Joni: 

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast from Works, healthcare's flexible staffing platform. Today we're thrilled to have an extraordinary and returning guest, Dr. Josh Wymer. Dr. Wymer serves as the Chief Health Information and Data Strategy Officer with the Missouri Department of Health and Senior Services, where he leads initiatives impacting the health of 6.2 million Missourians. He's also a faculty member for advanced informatics and executive leadership and an advisor to numerous healthcare startups. 

Dr. Wymer’s career is marked by a distinguished 20 year tenure in the US Navy, during which he held key leadership roles, including Chief Health Information Officer for the defense health agencies San Diego Market and Chief Nursing Informatics Officer at Naval Medical Center San Diego. His contributions in surgical surfaces, combat zone field support and leadership in complex healthcare environments have set him apart as a leader in the field. He is a fellow with the American College of Healthcare Executives and the American Academy of Nursing, and his expertise spans healthcare system excellence, digital health transformation, and sustainable change. In today's episode, Dr. Wymer will share insights on transforming legacy thinking and governance structures to empower nurses, the future of healthcare data, and aligning nursing competency with the real world demands of nursing work. Welcome back to The Handoff, Josh.

Josh: 

Thank you very much, Joni, privileged to be here.

Joni: 

Absolutely. We're excited to have you. 

Josh: 

Yeah, so just before we get started, I wanted to just make a brief statement that what I share with you today during our conversation is going to be very exciting, but it is my own opinion and does not necessarily reflect the policies or positions of the organizations I'm involved with.

Joni: 

Excellent. Well, we are thrilled to have your opinions and expertise today, Josh. I've been looking forward to this. So when we have talked before, we have talked about the importance of democratizing the workforce, especially around ensuring fair compensation, which is a hot topic. I mean, especially on the heels of COVID-19 financial recovery, there are a lot of compensation changes happening across the United States. Maybe there are enough, maybe they're not enough. I'm curious from your perspective, how do you think organizations can actually democratize the workforce and ensure fair compensation in this current economic climate?

Josh: 

Well, there are a lot of caveats there. And first of all, we are in such a unique economic climate. Leaders everywhere are struggling with inflationary pressures, not only in workforce, which is their largest cost center, but across every expense that they line item. And I think that when we think about doing better for our teams and our team members, we definitely start with communication. How are your teams doing? We know how our teams are doing. We know how healthcare is doing. Healthcare is stressed, healthcare is stretched, healthcare is pulling out all the stops to even meet daily operations requirements. And I think when you tack on making sure you're connected to your teams and the reality that they're experiencing, we automatically go to what is the market for a healthcare professional? What is the sense that they have? What is the alignment they have with the mission and vision of your organization?

We know that has value across the healthcare industry, especially if you can keep your teams and your team members aligned. But where are we failing? Because we know that a large percentage of healthcare professionals feel owned by health systems or their organizations, and that really has resulted in many healthcare professionals stepping away. I call them “players on the bench.” They are ready to provide care, they're ready to care in the context of health, but it just economically does not align for them anymore. And I think with your experience especially, it's so exciting that we can begin to really look at solutions that are democratizing these challenges. And what I mean by that is, is that we know that the gig workforce is in full force across healthcare as well. We see this with health systems developing externally facing apps, offering gig shifts alongside their traditional staffing cultures and ultimately hopefully bringing those bench players back onto the field. Because I think when we look at, I mean just as an example, Michigan has 50,000 plus licensed nurses that aren't employed in healthcare, and that's an incredible amount of caring that is not being provided. And I don't want to presume on the individual professional or their choices, we know that often nurses are women, often nurses are caregivers. Often nurses are the linchpin in their families, their communities, but we know that they have immense value to bring to the profession that we're both very proud of being part of.

Joni: 

Yes, I wholeheartedly agree. I love how you phrase that these clinicians are kind of on the bench. They're right there, they're ready and waiting in many cases to step back clinical roles when the environment and the leadership and the structures are there to support them in the ways that they need and want. And I mean, if I just think about myself and my network of colleagues and we're gigging all over the place and have for years. So I really appreciate that experience. Kind of digging a little bit deeper into this, Josh, because our clinicians are really just beautiful amalgams of experience. I mean all different backgrounds, degrees, some of us are second or third or fourth career nurses, just beautiful experience. So I'm curious, coming from an integrated healthcare background, how do you bridge the gap to maximize the knowledge and the value of your team rather than letting some of that experience go to waste, so to speak?

Josh: 

Right. Well, I think you have important steps occurring at the national level around nurse compensation, so I just want to acknowledge that. But there are nurse leaders trying to change this dynamic and empower nurses to have more say and a larger role in the broader picture of not only reimbursement but shaping their role and their impact across healthcare. They're part of the interprofessional team, but I think you bring up an incredible topic, which is moving beyond the interprofessional team where it's vital to have nurses. I think seeing nurses as this incredible interdisciplinary cohort across the country, millions of professionals and all those that come alongside us and support us in our care delivery, I think that we really need to be creative. And I see nurse leaders around me being incredibly creative. Virtual nursing resources are an incredible way to retain and sustain talent, especially for nurses who have non-traditional personal or family or professional requirements, as well as the ability to retain some of that more experienced talent as it ages in the workforce.

And so for me, I know that I did not develop that kind of sixth sense around particular clinical conditions or the status of a patient for some time. It just took a natural evolution of practical experience, academic knowledge, and bringing that all together to really proactively provide the best and safest and be a part of that continuous care team. And I think that the ability to retain talent, especially seasoned talent later on in their careers and leverage them as mentors and advisors is incredibly important. And I think I want to go back to the concept of what is a nurse? What is a healthcare professional worth? And I think that we know there's so many distortions, especially in a post-COVID pandemic environment. I don't know what the official phase we're in is called right now, but the reality is that there are a lot of economic drivers and we know that there is a true value for every healthcare professional out there. 

And we know that healthcare organizations are hungry to get closer to that true value because then it makes their balance sheets and their operations more predictable, more reliable. And so I think that's why you see these gig opportunities, whether it be internal health system opportunities, whether it be traditional staffing models that are now moving into mobile apps and evolving, but truly what can we do to push our care as we look at hospital at home and virtual, anything that I can seem to achieve with almost every specialist that I would want to maybe visit in my life, why can't we do that with our healthcare professionals writ large? And I think nurses represent an outsized voice in creating expectations and empowering themselves to pursue those opportunities. And I think that what you do see is these and the generations of this technology and these solutions are really evolving so quickly that, I mean, I believe we will be at a pure kind of 990 independent contractor opportunity here very soon in healthcare. 

I think that healthcare is often associated with labor contracts, etc. In some of these states, there's going to be an increased pressure to be where the professional is so that you can have that talent as a part of your team. And I think the ability to see all of healthcare and all of health writ large as a part of the same continuum is part of what has me excited, given that I'm currently spending some time academically looking at that. And then also professionally in a public health role, very non-traditional for someone from an integrated background, integrated healthcare background to be in this kind of a role. But it's all health. And I think if we can all come to that recognition and agreement, we can start to use the same terms, at least be able to understand each other's perspectives. And I think that is vital because we know the pressures are only going to continue on the demand side and the supply side for healthcare in the years to come.

Joni: 

Yeah, I totally agree with you. When I talk with other nurses about how they're moving and transitioning in their career, one of the things that we usually talk about is it is all health and our nursing background and expertise is really one of those value drivers and levers to help any organization. And man, that nursing process won't let you down. It really won't.

Josh: 

Yeah, and I really want to key off of that because there's no one worse to nurses than our own profession and we need to open the gate. We need to give each other permission to make our own professional journey what it should be. I would never have plotted out the line that my career has followed, but it's involved sequential steps that made sense and really followed my passions and the growth of my interests and my own professional evolution that really in a way we aren't always fair or kind to our fellow professionals and we have a mold and we want to fit everyone into it. And the reality is that we have this diverse set of talent. Nurses come in every stripe from the legal professions to the business professions, to engineering. I mean, they are in Tesla, SpaceX, they're in Apple. I mean, again, I'm not endorsing any of these brands, but they're in all the biggest brands. Nurses are making a difference as design thinkers and original thought leadership.

And so when I think about that, I think that we should really just make every attempt in our own personal daily leadership who needs to influence others to just get out of the way. And when we see someone doing great work, say something because that feedback, that positive little nudge of affirmation and validation that could fuel that person for an incredible amount of time. And the other piece would be by having this positive culture, I always like to say that innovation is one good collaboration away. And so for me, you're opening yourself in a proactive way to a relationship professionally, academically, maybe even a business with a fellow healthcare professional. And I promise you that you can do better together than on your own.

Joni: 

Absolutely. Josh, I am emphatically just shaking my head yes. I also love that you mentioned this sort of forward propelling and move to nurses having this form 990 independent contractor model of payment. And it's interesting that you say that because we had a colleague on the season earlier this season who talked about how she really hasen’t worked as an independent contractor very much over the course of her career, but now she's starting to kind of lump things into this W2 mindset and form-990 mindset. And it's interesting, a lot of nurses are starting to do that in order to build the life that they want and contribute in ways that are meaningful to them.

Josh: 

Yeah, and I'm absolutely privileged to be a co-founder with a player in this space. And again, I'm not going to be all about the shameless plugs today, but what we benefit from with Medical Match is that the founder is a nurse. She had a clear passion and vision for empowering single parents, non-traditional caregiver circumstances, folks that can really benefit from, they might not be able to align or fit into the traditional 40-hour work schedule. And we know it's rare for a nurse to even only work 40 hours. We're a little compulsive in our caring. And so I think that we all have gigs, right? I love to teach. For me, I call myself a hobbyist academic and I think that that's a very safe way to label yourself in academic meetings, but it's also a way to stay connected to the body of knowledge and to influence the profession that we have.

And I think the same can be said for empowering that nurse because whether it be the solution I just mentioned or some other players out there, what we're doing is giving the professional, the nurse in this case that we're talking about, empowering them to dream bigger. And when we know, and you've led in a traditional environment, I led in a traditional, traditional environment, I know my staff costs per role. I know the cost per experience. I know what the carrying cost is of the benefits, and then I know what the traditional models of agency and outsourcing staffing costs me, and I am desperate to find that place in the middle that's closer to being fair and equitable, but also the real market for that skill set for the organization and the individual professional. I think let's start though with dreaming bigger, empowering the healthcare professional to see themselves as capable because we've always had that talent.

How many of us carry clinical liability insurance even though we have umbrella protection from our organizations, right? We've always been responsible and with a little education about forming your own LLC, etc. I have some advanced practice acquaintances across many specialties that are doing quite handsomely by themselves because they've taken ownership of the business side of delivering their unique set of skills. I think again, it's not for everyone. Everyone listening to this podcast is not going to be all about it, but I do think that I don't care if someone wants to stay in that traditional integrated healthcare environment and the safety that it offers. But the future is coming and the future is very much a quilted opportunity set that's going to allow everyone to pursue their preferred structure.

Joni: 

Yes, Josh, I will move from this topic in just a moment. You're going to see my bias here because I agree with you that nurses who are taking control of their own business, how long have we done that with integrated traditional healthcare? I mean, if a nurse doesn't know how to stretch a dollar, I don't know who does because we do this really well. We do the quintuple aim really well. 

Josh: 

And we're aligned to all those standards. If you are of an ilk that had to go through nursing school and produce your 18 to 25 page care plans, trust me, a business plan comes naturally to you. And if you're someone who confidently walks into a code, if you're someone that confidently walks into deescalate a situation, if you're someone who leads in front of 5, 10, 15 people, you have the skills to go all the way to that pinnacle of leadership in your integrated health system. But what we also know is you have the skills to advocate for yourself. And it seems, for some, like such a risky step that they're making big bets on themselves every day with high acuity patients and they're applying their vast professional academic and clinical knowledge base and they're directing a symphony. I mean they are really delivering, so empowering them, the healthcare professional to deliver on their own future and is again, it's just an incredible model that is going to only continue to grow.

Joni: 

You know, one of the models that we use, or at least I have used a lot over the course of my career just because it makes sense to a lot of different groups that I tend to work with, is the model of thinking through people, process and technology. You have made quite the career transition yourself. I mean talk about in amalgam a beautiful amalgam of experience. Has the move from integrated healthcare to public health changed your perspectives on people, process or technology as it relates to nursing in any way?

Josh: 

Well, I hope we're always growing and that's my goal. And I think that when we look at the evolution of my career, I got into surgical services because I'm very process oriented. I love the variety, the uniqueness of each circumstance, regardless of if the primary procedure is identical across your day, nothing's going to be the same. There are going to be unique challenges and circumstances and opportunities with each case. I think moving towards managing as a leader, the business and the clinical outcomes and the surgical space, I just really embraced that journey and appreciated it because it really is a way to take such a qualitative experience of a healthcare professional alongside very discreet procedure-based coding and quantitative numbers, and really shape the future of resources for an entity, maturing the organization, growing your team and you're funding that yourself. And I think then collaborating with other departments and divisions and seeing that I really enjoyed their data too.

And then understanding moving into a health system role where I was seeing the entire data infrastructure of the company and collaborating with incredible technology, hardware and security and privacy professionals. And it just comes naturally to people who serve in roles like ours. And so, I think it really just is the ability to say “yes” to opportunity, but it's also the ability to empower your teams and be good at change. And I think something that nurses also need to be better at is how many times have you and I walked into a room and there are 35 nurses trying to solve a problem on their own. And I think that while we have an incredible skill set, we can be incredibly interdisciplinary across nursing, be the nurse that brings the physician, be the nurse that brings the therapist, be the nurse that brings the pharmacist laboratory leader, the facilities insights to those meetings because how do we get better? 

Joni: 

I agree. 

Josh: 

Nursing is the pinnacle for me of how I want to be involved with healthcare. I am still connected to every bedside and so much through what I do, but we just have to give ourselves permission and then do the follow on, “yes” to opportunities. And I think for me it's always involved new and challenging ways to grow. And so the move from integrated healthcare to public health, first of all, for those that have the luxury of this, picking your employer, picking your leader and aligning your values, because I very much benefit from a visionary leader who wants to stretch her knowledge.

She wants to stretch her team's capacity and capability. The ability too, because I am the inaugural Chief Health Information and Data Strategy Officer here in Missouri, is I get to build something brand new and who doesn't want the opportunity to build something brand new, especially when you have a collaborative leader who empowers you and trusts you to do your best work and trusts you? We have six divisions across our 2,000 team members. We have a $3.5B budget. An incredible component of that is technology. We are serving the Missourians not only in our state, across our state, 6.2 million folks, but Missourians travel like all of us. They have full rounded lives and try to make that life more engaged and accessible, whether it be in the structure and the integrated components of our EMS, which falls under us and public health, whether it comes down to our licensing and regulation of all the levels of care and some of the more valuable pieces of capital equipment across the state. That ability to move as a nurse and to really benefit from incredible collaborations with physician colleagues. 

I can give credit for my impact in the latter part of my military career to having a physician colleague pull me alongside and say, you know what? I don't have a direct peer ready for this, but you are ready. I'm going to give you the weekend to think about it. Do you want to be the Chief Health Information Officer position for the San Diego market? And that doesn't happen overnight. You build trust, you build collaboration, you demonstrate that you're willing to empower your teams, you're willing to effectively plan for and execute change. You're demonstrating a high level of trust, you're delivering on safe, continuous patient care. And nurses are ideally suited for that. We sometimes run against legacy structures in healthcare, but I think there's a new generation of medicine and even some of the old guard in medicine are really now seeing the value. And I think we just need to grasp at it. And I can say my opportunities have been opened often by other professions and professionals from other disciplines, and it's because of kind of what we just talked about. They are mutual co-conspirators, positive devients if you will. They see a way to make change happen. They don't want to break anything, but they're willing to dig deep to find the correct and the most realistic and most practical, most sustainable solution. I think nurses are incredibly ready for that.

Joni:

Yes, wholeheartedly agree. And you mentioned a little phrase in there that I kind of want to pick your brain on because with positive deviance, there comes a bit of wanting to stir the pot a little bit and look at ways to do things differently. And so in nursing, we do a lot of things to ourselves for sure, in our profession. Sometimes we hold really tight to things that we say needs to change, but we don't want them to change at the same time. So there's kind of this weird tension and we definitely have some sacred cow legacy systems, not just in nursing, but in healthcare systems. When you think, Josh, about workforce transformation, what legacy tools or approaches do you think that we need to rethink to adapt to the evolving landscape?

Josh: 

Well, that’s a very loaded question. I think what I want to point folks back to though first is, surround yourself with individuals. They don't have to necessarily be true. My dear friend Dan Weiberg, we were sitting next to each other as we were being inducted into the Academy of Nursing, and I was like, “man, how many times did you go to the principal's office in high school?” But he's got this forward looking positive. I mean, he sees change everywhere. Tim Porter, O'Gradys, those types of individuals in the world where they're 20 years ahead in thought leadership and the impactful writing and academic pursuits. But setting that aside the remarkable rock stars that I mentioned, this is really about essential leadership behaviors. When we talk about workforce, I had the privilege of writing about this last year for the American College of Healthcare Executives in that we got to start with wellbeing and resilience in our workforce. If your team does not believe you truly care, they're not going to respond to you if you're not proactively engaging around resilience and contributing beyond pizza parties and all the kind of little flag waving, pom pom waving activities. I think that's so huge. 

And there are concrete positive brands, whether it be recognizing the many clinical recognitions that are out there. For me, one of the proudest moments of my career, I've had many, is to receive the DAISY Award for leadership, right? Because it comes with a pedigree. It is nurses recognizing nurses and it is nurses elevating each other. And I had the opportunity before I received that recognition myself and it was very humbling…and I admit that I might've used a tissue or two…of submitting full stories of these people. And that's what we're talking about, is if you don't understand and know your teams, they aren't going to care about what you're trying to do. I think the next one is definitely just being that positive presence and having that proactive posture around. It's not you coming by to talk about feelings, but “Hi, I'm Josh. This is my role in the organization. What can I do? What's one thing I could do for you today to make your job easier?”

This is proactive, this is prospective on the leader's part, going not in there to stress out your mid-level managers or leaders because the boss is on the floor, but to proactively bring that leader alongside of you and you both approach a professional or a group of professionals heavily engaged, most likely in clinical care and say, “Hey, we don't want to take much of your time. We know you're doing important work, but what is one thing? What's one barrier? What's one inconvenience that we could resolve for you today?” And I've seen remarkable, I don't want to get into the examples, we could burn an hour two just talking about that. But I think there are profound things that leaders are just separated from and then engagement and culture. So I think it goes back to kind of the recognition piece and recognition. I firmly believe recognition is retention, recognition is so many things.

My dear friend Stuart Downs out of Georgia has an incredible philosophy of, he calls it “recruitment at resignation” where you say “Hey, we understand that we're not a fit for you right now for whatever circumstance, but you know what? We know that you have had an incredible impact.” You, the healthcare professional that's chosen to leave us instead of rejecting you, othering you saying bye and sending a meme mentally to yourself about it. Why don't we sit that person down and say, “Hey, we hate to see you go. We understand, and again, we hope you have incredible success, but when you find yourself needing a home, please know that you'll always have a home with us here in our teams and in our organization.” I think that's just a new paradigm. 

Then finally, it comes to the positive deviance, which is if you do all three of those, if you create this culture, this warmth, even in talking about that, and my friend Stuart Downs, he's a remarkable nurse leader and high impact and gives me the chills just thinking about that concept when he first introduced it to me because I've used it in modified ways ever since I heard about it.

And I think if you do those first few sets of activities, you can move on to creativity and inspiration because your team trusts you. They know that you will not throw them under the bus. And for healthcare, we are not just suspicious that somebody's going to throw us under the bus. We're pretty sure that they're going to back over us after they drove over us the first time. That's our gut instinct, right? And I think if you can create this culture with those first sets of behaviors, you can truly unleash the creativity and innovation because your team will be empowered to take risks because creativity and innovation involves sharing of yourself, and we all know, and an interprofessional interpersonal environment, sharing yourself involves risk. And so I think that creating that culture where folks can step out and say something and share their ideas or identify a deficiency, just not even waiting, don't let it fester.

We could be better here right now. I think that that's a more holistic answer. I would love to be. I have some incredible friends, Dan's one, we both know of incredible names out there that are truly stirring the pot in a good way. I'm not that person. My success has been through governance and more of that internal insurrection where you're building positive change on your own, but with relationships, and I think we need all of us. We need the pot stirs, but we also need the folks that are just there providing the burner under the pot and just always raising the temperature. We don't want to go too fast or too slow. We want to make effective change happen. And for some of us, I'm just more of a collaborator and integrator, a convener of people, but we do need those that are willing to shake the structures and change things. And I think in my own way, I've found a way to do that through technology, data and solutions. And I think we all have our own unique stamp to put on the future of healthcare.

Joni: 

Yes. Well, whatever helps you sleep at night, Josh, to not be called a pot stirrer. 

Josh: 

Well, I think we just need to embrace that, right? Because having been a data and IT leader now for a chunk of years, I am used to going before a board of directors and seeing the disappointment around a missed target or a technical challenge and understanding that it's not personal. It is the drive of these leaders to do their best work every day. And it is their drive to support you if you assume a positive posture of collaboration and you approach problem solving. I've gone into boardrooms to make impossible asks of already stressed and stretched leaders, and we've come out with the correct and the right and the best answer, and none of us saw it. Maybe some of us even had heartburn going into those meetings, but we came out and while we might not necessarily agree on the overarching plan, we know what, and everybody has agreed to the next step, and that's all it takes to do something great is take one more step towards the target. 

Joni: 

Yes, definitely. And I appreciate the analogy of sometimes being the burner under the pot as well. That's a great analogy. I tend to tell people that my leadership style is either “sheet cake leadership” or “meringue pie leadership.” Sometimes I'm smoothing, smoothing the icing, and sometimes I'm flipping it up. So sometimes I stir the pot, sometimes I'm the burner. I appreciate that analogy. I'm curious, so thinking about those things that you've mentioned, are there any governance structures that you think we need to reevaluate to support agile skill management better? Anything else that we need to think through?

Josh: 

Sure. And I'm hesitant to recommend a cookie cutter approach to this, But what we know is that when you bring in your teams, no matter what environment you're in, in healthcare, when you bring in the customer patient, consumer facing teams and you show them and make them a part of your planning and your management and your leadership from a strategic and an operations perspective, you're just going to be more effective. We know this and I think it comes back to us being the right kind of leader in that Chief Health Information role with Defense Health. I had virtual meetings with more than 120 callers on them on a monthly and sometimes biweekly basis. And the beauty of what we achieved with that is, yes, there are the 12 people with an agenda item. We have an hour and a half to accomplish it and we're going to get it done. The beauty of it was is that we were able to get to a structure and a cadence where we would typically have up to a half hour or 45 minutes left because everybody had been pre briefed, all the decision points had been previously circulated, the informed perspectives were there, and then we were actually able to move to a round robin and sometimes even some of our parking lot future state items, and most leaders would outright reject that.

I think it is risky if you haven't created the right culture because you're very liable to lose control, especially when it just involves one person needing to unmute to ruin the cadence that you have going on.

But there really is an opportunity if you create the right culture, you create a cadence, you create a professional environment, you create a collaborative, collegial, accepting environment that you can have, you can literally call for feedback from the group and you'll get the valuable 3, 4, 5 insights. You won't need to herd a hundred responses. And I think that is what I'd really like to point folks towards, which is that the answer is somewhere in the middle for sure. But unless you're going all the way down to that customer/ patient facing team, whatever your challenge is, they've probably already solved it. Find out what they're doing to work around that or mitigate the issue. 

Many of us think we have the smartest idea or the latest technology, and we think we've thought through the whole risk matrix and we've solved for it. And if we just took it down to the lunchroom on a casual pass through and identified someone and spoke with them, they would tell us how off base we are. And I think that that is literally, I mean, when I think about that, that's why you see nurses succeeding, startups that bring healthcare professionals relevant to the solution they're trying to solve, they're going to succeed because they're closest to the workflow. They're closest to the bridge of the solutions. But I do think you can't get there without introducing a certain level of familiarity and kind of tone around how we run meetings? What is the context? I wear 9, 10, 13 hats depending on the week. What's your role in this meeting? And if we can create that and people understand their opportunities to make a difference in that context, we're going to have a great meeting. We're going to move the ball forward, and as an organization, we're much more likely to succeed. 

Joni: 

I appreciate that. One of the things you mentioned earlier, Josh, was the importance of your leader in stretching you and with a big vision. I appreciate that too. I often look for a leader, whether it's in a traditional role or even a contracted role, the next leader up is super important to me. And so as we think about leaders today, I mean leadership and even as I think of nurse managers, nurse directors, those are some of the hardest roles in healthcare. I am probably a little bit biased just because of my nursing leadership experience, but they are difficult roles. And there's a lot of conversation these days about control, span of control and all of the conversations happening in nursing today, probably not enough conversations in my opinion. So I'll ask you, how do you address the challenges of leaders being swamped with direct reports and potentially losing connection with their teams? It's a very real issue. What solutions have you found effective?

Josh: 

I think this does go back to some very traditional leadership structures that business has figured out for a long time that we know. And depending on the roles I've had, I've had somewhere between 7 to 12 direct reports and up to a thousand team members delivering on information and IT projects, the kind of matrix relationships that I have in my current role are pretty much infinite. So your willingness to collaborate and collegially dialogue across whatever might come across your plate representing public health and data and the future of innovation in the context of public health for a state, I think it is remarkably humbling, but I think we can go back to, we might not be able to solve our own particular tasking because of our relationship, whatever state that's in with our supervisor or leader, but we can have direct influence on those relationships below us.

And I think I would go back to, I don't want to bore folks with cookie cutter solutions. I would go back to what is the right thing to do? And I had a privilege last year to write with Dr. Christopher Stucky around ethical reasoning as a core competency because it makes us better and more effective at strategic planning and the operational realities we face when we look at the fact that we are operating in this exceedingly complex and dynamic healthcare environment. And we need leaders of all stripes, and especially healthcare leaders and nurse leaders to step up and really have a gift around ethical reasoning engagement and their own leadership style. Because I think it's not always comfortable, but being able to be direct, have those hard conversations, say when you've been over tasked or you're not going to deliver to your own expectations around a work product or the management of a team or a strategic objective. It's absolutely huge. And our organizations and our communities will be better because of that. Because if we are that leader that steps up and kind of sounds the alarm, we can do it early enough that we can course correct versus I don't want to be famous on the front of a newspaper or a news show because of some error that snowballed over time across my organization. And too often, this failure is not a discreet technical failure or something. It's a culture and a lack of engagement that you get that gap because you've overwhelmed all the layers in your leadership and they're just trying to survive and find oxygen to make it to tomorrow. They're not delivering as a clinician, a professional, a manager, or a leader for you. And I think that's such a huge and important part. And when I think about the role models, those that I want to be like, they're able to break through that and they're able to also say, “Hey, slow down a little bit. Did you really mean the answer? You just gave me this. Can you take this additional item on?” And I think I've matured into learning how to say no because we know that we have the knowledge that it's essential to say yes quite often early in your career to succeed, to grow and to have opportunity. But I think the true sign of that maturing leader once you've been in healthcare a couple decades or more is really learning to size the ask because then that's going to drive the task for your team.

Joni: 

Agreed, agreed. Well, Josh, I'm going to switch the conversation again just a little bit. I know that you are a tech lever and a lever of all things IT. So what trends or emerging technologies are you most excited about in the field of health IT these days, and how do you see them shaping the future of healthcare or public health in your state even?

Josh: 

Sure. So thank you for that question. I think that obviously machine learning and AI are going to be right up there. We have been very effective at data and analytics for a long time, but these new tools are so exponentially more efficient that they really, we use the term “social influencers of health” in Missouri and the ability to truly have a chance to start to wrap our fingers around what has previously been pretty amorphic and hard to capture, it's going to make future responses like the COVID-19 pandemic or other health challenges we have, or I think the economic reality of healthcare today, it's going to make the fact, I firmly believe we actually have some of the tools we need to actually solve these problems, kind of the unsolvable problems from 20, 30, 40 years ago. Again, I do not have a timeline. I'm just watching my X to see when we're truly going to Mars, that kind of thing, right?

I truly love everything technology and innovation. I love it, but you can't tell me. I mean, if we're dropping rockets back out of the sky, landing them at the place that they were launched from, with all the incredible technology that takes, I know that reciprocally, we can turn around and apply those same creative approaches to what are really legacy challenges. We've got food deserts, we've got gaps in healthcare, rural and urban across the country, not just in our state. We have chances to truly look at distribution of care, whether it be for high acuity populations such as pediatric intensive care or any discreet group you want to talk about. We actually can apply these tools and solve these challenges. And I think that, again, that's very broad strokes, and I'd be happy to be cornered by anybody listening to this at any of the events I'm at over the next year.

But to me, I think there really is an opportunity for optimism that there really is a chance to not only do better, but for us to be better as a healthcare profession, as a healthcare industry, and as citizens, that ability to look out and support each other while recognizing self-determination, et cetera. Because those tools also do profound gifts to autonomy, independence, especially for groups that need support and resources. 

So again, I think this is a remarkable opportunity in the future in the next few years. We know that generations of the evolution of this are now measured in one to three years, not the typical five to 10 years. That was legacy for us, and that's only going to continue to accelerate. So it's exciting. 

And for those that were looking for a discreet solution or a specific, again, let's have that conversation at one of the events we're all at because I would love to fill your time, but I think that we know that it's out there. And our competition is a very effective consumer environment with huge players that make separating you from your money and return for a product or a service relatively painless and pretty much seamless now. And healthcare needs to be better and deliver in that same way.

Joni: 

So much potential. Josh, I love that. I love that you wear 9, 10, 11 hats. I was just talking with someone recently and they said, “Joni, it seems like you've got five or six things going on.” I was like, “Yeah, I do. You're right.” But I love that. And it seems like, Josh, that you also love to do a lot of different things, and you're a curious thinker. And so I'm curious when I find leaders like that, what drives them? What are they doing? What are they reading to sharpen themselves? Because I know that you also teach nurse executives who are currently executives and leaders. They're the movers and the shakers of the world. So what are you reading or learning about or doing these days to spur your thinking or nourish your soul?

Josh:

Well, I don't know how connected I am to my feelings. So nourishing my soul is a step too far for me personally. I don't use that terminology personally, but no, for me, I'm an insatiably curious person, and I consume media and information on an almost continuous basis. And I think the source of that is just curiosity. And it's also what we know about healthcare and what we know about data and innovation is that this is a profoundly interdisciplinary, interprofessional interconnected opportunity. And I think that everybody listening, I would encourage them to try to separate themselves from the political, social, political environment that they're swimming in. I know it's very hard, but I encourage them to try to remove themselves from the tension of that and start to see the underlying themes. I'm not telling you to betray your values. I'm not telling any individual to ignore something that they want to make a difference, and it has incredible meaning for them. Please pursue those passions, but look at your newsfeed. Look at economic data, look at technology and innovation solutions that are out there. Consume social media. I know that it's a vast wasteland, but there's a lot of incredible nuggets in there.

Don't be shy about pulling down a meme that actually has meaning for you and make it something that's not hurtful to an individual or a group of people, but make it something that inspires you from a leadership perspective, from a creative thinking perspective, and try to free yourself from your assumptions. I am profoundly aware of my assumptions, and I really do try to separate myself from how I might initially perceive, because I want to know what that person's ideas really are, and I'd like to hear it from them, and I would like to hear it as close to the original as possible. So I'm the person that in the journal article goes to the reference, and then I want to read the reference document because how many times have we gotten there and we're like, “Oh my God, I don't know if this person was breathing oxygen when they cited this reference because I got something that totally different.”

And I think it's the same thing from us. We just try to remove ourselves. And again, I know it, it's impossible to fully remove yourself, but try to remove yourself from the downhill avalanche a little bit to the point where you can objectively look left and right of you. We know there are people doing great things for our payers. We know there are people doing great things for our providers and clinicians. We know there are people doing great work who, and I just said payers, so somebody is frowning as I say this, but there are health systems and government leaders that are doing their darndest to do better with the resources we have. And I'm not saying everyone is pure of heart or a hundred percent, I do think we all have our own interests, but try to just bring as much of that into you as possible because you're going to develop themes in your own priorities and values, and you're not going to be as reflexive as a leader. You're going to be able to condense and collect and condense and analyze information in a way that allows you to see the next thing, not what's making noise right in front of you, but what by nature comes next as a leader. 

And I think that the best part about maturing as a healthcare leader is, yes, we're talking about this, but there's this incredible opportunity coming for healthcare. We are going to break free from this malaise around inflation and the current economic situation and individual professionals and leaders are going to have an opportunity to prepare for the next challenge. 

And I think that knowing that is so exciting. So I'm really focused right now on patient and consumer-activated healthcare. I'm focused on how services are being moved as close to the consumer and the patient as possible, and who's winning at that because it's not always a terribly expensive solution. And then how do we do the most good with very finite resources? I think that that is going to be the challenge of our future because baby boomers are really immersing us right now in a golden age of research and technology that the next generation is not going to have those same resources. So we have to be prepared for what's next after these folks that are investing profound sums of money on the average for longer and higher quality of years. What is next for healthcare? Because that's going to be the challenge for leaders in the years ahead.

Joni: 

Good stuff, Josh. You have several things in there that I'm going to be chewing on myself, so thank you for that. We've talked about a lot of different things today, and I would not have it any other way. As I was working on questions, I thought, “Oh, I want to talk about this. I want to talk a little bit about this.” So we've talked about democratizing the nursing workforce and compensation changing legacy systems and structures of governance growth as nurse leaders. We've thrown in some technology pieces, integrated healthcare, public healthcare, all the things. Josh, in today's episode, I love it. Ultimately, what would you like to hand off to nurse leaders in every role, in every setting today?

Josh: 

Well, and I first of all, thank you for your time. I enjoyed the conversation, but I would really love for everyone listening to this conversation to pull out some value for themself, challenge yourself, no matter what you're pursuing, to find some value in your activities because you have value to give back to all of us. And when I have a chance to sit down at events and collaborate and just engage even over a beverage with other healthcare professionals, I can always find value or synergies with that person. I can always find that, and I think that is a skillset that I would just ask everyone hearing this to consider is how can they advance their listening and their collaboration and the environments that they go into to develop those relationships? Because nurses, healthcare professionals, writ large need to get out. They need to exchange ideas and more.

So even I would say if you've had something and you have a passion, it's well known by your community, et cetera, start writing about it because that's one of my regrets is I wish I had started publishing peer reviewed content earlier. Part of it was my own personal and professional and academic evolution, because I think you do need to, most often, you need to achieve a certain level to be heard and respected. But the reality is, regardless of your level in the healthcare profession, you have valuable thoughts to share, share. And I hope to see that culture only continue to expand and we be more accepting and promoting each other towards whatever that bold future is for healthcare.

Joni: 

Exceptional handoff, Josh. So after today, I know that there are new listeners who are going to first check out your previous episode on The Handoff, but also connect with you. So as you've just encouraged us all, where can people connect with you or find you to talk about more of your work?

‍Josh: 

Sure. Well, thank you again for the conversation. Delightful. Feel free to look me up and engage with me on LinkedIn. I'm always welcoming conversations with healthcare professionals and leaders and want to collaborate about whatever matters to the community or to our incredible professionals. So I would invite your listeners to find me on X @HealthITLeader and LinkedIn where I'd welcome communication and collaboration.

Joni:

Excellent. Everyone, be sure to find Dr. Josh Wymer on X and LinkedIn to continue the conversations. Josh, thank you so much for sharing your time, energy, expertise, and passion with us today. Thank you for serving our country in all of the ways that you have and currently are serving the 6.2 million Missourians. We look forward to continuing the conversation. Thanks so much, Josh, for returning to The Handoff. Thank you.