Steadfast attention to quality, safety, and patient satisfaction prevails in our current healthcare environment. Accordingly, today's healthcare leader's skill set must be adaptive, keeping customers at the center and placing strong emphasis on problem identification, change management, innovation, inspiration, and engagement.1,2 In addition, the pursuit of quality calls for an improved patient experince, service excellence, and reducing care costs, all of which present further challenges to traditional healthcare delivery models and organizational leadership.3 The doctor of nursing practice (DNP) degree focused on executive leadership prepares nurses for leadership roles within the healthcare system. The DNP-prepared leader has education and training in several key areas, such as quality, service, process assessment, and improvement, making him or her a valuable asset to address these challenges and transform the healthcare landscpe.
There has been a lack of research on DNP degree utilization, due largely to lack of clarity about the DNP role.4 However, interest in understanding the executive DNP role is being perpetuated by the increasing demand for performance and quality initatives to drive change and cost containment within healthcare systems. To a large degree, the American Association of Colleges of Nursing's Essentials of Doctoral Education for Advanced Nursing Practice outline the roadmap for healthcare transformation and can be directly linked to desired leadership attributes.5
Scientific underpinnings for practice
The DNP-prepared leader integrates nursing theory and scientific principles from the social sciences to guide nursing practice for complex patient and family conditions in a variety of practice settings.5 As part of the integration of current evidence into bedside practice, the DNP-prepared leader can facilitate the increased use and application of research evidence through translational science. DNP education assists in the development of leadership qualities that allow for the evaluation and generation of strategies to enhance patient care, driving change through application of evidence-based interventions. Healthcare leaders educated through a DNP program gain the insight, skills, and knowledge to incorporate translational activities through research synthesis into solid evidence-based programs that enhance their clinical environments.
Organizational and systems leadership
The executive DNP graduate has the skills and knowledge to positively affect both patient and population outcomes through the development of new care models. Additionally, the DNP-prepared leader understands the importance of navigating complex healthcare systems, as well as the organizational and policy implications of patient care decisions.5 Changes in the healthcare business model are occurring at a rapid pace; reimbursement and compensation methods are now being driven by population health and avoidance of costly hospital care.1 These changing reimbursement incentives challenge systems to promote innovative team-based care models to improve quality and services.
The DNP-prepared leader is uniquely qualified to helm efforts to standardize practice across healthcare teams to promote quality outcomes. Incorporation of clinical practice guidelines has important implications in the redesign of the healthcare delivery system as called for by the Institute of Medicine and the Robert Wood Johnson Foundation.6 From an institutional standpoint, relevant disease-specific clinical practice guidelines, such as those for heart failure and diabetes, can be implemented systemwide to positively promote Accountable Care Organizations. Leaders from executive DNP programs can accomplish this by assessing relevant literature for evidence-based practice (EBP) and developing a model for application of best practices designed for organizational fit.
Clinical scholarship and EBP analytical methods
Advanced practice nurses prepared at the DNP executive level are redesigning, evaluating, and disseminating the results of quality improvement projects to promote safe, cost-effective, and efficient patient-centered care.5 The DNP graduate is educated with the exploratory skills necessary not only for clinical problem identification, but also translation and application of research information in the form of an EBP solution. This becomes increasingly important for leaders in a changing healthcare climate where emphasis is placed on Value-Based Purchasing and penalties for hospital readmission, clinical complications, hospital-acquired conditions, and errors.
DNP-prepared leaders are also qualified to develop and assess organizational metrics by critically appraising their clinical environments. Again, through translational research activities and a command of the literature, the DNP-prepared leader can link EBP to direct care and develop action plans to improve quality, patient safety, and patient satisfaction outcomes.7 Strategic efforts regarding clinical improvements through resource utilization are critical in today's healthcare environment. Leaders prepared through DNP programs are ever more adaptive to the new climate in which analytics drive change and organizational strategic direction.
Technology for transformation
The executive DNP graduate gains new knowledge and abilities regarding the use of information technology (IT) and its importance in the planning, implementation, and evaluation of EBP. IT allows for connectivity to disease-specific databases, which in turn allows for outcomes measurement and quality improvement opportunities. As a systems leader, the DNP graduate is positioned to promote the purchase and utilization of IT and other technologies to promote high-quality healthcare.
For example, the use of individual provider scorecards and service line-specific dashboards can assist organizations in the creation of quality incentives to reward provider behavior and participation in healthcare processes. The application and widespread use of telemedicine and remote monitoring moves us toward healthier populations and avoidance of costly hospital care. Healthcare leaders prepared through a DNP executive leadership program can be early adopters of IT by assessing their system's needs.
Healthcare policy for advocacy
The DNP-prepared leader is poised to positively affect healthcare policy at the local, regional, national, and international levels.5 Leaders emerging from DNP programs have the knowledge and understanding to advocate for change within the state and federal healthcare arenas.5 Executive DNP graduates have the capacity to influence healthcare models that influence policies associated with practice regulation and the financing of health services. A critical skill for DNP-prepared leaders is the ability to access healthcare policies to ascertain organizational fit. A healthcare leader must strive to continually evaluate policies to sustain effective processes that lead to appropriate access to care and safe practice environments for patients and providers, along with maintaining the highest quality of care provided.
The executive DNP graduate gains the knowledge and skills necessary to develop and lead diverse interprofessional teams. The complexity of patient and family conditions requires input from a variety of disciplines, providing a breadth of experience and understanding to solve healthcare problems.5 This practice model of multidisciplinary collaboration has become the gold standard for care. Quality initiatives should be both defined and solved by a key group of stakeholders from various disciplines to achieve the best possible results. Healthcare leaders trained through DNP programs possess the ability to assess the need for specific stakeholders and develop an interdisciplinary team to focus on the challenge at hand. Transparency in regards to targeted goals, timelines, outcomes, and expectations should be set by organizational leaders. The project management skills learned through DNP education are critical to healthcare leaders.
Clinical prevention and population health
The DNP graduate's EBP knowledge can positively affect individual patient outcomes and improve the health of an entire population. As a health system leader, the DNP graduate can identify and align the organization with critical state, national, and specialty organizations to ensure benchmarking to promote important organizational initiatives and programs specific to particular environments and the populations served. The interpretation of organizational and community data allows for identification of gaps in care and drives decision making regarding healthcare program development.
The DNP-prepared leader is also well positioned to partner with state and national organizations to lead health promotion and prevention campaigns. Development of EBP clinical programs to assist individuals and communities to manage health further supports the goals of our changing healthcare environment. The DNP graduate possesses both the knowledge and skills to pursue the acquisition of funding to support these innovative programs through grant writing and research.
Advanced nursing practice
The DNP-prepared leader develops skills and knowledge to advance the nursing profession. From an organizational perspective, important implications include the creation and fostering of an environment conducive to EBP to create innovative strategies to facilitate clinical problem solving. Dissemination of knowledge and early adoption of new ideas further promote adaptation. Finally, the DNP-prepared leader acts as a change agent, posessing the skills and ability to advance nursing within the area of healthcare administration. Through both a formal leadership role and the associated professional mentorship, the DNP leader can positively influence important healthcare policy decisions and help redesign our healthcare system.
Positioned for success
Today's healthcare system leader has an increasingly difficult job. As such, the metrics of success have changed and continue to expand. The pursuit of care quality calls for an improved patient experince, service excellence, and cost containment, which require a different skill set than what has traditionally been ascribed to the C-suite. Clinical scholarship, collaboration, change management, quality assessment, and process improvement activities are but a few of the critical elements associated with success. DNP-prepared leaders must demonstrate organizational accountability within practices accepted as standards of patient care and safety. IT must be continually evaluated to transform systems and bring research findings closer to the point of care.
Leaders trained through executive DNP programs can positively affect change by developing policies within their organizational environments or through a broader role within state and/or national policy development. The DNP-prepared leader possesses key traits to serve as a change agent within complex healthcare environments. The redesign of healthcare models and delivery systems requires leaders who are prepared at the doctoral level to sustain and lead the change required for us to be successful.
3. Institute for Healthcare Improvement. IHI triple aim initiative: better care for individuals, better health for populations, and lower per capita costs. https://www.ihi.org/engage/initiatives/tripleaim/Pages/default.aspx
4. Nichols C, O'Connor N, Dunn D. Exploring early and future use of DNP prepared nurses within healthcare organizations. J Nurs Adm
5. American Association of Colleges of Nursing. The essentials of doctoral education for advanced nursing practice. www.aacn.nche.edu/dnp/Essentials.pdf
6. Mitchell P, Wynia M, Golden R, et alCore principles and values of effective team-based health care. https://www.nationalahec.org/pdfs/vsrt-team-based-care-principles-values.pdf
7. Elliott N, Begley C, Kleinpell R, Higgins A. The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis. J Adv Nurs