Dr Ferren: Can you describe how your career journey contributed to who you are today as a healthcare leader, President, and chief executive officer (CEO)?
Ms Silard: I have had a lot of great mentors. Learning from mentors started during my 1st role as a novice nurse in the neonatal intensive care unit (ICU) at Albert Einstein Hospital. Patricia, my nurse manager, did 1:1 onboarding with me because I was the only new nurse at the time. She taught me much more than clinical skills; she was an inspiration, a wonderful teacher, smart, nice, and very competent. She shared her interest in the business of healthcare, which made me think differently about my career and motivated me to go back to school for a master's degree.
Dr Spencer Foreman and Fred Rosenstein were influential mentors for me when I was at Montefiore Medical Center as the executive director of the medical group. They challenged me to be strategic and adopt a global view of healthcare by thinking outside of the organization. This experience leading healthcare workers beyond nursing led to being tapped for additional healthcare leadership roles. I have intentionally developed relationships with nonnurse colleagues like the chief operating officer (COO) and CEO throughout my career. I am grateful for these individuals and their influence on my career.
Dr Ferren: How would you describe your leadership style or philosophy?
Ms Silard: The number 1 component of leadership is about building trust. Trust is fundamental to everything. If you take the time to build trust, you have the foundation to do anything you need to do. Next, great leaders have excellent communication and transparency. Your people need to know what is happening. Clear and articulate communication on what needs to be done really builds trust. Alignment of expectations and good communication takes exploration. Take time to listen so you can understand where people are at, what they want, and how you can help them. Give them time to work together to achieve outcomes. Great leaders put accountability structures in place. Both leaders should agree on a project initiative, the goals, and the timeline.
Effectively managing change is another key component of leadership. Three massive changes are coming to our organization related to access, patient experience, and a new electronic health record. To proactively identify and overcome obstacles, I brought in a change management consultant for a director retreat. We are doing the same retreat with our managers as well. Sometimes we stop at the director level, and this is a mistake. It can't be just us; we need change management experts to show us how change occurs, and how success happens. For day-to-day communication, team members trust their managers. We must engage all nursing and nonnursing managers when we make changes to prioritize and achieve better outcomes.
Dr Ferren: How does culture affect your leadership?
Ms Silard: Culture is so important. We should focus more on the culture than on outcomes. Leaders create the conditions for people to be successful. Our focus should not be on telling people what to do but on why we need to do it. People feel good about getting good results and should also be open to failure. Culture should include safety in the environment, so leaders feel comfortable speaking up about something that is not going well. For example, I had an executive come to me and share that a project was not going well and way. The timeline of the project needed to be altered because of conditions beyond our control. Sometimes we need to pay more attention to how much time a project will take. I'd rather have success at the end than push the timeframe. There is a balance between accountability, grace, tolerance, and failure. We have rigor, and we achieve most of our goals. In our culture, leaders know that failure will occur, and it is safe to come in and say something is not working. Then, we problem-solve what we need to fix: people, time, budget, etc. People are not machines, and not everything is perfect.
A final crucial aspect of leadership is to recognize your vulnerabilities. There is a myth that leaders must have all the answers. When I lean into vulnerability, I ask others what they think. I am not afraid to expose my humanness. I don't have all the answers, so I need to engage others and ask for their perspective. You build trust when you create solutions together.
Dr Ferren: What are the most critical issues you are facing today?
Ms Silard: Workforce, workforce, workforce. All CEOs and organizations are focused on having the right talent in place to do what we need to do. We underestimated the impact of the pandemic and the influence this would have on our relationship with work. Just being out of the pandemic is not enough because people are still burned out and tired. Asking everyone to come back to work and get back to normal was unrealistic. We must appreciate our workforce by investing in retention and valuing the people.
Listening to team members provides critical opportunities to build back up the workforce. We improved employee engagement by 3 points by doing a lot of listening. We unpacked the engagement results and looked at the top team members' concerns: compensation, work/life balance, staffing, career advancement, recognition, and career pathways. At the unit level, leaders must equip managers with engagement strategies. Managers should focus on retention; we can recruit, but retaining team members is key. We retain team members by fostering teamwork, putting structures in place for work-life balance, celebrating diversity, and building healthy environments. Inclusion in decision making is a huge satisfier. People feel valued and appreciated when we ask for input and team members' voices are heard. Connect team members to their passion, what brings them to work every day, and to meaningful work. Professional development is essential to retention. Take time to understand what team members want from their careers and where they want to go and help them reach their dreams. We celebrate when people leave our organization to go on and do better things and for promotional opportunities. If they leave for a similar position and we did not help them be successful in our institution, we failed them. Healthcare is a great profession. We need to create the pipeline and career pathways for all positions. Entry-level roles like housekeeping and transporters can become nursing assistants and then on to registered nurses (RNs). There are so many job opportunities; we need to get creative so young people get excited about the possibilities. We also need to get specific about how to help people get to the next place or level. Invest in mentorship and help people get to the right pathway for them.
Dr Ferren: What wisdom can you share with nurse leaders?
Ms Silard: Be open to new ideas and opportunities. I never planned to be a CEO; however, my career journey prepared me for it. Some nurses think they need to be in traditional roles and fear stepping out into the unknown. I didn't know anything about running a medical group, but if you are a good leader, you can do it. Surround yourself with people that can help you follow your passions. Ask a lot of questions. Embrace lifelong learning; go to conferences, read books, or get the next degree. Surround yourself with a network of people that are safe and that you can call when you are stuck on a problem. They have ideas for how to deal with the challenges you are facing. Take advantage of subject matter experts that are all around you. If you have a finance question, schedule time with a finance colleague. A lot of learning can happen in the workplace when we are intentional about making connections. Don't be afraid to say that you don't know and that you need to ask a few colleagues.
Finally, the time you spend building trusting relationships with colleagues, especially with colleagues in the C-suite, will always have a significant return on the investment. Commit to being honest with each other. Set high, lofty, aspirational goals and go after them relentlessly. Support each other when things get tough. Build trust, and the rest will get done.