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This is Laura Dierdo
with the Becker's
Healthcare podcast. I'm thrilled today to be joined
by doctor k David Bailey,
chief nursing officer at UCLA Health Santa Monica
Medical Center and adjunct assistant professor at UCLA
School of Nursing.
Doctor Bailey, it's a pleasure to have you
on the podcast today.
Thank you so much for the opportunity. I
look forward to spending some time with you.
Now I think this will be a great
conversation. I know nursing is such a big
topic right now, and so many health systems
and organizations are trying to find innovative ways
to really,
lift up their nursing organization. So I'm excited
to learn more about what you're doing at
Santa Monica Medical Center. But before we dive
into my questions, can you tell us a
little bit more about yourself and your background?
Sure. Happy to, Laura. Thank you.
So I have been a nurse for for
multiple decades, and I have
been at the Santa Monica campus for a
little over a decade at this point
and have been in the chief nursing role
for over 8 years at this point.
But in addition to my role as the
chief nurse, I have also,
professionally involved in the sense of having led
a professional organization.
And it really to me was a compliment
of what I do.
I was the, I'm the immediate past president
of the Association For Leadership Science in Nursing.
And that really is that bridge
between academia
and practice.
And with me sitting on both sides of
that, I really felt that I needed to
be more involved professionally.
And that is why I chose
that I am and chose to be
a board member in that organization
as I continued
to push that boundary between the 2.
Years passed,
for most academic and practice partners, those were
very different paths.
But we cannot do this alone.
We have to have our academic practice partners
to make this work,
because you need this for centers of innovation,
for research, for expansion,
for really trying new models of care. And
so that is really what I do between
trying to bridge that academic private partnership. So
I appreciate that opportunity to share that background.
Absolutely.
You know, and your point is so well
taken that having those partnerships today between the
academic side and the,
you know, provider side on the front lines,
it can really make a big difference in
how you're growing and developing for the future.
So,
that that's really fascinating and cool to see
that you're able to bridge that gap. Now
from your perspective, what are some of the
biggest issues that you're following in health care
right now?
So, really, I mean, I can share some
from my own organization, but I'm pretty well
connected across the country and with colleagues, you
know, chief nurses and other
leaders across the country,
we continue to face
workforce challenges. While I sit in a pretty
good spot at this point,
it hasn't always been that way. You know,
when you look back in 2 years ago
in 22,
I really
was,
had a shortage that I had never experienced
in this organization.
But it was really a time when people,
okay, the acute phase of the pandemic is
over.
I'm going to go do something else. And,
you know, we have recovered from that. But
many of my contemporaries across the country have
not. And they are still facing,
big shortages
with high volumes.
They are
relying heavily on temporary staff and we do
need our partners that run the temporary staffing
organizations.
But when you are looking at significant
backdrops
of temporary staff,
you have to look at where's the balance
of stabilization and what's an appropriate amount to
have. And many of my colleagues across the
country are continuing to struggle with that. So
I think as we continue to march down
this path,
we in nursing, but also our partners and
our intercollaborative
partners and our interdisciplinary
partners,
they too are facing these shortages. I'm talking
my medical colleagues,
all types of therapies,
our unlicensed staff. And so, you know, when
you can put burgers
in a in a place
and a nursing assistant
makes the same amount of money
for less challenges and less threats, lots of
risk,
where's the choice there? And so I think
we
as healthcare leaders, healthcare organizations,
have to continue to
push the boundaries
of what can our teams do, how can
we do it differently,
how do we build our pipelines,
through
enhancing
the academic practice, partnerships with multiple organizations, not
just one. How do you because you have
to have the different therapies or the the
different disciplines in place. And how do you
continue to build those and create new models
of care?
That is what we are doing, but also
many places in the country are looking at
how do we do things differently because we
can't continue to do it the way we
used to do it.
Some of the other things that we are
facing,
across the country
are people only working a few years in
one place versus in my generation from years
ago,
we would stay many years, sometimes 8, 10,
20 plus,
in an organization.
And that is not what our current,
the newer generation is doing. That is no
slam against them at all. It's really just
a new
situation. And I don't even want to call
it a challenge. It's a new opportunity
for us to embrace.
But we have to look back at what's
the real reason why people are doing that
and living the shorter tenure or working the
shorter tenures.
Is it because we're not giving them the
flexibility?
Is it we are not challenging them enough?
Are we not mentoring them enough? Do they
not have
developmental opportunities to grow within the organization? And
they're looking those ex looking for those externally.
I think we have to continue to ask
those important questions.
What what is the reason for this?
I think, you know, some people have looked
back and think, well, this is the way
we've always done it. Well, that really, unfortunately,
is a term that we are going to
have to get rid of in health care
because it's not the same anymore. I
mean, when you look at, some of my
contemporaries across the country,
they have an entirely new workforce every 3
to 4 years.
I mean, that is scary
on some levels. And how do you come
in and stabilize
that the cost of turnover
and to ensure
that you're meeting
patient outcomes,
patient satisfaction,
organizational
outcomes
and really thriving
slash surviving in these turbulent times. So I
think those are some of the other things.
Another big one for all of us across
the country
is workplace violence.
That
is a situation
that if I even think back pre pandemic,
those were rare events.
Today, those are daily events in every healthcare
organization across the country. And sometimes it's multiple
events in a day.
Sometimes it's as simple as an argument.
And I'm talking this can be staff to
staff, this can be patient or slash family
to staff,
interdisciplinary
conflict. So it can really come from many,
many angles.
So I think we,
as healthcare leaders and not only in nursing,
we are the largest workforce. So we have
the largest
share of this. But we have to really
look at
how do we continue to move forward through
the path
of decreasing
workplace violence
and building
teams
that can be resilient during that while we're
trying to eliminate one thing,
how do we build teams to survive in
that
unstable workforce?
Unfortunately, our society is more unstable now than
I've ever experienced.
And people feel it's okay to take it
out on the people that are providing care.
Well, that's not okay. And I think organizations
will have to continue
to enforce
situations, parameters,
guidelines
on on how we're gonna handle that and
really resituating
this of what's appropriate and what's not appropriate.
I I have colleagues across the country that
have just faced some horrific events,
with this. I've had certainly my own challenges
locally. But I do think that this is
a place where there will need to be
constant attention.
Because when you shift that and move it
and and you're striving to move it
to an environment where people want to be
and where people want to work and thrive,
and we really turn that a healthy
work environment,
well, that that that is those are 2
very, very different ends of that equation.
And so we have to continue to move
our efforts.
Now internally for us, we have created
a pretty significant program,
that's about a year old. It's not to
say that, we haven't done other things along
the way, but we really launched a large
model, and it's called a Safer U program.
And it really looks at how do you
prepare staff
to be prepared for situations.
And we have sent most of our staff
at this point through crisis prevention intervention
training. And that is really a model of
de escalation.
How do you do that? So, but we
are looking at ways, how do we take
and even enhance that program
for people to really be able to navigate
through the situation,
whether it's a verbal
or other altercation.
And how do we do that? So we
really have learned about,
setting parameters better. How do we have these
difficult conversations with patients and our families
and setting limits?
And when I think back
into
my own clinical career and even my earlier
leadership career, these are not conversations we had
to have with patients and our families.
So I think this will continue to be
a struggle for quite a while. And, you
know, certainly, the the pandemic
illuminated
the mental health crisis in our country. And
I do think as we continue to struggle
with that, it also escalated
the unhealth population.
And I think as we continue as organizations
to try to
remedy some of those,
we will continue to face many of these
challenges. So I think, and to me, some
of this is not only health care.
Our communities
are are we're gonna need further state local,
state, and federal
support to do some of this to really
help
people move from an unhealth situation
instead of using the emergency room as their
primary care setting into other models.
And we are working on some of that
now. We've created a band program here
to really look at, and that band program
is staffed with clinicians.
And they are going out into those unhoused
areas
to look at and see how they can
support,
patients
or individuals
who need
primary care. So I think, you know, other
places are trying similar models.
I think we have to embrace innovation.
Because like I shared a few minutes ago,
what we've always done, we can't continue to
do that because it's not working anymore. So
we have to embrace innovation. And I think,
you know, a lot of people are scared
of that work.
But we have to embrace this. We have
to look at how do we allow technology
to come into innovation? How do we allow
technology to support us?
How do we allow
artificial intelligence
to come in to our our
model?
Clearly, there's a lot of dialogue out there
right now.
What's safe and what's not safe? How do
we incorporate that? So, you know, our EMR,
company is All Star Electra Medical Record. They
are, you know, looking at how do they
improve this. We're looking at that. But so
are all of my contemporaries across the country.
How do we do this and how do
we do it better? How do we improve
care? How do we use that as an
earlier warning system? And how do we do
this to really
streamline care
from the acute care side, but also the
primary care side in the the post acute
world. So I think we have to continue
to to do all of that with our
inter collaborative partners.
That makes a lot of sense. And, you
know, that's really fascinating to hear,
everything that you're faced with and dealing with
from, you know, some of the clinician shortages
and trying to, bring on additional
providers and and then, 2,
collaborating
across the board and developing new partnerships
to troubleshoot some of these challenges. I think,
you know, it's just so fascinating to hear
about, some of the different generational,
preferences as well as how they're looking into
the workforce, what really, you know, different people
are needing in different points of their careers.
And so I appreciate you talking through that
as well as the workplace violence issues and
solutions that you've seen work really well. I
think it's just really an important time in
health care to troubleshoot all of those issues.
So,
it's great to hear that there are some
really, really cool things that are being done,
to to attack those, challenges. Now from your
perspective and looking ahead, what are you most
excited about, and what makes you nervous?
Excellent question.
And, really, the few items I'm gonna share
could really be situated in either bucket.
They may they excite me,
but because of the unknown,
untried,
or
just the newness of it, then there's also
that flan of nervousness of all this work.
So some of the things that that I
am excited about is really
how do we,
as health care teams across this country and
really beyond our own boundaries of our our
country,
how do we continue to improve care?
And we are doing some exciting work locally
of
looking at how do we best situate patients
to be their their best selves
and the environments where they choose to live.
And and that sounds like a lot, but
let me back up and give you a
little bit of a backdrop.
We, as an organization, have done a great
deal of work around our readmission efforts.
And we really never did that because we
had a big problem. Our numbers were really
below the national,
sort of where the country sits at this
point with readmissions.
But we decided to do that because it's
the right thing to do. And we've been
on this journey for 7 years. And I
was at that sort of the forefront of
that with some of my qualities,
leaders.
And now fast forward through the years of
this work, we really have
handled
and moved through some of those earlier challenges.
Today,
when you look at through the lens
of health equity,
we are beginning to do a lot of
work in this area and I am helping
co lead that and I'm excited about this
work.
But when
you step back and you look at that
broader
lens of what is equitable care,
you know, and just, you know, looking through
that diversity lens,
it has really been a huge eye opener
for me
as well as my organization,
but also
for for many of my colleagues across the
country.
Because when you look at
health equity,
we are not all situated the same. We're
not all paid the same. We all don't
have the same background. And I'm talking
our ethnic background, our racial background, our cultural
background.
But yet we have to look at every
element
of who makes the fabric up of that
individual.
And then it's only when you do that
and you step in and really support
that person in their time of need? And
helping situate them and prepare them to be
able to take care of themselves and
or their family member at home. So we
are beginning to do a lot of work
in this area. But
I can honestly say
I have peeled a few onions, you know,
metaphorically in my life. This is probably one
of the more complex
onions with so many levels and layers,
to really look at
how do you do this and how do
you educate patients
and really looking at that. And you have
to look through their
literacy lens. You have to look through
their ethnic background. You have to look through
their primary
initial their their initial language, or is English
the second language, and really look and do
this. You know, interpretive services, you know, years
ago, I would say they were rarely used.
Today they are sitting at the forefront of
care and they have to be. Because
in the city where I live,
we have every culture, almost every culture in
the world
is also here. And so we have to
be prepared to meet those individuals in the
languages they
choose to learn in.
And they ideally would do that in their
native language. And how do you do that?
And that is a resource commitment, but it
is a commitment we have made to do
the right thing.
And so as we continue to look at
that,
I think this will be a long journey.
And I'm not saying a long journey for
for my organization. I'm saying a long journey
for the world.
Because
when you look at
health literacy
and when you look at the communities in
which people live, and sometimes it used to
be by city
or zip code,
Now it could be down to
the the the narrow window
of a neighborhood
and a ZIP code or a block,
a city block in a neighbor in a
in a city.
So it it really has opened my eyes.
And I'm starting to see,
colleagues across the country have the same experience.
And, you know, thankfully there's some ahead of
us and many are behind us. But I
think as we all do through this work
together,
it really just illustrates that need
on how do you meet that person
where they are today.
So that is exciting.
It's not scary to me,
but
it will
continue to require
a great deal of resources
to make sure that we're doing it well
and doing it right.
And that people recognize
we care about them as an individual
and not as a number.
And I'm not saying that's what we do.
That's not it at all. But how do
we move to that
person,
that individual,
knowing that we care about them
and how are we meeting their needs
where they are at this point?
I think we have to continue
down a path of moving from
reactive care
on the acute care side of
our healthcare systems across the globe
to a proactive care. And I have
talked about that for a long time, but
we have always been to the or most
organizations and most communities live on the reactive
side of care. We'll just go to the
ER, go to the hospital.
Well, if you can start looking ahead
and really doing it proactively
and doing it in the primary care model,
and it and it saddens me that so
many other
organized and, you know, well recognized countries in
the world
have done so much better than we have
here in the United States.
And so my hope is that we
it's exciting, but it's also scary that we
are this far behind. And my hope is
that we
as
healthcare leaders and nursing leaders, because I do
believe nursing can be at the center of
this movement
to help us move this
forward across the globe
in our communities, but also beyond
on how we move back to a community
health model
to really educate patients and their
and our community members, I should say, is
probably the better term there,
in the schools, in their churches, in their
homes,
so that we can
not have so many
bad outcomes because people didn't know they had
heart disease,
or they were at a risk for stroke
or they had diabetes
or whatever
long term, you know,
medical condition they may have. And it's untreated
because people didn't go to primary care.
And I think, you know, during that
earlier year, year and a half of the
pandemic, it illustrated people weren't seeking care. And
now we all are experiencing, including the individuals
who have the diseases,
we are experiencing
all of that with them now. And I
think we
will be faced with continuing to manage that
for a long time.
I do think, and this really to me
sits on both sides of the equation of
exciting but scary,
embracing
artificial intelligence more. I think
we will continue to see that
integrated into our schools,
our educational programs for health care team members,
but also into care. And how are we
going to do that and embrace that further?
I am a little nervous though.
When you hear of these situations where students
have submitted
papers that were only generated through
chat GPT or some of the other artificial
intelligence. That's scary.
And how do we as health care leaders
differentiate
what is safe and not safe? So to
me, this one sits on both sides.
I think the workforce challenges continue to make
me nervous,
in the sense of
will we have enough people
excited to be health care providers,
health care team members
based on what they're seeing, how people are
treated based on some of the things we
talked about in the last item, the workplace
violence.
And when you look at that and, and,
you know, some of the, the portrayals
in the media of what nurses do,
that is not what we do for the
most part.
And when, you know, they show people, you
know,
dressed in mini skirts and saving everybody's life
and things like that, those are not true
portrayals. And it saddens me. I mean, I
don't watch healthcare shows for that very reason.
Because
it's portrayed that it's all glorified and you
just run-in and do something and the person
is healed. But we all know that that
are on this side of the equation. That's
not real. And how do we
increase
the professional nurses'
identity?
How do we increase
the level of respect that a nurse should
receive?
So I think those will continue to be
challenges.
And those make me nervous because
who
is doing that marketing for us? It should
be us and not others. But we have
to step in as nurses and and health
care leaders to help do that.
So I sort of tried to give you
a mix of, the nervous and what make
what I'm excited about. But some of those
really are situated on both sides of that
equation.
It really makes a lot of sense. And,
you know, what a great overview in terms
of all the different ways that,
health care providers are integrating into the system,
how you can use technology and other things
in order to tackle some of the health
equity issues, but also, you know, wanting to
make sure, you know, that,
what the medical system is doing and can
do is portrayed accurately, I think, is a
100% a huge huge challenge and something, you
know,
I can imagine clinicians and organizations face every
day.
Now before we wrap up here with our
last minute or 2, I'm wondering if you
could talk about,
leadership.
What is most essential for health care leaders
to be successful over the next 2 to
3 years or so?
Laura, thank you so much for the question.
And this is really important work to me.
In fact, I have some,
a lot of work going on right now
looking at
what are the ideal leadership traits
that make it work.
And so I am working with a small
group or have been working with a small
group of individuals
looking at because there's many leadership styles,
but we have coined the term
relational leadership.
Because, you know, when you look at it,
and I sort of compare this to Maslow's
hierarchy.
If you don't have some fundamental
elements of leadership,
those are trust, those are communication,
and able to to establish,
nurture,
and build relationships,
if you don't have those three elements, the
rest of it is really not gonna work.
And so
I believe the leaders that will continue to
make a difference
have some
form. Now there's many under many
identified leadership traits or or styles under that.
You'll have transformational, but that could be or
could not be. You have servant, you have
humble, you have authentic, leadership.
When you look at that, I like to
broaden the term out to relational leadership. Because
if you don't have those fundamental
elements that people trust you
and,
that you can have that relationship with and
you can communicate with them well, and
you have to be willing
to nurture and mentor them
to to grow.
When you can't do that,
it really makes me worry about an individual's
leadership path. And so I think
those
individuals
that do have adopt, develop, and you can
put whatever, you know, sort of word in
there, but
or or verb in there,
those leaders that have the capacity
to embrace
a relational leadership style,
I think, will outperform
most of the other leadership styles.
Because I think it's gonna take that foundational
work for a leader
to create the culture where people wanna be,
where people can thrive,
to create that healthy work environment where individuals
wanna come to work and not dread coming
to work. So I think that is to
me is just foundational.
And that's why I've chosen to do some
work in that. I've spent a couple of
years doing that and will continue to do
that because I do think it's important. And
the work that I'm looking at is not
only related to
the nurse.
It's also looking
to patients
at better outcomes and better satisfaction.
So I'm looking at it with my group,
the team, from both sides, the nurse
outcomes of it and the patient outcomes of
it. And we are beginning to recognize
there is a difference. And so I do
think,
health care leaders, and it's really to be
nurse and other leaders in health care that
are not nurses,
you have to have that that foundational element
of being a relational leader to make it
work and to make
your organizational
be differentiated from others. Doctor.
Billy, that's such an important point and certainly,
you know,
essential for educating the next level of leaders
as well as nurse professionals.
Thank you so much for joining us on
the podcast today. Yeah. Of course. And thank
you so much for the opportunity.