Chapter 20. Leadership

Reports from the Institute of Medicine (IOM) have emphasized that leadership is essential to achieving goals related to quality care and patient safety. Leadership is expected from individuals at all levels of an organization, from the executive suite to those working directly with patients. Leadership is also expected regardless of where care is delivered—inpatient units, clinics, settings for ambulatory procedures, long-term care facilities, or in the home. Because of the breadth and complexity of the literature on leadership, the authors narrowed the focus to leadership at two distinct levels of health care organizations. First, the literature on executive leadership was reviewed, with a particular focus on the relationship between the chief executive officer (CEO) and chief nurse officer (CNO), to examine leadership by individuals responsible for setting the organization’s vision and direction related to quality of care and patient safety. Second, an exploration of the literature related to the leadership exerted by nurses and physicians as co-leaders of the patient care areas—that is, the type of leadership provided by co-leaders who are responsible for actualizing the vision and creating the local environment in which care is provided—was conducted. A search of the relevant literature yielded little useful information on either of these leadership topics. Studies relating to the CNO or the individual in an equivalent position focused on hospital directors, nursing home administrators, CEOs and boards of directors, and CNOs, with no empirical evidence regarding the CEO-CNO relationship. Thus, the focus on the CNO shifted to reporting findings regarding the CNO’s leadership style and its impact on the organization. On the second level, that of nurse-physician co-leadership, there was a similar void in the literature. Thus, this chapter describes the very few studies that have examined nurse-physician co-leadership and reports findings from interventional studies on the broader context of nursephysician collaboration and its impact on quality and safety of patient care. Collaboration is certainly a precursor to nurse-physician co-leadership.