1. Section Editor(s): Sanford, Kathleen D. DBA, RN, FACHE, FAAN

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I just came from my 163rd meeting (I'm exaggerating, of course. I haven't kept a precise count, so it may only be 161 in the last 9 months) in which someone stated (more or less in these words): "Healthcare organizations can't afford to do things the same way as we have in the past. We have to decrease costs and increase quality. We must come up with innovative models for how we are going to provide care."

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This is usually declared as if we haven't ever before thought about, or dealt with, the quandary of balancing cost and quality. Having been a nurse executive for decades, I'm bemused by this apparent amnesia about our history-both recent (in the past 10 years) and in the more distant past. I can't remember a time when nurse leaders have not been designing care and leadership models to fit reduced, or tight, budgets. I can't remember a static period when we were not continually trying to figure out better ways to balance the clinical and business needs of our organizations.


It's not that I disagree with what colleagues are saying about the need for new ways of working and leading. In fact, I've said and written similar words myself. It's the word "innovative" that fascinates me, because so often what we put in place is not very different from what we've done before ... more than once. Our new, "innovative" models may seem familiar to those of us who've been around a while. (How many times have we "invented" team nursing?) Sometimes they are altered versions, with a new twist. (This time we are adding paramedics to the inpatient hospital team.) However, sometimes models are profoundly different from what any of us have experienced, due to use of new technology, such as the growth of virtual care models. A very few are revolutionary because they require deep cultural shifts to fulfill their potential, such as the management model, Dyad leadership.1


Our current authors have approached the broad topic of new clinical leadership models from an eclectic set of viewpoints. Shannon Denney and Libby Evans share the challenges of implementing a radically different inpatient care model. Ingrid Johnson offers her experience in setting up a program to provide a source of new caregivers. Camille Haycock and Annette Shandl suggest use of a tried and true financial tool as an instrument for improving quality of care. Cecilia Crawford suggests a blueprint for nurse leaders of the future. They and the other journal contributors are doing what nurse leaders have always done. They have sought and implemented ideas for improving the health care world for both patients and those who care for them ... and then shared their work with the rest of us.


Nurse leaders are clinicians. We are the major operators of our organizations 24 hours a day, 7 days a week. We are members of multidisciplinary teams involved in strategy and planning for the future. We have continually been on point to improve both operations and care. I, for one, am certain that, as always, we will figure out how to decrease costs and improve quality. We will come up with innovative (however that is described) models for both care and leadership. After all, the best predictor of behavior is past behavior, and nursing leaders have proved their capabilities time and time again.


Thank you for choosing to lead,




-Kathleen D. Sanford, DBA, RN, FACHE, FAAN




Nursing Administration Quarterly




1. Sanford K, Moore S. Dyad Leadership in Healthcare: When One Plus One Is Greater Than Two. Philadelphia, PA: Wolters Kluwer; 2015. [Context Link]