Bill Klaproth (Host): This is a special episode of Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership, recorded live at the AONL 2024 conference. I'm Bill Klaproth as we talk about building a culture of inquiry and leadership in international collaboration. With me is Adam Cooper, Director of Nursing Continuous Improvement at UCSF Health.

Host: Lisa Lommel,

Bill Klaproth (Host): Clinical Professor at UCSF School of Nursing, and Elisa Jang, Associate Director at UCSF Leadership Institute. Lisa, Elisa, and Adam, welcome.

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: Thank you for having us, Bill.

Elisa Jang, DNP, RN, CNS, EBP-C: Thanks Bill, we're happy to be here.

Adam Cooper, DNP, RN, NPD-BC, EBP-C: This is going to be a great opportunity.

Host: This is going to be a great panel, I can tell already. This is good stuff. So Lisa, let me start with you. When it comes to your session, building a culture of inquiry and leadership in international collaboration, tell us more about your session and why you put together this international collaboration.

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: Great question, Bill. Domestically, we've noticed that leaders really struggle with how to impact patient outcomes, return on investment, and clinician wellbeing. And we found this to be a challenge in leaders globally as well. So, we really focused on a particular area of leadership, which is evidence based practice.

So that's what our institution really decided to hone in on, to really kind of impact some of these outcomes.

Adam Cooper, DNP, RN, NPD-BC, EBP-C: Yeah, and just to bounce a little off of that, our institute, UCSF, has a leadership institute. And that leadership institute is really a hybrid between our academic and practice areas, our school of nursing and our medical center, our hospital. And that got burrowed through leadership engagement. We, it was an engagement with our chief nursing executive and our dean at the school of nursing who really had a vision to bring these entities together to provide leadership development opportunities and evolved into also providing evidence based practice development opportunities.

And this is what we have been deeply involved and part of what has led us to build up infrastructure locally within our institution and provide opportunities for international work, which is what we're excited to talk more about today.

Host: Absolutely. Adam, when we talk about evidence based practice or EBP, do you think we're lacking in that?Do we need to have more conversations on that? Are we moving in the right direction on that?

Adam Cooper, DNP, RN, NPD-BC, EBP-C: We are moving in the right direction and we need to continue the discussion both on building up individual local cultures of evidence based practice, but also how do we then share and bring up the whole healthcare system globally to make sure that we are actually providing the best care that we can.

That includes making sure we've got evidence based approaches to our practices. Making sure that we leverage the expertise of our teams. And that we also keep the patients and the families front and center in how they are part of the decision making that goes on to how they are cared for. So putting that all together is really what EBP is all about.

And different institutions globally are in different pieces of that spectrum in terms of where they are and how they've developed their own internal culture, including ours. We are continually evolving our culture at UCSF, but excited to continue that discussion.

Elisa Jang, DNP, RN, CNS, EBP-C: I think at the local, regional, and national level that there is an awareness at least now. I think maybe 10, 15 years ago there wasn't as much awareness of what EDP is. I think that we're at that place now, generally, I think, where the awareness is there, but the specific skills and knowledge that are needed in order to embed EBP principles into your practice and getting to those patient outcomes; I think that's the focus of our institute and how we're collaborating with other healthcare organizations.

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: I was going to say, importantly, too, we really are intentional about focusing on leaders and their understanding of EBP, because we are focused on the bedside nurses, mid level leaders, but we're really looking at all levels of leadership, because without their foundation of understanding what EBP is, we can't really move the needle very far.

Host: We need the leaders buy in to really push forward. So Elisa, let me ask you this. When it comes to everything we've just been talking about, can you tell us about the initiatives or the things you did to address this issue or solve this issue? Tell us about that.

Elisa Jang, DNP, RN, CNS, EBP-C: So it, I think starting out, it seemed like a monumental thing. How are we going to approach this? And I think looking internally first, was really a main focus. Because without building a strong culture, as we are concentrating on evidence based practice, without building your own culture first and that infrastructure in place, I think it will be very hard to be able to collaborate with others and provide that supportive conversation and collaboration with other healthcare organizations.

So I think in the beginning, it was really about focusing internally about how we build our own product and how we build value to that. And be successful in that and having positive outcomes. And then from that, then forging those partnerships. We started with some regional and domestic partnerships first with other healthcare organizations who were of like minded, who were also on this journey of building a culture of inquiry and EBP.

And then through networking and building those collaborative relationships, then we expanded out to international healthcare organizations as well.

Host: So when you say you looked internally first, you had to look at your own culture first. So, for someone listening to this podcast, they might be saying to themselves, that sounds great. How do I do that? How do I evaluate my own staff first? What did you do?

Elisa Jang, DNP, RN, CNS, EBP-C: So, there are specific tools and, and questionnaires and surveys of how you can distribute that in your organization among the leaders and your frontline staff in helping to identify what are the gaps in building your infrastructure and in building the knowledge and skill set that is needed for evidence based practice.

Host: I love that. That sounds like a great way to address it first is do that. And then, Adam, let me bring you in on this as well as we talk about first steps to take. For anyone listening to this podcast, it's like, okay, I need to start doing this. We talked about a couple of first steps. What are some of the other leadership tactics that someone can deploy in their own organization to address this further?

Adam Cooper, DNP, RN, NPD-BC, EBP-C: Some leadership tactics are once you understand where your gaps are, to start to prioritize what you want to work on first. What will be critical to sustaining a foundation of evidence based practice. And this is what we've been on this journey for 15 plus years at UCSF. But for organizations that are just starting out, using a baseline assessment tool like Elisa mentioned is a good way to start the discussion.

And then you get your core leaders together and say, this is what our assessment found. What do we think as a collective here, the leaders of our organization, what do we think would be the best place to start? Knowing that you will eventually tackle most of those gaps over your designated time frame, but you have to start somewhere.

A lot of that can start with just building awareness and education around what EBP is, and you can start down that pathway. And then there are celebrating successes, as you implement evidence based practice. The research shows and our experience shows that you do have positive outcomes. You have positive patient outcomes. You have a return on investment for any of the financial resources you put into it. You have clinician wellbeing outcomes. And you celebrate those outcomes to further bolster the impact of EBP.

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: I would add to that too, I think one of the primary first steps is really one of the tenets of EBP, which is really looking at the evidence and really understanding the connection between EBP and outcomes, before assessment, to really understand how it can move the needle to better patient outcomes, return on investment, and provider wellbeing.

There are a lot of articles and literature in the evidence that can really demonstrate that and to really have your constituents, so the nurses, providers in the hospital or the setting, really understand that there's a strong connection and get their buy in as well.

Host: So, Lisa, is that the quadruple aim, if you will, the goal of EBP? You said patient outcomes, cost, clinician wellbeing, quality, that, so that's, so for someone listening to this, this is the end result. The goal you're going for is these four tenets, is that right? Yes?

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: Correct. Evidence demonstrates that they all work toward the quadruple aim, and for many nurses, the magnet status, which is also a place that many nurses want to be in, within their organization.

Host: Okay, so first evaluate, then Adam said once you learn the gaps, then you prioritize, right? So those are the next steps. So then what do you do after that, Lisa? What is a key takeaway once you've put those things together?

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: Well, I think it's really important to understand the infrastructure, to really understand what is available. We have worked with many other, many different institutions, locally and globally, and the infrastructures vary. So, it's really important to go in and help support their infrastructure. Sometimes we have to provide some of the infrastructure for them. Sometimes it's a matter of us meeting with our stakeholders, and really discussing the importance of kind of revving up and bolstering some of this infrastructure around needing to do EBP and creating EBP projects that really endorse the mission, vision, and value of the organization because until they work on something that's really going to be irrelevant from the top down, people really aren't going to buy in and really be excited about it.

And maintaining strong partnerships. You can't really do this alone. We've noticed that. We're still using our partners to move along our EBP journey. So these things are really important. And I think the last one really is sustaining projects, and that needs to be infused early. So not just,

Starting, You know getting people on the road, implementing this EBP journey, but really, how do you really infuse it permanently within the organization?

Host: Execution matters.

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: Correct.

Host: For sure. So where does this start? Does this start with a nurse leader? Does this start with the director of nursing? Who starts the mission, generally. I'll leave it to any of you.

Elisa Jang, DNP, RN, CNS, EBP-C: I would say, oftentimes it starts with a very serendipitous conversation. It can oftentimes where you have a informal conversation, you talk about your common goals. And we've learned that, as we've had these conversations that then having a conversation, then focusing on evidence based practice is a good way to start talking about how we get to our patient outcomes and a positive return of investment.

Then it's really having these collaborative discussions around how can we merge, in a way, our common goal and mission. And even though we may have certain differences in, perhaps, in language, oftentimes, if we're dealing with international collaborations, and often systems and processes may be different, but how can we learn about each other so that we can learn and then develop a valuable program, that we can then, be able to approach this and combat the problem.

I, just to add on to what Lisa had just said, I think that one of the other reasons why we have been successful in this is that we have a very longitudinal approach to how we collaborate with our partners. So, it's not just that we're offering an EBP program and teaching leaders and frontline staff about evidence based practice, but that we also have very regularly scheduled meetings with the leaders to talk about how they can create this culture.

It's not just a one and done. We are invested in our partners. And that's what, that's how we refer to our collaborations is that it's really a partnership and that our investment is really around how to help them succeed. And then there's a big return of investment on our part because we learn equally from them as well.

Host: So why international collaboration? Why not collaborate with somebody three states over?

Elisa Jang, DNP, RN, CNS, EBP-C: I think in the beginning, that's how we started. We have definitely have various domestic partnerships. But one of our mission and vision at UCSF is around global health. And we actually have a center for global health. And so, I think our interest in that and expanding our reach was really an interest of ours. And seeing how far we can go and seeing how much we can make a difference. Not just domestically, but globally as well.

Host: So when do you bring the international partner in? So now you've established this, let's say, at UCSF. When do you go and find an international partner? Once you're set internally?

Elisa Jang, DNP, RN, CNS, EBP-C: I think that that is our recommendation from our experience so far. That once you have a solid program that you've built that has successful outcomes; that's a time where perhaps you can explore those either domestic or international partnerships.

Adam Cooper, DNP, RN, NPD-BC, EBP-C: And sometimes that happens organically, because part of our process and part of the EBP process is actually dissemination and sharing your work at conferences like here at the AONL conference or at publishing in journals or doing podcasts, like all these different ways that you can share the stories in your experience start to put you out there.

And then actually instead of seeking partners, sometimes partners find us.

Elisa Jang, DNP, RN, CNS, EBP-C: They come to us, yes.

Adam Cooper, DNP, RN, NPD-BC, EBP-C: Yeah, and they say, oh wow, this is really interesting what you've developed there. We would love to have some further discussions on it. And that discussion leads into potential partnerships or different types of collaborative opportunities.

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: Also, I would add, because UCSF is a strong research institute, that includes the School of Nursing, we have some very strong longitudinal partners with international universities and hospitals. And so, we also made an intentional effort to not just partner for research purposes, but for practice purposes.

So that really was a jumping off point for us many times in really establishing how to improve patient care, not just knowledge, improving knowledge. So that really was an important factor.

Host: Yeah, build it and they will come.

I think I have two.

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: The good bumper sticker for us.

Host: Yeah it is, for sure. And Elisa then, what have been the results of these initiatives, and tell us about things you learned along the way.

Elisa Jang, DNP, RN, CNS, EBP-C: Sure. So we've built a good handful of domestic partnerships that we continue as of today. And then same thing around a handful of international partnerships as well. So, these are great collaborations, great opportunities for development on both ends. We measure and follow the projects from beginning to end, and we help them to develop or identify what their project outcomes will be, and they're focused on patient outcomes and giving that organization a positive return of investment.

I think one of the aha moments or surprising thing is that we found and this is one thing that we learned, I think, at UCSF is that their approach right off the bat with some of these international healthcare organizations was inter, an interprofessional approach. And I think we have then followed suit and adopted that and we realized that, especially with evidence based practice, that is a very universal topic that can be a focus of all clinicians, nurses, and interprofessionals.

And so that was something pleasantly, that we were pleasantly surprised with and that In turn, it really reinforced these partnerships, how we can learn from each other and build off of each other.

Host: Yeah, and I have my notes here. Six partnerships, is that right? With six healthcare organizations, is that right?

Elisa Jang, DNP, RN, CNS, EBP-C: Internationally, yes.

Host: That's amazing. You guys are amazing. Just let me say that right now. Amazing. Well, this has been a great podcast. I want to thank you all. This has really been insightful and informative and a lot of fun talking with each of you.

I'd like to get a quick wrap up from each of you, if I could. Lisa, let me start with you. Any final thoughts or things you want to add?

Lisa Lommel, PhD, RN, MPH, FNP, EBP-C: I would say don't be afraid. Jump in. We as nurses around the world have expertise that we may not really spend a lot of time considering. We need to continue sharing more, collaborating, working with like minded individuals around the world. And so just take that step forward and take someone on a journey with you.

Host: I love that sentiment, that is a great thought, so thank you so much. And Elisa, how about you?

Elisa Jang, DNP, RN, CNS, EBP-C: I would say as nursing leaders, most often those people are lifelong learners and I think the best way to learn is to ask questions. So I think that would be my parting message is, don't be afraid to ask questions. That's a great way to learn and identify new opportunities.

Host: Another great message, thank you so much. And Adam, how about you?

Adam Cooper, DNP, RN, NPD-BC, EBP-C: Yeah, I love both of those answers.

Host: They set the bar high.

Adam Cooper, DNP, RN, NPD-BC, EBP-C: I know, right?

Come on. Couldn't I have gone first? 

Host: Sorry the pressure is all on you now.

Adam Cooper, DNP, RN, NPD-BC, EBP-C: The, uh, so, healthcare across the world needs each other. And we need to reach out and collaborate to improve healthcare globally. No institution by itself can do this. And at UCSF and with the Leadership Institute, we found one sliver of a pathway to get there, right?

And that was with our EBP program and collaborating internationally with organizations to help and learn from, to elevate health care. But as we talked about earlier, other institutions can find their own expertise in their own special way, their unique contribution to health care. And they can push into that and start to really develop that and start to build local, regional, national, and then potentially international collaborations.

And that's truly how we all work together to evolve health care to where we need it to be.

Host: I think you did a nice job. I think you reached the moment.

Adam Cooper, DNP, RN, NPD-BC, EBP-C: I appreciate that.

Host: Yeah, good job, Adam. Well, I want to thank all of you. This has been a lot of fun. Once again, Adam Cooper, Lisa Lommel, and Elisa Jang. Thank you so much. This has been awesome. And for more information, please visit aonl.org. And if you found this podcast helpful, and how could you not? Please, come on, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.