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Becker’s Healthcare Podcast
Leading Nursing at Scale at Memorial Hermann Health System with Bryan Sisk
00:18:05
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit Beckershospitalview.com and click on the events tab in the upper right.
- [00:38]
B
This is Scott Becker with the Becker Healthcare Podcast, Thrilled today to visit with Brian Sisk. Brian's the chief nurse executive at Memorial Herman Health System. Memorial Herman Health System, one of the great health systems in the country. Brian, we're so thrilled to visit with you today. Can you take a moment and introduce yourself and tell the audience a little bit about yourself and about Memorial Herman Health System?
- [01:03]
C
Yeah. I'm so happy to have a conversation today. Yes, I'm Brian Sisk. I'm the chief nurse for the Memorial Herman Health System. I have the privilege of leading nursing practice, workforce strategy and care delivery innovation across our 17 hospital system and our extensive ambulatory footprint here in Southeast Texas. We're a clinically integrated, not for profit system serving an incredibly diverse and fast going region, growing region here in Houston, home to the largest medical center in the world. We're very proud of that. And then I would be remiss if I didn't mention how proud I am of our 9 soon to be 11 magnet designated facilities in our region, which really is a reflection of our team, not just our nursing team, our entire team's dedication to really high quality and delivering on the promise of making nursing a place that's empowering and a place that everybody wants to work.
- [01:59]
B
And how many nurses are there today in the system at Memorial Herman when you've got 17 systems, 17 hospitals.
- [02:06]
C
Yeah. So we have about 14,000 nurses. Now. The funny thing about Houston, most people don't realize this is the state of Delaware fits inside the greater Houston metro. So it's quite a large footprint when you think of it that way.
- [02:21]
B
Well, no. And Houston's a sprawling, sprawling place. And it's fascinating. People used to joke that it's a city that was built without zoning because it sprawls in all kinds of different directions. Directions. And it's a great city, but it is a fascinating city. And talk about sort of when you lead a team of 14,000 people, many people can't even understand how that's possible or how do you go about that. How do you think about leading a team with 14,000 people? And it's probably more than that, because probably in addition to the nurses, you probably have others that work with the nurses. But how do you think about being a chief nurse executive with 14,000 nurses?
- [02:57]
C
Yeah. So I think there are a few things that are incredibly important because you're absolutely right, it's not just about the nurses. It's about our entire care team, from our physicians to our frontline bedside staff, all the way to the ones that are supporting our discharge planning, all the way up to our nursing and C suite leaders. Everybody has to be on the same page. And I think what's important is how do you pull all that together? And especially when you're looking at healthcare today and we're looking at the evolution of our workforce and how that impacts, how do you leverage that differently so that you can truly impact. Zero harm, road to value, quality, safety, high reliability, because all these things are so incredibly intertwined. But doing that with nurses, physicians, nurse leaders, the entire care team like we were talking about, is so critical. And at the same time, those high reliability principles, making sure that we are supporting our staff and navigating such a complex landscape with multiple generations, rising mobility, shifting expectations, flexibility, growth, care models, technology, all the things that come into play. I think what's important is for us is really elevating the voice of nursing, because all these things have to be true in the same space and we have to deliver on all of them at a very high level. And making sure that we're elevating the voice of our nurses and our care teams, that. That really is number one, because that. That's our true north.
- [04:34]
B
Thank you. And talk about this just a few years ago, it seems like we're on the verge of complete meltdown in nursing, which is complete shortages. Million nurses or so retired during COVID It seems like in the nurse education sector, the nurse leadership has done an incredible job of accelerating nurse education. It's imperfect, of course, but we produce about 185,000 nurses a year. We still only produce about 25,000 doctors a year. How is it there's been so much improvement in the education of nursing? And I know there's still shortages, I know there's still shortages in inpatient, but it seems like so much progress has been made in the nursing community, where the progress in accelerating medical training in the doctor community is so slow. And I don't need you to. I don't need you to take a knock at Dr. T.R. Dr. Education is great. It just is not accelerated for 50 years and was developed pre the Internet. How have they done such a good job in the nursing world? And I know it's imperfect and people would complain, oh, we're doing it too quickly or this or that, but there was such a gap and it seems like that gap is being filled far better than it is in some other areas. Any thoughts on that or any thoughts on the improvement in nurse education?
- [05:49]
C
Yeah. First of all, thank you, Scott, for recognizing because I agree with you. We have made such an incredible stride. Sometimes we do get focused on that last 10 miles versus the first 90 we've traveled. Yes, I'm very proud of our team because we've really taken a run at. And one of the things I'm excited about is looking at what does sustainability in the nursing workforce look like. We focus a lot on recruitment, retention, but where I think the real value has really started to show is not necessarily academic partnerships, but academic integrations. How do we look differently at these integrations through some of the things that you're seeing in the industry with shared faculty, more nurse work ready workforce, really challenging ourselves on, you know, making sure that we can transition from a practice environment where I'm an academic nursing student into now I have six patients. That's, that's a, that's an incredible transition we gotta make. And I will tell you, during the period you're talking about, the initial period during COVID when there was a meltdown, up to, you know, 40, 50% of our new grads were leaving the nursing profession. So incredibly proud of our team here at Memorial Hermix. We put so much energy into this space making sure that we are supporting our nurses, that we're wrapping the services around them. We have a 98%, 98% retention rate through the first two years right now. And I'd put that number up against anybody because that is such an amazing number that our team is doing. And so we are seeing those trends reverse. And I may sound like a broken record, but I think the way you get there from here is you got to listen to your frontline staff. You've got to make sure that you're doing the things that are important to them, that the experiences that they're getting. And that has to not just start when they walk in your door, that really has to start in your academic partnerships when they're a nursing student. And that's what we're finding is incredibly valuable. So I think that's one of the key things that you know, Recruitment, retention, those are things that we're always going to talk about, no matter if we're in a nursing shortage or not. But it really is more about how do you make somebody comfortable in the environment when they do take patients? And at the same time, that environment is someplace that they thrive. We've put a lot of energy into that over the last few years as a nursing professional.
- [08:15]
B
Well, thank you. And that movement towards those kinds of retention levels, there's almost nothing more important than. Than maintaining a great institution than that type of retention. It's just very, very hard to do it with people switching in and out all the time to really build the culture that you want to build. I think that's a fantastic thing to be proud of. I'm going to ask you one question. I'm going to start with a very serious question, which is any advice on improving those retention rates and keeping retention rates and what you've done to improve that retention rate that you could share with other systems, other leaders? What advice? And then I'm going to ask you a non serious question that I'll check for a second. Why focus the serious question, which is advice on that kind of retention rate.
- [08:57]
C
Yeah. So I think it really boils down to a couple things. We spend a lot of energy making sure that we are doing the right thing, that looking at how our competencies align with what they're teaching in different nursing programs. We have over 200 academic affiliations here in the greater Houston metro. And so you can see how kind of integrating that. Really, it's a big lift if you take. And I can teach and exercise on the unit the same thing as far as skills and expectations and patient experience. If I can do all of that for two years while I'm a nursing student, transitioning into practice becomes less traumatic. And I think that's what's key. It really is about how do we align differently. You know, we. We went through a phase where you're a nursing school, I'm an organization, the two don't really meet except for clinical placements. And I think what I'm excited about now we're truly looking at what does that experience, what does that transition look like? How do we share competencies, how do we share staff, how do we really work together to do this thing differently so that nurses are ready and feel comfortable? Because I think that's the key. Right. Just because they have the skills doesn't mean that we've done all the things with the time management and everything else. They need to really be independent On a unit. So wrapping those services around them, following them through a transition to practice program, all those things are incredibly important.
- [10:27]
B
Fantastic. Now here is my non serious question. Okay. What people don't realize is because we're on audio as you're listening to this, but I could see Brian on video and Brian is wearing the coolest Memorial Herman vest, like sort of like a Patagonia type vest that you'd ever seen. I don't know what the brand is, but maybe you'll tell us what the brand is. But how do people get those cool vest that, that you are wearing? Because that is really cool, the Memorial Herman vest.
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C
So I don't know where the vest came from and I appreciate you acknowledging that, but this is from our Memorial Herman Institute for Nursing Excellence. So one of the things that we have done over the last few years is put together a simulation center. That's more than a simulation center, it really is. How do we support our nurses through all stages of their career, People, process and technology they've been a big part of. And we had over 150 nurses publish or present last year, which we're very, very proud of. At the same time developing some really forward thinking virtual training. So with our Oxford Medical Solution partner and looking at how do we, instead of getting out of a classroom environment, how do we put them in a virtual environment and kind of wrap all this together as we transition into practice. So yeah, comes from our nursing institute. Again, a team that I'm super, super, incredibly proud of.
- [11:53]
B
So let me ask you the next question. 14,000 nurses. I know I touched this a little bit earlier. You obviously can't have 14,000 direct reports. Nor would you want to. Nor would they want to. How do you deal with managing culture in a large organization? And just as you do your job as chief nursing executive, people talk about this concept of spans, meaning how many people can one directly manage? And that doesn't mean you can't as a scale, an organization manage 14,000, but directly. You know, they always say that the span is, you know, five to 10 people that maybe are direct reports to you or maybe more. I don't know what that is, but what does that look like and how do you think and how does it grow into the leadership? And obviously you ran a division like this at HCA for some time. That was a huge division. So it's not new to you at this point at all. But how do you think about managing 14,000 people and building the right culture? And how do you think about how many direct reports that any leader you could use usually as an example, but any leader can actually really work closely with.
- [12:55]
C
Yeah. So I will tell you this is something that in nursing as a profession we're evolving. We have had large spans of control at our nurse manager level. And what we have seen over the years is as individuals are wanting more flexibility in their workplace, working more part time hours, which we certainly support. But what happens is where I probably in the past had 40 nurses on my units, I might have 80 now. And so the strain that puts on our managers. So we're still evolving and thinking a lot about how do we support them differently, remove administrative burden. Because the most important thing is that they're available to be, be there for their frontline staff. We know that's, that's incredibly important. But I will say, how do you manage a footprint? I have the best chief nurse officers in the industry. I'd put them up against anybody. I am proud of that team. Our from our top, you know, from our president all the way down. We share a shared set of values, shared mission, vision. Values is not just on a piece of paper. We live it every day. And when we look at creating healthier communities now and for generations to come, all being centered around how do we pull together to do that. And I'll tell you what's what I love about what we're doing that is unique is we're committed to our community differently from many organizations that I have been a part of. And you take a look at our Hill High School, we are partnered with Aldine Independent School District. And to have a operational partner like Memorial Herman partnered with an independent school district supported by Bloomberg Philanthropy through our Memorial Herman Foundation. All that coming together where we're actively working daily in a high school with we have 190 in the 9th grade, 145 in the 10th grade. When we have the full high school, we'll have about 750 to 800 kids. All these kids are working towards entry into healthcare as a career. From LVNs to physical therapists to pharmacy to administration to imaging. And our commitment is we're treating these guys today at 14 like they're our employees. Mentoring them, making sure that they have relevant job experience. And then ultimately when they get into the right now they're in 9th and 10th grade, they're going to go to the 11th grade. Next year they'll actually transition into apprenticeships, internships where they're getting real on the job experience. So they'll have that opportunity for two years before they transition into the Workforce, we're more than happy to have them. That's the idea, right, is transition them into the workforce. But what a better way to kind of wrap up. When you take a look at how do you maintain your culture, how do you look at a span of control of 14,000 having that shared mission, vision, values, deep trust, high expectations, living that every day and really pulling towards some of these things like a high school or some of what we're doing in our new grad transition equal, equally proud of what we're doing on just retaining our nurses overall. That's where it comes down to our chief nurse officers, our CEOs, our C suites here at the, at the system level, everybody really pulling together to make sure that we're doing the right thing.
- [16:28]
B
Brian, it's literally a magnificent career. You went back and did a Master's of Public health now about 20 years ago. How important was that to your leadership development? And would you recommend that for others?
- [16:40]
C
So I would. And I will tell you, at that point in time I was still active duty military and you know, I had the do I go and stay in the masters of nursing lane? Do I go into something that is more geared towards public health? I am so happy that I chose the public health because it really gave me views into how does health policy get generated from legislative bodies? How do you take that, turn that into a budget on larger scales? So yeah, so it was incredibly valuable. Valuable for me also had the opportunity to Texas A and M here in Texas. So what, what better could that be, right? But yeah, so it's. For me it was, it was an opportunity to grow, but then actually went and got my doctorate in nursing to make sure that I, you know, had everything buttoned up in the nursing profession too.
- [17:31]
B
Fantastic, Brian, what a magnificent career. I want to thank you for joining us on the Beckers Healthcare podcast today. I would ask you if you have any advice for Arch Manning at Texas A and M. But he's at Texas. He's at University of Texas. Correct.
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C
Not.
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B
Not A and M.
- [17:49]
C
Yeah, I got nothing for him. Huh?
- [17:51]
B
Nothing to help there. But I want to thank you for joining us on the Becker's Healthcare podcast. What a remarkable system Memorial Herman is. And what a pleasure to visit with you today. Thank you for joining us today.
- [18:02]
C
Thank you so much.