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  1. Ponte, Pat Reid DNSc, RN
  2. Branowicki, Patricia MS, RN
  3. Somerville, Jackie MS, RN
  4. Anderson, Dianne MS, RN
  5. Erickson, Jeanette Ives MS, RN
  6. Kruger, Nancy DNSc, RN
  7. Sporing, Eileen MSN, RN
  8. Connaughton, Mary MS, RN
  9. Conlin, Genevieve MS/MBA, CRRN


In the past decade, many healthcare institutions have formed new partnerships, alliances, and networks. Collaboration among chief nursing officers and other leaders from affiliating institutions is essential to the success of these new organizational structures. The authors explore the nature of the collaboration among chief nursing officers and senior nurse leaders at 5 Harvard-affiliated teaching hospitals that provide cancer care. In particular, this article examines how collaborative relationships have been fostered and highlights the challenges, benefits, and outcomes of successful cross-institutional collaboration.


Collaboration is often cited as a skill needed by today's healthcare leaders. In its landmark report, To Err Is Human, the Institute of Medicine (IOM) underscored the importance of collaboration, communication, and teamwork in ensuring patient safety. 1 A subsequent report, Crossing the Quality Chasm, went on to call for active collaboration and communication among clinicians and institutions, citing this as one of 12 "rules" that should guide a process of fundamental change in the healthcare system. 2


As chief nursing officers (CNOs) and senior nurse leaders in 5 Harvard-affiliated academic medical centers in Boston, Mass, we experienced a wave of mergers and restructuring in the 1990s that profoundly affected each of our organizations. Restructuring and realignments in the cancer care field were particularly complex and resulted in several new organizational entities that promised streamlined and improved patient service. However, as these new alignments began to emerge, we realized that the promised benefits would be achieved only if leaders and clinicians at the newly affiliated organizations were engaged in effective cross-institutional collaboration.


As the new organizational entities were defined, our focus quickly turned toward developing and implementing strategies that would promote cross-institutional collaboration between the organizations that had entered into partnerships. At the same time, recognizing the benefits we have long enjoyed from collaborating as colleagues, we also sought to revisit and bolster strategies we have used in the past to foster collaboration and collegiality among the CNOs from each of our institutions.