An Experience so Common That We May Not Even Realize Its a Problem

It Happens All the Time

Have you ever heard the story of Stonyfield Yogurt? If you haven’t, you should. It is the story of small gone big… in some respects. Demand grew, production grew, but the structures and systems necessary to support the growth did not. Operations stayed small. The supposedly “little things” stayed little while everything relying on those little things got bigger. If you’d like a really interesting audio version of this tale, check out this podcast. Recall the story of the Mom-n-Pop shop in the previous blog in this series? Guess what? It happens all the time.

And this is the story of many schools, colleges, programs, and departments of nursing (we’ll refer to this cluster of entities as Nursing Education Organizations or more simply, “NEOs”). Nursing education over the past decades has grown quickly. We all worked together for valid reasons to produce this expansion. Provosts and other higher ed administrators saw opportunities to meet student demand and generate more revenue. Organizations that employ large numbers of nurses, such as hospitals, saw opportunities to mitigate the possibility of forecasted workforce shortages. Deans, Directors, and Chairs saw the opportunity scale up and meet perceived need while gaining influence in their academic settings.

Yet, while our mission facing activities such as teaching flourished, our operations grew erratically or not at all. Is there data to support that statement? One could wish! We can, however, look at the bags under the eyes of our staff, hear the frustration in the voices of our colleagues, witness the incredulity of our students when they realize that our core systems don’t share data, and realize that something is not right. If you ascribe to the “we measure what we treasure” adage, the absence of aggregated empirics for operations in NEOs is, perhaps, another piece of evidence that we overlook operations.

To put it in medical terms, many of our organizations suffer from a small heart syndrome. Like a small heart, our operations are simply not large enough or effective enough to accomplish the work of servicing the organization with much-needed oxygen to keep it healthy and vibrant. Our mission-facing activities keep getting bigger and bigger, but our infrastructure, systems, and processes do not keep pace. And just like an oxygen-deprived patient, our organizations become less effective, less efficient, and more irritable. Faculty’s roles become larger and more complex, staff roles are unclear and overwhelmed, and administrators can’t understand why nothing ever goes smoothly. The biggest losers in this whole scenario are students because they are not getting the best the organization has to offer. Too much time and energy is eaten up just trying to get things done versus focusing directly on the mission.

A Working Definition of Operations for NEOs

Before going further, let’s build out our definition of operations. The goal of this annual series on operations is to better equip NEOs to build and sustain high-quality operations so that our missions can be more excellent than ever. Last month, we spent some time reviewing how others have defined operations. We did not, however, arrive at a working definition for ourselves. Let’s take a moment to do that before we go on to think about some of the reasons operations have been overlooked in NEOs.

Put simply, operations include the structures, systems, and processes that support the delivery of the mission to the people we serve. Even more plainly, operations are everything we do to support the people who are on the delivering and receiving ends of our mission work. Don’t miss it - all the operations in a NEO are ultimately about people. The more closely we tie our functional conceptualization of operations to people, the more successful we will be. With a people-centered mentality in mind, it turns out that operations tend to cluster around three overlapping foci in NEOs: Employees (faculty and staff), students, and the organization as a whole. We can unpack this pretty quickly by taking one seemingly simple event, the delivery of a live lecture, and sampling from the onion-like layers of operations that are necessary to support the event.

• Faculty & Staff: Recruiting, hiring, onboarding, curriculum review and approval, training for operating videoconferencing, LMS, and testing software, and scheduling of staff and space for support of content delivery

• Students: Onboarding and orienting, advising and course registration, training for operating videoconferencing, LMS, and testing software, support for troubleshooting technology

• Organization: Recruiting, screening, interviewing, admitting and enrolling students, HR processes to provide benefits to employees, selection, installment, maintenance and continuous improvement of hardware and software for delivery of content to remote students

And we are just getting warmed up! It is easy to see that there are myriad operational activities touching any one activity in a NEO. All of these operations are necessary to deliver the educational mission: Preparing students to be nurses. Yet, none of them are the mission itself. When you consider this mass of operational activities in proportion to the event that is direct value to the student, it may be hard to understand why we do not explicitly focus more on operations. Which brings us to our final point.

Why Are Operations Overlooked?

Whether centralized at a level outside of the NEO or decentralized and supported directly by the NEO, all of the operations described above are critical to achieving mission. Undoubtedly, levels of quality and predictability vary significantly across and within organizations, but somewhere in every program there are people trying to make all these pieces and parts work together to support the mission. If this is so, why does it seem there is so little public discussion about this aspect of organizational life among our academic nursing leaders and academic nursing organizations? Let’s start with three explanations, any of which may be more or less true for your setting.

• We’re Nurses! We probably overuse this explanation but for many of us the ethic of “finding a way” dogs us. We learned to master workarounds and bootstrapping in short-staffed and under-supported clinical environments. While that skill is critical to any clinician in today’s health system, it tends to become a weakness when it supplants the building of failure-resistant systems and processes (aka strong operations) in academia. A dominant outcomes-driven mentality or “Get-R-Done” culture obscures the toll that poor operations takes on people and exacerbates our inattention to this area.

• We Generally Operate in Environments of Financial Constraint. Today, it seems that most academic organizations live in a never-ending cycle of financial moods that vary from sad and depressed to scared and scrambling. In this environment, NEO’s are often turned to by provosts and other academic leaders as a source of increased revenue because of the massive unmet student demand for programs and the easy-to-scare-up projected workforce needs. In this scenario, confusion easily arises between fixed costs and variable costs. Administration usually understands that increasing students will likely require increasing clinical faculty. The expense of clinical faculty are a variable cost. This increase is tolerable because the increased tuition dollars will more than cover the faculty costs.

  The critical error that can often occur is that supporting staff or faculty (those doing the operational work) are viewed as fixed costs. That is, the need for supporting staff does not grow with the increase in student numbers. This thinking leads to what we described earlier as small heart syndrome. In most cases, for a service-based business (which is what a NEO is!) the cost of operations personnel is going to increase as sales increase. Because we tend not to monitor operations closely or think about them deeply, we inadvertently fail to scale operations with student headcount. While this maximizes revenue after expenses, it damages the morale and capability of the NEO. Such a trade-off laces the pathway to excellence with difficulty.

• We Undervalue Outsider Expertise. Another way to state this is, “We overvalue our own ability.” Now that’s a little ouchy - but if we are honest, most of us with experience in NEOs know how difficult it is for non-nurses to be successful in our environment. We believe that only a nurse, and a nurse with advanced degrees, could provide the value that is needed. Unfortunately, that is a bit myopic and may reveal a lot of assumptions we have about ourselves and others that need to be examined.

  Has your NEO hired a student affairs professional (i.e. not a nurse) to lead its student success, student services, or enrollment operations? Has your NEO hired someone formally trained in operations to oversee the full value stream delivering your educational product? How about a pedagogist or instructional designer to play a leading role in your academic affairs? There is a longer conversation here that extends into our selections for faculty and leadership but we’ll save that for another blog. Suffice it to say that our overlooking of other professions in our NEO’s has likely contributed to the problems we have with operations.

We’ve successfully immersed ourselves in a discussion about operations. Who ever thought something so mundane could be so interesting? Hopefully by now you are hooked! The next blog focuses on how to detect operational fitness and will provide you with a few simple and basic tools for evaluating your organization. Until then, take some time to reflect on the condition of your NEO. It is as great as it can be? If not, consider that you might be swimming in the reason why: Your operations have been overlooked.