MUSC Health revamps hospital's chief nursing role

Jerry Mansfield, Ph.D., RN, and Patti Hart, RN, have more than six decades of combined experience in the nursing field. Their new roles at MUSC Health reflect the organization’s appreciation for the key contributions of nursing, not only in the daily care of patients and families, but in developing new care delivery models for the future. Mansfield, as executive chief nursing officer, and Hart, as associate chief nursing officer, will expand the responsibilities of the chief nurse in two important ways.

First, Mansfield will bring a renewed focus on nursing practice, helping to redefine what nurses do at MUSC and chart a course through a rapidly changing and increasingly unpredictable health care environment.

"Health care is changing, and we have to maximize the use of this valuable resource called nursing in new and innovative ways," he said.

Second, Hart will manage the nuts and bolts of daily operations in nursing, with nurse directors working with each Integrated Center of Clinical Excellence reporting to her. Previously, nurses reported through their service lines to the chief operating officer, bypassing the CNO entirely.

"I'm responsible for what happens day to day on the nursing units, as well as for making sure we have consistency and synergy across the enterprise," she explained. Budgets, logistics and quality assurance all fall within her purview.

This change has been in the works for a while, the pair noted, explaining that as health care becomes more interprofessional and outcome-driven, nurses play an increasingly important role. 

"We are becoming much more quality-driven than quantity-driven," Hart said. "We are transitioning from operating in silos and moving from hospital-based to systems-based care. We are and must continue to think about how the patient flows through our entire health system.”

Systems-based care means more collaboration between inpatient and outpatient services with shared standards of care across those areas.

Mansfield agreed. "Traditionally, patients went to hospitals when they were sick, and health care was very illness-focused," he said. "That's not good enough anymore."

For one, he explained, it's too expensive, and it's a disservice to patients, who are more likely to suffer complications and be readmitted under the old system.

Mansfield spends a lot of time thinking about how to best serve patients. In addition to his role as ECNO, he holds another title, chief patient experience officer. He said it’s no coincidence hospital leadership chose a nurse to fill that role. In every department, both in the hospital and MUSC’s many clinics, nurses are on the front line of the patient experience.

“Nurses are best suited to interact with patients and families and to take information about the medical treatment plan and help them incorporate it into their lives going forward,” he said. “The goal is that patients shouldn’t stay in the hospital too long, they shouldn’t have a complication while they’re here and they certainly shouldn’t have to come back for a related issue because we missed it.”

In the past, hospitals have been paid based on how many patients they treated and how many services they provided. “In the future,” Mansfield explained, “we’ll be paid based on outcomes instead.”

That means it’s important, both for patients and health care providers, to think about ways to reduce costs.

“We just can’t afford to keep delivering health care the way we’ve done it in the past.” Instead, he said, it’s important whenever possible to keep patients out of high-cost health care settings, like emergency departments, and instead shift to urgent care centers and after-hours clinics that can better serve the needs of patients at lower costs.

Hart agreed, highlighting the importance of telehealth in giving patients more options in how they receive care. “Our telehealth program here is unbelievable,” she said. “MUSC has invested a lot in that area, and I am amazed at all that this team has accomplished.”

Mansfield and Hart said they have four main goals for nursing at MUSC. The first is to develop a nursing strategic plan to directly connect the work nurses do every day to MUSC Health’s pillar goals and those of Imagine MUSC 2020.

“I want every nurse in the organization to be able to relate what they do on each shift to the overall goals of the organization,” Mansfield said. “That’s big goal No. 1.”

Their second goal is ensure MUSC is redesignated a Magnet hospital in 2019. “Magnet designation is a rare thing to get and a hard thing to keep,” he explained.

Hart said that almost half of hospitals that achieve Magnet designation fail to attain redesignation. “The first survey is all about process, but the second and subsequent surveys are all about outcomes,” she said.

Their third goal is to develop and implement an organizational structure that emphasizes leadership development and shared governance.

“The nurses at MUSC are agile and willing to do whatever it takes to care for their patients,” Hart said. “I’ve been so impressed with the teamwork here. Helping nurses develop a voice in leadership and embrace their decision-making power has been amazing, because the people who do the work understand it the best.”

The fourth goal Mansfield and Hart cited is to improve the patient experience at MUSC.

“Any patient in any setting should see MUSC Health as a single unified concept,” Mansfield said.

Hart emphasized the importance of the leadership structure for patient experience. “The new nursing directors will assure the standards are maintained across the continuum so that families don’t feel like there is fragmentation in their care.” 

Both Mansfield and Hart came from large universities, Ohio State and Pennsylvania State, respectively. In addition to Charleston’s weather and great restaurants, they both say the health care-focused nature of MUSC and the collaboration and teamwork on campus are key reasons they decided to make the move.

And both are very excited about where MUSC is headed.

“MUSC, as an academic health center, has the unbelievable potential to train future nurses to work in the interprofessional environments that we will create,” Mansfield said. “There is energy and talent here, and we have made some real strategic steps to build a health system for the future.”