Episode 25 : Innovating for Our Little Ones:

Dr. Jane Mericle

Executive Vice President at Nemours Children's Health

"I would say that we have optimized the monitoring of children across states. We can go into the room and see the patient, but then this next phase of virtual nursing has taken that to a whole new level. So with the new technology and with support from our technology partners, this camera now, not just can see in the room, but it can be interactive and that the virtual nurse can come up on the screen. We've actually been able to pull up an interpreter as well." - Dr. Jane Mericle

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

Molly McCarthy:
Too often, technology makes caregivers lives harder, not easier. It's time for smart technology to empower care with a more human touch. I'm thrilled to share a little bit more about our guest today, Doctor Jane Mericle. Doctor Mericle is executive vice president, enterprise chief nursing executive, and patient operations officer with Nemours Children's Health. She is a member of the executive cabinet and serves as the senior nurse executive for Nemours Children's Health. Doctor merkel brings more than 40 years of health care experience to her role, and is a certified and executive nursing practice with expertise in clinical quality and patient safety, strategic planning, fiscal accountability, operational management, magnet designation, performance improvement, patient experience, and interprofessional collaboration. She is a Team Step Master Trainer, a certified Six Sigma Black Belt, an executive leader for LEAN, and she completed the Disparities Leadership Program sponsored by Mass General Hospital. Prior to joining Nemours, Doctor Mericle served as associate chief nurse for Duke Children's Hospital and Health Center. She has received numerous professional awards during her career, including the very prestigious Founder's Medal from Vanderbilt University, the North Carolina Great 100 Award, and the Duke University Health System Emeritus Presidential Award. Doctor Mericle completed her Doctor of Nursing Practice program at Vanderbilt School of Nursing, earned her Master of Health Science in Clinical Leadership from Duke University School of Medicine, and her BSN from Columbia University. Welcome, Doctor Mericle, it's so great to have you here today. Do you mind if I call you Jane?

Jane Mericle:
That would be perfect. Thank you.

Molly McCarthy:
Thank you so much for taking time today to speak with me and our listeners and share your story and insights. So, Jane, I almost don't know where to start. Your career obviously is so rich in terms of experiences around nursing quality and safety and children's health care. And I'd like to dive into all of these areas. But first, really want to start with Nemours and Pediatric Care, as you are a first guest on the podcast leading a dedicated children's hospital. And I'm biased because I started my career as a NICU and pediatric nurse. Many of our listeners and including the podcast host, myself, have a special place in our hearts for those who care for children. So I'd love for you to share a little bit more about what leaders and innovators should know about what is different about delivering care in a pediatric setting, rather than in an adult-focused hospital? And what are the issues that you may differ but also have in common?

Jane Mericle:
Sure. Thank you, Molly. I'm glad to hear about your experience, because clearly you understand what a privilege it has been for me to serve and enrolls in children's health. All of my whole career has been as a nurse in children's health, and I can't think of a more important mission. When you think about children's health, we clearly say, It's not about having, taking care of little people. We will care for children and infants from prematurity to all the way through adolescence, 18, 21 and so, as you can imagine, just as you think of that span and the body and the size that changes, so we're having to think about that, we're thinking about developmentally; what an infant, what a child, what an adolescent needs. So highly specialized care around there. Move on to the kind of ways we communicate where you're not just communicating with the families and the adults, but we're communicating with the children. And there are definite ways of doing that in the different developmental stages. And I would say another thing is that children's health is always around the family-focused approach. Families have to be a part of that care, part of the care plan, a part of that understanding. And our teams are really specialized in delivering that sort of care. Then when we move from caring for children in periods of wellness, great deal of focus on prevention. So we want to have that health care delivered with that priority so that we can prevent disease from even developing. And then we have subspecialists who are specially trained in pediatrics and then in the specialties because there are children, small proportion, but there are children that have congenital defects, that have special childhood diseases, childhood cancer. I could go on and on. But there, it is, all wrapped around these children. And so you can imagine then also the psychological support for both children and the families that are a part of their care. So very specialized and very specialized around the different ages and phases of these children.

Molly McCarthy:
Yeah. Thank you. I've worked both in hospitals that take care of pediatric patients and specialized children's hospitals like Nemours. And the family-centered care is definitely an aspect I remember just because you are, and the parents, obviously, so important in the communication loop, especially having worked in the NICU, you have extended stays so the parents might not be at the bedside all the time. So even today, thinking about how far we've come, I'm just going to throw out technology just to.

Jane Mericle:
And I was going to add to that, Molly, even one of the comments that I saw last week from one of our parents was, Thank you so much. This was a child that was pre-teen. Said to the providers, Thank you so much for speaking directly to my child as well and knowing how that was important. So it's both ...

Molly McCarthy:
Yeah, that's a really good point because obviously that child, depending upon where they are developmentally, wants to be and should be included in that process. Thank you. I hope our listeners really can differentiate that specialized care that you provide. From a quality and safety perspective, specifically, what unique challenges must you address in pediatric settings as you consider opportunities for innovation?

Jane Mericle:
I think that if you think about, and what we just talked about, the individuality, we're thinking about the kind of care that really optimizes within that communication, optimizes within whatever developmental stage helps whether a parent is present or not present. And I think that the safety and the quality, also children are more vulnerable to complex systems if they don't go well. When we think about something like medication safety, the kind of dose from an infant to an adolescent is very different. And some of the equipment that we use is very different. And so we have to be able to create systems that are really address each in those sizes and the individual needs. And I think neonates are particularly vulnerable around infections because they have an immature system that protects them. And so we have to take all of those into consideration.

Molly McCarthy:
Yeah. Just drawing upon what you said earlier, they're not little adults, regardless of where they are in the developmental. And so both physically and I think spiritually and mentally they're at different levels. So very important. I know you mentioned medication dosing, which obviously done per the weight when they're very tiny, but also even the technologies aren't necessarily approved to use at at certain weights or levels of care. Really important as we look at the pediatric market to make it, it is very different and specialized.

Jane Mericle:
So when we think of technological innovation in pediatrics, I have to say that it's always been a part of our DNA at Nemours. So let's think about that vulnerability and children. We've had cameras in rooms and in patient rooms since 2011, where we knew that we wanted additional ability to monitor and to see those children in case there was an adult in the room, or in case there was vital signs that were telling us that they needed attention, or we could alert a nurse to go check on a child. We've had Kidshealth.org, which is an information sharing platform, since 1995, and that has been to really be able to share information to providers, to parents, and to those kids that can take in that information like school age and adolescence. And so we've been developing that over time. Telehealth has been part of what we've adopted to make care easier. And as during a period of Covid, the adoption absolutely skyrocketed because in some cases, it was the only way that we could deliver that care. And what a profound way, if you think about, for example, a child needing to have some counseling or a therapeutic intervention and being able just to be comfortably at home and dial in with their provider or parent, being able to ask the questions and have that interaction. It's really, it is part of what has enhanced our care. But there's so much more to do.

Molly McCarthy:
Yeah. Thank you. I love you mentioned having cameras in the room since 2011. I'm going to come back to that in a little bit. But you mentioned telehealth and my next question is a couple different parts. So I'll piece it out. But obviously Nemours is you are multi-state operator with, you have two hospitals, one in Delaware and one in Florida. And I know that you've got multiple outpatient clinics in Jersey and Philadelphia area, etc.. So I'd love to better understand how you think of care geographically. Obviously you oversee all of those sites.

Jane Mericle:
Yes. We are one of the largest multi-state pediatric healthcare systems in the country, and we're very fortunate to have such diversity across regions geographically, socioeconomically, regulatory, politically, which challenges us, but also this helps us to really push on new approaches that withstand diversity and the needs of our patients. Ultimately, we believe we can develop innovative approaches at Nemours, and it can be emulated by many other diverse organizations across the country. It's important to underscore the importance of Nemours Children's, and that we see ourselves as not only providing health care, but delivering health. And so we're really looking at how do we intervene with children in those healthy phases, because a healthy child creates a healthy adult, and we understand that and we take that burden seriously. And so we see ourselves also as both a leader and a convener. I would say that part of children's health care is also about coming together, whether it's different children's hospitals as an organization such as the Children's Hospital Association or whether it's in different collaboratives because there is nothing that should be protected around learning and quality and safety and technology and interventions and research. I could go on and on. But the more that we do that together, so as a health system, we're learning how to do that regionally, internally. But we're also doing that externally with many partners and with many other caregivers.

Molly McCarthy:
Yeah, I just want to point out that historically, and this was the next part of my question, which you already really touched upon it, that children's hospitals have always been, from my standpoint, really collaborative and open to sharing with one another. Obviously, how can, as you mentioned, how can we share our findings so that other hospitals don't necessarily have to recreate the wheel? I love that, I love the collaboration among children's hospitals. I worked with the Children's Hospital Association of America before. I've done some work with the International Society of Pediatric Innovation. That's fabulous, and I love that sharing of knowledge. Do you have any specific examples where you've led in that space or particular projects that you've worked on?

Jane Mericle:
I think probably the one that we want to talk about is the newest of our projects, where we're doing it across the state, but we're also doing it as hospitals is the virtual nursing care, and we can get into that. But I think that's a good example. I think the other thing is we collaborate on care bundles for ... bloodstream infections in children; how to prevent them. We collaborate on strategies for preventing harm in children. And I think that one of the areas that we led in several years ago was identifying septic shock. We were in a collaborative with SPS, or solutions for patient safety, and how to create the bundles and their response for early recognition of that septic shock. So I think there are examples of where were the innovators examples were that happy to be the partners and early adopters as well.

Molly McCarthy:
That's wonderful. I know, I do want to tell you mentioned virtual nursing, so I will take advantage of that and really dig into that a little bit more, obviously, with my tech background and our listeners wanting to learn more about the different uses of technology and sharing, really, that's the purpose of this podcast. So you mentioned earlier that you installed cameras in every patient room way back in 2001. So congratulations to you. I know that's so important, not just as a nurse, but as a parent myself and having kids in the hospital before. I think that's really important. And so building off of that foundation, what's your vision for the future of nursing within your hospitals when you think about the next generation of, for example, advanced sensors, which have broader capabilities beyond just the camera in the room, but thinking about ambient monitoring or smart alerts? So just, can you tell our listeners a little bit more about how technology will enable you and your nurses to reimagine care models and really to broaden the scope, and ultimately, from my standpoint, what I've seen is improve patient satisfaction, improve the caregiver experience? I want to hear where you are in that journey.

Jane Mericle:
There's so much there. And let me just, by contrast, let me share a one short story with you as a new nurse on a medical unit taking care of children. When I started, I would count drops in an IV to regulate the rate of a fluid that a child got. So I would literally stand there and adjust a roller clamp to be able to deliver the right amount of fluid to gravity. And fast forward, now it's, you talk to our nurses now and they can hardly even imagine. But fast forward to then using smart pumps and having IV delivery systems, a technology that not only delivers it accurately but also has guardrails and libraries so it alerts the caregiver as to are you sure you want to deprogram that? Or, this is infusion is done; your next, ready for the next. So we've already seen some of that progress in the same way in a more started with cameras in the room. And I would say that we have optimized the monitoring of children across states. We can go into the room and see the patient, but then this next phase of virtual nursing has taken that to a whole new level. So with the new technology and with support from our technology partners, this camera now, not just can see in the room, but it can be interactive and that the virtual nurse can come up on the screen. We've actually been able to pull up an interpreter as well. So if English is not your first language, right there, we're starting to do the interpretation where that virtual nurse is also doing something. Not all the listeners may understand that sometimes the team's work is administrative and entering a lot of information into the computer, into our electronic record. And so while the electronic health record has been an advance, it's also one of those things that has a double edged sword because there's a lot of interacting with computers. And now what we're finding is these nurses are able to do a lot of that administrative work virtually. Our families understand the virtual model because of what we've just gone through with Covid and Zoom. And what we're able to do then is create much more space for the caregivers that are right at the bedside to do the hand on, the interaction, the human connection. And so what we have found that is done is really twofold. One, you talked about our workforce. Nurses, about 80% of our nurses are still express a great degree of satisfaction. However, when nurses are not feeling satisfied, we do know that one of the largest impacts is that burden, that work burden, that burnout. So many things to do, so many things to handle. But we are finding that this kind of model, the virtual nurse, has lifted up some of that burden. And so the satisfaction at the bedside is great. The satisfaction for the virtual nurse can be great, because it may be that they're at a point in their career where they couldn't imagine running the halls anymore and doing that, and that being able to use all their expertise in that kind of fashion is a beautiful thing. So that's been really positive. We're about eight months into our pilot, and we early on, 75% of the nurses that experienced virtual nursing model were very positive about it. But then there's the thing around the parents and the families. We have some early data that's coming in that also says it's improving their ability to interact with the nurses, to communicate, to understand, and to get that information. And we're seeing some of that, those early outcomes from both English-speaking and Spanish-speaking families, which is just really very positive, because in health care, sometimes those language barriers can be daunting. And then when we think about, let's go back to quality and safety, which you know is near and dear to my heart. We are finding that by having this overlay of this virtual nurse, that we are having opportunities to prevent harm, whether it's clarifying education and making sure that the caregiver really understands, whether it's a clarification of an order that may have not been fully understood, it may even be that they're being able to understand whether there's a therapy available fo the child at home. So we're seeing this and not just helpful to our teams, but incredibly impactful to the care that we're delivering. So that is an exciting new model of care. However, to your point, I think it's just the tip of the iceberg. I think that what it's telling us is we have to get out of our traditional models and thought process. And so what about this on-demand voice? What would it be like to have a nurse dialoguing in the room with a family and that program, being able to discern that and put that into the record as part of our record, what would it be like? And we could, I'm sure we can do this now, is to say, just like Alexa or Google, say, Hey, I'm worried about my child and have a rapid response team come ..., right? So there's so many possibilities of this. And I think that we won't get to that by working in traditional silos, the way that we are going to get to it is like what we're doing now is where we work with clinicians, analytics, engineers, technology, and that we really break down those silos, and that is what we're doing now. That's what's helping us to advance, to think of, so what are the possibilities? And then what is the application in this particular environment?

Molly McCarthy:
You have so many great points. I just want to summarize a few that I heard from you and congrats on. I know you mentioned you're eight months into your pilot, and I love always to hear the anecdotal feedback and outcomes. Maybe it's not published yet, but I think it's really important and very important learnings just in terms of burnout. You mentioned alleviating burnout and increasing the satisfaction of the nurse as well as the virtual nurse, which is fantastic. I have heard that so many times. And one thing I do want to mention too about that partnership between that maybe you have a seasoned nurse who's remotely and working with, for example, a newer nurse. I know when I was a new pediatric moving from NICU into pediatrics, I remember the nurse manager saying, It's going to take you one year to see every diagnosis across the pediatric spectrum, from newborn to, all the way up to the adolescent. And I just remember thinking, actually, today I think about what if I had a resource, a seasoned nurse at that time just to help me through those newer situations. So I think that's amazing. And it does increase that seasoned nurse. Her knowledge is being put to use, and that newer nurse has more confidence.

Jane Mericle:
I have to tell you that you are right on point there, and we are using that resource. The other thing is, it sometimes is very hard for nurses to ask for help, or you look down the hall and there's nobody there, and you think, I'll just, you know, and this is just so easy because it's set up as this is a person you call, this is the backup. These cameras, this technology is getting so good they can even do a double check on a dressing change. We haven't tested that yet, but those are the kind of applications it doesn't take two bodies in the room, right? We can do it with a virtual ... And so you're right: mentor support. And the other thing I would say is we are moving away from calling it virtual nurse and calling it virtual care because our other disciplines like our pharmacists, our respiratory therapists, our social workers are seeing applications for this as well as we deliver care to these kids.

Molly McCarthy:
And then we'll move to, we'll take out the virtual because that will just be expected, that care is both in person and it will hop some of it remote. And we're obviously not there yet. But I think eventually the whole concept of virtual health it's health includes virtual on-site, etc.. One other point that I just want to call out to the listeners is that you mentioned the quality and safety. Obviously, you're very well known for all of your work in that and the opportunities to prevent harm. And just going back to even thinking about physically how, for example, ... units are built today more as single room rather than you had when I worked, I've actually worked in both single rooms, and then you have more of a cohort with nurses and the babies more together. And I think from a patient safety, you mentioned just having the ability to call out for help. I think about a baby that I remember was coding multiple times. He had a congenital heart defect, and just the fear of actually even leaving him in that room alone. So having that virtual nurse and really for that patient safety and peace of mind for the nurse. So really great callouts. And then also just your comment about it's really a partnership. It's, people, we need to come out of our traditional silos and work together across IT, clinical, biomedical engineering to make this transformation happen. So thank you for that. I know, I could probably sit here and talk to you forever, but we do need to wrap up. And one thing that I always love to hear from my guests; our listeners are CNOs, CNIOs, nurses, hopefully some other clinicians just learning about what's going on in the nursing world. But obviously you've got a ton of experience in healthcare, and I would love for you as you think about all of your experience and where you are today, just leaving one little parting gift of wisdom with our listeners. So what would be your single most important practical piece of advice as it relates to their responsibility of being tireless advocates for their patients?

Jane Mericle:
I would just say that probably one of the most important things that I test myself on as well is being open. I think that so much has changed, yet there is so much possibility. How do we create for ourselves the ability to see what's next, what's down the road, and not to stop because these children deserve it? And so I am a big believer in building relationships, building these partnerships, collaboration, asking the questions. And I think that's going to be what we need to do. And I need to do that individually. You look at, my experience has been very hospital-centric, it's been very operationally-centric. But by adding in these relationships and these partners, I can just start in my head thinking about, could we do this? Can we do that? So I think as leaders. And secondly, is really to say the kids come first in children's health care. So our children, our family are central to everything that we do, and our teams. Taking care of our people, making sure that we are delivering systems and adjunct technologies that support them, that help simplify, that help make their work easier because a happy caregiver is going to help deliver the best outcomes that our children deserve.

Molly McCarthy:
Yeah, I love that. I just interviewed someone from Leapfrog the other day, and she said that the best organizations, in terms of quality and safety, are the ones that have the most respect for their nurses and the nursing protocols. So spot on. Thank you so much, Doctor Mericle. Really appreciate all your insights today and wish you the best as you continue on your journey.

Jane Mericle:
Thank you, Molly. Really appreciate the time.

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