CHICAGO—When Joseph DiPaolo led an initiative to combine nursing and operations under one role within the two hospitals that make up the Atlantic Health System’s (AHS) western region, he was met with resistance every step of the way.
There were naysayers and roadblocks throughout the process. But DiPaolo, president of the western region of the New Jersey-based five-hospital system, saw an opportunity to change the way Newton Medical Center and Hackettstown Medical Center operated and also break down the wall between operations and nursing. His goal was to align the way the hospitals delivered care and create a more positive patient experience.
The process to create the role and hire the eventual chief operating officer/chief nursing officer was rigorous and challenging, but he said it was worth the time and investment.
DiPaolo, along with Tracy Duberman, Ph.D., president and founder of The Leadership Development Group, discussed the system’s strategy during a session Monday at the American College of Healthcare Executives (ACHE) 2017 Congress. While the succession planning process may be new to hospitals, Duberman said it isn’t unique in corporate America.
The five-step method to align talent to strategy involves understanding the business strategy, aligning roles to execute it, creating success profiles, applying the process and evaluating the impact on business results. DiPaolo and Duberman used AHS-Western’s experience to illustrate how the process works.
Understand business strategy: Duberman suggested to attendees that they ask their senior leaders whether they have enough leaders with capabilities to tackle the challenges facing the healthcare industry today. If the answer is no, ask them to determine who has the greatest potential in the organization and how to go about recruiting them to enable a cultural fit. For AHS-Western, the strategy included building the system brand within the community to leverage services across the care continuum and enhance its reputation as having the “safest” hospitals in the region.
Align roles to execute strategy: DiPaolo's idea was to combine roles into one position, which meant hiring someone who had multiple skill sets. The two hospitals would now share one CNO/COO who oversaw nursing as well as operations, including housekeeping, food services and transport. The role also required someone with nursing experience who mastered the ability to be a nurse executive and had the ability to hire, promote and manage broad nursing disciplines. One of the biggest obstacles, DiPaolo said, was that the operations staff was afraid to report to a CNO, who they viewed as someone who would favor nursing over their department.
Create success profiles: The process required a concerted approach to identify what the organization needed in an individual. To do so, the organization created a success profile that looked at what the role currently required as well as what the person would need to accomplish three to five years from now. These profiles are more than job descriptions and look at behavioral and job competencies, leadership and requirements for job success and business success. Duberman explained that the components are who people are, what they can do, what they have done and what they know. The most critical requirement, DiPaolo said: The eventual hire would need nerves of steel. The job also required someone who understood operations even if the person never managed the department before. And the role required an executive who was not defensive and could help instill a culture where people aren’t afraid to say something if they notice someone about to make a mistake. Basically, he said, the job needed a nurse who was all about quality and outcomes.
Apply success profiles: But Duberman said organizations won’t get a return on investment unless they take these detail-oriented profiles and put them to use. In AHS-Western’s case, that involved creating a committee and training them on how to conduct assessments and interviews, collect data and eventually select the right candidate. Six internal candidates applied for the COO/CNO position and each had to take a series of tests, which gave the committee information on their personalities and competencies. Although no one really knows if a new hire will be a success until the individual is in the role and doing the job, Duberman said the probability of success is much better under this process. And to ensure success, the organization provided the new COO/CNO Denise Fochesto with a 90-day onboarding program and an external coach to provide her with feedback. Fochesto’s direct reports also ran team assimilation meetings so staff could ask questions and then provide feedback to her so they could align expectations.
Evaluate the impact on business results: In addition to the COO/CNO position, AHS-Western also consolidated departments to scale back the number of direct reports and created another management level and consolidated different operations. Although the transition was a bit bumpy due to how staff accepted the changes, DiPaolo said it was easy to measure success based on HCAHPS surveys, lengths of stay, turnaround times and wait times. But the organization also engaged staff to make them all accountable for patient satisfaction and outcomes. The overall results have been positive: Since the position was filled two years ago, there has been little turnover and the Newton Medical Center has seen an improvement in its finances, which DiPaolo credited to blending nursing and operations together.