“The Executive Insider” series provides an in-depth look at how hospital leaders found their way into this career, their views on industry trends and the steps they have taken to create and maintain a successful work environment.
In this edition, our own Thomas McKeever, VP Solutions, had the privilege to speak with Teresa Fisher, COO/CNO of Lakewood Health System in Staples, MN. Teresa has been the COO/CNO of Lakewood since 2014 and has over 20 years of healthcare administration and nursing leadership experience. Teresa has a wide variety of career experience from managing a single department to leading entire organizations. In an executive capacity, she has led both critical access hospitals and large metropolitan health care systems. In recent years, Teresa’s work experience has been focused on total population health, strengthening financial platforms through payer contracts and ACO arrangements, clinical team management/transformation, and medical group management.
Below is the transcribed interview with Teresa covering a wide range of topics:
Thomas McKeever: When did you first realize that you wanted to pursue a career in healthcare?
Teresa Fisher: It starts as a sad story, when I was a teenager my grandmother was diagnosed with cancer and I watched her go through a very painful, difficult process, but at the same time, I watched her be cared for by wonderful hospice nurses. Being young, I remembered thinking I want to do that – you can get so much job-joy in nursing and to make a difference in the lives of people, improving their health, serving them and being there for them in times of need. That experience is what began my journey in healthcare. I started as an LPN, RN, BSN, and I am now in healthcare leadership.
TM: What factors led you into a leadership role within healthcare?
TF: I just told this story yesterday so it is fresh on my mind – I was working as an ER nurse at the time, through most of my profession I have really gravitated towards emergency services for much of my nursing career. I was working in a small, rural ER, no physician on site, and at the time, you never saw hospital leadership yet, my boss abruptly came down to the ER with a new policy. I remember thinking, who are these leaders that sit in a room and write policies and have no idea, no clue what is happening at the unit level of their hospital. It was a policy that made no sense – it was not going to work. I remember at that moment I wanted to be at the table where decisions are made; to provide nurses the voice on input and help write policies to be implemented. My manager at the time did not want input from the nursing staff, I remember this being a pivotal moment for me in my career. I needed to now not serve patients directly, but rather I needed to serve patients indirectly by empowering people to serve them better. That is exactly what I did. The next week I re-enrolled in my master’s program and within one month, I had accepted a management position. I changed immediately – it was a calling. I wanted to do something bigger, to lead, to guide, to do things that were more collaborative, more encompassing of the people. If I was going to get into a leadership role, I would also do my part and make it my job to drive policy, procedures and programs that are best for both the patients and the employees. Get involved, don’t just complain or be the one who says this will never work – go do something about it – so I did.
TM: What do you feel makes you an effective healthcare leader?
TF: I don’t do anything in a vacuum – it’s not about me, it’s about what’s best for the patients. I cannot do that alone – I have to ask the nurses, the physicians, the entire staff because I am not involved in direct patient care anymore. I need to hear from them what impacts their daily lives. Being in a collaborative working environment, I have the ability to ask them the needs. I never pretend to have all the answers. It is team based and we move together seeking buy-in and support from everyone for a plan to work.
Be vulnerable and humble enough to say that you don’t have the answers. Don’t be afraid to try things that may fail or not work but realize that we are going to figure it out – I don’t know if leaders are always that flexible. Collectively we can still make mistakes but together we can do better this is in all industries not just healthcare. Let’s take risks, let’s be innovative – we’re going to push forward and challenge our employees. Sometimes we might fail – but we get back at it. Successes come with risk and efforts.
TM: What are some of the most pressing challenges you are seeing within healthcare today?
TF: The most pressing challenge, hands down, is reimbursement. I would have to say the “cost of doing the right thing”. There are the right things to do, many of which you do not get reimbursed for. How do we constantly balance taking care of our patients, population health management, care coordination and preventing you from coming through our doors. Our business is to put ourselves out of business. We need our patients to stay healthy, health & wellness are so important, which is a direct hit to our bottom line. How do can we balance keeping people out of the hospital and lower the costs of healthcare but also drive revenue enough to pay for our staff and our services. To me, it is the cost equation of doing business that is so difficult to manage and will continue to be.
We’re in a rural community and there are times that I will ask for a physician to conduct a house call if we feel that someone needs to be checked on. We may not get reimbursed for that but it is the right thing to do. There are some things that we just do. That is a special thing about our organization – doing what is best for the patient and what is best for the community.
TM: What concerns you most about the current state of being a nurse in today’s healthcare environment?
TF: The nursing shortage, not having enough, not having the right people with the right passion. Not everyone today, not just in healthcare but in all industries, goes into their line of work for the same reasons that my generation did. There was a clear calling that I had to go into a service profession. Some go into nursing now because they want to work from home with some of the new jobs that are available in nursing. They don’t want to be on the floor providing direct patient care or caring for the elderly. Who is going to care for me when I am older, that concerns me in general. Are all the people in healthcare now going to be in office jobs and will there be enough actual nurses for the ICU, the ED, the places where chronic care must take place? We’re going to have to look at what other types of professionals we can bring in to support nursing and we are already doing that now. I cannot imagine what types of innovations we’re going to need 5 or 10 years from now to meet the needs of our patients.
TM: How do you define and strive for nursing excellence within your departments?
TF: Engagement and nursing excellence to me is that you have profound job joy. You are still able to say that you love coming to work, as that passion will be reflected in the care you give and will resonate in the care you deliver. I can measure engagement, job satisfaction and outcomes. We have so many quality measures through data and measurable quality metrics – but at a higher level I do care people genuinely enjoy coming to work as it directly impacts retention and recruitment. Being loyal and being committed to your work is tough as nursing is not easy – it is extremely difficult and very emotional. You see life and death every day. If I can keep you loving what you do every day, that is very important to me, personally as a peer nurse.
I have worked in Magnet designated facilities. The pillars of Magnet focus on nursing leadership, nursing voice, clinical decision making and collaboration – these core components are in our nursing governance and nursing standards groups. We have that shared decision making. It can be a recruiting tool, as it reflects a culture and environment nurses are drawn to, as a symbol that embodies a culture. For rural, critical-access facilities you can have components and culture to ensure staff enjoy coming to work and they like the environment in which they do their work.
TM: Is there one leadership decision that did not deliver the desired outcome and what did you learn most from that experience?
TF: Every single decision has pro’s and con’s. Let’s face it – change is hard and it is global within healthcare today. Structures are changing especially with the implementation of Care Coordination initiatives. The result of Care Coordination has changed the way care is provided to the patient. As this is a team approach and has resulted in new job processes. The clinic nurse process flow is different than it was before. Our employees come to work one day and everything about their job has changed. Reviewing and utilizing change management skills and tactics is important as it helps our employees navigate through changes. In order to lead through change communication is the key.
TM: What steps do you take to make sure that the goals of administration are carried out by your nursing leaders and overall nursing staff?
TF: This is an easy answer, we have our strategic planning that starts in the Spring, with leaders being engaged and involved very early in the process. Lakewood Health System is a collaborative environment. Goals are not set without the voice and involvement of nursing leaders, staff, providers and board members. We bring in our emerging leaders as part as our growth and succession planning. There is a group of about 100 people within the organization that start planning for the next year, measuring goals with monitoring systems for our top 5 goals from the previous year and how we performed. This is part of the Studer teaching. Our goals and performance are written through the eyes of our current and emerging leaders with their help and input. In the Fall we review our upcoming years goals based on how we’re doing relative to the market, competition, what is happening in individual units, departments and where we see the future of the organization. As an independent, rural health system it is critical that if we are going to remain independent and stay viable for the future – everyone has to have input and be on board so we are all heading in the same direction. Progress is updated monthly with updates in systemwide manager meetings on how we’re doing. Videos are available on out intranet on stated and future goals. Staff, providers and board members have the opportunity to have their voice throughout the year.
As I have a dual role here, being both the COO and the CNO, the majority of my time is spent in a COO capacity. With a dual role, many times those two hats conflict with each other as I have to run nursing and I have to run operations to make sure that as an organization and a system we are meeting our goals and budgets. It is so important to have the right people in the right positons and this may be through a duel position, such as the COO/CNO. The clinical to administrative transition is no longer coming just from the physicians on the medical staff, it is now extended to the nursing staff as well. It is encouraging to see more nurses in those roles today than in years past. There are so many more avenues for nurses now, and since we are structure and process driven people, we gravitate towards the roles of being leaders.
TM: How would you define a successful administrator?
TF: I would define a successful administrator as a leader worth following. People have to want to follow you, they have to believe in you. You have to set your vision, where you are going, see the big picture and be willing to take on the challenges with every scenario, then be able to lead through it. Be consistent and willing to not back down and to stand for something. It’s not easy all the time.
TM: What has made you most successful in dealing with your administrative and physician partners?
TF: Listening. You have to listen. Sometimes people just want to vent and to be heard. You can’t fix every problem. You can’t be reactive, but you also can’t solve everything. Have an open door and be accessible – help when you can help. Then do what you say you’re going to do, people are giving you the baton, they expect you are going to do something with the baton. Be clear about the expectations of what you are going to do. When I am meeting with someone, I ask them if they want me to listen or if they want me to help?
TM: What advice would you give to an aspiring healthcare leader?
TF: I would encourage them to find a good mentor. Find someone that will help give them advice around what education maybe needed and tools for in their tool box. They may need some different classes, or further education and competencies to be developed. Then develop the experiences through a good mentor they trust. Starting a career in management they may need a mentor and someone to serve as a coach, to bounce things off of. Role playing conversations – being brutally honest. I do mentoring and I find great joy in it, I truly enjoy it. The first thing that I say when I started mentoring someone is – be ready, some of the things that I say may not be nice, so prepare yourself. You’re not going to want to hear everything that I say. I recommend to find someone you trust. Someone you aspire to be like that has similar values you do.
TM: Who have been your most prominent professional and personal influencers throughout your career?
TF: There have been so many great individuals. At each job, each level as it were – manager to director, I was always trying to find someone at that next level as I have climbed the ladder, to find the next one up. If I was a manager, I would find a director, if I was a director I would find a VP. I have had different mentors for the different positions that I have wanted. One of the greatest mentors I had, who help get me into the position that I am in today of COO, was a nurse from Children’s Hospital of Minneapolis. We met early on in my career and was a role model. She was the one that got me thinking a nurse can be a COO. That was 20 years ago, here I am today and she never leaves the back of my mind. I don’t think she knows the impact she made on my life.
I have had CEO’s that have been fantastic mentors to me. The most interesting leader and mentor I have had was a VP of building operations. It may seem odd for a nurse to have a mentor in building operations however, I was living in Denver, Colorado at the time working for a large system. He was leading this massive project for the hospital and the way he led seemed perfect. I wanted to learn how he navigated the difficult conversations and then how he was willing to go through the fire(s). I asked him to be my mentor. He had no idea who I was but was flattered which resulted in a great relationship. We’re still friends to this day, this was 15 years ago, he was a great mentor. He was not a clinician or a nurse which provided me with a different skill set than what I had.
TM: What accomplishments to date are you most proud of?
TF: Professionally and personally I am most proud of the fact that I am a farm girl that went after her dreams and am accomplishing them. I have worked hard in pursuing my dreams and making them happen. Being a COO has been a goal of mine and to accomplish that has been gratifying, however I remind myself not to take it for granted. I have worked hard and am grateful for the opportunities I have had within the healthcare industry. I am deeply appreciative for all the individuals that have given me the chances in progressing my career – especially when I may not have had the right experience – but they believed in me.
TM: Where do you see yourself in 5 years?
TF: My hope I am still leading this organization, this is where I want to be, I love where I am at with Lakewood Health System. I love the people, the work that we do, and the care we provide. I enjoy what I get to do every day and could not be more grateful.