Dan:

Josh, thanks for being on the show.

Josh:

Yeah, thanks for having me. It's a privilege to be here.

Dan:

So, Josh and I saw each other a couple weeks ago at the academy. We both were inducted as fellows. So, first of all, congrats fellow, fellow.

Josh:

Right back at you, fellow, fellow. And I've been stealing that tagline for about a month now.

Dan:

Yeah, we had a good time. A lot of great connections there. And we talked a lot of leadership and the future of healthcare there too. So, before we jump into some of the topics that we're going to chat about today, would love to hear just what's top of mind as you lead some amazing transformation and technology work at your organization.

Josh:

Sure. And thank you again for having me. I do want to lead off with a small disclaimer that the views expressed by myself are solely those that are my own and do not reflect the official policy or position of the US Navy, the Department of Defense, the Defense Health Agency, or the US government. And when it comes to current things that are top of mind, I think that the shiny object is what I spend a lot of my time defending my staff and my teams from. And I think that health innovation, digital health transformation, while they may be buzzwords, it is where healthcare is looking right now.

Dan:

Yeah, I think my experience in the innovation space, there are a lot of shiny objects and a lot of vendors. I think as we're recording this, that HLTH or health conferences going on, which is a huge trade show of all things healthcare, shiny technology. When you're thinking about leading your team or protecting them from those shiny objects, what are some of those key things you look for to weigh, is it sort of that vaporware, shiny thing that everyone's excited about, but can't deliver, versus something that might be on the edge of what we know but is adding value or could add value to the organization?

Josh:

I do think this is about fundamentals. And while it isn't exotic or come across as a innovation mindset, I think finding out what the question or the problem we're actually trying to solve is, is so critical. And I think that we see this change. You and I love the latest and the greatest. But even with something as innovative as blockchain, et cetera, as healthcare looks at something that is so promising but still poorly defined, we need to develop those multi-criteria kind of decision making models or formulas for ourselves. And I think that if we can align to the financial business and clinical leaders in our organizations, I think they can show us the roadmap to the practical implementation of some of these exciting technologies.

Dan:

And I keep asking leaders to dig under the hood too. It's easy to get caught up in the marketing and the flash and the PowerPoint decks and the demos, but to ask those hard questions about what's under the hood and who's leading this work and who are your experts and advisors, and all of those things that we sort of forget about when we see the next cool thing. And so, I think it does go back to that fundamental of leadership and really getting the data you need to make an informed decision.

Josh:

100%. And I think that as nurses, as nurse leaders, we have to focus on that value and we also have to bring it back to caring and how does this improve or optimize the caring environment for our patients.

Dan:

And so, you're a huge leadership mentor and proponent and scholar. And so, one of the things that you continue to say is you need to get specialty certifications for nurses, not only at the bedside, but beyond that in informatics or leadership or whatever your specialty is as a clinician. Talk more about your thoughts on that and the value that certification brings.

Josh:

Sure. And this is something that I'm exceptionally passionate about, because I believe as nurses, as nurse leaders, we can take this back to those actual caring actions, our nursing science, our work pathways. And I think when we look at nursing specialty certification and the direct and positive impact it does have and is known to have on rates of certain disease states and outcomes, it becomes essential to our growth and the growth of our teams. And specifically we know it impacts falls, we know it impacts pressure ulcers, we know it impacts certain hospital acquired infections, but also impacts those critical opportunities to rescue our patients with improving failure to rescue. So, when I think about the consumer paradigm in healthcare where our physicians, we as consumers expect our physicians and allied professional partners to be board certified, and we know that this ties back to safety, quality and outcomes, that's why we demand that certification, that board credential of a physician as a consumer.

And this really represents an opportunity for nursing to act on its own behalf, for nurses to act on their own behalf, for nurse leaders to act on behalf of their teams and their organizations to basically declare, show that way forward with alignment to nursing science, demonstrate that individual and specialty commitment to the latest evidence. And then ultimately, leading to influencing the standard of care and the standard of practice in our individual locations. Because for me, this is really an opportunity to not only advance our care, but also further understand those intrinsic and extrinsic factors that may drive us, our nurses or our teams towards or away from specialty certification. And then how that shapes the outcomes and making a difference for our patients, our staff, our organizations, and the community.

Dan:

And if you ever look at Josh's credentials, you'll see that he not only believes in certification, but he has a lot of them and recognition. And one of the things when I was an ER nurse, I felt that need to become certified just to have that sort of external validation that I knew that what I was doing and got certified as an emergency nurse within my first year of practice. And I think it's so important, it's that external validation of your work, your knowledge. It demonstrates to the public that you're committed to the profession, that you have a certain baseline of understanding of the populations that you're serving. And I couldn't agree more with you that certification maybe should be even required, similar to what physicians have to do and maintain board certification throughout their careers. Maybe we move that way in nursing.

Josh:

Well, and I'm a passionate believer in that. While I do know, and thank you for the acknowledgement that certification does matter to me personally. I have sipped the Kool-Aid, so to speak. I've had the privilege to write on this with Dr. Christopher Stuckey, and we actually put a creative controversy piece out there that advocates for nursing specialty certification as a national standard for nursing. So, I'd invite your listeners to look that piece up and think about where they fall out relative to the arguments we make in that piece.

Dan:

Yeah, I didn't know you had that out there, so I got to read it. Because that is something that I think nursing in general needs to sort of standardize around, which is our educational standards and then our practice standards and certification is one pathway to that. So, I think that's awesome. Kind of continuing down the leadership route, you recently wrote a white paper about the fact that nurse leaders today need to be able to move quickly, more quickly than they have in the past in order to make decisions, figure out the solutions to very quick moving, unpredictable, unknown problems that are popping up. Can you talk more about some of the findings that you wrote about in that paper and why you're so passionate about leaders gaining a different skill set, one of those being speed?

Josh:

Sure. And I think that this goes back to a very hip and kind of buzzword term being used right now, which is urgency. And I think that COVID-19 obviously injected a lot of urgency into our practice, as individual nurse leaders into the operations of our teams and our organizations. And so, I think the inclination is also to try to discover something new, to try to discover something that changes the paradigm, when in reality we've had challenges before in the history of nursing, in the history of modern healthcare, et cetera, and there are thought leaders out there in this space. So, when looking to write specifically about COVID-19 and nursing's ability to really define the ambiguity or as I called it, the shadows of our operations, and really lead into the data as that data evolves.

I really need to point your listeners back to Dr. Carol Huston's eight essential nurse leader competencies. And in preparing to write the piece and develop the thoughts there, it's remarkable how her piece from 2008 really gave a framework whereby a nurse leader in 2019, heading into 2020, would've been very well positioned to do just that, to lead ahead of data, to shape their teams, even as we're defining the challenge that we're encountering, those eight competencies represent success even in a new paradigm that we have, and I don't say post COVID, but in the new reality that we're leading in.

Dan:

It's important to have a leadership framework and be able to rely back on not only the evidence of what works in certain situations, but also a way to take in new knowledge or new information and sort of vet it out before decision making. And so, the leadership frameworks provide that, instead of shooting from your hip and throwing stuff at the wall and seeing what sticks. So, what are some of the top behaviors that Dr. Huston talks about that you're really passionate about?

Josh:

Sure. And I think that this is an incredible opportunity. You and I are both strong advocates for having that framework to launch an initiative or to perform a task, or to lead our organizations towards the future of healthcare. And these eight competencies are absolutely essential in the sense that if you can actualize them, you're going to have that well-rounded team environment. And the first one is for sure to have that global perspective or mindset regarding healthcare and professional nursing as they relate to each other, and understanding that our ability as leaders to anticipate change is really going to help us be successful champions in our organization. And then ultimately, pursuing alternative points of view with a supportive posture and an environment that's conducive to success that really embraces and makes it safe to share competing or alternative perspectives. And then ultimately, having that opportunity through these varied views and maybe making it a safe space to have a wide variety of opinions, you can maybe reach consensus where you weren't able to before.

And you can also achieve opportunities where they had previously been unattainable due to the integration of those various interests and often competing perspectives. And that's just the first, because for me, acquiring technology skills has been integral to my growth as a nurse and a nurse leader. And I think that that being her second essential competency, that acquiring technology skills to facilitate mobility and portability of relationships, interactions, and operational processes, feeds right into what we all experienced in COVID-19. That we're going through the seismic shift in system processes, staffing contingencies, and the environment of care was completely disrupted around COVID-19, and really in a way has helped to accelerate the evolution of healthcare in ways we had not anticipated due to the changing in Medicare, Medicaid fundings around virtual care, et cetera. And ultimately, creating that opportunity for the exponential growth of skills and competence in our teams to meet whatever that challenge is.

Dan:

Yeah. I think those are two great ones to start off with. And I especially like the technology one. And one of the platforms that I've had for a while is, nowhere in nursing school or really in master's or PhD, doctoral work in healthcare, are there other, outside of formal informatics programs, are there really a great wealth of teaching and knowledge on how leaders can build that technology capacity. And so, what I've seen in several large organizations across the country is nursing just not there, because they're not comfortable in speaking to the technology leaders in a way that the technology leaders can translate into something they know, and then the technology leaders don't translate their work into the clinical. And so, there's sort of this disconnect that leads to either poor decision making or shiny object buying, instead of really getting to the core. So, do you have any tips on where a nurse manager could go and start getting some of that technology competency that you talked about, number two?

Josh:

First of all, they just need to wander outside their nuclear team, their nuclear unit, their organization, and start to dialogue with others because these conversations are occurring everywhere. And I think that if nursing can see itself as grounded in a unique body of science, but in integral part of that interprofessional team, a vested peer collaborator alongside physicians and allied health partners, I think that that empowers the nurse to really have that appropriate mindset and that energetic engagement and that advocacy for the nursing perspective. We have this push around policy and maybe labor law and other aspects of our profession that don't make a decision about us without us, but uniquely to technology and innovation, nurses have tended to lag behind. And I think that there are exceptions to this. You and I are both familiar with rockstar nurses that are working tirelessly to change this paradigm. But that ability to just start having the conversation and having it as that vested peer collaborator who can come alongside and not be dependent on another profession, that's the framework that a nurse needs to be successful in that kind of an engagement.

Dan:

And I think also, they don't have to be experts in the coding and technology backbones, but they need to understand the questions to ask and the implications for some of those decisions. And to bring alongside, like you said, the interprofessional partners that can be the technology experts, while you're the clinical expert, and to have that relationship and that's something I've seen on very highly successful teams. So, we talked about one and two, let's go to the next one. What's 3, 4, 5, 6, 7, 8?

Josh:

Sure. So, I mean, this is incredible that we want to have our decision making skills rooted in empirical science. That's her third essential. And I think that you and I are both passionate advocates for nursing science and that decision making expertise that empowers our nurses, but we really need to have well honed decision making skills that most effectively create that supportive and change welcoming environment. Because we are there, we are communicating, we are collaborating across our entire organizations, and we're going to be that change agent that can make the difference. And then the fourth would be creating organizational culture that permeates with healthcare quality and safety at its core. And I think as nurse leaders, that's one of our highest callings, that we really do not want to miss any opportunity to elevate our staff, our patients and quality that we see being achieved in our teams and our workflows.

And many methods are out there that you can buy a book or attend a workshop to make your team more productive or have a more inclusive workplace culture. But I think that not just COVID-19, but every challenge nursing has faced over its evolution has resulted in success due to nurse leader's ability to acquire, track, identify, isolate, evaluate, analyze, document, and pursue all those variables and concerns that influence our teams. And I think that it seems complex. It is remarkably complex, but it goes back to a core skill that nurses have. And as respected collaborators across those multidisciplinary interdisciplinary teams, we really can contribute to enhancing quality and safety everywhere in healthcare.

Dan:

I think those are another two that go really well together. So, one, empirical science, you can do that through evidence based practice skill sets, conducting research, being able to read and interpret scientific results. So, I think that's a given, and that's definitely a core of a lot of healthcare programs. The second around culture change, and I think they go hand in hand because there is evidence that the number one barrier to the adoption of evidence based practice or scientific based answers to questions is frontline nurse managers. There's countless surveys around chief nurses and their sort of prioritization of what they want in their organizations, and quality and safety are always at the top, but evidence based practice is down at the bottom.

And I think we have to understand that culture change is a specific skillset and there's frameworks for that and interventions you can do, but I think we overlook it. It's like, we'll do these tasks and then the culture will change, but that's not necessarily how it goes. So do you have any advice to leaders on how they build a culture that sort of supports that inquiry and quality and safety culture?

Josh:

Sure. So, I think that it is for sure a blend of what we've talked about to this point, that the individual nurse has the ability to acquire, analyze, process, and act on very complex situations and very discreet data. They have the ability to develop a perspective and an opinion, which we're going to cover in one of the next competencies shortly, that really empowers them to influence the full spectrum of healthcare and policy. So, as a leader, giving them the safety and the space to express their perspectives and opinions, and then bringing those in alignment with the overall input of the group to reap a result, it's really a beautiful thing. And I think that you and I would both acknowledge that we've gone into meetings, collaborative environments and come out way better than we thought we would, because we were able to create that space where ideas were brought together and they were able to compliment each other and became more than the whole.

Dan:

Yeah. And it goes back to number one or two, I can't remember which one, I think it was number one, which is this diversity of thought and having diverse teams that bring different skill sets, different life perspectives and different problem solving abilities is that magic piece for innovation as well. So, let's do five and six. I feel like they're paired up in a way that make a lot of sense. So, what's five and six?

Josh:

Sure. So, recognizing opportunities to appropriately intervene in political processes. And I'm not talking about the experience we just all went through necessarily, but in some ways, yes, that as highly respected healthcare advocates, nurses, we are the most trusted profession. We are the largest healthcare profession, and we are that bridge between health policy and healthcare delivery. And no group is more equipped to appropriately intervene in the political process. And by that, I mean good policy positions to influence the outcome of anything, whether it be from the pandemic to any number of natural disasters we have and will experience in the future, and then the social issues that might to a certain degree or greater impact our direct patient care population. And for me, seeing nurses play their part in addressing threats to the profession, to our patients and our communities, is especially empowering.

That does pair up nicely with Dr. Huston's six essential competency, which is possessing highly developed collaborative and team building skills. And that ability to really start by living the standards and expectations we expect of our staff. As nurse leaders, are we living the standards and expectations we have of our staff and our teams? And then establishing expectations around professional communication. What is collaboration in the context of our care environment, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership. And I'm not talking the authentic leadership of social media fame. I'm talking engaging our employees actively, contributing as team members alongside of them, even as a leader in the organization. And really developing a sense of a common purpose and a kind of cooperative work environment that highlights nursing's contributions and our obligations as nurse leaders to educate our staff and bring in that consensus and support. And seeing that our agreement with a staff member or a team or their desired priorities and support for those desired priorities, they're not codependent concepts.

We can have a little bit of churn, we can exchange ideas. We can have certain concepts or principles accepted as having more merit, but at least we've come together to test them against each other's ideas so that we can settle on something that we all agree as the way forward.

Dan:

Yeah, I think again, a unique skill of team building isn't just being nice to people and having effective meetings, but accountability, relationship building, those type of things. And again, we can learn a lot from popular books from Simon Sinek and others, but there is science behind all of that stuff too. And so, really as a healthcare leader, your obligation is to practice on the best evidence and the evidence changes. You need to start reading leadership literature and culture change literature and team literature, because that's your scientific foundation for building these things. And so, it's your obligation to found your practice on that. So, one thing that at least from an outsider the military gets right, is that teamwork piece. From your work in the Navy, what are some tips or ways that the military sort of builds that camaraderie in teamwork that other healthcare leaders could learn from?

Josh:

I do think it starts with respect and empowering the individual. In military healthcare, in Navy medicine, in tri service healthcare, we do very well at implementing principles like team steps or any number of other framework that are kind of the standard out there. And I think that, that ability to empower every member of the team to speak up without regard for rank or privilege or status, that ability to appreciate and accept and integrate the perspectives of every single team member. My clinical background is the operating room. So, if somebody sees something, they say something in the operating room-

Dan:

Nice catch phase.

Josh:

... but well before that was a block watch phrase or a Department of Homeland security phrase or anything. We have always leaned on the surgical tech, any member in the team to speak up when they see something because it makes us all better. And it's what ultimately protects the patient. So, from my perspective, I don't think this is unique per se to the military or any other healthcare environment, but we do place a premium on the value of the individual, the fact that we have trained them to a standard and they're expected to contribute at that standard. And I think that that's the exciting piece, is when you do allow your team to feel accepted, respected, and engaged, they will do so and they will contribute to the overall awareness. Your team will know where it is in time and space, and you'll be able to achieve your goals and your targets much more quickly.

Dan:

And I think it goes back to some of the other principles, is teaming, culture. Those are some just thrown out there as magical things. Oh, yeah, you got to build a culture in order for this to work, but it really underlies the underlying assumptions and behaviors that your team does. So, without a culture where that's accepted, then you have fear to speak up. You have people who will undermine things, passive aggressive behaviors, those type of things. So, as a leader, we have to know those things will happen and start addressing them to change the day to day, minute by minute behaviors and interactions that we have in order to build the operating norms that lead to a more effective culture. And I think there's a lot of times where you're like, oh, yeah, we got to get culture change and we hire some leader to come do culture change. And without understanding the science.

And culture change's a five, seven year process in many cases, and it takes a lot of deliberate actions by a lot of people in order to flip the way people come to work every day and make decisions. So, I think that's another really, really strong behavior on number six around teaming and then also the culture one. All right, so now we've got six down. I'm hoping the next two are also related. So, let's do the next two.

Josh:

And they are. Balancing, number seven is balancing leadership authenticity, and performance expectations. And I think this is a struggle we always have as leaders, that we want to engage, we want to be perceived as communicative and as available to our teams, but we also need to hold our teams to a standard. And when it comes to that, I think that nurses and nurse leaders, we drive that performance. We are looking to enhance safety, we're looking to impact quality and deliver those better outcomes. But how do we achieve that given the dynamic nature of all the challenges facing healthcare today? And so for me, authenticity is a tool that I use to bridge between what needs to get done, how we do that, and what my expectations are. So, being authentic, like I said, it does not mean that I have a robust Instagram and I post selfies from everywhere I do or what I eat or share my emotions around a particular political event or social event or sporting event. That's not my style.

But for me, authentic leadership goes back to those authentic leadership principles of self-awareness. How do I impact positively or negatively my team's inputs and outputs? Relationship transparency, making sure that I'm treating everyone equally, that we're dialoguing, that everyone has the same chance to have input and no one is perceived to have favoritism, whether it be access or privileges or recognition. And then having that internalized moral perspective about where are we headed. This is a really important part of being aligned to the mission, vision, and values of the place you work, that you can authentically align to the priorities of the organization. And deliver on them while not losing focus on your own personal development, knowing yourself and having that transparency because you're already there where the organization is.

And then the eighth is envisioning and proactively adapting to the healthcare system that continues to be defined or characterized by rapid change and chaos. And this is the reality in which we all live, and I don't think this is going to change. If anything, it's going to accelerate. And nurse leaders really have that unique ability to assess, develop, and enhance their organization's, their team's ability or capacity for change. And the unique demands of strategic leadership or operational excellence or relationship management that we all encounter, we need to be able to rise to that challenge.

And in this way, I think that nurse leaders really can model our profession's well established capacity to thrive and sustain ourselves through chaos and change. And if there's one thing that's consistent is that nursing has evolved alongside of healthcare. Our body of knowledge continues to grow, it continues to answer questions that we need the answers to. And for me, I think that the current nursing leadership experience as defined by this rapid change and chaos represents an absolute opportunity for us to stress test our teams and our organizations in a very real and practical way that we might not have been able to pre-COVID.

Dan:

Yeah, I think those are also two great ones, especially around the idea of leading through change and chaos. And from a complex system standpoint, that can be a better competency for a leader because the idea that things are predictable is a fallacy. And so, it's all about patterns and looking for trends and things, but you can't predict what's going to happen tomorrow. Or during COVID, it was a minute by minute, things were changing, we didn't know what was happening with the virus, with PPE supplies, with staffing, with all these different things, and nurses are in that situation with our patients. A lot of times, we look for those patterns that tell us something that maybe something's going to happen or patterns related to how people react to medications.

Those same skills work for leaders and looking for patterns and how people interact and the relationships that you built and the way the meetings are structured and all of those things are using that same skillset to not predict the future, but to be able to adapt and make informed decisions in order to evolve with it, like you mentioned. So, another two great ones. So, Josh, out of all eight of those, if you had to pick one, what do you think the most essential one is for the healthcare leader for today?

Josh:

And that feels very much like a trick question in the sense that we are in such a complex environment. But I think that when we think about nursing as a collaborative workforce, when we think about ourselves as part of an integral and vital part of that interprofessional team, I think that I would probably go back to our culture and making sure that that's permeated with healthcare quality and safety, that our ability to influence those outcomes, it is profound. And I think that that's what with this paper that was written by myself and Dr. Stuckey, we really looked at, we don't know what the thread is, but we can see it starting to be defined. And that's where the concept of defining the shadows comes in. If you can't see an object, you look for it's shadow and you work your way back to the object to locate it and define it and characterize it and understand the whole.

And I think that that's what nursing is capable of. We know that we can acquire data. We know that we can track that data once we acquire it, we can identify it, isolate the particular variables, evaluate what those are, analyze our influence on, and ultimately pursue them to actually influence the healthcare environment of tomorrow. And I think no matter what the challenges that we face either now or in the future, if we lean on these eight essential competencies, we lean into them. I think that we can be successful as nurse leaders.

Dan:

And I love that idea of the shadow of the object. And in complexity science, there's a concept called attractors, which is the same thing. You may not be able to put your finger on the exact problem or the thing going on, but you can see the way people behave around it or the way the system shapes around these things. And you can back into what those could be. And there's positive attracts that pull people forward into the future. There's negative attracts which pull people back to behaviors of the past. There's unpredictable attracts that pop up and cause people to shift focus and energy. And so, it's a great tool to learn about. You can't always put our finger on the thing, but we can see that something's not right and we can back into that thing. So, you picked wisely on that one.

So, we're going to transition a little bit here and go back to the technology talk. So, we talked one of those competencies was nursing or healthcare leaders competency with technology, culture change. From your vantage point in working primarily with technology, what are some of the emerging trends that you're really excited about and what are some of the hypes that maybe we need to let fester a little bit and get some more information on before we jump in on them?

Josh:

And I think that's a great cue in that we don't have to pick up every object and implement it. I think that we know that investment and growth in the area of digital health transformation, that health technology is just going to continue to be sustained and accelerate in the years ahead. So, when we look at themes that are out there, obviously front and center is analytics, dashboards, the machine learning, artificial intelligence, paradigm, and obviously robotic process automation. I think that the ability to apply those algorithms and automation to any number of our internal, whether it be clinical or business processes, it's going to continue to accelerate, but it does require that engagement from a human. And who better than a nurse when it comes to a perspective on healthcare to inject into those algorithms, look for the biases that might be out there in a particular data set. So, we don't ingrain those in our automated processes. And looking at the ability to keep that caring even within an automation framework.

I think that another one is obvious that will benefit nurses profoundly would be any of the low-code, no-code environments that are continuing to evolve. I think this is still a opportunity. I don't think that technology is quite where it needs to be, but I think that the future of low code, no code and those tools and the data that we can process with them will open this concept and technology to a wider range of physicians, providers, and clinicians obviously. And then this cloud everywhere, cloud everything, everything as a service that is just continuing to dominate the conversation, including this week at health, I think is really something that we're going to continue to see it accelerate. It's probably going to be the source of some of the most inspiring and creative solutions we see here in the near term, but they're often going to be obscured by the absolute jungle, the ocean of offerings that are in that space.

So, finding the winners, picking the winners, I think is going to continue to be a very tough task. And you and I encounter a lot of this, we've even done some work in this space. I think that being a part of winning teams not only comes down to having a great idea, solving a real problem and having a real value proposition, but it's going to involve being found. It's going to involve having the right advocates and making a difference for a consumer to the point where they become your advocate. And then obviously cybersecurity and privacy is going to stay front and center. I think that trust in nursing, the concept of nurses as that protection for patients is going to mean that nurses must evolve our role and contribute to cybersecurity and privacy initiatives.

I think that we have been and will continue to be a source of solutions in this space, but I think that when I look at the overall paradigm, who better to help ensure trust than nurses across all these technologies. And then from all of those, what is over promised or over hyped? I think that automation has always been over hyped. I think that eliminating redundant and menial tasks has meaning within these tools. But I think that the concept, that entire processes, whether they be business or clinical, can be removed from human influence or shaping, is really a pipe dream that we're several decades if ever away from achieving. And it's continues to require highly-skilled engaged professionals from both the business and the clinical side to drive those tools.

Dan:

Yeah, I think you painted the landscape pretty well. Like we mentioned, that skill set in technology, there's nowhere in undergraduate nursing school that teaches you how to incorporate machine generated insights into your clinical decision making. So, we have a gap in, we could have the greatest algorithms on the planet, but if you don't understand how to incorporate that into your clinical decision making and not just blindly trust the machine, then we have to figure that human side. And then the automation, I see that all the time with vendors when I was working in the innovation space, is they come in, oh, we can replace the XYZ thing a nurse does, or we can eliminate four FTE's worth of time if you just do implement our system. And at the end of the day, you still need people to deliver care. And so you're not really eliminating the time they're spending, you're maybe supporting them to do more value added work.

But we have to sort of flip that equation. And you're right, we can't automate everything. There is a huge human need in healthcare. And so, being really deliberate about taking those redundant, repetitive tasks that machines are good at and automating them, but also incorporating the clinical workflow are two things that I think we could do better at in the technology space. And I posted today on LinkedIn, the Gartner hype curve. So, as a healthcare leader, if you're looking at new technology, Gartner puts out what they call the hype curve, maybe once a year, a couple times a year. And healthcare is one of the industries they do it. You can see where your cool shiny object lands. Is it in the hype of inflated expectations or is it down into the trough of productivity? And I think it just provides, again, another mental model for you to assess those technologies as we move forward.

Josh:

That's for sure, that where we are as nurses, that nothing can replace the caring we offer and ultimately where we see value or derive value for ourselves, our patients, our organizations, we will thrive. And the tools we pursue, the technology we pursue will thrive. So, to me, you couldn't have said it more clearly that we need to come together and see the potential we have as a profession to shape the future for all of healthcare.

Dan:

Agreed. Well, Josh, we're coming up on the end of our time together, so just want to really appreciate your insights here, the leadership framework, your commentary on those. I think there's a lot of nuggets in there that the healthcare industry can take away and learn from. And again, I just want to reiterate that, and you mentioned this too, leadership is a science and an art, and we have to found... If you're in a formal leadership position or an informal leadership position, you're obligated to understand the science of what you're doing. And Josh has some papers out on it, of course, I've written on it. And so we need to get that out there. But before we wrap up here, Josh, what is the one nugget that you'd like to hand off to our audience from today's conversation?

Josh:

I hope that your audience has heard that this posture of continuous learning and adaptability and collaboration across interprofessional teams that defines nursing really is the answer. And that with strategic planning and foresight and staying connected to the bedside, that we really will be integral to visioning the future of healthcare and we'll succeed together.

Dan:

Great summation. So, Josh, where can we find you? If people are interested in learning more about your work, reading some of your articles, connecting with you, where is that online?

Josh:

Sure, I would love to connect or collaborate and they can find me on LinkedIn for sure, as well as ymirstrategystrategy.com and on Twitter at Health IT Leader.

Dan:

Awesome. Go check out Josh there. If you're in San Diego, look him up. He's everywhere. He's writing, he's going to conferences. We serve on some hymns boards together. And so, really encourage you all to look at what Josh is up to, has a really great framework for creating change in healthcare. So, Josh, thanks so much for being on the show and we really appreciate it.

Josh:

Privilege to be here. Thank you.

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