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Becker’s Healthcare Podcast
Shaping Nursing Excellence Across UF Health with Dr. Janice Walker
00:20:25
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:32]
B
Hello everyone, and welcome to the Becker's Healthcare Podcast. I'm Mackenzie Bean, Associate Vice President and Managing Editor of Becker's Hospital Review. Today I'm so, so excited to be joined on the podcast by Dr. Janice Walker, who recently became the inaugural Chief Nursing Officer of UF Health. Dr. Walker, thank you so much for joining us on the podcast. I'd love to turn it over to you to introduce yourself and tell us a little bit more about your background.
- [01:01]
C
So thank you. Mackenzie, thank you for the opportunity to speak to you this morning, as well as all my colleagues that I know will eventually listen because I listen to theirs and I learn things every single time across Becker's world when I listen to other system chief nurses, other healthcare executive leads. So, so blessed to be in front of you today.
- [01:25]
B
We are lucky to have you on the podcast and I'm glad that you've been enjoying the episodes. So I know I believe you stepped into your new role January 19, is that correct?
- [01:35]
C
That's correct.
- [01:37]
B
Congratulations. So talk to you about a month and a half in, you know, excited to hear about everything and how it's going. But before then, can you share just a little bit more about your career and you know, where you've come from and what you've done before joining UF Health?
- [01:51]
C
Absolutely. So I have led and very blessed to lead large complex healthcare systems period of time where I probably understood what systemness really was. As we continued to grow when I was at Baylor Scott and Wide Health as the largest not for profit in Texas, I would say to you that's where as we were flying the plane, we were building it to understand the beauty and the scale you can create as well as on quality outcomes that bigger is better in terms of driving quality and outcomes. So as the as the system chief nurse at Baylor Scott and White as well as during the pandemic, systemness just became very natural to me. So when the opportunity presented itself to to come to UF Health, who also has given interviews and articles related to transforming to an integrated healthcare system, I knew the fit and I was very hopeful that the fit was perfect. And then when I learned it was an inaugural role, what an additional blessing to build it from the ground up. So I have 12 hospitals currently with more coming on board. And for the last six weeks I've devoted my time to getting to know those hospitals. By the end of this week, I'll have rounded in every single one. Mackenzie I learned early in my career I can't lead you if I don't know you. And so therefore and I can't support you if I don't know you and know exactly where you are. So I've traveled all over the state of Florida getting to know my new hospitals, my new clinic settings, my new transfer center, and all the support that goes with them.
- [03:48]
B
I think those types of listening tours are so, so crucial as you're jumping into the role. And it sounds like your expertise and systemness is really just so complementary to a lot of the work that's been going on at UF Health. I know there's been that focus on unifying under academic operating model. As you said, you'll be very focused on aligning the nursing infrastructure across the system in the inaugural role. Let's go a little bit deeper there. What does a truly integrated nursing strategy look like in practice? What are you focusing on and how are you planning to balance standardization with maybe the needs of regional markets or specific hospitals across the state?
- [04:30]
C
That is a great question. As I'm meeting people out and about, I ask many of them, have you ever worked in a health care system that had a system chief nurse? And I probably get only 20% of hands raised. So it's new for them to understand where the balances of my role as well as the entity and the regional chief nurses. So I would say that I describe it to them very much like I'm going to describe it to you. I'm here to represent nursing at the highest level of visibility at the UF Health System, that is at the president of our entity organizations table, Dr. Steven Motu. So when they realize that I am their voice as well as their balance measure of driving quality outcomes, then they start to embrace why we needed one. When you start to grow and become more complex with some academic hospitals, some that are not, and adding more hospitals, you understand that systemness drives quality outcomes. So an example might be we're working too hard to create individual policies when truly the best practice is found somewhere in the industry. And that's the policy we would like to adopt, not having 12 different versions of it. Same things with Protocols to prevent harm. Same things with nursing professional development. What do the plans look like? What do the succession plans and advancement of your degrees look like? How do we celebrate them together? How do we have standardization? So the list is endless, related to systemness. And it's such exciting work. And I truly think I was born to do that complexity work and support them. I'm very cautious to describe to them that it's not about losing your own entity identity. Even at Baylor and other healthcare systems I've worked at, you still retain your own community identity, but that doesn't mean that you don't have to work as hard with creating standardization of compliance policies, standardization with regulatory policies. So let's work smarter together so we can continue to care for our communities. And once you describe to them what a system chief nurse really does, then they understand why. Now they understand the purposeful work. And I tell them all along the way, you'll be part of identifying the variation as well as prioritizing which piece of the variation we're going to go after first, as well as how we're doing on removing that variation. So, you know, as long as they understand you are part of the integration, this is something we're going to do together. We're not going to make decisions about nursing practice without nurses at the table. Then they understand the why.
- [07:51]
B
It sounds like that work up front on the education and the communication and that very collaborative approach is so crucial to ensuring this system approach really works.
- [08:03]
C
And one of the things that I'm very purposeful with is the chief nurses, the regional chief nurses, and well, as the entities. I've met them all, but I'm not bringing them together to really start to strategize what we go after first, until I visit all of these hospitals, because again, I have to know you to lead you. And I can only know you if I come to your space and meet you where you are. So they're giving me grace to get that done. And once that really starts to come to a final traveling journey, listening tours, then I will do it at a cadence of about quarterly and we will really get to work on identifying our variation and how we're going to transform to one center of nursing excellence with the academic arm as well as the operational arm.
- [08:59]
B
That timeline makes sense and you'll truly be able to hone in and get a little bit more strategic of which areas you're going to tackle first and go from there. I'm looking forward to following along and hearing about some of the progress, but I also wanted to talk with you about nursing recruitment and retention. I know you're nationally recognized for your work here, have great expertise on it. I'm curious, what's been successful for you in the past when it comes specifically to recruiting and retaining nurses? What distinguishes organizations that really achieve workforce stability from those who are being a little bit more reactive in trying to solve nurse turnover?
- [09:38]
C
So let's answer recruitment and then I'll talk a little bit more about retention, but recruitment. What I found that healthcare systems and complex healthcare systems really have to zone in on is I would describe it as candidate centric work versus employee centric. So there's a difference. You have to go after talent faster and more agile than you ever could imagine pre pandemic. For every vacancy you have, you have to source those talents and you have to move at a cadence of what I like to build as seven days from, from the moment that we find the candidate or the candidate finds us, till job offer is in hand. Or we can do it in seven days if we have structure, important metrics, escalation of metrics, whether it's on the recruiter's end or the hiring manager's end. So completely rebuild the way you go after talent. That's the recruitment arm and you measure yourself. Am I hitting that seven day cycle? So I've nationally published about that. I've taken that to other states to talk about and the model works. It's a joint effort with talent acquisition, recruitment and operators to know we must go after the applicant faster than ever. So turn it from employee centric, employer centric, excuse me, to candidate centric. So once we have the talent in the door and have made the commitment to them, then let's talk about the retention strategies. So retention has to do with the listening of the voice of your clinician in any discipline, not just nursing. So do you have a professional shared governance structure where we don't make decisions about nurses without nurses, we don't make decisions about pharmacy workflows without pharmacists, we shouldn't be making decisions about therapy workflows without therapists. So professional shared governance is a pillar of magnet organizations. But I would say to you it should be a pillar of all organizations where you're magnet or not. Because if you are not listening to the voice of your clinicians who are the experts in the care they provide, you're going to have gaps and you're going to lose staff quicker and you're going to have challenges with retention. So put in that professional shared governance structure. Start with small projects Learn to get stronger in removing barriers of their practice through your shared governance structure and continue to celebrate your successes. So one of the things that I've done in my career around huddle boards, where you're taking on your most complex problem inside of an entity. You track the progress of that shared governance solution and the ownership of that shared governance solution until you really get meaningful solutions. But you also keep a track record of everything that professional shared governance has accomplished and you maybe surround that huddle board with the annual successes so you never lose sight of what you've actually accomplished in a professional shared governance setting. Because if we don't elevate it and celebrate it, our staff tend to forget it because we always have issues and problems that we need them to lean in and help us solve. And they do such great work that I'm very purposeful in always monitoring what you've accomplished and celebrated. So professional shared governance is a non negotiable related to retention as well as understanding the different generations that we lead and in the same infrastructure. So one of the things I would suggest for all listeners and I've shared across the nation, as well as looking for nuggets of success, is what is best practice to teach our leaders to leave five generations at once. Because they really have to start to develop a generational emotional intelligence on how to do that and meet each generation where they are related to their needs of balance, work, harmony, their needs on how they learn, whether it's technical versus classroom, how they process information is different from the generations. So one of the things that I think we must always do as nurse leaders and clinical leaders is never forget that our direct management staff must understand generation complexity because they deal with it front and center every day. And the evidence is still being gathered on how to lead our generation X teammates and what their expectations are. So there's nothing we can do that's more important to our frontline leaders than to teach generation intelligence.
- [15:09]
B
I appreciate that comprehensive overview for listeners of those crucial components of retention. As you said, shared governance and then of course, understanding different generations. And then when it comes to recruitment, it seems like really the speed and efficiency is key there. And I want to ask a quick follow up on that seven day timeline you mentioned. What have you seen as the biggest, perhaps operational challenges or pitfalls that are commonly blocking hospitals or health systems from realistically hitting that timeline?
- [15:42]
C
You've not taken the time to build infrastructure that prompts you that you're falling out of the seven day metric. So you really have to build the infrastructure to fire alerts that we have a candidate in the queue and we're approaching that deadline. And, and what is the escalation methodology that the backup plan or plan B is going to kick in? An example might be if the manager, nurse manager is out for that day and a candidate say they're on PTO for the week, but we have a seasoned nurse that's shopping for a certain specialty but the manager's out then who is in charge of their seven day cadence of decision making? Don't leave that such an important role unattended. You got to have backups and so does the recruiter. Some hospital systems divide up recruitment by specialty. So if someone's out for emergency room recruitment, who is the backup? Because the talent is so precious to health care organizations, we cannot afford to to lose candidates just because someone is off for the day or out on pto. So a backup plan and then you monitor any fallouts, treat them like a never event that we should never have lost a particular candidate because of our slowness. So all fallouts must be looked at, measured and solution for the next candidate.
- [17:26]
B
Mm. That's incredibly, incredibly valuable advice for our listeners. And just Speaking with you Dr. Walker, you're such a, you have such a wealth of knowledge and wisdom and looking at your career, I know as you said, you've led large complex multi state systems, now really shaping your new flagship academic health system role at UF Health. As you're thinking about your current stage in your own career, I'm curious, how has your leadership philosophy evolved and what does it really take today for a Chief nursing officer to not just function as a very important nursing leader, but really as that strategic voice operating at the system level.
- [18:05]
C
So I would say the strategic voice right now is constantly leaning in on outcomes. But even stronger than outcomes is talent pipelines. So what I bring to the table strategically is years of experience of successful succession planning. So not only where is our pipeline of talent entering our organizations, where are we in our high schools, counselors, where are we with taking students that may be considering entering health care? So that's the front end pipeline. What have we designed strategically to to grow future healthcare workers, but then on the back end, what are we doing and what are we building inside of our infrastructure to do our own talent navigation, coaching and counseling for our current teammates that are continuing to grow in the cycle of entry inside of healthcare. So strategically, the voice of the Chief Nursing officer is a balance of operational expertise, quality outcome expertise and pipeline development that is a must have for strong retention metrics.
- [19:34]
B
Well, Dr. Walker, this has been such an enlightening discussion and speaking with you, it's just clear UF Health is so lucky to have such a strategic, passionate leader like you on their team. So we're so excited for you in your new role and to follow along of all the great work you're doing. And just thank you for your time to join us on the podcast today.
- [19:55]
C
Thank you. There's no doubt in my mind. I I'm the one blessed to be at UF Health, and I'm exactly where I'm supposed to be during my final season season as the Chief Nurse Leader. So thank you.
- [20:09]
B
Of course, thank you again. And to our listeners, thank you as always, for tuning in. You can find more podcast episodes by visiting the Becker's Healthcare podcast page@beckershospitalreview.com podcast.