Investing Early in Frontline Leaders: The Story Behind the Hillcrest Winning Metrics

BY DAN COLLARD, COFOUNDER (WITH QUINT STUDER) HEALTHCARE PLUS SOLUTIONS GROUP

A few years ago, Hillcrest Medical Center in Tulsa, Oklahoma, was at a crossroads. The organization was experiencing some pretty big challenges. Registered nurse turnover and contract labor costs were higher than desired. Employee engagement was lower than desired. Meanwhile, charge nurses were under pressure, stretched thin, and often inexperienced, yet expected to lead without formal preparation or support. 

Of course, this predicament is hardly unique to Hillcrest. Across healthcare, charge nurses are expected to lead teams, manage flow, and influence outcomes in an incredibly tough environment—yet many are never developed for the role.

Hillcrest leadership knew something needed to be done. Over time, they realized, the combination of challenges they were facing could show up in both the employee experience and the overall patient experience—and so, they took action.

Fast forward to today, and the picture looks very different. Charge nurse turnover dropped to 1.1 %, with measurable improvements in patient experience, engagement, and quality metrics. (One interesting example: HCAHPS outcomes in “Courtesy and Respect” skyrocketed past the 73.9% goal, going from 84.25% in August of 2025, all the way to 92.54% in January of 2026.) 

Those results didn’t come from adding more staff or changing staffing models. They came from one key shift: investing earlier in frontline leaders.

Hillcrest’s experience dovetails with a broader trend. The Models of Care Insight Study—conducted by Healthcare Plus Solutions Group® with the American Nurses Association (ANA), the American Organization for Nursing Leadership (AONL), and Joslin Insight—identified charge nurses as one of the most critical roles in care delivery, yet also one of the most underdeveloped. At the same time, it showed that nurses are actively seeking meaningful career and professional development. In short, there’s a clear gap between what the role requires and how organizations are supporting it.

All of this raised a simple but important question in the minds of Hillcrest leadership: Why are we waiting until someone becomes a manager to develop them?

Director of Nursing-Workforce Development Dannette Staples, BSN, RN, CCRN, took the lead in launching what Hillcrest calls its Frontline Leadership Development program with a specific focus on developing charge nurses. From early conversations within their Nurse Practice Council to specific exchanges with existing charge nurses, the idea was a big win.

“Leadership was hugely supportive—no, not just supportive, truly enthusiastic,” said Staples. “Between the CNO and the CEO, who were all-in from the beginning, there was this incredible optimism that really fueled our momentum. And I’m thrilled to say that the senior team has maintained a visible presence at each of the quarterly sessions. Really, we couldn’t ask for more.”

But I’m getting a little ahead of myself! Here’s a quick look at how things unfolded at Hillcrest.

Year One began with a workforce assessment. Hillcrest wanted to get a solid understanding of the workforce (How many nurses? How many charge nurses? Tenure?) to map their readiness (Who had formal training? Who understood organizational goals?) and surface the reality they faced (Who had been promoted beyond their skill set?).

It revealed that:

• 75% of nurses had no formal training.
• First- and second-year RN turnover was at 53%. (This made early leadership support a retention issue, not just a development issue.)
• Thanks to COVID-19, nurses had been placed in charge roles and promoted beyond their skill set—and never brought back for formal training.

Hillcrest responded by focusing on two key structures: the Nurse Practice Council and a series of Frontline Leadership Development sessions designed specifically for charge nurses. (Incidentally, the Models of Care Insight Study confirmed that charge nurses, more than ever, play a critical role in care delivery and daily nursing operations.)

They designed development around real needs. Instead of generic training, they identified the actual scenarios charge nurses were facing every day. The goal was simple: Make development practical, relevant, and immediately usable on the floor.

They launched quarterly sessions focused on specific skill-building. These were designed to fit into the realities of the role, not add more burden to it.

The first year focused on the fundamentals of how leaders show up day-to-day. This included building skill and confidence in:

• Having difficult conversations. They asked leaders for their top 12 to 15 hard conversations, then workshopped a simple framework for coaching on the floor.
• Managing emotions under pressure. Before leaders can help their team, they need to recognize and regulate their own emotions first.
• Communicating clearly and consistently. They focused on verbal and nonverbal communication and what daily behaviors communicate to staff.
• Establishing a steady, reliable leadership brand. How you show up, calm and steady, and interact every shift becomes the leadership experience your team feels.

As these behaviors became more consistent, teams began to stabilize. Engagement improved, and day-to-day operations became more predictable.

Then, in the second year, the focus expanded from individual capability to team and unit impact. Leaders worked on building trust, reinforcing courtesy and respect (their top HCAHPS focus area become a frontline leadership practice challenge), and developing strategies for navigating generational differences across the workforce.

One example of this showed up in how Hillcrest addressed generational differences across the workforce. Leaders recognized that traditional communication methods weren’t working for everyone, particularly younger nurses who valued flexibility and accessibility. In one unit, two charge nurses responded by creating a closed Facebook Live series called “Chatting with Charges,” allowing staff to engage on their own time and in a format that felt more natural. The result was a sharp increase in participation and a stronger sense of connection.

Hillcrest began to apply what they had learned across their teams, influencing culture at the unit level. Over time, these shifts showed up in broader performance trends, including (as mentioned earlier) patient experience and operational metrics.

By developing nurses early, Hillcrest sent a clear message to staff: You are valued, and we are investing in your future. The result was greater confidence in the role, stronger connection to leadership, and a deeper sense of belonging.

For organizations looking to replicate this, here are some tips:

• Start earlier than you think you should. Don’t wait until someone has the title to begin developing them. By the time a nurse becomes a charge nurse, the pressure is already there. Early investment builds confidence and capability before the stakes are highest.
• Prioritize the charge nurse role. This role sits at the center of daily operations, influencing both staff experience and patient outcomes. Strengthening this layer creates stability on the unit and consistency across teams.
• Build around real, daily challenges. Focus on the situations leaders actually face, like difficult conversations, managing emotions, and keeping teams aligned during busy shifts. Development should feel immediately useful, not theoretical.
• Make development personal and specific. One-size-fits-all training doesn’t stick. The more development reflects individual needs, experience levels, and learning styles, the more likely it is to translate into real behavior change.
• Make development ongoing, not one-time. One session won’t change behavior. Growth happens over time, with reinforcement, practice, and opportunities to apply what’s learned in real work settings. 
• Connect it to outcomes people can see. Tie development to metrics that matter, such as engagement, retention, patient experience, and operational performance. When leaders see the impact, it builds momentum and reinforces the value of the work.

The big, overarching lesson is the first one on the list: Start earlier. Do not wait until someone becomes a manager to begin developing them. If charge nurses are expected to lead, they need support, preparation, and a clear path forward before the pressure peaks. Hillcrest’s results make the case that when you strengthen frontline leadership early, everything downstream gets better.

Dan Collard and Dannette Staples will present Investing Early in Frontline Leaders: Hillcrest Medical Center’s Metrics Success Story (Sunday, May 17, 12:00 p.m.) at the ASHHRA26 Annual Conference and Exposition, to be held May 17-19, in Savannah. ♦

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Author bio:

Dan Collard is the cofounder (with Quint Studer) of Healthcare Plus Solutions Group^® (HPSG). He recently coauthored with Dr. Katherine A. Meese the book Genfluence: How to Lead a Multigenerational Workforce (ACHE Learn). He is also the coauthor (with Quint Studer) of Rewiring Excellence: Hardwired to Rewired and Rewiring Leadership in Post-Acute Healthcare: Equipping Leaders to Succeed. For more information, please visit www.HealthcarePlusSG.com. 

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