1. What does a typical work week for a hospital administrator look like?

The work week is strange in that we have 24 hour responsibility – so the week never begins or ends.
Typically, however, the day begins at 5:30 AM – when I review the current patient census in the 6 units
of the Surgical-Trauma Division (my division) and the Medical Intensive Care and Progressive Care units.
I review these other two units as I am covering one half of the Medical Division. I look at the OR
schedule for the day, look at the Emergency Department census to see how many people are waiting for
beds in that department that may come to my areas. I then come to the hospital arriving between 6:00
and 6:15 AM. Check important email that may have come across that needs to be addressed, review my
calendar for the day, and then go to two of my units for morning huddle. This is often tough as the
huddles take place at either 6:45 AM or 6:50 AM – so I spend a few minutes at one then run to another.
It is an opportunity to see teammates and listen to their concerns. After that I round on the managers,
nurses, and physicians. Following that I head to my first formal meeting of the day.
On Mondays it is a 1:1 meeting between my boss, the Chief Nurse Executive, and me. In that meeting
we review how well the Division is performing financially, quality and safety wise, and from a patient
satisfaction standpoint. That meeting lasts on hour.
From 10 – 11, I attend the safety meeting where all divisions in the hospital report and concerns or
obstacles they may have preventing them providing safe and efficient care. I then go to the Emergency
Department and round on patients, nurses, and physicians to see if there is anything I can do to improve
their experience or help them deliver excellent care. I then report those findings back to the group –
wrapping up at 11:15.
11:30 I have a 1:1 meeting with the manager of the Surgical Trauma ICU where we discuss the safety
and morale of our teammates (the nurses), we look at the quality metrics, discuss obstacles and what I
can do to remove them. We discuss their challenges and often goals for the future or succession
planning. Succession planning is preparing for when I am no longer in my role, could one of the
managers step in and serve as the AVP.
12:30 – 1:30 I meet with the Performance Excellence Team to develop a strategy to improve outcomes
using a Lean Six Sigma Tool known as an A-3. It organizes ideas to keep them inline and on target.
1:00 there is a meeting on Bone Marrow Transplants and Collaboration with the ICUs – while I cannot be
there at 1:00 when it begins, one of the managers from my team is there and she expresses my concerns
if needed based on the 1:1 meetings we have had during the week. Sending her to these meetings is
part of succession planning. At 1:30 I join the Bone Marrow Transplant Meeting and receive an update
about where we are in the meeting.
1:40 – return phone calls or email.
2:00 – Grab lunch
2:30 – Staffing Meeting with 5 of the six managers in my Surgical-Trauma division. We discuss staffing
and coverage for that night and the next day. We look pro-actively at staffing and patient concerns and
move teammates around in order to ensure teammates and patients are safe.
3:00 – 1:1 with another one of the managers on my team – same as the previous meeting
4:00 – Clinical Rounding – this is the best part of my day – I go to different units and visit with my team,
the frontline staff. I may bring candy or something and I talk with them, help with a bed bath, clean up a
patient, sometimes start an IV – it is about being present to, and for, my team.
5:00 – back to the office. Return phone calls, answer e-mail, respond to patient complaints. Review what
I call actionable data from various sources that we then use to design programs and interventions. Send
a note to a nurse who has earned a certification or graduated with a new degree, and then head home
around 6:30 to 6:45 PM. Some nights I hang around to see the night shift, not nearly as often as I would
like, however.
That’s a typical Monday. The rest of the week is like that as well. We just have different meetings. We
spend a lot of time building a program we call transformational leadership. This is important because
there is nothing more important than the frontline nurse. My job is to take of them so that they, the
bedside or frontline employee, can take of the patient. The way I do this is to place as much control in
the hands of the managers and staff as I possibly can so that they can provide the best care possible.

2. How do you ensure your organization delivers the best care, for every patient, every time?
We do this by using the latest evidence based practices found in the literature. In some instances we
are writing the protocols and literature that becomes the foundation for the best practices in the United
States. We are quaternary center which means we not only take the sickest of the sick, we conduct
research; Medical research as well as Nursing research.
Using benchmarks from other leading institutions we compare ourselves against other like
institutions. We take deep dives into our failures, look to find common themes, and correct our errors. I
believe most people are good people and when given the chance will make the right choice. When they
don’t, we look at what prevented them from doing what is right and try to remove the obstacle. When it
is a situation where the person was given all the support they needed to do the right thing and they
chose not to do so, we hold them accountable using a progressive disciplinary system.

3. What issues do you normally have to deal with?

Typically, I am responsible for setting the tone and the direction of the Division. I am responsible to
ensure the safety of teammates and patients. I deal with staffing, patient concerns, quality metrics,
regulatory bodies, supply issues, personnel issues, policy and procedure development, human resources
issues, payroll, approving of new and replacement positions, and the happiness of teammates and
patients.

4. What clubs/ activities should those interested in hospital administration participate in?
Be as active as you can possibly be – be focused on community service type of groups. Academic
honor societies are great as well. If you are interested in pursuing a nursing degree that is great as it
gives you a perspective those in leadership who are not nurses do not have. At the same time, we need
people who are innovators, business leaders who are part of the future businessmen/women
organizations.
5. How did you get where you are now?
I got here because I believed I could help nurses provide a better level of care if they had the
support they needed from leadership. Each of the steps I have taken away from direct patient care has
been with the nurse and the patient in mind. Clinically, I believe, and am told, I was fairly strong, and
now I have taken that strength to first become a clinical nurse educator. From there I became a nurse
manager over Critical Care areas leading to a role as the Patient Safety Officer over a 6 hospital system.
After serving in that capacity for a few years I returned to a closer level of control as Director of Critical
Care and Medical/Surgical Services. I had the honor to work with some of the best nurses, I believe, in
the world, and when I stood back and let them innovate, we changed our corner of the world. We
eliminated common infections such as ventilator associated pneumonias, catheter associated urinary
tract infections, and Central Line associated blood stream infections, and a few others. Their work was
amazing and we earned a number of awards for that work. Then in 2014, I was honored and humbled by
team who nominated me for an award given by the March of Dimes in State of Georgia when I was
named Nurse of the Year for the State of Georgia in the Adult Critical Care category. Honestly, I don’t
think I deserved the honor, the team did the hard work, I was just their cheerleader. Much of what I do
now is advocating for my nursing teams to get them what they need to do their work. It is a slow
process sometimes because big hospitals move slowly, but I hang in there swinging for them and our
patients.

In addition to the work accomplishments I went on in my education earning a Bachelor of Science in

Nursing, a Master of Science in Nursing (concentration Healthcare Systems Administration), a Bachelor
of Science in Biology & Chemistry, and I am currently completing my Doctorate in Nursing Practice.

That, in a nutshell is how I got here.

I hope this all makes sense

Thomas Calabro, MSN-HCSM, RN, NEA-BC, CCRN-K

Assistant Vice President, Patient Care Services
Surgical Trauma Division

Carolinas Medical Center, A Magnet-designated facility

Carolinas HealthCare System
O: 704-355-8761
C: 229-886-7705