Nancy Dickenson-Hazard, former CEO of the Honor Society of Nursing, Sigma Theta Tau International (STTI), interviews Bonnie Wesorick, founder and chairman emerita of Elsevier CPMRC Resource Center. (Part One)
Bonnie Wesorick, MSN, RN, FAAN, is an entrepreneur, philanthropist and teller of stories—sadly, many of them true stories about health care gone wrong. But Wesorick’s own story is about a nurse who, instead of cursing the system, sets about changing it by founding a company—CPM Resource Center (CPMRC), now a business unit of Elsevier—that seeks to create the best places to give and receive care. Central to the company’s success is the CPM Framework, an interdisciplinary, technology-supported and evidence-based approach which, in taking advantage of the benefits and protections offered by standardization, is anything but one size fits all and is on track to becoming a model for interdisciplinary practice.
Recently, Nancy Dickenson-Hazard, MSN, RN, FAAN, former chief executive officer of the Honor Society of Nursing, Sigma Theta Tau International, spoke with Wesorick, now chairman emerita, about life after active leadership of CPMRC and before something called retirement, a word Wesorick dislikes. Read to the end of this two-part article and you’ll find the word this tech-savvy nurse leader is using instead.
: In November 2008, an article in Reflections on Nursing Leadership
, written by Jim Mattson, profiled your early career and influences, your founding of CPM Resource Center (CPMRC) and how you moved through that part of your leadership and career journey. You are now chairman emerita of CPMRC. I know the company, which is now part of Elsevier, is still very much part of your life and passion, so I’d like to talk with you about where you are in Act 3 of your career.
Bonnie Wesorick: Act 3 definitely has started. The purpose—the mission—we had at CPM Resource Center to create the best places to give and receive care is now ingrained in every element of health care. The home for the center has changed over time. It began in a typical 500-bed hospital where caregivers understood that something needed to be done about their practice and culture. That’s where my first success was, one hospital in my community that realized something needed to be done.
That hospital had multiple issues, just as every hospital does, and we started to implement what I called the CPM [clinical practice model] framework. The nurses who took care of patients in that hospital wanted to see change; they knew things had to change. It was almost magical, and we had great success. I had an agreement with that hospital—a contract—that said they were the lab and our role was to look at the nature of the work it takes to really transform culture and practice, not just talk about it. (Thank God I was smart enough to draw up a contract!)
So there was a lot of freedom. Then, of course, our success became known, and people were talking about it. But then that hospital merged with another hospital—a competitor in that community—and there was no longer support for the work that had been done and made such a difference. Since they were no longer committed to the work, I left, and that’s when we created the CPM Resource Center. (This is background, but it relates to Act 3.)
Running a business was a new experience for me. But you need to know why I knew we had to be a business. It was because there was no money available. I applied for grants—failed at that—and I thought, “We have to have money to do this work. How can I get it?” And I thought, “I guess I’ve got to go make it myself.” That’s when I realized we had to be a business.
At the time, I was giving workshops through the hospital that people were paying for, and I thought, “Well, maybe I can continue that.” So I opened the center. That was in 1992. We had a very small staff, and we worked pretty much day and night, because we all were driven by the same passion, and we were successful, although we did struggle financially at times.
It soon became clear to me that we absolutely could not do this work without moving into technology. We were promoting professional scopes of practice, developing evidence-based guidelines, teaching nurses about the importance of understanding the wholeness of patients’ stories, doing plans of care and recognizing the need for an interdisciplinary approach, but I knew that none of this would be achieved unless we had technology to help us do it. That’s when I made the decision to go into partnership with Eclypsis (now Allscripts). When I went into partnership with them, I stepped into a whole different business world. I was naïve about many things.
Dickenson-Hazard: I remember having conversations with you at the time on how different it was to be in that type of environment and whether the mission and purpose of CPMRC were being compromised. Do you remember those conversations?
Wesorick: I surely do! I had these false assumptions that people who are in the same field as you are on the same track with you. We had become partners so we could create a product that was intentionally designed to support practice—professional practice—and interdisciplinary, integrated practice. That concept was foreign to them, but they knew their customers liked it. I had “grown up,” so to speak, with hospitals in the same community being competitive with one another, but that was nothing like competition between vendors. That was scary for me. There was hostility between vendors; they wanted to eliminate each other.
But I knew we needed technology that was intentionally designed for all clinicians, no matter the hospital. I also realized we were having success in intentionally designing technology to support clinicians so they could deliver the care they carried in their hearts, That’s when I knew I had to become, in some way, vendor neutral. Actually, before I finished my association with Eclypsis, we did something that people still can’t believe to this day. Knowing they would benefit financially, I got them to agree to do a partnership with their major competitor, because their clients needed it.
Dickenson-Hazard: Did that business acumen you discovered in yourself surprise you?
Wesorick: That’s a great question! I was gifted in math, so numbers I liked. Had there been a guidance counselor in my high school—there wasn’t—I probably would have been tracked into engineering. And wouldn’t that have been sad, because I would have missed this! So my ability to handle numbers was a significant asset in learning the business side of things, but probably most significant was my clarity of purpose and direction.
Dickenson-Hazard: I absolutely agree with you there! Your passion, your focus on what was important and your ability to align that focus, purpose and passion with the realities of the business world were unique and, no doubt, account for your success.
Wesorick: It surprised them. I think I got a lot of places because of the element of surprise. It was like, “Well, I’ll be darned! She understands our side of the business, but what is driving her is different than what’s driving us.” Anyway, I knew that for us to really impact culture and practice in the world of health care, I had to move out of that one-vendor relationship. That was difficult. It was time to look for a new home for the CPM Resource Center.
Dickenson-Hazard: You needed a partnership with somebody who was interested in operating across vendors.
Wesorick: Yes, someone who was vendor neutral. I looked at what would be a natural, functioning business entity with whom we could partner. I wasn’t in a competitive mode. Although I knew we needed to be smart about it, I also knew we needed to partner. Back then, there wasn’t much support in the nursing profession for partnering with the business world, but I thought, “We need to be in partnership with a company that is committed to evidence-based practice!” As it turned out, we were blessed that our new home was Elsevier. Although the concept of moving evidence into the real world to transform practice was as new to them as it was to Eclypsis, they understood the rigor and importance of evidence-based practice.
Dickenson-Hazard: So you were back in your educator role, helping them understand the value of this and how they could make evidence-based practice live in the practice environment. What are your goals now?
Wesorick: Well, now, I am chairman emerita at the CPM Resource Center, and absolutely no one knows what that means. It is the best title I have ever had, because it offered me the opportunity to pick and choose. For three years, I had prepared Diane Hanson [BSN, RN, MM, now executive vice president and chief operating officer] and Michelle Troseth [MSN, RN, DPNAP, now executive vice president and chief professional practice officer] to take over the business. What I needed to do was step back and not be engaged in the running of the business, because doing that and providing thought leadership is an 80-hour week.
There was legacy work to be done. We had always moved in a partnership mode rather than a hierarchical one, and I wanted Elsevier to understand that, so, as chairman emerita, my goal has been to support Diane and Michelle in any way I can. And there is some work I continue to do. For example, I continue to do what we call engagement overviews. This is where I meet with all the staff of an organization that has committed to beginning the work of transforming its culture and practice, and I still do that.
In my new role, I also spent two years creating a Web-based tool to help organizations evaluate how well they are managing fundamental polarities. Polarity thinking is new to health care, and it must be done if we are to truly transform culture and practice, and it’s very exciting work, very exciting work. I regard Barry Johnson as the father of polarity management, which involves “both/and” thinking.
For example, it is unproductive to focus on staff satisfaction without simultaneously working on patient satisfaction. We had devised a paper-based polarity management system to help companies analyze how well they are managing polarities, but it was too slow and tedious. We needed a system that incorporated intentionally designed technology, so I told Barry I’d help him develop it, and that’s what we did.
Working with a technology expert and his son, it took two years just to uncover what this tool needed to have in it. I then did the content for health care polarities. I knew the tool had to be based on reliable and valid data, so we conducted a study, using two Canadian and two U.S. hospitals, and the result was phenomenal. So we now have a very excellent tool with which companies can survey how well they are managing fundamental polarities, even if they don’t fully understand polarities. And we can turn it around and get the results within 24 hours from the time the last person takes the survey.
Dickenson-Hazard: It sounds to me as though your role has evolved into that of the innovative thought partner, the wise counsel, so to speak.
Wesorick: Speaking of Act 3, one of the greatest honors I’ve received was when Grand Valley State University in Grand Rapids, Michigan [USA] announced plans to create The Bonnie Wesorick Center for Health Care Transformation. It’s wonderful when such an honor comes from your own community. I was blown away.
Dickenson-Hazard: Congratulations! That is awesome, truly a testimony to the importance of this work!
Wesorick: It’s not fully funded yet, but almost. Our goal is to reduce the time between conducting research and applying that research to impact care. I said I would not want to engage in a center that was just theoretical. It had to produce something that impacted at the point of care, and it had to be interdisciplinary.
The Elsevier CPM Resource Center, headquartered in Grand Rapids, Michigan [USA], will work in partnership with The Bonnie Wesorick Center for Health Care Transformation, which is located in the Kirkhof College of Nursing at Grand Valley State University, also in Grand Rapids. We developed it in close partnership with their interdisciplinary lead, you know, their executive lead. We’re actually doing it, and we now have more than 370 hospitals in rural, community and university settings in the CPM Resource Center, and they’re all agreeing to do the work in the real world of interdisciplinary integration.
Dickenson-Hazard: The Bonnie Wesorick Center is evidence that your CPM Framework approach is on the path to becoming a living, breathing national model.
Wesorick: It’s interesting that you mention that, because we just applied for a grant that’s available to create a center for interdisciplinary integration in education and practice. Obviously, at the national level, it’s very clear that we must have interdisciplinary integration, and we can’t expect it to happen in the real world if it’s not happening in education. In education, we’re still siloed in our disciplines, and changing the curriculum within the educational system has been such a challenge.
When this grant became available, I recognized that the CPM Resource Center was young and that the center funded by the grant had to be lodged within an academic setting, but the CPMRC is just the field and model for making it work. So, we went into partnership.
I said, “We have to partner with a place that is stronger than we are in the academic setting, and we picked the University of Minnesota. They’re very supportive of our work. Connie Delaney, [PhD, RN, FAAN, FACMI], the dean at the University of Minnesota School of Nursing, sits on the board for the CPM Resource Center, and so it was just natural. It was also natural to connect with Regenstrief Institute and Brad Doebbeling [MD, MSc, FACP, research scientist, Regenstrief Institute Inc. and Indiana University Center for Health Services and Outcomes Research; professor of medicine and epidemiology, Indiana University School of Medicine], and we have very strong ties with the interprofessional work being done at the University of Minnesota. What we offer is a model to show how to make interdisciplinary practice happen in the real world.
Dickenson-Hazard: When you think about what’s going on at the national level—the IOM report, for example—your model is exactly what is needed.
Wesorick: Yes, because it calls for transforming education, culture and practice, and we have been actually doing that at the point of care for more than 30 years. Many people still do not think, for example, in terms of managing polarities.
Dickenson-Hazard: Well, they don’t know how. They haven’t seen it—I don’t like this word, but I’ll use it—operationalized. They have not seen the idea “operationalized.”
Wesorick: I know, without any doubt in my mind, that the reason we’re still here is because we developed the CPM Framework. What makes it so good is that we have consciously and intentionally designed—based on evidence—every element of it. I said it had to be replicable, and it had to move beyond theory and be action-oriented.
Dickenson-Hazard: And your model hasn’t remained static. I think that’s the other positive part of it. You’ve been very nimble, and you’ve been very intentionally strategic, maintaining your interdisciplinary, evidence-based, technology-driven focus. You’ve kept that in the forefront and, over time, have been innovative in how it was deployed. And in regard to all those buzzwords in the IOM report about nursing’s future—implementing evidence-based practice, advancing the interdisciplinary component, incorporating integrated information systems to inform and transform care—you’re already there!
Wesorick: You know, almost every week, somebody asks me, “You’ve been doing this for how long? Is it really working? I’ll never forget when we did the first TIGER [Technology Informatics Guiding Education Reform] Summit. Two of our sites were exemplars for that. I was showing how the model works—what it looks like—in the real world. We only had about 10 minutes. Afterward, about four faculty members came back to our table and said, “We just want to make sure we understand something. Now, are you saying you are actually doing this in the real world?” And I said, “Yes!” And they go, “No kidding!” It was one of those moments you never forget.
Dickenson-Hazard: Talk a little bit about TIGER. I saw this initiative as a way to move the CPM concept into education and see how we could reform it. I know you were involved with it from the beginning.
Wesorick: Well, it was stimulated by Marion Ball [EdD, FAAN, FCHIME, FHIMSS, FACMI], a nursing informatics pioneer. She was at a meeting in which it was observed that something needed to be done about the absence of nursing’s voice in Washington, and that we needed to do something about that in education and practice. So a group was started, just a few people saying we’ve got to pull this together and have nursing’s voice be heard.
Dickenson-Hazard: From your perspective, what is it accomplishing today?
Wesorick: Well, first, it is educating and bringing people together, and they have accomplished way more than I could briefly outline for you. Today, Michelle Troseth is co-chair of TIGER, along with Marion Ball, so she could answer your question much better than I can. But they’ve created nine collaborative TIGER teams. They’ve created a virtual system. The TIGER Initiative is now under HIMSS [Healthcare Information and Management Systems Society], is growing in leaps and bounds, and is making a difference in both education and practice.
Dickenson-Hazard: So, if we were to boil it down to TIGER’s single greatest contribution, it is that nursing is being heard, that nursing is at the table and making a difference at the point of care that’s visible. We’ve known for years that nursing makes a difference at the point of care, but having it visible across disciplines and organizations and to have the support of multiple governmental entities—both national and state—is pretty phenomenal.
Wesorick: And it’s saying that technology is not a problem. If intentionally designed, technology gives us hope that we can do the work that has to be done. That word “intentionally” is so important. Technology has to be intentionally designed to help us know the person’s—the patient’s—story. It has to be intentionally designed to bring us evidence at the point of care—when we need it—to help give the best care possible. And it needs to offer us a place where we have a plan of care that’s coordinated across all roles and disciplines, a place to stop duplication and repetition. And it can help us with all of that so that we get the outcomes we need.
Dickenson-Hazard: I agree. Technology is a tool, the means, not the end. At first, it was seen as the solution. So that has evolved, but you know there are people and organizations who bemoan that uptake of technology is too slow, and that frequently nursing leaders do not fully embrace or deploy these types of systems. What is your perspective?
Wesorick: This is really significant, I think, and needs some attention. CNOs within the U.S. health care system work day and night and have major responsibility for day-in-and-day-out operations and assuring that patients are getting the right care. And way before the mandate came along that, by 2014, everybody had to have EHR [electronic health records], it had become clear that we had to have technology. Because it was thought that the technology people would best understand how to automate the health care system—and they obviously were needed to implement that—responsibility for achieving that was usually assigned to the chief technology officer. Well, the mentality that IT would provide the solution—that IT would take care of everything—has cost us millions of wasted dollars.
To put this into perspective, I was to do a workshop with the nurse leaders of an organization on what it takes to transform cultures and practice. They had multiple settings at 20-some sites. Well, before I began my presentation, they asked me, “Would you mind if the chief information officer said a few words?” Well, of course, I was the guest, so I said, “No, that would be fine.”
Here’s what happened. He got up there and said, “We have spent $270 million on our EHR, and we have no sustainable clinical outcomes. We still have duplication and repetition—all the issues.” Then he asked the audience, “What are you going to do about it?” Dead silence filled that room, Nancy.
Finally, I spoke up and said, “Is it OK for me to ask a question?” Nobody was saying anything, and you could cut the tension with a knife. He was so glad somebody broke the silence that he said, “Well, certainly.”
I said, “I’d be in tachycardia if I signed a $270 million contract, but when you signed it, what did you commit to? Did you commit to automate—to put in this electronic health record—within a certain time frame, or was there a collective commitment to transform the culture and practice at the point of care with this tool of technology?”
I appreciated his response. He said he knew the right answer, but that’s not what they did. But, you know, if you’re going to spend $270 million on something, it should take care of everything—that’s my thought—but what is everything?
I have this like almost-driven concern that we have not been clear enough in trying to help people understand that we can use technology to get us to sustainable advancement in clinical outcomes but, to do that, it must meet certain criteria. It has to do certain things, all of which need to be judged on the practice platform. What is your practice platform?
The reason I bring this up is that there is a lot of talk now—we started it, actually—about technology’s role in helping us reach exponential growth. How come technology has reached exponential growth? The best example that comes to mind is the phone. Look at the phone and what it can do. It has revolutionized. It has advanced. There’s been exponential growth in the phone and the outcomes of the phone. How come we haven’t seen that in [health care] practice?
Well, now we know why we’re wasting millions of dollars, because the technology wasn’t designed to support the practice platform. The reason I can speak to this is that I have worked with literally thousands of people, and I do this red-dot exercise with them. (It has just recently been published.) I ask them to define their practice reality—in other words, their practice platform. You can’t reach exponential growth unless you have a solid practice platform. Well, we don’t have a solid practice platform!
In this exercise, I ask, “On a scale of 1 to 5, five being really strong and good, tell me your reality around these 10 fundamental elements—based on the IOM report—that must be present in the best places to give and receive care. Anything below a certain point—according to quality—is considered an endangerment zone. I have done this, and I have constructed a graph based on 6,000-some responses from 100 organizations. It doesn’t matter which organization. In regard to the fundamental elements, no one was out of the danger zone—no one. RNL