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Michael Carrese (Host):   Welcome to the ASHRM podcast made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. Visit ashrm.org/membership to learn more and become an ASHRM member. I'm Michael Carrese and on today’s show we’re going to be talking about leadership and the obstacles that have to be overcome on the path to becoming a leader. We couldn’t ask for a better guide than Meg Garrett, ASHRM’s president elect and president of Garrett Healthcare Risk Management Consulting. For 33 years she put her nursing experience, master’s in education, and law degree to good use as the vice president of risk management and chief legal counsel for the Johns Hopkins Health System where she was responsible for designing, implementing, and overseeing all aspects of the risk management program. She continues to provide educational programs in the JHU’s school of medicine and school of nursing and is an adjunct faculty member at the University of Maryland school of law.

She’s also been very active in risk management organizations including service on ASHRM’s board and serving as faculty for the advanced risk management module. Her board service extends to numerous organizations including Healthcare for the Homeless, Villanova University Nursing Board of Consultors, the Maryland Bar Healthcare Law Committee, and others. So Meg Garrett, thank you so much for joining us today.

Meg Garrett, BSN, MED, JD, CPHRM, DFASHRM (Guest):   Thank you.

Host:   At the root of all of that career experience, you were a nurse first. I wanted to start as we explore your career, what was the spark that set you on that path to be a nurse and to be in healthcare?

Meg:    Well, it’s interesting because I'm the product of the baby boom. Back in the 50s, 60s, early 70s women were either teachers, secretaries, or nurses. I had a passion for people. I still to this day love to teach, but I decided that I wanted to be a nurse. Probably not as much a bedside nurse, but to become essentially a leader to nurses across the world.

Host:   What was it about the bedside nursing that appealed to you?

Meg:   Just really caring and helping people has always been my passion. I'm not certain that you are aware, but I joined the military. I was a Navy scholarship individual at Villanova University in Philadelphia. I chose Villanova of their values and visions, which was again caring for the individual, respect for people, and trying to move healthcare forward. I become a Navy nurse in 1971 in the height of the Vietnam Conflict. I had volunteered at the Navy hospital in Philadelphia as a college student and saw many individuals who were even younger than me who were coming back from the war with horrendous injuries. This was a time of conflict in the United States where many people didn’t believe in the war. I can't say that I believed in the war, but I believed in the people who got sent to war. That really set me on the trajectory of being a Navy nurse for eight years after I graduated from Villanova.

Host:   Well, I should say thank you for your service mam.

Meg:   Thank you.

Host:   Did you know early on that leadership was where you were headed?

Meg:   Well, yes probably because I was a 21 year old Navy nurse [inaudible 03:31] stationed for my first duty station in Boston in charge of a 35 bed orthopedic unit at age 21 even prior to passing my boards. My first duty assignment I was responsible for about 18 corpsman enlisted individuals, many who were much older than me and probably more educated but who had been drafted. I was responsible for making sure that our mission was completed. So I actually stepped into that role quite early. I enjoyed it. I enjoyed mentoring people. I enjoyed having to make decisions with a lot of support from folks. I had a lot of pride in my team and really enjoyed it. From there I went to Charleston, South Carolina. I was stationed there for a period of time and actually ran the psychiatric units, which, again, were fascinating. Because these were people who didn’t need all the IVs and all the tubes and so on, but they needed someone who would listen to them. Again, I was responsible for a number of individuals and, by that time, more junior officers and as well as enlisted individuals.

Host:   Now, it was around that time that you pursued a master’s degree if I'm not mistaken. I'm wondering if you were thinking about additional education and eventually the law degree because you knew it would help you moving forward in your career or were there other reasons for that?

Meg:   Well, I always felt that the mental health world was an area that we needed a lot of individuals who had compassion and who had a passion for helping folks who didn’t just need medications but needed other type of therapies. I was stationed in Charleston. My first day of duty station was July 1, 1974. By July 15 I had been accepted at the Citadel, which was an all-male institution except for graduate school in their degree in counselling, which I felt that would enhance me as a human being to learn different theories to counselling and to better understand people, their thought processes, and so on. Also help me as a leader know and understand the world around me and my people.

Host:   You know, I'm thinking in the post-Vietnam era this was probably before there was a real awareness of what PTSD even was, right?

Meg:   Absolutely. Especially in Charleston, we were the number one hospital for the Marine recruits at Parris Island. I would say any given day over half of my psychiatric unit was filled with those individuals who were coming into the military and understanding and then the other half were those folks who were returning to the war.

Host:   My goodness. Had your hands full there. Then what about the law degree? What set you on that path?  

Meg:   Well, when I was in eight grade I mentioned to my parents that I would like to be a lawyer. Again, women were nurses, they were teachers, or secretaries. I remember my parents saying something to the effect of, “Well, lawyers are liars.” So I was like hm, okay. So the law degree came partly—After my duty station in Charleston, I was stationed at Bethesda Naval Hospital in charge of the psych units, and I met my husband at that time. We got married and moved to South Carolina. It was somewhat challenging being a northern individuals being a doctor’s wife in South Carolina. I felt like I needed to do something else to grow. So I basically had my first child who was 13 months old when I started law school. I basically majored in sandbox and minored in law. I was very blessed. I had the GI bill. I did school pretty much in the morning, in the afternoon took care of my son. My second son was born during exams in law school. Then we moved to Maryland and I finished my final year at the University of Maryland. After that I had a set of twins right after the bar exam and helped start the American Association of Nurse Attorneys with several colleagues from Maryland at that point in time. Because I really felt that—Physicians knew how to call a lawyer, nurses didn’t always know. The world of healthcare law was just developing, especially in the mental health area. Patients were being discharged from every psychiatric facility, especially state facilities, without having proper treatments available to them.

So my passion continued for healthcare for patients as well as hopefully at some point to be a leader in trying to move really the vision of ASHRM and Hopkins safe and trusted healthcare. I was very blessed. I got a phone call from the general council at Hopkins one day who had heard me speak on behalf of the American Society of Nurse Attorneys and asked me if I would be willing to come to Hopkins. At that point, I had four children under six including a set of six month old twins. I went for the interview and they were kind enough to offer me the position. I was kind enough to accept it except to say that could only work two days a week, so somebody had to parent my children.

Host:   Right.

Meg:   That was the beginning of a phenomenal career of 33 years.

Host:   Well, I was going to get around to as we were going to discuss some bumps in the road on the way to becoming a leader to what extent being a woman was one of those obstacles. As you're describing having to be the mother of so many children and all of that, that’s one obstacle. Were there others as well?

Meg:   There were numerous obstacles being a woman. I went to Villanova the first year it turned co-ed. Women were not highly appreciated on the men’s campus. I think that was one of the first challenges. Being an only girl in a family with two brothers, that was a challenge having to have a voice in those kinds of situations. Certainly being a woman in the Navy back in war days where the men were definitely treated far better than the women. When I first joined the military, women were not allowed to call their husbands dependents, the female officers. That changed sometime in the early 70s. Again, very, very different type of world. When I went to the Citadel, there were only three women in the graduate program that I was in. Then when I went to law school at the University of South Carolina, my class had five women. Then going to Hopkins, very few women in administrative leadership roles. Being a nurse was also somewhat of a challenge and then being a lawyer with a group of physicians. I remember at one of my first medical board meetings a physician saying, “Well, what’s worse than having women at the table, but women who are nurses and then who are lawyers.”

Host:   Nice.

Meg:   The following meeting someone put a copy of Robert’s rules on the desk and thereafter everyone was treated with the utmost respect and dignity.

Host:   Oh my goodness. What a story. You're listening to the ASHRM podcast made possible by the American Society for Healthcare Risk Management. To support efforts to advance safe and trusted healthcare through enterprise risk management, you can go to ashrm.org/membership any time to learn more and become an ASHRM member. Our guest is Meg Garrett who is ASHRM’s president elect and president of Garrett Healthcare Risk Management Consulting. Spent 23 years at Johns Hopkins helping to design, implement, and oversee all aspects of the risk management program. So there you are at Hopkins, you’ve accepted this job. When did you start the leadership path there?

Meg:   I would say it was after the first several years. Risk management and the legal department were very small at that time. It was just beginning to surface as a healthcare model for risk management. The financial community had had risk management for a while, but just beginning to show its head at Hopkins probably late 80s/early 90s. Lawsuits were starting to blossom. Certainly, we were in the age of the HIV epidemic and a number of other healthcare issues started to surface.

Host:   So in addition to what we’ve talked about already—having some obstacles because you were a woman and nursing background and all of that—what were some other things in your way or bumps and twists in the road in your Hopkins experience?

Meg:   Well, I think initially it was pretty much a male ran institution used to doing things the old way, the Hopkins way. A lot of organizations followed the Hopkins model of healthcare for the individual and so on. Just really learning the culture was a challenge. At the same time, trying to raise small children and keep up with community activities and social activities and so on.  I think that certainly the late 80s/early 90s, everywhere began to see somewhat of a change in healthcare. The whole patient safety movement started moving forward. Certainly, Hopkins had its share of tragic incidents that patient safety and risk management came to the forefront. In board of trustees meetings back in the late 80s/early 90s, the majority of discussions were about finances. By the early 90s to the mid-90s, everything focused to patient safety, patient care, quality of care. How can we prevent something from happening again? I saw a total change in the atmosphere in my organization and I embraced that. That’s where I really think I managed to take foothold as far as becoming a leader in the organization. Everybody started getting the passion, but I think our group really pushed to emphasize. It was passion. We wanted the best healthcare for our patients. Did we make mistakes? Absolutely. Did we learn from them? Yes. I pray that we continue to learn from them.

Host:   So when you did hit bumps in the road, and for folks listening, what are a couple of strategies for overcoming those? What kind of support did you get or did you seek out? What other elements were there that made you ultimately successful?

Meg:   Well I think developing relationships was number one with senior leaders. I think them understanding that I did have a passion for our patients and our staff and for overall quality healthcare. Knowing that they would always hear from me the truth. The truth might hurt in a sense, but always knowing that I would be honest. My integrity was always first and foremost. Respect for them and as a result from that I think I gained a lot of respect. I also feel that it was very important to listen and not jump to conclusions. Because I listened, so often near the end of a meeting everybody would start looking to me and say, “Well, what are your thoughts?” But I had the opportunity to let other people speak and then was able to pull together basically some of the better thoughts of the whole group and hopefully to identify next steps. There’s a lot of leaders who may not always listen to the team, and I think that absolutely critical. Then speaking of my own team, I think my passion and my motivation kept my team moving forward. I think being a good leader was also exposing them to senior leadership and not taking the credit for everything my people did. I think that’s what's helped them move forward with or without me.

Host:   So obviously a lot of challenges and pressures being a leader, but I'm wondering what you enjoyed most about it.

Meg:   I loved watching my people grow, and I loved being part of a leadership team that changed the focus and moved forward patient safety and risk management in healthcare. That’s my sense of pride. I think I'm a very humble person, but I am really proud of what we on my team—we at Hopkins—have been able to do for healthcare.

Host:   As we wrap up here, I'm also wondering for folks listening who are aspiring to leadership, what are a couple of concrete steps that you would advise them to take?

Meg:   I think getting invited to the table is critical. When you're in a meeting and someone starts talking about be it corona, be it about an ethical dilemma, be it about whatever that you offer to help. Once people start seeing you being a good worker, a good advisor, a good leader knowing that you can make decisions and so on, that door will be open. Being humble I think is absolutely critical. Being respectful is critical. I think those are the ways to get yourself at the table. Then once you get there you need to continue working in that direction. The other important thing is mentor your people below you, your staff. One of the things that I did everyday that my staff really appreciated, I walked around that building and said hi to people. I knew who was having a baby. I knew who’s child was having a challenge in school. I know who’s family member had been ill. I think really being on a personal level—and I was at one with leadership as well—being on a personal level so that you could communicate, have some empathy for what they're going through, and be able to pick up the ball for them I think was critical. In healthcare, making decisions can impact a huge group of people. Even right now the folks in the corona world and so on, trying to decide whether you're going to open different areas of the hospital, whether you're going to furlough people, these are all challenging decisions. You have to sometimes make them. I think that being there as part of that team and eventually leading that team is critical. You have to be humble, you have to be transparent, you have to be honest. I think you have to have a passion for what you're doing.

Host:   Well, that’s wonderful advice. These days, Meg, they call that a wisdom drop. It really has been wonderful to hear your story and I want to thank you very much for spending the time with us to be here today.

Meg:   Well, thank you very much. Happy healthcare risk management week and thank you again. Be safe.

Host:  Will do. Speaking of healthcare risk management week, we want to encourage everybody to go to the ASHRM website. So that’s www.ashrm.org/resources/hrm-week to learn more about the available HRM activities. This podcast is made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. Visit ashrm.org/membership to learn more and become an ASHRM member. Thanks for listening.