Webinar | Developing Modern Leaders for a New Era in Healthcare

Virginia Mason Institute

Today’s healthcare leaders face immense challenges that require a modern mindset, skills and capabilities to address growing backlogs, financial pressures, workforce disengagement and turnover. It’s time we shift our paradigm on leadership into a new perspective focused on purpose and capability, including improvement skills, effective dyad leadership and behaviors that promote meaningful team engagement.

Learning objectives:

  • Learn how the human and technical dimensions of change serve as a foundation for understanding the role of leadership
  • Understand key leadership behaviors and systems that create more effective teams
  • Understand how foundational systems like World-Class Management and dyad leadership support effective leadership

Note: If the video is not appearing above, try refreshing the page or you can watch the video here on YouTube.

Listen to the audio-only recording as a podcast:

Q&A Transcript

Somer: As leaders who are comfortable with leading from a standard management method that we have been relying on, and felt secure in for so long, to have some of our standard processes stopped, or standing down from meetings that are helping us to move improvement work forward, it can be scary.  The stand down was more about our executive leadership recognizing how important it was for us to be present and available at the front line, and we needed the space and time to re-focus and just manage the crisis response. So, it doesn’t mean that we stop meeting with our people, it doesn’t mean that we stop being present or that we as leaders decided we’re going to work from home, and yet dealing with the challenge of social distancing we had to learn how to lead differently, with new technology and dealing through the frustrations of that, but at the end of the day it resulted in more frequent huddling. So, we’re using the same structure that we’ve had, the same tools we’ve had, and that we’ve relied on, maybe in different ways. We are focused on one or two important things; its lights on, doors open, and keeping our people safe, talking daily about how we could address safety and get communications out.  There’s a lot of scary times where workforce challenges were affecting us, and there was a lot of fear, so being transparent and having daily communications whether it’s in a debriefing model or a small huddle, sometimes multiple times a day, it’s really about focusing on the “one thing”, to say to our people we really are in this together with a laser focus on the most important things that we need to address right now.

 

Melissa: I would reiterate what you just said there about being on the front lines and being physically present. Because even if it felt like we were going to get in the way of the pandemic and our colleagues trying to take care of very sick people when there was still not enough information out there to really respond to Covid-19 back in 2020 – it was interesting how both at Virginia Mason and with a number of our clients people said, “I was actually relieved that for some of the meetings that got cancelled, it actually gave me the opportunity to go out more.” So, they were relieved because it allowed for them to just get out there and ask questions directly or offer some communications directly and they could see how much people appreciated that one-to-one and being able to see your CEO and say, “Oh, hi – you’re standing here right in front of me and not secluded away in an office. You’re standing here fully donned in PPE and so you appreciate the risks that I’m personally taking. I want to take a risk and share with you some of some of my concerns that I have.” I loved how we saw that connection with a number of our partners around the world.

Somer: In my own personal experience as a leader through this crisis, it really comes down to a few things.  I think where we are today there is just a lot of depletion, everyone is tired from top leadership down to the front line, so what do we do to reinforce and re-engage our team, keep them healthy and sustainable for the future? As we face these growing workforce challenges, we are in a place right now where it’s really a back-to-basics mentality. If you think of Maslow’s hierarchy of needs, at the bottom is food and shelter, and I would add PPE. We’ve got to get stabilized at a basic level and then what’s next?  It’s going back to those basic tools that we know have sustained us in the past, and one of them that’s so important is the leader rounding. In the video, Bess talked about how important it was that she just got out there on the floor and asked some open-ended questions. If you don’t know where to start, go back to the training that Studer brought us that was so helpful, and he has four critical questions – What’s going well for you today, What tools and equipment do you need to do your job, What processes should we be paying attention to, and probably the most important right now, Who should I be recognizing? Then follow up on that. If that’s the only thing a leader did all day long, it is going to help our team members feel that we are listening to them, that we are present, and we’re focused on the right things. What we need are those behaviors you were talking about earlier that are so needful in today’s modern leadership. As a leader you always are balancing, “Do I have time for this? Do I have time to get out there and have these conversations?” And I think about my own Vice President of Operations – with predictable regularity she sent meaningful recognition and it was timely, it was thoughtful, it was appropriate and personal. I thought if my VP, who has a schedule that is five times as intense as mine, can take the time to make sure that I get recognized appropriately then I know I can make space for that. And it meant something to me, so I think that’s just a place to start and we’re going to have to build from here.

 

Melissa: I love that cascading of role modeling. And really starting to have that moment of self-reflection for yourself as a leader in recognizing, “Hang on a minute. If my vice president can do that, what’s the excuse for myself? How can I carve out that five minutes of time and start off with one thank you, and then maybe extend it to two, and how can I find time for more and more and more?” It’s just a magical moment there for a lot of staff members when they say someone noticed, someone noticed something that I did and that’s such an impact. For so many of our staff members who’ve had two plus years of going through the pandemic, that’s all people want – they don’t need the yoga or the massages or anything like that, they just need to be acknowledged that they’re trying their hardest in these difficult times.

 

Somer: In some ways it’s actually simpler than we than we think. Like I said, that back to basics mentality of going back to just the getting out there on the floor and asking the open-ended questions and doing compassionate listening.

Somer: Yes, absolutely. As we’ve faced this crisis and all of our efforts have gone to this and we’re feeling depleted, being a compassionate leader is so important in terms of reinforcing the wellness of our team members and even ourselves. I saw myself evolving as a leader through this journey, and part of it was just taking that time to listen, to really listen, and then to be really flexible with what my expectations were – meeting people where they are. We had to make lots of changes that I would have never anticipated. 

 

Melissa: I was just reflecting on those modern leadership behaviors we discussed in the presentation, and one of the things we talked about quite a bit was letting go of control and recognizing that you, the leader, might not actually solve the problems and there was something that you had mentioned about a critical moment where you had to make some difficult decisions in the early stages of the pandemic as it relates to furloughing, and it’s just phenomenal to hear what you and your team decided to do in that case, and I just would love it if others could hear that as well.

 

Somer: I think that was a key moment and one of the things I’m really pleased about coming through in this pandemic is the culture I was working in. There was really strong sense of culture that was very positive and as difficult as it was, we didn’t experience some of the incredible fears and sense of inequity in terms of how things were handled, for example, during the time where people had to be asked to step away from work. You know that’s a very scary thing to be asked to do, not only did we have so much work, it was different work, and it felt heavy. It wasn’t the kind of work we had done before, and what really helped us was that we came together as a team and we listened to everyone’s needs, we responded as a team, to say okay this is what’s needed, we need to meet a goal that’s been set forth by our organization, many people have to step back from work for a period of time – this is what has to happen for us to survive right now and how are we going to do this? We talked about it as a team and the team really came together. It wasn’t me saying, “This is what you’re going to do, this is how I’m going to tell you what your job is.” We had a goal, I was very clear about the goal, it was non-negotiable that we had to meet the goal, but how we got there was decided among the team members and their compassion for one another came out so loud and clear. Even though it wasn’t completely equitable it felt fair and people came back feeling supported. I’m so proud of the team for getting through that time in the way that they did and as a leader my role was really about what you said earlier – letting go of control, stepping back and saying “Here’s the goal, we know what we need to do, we have to meet this goal, and how are we going to do it together?”

 

Melissa: You were so clear about what needed to move towards, in terms of that goal, and yet because of the work that you’d clearly been doing to help this team create that level of support and trust with each other – they could have honest conversations and say, “You know what, I can take an additional sacrifice or this is a way that we can support each other because we love each other, we want to support our patients and our community members, we want to make sure that everyone is managing to become whole again.”

Somer: Just a couple things I would start with, it’s being present, getting out on the shop floor and making those rounds. I know that so many people will say it’s been difficult to have physical presence because of this pandemic but we figured out ways to make it work, we figured out ways to do it differently. It’s like this, a video chat, but people need to see their leaders, they need to know their leaders are present. The other thing that is so important is just starting somewhere when it comes to the visual management. As we’ve transitioned to not being in the office as much, we’re working virtually, and we’ve had to do it differently. So get back to something whether it’s visualizing what your demand is today and what the capacity is and making it visible so that people can get back into a routine of having visual management. What’s visible is what gets worked on – that’s what gets changed, we just know that from experience.

 

Melissa: Absolutely and I keep going back to that visual image of the daily management six elements that we have available and I certainly invite anyone here to check it out on our website if you’re curious about it. But those are probably the two that people start with. Visual management really because it helps to be more transparent about what the business is about and I’m personally not withholding information that might actually help my staff members be able to do their jobs better and creating a space for us to look at the same data look at the same information and be able to make qualified decisions about making sure that we all end the day on time with all patients, and doing them safely, and knowing what needs to be put into place if problems arise midday, that counter measures are in place so we’re not scrambling but we already know that there’s a standard way for us to connect back as a team.

 

I’ll also add one more thing which is the huddling and that’s just that daily accountability for us to come together and it’s creating a space, it’s carving out space for us to connect and convey information or issues as a team. It’s also about creating a space for daily improvement.

Melissa: It depends on where your organizational culture is at. It’s related to another question about what you do if your executive leaders don’t appreciate the importance of leadership which was an extremely profound question in itself. If you have skepticism on the ground in the organization, proof is in the pudding. Being able to start with some of these basic things maybe having a couple of leaders who are eager to demonstrate that this is the way that we need to move forward in terms of modern leadership – those are some easy ways to get people on board or at least help drive curiosity about how some might find success creating that that space to establish visual management or where we can do more leader rounding across the organization. We’re certainly biased in saying that it only really works to its best when you’re using all of the World-Class Management system together, making sure your strategic goals align nicely with what you’re seeing on the front lines in terms of what they’re contributing towards or working towards but I think those are some basic ways to begin. So certainly, look at where the where the appetite is for the organization and if need be start small but don’t feel like you have to solve for the whole organization in order to get started.

Additional Q&A Responses

Somer: One of the key aspects, and a primary reason change management is successful in an organization like Virginia Mason, is predicated on our Respect For People principles. When Respect for People is embedded in the culture, we work through hard times and challenges together in a way that is supportive and highlights the human elements of change. A couple of the key principles of Respect for People at VMFH are “listening to understand” and “walk in my shoes.” We know that navigating any change requires a great deal of leadership presence, listening to the concerns and fears coming from the team, and genuinely showing empathy for where they are in the process. And in a practical sense, we know that our workforce needs flexibility more than ever. This means different things to different people, so by listening and responding to the needs of individuals, and finding ways to offer flexibility, we reinforce their trust and confidence in our ability to lead them through the change. 

Somer: I would reflect on something my direct leader always did, and that was to FIRST ask me how I was doing, and what support I needed. It was always important to her to know that before we could dive into any details about the work. She often mentioned the airplane logic that you need to put on your own mask before you put on the mask of others around you, and so taking care of yourself was so important if you wanted to have the capacity to take care of others. In that regard, wellbeing and providing quality care are beautifully aligned as mutually dependent. This also helped me to have a lot of trust in my leadership, knowing that I could be vulnerable and tell her when things weren’t going well, or when I was personally struggling, and knowing that she would listen without judgment.

Somer: I always think back to understanding the “why.” Where there is resistance, there is lack of understanding or lack of feeling this is important. If my team doesn’t understand why we are doing something, they will struggle to make it a priority. Taking the time to connect the why is always value-added time. Also, I always try to assume best intent. At the core of every leader is the desire to do a good job. To be a good leader. There are exceptions, but not that many. When I see resistance, it is usually because the leader doesn’t perceive this as being helpful to him/her as a leader. They don’t understand how it will make them better or help them lead. They haven’t connected the dots. In some ways we need to get them on board to trust the process, but most importantly help them to see the “why.” Have they been on an improvement event? Have they seen firsthand how the process works, and how quickly the magic happens when people from all different areas come together to work on a problem? Is their executive leadership modeling the importance of this? How does it show up?

Somer: Compassionate listening is one – see some comments above. Leadership presence is another – as difficult as it may be, don’t back down on this. We all struggle with physical presence in this new world, but presence can be felt in different ways. Make it a priority to be present, in whatever way you can. Transparency is another. This is probably the number one reason at Virginia Mason Bainbridge when we went through the whole furlough activity just like everyone else, the difference was how our team members responded. They rallied together. They worked together to decide when to be gone, how much time each one would take (there were factors that differed for each person’s life situation, and simply sharing “equal” time out was not necessarily fair). And because of this, the culture was strong, resilient, the team stood together without resentment. Not every team could say that, many other teams struggled with feelings of unfairness over the process. And much of that is because of the transparency that we had every step of the way. We shared everything we could, as soon as we could, with everyone. We were honest when we didn’t have an answer. We were honest when the answer wasn’t popular. 

Melissa: I think about something Dr. Gary Kaplan says all the time – that those priorities shouldn’t be mutually exclusive. By choosing to focus on quality and safety, you should by default also be reducing costs. If you are finding these priorities are at odds, you may need to re-evaluate your approach.

Somer: First, just spend time with them. Spend one-on-one time to get to know people and show them they are a priority, and then spend time with them in their natural work environment. Move your workplace out to where the work happens and spend time observing and listening to what’s going on there. This shows your commitment to working on the right things. Show transparency whenever possible. Have open and honest conversations about fears and expectations. And as you start to work through issues, be relentless about following through with whatever you say you will do. Distrust breeds in silence, and compounds when leaders don’t follow through. Show your commitment to a culture that feels open and honest and be diligent about following through and following up. 

Somer: This can be tricky. First, and maybe the greatest hurdle, is a leader needs to recognize they need to make a change, that the old leadership model is no longer working for them or will not take them where they want to go. Once there is recognition and alignment with the need for change (we often refer to the “urgency for change”), the work can start. If a leader is mature enough to be okay with a little vulnerability, they might start by asking a few close team members, colleagues, a direct leader, or even direct reports on their team, to give them feedback. Start by telling them they are trying to model some new behaviors, explain what they might see that is different, and ask them to be open and honest about when they see the behaviors working, or when they see old behaviors creeping in. This requires a good level of trust between co-workers but can be a powerful way of generating and sustaining behavior change. 

Melissa Lin, MS, CPHQ, LSSBB, Senior Partner, Transformation Services

Melissa Lin, MS, CPHQ, LSSBB, Senior Partner, Transformation Services

Melissa Lin, MS, CPHQ, LSSBB, is a Senior Partner of Transformation Services at Virginia Mason Institute. She coaches and guides healthcare leaders and providers worldwide through their cultural transformation toward lean as their management method. Melissa is certified in the Virginia Mason Production System® and in TapRoot Root-Cause Analysis. With her continuous improvement foundations originating from The Dartmouth Institute of Health Policy and Clinical Practice, where she earned her master’s degree, she is a Lean Six Sigma Black Belt and a Certified Professional of Healthcare Quality.

Melissa Lin, MS, CPHQ, LSSBB, is a Senior Partner of Transformation Services at Virginia Mason Institute. She coaches and guides healthcare leaders and providers worldwide through their cultural transformation toward lean as their management method. Melissa is certified in the Virginia Mason Production System® and in TapRoot Root-Cause Analysis. With her continuous improvement foundations originating from The Dartmouth Institute of Health Policy and Clinical Practice, where she earned her master’s degree, she is a Lean Six Sigma Black Belt and a Certified Professional of Healthcare Quality.

Somer Shields, MBA, CMPE, Senior Partner, Transformation Services

Somer Shields, MBA, CMPE, Senior Partner, Transformation Services

Somer Shields, MBA, CMPE is a Senior Partner of Transformation Services at Virginia Mason Institute. As a former practice manager, medical practice management consultant and Director of Operations, Somer brings over 20 years experience in healthcare operations and leadership. She is board certified with the American College of Medical Practice Executives, holds a Bachelor of Science in Business Administration from Oregon State University and MBA in Healthcare from Oregon Health Science University and Portland State University. As a Director at Virginia Mason Medical Center she has led the strategy, growth and operations of a multi-specialty outpatient medical center. Somer was instrumental in leading the design and construction of a new 30,000 square foot medical facility, built from concept to fully operational using Virginia Mason Production System design and flow principles. She has served as participant and leader on several innovation and design events, and brings extensive experience in applying the concepts of World Class Management, change management and continuous improvement to the practice of medicine. Somer has advanced training in the Virginia Mason Production System®.

Somer Shields, MBA, CMPE is a Senior Partner of Transformation Services at Virginia Mason Institute. As a former practice manager, medical practice management consultant and Director of Operations, Somer brings over 20 years experience in healthcare operations and leadership. She is board certified with the American College of Medical Practice Executives, holds a Bachelor of Science in Business Administration from Oregon State University and MBA in Healthcare from Oregon Health Science University and Portland State University. As a Director at Virginia Mason Medical Center she has led the strategy, growth and operations of a multi-specialty outpatient medical center. Somer was instrumental in leading the design and construction of a new 30,000 square foot medical facility, built from concept to fully operational using Virginia Mason Production System design and flow principles. She has served as participant and leader on several innovation and design events, and brings extensive experience in applying the concepts of World Class Management, change management and continuous improvement to the practice of medicine. Somer has advanced training in the Virginia Mason Production System®.

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