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Episode 96: How AI & Machine Learning are Transforming Nursing

May 3, 2023

Episode 96: How AI & Machine Learning are Transforming Nursing

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May 3, 2023

Episode 96: How AI & Machine Learning are Transforming Nursing

May 3, 2023

Dani:

Welcome to the Handoff, the podcast or nurse leaders from Trusted Health. I'm Dr. Dani Bowie. Today I'm talking with Dr. Brian Weirich, the System Chief Nursing Informatics Officer for Banner Health System. He's a nurse leader with a passion for new ideas to lessen the documentation burden for frontline nurses. He believes in reducing physical tasks and enabling decision support tools for nurses to free them up to focus on what they do best, taking care of patients. You'll hear Brian's shared passions and technology, startup entrepreneurship and leadership, and how those combined passions have motivated him to find new ways to empower nurses to succeed. Let's dive in. Brian, welcome.

Brian:

Yeah, thank you for having me. Excited to be here. Excited to talk to you.

Dani:

Yep, me too. You know, I've been talking with a lot of leaders across the country around workforce flexibility, and I've talked to a variety in different roles, different health systems. But you are our first CNIO, and I've studied a bit of your background, Brian, and you have a really unique kind of upbringing into the space that you're currently in. And so I would just love it if you could share briefly a little bit about your professional journey and background and what led you to your current role at Banner Health.

Brian:

Okay. Yeah, this was, it's been an interesting journey for me. I've taken some non-traditional paths, but I I, I wanted to be a nurse in high school, and I wanted to be a flight nurse. I, I went into the profession. I wanted to fly in the helicopter, wear the fancy suit. So I graduated nursing school or graduated high school, went to nursing school, pursued my associate degree. That's all I needed, and that was that's what I needed to accomplish my goal. I met my wife in nursing school. From there we took our first jobs at the Cleveland Clinic in Ohio. I'm from Ohio. I worked in the ICU. I was strictly working to do what was needed to get on a helicopter. From there, I went to Ohio State Medical Center and recovered open hearts at Ohio State.

Loved that. Spent a lot of years at Ohio State. It was there though, when I got my years in, I went to pursue flight and was told their heightened weight restrictions to fly, and I exceeded both of 'em. <Laugh>. I, I'm a bigger guy. I played college football. I was never taught that and I was kind of crushed. At the time, I didn't know what I was gonna do. I guess that's a good thing about nursing. There's a lot of paths. And it was actually a mentor of mine at Ohio State. I was in like an emerging leaders class, and it was the CEO who was like, Brian, do you like what you're doing? And I said, well, I do. I like being an ICU nurse, but this was not the plan. I wanted to get on a helicopter. And he said, I think you should think about getting into leadership.

You seem very business minded, very entrepreneurial. You should consider leadership. And that's what it took. It took a mentor to tell me that, to head down this path. So from there, my journey has taken me kind of all across the country. I went back to first, back to school. I got my bachelor's, master's, doctorate degree. Took roles with different scopes and ambulatory inpatient periop to learn all those, a facets of what healthcare is traveled around the country. And it wasn't till I landed in my first CNO role in 2016. I was back in the Midwest at a large academic health system, and this was pre covid. I was trying to solve the problem of nurses making errors at the bedside. And I, I even felt like then there was a nursing shortage and the quality of nurse we were getting isn't necessarily what it used to be.

And so I really branched out into the startup healthcare startup world. I went down that rabbit hole with the local startup community and then the national startup community. We met a lot of interesting people and that really kind of got the innovation bug, like, Hey, let's solve problems truly in a novel way, not what's published out there as evidence. Like let's get a novel solution. And from there, I relocated out to Arizona about two and a half years ago. Came out here, my wife, my kids came out here, got a job with Banner Health as a facility, CNO at one of the large academic health systems or the large level one traumas was here. And even in that role I was kind of the innovation guy. I was really focusing on virtual nursing during the pandemic have a background in natural language processing and artificial intelligence machine learning.

I was really trying to bring new tools to the forefront for solutions for Covid. And then our chief nursing informatics officer left. I came in and, you know, I, I came in as the interim and I wasn't I made it clear like, Hey, I don't love the electronic health record and I have too much energy to just focus on this. And was really given permission, Hey, we really need to, the role needs to evolve. It doesn't have to look like it always looked. So it's really evolved a little bit to focus on merging with emerging technologies and then how can we really build new models of care and then reducing the documentation burden should be a byproduct if we accomplish those first two. So that's what's led me here today.

Dani:

That's impressive. I was listening and, and I was getting tired as I was listening, and I was like, man, the journey that you've been on and the experiences that you had is just phenomenal. And the, I think the depth and breadth of that experience is quite unique. I love that you knew that you wanted to be a nurse even in high school, and that you stuck to that vision and then the vision expanded and grew is you got more experience and, and exposure into these different spaces. And another thing that I think really resonated with me that you were talking about was how you were really trying to solve problems. You went into these different roles with a mindset of problem solving and through the problem solving, bringing innovation and new ways of operating to clinical practice at any level. And so that's just very inspiring to me and something that I think is a good pulse check for a lot of leaders is, you know, looking at it at what are you trying to solve and let, letting that be your true north and a lot of things that you do here.

Now as I've been talking with leaders across the country, as I mentioned the intro around flexibility. And, you know, we're going to jump into and dive into a bit more of the, some of the innovative work that you're doing at Banner Health System. But before we go down that path I'm curious from your perspective, you know, what flexibility means to you as a nurse leader and what does it mean to the, to the nurses that you lead? And as I mentioned, you have that depth and breadth of experience in a variety of roles from the startup space and innovation to CNO of large hospitals as well as, you know, systems, CNIO for Banner Health. What does flexibility mean to you as a nurse leader? And then what do you think it means to the workforce that you're also leading? And this is in terms of the workforce, and oftentimes what I'm seeing in the literature is just the tagline and a flexibility. It's a hot topic, everyone's putting it out there, but I really wanna know, what does it mean to you as a leader and what does it, what do you think it means to the, the nurses that you lead today?

Brian:

Yeah, that's a, a great question. I could really go into multiple levels of this with flexibility and work-life balance. Lemme take this kind of into two parts. So flexibility for me and then I think it resonates. I can really kind of speak for a generation. Things are different. What matters to the nurses coming into the workforce, we'll call 'em the early careerists. You know, they were shaped by different milestones and their priorities are very different. They're not worried about health insurance when they graduate. They can stay on mom and dad's health, insurance life experiences are important to myself and to them. So what does flexibility mean as things in life change? The global pandemic nurses who are starting families and aging nurses who are taking care of aging parents. It's not the same journey throughout. And I, I really want an employer who is gonna work with me as the individual, as Brian as I go through these life changes.

And my wife is a nurse, so we're very fortunate we didn't lose jobs during the pandemic. But we knew a lot of people who did. And we have to have some empathy and some flexibility to work with people through these life changes. And that's gonna mean scheduling. But hey, I also, I heard about chatGPT, what does this mean? Who can teach me about this? We've got a large Hispanic population here in Arizona, so a lot of people wanna learn Spanish. What resources do we have for people to learn this? And if they make an effort to go learn this skill, again, we have to be flexible with them just do these life milestones because it's different. We're so, we're so rules based and that there isn't, there often is no flexibility. And I often preach that, hey, as long as things are fair and equitable, we got, we need things to be fair and equitable. But with life changes I'm not saying you have to make exceptions, but you have to be flexible cuz nurses and nurse leaders have so many choices. If I hit a hard stop that doesn't align with what I need or what my personal life goals are, or my family life goals, I'm gonna go somewhere else. So we have to meet people in the middle.

Dani:

You bring up a good point about, I'm asking, you know, what does flexibility mean to leaders as they're leading their workforce and ensuring that there's scheduling and options and moving through the life journey. But what you also referenced was that there's the ability of the workforce and the nurse to choose where they go. So right now we're living in an era and a time of choice and flexibility around who we choose as an employer. And so we have the ability to move and look for new opportunities if by for some chance we're working with an employer that isn't meeting our, our life needs. And so I think you're calling out something that's really important for leaders and health systems to hear is that there's a lot of flexibility of choices for the initial entry point and then the depth of flexibility in the organization could sustain or help your workforce, you know, retain and work at that organization. And being mindful of that. And moving from a place of, you know, rigid rules to understanding how to adapt to, to life changes. As we think about life changes though, and and how important that is and the journey of our careers, from your perspective, is there anything that you would recommend for nurse leaders to do or health systems to do to be more flexible or agile or nimble in meeting the life journey of the workforce that, you know, a lot of nurse leaders are leading today?

Brian:

One of my previous employers was taking this journey kind of through their high reliability organization journey. And that's where the quote we wanna go from rules-based to values-based really came from, and I, although I'm no longer with them, I've really adopted that philosophy. And it is just that, hey, we need to see people as an individual. This is the dress code and tattoos and people need to be able to express themselves in different ways. And we have to work with them for that. Again, if we, if we draw this box and put people in it, they're not gonna be happy. And, and joy who, which became the fourth quadrant of the quadruple aim, the previous triple aim became the quadruple aim when we added physician satisfaction and employee satisfaction. And, and this is a part of it and scheduling is a part of it too.

 You know, we historically have always been, you know, you have to work your weekend obligation every other weekend. And an example of something I dealt with recently, there was a team member who wanted she wanted to work every weekend. The weekends that were being scheduled were like Friday and Saturday. That was considered the weekend. And she wanted to work every Saturday cuz she was taking care of an aging parent and didn't have help during the week, just on the weekend. So she wanted to work weekends and the rule was, hey, the weekend obligation is Friday, Saturday and this is any like, no, we have to work with this employee. She wants to work more than her weekend obligation, you know, every Saturday. But additionally Sunday, which is a hard to sche frequently, a hard to schedule day. We're not, we're not cheating everybody else by not making her work weekend.

And that's where, you know, that's where it would come in if, if they could opt out of weekends, she's willing to work more than her share. But the rules were you have to work the Friday, Saturday and, and we, that was one I hate to use the term exception, but we had to be flexible for that. Let me take it another step further with kind of the flexibility and I'll switch it to, I think work-life balance is a term that a lot of people use. And I tell my teams, and I think I adopted this from General Electric, a book coming outta GE that said, there's no such thing as work-life balance. They're work-life choices and you have 'em and you make 'em. And I truly agree with that. To personalize this a little more, in 2019, my, one of my older brothers was getting married and he was just under 40 and he was talking about a bachelor party and he says, you know, most of his friends were married with kids.

So a traditional bachelor party was probably out of the question. And he said, let's go do a bucket list item. Let's do the Mount Everest base camp track and if we're gonna be over there, let's extend it and do the three pass extension. And I would love to climb a mountain, any mountain in the Himalayas. So this was overall, this was a month long journey with minimal cell phone service. And at the time I was in a vice president role and it had not been uncommon for me to go off the grid for a weekend or maybe a week, but never a month. But this to me was, I felt like a great opportunity to do a once in a lifetime thing, check a bucket list item, and then do it with one of my brothers. So I booked this trip, I paid for it, had the flights and I sat on it for like seven months.

I was really nervous about asking for a month off and I told my wife who is super supportive of this hobby of mine, and she says, you know what, if they say no, and I said, well, I'm going on this trip and if they say I can't go, I'm, I'll quit and I'll find a new job when I get back. I'm a nurse, you're a nurse, I can find a job even if it's not a leadership job, I'll cross that bridge when I get to it, but I'm not gonna turn down this opportunity. And I left in March of 2019 and it was December. I was at the holiday, the Christmas holiday party and I approached my boss probably with an alcoholic beverage in me <laugh> and said, Hey, I, I just booked this trip for a month to go to Mount Everest and are you okay with it?

And I didn't get a a yes right away, but about a week later it came back and said, yeah, it seems like a great opportunity. You should go. And you know, I can't wait to hear about it. And they really took a great approach and was supportive. I would've left. And I still feel that way today. And I often see this in the early careers, the new generation coming in. So we, we have to work with because it, it was as personal to me. So when they say I've got this great opportunity or you know, there was a time when I would have three to five nurses all resigned together cuz they were gonna go do a travel assignment in California. And I'm like, that sounds like the most fun ever. How do you say no to that? Yeah, but how do we set 'em up to make sure that when they wanna settle they come back, they're all in Arizona, they graduated nursing school here.

Like this is a great opportunity. I can't falter for that. It sounds like a lot of fun with friends to go live in California and help out in the pandemic, but how can we get you to come back and then work with them about holding their seniority and a spot on their unit cuz they, there's no orientation required to come back and they'll probably learn more critical thinking and new, new skill sets and how to do things differently and that, so just to work with those people. But I think about that a lot and during the pandemic here, because I live in Arizona and we're so rich in outdoor activities, we built a spreadsheet of bucket list items. Like here's the hikes, here's the mountain bike trails, here's the waterfalls, go do this. We want you to get out and explore and then potentially stay.

And then I wrote an article that published last October called Nature a post pandemic prescription. And it just ties all the literature about the benefits of getting outdoors and being in nature and seeing sunrises and sunsets and how it helps with PTSD symptoms. And so now I encourage people to go do this. And for me the higher the mountain, the more remote the better. So when I, when I hear people that have done these adventures or people, you know, the, the respiratory therapist I've seen every day who tells me she's an ultra runner, like, oh my gosh, that is so cool and I've connected with people on a different way. And then we would do like, try to get like Saturday hikes and group hikes and walk with the dogs or some initiatives, but to do that, to get people outside and then those that truly are looking for adventure to work with them so they can do this and have a, have a reset cuz we, we need that with what we've been through the last couple of years.

Dani:

Yeah, yeah. You're I mean that's a phenomenal story and even your mindset around how you engage the existing workforce around their desire for new opportunities, flexibility, work life balance, work life opportunities and, you know, you're leading from this place of holistic approach, allowing them to have experiences, not burning bridges, maintaining this open door opportunity. Cuz you're right, you know, they, they started their career in Arizona, the example that you gave of the, those the five that resigned for a travel experience. And I know a lot of health systems would be very upset or a lot of leaders would take it personally. It's hard not to, but being able to look beyond the immediate to say this will build into your professional experience it'll give you opportunity to bond with your friends and in fact when come back, we have a place for you and you're gonna bring some institutional knowledge from your experience at other places that will be valuable to us.

I view that right there as an example of transformational leadership. We talk about transactional versus transformational and that to me is truly transformational leadership. And it's generosity that's being exhibited in how you treat people. And it came from a place of, you know, hey, I'm, I, I operate this way, I, I like these experiences and these are meaningful to me. So that's a really powerful approach and experience and thank you for sharing that and it makes me wanna be a better leader and lead that way as well. Can we talk a bit more around, you know, your innovation and technology space and how you're thinking about that for Banner Health and some of your current initiatives and what you're doing there to bring innovation and ease the documentation burden for your bedside nurses?

Brian:

Yeah, so this started again, I went down this path in 2000, I guess 16 through 20. I, I was trying to solve, I, we had the nurses coming into the workforce. I, I felt like there was a, a learning curve there. The specific problem I was trying to solve was like med errors and you know, when a nurse goes into a room to give a medication, they should know what medication they're giving, why they're giving it, what the side effects could be so they can teach the patient what to look out for. And I don't know that they, they do that cuz we're very task focused, right? We're stretching ratios, people would use that term. And patients acuity is just higher. So patients are sick and nurses, especially those that have come into the profession recently, you know, had maybe not the greatest clinical experience during the pandemic or no clinicals at all perhaps, but, so we have, my job as a leader is to give them the tools to be successful.

So we had like mosby's drug guide book at every nurse's station and you could go to the computer and log into various drug databases and other databases for how to do procedures and look up diseases. And I just don't think they were doing it because they're too busy. So they had this knowledge gap and about this time Alexa and Siri were very popular and that technology, natural language processing is so easy. So I actually reached out to Amazon, I was like, Hey, I want, I'll buy these, I'll bring these Alexa devices in, but I need to know where the information comes from. I do not want a nurse to get information that comes from the worldwide web. I have to have total control about what databases they're accessing. And Amazon was great. They said, you know, this is not our model. You can teach Alexa skill though and that platform's free.

So I created arni, spelled A R N I a combination of ai, artificial intelligence and rn, registered nurse, and taught Alexa the skill of Arne. And I taught Arne just certain databases, Lippincott databases or EBSCO or elvir, whichever one your health system would use, and put a team together from Purdue graduates and did raised a bunch of venture capital and learned a ton in this health space doing kind of the shark tank thing and what the definition of bootstrapping before you've raised venture capital. And it was a great learning experience for me. And during that I went to Northwestern and put classes on artificial intelligence, machine learning. I really wanted to understand what we were doing. So I have that background and I tend to go to a natural language processing, this is the future. Big data, massive data dumps, and have an algorithm that can read through it immediately and make a recommendation.

This is, this is the future. You have to be able to play in this sandbox and get very comfortable with this. So I bring that into my c i o role and that's kind of how the role has evolved. I really have three approaches for work right now. How can we eliminate decision making for nurses? So what this means, you know, we have the, a lot of people have the early warning systems. You can read a set of vital signs and it might trigger, hey, this patient might be at risk of going septic. It'll send an alert and in addition to those hey this is what we just saw, we're gonna trigger this care plan for you. This patient needs to ambulate, they probably need a walker and it'll start alerting and start auto firing care plans to, for the nurses to follow. So they're not worried about, I guess just it, it makes the decision for 'em any nurse-driven protocol. When the data meets the criteria, we want an alert that tells the nurse, Hey, there's a nurse-driven protocol, go ahead and pull that fully out <laugh>. Again, just to take that decision making away from them

Dani:

As I'm listening, eliminate decision making. Is it, is it also more of like decision support or like, hey, this is decision you need to make, but you gotta action on it. But the reasons I'm asking is cuz like I worked in a space of like muse, like early warning system, but it wasn't titrated the right way for the population that I serve. And so in fact, some of the decision points of like they're heading into this space is like, well they actually weren't because they're a C O P D patient. We weren't calibrating, you know, their respiratory rate or their are their O two rate the right way. So I was getting over notified and so I, is it the clinical decision making piece, but it's reducing, like it's guiding that decisioning? Is that correct? Or I'll elaborate just a little bit more if

Brian:

That's okay. No, and I actually, your term is, is probably, is probably the more correct term. So you have to have that human in the loop to verify everything. I'm, I'm more pro artificial intelligence machine learning than most people and it's still not a perfect science. So you have to have that human in the loop somewhere in the loop to verify yeah, this is a C O P D patient. We expect those numbers to look like that, just to verify what it is. So it is more that decision support or decision guidance. I use the term nudge and that's probably the best way to think about it. You have to have these clinical nudges to make sure people are thinking. But you, you can never replace critical thinking in a nurse that's just not, that's just not there. And I'll, I'll probably die on that hill that, you know, a, a nurse that can look at a patient regardless of what the numbers are saying and have that intuition, that's a, that's a skillset that we really need to keep

Dani:

A hundred percent agree we're aligned there. <Laugh>, I knew that that's kind of, that was what it was referencing, but I wanted a bit more clarity around just how it was being positioned into, you know, the space for the workforce and anything I, I mean, as a nurse, anything that would help me make a better decision, I'm all for, but I just was kind of curious how it was all coming together. So thank you on collaborating about that

Brian:

<Laugh>. So, but the next part is eliminate physical tasks and I do mean eliminate. Where can we, what are nurses doing that? I don't want them to be doing So at Banner, we don't use Moxi the robot, but a lot of people have had a lot of success with Moxie and I've, I've done a ton of literature reviews. I know a couple people have done D M P projects on Moxi and I'm not paid by Moxi, but it seems to truly have a benefit that can help. So this is the robot that can go run labs down or get towels and re restock the linens. And these are tasks that, you know, if, if you truly want nurses working top of scope, they shouldn't be doing this stuff. And if you can automate that, that's great banner. We're just, we're not at a point where we've rolled that out yet, but I'm a big fan to everyone using that.

 And then if you could eliminate the physical task of charting by maybe someone else doing it. So if you have a virtual nurse program up and running being able to talk to the virtual nurse and say, Hey, I just did this central line dressing change, can you chart that for me? It's better for the virtual nurse to do that so the bedside nurse can go on to the next task that has to be done by a nurse at the bedside, like changing a central line dressing. We definitely want to go that direction. So those are the two focuses. And the third one is reducing the documentation burden really in any way that we can. And the team here had always been, let's reduce clicks. We need how many clicks does it take for a nurse to chart this? I wanna reduce that.

And we're adding clicks faster than we're reducing 'em. So I really wanna take a different approach. Even the way we do document, if you're not documenting by within defined limits using a focused assessment, it's maybe something to consider as opposed to nurses feel obligated if there's an empty cell to put something in there and that they, we create that problem ourselves. So take those cells away from 'em so they don't feel that way. And then again, the natural language processing physicians use this to solve the documentation burden years ago, the Dragon and m modal, but they chart in a narrative format when they're doing an h p or something like that. Nurses have a very structured way to chart with cells within Epic or Cerner or any other kind of electronic health record. And the technology didn't use to exist, but now it does that you can pull out pieces and parts of a, a narrative saying and plug those into those key cells.

So I have spent the last year really going down this path working with reaching out to startups, work, reaching out to big companies the big players in the tech space and saying, here's where I wanna go. Can you help us get there? And to varying degrees, everyone has said yes or has waited to see kind of what we are ex what we're learning. We have had a, in the last six months, a couple companies come on site and do demos for nurses. And the feedback was amazing, just the fact that, and this was a, a minimum viable product, a simple prototype, but the nurses could engage with it and then wrap their head around what this could become and the time that it could save.

Dani:

A hundred percent. Yeah. I like how you said feel fast, share. It's from what I am listening to in regards to your journey and who you are, you sound like a lifelong learner and you just have a, a big appetite for learning new things. Again, it's a, it's a great trait and I think actually Harvard Business Review published an article around high achievers and one of the qualities was lifelong learning. One thing I wanted to mention, I would agree with you around automation reducing clicks, particularly my focus has always been in staffing and scheduling and understand the technology that exists. And that is one of the reasons I joined Trusted is because we have developed technology to reduce the, I wouldn't call it documentation burden, but the click burden associated with workforce management staffing. We've automated this space and we've reduced the need for managers and leaders to send out, you know, text messages, one-off group messages here or there and provided intelligence around intelligent shift pricing, who they should go to, when, where shift should go, when it should go at what price point.

I mean it's phenomenal and it's just changing the game of how we can automate and move from a space of doing tasks and moving people around on a schedule or sending off a message to knowing that it's getting done for us and we're getting the analytics around it. But it still is a bit of a uphill battle for change in this space. It's something that's not widely done and can be somewhat of a challenge in accepting just because, you know, we've done w things for 30 years a certain way, and so now it's kind of, it's, it's turning it upside down in the industry. So exciting times, and I'm with you in the space of automation, reduced it, reducing burden and I've viewed it studied it in a different way. One last question around the technology that you founded. How is that coming into play? Like, is that, is that still alive? Are you doing pilots? Is that something that banner's looking at? And maybe I, you know, again, we can take that out if I shouldn't ask that question, but how, how are you continuing to move forward with your and how do you say Arne is it or is it Ann? Yep.

Brian:

Okay. Nope, Arne, <laugh>.

Dani:

Arne.

Brian:

Okay. You know, once once we raised venture capital, I really took a backseat because the, okay, the investors really want someone working on this full-time. And I, I like engaging with the nurses. So like the tech piece, I really wanna be the guy that kind of marries them together. So I don't have much to do with this. The company is still running. There are some big systems in the Midwest using it. I'll say we were before our time now with, with chat g p T out there and the technology is free. Like that's what we, we kind of built a version of that before it existed. And still you can dictate what information gets from it, but I knew then, hey, this is, this is the future and we need to get on board. We need to get on board with this and get very comfortable in this space. And I think voer, the wearables that people use, the voer, the Vaser badges have been great to introduce workforces to, you know, using voice to search databases and natural language processing. So that's kind of the update there. More will come in this space. We will, I think we'll have nurses using natural language processing in their everyday workflows or they are already with Vocera, but very, very soon in other aspects,

Dani:

You're before your time. And that is a piece around innovation, which I'm sure, I mean, you've, you've written books around innovation and you could speak to it a bit more, but timing is a key thing and how to move a new reality into, you know, practice. It has been something that I've grappled with my whole career of like how do we change and bring forth change that I don't even think is that revolutionary. But it takes time and a lot of the ideas that I've seen in the end seen in my peers are ahead of their time and then like 10 years later they're coming to life. So you kind of hit the nail on the head with timing. Would you have any recommendations to our listeners about innovation or bringing that to life and, you know, things that you've learned in the process of bringing you know, your ideas and, and the way that you see the industry growing into a reality and into practice that others can also learn and, and start to take some of those nuggets of truth and implement as well?

Brian:

Yeah, you know, there's a big soft spot for nurses right now. Everybody wants to help nurses and rightfully so, the last couple years have has been brutal. And it is true. Our bedside nurses are our greatest problem solvers. That's why we can cut corners so easy. So if you have an idea, there is a large network out there of nurse innovators, of nurse leaders. So reach out to those people cuz they're a path has already been forged. You mentioned the book I help co-author a book called The Nurses Guide to Innovation, which talks about taking a product from conception to commercialization. You can reach out to myself or any of the authors, but really on social media Twitter, LinkedIn, there are a ton of nurses who are influencing this space who can definitely connect you with the right people wherever you are with, with a certain concept or idea. And then it's important for CNOs like myself who are still acting in i roles chief nursing roles at large systems to really embrace these a and then be the influencers for this change and the advocates for this change at the system levels.

Dani:

Hmm. I'm sure you'll have a lot of listeners reach out to you about the book and the work that you've done. As you mentioned there's been many that have gone ahead and pa paved a path and it's it's helpful to learn from those that have, and you know, what does it take to bring an idea to reality? And that's even part of the doctoral journey. Like if you look at research, it typically takes 17 years to get research into practice, which is like mind blowing and astounding and it, and it shouldn't be that way, but unfortunately it has been tough to get new research, new ideas into practice. And so how can we accelerate healthcare to be nimble ex, you know, and do, you know, pest concepts quickly fail fastly as you mentioned, but do so in a controlled way. I recognize the healthcare needs some safety and guardrails, but still be more open to those opportunities so we can truly test what works or doesn't work or innovate or riff off of where we need to make adjustments. Brian, this has been a really delightful conversation. You have helped me think differently around some innovation and addition definitely around, you know, the language and voice initiated ability of technology to help aid the workforce and the clinician at the frontline. What would you like to hand off to our listeners today as a final piece of advice?

Brian:

Think different. I keep going back to, and I often share the apple commercial I don't think different and I actually make my teams watch that occasionally. We really need innovators. We really need novel solutions. So if you have a, if you have one don't keep it to yourself and share it and reach out to people cuz we need things need to look very different. We need to come out of this pandemic with a new build not a rebuild. It's not gonna look the same. So we need everybody to kind of play a role in de designing what this looks like cuz nobody's quite figured it out yet.

Dani:

New build, not a rebuild. That is a statement to end on. I a hundred percent agree with you as we think about our profession, healthcare and particularly the workforce. Thank you so much. I really appreciate your time and I can't wait to hear more of the great work at Banner Health and the things that you're leading. And hopefully we'll check in in a year or so and you can share some of those results.

Brian:

Yeah, that'd be awesome. Take care. Thank you.

Description

Dani welcomes Brian Weirich, the System Chief Nursing Informatics Officer for Banner Health. Brian shares his thoughts on the future of nursing and how technology can reduce the burden on nurses and improve the overall healthcare experience. Brian shares his experiences in developing a natural language processing tool that can help reduce the documentation burden on nurses and automate some of the physical tasks they are responsible for. He emphasizes the need for human oversight in this process and acknowledges that technology can never replace critical thinking in nursing. He also shares his passion for the importance of being a lifelong learner.

Transcript

Dani:

Welcome to the Handoff, the podcast or nurse leaders from Trusted Health. I'm Dr. Dani Bowie. Today I'm talking with Dr. Brian Weirich, the System Chief Nursing Informatics Officer for Banner Health System. He's a nurse leader with a passion for new ideas to lessen the documentation burden for frontline nurses. He believes in reducing physical tasks and enabling decision support tools for nurses to free them up to focus on what they do best, taking care of patients. You'll hear Brian's shared passions and technology, startup entrepreneurship and leadership, and how those combined passions have motivated him to find new ways to empower nurses to succeed. Let's dive in. Brian, welcome.

Brian:

Yeah, thank you for having me. Excited to be here. Excited to talk to you.

Dani:

Yep, me too. You know, I've been talking with a lot of leaders across the country around workforce flexibility, and I've talked to a variety in different roles, different health systems. But you are our first CNIO, and I've studied a bit of your background, Brian, and you have a really unique kind of upbringing into the space that you're currently in. And so I would just love it if you could share briefly a little bit about your professional journey and background and what led you to your current role at Banner Health.

Brian:

Okay. Yeah, this was, it's been an interesting journey for me. I've taken some non-traditional paths, but I I, I wanted to be a nurse in high school, and I wanted to be a flight nurse. I, I went into the profession. I wanted to fly in the helicopter, wear the fancy suit. So I graduated nursing school or graduated high school, went to nursing school, pursued my associate degree. That's all I needed, and that was that's what I needed to accomplish my goal. I met my wife in nursing school. From there we took our first jobs at the Cleveland Clinic in Ohio. I'm from Ohio. I worked in the ICU. I was strictly working to do what was needed to get on a helicopter. From there, I went to Ohio State Medical Center and recovered open hearts at Ohio State.

Loved that. Spent a lot of years at Ohio State. It was there though, when I got my years in, I went to pursue flight and was told their heightened weight restrictions to fly, and I exceeded both of 'em. <Laugh>. I, I'm a bigger guy. I played college football. I was never taught that and I was kind of crushed. At the time, I didn't know what I was gonna do. I guess that's a good thing about nursing. There's a lot of paths. And it was actually a mentor of mine at Ohio State. I was in like an emerging leaders class, and it was the CEO who was like, Brian, do you like what you're doing? And I said, well, I do. I like being an ICU nurse, but this was not the plan. I wanted to get on a helicopter. And he said, I think you should think about getting into leadership.

You seem very business minded, very entrepreneurial. You should consider leadership. And that's what it took. It took a mentor to tell me that, to head down this path. So from there, my journey has taken me kind of all across the country. I went back to first, back to school. I got my bachelor's, master's, doctorate degree. Took roles with different scopes and ambulatory inpatient periop to learn all those, a facets of what healthcare is traveled around the country. And it wasn't till I landed in my first CNO role in 2016. I was back in the Midwest at a large academic health system, and this was pre covid. I was trying to solve the problem of nurses making errors at the bedside. And I, I even felt like then there was a nursing shortage and the quality of nurse we were getting isn't necessarily what it used to be.

And so I really branched out into the startup healthcare startup world. I went down that rabbit hole with the local startup community and then the national startup community. We met a lot of interesting people and that really kind of got the innovation bug, like, Hey, let's solve problems truly in a novel way, not what's published out there as evidence. Like let's get a novel solution. And from there, I relocated out to Arizona about two and a half years ago. Came out here, my wife, my kids came out here, got a job with Banner Health as a facility, CNO at one of the large academic health systems or the large level one traumas was here. And even in that role I was kind of the innovation guy. I was really focusing on virtual nursing during the pandemic have a background in natural language processing and artificial intelligence machine learning.

I was really trying to bring new tools to the forefront for solutions for Covid. And then our chief nursing informatics officer left. I came in and, you know, I, I came in as the interim and I wasn't I made it clear like, Hey, I don't love the electronic health record and I have too much energy to just focus on this. And was really given permission, Hey, we really need to, the role needs to evolve. It doesn't have to look like it always looked. So it's really evolved a little bit to focus on merging with emerging technologies and then how can we really build new models of care and then reducing the documentation burden should be a byproduct if we accomplish those first two. So that's what's led me here today.

Dani:

That's impressive. I was listening and, and I was getting tired as I was listening, and I was like, man, the journey that you've been on and the experiences that you had is just phenomenal. And the, I think the depth and breadth of that experience is quite unique. I love that you knew that you wanted to be a nurse even in high school, and that you stuck to that vision and then the vision expanded and grew is you got more experience and, and exposure into these different spaces. And another thing that I think really resonated with me that you were talking about was how you were really trying to solve problems. You went into these different roles with a mindset of problem solving and through the problem solving, bringing innovation and new ways of operating to clinical practice at any level. And so that's just very inspiring to me and something that I think is a good pulse check for a lot of leaders is, you know, looking at it at what are you trying to solve and let, letting that be your true north and a lot of things that you do here.

Now as I've been talking with leaders across the country, as I mentioned the intro around flexibility. And, you know, we're going to jump into and dive into a bit more of the, some of the innovative work that you're doing at Banner Health System. But before we go down that path I'm curious from your perspective, you know, what flexibility means to you as a nurse leader and what does it mean to the, to the nurses that you lead? And as I mentioned, you have that depth and breadth of experience in a variety of roles from the startup space and innovation to CNO of large hospitals as well as, you know, systems, CNIO for Banner Health. What does flexibility mean to you as a nurse leader? And then what do you think it means to the workforce that you're also leading? And this is in terms of the workforce, and oftentimes what I'm seeing in the literature is just the tagline and a flexibility. It's a hot topic, everyone's putting it out there, but I really wanna know, what does it mean to you as a leader and what does it, what do you think it means to the, the nurses that you lead today?

Brian:

Yeah, that's a, a great question. I could really go into multiple levels of this with flexibility and work-life balance. Lemme take this kind of into two parts. So flexibility for me and then I think it resonates. I can really kind of speak for a generation. Things are different. What matters to the nurses coming into the workforce, we'll call 'em the early careerists. You know, they were shaped by different milestones and their priorities are very different. They're not worried about health insurance when they graduate. They can stay on mom and dad's health, insurance life experiences are important to myself and to them. So what does flexibility mean as things in life change? The global pandemic nurses who are starting families and aging nurses who are taking care of aging parents. It's not the same journey throughout. And I, I really want an employer who is gonna work with me as the individual, as Brian as I go through these life changes.

And my wife is a nurse, so we're very fortunate we didn't lose jobs during the pandemic. But we knew a lot of people who did. And we have to have some empathy and some flexibility to work with people through these life changes. And that's gonna mean scheduling. But hey, I also, I heard about chatGPT, what does this mean? Who can teach me about this? We've got a large Hispanic population here in Arizona, so a lot of people wanna learn Spanish. What resources do we have for people to learn this? And if they make an effort to go learn this skill, again, we have to be flexible with them just do these life milestones because it's different. We're so, we're so rules based and that there isn't, there often is no flexibility. And I often preach that, hey, as long as things are fair and equitable, we got, we need things to be fair and equitable. But with life changes I'm not saying you have to make exceptions, but you have to be flexible cuz nurses and nurse leaders have so many choices. If I hit a hard stop that doesn't align with what I need or what my personal life goals are, or my family life goals, I'm gonna go somewhere else. So we have to meet people in the middle.

Dani:

You bring up a good point about, I'm asking, you know, what does flexibility mean to leaders as they're leading their workforce and ensuring that there's scheduling and options and moving through the life journey. But what you also referenced was that there's the ability of the workforce and the nurse to choose where they go. So right now we're living in an era and a time of choice and flexibility around who we choose as an employer. And so we have the ability to move and look for new opportunities if by for some chance we're working with an employer that isn't meeting our, our life needs. And so I think you're calling out something that's really important for leaders and health systems to hear is that there's a lot of flexibility of choices for the initial entry point and then the depth of flexibility in the organization could sustain or help your workforce, you know, retain and work at that organization. And being mindful of that. And moving from a place of, you know, rigid rules to understanding how to adapt to, to life changes. As we think about life changes though, and and how important that is and the journey of our careers, from your perspective, is there anything that you would recommend for nurse leaders to do or health systems to do to be more flexible or agile or nimble in meeting the life journey of the workforce that, you know, a lot of nurse leaders are leading today?

Brian:

One of my previous employers was taking this journey kind of through their high reliability organization journey. And that's where the quote we wanna go from rules-based to values-based really came from, and I, although I'm no longer with them, I've really adopted that philosophy. And it is just that, hey, we need to see people as an individual. This is the dress code and tattoos and people need to be able to express themselves in different ways. And we have to work with them for that. Again, if we, if we draw this box and put people in it, they're not gonna be happy. And, and joy who, which became the fourth quadrant of the quadruple aim, the previous triple aim became the quadruple aim when we added physician satisfaction and employee satisfaction. And, and this is a part of it and scheduling is a part of it too.

 You know, we historically have always been, you know, you have to work your weekend obligation every other weekend. And an example of something I dealt with recently, there was a team member who wanted she wanted to work every weekend. The weekends that were being scheduled were like Friday and Saturday. That was considered the weekend. And she wanted to work every Saturday cuz she was taking care of an aging parent and didn't have help during the week, just on the weekend. So she wanted to work weekends and the rule was, hey, the weekend obligation is Friday, Saturday and this is any like, no, we have to work with this employee. She wants to work more than her weekend obligation, you know, every Saturday. But additionally Sunday, which is a hard to sche frequently, a hard to schedule day. We're not, we're not cheating everybody else by not making her work weekend.

And that's where, you know, that's where it would come in if, if they could opt out of weekends, she's willing to work more than her share. But the rules were you have to work the Friday, Saturday and, and we, that was one I hate to use the term exception, but we had to be flexible for that. Let me take it another step further with kind of the flexibility and I'll switch it to, I think work-life balance is a term that a lot of people use. And I tell my teams, and I think I adopted this from General Electric, a book coming outta GE that said, there's no such thing as work-life balance. They're work-life choices and you have 'em and you make 'em. And I truly agree with that. To personalize this a little more, in 2019, my, one of my older brothers was getting married and he was just under 40 and he was talking about a bachelor party and he says, you know, most of his friends were married with kids.

So a traditional bachelor party was probably out of the question. And he said, let's go do a bucket list item. Let's do the Mount Everest base camp track and if we're gonna be over there, let's extend it and do the three pass extension. And I would love to climb a mountain, any mountain in the Himalayas. So this was overall, this was a month long journey with minimal cell phone service. And at the time I was in a vice president role and it had not been uncommon for me to go off the grid for a weekend or maybe a week, but never a month. But this to me was, I felt like a great opportunity to do a once in a lifetime thing, check a bucket list item, and then do it with one of my brothers. So I booked this trip, I paid for it, had the flights and I sat on it for like seven months.

I was really nervous about asking for a month off and I told my wife who is super supportive of this hobby of mine, and she says, you know what, if they say no, and I said, well, I'm going on this trip and if they say I can't go, I'm, I'll quit and I'll find a new job when I get back. I'm a nurse, you're a nurse, I can find a job even if it's not a leadership job, I'll cross that bridge when I get to it, but I'm not gonna turn down this opportunity. And I left in March of 2019 and it was December. I was at the holiday, the Christmas holiday party and I approached my boss probably with an alcoholic beverage in me <laugh> and said, Hey, I, I just booked this trip for a month to go to Mount Everest and are you okay with it?

And I didn't get a a yes right away, but about a week later it came back and said, yeah, it seems like a great opportunity. You should go. And you know, I can't wait to hear about it. And they really took a great approach and was supportive. I would've left. And I still feel that way today. And I often see this in the early careers, the new generation coming in. So we, we have to work with because it, it was as personal to me. So when they say I've got this great opportunity or you know, there was a time when I would have three to five nurses all resigned together cuz they were gonna go do a travel assignment in California. And I'm like, that sounds like the most fun ever. How do you say no to that? Yeah, but how do we set 'em up to make sure that when they wanna settle they come back, they're all in Arizona, they graduated nursing school here.

Like this is a great opportunity. I can't falter for that. It sounds like a lot of fun with friends to go live in California and help out in the pandemic, but how can we get you to come back and then work with them about holding their seniority and a spot on their unit cuz they, there's no orientation required to come back and they'll probably learn more critical thinking and new, new skill sets and how to do things differently and that, so just to work with those people. But I think about that a lot and during the pandemic here, because I live in Arizona and we're so rich in outdoor activities, we built a spreadsheet of bucket list items. Like here's the hikes, here's the mountain bike trails, here's the waterfalls, go do this. We want you to get out and explore and then potentially stay.

And then I wrote an article that published last October called Nature a post pandemic prescription. And it just ties all the literature about the benefits of getting outdoors and being in nature and seeing sunrises and sunsets and how it helps with PTSD symptoms. And so now I encourage people to go do this. And for me the higher the mountain, the more remote the better. So when I, when I hear people that have done these adventures or people, you know, the, the respiratory therapist I've seen every day who tells me she's an ultra runner, like, oh my gosh, that is so cool and I've connected with people on a different way. And then we would do like, try to get like Saturday hikes and group hikes and walk with the dogs or some initiatives, but to do that, to get people outside and then those that truly are looking for adventure to work with them so they can do this and have a, have a reset cuz we, we need that with what we've been through the last couple of years.

Dani:

Yeah, yeah. You're I mean that's a phenomenal story and even your mindset around how you engage the existing workforce around their desire for new opportunities, flexibility, work life balance, work life opportunities and, you know, you're leading from this place of holistic approach, allowing them to have experiences, not burning bridges, maintaining this open door opportunity. Cuz you're right, you know, they, they started their career in Arizona, the example that you gave of the, those the five that resigned for a travel experience. And I know a lot of health systems would be very upset or a lot of leaders would take it personally. It's hard not to, but being able to look beyond the immediate to say this will build into your professional experience it'll give you opportunity to bond with your friends and in fact when come back, we have a place for you and you're gonna bring some institutional knowledge from your experience at other places that will be valuable to us.

I view that right there as an example of transformational leadership. We talk about transactional versus transformational and that to me is truly transformational leadership. And it's generosity that's being exhibited in how you treat people. And it came from a place of, you know, hey, I'm, I, I operate this way, I, I like these experiences and these are meaningful to me. So that's a really powerful approach and experience and thank you for sharing that and it makes me wanna be a better leader and lead that way as well. Can we talk a bit more around, you know, your innovation and technology space and how you're thinking about that for Banner Health and some of your current initiatives and what you're doing there to bring innovation and ease the documentation burden for your bedside nurses?

Brian:

Yeah, so this started again, I went down this path in 2000, I guess 16 through 20. I, I was trying to solve, I, we had the nurses coming into the workforce. I, I felt like there was a, a learning curve there. The specific problem I was trying to solve was like med errors and you know, when a nurse goes into a room to give a medication, they should know what medication they're giving, why they're giving it, what the side effects could be so they can teach the patient what to look out for. And I don't know that they, they do that cuz we're very task focused, right? We're stretching ratios, people would use that term. And patients acuity is just higher. So patients are sick and nurses, especially those that have come into the profession recently, you know, had maybe not the greatest clinical experience during the pandemic or no clinicals at all perhaps, but, so we have, my job as a leader is to give them the tools to be successful.

So we had like mosby's drug guide book at every nurse's station and you could go to the computer and log into various drug databases and other databases for how to do procedures and look up diseases. And I just don't think they were doing it because they're too busy. So they had this knowledge gap and about this time Alexa and Siri were very popular and that technology, natural language processing is so easy. So I actually reached out to Amazon, I was like, Hey, I want, I'll buy these, I'll bring these Alexa devices in, but I need to know where the information comes from. I do not want a nurse to get information that comes from the worldwide web. I have to have total control about what databases they're accessing. And Amazon was great. They said, you know, this is not our model. You can teach Alexa skill though and that platform's free.

So I created arni, spelled A R N I a combination of ai, artificial intelligence and rn, registered nurse, and taught Alexa the skill of Arne. And I taught Arne just certain databases, Lippincott databases or EBSCO or elvir, whichever one your health system would use, and put a team together from Purdue graduates and did raised a bunch of venture capital and learned a ton in this health space doing kind of the shark tank thing and what the definition of bootstrapping before you've raised venture capital. And it was a great learning experience for me. And during that I went to Northwestern and put classes on artificial intelligence, machine learning. I really wanted to understand what we were doing. So I have that background and I tend to go to a natural language processing, this is the future. Big data, massive data dumps, and have an algorithm that can read through it immediately and make a recommendation.

This is, this is the future. You have to be able to play in this sandbox and get very comfortable with this. So I bring that into my c i o role and that's kind of how the role has evolved. I really have three approaches for work right now. How can we eliminate decision making for nurses? So what this means, you know, we have the, a lot of people have the early warning systems. You can read a set of vital signs and it might trigger, hey, this patient might be at risk of going septic. It'll send an alert and in addition to those hey this is what we just saw, we're gonna trigger this care plan for you. This patient needs to ambulate, they probably need a walker and it'll start alerting and start auto firing care plans to, for the nurses to follow. So they're not worried about, I guess just it, it makes the decision for 'em any nurse-driven protocol. When the data meets the criteria, we want an alert that tells the nurse, Hey, there's a nurse-driven protocol, go ahead and pull that fully out <laugh>. Again, just to take that decision making away from them

Dani:

As I'm listening, eliminate decision making. Is it, is it also more of like decision support or like, hey, this is decision you need to make, but you gotta action on it. But the reasons I'm asking is cuz like I worked in a space of like muse, like early warning system, but it wasn't titrated the right way for the population that I serve. And so in fact, some of the decision points of like they're heading into this space is like, well they actually weren't because they're a C O P D patient. We weren't calibrating, you know, their respiratory rate or their are their O two rate the right way. So I was getting over notified and so I, is it the clinical decision making piece, but it's reducing, like it's guiding that decisioning? Is that correct? Or I'll elaborate just a little bit more if

Brian:

That's okay. No, and I actually, your term is, is probably, is probably the more correct term. So you have to have that human in the loop to verify everything. I'm, I'm more pro artificial intelligence machine learning than most people and it's still not a perfect science. So you have to have that human in the loop somewhere in the loop to verify yeah, this is a C O P D patient. We expect those numbers to look like that, just to verify what it is. So it is more that decision support or decision guidance. I use the term nudge and that's probably the best way to think about it. You have to have these clinical nudges to make sure people are thinking. But you, you can never replace critical thinking in a nurse that's just not, that's just not there. And I'll, I'll probably die on that hill that, you know, a, a nurse that can look at a patient regardless of what the numbers are saying and have that intuition, that's a, that's a skillset that we really need to keep

Dani:

A hundred percent agree we're aligned there. <Laugh>, I knew that that's kind of, that was what it was referencing, but I wanted a bit more clarity around just how it was being positioned into, you know, the space for the workforce and anything I, I mean, as a nurse, anything that would help me make a better decision, I'm all for, but I just was kind of curious how it was all coming together. So thank you on collaborating about that

Brian:

<Laugh>. So, but the next part is eliminate physical tasks and I do mean eliminate. Where can we, what are nurses doing that? I don't want them to be doing So at Banner, we don't use Moxi the robot, but a lot of people have had a lot of success with Moxie and I've, I've done a ton of literature reviews. I know a couple people have done D M P projects on Moxi and I'm not paid by Moxi, but it seems to truly have a benefit that can help. So this is the robot that can go run labs down or get towels and re restock the linens. And these are tasks that, you know, if, if you truly want nurses working top of scope, they shouldn't be doing this stuff. And if you can automate that, that's great banner. We're just, we're not at a point where we've rolled that out yet, but I'm a big fan to everyone using that.

 And then if you could eliminate the physical task of charting by maybe someone else doing it. So if you have a virtual nurse program up and running being able to talk to the virtual nurse and say, Hey, I just did this central line dressing change, can you chart that for me? It's better for the virtual nurse to do that so the bedside nurse can go on to the next task that has to be done by a nurse at the bedside, like changing a central line dressing. We definitely want to go that direction. So those are the two focuses. And the third one is reducing the documentation burden really in any way that we can. And the team here had always been, let's reduce clicks. We need how many clicks does it take for a nurse to chart this? I wanna reduce that.

And we're adding clicks faster than we're reducing 'em. So I really wanna take a different approach. Even the way we do document, if you're not documenting by within defined limits using a focused assessment, it's maybe something to consider as opposed to nurses feel obligated if there's an empty cell to put something in there and that they, we create that problem ourselves. So take those cells away from 'em so they don't feel that way. And then again, the natural language processing physicians use this to solve the documentation burden years ago, the Dragon and m modal, but they chart in a narrative format when they're doing an h p or something like that. Nurses have a very structured way to chart with cells within Epic or Cerner or any other kind of electronic health record. And the technology didn't use to exist, but now it does that you can pull out pieces and parts of a, a narrative saying and plug those into those key cells.

So I have spent the last year really going down this path working with reaching out to startups, work, reaching out to big companies the big players in the tech space and saying, here's where I wanna go. Can you help us get there? And to varying degrees, everyone has said yes or has waited to see kind of what we are ex what we're learning. We have had a, in the last six months, a couple companies come on site and do demos for nurses. And the feedback was amazing, just the fact that, and this was a, a minimum viable product, a simple prototype, but the nurses could engage with it and then wrap their head around what this could become and the time that it could save.

Dani:

A hundred percent. Yeah. I like how you said feel fast, share. It's from what I am listening to in regards to your journey and who you are, you sound like a lifelong learner and you just have a, a big appetite for learning new things. Again, it's a, it's a great trait and I think actually Harvard Business Review published an article around high achievers and one of the qualities was lifelong learning. One thing I wanted to mention, I would agree with you around automation reducing clicks, particularly my focus has always been in staffing and scheduling and understand the technology that exists. And that is one of the reasons I joined Trusted is because we have developed technology to reduce the, I wouldn't call it documentation burden, but the click burden associated with workforce management staffing. We've automated this space and we've reduced the need for managers and leaders to send out, you know, text messages, one-off group messages here or there and provided intelligence around intelligent shift pricing, who they should go to, when, where shift should go, when it should go at what price point.

I mean it's phenomenal and it's just changing the game of how we can automate and move from a space of doing tasks and moving people around on a schedule or sending off a message to knowing that it's getting done for us and we're getting the analytics around it. But it still is a bit of a uphill battle for change in this space. It's something that's not widely done and can be somewhat of a challenge in accepting just because, you know, we've done w things for 30 years a certain way, and so now it's kind of, it's, it's turning it upside down in the industry. So exciting times, and I'm with you in the space of automation, reduced it, reducing burden and I've viewed it studied it in a different way. One last question around the technology that you founded. How is that coming into play? Like, is that, is that still alive? Are you doing pilots? Is that something that banner's looking at? And maybe I, you know, again, we can take that out if I shouldn't ask that question, but how, how are you continuing to move forward with your and how do you say Arne is it or is it Ann? Yep.

Brian:

Okay. Nope, Arne, <laugh>.

Dani:

Arne.

Brian:

Okay. You know, once once we raised venture capital, I really took a backseat because the, okay, the investors really want someone working on this full-time. And I, I like engaging with the nurses. So like the tech piece, I really wanna be the guy that kind of marries them together. So I don't have much to do with this. The company is still running. There are some big systems in the Midwest using it. I'll say we were before our time now with, with chat g p T out there and the technology is free. Like that's what we, we kind of built a version of that before it existed. And still you can dictate what information gets from it, but I knew then, hey, this is, this is the future and we need to get on board. We need to get on board with this and get very comfortable in this space. And I think voer, the wearables that people use, the voer, the Vaser badges have been great to introduce workforces to, you know, using voice to search databases and natural language processing. So that's kind of the update there. More will come in this space. We will, I think we'll have nurses using natural language processing in their everyday workflows or they are already with Vocera, but very, very soon in other aspects,

Dani:

You're before your time. And that is a piece around innovation, which I'm sure, I mean, you've, you've written books around innovation and you could speak to it a bit more, but timing is a key thing and how to move a new reality into, you know, practice. It has been something that I've grappled with my whole career of like how do we change and bring forth change that I don't even think is that revolutionary. But it takes time and a lot of the ideas that I've seen in the end seen in my peers are ahead of their time and then like 10 years later they're coming to life. So you kind of hit the nail on the head with timing. Would you have any recommendations to our listeners about innovation or bringing that to life and, you know, things that you've learned in the process of bringing you know, your ideas and, and the way that you see the industry growing into a reality and into practice that others can also learn and, and start to take some of those nuggets of truth and implement as well?

Brian:

Yeah, you know, there's a big soft spot for nurses right now. Everybody wants to help nurses and rightfully so, the last couple years have has been brutal. And it is true. Our bedside nurses are our greatest problem solvers. That's why we can cut corners so easy. So if you have an idea, there is a large network out there of nurse innovators, of nurse leaders. So reach out to those people cuz they're a path has already been forged. You mentioned the book I help co-author a book called The Nurses Guide to Innovation, which talks about taking a product from conception to commercialization. You can reach out to myself or any of the authors, but really on social media Twitter, LinkedIn, there are a ton of nurses who are influencing this space who can definitely connect you with the right people wherever you are with, with a certain concept or idea. And then it's important for CNOs like myself who are still acting in i roles chief nursing roles at large systems to really embrace these a and then be the influencers for this change and the advocates for this change at the system levels.

Dani:

Hmm. I'm sure you'll have a lot of listeners reach out to you about the book and the work that you've done. As you mentioned there's been many that have gone ahead and pa paved a path and it's it's helpful to learn from those that have, and you know, what does it take to bring an idea to reality? And that's even part of the doctoral journey. Like if you look at research, it typically takes 17 years to get research into practice, which is like mind blowing and astounding and it, and it shouldn't be that way, but unfortunately it has been tough to get new research, new ideas into practice. And so how can we accelerate healthcare to be nimble ex, you know, and do, you know, pest concepts quickly fail fastly as you mentioned, but do so in a controlled way. I recognize the healthcare needs some safety and guardrails, but still be more open to those opportunities so we can truly test what works or doesn't work or innovate or riff off of where we need to make adjustments. Brian, this has been a really delightful conversation. You have helped me think differently around some innovation and addition definitely around, you know, the language and voice initiated ability of technology to help aid the workforce and the clinician at the frontline. What would you like to hand off to our listeners today as a final piece of advice?

Brian:

Think different. I keep going back to, and I often share the apple commercial I don't think different and I actually make my teams watch that occasionally. We really need innovators. We really need novel solutions. So if you have a, if you have one don't keep it to yourself and share it and reach out to people cuz we need things need to look very different. We need to come out of this pandemic with a new build not a rebuild. It's not gonna look the same. So we need everybody to kind of play a role in de designing what this looks like cuz nobody's quite figured it out yet.

Dani:

New build, not a rebuild. That is a statement to end on. I a hundred percent agree with you as we think about our profession, healthcare and particularly the workforce. Thank you so much. I really appreciate your time and I can't wait to hear more of the great work at Banner Health and the things that you're leading. And hopefully we'll check in in a year or so and you can share some of those results.

Brian:

Yeah, that'd be awesome. Take care. Thank you.

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