1 00:00:05,075 --> 00:00:06,565 This is the Becker's Healthcare Podcast, 2 00:00:06,635 --> 00:00:08,245 created by the team of Becker's Healthcare, 3 00:00:08,405 --> 00:00:11,445 a multimedia company devoted to the people who power us healthcare. 4 00:00:11,755 --> 00:00:15,725 Four new 15 minute episodes are released daily containing industry news analysis 5 00:00:15,725 --> 00:00:16,525 and thought leadership. 6 00:00:16,525 --> 00:00:20,565 From powerful healthcare decision makers Support our show by leaving it a five 7 00:00:20,565 --> 00:00:23,845 star rating and review on Apple Podcast or other platforms you use. 8 00:00:23,995 --> 00:00:27,085 It's a chance to tell us what you like about the show and act on your feedback. 9 00:00:27,085 --> 00:00:29,045 Thanks for listening. Now here's the episode. 10 00:00:31,115 --> 00:00:35,085 Welcome everyone, to the Becker's Healthcare podcast series. I'm Ryan Mohammed, 11 00:00:35,085 --> 00:00:37,445 writer and moderator Becker's Healthcare. Now, 12 00:00:37,445 --> 00:00:39,765 I'm absolutely thrilled to have with me today, Tim pl, 13 00:00:39,865 --> 00:00:43,965 senior Vice President and division Chief Nursing Officer at Midwest Division 14 00:00:44,065 --> 00:00:47,325 Common Spirit Health. Tim, very nice to have you on the podcast today. 15 00:00:47,325 --> 00:00:48,158 How are you? 16 00:00:48,345 --> 00:00:50,005 I'm doing well. Thank you for having me. 17 00:00:50,275 --> 00:00:52,325 Yeah, of course. Well, too good. It started. 18 00:00:52,325 --> 00:00:55,285 Would you mind please introducing yourself and telling us a bit about your 19 00:00:55,285 --> 00:00:56,118 background? 20 00:00:56,765 --> 00:01:01,605 Absolutely. So I am the division, uh, CNO for the Midwest Division. Um, 21 00:01:01,825 --> 00:01:04,405 and that's of Common Spirit Health, which, um, 22 00:01:04,705 --> 00:01:09,245 is a national organization providing not-for-profit Healthcare, um, 23 00:01:09,545 --> 00:01:13,525 across the country. Um, like you can tell by my title, 24 00:01:13,725 --> 00:01:18,325 I am a registered nurse. I've been, so, um, for about 20 years now, 25 00:01:18,845 --> 00:01:23,845 I got my start as an LPN for a short time before, you know, going on and, um, 26 00:01:23,845 --> 00:01:28,805 getting, uh, my, my RN degree. Um, since then I've gotten, uh, 27 00:01:28,905 --> 00:01:32,525 my BSN and then two masters. One, I have an MSN. Um, 28 00:01:32,585 --> 00:01:34,565 and then I have an MHA as well. 29 00:01:35,685 --> 00:01:40,005 I am originally from the West coast, so I, uh, was, uh, 30 00:01:40,185 --> 00:01:45,085 raised in the Seattle area where I worked for, um, a, 31 00:01:45,185 --> 00:01:49,205 the Common Spirit, uh, subsidiary, uh, the Franciscan Health System at the time, 32 00:01:49,785 --> 00:01:54,285 um, where I sort of, uh, grew up as a nurse. I was an ICU nurse there. 33 00:01:54,945 --> 00:01:59,525 And, um, where I then went into management where I was a clinical manager. 34 00:02:00,045 --> 00:02:02,365 I worked in an ED as the director, um, 35 00:02:02,365 --> 00:02:07,365 before I was the CNO of that hospital there. Back in 2016, 36 00:02:07,925 --> 00:02:12,325 I decided to make a small move, well, maybe not so small to some folks, 37 00:02:12,425 --> 00:02:15,285 but I moved to Nebraska from Washington State, 38 00:02:15,665 --> 00:02:20,125 and I did that to take a role as a, a critical access hospital, um, 39 00:02:20,365 --> 00:02:24,565 CEO. Um, so had a lot of learning there. And then, um, 40 00:02:24,625 --> 00:02:25,845 was the chief nurse at St. 41 00:02:25,845 --> 00:02:30,165 Elizabeth in Lincoln before moving into this division role, um, 42 00:02:30,675 --> 00:02:33,365 with, uh, common Spirit Health in the Midwest division. 43 00:02:34,895 --> 00:02:38,265 Wonderful, wonderful. Thank you so much for giving us all that insight. 44 00:02:38,395 --> 00:02:39,945 Definitely sounds like you're busy. 45 00:02:40,045 --> 00:02:42,105 So the first question I wanted to ask you is, 46 00:02:42,485 --> 00:02:46,785 can you tell us about your most successful project or initiative from the last 47 00:02:46,895 --> 00:02:51,105 year? What issues were you trying to solve and also what drove the success? 48 00:02:52,265 --> 00:02:53,098 Absolutely. 49 00:02:53,445 --> 00:02:57,865 So I believe from the bottom of my heart that if you are able to 50 00:02:58,525 --> 00:03:00,565 engage your frontline staff, 51 00:03:00,825 --> 00:03:04,445 and so these are the folks that are the clinical experts, um, 52 00:03:04,655 --> 00:03:07,325 physicians and nurses and all the other, uh, 53 00:03:07,325 --> 00:03:09,125 disciplines that contribute to the team, 54 00:03:09,145 --> 00:03:13,725 if you're able to engage them and put decision making where I believe it needs 55 00:03:13,725 --> 00:03:17,965 to be, which is with, um, your staff, um, 56 00:03:18,035 --> 00:03:22,445 only good things come from that and you end up, uh, with more success, um, 57 00:03:22,995 --> 00:03:24,325 than, say if you, um, 58 00:03:24,425 --> 00:03:29,245 decide to do perhaps a top down initiative or something, um, 59 00:03:29,705 --> 00:03:32,885 you know, where, where you don't rightfully engage, uh, those, 60 00:03:33,015 --> 00:03:37,805 those frontline teams. And so to do that within our health system, um, 61 00:03:38,745 --> 00:03:43,125 we have built a, uh, system, shared governance. And so just to give you an idea, 62 00:03:43,345 --> 00:03:47,485 we are a 28 hospital system, um, where we operate in four states. 63 00:03:48,185 --> 00:03:51,565 Um, and, and I saw the need to, you know, really, uh, 64 00:03:51,615 --> 00:03:56,165 bring everybody together from a nursing perspective. We are only as good as, 65 00:03:56,505 --> 00:04:01,125 um, as the team. And, um, we are often, in most cases, 66 00:04:01,385 --> 00:04:05,965 the largest part of any hospital or hospital system, healthcare system, 67 00:04:05,965 --> 00:04:10,565 workforce. And so at having a collective voice is a very powerful thing, um, 68 00:04:10,565 --> 00:04:12,685 for, for nursing. So, um, 69 00:04:13,025 --> 00:04:18,005 we created a system process where our hospitals have, um, councils, 70 00:04:18,265 --> 00:04:22,085 the units on the hospitals have councils, and then we have a system council. 71 00:04:22,865 --> 00:04:27,645 And, um, this is all consisting of frontline staff and they're able to, um, 72 00:04:27,835 --> 00:04:32,525 participate in change management processes, but they're also able to, um, 73 00:04:32,535 --> 00:04:37,365 bring the voice, um, of our bedside staff through this process, um, 74 00:04:37,585 --> 00:04:42,125 all the way up to the system level where decisions are getting made. Um, 75 00:04:42,395 --> 00:04:46,805 like I said, this, this really promotes frontline ownership and leadership, 76 00:04:46,855 --> 00:04:50,085 right? And so you're able to, um, through the, 77 00:04:50,145 --> 00:04:55,005 the different delegates that participate in this, you are able to build a, um, 78 00:04:56,265 --> 00:05:00,845 you know, a, a network or a team, um, that also helps, you know, 79 00:05:01,205 --> 00:05:03,845 identify your leaders of tomorrow. So as they start to, 80 00:05:03,905 --> 00:05:07,725 to to work with other hospitals and bring their ideas to the forefront and then 81 00:05:08,005 --> 00:05:11,725 actually see them get put into action, that's, that's very powerful. 82 00:05:11,985 --> 00:05:16,325 So our system, uh, shared governance team has three different councils. 83 00:05:16,325 --> 00:05:19,485 We have evidence-based practice and research. Um, that's one. 84 00:05:19,485 --> 00:05:23,405 We have a professional practice group, and then we have a, uh, 85 00:05:23,405 --> 00:05:24,925 team that works on, uh, 86 00:05:24,925 --> 00:05:29,645 what we call triple our recruitment recognition and retention. Um, 87 00:05:29,825 --> 00:05:32,005 and, and then these three teams have done so much, 88 00:05:32,055 --> 00:05:36,525 we've seen changes to order sets, um, or processes in our EMR. 89 00:05:37,025 --> 00:05:41,205 Um, we have implemented many different practice changes, um, 90 00:05:41,425 --> 00:05:44,245 all the way from, you know, I, you know, how we, we do a, 91 00:05:44,405 --> 00:05:48,965 a dressing change for a central line to, um, alcohol, 92 00:05:49,305 --> 00:05:54,085 um, order sets, um, for alcohol withdrawal. Um, and, 93 00:05:54,085 --> 00:05:59,045 and probably most our biggest achievement is the implementation of 94 00:05:59,245 --> 00:06:03,245 a clinical ladder, um, which we affectionately called, uh, the PNAP, 95 00:06:03,245 --> 00:06:05,725 and that stands for Professional Nurse Advancement Pathway. 96 00:06:06,515 --> 00:06:11,405 This was literally created by a team of bedside nurses that saw a need for 97 00:06:11,405 --> 00:06:15,525 professional growth, um, but they also saw a need for some sort of incentive. 98 00:06:15,665 --> 00:06:18,605 And so, uh, through a yearly process, um, 99 00:06:18,865 --> 00:06:23,565 our bedside staff can put in a, a package where they have to, uh, 100 00:06:23,565 --> 00:06:27,845 participate in different professional activities from poster presentations to 101 00:06:28,045 --> 00:06:31,165 research, to just, you know, attending your staff meetings and, and committees, 102 00:06:31,185 --> 00:06:35,645 and you build a point profile and they can actually earn up to $4,000 a year, 103 00:06:35,985 --> 00:06:39,965 uh, doing this. And so, um, we just had our second, um, 104 00:06:40,705 --> 00:06:43,845 our second payout is happening this month, and so we're really proud of that. 105 00:06:43,945 --> 00:06:48,165 And, uh, just so many different initiatives we've been able to bring, um, 106 00:06:49,065 --> 00:06:53,485 you know, to, to the level of decision making and change that we're really, um, 107 00:06:53,635 --> 00:06:58,045 organic in growth and, and, and the ideas belong all to our bedside staff. 108 00:06:59,955 --> 00:07:04,165 Yeah, that sounds absolutely amazing. Congratulations on that success. Thanks. 109 00:07:04,465 --> 00:07:08,165 As you know, the clinical workforce has changed a lot in the last few years. 110 00:07:08,795 --> 00:07:10,725 What challenges are you still facing? 111 00:07:11,265 --> 00:07:13,165 How do you see the clinical workforce evolving? 112 00:07:14,315 --> 00:07:17,805 Yeah, it has been a very tumultuous few years, and, you know, 113 00:07:17,805 --> 00:07:20,125 over the course of my 20 years in the profession, 114 00:07:20,685 --> 00:07:24,885 I would say the last three have been the most challenging. And, you know, 115 00:07:24,885 --> 00:07:26,445 for a long time we've been saying, you know, 116 00:07:26,705 --> 00:07:30,365 if there's any constant in healthcare, it's changed. And I don't, 117 00:07:30,605 --> 00:07:35,285 I don't know of any other time where that's been, um, more prevalent in our, 118 00:07:35,905 --> 00:07:40,605 um, in our profession. Y you know, we are in a post pandemic, um, 119 00:07:40,705 --> 00:07:43,445 period, um, c Ovid 19, 120 00:07:43,665 --> 00:07:48,285 and how we took care of patients and how we addressed issues and how we 121 00:07:48,565 --> 00:07:52,685 communicated really everything, um, that, that leaders need to be working on. 122 00:07:53,105 --> 00:07:55,725 Um, the, the pandemic changed everything. 123 00:07:55,985 --> 00:07:59,605 We lost a significant amount of our experienced nurses. Um, 124 00:08:00,805 --> 00:08:03,925 evidence is still unclear as to why that happened, but, uh, 125 00:08:04,165 --> 00:08:08,125 I know our researchers in the profession are working on it, 126 00:08:08,545 --> 00:08:13,125 but opted out, opted out of nursing, opted to go do other things or, you know, 127 00:08:13,225 --> 00:08:17,445 change careers or maybe just, you know, um, not be a nurse anymore. 128 00:08:17,905 --> 00:08:21,485 And we saw a lot of our experienced nurses leave. 129 00:08:22,025 --> 00:08:26,885 And so what, what that did is, um, you know, it, it two things. 130 00:08:27,345 --> 00:08:31,915 Um, it, the wisdom and, uh, that, that, 131 00:08:31,915 --> 00:08:34,995 that you get by being, doing this for many years, um, 132 00:08:35,015 --> 00:08:38,675 is very important as you look at safety and quality of care. 133 00:08:39,175 --> 00:08:42,795 And when you had so many of our experienced nurses, um, 134 00:08:42,795 --> 00:08:45,075 decide to go do other things, you know, 135 00:08:45,075 --> 00:08:48,515 we've been able to catch up with staffing, but our staffing workforce, 136 00:08:48,655 --> 00:08:52,435 our nursing workforce is much, uh, much newer, much younger. 137 00:08:52,605 --> 00:08:57,165 We've seen a significant decrease, um, in years of experience. And, 138 00:08:57,505 --> 00:09:01,325 um, and, and that correlates to average age. Um, and, 139 00:09:01,345 --> 00:09:06,245 and I'm really excited that we have a new, you know, uh, uh, 140 00:09:06,555 --> 00:09:08,285 invigorated nursing workforce. 141 00:09:08,425 --> 00:09:13,005 But I'm also very concerned that our experience level and our 142 00:09:13,125 --> 00:09:17,565 knowledge, um, has, has taken a hit through, through this process. 143 00:09:18,425 --> 00:09:23,285 And so, um, I think that the main challenge that we're facing, 144 00:09:23,705 --> 00:09:24,805 um, as, as, 145 00:09:24,905 --> 00:09:29,565 as nursing leaders and healthcare leaders is how do we equip this very 146 00:09:29,905 --> 00:09:30,965 new, um, 147 00:09:31,905 --> 00:09:36,325 in some cases inexperienced workforce with the tools and the processes 148 00:09:36,825 --> 00:09:41,485 to still achieve safe outcomes for our patients? How do we, 149 00:09:41,825 --> 00:09:44,765 um, achieve that high reliability, um, 150 00:09:44,765 --> 00:09:49,365 organization that most of us are, are, are seeking? Um, 151 00:09:49,665 --> 00:09:54,445 and, and so I, so, so this is evolving day by day. Um, right now, 152 00:09:54,685 --> 00:09:59,565 I, I think the answer is we need to develop job aids, um, for these, um, 153 00:09:59,745 --> 00:10:02,765 nurses and healthcare workers that can, um, 154 00:10:02,795 --> 00:10:06,725 help make sure that you're thinking of everything. So this could be, you know, 155 00:10:06,725 --> 00:10:10,485 best practice advisories and the EMR, um, checklists. 156 00:10:10,525 --> 00:10:14,165 I think there's a lot of room for us to use more checklists in, in healthcare, 157 00:10:14,555 --> 00:10:19,245 much like aviation has done, it really does result in safer outcomes. 158 00:10:19,575 --> 00:10:20,965 We've struggled with that in healthcare. 159 00:10:20,975 --> 00:10:24,685 We've struggled getting checklists to be a part of our day-to-day work. Um, 160 00:10:25,065 --> 00:10:29,045 but most of what we do is evidence-based. 161 00:10:29,135 --> 00:10:32,485 There is good signs behind it. If we would only follow a process, 162 00:10:33,235 --> 00:10:37,605 it's when we deviate from that, when we forget things or we don't notice things, 163 00:10:37,785 --> 00:10:41,005 you know, these small changes in our patient's conditions, um, 164 00:10:41,255 --> 00:10:45,245 might go unnoticed because we might be skipping steps or we might be, um, 165 00:10:45,785 --> 00:10:50,165 you know, focused on something else and not looking at the whole picture. So, 166 00:10:50,385 --> 00:10:54,485 so our plan is to keep evolving our workforce, um, and, 167 00:10:54,485 --> 00:10:58,285 and making sure that we're giving them the right tools, um, 168 00:10:58,755 --> 00:11:03,205 that really doesn't substitute experience and wisdom. We have to rebuild that, 169 00:11:03,825 --> 00:11:07,325 but we still need to keep patients safe. Um, so that's, 170 00:11:07,325 --> 00:11:08,365 that's what we're working on. 171 00:11:09,985 --> 00:11:13,445 Yes, definitely an important thing to work on always, um, 172 00:11:13,445 --> 00:11:16,565 even throughout the year. So thank you so much for sharing that insight. 173 00:11:17,025 --> 00:11:19,765 And Tim, before I let you go, the last thing I wanted to ask you is, 174 00:11:19,995 --> 00:11:23,845 what is your best advice for aspiring physician and nurse leaders? 175 00:11:25,145 --> 00:11:25,765 You know, there, 176 00:11:25,765 --> 00:11:29,045 there's so much opportunity out there for physician and nurse leaders. 177 00:11:29,285 --> 00:11:32,365 I think that, you know, over the years I've, I've, I've learned a lot, 178 00:11:32,385 --> 00:11:36,565 but I continue to be humbled and, uh, every day as I, um, 179 00:11:37,225 --> 00:11:40,205 you know, uh, engage in the team. So I, I, I, I have a, 180 00:11:40,205 --> 00:11:43,325 I do have a couple of pieces of advice here. 181 00:11:43,345 --> 00:11:47,125 So the first one is something I'm still working on every day, and that's to, um, 182 00:11:47,235 --> 00:11:51,085 have a vision. We need to have visions, we need to share it with our teams. 183 00:11:51,745 --> 00:11:56,165 Now our, our visions need to be aligned with that of the organization, 184 00:11:56,305 --> 00:12:01,005 the mission and the values and our leaders, you know, uh, their visions. 185 00:12:01,005 --> 00:12:05,445 But we need to be able to articulate where we're going, um, to our staff and, 186 00:12:05,465 --> 00:12:09,485 and, and to all the folks that report to us, we need to be able to say why. Um, 187 00:12:09,485 --> 00:12:12,165 because people will rally around that. Um, 188 00:12:12,475 --> 00:12:17,205 it's important to have a very well thought out, um, strategic, um, 189 00:12:17,355 --> 00:12:22,205 plan and vision so that, um, you know, provides the roadmap. And then of course, 190 00:12:22,585 --> 00:12:25,645 uh, we may not be working on all the tactics, um, 191 00:12:25,645 --> 00:12:28,245 depending on what level of leadership you're at. Um, 192 00:12:28,465 --> 00:12:31,085 but constantly reinforcing that. So that's number one. 193 00:12:31,085 --> 00:12:36,085 Number two is to place decision making as much as possible with the 194 00:12:36,085 --> 00:12:40,525 frontline caregivers. Um, I will say this is, takes extra work. 195 00:12:40,595 --> 00:12:43,925 It's much easier to make a top down, quick decision. Um, 196 00:12:44,305 --> 00:12:47,045 and engaging more people can lengthen a process. 197 00:12:47,305 --> 00:12:50,565 But every time that I make the decision, um, 198 00:12:50,705 --> 00:12:55,685 to not engage our frontline staff and physicians, it always takes longer, 199 00:12:56,025 --> 00:12:59,765 um, to, to get the buy-in. And it often, um, 200 00:13:00,415 --> 00:13:02,205 fails because, because of just that, 201 00:13:02,205 --> 00:13:05,125 that we didn't rally the right support and get the right advice. 202 00:13:06,105 --> 00:13:10,925 Anyone can be a captain when the cess are calm, right? So I was in the Navy, uh, 203 00:13:10,925 --> 00:13:15,925 many years ago, and when things are going well, um, it's just that, it's, it's, 204 00:13:15,925 --> 00:13:17,085 it's not hard to be a leader. 205 00:13:17,115 --> 00:13:20,805 It's when times get tough or you're faced with adversity where you really gotta 206 00:13:20,835 --> 00:13:22,045 lean in, um, 207 00:13:23,315 --> 00:13:26,645 rely on the vision of your leader and your own vision, um, 208 00:13:26,865 --> 00:13:31,285 and get those frontline leaders, um, engaged and the frontline staff engaged. 209 00:13:31,305 --> 00:13:36,125 And the last piece of advice I'd have is to be obsessed with safety. Um, 210 00:13:36,355 --> 00:13:40,205 sometimes when you see something happen, for instance, patient falls, 211 00:13:40,205 --> 00:13:43,925 when you start to see that happen over and over again, um, 212 00:13:44,425 --> 00:13:48,445 or you know, that we miss counts in the or, or you know, 213 00:13:48,735 --> 00:13:50,925 we're copying pasting in the EMR, all these, 214 00:13:51,615 --> 00:13:56,365 these things that it becomes normalized, right? And so, 215 00:13:56,545 --> 00:14:01,525 so you often kind of accept the fact that patients fall and get injured. And, 216 00:14:01,525 --> 00:14:04,925 and, and I'm not okay with that. I think we need to be obsessed with improving, 217 00:14:05,545 --> 00:14:07,685 um, the safety for our patients. 218 00:14:07,985 --> 00:14:10,885 But that means you gotta pay attention and you gotta talk to people and you 219 00:14:10,885 --> 00:14:13,965 gotta learn, um, where these safety issues are. 220 00:14:14,225 --> 00:14:16,285 So somebody within the organization, 221 00:14:16,285 --> 00:14:20,525 hopefully everybody needs to be obsessed with patient safety, um, 222 00:14:20,625 --> 00:14:22,405 to make sure that it stays in the forefront. 223 00:14:24,695 --> 00:14:26,845 Thank you so much for those final thoughts. Tim. 224 00:14:26,995 --> 00:14:29,485 This has been an amazing discussion. So again, 225 00:14:29,485 --> 00:14:31,685 I wanna thank you so much for coming on Beckers Healthcare, 226 00:14:31,825 --> 00:14:34,165 and I look forward to connecting again with you soon. 227 00:14:34,755 --> 00:14:36,645 Very good. I appreciate the opportunity. 228 00:14:39,915 --> 00:14:43,325 It's so important for leaders at the top of organizations to keep learning, 229 00:14:43,475 --> 00:14:45,125 stay sharp, grow their networks, 230 00:14:45,555 --> 00:14:48,725 help our audience better do this in a more simplified, personalized, 231 00:14:48,745 --> 00:14:52,725 and meaningful way. Becker's Healthcare has launched my BHC, 232 00:14:53,235 --> 00:14:56,245 it's your trusted Becker's healthcare experience and more with content, 233 00:14:56,315 --> 00:14:58,485 connections, events and learning opportunities. 234 00:14:59,195 --> 00:15:04,085 Join the community free of charge@www.my dot becker's hospital 235 00:15:04,085 --> 00:15:05,765 review.com and we'll see you there.