HJBR May/Jun 2021

HEALTHCARE JOURNAL OF BATON ROUGE I  MAY / JUN 2021 43 Karen C. Lyon, PhD, MBA, APRN-CNS, NEA Chief Executive Officer Louisiana State Board of Nursing the pandemic, not because we anticipat- ed a 100-year event, but because we were focused on the last year for preparing our organization to function under disaster circumstances. Beginning with “Failure,” we began focusing on failure of our data management system, known as Nurse- Track, over five years ago and knew that we needed to either build our own new system or import a system from a vendor. When the National Council of State Boards of Nursing (NCSBN) offered us the oppor- tunity to partner with them in 2015 to build a state-specific optimal regulatory system, we were ready, because we had been mon- itoring the expected failure of NurseTrack and had been slowly moving toward a pa- perless system with Laserfiche electronic data management. Reluctance to “Simplify”is the next prin- ciple of HRO. Simplification of problems, errors, snags and glitches leaves an organi- zation blind to early warning signs. A great example of this is the Columbia shuttle di- saster in which NASA had simplified a 22- year recurring problem of foam shedding to normal process. NASA’s oversimplifica- tion cost seven astronauts their lives as the accident investigation board opined that, absent this oversimplification, the astro- nauts could have fixed the problem prior to reentry into earth’s atmosphere. 3 Reluc- tance to simplify as a guiding principle of HROs means knowing what one does not know, appreciating that knowledge is fal- lible. LSBN refused to simplify the process of building a new data management sys- tem and creating paperless data storage despite steady pressure from many staff to do so. The work of building a new nurse portal was difficult and time-consuming, but in the end, it has simplified and coor- dinated the work among all divisions. Our licensees have been the beneficiaries of that complex work. Interdependence is the key to “Opera- tions” success. Institutions that are catego- rized as HRO must be sensitive to opera- tional interactions and interdependencies. Relationships among divisions and de- partments and constant communications are essential. LSBN tended to operate in the typical silos of regulatory work: licens- ing, education, investigation, discipline. This work was supported by human re- sources, finance and accounting, technolo- gy and records retention. Implementation of a new regulatory system meant tearing down silo walls and building interdepen- dent teams through communications and process improvements to include all staff in planning and implementation of the new nurse portal and Laserfiche electronic data management system. “Resilience” has been LSBN’s motto throughout the process of change but particularly during the pandemic when we were forced to operate remotely. Resil- ience allowed us to maintain all functions in the face of external change over which we had no control. In the face of continu- ous stressors, we continued to perform as required. LSBN may have suffered some degree of loss of efficiency and effective- ness in operating remotely, but all required functions continued. We managed the un- expected. Finally, HROs organize around “Exper- tise.”That is no less true at LSBN than it is at other reliable organizations. The initial prod for our creation of a new nurse por- tal emanated from our information tech- nology (IT) department. Our IT manager, Carl Nagin, had the greatest seniority at LSBN among all staff, and he had created and developed our NurseTrack system. He knew it wasn’t a matter of “if” the system would fail, only “when.” Carl has forgotten more about technology than most people learn in a lifetime. When we decided to work with NCSBN to build a new nurse portal, he and Chief Administrative Officer Isonel Brown were the point persons for implementation. They then brought in all directors of functional teams at LSBN and began the work, which would ultimately involve all staff who organized around ex- pertise to develop a variety of options to support regulatory work. LSBN was successful in creating this massive change in work processes, be- cause our culture has changed over the past seven years and is constantly evolv- ing. We are working to continuously iden- tify problems and challenges; communi- cate effectively from bottom up, top down and laterally, as required; and to engage in our core work with stability and flexibility. Like a human organism, our emphasis in adapting will continue to focus on main- taining homeostasis through engaging staff, providing direction, attending to what is happening in our environment and enabling considerate connections. n REFERENCES 1 Taleb, Nassim Nicholas. (2010). “The Black Swan (The Impact of the Highly Improbable),” Second Edition. New York: Random House Trade Paper- backs 2 Wikipedia (2021). Black swan theory. Black swan theory - Wikipedia 3 Weick, KE and Sutcliffe, KM. (2015). “Managing the Unexpected: Sustained Performance in a Complex World,” Third Edition. New Jersey: John Wiley & Sons, Inc.