Nursing alum champions high-reliability health care

Published on Thursday, March 22, 2018

By: Alana Bowman

Health care is a demanding field, whether in the clinical environment or the executive suite.

Even so, Chuck Stokes has been up to the challenge since his 1977 graduation from the University of Mississippi School of Nursing. Last March, he reached the pinnacle of his career — so far — when he was named CEO of Memorial Hermann Health System in Houston, Texas after serving nine years as chief operating officer. 

Memorial Hermann consists of 15 hospitals and additional specialty centers located in the Houston area with a physician workforce of 5,500 and 26,000 employees overall.

Stokes, who grew up in Yazoo City, worked his way through nursing school as an OR scrub tech and an ICU nurse tech at the University of Mississippi Medical Center in Jackson. Dr. Janet Harris, professor of nursing and associate dean for practice and community engagement at the School of Nursing, was head nurse in the adult intensive care unit at the time. The two became lifelong friends.

After spending several years as a critical care nurse at UMMC with the intention of becoming a nurse anesthetist, Stokes found his interest turning elsewhere.

“I was convinced that [becoming a certified registered nurse anesthetist] was what I really wanted to do, but after working for a couple of years as a critical care nurse at the University, I became more interested in how the entire hospital worked, not just nursing,” Stokes said.

He took a night-shift position as assistant director of nursing instead of going to CRNA school.

It was in this role as director of nursing, recruiting nurses for UMMC at a state nurses’ convention, that Stokes met his wife Judy. She was an assistant director of nursing at Children’s Hospital in New Orleans and was recruiting nurses as well. The two became friends and were married several years later.

In 1981, Stokes left the Medical Center to earn his master’s degree in hospital and health care administration.

“I realized that in order to become a better leader, I was going to have to go back to graduate school and get a graduate degree,” Stokes said.

“I remember having a cup of coffee with him before he left,” Harris said. “He told me, ‘My goal is to be a chief operating officer within five years.’ And he was. He loved hospital operations.”

“I pretty much stayed on track within a year of meeting that target,” Stokes said.

He gives credit to the UMMC nurses who taught and worked alongside him for his career success.

“The people I worked with at the University back then always told me, ‘Keep the focus on the patient,’” Stokes said. “One of the reasons I've been very successful is I've always put the patient first. High quality, safe care to the patients, that's what will make your career.”

Harris recounts visiting Stokes when she was interim CEO of UMMC’s adult hospitals. “Memorial Hermann had just finished one of the most successful years in the organization's history, both financially and in their quality measures, and I wanted to find out what he was doing,” she said.

What impressed Harris the most was the practice of quality rounds each morning. Stokes and the senior staff would videoconference with staff from hospitals throughout the Memorial Hermann Health System to discuss quality measures.

“If there was an infection, like a bloodstream infection in one of those hospitals, he wanted to know about the patient. ‘Tell me who it was,’” Harris said. “He forced them to put a face on every variation in their quality. ‘What did we do about it? How did we communicate that?’ You have to put a name and a face with an infection to really bring it home. They did that consistently.”

Stokes says his short list of tips for success as a medical executive is to be accountable, put the patient first, be results oriented and don’t micromanage.

“I think the other key to being a good leader is being a servant leader,” Stokes said. “If you have people who know what they are doing, empower them and let them do the things that they do best.”

The next step, he said, is to get out of the office and interact with those people, letting them know you see them as a person and not only as the role they fill as front-line staff in the organization.

“You have to be visible,” Stokes said. “You have to ask the front-line worker, ‘What can we do as an executive team to make you more successful and to make your job easier so that you can better serve the patient?’"

It’s the personal interactions, Stokes said, that separate the really successful executives from the rest.

“It's fine to come out at midnight and bring bagels or donuts to the night team and say, ‘Hey, thanks for being here.’”

He is also a proponent of hand-written thank-you notes and considers it to be a priority, an executive discipline similar to looking at the financial reports.

“Clinical staff see patients at their best and their worst, and that is emotionally taxing,” Stokes said. “Taking one minute to write a three- or four-line hand-written note thanking someone for something specifically that they've done, it means so much, and it takes so little time.”

It’s this engagement with front-line staff that is necessary to having a high reliability organization, a topic that is Stokes’ passion.

A 2016 paper published in The BMJ by Martin Makary and Michael Daniel from the Department of Surgery at Johns Hopkins University School of Medicine stated that if medical errors were a disease and tracked by the Centers for Disease Control, it would be the third leading cause of death in the United States following heart disease and cancer.

“That is the equivalent of a fully loaded 737 airplane crashing every 7 hours in this country,” Stokes said. “This is why high reliability has to be top of mind awareness, the highest priority in a health care organization.”

In his role as chair of the American College of Healthcare Executives, Stokes worked with Dr. Gary Kaplan, CEO of Virginia Mason Health Systems in Seattle, to put together a “blueprint for success” for health care organizations seeking high reliability.

“We interviewed the top 50 health care systems in the country. We interviewed people from nuclear power, the military, aviation and oil and gas industry — other high reliability organizations — and we produced this 44-page document, a very practical way of getting on the journey to high reliability,” Stokes said.

The document is available to download for free. Stokes said that since its introduction at the national conference of the Institute for Healthcare Improvement in May, the guide has been downloaded more than 4,800 times.

“That was my most significant accomplishment as a chair-elect and chair,” Stokes said. He will become immediate past chair of the ACHE after the March congress.

Stokes’ efforts for quality in health care do not stop there. He and his wife have given the Medical Center $25,000 to set up the Chuck and Judy Stokes Endowment for High Reliability.

Designed to encourage high reliability in research by graduate students in the School of Nursing, it will be used to establish an award for the benefit of one or more nursing graduate students engaged in high reliability projects.

The students should be nominated by the program director, be engaged in a high reliability project that would benefit from monetary support, and be in good academic standing. If no one meets this criteria in any given year, the funds may be used for program support to provide learning around high reliability.

“UMMC is a very special place for me,” Stokes said. “I have a very strong affinity for Mississippi. It's home.”