Becky McCulley, on organizational managment

By Glen Fest
June 25, 2003

Explain the relationship between St. Paul and Zale Lipshy.

St. Paul is a community hospital, where 80 percent or more of its patients come from the private physician community and some patients admitted by UT-Southwestern faculty.

St. Paul is a Catholic hospital and maintains close ties to the Catholic community. We performed the first heart transplant in Dallas at St. Paul, and we have an active heart and lung transplant program. It is primarily a medicine-based facility.

Zale Lipshy is primarily a surgical-based hospital-about 70-plus percent [of patients] undergo some kind of surgical procedure. It's known primarily for neural surgery … urology and ophthalmology.

What were the challenges you and the administration faced in integrating the nursing programs at St. Paul and Zale Lipshy?

Each of the hospitals has a very separate culture. They have a different mission. The Zale Lipshy culture is much more academic-based by virtue of its association with the medical school. It's more science and technology-based. St. Paul's culture has a high component of technology and scientific application, but it also has a caring, compassionate and nurturing type of environment.

They are two different types of organizations and they attract two different types of clinical practitioners. So, we are attempting to maintain [separate] cultures while moving toward standard policies and procedures, standard nursing nurse-to-patient care requirements, standard staffing models, standard care guidelines and standard reporting structures.

Three years ago, nurses at St. Paul were faced with a lot of uncertainty, such as canceled expansion plans and an open rift between doctors and the previous owners. How was morale for nurses at that time, and how is it today?

Going through five different owners, you can imagine that policies changed every time the owners changed. I was just amazed at how well they have done. Morale was pretty low. The physicians and the nurses really bonded to make sure they saved their hospital, and actually had a way to assure it was going to grow and prosper.

What kind of input did the St. Paul nurses give you in their transition?

What we did was work together using that [nurses'] bond to our advantage and using that as our platform for moving forward. I think what they were wanting is to know that the commitment was there, from the executive level and the board, to furthering the care they delivered to their patients and to help them grow professionally. With technology, we needed a lot of equipment and repair, but I think with that said, most importantly, they wanted to know that somebody cared.

How has your role evolved with oversight of two hospital nursing organizations?

We have a combined administrative staff, so we have one CEO, one COO, one CFO and one VP of patients. Many of the directors also have shared responsibility between the two facilities.

[Each hospital's] directors of surgical services and the nursing units in therapy services and clinical support, nursing and therapy services all report directly to me. And I have responsibility for creating our vision for patient care services in both of our organizations, to make sure we deliver a high-quality service to our patients and to our physicians.

And we try to do that with no money.

What is your background in nursing?

I was a staff nurse in pediatrics [at Parkland Health & Hospital System] and went into management after a year and a half. During my career, we established a nurse midwifery program and a pediatric nurse practitioner program at Parkland. We opened the first pediatric nursing trauma center in the country, and we did away with white uniforms and caps so nurses actually got to wear slacks instead of dresses.

What is the future of the St. Paul/Zale Lipshy organization?

I really don't see that we're going to make any changes to the individual cultures. What we are doing is developing our own interhospital agency, so that we have nurses who, if they wish, can float back from one hospital to the other. We have cross-pollination between the two hospitals at the staff level.

[For example], St. Paul nurses provide dialysis services there and come over to Zale to do that, also. And we have the peripheral catheterization team at Zale that staffs St. Paul. So, we have certain programs where you need a core volume to maintain your level of expertise, so we really just develop that at one hospital and then help the other hospital out.