MODERN HEALTHCARE: Hey, Kathy. How are you doing?
KATHLEEN SANFORD: I’m rather well right now, Kadesha. How are you?
MODERN HEALTHCARE: I’m good. Thanks a lot for making time.
So, we began this dialog in the course of the Fashionable Healthcare Girls Leaders Convention. You talked about that you simply had been in the midst of strategic planning. I needed to have you ever on this podcast to listen to the way you’re approaching strategic planning, particularly for the nursing scarcity that has been looming for a very long time. I need to begin with three information factors after which we’ll get into the questions.
The primary is that greater than 500,000 seasoned RNs are anticipated to retire in 2022. Which means not less than 1.1 million new RNs are predicted to be wanted to increase the workforce, exchange the retirees, and keep away from a nursing scarcity. The following information level is that by 2030, the variety of US residents aged 65 and over is projected to rise to 82 million — resulting in an elevated want for geriatric care and look after folks with power situations and comorbidities. After which the final level is {that a} examine of COVID-19’s impression on nurses reveals that over half of nurses felt exhausted in the course of the pandemic — and that’s in all probability an understatement. And almost 30% have expressed a need to give up.
I don’t assume any of that information surprises you; I do need to understand how you propose for it. So, let’s begin with simply your private nursing expertise. How did you transition from direct affected person care to the technique facet of nursing?
KATHLEEN SANFORD: I started my nursing profession in a distinct place than lots of my colleagues. I used to be what was known as a Walter Reed Military Institute of Nursing Scholarship recipient. And so, discovered all of my nursing training on taking good care of sufferers similtaneously I used to be studying how one can be an officer. That’s one thing that the Military does. And I wouldn’t say that I used to be notably strategic as a military officer. I used to be a head nurse, however I used to be taking good care of sufferers. It was once I left lively responsibility that I found that if you go right into a administration place, it’s worthwhile to not solely assume tactically — it’s worthwhile to assume strategically about the way you’re going to get issues performed.
And one of many issues that I found early on was that I had issue speaking to my finance colleagues and a few of my NHA colleagues as a result of they talked in numbers. Finance colleagues had issue understanding what I used to be speaking about: sufferers and high quality and expertise. There gave the impression to be a language barrier. I spotted that it could in all probability not occur that my finance colleagues would return to highschool to be taught the medical world. So, I made a decision I wanted to return to highschool to be taught the administration world. Now, I already had a Bachelor’s and a Grasp’s that the Military paid for once I was on lively responsibility. So, what I did was return and get an MBA. Now, that’s not an actual massive deal today. However again once I did it, there have been only a few nurses in enterprise faculty. So, I discovered there and among the courses that you’ve got are about, in fact, technique in addition to finance.
So, I discovered that and was in a position to perceive that I actually do get pleasure from management and administration positions. And the one manner that you’re going to make adjustments which are wanted for the great of sufferers and society, is when you’ve got a bit of place energy. And also you get that by turning into a supervisor or a frontrunner after which serving to different folks develop into managers and leaders — even when they do need to keep on the bedside. So, that’s how I made a decision to get into studying about technique. I went about it in a really organized manner: Get the training, get the understanding of the phrases, with the intention to talk with these people who find themselves planning technique for the group.
MODERN HEALTHCARE: Your direct affected person care expertise and your nursing expertise simply provides an extra layer that’s in all probability not current at these tables fairly often. What would you say has modified probably the most about strategic planning for nursing over the course of the pandemic? What do healthcare leaders have to consider now that perhaps they didn’t have to consider a lot earlier than?
KATHLEEN SANFORD: I believe one of many largest issues that got here out of this pandemic was a much bigger understanding from folks concerning the worth of nurses. Now, I don’t assume we didn’t worth nurses, however I don’t assume that we understood how very priceless they’re in all elements of healthcare. And one of many massive “ahas” for me is after we began having shortages attributable to the truth that we had so many COVID sufferers. And we had been attempting to determine how we had been going to maintain them in crucial care. If we didn’t have sufficient crucial care nurses, might we ship in surg nurses there? Might we ship workplace nurses there, and many others.? It was astonishing to me how many individuals who I had labored with for years throughout the complete nation, didn’t perceive {that a} nurse just isn’t a nurse just isn’t a nurse. They really didn’t perceive that you simply couldn’t simply take a nurse who had been in an workplace for 20 years and have them actually have the ability to perform utterly, both on a med surg unit or in crucial care.
Sure, nurses have a fundamental training and have the fundamental understanding of nursing care. However nursing through the years, identical to drugs, has develop into increasingly specialised. And so one of many issues that we now have to consider now that I don’t assume we thought of fairly as a lot earlier than is the truth that nurses are specialists. And as we have a look at nursing shortages, we are able to’t simply be speaking about nursing shortages basically. We should be speaking about the place are we going to wish these folks sooner or later? What sort of abilities are they going to wish? What specialties do we have to put together them for? As a result of we perceive that healthcare goes to be altering, too.
The second factor that got here out of the pandemic is, we’re doing a greater job eager about the well being and wellbeing of our employees than we’ve performed earlier than. It’s not like burnout is new. I’ve been in nursing because the Seventies. I additionally acquire literature from years earlier than I had been in nursing, and burnout was one thing nurses had been speaking about many years in the past. And I keep in mind the early analysis in it. It wasn’t about working laborious, it wasn’t a few job the place you ran on a regular basis — which we did and we nonetheless do — nurses nonetheless do. It was about lack of energy, lack of management over your life, your work life, and what was occurring. And that was what was resulting in burnout. In truth, that’s the way it was described within the ‘70s. It’s an absence of management. And so they stated that’s why the nurse execs are much less burned out than the entrance employees nurses as a result of we had extra management — over our time and what’s occurring.
Watching others speaking about burnout — I checked out that and had some conversations with them and what got here out loud and clear was I now not have management over my time. There’s productiveness, what number of sufferers I’ve to see, how rapidly I’ve to see them. I now not can management issues like I used to have the ability to management issues. There are folks attempting to inform me how one can apply drugs. Wow! This is rather like what nursing has gone by way of for years and years, and so now we’re having burnout with different folks. So, after we speak about burnout, it’s not about working laborious — it’s about lack of management.
And one of many issues that the pandemic has brought about is extra lack of management due to the variety of sufferers coming in, and also you needed to cope with so many belongings you hadn’t needed to cope with. So, we have to have a look at it in a different way. We should always have at all times been eager about it. It’s not solely the bodily well being of the individuals who maintain our sufferers and our purchasers and our households, however their psychological well being, wellbeing. And we’re going to have to consider that endlessly into the long run. And proper now attributable to COVID, we’re going to have to consider it a bit of bit in a different way.
And having been a navy nurse — by the point I did my lively responsibility after which my Reserves and Nationwide Guard, I’d put in 34 years with the navy. So, I’ve lots of understanding of PTSD. What we’re going to see within the subsequent few years goes to be much like that PTSD, and we’re going to have to consider that in new and alternative ways — and the way we as leaders are going to assist all of our employees. I do know we’re speaking nursing proper now, however it’s all of our employees — notably these on the entrance strains — cope with the feelings which are going to be hanging on for fairly some time.
MODERN HEALTHCARE: Completely. How do you even begin the method of strategic planning, then? So, you’re eager about the necessity for nursing specialists, you’re eager about the necessity for giving nurses extra management, you’re eager about the scarcity. So, if you happen to needed to provide you with a step-by-step course of for how one can strategically plan round nurses — particularly with this scarcity — what would you intention for and what steps would you embrace?
KATHLEEN SANFORD: Properly that’s an ideal query as a result of I did must and we’re! We began earlier than COVID.
MODERN HEALTHCARE: Proper.
KATHLEEN SANFORD: We began our strategic planning earlier than COVID, simply trying on the analysis about why nurses keep in nursing. What’s going to occur with the inhabitants going ahead, and many others.? So, COVID has exacerbated it, however we began earlier than COVID. In truth, the final giant assembly we had of our employees was our Chief Nursing Officers from throughout the system coming collectively to start our strategic plan. And that was in November earlier than we had heard about COVID in January.
It doesn’t matter whether or not you might be beginning it now otherwise you began it earlier than COVID — that is the way in which that we have a look at it. Initially, we consider, and I consider, that you simply have a look at analysis first. Just be sure you have appeared on the analysis of what the difficulty is true now as we’re trying on the future — there’s analysis about what we predict goes to occur sooner or later, however what does the analysis say about why folks stick with you? Or why folks depart you figuring out that this scarcity has come and gone over a few years? And it was foretold for a very long time, that we wouldn’t have sufficient nurses on this period.
So, you have a look at your analysis, and your analysis contains your employees satisfaction scores, how your hygiene vs. your motivational components are. In administration 101, we studied a psychologist named Frederick Herzberg. And he talked concerning the Two Issue Concept about what it’s that truly motivates folks, what makes folks stick with you, and what makes folks depart you. And I’m at all times amused once I go someplace and persons are speaking about, “That is what makes nurses depart, that is what makes docs depart.” It’s all the identical — it’s all the identical principle. There are issues that you must have in any job that may maintain folks from being unhappy. However you must produce other issues that make them happy! So, only a reminder, as a result of if you have a look at the analysis, it talks about relationships with the employees — the remainder of the employees, relationships with their bosses, their workload. And it talks about worth of the work they’re doing — whether or not they really feel valued, and whether or not they assume the work they’re doing is valued. And it talks about having a voice, and that goes again to the burnout half. In the event you don’t have a voice, you get burned out since you don’t have any management.
Again to nurses once more. On this analysis, you’d be taking a look at working situations, wage advantages, insurance policies, and how one can get together with co-workers. In the event you don’t have these, you’re unhappy. But when we would like them to remain and to be glad, and to be fulfilled of their jobs — which we do — then you must have a look at motivators that are, they should really feel like they’ve achievement, that they love the job itself, that they get recognition, they usually have an opportunity to develop. So, that’s the analysis half that primary, you’ve bought to do your analysis first. You don’t simply begin doing technique with out some analysis.
I’m fairly simplistic about technique. I took a bit of break from being a chief nurse for some time — spent two years working in a technique division for a system and discovered about it. And I’m fairly simplistic and that’s, you’ve got a imaginative and prescient of what you need to be, what you need your group to be. And with that imaginative and prescient, you provide you with objectives that may get you to that imaginative and prescient. After which you determine the place you might be proper now, after which you determine a plan how one can get from the place you might be proper now to the place you are going to go. I don’t assume technique is an enormous thriller. It’s the place do you need to go? The place are you now? And the way you’ll get there over a sure period of time?
We began out ensuring that we had been going to contain everyone — as a result of keep in mind, I stated the motivator is to have a voice. Properly, we now have 45,000 nurses. How do 45,000 nurses have a voice? So, we began out — determining how we had been going to provide folks a voice in strategic planning. It may’t be one thing that Kathy Sanford, or Kathy Sanford and the opposite chief nurses sit round and resolve. Lots of people must be concerned. So, we got here up with a imaginative and prescient, and we spent virtually a 12 months — throughout COVID — arising with a imaginative and prescient and nonetheless bought 16% of our nurses concerned in placing that imaginative and prescient collectively.
And ultimately, gave each nurse the chance to vote on what could be, of what we’d be 5 years from now. And with that imaginative and prescient — primarily based on the analysis we’d performed and primarily based on what the employees had advised us — we got here up, then, with a particular aim. And I’m going to let you know what ours is as a result of there isn’t a secret about it: Grow to be the employer of selection for nurses and the complete care workforce in a system that’s well known for excellent care and repair. That’s ours. Different folks have completely different objectives.
I truly spoke to a different system lately who had requested me to come back and speak about strategic planning and I got here on to their name — it was a Zoom name — and a bit of sooner than they knew I used to be there. And so they had been saying, “We’re gonna be primary. All people’s gonna need to work for us.” Once they launched me, I stated OK, I heard what you all stated and you recognize what? I like it that you really want that, as a result of if all of us did that, we’d have the ability to make a greater healthcare system for the complete nation. And we might have the ability to take higher care of the folks we maintain and the communities we maintain. However simply keep in mind, we at CommonSpirit are going to provide you a run in your cash. And I hope that everyone else does, too.
After we had been trying on the hole after we had provide you with the aim and the imaginative and prescient, we arrange teams to handle completely different ways that we thought might get us there. We’re nonetheless in the midst of that as a result of as I stated, we now have been fairly busy with COVID and employees nurses are tough to liberate. If that is going to contain folks, issues shouldn’t be performed to folks. They need to have an element and a voice, they usually greatest know what would work or what wouldn’t work.
MODERN HEALTHCARE: That’s proper.
KATHLEEN SANFORD: So, that’s primary. We’re placing collectively completely different teams — even when a few of them are committees to provide you with options — after which different bigger centered teams to say, did what we provide you with make sense? Is that this going that will help you? After which you must prioritize all the completely different objectives, all the completely different ways that you simply’re going to make use of to get to the technique as a result of you’ll be able to’t do all of it. It will be an excessive amount of change at one time, they usually must be funded they usually must be critiqued. So, you’ll be able to’t do all of it. It’s a must to prioritize it, after which you must say proper up entrance — what are we going to do to appropriate our technique if the world adjustments remarkably and if we discover out that we had been mistaken? So, proper up entrance in our plan, provide you with what are we going to do to vary if the objectives aren’t actually the suitable objectives for the long run? Virtually a system of what it’s worthwhile to do if you happen to’re actually going to make significant change.
MODERN HEALTHCARE: That was like an MBA in 5 minutes. So, let’s say you’re on the level the place you’ve got your want listing of what your objectives are, you’ve got your mission clarified, and also you’re at that time the place you might be prioritizing and also you’re deciding the way you’re going to course appropriate. Who needs to be on the desk throughout these discussions? Who needs to be concerned in these strategic conversations? You’ve already stated nurses ought to completely have a voice, however who else within the well being system ought to have a voice?
KATHLEEN SANFORD: I additionally imply the entrance line managers, the center managers, the chief nursing execs, the system execs — I believe all sorts of nurses needs to be concerned. And one group that will get missed so much is your evening supervisor. Whoever thinks to ask the evening supervisor something? I’ve been an evening supervisor and let me let you know — they arrive to work with inconceivable odds. Not sufficient employees, emergency rooms full, employees calling in sick, and many others., and in some way they get us by way of to the morning with all the pieces turning out all proper. So, it’s worthwhile to take into consideration all of these folks together with the nurses that you simply don’t keep in mind.
However you additionally want to speak about different workforce members since you want a number of tables, a number of focus teams — as a result of nursing just isn’t a single-person sport, it’s a workforce sport. Pharmacists, your respiratory therapists, and your OTs, and your dieticians, and, in fact, your doctor companions. And I can undergo the entire listing. So, despite the fact that it’s nursing, I’m not a nurse chauvinist, and I consider that that is all performed collectively. And make certain that you haven’t forgotten the one group that we regularly do and that’s the folks we maintain themselves!
MODERN HEALTHCARE: Completely.
KATHLEEN SANFORD: What we now have at CommonSpirit Well being are known as P details, affected person and household teams that advise us about how issues are working for them, how they don’t seem to be working, how they might work. And so it’s essential to contain them as properly. What do you see as a ache level as a affected person who involves us or somebody who’s getting a service from us? What do you see as a ache level and even if you happen to don’t know, what do you assume may be the factor that may resolve it? So, you must contain them, too.
It’s not a quite simple factor to do a nursing technique as a result of so many individuals are invested in what nursing does. And nursing is so invested in what all the remainder of these folks do as properly. So, throughout that just about two years that I took out and labored for technique, I used to be the particular person on the technique workforce that was despatched out to speak to the Lions Membership, the Rotary Membership, all of the completely different golf equipment, and ask folks what they needed and it was very attention-grabbing as a result of it wasn’t at all times what we thought.
MODERN HEALTHCARE: That’s proper.
KATHLEEN SANFORD: It’s an enormous desk however what it truly is, is a number of small tables being coordinated.
MODERN HEALTHCARE: I’m so glad you stated that as a result of the nursing expertise truly form of makes or breaks the affected person expertise.
KATHLEEN SANFORD: I at all times say that one of many points that we now have in administration: We keep away from, typically, issues that give us acute ache on the threat of power ache. “Oh, we now have to make this alteration, it’s simply going to trigger all this hassle. It’s going to be an issue, perhaps we shouldn’t do it.” And so we stick with power ache for years and years and years — and don’t repair it.
OUTRO COMMENTS: Thanks, Kathy Sanford, for that perception on strategic planning for the nursing scarcity. Earlier than the pandemic and now, strategic planning for nursing is a crucial facet of maintaining our healthcare system afloat, and we’ll proceed with half 2 of this dialog within the subsequent episode.
Once more, I’m your host, Kadesha Smith, CEO of CareContent. We assist well being methods attain their goal audiences by way of digital advertising and marketing that focuses on the suitable content material.
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