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  1. Brown, Barbara J. EdD, RN, CNAA, FAAN, FNAP, Editor-in-Chief

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Innovation in Transforming Organizations

Change is irritating, change is stimulating, change is transforming-Leapfrog named 13 top facilities nationwide that provided the best quality of care with the most efficient use of resources as published in an article on December 11, 2008, in Modern Healthcare. These hospitals, mostly from the Midwest, were deemed the "highest value" through a review of Leapfrog's annual survey, according to the organization. What is it about these hospitals that differentiates them from the rest? How is this different from the new Magnet model of the American Nurses Credentialing Center? Or, is there similarity that creates exceptional, "out of the box" thinking to renovate and modernize organizations? Having experienced "transforming" 2 hospital organizations in the seventies and eighties, which became Magnet in the original study by the American Academy of Nursing (Family Hospital, Milwaukee, Wisconsin; and Virginia Mason, Seattle, Washington), there are certain characteristics of transformational leadership that are applicable today, as depicted in this issue of Nursing Administration Quarterly. As director for the Arizona State University, College of Nursing, Master's in Healthcare Innovation program, Kathy Malloch, PhD, MBA, RN, FAAN, is the most qualified nurse leader to serve as guest issue editor for Innovation in Transforming Organizations. Dr Malloch is a recognized expert in leadership and the development of effective evidence-based process and systems for patient care. Her uncanny focus on accountability and results is the hallmark of her practice as well as expertise in the identification of organizational, clinical, productivity, and financial indicators/variables for the analysis and evaluation of futuristic healthcare systems engaged in evidence-based facility design. This work has been useful to many organizations across the country.


Currently, Dr Malloch serves as president of the Arizona State Board of Nursing, senior consultant for Tim Porter-O'Grady Associates; Area I director, National Council of State Boards of Nursing Board of Directors; and Consultant to API Health, Inc. Her awards include "Excellence in Nursing" from the American Nurses Association, the American Organization of Nurse Executives' Educational Scholarship, and the Edgar C. Hayhow ACHE article of the year. She is truly one of Arizona's top leaders.


What makes her and other nurse executives "top" leaders is the ability to use originality and creativeness in changing and transforming organizations. In altering and modifying direction of an organization, the leader has courage of one's convictions about patient-centered care with strength and self-confidence and a willingness to change. In developing successful leadership abilities in any culture or environment, you have to be willing to acknowledge and learn from your mistakes and have self-control.


This lesson, I learned while serving as Associate Executive Director at the King Faisal Specialist Hospital, Riyadh, Saudi Arabia, from 1987 to 1991.


I spent more than 3 months gathering financial data and comparison of salaries from several different countries as well as the costs of recruitment and in-service education of Western nurses (United States, Canada, Australia, New Zealand, Great Britain, and Europe). These data were then presented to the Saudi executive committee in the attempt to gain better salaries in order to retain these highly skilled Western nurses. My main argument was the excessive use of recruitment monies instead of retaining the best nurses we had. After this data-based presentation, I was firmly told that since recruitment monies came from the Royal Cabinet in a separate chapter of funding, there could be no transferring of monies from recruitment to salaries. I lost it and said, "Hogwash!!" (Note. Pigs and pork are prohibited in Islam and this was a grave insult.) I did not want to use other forceful words, so that came out.


The next day, I humbly walked into the chief executive's office and apologized. Because there was team support among my colleague nurse leaders and I had the courage of my convictions for advancing nursing practice, we were able to initiate many organizational changes such as collaborative practice committees, advanced nursing practitioners, distance learning programs for nurses to earn bachelor's and master's degrees while working in Saudi Arabia, and even home healthcare, based on an evidence-based research model I had used previously, when I was told that it was culturally "not possible."


Today, as I use my imagination to allow creative thinking in a very dangerous healthcare system of turmoil and uncertainty, there are so many lessons to be learned from the past to enable transformation and restoration of family-focused patient care, even a metamorphosis of nursing practice for the future. Never run away from a challenge; the challenge will transform you. And, while you are in the midst of shifting the scene organizationally, remember to create a constant shift in your personal life by taking good care of yourself and developing a capacity to relax amid the turmoil of a nurse leader's life. A work-personal life balance is a critical issue in our future as a profession.


You may need to change your definition of success as you uphold your own family values and the quality of life for those most important to you. Even the quality of life at death may ultimately be your greatest challenge and responsibility. It was mine and I embrace the future with a renewed love for nursing and life.


Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP


Editor-in-Chief Nursing Administration Quarterly