Organizational Transparency - From Words to Actions
Johnese Spisso, RN, MPA, President of UCLA Health, CEO of UCLA Hospital System, and Associate Vice Chancellor of UCLA Health Sciences, joins host Dr. Brian Bolwell to discuss the importance of accountability, organizational transparency, and her leadership journey.
Organizational Transparency - From Words to Actions
Brian Bolwell, MD: Beyond leadership, a Cleveland Clinic Podcast at the intersection of leadership, and everything else. In this podcast, we will commingle with extraordinary thinkers, and explore the impact of their ideas and experiences on leadership and management.
Hello, everyone, I'm your host, Dr. Brian Bolwell. And today I have the pleasure welcoming Johnese Spisso, president of UCLA Health, CEO of UCLA Hospital System, and associate vice chancellor of UCLA Health Sciences to this episode of beyond leadership. Welcome, Johnese.
Johnese Spisso, RN, MPA: Hi, Brian. Thank you for having me.
Brian Bolwell, MD: It's my pleasure. And we're very honored to have you join us. You started out as an RN, correct? Back in Pittsburgh, not too far from here in Cleveland?
Johnese Spisso, RN, MPA: That's correct. I did. I started my career as a registered nurse in critical care at the University of Pittsburgh Medical Center.
Brian Bolwell, MD: And tell us about your journey that led you to be the leader of one of the largest and most well-respected healthcare organizations in the world.
Johnese Spisso, RN, MPA: Well, thank you. I will just start by saying it's nothing that I really set out with a clear, and direct plan or path to do. As mentioned, starting my career in critical care, I really loved being an ICU nurse, and started my career at the University of Pittsburgh Medical Center. And then I moved to California to pursue a graduate degree. And I started working at the university of California Davis Medical Center in critical care. And from there I spent 12 years at UC Davis, and I went from staff nurse to charge nurse, to nurse manager, to then an associate director of nursing there. So, really kind of climbed every ladder in the nursing profession and got a lot of great experience along the way, had the opportunity to really work with fantastic physicians, and nurses who were mentors and leaders, and really helped me get opportunities to develop, which I greatly appreciated. And then finished my master's degree while I was there.
And then when I got married, my husband lived in Seattle, Washington. So, I moved to Seattle and started work at the University of Washington at Harborview Medical Center as the chief nursing officer there and spent 22 years at UW Medicine. So, I went from chief nursing officer to eventually chief operating officer and then CEO of one of the hospitals, and then became the chief health system officer of the system. And I was there for the last eight years that I was at UW Medicine and responsible for the four hospitals, the community clinics, the airlift Northwest Flight Program. And then most recently I've been for the past six years at UCLA as a CEO of the hospital and clinic system.
So, I kind of am one of those people who I think I was in the right place at the right time. I always benefited from great role models and mentors. I also, each time I was promoted, it was a national search, but I definitely felt I had the confidence of the institution already from spending so much time there at different levels. But I can honestly say in each of those jobs that I was in, I always felt, "Wow, I love this job. I could finish my career in this job." And so, I was someone who always focused on just doing the best job I could in whatever role I had rather than looking constantly for that next job.
Brian Bolwell, MD: So, that's a wonderful resume. Obviously, you learned a lot about leadership on the way. I mean, you kept getting promoted, kept getting bigger jobs, more opportunities. The University of Washington health system is big and complicated, and, as you mentioned, there's several hospitals that are associated with it. What did you learn from a leadership perspective as you were growing your sphere of influence?
Johnese Spisso, RN, MPA: Yes. And particularly when you advance to senior leadership, I think there's a lot of learnings within the institution, but then the external environment that you work with is so key. One of the things that when I was at UW Medicine, the organizational structure, we had a governing board at the highest level, which was the Board of Regents. But then at each of our institutions, we had another board. So, it was working a lot with board members as well. And then at one of our institutions Harborview Medical Center, it was owned by the county operated by UW. So, we had a board appointed by the county. So, then you're working with a board that is representing the public. So, I certainly, during that time, learned a lot about working with boards, what the role of the board is, what the role of management is.
And again, I felt I was so fortunate to work with such skilled and talented board members who were leaders in their community. And I learned a lot about how the external community looks at healthcare systems and seeing things through their lens rather than just the way we look at ourselves. And it really, I think, causes you to be much more transparent with what you're doing. And as you're thinking about planning growth, planning new services for the community, really, the importance of inviting the community in to listen to what their needs are, rather than just going forward, and telling them this is what you're going to do. So, that piece, I think, was really fundamental in my development.
Brian Bolwell, MD: That's an interesting topic. We haven't really talked about that a lot on this podcast. So, working with boards is, I agree, it's an acquired skill, at some degree, it's an art. What are some of your keys about how to do that successfully?
Johnese Spisso, RN, MPA: I think the board in whatever role they're in, whether it's a fiduciary board, whether it's an advisory board, whether it's a strategic board, these are people coming together, and most of the time volunteering their time. So, they really want to make a difference. So, I really learned that it isn't just about the institution doing presentations to them and telling them about what we're doing. It's really creating those types of meetings where you can have key discussions and get key input from board members on their perspectives and hearing them and listening to that. And that certainly is something, as healthcare leaders we have to learn to do, and not just for the senior leader, but for the whole leadership team.
So, even in my earlier days in the system, when I was the chief nursing officer, a chief operating officer, I got to participate in those board meetings. So, I learned a lot. So that by the time I was at the most senior leadership position, I knew a lot about the board dynamics. I knew what was important to them, and I knew what the organization had to do in order to be transparent and inclusive. So, I was fortunate to be able to look at that through the lens of a few different roles.
Brian Bolwell, MD: Did you apply that within the organization? I mean, you're talking about transparency, you're talking about listening, you're talking about valuing input, all of which are obviously important from a leadership perspective. I mean, those are skills though that apply to just about any situations.
Johnese Spisso, RN, MPA: They really do. And that's such an important point that you raise because the entire organization really has to walk the talk, right? You just can't say the buzz words, or do these splashy marketing campaigns, and focus on all the great things that you think you're doing. If everyone doesn't feel that, if patients don't feel that, if families don't feel that, if the staff who work there don't feel that, and quickly people find out the real things. So, it is a whole learning for the organization. And I think one of the things that's always important to share with the staff is the thoughts and direction of the board. The things that the board feels are important to the community, the things that the organization is really doing to make a difference in the public viewpoint. I think that really helps connect them to purpose on what they're doing.
Brian Bolwell, MD: You're the CEO of the UCLA health system. And you're one of the highest ranked hospitals in the United States. What is the focus of UCLA and how does that connect with the board? And then there's other things that we've got to do within health systems, which certainly connects, but maybe not quite as directly, such as quality, and safety, and patient experience. How do you prioritize and what are your priorities?
Johnese Spisso, RN, MPA: Yes. And thank you. And while we are top ranked number one in the state of California, number three in the nation, we really focus on the elements that go into really success for patients, and that is quality safety service and their outcomes. So, our work and focus on that, particularly over the past five years, and doing better in patient outcomes, reducing mortality, reducing preventable deaths, reducing anything that is harmful to patients has led to better quality scores. And that helps lift us in rankings, the same way the patient satisfaction does, which is so important. So, we focus on those things rather than saying we need this or that for our ranking, we focus on our core values.
We have something that's called a movers dashboard that is transparent to the staff. It looks at morbidity outcomes, value, excellence, the things that reducing readmissions, and service. So, there's a scorecard for every unit in clinic, and we have targets each year, and we work towards those improvements, really benchmarking ourselves, not only against national peers, but also against ourselves each year to say, how are we really making a difference? And as an organization that is really on a journey towards zero harm, those types of metrics are really important for all of our staff who work there.
Brian Bolwell, MD: Tell us why transparency is so important.
Johnese Spisso, RN, MPA: I think it is so important because as organizations and particularly for us at UCLA Health, we're a public organization, right? The accountability factor is really very high, and you need to build that sense of public trust. And I think as healthcare organizations over the past decade, we've all been making progress towards greater transparency with the public, even when we have sentinel events, untoward events for patients, and their families. We've learned that being honest, and transparent, and sharing that and disclosing has really led to trust with patients. So, we all see the benefits of that. And I also feel it's so important. As we are always wanting staff to raise any good catches, or near misses. You have to have that environment of transparency, and a culture of no blame in order for people to bring that forward.
And we learn so much every day by these good catches that staff identify and raise forward. And in healthcare, I think we can be really proud of the work over the past 20 years that we've done in that there's still a lot more to go, but I think definitely the Institute of Medicine and other organizations have helped push us forward in that way.
Brian Bolwell, MD: So, those good catches are very important. And one of the things that's always talked about in a just culture environment is making sure that everybody along the line feels psychologically safe to speak up. How do you create that? And what do you do when there's a lack of psychological safety, which is usually because of physicians?
Johnese Spisso, RN, MPA: That's such an important point, Brian. And sometimes I feel even in academic medicine, we sometimes have to work harder because we're working side to side with Nobel prize winning physicians, people who have a lot of really impressive titles, impressive resumes, but we have to have the culture where anybody on the team can raise the flag and say, "We need to stop. We need to pause." So, we've done a lot of training within the institution, particularly, using tools like team steps and others to make everyone feel safe. When I reflect on the timeouts that we do in all of our surgical, and procedure, and interventional areas, that really is a time where everyone in that room has a chance to say something. And I think having the organizational support for that, the leadership expectation for that, helps to create a safe environment for everyone to raise those. But that culture really needs to start at the top, and you need to make sure that it really translates throughout the organization, and also promptly address it in areas where it isn't happening.
Brian Bolwell, MD: There's a national nursing shortage right now. And one of the challenges I think every healthcare system has, is how to continue to execute on quality, and safety, and patient experience when people have been very stressed over the past couple years, and it speaks not just to potential burnout, but also to employee engagement in general, and just how to execute really any priority. It depends on our people. How do you do that? What's your philosophy of how to keep employee engagement high, how to deal with the fact that we've been through a very challenging couple of years, and how do we go forward?
Johnese Spisso, RN, MPA: That's something we're always working on, and I'm always looking for those best practices nationally as well. So, pausing and reflecting over the past two years, right? Certainly, our staff are exhausted. And as we looked at how we navigated the COVID-19 pandemic, all the new treatments that were available, the vaccine program, there was a lot of mandatory just in time required training that we were doing with staff. And then we layered on top of that, a lot of additional training we were doing for health equity, diversity, and inclusion because of the events that were happening, right? And realizing that as an organization, we needed to get moving on our roadmap to be an anti-racist organization and an anti-racist society. So, we did a lot of work over the past two years, and I was just looking the other day to say how much training are staff having to do in the midst of their busy jobs.
And what else can we take off the plate? So, I do think you need to be constantly looking at the organization. And again, looking at the workload through the lens of the staff, right? As leaders and as managers, we sometimes have more flexible time with our schedules. It's very hard for staff to get training in when they're at the bedside and when we have to take them off for training, and we're short staffed and things like that. So, we're looking at ways to really make that more efficient for staff. And the first thing starts by asking the staff and getting feedback from them. And we do pulse surveys quarterly in our organization, where we ask five questions. And so, we tailor it around, whatever we feel is the hot topic. We get a lot of valuable comments from staff about things that they're doing that is making their jobs more difficult.
And often we get a few great points about little things we can do that make it a lot easier. So I would say in general, at times like this, it's best to listen to what the staff say. During COVID, we tried to do a lot of things that we felt would help staff with wellness. We offered yoga, mindfulness, meditation, those types of things. People just wanted time off. They didn't want to come in and go to those classes. So, it was really about trying to meet their needs at where they're at in phase of work.
Brian Bolwell, MD: So, I love the idea of a five-question pulse survey, quarterly. What are your last five questions?
Johnese Spisso, RN, MPA: Our last five questions really had to do with a lot around training. How do you feel our training modules are? Do you like the virtual environment? Are they too long? Are they too short? How could we do more training, more efficiently? In the past, we focused on wellness amenities. We focused on peer-to-peer interactions that could be improved, things that they'd like to see around teamwork. So, we try to see kind of what the latest organizational stress is, and maybe how we can address it.
Brian Bolwell, MD: The key is then you've got to act, right? I mean...
Johnese Spisso, RN, MPA: You have to act.
Brian Bolwell, MD: …if you just listen, but don't do anything that becomes deflating. How do you publicize your actions?
Johnese Spisso, RN, MPA: What we try to do is after each survey, we try to pick one to two things that we heard, and an action plan for that, and we share that. Many times, it can be local to a unit, or it can be broad to the institution, but you're absolutely right in that you have to get that feedback. Otherwise, staff quickly figure out we're not even going to participate if you're not even going to listen to us. So, the staff definitely hold us accountable for that. And I do think that's something that leadership has to transcend through the organization.
Brian Bolwell, MD: Yeah. I think that's really important. So, that's actually really cool. I think that's probably the best practice. One of the things that we've found over the past two years is the number of inbox messages in our electronic medical record from patients has doubled since the pandemic started two years ago. Have you found that to be the case at UCLA?
Johnese Spisso, RN, MPA: We have. And in fact, that's probably something that we heard loud, and clear from our physician feedback on just the sheer exhaustion with keeping up with the inboxes. One of the things that we tried to do, because a lot of those questions were about COVID-19 about vaccines, about treatments, about testing. What we began doing is we sent out an electronic letter, and in the midst of the pandemic, we were doing it weekly. Now we're doing it monthly. But talking with them about all the new developments that were happening, trying to put as much advice as possible in that memo, they got it on their eCare portal. We were sending that to over 600,000 patients. And then on our website, we also created a chat bot. So, people could go on the website and through use of that chat bot, they could ask questions. And then we also monitored those questions. And the next week we would come out with a Q&A about a lot of the questions received to try to really diminish that. And we were constantly guiding patients to that website for more information so that they weren't just constantly sending notes to their physicians.
Brian Bolwell, MD: And that's fabulous. I think that's a great idea, but is that... Are you getting traction? Is that used widely?
Johnese Spisso, RN, MPA: We have felt that once we deployed that, which was in the first year of the pandemic, we were able to reduce those messages related to COVID pretty significantly. But the other thing I will say is another kind of silver lining in the pandemic is we did drive a lot more people to our portal, and to telemedicine. So, we've had a lot more traffic there, which I think, at times, our physicians, and healthcare professionals translate that into a lot of additional work. I do feel, though, we're able to do that work more efficiently in many times through that. I mean, we went from prior to the pandemic, we were doing something like 150 telemedicine visits a week. And then when we were in the midst of the pandemic, we were doing over 10,000 telemedicine visits a week, and now we've settled out to about 80% of our patients coming in-person into our clinics. And about 20% in telemedicine, and our numbers in-person are where they were pre-pandemic. So, what we feel is we've been able to actually add a lot of capacity by keeping the telemedicine visits there without having to put up more bricks, and mortar around that, so that part has been really helpful.
Brian Bolwell, MD: You mentioned earlier that you've got a lot of very distinguished faculty, and so academically, UCLA, again, is one of the most respected organizations in the country. You're responsible for running a hospital. How do you marry the two? How does that work?
Johnese Spisso, RN, MPA: Yes. Well, we're so fortunate to be on the UCLA campus where we have the Schools of Engineering, the School of Medicine, the School of Nursing, School of Public Health, School of Dentistry. So, we have this, and all of the research institutes that go along with that, so we have this huge think tank. And for us, it has really helped us accelerate so many new discoveries in patient care, not only in the novel therapeutics, but really just in our work with bio design, and innovation. We started about five years ago at UCLA health. We started a center for innovation, and then about four years ago, added bio design to that. So, we have great support from those schools. They provide funding as well. So, each year we have 10 bio design fellows that are working in our health system, helping us design new ways to care for patients, new treatments.
And we have a whole group that works together so we can wrap around resources for them. We call it a startup in a box so that these experts can help them guide everything from that initial discovery all the way through commercialization. So, for us, I think the greatest benefit is it fosters that environment of constant learning. And another great opportunity we had during the pandemic is a lot of our students in all of those schools really were there as an additional workforce for us. They were 3D printing swabs, and shields, and things like that, and really doing anything that they could support the health system through the pandemic. So, it also made our staff realize and recognize the value of those schools. And also, the value of the research that's done at academic health systems and campuses. And I think the COVID-19 pandemic really shined a great light on that. When in record time, we were able to have testing, vaccines, and treatments due to the research efforts that were led across the country.
Brian Bolwell, MD: And how do you foster great teams?
Johnese Spisso, RN, MPA: I think that's the question, right? I think it starts with their connection to the purpose, and the passion of the institution and the work that they're doing. And I've always felt that inpatient care, we kind of have an embedded advantage of doing that because everyone working on the team can see the benefits of their work in the patient's lives, and the lives of the patients, and the families. And particularly, I think in organizations that do really complex care, right? The families are so grateful as they watch their patient on the journey with the entire healthcare team that is moving them towards a better outcome. And that appreciation I think is a great benefit. I know when I worked as a staff nurse and a bedside nurse, I always felt so valued by patients and their families. It can be rewarding, it can be highly stressful, but I think the type of work that we're doing and the passion around that work definitely bonds the team. I'm always so impressed when I go on rounds, and even when patients aren't doing well, their disease or their injury or illness is so significant seeing how grateful the family is just knowing that team is doing everything to care for them. And I think that appreciation really helps bonds teams together. It's more about our collective work together than anything anyone individual is doing.
Brian Bolwell, MD: What new have you learned since you've been at UCLA?
Johnese Spisso, RN, MPA: Wow. I've learned so many things. I've had a fortunate career in working at now four great academic institutions I've learned from each one of them. UCLA, I will say what I've learned most is the opportunity to work in a city as large as Los Angeles, right? In a county, in a city we have over 10 million people and some of the most significant health disparities in the country. It has really allowed me to take a look at what the institution can do to make a difference in the entire community. And how do we take not only our leading-edge clinical care, but the research, and training that we're doing to really help solve some of these most difficult problems in Los Angeles. And we can't do that alone. So, it's taken a lot of collaboration with other institutions with state, and local government with the mayor's office.
And we have a lot of work ahead. I think the COVID-19 pandemic shined of a big light on health disparities when we began to see such different outcomes in underserved populations. And so, for us at UCLA, what we know is we have to do more. And so, we've been focusing on our efforts around health equity, diversity, and inclusion over a year, and a half ago. Now we brought on our first chief health equity, diversity, and inclusion office for the clinical health system. We've always had health equity positions in human resources, and in the School of Medicine, but really to say, "Let's start looking at the patient population we're serving. Let's start looking at where the disparities exist, and how can we create programs to make a difference?"
So, most recently in January, we launched a homeless healthcare initiative. In Los Angeles, we have about 66,000 people every night that are experiencing homelessness. And the barriers to healthcare for that patient population are huge. So, we have equipped vans and we take our teams out to the encampments, out to the areas where there are shelters, out to the streets and really provide that healthcare. And that's just one step going forward, but it's something that we feel is critically needed.
Brian Bolwell, MD: Is it making an impact?
Johnese Spisso, RN, MPA: So, far…we're only a few months into it. And we are, as a data driven organization, we are collecting that data, and studying it. And one of the things we did prior to the launch is we looked at our two emergency departments in Westwood, and in Santa Monica where our medical center campuses are. And we saw that in the population of people experiencing homelessness, a lot of their ED visits could have easily been handled in a clinic or in a mobile van. So, we are expecting to see a decrease in emergency visits for that, but we're early on, it's looking promising, but we hope to share that data more broadly once we have it.
Brian Bolwell, MD: Well, that's a very cool initiative. Congratulations on that. How about you personally? So, our listeners know that about 20 years ago, I got a 360, and I assumed it was going to be glowing. And unfortunately, or fortunately for me, it wasn't. And I realized I had a lot of opportunities to learn more about leadership, and to improve my leadership. Have you had 360's, and if so, what have you learned, and how have you gone forward?
Johnese Spisso, RN, MPA: I have, and most recently we do them every few years. So, I've had them in every organization that I've been in. And I do, I like using them as a tool because even when I'm evaluating team members, sometimes I feel someone is just doing an amazing job. And then I learn that not everyone is feeling that. So, it's always helpful to know. And then to use that as a tool to help that person develop. And people have been really wonderful about wanting to receive that. And I like to see it as well. And each time I see that, I learn things about myself, about my style. Times when, if I'm moving too fast, and I need to slow down and make sure people understand kind of the why that I'm doing it, the vision, how they can be a part of it.
And you also, I think, pick up a lot on the little things that you do too, that make a big difference. So, things about your style that come second nature that are impactful for people. And I like to see that as well, but I mostly use them, just like you mentioned, as a development opportunity, right? We're a big organization, 35,000 people. And it is interesting, just one of the things I'll share. Having spent like 12 years at UC Davis, 22 years at UW Medicine, I kind of grew up there and knew everyone there. So, it's a lot easier to make sure you're including everyone, you know everyone on the team. When I came to UCLA, I really didn't know anyone. And there are 35,000 people there. So, the first year I was just really getting to know who people were, and how they liked to work and what they expected of a leader.
So, there were a lot of things that would come second nature to me in an organization that I had to... It's a lot harder when you don't really have that long-term visibility, but I must say now at almost six years, I think I figured it out. But I think as leaders, we have to be open every day to learning, and also too working in organizations where there's a lot of people that have been there for a long time. I always find value in learning the history, but also as we bring in new people, and they bring in the ideas from these other fantastic organizations, I find that we learn so much from those. And that is one of the things I'll say, even as organizations are successful, so you work at a fantastic organization, so do I, but you never want to lose that thought that you can always learn from someone else. You have to really stay humble in that approach and realize that you can learn from other institutions as well. So, I really try to stay focused on that.
Brian Bolwell, MD: Yeah. You just brought up a lot of really important things. So, your last point, yes. I like to quote Henry Ford as I continue to age, who said, "You can be 20 years old, stop learning, and you’re old, and you can be 80 years old, continue to learn, and you're young", I'm holding onto that.
Johnese Spisso, RN, MPA: Yes.
Brian Bolwell, MD: You mentioned how you come across to other people. And one of the things that I think is increasingly important is to realize that communication, isn't just about the facts that you're trying to convey, but also the emotional impact of your words. Have you found that to be true? And if so, how do you pay attention to that?
Johnese Spisso, RN, MPA: Absolutely. And I think that emotional intelligence is so important. I'll give you an example. During the pandemic, when we had a shelter in place order in Los Angeles, some of our support departments that weren't clinically facing were working from home. And we would be, just an example, we would be every day crafting the daily communication, and things that would go out. And we would kind of get a draft some days and think, "Wow, we would never say it like that, based on what we just heard on rounds, what people were feeling." So, I feel you have to have that pulse of the organization to know how your words are going to come across, kind of what they're feeling, what they're interpreting.
So, it was one of the big reasons why we wanted as many people back in person as possible so that we could really understand what our staff were going through, and how, as an organization, we needed to put out the right kind of messages that would be well received by them. And that would acknowledge what they were going through. So, I tend to always look at things and read it through the lens of how I feel people are going to want hear it, and from what I'm observing that they're going through.
Brian Bolwell, MD: Yeah. I think that's a really important point. Another thing that you've mentioned a couple times is as you're trying to go from point A to point B or change something is starting with why, and certainly starting with why is really important, probably the most important thing actually. But then, then you've got to execute on it. And so, you've got to... One of the challenges I see sometimes is people, as leaders, can be very good at saying what they want to do and maybe less good at how you're going to execute it. How involved are you in operations or at least understanding the challenges of a new initiative, and how important is it to you to hear the contrarians? To listen to the people who say, "Man, that can't be done."
Johnese Spisso, RN, MPA: I think that's so important and all these great ideas come forward and all these great programs and things that we want to do, but the success or failure is really based on the implementation plan. So, if there isn't a good plan that isn't easily executable with the staff, and the broader institution, it ends up just becoming words. And that is something that I do stay involved at a high level. Every other week I have a two-hour meeting with the senior leaders on my executive team and we review every new initiative there. And I will say that dialogue between the group is always helpful because even sometimes the best laid plans, we have people saying, "Look, this isn't going to work right now. You're launching this plan right in the middle of a Care Connect upgrade, or a joint commission survey prep, and the staff are taxed. We need to do this in smaller steps."
So, I do appreciate that with the executive team members, they will push back. They speak their mind. We don't always agree. And I really like to keep fostering that environment because if you don't, if it's a group that everyone is just saying, yes, you quickly lead the organization down a path that really isn't helpful. And so, I do think that group input on really what's going to work best has really been key to success on some of our initiatives. And some we've had to take off the table. It's a good idea, but we're not going to be able to do this successfully, so let's rethink it at another time. You can't always do everything and do it well. And I think that's an important…the other thing too, is you can't be afraid of having a few failures because I think the organization learns from failures. The key is, how do you really turn that failure around quickly? And how do you build that resiliency when a mistake happens to go on and do the next thing even better? And that's the part that I think makes the organization most adaptable.
Brian Bolwell, MD: I think what you just said is really profound on many levels. Yeah, I totally agree. I think that having the psychological safety to receive input from everybody is really important. And I think sometimes I have... I remember when I was a resident Johnese, [Johnese laughs] and an attending told me in academic medicine, "Bad ideas die hard." And I thought about that, and I didn't really get it, [Johnese laughs] but as I've gone throughout my career, sometimes we get married to an initiative, and we think about it forever and we say, "All right, we're going to do X." And yet, if X is going to be impossible to execute, sometimes we stick to it anyway. But I totally agree with what you said. Sometimes you've got to put X on a shelf, and say, "For these reasons", maybe it's not the best idea. Maybe it's the bad timing, whatever. And having the inner security to do that. And as you said to learn from other times when you haven't achieved success, well, I think if you can do that, you can achieve almost anything in leadership.
Johnese Spisso, RN, MPA: Yeah. I think you're right, Brian, and when we think about healthcare over the years, and the decades and the things that we've done to change, it's a constantly moving field and we have to be flexible in that. And also, we want to keep trying new things, and again, not everything works out. So, we don't want to have people with that fear of everything we do just has to be perfect, and lose that innovation, and ingenuity that really has led to success.
Brian Bolwell, MD: Yes. I agree. As we're wrapping up…this has been an absolutely wonderful conversation. Thank you so much.
Johnese Spisso, RN, MPA: Thank you. It's been a pleasure talking with you.
Brian Bolwell, MD: Any leadership pearls you'd like to lead us with any kind of your north stars that have served you well?
Johnese Spisso, RN, MPA: I think through my career, I've just always tried to be genuine and honest about who I am so I can really maintain credibility and integrity. And I always try to walk the talk. I think that's so important. And I think if you don't walk the talk staff identify that very easily and it ends up that they lose confidence in leadership. So, I think that's most important that you are genuine, and deliver on what you say you're doing, and that you uphold your values in that in every step possible.
Brian Bolwell, MD: And if you do that, you generate trust. And if you generate trust, everything becomes a little easier.
Johnese Spisso, RN, MPA: Yes. And it's a privilege for us to be in these positions. And I never forget that. We get to represent all of the fantastic work that our staff do every day, 24 hours a day. And I'm always grateful to have the opportunity to work with such an amazing team.
Brian Bolwell, MD: I think that's totally correct. And I think that's very profound. Thank you so much, Johnese. To our listeners, I hope you've enjoyed today's conversation, which I thought was really, really good. And thank you so much for tuning in, and we look forward to having you listen to another episode of Beyond Leadership. Have a great day.
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