Ann Hendrich, RN, MS, FAAN

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Dz: Ann, I Have Had The Pleasure Of Working With You For Some Time Now And Am Amazed At Your Accomplishments And Leadership Abilities. Let'S Talk About What Shaped Your Childhood And Gave You The Base For Your Leadership Drive.

AH: I learned early in life about responsibility and problem solving, and those traits seem to have shaped my career in many ways. Growing up in a Midwest farm family, one learns how to work in an uncertain environment. In other words, this is where many of my values were formed and my attitudes about the need for flexibility and resiliency. My father, in particular, was a visionary, and he taught my sister and me how to plan, budget, run businesses, and most importantly, how to think strategically a plan for what might come next.

There were numerous examples of catastrophic events where nature altered our livelihood through drought, disease or floods. The lessons we learned were about resiliency and how to face adversity with different eyes.

At an early age he would sometimes take me up to the top of a hill and ask me, “Ann, what do you see?” I would reply, “Grass, bees.” He would say, “No, Ann, what I see is fences and a new field of grain.” My dad taught me how to look beyond and into the future. The hardships of the depression kept my father from finishing his formal education, but it didn't deter him from being successful in many ways. He read the Wall Street Journal everyday an had many ways to get information he needed to be successful in an uncertain occupation. As a systems thinker; he averted the farming crisis because he saw it coming. He taught me how to build reserves.

DZ: When did you know you wanted to be a nurse?

AH: When I was growing up, my aunts who were teachers developed diabetes. I remember visits with them and watching the devastating effects of the disease take hold of their bodies and lives.

When I visited my aunts in the hospital, I also remember being in awe of the nurses and doctors. It was from that experience that I knew I wanted to go into healthcare. I decided on nursing because I saw how the nurses comforted and treated my aunts; they seemed to be the ones who spent the most time with them and ultimately made a noticeable difference in their quality of life as part of the care team.

DZ: Tell me about your nursing career and memorable moments that shaped your work.

AH: My degree from DePauw was well-rounded, particularly the time I spent in the community health. In my junior year, I was assigned a prenatal patient; she was 14 years old. Twenty-five years ago, that was rarely heard of. I followed her through her pregnancy and attended her delivery. I really developed a deep understanding regarding access to care and knowledge deficits—hers and mine. When she brought her baby home, she didn't have a crib, she had a dresser drawer, but that baby didn't know it was a drawer and not a crib. That baby did know love, and that young mother loved her baby. I learned then that things don't go by the textbook; it's about the people and the setting.

After graduating I initially worked in a physician practice and then moved to high-risk obstetrics, followed by emergency trauma nursing and then ICU. I would also float to all medical-surgical units because I wanted to expand my clinical knowledge and experience in all the different nursing specialties. As a clinician, I have always had a passion for quality and excellence in patient care, and I also believe every caregiver ultimately wants to do the same. That's why we choose nursing, a field that allows us to comfort, teach, intervene, observe, and assess our patients.

After a several years as a bedside nurse, manager, and educator, first in OB, medical-surgical, then in the ER, I was offered a new challenge as the hospital nursing quality assurance director. This role provided a broad organizational view of quality and care delivery, and it fueled my interest in research and the measurement of outcomes. I transitioned from this role to a clinical research nurse position in a large tertiary hospital. In this role, I helped set up research protocols, quality programs, and database tracking systems for care management and continued furthering my research in patient fall risk factors.

After several years of learning how a healthcare system works, I moved into senior leadership roles in hospital administration. I served as the senior vice president/senior nurse executive for nursing and patient services for about 8 years in a large tertiary care center. A major focus during this time was on transforming the work environment, and we established a demonstration project for acuity-adaptable patient rooms. During this time, I was also fortunate to be selected in the first group of Robert Wood Johnson Fellows. This is a 3-year leadership fellowship that focuses on five key leadership competencies in the areas of self-knowledge, strategic vision, risk taking, and creativity, interpersonal and communication effectiveness, and inspiring and leading change.

Right after the fellowship, I also had the opportunity to be on faculty with the Institute for Healthcare Improvement (IHI) and the AHA/IHI national workforce improvement series (IMPACT).

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In 2003, I was given the opportunity to be the VP for clinical excellence operations with Ascension Health, the largest Catholic health system; this has been an expansive and challenging opportunity.

DZ: Let's back up. Tell me more about your work with caregiver environments and patient fall risk factors and how that developed.

AH: Over the past 20 years, I have always been interested in the relationship between the physical work environment, the role of the nurse with the care team, and what impact this has on the patient experience and their outcomes. Patient falls and many other care issues are contained within this phenomenon. I noticed trends and started formulating my own concepts of factors that caused falls. That led me to ask: “How can I describe these falls and fall risk factors?” That culminated into the Hendrich II Falls Risk Model© now used nationally and internationally.

My major focus during the past 12 years or so has been on the importance of the relationship between the caregiver and the work environment. This subject evolved into a large multisite study (36 sites), funded by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, Ascension Health, and Kaiser Permanente, using time and motion to measure how medical-surgical nurses spend their time.

As I began to look for funding sources, I started small with state nursing organizations and “seed grants.” Finding funding, especially in this economic environment, can seem overwhelming, but my experience is that good ideas that help improve patient care quality, effectiveness, and efficiency are almost always funded in one way or another. It is really up to the leader to find key stakeholders and appropriate funding sources to support the topic need. Creativity is important, but understanding the implications of the problem is equally important. This may require financial and operational impact analysis to help the organization see the opportunity if the problem were solved or eliminated. This is what a nursing leader should be able to do.

DZ: Talk to me about influencing “at a larger” view and the leadership characteristics needed.

AH: I think all nurses have the ability to influence and participate at many levels. We have the knowledge to improve the patient care experience and that includes quality and cost. This occurs every day with patients in hospitals, clinics, homes, and communities where nurses provide care and make a difference. We should also be contributing at the public policy level— especially now while key societal drivers of access and cost are creating a unique opportunity. We should continue to focus on the six aims from the Institute of Medicine and Transforming Care at the Bedside imperatives to shape future care delivery. This requires that we embrace our many partners in the care discussion. We should also bring certain leadership characteristics with us, such as creativity, perseverance, innovation, business acumen, reverence, respect, deference to expertise, and a strong drive to make things better for the patient and the provider.

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Today, I serve as the VP for clinical excellence operations in Ascension Health's system office. I worked with our chief nursing officers (CNOs) to create a system-wide CNO Advisory Council (CNOAC), which leads and directs the system-level strategic and tactical aspects of nursing and patient care. Each council member chairs a smaller regional group of CNOs, with a CNO group made up of four to five nurse executives. These groups review the CNOAC agenda to provide input and consensus-driven decisions for our distributed nursing leadership model. This shared-governance model facilitates alignment of nursing with the strategic imperatives of the organization.

As an example, one of our first efforts as a council was to target one of our eight system-wide Priorities for Action (PFA) from our Journey to Zero priorities. They selected the elimination of hospital-acquired pressure ulcers as one of our first major projects, and as a result, nursing developed an evidenced-based skin protocol for the system. More than 80 different standards were in place, given the number of hospitals. A rapid design meeting format brought our key stakeholders (educators, CNO, bedside nurses, managers, wound/ostomy, clinical nurse specialists, and physicians) together to create a standard of care for the system. The group decided to adopt an attitude of “Letting Go” of the current state to identify the best evidenced-based standard in pursuit of excellence patient care. As a result, our nursing team came up with the acronym: SKIN: Surface, Keep Turning, Incontinence, and Nutrition. Today, this protocol is followed in all of our Ascension hospitals and healthcare facilities, and the prevalence rates is one of the lowest in the nation at about 0.9/1000 patient days. Literally, the work of nursing has impacted thousands of patients.

The other PFA areas that Ascension Health has focused on over the past 5 years include a composite of significant hospital issues, including the national patient safety goals and core measures. We refer to this as our Journey to Zero at Ascension Health.

This work is critical for eliminating harm and in transforming quality and safety into performance outcomes.

DZ: What do you want to say to aspiring nurses?

AH: First of all, thank you for being a nurse. We have a unique opportunity to help provide access to healthcare, prevent complications, and promote self-health maintenance and how to improve the acute care delivery experience (outcomes and cost) with our many partners. We can all contribute to the effectiveness and efficiency of a holistic care experience in a variety of environments. Nursing holds the essence; each of us can and does make a difference. We must focus on building relationship with our physican partners. A collaborative approach is critical, and nursing has a very unique place as part of the care team.

DZ: How would you summarize your career in nursing?

AH: It has been rewarding and challenging in a variety of ways. I have also been blessed to hear about life from my patients, and learn from and work with many talented individuals who care deeply about the patient. Nursing provides a wide range of career opportunities, and I am grateful to be a member of this profession.

DZ: What are the greatest lessons you would like to impart with the readers?

AH: As nurse leaders, we are here to contribute to the improvement of patient care and their individual experience. Our role is to align patient care resources and then measure the impact of the change upon healthcare. The measurement of outcomes, efficiency, and effectiveness must be part of any nurse leader's role.

Many of our problems today can't be solved by looking backwards or inward. I've learned building effective, diverse teams and utilizing the talents of each unique individual is vital. Sometimes, organizations limit their effectiveness by believing 1 person or an organiztional structure can solve for this. It is really more about the mind set of the right group of people, who believe the change is possible, and work to find the solutions to change the culture. Inflexible organizational structures rarely produce these results.

The needs of the patient, the work environment, the caregiver's knowledge, and supportive technologies, are inter-related and they need to work like an ecosystem. This requires system-thinking when bringing key stakeholders together. The creation of these types of partnerships should extend beyond the hospital to include vendors, Dean's, patient, and educators who can help us transform healthcare.

I also think active participation in the American Organization of Nurse Executives allows nurse leaders to influence and promote change in our healthcare system through impacting policy at the national level. Our role in this cannot be overstated. I would say more participation by nurse leaders is a responsibility we owe to society and our profession.