One Reason It’s So Hard to Get Things Done in Your SON

An Opening Illustration

In 1922, Fred Meyer opened his first grocery store at the corner of 6th and Yamhill in Portland, OR. He bested his competitors by putting multiple kinds of products under one roof. Dairy, grains, and meat were all conveniently co-located for one-stop shopping in an era when you had to walk from the butcher to the milkman to the bakery in the effort to gather your groceries. Although an innovation at the time, the storefront was small and without doubt, the back office operations were closely co-mingled with storefront activities in terms of personnel and processes. This was sufficient. Complexity was low and volume was small and predictable. “Mom and Pop” could run the store by day with their 20 employees and do the books by night.

Little did anyone know that this pioneering neighborhood grocery would become one the forerunners of today’s supermarket. Merging with Kroger in 1998, Fred Meyers is now part of the largest grocery store chain in the U.S. and second only to Wal-Mart in overall retail sales. Its stores can exceed 150,000 square feet and carry over 225,000 products. With that growth has come the massive expansion of its operations. This includes everything from marketing to logistics to management to systems to distribution… and the list goes on. Operations are everything it takes to get the milk, the meat, the bread, and 224,996 other products on the shelves of the stores. If you take a look at Kroger’s income statement, you can see just how much of their money is eaten up in operations.

Now imagine for a moment if Fred Meyer decided that while expanding the number and size of its storefronts that it would minimally expand its operations - lurching forward only when circumstances made it absolutely necessary. Undoubtedly, they would soon have disgruntled employees because they were always being asked to do more and more; dissatisfied customers because the bread ran out, the milk was sour, and the meat cuts limited in selection; and ultimately, disillusioned stakeholders because the value Fred Meyer promised fell short of expectations.

Got Operations?

If you have a good imagination and a penchant for making connections, you may be looking up and down the halls and wondering if this is a parable about your school of nursing … Well, it just so happens that it is! Think about it from this angle. In the past 20-30 years

• By what percentage has your student headcount and FTEs grown?

• How many more educational programs and pathways do you have?

• Has your regulatory and accrediting environment become more complex? (Yes, that is a rhetorical question!)

• Do you spend more time and energy in the process of clinical oversight and placement?

• Has any part of the student life cycle (recruitment, admissions, enrollment, retention, success support, alumni relations, etc.) gotten simpler?

• How many more software packages or applications are you running to support the delivery and assessment of learning or other core operations in the school?

Is it getting warm in here? For those academic nursing leaders steeped in supporting the day to day success of their shops, contemplating this abbreviated list can give you a panic attack. Being in the business of delivering nursing education (or any of our other missions) is no longer a Mom & Pop proposition. We get that… Or do we? This brings us face to face with this question: As the scale and complexity of our nursing schools, colleges, departments and programs has grown, have our operations kept up? Have they grown commensurately in sophistication, depth, and scope? Are we operating, without operations? And this brings us to the topic of the annual series: Operations. Over the next year or so, a monthly post will be dedicated to a consideration of operations in organizations dedicated to nursing education.

If you get excited reading that last sentence, don’t be embarrassed! There is something special about you. You have an insight and understanding that most miss. You know, or at least suspect, that to be truly excellent in preparing the nurses of the future, an organization must be built upon operational excellence. Before we can go further in this conversation, however, we need to make sure we are on the same page. What is meant by operations? And even more specifically, what is meant by operations in a school of nursing?

What are Operations?

Let’s start by considering a few broad and general definitions of operations available on the internet. In this article by Ty Kiisel at ondeck, operations are defined broadly as, “...the work of managing the inner workings of your business so it runs as efficiently as possible.” That definition begins to delimit the concept. This article from Will Kenton at Investopedia takes us a step further by unpacking a more functional perspective.

Operations management is the administration of business practices to create the highest level of efficiency possible within an organization… one must be able to understand the processes that are essential to what a company does and get them to flow and work together seamlessly… ensuring products are delivered within the agreed time commitment… follow[ing] up with customers to ensure the products meet quality and functionality needs… operations management takes the feedback received and distributes the relevant information to each department to use in process improvement… coordinating and developing new processes while reevaluating current structures… the work often requires versatility and innovation.

Finally, this article at Medium by Honey Patel provides an insightful and helpful summary of 50 job descriptions for positions in business operations. She summarizes the roles and responsibilities associated with these positions into ten areas: Cross-functional managment; operations; data; reporting, metrics, and KPIs; strategic planning; growth; programs; people; money; and communications and change management. After reflecting for a moment on the above excerpts, if you take the time to peruse Patel’s work (strongly recommend!), you’ll likely have your “Aha! Moment” - you’ve glimpsed this larger interrelated picture in your organization but have struggled to understand how or where it fits into the greater mindset dominated by nursing and academia’s triple mission. Perhaps you’ve even tried to bring business concpets or words into your organization only to be sternly reminded that, “We’re not a business!” implying that the ivory tower might be stained by the practices of Corporate America.

Working under the assumption that some new connections are forming in your mind, here is a question that may be begging to be answered: If there is a whole area of well-developed business training that focuses deeply on operations… why have we never seen or heard of an operations professional in a school of nursing? Why are nursing administrators not headed off to workshops and trainings for business professionals teaching the fundamentals of quality operations? Why indeed. We’ll save answers to those questions for future posts.

Why Do Operations Matter?

There is a lot here to take in. So, let’s step back and wrap up with a picture that will help center us on the importance of operations. The French have a term that they use to describe the collective natural elements that make up the environment surrounding a grapevine: Terrior (/terˈwär/). Terrior is the climate, the soil, the terrain, etc., in which a grapevine grows. Each of these elements will contribute to the overall quality of the grape that the vine yields. Wine writer Keith Beaver captures it well when he explains that a winemaker in Burgundy, France and a winemaker in the Williamette Valley of Oregon plant and cultivate vines from the same clone yet the resulting wines differ significantly. Even more interesting, the winemaker in Oregon plants the clone in two separate plots of land just a few miles apart and… again, the resulting wines differ significantly. What explains the difference? Terrior.

Operations are like terrior. Even though nursing education organizations are generally focusing on delivering the same limited selection of programs, the quality of the resulting products can vary significantly. Why is that? Before you answer, “Faculty!” Open your mind to the idea that it may have a lot more to do with the quality of the operations - all those elements surrounding the actual delivery of the mission, than the people alone. In other words, could it be true that many nursing education organizations, if not most, have great faculty held back by poor operations?

Poor terrior leads to inconsistent and low-quality wine. Poor operations in a school of nursing lead to inconsistent and low-quality education. If as an industry we are going to aim for excellence in the nurses we educate, if as a practice discipline we are going to aim for excellence in our impact on healthcare, if as organizations we are going to aim for excellence in how we care for our people… we will need to become expert at managing our operations. To do so is consistent with our ethos as a profession: When we care for operations, we are caring for the mission and the people of our organization. Let’s pour a glass of wine coming from vineyards with the best terroir and toast to a year of focusing on high-quality operations.