This week on the Clinicians in Leadership podcast, we sit down with Justin Cauthen, MHI, CLSSBB, PMP and Veteran Army Chief Clinical Sergeant Major and now Federal Account Manager for Vaccines (NW Territory) at Sanofi —to unpack the lessons learned at the intersection of battlefield medicine and hospital boardrooms. With more than 20 years spanning medevac missions, health system executive leadership, and federal health strategy, Cauthen offers a rare dual perspective. The conversation explores the structural and cultural divides between clinicians and administrators—and actionable strategies any U.S. health leader can deploy to bridge them.
In an era when only one in three nurses remain in their roles each year, Cauthen’s insights on presence, empathy, professional development, and servant leadership—are more urgent than ever.
Q: What are the main misunderstandings between frontline clinical staff and healthcare administrators? The central disconnect, according to Cauthen, comes down to “living in different hats”—a vivid metaphor he uses to describe the siloed perspectives that naturally develop when staff only see their own side of the healthcare universe.
“Imagine if you were born in this hat and you went to school inside this hat and you got married in this hat and you had a career in this hat. Your universe would, of course, be that hat, and that really is just a metaphor...that we can never see past our own experiences.”
In military medicine, Cauthen notes, most leaders “have seen both sides”—serving years as clinicians before ascending to command. By contrast, many U.S. civilian administrators may have business backgrounds, leading to both insecurity and communication gaps:
How do we bridge this?
Q: Why does military medicine invest so heavily in leadership development, and what can civilian systems learn from this?
Unlike many civilian systems, military healthcare formalizes the transition from clinician to leader. Cauthen describes reaching a point where his “full-time job was how to lead, take care of, advocate and work for people”—not clinical care.
“The way that the Gen Z force is going to come into healthcare is going to be so much different than working with and for millennials and working with a generation X and previous to that. We have to reinvent ourselves as leaders.”
Actionable civilian takeaways:
Q: Where must health administrators explicitly advocate for clinical teams?
Cauthen is blunt: annual certifications and upskilling are standard for clinicians but rare for executives. This disconnect sends the wrong signal about what is valued.
“There’s a hero of mine...a chief people officer...she doesn’t have an office. She has rolling desks in all her different buildings...it’s her job to study, not the patient, but that person to see what they need.”
“If we were to give bonuses, rewards, promotion opportunities...based on how many people stuck around, that would be far more telling of the environment you have.”
Q: How can healthcare administrators structurally protect the wellbeing of clinical teams?
Burnout and moral injury are not just individual failures—they’re the result of broken systems and outdated expectations. Cauthen highlights several structural fixes:
“You need to take your laptop and live in that ICU. You need to take your computer and go and be in the outpatient surgical waiting room. You need to bask in these environments.”
Notably:
Q: How do you create a culture where staff feel safe reporting abuse and mistakes?
It’s not about “fixing” culture in a single crisis, Cauthen says—it’s about daily, habitual rituals:
“In a perfect world, if PA McConnell has a bad moment with a patient, they feel safe enough to talk about it and bring it up to someone immediately.”
“We couldn’t find the hospital commander because chances are he was going to surgery to watch surgery or he was learning why a vasectomy takes this amount of time...”
Action Steps:
Q: What actually moves the needle on retention and engagement?
Money matters, but empowerment matters 11x more, according to Cauthen. Staff who feel they co-own the organization and its decisions stay longer and contribute more.
“There is a chance we are going to lose this fight. And if we do for now, I think the right answer is to continue what we’re doing for the next 30 days and then readdress in 60 days. Team, what do you think about how we approach this?”
“I’d like to see more teams say, hey, we’d like to pay for and sponsor to send you to become a, let’s say for you, an ortho specialist...Are you willing to do that for us and come back and be that?”
Q: What innovative support programs actually work for clinical staff?
From Lean Six Sigma to clinical rotations and skill-building, Cauthen’s facility experimented with:
“This involved 26 different specialties, and it includes about 800 people across Fort Carson currently, coming in and rotating through.”
Q: If I’ve never worked at the bedside, how do I become a more effective leader?
Cauthen’s advice is both simple and profound:
“No one went to medical school, to nurse school, trained to be a...laboratory tech with anything less than the highest and most noble of intentions for their craft.”
“The best leaders are the ones that see the humanity in all of their people...Sometimes we’re so scared to simply ask the question of, I want to know more about your son. What does your son do?”
“The acknowledgment and the value placed in EQ is so important. And probably the most underspoken about thing in healthcare today.”
Justin Cauthen, MHI’s journey from the battlefield to the boardroom proves that bridging the clinical-administrative divide requires more than policies—it requires presence, humility, and daily acts of advocacy. The most effective healthcare organizations, military or civilian, are those where leaders are “fanboys and fangirls” of their teams, shield their staff from harm, and relentlessly empower clinicians to drive change.
For U.S. health executives, the call to action is clear: Be present, empower your people, and champion professional growth. Invest time where it matters—on the front lines, not just in the conference room—and you’ll find that culture, retention, and innovation will follow.
For more insights from frontline leaders like Justin Cauthen, MHI, subscribe to the Clinicians in Leadership podcast or follow the American Journal of Healthcare Strategy for future episodes and analysis.
<p>I'd like to see more teams say, "Hey, we'd like to pay for and sponsor to send you to become a let's say for you an ortho specialist, right? Um are you willing to do that for us and come back and be that?" Um I know a lot of um that was really popular for systems in the 90s um on the civilian side and then that died out.</p> <p>[Music] Hello, this is Zach with the American Journal of Healthc Care Strategy and you are listening to the Clinicians and Leadership podcast series where we focus on empowering clinicians from bedside to boardroom. Today I am joined by Mr. Justin Cawen. Mr. Coffin, why don't you take a second to introduce yourself, tell us a little bit about your experience and in your current role today. Hi everyone. Hi uh clinicians and podcast for those people who are aware.</p> <p>Happy Super Bowl Sunday for when we're recording this. Uh my name is Justin Cawan. Um I've been in the Army for a little over 20 years now. Um I'm actually going to be a civilian in about three weeks. Um for so I'll be retiring. With that being said, my opinions are my own. Every answer I have today is based off of the experiences I have, but this is just how I feel about certain things. Um I'm a flight medic by trade.</p> <p>So the Blackhawk helicopters with Red Crosses is where I did the majority of my job. Um I but I transferred into or transitioned rather into a clinical executive side of things. Uh later on in my career and fell in love with that through both my degree and some positions I had an opportunity to do. Um I at one point I had the honor and the opportunity to be the American adviser to the Afghan surgeon general of um the Islamic uh Republic of Afghanistan.</p> <p>And uh there I advised him on all things from acquisitions, extending healthcare service lines, capability growth, um training of healthcare providers as well as optimization of them. Um, I later got a chance to lead a medevac unit, again, 15 helicopters and 140 uh soldiers, including flight paramedics.</p> <p>And we had a chance to optimize where our flight paramedics train and um the vast majority of uh flight, excuse me, of critical care capabilities that happen here in Colorado Springs is actually a joint effort with our flight paramedics, training with them. Uh I went on later to become the uh the chief clinical sergeant major, the the closest thing in the civilian world to be um the chief executive director or sorry the clinical executive director of a uh 2,700 person facility.</p> <p>Um it's a healthcare system that ran across 28 buildings, three different installations and uh two different states. Um, and I I I tell I tell people a lot I was like the cruise director of a ship where I dealt with kind of the more acute daily things and I was also the um the eyes and ears and kind of the uh the observation capability of the seauite. Um yeah, the hospital is called Evans Army Community Hospital.</p> <p>I'm proud to say on Friday they actually passed their TJC inspection and we're really proud of that team. Um and uh we we still live here in Colorado Springs. My wife's actually getting ready to work for that hospital uh here starting tomorrow. That's awesome. Well, Mr. Coffin, we're we're grateful to have you on today. Congratulations on your your upcoming retirement um in the career and thank you for our service to and not just in the health industry, but to to our country as well.</p> <p>And so, um, I'm I'm excited to dive in and to hear about your your experience and insights on on this topic and these questions that we're going to cover today because I just I think throughout your career, you're you're starting off as as the flight medic and then and then moving all just throughout the career, stepping into the current role that you are now, you have you have bridged the gap between the frontline clinical staff, sometimes quite literally the the frontline clinical staff and and and the seauite and and the administration side and that there are there are gaps in in experience and in in goals and in in language that that you have stepped into and filled and and filled well.</p> <p>And so I'm I'm really excited to to have you on today and to to be diving into these topics. And um I I think I guess starting off recognizing that there are there are gaps and misunderstandings that can be had between the clinical staff and and the administrators. what are some of the common misunderstandings or gaps between clinical staff and administrators and and how can we bridge those gaps? So, thank you first of all, your compliments are not warranted, but I do appreciate it a lot.</p> <p>Um uh one thing I used to tell my soldiers a lot is I would hold a hat in front of them and I would explain to them um imagine if you were born in this hat and you went to school inside this hat and you got married in this hat and you had a career in this hat. Your universe would of course be that hat. And that really is just a metaphor that I tell junior soldiers and junior clinicians as well that we can never see past our own experiences.</p> <p>Um in the military we uh really enjoy the advantage of everyone in the the healthc care seuitees of these military hospitals are have been in the military for a minimum of 16 to 18 years and they've gotten to see both sides of it. But outside that seauite there's a lot of very good, very smart, very committed clinicians that haven't had that opportunity yet, right? They've only seen one side of that.</p> <p>So we do have different love languages that clinician you as a as a as a soon to be amazing PA and I'm so proud of you by the way Zach should be focused on no more than that 25 or less patients a day focusing on the down and in if you were while that seuite is focusing on the proverbial up and out right you with those 25 patients I had 37 service lines I had to deal with a day and I am a baby hospital compared to some of these much larger systems that we see on the outside world.</p> <p>Um that could have in excess of a sea suite could be worried up to quite literally 213 service lines is one hospital that comes to mind. So the allocation of resources and the focus of energies um and that can be people, money, opportunities and things is always forefront in their minds. Well, as a PA, practitioner, nurse, um even our front desk workers at our amazing clinics, their focus needs to be heavily in the acute, thinking about that single patient at a time, and rightfully so.</p> <p>But I have found that the clinics, the service lines, the capabilities that get the most fiscal and manpower attention are the ones that speak the love language of the seauite, right? And there's a two-way bridge here that we'll talk about here in a second, right?</p> <p>But from the clinician side of things, those that become students of finances and understanding business and I think that every single college student should be required to take a lean six sigma white belt at a minimum so that we all have a commonality in language, right? And that's something you can do online for four hours.</p> <p>I think that's the most powerful thing an orthopedic surgeon or a chief of internal medicine could do for him or herself and for their teams is to understand that at a minimum explain this is how fiscally and I don't mean just dollars and cents I mean also people hiring opportunities building of physical clinics expanding of service lines this can help the team right because sometimes it's very quick I did it as well we can look at the seauite demonize them as the proverbial Mr.</p> <p>Moneybags that at the end of the day just thinks about how can I make more money. But the truth is that they feel as much pressure from a meta scale of how much stuff I have to put to keep the machine running, much less be able to expand it to uh alleviate stressors that each individual group practice manager or chief of department or clinic leader or charge nurse feels, right? just as much as you feel at that critical and acute patient that is actively trying to pass. Right. Well, and Mr.</p> <p>Coffin, I think that you I I think that that highlights just the importance of of this podcast and and the importance of individuals like yourself who step into roles like that who who have the perspectives and and the experience and can speak the language of the clinicians as well as the perspectives and the experience and can speak the language of the executives.</p> <p>And and that that gap is is is there's there's like you said there's there's pressure and strain that that both components of health care systems face and and having someone with experience and the perspective of both that can step into that is is is critical for the success of of both both camps of both the patient care clinical staff as well as the administrative seuite staff.</p> <p>And so um I'm sorry and to humanize the seauite a little bit to your point um in the military we have a doctor we have a nurse um we have clinicians and specialties that come from those areas um that's not as common necessarily in the civilian and the executive world and as a guy who's who is the least qualified to be in that seauite I can tell you um seauite members really do have a intimidation of those providers as well there is a sense ense of unworth a healthy sense of unworthiness of I'm just a I'm a business guy.</p> <p>I got an MBA from insert X school. How how am I really worthy to tell these doctors what to do? So sometimes through that fear there's this paralysis of action because how could I ever understand and empathize what that incredibly smart, incredibly talented and incredibly stressed doctor is going through? I think both sides desperately want to come together, but that gap fear is is something that we don't it's so visceral and it's something that we don't acknowledge enough.</p> <p>And I think the first thing to bridge that gap comes with saying Dr. So and so PA McConnell I I don't even know what I don't know about your world. Can you help me with this? These are the things that I do know and this is what I focus on. Do you think that from your opinion and this could be valid warranted or not is that what I should be worried about? If we all take a more unilateral student mindset, I think that's the first step.</p> <p>And I know I'm talking about kind of nuanced soft skills, but in a world where it is very technical skilled focused, I think we need an injection of that a little bit more. Right. Right. And I think that trans that that transitions to this next question I'm interested in asking you and hearing your perspective on um you you've just mentioned seeking out and and listening and and in a sense advocating for for clinical staff.</p> <p>And so I'm I'm curious, what are some of the more critical areas where a health administration should be advocating for their clinical staff so that that clinical staff feels that support and and bridges that gap? Um, how can your administration kind of take that step forward and and where are those areas where advocacy is critical? Yeah. Yeah. Thank you.</p> <p>So I think in in your world as a PA, as providers, as nurses, and as technicians, we all have very robust certifications that we have to do every year to maintain those skills. Not so much in the executive, administrative or leadership world. I would like to see, and this is just if I was king for a day, right? I would like to see a far more uh substantiated leadership path.</p> <p>And I think that's one of the reasons why the military is so successful is there's a point in our careers where we just become professional leaders. Like I stopped being a medic a long time ago and my full-time job was how to lead, take care of, advocate and uh work for people, right? And we have this, you know, very indoctrinated servant leadership standpoint. So much so that very very very accomplished uh professionals come to the military to study that.</p> <p>And it's not because we're better, it's just because we have time allocated in our careers to focus on those things. So it does start with the executives trying to be better and acknowledging that our leadership changes. The way that the Gen Z force is going to come into healthcare is going to be so much different than working with and for millennials and working with a generation X and previous to that excuse me previous to that. And we do have to reinvent ourselves as leaders.</p> <p>With that being said though there's only one seuite and there can be up to as we said up to you know 413 service lines. Um, one of the ways that I think is the biggest way that we can advocate for people is one, physical presence, but not just from walking around. I think the way that we have to do it is we have to establish a level of trust. There's a uh a hero of mine. Um, she's a chief people officer of a of a facility. Um, and she doesn't own she doesn't have an office.</p> <p>She has rolling desks in all her different buildings. and uh she just took some of the rolling nurse uh uh vital signs machines, chopped them down, put a desk on it, and moves them around the facility. And it's her job to study not the patient, but that person to see what they need. We talk a lot about, especially in in the healthcare system I'm in, that the patient is the center of the healthcare model.</p> <p>And yes, they should be centric in the standpoint of that's who we're caring for, but also their opinion should be validated. But we focus so much on the responsibilities and conduct of our health care teams. I wish that our executives did a better job and our leaders, our managers, our senior nurses, our directors of uh healthcare lines, healthcare service lines that we that we also expected that same level of conduct with those patients.</p> <p>I've seen a lot of ner a lot of teams suffer at the benefit of the patient when there wasn't necessarily a fiscal opportunity to really delve in and say was this nurse coffin's fault or is there something deeper at play here? I would argue that if we spent a little bit more time asking the well I have known PA McConnell for a long time and one of the things that he's always done is he's always treated patients with any respect. I've never seen this before.</p> <p>And sometimes we do hurt those teammates on those teams, right? And I think we need to be more formally trained in the in the leadership and admin side of kind of helping differentiate between um poor victim patient versus provider and what they're trying to do on a daily basis. Right now, could that pendulum swing and be an extreme on the other side and completely take into account that patient's suffering? 1,000%. But what I see right now in the world is we're on the other end of that spectrum.</p> <p>Um really focusing on um catering to the patient potentially an unhealthy way at the uh just to the detriment of our teams. And I Mr. Cin I I I think you made a lot of really interesting points there and I'm I'm excited to to dive into this next question. You you talked about the the the pendulum swinging to to prioritize the patient and and healthcare is about taking care of the patients.</p> <p>Um yet there's an opportunity there seems to be opportunities for for your administration and organizations to to provide care for both the patients without having to neglect or or cause some issues with with the clinical staff that's responsible for providing care for the patients.</p> <p>And so with that there's with looking at healthcare and and and just personally talking in with uh clinicians and and seeing being in clinical environments burnout and moral injury are are significant concerns and those concerns are are growing. And so what are some structural changes or or some ways that administrations and administrators can can implement changes or or uh structural changes to to protect the well-being of their clinical teams. Thank you.</p> <p>So I'm going to lump not just executives into this but anyone that's in a leadership position. And I'm going to put this as a two-part so bear with me. So, first things first, I think that we've thrown so much on our care teams where we've kind of created this like separation of church and state, if you will, between oh, the executives don't talk to the patients at all. The leaders don't talk to the patients. That's the nurse's job. That's the primary care manager's job.</p> <p>That is the con that is the person giving a consult's job to talk to the patient. I would love to see and we I had an opportunity to do this at our last hospital um and I was supported in this um where the people that were really giving the bad news to the patient of you're not behaving the way that we would expect you to. You are doing things that are not fair to this team fell on a more administrative side of things. And this was great for two reasons.</p> <p>One, the patient is able to separate who the caregiver is and who their advocate is versus someone who is the proverbial referee of health care. Does that make sense? And second of all, your team sees you do it. There's a lot of there's a big statement when I had to walk the quarter mile one way, take some stairs up, get on my visa and say, "Bear with me. Let me talk to you." I talk to the supervisor and say, "Hey, I'd like to handle this." And then I go in and advocate for that team.</p> <p>nurse isn't in there, but they know what's going on, right? And they talk to each other and they know that they if if an executive is willing to put themselves in the line of fire for that patient and be the bad guy. One is you're ingesting the negative comments. And in the military, comment cards really are kind of powerful for a number of services, not just healthcare, right? For for a lot of things.</p> <p>those can really affect people's uh reports in a very direct or performance reports in a very direct way, right? So, you're now ingesting that and you are being the shield of that team. And I noticed that the more we did that, the more honest teammates were with us in a good way and a bad way. And I think we'll probably talk about that a little bit later, but that is really your gateway into establishing a much stronger locust andor relationship with those teams.</p> <p>and you're going to discover things about those teams and the functionality of them that you wouldn't necessar necessarily had before. That's part one. I think the other part to that is the supervisors, the nursing supervisors, the senior clinicians, the um the department chiefs, those people that have a foot in both doors, if you will. Um they need to also understand at what point in time is this nurse being enough.</p> <p>I think sometimes these supervisors get the impressions from executives of certain expectations and that's also on the clinical leaders as well as the executives to have honest communications. No, I'm not trying to add more patients. I don't want to see a 1:6 ratio with your nurses. I've never said that. Right? And I think sometimes we reward the wrong things in our uh in our mid-level leaders, those those clinical leaders, if you will.</p> <p>I think sometimes necessarily reward indiv uh acute efficiency as opposed to retainability. I think if we were to give uh bonuses, rewards, promotion opportunities, and maybe just good reports, good report cards um based on how many people stuck around, that would be far more telling of the environment you have as opposed to you have now uh created uh the ability to house 18 out of 18 patients at all time on your floor.</p> <p>What you didn't know from that is that you are now making nurses do a 1:7 patient ratio. Three of those patients are in heperin drips. one of those patients is a suicide watch and that's every single day. Um the the professional world's average turnover um for anyone that receives a um pay scale of $150,000 a year and less is 50% a year. That means half the people are going to leave and you're going to need to replace them.</p> <p>Um and we talk about from a financial standpoint that doesn't make sense anyways because you're probably have to pay the next person more and things like that. Um healthcare is worse. Healthcare is hovering around 34% retainability for uh nurses specifically, which means you can expect to keep onethird of your staff. Now, that one-third of staff that stays is most like is I think 80% likely to stay for 10 years or longer.</p> <p>Um, but to kind of be okay with twothirds of your staff just leaving, that's big. Um, and it's for two reasons. One is there's cultures within each of these things, both being a doctor, a PA, a nurse, we still have these environments of eating their young. the best way to train you is dump all the patients on you.</p> <p>And I think we've kind of created this assembly line of I'm going to milk this p this nurse who's getting or this doctor who's getting their opportunity uh for the first year or two immediately after school and I'm going to utilize them the best to to uh to to everything that I can to to the most of their potential. And that's that's a very 1960s mentality where the people who are new, they haven't really earned their their safety net that the organization should provide them, right?</p> <p>We saw that in the military of the 1960s as well as the executive world of the 1960s. And that doesn't fit with Gen Z coming in. Gen Z's biggest focuses are safety, security, and belonging. And we're not giving those things to them when we have the you're the brand new nurse. The best way I can have you learn is six patients at once. You're the brand new PA.</p> <p>The best thing I can have you do is be the acute patient with 20 minute or sorry, 15-inute consults and you're going to see a minimum of 34 patients a day.</p> <p>And now you as the PA have immediately learned once you came into the team is I can either physically see the patient and then add another four hours on on the backside doing good honest charting for those patients thinking down and in as the clinician you are or I can turn around and start making that patient suffer and there's going to be a trickle down and a trickle up effect either way that we go on that and it starts and ends with the executives being present in those teams and sen and senior leaders being present in those teams and telling them honestly.</p> <p>It is okay to do less with less. I want you, Dr. McConnell, to be here for the next 30 years. What would it take to stay within the Justin Hospital for the next 30 years? How can I make you feel loyal to this team? Well, Mr.</p> <p>Coffin, I I I think that there's a lot of really interesting points you brought up and I I love just that the emphasis on on on culture and and creating that culture um that that is supportive and and uh just I mean I I I just think about walking into the a room of of a patient that's not behaving properly.</p> <p>the the benefits that that brings between that administrator and their their frontline clinical staff, that relationship, the benefits that that does there, but but also the the perspective that that administrator gains on what clinical staff go through on on a regular basis and especially in the the healthc care field. One what a key characteristic that you need is is resiliency.</p> <p>and and it's it's easy to to say resil to preach the importance of resiliency if if you're not necessarily don't have that perspective of what other people go through. And I I think that you you balanced that that culture and and how you create that that really really well. On that note, Zach, the sad truth is as we sit here and record this and as the listener listens to it, somewhere in America right now, there is a health care professional getting physically or sexually assaulted by a patient.</p> <p>And the truth is those nurses, those caregivers, maybe the housekeeping staff, they have been given the uh the impression that someone up the chain doesn't care. Maybe it was a manager that misunderstood something an executive said. Maybe it's an executive that's never once considered that ever being a thing because patients are perfect and they never do anything wrong. Just like nurses are always having good days, just like doctors never make a mistake, right?</p> <p>these assumptions that we have right we in the army we say that you get what you ex what you inspect not what you expect out of your people I can't trust anything more than the than the first person witnessing that I have of a patient's conduct and and say a and a healthcare provider's expertise I think that that transitions us to this this next question really well and and it's just this this you pe people in healthcare especially your clinical staff go through a and and you just mentioned how somewhere right now and that's the sad truth is that there's there's a nurse that is being assaulted by a patient.</p> <p>Um and that is terrible and and tragic and and we'd love for all of that to go away. It's sad to say that that's not going to go away at least overnight.</p> <p>And so how can healthcare leaders create a culture of safety where uh not both both physical but also psychological where where clinicians and your your other staff feel comfortable bringing concerns to administration and and and bringing forth these these terrible things that happen because there's not another industry where where someone gets assaulted and we say like tough luck that's how it goes.</p> <p>every other industry there's repercussions but but but not necessarily all the time in healthcare. So so how do how can we create this culture of psychological safety for for staff? I will say first and foremost that I think it's great that we acknowledge the problem. There is health care systems internationally that refuse to admit that this is a challenge. And if there's anywhere that's going to get fixed first, it's going to be in the United States of America.</p> <p>We we're very good culturally at celebrating mistakes, mishaps, and as we call it in the military, near misses, right? Not celebrating them for the fact that they're things, but acknowledging and saying, "We saw this. This is something that is a challenge, and now we're acknowledging that there is a fix needed." And we do that.</p> <p>I know like because we live in this culture, we kind of like say, "Yeah, whatever." But truthfully, I've I've seen a lot of international systems and and and if it's ever going to get fixed, it's going to get fixed here first. On that note, I think it really does, not to sound too cheesy, but it starts with the safety huddle because a safety huddle shouldn't be considered this thing that we have to do for the purposes of the joint commission.</p> <p>This isn't art is that of a safety huddle because safety huddles can so quickly turn into just a hey, we have the corporate party coming up or we have the Christmas thing or hey, we got to vote for the new t uh you know, clinic t-shirts, right? instead of saying in the last 24 hours these things happened.</p> <p>In a perfect world, if PA McConnell has a bad moment with a patient, they feel safe enough to talk about it and bring it up to someone immediately to call me on Vera or call me on um the Am I system or whatever you're using immediately. But that, like you said, that doesn't happen overnight.</p> <p>If we can reflect on the last 24 hours and we can get people feel safe enough to say in this group in this uh room of colleagues there's no chain of command in there right of colleagues saying yeah so uh room 17 yesterday uh it was a challenge and this is why right if we could if we could actually say those things there right I love the executives I got to work with because they really embodied the I get what I inspect not what I expect out of the came, we couldn't find the hospital commander because chances are he was going to surgery to watch surgery or he was learning like why a vasectomy takes this amount of time or why an optometry consult cannot be faced or cannot be telephonic ever.</p> <p>Why these coh constraints are still stopping our our Red Cross team from doing this, right? and our and our um and my uh chief nurse, my chief doctor, my chief of safety, they all did the same things, constantly at other clinics safety huddles prior to the hospital safety huddle, simply watching and observing.</p> <p>And the teams that were the most effective and the teams that were safe enough or sorry, that were honest enough and felt safe enough to talk about things were teams that had very very hard talks in their safety hole.</p> <p>And that's hard to do when your boss is staring at you and you're trying to get that promotion to be a um a charge nurse or you're trying to get that opportunity to move into an outpatient setting and that you have, you know, proven your stripes on the surgical consult world um or you are a radiology tech and you really want to be able to go to MRI school, right? That's hard to say we're doing this wrong.</p> <p>So, it starts with that executive being there and just slow clapping every time they say something and pointing that out. So those supervisors see where those executive focuses are. Well, Mr.</p> <p>C, I think it's really interesting that the it it sounds like part of the solution at least is is to that that culture is not created in the exact moment that the nurse gets assaulted and that nurse is having to process emotionally, physically what just happened and then decide whether she's going to bring that to administration or not.</p> <p>that that culture is created each and every day through the habits and the characteristics and the routines and the processes of of an organization and of a clinic and of a group. Um, and I and I think that that's such a helpful distinction to know that this this takes time, but it it's the result of repeated rituals and habits. And and there's only so much time in a day. I acknowledge that. But if you're a leader, I need you to ask yourself, how many hours am I legitimately spending in meetings?</p> <p>There was a time when I had a 7-hour meeting day, like between all the different meetings, seven hours. And it was that way every single week for a while. I was stupid enough to ask, "Do I need to be at these?" And I just I was empowered not to show up to certain things. And there was far more important things that we can do with our time. I think we need to have some very critical questions of do all these people need to go all to all these things.</p> <p>and I start putting time in my schedule where I go around and I'm present and just being there 5 hours a day once every 3 weeks ain't going to cut it, right? You need to take your laptop and live in that ICU. You need to take that take your computer and go and be in the outpatient surgical waiting room. You need to bask in these environments.</p> <p>And I would even argue that we probably need to go so far as to say that we need to be brave enough to be patients of our facilities so we can have that true empathy of the patient because you have bad days, you get tired, you get annoyed by waiting, too. Even though they're doing the best they can and there's a seasonal flu and all of our screeners are now out and they're doing four screeners and they have a clinic of, you know, 82 providers, they are doing the best they can, right?</p> <p>So understanding those things is so important. You have to give time to this. But on the backside, what if I told you that you had to sacrifice 40% of your meetings, but on the back side of that, the decisions that you make are going to be 300 to 500% more effective because of it and more accurate and therefore you'll need more need less meetings.</p> <p>Anyways, there are so many times where there's meetings of leaders around the world on the executive side, on the corporate side, healthcare, whatever business, where a handful of people are in an echo chamber banging their heads against a very fancy, very big table, right? Completely out of tune with what the the workforce, what the team, the people that actually do the magic every day truly need.</p> <p>I also would say that if you are a leader in an organization that that has safety holes, healthcare specifically, every day that you get to go to the if you have an opportunity to go to the hospital level one, bring a different employee or teammate with you to that one so that you so that they can understand the love language of those teams to better arm your teammates with the ammunition that it takes to be able to actually like talk to the leaders.</p> <p>As people on board, hopefully your executives are going to give you kind of a background of themselves, what the hospital leader wants and things like that. And if they have a slide up that talks about their Briggs Meyers personality test, that is actually them saying, "This is the key on how to beat me.</p> <p>This is how you win against me and win me over." Actually, in the military, we literally have a slide in our we call it a baseball card, which is our bio and our photo and stuff like how to beat me. how how to convince me of something that is absolutely critical, right?</p> <p>And and and and I hope we have more of that more often because there are so many there's there's a there's a there's a housekeeper right now that is banging their head against a wall trying to show how at risk a healthc care facility is right now from infection control but just can't find the right words to explain it to a leader. Right. and just the equipping nature of that.</p> <p>Not not only are you bringing those frontline staff, those clinical staff into the environment where decisions are being made, but also you're telling them, hey, as much like as I want to communicate with you, well, here's a way that you can communicate with me well. You're you're equipping them beyond just the simple, oh, you're just in the environment now.</p> <p>Now you got to kind of sink or swim, figure it out, figure out the business language, the administration language, how to navigate these new waters that you haven't necessarily maybe willingly wanted to step in. There's just an issue that you are trying to bring to the administration's table, but you're also letting them know how here's how you can talk to me and and help, you know, see what I prioritize and and how I approach these decisions as well. And I think that goes so far. Exactly.</p> <p>Thank you. And I think a lot of leaders are quick to say, well, if I give that to them, then they will abuse that. I would say that us as leaders really need to check our ego a lot. A lot of these people want very little to do with that world, right? They if they are coming to you and they're trying to seek try and knock on that door and seek you out, it is not because they want to be there. It's because there is a solution that needs to happen to a problem.</p> <p>And a lot of executives when they first and leaders in general when they first open themselves up to that, they're like, "Okay, I'm going to take a leap of faith. I'm going to go to um med surge floor this uh nurse Zach, tell me all your problems, they're going to get attacked." And that is part of it. You have to go there and understand that that nurse, that PA, that surgeon that's yelling at you, he or she is not the problem.</p> <p>Even though they may use words like you, the executive, the evil leader in the sky, the man behind the curtain are the problem, you have to be mature enough to know that the problem is the problem. And you have to recapture the efforts of both sides of that to have good conversations of how to fix things. classic example.</p> <p>Um they're building um in in inpatient facilities now they're changing kind of how they put the pit for nurses, PAs, anyone like that that's visiting the floor and needs to work on Epic or whatever system they're working on. Um and how they're changing the computers and privacy and things like that.</p> <p>But uh initially a lot of facilities um especially in the Midwest kind of missed the mark on how they built them and accidentally messed up um the angles of things which would cause HIPPA concerns and stuff like that. And so they spent all this money to build this system. And now we have these six nurses plus two PAs and one doctor that only have access to like four computers at a time. Um, and it's very easy to demonize that leadership team of you guys are idiots.</p> <p>You didn't bother understanding. And yes, we can definitely talk about that. We should have built some empathy prior to that, but that's that's that that's behind us, right? We're here now. That team, those leaders have to come in and say, "Yes, the this is where we're at right now. I'm not going to have the money, the resources, or the ability to fix this for eight months. That is the truth. In the next eight months though, what would you suggest?</p> <p>What is the best way to make this good for your team? Not easy, good. And good means good for the patient and safe for the leaders, good for I'm sorry, safe for the for for the teammates also. Also, uh comfortable is not the same thing as as as effective, right? So give them constraints like that.</p> <p>If leaders are asked or are given problems without solutions, sometimes leaders just say, "Well, this isn't fixable anyways." Other times we produce a very ineffectual fix that's not going to be really what they need and we're back to square one anyways. That's how we ended up with those pits in these um in these uh impatient facilities anyways, right? You need to encourage and empower them to say, "How can you if if I if if you didn't have money, which we don't.</p> <p>If I and if I didn't have time, which we don't, what's the best way to make it good for you guys? What would that take?" Right? One, it takes a lot of stress off the leader, right? In the sense of like I because there's no way I can come up with a good idea because I don't live, work, and and deal with that environment every day anyways. And two, there's a subconscious empowerment of I'm an executive, too. I have to think like this, too. I now have onus in this team.</p> <p>And back to that, people that get to truly emotionally and intellectually invest in that organization want to stay longer, right? They just want to stay longer. Empowerment is considered 11 times more um influential in a person's in a career in a person determining on whether they're going to be a careerist organ careerist organization or being there for less than 24 months. 11 times more effective than fiscal benefits. That says a lot to me, right?</p> <p>And that's probably the easiest thing of hey, can you do part of my job for me here and tell me how to fix this? Right? Like, but when they give you that idea, you have to take it seriously. You can't just say, "Oh, you feel better now that you got that off your chest." You have to deliver. And sometimes you got to take leaps of faith, right? You got to say, "Okay, this this isn't how I do it.</p> <p>I don't know if everyone's going to love this, but I'm going to tell the bosses and I'm going to because everyone's got a leader, right? I'm going to I'm going to advocate for this idea. I'm going to say that uh PA McConnell has this idea. He's closer to this problem than I could ever be. And I assess this to be the right answer in their minds. Is it the way I'm going to do it? Probably not. But I'm not the doctor working there every day.</p> <p>I'm not the nurse having to see these uh having to see these CO patients every day. It's them. I trust them on this, right? And I promise you, hospitals are small towns, it will get back to that workforce. It will get back to the end item user of Zach is really trying for this team right now, right? He may talk too much, right? He may he may not be he may not fully understand what what we do, but he's really really trying.</p> <p>I think the most impactful leader I've seen at uh at my hospital was a leader who himself had never done this been this world but they worked in a spe they got assigned to lead a specialty and they were really weirded out by it. Um they weren't ready for it but on their lunch breaks they were youtubing things they had bought on their own different uh study books and they were following these nurses around and they were following these doctors around.</p> <p>Ironically enough, now they want to be a provider in that world and they're about to go back to school and leave the military to do that and they come back in the military as that type of provider. But the level of loyalty that this workforce that these teammates had to them just because that they that they're saying my time is is is is best served by learning what you do. That's huge, right?</p> <p>Being fanboys and fan girls of your team is something that is so rare but so vital especially to that Gen Z workforce that you're about to have come in. And that's a that's an ongoing task in in a in a very active task especially in in an industry that has a retention rate of 34%. And so, but for that individual and and that team, like you mentioned that loyalty, I bet that I bet that team's uh retention rate was was quite a bit higher than 34%.</p> <p>So, our team is sitting at 94% retention and we're very proud of that. Um, and the and of that 6% we can't really quantify well because some of them are just retiring because um you are in the federal system especially, you're you're likely going to stay there for a long time. Um and some of them are also having opportunities to move over to other facilities. There's a promotion in Italy that you can get a chance to PCS to permanent change of station to and things like that.</p> <p>Um and I think a lot of these larger health care systems are slowly moving towards that of we have this opportunity here, right? I think um we also talk about incentives. A lot of clinicians, providers, and medical practitioners are well more motivated by education than they are by money as well. I'd like to see more teams say, "Hey, we'd like to pay for and sponsor to send you to become a let's say for you an ortho specialist, right?</p> <p>Um, are you willing to do that for us and come back and be that?" I know a lot of um that was really popular for systems in the 90s um on the civilian side and then that died out. Um but I I think you could get a lot of brand loyalty. Well, and and especially in in an industry like like healthcare with that has a retention rate of of 34%.</p> <p>I that that process of of being a fan girl and and a fan boy to use your your words of of knowing and and learning your team is is an ongoing and very active process. But yeah, I I bet for that leader and and for their team um and and and for your organization as a whole, I I I bet that that retention rate was was quite a bit higher than 34%. Yeah. So, uh thanks um to brag about my team a little bit that I'm fortunately retiring from now.</p> <p>Um 94% retire uh retention rate was what we were sitting at most recently. Um and I think that's for a number of reasons. Um, one thing on the 6% is it's probably the retention rate is actually higher because a lot of that 6% takes in account of people who are moving to other facilities within our system, but then also people that are retiring as well. Um, doing 20 to 30 years coming out of our system is not uncommon at all. I think that's for a number of reasons.</p> <p>One of which is we talked a little bit earlier about people who are professional leaders, but um within that professional leadership, we're learned to really be cheerleaders for our teams. And for a Gen Z worker and then for anyone who's kind of been in our system for any period of time, there is nothing more empowering than knowing that you have a leader that is a fan of what you do and loves to brag to other people about what you do.</p> <p>There's a level of unconscious confidence in that of saying, "I'm going to get to go to Justin and when I bring up this concern, he's going to think not on not for my people, not for my team. That's not good enough." And they're going to fight for that, right? A quick word on fighting for your teams really quick. I think a lot of people think that it needs to be this big Hollywood thing where it's like, "If I don't get this, I'm going to quit." Um, and all that.</p> <p>the whole proverbial hill I die on type thing is is not a very nuanced or intelligent way of leading. Um and it doesn't help your teams either, right? They don't want dramatics. Um but they do want unshakable uh direction. Um one of the best ways to do that is to simply say I am going to talk to leadership about this. These are the things that I'm going to say to them. This is how I'm going to say it.</p> <p>there is a chance that we are going to lose this fight and if we do for now I think the right answer is to continue what we're doing for the next 30 days and then readress in 60 days team what do you think about how we approach this so suddenly it's not just me being the leader and I'm not just dad rescuing them either it is a group effort and I am just speaking for them the most impactful leaders and executives that are the most respected, that have the highest retention rates in any industry are those that have created the feeling, the emotion, and the leadership style that I am one of the people.</p> <p>I just so happen to have a slightly different office in a different part of the building. That is it. And it goes beyond just using wei words, but it definitely starts there, right? Because as you say that, you start thinking like this isn't just a them nurse problem. This is an us problem. This is a this is a University of McConnell problem. This is a this is a Zach and people. I'm suffering with them. And that's a very powerful thought process.</p> <p>Coming off of that just a little bit, you you've we've talked a lot about how how your administration, your administrators and your your managers can can effectively support their staff. And so I'm I'm curious to hear some innovative support programs that that you have seen or or have seen implemented or that you have implemented where that have made a tangible difference for this clinical staff. Thank you.</p> <p>So there is from a lean six sigma standpoint of things there is always people that are not given the opportunity or not able to work at the top of their lensure.</p> <p>I think one thing that we did here that comes to mind is we have a lot of soldiers and enlisted soldiers have a lot of specialties from laboratory technician through to uh LP licensed practical nurses um medics of course um and we even have nurse admin or excuse me uh healthcare administrators as well um and there's a lot of them that work in nonclinical roles preparing for contingency operations combat things like that but they still need to work on their skills and this represented actually a very large uh workplace opportunity for us for for twofolds.</p> <p>One is um if there's contingencies that happen here at Fort Carson, um we could recapture those personnel and help build a more robust system here. Um but two, it gets them ready for the next thing. But most of all, it allowed a lot of our leaders to assign these people, these people from outside entities uh to train and work to team members, nurses, special x-ray techs, laboratory techs, pharmacy techs to really see what kind of leadership potential they have.</p> <p>There's been a number of actual promotions from this. This involved um 26 different specialties um and it includes about uh 800 people across uh Fort Carson currently. um coming in and rotating through the reason that and I think that's what a good innovation is. It's something that or innovative program is. It's something that grows capability and also includes more people in it that give them more skin in the game per se.</p> <p>There was a lot of a lot of staff members that were kind of on the fence of like am I really making an impact here? And now they get an opportunity to be a preceptor for one of these people. But for any innovation program, that's my favorite program that we've done, but there's been a lot of others that I could talk about all day. Um, and one of the reasons that I really like it is it takes advocacy on any type of program from a lot of different places within the hospital, right?</p> <p>You, if you're an innovator, you have to win over more than just the project management team, more than just the legal team, more than just the chief of whatever section this is going to be a part. You have to be a hype man. or as my teenager says, you've got to gas up a lot of the hospital, right, to be able to um advocate for this so that by the time that this change is happening, people are already one over to it.</p> <p>I think one of the best skills that clinical leaders can have is actually advertising skills from the sense of, hey, I I want to change it so that all of this type of appointment is telephone conference only. By doing this, I'm going to allow my PAs to have one hour of protected uh uh uh charting time every third day, and that's 40% more than they've been able to have.</p> <p>At the same time, the only patients that are going to be affected are these patients, which we already have a great great relationship with. Here, here's the uh the the comments of a couple of the patients who I ran this idea by, and they love it. There is one person that had this concern. I'd like to show that to you, but I think we can get after Mr. Johnson by doing or or Mr. Johnson's concerns by working through these things. What do you think? How do you feel about that?</p> <p>The more people that you recruit into that decision-making process, even if you're just trying to uh garner uh thoughts from them, suddenly they're no longer just the I'm the doctor that puts the things in the system. I type on the computer and then I go home. We inadvertently treat some of the most intelligent human beings in the world as just assemblyline robots, right?</p> <p>And and that's one of the biggest concerns that clinicians, PAs and doctors have is like I haven't gotten to I haven't had to make a real choice in years, right? And this is one of those nuanced ways that you can do that. Well, Mr.</p> <p>Cin, we're we're grateful for your your time today and and I I I know that personally I've sat here and and this this has been the longest interview that we've done, but also just the most I' I've been incredibly engaged the the just throughout this whole process and so great grateful for your insights and and your experience and in the way that you do these things and and it shows based on the the success of of your organization and and your team and and um before I let you go, just one final question, we'll we'll throw it out there is Uh what advice do you have for for administrators that without a clinical background that that don't have that patient care experience but they want to support their clinical teams effectively aside from from listening to this podcast and this interview?</p> <p>Uh what uh what what advice do you have for them on on how they can better support their staff um how they can get feedback from their staff um and and just navigate the uh this these waters? Yeah, thank you. So to my leaders out there, it is so important that you assume the nobility of the intent of all your teammates around all of your facilities.</p> <p>No one went to medical school, to nurse school, trained to be a um a a a front desk per a front desk teammate or a laboratory tech with anything less than the highest and most noble of intentions for their craft. When mistakes are made, when issues come up, when personality conflicts arise, you need to know that these are coming from noble places. Also, you need to you need to you need to acknowledge that in what they're doing.</p> <p>The best leaders are the ones that see the humanity in all of their people. And that means a lot of times knowing that we're not going to be operating at 100% performance every single day. Sometimes we're so scared to simply ask the question of, "I want to know more about your son. What does your son do? I think it's so cool that you have twin girls. Are they into anything right now? You've been married for 34 years. That's absolutely incredible. What's your secret to those things?</p> <p>And we just we we're so scared to ask those questions. But I'm here to tell you that just as much as AI is changing other industries, the acknowledgement and the value placed in mo in EQ is so important and probably the most under spoken or sorry under underspoken about thing in healthcare today.</p> <p>And if you aren't willing to kind of get into the gritty, emotional, gooey stuff of your teammates, you're going to be left behind and you're also leaving opportunities on the table that you could have with optimizing your teams and keeping people. Please know that these clinicians are some of the most important to the clinicians that are listening to this. You guys are some of the most important people in America. We don't celebrate you enough.</p> <p>There is no one that I can compare to a person that's willing to go through, you know, six to plus years of school, suffer through that, deal with the grind of learning that just for the opportunity to positively change someone's life for the better. And for that, you guys are doing God's work. And please know that the executives of America are, even if we don't say it effectively, we are your biggest fans and we think the world of you guys. Well, Mr.</p> <p>Cin, we're grateful for you joining us on the clinicians and leadership podcast and and just for the way that you lead um and in your role in your organization and just the the theme of just throughout your career on on empowering people that that work underneath you and and with you and that you work for and just the that's that's the goal of the podcast is is to empower others uh specifically the clinicians, but but that doesn't only apply to them.</p> <p>And so we're we're grateful for you um and for joining us today on the Clinicians and Leadership Podcast. Zach, I love what you're doing here. Thank you so much for building this um and and thank you for having me. has been an absolute honor.</p>
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