— Nancy Blake, Ph.D., RN, chief nursing officer of Los Angeles General Medical Center
No one is more skilled at personalization than a nurse.
Nurses are the highly trained masters of individual care. They have to see and notice and respond and act—meeting each patient’s unique needs in the moment.
Who better to learn from?
This is article 10 in a 14-part weekly series, in which I am sharing insights from the 2024 Healthcare in the Age of Personalization Summit. We heard from a wide range of healthcare experts—leaders spanning all facets of healthcare organizations from the boardroom and C-suite to the patient’s bedside. We covered topics such as why personalization is important, how we can shape our organizational cultures to facilitate it, how to inject personalization into your employer brand, why better care requires honoring individuality, and how industry incentives work against personalization[KP1] .
In this article I’ll share highlights from the panel discussion about what nursing can teach physicians and CEOs about how to lead in personalization.
Panelists included:
- Nancy Blake, Ph.D., RN, chief nursing officer, Los Angeles General Medical Center
- Rebekah Marsh, BSN, RN, clinical nurse educator, Harborview Medical Center, UW Medicine
- Anthony Betz, business manager, nursing operations, Wellstar Health System
Anthony Betz shared a story that gives us several clues about what nursing can teach the rest of us.
He said one of the facilities in the Wellstar Health System created a virtual nursing platform, thanks to the nurses themselves.
“It was started by unit nurses who saw there was a need for personalized care,” he said. “We know that demand is going up and there’s not as many nurses, and they saw that they were losing time with their patients. So they came up with this idea [for a virtual nursing platform] and they partnered with senior leaders.”
He had the opportunity to go and see it in action, while a patient talked with a nurse virtually.
“After the virtual nurse was finished going over some medication information with the patient, the patient looked over to me and a few others in the room, and said, ‘That was amazing. I’ve never spent that much time talking to a nurse before.’”
It was a win for the patient, and also a win for the nurses.
As a result, “unit nurses can spend more time with their higher acuity patients,” said Betz. “They recognized there was a need for that. The patients feel they’re able to be seen more.”
It also creates opportunity for nurses who need more flexibility in their work schedule.
“So far with our pilot program, the participating nurses are those who can’t work a standard hospital shift,” he said. “It creates an opportunity where they can still practice their craft and do what they love, while assisting the team in general.”
As Rebekah Marsh pointed out, this story gives us so many great examples of what nursing can teach CEOs and other leaders about how to both practice and deploy personalization.
“I just think that that’s a wonderful blend of using technology to create personalization, and I love that the nurses were involved from the beginning,” said Marsh. “I think that that’s where the real magic happens is when the frontline staff at every level of practice are involved.”
Lesson 1 – Listen To and Act On Other People’s Ideas
Sometimes leaders get hung up on thinking they need to be the ones to have the ideas.
But Betz said, “I believe that as leaders, we can approach our team members throughout our organizations and find those ideas and create that personalization that’s so desperately needed.”
Dr. Nancy Blake has been a nurse for 44 years and has a Ph.D. in nursing. She agrees that people have ideas and they want those ideas heard. She said too often new leaders come into a new job and feel like they have to show they’re confident and show they’re in charge. But she had some advice.
“New leaders should go on a listening tour,” said Dr. Blake. “You find out what the staff needs and then you plan. I think CEOs try and come in and be in charge because they believe that that’s what they need to do. [Employees] want professional development, they want a healthy work environment. They want some control over their schedule and their professional life. They have good ideas. I need to listen to their ideas, and I need to take risks and do things that are different. If we don’t listen to them, they will walk out and go somewhere else. Some of the things that you’re driving [as a leader], should be their ideas, not your ideas.”
To that end, Marsh said she likes to see her leadership role more as a facilitator. “I define myself as a facilitator of change. As many people as I can involve in that change, it helps me feel more successful and I think brings other people along with me.”
Lesson 2 – Collaborate Before Making Decisions
Marsh talked about the tendency of nurses to collaborate.
“When I walk out into my inpatient units, I always see nurses at the nurse’s station collaborating,” she said. “The minute that a nurse has a question, they immediately involve their team before they start formulating their own individual plan.”
This is a habit that might help leaders get out of the mindset Dr. Blake described, the one in which leaders think they have to come up with answers themselves.
“I work in an academic facility where we train new resident physicians,” said Marsh. “I see the new resident physicians under a lot of pressure to make independent decisions and to form care plans. And their second or third step might be to ask for help. But I learned that nursing is a safe space in a difficult healthcare environment, because of that true collaboration.”
It’s not perfect, though.
“I think where nursing loses the thread,” said Marsh, “is that we don’t collaborate well across levels of organizational authority and we don’t always get that collaboration with our physician providers. But at the base, we are really, really good at not making decisions until we’ve gotten second and third opinions.”
Betz agreed as well.
“There’s a lot of transition that happens, so you have new leaders coming in all the time,” said Betz. “The most effective leaders are the ones who are taking the time to get to know the people. Healthcare is so collaborative. You have to have those relationships. And if it’s just a surface level thing, when times get difficult, you’re going to have a hard time driving change and acting quickly.”
Lesson 3 – Cultivate and Celebrate Champions
Marsh acknowledged that we tend to place a lot of value on leaders who make decisions, but that first follower is also so important for a true change initiative to take off.
“We need someone who believes in the initiative enough to do the work and to do it publicly,” said Marsh. “Celebrating champions is a wonderful way of celebrating the change without taking all the glory. As many champions as you can find, celebrate the good work. I think there’s so much frustration in healthcare right now, and this is the kind of recognition that people are really looking for. You see me taking extra steps to do this thing, you recognize me for doing the right thing, you recognize me for championing change. That’s what leaders can do to help people feel engaged and excited about the difficult work we have ahead of us.”
Dr. Blake shared one way her team is getting champions.
“We’ve been very successful in the last three years in improving our patient outcomes because we’ve had unit champions that are driving it, but they’ve also had an empathetic ear,” said Dr. Blake. “We have an interesting model in which we have an administrator, a physician leader, and a nurse leader who are a triad who work together, and they round weekly on the unit and talk to the staff about any issues.”
She said they listen and try and fix the problems. Staff are empowered to speak up, because they see that when they do, things happen.
“When you listen, and they see that you actually fix the problem or address the issue, they’re more apt to speak up,” said Dr. Blake. “Your priorities should be getting your team to work together and getting them to understand you win as a team and you lose as a team. Patient care should be team centric and it should be focused on the patient, not the physician, not the nurse. You should be focused on the patient needs as a team.”
Marsh offered some perspective that reminded us why we need each other so much—doctors need nurses, nurses need doctors, everyone in healthcare needs everyone else.
“Think about the first care providers in human history,” said Marsh. “I can’t imagine that it was a doctor and a nurse. It was one person. I think about the specialization that has happened in healthcare, including the development of complete professions like nursing and physician professions. Those are wonderful professions, but they’re very specialized. I think that both the nurse and the physician are missing something in forming the plan of care in our silos.”
We think of decision making for the plan of care as the realm of the physician. We think of patient perspective and advocacy as the domain of the nurse.
“People get really upset when you say doctors aren’t advocates and nurses don’t participate in care planning,” said Marsh. “We totally overlap, it’s a spectrum. When we know that we overlap in that spectrum, we can’t be making decisions without each other. If I could make one recommendation about how to advance the conversation, it’s this: go in person and talk to someone. Have an in-person conversation.”
Lesson 4 – Be Accessible, Go In Person
Speaking of in-person interactions, Betz emphasized the importance of interaction between administrators and care providers.
“Early in my education, I had a lot of opportunities to shadow physicians and nurses,” said Betz, “and I started asking people, ‘When was the last time you saw your administrator?’ I was surprised at how often [their answer would be], ‘I can’t remember the last time they were here.’ That’s really stuck with me. Working with the nursing department now, I’ve been so impressed with how rounding and talking with the team members is such an important part of nursing leadership.”
CEOs, take note.
“I believe that CEOs, physicians, anyone in healthcare, could benefit from following rounding practices as well, to touch the business,” he said. “At Wellstar, it’s well-known that our CEO, who’s a nurse by trade, still goes on rounds and will even go onto units and work with nurses alongside them to touch the business. And I think that’s critical for us to do.”
Watch this short video for more from the panel.
Next time: patient experience, safety, quality and equity in the age of personalization
