Living like a leader: A day with Dr. Linda Hofler, SVP-nurse executive at Vidant Health

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"There aren't really typical days when you're a clinical leader in a 974-bed hospital. There's really no such thing as 'typical.'"

Between clinical objectives, financial concerns, patient needs and complex payer dynamics, there seem to be too few hours in the day for healthcare executives to address the diverse set of organizational goals they are tasked with accomplishing.

Linda Hofler, PhD, became senior vice president-nurse executive at Greenville, N.C.-based Vidant Health in 2009. She earned her bachelor's degree in nursing from LaCrosse, Wis.-based Viterbo University, along with both a master's degree and PhD in nursing administration from East Carolina University in Greenville.

Dr. Hofler took the time to speak with Becker's Hospital Review for our "Living like a leader" series, which examines the daily routines of influential decision-makers to offer readers an idea of how they manage their energy, teams and time.

Editor's note: Responses have been lightly edited for length and clarity

Question: What's the first thing that you do when you wake up?

Dr. Linda Hofler: The first thing I do when I get up in the morning is try and be quiet, because I get up at 4:30 a.m. I head to the gym three or four days a week. The rest of my family is usually still asleep, and so I try to be quiet, try and make sure the dog doesn't bark, and get a good workout in so I can come back, have a little breakfast and collect my thoughts for the day.

Q: What do you like to do before you get to the office?

LH: My breakfast is usually a protein bar or a piece of peanut butter toast — something with a little bit of protein in it, but not too heavy. When you're trying to be healthy with your food and manage a healthy lifestyle, I try to make certain that I always eat breakfast, but not too big a breakfast.

My boss jokes about my office. He says it reminds him a little of the Cracker Barrel [laughs]. I have an office filled with things that make me smile, or things that people have given to me over the course of my career along with a lot of pictures of my family and special events that I've been part of. There's a lot of things in here that make me smile. But my office is not a place I spend a lot of time.

I spend time here in the morning getting my thoughts organized for the day, and I spend time in here at the end of the day trying to reflect on what I've done and what I have to do for the next day. What might be happening in the next week or two that I need to be thinking about? But, most of the time I'm out and about. I'm talking to people and understanding how they work, and I'm in meetings trying to determine how we can create excellence in our organization.

Q: What's the first thing that you do when you arrive at work?

LH: So the first thing I do when I arrive is power up my computer, get a cup of decaffeinated coffee, and look at a 24-hour report from our supervisors. It's a good snapshot of what's happened in the last 24 hours. Then I've got the emergency department surge board on my computer, so I spend time looking at what's happening in the ED. That kind of gives me a sense of what my day might be like, as far as where I need to support my team members and some of the challenges they'll experience during the day.

Q: What kind of work do you like to get done before lunch?

LH: We have a daily safety huddle at 10:00 a.m. There's probably about 150 people in that huddle, and we talk about the past 24 hours and the plan for the day. That really is a grounding activity for our entire organization. It helps me shape what I am going to do. There aren't really typical days when you're a clinical leader in a 974-bed hospital. There's really no such thing as "typical."

Our organization spent a great deal of time this last year talking about health and wellbeing, and burnout and joy in work. So every Monday afternoon, we have what we call Mindful Mondays. This is a time to be present with your team, or do planned team-building or things that invest in your own resilience.

Q: How much of your time is spent with your direct reports?

LH: I have a weekly check-in for an hour with my direct reports, and then I have at least one hour a month where we spend time talking about their division's performance and their personal and professional development.

The personal one-on-ones are structured around our operational imperatives. So we're talking about what's related to quality, experience and finance, and then any outliers and what we're doing to correct variance. But the conversations around personal health and wellbeing and professional development are based on the American Organization of Nurse Executives' Nurse Executive Competencies assessment, which all of my team members completed. We created individual development plans based on that self-assessment.

I might split my time about 50-50 with hospital and system work. We have eight hospitals, 100 ambulatory clinics, home health and hospice. We are trying to integrate care delivery and build innovative systems, and we're very rural so we have challenges with geographic disparities. There's a lot of work that goes into coordinating efforts between our caregivers, but I've also got budget, human resources and operational responsibilities for our flagship hospital. That's a lot of people and a lot of real estate.

Q: How often are you meeting with clinical staff or performing rounds?

LH: Probably three out of the four Mondays per month, I'm rounding on clinical units and talking with staff. We also have a very robust clinical shared governance structure, which gives me another opportunity to interface with frontline staff once a month in a structured meeting format. When I'm in the units, I'm talking to clinical staff about their work, what they love about it and what gets in the way of them being their best. I do that at least once a week, if not more often.

Q: How do you think your role is different than that of other healthcare executives?

LH: I'm a little biased, because I believe that in a hospital, nurses are kind of the backbone of the organization. Patients are in a hospital because they need 24-hour surveillance by a nurse. If they didn't, they wouldn't be in a hospital. My role is to make sure that when we put a patient in the hospital, nurses can do that surveillance and care for their patients and be exceptional. My role is to make certain that every nurse, respiratory therapist and nurse assistant that comes to work in our organization can show up, be their best and deliver on our promise to patients.

Q: What would you say is the hardest part of your day?

LH: The hardest part is when somebody can't live up to the expectations we have. I say it's hard because it's really disappointing when you have great people, but if they make a wrong decision then you have to deal with the implications of that, and that's really hard. It's just hard from many perspectives.

Q: What is the most rewarding part of your day?

LH: I love seeing people who have joy in what they've been able to do for other people. Whether it's a leader who has developed their team to be great, a leader who's developed another leader to be great, or a staff nurse whose patient comes back to visit and says, "You might not remember me, but you saved my life." There is nothing better than that.

Q: What is the last thing that you do before you leave the office?

LH: I always spend some time to think and contemplate. Someone gave me a beautiful glass globe with a hole in it, and the hole has a place to slide in messages. The message that came with this gift was, reflect on your day and think about what you're grateful for, then write it on a piece of paper and stick it in that globe. Then you can look inside and see those things that you should be grateful or thankful for. At the end of every day I try to sit down and think about what I accomplished that day. What made a difference for my staff, for others, and — most importantly — for patients? What am I grateful for? I capture it on paper, stick it in the globe, turn off the lights and go home.

Q: Do you work at home at all? How do you unwind?

LH: I really try not to. Probably five years ago, in some work I was doing with my team, I realized that when you don't shut off then your people can't shut off. So I vowed to them that I wouldn't email them on the weekends or at night, because I didn't want them sitting waiting for something they needed to do or worry about. I try to be pretty true to that. There are times when I'm tempted to email, but I try not to.

To unwind, I sit down and spend some time with my husband and my son, who is getting ready to go to college in the fall. I don't have much time left with him, but hopefully we get to eat a meal together. Then I might watch TV, and I love to read. I read a lot for work but I try to also read things from other genres. I just finished reading Michelle Obama's "Becoming," which was awesome.

In the industry that we're in now, it's really important for leaders to be mindful of the stress that is on our front-line teams. One place where I have derived great joy over the last two years is our work in really looking at experience. We have an amazing chief experience officer, and she and I do a lot of work together looking at resilience and mindfulness. We think about how we can bring joy and engagement back to team members.

When you talk to people about why they got into this work, they'll talk so much about the human relationships, yet many times bureaucracy gets in the way. I just hope that our industry will continue to focus on creating environments where the humans we have trained to be caring and compassionate can be just that, and that we don't let some of the other distractions get in the way of what healthcare was designed to be.

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