Episode 8 : Nurses as Innovators:

SCTS_Hiyam Nadel: Audio automatically transcribed by Sonix

SCTS_Hiyam Nadel: 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. Today, we have the pleasure of being joined by Hiyam Nadel on the Smart Care Team Spotlight. Hiyam has a very unique background in platform as a change agent at the intersection of nursing, innovation, and entrepreneurship. In addition to her day job as founder and director of the Center for Care Innovations in Care Delivery at Mass General Hospital, Hiyam is also a Johnson and Johnson Innovation Fellow and president of SONSIEL, which stands for the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders, and that is where I met Hiyam a few years ago. As I think about the brightest voices advocating for nursing and innovation, Hiyam is among the very top of that list. So welcome, Hiyam. And thank you so much for joining the Smart Care Team Spotlight.

Hiyam Nadel:
Thank you, Molly, and I always love to see you and speak to you as well.

Molly McCarthy:
Well, great. It's great to have you here. I'm going to go ahead and dive right into a few questions for you today. So you've been a tireless pioneer and advocate to advance nurses, really to have a seat at the table for healthcare innovation, but also to create and to build new tables. I know you've been instrumental in the NurseHack4Health, which actually took place again this past weekend. And so as you think about technology and care models that we've historically put in place to really get healthcare where it is today, what have we missed by not having nurses more actively involved in the design and development and decision making, and how can we improve upon that in today's hospital environment?

Hiyam Nadel:
Well, thank you for that question. So, in the beginning, you made a statement that technology sometimes doesn't really help us, but actually creates a burden, and I am a frontline worker, and I really feel that almost daily. So if I may back up, we know that the best inventions or innovation is from people who either experience a problem or are closest to the problem. So what we're missing really is bringing the frontlines, especially nurses who care for patients 24 hours a day, who have intimate knowledge about all the problems, barriers, challenges, gaps to healthcare are not included when any of the technology is developed or even tested, maybe not even in development, which I would love to see everybody there, but if not, when things are developed. Are we going back and asking the people actually using it to give them feedback? And that's where I think we fail quite a bit. And in fact, I was at the HLTH conference last year, and incredible technology on the floor. Great ideas, but each technology I went to, I told them about five things why it wouldn't work. And the problem was I said, did you ever think to run this by a nurse or a clinician or actually who's using it? And they said, no. And I said, well, here are the five things just right off the bat that I can tell you why it's not going to work, so let's get together and collaborate with these two functions. And I think things would work better, they would cost less before commercialization to get it right, and then both sides, I think, would benefit.

Molly McCarthy:
Yeah, I know you've done that in the NurseHack4Health. And since you just came off of that this weekend, I'd love to hear about how you've been instrumental in bringing the technologists and the nurses together at the table so that when we design technology, it does have the frontline voice, as you mentioned, which is so critical.

Hiyam Nadel:
Exactly. And it was an incredibly successful event this past weekend. But the whole goal is to really upskill nurses. So what I mean is they know what the patient needs. They know when equipment doesn't work, technology doesn't work, but they don't know where to go with that knowledge. And the hackathon is one platform for us to try to upskill them and first say, you are an innovator, and we want your ideas, but let us give you some help. And that's where the developers come in, the designers, the engineers, and stuff. And so, although it's very focused on nursing, we know how important it is to have a multidisciplinary team at the table developing these. And over the years, I think it was our sixth hackathon. You can see the buildup. So at first, people are just coming up with process improvement. And as you upskill these nurses, you see that their solutions become higher level and higher level, and that's the goal.

Molly McCarthy:
That's wonderful. I'm, I was really happy to be part of that this weekend and just see the progression so well done.

Hiyam Nadel:
Thank you.

Molly McCarthy:
To you and to your team. I'm going to move on to our second question. And you always talk so passionately about ensuring entrepreneurial nurses really deeply understand and define the problems they seek to solve, whether adopting current technology to address a new use case or creating a new product or company altogether. There are certainly no lack of problems that health systems must address, and this podcast really was conceived to bring thought leaders like yourself to address, really, a couple different challenges. One, I mentioned it, and you summarized it again, how the technology can be a burden to caregivers at the bedside. And then, really, we're losing so many talented nurses at the bedside because what we're asking them to do is really humanly impossible, the amount of information as well on the patient. So with that in mind, what unaddressed problems do you think are most important to nurses today to be solved? And maybe you heard some of them during the hackathon, or maybe you're seeing some of them at your innovation center or even within SONSIEL. So we'd love to share with the audience what you think are most important to nurses to solve.

Hiyam Nadel:
Yes. So I think for me in particular, one of the trends that I'm hearing is this knowledge gap that is starting to take place because as more experienced nurses leave and then the younger generation comes in who are less experienced, so how do we support them within that knowledge gap? And looking at things like virtual nursing, perhaps as someone that could be at home, who's who may be retired or more experienced to be their support for that younger nurse, because the most frightening thing is to be a new nurse and something bad happens because it can really destroy you. Because none of us came into this wanting to hurt a patient, and so we have to think about that. And so, how do we onboard the younger generation, and how do we continue to support them throughout their journey so that they feel supported? They don't feel frightened. And, you know, technology is increasing by the day. So we should be able to do this in a very smart way. So that's one thing. And I think as we think about different models of care and moving care from the hospital to, let's say, at home to the hospital-at-home or other care models out into the community, what do we need there in those delivery models to be able to take care of patients better? And I think especially home at hospital is really primed for a lot of innovation, technology and things like that. And that's why the nurses should be there, because I'm going to the home, I know what's missing, so get them there. The other thing is, because these different models are moving outside of the hospital, what remains in the hospital is incredibly acute, very sick patients. So how do we do on-demand teaching and support so that everything is at your fingertips? So I think that's another place where it's really prime. Oh my God, I forgot how to do a PICC line or how do I flush it. How do I, you know? Things like that. I want to be able to get on my phone because that's what we use. We all have phones and stuff, and I want to be able to bring it up, but I want to be able to bring it up. I don't want to maybe have to read it. I might want to see a video, or I might want to see the different modalities of learning and addressing that. And we are seeing this sort of gap where more experienced nurses may not be as technologically astute, and the younger ones are. So how do we marry the knowledge with the technologically astute generations, so that the decision-making the technology helps with the decision-making, especially at the bedside? So that's, you know, again, I'm speaking from an academic tertiary care quadrant care hospital. And so we see the most complex. It's like, oh my goodness, how sick these and the new diagnoses and stuff like that. So those are what I'm seeing as trends, and people are struggling to come up with solutions.

Molly McCarthy:
Now, I think those are spot on. So I'm just going to reiterate what I heard, and please correct me. So really, how do we support our newer nurses? I know that as a new nurse myself, it can be incredibly intimidating and overwhelming, and not only just with the onboarding of the new nurses, but continue to retain, retrain, educate them. And you mentioned the concept of virtual nursing. Having nurses who are more seasoned or perhaps looking for not necessarily bedside care, but transferring their knowledge through virtual nursing, I think, is just a wonderful concept that I've seen work in practice. The hospital at home, of course, I think, to your point, what we're seeing in the hospital is incredibly acutely ill patients and really empowering our nurses at the bedside, as you mentioned, with technology point of care modalities, whether they like to learn through a TikTok video or a document, I think it's really important to provide that through their, what they are using every day, which is their phone at the bedside. So I would have to say that you really spot on from what I've seen, and really appreciate your insights there. And kind of building on that, and I'm going to say it again because I've already, this is the third time. So I made the point in our opening conversation and subsequently that technology has made caregivers' lives harder, not easier. My last question here is, given what was done to nurses with the EMR and recognizing the transformational promise of new solutions, for example, like AI and ambient intelligence, will this time be different for nurses and new technology? And if so, can you tell our listeners how and why it will be different?

Hiyam Nadel:
Well, I think it has, the burden on all the clinicians has garnered national attention, global attention, right? And it's a well-known fact that people are leaving, it's not worth it. I came here to be with the patient, but I spent five minutes with the patient and an hour and a half documenting or interacting with everything else but the patient. Generally, medicine historically has been very slow and clunky to accept a lot of technology, especially generative AI and all the newer technology that's coming up. I do think now we're primed. I think clinicians are learning about technology, they're interacting with technology, they're getting themselves to the table, they're being invited to the table, so that's where I think a lot of the changes are being made. So for example, in my center, we have internal innovation because we're actively eliciting from the front lines to give us their problems and their idea for solution. My center is an incubator, so I help them build that out. But then there's an external component, which is I'm not going to be able to solve this particular problem. Let me go outside and see who is solving this problem, and then teaming up with them to either co-develop, test, and give feedback, or whatever it may be, and I think more and more companies are actually wanting to do that. So that's where I think I always say we're shifting that paradigm. Don't just give me your solution. Let me be part of it, and we both will win.

Molly McCarthy:
You mentioned both your internal stakeholders at the bedside. It's great to hear that they have a place to share their challenges and start to ideate on solutions. And I love the second part, you said in terms of externally, you know, you're not going to necessarily solve everything at your center, but looking externally with your partners, with technology companies, with health IT companies think is so critical. And I saw that shift over the past five years, too, and the willingness to have that partnership, because no one's going to solve the challenges we face in a vacuum or alone.

Hiyam Nadel:
I'm so happy you said that because my next statement was going to be, we still have to figure out how we, innovation is generally done in silos. So, for example, we're all trying to solve the same problem in silo. So how do we bring everybody together? If I've come up with a solution for problem A, then you can take that solution, and now let's work on problem B so we can accelerate coming up with, you know, we can attack more problems in that way. So yes, I think it's really powerful. I think it's exciting. You know I love these IT companies and what they're trying to work on, and you know we invite a lot of startups. We can't always take everyone or pilot everything, but we definitely will give them feedback and a little bit of mentorship. So it's really accelerating. I think it's great.

Molly McCarthy:
I would love to hear from you a little bit more about the process within the Innovation Center. If you could just let our listeners know how long you've existed there and how, if a nurse sees a deficiency or they're coming up against a problem, what would they do within the innovation center? How would it work?

Hiyam Nadel:
Okay, so I was given this full-time position in 2019, September of 2019, just moving into my office that January, the pandemic hit. So that's how long it's been in existence. And again, like any startup, we said we just sent out an email. What are your pain points, and what are your ideas? And we had a committee that voted on which ones we were going to take. I was very strategic in what we chose to solve for, because I knew this was an opportunity to prove what nurses can do. And so we tackled CLABSI infections, which wasn't just a problem for the nurse, but especially for the patient and especially for the health system. So if we could make an impact on that, I knew we would garner a lot of attention within the institution, and that's exactly what we did. And in fact, I think the medical intensive care unit to this day has gone almost 75 weeks without a CLABSI infection. That's really impressive. And that neonatal intensive unit is like three years or four years or something. So that's internal. So the way over the pandemic, I really thought through how we can reach more frontline because on average I received about 27 applications a year. But after the pandemic, we worked with the Health Transformation Lab here, we built a platform, and then we put out this platform. So we lowered all the barriers that we learned the first time around. And so staff could just enter their idea and their pain points from anywhere, from any device, computer, anything, QR codes, anything. And this time, instead of 27 applications, we received 252. And it was just at the heel of the second pandemic, so I was really worried that people too burnt out are going to say, no, just leave me alone, but they were eager to tell us what the issues are at the front line. And this is fantastic for leadership because it closes that gap when I'm a leader and I think I know the problem, but if I actually hear it directly from the frontlines, then that helps you again garner credibility, and you actually know what the problems are. The other thing this platform is able to do was crowd vote. So no more committees, we sent all the ideas back. So we have 8800 staff that this went to, and then, they were able to vote on what was important to them. So what rose to the top, we knew resonated with most of the staff, and those are the ones we invited for full application, and then we chose four winners. You know, my center's based on philanthropy, so I would love to take care of every other idea, but I am working through the remaining 221 ideas so that people don't feel disengaged, that they put in an idea but didn't get awarded. So we've set up a lot of committees, a lot of those ideas were just, let's do it that were implemented already, and we're working through it. So that's internally how we do it. And externally, we put our name out there like, come see us. You want us to test something and, you know, let's work together.

Molly McCarthy:
I think that's amazing. Just asking for feedback. And you mentioned how eager everyone was to provide that feedback even after multiple rounds of COVID, right? So that's an important note, really as, you know, you can't get to the problem unless you're really asking your constituents.

Hiyam Nadel:
Yeah, and one other point I would love to make, we have an incredible well-being task force here. It's made up of physicians, psychiatry, social work, ethicists, employee, you know, employee programs. And when they were doing their rounds on the floors, they all said how empowering and help their well-being by being asked, they were empowered to solve their own problems. And they were asking the task force, when is the next methadone challenge. That's what we named our challenge methadone. And that's where the first anesthetic was used in surgery, and that's why we called it the methadone. And so that in itself tells me that it was very empowering and helped well-being, right? If I have no control over my life every day, then I don't feel empowered, and I don't feel like my voice is important, and that's what we accomplished here.

Molly McCarthy:
Well, congratulations, and congratulations on the results. As a former NICU nurse, the no CLABSI infections for 3 to 4 years is quite amazing. As we close out here today, so many nuggets of great advice from you to our listeners. And just a reminder, our listeners are CNOs, CNIOs, and their teams within health systems. And obviously, you bring such an amazing and unique lens, encouraging nurses to claim their place at the table as change agents, really to impact the future of care delivery. And I'm just wondering if you could give one piece of advice to our listeners today, what would that be?

Hiyam Nadel:
Don't be afraid to attend a hackathon or conference that is really geared towards innovation. Don't be afraid to speak up. The manager, sometimes people say, well, I'm afraid to go with this idea to my manager. Trust me, go with that idea and also put it on yourself that you will put it all together. The managers are very busy, and so if you say, "Look, I have this idea and I will pilot it, I will set it up, I will do it," it will get you very far. Also, I always was an early adopter, so if they were testing technology or anything, I'm like, I can do it on my unit, I can do it. So always volunteer and really go out and look for your tribe. I know I'm the president of SONSIEL, but we started SONSIEL because we wanted nurses to feel innovators. We wanted innovators to get together, and we wanted them to feel that there was an organization behind them in this movement.

Molly McCarthy:
Well, thank you, Hiyam and listeners. You heard it from Hiyam herself, don't be afraid, raise your hand, volunteer, and look for your tribe. So thank you so much, Hiyam, for being with us today, and we'll see you soon.

Hiyam Nadel:
Thanks so much, 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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