Naomi, Becker's Healthcare (00:07):

Hello everyone. This is Naomi with Becker's Healthcare. Thank you for joining us for today's webinar, how Advocate Health is using AI to redesign Nursing workforce strategy. Before we begin, I'll walk us through a few quick housekeeping instructions. We will begin today's webinar with a presentation. You can submit any questions you have by typing them into the q and a box you see on your screen, and we will follow up with answers after the webinar. Today's session is being recorded and will be available after the event. You can use the same link you use to log into today's webinar to access the recording. If at any time you have issues with audio or visuals, just try refreshing your browser. You can also submit any technical questions into the Q & A box. We are here to help with that. I am pleased to introduce today's speaker, Betty Jo Rocchio, EVP and Chief Nurse Executive at Advocate Health. Thank you so much Betty Jo for being here today. I'll now turn over the floor to you to get us started.

Betty Jo, Advocate Health (01:16):

Well, thank you Naomi. It's a pleasure to be here with all of you today and just share a little bit of the work and how nursing is starting to think about augmented intelligence in a couple of different lanes today. So we're going to talk around workforce work environment and workflows today. Just to ground us a little bit, I thought I'd start by talking a little bit about Advocate Health. So you could see the breadth of where we reach across the country. We treat almost 6 million unique patients a year. Overall, we have about 150,000 teammates that are across the footprint of Advocate Health. We have about 21,000 physicians practicing right alongside of us and we have about 42,000 nurses I will say, that are relying on us to get this right in Advocate Health. You can see some of the other things on the screen, but you will know us in certain areas of the country by certain names. In the Wisconsin area, in that division, we're known as Advocate Aurora Health, in the Chicago land market, we're known as just Advocate Health and in the North Carolina, Georgia markets, we are Atrium Health and we also have Wake Forest as our academic partner that exists in our health system.

(02:48):

And so I thought it would be great to start out with the why. So anytime we're attempting to take a look at where we might put technology into our workplace, it's very important to know the reasons why you are heading towards it. And I will tell you it's not just for nursing, but it is throughout all of our health systems and why we chose right now to start focusing on this and advocate. Our CEO Eugene Woods really has a very clear vision for what we're trying to accomplish as a health system. We're redefining care. We're not just looking at innovating or doing small changes. We believe that now is the time to really start looking and making some of those big bold statements to help not only our clinicians practice better, our nurses contribute to the best place to care, but also for how our patients experience us and our commitment to our patients.

(03:45):

Looks something like this. Number one, we lift everyone up. We know that it is going to take everybody inside of Advocate's Walls to make sure that we're looking at technology in the right place. You're going to see a lot of fantastic things today, but I will tell you it's done through partnership, both external vendors, how we bring them to Advocate, as well as our internal teams. We recently employed a Chief AI Officer, Andy Crowder, and he's on this journey with us along with finance, our IT partners, and of course our nurse is designing what it looks like lead the way in all of our markets. We want to make sure that we're not just deploying technology, but that we are looking at things in a brand new way that helps others be better, even in other health systems because patients belong in a community. And looking at how we're doing this together is so important.

(04:42):

Number three, we want to think boldly together. When I say bold, I'm talking about things we would've never thought about in healthcare that today we are actually embracing and using it to the best of our abilities and then embrace the unknown. I believe today we are at the very cusp of using ai and I'm going to call it augmented intelligence, but we're now just starting to get into a little bit of what this might do for us. And I will say that that fearless curiosity and unshakable optimism is exactly where all of our nurses, all 42,000 of them sit in Advocate Health today.

(05:24):

Let's talk a little bit about where we actually have been and where we are and then where we're going. I like to call it the now near far approach to how we are taking a look at redesigning care. When you look at where nurses are today, we are much better than where we were in the pandemic, but I would say we are slowly returning to that pre pandemic workload effort, but we actually want to be much better than that. And I think it's going to take all of us out there looking at this in the right way to make sure that we are at how nursing is embracing technology, where we're putting it in to actually augment care and making sure that while innovation and technology can be a disruptor that we're disrupting. So when we come back together, it's better for all of us.

(06:16):

So where we're going to start today, which I think is foundational to our approach is we know why for the health system we're doing it. Now we're going to talk a little bit about the why for nursing and in Advocate, it's all about reducing nurse cognitive workload. That cognitive workload I believe has not been explored in the industry far enough. And I will tell you it is what's burning out our nurses and it is really how we're designing everyday care and taking a look at cognitive workload. So in the past, nursing has looked at really ratios to try to get to this concept. We've looked at acuity and it's actually neither of these things. If you look at the literature that's driving nurse cognitive workloads, it's actually pure workload, which is a combination of all of the things we do every day as well as patients actually driving certain workloads.

(07:17):

And to do this, I talked about this in the beginning, but we're going to look at care delivery in the face of three things, workforce, workflows and work environment. And we're going to start with workloads, workforce. And I'll tell you why. Without a strong healthy workforce, the other two really matter less. And so how do we get there? And taking a look at our workforce is really key. And so our strategic foundation to our operational approach in Advocate nursing is looking at how people want to serve in our health system, which is a balanced workforce model, which we are going to dive into much deeper. And as I said, it's really the first pillar of making sure that we can do the other things. Number two, we're going to deliver, we're going to deliver performance. And the way that looks for our patients is fantastic quality care with amazing outcomes.

(08:16):

And we've been heading towards just the nursing for a lot of years. We have nurse sensitive indicators, we have other measures that we use to look at the care that we deliver, but really what we failed to do is take a look at cognitive workload and what actual workflow can do for us. And you're going to see some pretty innovative approaches to making that happen. And then the transform pillar is really about the vision. Where do we see us in that now near far framework that actually delivers an optimal work environment? And in advocate nursing, we're talking about this as the best place to care and we want our patients to love the care they're getting and we know that giving nurses what they need to deliver on that promise is key to getting there. And so we are going to start a little bit with workforce today.

(09:11):

One of the ways that we're looking at delivering on these promises is I would say nursing workforce platform thinking. And this is not about the small things that we've done to try to create flexibility today. All of us have some type of flexible workforce that we're trying to accommodate. Many of us as we're growing have some agency in our facilities. We have our core staff, our tried and true really the foundation of our nursing workforce. But I would say where we're divergent in the industry is that flexible in between models and that is what is demanding platform thinking. And I will tell you a platform is all about engaging your demand and your supply to fill that demand. When you look at the business principles behind this, we're going to step outside of healthcare nursing, pull them in and use a platform thinking model to design our flexible nursing workforce.

(10:15):

And so for us in nursing, I will tell you it is about flexibility, but it's also about matching the right nurse and engaged nurse. Regardless of what layer nurses are working in, they have to be engaged in the very wonderful aspect of patient care. I talked a little bit about the supply and demand principles and I will tell you right timing, not everybody should start a shift at 7:00 AM and end at 7:00 PM There are ways that we can start to mix that flexibility with not just people and shifts, but hours and making sure that people are working exactly where they want to work and when they want to work. And guess what? Happy nurses equals happy, engaged patient care and patients.

(11:09):

So we're going to flip a couple of long held principles on its head today and it demands if you're going to take on platform thinking, we have to start thinking about how we're going to measure ourselves that supports a smarter workforce management system. Many times we're looking at shifts, especially in our staffing and scheduling system. We schedule people in shifts, even if they're flexible shifts an advocate, we're starting to look at hours, yes, or some people working seven eight to 7:00 PM and 7:00 PM to seven A. They absolutely are. But instead of looking at that as a 12 hour shift, we're looking at it as 12 hours of supply that's filling a demand for 12 patient hours. And so when you take a look at our hours preparation day metric that we use, it's always around the nursing hours that are needed on a unit and our hours that we have of supply to fill it.

(12:09):

And so you're going to hear throughout this presentation moving away from the shift concept to ours. The other thing that we're starting to question and delve a little bit deeper with our finance partners is around productivity. So it's interesting, for years we've been talking about productivity. And here's the thing about productivity. If you're actually getting what you need in platform thinking, productivity actually becomes less important because productivity is about the number of people that you have working in a shift. We want to start looking at our fill rate, which is the number of hours we have available versus the number of hours that we have filled. That's actually a fill rate and how we choose to fill it really affects our productivity. For example, if we have a hundred patient hours that need fill, we can choose to fill 50 hours of that with an RN and 50 hours with the tech, or we could choose 70 30 depending on the type of unit.

(13:14):

We need a lot of flexibility with how we're filling it. And I will tell you in today's labor market, it actually demands us to look at how we fill it probably on a shift by shift basis. So our productivity actually goes down as we start to fill it with maybe more techs than nurses and we have a different compliment, but done correctly that fill rate drives an immense amount of both effectiveness and efficiency in our stewardship metrics as well. Our labor price may actually go down per unit of service, but our productivity may also go down, which may be fine. We're putting more hands at the bedside. I would argue a nurse manager who does it correctly could get a fill rate at less cost with a more productive model of care and we may have to mix it differently by shift. The third thing we're starting to question is ratios.

(14:10):

We build a lot in our staffing and scheduling system around ratios. Our staffing groups call for ratios. Again, back up to my previous concept as we need to mix different hands by the bedside to get care taken care of in our hours, we may have to flip flop that. And so ratios become way less important in a truly flexible model of care and looking at workload, both objective measures of workload as well as subjective measures of workload has proven to be more successful than looking at ratios. So it also demands us by unit and by shift to be able to measure that workload index and then staffing to the workload, it does mean that one nurse we're staffing to the workload measures of patients. So the nurse and tech may have different ratios in our old terms, but our workload scores become very, very even, which feels better across our shifts or our hours of patient care.

(15:13):

And so when you start to use these three new concepts, hours bill rate and workload, you end up with a much better highly scalable platform thinking model of care that actually demands flexibility. Without it, you can't achieve this. So if we are all thinking out there that we need to move to a more flexible workforce model of care, we have to change our thinking and how we're measuring ourselves and this actually separates the people that can start thinking differently for those that are stuck in the past and are going after the same model of care. And if you are heading in your market towards things you don't have, the problem is it's going to cost you more and you're still not going to have the efficiency and effectiveness that you have moving forward. That's why platform thinking is so important.

(16:07):

Alright, so as we're developing the concepts and I would say the processes behind how we power both our platform thinking and our workforce, one of the hardest things to do is to separate very clear thinking in both your workforce layers. We need to get very clear about that because we can mix all this up as we're starting to demand a new model of care. So doing the hard work upfront and how we look at these layers is going to be really important. Following these workforce layers, we have to look at job descriptions, compensation and how we pay people becomes very, very important. And then how we're measuring ourselves in the cognitive workload element. And so I joined Advocate about eight months ago and this is one of the first things we started out on was a workforce initiative with both our professional governance teams as well as our operational nursing partners that came together across with IT AI innovation as well as our HR partners to take a look at how we're going to line up ourselves to be able to fully capitalize on platform thinking.

(17:22):

And when you look at it, it comes down to three layers and what's in those layers really drives the outcome so core they are always going to be our highest workforce layer and cores our full-time, our part-time, I call it part-time flex, they may have flexible hours in there and our PRN unit based, they're people that just work on the unit maybe a couple of hours a month, but they're very, very PR ed. They go into that core layer and they get our benefits, they get our 401k if they meet the qualifications. And so they are actually in the staffing and scheduling system in a very static way. This makes managers, nurse managers feel very good about getting their shifts built. I'm going to bump up to the top in agency whether you have external agency, internal agency, we have really gone away from internal agency since the pandemic and we are only using external agency and we're trying to head towards getting enough fill rate.

(18:29):

One of our new concepts fill rate that we can move away from agency and move some of the agency hours that we used to use down into that flex layer. And here's what the flex layer looks like. You're going to say to me Betty Jo, this looks very much like what we already have, but it's a local flow pool that may go to different floors in the same hospital. It's a regional flow pool that by region nurses move around to multiple units and multiple hospitals, which I'm sure in that flex layer you have that today and we're going to talk about this gig per diem concept that opens up that flex layer to people that don't normally work in your health system. And it's exactly what it says it is nurses that may work across the street at another hospital but give you their hours and this is where this hours concept comes in.

(19:23):

They may not be picking up full shifts but they're picking up hours. But what I will tell you is these are nurses that are W2, they are employed by you, they do the same competencies, they just work somewhere else possibly or they're in that per diem gig workforce full-time and they're using the platform to pick up the majority of their shifts. This is what can't happen without platform thinking because you have no way to invite hours in from the outside on top of your core staff that's picking up extra hours. We're going to go through what this looks like here in a minute. And so how do you do this in platform thinking? What becomes most important is that you have the system set up to power all of your layers in a very equal and balanced approach. I'm going to talk about this in three segments because it's important to understand what you need foundationally and what you need to move.

(20:19):

One of the first things we did was you can imagine an advocate health of 42,000 nurses. We went to one RN job description across the entire enterprise. We are there, we have done that work and we're moving ahead. And so when you move to platform thinking, guess what's not important job descriptions, guess what is important? Skill-based competencies that allow nurses to apply their skills, what they've learned across multiple units. And so on the left hand side we have our nursing workforce framework that we've completely straightened out. I'm going to go to the right hand side and talk a little bit about what has to occur that we don't have today. And we have a nurse credentialing system where every single nurse that works in every layer is in our nurse credentialing system. And what that drives is we have a full accounting of all the nurses, all of their skills, all of their competencies, all of their certifications, all of their licensure and a profile for where they'd like to work.

(21:31):

And that's really, really important that we have staffing and scheduling on the left hand side and on the right hand side we have a full accounting that everybody works even agency is for in our nurse credentialing system. As you can imagine that helps with joint commission CMS and DNQI measures because we have a full accounting of all of our nurses and here's the magic that comes in. We have partnered with an outside technology company called Works Through, I will tell you Trusted Health and what we've done is we take our normal staffing and scheduling system, we take our credentialing system and we have an app based driven model that allows for a couple of things. It again, we talked about platform thinking, supply and demand. What it does is connect by unit the staffing and scheduling system. So the number of hours our supply that we have scheduled, it pulls in from Epic, our patient census and gives us our hours needed to serve those patients.

(22:37):

And then what it does is get us a fill rate. And that fill rate drives our logic behind incentives. And when you're talking about supply and demand, the higher the fill rate, the lower the incentive and the magic occurs because we have AI in the background that is matching fill rates across all of our units, all 69 hospitals an advocate. It is matching supply and demand across that and taking our holes out of our staffing and scheduling system and launching them over to our nurse credentialing system with the appropriate incentive rates. And one of the beauties about this is the nurse manager has a decreased workload because they make no more phone calls to fill their holes, they don't have to beg people to work and they have a larger pool with that per diem gig. Flexible workforce. We've opened it up to so many more nurses that can pick up right in an app.

(23:35):

Now you're saying I know what you're thinking to yourself. Well what about your own employees, your own nurses that want to pick up? This is the logic behind this system and what it does is allows us to, when the schedule's posted, it launches out to our own internal core nurses first for their incentives. So nurse managers aren't offering incentives anymore. It's based on math in the background with AI deriv tools and our own internal people get right at first refusal to pick up the shift. Then at the very same time our regional and local flow pool can pick right up in the app. And then after that it launches out to this per diem gig nursing workforce and they have the opportunity to pick up their shifts and this is where the magic happens because the nurse manager does nothing except do their normal staffing and scheduling and then all of the automation and AI takes over and prices the shift appropriately for pickup.

(24:35):

And if you know anything about large language learning models, you know that this algorithm gets better and better over time. So after a couple of years of using it, we are down to an exact science and the earlier you pick up the shift, the higher rate you see, so there's also some behavior modification in there. So holding out so later on does nothing for you because as people pick up and the fill rate goes up, the incentive shift goes down. So it's a beautifully designed technology empowered system that allows us to be better, get a better pickup and opens the world to the external environments and nurses that wouldn't normally get to get into advocate health and try us. And this is amazing because what happens is I will tell you, you convert people from that flexible layer down into your core layer because they're actually trying out units that they're qualified to work on and they find the people they love to work with and we're starting to watch people actually get into the core layer. So it's actually a very nice recruiting tool on top of everything else in addition to being very financially stable.

(25:49):

Alright, now you may say, well your nurse managers may have a hard time with this because they may see holes in their schedule but they're not going to be responsible for filling and you are 100% right as you launch this technology change management and having champions that understand it's very important. One of the other things that this technology does for us is it gives our nurse managers and hourly, daily, weekly look at what the AI in the background and launching incentive rates does for their actual fill rate. And so you'll notice the slide talks a little bit about fill rate again, and you'll notice the takeaway from the slide, and I know it's a bit of an eye for is the rate you're launching is not driving your pickup or your fill rate. We can't see it when we just start launching incentives manually. We don't know who's doing what.

(26:48):

And so we have no data because we don't track these things in a very organized manner. When you're using a platform, it gives each nurse manager a view into their unit. So you can see look at that red line as even hourly rates decreasing. Our overall fill rate is going up and our nurse managers can see that and it gives them the confidence through data to hang in there through some of the early days of letting technology take over and do it better than we could do manually. And I will tell you this is the savior of the nurse manager who has a lot of anxiety around loss of control over filling their shifts and the fact that they can follow this allows them also take in some very good things. What it does for the CNO at the hospital level is we can roll all this data up.

(27:41):

If you can get down to a unit level, you can certainly roll it up for a bigger picture. It informs us across the system on how we set our rate card. So what we do at our big CNO Council at Advocate is we get together and we set one rate card across the system, we set an upper rate and a lower rate and we let the technology go between there and decide on the AI decides on the rate that we lift per shift, but we still control our parameters on where we set it. And so the CNO of their hospital also gets a picture of each unit and then a high level rollup, our division CNOs get a picture of what their division looks like, how they're doing across. And of course I get a picture of the overall system view of this. And so it's really important as we're taking a look at this, that everybody has the data sets. They need to know that our AI in the background is delivering on our promise of more hands at the bedside, right nurse in the right place, flexibility for our nurses to choose where they want to work and also it allows them to do it right through an app. Everybody's used to working on their phone in apps and it keeps them writing the workflow of both their personal life and their professional life. And so everybody can see we're all in alignment and the platform's doing its job for us.

(29:09):

Alright, I know it sounds like a lot of work for workforce but I will tell you the results that I've seen in my past career is a higher fill rate turnover rate goes down, people are more satisfied because they can work how and when they want and they can move between layers seamlessly. And so it's a very flexible platform that basically allows the nurse to choose what price they work at and what it looks like for them. And I will tell you nurses in their career have different life events that pushes them into different layers and I absolutely want to embrace that and let them move across advocate how and where they want to work. If not, they will leave our system even though they may want to remain an advocate nurse, they will leave us because of the lack of flexibility or life circumstances.

(30:02):

So very intent on making sure that as we move through this platform thinking that we're taking a look at our market demands and our supply and demand in the market. Alright, the first half hour we spent talking about workforce and I will tell you the last half, we're going to take that platform enabled digital presence, more hands by the bedside doing what we love and we are going to now start to talk about what a digitally enabled work environment looks like. So it's one thing to get flexibility, but on the heels of that, we need to make sure that while we have the workforce working in advocate, that we have a work environment and workflows that absolutely bring back and we say it all the time, join in practice and we're going to talk a little bit about maybe how we got away from the joining practice so we can iterate on where we're moving for the future.

(31:02):

Alright, so we've done a lot of things. We've learned so many lessons through the pandemic I can't even tell you, but what we haven't done yet is start to take a look at a digitally enabled work environment that may be able to combine some things that we've learned and some disparate work environment and workflow practices that we have going on. I can tell you, I know everybody has bedside nurses doing their best. I would say most of us have some type of virtual component. We've seen the value of virtual nursing, we know that it exists. We all have care managers that are doing their best to design not only where they are in our system but next level of care and how people remain in our system even through handoffs of care. And this becomes much more important as we have different sites of care.

(31:58):

We all have hospital at home, we have hospice, we have home care, we have rehabs, we have skilled facilities. The care manager, guess what, they work across all of those areas not only getting the best care in the inpatient environment but getting them to the next level of care in the right way. And where I would say we need to start combining the way we're thinking about what a digital care environment can look like and what it does to actually how we combine some fire power to get us there. And of course we have the nursing manager and I put the nursing manager in this because if there's anybody that deserves technology and an AI powered environment to help them in their day as the nurse manager, I don't know today how nurse managers do everything that they do. They're the hardest working group in nursing leadership.

(32:54):

We ask the most of them and guess what? It's usually one of the first forays into leadership is the nurse manager. So why would we not put them? They are closest to the patient and they're closest to our nurses that are providing care and guess what? They intersect their units and they intersect with care managers, virtual nursing and bedside nurses all day long. So we're going to talk a little bit about how mixing this up differently might lead to transforming care that we talked about in the beginning, not just redesigning or some small innovation. This will take a heavy list but I will tell you we are on the path to start to combine this at advocates. The reason we think about it is when you look at overall cost of care, not that it's everything, but I will tell you everything we do in nursing, every innovation that we launch costs us money.

(33:49):

But what we never go back and do is say what does it look like in the overall cost per unit of service in patient care? Our workforce platform did it because it delivers our overall cost per unit and our data. Now we're starting to get into this digital environment and I think it's a combination of what our workforce costs, what we're delivering to patients and how we might mix this in an overall platform that delivers the best patient care. So bear with me here. There's some concepts in here that are going to overlay, and I know most of you are working in every single one of these lanes. I want us to start to think about what these verticals look like and could we make it more about the patient that moves horizontal across all those vertical lanes that we just looked like and to be able to take in what the patient needs, we are going to have to have a digitally enabled work environment.

(34:49):

So I want to just break down a little bit each of our verticals, and I'm not going to go real deep here, but I want you to see where we're adding just technology in for the bedside nurse. This is what we're doing in advocate. And so when you take a look at our overall care design model, it really takes a look at where we're putting technology in just for the bedside nurse to be able to augment their nursing process, that add pie process that we all work off of where we might be able to make it just a little bit of a decreased workload for them. Everybody does kind of that morning assessment. We're looking at AI summarizing all of the overnight events and you're starting to see that morning assessments start to occur if we're doing it correctly In bedside shift report, the oncoming nurse and the offgoing nurse are really starting to talk about that.

(35:45):

Medication administration. We have been barcode scanning and doing a lot of different things now with ambient coming in, you'll start to see some of that medication administration getting a little less clunky in how we do it. Patient education today we are taking a look at how does it off of the care plan and off of our documentation, our auto generate custom materials for the patient, not custom according to maybe their problem statements but according to actually what they need in the educational lane. And so AI can assist us there as well. Documentation, this is an easy one overall goal. Take every single computer that's in a room and take it completely out of the care model and start to use ambient voice capture doing care. And that frees up a lot of relationship time between the nurse and the patient as we're doing our assessments and our documentation.

(36:48):

Being able to voice text back and how to go straight into our EHR is definitely where we're heading. I will tell you it's far ahead in the physician lane that it is in the nursing lane, but we're getting there. We're starting to do a lot of work with our AI partners and seeing how we can make this a reality for nursing. The hard part's, not the technology. The hard part is the speaking, the workflow while taking care of patients. It's very interesting. We're trying to design for once we're designing the ambient technology around the nursing workflow. So we are really in the middle of all this right now and handoffs. There's no reason nurses should have to speak or auto generate a handoff. AI can literally tell us the most important things that occurred in one site of care and we can use AI to deliver to the next site of care. That AI generated handoff that will go far beyond what we did in nursing, but it has lab, pharmacy, blood bank, physician notes, nursing notes. When you put AI on top of our internal records, we can deliver a much faster, more concise AI handoff report. And so the bedside nurse is going to get all these things.

(38:08):

What I'm going to show you here is how we're using it. And so you'll notice we're talking a lot about workload. I didn't forget about that. It's clear at the top. The EHR drives nursing workflow period. Any technology that we add in, add on put into the nursing workflow must somehow go into the EHR because having disparate workflows outside of that leads to the nurse having to work around technology. And so you can see the workload indicator there. You can see we have something in Epic called the nursing brain again and AI generated it is really the handoff report that nurses shouldn't have to generate. It should be driven from their past documentation for the 12 hours or however long they were working. Our care transition handoff. We talked about that. That AI generated tool that literally has the handoff ready to go for the nurses and delivers it to the next site of care.

(39:08):

As side shift report, we talked a little bit about that. We are making a room of the future an advocate where we have virtual nursing cameras mounted, we have digital whiteboards, and that digital whiteboard is populated from the nursing brain and literally prompts the nurse to make sure that we're addressing all the concerns from the care plan as well as the last documentation pieces. And it actually makes honestly the care plan actually a plan of care that we use today in nursing. We document against the care plan, but we don't use it in the patient care arena. Plan of care rounds as physicians and nurses, some of you call it geographic rounding. Our rounding, we can literally use voice to text to get the orders placed to get our text results, tell me what the last h and h was while we're in the room and it'll speak to us and take it right out of the epic record.

(40:07):

Rather than somebody trying to search on a computer, trying to write things down on a piece of paper, it makes those plan of care rounds much more interactive and we don't have to go back and do any documentation because GS who's left documenting everything, it's the nurse. And so if we learn to work in the workflows, all that work is accomplished right there and it can actually give us answers as well as push our documentation into the workflow and the voice recognition. I felt the need to call this out because it's the basis for being able to exchange in a very easy manner without tapping on a computer. It is the method that we're going to be able to push things into the EHR and drag things out of the EHR. So getting that technology perfected and it is not today, we are still working on it, is going to be key to getting to the next level care mobile decision tools, which we do have today.

(41:03):

I think nurses should never look for a policy, a procedure again, they should be able to call it up on their mobile phone, their PHI protected mobile phone that they have for their hours that they're working and we should be able to ask questions and draw it out. For example, how can we ask about the procedure to insert a urinary catheter? We should be able to ask a question and have it reach back into our evidence-based policies and procedure and deliver an answer to us on the spot waste of time if we have to go back through and figure it out. And you know what most nurses do today? They don't go back. It's too hard to look for it. And so we go with the best practice that we know of which may not actually be the evidence-based practice we should be using. So when we talk about Coty classy bundles, we can get answers.

(41:56):

Very novice nurses can get answers in the moment rather than spending time in classrooms trying to learn the answers. So very valuable tool that actually it's listed today. There's no reason we don't have to wait on ambient for that. There are very good ways of lifting that today I'm going to make a comment about the virtual nurse because we're all using it in some way, shape or form. I will tell you the virtual nurse, the way we're using it today, we're only touching the tip of the way virtual nursing CU in advocate, we are using the co-care model. They are actually in the bedside staffing per unit and virtual nursing and advocate. Actually it's two days on the unit, a day off in the virtual land. And it keeps us both relevant by the bedside. We know the patient and we are on the other side of the camera ringing into rooms because I told you the cameras were mounted in the ceiling.

(42:57):

And so you can get to a virtual nurse very easily by ringing the virtual nurse button or the virtual nurse can get into the room very easily with a little bit of a doorbell sound and then they come in the room. So helping bedside nurses stretch our workload and I would say ratios today, but workload, how do we put virtual nurses into the most challenging workload rather than just putting them into ratios. It's another thing that begs the question on cost per unit of service and how we put them into our care delivery model. Wearables I think are going to become more important, not less important today we use them for a deterioration index, looking at how we might be able to expend the wearable outside the walls of the hospital and the different sites of care and at home to make sure that as we're extending into that home environment, whether it's hospital at home or just home care, how we can monitor how people are doing in different sites of care. I would say that tags in very nicely to the virtual nurse that's going to expand across.

(44:04):

Alright, end of shift report. I'm going to talk a little bit about how it's generated today and how it might look moving forward in the future. So that end of shift report is generally done between two nurses, the ongoing and the oncoming nurse. And today it might be used if you're in Epic with a nursing brain. But I will tell you powering that nursing brain by an AI automated approach really opens up where we're going a hundred percent. And so we'll be able to bring in last labs very easily whether they're going for procedures and tests, what time they are. And also if you're using the epic bedside of the patient's using the app, they can actually get in and follow their care right along with end of shift report and the digital whiteboard. So connecting pieces of technology to make not only nursing physicians and our clinical bedside have a better experience, but also our patients engaging in their care in a way that they can't today because we are not connected visually and we are heading.

(45:17):

Alright, I'm not going to go over this in depth, but I want you to see that our nursing process components are outlined here. That ad pi that I talked about earlier. Assessment, diagnosis, planning, implementation and evaluation. Nurses will never move away from the nursing process component. It's how we're taught in school, it's how we practice if you really look at our workflows. But what we didn't do was go back when we added in the EHR, that digital component and the other pieces of technology that we're trying to add in to help nurses. It has to work within the nursing process. And actually the nursing process, while very valuable can be revamped with some of this technology. And I would say we're going to digitalize the nursing process components and make it come to life for the nurse so they don't have to work it in such a manual fashion. And you can see off to the right there the components that we are planning an advocate to put in certain spots. I connect it across.

(46:22):

Alright, the virtual nurse, we all know what that is. I put this in here just to remind us that it's a lane and how we're using it today. They do have virtual oversight of multiple patients. They are charting in complex situations for some of the bedside nurses. They deliver education, they do do some care coordination. And you'll notice an advocate that's a picture of how the nurse comes in to our hospital centered care. And you'll notice the cameras, our cameras are so good that they can literally help a nurse program an IV pump. And we also have remote digital stethoscopes that they can hear breast sounds and things and help the bedside nurses. So it's evolved to a point now where I think we're able to put it in a larger care model and we're going to talk about that, talk about the care manager.

(47:14):

We all know what a care manager does today. I will tell you some are even going remote. I can see a virtual presence for care management, but the nurse and the care manager work in the EHR and we both contribute to the documentation of the patient that not only contributes to the now goals of the patient, the near pivot for the patient, but also the far approach for where a patient may end up or things they need in their ongoing care. And that care manager is the link while the nurse is providing the documentation in different sites, the care manager needs to access. And so I think there's a way to maybe combine this we're going to talk about in a minute, but it does rely on us getting some pretty good analytics and thinking about skillsets that can combine according to what the patient needs, not according to how we're used to functioning in a larger health system.

(48:08):

So we're going to talk a little bit about what this looks like here in a minute. And then nurse managers, I'm going to tell you the hardest working job ever. They're responsible for both people and process and we expect them to have a very strong focus on people, but what they have to handle on the process side, payroll, staffing and scheduling, getting people to work, extra income's our digital platform to help them. But at the end of the day, I think there's so much more that we can do in the digital environment to make sure that our nurse managers are spending time with people.

(48:46):

All right. I want to talk a little bit about the AI enabled workflows for the nurse manager. This is where I see us moving for both workforce and work environment. Predictive staffing, looking to develop a staffing and scheduling system that has AI on the staffing and scheduling side. So predictive staffing. It's crazy if we're going to use AI and we have a sense speed per unit down into each of our units. Why nurse managers still have to use staffing grids, fill out a staffing grid and a schedule. We know by hour of the day, day of the week seasonality. When we start collecting this large language model, we should be able to predict the staffing and actually do an automatic staffing grid, automated position control as well as a template for every six or eight weeks. However you do your staffing for what you need by hours of day and day of week.

(49:46):

This is where this technology is headed. Automated scheduling through an app, just as our workforce platform allows us to pick up extra shifts. Self scheduling should be done on that same app and pushed into the staffing and scheduling system with rule-based things that are in our predictive staffing model. So nurse managers can get out of balancing schedules, making sure they have enough people. There's a way to do this with AI in the background. It's going to be our next level of staffing and scheduling and then resource optimization. If we can do it on the people side, we can do it on the resource optimization side. And so this is where AI comes in and that nurse manager. Alright, let's talk a little bit now about the four lanes that we talked about. Bedside nurse, virtual nurse care manager, and our nursing manager. When you think about it, they're all focused on one thing.

(50:42):

It's the patient. And so why we decide we had to start here, we had to have our vertical set up. And you can see we're still putting technology in the verticals, but we again, leading the way an advocate, we are starting to think about what that model might look like for virtual, for our virtual nurse to have the skillset of both a care manager and bringing an automated scheduling for our nurse managers into all of those workflows and designing their standard work around their processes around patients. We're all focused on the patient, but we're so heavily focused on our process needs that we can't see the overlap and how it affects the patient. So if we place a person virtual that was handling for the nurse manager, some of the more difficult things on the process side so they could spend time with people and patients big wins, that care manager could also have the skills of a virtual nurse and place that into the care model because think about it, the nurse is doing pieces of the assessment and charting it anyway.

(51:50):

But if you add in the skills of a care manager and start to combine the way it looks today, I think we could get efficiency and it would be more effective for the patient. And we're starting this today in our emergency department where our CAM managers are going virtual and starting out that process. And as we start to harmonize all these roles, I think over the next year we're going to have a pretty dynamic model that is focused on the patient, helps out the workload of both the nurse manager, the virtual nurse, the bedside nurse, and our care managers in the right way if we mix it. But you have to have that platform, that care platform. You have a workforce platform and you have a care delivery platform where the EHR is at the center of it. But we're starting to combine skills and talents to be able to leverage what we need to through ai. That feedback loop goes across both the manager that's in the workflows of all the people on the unit rather than staying external to workflows and trying to intersect it at certain points. I want you to think about more of a model where the patient moves seamlessly across the platform for both workforce and our work environment and workflows where we're all focused on the patient and we're leveraging technology to get there.

(53:07):

I talked a little bit about that, but you can see how we're combining it with AI to get there. So as we're starting to think as I'm closing an advocate, we use something called Rewire 2030. We're on a five year plan to get there. And what's so amazing about this work is it opens up the thinking and nursing is not working in a lane anymore. We are moving across with the patient and guess who's there 24 hours a day, seven days a week, 365 days a year. In fact, I'm hard pressed to think of a care environment anywhere in our health system outside of our walls. In our walls where a nurse is not present. And so it becomes important that nursing leads some of this thinking because we're going to have to contribute to all of it. So our rewire five-year plan for Advocate really focuses on what can we do today?

(54:06):

We have an urgency to improve care today, but we are promising a better future for both our caregivers as well as our patients. And we just opened up, I'm looking here, you guys can't see it, but I'm looking across the street. We opened an innovation district here in North Carolina, something called the Pearl. If you look at it online, it's housing some of the best innovation. It's got rooms of the future in it. We've got technology partners from the industry coming in and inhabiting floors of this to think differently. And I will tell you nursing is taking a big bold approach to what care delivery looks like alongside of our other partners. So I'm very proud of the teams and advocates, but I will tell you, we need partners to get this done. And so that big, bold thinking doesn't happen sitting off into yourself. And the pearl over here has just tremendous amount of innovation in it. And I think there's probably things we haven't even thought of. And so in closing, I just want to say be bold, think about things in a different way and don't take anything off the table because you never know what great ideas today. Turn it into the promise in the future of tomorrow. So I put down my contact information here and obviously happy to reach out to anybody, but I'm going to turn it back over to Becker's and Naomi, I think you're going to kind of bring us to a close.

Naomi, Becker's Healthcare (55:38):

Thank you so much again, Betty Jo, what an excellent presentation as well as Advocate Health for putting on today's webinar. I want to thank our audience as well for great questions in the chat. And thank you so much for joining us today. We hope you have a wonderful rest of your afternoon.

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