Top Insights from the 2017 System CNE Roundtables

8 insights to help nurse leaders address their most pressing issues

Top insights from the 2017 System CNE Roundtables

Every year, we gather system chief nurse executives to discuss some of the most pressing issues in health care and identify the specific role system CNEs should play in overcoming those challenges.

This year, we came away with eight insights that address three key challenges: health system strategy in the post-ACA era, embedding care standards into system-wide workflows, and getting multimillion dollar health care IT systems to advance clinical strategy and practice.

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These insights came out of our sixth annual System Chief Nurse Executive Roundtables—find out what we discussed in 2012, 2013, 2014, 2015, and 2016.



1. Widespread celebration of coverage expansion overlooks the rising challenge of uncompensated care.

The rate of uninsured adults reached a historic low in mid-2016: under 9% nationally. But when consumers have the option to choose their health plan, most opt for the plans with the lowest premiums—which also have high deductibles and high copays. These high-deductible plans contribute to the challenge of uncompensated care. Read more.

2. Health systems should push for the expansion of APRNs’ scope of practice in acute care settings.

Health care organizations in nearly all markets are striving to expand patient access and improve care affordability. But most are under-leveraging a key role that can help advance these aims: the Advanced Practice Registered Nurse (APRN). Read more.

3. Inflexible reimbursement policies are preventing virtual technology from revolutionizing health care.

Health care leaders’ interest in telehealth has exploded in the last several years, prompted by payment reform, consumerism, and developments in technology. But relatively few health systems can follow through with sizeable investment because so many virtual care services are not reimbursable. Read more.

4. Health care executives striving to reduce labor costs should first consider exponential growth of administrative staff.

Many health care executives are under intense pressure to control costs. And some organizations have made real progress by reducing labor expenses. One slice of the labor budget—administrative costs—deserves special attention due to its explosive growth in recent decades. Read more.

5. Most health systems must reduce unwarranted care variation to maintain positive margins.

To maintain positive margins, most executives must complement ongoing efforts to increase labor productivity with a much bigger cost saving opportunity: reducing unwarranted care variation. CFOs now estimate that there are twice as many cost savings opportunities in care variation reduction (CVR) as in labor or supply costs. Read more.

6. Achieving a culture of high-reliability care is the final step in minimizing care variation enterprise-wide, not the first one.

There is no better way to ensure every patient receives the known standard of care, every time, and in every setting, than making the development of and adherence to common care pathways the cultural norm for your health system. Nonetheless, efforts to build a high reliability culture should focus first on more concrete and operational issues. Read more.

7. Think horizontally as well as vertically when prioritizing which care processes to standardize.

Many organizations are striving to better leverage data in order to prioritize which care processes to standardize. A “vertical” approach to prioritization should be complemented by “horizontal” analysis—looking across targeted DRGs or clinical pathways for common foundational care processes that have not been standardized system-wide. Read more.

8. New care standards should make care delivery easier, not harder.

Most organizations respond to poor adherence to care standards by doubling down on their implementation efforts. But the root cause of poor adherence is often poor standard design. Read more.

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Top Insights from the 2016 System CNE Roundtables

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