Smart from the Start

SCTS_Eric Wallis: Audio automatically transcribed by Sonix

SCTS_Eric Wallis: 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. We're so fortunate today to have Eric Wallis, Senior Vice President and System Chief Nursing Officer for Henry Ford Health System, as our guest on the Smart Care Team's Spotlight. Eric has a passion for building culture and improving healthcare delivery to benefit both patients and clinicians. He's a transformational leader who engages all team members through innovative practices in collaboration. Henry Ford Health System and their 33,000 team members serve a growing number of customers across 250 locations throughout Michigan, including five acute care hospitals, two destination facilities for complex cancer care and orthopedics and sports medicine care, three behavioral health facilities, primary care, and urgent care centers. Welcome, Eric, and thank you so much for joining us today, and I hope I got your introduction correct. Anything that you want to add?

Eric Wallis:
No, that sounds great, Molly. We've got an amazing team of folks, and I'm very privileged to have the opportunity to work with them each and every day.

Molly McCarthy:
Great. Just to get started here, I know that you've been a bedside nurse and worked your way up through different clinical specialties, hospital operations across both academic centers and community hospitals, and truly understand the challenging realities of the current caregiver workforce crisis, really better than most out there. So with that in mind, I just wanted to ask you how you're thinking about this particular crisis at this time. Post COVID and any strategies that you've prioritized across your health system to really address not only the issues but the opportunities created by workforce challenges, workforce shortages, rather, and challenges for caregivers as well as the patients and hospitals.

Eric Wallis:
Molly, I think it's an interesting time in healthcare and certainly within nursing as well. I think when we think about Henry Ford's response to the crisis that we've been in, we put it in a few different buckets. And so the first bucket is we know that today there's not enough people in the workforce. And so looking at our partnerships with our academic partners and really thinking about how do we fix the pipeline, we know that even today there are more people applying for nursing school than are actually our spots in the nursing programs across this countries. So we've got to be part of the solution and figuring out how do we get more folks that want to work in that space so that the schools can actually open up enrollment. And we've had some great partnerships. We're in a partnership with Michigan State University. We're actually just started this summer. We're now some of our bedside team members. Bedside nurses are not acting as clinical faculty and a partnership that we have so that we're leasing or giving some of their time to Michigan State so that they can increase the size of their nursing school enrollment. We've got to look at those kinds of, I think, unique opportunities, unique practices to truly increase the size of the nursing workforce. So that's one of the things that we have to do. The second thing that I think is really key for not only us, but any health system in the current environment is we have to keep the talent that we have. We have to be in a space where we're actively listening to our front-line nurses, actively listening to what their concerns are, the challenges that they're facing, and really putting in not only solutions to solve some of those issues but engaging them in the work as we go forward. I'm really proud that our health system, all of our acute care hospitals are either magnet hospitals or on the magnet journey, and I think that's a key piece of our success. We've actually cut our nurse turnover from 2022 to 2023 this year, almost in half through working with our folks. And there's a lot of different solutions that I've come up and some of them are unique to Henry Ford Health. Some of those are things that would work anywhere. I think the key piece of that is the listening and really trying to address those concerns that our folks have, and making sure that we're creating an environment where our nurses feel like they're being heard and that they've got a great relationship with that frontline manager. Some of those are not new kind of things, but it's kind of going back to the basics and kind of reestablishing great practices that we know work now that we're post-pandemic. And I think that really leads into the third thing that I would say, which is part of what we hear as we listen to our frontline nurses is that we've got to make technology work for them. For a very long time in my career. What we have seen is new technology comes in the market, the EHRs improve, and really what they have done for a very long time is actually add to the workload of our bedside nurses. That's part of the challenge and what their real experiences have been. What I'm excited about is I think we're at a tipping point. We're at a point where technology can now actually start to take workload away. And if we design the right practices and we work with the right partners, then we actually have the opportunity to make it easier for our bedside nurses to do what they love to do, which is actually take care, put their hands on patients. I think that is really been a big focus of ours, is looking at how do we use this incredible investment that we've made in technology to actually make work better for our frontline teams.

Molly McCarthy:
Thank you. Yeah. First of all, congratulations on cutting your nurse turnover in half from 2022 to 2023. I actually haven't heard a lot of that. So that's wonderful. Second of all, I just really wanted to hone in on that third point around technology. I mentioned at the beginning of our conversation today that technology can really increase the burden that our clinicians, nurses look face every day, whether it be the EMR or just an onslaught of multiple-point solutions that can further fragment our system. And I want to hone in on the tech piece a little bit more, thinking about how there's been a lot of hype more recently around generative AI and predictive AI-based applications. What are your thoughts around AI helping to overcome technology burden and what benefits do you see or do you anticipate this type of technology, as you mentioned, taking away workload from nurses.

Eric Wallis:
It's an interesting time because I'm probably like most nurse leaders across the country, there's really not a day that goes by that I don't get a email, a call, some kind of sales pitch from some company that now is touting their AI. And I think when you start to weed into it, you find a lot of the same things that we found with technology over the course of my career. Some of it is vaporware. It's something that people have imagined, but they haven't actually made it work yet. Or when you actually start to dig in what they're doing, it's really not artificial intelligence, it's the same systems that we've had for years and years. So I think that it's an exciting time, but it's a moment where we have to be really thoughtful about the partners that we're choosing, the technology that we're putting in place, and does it really help us to solve our problems. Because I think, as you mentioned, Molly, adding another piece of technology that layers on top of all the other things that we're asking our nurses to use, may just make things more complex and may not actually solve the problem. In addition, I think we have to be thoughtful that when we buy some of this technology health systems, we are famous for buying it and never really turning on its full power. So we have something that doesn't quite meet our needs, frustrates everybody, and we wonder why did we purchase this and integrate it in the first place? That being said, what's exciting when you start to look at some of the artificial intelligence technologies that are coming to the market, they are starting to do things like actually learn, right? To machine learning, where they're looking at the same patterns of things over and over again, and understanding that when A happens, B is about to happen and we can do something about that. So those are the kinds of things that are exciting to me, things that technologies and artificial intelligence that integrates with the workflow of the nurse. So it's not one more thing that the nurse has to go out and do but isn't and wouldn't it be amazing that when the artificial intelligence and the sensor that's potentially sitting in a smart room notices that a patient is doing something that's going to probably lead to them getting out of bed and maybe falling, that not only can it alert, but can it alert the right people who are the closest to the room, who can take action in a required amount of time to actually stop the event from happening, as opposed to just a blast to everybody who's on the floor who may not be the right folks to be notified. It's that kind of thoughtful intelligence that gets to the right intervention at the right place, at the right time. That I think is the game changer that's coming in front of us. I think our health system, every health system in the country right now is trying to figure out what the heck is virtual nursing, and it's one thing to go through and put a camera in every single patient room. That's great, but what are you going to do with it? What are the interventions that it can do? And are you just adding additional cost because few of us are in a position to just take on additional cost in our health systems? How do we use that technology to actually support the workflow of our nurses? Take away the things that aren't value-added, and then really get a user-friendly not only for the nurse, but for the patient and the family member who are there in the room, who have to interact with this technology and feel like it's adding value to their overall care as well. It's a lot of different elements, but I think we're at a place where there's a lot of different things being tried and a lot of different opportunities, and I think the key skill for us as nurse executives right now is to try to kind of wade through all of it and again partner with our frontline teams to understand what the problems are really trying to solve are, and then how do we pick the technologies that are going to help us solve those specific problems, or maybe even things we haven't thought of yet?

Molly McCarthy:
Now, I love that. I think that sifting through the noise, so to speak, of what's coming at you every day, is really important, and to really trust and have the relationship with the partners out there, that working together to really solve the issues. And you really dug into a little bit of where I was going next, which really is around thinking about virtual nursing. What does that mean even with you in your health system? I talked to some people, they think it's having a robot come in or what's having a camera. And so it's a term that might be thrown around AI and that it's nebulous and means something different to different people. So I would love to hear a little bit more about what you're specifically doing at Henry Ford around that. And what use cases are you prioritizing for your nurses? I think that's really important. And the other piece I think that I heard is really looking at that technology that's integrating into the workflow, that's not creating new workflows.

Eric Wallis:
Yeah, I would say our position in Henry Ford's position when we think about virtual nursing has been we don't quite want to be on the bleeding edge of the technology, and I'm grateful. I've had lots of great conversations with CNAs from around the country, and some of the things that they're thinking about and how they're starting to run some of their pilots, and even now starting to bring some things to scale for us. What we're moving toward is we're kind of just in that pilot phase. Where what we are looking at is how do we partner with a technology company, put the right camera sensor in the patient room, and allow a virtual nurse who is part of the team on the floor, not sitting on the floor, because we've learned that if they're too close by, then it's too easy to go down the hall and say, hey, we're a little short today. Can you step out and help us do this work? So building that model in a way that we're thinking about hubs in each one of our hospitals that have a kind of a virtual command center that will allow those nurses to be just a little bit separate, but still know the culture, know the people, know the goings on within their site, and allow that nurse at the bedside to think about what is top of license work for the nurse at the bedside. We want them to be doing the things that require them to put their hands and touch patients, and skills that a registered nurse is uniquely qualified to do. We want the virtual nurse to be able to take away those things that maybe aren't top of license work, but maybe their data entry. They are things that suck up the time of our bedside nurses. So we know that two of the busiest times for any patient is when they're being discharged. So how do we pull that work away of going through those questionnaires and just manually entering data into the virtual nurse can do that and allow the nurse at the bedside to think, concentrate more on things like the plan of care. And how do we prepare you for procedures and tests and get you ready to go home and really be thinking about some of those more in-depth questions. We know things like nursing education on new medications, new procedures. Again, that's something that a virtual nurse can drop in and do really well in collaboration in a team model, the nurse at the bedside. So those are some of the things that we're thinking about. We know the great thing about partnering with a company that has not only the camera, but things like artificial intelligence, is that those artificial intelligence pieces can help us to pay for the model for virtual nursing. If you have artificial intelligence that can reduce falls, that can maybe eliminate the need for patient sitters, for patients who are confused, that can tell you if a patient hasn't been turning in bed enough and that their risk for a pressure ulcer. So at some of those things that add to the cost of care, if we can use artificial intelligence to tell us when that patients at risk or when there's a potential for something that we don't want to happen, then those things, those savings can actually help pay for some of the care model. On the other side, for things like virtual nursing, I think it's a mixture of the really high tech and the really, I won't call it low tech, but really thoughtful thinking about what is the work of a registered nurse and what do you really need to have at the bedside, and what can you do, maybe virtually from a distance.

Molly McCarthy:
One thing that I heard you talk about even, before we started talking about virtual nurses around the AI component, which I think is so key, is we don't need to alert every nurse on the floor, we don't need to distract them, etcetera. We need to with that intelligence, we're directing it, as you mentioned, to the right person, at the right time, about the right patient, and what needs to happen. We all know that a patient fall is an event, so I think that's critical. It really goes beyond the camera.

Eric Wallis:
An alert fatigue is there's been lots of research, right it's one of the most challenging things that we've dealt with in healthcare over the last number of years, whether it's telemetry systems or cell phones that all of our nurses are now carrying and texts and messages that they get notifications from EHR. So how do we again, how do you glean down and get rid of some of the noise so that they really have actionable things that are coming to them. and again, I think that's one of the places where artificial intelligence can really help, is help to filter all that noise and say, what are the things that are really meaningful and are going to actually have an impact on the way we care for this patient?

Molly McCarthy:
I think some of the use cases you mentioned ADT admit discharge transfer, some of the education, etcetera. Are there any other use cases that you've seen above and beyond some of those? For example, I've heard about just even patient safety use cases that really impact patient safety. I'm wondering if you seen that anecdotally. Sorry.

Eric Wallis:
No, absolutely. I think one of the ones that I'm most excited about is I'd maybe say not so much patient safety, but safety of our team. We're all in a place right now where we say society today has lost the ability to be empathetic. And we see that even within our own team when people come into the hospital, the level of anxiety and the level of frustration and just violence that have been going on in healthcare has been a little bit out of control. When you think about the ability of something like artificial intelligence, who's ambiently just watching the room to say, hey, this patient is known, right? To have some tendency to be a little bit aggressive or violent. And if we have a staff member in the room and they've got their back turned doing something at a computer or doing getting meds ready, and the patient starts to approach them, it can alert them to say, hey, you might have a problem. We want you to be safe. Things like code, words to keep people safe. And an example that's been used is if you have a key phrase that says something like, there's cake in the break room, that could be a key phrase that the ambient listening could hear and know that there's a problem. And I need to notify security to cover this room right away. So I think that's one of the things that's probably been most exciting to me and to some of our staff, is that having that extra layer of security to keep them safe is one of the things that they are most passionate about in the environment that we've been working in for the last couple of years.

Molly McCarthy:
And I know that's part of the quintuple aim as well, ensuring that the caregiver experience is positive. And unfortunately, we're at a point where that's critical for our staff. Thank you. That really gives me a great picture and our listeners, a great picture of what you're doing. I'm curious, you mentioned you're in the pilot phase. And just in general, I've seen a lot of technology in pilot space. And you mentioned even at the beginning, if you're going to adopt a technology, you want to use it, you want to see the impact. So how do you envision scaling this across all five systems or even beyond?

Eric Wallis:
I think that's why we've probably spent a little bit more time getting to this pilot phase than maybe some others. Is that one of the things that we are really passionate about is making sure that any technology that we're bringing in integrates really well with our electronic health record. We're an epic shop, and so we want to make sure that this isn't just, again, an add-on system that is going to make life more complex. And so we took more time trying to make sure that we are choosing a solution that can integrate, and that actually is going to make life simple and makes it easier for us to go to scale. We're right now in the midst of presenting a business case across the enterprise. I think one of the things that we have learned is that healthcare of the future is going to involve smart patient rooms and that all the things that we want to do aren't going to be possible without having that camera and sensor in each one of our patient rooms. So we're probably like a lot of healthcare systems. We've got a mixed bag. We have some sites, some rooms, some buildings that have a lot of technology, and others where we're a little bit behind. So again, trying to find a partner that has not just here's the way that we deploy it and this is the only way it can be. But having someone that can bring us different tools for the different situations that we're in has been a big piece of this as well. And then, like I said, really deciding on what you think your model is going to be and understanding, especially when you start talking about things like virtual nursing, it would be easy to say. That world. We're gonna put a bunch of nurses in a command center somewhere in southeast Michigan, and they're going to provide all this care across the enterprise. The reality is, they don't have that relationship. When you start talking about team models of nursing, you really do want to know and trust the person that's on the other end of the camera or standing there in the room. And so we thought it was important to try to find that kind of happy medium between this is somebody who's just out of an assignment today but they're sitting on the unit trying to do this virtual thing and having that full command center. So we're thinking about hubs at each of our sites. And I think that we've really tried to design the pilot thinking about the end in mind. And is the pilot going to really tell us whether this end design that we're going to use is actually going to work or not? And I'm sure we're going to learn things as we go along and make some tweaks and changes. But we thought this was a great place for us to start. The interesting thing is, I'd say there's a lot of different things in this space of AI and virtual nursing that are going on. So I mentioned that as one pilot. We've actually just recently stood up. A first virtual ICU is crazy as this sounds. I was a virtual. I worked at an ICU in late 90s that had a virtual ICU, but there really aren't any in the state of Michigan. We were trying to fill in that hole and we've got one of our hospitals live, the second one coming up here in about a month to start virtual ICU, and again with our partner EPIC. So we're not using a third party to do this, which I think is kind of unique. But we're excited to bring that additional artificial intelligence and early warning systems, machine learning that is embedded within Epic into our ICU space. So we've got a couple of different things going on at this time, and we're also spreading virtual sitting for all of our patients. And again, doing that internally rather than doing it through a third party. It's kind of a busy time right now for us and trying to move into this space of virtual care.

Molly McCarthy:
That's exciting. And I think you talked early on in our conversation today about three different ways that you're really addressing and looking at some of the workforce challenges. The first one was the pipeline of more nurses, and the second one was keeping talent that we have. And I'm curious to see if you've seen, just in thinking about your more seasoned nurses or some of your nurses who might want to try different, you know, skills within their career and how they've accepted or really learned from the virtual nursing model. Just wondering if that in terms of retaining or even attracting.

Eric Wallis:
Yeah, it was interesting when we started our virtual ICU. Obviously, our hope was that we wanted the best and brightest of our ICU nurses to maybe come in and step into those virtual roles. I'm excited to say don't have a nurse in our virtual ICU that's got less than eight years of ICU experience, which is, you know, exceeded our expectations. We were hoping everybody would have at least two, but it took us a little while. People were not sure with this virtual nursing thing actually is. And so it was kind of funny when we posted the positions, we sat back and we thought we'd have people rushing in, and what we found was no one was applying and we had to go back and actually helped people understand what virtual nursing looked like and what it felt like. Today, I've got a waiting list, and we've been doing this for six months because people have now seen it, they've touched it, they understand what the benefit of it is and people want to be part of it. And so I think there is a little bit of that change management cycle. You know, nurses are just like everybody else. Sometimes we're a little cautious until we actually see it working, see what it's going to look like. So I think trying to find ways to again get the team engaged in not just that, 'Hey, we're going to do this and we want your input'. But really help the design; it help to understand what it looks like and what the different roles are. We spent a ton of time both in our pilot for virtual nursing and our virtual ICU, designing workflows, getting their input, and having teams kind of do that front-end change management so that we can be successful. And we were thrilled. The feedback that we've gotten from our virtual ICU being stood up has been universally positive. People feel supported. People feel like they've got a better environment to work in, and we're actually seeing it easier to recruit nurses to the ICUs that now have the virtual component because they know that they've got that resource there to support their practice. And so that's been one of the great, I would call it, side effects of starting to do this work.

Molly McCarthy:
That's wonderful. And I think you mentioned early on in terms of keeping your talent, just listening and including them in the design of the workflow is so key. Otherwise, we know that the tech will just sit there at the end of the day. So many great happenings within your system; it's exciting. So congratulations! I do want to, unfortunately, we do have to wrap it up and I would love for you just as you think about our listeners. CNOs, CNIOs, many of your peers and their teams. Just to think about all the lessons that you've learned throughout your amazing career. And if you could pinpoint one at this day and age where we are with healthcare. Just a piece of advice, a practical piece of advice for your colleagues; what would it be?

Eric Wallis:
I think that all of these things, no matter whether you're talking about virtual care or whether you're talking about becoming a magnet hospital or anything that you're trying to implement, it's really spending the time on the front end with the change management process. I've learned through my career, as much as I hate to sometimes slow down and get a documented change management plan in place before we go forward, it has served me so well across my career that really taking that time and understanding who all your stakeholders are, who needs to be on the team, what outcomes are you trying to achieve? And oh, by the way, how are you going to make sure that once it's implemented that it's actually working. Having all of those details and spending the time planning that on the front end will make the outcome so much better, as opposed to kind of the ready, shoot, aim version that we sometimes have to use in crisis. So I think really understanding change management science, having a plan for it, and taking the time to work through that plan before you get started is something that I think is well worth it, and makes these kind of endeavors go much more smoothly.

Molly McCarthy:
Yeah, I couldn't agree 10% with you just because it's so critical not just to design and then deploy but really work cohesively across the entire continuum and spectrum, and inclusion of the clinicians in that process is critical. Eric, thank you so much for your time today and your insights, and we look forward to sharing them with our listeners, and we hope to see you soon again on the Smart Care Team podcast. Thank you.

Eric Wallis:
Thank you. It's been great.

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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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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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 Hiyam Nadel on the Smart Care Team Spotlight. Hiyam has a very unique background in platform as a change agent at the intersection of nursing, innovation, and entrepreneurship. In addition to her day job as founder and director of the Center for Care Innovations in Care Delivery at Mass General Hospital, Hiyam is also a Johnson and Johnson Innovation Fellow and president of SONSIEL, which stands for the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders, and that is where I met Hiyam a few years ago. As I think about the brightest voices advocating for nursing and innovation, Hiyam is among the very top of that list. So welcome, Hiyam. And thank you so much for joining the Smart Care Team Spotlight.

Hiyam Nadel:
Thank you, Molly, and I always love to see you and speak to you as well.

Molly McCarthy:
Well, great. It's great to have you here. I'm going to go ahead and dive right into a few questions for you today. So you've been a tireless pioneer and advocate to advance nurses, really to have a seat at the table for healthcare innovation, but also to create and to build new tables. I know you've been instrumental in the NurseHack4Health, which actually took place again this past weekend. And so as you think about technology and care models that we've historically put in place to really get healthcare where it is today, what have we missed by not having nurses more actively involved in the design and development and decision making, and how can we improve upon that in today's hospital environment?

Hiyam Nadel:
Well, thank you for that question. So, in the beginning, you made a statement that technology sometimes doesn't really help us, but actually creates a burden, and I am a frontline worker, and I really feel that almost daily. So if I may back up, we know that the best inventions or innovation is from people who either experience a problem or are closest to the problem. So what we're missing really is bringing the frontlines, especially nurses who care for patients 24 hours a day, who have intimate knowledge about all the problems, barriers, challenges, gaps to healthcare are not included when any of the technology is developed or even tested, maybe not even in development, which I would love to see everybody there, but if not, when things are developed. Are we going back and asking the people actually using it to give them feedback? And that's where I think we fail quite a bit. And in fact, I was at the HLTH conference last year, and incredible technology on the floor. Great ideas, but each technology I went to, I told them about five things why it wouldn't work. And the problem was I said, did you ever think to run this by a nurse or a clinician or actually who's using it? And they said, no. And I said, well, here are the five things just right off the bat that I can tell you why it's not going to work, so let's get together and collaborate with these two functions. And I think things would work better, they would cost less before commercialization to get it right, and then both sides, I think, would benefit.

Molly McCarthy:
Yeah, I know you've done that in the NurseHack4Health. And since you just came off of that this weekend, I'd love to hear about how you've been instrumental in bringing the technologists and the nurses together at the table so that when we design technology, it does have the frontline voice, as you mentioned, which is so critical.

Hiyam Nadel:
Exactly. And it was an incredibly successful event this past weekend. But the whole goal is to really upskill nurses. So what I mean is they know what the patient needs. They know when equipment doesn't work, technology doesn't work, but they don't know where to go with that knowledge. And the hackathon is one platform for us to try to upskill them and first say, you are an innovator, and we want your ideas, but let us give you some help. And that's where the developers come in, the designers, the engineers, and stuff. And so, although it's very focused on nursing, we know how important it is to have a multidisciplinary team at the table developing these. And over the years, I think it was our sixth hackathon. You can see the buildup. So at first, people are just coming up with process improvement. And as you upskill these nurses, you see that their solutions become higher level and higher level, and that's the goal.

Molly McCarthy:
That's wonderful. I'm, I was really happy to be part of that this weekend and just see the progression so well done.

Hiyam Nadel:
Thank you.

Molly McCarthy:
To you and to your team. I'm going to move on to our second question. And you always talk so passionately about ensuring entrepreneurial nurses really deeply understand and define the problems they seek to solve, whether adopting current technology to address a new use case or creating a new product or company altogether. There are certainly no lack of problems that health systems must address, and this podcast really was conceived to bring thought leaders like yourself to address, really, a couple different challenges. One, I mentioned it, and you summarized it again, how the technology can be a burden to caregivers at the bedside. And then, really, we're losing so many talented nurses at the bedside because what we're asking them to do is really humanly impossible, the amount of information as well on the patient. So with that in mind, what unaddressed problems do you think are most important to nurses today to be solved? And maybe you heard some of them during the hackathon, or maybe you're seeing some of them at your innovation center or even within SONSIEL. So we'd love to share with the audience what you think are most important to nurses to solve.

Hiyam Nadel:
Yes. So I think for me in particular, one of the trends that I'm hearing is this knowledge gap that is starting to take place because as more experienced nurses leave and then the younger generation comes in who are less experienced, so how do we support them within that knowledge gap? And looking at things like virtual nursing, perhaps as someone that could be at home, who's who may be retired or more experienced to be their support for that younger nurse, because the most frightening thing is to be a new nurse and something bad happens because it can really destroy you. Because none of us came into this wanting to hurt a patient, and so we have to think about that. And so, how do we onboard the younger generation, and how do we continue to support them throughout their journey so that they feel supported? They don't feel frightened. And, you know, technology is increasing by the day. So we should be able to do this in a very smart way. So that's one thing. And I think as we think about different models of care and moving care from the hospital to, let's say, at home to the hospital-at-home or other care models out into the community, what do we need there in those delivery models to be able to take care of patients better? And I think especially home at hospital is really primed for a lot of innovation, technology and things like that. And that's why the nurses should be there, because I'm going to the home, I know what's missing, so get them there. The other thing is, because these different models are moving outside of the hospital, what remains in the hospital is incredibly acute, very sick patients. So how do we do on-demand teaching and support so that everything is at your fingertips? So I think that's another place where it's really prime. Oh my God, I forgot how to do a PICC line or how do I flush it. How do I, you know? Things like that. I want to be able to get on my phone because that's what we use. We all have phones and stuff, and I want to be able to bring it up, but I want to be able to bring it up. I don't want to maybe have to read it. I might want to see a video, or I might want to see the different modalities of learning and addressing that. And we are seeing this sort of gap where more experienced nurses may not be as technologically astute, and the younger ones are. So how do we marry the knowledge with the technologically astute generations, so that the decision-making the technology helps with the decision-making, especially at the bedside? So that's, you know, again, I'm speaking from an academic tertiary care quadrant care hospital. And so we see the most complex. It's like, oh my goodness, how sick these and the new diagnoses and stuff like that. So those are what I'm seeing as trends, and people are struggling to come up with solutions.

Molly McCarthy:
Now, I think those are spot on. So I'm just going to reiterate what I heard, and please correct me. So really, how do we support our newer nurses? I know that as a new nurse myself, it can be incredibly intimidating and overwhelming, and not only just with the onboarding of the new nurses, but continue to retain, retrain, educate them. And you mentioned the concept of virtual nursing. Having nurses who are more seasoned or perhaps looking for not necessarily bedside care, but transferring their knowledge through virtual nursing, I think, is just a wonderful concept that I've seen work in practice. The hospital at home, of course, I think, to your point, what we're seeing in the hospital is incredibly acutely ill patients and really empowering our nurses at the bedside, as you mentioned, with technology point of care modalities, whether they like to learn through a TikTok video or a document, I think it's really important to provide that through their, what they are using every day, which is their phone at the bedside. So I would have to say that you really spot on from what I've seen, and really appreciate your insights there. And kind of building on that, and I'm going to say it again because I've already, this is the third time. So I made the point in our opening conversation and subsequently that technology has made caregivers' lives harder, not easier. My last question here is, given what was done to nurses with the EMR and recognizing the transformational promise of new solutions, for example, like AI and ambient intelligence, will this time be different for nurses and new technology? And if so, can you tell our listeners how and why it will be different?

Hiyam Nadel:
Well, I think it has, the burden on all the clinicians has garnered national attention, global attention, right? And it's a well-known fact that people are leaving, it's not worth it. I came here to be with the patient, but I spent five minutes with the patient and an hour and a half documenting or interacting with everything else but the patient. Generally, medicine historically has been very slow and clunky to accept a lot of technology, especially generative AI and all the newer technology that's coming up. I do think now we're primed. I think clinicians are learning about technology, they're interacting with technology, they're getting themselves to the table, they're being invited to the table, so that's where I think a lot of the changes are being made. So for example, in my center, we have internal innovation because we're actively eliciting from the front lines to give us their problems and their idea for solution. My center is an incubator, so I help them build that out. But then there's an external component, which is I'm not going to be able to solve this particular problem. Let me go outside and see who is solving this problem, and then teaming up with them to either co-develop, test, and give feedback, or whatever it may be, and I think more and more companies are actually wanting to do that. So that's where I think I always say we're shifting that paradigm. Don't just give me your solution. Let me be part of it, and we both will win.

Molly McCarthy:
You mentioned both your internal stakeholders at the bedside. It's great to hear that they have a place to share their challenges and start to ideate on solutions. And I love the second part, you said in terms of externally, you know, you're not going to necessarily solve everything at your center, but looking externally with your partners, with technology companies, with health IT companies think is so critical. And I saw that shift over the past five years, too, and the willingness to have that partnership, because no one's going to solve the challenges we face in a vacuum or alone.

Hiyam Nadel:
I'm so happy you said that because my next statement was going to be, we still have to figure out how we, innovation is generally done in silos. So, for example, we're all trying to solve the same problem in silo. So how do we bring everybody together? If I've come up with a solution for problem A, then you can take that solution, and now let's work on problem B so we can accelerate coming up with, you know, we can attack more problems in that way. So yes, I think it's really powerful. I think it's exciting. You know I love these IT companies and what they're trying to work on, and you know we invite a lot of startups. We can't always take everyone or pilot everything, but we definitely will give them feedback and a little bit of mentorship. So it's really accelerating. I think it's great.

Molly McCarthy:
I would love to hear from you a little bit more about the process within the Innovation Center. If you could just let our listeners know how long you've existed there and how, if a nurse sees a deficiency or they're coming up against a problem, what would they do within the innovation center? How would it work?

Hiyam Nadel:
Okay, so I was given this full-time position in 2019, September of 2019, just moving into my office that January, the pandemic hit. So that's how long it's been in existence. And again, like any startup, we said we just sent out an email. What are your pain points, and what are your ideas? And we had a committee that voted on which ones we were going to take. I was very strategic in what we chose to solve for, because I knew this was an opportunity to prove what nurses can do. And so we tackled CLABSI infections, which wasn't just a problem for the nurse, but especially for the patient and especially for the health system. So if we could make an impact on that, I knew we would garner a lot of attention within the institution, and that's exactly what we did. And in fact, I think the medical intensive care unit to this day has gone almost 75 weeks without a CLABSI infection. That's really impressive. And that neonatal intensive unit is like three years or four years or something. So that's internal. So the way over the pandemic, I really thought through how we can reach more frontline because on average I received about 27 applications a year. But after the pandemic, we worked with the Health Transformation Lab here, we built a platform, and then we put out this platform. So we lowered all the barriers that we learned the first time around. And so staff could just enter their idea and their pain points from anywhere, from any device, computer, anything, QR codes, anything. And this time, instead of 27 applications, we received 252. And it was just at the heel of the second pandemic, so I was really worried that people too burnt out are going to say, no, just leave me alone, but they were eager to tell us what the issues are at the front line. And this is fantastic for leadership because it closes that gap when I'm a leader and I think I know the problem, but if I actually hear it directly from the frontlines, then that helps you again garner credibility, and you actually know what the problems are. The other thing this platform is able to do was crowd vote. So no more committees, we sent all the ideas back. So we have 8800 staff that this went to, and then, they were able to vote on what was important to them. So what rose to the top, we knew resonated with most of the staff, and those are the ones we invited for full application, and then we chose four winners. You know, my center's based on philanthropy, so I would love to take care of every other idea, but I am working through the remaining 221 ideas so that people don't feel disengaged, that they put in an idea but didn't get awarded. So we've set up a lot of committees, a lot of those ideas were just, let's do it that were implemented already, and we're working through it. So that's internally how we do it. And externally, we put our name out there like, come see us. You want us to test something and, you know, let's work together.

Molly McCarthy:
I think that's amazing. Just asking for feedback. And you mentioned how eager everyone was to provide that feedback even after multiple rounds of COVID, right? So that's an important note, really as, you know, you can't get to the problem unless you're really asking your constituents.

Hiyam Nadel:
Yeah, and one other point I would love to make, we have an incredible well-being task force here. It's made up of physicians, psychiatry, social work, ethicists, employee, you know, employee programs. And when they were doing their rounds on the floors, they all said how empowering and help their well-being by being asked, they were empowered to solve their own problems. And they were asking the task force, when is the next methadone challenge. That's what we named our challenge methadone. And that's where the first anesthetic was used in surgery, and that's why we called it the methadone. And so that in itself tells me that it was very empowering and helped well-being, right? If I have no control over my life every day, then I don't feel empowered, and I don't feel like my voice is important, and that's what we accomplished here.

Molly McCarthy:
Well, congratulations, and congratulations on the results. As a former NICU nurse, the no CLABSI infections for 3 to 4 years is quite amazing. As we close out here today, so many nuggets of great advice from you to our listeners. And just a reminder, our listeners are CNOs, CNIOs, and their teams within health systems. And obviously, you bring such an amazing and unique lens, encouraging nurses to claim their place at the table as change agents, really to impact the future of care delivery. And I'm just wondering if you could give one piece of advice to our listeners today, what would that be?

Hiyam Nadel:
Don't be afraid to attend a hackathon or conference that is really geared towards innovation. Don't be afraid to speak up. The manager, sometimes people say, well, I'm afraid to go with this idea to my manager. Trust me, go with that idea and also put it on yourself that you will put it all together. The managers are very busy, and so if you say, "Look, I have this idea and I will pilot it, I will set it up, I will do it," it will get you very far. Also, I always was an early adopter, so if they were testing technology or anything, I'm like, I can do it on my unit, I can do it. So always volunteer and really go out and look for your tribe. I know I'm the president of SONSIEL, but we started SONSIEL because we wanted nurses to feel innovators. We wanted innovators to get together, and we wanted them to feel that there was an organization behind them in this movement.

Molly McCarthy:
Well, thank you, Hiyam and listeners. You heard it from Hiyam herself, don't be afraid, raise your hand, volunteer, and look for your tribe. So thank you so much, Hiyam, for being with us today, and we'll see you soon.

Hiyam Nadel:
Thanks so much, Molly.

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

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SCTS_Kristi Henderson.mp3: Audio automatically transcribed by Sonix

SCTS_Kristi Henderson.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 health care 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, I'm so excited to have Dr. Kristi Henderson, healthcare visionary and digital transformation leader, on the Smart Care Team Spotlight. Dr. Henderson's journey from a bedside nurse practitioner to CEO has been marked by a tireless dedication to enhancing the healthcare experience for patients and clinicians over the past 30 years. As the former CEO of Optum Everycare, Dr. Henderson led a national care delivery organization with virtual and in-person care options that were provided through community clinics, employer worksite clinics, and a national virtual health clinic. Dr. Henderson has also led clinical operations for Amazon Care, where she played a pivotal role in the development and expansion of the company's innovative telehealth and home care program. She also led a National Center for Patient Access, Virtual Care, and Care Coordination for Ascension Health, where she developed and implemented innovative models of care delivery. Christie is also the board chair for the American Telemedicine Association, and she has been a vocal advocate for telehealth expansion and its potential to improve healthcare access and delivery for all. As the new CEO of Confluent Health, Dr. Henderson is committed to building on the organization's legacy of excellence in physical therapy and rehabilitation while also driving innovation and growth across the broader healthcare landscape. Welcome, Christie. It's so great to have you.

Kristi Henderson:
Thanks for having me, Molly. Excited for the conversation.

Molly McCarthy:
I'm going to get right into it. You obviously have an amazing and extensive background within healthcare. I mentioned on the provider side, on the payer side, and the technology side. And so as you think about that journey retrospectively and the evolution of health IT, to really bring us to where we are today. I would love for you to share with our listeners your opinion on what we got right over those years and perhaps what we could have improved upon.

Kristi Henderson:
First of all, Molly, thank you for having me. I'm excited for this conversation because it brings back such a flood of amazing memories. I'm just trying to pioneer and work through, like we're all focused on the same thing. How do we improve health outcomes and how do we make this system easier to interact with? And so there's a lot of great successes, and there are definitely things we could have done differently. And maybe I'll take two that maybe are less expected around the things that we got. First of all, through all of this work, it could have been really easy for us to sacrifice some of our core tenants as healthcare providers and trusted partners in the healthcare industry, but we remain as nurses in particular, the most trusted healthcare professional. And so just we never lost that. And so I just that is that relationship and that trust we have with patients could have easily been put to the wayside for us to try things. And so just we should celebrate that with that. You know, we also never lost our determination and perseverance. I mean, how many times have we tried things it didn't work, or we didn't have the aligned incentives or policies or regulations to really get the traction that we wanted. And myself have been involved in so many different projects that were really a great idea at the wrong time, and but we didn't lose our perseverance. And so I think those are the two things we got right. We're still a trusted healthcare, the most trusted profession, and we are still focused on the right things, which is improving the system and improving outcomes. The things I think we've gotten wrong, and I think we still do it today and maybe we're we'll get better at this. But the first one is change management. And I just think that too often the excitement around new technology omits the complexity of our system and the need for us to slow down and really think through all the stakeholders how they'll be impacted, how a technology may have a dependency on something else. And so I think we miss getting adoption and engagement because we don't do change management. And so I think that we've got to slow down and do the planning and involve patients, clinical team, and others in that decision making. It's so logical. But the first thing that happens every single time is people misstep on a communication and an engagement or a training that's going to be necessary for success and adoption. So that's one. The other is I think we constantly are in our own way, and we are assuming what people want. And we really, until recently, had the ability to really treat people individually and configure solutions to be able to adjust for Kristi or Molly or whoever it may be. You know, our social media pages are all customized to us based on what we've been doing in the system. So healthcare should be the same way, and it should be more intelligent and personalized so that you get that adoption. And that's true for the clinician side as well. Nurses need to have technology that really responds to what their needs are as well. So a lot more flexibility and dynamic nature to the technology and use that intelligence and data that we have to personalize things for both sides so that you can actually make the system work easier. So I think using the data, personalizing it and change management is where I think we've fallen short.

Molly McCarthy:
And just to touch on that last point, because when you started to dig into that, when you first said, we assume what people want, my question was, well, what people? And I love your point about patients, but also clinicians, so that either the person receiving care or giving care or part of that care team, it's personalized to the information that really they need to have and really know to provide better outcomes.

Kristi Henderson:
Well, I'll add one piece to that too. I think that and this came from my experience really working at Amazon, where there's nobody more customer-obsessed than Amazon and the—variants of an individual. Healthcare is different though. What I want may not actually be what's best for me, and so I may need to make sure that we focus on the core piece and sacrifice a star rating because it is what people need. So I think that we have to hold true to we know the standards of care, but we can create experiences that are personalized and adopted and adjusted for what that individual, how they learn, cultural beliefs, language preferences, all of those things can be done. But I just thought of that when you were describing that. I think that there is still this piece where we've got to maintain our trusted relationship because we're advocating for what's best for an individual, even if it might not be what they want.

Molly McCarthy:
And that goes, I'm just going to highlight again what you said at the beginning in terms of what we got right and that trusted health care professional, the relationship with our patients. Nurses continue to rank number one as the most health, most trusted healthcare professional. And then obviously the perseverance and determination. And then I'm just going to close out before I move on to my next question with the change management piece. You really brought up a great point there in terms of multidisciplinary stakeholders from the beginning. Slow down, and doing that hard work in the beginning will pay off. And that's something I couldn't agree with you more in terms of where we continue to struggle. So my follow-up question to that, obviously you've had so many experiences, and I would love to share with our audience how you got from within health systems to tech to chair of the ATA board, as well as your current position as CEO, as Confluent Health.

Kristi Henderson:
Maybe I'll start with the piece ATA because it's held true across all of the different jobs, and I'll use that word, but I've had but actually got involved with ATA. It was probably in 2000 or 2001. I actually need to figure that out because it was a long time ago, but I was working at a medical center and looking to get into telehealth, and went to visit one of their conferences that they had in Orlando. And I can vividly remember the room I walked into and the people sitting on the stage in club chairs talking about the investments in health tech and delivering remote care. And one of the things that holds true today, and the reason I've continued to be involved in the ATA is the membership. And this is hard stuff. We're modernizing policy and regulations. We're advocating for new clinical models. We're networking among each other to figure out best practices. What has worked, how are you solving this problem? And so it's incredibly energizing to be with all those thought-led leaders and people, really pioneering new ways to deliver care. And of course, telehealth became all the craze during the pandemic. But many of us were doing this early in 2000 and really had no reimbursement model. That came because of work from the ATA. And these are things that none of it's easy, but this group is willing to keep knocking away at every little piece of policy, regulation, advocacy, trust building exercises and be on the forefront of advancing technology into healthcare, and it's not about telehealth. It's about technology and healthcare to improve health outcomes and reach. So that's what inspires me about that. We still have a ton of work to do, and so I continue to be excited about my involvement there on the board. Now, my journey from bedside nurse practitioner to academic medical center, you know, Ascension and Amazon and Optum and now Confluent, all of those are really different sectors of the healthcare industry. And so, you know, learning from actual clinical provider, learning from a large system approach nonprofit that then transitioned into big tech and then a payer-provider organization. Every one of those really gave me more insights into how I could be a better leader and and really appreciate all the stakeholders. It doesn't do me any good to just focus on it. From my lens of a clinician, I've got to understand the why, what is causing people to behave a certain way, what is influencing policy? What are there's just so much complexity to the healthcare system, which is what makes it so much fun at the same time, like a big puzzle. So all of those things really excited me about this new role. To be able to bring all of that together into a role of CEO of Confluent Health, which is a national law school skeletal provider that is seeing through about 650 actual physical PTO speech clinics that are in the community. They're locally branded, so no one's heard of Confluent Health. We wanted to maintain that local trust with clinics that have been there oftentimes for 20-plus years, so they're trusted partners. We also have clinics in about 2000 employer sites where we're actually on the injury prevention and safety side. So we may treat conditions, but we're also working upstream to try to prevent those as well. We have hundreds of relationships with health systems where we are actually their physical therapy arm, and providing that because we have a more efficient and effective model and great outcomes. And so integrating into their system of care. And then most don't know that we actually have a educational arm where we're actually training the workforce that we need. We're all challenged with workforce. So we have post-professional PT programs, and we've partnered with universities and our training all over the country as well. So all of that, plus an innovation arm that allows me to integrate technology across the whole musculoskeletal experience, is really getting on value-based care for musculoskeletal. So it's exciting. But all of that, I've been prepared for that because of these other roles in every one of them. Layering a new experience on top.

Molly McCarthy:
Yeah. And you said something previously around the ATA I think it's really applicable as you talk about your journey too. And that's not about telehealth but really about tech and health and how can we improve patient outcomes. And that's so critical as we continue to evolve as a healthcare system.

Kristi Henderson:
I couldn't agree more. Just sorry. I'll add one thing to that. I remember when we have all this data coming from everywhere and say it all the time around, like data for the sake of data does us no good. We have to get insights out of it, so it's actionable. Same thing for tech. The tech is for a purpose for us to reach more people, deliver better outcomes, whatever it may be. So there's a lot of shiny objects out there, but you've got to really back up to where's the pain point and friction that we're really trying to simplify.

Molly McCarthy:
Yeah, we'll talk about shiny objects in a little bit. But we started to touch upon care models. And so I want to delve into that a little bit deeper. And obviously current care models are becoming unsustainable both economically, physically, emotionally. We know the clinician burnout and to some extent clinically. So I have actually two questions for you. So I'll ask them one at a time just so I don't overwhelm you. So as you think about the clinical transformation, which you've obviously been a part of for many years, but it's happening readily right now. What role must nursing have to ensure new care models best serve their patients as well as themselves?

Kristi Henderson:
Come circle back to something I said earlier about that. Nurses being the most trusted healthcare professional. So they have the trust of individuals. They have the trust of the healthcare team, and therefore they have the best visibility, understanding where there's gaps in the current system or what's not working.

Molly McCarthy:
Right.

Kristi Henderson:
And so nurses have been working in across the entire care continuum. And so they have a unique perspective. And they've been solving coming up with creative solutions for these problems. And so if you ever want to know where there's a friction point or something not working well, go to the nurse, wherever that may be, in the clinic, in the hospital, in school, and you'll find a creative entrepreneur, for a lack of a better word, in those spaces, solving for the problems. So they need to be at the table to be able to bring a credible voice, to be able to be the voice of patients, voice of the workflow within the healthcare system so that we make sure that when we roll things out, new technology is implemented, that we're doing so in a way that's going to be well received and that is thoughtful, maintains the relationship and trust with patients, and it gets the outcomes that we want. So there is nobody better to be at the table to help us transform. And they're also the best ones to help with change management as well, because they're so aware of all the different nuances in the healthcare system.

Molly McCarthy:
Yeah, I think that I always beat my drum that nurses need to be involved in the design, development, and deployment of technology really across the care continuum. So I like how you really pulled in the continuum, regardless of where the nurse is, because they're in so many different settings. The second part of this question really is how do you think about technology as an enabler to make new care delivery models possible, to do what we talked about before improve quality, improve safety, equity, and clinical outcomes, while also lowering costs? It sounds like the quintuple aim to me here, but would love your thoughts around that.

Kristi Henderson:
Yeah, my actually flip your question a little bit because in my mind it's not about how can technology be the enabler? I don't know how we have a sustainable, effective healthcare system moving forward without technology being an enabler and really the whole foundation of it. Again, we're not leading with technology; we're just modernizing and making our healthcare system work better for everybody. And so to get the personalization, to get the engagement that we need, we have to have technology. We use it in everything else in our life. We have to do it here as well to get the access to think about treatment adherence. I'll take it from musculoskeletal where I am now, who wants to go to three times a week to physical therapy for six weeks? If I'm not using technology to allow a more convenient way to actually complete the treatment plan, odds are we're not going to have adherence and completion of that, just like we have with all the chronic diseases. It's fatiguing. So we've got to make it simpler. And that allows us to get behavior change and get better outcomes. All about the technology and scalability. All of those things are going to require that. So I would say we really cannot build a model that's sustainable and effective without technology. It's how they use it. And in making sure the design thinking process that goes into development is one that has all the stakeholders at the table helping to design that so that it actually gets adopted.

Molly McCarthy:
Yeah, I think those are all really good points, especially the technology as the backbone in this day and age when we know it's ever present in every other aspect of our lives. Thank you for that. That's some great insights. I wanted to just move on. We talked a little bit about the ATA, and I don't know if you remember, but I met you back in 2015 at the ATA meeting in Los Angeles. I heard you present on telemedicine. I think it was in a diabetic population, perhaps in Mississippi, rural Mississippi. And you even mentioned you started working with ATA back in 2000. And we know that virtual care has been around for quite some time, even before the pandemic. And as we progress in adapt our models of care, what are your thoughts on how virtual nursing should fit within the broader context of creating a smart care team? To your point, earlier, not just data for data's sake, but providing those insights first.

Kristi Henderson:
Just in general, virtual nursing is really essential. Whether it's the reasoning around workforce shortages, it's just about making a more efficient, effective model. So I think virtual nursing is here to stay. I think we still are at the tip of the iceberg of the possibilities of that. But to your question around, is it just a camera in a room, or what does it take to actually develop a virtual nursing program or any technology integration into the healthcare system? I wish it was just as easy as implementing the technology. We would all be a lot further along, and there would be a lot less casualties and pilot projects if it was just about implementing the technology. But it goes back to minimizing the change management complexity of any of these programs, and virtual nursing being one of them. We've got a muscle memory of how we've done any anything in the healthcare system, whether that's patients and how they schedule appointments and where they go to get their healthcare, or whether it's a nurse and how they do their job. Changing how people do their job to make it easier with technology actually is harder than we think. And once people try it and get used to it, then they adopt it. But I think we have got to make sure and give adequate time, training, and even involvement again back in the product development to gain the traction that we need to. And it's one of the hardest things I ever did with virtual nursing is because people are remote and distant. You lose some of that camaraderie that comes with being in the bunker with your team. And so I used to say all the time, how do I recreate the tap on the shoulder and make a virtual tap on the shoulder, where I can collaborate more organically and have this fluid relationship when it actually takes me stopping and remembering there's somebody in the cloud, I just got to click this button to collaborate or monitor. So just just highlighting the complexity of this work. And when you put technology in, it has a downstream ripple effect on the entire workflow and even how teams work together. So being conscious of that and intentional and building that into your change management project is really important.

Molly McCarthy:
And I guess to that last point there, when we think about change management, and I'm sure you've been involved in so many pilots, as have I, how do you move from a pilot to a bigger scale?

Kristi Henderson:
I think the first piece is, is making sure at the very beginning you're defining what you want to learn and what success looks like. And so if it is a pilot for remote monitoring for diabetes or it is a virtual nursing program defining what success is and if you reach success, what are you going to do next really shows the potential of scaling the project. And so if I think so many times, people will go in and send in a pilot, a virtual nursing program, and maybe they skip what the success criteria are and building the buy-in from stakeholders that if I reach this and we prove this, then are we all agreeing that we're going to scale this to the next level? I think people just get tired and they're running busy all day long. And so again, this takes a lot of energy. And if it's off the side of people's desk, I just think that without that framework from the very beginning, it will be another casualty of a pilot project.

Molly McCarthy:
And hopefully I know that we'll both be at the Virtual Nursing Summit in November in Washington, DC. We can definitely explore many of these issues at that time. I do need to wrap up, though. Just one last closing question for our listeners who are primarily healthcare leaders, CNOs, CNIOs, and their respective teams. And obviously, you have an amazing background. I've known you through many of your different roles, had the opportunity to present with you, and you're in a very influential position as a national thought leader. If you could pick out one practical, important piece of advice for our listeners today, what would that be?

Kristi Henderson:
Well, I think first, be a part of the solution and don't wait to be asked to help. I think that we're all committed to improving the healthcare industry. And I mentioned all this change management. But I would say as you step up to the plate to say and raise your hand and say, I'm here to help, I think bringing that expertise and knowledge of the workflow and clinic and the clinical environment that's so critical for change and the life flow of the patient, both of those are so critical for us to be able to implement technology and be successful. So raise your hand. And bring that expertise to the table so that we can really continue to modernize and advance our healthcare delivery system.

Molly McCarthy:
Thank you, Kristi so much. I love that it reminds me of the growth mindset, really having the ability to think differently. And to your point, step up to the plate. Thank you so much today for joining us and look forward to seeing you soon.

Kristi Henderson:
Thank 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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SFTS_Holiday Special Becker's episode.mp3: Audio automatically transcribed by Sonix

SFTS_Holiday Special Becker's episode.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Molly McCarthy:
Welcome to a special holiday episode of the Smart Care Team Spotlight. I'm Molly McCarthy, and I hope you all are reveling in the joy of the holiday season with your friends and family. Today we have a treat for you! Another special crossover event with my friend Steve Lieber and his podcast Smart From the Start, also presented by care.ai. In this episode, host Steve Lieber interviews six health system leaders at the recent Becker's Health IT conference, delving into transformative technologies that are revolutionizing healthcare. Key topics include the vision for smart hospitals, the role of AI and ambient intelligence, and reimagining care delivery models, and the cost of maintaining the status quo. Gurmeet Sran from CommonSpirit Health envisions smart hospitals leveraging technology to enhance patient care, while Brian Sisk from Memorial Hermann discusses the challenge of balancing innovation with practical value for nurses and patients. Reed Smith from Ardent Health focuses on the potential of AI in addressing workforce challenges, and Nick Patel, formerly from Prisma Health, emphasizes the need for AI to drive insights and automation in healthcare, especially in managing chronic conditions. Bill Feaster, formerly from Children's Health of Orange County, calls for intelligent use of AI tools like generative AI to enhance predictive analytics, and Arz Raheem from Montefiore Health proposes ambient technology as a solution to physician burnout. Tune in and discover the transformative possibilities shaping the era of smart hospitals, AI and ambient intelligence can propel health care into the future, and it's already happening. Wishing you all a joyful holidays and a Happy New Year. Enjoy the show, and see you in 2024.

Intro/Outro:
Welcome to Smart From the Start, presented by care.ai, the smart care facility platform company and leader in AI and ambient intelligence for health care. Join Steve Lieber, former CEO of HIMS, as he interviews the brightest minds in the health providers space on truly transformative technologies that are modernizing healthcare.

Steve Lieber:
Hello, and welcome to Smart From the Start, I'm your host, Steve Lieber, and it's my pleasure to bring to you a series of conversations with some of the sharpest minds in health information technology. We'll discuss the smart directions healthcare companies and providers are pursuing to create smart care teams. While at the Becker's Health IT and Revenue Cycle Management Conference in Chicago, we had the opportunity to explore key topics on innovation. In this podcast series, we're giving you a sneak peek into the discussions we had with health system leaders at this event. The key questions we covered during the series are as follows: What is your vision for a smart hospital? How do you see AI and ambient Intelligence enabling you to reimagine your care delivery models? And what is the cost to hospitals of keeping the status quo? We hope you enjoy this abridged version of the insights shared at the conference. First, I want to share the insights. Doctor Gurmeet Sran, chief clinical Data Science officer at CommonSpirit Health, shared with us. Doctor Sran, what is your vision for a smart hospital?

Dr. Gurmeet Sran:
Well, thank you for that question. I think it's a very diverse question overall. You know, there's a lot of thoughts around how you can start to use technology, both either audio-visual AI, augmented intelligence, artificial intelligence to help support a more robust and more dynamic opportunity for patients to give better care. Part of it is really how do we actually start to enable the technology stack, so we can transform these hospitals to be able to become more well-equipped for better patient care? Part of that has a lot to do with how do you actually re-envision the way that the patient rooms should be actually managed, both in terms of the the layout of the room, as well as actually the technologies that you need to help enable this care. And then two, we often sort of forget about the fact that the operating rooms and the way that ours are managed nowadays. Often you have hybrid models of how the operating room needs to be managed. All that has to be sort of taken into consideration. The third part, which I think is actually a part of the word hospital itself, this idea of us having a containerized hospital where it's four walls, where physical patients are physically located there, that's becoming a more antiquated idea. Now, the hospital itself could actually be not only with a physical hospital that we know of today, but it could actually be partially, maybe in a nursing or a rehab facility. It could be the patient's home in some sense, actually, you know, now with mobile, mobile technology, people are beginning to think about mobile hospitals or mobile urgent care centers. So that whole sort of trajectory of it's not bounded by the four walls of the hospital anymore. We have to think about digital transformation and all these other care spaces. And a lot of that, as I'm sure you recognize, comes from using telephony and audio video technology to help enable us to help enable that vision to become a reality in the next decade or two.

Steve Lieber:
Doctor Sran, how do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Dr. Gurmeet Sran:
So sort of following on on the question that you just asked, uh, there's a huge opportunity here as it relates to the fact that we have a big workforce shortage, the fact that we're actually concerned that we aren't going to have enough nursing or physician staff to enable patient care in the next decade or two. The other part that has the opportunity around ambient intelligence is that how can you centralize the care to remote stations or remote command centers? So getting back to sort of on a per patient basis, as well as then thinking about a population basis on a per patient basis, how do you enable real-time analytics, real-time opportunities to intervene before a quality or a safety event happens, better sort of improve the patient experience, whether it's around sort of ensuring that the family members, the patients are given the information that they need, or at least their requests can be managed at that right time. Part of the idea behind ambient intelligence itself will also, as I mentioned, be around the fact that we don't have enough FTE labor. And so that ability and that power to scale that I think is going to be a super powerful opportunity that's going to actually become probably table stakes in the next decade or so. The others, uh, piece that I mentioned on the population side is now, if you actually have ambient technology working at the patient level, you can then also take that same technology that's built up and syndicate that out to command centers. So possibly allowing for more remote enabled care, remote-enabled care that's not just at your facility, but possibly even care at home care at actually other acute care sites as well. So all of that, um, will probably become a very big sort of opportunity of expansion, uh, to enable better patient care as they sort of move into this next decade.

Steve Lieber:
And for our last question, Doctor Sran, what is the cost to hospitals of keeping the status quo?

Dr. Gurmeet Sran:
Um, as we all know, the significant margin problems that all health systems in the nation face as it relates to both top line and bottom line opportunities, uh, the status quo is going to actually go and allow for dissolution of sort of health systems as we know it. If we don't think about how to reinvent the care models overall. So I'm not saying anything that probably anybody else has not said, but the fact is that we're seeing such a migration and shift in the definitions of where care can be managed, what it means to actually manage care not only from a medical perspective but a mental health perspective from a social determinants perspective. And so all of the way that we've been looking at, let's say, medicine being very medically focused and diagnosis focused, that envisionment of redefining what medical care is, is inevitably going to actually change the way that we have manage and care due care redesign over the course of the next couple of years. So. Put this answered very quickly. Status quo will lead to a, um, ultimate dissolution of, I think, the way that health systems practice if they don't go and they don't reinvigorate and rethink of where they want to go in the future.

Steve Lieber:
Now I want to invite you to listen in to a conversation we had with Brian Sisk, Senior Vice President and Chief Nursing Executive at Memorial Hermann. Brian, what is your vision for a smart hospital?

Brian Sisk:
You know, it's interesting because there's a lot of noise out there in the system right now. You know, we're just having this conversation around the show here. It's you know, it really is getting down to I think we have a lot of energy in this space, especially from front-line nurses all the way up through leaders. It really is getting down to those things that truly provide value to both of our nurses and to the patients, and that's an interesting place to be, right? It's it's because we all we see a lot of innovation that comes through, especially since Covid, right? All these new bells and whistles. But the adoption sometimes lags because it actually creates extra work on the front line or it's not valuable to the patient. And so it really is finding that sweet spot in between those two.

Steve Lieber:
For our next question, Brian, how do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Brian Sisk:
Yeah, so part of our nursing strategy is reimagine is actually one of the buckets. And we put a lot of energy into that with our front-line nurses, because they really want to be a part of reimagining their healthcare environment. And that really comes down to like everything from the number of times that patients have to press the call bell. Can we eliminate some of that? Can we be more proactive? Can AI help us in some of this ambient monitoring that's out there? Now identify the needs of the patients. We see a lot of things with falls and pressure injuries that I think this is a prime space that would be very beneficial to those that are actually delivering that care.

Steve Lieber:
And for our last question, what is the cost to hospitals of keeping the status quo?

Brian Sisk:
So I say this all the time. What we have now is a much smarter workforce. Um, you can't underestimate how dialed in that nurses docs are in the technology that is out there on the horizon. Some of it's true, some of it's not true. We realize that, right? But it really is, it's going to be a differentiator in these spaces. Because if I can work for an organization that has some of these tools and it makes my job easier, I will probably migrate that way or stay with that company. So I think that's going to have a huge implication. Um, as we kind of go down this pathway.

Steve Lieber:
In our conversation with doctor Nick Patel, founder and CEO of Stealth Consulting, we covered some of the same themes and picked up on some great ideas for innovation that you can also think about and apply at your health system. Doctor Patel, what is your vision for Smart Hospital?

Dr. Nick Patel:
Yeah, the future of Smart Hospital needs to be contiguous with not only just what happens on the acute space but also on the ambulatory space. A smart hospital should be able to know when someone is getting sick at home, alert the right people, and then bring that person seamlessly from the home into the acute bed, bypassing ERS and wait times there and directly into an acute bed to get that treatment quickest. And honestly, when that sort of thing happens, the treatment needs to start not only at the hospital but actually starts at the home through telemedicine, the EMS transport all the way to the acute space.

Steve Lieber:
Nick, how do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Dr. Nick Patel:
I've been practicing for 20 years and want to tell you health systems even now do a lot of manual tasks, and there are thousands and thousands of tasks that a person has to do for one patient visit, just from the checking-in process to the the the nursing intake to the provider to the checkout process. And then that's exponentially increased if you go to the good side. So what we can use AI is not only to get insights but to drive the patient to the right avenue of care, use automation to make sense of the large data sets from wearables and other chronic disease states coming in, and then make sure that person gets the right avenue of care and gets alerted proactively when they're going the wrong path. Let's not wait for someone to actually have high sugar that puts them in a DKA. Let's see. This person's sugar is actually been going up. Let's increase the treatment. Let's make sure that person talks to a pharmacist. Let's make sure it talks to a nutritionist all virtually. In order for that person to avert an organ damage from chronic kidney disease, blindness, heart disease, etc.. So it's all about using effective clean data to drive automation and get the insights from AI.

Steve Lieber:
And for a final question, Doctor Patel, what do you see as the cost to hospitals of keeping the status quo?

Dr. Nick Patel:
Most hospitals currently, are still working, like if they're in the 80s, even though we've had the high-tech act, the EHR come out. The cost is huge because the population has changed. If we don't change how we take care of our patients and move to more value-based care, more proactive care, more wellness care, then we're going to continue to have sicker and sicker patients in our hospitals, and our beds are going to continue to overflow. So the cost for a health system not to do anything and modernize and digitally transform is could be a threat for them to actually close, because there's no way that they can keep up with the cost of healthcare, the cost of inflation, the ever-growing population of our patients, the heart, and the fact that is continue to have a nursing shortage. So we have to do things in a different way. We have to modernize how we transform care. We need to make sure that we have patients, have proactive care and seamless care without having to see have a person see them. Uh, so it's all about that narrow margin of health systems have average health system has 2 to 3% margin. And if you modernize and transform your business to do things that require less people skill and more asynchronous skills and virtual care, you're going to improve access. You're going to actually bring in more commercial payers. The consumers are going to want to come to your health system. You're going to retain, and you're going to do better from a reimbursement perspective, because you're actually building much better quality to the patient.

Steve Lieber:
Reed Smith, chief consumer officer at Ardent Health Services, shares his experience from the lens of the consumer of health care. Reed, for our first question, what is your vision for a smart hospital?

Reed Smith:
The smart hospital is an interesting time. I think a lot of people probably, um, try to tie that back to technology specifically, and that is part of it. But I think a lot of it is how we educate and train our clinicians and the other people that operationalize, uh, you know, what we do on a daily basis. So when we think about smart hospitals, uh, it's not that it's not a virtual hospital or something to that effect, but how do we take that technology and actually leverage that against the people and the processes and even the education, uh, so we can better care for the communities that we serve.

Steve Lieber:
How do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Reed Smith:
Ai is interesting. I think it's hard to, you know, go to a conference or a webinar and, you know, this isn't on the agenda. So you take that and the ambient monitoring piece. And I think what we're doing is actually trying to solve real issues that we have in the hospital. So you take labor for example. There's not enough nurses. I've been doing this for 20 years. There's never been enough nurses. I'm not sure we'll ever have enough nurses. So how can you use these to actually enable, um, virtual clinicians, virtual nursing, things like that, where we can actually take some of the administrative burden off those people that are there in person and allow them to really maximize? We talked a lot about pricing at the height of your license. You know, how do we actually do that in a way that we're caring for the patient, actually bringing in their care team, their family members, things like that. So again, we could be more predictive. We can head off potential things like falls, for example, but then also care for them, uh, in a very systematic way that allows them to feel supported and hopefully goes home quicker. Uh, they heal faster, things like that.

Steve Lieber:
And for our last question, Reed, what do you see as the cost to hospitals of keeping the status quo? You know.

Reed Smith:
If we just keep doing what we're doing, we're probably going to keep getting what we're getting right, or however that analogy goes. And so, um, I don't think we can, you know, our chief medical officer, I've heard him say a few times now that he never wants to be called innovative. He's even doing what he's doing. He says we have to. Right. So I don't think we can keep doing what we're doing. Um, I think that's. Really, we run the risk of being irrelevant at some point. Um, I think hospitals will always they'll always be a need in that higher acuity. But how do we actually use all these technologies, these new processes, to really become more consumer-centric? And that's whether they're in the home and the evolving side of care, or they're in our hospitals or otherwise. So if we stay where we are, you know, we run the risk of being out of business, quite honestly.

Steve Lieber:
Doctor Bill Feaster, former Health Information Officer at Children's Hospital of Orange County, kicks off the questions with a candid approach that got right into the opportunities we have. So Doctor Feaster, for our first question, what is your vision for a smart hospital?

Dr. Bill Feaster:
Well, I would say the way we operate our hospitals right now is sort of the furthest thing from being smart, and that basically we do things the same way we did them. When I started my practice in 1981, we staff in the same way, and often that staffing is regulated by the state. Uh, we, uh, have processes that are all pretty much the same. We've, uh, inserted electronic medical records into our care since then, but we haven't really been able to use them in any sort of intelligent way. So I think the whole industry is ripe for, uh, completely redoing what we do now and trying to add some intelligence in it. So instead of just operating, can we operate intelligently in the future?

Steve Lieber:
Our next question is how do you see AI and ambient intelligence enabling you to reimagine your care delivery models?

Dr. Bill Feaster:
Well, um, we've been applying intelligence to our care of patients for some time now. Uh, we started our data science journey about five years ago, doing predictive analytics and applying it back to healthcare. But in the last year, there has just been a quantum leap in intelligence capabilities through the use of Generative AI, the ChatGPT of the world, and the other AI tools, of which some are now really focusing on healthcare. So the application of those tools in the right way, the correct way to healthcare that both preserves privacy but also gives true intelligence, I think is going to be a game changer moving forward.

Steve Lieber:
And for our last question, Doctor Feaster, what do you see as the cost to hospitals of keeping the status quo?

Dr. Bill Feaster:
Uh, well, the cost of hospitals right now with our current status quo is unacceptable. Uh, we can't function much longer because our costs are all increasing. Our providers are sort of getting swamped by costs in their practices. Uh, everything is not, you know, it's not a sustainable solution. Nobody wants to pay what we're going to need to charge to keep doing things the way we're doing them now. So, uh, I don't think healthcare has a choice but to transform and try to figure out ways to not only staff smarter, but use staff or smartly. Like, for example, physicians, uh, currently are kind of the top of the food chain, and I appreciate that being a physician. But at the same time, with the advance of mid-level practitioners, if we can get intelligent tools in their hands to try to decrease the divide in knowledge between the two groups, we're going to be able to let the mid-level practitioners just have more and more responsibility over care and try to balance out, uh, some of our other shortages.

Steve Lieber:
Finally, we wrapped up the sessions with Arz Raheem, Senior Director at the Digital Transformation Office at Montefiore Health System, who focused his responses on ways we can transform healthcare today. Arz, what is your vision for a smart hospital?

Arz Raheem:
My vision for a smart hospital is to incorporate new technologies. I mean, we're at the back of conference today. I've been speaking to a lot of different people talking about generative AI, talking about AI, ambient technology, uh, you know, RTLS things that have been around for a while as well. So my vision is to incorporate all of that and to look at pain points within the health system that we have. So my role is I oversee digital transformation, and it's a good space to be in because we're outside of IT, but we sit very, very closely with the faculty practice group. We listen to the clinicians, to the physicians, to our operations staff, and and we try and understand the pain points that they have, uh, in their workflows, both operational and clinical, and try and address that with the right technology. And sometimes technology is not even the answer, but we want to make sure that we we address that with the right technology by listening to the folks that are actually undergoing the actual problems.

Steve Lieber:
For our next question, how do you see AI and ambient intelligence enabling you to reimagine your care delivery model?

Arz Raheem:
I think it's a really exciting, the space to be in with digital transformation and ambient technology. Um, you know, I've been talking to Care.ai and we've been working with some other organizations that do ambient technology and, uh, you know, have the technology to listen in to a conversation with a provider and a patient. So that kind of technology is a win win, not only for the patient, because I think it's a patient satisfier. Um, and I'll go into that in a second, but it's also something that can really reduce, uh, physician burnout. Uh, we are desperately trying to address physician burnout. What we have is we have a situation where, uh, pajama time and our hospital is through the roof. We have folks who are switching on Netflix at the end of the day and catching up with their notes and doing all their charting. When ambient technology has the ability to listen into the conversation, to create, uh, you do the charting for you do the medical note for you, and it requires minutes, if that, for a physician to quickly look at what the what's been suggested, check it, post it, and it saves a lot of time. It's an opportunity to see more patients as well. And obviously it reduces, uh, pajama time and physician burnout as well. So I think that's what excites me about, uh, ambient technology today in healthcare.

Steve Lieber:
And for our last question hours, what is the cost to hospitals of keeping the status quo?

Arz Raheem:
That's an interesting one. Uh, cost to hospitals is really. It's a trade-off. Do you want to stand still and hope that where we are is sufficient, or do you want to explore new technology? Do you want to look at generative AI? It's a really tough question to answer because healthcare has historically moved very, very slowly. I used to work in finance before. It was very, very fast-paced, but healthcare is a little bit slow, and healthcare, uh, is comfortable, I think, with being a little bit slow. But I think things like generative AI, it's, uh ChatGPT. It's not even a year old. And everyone in this conference is talking about it, talking about conversational AI. So I think you can either take a risk and jump on that bandwagon. But you have to be very, very careful about making sure that you select the right technology for your hospital, for your patient demographic. Otherwise, you lose that patient demographic. Not all this technology is the right technology for your particular patient demographic, so you have to make sure that you have the right, uh, strategy if you like. And I think the strategy has to be a change in culture, of a culture of innovation versus a culture of maintenance and preservation that we've had for so long.

Steve Lieber:
Well, folks, that's a wrap. We hope you enjoyed the insights from these health system leaders on today's podcast. We are always in search for insights from the brightest minds in healthcare that could help us move healthcare forward at the speed of tech. A big thanks to all of those that participated and a thank you for joining me today. Until next time.

Intro/Outro:
Thanks for listening to Smart From the Start. For best practices in AI, in ambient intelligence, and ways your organization can help lead the era of smart hospitals. Visit us at Smart hospital.i and for information on the leading smart care facility platform, visit care.i.

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