As senior vice president and chief learning officer Kathleen Gallo, PhD, RN has created and implemented a comprehensive learning strategy at the North Shore-LIJ Health System via the Center for Learning and Innovation (North Shore-LIJ’s corporate university) and the Patient Safety Institute.
Now, Dr. Gallo will serve as the founding dean of the Hofstra North Shore-LIJ School of Graduate Nursing and Health Professions. Upon approval from the New York State Department of Education, the program will address the need for advance practice nurses as a result of health care reform.
Question from interviewer: You were recently named the founding dean of the new nursing school that will be established at Hofstra University. Tell me about the new school and its programs.
Dr. Gallo: When the Hofstra North Shore-LIJ School of Medicine was founded, we knew that this was the first step and that we would need a school of nursing to align with it. We also knew that it was the beginning of redefining health professions education.
The Hofstra North Shore-LIJ School of Graduate Nursing and Health Professions is different. First, we will be a graduate school and we will be graduating nurse practitioners [NPs]. Second we are fortunate that Hofstra already has well-established undergraduate and graduate physician assistant [PA] programs.
We will have the PA programs within the School of Graduate Nursing and Health Professions. Now we have the opportunity between the School of Medicine and the School of Graduate Nursing and Health Professions to implement an interprofessional education model.
Q: You talked about the nursing program being different. Will you eventually expand to include an undergraduate nursing school?
Dr. Gallo: Our plan is to offer graduate programs in nursing. There is no desire to have an undergraduate program. There are schools in the region that offer excellent undergraduate nursing programs, and we don’t think that we need to be in that space.
Unique Take, Unique Tactics
Q: How will you approach the programs differently than other nursing schools across the nation?
Dr. Gallo: With the School of Medicine and the School of Graduate Nursing and Health Professions, we have the opportunity to respond to the Institute of Medicine’s sentinel work, “To Err Is Human” which focused on patient safety, as well as the Carnegie Foundation’s recommendation to integrate the health professions in education before they become employees. These are just two national institutions that are calling for changes in how we currently educate health care professionals. It is critical to patient safety and quality.
One advantage that our new schools have is that we have no legacy. Therefore, we have no minds to change. NP students, PA students and medical students will learn together at certain points in time.
Another difference is related to the teaching methods we will use. The School of Medicine is founded on how learners learn, not how teachers teach. The new graduate school will be very learner-centric as well.
Q: What degrees will you grant?
Dr. Gallo: We have applied to the New York State Department of Education and upon their approval we plan to offer a Master of Science degree with a major in nursing. The program will offer two tracks: family nurse practitioner or adult-gerontology acute care nurse practitioner
The Advance Practice Advantage
Q: As you look at nursing over the next five to 10 years, you are obviously focusing on a graduate level because there is a larger need. What are the actual needs for these advanced nurses over the next five to 10 years, and are there other institutions that are competing with you to do this?
Dr. Gallo: There is a tremendous need for advance practice nurses. There are 10,000 people a day turning 65 for the next 19 years. In addition, the Affordable Care Act mandates access to health care for all. To be able to have access to high quality health care, additional advance practice health care providers need to enter the marketplace. NPs have a very long history in the country of providing high-quality, safe, efficient and effective care.
There is plenty of research, particularly in primary care, that NPs provide exceptional care at a lower cost just in terms of the models that they work in and their efficiency. There is also research that patients have a preference in dealing with and getting care from NPs because of their communication skills, as well as the time that they spend with patients. NPs demonstrate a holistic approach to providing health care services.
Q: In addition to these advanced degrees, and in addition to doing more within the medical community, how will nursing change over the next three to five years?
Dr. Gallo: The numbers of advance practice nurses will grow extraordinarily. Advance practice nurses can work in a number of different areas in ambulatory settings or they may choose to have their own practices. They may work in the Minute Clinic at CVS. They will have the opportunity to join physician groups and be part of that team, along with physician assistants. As the models of health care delivery change and it is moving to outpatient, the nurse practitioner is actually right in the center and is necessary for those models to be successful.
Inter-Disciplinary Health Professions Faculty
Q: What else should we know about the nursing program and what makes it unique?
Dr. Gallo: This is another area where I think we’re quite different than any other academic medical center that has medical and nursing schools. Both North Shore-LIJ and Hofstra University are founding partners, so this is not a traditional affiliation agreement between a health system and a university. The dean of the medical school is also the executive physician in charge of the health system.
I am the founding dean for the Hofstra North Shore-LIJ School of Graduate Nursing and Health Professions; however, I am also the chief learning officer for North Shore-LIJ, so that keeps the alignment between what the university is teaching and what the health care field needs. We have the opportunity to close the gap between the level of work readiness at graduation and the level of readiness the employers need.
The other interesting difference will be our interprofessional faculty. We will have physicians, advance practice nurses, doctorally prepared nurses, pathologists, pharmacists, etc. as faculty.…
Another big plus is our vast educational resources. We have our Patient Safety Institute at North Shore-LIJ, our Center for Learning and Innovation (which is the other campus to the medical school) and our Bioskills Education Center. These educational resources are enormous, and we have every clinical site that any school would ever need. Where other universities have challenges in terms of clinical sites or faculty, we really are very blessed that we have those resources.
Anticipating Organizational Needs
Q: Your title is chief learning officer, which is intriguing. What is a chief learning officer?
Dr. Gallo: I asked the same question 14 years ago. My background is emergency and trauma nursing. I was in that area for close to 30 years. When our president and CEO, Michael Dowling, wrote a white paper for a leadership institute, he asked many people to read that document. I read it, had a couple of comments about it and he asked if I would take over that role.
At first, I wasn’t that excited about it because I thought, “What is a chief learning officer?” Then I thought, “I’ll take the job nobody ever heard of and try to figure it out.”... I called GE [General Electric]’s Jack Welch and Steve Kerr, his chief learning officer. Steve became my mentor in terms of what chief learning officers do.
Q: And what do chief learning officers do?
Dr. Gallo: The role of chief learning officer is to develop a learning strategy for the organization aligned with its business goals and objectives. Essentially, the chief learning officer is a strategic change agent.
Q: CLI educates more than 50,000 employees across all departments and levels from doctors and nurses to food service employees and so forth. This population is larger than most universities. How do you insure that new learning objectives are indeed going through? How are you changing the culture?
Dr. Gallo: We offer a variety of programs including: management and leadership development, improvement sciences, and administrative, clinical, and physician High Potential Programs. Our Patient Safety Institute offers simulation programs to over 90 clinical teams. We are in operation from 7 in the morning until 10 at night, except for Fridays when we end at 5. Last year, we had approximately 300,000 learning hours. In terms of making sure all this time and effort is worthwhile, we don’t work in a silo. We work very closely with leadership and operations.
We use a leader-as-teacher model. Our leaders teach with a content expert in these programs. For example, our CEO and president is on the faculty for the leadership course. Our physician leaders are faculty members for our high potential programs, and as our chief financial officer and his team teach the health care finance course, etc. Again, they are partnered with our faculty. We conduct a lot of faculty development because we do not use PowerPoint presentations. Our curriculum is all case-based. Sometimes we use real cases. Sometimes we’ll use cases from the Harvard Business School.
The learners will be in teams as they work through cases. They have to do pre-work to prepare for the classroom activities. Outcomes are program dependent.
For example, in our High Potential Program, we ask… “Have we built a pipeline of leaders?” As they graduate from the program, we ask… “Where are we moving them to?” The same is true for our clinical programs. We have a Critical Care Nurse Fellowship Program, as well as an Emergency Fellowship Program and Pediatric Nurse Fellowship Program.
The outcomes on those programs have led to positive financial outcomes due to the retention rate now being in the high 90s. There are very few people who leave the organization once they come through these fellowship programs. The quality metrics have also been very positive with these new nurses graduating. It is a year-long program and then they are ready to work in our specialty units.
Culture of Empowerment
Q: A lot of activity is going on. How does this relate to patient care?
Dr. Gallo: It directly relates to patient care.
If we talk about our leadership programs, the leaders set the culture in the organization in all the facilities, so we need to develop leaders that understand that we need to have a culture of empowerment and innovation within the organization. As we develop those leaders, that is one of the skill sets and competencies that we look for them to embrace.
Q: Can you provide some specific examples of how all of these different training courses--leadership, clinical and others--relate to patient care?
Dr. Gallo: The health system has a system-wide initiative related to sepsis. The goal was to decrease sepsis mortality by 50% within five years. CLI has participated in this initiative by developing the educational program known as the Taming Sepsis Education Program (TSEP).
Five years later, due to the efforts of many across the health system, sepsis mortality has decreased by 50%. Now it is never just education alone to achieve results, but it is CLI being strategically aligned with health system initiatives. It is the leaders at my level coming together and saying, “We need to do this.”
Knowing When to Act
Q: As you look at health care, which is ever-changing, what are the two or three big challenges you face in the next three to five years that perhaps you didn’t face three to five years ago?
Dr. Gallo: One thing is knowing when to develop a program and knowing when to wait. Things are changing so rapidly, sometimes you just have to sit back and wait to see what the real priorities are. As you can imagine there is a constant demand for new programs. Probably our biggest challenge is related to logistics.... I don’t want a “car wash” approach to learning. We certainly can bring people through and just check off the list that they came through, but we’re not into body counts. What we’re looking for is real learning outcomes, so that is the challenge.
Q: One of the big challenges that every health care worker faced recently was the Ebola crisis and whether it is Ebola or another disease; clearly infectious diseases have to be a challenge for training. How did you approach Ebola and what are you doing to prepare for the next crisis?
Dr. Gallo: We were very excited about collaborating on the educational program for Ebola. The staff at CLI and PSI worked with Emergency Management, the Institute for Nursing, and our team at the Bioskills Education Center.
We had a three-tiered approach to our Ebola training. It had an online component and depending upon what type of employee you were, you were assigned certain modules and that was step one.
Then, there were hands on skills training and that was about how to don and doff level 1 and level 2 suits, and then when it came to the Hazmat suits… level 3… where the employees can be at the most risk; we went down to our Bioskills Education Center and our Emergency Management colleagues did the training for level 3.Two simulation rooms were created up at Glen Cove Hospital, which is our designated hospital for an Ebola patient. The PSI staff conducted what we call “in situ training”… all the training took place in the Hazmat suits with the special teams that were going to care for patients at Glen Cove, and we were able to tape out cold zones, warm zones, hot zones, and simulate real life events.
Everything was video- and audio-recorded so that the teams could sit back and debrief their performance. This is the moment where everybody learns. That was a very rewarding program for everyone involved. Lots of work but lots of rewards.
The training is good for any endemic outbreak. What I can say about the health system is that when it comes to emergencies, we have had an emergency management structure in place called Incident Command System for a decade. This is an organizing structure that allows us to respond quickly to emergencies.
We are experienced in responding to emergencies and Ebola was one of those times because it really hit New York City very quickly.
Q: This is obviously very intense. When you leave here, what do you like to do?
Dr. Gallo: I process on the way home. I like to exercise and I have grandchildren now, so I like to take care of my grandchildren and babysit. I like the beach in the summer. I think many of us here feel the same way that when Monday rolls around, we hop out of the bed because there are so many moving parts and you never know what is coming up the next day, it is really a very exciting job.