Return on Learning

Baylor Health Care System’s executive nursing development program with SMU Cox School of Business produces a multidimensional return.

By Frank Lloyd, Associate Dean, Executive Education, Southern Methodist University (SMU) Cox School of Business

When Rosemary Luquire joined Baylor Health Care System (BHCS) as Senior Vice President and Chief Nursing Officer a few years ago, she recognized the need to strengthen the system’s nursing organization by developing leaders from within. BHCS nurses had education and training experiences that enabled them to handle every clinical situation, but they lacked the leadership and business knowledge needed to advance their own careers and fill high-level leadership positions within BHCS. As a result, these leadership roles were too frequently filled with individuals recruited from outside the organization, and BHCS incurred excessive recruitment costs. Quality and efficiency of service delivery was threatened as restricted career opportunities may have sapped morale and impeded communication with physicians and senior managers.

In response to this business case, Remy Tolentino, Luquire’s System Vice President of Nursing Workforce and Leadership Development, set to work with BHCS chief nursing officers to build a pipeline for nursing leadership succession. The key element was an effective leadership development program based on the most current best practices in the field.


Tolentino and her team knew about the successful BHCS Physician Leadership Program developed and conducted with the SMU Cox School of Business. Therefore, they approached SMU Cox Executive Education about a formal leadership program for nurses. Rather than access off-the-shelf or publicly available programming, BHCS collaborated closely with SMU Cox to develop and implement a unique solution tailored to BHCS’ need. The joint BHCS/SMU Cox development team focused on nurse executive competencies established by the American Organization of Nurse Executives and on BHCS Senior Leader Competencies that tied closely to high quality and efficient health-care service delivery. The goal was to create transformational nursing leaders.

Multiple Sources of Learning

BHCS scrapped the prevailing rule of thumb that 70 percent of executive development takes place on the job, 20 percent takes place through informal relationships, and 10 percent in the classroom. Core learning did take place in the classroom, where SMU Cox faculty and experienced practitioners led application-oriented sessions in both business and interpersonal leadership skills. However, from there, the boundaries between the classroom, the workplace, and relationships began to blur.

To ensure that program learning transferred directly to the workplace, each fellow created and implemented an individual development plan based on a 360-degree feedback process guided by their manager and a senior leader mentor. Targeted personal development actions included experiential activities focused on specific leadership behaviors and skills. For example, some nursing leaders shadowed executives in general business areas such as strategic planning. Others focused on improving executive presence by soliciting immediate feedback from colleagues after a formal presentation.

To encourage nurse fellows to expand their internal learning resources, each fellow developed an individual capstone project that had to be investigated and implemented within BHCS. Of course, these projects also provided the fellows with opportunities to apply their classroom learning in the workplace. One project, for example, established a standardized, online tissue-tracking system that was implemented in operating rooms system-wide. By automating a previously manual tracking process and standardizing handling procedures throughout the system, all BHCS hospitals could meet FDA and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards for purchase, storage, retrieval, tracking, and recall management—all indicators of improved quality and efficiency.

Championed by executive sponsors, other nursing fellows’ projects spread system-wide, too. For example, two fellows from a system hospital that specialized in heart care collaborated with their cardiologists to establish criteria that reduced hospital stays for patients recovering from a specific surgical procedure from 24 to six hours. Another project that spread system-wide from a fellow’s home hospital is called “Green OR.” It significantly reduced waste and trash in operating rooms by recycling.

Return on Learning

Forward-looking organizations can support immediate application of new learning by blurring the boundaries between classroom, workplace, and relationship-based learning resources. This also permits them to recognize multiple benefits from their investments in management development. That, in turn, broadens their approach to calculating the return on those investments. For example, BHCS’ Office of the Chief Nursing Officer estimated that hard cost savings from the inaugural nurse fellowship program’s projects exceeded $900,000.

In addition, participants in Baylor’s first nurse fellowship program advanced their careers. Nurse fellows were tapped to fill positions as director of Acute Care at THE HEART HOSPITAL Baylor Plano; director of Nursing at Baylor Southwest; and two positions at Baylor University Medical Center at Dallas: vice president of Critical Care and director of the Truett Operating Room. Internal promotions saved approximately $87,600 in recruitment agency costs, bringing the financial impact of the first nurse fellows program close to $1 million. Additional nursing fellowship programs have continued the first program’s impact.

BHCS’ experience with its nurse fellowship program shows that organizations benefit in many ways from investments of money and time in well-designed executive development experiences that are integrated with the business. Developing and implementing the capstone projects improved speed and quality of decision-making, system-wide in many cases. This resulted in tangible cost savings. Program learning resulted in accelerated progress of internal candidates to executive levels of responsibility, which generated further savings. It all added up to higher quality and more efficient health-care delivery.

Rosemary Luquire assessed the program’s impact this way: “The SMU Nurse Executive Fellows Program is a year-long immersion program in which the fellows receive first-class education, 360-degree feedback, one-on-one mentoring, and accomplishment of a capstone project that stretches them. Each capstone project not only improves the environment for patients and staff, but has a return on investment. We are fortunate to be able to provide this development for our nursing leaders.”

These results were achieved because BHCS accessed best practices in leadership development to tie the program to the business. The effort was driven by a clear business case. It focused on specific leadership competencies defined by the requirements of the profession and the business. The close relationship to the business made it easy to involve management as program champions and participant mentors. Participants used 360-degree feedback data to construct individual development plans their supervisors and mentors could support. Centered on the capstone projects, program delivery blurred the lines between classroom, workplace, and relationships, and this promoted immediate application of learning. In the end, BHCS recognized immediate and tangible benefits in cost, human resources, quality, and efficiency. BHCS not only received an impressive financial return on its dollar investment in executive development, it also received a multidimensional return on its commitment to executive learning.

Frank Lloyd is Associate Dean, Executive Education, Southern Methodist University (SMU) Cox School of Business.

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