Episode 6 : Sifting Through The Noise:

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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. We're so fortunate today to have Eric Wallis, Senior Vice President and System Chief Nursing Officer for Henry Ford Health System, as our guest on the Smart Care Team's Spotlight. Eric has a passion for building culture and improving healthcare delivery to benefit both patients and clinicians. He's a transformational leader who engages all team members through innovative practices in collaboration. Henry Ford Health System and their 33,000 team members serve a growing number of customers across 250 locations throughout Michigan, including five acute care hospitals, two destination facilities for complex cancer care and orthopedics and sports medicine care, three behavioral health facilities, primary care, and urgent care centers. Welcome, Eric, and thank you so much for joining us today, and I hope I got your introduction correct. Anything that you want to add?

Eric Wallis:
No, that sounds great, Molly. We've got an amazing team of folks, and I'm very privileged to have the opportunity to work with them each and every day.

Molly McCarthy:
Great. Just to get started here, I know that you've been a bedside nurse and worked your way up through different clinical specialties, hospital operations across both academic centers and community hospitals, and truly understand the challenging realities of the current caregiver workforce crisis, really better than most out there. So with that in mind, I just wanted to ask you how you're thinking about this particular crisis at this time. Post COVID and any strategies that you've prioritized across your health system to really address not only the issues but the opportunities created by workforce challenges, workforce shortages, rather, and challenges for caregivers as well as the patients and hospitals.

Eric Wallis:
Molly, I think it's an interesting time in healthcare and certainly within nursing as well. I think when we think about Henry Ford's response to the crisis that we've been in, we put it in a few different buckets. And so the first bucket is we know that today there's not enough people in the workforce. And so looking at our partnerships with our academic partners and really thinking about how do we fix the pipeline, we know that even today there are more people applying for nursing school than are actually our spots in the nursing programs across this countries. So we've got to be part of the solution and figuring out how do we get more folks that want to work in that space so that the schools can actually open up enrollment. And we've had some great partnerships. We're in a partnership with Michigan State University. We're actually just started this summer. We're now some of our bedside team members. Bedside nurses are not acting as clinical faculty and a partnership that we have so that we're leasing or giving some of their time to Michigan State so that they can increase the size of their nursing school enrollment. We've got to look at those kinds of, I think, unique opportunities, unique practices to truly increase the size of the nursing workforce. So that's one of the things that we have to do. The second thing that I think is really key for not only us, but any health system in the current environment is we have to keep the talent that we have. We have to be in a space where we're actively listening to our front-line nurses, actively listening to what their concerns are, the challenges that they're facing, and really putting in not only solutions to solve some of those issues but engaging them in the work as we go forward. I'm really proud that our health system, all of our acute care hospitals are either magnet hospitals or on the magnet journey, and I think that's a key piece of our success. We've actually cut our nurse turnover from 2022 to 2023 this year, almost in half through working with our folks. And there's a lot of different solutions that I've come up and some of them are unique to Henry Ford Health. Some of those are things that would work anywhere. I think the key piece of that is the listening and really trying to address those concerns that our folks have, and making sure that we're creating an environment where our nurses feel like they're being heard and that they've got a great relationship with that frontline manager. Some of those are not new kind of things, but it's kind of going back to the basics and kind of reestablishing great practices that we know work now that we're post-pandemic. And I think that really leads into the third thing that I would say, which is part of what we hear as we listen to our frontline nurses is that we've got to make technology work for them. For a very long time in my career. What we have seen is new technology comes in the market, the EHRs improve, and really what they have done for a very long time is actually add to the workload of our bedside nurses. That's part of the challenge and what their real experiences have been. What I'm excited about is I think we're at a tipping point. We're at a point where technology can now actually start to take workload away. And if we design the right practices and we work with the right partners, then we actually have the opportunity to make it easier for our bedside nurses to do what they love to do, which is actually take care, put their hands on patients. I think that is really been a big focus of ours, is looking at how do we use this incredible investment that we've made in technology to actually make work better for our frontline teams.

Molly McCarthy:
Thank you. Yeah. First of all, congratulations on cutting your nurse turnover in half from 2022 to 2023. I actually haven't heard a lot of that. So that's wonderful. Second of all, I just really wanted to hone in on that third point around technology. I mentioned at the beginning of our conversation today that technology can really increase the burden that our clinicians, nurses look face every day, whether it be the EMR or just an onslaught of multiple-point solutions that can further fragment our system. And I want to hone in on the tech piece a little bit more, thinking about how there's been a lot of hype more recently around generative AI and predictive AI-based applications. What are your thoughts around AI helping to overcome technology burden and what benefits do you see or do you anticipate this type of technology, as you mentioned, taking away workload from nurses.

Eric Wallis:
It's an interesting time because I'm probably like most nurse leaders across the country, there's really not a day that goes by that I don't get a email, a call, some kind of sales pitch from some company that now is touting their AI. And I think when you start to weed into it, you find a lot of the same things that we found with technology over the course of my career. Some of it is vaporware. It's something that people have imagined, but they haven't actually made it work yet. Or when you actually start to dig in what they're doing, it's really not artificial intelligence, it's the same systems that we've had for years and years. So I think that it's an exciting time, but it's a moment where we have to be really thoughtful about the partners that we're choosing, the technology that we're putting in place, and does it really help us to solve our problems. Because I think, as you mentioned, Molly, adding another piece of technology that layers on top of all the other things that we're asking our nurses to use, may just make things more complex and may not actually solve the problem. In addition, I think we have to be thoughtful that when we buy some of this technology health systems, we are famous for buying it and never really turning on its full power. So we have something that doesn't quite meet our needs, frustrates everybody, and we wonder why did we purchase this and integrate it in the first place? That being said, what's exciting when you start to look at some of the artificial intelligence technologies that are coming to the market, they are starting to do things like actually learn, right? To machine learning, where they're looking at the same patterns of things over and over again, and understanding that when A happens, B is about to happen and we can do something about that. So those are the kinds of things that are exciting to me, things that technologies and artificial intelligence that integrates with the workflow of the nurse. So it's not one more thing that the nurse has to go out and do but isn't and wouldn't it be amazing that when the artificial intelligence and the sensor that's potentially sitting in a smart room notices that a patient is doing something that's going to probably lead to them getting out of bed and maybe falling, that not only can it alert, but can it alert the right people who are the closest to the room, who can take action in a required amount of time to actually stop the event from happening, as opposed to just a blast to everybody who's on the floor who may not be the right folks to be notified. It's that kind of thoughtful intelligence that gets to the right intervention at the right place, at the right time. That I think is the game changer that's coming in front of us. I think our health system, every health system in the country right now is trying to figure out what the heck is virtual nursing, and it's one thing to go through and put a camera in every single patient room. That's great, but what are you going to do with it? What are the interventions that it can do? And are you just adding additional cost because few of us are in a position to just take on additional cost in our health systems? How do we use that technology to actually support the workflow of our nurses? Take away the things that aren't value-added, and then really get a user-friendly not only for the nurse, but for the patient and the family member who are there in the room, who have to interact with this technology and feel like it's adding value to their overall care as well. It's a lot of different elements, but I think we're at a place where there's a lot of different things being tried and a lot of different opportunities, and I think the key skill for us as nurse executives right now is to try to kind of wade through all of it and again partner with our frontline teams to understand what the problems are really trying to solve are, and then how do we pick the technologies that are going to help us solve those specific problems, or maybe even things we haven't thought of yet?

Molly McCarthy:
Now, I love that. I think that sifting through the noise, so to speak, of what's coming at you every day, is really important, and to really trust and have the relationship with the partners out there, that working together to really solve the issues. And you really dug into a little bit of where I was going next, which really is around thinking about virtual nursing. What does that mean even with you in your health system? I talked to some people, they think it's having a robot come in or what's having a camera. And so it's a term that might be thrown around AI and that it's nebulous and means something different to different people. So I would love to hear a little bit more about what you're specifically doing at Henry Ford around that. And what use cases are you prioritizing for your nurses? I think that's really important. And the other piece I think that I heard is really looking at that technology that's integrating into the workflow, that's not creating new workflows.

Eric Wallis:
Yeah, I would say our position in Henry Ford's position when we think about virtual nursing has been we don't quite want to be on the bleeding edge of the technology, and I'm grateful. I've had lots of great conversations with CNAs from around the country, and some of the things that they're thinking about and how they're starting to run some of their pilots, and even now starting to bring some things to scale for us. What we're moving toward is we're kind of just in that pilot phase. Where what we are looking at is how do we partner with a technology company, put the right camera sensor in the patient room, and allow a virtual nurse who is part of the team on the floor, not sitting on the floor, because we've learned that if they're too close by, then it's too easy to go down the hall and say, hey, we're a little short today. Can you step out and help us do this work? So building that model in a way that we're thinking about hubs in each one of our hospitals that have a kind of a virtual command center that will allow those nurses to be just a little bit separate, but still know the culture, know the people, know the goings on within their site, and allow that nurse at the bedside to think about what is top of license work for the nurse at the bedside. We want them to be doing the things that require them to put their hands and touch patients, and skills that a registered nurse is uniquely qualified to do. We want the virtual nurse to be able to take away those things that maybe aren't top of license work, but maybe their data entry. They are things that suck up the time of our bedside nurses. So we know that two of the busiest times for any patient is when they're being discharged. So how do we pull that work away of going through those questionnaires and just manually entering data into the virtual nurse can do that and allow the nurse at the bedside to think, concentrate more on things like the plan of care. And how do we prepare you for procedures and tests and get you ready to go home and really be thinking about some of those more in-depth questions. We know things like nursing education on new medications, new procedures. Again, that's something that a virtual nurse can drop in and do really well in collaboration in a team model, the nurse at the bedside. So those are some of the things that we're thinking about. We know the great thing about partnering with a company that has not only the camera, but things like artificial intelligence, is that those artificial intelligence pieces can help us to pay for the model for virtual nursing. If you have artificial intelligence that can reduce falls, that can maybe eliminate the need for patient sitters, for patients who are confused, that can tell you if a patient hasn't been turning in bed enough and that their risk for a pressure ulcer. So at some of those things that add to the cost of care, if we can use artificial intelligence to tell us when that patients at risk or when there's a potential for something that we don't want to happen, then those things, those savings can actually help pay for some of the care model. On the other side, for things like virtual nursing, I think it's a mixture of the really high tech and the really, I won't call it low tech, but really thoughtful thinking about what is the work of a registered nurse and what do you really need to have at the bedside, and what can you do, maybe virtually from a distance.

Molly McCarthy:
One thing that I heard you talk about even, before we started talking about virtual nurses around the AI component, which I think is so key, is we don't need to alert every nurse on the floor, we don't need to distract them, etcetera. We need to with that intelligence, we're directing it, as you mentioned, to the right person, at the right time, about the right patient, and what needs to happen. We all know that a patient fall is an event, so I think that's critical. It really goes beyond the camera.

Eric Wallis:
An alert fatigue is there's been lots of research, right it's one of the most challenging things that we've dealt with in healthcare over the last number of years, whether it's telemetry systems or cell phones that all of our nurses are now carrying and texts and messages that they get notifications from EHR. So how do we again, how do you glean down and get rid of some of the noise so that they really have actionable things that are coming to them. and again, I think that's one of the places where artificial intelligence can really help, is help to filter all that noise and say, what are the things that are really meaningful and are going to actually have an impact on the way we care for this patient?

Molly McCarthy:
I think some of the use cases you mentioned ADT admit discharge transfer, some of the education, etcetera. Are there any other use cases that you've seen above and beyond some of those? For example, I've heard about just even patient safety use cases that really impact patient safety. I'm wondering if you seen that anecdotally. Sorry.

Eric Wallis:
No, absolutely. I think one of the ones that I'm most excited about is I'd maybe say not so much patient safety, but safety of our team. We're all in a place right now where we say society today has lost the ability to be empathetic. And we see that even within our own team when people come into the hospital, the level of anxiety and the level of frustration and just violence that have been going on in healthcare has been a little bit out of control. When you think about the ability of something like artificial intelligence, who's ambiently just watching the room to say, hey, this patient is known, right? To have some tendency to be a little bit aggressive or violent. And if we have a staff member in the room and they've got their back turned doing something at a computer or doing getting meds ready, and the patient starts to approach them, it can alert them to say, hey, you might have a problem. We want you to be safe. Things like code, words to keep people safe. And an example that's been used is if you have a key phrase that says something like, there's cake in the break room, that could be a key phrase that the ambient listening could hear and know that there's a problem. And I need to notify security to cover this room right away. So I think that's one of the things that's probably been most exciting to me and to some of our staff, is that having that extra layer of security to keep them safe is one of the things that they are most passionate about in the environment that we've been working in for the last couple of years.

Molly McCarthy:
And I know that's part of the quintuple aim as well, ensuring that the caregiver experience is positive. And unfortunately, we're at a point where that's critical for our staff. Thank you. That really gives me a great picture and our listeners, a great picture of what you're doing. I'm curious, you mentioned you're in the pilot phase. And just in general, I've seen a lot of technology in pilot space. And you mentioned even at the beginning, if you're going to adopt a technology, you want to use it, you want to see the impact. So how do you envision scaling this across all five systems or even beyond?

Eric Wallis:
I think that's why we've probably spent a little bit more time getting to this pilot phase than maybe some others. Is that one of the things that we are really passionate about is making sure that any technology that we're bringing in integrates really well with our electronic health record. We're an epic shop, and so we want to make sure that this isn't just, again, an add-on system that is going to make life more complex. And so we took more time trying to make sure that we are choosing a solution that can integrate, and that actually is going to make life simple and makes it easier for us to go to scale. We're right now in the midst of presenting a business case across the enterprise. I think one of the things that we have learned is that healthcare of the future is going to involve smart patient rooms and that all the things that we want to do aren't going to be possible without having that camera and sensor in each one of our patient rooms. So we're probably like a lot of healthcare systems. We've got a mixed bag. We have some sites, some rooms, some buildings that have a lot of technology, and others where we're a little bit behind. So again, trying to find a partner that has not just here's the way that we deploy it and this is the only way it can be. But having someone that can bring us different tools for the different situations that we're in has been a big piece of this as well. And then, like I said, really deciding on what you think your model is going to be and understanding, especially when you start talking about things like virtual nursing, it would be easy to say. That world. We're gonna put a bunch of nurses in a command center somewhere in southeast Michigan, and they're going to provide all this care across the enterprise. The reality is, they don't have that relationship. When you start talking about team models of nursing, you really do want to know and trust the person that's on the other end of the camera or standing there in the room. And so we thought it was important to try to find that kind of happy medium between this is somebody who's just out of an assignment today but they're sitting on the unit trying to do this virtual thing and having that full command center. So we're thinking about hubs at each of our sites. And I think that we've really tried to design the pilot thinking about the end in mind. And is the pilot going to really tell us whether this end design that we're going to use is actually going to work or not? And I'm sure we're going to learn things as we go along and make some tweaks and changes. But we thought this was a great place for us to start. The interesting thing is, I'd say there's a lot of different things in this space of AI and virtual nursing that are going on. So I mentioned that as one pilot. We've actually just recently stood up. A first virtual ICU is crazy as this sounds. I was a virtual. I worked at an ICU in late 90s that had a virtual ICU, but there really aren't any in the state of Michigan. We were trying to fill in that hole and we've got one of our hospitals live, the second one coming up here in about a month to start virtual ICU, and again with our partner EPIC. So we're not using a third party to do this, which I think is kind of unique. But we're excited to bring that additional artificial intelligence and early warning systems, machine learning that is embedded within Epic into our ICU space. So we've got a couple of different things going on at this time, and we're also spreading virtual sitting for all of our patients. And again, doing that internally rather than doing it through a third party. It's kind of a busy time right now for us and trying to move into this space of virtual care.

Molly McCarthy:
That's exciting. And I think you talked early on in our conversation today about three different ways that you're really addressing and looking at some of the workforce challenges. The first one was the pipeline of more nurses, and the second one was keeping talent that we have. And I'm curious to see if you've seen, just in thinking about your more seasoned nurses or some of your nurses who might want to try different, you know, skills within their career and how they've accepted or really learned from the virtual nursing model. Just wondering if that in terms of retaining or even attracting.

Eric Wallis:
Yeah, it was interesting when we started our virtual ICU. Obviously, our hope was that we wanted the best and brightest of our ICU nurses to maybe come in and step into those virtual roles. I'm excited to say don't have a nurse in our virtual ICU that's got less than eight years of ICU experience, which is, you know, exceeded our expectations. We were hoping everybody would have at least two, but it took us a little while. People were not sure with this virtual nursing thing actually is. And so it was kind of funny when we posted the positions, we sat back and we thought we'd have people rushing in, and what we found was no one was applying and we had to go back and actually helped people understand what virtual nursing looked like and what it felt like. Today, I've got a waiting list, and we've been doing this for six months because people have now seen it, they've touched it, they understand what the benefit of it is and people want to be part of it. And so I think there is a little bit of that change management cycle. You know, nurses are just like everybody else. Sometimes we're a little cautious until we actually see it working, see what it's going to look like. So I think trying to find ways to again get the team engaged in not just that, 'Hey, we're going to do this and we want your input'. But really help the design; it help to understand what it looks like and what the different roles are. We spent a ton of time both in our pilot for virtual nursing and our virtual ICU, designing workflows, getting their input, and having teams kind of do that front-end change management so that we can be successful. And we were thrilled. The feedback that we've gotten from our virtual ICU being stood up has been universally positive. People feel supported. People feel like they've got a better environment to work in, and we're actually seeing it easier to recruit nurses to the ICUs that now have the virtual component because they know that they've got that resource there to support their practice. And so that's been one of the great, I would call it, side effects of starting to do this work.

Molly McCarthy:
That's wonderful. And I think you mentioned early on in terms of keeping your talent, just listening and including them in the design of the workflow is so key. Otherwise, we know that the tech will just sit there at the end of the day. So many great happenings within your system; it's exciting. So congratulations! I do want to, unfortunately, we do have to wrap it up and I would love for you just as you think about our listeners. CNOs, CNIOs, many of your peers and their teams. Just to think about all the lessons that you've learned throughout your amazing career. And if you could pinpoint one at this day and age where we are with healthcare. Just a piece of advice, a practical piece of advice for your colleagues; what would it be?

Eric Wallis:
I think that all of these things, no matter whether you're talking about virtual care or whether you're talking about becoming a magnet hospital or anything that you're trying to implement, it's really spending the time on the front end with the change management process. I've learned through my career, as much as I hate to sometimes slow down and get a documented change management plan in place before we go forward, it has served me so well across my career that really taking that time and understanding who all your stakeholders are, who needs to be on the team, what outcomes are you trying to achieve? And oh, by the way, how are you going to make sure that once it's implemented that it's actually working. Having all of those details and spending the time planning that on the front end will make the outcome so much better, as opposed to kind of the ready, shoot, aim version that we sometimes have to use in crisis. So I think really understanding change management science, having a plan for it, and taking the time to work through that plan before you get started is something that I think is well worth it, and makes these kind of endeavors go much more smoothly.

Molly McCarthy:
Yeah, I couldn't agree 10% with you just because it's so critical not just to design and then deploy but really work cohesively across the entire continuum and spectrum, and inclusion of the clinicians in that process is critical. Eric, thank you so much for your time today and your insights, and we look forward to sharing them with our listeners, and we hope to see you soon again on the Smart Care Team podcast. Thank you.

Eric Wallis:
Thank you. It's been great.

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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