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Vol. 23, No. 5, MAY 2006

Engage and Transform: Getting or Becoming? A Journey of Transformational Change

By Debbie Brinker, RN, MSN, CCRN, CCNS
President, AACN

We don’t get Magnet. We become Magnet. Nor do we get Beacon. We become a Beacon unit.” That’s how Joan Vitello-Cicciu, chief nursing officer at Boston’s Hallmark Health System and one of AACN’s past presidents, provocatively positions her challenge. When her staff members ask whether she believes their unit will receive either designation, she focuses their attention on the journey to excellence instead. She knows what’s most important: creating a healthy work environment where everyone is committed to quality and optimal outcomes for patients and families.

Is the goal to receive the award or designation, making cosmetic changes in order to qualify? Or is the goal one of transformational change in work culture and patient care systems validated by the recognition? Cosmetic changes are transitory and superficial. They never become part of an organization’s DNA and are nearly impossible to sustain.
This spot-on perspective prompted me to replay my visits to dozens of hospitals and units during my term as AACN’s president. I realize that as I engaged in this rewarding and important work, I found myself being transformed by you and with you. Here are just a few of the things I learned.

Excellence Is a Journey, Never an Endpoint
Just when we thought we’d arrived and everyone was inserviced and on board with the new standard, another new change appeared. Sound familiar? Knowledge is exploding. Luther Christman reminds us that scientific knowledge expands exponentially every two years. A dozen years from now, we’ll have at least 128 times as much scientific knowledge as we have today. Drugs. Technology. New evidence that dethrones one standard and forces creation of a new one. Since excellence requires that we seek knowledge, and then apply it, we’ll never be free of change.

Leaders Set the Tone
We finally have a chief nursing officer who’s respected by both employees and administrators. She listens, values our contributions and makes changes that move us forward. That’s how one nurse described it. Repeated studies confirm that the leadership approach at the top sets the tone for true collaboration and effective decision making. That applies equally to the top of the organization and the top of the clinical unit where nurse managers, clinical nurse specialists and seasoned nurses lead. It is leadership that sets a high bar with zero tolerance for disingenuous collaboration; everyone is empowered to optimize their contribution.

Individual Competence Isn’t Sufficient
Competent individuals are hindered when they do not work with a competent team. This becomes obvious when you read exemplars for the Beacon and Datascope-AACN Excellence in Collaboration awards. Individualized pain management, family presence, interdisciplinary care protocols—all of these fall into place when individual and team competence becomes the norm. Last month, I engaged in dialogue with leaders of the American College of Chest Physicians about how individual competence alone will not transform healthcare. We discovered a shared commitment but an uncharted course. So AACN and AACP will continue our collaboration until the course is set.

AACN Is Transforming Ahead of the Curve
AACN’s contributions bear witness to our “big hairy audacious goal” of becoming the undisputed and indispensable leader in critical care. Among those contributions are national standards for healthy work environments. New editions of the AACN Core Curriculum and Procedure Manual for adults with new versions for pediatrics being developed. Critical care essentials book and pocket guide and progressive care ones being developed. PCCN reviews. Online ECG e-learning module to complement the online Essentials of Critical Care Orientation. A relaunched quarterly journal focusing on advanced critical care. End-of-life care protocols. Practice alerts. PDA resources. Cutting-edge education and local action by chapters. Online essentials of nurse manager orientation in development with the American Organization of Nurse Executives.

Our Quest for Excellence
AACN’s list of contributions seems endless. That is, until we look at the daunting list of what remains to be done. As a guide in our continuing journey toward excellence, AACN adopted the Baldrige National Quality Program’s criteria for performance excellence (www.quality.nist.gov/Criteria.htm). To measure our progress, we applied for an onsite evaluation through California Awards for Performance Excellence, a highly respected state program using the Baldrige model for excellence. Much to our delight, AACN was one of the four top winners for 2005, sharing the spotlight with such distinguished companies as Boeing Air Force Systems, Sharp Healthcare of San Diego and Spectrolab (www.calexcellence.org/newsite/press12.html).

We’re proud of the honor but we recognize that it’s not about getting the award. It is about doing the right thing. It is about creating value and quality, stimulating a work environment that is respectful, healing and humane. Becoming excellent is about continuing to find more effective, efficient and, yes, financially healthy ways to transform our work systems. Doing the right thing requires leadership, commitment, the courage to speak up and the determination to have crucial conversations. Above all, becoming excellent is about competent individuals and competent teams.

Excellence isn’t an endpoint. It’s a lifelong commitment to pursue relentlessly. Because I agreed to engage in our shared quest for excellence, you have transformed me in many ways—some I have yet to realize. My presidential year may be nearing an end, but not my commitment to remain engaged with AACN. I will continue to reflect on how I have been transformed and where, on my own and with AACN, I can continue to make a difference. What about you? Will you join me?

Life is not a path of coincidence, happenstance, and luck, but rather an unexplainable, meticulously charted course for one to touch the lives of others and make a difference in the world.
—Barbaa Dillinham


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