intro: This episode is part of a special Women In Leadership Podcast series.

Sara Brownell (Host): Hello, and thank you for joining us. My name is Sarah Brownell. I am the Strategic Growth Director for HDR Architecture. Really excited to bring another podcast to you today for the Society for Healthcare Strategy and Market Development. Thank you so much to SHSMD for this platform and this opportunity to share these interviews of resiliency and authenticity, and highlighting the career journeys of female leaders in healthcare today. I think our interview today is particularly special, and I'm just really excited about sharing this with you all.

So, I am so incredibly excited today to have Jennifer Nickoles, who is the president of Johns Hopkins Bayview Medical Center, to talk a little bit about your journey, your insights, and just share some time with us today talking some of the things you've learned along the way. So, thank you so much for being here.

Jen Nickoles: Thank you for having me, Sarah.

Host: And also, thank you to SHSMD for providing this platform. We've done a few of these interviews and I think I personally have just enjoyed them so incredibly much. And I think it's been a really great contribution to the conversation, the fact that SHSMD is doing this. I'm really particularly excited about this one because I've talked to you a little bit and I know a little bit about your story. And not to foreshadow too much, but you've certainly inspired me, and I think your story's going to touch a lot of people.

So, let's get started. If you could, could you just give us a background of your career trajectory and a little bit about how you got here today?

Jen Nickoles: Sure. So growing up, my father was an architect and my mom was an early childhood educator. And I was always really good at school, and my father would just tell me from the time I was young that I was supposed to be a CEO. Now, he always said it was of Coca-Cola. I don't know why, specifically Coca-Cola. Nevertheless, I kind of grew up with this idea that someday I was going to be a leader, but I didn't know of what or how. And I think that was deeply rooted in me from the time I was young. But I always thought I was going to go into international business. I wanted to see the world. I thought I'd be a Secretary of State one day. I certainly didn't think that I would be a hospital president, so I'm kind of surprised that I'm here in this role on some days, which I think is not unlike other leaders. In many respects, our journeys are circuitous, and yet here we are.

And so, I am a Blue Jay. I did my undergrad at Johns Hopkins. I also got married right out of high school and started my family, and so was working and going to school and had a family. My first job was in facilities management. As the daughter of an architect, my job was to manage space on behalf of Johns Hopkins as part of a contract he had. So, I learned very early on about the academic mission here and got to know Hopkins.

Not really thinking I would stay, but I developed a lot of interesting relationships over the years when I was in that first role and kind of went into administration up through a finance track, just kind of naturally through relationships on the School of Medicine side. And so, the majority of my early career, probably 23 years, was spent on the School of Medicine, both in the Department of Medicine in various finance and administrative roles. And then, I moved into the Vice Dean's office in the School of Medicine, focusing on research infrastructure and faculty resources and space planning yet again.

And then, I was kind of happily in the Vice Dean's office and Dean Paul Rothman was looking for a Chief of Staff. And so, I applied for that position and was fortunate enough to be the Chief of Staff for Johns Hopkins Medicine for several years, where I really got a front row seat to leadership and governance and crisis management and all of the really big strategic issues that we were facing as an institution. It was a great education for me.

From there, I took health system roles, working on network affiliations and partnerships, furthering our health system to be more integrated. That was a really kind of interesting time for me, and I had some interim roles along the way. But ultimately, it led me here to Bayview as the hospital president.

Host: That's amazing. So, I think having sat in a lot of seats and led a lot of functions and done so many different things. I'm curious if you can expand a little bit more on how you have navigated the challenges, knowing when you're ready for the next move, advocating for yourself. How have you really navigated all of those different elements to get to this point?

Jen Nickoles: Yeah, it's a great question. And it's one where I think whatever phase of my career that I was in, I always took stock of my values at the time, what were my goals, what were my priorities. Early on, I really only worked part time. I was raising children. I have four sons. And so, family kind of took the lead spot in terms of how I wanted to spend my time. And I always knew that there would be opportunity for career when I really wanted to accelerate it, and that absolutely came to be true.

I think there were other times where I am a person who really seeks out challenges. I like to build new things. I like complexity. I believe I'm fairly good in a crisis. And so, if there's kind of a big audacious challenge organizationally or something new, I'm usually the first one to raise my hand. And so, I know when I'm ready for my next move, when I feel like I've kind of completed the important missions that I set out to, is the reasons why I took on the roles that I did, I always kind of seek out new opportunities based on the leaders that I get to work for. That's a big part of my decision-making.

When I think about how I have evolved, I think very much early on I was an independent contributor. And as you move into leadership, you recognize you have to be a force multiplier. You have to learn how to get the best out of the people that you have been kind of honored and asked to lead. And you have to recognize kind of the leadership traits within them that they too need to develop and grow as they prepare for their next steps in their career.

Host: Yeah, I think that's a great point about looking at the leaders that you wanted to work with because I think that that is so important. You know, Who do you want to surround yourself with and who do you think you can be really help be successful? So, I think that's great. That's great insight. So, understanding that this audience is really focused on healthcare strategy and, I mean, obviously you touch strategies in so many different ways throughout your career, can you talk a little bit more about your perspective on what good strategy looks like?

Jen Nickoles: Sure. I think at its core, it is really something that is aspirational, that magnifies kind of your strengths and competitive advantages and positions you for success in a really durable, sustainable way. And the starting point is always to have kind of a clear vision of the future in mind. What is it we're trying to accomplish? What is it that we're trying to solve for? And it's much bigger than a strategic plan. I think that's the outcome of the high-level strategy work, but it's really understanding kind of your current state really, really well, taking the time to take stock of who are we, how are we doing, what are our strengths, what are our weaknesses, what are those opportunities and challenges, right? And really educating others to understand this is who we are and being honest about that and being transparent. And then, creating that case for change. Why are we doing what we're doing? What's important about now, about where we are today that needs to change? Or what do we want to be? Again, envisioning that future state. And then, really doing that assessment, particularly as part of the network affiliations work or some of the regional planning that we're doing here. You have to assess not just the trends of what's happening, kind of within health care or what other health systems are doing. It's locally that competitive landscape. It's really looking at the shifts in demographics and those community health needs assessment. And what does this community need? What's the disease burden of the people that we serve here? There's so many great things that we can do in medicine.

For most of us, unless we're a big AMC, we don't really get to be everything to everyone, and so we have to make choices. And I think the best strategies are ones that align with the needs of the communities that we serve best, and then you resource it in a way that's appropriate. I think that the best strategies have taken the time to engage all the stakeholders. So often, we think that we come up with brilliant ideas and then we pressure test them and find out that, "Oh, no, indeed, that is not actually the best strategy for us," right? And so, really taking the time to understand, and not just within the organization, right? It's external to the organization. We work within states and government that have a lot of kind of regulatory requirements for us as well.

And then, I think you do that scenario planning, you pressure test, right? You bring the teams in and you come up with this really robust recommendation that I think people believe in, right? Because you can't execute on the strategy unless people really believe in what it is you're trying to achieve.

And then, you get into the plan, right? You have your road map, you know where you're headed and you have to think about how you're going to resource it and the viability of that and the time frame and all the steps and you have that great work plan. It really does come down to people understanding why you're doing what you're doing and making sure that that final recommendation, that final vision for the future really aligns with what your communities need and what you want to be in the future.

Host: Yeah. And I think that's great. And I think you're right. Tying it to the aspiration and the vision is so critical. I saw a definition on strategy, and strategy is about choices. And I think those choices really do have to point somewhere significant and meaningful to get traction.

So, shifting gears a little bit, I want to talk a little bit about struggles and conflict. You know, as a mom, I've got three daughters, and so I'm very familiar with struggles and conflict. But I think as a mom, and as a professional, I want everything to be just easy for them. I want to do everything I can to make things easy, and I want my job to be easy. But as I've been reflecting and as I've been meeting just incredible leaders like you, I mean, I've just underscored the fact that struggles and conflict, that's where the growth happens. And I think circumventing that for my own children and for myself, it's something that there's trade offs with that. So for you specifically, can you share a little bit more about times in your life where, you know, you've had to navigate these struggles and challenges and what that was and how you found the motivation to keep going?

Jen Nickoles: I'll say, I think this goes back to kind of pursuing your personal legend, right? You don't gain wisdom without experience. And we can have these life experiences that feel good and feel positive and they're fun. And we may learn something, right? We may test our limits in doing something that's enjoyable. But most of the time, it is through these challenges that we really gain the resilience. We really learn who we are. We push on the limits of what we're capable of. And around being a mother, I have four sons. And when I had my fourth son, I was an assistant administrator in a division in the Department of Medicine. The needs of the department were such that I needed to go to work full time. And I had a conversation with my then boss, Dr. Antony Rosen. And I said, "I think I need to take a step back." And he said, "What does that look like for you?" And I said, "Well, I think I just want to be a financial manager. I just want to get my little one into elementary school, starting kindergarten." And he said, "Are you sure? This is going to be really hard for you. You're going to have to..." I was going to stay in the division, continue to work there and train my replacement, which I did twice. And some days, it was a bitter pill to swallow. But, again, I made a values-based decision, right? I knew what my priorities were, and I knew when I was ready, I would come back full time and the opportunities would be there for me, right? I think so often we think that we make these hard decisions, and that's it, and that's the end, this is forever. And it's not. It's for a phase of life, a period of time.

And then, there have been other times in my life where there are work challenges, but there are personal health challenges. And just about three years ago, I was diagnosed with an acoustic neuroma. I had a lot of ringing in my ear, I had trouble hearing, and an MRI showed that it was this benign tumor. And so, I had to undergo translabyrinthine craniotomy. It was a 12-hour neurosurgery and I was in the NCCU for five days. And out of that, I learned it was very challenging, right? I learned what my limits were physically. I mentally came out of it feeling kind of fuzzy and foggy and kind of had some short-term memory issues. And I thought, "Oh gosh. So much of what I do is based on my intelligence and my ability to think critically, and to show up in meetings in important ways to help make decisions and weigh options. Will I ever get back to that?"

And that's when I learned I have to respect where I am in the healing process. I had to prioritize wellness and working out things that I didn't necessarily enjoy, right? To pursue and regain part of what I had lost kind of in that process. And what's amazing is that I learned patience, I learned what my limits were in ways that I would have never learned otherwise and were so helpful to me in preparing me for this job. Because believe it or not, I was promoted into the interim presidency about nine months after that surgery. And I think so much of leadership requires you to balance all of those physical, mental, emotional wellsprings that had I not been through that, I probably wouldn't have been able to self-regulate, right? I probably wouldn't-- I mean, maybe I would have learned it. But I think these challenges in life, right? Whether they are family, whether they're work related, whether they're health related, we all have them. And I think that it also hones a level of empathy in you where you start to recognize that while you can't necessarily see what I'm going through, that we are all going through something, right? We all have these challenging circumstances in our lives. And for most of us, we don't really know about it. And so, it helps you meet the moment when you are having conversations with people, I think, in a different way too.

Host: Yeah, I think the fact that you can gain such insights from such a challenging experience, I think is really just a testament to you as a person and to what you bring as a leader. I think that that's just so powerful because I think that's what we all hope to do. You can let those moments kind of cripple you, or you can learn from them and grow from them and carry it forward. So, I think that's just incredible.

Talking a little bit about authenticity, you talked about leaning into your values and setting your values, and I think you can hear it just in the stories you're sharing now that you really embrace empathy and understanding of how to be an authentic leader. Can you talk about that a little bit? How you make sure you are showing up? How do you maintain that authenticity as a leader?

Jen Nickoles: I think authenticity is complicated. There is kind of this duality of authenticity. And in most circumstances when we talk about it in terms of leadership, it's all those really positive qualities that we want from leaders, that if you are authentically yourself, that you are transparent and you're empathetic and you're trustworthy, right? And you can moderate your emotions in a way that you are able to adapt to any circumstance.

But not to get too spiritual, I think we all have some light and dark in us. And so, my authentic self sometimes responds to situations with impatience or with anger or frustration, right? And those are not the qualities that we want to see show up in leaders. And so, I think that there's this quality to authenticity. When people say, "Oh, you just need to bring your whole self to work." I'm not sure that's actually true. There are parts of us that we need to regulate. We need to have self awareness. And what is that rooted in? When I respond negatively, is it because I'm being prideful? Is it because I want to win? Is it because I'm feeling loss of control? Do I want revenge for some other loss that I had? And I think it's important that when you are leading with authenticity that you also self-regulate those negative emotions. And you really say, "I have to take a pause here because I'm not going to show up well in this conversation." And that's where I think authenticity as a leader, to me, is not just for me, myself, in kind of being true to my values and my sense of purpose and who I am, but it's making sure that they align with the organization that I'm working for, because that's a truly authentic leader who's not only representing themselves and showing up in a way that is consistent with their values, but they align with the organization's and they have that ability to self-regulate. Because I think so often we get ourselves in trouble in situations, particularly around enormous change. And we are all going through it post-pandemic, right?

Many of us are going through financial transformations because of our post-pandemic financial situations where we're dealing with kind of the new workforce and all of the challenges that come. We're trying to very rapidly keep up with all the technologies and things that we're trying to do. And this change management, I think, stirs up in us all of these, feelings, right, that sometimes cause us to say, "I'm going to go into the self-protective state." And you have to, as a leader, be able to kind of break the organization through that and say, "Let's focus on who we are. What is our vision? What's our values? Why are we all here?" For us, it's we believe in Johns Hopkins medicine. We want to lead the world in the way that we cure diseases and we train the next generation of leaders and how we care for our patients in personal ways with high quality and safe care, right? And you have to point people to the authenticity of who we are as an organization and then align that with who you are as a leader.

Host: Yeah. It's a great point. I haven't really heard it articulated that way before, but you're absolutely right, when we talk about authenticity, really, it's not me being in a bad mood, coming to work and being short with people. That's not the authentic people anybody wants to see. So, yeah, I think that's really great.

I do want to ask this question because I think when I talked to you before, I think it was something, you said something really powerful to me. And we were talking about empathy and vulnerability, and I think it's something that you really bring to your role as a leader, and being empathetic and not shying away from feelings and vulnerability and having that on display as a leader.

And I think that's something that as you look years ago hopefully, it's changing more now, but I think there is still a stigma around female leaders and being emotional and emotions having negative connotations in the workplace. It's something you haven't shied away from and I think it's something that's really impressive. How have you navigated that?

Jen Nickoles: Yeah, I think that we are in the business of caring for people. We meet people at moments in their life when they are typically most vulnerable that they will ever be. And I think to be a leader devoid of empathy and love and compassion and acknowledging that these are hard things for all of us as humans, that I think we're doing a disservice to ourself.

I don't think we can disassociate from. Who we are as people when we are doing this work. I am not a physician, a clinician, a nurse. And so, I stay that with a little bit of naivete around what it takes to show up every day and serve critically ill patients, right? Yes, we have moments of celebration where we are celebrating new life and recovery and the end of a journey for a patient. But I think to really honor that for us, for our patients, we have to talk about the emotion. And it's hard when the outcomes we hope for and work really hard for, we don't achieve when we lose patients, when we do everything we can, and it's just not enough, right?

And I think part of the process of being in healthcare is acknowledging what we go through and supporting each other through that, I think. There is a certain just incredible resilience in our teams every day to come in and do what they do. But I think to be a leader who doesn't acknowledge that, I think, it's not what I think that the workforce needs or is looking for now. And people really do want to connect with the mission and they want to see that you care deeply about them and the patients.

Host: So, as you reflect, what have been some of the standout moments in your career so far?

Jen Nickoles: Oh gosh. There are definitely a few. I would say when I was in the school of Medicine, gosh, there were so many. I think the one that I would call out, though, is a senior faculty retirement program in a post-retirement academy that I helped to work on with Dr. Cynthia Rand and Dr. Janice Clements. I have an enormous respect and deference for the faculty who work here. Working in Academic Medicine is incredibly difficult and understanding what it takes to reach a full professorship, what it takes to lead a lab and to train the next generation of clinician scientists. It's incredible and very humbling to be a part of that.

And so, one of the things I'd noticed when I was in the Vice Dean's office was that we did not have a faculty retirement program. And I think you honor a faculty member's career along the way, but certainly as they retire. And so, we worked to develop a retirement program. And then, as part of that kind of stakeholder engagement that I talked about earlier, when we were meeting with senior faculty, they really wanted a way to continue to stay on and be a part of the institution and contribute in meaningful ways. They didn't necessarily care that they were paid. They wanted space, they wanted an opportunity to collaborate with other physicians and faculty, and they wanted to be able to continue to do research and teach.

And so, the Academy was kind of born out of those recommendations in an effort to respond to that. And so, it is a post-retirement academy that many of our faculty go into, and there's special programming around it. And it's resourced in a way that those faculty members have the support they need and space to be able to engage.

I would say the other big thing that I'm really proud of is the convention center, the field hospital that we set up during the pandemic. It was a joint effort between the University of Maryland and the state and the city and FEMA. And it was a 250-bed field hospital at the Baltimore City Convention Center. And I was so incredibly proud to be the COO who helped to stand it up and operated it kind of through the first phase. It was the longest running field hospital during the pandemic. And I learned so much from that opportunity. Not one just because, as I said before, I love rushing into any type of kind of a situation where it's this great challenge. And so, the governor called President Sowers. He asked us if we would set up the field hospital in partnership with the University of Maryland and others, obviously. But we had about four weeks to do it. And so, we were ready. We hit the deadline and we were ready to meet that challenge. And it was wonderful work.

I also learned what my plans are aren't necessarily best, because it was parlayed into a facility for testing and a facility for vaccinations and monoclonal antibodies and a supply chain hub. And like many of the other field hospitals, our recommendation after that first wave was we don't need it anymore for surge capacity. And we were right, we didn't need for surge capacity necessarily. But it was all of these other missions that it continued to support. And yeah, that was very meaningful work. Challenging, but very meaningful work.

Host: Yeah. I think, going back to challenges and struggles, I don't think COVID really redefined effective leadership for so many people. And the need for collaboration was obviously so imperative at that time. But it's interesting to hear reflections and all across these journeys that your ability to just really self-reflect and self-assess, I think that that's something that's really a great thing. Something that I certainly struggle with myself.

So, as you go back to, Jennifer, just getting started in your career, coming out of school, what advice would you give yourself as you're thinking about that girl or young woman that doesn't have any idea what she's in store for? What would you tell her?

Jen Nickoles: Yeah. Oh gosh. I mean, definitely enjoy the journey, right? I think I talked to so many fellows and new graduates and early career professionals, and they're just trying to figure out how to hack their careers, right? Like, how do you get to where you are? And there's no one path. Again, you have to put in the time, you have to put in the work. You have to gain that experience to be ready for the next step. And it requires you to just be all in and fully invested in whatever position you're in. Innovate to the extent that you can. Do the best job that you can. And when that next opportunity comes, you will have gained the skill set you need. You can't build upon a foundation if it's not there, right? You just have to do the work. There is no easy answer or life hack to careers. I would tell myself that.

I would tell myself to be a little more patient. I like to move quickly. I like to get things done. I think it's part of what's made me successful in my career. And I'm learning that as you get to kind of this level of executive leadership, the pace of change can really only move as fast as the organization's pace of change. I cannot get ahead of the organization. I can't move faster than what my senior most leadership and my board want me to. And I think it's, again, back to the self regulation, right? Understanding that now this is much bigger than just me and my plans and how quickly I think I can move things along.

I would definitely tell myself to create that my own like board of trustees personally or that network of other leaders much earlier in my career. I was raising my family and spent a lot of time investing in my children and less so in kind of attending conferences and developing networks. And I had the good fortune of being a Carol Emmott fellow. And there, I really gained instant access to this national network of incredible women healthcare leaders, and it just continues to grow every year. And so, that for me has been such a gift in so many circumstances, personally and professionally, to have really, really talented leaders across the country weigh in on issues that I'm facing, or just to be resources for me.

I think it's really important that women leaders support women leaders. I think it's something special about the culture we have at Hopkins in that we really do support one another in meaningful and deliberate ways, not just as mentors behind the scenes, but as vocal sponsors of each other and supporting each other in, kind of meetings and in forums where, when we're there and when we're not there. And so, I think I would tell myself to forge those relationships earlier in my career than I did.

Host: Yeah. And I think the sponsoring others and helping other women, I think, is just so important. And you know, Carol Emmott is such an incredible organization. I appreciate you mentioning them. But I think in general, it's something that I've been really looking at my own leadership style and my own organization and saying, like, "What is my role?" because I think it's upon us to say, "Okay, we get to a certain point in our career. But then, how do we then turn back or even turn to the side and say, 'Okay, how can we help others?'" And there is this real unhealthy competitive nature, I think, that a lot of women feel in their leadership and climbing the ladder and trying to accelerate and trying to grow that it's not healthy. And I think that it really can be a disservice, I think, to ourselves and our own career journey. So, I think that's a really powerful thing to say.

So, second to last question, because I have another one, but you're obviously such a dynamic leader. You have so much going here. I mean, this campus is growing. This campus is beautiful within your organization. But can you talk a little bit about what's next for you?

Jen Nickoles: Sure. What's next for Bayview in Baltimore at Johns Hopkins is really exciting. We are working on a regional strategy with Redonda Miller at Johns Hopkins Hospital, talk about an incredible female leader, right? An example for me, mentor, sponsor, friend, and we're working on a strategy for the Baltimore region that will help to define kind of the future, not just of JHH, but of the Bayview campus. We are focused on recapitalizing the campus. We need a new inpatient tower. And so, that vision for the future, that identity for Bayview is so exciting to contemplate.

I think what I struggle with in the what next is that we're under a global budget. We are moving into the next phase of our CMS waiver, which is the AHEAD model, which is very exciting. It presents a whole new set of opportunities for us and for other states across the country.

But with it, there is uncertainty about what we will negotiate as part of this. We have our model in Maryland. Our hospital payment system is a global payment. Again, it's capped for each one of the hospitals based on our rate structures. And so, when I think about the goal of the waiver that we are under in Maryland, it's really to reduce utilization, to bring down the total cost of care, to move care to the lowest possible care setting, right? Which is not unlike what other states are doing. I think that our model just accelerates that a little further. And so, this notion of how that model intersects with the growth that we anticipate in terms of the demand for services that will be associated with our aging population, I think is one that we are wrestling with.

And so, a lot of the model is based on the total growth of the Medicare payments and costs across the country. And so, we know that we will move in tandem with the rest of the country as the population ages and the needs increase. But that's part of the dynamic of Bayview, especially because we are so invested in aging. And Geriatrics at Johns Hopkins has such a strong foundation here at Bayview. That's going to be a big part of our strategic future. And so, it's a puzzle to solve. How do we make sure it's the right level of utilization? What do we have to build on this campus to meet that need? What do we have to build it in a complementary, collaborative way at Johns Hopkins Hospital, again, to support the city of Baltimore?

And then, I think two other things. I think one is also how the future of the way we deliver care will look, right? Thinking you can't not have a conversation about healthcare and not talk about artificial intelligence or digitization or remote health, telehealth. But I think what's really exciting about being at Johns Hopkins is the fact that the academic medicine that's layered onto it, and the incredible advancements that are being made every single day in how we treat patients, the discoveries we are making that are either curing or halting the progression of disease, the kind of the predictive models that we are developing to be able to prevent a bad outcome for patients, the new hospital of the future where we have all of this, you know, they're wired for all kinds of monitoring, and whether it's ambient or active, and how that plays into how we provide care, moving more things into the home. It's just an exciting time to be in medicine. There's a lot that we can do. It will not change in a day, right? You know, it won't be like the futuristic movies where we hop into one of those pods and we press a button and our surgeries are done for us, but it is exciting to contemplate what this looks like 10 years from now. And again, we'll have to meet that moment when it comes, but the planning for it now, the readiness, and really starting to change the outcomes of patients' lives because of these therapeutics and these interventions is exciting.

And the last thing I'll say, right, it's less glamorous. But I think as a healthcare industry, back to that total cost of care, we know that the cost of healthcare in this country is really high. And when you look back at the past couple of decades, the kind of the M&A, the acquisitions and mergers of hospitals into health systems has only proliferated. It's, you know, advanced at a rate that's pretty impressive, kind of before, during, and after COVID. And I think a lot of hospitals have focused on, certainly was part of my role, integration, and how do we integrate it as a health system. How do we create these centralized support structures and administrative offices and services and roles to support this much larger structure.

And I do think that there will be a time, I think that time is probably now, as we're looking at costs, where we have to revisit that and say, "All right, did that structure create the outcomes we intended? Did it produce the results that we had hoped for? Are we a better health system because of it?" And I do think that that's going to take some work for us, as an industry. Because we know that this is just kind of the new normal for hospitals to be part of health systems to leverage all the assets that we realized that made us vulnerable during COVID particularly. And so. I think that's kind of what comes next too. And hopefully, one day, I'll be a health system president and both now and in a role like that, I'll get to be a part of those bigger conversations.

Host: Absolutely. Well, I hope so. I think you need to be a part of those conversations. And I think your point about Hopkins, hopkins obviously has the reputation for a reason, but even just walking around this campus like I was earlier, there's an energy here. You can feel it. It's kind of palpable. And so, I'm also just really excited to see what you all do and the impact you have on health care.

So, my last question, and I know this isn't on the list of ones I gave you, but I am curious about, so you mentioned your four sons, and I know that they're kind of at different points in their own life stage, but do they know how impressive you are? Like, are you just like mom to them, or they understand all that you've been able to accomplish just even so far in your career?

Jen Nickoles: So, I don't know their specific answers. I will say, I think they know a little bit about who I am. And they certainly appreciate the career advice I can give them now, right? They are between the ages of 20 and 29. They're incredibly supportive of me. And I remember when I was working part time and I had my first opportunity to take a full time job. And we sat around the dinner table as a family. And I brought the conversation to them and I said, "Okay, mom's got this opportunity. Here's the job. What do you guys think? I'm not going to be able to pick you up from school and I won't be there to make you snacks afterwards." And I'll never forget my one son, he said, "Well, mom, I mean, do you think you're going to be good at this?" And I said, "Well, I hope so," right? And he's like, "And do you think you're going to do good things and you're going to have an impact?" And I said, "Yeah, I believe I will." And he goes, "Okay, then you gotta do it. We can make our own snacks, right?" And I often think back to that moment. And, like, I have an incredible husband and partner, and a family that supports me, but they do still ask, "What's for dinner?" They do still expect for me to-- we call it being QB1 on vacations, like, I'm the first ring quarterback on vacations, and there's me as mom. I do think that they have some sense of this role in particular. I think of all the roles I've been in, this is the one that they can most easily articulate what I do every day, right? So often our titles in healthcare are a little confusing, but they understand this one.

Host: Well, that's great. Well, Jennifer, thank you again so much. Truly, I could talk to you all day and ask you a million questions. I really appreciate you taking the time to do this. I appreciate your insights and your sharing and, thank you so much for all the work you're doing.

Jen Nickoles: And thank you for having me.

Host: Absolutely.