Rounding, May/June 2018

In May, hospitals across the country celebrated Nurses Week and the vital role nurses play in patient care and successful hospital operations. These five Texas hospital CEOs are all proud RNs, who have seen many facets of hospital operations thanks to their nursing backgrounds. Here, they share their perspectives on fostering strong relationships across functions within the hospital.

Rolling Plains Memorial Hospital, Sweetwater

My background as a chief nursing officer was a great position — and perspective — to come from when I moved into my role as hospital administrator. Whether that was understanding ‘the rubber meets the road’-aspects of the business from day one or being able to rely on a level of trust from my clinical and medical staff that my decisions are going to be what’s in the best interest of patient care, I do think it put me in a great position.

do think it's important to spend some one-on-one or small group time in the different units to understand how the clinical staff supports the mission of the hospital. Have a firsthand look at what their day-to-day lives are like because it really does give you a different perspective of the hospital as a whole, from the complicated dynamics of dealing with families under stress or complex clinical situations, to the relations between the clinical staff and the medical staf

It’s impossible to over-emphasize communication. I know our organization is very small but even in a small organization, it’s easy to fall short of communicating everything that you need to communicate. We all have the technical background to be able to do our jobs. It’s the ability to listen, communicate – and then communicate again – what the values of the hospital are and then to embody those values. If you’re going to say that this is what we uphold as our core values, then you need to live it.

Finally, being visible is huge to clinical staff. They really want to know that the CEO is not just someone sitting in an office; it’s someone who’s out in the halls and the units, knows what’s going on and, as much as possible, knows the people who are working there to provide the care. And really, all of that is part of communication.

Hill Country Memorial Hospital, Fredericksburg

I served as chief nursing officer before becom - ing CEO of Hill Country Memorial. I’ve always been proud of my nursing experience and often reference it when I introduce myself professionally.

As we navigate through the transformational challenges in health care today, our clinical staff is addressing many complex situations. My nursing background brings context to my approach around quality measures, patient experience and outcomes. My role as leader is to ensure that we provide an environment that actively encourages every team member to utilize their talents.

I believe those closest to the work are accountable for practice decisions, outcomes and results. If we ask our teams to be accountable for such important work, then we need to make sure they have the systems and structures in place to affect that work. At HCM we have implemented "Whole System Shared Leadership" across the organization.

We have clinical and non-clinical councils with team members represented. Some councils work side by side with community members and several of the executive team are members of the innovation council. The councils have charters and goals and are accountable for outcomes. Councils always come up with a well thought out plan that considers financial viability and the complexities of the work, and builds on their own competence and talents.

A council team may also refer an idea to HCM’s "war room" as a strategic breakthrough initiative. If selected, the idea will be evaluated for one quarter by an assigned war room team to research the project's feasibility and ways to execute. The executive team joins the weekly war room activities for project updates, and to ask and answer questions.

The councils are instrumental as a clinical or non-clinical leader, and the councils are instrumental in helping us accomplish our strategies and financial goals and meet the needs of our patients and our communities, while leveraging the skills of our HCM team.

Our strategic breakthrough initiative and councils contribute to our agility to move forward or pull back when necessary. The councils give me the current context of the work they are doing and what they experience day to day. Through the Shared Leadership System, I am a better leader, able to build trust with our teams and engage them in the larger work of the hospital.

The Hospitals of Providence, El Paso

I think the key is in understanding the workflow of others, no matter what area you work in. For example, if you work in finance, learn more about hospital operations so that you can be a credible source. Spend time with those who are doing the job on the frontlines to build understanding. And it applies both ways, whatever your background is – if you are a nurse, learn more about finance. You can’t go in and automatically think you know about something. You can learn from a junior accountant and take that understanding back to the field. I’ve worked with great CEOs who had no clinical background, but they were open to learning and asking questions. They asked lots of questions to better understand the physiological process of what is happening to patients. And they were able to build trust with clinicians.

Yoakum Community Hospital, Yoakum

Operating a small hospital like Yoakum Community Hospital can be all encompassing, but when it comes to building trust with clinical and non-clinical staff alike, no detail is too small.

I approach every day with lessons learned from my early career in banking on through years as a labor and delivery nurse at YCH. One critical lesson—listen to frontline staff and the challenges they face. As I evolved at YCH into leadership positions then CEO, I carried with me a service orientation so critical for improving communication, building trust and engaging both clinical and non-clinical staff.

Trust is based on the relationships that you create and nurture every day and over time. At YCH, we have 10- to 15-minute morning huddles with staff from each department; everyone is empowered to bring up concerns for the team to discuss, and through this approach, issues are often resolved in real time. I reach out to frontline staff to test ideas because they know what will work. When we literally “round,” it’s not all about the numbers—staffing and census—it’s also about touching base on a personal level. At YCH, we also hold departmental reviews each October in which open forums welcome questions and concerns. By following up with staff afterward, they know they have been heard, making it easy for them to bring forth any issue that arises other times. We also involve clinical managers and department directors in our strategic direction and planning since after all, they are integral to our success.

Memorial Hermann Health System, Houston

There’s no question that my clinical background has helped me immensely in my leadership roles, which is likely a key reason why physicians and nurses now comprise the fastest growing demographic of aspiring health care leaders. Starting my career as an orderly and serving as a scrub tech and a critical care nurse has given me the unique advantage of being able to see the business of health care from a clinician’s point of view and allowed me to more easily understand the concerns and challenges facing providers, which has been tremendously beneficial in this evolving era of health care.

But those without clinical backgrounds can elicit the same level of support and credibility by directly engaging themselves and their teams and making it a point to learn about the work happening at the bedside. I always encourage leaders – especially those coming from strictly administrative roles – to slip on a pair of scrubs and venture out into the hospitals to meet the people who make your organization run. Visit an operating room. Spend time in the physicians’ lounge. Stop by a nurses’ station. Ask questions and really listen to the answers. Leaders who consistently carve out the time to meet with doctors, nurses and other employees demonstrate respect for their employees, which in turn builds a foundation of trust and support. I’m a firm believer that the most effective and influential executives are accountable, respectful, transparent and, most importantly, dedicated to serving others – and these leadership qualities can be fostered and nurtured regardless of your background.