Episode 26 : Streamlining the Burden:

Becky Fox

Chief Clinical Information Officer at Intermountain Health

"Now more than ever, nurses in particular have the opportunity to really lean in, be a part of entrepreneurialship, innovation, driving how technology is going to revolutionize and modernize the nursing care process." - Becky Fox

SCTS_Becky Fox.mp3: Audio automatically transcribed by Sonix

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

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

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

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

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

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

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

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

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

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

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

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

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

Becky Fox:
Yep. Just over a year.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Becky Fox:
Always good to see you, Molly.

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

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