January 14, 2025 • 28 mins
Exploring the intersection of clinical expertise and leadership, this episode features Clair Kuriakose, PA-C, FACHE, Clinical Assistant Professor at Stanford University. Join us as Clair shares her journey from hands-on patient care to leadership roles, emphasizing the essential skills that pave the way for effective healthcare management. Discover how clinicians can ignite their passion for improvement—be it in quality enhancement or patient efficiency—while balancing the demands of clinical responsibilities with leadership initiatives. With insights on decision-making principles that impact both team members and patient outcomes, Clair highlights the crucial leadership attributes that can help clinicians thrive in today's evolving healthcare landscape.
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Episode Transcript
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(00:00):
(upbeat music)
- Welcome to Stanford Medcast,
the podcast from Stanford CME
that brings you the latest insights
from the world's leadingphysicians and scientists.
If you're joining us for the first time,
be sure to subscribe on Apple Podcast,
Amazon Music, Spotify, or YouTube
(00:22):
to stay updated with our newest episodes.
I am your host, Dr. Ruth Adewuya.
Today, I will be chattingwith Clair Kuriakose,
who is a distinguished healthcare leader
with extensive experience
in managing advanced practice providers,
and driving performanceimprovement initiatives.
She currently serves as theInaugural Chief Advanced
(00:43):
Practice Officer at Stanford Healthcare,
where she oversees strategic initiatives
for APPs, including nurse practitioners,
physician assistants,clinical nurse specialists,
and certified registerednurse anesthetists.
With a clinical backgroundin pediatric surgery
and a Lean six Sigma black belt,
(01:04):
Clair has shown a proventrack record in implementing
lean management principles toenhance operational efficiency
and improve patient outcomes.
A graduate of St. John's University
with a physician assistant certification,
Clair also holds an MBA
from the University ofHouston's College of Business,
and is recognized as a Fellow
(01:25):
of the American Collegeof Healthcare Executives.
Recently honored as oneof modern health care's
top 25 emerging leaders,
Clair is celebrated forher innovative approach
to healthcare leadership,
and her commitment to improvingthe patient care experience.
Clair, thank you so much for chatting
with me today on the podcast.
- Thank you, Ruth.
(01:45):
Really appreciate this timeto chat with you, as well.
- You have had such a uniquecareer journey in healthcare,
blending clinical expertise
with leadership and management skills.
Could you start bysharing your career path,
and what initially drew youto healthcare and leadership?
- I started my career asa PA in pediatric surgery.
(02:06):
Back in those days,there weren't that many
advanced practice providers,so I was the first PA
to join my surgical team.
I had the opportunity to clarify
the role of what does a PA do,
how do you utilize advanced practice
providers in your care team,
it was challenging, 'causeI was still figuring
that out myself as a new grad PA,
(02:26):
by drawing on my experiencesfrom my clinical rotation
allowed me to say,
"This is how I could beintegrated into the care team."
By doing that, I hadinformal opportunities
where I was asked tojoin different committees
and task forces, throughthose opportunities,
and the exposure that I hadwith these different projects,
(02:48):
it sparked excitement for me
to say "I could enjoy myone-on-one interaction
with the patient, but throughsome of these administrative
or leadership initiativesthat I got to be part of,
I could improve patient care at scale."
For me to transition
to a leadership or administrative role,
I knew I had some gaps.
I looked for opportunitiesby pursued an MBA,
(03:09):
I did some certificationsin Lean Six Sigma,
again to just give me that business acumen
that I knew I didn't havecoming off of PA schools.
In my current role, I leadadvanced practice providers,
that was like a match made in heaven,
finding a leadership role that looked
for a advanced practice provider,
(03:29):
but then also thisinterest in administration
and performance management.
- Thank you for providing an overview
of your career journey, ittruly demonstrates the value
of combining clinicalexpertise with leadership.
I heard you talk about thetrainings that you took
to equip you to navigate this transition,
(03:51):
it's also interesting toreflect on the mindset shifts
that are required when one moves
from individual patient care
to influencing systems andteams at a leadership level,
and that transition canbe quite challenging
for many clinicians,
which leads me to my nextquestion related to that.
(04:11):
How did you personally navigate that shift
from a purely clinical roleto a management-focused one?
- I think it's an important question,
as clinicians think throughif this is a path for them,
just because you're areally great clinician
doesn't mean that you may havethe skillsets that you need
for a leader or administrator,
(04:32):
we have our clinical expertise,
and then there are leadership
in healthcare administrative competencies.
Acknowledging that, forme, that's why I took on
and recognizing theseare some of the gaps,
this is where I could strengthenmy healthcare knowledge
by understanding whathappens on the payer side.
As a PA, when I did step one,
(04:54):
recognizing "This is what I wanted to do",
it was really challenging,
there weren't that manyleadership opportunities
that recognized PAs as someone
who can be qualified for the role.
There were many nursing leadership roles,
or physician leadership roles,
and so it was a little discouraging,
I knocked on so many doors,looking at clinic manager roles,
(05:15):
performance improvement, likequality improvement roles,
and I think it was theuniverse telling me,
"Hey, we need to look at howto diversify your experiences"
so I could be consideredmore eligible and qualified,
it pushed me to go anddiversify those experiences,
and enrich my resume,so folks could see me
(05:38):
as a qualified clinician who could lead,
I'm grateful that itpushed me at that time
to go do those things,but I am hopeful that now,
in this day and age,
these are more recognized in understanding
the clinical role that PAs have,
I hope that PAs don't havethe same challenges I did
back then, but needless to say,
(05:58):
it helped me to be where I am today.
- What I'm hearing yousay is that you had to do
a lot of intentionalreflection and growth,
seeking out how to learn eithernew leadership competencies
or skills that were beyondyour clinical education.
For clinicians who are listening,
who might be considering a similar path,
(06:20):
what advice would you give them
as they think about makingthis kind of career transition?
- One of the things that Ilearned during this process
was that I almost waswaiting for a formal title
or permission to be a leader.
My advice, if you think thisis something that you wanna do
(06:41):
as a clinician, we're already leaders.
As clinicians, we leadour patient care teams,
our patients look to us,
other care team memberslook to us as providers,
leveraging your own clinical leadership
and thinking about how you don't need
a formal title to lead, findthat passion that you have,
(07:02):
if it's quality improvement,
if you wanna improve patient outcomes,
if you wanna improve patient efficiency,
who else better than aclinician with that expertise?
Let's not wait for a formal title,
raise your hand, volunteeron informal committees,
or task forces, whereyou could start doing
some of that work,
(07:22):
and see, first of all,if you really like it,
and two, just startoffering your expertise,
and people will askyou to be at the table.
- That is not only practical,
but empowering advice for folks,
because it's clear that clinicians have
so much to offer in formalor informal leadership roles,
but it's also important to identify
(07:42):
how their own unique skillset can align
with the broader goalsof the organization,
and stepping up to fill in those places
is what leadership is all about.
I want to shift a little bit
to talk about balancing clinical knowledge
and leadership objectives.
In your experience,
how does the need tobalance clinical knowledge
(08:02):
with leadership goalsimpact decision-making
and ultimately, patient care?
- As frontline providers,we understand the workflows,
how things get delivered to patient care,
and how patients visualizeand change in the system,
or that interaction, sothere's no one better
who can influence and make decisions
(08:24):
with that understanding, Imean, how powerful is that?
It's almost a superpowerto have the understanding
of how clinical interaction works,
and then being able to make system-level
improvements and changes knowing that.
To me, I think having aclinician in a leadership role
is an amazing strength
that brings into theentire leadership team,
(08:45):
diversifies the expertiseof that executive team
leading the organization,
but like I said earlier,even then for clinicians,
there could be other gaps,
but you build on those knowledge gaps.
Relying on the partnerships,
having, creating diadic leadership styles,
where there's an administrator
and a clinician working closely together
(09:07):
to impact whatever changes
you're making in the organization,
that's when I believethat you're really able
to leverage each individual superpower,
and make informed decisionswithout breaking anything.
Just leaning into that to close the gaps,
and making sure thechanges and initiatives
that organizations areleading are meaningful,
(09:28):
and making a positiveimpact on patient care.
- You bring up a greatpoint about the balance
between how leadership roles in healthcare
are not just about operational efficiency,
but really staying connected
to the impact on patient outcomes,
and ensuring that you have bothof those voices represented.
When you are making decisions as a leader
in your current role,
(09:49):
do you rely on any particulardecision-making framework
or set of principles
to guide you when you'remaking tough decisions
that impact clinical staffand patient outcomes?
- One framework that Italk about with my teams
is the quintuple aim.
We have this charge as clinicians
to improve clinical outcomes,to improve patient experience,
(10:14):
but also improve clinician being.
We're being charged to do that
along with improving health equity,
and creating a sustainablefinancial model.
I love this framework,because it speaks to everyone,
it speaks to patients.
Why are we all clinicians?
We're here to serve patients,so we want better outcomes,
(10:34):
we want our patients tohave a positive experience
as they're getting care, soI think that really speaks
to both the patient and the provider,
and clinician being, thisis saying that the workforce
that provides the care for our patients
needs to be taken care of, as well.
Again, bringing administration
and clinicians together, bysaying we have to take care
(10:56):
of those people, and then recognizing
that the creating asustainable financial model
is important to be ableto continue providing
that amazing care for our patients,
along with health equities.
The quintuple aim allows meto frame my decision-making,
deliver the message, andconnect with clinicians,
and other team members to say,
(11:17):
"Look, this is how it's making
a meaningful impact on patients."
Connecting it back to the framework
helps better implement the messaging.
- I appreciate how youuse the quintuple aim
as a decision-making framework,
but if I can push in a little bit on that,
how do you ensure that this framework
is not only a guiding principle
(11:39):
but actively shapes the culture
in your daily decision-making?
- Organizations have different ways
of taking this big quintuple aim,
and executing it in their organization.
Many have strategic plans
that may be spread overone to three years,
they all somewhat have thesame thing on there, right?
(12:00):
Quality and safety,patient access, efficiency,
wellness and engagement,
'cause that's a huge partof the workforce strategy.
So the principles from the quintuple aim
is what I find in manyorganizations' operational plans,
and that allows leaders and clinicians
within an organization to know
(12:21):
how are things prioritizedfor that organization,
for that specific year,
taking that big quintuple aim,
and then applying it tothe operational plan,
creating vision of whatthis next year looks like,
here are the priorities,
and then informing andsocializing that plan.
- Thanks for that additional insight.
(12:43):
In your role, you are quite aware
of how the healthcare industry,
and how healthcareorganizations shift so rapidly,
and face uncertainty.
What leadership qualitiesdo you believe are essential
for clinicians to thrivein this environment?
- The top three that cometo my mind is number one,
(13:04):
being goal-driven.
It's easy to not know whichproblem you're solving,
you have to understandone, what is the problem,
and then, therefore, what arethe outcomes you're expecting?
As a leader, we have to take a step back,
and think about the overall impact,
so I would say beinggoal- and outcome-driven
(13:25):
is a wonderful skillset to have.
Number two is ability to influence.
Leadership is not aboutauthority, it's about influence.
Bring people along, make it their idea,
get their involvement, sothey're excited about it,
and last, communication.
When we say communication, it'snot just about what you say
(13:47):
and how you say it, sometimesit's about how you listen,
so you can communicate effectively.
These three stand outto me to be effective,
and gain the trust of theteams that you're working with
to hopefully make an impact.
- You highlighted someimportant attributes
that would really behelpful in the dynamic field
(14:09):
that we are in healthcare.
I loved how you highlighted communication,
and not just the ability to speak well,
but the component of listening,which, as you mentioned,
is really the more importantpart of communication
that we often miss,
and how all of the threequalities play a significant role
in unifying diverseteams, developing skills
(14:32):
in other people, and can really help
with the clinicians' transitioninginto leadership roles.
One of the things that Iimagine you face all the time
being an administrator,
but also working with a lotof clinicians is the fact
that you might come froma different mindset.
How do you bridge the gap
(14:53):
and encourage a balanced perspective
considering patient carein operational efficiency?
- It goes back to leveragingindividual expertise.
Oftentimes, how you see this played out is
having formal diadicleadership structures,
or sometimes even triads,whether it's an administrator
(15:14):
and a physician, oradministrator and a nurse,
administrator and anadvanced practice provider,
finding the ways to havea leadership structure
that is informed wellenough to make adequate,
appropriate, and safe decisionsthat impact patient care,
it is about leaning intothose relationships,
(15:36):
even if it doesn't formally exist,
knowing when to bringthose people to the table.
Oftentimes, we have to recognize
that the healthcare landscape has changed,
it's really more aninterprofessional environment,
think about the variousclinical disciplines
that need to be voiced,leaning on those experts,
(15:57):
and bringing them to the table as needed
is an important part ofbalancing those challenges.
- I wanna make surethat we spend some time
talking specifically aboutadvanced practice providers.
Advanced practice providersoften have unique roles
within clinical teams.
What unique perspectives and values
do advanced practice providersbring to patient care,
(16:21):
and what direction doyou see the role heading?
- I go back to the quintuple aim.
It's about improving patient outcomes,
it's about improving patient experience,
and, to me, that's access.
That is being able to reach
and give our patients the best care
that they need in a timely fashion,
and also the otherelements of health equity,
(16:42):
and financial sustainability,and clinician being,
I also feel like advancedpractice providers
have the ability to workin these remote settings,
and help our providerreach health disparities
that are happening in our communities.
Advanced practice providers are growing,
and they're a huge complimentto the provider workforce,
(17:04):
so we can continue enriching
and providing the bestcare for our patients.
I also think it's really awesome to see,
there's many studiesout there that highlight
how having an advancedpractice provider in your team
has improved physician wellbeing.
It's this evolution of healthcare
changing from this doctor-nurse model
(17:24):
to truly a team-based care model,
and you get to share the burden
with other interprofessional team members,
and that itself is beautiful,
and really recognizing that as a team,
we can achieve so much more.
I think the Bureau of Labor and Statistics
actually predicts abouta 45% growth for of NPs,
(17:45):
and 25% growth of PAssomewhere around that ballpark
in the next 10 years, so it'sa rapidly growing workforce.
Organizations are recognizingthe value that APPs bring,
it's just this evolution of healthcare,
and where we're headed,
and I think as we're justseeing this larger, rapid growth
of APPs within the systemsand healthcare teams.
(18:09):
- Evolution that youdescribed is really exciting,
particularly as APPs take onthese expanded clinical roles,
and also thinking about their ability
to bridge gaps between disciplines,
and be relevant towardsthe healthcare landscape
as it continues to evolve.
I'm curious though about managing
and aligning these roles
with broader healthcareorganizational goals,
(18:31):
because I imagine that itrequires a nuanced approach.
How do you approachthe management of APPs,
particularly when you're trying to align
their clinical strengthswith organizational growth?
- I'm so glad you asked, Ruth,
'cause I think that is a question
that I would encourage organizations ask.
(18:52):
This is a rapidly growing workforce,
and we all need to evaluate,
are we set up for thisworkforce to continue growing,
and being successful within your systems?
Many of our systems andleadership structures are built
based on our understandingsof what the provider workforce
looked like ages ago,
(19:13):
you do have to be moreintentional about the structures
that you need in a healthcare organization
to support this rapidly growing workforce.
Otherwise, you're gonnahave the same problem,
burnout, turnover,challenges in meeting access
if we're not appropriatelyutilizing the roles,
all of the functions
that the advanced practice provider role
(19:34):
is meant to solve for cannoteven happen if we don't utilize
or understand the role appropriately.
How is an organization or ateam structured to help provide
the support they needfor this new workforce
that's rapidly growingwithin healthcare teams?
Top of licensure practice goesback to really and end role,
(19:57):
we have to be intentional in finding
that exact unique role
that APPs play within the healthcare team.
I encourage organizationleaders to do that,
so they can create a professionallyfulfilling environment
that has a strong APP workforce,
that is meeting thenyour organizational goals
(20:19):
of improving access,complementing team-based care
to improve patient experience,working collaboratively
with our physician colleagues
to make sure you're delivering
the best collaborativecare for your patients.
- We are fortunate at Stanfordthat we have someone like you
as a Chief Advanced Practice Officer.
Not a lot of organizationshave the same role.
(20:40):
I do know that a lot oforganizations are doing
the hard work of trying toset up a formal structure
for leadership for APPsin their organizations.
If we use Stanford as a case study
to reflect on thesethree important things,
how are we handling theissue of aligning APPs
with organizational goals?
- I think we have done an incredible job
(21:02):
in the last 10 years, I would say,
in being more intentionalabout advanced practice.
Let me just start with, itwasn't always like that.
I will say back in 2017, our turnover rate
for our advanced practiceproviders was at 18%,
well above the nationalturnover at that time of 12%,
so here we were hiring and growing,
(21:24):
it's not good for the people who leave,
it's not good for thepeople who end up staying,
because they're training folks, again,
we knew we were doing somethinguniquely wrong at Stanford,
when it came to advancedpractice providers,
and that's when we decidedwe have to stop this,
we were able to identify thekey drivers that drove burnout
(21:46):
and could drive fulfillment for APPs.
That's where we found role clarity,
top of licensure practice,
and leadership structure andsupport being critical elements
that improve AP practice.
In the last seven years,
that's exactly what we've been doing,
we've been chipping awayat creating AP leads,
AP managers, AP directors,
(22:07):
and just about two yearsago is when we embarked
on this new inaugural role that I'm in
to have a chief advanced practice officer.
Today, our turnover,we've actually dropped it
all the way to 8% during the pandemic
when turnover was high, around 10,
now well below the national average,
which is something we're proud of.
I think organizationsare in different phases
(22:30):
of integrating advancedpractice into their structures
and what we can all learn from each other,
thinking about how toshare best practices,
learn from each other, so wecan continue elevating the role
of APPs in an organization
to ultimately meet theorganization's goals,
best patient care.
- Thank you for elaborating on that,
(22:50):
and sharing what we are doinghere at our institution,
fully recognizing that there'salways room to improve.
I imagine, for theorganization and for you,
when that alignment is happening,it must be so rewarding,
not only because you see the results
in terms of better patient outcomes,
but also in staff engagement.
(23:11):
What are some of the strategiesthat you have utilized
to empower APPs to adaptto some of the changes
that you've made here atStanford over the past 10 years?
- One of our key drivers to that
is our shared leadership strategy.
It's a council that wehave where frontline APPs
come together to identify a problem
(23:33):
that they would like to solve,
and figuring out how theywould like to solve it.
Engaging our clinical teamsand clinical experts to say,
"Where do we wanna focus our energy on,
and how we improve professional practice,
and professional development,leveraging their expertise?",
this shared leadershipstructure is something
that we've adopted fromthe Magnet Philosophy,
(23:55):
it's a really prominent frameworkin professional excellence
and nursing practice,
and we've translated thatto our PAs and APRNs.
They've developed programs thatdirectly support APPs today,
one that I will share isour APP mentorship program.
When we were seeing thatturnover rate of 18%,
(24:17):
we also noted that most ofthat turnover was happening
in the first year of an APPbeing in our organization.
The council and the committeescame together to say,
"Let's develop a mentorshipprogram meant to support APPs
with less than three years of experience
to help them transition to the APP role."
(24:39):
This is a program thathas been so successful
in implementing and helpingAPPs transition to practice,
and it came out of shared leadership.
That's just a great example of
how powerful shared leadership could be,
that has been our engagement source
in the driving turnoverand improving retention
(24:59):
in our organization.
- It's great to hear how theShared Leadership Council
has fostered the sense ofownership and community
that APPs have, and howthis mentorship can support
not only professional growth,but also adaptability.
As we wrap our time together,I'd love to hear from you
what trends in healthcareleadership that clinicians,
(25:21):
especially those who are aspiring
to leadership roles should be aware of.
- One of the major trends in healthcare
that we're seeing is thefiscal responsibility
and fiscal pressures onhealthcare organizations.
When there's this shiftto value-based care,
where our payment models arechanging in many organizations,
(25:41):
as clinicians, we havethe clinical knowledge
to be experts in that space,
and looking at utilization review.
What are the optimal medications
that we should be using right now
with the IV fluid shortage?
Many organizations arefacing challenges here,
and guess who's helpingto solve these problems?
It's our clinicians.
Thinking about just creative ways
(26:03):
of being able to save our fluids.
Similar to that,clinicians have the ability
to think more fiscally, as well,
whether it's in their practice,
or partnering with theiradministrative leader,
let's embrace that healthcaretrend that we're seeing.
I think as clinicians, wecan provide such creative
and invaluable ideas to helpsolve with our administrators.
(26:25):
The second piece that Ithought I'd mention is
the leadership landscape in healthcare,
we are seeing more clinicians in formal,
administrative leadershiproles, which is amazing to see,
we talked a little bit abouteven advanced practice,
and how we're seeing moreleadership structures.
Sullivan Cotter has asurvey that highlights
(26:46):
that 65% of organizations have
formal APP leadershipstructures as an example,
and in fact, 82% ofacademic medical centers
shows that 82% of AMCs alsohave APP leadership structures.
So I just bring that upto say that we are seeing
more and more physicians
and advanced practiceproviders in leadership roles.
(27:07):
We do have to think about how we continue
to educate our team members to ensure
that they have thetraining and the resources
that they need to besuccessful in those roles.
We have to find those resourcesto help bridge the gaps
that we may have to help us get there.
- That's a wonderful placeto end our conversation.
(27:27):
I know we could continue talking,
but I wanna thank you so much for sharing
all of your insights, and I want to end
where we started with your story.
Your story is a wonderfulexample of an APP's journey,
and the importance of takingtime to be intentional
to reflect on what your strengths are,
and what your needs are, andto seek training resources,
(27:50):
and whatever you mightneed to equip yourself
to be a leader withinthis healthcare landscape.
This has been great.
Thank you.- Thank you, Ruth.
- This episode was broughtto you by Stanford CME.
To claim CME forlistening to this episode,
click on the claim CME link below,
or visit medcast.stanford.edu.
Check back for new episodes
(28:12):
by subscribing to Stanford Medcast
wherever you listen to podcasts.
(ambient music ending)
(upbeat music)
- Welcome to Stanford Medcast,
the podcast from Stanford CME
that brings you the latest insights
from the world's leadingphysicians and scientists.
If you're joining us for the first time,
be sure to subscribe on Apple Podcast,
Amazon Music, Spotify, or YouTube
(00:22):
to stay updated with our newest episodes.
I am your host, Dr. Ruth Adewuya.
Today, I will be chattingwith Clair Kuriakose,
who is a distinguished healthcare leader
with extensive experience
in managing advanced practice providers,
and driving performanceimprovement initiatives.
She currently serves as theInaugural Chief Advanced
(00:43):
Practice Officer at Stanford Healthcare,
where she oversees strategic initiatives
for APPs, including nurse practitioners,
physician assistants,clinical nurse specialists,
and certified registerednurse anesthetists.
With a clinical backgroundin pediatric surgery
and a Lean six Sigma black belt,
(01:04):
Clair has shown a proventrack record in implementing
lean management principles toenhance operational efficiency
and improve patient outcomes.
A graduate of St. John's University
with a physician assistant certification,
Clair also holds an MBA
from the University ofHouston's College of Business,
and is recognized as a Fellow
(01:25):
of the American Collegeof Healthcare Executives.
Recently honored as oneof modern health care's
top 25 emerging leaders,
Clair is celebrated forher innovative approach
to healthcare leadership,
and her commitment to improvingthe patient care experience.
Clair, thank you so much for chatting
with me today on the podcast.
- Thank you, Ruth.
(01:45):
Really appreciate this timeto chat with you, as well.
- You have had such a uniquecareer journey in healthcare,
blending clinical expertise
with leadership and management skills.
Could you start bysharing your career path,
and what initially drew youto healthcare and leadership?
- I started my career asa PA in pediatric surgery.
(02:06):
Back in those days,there weren't that many
advanced practice providers,so I was the first PA
to join my surgical team.
I had the opportunity to clarify
the role of what does a PA do,
how do you utilize advanced practice
providers in your care team,
it was challenging, 'causeI was still figuring
that out myself as a new grad PA,
(02:26):
by drawing on my experiencesfrom my clinical rotation
allowed me to say,
"This is how I could beintegrated into the care team."
By doing that, I hadinformal opportunities
where I was asked tojoin different committees
and task forces, throughthose opportunities,
and the exposure that I hadwith these different projects,
(02:48):
it sparked excitement for me
to say "I could enjoy myone-on-one interaction
with the patient, but throughsome of these administrative
or leadership initiativesthat I got to be part of,
I could improve patient care at scale."
For me to transition
to a leadership or administrative role,
I knew I had some gaps.
I looked for opportunitiesby pursued an MBA,
(03:09):
I did some certificationsin Lean Six Sigma,
again to just give me that business acumen
that I knew I didn't havecoming off of PA schools.
In my current role, I leadadvanced practice providers,
that was like a match made in heaven,
finding a leadership role that looked
for a advanced practice provider,
(03:29):
but then also thisinterest in administration
and performance management.
- Thank you for providing an overview
of your career journey, ittruly demonstrates the value
of combining clinicalexpertise with leadership.
I heard you talk about thetrainings that you took
to equip you to navigate this transition,
(03:51):
it's also interesting toreflect on the mindset shifts
that are required when one moves
from individual patient care
to influencing systems andteams at a leadership level,
and that transition canbe quite challenging
for many clinicians,
which leads me to my nextquestion related to that.
(04:11):
How did you personally navigate that shift
from a purely clinical roleto a management-focused one?
- I think it's an important question,
as clinicians think throughif this is a path for them,
just because you're areally great clinician
doesn't mean that you may havethe skillsets that you need
for a leader or administrator,
(04:32):
we have our clinical expertise,
and then there are leadership
in healthcare administrative competencies.
Acknowledging that, forme, that's why I took on
and recognizing theseare some of the gaps,
this is where I could strengthenmy healthcare knowledge
by understanding whathappens on the payer side.
As a PA, when I did step one,
(04:54):
recognizing "This is what I wanted to do",
it was really challenging,
there weren't that manyleadership opportunities
that recognized PAs as someone
who can be qualified for the role.
There were many nursing leadership roles,
or physician leadership roles,
and so it was a little discouraging,
I knocked on so many doors,looking at clinic manager roles,
(05:15):
performance improvement, likequality improvement roles,
and I think it was theuniverse telling me,
"Hey, we need to look at howto diversify your experiences"
so I could be consideredmore eligible and qualified,
it pushed me to go anddiversify those experiences,
and enrich my resume,so folks could see me
(05:38):
as a qualified clinician who could lead,
I'm grateful that itpushed me at that time
to go do those things,but I am hopeful that now,
in this day and age,
these are more recognized in understanding
the clinical role that PAs have,
I hope that PAs don't havethe same challenges I did
back then, but needless to say,
(05:58):
it helped me to be where I am today.
- What I'm hearing yousay is that you had to do
a lot of intentionalreflection and growth,
seeking out how to learn eithernew leadership competencies
or skills that were beyondyour clinical education.
For clinicians who are listening,
who might be considering a similar path,
(06:20):
what advice would you give them
as they think about makingthis kind of career transition?
- One of the things that Ilearned during this process
was that I almost waswaiting for a formal title
or permission to be a leader.
My advice, if you think thisis something that you wanna do
(06:41):
as a clinician, we're already leaders.
As clinicians, we leadour patient care teams,
our patients look to us,
other care team memberslook to us as providers,
leveraging your own clinical leadership
and thinking about how you don't need
a formal title to lead, findthat passion that you have,
(07:02):
if it's quality improvement,
if you wanna improve patient outcomes,
if you wanna improve patient efficiency,
who else better than aclinician with that expertise?
Let's not wait for a formal title,
raise your hand, volunteeron informal committees,
or task forces, whereyou could start doing
some of that work,
(07:22):
and see, first of all,if you really like it,
and two, just startoffering your expertise,
and people will askyou to be at the table.
- That is not only practical,
but empowering advice for folks,
because it's clear that clinicians have
so much to offer in formalor informal leadership roles,
but it's also important to identify
(07:42):
how their own unique skillset can align
with the broader goalsof the organization,
and stepping up to fill in those places
is what leadership is all about.
I want to shift a little bit
to talk about balancing clinical knowledge
and leadership objectives.
In your experience,
how does the need tobalance clinical knowledge
(08:02):
with leadership goalsimpact decision-making
and ultimately, patient care?
- As frontline providers,we understand the workflows,
how things get delivered to patient care,
and how patients visualizeand change in the system,
or that interaction, sothere's no one better
who can influence and make decisions
(08:24):
with that understanding, Imean, how powerful is that?
It's almost a superpowerto have the understanding
of how clinical interaction works,
and then being able to make system-level
improvements and changes knowing that.
To me, I think having aclinician in a leadership role
is an amazing strength
that brings into theentire leadership team,
(08:45):
diversifies the expertiseof that executive team
leading the organization,
but like I said earlier,even then for clinicians,
there could be other gaps,
but you build on those knowledge gaps.
Relying on the partnerships,
having, creating diadic leadership styles,
where there's an administrator
and a clinician working closely together
(09:07):
to impact whatever changes
you're making in the organization,
that's when I believethat you're really able
to leverage each individual superpower,
and make informed decisionswithout breaking anything.
Just leaning into that to close the gaps,
and making sure thechanges and initiatives
that organizations areleading are meaningful,
(09:28):
and making a positiveimpact on patient care.
- You bring up a greatpoint about the balance
between how leadership roles in healthcare
are not just about operational efficiency,
but really staying connected
to the impact on patient outcomes,
and ensuring that you have bothof those voices represented.
When you are making decisions as a leader
in your current role,
(09:49):
do you rely on any particulardecision-making framework
or set of principles
to guide you when you'remaking tough decisions
that impact clinical staffand patient outcomes?
- One framework that Italk about with my teams
is the quintuple aim.
We have this charge as clinicians
to improve clinical outcomes,to improve patient experience,
(10:14):
but also improve clinician being.
We're being charged to do that
along with improving health equity,
and creating a sustainablefinancial model.
I love this framework,because it speaks to everyone,
it speaks to patients.
Why are we all clinicians?
We're here to serve patients,so we want better outcomes,
(10:34):
we want our patients tohave a positive experience
as they're getting care, soI think that really speaks
to both the patient and the provider,
and clinician being, thisis saying that the workforce
that provides the care for our patients
needs to be taken care of, as well.
Again, bringing administration
and clinicians together, bysaying we have to take care
(10:56):
of those people, and then recognizing
that the creating asustainable financial model
is important to be ableto continue providing
that amazing care for our patients,
along with health equities.
The quintuple aim allows meto frame my decision-making,
deliver the message, andconnect with clinicians,
and other team members to say,
(11:17):
"Look, this is how it's making
a meaningful impact on patients."
Connecting it back to the framework
helps better implement the messaging.
- I appreciate how youuse the quintuple aim
as a decision-making framework,
but if I can push in a little bit on that,
how do you ensure that this framework
is not only a guiding principle
(11:39):
but actively shapes the culture
in your daily decision-making?
- Organizations have different ways
of taking this big quintuple aim,
and executing it in their organization.
Many have strategic plans
that may be spread overone to three years,
they all somewhat have thesame thing on there, right?
(12:00):
Quality and safety,patient access, efficiency,
wellness and engagement,
'cause that's a huge partof the workforce strategy.
So the principles from the quintuple aim
is what I find in manyorganizations' operational plans,
and that allows leaders and clinicians
within an organization to know
(12:21):
how are things prioritizedfor that organization,
for that specific year,
taking that big quintuple aim,
and then applying it tothe operational plan,
creating vision of whatthis next year looks like,
here are the priorities,
and then informing andsocializing that plan.
- Thanks for that additional insight.
(12:43):
In your role, you are quite aware
of how the healthcare industry,
and how healthcareorganizations shift so rapidly,
and face uncertainty.
What leadership qualitiesdo you believe are essential
for clinicians to thrivein this environment?
- The top three that cometo my mind is number one,
(13:04):
being goal-driven.
It's easy to not know whichproblem you're solving,
you have to understandone, what is the problem,
and then, therefore, what arethe outcomes you're expecting?
As a leader, we have to take a step back,
and think about the overall impact,
so I would say beinggoal- and outcome-driven
(13:25):
is a wonderful skillset to have.
Number two is ability to influence.
Leadership is not aboutauthority, it's about influence.
Bring people along, make it their idea,
get their involvement, sothey're excited about it,
and last, communication.
When we say communication, it'snot just about what you say
(13:47):
and how you say it, sometimesit's about how you listen,
so you can communicate effectively.
These three stand outto me to be effective,
and gain the trust of theteams that you're working with
to hopefully make an impact.
- You highlighted someimportant attributes
that would really behelpful in the dynamic field
(14:09):
that we are in healthcare.
I loved how you highlighted communication,
and not just the ability to speak well,
but the component of listening,which, as you mentioned,
is really the more importantpart of communication
that we often miss,
and how all of the threequalities play a significant role
in unifying diverseteams, developing skills
(14:32):
in other people, and can really help
with the clinicians' transitioninginto leadership roles.
One of the things that Iimagine you face all the time
being an administrator,
but also working with a lotof clinicians is the fact
that you might come froma different mindset.
How do you bridge the gap
(14:53):
and encourage a balanced perspective
considering patient carein operational efficiency?
- It goes back to leveragingindividual expertise.
Oftentimes, how you see this played out is
having formal diadicleadership structures,
or sometimes even triads,whether it's an administrator
(15:14):
and a physician, oradministrator and a nurse,
administrator and anadvanced practice provider,
finding the ways to havea leadership structure
that is informed wellenough to make adequate,
appropriate, and safe decisionsthat impact patient care,
it is about leaning intothose relationships,
(15:36):
even if it doesn't formally exist,
knowing when to bringthose people to the table.
Oftentimes, we have to recognize
that the healthcare landscape has changed,
it's really more aninterprofessional environment,
think about the variousclinical disciplines
that need to be voiced,leaning on those experts,
(15:57):
and bringing them to the table as needed
is an important part ofbalancing those challenges.
- I wanna make surethat we spend some time
talking specifically aboutadvanced practice providers.
Advanced practice providersoften have unique roles
within clinical teams.
What unique perspectives and values
do advanced practice providersbring to patient care,
(16:21):
and what direction doyou see the role heading?
- I go back to the quintuple aim.
It's about improving patient outcomes,
it's about improving patient experience,
and, to me, that's access.
That is being able to reach
and give our patients the best care
that they need in a timely fashion,
and also the otherelements of health equity,
(16:42):
and financial sustainability,and clinician being,
I also feel like advancedpractice providers
have the ability to workin these remote settings,
and help our providerreach health disparities
that are happening in our communities.
Advanced practice providers are growing,
and they're a huge complimentto the provider workforce,
(17:04):
so we can continue enriching
and providing the bestcare for our patients.
I also think it's really awesome to see,
there's many studiesout there that highlight
how having an advancedpractice provider in your team
has improved physician wellbeing.
It's this evolution of healthcare
changing from this doctor-nurse model
(17:24):
to truly a team-based care model,
and you get to share the burden
with other interprofessional team members,
and that itself is beautiful,
and really recognizing that as a team,
we can achieve so much more.
I think the Bureau of Labor and Statistics
actually predicts abouta 45% growth for of NPs,
(17:45):
and 25% growth of PAssomewhere around that ballpark
in the next 10 years, so it'sa rapidly growing workforce.
Organizations are recognizingthe value that APPs bring,
it's just this evolution of healthcare,
and where we're headed,
and I think as we're justseeing this larger, rapid growth
of APPs within the systemsand healthcare teams.
(18:09):
- Evolution that youdescribed is really exciting,
particularly as APPs take onthese expanded clinical roles,
and also thinking about their ability
to bridge gaps between disciplines,
and be relevant towardsthe healthcare landscape
as it continues to evolve.
I'm curious though about managing
and aligning these roles
with broader healthcareorganizational goals,
(18:31):
because I imagine that itrequires a nuanced approach.
How do you approachthe management of APPs,
particularly when you're trying to align
their clinical strengthswith organizational growth?
- I'm so glad you asked, Ruth,
'cause I think that is a question
that I would encourage organizations ask.
(18:52):
This is a rapidly growing workforce,
and we all need to evaluate,
are we set up for thisworkforce to continue growing,
and being successful within your systems?
Many of our systems andleadership structures are built
based on our understandingsof what the provider workforce
looked like ages ago,
(19:13):
you do have to be moreintentional about the structures
that you need in a healthcare organization
to support this rapidly growing workforce.
Otherwise, you're gonnahave the same problem,
burnout, turnover,challenges in meeting access
if we're not appropriatelyutilizing the roles,
all of the functions
that the advanced practice provider role
(19:34):
is meant to solve for cannoteven happen if we don't utilize
or understand the role appropriately.
How is an organization or ateam structured to help provide
the support they needfor this new workforce
that's rapidly growingwithin healthcare teams?
Top of licensure practice goesback to really and end role,
(19:57):
we have to be intentional in finding
that exact unique role
that APPs play within the healthcare team.
I encourage organizationleaders to do that,
so they can create a professionallyfulfilling environment
that has a strong APP workforce,
that is meeting thenyour organizational goals
(20:19):
of improving access,complementing team-based care
to improve patient experience,working collaboratively
with our physician colleagues
to make sure you're delivering
the best collaborativecare for your patients.
- We are fortunate at Stanfordthat we have someone like you
as a Chief Advanced Practice Officer.
Not a lot of organizationshave the same role.
(20:40):
I do know that a lot oforganizations are doing
the hard work of trying toset up a formal structure
for leadership for APPsin their organizations.
If we use Stanford as a case study
to reflect on thesethree important things,
how are we handling theissue of aligning APPs
with organizational goals?
- I think we have done an incredible job
(21:02):
in the last 10 years, I would say,
in being more intentionalabout advanced practice.
Let me just start with, itwasn't always like that.
I will say back in 2017, our turnover rate
for our advanced practiceproviders was at 18%,
well above the nationalturnover at that time of 12%,
so here we were hiring and growing,
(21:24):
it's not good for the people who leave,
it's not good for thepeople who end up staying,
because they're training folks, again,
we knew we were doing somethinguniquely wrong at Stanford,
when it came to advancedpractice providers,
and that's when we decidedwe have to stop this,
we were able to identify thekey drivers that drove burnout
(21:46):
and could drive fulfillment for APPs.
That's where we found role clarity,
top of licensure practice,
and leadership structure andsupport being critical elements
that improve AP practice.
In the last seven years,
that's exactly what we've been doing,
we've been chipping awayat creating AP leads,
AP managers, AP directors,
(22:07):
and just about two yearsago is when we embarked
on this new inaugural role that I'm in
to have a chief advanced practice officer.
Today, our turnover,we've actually dropped it
all the way to 8% during the pandemic
when turnover was high, around 10,
now well below the national average,
which is something we're proud of.
I think organizationsare in different phases
(22:30):
of integrating advancedpractice into their structures
and what we can all learn from each other,
thinking about how toshare best practices,
learn from each other, so wecan continue elevating the role
of APPs in an organization
to ultimately meet theorganization's goals,
best patient care.
- Thank you for elaborating on that,
(22:50):
and sharing what we are doinghere at our institution,
fully recognizing that there'salways room to improve.
I imagine, for theorganization and for you,
when that alignment is happening,it must be so rewarding,
not only because you see the results
in terms of better patient outcomes,
but also in staff engagement.
(23:11):
What are some of the strategiesthat you have utilized
to empower APPs to adaptto some of the changes
that you've made here atStanford over the past 10 years?
- One of our key drivers to that
is our shared leadership strategy.
It's a council that wehave where frontline APPs
come together to identify a problem
(23:33):
that they would like to solve,
and figuring out how theywould like to solve it.
Engaging our clinical teamsand clinical experts to say,
"Where do we wanna focus our energy on,
and how we improve professional practice,
and professional development,leveraging their expertise?",
this shared leadershipstructure is something
that we've adopted fromthe Magnet Philosophy,
(23:55):
it's a really prominent frameworkin professional excellence
and nursing practice,
and we've translated thatto our PAs and APRNs.
They've developed programs thatdirectly support APPs today,
one that I will share isour APP mentorship program.
When we were seeing thatturnover rate of 18%,
(24:17):
we also noted that most ofthat turnover was happening
in the first year of an APPbeing in our organization.
The council and the committeescame together to say,
"Let's develop a mentorshipprogram meant to support APPs
with less than three years of experience
to help them transition to the APP role."
(24:39):
This is a program thathas been so successful
in implementing and helpingAPPs transition to practice,
and it came out of shared leadership.
That's just a great example of
how powerful shared leadership could be,
that has been our engagement source
in the driving turnoverand improving retention
(24:59):
in our organization.
- It's great to hear how theShared Leadership Council
has fostered the sense ofownership and community
that APPs have, and howthis mentorship can support
not only professional growth,but also adaptability.
As we wrap our time together,I'd love to hear from you
what trends in healthcareleadership that clinicians,
(25:21):
especially those who are aspiring
to leadership roles should be aware of.
- One of the major trends in healthcare
that we're seeing is thefiscal responsibility
and fiscal pressures onhealthcare organizations.
When there's this shiftto value-based care,
where our payment models arechanging in many organizations,
(25:41):
as clinicians, we havethe clinical knowledge
to be experts in that space,
and looking at utilization review.
What are the optimal medications
that we should be using right now
with the IV fluid shortage?
Many organizations arefacing challenges here,
and guess who's helpingto solve these problems?
It's our clinicians.
Thinking about just creative ways
(26:03):
of being able to save our fluids.
Similar to that,clinicians have the ability
to think more fiscally, as well,
whether it's in their practice,
or partnering with theiradministrative leader,
let's embrace that healthcaretrend that we're seeing.
I think as clinicians, wecan provide such creative
and invaluable ideas to helpsolve with our administrators.
(26:25):
The second piece that Ithought I'd mention is
the leadership landscape in healthcare,
we are seeing more clinicians in formal,
administrative leadershiproles, which is amazing to see,
we talked a little bit abouteven advanced practice,
and how we're seeing moreleadership structures.
Sullivan Cotter has asurvey that highlights
(26:46):
that 65% of organizations have
formal APP leadershipstructures as an example,
and in fact, 82% ofacademic medical centers
shows that 82% of AMCs alsohave APP leadership structures.
So I just bring that upto say that we are seeing
more and more physicians
and advanced practiceproviders in leadership roles.
(27:07):
We do have to think about how we continue
to educate our team members to ensure
that they have thetraining and the resources
that they need to besuccessful in those roles.
We have to find those resourcesto help bridge the gaps
that we may have to help us get there.
- That's a wonderful placeto end our conversation.
(27:27):
I know we could continue talking,
but I wanna thank you so much for sharing
all of your insights, and I want to end
where we started with your story.
Your story is a wonderfulexample of an APP's journey,
and the importance of takingtime to be intentional
to reflect on what your strengths are,
and what your needs are, andto seek training resources,
(27:50):
and whatever you mightneed to equip yourself
to be a leader withinthis healthcare landscape.
This has been great.
Thank you.- Thank you, Ruth.
- This episode was broughtto you by Stanford CME.
To claim CME forlistening to this episode,
click on the claim CME link below,
or visit medcast.stanford.edu.
Check back for new episodes
(28:12):
by subscribing to Stanford Medcast
wherever you listen to podcasts.
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