So good morning, everyone. Thank you, Heather. Welcome to Phoenix and SCCM. I, too, have my readers, just in case I need them. Steve, what do I have to do to be a master of something? Like, I'm trying to do my thing. I'm trying to build a career. Maybe it'll come out, but I'm not a master of anything yet. That's my next goal. I feel like if you were in this morning's setup, the presidential address, and you got to hear the Surgeon General, both of which were outstanding, it feels like a nice primer for a discussion on leadership. So I think I hope we're in for a good session this morning. So I have no disclosures to make? Except I don't know how to? Okay. All right. So to start off, as I was preparing for this talk today, I asked myself, how do you actually win a debate? How do you win a debate, in particular, if you're debating someone like Steve Pastore, as an example? And so I did what any of you would have done, probably, and I Googled it to try to figure out how one actually does win a debate. And I think the most useful advice I got came from a 15-year-old who is an expert debater nationally. She lives up in the Boston area somewhere. And she taught me these three steps to making an effective argument and building an effective case. And they are to make a claim. I'm going to try to make a claim pro-leadership in the time that we spend together. She told me to support it with warrants and evidence and data. That part's a little trickier, given the topic we have, but I'm going to do my best. And most importantly, to impart impact so that there is sort of an obvious conclusion as to why the claim I'm making is the claim that I want you to follow. And so let's just start with leadership. What is leadership, after all? And there are thousands upon thousands upon thousands of definitions for this. Sharing, if you hear, that I thought were some of my favorite. Peter Drucker says leadership is someone who has followers. Kuz and Posner say it can happen anytime, anywhere, and in any function. Warren Bennis says leadership is the capacity to translate vision into reality. The U.S. Army defines it as the process of influencing people by providing purpose, direction, and motivation to accomplish the mission and improve the organization. John Maxwell says a leader is one who knows the way, goes the way, and shows the way. Douglas MacArthur says a true leader has the confidence to stand alone, the courage to make tough decisions, and the compassion to listen to the needs of others. He does not set out to be a leader, but becomes one by the equality of his actions and integrity of his intent. And then finally, Dr. Martin Luther King says a genuine leader is not a searcher for consensus, but a molder of consensus. I work with a colleague who says everything you need to know about leadership, you can read in a pamphlet. She's one of the smartest colleagues I have. I respect her. I seek her counsel often, but I struggle with that idea. But it made me wonder, is it true? Is leadership really just sort of an intuitive set of skills that some people have and some that they don't? Or are they distinct things that these programs like Wharton and Harvard and Stanford and SCCM and the Center for Creative Leadership tell us we need in terms of skills and training and coursework? I've done some of these courses. You probably have too. I've gotten value out of it. You probably have as well. But is leadership something that is taught and learned? Or is it something that we sort of come with and develop over time through experience? Simon Sinek is a, you may be familiar with him. He's an organizational psychologist who does a lot of leadership talks on, you know, TED Talks, has some books and that kind of thing. And he says leadership is proven over time. It's like exercise. If you wake up today and you decide you want to get into shape, you can put on your sneakers, you can go to the gym, you can work out. When you come home and look in the mirror, you're not going to look different. It's not like that. It takes discipline and patience and poise, deliberate intent, a sense of purpose, a real focus on your mission. Leadership is proven over time. And that's a little bit of the case that I'm hoping to make to you today. I want to ask you a couple of questions before I move on from this slide. Would you fly in a plane where there was no pilot? Would you sail on a boat with no captain? Why would we want to be on teams without leaders? I want to share a couple of stories with you. You may know some of these people on the slides. You may not. But all of them have had a role in teaching me something about leadership and about myself as a leader. So on your far left is C. William Schwab. Bill was the chief of trauma surgical critical care and emergency surgery at the University of Pennsylvania when I first joined the organization as a critical care nurse and then ultimately as a nurse practitioner. He taught me probably the most lessons about being a leader of anyone I've ever worked with. He treated everyone with such respect. He knew everyone's name. He paused to talk to everyone. He looked in their eyes. He knew their stories. He knew their families. He made everyone, regardless of the position or where you fell in the quote unquote hierarchy, feel like an important member of his family and an important member of the team. We were incredibly loyal to him as a result. Moving over to the next picture, that's Pat Riley. Pat Riley was the director of trauma when I first met him many, many years ago. He ultimately went on to succeed Bill Schwab on the left. Pat taught me the importance of humility and leadership. He would introduce himself to patients. He still does. Hey, bud, I'm Pat. That's how everyone would know him. He treated everyone fairly and with respect. Before people talked about servant leadership as a style, he practiced it. He would never ask his team to do anything that he wouldn't have done himself first. The third picture moving left to right is Vince Gracias. Vince was a fellow when I first met him as I was transitioning from a critical care nurse into my first position as a nurse practitioner. If anyone in this room knows Vince, he's a force. He is larger than life. He's got a powerful presence. When he walked into a room, even as a fellow, you knew he was there, even before his position or stature or title sort of gave him that kind of authority. Vince taught me so much about holding people up. He taught me so much about the importance of believing in people, about mentorship. He believed in me, and he believed as a trauma surgeon intensivist in the role of nurse practitioners in ICUs back in the 2000s when that was still kind of an unproven thing, at least at our organization. And so he really taught me, particularly with our trainees, to invest in them, to invest parts of ourselves in them, and to help them grow as leaders. And then finally all the way on the right is Regina Cunningham. Regina Cunningham, I met her about 12 or 13 years ago when she first came to Penn from Memorial Sloan Kettering. She joined our organization as the chief nurse executive. She is now our CEO. And what I learned from Regina, who is probably hands down one of the most phenomenal leaders I've ever watched practice, is the importance of exquisite communication. And those are her words. She's very deliberate about the use of the words exquisite communication as being a differentiator between good and great leaders. She taught me that as a leader, I could be in a room or be engaged in a conversation and not say everything that came into my mind, which was a little bit hard for me having been mentored by three surgeons on the left. But that I could learn to listen. I could learn to ask questions. I could just stay quiet. And I didn't have to share all of my thoughts. Sometimes silence was the more powerful way to communicate a message. I already told you there's not a ton of data around leadership. This is mostly, you know, a talk about style and softness. And so this is a paper that I really, really liked that I found. And so importance of leadership style towards quality and care measures in health care settings. So this is a paper that was written by a multi-professional team of authors out of Greece, which I also kind of like as a Greek woman, whose main aim was to really look for the association between leadership style and health care outcomes and quality. They did a systematic review of 18 papers. And you can see they analyzed papers across the U.S., Canada, Finland, Saudi Arabia, Kuwait, and Norway for this. They focused primarily on nursing leadership and nursing governance and leadership structures and saw that having one of these more, the variation in leadership style led outcomes around job satisfaction, productivity, retention, patient safety, environment, and clinical outcomes such as mortality. So again, a focus on leadership style, not leadership structure necessarily. This is a graphic from Sullivan-Cotter. If you're familiar with Sullivan-Cotter, they're a big consulting group out of Chicago. They focus on physician executive and advanced practice compensation workforce productivity work. And at this point in time, they have data from over 800 organizations and like 125,000 APPs. So they put out these sort of like aggregated reports based on their database. And they talk about the value of leadership when you think about leadership as a structural sort of context. And they say that the presence of an advanced practice leader in an organization can decrease turnover by up to 2%, and I'll show you some economics associated with that in just a second, can increase the optimization of APPs in your organization or on your services, can reduce physician administrative time, especially in these areas like onboarding, just day-to-day clinical and operational management, and then also with professional and disciplinary sort of activities, increase coordination between like offices and departments. So HR, medical staff offices, the clinical departments, the healthcare entities themselves, reduce the length of APP orientation, and then finally coordinate key processes, which we all know are often quite fragmented. So one might say it's kind of crazy to put up a paper here in front of you, and one of the authors is here in the audience, and I know he'll use it to make his con case as well. But this is a paper about critical care organizations building and integrating academic programs, and you'll hear more about it in a second. In fact, I see more than one author in the audience as I scan it. But I want to go on record and just say I believe in this too. I really do believe in the integration and alignment and collaboration and coordination of programs and processes. I believe in anything that promotes critical care advancement and healthcare service advancement, and certainly anything that promotes what they define as the key elements around patient care and safety, quality, research, education, and professional development. I also believe that you have to look at this through the lens of the people who drive the impact, and those are the leaders. This organizational structure is not necessarily about leaders or people or leadership per se, but certainly they're at the helm of all of this work that is being done. I'm quite sure you'll hear more about it in just a little bit. So having heard some of that, why do we need leadership? And some of this was addressed, I think, in Lauren's presidential address this morning. In fact, I think she touched on all of the bubbles around their circles. If leaders on their own cannot do anything necessarily in a vacuum, then what is the point? And the point really is that leaders can create cultures and environments where great things can happen. For all of the reasons you've already heard and everything that's in that diagram and probably many other things that I have missed, we're at an interesting, as Lauren said, time in healthcare. We've got economic pressures. There's a lot of market competitions depending on where you are and what workforce you're talking about. Critical care provider burnout, healthcare provider burnout in general, the pandemic, unionization of our healthcare team members, and then certainly workforce shortages. All of these beg for strong leadership. The question for us is what kind of leadership is the right kind of leadership to move us into the future? On the right, I just included a couple of stats with some references down below for you in the back that support a couple of those bubbles. But did you know in 2021, we lost almost 334,000 healthcare providers across the U.S.? You know that turnover is expensive, and I'll show you some data from our organization in just a moment. And unionization, whether you're pro or against, is just a very big reality right now. We increasingly have several members of our teams voting to unionize. About 15% of residents and interns are now represented by unions. So that's 30,000 across the U.S. And about 30% of registered nurses in this country are now represented by unions. That's about 230,000. And so the climate is changing, the landscape is changing, and one might wonder whether or not leadership has to change to meet these changing environmental demands. This is a little bit of data from our organization. Our story is your story. Here's our growth over the past decade in advanced practice. And we've experienced an incredibly steep incline in hiring for all advanced practice roles across our organization. The dark blue bar there represents our system as a whole. The red bar there represents our main hospital, the Hospital of the University of Pennsylvania. But you can see that the trend lines are the same across the board. We've got about a 400% increase in hiring of APPs to fill roles in not just critical care, but all areas of our healthcare enterprise. As I said, this is not unique to us. This is a local, regional, and national thing. Lots of stats out there about the demand for this workforce, our workforce in the future, and a lot of projections around growth that is yet to be realized. And so there are some estimates that say by 2031, the PA workforce will grow by about 28%, and the APRN respective roles will also grow by about 40%. So growth is happening. This kind of growth needs leadership. On the flip side of this, this is our turnover story. I couldn't show you the fun side before and not sort of show you some of the challenges that we've had along the way. And so this dates about the past nine years as well. You can see that back in 14, before we had some FY14, before we had some structure around our leadership at our organization locally and across our system, we were suffering from some pretty high turnover in the range of, you know, 13 to 14%. At that time, that exceeded national benchmarks and I've got some benchmarks there for Sullivan-Cotter there in the lower left. It was costing us a lot of money and people and was certainly having an impact on the work that we were able to do and our clinical growth targets and the care that we were providing. And then over years, as we've developed leadership, excluding the pandemic on the far right for a second, you can see what an impact we had down to FY19, where it was about a third of sort of the pre-leadership structure timelines. Now, I told you turnover is expensive. And so the national math for this generally says that you should calculate turnover costs at about 1.5 times your market's salary, wages, and benefits. And these are just direct cost formulas at this point. And that at our organization, at our scale, what that translates into is about a million dollars in cost avoidance for every 1% decrease in turnover that we can actualize. And so you could quickly, if you had the wrong numbers, see the math between FY14 when we were at 14% turnover and FY19 when we were at like 4% turnover. So this is a leadership story. This was putting leadership in place at across the enterprise at all levels to really focus on understanding what some of the drivers were, what some of the challenges were, and what some of the needs were. This is a big part of the work that I do with my senior team of leaders at our organization. It is our job to know that within some of this, there is service-to-service variability. It is our job to know that APPs are leaving a lot sooner now than they were pre-pandemic. They're leaving at year three, not at year seven. Leadership sees around corners. So this is a story of data, but it's also a story of perspective, and I think that's part of the value proposition of having leadership. And then finally, I want to end with this. We may be at a point where we're not so much, as I said when I started out, talking about more leaders or less leaders, but talking about different leadership, new types of leadership. This is a paper out of Canada, A New Era of Health Leadership, and they really focus on the transition we're at between more traditional models of leadership that are top-down, hierarchical, kind of command and control, a lot of what many of us probably grew up within, focused on the business of leadership, into an environment of leadership where there is empowerment, where we're adaptable and agile in our roles, and where we're leading teams through our values. And in their description, the values in particular around the culture of respect and civility, open communication, transparency and compassion. And so they say the groundwork is there for us as health leaders to embrace a new era of leadership, to develop an era of a diverse and empowered workforce and a culture that aligns with the values we want to instill. So I ask you, as I pass the podium over to our next speaker, to consider whether or not we need more leaders or less leaders, or just different leaders and different leadership in the future. Thank you very much.

healthcare leadership

workforce challenges

empowerment

value-driven cultures

leadership evolution