Maybe the answers to your hospital's most troubling quality conundrums lie with nursing leaders at the competing institution on the other side of town.

I'm oversimplifying a bit, but that was the case recently for a handful of Boston-area hospitals. Through a 16-month program funded by the American Association of Critical-Care Nurses, nursing leaders were able to sharpen their skills, share best practices and inch the quality needle forward. All told, the seven hospitals saved about $8 million through everything from reducing the incidence of pressure ulcers to bettering communication during handoffs and dropping lengths of stay for ICU patients on ventilators, the association announced earlier this month.

Jeanette Ives Erickson, R.N., chief nurse and senior vice president for patient care at Massachusetts General Hospital in Boston, says that participants never worried that their employers sometime contend for the same patients.

"This was really bringing exemplary nurses together and creating a new community to improve care delivery. We didn't care about competition. It was about how nurses can provide leadership in improving patient care outcomes," she says.

The seven hospitals were taking part in the AACN's Clinical Scene Investigator Academy, which dates back to June 2012, when the first cohort was selected in Indianapolis. Through it, participating hospitals receive educational programming, along with grants to help implement improvement projects. All told, 42 hospitals will have taken part in the program by the end of this year, including three still ongoing in New York, Pennsylvania and Texas, with some $1.25 million invested in the first three years by the AACN.

Ramon Lavandero, R.N., a senior director with the association, says group officials hope to further spread lessons from the project through its CSI Academy Innovation Database. There, hospital leaders can peruse through all sorts of materials demonstrating what made these nurse teams click, including project plans, clinical interventions, data collection tools and outcomes.

Before you dive into the database, one key lesson nurses learned, Lavandero tells me, is that quality improvement requires a collaborative effort, and can't just be dictated by the C-suite or nurse team alone.

"If this were just a top-down initiative, then it would really diminish the whole driven-by-nurses-at-the-bedside element, which is key, because the point of care is where the whole program is focused," he says. "At the same time, if nurses at the bedside were the only ones driving this, then it would be a tougher road to demonstrate the benefits and the values, and what the contributions are to the organization in terms of improvement in safety, improvement in patient outcomes and contribution to cost-effectiveness and the bottom line."

Lavandero, who is also an associate professor at the Yale University School of Nursing, stressed the importance, too, of getting leadership to buy in to such initiatives. Leaders must place power with nurses to pursue such quality improvement initiatives, and build "strategic time" into their daily routine, so they don't feel bogged down and burned out from wearing too many hats.

RNs in every hospital can and should play a major role in the transformation of health care, but they just need their leaders to give them the tools and time to get there.

"Nurses will always focus on the patient and so I think with CSI Academy, one of the lessons it's validating is that a nurse at the bedside is sometimes one of a senior leader's strongest allies in bringing about planned change," Lavandero says.