Lisa Mogannam has worked in nursing at University of California-San Francisco (UCSF) Health for 21 years. So she knows a few things about what nurses need in clinical environments to provide the best in patient care.
I sat down with Lisa to talk about her more recent role serving as the connector between nursing and hospital operations teams like EVS, dietary, clinical engineering, and many more.
What began as one small project to create the best environment for nurses and patient care in her hospital turned into a years-long endeavor as Lisa was invited back again and again to give expert recommendations on how to create nurse-ready rooms and design nurse-friendly operations.
How did the nurse-ops connector role come to fruition?
In her 30s, Lisa worked as a neurosurgical transitional and acute care bedside nurse. After about eight years, she became the charge nurse.
With that came the responsibility of looking out not only for her own patients, but also everyone else’s, and the environment as a whole.
“We went through a period where they were switching out how our supplies were oriented in specific areas,” Lisa said.
“And they hadn’t really touched base with any of the end users, which I thought was just the most bizarre thing in the world.”
Simultaneously, the hospital was giving the nursing unit a facelift, which was originally built in the 1970s.
“The carpenters were putting things on the walls without consulting the nursing staff … it was kind of like, ‘Why are you in my house hanging my flower pots where I don’t want them to be?’”
Two important changes were happening without the nurses’ input: the environment they worked in, and the supplies they worked with.
Lisa became very vocal about her thoughts around these events as they were unfolding in the hospital.
In a staff meeting, Lisa said, “This is crazy. We need to be able to say where our sharps containers go, where our gloves, our gels -- we need to know where our supplies are.”
The new chief nursing officer at that meeting challenged Lisa to do something about it. That was what initially planted the seed.
Later on in a meeting with the CNO, she was formally asked to take on a small project to address the issues she was seeing. Lisa told her she was willing, but was open about her limitations.
“I said, ‘Listen, there are a lot of things that I know how to do, and there are a lot of things I don’t know how to do -- I don’t type, I don’t do spreadsheets, but, you know, I can get this place turned around as far as supplies go.’”
That was the beginning of a two-week project that turned into a 14-month endeavor to connect nursing and hospital operations teams to create better physical environments for nurses and patients.
I worked with Lisa on this project at UCSF Health in 2010. The program I spent time on was called the “Environment of Care Optimization.”
We spent up to three weeks on every nursing unit. We brought in the directors of every support service (pharmacy, material services, etc.) and engaged the nurses to streamline and inform the process of changing the physical environments.
Lisa was there to help ensure the nurses were being heard. I was there to help document processes and keep things moving along.
How did you build trust with the support teams?
It is easy to see how a nurse could build the trust of other nurses during a project like this, but how did Lisa build trust with the support teams?
“They trusted me for a few reasons. I wasn’t going away, I spoke highly of them and I supported them,” she said.
“We went from floor to floor to floor … and what you learn in that process is that everybody has their struggles -- it’s not all about us, the nurses,” said Lisa. “So how can we make all of these isolated islands kind of linked together?”
Her approach was building relationships and finding the middle ground. It was all about listening, and understanding the support teams’ strengths and limitations.
Lisa said that by empowering the nursing staff and engaging them with support services, there were names and faces involved, and everyone felt more connected.
And the key, Lisa said, was making decisions from the patient’s perspective. “Once you lose that perspective, you’ve lost the whole journey.”
How did the project evolve?
After about a year-and-a-half, with the project successfully empowering nurses to have control over their working environments, Lisa was asked to look at other UCSF hospital locations. This time, it was new construction on a planned children’s hospital.
She had enough knowledge at that point to be able to look at construction plans and start giving recommendations on how to tweak the nursing units.
Lisa admitted there were politics involved, but she held strong to her recommendations, which came from the patient’s perspective. “That was my mantra for that whole project for two years,” she said.
There was standardization in terms of how rooms were set up, but there was also a lot of personalization, from the clinics to the operating rooms to the children’s perspective.
Despite the fact that Lisa showed up to work seven days a week for 14-hours each day for a year without any time off and no special monetary gains, “It was very rewarding,” she said.
“I wasn’t motivated monetarily,” said Lisa. “I showed up because I wanted to make sure that when we opened those doors on February 1, that the patient and the families were taken care of.”
After this project, Lisa moved on to working on another project where she was able to this time collaborate alongside the architects doing a hospital wing redesign set to open in 2020.
“I went around and connected with material services and pharmacy and hospitality (environmental services) -- you know all these connections I had made in the last six or seven years,” she said.
She leveraged those relationships to brainstorm ideas for designing nurse-ready rooms from the ground up, so that nurses could focus 100 percent on providing the best in patient care.
What are the keys to success in replicating this role?
The secret to Lisa’s success, she says, is to ensure you have the input of everybody involved, from the person who checks in the patient to the doctor and beyond.
“The key is to have everybody there in the room, and to make them feel comfortable enough to communicate together. Then the magic starts to happen.”
Lisa was also given full access to the hospital and a budget that let her do what she needed to do. Not only that, but she reported directly to senior management, not to a supervisor four levels down.
“You’ve got to be able to walk into the room of the COO, CNO -- whoever -- and articulate what you’re thinking,” Lisa said.
When asked about her final thoughts on the attributes for a role like this at another hospital, she said:
Someone who is a nurse and has an understanding of what nurses need.
A good communicator with the ability to observe and listen to everyone involved.
Someone who is not intimidated when sitting at the table with all levels of professionals.
An amazing team of people behind you.
“Everybody is so busy, and we’re moving so fast. This role is such an important position that every hospital should have. If you can synchronize nursing and support staff, you will have an amazing operational workflow,” she said.
For a nurse to have a successful day, a lot of little things need to go right. A role like Lisa’s helps ensure they do.
My thanks to Lisa for taking the time to share her story about the ups and downs and insights gleaned from living in a role like hers.
For more information on nurse-ready rooms, check out an earlier article I wrote on the steps to creating a nurse-ready room.
Brian Herriot is a hospital operations leader and CEO of ReadyList, Inc. ReadyList software ensures fully operational clinical environments to help clinicians dedicate more time to their patients.