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Smart Care Team Spotlight Podcast

In a rapidly evolving healthcare landscape, the challenges faced by clinicians are mounting. Join host Molly McCarthy MBA RN-BC, former US Microsoft CNO, as she leads captivating conversations with today’s health leaders about the game-changing potential of AI and Ambient Intelligence for care teams. Visit virtualnursing.com, your go-to resource for accelerating the transition to smart care teams. Presented by care.ai ®.

Meet Your Host

Molly McCarthy, former US Microsoft CNO

Molly K. McCarthy MBA, BSN, RN-BC is the National Director, US Provider Market and the Chief Nursing Officer for Microsoft’s US Health and Life Sciences sector. Molly’s primary focus is business development and strategy for the US Health Industry team that includes supporting and developing solutions such as virtual health, patient engagement, care coordination and analytics. With almost twenty-five years of experience in the healthcare industry, Molly is passionate about uniting technology and clinicians to ensure improved patient safety and outcomes.

Episodes

Mary Morin Chief Nursing Officer and Senior Vice President at Sentara Health

"In addition to the virtual transformation initiative we are under, or we are engaged in care delivery, redesign. And so the role of the registered nurse, and this is something that I learned in the Navy. You have to be a leader at the bedside. And that leader means leading others who can deliver care safely, effectively, and efficiently." - Mary Morin

Mary Morin Chief Nursing Officer and Senior Vice President at Sentara Health

Episode 27 Virtual Transformation:

Redesigning Care Delivery for the Future

SCTS_Mary Morin: Audio automatically transcribed by Sonix

SCTS_Mary Morin: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CNO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers' lives harder, not easier. It's time for smart technology to empower care with a more human touch. I'm thrilled to share a little bit more about our guests today, Mary Morin. Mary has been a registered nurse for almost 43 years. Currently, she is the Enterprise Chief Nursing Officer and Senior Vice President for Sentara Health in Virginia Beach, Virginia. She is accountable and responsible for nursing practice and care—employee health workers compensation with over 33,000 employees and other system clinical support services. Sentara Health, an $11 billion healthcare system, is composed of 12 acute care hospitals, a large integrated medical group, ambulatory services, large post-acute services, and four health plans. It's also the largest healthcare system and the second largest employer in Virginia. Upon graduation from George Mason University in Fairfax, Virginia, Mary was commissioned as a Navy Nurse Corps officer in the United States Navy, retiring after 25 years of active and reserve duty in June of 2006. During the past 43 years, Mary has been a staff nurse in medical, surgical, critical care, specialty critical care, and emergency room and trauma and has held nursing leadership positions in acute and ambulatory settings. Welcome, Mary. So wonderful to have you here and to get ourselves situated today.

Mary Morin:
Yes.

Molly McCarthy:
Thank you so much for your time.

Mary Morin:
Thank you, Molly.

Molly McCarthy:
I want to get started by talking a little bit about your career journey. It's obviously an inspiration to many and quite a unique path to your current role as CNO at Sentara. Can you tell us a little bit more about how serving in the United States Navy Nurse Corps for 25 years has prepared you for your current leadership role, and how you approach the challenges of today's healthcare systems?

Mary Morin:
Yes, and thank you, Molly. I want to start with that. It was such an incredible opportunity and honor to be able to serve in the United States Navy Nurse Corps. That 25-year history was both active duty as well as reserve time and how the Navy prepared me for my current role. The Navy makes you very flexible and very adaptable. It allows you to work with diverse groups of people across multiple settings. And you have to be flexible because you're expected to move and change your job essentially every, you know, sometimes 18 months to three years. The other thing about the military is that many times they're early adopters of technology. So as I moved more into the civilian healthcare world, that was important as well. As a young Navy nurse, you immediately move into a leadership role, leading teams of young corpsmen as you advance. You have younger nurses, but you're working with relatively in hospitals, relatively young people, physicians, and nurses. And so it does prepare you for that leadership role, not only at the bedside but in an organization leading larger initiatives. And so today, with technology, one of the things that we are moving very quickly on is the use of virtual nursing technology.

Mary Morin:
We've had that virtual care more in our ambulatory environment. One of the advantages of COVID-19 is that we learned to use and leverage technology differently. And so those virtual visits on the ambulatory side have continued. What we are currently doing is moving that virtual technology into the acute care hospital settings. So we are focused on medical-surgical units and intermediate care units and leveraging a virtual nurse to, first of all, take some of the burden off that bedside RN. Sentara is no different than other healthcare systems challenged with having those bedside nurses, particularly in the medical-surgical areas. And so, based on feedback from around 1000 direct care RNs in Sentara, we are moving forward with a virtual RN, bi-directional cameras, and bi-directional audio, as well as the use of ambient and artificial intelligence to start with admission discharges and patient education. And we've had the advantage of seeing on-site. I've had the advantage of interacting with other systems—CNOs who have already implemented components of virtual nursing and learning from them. First and foremost, patients love it. And the staff on the units love it. You know, you don't need a nurse at the bedside to do an admission or a discharge.

Mary Morin:
You need that nurse at the bedside to do those critical assessments that require hands-on care to administer those critical medications. And so that's the advantage of leveraging that technology and bringing in a registered nurse. Right into the room in real-time and do work that can be done virtually. And so we're learning from other organizations and getting ready with phase one. Our plan is, by October of 2025, to have all of our medical-surgical units in intermediate care units across Sentara live with virtual RNs. And again, starting with admission discharges and patient education. We then will expand because the opportunities are almost limitless as to what you can do using virtual technology. Then, you layer ambient intelligence and artificial intelligence onto it, and it becomes an incredible learning system. And, of course, there's a huge safety component to this as well, meaning it can improve safety. The ability for a virtual nurse to zoom in and read the fine print on an IV bag, for example, to perform a double check with another nurse when administering high-risk medications. I mean, that's just one example of many.

Molly McCarthy:
Yeah. No, I love that. You dug in there from the beginning. So, thank you for sharing all that. I love your stories about getting into leadership early on, obviously within the military, diving in, being flexible, and just going because you must. You have to. Obviously, you've accomplished so much during your time with the Navy, and then currently, you have, I think I read, over 9000 nurses who support the 12 hospitals and numerous medical groups, as I mentioned, and ambulatory sites. So, aside from thinking about some of today's challenges, how do you get feedback from your team, and how do you prioritize where to invest the systems, time, and resources to best serve your front-line caregivers? And obviously, it sounds like virtual nursing is at the top of your list today. I mean, wow, I'm impressed that you have that goal by October 2025. So just curious about some thoughts about feedback from the team and then how you move those forward.

Mary Morin:
So in terms of the TMLs, speak to the direct care nurses out there taking care of our patients 24/7. And that started with meetings with direct Cairns back in August and September, October of 2023. Most of them were not familiar with virtual nursing, and this was part of a larger strategy. We were in a transformation evolution, and this was one of the top transformation initiatives. That isn't just about the acute care setting. We're also looking at leveraging that technology across the post-acute environment, home health, for example, even more so in our medical groups, and potentially in our health plans, using that virtual technology to help manage inpatients, our post-acute patients, and then our consumers that we serve in our medical groups as well as our health plans. So, it's a system priority as well. This is something the virtual work you have to do. I mean, this is what I call the ATM machine of healthcare, that we will never deliver healthcare in the same way. Because as you start to think about all the things you can do, really, your mind explodes with ideas. But getting in front of frontline staff nurses, before we were looking at virtual care, we were conducting site visits.

Mary Morin:
And so with those meetings with frontline staff, they're the ones, as I talked about virtual nursing, they are the ones that said, hey, admission discharges and patient education for us, our major pain points. And that's where the decision came from. It wasn't a leadership decision. It was really what did our frontline staff say? So we've taken that and really focused on learning from other organizations that have implemented that component, specifically knowing that it will most likely quickly evolve. We have shown demos to our frontline staff, and they're no different than leaders like me who see it and start going, hey, can we do this? Can we do that? And we've heard from other organizations that it can quickly evolve. And you do have to have a well-constructed plan because it's very easy to get overwhelmed with all the things that you can do. But there is a system, a major system initiative that crosses all the venues of care. It is a top priority in Sentara. So those resources have been financial resources, in particular, have been allocated to make this a reality.

Molly McCarthy:
Yeah. I mean, I love your analogy of the ATM. Actually, a lot of times, I make an analogy around depositing a check where, in the olden days, you'd walk into a bank or even then evolve into a drive-up teller. I personally make my deposits on the phone, or it's automatic. So, I think that's a really good analogy. It's changing the workflow and making us more efficient. When you think about it, and it's you mentioned a few of the use cases. I know ADT admits discharge and transfer patient education and that you're conversing with your CNO colleagues. So important in terms of sharing what works, and what doesn't work. And we're not waiting around a year to figure it out. But we're collaborating with other orgs. And I think we're going to, you know, as many people have said, this is really just the tip of the iceberg. And it's really beyond nursing, too. It's looking at pharmacy and other specialties, and it's really just going to be part of care. And we won't necessarily in the future, call it virtual inpatient care, we'll call it inpatient care. And that will be a component kind of like what works today. We also work remotely. Yeah. So I think that's fantastic. I love that plan. And I love that you're getting feedback from the front line. Nurses are so critical in the adoption and really figuring out the best ways to utilize the technology. So we've talked a little bit about virtual nursing and ambient intelligence, I'm sorry, ambient monitoring and artificial intelligence. So, when you think about the future of nursing within the hospital, what is your vision for nursing? And also when you think about change management as care models are being reimagined, as we just discussed, and the role of technology will play to empower the bedside caregivers and patients in new ways. How do you see nurses, I guess, working and their role as that center of the wheel, so to speak, of care with that patient and advocating for them? And how will that change your ideas of nursing?

Mary Morin:
So will it. Absolutely. So in addition to the virtual transformation initiative we are under, or we are engaged in care delivery, redesign. And so the role of the registered nurse, and this is something that I learned in the Navy. You have to be a leader at the bedside. And that leader means leading others who can deliver care safely, effectively, and efficiently. But they don't require an R.N. license. So, by leveraging others to get the patient care work done, there will be fewer registered nurses at the bedside. We're we're already seeing it today. And so that RNs got to be comfortable leading a team and partnering with other caregivers and patient care technicians. Again, licensed practical nurses are very important and very valuable, particularly in a med surg area, because they can administer medications. Leveraging other team members to take care of patients, then moving into a role of still doing hands-on care, they move into a role of prioritizing what needs to be done for the patient, delegating the care, monitoring, and supervising that care. So, I do call it being a leader at the bedside. And I would say that that is top of licensure work for a registered nurse. We need them to do those thorough assessments on patients, make decisions about the status of the patient, connect those dots based on the findings and data that are collected from others, assistive staff, for example, to make decisions as to does something needs to be done differently for this patient and escalating.

Mary Morin:
But it is, again, coordinating a team. So we're moving back to what we're going to call zone nursing. But more of a team approach. You mentioned I've been a nurse for 43 years as of next month, and we moved from a team-based model in the 80s to primary nursing. And I would challenge that we never did primary nursing. What we did is we fragmented how we approached care on a unit. Molly, you had your six patients. I had my six patients. Wasn't that we weren't good team members, but we didn't approach the care that we delivered to our patients as a team like we did in the 80s. So there's relearning here for nurses—my contemporary and maybe about 5 to 10 years younger. But for most of the workforce, it's a model they've never practiced. So we have to invest in that training. So Sentara's partnering with our schools and universities to re-establish that type of training, training RNs to be leaders at the bedside, and learning how to delegate delegation takes practice. It's a skill. It requires that you understand what needs to be done. It requires prioritization. It also requires being comfortable setting expectations, following up, and asking questions as to whether or not somebody is competent to perform a task or a procedure that you will delegate. So, I see it as an exciting revitalization of the role of the registered nurse, from a taskmaster to a leader of the bedside.

Molly McCarthy:
Yeah, so many nuggets of wisdom in what you just said. And just I'm going to pull out a few for our audience today. Just the top of license is critical with, quite frankly, the shortage of nurses. And I think working as a team is critical in your point about being a leader at the bedside. I like to think of it as being able to hone our critical thinking skills as nurses. Yes, that we've learned, and putting those to work and not being so concerned with obviously checking off a list, so to speak, but looking at the big picture and orchestrating that care, whether it's with the family, the LPN or other licensed caregiver, the physicians, nurse practitioners, and whoever it might be dietary. Obviously, coordinating that care is critical. And your point about prioritizing, obviously, who's most at risk, etc. So many good points there. And the other piece I want to reiterate is the partnership you mentioned Sentara is having with schools and universities. We want to infuse into our schools and universities into our students what's going to help us the most when they come out. And it is that team-based approach, and it's for me. And I'm not going to get on my soapbox here. But it's not just within nursing but with the whole care team. That's important for them to have modeled, seen, and participated in during their education.

Mary Morin:
Absolutely. And I jokingly refer to it as back to the future.

Molly McCarthy:
Back to the future.

Mary Morin:
Yes.

Molly McCarthy:
So, the pendulum always swings. Yes. First of all, thank you for your time. I do have one final question. I would love for you to talk with our listeners, obviously some of our CNOs, some of our CNIOs, some are bedside patient caregivers, and some might not even be nurses. So, given each of your experiences in healthcare, could you just share 1 or 2 parting gifts of wisdom with our listeners? What is your single most important, practical piece of advice for them as it relates to their responsibility of being tireless advocates for their patients?

Mary Morin:
So, first and foremost, the patients aren't always right, but they're always our patients. And I think we sometimes forget that, and when patients and their family members come into our care, they relinquish control. And they also place their humanities into our hands. And I think it's both an honor and a privilege to be able to care for the people. And so that is something that I felt very strongly about my whole career, it is always about the patient. And I also just say to those out there, if you don't have the fire in the belly anymore. Then seriously think about how you can get that back, or where you can go where that is rekindled because that fire in the belly is so important. It matters. It matters to leaders like myself. And I think it really matters to those we work with as well as those we care for.

Molly McCarthy:
Yeah, Mary, I think it is a privilege and honor to care for the patients. And to your point, we're all human, and we need to continue to remember that when we care for them. I just want to say, first of all, thank you so much for your 25 years of service.

Mary Morin:
Oh, thank you.

Molly McCarthy:
And thank you so much. Yeah. Thank you so much for being a guest today. I appreciate your patience. I know we had some technical challenges, but really grateful for you to share your experience with our audience. So thank you.

Mary Morin:
Well, thank you for the opportunity.

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight for best practices in AI and ambient Intelligence, and ways your organization can help lead the era of smart care teams. Visit us at VirtualNursing.com, and for information on the leading smart care facility platform, visit care.ai.

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Becky Fox Chief Clinical Information Officer at Intermountain Health

"Now more than ever, nurses in particular have the opportunity to really lean in, be a part of entrepreneurialship, innovation, driving how technology is going to revolutionize and modernize the nursing care process." - Becky Fox

Becky Fox Chief Clinical Information Officer at Intermountain Health

Episode 26 Streamlining the Burden:

Leveraging Technology for Nursing Efficiency

SCTS_Becky Fox.mp3: Audio automatically transcribed by Sonix

SCTS_Becky Fox.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CMO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers' lives harder, not easier. It's time for smart technology to empower care with a more human touch. I'm thrilled to share a little bit more about our guest today, Becky Fox. Becky is the chief clinical information officer for Intermountain Health, where she collaborates with clinical leaders to help set the strategy and vision of how we can bolster health information technology to help people live their healthiest lives possible. Becky has a diverse clinical and leadership background, serving as a champion for numerous large-scale IT implementations, an executive leader at Cerner, a founder of a startup using technology to make gatherings and events safer during Covid-19, and as an emergency department nurse. Becky is passionate about optimizing health care delivery, while at the same time innovating new processes, workflows, and technologies to enhance the health care experience for all. Welcome, Becky. It's so great to have you here today.

Becky Fox:
Thanks, Molly. Great to be here with you.

Molly McCarthy:
Well, first of all, thank you for taking time. I know that you're busy. And appreciate the insights for our audience here today over your career. And really thinking about your career, it's quite an inspiration to many, including myself. You have a diverse background with experiences in many clinical settings, and quite a unique path to your current role as CCIO at Intermountain Health. I would love for you to share a little bit more about how working in various settings, including a health IT company like Cerner, and I know founding a startup has prepared you for your various roles in a health system, both as CNIO and CCIO.

Becky Fox:
I've been very fortunate, you know, in my career to have lots of different opportunities. And I think, you know, when you go to nursing school, that's not necessarily what you plan is, you know, In two years, I'll do this, and in five years, I might take a different path and try something else. But that's the great thing about being a nurse is that you have really visions, like the aspects of your life that might be developing. So, for example, when I was newly married, it was a perfect time to join and partner with Cerner and travel around the world. I didn't have children and other responsibilities of soccer games or, you know, activities at school. So I was able to travel around and really dive into that aspect of learning different areas within the health care system. As my children got a little bit older and other dynamics changed our family, then it also became an opportunity for me to really hone my skills as a chief nursing informatics officer in my local community and really understand the challenges that every healthcare system faces, and then, most importantly, work collaboratively with other leaders to really make differences, which to me felt like in my backyard and still be at home. So that's always the biggest challenge, I think, for women, women leaders is how do you figure out the balance? And just always looking at it as every single opportunity that you have in your career is another skill set that you can put in your tool belt. So even when I look back at my graduate time, at that point in time, I really had to kind of piecemeal together some things to pay the bills. And so I got an opportunity to work part-time for a pharmaceutical company, I worked part-time for a staffing agency and got to work in an ambulatory clinic, got to work at a long-term care. And even though, you know, I'm sure my mom was probably questioning: What kind of career is this, that you're doing all these little things? What they really taught me later on, though, is really having that experience of being the boots on the ground and understanding what is medication delivery in a long-term care facility. What does it mean in an ambulatory clinic on Friday afternoon at 5:00, when patients are really trying to renew their prescriptions? How those different dynamics really make a difference, now, when we're trying to put in technology and make all of those processes less smoother? So I'm very thankful that I had those opportunities. And there's no other career than nursing that can give you all those opportunities to really learn about the entire continuum of health care.

Molly McCarthy:
Yeah, I love that. Really, obviously, balancing your personal journey with your professional journey is so important regardless of where you are, I think. And also I love your point around opportunity, just the ability to learn different skill sets and really taking those skill sets, they're transferable, from one role to another; I think that's really something that's unique about nursing. The other piece that I heard, actually, when you were mentioning your mom, is just flexibility, not just in terms of the roles that you have, but the opportunity to be flexible and creative in your life. And I'm sure that came in handy when you were at Atrium as the CNIO with Covid-19. So just being flexible during that time period, I know you did a lot of innovative work then, so really appreciate your insights there.

Becky Fox:
I want to, I do think that, you know, that is the thing in every opportunity. There's always great experiences that you can have in any job and any role. And sometimes there's challenging experiences. And what I always try to say is, even in the challenging moments where I'm like, man, I don't want to do this kind of work, or maybe this isn't the team for me, there's still a lot of nuggets of wisdom that you can take forward. So in Covid, we learned a lot. There were some things where like when, man, we shouldn't have done it that way, or we should have really gone in a different direction. And so just pausing and saying, Okay, what can I take that I learned from that to make me a better leader, to make me a better colleague, to make me a better nurse, and make me better for patients or our communities or our health system. If you can always have that perspective, that's what helps keep you going. You know, again, if I look back in my career, there's lessons I learned along the way that you just put in your tool belt and then you never know when you're going to need. You know, something I might have done ten years ago, and, you know, I used to support the special events team and help really provide nursing care at football games and basketball games and those kinds of things. And so when we were looking at vaccine distribution, well, that was a great example where I'm like, wait a minute, I know exactly how to take care of, you know, of patients as they're coming in through a football stadium, you know, because we had seen that. And so having those lessons learned, and even though there might be challenging at times, they might pay off later on somewhere in your career path. So always think of them as gifts and little nuggets of wisdom, and that someday you'll be able to use them to your advantage.

Molly McCarthy:
Yeah, I love that. Those little golden nuggets that sometimes you appreciate more in hindsight. So kind of switching gears now, talking a little bit about Intermountain, obviously it's, you know, I've worked with Intermountain in many different roles and it's a well known system, very highly respected for innovation. And you and your colleagues are really among an elite few major health systems that have embraced value based care at scale. Intermountain has ceded transformative companies like Civica RX and Graphite Health. You've embraced new models of care, expanded into new service areas with acquisitions, etc.. So I would love for you to tell our listeners about the advantages of the culture of innovation and what that brings to your role and how that manifests itself in your work every day.

Becky Fox:
So one of the important things is you can want to be innovative, but if you don't have the culture to build and sustain that, it's really difficult to get innovation done. And so we are very fortunate that Intermountain has a long history of really leaning into innovation and leaning into innovation that comes directly from the front-line caregivers and staff; nurses, providers, anyone in the organization today can submit an idea for change, which is really exciting to have that opportunity. When you walk through the campuses and the different, you know, health care settings within the Intermountain Health, you'll see posters or you'll see signs or big banners that will say, Submit your idea here. And, you know, any clinician or caregiver can take a picture of a QR code, submit an idea that will be evaluated by the organization to see if that's something that can bring efficiency, better quality, and outcomes for our patients. And we know that some of the best ideas that we had at our company and in healthcare really come from those that are delivering the work on a daily basis. So it is exciting to have that kind of culture and that climate. And right now we're doing some piloting and some work in expanding our telehealth services, looking at AI for nursing. And so if you have that culture where everyone says, Hey, we're going to lean in and try things out, there might be things that don't work, and we absolutely want to hear it, learn quickly, pivot as appropriate, and move things forward and share those experiences with both inside the organization as well as outside and externally. We do think there's a really important aspect of having a collaborative culture as well, so we can learn things, which is awesome, and we can make differences to patients and families and communities, but it's really much more a part of our bigger mission, which is to help everyone live their healthiest lives possible, which means that you have to be a good partner, you need to share these lessons learned with other healthcare entities in the entire ecosystem so that collectively, we can all make a difference together. And so that's what I'm very fortunate to work in that. It is something that is felt at all levels of the organization, I would say as well, which again, is really important to have not only a culture at the top line, but also at the front-line caregivers. And so when you have that culture where you have that openness, when you have that transparency and really seeking feedback, listening to learn, and really embracing that at all levels of the organization, that's why I think you're able to make differences and try new things out and hopefully make a difference to the patients and communities that you serve.

Molly McCarthy:
Yeah, I think that's really important, just the culture piece and then the ability for front line staff, and I'm assuming it's not just nurses, but it could be someone from pharmacy, it could be someone from PTOT, speech therapy, just all the different disciplines, as well as someone who might be in more of an administrative role can participate in that. So that's great. And I love your comment about collaboration internally and then really externally, because as we know, having been in healthcare for quite some time myself, I know that collaboration is key between health systems, between tech companies and health systems, really, because it's going to take a village to make transformation happen.

Becky Fox:
And that's the thing that we all really learned in the pandemic was, I would say five years ago, if someone discovered something great, a new process or a way to take care of patients, then a lot of health systems would then want to replicate that to validate the information. And so what we found is during the pandemic, instead of replicating things, we're just carrying it forward. So if someone has a great idea and they can get through steps one, two and three, then the next health care organization needs to do four, five, and six, and then collectively they all move together faster. That's what we really seen in the telehealth space, especially, how do we bring efficiencies to nursing? Every health care system is experiencing a shortage predominantly in nursing, but it's impacting all of the disciplines. And so if we don't collaborate together, really focus on retention, recruiting, making sure there isn't a burnout aspect and making life as best as we possibly can for our caregivers, then we're all going to be impacted by that. So it really is this collaborative attitude that I've found has really evolved in the last few years. I think the pandemic drove a lot of that, but I'm really excited to be at a point where we can all very quickly if we have a challenge in our telehealth space, I could pick up the phone, text some friends and say, Hey, what did you do to solve this? And then we can share ideas and most importantly, make a bigger difference quicker.

Molly McCarthy:
Yeah. Without like you mentioned, additional proof points, etc.. So obviously you've got a lot going on at your organization. I know you're about a year into your role, I think?

Becky Fox:
Yep. Just over a year.

Molly McCarthy:
Just over a year. Yeah. So how do you set your priorities? And would love for you to share some initiatives that are kind of top of your list today.

Becky Fox:
Probably the biggest one is how do we bring relief to our caregivers on the front line. So one of the things our CEO, Rob Allen, has really focused on is simplification. It really is just as simple as that. How do we make your work life experience easier? And so that can be anything from signing your time sheets to maybe having a name change to using our EMR, to placing orders to getting equipment supply chain; every aspect of the organization, we need to try to make it things as easy as possible. You know, even though we might have the best intentions, sometimes we put technology in place that might have a few speed bumps along the way. So really having open dialogue, transparency, and again, that culture of ideas sharing from our frontline caregivers has really been beneficial to helping us focus and reprioritize those things. There always is the challenge of, you know, there's 8 million things that we would like to go do, and we only have the time and or the resources to do a lesser number of those. So it really is important, again, to work with our operational leaders to help us with prioritizing those things. We are really focused on making sure that our tools are operating at the highest efficiency, bringing the biggest values to the caregivers, and smoothing and optimizing along the way. So for us as informaticians within the organization, we really focus on building tight relationships with our clinical and operational leaders so that we know directly from the top line. And then we also hear directly from our frontline caregivers. So really, again, listening, leaning into what are the biggest challenges and then trying to serve as the translators and help to reprioritize those things from an IT perspective is really important.

Molly McCarthy:
Yeah, I love that. You mentioned translators. I know that we often sit in that space between tech and clinical. It's so critical to really have you in that role, just because you're able to really understand from a technical perspective and clinical. So very unique. So that's great. I would love to kind of dig in a little bit more to technology. And as I mentioned at the beginning, sometimes technology can be somewhat of a hindrance. And our goal really, at least my goal in my career is to ensure that technology can really empower clinicians. And to your point around bringing relief to your frontline caregivers so that it's not so frustrating and they can do their job and they're not encumbered by administrative tasks. So I'd love for you to just share a little bit more around rapidly evolving technologies and workflows, like virtual inpatient care. I know you've done a lot with you mentioned telehealth, not just, you know, having cameras and rooms, but ambient monitoring. And then also, you mentioned artificial intelligence to really help address your priority of bringing relief to the front line.

Becky Fox:
So one of the things that we're really focused on is how do we bring tools and technology to help support the caregivers? So nursing staff, for example: How do we help them in the process? If there's administrative tasks that they're doing, then how can we relieve that burden? How do we streamline that burden? And then how do we optimize that activity? So for example, you know, in the last six months, we evaluated our admission process in one of our regions and really looked at some of the content. And we realized that here, content that we were gathering that was very important, maybe a few years ago, was now less important or perhaps it was gathered at other points during a patient's in-country visit. And so we realized that this was something we did not need to collect anymore. And so we went through all the right governance channels to make sure we were meeting regulatory compliance and those types of things. And we were able to remove just one section off of our admission process. And while some people might say, Well, that was just one section, it ended up being about 5.6 million clicks, you know, or assessment points that we were able to eliminate on an annual basis. Now, that does not mean that we can do with one less nurse on a unit, that doesn't mean that we're going to change FTEs, but what it does mean is that is not a bedside nurse standing with a patient and asking them for information that it really is not valuable or contributing to the care of the patient. So not only is it impacting, the nurse is not collecting the information that really doesn't go anywhere, it really is also the patient experience. I'm not asking the patient something that they really is not going to help and change their outcomes at all. And it did end up being, you know, quite a number of hours. If you add up all the time of all those 5.6 million clicks. But those are just examples where sometimes just reevaluating what you did and put in place five years ago, three years ago, can really find some little nuggets of benefit and simplification. Now, at the same time, we're also looking at how do you streamline alerts, how do you streamline notifications, how those notifications come to a nursing staff? I'm sure many of us in our own personal journey, as everyone has become acclimated and, you know, can't live without a smartphone, we all have that experience where, Oh my goodness, I'm getting this text message five times from the store or travel or whatever it might be, and they didn't, or the school or, you know, and they didn't mean to text me six times. Everyone's had that experience. So what I would also say is everyone lives their last best experience and their last worst experience. So if you have a terrible experience with a personal shopping or a personal travel that impacts you, when you come to work, you don't want to repeat that. If you have a great experience at any of those other personal things in life, you've come to work and you want to have the same similar great experience. And so that's what we're really trying to look at now of how do we make sure that alerts are functioning in the best way that they're really functioning in the most appropriate way, and then we're not driving people crazy by either alert, over-alerting, you know, fatiguing them with having to answer or re-answer things and really kind of trying to smooth the edges of the technology that we put in place.

Molly McCarthy:
I think optimizing your investment in what you've already financially committed to is so important in this day and age. I love the example around the admission process, and that's quite a tangible number, 5.6 million clicks on an annual basis. I know sometimes as a nurse or a patient, some of the questions are like, well, it's charted or it's been asked of me 20 times. It's got to be somewhere. So that's wonderful. And it's not just because, you know, you're making changes because it just doesn't make sense for the clinician or the patient. And then the, obviously, the streamlining alerts and notifications, as you mentioned, I do that on my smartphone. I don't like to be disturbed by certain apps, etc.. The thing that I heard you say, which was really neat, that I just want to repeat for everybody, is, you know, your last, best experience and your last worst experience. And that's really true. And it's not just for that patient coming in, but it's for our clinicians at the bedside. So I commend you guys for looking at it from kind of both of those lenses because I think that's really important to improve the overall experience.

Becky Fox:
Yeah. So that simplification, how do we make things simple, it's everything from how do we help patients with scheduling appointments, how do we ensure they get notifications. And the other thing I would just encourage, like I said, there's always a full agendas and schedules and calendars and meetings that every one of us have to attend to, that if you don't have the opportunity to go and see it, to feel it, to experience of what our patients and their families experience, it's really hard sometimes to see some of those nuances that need to go away. I know recently I had, you know, had to schedule an appointment annual well checks for some of my family members, and the process, again can be very easy or it can be very challenging depending on the technology that set up the health systems. And so it's really important for folks to understand that, that there's a lot of different nuances that go into that, whether if you have one child you're trying to schedule an appointment for, if you have three children and you're trying to schedule an appointment for, and really trying to understand, how do we make that as simple as possible? That's what's really important is because the best experiences are what's going to keep patients coming back and families coming back; the worst experiences are what it makes it easier for them to go somewhere else.

Molly McCarthy:
And that's really important. And not only thinking about how you make that appointment. I know for me, for example, I had to make an x-ray for my son's foot for this evening, and I was like, if I can't do it online, I'm not going to make it at a certain place. But I think that's important. As we think about the demographics of today, who's in the workforce, who's in the patients in terms of five generations of people and what they might prefer. Some people might want to call and speak with someone. Other people are like, you know, for me, I was like, I want to do it online. If I can't do it online, then, you know, I'll find another place. So I think that's really a great point around ease of use and simplification.

Becky Fox:
I think the other key aspect is it's more than 80% of all health care decisions for families are made by women in the family. So the reality is, if you're not focusing on that of how do I make it easier for the woman of the household to make appointments, to schedule things, the convenience, the information, make it easy for them to access that information, get to it in a multitude of different ways, meaning, if I go to the website, it's the same type of experience as if I was on my phone versus if I was calling in. It's all the same types of information, same experience, a good experience at every point of the way. And that's how you're going to help women make the decision to keep coming back. The women are the primary decision makers of health care for not only themselves and their immediate family, but also for extended family. And so we have to again, continue to remember the last best experience they had is what they're going to compare you against. And so if you can make it convenient, easy, forward-thinking for them, then that's how you're going to have a loyal family that'll keep coming back to your health care organization. And so as Informaticist, we have to keep that perspective in mind. And when we find pain points, when we find stumbling blocks, when we find those little bumps in the road that make it a little bit harder, that's what our role, is to really help surface that, help everyone else understand that, and then make better choices and make it easier.

Molly McCarthy:
Really great points. Thanks for, you know, mentioning that. And just what keeps, you know, to some extent our loyal consumers, it's important in this day and age, and just to drive that continuum of care as well. So my second to last question is I would love for you to share your vision for the future of nursing within the hospital. Really, when you think about change management as care models are being reimagined right now, and obviously the role of technology will play to empower bedside caregivers as well as patients in new ways. We've talked a little bit about scheduling. Just would love for you to share some of your thoughts around care models within nursing, and how that will help nurses simplify as well as patients.

Becky Fox:
I'm really excited to be in health care right now because there is so much technology that's evolving, and even though there are some scarier aspects, uncertain aspects from a regulatory perspective of what's going to happen in the future, I'm also really excited because now more than ever, nurses in particular have the opportunity to really lean in, be a part of entrepreneurialship, innovation, driving how technology is going to revolutionize and modernize the nursing care process. I'm sure many of my colleagues out there remember writing on paper, which now sounds so like dinosaurian. And the dinosaurs brought us a piece of paper and we wrote down a care plan. But really, this is our opportunity to say, like, I don't want to just take the care plan and put it in an electronic format. I really want to say, Why am I writing this care plan at all? For how can we completely have AI help generated and make me focus as a nurse on the more higher priority things for a patient? That's where I think is the greatest opportunity. And nurses, in particular, have the opportunity now to really be a part of those conversations, to drive those conversations about what this technology needs to be. So to me, it's an exciting time to be a part of that, to be a voice at the table that says, Hey, this is what we need to do and change and really revolutionize what we've been doing. What I envision is there is going to be a lot of technology coming at us fast and furious, and I'm really excited because no longer will the nursing staff have to spend a lot of time trying to figure out staff scheduling as a nurse manager. We have tools, and there will be tools that will help them figure out where the challenge is going to be in the staffing model, where are the gaps going to be, and how do you help fill those? Where are you going to have overage? And how do you help shift things around? We want the technology to help drive those things. So the nurse manager, instead of filling in holes, is really focusing on managing the units and supporting the team that he or she is responsible for. When I'm really excited for too is that the nursing assessments can change and the care planning can change. And again, now with AI capabilities, you can look at this large data sets of patient information and serve up to the nursing staff priorities, things that might need further evaluation, and really refine and hone in their assessments where in the past might have been something that was overlooked. So I am excited about how it will change not only the operations of things, but the assessments and how we plan care and how we are notified that the patients at risk for different things into the future. And then I am really excited about the capabilities that are coming with regards to data analytics. So right now we make decisions with the best sources of information that we have. And you can imagine now, not only having information within our health system, but across other health systems, I really think there's going to be a greater ability to drive care planning, meaning treatment planning, interventions, surgeries, etc., for our patients. So I do think that's just going to be a really a big change and shift in how, you know, it's not going to be the same cookie cutter treatment perhaps for patients; it really can be much more personalized, much more driven, and that will hopefully lead to better outcomes, lower costs, and a better experience for everyone.

Molly McCarthy:
Yeah, so many good points that you mentioned. Just, you know, one thing that I heard right off the bat was just, you know, we don't want to take what exists today and just digitize it for the sake of making it digital. And I think that's so critical. Even when we think about documentation, you know, moving from paper to computer, really as nurses working with our critical thinking skills, so important. And that's what technology can enable us and allow us to do is to work to the top of the license. So that's where we're focused. And really, I'm going to reiterate your point about nurses more than ever, having the ability to drive the transformation within nursing. We own it. So we should be driving it, quite frankly, in partnership with our technology, vendors, and our IT departments, chief clinical information officers. But there's no reason why we shouldn't be at the table.

Becky Fox:
Absolutely. And so what I would say to encourage those out there, because some folks might say, Well, how do I get involved in that? So the first thing is really just learning all you can. You can simply Google, Safari, any of the platforms you can go and just research what other folks and other healthcare systems, what other companies are doing around the AI development, and understanding how people are using it. That's the first thing is really to help educate yourself. ANA is a great source of information, AONL; there's a number of different professional organizations that also are bringing forth educational sessions so that nurses can really understand, and all caregivers can really understand how AI might impact the care that they deliver, and most importantly, change things for the better. The second thing I would say is raise your hand anytime you get asked an opportunity of, Hey, do you want to get involved in a project, a pilot, you can reach out to the technology arm of your healthcare system and ask about how you can get involved, and you'll be surprised about if you let others know that you're interested in helping it to be a voice of that, and learn and test things out, then you'll be surprised how you can find some great ways to really expand your involvement in your ability to make a difference.

Molly McCarthy:
That's great. My last question, which I think you just answered, but I'm going to ask it just to make sure we didn't forget anything, is obviously our listeners from different cross-sections, but CNO, CNIOs their respective teams. And so given that your experience is, you know, very unique within healthcare and really across different portions of the health care system, if you had to give one piece of advice to our listeners, what would that be as they are thinking about the responsibility of being tireless advocates for their patient? I know I do want to reiterate what you just said in terms of learn all you can and raise your hand to get involved. Anything else that you want to leave our listeners with today?

Becky Fox:
I would say the other thing is don't be afraid. Well, it's two pieces of advice. Don't be afraid to jump in. You'll be surprised. Like if you can figure out how to connect up a chest tube in a crisis moment and do CPR and save lives and all those kinds of things, you can do really big, amazing, incredible things. So don't be afraid to jump in with an idea, with an innovation, and really helping to lead the way. The other thing I would say is don't sweat the small stuff, and build relationships along the way. So I guess it's three pieces of advice and that is, I've been surprised in my lifetime that there's been things that might have felt like stumbling blocks, and maybe I gave it more emotional energy and time and effort than it really needed to. And so instead of focusing on that stumbling block, instead focusing on how to get around the stumbling block and how to proceed forward. And so I think if you spend your time and energy on the path forward, even though it might be a different path forward, you'll come out further in the end and your idea will come out further in the end. And then, like I said, just don't sweat the small stuff and don't be afraid to jump in.

Molly McCarthy:
Well, Becky, thank you so much. Always great to have you enlighten me with all of your amazing experience and wisdom as well as our audience. So thank you so much for your time today and I look forward to seeing you soon.

Becky Fox:
Always good to see you, Molly.

Intro/Outro:
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Dr. Jane Mericle Executive Vice President at Nemours Children's Health

"I would say that we have optimized the monitoring of children across states. We can go into the room and see the patient, but then this next phase of virtual nursing has taken that to a whole new level. So with the new technology and with support from our technology partners, this camera now, not just can see in the room, but it can be interactive and that the virtual nurse can come up on the screen. We've actually been able to pull up an interpreter as well." - Dr. Jane Mericle

Dr. Jane Mericle Executive Vice President at Nemours Children's Health

Episode 25 Innovating for Our Little Ones:

A Spotlight on Pediatric Healthcare

SCTS_Jane Mericle.mp3: Audio automatically transcribed by Sonix

SCTS_Jane Mericle.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CMO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers lives harder, not easier. It's time for smart technology to empower care with a more human touch. I'm thrilled to share a little bit more about our guest today, Doctor Jane Mericle. Doctor Mericle is executive vice president, enterprise chief nursing executive, and patient operations officer with Nemours Children's Health. She is a member of the executive cabinet and serves as the senior nurse executive for Nemours Children's Health. Doctor merkel brings more than 40 years of health care experience to her role, and is a certified and executive nursing practice with expertise in clinical quality and patient safety, strategic planning, fiscal accountability, operational management, magnet designation, performance improvement, patient experience, and interprofessional collaboration. She is a Team Step Master Trainer, a certified Six Sigma Black Belt, an executive leader for LEAN, and she completed the Disparities Leadership Program sponsored by Mass General Hospital. Prior to joining Nemours, Doctor Mericle served as associate chief nurse for Duke Children's Hospital and Health Center. She has received numerous professional awards during her career, including the very prestigious Founder's Medal from Vanderbilt University, the North Carolina Great 100 Award, and the Duke University Health System Emeritus Presidential Award. Doctor Mericle completed her Doctor of Nursing Practice program at Vanderbilt School of Nursing, earned her Master of Health Science in Clinical Leadership from Duke University School of Medicine, and her BSN from Columbia University. Welcome, Doctor Mericle, it's so great to have you here today. Do you mind if I call you Jane?

Jane Mericle:
That would be perfect. Thank you.

Molly McCarthy:
Thank you so much for taking time today to speak with me and our listeners and share your story and insights. So, Jane, I almost don't know where to start. Your career obviously is so rich in terms of experiences around nursing quality and safety and children's health care. And I'd like to dive into all of these areas. But first, really want to start with Nemours and Pediatric Care, as you are a first guest on the podcast leading a dedicated children's hospital. And I'm biased because I started my career as a NICU and pediatric nurse. Many of our listeners and including the podcast host, myself, have a special place in our hearts for those who care for children. So I'd love for you to share a little bit more about what leaders and innovators should know about what is different about delivering care in a pediatric setting, rather than in an adult-focused hospital? And what are the issues that you may differ but also have in common?

Jane Mericle:
Sure. Thank you, Molly. I'm glad to hear about your experience, because clearly you understand what a privilege it has been for me to serve and enrolls in children's health. All of my whole career has been as a nurse in children's health, and I can't think of a more important mission. When you think about children's health, we clearly say, It's not about having, taking care of little people. We will care for children and infants from prematurity to all the way through adolescence, 18, 21 and so, as you can imagine, just as you think of that span and the body and the size that changes, so we're having to think about that, we're thinking about developmentally; what an infant, what a child, what an adolescent needs. So highly specialized care around there. Move on to the kind of ways we communicate where you're not just communicating with the families and the adults, but we're communicating with the children. And there are definite ways of doing that in the different developmental stages. And I would say another thing is that children's health is always around the family-focused approach. Families have to be a part of that care, part of the care plan, a part of that understanding. And our teams are really specialized in delivering that sort of care. Then when we move from caring for children in periods of wellness, great deal of focus on prevention. So we want to have that health care delivered with that priority so that we can prevent disease from even developing. And then we have subspecialists who are specially trained in pediatrics and then in the specialties because there are children, small proportion, but there are children that have congenital defects, that have special childhood diseases, childhood cancer. I could go on and on. But there, it is, all wrapped around these children. And so you can imagine then also the psychological support for both children and the families that are a part of their care. So very specialized and very specialized around the different ages and phases of these children.

Molly McCarthy:
Yeah. Thank you. I've worked both in hospitals that take care of pediatric patients and specialized children's hospitals like Nemours. And the family-centered care is definitely an aspect I remember just because you are, and the parents, obviously, so important in the communication loop, especially having worked in the NICU, you have extended stays so the parents might not be at the bedside all the time. So even today, thinking about how far we've come, I'm just going to throw out technology just to.

Jane Mericle:
And I was going to add to that, Molly, even one of the comments that I saw last week from one of our parents was, Thank you so much. This was a child that was pre-teen. Said to the providers, Thank you so much for speaking directly to my child as well and knowing how that was important. So it's both ...

Molly McCarthy:
Yeah, that's a really good point because obviously that child, depending upon where they are developmentally, wants to be and should be included in that process. Thank you. I hope our listeners really can differentiate that specialized care that you provide. From a quality and safety perspective, specifically, what unique challenges must you address in pediatric settings as you consider opportunities for innovation?

Jane Mericle:
I think that if you think about, and what we just talked about, the individuality, we're thinking about the kind of care that really optimizes within that communication, optimizes within whatever developmental stage helps whether a parent is present or not present. And I think that the safety and the quality, also children are more vulnerable to complex systems if they don't go well. When we think about something like medication safety, the kind of dose from an infant to an adolescent is very different. And some of the equipment that we use is very different. And so we have to be able to create systems that are really address each in those sizes and the individual needs. And I think neonates are particularly vulnerable around infections because they have an immature system that protects them. And so we have to take all of those into consideration.

Molly McCarthy:
Yeah. Just drawing upon what you said earlier, they're not little adults, regardless of where they are in the developmental. And so both physically and I think spiritually and mentally they're at different levels. So very important. I know you mentioned medication dosing, which obviously done per the weight when they're very tiny, but also even the technologies aren't necessarily approved to use at at certain weights or levels of care. Really important as we look at the pediatric market to make it, it is very different and specialized.

Jane Mericle:
So when we think of technological innovation in pediatrics, I have to say that it's always been a part of our DNA at Nemours. So let's think about that vulnerability and children. We've had cameras in rooms and in patient rooms since 2011, where we knew that we wanted additional ability to monitor and to see those children in case there was an adult in the room, or in case there was vital signs that were telling us that they needed attention, or we could alert a nurse to go check on a child. We've had Kidshealth.org, which is an information sharing platform, since 1995, and that has been to really be able to share information to providers, to parents, and to those kids that can take in that information like school age and adolescence. And so we've been developing that over time. Telehealth has been part of what we've adopted to make care easier. And as during a period of Covid, the adoption absolutely skyrocketed because in some cases, it was the only way that we could deliver that care. And what a profound way, if you think about, for example, a child needing to have some counseling or a therapeutic intervention and being able just to be comfortably at home and dial in with their provider or parent, being able to ask the questions and have that interaction. It's really, it is part of what has enhanced our care. But there's so much more to do.

Molly McCarthy:
Yeah. Thank you. I love you mentioned having cameras in the room since 2011. I'm going to come back to that in a little bit. But you mentioned telehealth and my next question is a couple different parts. So I'll piece it out. But obviously Nemours is you are multi-state operator with, you have two hospitals, one in Delaware and one in Florida. And I know that you've got multiple outpatient clinics in Jersey and Philadelphia area, etc.. So I'd love to better understand how you think of care geographically. Obviously you oversee all of those sites.

Jane Mericle:
Yes. We are one of the largest multi-state pediatric healthcare systems in the country, and we're very fortunate to have such diversity across regions geographically, socioeconomically, regulatory, politically, which challenges us, but also this helps us to really push on new approaches that withstand diversity and the needs of our patients. Ultimately, we believe we can develop innovative approaches at Nemours, and it can be emulated by many other diverse organizations across the country. It's important to underscore the importance of Nemours Children's, and that we see ourselves as not only providing health care, but delivering health. And so we're really looking at how do we intervene with children in those healthy phases, because a healthy child creates a healthy adult, and we understand that and we take that burden seriously. And so we see ourselves also as both a leader and a convener. I would say that part of children's health care is also about coming together, whether it's different children's hospitals as an organization such as the Children's Hospital Association or whether it's in different collaboratives because there is nothing that should be protected around learning and quality and safety and technology and interventions and research. I could go on and on. But the more that we do that together, so as a health system, we're learning how to do that regionally, internally. But we're also doing that externally with many partners and with many other caregivers.

Molly McCarthy:
Yeah, I just want to point out that historically, and this was the next part of my question, which you already really touched upon it, that children's hospitals have always been, from my standpoint, really collaborative and open to sharing with one another. Obviously, how can, as you mentioned, how can we share our findings so that other hospitals don't necessarily have to recreate the wheel? I love that, I love the collaboration among children's hospitals. I worked with the Children's Hospital Association of America before. I've done some work with the International Society of Pediatric Innovation. That's fabulous, and I love that sharing of knowledge. Do you have any specific examples where you've led in that space or particular projects that you've worked on?

Jane Mericle:
I think probably the one that we want to talk about is the newest of our projects, where we're doing it across the state, but we're also doing it as hospitals is the virtual nursing care, and we can get into that. But I think that's a good example. I think the other thing is we collaborate on care bundles for ... bloodstream infections in children; how to prevent them. We collaborate on strategies for preventing harm in children. And I think that one of the areas that we led in several years ago was identifying septic shock. We were in a collaborative with SPS, or solutions for patient safety, and how to create the bundles and their response for early recognition of that septic shock. So I think there are examples of where were the innovators examples were that happy to be the partners and early adopters as well.

Molly McCarthy:
That's wonderful. I know, I do want to tell you mentioned virtual nursing, so I will take advantage of that and really dig into that a little bit more, obviously, with my tech background and our listeners wanting to learn more about the different uses of technology and sharing, really, that's the purpose of this podcast. So you mentioned earlier that you installed cameras in every patient room way back in 2001. So congratulations to you. I know that's so important, not just as a nurse, but as a parent myself and having kids in the hospital before. I think that's really important. And so building off of that foundation, what's your vision for the future of nursing within your hospitals when you think about the next generation of, for example, advanced sensors, which have broader capabilities beyond just the camera in the room, but thinking about ambient monitoring or smart alerts? So just, can you tell our listeners a little bit more about how technology will enable you and your nurses to reimagine care models and really to broaden the scope, and ultimately, from my standpoint, what I've seen is improve patient satisfaction, improve the caregiver experience? I want to hear where you are in that journey.

Jane Mericle:
There's so much there. And let me just, by contrast, let me share a one short story with you as a new nurse on a medical unit taking care of children. When I started, I would count drops in an IV to regulate the rate of a fluid that a child got. So I would literally stand there and adjust a roller clamp to be able to deliver the right amount of fluid to gravity. And fast forward, now it's, you talk to our nurses now and they can hardly even imagine. But fast forward to then using smart pumps and having IV delivery systems, a technology that not only delivers it accurately but also has guardrails and libraries so it alerts the caregiver as to are you sure you want to deprogram that? Or, this is infusion is done; your next, ready for the next. So we've already seen some of that progress in the same way in a more started with cameras in the room. And I would say that we have optimized the monitoring of children across states. We can go into the room and see the patient, but then this next phase of virtual nursing has taken that to a whole new level. So with the new technology and with support from our technology partners, this camera now, not just can see in the room, but it can be interactive and that the virtual nurse can come up on the screen. We've actually been able to pull up an interpreter as well. So if English is not your first language, right there, we're starting to do the interpretation where that virtual nurse is also doing something. Not all the listeners may understand that sometimes the team's work is administrative and entering a lot of information into the computer, into our electronic record. And so while the electronic health record has been an advance, it's also one of those things that has a double edged sword because there's a lot of interacting with computers. And now what we're finding is these nurses are able to do a lot of that administrative work virtually. Our families understand the virtual model because of what we've just gone through with Covid and Zoom. And what we're able to do then is create much more space for the caregivers that are right at the bedside to do the hand on, the interaction, the human connection. And so what we have found that is done is really twofold. One, you talked about our workforce. Nurses, about 80% of our nurses are still express a great degree of satisfaction. However, when nurses are not feeling satisfied, we do know that one of the largest impacts is that burden, that work burden, that burnout. So many things to do, so many things to handle. But we are finding that this kind of model, the virtual nurse, has lifted up some of that burden. And so the satisfaction at the bedside is great. The satisfaction for the virtual nurse can be great, because it may be that they're at a point in their career where they couldn't imagine running the halls anymore and doing that, and that being able to use all their expertise in that kind of fashion is a beautiful thing. So that's been really positive. We're about eight months into our pilot, and we early on, 75% of the nurses that experienced virtual nursing model were very positive about it. But then there's the thing around the parents and the families. We have some early data that's coming in that also says it's improving their ability to interact with the nurses, to communicate, to understand, and to get that information. And we're seeing some of that, those early outcomes from both English-speaking and Spanish-speaking families, which is just really very positive, because in health care, sometimes those language barriers can be daunting. And then when we think about, let's go back to quality and safety, which you know is near and dear to my heart. We are finding that by having this overlay of this virtual nurse, that we are having opportunities to prevent harm, whether it's clarifying education and making sure that the caregiver really understands, whether it's a clarification of an order that may have not been fully understood, it may even be that they're being able to understand whether there's a therapy available fo the child at home. So we're seeing this and not just helpful to our teams, but incredibly impactful to the care that we're delivering. So that is an exciting new model of care. However, to your point, I think it's just the tip of the iceberg. I think that what it's telling us is we have to get out of our traditional models and thought process. And so what about this on-demand voice? What would it be like to have a nurse dialoguing in the room with a family and that program, being able to discern that and put that into the record as part of our record, what would it be like? And we could, I'm sure we can do this now, is to say, just like Alexa or Google, say, Hey, I'm worried about my child and have a rapid response team come ..., right? So there's so many possibilities of this. And I think that we won't get to that by working in traditional silos, the way that we are going to get to it is like what we're doing now is where we work with clinicians, analytics, engineers, technology, and that we really break down those silos, and that is what we're doing now. That's what's helping us to advance, to think of, so what are the possibilities? And then what is the application in this particular environment?

Molly McCarthy:
You have so many great points. I just want to summarize a few that I heard from you and congrats on. I know you mentioned you're eight months into your pilot, and I love always to hear the anecdotal feedback and outcomes. Maybe it's not published yet, but I think it's really important and very important learnings just in terms of burnout. You mentioned alleviating burnout and increasing the satisfaction of the nurse as well as the virtual nurse, which is fantastic. I have heard that so many times. And one thing I do want to mention too about that partnership between that maybe you have a seasoned nurse who's remotely and working with, for example, a newer nurse. I know when I was a new pediatric moving from NICU into pediatrics, I remember the nurse manager saying, It's going to take you one year to see every diagnosis across the pediatric spectrum, from newborn to, all the way up to the adolescent. And I just remember thinking, actually, today I think about what if I had a resource, a seasoned nurse at that time just to help me through those newer situations. So I think that's amazing. And it does increase that seasoned nurse. Her knowledge is being put to use, and that newer nurse has more confidence.

Jane Mericle:
I have to tell you that you are right on point there, and we are using that resource. The other thing is, it sometimes is very hard for nurses to ask for help, or you look down the hall and there's nobody there, and you think, I'll just, you know, and this is just so easy because it's set up as this is a person you call, this is the backup. These cameras, this technology is getting so good they can even do a double check on a dressing change. We haven't tested that yet, but those are the kind of applications it doesn't take two bodies in the room, right? We can do it with a virtual ... And so you're right: mentor support. And the other thing I would say is we are moving away from calling it virtual nurse and calling it virtual care because our other disciplines like our pharmacists, our respiratory therapists, our social workers are seeing applications for this as well as we deliver care to these kids.

Molly McCarthy:
And then we'll move to, we'll take out the virtual because that will just be expected, that care is both in person and it will hop some of it remote. And we're obviously not there yet. But I think eventually the whole concept of virtual health it's health includes virtual on-site, etc.. One other point that I just want to call out to the listeners is that you mentioned the quality and safety. Obviously, you're very well known for all of your work in that and the opportunities to prevent harm. And just going back to even thinking about physically how, for example, ... units are built today more as single room rather than you had when I worked, I've actually worked in both single rooms, and then you have more of a cohort with nurses and the babies more together. And I think from a patient safety, you mentioned just having the ability to call out for help. I think about a baby that I remember was coding multiple times. He had a congenital heart defect, and just the fear of actually even leaving him in that room alone. So having that virtual nurse and really for that patient safety and peace of mind for the nurse. So really great callouts. And then also just your comment about it's really a partnership. It's, people, we need to come out of our traditional silos and work together across IT, clinical, biomedical engineering to make this transformation happen. So thank you for that. I know, I could probably sit here and talk to you forever, but we do need to wrap up. And one thing that I always love to hear from my guests; our listeners are CNOs, CNIOs, nurses, hopefully some other clinicians just learning about what's going on in the nursing world. But obviously you've got a ton of experience in healthcare, and I would love for you as you think about all of your experience and where you are today, just leaving one little parting gift of wisdom with our listeners. So what would be your single most important practical piece of advice as it relates to their responsibility of being tireless advocates for their patients?

Jane Mericle:
I would just say that probably one of the most important things that I test myself on as well is being open. I think that so much has changed, yet there is so much possibility. How do we create for ourselves the ability to see what's next, what's down the road, and not to stop because these children deserve it? And so I am a big believer in building relationships, building these partnerships, collaboration, asking the questions. And I think that's going to be what we need to do. And I need to do that individually. You look at, my experience has been very hospital-centric, it's been very operationally-centric. But by adding in these relationships and these partners, I can just start in my head thinking about, could we do this? Can we do that? So I think as leaders. And secondly, is really to say the kids come first in children's health care. So our children, our family are central to everything that we do, and our teams. Taking care of our people, making sure that we are delivering systems and adjunct technologies that support them, that help simplify, that help make their work easier because a happy caregiver is going to help deliver the best outcomes that our children deserve.

Molly McCarthy:
Yeah, I love that. I just interviewed someone from Leapfrog the other day, and she said that the best organizations, in terms of quality and safety, are the ones that have the most respect for their nurses and the nursing protocols. So spot on. Thank you so much, Doctor Mericle. Really appreciate all your insights today and wish you the best as you continue on your journey.

Jane Mericle:
Thank you, Molly. Really appreciate the time.

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight for best practices in AI and Ambient Intelligence, and ways your organization can help lead the era of smart care teams. Visit us at VirtualNursing.com, and for information on the leading smart care facility platform, visit care.ai.

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Leah Binder President and CEO of The Leapfrog Group

"When nursing and nursing perspectives and nursing leadership are respected within a hospital, that's when you feel like the patients are better protected because it is the nurses who are really closest to the patient in an ongoing way, and they're the ones also with that expertise." - Leah Binder

Leah Binder President and CEO of The Leapfrog Group

Episode 24 Nurturing Excellence:

Celebrating the Role of Nursing in High-Performing Hospitals

SCTS_Leah Binder.mp3: Audio automatically transcribed by Sonix

SCTS_Leah Binder.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CNO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers' lives harder, not easier. It's time for smart technology to empower care with a more human touch. I'm thrilled to share a little bit more about our guests today, Leah Binder. Leah Binder is president and CEO of The Leapfrog Group, representing employers and other purchasers of healthcare, calling for improved safety and quality in hospitals. She is a regular contributor to Forbes.com and consistently named among Modern Healthcare's annual list of the 100 most influential people in Healthcare. Under her leadership, the Leapfrog Group has grown fourfold in size and launched major new initiatives, including the Leapfrog Hospital Safety Grade, which assigns letter grades assessing the safety of general hospitals across the country, as well as ratings of ambulatory surgery centers and outpatient surgery, and the Judy Burrows Education Institute. She spearheaded successful initiatives nationally, including partnerships to reduce early elective deliveries, promote better hand hygiene in health settings, reduce infections, improve healthcare transparency, and promote safe use of health technology. Leah has served numerous national boards and councils, including the National Quality Forum, Women of Impact, CMMIs Accountable Action Collaborative, the National Alliance of Healthcare Purchaser Coalitions, the Jewish Healthcare Foundation, and AARP's Champion for nursing. Prior to her position at the Leapfrog Group, Leah spent eight years as Vice President at Franklin Community Health Network and award-winning Rural Hospital Network in Farmington, Maine. Prior to that, she served as senior policy advisor at the New York City Mayor's Office. She started her career at the National League for Nursing, where she handled policy and communication for more than six years. Welcome, Leah. It's so great to have you here today.

Leah Binder:
Well, thank you for having me, Molly. It's great to be here.

Molly McCarthy:
And first of all, really appreciate time out of your day to speak with us and our listeners. And I suspect that many of our listeners know Leapfrog as a name and associate that name with quality and healthcare. But I also suspect that very few really know the who, when, how, and why of Leapfrog. So can you take us back to the beginnings of the Leapfrog Group and tell us the story of the inspiration of its founding mission and how the organization has evolved over time?

Leah Binder:
Absolutely, and I will say, I can brag about the founding of Leapfrog, in part because I'm not telling my own exact story. I didn't start at Leapfrog until Leapfrog had been around for about eight years, so I can look back fondly at its origins and brag about them all I want without sounding a little too pompous. But they started with a group of employers. These were large companies, and they were HR executives or like GM, GE, Boeing, Marriott Corporation, some very large companies, all of which you would know the names of. And these executives got together because they were very concerned about safety and quality in healthcare. A report had just come out in the year 2000, or actually the report came out in 1999 called 'To Err Is Human'. It was from the Institute of Medicine, and it suggested that upwards of 100,000 people were dying of preventable medical errors in hospitals, and they were concerned about that. They had very concerned about that because they had spent decades really trying to improve the healthcare their employees were getting, and both from a quality point of view, but also cost effectiveness point of view. And both of those they felt had not been successful.

Leah Binder:
And here they were hearing about yet another issue that was perhaps the most outrageous of all, that people were dying of preventable errors. That was just terrible. So they formed Leapfrog, and that was the nonprofit with a very focused, very simple mission, which was to make public how hospitals are doing on preventing these errors and accidents and encourage their employees to use the information. And they use the information themselves when they contracted for healthcare benefits. So when they would try to pay for the best care and not pay for the worst care and really be more businesslike, in other words, in their approach to their purchase of healthcare. And so a simple idea, really, of public transparency and really driving the ability to be discerning about picking among hospitals. And they started with hospitals. It was very little data at the time, but they went out to hospitals and said and via a survey called the Leapfrog Hospital Survey, they said, could you please provide us with information? And here are the questions, and the questions were about things, as Bob Galvin at the time was a GE, and he said he wanted the Leapfrog survey to ask questions that his mother would want to know about a hospital.

Leah Binder:
So that's what they did. There was some evidence behind it, so they still had some really top experts in patient safety to advise them. But even so, at the time, there just wasn't much that they could use. That was really great measures of safety that they could really call on. Anyway, so fast forward, and today we do the same thing. We really have that same fundamental value, which is we should be transparent about how hospitals are doing on safety. We should publicly report that information, and people should use it to make decisions and to communicate with the hospitals that they work with or the communities that they live in. They should be communicating with hospitals and saying, we expect you to do better on safety, and we will reward you when you do. And that's the same with employers to do the same thing that when you do better on quality and safety, employers should reward that with their purchasing. So that's still fundamental to what we do. We have a lot more tools in our toolkit and a lot more people involved, but it is really fundamentally the same principle, and it's working.

Molly McCarthy:
That's wonderful. I know early in my career, around the start of Leapfrog, I was actually back in DC working for A1 and I, you know, worked on a consulting group with really looking at root cause analysis, and patient safety was really becoming such a highlighted item, really, as you mentioned, really to provide that transparency to consumers to, as you mentioned, GE GE's, uh, executives mom, what they would want to know about healthcare. So, so important to provide that transparency. So kudos to to, you know, being part of that evolution. I want to switch gears a little bit and talk a little bit about looking at healthcare providers and obviously starting my career as a nurse. And you've worked in healthcare for quite some time, National League for Nursing. So, our healthcare providers take an oath to do no harm. And every one of our caregivers really choose this profession to heal those in need, obviously with compassion, empathy, and even with the best intentions, quality and safety have room for improvement. What's the current state of quality and safety across our hospitals, and where have we made progress, and where do you think we have more to do?

Leah Binder:
So I think the current state is certainly not what we would all want. It certainly is not the healthcare system that I think anyone who chose a career in healthcare wants. I mean, we all, everybody who's involved in healthcare in any way wants the United States to have the very best healthcare in human history. That's basically what we want. And we don't have that. But we do have progress, and I believe progress is something to celebrate. So I do think there are really bright spots and those are worth celebrating and also learning from, because I think we can build very quickly, we can scale some of those successes. So the success that I would see that, that I see every day actually is in patient safety. Now, patient safety is an example of where there's a lot to complain about. So, the statistics on patient safety are quite disturbing. There was a recent report from the office of the Inspector General. It's sort of independent body that looks at how the Department of Health and Human Services is doing, and they looked at a random set of records of Medicare beneficiaries who had been admitted to the hospital, and they found that 1 in 4 of them were harmed at some point during their stay.

Leah Binder:
That's a very high rate of harm. 25% is a very high rate. Anybody in any other industry that would never be even in the realm of tolerable. So it is very high. And we know also now with good estimates in peer-reviewed journals, that it's about 250,000 people die every year from these preventable errors. So that's also a very high number that would make it the third leading cause of death. So we have a long way to go, I always have to preface with that, this is a major problem. It should be considered a top national priority to address it. For every single person in healthcare, this should be a top priority. That's it. We have seen real progress in especially in the past decade with hospital-acquired infections. There was a spike in them, they went up during the pandemic. That was a major problem, which we reported on and discussed at length at the time. However, that's coming down really rapidly. We also have seen a reduction in the patient safety indicators, so-called, that are measured by CMS, the federal government, and the ones that are most publicly reported. We are seeing real reductions of falls, pressure ulcers, injuries such as that. We're seeing very significant reductions in those as well.

Leah Binder:
So I think in hospitals we are definitely seeing progress. And I mean by like 20 or 30% in some cases even higher than that 50%, I think, for central line infections. So, really, really significant reductions in. Some very high profile and deadly, in many cases, deadly events. So that's good news. And I think what makes that the kind of news that I want to focus on in my own work, and I think everybody should look at, is because it's a success, it's progress. And we need to ask ourselves, how did that progress come about? What did we do as a country because we did something as a country to see that kind of change nationally. And I think there's a variety of things we did. But I will say one thing that's different in the past decade when we saw this progress that's different from other decades where we have continually not seen progress, is transparency. We have been publicly reporting those measures since the Affordable Care Act since 2009. I certainly want to take some credit for Leapfrog, which I think has put patient safety and transparency on the map, especially in the last decade when we launched the hospital safety grade. So I think we've seen but so we take part of the credit for that.

Leah Binder:
But really, having that data available publicly reported has made a difference. It's not just the difference, by the way, for the public, I'm not sure if everyone in the country says, oh, I have to figure out what CMS says about this hospital before I go there. I actually don't think that's necessarily happening all the time. Some people do, but not it's not happening all the time. The biggest thing that's happening is that hospital leaders themselves and clinicians are aware of this data. They see it, they recognize it. They challenge themselves to do better on it when it's there, when it's in front of you when it's public, it just has a galvanizing effect. You really want to see it change. You want to be better than your competitors in those met. You want to. It's galvanizing. So I think that's been a big difference, along with all of the tools and efforts that have been really put out there from not only from a little bit from Leapfrog, but a lot from CMS and many other really great organizations that are out there really helping hospitals especially get better. So I think combined with that push from transparency, we've seen real progress, and now we need to grow it.

Molly McCarthy:
So many great examples. I love that you really focus on the progress that we've made, because I think that's really key. And especially over the past ten years with hospital-acquired infections, falls, pressure ulcers, central line infections, I know those are all, you know, never they should be never happen events. And really attributing that to transparency and awareness. I always like to say you can't really change what you don't measure. And so measuring that and providing that back to the hospital leadership is key. And to your point, I am a consumer. We're all consumers. I don't necessarily go every time and look up the safety scores, although I am probably a little bit more in tune than others. But to your point, it's information back to the leaders of where they are and where they need to go, which is fantastic. And they need that in order to have the CQI in that improvement. So, thank you for sharing that.

Leah Binder:
It's also information back to everyone who works there.

Molly McCarthy:
Right.

Leah Binder:
It's the leaders. Yeah, And the board. But it's also the person who's serving the meals to the patients. The inpatient unit, from dietary, everybody gets involved. And that's especially true when they get a good grade. So what we find is when we give an A to a hospital, they will often celebrate it throughout the entire hospital. But where pins that say we got an A for patient safety, it's just very visible. And it's a recognition of their achievement when they get this and when they don't get it, they know about that too. That can be really, I'm sure, upsetting. But it's also goading. It says, no, we got to do better. We got to do better. Everybody gets involved. And I think that's, um, you just can't substitute that level of all team engagement.

Molly McCarthy:
Yeah. Thank you for pointing that out. I think that's really crucial. You know, it's not just those at the top, but it's very much everyone across that value line, value chain who provides care, whether they're delivering a medication or taking a patient from the floor to a procedure. It's really critical and it is a team approach.

Leah Binder:
Yeah.

Molly McCarthy:
So we've talked a little bit about the trends that you've seen and the current state and the improvement. What characteristics do you see as common to the top-performing health systems as it relates to quality, safety and patient experience?

Leah Binder:
I would say the first thing I notice about the highest performing hospitals when we look at the data when I go to visit the highest performing hospitals, the number one characteristic I will see that is at least striking to me, is that the CEO or top leadership will be unsatisfied with their own performance. I can't tell you how many CEOs of truly, outstandingly safe hospitals. I mean, now nobody's perfectly safe. There's no hospital in this country that's perfectly safe, but ones that have shown continuous excellence. The CEO will say, well, you know, I don't know. I worry about this, I feel like we don't do enough with that or we don't have people trained the way they should be and something else, or our hand hygiene. And I still wonder if people are truly washing their hands, and I want it monitored. They always have something else that they think needs to be done. They're never satisfied. They're always worried about safety, they're always worried about the patients. And it strikes me every time because I don't always see that with hospitals I visit that aren't doing so well sometimes. That will be a long story from CEO of how all the great things they're doing, which is important here, by the way. I do respect and like to hear that, but it also it is very different from other kinds of hospitals where they're that just are never satisfied that they've got to do better and better and better and better.

Leah Binder:
And that's I think that's needed for safety, because safety is a 24\7 ongoing enterprise, and you got to be worried about the patient 24/7. That's got to be your keeping you up at night in order to maintain safety. You can't just say, oh we got our central line infection down. We got that rate down to zero, pop-open the champagne and we're done. Because if you stop what you were doing to prevent those infections, then the very next day they'll be back, and your patients are at risk. So you can't see it that way. It's not a series of like one-offs. Patient safety is an ongoing way of life in a hospital, and it means that you have to worry, worry, worry about your patients all the time. Are we doing everything we can to make them safe? And when you see that from the top, from the CEO, that's when you recognize an excellent hospital that's really standing out for its performance. And I would say the other thing that I've observed in hospitals that are particularly high performing is a real respect for nursing. Most of what a hospital does is provide nursing care. Those are usually the most numerous of all the professionals working there. And everything that happens when you're a patient, nurses are just 90% of your day is nurses.

Leah Binder:
You depend on nurses, you depend on their expertise enormously. You look to them for their also their concern. And when you're scared in the middle of the night, it's the nurse that you want to talk to, and it's the nurse who has that expertise and education to really help you in the way you need to be helped as a patient. It's just they're very important. And when nursing and nursing perspectives and nursing leadership are respected within a hospital, that's when you feel like the patients are better protected because it is the nurses who are really closest to the patient in an ongoing way, and they're the ones also with that expertise. I saw a really interesting presentation by a collaborative in Michigan that came out of the Michigan Hospital Association, and they actually worked with us to go through Leapfrog data to find highest-performing hospitals. And they found, among many interesting insights, one of the top insights was that where in hospitals that where nursing protocols are respected by everyone, whether it's the chief of surgery or the dietary staff, everybody respects the nursing protocols and adheres to them, that those were the hospitals that were just much at the top of the quality spectrum. So I think that nursing is something to look at.

Molly McCarthy:
Well, I know our listeners are going to love that. The one other thing that I was just thinking about why we were talking and you were mentioning some of the common top-performing health systems with leadership who are unsatisfied and really always worried about their patients. And then to the respect for nurses, one of the things that I saw in the shift, probably around the time Leapfrog started, was just the involvement of patients and their families in terms of asking questions. And I think historically, like I think about, if I take my father to an appointment, he might not grill them as much as I do. But how have you seen, like, the patient engagement change over time to I'm just curious.

Leah Binder:
Significantly, that's a very good point. That has really changed, especially over the past decade. And one of the things you see now are, most hospitals, at least, that I've encountered, have patient and family advisory councils, and some of them have a variety of them throughout. We have many more standards now related to engagement with patients or patient perspectives. We have, for example, on our survey, we have a standard around patient consent and how that should work and engagement of patients when there's a root cause analysis done. Are the patients and families of engaged in that, things like that. And that's really consistent with I think, where a lot of hospitals are going, is really bringing patients into the really the center of how everything is done, which is where they belong, and everything should be about the patient because that's why the patient is there, because the delivery system is delivering care to them. But we haven't thought of them as part of the team. And you're right, that has been a really major trend. And CMS also drove that trend, that was part of their efforts in the Affordable Care Act, that a lot of supports for hospitals in moving and shifting toward having more engagement of patients in their overall operations, and also measuring whether that was working with the H-Caps surveys, which are the patient experience surveys that are CMS requires hospitals publicly to report on their results. That also had an impact, and so I think I think we've definitely seen that shift.

Molly McCarthy:
Yeah. And I think just that curiosity and questioning, I think from patients really as a partner rather than, you know, a threat to what's the institution or the team that's providing the care, I think is really important. Just that mindset shift.

Leah Binder:
Absolutely.

Molly McCarthy:
So you may have noticed that I opened our podcast today with the statement that too often technology has made caregivers' lives harder, not easier. And I've been in tech for a long time, so I feel okay saying that. But from your view, has healthcare technology made patients safer or in any way at greater risk? And this is kind of a two-part question. So I'll let you answer that and then I'll go on to the next part.

Leah Binder:
Yes, and yes. I guess I'd have to say one of the founding principles that Leapfrog, incorporated into that overall overarching transparency mission is that we need hospitals and health systems to adopt technology in a way that improves safety, and we actually want them to adopt the technology. We are very pro technology because that improves our world. We kind of see that in other industries, and we want it to happen in healthcare. And, you know, we know healthcare tends to be behind on technology. I always joke that it's the last place you can sell a fax machine to anyone. And my son, who's 20, he said, mom, they asked me to fax over something to the doctor's office and I said, okay, just do that then. And he said, well, I don't even know what a fax is. He didn't know what it was in his 20. You know, the rest of the world is not using fax machines, but healthcare is. So anyway, we want to use it to the greatest benefit of patients. And we started Leapfrog with one of our founding, we call them Leaps was around computerized prescriber order entry CPOE. So that's the systems that even back in 2000 were available. It was used by about 1% of hospitals, but it was available.

Leah Binder:
They would check orders, medication orders and check against the patient record to make sure that the patient you know wasn't allergic or the variety of other reasons that a medication order could be dangerous to the patient. Those would alert to the physician so that the order would not go through or that the prescriber could order something else. So that was available and very important. And the studies at the time back in 2000 suggested that it will really did reduce medication errors by like 40%. It was very significant improvement, but it really wasn't again, until the Affordable Care Act actually, after that, when the stimulus money after the economic crisis of 2008, we had stimulus money thrown into the economy, and a huge amount of that was used to help hospitals invest in electronic medical records, and with that, CPOE. So then all of a sudden, we saw almost every hospital had CPOE, and we did something else with that. So we realized that it wasn't going to be enough. Just to ask, do you have CPOE? We also want to know, does it actually work to the benefit of your patients? Because you can't assume that it's automatically works when you turn it on. And it turns out we were right about that. We had, um, developers who include David Bates, David Klassen; these are world-renowned experts in patient safety and technology who developed a test that hospitals take as part of their completion of the Leapfrog Hospital Survey every year. They take this test, and we give them a set of dummy orders for a set of dummy patients, and they administer the orders, and then they report back on what happens in their cpoe system when they make these orders. And the all of the orders are almost all of them will would result in harm to the patient, very significant harm in some cases death to the patient like very these are not kind of nuanced orders. These are orders that would definitely harm the patient if they were administered. So they should alert. And there are a few that we throw in there that shouldn't alert, that actually are frivolous problems, that should not alert because you don't want to have too many alerts or you have alert fatigue. And that's also dangerous, right? So we actually test for that. But this for the most part is just really bad or really dangerous orders. And can they are they alerting to them. So the thing that we found is that in about half the time not really. These systems are not alerting properly today.

Leah Binder:
We've seen lots of improvement, but we still don't see most hospitals getting to even like 80% of the orders, they're not getting there. So we're still a problem, and our advice to hospitals has always been and continues to be: You have to double-check and triple-check. It's not enough. Just because you have a CPOE system doesn't mean that's the end of it. It's got to be checked again and checked again and checked again before it actually gets to the patient because we can see that it's not always there and it needs to improve, but it's not always there. So technology yes, it definitely improved. We did see improvement with CPOE and we're seeing it more over time. So it is got to be better then a scribbled prescription on her pad. God knows how that ever worked in a hospital. It's just scary to think about it, you know? But nonetheless, they are not always doing the whole job. And there's lots of things that aren't safe. And if they're not administered correctly, if not watched, if they're not, these systems are not really fine-tuned over time and checked over time. Then they can actually backfire and not be safe at all. So yes, to both of your questions. Yeah.

Molly McCarthy:
And I think that's so important. Just and I actually even use CPOE in 1995 locally I worked at Inova and I remember it coming into play versus the handwritten orders. But it goes to the point where, you know, it's not just the technology. It's really it's important for the nurse, for that care provider, whoever it is could be, you know, perhaps even that person who might be inputting orders. But it's really important to have that critical thinking piece that nurses can utilize in that human aspect of it. You know, that won't ever go away into question, I think is really important. So the second part of my question is moving ahead and thinking about the technologies that are available today. So for example, next-generation solutions like artificial intelligence, and ambient monitoring, I've done a lot of work in the virtual nursing area, but how can they work to ensure that quality and safety can paradoxically improve in an era where there's a lot of ongoing shortages of caregivers, people leaving the profession due to many different reasons and challenges, but using technology to do more with less providers, I guess.

Leah Binder:
Yeah, I I'll step back a little bit from the question because I'm not as I don't live my day-to-day life in a delivery system. I live in front of tons of data looking at how we're doing, but I don't necessarily see it close up. I like to visit hospitals and see it, but I don't always see it right. But what I would say that we're concerned about with AI and just all the advanced technology that we're seeing really rapidly grow in hospitals is that there are many ways to deploy this technology badly and not do it well, or do it in a way that is not helpful to the patient or harmful even to the patient. Now, the example I just used, or how decisions work within CPOE doesn't always work the way people think it will, and can lead to some complacency because you think the system is going to check for that. And if nobody else does, you can, you know, that's a danger. So I think that's the case in, you know, maybe exponentially with AI, we know that AI has makes mistakes, but it looks like it's not making mistakes and it has hallucinations, but you can't tell they're hallucinations unless you dig in. You know, the most famous example are footnotes that they'll give to some research and they make up studies. Just make them up out of thin air. They don't exist. So you got to get someone to double-check their references.

Leah Binder:
So that is directly dangerous to patients. If the AI is giving advice or decision support or whatever support and it's incorrect but looks correct, which it will look correct because it always comes out of AI, it looks really pretty impressive. So that's a danger. And if there's too much reliance and there's not a system set up to double-check it, that's a problem. So that's one worry. And then the other thing that we're excited about, on the other hand, is that it can be used for some really positive things. I mean, it can be used, for example, to automatically check through ongoing patient records as they're happening, as the patient's in the bed, they can check through EHRs and trigger when there appears to be some issue that could lead to a problem. I mean, that's exciting. We think that's that could potentially be a game changer for patient safety. The other thing that we think is exciting is an ability to synthesize a patient record itself quickly. I would imagine that it must be frustrating for all providers when you have a very long EHR, let's say, and you've got to figure out right now what's happening with that patient because you're talking to them and you want to know right now what was their last blood pressure reading or something you want to know now. And definitely AI is going to be able to help with that.

Leah Binder:
So I think that's exciting. I think that it'll help. I think anyway, make the day-to-day experience of a provider better, but it also will help the patient. So I think that's an exciting use of it. So I guess I don't know what that's going to mean in terms of being able to manage around a shortage in the workforce. I'm not sure how that's going to play out. I don't know, I've seen actually, I should say I have seen one example that I didn't like, which was using AI to handle call. And the example they showed me was a pediatrician's office where a mom calls in the middle of the night. A three-year-old swallowed a dime and what do I do? And the call is answered by basically a bot that's AI. And the AI says this two-page explanation of the clinical issues and risks, and something like that misses a key thing, which is make sure that it wasn't actually a battery instead of a dime, because it's a battery. They get under the ER and all that. So I missed a clinical indicator that was important, but I think even more so, it just was as somebody who's been a mom calling in the middle of the night to the pediatrician's office, I don't want to talk to a bot, and I don't want two pages of clinical gibberish. So that was not a good example.

Molly McCarthy:
Now, I think I appreciate that and I appreciate your perspective. I think, you know, different from maybe someone who's in the hospital every day, but really important from that patient safety perspective and just even your, I think, comment around the ongoing analysis retrospective, instead of looking at patient trends, root cause analysis, a week after an event happens, you know, we're sifting through the data as that patient's decline. Maybe their temperature is going up, their heart rate's going up. They're becoming septic and making that alert then and there rather than a significant decline coding etc. and a poor outcome. So appreciate that perspective. I could sit here and talk to you for so much longer, but I want to be mindful of everyone's time and want to wrap up with just one question, one piece of advice. I always like to ask our guests, but so our listeners are primarily Chief Nursing Officers, CNIOs, and respective teams within healthcare systems. And obviously, you bring a really unique perspective, understanding priorities and opportunities across large employers, payers, government, and providers. I guess if you could just share a parting gift of wisdom with our listeners. So what would be your single most important practical piece of advice for them as it relates to their responsibility of being the front line for patient safety?

Leah Binder:
I would say lean into transparency. That works on a political level, but it also works on a personal level. But it isn't human nature, so you have to be deliberate about it. So on a political level, is the one thing that both parties are maybe the one, maybe there's other things. But really, one thing that both parties agree on here in Washington is that we should have more transparency in healthcare. And there's all kinds of ways they define that, but basically they want more transparency. And that's been the movement on both sides of the aisle. And that's where it's going, the transparency is the name of the game. Their employers are also under enormous pressure to make everything they know public about how hospitals and health systems are doing. There are lots of risks if they don't nowadays, so it's really a big deal to them as well. It is also a big deal, though, if you are a clinician or working in a hospital because it is, you want to build trust. And one of the things I think we've we're losing in all segments of our society, unfortunately, but healthcare included, is that personal trust among people.

Leah Binder:
And you want patients to trust you, and patients really do want to trust you. And the best way to build trust is by being as honest and open as possible. And that starts with transparency and lean into it on every way. You're a hospital administrator. The one thing we report to Leapfrog, I mean, I'm going to say that because that's how you're transparent. It's not a doesn't cost you anything. Just do it because it's do anything you can to show that you're not hiding anything, that you're public, even if everything's not perfect, even when you have to tell a patient something that is uncomfortable, telling them, being honest about it will build trust, and trust is what is going to carry the day for all of us. It carries the day for every single one of us. It will get us away from this burnout problem and all the problems we're seeing for people who are frustrated and feeling like they're not fulfilling their life purpose. Transparency is a way past that. It's just uncomfortable and hard. But please do it. It will help.

Molly McCarthy:
Well, thank you. Leah Binder, CEO of Leapfrog. Transparency and trust are key for safety for our patients. Appreciate your time today and look forward to hopefully meeting you in person soon. Thank you.

Leah Binder:
Thank you Molly. It's great to be here.

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight for best practices in AI and Ambient Intelligence, and ways your organization can help lead the era of smart care teams. Visit us at virtualnursing.com. And for information on the leading smart care facility platform, visit care.ai

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Amy K. McCarthy, MSN, RNC-MNN, NE-BC Director Of Nursing, Women, Infants and Oncology at Texas Health HEB President-Elect, Texas Nurses Association

"Our nurses are incredibly intelligent. They're doing wonderful things. They know the criticality of their patients; they know their right and wrong answers. But there's a lot going on throughout the day. And I think having that added buffer to just say, listen, hey, did you see this? Or maybe I can pop in and just check on that patient for you while you're in another room? I think that's a neat way to look at the cure model that we now have the technology to do." - Amy McCarthy

Amy K. McCarthy, MSN, RNC-MNN, NE-BC Director Of Nursing, Women, Infants and Oncology at Texas Health HEB President-Elect, Texas Nurses Association

Episode 23 Beyond the Bedside:

Exploring the Evolution of Nursing in the Digital Age

SCTS-Amy McCarthy: Audio automatically transcribed by Sonix

SCTS-Amy McCarthy: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CNO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers' lives harder, not easier. It's time for smart technology to empower our care with a more human touch. I'm thrilled today to share a little bit more about my guest, Amy McCarthy. And just for our listeners, Amy and I are not related, but she would be a really fun sister, just as a side note.

Amy McCarthy:
Thanks, Molly.

Molly McCarthy:
Amy currently serves as the Director of Nursing for women, infants, and Oncology at Texas Health Resources at HEB. An alumna of George Washington University, she earned her DNP with a focus on executive leadership. Amy is a champion of transformational and heart-led leadership, aiming to foster innovative and health-centered environments for nurses. Her decade-long experience involves collaborating with state and national leaders in nursing improve outcomes for the public and employees she serves at the bedside and in leadership. Amy serves as the president-elect of the Texas Nurses Association and is a member of the Nursing Advisory Council for Hippocratic I. She has notably served as Director at Large on the American Nurses Association Board of Directors, addressing crucial issues like safe staffing, workplace violence, and racial equality in nursing. Her involvement with the National League of Nursing includes contributing to the Advisory Board of Accelerating to Practice program, focusing on new graduate integration into the workforce. Amy's role extends to the Nurses on Boards Coalition, where she was a Texas Action Coalition representative and co-chair of the Communications Workgroup, overseeing coalition marketing and communication strategies. As the secretary of the Texas Nurses Association from 2019 to 2021, she was instrumental in integrating younger voices into the organization, fostering ties with the Texas Nursing Student Association, and launching a podcast that highlights nursing innovation and mental health. Amy's educational background includes a Bachelor of Arts in Biology from Southern Methodist University and both a Bachelor of Science and Master of Science in Nursing Administration from the University of Texas at Arlington. She holds professional certification in executive nursing and maternal newborn nursing. Welcome, Amy. You have a fabulous background, and I can't wait for our listeners to learn a little bit more about you.

Amy McCarthy:
Thanks, Molly. I'm really excited to be here today.

Molly McCarthy:
Great. Well, first of all, thank you for taking time out of your schedule to speak with me and our listeners and share your story and insights. Obviously, you've got an extensive background and varied background, which I didn't mention. You started your career in communications and then transitioned into nursing and health systems and also have extensive experience in the association world, which is fabulous. I think that gives you a really diverse perspective. So just to start out, I would love for you to share with our listeners more about your career journey, maybe starting with how you transition from communications into nursing and then how communications actually assists with your role today.

Amy McCarthy:
Yeah, absolutely. So it's funny, looking back, I never realized how important that communications background would be in my current role in my career as a nurse, but I had always been really creative. I had taken a lot of art classes in high school into college. I had served as the editor-in-chief of my college yearbook, and a friend of mine had offered me an internship to a nonprofit management consulting company early on in my college days. And so I started to dabble in the world of communications and PR, do graphic design, photography, and media. And that led to another internship at the local hospital here in the DFW area, where I was able to do communications and PR specific to healthcare, which was so neat. I spent about almost a year and a half being able to cover things throughout the hospital, being able to go on media sources, and oh, can we stop that? Can we start that again?

Molly McCarthy:
Yeah, yeah. Um, yeah.

Amy McCarthy:
Okay. I spent about a year and a half at the hospital, just kind of rotating with our media team, with our communications team, and just learning the ropes of how to handle PR and communications in healthcare. And there's a lot that goes on in the background that you're having to manage when it comes to patient stories, when it comes to news, when it comes to patients who are entering the facility.

Amy McCarthy:
And so it was just a really neat experience to be able to see that side. And as I was doing nursing school at the same time, I really continued to delve into this, had a lot of interest at actually ended up working throughout nursing school for a nonprofit that was focused on crisis communication, and so was still able to take a look at that healthcare lens, but offer communication support, offer that PR. And as I transitioned into nursing, that communication piece became vital, especially as I started serving on boards, even just talking to my patients. One of the key things that you learn in communications and PR is that you have to alter your message and be very specific with the population that you're marketing to or that you're serving well. The same occurs in nursing. I have to really tailor my message whether my background is in women's health. If I'm talking to a first-time mom, how am I communicating to that family versus a mother who has 3 or 4 kids? It's a very different experience for them. And so it came in instrumental in that early phase of nursing.

Amy McCarthy:
And then, as I mentioned, when I started to serve on boards, one of the skills that I was tapped for was this communications and PR experience. I was able to help lead campaigns, lead entire communications and rebranding efforts for boards, most notably for the Nurses on Boards Coalition, and helping them to get to the metric that they were looking for to get more nurses involved get more nurses serving on boards. Several of the campaigns that were utilized throughout that were things that I had designed that I had worked with that entire board and organizations. So it's been really neat to be able to combine both of these worlds into what I do today. It is certainly been, like I mentioned earlier, just instrumental in what I've been able to do, and I'm very grateful for the experience that I had early on. I had no idea that I would use it almost on a daily basis, especially in leadership and in talking with my nurses, whether it's in the hospital or within professional associations. But it has truly enabled me to be able to reach more people and to be very specific in my messaging, to be able to convey what we need to do.

Molly McCarthy:
I love that I think you have some great experience. You mentioned the crisis communication, and obviously, when you're dealing with patients and families, it can be difficult, difficult conversations. And I'm sure that your patient's experience was so improved through your ability to communicate with them in the family. And I know that, too. You know, you mentioned you're in maternal child care, and it's not just taking care of the patient, but in specifically, it's really family-centered care. So, so critical. And just a shout out to Nurses on Boards Coalition and Laurie Benson. I worked with her when I was at Microsoft and love what they're doing there. I know they just celebrated an anniversary, so that's great. I'm glad to see that you're involved with that organization.

Amy McCarthy:
Absolutely.

Molly McCarthy:
Digging deeper in a little bit more into your nursing experience with where you are now at Texas Health Resources. And then, obviously, you've done a lot of advocacy work, and through Texas Nurses as well as your position with the ANA, just curious how you're involved in tackling some of the ongoing workforce issues that are plaguing our US health system, maybe locally and then nationally, if you have any examples?

Amy McCarthy:
Yeah, absolutely. So, with the Texas Nurses Association, we've done a lot of work over the last legislative session that's really pinpointed on workplace violence and ensuring that nurses have a safe space to be able to work in. We all know, as nurses and nurse leaders, there has been such a just evacuation, for lack of a better term from the healthcare space because nurses don't feel safe anymore. And so this became a really prime topic for the Texas Nurses Association. We previously had a law in the state where emergency nurses were protected. If they were attacked, it was a felony that they could charge the individual who had attacked them, but not for the rest of the hospital, which was kind of heartbreaking, especially for someone like me who's not in that realm. While people think that maternal newborn can be a very happy place, and it is, but there are things that happen on that unit that are also very difficult for nurses to work through. And so the protection was really needed for healthcare workers across the board. And so we actively worked with partners across the state and building coalitions and building relationships to ensure that we could bring forth a bill that would be passed to offer all healthcare workers this protection. And this previous legislative session, we were successful in being able to pass into law a bill that protects all healthcare workers, regardless of what unit they're working in, any time that they are attacked in the workplace. That is considered a felony charge. And that was such a big win for us. When you think about the shootings that have happened in the Dallas-Fort area across the United States, people are angry when they're coming in the hospital, and you have to think there's a lot going on when they enter the healthcare space; there's a lot of unknown.

Amy McCarthy:
They're losing control of their situation. And so it does lead to a lot of anger, whether it's intentional or not. We need to make sure that our healthcare workers feel safe. They feel empowered in that environment and that they feel protected. And so this was a huge win for the association and for our nurses across the state to be able to now say, yes, I do have that protection. While it's only a piece of solving the problem for sure, it at least gives us somewhere to start from and offers that additional protection as well. And when I think about my work at the national level, we've certainly had the conversation about workplace violence overall. In fact, I worked with the Ana board of directors to draft a proposal at our membership assembly that focused on gun violence and how we help to protect nurses and healthcare workers from that. Specifically, how do we partner with not only nurses and nursing associations but associations outside of that? Sometimes, the nursing, we like to say, within our own bubble, we're very guilty of that. But being able to talk with people across the board, people who are experts in this space. So, it was a huge proposal for us to be able to bring to our membership to all the states who are involved in this discussion. And it went you could tell in the room how grateful people were that we were having this discussion, that we were saying out loud, listen, this can't be tolerated anymore.

Amy McCarthy:
Nurses need to feel that they have that protection, that we're actively doing things while we don't have the solution and there's no immediate solution, at least we're working on it. And, of course, you know, the next big topic is staffing, right? It's something that nurses are talking about all the time. And same thing there. There's, unfortunately, not a one-size-fits-all solution. And so we're having to have very active conversations with our hospital associations, with our, our legislators to say, how do we fix this problem? Because the fact is, that current state isn't working. It's leading to nurses leaving the bedside. It's leading to an unstable healthcare system. And so the ANA board, we released a statement that showed that, you know, we do support tools to be able to focus on safe staffing, whether that be staffing ratios, whether it be talking with hospital associations. We want to ensure that we are doing our part to support states across the nation and ensure that we're having a good conversation about this because, for so long, we've avoided this topic. We've kind of stayed away from it just because it's something that's hard to talk about because there isn't a black-and-white solution and no matter how you look at it. And so I'm proud of the work that we've been able to do around that. But certainly, the work is not done. And so we're continuing to have those conversations across the board.

Molly McCarthy:
Well, congratulations, first of all, on your hard work within Texas and having that bill passed. That's amazing. You know, it makes me sad to think that that's where we are in our world. But that's the truth. And good for you for really pushing for that and also the collaboration with other disciplines. I think it is important, as you mentioned, you know, within healthcare, it can be siloed sometimes based upon your professional, where you are professionally or what licensure you have. But I do think moving forward, that team approach and collaboration, not only within healthcare but quite frankly, like you mentioned, with our policymakers, etc. So kudos.

Amy McCarthy:
Thank you.

Molly McCarthy:
The other question I have for you. And then staffing, we could spend a lot of time on that. I think, you know, that's very challenging. And it's not black and white and it depends upon so many factors. I'm just wondering too, if you think about staffing, what also just in terms of care models, you know, that's another component that I know we're revamping. Obviously, this podcast is looking at virtual nursing, which we'll get to in a minute, but I think those are all considerations when you take a look at the current environment. So absolutely, with that in mind, I think that obviously there are lots of challenges, but kind of as a follow up to that question, what reasons do you and your colleagues have to be optimistic about the future of inpatient nursing? And maybe we talked about some of the obstacles, but maybe specifically for you, what are you seeing at your local level with obstacles to realizing that future?

Amy McCarthy:
Yeah, absolutely. You know, I will tell you that the nurses and nurse leaders who are entering the profession right now are just so creative. They have so many ideas, and they're committed to really revamping health care, which is very exciting to see. And I think part of that is they have resources today that nurses previous to them didn't have. You think about the internet, you think about social media. There's this constant exchange of ideas. I was talking to my lab manager yesterday about something that I had seen on a social media group of what we should implement in our hospital, and that's just it. You know, we're able to do that on a daily basis to get these ideas and be able to implement a lot of them fairly quickly. And so I'm optimistic because I'm seeing this constant interchanging of ideas that we're implementing at a faster rate, and people are trying to make this better. I will tell you when I look at the obstacles, when I look at technology, I think that there's so much out there. My husband works in tech, and we have these conversations all the time of things that he's seeing in his world that haven't even touched healthcare yet. And so there's such a gap between those two worlds.

Amy McCarthy:
And the gap needs to get smaller because there is so much that has been produced that can really be so beneficial in our hospitals today. When you think about ambient monitoring, you're starting to see that, especially between providers and patients. I would love to see that for nursing. When you're walking into a room for that technology to exist, where a lot of this charting burden that you see today because nurses will tell you about 70% of their job is charting everything that they're doing. If we could have technology in place, that helps to eliminate some of that burden, and we're starting to see that. But I think that's a major area that we need to focus on so that nurses can practice to the full scope of their license and they can actually do what they set out to do, which is care for patients. Right? I think part of the obstacle with that, of course, is just financing some of that technology. As hospitals continue to experience limited reimbursements, decreasing profit margins, it becomes harder and harder to sometimes implement these technologies at such a huge scale. It involves really understanding that technology, being able to do that education and keeping an open mind. Sometimes I joke with my nursing colleagues that we are also the worst barrier to the implementation of new tech because we're fearful of it or we don't understand it. And then there's that automatic shutdown that happens, and we can't continue to think like that anymore because we need to have things in place, whether it's AI, whether it's that ambient monitoring that helped to make nursing what we want it to be, which is really being able to sit down, have those conversations with patients, provide that education, and taking away so much of the burden that has been placed on nurses.

Amy McCarthy:
I mean, when I sit in meetings, whether it's in associations or within the hospital, it's always, well, you know, the nurse can do that, the charge nurse can do that, the nurse manager can do this. And we've got to stop saying, let's put this on human people. How can we utilize the technology that we have, even if we're not spending millions of dollars in implementing all of these things within our organizations? But how do we leverage what we have to be able to really look at things creatively? And I think that requires nursing leaders who are willing to step outside of the box of how we've always done it. And that's a common phrase in nursing, whether we like to admit it or not. This is just the way we've always done it. We've got to step outside of that space and be able to say, listen, we've got to try something new because there's just not working anymore.

Molly McCarthy:
Well that's great. I'm excited to hear you talk about the up and coming generations in terms of the creativity. And quite frankly, they're new and they have fresh ideas and they're not necessarily molded to doing it a specific way, obviously. Absolutely, with patient safety in mind and optimal patient outcomes. But I agree there are different ways to think about care delivery. And really, to your point, ensuring that the nurses and the care team really are doing high value. I don't want to say tasks, but working on high value processes, etc. and taking away that administrative burden. Yeah, obviously documentation burden is a whole other topic, but I think you touched a little bit about on the rapidly evolving technologies, and that was kind of part of my next question. So just to as we think about specifically workflows like including virtual inpatient care mentioned ambient monitoring and AI, what use cases specifically within your areas do you see that would potentially make an immediate impact within your hospital system? I know that, and I'll just give you an example that I've heard having a virtual nurse doing admissions or discharge, teaching, etc.. I'm just curious, specific to you work in oncology and labor and delivery and NICU, where do you see technology kind of easing the burden?

Amy McCarthy:
I think the virtual nurse concept is one that we really need to take a long, hard look at because we have a lot of nurses. In fact, I had a conversation with the leader yesterday about this. We have a lot of nurses who are wanting to transition to something that doesn't look like the bedside anymore. They still enjoy the clinical realm. They want to be involved, they want to be engaged, but they're not necessarily wanting to do three 12-hour shifts anymore. And I think, you know, being able to transition individuals like that into a virtual nursing model where they can, to your point, instead of having a person handle admission and discharge teaching, being able to have a nurse pop on a screen. And a lot of our hospitals have adopted electronic keyboards, being able to utilize that technology and have that nurse pop in and say, hey, you know, how are you doing? Are there any questions that I can answer for you? Let's go over your admission teaching. Let's go over any questions you might have. How is your experience going today and being able to notate all of that so that it's traveling back to the nurse, it's going back to the nurse leader again; it helps with the overall flow of that nurse's work day because they're able to be engaged. I think about a labor and delivery nurse. They're in and out of that room every 15 minutes, charting to be able to ensure that a patient is having a safe delivery. And so even in that regard, to have a virtual nurse who is watching feel, monitoring strips and being able to give that feedback in real-time, because the reality is, is that the nursing workforce right now is relatively new at what they're doing.

Amy McCarthy:
There's a lot of questions, there's a lot of feeling as uncomfortableness, because all of a sudden, these nurses who have been around for 3 to 5 years are looking around and saying, well, I guess I'm the expert on the unit. And that's an uncomfortable feeling when I think about when I entered the workforce; I was surrounded by tenured veterans who had been on that floor for 15, 20 years. They knew the answers to my questions, and I think to have that virtual nurse there to one be a coach, but also to be able to pick up on those things. Our nurses are incredibly intelligent. They're doing wonderful things. They know the criticality of their patients; they know their right and wrong answers. But there's a lot going on throughout the day. And I think having that added buffer to just say, listen, hey, did you see this? Or maybe I can pop in and just check on that patient for you while you're in another room? I think that's a neat way to look at the cure model that we now have the technology to do. Ten years ago, we couldn't have had this conversation, but today, there are things now in place in rooms that allow us to have this conversation, to be able to really create a very patient-centric experience in a way that we've never been able to do so before. So I would say between that and then, of course, going back to the charting aspect of it, to be able to implement technology that makes that a little bit easier for them, that decreases some of that documentation burden. I think if you could do those two things, Molly, in a hospital, that would take such a burden off of the so many nurses today.

Molly McCarthy:
I agree with you wholeheartedly. I loved your example around the fetal monitoring piece. Obviously, we talked about I worked in NICU, etc., and worked for A1 with their fetal monitoring program. Yeah, but such a huge help for the nurses who are physically on the the unit. The other piece, just holistically, obviously patient safety comfort level of the newer nurses. And like you mentioned, it is not an exit strategy but a different role that the seasoned nurses can take on without having maybe the physical burden of being on a unit for 12 hours. I've seen that anecdotally as well. And then obviously, at the end of the day, thinking about the quintuple aim and looking back to not only the clinician experience, but that patient experience and really driving towards better outcomes, lower cost of care too.

Amy McCarthy:
Yeah, absolutely.

Molly McCarthy:
Well yes. Go ahead.

Amy McCarthy:
Oh, I was going to say, you know, and I think one thing that I'm definitely seeing in my world is that the patient population is growing sicker. You know, we joke in women's and infants that used to be somewhat of a plain vanilla type of patient population. They'd come in; they were relatively healthy. They were coming in to have their baby. Everything was great. But I will tell you, Molly, just from my patch, from my experience just being on the floor to where I am today, the acuity of that patient population has changed immensely. We are talking more and more about maternal morbidity and mortality. We're talking about patients coming in with multiple comorbidities in their late 20s to early 30s. And so you can only anticipate what that looks like later down the road. And so having these tools in place, even for, you know, your regular nursing care model, would be so instrumental because there's so much to be watching in these patients today. They're unlike even the patients of 5 to 10 years ago. And having this ability to be able to constantly monitor and to have that, you know, second person there, just kind of looking at everything, I think would just, you know, it would help to really decrease a lot of fears and a lot of burden on the nurses today. Yeah, I.

Molly McCarthy:
Agree; I mean, I worked in NICU and peds, and I took care of a lot of cystic fibrosis patients, for example, that lived to a certain age. But I know now some of them are having children, etc.. So, to your point, the chronic illnesses, the comorbidities really make the care so much more complex. So many more things to consider. So a couple more questions I want to ask. The next one is, as you think about all your experience with the association's communications and your current role, what's your vision for the future of nursing and smart care teams, and how do you see nursing spearheading this collective effort?

Amy McCarthy:
That's a loaded question. Uh, you know, when I look at the future of nursing, and I'm an optimist, I'm going to put that right out there. And my team sometimes makes fun of me for this because I am the eternal optimist. But I truly do believe that nurses have the power to change health care. We know so much about our patient population. We're there 24 over seven and. Any instances were able to spot trends before anyone else can. Not just trends with in one patient but within an entire population. I'll share my experience of just in maternal health, of being able to track when postpartum hemorrhages started to become a major issue. That hasn't been something that's been, you know, necessarily a thing that we've talked about for the last 20 years. But I remember specifically in my career when that started to become a huge trend, and we started to see more and more of that. And that's an example of what nurses are able to bring to the table. And so when I look at the future of nursing, I see a future where nurses are fully practicing to the full scope of their license that we are able to no longer have to be combined with room and board, that we are a line item in and of itself, where we're able to capture what nursing is doing and bringing to the table when it comes to caring for patients.

Amy McCarthy:
But I also see nurses active throughout our systems, not just being contained to the bedside. And sometimes, especially with my communications background, I think about how we market ourselves as nurses. Still, the public today sees us as those individuals in scrubs as the bedside. And so I think that we have to do a whole rebranding campaign, just of the profession to say, listen, nurses are found everywhere. They're found in technology, they're found in government, they're found. I mean, truly, the skills that we develop as nurses, as we go through our careers are just invaluable in a variety of different ways. And so I see nurses inserting themselves into those conversations and finally making room for themselves at these tables or pulling up a chair if there's not one already. And when I think of, you know, what might be obstacles to that, you know, I'll be really frank, Molly. I think sometimes it's ourselves. When I was completing my doctorate work, one of the things that I focused on was the self-efficacy of nurses and how that motivates them to pursue board leadership positions. And what I found with so many times is that when you examine nursing, you also are examining the history of females in the workplace. 88% of nursing is female today. And so you have to think of that and how that has worked itself in history. Nurses are you know, typically we like to be people pleasers.

Amy McCarthy:
We're the ones that will work ourselves; we'll put ourselves last, and we really need to change that. We need to ensure that we're taking care of ourselves, that we are developing that confidence, whether it's through mentorship, whether it's through training. And I'm speaking to my nurse leaders, we've got to do more of this coaching and developing of our nurses who are coming into the field. We've got to start talking about advocacy at a much earlier point in an individual's just career in their education so that they come into the workforce understanding that my job is not just to take care of patients, it's also to advocate on behalf of the profession, but also for the patient population and where we want healthcare to be. And so I tell nurses all the time, listen, we've got to start somewhere. There is a place for your voice. But the most important thing is that you put your voice out there, that you don't stay silent, that you don't stay just within the four walls of your work environment, that you're out there, and that you're sharing what you're seeing. Because people need to understand those stories; it's how we're going to reshape healthcare, and we've got to have a place for ourselves in that narrative because otherwise, the story of healthcare will continue. But it may not be as friendly as we want it to be.

Molly McCarthy:
Yeah. No, I mean, I couldn't agree with you more. And as soon as you said the biggest obstacle is, you know, nurses, I was like, yep, I see that. And that's why it's so important to have that cross collaboration within healthcare. But then quite frankly, outside and looking at other industries, how other industries tackle certain problems.

Amy McCarthy:
Absolutely.

Molly McCarthy:
So critical. So, thank you for that comment. I think, you know, it couldn't have been said better.

Amy McCarthy:
Thank you.

Molly McCarthy:
So, last question. And so, you know, our listeners, our CNOs, CNIOs directors, the respective teams, other nurse leaders, nurses at the bedside. So, obviously, you've had some varied experiences in healthcare. And I guess I always ask my guests to share a parting gift with our listeners. Your single most important, practical piece of advice for them as it relates to responsibility being tireless advocates for their patients. And then I'm going to also say, and your nurses, as I hear you doing.

Amy McCarthy:
Absolutely. You know, I think to sum it all up, I would tell my colleagues out there to stay curious and to stay connected. Like I mentioned, I think sometimes it's the fear of the unknown that causes us to shut down. And when you think about AI and technology and all of the change that's happening almost on a daily basis, if we're going to be real about this, sometimes I think nurse leaders shut down because they don't know where this is headed, and they don't know the answer right off the top of their head because they've never experienced anything like this before. And what I tell nurse leaders and those leaders that I'm working with right now is that it's okay to not have all the answers to everything. In fact, it's okay to say, like, let's ask some more questions. That's what I love about my CNO is that, you know, I come to her with a lot of crazy ideas. I'm going to be the first to admit it, but one of the things that I love about her and what I've instilled in just in my leadership, too, is that I never completely say no. I say, well, let's explore this. Let's talk about how we can put forth this idea. And maybe now is not the time, but I'd love to understand a little bit more about what you're bringing to the table, how we could implement this. You know, we haven't done this before, but that doesn't mean that we can't do it.

Amy McCarthy:
And I think that for nurse leaders, having that type of inquisitive mindset to try and get past that fear, that not knowing all the things because we don't know, I mean, there's so much that's happening with these technologies that we don't have all the answers and we don't know how it might fit into the healthcare space, but that doesn't mean that we shut it out again. When I'm talking with leaders when I'm talking with nurses, you can tell that fear that just bubbles up a little bit, and they're like, oh, well, there's a regulatory reason that we can't do this and all of these things. And instead of just going straight for that, saying, well, you know, maybe we need to change things. So, where do we start with that? How do we have these conversations to start to change the hospital space or work environment that it is able to coexist with some of these new things that are coming out, and the stay connected portion is just, you know, when I think about what I do, whether it's within the hospital, whether it's within my professional associations, I always think back to where I started and I think back to nurses today and where they're starting, and that's who I'm advocating for in so many different ways. I know that the bedside today looks way different from when it did when I started ten years ago, and I'm knowledgeable of that.

Amy McCarthy:
And I ask a lot of questions to my staff. I try to follow them, see how their day-to-day is going, and just ask the question of what's happening. What is the biggest barrier to you being able to be a nurse successfully? And I think sometimes what happens is as a leader, as you go up and up and up, you sometimes lose that connection. But I challenge leaders today that if you don't connect with that bedside nurse, if you don't connect to the heart of your organization and the heart of the profession, if you will, you're losing out on a lot of knowledge and a lot of the reality of what it looks like today because we can't read always from our personal experiences of what nursing looked like when we started, we have to understand that the reality is quickly changing. And so while I may not have the same lived experience as a nurse who's starting today, I'm at least going to try and understand it, and then I'm going to advocate tirelessly for it because that is what I'm doing in these positions. That's why I love what I get to do every day. And I know that so many nurse leaders share the same sentiment as I do. And so those are certainly two things that have worked for me and I continue to recommend to leaders as they come out today.

Molly McCarthy:
Well, Amy McCarthy, thank you so much. I love your focus on curiosity and staying connected. Yeah. And to your point around being curious, not knowing everything. When I was at Microsoft, we had what we called learn it all rather than know it all. So really going after what you don't know and not taking a little risk. So that's so fantastic. I love your passion and optimism. And let me know if you want to run for some official position, because I love to work on your campaign.

Amy McCarthy:
Absolutely, Molly. I'll let you know. Well, thank you so much.

Molly McCarthy:
And I look forward to seeing you again in person soon.

Amy McCarthy:
Absolutely. Thanks, Molly.

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight for best practices in AI and Ambient Intelligence, and ways your organization can help lead the era of smart care teams. Visit us at VirtualNursing.com and for information on the leading smart care facility platform, visit care.ai.

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