Joni:

Hi, this Dr. Joni Watson. Welcome to The Handoff, the podcast for nurse leaders from Works. I’m happy to introduce this episode’s guest.

Today, we're diving deep into the world of clinical leadership, innovation, and strategy with a true visionary, Dr. Kelly Larrabee-Robke. Kelly's not your ordinary innovator. She's a clinical innovation advisor, technology strategist, and a trailblazing chief nursing informatics officer whose achievements have reshaped the landscape of healthcare technology solutions. With a track record of driving impactful change and fostering customer engagement.

Kelly is known for her relentless pursuit of healthcare excellence and unwavering commitment to patient engagement. Previously serving as the Associate Vice President and Chief Nursing Informatics Officer at Ascension, one of the largest nonprofit healthcare systems in the United States. Kelly led groundbreaking initiatives that transformed the delivery of care. Prior to that, she held the prestigious position of Director and Chief Nursing Officer at Microsoft, where she played a pivotal role in shaping the future of healthcare through innovative technology solutions. Welcome, Dr. Kelly Larrabee-Robke. Kelly, it's so great to spend time with you today.

Kelly:

Oh, thank you, Joni. The pleasure's all mine, and I look forward to our discussion today.

Joni:

Absolutely. So, Kelly, I'm going to just jump right into it. So, this is a bit of a monster question, lots of pieces. When we've talked before, you've mentioned a concept that I just can't get out of my head, dimensions of leadership. I love this thought because I've even struggled myself at times with all the facets of just me. Can you share more about what you mean by dimensions of leadership? And maybe in your experience, what are the key dimensions of effective leadership in the healthcare sector today? And then maybe how they've evolved to meet modern challenges.

Kelly:

I love that you said facets, Joni, because to me, when I think of leadership, I really think of a kaleidoscope. And for anyone that hasn't seen a kaleidoscope, it has different colors in it. And when you first look at it, you'll see all of the colors that are in the kaleidoscope, but all you have to do is turn the lens a little bit and you see an entirely different shape or view. And I think understanding that there are elements or facets of how we lead and the methods by which we lead in our profession is really what I'm getting at when I talk about the dimensions. Now, I have five that I operate from in terms of my expertise, in terms of my responsibilities throughout my professional career. And I can go through a few of those today. I think the first dimension is when I think of leadership, I think of everyone on the team. I'm not talking necessarily about a leader or a follower. I'm not talking about a director and a staff nurse. I'm talking about the act of leading, whether it be a new opportunity, whether it be a standard of care implementation, whether it be an update and upgrade to our EHR systems, but I'm thinking about the act of leadership across every team member. So that first dimension or that first facet is really talking about how we, regardless of what we're working on, what are our leadership values and attributes as an individual? So, are you, in your work, acting towards efforts that really represent what our profession is all about the context and the scale of your practice? Are you looking at bedside nursing? Are you looking at it as a member of a committee? Are you coming into leadership as a member of staff that's been asked to share their opinions or their viewpoints with a broader interprofessional team. All of these examples that I've mentioned, and I'm sure there's thousands more, really are situations that require skills and insights for supporting, for articulating, and for representing. And that could be as a leader, it could be as a team member, it could be as a subject matter expert, it could be as an innovator. So dimension two is really about the team. Even as a leader, we're a member of the team, but the leadership dynamics of the team and the behaviors that really fortify efforts and act as traction for success is the second dimension that I'm talking about. And it's about how we interact and engage with the team. But it's really about how we interact and engage, and that doesn't always mean straightforward work and progress. It also means having the confidence to challenge the team or a member of the team towards finding that resolution to an unknown risk or a problem that may arise as expected or potentially unexpected. But it's really about supporting that team dynamic.

Joni:

So good, Kelly. I'm like shaking my head just in emphatic agreement with you.

Kelly:

This is great. I love it. So that's two dimensions. I think the third dimension, as I start to get into it, I'm going to pivot the kaleidoscope again a little bit. And I'm going to say the next several dimensions really focus on how we engage in our work. And its work is about predictable steps and processes and policies that we follow. But it's also about how we create. It's about how we evolve and transform. It can be in areas that are very process specific that have a highly predictable outcome. But as nurses, we've all gone into a care instance for a patient or for a set of patients with a plan and then seeing that unravel or quickly shift and it requires a degree of flexibility and competence but also confidence in how we adapt. So when I think about the third dimension it's really about skill shifting and I think of it as a toolbox. We all have our clinical expertise, we all have the know-how from being in the trenches and seeing things and being able to intuitively pick up on things. And also what we've learned from our mentors, from our preceptors, and from our colleagues over the years. So we have this great toolbox. Our toolbox is constantly changing in terms of what we need.

That could be something as simple as shifting from a position on night shift to day shift. Our work is gonna be a little bit different. Our engagements are going to change. The way we manage our work is going to shift. It can be something like shifting from one hospital to another, from one care area to another.

Some of those tools will need to be maybe deprioritized. Maybe we're not going to get rid of that skill, but we're going to put it in our toolbox underneath our bench. But think about how you decide which tool or which set of skills or which expertise you use as process unfolds as expected, as you're asked to step up and take on additional responsibilities, and or even how you need to step outside of the traditional realms of your practice and maybe work on something that is completely foreign to you. But it's so important as a nurse in leadership to be able to represent nurses, represent your area of practice in terms of skill shifting. And that skill might be something as elemental as the confidence to put your voice out there when you don't necessarily know all of the details. It might be about learning budget and accounting skills because you're now responsible for a service line. It might be as complicated as there's been an acquisition, you're working with different facilities that have different ways of doing things, but the tools that you use, the frequency that you use them in, and the necessity to gather new tools in your toolbox is probably going to be a constant theme throughout our careers.

Joni:

That is such gold, Kelly. I have never heard of somebody describing leadership like a kaleidoscope before, but I'm totally replicating that language in the future. So, and I love your thought about skill shifting because, oh, my goodness, we have to do this continuously as have all the nurses and leaders before us and all who come after us. It's just not something that we press into, at least I don't think we press into it enough because sometimes I have felt like a fish out of water as I have tried to skill shift myself.

Kelly:

Yeah, I think, yeah, I think, segue, because the next dimension that I'll talk about is really about the self-awareness element here. I mentioned when I was talking about skill shifting, it's the confidence. I think it's also the confidence to experiment with the fundamentals of an element of your expertise. And also be aware that it's time for you to maybe put down one set of skills and pick up another. Put down that hammer and pick up the screwdriver, as an example. Maybe shift from clinical expert to operations expert or change management expert. And these are all skills that we have in our day-to-day practices. But having the self-awareness, and we've had a lot of attention with emotional intelligence and just understanding your own strengths and limitations, but also having the courage in your leadership approach to develop the awareness or the competency, but also the confidence to put yourself out there and say to yourself and potentially other members of your team, you know, this is new to me and I'm not exactly sure what I'm doing or how I'm doing it, but I'm going to try and I need your support. It's also the willingness to continue to learn and to learn as you see a transformation occurring in practice or in industry. And I know we've both taken up the opportunity of lifelong learning. But that might be something as simple as taking on a new assignment. It might be something as dedicated as going back to school and acquiring new skills, even new skills outside of traditional nursing that can really help you develop new ways of thinking and new ways of exploring problems.

Joni:

Oh my goodness, Kelly. That's incredible. So if I'm counting, was that four of five facets?

Kelly: 

Yes.

Joni:

Okay, what's the last one? I'm anxiously awaiting.

Kelly:

So last but not least, is communication and particularly interprofessional communication. And nurses are natural communicators. We communicate through our documentation. We communicate through shift reports. We communicate with our physician counterparts and colleagues. But I'd like to really think about how we talk about engagements now with the spirit of transformation as our motivator. And we talk about rapid change and evolving needs that are the norm and not necessarily the exception in healthcare today.

Joni:

Right.

Kelly:

We've typically operated from process improvement and in process improvement, we have very tested and defined ways of doing work and or communicating. We have very defined ways of who we communicate with and when. We also have the opportunity ahead of us to really expand and explore the dynamics of communication, the responsiveness of communication, the synergies of communication, outside of what I'll call our traditional practice areas. So when we think about change and leadership and driving transformation, communication is kind of, like I said, last but not least, it's so important in what we do, but it also involves having the intestinal fortitude, if you will, to really advocate on behalf of nurses to ensure that other parts of the organization that are responsible for the tools and the processes and the underpinnings of nursing care hear our voice and understand our perspectives and incorporate that into the work. And this is interprofessional, intra-professional. professional. So we want to make sure that our interactions are reflective of the need to be advocates for our profession and therefore our patients, but also it's almost holding us accountable as a call to action to ensure that we are not stopping with a committee, that we are like finance, like legal, like HR, like technology, to really make sure that our voices are heard and our needs are understood and they're being defined by us. So that last piece is a call to action on our part. 

Joni:

Oh my goodness, Kelly, this is why I love talking with you because every time I'm with you, I just, I feel sharpened by you, honestly. I mean, these dimensions of leadership have helped bring some language to me personally. I love the kaleidoscope metaphor. And then you said a phrase that I don't think I've ever recognized before, intestinal fortitude. I love that because it's so true.

And speaking of intestinal fortitude, to me, that is like a great descriptor of you, Kelly, because you have done some pretty cool things in your career, walking this tightrope of innovation and risk quite well. And I'm curious, you know, in your view, what role does risky innovation play in healthcare and how do you cultivate an environment that supports innovative thinking while still managing very real potential risks?

Kelly:

That's an excellent question, particularly in the environment that we're operating in. I think if I have to start answering that question, which will also be multifaceted in my answer, I would say we are rooted in a practice that is based on evidence. Healthcare is very much a privet. We have to be. We operate under a first do no harm. We operate with the intention of improving quality of life, of improving the lived experience of our patients, of the communities that we serve. But I think I want us to all just recognize that we start from a foundation of evidence. And let me just take this down to the nuts and bolts level. It's around journal articles that we all read and have read and have looked at as a basis for best practice, determining the best path forwards to opportunities and creativity in how we solve problems. But if you think about that evidence, I think it's about signals, it's about correlation, it's about how do we continue to push what is excellence in our practice. So there's that. The next thing I would say is innovation is a journey. It is not something that happens overnight. It is not something that is necessarily for the weak of heart, but potentially for different reasons than what that may emote in terms of thought process. But when we think about the journey, we often think about certain parts of that innovation journey, most notably how we discover and invent. That's really the initial phases, but it's also about how we implement because we've all been through implementations in some way, shape or form of a new technology, a new process that was just fraught with bumps in the road. 

So I think in order to successfully manage and champion innovation, you have to look at it as a journey that is a much bigger initiative and endeavor than just those two parts that get all of the attention, usually negatively. I think that if we look at innovation, most notably, I mentioned there's that initial element and we all know about medical devices that we work with and new medications that come on the formulary for certain patient conditions. And we look at patient portals and how that's becoming a part of care. I think that's a reflection of how practice has adapted and potentially transformed that we're all familiar with. But what I really want to challenge the listeners to as a member of our practice community is part of that leadership that I mentioned in the dimensions is being able to use your voice, to use your communication interprofessionally and make sure that nursing is a part of those steps of the innovation journey, including the parts that I mentioned, but also including at looking at scenarios that support innovation planning. You shouldn't go in with just one good idea. You should be open to or have options available in those ideas that occur in between discovery and piloting and implementation. So the best way that I found in supporting large-scale innovations is several scenarios that you might want to test over time, over the course of the innovation journey, and also be flexible and adaptive to what those scenarios evolve in based on the evidence that you get back. This very much mirrors the learning healthcare system model of iterative learning, and really starts to also speak to the importance of comfort and confidence in what we typically regard as failure as a learning moment, as a teachable moment, as a moment for improvement. I think also supporting innovation throughout and beyond those two elements.

So as we move from discovery and pilot towards implementation, we have to look at scale. How do we scale an innovation in a manner that supports adoption, acceptance, and learning along the way? And that sounds very straightforward, but it's really very complicated. Scale involves taking it from one unit to a series of units. It involves taking an innovation from potentially a med-surg experience into an ICU experience. It involves taking it from a small community hospital to a large multi-state system. And the way that we go about this, and this comes back to a dimensions of leadership where I was talking about advocacy, is making sure all of the players in the innovation that support it, that develop it, that measure it, that monitor it, are acting on behalf of our community of practice in nursing, which ultimately serves to benefit the patients.

Now, what does that mean? That means ensuring that those pillars of support exist, those multifaceted layers of support exist, ensuring that we have the tools and the materials and the communication channels that support awareness, that support initial competencies, that support collection of evidence, good, bad, and ugly in terms of what's going on with the innovation, and that allow users and stakeholders and sponsors of innovation alike in the nursing community to see results, to understand what's working, to understand what's not working, and to adapt and respond according to the data. Now, that could mean making some very hard decisions, but that could also mean continuing in support of it. evidence that is obtained, which requires us to be advocates, to act from our leadership approach so that we're actively and responsibly providing that information back and not just allowing innovation to happen to us, but allowing innovation to happen for us.

Joni:

Oh man, Kelly, that is, that's gold for sure. You know, it's so interesting to me that we talk about, and you mentioned this, we say how simple innovation is, but when you really pull all of the pieces back, it's quite complicated and it takes so many different skills to make innovation successful. successful, you know, scaling in and of itself. What a difficult skill that we often overlook in healthcare leadership.

We just kind of think everybody should be able to scale things, and that's not the case. So, you know, going back to your dimensions of leadership, when you talk about skill shifting, I mean, great points that there are so many skills embedded within risky innovation. You know, the other thing I think that you do really well, and you've spoken to this in layers already, is strategy. You know, I think that like you've mentioned, it's a skill that you have to realize that you need and you have to be intentional and nurture it. How do you identify and cultivate strategic planning skills within your team? And what do you think? How important is this skill for others to have, everyone on the team to have?

Kelly:

Well, I look at strategy as something as fundamental and as embedded in what we do. It's almost a cultural norm, but, and I'll give you a great example. I worked for several years here in Texas and Houston at MD Cancer Center and their mission statement is making cancer history. Right. And every morning when I would walk into work into the arboretum, I believe, you walked in and the second you entered that arboretum, you knew what you were there to do. And it came from every aspect, every element. You saw care providers, you saw students, you saw families, you saw patients, you saw volunteers, you just knew what you were there to do, you knew the shared goal and mission, and that's how I regard strategy. Back to strategic initiatives to help prioritize, to help level set, to help remind me during the challenging time of what I'm there to do and why we're there to do it. 

So in looking at strategy, I think you have to have some groundwork again. And I think there's three buckets here when I look at strategy. There's an administrative side, and this is very high level. There's the processes, the methodologies, the tools, the best practice, the operations that we do that fortify us. It provides boundaries to how we structure strategy, how we prioritize strategy, and how we actually execute against strategy. I think the next bucket of strategy and how we identify and really encourage this in teams is about the adaptiveness and the flexibility within a strategic initiative. We all know that we have these true north that guide us. But within those structures that I just mentioned, how can we be creative? How can we push some boundaries within the confines of the limitations? And usually within strategy, there's also stretch goals or, you know, really pie in the sky opportunities for us to flex that innovative muscle as it pertains to strategy. Are there different ways of doing things? Are there different teams that we can pull in?

But it's really about how we can do things differently at multiple levels to apply a flexibility or adaptability that might allow us to really fly in terms of the goals that we're trying to achieve. And that third piece that I was talking about just now, in terms of new ways of working, of being flexible enough to really look at problems a different way, look at opportunities not so much from the risk facet, but from the opportunity, is really that entrepreneurial spirit or the third pillar of strategy that I like to work from. 

And within those pillars, and this is where I think it helps teams evolve, there's the strategic initiative itself, which involves the entire organization and how we're each going to contribute to it. But if I go to the most granular level, it's really about tactics. How are we going to go about doing our work? What processes do we need to follow? Where do we have flexibilities? Where can we take steps that work best for us in a particular setting? Where do we need to really follow a process to get more repeatable results? Operations might be a little more elevated and really serve as that in-between strategy and tactics that allow us to see how our individual efforts, how our team efforts, how our unit efforts can help support a program, if you will, of what we're trying to achieve, of the parts that we play, of the interconnectivity and the networks that are involved in achieving those goals. And I think understanding those different elements and understanding the different pillars of those elements are really where leadership can help individuals flourish and gain competencies or expertise in how we do things, but also that confidence in, I know how this works. Now, let me elevate it. Let me elevate it to a new level. Oh, there's a degree of connectivity when I elevate to the operational level that I hadn't considered before.

Let me explore that. Not only developing competencies and confidence, but also understanding the upstream and the downstream ramifications that need to be considered and controlled for and maximized when the results are what we're looking for. And that's part of the creativity element that I find to be empowering, that I find rewarding, and helping people gain that confidence and trust in self outside of what can be traditional expertise in our community that really matters most, not only from a professional development standpoint, but also from a transformation effort standpoint.

Joni: 

Wow, Kelly, you're saying words that are just resonating with me. For example, you're using terms like interconnected and adaptability. And so I know that you're a systems thinker, which I'm totally biased based on the way I've been trained and some of my beliefs and experiences in healthcare. But to me, that's probably why you are an exceptional strategist, you're a systems thinker. And so I know you're a fan of complexity science as well. 

Can you tell me how you operate or think about operating in systemness? I mean, particularly in technology spaces, I feel like we get so siloed and, you know, we lose the big picture often. So how do you operate in systemness and how do you think about seamless technology integration either supporting or hindering care and work?

Kelly: 

I think we have a lot of work to do in this space, but I think there's a lot of good opportunities and I think that as a profession we can help shape the way that technology enables, empowers and transforms care delivery. Yes, I am a huge advocate of systems theory, systems complexity, systems, leadership. I think being able to understand we're a part of a system at the micro, macro, and mezzo levels and all of us can relate to this because a patient is seen in our care area, but where has that patient been before they got there? Where are they going after they got there, what information needs to flow seamlessly between those places in order to ensure that patient receives the best care, not just now, but when they leave, and how do we ensure that that information and that data that transpires while they are receiving care in other areas comes back to us. 

I think that's the fundamental, that's the ground rules for what we're playing in. That sounds very simple and elegant in description, but as we start to operationalize, it becomes a little more complicated. I think we've all been recipients of what I'll call technology overload. Is that ongoing updates and upgrades? Is that dealing with technology that is antiquated? Is that being bombarded by alarms and notifications and alerts? Probably yes to all above, but I think we can all relate to the environment of care and apply it to a systems-based approach. We typically think about the EHR as the center of our universe if it wasn't documented, if it wasn't done. But when you think about other technology that is interacting and encompassing what you use on a daily basis to deliver care. And also keep in mind when I'm saying care delivery, I'm also not just speaking about the patient to nurse interaction, but the nurse to clinician interaction, the nurse to operations interactions. 

Think about how you're interacting with physicians, how frequently you're interacting with physicians, how you're interacting with other advanced care providers, how you're communicating with pharmacy, how you're communicating with social services, how you're communicating with admissions, discharge, and transfers. And I'm probably missing a bunch of other interaction points, but when you think about that, think about the limitations and the opportunities that you see and experience on a day-to-day basis. And it's not just in how we can extend the EHR, but what information, what knowledge, systems that allow us and enable us to transform care. 

Data and analytics is a part of what transformation looks like. And if we really challenge ourselves to how do we get access to that data, how do we layer that data in a way that's meaningful and useful to us, that's an area of complexity that we're starting to see solved, that we're starting to really examine closely, that nursing is engaged and empowered in leading. But being able to address and assess what's going on within our technology systems, how they're interacting with each other and producing data that is relevant and pertinent to the transformation efforts that we're all responsible for and engaged in. 

I think being able to really look at opportunities for us to generate and access and utilize data will really uncover and activate opportunities for us as a profession, opportunities for us as a practice, to really transform the care and the changes that we seek to recognize. But I think it can be very complicated in terms of how we go about this, in terms of what we have to do, what we need to do, the responsibilities and requirements of the technology, because when you think of all we have to learn, one more piece of technology can be daunting, and it should enhance our work. Technology is a tool that's utilized in care. It's not the care. So being able to articulate what's needed for successful processes, and what is generated as a result of those processes is really what technology and systemness is about.

Joni:

Wow, that's incredible, Kelly. So, you know, I'm always curious what other leaders are doing. We've talked about, you know, reshaping your skills over the course of your career, and I'm always curious about what other leaders are reading or doing to sharpen their skills. What are you reading or learning about these days, either personally or professionally, what are you doing to sharpen the saw, to feed your soul?

Kelly:

That's a great question. I previously mentioned, and I've probably brought this up several times during the course of our discussion, but I find creativity and looking at things differently to be really fundamental to what we do and what I'm asked to participate in as an innovator in health care. And that being said, I've really been diving into creativity lately. Julia Cameron is an author that's written several series of books, The Artist's Way. 

These are not new textbooks, but I visit and revisit these textbooks as a means of really tapping into my creativity and some of the challenges experienced in creativity, whether it be a block, whether it be new forms of inspiration, trust of self. But I've been reading a lot of Julia Cameron and really diving into that creativity. 

I live in Austin, Texas, and we have an amazing museum here, the Blanton Museum of Art. And I've been going to the Blanton and just getting lost in the exhibits and the creativity and the curation of the exhibits. And that also helps me to push the reset and reboot button that inspires me and fortifies me as a creator who experiences frustration and confusion and, you know, just helps me get back on the horse, so to speak, in finding new ways of inspiration.

Joni:

Ah, that's great. Yeah, being in Austin, you have quite a plethora of creative outlets for sure. I too love going to museums and just kind of walking around. There's great evidence to show that it certainly fosters your creativity in different kinds of ways. I don't know about you, Kelly, but when I'm at museums or when I'm reading books, I just feel like I have an influx of ideas and thoughts. It's so cool. 

Kelly: 

Yes, I do as well. And I think finding that space for yourself to be able to get in touch with that part of you that is inspired and back to your true north is essential in what we do.

Joni:
Yeah, that's great. So Kelly, we've talked about a lot of different things in a short amount of time. It has been so rich and wonderful. What would you like to hand off to nurse leaders at all levels and in every setting?

Kelly:

I would just say I am encouraged by our community. I am still a big advocate for nursing. I am so inspired by what nursing is doing as a profession, as a practice, as leaders in healthcare. 

I want to encourage folks to pursue your passions in the profession, to not be afraid to step outside of your comfort zones, to get comfortable with ambiguity and what we know as risk, and really shift thoughts and perspectives and belief towards opportunities for learning and growth. And I just continue to be so honored to be a part of our profession and to be included in this tribe of really special people.

Joni:

I concur. Kelly, where can people follow or connect with you or find more of your work if they wanna do so after The Handoff?

Kelly

I think LinkedIn is really the best place, so don't be afraid to look me up on LinkedIn. I love to connect with other nurses along their professional journey, and I'm here to support you and engage. So LinkedIn is probably the best place.

Joni

Excellent. Everyone, be sure to find Dr. Kelly Larrabee-Robke on LinkedIn to continue conversations. Kelly, it is always a delight spending time with you. Thank you for handing off such great wisdom today. 

Kelly:

Thanks, Joni. 

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