Gaurava Agarwal (Intro): Too often, we reserve the label of leader for someone with a fancy title before their name.

Logan Pause (Intro): But great leaders are everywhere in our midst.

Gaurava Agarwal (Intro): I'm Gaurava Agarwal, but everyone calls me G.

Logan Pause (Intro): And I'm Logan Pause.

Gaurava Agarwal (Intro): On Anatomy of an Everyday Leader. We believe that everyone has the potential to be a great leader on a healthcare team.

Logan Pause (Intro): To find out what it takes and what it means to lead in healthcare, we talk to people from around Northwestern Medicine who are doing just that.

Gaurava Agarwal (Intro): Whether you've just started your career in healthcare or are a seasoned professional, have a leadership role or hope to take one on someday, this podcast is for you.

Logan Pause (Intro): Join us as we peel back the layers of leadership to ultimately make healthcare better.

Gaurava Agarwal (Host 1): How do you identify a leader on a healthcare team? Well, in the case of our guest today, it was pretty easy.

Logan Pause (Host 2): Ali Stewart is one of the managers of the float pool nursing team at Northwestern Memorial Hospital.

Host 1: A few months ago, we sent out a survey to our nurses asking them about their experience working at Northwestern Medicine totally spontaneously. Many nurses mentioned specific managers that they felt made a huge contribution to their time at Northwestern Medicine. Ali was one of those managers whose staff clearly loved working for her.

Host 2: So, we knew we had to have her on the podcast.

Host 1: We wanted to know how she did it.

Host 2: Good morning, Ali.

Ali Stewart: Good morning.

Host 2: It is such a joy and pleasure to have you on the show and get to know you a little bit. I love to just start out, for those that don't know you, Ali, share a little bit about who you are, your background, and what you do.

Ali Stewart: I am the nursing operations float pool manager at Northwestern Memorial Hospital. We oversee a really big team, 125 staff, that encompasses staff that are floating all throughout all five pavilions of the hospital, 38 different units, all the ICUs, women's health, medicine, surgical lines, oncology. I have a background in labor and delivery. So, I worked there for three years before becoming the education coordinator there. We had 220 nurses at the time when I was working there, so I got a lot of experience with big teams and learning how to lead all different types of personalities.

Host 2: When did you first realize that you wanted to be a leader?

Ali Stewart: I think I realized it when I was working the bedside and labor and delivery, and I just wanted to be a sponge. I knew there was so much to learn. I was working alongside physicians, OB, anesthesia, and a lot of resident physicians. And we all kind of sat on the same floor. And we would talk to each other all day long, which is a little bit different than some of our floors where physicians are off unit and you're kind of paging or calling them to come visit a patient. And I just knew that there was so much to learn. I was never going to know it all.

And I was really excited with the opportunities for growth in my old department. After a certain amount of years, you could apply to be what was known as the mentor on the unit, what was known as the team leader on the unit, to work in the OR, to work in OB triage. And so, there was always a growth pattern where I came from. And I was always grasping to get to the next step. And I decided to go back-to-school knowing that it would open a lot of doors, and that I could, you know, precept continue to mentor people and then, obviously, would have the best mentor opportunities throughout those experiences too.

Host 1: When we did our focus groups earlier this year, I think what struck me most about you, obviously, we were on a focus group with several folks, was that when I studied the issue around leadership and sort of the mindset of a leader and the personality of a leader, you can't be so pollyannish, pretend like everything's, you know, roses all the time, then you got no credibility.

But on the other side, if you're sort of cynical, dour, negative all the time. That's not going to work either for most people. And you struck me as someone who had found this ability to navigate those two extremes. I was wondering if you might talk a little bit about how you maintain that outlook, that attitude, that mindset, which I think is so critical to the anatomy of an everyday leader.

Ali Stewart: Yeah, I would love to. So, I think we're talking a little bit about optimism. I'm kind of person that when I'm coming to work, once I'm here, I am working and I want to give my best to the whole day. And everything that I have on the schedule and everyone that I see throughout the day until it's time to, you know, go home. And then, I focus on my family. And I really try to keep things as separate as possible. But when I'm here, I definitely don't like to necessarily sugarcoat everything. I want to have a positive outlook. But what I try to do with my team is just talk through things. This is the why behind what we're doing. You know, understand the bedside nurses and how it impacts them, understand the leadership team and how it impacts them. But just knowing that we can talk through it all, we can find the best resolution, and that might not always be my idea. But I've created a team that has really great ideas and isn't afraid to share them with me as the manager. And I love to be able to kind of lean a little bit on everybody so we're sharing the workload so that they also feel empowered to make decisions too without, you know, worrying how I'll react.

Host 1: How do you create that safety so they don't feel afraid about how you're going to react?

Ali Stewart: Well, I think everybody, at first, there's some time where they're settling in, they're understanding the role. And like our clinical coordinators and our education coordinators, they oversee a little bit of everything since we have staff that go everywhere. So, things aren't going to be perfect, but I'm always willing to talk through or try out something that means something to them.

So if they're saying, "Hey, I've put in the effort and the work. I really want to see this through," then I'm going to stand behind them and try to help them see it through. And if it doesn't work, it doesn't work. And sometimes I come in the next day and I'm like, "Oh, why did we make that decision?" And they give me the rationale. And I always support them in the moment, like to the bedside nurse, to the other managers, to the other clinical coordinators that they work alongside, they're always supported. And then, we just have smaller conversations of, "Okay, Well, I think, you know, we've tried this before. And I think, next time, let's try it this way or what are some other opportunities we can learn from this. Because not everything's going to go perfect, but I think everybody deserves a chance to feel empowered and work at the highest level of their scope. And so, I really try to promote that.

Host 2: Ali, are there career experiences or mentors that you've had that have helped shape that optimism? Where did this philosophy and perspective come from?

Ali Stewart: That's a great question. My director, she is very calm. And anytime I go and talk to her about something, we work through it and she wants to hear both sides of the story. She wants to help me kind of come up with the best decision or the best route to take back to my team. And she's not trying to, you know, fight every battle for me, but more so just trying to talk things through with me. As a younger nurse and as a bedside nurse, I had a really great leader. And my prior director and manager, every time I talked to her, she was, you know, very cool, calm, and collected, and was just like, "Hey, we're not going to let this ruin our day here." We're just going to do the absolute best we can, and that's all we can do. It's just the best we can do, and that's being human. And so, I really enjoyed working for both of those directors.

Host 1: Ali, one of the things that healthcare leaders often do is they assume that the competence they have in their field is the reason people will follow them. So, "I'm the best surgeon in the world, that's why I should be the leader of surgery." My understanding is you lead a group, you're a labor and delivery nurse, that's not who you're leading. So, tell us a little bit about how did you gain their respect, their admiration, despite not having competency in what they do every day as a medicine nurse or a surgical nurse.

Ali Stewart: Yeah. I think that's a huge misconception. A lot of people really put themselves in a box when they think about management and growth to where, "Oh, I can only become a manager on this floor, on this unit, and this is my background. This is the only thing I would feel confident in." And I just jumped ship to work in women's health only, and then to start to manage ICU nurses, essential staffing office that we didn't even use in labor and delivery and medicine team and surgical nurses.

I haven't done those things at the bedside myself. I can learn from all of those nurses and I can be very curious as to why they might do things a certain way, why that would be different from what I've learned as a nurse. And trying to just gather as much information as possible and stay curious. When someone comes to me about something, like, my biggest advice for anybody that's wanting to do something different, maybe manage a team that they don't feel a hundred percent confident in doing the bedside care for, but people that are looking for a leader aren't necessarily looking for somebody who can work alongside them and care for the patients the way they are. There's plenty of them to care for the patients. They need somebody that cares about their everyday work, that will listen to them, that will escalate things that need to be escalated. And that will, you know, make the greater change, because they're there to take care of their patients, maybe their five patients for the day, but they're looking for somebody that will impact them when they go to care for patients weeks from now, months from now, how have things changed and how have they gotten better for them and the patient.

And so, I try to close the loop when they're coming to me about things. I try to followup on things and just keep the lines of communication open. And I find that people really like that, having a manager that they think they can approach and talk to confidently.

Host 2: What would you say to someone that maybe is struggling with their confidence to get outside of their comfort zone. I mean, I hear you go from an L&D nurse to managing a big team in an environment you don't know. Obviously, you're calculating some sort of risk in making that decision. How did you do that and how would you encourage those to think about growing in their career?

Ali Stewart: So, I think just being a sponge, you never want to act like you know more than you do. You want to instead say, "Hey, I don't have a ton of experience with this, but I'd love to learn from you a bit." I'd love to learn more about this team. I'd love to partner with you. And sometimes that means partnering with people that work for you. I remember partnering with our education coordinators at the time when I moved over to float pool. They were someone who reported to me, but they were making files on the computer with all important things that they thought that I might need, and teaching me a little bit about orientation for staff. We were onboarding and the current processes, and I wasn't trying to change anything right away. I was really just trying to observe and be their peer at the moment so that I could eventually be their leader, but I had to understand their groundwork a little bit more before I could lead them.

Host 1: This issue of curiosity is so crucial to the anatomy of an everyday leader. When I coach, people assume I'm going to be the best coach for a psychiatrist, because I am a psychiatrist. I'm probably a way better coach for everybody but psychiatrists because I am authentically coming in curious. And probably, sometimes I'm the best coach for people outside of healthcare, because I truly have no idea about their life, and I am a sponge, as Ali said initially, so that I can understand what they're going through.

Host 2: Now, Ali, you've used the word sponge twice. Tell us a little bit, what do you mean by that? I mean, I think G put a little more language talking about curiosity, but what does that mean to you?

Ali Stewart: So, being a sponge means that there's always more to learn and there's always more to be curious about. When someone comes to you about something, there's always two sides to a story or multiple sides to a story. And there's just more evidence to look into before you make a final decision. I just think that whether it's someone with hope for an improvement, or if it's somebody who's just trying to teach you about something to help grow your leadership skills, I just think that if you're listening to always respond, you're not actually listening, you should really be listening to keep that knowledge and retain it and use it later. And then, take a pause. It's okay to take a pause before you respond or make a decision. Some stuff is going to fly right off the cuff. And other things, you're like, "I'm going to have to really think about that." Because I have to see how it impacts other people. I have to treat everybody the same way and remain curious, remain approachable. And if you are ready to just respond to somebody the second they bring something to you, maybe that's not what they needed. Maybe they needed to vent for a while, have you hear it all out, and then be like, "Okay, I want to go home. I'm tired. I worked 13 hours." And that's okay. Sometimes that's all it takes. But becoming a sponge is really just like, "Yeah, share it all with me. I'm here to hear it all, and then we'll get through it together."

Host 1: Logan has mentioned a couple of times, the large span of control. You have number of people you manage. And then, obviously, nurses are our largest workforce. My job as a chief wellness executive is to design better workflows and work design. And most people would tell you that at a certain number of people that you manage, it's too much. But you never did. And that struck me when we talked the first time. You said, "Yeah, I got 120 people, but I try to get to know them."

Tell me a little bit about that. How do you think about this issue of how many people you manage and how do you continue to have that sort of personal connection with the people you manage?

Ali Stewart: I think at some point it becomes a lot to have so many people that report to you, and I'm lucky that my co-manager started in January and we're doing this together. We have about 125 staff right now, and they work all different shifts. So, some are overnight, PMs, and day shift. We're not on one unit. So, we have to communicate in many different ways, and that's not always face to face. There's a lot of phone calls. There are a lot of messages that go back and forth, A lot of emails.

And when I've asked staff, what do you need as far as communication? Do you like how we're communicating? Do you feel like you see us enough? Do you feel comfortable coming down to all of our offices and seeing us if you need us? They're always like, "Yes, because what I look for is someone that just responds to me and that cares about what I'm saying." And I really took that to heart to understand that I don't have to be there at 7:00 AM on the floor that they're working on and say, "I'm here. What do you need?" Because they might not need their manager at 7:00 AM just asking them what they need face-to-face every day. What they need is somebody who is going to respond to them when they have needs.

We round on our staff. Our clinical coordinators go and see our staff every day as often as they can to help out. But those regular check-ins are important. If I haven't seen somebody in a while, I shoot them an email, a message, try to see them on the floor when I can as well. And then, I try to do mid-year meetings and performance evaluations in-person in the office when I can so that we can keep those lines of communication open. We're at least seeing each other in-person some of the time.

Host 1: So, what I heard was ask them how they like to be communicated with. I heard quality over quantity. But quantity matters too. There has to be a bare minimum that we're seeing each other, connecting with each other in some way. So, I appreciate that. Also, recall you mentioned a couple of tools you've created and ways that you've delegated to other leaders on your team to help you sort of keep track of everyone and everything. I was wondering if you might share with our audience

Ali Stewart: I like to remember that the reason why I went into nursing was because I wanted to be able to care for my own family in the same way that I care for my patients. And so, I know at the end of the day, nursing is a passion, but it's not people's entire life and a lot of them are coming to work, but to have their time off with their families and their kids. And I think it's really important to remember why people are coming to work every day and what kind of inspires them. And a lot of that is things that are going on outside of work.

So, I created just like a very basic spreadsheet, we'll call it, where I have everybody's names and, you know, when they started and the shift that they're on and all of that. So, it's very easily visible. But I keep notes when I meet with people, so I know if it's been a while since I've seen somebody; I know their children's names; I know if, like, they have kids in college or if their kids are starting kindergarten; I know if they have trips coming up; things that really matter to them outside of work, that I know that that's what they're working for is really important for me to talk to them about. It doesn't always have to be a conversation about work. It could be just a conversation about connecting about, "Yeah, I remember what your kids' names are, and what suburb you're living in," and things like that. And I have more to talk to them about than just the patient.

Host 2: You know the other thing that I heard as well, Ali, is ability to ask good questions. And hearing you talk in every interaction that you have with your staff, it sounds like you're constantly asking them, "How can I help? What do you need?" And asking them questions. I think that there can be a misconception that leaders need to tell. And so, I just love hearing your ability to ask questions. I think that's wonderful. I do have a question in followup to what you just said. I think a spreadsheet and keeping notes is fantastic. How do you do that with 120 people?

Ali Stewart: Well, when I see somebody, I try to make an effort to go into my spreadsheet right away and write down my notes of what we just talked about, so that's fresh in my mind. Sometimes I jot those things down in a notebook, and then I go back and add them to my spreadsheet later.

But it's things that I really don't want to forget about, and I know that I'm going to ask them about when I see them next, so that it reminds them of our connection. It reminds them that I care more about them than just their performance at work. I just try to, you know, take a note in my phone or write down something in my journal so that I can reference it again when I talk to my team.

And then, also, I lean a lot on my clinical coordinators. I have a really, really great leadership team. My education coordinators are phenomenal. And we share a lot of the work of keeping everybody up-to-date and what's going on with our huge staff. So, we have weekly leadership meetings. And we do about 90 minutes each week where we talk about things that have been brought to the leadership team or have been maybe some constant kind of pebbles in our shoe and what we can do or decide if we put all of our heads together, what we can decide is like the best way to move forward. And so, a lot of the times I hear about things that are going on with the team in those meetings as well. And I keep note of that too, so that I can followup with certain team members when it's necessary.

Host 2: It's really good. If we were to go into one of those meetings, Ali, and ask the clinical coordinators or educators to describe you as a leader, what would they say to us?

Ali Stewart: I hope they would say that there aren't a lot of things that would make me really upset, that we can talk through anything, and we can work through anything. I feel pretty confident that, you know, they come to these meetings with huge lists of things to talk about, so I don't think they hold back and I appreciate that. I want to fill the whole 90 minutes. We usually go over time. And I would hope that they think I lead by example and lead with optimism too, that it's not always going to be perfect or there might be a huge chain of command that we need to go down to get this on the right person's radar, especially if we're trying to make a change, but they never hold back or they never hesitate, and I appreciate that about them. And I think they're looking for someone who's approachable and can talk them through topics or even just share ideas with them. Reminding the team that celebrations really matter. And it's what our team remembers too.

Even today, you can see in the back of my office, we're having a little get together, a bridal shower for one of our clinical coordinators. And so, remembering to celebrate those things is really important to my team as well.

Host 1: For the early leader, early in their journey, the things you've talked about all require time. And every early leader I talk to always says, "I don't have time to do those things. All those fun things that Ali's talking about, that's the fun stuff, but I got budgets to manage." What would you say to them? How would you say you've found the time? And also, how do you think about these things that you've talked about this morning versus the budget stuff that people think is their job?

Ali Stewart: I would say it's all your job, and it's really just how you prioritize every day. So, I take one day at a time. My calendar might be a hundred percent full that day, and that's okay. I take one meeting at a time, one day at a time. I try to have a few wins every day, but I know that I'm not going to finish all my work every day. I know that I'm going to leave and then take off my manager hat, instead put on my mom hat at home, and that's what I want to be doing. And I encourage that for my team as well. But I really feel like our clinical coordinators, our education coordinators are working at such a high scope. We're sharing the workload.

So as much as I can delegate, I really do, because they want experiences. A lot of them want to become future managers, or a lot of them want to grow in their leadership experience. And so, if they tell me they want to be a part of something, then I really let them be my partner in a lot of the things to grow and advocate for patients, for our team, things like that.

You know, when we talk about celebrations and things like that, we all have a spreadsheet of what we're doing and we break it up and divide it eight ways or so. And it's so much easier to do one-eighth of something than it is to do the whole entire thing. And that goes for budgets and that goes for the workload as well.

If you can share any of the workload with your team and empower them to help you do things, then I think it really gives them a sense that they're growing every time that they come into work, that they're getting new experiences, they're feeling empowered, and they're not micromanaged, but then it's helping you too.

Host 2: Ali, you seem so even keeled and balanced. I'd love to hear what is it like for you in stressful situations or managing through difficult or challenging conversations? How do you either maintain that balance or what is it like for you to lead in those spaces?

Ali Stewart: We have a lot of challenging conversations with a big team that goes to all different units. They all have different workflows, they all have different expectations sometimes. And patient assignments can even be really difficult depending on what floors you go to. And you sometimes have nurses that are sharing that they think they have the hardest assignment on the whole entire floor, and this is happening to them every day, because they're the float nurse. And so, that comes up very frequently, is that they're feeling like they're working really hard.

And I try to frame it in a way of, you know, you might have the most seniority, you might have the best experience with these patients. We can look at acuity and we can tally it up and see how it is dispersed throughout the floor. But I always see it as kind of a good thing when someone trusts you with a lot of responsibility. And I like to frame things, I guess, in a way where it's not always a bad thing. Things aren't always punitive. I might bring you down to the office for, you know, a NETS report or some feedback where we have some opportunities to grow, but how long would maybe some of these things continue on if we hadn't ever met about it?

And so, it's a conversation about growth every time and coming together to find the best answer. It's not always going to come from me, it's going to come from a combination of, you know, a couple hats in the ring to find the best foot forward. I welcome the challenging conversations, because I think it gives everybody an opportunity to grow. It gives everybody a good experience. If all of this was easy, it wouldn't make any sense.

So, I try to remind my team of that. And if we can look at the glass half full, we have to work. Everything's not going to be perfect when you come to work, but you've signed in for the day, you're ready to go and it's a challenge. But these challenges give good leadership styles and abilities to grow. And let's use it and grow from it.

Host 1: So, sometimes there's a misconception that when we're nice, everyone likes you. We're not able or willing to have the hard conversations to do the hard things. Someone's not performing or not meeting budget, et cetera. Will you talk a little bit about how you handle the hard stuff, these hard conversations when you know everything isn't good, whether it's from the perspective of managing your department, or certainly managing people that may be struggling in some way?

Ali Stewart: Yeah. I think you want to be perceived as nice from your team. That leads to approachability and people wanting to work for you and keeping up morale and things like that. But I think it is really important to put your foot down. You have to stay within budget. You have to meet your goals, and you have to continue to grow. And so, there has to be ways where you can have a little bit of both.

And so, what I like to share is the why behind something, you know, if someone's hesitant to change or whatever it might be, the why behind it, really shares why we all need to be on board for something. There is a greater reason for why we want to push this through, or why we need to meet budget, or why we need to schedule balance or whatever that might be. It might not seem fair to the person at the time.

But usually, by the time I explain the why to them and how we want to be consistent and fair with our team, that nurse or that employee can really get on board with that. They don't expect to be treated differently than their teammates, and they really are just looking for someone who is consistent and can obviously help them reach their goals too. And you don't reach your goals by just being like super nice and being a pushover. And so, reminding them, again, the reframing, and then also there's a reason why we do things. And this has to be the end-all be-all. We have to do it this way. And people like that, I feel like they like consistency. They like to know that there's a right answer. And so, being able to get them that answer is really important.

Host 1: Yeah, I love that. And yeah, I don't know if I ever told you, but one of the things they said was, Yes, of course, you're nice. But they also said you are fair and you hold people accountable. In the work literature, they say the worst thing you can do for a good employee is tolerate a bad one. You're really highlighting that accountability doesn't make us nice or not nice. It's what actually makes us great leaders.

Host 2: I love that you reframe challenges and difficult conversations through the lens of growth. I think that's so wonderful. Ali, we've got some rapid fire questions for you. So, I love just like first instincts, what was your first job?

Ali Stewart: I worked at a salon when I was 15.

Host 2: If you hadn't chosen a career in healthcare, where might you have landed instead?

Ali Stewart: Probably something with kids and childhood development.

Host 2: And is there one perceived failure throughout your career or experiences that have helped shape you as a leader?

Ali Stewart: I guess my biggest challenge would be, you know, not trying to change too much, right in the beginning. I think I saw some gaps where we could hold our team more accountable or we could make some changes. I think right off the bat, as a new leader, you kind of want to showcase all the changes you can make and all the growth that you can provide to a team. But if you don't have the buy-in from your team, then your growth and your change isn't perceived well.

I remember having a list of changes that I thought would benefit everybody that I wanted to talk through with everyone, but knowing when it's too early, when you think it won't be perceived well, and just going to those leadership meetings and being like, that's going to be really tough for our team to swallow before implementing them, of course. But running them past a few key stakeholders, those types of things really remind you to reel it in a little bit and get to know the people you're working with and get to know how they perceive a leader and what they want in a leader before you just kind of start to make changes, which everyone can do when you take a new job. You might have really great ideas. But I think I learned really quickly that that's not the way to get buy-in from your team. The way to get buy-in from your team is to understand why things are the way they are and understand the people that will be working for you and with you.

Host 2: You are inspiring as a leader. We are so grateful for your time and all that you do for your team and those around you and the patients you serve. We appreciate you.

Ali Stewart: Thank you both.

Host 2: Thank you so much, Ali, for being here.

Ali Stewart: Thank you.

Host 1: Thank you for listening to Anatomy of An Everyday Leader.

Host 2: Subscribe to the show wherever you get your podcast so you don't miss an episode.