On adapting to life as a leader and working with non-clinical hospital departments

With Debra Olson, RN, BSN, MS, RNFA
Director of Surgical Services
Charlotte Hungerford Hospital
Torrington, Conn.

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AORN Management Connections: What was your experience in becoming a manager? What were some of the challenges you faced?

Debra Olson: The transition was a difficult transition for me. It wasn’t one that I interviewed for or came into with a complete understanding. At the time I was the only one at my facility who could do the job.

The biggest challenge was in understanding the financial side of things, understanding the patient care side. Immediately I had to learn what I was accountable for and why. Working with the financial department, I didn’t understand immediately why I was the one responsible for paying vendors and outside service providers.

I felt the commitment on the patient care side, to getting the nurses and surgeons what they needed. Coming from the clinical setting, it was difficult dealing with vendors who asked for packaging instructions or contracts.

The biggest challenge for me was getting to the point where I understood if I was going to continue in this role, that it was my job to work with people outside of the clinical setting, and ultimately if I could get good at that, and be able to communicate, I could actually improve patient care and staff morale. Having a respect for the financial side of healthcare was a difficult challenge.

AMC: What was it like working with your chief financial officer? How did you build a relationship, particularly when it came to dealing with costs and supply management?

Olson: It was intimidating when I first started. I never felt like I was giving my CFO what he wanted, it was so different from any other service I was accustomed to. With patient care, for instance, I know what a patient expects and I can deliver. I felt like I was failing early on as a manager.

Fortunately I had a lot of support in the organization and from the medical staff, and knew through communication, that I could do better. It was a matter of starting at that most basic level and then improving from there. When I got to that next level, I began to understand what was needed and how to communicate the challenges and roadblocks I felt were standing in the way. From there I counted on the financial division to help me by bringing their perspective to the challenges we faced that involved materials management. Materials management was a place where we could bring the clinical perspective as well as the financial perspective to the discussion because it involved critical decisions from both departments.

AMC: What were some of the things within materials management that were difficult at first, or that you found you could improve?

Olson: Supply lines, or how supplies got to our facility, how they were ordered and why they were ordered, brought a lot of costs to our facility because a lot of times items were ordered “just in time.” We didn’t have perpetual inventory for most of our supplies. Our facility was running out of supplies, or didn’t have enough in stock, and we found we were incurring costs because of priority and overnight deliveries. There was no real rhythm to the way we were ordering supplies.

Getting ourselves to the point where we were cleansing inventory – cleaning up our item dictionary – was a huge process. It took a great deal of man-hours; materials management was involved, finance was involved, my inventory person was involved. We went through and simplified the process, organized preference cards and consolidated our lists of supplies the hospital needed. Getting people involved in that process, including vendors, helped us improve our operations as a whole. This didn’t happen overnight, though. It didn’t happen in a month, it didn’t happen in six months. We set our goals and took one step forward at a time. Even though there were setbacks, we looked at where we improved and kept focused on spending time to reach our goals.

It takes a lot of research from other people who have done things well. Taking over as director of surgical services, when you’re in an organization that has five ORs like we do, or if you’re in a facility with 25 ORs, the premise is the same. You have to have trust, you have to have support from all directions, and if you don’t, you are constantly swimming against the current, and it doesn’t have to be that way.

In my experience, it was difficult at first; there were times I thought I didn’t want this job. Now that I have grown with it, it’s been a huge sense of accomplishment. You start to realize that you can do this.

AMC: What helped in building trust and building that relationship with your financial department?

Olson: You have to allow yourself to become completely vulnerable. You have to allow criticism, even though you don’t think you deserve it at that moment. Allowing yourself to realize that, especially with the financial department, you are going to have to answer questions, often because they don’t always know what you’re dealing with in the OR.

And the more you let yourself look at things through the eyes of the hospital’s accountants, you start to see areas where supplies might be wasted or things are not being used right. You take on more of a global perspective. You don’t always need to have your finger right on the pulse, but you have to be looking at the big picture.

When did the walls start to break down a little bit in my experience working with the financial department? I think it was when I started to hit the pause button and ask myself what they were really looking for, what makes sense to them. Spending time with the financial department and getting a better education in what they do was critical in helping me learn how to make decisions that would benefit both our surgical staff and the bottom line.

AMC: What advice would you offer a new manager breaking into a role like yours?

Olson: Build support systems early. Get yourself involved in the product analysis group, have good relationships with your physicians and your staff. One of the things we did was put service leaders in charge of every service line that we had. That helped us get our preference cards clean, it helped us deliver a little bit more “expectability” as far as what the day was going to look like and inventory control. Keeping yourself current with what’s happening each day and documenting it will help when you have to review things that happened in the past.

My best advice is to be completely transparent. If you don’t understand something you need to be able to admit it. The trust piece is very, very hard. Our nature is to be defensive with finance because we feel like finance does not understand the clinical picture. However on the other side of that, I don’t think as a clinician I had a complete understanding and respect for the financial side of healthcare.

Debra Olson, RN, BSN, MS, RNFA, is the director of surgical services for Charlotte Hungerford Hospital in Torrington, Conn. She has served as the director of surgical services for about five years. Hungerford Hospital is a 120-bed facility with five operating rooms and two endoscopy suites that serves the community of northwest Litchfield County in Connecticut.

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