Episode 30 : Human Solutions to Human Problems:

SCTS-Katie Boston-Leary: Audio automatically transcribed by Sonix

SCTS-Katie Boston-Leary: 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 really excited to share a little bit more about our guests today, Dr. Katie Boston-Leary. Dr. Boston-Leary is the director of nursing programs at the American Nurses Association, overseeing the Nursing Practice and Work Environment division and Healthy Nurse Healthy Nation program. She was also the co-lead for Project Firstline, a multi-million dollar grant collaborative with the CDC for training on infection prevention and control. Dr. Boston-Leary is also co-chair for the Diversity, Equity, and Inclusion Committee for the Healthcare Leaders Network in Delaware Valley. Dr. Boston-Leary is an adjunct professor at the University of Maryland School of Nursing and the School of Nursing at Case Western Reserve University. She also serves as staff on the National Commission to Address Racism in Nursing, and is part of the National Academy of Science and Medicine's National Plan to address clinician well-being supported by the US Surgeon General, Dr. Vivek Murthy. Welcome, Dr. Boston-Leary. So great to have you.

Katie Boston-Leary:
Thank you for having me. Really, really a pleasure. And please feel free to call me Katie.

Molly McCarthy:
Thank you. Yeah. I was just going to ask if I can call you Katie. So obviously, thank you so much for taking time out of your day-to-day to speak with me and to share your story and insights with our listeners. You, obviously, have an amazing background and experience, from hospital to national policy organizations, academic institutions, really with an emphasis on operations, program development, and leadership. So my first question is, I really would love for you to share a little bit more with our listeners about your career journey from hospital to where you are today with the American Nurses Association, and what motivated you to move from the clinical setting to more of a policy organization.

Katie Boston-Leary:
Yeah, I thank you for that question, Molly. I guess I'd like to call myself in terms of my career, which is not right for anyone, and I don't recommend this, but I've been more of an accidental tourist with my career. I wasn't planning on going into nursing, but someone saw something in me and suggested that I pursue a career in allied health, and I ended up in a line that was a line for nursing, and that's how I became a nurse. I haven't regretted it. Best decision, non-decision I've ever made. And then after getting into finishing nursing school and getting into practice, of course, naturally, organically you end up for most people starting in hospitals. And I worked there for a while and then in that setting for a while, and then continued to progress up the ladder and went from a charge nurse to a supervisor to a nurse manager to a director, to a senior director, and then a chief nursing officer. After about maybe 15 to 20 years in leadership, I decided that, in the practice setting, I decided to pursue my doctorate degree. And as I was pursuing that degree, I figured that I have to start thinking about what I'm going to do with it. So a fire was being light inside of me about getting into some social change, broader change and impact on a profession. So I decided to pursue something along the lines of social change to impact the profession more broadly. And I started to look into a position that a friend had forwarded me from ANA, but I had held that to share with someone else. And around the time that I was questioning what I wanted to be when I grew up, I revisited that email and inquired. And we, ANA and myself, we realized that we needed each other. And that's how I ended up in ANA. And it was scary for me because I felt that I would be bored. I felt that I would be forgotten because I also started during the pandemic. So we were remote, and the rest is history. I started as a consultant and was brought on staff six months later, and we've been doing this now for four years, and it's been another great decision, accidental decision that I've made that I'm really happy about.

Molly McCarthy:
Well, thank you. I love your phrase, an accidental tourist, and the best non-decision that you've ever made. So we're obviously glad that you decided to become a nurse. And your focus within ANA, you know, I recently read that your work at ANA also included reinvention of the Healthy Nation program, supporting the physical, mental, and emotional health of nurses nationally through peer-to-peer education. And I would love for you to share with our listeners a little bit more about the program. And then I have a follow-up question to that too, is: It's really is why is this so critical in today's healthcare environment and ever-changing landscape?

Katie Boston-Leary:
Yeah. Well, I will start with the last part of your question and then work my way to the initial question. All roads in terms of care delivery leads to how nurses are in terms of their health and well-being. The nurses not optimally healthy and to a certain degree, at a certain point, have some level of wellness or on a continuum of well-being; that's in a positive sense. It will impact everything else. There's such a thing called presenteeism, where it's on the other side of absenteeism, where people don't show up. But with presenteeism, when people show up, how are they showing up? And I think we've, for a long time, too long ignored that piece. We have not done enough work to understand how nurses are, how they're feeling, how they're showing up, what's impacting them before they show up, what's impacting them while they're at work, how do we take the, put themselves back together after they're done. So that's why the Healthy Nurse Healthy Nation program is so important. And Healthy Nurse Healthy Nation is a free program that we provide to nurses and others, because it's not just for nurses, for them to focus more on their health and well-being, their overall health and well-being. We have six domains that we focus on that is beyond the physical and the emotional or psychological. We also talk about rest. We talk about sleep, we talk about nutrition and quality of life. And we really feel that that holistic view of how nurses are doing is important to understand for them to be able to deliver on the outcomes that we would like to see in terms of patient care. So the best part about Healthy Nurse Healthy Nation, and we have a number of things that we offer where you can do a heat map survey to understand how you are and compare it to other nurses that complete the survey. We also offer a community that's very lively, where the nurses talk to each other on what they need to do to be well. We do challenges every month, some sponsored by our funders, for people to take on a new activity for that month to be well. Some, we did one on allyship, drinking water, showing gratitude, all those different things. So after the challenge is over, we hope that it builds into your being where you keep it moving forward. So those are the different pieces about Healthy Nurse Healthy Nation. And we just revised the definition of what a healthy nurse is because we realize, especially with after the pandemic, and there are a number of things that we've revisited because we became more attuned to a number of things that we felt were done. We revisited our definition because we felt that our definition was inadequate, and it needed some rework based on what we now know about nurses. And we're excited about that too. And we really talk about how it's about nurses striving to get to a positive sense of well-being. It's not an end game or an end state. It's really about recognizing that we are humans, we're open systems. We're impacted by a number of things because we're humans. And we have holes. So it incorporates all that in the definition, which I really love. And thanks to our committee that helped with that redesign.

Molly McCarthy:
Yeah. That's fantastic. I love a couple of things that I just want to reiterate. Your first comment about all roads lead to nurses within health care; I think that's really important. And I know, I actually recently had Leah Binder from the Leapfrog Group, the CEO, and she, her parting message, really, to the listeners was that if your nurses aren't healthy and respected and taken care of, the patient safety will be impacted. And so that reminded me of what she had said and really resonated. I think also your comment about presenteeism, and that's a newer word to me, I mean, obviously absenteeism, but when we're here, are we actually here and how do we show up? How do our nurses show up? Obviously, it is critical. So appreciate that. I know when I was at Microsoft, we did a little bit of work with that program around a bot actually, and I believe it was before Covid. I'd have to go back and look, but it's been a while. My next question really is based on an article of yours that you recently co-authored. I saw it in nursing management. And really looking at accountabilities, responsibilities, and competencies for nurse leaders. And I wanted to share an excerpt with our listeners. Says: Advancing digital technology as a leader to align with workforce strategy is important to ensure that the workforce has efficient systems. Since the pandemic, the emphasis on emergency mitigation and recovery is expanded to be certain that leaders are prepared and connected internally and externally with the communities they serve to manage events. And it goes on to say it's also critical that leaders engage staff by co-creating a shared decision-making model to make changes in the workplace. That really stood out to me just as we think about the well-being of nurses, but then also the partnership between nurse leaders and bedside nurses. And so when I thought about that and really around the digital technology piece, but I would love for you to share how you envision digital technology aligning with workforce strategy in light of the challenges faced by nurses at the bedside and nurse managers, quite frankly, safely staffing the care units.

Katie Boston-Leary:
Yeah, I think that this is a key focus area. I, one of the things that is included, you mentioned in my introduction, the work that we're doing with the National Academy of Science, Engineering, and Medicine with the Clinician Well-being Action Plan. And one of the tenets that's included in terms of things that should be addressed is the technological burdens that falls on health care professionals overall, which includes nurses. And it's hard for you to meet a nurse that would say, that they're happy with their electronic health record systems. I've tested this in a number of rooms over the years when I do talks, and you're hard pressed to find anyone that says, I'm really happy with this. It's working to what I expected. And some people even call it healthcare's biggest letdown, because there were so many promises that were supposed to come with that digitalization of the electronic record or the patient record that never really materialized. And not only did some of those promises not come to fruition, but we also know that in a number of ways, it's added to the work burden for nurses cognitively and physically. It's also impacted that nurse and patient relationship and interaction, and it's really become this thing where you can say the tail is wagging the dog here now. It's setting up how nursing is delivered in almost every way. It's driving everything. Care is heavy protocolized. So we have to figure out how we address that. Even though we're all healthcare professionals, we're also consumers. So as consumers, we see it. We see that the typical hellos that we get and when people are doing our assessments or nurses are doing assessments, the eye contact isn't there. Most of the attention is on that computer. And that's also with physicians. So how do we look at these systems that we created, where to a certain degree, we've created systems that takes nurses away from patients versus bringing them closer to patients. And maybe this was some unintentional design, but we have to get to the fact that this is a human-created problem so humans can fix it. And we have to look at how we can look at technology differently as a tool to augment care, to improve that human connection versus the other way around. And that's part of what it is. It's not, as for nurse leaders, with that article, we want to emphasize that this is a priority for every leader. This is our charge. We have to own this and take it on because we've seen enough and it's not working the way it was intended to.

Molly McCarthy:
Yeah, I think that's really some fabulous points with regards to the EMR and just taking paper records and making them digital. It's very different than rethinking care model delivery. And so in your opinion, what role do some other technologies play? For example, I know we've done a lot around virtual inpatient care, virtual nursing, ambient monitoring, and artificial intelligence. And to your point, how can technologies like that augment nursing care?

Katie Boston-Leary:
Well, we published a couple of years ago with the National Nurse Staffing think tank that we put together, we published Under Care Delivery Model, because we're actually saying that this is a part of the care delivery model redesign. And we had in there a model that we encourage every institution to take on. And we called it a tribrid model, similar to, you know, you hear about hybrid meetings and hybrid cars. We're saying take a tribrid model to redesigning care. One, of course, you're going to have nurses on the ground, boots on the ground, providing care for sure. Two, look at technology to reduce nurses workload. And three, use technology as an additive to, similar to what you see in virtual nursing hospital at home, to make sure that you have that virtual nurse or support to improve care. You take that three-armed approach to redesign your care delivery model, you have a winner. And can't emphasize enough the technology to reduce nurses' workload piece. We know one of the biggest barriers for throughput in institutions is pulling patients out of the Ed and discharging patients. We also know that nurses, when they do their best job of having a great day, doing the care they should deliver, providing the care they should deliver, one of the things that they will tell you is that I do great care, but my reward is getting a new patient. And nurses usually fear getting a new patient because it means they have to do a full-on assessment that you barely have time to do. And right now, most assessments in most hospitals are done where nurses are writing on their pant legs or on paper towels and putting in the system later. Why haven't we automated that process and it's 2024? So that's an example of one of the things we can do to automate processes to reduce the work burden on nurses. We have voice-activated technology. We should not be here. And some of these things should be attacked with urgency. And I understand people say, Well, this is costly to and you have rural hospitals that probably can't afford it. Totally agree. But there are a number of things that we need to do to that we have the opportunity to do and had the funds to do to improve these work processes, to make them more efficient, and we never invested in them.

Molly McCarthy:
I want to call out the Tribrid model, I love that phrase as opposed to hybrid, but really making it a three-pronged approach, and with the ultimate goal when you're redesigning care is to reduce nurses, what I'm going to call that I've heard be called before, Non-value added tasks, and enabling them to be with the patient, to do that assessment hands-on and really focus on the patient in front of them rather than the technology. And just as a lifelong tech geek, I, you know, I definitely agree with all of those comments, especially around making the life of clinicians easier through technology, not the opposite way. And, you know, understanding what the problem is and how technology can really enhance either the process or workflow is critical. And actually a lot of the virtual nursing programs that you've probably seen, and I've seen, the discharge, the admissions, or some of the areas where I've seen virtual nurses make an impact for those nurses. And you're right. I mean, I remember you would be afraid to discharge your patient because you would get another one, and those patients would require a lot of time and assessment, right, when you're getting them, regardless of where they're coming from. E.R., O.R., ...

Katie Boston-Leary:
Yeah, absolutely.

Molly McCarthy:
Thank you for that. I wanted just to leave our listeners here today who typically are chief nursing officers, CNIOs, you know, their respective teams, and you have just a really neat variety of experiences within healthcare. And I would love for you to share just one parting gift of wisdom for our listeners. So what is your single most important, practical piece of advice for our listeners and nurses as it relates to the responsibility of being tireless advocates for their patients in thinking about today's challenges and environment?

Katie Boston-Leary:
Yeah, I think the one, I'll put a header on it, then I'll go into detail on how it applies to different groups. But the one takeaway that I'll give, and it's probably going to sound like a Captain Obvious type of statement, but I'm going to give it anyway. Collaboration is a no competitive edge. And there's deeper collaboration that needs to happen internally and not assume that just because there are relationships, that is collaboration. Collaboration is really about understanding what the vision is and what the outcome is and how you measure it based on that relationship. And when I say that, it's not to say that these are transactional relationships. It's really about making sure that we stay focused on the main thing, right? They say, Keep the main thing, the main thing. And keeping the main thing about collaboration being that internally, the cross-functional teams and the matrix teams that we have should be communicating to figure out ways to make things more efficient. When you look at good to great principles, it's really not necessarily about taking on something new; it's about what you can take away so you can be better at what you do and finding out what your niche is. And that niche can also be attained by establishing new relationships externally. A lot of companies or competitors that you never would talk to should be the ones that you should be engaging to help make you better. I remember one of the things that I struggle with as a chief nursing officer years ago. I was in an institution where we were in a rural part of the state of Maryland. And the only schools that I had nearby was community college that didn't graduate a lot of students. And before you knew it, because we were in such a place where it was a struggle to get nursing talent, they will all go to the larger hospital. I had a pediatric unit that was small, and I had this giant pediatric hospital that they will all go to. My daughter was admitted there and I walked into the emergency room. I knew almost every nurse. Because they all had worked for me at some point. So I was their training ground. And yes, that hospital had something to offer to them that I did not have, which was a larger portfolio of care because we were in a small community hospital. So one day, out of frustration, after I heard about more transitions and turnover, nurses leaving to go to that larger hospital, I decided to call the CNO at that hospital. That was a big no-no because they would consider it to be a competition. Cold-called her. She answered the phone. And I said, We need to collaborate. And she said, I'm intrigued. And I quickly thought on my feet and I said, I need you to employ my nurses while they work for me. And that started off a lot of conversations where ultimately we worked on a master services agreement, where we put their brand, because they had a strong brand, on our pediatric unit. They employed my nurses. We kept them whole, even made put them over what they were in terms of their salary and wages and their wages and benefits package, and then reopened the unit like under new management with their logo and branding and collaboratively did that. Community came with a celebration. And with that effort, we reduced transfers to their hospital because we didn't have the talent to care for patients to a level that we should, and then we built trust in the community that their patients can come here. So the point that I'm making is with that, that happened a few years ago, we need more of that. We need to look at the people that we've always considered to be our competitors, companies that we thought wouldn't care about what we do, and forge relationships to help make us stronger and better, particularly as we navigate this very, very challenging world as nurse leaders. And for nurses themselves, we need to look for collaborative opportunities within the places that we work as well, different floors, different departments, because we can't do this alone. And this is the attitude that we need to have for us to be better. So that's my one takeaway that I can give today.

Molly McCarthy:
I love that. And he mentioned it was Captain Obvious. But I think really it's not, when you think about what you did at your hospital and engaging the larger hospital, which people probably would have considered just a crazy idea. I love it because coming from, you know, I've worked in industry, I've worked for an association, I've worked across many different organizations within healthcare, and at the end of the day, we really need a variety of talent and skills on the care delivery side, on the tech side, and that collaboration to really start to make a transformation within healthcare as nurses. But at the end of the day, quite frankly, we're all consumers too, as you mentioned before. So Dr. Katie Boston-Leary, thank you so much for all of your insights today, and really appreciate your time here.

Katie Boston-Leary:
Thank you so much. Appreciate you, 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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