Episode 22 : Redefining Nursing:

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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. I'm thrilled to share a little bit more about our guest today, who I met at the Digital Health conference at South by Southwest in 2017. Doctor Dan Weberg is a fellow of the American Academy of Nursing and an expert in nursing, healthcare innovation, and complex systems leadership. He has extensive clinical experience in emergency departments, acute inpatient hospital settings, and academia. Dan currently supports Kaiser Permanente as the Executive Director of Nursing Workforce Development and Innovation. He has also held leadership roles within Kaiser in Nursing innovation, research, and technology strategy across eight regions, 38 hospitals, and 70,000 nurses. Dan was part of the founding faculty for the new Kaiser Permanente School of Medicine. Dan also previously served as the Vice President for Transformation Services at Ascension, supporting over 60,000 nurses and 140 facilities in modernizing nursing technology, developing new care models, and measuring innovation outcomes. Prior to Ascension, Dan was Head of Clinical Innovation for Trusted Health, the staffing platform for the healthcare industry, where he helped drive product strategy and work to change the conversation around innovation in the healthcare workforce. Welcome, Dan. It's great to see you.

Dan Weberg:
Yeah, great to see you too, Molly. Thanks for having me.

Molly McCarthy:
Yeah. So thank you so much. First of all, for taking time to speak with me and share your story with our listeners today. You obviously have an extensive and varied background between academia, startups, large health systems. I love your diverse and interesting perspective, and I actually think I first met you or had a first phone call with you. I was on a train actually going to New York. I remember it when you were at Kaiser and then, right after that, Trusted Health. So this is your second go-round with Kaiser. So I wanted you just to share with our listeners a little bit more about your role at Trusted Health and how it impacts your current approach at Kaiser, specifically with regards to how you're tackling ongoing workforce issues that are plaguing our US health system, and obviously, any insights from Ascension and other experience, too?

Dan Weberg:
Yeah, it was interesting. It was really hard to leave. I had spent about seven and a half years at Kaiser at very varying roles, from innovation, working in the Innovation Center all the way through, starting the new medical school and working at the national level across multiple markets, and thinking about nursing innovation. And in 2019, made the choice to jump over to the startup world. At the time, I had been advising a lot of startups through my role at Kaiser and Innovation. And so I was working with UCSF and their accelerator program and just various, including groups that I met at South by Southwest, continue to work with some of those connections, and it was time to double down and say, If I'm going to advise startups, I probably should have experience in one. And Trusted Health was there. They were actually talking to Kaiser at the time, at the venture group, at Kaiser for some funding, and I had met Matt Pearce there and Sarah Gray, who's the founding clinician. Matt's a co-founder of the company, and we just hit it off and ended up creating a role. So I was employee number 50 at Trusted Health, which in a startup that was really interesting to go from 50.

Dan Weberg:
I think by the time I left two years later, there was about 300 or 250 employees. So that scale and just understanding how organizations work it was really fun. What really opened my eyes at Trusted was I got to see across eight regions of Kaiser, and while Kaiser's massive, I got to see across 5000 healthcare facilities and how they treated nurses and specifically travel nurses. It was a travel nurse company and technology company. So I got to see all of the broken things in healthcare, from how you onboard nurses to the competency assessments, to the hiring methods, to the amount of pre-work that a nurse has to go through, even if they have 20 years experience. And it worked at the top health systems. Now they're coming to your organization. You make them go through the same stuff, just the waste in the system and the sort of the flip side. And I was asked this in a meeting at Kaiser the other day was, why, Dan? Why do nurses gravitate towards travel companies, as like the big difference between a health system and a travel company? Is health systems see nurses as a cost, and travel companies see nurses as a revenue stream.

Dan Weberg:
And just that simple flip changes the way they treat the entire workforce. I get to see all these broken things and see how you could potentially engage a workforce differently and how you could treat them as very special, important, knowledgeable individuals and clinicians. And that just opened my eyes, that experience. And then, as well as working at another large health system, comparable size of Kaiser is Ascension. And again, just how a different health system manages that sort of huge complexity. And those two learnings really help me come back to KP and just have a different perspective on things. I just got that outside view, and many times, they keep people stay there for a very long time. That's one of the benefits of KP is people have a long tenure, and my whole goal from day one at KP was not to be what they call Kaiser-ized and become part of that sort of one worldview. And so just leaving allowed me to have that perspective from across the nation and have just interesting conversations to bring back and hopefully catalyze some things at Kaiser.

Molly McCarthy:
Yeah, I love that. That's great. I think that having that experience in different settings, and we didn't even touch on the academia, but just to have your perspective on why and how nurses are treated differently, and just to highlight what you said within our system is health IDNs large facilities see nurses as a cost. And quite frankly, travel agencies see them as a source of revenue. And that is a huge difference. Always trying to cut costs, always trying to grow your revenue. So that's a great perspective. How have you with your second tour at Kaiser, how has that impacted your approach just in terms of what within your own system and maybe some of the biggest issues that you're tackling right now within the workforce?

Dan Weberg:
Yeah, it's been really interesting. What's nice is I came back to many of the same colleagues I had before because I was only gone for three years, and it was like it wasn't really starting over. It was coming back to a group of friends who were very welcoming and warm and ready to do some great work. That part that is part has been great, and KP is just a very mission driven organization. And right now, with all of the the sort of drama and healthcare and finances and all that kind of stuff that KP is really trying to grow out of it instead of reduce out of it, which I appreciate. And I think that's the right approach. So I think for us, it's really about growing programs. And I got to step into this role, this workforce development and innovation role, which is really the hardest problem in healthcare. How do you recruit, retain, optimize, grow your clinical talent in one of the largest health systems in the country? So, I see it as the ultimate innovation challenge. And I've been approaching it like that. And I stepped in with a senior director who had been there, Lori Hill, who's amazing, and we created a residency program, a new grad residency program.

Dan Weberg:
Lori had done the business case, and it was time to execute it. What we ended up doing is hiring or reorganizing about 20 folks to run a multi-million dollar program across eight markets. So, this is one of Kaiser Nursing's first standardized approaches to clinical education. So, each market was doing their own residency program. Many were getting accredited. But what we saw is there's still a lot of variation that did need to be there. And what we did is pulled that program to a national perspective and run it as a single platform across all eight markets. And so that's that rolled out late 2023 and 2024. All of those next cohorts will be in the national program. We're really excited to have that. So that's one that's bringing in roughly 800 new grads last year into the KP, which was never really a focus or a hard focus. And we're continuing to grow that program. I think for us, it's really about how do you engage the workforce and understand it. So we're starting to look at platforms. How do we have single clinical education platforms, competency platforms, just to understand our workforce. And then the next step is let's look at what do we what can we standardize and not from the traditional approach of standardization, where everyone has to fall in line and follow this one tool that's not sensitive to local conditions, but really just looking at big programs like residency, like transition between specialties that don't need that variation between markets, because moving from an OR to an ICU is basically the same everywhere in the country.

Dan Weberg:
And so we can standardize some of those core education components, which frees up educators to do more of that local work and gap assessments and that kind of stuff. So we're working on those initiatives as well. And I think for us, we're also looking at our retention is actually really good. Our turnover is really low. And we're looking at now what are those career growth because we've nailed keeping people in the company and keeping nurses around, which is great. But we want to help them grow as well. We're focusing on what are those leadership development, what are those career paths, and things that we can get nurses engaged in so they can grow and become the best nurses on the planet, whether that's at the bedside or in a leadership role or educator, etc.. So those are some of the problems we're tackling now.

Molly McCarthy:
Yeah. In summary, obviously, you mentioned the residency program, which I love. I remember being a part of that way back when, and that's so critical. Just as we onboard new nurses in terms of ensuring they have those competencies, but then also are comfortable and can really fly once they're released into the wild, so to speak. So, really investing in your nurses, which has oddly paid off because your retention. I don't know your rates, but you just mentioned that they're good. And yeah, that's amazing. And I've talked to with so many different people tackling similar problems; I'm just wondering, from your perspective, what reasons do you and your colleagues have to be optimistic around the future of inpatient nursing. We've talked about some of the obstacles, but what have you seen since you've been back to Kaiser, or just even in the market that gives you hope and your colleagues a positive outlook?

Dan Weberg:
I think I frame it as this is our blockbuster moment, and the theme that I've been doing in different talks around the country and things is and people think of blockbuster as like the latest, greatest movie. But I see it as the video store. And so this is Nursing's chance to do the blockbuster moment. We can double down on brick-and-mortar in the past, or we can move boldly and build the future that we want. And right now, there's so much chaos that really the only way is up. And so building these programs, like the residency program, into these career paths and different platforms to help our clinicians, it's exciting. COVID hit the bottom of the barrel. And if we can set a new standard for how nurses work, the way that we support them, that there's only up from here. And so I think that gets people excited. I think the growth of KP and just the sort of the energy that I see in nursing right now to do things differently and coming out of the pandemic and wanting a better support system to do the great work that they're doing; I think everyone's really excited about that. There's a lot of energy in the air around that, and I think that keeps people moving, and I think the opportunity to really work with a sort of stabilized workforce allows us to not just have to fill holes and get more travelers and figure out that piece, but really work on these long term programs that will benefit the profession moving forward. So I think we're excited about that piece and just building things that haven't been done before. And there's a new appetite for that, and that that keeps us moving.

Molly McCarthy:
Yeah, I love that. Especially your reference to the blockbuster moment. I actually know you're located in Northern California, and I lived in the Bay area for some time around the birth of Netflix. And I remember my husband saying, hey, we can get these videos sent to our house on DVDs in the mail and then return them. And I was like, why would we want to do that? I like going to the video store, but I think that's a really great comparison because we do need to think about new models, and quite frankly, we need to define them as nurses. And I think the combination of people like you and some of my other guests on the show can really help move that with the energy that we're seeing in the younger generations. And one other thing I wanted to mention is this what I think is a misnomer in the market: when I see a headline every day about nursing shortage, I think it's just a shortage of nurses who want to continue to practice in the brick-and-mortar, old style way, quite frankly. And so, I don't know, just as a sidebar, your thoughts on that terminology and how you address it, if you're seeing that or what are your thoughts around that time?

Dan Weberg:
Yeah, I get mixed. I don't know; I have mixed thoughts on that. I do think we have a lot of nurses that are sitting on the sidelines right now, and I think that we need to rethink our care models. And I think at the end of the day, what the frame of reference that most health systems have is this sort of industrial model. Do we have enough nurses to run our med surg unit in a physical capacity or on location? And I think there needs to be this whole disruption of just how the care team is created and nurses need to be a core of that. But I think the same staffing and the same workflows and the same tools and all the stuff we've been using for a long time just aren't cutting it. And so I think we have to rethink, like, what? Who needs to be on the team, and how do we do that? And yeah, I'm still figuring out the virtual nursing and the benefits and those type of things. But I think those are sort of models that we need to start considering because I don't think we're going to have enough. And I don't see a day where overnight, where it automatically becomes attractive to go work at the bedside if that's not what you want to do. So, I think we do have to rethink our care teams and the way we do it. I think we can learn from the risk takers and the disruptors, like the Amazons and the Googles, and things that are willing to take that massive, the massive leap into the future and really disrupt fundamentally those assumptions that legacy healthcare systems have. So I think we can learn from that. But I really do think it's creating superpowers for our clinicians that do remain at the direct care in hospitals and brick and mortar.

Dan Weberg:
I see the robots, we have the AI, we have virtual nursing, all of those tools we have to really optimize to make nursing less burdensome. And I think Marilyn Chow was at KP for a long time, a great mentor of mine, and she kept saying 30%. She does study in 2007, I think is 36% of nurse's time is wasted on hunting and gathering information, people, and supplies. And that's four hours out of a 12-hour shift that's wasted on stuff that dental. And so I think we have a lot of room to just remove the waste out of the nurse's day and make it easier for them to spend time with patients. I think if we do that, the less that burden, and I think then we need a whole culture change in how we treat each other. Within health systems, there's been a lot of stress and drama and violence and all those type of things that just it just feels unsafe. So I think we have to address those pieces, and we'll have people come back. And then I think the other piece is we also need to really invest in our new nurses entering the profession, programs like new grad programs. We have a 90% retention rate. If they go through a new grad program versus a not 90% retention rate if they don't. And so I think just building those sort of pathways allow people to have more connection points and a little bit more legitimacy in their profession as they enter it, if they have a formalized, supportive environment. So to just being thrown in there and say, in three months you'll figure it out like I did, I think we got to break that in half.

Molly McCarthy:
I actually have a couple more questions, which you've touched on two things. One is technology and then smart care teams. And I wasn't sure which how to order these, but I'm going to go for more technology question first. And we've touched on this. So when you think about different technologies like you mentioned, virtual nursing, virtual inpatient care, ambient monitoring, artificial intelligence, where do you see the best use cases for immediate impact? That would really drive change within your health system if you are seeing any of those. I know that talking with so many people across the country and it's really the virtual nursing is really been the tip of the iceberg in terms of what it can open up. So just, what are your thoughts specifically around avoiding that 30% based?

Dan Weberg:
Well, what one we have to change some of the policies. There's still health systems that don't allow nurses to use smartphones in their facilities or at the nurses' station, which I think at the end of the day, the driving factor here is that care is too complex to memorize, and nursing school has been in medicine for much of it, is built on the memorization of care pathways and treatments and drugs and all that kind of stuff. And I think it's impossible to know all that anymore. And I think we need to have that foundation. You have to have a foundation. But then it's about accessing information in real time. And so I think we have to enable our clinicians with things like machine-generated insights, whether that's pure AI or machine learning, or even just really great algorithms that can take massive data sets and put out relevant information to clinical decision-making. I think that's the holy grail so that you can walk in a room and ask a natural language question to a device to help you make a clinical decision for your patient. I think that's where we need to get to, and I know there's pieces and parts in flight for that, and it's really been a focus on physician workflow. And then they try to adopt it into the nursing workflow.

Dan Weberg:
And you're like, nursing workflow is very it's not linear. And so it's very hard to adapt to those type of things into a nursing workflow. But I think we can do it. And I think if we have those tools we're going to we're going to be great. I think the other part of that problem is that very few nursing schools teach how to take machine-generated insights and put it into clinical decision-making. We teach evidence based practice, which is a longer process, but we don't say, how do you trust that algorithm that's built into your sepsis monitoring system? How do you even know that's right, and how can you question it or trust it? And I think we have to do as a profession really enable that education, or we're going to have people just either, and I've seen this happen, choose to completely reject that technology and still use the sort of old tools like music scores and those type of things that they can hand calculate, or they blindly trust the machine and they miss that issues that we have with data, insights that maybe aren't trained on all the right data sets. And so we're missing pieces are falling through the cracks. And I think we have to find a medium where it becomes another source of data for that clinical decision-making.

Dan Weberg:
So I think if we can enable those types of tools in the nursing workflow will go really far. And then I think we have to think about just who goes into a hospital and who doesn't. And this whole idea of remote monitoring and admission, direct admission to home, and those types of things are a great place for nurses. Because I'm in these conversations, they keep saying, we're going to direct, admit we're going to do remote monitoring, all these different things. And I'm like, well, who's going to look at the data? Oh, the primary care physician is going to look at that data. I'm like, they're not going to look at that data. They can't even manage their inboxes. They're overwhelmed but who's entire profession is based on longitudinal data assessment, its nurses. And so, why don't we have nurses doing all this remote monitoring and those type of things? I think that's a future I see in the next two, three, five years that's really going to impact our profession is just these in-context insights that are relevant. And then also the idea that nurses are trained to take those in and make decisions off them.

Molly McCarthy:
Yeah. And that's exciting to me. Just the different it just opens up a whole other pathway for students and nurses to enter into, quite frankly. One, a couple of things that I heard you say that I want to just shed some light on or bring to the forefront again is that I felt really important is just policies need to be changed. For example, smartphones, obviously there's a plethora of information that's coming at our clinicians, regardless if they're physicians or nurse 24 over seven. And so, how do they sift through that? Do they even have the time to hunt and gather, so to speak? No, they don't. And that's why we've improved some of the technologies around AI and machine learning, as well as just sifting through the tons of information. The other point you made was nursing-physician workflows aren't the same, which may sound obvious, but the other digging a little bit deeper in that, and even within nursing, it depends if you're in an ICU or if you're on what type of floor or specialty unit you might be working on, what type of setting. Obviously, I'm preaching to the choir here, so just some important pieces to consider. I think even when tech companies are looking at the health space because it's not apples to apples and just the investment, I think in general, in nursing the education piece, we could have a whole other podcast on that. That's very complex, especially when I've done guest lectures and gone in and talked about technology, and technology to them was be an EMR. So, just that whole piece is a Pandora's box. So I'm not going to go there. I'm going to switch gears and go to something that you mentioned earlier around, how do we work smarter? How do we work to the top of our license? How do we do what we need to do to take care of the patient and improve those outcomes? So, what's your vision of what we call smart care teams, and how can nursing really spearhead this effort within changing working models and transformation within the inpatient setting?

Dan Weberg:
Yeah, I think because one, and this is like one of those provocative statements, but I think in the foreseeable future, we're not going to have enough clinicians. And you can name your profession within healthcare. We're not going to have enough. We don't have enough nurses, physicians, etc. So the only way in the short term to mitigate that, I think, is with other tools, whether those are technological tools that allow for better workflow or better decision making, or better coordination of the limited resources, etc., and the idea that you can place a single clinical resource to help monitor or support multiple other resources, that would be something like virtual care. And virtual care has been around for a long time. Banner was one of the first, I think, to set up the ICU way back in 2007 and had been running those programs for a really long time, and there's value to it, especially in rural hospitals where they really don't have enough. You can put really experienced clinicians behind a screen and cameras and with tools and insights to help support boots on the ground. I think that's the way we need to go. Do you think the challenge is become and especially in states like California now, Oregon, and other ratio-related states, the business case becomes hard because if you're staffed on the floor now, you're adding another resource on top of it? If you're mandated staffing is met, now you have another resource on top of it.

Dan Weberg:
So, trying to create that business case is something that multiple organizations are struggling with. And while I think there's data to show quality outcomes and those types of things, I think they're still trying to figure out, do we invest in the virtual person or do we invest in the boots on the ground? And making those cases, I think, is still up in the air. But I think for the smaller hospitals, for big networks, it just makes sense. And to consolidate some of those virtual resources to work across state lines and all those types of things. I think that scale is the way to go and then enables the people boots on the ground to have the tools to be able to do their work more seamlessly and communicate. And I think the last piece is it's not just popping someone in the back of into some command center and zooming in and saying, hey, you missed your rounds today, but you have to figure out how to embed that virtual person as part of the on-site clinical care team. And they're doing rounds and all those types of things. They build that relationship because that's so much of how the care team manages itself. So I think if we get that technology, that virtual approach at scale, then we can mitigate some of those staffing issues and care gaps that we have right now.

Molly McCarthy:
Yeah, I think you make some great points. And one is trust and those relationships. And I've seen some great programs working out there with virtual nurses. And it's not just someone sitting watching a camera, but it's really participation in the care process. And I've seen more successful sites do it when they have nurses who've already had those relationships in person, and then going out virtual and ensuring that there's crossover and meaning. Sometimes, they're remote monitoring, and then sometimes, they're on in the unit. So really good points I do need to wrap up. So I've got one question here for you that I usually ask everyone, but would love your thoughts for our listeners, our CNOs, CNIOs, their respective teams, and just giving your experiences within healthcare, academia, and health IT. I would love for you just to share one 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 tireless advocates for their patients?

Dan Weberg:
Yeah, I think for me, it's if it touches a nurse, you need to include a nurse. And that's very biased. But I know, Molly, you've been advocating for that for a long time. I just see too many of these solutions. It's we have a physician leader on our team and he'll figure it out if it's touching nurses, that's not that. They're not going to know the workflow. They don't get taught that in medical school. And despite their years of service, they probably don't understand how the profession works or even the scope of practice that well. So I think just with that, if and that goes for really any profession, it's if it touches the physical therapist, the physical therapist leading the charge on how you design that technology, that workflow, or it ends up in the drawer at the nurse's station and it never to come out again. And I know both of us have seen that happen many times. So I think that's the biggest piece of advice. And I think the other one is just we got to challenge some of these old assumptions, things like service lines and just this structure and bureaucracy we've set up within healthcare. I think challenging those things now is the time and to enable it with really quality technology, not this vaporware sort of shiny object. Hey, ChatGPT, everything, but really fundamentally workflow-driven technology. I think that now is the time to make that happen. And nurses want it. They want to be involved. I talked to three nurses last week who want to be involved in technology. So go out and find them because they're there, and they're probably on LinkedIn. And so, I think just including the right clinician at the right time it will make a world of difference. I know it's probably been said many times, but I just still don't see it happening. I still don't see these large disruptors like the Amazons and stuff really hiring, the right clinicians necessarily to make the change they want in healthcare. And so I think just being intentional about that is the biggest piece of advice I could give.

Molly McCarthy:
I love that, obviously, because I'm going to just pile on to your drum here and go on my soapbox. I recently chatted with Shawna Butler, too, and it's I've been saying this for years and it's smart business all around. It's including nurses in the discovery of the problem, the design and development of the solution, and the deployment. To your point, you just can't bring them in when you're like, here, we're ready to implement, I don't know, a new Vital Signs machine or a new EMR. And they have to be part of the process or, to your point, it will sit in the drawer. Thank you so much, Dan. It was great to chat with you and hear your insights and your amazing career journey. And I look forward to hopefully seeing you in person again.

Dan Weberg:
Yeah, no, I appreciate it, Molly. It's great to be on here, and let's hope, hopefully, someone gets a nugget and make some change.

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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