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SCTS_Leah Binder.mp3: Audio automatically transcribed by Sonix

SCTS_Leah Binder.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 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, Leah Binder. Leah Binder is president and CEO of The Leapfrog Group, representing employers and other purchasers of healthcare, calling for improved safety and quality in hospitals. She is a regular contributor to Forbes.com and consistently named among Modern Healthcare's annual list of the 100 most influential people in Healthcare. Under her leadership, the Leapfrog Group has grown fourfold in size and launched major new initiatives, including the Leapfrog Hospital Safety Grade, which assigns letter grades assessing the safety of general hospitals across the country, as well as ratings of ambulatory surgery centers and outpatient surgery, and the Judy Burrows Education Institute. She spearheaded successful initiatives nationally, including partnerships to reduce early elective deliveries, promote better hand hygiene in health settings, reduce infections, improve healthcare transparency, and promote safe use of health technology. Leah has served numerous national boards and councils, including the National Quality Forum, Women of Impact, CMMIs Accountable Action Collaborative, the National Alliance of Healthcare Purchaser Coalitions, the Jewish Healthcare Foundation, and AARP's Champion for nursing. Prior to her position at the Leapfrog Group, Leah spent eight years as Vice President at Franklin Community Health Network and award-winning Rural Hospital Network in Farmington, Maine. Prior to that, she served as senior policy advisor at the New York City Mayor's Office. She started her career at the National League for Nursing, where she handled policy and communication for more than six years. Welcome, Leah. It's so great to have you here today.

Leah Binder:
Well, thank you for having me, Molly. It's great to be here.

Molly McCarthy:
And first of all, really appreciate time out of your day to speak with us and our listeners. And I suspect that many of our listeners know Leapfrog as a name and associate that name with quality and healthcare. But I also suspect that very few really know the who, when, how, and why of Leapfrog. So can you take us back to the beginnings of the Leapfrog Group and tell us the story of the inspiration of its founding mission and how the organization has evolved over time?

Leah Binder:
Absolutely, and I will say, I can brag about the founding of Leapfrog, in part because I'm not telling my own exact story. I didn't start at Leapfrog until Leapfrog had been around for about eight years, so I can look back fondly at its origins and brag about them all I want without sounding a little too pompous. But they started with a group of employers. These were large companies, and they were HR executives or like GM, GE, Boeing, Marriott Corporation, some very large companies, all of which you would know the names of. And these executives got together because they were very concerned about safety and quality in healthcare. A report had just come out in the year 2000, or actually the report came out in 1999 called 'To Err Is Human'. It was from the Institute of Medicine, and it suggested that upwards of 100,000 people were dying of preventable medical errors in hospitals, and they were concerned about that. They had very concerned about that because they had spent decades really trying to improve the healthcare their employees were getting, and both from a quality point of view, but also cost effectiveness point of view. And both of those they felt had not been successful.

Leah Binder:
And here they were hearing about yet another issue that was perhaps the most outrageous of all, that people were dying of preventable errors. That was just terrible. So they formed Leapfrog, and that was the nonprofit with a very focused, very simple mission, which was to make public how hospitals are doing on preventing these errors and accidents and encourage their employees to use the information. And they use the information themselves when they contracted for healthcare benefits. So when they would try to pay for the best care and not pay for the worst care and really be more businesslike, in other words, in their approach to their purchase of healthcare. And so a simple idea, really, of public transparency and really driving the ability to be discerning about picking among hospitals. And they started with hospitals. It was very little data at the time, but they went out to hospitals and said and via a survey called the Leapfrog Hospital Survey, they said, could you please provide us with information? And here are the questions, and the questions were about things, as Bob Galvin at the time was a GE, and he said he wanted the Leapfrog survey to ask questions that his mother would want to know about a hospital.

Leah Binder:
So that's what they did. There was some evidence behind it, so they still had some really top experts in patient safety to advise them. But even so, at the time, there just wasn't much that they could use. That was really great measures of safety that they could really call on. Anyway, so fast forward, and today we do the same thing. We really have that same fundamental value, which is we should be transparent about how hospitals are doing on safety. We should publicly report that information, and people should use it to make decisions and to communicate with the hospitals that they work with or the communities that they live in. They should be communicating with hospitals and saying, we expect you to do better on safety, and we will reward you when you do. And that's the same with employers to do the same thing that when you do better on quality and safety, employers should reward that with their purchasing. So that's still fundamental to what we do. We have a lot more tools in our toolkit and a lot more people involved, but it is really fundamentally the same principle, and it's working.

Molly McCarthy:
That's wonderful. I know early in my career, around the start of Leapfrog, I was actually back in DC working for A1 and I, you know, worked on a consulting group with really looking at root cause analysis, and patient safety was really becoming such a highlighted item, really, as you mentioned, really to provide that transparency to consumers to, as you mentioned, GE GE's, uh, executives mom, what they would want to know about healthcare. So, so important to provide that transparency. So kudos to to, you know, being part of that evolution. I want to switch gears a little bit and talk a little bit about looking at healthcare providers and obviously starting my career as a nurse. And you've worked in healthcare for quite some time, National League for Nursing. So, our healthcare providers take an oath to do no harm. And every one of our caregivers really choose this profession to heal those in need, obviously with compassion, empathy, and even with the best intentions, quality and safety have room for improvement. What's the current state of quality and safety across our hospitals, and where have we made progress, and where do you think we have more to do?

Leah Binder:
So I think the current state is certainly not what we would all want. It certainly is not the healthcare system that I think anyone who chose a career in healthcare wants. I mean, we all, everybody who's involved in healthcare in any way wants the United States to have the very best healthcare in human history. That's basically what we want. And we don't have that. But we do have progress, and I believe progress is something to celebrate. So I do think there are really bright spots and those are worth celebrating and also learning from, because I think we can build very quickly, we can scale some of those successes. So the success that I would see that, that I see every day actually is in patient safety. Now, patient safety is an example of where there's a lot to complain about. So, the statistics on patient safety are quite disturbing. There was a recent report from the office of the Inspector General. It's sort of independent body that looks at how the Department of Health and Human Services is doing, and they looked at a random set of records of Medicare beneficiaries who had been admitted to the hospital, and they found that 1 in 4 of them were harmed at some point during their stay.

Leah Binder:
That's a very high rate of harm. 25% is a very high rate. Anybody in any other industry that would never be even in the realm of tolerable. So it is very high. And we know also now with good estimates in peer-reviewed journals, that it's about 250,000 people die every year from these preventable errors. So that's also a very high number that would make it the third leading cause of death. So we have a long way to go, I always have to preface with that, this is a major problem. It should be considered a top national priority to address it. For every single person in healthcare, this should be a top priority. That's it. We have seen real progress in especially in the past decade with hospital-acquired infections. There was a spike in them, they went up during the pandemic. That was a major problem, which we reported on and discussed at length at the time. However, that's coming down really rapidly. We also have seen a reduction in the patient safety indicators, so-called, that are measured by CMS, the federal government, and the ones that are most publicly reported. We are seeing real reductions of falls, pressure ulcers, injuries such as that. We're seeing very significant reductions in those as well.

Leah Binder:
So I think in hospitals we are definitely seeing progress. And I mean by like 20 or 30% in some cases even higher than that 50%, I think, for central line infections. So, really, really significant reductions in. Some very high profile and deadly, in many cases, deadly events. So that's good news. And I think what makes that the kind of news that I want to focus on in my own work, and I think everybody should look at, is because it's a success, it's progress. And we need to ask ourselves, how did that progress come about? What did we do as a country because we did something as a country to see that kind of change nationally. And I think there's a variety of things we did. But I will say one thing that's different in the past decade when we saw this progress that's different from other decades where we have continually not seen progress, is transparency. We have been publicly reporting those measures since the Affordable Care Act since 2009. I certainly want to take some credit for Leapfrog, which I think has put patient safety and transparency on the map, especially in the last decade when we launched the hospital safety grade. So I think we've seen but so we take part of the credit for that.

Leah Binder:
But really, having that data available publicly reported has made a difference. It's not just the difference, by the way, for the public, I'm not sure if everyone in the country says, oh, I have to figure out what CMS says about this hospital before I go there. I actually don't think that's necessarily happening all the time. Some people do, but not it's not happening all the time. The biggest thing that's happening is that hospital leaders themselves and clinicians are aware of this data. They see it, they recognize it. They challenge themselves to do better on it when it's there, when it's in front of you when it's public, it just has a galvanizing effect. You really want to see it change. You want to be better than your competitors in those met. You want to. It's galvanizing. So I think that's been a big difference, along with all of the tools and efforts that have been really put out there from not only from a little bit from Leapfrog, but a lot from CMS and many other really great organizations that are out there really helping hospitals especially get better. So I think combined with that push from transparency, we've seen real progress, and now we need to grow it.

Molly McCarthy:
So many great examples. I love that you really focus on the progress that we've made, because I think that's really key. And especially over the past ten years with hospital-acquired infections, falls, pressure ulcers, central line infections, I know those are all, you know, never they should be never happen events. And really attributing that to transparency and awareness. I always like to say you can't really change what you don't measure. And so measuring that and providing that back to the hospital leadership is key. And to your point, I am a consumer. We're all consumers. I don't necessarily go every time and look up the safety scores, although I am probably a little bit more in tune than others. But to your point, it's information back to the leaders of where they are and where they need to go, which is fantastic. And they need that in order to have the CQI in that improvement. So, thank you for sharing that.

Leah Binder:
It's also information back to everyone who works there.

Molly McCarthy:
Right.

Leah Binder:
It's the leaders. Yeah, And the board. But it's also the person who's serving the meals to the patients. The inpatient unit, from dietary, everybody gets involved. And that's especially true when they get a good grade. So what we find is when we give an A to a hospital, they will often celebrate it throughout the entire hospital. But where pins that say we got an A for patient safety, it's just very visible. And it's a recognition of their achievement when they get this and when they don't get it, they know about that too. That can be really, I'm sure, upsetting. But it's also goading. It says, no, we got to do better. We got to do better. Everybody gets involved. And I think that's, um, you just can't substitute that level of all team engagement.

Molly McCarthy:
Yeah. Thank you for pointing that out. I think that's really crucial. You know, it's not just those at the top, but it's very much everyone across that value line, value chain who provides care, whether they're delivering a medication or taking a patient from the floor to a procedure. It's really critical and it is a team approach.

Leah Binder:
Yeah.

Molly McCarthy:
So we've talked a little bit about the trends that you've seen and the current state and the improvement. What characteristics do you see as common to the top-performing health systems as it relates to quality, safety and patient experience?

Leah Binder:
I would say the first thing I notice about the highest performing hospitals when we look at the data when I go to visit the highest performing hospitals, the number one characteristic I will see that is at least striking to me, is that the CEO or top leadership will be unsatisfied with their own performance. I can't tell you how many CEOs of truly, outstandingly safe hospitals. I mean, now nobody's perfectly safe. There's no hospital in this country that's perfectly safe, but ones that have shown continuous excellence. The CEO will say, well, you know, I don't know. I worry about this, I feel like we don't do enough with that or we don't have people trained the way they should be and something else, or our hand hygiene. And I still wonder if people are truly washing their hands, and I want it monitored. They always have something else that they think needs to be done. They're never satisfied. They're always worried about safety, they're always worried about the patients. And it strikes me every time because I don't always see that with hospitals I visit that aren't doing so well sometimes. That will be a long story from CEO of how all the great things they're doing, which is important here, by the way. I do respect and like to hear that, but it also it is very different from other kinds of hospitals where they're that just are never satisfied that they've got to do better and better and better and better.

Leah Binder:
And that's I think that's needed for safety, because safety is a 24\7 ongoing enterprise, and you got to be worried about the patient 24/7. That's got to be your keeping you up at night in order to maintain safety. You can't just say, oh we got our central line infection down. We got that rate down to zero, pop-open the champagne and we're done. Because if you stop what you were doing to prevent those infections, then the very next day they'll be back, and your patients are at risk. So you can't see it that way. It's not a series of like one-offs. Patient safety is an ongoing way of life in a hospital, and it means that you have to worry, worry, worry about your patients all the time. Are we doing everything we can to make them safe? And when you see that from the top, from the CEO, that's when you recognize an excellent hospital that's really standing out for its performance. And I would say the other thing that I've observed in hospitals that are particularly high performing is a real respect for nursing. Most of what a hospital does is provide nursing care. Those are usually the most numerous of all the professionals working there. And everything that happens when you're a patient, nurses are just 90% of your day is nurses.

Leah Binder:
You depend on nurses, you depend on their expertise enormously. You look to them for their also their concern. And when you're scared in the middle of the night, it's the nurse that you want to talk to, and it's the nurse who has that expertise and education to really help you in the way you need to be helped as a patient. It's just they're very important. And when nursing and nursing perspectives and nursing leadership are respected within a hospital, that's when you feel like the patients are better protected because it is the nurses who are really closest to the patient in an ongoing way, and they're the ones also with that expertise. I saw a really interesting presentation by a collaborative in Michigan that came out of the Michigan Hospital Association, and they actually worked with us to go through Leapfrog data to find highest-performing hospitals. And they found, among many interesting insights, one of the top insights was that where in hospitals that where nursing protocols are respected by everyone, whether it's the chief of surgery or the dietary staff, everybody respects the nursing protocols and adheres to them, that those were the hospitals that were just much at the top of the quality spectrum. So I think that nursing is something to look at.

Molly McCarthy:
Well, I know our listeners are going to love that. The one other thing that I was just thinking about why we were talking and you were mentioning some of the common top-performing health systems with leadership who are unsatisfied and really always worried about their patients. And then to the respect for nurses, one of the things that I saw in the shift, probably around the time Leapfrog started, was just the involvement of patients and their families in terms of asking questions. And I think historically, like I think about, if I take my father to an appointment, he might not grill them as much as I do. But how have you seen, like, the patient engagement change over time to I'm just curious.

Leah Binder:
Significantly, that's a very good point. That has really changed, especially over the past decade. And one of the things you see now are, most hospitals, at least, that I've encountered, have patient and family advisory councils, and some of them have a variety of them throughout. We have many more standards now related to engagement with patients or patient perspectives. We have, for example, on our survey, we have a standard around patient consent and how that should work and engagement of patients when there's a root cause analysis done. Are the patients and families of engaged in that, things like that. And that's really consistent with I think, where a lot of hospitals are going, is really bringing patients into the really the center of how everything is done, which is where they belong, and everything should be about the patient because that's why the patient is there, because the delivery system is delivering care to them. But we haven't thought of them as part of the team. And you're right, that has been a really major trend. And CMS also drove that trend, that was part of their efforts in the Affordable Care Act, that a lot of supports for hospitals in moving and shifting toward having more engagement of patients in their overall operations, and also measuring whether that was working with the H-Caps surveys, which are the patient experience surveys that are CMS requires hospitals publicly to report on their results. That also had an impact, and so I think I think we've definitely seen that shift.

Molly McCarthy:
Yeah. And I think just that curiosity and questioning, I think from patients really as a partner rather than, you know, a threat to what's the institution or the team that's providing the care, I think is really important. Just that mindset shift.

Leah Binder:
Absolutely.

Molly McCarthy:
So you may have noticed that I opened our podcast today with the statement that too often technology has made caregivers' lives harder, not easier. And I've been in tech for a long time, so I feel okay saying that. But from your view, has healthcare technology made patients safer or in any way at greater risk? And this is kind of a two-part question. So I'll let you answer that and then I'll go on to the next part.

Leah Binder:
Yes, and yes. I guess I'd have to say one of the founding principles that Leapfrog, incorporated into that overall overarching transparency mission is that we need hospitals and health systems to adopt technology in a way that improves safety, and we actually want them to adopt the technology. We are very pro technology because that improves our world. We kind of see that in other industries, and we want it to happen in healthcare. And, you know, we know healthcare tends to be behind on technology. I always joke that it's the last place you can sell a fax machine to anyone. And my son, who's 20, he said, mom, they asked me to fax over something to the doctor's office and I said, okay, just do that then. And he said, well, I don't even know what a fax is. He didn't know what it was in his 20. You know, the rest of the world is not using fax machines, but healthcare is. So anyway, we want to use it to the greatest benefit of patients. And we started Leapfrog with one of our founding, we call them Leaps was around computerized prescriber order entry CPOE. So that's the systems that even back in 2000 were available. It was used by about 1% of hospitals, but it was available.

Leah Binder:
They would check orders, medication orders and check against the patient record to make sure that the patient you know wasn't allergic or the variety of other reasons that a medication order could be dangerous to the patient. Those would alert to the physician so that the order would not go through or that the prescriber could order something else. So that was available and very important. And the studies at the time back in 2000 suggested that it will really did reduce medication errors by like 40%. It was very significant improvement, but it really wasn't again, until the Affordable Care Act actually, after that, when the stimulus money after the economic crisis of 2008, we had stimulus money thrown into the economy, and a huge amount of that was used to help hospitals invest in electronic medical records, and with that, CPOE. So then all of a sudden, we saw almost every hospital had CPOE, and we did something else with that. So we realized that it wasn't going to be enough. Just to ask, do you have CPOE? We also want to know, does it actually work to the benefit of your patients? Because you can't assume that it's automatically works when you turn it on. And it turns out we were right about that. We had, um, developers who include David Bates, David Klassen; these are world-renowned experts in patient safety and technology who developed a test that hospitals take as part of their completion of the Leapfrog Hospital Survey every year. They take this test, and we give them a set of dummy orders for a set of dummy patients, and they administer the orders, and then they report back on what happens in their cpoe system when they make these orders. And the all of the orders are almost all of them will would result in harm to the patient, very significant harm in some cases death to the patient like very these are not kind of nuanced orders. These are orders that would definitely harm the patient if they were administered. So they should alert. And there are a few that we throw in there that shouldn't alert, that actually are frivolous problems, that should not alert because you don't want to have too many alerts or you have alert fatigue. And that's also dangerous, right? So we actually test for that. But this for the most part is just really bad or really dangerous orders. And can they are they alerting to them. So the thing that we found is that in about half the time not really. These systems are not alerting properly today.

Leah Binder:
We've seen lots of improvement, but we still don't see most hospitals getting to even like 80% of the orders, they're not getting there. So we're still a problem, and our advice to hospitals has always been and continues to be: You have to double-check and triple-check. It's not enough. Just because you have a CPOE system doesn't mean that's the end of it. It's got to be checked again and checked again and checked again before it actually gets to the patient because we can see that it's not always there and it needs to improve, but it's not always there. So technology yes, it definitely improved. We did see improvement with CPOE and we're seeing it more over time. So it is got to be better then a scribbled prescription on her pad. God knows how that ever worked in a hospital. It's just scary to think about it, you know? But nonetheless, they are not always doing the whole job. And there's lots of things that aren't safe. And if they're not administered correctly, if not watched, if they're not, these systems are not really fine-tuned over time and checked over time. Then they can actually backfire and not be safe at all. So yes, to both of your questions. Yeah.

Molly McCarthy:
And I think that's so important. Just and I actually even use CPOE in 1995 locally I worked at Inova and I remember it coming into play versus the handwritten orders. But it goes to the point where, you know, it's not just the technology. It's really it's important for the nurse, for that care provider, whoever it is could be, you know, perhaps even that person who might be inputting orders. But it's really important to have that critical thinking piece that nurses can utilize in that human aspect of it. You know, that won't ever go away into question, I think is really important. So the second part of my question is moving ahead and thinking about the technologies that are available today. So for example, next-generation solutions like artificial intelligence, and ambient monitoring, I've done a lot of work in the virtual nursing area, but how can they work to ensure that quality and safety can paradoxically improve in an era where there's a lot of ongoing shortages of caregivers, people leaving the profession due to many different reasons and challenges, but using technology to do more with less providers, I guess.

Leah Binder:
Yeah, I I'll step back a little bit from the question because I'm not as I don't live my day-to-day life in a delivery system. I live in front of tons of data looking at how we're doing, but I don't necessarily see it close up. I like to visit hospitals and see it, but I don't always see it right. But what I would say that we're concerned about with AI and just all the advanced technology that we're seeing really rapidly grow in hospitals is that there are many ways to deploy this technology badly and not do it well, or do it in a way that is not helpful to the patient or harmful even to the patient. Now, the example I just used, or how decisions work within CPOE doesn't always work the way people think it will, and can lead to some complacency because you think the system is going to check for that. And if nobody else does, you can, you know, that's a danger. So I think that's the case in, you know, maybe exponentially with AI, we know that AI has makes mistakes, but it looks like it's not making mistakes and it has hallucinations, but you can't tell they're hallucinations unless you dig in. You know, the most famous example are footnotes that they'll give to some research and they make up studies. Just make them up out of thin air. They don't exist. So you got to get someone to double-check their references.

Leah Binder:
So that is directly dangerous to patients. If the AI is giving advice or decision support or whatever support and it's incorrect but looks correct, which it will look correct because it always comes out of AI, it looks really pretty impressive. So that's a danger. And if there's too much reliance and there's not a system set up to double-check it, that's a problem. So that's one worry. And then the other thing that we're excited about, on the other hand, is that it can be used for some really positive things. I mean, it can be used, for example, to automatically check through ongoing patient records as they're happening, as the patient's in the bed, they can check through EHRs and trigger when there appears to be some issue that could lead to a problem. I mean, that's exciting. We think that's that could potentially be a game changer for patient safety. The other thing that we think is exciting is an ability to synthesize a patient record itself quickly. I would imagine that it must be frustrating for all providers when you have a very long EHR, let's say, and you've got to figure out right now what's happening with that patient because you're talking to them and you want to know right now what was their last blood pressure reading or something you want to know now. And definitely AI is going to be able to help with that.

Leah Binder:
So I think that's exciting. I think that it'll help. I think anyway, make the day-to-day experience of a provider better, but it also will help the patient. So I think that's an exciting use of it. So I guess I don't know what that's going to mean in terms of being able to manage around a shortage in the workforce. I'm not sure how that's going to play out. I don't know, I've seen actually, I should say I have seen one example that I didn't like, which was using AI to handle call. And the example they showed me was a pediatrician's office where a mom calls in the middle of the night. A three-year-old swallowed a dime and what do I do? And the call is answered by basically a bot that's AI. And the AI says this two-page explanation of the clinical issues and risks, and something like that misses a key thing, which is make sure that it wasn't actually a battery instead of a dime, because it's a battery. They get under the ER and all that. So I missed a clinical indicator that was important, but I think even more so, it just was as somebody who's been a mom calling in the middle of the night to the pediatrician's office, I don't want to talk to a bot, and I don't want two pages of clinical gibberish. So that was not a good example.

Molly McCarthy:
Now, I think I appreciate that and I appreciate your perspective. I think, you know, different from maybe someone who's in the hospital every day, but really important from that patient safety perspective and just even your, I think, comment around the ongoing analysis retrospective, instead of looking at patient trends, root cause analysis, a week after an event happens, you know, we're sifting through the data as that patient's decline. Maybe their temperature is going up, their heart rate's going up. They're becoming septic and making that alert then and there rather than a significant decline coding etc. and a poor outcome. So appreciate that perspective. I could sit here and talk to you for so much longer, but I want to be mindful of everyone's time and want to wrap up with just one question, one piece of advice. I always like to ask our guests, but so our listeners are primarily Chief Nursing Officers, CNIOs, and respective teams within healthcare systems. And obviously, you bring a really unique perspective, understanding priorities and opportunities across large employers, payers, government, and providers. I guess if you could just share a parting gift of wisdom with our listeners. So what would be your single most important practical piece of advice for them as it relates to their responsibility of being the front line for patient safety?

Leah Binder:
I would say lean into transparency. That works on a political level, but it also works on a personal level. But it isn't human nature, so you have to be deliberate about it. So on a political level, is the one thing that both parties are maybe the one, maybe there's other things. But really, one thing that both parties agree on here in Washington is that we should have more transparency in healthcare. And there's all kinds of ways they define that, but basically they want more transparency. And that's been the movement on both sides of the aisle. And that's where it's going, the transparency is the name of the game. Their employers are also under enormous pressure to make everything they know public about how hospitals and health systems are doing. There are lots of risks if they don't nowadays, so it's really a big deal to them as well. It is also a big deal, though, if you are a clinician or working in a hospital because it is, you want to build trust. And one of the things I think we've we're losing in all segments of our society, unfortunately, but healthcare included, is that personal trust among people.

Leah Binder:
And you want patients to trust you, and patients really do want to trust you. And the best way to build trust is by being as honest and open as possible. And that starts with transparency and lean into it on every way. You're a hospital administrator. The one thing we report to Leapfrog, I mean, I'm going to say that because that's how you're transparent. It's not a doesn't cost you anything. Just do it because it's do anything you can to show that you're not hiding anything, that you're public, even if everything's not perfect, even when you have to tell a patient something that is uncomfortable, telling them, being honest about it will build trust, and trust is what is going to carry the day for all of us. It carries the day for every single one of us. It will get us away from this burnout problem and all the problems we're seeing for people who are frustrated and feeling like they're not fulfilling their life purpose. Transparency is a way past that. It's just uncomfortable and hard. But please do it. It will help.

Molly McCarthy:
Well, thank you. Leah Binder, CEO of Leapfrog. Transparency and trust are key for safety for our patients. Appreciate your time today and look forward to hopefully meeting you in person soon. Thank you.

Leah Binder:
Thank you Molly. It's great to be here.

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-Amy McCarthy: Audio automatically transcribed by Sonix

SCTS-Amy McCarthy: 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 our care with a more human touch. I'm thrilled today to share a little bit more about my guest, Amy McCarthy. And just for our listeners, Amy and I are not related, but she would be a really fun sister, just as a side note.

Amy McCarthy:
Thanks, Molly.

Molly McCarthy:
Amy currently serves as the Director of Nursing for women, infants, and Oncology at Texas Health Resources at HEB. An alumna of George Washington University, she earned her DNP with a focus on executive leadership. Amy is a champion of transformational and heart-led leadership, aiming to foster innovative and health-centered environments for nurses. Her decade-long experience involves collaborating with state and national leaders in nursing improve outcomes for the public and employees she serves at the bedside and in leadership. Amy serves as the president-elect of the Texas Nurses Association and is a member of the Nursing Advisory Council for Hippocratic I. She has notably served as Director at Large on the American Nurses Association Board of Directors, addressing crucial issues like safe staffing, workplace violence, and racial equality in nursing. Her involvement with the National League of Nursing includes contributing to the Advisory Board of Accelerating to Practice program, focusing on new graduate integration into the workforce. Amy's role extends to the Nurses on Boards Coalition, where she was a Texas Action Coalition representative and co-chair of the Communications Workgroup, overseeing coalition marketing and communication strategies. As the secretary of the Texas Nurses Association from 2019 to 2021, she was instrumental in integrating younger voices into the organization, fostering ties with the Texas Nursing Student Association, and launching a podcast that highlights nursing innovation and mental health. Amy's educational background includes a Bachelor of Arts in Biology from Southern Methodist University and both a Bachelor of Science and Master of Science in Nursing Administration from the University of Texas at Arlington. She holds professional certification in executive nursing and maternal newborn nursing. Welcome, Amy. You have a fabulous background, and I can't wait for our listeners to learn a little bit more about you.

Amy McCarthy:
Thanks, Molly. I'm really excited to be here today.

Molly McCarthy:
Great. Well, first of all, thank you for taking time out of your schedule to speak with me and our listeners and share your story and insights. Obviously, you've got an extensive background and varied background, which I didn't mention. You started your career in communications and then transitioned into nursing and health systems and also have extensive experience in the association world, which is fabulous. I think that gives you a really diverse perspective. So just to start out, I would love for you to share with our listeners more about your career journey, maybe starting with how you transition from communications into nursing and then how communications actually assists with your role today.

Amy McCarthy:
Yeah, absolutely. So it's funny, looking back, I never realized how important that communications background would be in my current role in my career as a nurse, but I had always been really creative. I had taken a lot of art classes in high school into college. I had served as the editor-in-chief of my college yearbook, and a friend of mine had offered me an internship to a nonprofit management consulting company early on in my college days. And so I started to dabble in the world of communications and PR, do graphic design, photography, and media. And that led to another internship at the local hospital here in the DFW area, where I was able to do communications and PR specific to healthcare, which was so neat. I spent about almost a year and a half being able to cover things throughout the hospital, being able to go on media sources, and oh, can we stop that? Can we start that again?

Molly McCarthy:
Yeah, yeah. Um, yeah.

Amy McCarthy:
Okay. I spent about a year and a half at the hospital, just kind of rotating with our media team, with our communications team, and just learning the ropes of how to handle PR and communications in healthcare. And there's a lot that goes on in the background that you're having to manage when it comes to patient stories, when it comes to news, when it comes to patients who are entering the facility.

Amy McCarthy:
And so it was just a really neat experience to be able to see that side. And as I was doing nursing school at the same time, I really continued to delve into this, had a lot of interest at actually ended up working throughout nursing school for a nonprofit that was focused on crisis communication, and so was still able to take a look at that healthcare lens, but offer communication support, offer that PR. And as I transitioned into nursing, that communication piece became vital, especially as I started serving on boards, even just talking to my patients. One of the key things that you learn in communications and PR is that you have to alter your message and be very specific with the population that you're marketing to or that you're serving well. The same occurs in nursing. I have to really tailor my message whether my background is in women's health. If I'm talking to a first-time mom, how am I communicating to that family versus a mother who has 3 or 4 kids? It's a very different experience for them. And so it came in instrumental in that early phase of nursing.

Amy McCarthy:
And then, as I mentioned, when I started to serve on boards, one of the skills that I was tapped for was this communications and PR experience. I was able to help lead campaigns, lead entire communications and rebranding efforts for boards, most notably for the Nurses on Boards Coalition, and helping them to get to the metric that they were looking for to get more nurses involved get more nurses serving on boards. Several of the campaigns that were utilized throughout that were things that I had designed that I had worked with that entire board and organizations. So it's been really neat to be able to combine both of these worlds into what I do today. It is certainly been, like I mentioned earlier, just instrumental in what I've been able to do, and I'm very grateful for the experience that I had early on. I had no idea that I would use it almost on a daily basis, especially in leadership and in talking with my nurses, whether it's in the hospital or within professional associations. But it has truly enabled me to be able to reach more people and to be very specific in my messaging, to be able to convey what we need to do.

Molly McCarthy:
I love that I think you have some great experience. You mentioned the crisis communication, and obviously, when you're dealing with patients and families, it can be difficult, difficult conversations. And I'm sure that your patient's experience was so improved through your ability to communicate with them in the family. And I know that, too. You know, you mentioned you're in maternal child care, and it's not just taking care of the patient, but in specifically, it's really family-centered care. So, so critical. And just a shout out to Nurses on Boards Coalition and Laurie Benson. I worked with her when I was at Microsoft and love what they're doing there. I know they just celebrated an anniversary, so that's great. I'm glad to see that you're involved with that organization.

Amy McCarthy:
Absolutely.

Molly McCarthy:
Digging deeper in a little bit more into your nursing experience with where you are now at Texas Health Resources. And then, obviously, you've done a lot of advocacy work, and through Texas Nurses as well as your position with the ANA, just curious how you're involved in tackling some of the ongoing workforce issues that are plaguing our US health system, maybe locally and then nationally, if you have any examples?

Amy McCarthy:
Yeah, absolutely. So, with the Texas Nurses Association, we've done a lot of work over the last legislative session that's really pinpointed on workplace violence and ensuring that nurses have a safe space to be able to work in. We all know, as nurses and nurse leaders, there has been such a just evacuation, for lack of a better term from the healthcare space because nurses don't feel safe anymore. And so this became a really prime topic for the Texas Nurses Association. We previously had a law in the state where emergency nurses were protected. If they were attacked, it was a felony that they could charge the individual who had attacked them, but not for the rest of the hospital, which was kind of heartbreaking, especially for someone like me who's not in that realm. While people think that maternal newborn can be a very happy place, and it is, but there are things that happen on that unit that are also very difficult for nurses to work through. And so the protection was really needed for healthcare workers across the board. And so we actively worked with partners across the state and building coalitions and building relationships to ensure that we could bring forth a bill that would be passed to offer all healthcare workers this protection. And this previous legislative session, we were successful in being able to pass into law a bill that protects all healthcare workers, regardless of what unit they're working in, any time that they are attacked in the workplace. That is considered a felony charge. And that was such a big win for us. When you think about the shootings that have happened in the Dallas-Fort area across the United States, people are angry when they're coming in the hospital, and you have to think there's a lot going on when they enter the healthcare space; there's a lot of unknown.

Amy McCarthy:
They're losing control of their situation. And so it does lead to a lot of anger, whether it's intentional or not. We need to make sure that our healthcare workers feel safe. They feel empowered in that environment and that they feel protected. And so this was a huge win for the association and for our nurses across the state to be able to now say, yes, I do have that protection. While it's only a piece of solving the problem for sure, it at least gives us somewhere to start from and offers that additional protection as well. And when I think about my work at the national level, we've certainly had the conversation about workplace violence overall. In fact, I worked with the Ana board of directors to draft a proposal at our membership assembly that focused on gun violence and how we help to protect nurses and healthcare workers from that. Specifically, how do we partner with not only nurses and nursing associations but associations outside of that? Sometimes, the nursing, we like to say, within our own bubble, we're very guilty of that. But being able to talk with people across the board, people who are experts in this space. So, it was a huge proposal for us to be able to bring to our membership to all the states who are involved in this discussion. And it went you could tell in the room how grateful people were that we were having this discussion, that we were saying out loud, listen, this can't be tolerated anymore.

Amy McCarthy:
Nurses need to feel that they have that protection, that we're actively doing things while we don't have the solution and there's no immediate solution, at least we're working on it. And, of course, you know, the next big topic is staffing, right? It's something that nurses are talking about all the time. And same thing there. There's, unfortunately, not a one-size-fits-all solution. And so we're having to have very active conversations with our hospital associations, with our, our legislators to say, how do we fix this problem? Because the fact is, that current state isn't working. It's leading to nurses leaving the bedside. It's leading to an unstable healthcare system. And so the ANA board, we released a statement that showed that, you know, we do support tools to be able to focus on safe staffing, whether that be staffing ratios, whether it be talking with hospital associations. We want to ensure that we are doing our part to support states across the nation and ensure that we're having a good conversation about this because, for so long, we've avoided this topic. We've kind of stayed away from it just because it's something that's hard to talk about because there isn't a black-and-white solution and no matter how you look at it. And so I'm proud of the work that we've been able to do around that. But certainly, the work is not done. And so we're continuing to have those conversations across the board.

Molly McCarthy:
Well, congratulations, first of all, on your hard work within Texas and having that bill passed. That's amazing. You know, it makes me sad to think that that's where we are in our world. But that's the truth. And good for you for really pushing for that and also the collaboration with other disciplines. I think it is important, as you mentioned, you know, within healthcare, it can be siloed sometimes based upon your professional, where you are professionally or what licensure you have. But I do think moving forward, that team approach and collaboration, not only within healthcare but quite frankly, like you mentioned, with our policymakers, etc. So kudos.

Amy McCarthy:
Thank you.

Molly McCarthy:
The other question I have for you. And then staffing, we could spend a lot of time on that. I think, you know, that's very challenging. And it's not black and white and it depends upon so many factors. I'm just wondering too, if you think about staffing, what also just in terms of care models, you know, that's another component that I know we're revamping. Obviously, this podcast is looking at virtual nursing, which we'll get to in a minute, but I think those are all considerations when you take a look at the current environment. So absolutely, with that in mind, I think that obviously there are lots of challenges, but kind of as a follow up to that question, what reasons do you and your colleagues have to be optimistic about the future of inpatient nursing? And maybe we talked about some of the obstacles, but maybe specifically for you, what are you seeing at your local level with obstacles to realizing that future?

Amy McCarthy:
Yeah, absolutely. You know, I will tell you that the nurses and nurse leaders who are entering the profession right now are just so creative. They have so many ideas, and they're committed to really revamping health care, which is very exciting to see. And I think part of that is they have resources today that nurses previous to them didn't have. You think about the internet, you think about social media. There's this constant exchange of ideas. I was talking to my lab manager yesterday about something that I had seen on a social media group of what we should implement in our hospital, and that's just it. You know, we're able to do that on a daily basis to get these ideas and be able to implement a lot of them fairly quickly. And so I'm optimistic because I'm seeing this constant interchanging of ideas that we're implementing at a faster rate, and people are trying to make this better. I will tell you when I look at the obstacles, when I look at technology, I think that there's so much out there. My husband works in tech, and we have these conversations all the time of things that he's seeing in his world that haven't even touched healthcare yet. And so there's such a gap between those two worlds.

Amy McCarthy:
And the gap needs to get smaller because there is so much that has been produced that can really be so beneficial in our hospitals today. When you think about ambient monitoring, you're starting to see that, especially between providers and patients. I would love to see that for nursing. When you're walking into a room for that technology to exist, where a lot of this charting burden that you see today because nurses will tell you about 70% of their job is charting everything that they're doing. If we could have technology in place, that helps to eliminate some of that burden, and we're starting to see that. But I think that's a major area that we need to focus on so that nurses can practice to the full scope of their license and they can actually do what they set out to do, which is care for patients. Right? I think part of the obstacle with that, of course, is just financing some of that technology. As hospitals continue to experience limited reimbursements, decreasing profit margins, it becomes harder and harder to sometimes implement these technologies at such a huge scale. It involves really understanding that technology, being able to do that education and keeping an open mind. Sometimes I joke with my nursing colleagues that we are also the worst barrier to the implementation of new tech because we're fearful of it or we don't understand it. And then there's that automatic shutdown that happens, and we can't continue to think like that anymore because we need to have things in place, whether it's AI, whether it's that ambient monitoring that helped to make nursing what we want it to be, which is really being able to sit down, have those conversations with patients, provide that education, and taking away so much of the burden that has been placed on nurses.

Amy McCarthy:
I mean, when I sit in meetings, whether it's in associations or within the hospital, it's always, well, you know, the nurse can do that, the charge nurse can do that, the nurse manager can do this. And we've got to stop saying, let's put this on human people. How can we utilize the technology that we have, even if we're not spending millions of dollars in implementing all of these things within our organizations? But how do we leverage what we have to be able to really look at things creatively? And I think that requires nursing leaders who are willing to step outside of the box of how we've always done it. And that's a common phrase in nursing, whether we like to admit it or not. This is just the way we've always done it. We've got to step outside of that space and be able to say, listen, we've got to try something new because there's just not working anymore.

Molly McCarthy:
Well that's great. I'm excited to hear you talk about the up and coming generations in terms of the creativity. And quite frankly, they're new and they have fresh ideas and they're not necessarily molded to doing it a specific way, obviously. Absolutely, with patient safety in mind and optimal patient outcomes. But I agree there are different ways to think about care delivery. And really, to your point, ensuring that the nurses and the care team really are doing high value. I don't want to say tasks, but working on high value processes, etc. and taking away that administrative burden. Yeah, obviously documentation burden is a whole other topic, but I think you touched a little bit about on the rapidly evolving technologies, and that was kind of part of my next question. So just to as we think about specifically workflows like including virtual inpatient care mentioned ambient monitoring and AI, what use cases specifically within your areas do you see that would potentially make an immediate impact within your hospital system? I know that, and I'll just give you an example that I've heard having a virtual nurse doing admissions or discharge, teaching, etc.. I'm just curious, specific to you work in oncology and labor and delivery and NICU, where do you see technology kind of easing the burden?

Amy McCarthy:
I think the virtual nurse concept is one that we really need to take a long, hard look at because we have a lot of nurses. In fact, I had a conversation with the leader yesterday about this. We have a lot of nurses who are wanting to transition to something that doesn't look like the bedside anymore. They still enjoy the clinical realm. They want to be involved, they want to be engaged, but they're not necessarily wanting to do three 12-hour shifts anymore. And I think, you know, being able to transition individuals like that into a virtual nursing model where they can, to your point, instead of having a person handle admission and discharge teaching, being able to have a nurse pop on a screen. And a lot of our hospitals have adopted electronic keyboards, being able to utilize that technology and have that nurse pop in and say, hey, you know, how are you doing? Are there any questions that I can answer for you? Let's go over your admission teaching. Let's go over any questions you might have. How is your experience going today and being able to notate all of that so that it's traveling back to the nurse, it's going back to the nurse leader again; it helps with the overall flow of that nurse's work day because they're able to be engaged. I think about a labor and delivery nurse. They're in and out of that room every 15 minutes, charting to be able to ensure that a patient is having a safe delivery. And so even in that regard, to have a virtual nurse who is watching feel, monitoring strips and being able to give that feedback in real-time, because the reality is, is that the nursing workforce right now is relatively new at what they're doing.

Amy McCarthy:
There's a lot of questions, there's a lot of feeling as uncomfortableness, because all of a sudden, these nurses who have been around for 3 to 5 years are looking around and saying, well, I guess I'm the expert on the unit. And that's an uncomfortable feeling when I think about when I entered the workforce; I was surrounded by tenured veterans who had been on that floor for 15, 20 years. They knew the answers to my questions, and I think to have that virtual nurse there to one be a coach, but also to be able to pick up on those things. Our nurses are incredibly intelligent. They're doing wonderful things. They know the criticality of their patients; they know their right and wrong answers. But there's a lot going on throughout the day. And I think having that added buffer to just say, listen, hey, did you see this? Or maybe I can pop in and just check on that patient for you while you're in another room? I think that's a neat way to look at the cure model that we now have the technology to do. Ten years ago, we couldn't have had this conversation, but today, there are things now in place in rooms that allow us to have this conversation, to be able to really create a very patient-centric experience in a way that we've never been able to do so before. So I would say between that and then, of course, going back to the charting aspect of it, to be able to implement technology that makes that a little bit easier for them, that decreases some of that documentation burden. I think if you could do those two things, Molly, in a hospital, that would take such a burden off of the so many nurses today.

Molly McCarthy:
I agree with you wholeheartedly. I loved your example around the fetal monitoring piece. Obviously, we talked about I worked in NICU, etc., and worked for A1 with their fetal monitoring program. Yeah, but such a huge help for the nurses who are physically on the the unit. The other piece, just holistically, obviously patient safety comfort level of the newer nurses. And like you mentioned, it is not an exit strategy but a different role that the seasoned nurses can take on without having maybe the physical burden of being on a unit for 12 hours. I've seen that anecdotally as well. And then obviously, at the end of the day, thinking about the quintuple aim and looking back to not only the clinician experience, but that patient experience and really driving towards better outcomes, lower cost of care too.

Amy McCarthy:
Yeah, absolutely.

Molly McCarthy:
Well yes. Go ahead.

Amy McCarthy:
Oh, I was going to say, you know, and I think one thing that I'm definitely seeing in my world is that the patient population is growing sicker. You know, we joke in women's and infants that used to be somewhat of a plain vanilla type of patient population. They'd come in; they were relatively healthy. They were coming in to have their baby. Everything was great. But I will tell you, Molly, just from my patch, from my experience just being on the floor to where I am today, the acuity of that patient population has changed immensely. We are talking more and more about maternal morbidity and mortality. We're talking about patients coming in with multiple comorbidities in their late 20s to early 30s. And so you can only anticipate what that looks like later down the road. And so having these tools in place, even for, you know, your regular nursing care model, would be so instrumental because there's so much to be watching in these patients today. They're unlike even the patients of 5 to 10 years ago. And having this ability to be able to constantly monitor and to have that, you know, second person there, just kind of looking at everything, I think would just, you know, it would help to really decrease a lot of fears and a lot of burden on the nurses today. Yeah, I.

Molly McCarthy:
Agree; I mean, I worked in NICU and peds, and I took care of a lot of cystic fibrosis patients, for example, that lived to a certain age. But I know now some of them are having children, etc.. So, to your point, the chronic illnesses, the comorbidities really make the care so much more complex. So many more things to consider. So a couple more questions I want to ask. The next one is, as you think about all your experience with the association's communications and your current role, what's your vision for the future of nursing and smart care teams, and how do you see nursing spearheading this collective effort?

Amy McCarthy:
That's a loaded question. Uh, you know, when I look at the future of nursing, and I'm an optimist, I'm going to put that right out there. And my team sometimes makes fun of me for this because I am the eternal optimist. But I truly do believe that nurses have the power to change health care. We know so much about our patient population. We're there 24 over seven and. Any instances were able to spot trends before anyone else can. Not just trends with in one patient but within an entire population. I'll share my experience of just in maternal health, of being able to track when postpartum hemorrhages started to become a major issue. That hasn't been something that's been, you know, necessarily a thing that we've talked about for the last 20 years. But I remember specifically in my career when that started to become a huge trend, and we started to see more and more of that. And that's an example of what nurses are able to bring to the table. And so when I look at the future of nursing, I see a future where nurses are fully practicing to the full scope of their license that we are able to no longer have to be combined with room and board, that we are a line item in and of itself, where we're able to capture what nursing is doing and bringing to the table when it comes to caring for patients.

Amy McCarthy:
But I also see nurses active throughout our systems, not just being contained to the bedside. And sometimes, especially with my communications background, I think about how we market ourselves as nurses. Still, the public today sees us as those individuals in scrubs as the bedside. And so I think that we have to do a whole rebranding campaign, just of the profession to say, listen, nurses are found everywhere. They're found in technology, they're found in government, they're found. I mean, truly, the skills that we develop as nurses, as we go through our careers are just invaluable in a variety of different ways. And so I see nurses inserting themselves into those conversations and finally making room for themselves at these tables or pulling up a chair if there's not one already. And when I think of, you know, what might be obstacles to that, you know, I'll be really frank, Molly. I think sometimes it's ourselves. When I was completing my doctorate work, one of the things that I focused on was the self-efficacy of nurses and how that motivates them to pursue board leadership positions. And what I found with so many times is that when you examine nursing, you also are examining the history of females in the workplace. 88% of nursing is female today. And so you have to think of that and how that has worked itself in history. Nurses are you know, typically we like to be people pleasers.

Amy McCarthy:
We're the ones that will work ourselves; we'll put ourselves last, and we really need to change that. We need to ensure that we're taking care of ourselves, that we are developing that confidence, whether it's through mentorship, whether it's through training. And I'm speaking to my nurse leaders, we've got to do more of this coaching and developing of our nurses who are coming into the field. We've got to start talking about advocacy at a much earlier point in an individual's just career in their education so that they come into the workforce understanding that my job is not just to take care of patients, it's also to advocate on behalf of the profession, but also for the patient population and where we want healthcare to be. And so I tell nurses all the time, listen, we've got to start somewhere. There is a place for your voice. But the most important thing is that you put your voice out there, that you don't stay silent, that you don't stay just within the four walls of your work environment, that you're out there, and that you're sharing what you're seeing. Because people need to understand those stories; it's how we're going to reshape healthcare, and we've got to have a place for ourselves in that narrative because otherwise, the story of healthcare will continue. But it may not be as friendly as we want it to be.

Molly McCarthy:
Yeah. No, I mean, I couldn't agree with you more. And as soon as you said the biggest obstacle is, you know, nurses, I was like, yep, I see that. And that's why it's so important to have that cross collaboration within healthcare. But then quite frankly, outside and looking at other industries, how other industries tackle certain problems.

Amy McCarthy:
Absolutely.

Molly McCarthy:
So critical. So, thank you for that comment. I think, you know, it couldn't have been said better.

Amy McCarthy:
Thank you.

Molly McCarthy:
So, last question. And so, you know, our listeners, our CNOs, CNIOs directors, the respective teams, other nurse leaders, nurses at the bedside. So, obviously, you've had some varied experiences in healthcare. And I guess I always ask my guests to share a parting gift with our listeners. Your single most important, practical piece of advice for them as it relates to responsibility being tireless advocates for their patients. And then I'm going to also say, and your nurses, as I hear you doing.

Amy McCarthy:
Absolutely. You know, I think to sum it all up, I would tell my colleagues out there to stay curious and to stay connected. Like I mentioned, I think sometimes it's the fear of the unknown that causes us to shut down. And when you think about AI and technology and all of the change that's happening almost on a daily basis, if we're going to be real about this, sometimes I think nurse leaders shut down because they don't know where this is headed, and they don't know the answer right off the top of their head because they've never experienced anything like this before. And what I tell nurse leaders and those leaders that I'm working with right now is that it's okay to not have all the answers to everything. In fact, it's okay to say, like, let's ask some more questions. That's what I love about my CNO is that, you know, I come to her with a lot of crazy ideas. I'm going to be the first to admit it, but one of the things that I love about her and what I've instilled in just in my leadership, too, is that I never completely say no. I say, well, let's explore this. Let's talk about how we can put forth this idea. And maybe now is not the time, but I'd love to understand a little bit more about what you're bringing to the table, how we could implement this. You know, we haven't done this before, but that doesn't mean that we can't do it.

Amy McCarthy:
And I think that for nurse leaders, having that type of inquisitive mindset to try and get past that fear, that not knowing all the things because we don't know, I mean, there's so much that's happening with these technologies that we don't have all the answers and we don't know how it might fit into the healthcare space, but that doesn't mean that we shut it out again. When I'm talking with leaders when I'm talking with nurses, you can tell that fear that just bubbles up a little bit, and they're like, oh, well, there's a regulatory reason that we can't do this and all of these things. And instead of just going straight for that, saying, well, you know, maybe we need to change things. So, where do we start with that? How do we have these conversations to start to change the hospital space or work environment that it is able to coexist with some of these new things that are coming out, and the stay connected portion is just, you know, when I think about what I do, whether it's within the hospital, whether it's within my professional associations, I always think back to where I started and I think back to nurses today and where they're starting, and that's who I'm advocating for in so many different ways. I know that the bedside today looks way different from when it did when I started ten years ago, and I'm knowledgeable of that.

Amy McCarthy:
And I ask a lot of questions to my staff. I try to follow them, see how their day-to-day is going, and just ask the question of what's happening. What is the biggest barrier to you being able to be a nurse successfully? And I think sometimes what happens is as a leader, as you go up and up and up, you sometimes lose that connection. But I challenge leaders today that if you don't connect with that bedside nurse, if you don't connect to the heart of your organization and the heart of the profession, if you will, you're losing out on a lot of knowledge and a lot of the reality of what it looks like today because we can't read always from our personal experiences of what nursing looked like when we started, we have to understand that the reality is quickly changing. And so while I may not have the same lived experience as a nurse who's starting today, I'm at least going to try and understand it, and then I'm going to advocate tirelessly for it because that is what I'm doing in these positions. That's why I love what I get to do every day. And I know that so many nurse leaders share the same sentiment as I do. And so those are certainly two things that have worked for me and I continue to recommend to leaders as they come out today.

Molly McCarthy:
Well, Amy McCarthy, thank you so much. I love your focus on curiosity and staying connected. Yeah. And to your point around being curious, not knowing everything. When I was at Microsoft, we had what we called learn it all rather than know it all. So really going after what you don't know and not taking a little risk. So that's so fantastic. I love your passion and optimism. And let me know if you want to run for some official position, because I love to work on your campaign.

Amy McCarthy:
Absolutely, Molly. I'll let you know. Well, thank you so much.

Molly McCarthy:
And I look forward to seeing you again in person soon.

Amy McCarthy:
Absolutely. Thanks, Molly.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight. For best practices in AI and Ambient Intelligence and ways your organization can help lead the era of smart care teams, visit us at VirtualNursing.com and for information on the leading smart care facility platform, visit care.ai.

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SCTS_Barbara Pelletreau: 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 delighted today to have a special guest on the Smart Care Team Spotlight, Barbara Pelletreau. Barbara was formerly the patient safety officer at CommonSpirit Health, one of the largest nonprofit healthcare systems, where she was responsible for regulatory readiness, medication safety, management of controlled substances, reduction of hospital-acquired conditions, voluntary events reporting, and loss control prevention. Under her leadership, CANDOR, which stands for Communications and Optimal Resolution and Just Culture, were implemented system-wide. Barbara also led system-wide employee safety efforts, resulting in the reduction of worker's compensation costs at the University of California Office of the president. Barbara is known for her strategic and collaborative leadership and implementer of transformative and large-scale initiatives, patient-centric results, adoption of innovative technology solutions, and investment in her team and colleagues. Barbara continues her passion for safety by serving on advisory boards for innovative companies, chairing policy committees promoting candor, and mentoring future healthcare leaders. Welcome, Barb. It's great to have you with us today.

Barbara Pelletreau:
Nice to be here, Molly.

Molly McCarthy:
So many conversations on this particular podcast to date have described the significant challenges facing our caregivers, really with a focus on how we can build smart care teams and smart hospitals by reimagining our current models of care with new technology. But another important dimension for us to consider is the imperative to focus on quality, safety, and regulatory compliance in an era where we all are compelled to achieve more with less. So this leads me to my first question, Barb. And before we really dive into more potentials around technology and patient safety, I would love for you to share with our listeners more about your most recent role, including perhaps, the scope and scale of the requirements, mandates, and elective priorities that achieve quality and Patient Safety Officer is responsible for implementing and then also accountable to oversee.

Barbara Pelletreau:
That's a broad question. First of all, my previous role with what, over 23 states and 140 hospitals and let alone the many hundred sites of care. So primarily, people often ask, what does a Patient Safety Officer do? And I often break it down into buckets categories, and again it's not siloed, they all work together and across the spectrum. But we certainly have medication safety, you have regulatory compliance, you also have the high-reliability organization putting those skills into place. You also have the voluntary events reporting system; how that information is used, certainly working with root cause analysis, how to do good root cause analysis. Also, just public reporting of harm events. And then on top of that, we also have innovation. How can you make it easier to do it right for those at the bedside, those that deliver care, those that are at small community hospitals. So in my role in the department, we were what, I'd stay here to serve. Our goal is to support those on the front lines and those leaders to get it right and bringing innovation and bringing the most, the latest and greatest, because it's not the flavor of the day, but it's what works, what's proven, what's evidence-based, and then how do you spread that for adoption? The last thing I'll just say on this, Molly, is we all know, especially in healthcare, it takes 17 years for something to be adopted. So a personal goal is, can we adopt this a bit sooner? Because when we do, patients are going to benefit and so will those that provide the care.

Molly McCarthy:
I think that's a really good point, especially since technology is so rapidly changing, and those innovations will definitely come and go over the course of a 17-year period. So I hear you; I think you make a good point, though, of your role and others in this particular role is, how can you make, how can you utilize innovation to make what caregivers do on the front lines easier and really work to the top of their license? So that's fantastic. And to your point, not just taking what's the latest and greatest, because we know there's so many different options and point solutions on the market, so many different buzzwords of the month. For example, generative AI has been all the buzz this year, but really, ones that have been proven and directly shown evidence. So that's great. My next question is a little bit deeper, it's two parts. I'm going to ask the first part and allow you to answer because sometimes it's just easier like that, but related. And you talked about this a little bit, but I would love to hear how closely correlated are a hospital's financial outcomes to high quality and riot reliability.

Barbara Pelletreau:
Well, that is a great question and certainly could be discussed for hours. But I think when you look at quality, safety, patient experience, and you get those three right on all cylinders, not just in 1 or 2 categories, but across the board, and it's more than just what we're reporting or measuring through CMS, but you look at the ongoing application of the evidence-based practices, whether it's by nurses, by doctors, by the laboratory, whatever it is that defines high quality and safest care, and of course, with kindness for the patient experience and respect for those that are using our services. It is absolutely, in my opinion, a direct correlation with your financials, and here's why. When you get it right for quality and safety and patient experience, first of all, that's the business we're in. If we can't do that, why are we in business? The next step for that, though, we got to do it well in many areas and in many disciplines, and that takes good leadership. And when you get that right, and I find you have the physicians working with the leaders with nursing and the other professions, and then it builds a reputation. And when you get that reputation, and you sustain it and nurture it and keep staying current with what I'll call simply evidence-based practices in a nice work setting for kindness with patients, you know, what your financials are going to follow. And I've also seen where certainly leaders are changed and you have the potential, but you have the wrong leadership. But you get the right leaders in all three are firing on all cylinders, and you get that reputation, and it certainly drives your bottom line.

Molly McCarthy:
Yeah, I like that, what you said. Why are we even in this business if we can't deliver a quality, safety, and patient experience? 100% agree with you. The second part of that question, and you touched on this a little bit, but one, I would love for you to share any examples that you've done during your tenure in that role, and then obviously, consequences of falling short of that and then obviously benefits of improving.

Barbara Pelletreau:
Okay. Well, let me break that down a little bit. For example, most of our system that where I worked was made up of small hospitals, community hospitals, and we had some large ones, but for the most part, healthcare is delivered through the small community hospital. And in order to do that, certainly, you have to get the right information together to be able to get it to your colleagues and partner in how it delivers it, care. With that also comes interaction with the medical record. That's our documentation on how we deliver care. And we, I can't believe that there's hospitals still on paper these days, but there was at one point, not everybody was on board. But now, with everybody on, using some type of electronic medical record, we really need to make it work for us. So we're not just educating. When I started in this business a long time ago, I remember everything was about education. In fact, it was an education department. It wasn't a quality department. It was everybody. Well, we need to educate. And how many times do we sit in training and educate, and we still need the education. However, I think education maybe gets us to a 60% confidence level. We got to go beyond that because education we know just does not work in and of itself, but complementary net medical record to be able to drive the highest quality, the evidence-based work and help those front line work get it right. So any kind of technology that is consistent and makes sense for the front lines definitely can achieve that. So I can think of several examples. So I'm going to give you two. So one is small community hospital near big city but not in a big city. I don't know has maybe a little over 100 beds, maybe 150 beds. And they weren't doing well on all of their quality measures and harm, and boy, seemed like regulatory was showing up regularly and, after events, because certainly in states, I think there's 22, 25 states where there's public reporting, so there's certain things that happen that you must report, and that usually brings out your Department of Health Services, and that represents CMS. Anyway, after a few events like that and now getting in the right leader, right leaders, usually I think of the triad, I think of the president, the Chief Nursing Officer, and the CMO. If those three are on the same page, they can drive change along with the chief of staff, of course. But anyway, so with that did not have great outcomes when it came to the hospital acquired infections. Many hospitals now have gone, you know, well over a year, two-three years without hospital-acquired infection, especially central line, and yet there they had them. So again, when they start applying the evidence-based practices, they got the right leadership in, they got it down to the front line, and they had a multidimensional approach. They're now well over, and there are other quality, and they are A-rated in Leapfrog, and there are many other outcomes that are publicly reported, and they've gone quite a period of time without a HAC, a hospital-acquired condition. Another example is a hospital that did fairly well in their measures, whether there's quality, safety, but let's just say their dashboard for how we're delivering healthcare and what we're publicly reporting. And then, there's other criteria also that they thought were important that they added in, so it wasn't just limited to CMS public reporting. Anyway, with that, they were doing very well. They had safety coaches in the units, they had regular safety huddles, they had a very integrated team with the doctors and with their Chief Medical Officer, with their quality, with their safety leader, and really helped that the president and others were all about the bottom, not the bottom line, but the bottom line of safety and quality that would drive the bottom line. And they were just consistently getting great outcomes publicly as well as one of their key measures was Leapfrog and being able to look at Leapfrog as well as their star ratings with CMS. So that was a couple of their measures, and then they had deeper measures inside. But with that, again, their financials followed, and I just think that it's a win-win-win. It's a win for the patient, it's a win for the quality, and the care, the evidence-based practices, and it's a win for the bottom line, and to me, that's good healthcare.

Molly McCarthy:
Yeah, that's critical, obviously, and really working towards the quintuple aim. And I'll put that fifth piece in of health equity. Appreciate those examples, and I love what you described as the triad of successful leadership, including the president, the chief nursing officer, the chief medical officer, to drive that change within an organization and drive that culture and that multi-pronged approach. Specifically, you describe the central line infections, and that's pretty amazing over 1300 days without. So appreciate that. Do you have any other thoughts around consequences of falling short other than the obvious financial or just from a culture perspective?

Barbara Pelletreau:
Certainly, culture plays a huge piece. We can say we need better culture, but it's our actions that get us better culture. So what are the very specifics and what's the plan for improving our culture, and what do we need, and how will we measure it? I'll add in another dimension for safety, and certainly using the latest and greatest and proven technology, is that your claims should also follow your lawsuits. And sometimes safety, patient safety lives in its world and doesn't connect with those that are managing the claims. And they're kind of often put into another little room, and you often hear, well, we can't talk about it, it's litigated. Somebody's going to be talking, have to talk about it so that it doesn't impact another patient. And when you impact patients, you're impacting those that care for patients. So with that you're, if you do all of this correctly, you should also not see your lawsuits and your claims, and that is depending on your size. And most healthcare isn't self-insured, that's a huge contribution to the bottom line. So I'd like to challenge the safety officers, the leadership, that you should be doing safety and you shouldn't be also seeing positive results on your claim side of the house, and then again, contributes to your bottom line. As for culture, certainly, when many hospitals participate in Leapfrog and do surveys of culture of safety, it used to be that you had your culture of safety survey, and then you had your employee safety survey. And, I don't know, a few years ago, I approached Leapfrog and said, we got to combine these. You cannot have the poor person that's managing a unit have two different sets of surveys, two different sets of measures. We got to combine these, and thankfully, Leapfrog agreed that, yes, you can combine them. And so now, I think quite a few organizations have combined their culture of safety questions in with their employee survey questions. And with that, certainly, having your different domains or grouping of questions and knowing exactly where to focus. And that's a great opportunity to take those results and sit with the teams at their safety huddles to say, give me some feedback. What else do we need to know to improve this? And here's the things we're doing really, really well and what contributes to that. But having those conversations at that front line is critical because you will find out exactly what people think and feel and how they perceive. And even if it's not quote, unquote right, or close, then that's your opportunity to get more information and partner for a better culture. Because over and over, when these adverse events happen, you'll find that the culture was a problem. So why wait? Let's use these survey results and dig deeper, and come up with the plan. The last point I'll say about this, Molly, is the thought of transparency. When I started doing this, I don't know, public reporting in the state of California began, oh gosh, I think it was July 1st, 2007. And I know that because right before that, about six months before, they created a patient safety officer position. And with that, over 40 hospitals learned very quickly that there's a lot of things that go on that are now going to be public. And I just don't think we're ever going to see the change until we figure out how to get past transparency and or move forward with transparency, but get past this whole, well, we can't talk about it. We got to learn from it, because certainly those that are taking care of our patients know what's happening, and they must think we're living in the sky or in the sand or wherever you're it's. But you definitely need to have that information out so we can do better. And I think my last comment is healthcare providers, you and I know, show up and want to do what's right, but they need information and they need direction, and we need to make it easy for them.

Molly McCarthy:
I love all those. I especially love the transparency piece that's so key moving forward and continuous improvement. Quite frankly, if you're not acknowledging it and doing that root cause analysis, how can you make changes? My next question, really, maybe reflecting on your last few years within your role. I would love to hear your thoughts on just when you look at the market with so many health systems today and really over the past few years, struggling to find staff to keep their beds open for care for patients, how have you seen the role of the quality and safety team changing, perhaps like thinking about through COVID and then post-COVID? And just with the workforce shortages in the market today across many disciplines, not just nursing.

Barbara Pelletreau:
Yeah, boy, it's quite a challenging time recovering from COVID and less in the workforce. And then I think the saddest part is I think there's not enough in the pike that are coming out of nursing anyway and to be able to meet our needs. So with that, being an optimist, I think this is the opportunity to step back and say, wow, how are we going to get there? What works, and what do we need to change? Maybe we need to not keep adding on in healthcare. Maybe we need to go back and redesign a path forward. And I happened to, I don't know, at one point in my career, receive the Innovation Award for one of the top innovators. And I think that came about because there's certain technology that is really going to help us get it right, and we need to be able to get that implemented as quickly as possible without certainly without errors and problems in itself, and show that it works and get that to our front lines. I also think, as I've looked at the last few years, is there's a lot of innovation going on out there, my goodness... Just to check with the innovation officers, they're being hit left and right with new startups, etc., but what it's done for me is it made me think, you've got to find partners that are not single solution. You need to find a partner that will grow because, of course, the technology is integrated with that medical record, it's integrated with other systems that are already embedded in healthcare that are working. So you can't just keep laying things on top. One, it's costly to integrate, two, it takes time, and on top of that, it's hard to sustain. So looking for innovation that solves multiple problems is actually, I think, really a key strategy for a large companies or even small companies to hook their wagon to and look for those right partners that are going to grow with them and solve many problems, not just single solution.

Molly McCarthy:
Yeah, a great point. I think that partnership between the tech industry, healthcare, the clinicians is so important because we know, and I know, and our listeners know it's not going to be solved by one entity. It's really that partnership and working together to make that change. I also just echo your point around single solutions, I think I've talked to many technologists and CIOs, etc. CTOs, over my time, and they really want to move away from single-point solutions more towards platforms. A couple more questions. So appreciate your time here. And you mentioned this a little bit in one of your answers previously, but would love your perspective on different organizations around quality and safety, for example, like the Joint Commission, Leapfrog, IHI, which is the Institute for Healthcare Improvement, and others within that area. Just in terms of how has their thinking and guidance changed over the past few years? If you think about, obviously, with COVID and then the economic and operational realities that health systems are facing today.

Barbara Pelletreau:
Well, let me pick off some of the top ones and spend a few minutes, a few sentences on each of those, certainly starting with the Joint Commission, all of our hospitals, or I think probably 95% of them were had joint Commission surveys. And with that, they've had new leadership in the last few years, and certainly, they've put and put patients over paper. And I know through the years overseeing regulatory, a lot of hospitals spend a lot of time preparing for the test, if you will, and then you've got a three-year gap as long as nothing terrible comes along, and then you brush it off and get ready again, I'm not sure anybody outside of healthcare would ever agree that's a good process. I think many in healthcare agree that's not a great process, but I think with their new leadership, they're definitely trying to figure out what regulatory requirements make sense, what standards make sense, and what we can retire, if you will, so we can get down to what matters. The next one that I will mention certainly is IHI. Boy, they've been a leader for a long time, and I think they were the one of the first ones I looked to and went through my patient safety fellowship with when I started in, working in defining patient safety, and they're international, and I think they've just taken so much of the work that we've done in the United States and have spread it to those that do not have IHIs or structure in place and, and made a difference around the world for them. So a lot of respect for the work that they've done and continue to do and especially their investment in boards; certainly, we all know we got strong boards we're going to have better outcomes and better again, under the leadership category. My favorite, I'll have to say, is Leapfrog. I've watched them evolve, and I watched these to be more bicoastal because they were started from companies that were fed up with healthcare. And as the company said, we got to get out of this fee-for-service, to manage care, etc., and Leapfrog and Leah Binder moved forward with Leapfrog and watched them to where it was a lot of process and reporting and no validation to where now they actually validate what you say, and 50% of it is outcomes and nothing you can control. What you can control getting there, you're going to pull the data. It's not what you answer on paper, and then 50% and roughly on process. So I find their structure, I personally really have a lot of respect for, they pull together experts in different categories. I know they've started one with technology innovation, and they've brought in experts and people to listen to for that. So they don't pretend to know it all, but they go out and find the right people, to help provide guidance for them. They also celebrate, love it when hospitals get A's in their reports just came out the last few days. And so, with that, let's celebrate people that have done well. Let's acknowledge them and help them share with others that haven't done so well what needs to change. So with that, I definitely think there's one other one I'm involved with, which I'll mention because I, very passionate about this work. The medical errors is the third leading cause of death, and the only reason you don't see it is because there's not a second place to put on a death certificate why, or what happened, or where, or... So third leading cause of death, heart cancer, and now medical errors. And this just seems to come out over and over David Bates's study last January that published over Harvard System came up with all the harm that had happened. So it just keeps getting validated over and over. The University of Washington has been a big leader in CANDOR, and just a few years ago it was top. AHRQ did a toolkit on it, so anybody can follow the toolkit and start implementing how to manage these adverse events, how to not defend, deny, delay, but how to talk and give information and make it so it doesn't happen to another patient. And the University of Washington, under their collaborative for Accountability and Improvement, has done a lot of work in leadership, along with IHI in Adriana Labs, a tool in Wendy's company, and have led 25 hospitals to up their skills and their tools and their leadership for managing medical errors and preventing medical errors. So anyway, I think it's all going in the right direction. Certainly, 15, 10, 15 years ago, a lot of this was not in place except for IHI and certainly the Joint Commission. But you read about it a lot more now, you see it in Becker's, you see it in the news, on some of the proven tactics that need to happen at every single hospital to manage and prevent these errors.

Molly McCarthy:
Yeah, I'm going to pick on Leapfrog just because you mentioned their tech and innovation component, which obviously is so critical moving forward. We talked earlier about the electronic medical records and electronic documentation. So when you think about evolving technologies like virtual and patient care, ambient monitoring, AI, what are your thoughts around the best use cases for immediate impact without using your lens of a quality, safety, and regulatory compliance?

Barbara Pelletreau:
Well, certainly looking at how we redesign patient rooms and how healthcare is delivered in the room to the patients. So I'll get a little hospital-centric for a moment with that. Certainly, we're all fighting to get those nurses that we don't have enough of. So we've got to think differently to help the nurses that we have to want to stay in practice, and also nurses that might be leaving practice but could still be incredibly valuable. So as the virtual nurse, now, I'm just going to step back a second, Molly, and say, this reminds me, I'm really going to date myself here, but it reminds me of the 80s when the word wellness came out, and in healthcare, you remember that was that's going way back. But you couldn't even get a blood pressure, you couldn't even get a lipid panel percent body fat in that unless you went through your doctor. And so in the 80s, all of a sudden, right, everybody says, oh, we got to do wellness. And the doctors and people are saying, what's wellness? Well, I feel like we are in the, back in the 80s, but now defining artificial intelligence in healthcare, because certainly any day you read Becker's or any other Modern Healthcare, you start seeing the word of AI or virtual nursing, and then you start talking to nurse leaders. What does that mean? Here, we're doing this, and here we're doing that, and we've got a bigger plan. So it really has a huge realm that needs to get to be defined. And I always say when someone mentions those words, my first question is, how do you define it and what are you doing, and what's your long-term plan? Because then you find out much sooner where they are, where they plan to go and how they're currently defining it for their company, their location. So with that, there's many immediate and, I don't know, low-hanging fruit that can be picked up. Certainly, the falls, as we know, can really change someone's life when they start getting over 60, and there's that fall, oftentimes within a year or two. It's not a good scene, and it's the beginning of going down the wrong path, if you will. So, certainly, preventing falls is key. Pressure ulcers is another area. If somebody, when they leave the hospital, and they've gotten this great care, it definitely don't want them spending the next six, nine months recovering from pressure ulcers, from lying and positioning, etc., so anything to help with that. Medication reconciliation, I just heard a terrible story of someone who's just lost their daughter to medication reconciliation, the lack of, and the medical record was not current, and they gave them all the drugs that they were no longer taking and ended up sadly killing this young lady. And so medical reconciliation is just poor, it should be at the very, well, they all should, but this one is, we got to get this right to know what medications currently, plus what they've taken in the past. Some other area certainly is safety. We talk about safety for the nurse, those that are in the room caring for patients, certainly in the emergency room. So being able to use artificial intelligence and technology for safety is another key one. So I named a few of them, but I think the key is that's just the tip of the iceberg. In one area, somebody say, May I, may I have this issue? How can this technology help? And again, I'll go back to what I said before. Partnering with the right people that can help solve the problems is equally as important as having the right technology.

Molly McCarthy:
Right, no, I think what you started off saying there was, how do you define, I don't know, virtual nursing? I always ask people when I talked about virtual health many years ago, how do you define it? It's going to differ really where place to place. And then, to your point, what problem are you trying to solve? We can't lose sight of the underlying problem or workflow because we don't want to just attach technology to attach technology. We really need to be specific, so appreciate those examples, and to your point, they are low-hanging fruit. To wrap it up today, unfortunately, we have to close out here, but would love for you to share with our listeners, who typically are Chief Nursing officers, Chief Nursing Informatics officers, and hopefully now some Patient Safety and Quality officers. But would love your thoughts around what, if you could leave our listeners today with one piece of important advice as it relates to the responsibility of being tireless advocates for their patients, what would that be?

Barbara Pelletreau:
Well, I'm going to describe it as be bold, be brave. What that means is that often, in healthcare, we each create our own solutions. Each you have something proven, you have something that's working, it's in the medical journals, it's all over, and yet we look and say, that's nice, but what are we going to do here? So I say, be bold, be brave. Look outside of your own domain, your own hospital healthcare setting, and say, what are others doing and what are they doing? Well, and get out of your comfort zone. So that goes into be bold, be brave. The next part is you're probably not going to be doing this yourself. Developing your own technology sounds great in the beginning, and you get approval for all the money and the board support and everybody, but it's not sustainable. You must find partners that do this work and do it better and work with other healthcare settings so you can benefit from what their problems are, what their solutions are, that then automatically are transferable to your solutions. So I would say after be bold, be brave, looking outside is to find that right partner, that right platform, and it's not just technology, it's about the aptitude for them to grow and deliver services and partners. I think for me, I've always, throughout my career, looked at what the solution or what solution a company is bringing, but what brings them in the door for me is the long-term partnership. What are their values? Where are they going, and how can I benefit from all their other clients to help me on what I may not know?

Molly McCarthy:
I love that! Be bold, be brave, look outside of your own domain, and that partnership is key, and it really goes beyond just the technology but inclusion of that, the people, the process, the platform. So thank you so much for all of your insights today. Certainly appreciate your time and look forward to seeing you in person, hopefully soon.

Barbara Pelletreau:
Thank you, Molly. It's been a joy.

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_Tracy Breece & Betty Jo Rocchio: Audio automatically transcribed by Sonix

SCTS_Tracy Breece & Betty Jo Rocchio: 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 am delighted to have two special guests today on the Smart Care Team Spotlight, Betty Jo Rocchio and Tracy Breece. I'll go ahead and tell you a little bit more about each of them before we get into our conversation. Betty Jo has served as Mercy's senior vice president and chief nurse executive since October of 2020. Previously, she was the chief nursing optimization officer beginning in April 2018. Prior to joining Mercy in 2013, Betty Jo held several leadership positions in the Mount Carmel Health System in Columbus, Ohio. These include Chief Nurse Anesthetist System Director of Surgical Services, and Vice President of Nursing, and Chief Nursing Officer. Betty Jo has a passion and drive toward technology and analytics to assist nursing and clinical teams in patient care to drive optimal outcomes. She understands that collaboration in the industry, often outside of healthcare, produces unrivaled impact. Betty Jo is currently working on a nursing workforce strategy that includes matching patient demand and a gig nursing workforce with a modern, nurse-focused company that has the platform to support efficient and effective deployment. Welcome, Betty Jo.

Betty Jo Rocchio:
Hi, Molly! Nice to be here with all of you today.

Molly McCarthy:
Thank you. I'm going to tell you a little bit about Tracy too. Tracy Breece, a registered nurse, has over 25 years of experience in the hospital and healthcare system. Early in her career, as new technology developments were introduced into a nurse's daily life, Tracy quickly identified a natural affinity for connecting how technology is applied in the nurse's thought process. She embraced technology change, advocating for enhanced workflows. Some might have even called her an early adopter. Through countless implementations of multiple system-wide clinical technology products, her true north is the passion for improving the daily life of the nurse by freeing up time for nurses to do exactly what they do best: care for patients. Today, Tracy serves as the Executive Director for Nursing Informatics at Mercy. At the system level, she facilitates the integration of clinical, technical, operational, financial, and usability components of multiple information systems. Welcome, Tracy. It's great to have you here today.

Tracy Breece:
Thanks, Molly. I'm excited to share our story with your listeners.

Molly McCarthy:
Great! Really appreciate you taking time out of your very busy schedules right before the holidays. And I also wanted to share with our listeners that I personally had the opportunity to visit with Mercy and Saint Louis a little over a year ago and to see firsthand the amazing work that you are doing for nurses and patients across many different units. And more recently, I connected back with Tracy during the September NurseHack4Health, where your systems had two separate teams participate, and obviously, I love to see that, and I can attest to the fact that you're both eager to tackle old problems in new ways at your 40 hospital system across four states and 12,000 nurses. My first question, Betty Jo, I was recently reading your Day In The Life overview with Johnson and noticed that you continue to work in the OR twice a month, and I would love for you to share a little bit more about how working on the front lines inspires you as a leader and a change agent.

Betty Jo Rocchio:
Molly, for me, making system-wide decisions for nurses demands that I'm in contact with the front line, so I feel an obligation to not only continue my patient care but also stay up to date on the everyday problems that we experience at the front line. I enjoy it, I learn a lot, and I get a lot of information back while I'm working.

Molly McCarthy:
Great, thank you! Just a follow-up question. I also read that your work in the OR inspired the idea for Mercy Works on Demand, and I would love for you to share with our listeners about how you went about internally selling this concept and idea for the program and the value it brings to your workforce. And this question really is for both of you.

Betty Jo Rocchio:
Yeah! While I was spending time in the OR, we developed an inventory management system that reduced workload at the front lines for our nurses and the OR, and when I looked at the workload of especially our med surg nurses and inpatient nursing, it really started to inspire me to think about ways to reduce that workload. And you read Tracy and I's bio together, and you can see our synergy. You can see how we combine our passions because, at the very heart, we both are still nurses, and we feel their everyday struggle to not only deliver patient care, but exceptional service. And so she has a great skill set that fuels me, and she loves the vision that we set across Mercy. So we synergistically it came together and it's all driven off of serving the front lines.

Tracy Breece:
Betty Jo, I couldn't have said that any better. You're leadership and guidance through our Mercy System, understanding the reality of the workforce constraints, right? So knowing that when we show up to work every single day, we know for weeks and months that nurses were working short, and we knew that there was a supply and demand problem and that supply and demand problem is begging for technology solutions. So here we are, Molly, having a strategic plan on how technology can help us work smarter with the resources we have because we know we're not getting any more, and putting the right resources in the right spot, specifically with staffing, allows our nursing colleagues to be fulfilled, to do what they do best and take care of patients rather than be stressed and under pressure. And am I doing all the things that I need to do to fulfill not only what my patients deserve of me my employer deserves of me, but what I want to give my profession? And so Mercy works on demand, does just that allows us to pull a shift when we want to pull a shift, where we can pull the shift on the time that we need to pull it.

Betty Jo Rocchio:
Expanding on that just a little bit further when you take a look at how we're building our workforce. We went from 25% agency coming down off the pandemic to 8% agency, and the way we expanded it was through that flexible workforce layer. And so our core is coming up a little bit, Molly, but what you'll see is that flexible layer is filling in those hours that we need it where we need it the most. We know that productivity at the front lines isn't the same on a 12-hour shift, so launching the shifts that make the most amount of sense to help decrease workload at the front lines through an app-based product allows our nurses to choose, and it's really delivered great results at the front lines.

Molly McCarthy:
I love just stepping back and summarizing a lot of what you've talked about. First, just connecting, staying connected with the front lines. That was obvious to me when I was there a year and a half ago with you all, but I think that's so important, as you mentioned, Betty Jo, as a leader to stay connected, and we mentioned you are both still nurses, and I consider myself one as well, really looking to reduce burden, Tracy, as you mentioned, and putting your passions to great work. Congrats on dropping your agency use from 25 to 8%. That's amazing. The other thing that I heard through this program is just giving nurses the ability to choose, and I think that says a lot about your institutions and your leadership styles, especially in this day and age.

Betty Jo Rocchio:
Thank you! We appreciate it. And I just have to compliment Tracy on the way that she gets to the front line. She's not just engaged in nursing informatics; she's engaged in practice and using what she knows at the front lines. I, the nurses, continually, when I'm out rounding mention Tracy and the informatics team as being their support. And I think that's important because they're not seen as a ministry function, but they're seen as support at the front lines. And that, to me, really, just lights my soul on fire.

Molly McCarthy:
I think the other thing that I heard mentioned was you need to work smarter, Tracy, with the resources that you have. And one thing, my next question really will dig into this a little bit more. But when I came to visit you, you were really looking to maximize your investment in technology to minimize and automate administrative tasks for your bedside nurses and managers. So I would love for you all to share, for each of you to share some examples of what you've done with both bedside nurses and managers to really achieve that goal of maximizing technology, for example.

Tracy Breece:
Absolutely, I'm happy to start in this part of the conversation, because it's something that drove a passion in me at the start of understanding the problems, and Betty Jo just nicely outlined, being in the front lines means you actively listen. You are actively part of the team, and understanding how technology is either a catalyst for success or it's burdening the success of your daily work. And so, since you've last visited several things I'm excited to talk about, we have an innovation unit. That innovation unit is at Mercy Hospital, Saint Louis, and this is the unit that we are cultivating that spirit of evidence-based inquiry. We're cultivating the spirit of technology, early adopting of what's possible, working different in our lanes of daily work, and also supporting the entire care team with the patient at the center of the technology, and so that is absolutely new. We have expanded integrating hardware in the form of mobile solutions. So, Betty Jo, I really want you to talk about mobility and virtual nursing. Your vision is really going to transform and advance the science of nursing for not only Mercy, but the country. Let's talk about that a little bit.

Betty Jo Rocchio:
Tracy has set me up to talk about something that we are still in the early stages of, Molly, but we believe nursing derives their satisfaction with their profession, and that just love of patient care is by spending time at the bedside. It is not by documenting, it is not by trying to get into the EMR to see what has been going on. Nurses need to be by the patient's bedside, and the only way to do that is to make sure that they can document and see everything in that mobile solution. And in order to do that, those of us that work in the EMR daily know that it is set up in lanes, so there's a physician lane, a nursing lane, a lab lane, a pharmacy lane, and the nurse is really the one that spans across all those lanes. And so we are starting to take a look at the evidence around virtual nursing. And I know in this country we're hearing a ton about virtual nursing, but you're hearing about it, extracting people by the bedside, taking them out of patient care, and putting them in either a virtual place or a place off the unit to be able to take a look at delivering information and patient needs back to the nurse at the bedside. We are starting to look at AI and creating that virtual nurse brain. And so virtual nursing we believe, will be transformed by that augmented information, and we're creating a literal virtual nurse brain. And it is going to start delivering to the bedside with the very best evidence, those things that frontline nurse is going to need. So our concept of virtual nursing today is an actual nurse. We are starting to develop this technology, so it won't be, reducing workload on the nursing brain that's at the bedside by an AI-invested brain, and delivering what they might need so they can make critical decision-making at the bedside and stay by the patient's bedside. So it's, we're at the very early stages of this, but it's planned, and our innovation unit and Tracy is knee-deep in thinking about this with us because we have to do it correctly, but we know that the nurse is just going to be thrilled to have that information extracted out of the EMR directly onto their mobile secured phones, so they can make decisions and then interact with the EMR, either by ambient voice or by that mobile platform that we have.

Tracy Breece:
And Betty Jo, this parallel path that we've been on, right? We've been cleaning up everyday workflows and the environment of which we're working today, but also visioning and pulling our thought processes and our technology partners into a different lane with us. And Molly, we have framed this. When we socialize, and we talk about this work, we talk about it as Maslow's hierarchy of needs in order to get to the tippy top of self-actualization, utilizing generative AI, utilizing different levels of technology far beyond what we are using today, we have to have our basic needs met. And so for the last year since you've last visited, we have been working on our basic needs as well. We have reduced documentation burden. We're up to over 130 million clicks saved in our EHR. Our med surg nurses were spending upwards to 200 minutes in Epic, who is our partner for Electronic Medical Record, documenting the activities and patient care. We are now proud to say that we are nearly best in class for the worldwide Epic platform community around 123 minutes. So those elements of success that met, I call that Maslow's Foundation for our Technology journey for nursing. It is truly creating a highly usable environment with the software, the hardware, the thinking of newer technologies, and really focusing on human factors in advanced learning of our nurses. It is no secret to our nation that nursing informatics is a discipline that oftentimes folks are like, tell me a little bit about what you do, you're a nurse informaticist, tell me a little bit about that. And as Betty Jo and I have been talking, we are re-engineering the environment in which nurses work, and that's what a nurse informaticist does. We are an engineer, taking the nursing process and building technology into that, and excited to be on this new journey not only for Mercy, but the entire country, as technology is evolving.

Molly McCarthy:
It's great, I had there's a lot that I want to go back and pull back out for our listeners, but I'm going to start with what you just said, Tracy, because I know we've talked about this before, and I saw a post on LinkedIn more recently that you were at a conference where a PhD engineer student mentioned nursing as a Stem profession. And I think you said nurses who specialize in information technology are engineers and essential for healthcare systems in the quickly evolving digital technology era. And you talked a little bit about why that's so important, so you beat me to it. But thank you for bringing that up. And I think with the establishment of the innovation unit and really thinking about what's possible and supporting the care team and going mobile, that's amazing. I know it's more recent. And I'm just curious how you chose that, the particular unit or people or types of patients for that unit.

Tracy Breece:
That's a fantastic question. And I would say the hospital Senior Nurse, Chief Nursing Officer, was raising her hand saying, we are ready. We know technology can work better for us. We have a unit ready. I have a nurse leader ready. Certainly, it hasn't been perfect along the way. Originally thought we were going to do a three-bed part of a unit, and for reasons that we didn't know at the time, we're like, that's a great idea. We'll interview nurses. We did evidence-based literature to describe to us what is the foundation of an innovative nurse, what is the foundation of the thinking? And Betty Jo, I'm going to have you talk a little bit about how and why we expanded to the whole unit and why Mercy Hospital Saint Louis.

Betty Jo Rocchio:
We needed a big enough use case. To just do three beds, we thought, wouldn't give us a true test of everything we were putting in. And the other thing is, this is really coming from the front lines. It's not coming from Tracy, myself, or even the unit managers. The front lines are designing the workflow that they want and need in order to spend time with their patients, so they're really designing it, but we decided to do the whole unit. That way, we could get a bigger use case. And as you launch technology, it's really hard to launch in three beds rather than a whole unit. So as we were thinking through it and we started looking at their ideas, it naturally came to us that probably launching the whole unit would be a better choice.

Molly McCarthy:
That's amazing, I think. I love that. Going back to the front lines and really driving that, the workflow, because they know best, really, when they're with the patients 24/7. And I also just want to say congratulations on the reduced documentation burden. I know that's an overall goal for all of healthcare. So I think that's definitely going in the right direction. And to your point, earlier, nurses want to spend time with the patient at the bedside, not anywhere else. My next question, you touched upon, but I'm going to go back to it again. So my next question really was, when you think about rapidly evolving technologies and workflows like nursing care that you do now in terms of what you've seen in terms of return for your nurses who are supported through a virtual nurse, etc., especially for newer nurses coming in today being given assignments that are probably complex patients, I'm just curious if you have any stories around success with virtual nursing as it is today.

Tracy Breece:
We do, Molly, yes, and it's probably important for your listeners to know that our virtual nursing model is over ten years old. So we have a ten-year-old virtual nursing model. And with that, we have found that a virtual nurse has assisted in the very beginning of our journey. Alongside, our providers were looking for our critical care areas for decompensation models, right? So early, sepsis early. So Betty Jo, I'm going back, gosh, probably 15 years at Mercy. Early sepsis around decomposition or unrecognized sirs that would fall into full-blown sepsis. And so today, we have a very significant, robust example of how critical thinking and mining of our patient data can prove sepsis and surviving sepsis campaign. So that's one example, I think, Betty Jo, that comes to the top of my head just because our grassroots developed in sepsis with virtual nursing. I'm certain you have others as well.

Betty Jo Rocchio:
If you look at our V-Acue program in our ICUs, we do have nurses that are communicating at the front lines. They're looking, that's where we got the idea, really, for that virtual AI-assisted brain, Molly, because we're using nurses to identify in the EHR areas where a single nurse couldn't see. And so we know that nursing brain is fantastic in looking at some of those things. But with everything coming on, with all the technology, we know that AI is going to far surpass what our human brain can do. And so using what we've learned for ten years, augmenting it right in that generative AI is going to probably boost it by 100%. And then we can take some of that virtual nursing and use it to onboard some of our new student nurses and help in that way so they could be virtual preceptors. We believe there's still a spot, but it's probably not going to be the way that it looks today. So we're redefining that, the role, right? Just like we redefine the roles in ICU or med surg, we're redefining that virtual care model role, and I think it's going to shift a little bit.

Molly McCarthy:
Yeah, no, I agree. I think we're really just at the tip of the iceberg in terms of the human components and really the technological components of it. One other thing, this kind of leads into my last question that I loved when you were talking about the EMR has different lanes for the physician, for the nurse, for the pharmacist, whoever that caregiver is, and the nurse overlays all of them, or they, in theory, they do. I know that working as a nurse a long time ago, I used to think of myself with the patient kind of at the hub of a wheel and then outreaching as needed to whichever department I needed to consult with, if it was a radiology, pharmacy, physicians, etc.. So, really being that advocate. So with that concept in your mind, I would love for you to share with our listeners your vision for the future of nurses and nursing and smart care teams and really how nursing and our listeners can spearhead this collective effort, because I feel like it's so important that nurses are not just at the table, but leading it. And it, obviously, to me, it sounds like you are doing that, and I want to share a little bit more about your vision for where you are today and beyond.

Betty Jo Rocchio:
Tracy, why don't I lay the vision components? If you could layer on some detail because you're are so involved with the detail. But let me talk about why we started in med surg, and Molly, you know this. We have no shortage of filling our ICU positions, our ED positions today like we do med surg. The basic component behind why we started in med surg, we believe it's a workload issue, meaning it's not an acuity issue. There's a difference between acuity and workload. Acuity happens in the ED, it happens in the ICU. They have a couple of patients, but they go deep on that patient. That is actually less workload on the nursing brain than having 5 or 6 patients with multiple diagnoses, multiple needs, multiple friction. And you take those six patients and then overlay those lanes that we talked about, that workload is astronomical. And then if you get the wrong combination of patients, remember back to your nursing days when the wrong day would kill you more than actually the number of patients you had. You remember you were like, that was a horrific day. Why was it so bad? It was because you had to go wide and deep, and there were friction points in your day. So taking a look at med surg and redefining what that workflow looks like to take off some of that cognitive workload, that perception of workload we believe is going to bring some of the joy back to med surg nursing. It's the basis of all other nursing, and nobody wants to do it today. Think about nursing school, they have 1 or 2 patients, so they're going deep on 1 or 2 patients. And then we're like, here you go, let's be a med surg nurse, here's your six patients. Spam your face, right? Like you're not, your brain isn't trained for that, and I'm not so sure anybody's brain should be trained for that. But so we're redesigning each one of those lanes. And I'm going to lay out the lanes one at a time, Tracy. If you could just put a little color to it, let's talk about the start of a shift with bedside shift report. So we used to give report writing this little room where you used to talk about the handoff between the patients, what we were really doing, extracting information out of the EMR so the next nurse did not have to get it. Today, talk a little bit about what Epic has as far as the nursing brain and where we're doing report Tracy real quick, and then...

Tracy Breece:
Absolutely. So the future, imagine generative AI utilizing my mobile device that Epic serves up through the rover application. I hit a play button when the ED is sending me a patient, and I hit play on my phone. I'm holding it up to my ear, probably not any dissimilar to the recorders, Betty Jo, that you and I probably used way back when.

Betty Jo Rocchio:
Yep, yep.

Tracy Breece:
And so I'm mobile, and I hear everything synthesized in the medical record in a playback feature. Not only do I get that at Handoff, and Betty Jo, you're probably going to go through the work we're going to it's not going to stop there. So at that point in time, I know all the important details about my patient: age, chief complaint history, allergies, isolation, who is admitting what tests have been completed, and what still needs to be done. At that point in time, the computer that I'm touching is the mobile phone. That's where I'm getting all of the information, and I have a question. My patient's getting a blood transfusion that I'm receiving. I can stop what I'm doing, type it on my phone, and say, tell me a little bit more about the blood transfusion. How many more minutes does it have left? So I know immediately when that patient arrives to the phone floor, what I need to do all of this is utilizing technology. Okay.

Betty Jo Rocchio:
Thank you! Yeah, no, that's exactly it, and we're doing it at the bedside. So we're right there with the patient. We're not getting it on the phone, stopping, trying to talk on the phone; it's all coming there. And then we know exactly the next steps for that patient. And then just talk about the a little bit about the care model. So envisioning like rounding the next morning, right, rounding that occurs that nurses are too busy to go in with every doctor. Remember the days where we had time? We would go in with every physician and hear the report off, okay, today we want this patient's hemoglobin get to 11. We're going to give two units of blood, we're going to change this medication. I need that dressing changed, right, we're not healing. What they're really doing is setting the plan of care. Today, they do it. The nurse is off giving medications or doing something else, they don't have time to round with the physician. And we're going to have that virtual AI brain that's scanning that record and delivering up that plan of care based on all those lanes. And where's the plan of care? How's, Molly, do you remember care planning? Do you remember? I know I'm bringing up some... You're probably like, oh, I'm having flashbacks.

Molly McCarthy:
That, you're bringing up sensitive memories here.

Betty Jo Rocchio:
That care plan, and I hate to say it, and it's going to let the nurse educators are going to be slapping me on the wrist with a ruler, it's useless. It it always was useless, it was a good teaching tool, but it sits in a spot in the EHR that nurses don't even use it. We would go at the end of our shift the last thing, and try to update a care plan so we could check the joint commission. We're doing that. As we're documenting mobility throughout the day, we're going to have the plan of care or the care plan updated based on all those lanes. So the nurses are going to have to go back in and do it, and then that plan of care gets translated back into that bedside shift report that says the top three goals for this patient in the next 12 hours, right nurse Tracy, is these three things. And then you're going to document against that all day long for the next 12 hours, rewrite it back to the care plan, and then have it launch for the next 12 hours. That continuity across the EHR is going to be exciting, and then the nurse has a plan of care that's going to, by the way, come up on a digital whiteboard in the room for all to see, including the patient and family so they know the three goals for the day. We want mom to get up and walk to the bathroom today. They will know that's our goal. So they will reach out and call so we can make sure that we're documenting everything. So what else, Tracy? I know I missed a couple of details, but it's literally we're going to try to passively document as much as we can fill in the medical record so we can provide the care rather than the documentation.

Tracy Breece:
Absolutely, I think you touched on everything, the people and processes and our complex healthcare system and technology being that catalyst, Betty Jo, I think you've touched on everything that's important around where we're going. Molly, we know advancements in health technologies are coming quicker and faster than we can consume, but Betty Jo and I are here in our health system saying we want to be the first, we want to be out there, and we want to partner with our technology teams to enhance what has been known as interoperability features and leverage technology in a different way for that seamless communication that Betty Jo just talked to, talked through.

Betty Jo Rocchio:
And then, try all it in the innovation unit, because it sounds good talking about.

Molly McCarthy:
Correct.

Betty Jo Rocchio:
But when you launch it, it'll, there'll be some things to work out. So launching it in that one innovation unit, getting a full complete shift rollout and then into the next shift, and then launching across the ministry once we have the kinks worked out.

Tracy Breece:
Yeah! And nurses are working in non-traditional environments, Molly. We launched hospital at home, and why that initiative is important for us from a technology perspective is remote patient monitoring. And during COVID, we all had the ability to leverage technology around, okay, our patients are in their homes, we're sick. We don't know what it is that we're doing through this pandemic. Remote patient monitoring, really began generating some excitement. Where we're going is remote patient monitoring in our hospitals to continuously do the vital signs and that integration that Betty Jo just spoke to around the whiteboard. Here are your vital signs. Here's your blood pressure. These are the things of integrating the family around family-centered care that has been driven in clinical practice, in best practice standards, through evidence for so long. Technology is really laying a framework for us to do in a different way, and we're just thrilled and excited to be telling our story today.

Molly McCarthy:
I love it, I love your passion and your enthusiasm and to your point about including the patient and family, I think that's so important. I know myself as a healthcare consumer, I want to know if someone's taking my blood pressure or my pulse. Tell me what it is. Don't just go and chart it or write it down, let me know. And so having that information for the family is fantastic. And people want to know they are they have access to more data in every aspect of their lives. So to your point around using technology as a catalyst, I love that in combination with your people and processes. I do have one final parting question as we wrap up here. Unfortunately, we do have to wrap up. I know that I could talk to you guys all day. So our listeners are CNOs, CNIOs, and respective teams across the country, maybe world, hopefully, one day. But given each of your experiences in healthcare, I would love for you to each share a parting gift of wisdom with our listeners. Perhaps, what is your single most important practical piece of advice for them as it relates to their responsibility of being a tireless advocate for their patients and quite frankly, as leaders for your nurses? So I say one, but there's one for each of you. So, Betty Jo, if you want to go first.

Betty Jo Rocchio:
I would say never quit dreaming of a better world, being curious about the things that we think are not solvable, and applying the best evidence to make sure that we're doing the right things and we're not doing too many things because the focus really needs to be very narrow at this point on workforce practice, work environment, and workflows. If we're going to solve one problem, it's going to be that, and breaking that down into manageable pieces is going to be key.

Tracy Breece:
And in breaking down into manageable pieces, every hospital and health system, all processes can be improved. Embrace the roles of your nurse experts, those that are doing the work, those that have the insight into what needs to be improved and what can be improved. The role of a nurse informaticist is an enabler to help balance your workflows and your work environment for nurses. Nursing informatics specialists are workflow engineers. You heard me say it earlier in our discussion. We have a strong understanding of healthcare processes and workflows. We're implementing and integrating complex systems. Because of this, develop a team of nurse Informaticists to work alongside your nurses to actively listen, they will support your nursing strategic plan.

Molly McCarthy:
Wonderful! Thank you both so much for your time here today. I'm definitely hearing the work smarter, not necessarily harder, but I think with technology we can do that through that, the AI brain that you mentioned and just thinking about actionable insights, we shouldn't have to be delving through tons of information when we have technology that can bring it to the forefront for us. My last thing is I hope you guys will have me back soon. I would love to come see everything that you've done and I wish you all the best in the upcoming 2024 year. So thank you.

Betty Jo Rocchio:
Thank you, Molly.

Tracy Breece:
Thank you, Molly. And you bet, come back anytime, our doors are open.

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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