Episode 3 : Care Catalysts:

Tech's Impact on Nursing Innovation

Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN

Founder & CEO at Innovation Advantage

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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 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, I am so thrilled to have the nursing visionary who literally wrote the definitive book on innovation in nursing, two of them, actually, and I think I see them in your background, Dr. Bonnie Clipper, as our guest on the Smart Care Team Spotlight. Dr. Clipper founded Innovation Advantage after more than 20 years as the chief nurse executive when she had the opportunity to commit to innovation during her Robert Wood Johnson Foundation Executive Nurse Fellowship and then jumped at the chance to become an ASU AONL Executive Fellow in Innovative Health Leadership. She is a trailblazer and was the first Vice President of Innovation at the American Nurses Association, where I actually met Bonnie, where she created an innovation strategy to bring over 4 million nurses into the innovation space. Her unique understanding of operations, strategy, workforce, and technology make her the perfect bridge builder to create new workflows and processes to ensure that technology improves care and experiences for everyone. So welcome, Dr. Clipper, and thank you so much for joining the Smart Care Team Spotlight. It's great to have you with us.

Bonnie Clipper:
It is awesome to be here today, Molly. Thank you.

Molly McCarthy:
I'm going to get right into one of several questions, and I just wanted to start by reflecting on the challenges for our traditional inpatient nursing teams. I think we know many of the problems that exist today, both pre and post-COVID, and you personally have been on the bleeding edge of nursing innovation for decades. Today, transformational changes in current models of care are needed more than ever, recognizing that keeping the status quo or making small incremental changes are no longer acceptable. How do you prioritize where to find the quick wins that can fuel a transformational journey?

Bonnie Clipper:
That's a great question. Look, we've both been nurses for a while, so you know that there aren't many times or many opportunities that we have to completely transform care delivery. I think we're at one of those times, right? We've moved through team models. We've moved through patient-centered care. Because the workforce with the challenges that exist today, it's only going to get more difficult. I don't believe we've even come close to hitting the bottom yet with shortages not only of nurses but physicians and other disciplines as well. We know that we're seeing student nurse applications decrease for the first time in over 20 years. I think we have to change the care delivery model, and I think this is our opportunity to do that. For organizations that continue to be rooted very deeply in traditional care delivery, I think we're going to start to see those organizations have a very, very difficult time delivering quality and safe patient care. In my opinion, this is not an either-or, it's going to be an and. I think we're going to have to find the appropriate technologies and people to create care models that allow us to provide safe patient care.

Molly McCarthy:
I love that combination you just mentioned of the tech and the people to create those new models of care is so important. With that spirit of people, what is your vision for the creation of smarter care teams, and how can practicing in that environment address such challenges? You mentioned the different models before team nursing, primary care nursing, but as we move forward, ensuring our teams are smarter.

Bonnie Clipper:
Yeah, that's a good question. So often, we're talking about changing or revising teams, even in today's world. What's funny is that so many of these conversations literally are dusting off things we did in the 70s, 80s, and 90s. I'm not sure that that's very innovative, or maybe it's a way to try something that worked for a while at a different period in time, maybe it will work again. I like to challenge some of that thinking though. For example, when we talk about care teams, these are man-made or women-made rules, right? We decided that the team meant humans; we can change that. What if the care team was comprised not only of people that had very specific functionality and roles? What if we also added service robots to the care teams? Think about the 36% of the time that nurses spend hunting and gathering and fetching on non-value added activity, looting documentation, right? What if we simplified and streamlined that work?

Molly McCarthy:
Now, I love that. I think that there are so many tasks, as you mentioned. I think you said 36% that are administrative that we can potentially offload to technology or to some other personnel that might not be fully licensed and really pushed our clinicians to work to the top of their license. I think most every health system that you've probably worked with and I've worked with over the course of many years has done a pilot more recently for virtual nursing, and we talked a little bit about what worked in the 70s and 80s. And I think one challenge is that the pilots are very slow to achieve scale and to really roll out across the health system. What are your thoughts around or what are you seeing around the limitations of workflow redesign tech, as well as cost justification currently? And then the second part of that question that I want to weave in is how do we overcome those limitations to accelerate time to value?

Bonnie Clipper:
Okay, great, separate questions. And I'm going to try to not forget part two. So for part one of that, virtual nursing for inpatients is literally the new big thing, right? Everyone's talking about it or doing it, really exploring, implementing, evaluating whatever verbs you want to throw out there. I think what we have to really remember here is that virtual nursing is a strategy. When I talk to organizations, and they tell me they are acquiring or working with this technology or that technology, and it's their virtual nursing model, organizations have to remember that the technology is only the tool. The strategy is really where virtual nursing comes into play. This is what allows us the opportunity to transform care delivery, is through the virtual nursing strategy. So that does require a lot of thought, and it's not just as easy as flipping a switch. So even when organizations want to do this work and get into it, it's very time-intensive, and there isn't a cookbook that says if you do steps A through Z, you'll be good to go because every organization is different. When you talk about part two of that, which is really sort of where's the ROI and how do you build the business case, what we're seeing in the hospitals and the CNOs that we work with is that you have to be very mindful about what you're trying to achieve. What's the original problem you're trying to solve? And while there is not yet an aggregate database of all of the results we're seeing around the country. Remember, virtual nursing is 15 years old, but it's been around in its present state for around 3 to 4. What we know is that there are patterns that we are seeing emerge. There are patterns of improving nurse turnover. There are patterns of improving patient experience through HCAHPS, reducing length of stay, improving throughput, decreasing readmissions, depending on the technology you use. And I always encourage organizations, you have to be willing to think future-facing and be willing to spend accordingly instead of buying, frankly, dumb technology like a static camera speaker and microphone that only just captures and conveys images. So if you're going to use future-facing technology, it really can assist you even more in potential safety hazards, fall detection, hand hygiene. It can assist you with things like ... prevention by identifying patients that have not moved for a prolonged period of time. This really is where we have the opportunity as well to get technology that will take you into the future, not just through this year, and think about how do you build a strong business case that way.

Molly McCarthy:
Yeah, I love that. I think your comments around technology being the tool or the vessel, so to speak, to get an organization there, and really going back to the strategy and what you said was, what is the problem we are trying to solve? What is the problem we're trying to solve, and how can we do that? The other key piece that you mentioned was virtual nursing has been around for 15 years plus years. I can't emphasize that enough. It's really thinking about how can we implement the change, change the behavior, think differently about the models of care. The other piece is the outcomes that you've seen, and you mentioned different adverse events, patient falls, for example, which are all events that are non-reimbursable. So we're talking about ROI, I love that. Also, I think one of the key anecdotes that you mentioned seeing through many of these pilots is just the increase in patient satisfaction, the decrease in clinician burnout, the retention. There's so many positives to this new model of care. So when we think about virtual nursing within the broader context of creating a smart care team, you mentioned earlier the robot concept. How do you see the transformation of virtual nursing into the smart care team? What does the transformation into smart care teams require beyond an in-room camera to remotely complete an ADT, admit, discharge, transfer paperwork, patient education, and other use cases?

Bonnie Clipper:
If you think about it, when rooms have the ability to be wired with ambient computer vision or smart sensors, that actually allows us to gather data at all times, right? And we can build algorithms through the AI to identify what it is we're looking for. Are we monitoring patients for falls? Are we identifying patients that need to get up and use the restroom? We can also use ambient computer sound as a way to listen. And with phrases such as, Hey, Siri, please document, patient turned from right to left side, wound is approximating, emptying fully bag of however many CCs of urine, right? In technologies that have that smart sensor application, we not only can use the vision piece, but we can use the sound piece. Imagine how we would dramatically change a nurse's life when you can speak to document any of your notes or all of the things that nurses spend time in EHRs every day. It's a tremendous amount of time, and that administrative burden is very, very heavy, it's required, it's a necessary evil. We talk about simplifying that through keystrokes here and fields there. Imagine getting to the point that you could speak the documentation, and it can use, even if we decide that we want to use generative AI to create better notes, we have the ability to improve the nurse's work life by adopting the technology that is available today to make this better and safer for our patients.

Molly McCarthy:
Yeah, that's great. I think beyond the camera, beyond that vision, really is that ambient piece that you mentioned. The sound is really critical in driving nursing, I would say to the next frontier.

Bonnie Clipper:
Absolutely.

Molly McCarthy:
You mentioned a couple of different use cases for virtual nursing. I'm wondering if you've seen or researched any additional use cases that can be addressed with AI and ambient monitoring layered in with virtual nursing, aside from the ones we've already discussed.

Bonnie Clipper:
All right, so let me take a running start at that, since literally, I'm the one that's been publishing on different models of care for virtual nursing. There's two models. One of them is the ADT, the admission, discharge, and transfer model, the other one is the care partner model. So from an AI perspective, I absolutely think we will utilize AI to assist us in the documentation of admissions, limited assessments that happen through the optics and the visioning, or just frankly, the nurse in the box, the virtual nurse. We also have the ability, through discharge, to make that life much easier when it comes to ... or medication teaching or discharge teaching. I think there's definitely use cases in the admission, discharge, and transfer processes. On the flip side of that, when we look at a care partner model, that really means we are going to scale the work of the virtual nurses and the technology so that we can provide a lot more leverage on those that are off-site to assist the nurses that are the direct care nurses. Some of those use cases look like dual nurse verification processes. Can we utilize technology to more easier and faster identify another on the floor and the nurse in the virtual nurse to say, Can you please verify this blood, or this PCA, or this pump setting with me? We can zoom in. We can use technology to literally do that. The other thing that we have the ability to use that virtual nursing for is we can get really good at providing expert clinician oversight, patients that may start to become compromised. Think about all of this activity around rapid responses. What if we actually could identify, before patient started the downward spiral, what was going to happen? So we know that there are AI platforms out there now that can identify a patient before they're even septic. They can identify them as pre-septic by looking at their labs, a translational table of nurses' notes, and then also vital signs. Now imagine that coupled in a virtual nursing model. We know this information is being fed to the virtual nurse. That virtual nurse, literally, can either obtain or start to work with the direct care nurse at the bedside to initiate orders much faster. So we can eliminate many codes. We can eliminate rapid responses by identifying them way before our human eyes and ears are prepared to do that. I think between expert clinician oversight, dual nurse verification, ADT work, we also have a ton of other use cases, particularly in a smart hospital setting. We can use them as safewords to help us with security or unruly patients, patients that may be overmedicating themselves, or something that requires us to intervene. I think that number of use cases literally grows, and it's only impeded by our creativity, everything from patient education to family education to literally bridging the gap between the family who might be off-site and the medical translator and interpreter. I think the use cases are unlimited at this point in time, and as we even add more technology to them, they're going to be much more accurate, much more efficient, and I think that's where we're going to see the value for the nurses that are the boots on the ground. It will start to relieve all of this workload that's almost impossible, that they have to pull off every shift to be successful.

Molly McCarthy:
I'm just going to reiterate for our listeners the use cases. We talked about ADT, we talked about care partners. I like the concept around dual nurse IDs, for example, for specific medications or chemotherapy, expert clinical insight, the rapid response concept, moving that towards patient safety and quality, the patient education, the family education, really important, especially to have that one-on-one time. The staff safety, speaking with someone else more recently, and they mentioned that as well. Unfortunately, that's the world that we live in right now. And I think going back to a comment you made with the AI and the technology is that instead of having the nurse delve and sift through all the information, it can be presented to the caregiver in an easily digestible manner. I think you said Fed, was your term, but I think that's so critical. We have so much information, and are we using it to better patient care? I'm going to go back to something you said earlier in that it goes back to our use cases is, what is the problem we are trying to solve? So let's get creative around that.

Bonnie Clipper:
Absolutely. It's crazy to me that we're still trying to convince hospital leaders, CNOs, and nurse leaders to actually think differently, right? Talking about adjusting your staffing ratio is not innovation. Identifying technology that can assist you in changing your care delivery model. we're going to run out of runway. Wrote the Innovation Handbook, it was specifically to help tee up a lot of content for nurse leaders that are looking at ways to approach the problems that have been long-standing problems and to try to come at them from a different angle. I applaud leaders that are working on this each and every day. We really have to just continue to try to poke and poke and poke until we break through the noise and find something that works.

Molly McCarthy:
I couldn't agree more, and our listeners are really from different hospital systems nurses, CNIOs, CNOs, and their care teams. Obviously, you've got a really unique perspective of having walked many miles in each of their shoes, from bedside nurse all the way to innovation leaders. And I'm just curious: if you were to leave our listeners today with one piece of advice, practical piece of advice that they could leave here today and go do, what would that be?

Bonnie Clipper:
Oh, this, when I go on-site visits and talk to organizations about virtual nursing, I say, plan and spend more than you think you need to because it will help you as you literally move forward. Otherwise, you are going to be stuck with today's technology that is going to be outdated by the time you install it.

Molly McCarthy:
I love that. Dr. Clipper, her advice to everybody out there is, plan and spend more than you anticipate so that you are not stuck in today's tech to solve tomorrow's problem. Well, thank you so much. It was a pleasure having you on our show today, Bonnie, and hope to see you soon.

Bonnie Clipper:
My pleasure, Molly. Thank you.

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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"This really is where we have the opportunity as well to get technology that will take you into the future, not just through this year." - Bonnie Clipper

Presented by care.ai

care.ai is the artificial intelligence company redefining how care is delivered with its Smart Care Facility Platform and Always-aware Ambient Intelligent Sensors. care.ai’s solutions transform physical spaces into self-aware smart care environments to autonomously enhance and optimize clinical and operational workflows, delivering a transformative approach to virtual care models, including Virtual Nursing.