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Welcome everyone, to the Becker's Healthcare podcast series. I'm Ryan Mohammed,
writer and moderator Becker's Healthcare. Now,
I'm absolutely thrilled to have with me today, Tim pl,
senior Vice President and division Chief Nursing Officer at Midwest Division
Common Spirit Health. Tim, very nice to have you on the podcast today.
How are you?
I'm doing well. Thank you for having me.
Yeah, of course. Well, too good. It started.
Would you mind please introducing yourself and telling us a bit about your
background?
Absolutely. So I am the division, uh, CNO for the Midwest Division. Um,
and that's of Common Spirit Health, which, um,
is a national organization providing not-for-profit Healthcare, um,
across the country. Um, like you can tell by my title,
I am a registered nurse. I've been, so, um, for about 20 years now,
I got my start as an LPN for a short time before, you know, going on and, um,
getting, uh, my, my RN degree. Um, since then I've gotten, uh,
my BSN and then two masters. One, I have an MSN. Um,
and then I have an MHA as well.
I am originally from the West coast, so I, uh, was, uh,
raised in the Seattle area where I worked for, um, a,
the Common Spirit, uh, subsidiary, uh, the Franciscan Health System at the time,
um, where I sort of, uh, grew up as a nurse. I was an ICU nurse there.
And, um, where I then went into management where I was a clinical manager.
I worked in an ED as the director, um,
before I was the CNO of that hospital there. Back in 2016,
I decided to make a small move, well, maybe not so small to some folks,
but I moved to Nebraska from Washington State,
and I did that to take a role as a, a critical access hospital, um,
CEO. Um, so had a lot of learning there. And then, um,
was the chief nurse at St.
Elizabeth in Lincoln before moving into this division role, um,
with, uh, common Spirit Health in the Midwest division.
Wonderful, wonderful. Thank you so much for giving us all that insight.
Definitely sounds like you're busy.
So the first question I wanted to ask you is,
can you tell us about your most successful project or initiative from the last
year? What issues were you trying to solve and also what drove the success?
Absolutely.
So I believe from the bottom of my heart that if you are able to
engage your frontline staff,
and so these are the folks that are the clinical experts, um,
physicians and nurses and all the other, uh,
disciplines that contribute to the team,
if you're able to engage them and put decision making where I believe it needs
to be, which is with, um, your staff, um,
only good things come from that and you end up, uh, with more success, um,
than, say if you, um,
decide to do perhaps a top down initiative or something, um,
you know, where, where you don't rightfully engage, uh, those,
those frontline teams. And so to do that within our health system, um,
we have built a, uh, system, shared governance. And so just to give you an idea,
we are a 28 hospital system, um, where we operate in four states.
Um, and, and I saw the need to, you know, really, uh,
bring everybody together from a nursing perspective. We are only as good as,
um, as the team. And, um, we are often, in most cases,
the largest part of any hospital or hospital system, healthcare system,
workforce. And so at having a collective voice is a very powerful thing, um,
for, for nursing. So, um,
we created a system process where our hospitals have, um, councils,
the units on the hospitals have councils, and then we have a system council.
And, um, this is all consisting of frontline staff and they're able to, um,
participate in change management processes, but they're also able to, um,
bring the voice, um, of our bedside staff through this process, um,
all the way up to the system level where decisions are getting made. Um,
like I said, this, this really promotes frontline ownership and leadership,
right? And so you're able to, um, through the,
the different delegates that participate in this, you are able to build a, um,
you know, a, a network or a team, um, that also helps, you know,
identify your leaders of tomorrow. So as they start to,
to to work with other hospitals and bring their ideas to the forefront and then
actually see them get put into action, that's, that's very powerful.
So our system, uh, shared governance team has three different councils.
We have evidence-based practice and research. Um, that's one.
We have a professional practice group, and then we have a, uh,
team that works on, uh,
what we call triple our recruitment recognition and retention. Um,
and, and then these three teams have done so much,
we've seen changes to order sets, um, or processes in our EMR.
Um, we have implemented many different practice changes, um,
all the way from, you know, I, you know, how we, we do a,
a dressing change for a central line to, um, alcohol,
um, order sets, um, for alcohol withdrawal. Um, and,
and probably most our biggest achievement is the implementation of
a clinical ladder, um, which we affectionately called, uh, the PNAP,
and that stands for Professional Nurse Advancement Pathway.
This was literally created by a team of bedside nurses that saw a need for
professional growth, um, but they also saw a need for some sort of incentive.
And so, uh, through a yearly process, um,
our bedside staff can put in a, a package where they have to, uh,
participate in different professional activities from poster presentations to
research, to just, you know, attending your staff meetings and, and committees,
and you build a point profile and they can actually earn up to $4,000 a year,
uh, doing this. And so, um, we just had our second, um,
our second payout is happening this month, and so we're really proud of that.
And, uh, just so many different initiatives we've been able to bring, um,
you know, to, to the level of decision making and change that we're really, um,
organic in growth and, and, and the ideas belong all to our bedside staff.
Yeah, that sounds absolutely amazing. Congratulations on that success. Thanks.
As you know, the clinical workforce has changed a lot in the last few years.
What challenges are you still facing?
How do you see the clinical workforce evolving?
Yeah, it has been a very tumultuous few years, and, you know,
over the course of my 20 years in the profession,
I would say the last three have been the most challenging. And, you know,
for a long time we've been saying, you know,
if there's any constant in healthcare, it's changed. And I don't,
I don't know of any other time where that's been, um, more prevalent in our,
um, in our profession. Y you know, we are in a post pandemic, um,
period, um, c Ovid 19,
and how we took care of patients and how we addressed issues and how we
communicated really everything, um, that, that leaders need to be working on.
Um, the, the pandemic changed everything.
We lost a significant amount of our experienced nurses. Um,
evidence is still unclear as to why that happened, but, uh,
I know our researchers in the profession are working on it,
but opted out, opted out of nursing, opted to go do other things or, you know,
change careers or maybe just, you know, um, not be a nurse anymore.
And we saw a lot of our experienced nurses leave.
And so what, what that did is, um, you know, it, it two things.
Um, it, the wisdom and, uh, that, that,
that you get by being, doing this for many years, um,
is very important as you look at safety and quality of care.
And when you had so many of our experienced nurses, um,
decide to go do other things, you know,
we've been able to catch up with staffing, but our staffing workforce,
our nursing workforce is much, uh, much newer, much younger.
We've seen a significant decrease, um, in years of experience. And,
um, and, and that correlates to average age. Um, and,
and I'm really excited that we have a new, you know, uh, uh,
invigorated nursing workforce.
But I'm also very concerned that our experience level and our
knowledge, um, has, has taken a hit through, through this process.
And so, um, I think that the main challenge that we're facing,
um, as, as,
as nursing leaders and healthcare leaders is how do we equip this very
new, um,
in some cases inexperienced workforce with the tools and the processes
to still achieve safe outcomes for our patients? How do we,
um, achieve that high reliability, um,
organization that most of us are, are, are seeking? Um,
and, and so I, so, so this is evolving day by day. Um, right now,
I, I think the answer is we need to develop job aids, um, for these, um,
nurses and healthcare workers that can, um,
help make sure that you're thinking of everything. So this could be, you know,
best practice advisories and the EMR, um, checklists.
I think there's a lot of room for us to use more checklists in, in healthcare,
much like aviation has done, it really does result in safer outcomes.
We've struggled with that in healthcare.
We've struggled getting checklists to be a part of our day-to-day work. Um,
but most of what we do is evidence-based.
There is good signs behind it. If we would only follow a process,
it's when we deviate from that, when we forget things or we don't notice things,
you know, these small changes in our patient's conditions, um,
might go unnoticed because we might be skipping steps or we might be, um,
you know, focused on something else and not looking at the whole picture. So,
so our plan is to keep evolving our workforce, um, and,
and making sure that we're giving them the right tools, um,
that really doesn't substitute experience and wisdom. We have to rebuild that,
but we still need to keep patients safe. Um, so that's,
that's what we're working on.
Yes, definitely an important thing to work on always, um,
even throughout the year. So thank you so much for sharing that insight.
And Tim, before I let you go, the last thing I wanted to ask you is,
what is your best advice for aspiring physician and nurse leaders?
You know, there,
there's so much opportunity out there for physician and nurse leaders.
I think that, you know, over the years I've, I've, I've learned a lot,
but I continue to be humbled and, uh, every day as I, um,
you know, uh, engage in the team. So I, I, I, I have a,
I do have a couple of pieces of advice here.
So the first one is something I'm still working on every day, and that's to, um,
have a vision. We need to have visions, we need to share it with our teams.
Now our, our visions need to be aligned with that of the organization,
the mission and the values and our leaders, you know, uh, their visions.
But we need to be able to articulate where we're going, um, to our staff and,
and, and to all the folks that report to us, we need to be able to say why. Um,
because people will rally around that. Um,
it's important to have a very well thought out, um, strategic, um,
plan and vision so that, um, you know, provides the roadmap. And then of course,
uh, we may not be working on all the tactics, um,
depending on what level of leadership you're at. Um,
but constantly reinforcing that. So that's number one.
Number two is to place decision making as much as possible with the
frontline caregivers. Um, I will say this is, takes extra work.
It's much easier to make a top down, quick decision. Um,
and engaging more people can lengthen a process.
But every time that I make the decision, um,
to not engage our frontline staff and physicians, it always takes longer,
um, to, to get the buy-in. And it often, um,
fails because, because of just that,
that we didn't rally the right support and get the right advice.
Anyone can be a captain when the cess are calm, right? So I was in the Navy, uh,
many years ago, and when things are going well, um, it's just that, it's, it's,
it's not hard to be a leader.
It's when times get tough or you're faced with adversity where you really gotta
lean in, um,
rely on the vision of your leader and your own vision, um,
and get those frontline leaders, um, engaged and the frontline staff engaged.
And the last piece of advice I'd have is to be obsessed with safety. Um,
sometimes when you see something happen, for instance, patient falls,
when you start to see that happen over and over again, um,
or you know, that we miss counts in the or, or you know,
we're copying pasting in the EMR, all these,
these things that it becomes normalized, right? And so,
so you often kind of accept the fact that patients fall and get injured. And,
and, and I'm not okay with that. I think we need to be obsessed with improving,
um, the safety for our patients.
But that means you gotta pay attention and you gotta talk to people and you
gotta learn, um, where these safety issues are.
So somebody within the organization,
hopefully everybody needs to be obsessed with patient safety, um,
to make sure that it stays in the forefront.
Thank you so much for those final thoughts. Tim.
This has been an amazing discussion. So again,
I wanna thank you so much for coming on Beckers Healthcare,
and I look forward to connecting again with you soon.
Very good. I appreciate the opportunity.
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