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Theresa McDonnell: (Intro) I think the way we deliver care is going to look very different, even in two years, let alone five years. The technology is coming fast and furious, and I personally believe that we need to own, we meaning nursing and frontline clinicians need to own what that integration looks like

I'm Sarah Richardson, a former CIO and president of this week Health's 2 2 9 community development where we are dedicated to transforming healthcare at one connection at a time.

Our keynote show is designed to share conference level value with you every week. Now let's jump into the episode (Main)

Sarah Richardson: Today I'm thrilled to welcome Dr. Theresa, also known as Terry McDonald.

Her work is reshaping how we care, how we lead, and how we innovate. Thank you for joining us today, Terry, and welcome to the show. Thank you so much, Sarah. It's a pleasure to be here, and you've been described as someone who bridges the bedside and the boardroom, and I'm curious how your clinical background shaped your executive leadership style.

Theresa McDonnell: so one of the things that I find very important, even in my administrative role is to maintain a clinical practice. So I am also still a practicing nurse practitioner. GI oncology is my clinical subspecialty, and I've been doing that for 20 plus years. So I know the challenges of seeing patients in a clinic.

Sarah Richardson: What's interesting about you still having honestly feet in, in all different camps of what you do and how much that's appreciated, I think by those that you serve those with also, whom in some cases you have to influence and convince. What would you say are some of those core leadership principles that guide your approach in overseeing large diverse clinical workforces?

Those are the components that I feel I rely on heavily in my leadership. Because you've gotta pull people together that are coming at things from very different perspectives, with different opinions, different priorities. But at the end of the day, the North Star always has to be the patient and the patient experience.

Sarah Richardson: I often will have that conversation with people. Terry and I say, we are all patients, and are you leading from that perspective when you're making decisions in healthcare and technology and you really lean in on innovation heavily for so many of the reasons that are so important to those that are performing the care being given to patients, and you've made major strides in nurse retention, cutting turnover from 21% to 11%. What are some of the specific changes that made the biggest impact?

When we ask them what the pebbles are in their shoes, but then we ask them what they see as the path forward in the solution that helps create that culture of empowerment, and it's that culture of empowerment that then drives the retention. You know, when people feel like they're just a cog in a wheel.

They don't feel any sense of belonging. And One of the things I'm most proud of in the last 12 months here at Duke is we actually just had another culture pulse survey where we, you know, send a survey out to our staff. And our belonging scores were some of the highest we've ever seen, and we benchmarked far higher than some of our sister organizations.

That brings me joy to know that people feel like they belong here.

You're also having them be part of that solutioning. And too often when we think about how challenging it is to truly achieve organizational change management at a level that is successful, it's because we don't involve people early enough. And then if we do ask them, we almost ignore what they tell us.

And I gotta believe that's partly what led for you To a point, Duke's first ever Chief Nursing Innovation officer. How has the role evolved and how has it played really an a pivotal impact on. What you're achieving there at Duke?

Theresa McDonnell: Well, so it was interesting how we got to appoint doctor. So our Chief Nurse Innovation officer is Dr.

So I'll use one prime example. There was a nurse who worked in the pediatric ICU. Who was finding it? Very difficult for little squirmers those little kids in beds with all the tubes and the lines and everything, making sure that those lines were safe. So she went home and she was somebody who liked to sew and she crafted this Velcro enclosed tube called the Line Snuggler, and Ryan worked with this nurse.

because we all know nurses are the great experts of the workaround. We solve problems in the moment with what we've got, but then to take some of those concepts and bring them all the way through so that. They're actually something that can be manufactured and shared and disseminated broadly, not just in our hospital or our health system, but around the world.

And that is one of the primary goals of Ryan's role. But also as we're introducing new technology, new innovation, how do we measure, how do we evaluate, how do we pivot? His role is also integral in that as well.

Sarah Richardson: I was reading about that invention. I literally was thinking, what a perfect name for the environment.

Hackathons have engaged over 10,000 frontline staff. How do you foster that grassroots innovation at scale like that?

Theresa McDonnell: , It's a number of different levers that we pull in order to get that culture of innovation. So we put a call out and we've done a few of these now for the hackathons, and we ask all of our nurses, so again, about 10,000.

And then we give the awards and we understand then from that work who we're gonna move forward. But the other piece of this puzzle that continues that engagement and Kind of that chronic innovation is we launched an initiative during nurses week this year called Empowerment Through Innovations.

So we've got CLS up everywhere. We've got a SharePoint site. We include it in our weekly newsletter. There's a QR code where anyone can scan the QR code and it brings them to a series of four questions. What's the problem? What have you tried? What do you see as being the solution and what resources do you need?

I'll give you an example. We had one nurse in interventional radiology who was bringing forward the issue around patient falls. You get the patient there, you get them up on the table, but then they've gotta go to the bathroom and they don't wanna use a urinal or a bed pan when they're up on an interventional radiology table.

So what they wanted was walkers, very simple, very inexpensive. So we bought them a bunch of walkers, and we delivered them. Those are the types of things where in isolation it doesn't seem like a big deal, but when you're that group of nurses that are frustrated and perseverating on the issue, the problem, the thing that they can't fix for the patient, and you bring them a solution that then unlocks something in the staff, so then they start thinking bigger and they start thinking of different ideas and different solutions.

But it all comes from like strategic transformation, which is another one of your hallmarks. And when you were at Fred Hutch, you were part of a team that led one of the most complex mergers in healthcare history, $1.7 billion, clinical integration. I would love to hear more about that.

Hundreds of thousands of patients, but the foundational issues remained

[Mic bleed]

throughout the continuum of the existence of the SECA brand recognition. Operational inefficiencies because of the way it was constructed and a little bit of a disconnect from the natural synergistic relationship with research.

So, the man who really led the charge and made it all happen together with the leaders of the member, owner organizations was. Tom Lynch, who is the director of the Fred Hutch Cancer Center he brought us all together and there was a commitment to restructure after two decades of really trying to think this through.

It was quite. A wonderful journey. Lots of learning, lots of mistakes made along the way, but the organization that is now thriving is very impressive and I'm proud to have been part of that. But it was a lot of shuttle diplomacy, a lot of reassuring people because when you're doing that kind of work, reassuring people that it's all going to be okay at the other side that's really important.

Sarah Richardson: Terry, you didn't stop there. You went then and secured 710 million in philanthropic investment, which is also a huge win. How did you align the vision with that fundraising effort to create such an impact in that community?

In that space, and I'm hopeful that we will continue to see cures and discovery out of the Fred Hutch because of that work.

Sarah Richardson: They are very much part of our ecosystem UDub and Seattle Children's and Fred Hutch, just from the presence we have with Seattle City tour dinners. And one of our principals used to be at Seattle Children's, but all those organizations are in the mix of this week health.

Theresa McDonnell: I think the way we deliver care is going to look very different, even in two years, let alone five years. The technology is coming fast and furious, and I personally believe that we need to own, we meaning nursing and frontline clinicians need to own what that integration looks like

We need to embrace it. And the reality is right now we are dealing with a math problem. We have an aging population. And We have dwindling resources, meaning our precious human resources. We simply don't have the size and magnitude of workforce that we need, and we can't manufacture more people out of nowhere.

You know, the concept of a nurse bot replacing nursing, I don't believe that

we will ever see anything like that. But that is a fear-driven narrative. And you see those fear-driven narratives when people aren't at the table and when they're not evaluating and when they're not helping make the decisions on how to integrate technology.

Sarah Richardson: And part of that's gonna come from. Policy from when you've done licensure reform to out of practice advocacy, you continue to influence those policies being made at a national level.

What do you see next from what you've been sharing in advancing some of that workforce freedom and some of the shortages that are coming?

Is it time that we really look at national licensure and scope of practice? There's likely more that nurses can be doing to augment the care paradigm as well as leveraging people like me as a nurse practitioner with 20 years experience. What does that look like together in a truly integrated, team-based model of care?

And I think that's the key. How do we leverage technology and really the value of the team around the care of the patient?

Sarah Richardson: If you ever need though, like someone to test out the nurse bot or some of those activities, I'm down for it. I always joke, there's a whole group of my friends and I that we didn't have children.

We're like, who's gonna take care of us? We're like robots, nursing robots. And so we're a hundred percent on board for, I don't know, 25 years from now. I'm okay if I have a C3 PO caregiver. I think.

There isn't the community to care for an aging population. So these concepts are being played out as you and I are speaking. And again, it's not that high level human touch, but it's the basics. It's maintaining safety, it's medication management, it's falls prevention. It's all of those things that can help keep a patient safe and also help the primary care team, the humans in all of this with information and decision making.

So I don't think that home care bot is that far out. I just wanna wait 25 years

But all of this comes with clinical and operational integration. How do you balance the daily realities of patient care with the long-term strategic innovation? Across a billion dollar system, which for you is common, and I am curious how others can adapt your thinking to even their rural healthcare setting.

Theresa McDonnell: We wear many hats and I think the key to success is empowering leaders to come together and be open to the possibilities. I've been in healthcare now 24 ish years and growing up everybody had their silo and their role, and this was the way we do things. Fast forward to today, we're creating the way we do things.

Sarah Richardson: Very true. How do you measure it when you think about either metrics or even signals within the organization to know when transformation efforts are truly working? You might have your KPIs and your krs, et cetera, but what are the other elements, Terry, that you say, I know what's working because of x.

Theresa McDonnell: Again, we do have all the KPIs. We are inundated with information, patient satisfaction, staff satisfaction outcomes. But at the end of the day, it's the culture of a unit or a clinic. When you walk in with the coffee cart and the basics still hold true. You need to round. You need to talk to people.

Sarah Richardson: I really appreciate that one of your measures of success is that people want to talk to you, that they find you and share ideas because you're gonna hear what they're having to say when you think about the future, and as well as advice you would give to others. They read your stories, they see what you're doing.

What excites you the most about the future of the clinical workforce in the next few years?

Theresa McDonnell: The potential.

[Mic bleed]

But really helping people be well, and that to me is exciting. I think the other piece of it is seeing how we evolve. There will always be a need for some kind of critical care. There will always be accidents and emergencies in the unforeseen, and how much better will our outcomes be? How much shorter will admissions be?

Episodes of care with all of the innovation that's coming? How much better can we take care of people?

I think those are the things that excite me. The potential is unlimited. I think the only thing that prevents us from moving forward is our own fear and anxiety.

Sarah Richardson: Yeah. We've seen societally that I call it the easy button.

If we can help people with wellness, what do you believe gets them there sooner or thinks about it differently? Because being truly healthy and well, there's not an easy button. You have to exercise, you have to get sleep, you have to have nutritious food, you have to be hydrated and mentally well. What are some of the things that with all the technology, making it easier, how we actually still address the harder parts of our lives?

Sarah Richardson: And I don't

Theresa McDonnell: have the answers for all that.

Sarah Richardson: I do use chat GPT for healthy versions of recipes. Some of the things that my husband I'd love to do, we're like, how do we make banana bread healthier? How do you make cacio to pepe healthier in your approach to it? And then, you know, how long do I need to exercise?

So, to your point, if you make technology and being healthy, fun, that's, it's a really nice crossroads. What advice though would you give to an early career nurse or a clinician who wants to step into system level leadership, yet may find it overwhelming as a place to start?

Theresa McDonnell: Never be afraid to raise your hand or use your voice.

You know, we focus on all of the wonderful successes, but for every success theres at

least two failures. And I think, you know, when you're early in your career, those things can be devastating and they can prevent you from moving forward. Failure's, okay? We learn from it and we move on, and I think the truly successful early career people are gonna be okay with that.

And they're gonna know that there are people like me behind them that are going to encourage the failure and be willing to dust them off and help them move to the next thing.

Sarah Richardson: When you shared earlier in the conversation about empathy and empowerment, that goes right along with when they do fail, making sure that you have empathy and empower them to try again.

You might still mess them up to, but at least you know what I did. And they go, oh wow, you really did that. Yeah, I really

Theresa McDonnell: [Mic bleed]

Sarah Richardson: Yeah. So it's good to hear it from others. Anything else that you believe is important for those listening to our conversation to know about the amazing work you're doing at Duke and some of the life journeys that have gotten you there?

Theresa McDonnell: Well, I think, you know, I've been extraordinarily fortunate. I've never met an open door that I wasn't willing to walk through. But that's because I was encouraged and I had lots of incredibly supportive family and friends and colleagues along the way, and I can't underestimate the amount of potential that is there in the people that are joining our workforce is incredibly exciting.

Sarah Richardson: Yeah, same. It's fun to work with 20 somethings today because I feel they try to keep me cool, but I also am able to like, you know, help bridge some of these gaps more effectively for others.

No conversation is complete without some speed round. Are you ready? Sure. All right. Along the theme of being healthy coffee or tea to start your day,

Theresa McDonnell: coffee.

Sarah Richardson: Agree. Gonna read more. What do you believe Terry is the one piece of technology that is overhyped, and then which one is underappreciated?

Theresa McDonnell: Overhyped, I think right now is wearables. And underappreciated. I don't know if you can call this technology, but whiteboards, good old fashioned whiteboards, so

Sarah Richardson: underappreciated all at this week. Health have them in our home offices and we like, oh, it's right behind us on the whiteboard. People are like, what do you guys still have those for?

So I'm like, I have really good habits. I don't know that I need my wearable to constantly be reminding me. It was fun for like seven years and now it's not that fun anymore. Yep. All right. Last question. If you were not in healthcare, what career would you have pursued?

Theresa McDonnell: Well, I had a few careers before healthcare.

You had some really cool ones actually. Probably either education or law.

Sarah Richardson: Would you ever think about combining 'em, like there seems like there's so much space for all of the above and you're basically doing that today. You're influencing policy and you're educating all these generations on the amazing innovation in nursing, so you're kind of already doing it, which I love.

Theresa McDonnell: Without the degree,

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