Dr. Carol Parker Walsh:
Welcome, welcome to the People-Forward Leadership Podcast. The show for leaders who know results and relationships are not competing priorities. Now, I have a question for you. What if the nursing shortage isn't just a pipeline problem, but a system design problem? And today we're talking about what it really takes to retain clinicians, rebuild resilience, and create care teams that can execute under pressure without burning people out in the process. And on the podcast, what we love to do is sit down with leaders who are catalysts in their industries and people doing the hard human work of leading and complex systems. And today we are lucky and blessed to have our guest today, Dr. Keisha Kelly, who's the senior vice president, chief nurse, and philanthropy officer at Legacy Health. She began her nursing career as an officer in the United States Army Nurse Corps and has led across multiple healthcare systems and roles.
At Legacy, she's been at the center of the work to strengthen the nursing workforce by expanding the nurse residency, shifting to a coaching model for new nurses, and piloting new ways of structuring care teams so nurses can practice at the top of their license. And you could read so much more about this amazing guest in the show notes about her education, her accolades, and on and on in our show notes. But I want to jump into our conversation today. So Dr. Kelly, welcome and thank you for being here.
Dr. Kecia Kelly:
Thank you. Glad to be here.
Dr. Carol Parker Walsh:
So what we'd like to do is frame the conversation in our People-Forward Leadership Framework, which is around leader awareness, empowered ecosystems and adaptive continuous learning. And as we think about... But before we jump into that, on people forward leadership, we always start with the leader's pathway because how you came up often shapes how you lead. And in healthcare, the why matters because the work is tested on a daily basis. So what's the through line of your leadership journey and what ultimately pulled you into the work that you're doing now?
Dr. Kecia Kelly:
Okay. Well, I'll try to give the Cliff Notes version of my journey. I mean, I've been a registered nurse for, it'll be 34 years this year, I believe in May, it'll be 34 years. And I've had a pretty unique journey in that I started my career as a commissioned officer in the Army and as an Army [inaudible 00:02:42] officer. And it's important to share that because being an officer in the military, just by virtue of what sits on your shoulder, you're a leader. You just are, you're in charge. And so I was really thrown into leadership very early on in my career, in my early 20s and was left to my faculties of really just trying to figure it out and really learn as you go because as a 22-year-old, I actually led nurses that were not in the military, but that had been practicing longer than I had existed on the planet.
So I share that because the majority of my career has just really kind of lived in that space. So I had my career as a commissioned officer in the military. And then I actually worked in big pharma for eight years. I worked in pharmaceutical sales for eight years, and that's an interesting journey in that I really felt like I wasn't good at the whole leadership thing. I actually was like, "You know what? I suck at this. I Don't like it and I don't want to do it anymore."
And so I pivoted, resigned to my commission from the military, and then went into big pharma for eight years and did that for eight years and worked for Pfizer Pharmaceuticals, got laid off. I was one of 10,000, so I don't know what it's like to be laid off. And so it's like, "Okay, well now what? What am I going to do?" Well, what I realized is I really hate sales. I did it for eight years and I hate it. I absolutely hate it and could not find my way back into sales. And so I actually felt like I should, let me just go ahead and go back into nursing, but I'm not going to do the leadership thing. Let me just go back as a civilian and I'll just take care of patients.
Well, that didn't even last a year. And I think that that's where I really learned that leadership is really, it's a natural tendency. Management is something you can learn. Leadership is just who you are. And so having not practiced at the bedside for eight years in less than a year, I was already back in a nurse manager position coming back in as a civilian and just realizing that I'd lost eight years, my trajectory, and I'll just kind of fast-forward, is that got in back into healthcare, realized healthcare is a business, but I also realized that I had not really had any leadership development training in the military. And so I actually ended up working for what is now known as Baylor Scott & White, who was wholly invested in leadership development and training and how to have difficult conversations and succession planning and nine boxes and high, middle, low.
And so I learned all these things about leadership and I got very hungry and I got very hungry and realized, and so that's where I ended up getting my MBA, getting my doctorate. And I have a trajectory up until the point of now where I was getting promoted every two, two and a half years. I was just getting promoted from manager to director, assistant vice president, associate chief nurse, chief nurse, chief nurse, chief operating officer, division chief nurse, and to where I am now. And so there was just really this catch-up period. And so that's really kind of the through line.
And I am a nurse, but I also, I shouldn't say I identify as, but I really identify as a very highly diverse executive leader where nursing is how I got where I am, because you're right, I have the privilege of leading and representing over 5,000 nurses for Legacy Health, but I also lead all of our fundraising efforts.
But I also oversee pharmacy. I oversee lab, environment of care, security, construction management. So there's a lot on construction management, there's more there, environment of care. So there's a lot there that I do. And so I think the story that I like to share is that what I love about being a nurse is it keeps me connected to the patient, the patients at the center of everything that I do, but I have this really interesting, intriguingly diverse portfolio. And that's really my through line, and the story I tell is that nurses can do a lot of things. And unfortunately, we get siloed and we kind of get what I call Jerry Seinfelded into just being a nurse. And I always think of Jerry Seinfeld because he never pivoted. You just could not get him out of that. And I try to be, but my example is that we are leaders, we're healthcare executives, and we can apply our leadership principles, our knowledge across more than just nursing. And so that's where I am now.
Dr. Carol Parker Walsh:
I love that. I love that. And so I love the diversity that using that term in terms of, my goodness, because the areas that you are over and leading are very diverse in terms of your portfolio of leadership. But something you said really captivated me, and I felt like it's almost a little bit of a formula in that you said leadership, like management is something you could learn, but leadership is a natural tendency, but then you also added to that training. So there's a natural tendency that's there, and I would love for you to talk a little bit about what do you mean by that, but also how training and getting the tools added to the natural tendency just really elevated you and leveled you up. So I would love for you to talk a little bit more about what do you see as those natural tendency so people can know and identify that within themselves and wedding that with training to really take it to the next level.
Dr. Kecia Kelly:
Yeah, I see it as, and I use a term a lot with leaders that I'm coaching and developing is it's almost like being a diamond and rough. A diamond is, it's all dirty and rusty and all that, but it needs a lot of polishing and shaping in order for it to be able to shine. And when I think about my career, when I think about just my life in general, there's not been a point in my life, even as a child where I continue to always be out front. And a lot of times I didn't put myself there. I got pulled there, I got shoved there, I got placed there. And so I think being a leader has been something that has always been very natural to me. And I think we can see with leadership that it can be good or it can be used for the bad because it's all about the ability to influence people and to move people in a direction.
So that's really when I think about it and is that it's just been a natural tendency and it's something that I've tried to run away from where I was always a leader, but what I didn't have was the tools to be a successful leader. And so when I think about the things around the investment and training was that not understanding the language around equity and fairness and leading your teams. I had tough lessons of where I knew if I did something for one person, I didn't understand that they were going to go and tell everybody else. So I knew that I couldn't apply it to, and I would try to apply something different to another.
And so I learned this thing around fairness and equity. And the fact is that follow your policies and your procedures, don't make exceptions for people because I will come back and bite you. So there's that piece of it, but the piece around having difficult conversations, having coaching conversations, having development conversations, and what do those look like? How do you connect with people first? And so there's just holes in the military, everything can be pretty black and white, either you're good or you're not. I mean, it's a very binary existence. And so when I moved into the civilian world, I had a very binary view around leadership. Either you're doing your job or you're not.
And what I've learned in my evolution and growth is that people are on a spectrum of development as employees. And so learning to appreciate that. And I think about a book that I read one time, it was called First Break All the Rules. It's a very pivotal book for me because it was a book around managing people according to their strengths and talents. It was about meeting people where they are and then helping them to grow. And so that has been, and I use that as a term of how I've led my teams. I may have a person who is very good at Microsoft Excel and are good with tables and spreadsheets, but you put them in front of people and they're going to fail. They're just not... And so how do I capitalize and optimize the strength of that individual versus I have another person who is a highly extrovert, loves to be out in front, loves to present, loves that. You give them a spreadsheet and they absolutely fail.
So it's all about meeting people where they are and then working alongside with them and helping to unlock their potential. And so these are just a couple of the examples of just my development and growth as a leader. And I have lived experience where people didn't have that appreciation for me. Growing up as a leader... You go by Carol or Dr. Walsh? I'm calling you Dr. Walsh. That feels good to me.
Dr. Carol Parker Walsh:
Okay.
Dr. Kecia Kelly:
We'll go with Dr. Walsh, is that I am an introvert and I'm an internal processor. And so I'm very thoughtful. I can sit in a meeting for four hours and I may not say a word, but I am processing. And I was often criticized for not giving input, not contributing, not just... So there was this whole thing of where my introversion and my internal processing was not appreciated and I was actually criticized for it and not being a contributor or being mad. We know that whole notion. And so I've taken that lesson and when I see someone on my team that maybe is quiet and not contributing, I use it as an opportunity to get to know that person and finding other ways for them to contribute. I may just call on them, "Hey, Jane, what do you think about X, Y, Z?" Because I know Jane's probably not going to just spit things out. She's processing and analyzing the room.
So these are just examples of ways that I have learned to lead my teams. And I would go back to say it is about meeting people where they are, having an appreciation on where they are and going along their journey with them and helping them to unlock their potential because it was something that I had to figure out on my own. And so I try to in turn make sure that no one else has that experience that I had.
Dr. Carol Parker Walsh:
Yeah. Yeah. No, I think that's fantastic. And I think what you said, which often gets missed, is your own self-reflective work and evaluation. What you shared about how when you were little, you were always either thrust into leadership or were a leader and understanding your introversion and how that could be misinterpreted. But sounds like turning that into a superpower as opposed to a limitation, but also understanding the self-reflective and self-examination work of yourself helps you to become more open, at least I think that's what I'm hearing you say.
Dr. Kecia Kelly:
No, you're right.
Dr. Carol Parker Walsh:
A much more open and effective leader because then you get to see things in other people that helps to develop them. And that piece around self-awareness often gets missed because we look for the tools and the tricks, but we don't elevate and explore that natural tendencies or the things within ourselves that can really wed well with those tools and tricks to become a more effective leader.
So I love that you... I just really wanted to highlight that piece too, that littered through your story you talked about, "Yeah, but then I learned this about myself and I learned this about myself and I learned this about myself," which I think is so powerful.
Dr. Kecia Kelly:
Yes. And when I'm coaching my leaders, I try to be very authentic about my experiences growing as a leader because there's this notion that when you land in a position like I am, that it was an easy journey and no one knows the story of the failures and the mistakes and the errors and the pivots. And so I really try to weave my experiences when I'm coaching my team around that because I think it humanizes me and it takes away that notion of perfection and it gives people the opportunity to be very human and authentic in their journey because some people think that I just landed where I am and no, I didn't. And it's a pretty horrifying story of how I've landed where I am, but I use it as a tool. I use it as a way to be a witness to, I use the word administering to people, but it is a way of leading people through authenticity.
Dr. Carol Parker Walsh:
Yeah. Yeah. I love that so much. So as I talked about, we talked about leader awareness, but another aspect of it is about staying future ready, because the version of you that may have got the results in one season can be a bottleneck for you in the next season. And I'm sure as you're coaching people, you're helping them, don't stay stuck, but it's always kind of a growth and learning process. So in the last year, what have you learned about yourself as a leader that's changed how you show up and how you're supporting and coaching other future-ready nurses and leaders?
Dr. Kecia Kelly:
Well, it's interesting, and this is something that I actually shared with my CEO recently in that what I've learned about myself in the last year, but I would probably say in the last two or three years, but more so this year is really this power of leadership and this power of being curious, this power of humility. And I say that, Dr. Walsh, because just a little over a year ago, my CEO asked me to take on philanthropy and I was like, what?
I mean, my role in philanthropy was always with my hands out. How can I get some money? I can fund this and fund this and fund this. But he literally asked me to be the chief philanthropy officer when we had a retirement. And I actually had to take some time to think about that. And then I actually took a step back and I was like, "You know what? I am a leader and my job is I don't have to know all the things, but what I need to know is what is the talent and strengths on my team and how can I lead and support them?" And so that's what happened with philanthropy is I went in with, "Hey guys, I am not the expert. You are the experts, but I'm here." And so there was a humility of me learning some of the basics of fundraising and foundations and grant making and all that, but really leveraging my team and unlocking nurse strength.
And so I learned that again when he asked me to take on environment of care, and environment of care is all of our facilities and that is our security, that is our construction and I'm missing... There's five different areas, environmental sustainability and another. And it was that same thing of, "Okay, so let me just apply this again. You guys are the experts. I'm here as your leader."
And so what I've learned is that I don't have to know all the things, but what I have to know is how to lead teams and how to unlock potential, elevate my teams, elevate my leaders and create spaces in where they can grow and flourish and do their best work. And that's what I've learned about myself because there was always this, we use that term imposter syndrome. And I literally had it with philanthropic, I don't know what I'm doing here. But when I got out of my head and I said, "You know what? No, you don't, but you're a leader." And so I think what I've learned more is the importance of what that means in being a leader. And it is about the people that you're leading.
And they have more of an appreciation for you if you don't come in like you know everything, you come in with humility. Brene Brown says there's power and humility. And I wear that as a badge of honor because what it does, it creates space for people to bring me into their space to learn their work and to learn more about what they're doing and then how's that? I'm like, "Well, how can we create more exposure for you?" I mean, I think a perfect example now is with philanthropy is philanthropy now for Legacy Health is actually a strategic pillar in this organization.
And so instead of being a pot of gold that everybody taps into when they want to do something, I've been able to elevate philanthropy to be a key strategic partner in Legacy Health's future, which has not been what it's been. And it has been just this whole thing of just elevating the team and elevating their work.
Dr. Carol Parker Walsh:
Yeah. What you said is so powerful. I mean, well, everything you said, you don't have to know everything. And I think that is such a hard lesson for new leaders to think or believe that they think if I'm going to be elevated, that I have to know everything either before I become a leader, because if I don't, you're right, the imposter syndrome kicks in. But the words that you used around curiosity and humility, I mean, two words that most people would never think go hand in hand with leadership or people should think that, but wow, it opens you up to really being available and supportive for your people. So I love those words of curiosity and humility. And speaking about teams, empowered ecosystems really for us is about building teams that can execute across all functions. So that requires knowing who they are so that you can influence and lean into them and really support them, especially when there's competing priorities.
And your portfolio sits at the intersection, as you just named of clinical operations, mission and things of that nature. So while you're supporting them, how do you build trust across functions and personalities and priorities so people can actually execute together?
Dr. Kecia Kelly:
That's a great question. And that's actually the work that we're involved in right now because newsflash, legacy is not becoming a part of OHSU. And so yay. But what that's done is it's created this beautiful opportunity for Legacy Health to be an independent organization. And I think how you build trust and how you build engagement within your teams is that every person at every level of the organization needs to know how they connect to the bigger picture. How does my work contribute to Legacy Health's future? So perfect example, we are working with our board on our enterprise strategic plan, which is great, but simultaneously with my nursing leadership team, we are building a strategic plan that is connected to the enterprise strategic plan that will be cascaded down to every nurse in the organization. I'm doing the exact same work with pharmacy and I'm doing the exact same work with my pharmacy philanthropy.
I'm doing it with philanthropy as well, is because when people come into work every [inaudible 00:21:32], they're like, "Well, why am I even here? I'm just a widget. I'm just here to take care of this patient and go home." We don't want people to feel like a widget. So really trying to create that connection because that's where the trust is going to happen. When people feel connected to the organization, when they feel connected to the purpose, when they feel like their work and what they're doing every single day contributes to not only the wellbeing of our patients, but the wellbeing of the organization, that's where trust and engagement happens.
Dr. Carol Parker Walsh:
Yeah. So the more they feel valued and the more they know you value them, the more they trust and you have their back, you have their best interest. So whatever you're rolling out is obviously going to consider them and their wellbeing. So I love that as a way to think about how you build trust is really bringing them into the conversation so that they feel connected to use your word and not just another widget.
Dr. Kecia Kelly:
Exactly.
Dr. Carol Parker Walsh:
Yeah. Yeah. No, I love that. And people say they want to empower teams, but empowerment without the capability is just application. So yes, you want them to feel valued, but you also want them to make sure that they have the capacity to grow, to learn, and to do what they need to do. So I'm curious, where do you intentionally push decision-making down? In your delegation, I mean, obviously with everything you're leading, you cannot do it all. And you even mentioned that you look for where's the talent on the team to make sure you're fostering and helping that grow. But in terms of a strategy or way that you think about delegating or giving other people the decision-making authority to take on some things for their own growth in the development, how do you build that capability and confidence into your people to own those outcomes?
Dr. Kecia Kelly:
Well, there's a couple of ways. Well, there's one kind of segment of where I have a commitment to developing leaders and in developing individuals. So there's a piece of work where every year, one or two leaders, I kind of sponsor them into some type of leadership development program. So there's this piece around development that I do, whether it's ACHE or AONL, or we've got somebody in executive leadership certificate program. So these are ways just to help them to build their tool chest. So there's that piece. But I think in terms of the delegation, because that's the piece that I... It's a badge of honor for me. I am a master delegator, but I will never delegate accountability, but I do believe that delegation is about empowerment.
And so in some of the spaces that I lead in, Dr. Wash, I have no choice but to delegate. So I'm going to talk to you a little bit about pharmacy. I've had pharmacy in my reporting structure for the last three and a half years. And pharmacy, we have a whole piece around 340B, which is where we get our discounted medications. There's a clinical piece to it, highly regulated under DEA. There's a whole revenue capture piece. And so giving my team the true north of, "Hey guys," and right now with Legacy trying to be financially healthy, I have worked with my leaders on, "Here's what we need to do. I need you to help me to find revenue growing opportunities and how can we improve and grow revenue in pharmacy? And also, how can we maximize and optimize savings through our 340B program?"
Because both of those are going to contribute to the bottom line. So I gave it to them and said, "What are you thinking?" And so that's what has happened and that's what's really evolved into our strategic plan. It's fascinating. When I think about pharmacy, these are really smart people. They're scientists, they're operators, they're all the things. And just to give them that work, "Now tell me what do you have? What do you have?" Well, I can tell you right now, retail pharmacy was losing $3 million a year a few years ago. We're projected to make close to $40 million this year. I mean, it's literally just that example. And it was just get out of their way. These are experts. So there is that delegation that I have done in that space.
Another perfect example was you probably have heard in Oregon about the whole, because you've connected with nursing, the whole staffing bill, the law, mandatory ratios. I don't have the capacity to design that work, but I did appoint a leader and say, "Listen, I need somebody that's a little bit closer to this work to design what this is going to look like and make sure that we are in compliance with law."
And so we were able to implement the staffing plan according to the Oregon Health Authority and to do the mandatory ratios. So we've been able to operationalize that. But what I've done in a lot of the work that I do, Carol, is I position myself as the executive sponsor. And so as the executive sponsor, my job is to elevate the work. My job is to remove barriers. Anything that's been escalated to me, my job is to remove barriers and to provide resources wherever they're needed, but also to provide coaching and guidance for the team. Because a lot of times people, they can advance work, but sometimes they need that executive leadership cover in case they make a mistake. They need an advocate or someone to... Because sometimes people can be crippled and be afraid to make mistakes, and so they work on trying to create something that's perfect.
But when you have somebody that's an executive sponsor where you're having regular check-ins around the work, it's an opportunity to coach them along the way. And a lot of times I'm like, "I don't have anything to add. What do you need from me?" And a lot of times it creates that opportunity. If there's a barrier, they're going to escalate it to me in that, and then I'm going to do a crosswalk to an accountable executive that can help remove that barrier. That's how you empower people. That's how you build that trust because I can't do... I'm one person.
Dr. Carol Parker Walsh:
Yeah. No, I love that. I feel like that's a great formula that I just want to just pull out in terms of when it comes to empowerment and delegation, serving as an executive sponsor, which includes elevating your people, removing the barriers that prevent and the obstacles that prevent them from being successful, give them the resources that they need and make sure that you're giving coaching and feedback to support them in the process. I mean, that's a great little formula.
Dr. Kecia Kelly:
Yeah, you're a good listener too, but you're good at that. I love that. So thank you. [inaudible 00:28:13]
Dr. Carol Parker Walsh:
One of the things you talked about too was this kind of fear of making mistakes. And so I know that Amy Edmonds's work came out of the hospital setting, this whole thing about psychological safety. So I want to talk about that for a moment Because it is a performance system and in healthcare, silence equals risks, fear of making mistakes can equal risk. I have to say that I know the higher you go up the chain, the more there's also a target on your back. So even having your own safety as a leader is important while you're also trying to create safety for your people so that they can feel comfortable admitting when they make a mistake or if they were off target to make sure that... Because in your setting, it's a life or death situation in a lot of situations if something goes wrong, the impact can be severe.
So what does psychological safety look like in practice in your organization? What are some of the things that you do to help implement it to make sure that it is felt by all within the organization? What are some of maybe the observable behaviors that you've noticed that really supports having that kind of safety within legacy?
Dr. Kecia Kelly:
Yeah. And the term psychological safety, it's interesting that that term can be weaponized.
Dr. Carol Parker Walsh:
Yes.
Dr. Kecia Kelly:
And so-
Dr. Carol Parker Walsh:
Because people don't understand it. You are totally right. They don't understand it. And so they use it.
Dr. Kecia Kelly:
They weaponize it.
Dr. Carol Parker Walsh:
Yes, they weaponize it.
Dr. Kecia Kelly:
And I use a parallel, and this is my service to my country. Being a veteran, in the military, "If you say with all due respect, you're about to say something-"
Dr. Carol Parker Walsh:
Disrespectful.
Dr. Kecia Kelly:
Right. And so, "With all due respect," means I'm about to tell you something. And so in the world of healthcare, when people will say, "I'm exercising psychological safety," it usually means they're getting ready to weaponize something. And so I'm always mindful of that. But what I would say is some of the things we do around creating psychological safety, and one thing I would tell you is that in a previous organization, we were on a high reliable organization, HRO journey. And in that journey was around leveling, you want to level the playing field and you want to close the power gap between physicians and nurses, senior leaders.
And so there's this notion of, first of all, you got to level the playing field and find common ground. And usually when there's a power dynamic, finding the common ground is that we all just want to take care of patients and we want to do it in the best way that we can. So there's a notion around of closing the power graph, leveling the playing field and finding common ground in the room. And that is my role in creating that psychological safety in the room. But there's also this notion of too often there's this whole term, you've heard it, fail fast to fail forward.
And sometimes we want everything to be perfect before we execute. And sometimes striving for perfection is a recipe for failure because by the time you've reached perfection, patients or employees or people have been harmed along the way. So my military career taught me the power of decisiveness. And in leadership as an officer, I'm held accountable for making decisions. And then if the decision is not a good one, then we check and adjust, we pivot and we pivot, we check and adjust. And so in healthcare, one of the things I really challenge my team is that we're not going to have a perfect product. If we have something good that we can implement. If it's not going to cause significant harm to employees or patients, we need to do it today and then let's check and adjust along the way and perfect along the way. And that creates safety for people because then you're creating space for mistakes to happen and you're creating the opportunity.
What did we learn from that and how do we move forward? What do we learn from that and how do we move forward? Because oftentimes we make a mistake and then we want to just cease and desist and move on to something else. So that's one example of how we've tried to create that psychological safety. And I believe also, I say this in that as leaders, we need to be able to share things with our whole name and our whole chest.
And I say that because a lot of times in online forums, we used to have an environment where people could say things anonymously. And we actually changed that and said, no, we're all leaders. If you have something to say, you're going to say it with your name attached to it. If you have to do something anonymous, we have a channel where you can do that, whether it's a compliance or a hotline or something like that. So we really have tried to create that environment, because there's something about being in a forum as a leader, and then you have anonymous complaints coming at you in that forum. That's not psychological safety. That is a weaponization of the term. Don't get me down the rabbit hole on that one, but those are just some of the examples.
Dr. Carol Parker Walsh:
But no, I love that you said that because I often... You're right, psychological safety can be weaponized and it's because people don't really understand it. I often tell people psychological safety is not about politeness, it's not about perfection, it's not about lowering standards. It is about having a space where there can be radical candor, where there can be open and honest communication, where standards still need to be met. There's accountability. People have a misconception that it means that if you're making me uncomfortable, I'm not safe.
Well, the whole thing about psychological safety is that we have a space of trust that uncomfortability is okay. We actually strive for conflict. We strive for that uncomfortability, because if it's there, it means that I'm safe enough to show all the differences that are there are safe enough to show up. They're safe enough to speak up and we're safe enough to have a conversation about it and not let it fester or do this kind of anonymous backdooring triangulation kind of thing. And those are the ways it definitely gets weaponized.
And so that's why I said is that people don't understand what it is. And so they weaponize it and use it incorrectly. But I love what you shared about check, adjust, and pivot. And knowing whatever happens, the question is always, what can we learn from this and how can we grow from it? And that comes with open dialogue, open conversation and transparency, which I love that you shared. So thank you. Thank you for that.
You've talked publicly about scaling development approaches, expanding cohort, shifting from a preceptor model to a coaching model. And you've talked a lot about coaching, setting that up, which is a big cultural move. It changes how people learn, how they ask questions and how they recover from mistakes. What did you learn building that learning culture at scale through that shift to coaching?
Dr. Kecia Kelly:
Yeah, and interestingly, this was another one that actually I'm going to share, give credit to my nursing leadership team. When I moved here, we had a perfect problem of a radical nursing shortage, and we had a north nursing shortage and we had a bunch of vacancies to fill and in a highly competitive market. And we could either continue to steal from Providence and OHSU and Kaiser for nurses, or we could make this investment in growing in our own. And so my team had this idea of moving to this kind of a coaching model for nursing, which it allowed us to be able to grow our workforce by 300% by doing that.
Dr. Carol Parker Walsh:
Wow.
Dr. Kecia Kelly:
And what I mean by that is that our residency program, we used to only take 35 people twice a year for our RN residency program. We grew that program where we were taking upwards of 100 every four times a year, and that's how quickly we grew it. And what it was was that we had our preceptors, which are the people that are literally working at the hip with the nurses and helping them on how to navigate a patient assignment.
But then we developed this coaching model, which was because of the workforce that was coming around that time, it was just teaching them what does it mean to even be a nurse. I mean, we literally took a step back and said, "These nurses have grown up in a virtual environment, afraid of the shadow." I mean, so we created this coaching model, which was not necessarily preceptors, but it was a different group of people. We had some people who were on light duty. We had some people that came out of retirement, and they basically took these groups of nurses and said, "I'm going to spend six weeks with you and we're just going to teach you what it means to be in healthcare."
So it was really just an investment in time that we did to really help to grow our workforce and to also minimize the burden on our preceptors. And so by the time these nurses got to their preceptors, they were actually more ready to learn and more ready to engage and do the critical thinking and work that it takes to take on a patient assignment. And so we had piloted that program when I first got here, which was really what attributed to the growth. And that program is now sitting in the hospitals now. And so the chief nurses at the sites actually have varying degrees of that program for our incoming residents as well too.
So it's a coaching model in a very unique way. But what I can only take credit for is being the cheerleader of my team. And it was more of, what do you need and how can I support this? I did publish this article. I published it in Frontier Magazine, which was ACHE's one of their publications for executives because I thought it was a very important story to tell of how you... And it's not only that we've been able to grow, our retention rates, we have about a 93% retention rate at year two for our nurses.
So that's nine out of 10 of our nurses are going to be here in two years. And legacy overall, our retention and turnover rates are nowhere near the national trend. I mean, and we're talking single digits that we are, whereas the national trend is around 20, 24%. Our overall is around, and when I think of turnover, we're around 11%. I mean, we're even lower than that. So it's just something about the culture. But I think what that did is it created a safe learning environment for the nurses because there's a lot of pressure. So I'm just very proud of that work, but I can only take credit for being the cheerleader of that work. My team did that work.
Dr. Carol Parker Walsh:
Okay. Okay. And I think you noticed a really striking insight about something you began piloting new interdisciplinary models so nurses could practice at the top of their license. Something around that, the kind of redesign that I know takes trust and experimentation, what was that kind of concept of having them work at the top of their license, [inaudible 00:39:52]
Dr. Kecia Kelly:
Yeah, that's some of the work that we are... And it's continuing to evolve because what I would tell you is that, and you've worked inside of healthcare, it's all around resources that they kind of expand and they constrict, they expand and they constrict. But at the end of the day, it's important. And we actually had a team that was exploring a multidisciplinary model that... And when I say multidisciplinary, in a perfect world, that allows your RNs to practice at the top of their license.
And so my RNs, I mean, it should be a courtesy to do ICE and make beds and things like that, but really they need to be critically thinking and thinking about their patient, their plan of care, collaborating with our providers, really working at that type of license. And so in that interdisciplinary model that we wanted to pilot would have included maybe having a physical therapy tech that could ambulate our patients, having a pharmacy tech.
So it was in a perfect world that we were looking to do that, and we're still on that journey. One example that we're doing right now is we're implementing a virtual care program, a virtual model of care, which actually, I don't want to call them virtual sitters, but we actually have engaged with a platform where we have patients that need to have an attendant sitting with them. A lot of times an RN who will be just sitting with the patient for 12 hours, that's not practicing at the top of the license. So we're implementing a technology where we will have a technician that can watch up to 12 patients at a time from a monitor and be able to digitally monitor, have digital borders on a patient and creating escalation pathways.
And so what that does is that's 12 patients that an RN is not sitting with, and we can have a technician. So that's one example of getting our nurses to practice at the top of their license. So that's been a journey, but I can tell you that the virtual care model is one that we are in the early stages of implementing that.
Dr. Carol Parker Walsh:
Okay. Wow. Yeah. If anybody could do that, I'm sure it's you, with your own interdisciplinary experience. What other kind of... I know it's virtual, you didn't call it AI, but it reminded me of, are there other type of AI tools or AI technology that you all, as you think about the future of nursing, have been thinking about implementing to really support the growth and development and maintain that 93% retention rate and the like within Legacy?
Dr. Kecia Kelly:
Well, there's a couple that are in there, they're still kind of in their development stages. There is an AI tool that's built into Epic that we are actually, we're still kind of piloting it behind the scenes, trying to work through the kinks of it, my team is, but that AI tool will basically pull everything that a nurse has done in a 12-hour shift, and then it will create a summary of everything that's happened in that shift.
Dr. Carol Parker Walsh:
Wow.
Dr. Kecia Kelly:
It'll create the summary, and then the nurse has the accountability to read the summary to make sure it represents all the things that happened. And so that is a way to do what we call an end of shift note. So that's one of the things that's actually still in development. And then we know that in the physician world, which we're bringing into nursing, this whole thing around ambient listening. And so there's a tool, it's called DAX, DAX, and we actually have piloted that with our physicians. And as a patient, I've seen it where basically it's ambient listen, it's in the background, and it's listening to the entire interaction so that the doctor can be facing you. And then what happens is in the background, this tool actually will summarize your visit. And so then the doctor can in the end be able to review those notes and maybe make some edits to it, and then it gets uploaded into the medical record.
We are actually looking at ambient listening for nursing as well too. And in that tool, it would be a tool that they go into a patient's room and the ambient listening will be able to summarize that entire interaction for that nurse.
Dr. Carol Parker Walsh:
Wow.
Dr. Kecia Kelly:
So that's still, we haven't done it yet, but my informatics team is psyched about it, but we have to make sure that with AI, because it's important, it's overwhelming, and there's just a lot of noise around AI, and we have to be careful with it. But those are a couple of them. And I think the one that we're going to be closer to implementing is going to be the end of shift note. That's going to be a huge satisfier because then that actually... I mean, it's a patient safety piece. You got a whole summary of everything you did that a nurse, instead of having to flip through 20 different pages in the medical record, there's going to be a summary. They can just read the summary and don't know everything that's happened with their patient in that 12-hour shift.
Dr. Carol Parker Walsh:
Wow. That is so amazing. And that'll save time with charting and reporting and increased productivity and reduce errors. Wow, that's pretty amazing. Wow. So that'd be exciting if that comes through.
Dr. Kecia Kelly:
Yeah. Very excited about that. Yes.
Dr. Carol Parker Walsh:
Okay. So one question I have to ask is, you named several verticals that you were over in managing and directing and leading within Legacy Health. I mean, a big chunk of everything that they do.
And I know leaders who aren't managing and overseeing nearly as much as you are, but you are calm and collected and had the time to be able to do this podcast. And we were talking offline about if you weren't able to delegate and lead and do all the things that you said before, you probably wouldn't be here. So I have to ask, what's your secret? What's your time management secret to be able to handle all of this, and still be calm and able to be so effective in the work that you're doing?
Dr. Kecia Kelly:
Well, thank you. And it was a good conversation. And I think I'll go back to what I talked about earlier in your podcast, around delegation being empowerment, and empowering your leaders to do their work. But what we were just talking about was this overglorification of being busy. There's this romanticizing of being busy and overwhelmed all the time, which is just the notion that I don't buy into it at all.
I truly believe that we need time to be able to reflect and plan on Mondays. And on Friday afternoons, I need to be able to look back on my week. And so, I do work very closely with my executive assistant who builds in time, four hours on Monday morning. There are no meetings and not without my permission. And on Friday afternoons, afternoon, there are no meetings on my calendar because that is my time to reflect. But she also protects my lunch hours and my time at four o'clock in the afternoon.
Now there are meetings that will take place during those times. But we actually, as leaders, particularly given my broad portfolio, I need time to think, reflect. I need to plan for meetings. I need to open attachments. I need to actually read emails, think process. And I can't do that if I'm moving from one meeting to the next to the next to the next.
So what happens, is I end up working at night. I don't fire off emails after five o'clock in the evening unless I have to. And you will not see emails from me coming out on the weekends. It's not a flex. It is actually a sign, in my personal opinion, of poor management. And as a senior executive, if I send emails on the weekend, my team reads that and then they think that there's an implied expectation that they should be doing the same.
So I have this belief in role modeling that. And I have tried to instill that in my vice presidents and my directors as well too, that, don't email me on the weekend because I'm not going to respond to it. I mean, I'm all about protecting our time. So that's what has allowed me. I have a lot that I'm thinking about and I need time to think about it.
But I think it also goes back to this whole thing around this delegation, Dr. Walsh, is that you got to delegate and the work that you're accountable for, it needs to sit with the right people who can carry that work forward. And too much, too often as senior executives, we think that we need to know everything about what everybody is doing and we don't. We need to trust that people are doing the work that they're accountable to.
Dr. Carol Parker Walsh:
That's so good. That's so good because you're right, this letting go, if you're building and investing in your people and trusting your people, then it allows you to have the space to manage because you are managing a multitude of things. And I love what you said about, I need time to think and to strategize and to pour into those things and your people so that they're effective.
And you have the receipts to prove it, because the impact that you're having in the organization is monumental and you wouldn't be able to do that if you didn't have the capacity to think, as well as take care of yourself while you're taking care of the organization.
Dr. Kecia Kelly:
Exactly.
Dr. Carol Parker Walsh:
Yeah. Thank you. Thank you for sharing that.
Dr. Kecia Kelly:
Oh, no problem. I stand by that.
Dr. Carol Parker Walsh:
So I always like to close out, and I so appreciate this conversation, and we could go on for hours, but I like to close out with something that listeners can carry into their Monday morning, a simple, practical, and real something. So if you can leave the leaders with one shift, one practice or one mindset shift to be more people forward, what would it be?
Dr. Kecia Kelly:
I would actually go with what I land off with, and it's the curiosity and humility. I think that that's the piece that I think is missing in leadership right now. And when you are working with your teams, remain curious at all times, ask questions, ask questions to understand. Now, don't ask questions to make sure that you know what they're talking about or like you're quizzing them, but it's this whole thing of being curious, asking questions. But I do truly believe that where I've been able to connect with my teams is through humility and being humble and understanding that you don't always have all the answers for everything. You're not expected to know everything. You are expected to know the strengths of your team and to understand what their strengths are and what their opportunities are to know the members of your team and how you can orchestrate that team and help that team move forward. I just think that those are the two areas I think that have really helped position me into having a healthy life up here in Oregon.
Dr. Carol Parker Walsh:
Fabulous. Thank you. Thank you.
Dr. Kecia Kelly:
My pleasure. My pleasure.
Dr. Carol Parker Walsh:
Dr. Kelly, I just want to thank you for your leadership. I want to thank you for all the nuggets that you dropped this episode, the frameworks that you shared that I think will be really helpful for leaders to naming what it really takes to build teams that can deliver in high pressure systems, which you are in without losing the humanity of yourself as a leader and the humanity of the work that you're doing. So thank you for that.
Dr. Kecia Kelly:
Thank you.
Dr. Carol Parker Walsh:
And to our listeners, listen, if this conversation resonated with you, please share it with other leaders who are trying to rebuild capacity and culture and really striving to understand what it means to be a people forward leader, to empower their teams and create systems of learning, growth, and innovation. And until next time, keep leading people forward and I will see you soon.
