The rise of the hybrid CNO-COO

As financial pressures grow and health systems look to reduce administrative teams, it's not uncommon for the COO role to be eliminated or left unfilled after a leader departs. However, some systems have taken a less traditional route, creating hybrid COO and chief nursing officer roles. 

Traditionally, COOs are responsible for overseeing health system operations while CNOs have focused more specifically on nursing leadership and practice. But Amber Egyud, DNP, RN, CNO and COO of Chesapeake (Va.) Regional Healthcare, says there is a logical case for combining the roles in some organizations. 

"There's such a good benefit to have CNOs be COOs as well because everything in operations eventually touches a patient," she told Becker's in a recent interview. "That role alignment really allows for good planning from both a strategy and operational perspective."

A dual focus on nursing and operations can allow for better collaboration and care continuity in existing service lines such as pharmacy or rehabilitation services. It also has perks for health systems planning to roll out new services, according to Dr. Egyud.

"All of it is so integrated into patient care that having a dual role makes the most sense from a planning and alignment perspective and a collaboration perspective," she said. 

Dr. Egyud stepped into her hybrid role at Chesapeake Regional — an independent nonprofit system with two hospitals — in 2017.

For smaller health systems, the decision to combine the CNO and COO roles may be fueled by budget constraints, limited staff and the need for streamlined leadership. However, some larger organizations are also embracing the dual role. In 2018, Broward Health — one of the 10 largest public health systems in the nation — tapped Netonua Reyes, MSN, RN, to serve as COO and CNO of Broward Health Imperial Point, a 204-bed hospital in Fort Lauderdale, Fla. Wilhelmina Manzano, RN, currently serves as group senior vice president, chief nursing executive and COO for perioperative services of New York City-based NewYork-Presbyterian. 

Ultimately, there is no one-size-fits-all approach to C-suite composition, and whether hospitals or health systems opt to pursue a hybrid role largely depends on their specific needs, priorities and available resources. But for some systems, the hybrid approach could be a valuable solution to help manage costs while maximizing patient care. 

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