Share Public Health Podcast Transcript: Move Fast to Move Slow. An Interview with Denise Foster.

Season 1 Episode 9

Laurie WalknerWelcome to Share Public Health, the Midwestern Public Health Training Center’s podcast connecting you to public health topics, issues, and colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning into this series of interviews with public health leaders where we learn about different perspectives on current and emerging public health issues.

Suzanne Hawley Hi, welcome to our leadership series. My name is Suzanne Hawley and I’m with the Midwestern public health training center. Today we’re going to talk a little bit about public health leadership skills from a personal perspective with a real public health leader, so thank you for joining us today, and if you could just introduce yourself and tell us what got you into public health.

Denise Foster Good afternoon, I am Denise Foster, the Chief Nursing Officer for the county of San Diego, and what brought me to public health was an interest in moving upstream and making a difference in a grander level. I had done a lot of time in the hospital setting and really valued the important clinical work that I had done and learning more about the social determinants of health and how important it was to address those. I felt like I could make a difference in the public health setting.

Hawley So, what excites you about public health?

Foster What excites me about public health are all the challenges there are right now, especially for nursing. I’ve seen, I mean, I’ve been a nurse for many years and I see that the nurses role in understanding the basics of care delivery, the importance of doing an assessment and understanding what’s happening at the individual level as well as the population level- level is so valuable, so I’m excited to see what nursing can bring to the role of public health. I’m also very excited in how much attention is coming to Public Health and awareness of the importance of the things that make a difference for individuals, populations, communities, the nations in the world. Climate health, for instance, being able to address the social determinants of how homelessness, the opioid addiction problem that we have in our country; those are- they all sound so overwhelming as problems, but it also it excites me and knowing that we can be in the forefront of making a difference.

Hawley Great, so with that said you know the field of public health is changing to prepare for the issues of the 21st century. So, what are some of the things that you think are important things in terms of some skills in managing or leading change?

Foster So, I think nurses need to really develop their understanding of change management. Those skills that come along with it, that as part of their foundation of being a nurse- really, really tapping into the basic roots of a nursing process. For instance, how do you do an assessment collecting that data, formulating a diagnosis on a broad level of what’s happening, you know, analyzing the data, being able to really determine what they want to achieve; setting goals, creating interventions- evidence-based interventions- looking at the literature, analyzing that, and then doing evaluations. So, these are all the skills that nurses bring to the table. However, they’re not really trained to magnify those skills on a broad level to an understanding of public health, policy development and implementation.

Hawley So, when you think about going from the individual to the population kind of approach that a nurse or any public health professional would want to think about, I’m wondering: in your work, how has systems thinking supported your ability to manage change and- and move Public Health forth?

Foster Yeah, so one of the key skills that comes from leadership experience and training is really understanding that political acumen, and I’m not talking about politics and the traditional sense, but really understanding: who are your stakeholders? And that sometimes are the people that report to you, some of them may be your community, but it’s also your leadership. It’s really important to know what’s important to them and their organization-

Hawley In your organization.

Foster -in your community, in your, you know… I work in a county environment, so the government officials that govern our county- it’s important to know what’s important to them so that I can speak to those, you know, those shared values; knowing what people- what’s important to people. You know, Sue Hassmiller spoke about being able to use language that resonates with people, so knowing their language to avoid those hot buttons that get people, but also knowing what’s important in terms of something that connects to the heart, and nurses are so good at that. And so that’s one of the systems thinking things being able to put that together. The other thing is really understanding that when you make a change in one place, there’s impact across so you don’t have to make a huge, huge change to see that ripple effect across the organization or community, even nations. The other part of systems thinking that’s really important is people to understand each other’s roles. So, how do we complement each other? How do we reinforce each other’s role? So, you know in a traditional hospital setting those roles are pretty well defined: nurses know what doctors do, doctors know what nurses do. For the most part I think nurses know more about what doctors do, but in the public health setting, those roles get very blurred, and I loved what someone spoke up about nursing’s role being defined by others and it’s time for nurses to step up and define their role. But, they also have to understand how they fit into that big picture.

Hawley Sure, and you know, you- you’re really talking about all these partnerships that are so critical within the organization, across the community, you know, at every way of sectioning off and, and knowing what their priorities are makes me think about you know, how do you find those through effective and persuasive communication being another skill, and do you feel like there are certain types of pieces within persuasive communication that are especially important to you in terms of, you know, managing change and building these partnerships?

Foster So, when someone comes to me with a proposal, so they’re going to ask for something, that’s typically what they want, and usually it’s in the form of resources or help, it really helps if they connect it to the purpose, the mission. The- whether your- be your organization’s mission, whether it be the community’s mission, when they can connect to that it becomes much more purpose persuasive. So, the persuasive discussions that we have must center on what we want to achieve. Nurses often lack that ability to do that in a real effective way and one of the skills we can help them with is developing that sense of confidence and being able to speak to what’s important in the, the outcome, so how do we speak to outcomes we want to achieve versus what we want to do? Because when we talk about asking for resources, when we talk about needing, you know, money or, you know, funding, people want to hear what are we going to achieve with that, not what we’re gonna do with it, what outcomes we’ll achieve.

Hawley And how did those outcomes connect with their mission?

Foster Exactly.

Hawley Their vision, um.

Foster And what’s important to them, what’s gonna make- what’s gonna resonate with them and make them want to go to bat for you?

Hawley So really, that might take a lot of listening and some homework probably.

Foster And an understanding about the importance of hearing and listening back to the important part about change is just really understanding what’s important to people so that you can help create that platform for them. Sometimes it’s connecting the dots so you can go out and ask people questions; asking a lot of questions and then coming back to them and reflecting back and say, you know what? I’ve talked to a lot of people, including you, and this is some of the feedback I received based on that feedback it sounds like you all are really interested in creating X Y & Z program, or, you know, my case with the teach and residency program, that’s how I got it through was to be able to do- go out and do interviews and talk to people what’s important to you. Then giving me an outline and it was pretty- pretty telling, and me being able to come back saying, well, here’s what you asked for, and based on what the evidence shows in the literature and what other people are doing, this is what I recommend. And people when- yeah you heard me- so I mean that’s exciting.

Hawley Yeah, I mean that’s a great example of truly collecting or creating a collective vision for the group which is- is what we hope I think a lot of professionals would do. Are there other things or skills that you think would be helpful for somebody who’s trying to further this work?

Foster I do think it’s going to be really important for nurses to develop their understanding of the literature, how to analyze research how to look at data and really understand what the data is telling them. So, quality improvement skills are gonna be really, really essential for the next iteration of nursing in public health. I think, I mean, it’s kind of always part of who we are, and so, but being able to really speak that quality improvement language is so important. I heard a couple examples of that in the last couple days where nurses collected data. They were able to look at that root cause analysis of the problem versus assuming this was the problem. They really were able to get at the root cause analysis and then determine an intervention that was successful. We need to do more to promote those skills in every nurse, but in public health is particularly essential.

Hawley So, it sounds like some of the things that you’re recommending are things that can take some time it can take some resources to do that, but you know you’re kind of moving slow to move fast, you know.

Foster Actually one of my sayings! And sometimes they end up moving faster because of it, yes, yes. I do think they take time and they take resources, but if schools- one of the recommendations I do have, especially in a master’s level program or doctoral level program, I ensure that all of their graduates have a pretty strong foundation in quality improvement and performance management. I think that’s going to be essential, but even at the baccalaureate level starting to introduce those concepts into how nurses approach their work is going to be evermore important.

Hawley Great, so when you think about just the broad public health workforce, what advice might you give somebody who’s just kind of starting out in public health?

Foster Ask a lot of questions. Listen and really, really, really take some time to learn because it’s very complicated- I mean, it’s a very complex system; there’s a lot of funding streams and silos and arms of public health that don’t always speak together, and you can learn about them the more you’ll be able to put together an understanding of that that how they function together and how they complement each other and understand how your role complements them.

Hawley Well it sounds like you’ve definitely had a lot of experience connecting those dots in your work, and hopefully continuing to mentor others to do that, so I really thank you for this time and sharing your perspectives it’s been very very helpful, so thank you.

Foster Thank you.

Hawley Thank you very much for joining us today with our leadership series. We hope you join in again for a future session, thank you!

Laurie Walkner Thank you for joining us today. Special thanks to our guests, Shirley Orr, executive director of the Association for Public Health Nurses, Suzanne Hawley, Roger Hileman, Melissa Richlen, Hannah Shultz, and Laurie Walkner.

Funding for this webinar is provided by the Health Resources and Services Administration. Please see the podcast notes for an evaluation and transcript.

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