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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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SCTS_Rich Kenny: Audio automatically transcribed by Sonix

SCTS_Rich Kenny: 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 excited to share a little bit more about our guests today, Rich Kenny. Rich is the SAAS Healthcare Industry executive advisor. A nurse first, his prior office used to be the back of a helicopter for Duke Life Flight, where he gained experience in just about every type of hospital and care setting. Seeing the blurring line between healthcare operations and technology, he pivoted his career into informatics with a master's of Management in Clinical Informatics from the Duke School of Medicine and postgraduate coursework with the Duke School of Nursing and the Fuqua School of Business. Rich has led operations at Duke Health, one of the oldest flight programs in the US, and has consulted for the world's largest healthcare systems in cancer centers with PricewaterhouseCoopers. At the onset of the pandemic, Rich returned to Duke to create their Hospital at Home program and lead remote patient monitoring programs before his nonlinear career brought him to SAS in Cary, North Carolina, where he now serves as an entrepreneur to drive the development and adoption of analytics and AI into care delivery and operations. Welcome, Rich.

Rich Kenny:
Thank you so much. It's a pleasure to be on here with you, Molly. Thanks.

Molly McCarthy:
First of all, thank you so much for taking time to speak with me and share your story with our audience today. And I look forward to seeing you in person, actually, later this week when you're in DC at a conference. First and foremost, you describe your career as non-linear, with a very diverse set of experiences in many clinical settings, and your last role at Duke creating the Remote Hospital Program during COVID. I would love for you to share with our listeners a little bit more about your career journey thus far, from clinical nurse to consultant, and especially your last role at Duke creating the Hospital at Home program and remote patient monitoring program.

Rich Kenny:
Yeah, absolutely. One thing that I love about being a nurse is that no two career journeys are the same, right? Every nurse that I've had the opportunity to meet, and no matter what phase they are at in their career, tell their story in unique ways. And so we've got this profession. That part of the richness is the diversity and the variation in career paths we can take. And if we get tired of doing any one thing or we think we've maxed out our skills here, it's so easy to pivot and yet stay within the same profession doing something completely different. So that's why I like to talk about these non-linear careers. In part, I think it also might be a bit to pushing back against this, maybe some this context around career ladders, right? Because we think of career ladders as linear, like something that I learned a number of years ago is how do we start thinking about those as being more dynamic career progression models? So little callouts being maybe a little subversive to some of those concepts. But yeah, I guess to spend a little bit of time just talking about my career journey started as a nurse, and when I graduated with my bachelor's of nursing degree, I wanted to, I actually met a flight nurse. And so that's where I decided, hey, that looks really cool. I want to pursue that, and then we'll go from there. So started in an ICU as a new grad nurse, went from the ICU to the ER. And then started at Duke in the ER there, and then very quickly joined the flight team at Duke Life Flight. I was very fortunate enough to become the youngest member to join the team and was on the team for close to six years, and we were a team that took care of kind of cradle-to-grave type model. So I learned how to take care of neonates, and we were one of the first programs to start doing to start patients on ECMO and then transport them over to Duke. So got to see a lot, and I think part of what you had mentioned is that's also meant I've gotten exposed about every type of care setting, from the large academic systems to the small rural hospitals here in North Carolina to pre-hospital scenes. So you just really getting to see that breadth of our healthcare system, and again, that's one of the things I really appreciate being a nurse is I feel like we really understand when we talk about systems thinking and understanding how healthcare works as a system. Nurses get that, I think, better than any other discipline. So, from there, I became the manager of the program. I was fortunate enough and led the team. I was privileged to lead the team for about two years, and that's really what started my pivot into informatics. If you think about this was around 2012, 2013, everyone was really in full push to implement their new EMR systems. Flight is really left out of that. Still, we have our own EMR systems, and I was managing that, and it would take me an hour to document what would happen in a 15-minute flight. When I became manager, I thought, okay, we're doing collecting all this data. Surely, we can do something with it. And you can probably guess that we're collecting all this data and it's very difficult to do anything meaningful with it. And so I'm thinking, okay, we have a usability problem and we have an analytics problem. And that for me was okay, that's this, what this new field of informatics is supposed to be about solving. So went through a couple programs, the Duke School of Nursing, and the Duke School of Medicine and Fuqua School of Business also have this joint program called a Master of Management in Clinical Informatics. So it just carries a little bit of that business component as well. And I'm laying a little bit more of this story out just to we're talking about the non-linear careers. And my guess is you were listeners and followers are probably going to be picking this up at multiple stages. So, hopefully, this is helpful. But pivoted there and then started applying and using that and ended up leaving the bedside, as we say. I need to come up with a better phrase for that. But we started doing consulting for PricewaterhouseCoopers. So did a couple things where I really was just trying to get as much experience as I could, right? This is just like in nursing how we would do our clinical rotations, or we'd get exposure to all these different units and care settings. I was doing that just at an executive health system level, so I was getting exposed to health systems like HCA and Ascension and MD Anderson and Mayo and the like, and loved that, did that for a few years. Came back when my third kid was born, and I started just doing some fractional stuff for some startups. And then the pandemic hit, like you mentioned. And at the time, the goal was, I was just going to come back to Duke, and I wanted to just pick up some moonlight shifts as hospice nurse, ironically, because that was really deeply bothering me, how we were handling death and dying through the pandemic. But they said, hey, you've got all this like digital transformation type experience. Can you help us with that? So I had a fortunate opportunity to come back and help them with the digital transformation initiatives, where we designed and launched a hospital-at-home program in seven days. Actually, I think it might have been six days technically led their all their evaluation for like remote monitoring strategies and that kind of stuff, and loved that. But what I had realized coming back into industry is we still have this gap around analytics. I've got a couple problems, right? If we think about the hospital at home, you wanted me to touch on two problems. One being, how can I identify patients that are appropriate for that model of care. That's an analytical problem or something I could solve or use analytics to help augment that decision making, right? The other one is remote patient monitoring. And you've had a lot of exposure to this and worked in this space as well. The problem that I continue to hear and see is that we've got all these devices we're trying to hook up that are generating all this data, yet it's still really hard to distill that signal from all that noise. And no one wants to dump all this data into the EMR for many reasons. That we could dive into that again is an analytical challenge. And so SAS founded this industry of analytics software close to 50 years ago. I started uncovering their technology and their platform. And my reaction was like, Holy crap. Like, this is exactly what we need in healthcare. So let me go and see what it's like working for a technology company and seeing how I can try to help shift and shape their influence on an industry as well. So that's what I've been doing for the last three years.

Molly McCarthy:
Great! And you answered the first part of my next question, and what motivated you to move from the clinical setting into your current role. And I hear you; I've worked in industry and bedside more industry than bedside, but I understand that the desire to try and help solve these challenges that really are age-old, so to speak. But before we go into SAS, I just want to highlight a couple of points you made for our listeners in terms of the career ladder. I love how you talk about the non-linear and more dynamic career because I think that's important. I know, for me, when I was a new nurse, it was, you had to go work in the hospital for a year. You couldn't, if you wanted to do academics, you had to go a certain route, and those were the two routes that most people took. And I think that today, there's so many more options and choices and really just to create based upon where you see the challenges and opportunities, so kudos to you for doing.

Rich Kenny:
I think part of that is.

Molly McCarthy:
I also.

Rich Kenny:
I was just going to comment on that. And you've pioneered this, by the way, as we think about what a healthcare leader of the future needs to look like, that's, part of what I was seeing as I was sitting in my manager chair, recognizing the influence and impact technology is having on not only our profession but our industry as a whole, and that healthcare leader of the future needs to be able to bridge between operations and technology. And so that's been part of my hypothesis that I've been driving towards, is what I felt like that was going to need to look like. And so I actually think, thanks to you for helping pioneer that.

Molly McCarthy:
Oh, thank you. That's nice. I have to say that hearing you talk about flight nursing early in my career, I was at a crossroads and I was, I really wanted to do flight nursing or go back to business school.

Rich Kenny:
All right.

Molly McCarthy:
Yeah, we see what I chose, but I do, I feel that kindred spirit in that adrenaline junkie feeling. And I worked in NICU, so we had huge transport programs. Congrats to you for following through. So really talking about your role right now that you've been in for the past three years as a healthcare advisor, executive advisor to SAS. You talked about SAS, what it does in terms of being around for 50 years, data, and analytics. I would love for you to share with them a little bit more about how you got connected with them and then what your every day looks like.

Rich Kenny:
Yeah, so I'm laughing because I'm trying to think how to tell this story. I've shared this openly, and I haven't gotten in trouble for it, so I think I'm okay. When I was in, people who know SAS in healthcare think of it as a statistical programming language. That's what SAS used to stand for: statistical analytic softwar. And people, i think, in healthcare, you really only know of it if you are a PhD biostatistician publishing clinical research. I had only gotten exposed to it when I was in my master's program, and we did some decision modeling on us, like a CAD, relegated it to this legacy programming language, and moved about my day and thinking there are other ways for us to solve the analytical challenges. What I've come to appreciate is SAS has been innovating and stayed ahead of the curve in how they how their R&D has been developing the new technology. We've just seen it come to fruition in other industries that are more, we're operating at that more enterprise level. When we think of, honestly, a lot of government agencies, when we think of life sciences, are heavy users of SAS, we think of finance and retail, and some and manufacturing is huge. Aerospace, they have, are using SAS, those types of industries that are generating lots of data that arguably we can talk about how it's probably a little bit easier to integrate some of those data than healthcare data, but they found ways to do that and develop models that are running in real-time. We're talking thousands of models, and they're doing all that by orchestrating it through the SAS platform. And how I got connected with SAS is they honestly reached out to me about this position. And so at me doing a little bit of due diligence. So, I had that domain expertise. So, as nurses, that's what we cultivate, that understanding of how the systems work and be able to apply that domain expertise. That's what SAS was needing, and so they were reaching out to me about that. I was doing some of my research about what SAS is and has, and that's where I said let's yeah, let's link up. Let's figure out how I can help inform our strategy to bring this technology that's helping evolve these other industries and really try to apply it to the healthcare provider space. So that's been the focus over the last three years is doing that. We talk about the role that the EMR has played in, better or worse. Maybe that's another episode, but what it has done is it has allowed us to consolidate a lot of different solutions into coordinating that information at the point of care. I still think of it as a single data source, though, right? We're talking about that production system for that. There are all these other data sources. We mentioned the remote monitoring and the like as well that we need to orchestrate. And what I hear so often still today, and it seems like increasingly so with all this push in AI, is everyone, all our administrators are being point solution to death. And so, how do we orchestrate that again? So, I'm thinking that other platform is really an analytical layer. And the only thing that I've seen capable of really doing that would be the SAS Viya platform. So that's what I've been trying to put my bets on over the last few years.

Molly McCarthy:
Yeah, that's great. I know I could have used that. I started my PhD a few years ago, five years ago, six years ago. And I remember taking statistics and I'm like, I know there's got to be a technology or software program that can do this. This is not my expertise. But I think that's important to just call out that we're still in an era, I think, of multiple-point solutions and how can we integrate and ensure there's interoperability really for two people. One is that clinician who's providing that care and then the patient. Our consumer, and more and more, I'm actually hearing from consumer friends who are incredibly frustrated with healthcare in terms of all the just the disparate data sources, that they have a procedure at one place, they need to go take their CD, DVD, whatever it is with the images, and I had to explain why that is. But it's continuing to be a challenge, I think, within our system. So I fully support what you do, and also the fact that as a nurse, really understanding where the obstacles are in the process and the work streams, and that you can have those conversations both with the clinical workforce and then with the technical. And I've always considered myself somewhat of a translator negotiator between the groups so that, at the end of the day, it's a win.

Rich Kenny:
Yeah, exactly, yeah. That role of a translator, I think it goes a long way, at least in how I define what we all have different definitions for informaticists. But that's how I prefer to understand this discipline, or at least where I think we should be heading towards as an informatics discipline, as being that translator. And I think to your point, we can sometimes either try to draw a line between nursing administration or that operational leadership, and then we've got maybe more of the information technology and product silos. And informatics sits on the IT side of the house. I think it really, truly is that blend and understanding, you know, both of those fields.

Molly McCarthy:
Exactly, yeah. Like you said, the blurred lines here, and I don't it's not going back. So I think if we have more people that can understand both areas. My next question: I want to talk a little bit about an article you wrote in 2021 entitled Can Data Analytics Rescue Hospitals from a Healthcare Workforce Crisis? And recognizing now, almost three years later, that our workforce challenges are not going away anytime soon, can you summarize for us what you meant back then by that question? And in your opinion, if we're any closer today to being able to answer that question?

Rich Kenny:
Yeah, first of all, I'm thinking it's 2021. So that meant, without beyond a shadow of a doubt, like I did not have ChatGPT help me write it. Right now, we see all these articles come out, and that's usually what's in the back of my mind is okay, did this person write it, or did they have ChatGPT or Gemini or Lama, whatever model of choice, right, that for them. So, this is pre-generative AI days, at least in my writing at the time as we think about rewind to 2021. We're coming, they're starting to come off the heels of the pandemic, and we just, we burnt out our workforce. And I often think back to my days as a manager. So at one point, I had over 70 nurses and medics that were reporting to me. And I will still say to this day, the toughest job I've ever had was as a nurse manager. And so we're managing these workforces and we're putting managers in place to manage significant numbers of direct reports, and they can't maintain situational awareness as to what's going on with such a large workforce. Again, that's part of my hypothesis, is that we are collecting all this data on our people. How can we use that for good to help identify those flags or those signals that something's changing, whether or not we're detecting a shift in the sentiment and how they document or detecting, even if it's a subtle change in the times that they're clocking in or clocking out, there's all kinds of little signals in data, often the data exhaust or that metadata, the stuff that we typically don't think about or that's front and center that I think could give us some really rich insights. And if we could do that in a way that allows us, that manager, to be much more proactive and engaging with that, with their direct report, we could create more stickiness. Because I'm also thinking on the flip side, right, people who resign, they get burnt out, but it's often because they don't feel supported by their supervisor. We know what we hear from all the management research as far as the number one reason that people leave is because of their boss. And so we have to just connect that into what's going on in the healthcare environment. Even in some of the most difficult times when I know, when I knew I had somebody who had my back, like I was good going into the trenches, it's when I didn't feel like I had someone who had my back that I got concerned, and I think that's what people were starting to experience. And so how could we leverage this data just to give that nurse manager that leg up, that even if it's just a little bit of that prediction to say, I need to focus on Sally today, or hey, it looks like something is shifting with Dan his. He looks like he's a little bit more of a risk for burnout or whatever it might be that we're tracking. Let me prioritize to make sure I focus on him. We've started thinking about that in terms of care management with patients, right? We look at care pathways. Ways and protocols and all that, and look at who's adhering and who might be slipping to say, okay, I need to prioritize that patient. Let's just do that with the workforce. So a lot of these concepts I think of, I was like, okay, we've spent so much time and done a lot around patient experience. You know, I say done a lot. I, to your point, we could probably argue as far as how well that's been implemented, but we at least talk about it. How easy would it be for us to shift those same concepts? And whereas we've been focusing it and literally focusing our vision on the patient, where we just focus that on the nurse or on the clinician, on the caregiver, because that other hypothesis I always have is we want to solve for patient experience. Let's solve for the clinician experience, and the patient experience will take care of itself.

Molly McCarthy:
Now I couldn't agree with you more, I think, sorry, I didn't mean to interrupt you there, but I think you're spot on. And when you think about the creation of the triple aim and how it's evolved over time, with now you better lower cost of care, better outcomes, better patient experience. Someone critical in that circle really is the clinician. So how are we addressing clinician well-being and addressing that through similar technology or programs I think is important. And then obviously the fifth part of that now with health equity, which we won't necessarily get into today, but I want to talk to you a little bit more about the evolving technologies, and especially since you're in a company that plays in many different industries, which I think is really important. When I was at Microsoft, you get to see in your role finance, you get to see oil and gas, and you get to see other industries and how they're doing it. I want to combine technology with your clinical experience. And what do you think about rapidly evolving technologies like virtual inpatient care? I know you did a lot with remote monitoring, etc., but thinking beyond just that monitor or that camera at the bedside, but thinking about ambient monitoring, artificial intelligence, smart technology that can really inform not only the nurse but the patient and their family or whoever's involved in that care circle.

Rich Kenny:
Yeah. So the other concept I like to talk about quite frequently is we'll know we will have implemented technology well, if we're not actually interacting with technology, right? Like it's when it disappears into the background. And that's sometimes hard, I think. And I think nurses intuitively get that. But it's also easy to get distracted because the narratives, the people who are pushing the products, you're right. Everything is about the technology. And I think even just for us at Human Nature is that we are beings that are infatuated with the complex and the complicated, and that's what draws our attention. And so when we see something new and fancy, like we're going to be drawn to that naturally. And so then it takes the work of thinking, okay, what does it mean to be human? What are the experiences that we want to really foster in our humanity and just in how we live out life? And particularly when we were talking about the care setting as nurses, like we're meeting people when they're most vulnerable, people are reaching out for help when they're hurting. And as hopeful as I am about the ways in which we are creating robots, and we're utilizing AI to to mimic empathy in some of those things. And at the end of the day, we want to and we desperately need to be able to connect with another human being. And so implementing technology looks like where we're doing that, and it's disappearing into the background. So that's what gives me hope and gets me excited about these advances and these more sophisticated analytical technologies or advancements. And I'm trying to be more intentional about my verbiage because we now just say AI to mean there's a whole host of anything. And so we often talk about, okay, we need so much education about what AI is, what it's not, and the like, but those types of technology isn't necessarily about putting a device in between the patient and the caregiver. We can actually now remove the device and have something ambient to your point that's sitting up on the wall, and that's being able to understand or interpret what it's recognizing through its sensors and form the caregiver to augment them, to let them know that a patient's starting to exhibit some movements that might put them at a more of a risk of a fall, those types of things. And yet, ..., as big brotherish as having a camera that's constantly monitoring me. So there's other interesting things about that. I was just having a conversation with a colleague of mine this morning, and we were talking about some advancements around being able to look at EKG and that correlate with potassium levels. His area of research is around the dialysis units and the frequency in which patients code in the dialysis unit, and yet how poor we deliver basic CPR care in those settings, and how easy it would be to avoid those if we just checked potassium levels before we started patients on dialysis, which when I learned that we don't do that, I was shocked, but that's not standard practice today. So, the ways in which we can leverage these things that give us the analytics that are can be proven out through the research with that allows us to improve the quality of care, but without this whole technical interface in between. So that's what excites me about where the direction that we're headed.

Molly McCarthy:
Yeah. No, I think those are all great points. Especially you mentioned the specific example of dialysis and having that data and information to go back and say, what could we have done? What should we do? And not having to wait 17 years from bench to bedside to change practice, I think, is really important with technology. And I'm not saying it's all Pollyanna, but I think thinking about how we can utilize it, like you mentioned in the background, to really improve our care. Or, as you mentioned, you talked about an example within as a nurse manager, looking at the health and wellness of his or her staff is critical, too, because that ultimately impacts patients. So thinking about that and where your brain is going right now, I would love for you to share your vision for the future of nursing, specifically within the hospital. When you think about change management, as care models are reimagined, and the role of technology will play to empower bedside caregivers, managers, as well as patients in new ways. And we talked a little bit about some of them, but any other insights?

Rich Kenny:
Yeah, oh, the other thing that we've touched on the hospital-at-home, and the thing that gets me excited, another thing that gets you could probably find it. There's a lot of things that get me excited, but I love it. What I love so much about that program, and I'll continue to try to advocate for it. And there's a lot of still up in the air with how the regulation went falling and a lot of programs trying to reevaluate that, the ROI on those things. But fundamentally, shifting that care into the home environment is the right thing to do. It turns out patients don't actually want to be in the hospital. Who knew? So the outcomes are better, right? All that research is showing that's a better model of care. We've got to figure out and make sure that the ROI works. And it does work unless we've got these big, expensive, empty hospitals that we've got to figure out how to justify. How do we look at these as systems of care that are oriented around the patient? We bring the right resources to the home, which also means helping the family caregivers that are really burdening or shouldering the majority of that burden. We're bringing up all these topics. We could have a whole episode on this and on that. Yeah, but those models of care I'm really hopeful for, and I think of anything that where we're we're getting back to where we're going to the patient we're meeting. We always talk about meeting them where they're at. We want to meet the customer where they're at. In this case, we want to meet the patient where they're at. That's not historically been the model for many years in healthcare. We started having everybody come to us, come to the doctor. So, meeting them where they're at, even if that means meeting them in their home and caring for them in their home, right? And I think we're as that pace of change continues to accelerate. Not to be all Pollyanna, as you mentioned, we do have to be smart about this, right? And so I'm also involved in the coalition for health AI, which is thinking very critically about how we implement the ethics of AI and ensure that we're doing this in the right way. And so when we talk about the future of nursing, the biggest thing is that nurses got to have a seat at the table. Let's not repeat what happened when we implemented all these EMRs where nursing really wasn't at the bedside up front. I want nurses at the bedside, which means that the onus is on us to make sure that we're educated. It doesn't mean we all have to be AI experts, right? But at least have some awareness to be able to ask the same questions that other people ask. Because I'll tell you what, a lot of us are faking it till you make it. Like we're all trying to figure this out as we go. But if we can just rediscover that willingness to just engage in open conversation and civil discourse and recognizing that there are things that we all don't know, but we want to figure it out together, set aside the egos, right? A lot of this comes back to, okay, how do we just tackle change management and try to get everybody on the same page? We would like to focus again on the technology, but more and more, it's about the people and then the processes. Let's focus us on those elements first and make sure we have identified the right problem that we want to solve, and then we can go match up the technology to it. Right now, especially with all this generative AI, we've got this new shiny toy, and this is how this is going to solve this and that. And it's got some values, no doubt. I enjoy using it. I probably use it every day in some capacity, just even if it's helping me think about something or be a bounce back of some ideas. But it's not going to solve every problem. And so we've got to start with that problem identification. And I think nobody can do that better within healthcare than the nurses who spend the majority of time with patients.

Molly McCarthy:
Well, a couple nuggets that I just want to make sure I pull out again from our for our listeners; from what you just said, one is the hospital-at-home and even thinking about what patients will make good candidates for hospital-at-home versus which ones will not, based upon many different aspects of their care or their diagnosis or their stay within the hospital, and we can use data and analytics to help make an informed decision. So that, I just want to highlight that. I think that's important. Another way, rather, is what you talked about before in terms of using that data to guide nurse managers or nurse leaders or even the leadership within the health system. The other point that I heard you make that I always beat the drum on, so I will take the opportunity again. But being nurses, being at the table, and I'm a real strong proponent of having them not just at the table but in the discovery period, because they understand what the problems are in the design, in the development, and the deployment. Really thinking about a multi-faceted stakeholder group across that continuum. And then, with that in mind, and I you've given so many great nuggets of wisdom here, but I want to remind you that our listeners are CNOs and CNIOs and their teams. And given that you've had such an amazing, unique experience within healthcare, I would love for you to share just one tidbit of wisdom with our listeners. So what would be your single most important, practical piece of advice for them as it relates to being tireless advocates for their patients?

Rich Kenny:
Oh, you said practical, and the thought that came to mind. I would just say how we can weave this together. But I always talked about nurses being the MacGyvers of healthcare. You give a nurse a roll of tape. What we can do with a roll of tape is mind-blowing, and I don't know how I weave that into kind of a practical piece of advice for CNOs and CNIOs. But probably, you know, something I feel like maybe is a common thread that we've touched on is this notion of the systems think. Like, in the same way that maybe that piece of tape represents so many different things that we can do, and we understand how the world of healthcare and how these systems are held together, recognize that understanding that we have as nurses, and understanding how all the different departments work together, and interface and understanding better than anybody else what that patient journey actually is. And so we talk about systems thinking, we talk about human-centered design thinking, I would say as far as practical advice, spend some time, if you haven't already, learning and digging into those disciplines. Because if we're talking about having a seat at the table and if you don't have one, bringing your own chair, I think that chair looks like the education and knowing how to show up in conversations and ask the important questions. And so we can ask better questions if we are thinking in a way that is human-centered, and that is in that more design thinking type approach, right? And these are all these kind of concepts start to blend together a little bit, so I'm bringing them all up. But I think that's an area of discipline that we would do well in to try to bring in. And that's also, and we talk about that in just the nursing process, and we call it different things. But it might be that we need to get a little bit more comfortable with the language that our technical our administrative counterparts are might be a little bit more familiar with or have heard to be able to translate that. And so that problem definition, that kind of design thinking, if we're talking about the patient journey, it's still fascinating to me how few health systems I work with that can articulate or have a visual representation and an understanding of what their patient journey is, and map out all those touch points. Because until you can do that holistically, it's really difficult, I think, to pick apart any one of those touch points and say, we're going to fix this one without an understanding of how does that affect the process overall, that might be the same as practically think and reflect and build that critical. Thinking muscle around systems, thinking, design thinking. And I think there'll be ways that you'll start to discover how you can apply that and how we're thinking about care model redesign and applying these technologies and the like.

Molly McCarthy:
I love that I know the patient journey, and just following a patient from before discharge to home and then looking across the care continuum is really important. And I'm just going to add in there, since we spoke about it, just thinking about the clinician journey too. And where are the points where within the system that we can alleviate some of the obstacles and the challenging workflows with that technology? But you can't really do that when I'm hearing you saying it. Just you need to understand the whole system. And who better to do that than nurses?

Rich Kenny:
I think so, starting to understand what everyone's role is in these redesigns. Like I've got some great physician colleagues, I need them when we're talking about the physiology and pathophysiology and the disease process and diagnostics and those pieces. But when we're talking about kind of patient flow and journeys and treatment, the nurse, that's our area to own, we need to be stepping up and advocating and providing that voice.

Molly McCarthy:
Well, Rich, I just want to say thank you so much for your time today. Really appreciate your perspectives, and I look forward to hopefully meeting you later this week when you're in DC. So thank you.

Rich Kenny:
Likewise, this has been a pleasure and I've enjoyed it. And yeah, thank you so much for the opportunity to chat.

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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SCTS_Dr. Robyn Begley 2: Audio automatically transcribed by Sonix

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Molly McCarthy:
Hi, it's Molly McCarthy, podcast host for the Smart Care Team Spotlight. I'm excited to reshare an episode I did with Robyn Begley, CEO of the American Organization for Nursing Leadership, AONL Foundation president, and AHA's Chief Nursing Officer. Robyn recently announced her plans to retire at the end of 2024. Thank you, Robyn, for your passion, leadership, and willingness to collaborate over the years and personally, thank you for being a mentor to me, always answering my calls and questions. And, of course, go Hoyas!

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 today to have a leading voice in nursing and healthcare. Dr. Robyn Begley on the Smart Care Team Spotlight today. Dr. Begley is Chief Executive Officer of the American Organization for Nursing Leadership and Senior Vice President, and Chief Nursing Officer of the American Hospital Association. In her role at AONL, she leads a membership organization of more than 11,000 nurse leaders whose strategic focus is excellence in nursing leadership. She oversees a number of key initiatives involving workforce quality and safety, and future care delivery models. In addition, she works collaboratively with the AHA to ensure their perspective and needs of nurse leaders are heard and addressed in public policy issues related to nursing and patient care, and leads the AHA workforce initiative. Dr. Bagley previously served as Vice President of Nursing and Chief Nursing Officer in Atlantic City, New Jersey. Welcome, Robyn.

Dr. Robyn Begley:
Thank you, Molly, it's really a pleasure to be here with you today.

Molly McCarthy:
I appreciate your time. I know that you've been traveling and busy, so thank you. And I know our audience is really excited to hear from you. And so I'm going to jump right into my first question—just a little background information. Obviously, there's certainly no lack of problems that healthcare systems must address today, that goes without saying. And this podcast is really developed to bring thought leaders like yourself together to address two overarching challenges right now. One, what we ask of our bedside caregivers has become humanly impossible, and therefore we're losing so many talented and passionate nurses. And then two, even if we had all the caregivers we needed, the underlying costs of our current care delivery models are fiscally unsustainable. So my question really for you is, as the CEO of AONL and CNO of AHA, can you share with our audience today how you and your organizations are working to combat these challenges?

Dr. Robyn Begley:
Thanks, Molly. They are large challenges, but we do have lots of work in play. So let me give you a few examples of what we're doing. The American Hospital Association has been working on the workforce issues for a number of years. I am leading, along with others in our organization, a board-led task force that is comprised of AHA board members and also AONL board members as well. And so we're tackling issues on the clinical side as well as the non-clinical side. I would say that recruitment and retention, and pipeline issues are top of mind. We have work going on. I think one of the things when we think about healthcare across the country, it's not one size fits all. We have so much variation from really tiny critical access hospitals to very large academic centers and systems across the country. So there's there really is no one size fits all. So the information that we gather from our members illustrates some of, we've done a very intentional job at gathering best practices from across the country. What are organizations doing? How are they partnering with their local communities, with their educational, with their educational partners, in their communities? And we are really pleased by some of the emerging work in Virginia; for example, the Board of Nursing, the hospitals, and academia are partnering not only to make sure that nursing students get great educations, but really to support those students as they are in school with paying positions.

Dr. Robyn Begley:
And this is all vetted with the Board of Nursing. So those though some of those hours can also be counted towards their education. We're finding that there's other disciplines besides nursing for sure that are experiencing real challenges as well. And again, how can the community connect with the hospitals? We think about challenges that some challenges that are unique are not only attracting the nurses and other caregivers to the regions, but when we get them there, there are certain areas of the country that are very expensive to live in. Housing becomes an issue. That was something that when I spoke to some of our colleagues in California, I had not realized was such a major issue. And it involves traveling for hours from affordable housing. And those hospitals are doing things like subsidizing housing for employees and in some cases, actually have a very creative purchase agreement with local homeowners or property owners, where then our staff can be their staff can become part of the local community. That's just one real example, real time example rather of what's happening. I think that on the AONL side, just want to talk a little bit. Last year we and into the beginning of this year, we produced a compendium that if you go to AONL, aonl.org, you can see the compendium which was originally released in three sections, but now is all combined and takes a look at the topics we would expect to see recruitment and retention.

Dr. Robyn Begley:
But when we really drill down into that, what is that about talent acquisition? How can we really work on that? Using some tools that perhaps were found in healthcare prior to the pandemic, but we're doing using really unique tools to be able to attract people. We have a section on a positive practice environment. We could probably take another whole section and just talk about work environment and how we have to make the work setting attractive and make it a place that is welcoming to not only senior healthcare members, but also our new generation that's just joining the workforce—best practices in leadership, academic practice, partnership, the culture of inquiry. How can we really change the cultures in our healthcare system, and we can't minimize how important comp and benefit is to our staff. So we have a section on total rewards, and we just talk about some of the issues and benefits that are important, for example, to different generations. So are entering, new clinicians into the workforce might be really attracted by an organization that provides child care or has benefits that help them repay their student loans. For example, when our older and more seasoned, I like to say healthcare workers are looking for retirement benefits or maybe less aggressive scheduling. As people are getting older, there's not really a one size fits all, and we're finding that the most progressive and successful organizations are the ones that realize that there has to be, if you will, a menu of benefits.

Dr. Robyn Begley:
And how can we appeal to really the four generations that we have in the workforce? Right. Just some those are just some high level ideas. One thing, several things that we are working on in 2023 from the perspective we are partnering with IAG, who is funded by Johnson and Johnson Grant, to evaluate new models of care. We are working with IAG, rather, they have a learning collaborative that began and is underway and will finish their inquiry in January of 2024, and they've outlined the metrics, they're looking at the different models that are being evaluated. And of note, they're not just hospitals or health systems that look the same. There's a world there's actually a military hospital from the West Coast, as well as some other organizations across the country. We're monitoring that very carefully, and in collaboration with IAG, we hope to make sure that the learnings get disseminated, not just at the end of the process, but at points in time along the way. So we're very excited about that. Out of the care models work, we've also identified the importance of and some of the things that we're talking about today is really how can technology be an enabler for the new care models? Virtual nursing is something, for example, that everyone is talking about and considering. But what does that really mean? And there's we're finding that there's variations in virtual nursing, which is probably good at this point in time, because this is the time that we are doing innovation and evaluation.

Dr. Robyn Begley:
And hopefully as we move a little further, we will know what are those either common elements that are scalable or what might have sounded like a great idea, but in practice was really something that we need to move on from. And finally, the actually, the second really large initiative that AONL has underway is a really deep dive into the nurse manager role. And for anyone who's ever worked in a hospital or health system, I think it is so apparent that the role of that frontline manager is critically important to the success of really good patient care. They have those managers have such a breadth of responsibility and depth, and so things like span of control we are evaluating. We're looking at what are the rewards and recognition for the nurse manager. What are some of those tools that can really help alleviate some of the stress? Most of our nurse managers work or have responsibility for the care on their units 24/7. It's quality and safety. It's staffing, which is, I think, the bane of every nurse manager's existence. It's the well-being of their staff. It is certainly the well-being of their patients, and they have costs and financial responsibility, so they are just pretty much overwhelmed with their current responsibility and also really very tired to what's happened over the past several years.

Molly McCarthy:
All very salient points. I think one thing that I heard throughout your discussion, really, that which you led off with that one size doesn't necessarily fit all. And it's really important to look at the profile of where the care is happening and where it's given, whether it's rural or inner city, etcetera. As well as to really understand the aspects around who is giving the care. So with your nurse, I think you made a great point around, we currently have four generations in the workforce. So again, what we perhaps reward them with is going to differ based upon what's important at this stage of their lives. So all really good information. Again, you mentioned the Nurse Compendium. I know that's on your website. So I would just ask listeners to go check that out. I know it's incredibly detailed. I looked at it again yesterday. So thank you. Just to follow up question and so you talked about new models of care. And as we think about these transformations happening clinically, what role do you see nursing playing, whether it's a bedside nurse or nurse leader or CNO to ensure that the new care models best serve their patient populations as well as themselves?

Dr. Robyn Begley:
I think that's a really great question, Molly. I always believe that if a person or an entity or a profession is involved in the design, that it's better. I think we have to be very careful about not saying this is what our patients want, or this is what our community wants, or this is what our nurses want. We really need, nurse leaders need to feel comfortable enough, and they need to be aware enough and smart enough to say, we need the nurses now. We need the staff to be able to help design the solutions. We need the patients. And sometimes I think we think it's easier for us to do the work and then present it, if you will, to either the patients or to part of the team delivering the care. And it might take less time, but I don't think it's as rich a process or really gives us the real insight into care delivery. And you mentioned earlier, and I just agree with what you said about care being needs. It's happening in many different places, both in hospitals as well as really pretty much any setting across the continuum. And in a lot of those different in a lot of the communities, we find that they have different resources. What might make perfect sense in one area of the country might not in another, because they may have a very robust LPN program, for example.

Dr. Robyn Begley:
Or they might have a technical school or a college that is able to really attract and produce students, so that can do certain roles. But of course, nursing always comes top of mind. But I think it just when we look at what's required for healthcare, we just have much, complexity. And I think nurses need to, because what we do is direct care and we need to make sure we coordinate care. Maybe that's the best a better way of terming it, but other disciplines and other roles can really participate in the delivery of that care. But from my perspective, it's the nurse that makes sure that these pieces all connected. The extraordinary puzzle putter together and connector. So we really need to think about we're not going to have enough nurses to do nursing in the old primary nurse way that I learned 50, almost 50 years ago, which was a very innovative model at the time, replacing the team, the old team knock model of care. Now it's as we look to the team of the future. I think nursing obviously has a very important role, but it's not just about the nurse. So that ability to get all the disciplines that need to participate on that particular patient or patient population, I think is one of the things that we have to figure out. We bake similar language in healthcare, but not always identical.

Dr. Robyn Begley:
We have different ways of documentation. There's just so much variation. And I think those days have to be in the past, and we really have to think about what's best and what's most efficient for our patients. We know our population is aging. I recently, I think I read that 10,000 baby boomers are turning 65 every day, and by the end of the decade, everyone in the baby boomer generation will be 65 or older. When we think of the group that consumes most of our healthcare, the age group, it is certainly our seniors. And not only are our is our nursing workforce aging as our baby boomers nurses age out, but we also have then that additional bulk of population, if you will, to care for. So it's a double whammy. And before the pandemic, I think we saw challenges in the way we were delivering healthcare, and we knew we were facing an attrition of our senior nurses, but it only became accelerated. The National Council of State Boards report that they put out earlier this year, is a great example of actual data collected around the numbers, and we know we have to change. I think never waste a good crisis. We have to take what we see right now as a challenge and make healthcare better for the future for all.

Molly McCarthy:
Yeah. Think you made some very interesting points, especially inclusion of the patient. So important as we continue, I think as nurses to really be at the forefront of that bedside care, but also to your point around an inclusive model that includes multi-stakeholders within the team, whether that's the OT, PT, the physician, the radiologist, etcetera, because we know that patients are becoming more and more complex, especially within the acute care setting. So thank you for sharing that. I think one other piece that I wanted to pull out that you said was to slow down and take the time upfront to really think about what you're trying to achieve. And that's something I've heard really throughout this podcast. It's so important. It might feel slow and frustrating at first, but to really think about it and do the hard work will pay off in the end in terms of adoption, etcetera. All right, so speaking of adoption, my last question here, second to last. So I made the point in the opening piece really around technology can make caregivers lives sometimes harder, not easier. And obviously in today's world there's so much noise, especially this year around AI, generative AI, ChatGPT, you mentioned virtual nursing, and more specifically, let's hone in on virtual nursing. But based upon your conversations with your members and constituents around the transformational promise of virtual nursing, really, beyond just a camera in the room, what are your thoughts around nurses adoption of this new technology based upon what we've learned from the past? So, for example, with EMR adoptions, I would love for you to share what you're hearing and seeing in within your membership.

Dr. Robyn Begley:
Yeah, happy to do that, Molly. And right now, we've got a call out to our members at AONL to share with us where they are in the innovation space. And one of those categories is absolutely virtual nursing. So we are seeing, it's very interesting. We're seeing different applications, which we, that we hope to really learn more from. And I don't know if you want me to share particular names and systems, but there are, and so we'll stay away from that. But there's a large system, for example, that has done a lot of work, as we said, preparing the ground and piloting in one of the hospitals the virtual care model. At first there was not a lot of interest, but it was one unit. And they they put the time in to really identify the roles. What was the what were the expectations of the nurse that is in the room at the bedside versus the virtual nurse. And we're very deliberate about trying to identify upfront what would be how the day would go, what it would look like, the workflow, etcetera, doing reeducation. And it also involved not only in other. It was actually part of a care team, the virtual nurse, and defining the roles of the other members of the care team. Fast forward the outcome and also what how the patient is educated. What is the expectation? All of a sudden there is a screen and a face on the screen. How do we prepare the patient for this? The results have been remarkable for this particular organization. They have, almost a year later, 100% retention of the staff.

Dr. Robyn Begley:
They have excellent patient satisfaction numbers. They have calculated near-misses and things that have been averted because of the oversight of the virtual nurse. And even as importantly, is everyone is signing up and wants to be on one of the one of the virtual units. And the plan is to spread from what was initially one unit in one hospital to, I believe, 50-plus units by the end of the year, the calendar year. And have there been modifications? Absolutely, as they learn new things. Is this a role that you do or do you become a virtual nurse, or is it a role that you might do one day a week and do your other shifts in the hospital? So they're testing things like that. Another healthcare organization is also using the virtual nurse as the educator for the families, and it doesn't necessarily mean that discharge, education, and planning all happens in the hospital. But they're experimenting with the patient gets home, and then within two hours, the family is there at the request of the patient, of course, for hearing the plan, the reinforcement of the education and the virtual nurse is very effective in saying things like, okay, get your prescription. Can you show me exactly... And the patient then or the family can do the return demonstration in the home so that the nurse can be really reassured that the family and the patient get it. So I think there's some opportunities that probably, in the beginning were not identified that really are very helpful. And that might avert a home visit if it's something that the virtual nurse can check off.

Dr. Robyn Begley:
We haven't really talked about how they can enhance the new graduates, but that is a role that is pretty consistent across our that we've been hearing across our hospitals that are implementing and how it is received by the new nurse. And for the most part, it is very positive because they feel like they have a set of very knowledgeable eyes, not only just watching a particular task that a nurse is maybe doing for the first time, once since they've graduated, but also really just someone to say, I'm looking at the labs and, and a person who has a lot of experience that can either validate their concerns or say, in my experience, it's okay, let's continue to wait until the next lab value comes back or something like that. But so I think we're really just beginning to learn all of those facets of the virtual nurse. I would also just really quickly add here that usually there's a doorbell or something that announces the virtual nurse to the patient. But in other words, there's privacy for the patient. Because I know a big concern was, well, we just going to have someone observing in a room and nobody knows that they're there. And that might be intrusive, but that is not the case. They announced themselves, and many family members have expressed that they feel very comfortable that there's also that extra set of hands and eyes or eyes and virtual hands. I should say that also is part of the care team.

Molly McCarthy:
That's great. I love your anecdotes around the results and the 100% retention of staff. Kudos to that health system. I have obviously heard the increase in patient satisfaction and then the near misses, the patient safety, the quality all wrapped in also with the new grads and just even boosting their confidence, I think is such a huge component of the overall promise of virtual nursing. And then the thing that I loved, what you said is, and I'm just going to put it in my own words, is really it's the tip of the iceberg. As we continue along in this path, more applications are identified, even the education in the home. I actually hadn't heard that yet, but that's so key to prevent readmissions, etcetera as well as satisfaction. So those are all amazing examples, and I'm excited just to see it continue and to grow. As we wrap up today, our listeners are healthcare leaders, CNOs, CNIOs, and their respective teams. And obviously, you have a wealth of knowledge, a unique lens of having walked in the hospital for many years from bedside to boardroom and now with AONL and AHA. And if you could just give one nugget of important practical advice for our listeners today, what would that be in today's environment?

Dr. Robyn Begley:
Hard to say. Just one thing, Molly, but..

Molly McCarthy:
You can say, okay.

Dr. Robyn Begley:
First of all, I think timing is everything. And I think we are at a place in time where all of us intuitively know that the way we've done things in the past needs to change. So some of those ideas that maybe it wasn't their time ten years ago and they might not look exactly the same, but maybe the time is now to to reexamine them and see if there's a way to find a way to make things happen. And I guess I would just end by saying that as I we have many challenges and healthcare, we are from a workforce perspective, for sure, it's been crisis mode. But as I have been back traveling the country and talking to nurses at conferences and doing site visits, and just this morning, I actually was on, I participated in a class with nursing students, and I'm so energized because they're very optimistic. And I really think we have the brainpower and the will to continue to really transform the way we deliver care. So I'm excited about it and I hope everyone gets a chance to, and I'm not a Pollyanna. I try to be an optimist most of the time, but I know the real challenges that do exist. But I'm very optimistic about the future, and I believe we have the desire, the knowledge, and I think the innovation piece is what I'm so excited about seeing because we're appropriately questioning the way we've always done things. And I think I see that there's other ways for us to accomplish our goals, and I'm very confident that we're going to be able to make some significant changes.

Molly McCarthy:
Thank you. Robyn, as you mentioned, timing is everything. And it sounds like the time is now. I will let you get back to your members and your organization and really appreciate your time and insights today.

Dr. Robyn Begley:
Thank you Molly, it's been great to be with 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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SCTS_Mary Morin: Audio automatically transcribed by Sonix

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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 guests today, Mary Morin. Mary has been a registered nurse for almost 43 years. Currently, she is the Enterprise Chief Nursing Officer and Senior Vice President for Sentara Health in Virginia Beach, Virginia. She is accountable and responsible for nursing practice and care—employee health workers compensation with over 33,000 employees and other system clinical support services. Sentara Health, an $11 billion healthcare system, is composed of 12 acute care hospitals, a large integrated medical group, ambulatory services, large post-acute services, and four health plans. It's also the largest healthcare system and the second largest employer in Virginia. Upon graduation from George Mason University in Fairfax, Virginia, Mary was commissioned as a Navy Nurse Corps officer in the United States Navy, retiring after 25 years of active and reserve duty in June of 2006. During the past 43 years, Mary has been a staff nurse in medical, surgical, critical care, specialty critical care, and emergency room and trauma and has held nursing leadership positions in acute and ambulatory settings. Welcome, Mary. So wonderful to have you here and to get ourselves situated today.

Mary Morin:
Yes.

Molly McCarthy:
Thank you so much for your time.

Mary Morin:
Thank you, Molly.

Molly McCarthy:
I want to get started by talking a little bit about your career journey. It's obviously an inspiration to many and quite a unique path to your current role as CNO at Sentara. Can you tell us a little bit more about how serving in the United States Navy Nurse Corps for 25 years has prepared you for your current leadership role, and how you approach the challenges of today's healthcare systems?

Mary Morin:
Yes, and thank you, Molly. I want to start with that. It was such an incredible opportunity and honor to be able to serve in the United States Navy Nurse Corps. That 25-year history was both active duty as well as reserve time and how the Navy prepared me for my current role. The Navy makes you very flexible and very adaptable. It allows you to work with diverse groups of people across multiple settings. And you have to be flexible because you're expected to move and change your job essentially every, you know, sometimes 18 months to three years. The other thing about the military is that many times they're early adopters of technology. So as I moved more into the civilian healthcare world, that was important as well. As a young Navy nurse, you immediately move into a leadership role, leading teams of young corpsmen as you advance. You have younger nurses, but you're working with relatively in hospitals, relatively young people, physicians, and nurses. And so it does prepare you for that leadership role, not only at the bedside but in an organization leading larger initiatives. And so today, with technology, one of the things that we are moving very quickly on is the use of virtual nursing technology.

Mary Morin:
We've had that virtual care more in our ambulatory environment. One of the advantages of COVID-19 is that we learned to use and leverage technology differently. And so those virtual visits on the ambulatory side have continued. What we are currently doing is moving that virtual technology into the acute care hospital settings. So we are focused on medical-surgical units and intermediate care units and leveraging a virtual nurse to, first of all, take some of the burden off that bedside RN. Sentara is no different than other healthcare systems challenged with having those bedside nurses, particularly in the medical-surgical areas. And so, based on feedback from around 1000 direct care RNs in Sentara, we are moving forward with a virtual RN, bi-directional cameras, and bi-directional audio, as well as the use of ambient and artificial intelligence to start with admission discharges and patient education. And we've had the advantage of seeing on-site. I've had the advantage of interacting with other systems—CNOs who have already implemented components of virtual nursing and learning from them. First and foremost, patients love it. And the staff on the units love it. You know, you don't need a nurse at the bedside to do an admission or a discharge.

Mary Morin:
You need that nurse at the bedside to do those critical assessments that require hands-on care to administer those critical medications. And so that's the advantage of leveraging that technology and bringing in a registered nurse. Right into the room in real-time and do work that can be done virtually. And so we're learning from other organizations and getting ready with phase one. Our plan is, by October of 2025, to have all of our medical-surgical units in intermediate care units across Sentara live with virtual RNs. And again, starting with admission discharges and patient education. We then will expand because the opportunities are almost limitless as to what you can do using virtual technology. Then, you layer ambient intelligence and artificial intelligence onto it, and it becomes an incredible learning system. And, of course, there's a huge safety component to this as well, meaning it can improve safety. The ability for a virtual nurse to zoom in and read the fine print on an IV bag, for example, to perform a double check with another nurse when administering high-risk medications. I mean, that's just one example of many.

Molly McCarthy:
Yeah. No, I love that. You dug in there from the beginning. So, thank you for sharing all that. I love your stories about getting into leadership early on, obviously within the military, diving in, being flexible, and just going because you must. You have to. Obviously, you've accomplished so much during your time with the Navy, and then currently, you have, I think I read, over 9000 nurses who support the 12 hospitals and numerous medical groups, as I mentioned, and ambulatory sites. So, aside from thinking about some of today's challenges, how do you get feedback from your team, and how do you prioritize where to invest the systems, time, and resources to best serve your front-line caregivers? And obviously, it sounds like virtual nursing is at the top of your list today. I mean, wow, I'm impressed that you have that goal by October 2025. So just curious about some thoughts about feedback from the team and then how you move those forward.

Mary Morin:
So in terms of the TMLs, speak to the direct care nurses out there taking care of our patients 24/7. And that started with meetings with direct Cairns back in August and September, October of 2023. Most of them were not familiar with virtual nursing, and this was part of a larger strategy. We were in a transformation evolution, and this was one of the top transformation initiatives. That isn't just about the acute care setting. We're also looking at leveraging that technology across the post-acute environment, home health, for example, even more so in our medical groups, and potentially in our health plans, using that virtual technology to help manage inpatients, our post-acute patients, and then our consumers that we serve in our medical groups as well as our health plans. So, it's a system priority as well. This is something the virtual work you have to do. I mean, this is what I call the ATM machine of healthcare, that we will never deliver healthcare in the same way. Because as you start to think about all the things you can do, really, your mind explodes with ideas. But getting in front of frontline staff nurses, before we were looking at virtual care, we were conducting site visits.

Mary Morin:
And so with those meetings with frontline staff, they're the ones, as I talked about virtual nursing, they are the ones that said, hey, admission discharges and patient education for us, our major pain points. And that's where the decision came from. It wasn't a leadership decision. It was really what did our frontline staff say? So we've taken that and really focused on learning from other organizations that have implemented that component, specifically knowing that it will most likely quickly evolve. We have shown demos to our frontline staff, and they're no different than leaders like me who see it and start going, hey, can we do this? Can we do that? And we've heard from other organizations that it can quickly evolve. And you do have to have a well-constructed plan because it's very easy to get overwhelmed with all the things that you can do. But there is a system, a major system initiative that crosses all the venues of care. It is a top priority in Sentara. So those resources have been financial resources, in particular, have been allocated to make this a reality.

Molly McCarthy:
Yeah. I mean, I love your analogy of the ATM. Actually, a lot of times, I make an analogy around depositing a check where, in the olden days, you'd walk into a bank or even then evolve into a drive-up teller. I personally make my deposits on the phone, or it's automatic. So, I think that's a really good analogy. It's changing the workflow and making us more efficient. When you think about it, and it's you mentioned a few of the use cases. I know ADT admits discharge and transfer patient education and that you're conversing with your CNO colleagues. So important in terms of sharing what works, and what doesn't work. And we're not waiting around a year to figure it out. But we're collaborating with other orgs. And I think we're going to, you know, as many people have said, this is really just the tip of the iceberg. And it's really beyond nursing, too. It's looking at pharmacy and other specialties, and it's really just going to be part of care. And we won't necessarily in the future, call it virtual inpatient care, we'll call it inpatient care. And that will be a component kind of like what works today. We also work remotely. Yeah. So I think that's fantastic. I love that plan. And I love that you're getting feedback from the front line. Nurses are so critical in the adoption and really figuring out the best ways to utilize the technology. So we've talked a little bit about virtual nursing and ambient intelligence, I'm sorry, ambient monitoring and artificial intelligence. So, when you think about the future of nursing within the hospital, what is your vision for nursing? And also when you think about change management as care models are being reimagined, as we just discussed, and the role of technology will play to empower the bedside caregivers and patients in new ways. How do you see nurses, I guess, working and their role as that center of the wheel, so to speak, of care with that patient and advocating for them? And how will that change your ideas of nursing?

Mary Morin:
So will it. Absolutely. So in addition to the virtual transformation initiative we are under, or we are engaged in care delivery, redesign. And so the role of the registered nurse, and this is something that I learned in the Navy. You have to be a leader at the bedside. And that leader means leading others who can deliver care safely, effectively, and efficiently. But they don't require an R.N. license. So, by leveraging others to get the patient care work done, there will be fewer registered nurses at the bedside. We're we're already seeing it today. And so that RNs got to be comfortable leading a team and partnering with other caregivers and patient care technicians. Again, licensed practical nurses are very important and very valuable, particularly in a med surg area, because they can administer medications. Leveraging other team members to take care of patients, then moving into a role of still doing hands-on care, they move into a role of prioritizing what needs to be done for the patient, delegating the care, monitoring, and supervising that care. So, I do call it being a leader at the bedside. And I would say that that is top of licensure work for a registered nurse. We need them to do those thorough assessments on patients, make decisions about the status of the patient, connect those dots based on the findings and data that are collected from others, assistive staff, for example, to make decisions as to does something needs to be done differently for this patient and escalating.

Mary Morin:
But it is, again, coordinating a team. So we're moving back to what we're going to call zone nursing. But more of a team approach. You mentioned I've been a nurse for 43 years as of next month, and we moved from a team-based model in the 80s to primary nursing. And I would challenge that we never did primary nursing. What we did is we fragmented how we approached care on a unit. Molly, you had your six patients. I had my six patients. Wasn't that we weren't good team members, but we didn't approach the care that we delivered to our patients as a team like we did in the 80s. So there's relearning here for nurses—my contemporary and maybe about 5 to 10 years younger. But for most of the workforce, it's a model they've never practiced. So we have to invest in that training. So Sentara's partnering with our schools and universities to re-establish that type of training, training RNs to be leaders at the bedside, and learning how to delegate delegation takes practice. It's a skill. It requires that you understand what needs to be done. It requires prioritization. It also requires being comfortable setting expectations, following up, and asking questions as to whether or not somebody is competent to perform a task or a procedure that you will delegate. So, I see it as an exciting revitalization of the role of the registered nurse, from a taskmaster to a leader of the bedside.

Molly McCarthy:
Yeah, so many nuggets of wisdom in what you just said. And just I'm going to pull out a few for our audience today. Just the top of license is critical with, quite frankly, the shortage of nurses. And I think working as a team is critical in your point about being a leader at the bedside. I like to think of it as being able to hone our critical thinking skills as nurses. Yes, that we've learned, and putting those to work and not being so concerned with obviously checking off a list, so to speak, but looking at the big picture and orchestrating that care, whether it's with the family, the LPN or other licensed caregiver, the physicians, nurse practitioners, and whoever it might be dietary. Obviously, coordinating that care is critical. And your point about prioritizing, obviously, who's most at risk, etc. So many good points there. And the other piece I want to reiterate is the partnership you mentioned Sentara is having with schools and universities. We want to infuse into our schools and universities into our students what's going to help us the most when they come out. And it is that team-based approach, and it's for me. And I'm not going to get on my soapbox here. But it's not just within nursing but with the whole care team. That's important for them to have modeled, seen, and participated in during their education.

Mary Morin:
Absolutely. And I jokingly refer to it as back to the future.

Molly McCarthy:
Back to the future.

Mary Morin:
Yes.

Molly McCarthy:
So, the pendulum always swings. Yes. First of all, thank you for your time. I do have one final question. I would love for you to talk with our listeners, obviously some of our CNOs, some of our CNIOs, some are bedside patient caregivers, and some might not even be nurses. So, given each of your experiences in healthcare, could you just share 1 or 2 parting gifts of wisdom with our listeners? What is your single most important, practical piece of advice for them as it relates to their responsibility of being tireless advocates for their patients?

Mary Morin:
So, first and foremost, the patients aren't always right, but they're always our patients. And I think we sometimes forget that, and when patients and their family members come into our care, they relinquish control. And they also place their humanities into our hands. And I think it's both an honor and a privilege to be able to care for the people. And so that is something that I felt very strongly about my whole career, it is always about the patient. And I also just say to those out there, if you don't have the fire in the belly anymore. Then seriously think about how you can get that back, or where you can go where that is rekindled because that fire in the belly is so important. It matters. It matters to leaders like myself. And I think it really matters to those we work with as well as those we care for.

Molly McCarthy:
Yeah, Mary, I think it is a privilege and honor to care for the patients. And to your point, we're all human, and we need to continue to remember that when we care for them. I just want to say, first of all, thank you so much for your 25 years of service.

Mary Morin:
Oh, thank you.

Molly McCarthy:
And thank you so much. Yeah. Thank you so much for being a guest today. I appreciate your patience. I know we had some technical challenges, but really grateful for you to share your experience with our audience. So thank you.

Mary Morin:
Well, thank you for the opportunity.

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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SCTS_Becky Fox.mp3: Audio automatically transcribed by Sonix

SCTS_Becky Fox.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CMO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers' lives harder, not easier. It's time for smart technology to empower care with a more human touch. I'm thrilled to share a little bit more about our guest today, Becky Fox. Becky is the chief clinical information officer for Intermountain Health, where she collaborates with clinical leaders to help set the strategy and vision of how we can bolster health information technology to help people live their healthiest lives possible. Becky has a diverse clinical and leadership background, serving as a champion for numerous large-scale IT implementations, an executive leader at Cerner, a founder of a startup using technology to make gatherings and events safer during Covid-19, and as an emergency department nurse. Becky is passionate about optimizing health care delivery, while at the same time innovating new processes, workflows, and technologies to enhance the health care experience for all. Welcome, Becky. It's so great to have you here today.

Becky Fox:
Thanks, Molly. Great to be here with you.

Molly McCarthy:
Well, first of all, thank you for taking time. I know that you're busy. And appreciate the insights for our audience here today over your career. And really thinking about your career, it's quite an inspiration to many, including myself. You have a diverse background with experiences in many clinical settings, and quite a unique path to your current role as CCIO at Intermountain Health. I would love for you to share a little bit more about how working in various settings, including a health IT company like Cerner, and I know founding a startup has prepared you for your various roles in a health system, both as CNIO and CCIO.

Becky Fox:
I've been very fortunate, you know, in my career to have lots of different opportunities. And I think, you know, when you go to nursing school, that's not necessarily what you plan is, you know, In two years, I'll do this, and in five years, I might take a different path and try something else. But that's the great thing about being a nurse is that you have really visions, like the aspects of your life that might be developing. So, for example, when I was newly married, it was a perfect time to join and partner with Cerner and travel around the world. I didn't have children and other responsibilities of soccer games or, you know, activities at school. So I was able to travel around and really dive into that aspect of learning different areas within the health care system. As my children got a little bit older and other dynamics changed our family, then it also became an opportunity for me to really hone my skills as a chief nursing informatics officer in my local community and really understand the challenges that every healthcare system faces, and then, most importantly, work collaboratively with other leaders to really make differences, which to me felt like in my backyard and still be at home. So that's always the biggest challenge, I think, for women, women leaders is how do you figure out the balance? And just always looking at it as every single opportunity that you have in your career is another skill set that you can put in your tool belt. So even when I look back at my graduate time, at that point in time, I really had to kind of piecemeal together some things to pay the bills. And so I got an opportunity to work part-time for a pharmaceutical company, I worked part-time for a staffing agency and got to work in an ambulatory clinic, got to work at a long-term care. And even though, you know, I'm sure my mom was probably questioning: What kind of career is this, that you're doing all these little things? What they really taught me later on, though, is really having that experience of being the boots on the ground and understanding what is medication delivery in a long-term care facility. What does it mean in an ambulatory clinic on Friday afternoon at 5:00, when patients are really trying to renew their prescriptions? How those different dynamics really make a difference, now, when we're trying to put in technology and make all of those processes less smoother? So I'm very thankful that I had those opportunities. And there's no other career than nursing that can give you all those opportunities to really learn about the entire continuum of health care.

Molly McCarthy:
Yeah, I love that. Really, obviously, balancing your personal journey with your professional journey is so important regardless of where you are, I think. And also I love your point around opportunity, just the ability to learn different skill sets and really taking those skill sets, they're transferable, from one role to another; I think that's really something that's unique about nursing. The other piece that I heard, actually, when you were mentioning your mom, is just flexibility, not just in terms of the roles that you have, but the opportunity to be flexible and creative in your life. And I'm sure that came in handy when you were at Atrium as the CNIO with Covid-19. So just being flexible during that time period, I know you did a lot of innovative work then, so really appreciate your insights there.

Becky Fox:
I want to, I do think that, you know, that is the thing in every opportunity. There's always great experiences that you can have in any job and any role. And sometimes there's challenging experiences. And what I always try to say is, even in the challenging moments where I'm like, man, I don't want to do this kind of work, or maybe this isn't the team for me, there's still a lot of nuggets of wisdom that you can take forward. So in Covid, we learned a lot. There were some things where like when, man, we shouldn't have done it that way, or we should have really gone in a different direction. And so just pausing and saying, Okay, what can I take that I learned from that to make me a better leader, to make me a better colleague, to make me a better nurse, and make me better for patients or our communities or our health system. If you can always have that perspective, that's what helps keep you going. You know, again, if I look back in my career, there's lessons I learned along the way that you just put in your tool belt and then you never know when you're going to need. You know, something I might have done ten years ago, and, you know, I used to support the special events team and help really provide nursing care at football games and basketball games and those kinds of things. And so when we were looking at vaccine distribution, well, that was a great example where I'm like, wait a minute, I know exactly how to take care of, you know, of patients as they're coming in through a football stadium, you know, because we had seen that. And so having those lessons learned, and even though there might be challenging at times, they might pay off later on somewhere in your career path. So always think of them as gifts and little nuggets of wisdom, and that someday you'll be able to use them to your advantage.

Molly McCarthy:
Yeah, I love that. Those little golden nuggets that sometimes you appreciate more in hindsight. So kind of switching gears now, talking a little bit about Intermountain, obviously it's, you know, I've worked with Intermountain in many different roles and it's a well known system, very highly respected for innovation. And you and your colleagues are really among an elite few major health systems that have embraced value based care at scale. Intermountain has ceded transformative companies like Civica RX and Graphite Health. You've embraced new models of care, expanded into new service areas with acquisitions, etc.. So I would love for you to tell our listeners about the advantages of the culture of innovation and what that brings to your role and how that manifests itself in your work every day.

Becky Fox:
So one of the important things is you can want to be innovative, but if you don't have the culture to build and sustain that, it's really difficult to get innovation done. And so we are very fortunate that Intermountain has a long history of really leaning into innovation and leaning into innovation that comes directly from the front-line caregivers and staff; nurses, providers, anyone in the organization today can submit an idea for change, which is really exciting to have that opportunity. When you walk through the campuses and the different, you know, health care settings within the Intermountain Health, you'll see posters or you'll see signs or big banners that will say, Submit your idea here. And, you know, any clinician or caregiver can take a picture of a QR code, submit an idea that will be evaluated by the organization to see if that's something that can bring efficiency, better quality, and outcomes for our patients. And we know that some of the best ideas that we had at our company and in healthcare really come from those that are delivering the work on a daily basis. So it is exciting to have that kind of culture and that climate. And right now we're doing some piloting and some work in expanding our telehealth services, looking at AI for nursing. And so if you have that culture where everyone says, Hey, we're going to lean in and try things out, there might be things that don't work, and we absolutely want to hear it, learn quickly, pivot as appropriate, and move things forward and share those experiences with both inside the organization as well as outside and externally. We do think there's a really important aspect of having a collaborative culture as well, so we can learn things, which is awesome, and we can make differences to patients and families and communities, but it's really much more a part of our bigger mission, which is to help everyone live their healthiest lives possible, which means that you have to be a good partner, you need to share these lessons learned with other healthcare entities in the entire ecosystem so that collectively, we can all make a difference together. And so that's what I'm very fortunate to work in that. It is something that is felt at all levels of the organization, I would say as well, which again, is really important to have not only a culture at the top line, but also at the front-line caregivers. And so when you have that culture where you have that openness, when you have that transparency and really seeking feedback, listening to learn, and really embracing that at all levels of the organization, that's why I think you're able to make differences and try new things out and hopefully make a difference to the patients and communities that you serve.

Molly McCarthy:
Yeah, I think that's really important, just the culture piece and then the ability for front line staff, and I'm assuming it's not just nurses, but it could be someone from pharmacy, it could be someone from PTOT, speech therapy, just all the different disciplines, as well as someone who might be in more of an administrative role can participate in that. So that's great. And I love your comment about collaboration internally and then really externally, because as we know, having been in healthcare for quite some time myself, I know that collaboration is key between health systems, between tech companies and health systems, really, because it's going to take a village to make transformation happen.

Becky Fox:
And that's the thing that we all really learned in the pandemic was, I would say five years ago, if someone discovered something great, a new process or a way to take care of patients, then a lot of health systems would then want to replicate that to validate the information. And so what we found is during the pandemic, instead of replicating things, we're just carrying it forward. So if someone has a great idea and they can get through steps one, two and three, then the next health care organization needs to do four, five, and six, and then collectively they all move together faster. That's what we really seen in the telehealth space, especially, how do we bring efficiencies to nursing? Every health care system is experiencing a shortage predominantly in nursing, but it's impacting all of the disciplines. And so if we don't collaborate together, really focus on retention, recruiting, making sure there isn't a burnout aspect and making life as best as we possibly can for our caregivers, then we're all going to be impacted by that. So it really is this collaborative attitude that I've found has really evolved in the last few years. I think the pandemic drove a lot of that, but I'm really excited to be at a point where we can all very quickly if we have a challenge in our telehealth space, I could pick up the phone, text some friends and say, Hey, what did you do to solve this? And then we can share ideas and most importantly, make a bigger difference quicker.

Molly McCarthy:
Yeah. Without like you mentioned, additional proof points, etc.. So obviously you've got a lot going on at your organization. I know you're about a year into your role, I think?

Becky Fox:
Yep. Just over a year.

Molly McCarthy:
Just over a year. Yeah. So how do you set your priorities? And would love for you to share some initiatives that are kind of top of your list today.

Becky Fox:
Probably the biggest one is how do we bring relief to our caregivers on the front line. So one of the things our CEO, Rob Allen, has really focused on is simplification. It really is just as simple as that. How do we make your work life experience easier? And so that can be anything from signing your time sheets to maybe having a name change to using our EMR, to placing orders to getting equipment supply chain; every aspect of the organization, we need to try to make it things as easy as possible. You know, even though we might have the best intentions, sometimes we put technology in place that might have a few speed bumps along the way. So really having open dialogue, transparency, and again, that culture of ideas sharing from our frontline caregivers has really been beneficial to helping us focus and reprioritize those things. There always is the challenge of, you know, there's 8 million things that we would like to go do, and we only have the time and or the resources to do a lesser number of those. So it really is important, again, to work with our operational leaders to help us with prioritizing those things. We are really focused on making sure that our tools are operating at the highest efficiency, bringing the biggest values to the caregivers, and smoothing and optimizing along the way. So for us as informaticians within the organization, we really focus on building tight relationships with our clinical and operational leaders so that we know directly from the top line. And then we also hear directly from our frontline caregivers. So really, again, listening, leaning into what are the biggest challenges and then trying to serve as the translators and help to reprioritize those things from an IT perspective is really important.

Molly McCarthy:
Yeah, I love that. You mentioned translators. I know that we often sit in that space between tech and clinical. It's so critical to really have you in that role, just because you're able to really understand from a technical perspective and clinical. So very unique. So that's great. I would love to kind of dig in a little bit more to technology. And as I mentioned at the beginning, sometimes technology can be somewhat of a hindrance. And our goal really, at least my goal in my career is to ensure that technology can really empower clinicians. And to your point around bringing relief to your frontline caregivers so that it's not so frustrating and they can do their job and they're not encumbered by administrative tasks. So I'd love for you to just share a little bit more around rapidly evolving technologies and workflows, like virtual inpatient care. I know you've done a lot with you mentioned telehealth, not just, you know, having cameras and rooms, but ambient monitoring. And then also, you mentioned artificial intelligence to really help address your priority of bringing relief to the front line.

Becky Fox:
So one of the things that we're really focused on is how do we bring tools and technology to help support the caregivers? So nursing staff, for example: How do we help them in the process? If there's administrative tasks that they're doing, then how can we relieve that burden? How do we streamline that burden? And then how do we optimize that activity? So for example, you know, in the last six months, we evaluated our admission process in one of our regions and really looked at some of the content. And we realized that here, content that we were gathering that was very important, maybe a few years ago, was now less important or perhaps it was gathered at other points during a patient's in-country visit. And so we realized that this was something we did not need to collect anymore. And so we went through all the right governance channels to make sure we were meeting regulatory compliance and those types of things. And we were able to remove just one section off of our admission process. And while some people might say, Well, that was just one section, it ended up being about 5.6 million clicks, you know, or assessment points that we were able to eliminate on an annual basis. Now, that does not mean that we can do with one less nurse on a unit, that doesn't mean that we're going to change FTEs, but what it does mean is that is not a bedside nurse standing with a patient and asking them for information that it really is not valuable or contributing to the care of the patient. So not only is it impacting, the nurse is not collecting the information that really doesn't go anywhere, it really is also the patient experience. I'm not asking the patient something that they really is not going to help and change their outcomes at all. And it did end up being, you know, quite a number of hours. If you add up all the time of all those 5.6 million clicks. But those are just examples where sometimes just reevaluating what you did and put in place five years ago, three years ago, can really find some little nuggets of benefit and simplification. Now, at the same time, we're also looking at how do you streamline alerts, how do you streamline notifications, how those notifications come to a nursing staff? I'm sure many of us in our own personal journey, as everyone has become acclimated and, you know, can't live without a smartphone, we all have that experience where, Oh my goodness, I'm getting this text message five times from the store or travel or whatever it might be, and they didn't, or the school or, you know, and they didn't mean to text me six times. Everyone's had that experience. So what I would also say is everyone lives their last best experience and their last worst experience. So if you have a terrible experience with a personal shopping or a personal travel that impacts you, when you come to work, you don't want to repeat that. If you have a great experience at any of those other personal things in life, you've come to work and you want to have the same similar great experience. And so that's what we're really trying to look at now of how do we make sure that alerts are functioning in the best way that they're really functioning in the most appropriate way, and then we're not driving people crazy by either alert, over-alerting, you know, fatiguing them with having to answer or re-answer things and really kind of trying to smooth the edges of the technology that we put in place.

Molly McCarthy:
I think optimizing your investment in what you've already financially committed to is so important in this day and age. I love the example around the admission process, and that's quite a tangible number, 5.6 million clicks on an annual basis. I know sometimes as a nurse or a patient, some of the questions are like, well, it's charted or it's been asked of me 20 times. It's got to be somewhere. So that's wonderful. And it's not just because, you know, you're making changes because it just doesn't make sense for the clinician or the patient. And then the, obviously, the streamlining alerts and notifications, as you mentioned, I do that on my smartphone. I don't like to be disturbed by certain apps, etc.. The thing that I heard you say, which was really neat, that I just want to repeat for everybody, is, you know, your last, best experience and your last worst experience. And that's really true. And it's not just for that patient coming in, but it's for our clinicians at the bedside. So I commend you guys for looking at it from kind of both of those lenses because I think that's really important to improve the overall experience.

Becky Fox:
Yeah. So that simplification, how do we make things simple, it's everything from how do we help patients with scheduling appointments, how do we ensure they get notifications. And the other thing I would just encourage, like I said, there's always a full agendas and schedules and calendars and meetings that every one of us have to attend to, that if you don't have the opportunity to go and see it, to feel it, to experience of what our patients and their families experience, it's really hard sometimes to see some of those nuances that need to go away. I know recently I had, you know, had to schedule an appointment annual well checks for some of my family members, and the process, again can be very easy or it can be very challenging depending on the technology that set up the health systems. And so it's really important for folks to understand that, that there's a lot of different nuances that go into that, whether if you have one child you're trying to schedule an appointment for, if you have three children and you're trying to schedule an appointment for, and really trying to understand, how do we make that as simple as possible? That's what's really important is because the best experiences are what's going to keep patients coming back and families coming back; the worst experiences are what it makes it easier for them to go somewhere else.

Molly McCarthy:
And that's really important. And not only thinking about how you make that appointment. I know for me, for example, I had to make an x-ray for my son's foot for this evening, and I was like, if I can't do it online, I'm not going to make it at a certain place. But I think that's important. As we think about the demographics of today, who's in the workforce, who's in the patients in terms of five generations of people and what they might prefer. Some people might want to call and speak with someone. Other people are like, you know, for me, I was like, I want to do it online. If I can't do it online, then, you know, I'll find another place. So I think that's really a great point around ease of use and simplification.

Becky Fox:
I think the other key aspect is it's more than 80% of all health care decisions for families are made by women in the family. So the reality is, if you're not focusing on that of how do I make it easier for the woman of the household to make appointments, to schedule things, the convenience, the information, make it easy for them to access that information, get to it in a multitude of different ways, meaning, if I go to the website, it's the same type of experience as if I was on my phone versus if I was calling in. It's all the same types of information, same experience, a good experience at every point of the way. And that's how you're going to help women make the decision to keep coming back. The women are the primary decision makers of health care for not only themselves and their immediate family, but also for extended family. And so we have to again, continue to remember the last best experience they had is what they're going to compare you against. And so if you can make it convenient, easy, forward-thinking for them, then that's how you're going to have a loyal family that'll keep coming back to your health care organization. And so as Informaticist, we have to keep that perspective in mind. And when we find pain points, when we find stumbling blocks, when we find those little bumps in the road that make it a little bit harder, that's what our role, is to really help surface that, help everyone else understand that, and then make better choices and make it easier.

Molly McCarthy:
Really great points. Thanks for, you know, mentioning that. And just what keeps, you know, to some extent our loyal consumers, it's important in this day and age, and just to drive that continuum of care as well. So my second to last question is I would love for you to share your vision for the future of nursing within the hospital. Really, when you think about change management as care models are being reimagined right now, and obviously the role of technology will play to empower bedside caregivers as well as patients in new ways. We've talked a little bit about scheduling. Just would love for you to share some of your thoughts around care models within nursing, and how that will help nurses simplify as well as patients.

Becky Fox:
I'm really excited to be in health care right now because there is so much technology that's evolving, and even though there are some scarier aspects, uncertain aspects from a regulatory perspective of what's going to happen in the future, I'm also really excited because now more than ever, nurses in particular have the opportunity to really lean in, be a part of entrepreneurialship, innovation, driving how technology is going to revolutionize and modernize the nursing care process. I'm sure many of my colleagues out there remember writing on paper, which now sounds so like dinosaurian. And the dinosaurs brought us a piece of paper and we wrote down a care plan. But really, this is our opportunity to say, like, I don't want to just take the care plan and put it in an electronic format. I really want to say, Why am I writing this care plan at all? For how can we completely have AI help generated and make me focus as a nurse on the more higher priority things for a patient? That's where I think is the greatest opportunity. And nurses, in particular, have the opportunity now to really be a part of those conversations, to drive those conversations about what this technology needs to be. So to me, it's an exciting time to be a part of that, to be a voice at the table that says, Hey, this is what we need to do and change and really revolutionize what we've been doing. What I envision is there is going to be a lot of technology coming at us fast and furious, and I'm really excited because no longer will the nursing staff have to spend a lot of time trying to figure out staff scheduling as a nurse manager. We have tools, and there will be tools that will help them figure out where the challenge is going to be in the staffing model, where are the gaps going to be, and how do you help fill those? Where are you going to have overage? And how do you help shift things around? We want the technology to help drive those things. So the nurse manager, instead of filling in holes, is really focusing on managing the units and supporting the team that he or she is responsible for. When I'm really excited for too is that the nursing assessments can change and the care planning can change. And again, now with AI capabilities, you can look at this large data sets of patient information and serve up to the nursing staff priorities, things that might need further evaluation, and really refine and hone in their assessments where in the past might have been something that was overlooked. So I am excited about how it will change not only the operations of things, but the assessments and how we plan care and how we are notified that the patients at risk for different things into the future. And then I am really excited about the capabilities that are coming with regards to data analytics. So right now we make decisions with the best sources of information that we have. And you can imagine now, not only having information within our health system, but across other health systems, I really think there's going to be a greater ability to drive care planning, meaning treatment planning, interventions, surgeries, etc., for our patients. So I do think that's just going to be a really a big change and shift in how, you know, it's not going to be the same cookie cutter treatment perhaps for patients; it really can be much more personalized, much more driven, and that will hopefully lead to better outcomes, lower costs, and a better experience for everyone.

Molly McCarthy:
Yeah, so many good points that you mentioned. Just, you know, one thing that I heard right off the bat was just, you know, we don't want to take what exists today and just digitize it for the sake of making it digital. And I think that's so critical. Even when we think about documentation, you know, moving from paper to computer, really as nurses working with our critical thinking skills, so important. And that's what technology can enable us and allow us to do is to work to the top of the license. So that's where we're focused. And really, I'm going to reiterate your point about nurses more than ever, having the ability to drive the transformation within nursing. We own it. So we should be driving it, quite frankly, in partnership with our technology, vendors, and our IT departments, chief clinical information officers. But there's no reason why we shouldn't be at the table.

Becky Fox:
Absolutely. And so what I would say to encourage those out there, because some folks might say, Well, how do I get involved in that? So the first thing is really just learning all you can. You can simply Google, Safari, any of the platforms you can go and just research what other folks and other healthcare systems, what other companies are doing around the AI development, and understanding how people are using it. That's the first thing is really to help educate yourself. ANA is a great source of information, AONL; there's a number of different professional organizations that also are bringing forth educational sessions so that nurses can really understand, and all caregivers can really understand how AI might impact the care that they deliver, and most importantly, change things for the better. The second thing I would say is raise your hand anytime you get asked an opportunity of, Hey, do you want to get involved in a project, a pilot, you can reach out to the technology arm of your healthcare system and ask about how you can get involved, and you'll be surprised about if you let others know that you're interested in helping it to be a voice of that, and learn and test things out, then you'll be surprised how you can find some great ways to really expand your involvement in your ability to make a difference.

Molly McCarthy:
That's great. My last question, which I think you just answered, but I'm going to ask it just to make sure we didn't forget anything, is obviously our listeners from different cross-sections, but CNO, CNIOs their respective teams. And so given that your experience is, you know, very unique within healthcare and really across different portions of the health care system, if you had to give one piece of advice to our listeners, what would that be as they are thinking about the responsibility of being tireless advocates for their patient? I know I do want to reiterate what you just said in terms of learn all you can and raise your hand to get involved. Anything else that you want to leave our listeners with today?

Becky Fox:
I would say the other thing is don't be afraid. Well, it's two pieces of advice. Don't be afraid to jump in. You'll be surprised. Like if you can figure out how to connect up a chest tube in a crisis moment and do CPR and save lives and all those kinds of things, you can do really big, amazing, incredible things. So don't be afraid to jump in with an idea, with an innovation, and really helping to lead the way. The other thing I would say is don't sweat the small stuff, and build relationships along the way. So I guess it's three pieces of advice and that is, I've been surprised in my lifetime that there's been things that might have felt like stumbling blocks, and maybe I gave it more emotional energy and time and effort than it really needed to. And so instead of focusing on that stumbling block, instead focusing on how to get around the stumbling block and how to proceed forward. And so I think if you spend your time and energy on the path forward, even though it might be a different path forward, you'll come out further in the end and your idea will come out further in the end. And then, like I said, just don't sweat the small stuff and don't be afraid to jump in.

Molly McCarthy:
Well, Becky, thank you so much. Always great to have you enlighten me with all of your amazing experience and wisdom as well as our audience. So thank you so much for your time today and I look forward to seeing you soon.

Becky Fox:
Always good to see 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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