VANA Speaks: A conversation with Inova Health Senior Vice President, Susan Carroll

This month, VANA sat down with the Senior Vice-President of Inova Health, Susan Carroll, to talk about leadership, mentorship and the constantly changing healthcare landscape in Virginia. We’re grateful to Susan for her time and look forward to VANA members learning more from our conversation.

Can you tell us a little bit about yourself, your role, and your history with Inova Health?

Sure! My name is Susan Carroll and I’m the President here at Inova Loudoun Hospital. This June, I’ll have been with the Inova Health System for 25 years. I’ve had incredible opportunities – at one time or another, I’ve been the President at all five of our hospitals and have served as a Service Line Administrator over the Cancer Service Line, I’ve been a COO at two different hospitals, and I have system responsibility for safety, security and emergency management as well.

As you’ve grown in your role over the years, what role have mentors played in helping you achieve your goals and how do you work to mentor the people around you?

I’m a strong believer in mentors! You don’t just have to have one. Sometimes, a mentor relationship is with a peer who you can go to for help, and other times it’s with someone entirely outside of your field or chain of command who you can turn to for those smaller interactions that can really make a difference. I’m a big believer that it’s really just about a relationship. If you can establish great relationships with your colleagues, then anybody can become a mentor for you.

I spoke with the head of surgery at Fairfax just this week asking, “if you have five minutes, I would love to run something by you, I would love a different perspective” and he called me right back – we worked together years ago and we still have a great working relationship. If someone reaches out to you for help and you give that person five minutes, it’s going to come back to you tenfold when you need the help. It’s always worth the investment.

As someone in leadership at Inova, what challenges do you face in your role and how do you continue to push yourself while serving at a leadership level on a daily basis?

I was young when I became an executive and I had worked hard but didn’t look like the people who had held my roles before me. I felt like I had to overly defend why I was in that position. I was constantly still interviewing for jobs I was already in. I had some imposter syndrome in the beginning, and it took time to realize that I was placed in these leadership roles because I was able to produce great outcomes. If I went back to the core of who I wanted to be as a leader, I didn’t need to keep proving myself time and again. When I stepped into my first role as the President of a hospital a friend of mine said to me, “every time you’re in a meeting you tell people you’re the President. We already know who you are.”

It was great because I’m sure I was coming off in a light that wasn’t genuine to who I was because I was feeling more self-imposed pressure as a young female in this role than my peers were placing on me. I’m sure that comes with any leadership role – you never feel ready and you don’t have to know everything, but someone gave you this role because they thought you were the right person for the job.

Let’s talk about the role that CRNAs play at Inova and within Virginia’s healthcare system in general:

CRNAs play a crucial role for us to meet the needs of our communities, and for us to provide world class care. Without each person or group’s contribution to our team, we would not be where we are. COVID helped us reframe within that mindset because we recognized that the surgeon isn’t the most important part of the care team, they’re part of the care team. The surgical tech is a very important part of the care team, the CRNA is a very important part of the care team – without one, you can’t maintain the whole. We’re trying to be very inclusive with what we define as our care team because everybody has a role.

As a system, we value our advanced practice providers. That’s CRNAs, APPs, PAs, NP’s and they are only going to become a greater portion of the care team moving forward and we consider them as members of the medical staff. It’s not just about being in the room but giving a voice to all members of the team. I know how our physicians speak about our CRNAs and how they value and appreciate the impact CRNAs have on patient outcomes.

That being said, we may be valuing CRNAs at the bedside and in the O.R. but were we valuing them throughout the culture in every aspect? We’re very focused on doing that now. Even making simple changes like including all medical staff at mixers and changing the name from “Physician mixers” to be more inclusive to our entire medical community.

What are the big issues facing health systems like Inova in Virginia at the moment?

We’re all just starting to recover from this group trauma that was COVID and while the whole country faced it, healthcare as an industry faced it that much more because it shook the core of our system. I personally had friends who were anesthesia providers, CRNAs and physicians, who were close to retirement but probably wouldn’t have been close if it wasn’t for COVID and chose to retire a little bit early. We saw that in nursing as well and there are many things along that vein that we’re still dealing with, like employment shortages. We’ve only just seen that turn around in the past six months.

It was an unprecedented shifting of the financial landscape and that can take years to recover from. We’ve probably seen two of our worst financial years here at Inova but have not backed off of our commitment to doing our best to support our staff and employees.

The other variable that has contributed to be a challenge facing health systems in Virginia is the massive rise of workplace violence against healthcare workers. I could talk about this for over an hour, on this topic alone, but it’s very concerning. We want to make sure Inova isn’t just a great place to practice medicine but is a safe place to work and safe for our patients. It’s been a struggle; violence against caregivers is very difficult – we went from being heroes in 2020 to unprecedented levels of violence against clinicians just a short period of time later. We’ve invested in technologies I never thought we would have. We have armed guards at every hospital, we have weapons detectors at every one of our hospitals, we’ve increased our security staffing by 20-30% across the board. We want our teams to feel safe.

You’re tackling some big issues – what are the solutions?

If you make this a great place to work – if you solve your labor issue – then everything else gets better. You don’t need to worry about people practicing great medicine if they want to come to work, feel safe, if they’re working in a desirable place, if patients want to be there. Quality scores will go up. That’s the formula that will work today and that’s the formula that will work in ten years and in 20 years, but that means listening to your team.

That faith in the employee experience doesn’t exist everywhere, but it’s rooted in Inova. I need our employees to help me understand how certain systems and processes will work best, because they’re seeing them every single day, on the ground. There needs to be mutual trust.

VANA supported legislation this year that removed physician supervision from the Virginia regulatory code. It would change “supervision” to “consultation” allowing the CRNAs to work independently. Is this something Inova supports?

We always support top of license for our providers, top of training practice for all of our providers. Because of that, we do believe that CRNA consultation is consistent with that principal. We want everyone working at top of license.

CRNAs have barriers to practice at their full scope in Virginia. The Virginia regulatory code is one barrier, but hospital bylaws have a much larger effect on CRNA scope of practice. There are hospitals in Virginia that use different staffing models – has Inova explored any of these staffing models? Are you using them already?

We’re always open to exploring unique models for delivering any care and I think we have to be. We’re always looking to be a progressive organization so if someone else across the nation or even across the state is having success, we would certainly be open to learning more. We are an organization that is clinician led, so we would want our care models to be developed by our clinical teams.

We’re moving from a contracted model to an employee model in June for Anesthesia and I really do believe that our new model will allow for different conversations and the ability to explore different models because we will have, for example, a lead CRNA, from whom we will be getting additional input. Through this change we’re excited to say we’ll be moving forward with 100% of the employees who have been working with us under our previous contract model, and we feel this will serve our entire community in a more beneficial way.

When deciding to implement this system we relied on our CRNAs, who are already working with us and alongside us and who support this change. We’re trying to build this as one team, with input from our team members, and this shift is no different – we’re excited to be locally led and to be putting in place some of the very changes our team has been asking for.

Have you met with other health systems about this? Would you?

We’re always in contact with other health systems! COVID was one thing that brought health systems together because none of us knew what we were doing and we were all in the trenches together, so now we’re always talking. I’m on the board of two universities in the state and one of them, with a strong nursing and NP program, in our strategic planning session I advocated for an official study to on start a CRNA program because we need to advocate within the education space to continue to grow and partner. Partnering with other health systems includes partnering with other Universities.

News, Spring 2023 VANA Newsletter