Bill Klaproth (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. You can visit ashrm.org, that's ashrm.org/membership, to learn more and to become an ASHRM member. I'm Bill Klaproth.

On this podcast, we talk with Rebecca Cady about her journey as a healthcare risk professional. Rebecca is the Vice President and Chief Risk Officer at Children's National Hospital in Washington, D.C. Rebecca, welcome.

Rebecca Cady: Good morning, Bill. Glad to be here.

Host: Well, thank you for your time. It's great to talk with you. Rebecca, could you start off by telling us how you got into risk management?

Rebecca Cady: Sure. So, I had a somewhat typical path into risk management. I was a nurse by background. And as a young nurse, I encountered a couple of colleagues who were witnesses in a medical malpractice case, and as we had break room chats about what was going on with that, they were very upset and scared. And it seemed to me at the time that the attorneys representing them weren't doing all that great of a job in terms of understanding what it was like to be in their shoes as a bedside nurse. And this was in a high-risk obstetrics unit. So, obviously, it's very serious. I mean, all med mal cases are serious, but this involved a birth injury. So, very serious cases and very upsetting to the staff.

And so, as I was thinking about going to grad school, I decided, "You know what, I'm going to go to law school. And I'm going to be a lawyer that takes care of nurses and helps them understand and feel comfortable with the legal process." And so, I continued to work as a nurse while I went to law school and then ended up getting a job in a firm that did insurance defense and healthcare law. And so, as I worked as an attorney, I not only defended the case that was in front of me, but I made it a point to really work with the clients to understand what were some of the lessons that they could learn from these cases and what were some of the sort of risk management tips that they could do to improve their risk profile, to improve patient safety, and to decrease the risk that their staff would have to be involved in a claim. So, ultimately, I became a partner in that firm.

And then, at another point in my life, an opportunity came open for me to come work in-house here at Children's National. And this has passed in a blink, but this will be 16 years ago in June. So, it's been a great experience, and having the background of a clinician and knowing what it's like to be a bedside nurse and knowing what it's like to have a patient have a bad IV infiltrate, because you got caught up with another patient who coded and you didn't get in to look at it fast enough to make sure the IV was all right, or looking at instances where folks make medication errors. Having that background as a risk manager is very, very important, but also having the background as an attorney where you understand that there are other sort of business processes that you need to understand as an in-house risk person, that the business of the hospital is also something you need to understand. And so, those are the things that really contributed to my background and, frankly, I think to the things that I've been able to accomplish in the risk management profession.

Host: What an interesting story. So Rebecca, you felt the pull of working in-house at a hospital as a risk manager more than being a lawyer in a firm.

Rebecca Cady: Yes, definitely. I really, overtime, to avoid similar litigation in the future. And it occurred to me that really being in-house was a great opportunity to really impact safety, quality, and risk for the organization and its employees really at the sharp end of the stick to get things situated. I guess somewhat frustrated because, once the case gets to the outside law firm, it's kind of like the horse is already out of the barn, right? So, as I said, I would purposefully try to help them identify lessons learned and things that they could do to change practices in the hospital where the hospital wouldn't need to go to an outside law firm and defend them in a lawsuit, because they could put measures into place which would decrease their risk.

Host: Yes, that absolutely makes sense, and what an interesting career you've had starting out as a bedside nurse, becoming a lawyer, and now a risk manager. So, I think it's probably safe to say most risk managers aren't lawyers like you. So, for someone who's not a lawyer or is getting into risk management or newly into risk management, in your opinion, what qualities make someone a good risk manager?

Rebecca Cady: I think the most important quality is a natural curiosity and understanding that things that come in to the risk management department are not always what they seem on first blush. So, you also need to have a little bit of a detective in you to be able to go talk to people in a way that's not going to be threatening to them so that you can find out really what happened and what are all the various complicated things that led to a certain event happening? So, you don't ever want to assume that the initial report you get is the whole truth of the event. There are often many different perspectives that are very important for you to uncover and learn. And then, that way, you can make the best decisions about how event should be managed. So, curiosity, the ability to talk to people to make yourself sort of indispensable, to look at yourself as a problem-solver and not necessarily as someone that's going to keep things from happening. You know, the old-fashioned view of risk management was risk avoidance, right? We're not going to do this. We're not going to do that. We're going to avoid, avoid, avoid.

But the modern risk manager needs to be a good business partner, and they need to look at solutions to something that the organization needs to do that are going to decrease the risk and helping the organization come up with a process to where if there's something the organization needs to do and there's a significant amount of risk involved in that, then at what level of the organization does that decision get made? It shouldn't get made at the level of the manager or director of whatever department is trying to make that decision. If it's going to pose a lot of risk to the organization, then that decision probably needs to be reviewed and made at the C-suite level. And so, that's something that the risk professional can help shepherd along in terms of a process. But it requires good relationships. And the way you make good relationships in healthcare is to help people solve their problems. So, getting to know managers, directors, frontline leaders, and understanding what are the things that they're wrestling with, what are the things that worry them, what are their sort of single points of failure, what are the big things they're working on, and figure out how you can help them be successful.

Host: Yeah, so a lot there. Obviously, you said being a good business partner is important, being curious, being a bit of a detective, the ability to talk to people. You talked about relationships as well. Could you spend a little more time on how important relationship-building as a skill is for a risk manager?

Rebecca Cady: It's really imperative, and you can't do the job without it. Because if people don't have trusting relationships with you, they're not going to bring you information that frankly you need in order to be effective in your job, and they're not going to bring you information that you need, that the hospital needs them to bring to you in order to best manage the business of healthcare that they're undertaking. So, understanding who people are, what they're worried about, what their sort of pain points are, and taking small steps early on to do things to help them out. In other words, you want to sort of prove that you're not there to play gotcha, but you're there to really understand their problems and be kind of a sounding board and a business partner for them to help them see maybe some big picture things that they wouldn't be aware of, or maybe things that are going on in other parts of the organization that they may not be aware of, that could be really important to the success or failure of whatever it is that they're working on. And so by, you know, risk management sees things from all over the organization, you kind of have a 35,000-foot view of what's happening.

And so, to be able to share that intelligence with your individual business partners throughout the organization, to help them be more successful and work smarter instead of harder, that can be a big step in establishing a relationship. And then, also just remembering that everybody's under strain and you're under strain too in the risk department, but you always just have to be nice to people and be kind. And I think that there's sadly so little of that today, not just in the public discourse, but in the workplace environment, that being kind and nice to people actually makes you stand out. And especially if you can manage to do that when you're in a very stressful situation, taking the high road and being kind, people will remember that for a very long time.

Host: We need a lot more of that in all areas for sure. Be nice, be kind, and you said don't be the gotcha person, which is real important. In your career, it's very interesting, so you started out as a bedside nurse. And then, you saw what was happening there. And you said, "You know what? I want to represent nurses. I want to become a lawyer." And then, you went after that. And then, you had an opportunity at Children's National and you went after that. How does someone make an opportunity for themselves versus waiting for someone to come and offer them an opportunity? You seem like somebody that you saw what you want, you've gone out and got it. How can someone listening to this do that like you did, see something and go after it instead of waiting for somebody to come to them?

Rebecca Cady: So, I always subscribe by the proposition that it's better to ask forgiveness than permission. And I think that sort of applies here wherever you see a gap or something that's not quite working right, or a big problem that really, if it were solved, would make a big difference for the organization. You can raise your hand and say, "Hey, I identified this problem. Go talk to your boss about it, right? I've identified this problem. Here is the impact on the organization." I think that if we applied some of the risk management process to this, or if we looked at enterprise risk management principles, we could fix this process to make it more effective, to make it more highly reliable, and to improve things in the organization. "And I think maybe we could save X number of dollars if we did that and we probably wouldn't have to hire anybody else to do it. Is it okay if I go talk to so and so and start working on this with them?" Nine out of ten times, your boss is going to say, "That's great. I am really thankful that you identified this issue. And, yes, we're going to pull a group together and you can start working on it."

And so, if you do those things bit by bit over time, you're not only going to develop a reputation as somebody who's a good business partner, but you're going to get the attention of people who might not have otherwise noticed you in the organization and then keep your ear to the ground. Again, relationships can be a huge way to advance your career because if you've been helping out somebody in the organization and they get promoted, then they're going to have an opportunity to say, "Hey, I've been working with so and so over in Risk, and they've done really good work. And what if we considered them for this, that, or the other, right?" And so, having those relationships, keeping your name and yourself in front of people higher up in the organization and proving yourself to be somebody who can work across disciplines to solve problems without a lot of drama gets people's attention in healthcare. And then, go ask questions of people. Go see if the COO will give you half an hour just to tell you about their job. And how they got there, have a conversation with them like we're having this conversation here. Go talk to your general counsel. Think about what level of graduate education might help me move forward in my organization. And also, going to conferences and seeing what are other people doing and what are some of the things that I might do to build out my portfolio of experience and education. What kind of certifications might I get? That would make me a stronger candidate for, say, a Chief Risk Officer position. And then, you start to kind of build that up block by block. And then, when an opportunity becomes open, then you're a natural candidate for it. Or you go to your general counsel and you say, "You know, we don't have a chief risk officer. Why is that? Why does this organization not recognize the importance of enterprise risk management at the level that they would hire a chief risk officer?" And if you've been laying the foundation for that, you may well then have a conversation back like, "Hey, that's a really good question. I think probably nobody's ever thought of it before. Let's talk about what that might look like, right?" So then, you can make the case that if there was somebody whose job it was to kind of facilitate these things, strategic risk at an enterprise level, after you've already been successful in helping people solve all these problems, then there's a decent chance that the organization is going to say, "Yeah, you know, we should formalize this. And nobody in healthcare can afford to waste money, so let's give this a shot and what it does to improve our bottom line."

Host: Yeah. As you said, stepping up bit by bit, block by block, ask questions, go to conferences, be that problem-solver. When you see something, step up to try to make a difference. And over time, you will be seen as a problem-solver. And like you said, people will notice you, which is really, really great advice, Rebecca. So, thank you for that. You mentioned going to conferences. I would imagine networking as well. When did you become involved with ASHRM?

Rebecca Cady: I became involved with ASHRM when I was still a partner in a law firm because I wanted to really have a good feel for and my thumb on the pulse of what the in-house clients at the time were talking about. What were they learning about? What were their needs outside of coming to the law firm so that I could understand more completely what the picture of risk within hospitals was at that time. And so, that's why I joined ASHRM when I did.

Host: How important has it been to you in your career to be a member of ASHRM?

Rebecca Cady: It's been really invaluable. It's been great from a networking and peer information sharing perspective. So, hearing from other risk managers, how they're handling different problems that come across your desk, looking at the trends and themes in terms of litigation. You know, healthcare is so highly regulated and looking at how we pivot and manage risks as they come forward in terms of regulatory changes, how we manage the pandemic. ASHRM was a huge resource for its members during the pandemic in terms of how people were pivoting in all sorts of ways in terms of supply chain issues, staffing issues, materials management, patient care, all those kinds of things. And so, having those sounding boards, people who are experiencing things all across the country is a really big important part of ASHRM, and the networking's great. I've met some awesome people, some really inspiring and impressive people. And so, it's been personally fulfilling as well.

Host: Yeah. Was there someone early on in your career that made a big difference? Somebody that mentored you a bit?

Rebecca Cady: Yeah. When I started as a young attorney, one of the partners in the firm at the time was also a nurse attorney. And so, she was a great mentor to me, and she and the other partner that I worked with primarily, they had been doing Healthcare Law and malpractice defense for a long time at that point and really kind of taught me everything I needed to know about the legal aspects of it. And then, when I came into Children's, my still boss, she was the chief risk officer when she hired me. Now, she's our general counsel. She's also a former President of ASHRM as am I. So, I think we might be the only hospital in the country to have two chief risk officers having served as president of ASHRM, but she has been a great mentor, and especially in terms of that understanding the business needs and being a responsive business partner. So, you know, it's unusual for a nurse attorney to fleet up from a chief risk officer to a general counsel. And so, she's obviously a special person with some great skills in the people arena.

Host: That's a powerful duo you have there at Children's National in Washington, D.C. So, I'm sure that you play that mentor role now for other people, would that be correct?

Rebecca Cady: I do. Yeah, I have younger attorneys on my staff people who have been paralegals who went to law school and then, and now are practicing attorneys. We have a great team of risk professionals that we mentor and lift up. And also, you know, outside of my workplace, I talk to pretty much anybody. And I think people know this about me, they'll reach out to me on LinkedIn or via email and say, "Hey, I'm interested in talking about career advice or anything, you know, problems to noodle through." And so, I really enjoy those conversations because it's nice to be able on a one-on-one basis to be able to give people advice and to help them noodle through career challenges that they're going through.

You know, I enjoy speaking and ASHRM's also been a great forum for that. It represents lots of opportunities for public speaking and that's fantastic. I also really enjoy one-on-one conversations and mentoring that I'm able to do. And really, ASHRM has provided that opportunity for me as well.

Host: Yeah, that's wonderful to hear. So, let's switch gears a little bit. I'm curious, as a risk manager, I want to talk about work-life balance for a minute. Obviously, risk manager can be a 24/7 job, as you know. And I also understand your husband served for 26 years in the Navy and was gone a lot. You have three kids. How did you manage the whole work-life balance thing?

Rebecca Cady: Work-life balance always makes me kind of pause and grit my teeth a little bit. I think that we do ourselves a disservice by really thinking narrowly about this concept. I always thought of work-life balance in this way. I may have days that are not balanced. I might have weeks that are not balanced, right? I might have months that are not balanced. But what I'm looking for is balance over the course of time. So, you may have a week, for example, if you're a lawyer in a law firm and you're in trial, you are not going to have any work-life balance while that trial is going on. And unless you accept that and just lean into it and figure out what can you do to keep your home life going smoothly while you have to really fully devote your mental and emotional energy to this trial, if you don't make those plans, then you are going to be destined to fail and you're going to fail your family, you're going to fail your client, and you're going to fail yourself.

And so, the same thing applies to an in-house risk management job. You're going to have weeks that are pretty low key, pretty low threat, things aren't all that busy, we don't have all that many events we have to investigate, we don't have any Department of Health in the house. And so, on those weeks, you need to take some time. Go to your kid's softball game, come in a little bit later one morning. Go for a nice long run if it's a beautiful day. And if you're working remotely, that obviously gives you a little bit more flexibility there, but you have to seize those opportunities as they arise, because you know there's going to be a week when the Department of Health is there, or you've had a serious patient injury that you're going to be expected, and you're going to have to be 100% in the game at work. And so, what are your backups for how your home life is going to go smoothly when those times arrive? That's really the way that I have thought about it, and that has been a huge part of my ability to juggle all these things.

Host: Balance over the course of time. I love how you put that. That makes lot of sense

Rebecca Cady: And I think working parents beat themselves up a lot about, you know, they don't feel like they're fully at work, they don't feel like they're fully involved with their kids. And so, you've got to choose the day. Today is a family day, okay? So, I'm going to do that and I'm going to do it without any guilt or remorse, right? I've got other people at work that can handle what needs to be handled for this day, and I'm going to be with my family. I'm not looking at my phone. I'm not taking phone calls. And then, there are other days where, "I'm at work, kids. And so, unless the house is on fire, don't be calling me." And in my case, my husband, you know, "Call dad." And so, having those discussions. And I think it's good modeling for your kids as well to see that there are times when you're fully theirs, but there are also times when you have to be fully at work.

Host: Yeah. That's very well said. I'm going to spend this day with my family without guilt or remorse. So, I think that's a great way to look at it. Rebecca, just a couple more questions for someone listening to this early on in their risk management career. What advice would you give them?

Rebecca Cady: I would say be voracious in seeking out experiences and education and understanding the complex environment that we operate in in healthcare. Go to conferences, read books, listen to podcasts, get on the ASHRM exchange and see what kinds of questions are being posed and answered. Get on the ASHRM website and see what resources are available to you. Volunteer for something. ASHRM is a volunteer-led organization, and there are so many things that need to be done. And one of the big things that I sort of harped on when I was president is we need to see new people. I don't want to see the same people doing the work for the organization over and over and over again. We need to have a diversity of backgrounds and perspectives and opinions in this organization, just like any other. The diversity makes us better. And so, raise your hand and volunteer for something. You don't have to be a senior risk management executive in order to volunteer for ASHRM. It's a great way to learn things. It's a great way to meet people. And it's a great way to, again, sort of get your name out there and have people recognize you for the work that you're doing.

Host: Absolutely. Rebecca, thank you so much for your time. Before we wrap up, is there anything else you want to add?

Rebecca Cady: No. I would just say, try to remember not to take things too seriously and don't be hard on yourself. Be gentle with yourself and kind to yourself in addition to other people.

Host: Well said. Rebecca, thank you so much for your time. This has really been a joy talking with you today and thank you for sharing your knowledge and experience with us. We appreciate it.

Rebecca Cady: Thanks for having me, Bill. I appreciate it.

Host: And once again, that's Rebecca Cady, and the ASHRM 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, that's ashrm.org/membership, to learn more and to become an ASHRM member. 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. Thanks for listening!