Dan:

Sandra, welcome to The Handoff podcast.

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Sandra:

Hey, I'm happy to be here. I've been waiting to be invited to the podcast, Dan.

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Dan:

I know. It's long overdue, but season five, which we're in now is the best season. It took four seasons of warmup and figuring it out and now you're on the best season.

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Sandra:

Awesome. Happy to be here.

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Dan:

That's awesome. Sandra, we like to start off the show with what are you up to lately? What are some of the most critical topics in your mind as a dean of a large university nursing program?

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Sandra:

Not dissimilar to what's on a lot of people's minds in healthcare, is how do we recover from the pandemic in two years of working in one way? What does it look like beyond pandemic knowing that COVID isn't going away, it's just moving into a different cadence? And what does that mean for the services we provide? And in our case, as a faculty of nursing, what does that mean for learning and the quality of education and the programs that are needed for nurses moving into this next era?

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Dan:

I've been posting a lot on LinkedIn recently because I've been in these conversations about how do we get back to where we were? And I keep saying we don't want to go back. That is the worst place to go.

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Sandra:

I agree. And it's like, let's just get back to normal. Well, normal's broken, right? And I think the pandemic is showing that our normal was broken in a lot of ways. We had a faculty town hall earlier today by Zoom. And we were talking about moving back to face to face, what does that look like? It's not going to be face-to-face learning like it was two and a half years ago. And in fact, the funny thing is when we had to turn on a dime and move from lectures in classrooms in March of what was that? 2020. The students and the faculty were like, "Oh my gosh, how are we going to do this? You can't possibly learn as well in an online classroom."

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Sandra:

And literally we have students now petitioning saying that they don't want to come back to face to face. That they learned how to work and live and learn online and they really like the flexibility that that brings. So there's lessons learned here and flexibility and student centeredness that technology provides, that I think we would be missing a huge opportunity if we didn't take those learnings from the pandemic to make learning even better.

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Dan:

I think that's a great point. And yeah, I mean, I just remember even when we were working together at Arizona State and I was in the SIM Lab, and I remember looking at that pyramid of what you retain from different learning pieces. And at the top is being talked at, in this passive learning is 10%. And then for some reason we just continued to do it. And then the pandemic came in, it's like, "Oh, wait, we can deliver some of this passive content online." And really because we had to make those in-person gatherings valuable from either a clinical standpoint or a simulation standpoint because we had to. I think we set a new standard and I like your approach of let's learn from that and let's keep what worked and move in this different direction.

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Sandra:

Yeah. Absolutely.

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Dan:

So what were some of the things that you're going to keep moving forward? So coming off a conversation with your faculty, what was some of the excitement around that or maybe some of the concerns about maybe a new normal of education delivery?

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Sandra:

It's interesting because we had to learn and adapt really quickly in the pandemic to taking what was a fully planned semester face to face and quickly over a weekend put it online, which is nobody does their best work of pedagogy and teaching and learning then. But now we're a couple years into this and people have been able to tinker and try things out and say, "Well, that didn't work or maybe if I just tried it a slightly different way this next week." So we've learned a lot. And so I think we have people in our faculty that are going to continue tinkering and students who are now willing to try things out using technology a little more readily and it'll be things like using more flipped classrooms. And I know we've been talking about flipped classrooms and hybrid learning for a long time now, but I think the critical mass of people that actually understand what that can look like done well is bigger than it was pre-pandemic.

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Sandra:

The light bulbs have gone on and they've shared best practices amongst themselves around, "Oh, this is a really cool strategy for flip." And you put this passive content. [inaudible 00:04:25] I record myself doing the passive content, students can watch it five times if they need to. And then we come together in a Zoom and we have a really good conversation about what are their questions, what are the muddiest points, the clearest points and move that learning into a different sophistication than just talking at as you said. And people necessarily have had to get used to changes. I think about the number of times over the past couple years where we were all signs point to, "Hey, we're going to be back next month," only to have COVID hit another wave and they go, "Oh, sorry, no, you're going to be online for the rest of the semester. Oh, now you're going to go face to face. Oh, sorry."

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Sandra:

And there's some exhaustion in that, but there's been this ambiguity and I've used ambiguity tolerance as a phrase, as a leader and an innovator for many years. But this is a real example of people on mass developing that ambiguity tolerance where we don't know what next week's going to look like, but here's our best laid plans and we're ready to pivot if we need to. And so that nimbleness of learning and that willingness to try things and learn from them and not be scared to make a mistake from an educational perspective is something that's more front and center than it ever was before.

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Dan:

Yeah. I love that approach and being comfortable with pivoting and having some plans in case things go sideways, I think is always a good way to mitigate some of that stress. The best leaders have that outcome you're trying to achieve, which is create the best nurse or leader or deliver the best educational programming and that can drive where we're headed and then the stuff in the middle's a little messy, but you have guardrails at least in the direction you're going. And so it allows for a little bit of that tinkering and we could go deep into Everett Rogers and all kinds of stuff with that. But it's the essence of innovation, is being able to try things out in your own way and be able to adapt them to where you're headed and that'll drive adoption over time. It sounds like that's working.

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Sandra:

Yeah. And I think the other interesting thing is, to use the innovation speak, there's much more capacity and interest in scale and spread, right? So I think at least the sense that I have and in talking to the faculty and the students for that matter is let's not each one of us reinvent the wheel. We're all struggling. We all don't have enough hours in the day, not that we ever did, but there seems to be this more willingness to say, "Hey, I tried this in my class and it worked really well and here's what I think made it work. Feel free to on this, or take this and run with it." We're seeing that scale and spread of best practices and things that work in a very pragmatic way across the confines of a class, right? I just used air quotes when I said a class.

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Dan:

And we can see them.

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Sandra:

I realize you can't see. I know. You can hear it in my voice.

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Dan:

I love it. Well, and one of the adaptations I would love for you to talk about as well is you during the pandemic and even before that had the foresight to create first of its kind leadership program, the doctor of nursing degree. That's one of the first in all of Canada, I believe. Can you talk about the impetus for that program and how you think that's going to help prepare some of the leaders of the future?

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Sandra:

Absolutely. I am so excited. This has been a passion project and actually honestly something, Dan, that I have been thinking about since I returned to Canada 10 years ago, something like that. So it's going through approvals right now. It's been approved by our university and it's at the provincial government or for you Americans equivalent of state approvals, for our program approvals because it's the first of its kind. University of Toronto down east has the doctor of nursing that they launched just this past year. So it is in essence a professional applied degree at the doctoral level. So not a PhD, which tends to be more focused on educating people to be researchers and to discover and develop new knowledge. And this is more of a professional applied degree for leaders that are embedded in healthcare systems that are making use of evidence that is coming to the fore.

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Sandra:

We talked about the process of innovation scale and spread really leveraging process improvement projects and driving change through organizations. It really is that applied degree. And I would say University of Toronto, their DN is a little bit different, more broad than ours. Ours is really focused on supporting nursing and healthcare leaders that are embedded in systems that have a willingness and want to learn more about how to affect transformational change in healthcare from wherever they are. And so it's really looking at everything from who are you as a leader and an innovator to understanding the system within which you're working, understanding some of the tools and lenses of innovation and frankly healthcare business that help us to effect change, how we evaluate change, how we scale and spread change in all that situated contextually around some of the very important things in healthcare that leaders have to deal with and can't ignore.

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Sandra:

So for instance, one of the conversations we've been having is particularly around what do leaders in healthcare that are looking to make these changes, these kinds of transformational changes need to know and understand around equity, diversity and inclusion in healthcare. How do we design and create systems that get us more of what we want in terms of greater diversity, more inclusion, less healthcare disparity that we've been challenged with for so very long? Because there are particular leadership styles and practices that are better suited to address those kinds of wicked challenge than just steady state leadership and management of a system. Right? So I could go on forever.

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Sandra:

This thing is going to be amazing, great. It really represents the state of art and science of healthcare leadership. And I'm just so pleased to be able to provide this for nurses because as we know, nurses are the glue in healthcare systems. And if you want to talk transformational change in where the inflection points can be, you ask any nurse, what are the challenges here? What are the greatest opportunity and where they are situated? Given the right tools and support and mindset and education, what can't we do? Right?

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Dan:

Yeah. We can hear your passion and I love it too. I've had a chance to review some of the documents as well, and I'm excited about it because there definitely is this need. And I think it's this paradigm shift and coming out of the pandemic there's lots of... You look at Becker's Healthcare, any given day there's 50 million turnovers of the executive leaders. And it's now the time that we have a next generation of leaders step in and the next generation needs to be trained in all the things that are impacting our world right now.

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Dan:

It's not the finances in that traditional MBA that's going to add value across the C-suite anymore. It's talking about the diversity pieces. It's talking about the science of leadership, the understanding from other industries about how change occurs and why innovation happens and how to lead that. And all of those factors that just seem to be missing from what I'll call the old school leadership dogma. And so I'm really excited to see more and more of these programs pop up to create the leaders that are prepared for these complex systems moving forward.

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Sandra:

Yeah. Absolutely. And I think we've had some ability to test out some of these concepts and like you say, the new lens of how to lead in these systems. We actually have a master's program that has graduate certificates that can stack towards a course-based masters. And one of those certificates is a four-course series in transformational health leadership at the master's level. And that in itself, we've delivered it now for three years in a row. So we have a cohort of these freshly minted and enthusiastic nurse leaders that are themselves embedded in various parts of the healthcare system and numerous healthcare systems. And just to see within their own little spheres of influence in their clinical areas or wherever in the world they are, the small tests of change that is palpable, that they are able to make and bringing their colleagues along and changing the dialogue around what's important and what to focus on in order to make change and to make change that is sustainable and gets better outcomes, is just amazing. So we're just amplifying that to the next level. So it's really exciting.

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Dan:

That's great. Yeah. And I think that it's a pipeline of all levels and what really drove me through my degree programs was that passion around that content and realizing that it's a special skill and a special sauce that if you go through some of these more innovative programs, there's really nothing that's impossible. I like that. I think, and we've talked about this too, it's like join the matrix. You can choose and go through the world and be that accountant and just sit there and have your eyes closed to everything or you can see the code behind how all this stuff works. And when you see the code, you can change things differently. And I think that's the exciting piece of it.

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Sandra:

And we often talk about this, with students that have gone through that program and they're out now making change and the comment is you can't unsee it, right? Once you see it, you can't unsee it and you're forever changed in how you think about how you go through the world as a nurse and as an innovator and a leader. And I think that is really cool. And the other interesting thing that I think is often a barrier, and this goes back to that old school dogma of leadership and again I'm using air quotes, is so many nurses come to our graduate program thinking, "Well, I'm not a leader because I don't have a title of unit manager or I don't have a title of director or whatever else."

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Sandra:

And one of the first conversations we have is that, "No, you are a leader wherever you are, and whatever your title is in healthcare, because you're a nurse and you have that agency to make change on behalf of your patients and those you work with." And we do some activities to get them to realize, "Wow, I don't have to have a title to be a leader and make change." And it's almost like you give them this imaginary license to make change. And just to see the opportunities that folks that... Floor nurse or clinical instructor or whomever it is that doesn't have a title as leader, but if they in their own mind legitimize themselves to say, "Hey, I know some stuff and I want to try this out and I see how I can make an impact," it is so cool to see this change emerge in a grassroot way.

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Dan:

Mm-hmm (affirmative). Yeah. And our mutual colleague, Kathy Mallek, who will be on the show this season as well said, "Sometimes it's just saying it's okay." And hearing that as a student or as a leader to say, "It's okay. Yes, go try it," and just that simple permission opens up the world to, "Oh, yeah. Well, maybe I can." And you just see that light bulb. And I think that's what I really enjoy both with the master's innovation students, the DN student, and everyone who's become a student of leadership to have that light bulb go off that you have the tools to do anything you want. You don't have to wait for some magical executive to come in and give permission. You have the tools yourself.

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Sandra:

Yeah. Yeah.

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Dan:

One of the things that you and I have worked very closely on is obviously our book, Leadership for Evidence-Based Innovation and Health Professions. And one of the reasons we wrote that was because we couldn't find any book out there that talked about the stuff that we felt mattered. As we're looking at leadership and the evolution of leadership and systems, what are some of those key themes that our listeners should be thinking about that differentiate the future of leadership from what they may have heard or thought about leadership in the past?

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Sandra:

Yeah. And I've been thinking about this a lot, we're in our second edition now and I suspect we're going to get a tap on the shoulder saying how about a third? So I've been thinking about what are those things that we would want to add or emphasize? And Dan, one of the things that I keep coming back to is in old school leadership and how healthcare works, it's all around that 20th century brick and mortar hierarchy, going back to what we just talked about, that you have to have a title to be legitimized as a leader to make change or somehow endorse things to happen in an organization. And I'm fond about this and this is the lens that I see the world through is really that relational aspect of leadership, that it's not around the brick and mortar and the hierarchy and the command and control.

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Sandra:

If you take a different metaphor, so that metaphor that we've been working in, in the hundreds of years has been this organization as a machine where it's just chugging along and we're all cogs in this big machine and switch out this cog for that cog and it doesn't make any difference, we just keep going, the inputs, the outputs, blah, blah, blah. We're all very habituated into that way of being and thinking and even talking in the world. And when you change that metaphor to organization as an ongoing conversation, different possibilities open themselves up to you and different ways of being and different inflection points show themselves.

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Sandra:

The big focus I think is getting more on relational leadership rather than traditional top down style leadership. In a human endeavor like healthcare where we are charged with providing the best quality care to people at very difficult, critical times in their lives, we darn well better be a relationally astute to have that happen. And even more so leaders of those systems need to have that relational capacity to make the systems do what they need to do in the service of humanity quite basically.

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Dan:

Yeah. That relational piece is very timely at a time where we're seeing our nursing profession vote with their feet and really around their interactions with leaders. They won't stick around for teams that don't respect them, value them. I think now more than ever you got to have leadership skill to keep people, or we're seeing hospitals close, go bankrupt, be completely short-staffed because they don't know how to treat people like people and lead in the new way. So I think that's key.

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Sandra:

And I heard, this is years ago and I think it was when I was doing my doctoral program in leadership. And one of my professors said, "People don't leave organizations. They leave leaders." And I've never forgotten that. And I keep coming back to that and it's that relational capacity as a leader to create a culture of valuing, of supporting and empowering people with good ideas or people that see problems that have a solution to say, "Yeah, try it out. It's okay. By you doing this, we're not going to be worse off. We're going to get closer to being better. So do it." Right?

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Sandra:

And I think same thing especially with the pandemic. Nurse, healthcare practitioner, provider burnout has never been higher because of what we've been through these last two years. And the relational capacity that leaders and the relational currency, if you are a leader that leads in a relational way that can empower your staff, make them feel safe, make them feel supported and part of something that is bigger than themselves where they can see change happening for themselves and our patients in a way that is energizing, that's what healthcare provider nurses are flocking to. And when it's not there, they leave.

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Dan:

That's exactly right. That's a great point. A lot of our listeners are frontline nurses, either travel nurses or nurses taking care of patients in every setting you can imagine. What's some advice for them? I think I talk to a lot of them, both on social media as well as in my various roles and things about... They feel like they're not leaders unless they have that title or they don't have that degree behind their name, but nurses lead with their behaviors and things. But what are some advice for the frontline nurses who say, "Well, I'm not really there. I'm not really a leader. I just do what I'm told. I show up to my shift"? What's some advice for them to own their leadership skills no matter where they are?

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Sandra:

Something that I keep going back to is start with your passion. Start with something that fires that part of you where you go, "Huh, there's got to be a better way or this specialty that I work in, I'm so passionate about this patient population or this group of people that I want to build to help more. And if we only did X." If you're having those kinds of thoughts and those kinds of emotions where you're just... Something in your day-to-day work that you get intensely passionate about, you could say, "If only if," focus on that, harness on that, move in that direction and then start talking to people. Again, think about an organization as a conversation.

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Sandra:

And you think about who is around you that might think the way you think and have the similar passions or interests that you have. And leadership and organizational change movements can start over a conversation in the lunchroom to say, "I was noticing today, this happened in the course of patient care and wouldn't it be great if." And you say that, and then somebody else says, "Yeah." And before you know it, you have this conspiracy of like-minded individuals that have passion in a certain direction, that can synergize together and bolster each other and encourage each other along the way. And eventually you're going to find a manager or an educator or somebody else in the organizational ecosystem that's going to go, "Yeah, I totally hear you." And you'll have that champion and you can move it forward. So that's a long-winded answer to say move in the direction of your passion.

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Dan:

Yeah. And I think you and I both in our careers have a lot of stories around that too. I remember just raising my hand in nursing school to go learn about simulation. I had no idea what these mannequins were or what could happen there, or really no idea. Just sounded interesting and rose my hand and spent two weeks in a closet with SimMan, learning how to program him. And that turned into a 45,000 foot SIM Center that delivers 70,000 hours of simulation every year. And it's like that one moment of just saying that sounds interesting, I'd love to learn more turned into something that was career defining for me. And similar things, the negative experiences too also are places to lead.

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Dan:

And I have had managers in the ER say, "We're over budget. You need to use less gauze." And just being like, "Are you kidding me? Is that really the solution they came up with?" With all this time to be in meetings, they are like, "To use less gauze. That'll change our financial situation." And really thinking there's more to this, leaders can be better. And so that passion drove me into formal programs and mentorship around leadership. And it's like, you just got to find those moments that either excite you or irk the heck out of you and turn that into something to go do the next step.

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Sandra:

Yeah. Absolutely agree. Yeah. And again, when something irks you, if you have an example of what not to do as a leader that you're confronted by, there's passion behind that, right? Because there's that emotion where you're like, "Oh, I'm not going to do that given the chance. Or if I was that leader I'm not going to behave that way." Those are important moments too as you just alluded to. And so looking at what fires strong emotion in you, positive or negative and taking note of that and navigating in that way to either be a part of the solution or for heaven's sake, not perpetuating the issue, the challenge. Right?

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Dan:

Yeah. And those experiences I think drove a lot of what's in our book too, chapter 13 specifically, I think.

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Sandra:

It's so interesting though, because when you use these and we both through our hats as educators, we use the book in graduate education and it's always interesting every year when students read those chapters. It resonates with them because it's true to life. Well, we do have the theory into science and leadership, but it's also informed by our lived experience within healthcare organizations and educational organizations. And so it always amazes me how it resonates with people when they read it and they go, "Yeah, I could really see myself and I could think of examples when similar things happen to me." So that's just always really interesting to see for me.

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Dan:

Yeah. And giving language to things like toxic leadership and complexity leaders. These are all things that people hear. Complex systems are like, "Oh, yeah, healthcare is complex." But to pull back the covers and really see what's there, I think it's like you said, you can't unsee it and it just allows you to just see the world differently. I know we could talk forever, Sandra, but one thing we do would like to end on is really talking about that one nugget of information that you'd like to hand off to our audience, that one key message to inspire our listeners into next steps to become the innovation leaders and the healthcare leaders of the future.

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Sandra:

Okay. So this is going to be maybe corny, but I really take it to heart. And I'm reminded of a quote that has steered me through my career and it's a quote from Gandhi and that is be the change you wish to see in the world. And that's what it is. And it's move in that direction of that passion, be the change, be that leader that you wish you had, and it will be fulfilling to you because you're moving in your direction of passion and it will motivate those around you and lift them up as well.

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Dan:

Yeah. I think that's the big piece, is the future's not written and we can write it. And I think that's the most hopeful thing we can cling onto as we move through a pandemic and into the future to fix healthcare and nurses are positioned very well to be those leaders, to build the future that we want to see for ourselves, our profession and our patients. So Sandra, thank you so much for being on the show. If people would like to reach out or learn more about the programs at University of Calgary and your work, where's the best place to find you?

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Sandra:

You know what? You can go to our website. So if you search University of Calgary faculty of nursing, you can go to our graduate program page and you will see all of our graduate offerings there. And right now there's a coming soon I think doctor of nursing. There will be more up there in the next coming months. We're hoping to have our first inaugural class in January of 2023. So more information coming to a website near you soon.

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Dan:

Awesome. We'll make sure we get those links up in the show notes as well. And Sandra, thank you so much for being on the show. It's always awesome to chat with you and thank you for leading forward in an artful and scientific way that you do.

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Sandra:

Thanks, Dan. Always great to chat.

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