Making A Difference Through Nursing Leadership Development at Texas Children's Hospital

As one of the largest children’s hospitals in the U.S.—ranked nationally in 10 pediatric specialties—Texas Children’s Hospital has become a leader in maternal child health. Every year our Pavilion for Women performs 7,000 deliveries, over 25,000 surgeries, and provides emergency care to more than 113,000 patients.  And with over 9,000 employees and 3,000 affiliated providers, we are among an esteemed group of healthcare organizations awarded designated ANCC Magnet status—the most prestigious distinction a healthcare organization can receive from the American Nursing Association that recognizes nursing excellence and quality patient outcomes.
What we see today at Texas Children’s—exponential growth with a focus on achieving excellence—began more than 25 years ago with the arrival of Mark Wallace, our current CEO. Since 1989, he has made leadership and leadership development an everyday priority, building and sustaining a culture driven by leadership maxims that are all fully consistent with The Leadership Challenge and that define the importance and contribution of leadership to achieving both personal and organizational outcomes.  

Leadership applies to everyone, a winning attitude is key, and a strong work ethic is essential

Since 2013, Texas Children’s has been continuing the push to sustain a culture of leadership with one initiative in particular—a program focused on bringing nurse leaders closer to the care of patients and families and increasing the number of nurses at the bedside. And in a health system of over 2,500 Registered Nurses and over 200 Advance Practice Nurses, implementing the changes needed to accomplish these outcomes has been a team sport. From the start, our Director of Organizational Development, Jim Smalley, PhD, has worked in partnership with the hospital and nursing leadership team to create the structures and processes needed to select the right candidates for the frontline leadership positions and to prepare them for their transition into one of the most difficult manager roles in healthcare. I joined the team only recently, as we began rolling out the frontline leadership model across the system, and it was immediately apparent that The Five Practices of Exemplary Leadership® model had been integrated into a number of key components. Among the most notable have been the following:  

System-wide nursing summit and strategic planning sessions. Led by our Chief Nursing Officer (CNO), each of these sessions embodied the Practice of Inspiring a Shared Vision as leaders and staff from across the system came together to begin forging a vision and formulating plans of action with shared goals, key drivers, and interventions. Together they envisioned the future and set the stage for nursing leadership and clinical bedside nurses to strengthen the delivery of care to patients and their families.  The CNO inspired the entire team to challenge current structures and processes to achieve system goals.

Restructured frontline bedside management. Texas Children’s leadership development program had many facets but the primary goal was to restructure frontline bedside nursing management.  The important role of the Patient Care Manager was created at the unit level and staff was restructured to include a mix of experienced clinicians and managers.  A robust training and development program provided critical support for this group and was heavily influenced by the belief that all nurses are leaders and that developing leadership skills among clinicians as well as managers was key to our success.  Leadership competencies, consistent with The Leadership Challenge, were subsequently hardwired into the performance evaluation structure to help ensure broad application of The Five Practices across the organization. 

Bedside Fridays. Role modeled and initiated by all nurse leaders, Bedside Fridays grew from the second overall goal of  our leadership development initiative: to increase the visibility of nurse leaders at all levels and increase the frequency of their interactions with direct patient care, and frontline staff and leaders.  Off with business dress and on with scrubs and sneakers.  Fridays are now reserved as rounding days, with regularly scheduled meetings only occurring on other days of the week. The presence of nurse leaders in the bedside patient care areas fosters collaboration by building trust between leaders and staff—exemplifying the Practices of Enabling Others to Act and Modeling the Way as they set the example by aligning actions with key values.  More than making rounds, the presence of nurse leaders provides an opportunity for them to see first-hand  nurses in their element and functioning as part of a team— living out the nursing process in action.  

Interactive coaching sessions with frontline managers. During the initial launch phase of the program, frontline managers participated in Language of Leadership sessions, held over a four-week period as part of the preparation for our annual team member satisfaction and engagement survey. Held in roundtable fashion, 15-20 managers came together to practice formulating data-based descriptions of their unit’s accomplishments related to staffing, hiring, turnover, and unit-based outcomes. 

Three thank yous.  We also introduced the concept of three thank yous, which embodied the Practice of Encourage the Heart. Because genuine appreciation and personal recognition are critical to leadership success, managers continue to be encouraged to thank a nursing team member at least three times when delegating a specific task or function: when they accept the task, when they're doing the task, and after the task is completed. For example, when census peaks and patient care demand exceeds the number of nurses scheduled, asking staff to work overtime or asking part-time staff to pick up extra shifts is a customary strategy.  Patient care managers are encouraged to thank the nurse when they accept the extra shift assignment, thank them again during the actual shift, and sometime later, usually the next time the nurse is on shift, the manager is encouraged to thank them again.  This third thank you may come at a time when the extra shift is “ancient history” to the manager and there may have been numerous other staffing issues raised and solved in the meanwhile.  But to the individual returning to work, it’s likely a fresh memory.  Sincere appreciation not only acknowledges team member contributions, it Models the Way for team members to Encourage the Heart of everyone they come in contact with and delegate to in the course of their patient care shifts.   

We are continuing to look for ways to more fully integrate The Five Practices and the Leadership Practices Inventory® as we move forward in expanding our frontline nursing leadership programs. With the full support and dedication of our entire leadership team, we are committed to working together to enable everyone on the staff of Texas Children’s to continue the extraordinary work of caring for children and their families. 

Richard A. Ridge, RN, MBA, PhD is Director of Nursing Innovation and Outcomes for Texas Children’s Hospital. He has published and presented nationally on topics such as nursing professional and leadership development, nursing workforce planning, systems thinking, patient safety, clinical outcomes, professional boundaries, and strategic planning.  An Adjunct Clinical Professor in the University of Texas Health Science Center’s School of Nursing in Houston, Texas, Richard can be reached at raridge@texaschildrens.org.  

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