Transcript

SPEAKER_02
0:05

How are you? Tinder. I'm great. How are you? I'm doing good. I'm doing good. I'm happy to be on why.

SPEAKER_01
0:16

You know what? I always get upset because I don't do a lot of camping anymore. I want to, but I need to get my feet on the ground. I need to be in my mountains. Yeah.

SPEAKER_02
0:26

Yeah. You and you and William, yeah. Go walk.

SPEAKER_01
0:29

I know. William and I have a lot in common as far as that goes. And I'm going to go check into my Czech ancestry. I'm going to go find some relatives that I've never met. So my gosh. That's so cool. Going back to my roots is what my friends tell me.

SPEAKER_02
0:43

Well, we are taking our new camper out for the Labor Day weekend with our granddaughter. So we're kind of excited about that. Okay, I'm jealous about that one of these days. Well, that's going to lead us straight into new news. And there is a publication from of just a preeminent leader in the business world called the Harvard Business Review. And I recommend that to a lot of people who are leaders in a variety of roles. And one in particular, I think, is midwives who are practice directors could find a lot of value in this, not just C-suite people, right? But folks who find themselves in leadership positions. And an article came out that was featured August 12th that really resonated with me. And as you know, I try to link these things to our guests that we have on. And the title of this article, August 12th, is Before Rolling Out a New Strategy, assess your team's readiness. So this author, Stephen Morris, it's it's really a pretty robust article. I will I will link what I can on our Best Route website and YouTube, but you have to have a subscription to the Harvard Business Review to access a lot of their articles. It's not that expensive, guys. I would encourage you to do it. But I want to highlight three qualities that I I'm going to be interested, our guest to respond to that he points out about leading teams. Which are so relevant to midwifery. And where you and I know, Denise, we have a lot of midwife practices out there that are struggling. Yes. So he has this sort of he calls it three conditions necessary for effective execution of a leader. And it's called appetite, capacity and skill set. So I'm just going to read like maybe three or four sentences that sort of really capture what he's talking about. So let's say, Denise, you're you're a leader of a practice and you have the appetite, right? You've got people who show up in your room and they're ready to listen. But when things begin to collide and things are inconvenient and people have to decide what they're going to protect with their time or whatever, the momentum begins to wane a little bit. So how do you keep people's appetite going? It it it reminds me of when I go work with affiliates and people come and rally, and Shana, you're at one of those. How do you keep the appetite sort of fired up with people who aren't necessarily sure what you're doing? The next one is capacity. The effort the system can sustain. And this is a great sentence. Appetite tells you whether people want to carry the work. Capacity tells you whether the system around them, the organization, the team, the individual can sustain it.

SPEAKER_01
3:55

Right.

SPEAKER_02
3:56

And sometimes I think we don't completely assess the capacity of the people we're trying to lead. We just make a lot of assumptions. It's a great idea. So let's just go do it. And the third one, the third one is the skill set, the capability at the level of the work. Even when the appetite and capacity are present, another question remains. Do the people responsible for the execution and the decisions have the skills the work demands? Isn't that fascinating? So what are your thoughts about that?

SPEAKER_01
4:32

No, I think that I think that really does. Well, I mean, he he wrote about it, right? I think that really hits on all three points very well. And I do think I really do think the capacity really like I we we can have a great passion, um, but we have to have the support around it. That one speaks the most to me, I think, right now. So um because I'm in a big institution myself. So you can have all the drive and you can even have the skills, but you have to have all three. I do think so.

SPEAKER_02
5:01

Yeah.

SPEAKER_01
5:01

Um the ingredients have to be there. Otherwise, what are you gonna make, right?

SPEAKER_02
5:05

Yeah. So he goes into strategies on each of those um tasks, I guess, or or concepts that you have to really assess and how to how to address them, because it's hard to have all those three present at the same time.

SPEAKER_01
5:21

It's uh that's a great point, Sindra. I think you I think that's really good. I think we have great ideas, but to have more of a toolkit um with those ideas and strategies are very important.

SPEAKER_02
5:32

So oh my gosh, you just said a keyword, a toolkit, uh, which is a great intro to our guest today. Um I'm so excited to to have Shana French with us today. I've I've watched her from afar, uh, now have the pleasure of working with her very, very closely on some graduate uh doctoral work she's doing on practice director leadership in our country. Um, we've known this has been an issue since decades ago when I attended the Service Directors Network meetings, and we still have need for our leadership to gain skills and entree into really being phenomenal leaders. So, Shana, welcome to the Possibleist Podcast. Shayna, thank you. Yeah. We would love for you to share a little bit about who you are and sort of what brought you to Midwifery and why you're here today.

SPEAKER_00
6:33

Sure. Um Midwifery is kind of a natural fit for me. Um, I love the education piece of it uh and building this rapport with our clients and the ability to kind of take the knowledge that we have and share that with our clients so that they can understand it. The medical system is hard to navigate. We oftentimes don't have enough education about our bodies, about our needs, both physical and mental. And I think that we do a great job as midwives meeting our clients where they're at uh and assisting them and seeing, okay, how can we best support them, basically? Um, and that patient-centered care uh is really important to us. And so that was what drew me to midwifery. And I've been a midwife for 19 years now. I started off in a very, very busy practice in Atlanta, uh the second busiest delivering hospital in the US, which although was very overwhelming as a new graduate, um, it was really helpful in thinking, okay, I can address anything that comes in the door. Um, I've got the skills for high risk, low risk, everything in between. So uh, and from there I was able to take that and have that confidence to do birth center birth and hospitalist midwife free care at the same time. I was a first center midwife for 11 years. Uh, and then later in my career now, I have translated um my skills into doing triage. Uh, and I'm working in a triage job. It's very helpful to allow me to have the hours that I need to put in school. So that's pretty critical.

SPEAKER_02
8:14

Oh yeah. Juggling a lot. So, so what are you studying?

SPEAKER_00
8:20

So, my main focus is I'm uh currently attending Johns Hopkins University in a dual degree program. So, I'm getting both my doctorate of nursing practice and uh master's of business administration. And this is something that uh I felt passionate about since uh about 2019, 2020, started uh with a couple of my midwife colleagues to try to open a private practice. And we were trying to educate ourselves on the fly, no guidance, no learning in school, no learning on the job. Uh and we really wanted to get our practice off the ground and it took several years. And unfortunately, we we learned that it was not the way that we should be going. And so we did not formally open the practice, but came about three months away from doors open. Um, so so many lessons that has then led me to this program. And not all midwives can go get business degrees. So I'm the guinea pig, I'll do it for you guys. I'm learning these skills, and then my job is going to be able to um put those lessons out there so I can share it with everybody.

SPEAKER_02
9:31

Yeah. Denise, I think you and I know that that when we when we hear stories, there's such incredible passion from midwives who who have fantastic outcomes and high patient experience satisfaction. Yes. But know little to nothing about the business side of what they're contributing.

SPEAKER_01
9:52

It's a whole other part that we just don't learn anything about. It's really um right. I mean, and if we want to bring that passion into a business setting, yeah. You got to start from zero. So, yes.

SPEAKER_00
10:08

I think that a lot of um midwives, we know exactly how to take care of our patients and we know what works well, but that doesn't always jive with what an administration of a hospital, of a practice, of what they're looking at, which is more on the dollars and cents side of things, sustainability, um, team uh integration, those sorts of things. And so we need to take it upon our ourselves to do some learning in that area uh so that way we can navigate uh those minefields.

SPEAKER_02
10:44

Denise, I remember when I visited your practice um years ago, years ago, and there were what maybe six of you. Um and the the need for the group to coalesce beyond just the monthly meeting, you know, it was like, what's the vision? What's what's what's the growth that we want? What could we do to really scale and be more heard in the system? And I think you all have done that, but it's taken what a decade?

SPEAKER_01
11:16

I mean, it took some painful years. Um, and I think um it it took really just yeah, it took a lot. There was a lot of yeah, a lot of struggle, um, yeah, lots of tears, lots of like blame, lots of like frustration about like wanting a leader um and not just a manager.

SPEAKER_02
11:38

Right.

SPEAKER_01
11:38

That's a great concept, right? To really allow us to grow, to be heard, um, and to really be an ally with our or large organization for us, to be an advocate for us. And yeah, a lot there was a lot of painful times there.

SPEAKER_02
11:55

So yes, Ginger, it was But I I think the point is there were there were a core of you who weren't gonna stop.

SPEAKER_01
12:06

There was a core that was willing to um go to give up everything. Um, and and you have to say that sometimes like this is what I I will stand for, and this is what I can't stand for. And there's there's the other ones who can't um who can't come to the table with the same energy um because they need to have a job sometimes. They need to be, they're the breadwinners and they don't have the flexibility of going elsewhere. And so, or there's there's fear so much built into it. So there, you know, you have to have your it ideally if you had everybody on the same page, it would be a great strong front, but there often has to be the the um the loud people, the verbal people to to pave the way.

SPEAKER_02
12:53

So, Shana, do you do you think fear is an underlying challenge for some of our our leaders?

SPEAKER_00
12:59

Uh absolutely. And I think part of that fear is that we don't understand the language that the administrators are using. We don't know how to communicate effectively with them. You know, we're used to, as midwives, leading teams of birthing people, leading um the medical teams with the nurses and our colleagues. Um, but we're not used to speaking to the C-suite. And C-suite means the executive suite. So we're talking about the chief nursing officer, the chief um medical officer, the president of the hospital system, all those folks. And it is intimidating to sit in front of a board of them and try to explain because they do not understand midwifery most of the time.

SPEAKER_03
13:46

Right.

SPEAKER_00
13:46

So we have to start off our conversation with this is who we are, this is what we do, and then explain, you know, why is this vital to the system? But we have to do that in a succinct manner in which they understand talking in dollars and cents. And so learning more about the business aspects of how a hospital operates, how a practice operates, uh, I'm hoping will demystify or take away some of that fear from having those conversations.

SPEAKER_02
14:17

And maybe equalize it, put them on a level playing field. There are no surprises here, so let's just talk about it.

SPEAKER_01
14:23

It is a different language, I agree. Um, so I think that is very important. Yeah.

SPEAKER_02
14:29

So what are you exploring in your doctoral study, Shana?

SPEAKER_00
14:34

So I'm exploring uh basically leadership concepts within practice directors, right? So practice directors um bluff them, they are working hard out there, right? Most of the time, um, these are folks that are staff midwives who maybe they're the most senior in the practice. So they've been chosen to be the director, or maybe simply nobody else wanted to do the job. It's a hard job. Um, basically, you've got one foot in the clinical space, you've got one foot in this administrative managerial space, and suddenly you're managing your friends, right? Right. These are people that you're in the trenches with every day. And now you have to have tough conversations. Um, and so what I'm studying is in my doctoral um project, I'm wanting to know what are practice directors experiencing because there is not data out there telling us. We don't even know how many practice directors there are in the United States.

SPEAKER_03
15:37

That's right.

SPEAKER_00
15:38

So there's so much unknown. So the first step of what I've chosen to focus on is really just finding out um the standards, finding out what is the norms. So, practice directors, are they getting paid differently than other midwives? Are they given separate administrative time than other midwives? Uh, who do they report to? How many people report to them? Uh, those types of issues. And then the general kind of taking the temperature of where do we find, where are our strengths? So where are we best at? Uh, and then where are those learning gaps that need to be addressed? And how would they prefer to learn? How can we give them this information? Um, and I find that in knowing this data, it'll help us guide um the interventions to make sure it's what people want and what people need.

SPEAKER_02
16:34

Yeah. Do you have any assumptions about what you're gonna what you're gonna get?

SPEAKER_00
16:40

Yeah, I mean, my assumption was that we need business skills. We don't know about reading a profit and loss statement. We don't understand about insurance carriers and accepting different ones. Those are the things that we're struggling with. Um, I can tell you just a peek of the data, a little bit of what I'm I'm just starting to get the um the data rolling in. It's actually communication and relationships management so far that's taking the lead.

SPEAKER_03
17:10

Wow.

SPEAKER_00
17:11

Yeah, because again, we're not trained in interpersonal skills as far as management perspective, right? You know, creating schedules, managing when people, you know, can and and cannot show up to work, hiring, firing. These are things that we might or might not have authority in, but and we're never taught to navigate.

SPEAKER_02
17:33

So true. We we uh we do it by the seat of our pants. And hope that your life hope that your life skills, you know, that you've done something that that that helps you. I mean, I've been in those situations leading a big practice St. Luke's where Denise uh and I worked together with what, eight or nine other midwives. And, you know, I didn't have any classes. I my Bible was the AC and M Midwifery Service Director's Manual. And my friends, you know, you and I, Shana, have talked about um Nancy Joe Reedy, whose funeral was this past weekend. Um Nancy Joe was a mentor to so many of us starting practices, but there there were and still are not any formal programs. Like A, is it A1 or who are they in the nursing world? The A1.

SPEAKER_00
18:25

Uh there's also the American Organization for Nursing Leaders, that's A O N L. That's um that's big right and now.

SPEAKER_02
18:33

Yeah.

SPEAKER_00
18:33

Uh and AC and M is wanting to get back to training midwives in business, mid-free business network, yeah, um, the leadership committee, those sorts of things.

SPEAKER_02
18:43

Right, right. Um we need it now. We need it now. We got a lot of people suffering out there, and it's almost like this is anecdotal, as many new practices I see in in the public domain opening, as many are being blindsided and closed. And they have no idea why. Just they're closing them.

SPEAKER_00
19:08

Yeah, I I followed um Brie Thumb's uh research uh about, you know, that's highly influenced uh what I'm asking about in the practice director survey that I've done, uh, is positive practice environment, that concept of how can we create a uh practice where midwives want to stay, where not only are we making it, but we're thriving, right? Not just surviving. Um, and so that's been critical. And her research has also shown uh why midwives are leaving full scope practice.

SPEAKER_03
19:43

Yeah.

SPEAKER_00
19:44

I was blown away when I went to the last midwifery works conference, and it's been a while since that took place, but to learn that 30% of our midwives are leaving full scope by five years, and by 10 years, 50% of our colleagues are no longer delivering babies in a time when there's a an OB shortage, when we need more OB care, um, when we know that we're 22,000 midwives short of what we need in the United States, roughly, um these are problems that need to be tackled now. And I I view practice directors as the boots on the ground locally to create that strength so that we can unite um and bring people together then nationally.

SPEAKER_02
20:32

So I'm I'm gonna go back to this HBR article and then ask you a question about Maryland as an affiliate, Shayna. I'm just gonna read this because I think appetite is a lot of what we're talking about, not just the practice director, but those other midwives like Denise was talking about. There were tears. Appetite is a form of energy at the organizational level. It involves leaders and teams investing discretionary effort, even when circumstances make it easier to let things slide. Within work groups, it's the shared sense that the project belongs to us. For individuals, it's whether someone experiences a responsibility is genuinely theirs to lead or is an obligation imposed from above. So if we just walk over to the Maryland affiliate that has over 300 members and post, you know, during COVID, it sort of shut down. I I think you're in a you're in a Maryland affiliate member. Um, and the desire to sort of, I can't say Jamie's name right, um, to to sort of reinvigorate it. Um, like how did how what was the appetite there that you think led to all the other amazing things that Maryland affiliate pulled off, including a huge Johns Hopkins grant?

SPEAKER_00
21:51

Yeah, uh I think that in Maryland, we're very closely located with Virginia and the DC area. Um States are nestled back and forth. And we have a lot of folks that may live in Maryland, work in DC, live in Virginia, work in Maryland. And so there's a lot of back and forth sharing in a way that I don't think happens in other states. And so it's also an area that's um ripe for all of us coming together then, right? So we needed to view that as an asset. So Maryland, we were so thankful to have this ACM affiliate leadership. There were six women that midwives that came together and said, we need to restart this. We can't just let our affiliate go dormant. We know COVID's been overwhelming. We're all struggling with finding capacity, but there are serious issues that we need to tackle. And so it was with their leadership that things kicked off and that began bringing Grow Midwives and Ginger to the state affiliate to have a few days where we sat down and said, what issues are critical within our state? How can we create action items in the next three months to 12 months? And that really kicked things off.

SPEAKER_02
23:11

So when you when you I you know I'm trying to drill down here because I don't know that there's an answer, but in your experience, it's the same with a practice, right? Denise, you've got 20-some midwives. How do you get the appetite for like a gourmet meal for people to want to participate? Like, how did that happen? Why did they care?

SPEAKER_00
23:33

I think part of it is that we wanted to know what the topics were that were critical within our state and our region. And you spoke in the article the other word that we use is buy-in, yeah, right. That you need to have buy-in from whoever is going to be on this change team. Um, and so in listening to each other, what were the topics that we're interested in and focusing on that, instead of going based off of assumptions or generalizations on what was needed, uh, that way that created the appetite because in taking the temperature of the state, we knew, okay, this is a majority subject that people want to work on. Um, in that way, we know that reimbursement is a hot topic, create um parity between certified midwives and certified nursed midwives and Medicaid reimbursement. Those issues are things we want to focus on. Self-governance in Maryland. Um, these are topics that keep coming up over and over. And then this past year, uh a group of us from Johns Hopkins, um, I was so delighted to be asked to join a team of Hopkins professors uh who were working on the subject of bringing together the um Maryland, DC, and Virginia area so that we could increase our voice, our strength uh in advocating for each other. And that was great. We had a conference, a regional conference in May where we came together and figured out what was the hot buttons for all three states or regions.

SPEAKER_02
25:15

The power of um legislate legislators looking at what's happening in neighboring states is very common. I know it is in the Midwest, Kansas, Oklahoma, Nebraska, Colorado, and sort of letting those legislators know and other payers what's happening. Because they are in silos, right? And if we're not helping share those facts, then who is? Yeah.

SPEAKER_00
25:42

Correct. And I think sometimes we don't understand that there are other folks that are struggling with the same issues that we are. Um, and instead of reinventing the wheel, instead of feeling like we're alone, let's really come together to unite to address these issues. Um so if you know DC is doing great work on trying to get preceptor reimbursement or support, um, why don't we take those lessons learned and help guide the other states within the region, right? If one state like Virginia just um got great policies around supporting certified midwives, if we can model our legislation after that, if we can model our hospital policies after that, um, let's support each other. It will make us all stronger.

SPEAKER_02
26:33

Absolutely. Coming out of the silos, huh, Denise?

SPEAKER_01
26:38

Right. I would I was just thinking about, I'm just thinking about like Wisconsin and about how like how do you get your how do you get people, um, how do you increase the appetite? And um, I think the appetite's been a little bit low in the state for a long time. And now that we my own practice is getting bigger and bigger, um, I think really one of the things that's I I keep trying to pep it up, you know, like I think you need people that are constantly trying to remind them about what historically you've been able to do as an affiliate, um, and that they are here um benefiting from what the affiliate has done in the past, even though it's a little bit calmer and quieter now, so to speak. Um, but I, you know, remembering that like as in tomorrow, I think Wisconsin will have independent practice. Um, and that's a that's a big, it's either at the end of the month or the beginning, but I think it's the beginning, which is tomorrow. And it's like that didn't come because people were were just sitting around waiting for things to happen. That was a lot of work of our own affiliate and paying for a legislative policy policy person. Um, I don't know what their exact title was, but we had a lobbyist? Yeah, we had a lobbyist. Thank you. Yeah, yeah. Um one of our midwife's um husband was the lobbyist for a long time, and then somebody else has taken over now, Catherine Osborne's husband and Patrick, I think is his name. And they that work led to a lot of difference in the state for midwives, and then the rest of the APNPs or the advanced providers have, you know, followed. Um, and now we have we're doing things that we didn't do before. And I think reminding those that are new to the practice, new to the state, that that would not have happened otherwise. So I think leaning, you know, having a leader and just reminding that, you know, you can't just sit back and wait for other people to do things um is very, very important. And, you know, it's a it's a proud moment to have tomorrow happen.

SPEAKER_03
28:37

Yeah, for sure.

SPEAKER_01
28:38

And um so I and I, you know, it doesn't fix all the hospital. Maybe that's the launch. Maybe that's the tomorrow, Denise. But it is, it is, I really do think it is. So I we have a, you know, our affiliate has a new president, so we're excited to move forward and make better things happen. But it just reminds me of your affiliate work, um, Shana. So it's you need somebody to keep pulling everybody else along that remembers um and is excited. And I think a lot of like in the practice setting, being the midwife that's been there the longest in my own, um, I I have to say that sometimes I've been accused of being the negativist. And I said, actually, I'm the historian, I'm the realist. I'm telling you what occurred in the past because when you recognize what occurred in the past and what used to happen and the fight that needs to happen, you can then move forward in like creating an excitement, a passion for what is currently happening and what can lead to greater and future change coming up. So I I now say I'm the possibleist because we're the possiblist midwives, but I think you need a realist in the group to share the history, and and it's not a bad thing to share the history and where we've come to ignite the fire.

SPEAKER_00
30:02

Yes, and that saves us from hitting the same roadblocks that have happened before. Let's take lessons from the past that we can benefit from. Maybe part of that answer is uh teamwork, right? Like so us experienced nurse midwives, uh tapping into some of that new graduate energy, dare I say, right? That some of our new midwives are bringing to the field, and us all working together to try to move these topics forward. So we can add the historical piece, they can add a little bit of energy, and we can also then show them hey, you can be a leader at every single part of your career. Right. Every single day, right? It doesn't require you to have a wealth of experience. Find a topic that you are passionate about within your because part of what I struggle with is that there are just so many things, right? That I feel like need to change. Yeah. Um, but in my focusing on practice director leadership, that's allowed me to say, this is my field, this is my expertise. And I know that there are amazing midwives that are focusing on other parts. Right. And we can each benefit from all of it.

SPEAKER_01
31:20

Oh, you're so right. I I that resonates so much, Shana, with just, you know, you're looking at the more global picture, but within each of the practices itself, how you keep that appetite going is you figure out what the skills and what the desires are of the midwives doing the work. I'm thinking about like our midwives now. We we're growing to 2021. We're searching for someone else. Like, like it's because now we're being allowed to explore our own passions and specialties in a way that serves the greater organization, the greater access to care. And yet it it's because we get to do what we want. Like that keeps you there, that retains you there. So I I think, yeah, I you need a good practice director and a leader to recognize and to push for that in order to say, hey, this is how you keep people here, how you keep people happy. And and you you get the for the greater good of everyone.

SPEAKER_02
32:19

I want to I want to take you back if you feel comfortable in this in this line of thinking about history and the preservation of how, as Denise said, the evolution of change is slow. Um, and history is important. And we have a lot of midwives who are retired who who sit back and are compassionate about our profession but feel ignored, left out, diminished. And I remember referring Nancy Joe Reedy to you as you were thinking about this whole project. And as I say to all my doctoral students, so what? If you're gonna do something, tell me what the so what's gonna be. And would you mind sharing a little of what you learned from Nancy Jo about the history? Because she really was evolutionary in helping strengthen practice directors, the very topic that you're investigating.

SPEAKER_00
33:15

Yeah, absolutely. Um, I am so thankful that you referred me to Nancy Joe. Um, she was such a firecracker. I loved our conversations, her and I. Um she really tells it how it is. And so she was sharing with me about how the Midwifery Business Network, um, traveling back, you know, 20, 30 years, how it really just started at ACM with a bunch of practice directors having their meetings in the bar, yep, getting together over drinks and talking about what their struggles were, um, and identifying, okay, what have you been through and what were the lessons that were learned? And she said that she acted um as a resource that people would know her directly and call her for emergencies. You know, our our hospital is now having to teach residents. Oh my gosh, what do you do with midwives trying to train residents? How does that work? And of course, Nancy Joe would be like, well, I wrote a policy on that. Well, I did this work on that. Um it seemed like she'd done it all. Um, and it's amazing the progress that she'd made. Uh, and so she another really fun uh thing that she described to me was she said practice directorship happens after 10 p.m. She said it is one of those things that we're late night people, that we put the kids down for bed, and then we have time to really go through the schedule, to try to write the policies, to bring people together. And she wanted there to be this kind of midwifery practice director bat signal, like somebody put out the bat signal, this person's having um a struggle. Who can help that midwife practice director? Um, and so part of what she really wants is us all to be able to come together to offer that help to each other. And it's really that connectedness that was a big takeaway. Uh, and she also talked very much about a lot of the progress she made was through finding a physician champion for the programs that she was involved in. Because she found that having that physician champion, you know, she would go to say something, but not always be taken seriously. And that practice champion would come in behind her and say, you listen to what Nancy Joe says. She knows what she's talking about. And that goes to speak to the partnerships that we can create with our colleagues. And I think that should extend out not only to our physician colleagues, but to our fellow nurse practitioner, our other APP colleagues, you know, physician associates, all those folks, they are often in that same boat that we are, feeling not always respected in the workplace, not always valued in the workplace. Um, so how can we help each other?

SPEAKER_02
36:07

Yeah. I think that circles around one of your questions on the survey, maybe is is like not just who do you report to, but something about relationships with, I mean, you it's a team, right? You can't do this by yourself. And and how much what's what's your team configured like and how much support do you have?

SPEAKER_00
36:29

Exactly. Um, so part of the questions that I ask about in the survey are, you know, when you need professional assistance with your practice director role, who do you call on? Who is your support system? Yeah. I wanted to know if this was an internal practice, um, you know, cry for help. Is this something that you're calling people outside of your region, your realm? Um, who is assisting you? Uh, I don't think practice, I don't think capital administrations are really being supportive of their practice directors as a generalization. And so, how can we get that in place and explain to them why investing in practice directors and midwifery in general is so valuable. They're gonna get that return on investment.

SPEAKER_01
37:15

I have I have one question that I keep thinking about. Um, this, I don't know if it's in your survey. Do you ever inquire about like the maybe not like okay, so like an administrative assistant? Um, like what we're struggling with, our group of 21 midwives is we have no administrative assistant to do anything. So our practice director is absolutely left to do all this tedious work and no, no, never taught, doesn't even know how to do the process of doing purchasing orders for things that we've never done for, for like locums. And and every physician that works in the organization, there's one administrative assistant for they all get their own, and the midwives have zero, and the the practice director has zero. And the struggle and the waste of energy um that goes into all the tedious work, is that an inquiry that you have on your survey or something you've come across?

SPEAKER_00
38:09

Yeah, there is something that you know touches on that, which is asking, you know, how many people directly report to you? Um, but then also uh who what is your relationship like with the administration? What is your relationship like uh within the practice? Do you feel supported by the midwives who you work with? Um, and I do leave some space for them to kind of make some free comments on what they're experiencing. And I think um as midwives, we've oftentimes made it about our clients, right? It's about the birthing person. It is about uh the person who we're doing their GYN exam. But sometimes we need to speak up a little louder and say, listen, we can do our job so much better if we have the same resources. But if we don't ask for it, nobody is going to know that one, it's a problem, or two, that it could help. Um I think physicians have historically been more demanding of what they need. And we have not. We've just been like, oh, I'm thankful for being there. I'm thankful for for being being able to have my clients there. I'm so happy to have a job. I am so happy to have a job. Absolutely. And I hate that that's been our history, just showing up every day and having to justify who we are and what we do. It's time for us to come together and move past that. It's time for us to say, we are a vital part of these systems, and hey, we can take better care of our clients if we have A, B, and C. Yeah. Uh and let me tell you why that's important.

SPEAKER_02
39:53

That's a good, that's that's good. Who can take your survey, Shana?

SPEAKER_00
39:58

So, practice directors currently who are employed by hospitals or private practices, um, there are lots of certified midwives who own businesses. There are tons of folks out there, but really what I wanted to get at is the hospital practice directors, because I feel like in working for a hospital administration, those are is creating some difficulties. Whereas if you're a certified midwife working with other midwives at a birthing center or home birth, you probably are working with each other and are a lot more felt like your voice is heard more. Maybe you need a little less assistance. Um, but those the outcomes that I find might extend to that realm as well, but had to narrow it down. Um, and so this is the choice that I made. So anybody who is an active practice director and that doesn't need necessarily need to be your title. It can be um chief of midwifery, it could be division leader, supervisor, it could be that you're in that role informally because a lot of us are not even given a title, right? But we sure do the work. So if you're out there and you're feeling like you're doing the work of a practice director, take my survey.

SPEAKER_02
41:14

So, how do they find it?

SPEAKER_00
41:17

So we're gonna link in the comments how to access the survey itself. It'll take about 30 minutes to fill out, and what you're gonna learn from it is a little bit of a self-reflection on where your strengths are and where your learning gaps are. And maybe that will help carry forward. You'll get some resources at the end. We've created a resource list which includes podcasts, books, uh, online classes, continuing medical education, such as the Grow Midwives um yearly conference that happens. Uh, all those great resources. There are some out there. Of course, we need more, but there are some. And um, we provide that for you for taking the survey.

SPEAKER_02
42:01

So it's a fantastic resource list, Denise. Um that's so great. So there's there's there is some reward there uh in terms of taking the time to fill it out.

SPEAKER_01
42:14

It's better than an Amazon gift card that you give for filling out many surveys, Shana.

SPEAKER_00
42:19

So and actually Grove Midwives has been so generous to offer actually a $250 gift card um for anybody who fills out the survey will get their name entered in a drawing. The drawing will happen at the close of the survey, which will be sometime in December. Um, so one lucky winner uh will be able to get that gift card.

SPEAKER_01
42:39

Also better than Amazon.

SPEAKER_00
42:40

Way better.

SPEAKER_01
42:42

Thank you, Crow Midwives. Yeah. Yeah. Oh this is so this has been so great to hear that you're doing this work. I mean, it's so exciting, and um I feel so hopeful for service directors getting the support they need. And I I hope that you've written down all of Nancy Joe Reedy's uh very wise advice. Um I almost just want to have a segment, Ginger, about all the wise things that all of our legacy midwives have provided. Like we're gonna do that, aren't we? Because this is just these little bits of information. Um, I've told you how much I want to do just a historical project. So, China, you're the you're the recipient of some of this great wealth. So I hope that you wrote it down. Not that you need one more thing to do, but um you might forget, like we all forget when we get older. So um, you know, please do that.

SPEAKER_00
43:40

And it's our job really to carry that forward, right? Yes, um, we stay alive, the hard work that people have put in before us. The more that we speak that into existence, um, the more that we share that uh wisdom that has been shared with us, the better. And so, yes, out there. definitely be carrying on in her name and in the name of so many others who have come before me. So and if there's anything, I also feel like in the spirit of coming together, if there's anything that I could ever do for anybody else within the system, please just my contact information will be included. Reach out to me. Let's help each other out.

SPEAKER_02
44:18

Yeah, for sure.

SPEAKER_01
44:20

Thank you.

SPEAKER_02
44:22

In your in your assessment that sort of led you to the questions questions that you're asking. What do you see as a predominant like the predominant challenge? If it if it's physical, if it's business, which your MBA is just going to put you light years ahead of so many of us, including me. What are they really struggling with that is essential in that world to begin to study, learn and feel confident in?

SPEAKER_00
44:55

I think it's in speaking to the value of midwifery financially. A fiscal value. Fiscal value, yeah. We're all very well versed in how patient satisfaction scores are very high, how having midwifery present will drop C-section rates at a hospital, right? The decrease in preterm births, all those outcomes are fabulous. And it's been researched to the ninth degree. It's globally known the impact that midwives can have. However, what's not as well known is the financial impact of those things, right? So how midwives financially can benefit a hospital, benefit a community, um, and really do things like in providing the education that we share with our clients, uh, decrease ER visits, decrease hospital visits, like all that has rippling effects throughout the system that can benefit. And I need, I think we need to learn how to build the confidence to speak about those aspects in a way that the financial folks can understand. So I think that's key. And then we also need to know how to navigate interpersonal conflict the kind that happens within practices when maybe people are not on the same page. And then also the kind of interpersonal conflict that happens between our backup physicians, our nursing colleagues, right? There's a fair amount of unfortunately circumstances that happen where midwives feel that they've had poor interactions with the nursing staff that we work with. And so we want to be able to navigate that with more skill negotiation techniques, advocating for ourselves for higher salaries all those are things that I feel are vital.

SPEAKER_02
46:59

It's what we preach, Denise. I know I know Ginger It's gonna be so great to have some data on this because I think once we have a base of understanding as as Shana has said you can have targeted educational programming whatever you want a variety of ways of things you can create but also the potential to begin to change the landscape because in my opinion there's just so few of us. There's a whole lot of physicians there's a whole lot of nurses you know there's not a lot of midwives and so we seem to be at the bottom of the priority level and when a midwife wants to bring something up it's just sort of like strange. Why don't you just you know go do your job and we'll take care of it, the Isaac's Trust Me Bro model. It it's it's very crystal clear to me. And that the conditions the two of you are working under now are very different than the 25 years I was in full scope practice. I was so fortunate to work in two very different environments pr the the preponderance of my clinical career a birth center and then a hospital where Denise and I worked where we had a remarkable physician leader. Dr. John Yeiss is actually one of our consultants at Grove Midwives. I never really experienced all the hardships that I now hear that put pressure on not only practicing midwifery the way you want to practice but now the fiscal constraints, the costs of care, the public, the growing distrust of the public of healthcare in general it's a very different beast now and and and um I I think midwives desperately need this kind of help in a leadership role.

SPEAKER_01
49:10

Yeah I also think fiscal representation is it understanding that is so obscure sometimes. You know relationship like not knowing really what midwife fiscal value is coming out of there because of other people taking credit or I mean just yeah like who's getting the credit for the WRVUs that people are actually that midwives are actually you know generating I don't know there's just so much that's more than the language it's the underlying things that are making that difficult to know yeah I think that um unfortunately sometimes in navigating these hospital systems transparency is not there.

SPEAKER_00
50:08

That's the word when yes so when you know the practice is not owned by the midwife maybe it's owned by a group of physicians or maybe it's owned by a hospital system. Most things are going now to being owned by the hospital system. Exactly that consolidation of uh ownership basically uh that there is not transparency and when you ask for numbers in fact they view that as somehow like rude like why are you asking me this how dare you ask are you not trusting us right right it's all right to be able to know these things especially if they're telling us you have to have this much productivity or you have to um you're not bringing in what we need you to we're contemplating closing your practice then show me the numbers so I can know how do we turn this around how do we address this and sometimes that that lack of transparency is because things are not on the up and up. So I think you know us understanding the numbers better will allow us to navigate systems and identify when that's taking place. Maybe we shouldn't be working there or how can we turn this around right what's what are possible solutions?

SPEAKER_01
51:28

It feels like the generational like lack of transparency that comes from even salary sharing like you never used to be able to or you shouldn't tell you know what you made it's so it's just so so different now among like newer generations but it's it seems like that part is still kind of hidden don't talk about it.

SPEAKER_02
51:51

Anyway it's an interesting landscape out there. Yeah it's an interesting landscape and just imagine if either of you were going to be a new practice director in a state you've never worked in with five six other midwives you don't know the payers you don't know the population you don't know the politics and now you're the the new practice director and let's just say you're gonna get a lot of money. I'm gonna pay you $175,000 Shana to move out to North Dakota. Let's let's do it boy you know sometimes you don't know what you're walking into.

SPEAKER_00
52:32

You just don't we have to be able to carefully evaluate um there's a great book Right Fit Wrong Fit that I recommend to anybody considering a job or kind of trying to look at where they are in their career and what is going to be the best fit for them. It's a lot of self-refle reflection that helps guide you in that um and you need to be able to go into things not just thankful that there's a job opportunity but saying that they should hire me because I am of value.

SPEAKER_02
53:05

Yeah.

SPEAKER_00
53:06

I am worth it and be able to show people what that value is brought through. We are unique in ourselves right and we want to continue to be our our authentic selves um and have them pay us accordingly so just roll that right into a job interview for a practice director what do they need to know you know about the system about about the culture about their voice like I wonder how many people ask those questions Shana about the history unfortunately not enough um but I think that there are great resources on the resource list that we created for addressing those questions you know tons of the podcasts that you guys have been doing um the webinars from Grow Midwives these are all valuable resources on what to ask um and part of what I hope to bring um in the education that I want to provide later on based on this survey data.

SPEAKER_02
54:06

So Shana I think you're coming to the great state of greater Kansas City I'll say it that way because the conference is really in Missouri it's not in Kansas where Grow Midwives lives but I think you're gonna come hang out and try to find people am I right?

SPEAKER_00
54:21

I am so I'll be at the ACM um the annual conference and I would love for people to come find me. Let's talk please tell me what your needs are tell me how I can kind of focus our intentions for providing education and support for practice directors. And even if you're not a practice director right like tell me what you want in a leader.

SPEAKER_02
54:44

There you go.

SPEAKER_00
54:45

I know I know we've all been in places where we're not the leader. Maybe we're never gonna be the leader but we know what we need we need that guidance and we don't share that enough with each other about hey this is working for us this is not working for us.

SPEAKER_02
55:01

Um and so let's talk I would love to hear that I love that's great. Well we're close to to an hour here and we'd like to wrap up with um sort of closing takeaways you know calls to action so let's start with you Shana what what would you like the listeners to walk away with today?

SPEAKER_00
55:22

Yeah I would love for the listeners to think about just one way in which they are a leader currently and one way which they can take those skills that they have and lead others in the future and this doesn't have to be being a practice director uh we lead folks every day uh and really how can you grow maybe that leadership skills um that's what I love.

SPEAKER_01
55:49

Great Denise Well I mean on a very simple level I can get you some people to answer your survey I'm pretty sure so I'm gonna recruit for you um because I do love this content is just I love it. So I'm pretty happy that you're doing this work. So that's what I'm gonna do. Um then I'm thinking I I think I'm gonna work on um you know helping our own practice maybe get an administrative assistant because this is ridiculous. The ridicularity continues and that has got to be done.

SPEAKER_02
56:28

You know Denise what's starting to happen and we we promote this and I was just at Women and Infants in Rhode Island where after 10 years of phenomenal midwife faculty there they just celebrated their first anniversary as a new division. And sometimes getting that division title will give you much of what Shane is talking about.

SPEAKER_01
56:48

Do you know the history of that ginger for us?

SPEAKER_02
56:50

I tried but um got to try again gotta try again it's possible cyclical you got to just try again so exactly exactly um I'm gonna leave people referring back to this article whether it's your practice your work environment that you want to change something or your affiliate we're still struggling in Kansas as well and I'm heading out to Maine in a couple weeks to help them I want you to individually think about your own appetite and assess where you are we're not always in a place where we can go do something but we might be able to contribute in other ways think about the capacity of the issue that you're pondering and constantly thinking about and the skill sets of what's it going to take for us to do X. Because I think that self-reflection is a first step to the reality test and and selling it, pitching it to other people because we can all be frustrated and and complain and be angry but we've got to have possible solutions and it's not a light switch it's a process. So this has been such a great time to visit with you Shayna I can't thank you enough. There's a couple researchers out there right now I'm gonna elevate you the work that Breatham is doing is incredibly important for our workforce our individual midwife sustainability and scaling and the work you are doing for the specific subset is so needed. You meet the so what test 10,000 times. So thank you for committing to this project and your interest that if Nancy Joe were alive today she would be smiling. She's still smiling I'm pretty sure she would be smiling. So uh another day Denise I think we're gonna come up on a topic that we touched on just a little bit incivility in the workplace and and uh challenges in the workplace uh coming up soon so uh we'll add all those resources to uh the YouTube channel to the bus route and to our ProMeadwise uh webpage that you can also find the live thanks so much for making this thing for you

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