Dani:

Welcome back to the Handoff from Trusted Health. I'm Dr. Dani Bowie, Chief Nursing Officer of Trusted Health. This season recovering all things healthcare innovation and the importance of fearless leadership for change. In this episode, I have the pleasure of speaking with Dr. Karlene Kerfoot, CNO, and Ali Morin, VP of Nursing Informatics at symplr. Today we discuss their work with AONL to prepare leaders for digital transformation in the pivotal partnership between IT and clinical leaders to advance digital change. We also cover the past, present, and future of the CNIO role. Here's my conversation with Dr. Karlene Kerfoot and Ali Morin.

Welcome to the Handoff. I am so excited to be having a conversation with Dr. Karlene Kerfoot and Ali Morin from symplr. Welcome, Ali and Karlene.

Ali:

Thanks for having us.

Karlene:

Thank you.

Dani:

My pleasure. I'm excited to dive into some of the unique conversations that we'll be having today, but first and foremost, I would like to bring us back to our purpose, which is the patient and would really enjoy and appreciate if both of you could share a particular patient experience or story that has had an impact on your career or just life lessons in general.

Ali:

So I've been a nurse since 1997 and the story that resonates the most with me about a patient is I was a pediatric critical care nurse and I was newly out of orientation and had experienced the first death of a patient while not on my watch. I was there in the unit while he passed and he was a triplett. He was nine months old and he had liver failure and even post-transplant, never recouped from the transplant and never got better. I mean, obviously heartbreaking as a new nurse to see a child die, but what I learned from it, probably more than just the tactical taking care of a dying patient was watching the nurses who had been there for a long time take care of him and take care of him like he was their own and take care of them as if that mom was their sister.

And the compassion and empathy that I learned about nursing from those nurses who had taken care of him for nine months landed with me more than probably anything I've ever experienced in nursing since then. And as I think about your podcast and our work to do, which we have lots to do, it comes back to where are those nurses today and what are new grads who are our new grads looking up to learn those kind of nursing life lessons about how to take care of families and patients in their most vulnerable and horrible. So again, it wasn't about really learning the tactical, how do you take care of that patient as they're leaving the earth, but learning from the experience of others around me was the most impactful part of that.

Dani:

Yeah, learning from experience or watching, that's something we read about, but you just don't see it. You don't internalize it until you see it and experience it, and that's a really wonderful call out of the compassion empathy that is so necessary for healing and caring for people. Karlene, I would love it if you could share a story as well.

Karlene:

Oh yeah. I had a lot of wonderful stories and I think that there's so many moments that matter in nursing and I'm on the DAISY board and of course we celebrate with gratitude and DAISY awards, all the beautiful things that the extraordinary nurses do that make such a difference to patients and families and other nurses and so on. However, I think I had learned more from the negative experiences, the bad experiences, because those are moments that matter and I think if we don't run away from them and if we look at them and internalize them and understand how we can fix them, then we do a lot of wonderful things. For example, when I was a new nurse, I was working in the VA at a time where you had lots and lots of patients, so it was change of shift. I walked by this patient's door and he was relaxed in his chair with his head back.

He was about 48, 48 years old or something like that. And I thought I should probably go check on him because his head's back a little ways. But I had to get my meds out and I ran around and did all that kind of stuff. The time I came back, he died and he'd been dead probably from before the shift changed. Unfortunately, he left eight children and that just resonated with me for the rest of my life because I wanted to make sure that that didn't happen to another patient and to another nurse, if you can look at that and say, how can we change the system so that won't happen? So we change the system a lot in terms of having the nursing assistants go in more often and things that are commonplace today. But I resonate very much with the moments that matter and the ones that are negative and can really kill your soul unless you say, okay, we're going to run right into this, so we're going to figure out how to fix it and I will be better. The organization will be better, nurses will be better to do it. So I think it's really good to focus on the positive but also the bad things because that can keep you in the profession if you figure out how to fix it.

Dani:

Extremely important call out there. It's actually something I've learned a lot from maybe some bad leaders that I've had and thought I don't want to be that type of leader. However, this is so translatable across any healthcare professional listening, those experiences that you do kind of want to run away from because you're like, oh, that was not the best. But rather embrace it to understand what caused it for change is something that we desperately need. And the courage too, this is a podcast around courageous leadership and that's a piece of courage is pressing into what may not have been the best to uncover what can make it better so it doesn't happen to someone else. So thank you for sharing that. Really powerful. I want to change gears and talk a bit more around your guys' work in the tech space and you have such expansive careers, both of you and I know that digital transformation is upon us in healthcare and it is imperative for clinical leaders to be ready to embrace that transformation. You both are currently working with AONL to prepare leaders for that digital transformation. What are some key principles or call outs that you would like our listeners to hear and learn today about how to embrace digital transformation and actually lead in that space?

Karlene:

There's cycles in time, and this is a big cycle that's coming in in terms of the digital transformation. One of the challenges is to be able to be prepared for it and versus saying, well, it's not going to happen or I'm not going to participate, or it's evil or whatever. But the best thing you could do is be prepared for that. So we're working with AONLL, and I'm co-chairing this with Dan Ferris from UKG, and we're getting a group of people together, both nursing leaders and also nursing informatics leaders and asking the question, how can we partner better and how can we connect with each other better so that nurse leaders are more confident than what they are now and that they can sit at any table When you're talking about clinical transformation, unfortunately, there's a lot of times when the nurse leaders should be there, the clinical leaders should be there, and they're not there because they just don't have the competency to sit at the table, and so you don't get a seat at the table. We have to change that immediately because this is a clinical area. We have to have the clinical people there doing it, and Ali and I are great partners in this because she has the skillset that I don't have being a nursing informatics person, and I have some skillset he doesn't have. So it's a great partnership that we have to do. So Howie, take it away and talk about that partnership. It's really fun.

Ali:

Yeah, I mean particularly around the AONL group, the great part is Karlene and I are working with a lot of other groups that have already embarked on technology competencies and technology leadership, aia, aia, PIs, A N a, I mean the list goes on and on. I know I'm forgetting about 15 of them, but there's already been work done in this space around level setting technology competencies are really the part that I'm working on with a small subgroup from this larger AONL group of leaders who raised their hand and said, it matters to me that we do something about this because to Karlene's point, we don't have them in the room with us. And so we're working on not reinventing the wheel, but taking existing competencies that other groups have already really put the work behind and molding it into what does that mean for a leader? What do these competencies already existing mean to leaders? So it's really great to be pushing this work forward and AONL is a great partner. They're certainly supportive of us doing this because there's definitely a gap and they see it and we see it. And as we build nurse managers up to nursing directors and up to a VPs and up to CNOs, we have to be able to have them be competent in all those areas as they excel in their careers too. And sometimes that's a part that gets left behind. So it's fun work.

Dani:

I can't wait to see the output of that work. Just hearing the names of who you're working with and Nan is fantastic, and having both of you helping champion this work, I think will be really meaningful to leaders across the country in the space of healthcare. And something I would love to learn more about too, I feel like digital transformation or competencies was more of a trial by fire. Were you involved in a tech project? And if you were, then you started just to learn both the good and the bad experiences that help shape and mold that. But if there could be some more formal training and framework to set expectations with leaders, I think that would be extremely valuable and give us more confidence in this space.

Ali:

Not every health system or hospital has the ability to have what Karlene and I have where one of us is the leader and one of us is the informatics leader. And so being able to educate some of those leaders who might just be in a community hospital, but they have nurses who use technology and giving them the dialogue and the conversation so that they can be advocates for their staff. If they can't hire an informatics leader, I think about them more than I think about the large health system leaders who have large clinical informatics infrastructures underneath them. It's how do we make the CNO who's just the CNO slash CIO slash CCIO slash COO feel comfortable with it?

Dani:

That's a really good call out between resourcing and rural versus metro large academic versus community and the differences of the resourcing associated with that and structure to take on some of these, the transformation, the change that's needed. You recently conducted a survey in partnership with chime, and I would love it if you guys could share some results or key takeaways or any ahas that came out of that survey.

Karlene:

This is our second annual survey with chime, and there's some interesting things that happened, for example, that workforce and workforce shortages now are number one concern of this population. It used to be finances, of course, they kind of go together. And then we also had some interesting questions about people in patient care and the people in IT and how they work together or don't work together or whatever needs to be done. And Ali, you want to talk about those results that the discrepancies there?

Ali:

Yeah, I mean the key themes, and we're just getting the results back and we're still in the analysis phase and not going to give away too much of our findings yet, but the themes are to Karlene's point, workforce challenges, technical burden. How do we do a better job of not just putting technology in the space but leveraging it and consolidating it and then alignment. So IT and clinical perspectives are definitely varied and what it thinks is a problem is not necessarily what the clinical respondents thought was a problem and vice versa. Clinicians were speaking up about how hard it is to support nurses and it didn't really feel like that was that big of a priority for them. So it's interesting the themes that are coming out around the two paths of priorities for when you break it down beyond just the overarching survey, but from the IT side versus the clinical side. So it kind of feeds into again, Karlene and I'S relationship and how important that is to have both the yin and the yang.

Dani:

Absolutely. And sharing the sneak peek. I can't wait for the results to come out to read through that. As I'm listening to some of your war themes come through, they are kind of ahas but also not surprising. I'm sure any nurse leader or any IT partner would be like, I think we work well or maybe there are some discrepancies there. So bringing that to light and allowing for the conversation around that of there might be some discrepancies in how can we bridge the gap to be successful together is another, I'm suspecting key component of digital transformation in general and probably one of the competencies or skills that's needed as a nurse to cross the aisle or cross the table and make the connection with our IT leaders. Which kind of actually is a nice segue into the next question, which is the role of the CNIO in healthcare and what are you guys seeing in the industry and how pivotal is this role for digital transformation?

Ali:

In my experience, the history of the CNIO came to fruition around the time that EMRs came to fruition, and we suddenly needed nurses to translate and figure out how technology's supposed to work when we go from paper to electronic. And that was the simplistic version of clinical informatics in the late nineties, early two thousands, which is when I started doing it. Since then, those roles have come into, again, larger healthcare organizations who have resourcing and capacity to and build infrastructures which are critical. I mean certainly having that elbow to elbow clinical nurse informaticist alongside your nurses as you're rolling out technology, helping sit alongside of some of the developers or some of the IT analysts and building updates to flow sheets and updates to upgrades for EMRs is invaluable. The CNIO role, as I see it started off as that leader from an EMR perspective, but really the power of them now is transforming that role and becoming much more broadly engaged in the technologies and health systems.

As we're thinking about new care models for nursing and we're thinking about virtual nursing and we're thinking about telehealth and we're thinking beyond the four walls in hospital at home, the technologies that come along with that are much different than what they were 20 years ago as these roles were developing. So having that role to be able to be forward thinking about technology for nurses is critical. And sitting alongside of a chief nursing officer sitting alongside of a chief information officer, chief medical information officer at the same table, kind of laying out the roadmap and the strategy for what nurses need, not necessarily more technology but strategic about the technology is important. And it's critical as we go into digital transformation and as we think about ML and AI and generative, all of that, all the things that are coming at us, you need that kind of translator in the middle to say, this is what we need, this is what we don't need, and have that professional dialogue about the needs for the staff. And I don't know, Karlene, if you want to speak about from your seat as the chief nursing officer in healthcare organizations, what that role looks like for you.

Karlene:

It's such a pivotal role and there's always issues in terms of where that person should report. Should they report to the chief nursing officer or should they report into it? It doesn't make any difference. The whole point is that people should look at that role and not know where they report, just assume that they've got their feet in both areas there and then they are as welcome in the administrative and management meetings in IT as they are in nursing. I think if they're not integrated in nursing, if they're not part of the leadership team in nursing and if they're not part of the shared governance structure in nursing, then we leave a lot of information on the table that is very valuable to the nursing organization, patient care outcomes and so on. And ditto. If these people don't sit on the administrative and management teams in IT and bring in all that information, we leave a lot of stuff that it would be really much better to get together patient care.

So the point is it's very good, but it's a partnership and it really has to be an integrated partnership that you work together as one and between these two heads you've got one head. And if you don't have those, then really can't do your job. It's really serious because especially with digital transformation, there's a lot of stuff coming down the pike and you can't know it all as a chief nurse, but you can really lean on your resources in terms of nursing informatics to help you make those decisions and to really look in the future because that's what nursing informatics people do. They look at the technology, they look at simplifying it, they look at what you need for the future, and that's a real good place to be because if you just let it buy the technology or just let HR buy the technology, it doesn't work. You have to have the users out there know about the technology, know what they want, and to be able to articulate that. So it's a great partnership. The more we can do that, the better our healthcare systems are going to be

Dani:

Another good call out and marrying the clinical. And I really liked how you said it's okay if you don't know exactly where they fit because they're not supposed to fit in just one space. It's clinical and the IT space, and they're welcome in both, and that's going to help continue to bridge that gap and prepare for digital transformation. And it's an important call out for the CNOs to lean into those individuals that have that skillset to champion the message and vice versa for IT leaders. So I hope that we continue to see a rise of the CIOs and those that can continue to help support and bring transformation in this space with what we have coming at us, which is again another nice segue into the questions that I have, which is as we think about the technology ecosystem in healthcare, I mean this can be daunting for managers and leaders and frontline staff. We're touching multiple applications for daily work. How could this be simplified? What would an optimal technology ecosystem look like for health systems so that no longer are nurses Carleen? I once heard you say caring for the computer, but returning and caring for the patient.

Karlene:

Yeah, too much of their time is spent nursing the computer versus nursing the patient because of all the technology. And the technology burden I think is number two reason why a lot of nurses leave in some studies and ditto for the physicians. Also, the technology burden is just too much. So if you look at what's happening with Stanford, which is one of our questions when we did the survey with Chime was how much time could you redirect back to clinicians if this technology burden were lessened and it was efficient and they didn't have to deal with all these systems and phone calls and all that kind of stuff? Well, they estimated that probably 84% said they could redirect time and they talked up to as much as 20% a week could be redirected if we cleaned all this garbage out and simplified it and had common platforms.

Because as you know, as a staff nurse, you're going through multiple complex platforms and then in terms of managers, they asked the same question, how much could managers get back? And in some studies they talk about managers are spending 50 to 60% of their time with staffing either trying to find staff or whatever, which is criminal because that means they can't do other things such as staff development, connecting with patients, families and so on. So the estimate for them was 20%. So if we can clean out these systems, simplify 'em instead of having, and I think one of the questions was how many disparate systems do you have to work with? 80 was one of the answers, and that's a lot of technology to first of all learn about to understand and then to have to deal with right there on the spot. So we really need to think about simplifying and making it easier.

So if we can do that, then we can capture a lot of stuff. And if you look at, when we talk about the moments, look at the beautiful moments that people are missing because they're on the phone or they're trying to do all these kinds of things that they don't have the contact with the patients or the families so they don't have the beautiful moments that matter. We can bring those moments back if we can just clean up the chaos that's out there and we can do it, other industries have done it, we can do it.

Ali:

Yeah. I just think about what's the purpose of the technologies that we're putting out there. I think in the last 20 years in healthcare technology has gone faster than what adoption can tolerate. There's a lot of reasons to look at those 80 solutions and say, what are we not only financially, what are we getting out of them? We're spending a lot of money, but secondarily, what's the outcomes that either patients are experiencing from us having this technology, nurses, physicians, I don't want to speak for my doctor colleague, but we're adding things like dragging a nuance and that to accommodate for the fact that we spend too much time in the EMR. So maybe we should go back and look at the EMR and clean up the EMR so that we don't have to add technologies to do voice dictation in the EMR. Right? I just think about we are just adding on top of things without fixing the fundamental problems that potentially exist in our tech stacks at healthcare systems.

Dani:

Getting to the root of the issue is critical to solving it. I've often heard it mentioned that we're like symptom-based management, so instead of going to the cure, so if a patient has congestive heart failure but now they need more oxygen, well, it's like what we're doing. It's like, well, we'll just give you more oxygen, we'll give you another application. Versus getting to the root of what's causing the issue for our health systems. It would be ideal if we were given some time and space to really document those systems that we're using and how are we using them and where can we reduce and where can we lean into existing systems for simplification and cleaning them out. This is no small feat, but it's something that's necessary, especially as you mentioned and we're talking about digital transformation is upon us. These systems are fast, they're moving into our spaces and not only is, if I'm hearing you correctly, a nurse is spending time caring for a patient.

So you learn that clinical skill and competency, but then you have all these technical systems that you have to learn and manage. So that is a very complex space to operate in. And let's talk about if we want to ensure safety and lack of errors. 80 systems is a lot to deal with, or even just five for that matter. And I'm sure could increase the risk of errors because you're moving in and out of different systems.

Ali, you kind of touched on this a little bit. The frontline nurses, they do spend a significant amount of time charting, and I know the documentation burden is real. What are your thoughts around the documentation burden specifically for the frontline nurses? I

Ali:

Think there's a componentry with how long we've been out with EMRs, and I think this is the role of that CNIO and nursing informatics team to take a look at what is in there. Every conference I go to, there's always people talking about their EMR optimization project. It's continuous optimization, right? It's not just a one-time thing. You've got to be in a continuous state of optimizing and improving and not just adding to, one of the things I did in one of my jobs was I was the person who kind of translated what either we had a patient event or a joint commission requirement would come out, Hey, what does that look like in the emr? And I kind of liked being the person in the middle asking the questions, why does the nurse have to do this? Why is this a checkbox that she or he has to fill out?

And making people actually answer that, why is it them just because they're there 24 7? So I think there, there's a piece of thoughtfulness around what do we have today? And then to your point, what's the future look like for nursing documentation As we're talking about AI and ml, is there a place for that for nursing dictation? Certainly. How do we tie in the ability for them to easily document while they're on the go and on the fly and not sitting down at a computer? One of my favorite things to say is nurses didn't go to nursing school to spend 35% of their shift documenting. So let's figure out how to get that better. And I think the technologies are there. We just have to be smart about what we're asking them to use and make sure it adds value and not adds burden.

Dani:

Asking the question, why are we doing what we're doing? And as we mentioned, getting to the root of the issue, this has been a really insightful conversation, one that I'm extremely passionate about, and even Karlene, you mentioned managers are spending a ton of time around staffing and scheduling as well. And so there's ways to make that better, and I think that's our aligned passion here and just a continued call out for our listeners to continue to ask the question why? How do we make this better? What technologies can aid us in automation and support in this space so that we can free up the time to do the beautiful things and have those beautiful experiences both with our staff and our frontline nurses, et cetera. What are your thoughts about the future of nursing? What's exciting you? What's making you nervous? I just love your perspective, both Karlene and Ali, what you think about that?

Karlene:

I have two perspectives on that. Some days I can get very discouraged because you can go into a hospital and you can make a list of what hasn't changed since I was a nursing student. For example, the IVs go off at three o'clock in the morning and they never work. And people are in there trying to get them untangled and well, that stuff, the gowns haven't changed. Things like, and the communication between the techs and the nurses. Sometimes it's good, but sometimes isn't. And then of course the doctors, it hasn't changed. So I can get very discouraged sometimes when I think about that. However, I think that the digital transformation gives us a huge opportunity if we embrace it and if we say, yeah, there's going to be problems, but we're going to make sure that we do the best of it. Because with digital transformation, you can look at many of those things.

You can simplify many of those things. You don't have to be filling in those forms. We've really got to push that machine learning to get them to fill in the blanks much more than what we do. And then of course, if we had better predictive systems that would simplify our lives so much, if you can automatically fly an airplane, a jet airplane with a pilot doing nothing but just watching, or a Tesla or something like that, why can't we do that in staffing and scheduling? Why can't we just sit back and let the system look at the predictive, bring it in, look at the nurses you have, look at the patients, and then send it to you on a big silver platter and say, here, look at it. I get very excited when you think about those kind of possibilities because that's kind of a watershed moment.

It gives us another way of doing things. And without that digital transformation, we're still going to be doing things the same way we did when I was in nursing school. So this is a huge opportunity to embrace it, not be afraid of it, but to monitor it and never ever let the human piece get out of it. So if we have better prepared nurses, better prepared nurse leaders who can guide and work in that area, man, we'll be great. But if we have nurse leaders who don't want to touch the digital stuff and say it's not their job or whatever, then it's very discouraging. So I think we've got a huge opportunity here, and I think we're step on it. I think we're we're going to do it right. I think the stars are aligned that it's going to be good.

Dani:

I think we're on the precipice of change as well, Karlene, and we have to be. And if we don't, I mean, do we have to have the conversation one more time around some of these things like staffing and scheduling automation? So I'm in full agreement there, Alex, share your thoughts on the future of nursing.

Ali:

Mine's a little more simplistic and I get to watch it through the eyes of my nephew who's about to graduate from nursing school in about a couple months, and he is so excited about nursing. He always has been. He's just like, I can't wait to get out there and do my job. And for me, in my job and in my role, it's about making that runway smooth and easy so that he can go be a nurse that he's supposed to be and not deal with all this noise, not deal with short staffing, not deal with not hearing back about a job that he wants to go get, not hearing all the noise that we know exist in nursing today. The purity of his excitement is what excites me. There are still people out there that just want to go be really good nurses and we need to make it so that they can do that.

Dani:

Agreed. I love that you bring the lens of the fresh, a new perspective and the excitement, I'm sure that we all felt in joining the profession and that you're in a position to help solve it. So that excitement and joy and passion around why we enter the profession can continue and not get bogged down with all the noise around the work that we do or the things that can take our eyes off the beautiful moments and the prize of caring for our patients and making connections with our nurse colleagues or our care team that are so impactful. Where can our listeners find both of you? So if they have more questions about digital transformation, automation and staffing and scheduling, which I know symplr is a really great product that you guys are a part of today, how can they reach out to you?

Karlene:

Well, of course I'm at symplr.com also, my email is kkerfoot@symplr.com and symplr is spelled S Y M P L R. Got it. symplr. Simpler. So I'd be glad to take any questions or any thoughts or challenges or anything like that. It's fun to have that kind of dialogue.

Ali:

Yeah, I'm at amorin@symplr.com or I'm on LinkedIn, I'm on social. I also welcome dialogue and conversation about all things digital transformation and technology. I try to be as much of a sponge as possible and learn from others as much as possible. So it's really about not just what can I share, but what can you inform me about that I might not have insight into today.

Dani:

There you have it, two leaders who are telling the listeners, we want to hear from you, and in fact, we're okay if you want to challenge some of the things that you're saying or you have a different perspective because that adds to the depth of the way that we can solve these issues and problems. We often have one final question where we ask our guests to hand off to our listeners a piece of advice. It can be anything, Ali and Karlene. I would love it if you could share with our listeners today a final handoff that you think is important for them to take away from this conversation.

Karlene:

Well, I think as a profession, because we are so scientific and we are so risk averse and we're afraid if we change, we are going to kill patients. Consequently, we always say, no, no, no, it's not good enough. Or whatever it happens to be, which is good. But on the other hand, it holds us back a lot because there's a lot of things that we can do that doesn't kill patients. In fact, that makes patient care even better. So I would challenge people to say, yes, let's look at it versus say no. I think the more we say yes, let's look at it and then make a decision versus automatically cutting it out right now and just saying, no, that holds us back a lot. My suggestion is let's get to yes and look and check, and we can say no later, but let's say yes first.

Ali:

My handoff to you is we know, and this is from my technology lens, we know that we're asking you to do a lot. We see that we're asking you to do a lot. We're seeing the results of that in the research and in the findings and in the studies that you're telling us, you have too much on your plate. We hear you. We're working on it. We're trying personally, it's simpler. We're trying, but we're also trying across healthcare as a whole to make your experience as a leader better and provide you with the support you need and not just continue to make your day-to-day job harder. We want you to stay in the profession as long as you want to stay in the profession, and we don't want the reason why you leave to be because of us or anything that we could have solved for you. So it's slow. Healthcare is slow. Sometimes we can't run as fast as we want to run, but we're trying and we hear you. So we're working on it.

Dani:

Lead with the yes, and we are working on it. We have brilliant minds who are working hard with humble hearts to hear the feedback of those using the product to improve it and speed can not be something that we often experience in healthcare, but we're pushing for it. So Karlene and Ali, thank you for being courageous leaders, for listening and wanting to change what is a very complex space to operate in and preparing our future leaders for digital transformation in the work that you're doing with AONL. Thank you for your time and your contributions and what you're doing to help make healthcare a better place to work and a better space for our patients.

Ali:

Thanks, Dani.

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