Comments

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

 

As the healthcare industry begins to shift to value-based care, Pam Cipriano is utterly convinced that nurses are prepared to lead that transformation in many ways.

 

“I believe nurses are continuing to be the key providers in this transition of care,” says Cipriano, president of the American Nurses Association, which represents the interests of 3.4 million registered nurses. “Nurses have been the owners of care coordination for decades – they have this skill as a core competency. They tend to be the most holistic members of the team regardless of settings.”

 

Care coordination, says Cipriano, is a linchpin for quality, and the industry is taking notice of the pivotal role nurses can bring to the entire equation.
“That may come under many different names: care coordinator, case manager, outcomes manager,” she notes. “The major insurance companies have already seen the enormous value of having nurses in these roles.”

 

In every quality-improvement initiative, it is nurses who play a crucial role in determining if that patient experience will succeed or fail, adds Cipriano, who has served on boards and committees for a variety of respected industry organizations, including the Joint Commission and the National Quality Forum.

 

“When providers say, ‘We’re going to prevent readmissions, we’re going to prevent hospital-acquired conditions, or we’re going to make sure that people with chronic conditions don’t come back to the emergency room for their care and that they’re taking their medications’ – it’s nurses who are driving all of these activities.”

 

Cipriano herself has been driving the agenda for the ANA since her election in 2014. Yet she took a non-traditional path to nursing, beginning in a med tech program at a state college in rural Pennsylvania. Dissatisfied, she began looking for a parallel course of study to which she could apply her chemistry and biology courses and ended up at the Hospital of the University of Pennsylvania School of Nursing. She became heavily involved in the National Student Nurses Association and her career took off. She eventually earned a Ph.D. and has served in a variety of leadership and teaching roles for the University of Virginia, including chief clinical officer and chief nursing officer.

 

Her first year leading the ANA was a whirlwind, including a very visible role as the nation dealt with a number of cases of Ebola.

 

“What was most important was not only protecting the nurses, but also making sure we played a role in reducing the fear and anxiety of the public,” she says. “There was so much bad information that was being propagated and people were unable to focus on the science in the height of emotion.”

 

The ANA worked with the AMA, AHA, CDC, HRSA and many nursing associations to provide information and a reasoned response to the situation. Cipriano even did a media tour with Rich Umbdenstock, retiring CEO of the AHA, guesting on numerous morning radio shows across the country to assuage the public’s concerns.

 

That’s the kind of leadership that many nurses demonstrate, Cipriano shrugs. But she is not sure they receive adequate credit for their executive acumen.

 

“First and foremost, I believe there is a myth that nurses don’t understand finance, and so I believe there is a bias against placing nurses in positions that would oversee an organization’s financial position and budgets,” she says. “Yet if you think about a typical hospital, over half of the personnel and usually more than half of the budget is under the leadership of the chief nursing officer.”

 

That’s a lot of responsibility. And so Cipriano admits one of her pet peeves is when chief nursing officers or executives don’t report to the chief executive officer of the organization.

 

“It is absolutely critical that the chief nursing officer not only report to the highest level executive but also has access to and regular interactions with the governing body of the organization,” she says. “We now have pretty solid data linking outcomes of care and patient satisfaction and engagement scores with direct relationships to not only the nurses but also other employees directly involved in care. So why would you relegate that CNO to a role that is viewed as less important?”

 

Cipriano says many nurses don’t seek out a CNO role not only because they prefer to manage at the point of care but also because of the politics that can derail a career at that level.

 

“If you talk to nurse executives across the country, there are many who have left their jobs or been removed from their jobs because they didn’t get along with the CEO or they didn’t go along with the CEO,” she says. “And so, being in a CNO job is really tough work advocating for person-centered care and those who provide that care.”

 

If you get the impression that Cipriano is a fierce advocate for nurses, you’re right. As she continues her term as ANA president through 2016, she’s also helping nurses adjust to possible shifts in the setting of patient care as it moves from primarily hospitals to all sorts of venues, including the home, along the continuum of care. She’s also testified at briefings on Capitol Hill championing the installation of lifting equipment because nurses and so many others are injured trying to lift patients.

 

“Nurses are fifth in line among occupations for the most musculoskeletal injuries, ahead of many manufacturing jobs. It’s scary,” she says. “The turnover cost for a nurse can be huge --- it can be over $100,000 for an organization.”

 

Ultimately, she says, she wants to see nurses recognized by consumers and policy makers as intelligent, highly skilled and resourceful healthcare leaders.
“I want nurses at every level to be recognized as individuals who bring a lot of underrepresented knowledge to the conversation.”

 

Profiles in Leadership: Jeffcoat at ease under reform’s pressures

By | August 23 rd,  2011 | Boise, delivery, finance, Healthcare, reform, Saint Alphonsus, Top 25 Women, health system, hospital, Idaho, leaders, Modern Healthcare, operational effectiveness, patient safety, president, Sally Jeffcoat, wellness, Blog, CEO, clinical, leadership, operations, preventon, quality | Add A Comment

 

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

 

A lot of the dialogue about healthcare reform is focused on cost, but Sally Jeffcoat, president and CEO of Saint Alphonsus Health System in Boise, Idaho, says she thinks there’s an equally important element that is being overshadowed.

 

“Health reform has really taken shape in the form of financing reform, but what we haven’t done yet is the care-delivery reform that’s required,” she says. “This gets to the heart of operational effectiveness: how are we going to reorganize care delivery that shifts patients to lower cost environments so that we can still deliver better quality than what we have today?”

 

To do that, she says, some of the responsibility needs to shift to the patients.

 

“A focus on prevention and wellness is where we need to reform the system because, right now, there really aren’t any incentives and reimbursement for that type of care,” Jeffcoat says. “It’s difficult to manage the transition unless we reward our providers to deliver that kind of care and we shift some of the risk for those expectations to those patients and populations that we are trying to serve.

 

“Healthy behaviors are really where we can address some of the problems of our healthcare system today.”

 

All of that speaks to change, and that is something that Jeffcoat is comfortable with herself. A native Texan whose father was an Army surgeon, she worked for many years in her home state and Arizona, rising to a CEO position in the Ascension system, before taking her current role with Trinity Health.

 

“I’ve had the blessing of working in organizations that have a strong management development program, but I would not have been able to advance if I wasn’t willing to take on different roles that I had to grow into, or move to different locations,” she says. “Working in different environments shapes you as a leader, because you learn from the positive and negative experiences and integrate them into your leadership style.”

 

Strategic vision tops the list when Jeffcoat lists the qualities that rising female executives need in today’s environment. But vision must work in tandem with operational effectiveness, she says.

 

“You need to have the ability to take strategic vision and operationalize it,” she says. “You need to be connecting the dots from strategy to effective implementation to be successful. I also think the ability to communicate vision – the what and the why – is important for a female executive. If you can’t get people wrapped around the why, it makes it more difficult to implement your vision.”

 

Jeffcoat is known for her dedication to quality and safety, traits that were shaped not only by her pivotal role in Ascension’s “Journey to Zero” program but also by her history as a nurse.

 

“It’s so important to never get too far away from the bedside or from direct patient care,” she says. “I probably get a lot of my satisfaction from being able to interface directly with the caregivers who are on the front lines. The other thing I derive from that is the teamwork it takes to produce the kind of high reliability that we are all trying to achieve as an organization.”

 

And a clinical background, she says, can sometimes help a female leader shine.

 

“It’s important to have the business skills necessary to perform a CEO role. But some of the characteristics of women leaders that bring a balance, such as compassion and collaboration, are very important, particularly in an industry in which 50 percent of the workforce is made up of clinical caregivers.”

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