Episode 7 : Ctrl+Shift+Nurse:

SCT_Spotlight_Patricia Mook: Audio automatically transcribed by Sonix

SCT_Spotlight_Patricia Mook: 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. Today, we have the pleasure of being joined by Patricia Mook on the Smart Care Team Spotlight. Welcome, Patricia.

Patricia Mook:
Hi, how are you?

Molly McCarthy:
Great.

Patricia Mook:
Glad to be here.

Molly McCarthy:
Well, thank you. I want to just to give our listeners a little bit more information about your amazing nursing leadership experience. Patricia has a really unique combination of clinical, technical, and operational expertise. Her roles have spanned clinical practice as a critical care nurse, CNO, CNIO, and now serves as the SVP of Enterprise Nursing Operations, Education, and Professional Development for the third largest not-for-profit health system in the country. Advocate Health has a combined footprint of 67 hospitals across six states, supported by 150,000 employees, including over 42,000 nurses. Did I get that right?

Patricia Mook:
You did. That's a big number, isn't it?

Molly McCarthy:
It is a big number. So welcome, Patricia, and thank you so much for taking time out of your busy travel and work schedule to meet with us today.

Patricia Mook:
Yeah, I'm really excited to be here with you, Molly. So much going on in nursing today and across the country and certainly at Advocate Health.

Molly McCarthy:
I wanted to talk a little bit about your health tech background. You've been instrumental in EMR implementations and other technology implementations in many of your roles. Historically, as I mentioned in the beginning, health tech can sometimes be a burden to bedside caregivers, adding workload and workflow rather than taking it away. To address that reality, nurses are increasingly being given a seat at the informatics table or at the table in general, which I love. You were named CNIO at Inova back in 2013. Actually, when I first met you, I believe you were in that role, and really among the pioneers in creating that new role. So as you reflect, gosh, it's been ten years, and you've done a lot since that time, can you tell our listeners today a little bit more about the role and the significance of the CNIO position to help create a better care environment?

Patricia Mook:
Yeah, my development or transition into that CNIO role came after starting, and well on its way, the transition of multi-platform EMR to one single platform. Through that, my chief nurse executive, Dr. Maureen Swick, at the time, was very interested and really knew the importance of having clinicians be in the driver's seat, really driving how that kind of huge project went, and just really having someone, if not multiple people, had a CMIO, a chief financial officer, and myself together in a triad along with our technology to roll out that one EMR platform. We know that the outcome of that now, years later, was very successful. We did it on time, on budget, in fact, ahead of time, we were positioning ourselves to really listen to our practitioner, listen to our providers, listen to our nurses, listen to our end users who were in our business offices about their workflows and how important that was to really understand that in order to create something that was more useful than what they were using at the time. I think we were able to do that, and we were able to do that by making sure that we had really invested operational leaders. At the time, my background was not was not in technology, I was a critical care nurse. As a bedside nurse, I was very interested, and very techie, and clicking, and just really interested in making things flow efficiently for nurses, and often got included in implementations for a variety of different technologies at the bedside. That grew to being a liaison to IT, from the chief nurse executive table to being the Chief Nursing Information Officer and then VP of Ops for technology during, and as we went on with further implementation in that healthcare system. Then, I had the privilege to come and work here for what was the Atrium Health, now part of Advocate Health, work very closely with the CNIO who was reporting to me here in the work that we were doing for Atrium Health at the time. What I think was really fortunate is that I did have some understanding of the technology and what was under the hood. I think that it's really important for you to have that kind of individual who is like an interpreter between the bedside nurse, and the, but also that interpreter at the executive table to really bring that which is very valuable, important, bring the return on investment based on your knowledge and your experiences with your pilot in a way that if you've been an executive as an operations person and you're now an executive on the IT side as a CNIO or a VP of Ops, that you can bring it bring your clinical background to the table and really help people to understand and bring something forward in a very organized and understandable fashion.

Molly McCarthy:
I think that's critical. You said it so beautifully as an interpreter, really, to make sure that the people at the bedside and the end users practitioners, which you obviously were one in the ICU and working in an ICU, there's a ton of technology at the bedside, so that makes perfect sense, the ROI. And the other piece that I just wanted to reiterate, ensuring that the tech allows for more efficiency. Why do it if it's not going to elevate the game?

Patricia Mook:
Yeah, but you know what? The communication goes both ways, as I have learned. How do we get to yes for both sides? How do we have to understand our IT technology, support people, the infrastructure that goes along with? It's important to have an understanding of both worlds and also bring what's needed at the bedside to your technology partners, and they are your partners, and really brainstorm with them, because sometimes what end users think will be the answer to their question, or think they will be the answer to their need, and they share that with you, there's a better way. Until you bring them all to the table and you really listen both on both sides, that you come up with the best answer, interpreting and moderating that conversation because you have knowledge of both needs so that we come together with the best answer for our practitioners at the bedside, but also one that works with the technology that you own.

Molly McCarthy:
I think that's critical, and you see this every day. But with today's health systems and with a lot of the workforce challenges that we're seeing, one area that I'm quite pleased to see a lot of interest in, if not purchasing or evaluating or piloting, or, just the concept of virtual nursing. I want to talk a little bit about that, but before we dig in there, I would love to hear from you how you define virtual nursing, and is it synonymous with how others define it?

Patricia Mook:
I think, basically, yes. Virtual nursing is an opportunity for a nurse through technology, through video, through voice, through telemedicine, telehealth instruments, to care for individuals. That could happen in the ambulatory environment, using iPads, understanding information that's coming to you electronically that's being uploaded to your equipment so that you can see what a patient is doing and how they're doing, or it could be at the bedside. Historically, the first on the inpatient side where telemedicine was used frequently, in that electronic EIs, where you had primarily a physician-driven model, where you had some nurses that are at the bedside that are monitoring patients from behind the camera. For us, virtual nursing on the inpatient acute side is a virtual, is a nurse behind a camera who is visualized by a patient at the bedside, working in team with a nurse, providing care at the bedside or with a team of multidisciplinary clinicians, really providing care at the bedside, and we do it in a couple different ways. We have a model, we're working in a 24/7 situation where we have a nurse behind the camera that monitors ten beds and watches a patient virtually, compassionately caring for a patient, alongside either an LPN or an RN at the bedside, partnering with physicians and lab techs and med techs with the care of the patient. We do that here at Advocate Health, Atrium Health in the Southeast, 24/7 on three units that Med-surg, med tele, med pulmonary unit. Then we also do that in the Midwest where we, it was started as a admissions discharge nurse, where a nurse is virtually doing admissions nursing assessments for patients that are coming up from the ED and being admitted to the units. Also, a little bit of discharging, with that, doing some discharge teaching. And here in the southeast, we also have a model where we're supporting our freestanding EDs and our acute care EDs with the admission patients that are holding an EDs, waiting for a transfer to a hospital for a bed.

Molly McCarthy:
Those are great use cases. I'm wondering, as you think about beyond the technology that you've utilized in each of those different use cases, how does introducing that either in a pilot or scaling really change your care model design and how you deliver care? And alongside of that, what role does change management play into that? Because I know it's one thing to pilot, but another thing to scale and actually change the workflow, change the behavior of the practitioners.

Patricia Mook:
Yeah, it's been a little bit of a ride with the beginning of this. Many of us started virtual nursing care in, during the pandemic, trying to meet the needs of our patients in a very different way. I will share with you that we at Atrium Health, at the time, were trying to solve a problem. The biggest problem was on a pulmonary unit that was really challenged with their staffing, with patients that were just a hair shy, and maybe under other circumstances, were in critical care. In this case, they were on a unit on a floor, real high acuity. We were struggling with, we think we were challenged to take exceptional care of these COVID patients during the pandemic. And because of my background, I knew that there was technology that was available for us in our organization. I had individuals like Nicole Dale, Stephanie McDonald, nursing leaders here who were individuals who are not afraid to do things differently. Number one, you have to have a little bit of a risk-taking, but the risk-taking is calculated, so you have to have knowledge. So what we did was we got a really good, innovative, out-of-the-box thinkers from IT, I got my chief nursing information officer myself, these two nursing leaders, and then we started to brainstorm. We figured out how we were going to do it with some equipment that we had, some technology equipment that we had that gave us one-way video for our patient at the time. We used an iPad on a stick, we brought it all together, and then we had to really engage the unit. We had to figure out how we were going to stack the individuals behind the camera. At the time, there were nurses who were experienced who couldn't be at the bedside. They opted for either health reasons. They couldn't be on floors where there were COVID patients. Atrium was very generous and how we utilized those individuals, but we could utilize them to their highest degree by putting them behind a camera and having them help nurses at the bedside. There were many challenges, but believe it or not, we put that model, that first model up in ten days. We're able to help a unit that was really struggling with these high-acuity patients by creating a team model with the nurse behind the camera and the nurses on the floor. It was a lot of trepidation, and we did it really quickly. I guess one of the things that I say we talk about, and that is seizing the moment, seizing the right time to bring things forward. I think that at another time, I had a thought about doing something like this, and was probably before the pandemic. It wasn't something that was they were ready to do. But here we were with a big problem, and this was going to solve, really solve the problem. So we seized the moment, and I said to the gals and gentlemen that we were working with, Let's get it done. Let's take advantage of, people are really needing some help, let's get this done. And in that time we did, I, it was very challenging, Molly, because lots of change management that didn't happen the way it was supposed to because we were in, but we learned from that. I believe as we move forward, we engaged staff nurses on the floor in a much bigger way, had them contribute as we were iterating the model and understanding their workflows, how we could best partner from behind the camera with the staff on the unit, and with the little bit more work, it became less bumpy and engaging those staff. Lesson learned really was that we needed to engage those staff members on the unit. What we learned was a lot of our nurses weren't used to working in a team environment. We learned that about a lot of things during the pandemic because we had to work in a team environment because so many other care models were popping up with ancillary staff that were supporting nurses because we didn't have enough. We learned that we had to teach our nurses how to delegate. We learned that we had to teach our nurses how to communicate in a different way than they had ever communicated before. We also worked in an iterative fashion to kind of trial and error. Failed quickly, you're right, failed quickly so that we could course correct and make it the best that it can be. What I would say is you have to have courage, and you have to have strength, and you have to have fortitude to do things differently.

Molly McCarthy:
I love that. You really honed in on that from the beginning, not afraid to do things differently. I think this is what I wrote down, calculated risk based on knowledge. I think that's so important in healthcare, especially in emergent situations like COVID, for example, or other situations. The other nugget that I really took away was just having that team-based approach in all of your stakeholders. I know we could go down a rabbit hole, but I'm not going to on this podcast around teams, but that's just incredibly important as healthcare moves forward, which is why we called this a smart care team because that's what we're really looking to do. My next question is, and you've talked about this a little bit, but in your nursing journey and your virtual nursing journey, what are some of the top lessons learned about what to do and what not to do? And any examples or war stories that you can share with the listeners so that we're not reinventing the wheel?

Patricia Mook:
Yeah, gosh, lessons learned. I still say you have to seize the moment when the moment comes. You can't let it go by because people were right for doing something different. We needed to care for our patients in a different way. And let me tell you, I call it virtual compassionate care because, at the time, almost all of our patients, all they saw was people with masks on and having someone smile like you and I are smiling at each other, and this interaction here was really great for patients because they were able to see smiling faces of compassionate nursing nurses taking care of them in a different way. The other thing I would say is you really need to understand your workflows on the units where you start this. And I would also say that there's so much out there in my mind, I see so many opportunities for virtual nursing care, and it might be different. We started this conversation off with, What are you, what's your definition of virtual care? Well, I know what ambulatory looks like, and I know what critical care looks like, and I could see how acute care would look. We've created a model with that acute care, but being able to see how you can utilize virtual nursing in so many other ways, how it's really about knowing what your problem is and how you're going to solve it, and what are the different ways that you can solve it and what works for your units. Because as we've gone along with this journey, we toggled back and forth. What does the nurse behind the camera do, and what does the nurse at the bedside do, and where is that most efficient spot? Where is that sweet spot? It might be different on a different kind of unit, right? We started off on a high, high acuity, almost critical care patient unit, moved to a tele unit that was different and staffed differently. We adjusted what our nurse behind the camera was doing to support that unit. Right now, I think the biggest area of need across our country, not in the critical care spaces or even telemetry, it's our med-surg units that need the most. And so what does the virtual nurse behind the camera do on those med surge units? Might be a little bit different based on the type of care that they provide at bedside, and it might allow them to expand the number of patients that they, that are watching, or we might have to decrease based on what you're going to ask the nurse behind the camera to do. It's really about understanding the workflows and understanding your need. I've been really involved in the workforce work that is going on with the American Organization for Nursing Leaders on that workforce committee and on the care model redesign work that they're doing. We have a collaborative where there must be at least 30 hospitals, health systems, or hospitals across the country that have joined us in this sharing of virtual care. And all of them are doing it just a little bit differently. I mean, there's certain basic standard skills, and certainly, we need to look at what those standards are for virtual nurse, what those, what that scope and practice needs to be, and there are organizations that are the right organizations that are looking at that. So we need to look at what those standards need to be, but you, like you practice it a little differently in med surg, from neuro to ortho, to a renal unit, you have those little idiosyncrasies that are going to be adjusted for with virtual nursing. I think you just have to stay open and innovative, particularly as we're on this frontier, to figure out what that is and do it safely and have the right people at the table.

Molly McCarthy:
Right, so I've heard kind of a trifecta. One was, seize the moment, which I'll just say carpe diem, seize the day, and the other two really are knowing the workflows and knowing what the problem is, and that really goes to your point about, it might be a little bit different on med surg, versus neuro, versus pediatrics, perhaps you got family involved there. So that's helpful. I want to ask one more question really around the piloting, the scaling, and just the cost of programs like this as we're looking to change care models, etc. I'm just wondering, as a leader within multi-state health system, just wanted to get your perspective and experience on the, how you present this, the cost justification. What do you take to your CFO, your chief nurse exec, and how do you justify the ROI on a program like this?

Patricia Mook:
Yes, that is, we're all in partnership with our chief financial officers. I've always liked to have them as my best friend at the table, to be honest with you. But justifying cost takes recording information and getting good data. And actually, I shared with you that collaborative that we've got going on. Believe it or not, there is a lot of hospitals that are doing this work and coming up with really good data that is showing that virtual nursing can improve patient satisfaction, can decrease length of stay, can improve efficiencies in such a way that you're using your nurses in a very efficient manner, in a productive manner, and while it's doing that, allowing you to recruit with a very innovative environment for new nurses coming into the field, retain nurses who are at the bedside, who might be a little bit more mature like myself, who could not necessarily sustain the physicality of the nursing at the bedside and would like to utilize their expertise in a different way. The technology is really easy to learn and adapt and do things in a little bit of a different way. For me, I've pretty much sold my organization and my partners on how effective and how valuable this virtual nursing care is in the world of technology that we have today. How many more things are, can come from that with artificial intelligence being woven into the technologies that we're already using, and we're all challenged with nurse shortages of nurses across the country. This is a way to help nurses lessen the burden at the bedside. We have seen that turnover has gone down on units that have this kind of technology, that it's a great recruitment tool, and that we've retained nurses who otherwise would have left the profession. We have a couple of stories where we've actually recruited them back when they've left the profession. We've been able to utilize their mental skills and their clinical expertise in a very fine way. You have job data, we at Advocate Health are conducting two research studies on three different units, looking at how our admissions nurses are really affecting getting care started sooner and potentially lowering length of stay of patients.

Molly McCarthy:
That's wonderful. I think the patient satisfaction, the length of stay decrease, the improvement of efficiency, as you mentioned, and then the recruitment and retention is huge nowadays. I think it's how do we allow for that joy of nursing to really permeate back into these caregivers lives.

Patricia Mook:
You talk about joy. I was on a unit just last Thursday, a couple of days ago, rounding with the virtual care and talking to a nurse, that particular nurse. I said, So how does it feel? That nurse actually works two days on the floor and behind the camera one day of their three shifts, 12-hour shifts, And they said when they're working on the floor, they can leave their patient, they're sick, they're really sick, and they can leave the patient and go on to take care of their next patient and know that there's somebody who's got their eye on their patient, even if they get delayed or don't get back really quickly, that there's somebody who's got an eye on their patient and it just makes their day seem so much better. It's that anxiety, because we're all, we all want to take great care of our patient, but we're super busy. We've got 5 to 6, sometimes, really sick patients, ... nurses do. And so that, it's like a relief. He said, I come to work with a different mindset today, and I was just, it just warmed my heart because I could hear the joy. And then he said, It's really nice. It's not like it's any easier, it's just a different kind of work behind the camera.

Molly McCarthy:
I think that goes back to your earlier point teaching how to delegate, how, the nurses to delegate, and how to work in a team. I think that's going to be critical as we move forward. One last question for you. Obviously, it's been a wonderful conversation. I wish we could continue, but thinking about our listeners, CNOs, CNIOs, your colleagues, people in technology, and their teams would love to hear your thoughts on, just based upon your work with AONL and as a national thought leader. If you could give one single most important practical advice to our listeners today, what would that be?

Patricia Mook:
Oh, wow. I would say really be open to new things. Know that there are so many combinations of artificial intelligence and technologies that can help us provide better care at the bedside. Be innovative in your thinking. Listen to the staff around you, and just stay open to what is the potential of utilizing technology to really lessen the burden of our care providers at the bedside. I know we talk about our EMR and how do we lessen the clinical documentation burden. We can do that, but we have to listen to our bedside nurses. I think that the technologies that we've got coming now that will help us through virtual care, really amazing, and can make so much of a difference. So just stay open and be listening for the needs of your bedside nurses. Then harness the knowledge that your chief nursing informatics officer has that they can bring to the table that the clinical informaticists can bring to the table and really utilize their skills to say, here's the problem, and let them tell you what's possible in the realm of what's coming.

Molly McCarthy:
Well, thank you, Patricia. Speaking of listening, our listeners today, just if you could really hone in on some of those key nuggets, being open to new things, as Patricia mentioned, to decrease that burden for our caregivers today, so important. Thank you so much, Patricia. I really appreciate all of your insights today, and we look forward to seeing you soon. So thanks so much.

Patricia Mook:
Thanks, 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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