Championing better care 8,000 miles from home: Meet Tamra Minton, UPMC International's new VP of nursing and quality

In September, UPMC named Tamra Minton, MBA, MSN, RN, vice president of nursing and quality for UPMC International, a role in which she will work with UPMC's public and private partners in Ireland, Italy, China and Kazakhstan.

Most recently, Ms. Minton served as system senior director at Mon Health Medical Center in Morgantown, W.Va. Before that, she served as vice president of patient care services and chief nursing officer of UPMC East in Monroeville, Pa., where she helped open the hospital in 2012 and develop the UPMC International Training Center. 

Becker's caught up with Ms. Minton to discuss the operational and cultural components of her work, the benefits of a Pittsburgh-based system establishing a global brand, and the most essential skills one needs to truly thrive in a multicultural leadership role.

Question: UPMC has a footprint in Ireland, Italy, China and Kazakhstan. Leaders face challenges when managing teams and processes in disparate sites in the same market, so I imagine you face some unique hurdles in trying to do so across countries and time zones. What are your greatest tactical or operational challenges?

Tamra Minton: Trying to find a time that works for everyone's team members. There is a 12-hour difference between us and our partners in China, for instance. We try to split up time zones, so one day last week we had a call at 7 a.m., which was 7 p.m. for China. Later that day, I was on another call from 9:30 p.m. until about midnight with the same team in China. We must really work collegiately together to make sure we can communicate on a regular basis. That's one operational component that seems to happen well.

The next piece is related to the takeaways for a partnership. What does our international hospital partner want from its relationship with UPMC? Every country and hospital can be somewhat different based on its needs. Upfront, it's good to establish why we are joining this relationship.

Our conversations start from that understanding. Our international partnerships have to be a shared experience. Not only are we sharing our practices and best standards, but the partners are sharing with us — that's what makes the relationship so rich.

Q: What are your greatest cultural challenges?

TM: What we must realize very, very quickly is that we are not in this relationship to change another country's culture, by any means. We are there to support them.

I can give an example. I went to China for 30 days to work with physicians and nurses and talk about our partnership deliverables. I was rounding on one of the floors, and I can't speak Mandarin, unfortunately, but I noticed a blackboard behind the nurses' station. I asked, "What does that say?" A colleague said, "That says Zhang Jing in room 520 and that she had a heart attack."

My colleague continued to read patients' names, room numbers and conditions — diabetes, atrial fibrillation. I said to her, "Can you share with me — why do you put the diagnosis up there?" She explained the reasoning: Families who are at the hospital with their loved ones often come down to the floor to see if any of their friends and neighbors are hospitalized and, if so, what is wrong.

You are well aware of our confidentiality issues in the U.S. But in China, it's very common that patients want their friends to know they're in the hospital and their diagnosis. Very early on, I asked the nurse if that was something we could change — maybe remove the diagnosis but leave the patient's name and room number. I might not be able to do that. If it's something they feel strongly about, we need to work with that. But we can't have confidentiality issues risk what the deliverables of our partnership might be, like Joint Commission accreditation.

Q: Having a global brand is a big help for attracting top talent, no? What other benefits does the global brand draw for UPMC here at home in the U.S.?

TM: No. 1 — we have many employees across the system who want to learn more about other countries. When we have these relationships, we host a number of students and physicians who come to the U.S. to a UPMC hospital to shadow. This is also an opportunity to learn about our partners' medical care and their best practices. We aren't the only hospital with best practices. It's a sharing relationship.

I also believe it's an opportunity to really look at the research done in these countries. That's probably one of the most important assets that we have in working [with] them. Our partner in Italy has a research center, for instance, and our physicians are working with theirs to learn about different aspects of research, including transplants and how they take care of their patients.

Q: It takes specific strengths and skills to truly thrive in a multicultural leadership role. What are those, in your opinion?

TM: First of all, any experience you've had in a leadership role is going to be a plus. Many of our hospital partners in other countries are looking for opportunities to learn about management styles and the best way to sometimes work with nursing in general.

Flexibility is a must, I believe. Things are not always black and white; you need to be able to see some gray.

I also think understanding your management style is key. I'm a transformational leader, meaning I want to involve people. If I just wanted to tell people what to do, I would not succeed in working internationally. It's about working with them and making decisions together about what's best for their hospital.

You have to like to travel. Time zones can't frighten you. You must like to fly.

One of the most important pieces of this is emotional intelligence and how to be diplomatic in your communications, especially those involving a translator. Translation is not always translation. When trying to work with someone who doesn't speak your language, you  always need to ensure whoever is translating says it back to you first before they provide information to the person who doesn't speak the language. You must be conscientious of that — look at the verbal cues of the person you're working with, or nonverbal behaviors, and quickly realize that maybe something is incorrect in translation.

Finally, I can tell you that UPMC always practices accountable medicine and the best of quality and safety, but we can't go into our international partner hospitals like we know it all. We have to be modest in our approach. We must be firm about some things, but we can't go in as, "Poor you, you don't know how to do this," or, "Your care is not as good as what we provide at UPMC." We have to go in and be able to work with them and communicate some of the changes that might come out of our relationship with that hospital. I'm always humbled by how much I learn from the country we are working with.

Q: Let's stay with that last thought for a moment. Can you share an example? 

TM: When the first group came from China to UPMC East, they approached me about their schedule and I asked what time they prefer lunch. They needed 30 minutes for lunch and another 30 to 60 to nap. I asked, "Did you say nap? As in sleep?" Yes, they said — they are accustomed to taking a nap in the morning, midday or after lunch, then working after that and feeling much more productive. So we put time for naps into their schedule, because that's what worked for them.

When I traveled to China after that, from 11 a.m. to 1 p.m., my colleagues and I would walk about a mile back to our hotel while our colleagues took naps. We used that time to do a PowerPoint or work on an education system they asked for. One day I thought, I'm going to take a nap. I did that for 5 days in a row, taking a 30-minute nap. Afterward, I was energized and ready to run back to the hospital when it was time to go.

Q: Have you noticed any differences in how care teams in Ireland, Italy, China or Kazakhstan view the patient-provider relationship as compared to how we do so here in the States?

TM: In the U.S. we sometimes look at patient experience as one of the most important things behind quality and safety, because it's the right thing to do, but also because it's linked to reimbursement. I never look at it as a reimbursement issue. But the bottom line is that patient experience is part of pay for performance. In other countries, that doesn't exist. But what I'm seeing is every one of [the] countries we go to, they want their residents and people to stay within their country and seek medical care. They want to develop the experience a person may feel when they come to the U.S. or somewhere else for their care, but their goal is to keep them there at home.

Q: OK, have to ask — best tip to beat jet lag?

TM: Pack light and be careful what you have to drag around from one airport to another. Also, take advantage of sleeping on the plane. If you like to watch movies, a little bit's OK, but I do best if I take some type of nap. When I arrive, I feel much better, regardless of the time zone where we are landing.

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