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RN crisis: At UCLA Health, leadership must be visible, accessible, and transparent

From supervising staff members to delegating patient assignments, unit managers are expected to fulfill numerous obligations simultaneously. Increased healthcare demand and recent surges in COVID cases have stretched these managers and other hospital leaders thin, leading to dips in staff morale and, in some cases, miscommunication of vital data and delayed implementation of best practices. Medical centers that listen to the needs of their overworked staff, through direct engagement and continuous listening, position themselves to thoroughly and accurately assess opportunities for improvement and address areas that require urgent resolution. 

Of the many healthcare institutions that leverage Press Ganey’s annual surveys to gauge pain points and implement effective system reforms, UCLA Health stands out as an exemplary changemaker.

When a few units at the hospital scored below average in engagement, the overwhelming duties expected of unit directors seemed part of the problem. That’s when UCLA Health decided to revamp its leadership structure and create a new position: clinical nurse manager. Further, instead of promoting nurses based on succession, as similar roles had been filled historically, the organization changed its policy so that employees are now expected to apply for desired positions. This new hiring process emboldened a culture of accountability and ensured new managers would commit to change. By January 2020, the first cohort of clinical nurse managers had been approved, and units now station one leadership nurse for every 25 to 30 staff members.

“We stick to an annual survey schedule. Our individual units develop action plans from their

survey results, then marry them with nursing organization strategies in a way that is proactive and focused. Surveying helps us stay the course.” —Karen Grimley, Chief Nursing Executive, UCLA Health (31,800 employees) 

UCLA Health also streamlined its communication structure to correct failures in reporting to the C-suite and to provide more transparency. Karen Grimley now meets weekly with senior directors and monthly with unit directors. She hosts informal staff meetings, called “Conversations with Karen,” where unit leaders can flag concerns or simply discuss their day-to-day work. Opening these lines of communication has facilitated effective bedside-to-boardroom messaging and vice versa. Changes like these demonstrate system-wide commitment to improving nurse well-being and experience, in turn impacting organizational culture and patient experience outcomes. Rated the best hospital in California by U.S. News and World Report, UCLA Health continues to consider survey results when deciding the best next steps for team members, leaders, and patients. 

Key Takeaway:  Assess your leadership structure’s effectiveness and improve transparency between directors and the C-suite.

Managing teams through the pandemic has been a daunting task for many leaders in the healthcare industry. One of the biggest factors for success is understanding what your workers need from their managers and adjusting roles and responsibilities accordingly. By balancing workloads for unit leaders, organizations can ensure they’re less overwhelmed and give them the opportunity to better hold themselves and their team members accountable. As hospitals face high turnover, it’s also critical to ensure new supervisors are fit for their roles. Providing opportunities for talented team members to prove they can handle new responsibilities strengthens leadership ranks.

In addition, the constantly changing healthcare landscape demands open and transparent communication across all levels. C-suite members and senior executives should consider regular meetings with department heads, in which the latter discuss concerns and workday experiences from their units.

This approach allows team members to provide feedback to supervisors, receive instructions consistent with team goals, and understand they’re heard. The trust this openness fosters further drives better employee engagement, directly influencing improved patient experiences and outcomes. By joining the Press Ganey Workforce Well-Being Collaborative, you can identify potential solutions through participation in webinars and conversations led by peers and industry experts. 

This is the third article in our three-part “RN Crisis” series. Check out our second article featuring Cleveland Clinic's strategies for engaging RNs and elevating well-being among nurses, and our first article explaining how Bon Secours reduced and prevented RN turnover through a flexible staffing model.

About the author

As Chief Nursing Officer, Jeff leads Press Ganey’s focus on improving patient and caregiver experience and developing nursing leadership at healthcare organizations nationwide. He also plays an integral role in the company’s workforce initiatives, including Press Ganey’s Workforce Well-Being Collaborative, which focuses on supporting caregivers as they deal with the ongoing challenges of the pandemic. Prior to joining Press Ganey, Jeff served in various chief nursing officer roles at both community-based organizations and major academic medical centers throughout the US. In addition, he was the inaugural Vice President of the Magnet Recognition and Pathway to Excellence programs at the American Nurses Credentialing Center.

Profile Photo of Dr. Jeff Doucette, DNP, RN, NEA-BC, FACHE, FAAN