Coffee Break - Dina Dent

EP 26: Guide to Nurse-Physician Partnerships for Change

Summary: 

The impact of solid nurse-physician relationships on leadership success and cultural evolution in hospitals is pivotal.

In this episode, Dina Dent, Chief Nursing Officer at Inova Fairfax Medical Campus, brings her wealth of experience and prominence in fostering nurse-physician partnerships to lead with empathy, collaborate effectively, and drive a culture change within the healthcare space. Dina uncovers the strategies she employed to build robust relationships, including her innovative “donuts with Dina” sessions, mission rounds, and town halls that engage and recognize staff, even as they answer a staggering thousand questions monthly. She delves into the triad service line model, where 10 service lines of CNOs, vice presidents of nursing, and physicians come together in a matrix structure to sustain growth and propel development. Renee and Dina discuss the expansion plans for the healthy work culture initiative and why the involvement of leaders at all levels is crucial to success.

Tune in as this episode offers a glimpse into the importance of diversity in thought and the evolving face of healthcare operations.

About Dina Dent:

Dr. Dent is a Nurse Executive with 26 years of experience in broad administrative, operations, lean methodology, and clinical experience. Her experience includes Public Safety-Net, large Academic Medical Centers and Community Hospitals. She has led strategic business planning to drive organizational success and achieve goals through demonstrated expertise by developing and implementing facility safety policies and procedures while maintaining compliance with regulatory guidelines. 

Dr. Dent has experience as a faculty instructor and consultant at Mississippi College and Kennesaw State University. She was an Ethics guest lecturer at Our Lady of the Lake University. Her dedication to improving patient care and cultivating a collaborative environment quickly propelled her into leadership roles. 

Dr. Dent is currently the Chief Nursing Officer of Inova Fairfax Medical Campus in Fairfax, Virginia, where she leads nursing operations for the largest hospital in Northern Virginia. In this capacity, she is responsible for shaping the organization’s nursing strategy and ensuring the highest standards of quality patient care. 

Dr. Dent has a Doctor of Nursing Practice from the Southeastern University of Louisiana, a Master of Science in Nursing degree from the University of West Georgia, and a Bachelor of Science in Nursing from Norfolk State University. She is a Board-Certified Advanced Nurse Executive through AACN and is active in several nursing and executive organizations. 

When not immersed in the world of clinical nursing operations, Dr. Dent enjoys reading, vacationing, and spending time with her family and friends.

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Renee Thompson:
Plants thrive and grow in a peaceful, nourished environment, right? Well, it's the same with human beings. But what if that environment is not so peaceful? What if it's toxic? Welcome to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. In this podcast, you'll get practical, evidence-based strategies to help you cultivate and sustain a healthy and respectful work culture by tackling an age-old problem in healthcare: bullying and incivility. I am your host, Doctor Renee Thompson.

Renee Thompson:
Hi everyone. Welcome back to the Coffee Break podcast. Wherever you are, whether you're listening or you're watching, I hope you're having a really great week and that you're making progress on improving your work culture. Okay, what if you're the manager of, say, an ICU? You know that you're responsible for your culture, but what if you're the chief nursing officer of an entire humongous hospital? How do you cultivate a healthy work culture across a large healthcare organization? And today, we're going to talk to Doctor Dina Dent, who has done just that. So, Dina, welcome to the Coffee Break podcast.

Dina Dent:
Oh. Thanks, Renee. Doctor Thompson, such a pleasure to see you. Thank you for asking me to be a part of this Healthy Workforce podcast. It has been very intricate and our strategy for Inova Health System and Inova Fairfax. So, I appreciate being on this.

Renee Thompson:
The feeling's mutual. So Dina and I have been doing some work together for the last couple of years at Inova Fairfax Hospital, really working with the departments, helping them to cultivate and sustain a healthy work culture by addressing disruptive behaviors. And we've had amazing successes there that we're actually spreading this across all of Inova. And to tell you a little bit more about Dina. Dr. Dina Den is a nurse executive with more than 26 years of experience, and she's done a lot of different things. She's worked in these big academic organizations, she's worked in small community organizations, and she's also been faculty, which I think is really awesome because I've done some faculty work myself. And it's about making sure that we're equipping the future nurses and other healthcare professionals. So I love that about Dina. She's currently the chief nursing officer at Inova Fairfax Medical Campus in Fairfax, Virginia, where she leads nursing operations for the largest hospital in Northern Virginia. And when not immersed in the world of clinical nursing operations, Dina enjoys reading. Me too. Vacationing. Me too. And spending time with her family and friends. Me too, me too, me too. So we have a lot in common, Dina. First of all, can you just tell our listeners a little bit about your journey? Because, as I said, you've done a lot of different things. How did you end up the Chief nursing officer at what is the Fairfax? You have 1000 beds, or I think it might be more than that.

Dina Dent:
We have 1000 beds, a thousand-bed hospital. Yes, and very high number of ambulatory outpatient centers also.

Renee Thompson:
So, how did you get to that role? And if you want to then talk a little bit about your journey towards a healthy work culture at Inova Fairfax.

Dina Dent:
Sure, sure. I started out as a CNA. I was a home health aide, a CNA, and during school, I'll just share my trajectory. A lot of people. What made you become a nurse? What made you become a nurse? I actually thought I was going to be a psychiatrist at one time and thought about teaching. And then my grandmother had a stroke, and I really saw the impact that the nursing care had on us as a family, not just on the care of my grandmother. So, that kind of stuck with me throughout. So I went to school, college, undergrad here, Hampton University and Norfolk State and Southern Virginia, and received my associate's degree and bachelor's degree. And my first job was a surgical step-down unit after working as an extern or a nurse tech. And I encourage all that are going into nursing school want to be a nurse? Be a tech because it really helps you understand collaboration and how teamwork and survival around teamwork is. If you've had that experience, so did that for a few years. First worked surgical step down in Sentara Norfolk General Hospital, moved to Atlanta, and worked at Emory Hospital and Telemetry. I was a telemetry nurse first and then did some med surge, did a little float, went to grad school, thought I wanted to be a nurse practitioner, went into critical care, worked at ICU for a few years, did a little bit of emergency department and then started the rapid response team.

Dina Dent:
If you remember, that was back when the IOM mandated that we had to have some form of rapid response and was tapped by my chief nurse at the time and was like, we need this. And I'm like, okay, started that and switched from nurse practitioner to leadership because I started to like it. It's not something you really understand or know what; as a bedside nurse, it's not an attractive position to see your manager working 16, 18 hours a day. And that years ago, you didn't really know that a chief nurse was or the executive leadership at that time. It just wasn't the culture. So really started to enjoy that. And I had a mentor, and I encourage all mentorship is very important to have one to be a mentee and a mentor lifelong. It's a lifelong journey, and went to grad school and stayed on a nurse leadership track my first job after the establishment of the Rapid Response Team was a manager on a renal telemetry dialysis unit, and that was right after Katrina in Georgia. So that's when you really understand social determinants of health or social drivers of health, right? Even before it was a term, the impact of preventive health care and disaster care and the community care example and preventive health went through that journey escalated, worked at Grady Hospital system as the unit director of a medical ICU there.

Dina Dent:
And that was my first encounter with the diet relationship. The medical director, unit director, diet care, and how you lead a department and get buy-in from a group of baby residents and a group of new grads taking care of the most complex patients in the community. I had bumps and bruises on what that communication looks like and how to make sure. Yeah, how to make sure you don't forget to include someone in the conversation and understanding the role that infection prevention plays and regulatory and all of those areas and IT and technology and how learners learn. So, in an academic facility, you can have chaplaincy, residency, physical therapy, residency, pharmacy, physicians. And these are all learners understanding and trying to relate to each other from a multidisciplinary pace. So enjoyed that. It was just extraordinary. So, I was recruited by a search firm for a position for a director of critical care and emergency services at Christie's Health. Now, Renee, I thought I could save the world if I can be over ed and critical care. I can. This world peace thought it was the perfect position for me. Wasn't that familiar with Louisiana? I thought it was a perfect position for me, wasn't as familiar with Louisiana, but came to love crawfish, and my taste for seasoning has definitely changed.

Renee Thompson:
The salt is better, right?

Dina Dent:
Oh, definitely had to really increase working out and looking at other opportunities because the food was just extraordinary. So went through. That was a very challenging cultural experience. I am an African American woman from the South, originally from the North, then coming from an academic facility and thinking I can change the dynamics in the communication of emergency services and critical care. I had a few bumps and bruises, right? Really. And it all boils down. It boils down to communication. Understanding people's backgrounds. Taking the time. I think that's really when I embrace how important the 1 to 1 conversation is. The meet and greet.

Renee Thompson:
So it almost sounds.

Dina Dent:
Because when you.

Renee Thompson:
Went in and said, I'm gonna save this place; I'm this is going to be great. This is going to be my legacy. It's all going to be. And then you realize that there are people who have been in their roles in that organization for a really long time, and we had somebody else as a guest who talked about, you have to know who your key stakeholders are.

Dina Dent:
Definitely.

Renee Thompson:
And start with them first and build a relationship with them first. Absolutely. And I know myself when I've been new in an organization, I come in, and I think I'm going to make it better and raw. And then I realize, oh, wait a minute, not so easy, and you have to get that buy in. Yeah, and even with that, you have a little bumps and bruises along the way, but you don't. I think retrospect, if you would have done that, it's all lessons learned. You always been retrospective. You look at it and say, okay, if I could do that over again, what would I do? And that serves to help you the next time you're in that situation.

Dina Dent:
Absolutely. Because, of course, I was in it again. I mean, that's just how.

Renee Thompson:
Yes, you were.

Dina Dent:
But along with the key stakeholders, also learned building the relationships with the informal leaders because sometimes they have the they have the loudest voice, right? They really can move and really own change management on different levels of the organization. And that's not always encompassing of your cohort of just nursing, right? You have to look at the multidisciplinary teams, enjoyed that experience, grew into an executive director of operations, and that allowed me to understand professional services a little bit more. As that role expanded with nursing, but into respiratory and behavioral health, pediatrics, lab services, outpatient, ambulatory, those relate, and that was, and they were, new spaces for me. My learning from the importance of that 1 to 1 really came in handy there. And that's when you really understand how to meet goals and metrics, and KPIs from a collaborative approach. Right? So, meeting metrics is not just a one-man band; it is a group. And really you're leading as an executive sponsor. But the team drives the engagement for the outcome.

Renee Thompson:
And more and more what I'm reading out there and what we're doing as an organization at the Health and Workforce Institute is we're looking at the interprofessional team, the collaboration, and we've learned along the way, too. I actually have an article coming out. By the time this airs, it'll be out, but it's about breaking the silos in healthcare. We're still so siloed, and we catch ourselves like, oh, wait a minute, this is just for nursing. No, this needs to be everyone and to know. And one thing you said, Dina, is so important. It's not just those former formal leaders; it's the informal ones. And sometimes, it's the informal ones who they may not be a nurse; they may be a tech or.

Dina Dent:
Yes, definitely.

Renee Thompson:
Role, but they have power. And if you can get to know who those people are and build a collaborative relationship with those people, it makes everything else easier.

Dina Dent:
Totally agree. Totally agree. You have your unit secretaries that actually are the air traffic controllers of a unit or a department. Really, when you want your questions, go right to them. And everyone does the families, the doctors, you're going to the unit secretary. So there are layers of people. You have conversations with the parking attendant. You would be amazed at the ideas that are out there on how we can improve. That journey transcended into I moved to Arlington Lake Hospital in Baton Rouge and they were magnet trauma organization went for ADP role initially over critical care medicine or ED and med surge and then went to a vice president role vice president of nursing, a Catholic healthcare system. And so was Chris Health. So really understanding the servant leadership aspect, I believe, is key. And it definitely has stuck with me that my role is really to serve and support. Is to remove barriers and help you understand and grow and develop into how you can move those barriers yourself. I'm appreciative of that experience and that logic in the culture of Catholic healthcare.

Renee Thompson:
And it is really about serving. And sometimes I'll even write this in my journal, my daily journal. Who am I going to serve today? Who do I want to serve today? You. When you think about, you serve a lot of different people, but who do I really want to make sure I'm serving today? And sometimes, it's one of my clients, sometimes someone on my team. What? Other times it's my family because I have some family member who needs extra love from me, extra attention from me. And just to be thoughtful about that as a leader is important because it also reminds you that even though you have all these tasks that you have to get done every day and meetings that you have to go to, what's most important is the people who are serving.

Dina Dent:
Definitely true. You do have to take all of the learnings from different cultures along with the servant leadership. No margin, no mission.

Renee Thompson:
Right.

Dina Dent:
So, the operational aspect of the job is very key to being able to be successful, operationalize, and to encourage and support, and promote. Spent about six years. Received my doctorate while in Louisiana and then went to Texas and was the Chief Nursing Officer at GPS Health System.

Renee Thompson:
I didn't know that.

Dina Dent:
In Dallas.

Renee Thompson:
Texas. I love Dallas; I have brothers in Dallas. It's a great place.

Dina Dent:
Yeah, yeah. And that different different challenges. I say tell everybody different zip code.

Renee Thompson:
You mentioned the same.

Dina Dent:
But again they're on Covid, so. COVID changed whatever you thought was your leadership style, you had to learn how to be very contingent to it there. During that time, there was directives or mindfulness around how to be supportive and compassionate. So, there was the contingency leadership definitely pushed you forward during COVID and I think. It also challenged us with how we went to virtual so much, and a lot of us lost that, even almost the ability to have that in person and how to react differently in person, you go to. 100% of in-person meetings to 100% of virtual meetings. In 90 days.

Renee Thompson:
Oh my gosh.

Dina Dent:
Yeah, yeah, it is whiplash. Yeah. And we're now going back to what hybrid looks like at that point. So had a very extraordinary experience at that organization. Very large trauma program. And it really helped me add to my learnings from before around the relationship-based caring, really started to more empower the departments and the units and encourage of what the 1 to 1 looks like. So, we all learn from our student principles, right? That can all speak them. We know every single standard when it comes to and whether your organization uses them or not. You have encountered pseudo principles. The importance of the 30, 60, 90 check-in, the 1 to 1 and the rounding, the visibility. And that became very much more apparent during Covid, right, that your teams needed to see you. There was no way you were going to drive change and support from your office. It just didn't work like that.

Renee Thompson:
How difficult was that during this global pandemic to, especially because a lot of leadership roles? There were some that you had to be in the hospital because if you're a line manager, you're there. But it's you weren't there was the if I have an opportunity to stay home and do my work. Hey as a human being were designed. The default is to make it as easy for us as possible. If it's for me to actually get up, get ready, drive into work, walk into a facility that is rampant with COVID to attend a meeting, versus staying at home sitting in my jammies with a nice top on.

Dina Dent:
Yeah.

Renee Thompson:
But to your point, Dina, especially the front line during that time, they needed to see their executive leaders. They needed to see their senior leadership, their present that they were, because we said, oh, we're in it together. Well, not if you're having all of your meetings at home on teams with Zoom and lessons learned, great lessons learned. Yeah.

Dina Dent:
Yeah. There were some that when we were challenged with space that absolutely we needed you to work from home. There were some departments where your remote type of departments, please, we need the space and can't be up under each other anymore in the cubicle doesn't work. But as you start to lift, you start to realize not having that diversity of thought in the same room became more challenging when decisions needed to be made. And through all of that, I absolutely have been blessed with good team, a good team, good partners, good colleagues, and especially now where I am in Inova Health System. I think Inova leads the way, and really, I've worked at other organizations that attempted the service line model, and I'll talk about that a little bit and what triad and diet leadership looks like now. We are not perfect, but we acknowledge the journey, and we continue to grow. So we're very heavily matrix me as the chief nurse officer. I don't have one job, one title, just nursing. It doesn't work like that. I have a group that I work then we support each other, and we lead together.

Dina Dent:
I have a very active and engaged Rishi Garg, CMO. Unbelievable. Really. We call each other. This is my partner in crime. We are. Common goals around quality patient experience the regulatory. COO, Trish Schmehl, is also a nurse, the best operator I've had the opportunity to work with, just extremely compassionate and really could do a Ted talk on how to manage up someone. I definitely learned from her and our president Steve Narang is the most humble president I've ever worked with. Just owns humility. I am never alone from the day I started here. I can go on a unit apartment and around and have conversations by myself, but there are three people that will speak the same language and have the same thought process. So I don't have those other challenges that I've had in the past or other organizations, I'm sure have been through those challenges. I have an extremely supportive team, so it's definitely we and us. It's not I. Now there's a few things that I definitely put in place around visibility as it relates to my role when I call Donuts with Dina. And it's just so.

Renee Thompson:
You talk a little bit about that, and then I actually want to circle back and talk a little bit about your triad model because, okay, I experienced that when I was on site doing work, and we'll talk about that. But please tell us about Donuts with Dina first.

Dina Dent:
All right, I'll go back. So, donuts with Dina really started. We have about 40 off-site campuses around ICS ambulatory outpatient where Fairfax proper nurses work and very hard to the bandwidth. My helicopter doesn't know it's not running right now. So, for me so I so the focus areas was really the donuts with Dina on a consistent basis to the best of my ability on the outpatient ambulatory areas; they generally start at 7 or 8 a.m.. We have donuts. Just sit in a circle. I tell them about me; my experience. I talk about new things that's going on in the organization, and then I want to know about them very much. Listening. Take some things back on opportunity to do better, but I really take the time to recognize who what, who's doing a great job. Who do you think you can't work without? And I just think that's great. I've learned so much. We have nurses that used to be veterinarians and they work for the military. It's just a gemologist, you name it. You learn so much about people and their passion, and their backgrounds with the donuts with Dina. So also incorporate that on our inpatient side depending. So I switched a little bit for inpatient because it's a little more challenging because the 24-hour responsibility.

Dina Dent:
But we have mission rounds that we do every Thursday. And we do that with the team, our senior operations team, and our the entire team. We split out, and we do two different units. We have our AVP of finance that goes with this. Our HR Jeff Pratt goes, our president Rishi and Trish, that I mentioned, and we split. One goes to one unit, and we just go over their data before we get there. Recognize them for great outcomes. Speak about trajectories, tell them they're doing a great job, and then listen. What do we think the next safety event might occur, or what can we do differently? And it's extraordinary. So very consistent with that. We also have listening sessions that yeah listening sessions we choose different. We do about 3 or 4 a month, and we're now hybrid half a virtual half or in person depending on the unit and department. And again, it's time to recognize we highlight some team members might read a letter. Of course, you're very familiar with Daisy Awards and Peace Awards. Definitely make sure that's done. That's very consistent. And we have town halls.

Dina Dent:
We have over 400, sometimes 600 people on our town halls.

Renee Thompson:
Wow.

Dina Dent:
It's very hard. Yeah. Average about 600. And it's again our senior operations team. Of course, I have been a nursing part. Trish has operations, and we give updates. But the most part is the opportunity for them to ask questions. And it's over a thousand questions in every month. About three days later, we go through all the questions, disperse them out and we answer them. So they're on the Anova net. So you can go and read the questions and the answers. So, we want to make sure we're closing the loop. We also have empower 180. And that's every Wednesday for three hours. No meetings. And yay, it's been successful. We've been doing it over a year and a half now. A lot of organizations try it. It doesn't work. And but we have been consistent. Expectation is you're out on your departments and your units, and you're having one-to-ones. You're engaging with your teams. Rishi and our around on our healthy workforce units during empower 180. So that's just extreme visibility at that point. So that's just a few things that we do.

Renee Thompson:
And I'd like to reinforce a couple of it because I'm always looking for where's the practical strategies. What are the principles here? And based on what you just said, you have to spend time with your people, where your people are. And if you can do something like donuts with Dina. And it's funny because some other executives I've worked with, like Gerald Bryant, who's the chief nurse officer from Lake Charles Memorial Health, he have Java with Darryl and.

Dina Dent:
Oh, I like it.

Renee Thompson:
Carl Carton from University Hospital. Coffee with Carl. If you can find something that is the same letter as your first name. Yeah. Do it. But that's not as important as the whole concept of. You need to listen to your team. You need your people are they need to know who their executive leaders are. And I want to talk about that triad model because, again, I mentioned the first time I experienced it; I honestly, Dina, I was confused. I can't imagine I started we started doing work with your CBOR CICU and CT ICU. We did our department initiative with those three departments, and we started; we had the medical director there, we had HR, we pull in an executive, everybody. And this was before I think you had started at Inova Fairfax. But I remember one of our executive meetings, Francine Barr, the chief nursing officer from Alexandria Hospital, Inova, participated. And I was thinking, why is Francine here? Lovely person. Love Francine. She's terrific. But I didn't understand it. And it was because of this triad service line model that you have that it was really the, oh gosh, what's the service line called? The vascular.

Dina Dent:
Well, we have ten service lines. Okay. We have there's five care sites, five campus hospitals. We call them care sites. Each care site has a triad.

Renee Thompson:
Okay.

Dina Dent:
The triads consist of the four community hospitals: a CMO, a CMO, and a president. For Fairfax, because of the size, we have a CMO, CMO, COO, and we also have a president. We have ten service lines that range from oncology to pediatrics to women's services. MSc Neurosciences v Ishvi is the one medicine service line. Each of the casinos also their vice president of a service line. Okay. So, for example, I'm the CNO of Fairfax and I'm also the vice president of the medicine service line. Francine is CNO of Alexandria. She's the vice president of Ishvi, which is a Nova Shar Vascular Institute. It's our cardiology program. And so that's why she those two departments that she started with, she supported for as our Ishvi vice president. So, the service lines all have an administrator, a nurse as a vice president of nursing, and a physician. Each service line does.

Renee Thompson:
Okay.

Dina Dent:
And we're very highly matrixed. So we support each other in the service line. We have meetings a lot. We share responsibility of growth and development for the business side of it, for the professional development piece of it, for something as important as a healthy workforce, we share equally the responsibility and the drive and the promotion, the sustainability of the service lines.

Renee Thompson:
I think it's so just incredibly smart that okay, you if you have a if you're a five-hospital system like Inova, you have neurology and probably all five hospitals. You have cardiology in all five hospitals. But yet, yes, there are these siloed approaches to delivering that care across an entire system. But if you have service lines. So that's why Francine was participating in the work that we were doing with some of those departments that fell under that cardiology service line. And it made total sense. And so what I want to ask you now, Dina, is as it relates to a healthy work culture, as you mentioned, your partner in crime, Rishi, who has just been he's the chief medical officer of Fairfax, and he has been so engaged in the work that we've been doing to cultivate a healthy work culture, recognizing that it's there's no one role that is the problem role or the good role. It's all of us. We all show up with an intention to deliver really good care. But we don't always show up understanding that how our conduct, how our behavior impacts that care as a team and coming together as a team; you have done that so well. Can you talk a little bit about how you cultivate and sustain a healthy work culture across your system? And it can be using your triad model, maybe some strategies, how you do that. And I know you and I have talked about how you're always attending these meetings and always talking about what a healthy workforce means.

Dina Dent:
Yes. I want to be very transparent in saying that. It's constant new learning. Right? So this is not what we would identify as a secret sauce because to enculturate different departments, history is different. Turnover looks different. Outcomes look different. The generations of staff. It's different, right? There's not one strategy and that I have that I'm aware of that works. So we I combine a lot of different strategies. By no means do I want it to sound like it's easy to balance your calendar or to be able to go off-site to have donuts in the morning and then come back and by 2:00 and have a critical care operations meeting? That is not what I don't want anyone to think that it's a challenge to have support around. Calendar management is huge. And I think you mentioned it earlier, Renee. It's management, personal and professional. Right. So everything goes on my calendar this 7 a.m. surgeon meeting, as long as the four and the 4:00 workout time for myself, everything is on the calendar. So, I just wanted to make sur i speak to that it's definitely a journey. However, and it's a journey to continue to incorporate and incorporate a healthy workforce. But when something works, and it goes, well, I don't even always have to be the person to speak to it. The team members speak to it. I was Sharon, Renee. The concept around the question about me bringing it up at meetings.

Dina Dent:
I was at a care site council, which is one of our shared governance, um, meetings, and we have those of the, you know, the best, the brightest, the most highly engaged team members. We had our first in-person care site council. I don't even think I told you this, Renee, probably two weeks ago. And it was extraordinary for me to see what almost 100 of, yes, of our shared governance largest, our bedside staff. Right? It's just I can't even I was almost a tear. It was just amazing. Anyway, they have the time at the end that they can ask me anything. And someone stood up and said, can you talk to us a little bit more about healthy workforce? Now, again, this is 50 departments, Renee. Representatives from all over, and the word has spread. So, to your point earlier, we started with Cvicu CDR. Two of our most complex departments and divisions, probably alone eight 900 employees just in those two huge areas. Right? And I'm also in that number, the physicians. It takes perfusionists to run that respiratory nurses huge. And we're still on the journey. But the turnaround of the culture is just absolutely extraordinary. When you get the buy in and have the leadership from a physician champion and the nurse leader together, they have each other to commiserate with and have conversations when it goes well and when it doesn't go well.

Renee Thompson:
Exactly. And to your point earlier, you're right. You're not perfect. You still have issues. You're still working on it. Everybody should; you should never think that you're done. When it comes to culture improvements, never. The journey never ends. And I try to warn people that like it runs dirty. There's not an end point because things change. But what you have done so well is that you had those leader partners because right from the beginning, we worked with physicians and your nurse leaders to identify what are our challenges, what do we need to work on, how do we do this together. And I, I saw it was very I was very impressed with how initially it was very difficult, but they came together as an interprofessional team to say, okay, let's make our culture better. And they did that. But it's because they had a nursing leader and a physician leader who was equally as engaged in this. And it wasn't just a nice to have. They knew that this was a need to have and were involved.

Dina Dent:
I also think the units that have participated they really adopt healthy workforce in every meeting they have. Right? So all of the shared governance, the unit base, their huddles, and safety huddles, the boards, when you go on there, and you look at your healthy workforce boards, so any new members of those teams is automatically a part of the orientation. It's the preceptors own it; they live it. The docs are inculturated in it. So that is why I think the strategy that you have one now is each one teach one. Those that have been successful are able to stretch and to support other departments. I think that's a great initiative. But yeah. So Rishi and I try to communicate, at least speak in healthy workforce adjectives, as we talk about specifics of expectations just around how to improve quality care, psychological safety, and just the ease of conversation and what happens when you don't have that ability to communicate effectively. We've seen what happened before, and we don't want to go there. We want to continue to grow from there. So yes, it's a healthy part of our conversation, and it's a continuous part, and we have to keep having it. We're going to expand out to four more units very soon, which will stretch us to include in a in a in a very good way. But it will because it will be more voices, it will be more voices. It will cross over the service lines that I spoke to you about. So because we're looking at it differently now, our service lines are going to be engaged and involved from the beginning. Yes.

Renee Thompson:
And I think that's one thing we learned how you talk about. You're always learning. You're always learning even when you shared your journey; from you started out as a CNA to now, you're the chief nurse of Inova Fairfax Hospital is the learning along the way; we've learned, too and every organization is a little different. So Inova is different than Kaiser Permanente is different from advocate is different. And to be a little bit more, I think custom to say, okay, what do you do differently at Inova that we need to know if we're going to partner with you to cultivate a healthy work culture? And that whole service line is a unique opportunity to really tap into the synergy that you've already created, having a service line that goes across your organization and, then again, that triad model two. But when you've been successful, it's not when the leaders can talk about what a healthy work culture means; it's when your team can. And for you to have all those people asking you your front line, asking you about or talking about healthy workforce. I'll forget working with Alvin and the CIC towards the end of our initial journey together, she said. Renee, my people are driving me crazy. They're constantly coming into my office with new ideas on how they can even make our unit better, and they come up with all these ideas on how they can build relationships with the people, with everybody. And he said it's a good thing they are so engaged in this, but they're always coming up with new ideas. He was kidding around, saying, they're driving me crazy. But that's when it's when it's your people, the nurse or the tech who works at 2:00 in the morning, to talk about what a healthy work culture is.

Renee Thompson:
That's when you know that what you're making a difference and you're moving in the right direction. And again, you've done really well. Um, as we start wrapping up, we've talked about a lot of different things. You've you talked about, well, I have to laugh. You said you thought you were going to get into psychiatry. Yeah, that's actually why you're good at what you do. Because I always say you shouldn't have to be a psychiatrist to lead people. But it certainly helps if some people feel the same way. So we talked about making sure when, especially if you're a leader and you're going into a new organization, ease into it. You know that you need to build relationships with people first. Find out who your key stakeholders are. And then we really shifted to looking at the partnerships that you create, and especially in an executive role. But you could do this at if you're a frontline manager, if you're a director, who are the other, who are the leaders as part of your interprofessional team that you really need to partner with because you can't do it alone, and you have some dyad models you talked about, and now the service line and the triad models. If there's a leader who's listening, maybe you have there's another chief nursing officer who's listening, or even a director or frontline manager who maybe they're not on the journey towards a healthy work culture at all. And they want to begin. What advice would you give them, Dina?

Dina Dent:
For a nurse leader. Your best friend at work is your physician partner? Yep. When you can engage and be able to speak the same language and answer questions and ask questions and feel comfortable asking questions with that person, and they feel comfortable asking you questions because there's different, um, components of leadership trajectory for nurses and doctors. We don't have enough time. But there's our we are blessed as nurses that a component of our degrees have some leadership. Curriculum. So there are some things that we we graduate and have some idea around change management. Right. Early adopters. Late adopters. What does that look like? How to systematize some things. What performance improvement looks was part of our curriculum to a certain degree for our physicians. Not always. But they want to know. They want to engage, they want to grow, and they are the voice of the physicians. We still live in the area. The physicians will listen to the doc. They will. And when they see the nurse leader and the physician champion together, that's a mighty force.

Renee Thompson:
Power. There's power there. Powerful.

Dina Dent:
Greatness.

Renee Thompson:
That's right.

Dina Dent:
Yes.

Dina Dent:
It's greatness. It's greatness because it is. It's complementary. It's easy. And it should be personal. Like, get to know my family, and you're like, talk about it. Everything is not 100% what I learned in those 1 to 1 conversations. A good portion of one-on-one conversations should really be about what did you do this weekend.

Renee Thompson:
Where did you go on vacation?

Dina Dent:
Where did you go on vacation? Yeah, get to know. No. I'm weird. I don't like chocolate. You don't like chocolate? That's a conversation, not me. Just say I don't like chocolate.

Renee Thompson:
Seriously?

Dina Dent:
Oh, I like I don't eat it because I'm. But I do like. But you would be amazed. I don't think I'm. I don't think I've ever met anyone who doesn't like nuts.

Renee Thompson:
I don't eat it. I've never liked it. Now, I will eat a buttered salted popcorn. Okay, but you can keep the desserts. I'm a savory, a salty people. But yeah, you get to know somebody like.

Dina Dent:
You get to know them.

Renee Thompson:
Yeah.

Dina Dent:
So to me, that's. And it and it doesn't always have to be because all organizations are set up where you have a dyad, or I think we're. I think eventually they will be. I think we're growing in that trajectory to learn together that kind of mental model learning. But if you're not there now. There is a physician. That comes to your unit very consistently. There is a group, there is one, and work with that person. Learn from each other elevate because nurses also want to work and stay and retain where they feel that they have physician support. That's just and docs are the same way. The residents want to feel supported by the experienced nurses. They want to know that they're going to help them if they get into a serious situation. So to me, those are it's the power team, more and more importantly, and then it's the nurse leaders. You all know that human resources, your CFO, your finance people. But for culture change, it is definitely your physician leader.

Renee Thompson:
I think that's such wise advice. So, and to your point, if you don't have a dyad model, it's okay. Create one. Yeah. What physician is consistently in your department, pull them aside, maybe meet for coffee, and say, hey, I want to work on our culture because when you approach it that way and I'd like to partner with you because it's not any one of us, it's all of us. And I think sometimes we get into that trap of demonizing one role versus another role, and, oh, it's all them, or it's all this group. And that, first of all, that's not true. Okay. Yeah. And second of all, that's not helpful. So how do you put that aside and build that relationship with a physician champion or provider champion? Start in your department and then let it grow from there. So I think that's really great advice, Dina, especially for someone listening who wants to start this journey, who may not have things set up the way you have them set up at Inova Health System. So thank you for that.

Dina Dent:
Thank you.

Renee Thompson:
If people want to connect with you, what would be the best way? I know you're on LinkedIn. Okay, so I can give them your LinkedIn profile. Would that be okay?

Dina Dent:
Yes, that would be great.

Renee Thompson:
Okay. So we'll put Dina's LinkedIn profile. We'll put a link in our show notes. And I'm also going to include a link to the episode where I interviewed Doctor Rishi Gard medical officer from Inova Fairfax. And you said something earlier, Dina, about nurses. When you're in your graduate program, you learn leadership, change management, all these things. Rishi and I talked about the fact that physicians don't learn, that they don't learn about communication and conflict, and all of that. And so there's an opportunity for us to help each other. So it's a really great episode where I interviewed him. So we'll also put that in the show notes. So, I just want to thank you for being a guest on our show and thank you for the great work that you're currently doing at Inova Fairfax, in the work that you're going to continue to do at Fairfax to cultivate a healthy work culture.

Dina Dent:
Well, thank you, Renee. Thank you for your podcast, Tom, but thank you for healthy workforce. What you did with Healthy Workforce is pull together components of how to encourage and drive a culture. There are these pockets of things that we know we should do and how we should do it. And you create it. You have your be kind symbol. And then under be kind are all of these tactics that work. They work. And I appreciate you and and your team and your patience. You kind of help and support. Yeah. Because you're a phone call away. And that's remarkable and very important to be able to succeed. So thank you a lot. I appreciate your time.

Renee Thompson:
Time. Well, you're very welcome. And I appreciate all of the work that we've done together. And again, the work will continue because that's what we do. We try to make it easy for you. We have the expertise. We have a system. We know the system works. We just help you implement the system and then hardwire these principles into the very fabric of your organization so that people are always talking about, oh, healthy workforce and what that means. And continue looking forward to our continued work together.

Dina Dent:
Awesome. Thanks, Renee.

Renee Thompson:
And thank you who are listening right now or who are watching for doing your part to stop the cycle of bullying and incivility in health care. And as we end, remember, the way we treat each other is just as important as the good care that we provide. Thanks, everyone. Take care.

Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found these practical strategies helpful, we invite you to click the subscribe button and tune in every other week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility, visit HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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Things You’ll Learn:
  • The stellar impact of solid nurse-physician relationships for leadership success and cultural evolution in hospitals.
  • Initiatives like “Donuts with Dina” and the triad service line model are revolutionizing team engagement and system-wide growth.
  • Why getting to know your colleagues personally is the cornerstone of driving positive cultural changes in healthcare.
  • The power of “empower 180” and why dedicating time to your team can make all the difference in performance and satisfaction.
  • Combining the strengths of formal and informal leaders can dismantle barriers and enhance collaborative efforts.
Resources:
  • Connect with and follow Sufian Dina on LinkedIn.
  • Follow Inova Health on LinkedIn.
  • Explore the Inova Health Website!
Disclosure: The host may be compensated for linking to other sites or for sales of products we link to. As an Amazon Associate, Coffee Break earns from qualifying purchases.
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