Q4 2022 Leadership Letter -Yabo Alfred

March 10, 2023

Iyabode (Yabo) Alfred, Ph.D., RN, PCC

Vice President/Chief Operating Officer - Visiting Nurse Association of Albany Inc.

We recently interviewed Yabo Alfred who is the Vice President and Chief Operating Officer with Visiting Nurse Association of Albany (VNA), located in Albany, NY. VNA is a certified home health care agency that provides skilled nursing care, rehabilitative services (physical, occupational, speech pathology therapies), and medical social work to individuals in the comfort of their homes. The goal of this collaboration was to get to know Yabo on a personal level to better understand what motivates her to be a successful leader in home health care while navigating through the landscape of healthcare challenges that leads to positive patient outcomes.

Yabo’s personal mission statement is to be a driving agent of necessary change by engaging with teams across her organization leading to process improvement. She’s a successful leader with a proven track record of results. Yabo secured a $1.8M grant from the Mother Cabrini foundation to launch and operate a nurse residency program that helps new nurse graduates transition into clinical practice. The residency program serves as an opportunity for graduates to hone critical thinking and evidence-based decision-making skills. This effort allowed her the opportunity to give back to the profession that was personal to her. She was a beneficiary of a similar program after graduating from nursing school more than two decades ago.

Matt: To get to know you a bit better - What’s an unusual habit or unique thing you love?

Yabo: I love to shop. I am happy, I’m shopping. I'm sad. I'm shopping. I'm bored. I'm shopping! Unfortunately, it's a very costly habit. When I was in college and working for less than minimum wage because I was a foreign student, I still shopped. It's just a habit that's my biggest weakness, but also my biggest virtue meaning that I do get great stuff. I'll buy anything that I think is nice. I love to give and my mother was a giver, too. She would go in her closet, find something to give and people would be so appreciative. It’s good to always have gifts at the ready!

M: Can you tell me a bit about your background and where you’re from?

Y: I came to America when I was 18 years old from Nigeria. My father was a Baptist minister and had an affiliation with Southern Baptists in Alabama. Back in those days, we were known as 'PK’s' or the preachers’ kids. The missionaries from America that have been within our country for several years started this partnership. They offer educational scholarships to different colleges in the US. I came with a tuition free scholarship. My parents paid for room and board, but I went to an all-girls Baptist College in Marion, Alabama, that is not even on the map. I studied accounting and moved to New York after finishing my graduate studies in Alabama. I got a job working as an accountant, doing bookkeeping. Then I was the office manager for a large doctor's office. That’s how I started thinking about nursing. My parents wanted me to be a nurse, but I wanted to be an accountant like my Uncle Nelson. He was the chief accountant for a very famous bank in Nigeria. He was my role model and I wanted to be like him when I grew up. I don't know why because I didn't see females in that field back then. When I was in college, I used to go back to Nigeria every year. I met my husband here (in the US) and we went back and married in Nigeria as we both we have family there. We still visit very frequently.

M: Is there anybody that comes to mind that's had a significant influence on your leadership or the trajectory you've been on and why?

Y: My parents. My father was the pastor of a big church and had a radio ministry. And my mother started different things as well. There was a lot of adult illiteracy when I was growing up in Nigeria, so she started a literacy class in the evening. My mother was extremely innovative and a go-getter. She was a schoolteacher, but she did so many things after hours to support my father's ministry. When I think about leadership, I think of things that my parents would do and how they would handle people, too.

M: Do you have a book about leadership that's a favorite of yours or that you typically recommended to others?

Y: I'm not a reader, but I am a person of Christian faith and that's my go to. I have a handful of Christian websites that I subscribe to and they have lessons on how to be leaders. I'm not an avid reader because I have dyslexia.

It didn't matter to my parents, whether you went into science or liberal arts, they thought I was an extremely smart kid. I did well in school because I didn't want to get in trouble. My mother would make me read literature books, which is probably one of the reasons why I don't read now. She taught me to read the preface and a chapter here, chapter there, and then to the end. She would have me read the introduction and summary of textbooks. She'd say, “Go to the middle, you'll find examples of what the author is trying to tell you,” which was the textbook concept. She knew I was dyslexic, but she thought I was very brilliant. So I was pushed, but given the strategy to do things like that and overcome challenges I faced.

Throughout my years in college, when I was doing my MBA, I first heard the word dyslexia. I said, “Oh my gosh, that's what I have.” I got tested, and found out what I have is not common and very unique. There's a classification for it but I don't really remember anymore. But again, it goes back to my mother always saying to never use something as a crutch. Even if somebody had told her back then about my condition, she would tell them it’s not true. She wouldn't allow me to use that as a crutch. When I'm challenged, and know it’s so hard, I think, “You can do it.” That's when I show you, I can do it.

When I first took computer science as my minor, I remember my first class. My computer teacher said, “It's really a hard concept to grasp especially because you are not from here. So you may not be able to figure it out.” I said, “Oh, I'll show you!” I showed her and was the brightest in the class eventually. When I'm challenged is when the best comes out. When it's too easy, I don't want to do it. If it's hard, that's when I get drawn to it.

M: Do you have an apparent failure that later led to success? If so, what did you learn from that experience?

Y: I think everybody has good intentions. I just always believe that people are coming from noble - maybe not good, but noble intentions. When I get burned, it hurts.

Recently, I spoke to one of my managers about giving them more responsibility. Everything went well. I was confident she heard me and would rise to the occasion for the organization. I got a resignation from her right after. I'm very trusting. I always believe that everybody has good intentions. And then when it turns out that it didn't work out that way, it sets me back mentally. I remember that mother would say, “Never let them see you sweat.” So even though internally it got to me, externally I just was like alright, we'll figure it out.

I spent 16 years at VNSNY and every year or two, I got promoted to do something else. During one of those promotions, I was given a department of well over 150 staff. There were almost 20 RNs. It was handed to me really. The VP explained the department would be going through a huge layoff. I needed to downsize to the tune of 85 and was allowed only a handful of nurses right when we were getting more than 5,000 referrals per month. I didn't think it was possible. I started praying and with only six weeks to do it, I started to research different things we could do. I came across a little process to figure things out. It got exciting for me even though I knew people were going to lose their jobs. I started looking for different ways to repurpose the staff and come up with a plan. I reached out to collaborate with my immediate managers I could confide in because the union would get ahead of the game and fight us.

VNSNY had over 90,000 staff at the time that needed to go down to 17,000. My department was the only one that implemented a plan without any real issue. I was nominated for the very first Joan Marren award because I worked to promote evidence-based practice or quality improvements. I used an abbreviated version of the Lean process to make the changes. I had a lot of help but led the charge to downsize on that magnitude with limited issues and turned around something that used to be a heavy-duty clinical oversight. To be able to switch and make it work was a major leadership test for me I felt I passed in flying colors.

M: What was your inspiration for continuing your education?

Y: I had no choice in the matter. You came out of your parents’ house; you go to school. After seven years working as an accountant, and then an office manager, I got married and had children. I was still working a demanding job and had to change careers to make it a little more family friendly. My husband was focusing on taking care of our three young children, I went to nursing school for financial reasons. I wanted to always be able to have a job that is flexible enough to support my husband and family. When considering getting my MSN and PhD, I considered what I wanted to do and where I wanted to be in five years. So when I got my feet wet in home health, and the kids started junior high, I knew I was ready. I would look at everybody in positions of leadership, either managers or directors. I thought about what credentials they had, the majority being MSNs. I’d inquire about how to get that kind of job, looking up the kind of requirements needed and whether it's highly competitive. And again, money does not motivate me at all. What motivates me is the challenge of something that I'm in. It's the challenge of getting something done. I told my husband I’m going to get out of being in line staff and need to get my master's degree. He said you have your masters already. I said 'Yeah, but when I look at all these people, a few of them had MBAs.' I applied and got my MSN. And that was it.

I wasn't going to go to school anymore. But then I got this job for staff development at the VNSNY. While I was working there, somebody asked me right after I received my MSN and said, “Can you be the manager of staff development or quality for my department?” Again, VNSNY is huge and each department runs as a mini company under the company's big umbrella. I went there and started teaching. I helped organize the new hire orientation curriculum which had a huge impact for staff. After seeing my work in building out the new orientation curriculum, someone reached out to met about teaching at Hunter College. I started adjunct teaching at Hunter College and loved it. While there, I looked at all the college professor doors to see their titles. They had all PhDs and were much older than me. I figured when I get old, what I want to do is teach so I started talking to them. They told me that it doesn't matter that you have a doctorate. If you don't have a PhD, you will not be tenured.

So I figured that when I get older and closer to retirement that I'd like to be able to teach. Since then, I did chance my mind and wanted to work back in the industry, but I still will have the opportunity to teach if I want to in the future.

M: What do you believe are the characteristics that will help healthcare organizations be successful over the next 5 years?

Y: I think people have to embrace change, and the only thing that health care is certain to is change. We have to be nimble and flexible. We have to change course and read the environment. Things are changing at the speed of light and we have to be able to recalibrate and refocus because what got us here is not going to continue to take us further. Baby Boomers are getting older and retiring, but they're not like their parents. They are educated consumers. They will challenge you. They want to be educated consumers and hold companies accountable.

I used to teach my nursing students that their patients are consumers and to stop looking at patients as just patients. There’s this word I cannot get used to. I used to tell my students not to use the word non-compliance. For example: As a patient, who makes you the boss of me? I am a 59 year old educated woman (and I'm not talking academically only). Who knows me better than me? If you want me to follow your regimen, depending how it’s presented, I will let you know if I'm going to do it or not. For instance, if the medication you're going to give me is going to make me blind but keep me alive, let me be able to tell you I'd rather be dead than be blind. If I choose to be dead by not taking that medication because it's going to make me blind, don't call me non-compliant. Instead write notes that say, the patient received knowledge of ABCD and E and has chosen to adhere to or not adhere to what we're recommending. The patient views themselves as the boss and you know healthcare. So tell them all the ramifications, but allow them to decide. We need to be nimble. Customized care is what we need to give to our patients because good customer service is one that is customized for that consumer. We should become flexible and allow patients to participate in their plan of care. They should be able to make their own choices, even when it's not the choice we recommend.

I'm a big advocate of transition care in the community. Home is where healthcare really belongs. You can take patients to the hospital when they are going through an acute situation to be stabilized, but I think COVID has made us focus on how we look at health care. Caring for patients in their own environments is where healthcare is right now. And anything to support home health would really be valuable for the community that we serve, especially the generation that’s getting older. Baby boomers are not going to lie in your hospital bed and wait for you to bring them things like their pants. They want to be home, in front of their computers and still manage their health. I have been given this great opportunity to be part of home care right after I finished nursing school. I have not done anything else but home health. Home care is the bulk of my experience and I love it.

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