Latest / Becker’s Healthcare Podcast / Leading Nursing at Scale at Memorial Hermann Health System with Bryan Sisk

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Leading Nursing at Scale at Memorial Hermann Health System with Bryan Sisk · Becker’s Healthcare Podcast

• 0:01
  Every year, Becker's annual meeting brings health care
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  leaders together to unpack the most pressing issues
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  facing the industry.
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  And every year, those conversations shift in profound
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  and unexpected ways.
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  This April, more than 3,500
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  healthcare executives will return to Chicago
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  for Becker's sixteenth annual meeting.
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  Seven ninety five elite speakers will offer new
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  lessons, new case studies, and predictions about what
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  Join us April 13 through the sixteenth.
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  For the agenda and event details, visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right.
• 0:38
  This is Scott Becker with the Beckers HealthCare
• 0:41
  podcast.
• 0:42
  Thrilled today to visit with Brian Sisk.
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  Brian's the chief nurse executive at Memorial Hermann
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  Health System. Memorial Hermann Health System, one of
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  the great health systems in the country. But,
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  brian, we're so thrilled to visit with you
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  today. Can you take a moment and introduce
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  yourself and tell the audience a little bit
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  about yourself and about memorial herman health system?
• 1:03
  Yeah. So happy to have a conversation today.
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  Yes. I'm brian Siskay. I'm the chief nurse
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  for the memorial herman health system.
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  I have the privilege of leading nursing practice,
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  workforce strategy, and care delivery innovation across our
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  17 hospital system and our extensive ambulatory footprint
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  here in Southeast Texas.
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  We're a clinically integrated, not not for profit
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  system,
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  serving an incredibly diverse and fast going region,
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  growing region here in Houston,
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  home to the largest medical center in the
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  world. We're very proud of that. And then
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  I would be remiss if I didn't mention,
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  how proud I am of our
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  nine soon to be 11 magnet designated facilities
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  in our region, which really is a reflection
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  of our team, not just our nursing team,
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  our entire team's dedication to really high quality
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  and delivering on the promise of making, nursing
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  a place that's empowering in a place that,
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  everybody wants to work.
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  And how many nurses are there today
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  in the system at Memorial Hermann when you've
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  got 17
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  system 17 hospitals?
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  Yeah. So we have about 14,000
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  nurses.
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  Now the funny thing about Houston most people
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  don't realize this is,
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  the state of delaware fits inside the, Greater
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  Houston Metro. So it's, it's quite a large
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  footprint,
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  when you think of it that way. Well,
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  no. And Houston's a sprawling, sprawling place, and
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  it it's fascinating. It's people used to joke
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  that it's a city that was built without
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  zoning because it sprawls in all kinds of
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  different directions. And it's a great city, but
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  it is a fascinating city.
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  And and and talk about sort of
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  when when you lead a team of 14,000
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  people,
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  many people can't even understand how that's possible
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  or how do you go about that. How
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  do you think about leading a team with
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  14,000 people? And it's probably more than that
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  because probably in addition to the nurses, you
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  probably have others that work with the nurses.
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  But but how do you think about being
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  a chief nurse executive with 14,000 nurses?
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  Yeah. So I think, there are a few
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  things that that are incredibly important because you're
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  absolutely right. It's it's not just about the
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  nurses. It's about our entire care team from
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  our physicians to our frontline
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  bedside staff, all the way to the ones
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  that are supporting,
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  our discharge planning
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  all the way to our nursing and,
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  C suite leaders. Yeah. Everybody has to be
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  on the same page.
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  And and I think what's important is is
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  how do you pull all that together? And
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  especially when you're looking at at health care
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  today,
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  and we're looking at the evolution of our
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  workforce
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  and how that impacts, How do you leverage
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  that differently so that you can truly
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  impact zero harm road to value quality safety
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  high reliability?
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  Because all these things are so incredibly intertwined.
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  But doing that with nurses, physicians, nurse leaders,
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  the entire care team like we were talking
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  about
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  is so critical.
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  And at the same time,
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  those high reliability
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  principles,
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  making sure that we are supporting our staff
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  and navigating such a complex
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  landscape with multiple generations, rising mobility, shifting expectations,
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  flexibility, growth,
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  care models,
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  technology, all the things that come that come
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  into play.
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  I think what's important is,
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  it for us is really elevating the voice
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  of nursing
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  because all these things have to be true
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  in the same space, and we have to
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  deliver on all of them at a very
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  high level
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  and making sure that we're elevating the voice
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  of our nurses and our care teams,
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  that that really is number one because that
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  that's our true north.
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  Thank you. And talk about this. Just a
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  few years ago,
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  it seems like we're on the verge of
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  complete meltdown in nursing,
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  which is complete shortages,
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  million nurses or so retired during COVID.
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  It seems like in the nurse education sector,
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  the nurse leadership
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  has done an incredible job of accelerating nurse
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  education.
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  I mean, it's imperfect, of course, course, but
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  we produce about 185,000
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  nurses a year.
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  We still only produce about 25,000
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  doctors a year.
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  How is it there's there's been so much
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  improvement
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  in the
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  education of nursing?
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  And I know there's still shortages. I know
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  there's still shortages in inpatient,
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  but it seems like so much progress has
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  been made in the nursing community
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  where the progress in accelerating medical training in
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  the doctor community is so slow. And I
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  don't need you to I don't need you
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  to take a knock at doctor training. Doctor
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  education is great. It just is not accelerated
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  for fifty years,
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  and was developed pre the Internet. How have
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  they done such a good job in the
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  nursing world?
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  And I know it's imperfect, and people would
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  complain, oh, we're doing it too quickly or
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  this or that, but there was such a
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  gap. And it seems like that gap is
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  being filled far better than it is in
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  some other areas. Any thoughts on that or
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  any thoughts on the on the improvement in
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  nurse education? Yeah. First of all, thank you,
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  Scott, for recognizing,
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  because I I agree with you. We have
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  made such an incredible stride.
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  Sometimes we do get focused on, you know,
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  that last 10 miles versus the first 90
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  we've traveled. And so, so, yes, I'm very
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  proud of our team because we've really taken
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  a run at. And one of the things
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  I'm excited about
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  is looking at what does sustainability in the
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  nursing workforce look like? Like,
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  you know, we focus a lot on recruitment
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  retention,
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  but where I think the real value has,
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  really started to show is not necessarily academic
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  partnerships, but academic integrations.
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  And so how do we look differently at
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  these academic integrations
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  through some of the things that you're seeing
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  in the industry with shared faculty,
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  more nurse,
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  work ready workforce,
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  really challenging ourselves
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  on,
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  you know, making sure that we can
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  transition
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  from a practice environment
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  incredible transition we gotta make. And I will
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  tell you during the period you're talking about
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  the initial period during COVID when there was
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  a meltdown
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  up to, you know, forty, fifty percent of
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  our new grads were leaving the nursing profession.
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  So incredibly proud of our team here at
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  Memorial Hermit. So we put so much energy
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  into this space, making sure that we are
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  supporting our nurses that we're wrapping the services
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  around them.
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  We have a ninety eight percent ninety eight
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  percent retention rate through the first two years
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  right now.
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  And, I'd put that number up against anybody
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  because that is such an amazing number that
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  our team is doing. And so we are
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  seeing those trends reverse.
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  And I may sound like a broken record,
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  but I think the way you get there
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  from here is you gotta listen to your
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  frontline staff. You've gotta make sure that you're
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  you're doing the things that are important to
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  them, that the experiences that they're getting, and
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  that has to not just start when they
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  walk in your door.
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  That really has to start,
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  in your academic partnerships when they're nursing student.
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  And that's what we're finding is incredibly valuable.
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  So I think that's one of the key
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  things
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  that,
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  you know,
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  recruitment, retention,
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  those are things that we're always gonna talk
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  about no matter if we're in a nursing
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  shortage or not. But it really is more
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  about how do you make somebody
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  comfortable in the environment when they do take
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  patients, and at the same time, that environment
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  is some place that they thrive.
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  We put a lot of energy into that
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  over the last few years, as a nursing
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  profession.
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  Well, thank you. And that movement towards those
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  kinds of retention levels, there's almost nothing more
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  important than maintaining a great institution
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  than that type of retention. It's just very,
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  very hard to do it with people switching
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  in and out all the time to really
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  build the culture that you wanna build. I
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  think that's a fantastic thing to be proud
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  of. I I'm gonna ask you
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  one question. I'm gonna start with a very
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  serious question, which is any advice on on
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  improving those retention rates and keeping retention rates
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  and what you've done to improve that retention
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  rate that you could share with other systems,
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  other leaders. But what advice? And then I'm
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  gonna ask you a non serious question that
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  I'll check for a second. Why why focus
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  first on the serious question, which is advice
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  on that kind of retention rate?
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  Yeah. So, so I think it really boils
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  down to a couple things.
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  You know, we we spend a lot of
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  energy making sure that that we are doing
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  the right thing that looking at how our
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  competencies
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  align with what, they're teaching in different nursing
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  programs.
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  We have over 200
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  academic affiliations here in the Greater Houston Metro.
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  And so you can see how kind of
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  integrating that's, really, it's a big lift. But
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  if you take and I can teach and
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  exercise
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  on the unit the same thing as far
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  as skills
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  and expectations
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  and patient experience.
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  If I can do all of that for
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  two years while I'm a nursing student,
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  transitioning into practice becomes less traumatic.
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  And I think that's what's key. It really
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  is about how do we align differently.
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  You know, we we went through a phase
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  where you're a nursing school. I'm an organization
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  that two don't really meet except for clinical
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  placements. And I think what I'm excited about
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  now is we're truly looking at what is
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  that experience? What does that transition look like?
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  How do we share competencies? How do we
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  share staff? How do we really work together
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  to do this thing differently so that nurses
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  are ready and feel comfortable? Because I think
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  that's the key, right? Just because they have
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  the skills doesn't mean that we've done all
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  the things with the time management and everything
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  else they need,
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  to really be independent on a unit. So
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  wrapping those services around them following them through
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  a transition of practice program.
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  All those things are incredibly important.
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  Fantastic. Now here is my non serious question.
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  Okay?
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  What people don't realize
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  is because we're on audio as you're listening
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  to this, but I could see Brian on
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  video.
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  And Brian is wearing the coolest Memorial Hermann
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  vest, like, sort of like a Patagonia type
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  vest that you'd ever seen. I don't know
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  what the brand is, but maybe he'll tell
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  us what the brand is. But how do
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  people get those cool vest that that you
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  are wearing? Because that is really cool, the
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  Memorial Hermann,
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  vest.
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  So I don't know where the vest came
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  from, and I appreciate you, acknowledging that, but
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  this is from our Memorial Hermann Institute for
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  Nursing Excellence.
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  So one of the things that we have
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  done over the last few years
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  is put together a simulation center. That's more
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  than a simulation center. It really is. How
• 11:13
  do we support our nurses through all stages
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  of their career,
• 11:17
  people process and technology?
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  They've been a big part in, we had
• 11:22
  over a 150 nurses publish or present last
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  year, which we're very, very proud of,
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  at the same time, developing some really,
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  forward thinking,
• 11:32
  virtual training. So, So, with our, Oxford medical
• 11:36
  solution,
• 11:37
  partner and looking at, how do we, instead
• 11:40
  of getting out of a classroom environment, how
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  do we put them in a virtual environment
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  and kind of wrap all this together as
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  we transition onto practice? So, yeah, comes from
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  our nursing institute. Again, a team that I'm
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  super, super incredibly proud of. It it so
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  let me ask you the next question. 14,000
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  nurses. I know I touched this a little
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  bit earlier.
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  You obviously can't have 14,000 direct reports nor
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  would you want to nor would they want
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  to. How do you deal with how do
• 12:06
  you deal with managing culture
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  in a large organization?
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  And just as you do your job as
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  chief nursing executive,
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  people talk about this concept of spans,
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  meaning how many people can one directly manage.
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  And and and that doesn't mean you can't
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  as a scale in organization manage 14,000.
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  But directly, you know, they always say that
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  the that the span is, you know, five
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  to 10 people that maybe are direct reports
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  to you or maybe more. I don't know
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  what that is. But what does that look
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  like, and how do you think, and how
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  does you grow into the leadership? And and,
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  obviously, you ran a division like this at
• 12:37
  HCA for some time that was a huge
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  division. So it's not new to you at
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  this point at all. But how do you
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  think about managing 14,000 people and building the
• 12:45
  right culture? And how do you think about
• 12:47
  how many direct reports that any leader you
• 12:49
  know, you could use user as example, but
• 12:51
  any leader can actually really work closely with?
• 12:55
  Yeah. So I will tell you this is
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  something that, in nursing as a profession, we're
• 12:58
  evolving. You know, we have had large spans
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  of control,
• 13:02
  at our nurse manager level.
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  And what we have seen over the years
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  is
• 13:08
  as individuals
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  are wanting more flexibility in their workplace,
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  working more part time hours, which we certainly
• 13:16
  support.
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  And but what happens is where I
• 13:20
  probably
• 13:21
  in the past had 40 nurses on my
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  units. I might have 80 now.
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  And so the strain that puts on our
• 13:28
  managers. So we're still evolving and thinking a
• 13:31
  lot about how do we support them differently,
• 13:33
  remove administrative burden because the most important
• 13:36
  thing is that they're available to be,
• 13:39
  be there for their frontline staff. We know
• 13:41
  that's that's incredibly important,
• 13:44
  but I will say, how do you manage
• 13:45
  a footprint? I have the best chief nurse
• 13:48
  officers,
• 13:49
  in the industry. I'd put them up against
• 13:51
  anybody. I am so proud of that team.
• 13:54
  Our from our top you know, from our
• 13:56
  president all the way down,
• 13:58
  we share a shared set of values,
• 14:01
  shared mission, vision. Values is not just on
• 14:04
  a piece of paper. We live it every
• 14:06
  day. And when we look at creating healthier
• 14:08
  communities now and for generations to come,
• 14:11
  all being centered around, how do we pull
• 14:13
  together to do that? And I'll tell you
• 14:16
  what's what I love about what we're doing,
• 14:19
  that is unique is we're committed to our
• 14:22
  community differently from many organizations
• 14:25
  that, I have been a part of. And
• 14:28
  you take a look at our our Hill
• 14:30
  High School.
• 14:31
  We are partnered
• 14:32
  with Aldine Independent School District.
• 14:35
  And to have a operational partner like Memorial
• 14:38
  Hermann partnered with an independent school district supported
• 14:41
  by Bloomberg Philanthropies through our Memorial Hermann Foundation,
• 14:46
  All that coming together where we're actively
• 14:49
  working
• 14:50
  daily in a high school
• 14:52
  with,
• 14:53
  we have a 190
• 14:55
  in the ninth grade, a 145
• 14:57
  in the tenth grade. When we have the
• 14:59
  full high school, we'll have about 750
• 15:02
  to 800 kids.
• 15:03
  All of these kids are working towards entry
• 15:06
  into health care as a career from LVNs
• 15:08
  to physical therapist to pharmacy to administration to,
• 15:12
  imaging.
• 15:13
  And
• 15:15
  our commitment is we're treating these guys today
• 15:18
  at 14 like they're our employees,
• 15:21
  mentoring them, making sure that they have relevant
• 15:23
  job experience.
• 15:25
  And then ultimately, when they get into the
• 15:28
  right now, they're in ninth and tenth grade.
• 15:29
  They're going to go to the eleventh grade
• 15:31
  next year. They'll actually transition into,
• 15:34
  apprenticeships,
• 15:35
  internships
• 15:36
  where they're getting real on the job experience.
• 15:39
  So they'll have that an opportunity for two
• 15:41
  years before they transition into the workforce.
• 15:44
  We're more than happy to have them. That's
• 15:45
  the idea, right, is transition them into the
• 15:48
  workforce.
• 15:49
  But what a better way to kinda wrap
• 15:51
  up when you take a look at how
• 15:53
  do you maintain your culture? How do you
• 15:54
  look at, span of control of 14,000?
• 15:57
  Having that shared mission, vision, values,
• 16:00
  deep trust, high expectations,
• 16:02
  living that every day and really pulling swords
• 16:05
  or some of these things like a high
• 16:07
  school or some of what we're doing in
• 16:09
  our new grad transition,
• 16:11
  equal equally proud of what we're doing on
• 16:14
  just retaining our nurses overall.
• 16:16
  That's where it comes down to. Our chief
• 16:18
  nurse officers, our CEOs, our c suites here
• 16:21
  at the at the system level. Everybody really
• 16:24
  pulling together to make sure that we're doing
• 16:25
  the right thing.
• 16:27
  Brian, it's literally a a magnificent career.
• 16:30
  You went back and did a master's of
• 16:32
  public health now about twenty years ago. How
• 16:35
  important was that to leadership development, and would
• 16:37
  you recommend that for others?
• 16:39
  So I would. And I will tell you,
• 16:42
  at that point in time, I was still
• 16:43
  active duty military.
• 16:45
  And, you know, I had to do I
• 16:47
  go and stay in the masters of nursing
• 16:49
  lane? Do I go into something that is
• 16:51
  more geared towards, public health? I am
• 16:54
  so happy that I chose the public health
• 16:56
  because it really gave me views into,
• 17:00
  how does health policy get generated from legislative
• 17:03
  bodies? How do you take that, turn that
• 17:05
  into a budget
• 17:07
  on larger scales?
• 17:09
  So, yeah, so it was incredibly valuable for
• 17:11
  me. I also had the opportunity to Texas
• 17:13
  a and m here in Texas. So what
• 17:16
  what better could that be? Right?
• 17:18
  But, yeah, so it's for me, it was
• 17:20
  op it was an opportunity to grow, but
• 17:22
  then actually went and got my doctorate,
• 17:25
  in nursing, to make sure that I, you
• 17:27
  know, had everything buttoned up in the nursing
• 17:29
  profession too.
• 17:31
  Fantastic.
• 17:32
  Brian, what a magnificent career. I wanna thank
• 17:35
  you for joining us, on the Becker's health
• 17:37
  care podcast today.
• 17:38
  I would ask you if you have any
• 17:40
  advice for arch Manning at Texas and a
• 17:42
  and m, but he's at Texas. He's at
• 17:44
  University of Texas. Correct? Not not a and
• 17:46
  m.
• 17:48
  Yeah. I got nothing for him.
• 17:50
  Nothing to help there. But I I I
• 17:52
  wanna thank you for joining us on the
• 17:54
  Becker's Healthcare podcast. What a remarkable system Memorial
• 17:57
  Hermann is, and what a pleasure to visit
• 17:59
  with you today. Thank you for joining us
• 18:01
  today. Thank you so much.