Cathie Anderson

From the Air Force to UC Davis, nursing chief builds effective leadership skills

UC Davis Medical Center has thousands of nurses and nurse practitioners. Their boss, Toby Marsh, wants an environment where nurses contribute to healing solutions.
UC Davis Medical Center has thousands of nurses and nurse practitioners. Their boss, Toby Marsh, wants an environment where nurses contribute to healing solutions. Sacramento Bee file

Toby Marsh oversees more than 2,000 nurses and nurse practitioners as the chief nursing and patient care services officer for the UC Davis Medical Center. His appointment was announced Dec. 14.

The 42-year-old registered nurse had served as the division’s interim leader since April, he told me, but he was by no means certain that he would get the job permanently as candidates from around the nation lined up to interview for the post.

“I started April 1, April Fool’s Day,” Marsh said with a smile. “I didn’t know if the joke was going to be on me or what, but it’s been fun. (UC Davis Medical Center CEO) Ann Rice walked me through the process and told me that it would be a yearlong interim position. I thought, ‘OK, it’s going to be a yearlong interview.’ 

The son of a career U.S. Air Force veteran, Marsh grew up in Atwater, a town outside Merced with a population of about 18,000 during his youth. While Marsh’s father served most of his career at Castle Air Force Base, Marsh would later join the same military branch for the opportunity to travel far beyond the boundaries of his hometown.

In a recent conversation with The Bee, Marsh shared management and work ethic lessons that have served him well as he has risen to the top of his profession. The interview has been condensed into this Q&A.

Q: What shaped your work or management ethic?

A: Robert Olson, my squadron commander, was my biggest professional influence. He role-modeled how to treat people and how to work with people. He was more concerned about the outcome than about facilitating all the processes. He also believed that … people show up every day because they’re committed and want to do the right thing.

His job – and my job now – is to help facilitate other people’s greatness, to help them achieve what they showed up to do. There, it was fixing planes. Here, it’s delivering safe, quality patient care.

Q: What sets the UC Davis Medical Center’s culture apart?

A: When I came out of (nursing) school, I was so happy that I got a job. There was a shortage of nursing candidates. That first company offered me a bonus and high pay. … I took the job and within six months I left, and it was because I didn’t feel there was an environment that supported the practice of nursing.

During that nursing shortage, hospitals that could keep nurses, retain them, regardless of the amount of money they paid, were called magnet organizations, and people studied them to identify why. They found that they have a culture that supports nursing-practice autonomy, allowing nurses to fully practice as professionals, not just as somebody who is a taskmaster.

Nurses have a seat at the table where decisions are being made about how we are going to deliver care, how we are going to practice, how we will develop policy and so forth. That’s one of the things we have here at UC Davis, and I think it really is aligned. We talk about that alignment in different organizations, and sometimes you have to leave an organization because you don’t have that alignment. I left that first employer within six months, even though I had a bonus and high pay. It’s not about money.

Q: What defines your management style?

A: I learned early on that there’s a difference between being successful and being effective. I’m going to go on vacation here in a week. … I’m not going to be checking my email. I will give people a phone number, and I will say, “If you need to call, you call, but I am not checking my email.”

The difference between effective leadership and successful leadership is that the successful leader is always calling and checking in. An effective leader builds structures and processes and walks away and knows the work will get done at the same level. It’s not that I don’t have a role. I think my role is broader. I have to nurture that culture and network and ensure it’s sustainable.

There are times when I feel vulnerable and insecure because of the greatness of people around me. Their idea is so much better than my idea, and I feel like, “Oh, God, I should have had that idea.” I have a choice at that point: I could diminish them by saying, “That’s a stupid idea. What were you thinking?” or I could make a small comment like, ‘Well, I guess you had a great idea.’ That would really demoralize them. Or, I could go, “You’re right. That’s fantastic. Let’s do it.” I have to put my ego aside because if I inject even the smallest bit of my insecurities into that, then I’m not allowing people to reach their full potential and greatness. I truly believe that.

Q: What career advice can you offer?

A: When I was in the military, I would hear people say, “As soon as I leave, I’ll be making more money” or “I’ll just go to another unit, and then things will be better for me.” I don’t think that’s always true.

If you chose to be in a workplace, then you need to bloom where you’re planted. Fertilize your environment. Sow your own seed. Contribute where you are. … You have to identify opportunities and make things better where you are. You have the best insight to do that. No one on the periphery does. …

If you’re an up-and-coming employee, stretch beyond yourself. Get outside your comfort zone. If you want to move into a different role – let’s say they want to be a nurse – they should hang out with nurses and talk with them. If they want to be a physician, they should start talking to physicians and asking questions. They should get to know what the opportunities are and explore different experiences, even when the people around them don’t. They should follow their passion. …

I also think you have to formally do it sometimes. I belong to a professional organization, California Association of Healthcare Leaders, and I got into it because I felt like I was getting into groupthink. I didn’t know what people outside my sphere were thinking. I wanted validation of what leaders here were saying. Was it the same in other organizations or professionally? I began going to their events and then became active on their board. Now I can create a network outside my insular world. It’s a place where people can challenge me a little bit, or I can pick up a phone and consult people at other organizations.

Cathie Anderson: 916-321-1193, @CathieA_SacBee

Toby Marsh

Title: Chief nursing and patient care services officer

Employer: UC Davis Medical Center

Age: 42

Education: Master of science in nursing from Gonzaga University, an associate’s degree in nursing from Pacific Union College, master of science in human resources administration from Central Michigan University, bachelor of science in health services from Fresno State.

Grew up in: Atwater

Resides in: Sacramento

One book he cites: “Multipliers: How the Best Leaders Make Everyone Smarter” by Liz Wiseman with Greg McKeown (HarperCollins Publishers, 288 pages)

Other distinctions: Board member, California Association of Healthcare Leaders; Fellow of the American College of Healthcare Executives; 40 Under 40 Award from the Sacramento Business Journal in 2012; U.S. Air Force Commendation Medals in 2001 and 2004.