Leading with Love: Culture Change After a Healthcare Merger

Why This Episode Matters

Quality functions in healthcare often struggle with perception. Too frequently, they are viewed as auditors or enforcers rather than strategic partners in improvement. In complex environments like post-merger health systems, this perception can become an even greater barrier to progress.

In this episode, Lisa Harton, DNP, MBA/MPH, RN shares a grounded, experience-based approach to reshaping the role of quality by focusing first on relationships, mindset, and psychological safety. Her work offers practical insight for leaders trying to move from compliance-driven activity toward true system improvement.

Key Ideas Explored

• Why quality teams must first become trusted partners before driving accountability
• Using appreciative inquiry to unify teams after a merger of equals
• How clinicians move through “stages of grief” when confronted with performance data
• What healthcare underestimates about the human side of high reliability
• The role of boards and governance in advancing quality strategy
• Why changing mindsets is prerequisite to changing behaviors

Takeaways for Quality Leaders

• Start culture change by intentionally redesigning the relationship between quality and operations
• When clinicians question data, lean into joint learning rather than defensiveness
• Use established frameworks to create shared language across the organization
• Invest deliberately in teamwork and communication training, not just technical fixes
• Engage boards with accessible tools that build confidence in quality oversight
• Recognize and celebrate small wins to build momentum and trust
• Anchor improvement work in purpose and shared aspiration, especially during mergers

Continue the Conversation

Connect with Lisa on LinkedIn to continue the discussion.
This episode is especially useful for quality leaders navigating culture change, mergers, or reliability work.
If you found this conversation valuable, consider sharing it with a colleague or leaving a brief rating or review.

Resources & Frameworks Referenced

• Appreciative Inquiry framework
• IHI Whole System Quality framework
• IHI's Framework for Effective Board Governance of Health System Quality
• Barbara Fredrickson’s Positivity research
• TeamSTEPPS
• High reliability principles (nuclear industry examples)
• Root Cause Analysis (RCA)

Leading Quality is a podcast for healthcare leaders committed to improving systems, culture, and outcomes.

If you found this episode valuable, follow the show, rate and review the podcast, or share it with a colleague working to improve care.

Connect with Jason Meadows on LinkedIn for more insights on healthcare quality and leadership.

New episodes published every other Thursday at 7AM Eastern Time.

Credits:

Host, Writer, and Executive Producer
Jason Meadows, MD

Produced by
Thrive Healthcare Improvement

Edited by
Milan Milosavljevic

Transcript

Copy Transcript Copied

A Nuclear Lesson For Healthcare

SPEAKER_00 0:00

I took two groups last year to the nuclear power plant, and it was amazing. The things that the board and the clinicians took away was how in nuclear there is an unwavering commitment to zero. So they take a stand on zero, but they support learning and improving along the way.

Quality As Partner Not Enforcer

SPEAKER_02 0:21

Welcome to Leading Quality, the podcast spotlighting the people moving healthcare forward from the front lines to the C suite. I'm your host, Jason Meadows.

SPEAKER_01 0:39

One quick note before we start.

SPEAKER_02 0:53

Today's conversation is about something that many organizations want but struggle to achieve in practice. Transforming quality from an enforcement function into a trusted partner for improvement. My guest today is Dr. Lisa Harton, whose career journey from the NICU to enterprise quality leadership has given her a uniquely grounded perspective on what it actually takes to change culture at scale. What stood out to me in this conversation is her consistent focus on the human side of improvement. At a time when many systems doubled down on metrics, mandates, and monitoring, Lisa has leaned deeply into relationships, mindset, and what she calls leading quality with love. We explore what it really looks like to operationalize appreciative inquiry during a complex merger, how to move clinicians from defensiveness to ownership when confronted with data, and what healthcare still has to learn from high reliability industries like nuclear power. Throughout the discussion, Lisa makes a compelling case that sustainable performance improvement begins not with tools, but with trust. If you've ever struggled with the perception of quality as the enforcer or wondered how to shift culture in a meaningful way, this is a conversation worth your time.

From NICU Nurse To CQO

unknown 2:09

Dr.

SPEAKER_02 2:09

Lisa Hartin, welcome to the show.

SPEAKER_00 2:12

Thank you.

SPEAKER_03 2:13

So I wanted to get started with a high-level view of your career so far. So to ground our listeners, can you walk us through your career path and the roles that shaped you to where you are today?

SPEAKER_00 2:26

Absolutely. Thank you for asking. So by background, I am a nurse and I've been in healthcare for almost 30 years. And I started in the neonatal intensive care unit and I developed a really severe latex allergy. So at that time, there was no notion of removing latex from the environment. So I had to leave my clinical job that I loved very much and move into the only open job, which was infection prevention and control. So I did that for a few years. I was in operational leadership for many years. And then about 10 years ago, I got introduced and started supporting and leading quality. So I've been supporting quality for about 10 years now.

SPEAKER_03 3:11

And what kind of nudged you in the direction of quality? I think a lot of people, you know, end up in leadership roles the longer they stay in healthcare, but but quality is still a bit niche. What what can you tell me about the journey specifically into quality?

SPEAKER_00 3:25

You know, Jason, it's it's been just sort of who I've always been. I love learning and I love problem solving. And I think those are two key attributes to being successful in quality. And what I love most is pulling people together from various disciplines and backgrounds to solve a larger problem together that has a positive impact on healthcare. So quality was honestly just a natural fit. I've always been aligned and engaged in nursing quality and expanding now as a chief quality officer for Amplify Health, which is an organization in the Wisconsin area that, and we're on actually three years into our merger, um, leading quality across an enterprise and learning all of the different aspects of quality has been really fun. And we've done some really great work in this space. So I think it's just been such a rewarding career.

Leading Through Service And Influence

SPEAKER_03 4:20

As you progressed in this in this career arc, how did your understanding of leadership change as your scope and your influence grew?

SPEAKER_00 4:29

When you're in operations, you're an operational leader, you have a lot of authority to just do what you need to do to get things done. And when you find yourself in a shared service, that's what we called quality at our organization, a shared service role, you have to really learn to influence in different ways. And I have really tapped on my experiences and operations of dealing with quality, where oftentimes I, you know, you'd see quality or safety coming and the fear in your clinician's eyes, the fear in your staff's eyes. It was always around we did something wrong or we're not good enough. So I've actually been able to leverage my experience in dealing with quality to I think lead quality with love and very effectively and turn things around from it's not that we're doing anything wrong or someone did something wrong, but we're on this continuous journey to learn and improve together. And it's been a really rewarding transition.

SPEAKER_03 5:30

Do you think that your background in nursing was a key influence there?

SPEAKER_00 5:34

You know, I think, believe it or not, may perhaps, but prior to healthcare, I actually worked in hospitality leadership and went into healthcare based off of an experience I had when leading um hospitality management. And I think what's really critical is I've always been in professions where I'm here to serve. So I think it's the service-oriented leadership that is really helpful when you're trying to influence others that you don't have direct authority over. We're here to serve and help.

Merger Of Equals And Culture Risk

SPEAKER_03 6:07

You had a really unique challenge that you were going to talk a little bit about with us today, which was managing quality after a hospital merger. Was there something that told you that the traditional approach to quality wasn't going to be enough when you had to approach this merger?

SPEAKER_00 6:27

Yeah, absolutely. That's a great question. So we um came together as a merger of equals. So these were two great medium-sized or medium-sized to small healthcare systems that had strong brand reputation for quality, really good quality outcomes. So there was a sense of if we approach this the way we always did, then one region or the other felt like they had to give. So our approach was really grounded in appreciative inquiry and positivity. And I'm happy to share more on that framework. But really, our approach was how do we learn the best of each region? Really truly explore what are we great at? Why are we great at that? And then what do we want to spread to the other region? And then we looked at where are people outside of our system flourishing even more than we are? And how do we learn from them and incorporate that into our quality program? So we really focused on using the appreciative inquiry framework that really focuses on setting an affirmative idea, something you want to work on. We want to together be better than we were alone and be a top performer in the nation. And we do that by understanding our strengths, our opportunities, and where we want to even get better together. And then we put together a project plan and we were courageous and relentless and learning and executing that plan.

SPEAKER_03 7:56

And I can't wait to get more into it. I want maybe if you can first paint a bit more of a picture where you are geographically, kind of what these hospitals were and what the environment was like at the time of the merger.

SPEAKER_00 8:11

So we are two healthcare systems. So um we are located in the northeast region of Wisconsin and Upper Peninsula of Michigan, and then we are in the southwest region of Wisconsin, Lower Michigan and Minnesota and Iowa. So these were two really strong healthcare systems. Again, a really strong quality brand, great safety outcomes, and wanted to proactively merge as a merger of equals to be able to give and provide great care locally without having to become part of a much larger system. And so together we provide care for 67 different communities, um, cities, rural health. So we have some urban locations, a lot of rural locations, over 100 primary care and specialty clinics. We have 11 hospitals in total, over 1,400 providers or clinicians, 3,200 plus nurses, and we are about a little over $2 billion organization. And we invest over $200 million back into our community. So that is who we are geographically. And when we came together, the first thing we really did was what's our purpose, our aspiration, and our values that we call our spirit? And we really together, we want to inspire everyone's best life by relentlessly caring, learning, and innovating. And in our vision statement, we talk about leading with love. We courageously commit to a future of healthy people and thriving communities. So we have a real strong commitment to keeping care and resources local.

SPEAKER_03 9:59

What a what a geographically diverse and interesting reason for for being that that that must have been. You mentioned the setting new strategy, and that was part of this process. I wonder if some of our listeners have had varying experiences with strategy. Maybe that feels uh really impactful and really meaningful, and in other cases, maybe feels a little less so, a little more having the exercise to have the slogans. And I'm curious, it sounds like yours was such a thoughtful process. I wonder if you can tell me a little more about how that strategy strategy creation played out for you guys.

Building Strategy With Appreciative Inquiry

SPEAKER_00 10:38

Sure. So um specifically for quality and safety, it's really easy when you're anchored in a mission and vision that we have here. And um, quality and safety strongly influenced that mission and vision. So that was really important to me as a chief quality officer. And when we approached strategic planning, both for the quality function, I had to bring two different teams together into one team. That was an expectation of the merger. And I had to bring two quality programs together with a lot of different key stakeholders to um create our strategy. So I used the same framework that I use when I approach strategy, and that is the appreciative inquiry model. And this is really important to me because it's based in positivity, which appreciative inquiry obviously is um a positive attribute. And this model is really important to me because I was thinking of the situation I'm in when two organizations come together, there's mergers, acquisitions, there's a lot of fear. There's a fear in the people that there's a fear that they're gonna lose what made them great, a fear they're gonna lose their voice. And there's been some really great studies through all of my um leadership studies that I stumbled across, Dr. Barbara Frederickson, who, if if you haven't heard of her, she wrote the book Positivity, and in her research is absolutely fascinating. And I won't do it tons of justice, but she has a lot of data and research out there. And and what psychologists were looking at was we know that negative emotions are really obvious that have been studied deeply over time. Fear, fight or flight. I would say, as a healthcare leader, for many years, we experience fight or flight almost on a daily basis from the work we do. And the theory was if we didn't need our positive emotions, they would have evolved away. So, what some of this research showed is we actually need positive emotions because they get us out of fight or flight and they help us broaden our um thought repertoire, which leads to new innovative actions. So I always ground myself and my teams in positivity. And it really does, Jason, help the teams relax and open their minds to doing something different. So when you use this model, you just start with what is it we're trying to do? We want to be a top-performing quality organization that adds joy back into the life of those who serve. And then you go through this model where you discover the best of what is. And when people start sharing and talking about their success and what's made them great, they start relaxing and opening up. That fear goes away. And then you dream about what could be, which is really, really important. We want to dream big here, and we don't want to worry about how we're gonna get there. We're gonna dream big and we'll worry about how we get there later. And then you come together, design, and then you deliver on that destiny. So that's the approach, and that's what we took to come up with what has been a really meaningful strategy, not just for the quality team, which we're seeing great engagement. Our engagement scores are going up, our retention is phenomenal. Our team is providing more value to the organization and our quality programs, we're experiencing, um, we're moving measures that either region hasn't moved alone in over 10 years. And and what really makes me excited is when I have clinicians call and say, thank you. I feel like I have joy back in the work again. I'm contributing and making a difference. So it's been a really, really fun. It's been a fun process to work through through the two regions.

SPEAKER_03 14:26

It's inspiring just to hear you tell it. I wish I was there. The quality will sometimes have uh quality as a department or as a as a kind of a field of work will sometimes have uh you know a reputation for being uh maybe enforcers rather than than those who who kind of build up and and help and and uh show appreciation as

Changing The Reputation Of Quality

SPEAKER_03 14:51

you've done. Was there any any of those kind of barriers that your your new quality department had to overcome? What was the perception of quality at the time of the merger?

SPEAKER_00 15:01

You know, Jason, that's a great call out. And you know, people don't forget. People have really long memories. So we absolutely, I walked into a long history of quality as the enforcers. They only show up to tell us we're doing a terrible job, really not being a valued partner in the healthcare equation. And I think by bringing people together underneath this appreciative inquiry framework, we were not only able to design the strategy, but then we had a session where we talked about what is the role of quality? What is our contribution to the organization? And we negotiated that with operations and with the clinicians and came up with a shared mental model of how we're there to help. And then one of the things we did is we put in structure and process to make sure we were giving people feedback constantly. Great feedback and feedback where we needed to improve. But they were hearing from us when they were doing great. We were sharing learnings, they were sharing their learnings, they were on the stage, not us, but we were creating the conditions where they can share, where they can flourish. And, you know, it takes a couple service lines at a time, but as you keep um doing this, more and more people see this and they get on board. So we've come a long way. We still have a long way to go, but we absolutely had this perception of, you know, quality as this enforcer and not as a trusted partner for many, many years in both regions.

SPEAKER_03 16:31

And as you were doing this and you're employing, you know, you've just you've described to me separately that the appreciative increase framework was really important, and this was really the engine that helped you to execute on a lot of the work you've done.

Using IHI Frameworks With The Board

SPEAKER_03 16:46

You used two frameworks from the IHI, as I understand it, the quality governance framework and the whole system quality framework to help design your strategy. Uh what did those frameworks give you and how did it fit in with ultimately the appreciative inquiry framework?

SPEAKER_00 17:06

You know, Jason, I think I always tell people start with a framework. A framework is going to give you usually the most up-to-date, best evidence to have a top-performing program or a top performing team. Um, it's hard enough to bring different people together. It's hard enough to get through a merger. And while you're doing all this, still trying to achieve top decile results and keep people engaged and tracking with you. So the frameworks to me were extremely important. So when I shared with our quality governance, the IHI Whole System Quality Framework, we read it, we agreed on it, we saw the evidence, it became a nice anchor for us to design our program. We looked at how do we do strategy planning for quality? And then how are we going to improve and how are we going to manage? Um, I also worked with my board. You know, it's really important too. We brought two different boards together to become one board. And let me tell you, the the board's expectations and what they wanted from quality and safety were very, very different. So I had to harmonize this. So I worked with the board and we read the um IHI framework for board governance. And we created our own toolkit. There's a great toolkit out there. So, but one of the board members said, Lisa, I this needs to be more in community layman's terms. So I said, help me, let's do it. So we we used the framework to create a toolkit and an orientation for the board. And we talked about things like creating psychological safety, how to use humble inquiry to ask questions that actually open people up to wanting to answer it and don't scare people. And also the traditional foundational elements of what they need to know for quality and how they can add value, because your board members want to add value. And oftentimes when they get in the when you sit on the finance committee, I presented to the finance committee today, um, they have a lot of questions when it comes to finance. But when it comes to quality and safety, they're a little bit intimidated. So, you know, I share with them here's questions you can ask. And those frameworks give you the guidance and the knowledge to help people. And it also helps, especially when you're um working in a merger, that the evidence is coming from someone else. So it's not just Lisa Harton telling us that this is great. So what I would I often do is I expose people to the framework, but I have great partners through the Chief Quality Officer Network, Jason, you being one of them. And and I will always expose my board, my governance team to do you want to meet with other organizations? Other chief quality officers are happy to help. It just helps when you get different perspectives. It helps with the buy-in and the rapid adoption.

SPEAKER_03 19:52

Yeah, and it sounds like you were really using these frameworks as a starting point to give, in this case, your board members and the rest of the people in your organization some kind of concrete language, some concrete tools so that everyone had this shared mental model to start with. It's really refreshing to hear just how you might take this big landscape of merger and start with something so concrete and so accessible. I really like that framework.

SPEAKER_00 20:21

And so then how does Jason, I think you're right. Like words create worlds and language matters. And one thing you learn very quickly, even within your own organization, people think they're speaking the same language and they're not. So these frameworks really do help create a shared mindset, a shared um skill set, and a shared tool set. So we're all working out of the same playbook. It makes a huge difference.

SPEAKER_03 20:48

And I hear you, you know, in what you said, also really giving people the benefit of the doubt that these finance people or these whoever they are, right? Any kind of clinical or non-clinical domain just may not have the same shared mental model uh as you have. And bringing them together is Yeah, that's that's a great great thing. And then how does the appreciative inquiry framework is just present at every step? Where do you, you know, in concrete kind of frontline terms, where do you where are you applying that framework? And are you teaching it to others, or are you just applying it yourself?

SPEAKER_00 21:26

I have taught it to um my board through strategic planning, through our quality governance structure. So we have regional quality and safety committees, enterprise quality and safety committees, and um also with my team. We take little components of it when we're approaching how we improve quality and safety as well. And um, we we've kind of integrated it into our approach in almost everything we do.

SPEAKER_03 21:52

So really weaving it into the DNA.

SPEAKER_00 21:54

Um weaving it into the DNA. And you know, one of our aspirations was. We want to be a sought-out valued partner to everyone internally, externally. We want to share, we want to learn. And um, we have to create safe spaces and the conditions where people want to engage with us and add value and improve. So this is why we we integrated into the fiber of who we are as a program and as a team.

SPEAKER_03 22:25

Other leaders I've spoken with who have been through big changes, and this merger certainly is an example of that. We'll often talk about seeing signs of cultural change as this whole thing was unfolding. Language, behaviors, new people starting to reach out who didn't reach out before. Do you have any stories about how you could feel the culture starting to change?

Data Defensiveness To Clinical Ownership

SPEAKER_00 22:54

Yeah, I have I have some great stories. So, you know, we're two regions who were previously, you know, we're geographically about four hours apart, but still in competition from a quality and safety perspective. So there was always this notion of, you know, someone being maybe superior or inferior, or this competition between the two. So people generally, and I think this is even if you're in a merged merger situation or not, people are always a gonna defend that they go into the stages of grief when they look at their quality and safety data, and they're always gonna defend, deny, and try to figure out how we're unique. So one of the things that I have really seen, and I it's so easy for me to pick on our surgeons because for some reason I keep having lots of improvement work with surgeons everywhere I go, but this is pretty typical. So we show people their their data. Um, we acknowledge that we need to learn about the data. There's likely a lot of documentation improvements, a lot of things people might be calling a surgical site infection. So let's together clean up the data and then let's find out where the true care opportunities are and work on them together. So we have moved in a very short time from that data is flawed, it's not valuable. And I am so proud of this team. We are about a year and a half into this project. They are at top decal for SSI performance. So, what changed? Our relationship changed. Relationships matter. So they had to first see us as trusted partners. We had to make the conditions safe where there might be care opportunities here, but let's kind of clean up the noise so we can get to where we can improve. And then we let the clinicians sit around the table. We just brought actionable information, expert knowledge of the measures. We let them get around the table facilitated. Where are their care opportunities? They led the improvement, they led the charge. They just had to see us as their trusted partners. We recognize and celebrate every little um moment that we can to keep people going. But to see the pride and joy in their faces, to hear them saying, we can do even better. This isn't even good enough now. It's just, and it's the work. And then, and now Jason, there, Lisa, what else? What next? This isn't enough. We know we need to do even more. So I'm really proud because with that particular service line, we're working on a quality certification program because they have really just engaging in quality. We help set up the structure and process so that they can be successful, but they're doing and leading the work. So to me, what changed is um we created relationships and then mindsets changed. So you have to change mindsets before people are going to behave differently. So once they had a mindset of we can take a stand on something without knowing how we're gonna achieve that, but we're gonna commit to being the best in this space. And then we're gonna work courageously, relentlessly to learn and improve. And that's what I've seen. And I've seen the joy and work. People are happy again. They know they're providing great care and they're learning and they're improving. This is what people want to do.

SPEAKER_03 26:17

You know, I've never heard anyone apply the Kubler Roth model, the five stages of grief, to being shown data. And that as soon as you said that, it hit me uh that that's that's what you're seeing. And the I think the specific scenario you described will probably be familiar to a lot of our listeners, which is you show someone data you've worked really hard to get, and the first reaction is that's not accurate. If I'm a physician who comes to you, or you come to me, you've shown me that data, and my response is I don't think that's accurate. Where do you go from there?

SPEAKER_00 26:57

Yeah, and I've trained our whole team to do this. Well, let's sit down, let's talk about it, let's learn. It might not be accurate. Let's learn together. Um, and then people get really interested in learning the details of the data. And then they logically then go to, well, we're different, it's harder here, that can't be the right benchmark. So then I say, well, who should we benchmark with? Like you tell me who you want to benchmark with, and we'll figure out how to get the data. So you, and then from there, so I'll give you an example with surgical site infections. Once, once we said, okay, we understand the data, we've helped clean it up, we see the opportunities. And then it was, we don't like that benchmark source. I said, okay, well, tell me who you respect, who you think we're as good as or should be better than. And then we pulled um a subset of data out of our bigger database. And it turns out we perform better in the larger database, but I gave them those options and they said, okay, you're right. We can do better and we're going to do better. And I said, well, let's do it. And we will be right by your side, your partners in improvement, and we will improve. And we did, and we do every time.

SPEAKER_03 28:08

You've just given me a whole new set of tools to use for that situation next time I encounter it.

SPEAKER_00 28:13

No, Jason, I want to share. I just I did a presentation on this recently at IHI. And I had, it's interesting, I had a group of um people lined up afterwards. And the question for me was well, with kindness and positivity, what about accountability? And what about using data to drive improvements? And I said, that's a great question. I would wish you would have asked that in front of the larger group, but we we had, I think, run out of time. But, you know, listen, that doesn't mean um we don't hold people accountable. I would tell you, we are all in on rapid cycle improvement. If we are off track with the measure, we're meeting weekly, sometimes daily. Um, we have a great sustainability plan when we're when we're doing well so things don't fall off. But that doesn't mean you don't hold people accountable. And it doesn't mean you don't use data. What I have found is if you use this approach to build the relationship as a trusted partner. So that's our goal in quality. We want to be trusted collaborators, first and foremost. Once you build those relationships and they trust you, getting people to engage, be accountable, and rapidly improve is a lot easier.

SPEAKER_03 29:23

Start with relationships. You won't find any disagreement from you there. Yeah. And then you

Accountability With Kindness And Rigor

SPEAKER_03 29:29

had an interesting, interesting new kind of angle that you that you pursued with your team and your senior leadership team a

Touring Nuclear For High Reliability

SPEAKER_03 29:38

little while back. I I'm not sure if this was uh in the last couple of years, maybe, that you uh you took a trip together to a nuclear power plant. And this will be very familiar to anyone who's a you know quality improvement person who's knows about high reliability, which has been gaining more and more traction, more and more attention. But what prompted you to want to go to a nuclear power plant?

SPEAKER_00 30:02

So, Jason, this approach, if you think about everything we do, we have to get people to think differently. You're not gonna act differently unless you're you can think differently. So I just really wanted, I have a lot of respect for aviation and nuclear. And, you know, for for most of us who've been studying safety science for years, these are the organizations that we learn from. And we have a local nuclear plant, and I just wanted to expose people to different thinking. I wanted my board to be exposed, my clinicians on the board, and my regional and enterprise quality committees. I just wanted to expose them to different thinking. You know, in quality, we get a lot of resistance around taking a stand on zero or setting expectations that are too high, that it causes engagement issues and burnout. But but there is a balance. So I did. I took two groups last year to the nuclear power plant, and it was amazing. So the things that the board came back, and then we debriefed and we actually took action items and put them in our strategic plan to implement within our organization. So the things that the board and the clinicians took away was one, how in nuclear there is an unwavering commitment to zero. So, of course, we said, well, we have so many variables, we can't control everything, and we are um having engagement and burnout by trying to get to perfection. And they said, listen, just like you, we have humans coming in making decisions every day. If we make errors, if we don't learn, we are negatively impacting the health and safety of entire communities. So we take a stand on zero. A stand doesn't mean there has to be evidence or proof. You take a stand and you get people thinking differently, and then they start acting differently. So they take a stand on zero, but they support learning and improving along the way. So starting with that mindset is really important. Um, the other thing you'll see in Nuclear that the board really loved is they have a lot of signage and the culture is, you know, culture is what people do when no one's looking. When you go around the plant, it starts with when when you drive in the parking lot. You have to go slow. People will call you if you didn't go, um, if you didn't stop at a stop sign, if you were being unsafe. So it starts with the minute you drive onto the property, they expect feedback. They expect you to stop me if I'm doing something unsafe. And it's funny, when the nuclear plant, I said, well, you come visit us and give us feedback. And when they started, when they came in and started giving us feedback, people were offended because it's not our culture to receive this feedback. So um, just how natural giving feedback, expecting feedback was. And then the two other things that our team took away with is they take time to truly learn. You know, we do our orientation and our annual computer learnings, and um, they really invest in team training and training. Training is ongoing, it's not a one and done. People are giving tons of feedback to each other through training. It teaches people how to communicate with each other, how to take a stand on each other and support each other. And I think in healthcare, we we often, those are dollars that we, you know, we kind of take away. And then finally, when it comes to learning, they're learning organizations like us. But when they have a safety event, they do a leader RCA. So the leaders aren't allowed to go in with the staff when they do an RCA on um a serious event. And um, the leaders have to go do their own because there's a leadership accountability if there's an OSHA recordable or a safety incident. So those are the things they learned. And now what they learned from us, which I'm really proud of, is they spent time with us and I brought them through our management system. So our balance scorecards, they listened to tiered huddles. We went on leader rounds to go learn about team action boards, learning boards, and the units. And they said what they learned from me and my team was how relationships and people matter. So, what they changed in Nuclear was um they do these weekly report out meeting, deep dives, and they would always talk about how is the plant doing? What are the outcomes of the plant? And they said what they learned from us is it's about the people. And this is where appreciative inquiry comes in. It is about the people and supporting and serving the people. So they've changed their their outlook on how they approach things as well. So it was a really, really fun and interesting way to get people just to think differently.

SPEAKER_03 34:46

I heard they even adopted the question, what would Lisa say about this? Is that true?

SPEAKER_00 34:50

They did. They said on Fridays, um, they said the first Friday after they visited here, someone said, the plant's doing great. And their leader said, What would Lisa say? They said, You're right. Our people are doing great, which is why the plant is flourishing. And and they're out there. They're rounding with their people, they're talking to their people, they're they're more engaged with their folks there. So I'm I'm really excited about that too. So we've learned from each other.

SPEAKER_03 35:18

Yeah. And so what you described there was this really robust, high reliability organization in the nuclear power plant, and you mentioned aviation being another famous example. Do you think that healthcare is underinvesting in the human and relational side of reliability?

Why Relationships Drive Safety Culture

SPEAKER_00 35:36

You know, Jason, I really do. And I did a research study a few years back. I was trying to get to the root cause of why safety culture in nursing has been very low-scoring since we started measuring safety culture with very little improvement. And I just wanted to understand why. And the root of my study was relationships matter, relationships between leaders and staff, between staff and each other, between clinicians and non-clinicians. Once people establish those relationships, people flourish. They're not afraid to speak up, they're not afraid to give feedback. Um, and people start really truly working as a team. We know healthcare is, even though we've siloed the approach to healthcare into body systems and specialists, we all have to work together to provide the safest, highest quality care. And I do really do wish that we invested more in team training. So one of the clinicians who was on the nuclear tour said, my goodness, even learning how they communicate, if I applied even some of this into the cat lab with the team, I think we'd have better outcomes. And I said, you will, and I'm happy to support you. We have some team steps trainers. And, you know, so we're trying to find little spaces where we can um help and support and do things like team steps training. But I really do think we do underinvest in our people when it comes to that sort of training.

SPEAKER_03 37:08

Yeah, I I heard you mention the taking the time to really learn from serious events. And, you know, time is probably the the thing that feels most scarce in a lot of our healthcare environments. So I uh I I can see how maybe we have something to learn from the nuclear folks on that front.

Principles That Tie It Together

SPEAKER_03 37:24

So when you connect the the merger work that we talked about, the appreciative inquiry that you used, the nuclear experience that you had, um, what common principles kind of tie those together for you?

SPEAKER_00 37:39

That's a great question. I think we need to begin and end everything with thinking about the people. We think a lot about our patients, the people coming in. We've got to think about the people giving care, the people supporting those who give care. Um, how do we work together? So a team is how we get things done. So, how can you promote constant teamwork and teaching people to team? There's a lot of great um great literature out there on teaming and how to get people to work together. I think another great principle is that you have to influence mindsets if you think you're going to change behaviors. So the best way to influence mindsets is to engage people on something, something big. People want to add value. Don't be afraid to throw out a challenging goal. People will surprise you, they will rise to the occasion. Don't underestimate the power of people. I think that's really, really important. And absolutely use frameworks, use your improvement methodology, um, rigor and improvement, a bias for actions that produce results. That's really important. But if you don't start and end with the people and start with getting people to think differently, it's going to be really hard to change behaviors.

SPEAKER_03 38:59

Yeah, a lot of a lot of wisdom packed into a really uh succinct response. I appreciate that so much. You stand in your role, I think, as an inspiration to a lot of people who might aspire to a similar role to be a leader in in quality and safety. What do you think needs to change in how we develop and support

Developing And Supporting Quality Leaders

SPEAKER_03 39:21

quality leaders?

SPEAKER_00 39:22

Great question, Jason. I love it. I think first and foremost, we have to create some clarity around the role. And I'm really excited to be part of the IHI Chief Quality Officer Network. We're we are designing that consistency in the value of a chief quality officer. What is the role? What are the competencies? So I think we owe it to the people who are coming after us to help. There was a vision that um in data that shows if you have somebody leading quality, you'll have better outcomes. But we need to do better than that. We need to advance that with a little bit more concrete evidence with some more structure around that. And I think we are working on that now to help the people who are going to come after us because we know I believe in this, I see it. When you have somebody leading quality at the top of the organization, you really do get people to think and move differently, achieve outcomes, make healthcare of higher quality and safer. So I think we owe people that framework. And I think people need to get curious, learn. Everybody's a leader in a healthcare organization. People just need to get involved in how to learn and improve, learn improvement methodology, do small tests of change. So I do think um engaging in networks is important too. I have received so much inspiration, love, and support from the IHI Chief Quality Officer Network and you, Jason. That's how we met. And I'm never gonna let you go. You're always there, and I have somebody I can talk to who can help. It's it's a hard job. It's a really hard job. We have a lot of accountability, and um, you need a network. You need people to help, to brainstorm, to help you think differently and to support you. So I think those are things that are really important.

SPEAKER_03 41:09

You've just moved. Uh first of all, I'd like to reflect that that right back at you. So incredibly grateful for uh for your you as a colleague and a uh you know someone who I can bounce ideas off of and learn from all the time. So I really do appreciate that as well. You've now post-merger, you're the chief quality officer, and have more, you know, more ability, I think, to make change at scale than you might have had when b when you weren't yet merged. But thinking even more broadly, thinking at the the state level, the country level, or or even more broad than that.

Networks As Leverage For Scale

SPEAKER_03 41:46

Where do you see the the greatest leverage for us improving care at scale?

SPEAKER_00 41:52

Jason, it's honestly through these these impact networks, through working together, through bringing people together with a shared purpose and learning and improving. I think I think that's really important. I think we have a lot of work to do to influence regulations and external motivations for how we get paid. Um I I think that's that's a driver that sometimes is more disruptive than it is helpful. But I think at scale, it's how you take what's successful internally about bringing people together on a shared purpose with a great huge vision and um setting the vision and letting people learn and improve together. I think it's a really successful model. And it adds value to people. They want to be part of something bigger.

SPEAKER_03 42:46

Yeah, yeah, people do want to be part of something bigger. It's uh yeah.

SPEAKER_00 42:50

Listen, there's a whole bunch of ways we could make money that would be a lot easier. I think people who who uh join healthcare, who want to work in healthcare, they want to make a difference in the world every single day. And you know, I think we're privileged in quality and safety because, you know, people might gripe about the data or the benchmarks, but at the end of the day, who doesn't want to get involved in improving quality and safety, to be quite honest? It's it's

Hope And How To Connect

SPEAKER_00 43:20

rewarding and it can be fun if you do it in the right way. So I I think um we need to leverage that.

SPEAKER_03 43:29

And clearly you've tapped into something really unique there. And and uh, you know, I I wonder as you know, we're in an environment where burnout remains high, where, as you said, some of the challenges around metrics and reporting can feel you know, can feel hard. What is it that gives you hope right now?

SPEAKER_00 43:50

Aaron Powell What gives me hope right now, I think about even nationally and even in my own organization where there's a lot of you know polarization just because people are just double down. On what they're familiar with anytime there's change or disruption is if you build a bridge wide enough and invite enough people onto that bridge to improve quality and safety, you start seeing new relationships, new networks, new energy, um, groups of people thinking and acting differently. And I think why I feel really blessed to be in quality and safety, it's a really pretty safe place to bring people together and move people together forward on a shared common purpose. And I just love watching it. And every time when you bring people together, I have yet to see, I've yet to see people not make a difference or a change or an improvement. They just collectively do.

SPEAKER_03 44:45

I mean, that's an incredible place to end our conversation. I can always rely on you for uh for a great close out there. Um I would love to know for for listeners who would like to to follow your work or connect with you, what's the best way for them to do that?

SPEAKER_00 45:02

That's a great question. I'm a low-tech kind of CQO, I'll be honest. That's one of the things I'm learning from my my colleagues. But um I am on LinkedIn, Lisa Harton, and my emails out there. I'm part of the IHI Chief Quality Officer Network. I love to learn. I've learned so much from everyone, and I believe in giving back. So um I that's how you can get a hold of me, and I really will partner with anyone.

SPEAKER_03 45:28

We'll we'll link to that as well as the resources that we mentioned in the podcast in the um in the show notes for today's uh episode. I just want to thank you, Lisa, for taking the time to walk us through your path into quality leadership, for sharing how you navigated quality through a merger and reframing high reliability for us in a way that highlights the human side. Um and uh this was a deeply valuable conversation for me. Thank you so much.

SPEAKER_00 45:54

Well, Jason, I just wanted to thank you for having me for all of the support that you have given me, and a special thank you to everyone out there listening. This is not an easy job. I thank you for your courage and all you do and know that we are in this together.

SPEAKER_02 46:13

Thanks so much for listening to today's episode of Leading Quality. If you enjoyed the show, please take a moment to like, subscribe, and share it with someone who might find it useful. You can find all our episodes at leadingquality.budsprout.com or in your favorite podcast app. The show is written and hosted by me, Jason Meadows, edited by Milan Milostavievich, and produced by Thrive Healthcare Improvement. See you next time.