Leading Through Change: Inspiring Teams with a Shared Vision and Purpose

Podcast Transcript

Carol Pehotsky:

If you're waiting for things to settle down, to launch any type of change, you're going to be waiting a long time. We know now that the pace of change has been and will continue to be blistering at times, and yet it's what our caregivers deserve. It's what our patients deserve. We should always be asking ourselves, is there a better way? Is there a different way to do things to make outcomes better for our patients that we serve? I'm joined today by Kerry Major, Chief Nursing Officer and Vice President of Cleveland Clinic Florida, to discuss ways that we can lead through change regardless of the role we play in that change.

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

Welcome back everyone. In terms of the past several years, whether it's professional, whether it's in healthcare, whether it's just the world in general, really the only common theme has been change (laugh). Change, that sometimes we as individuals have some input on or sometimes change that feels like it's happening to us as healthcare professionals, as leaders, as human beings. But it's all change, and it's coming to us so very often that sometimes it can feel overwhelming. We certainly know that we feel that in our outside world, but we feel it in the hospital as well. We feel it as nurses and how do we manage that? How do we lead through it? How are we good participants in that change? Our topic today is leading through change. It's my great pleasure to introduce you all to my friend and colleague, Kerry Major. Kerry is a chief nursing officer and vice president for the Florida region and Chief Nursing Officer for Cleveland Clinic Weston.

Kerry Major:

Thank you so much for this opportunity. This is just so exciting.

Carol Pehotsky:

You have a fantastic nursing journey that I always learn from every time I hear a little bit about it. I'm hoping you'll share that with our audience to get us started today.

Kerry Major:

Sure. I grew up in Hong Kong and my best friend’s mother was a nurse. I always remember asking about what it meant to be a nurse, and I had a number of different individuals in my family or family friends that were in healthcare in some capacity. But I really didn't have anyone that was in nursing, per se. So every time we'd go over and spend the night at each other's homes, I would talk to her mom and just get a feel for what it was like to be a nurse. And I'll never forget when it came to applying for universities and thinking about what the next step was going to be after high school, I realized that you could get a bachelor's degree in nursing. I did not know that. And so that was my first launching point into looking at nursing as a profession, as something I would love to learn more about and make part of my life moving forward.

Fast forward, a little serendipity, I guess. The first hospital I ever worked at was the same hospital her mother worked at, and that was in Hong Kong. Very interesting. It was a wonderful experience. I did my bachelor's degree in England and then went back to Hong Kong and worked for about a year and a half. And then I was fortunate to come to the United States, to South Florida. I started my career here and never left.

Carol Pehotsky:

That's right.

Kerry Major:

So that's it.

Carol Pehotsky:

Awesome. Thank you so much. What specialties did you travel through?

Kerry Major:

It's interesting. I think it was med-surg, mostly surgical patients, post-surgical. I really have been doing leadership for the majority of my years. Yeah, I only spent about two or three years at the bedside. The rest of it was just wonderful opportunities to go on my leadership journey.

Carol Pehotsky:

Part of the reason I picked on you a little bit with that is because, audience members, what you don't know about Kerry, but you're going to learn over the next 20 to 25 minutes, is that Kerry is such a fabulous voice for the bedside nurse. You don't have to have done every specialty to be a successful executive. You don't even have to spend most of your career as a clinical caregiver. It's about who you are and who you surround yourself with. And Kerry is an example of that.

Kerry Major:

Thank you, Carol. That's very kind.

Carol Pehotsky:

Of course. When it comes to leading through change, something else to note is that several of the most recent members of the Cleveland Clinic family are all in your state, and you have got to welcome all of them and bring them into the fold and help with that transition. Here we are today with five hospitals in Florida, countless outpatient surgery centers and ambulatory practices. So yes, I can assure you folks that Kerry knows what she's talking about in terms of leading through change.

Kerry Major:

I tell you, leading through change is about having a great team that surrounds you. You hit on it, Carol. It is all about the team. It's about being able to bring people together with a shared vision and a common purpose, and to inspire them as they go through whatever transition they're going through. You know, change is hard. It's not easy. I see myself as someone who can help to shepherd the group or the team or whoever is being impacted by that change through that transition --- the highs, the lows. Because change is hard. It really is.

Carol Pehotsky:

The understatement of the century, right? (laugh) [Yes. Oh, yes.] And the one before that and the next one to follow. We'll start with the tough questions. Sometimes change is let's go make things better. But sometimes change is this is what's going to happen, right? Whether that sometimes is a regulatory thing, a position change, or a policy change. There's an organizational shift. We'll spend some time later talking about shared governance and the voice of the caregiver in that change. But sometimes there isn't opportunity for voice. That's the toughest change to lead through, I think. So we'll start with a tough one: when it happens that way, when there isn't necessarily opportunity for feedback from the people that are going through that change, how do you lead through that?

Kerry Major:

You know, I think it starts with transparency. I think it starts with open, honest communication and helping the team understand the why. They may not agree with it, they may not be sure about it, but I think as leaders, it's important that we articulate why we're doing what we're doing, or why we are moving in the direction we are trying to move in. What's the purpose? What are we really trying to accomplish? And how can each of these individuals or stakeholders help us to get there? So, it's understanding the why, but also how they can make a difference as we are making that transformation. Because I think when people can have that connection to the work and understand that they actually will be able to make a difference in that work and in that outcome, I think that buy-in and that sense of ownership for the success of that change or that transition, I think you have a better chance of accomplishing what you hope to accomplish.

Carol Pehotsky:

Well, and one of the things that I've learned by watching you is we don't always have the answers when this regulation has changed and we have to do something about it. And what I've always admired about you is you are also transparent enough to say, I don't know the answer. I'll commit to trying to find it so that you and others can understand the why.

Kerry Major:

Mm-hmm. You know, Carol, I have learned humility in leadership. (laugh) That is one thing that you learn, you have to be humble and recognize that you don't know it all. Reach out to those around you and surround yourself with those who may have that answer or can guide you in the right direction. But I have learned that it's okay not to have all the answers. That it is okay to be real with your team. And, as you say, tell them I don't know, but let me find out. Let me see what I can do. Let me get you the information that you need so we can move forward.

And that's not always easy as a leader. Certainly, earlier on in my career you wanted to have the answers. You wanted to be the one that had that support and guidance and that clear vision and path of how we're doing and where we're going and how we're going to get there. And sometimes it isn't clear. The path is not clear. You're almost creating that path as you go. I think it's important to recognize that, to articulate that and let people know it's okay. You know, it's not always a straightforward, easy path that we follow when it comes to change.

Carol Pehotsky:

Well, and you had mentioned this earlier, I want to come back to it, is thinking way back to the beginning of my nursing career, the reactions could sometimes be who made this decision? Or whether it's imposed or not, that feeling that something's happening to me versus I'm part of that. So as bedside nurses we'll take that perspective. How do we need to be listening and thinking about change and trying to get past that victim to understanding and perhaps participation?

Kerry Major:

I think it's important that we have an understanding of how the change is being perceived. How do people think this change is going to impact them? It's usually because there's some fear or uncertainty or concern of this is going to impact me in x, y, z way. And I think we have to listen. We have to listen to understand, to really understand what the concerns are, what the barriers are, what the challenges are, what the risks are, but also ask for those solutions because we have an incredibly talented group of caregivers that we work with every single day, and they have incredible ideas.

I think it's not only understanding what their fears and concerns are that might be causing them to be hesitant to step into that change process. But I think it's important to understand what their thoughts are as to how we can make this change successful, and how they can embrace it in a way that they take ownership and that sense of, I can help to make this work.

It takes time. It takes really sitting and listening and hearing and giving feedback, allowing them to provide feedback, really having the nurse feel that they have a voice. And you mentioned it earlier; shared governance is a great way to do that. It is so important that those individuals are going to be impacted, feel they have a voice, and can be part of the process, part of the change, and not just recipients of it. It doesn't happen to them; they are part of the process of making this happen for them.

Carol Pehotsky:

Well, listeners, that means you have to engage. If a leader comes to you with, this is where we're heading, or here's what we need to do. Or I'm hearing that there are concerns about X, Y, and Z. It does take some courage, especially that first time as a bedside nurse saying, I have a concern, or I have an idea. And, you know, talking about it in the break room after the staff meeting is not going to get that change happening. So, let's say I'm a brand-new nurse and I do have a concern, or I would like to see some change. What advice do you have for me?

Kerry Major:

Speak up. Talk to your colleagues, talk to your peers, get their feeling about where to go next. Go to your supervisor, take advantage of connecting with a leader you see on rounds. Visibility is key. I think that helps to build that sense of comfort or that relationship where you feel you can go to someone and ask those questions.

As leaders, I think we have to lead that charge, be out there, be visible, be authentic in how we lead, help those caregivers feel that they can come up to us and say, hey, I have an idea. And if it isn't us, speak up to someone who you feel might be able to give you some advice and support and point you in the right direction to be able to share your insight and to share the idea.

Carol Pehotsky:

Sure. Be part of that solution.

Kerry Major:

Yes.

Carol Pehotsky:

Even if a change is good, we know just changing can bring resistance. (laugh) What are you doing? You've moved my cheese. What sort of methods or strategies have you used to overcome that resistance or skepticism or even inertia?

Kerry Major:

It's clarity, clarity is key. Change is very uncomfortable. It's continuous. To me, change was that episode, right? It was that event, that one thing you were going to implement to change X, and then you went back to normal operations. It isn't that way anymore. Change is continuous. And I think when you weave that mindset into the culture of the organization, then it doesn't come as a surprise, right?

The expectation becomes that we are continuously learning and growing, we are continuously looking to do better and be better. That's part of who we are as an organization, as nurses, as caregivers, as advocates. I think it's helping people understand the difference they can make, that they do have a voice, that they can be part of the solution. We need to recognize their participation and success and engage them in the work where things aren't working so well and getting their ideas and suggestions.

It's really making sure that they feel valued, that they have a voice, they have seat at the table and can contribute in a meaningful way. And I think being able to do that helps to remove some of that resistance because then that sense of ownership starts, I hope, to develop as we move on in the process.

Carol Pehotsky:

Well, and we all went through the pandemic where we were time stamping, as of this date and this time, then an hour would pass, and we'd make a different decision. I think there was a lot of, well, this is going to slow down. Then it really hasn't. I think for all of us listeners, no matter what your role is, this is the pace of change we're going to have and how we as nurses can influence that change to make sure it's a positive thing for our patients and for our caregivers.

Kerry Major:

I agree.

Carol Pehotsky:

Like you said, once upon a time, (laugh), we would implement something. Did it work? Did it not work? Learn from it accordingly. Within this pace of change, we always want to make sure we're making the right change. We're not changing just for change's sake and that we can say this is better or this is not better. We need to do something different. With so many changes happening at the pace, how do you stay on top and monitor and measure? Is this improving things? Do we need to do something different?

Kerry Major:

That feedback is so critical and, whether it's qualitative in its nature through going to the gemba and talking to people and understanding what the real impact of the change is and really being empathetic in that space, you have to measure what you're trying to drive, right? Again, whether it's a qualitative measure of getting that feedback and understanding that impact to that caregiver through check-ins or survey results, whatever it might be. Or if it's something you can measure.

If you're making a change that is measurable, I think that's something that should be identified upfront and everyone understands how we are going to measure success. These are the milestones that we're going to use to measure whether the work we're doing is making a difference and having the impact we're expecting.

And if it isn't, hopefully the outcomes will show that too, and will allow us to determine if we need to pivot in this work, which again is all part of that continuous improvement process. That's what I love about using that framework when it comes to change and change management, because I think it allows us to recognize that change is ongoing, it's continuous, and we have to be constantly reevaluating, measuring and understanding impact so that we can make sure we're moving in the right direction. We take the feedback, but we also try and find ways to have some objective measures of that success as well.

Carol Pehotsky:

I was reading a writeup about a panel that you were on and I was really touched by the idea that says, it's having that humility to say, wow, that didn't work the way we thought it did or this didn't actually measure what we thought it was going to measure. That's not easy. And you mentioned learning humility over the years, so whether it's a bedside nurse or maybe a new leader, you can't fast track humility. What tips would you give for somebody to try to figure out how to be able to listen and learn and, and a little bit of it’s okay to say this didn’t work.

Kerry Major:

I think you have to role model it, Carol.

Carol Pehotsky:

Mm-hmm.

Kerry Major:

You have to be able to, as a leader, show that vulnerability and show people that it's okay that things don't always go the way you think they're going to go. That's with life, right? Anything in life. I think it's humble enough to say we're going to have to take a different direction. We're not getting the outcomes that we are anticipating, or things are going really well, let's keep on with it. But I think that feedback is important.

Being honest about how we're progressing is important and just helping people understand that part of continuous improvement is learning as we go. As we pivot and we adjust, things may require us to take a step back and ask are we really moving in the right direction?

But I think as a leader, you have to set that stage and be that role model. Lead with integrity, lead with humility, lead with authenticity, and let your team know it's okay to say this isn't working, or we made a wrong decision. I would rather do that than spend the time on something that is just fruitless empty work, right? It's okay to stop and say, let's time out, let's reevaluate.

Or conversely, I see it's not working, but I don't know what else to do so I'll just keep doing it. Right? Well, this is what we said we were going to do. It's not working, but I'll still do it. Maybe eventually it will turn around, six months a year down the road. And I think that part of learning too, is recognizing when things aren't working and learning when it's okay to say time out and when do you stop? Is it a week, a month, two months? And having those conversations as we start to look at the outcomes to determine what makes sense.

Carol Pehotsky:

And that's a fine art too, right? You want to give it enough time to say, are we doing what we say we're going to do? Have we given it enough of a shot versus it's been bad and it’s not going to get better. We should have done something different.

Kerry Major:

Yes. Right.

Carol Pehotsky:

Exactly. And it's part of the nursing process, right? It's the evaluation when working with teams, we know that some people are naturally can-do kind of people and some people less so. How, as an individual, should I be working on my can-do mindset and, and as a leader, how do I really help encourage people to embrace that change and we'll figure this out.

Kerry Major:

I think helping people to identify their strengths

Carol Pehotsky:

Hmm.

Kerry Major:

The things that they feel they excel in and, and where they feel they might be able to contribute in a meaningful way. I think that helps. There's nothing worse than being asked to do something that you absolutely detest, you know? But if you feel that you have something you can contribute or a specific skill or a specific strength that you can bring to the table to help the team, I think it's important to take a minute to understand what that would be. Especially for those who are a little bit more resistant or maybe push a bit more, what can they bring to the table? What is it that they're passionate about? What are their strengths? How can that be embraced as part of the work we're trying to do? And maybe if they feel that skill or that, whatever it is they can bring to the table is truly valued and can make a difference, hopefully that helps to change that mindset from I don't want anything to do with this to I think I can really contribute and make a difference.

Carol Pehotsky:

Yes, and sometimes you hear a nurse say, I just want to come in and do my job, but doing your job is bring your full self.

Kerry Major:

That's right.

Carol Pehotsky:

Well, and leaders, just a good plug too for not everybody's an extrovert, (laugh) and figuring out ways to ensure everybody has strengths. What are your tips for some nurses, some caregivers who are a little bit more introverted? [Mm-hmm] Please don't call on me. I'm dreading that you're going to call on me. I'm not listening because I'm sweating about you calling on me. [Absolutely.] How do we make sure all those voices are heard and not in a way that's going to, I don't know what she said or cause that sort of panic versus getting a genuine response out of someone.

Kerry Major:

I think there are different tactics that you can use. I always love the sticky note tactic. It's anonymous, but you get some great feedback and some great ideas.

Sometimes you can do that thinking round, but that can be a little intimidating for someone who's introverted and hates to speak up in front of folks. You can do a one-on-one. If folks tend to be a little bit quiet, pull them aside at the end, or commit some dedicated time to just sitting one-on-one with them and saying, I noticed you didn't say anything at the meeting. I would love to get your thoughts. Tell me what you think and give them that space to be able to share their thoughts and be respectful. Receiving that information when someone's coming out of their comfort zone to do that, I think we need to provide that safe space for them to share and feel that they are contributing in a meaningful way for them.

Carol Pehotsky:

I know I struggled with this early on, I'd like to think I'm getting better at it, but it's the timing of the communication of the change, right? Sometimes we know everything, and we can sit down with our teams and say, here's what's going on. But sometimes we don't have all the answers. And it's gauging — sometimes it's leaders go say this, right? That's great.

Kerry Major:

Mm-hmm. Yes.

Carol Pehotsky:

Sometimes it's a little more localized and it's the, I don't want news to get out and people be blindsided by this change that's coming. I want them to feel part of it but there isn't a lot of news to share yet.

Kerry Major:

Right?

Carol Pehotsky:

How do you strike that balance? Because the last thing you want is your caregivers to say, you were keeping this from me.

Kerry Major:

It is so hard, and you are right. It's trying to strike a balance of sharing what needs to be shared, sharing what you have to share, and having everyone feel that things aren't hidden because with change comes fear.

There's always that little story in the back of your head of what else aren't they telling me? I think it's being open and honest. You have to be transparent. If you don't have the big picture, you need to say you don't. If you are able to share more, wonderful. If you feel that you will have information in the near future, tell them that. It would be great to be able to come with a set timeframe, timeline, everything beautifully lined up, but it doesn't always work that way.

I think you need to be open and honest about that and say I just don't have a lot of information. I want to let you know this is coming. I want to be able to get your thoughts and feedback so we will set up time to meet. And as I learn more, I will bring the team back together again and we will be able to discuss what I have learned.

I think we just have to be honest about it and recognize that the process of continuous change is not set. It's a journey and it is not a linear journey by any stretch. We have to be adaptable and flexible and able to pivot as things progress and as things evolve and mature within that process. It's helping the team to feel comfortable with that because that's not always easy either, right?

Being able to just pivot on something when you've been doing a certain thing the same way for a while takes courage. You have to lead with that courage. You have to give them that hope. You have to set that stage of it will be okay because that to me is what change is about.

It's about being adaptable. It's about being incredibly flexible, being able and willing to pivot and make mistakes and feel that you are in an environment where it's not held against you. It's safe to make those mistakes and learn from them. And that takes courage and developing that sense of courage within your team.

And of course, creating that sense of hope because that's what that vision is, right? That's the hope. That's where we're hoping to go and what we're hoping to accomplish. I think with all those things, hopefully you set your teams up for success when it comes to change management.

Carol Pehotsky:

What incredibly wise words and lovely way to wrap this up. Thank you. Before we say goodbye, I always like to ask some fun questions of our guests so the audience can get to know you as the truly amazing human being you are as well as an expert in leading change. What's the best advice you've ever received, Kerry?

Kerry Major:

Don't sweat the small stuff.

Carol Pehotsky:

Mm.

Kerry Major:

Really it is. We get so mired in all the little things that come at us and we spend so much time on some of those things that really don't deserve our time quite frankly. Don't sweat the small stuff because there's plenty of big stuff coming (laugh).

Carol Pehotsky:

That's right. And back to change management. And then finally, we've spent a lot of time this year at Cleveland Clinic talking about the power of purpose, so I'm hoping you're willing to share with us what's your why.

Kerry Major:

You know, honestly, as a leader, I get so much joy. Joy is the word when I see it connect for people, and when they make a decision to take a step in their professional journey that I may have had a small role in, whether it's through mentoring, conversation or providing support resources. That is so fulfilling. It's all about connection.

I love connecting people. I love connecting people to their purpose, helping them to achieve their goals, their vision. And I love learning about their why. That's the joy of the work because it can be tough work. Leading is not easy. Leading can be lonely, but it's incredible when you can see when you have made that little difference in the lives of another leader, caregiver or another person. And so that's my why.

Carol Pehotsky:

And audience, I can assure your organization is filled with people who Kerry has had that wonderful positive influence on, including myself. Thank you so much for joining us today.

Kerry Major:

Thank you, Carol. This was awesome and I appreciate the opportunity.

Carol Pehotsky:

As always, thanks so much for joining us for today's discussion. Don't miss out — subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing.

Until next time, take care of yourselves and take care of each other.

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.