director of patient care at Emory Orthopaedics and Spine and Denise Assad, administrator of clinic operations for spine division at Emory Healthcare. As they dive into the importance of collaboration between clinical and administrative teams, discover how to build bridges in your practice to enhance decision-making and team engagement. All right. Good morning, everyone nice and caffeinated? All right, well let's kick this off. As we were just introduced, Denise and I do work together at Emory Healthcare. We're in the division of orthopedics, sports, and spine and due to the size of our organization, we're going to talk through that and how there's some barriers and how we actually connect and how we work with our providers, how we work with our staff, and how we get the job done. So we're going to give you a little bit of a story of basically our journey on what we were running into. Hopefully that's a little relatable for each of your practices and some of the hurdles we had to face, some of the defeat we had to eat, and and what we've learned from it. So as we were just introduced, I'm on the clinical side. I represent our clinical staff, that is all of our medical assistants, our nurses, our athletic trainers, our LPNs across our settings in various offices, and then Denise is in charge of more of our templates, our provider relations, our front desk, how we're getting the patient through their visit, and how we're taking care of them administratively on the backside. So to start off, I'm gonna have Denise tell us a little bit about the history of Emory, because she has been with Emory through various positions for years, has grew up in the Emory system, and again, not specifically to Emory, but I think a lot of you probably have someone in your practice who's been there from the beginning of time, right, since when they started. They know the ins and the outs, and maybe it's not on paper, but it's all up in their brain and they know it. And then you have newcomers come in and suddenly it feels a little bit different. Still have the same job to do, you're still part of the same organization, but very different wavelengths on who has all the knowledge and the history, and who's coming with fresh ideas. So Denise, why don't you set the scene of what was happening over Emory Spine over a couple years ago. Absolutely, thank you. So like Stephanie said, I'm Denise Azad, I'm the administrator for the Spine Division. So I'm gonna ask a couple questions before we get started. How many of you have ever felt like you get to work, you park before you go in, and you have like a tear session, trying to motivate yourself to go into work by a raise of hands. If your boss is here, you don't have to raise your hand. Okay, good. What about Sunday? Right, Sunday you wake up, it's supposed to be a relaxing fun day, and the first thought on Sunday morning is, tomorrow's Monday and I have to go to work and deal with this again. Sunday is very, tends to be very scary. So I'm gonna tell you a little bit of a sub story. I'm gonna set the stage. I hope you got plenty of coffee to make sure that you get through that. So like Stephanie said, I've been here for about 10 years. I started at the front desk when I first got to Emory. So born and raised in orthopedics, working with our spine teams, both surgeons and non-ops. When I started 10 years ago, the first thing that I noticed was how difficult it was to communicate between team members, right? I was at the front desk, I was having challenges with, you know, patients showing up and a clinic being canceled, and me not knowing that the clinic had been canceled. Or, you know, a new process that was rolled out for the clinic, and you know, we were hit with that new information that nobody shared with us, and now we're having to like, on the spot, go through that. That was one of the very first things that struck me when I first started, right? And it kind of developed, so then I started going to other locations, and I started to see, okay, well, it's the same organization, the same team, the same department, and when I go from Buckhead or to from Brookhaven to Johns Creek, it's like I'm in a different, completely different world. So there's definitely not a lot of continuity or not a lot of standardization of things. So what I know to be true at my home office, I basically have to relearn everything when I go to the other location, because it's completely different. And that was very challenging, for sure, for us to, for us to handle. So within the department, we have three service, three service lines, or three specialties. So we have spine, we have orthopedics, and then we have sports medicine. And all of us fall under the umbrella of MSK, and we have many locations that are multi-specialty. So you might go to Johns Creek, and there's all three of them. You have ortho, sports, and spine. You may go to, you know, Spivy Station, and you have all three, and then we added podiatry. Where I started, it was just spine. So everything that I managed, everything that I worked with, it was only spine, non-op spine, surgery spine. So me stepping out of that location, going to other places, was already a challenge, trying to figure out, okay, well, other specialties, not only the location does things differently, but also the specialties within work very different, differently from each other. So this is just a real quick snapshot. When I started 10 years ago, it was only three locations that we had. It was, Becky, you were here, if you can remind me, it was Executive Park, Johns Creek, and Dunwoody? I think so, Eowash, yeah, Tucker, that's right. So it was only three. Within a period of span of 10 years, now we're all too close to 13. I think I'm missing a couple there. So now we expanded way too much, way too fast, right? So not only we were having these challenges of different places doing different things, different specialties working very differently, but now times four, you know, based on how quickly we grew. And that's just a quick map showing the footprint across all Atlanta area, which brought also a brand new challenge, which is the things that may work at MSK in Buckhead, I mean in Brookhaven, are completely different than what works down at Spivey Station. And then when you go down to LaGrange, it's a complete different market. It's almost not applicable, right? Same thing for Johns Creek. The market at Johns Creek is very different from what we do at Spivey Station. So throw another challenge into the mix of having to, you know, coordinate and make sure that works efficiently. Yeah, I mean, I think any of your practices have probably experienced that, that you're growing. You're growing fast. You're being told to continue to do your job, but you're going to add more people. And you want to standardize, but sometimes it's just not possible. And so instead of replicating ourselves over and over, we quickly realized this plan isn't going to work. We can't just silo all of our administrators. We can't just silo all of our clinical staff. But on paper, it works, right? So we're told from our C-suite, this is going to work. Just rinse and repeat. We're going to quickly, you know, open a new site, and we already know the method. Let's make it happen. And so we kept running into challenges. And like anything that happens sometimes, we're a little slow to react. That it wasn't working, but we kept going. It wasn't working, but we're going to keep going, or we're going to keep growing. And that's really frustrating. It's frustrating to all levels, but especially that front level. The frontline staff, they're looking up to you to say, how are we going to fix this? This doesn't work for us down here. Our patient mix is different. Our provider mix, what they're trying to do is a lot different. So we were running into a challenge trying to lead our leaders and our frontline staff. And here's one of the problems that, again, when you grow large, it gets a little complicated. It looks, again, it's a great idea, but when you look at our org chart, we're getting stuck. I'm in the yellow over on the right. Denise is on the yellow over here on the left. And a lot of locations, we shared those locations, but we weren't getting it done. We weren't able to collaborate between how we could get the patient in. We could find a beautiful template, work it through the call center, get the patient to us, get them checked in, and then clinical would have a different idea. We'd drop things on the back, and we weren't taking care of the patients the way we wanted to. And part of the problem, too, is that Denise was going straight up through administrators up to our executive administrator, our VP. I am the chart of focusing here, but really, I'm pulled in a different direction. We're part of a larger healthcare organization, and I'm reporting up to the CNO. So we had constant challenges on how can we make this work in our setting against some of the challenges that we have, but also just continue to take care of patients for the reason that we both got into healthcare in the first place. So that led us to, I was the new one. Denise had already been there, knew what had worked for years. She was the one that kept everything together. I mean, had some bad experiences in the past with when we try to combine the different areas, and we try to focus on clinical, we drop administrative tasks. When we try to focus administratively, we burn through clinical staff and our providers get upset. So we had to come up with a new plan. I was new to the practice with a private practice background. Denise, again, grew up through the Emory system, knew more academics, and was used to that growth, and we had to come together. We both knew we had different jobs, but we had to pair, and this is only one part of our business. We had a lot of things happening, but we had to focus on our largest spine center, which was productive. It was a huge part, a good market share of the Atlanta market for spine, but we, again, were blowing through staff. Our providers weren't happy. Our staff engagement was going down, and yet we still had a high volume of patients to see. If I can just talk a little bit about kind of where we hit rock bottom, right? So fast forward from when I started with three locations to now 14, 15 locations to 2020. What happens? COVID hits. So throw an additional wrench into the mix of things are not working, they're not efficient, and now we're having to reinvent so we can stay, you know, pretty much alive and functional. One of the biggest missions that we had back then when COVID hit is trying not to furlough people. We were trying to make it work for everybody, and we needed to get very efficient, very quickly, and very creative to make sure that we kept our staff, we kept clinics open, we were going to be productive, and we're going to bring money to the business, which back then was pretty much unheard of. So it was another challenge for us to basically tackle. So some of the some of the things that happened in addition to all of the things we've talked about when COVID hit is, first of all, for the Spine Center, we didn't have any clinical leadership. So we didn't have a Stephanie, I didn't have a nurse manager, I didn't have a nursing leader in my in my sections, right? So it's just me handling all providers, all admin staff, and also trying to figure out from a clinical standpoint what are we going to do. I don't know anything about clinical, I don't know anything about nursing, I don't know about competencies for MAs or the scope of practice for those MAs. So we have to wing it, right? So that was very challenging. I remember one of the biggest things that happened is that we were trying to follow the lead from the rest of the department and everybody was doing something different. So clinical said, okay, we were gonna go to all work from home, and then admin said, well, hold on, I work at the front desk, so I want to go work from home too, I don't feel safe in here. Well, now I cannot say that because we need you here, we still have patients trickling in, we implemented this quarantine process and social distancing, so we're still open, but they didn't feel safe. So it's very unfair that we have this group of people that are gonna be quickly working from home and I don't get the same opportunity. There was no communication when the decision happened, there was no collaboration, there was no, okay, let's think through this, how much it applies, how does it affect us from a cultural standpoint. Another thing is, I hated this language, but essential staff, right? I mean, oh my gosh, that was to me, it could either be very, make you feel very important or make you feel like you meant nothing, because you were categorized in a bucket versus being essential and non-essential, but every single role back then I feel like was essential, from the janitor, from, you know, sanitation services, all the way to our VP who was on calls 24-7 trying to figure out what tomorrow is gonna look like, right? So that decision alone, whoever made it of, you know, differentiate us from essential and non-essential, created a very difficult culture, you know, and it's very difficult to swallow for the staff. Providers, I mean, some of them wanted to quarantine, they're close to retirement, they did not want to come in because they were very old, they were close to retirement, they did not want to do telemedicine or learn how to turn on a computer, none less how to work Zoom, right? I remember the first week we started with telemedicine and it was via Zoom, I had a surgeon calling me and my kid is, I'm at home because I was quarantining that week, and my kid is behind me, he's two years old and he's screaming bloody murder and the surgeon is angry because he doesn't resent why is it that he's struggling in the office and I am home, because again, who made that decision, right? Who thought through, okay, we're gonna send half of the staff home, half of the staff is gonna stay here, but then who's the point person that's gonna help when something goes wrong? Chaos everywhere, there was no trust, there was no loyalty, there was no, you know, willingness to work together, everybody basically said, okay, it looks like everybody's running on a different direction, I'm going to do the same, I'm gonna do what works for me, which make it even, made it even harder for everybody. We tried at some point, down into COVID, we tried at some point do a staff retreat for our spine department, where we're gonna bring the collaboration of physicians, MAs, front desk, we're gonna bring everybody together, but remember, I still didn't have those leaders, I still didn't have that collaboration or that partnership with somebody that manages half of the team to say, we're gonna, we're gonna come together and we're gonna challenge each other, right? It didn't work, it was a Saturday morning, we did it for like eight hours, everybody came together, we couldn't make decisions, nobody could get past the, well, that's not my job and why do I have to do this, but you don't have to do X, Y, and Z. I remember one of the leads that we had at the time said, well, I don't want my MAs to come and help with screening patients because I'm trying to keep them from getting sick, so what I'm saying to them when I saw them, when I walk and see them doing nothing is, act like you're busy so nobody pulls you. Why do you think the rest of the staff felt when they heard a leader say, act busy when I truly have half of the other group that's dying, working 24-7 non-stop trying to get the work done? We hit rock bottom. I think pretty much can, everybody can probably relate with that, but we truly did. To me, what did it was, Mother's Day 2020, I think it was 2020 actually, I think it was a Sunday and you know, I have my kid and my husband's trying to like do something for me, I spent all day from beginning of the day all the way until midnight working on templates because now we need to change the entire clinic and it's Mother's Day, it's my first Mother's Day and I'm exhausted and I'm so tired and I don't have anybody to bounce ideas up with. I don't have anybody to just go to and say, hey, this is what I'm proposing and I know it's gonna work for my team and I think it's gonna work for the provider, but how is it gonna work for your clinical staff? I'm just gonna have to wing it and figure out and I'm sure it's gonna go wrong and I'm sure I'm gonna have to come back and apologize and start all over. So when is that gonna be, Christmas night? Because at this point, I gave up. I know that, you know, I'm pretty much just stuck here in this vicious cycle of nothing is working. So I think we all know those COVID years were hard to rebound from and then again in all their infant wisdom, our system decided that this was now a good time for us to transition EMR systems from the inpatient and the outpatient side. Again, but we still have patients flowing through. We are still opening sites. The business, the business did not slow down. So we had to continue to adapt and and lead our staff confidently in a direction that we weren't even confident in, right? We've all been in these scenarios where we're like, I don't know if this is the right direction, but here we go. So that is exactly the point we found ourselves in. At one point, then, I did join the department and we started looking at how we were going to restructure our own teams. We're hearing from our staff they need some more support. Now, most your frontline staff would not say, I think we need more leaders, but at the time we did, we looked and we said, we do need more support. We need to give more support to our on-site managers and their teams. So this led Denise and I to work together multiple times, not only here, but also with our other administrators, but where we had the biggest dive was at our spine center and in Brookhaven and so that's where we needed to pull together and it wasn't always rainbows and easy. We had some big differences, but I think there were some things we came to know on what we had to do and we made some really big improvement that we're going to talk about at this really large location. And the first one was shared governance. I knew my job. I knew exactly what clinical needed. Again, I was aligned with our nursing leadership outside of our division. I knew the march. I had my marching orders. I knew what to do. At the same time, I couldn't break through to some of the old guard that was already at our spine division and be able to help them. They knew they needed help, but we both needed to rely on each other for that. So again, great minds coming together, but we also had to realize that we didn't know everything and I was going to have to rely on her for a lot of connections within the division with providers, as well as building trust with staff. And building trust with providers. I think, you know, one of the stories that now we laugh, back then we almost cry, is when Stephanie first came in and was trying to break through some of these barriers, some of the things that we implemented in our division is that now we have also physician representation from a leadership standpoint. So we have a division director for the for the spine specialty, one for ortho. Also, we break it down into non-operative and surgeons, so everybody has a way to, you know, voice it out and have representation, even in decisions like this. So back then, the division director for spine has the initial meeting with Stephanie. I'm gonna let you tell that story. It was painful. You know, when you go into a meeting, you're like, all right, I know what we're gonna talk about. I've got some great ideas. I've seen some of these problems. I can't wait to present this. It didn't go that way. It didn't. It quickly, the physician kind of cut off midway. We were talking about verbal orders and how we're gonna accept these safely. Well, so I can protect the staff if they misinterpret an order with a readback. How are we gonna get that into the system? And protect the staff if the physician makes a mistake. And on paper, it would look like it was the staff's issue. So I come in with this great plan. Hey, this is working in other divisions. I can't get two sentences in before the lead spine surgeon cuts me off and turns to someone else and goes, you know what? I'm so sick of leaders coming in here in their fancy clothes and they have no idea what's actually happening. And it was a big pause. It derailed the meeting for a moment. Had to eat crow for, not really eat crow for a second, but just sit there and say, all right, let's try this again. Again, I know what you want. You know what I want. It all benefits your patients. It benefits your staff. Let's keep going. And it had to have a couple of meetings that was a little uncomfortable. And there was a lot of resistance. And I sometimes would have to have Denise do a comfortable bridge to say, what's an easy win? We can get under our belt to show that we are committed to the team. Some really simple, very, very simple items that, what's a quick easy win we know we can fix? What's some of the need in the break room? Or what do we need to do? Get one more staff member? Where can we put them in a place that they're prominently noticed? So we had to quickly recognize we're gonna have to have shared governance. I can't always have the providers running to her when they're unhappy, but then come to me when they want more staff or their different staffing mixes have the staff unhappy. How are we gonna respond? HR was down our necks about what are you guys going to do with all of this staff and yet and low productivity. So shared governance really came into play. And so some of the things that we had to lead into then were meetings and constant communication. And it seems so basic. Why do we have to have one more meeting? But we really found that the reoccurring meetings and having a very set agenda, flexible enough that we can move around if there's a really hot topic, but we're gonna just put everything out there. So the co-directors meeting that Denise talked about is we brought in our physician leads, our lead spine surgeon, our lead non-op spine surgeon, our chief APP. So we brought representation among providers, but then also our clinical leadership, my clinical managers, as well as her clinical managers on the admin side and put them together. And the purpose of that was often we would make a change in one section and everyone else would say, well why did you do that? That affects me in this way. I don't like this. We spend a lot of time going over. These are some of the basic changes. Here we are in hiring. This is why we're gonna hire more nurses. This is why we're gonna hold off on a on a freeze temporarily. Or why we're going to go paperless at the front desk and do more wayfinding off a device. We had to explain that so everybody felt involved and also gave an open topic to say I don't like that and here's why. And so it gave an opportunity for us to really talk through what would happen. And these meetings also, there was prep on the back side. It was also Denise and I on the back side to say hey this is gonna be a rough, this is gonna be a rough swallow for them. How can we break this down or slow this project down to a more meaningful pace? And also appear united, right? How can your staff and my staff and we get the providers on board. So I hate adding more meetings to my schedule because our meetings are already flooded with Zooms as I'm sure a lot of you already have. But we had to have that, those constant meetings and also assign items for follow-up and accountability. That was a huge part of who's gonna take this item and when can we expect for you to follow up, right? And that would even go in an email, but the next meeting on the agenda, okay, what did you find out on that topic? We're not gonna just keep having meetings to talk about something. So after doing that and having those daily updates, it really showed that we were trying to make progress on both sides and also celebrate the little wins that were coming along the way. Absolutely, I think one of the main things that Stephanie and I were very intentional from the beginning was our partnership, right? Let's forget about there's different sides going on different directions. How do we come together and how do we make decisions that affect all of us, but from a partnership standpoint? Those division director meetings actually started as a 7 a.m. call every Tuesday for me to get on the call with the three of them who's interacted with spine surgeons or orthopedic surgeons. They are pleasant, aren't they? Very special. Now picture them on a Tuesday morning at 7 a.m. before they head to the OR, very special. So that call actually started for a 15 minute venting session from them to me about all the things that are not working and how angry they are and how nothing is changing and what else is coming down the pipe that I need to be informed of before I have a heart attack. Eventually, when Stephanie started, we tweaked it. Okay, it doesn't need to be a venting session anymore. How do we make this a productive meeting instead? So we said instead of the 7 a.m. phone call, while you're driving, I'm driving, I'm getting my kids ready, nobody's paying attention, it's just your opportunity to let it all out. How do we make this a productive working meeting? So what's productive? Well, her and I don't know at all. The physicians also don't know at all. So we need to bring in the key people that are really gonna give us the information that is necessary to make those decisions or to tell us what will work and what will not work and why. So we made it a working meeting. So now we meet in the afternoons after clinic, everybody comes together. Her and myself at a high level, our physician directors representing all of the faculty for spine for the location, and our local leaders, our manager or supervisor that works with the frontline staff, or our nurse manager and the supervisor for the MAs that work, again, with the frontline staff that works in the clinic. And they are the experts that are gonna be able to tell us what's working, what's not working, and why. So I can have a lot of ideas as to how I wanna fix a problem, but I don't know what's actually happening and how it's affecting the frontline staff, right? So I need to bring them all together, and it was a game changer. I mean, now they're productive meetings. They're not venting sessions. Now it's a, okay, here's our tracker of the things that we've accomplished, and this is how it's going. Now it's like the last two meetings has been, or the last two months' worth of meetings have been kudos and compliments to our team because now we don't have long waits at the front desk, which is historically, for the 10 years that I've been in the department, an issue. I would get up in the morning, 6.30, and I already have a message from my chair saying, there's a line at the front desk, somebody needs to jump in. Haven't heard from him in about a year now, right? Or the issue with we have five MAs call out, we have nobody to run our clinic. That doesn't exist anymore because now we're proactively seeking what is happening, what's coming up, and what can we do to try to fix it proactively rather than react to the issue once it happens. Absolutely, and I think that's when you start to question like why is this happening? What's happening behind the scenes that's causing this? And I think we have to just keep asking why until it makes sense, until it almost seems repetitive and it's annoying to say, well, why do we think that? Why has it always been this way? And why is that really the best way to proceed? And that makes people really uncomfortable when they think you're challenging their idea or challenging what has been working, but to do it in a respectful way makes all the difference. To say, why do you think that? Or why did we start doing that? And do you think that still makes sense now in our current state? We've all had to make adjustments. We talked about COVID, but I think a lot of us know some of our younger employees coming through the workforce, they need a different approach than some of our employees that have been with us for years and years. We have to appeal to everyone and be flexible enough that everyone wants to stay in the workplace, but we still get the same job done in the same safe way. So I think continuing to asking why until it makes sense. It also is a challenge to myself sometimes when I'm asked, well, why do we need to do that? Well, because we have a metric. Well, why do we have a metric? Well, what does that metric translate to? And that's when it's our responsibility to say, this is what it translates to financially. This is what it translates to for patient safety or for our marketing strategy. And so we have to be comfortable with knowing the why and also admitting to say, I don't know. Actually, that's a really great point. Let me go get some more information on that and I'm gonna follow up with you. Because it can be humbling, right? You're in the leadership position and everyone expects you to know. We don't know all the answers. That doesn't always happen. So sometimes we need to go back and really make sure that we understand the why behind it. Because it's our job to challenge the current norm to make sure that we're always on the front edge of what's happening in healthcare. I think the other part of the why behind things also when we start to investigate why are we having these problems or what's going on behind that is holding people accountable. And that's really hard for chronic behaviors that have been an issue for a really long time. Oh, that person gets a pass. They're always gonna call out on Fridays because they've worked up enough overtime over the course of the week that they don't wanna use PTO. What? How can they do that? Oh, yeah, that doctor's always gonna act like that. He just doesn't use his staff members that way. Why? Who approved that? So holding people accountable was another part and not always a fun part, but I think once our culture came around to say this is gonna be fair. It may not look the same for everybody, but it's going to be fair. It'll be equitable across the board here. So when we had to really dig into some uncomfortable parts of the why, that's where we also started to make progress and build more rapport with our staff. Yeah, and another thing about the why is also what else are we not taking into consideration when making decisions and how it affects us, right? So think about budget, budget season. The way it used to work is our finance director would meet with the clinical side to make budget decisions. I was not part of it. Then that person would meet with me to make budget decisions, and she was not part of it, and I don't know what she asked for, and she doesn't know what I asked for, and turns out we have a limit of how many FTEs we can ask for in a fiscal year. Well, it turns out, not you, Stephanie, because you're great, but the prior person, but it turns out that the clinical team member said, well, these are all my needs, and my needs are very important, so I'm going to ask for all of these things from a budget standpoint and a capital standpoint. Then when I come in and I'm asking for all of my needs that are equally as important, well, I don't have enough FTEs left anymore, so now I have to give up something because we already used them, and decisions in hiring was the same, right? We got to a point, especially during COVID, where we had to make tough decisions and say, this person left. I don't know if we're going to be able to replace them. We need to think through how to redistribute, either redistribute those responsibilities, or what else are we going to give up if you really need this? Well, those conversations were not happening. I was making that decision based on what I thought and what I wanted, and she was the person in the clinical side was doing the same, and we were going in completely different directions, so we got to a point where the fireman went to half of the nursing staff, right? Think about it. We have 19 physicians running clinics during the week, and we only have half of the nurses that we normally have to run those clinics. Who's frustrated? The staff? The physicians? Stephanie? Myself? The patients? Because now we don't have enough support for caring for them? So again, the nightmare continues, right? We have to get on the same page. So when we talk about the why and understanding why we don't need to have this meeting separately and you make decisions on your own and me on my own is for that same reason. Now our budget meetings are us together, right? At a site, from a clinical and admin standpoint, what is it that we need to support and help the site grow? Okay, well, and maybe it's one more MA, maybe it's more from the staff, maybe it's an MA coordinator that can function in both different ways. It can function on an admin and a clinic from a clinical standpoint, so it meets both of our needs. But now those decisions are made based on that collaboration of understanding. It's not for your win or my win, but it's for the practice win and for the success of making sure that we continue to be productive and continue to grow. I mean, absolutely. When there's friction at the top or there's friction at the bottom, all levels definitely feel it. I'm curious, how do some of your groups measure culture? What are some of the ways that we can feel it, right? You'll say there's a vibe or we can definitely feel things are off. How do your companies that you're with measure culture? Is it surveys, is it, what is he saying? Is it staff feedback? Yeah, surveys, anything like that? A management survey? Engagement surveys? Okay, fantastic. Okay, yes, absolutely. So a monthly survey even? Absolutely. Yeah. Oh, wow, monthly, that's great. That's a lot of feedback, that's awesome. Did I hear something over here? Absolutely, yeah, turnover data. The data's all over. How many times have we taken that data though and done nothing with it? What good was that, right? People eventually stop engaging, they stop responding. And that's a lot of what we found. We pulled our department engagement scores. And so this was just this individual department. We tracked it, this was lower than every other partner of our division. So on that map we were showing, all those other locations were trending in different directions. This one was constantly low at a 0.1 and that was actually 2020 during COVID. And so we've shown our move. We've had to respond to these engagement scores. We were asked over surveying the staff on what can we do? What do you like? How do you feel about things? We did nothing with the data and we didn't even share the data with them. It wasn't just our section. Our managers already felt overworked. They didn't wanna take that feedback. It was tough. So our culture of course was dripping. And HR also was giving us feedback that, hey, your one year retention rates, they're not looking great, right? What's happening that you're keeping some people that have been here for 10 plus years and then you bring new people into it and they're not meshing. So we had to do some work. Again, talking about some of those chronic behaviors and our chronic offenders to different policies. We had to address them and hold them accountable. And we did lose some people along the way, but I'm proud to say through that little period of hurt, we also rebuilt in a much stronger way. And we also had to not only survey our staff, but also survey our leaders. We did some things with a disk assessment, very similar to that awesome survey we did yesterday with our outliners and our go-getters and our whiteboarders yesterday. Same thing, we had to do a disk assessment for our team and then really take a look at like, what is your communication style? What are you looking from me? And can you also understand a little bit more why I need so much information before I can make a decision? So we had to really look at our company culture and commit that we had to change it. And this is an ongoing part. I mean, when we look at our engagement score, so point number one, it was 2020. We did a great job, we were making some progress, and then we dipped again. We went through a hiring freeze. That was part of the business, something that we couldn't directly influence, but we went on a hiring freeze, changed our CEOs, changed every CEO of every hospital. There was a massive change among us. So we just stopped hiring and I think everybody was in a scared state. With that being said, we kept steady and continued on in developing our staff. And we've made tremendous progress from our last Press Ganey score of our staff engagement. We're actually leading the entire division across all spots. And so that's how we knew we just had to lay in and continue to show our staff that we were there for improvement. And it continues on. We've recently committed to the Fierce Conversations. Has anyone heard of the Fierce Conversations, the book or the series? Yeah, it's been a long time, fantastic series. In fact, we did it in our department 10 years ago. A lot of people have been through it. It's a good refresher to go back on and say, what are the conversations we're avoiding right now? Why are we avoiding it? Like, let's look at this. Why aren't we tackling that head on? Why is it uncomfortable to have that conversation that we feel that we're not able to? Our job's gonna be in jeopardy if we do have that conversation. So we've had to continue to invest in our going through some other opportunities with our team to strengthen our culture and maintain the progress that we've made. Yeah, absolutely. And then talking about the next point that we've been focusing on, it's skills and knowledge. And just acknowledging that we are not the expert matters, even though I have the title in a specific area, right? So I am the administrator for operations, and I've been doing it for 10 years. And I can tell you what any physician is thinking at any given time. However, I'm not the know-it-all. And she may have a perspective about a decision or a topic that we're talking about that I'm not even considering. So even though I am the administrator for operations, we now have this collaboration of understanding. I also value your skills, your knowledge, and your experience to say, what can you contribute to the blind side that I may have when making a decision? I know that I'm gonna go back quickly to our org chart. That's actually a very condensed version of our org chart. It's way bigger than that. So on the top, we have also our chief APP. We have three APPs within our department, and we work very closely with her because our APPs have different functions in all departments. So again, when it comes to hiring APPs, how are we gonna, what's the scope of that APP? Who is that APP gonna support? What's the access for the APP gonna look like? It's not the chief's decision. It's a combined decision between her and the needs of the department, right? We didn't put it in there, but we also have a senior manager of patient access, and we actually have our team here today, right? They are the experts in access. They know everything that is out there in terms of metrics, news with intent, bringing patients through the door, but they don't know what's happening specifically in my location and the barriers that they have. So they depend on the skills and knowledge of the location even though they are the expert matters, and that's made a tremendous change in how we make decisions and how we improve processes. Yeah, I trust implicitly what they have to say, but they also have to come to me and my team to get the feedback as to, yeah, that may not work because X, Y, and Z that they probably didn't know, right? So that's a great partnership as well. We have a senior manager of facilities and projects. She's also here. She leads all of the expansions and new facilities that we open, right? She's the expert. She knows everything and anything that has to do all the way to the plug on the wall that you have to have, the outlet on the wall to make sure that this machine works, right? But she also depends on us because maybe the spine division uses this machinery that ortho doesn't, so we have to take that into consideration. Some of our doctors do EMGs, and they require a foot bath for some of their clinics. Well, there's no way she wouldn't know if she didn't talk to those and collaborated with those physicians, right? So we do have those expert matters at each level of the organization, but it's a combination of those skills and that knowledge and the respect of knowing, I don't know at all. I do need to come to you and collaborate with you because that's the only way we're gonna make it work, and we're gonna continue to see that trend upward. So one challenge that I wanna give to all of you is not only thinking about do you have that partner or are you acting that way in your industries, right? Are you collaborating with your team members? But challenge yourself to think about it not just from is that collaboration existing, but what are you doing individually? What are you doing personally to contribute to that collaboration? Because it's very easy for me to sit here and say, well, that person doesn't come to me. That person doesn't do X, Y, and Z. They don't ask for my feedback. But what do you do to change that? Do you collaborate? Do you reach out? Do you say, hey, pause. Let me tell you what my team is saying or let me tell you what I think the things are happening that are not gonna work and how we change them, right? I couldn't agree more. It's a constant work in progress, but it's one that, well, I think that's a great slide, actually. This is our senior team. Can we go back real quick? Sorry. Oh, of course. I don't think the, another thing we wanted to share with you was our retention scores. It didn't save on the slides, unfortunately, but when we were talking about retention over the last four years and how that was a challenge for us so we were able to get our metrics. And for our department, we started at 75.3 retention rate. We went down to 67.9 retention rate. And this year we ended up 90.3 retention rate. And that is, yeah, for first year employees. For first year, exactly. And the first year is a big year. There's a lot of onboarding and a lot of that onboarding goes to our frontline leaders. We have to give them credit. If they're feeling stressed, if they're just trying to handle the day-to-day, they don't really pour into that new employee or their team's not doing well and they stick a new employee with someone else who's there. It's like, oh, this place, it's gonna wear you down. You're gonna hate it. You don't wanna be here. And we'll lose those employees. And we spend so much money. There's our emotional effort that we put into it, but there's also the time spent, the overtaxing of other staff, the overtime that comes in as we stretch our staff to cover these vacancies. So that retention rate comes into a big part of what does our culture look like? How are we doing financially? How are we serving our patients and taking care of our staff, which is huge. And again, I know, Denise made a great point that I think some of us all need to pause and say, what are we doing for the greater good of the team? How could we be collaborating and get over, there are personality differences, right? We have very different personalities on our teams, but how can we partner? How can we put some of those differences aside and say, hey, I want my team to do great. You want your team to do great. How are we gonna succeed together? And I think it just puts everyone under a great light to say this team can really make it happen. And so we really proud, this is not our entire team, but these are different parts of our team that represent other sites. And we couldn't be more proud about the diversity that we have in personalities and backgrounds and what they all bring to the team, so. And the picture on the top is actually an award we won for patient access. So it was a collaboration. We had an Emory, there was a initiative to try to get patients same day or next day to make sure we're accommodating as much as we can. And it was not just a patient access initiative, right? It included clinical, it included physicians, it included operations. And together we were able to achieve the goal and go even beyond what was asked of us. So again, another good point of how collaborating is really the way to go and not just working on those silos. And we just wanted to put a snapshot in this picture with different sentences here. This is the latest press gaining survey result that we got from our employees, from our staff engagement. And these are some of the more common words that kept coming up for this latest one that we had in August. Sense of teamwork, sense of partnership, better retention rates, better patient satisfaction, sense of belonging in the company. This was a trend from the comments that we were hearing from them. And it was such a pleasant review to see and to look into that we need to share and also build up from. And the other thing we want to say is we're not done, right? We just started. This is actually the first time when you go back, sorry, we keep going back to the org chart. But when you go back to our org chart, it's the first time, at least that I can think of in 10 years, where all of those positions are fully staffed right now. We don't have any leadership vacancies. So it's great to see, but also it's a challenge that we have ahead. Because now we truly need to make sure we know how to work well together. Because this position, for example, I'm just gonna pick on somebody, may have been open for a long time and it was being managed by this person. So now this person may be feeling very territorial about all the change they made about here. And we need to learn how to work together and delegate and let this other person function, right? So the challenge that we have ahead is just how do we continue the momentum? Because we're not perfect. This is working for the challenges that we've had. But now we have a brand new challenge of how do we continue that camaraderie collaboration and making sure that all of these people have a say, all of these people are knowing what they have to do, but also collaborating to make sure that we're successful. I am one of the persons that cries in the mornings when parking outside of work. But the crying sometimes is not anymore because I'm so frustrated that I don't wanna work here anymore or that I am just so frustrated that I don't have any support. The cry is more because now I know I have to deal with that one doctor that I know it's going to give me a really hard time. But it's fine because the location, the benefits of the work that we're doing are there. I love my work and I actually do love coming to work. And I don't have that dread on Sundays anymore. I mean, I do sometimes when I'm tired, like it's normal. But it's not because I'm gonna come into chaos. It's not because I'm gonna come into a situation where I'm gonna feel like, what am I doing here? I just wanna turn around and walk out. It's just for different things that come with the role that I just have to accept that's part of my role and that's why I'm here for and I have to take charge of those things. But thank you all for your time and listening in. And do we have any questions or any other similar scenarios that anyone wants to bring up? Well, let's bring on the next speaker then. Thank you all. Thank you.

collaboration

clinical leadership

communication challenges

COVID-19 impact

organizational growth

staff retention

administrative gaps

shared governance