September 15, 2021

Episode 58: Closing the education-practice gap in nursing

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Podcast

Description

Our guest for this episode has spent his entire career in healthcare education, trying to close the gap between education and practice and give clinicians and healthcare leaders the skills they need to be successful. 

Today, Geoffrey Roche is a Senior Vice President at Dignity Health Global Education, where he helps create professional development and higher education programs that are shaped by the current, real-world needs of hospitals. 

In his conversation with Dan, Geoffrey shares the latest themes that he’s seeing in academia and healthcare leadership, what today’s nursing students are looking for from their education, and why the healthcare industry needs to do more to foster and engage the next generation of leaders. 

Links to recommended reading: 

Podcast

Transcript

Dan:
Geoffrey, welcome to the show.

Geoffrey:
Thanks, Dan. Glad to be here.

Dan:
Awesome. Let's get a high-level 30,000-foot view of your story and how you landed at your new role at Dignity.

Geoffrey:
Sure. Obviously, I always say I'll first start out that I'm the son of a nurse. Didn't ever think I would get into healthcare early in my career, but obviously, the influence of a nurse was pretty profound early on. Started in healthcare, was in hospital administration for nine years, really worked my way up into a multi-functional director role who generally was on the administrative side, but did actually have some clinical leadership, particularly in the oversight of emergency medical services when we acquired an emergency medical service agency. Then really, after nine years, made a transition into education from the vantage point of what I learned in hospital administration around education really needed to do a better job on the workforce side of helping prepare, not just clinical, but also leaders within healthcare, and have done that over the past three years. Just recently was recruited to Dignity Health Global Education as the senior vice president in the workforce development area, as well as with a strong focus on building partnerships to help address not just workforce challenges, but hopefully also workforce solutions.

Dan:
Awesome. Let's dig into that a little bit more. I hear "workforce solutions," and that can have a lot of different names, from the worst connotation of, "Hey, we're going to reorganize the entire thing and people will be shifted around and furloughed and all that bad stuff," to, "Hey, we're actually building partnerships with different education institutions, different clinical people, different non-clinical people, actually create a pipeline of talent to build the future of our organization." What's the focus of your role and which end of the spectrum are you on?

Geoffrey:
Yeah. I think it's important to highlight the fact that Dignity Health Global Education was founded in many ways by CommonSpirit Health, which as you know is one of the largest not-for-profit faith-based institutions in the country. But the goal is not just to support CommonSpirit. In fact, the goal all along is to support all of healthcare, which you know is broad, and so my functional role within the organization really looks at the idea here, to your point, that we have phenomenal academic partners that we brought to the table, like Duke, like Arizona State, Northern Arizona University, among others. We want to ensure that when it comes to healthcare education that we're partnering with not only the best institutions, but more importantly, that we're always threading the needle with listening to healthcare experts, whether they're current or retired. We bring them in throughout the entire curriculum development to the refinement of how courses are developed.

Geoffrey:
I think that's where I get to the solution side. I think as you know, oftentimes in academia, academics, while they're wonderful, will develop what they think are the right courses for healthcare or other industries, but they don't always have that exact background. Maybe they had it one day, but they don't necessarily have it today, and that's really where we have to make the move where we continue to really ensure we're getting a diverse audience and voices at the table. I look at it, if you're going to create a nursing program, you've got to have a diverse group of nurses. Don't just bring in administrators in, have nurses at the table so that it's literally developed for nurses by nurses.

Dan:
Yeah, I was remembering back to, I think it was like 2017, I think I gave a presentation to the American Association Colleges of Nursing. I had a picture in that slide that was the academic-practice gap and it was two buffaloes smashing heads in full speed because there is such a disconnect between what happens in the ideal academic world. I was just at Arizona State leading some faculty stuff, too, and we had the same conversation, what happens in the academic world, and then this gap where these students come out of school and they have to almost be retrained or given a different set of skills before they're even productive in these health systems. That gap is sometimes a year or longer and that just not meeting the dynamic needs of health systems and the employees and the clinicians are feeling like they're kind of spinning for that year, too, so it's great to hear that there's more intentional partnership there.

Dan:
How do you go about those conversations? Because in my experience, academia sometimes is like, "Well, we know that happens in real world, but we got to teach it to this thing and this thing," and operation side is like, "We're trying to tell them things where you can't translate it in any way. We don't know anything about education," so how do you broker those conversations?

Geoffrey:
Yeah. Well, I think as you know, first it comes down to the relationship side. I'll give you a real-life example to your exact point of the buffaloes colliding. When I was in a hospital setting as an administrator, we were facing those real-life examples. This is only back in 2017, in 2016, and so on, facing these real-life examples of having wonderful academic partners, wonderful programs in many cases, but not necessarily producing the right clinical skills that were absolutely needed for the student nurses to be ready day one. In that circumstance, fortunately for us, we had a hospital CEO who was a nurse, so she could speak very personally to it, but also professionally, and we actually worked with them to redo the curriculum. We brought leaders in, bedside nurses from all the different elements of the health system, and we worked with them to redo their curriculum.

Geoffrey:
As you know, sometimes when you redo the curriculum or look to innovate the curriculum, faculty don't always like that. But what it comes down to and how I've always approached it is it's a partnership. They are experts without question in their field, but sometimes in academics, they get more focused on research, they may get more focused in writing. They may just be awesome educators, but when it comes down to it, you got to have partners who are willing to help customize, willing to help ensure if it's online that that online program is effective, and truly, when it comes down to it, you got to give them the data. We all know faculty just like clinicians and other members of healthcare like data. We've got to help them understand, "Look, if you want your program to stick out and be recognized within the healthcare field, which we know in most communities is the largest employer, then this is your opportunity. Imagine if that's your imprint that you leave. That's an amazing opportunity." That's usually how I've always approached it.

Dan:
Yeah, and it boils down to content, which academia has a lot of, and context, which the health systems have. Combining those together, you have a superpower program because you've now combined the two edges of the system into something that's really value-added, it's contemporary, and it's preparing people for now in the future instead of what we've done for a million years, which hasn't always been working.

Geoffrey:
Yeah.

Dan:
Yeah. I love that. I love that mission. Now, in the program that you lead, is it just clinical education programs, or does it go beyond?

Geoffrey:
No, it goes beyond. I mean, we have everything from what you call your "stackable certificates credentials" to certainly more of a clinical focus. Mercy College of Health Sciences, which as you know, is in Iowa, they're part of our network, and so in fact, they have an online, fully accredited CCNE RN to BSN as well as allied health programs, and so we have that, but then obviously, even at the master's level, we have more of your leadership administrative type programs as well.

Dan:
I would say there's a definitely need for leadership education in healthcare. I know you used to teach in a healthcare-focused MBA program. What were some of the things that drew students to get an MBA specific in healthcare? What skills were they looking to develop that they didn't feel they had or that they couldn't learn on the job that they had?

Geoffrey:
Having been an instructor in an interdisciplinary program, which included an MBA, MHA, and then ironically, even nurse practitioner students because of the course that I taught, which was fascinating, the spectrum always was very different because obviously, most of them were coming at it very differently, whether they were clinical or nonclinical. But in general, what I often found was there was a burning desire to understand not only how they could lead or be a future leader, but how they could improve the healthcare system. Obviously, that can be really, as you know, challenging, because healthcare, while it should be all about people, I think has in many cases lost the human-centered approach at times and we've got to get that back into every element of interpersonal interprofessional. Whether we're serving patients or we're serving one another, we've got to have those human-centered components.

Geoffrey:
Then I would also say that in general, too, there was always a burning desire to understand when they heard the buzzwords "transformation," what did that exactly mean to them within the environment that they were in? Oftentimes, it was this idea of, "I'm working on a team. I need to understand how we can move something forward. My healthcare system hasn't necessarily been the one to adopt how we do that, but hey, can you help me understand how I may be able to do that? Because I know that it's the right thing and it's the right initiative that's going to improve patient outcomes."

Dan:
Yeah, that's right. I think in healthcare, a lot of people grow up on the job and they learn leadership from the person they took the role from, or from a mentor that also got promoted up through, but formalizing the content of leadership and the science behind leadership, I think people, they underestimate how powerful that is. I've seen transformations of people going through programs specifically on leadership, that it just changes the whole way they interact with people, and I think we need more of that, so I'm excited that your program has the leadership stuff because a lot of times, especially in nursing, we just promote the good clinician to be the nurse leader and the nurse manager and then they get up to the CNO and they've never really been coached or had formal leadership training, so I think it's a huge gap in healthcare.

Geoffrey:
Yeah. Dan, it's an interesting point you bring up because my first CEO was a nurse, and when I look at the work and what I learned from her while also, I had an interesting reporting relationship because I had a dual reporting to the CEO who was a nurse and then senior VP who was much more on the nonclinical leadership side of healthcare, but I always tell people it was the best situation for a young professional in healthcare to be in because I had a seasoned leader who literally started as an emergency room nurse in New York City who made her way early on in her career throughout her career as a woman and a nurse who made it, obviously, into the top spot in a healthcare system while it always was doubted because she was a woman and she was a nurse. What she taught me was so profound in that we're here to serve and if people are in our way, we're going to remind them we're here to serve and we're going to box them out because our commitment is to the community and our commitment is to the patients.

Dan:
I mean, that's such a powerful statement. I'm like, "I resonate with it," because it's literally part of the professional practice guidelines of nurses, which is your commitment as a nurse is not to the health system, necessarily, it's not to your employer, it's to the population and the community.

Geoffrey:
Yep.

Dan:
I think if you embody that, it changes your whole perspective, then all the noise that happens, the drama that happens within systems, it remains just that, it's just the drama within systems. If you have this calling to improve the lives of the community you're in, the community you serve, it's just an awesome perspective. I also want to make sure that our listeners hear that the nurse was the CEO, not the CNO, not...

Geoffrey:
Yep.

Dan:
I mean, there's a number, Kaiser Permanente, Greg Adams is a nurse as well and he's the CEO of Kaiser Permanente, so nurses can really go anywhere. I think they build the partnerships with the awesome, focused, other supporters in the room. It doesn't always have to be a clinician that can lend a lot of perspective there, so that's really awesome. As you've taught and as you're building these programs with academia as well, what are some of the themes of content that you're seeing change and evolve that are coming out of these conversations that you're having?

Geoffrey:
Without question, you never can talk about any academic today in healthcare without the continued themes that we've known of, but unfortunately, the death of George Floyd brought up these issues of systemic racism, I think not only societally, but even started to again, raise the alarm even in healthcare, I think without question, issues like systemic racism, but also health equity. I think the COVID-19 pandemic has further highlighted that.

Geoffrey:
Those issues, which we know have been around for quite some time, have just been further amplified in this situation. But I think also as we're seeing, particularly given the workforce challenges that we're seeing across the country, because of this really tumultuous experience that so many people have had to face in dealing with a pandemic and how it's been handled in many cases, we see that element of, I think people are hungry for, they want to see that trust is there within healthcare, that their leaders are trusting them to not only do the right thing, but to be the best that they can be at the time that they're in, and that they have that support behind them.

Geoffrey:
Going back to some of, I hate to say "the basics," but when we talk about, as you know, Dan is as leading others, you can't do that if there's no trust and you can't do that if you haven't created that psychological safety. I look back in my career with my CEO and that was the most important thing to her. I think a lot of that was because she was a nurse. She always thought of everything through the lens of a patient and the way she led her team was the way she served her patients and so her approach with me was all about, "Look, my job is to help you grow, help you succeed just as I would be to help my patient get better," and so I think you're seeing a lot of that get threaded back through.

Geoffrey:
I would also say that idea of leading through a tumultuous time or a turbulent time, here we sit with so much attention on our healthcare workforce and particularly nurses throughout this pandemic, yet then you again hear how people are treating nurses once again, whether it's administration or even patients. They said all throughout the pandemic, "They're so wonderful." They are wonderful, but then I hear stories of how nurses are getting treated again, and so these types of topics, these disruptions make it challenging. But I think in academics, we have a responsibility to make sure that not only are we educating on these topics but that we're really lifting up these topics in a way that can have a difference and an impact, not only in each student but also in each sector.

Dan:
Yeah, I think you bring up a couple of good points there. One of them is leadership is influencing people. In order to do that, you have to number one, be connected to them, which means you can talk to them or relate to them in some way. Then the second piece is the relationship, which is really the trusted communication. If you go on LinkedIn, I can connect with a lot of people, but I probably have a couple of dozen really trusted relationships that I feel I can give honest information in a two-way sense. Those two things, I think, lead to that's the secret sauce of leadership. I remember one of my mentors, Tim Porter-O'Grady used to say, "Leadership is 90% relationships and 10% everything else." I think people underestimate that. I think people think leadership is being able to do a budget or an ROI project plan or whatever. It's how you show up, it's how you communicate, and how you can help convince and influence people to do things that they never thought possible.

Geoffrey:
Yeah, and I think that's what we need so much more of when it comes to leadership in healthcare is we can't ever forget the people side of it. My former CEO used to say to me all the time, "It doesn't matter whether you're a doctor or a nurse, you get up in the same way every day and should be called to serve. It shouldn't matter what your title is, what your position is. It doesn't matter whether you're clinical or nonclinical. You're here to serve and that means serve everyone equitably."

Dan:
Yeah. I love that. It's about the team and the egos and stuff need to be pushed aside in many cases because it just gets in the way of pure teamwork. I know that you are passionate about lots of things, from startups to technology, to education. You have such an awesome background. I mean, we could probably chat for hours, but one of the things that you're interested in is the generational frictions that happen in healthcare. Talk to me more about your thinking there and maybe some things nurse leaders or healthcare leaders can do to help address that.

Geoffrey:
I always say that in my opinion, there's a lot of challenges in healthcare, but without question, this is most certainly one and certainly one that I hear from my students and certainly one that I hear from colleagues within healthcare. I can recall even facing this myself at a time when I was the youngest director in our healthcare system. People would doubt you, they would doubt you not only on age, they sometimes without you even on your cultural or your ethnic background. We've got to address these things because let's be honest, I mean, when you look at how much true succession planning occurs in healthcare systems, there's got to be a whole lot more if we're really going to be prepared for the healthcare leadership of the future.

Geoffrey:
When we look at these issues alone, we're not truly celebrating all the generations within healthcare. We're not lifting different groups and communities up and we've got to really start to think about that. I mean, you look at nursing alone. I mean, sometimes within the first, second, or third-year nurses are leaving the profession. A lot of times it's because they haven't been listened to, they haven't been lifted up. They haven't been empowered or supported by their leaders. I look at that as, "That could've been a future chief nursing officer. That could've been a future chief executive officer." We've got to be mentoring and empowering and coaching everyone because from my vantage point everyone should have an opportunity to be that future leader. I know I wouldn't have been if I didn't have that mentor who cared so much about me. Having managed different generations, it's taught me a lot about how even though I was the youngest in many cases, I could still be an effective leader if I listened to them, if I heard their concerns, and did the best that I could to help them in a very team fashion.

Dan:
I think you're right on there. There's this history in healthcare of putting your dues in before you're recognized as a contributor. It happens on the clinical side, for sure: "Oh, you've only been a nurse for two years. You can't tell me what to do." But what people don't realize is years of service do not equate directly into the value you add to your position.

Geoffrey:
Yep, exactly.

Dan:
We have to recognize that. That's why I always love the new graduates, whether they're MHAs or interns or new nurses or whatever, they just bring this excitement and this new skillset. Then a year later, you go talk to them again, it's been squashed out of them. There's just such an opportunity to elevate that and bring them on as a team player with knowledge that the rest of the people in this system may have, especially around technology and cultural and connecting through social and all these other things that existing leadership may not have. It's not about making them the way you are, it's about learning from them and building the next generation of the organization.

Geoffrey:
I think every healthcare system really needs to think about how you build a community around that, how you truly authentically build affinity groups in a way where it doesn't matter, every senior leader needs to be more open and engaged in a way that they're thinking that every member. Doesn't matter. Frankly, it doesn't matter, even if you start in housekeeping, you could be the future CEO or CNO if you choose the clinical route, COO, it doesn't matter. You got to be thinking about this truly from empowering the next generation of leaders.

Dan:
Yeah. There are stories where that's true. I know people watch movies where that happens, there's The Housemaid or whatever, the one that Jennifer Lopez is in or whatever, The Maid. Bernard Tyson, who was the previous CEO of Kaiser Permanente, he started in the mailroom. He started in the mailroom in Oakland, California, and became the CEO of an $85 billion company. It happens and it's about driving connection and opportunity. I think he had a number of leaders along the way that helped raise him up and make him feel heard and I think we could do a lot more of that, especially in times of crisis where we're literally all on the same team and there's no room for this other junk in there.

Geoffrey:
Well, and to your point, the keyword was he was raised up. There were actually people who invested in him and that's where I think whether you're a nurse or you're a nonclinical professional or leader, there has to be people who care about raising people up. If they are not, as far as I'm concerned, they don't belong in leadership.

Dan:
Yeah. Well, that's a whole nother topic we could go on down, the idea of the toxic leader. I wrote a chapter about that in my last book, and yeah, that's a whole nother thing. But I was just speaking with Lisa Wolf. She's a director at the Emergency Nurses Association, really doing a ton of research on organizational violence, not just violence from people coming in and hitting people and that kind of stuff, but the lateral violence, the hierarchical organizational violence that happens in organizations as well. It's 100% leadership and what she's finding is it literally impacts patient outcomes. We kind of just dismiss that, we're like, "Well, that leader is how they are. Oh, they're cranky today or they're mean, or whatever. You just got to deal with it." I think my call to action with her was we need to be treating true toxic leadership as intentionally as we treat all these falls and HAPUs and all the quality indicators that we have within healthcare system, leadership has that same impact on not only your workforce but also your patients. I don't think we take it seriously enough yet.

Geoffrey:
No, you're right. I always look at it from the vantage point within our society. We have to think about how every conversation can lead to a positive or a negative outcome, and I think when we think of organizational violence, we really have to think about that, especially in these times, these days.

Dan:
You're relatively new in your role. What's your vision for the future of the Dignity Health Education program and what are some of the key outcomes that you're looking to achieve?

Geoffrey:
Yeah. I'm really excited about the fact that not only do we have top-ranked academic partners, but that CommonSpirit really also shares this vision as I do for diversity, equity, and inclusion. One of my absolute missions and goals really is to ensure that as we think of education, we always think about it through those lens, particularly in healthcare, and we look around our whole country's workforce in healthcare, not only at the C-suite, but at all levels of leadership, but also even at the most important aspects of whether it's nursing, whether it's housekeeping, whether it's billing, whatever it may be in healthcare. We've got to diversify our workforce and I'm really excited that we're going to continue to work towards that. We have this awesome opportunity right now for Equity Impact scholarships that certainly can help towards that, provide individuals who may not have had an opportunity to earn an RN to BSN, earn a master's degree, earn a certificate at a very, very low cost or even potentially full scholarship because of the commitment that we have for equity that may not have had that opportunity ever before.

Geoffrey:
Some of the other things that particularly come to mind is that we've got to be continuing to think of the full continuum of healthcare, and particularly in the education space, I think oftentimes yes, we're very focused in the acute care space, we should be, but we've also got to be really focused in both prehospital and also post-acute, and so really thinking about what we do in a very, not only strategic, but in a way where we listen to the community, listen to the providers, listen to the clinicians, and ensure that we're providing them customized education training and workforce development that not only meets the needs of today but also is prepared for the future because we know we have an aging workforce, but we also know we have aging patients and consumers, and so we've got to be ready.

Dan:
Yeah. I love that. I think it's so needed. Again, the workforce should mirror the population you're serving so that you have your representative and understand what's going on. We've had a bunch of podcasts about that with some leaders on it as well and being intentional about it, I think, is key. I'm curious also, you mentioned at the beginning that this isn't to drive a pipeline for CommonSpirit or Dignity, this is really to influence the system. Tell me more about the thinking behind that.

Geoffrey:
Yeah, no, absolutely. Yeah, this is all about influencing the system. When it comes down to it, obviously, there's $3 million in these scholarships now, but the intention is that this will grow over time. To be honest, CommonSpirit shares this commitment, obviously, Lloyd Dean is the CEO of CommonSpirit, that we've got to really be sensitive to, if we're going to address issues of health equity, we've got to have clinicians and even other members that look and understand our patients, where their needs are at, and that comes down to diversity, equity, and inclusion, so that commitment is absolutely profound, and so they've really worked to thread that into all aspects of the healthcare system. Obviously, that's a work in progress and it's frankly, something that needs to happen each and every day, and especially in a large healthcare system, it does.

Geoffrey:
But even on the education side, we've got to do the same thing. We all hear of equity issues in education, and so for us, it really comes down to this is a unique opportunity where literally a nurse who may not have had this chance before could literally earn RN to BSN fully online for zero out of pocket. When you think of what that could mean for that nurse, for their family in the future, just that opportunity where they've been wanting to do this, they haven't had the chance to do it, it gives you goosebumps as far as I'm concerned because I look at it as the son of a nurse, the work my mother did all these years to think of someone else that could have that impact.

Dan:
Yeah, it's amazing. Those opportunities change lives. I had the opportunity to have my tuition paid for by working at Arizona State and get my master's and PhD for free and it was life-changing. I don't think I ever would have done it if I had to pay out of pocket for it. As a practicing nurse, I was working full-time as we went through it and all that, so I think those opportunities are huge and it's really exciting to see that happen.

Dan:
It was a similar mission with the med school that Kaiser did. People thought, "Well, you're just going to create more Kaiser doctors." That wasn't the case. It was taking something that we know is transformational for people and families and generations and developing a program around it and trying to change the world by putting a differently trained clinical expert out into the world and I think it sounds like a very similar kind of pathway here.

Geoffrey:
Absolutely.

Dan:
Oh, man. Well, we could talk all day. We should have you back on, too, and dive more into the leadership stuff and the startup stuff, too, because I know you're involved with lots of pieces there. Where can people find you and more information about the Dignity health programs and your thought leadership in this space?

Geoffrey:
Yeah, absolutely. In terms of finding any information about DHGE, all they have to do is go to dhge.org. They'll find information on all the programs, but they'll also find information about the Equity Impact scholarship. Obviously, there's opportunities to connect with me on there as well. Without question, individuals can find me on LinkedIn as well. The thing I'd want to say, Dan, is that I'm always happy to talk to anybody about anything related to healthcare because I always truly believe we've got to be all in this together and we've got to truly be thinking about what we do collectively for the future. We're in for some challenging times if we don't truly address not only the workforce of the future in healthcare but also the leadership side of healthcare.

Dan:
Yeah. I couldn't agree with you more. Just to note, Geoffrey is on LinkedIn a lot. He posts a lot, he comments a lot, and so that's a great place to engage, actually, both of us on there about any topic related to healthcare. In my experience, nothing's off-limits with you Geoffrey, either. You're willing to take the hard questions, too.

Geoffrey:
Absolutely, happy to. I also don't mind people challenging me. We need that. In fact, that's how we make things better.

Dan:
Yeah. I love it, I love it. Well, check him out on dhge.org and we'll post all that stuff in the show notes as well so you can link to it. Geoffrey, thanks so much for being on the show. Look forward to you growing in this role and making more of an impact.

Geoffrey:
Thank you, Dan. Thank you for all that you do.

Thank you and welcome to the Trusted Community!
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