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Michael Carrese: 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. You can visit ASHRM.org/membership to learn more and become an ASHRM member. I'm Michael Carrese.

You might say the US healthcare system went into the COVID-19 crisis with a preexisting condition, scarce resources, struggles for market share and a challenge in the breadth and depth of services among those issues. For risk departments, adding COVID-19 to the mix has led to more role combinations or even furloughs and position eliminations. Many risk management professionals are experiencing role expansion to include other duties or to include entire roles that were held by others.

Well, this podcast is not only going to be speak to skills that risk professionals have that can be transferred to other roles, but we're also going to provide advice on how to plan for the next steps in your career. Our guide in this important discussion is Dr. Michelle Kinneer, Senior Director of Corporate Compliance for Comprehensive Pharmacy Services. Dr. Kinneer is bringing a wealth of experience and education to the table here. She's earned a PhD in leadership, a law degree, a master of science in nursing and a certified in healthcare risk management, healthcare compliance and healthcare privacy compliance. Welcome back to the ASHRM podcast. So why don't you fill in a little bit on your background and tell us what your current role involves?

Michelle Kinneer: Well, I'm a registered nurse by background and training and ended up getting into the risk management compliance field, patient safety, working for a relatively small organization and we wore multiple hats. But after that, I transitioned into more of a risk management consulting role with an insurance carrier. And I, like many of those that are out there, saw my role become downsized and started trying to look for another position. And I'm very fortunate, very happy to now be with comprehensive pharmacy services. And we provide pharmaceutical management, thought leadership and really cutting edge when it comes to that sort of thing. And so I'm very excited about that role, but I'm still maintaining what I do and what I've done in risk management and bringing that experience to this role too.

Michael Carrese: Well, good. So you have personal experience in terms of next steps and planning and adjusting to what's been happening. But let me just start with asking, this obviously is not happening because there's less for risk management professionals to do. In fact, there's probably more because of COVID and things that are going on with the expansion of telehealth, all kinds of other things related to COVID. So is this being driven by budget constraints?

Michelle Kinneer: It is a combination budget constraints. It could just be a sign of the times with really wanting to make sure that your departments are as efficient and running as really I don't think most managerial types will like this, but running as efficiently and sparsely as you can and still maintaining what you're supposed to be doing. So I think we're seeing it with some restructure.

We're also seeing some retirements. I have a couple of friends who have decided that, you know, "Healthcare, it's enough. COVID, that was enough." And so, seeing that, you know, we also saw the fact that we've changed our services, increasing the telehealth as you mentioned, in addition, having a lot of those elective procedures that most people might not have even thought that elective procedure was elective, like shoulder and knee replacements, not bringing in that revenue that we saw.

And for our risk managers that have clinical background, some of us are even being pulled to the floors or pulled to manning the front areas and checking temperatures and that sort of thing too.

Michael Carrese: So, in addition to what you just mentioned, what are some other additional roles that risk managers are being asked to take on?

Michelle Kinneer: For the most part, in some of the smaller rural facilities and even probably in more than medium-sized too, we're seeing risk managers that could be in roles in compliance, patient safety, quality, performance improvement, really anything dealing with regulatory or reporting of some metrics. We can really see our skills being utilized in those areas.

Michael Carrese: So Dr. Kinneer, are there benefits to risk management professionals when their roles are expanded?

Michelle Kinneer: Absolutely. We can see some increases in organizational visibility. As you are being involved in more committees, being involved in more department concerns, people are seeing you as a resource. People are seeing you as the person that they can turn to. Your increased involvement also lets you be aware of what's going on within the organization. You might not get that phone call on Thursday afternoon saying that one of your providers is going to be offering a new service in the clinic starting tomorrow and have you called the insurance company yet? You would know about it from the ground up.

And at some point, it can also sort of reduce some redundancies that may be there. There may be a couple of us that are doing very similar activities or similar roles or playing with data extrapolating certain information. But yet, if one person did both reports, maybe that would save time. So we can see some benefits to it.

Michael Carrese: Can you explain the difference between job enlargement and job enrichment?

Michelle Kinneer: Absolutely. So job enlargement is where you see the role that you currently have, and you see some of those tasks, other duties, things being added to your plate, but you're not growing within the organizational structure. Maybe you are the department director, you're still the department director, and now you're doing duties that other people were doing that might've been other department leaders. So it's really more of that horizontal, getting wider at the middle type of thing.

Whereas job enrichment on the other hand is more of that vertical expansion. So you might be at the director level, but now you're starting to do some roles, some reports, some activities that are higher level. It's a good opportunity for professional growth. And you might even increase your decision-making capacity and role within your organization as well.

Michael Carrese: Are there drawbacks to expansion?

Michelle Kinneer: There are. So anytime, regardless of what expansion it is, we run the risk of professional burnout, right? You're adding more duties, you're adding more responsibilities, you're being spread more thinly. So we need to keep an eye on ourselves. We also see possibly some decreases in our productivity and maybe we're only scratching the surface. We're not able to get as deep into the root cause analysis as we might have last month when our CA's were our primary activity in risk.

And we also might see kind of that juggle, which hat do I wear? I can remember once where I was deposed and I had this attorney sitting there asking me how much of my job correlated with my compliance role? How much correlated with my patient's safety? How much of my risk? And I couldn't give him some quantifiable number. It wasn't like, “Okay, eight to four or eight to two, you're going to be compliance. And two to five, you're going to be risk." It doesn't work that way. So we do have those kind of drawbacks too.

Michael Carrese: I'm wondering what steps people can take if they've got more responsibilities on their plate now, and they're feeling overwhelmed. What's your advice?

Michelle Kinneer: If that is occurring and it's not your idea, it's not where you wanted to head with your career, you're concerned or you are having those feelings, really look at what you're doing, prioritize, figure out are there reports, are there things that you were doing because that's what we've done for the past five, ten years, are there things that we can minimize? Are there things that we can say, "You know what, this task right here is unnecessary. I don't need to go to this committee every time. They can call me and come in and maybe I'm an ad hoc member."

So when you're able to sit down and clearly think about what your priorities are during a particular month or a particular quarter, go to your supervisor and talk to them about, "Okay. Here's where I see where I'm being requested to spend time in. Are these the right priorities and how can you help me balance those to make sure that I'm hitting what we need?" So those are some of the things that we can do to really make sure that we are trying to balance that professional life.

Michael Carrese: Now for some folks, this might be a welcome change. They might embrace the idea of having more responsibilities or they're looking for career advancement. So what's your advice to those folks?

Michelle Kinneer: So if you're looking for a career advancement and you're wanting to think about where you want to be, there is nothing like going to ASHRM's job resource page, and look at the positions that you think you want to have. Take some keywords out of there. Maybe you want to be the vice president of risk management for instance. Look at a couple of those roles.

I'd toss the requirements or the objectives into an Excel spreadsheet and sort it, so that way I could see kind of, "Okay. All of these require this. And then think about what you have, what are your current skill sets, what are your current certifications, what training or other opportunities do you need in order to move your career from this point to that next level.

And then think about what you can do today. Maybe it's volunteering to be on the special task force. Maybe it's providing feedback to others and letting them know, "Hey, I'm interested in an opportunity," because sometimes all it takes is for us to raise our hand and say, "That interests me" or ask for cross training.

Something that we haven't talked about is one of a friend of mine was looking at a position and her level currently is in a director role. But she's seeing after a merger that she's not necessarily being tasked with director-type activities. So with speaking to her, I asked her, "What was it that you liked doing? What is it that makes you want to go to work?" It was being there for her staff members.

So when she said that, I was like, "Does really being involved in this computer transition help get you more with your staff members?" "No." "Then you know what? Don't worry about that. Focus on where you want your career, what you want to be doing. So volunteering for those roles that are in your organization, asking for cross training, looking for areas that you feel like you excel in and how can you make that even better. Kind of your value proposition statement, if you will."

Michael Carrese: Well, right. And I think there is so a positive vibe that comes from seeking more responsibility, seeking training, you know, in terms of your managers, this person's managers, that's always a positive, right?

Michelle Kinneer: It is. And it's looked on very favorably. And, during my transition period, I heard a lot of speakers that talked about making sure that you're showing your value and what you offer, what you can do, how your skill sets can be used. And so a lot of that is really raising your hand. "I want to be a part of this." "I want to..." Whatever that to is.

Michael Carrese: Right. So as we're wrapping up, are there any tips you can share with listeners on what you have seen work for yourself or for others when it comes to both of these things that we've been addressing? How do you deal with extra responsibilities? And then how do you seek out new opportunities?

Michelle Kinneer: So one of the things that I did was really looking at where do I want to be? And what do I have? What don't I have? So one of the things I looked at at one point was what are my skill sets? What can I offer? A lot of the positions that I was looking at required leadership, managerial-type people management, which I hadn't done in a while.

So, you know what? I never sat for the nurse executive board certification exam. So guess what? I went and sat for it because you know what? At my very next interview, I had a person asked me, "So tell me about your management experience." Well, while I haven't had direct experience yet, my experience plus my credentials qualified me to sit for this and it covered these topic areas. It was a way to show connection. It was a way to show that I'm still willing to grow. And I still want those extra responsibilities.

And as you're looking at this, whether your job is expanding because you want it to or because someone's told you it's going to expand, really make sure that you're investing in you. Think about how you can care for yourself, because if we're not able to care for ourselves, we're not going to be there for our organization. We're not going to be there for our teammates. We're not going to be there for the patients that we serve.

And as you are adding these things, leverage technology. One of the things I tend to tell people is be protective of your calendar. Put something on there. If you have a board-level committee, for instance, or some committee that you're worried about, add 30 minutes to that time on your calendar, so you have a minute to prepare, someplace that you can go and kind of sort out, "Okay, let's get into the infection control committee mindset and what we need to do for this." You know, really making sure that you're taking those time and think about when people ask you, "Can you help us with this?" I'm the world's worst. I will more than likely say yes, but I have to think about what my responsibilities are too. If I have a huge report, I need to be able to say to someone, "Yes, I can help you with this. I may not be able to get to it until next week," and that gives some boundaries. And so I think that really helps too.

Michael Carrese: Yeah, so it's kind of not saying no, but not now.

Michelle Kinneer: Exactly. Exactly. Because you still want to be there and still want to be probably involved in helping, but you have to make sure you get your roles and duties done too.

Michael Carrese: Yeah, just earlier today, I heard somebody make the analogy of, you know, when you're listening to the safety announcements on a plane and they say, "Apply your own oxygen mask first, before you help the person next to you." It's kind of the same thing. You've got to be in a position to be helpful and you have to think about that.

Michelle Kinneer: Exactly. That is a very good analogy.

Michael Carrese: Well, I'm afraid we're going to have to leave it there and wrap it up, but thank you so much for sharing all that terrific advice for our listeners today, Dr. Kinneer.

Michelle Kinneer: Well, thank you.

Michael Carrese: Dr. Michelle Kinneer is a Senior Director of Corporate Compliance for Comprehensive Pharmacy Services. A reminder that you mentioned, the job resource page on the ASHRM website. And in fact, 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. You can visit ASHRM.org/membership to learn more and become an ASHRM member. I'm Michael Carrese. Thanks for listening.