Betty Jo Rocchio (00:08):

My name is Betty Jo Rocchio and I am the Chief Nurse Executive at Advocate Health. And this is a concept today that pieces of it are in play. I came from Mercy, the health system out of St. Louis, where our workforce model is alive and well. And of course I'm bringing it to Advocate because it works so well there. I'm bringing pieces of it. And then you're going to hear some add-on concepts today about platform thinking to solve some of our most wicked problems that I think we keep moving around the plate, but we haven't actually solved yet. So you're the first audience that's hearing this presentation, including my fantastic team that's here, my Advocate Health team. I've got a lot of, there they are. Woo, they're hearing this for the first time. So we put a strategic plan and I arrived at Advocate in November and we had a strategic plan by January.

(01:06):

And so as you know, a strategic plan on paper is about as good as the paper that it's written on unless the leaders and everybody can get behind it and we can see the path forward to bringing it to life. And this presentation is a piece of bringing that advocate thinking to life. So they're hearing it for the first time. You're hearing it for the first time. So this will be interesting. Ai, right? It's all over the place. I would say responsible AI for nursing is really, really important. And a piece of why at least I'm so excited about AI is because it should give us back more time for relationships. And when you take a look at what's going on in this country and nursing, we have piled a ton of things on the plate of both nurses and nurse managers and we've taken very little off.

(01:56):

We haven't organized that plate very well and we're trying to figure that out now. And there's a couple concepts that are relevant in here, but I love this saying all this should be done to support the human experience. And the human experience is how we engage in our health systems every single day. It's about our patients, it's about our team, it's about our leaders. And quite frankly, it's about us. And so we are again, suffering from some of the work and overload because everything that they're doing at the front lines we're thinking about daily. And rather than organizing that, we're addressing problems that kind of bubble up through. And I think a comprehensive approach to this is the best way to go.

(02:43):

Alright? I wanted to just set the stage for Advocate Health and it is a very large system and my guess is knowing our CEO Eugene Woods, were not done growing. And so I feel alongside my nursing leaders a sense of urgency to get moving on some of these problems because adding more people into a workflow that doesn't make sense is just more chaos. And to be honest with you, we're not doing our nurses any great service, adding them into a system that's not organized. So we have about 6 million patients and growing about 150,000 teammates and 42,000 of them today are nurses and nurse leaders. And that's a very large number. And so you know this, when you start with an idea at the top of an organization and it gets down to the front, one idea takes about probably a thousand small cuts to execute.

(03:40):

So when you're thinking about what we're talking about today, AI and automation have to help us get there. Otherwise we'll spend the rest of our careers trying to make things happen. We have about 68 hospitals today. We're probably approaching 69 probably as I'm talking. And we have about 27 billion in revenue. So that tells you our size and scope. We are Advocate Health. We are one Advocate Health nursing as we're starting to say, but in areas of the country, we're known by different names because we added on three big systems to make Advocate Health in Wisconsin. It's Advocate Aurora, our patients know us that way in the Chicago area, it's Advocate Advocate, that's how they started. And in our North Carolina and Georgia markets, it's Advocate Atrium Health. We also have an academic center, Wake Forest that just became a part of us. So we have everything from soup to nuts.

(04:39):

And so this strategy needs to encompass all of that. Alright, I have to show our purpose and I'll tell you why. It sets the backdrop for the way we're thinking and advocate. And it's not just me. Every single leader is thinking in this way. We've been very good about this and I love this because in the very beginning it talks about redefining care. Notice it didn't say reorganizing care, working harder to try to make things happen. We are no longer in the spot where we can work any harder. And so you'll notice underneath our commitments, I love these because I love leading the way thinking boldly together, which is very important and embracing the unknown. I will tell you, we are stepping into an AI space that is largely unknown, but we have to get there. We have to figure out this is our most competitive advantage in nursing right now.

(05:30):

Alright, I like this picture because I think it depicts every single nurse after a 12 hour shift, right? And you'll notice it's not the physical that is hurting most of our nurses, it's the mental, it's that cognitive workload of working in the nursing process that occurs over 10 to 12 hours, sometimes 14 hours if they can't get done on time. And we are leaving them feeling like this whether we see it or not, that's what their whole day feels like to them. I have about 10 years left in my career and alongside my nursing leaders, we cannot leave our nurses like this. We cannot. We have got to figure out a better way and a path forward, what should we be focusing on? What should be our overriding goal? We have to figure out a way to measure nurse cognitive workload. And I would tell you everything in my whole body screams care delivery because when you're taking a look at things that matter, it's not several different initiatives.

(06:30):

It's how do we change the care delivery model to support both nurses and our nursing leaders at the same time? And that's why you'll notice for the next five years at Advocate, we're working on three things. The care delivery model for us encompasses our workforce. And you're going to hear a little bit about that this morning. Workflows how nurses are working and then our work environment. We know that workplace violence, organizing our work environment, everything is very much key. This will be our five-year plan right here in a nutshell. And we are working very hard alongside of our nursing informaticists and our IT departments to make sure that we're going to get there. And when you take a look at workforce, it's not about ratios, it's not even about acuity, but it's about workload. And that concept has not been well studied because certain people have taken a slice of workload of the objective workload and they always want to put acuity in there.

(07:28):

It's not that acuity doesn't matter, it's just not the overriding factor that leaves our nurses in that picture like we saw this morning. But it's that workload and you can see it. Our nurses are telling us that that's the way they feel because coming right out of school, everybody wants to go into the ED and the ICU where acuity is very high, right? Our patients are sick, they don't mind doing that. What they don't want to do is go into med surg and it's starting to back up if you look at it into our step downs. So people have a rank order of where they want to be and it's not in med surg and it's starting to hit step down. That's why we have to somehow find a way and a path forward to this because if we don't, that problem gets worse and that gap widens.

(08:13):

Alright, so our operational approach this morning, I'm going to set the stage for the workflows work environment and our workforce and we are going to start with workforce. And when I say balance, I mean total balance across all 42,000 nurses. That advocate, meaning how do we look at workforce and lift it out of the unit level, out of the local level, out of the regional level. And how do we start to take a look at where nurses want to be? And I will tell you the key to this is this. It's about looking at a platform approach. This is relatively new to us in nursing. When we say platform, I'm going to give you a great definition and then you'll see how it connects in. That platform approach is really about a digital infrastructure that supports people in exactly what they want or what they need.

(09:10):

And that is a very broad definition and we're going to take it down to workforce. So for us it's about connecting our workforce in a way that they want to work. It's not about us. Again, at the end of the day, we used to put out schedules, we talk about balancing schedules, we used to talk about requirements for working, not that that's still not important, but we're going to shift towards incentivizing and moving people to where they're happy, where they want to work, and then we will fill in the gaps in the right way. And that's a whole different thinking. And nurse managers struggle with this a little bit because guess what? At the unit level, their schedule matters. And so we have to get them into that platform approach across every single unit at Advocate to make this happen. What do nurses want today?

(09:56):

Why would we possibly think we could look across all 42,000 nurses and get this right? Because they want flexibility. We need to get the right nurse with all the competencies into the right places. Engagement of our nurses is important. We send out, I don't know what you guys do, but we send out a teammate engagement survey and our professional governance has been amazing at Advocate and they are behind all of this. But imagine a day where their engagement is so good that those surveys actually aren't needed because you can actually see them in their practice loving what they do. Our workforce platform is built on supply and demand principles and this is a business concept that goes into this platform that we can't overlook as nurses because everything is driven off of how many nursing hours we need and then what's our supply and how we get that supply.

(10:53):

That's where the magic happens. We need people to work at the right times. And we're going to talk a little bit about the way our concepts are going to shift and platform thinking here in a minute and then all of this people working, doing exactly what they want to do exactly the way they want to do it. That's amazing patient experience. How many people are trying to drive patient experience through tactics and things? It's not about that. Patient experience is about one patient at a time and how they feel on every single unit, every single hour. And nurses that are more engaged drive patients that have better outcomes and better experiences. And so connecting this in hits all of our core principles in nursing. Now what do we need to look at? So when you take on a platform thinking, you have to start thinking about definitions a little bit differently.

(11:44):

And today we may be looking at shifts. When you go to platform thinking, you're thinking about consumable hours. It's not about a 12 hour shift, a 10 hour shift, it's about how many hours of patient needs you have by unit and how many in your staffing and scheduling system that you have to supply it. And then building a workforce model that allows flexibility, which we're going to talk about in a minute. So hours are important, could care less about shifts. I'm not saying we don't schedule people in shifts, I'm saying we think about it in hours. Productivity. This is a concept that I love. My finance partners, they love productivity. Where are you on your productivity? I will tell you as you become more flexible, your productivity will drop, but your average hourly rate and cost can drop also because your skill mix when you're looking at skill mix or certain units that may need a heavier tech environment rather than a nursing environment, because we need to do certain things.

(12:43):

I'm thinking of a medical surgical unit where people are up and moving. We need to make sure people are getting their ADLs done for discharge. Productivity could be compromised there. If you look at it in the old model, what we need to start looking at is fill rate. So how many hours that we have that we need based on how many hours that we have, that's your percentage of fill rate. And what I will tell you is at about an 80% fill rate, your unit feels great. It's not even at a hundred percent, it's about 80. So we try to stay between the 80 to 90% fill rate and then your productivity just is what it is. I'm not saying we're ever going to give that up, but it's more of a barometer measure rather than an exact measurement on where we're headed. We talked about this a little bit earlier, but ratios, I believe we will see a time in the not too distant future where ratios don't matter.

(13:36):

If we could get a good workload indicator into our staffing and scheduling system, we could actually schedule by workload. What does that do for us? It allows our nurses to feel better at the end of their hours. I won't even say shift, I'll say hours because we're balancing workload. The same five patients on med-surg don't feel the same to the nurse. And I will tell you workload matters because a novice nurse will have a higher perception of workload faster. So your more experienced nurses, the same five patients may feel differently to them. And it's all about feel guys. It's not about a tangible number that we can put on it. So balancing the objective workload with the subjective workload and coming up with a workload score, that's going to be very, very important. I'm not saying we're not going to look at ratios, that's the way we're trained, but we will balance it.

(14:28):

Our charge nurses will have a tool built into your EHR that balances workload. So it's just another measure that helps us get it right. A lot of change management there because one nurse could have four patients when another nurse has six, but the workload is balanced and it's done by experience of the nurse. Alright, this model, this platform depends on us doing some very strategic things. And I will tell you at Advocate right now, we have a very big workforce initiative getting ourselves ready to take a platform, been here about five months, had a fantastic platform at Mercy, pulling that thinking across and actually adding to it. We get better as we learn more, but this workforce model has got to happen first because if you cannot straighten yourselves out from a programmatic standpoint, you can't add technology in because you will create a bigger mess than you have today.

(15:28):

And so straightening out these layers is important because the technology's going to move seamlessly between the layers to make things happen. And we're going to talk a little bit about technology and selecting the right partner that can get you there. So agency is what it is. We've got external, internal, even international in some of our places, but that agency layer largely remains the smallest hopefully. And at the top of our pyramid. And then at the bottom is our core staff. This is our full-time, it's part-time. It's also our PRN unit based people that just stay on our unit. They don't move around. They're probably for us, it's people that are closer to retirement that want to stay active and they're picking up a couple shifts on their unit in that middle though. That's the magic. The magic is in that flex layer that allows people to do what they want do.

(16:22):

And if you need benefits, if you want a 401k, you're staying in that core layer. So each layer has specific definitions to it that people can choose upon higher and move between the layers seamlessly. So the life cycle of our nurses changes too. When we're a little bit in our earlier stages or we're younger in our lives, we have kids, families, there's a lot more importance on that. We may need to go into some flexible hours. We could still be part-time core, but those flexible hours are important. Others benefits aren't important. Don't forget our workforce. We can get benefits from our spouses, our partners, our husbands and wives. And so that flex layer may be more important. You can earn more money, but the benefits aren't as important. You can choose what's important to you. There's the flexibility. And in that flex layer, local float pool, one hospital, several units, regional float pool, if you're like Advocate, we can work across even regions, but nurses can move multiple hospitals, multiple units and they're compensated for doing so.

(17:30):

And then we've got something called a gig per diem. And this is largely has to be a workforce that's employed by us, so their Advocate nurses. But what happens to them is they can work very infrequently. They may be working at the hospital across the street, but they pick up their extra hours with us. I will tell you this is a very popular concept that's still important today. That gig layer drags agency down to you and puts them in that flex layer rather than those agency rates. So how do you do it though when you've got 42,000 nurses? How do you make sure that nurses show up at the right time? Well, we can't do it in healthcare by ourselves and chosen a partner in Mercy, worked with them very carefully and they're sponsoring this morning. But works, trusted Health has a platform called works.

(18:24):

And the reason this platform is so important is because it moves seamlessly between these layers, it takes our current systems, our staffing and scheduling system does not go away. We can make it easier for nurse managers to schedule in, but that system is our core foundation for how we know who's showing up at every single level on every single unit. And then on the right hand side, we have a nurse credentialing system. Every single nurse that touches a patient in Advocate Health is credentialed in our nurse credentialing system and these two foundational systems. And you can set the system up a lot of ways. You can use your current HRIS system, but that credentialing system is based on skills, not jobs. And so one of the things that the Advocate team is working on right now is going from 800 RN job descriptions down to four, four or five because job descriptions don't matter.

(19:21):

I care about the credentialing, I care about the skill, I care about where nurses want to work and it's loaded in this automated credentialing system. So staffing and scheduling is automated. Nurse credentialing system has everything you could need for it. By the way, when joint commission comes, it's real easy to pull things because it's all automated and updated, which is fabulous. We know where people are working. And then here's the magic in between. The work system moves between all the workforce layers, looks at our staffing and scheduling system and based on fill rate by unit. So the unit of measure is our unit in the fill rate. It lifts all that out and we can see all of our holes across the system. And then the app and the AI in the background, this is where the AI comes in, is moving in the background to look at fill rate.

(20:15):

It looks across the unit for our flex layers across all of our units in the flex layer. It has rule-based engines in the back that don't allow people to work too many hours. The magic though is, and you're going to see some results here, the magic is that it prices that shift according to a fill rate. So the higher the fill rate, the less the incentive is offered. The lower the fill rate, the higher the incentive. When you set a rate card saying your top of rate card is a certain rate and your bottom rate card is this, the AI moves in between it and launches those rates based on the fill rate. So we're no longer competing at a unit level. We're lifting all those shifts out at an aggregate level and balancing them across. And when that happens, it opens up the world for our nurses in an app.

(21:08):

We are very used to working in apps today, very used to it. And so why would we think that a nurse wouldn't want to pick up an extra shift If they're core, it's their extra shifts that they pick up. If you're a gig nurse, it's all of your shifts. Your regional float pool can work right in this app and pick up their shifts because if you want more money, you're going to the shift, you're going to the units that need more help. It's based off of fill rates. So it automatically drives down incentives while getting fill rates up. If you're a nurse that wants to just work on a certain unit and you don't care about the money, you're just like, Hey, I want to work but I want to work where I want to work, pick it up, pick up. You're choosing money over flexibility or flexibility and you want the money, you're giving up some flexibility.

(21:55):

So it puts the nurse totally in control with where they're going and they can actually drive to what makes them happy. So your core people have right of first refusal. And that's the important piece here because as you're adding in, I'll tell you at Mercy we have over 3000 gig nurses picking up shifts. And so we want our core to have the first availability to pick up their extra shifts. It launches there first. And so this is the beauty of it, it's behavioral change as well as launching these shifts. They know when that schedule is lifted, they know their highest rate is going to be picking it up first, not waiting till later. They get trained to pick it up earlier because I told you fill rate as it goes up, the incentives get less. So it's the advantage to pick it up earlier because as people pick it up, fill rate goes up, incentives are launched in a different way.

(22:51):

And so that behavioral change is really important. The other thing is it doesn't launch flat rates. So it might be 1562 and then the next minute you go in it might be 1549. And so everything is kind of mixed up in that and people get the clues to get in there and get their shifts and get them going. And then it launches to your regional flow pool, your local flow pool, however you set up that system, you have that tiered approach to who can pick it up. And then obviously we had it launching to the gig nurses last because we wanted to make sure our internal people had rate of first refusal. Nobody can argue with that. Who can argue with gig nurses coming in to help when you had the opportunity to pick it up first and you didn't do it. And that's the magic sauce of platform thinking because it raises it up.

(23:40):

Now I will tell you, not all partners are created equal here. So you have to have somebody that can that platform to get you what you need. So it's not a one size fits all approach. Advocate may have a different setup than Mercy, than bond secures. We may all set this up differently, but the flexibilities in the platform. Alright, I love this slide because it talks about in a nutshell how this works. And we couldn't do this without analytics. This is the other thing. You can't just launch all this, I will say organized chaos out into the world for nurses without giving your nurse managers some analytics. And the secret sauce is the analytics in the background that show the nurse manager that this system's working because don't forget, we're asking them to shift off of exactly what they've been thinking all along, which is fill the schedule, get my schedule filled, how do I get more people to work?

(24:38):

The beauty of this is it takes all the weight off the nurse manager. So while they may have holes, they can see the data in the past of how many people have picked it up in that flex layer and they know it's coming. The other thing it prevents is nurse managers from having to pick up the phone to call people to pick up shifts. It's all done through the platform as soon as either somebody calls off or we have holes, all those shifts are launched into our automated nurse credentialing system. For anybody that can pick up this shift that's credentialed in an ICU that's credentialed to do med surg and wants to do med surg, they don't get every single shift across the health system. They only get what's relevant for them. And so when you do that, the nurse manager right at four 30 in the morning can stay in bed without looking for all the people that have called off and trying to get somebody to work because the app does it.

(25:32):

You literally have people that sit at home waiting to see who's calling off because that will launch a higher incentive shift if they call off last minute. And there are people that will do it for the right price. And so it automates the nurse manager's workload on how they do staffing and scheduling and the nurse likes it better. So it's like a win-win. I know it seems like why wouldn't we do this? That's exactly right. Why wouldn't we do this? And we have analytics that we don't have today. You can see your average hourly rate. You can see the effect that AI has had on adjusting these rates. It is a seamless collaboration for both nurses that want to move between the workforce layers. It's also seamless for lifting every single shift that's available across all 69 hospitals. It picks it up and launches it into the platform perspective.

(26:27):

We talked about the definition of platform that is merging people who have a need with are us filling patient care hours with people that can do it and it does it seamlessly working across. So what really does it show? Here's what it shows and there's many more detailed analytics that the nurse manager gives, but you can see we're talking about fill rate here. And so our overall fill rate increases while our average hourly incentive rate decreases. Because when you launch incentives regardless of who you're launching it to manually, you're picking a number. Every nurse manager or every staffing office is launching a static number and there is much waste in that. And so when you use AI in the background to launch these incentive shifts, you can see the result and I promise you this happens. And so you're paying less. People are more satisfied, they're picking where they want to work, it's a win-win for everybody.

(27:27):

And nurse managers can stay without messing or making any phone calls and this platform actually forces the function. You cannot change the incentive rates. AI in the background dictates it and when it's launched the nurse picks it up in the app and then they're paid. So it goes directly across to payroll. So you don't have managers approving rates, they're not getting up to try to fill things. It's an automatic load across and that's been, it's invaluable when you take a look at it, the nurse managers experienced decreased workload as well. Alright, I am going to stop there because without a strong healthy workforce and if I had to urge anybody to do anything from this talk today, it's get the workforce moving first because without the right number amount of help at the bedside, anything we're going to talk about next in platform thinking doesn't go well without the right number of nurses and making it happen.

(28:25):

But I wanted to extend this platform thinking into the newest thinking for what I think is going to happen in the next five years. And I'm taking a big bet here too and so are my entire Advocate team because we are heading here next. So we talked about workforce, have to get that moving, have to get the right hands by the bedside, please don't do it without some amount of technology help because you will cost your system money and it will be a massive failure. So urge you to think about what that platform thinking looks like for your health system. Trusted Health has been a great partner as well as I think they can customize to smaller places as well as the Advocates of the world who have just a ton of nurses. So it's easy to do both after we have our workforce alive and well.

(29:13):

This is going to be the next phase of platform thinking and it's going to be done in a digitally enabled work environment. And so this is where I'm going to start to talk about future trends underneath workflows and work environment. And this is a new concept and I'll tell you how it came to our minds and Advocate. There were a lot of leaders thinking about this with me. Virtual nursing is alive and well at Advocate. We have such a strong virtual nursing platform that remote into the bedside through cameras. We're doing a great job. So you know what worries me most? That finance is going to figure out that we have just taken nurses by the bedside, placed them virtually. We know nurses are happy, we know it's the right thing to do. We know they're a great amount of help at the bedside, but we didn't change ratios because people still need that bedside help.

(30:04):

All we did was add extra cost into that structure. And so I'm trying to think of a way to make virtual nursing sustainable for the long haul and it's going to take a platform and platform thinking to get there. I think we can get better results. We can still have our virtual nurses, we can still have what we need at the bedside, but it's going to be about combining a couple things in a digital platform. Alright, this is where we are going to start to head at Advocate Health under workflows and work environment. And I don't know how far we'll get this fiscal year, but we're going to start to dab our toe in it because we have such a great virtual platform up and running. We're in 24 of our hospitals with virtual nursing in some way, shape or form today. And we have plans for this fiscal year, which started in January to launch another 13.

(30:59):

So you can see we are heading towards making virtual nursing a standard. As I do that, I'm starting to look with my finance partners, I'm just getting ahead of it before they ask me what's our cost structure to deliver care combined. And as we do that, I'm going to start to think about some roles that could be combined for the better. The bedside nurse is finding just a tremendous amount of help with AI tools. So when we're talking about workforce, we have a great platform and now we have tools at the bedside to make workflows easier. Win win, win win. The virtual nurse is alive and well. And for those of you that don't have virtual nursing, I'm sure you're thinking about it or how to add it in. There may be benefits to waiting until this platform thinking kind of evolves. And I am meeting with partners today that can do it.

(31:51):

In fact, I see a couple of them out in the audience that are going to help us think about how to get to a platform. The virtual nurse is extending not only the knowledge at the bedside but the reach of nursing. And this is a very important point for virtual nursing. When I hear people say, well it's help for the bedside, it is actually not help for the bedside. It is a necessary part of care delivery that extends the thinking of the nurse from admission clear through other sites of care. And I'm sure your hospital systems today are not thinking about things in silos. So inpatient care, outpatient care, next phase of care if they're going to home health or hospital at home, these platforms extend across all this and have nursing thinking about things in the right way. So the virtual nurse to me is that connector across all sites of care.

(32:46):

And that's the way we're going to start thinking about virtual nursing. It's not only one patient, one unit, just as we looked at when we make it a platform, we can take it out of that and make it about the patient and the patient moves across sites of care. Very important. The care manager today is usually a nurse, sometimes it's a social worker too and they'll be in our platform as well. But that assistance of the transition of care doesn't have to be in separate lanes. And then we've got, I'm going to stop there and then say then we've got a nurse manager and they're working in a totally separate lane, but guess what? The common denominator is the patient. And when you talk about patient experience, you talk about high workloads, some of it our highest workloads are in transitions of care, admission, transfer and discharge.

(33:34):

If you look at where our workforce is using a good bit of their time, it's during those things. We've got a digital environment to do that in. Why are we putting it on the bedside? Let's straighten out our roles with a platform approach. Why don't we do it? Let me tell you why we haven't done it before this because the EHR is done in segments. The EHR has forced us into workflows that say, bedside nurse, here's your workflow, stay in your workflow. This is all you can see. Let's make it happen. Virtual nursing opened it up a little bit. They can see across a little bit more. Still not enough though. Still not enough. I will tell you that they've got much more capability, which is why I don't want to lose that compliment into our skill mix based off of finances, which is why I'm, we're thinking about getting ahead of it.

(34:24):

Care management comes in, they're working in a totally separate lane that are both inside the EHR as well as external. If they go into different sites of care that we don't own, that puts them in a totally different workflow. And God loved the nurse managers. I don't know if there's any nurse managers in here, but I will tell you, hardest job on the planet and we make it harder because guess what? They're not working in any workflows. They're trying to figure out everybody else's workflow and trying to figure out what's going on. This is what I love. I love when we're looking at quality or patient experience or teammate engagement. Here's what we say to the nurse manager, you've got nine systems you're working in. Could you please make sure everybody's happy? Could you please make sure that our quality is top notch? It has to be.

(35:07):

You got to know what every nurse is doing on the floor, right? And you can't, you're blind, you just got to walk around and do nurse rounding. It's a flawed approach guys. It's a flawed, it never had the opportunity to be successful because what you're asking the nurse manager to do is manage system thinking. You're asking them to manage data and analytics in several different systems. What quality is, it's all data that rolls up that the nurse manager's chasing. Can we do that? And you know what? My favorite is audits. I love that. That just like, oh, when I hear, hey, can we add an audit on to get a quality process going? I want to go like this. No, no, they can't do anymore. They're already like they're dying on the vine, but it's all somewhere. We just have to lift it into a platform.

(35:54):

And so the nurse manager, so let's talk about, I'm going to briefly here, I'm going to run through some of these slides. We're a little bit over, but I want to talk a little bit. I'm going to talk about separate workflows really quick with AI and then I'm going to talk about blending them and where the platform approach is going to help us most in this thinking. And so the bedside nurse works in something called the nursing process. And you guys know this and I'm not going to go through this, but you can see there are different points in the nursing process where we could just bring in AI without a platform approach. We would say voice activated charting. We're doing a pilot with Microsoft right now, copilot, it's going to be amazing. We need it. It's a point of use approach that only gets us so far. I'm not saying we're not going to do it at Advocate, we're going to do all these things, but we're going to raise it all up to some platform thinking here in a minute. Patient education. We can auto generate materials, documentation, ambient voice. We can do all of that handoffs. We have AI into handoffs now, so we don't have to generate all of that.

(37:00):

Here's another view of it. The EHR drives nursing workflows, it drives nurse manager workflows and it drives nursing workflows at the bedside. So straightening out the EHR is essential and not adding in AI or extra technology that's external to your EHR. When you put anything external to your EHR, you are creating more confusion. And so don't let anybody talk you into point of view solutions that are out here. It's all got to work into the workflow because the EHR we talked about it is driving nursing workflow in bits and pieces. And so you will notice at the top of this, and that's the reason I have the slide in here, the workload indicator is number one, if we can't measure ourselves, there's no sense of doing any of this. Because if we said workloads, what's affecting both the nurse manager and the nurse? I would say probably every single bedside position, but there's no sense because we've got to reorganize at that unit level first.

(37:55):

But you will notice the nursing brain, which we have in Epic, it's a task list. We don't use it today as effectively as we should because it doesn't drive anything. It sits there. It makes the nurse go into the task and figure out when to do it, how to do it. It's not useful on a flat screen like that. We've got to figure out a way to get that into the platform approach that care transition handoff again into the platform approach. Plan of care rounds become much easier when you've got AI assisted voice recognition and the nurse doesn't have to jot down on their scrubs or on a board and transfer it into Epic when things flow, we eliminate cognitive workload and we don't have to remember things. The whole goal is not to remember things for the nurse manager or the nurse at the bedside.

(38:42):

And so that's why the virtual nurse is such a big deal to us, right? Because it takes some of that workload they remote in at certain times. And the other thing I'll say is if we put virtual nursing in a platform approach, they don't remote in. They're part of the care team. They know what they're doing every step of the way. And so we are going to get there and advocate with how do we work that into workflows even better. We're starting to think about it now. And so, okay, the nursing process was developed in 1958 by Ida Gene Orlando. We have not updated it with any current thinking in any way, shape or form, but Epic is built off of the nursing process and they just took it flat on a piece of paper and put it into an electronic system. Now we have to take the nursing process and lift it into a platform approach that nurses can use.

(39:29):

And I put this on here and I'm sure you guys will get the slides in some way, shape or form, but I put in here the nursing process and where we might want to put point of use solutions to help us. And one of the biggest things I can see as a benefit is at bedside shift report where the relationships starts, right? This is all about relationships, this talk this morning, but it delivers the information to the two nurses and bedside shift report that are going to be talking about the patient. They don't have to remember what happened during their last 12 hours. They have that automated generated report and that report updates the care plan. The care plan develops the shift report. And so we don't want nurses going in at the end of their shift and documenting on a care plan that's a real live, I would say plan of care, not care plan, big difference.

(40:20):

That's where our goals should come from. But today they don't because they're flat in a file in Epic. But if we're truly nurses and we're working towards goals and length of stay, that is a dynamic document that could very much be automated and updated and then it would be compassionate personalized care, right? There's again, our relationship piece coming back and so there's many pieces that we could add in AI to help us, but again, it's still a point of use solution, but we need it now. The virtual nurse has a little more at their fingertips, right? They're able to remote in, they can get into charts and see trending across time, which is great for the virtual nurse, the bedside nurse, unless they go in and trend for themselves. It's really hard to see what's been going on with the patient because again, we're updating that plan of care in a non-automated fashion and it's essentially useless.

(41:12):

I don't know what else to say. We do it to check a box for joint commission, but we don't use it for anything. The virtual nurse can be a little bit more interactive with that. They do coordinate care a little bit better, but again, it's a cost to the organization. Now, the care manager, nobody's thinking about this function, but when you talk about care managers today, they don't have AI into their workflows and so they're doing almost everything manually, but risk stratification, perfect use case for ai. So if you had a virtual nurse helping with the admission assessment, which some of us are doing today, that could flow into risk stratification immediately into the care management module if we lifted it into a platform. And discharge planning actually will occur upon admission because that risk stratification pulls that into a platform approach that everybody can see, including the nurse manager by the way, who actually owns all of this but can't see any of it.

(42:10):

And so we're able to pull this across sites of care with Epic, we can see Care anywhere, so we could pull that stratification into the next phase of care. But again, the care managers working here off of the documentation that the nurse is doing, which by the way is way behind not timely documentation. So everybody's working from behind and working really hard in their brains to catch it up. And then nurse managers, God love these people. They are like the hardiest people ever. I might pull my hair out trying to do this job, but we put them into workflows. They're completely blinded to all of it, but responsible for everything. If they want to see anything that's going on, we do have epic dashboards, but they're largely not real time and they're not queuing into the nurse manager's calendar. I'm talking about a platform that manages the nurse calendar daily for standard work that puts all those things that are going on on the unit that is well documented into Epic with all the other AI tools, pulls it across their calendar and says, when you arrive today, there's a patient in 365 that something happened overnight.

(43:18):

You need to go in there first. I'm talking about queuing up the nurse manager for exactly what you want them to do. We talk about standard work for our leaders, but things get in the way of accomplishing standard work. If we lift their calendar out, we make it a live document that they're working off of, we can make this happen. They will have care seamless care coordination. They will know their risk points on the unit. They will know they don't have to go in and look on a dashboard to say that the Foley's been in for 48 hours and should have come out. It will queue them up. You have five Foleys today, you have three central lines. This is the suggestion order of priority based off the risk stratification that I need you to see them and it holds periods of time. So nurse rounding is inherently built in. It's not one thing they pull into their day, they are all day long interacting with nurses and patients in real time. That's what happens when you lift that calendar into something that they can manage. Now I'm not saying they don't have other pieces they have to do, but again, it's managed in the standard work and patients and nurses come first for nurse managers.

(44:23):

Alright, I'm going to come back to the workforce again. So when you give a nurse manager predictive staffing, I'm not talking about they're doing a schedule, I'm talking about the schedule opens up with the predictive patterns based on a large language model that's in the background because we know we're taking a census feed. We know time date stamps of when patient hours are occurring. We can launch a predictive schedule if we have automated position control for our people that are on our unit. We have predictive staffing that is occurring and it launches and opens up a self-scheduling with rules based in it so people can't and they have to pick up if they do have to do a weekend, all that's in there and the nurses can self-schedule in an app and it won't let them do anything that isn't rules-based. The nurse manager saves about two hours a day if you can get the right workforce platform moving.

(45:22):

Again, I don't want them in a schedule, I want them with patients and with their team. All this happens with better resource optimization at the right time, at the right price. You can't do it without some automation. Can't do it. Alright, in the last 10 minutes I want to paint a picture of what those four compliments can do working in a platform approach. And so when you're talking about an EHR that's built like this and the patient's moving like this, lifting all that data into a platform to help us is going to be essential. And I'm not saying we can get it with one specific platform, it will look seamless to our people, but at the end of the day, if we're going to create a human experience, it has to be making time for people and managing papers and managing the EHR is not value add.

(46:17):

And so when everybody can see all the information in the same way, you can have your care manager that is directing the care virtual. I'm going to argue, and I'm still tossing this around so don't hold me to this. The care management could be the virtual nurse. So where we have two separate people working today in the right workflow, you could pull that in and your virtual nurse could be the care manager and could be the virtual help. There you go. There's one FTE gone down. I'm trying to get to a cost model with an easier workflow. I have not done this, so my brain is still working around it and I'm going to tell you all the Advocate nursing leaders, you're hearing this for the first time too. We're going to have to put our brains around this because it's going to be really important that we get that one step right?

(47:05):

But I do think why do we have separate people doing this? Because virtual is managing care in the episode. Care management's trying to manage the patient across it would make sense that we would put that brain power together in a platform and manage it across. I'm not saying anybody's losing their jobs, I'm just saying we don't have enough people in either resource category. If we pull them together, we may have enough and we may do it the right way. Enhance communication through information sharing. If everybody can see everything, we will be better together. And guess what that makes the workload on the nurse way better, improved outcomes. Outcomes will be a result of the workflow, not something we're driving separately like we do today. And then continuous improvement is that feedback loop across all nursing roles. But the patient's in the center, the EHR isn't in the center like that one slide the patient is and the EHR is assisting, probably going to have to lift it into a platform, but it allows us to redesign care in the right way for the patient and our teams making way for relationships.

(48:10):

And so we're connecting all of this through the EHR. The EHR is always going to be essential. Your staffing and scheduling and your workforce platform essential how we merge thinking about the patient and the patient care. That's where the secret happens. The secret sauce happens right there. And so with AI coming into the picture, we can do this pretty much seamlessly. If we pick the right partners, we have the right vision and we execute. And then I will say, don't forget your cost model. We are going to have to have a cost model that drives us into the next century of care. And it's not just the cost in the four walls of the hospital. It's total cost per patient life. It is truly population health come to life with full visibility to both cost and outcomes. And the nurse manager spends their time managing the patient nurse connection.

(49:02):

The outcomes come, their cost and quality is managed at a level that they can't even see it today. And everybody's happy. Finance is happy, HR loves what we're doing, and at the end of the day, we're driving better care for the patients. So I love this slide and we use it, we call our five-year plan rewire 2030. This is literally a rewire when Gene Woods stands up and talks about, Hey, we have to rewire, this is what he's talking about. Different care models that allow us to go into thinking, we know it's not going to be seamless, but put us into that care delivery model that's way different. I love that. The urgency of today and the promise of tomorrow. If we don't do anything differently, guys, even if we make a misstep, if we keep doing what we're doing today and just add in point of use AI solutions, we're going to end up with a huge mess. We're not going to add 'em in the right order. So platform thinking, workforce work environment workflows, stay on that path for a better tomorrow for all of our people and our patients. So that's where we're headed. I have I think just a little bit of time for questions if anybody has something there. Yes. First of all, congratulations to your team. They're amazing

Speaker 2 (50:22):

At the same time. It's just amazing to have a CNE who understands.

(50:35):

So I did a study on significance of workflow automation in nursing practice, which you can see actually a poster of that. And three predictors that I would like to share is if the organization has a strong IT nursing partnership, IT support, and also if the organization prioritize innovation and efficient workflows, how do you guys get to that journey? I mean my study just totally reflects what I'm seeing here.

Betty Jo Rocchio (51:04):

Well, here's how you get to it. First of all, it has to be in your strategic plan for nursing. So you've got to call it out. You do have to have some nursing informatics help and we have an amazing nursing informatics team, but we're going to power up a little bit in the nursing informatics lane because that's that human-centered design with all this technology we're lifting because we've got to go from up here down to the front line to make it happen. So you are a hundred percent right. Here's the thing, I don't know if hospitals are going to make it without this infrastructure at some point. And so I don't think it's a matter of if, it's a matter of when and when they get on the train. And don't forget, let those of us that have more resources get out in front, like you have a whole poster going.

(51:43):

These type of things make a difference and calling it out. Sometimes it's two year journey to even get to see your hospital or your health system revamping it, but without it, you're costing yourselves a lot of money. So doing a proforma on where you can save, just like we're looking at that care delivery model is key. You've got to get finance in there too, right? Finance, hr. So pulling all the partners in on our workforce initiative that we have going on myself, my CHRO and my finance leader are sponsoring that work together. We can't go at it alone. You're a hundred percent right, but we're all going to get there. The question is when, because I do think Epic's going to have to take some of this into their system and we're working with them as well. So you can see how we can be great partners together. That's why I'm looking for all of us to get engaged in this because Advocate can't do it by themselves either. So we got to figure this out together. Anything else? It's early. So yes platform. We actually developed it out of, we had Workday at Mercy and we developed a piece of that out of Workday, but it's a whole separate standing. We developed it, I guess is what I'm going to say. Workday has a piece of it and Advocate, I'm going to use Workday and I'm going to fully develop it all there in Workday, but they don't know it yet. So we'll see how that goes.

Speaker 2 (53:04):

Thank you.

Betty Jo Rocchio (53:46):

So here's one of the things we have to work on it. Our staffing and scheduling systems that are launched out there today, they are black boxes that are holding patterns. And so we have to automate that piece of it to do exactly what you're talking about in an app. It's got to be app driven. So if they need to change anything, I'm not saying it doesn't have to be approved, but at the end of the day, everything needs to be able to go through that app base. So that's where we're looking at doing it and we are looking at how do we get an automated staffing and scheduling. Without that, you're not going to be able to make it happen. Even the intermediary can't get all that done because it is the staffing and scheduling. So head there first and more news to come, but starting to work on that automated staffing and scheduling, you have to have it. We don't have it. We have it nowhere today. So that's your key right there. Anybody else? I know it's a lot of thinking, there's a lot of work still to be done, but I appreciate you guys coming and listening and if you have any questions, I did put my email up here. Happy to chat offline and I would appreciate your partnership as we move forward. So thank you guys.

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