Alumna Aims For Health Care Advocacy With Johns Hopkins Degrees

With dual degrees now in Doctor of Nursing Practice and Master of Business Administration from Johns Hopkins University, Dr. Ashley Ramirez ’06 has positioned herself more than ever to be an advocate for health workers, a goal she started working on as an undergraduate in the nursing program at Dominican University of California.

Ashley, a Quality Improvement Advisor at UCSF Benioff Children’s Hospitals, is primed to make a difference in how to build effective teams to help improve health care delivery with more of an emphasis on quality and patient safety.

“I was going down the specialty path in pediatric and neonatal critical care medicine after graduating from Dominican and UCSF. I then wanted to shift, to look at health care with a different, more holistic lens. With an MBA, it gives me room and freedom to pivot and be more of a generalist with this specialized knowledge,” she says. “I’m trying to figure out what to do with that. More to come.”

Ashley’s inspiration for enrolling in the dual-degree program at Johns Hopkins materialized about seven years ago while she was completing her service with a public-private partnership between the United States Peace Corps and Seed Global Health in Malawi. She was focused on pediatric nursing and helping establish Malawi's first pediatric critical care programs.

However, when she returned the U.S. Ashley discovered health care systems shifting with incentives that didn’t necessarily align with delivering high-quality care or with the best interests of patients and staff in mind. She wanted to voice her concerns. She thought an MBA degree would help make her more effective.

“You have to understand the whole context to help change incentives,” Ashley says. “I’ve always had this global view of health and I just felt like I had all this experience and I saw the push in the health care system that’s all about the financial bottom line. I’m so passionate about education but what are the programs that get cut first? Education. I wanted a different way to problem solve and understand that bottom line so I can talk that lingo to advocate effectively and show the importance of it.”

In 2019, Ashley found that Johns Hopkins offered a dual DNP/MBA program that was online and aligned with the values she embraced in Dominican’s School of Health and Natural Sciences and held onto as the worldwide pandemic unfolded.

“Dominican has always built a solid foundation in my personal and professional life. The Dominican values of study, reflection, community, and service are a common thread that weaves through my personal and professional life,” she says. “Nursing naturally has a strong sense of service and community that pours out during a shock such as a pandemic. I also believe in reflection as a powerful tool, especially in my professional life during times of stress. Since the pandemic hit the United States, it has drastically and permanently changed our health care system. There is no going back. This is the beginning of a new world we are embracing. Spirituality and reflection will be instrumental in how we cope and heal ourselves as caretakers, healers, and providers.”

With her Johns Hopkins dual degrees, Ashley believes her DNP will help her with Implementation Science and her MBA will help her advance the quest for quality and efficiency. Both will complement each other in driving improved health outcomes with evidence-based practice. The three-year experience with a cohort of 16 students through the pandemic – “We had multiple freak-out sessions,” she quipped – was rewarding on many levels. This executive leadership learning track boosted her confidence and conviction in bolstering health care performance.

“My frustrations as a clinician were about: we have a lot of people making decisions at the table who are not health care workers. They don’t seem to have any direct health care or clinical experience and so we felt that. There is a drive to see more patients; you are sort of plugged into a machine and you just have to crank out patients,” Ashley says. “For me, I really care about quality, and I wasn’t seeing that as a priority. I was seeing a shift in that. I’ve got to do something about this. I want to look and learn and grow and kind of problem solve. I wanted to have a seat at that table, helping to make these decisions and understanding the incentives. Why are we just cranking out volume instead of looking at quality outcomes and looking at the patient experience; where is that tipping point?”

Ashley has been a Quality Improvement Advisor at UCSF Benioff Children’s Hospitals since September 2022. She provides quality improvement leadership to provide structure around and champion systemwide strategic quality and safety initiatives.

“I’m more of an influencer. I hold people accountable and help push things forward. Clinicians improve things intuitively. I bring in more of the performance improvement methodologies, structure, and do some coaching. It’s a lot of change management,” Ashley says. “Currently I’m shifting from my clinical background (in providing direct patient care) to playing a different role on the team. Now I get to focus on leading teams, where I focus on systemic issues. No matter what role I play, though, I will always be a nurse.”

A nurse on a mission to improve health care. With Johns Hopkins degrees in hand, she is waiting for the right time and opportunity to find “a seat at the table” to implement her ideas. 

“I don’t know right now what my end goal is, but I’ve always had this non-linear path, so I think I follow what’s going to give me a skill set to keep growing,” Ashley says. “We’re in a very unique time in health right now where there are a limited number of linear tracks and the landscape is competitive.”

Ashley is prepared to play hard ball with higher-ups in the health care industry after coming to Dominican as a softball player. She was a left-handed hitting outfielder for the Penguins in the California Pacific Conference before being inducted into the Will C. Wood High School Athletics Hall of Fame in Vacaville in 2019 as a three-sport star.

“I just loved Dominican because it was such a pivotal time transitioning from high school to being an adult and having that space to have a more intimate learning environment where you have that dialogue with your professors and the ability to have check-ins,” Ashley said. “Dominican has cultivated a brilliant group of professors who bring their own experiences. I remember some of my psychology and nursing professors had so much experience, not just here but internationally. All those experiences shape you as you are learning and give you more of a global view on things. Dominican has prided itself on diversity, so I think all of that helps with not just looking here but also globally.”

Ashley made many friendships, including one with Megan Krage ’17, now a Critical Care RN in pediatric cardiac intensive care at UCSF Medical Center.  They both came through the nursing program at Dominican and can lend advice to future students.

“Be open that things are going to continuously change. Be a lifelong learner,” Ashley says. “That’s the challenge people are seeing in health care: people learn things and then go into a profession and think they are good, they're an expert in their area. I think the reality is our health care system needs positive disruption. We need to embrace change and accept things are continuously evolving. We’re constantly shifting, reassessing. Finding comfort in being uncomfortable and leaning into a growth mindset will be a powerful asset.”