Anthony Disser, RN

Article Outline

• When you went into nursing, it was a time when it was not a career typically chosen by men. What made you choose nursing?
• Can you tell readers about your role at Kindred Healthcare?
• What are the major challenges that confront your organization and others in your position?
• Looking at the financial and workforce picture, how do you compete in the market?
• You are a successful leader, so what tools would you offer to nurse leaders?
• What nursing situations in your career have been eye-openers for you?
• What has been the centerpiece for your nursing leadership?
• What would you say to the up-and-coming leaders in our profession?
• As health care continues to be chaotic, what are your thoughts on thriving instead of just surviving?
• As you look back through the journey your career has taken, what thoughts do you have?
• Knowing that guiding principles are so critical for successful leaders such as yourself, what has guided you?
• What do you do when you aren't at work?
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Sometimes you meet a person who immediately adds dimension, value, and spirit to the nursing profession. I have been so fortunate to have this experience when I interviewed Anthony Disser, RN, senior vice president of clinical operations for Kindred Healthcare in Louisville, Kentucky. Tony is not a person who keeps his head down, fingers crossed, in the hopes that he crosses the finish line. Indeed, he is a dynamic, successful, and passionate leader. Tony's favorite quotation is from Florence Nightingale's Notes on Nursing, referring to “petty management”: “All the results of good nursing, as detailed in these notes, may be spoiled or utterly negatived by one defect, viz: petty management, or in other words, by not knowing how to manage that what you do when you are there shall be done when you are not there”[page 35, 1969 edition].

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When you went into nursing, it was a time when it was not a career typically chosen by men. What made you choose nursing? 

I wish I could say that there was some profound reason or that I “had a vision.” My mom was a nurse and my dad was the executive director of the Healing Arts Board in Tennessee, which had some influence on me. When I finished college the first time, they talked to me about the nursing profession as they thought it was conducive to my personality and passion for doing the right thing. After I graduated from my baccalaureate nursing program, it was Dr. Luther Christman who helped me ponder “the guy thing” and made me realize how much value all passionate people add to the professional practice of nursing. Dr. Christman also made it clear to me that caring is genderless and that leading nursing requires passion and excellent business acumen and management skills. I am proud also that my youngest son, having already completed a bachelor's degree in business, is now pursuing a career in nursing at the University of North Carolina at Chapel Hill.

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Can you tell readers about your role at Kindred Healthcare? 

Kindred Healthcare, Inc. is a for-profit Fortune 500 health care services company, based in Louisville, Kentucky, that provides services in over 500 locations in 39 states. Kindred, through its subsidiaries, operates long-term acute care hospitals, skilled nursing centers, institutional pharmacies, and a contract rehabilitation services business, Peoplefirst Rehabilitation Services.

In Kindred Healthcare hospitals, we have an electronic health record that allows us to review quality indicators for one facility at any given time, as well as all the hospitals' trends and patterns. This ensures accreditation preparation and allows us to access information for quality management and performance improvement. We have been able to develop best practices for areas such as wound care, vent weaning, bloodstream infections, and ventilator-acquired pneumonia. The Kindred Healthcare patient care enterprise comprises a very big database that we can use for performance improvement! I have a brilliant and passionate staff, and we are honored to care for our patients. Our motto is “Caring for Patients Who Cannot Take Care of Themselves.”

As the senior vice president for clinical operations, I am responsible for the quality of patient care in all our hospitals. I spend a great deal of time on the road in my role of supporting clinical operations and hospitals services. In addition to quality and outcome management, information services, credentialing, coding, case management, regulatory compliance, and patient safety are managed by clinical operations.

I also maintain a clinical practice in hospice and bereavement care in Louisville. Throughout my career I have believed that it is critical for nurse leaders to never lose sight of the point of care and maintain a clinical presence and practice.

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What are the major challenges that confront your organization and others in your position? 

With all the turbulence in health care, the constant “white water” and reimbursement changes, continuing to function as a vital and growing, four-time-zone national health care organization is most challenging. Our company seeks to be stable, predictable, and transparent; it is difficult to do so in turbulent times. Health care leadership demands focus and precision. It takes a lot of planning, strategy, steadiness, and focus—nothing new to those of us in health care executive positions. It's the work we have chosen!

Staffing the hospitals and workforce issues are huge now and will be for the next 20+ years. We have a philosophy in clinical operations that great patient care equals great business, and great business equals great patient care. Patient care leaders who cannot strike that balance will struggle in their work and lose the focus of their responsibility to manage the entire patient care enterprise.

Over the years, I have been challenged and learned more from health care leaders who couldn't strike this balance. We need nurse leaders at the executive and board level who know how to do great business, the business that provides the results our patients deserve. I have seen and worked with patient care leaders who “do their job to keep their job,” and that has been a major disappointment for me to watch and deal with during my career. Nurse leaders who stay in a position of leadership when they are not doing the job of balancing great business outcomes with great quality outcomes compromise patient care. I feel this lack of insight by our leaders has done damage to our profession and created challenges for our frontline patient care staff. When a patient care executive can't tell a board of directors how much a patient with a decubitus ulcer or bloodstream infection costs the organization or can't construct a skill mix and can't calculate return on investment to improve the same, it is time to get out.

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Also, nursing leaders need to be strong enough to criticize each other about the lack of business and management skills. We need to challenge each other and note that what might be best for the profession may not be the best for the patient and the organization we serve. As a professor in my nursing administration program once told me, “Accuracy is only in the aggregate.”

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Looking at the financial and workforce picture, how do you compete in the market? 

Kindred Healthcare is a major player in the postacute care arena. Kindred is a public company, which places us in a position of transparency. In collaboration with the Centers for Medicare and Medicaid Services, we are working on a postacute care assessment tool to measure where patients should be in the continuum of care.

As I mentioned earlier, we have a big database for comparison of practice across settings. We can compare all our quality indicators against each hospital, look for best practices to improve care, and add value to the patient care enterprise. We frequently establish performance improvements teams and rapid actions teams to implement practices that can improve care and add value. Whether it is supplies and services, practice rituals or documentation, we look for ways to resolve redundancy, cycle time, and rework.

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You are a successful leader, so what tools would you offer to nurse leaders? 

There are several things I would share with both new and experienced leaders in our profession. The first is to value the people you work with and keep them free to think, to criticize you, and to have good, honest dialogue with you and each other. Criticism makes you stronger (my screen saver). Diversity of opinion strengthens the decision and outcome. Also, I would encourage consistent interaction and communication with staff to test the reality of decisions to ensure actions can be implemented.

Nurse leaders need to be able to articulate themselves in front of one or hundreds of patients, staff, community, or board members. Being quick on your feet is also important, along with knowing that academic awareness and recitation of “studies” does not work in a business meeting; calculation of return on investment and net present value and managing expense does! We live in a digital age; it is essential to be able to use all the electronic tools we have available to us as leaders.

As leaders we need to also be able to walk down the hall and “walk the talk” with all staff, patients, and others. This is nothing new, but I want to stress the need for authenticity with the staff and those we serve. A successful patient care leader needs “charisma with substance”; a visionary leader without substance is useless to the staff. Likewise, a manager without vision is lost in the spreadsheets and reports. It's about the results! Making relationships for the sake of relationships and looking good to the staff doesn't help the enterprise of patient care. The purpose of rounds is not “to be seen”; rather to see, to ask, to learn!

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What nursing situations in your career have been eye-openers for you? 

Patients create eye-openers for me and can make very special moments and learning experiences. I took care of a patient early in my career who taught me that great patient care is seen only through a patient's eyes. I'll never forget him and what he taught me about whom we really serve—him.

I also remember a day that I had to stay at work several years ago and missed one of my son's soccer games. He said, “That's OK, Dad, what you do is important.” And he is right. What we do is very important, worth the effort, worth our focus, our tears; it's not about us!

Professional performance appraisals and executive coaching have always been good for me. You can cave when you get criticism, or you can listen and change yourself, or move on, adapt, and grow. I once had a health care administrator tell me that I got “too much work done” and that I was “too honest”! I did not know either was possible, and I knew working with him would not work. It was time for one of us to move on—he did.

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What has been the centerpiece for your nursing leadership? 

Servant leadership, being a good steward of the patient care enterprise, a “fire-bearer” is the role of the nurse leader. As individuals in leadership positions, we have the responsibility to serve, learn the most, and serve the most. We need to be skilled enough to make tough decisions, be analytic and merit-driven, and serve the patient and community while understanding the entire patient care enterprise. Jim Collins calls this “Level 5 Leadership” in Good to Great.

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What would you say to the up-and-coming leaders in our profession? 

I would say take a chance, shake the tree, step outside, and do something different. Be a character and don't worry about what will promote you. Keep your ego and your image out of decision making and focus on outcomes. Read outside of nursing and health care. Challenge everything. Lead, please! And stay balanced!

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As health care continues to be chaotic, what are your thoughts on thriving instead of just surviving? 

When we are in survival mode, we are being “safe.” The victim choice is just surviving, getting by, and perhaps looking past the duty we have to serve first. I believe that thriving is what it is all about. I am reminded of the saying from Red in The Shawshank Redemption, “Either get busy living or get busy dying.”

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As you look back through the journey your career has taken, what thoughts do you have? 

I am often surprised that I am where I am. I am proud I can do this work and have the opportunity to make change and challenge others to continually improve. I am never satisfied. For years I have said that I have the best job in the hospital! Serving others is the greatest work.

People may ask in passing, “How are you doing”? and I always say, “I couldn't be better.” I am lucky to have the opportunity to serve others, do meaningful work, and “care for people who cannot take care of themselves.” What an honor! This is the greatest work! Leaders who don't see that perspective don't get the joy we have to be in the position to serve others.

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Knowing that guiding principles are so critical for successful leaders such as yourself, what has guided you? 

I have these simple principles:

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What do you do when you aren't at work? 

I work lots of hours because I love my work and am proud to do it; I am energized by my work. I also work in a local hospice and for the American Lung Association. Family activities also keep me busy. And I spend a little time on my bike!