Dani:

Welcome back to the Handoff from Trusted Health. I'm Dr. Dani Bowie. Today I have the pleasure of speaking with Kasey Paulus, SVP of Patient Care Services and Chief Nurse Executive at WellSpan Health. We discuss pivotal moments in leadership lessons that shaped her career. We also do a deep dive into some of the innovative programs at WellSpan, including the launch of a hospital at home program and the emergence of virtual care. Here's my conversation with Kasey Paulus.

Welcome to the Handoff. I'm really excited to have a conversation with Kasey Paulus. She is the SVP and Chief Nurse Executive of WellSpan Health System. Kasey, welcome.

Kasey:

Thanks, Dani. I'm glad to be here.

Dani:

Great. Well, I would love to start the show off by centering us back to our purpose, which is what we've been doing this season, and that's around the patient and patient care. Kasey, I would love it if you could share a story or a particular patient experience that's had a profound impact on you that you could share with our listeners today.

Kasey:

Absolutely. I have a really fun story to share. I was recently going to visit a couple for lunch at their home, and when I got to the home, the wife told me that they had something they wanted to show me in the living room, and I walked into the living room and I saw one of our highly skilled WellSpan nurse practitioners admitting the husband into our hospital at home program. The husband had a history of getting severely dehydrated, which would result in him having to go to the emergency department. And so he talked with his primary care provider to see if there was an alternative solution, and his PCP referred him to our hospital at home program and it was such a great solution to keep him at home instead of in the emergency department. He could get his IV fluids, have his labs drawn, and then he was monitored by our nursing team.

And the wife and the husband were just so incredibly pleased and grateful for the program. He was able to be discharged within a couple of days. They were able to do their plans that they had to go out of town that coming weekend. And I love the story for a few reasons. So one, it's an excellent example of the shifts we're seeing on where we can provide care to patients. Two, it's a great example of the potential we have to enhance how we care for patients through the use of technology and advanced monitoring. And three, what a great example of being able to offer personalized care for patients and families that really meet their individual needs.

Dani:

Absolutely. Hospital at home, I'm super excited. We're going to dive into that topic shortly. The way that transformation is coming to our health system with that personalized touch. That's really, really powerful and I love hearing too an advanced practice nurse and how WellSpan is expanding the role and reach of your advanced practice nurses. That's amazing. Now Kasey, I would like to share with our listeners a little bit more about your background before we jump into some of the innovation and retouch on the hospital at home. You have a very accomplished career. Can you share a little bit more about some of the different roles or pivotal moments that have helped shaped your career?

Kasey:

Absolutely. It's hard to believe I've been a nurse now for 20 years. It's been such a rewarding and fulfilling career so far. I've been fortunate to work as a staff nurse. I've worked in a variety of roles within quality and safety and performance improvement and then eventually moved into leadership. And I remember as a staff nurse often being frustrated with the inefficiencies within my practice processes that didn't work well and that got in the way of me delivering great patient care. And I was also very in tune with the profound impact leaders had on my work environment and the culture of the department. I was initially hesitant to move into a leadership position, however, I had several colleagues who just kept encouraging me and helping me grow in my confidence and skills. And eventually I said yes. And honestly, my entire leadership journey and career has evolved as a result of saying yes to opportunities that were usually very outside of my comfort zone. And as I've moved into leadership, I have kept my experiences as a staff nurse at the forefront of my mind. And my goal is to create an environment where our nurses can do their very best work and where we continue to chip away at the frustrations and the challenges and the barriers that our nurses and our care teams face every single day.

Dani:

You call it saying yes to the uncomfortable and being able to use that uncomfortableness or growth or a little bit of that pressure, which is really good for formation. And so encouraging our listeners and when opportunity taps think about saying yes. But another thing you said that I think is really important too, and I wanted to highlight is your experience as a direct care nurse. You are using to keep at the forefront of how you are leading and bringing transformation to your health system. But I imagine also empowering your frontline and the way that you are helping the new generation of leaders arise as well. Did you have any specific mentors or is there a relationship or a professional community as well in addition to saying yes to those opportunities that helped you continue to grow professionally oppressed into those uncomfortable situations?

Kasey:

Yeah, I was very fortunate to have a couple of mentors who really, again, weren't afraid to give me feedback and help me grow. And also were usually in a position to help me take on maybe stretch assignments and I'd say kind of grow in a supported and contained way. And I think that's really critical. It's really important. I'll also just share, I've been really fortunate. WellSpan is an organization that really values lean in the lean management tools. And I grew up in an organization that did that as well. And that was another way where I was really able to cut my teeth as a leader and get a lot of on the job experience learning leadership skills through the lens of performance improvement and quality improvement. And so I share that. I think it's a really important way to learn and grow and often one that is available within organizations. So you might not need to be in a formal leadership role, but you might have the opportunity to tap in and participate in different improvement projects or initiatives where you can get some really great experience and exposure.

Dani:

The lean program is a really good call out and just a fundamental way to learn how to bring in process improvement and change into organizations. Let's talk a little bit more about wealth span. And this season's really about healthcare innovation and I know WellSpan embraces the spirit of innovation and has a culture of inquiry, as you mentioned with your patient story hospital at home, and it's a perfect example of innovation that's happening at WellSpan. Can you share a little more with our listeners an overview of that program and how it's coming to life?

Kasey:

Yeah. Hospital at home was really, I'd say born out of necessity in the midst of the pandemic. The pandemic really highlighted our need to treat patients when appropriate in their homes, and that certainly helped avoid coming to the emergency department or maybe even being hospitalized. And so we launched our hospital at home program in September of 2020 and we have now provided personalized care to over 1600 patients in their homes. Our patients love the program. We have a 98% positive patient experience results out of the program. And there's so many benefits. Patients can stay at home, they get to sleep in their own bed, they get to eat their own food, they can wear their own clothes, they often can have their support resources around them as well. And we've seen some really great outcomes as a result of the program. I'll share just a brief example.

If we think of a patient with heart failure in the hospital, we're often controlling the environment and particularly controlling diet. And so we might be able to manage heart failure symptoms in the hospital setting, but then when the patient goes home, they're often going to revert to eating what's in their pantry and getting back to their normal habits. And so the benefit in a hospital at home program, the patient's at home, and we actually can monitor and adjust medications in their treatment plan based on their normal habits and routines, but then the nurse is also in the home and they see what the patient's doing, what's in their pantry, and they can do some real-time teaching and education. And of course then incorporating that into the care plan so in the end, patients get better outcomes. It's a really rewarding environment for the nurses as well, and we've been able to carry that into other programs such as C O P D and diabetes, et cetera. So it's just a really excellent program and being able to again, provide that personalized care for patients.

Dani:

Absolutely. Well, those are some great stats. You said 1600 patients, 98% positive patient experience. What really stuck with me in that, the way you're describing and teaching me about this program that's new to me is you're absolutely right. The environment of inpatient is an environment that historically people, you're not there a lot. It's maybe one to two to five times in your life. You're in a hospital, hopefully less than that, but if you can get into their own environment and show them how to modify the lifestyle that they're going to live for success, that's amazing. I really like hearing that. And one thing I know about hospital environments too is they are notoriously loud. When I was managing my patients and my units, it was just tough to give 'em an environment to heal because it was loud and people coming in and out. So I'm really excited about this program and the way that it is transforming care and making it actually a bit more sticky based off of the personal environment. Now, I do have some interest my passions around the workforce, staffing and scheduling. And I'm curious, how have you helped develop the workforce for this new care delivery model? Delivering care in a home sounds a bit different than inpatient, so I'd just love to know how your team has been helping bolster up the workforce in this space.

Kasey:

Yes. Our WellSpan Hospital at home program uses a blend of registered nurses, nurse practitioners, and then a collaborating physician. And what we've seen that's been successful in the program is it's a mix of registered nurses that are coming with either home health experience, so in your traditional home care model or acute care backgrounds. And that has really been a good mix of experience that sets these nurses up to be successful in this unique level of care. And then from a training perspective, we really created a new training program that's a hybrid of what we would typically offer in the acute care setting and in a home health setting. And so again, that has worked well for our nurses and I think they felt supported in that new program. In the model, our nurses are seeing patients about one to two times a day, and then the NP is available and doing a video visit with the patient once a day and if needed, the NP can also go out to the house and they might be able to complete additional assessments, or maybe they can help with certain skills like a difficult IV start or wound care, et cetera.

So it's really a team-based model. And I think as we think of some of the skill sets that are really critical in acute care setting and home care setting, a lot of it's about being able to troubleshoot and think outside the box and be creative. And that's certainly the skills that our nurses and nurse practitioners get to bring within this role.

Dani:

Well done. It's also a unique opportunity to give another career pathway to the workforce as we think about. Oftentimes, I've helped develop career pathways within traditional healthcare settings, and this is one that I think I'd be curious to see the subset of the workforce, like, I'm interested in this, let's go this path. So way to open up new care opportunities and ways to develop the workforce there. In addition to the hospital at home program, I know WellSpan is also launching the first virtual care unit soon. So Kasey, can you share a bit more about that program as well and how you're launching it at WellSpan?

Kasey:

Yes, we are so excited for this work. So in early August, we're launching a pilot again focused on virtual nursing and tele sitting using an AI capable platform called Artis site and the model's based off utilizing a camera and a microphone and a patient room and then having access to a smart capable TV or tablet. And then we layer that artificial intelligence functionality on top. And so it allows us to augment existing acute care delivery models with virtual nursing staff who work alongside our bedside nurses and they help support patient care, including completing admissions, discharges, patient education, documentation of care, and then also helping with interventions that keep our patients safe such as falls prevention and other measures. And so the model really supports our nurses at the bedside, and again, it's an extension of the care they're providing, but it also creates another option for working clinically, which is really, really exciting when we think about meeting the needs of our workforce. So we're really excited to pilot this new care model at WellSpan, and our intention is to expand.

Dani:

Great. Another pathway is being developed for the workforce to work clinically, and so you're maintaining the critical knowledge of the workforce that is obtained through experience. I know the advisory board you used to put out the knowledge gap is usually the main concern as we hit the nursing shortage. So being able to retain the workforce in new ways and transfer on that knowledge is so critical there. I also really enjoy what I was hearing is ai and that's being layered on top of this. I've heard a lot about virtual care units. I would love to check in with you after it's launched and learn more also about this overlay of AI and how that's impacting the work in a better way. I think there's so much opportunity there as we're talking about innovation. I would be remiss if we didn't talk about health and wellbeing of the workforce as well. You need the right type of environment and setting to be successful with innovation. And I know this is a top priority for WellSpan and we'd love for you to share with our listeners approaches that you are taking, the organization is taking to address wellbeing, to build up the healthy workforce now and of the future.

Kasey:

We know we are headed for one of the most significant nursing shortages we've ever seen, and that is going to require us to figure out how to solve the root causes of burnout in our industry and how to deliver care in new ways because we just simply won't have enough nurses to care for our aging population. And so we have to double down on recruitment and retention efforts. Part of that is ensuring we're offering flexible scheduling options and really getting creative and meeting nurses where they're at and giving them several different ways to engage as an employee. And we need to be offering wellbeing benefits to our team. So I'm really proud of WellSpan's commitment to wellbeing. We have a comprehensive employee assistance program with a focus on mental health resources. We also have a new and improved wellbeing portal, and there's several tools and resources are available there for Whole Person Health.

I personally just completed my annual wellness screening and it generated personalized reports and told me where I was doing really well and where I had some opportunities. And then more importantly, the portal equipped me with resources, and this is available to all of our members at Well Spam, and of course we have to address our staffing challenges and shortages. And this will include preparing again for new models of care such as virtual nursing and preparing to care for patients in different care settings such as hospital at home and expanding beyond that and then incorporating technology to make it easier for nurses to do their work. So finding ways to eliminate the administrative tasks and reduce documentation burden off of our nurses. And we have set measurable targets and goals for reducing documentation time for our nurses at WellSpan. So we are absolutely committed to making some tangible improvements in this area, and I'm really excited the results. We're already starting to see

Dani:

Music to my ears here at Trusted. We actually launched our fourth annual survey around wellbeing and mental health or our work before the nursing workforce, and we had about 1900 respondents. And the things that you just mentioned at WellSpan were the things that were highlighted per the respondents of the survey. Staffing and flexibility was a key ask of the workforce, meet me where I'm at, continue to work with me to give me choice and autonomy with my schedule and staffing. Additionally, it was, Hey, we didn't know there's resources or is this a priority of our organization? And so you guys have ample resources and even just sharing this information, it's showing that that's a priority of your organization and getting it out there. And so I'm just so happy to hear the work that's going on and the way that this dovetailed so nicely with some of the things that I was seeing in the industry from our last survey of 1900 nurses. So well done there and I'm glad that you're taking this head on and addressing it because it is a core component of how we build into the future for sustainability. Kasey, this has been a really wonderful conversation. I would love it if you could share with our listeners where they could potentially reach out to you or get ahold of you.

Kasey:

Absolutely. I can be found on LinkedIn. I'm happy to connect with anyone, answer any questions, and share some of what we're working on here at WellSpan.

Dani:

That's great. I'm sure you're going to get a lot of messages from leaders in the frontline. And finally, just so what we do with every episode, we want to know what would you like to hand off as a final piece of advice or wisdom to our listeners today?

Kasey:

Yeah, one final comment and thought I'll share, and it's this, we have experienced many disruptions in the last few years, and I think we all know there's even more on the horizon, but this is an opportunity for us to take bold steps to redefine the future and reimagine how we deliver nursing care. And I'm just so grateful to be part of a team at WellSpan who values innovation and challenging the status quo, and that's what makes me so optimistic about our future.

Dani:

Lovely. I couldn't agree. More optimism leaders like you at the helm, bringing transformation is critical. Thank you for sharing some of the work that's happening today. And like I said, I want to check in a year or so in here how these programs have progressed and what's new and happening at WellSpan. So Kasey, thank you so much for your time and what you've shared today.

Kasey:

Thanks, Dani. It's been a pleasure.