Recruit, Inspire & Retain

Staff Recommending Improvements Increase Satisfaction for Both Staff & Customers!

Which of these hospitals would you rather be treated in?

At Hospital A, a major southwestern facility, the nursing staff is stretched so thin——and the intellectual and emotional demands of the job are so intense——that nurses question their ability to deliver quality care. This summer, the strain finally drove Rebecca Matthys, 40, to quit nursing after 16 years. Too many times, an emergency with one patient had meant postponing care to others, then scrambling to catch up on her remaining duties. "It was like playing Russian roulette," she says. "It was just a matter of time before I made some horrible mistake that I would have to live with the rest of my life."

At Hospital B—UPMC Shadyside, part of the University of Pittsburgh Medical Center—the ambience couldn't be more different. Even on a hectic day, things seem to be under control. There's a sense of energy rather than panic. "I truly love coming to work," says medical-cardiology nurse Cynthia Hostetler, 51.

Check into a random hospital in America, and you're far more likely to be in some version of Hospital A than Hospital B. Across the nation, nurses are feeling overworked and underappreciated, with little more than lip-service support from their managers. "New nurses aren't putting up with it," says Diana Mason, editor in chief of the American Journal of Nursing. "They're leaving hospitals at a higher rate than new graduates in the past." As of late last year, there were 118,000 vacancies for registered nurses in hospitals (8.5% of positions), according to the American Hospital Association. That's bad news for patients. A recent study in the Journal Health Affairs estimated that increased staffing by R.N.s could avert 6,700 patient deaths a year.

The true shame is that hospital nursing doesn't need to be in a state of crisis. As UPMC Shadyside shows, it's possible to get things right. And no person takes greater credit for that success than Tami Merryman, UPMC's vice president for quality improvement and innovation. A nurse herself, Merryman knows the convoluted procedures that typically bog nurses down. So nine years ago, when she became chief nursing officer at Shadyside, she started experimenting with solutions.

Early on, she zeroed in on the time nurses spend running to central supply cabinets. "In a year, nurses on the average unit walk the equivalent of the circumference of the globe," she says. So she suggested keeping basics like gauze and bedpans in patients' rooms. This simple fix saved nurses on a single ward more than 700 trips a week.

Every Friday, Merryman holds a brainstorming session where nurses, managers and even a patient's family member pinpoint problems and seek solutions. In addition, she trades ideas with other hospitals in the TCAB program. The result has been a spate of reforms. The hospital now leaves oxygen equipment in patients' rooms after surgery in case they need it again at night (eliminating 20 minutes of set-up time). If nurses are overloaded and want help, they post red flags on their carts; those who display green flags have time to spare and come to their aid, while those with yellow flags signal a full load but no emergency. Merryman has even given patients' families the authority to summon a rapid-response medical team if they feel an urgent problem isn't being addressed. "Who cares more than the family?" she asks. And for nurses trying to juggle myriad tasks, it provides a safety net.

These ideas and dozens of others have apparently been paying off — not just at Shadyside, but at all 10 hospitals that are now part of the TCAB program, including Cedars-Sinai Medical Center in Los Angeles and M.D. Anderson Cancer Center in Houston. At all 10, nurse satisfaction is way up, overtime is down and turnover of R.N.s has plummeted from an average of 15% a year in 2003 to 4% today. That translates into cost savings for a hospital. Equally important, the average amount of time nurses spend in direct patient care has risen from 40% of their shift to 52%, leading to fewer patient falls, fewer bedsores, and fewer failures to rescue patients from life-threatening complications.

Leading From the 2^nd Chair

Many capable, idealistic, servant-minded people find themselves in "second chair" management and leadership roles within Christian organizations and churches across the country. For many, this is a positive, fulfilling experience while for others it is frustrating and sometimes even painful.

Mike Bonem and Roger Patterson, co-authors of Leading from the Second Chair: Serving Your Church, Fulfilling Your Role, and Realizing Your Dreams, have done Christian leaders everywhere a real service by identifying the factors that can make the difference between frustration and fulfillment for "second chair" managers and leaders. At the same time, they have provided significant insight for all who occupy the "first chair" and those who report to "second chair" leaders.

This is a person who reports to someone else occupying the first chair and is therefore in a subordinate role. But it’s a role that, in the context of a team, significantly influences the overall organization. The resulting value added by the second chair makes the organization

much better than it otherwise would be. Through multiple interviews with second chair leaders around the country, Bonem and Patterson identified three significant paradoxes that all second chair leaders must understand and learn to balance.

Subordinate-Leader Paradox
"The subordinate-leader paradox is challenging to successfully balance because it is relationally intensive and partially dependent on another person: your first chair. It deals with how you as a leader are interfacing with and following the lead of your senior leader.

Some first chairs are a pleasure to work with, and some are not. Some are concerned

about the personal lives and careers of their subordinates, and others seem detached or self-absorbed. Some give their second chairs ample room to lead while others are much more controlling. At the end of the day, the second chair can do little to change the first

chair. A second chair leader’s most valuable tool for promoting change is his or her own attitudes and actions. "This does not mean that the second chair is to be a mindless robot, obeying whatever commands the first chair issues. Second chairs are leaders. Our definition makes it clear they are not content to sit back and wait for someone else to take action. This is the tension of the paradox. It is not easy to be a subordinate and a leader.

Deep-Wide Paradox
"Second chair leaders live in the deep-wide paradox every day. They have no choice. Their role requires them to see the big picture and make decisions that affect the entire organization. It frequently requires them to delve into the details to solve a problem in some part of the organization, or to launch a new ministry. They move from strategic planning meeting to analysis of why one department is over budget, from a discussion about the church’s spiritual maturity to recruiting additional small-group leaders. If a first chair is not well versed in details, it is excused because he or she is the ‘visionary leader,’ a big-picture person. But if a second chair misses either end of the deep-wide continuum, the person’s performance might be considered ‘in need of improvement.’"

Contentment-Dreaming Paradox
"Contentment vs. dreaming stirs up a restless tension in our souls. It makes us wonder if it is possible to dream great dreams and be content at the same time. One person might be pushed beyond contentment to complacency, thinking that dreams are only for dreamers or first chair leaders who can control their future. Another person is wound tighter than a spring, intent on seeing her dreams realized now! Yet another tries to mentally escape from his current reality, spending all of his time dreaming about the future rather than dealing in the present. Effective second chair leaders understand and live with the tension of contentment-dreaming. Rather than crumpling in the tension, they let it drive them.

Just knowing that these paradoxes exist and are common to all second chair leaders is extremely helpful. But learning to live joyfully in these tensions on a day to day basis is the key to fulfillment in a second chair role. And the first chair leader who learns to appreciate the tensions his or her second chair leader deals with will become the better leader for it.

How about when there is a change in first chair leadership, then you need to evaluate the effectiveness of the match anew.