Trustee Kimberly McNally knows what makes health care organizations tick from top to bottom. She started out as a nurse and then moved into health care management, leadership and community education before launching her own health care executive coaching and leadership development company 11 years ago.
With a clinical specialty in psychiatric mental health, McNally began her career as a staff nurse in a large psychiatric unit at Maine Medical Center in Portland. All her subsequent nursing positions were in hospital mental health care settings as well, and she says this taught her early on how to work in teams and constantly changing work environments.
"It definitely informed how I have worked with people over time," she says. "The foundation of being trained as a nurse helps with everything I do." Her background has also taught her to look at governance from a systems perspective. "I am trained to think holistically," McNally says. "Nurses are practical and action-oriented. They understand at a core level what it takes to run a safe organization. It's informed how I work as a trustee and how I lead as a board chair."
After close to a decade in nursing, McNally joined a Seattle-based provider of health care demand management services that helps "people to be better health care consumers," she explains. A product developed by nurses and sold to employers to improve their employees' health care outcomes, Carewise Inc. offers "nurse decision counseling" to help consumers weigh their options on health care decisions by providing research and questions to ask their physicians. McNally was the liaison between Carewise nurses and its sales and marketing departments. "It was interesting to provide health care services outside a health care setting," she says. "It encouraged my entrepreneurial spirit."
After three years with Carewise and a seven-year stint as director of educational services at Valley Medical Center in Renton, Wash. (where she had previously been director of psychiatric services), that entrepreneurial spirit came to the fore and McNally & Associates was born in 1998.
"I got interested in professional coaching, and I've never looked back," McNally says. "I've been fortunate to build relationships and strategic alliances. I always say that it's through relationships that results occur."
McNally's company provides health care leadership coaching and retreat facilitation, working with hospitals and health care systems, physician practices and clinics, as well as with senior and middle managers. In the past year, she says she has most often been asked to help leaders going through transition.
"People are looking to retool themselves for a new focus, to decide what's next," McNally says. "I work with nurse, physician and other leaders to see what they can do to influence change and make their teams work differently. I do individual and group coaching to help organizations grow their own leaders."
She also leads "culture change management," helping employees understand the changing nature of their work and how that fits into the organization's overall purpose. The result, she says, is more reliable teamwork, better patient safety and services tailored to each community's health care needs.
All of these skills have proved an excellent match with Seattle's Harborview Medical Center where McNally currently sits on the board, after having served as its president from 2007 to 2009. She has also served on Harborview's executive, joint conference, quality and strategic planning committees. "I love being a board member at Harborview," she says. "People who come there have such great need. There is a level of dedication to serve people from all walks of life. There is an incredible 'can-do' approach to challenges. It's a privilege as a board member to help set the tone and shape the culture of the organization."
David McDonald, McNally's fellow trustee and mentor, has known her since she came on the board as vice president in 2003. "Usually, someone serves as vice president for two years, but she was part way through her first year when the current president had to resign and she came in early," McDonald explains. "I worked with her as a sounding board and helped her understand the personalities of the board members to gain consensus."
He adds that "she is a great talent; I probably learned more from her than she did from me. She got to know the medical and senior staff in ways I wish I had time to do—she improved relations. She created a base of good will to guide us through a CEO transition."
McDonald notes that McNally was very successful in keeping the board working well together with an interim CEO who had dual leadership responsibilities at Harborview and another hospital. "She was a fundamental part of managing the transition between CEOs," he says. "It's very tricky when a CEO leaves. It suddenly introduces a lot of uncertainty for everyone. She did very well with that."
Additionally, because Harborview is a county-owned public hospital but is managed by the University of Washington, McNally had to maintain good relations on both sides. "There are obligations to the county and to the public," McDonald says. "You can have unconstructive tension, but she found ways to be more constructive. She had tools in her toolkit that not all trustees have."
During her leadership tenure, McNally made it clear that patient safety and quality were the highest priority for the board. "She got trustees to do internal review rounds in the hospital, doing safety checks on what needed to be better addressed," McDonald says. "She radiated interest on behalf of the board about what physicians and staff were doing."
"I have a sense of accomplishment about raising the level of the conversation on patient safety and quality at Harborview," McNally acknowledges. "Through my work with health care organizations and consulting, I've worked in every department in the hospital and I understand how complex and rewarding this work can be. I always feel very satisfied in a hospital environment because of the work people do. It's very fulfilling and meaningful."
Robb Menaul, senior vice president of the Washington State Hospital Association, met McNally after asking Harborview's CEO to suggest someone for the association's hospital governing boards committee. McNally joined the committee in 2006 and became its chair two years later. "She's fantastic to work with," Menaul says. "She has a great personality and is very inclusive of others' thoughts and opinions."
"The governing boards committee serves as a focus group for the state hospital association board," McNally explains. "It's very interesting to talk to trustees from different size hospitals with different structures, and it has helped establish governance competencies and educational programs."
In addition to accepting that post, she also joined WSHA's committee on patient safety and quality. Then, two years ago, the association decided to create a task force to study compulsory education for WSHA trustees and asked McNally to lead it.
"She recognizes that different hospitals have different things to bring to the table for trustee education," Menaul says. "Small hospitals can't send their staff to national meetings, but they still need education. She understands what they can still do and encourages that."
The resulting governance education task force recommendations parallel the American Hospital Association's Blue Ribbon Panel on Trustee Core Competencies while still tailoring needs to the state's trustees, Menaul says. McNally was also asked to join AHA's Blue Ribbon Panel to share her insights.
"We needed to shape a document that could be used in a practical way," McNally says. "There are many competencies that the board as a whole needs to have, but a desire to improve the status of health care in the country is No. 1. Trustees' No. 1 focus needs to be on community health needs and patient safety and quality." As a result of her outstanding work, McNally was nominated to the AHA's Committee on Governance in 2008.
"In all my different roles, I have found myself gravitating to leadership positions," McNally says. "I care a lot about the right things getting done. I've always wanted to influence people to create positive change."
How does she feel change will play out in health care nationwide?
"We know there will be health care reform, but that looks different every day," she says. "We know there will be significant changes ahead, but there's not a clear picture of what that change or future is.
"Leaders need a tolerance for ambiguity but they still need to move forward," she adds. "I try to help people anticipate change, to help individuals feel more competent and confident. The leader's job is to paint a picture of what they think things might be—to be practical and yet inspired." From nursing to executive coaching, McNally embodies both.
Laurie Larson is a freelance writer living in Chicago.