Bill Klaproth (Host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. And today, we're talking about leading healthcare transformation in Hawaii, preserving essential services, building community trust, and why developing the business and leadership skills of nurses is so important.

Joining me is Robin Kalohelani, Senior Vice President and Chief Operating Officer of the Queen's Medical Center, West Oahu and Wahiawa. Robin, welcome to the podcast.

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: Aloha. And good morning or good afternoon. Thank you for having me.

Host: Aloha to you too. I love this. This is great. Robin, you've had a really interesting career path from nursing and care management to project management, construction, and now serving as a chief operating officer. Can you take us through that journey? How did your nursing background prepare you for such a leadership role?

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: You know, I would say I was a late bloomer into nursing. I had already had three ch- little boys. And then, I said I wanted to venture into the nursing career. I was fortunate enough to get a Native Hawaiian health scholarship, and that put me in community health nursing. I think by having a little of life experience behind me, gave me a little bit of the opportunity to kind of explore and go into not the traditional nursing roles.

So, I started as a community health nurse, and it was going out on the beaches here, on the islands here, and I would serve the underserved. My organization recruited me then to come and take care of patients within the hospital. And so, I did care management, care coordination for many years. So, I did everything with transitions of care and patient flow, the patient's journey while they were in the hospital and then through discharge.

After that, our organization was looking at acquiring a property, a hospital that had been shut down a couple of years. On a fluke, I applied for a position and got it, which was project management. Never knew what that was there, but the job required critical thinking and good relationships to coordinate the activation and implementation of a community hospital. It was a leap of faith, I would say, that I, you know, ventured on a job where I'd never done it before. You know, I had trust with the COO even though I had just recently met her. But hearing her vision and what she aspired the community health center to be, it really aligned with my core values. And so, it was a leap of faith, which just put me on a trajectory of different opportunities and exploration within the nursing realm from a community standpoint.

Host: So on a fluke, and you also mentioned a leap of faith, and look where that's led you.

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: Yeah, it was one of the most rewarding opportunities that I've ever taken and probably one of the biggest decisions in my life and definitely in my career there, because, you know, it was venturing out into the unknown without having the security net. You know, I'm with my organization for 20 years now. And so, you know, I make every move decisive usually on it. But it was just something new here. So again, I was so fortunate and blessed to, like, just have exposure to a variety of different roles and responsibilities.

Host: A leap of faith indeed, and it worked out. It's really encouraging to hear that. So, you did mention transition a few times. So, I think one of the defining experiences in your career was helping transition a longstanding community hospital while preserving access to emergency care. So, what did that experience teach you about just how important a hospital is to a community beyond the medical services it provides?

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: You really are the lifeline and the safety net of a community. On this island, the region that I'm in also is the only place that is not really landlocked. So, there is development going on, and there's a variety of income classes within this geographic region here. So, you're providing access for underserved, insured and then, in some areas, there's like beachfront properties where they're pretty well off. So, you have to be able to do the gauntlet of services for these patients, all while remaining the same quality of care for no matter what class you're in, what your insurance is, that we're going to take care of the community, and we're going to care for them like they're our family.

Host: So, I imagine when you were going through this, there were some difficult conversations along the way about what services you could keep or preserve and what needed to change. So, how did you go about thinking about that, Robin? How did you balance being transparent about those realities while respecting what the hospital had meant to generations of families? You said earlier that, you know, the community depends on the hospital.

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: My first role, which was about 10 years ago, was activating this community hospital. This had shut down for a few years. And so, we have about 110 beds here right now, and we see about 200 patients through our emergency room every day. The situation that you're describing right now is, over the last two years, we actually acquired a hospital that had shut down, and we were really only able to preserve the emergency department. And, you know, the building wouldn't support the inpatient beds anymore. A lot of construction needs to happen.

So, we went out and did neighborhood board talks to talk about, you know, we're not going to have the hospital inpatient beds, but we will have access to care through the emergency department. And if those patients needed admission into a hospital, we would get them in our health system or whatever health system had an open available bed. That took a lot of trust from the community with us, where we had to go back in and really talk to them and share, you know, what services we'll have, you know, providing that safety net again for the community so that they still maintain access closer to home.

Host: So, I know you went out into the community and you spent a lot of time out there listening to their concerns, et cetera. What did that teach you about building trust and leading people through change, you know, especially when the decisions aren't always popular?

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: We had to really structure it so that we were going and informing the community on what was to come. We would do updates on where we were with everything during the acquisition and implementation. And then, after go-live, we would also go there to provide a look back on here's where we are and here's what we've done.

But being involved in those discussions, because we're entering their community and we're there to stay, we really went for an approach on listening and hearing everything, and sometimes things were not popular. So, learned a lot about myself and being, you know, resilient and having some grit to, like, take everything and not take everything personal. Because some times, I would be, you know, like, tearful and it wasn't a sign of that we were doing the wrong thing. But when you hear people talk about their passion, you know, it hits my heart also.

So, you know, I had one community board member come up to me and after and said, "Hey." He's like, "Don't cry. Don't cry through this." He goes, "Our role is to share everything and how we feel." He goes, "And you're doing the right thing, you know?" And I was like, "Okay," I said, "I got this. You know, I got it. I know we're doing what's right. I know we're going to provide quality care for the community, and we're not going away. We're going to be here for the duration here." And I just had so much faith in my clinical team that was going to be there and in our organization that, you know, we really were investing in an area that needed it.

Host: So looking back, I know that you've made some significant improvements, including modernizing the EHR, upgrading diagnostic services, et cetera. How do you measure success then, when the goal isn't necessarily to recreate what was there before, but to build something more sustainable for the future?

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: You know, I look at the patient's journey, I look at the feedback that we're getting. We round on our patients also, so then you can see what their experience is like. We also participate in community events. So, we do job fairs, we go to the high schools. We're really embedded in the community. And so, you get a lot of feedback there on, you know, how their stay was in the hospital.

You also will hear like, oh, it took a little longer than they wanted for a transfer from one place to another or, you know, it's still asking like, "Will we ever have those beds again?" Or, "What's on the horizon?" Some things I don't have an answer for just yet, but the fact that it's open dialogue where you feel part of the community, I feel like that that is a measure of success when you're in a new area.

Watching the clinical team, you know, like, master the new electronic medical record, because we switched over, and just looking at, you know, things that we could do to improve and modernize some of the care that's going on there, I think that's also a good measurement. Looking at the team that's there, the leadership structure, the physician collaboration. So, a lot of positives, and it's always a work in progress.

Host: So Robin, I really like one of your leadership philosophies. You've said that leaders don't need to know how to do everything themselves, but they do need to know who does. So, how has that philosophy shaped the teams you build and the way that you lead?

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: That is 1,000% me. I was community health nurse background, right? So, I've never spent a day of bedside nursing here, but yet I lead surgery, emergency department, ambulatory, inpatient, ICU, all of that stuff. So, I really go to the subject matter experts and really lean in to listen because, you know, I'm doubling the size of my emergency department right now.

I'm adding on two more patient care floors and, you know, some of those areas are not my wheelhouse. Construction is my wheelhouse. But the clinical bedside, you know, like I go to the source and ask for input and say like, "How can we make it better? And if we can't do this, what is a viable solution there?"

And I think that trust in your teams and knowing like who you go to for that type of guidance is so important when leading. Because if you're trying to learn everything and feel like you need to know everything down in the weeds, you're never going to have the opportunity to be a strategic thinker and think outside.

And really, you need others to help you move through the dynamic changes that are happening in healthcare right now, because things are evolving, and as soon as you master something, something else comes. And so, you have to keep moving forward.

Host: Yeah, you've talked about listening a lot, leaning on the team around you. So, that really does make sense. So, let's talk about developing future nurse leaders. We know that great clinicians often move into leadership positions without necessarily having all the management skills they need. I mean, this happens in a lot of businesses, you take the star employee and you move them into management. What should health systems and executive leaders be doing to better support and mentor those emerging leaders?

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: Investing in emotional intelligence curriculums also helps sustainability and it helps the leaders kind of acclimate into, like, what I'm saying, right? Like, you don't need to know everything, but you need to know others who know how to do stuff on there. And you really need a strong EQ for that because it's that relationship building that someone will take you on and show you all the tricks of the trade and all of that stuff so that you can build, like, a firm foundation. We pick our top charge nurses and plop them right into leadership roles, and sometimes we'll walk away and you wonder how they're even doing it.

Nursing is, they're so creative on doing things, but really you want them to have, like, a solid foundation. I really believe, like, a really good business acumen helps with nursing to drive strategic thinking, right? Putting a business model together can show the case for support so that you can move into innovative ideas with nursing.

Host: Let's talk a little bit more about that business acumen that you just mentioned. So, that is really important, the business side of healthcare and nurses understanding that. So, could you just expound a little bit on why financial and operational knowledge is so important for nurse leaders, especially for those who want to have a voice in major decisions and advocate effectively for their patients?

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: In our core for nursing, like, we're caring for people and we're going to take care of everyone there. And so, we do our best to lean into that. But it's when you put it and you put the pencil to the paper and you're going, "Okay, how much does all of this cost here?" It's really like we go in with an intent to do this holistic care for the patient, but everything comes at a cost.

And now, with reform and everything coming back, and then there's slight cutbacks here or cutbacks there, you want to be able to explain your operational day-to-day what you're doing, and then associate it with, like, where you want to be. And so, I partner with my finance team often. I meet with my leadership team to go over their monthly business, you know, ledgers and looking at that and asking the question, where, you know, if you drill down on a monthly cadence, it's much easier because you can see, like, tell me what happened this month. Why was it different? You know, you can go into overtime or supplies or, you know, all of those things. And you can tell if the nurse leader understands, like, even what you're talking about with labor and targets and productivity versus, you know, kind of like a blank stare, which is okay. That just means that we didn't lean in and go through, "Here's the reports that you look at and how you look at it."

So, you put that leader with a leader who excels in it so that they're learning from each other and they're looking at the same things over and over with it. And I think that's the best way. You know, you see one and, you know, really leaning into who does it well, partners, so someone can see you actually do the function instead of just trying to figure it out on their own.

Host: Yeah, that's interesting. Holistic care is great. But even behind that, there's dollars and cents. Let me ask you this, Robin, what's one financial or business concept you wish every new nurse manager understood before taking that first leadership position?

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: Again, I came, I learned as I went. So, I would not limit to something they need to learn. I think a curiosity to learn is more important, you know, and really being grounded in you don't have to know everything to step into a leadership role on it. You really just have to have the passion on wanting to serve in that capacity. And really, you're going to take care of your team like they're your own children at this point. And it's a bigger calling there because it's not it's not glamorous being in a leadership role, you know?

And you don't get all the accolades most times that, you know, people are looking for. Because it truly is, it's so much work, you know? And the nurse manager team, like I just—I am so grateful for them every single day because the clinical teams work so hard, but the leader is responsible for making sure that they show up and there's a good relationship, and they're putting their best foot forward taking care of the community.

Host: I think that is so well said, just having a curiosity to learn, as you said, and then realizing that you don't have to know everything like you said, but you just need to know of those people that do. I think that can be very freeing. If you put so much pressure on yourself like, "I've got to know everything," man, that's a lot of pressure, lot of stress.

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: Yeah, it's way to much.

Host: So if you have that mindset of, "Okay, I'm not going to know everything, but I just need to understand the people that can help me with this," that is really what's most important. Robin, this has been great. Thank you so much. What a great conversation. You've provided us with some valuable insights into leading change and building trust and preparing the next generation of nurse leaders. Thank you so much for your time.

Robin Kalohelani, RN, MSN/Ed, CCM, FACHE: Yeah. Thank you so much. Really appreciate taking the opportunity with me.

Host: Absolutely. Once again, that is Robin Kalahilani. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you at aonl.org/nursing-leadership-podcast. This is Today in Nursing Leadership. Thanks for listening.