As the health care system landscape continues to evolve toward more integrated care, a trend toward consolidation of hospitals into larger systems continues. The systems are more than the traditional hospital-centric structures, as acute care becomes just one component to a larger system that includes ambulatory care, acute and post-acute care, chronic disease and end-of-life management, and all structures in between. To provide leadership in these new models, there have been an increasing number of system chief nurse executives hired both to facilitate the integration of care and to align and standardize nursing practice across the continuum. By definition, the role of the system chief nurse executive differs from that of the entity chief nursing officer. A crosswalk is presented that describes the differences between the roles and reflects on the implication for system chief nurse executives during our changing times.

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Patients now, more than ever, need reassurance that they are indeed the focus of the healthcare team. Patients enter the healthcare system knowing that there are worldwide shortages of key personnel, that physicians can no longer afford malpractice coverage and are many times practicing "defensive medicine," and that there are reported issues in terms of patient safety that may affect their own care within a hospital setting. With inpatient care becoming increasingly focused on "curing" via application of new and advanced technologies, patients are beginning to ask the question "Does anyone care?" To answer that question, Baptist Hospital of Miami, part of Baptist Health South Florida, committed to the hospital-wide implementation of a new model of practice. In this model, a patient care facilitator (PCF) becomes the primary point person for the patient during their stay. Each PCF leads a "Twelve Bed Hospital," a smaller segment of the patient care center where staff work with the PCF to make the whole inpatient experience more personalized. Initial results of the pilot implementation are promising. Research is underway to assess the overall effects of this practice model on continuity of care, patient safety, satisfaction, efficiency, and effectiveness of patient care.

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