Redefining management through redesign of patient care delivery systems.

Nurse managers can no longer rely on power and control through hierarchial mechanisms supported by vertical organizational cultures. They can no longer coerce people to do things they do not understand because they were given directions without adequate explanations. Nurse managers, understanding what they can no longer do, are redefining their management practice by inviting creativity and participation from a variety of disciplines at all levels of the organization. They are moving beyond a small and narrow view of their department. They are taking actions that demonstrate an understanding that they are part of the bigger environment that promotes a patient needs-response approach to service delivery. Nurse managers are doing this by using principles of interactive planning and systems thinking as they redesign patient care delivery systems. These redesign initiatives are facilitating a redefinition of their management practice, resulting in a deepened and broader accountability for quality, service, and cost. This article draws on the experiences of four nurse managers involved in the redesign of patient care delivery systems while participating in "Strengthening Hospital Nursing: A Program to Improve Patient Care" (SHNP). SHNP is a national program jointly sponsored by The Robert Wood Johnson Foundation and The Pew Charitable Trusts.