Joni: 

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast for nurse leaders brought to you by Works. I'm thrilled to introduce our episode guests. We have two today. Today we're excited to discuss a topic at the heart of modern healthcare transformation, the vital role of workforce strategy in redesigning care delivery models. In this episode, we're joined by two distinguished guests, Cheryl Denison and Tracy Breece, two nurse informaticists transforming workforce strategy at Mercy Health. First, let me introduce Tracy Breece, Executive Director of Nursing Informatics at Mercy Health. With over 25 years of experience in healthcare, Tracy has always been at the forefront of integrating technology into nursing, significantly enhancing workflow and patient interaction. Her efforts now focus on leveraging cutting edge technology to revolutionize healthcare delivery and improve patient outcomes through innovative data-driven solutions, Tracy holds a master's degree in nursing, specializing in healthcare leadership, and both certifications from the American Nurses Credentialing Center and the Healthcare Information Management System Society.

Next we have Cheryl Denison, Integration Director of Clinical Applications at Mercy Health. Cheryl began her journey in healthcare as a nurse in 1992 and has since evolved into a leader in healthcare informatics. Since making the leap in 2006, Cheryl has been instrumental in implementing an electronic health record system across an impressive network of 40 hospitals. Today, she stands as a cornerstone of Mercy's Office of Transformation, where her unique ability to blend clinical acumen with technological innovation is reshaping patient care and organizational excellence. 

Today's discussion centers around Mercy Health's innovative work on workforce and workflows, particularly through a new project. Cheryl and Tracy will share insights into the importance of focusing on the workforce during the redesign of the Mercy care delivery model. Cheryl and Tracy's contributions to healthcare and nursing informatics are truly inspiring, and I'm thrilled to explore their perspectives on transforming healthcare delivery through strategic workforce planning and technological innovation. Cheryl, Tracy, welcome to The Handoff. Thanks for joining us.

Cheryl: 

Thanks for having us. 

Tracy:

It's great to be here. Indeed. Cheryl, I don't know about you, but Joni just introduced a highly, highly remarkable introduction for you and the Office of Transformation, and this project really is just wonderful.

Joni: 

You are both definitely our rockstar nurse leaders, and so every bit of that is appropriate for your introduction. So when I heard about Project Anew, it really captured my attention. I have always been interested in care, redesigned, innovating with care delivery models, trying new things so that we improve the work for our healthcare team members to ultimately improve patient care. And Mercy Health always seems to bubble to the top. My dad would say the cream always rises to the top. Mercy Health always seems to bubble to the top when we're talking about care redesign and transformation. And so I'd love for you to tell us about Project Anew. What is it? Can you share the origin story of Project Anew, including maybe what inspired its creation and some of the initial challenges you face? I just kind of want to hear all about it.

Cheryl:

Yeah. So really Project Anew, I would like to say probably started early in February of 2022. It was one of the last COVID surges at least in Missouri, in our four state region that we were having. And at the time, our hospitals and our nurses were just exhausted and not able to bring people in any longer. So they were just reaching out and asking, is there anyone out there who are working in other positions and Mercy who would like to come into the hospital and help us out. Pass water, pick up trash, just do anything to help the situation. So I gravitated to that quickly. I had been begging to do it the whole COVID time period, but there was so much that they wanted us to do from a technology perspective, for us to focus on that, that they didn't really want to take us from that to be able to help at the bedside.

Unfortunately, that's where my heart was, and that's what I was feeling for. But finally they allowed us to do that. And so when I went, no one knew who I was. No one knew that I worked in the technology portion of our organization. No one knew that I had helped to stand up the electronic health record that they were working on. And so I really got to look at it from that “behind the boss” type of situation that like you see on TV where I could just kind of see it in action. So once I got to really see how the nurses were using technology, and of course the workload that they were having with each of these patients, I was really disappointed and how I felt the electronic record really wasn't holding up to the current situation. We had certainly done magnificent work switching from paper to the electronic health record, doing a lot standardization as we did that, but I don't feel like even though we put a lot of technology changes into place during COVID, we really didn't help keep up with the needs of what was needed for that nurse at the time.

It was very evident. I was disappointed. I really hoped that the record was going to be doing better than that. Matter of fact, I was almost a little bit tearful about just how… I was that disappointed in the process and how they were using the system. So from that, I went back and Tracy had just joined a different portion, and Tracy, I'll let you speak to that, our MTS group, our Office of Transformation group, she had started a new position and I told her, “Hey, I went to go to the hospital and this is what I saw, and man, can we do something about this? What can we do here?” 

I didn't know what that was. I just knew we needed to do something. Interestingly enough, almost a week, maybe two weeks from that point, Betty Jo Rocchio, our CNO here at Mercy reached out and she said, I've been reading this article at Becker's, and this organization, UC Health, had stood up Project Joy, and she said, “Can we do something like this?” She goes, “I really think we need to do something like this.” 

What was interesting about that is UC Health has the same electronic health record system that we do. So of course, I reached out to her and said, “Wes, of course we can do that.” Secondarily, from that, our EHR vendor also reached out to us. They had put into place a new nurse wellbeing program that they're still doing today and still trying to expand that into other areas potentially. They reached out and said, “Hey, we kind of noticed your numbers here are not that great.” Validating my observations and said, “We have a program that maybe you guys would like to try to do.” So literally within a couple of weeks of me going and visiting the hospital and saying, we need to do something, all of this kind of came together to spark the idea of Project Anew.

Joni:

Wow. It sounds providential almost. 

Cheryl:

Exactly. That's how I felt about it at the time. I really felt like all of the pieces were coming together meaningfully like it was meant to happen. This was the right time and right situation for all of this to happen.

Joni: 

Cheryl, you mentioned your role at Mercy had been to roll out the electronic health record and then to kind of be in an “undercover boss” situation where you see that it's not really functioning the way that you want it. I mean, that is heartbreaking.

Cheryl:

Absolutely. We were so proud of the product, and I still am proud of the accomplishment that we did. I mean, you already said something about it being over 40 hospitals. Of course, we didn't always have 40 hospitals, but over time, Mercy has grown larger and we certainly are a large organization, and we did a big bang, as you like to call it, where we didn't do it in phases. It was just all at once, and we made the change immediately and from there. Yeah.

Joni: 

Wow. That's incredible. And so Tracy, when Cheryl came to you, she alluded to you were kind of maybe transitioning into a new role or a new group. Tell me your perspective when Cheryl came to you with this.

Cheryl: 

Sure, absolutely. I think one of the things that Cheryl identified in working in a hospital and healthcare system during the pandemic, the heart of what nurses do is to take care of our patients. And we saw personally, both of us out in the hospital that nurses weren't able to do what they do best every single day, and that's deeply care for our patients and families because of all of the disruption and noise in the environment. 

So, our work around advancing nursing efficiencies and workflows, using the qualitative data, the quantitative data that Cheryl identified really was the focus on improving the daily life of the nurse, reducing documentation burden. 

During the pandemic, we went to disaster documentation, and it was a streamlined approach to how nurses would spend their time documenting. And Betty Jo Rocchio, our senior vice president and chief nursing officer, she's like, “Can we just do disaster documentation all the time? We have all this information. Can we just do it?” And we're like, wow.

So at the heart of what Cheryl and I have done for years is healthcare technologies are embedded in the daily life of the nurse. So we wanted to develop a program on how we could fully understand that more, how we could fully understand how nurses interact with technology before we can improve it. Cheryl and I often talk about this project being Maslow's Hierarchy of Needs. If you're unfamiliar with that or if any of your listeners are, the base is establishing food, water, and shelter. So if you liken that to technologies, we had a broken base, we had lots of workarounds, we had lots of disruption with technology. The intersection between the mind of the nurse, the nursing process, nurses couldn't do best what they could do every day because they were so distracted with clicking here or documenting this same element 15 times. So we knew we had to do something. So improving the cognitive human interaction with technology was foundational to reestablishing that base.

Joni:

Oh, that's good. For our listeners, you mentioned what ANEW is an acronym for. Say it one more time for our listeners. Project ANEW stands for what?

Tracy: 

Advancing Nursing Efficiency and Workflows.

Joni:

It makes my heart be a little faster even when you say it.

Tracy:

Oh, good.

Cheryl:

What's funny, what's funny, every time that we say that, it just brings me back to when we created that acronym because it's funny in healthcare, and I think in technology in general, you have to have this catchy acronym for people to pay attention. So at first it was literally “advancing nursing efficiency and workflow,” and the people I worked for said, “you really need to come up with an acronym for that.” So…

Joni:

I love it.

Cheryl:

And when you look up the definition of “anew” it means refresh to again, start again. And so it really fit, again, all of these pieces together really was, I like to call it providence. It was just meant to be at the time at the right place. 

Joni:

Yeah, I wholeheartedly agree with that as well, Cheryl. So you mentioned that Mercy Health has grown over time, and that's pretty common for a lot of health systems these days with mergers and acquisitions, divestitures, we're always changing. Do we have X number of hospitals today or do we have X number today? Something like Project ANEW in, I think maybe correct me if I'm wrong, Mercy Health has somewhere around 48 hospitals now, which is a pretty large healthcare system. That can be kind of daunting for a nurse leader to think about, and even for frontline nurse leaders who are laying their hands on patients. Can you share a little bit more about the vision and the strategy for how you started Project ANEW and then how you scaled it across your system?

Tracy:

Sure. So Cheryl, I'll start just with the vision and then if you'd like to talk about how we went through the process. So Joni, as you know, we've already mentioned Betty Jo Rocchio. The first thing that we found foundational to our vision was having our Chief Nurse and Senior Vice President indicate this is important for our workforce. Foundationally establishing this is where we're going. I recognize the burden of technology and the excessive documentation, and I'm here to help and establish where we are going. And that establishment looks like this. Balanced workforce, balanced workflows, and balanced work environment. All three of those domains need to be equally balanced for a nurse to have a balance in her step, highly efficient in daily work, and to do best what we do take care of our patients. So that vision was laid possible by Betty Jo and Cheryl and I said, “we are all in. What is it going to take?” So Cheryl, what did it take for us to go to our hospitals and make this happen?

Cheryl:

Well, first I'd like to say that we weren't perfect out of the gate. And so don't ever feel like if you're putting something big like this together that you're going to have all the answers out of the gate. So when we first started this process, we thought, okay, we'll visit three of our hospitals. So we've already told you how many we had. So we said, we'll visit three of our hospitals, do some fixing on those, gain some knowledge and that'll fix it. That's all we really need to do. So we went to the first site first, of course, we sent our introductions, what we plan to do to the CNO of that location, and we set up a date to actually observe nursing and nurse managers, nursing really, we observe them. And then the nurse managers, we kind of asked them about their day. So we kind of did two lanes of work because the nurse manager is also their job over the years has changed to where before they got to spend a lot more time with the patients, helping nurses, new nurses, all sorts of nurses with whatever issues or helping them to learn education, all those different things.

They're spending more and more time themselves at the bedside being a nurse because of the increased effort there is around taking care of patients. So their job has changed as well over time. So we wanted to hear both sides of what is going on. So we had a group of nurses, so let me just say this. It was nurses listening to nurses talking about nurses working on the workflow for nurses. So it was really nurses about nurses owning our practice.

And so we took a group of nurses with us throughout the organization and some from the technology portion of our organization. We have nurses that also work within our Epic, our EHR,  Jamie Holland, Missy Seabaugh, and Kaylan Miederhoff. We have several nurses who were consistently with us throughout this process. So we all went and observed from that observation we created that day while we were there, a quick contract, at least a draft of a contract with that facility to say, these are the things that we heard from you. Does this seem appropriate? Okay, we're going to compile the rest of our notes once we leave here, but we wanted to kind of give you the baseline of what we heard to see if we were heading in the right direction.

Tracy:

We were looking at the shift handoff, the admission process for the nurse, how we give medications, communication and delegation through the treatment team, patient management throughout the shift, discharge, patient education and orders. So when we think about the entire nursing process in the key elements in the day in the life of a patient, those were the kind of the 10 core workflows that the observation team were at the elbow gathering feedback. And it was really an observation session as Cheryl identified these two tracks. But it was important not to solve it at that moment. And that's where Cheryl was going with this shared contract. That is what we were going away with. How can we be very intentional, purposeful, and process driven? So we have sustainability and scalability because Joni, as we recognized, we have 48 hospitals and we have one EHR

Joni:

Been There. 

Tracy: 

And so whatever change we were going to make, we knew we were going to impact the whole. So Cheryl, yes, that shared accountability, that shared approach. I really wanted to touch on those 10 core workflows of what we did.

Joni:

That's solid. I mean, yeah, when I think about a day in the life of acute care nursing, I mean, you really covered the big pieces of it. And so Cheryl, you built a contract before you left.

Cheryl:

Yeah. And again, it was a draft. It was mostly just to kind of indicate to them that we were listening, we heard what you were saying, and does this seem to indicate what you told us? So the things that we found in that first session were very reminiscent of the rest of the sessions from then on out, no matter which hospital we went to, we had very similar themes. So we did the similar process where we went and observed, did a track of nursing and a track of management, nursing management. And then later we increased that to also be educators, quality and regulatory leaders, because we found out in the first location that we really needed to get the whole group of people who are affecting the changes to nursing as well as part of their core group that they deal with on a daily basis, to kind of get the complete picture of what's going on in the nurses' day in the life of. So after our first site, we included more groups to those to actually participate. And we didn't observe their workflows, but more of how they interact with nurses on a day-to-day basis.

Tracy:

One of the things that was a lesson learned as we moved through the process is when we impact the day in the life of a nurse, sometimes those helping factors come from departments that are supportive, like quality, like risk, like safety. So we wanted them to be in the session to understand the vision and where we're going and be able to have that dialogue and that exchange back and forth. So when we move the cheese of documentation and therefore change reporting, everybody understands the why behind the work.

Joni:

Yeah, that's great. And so 48 hospitals, and you went to three of them, what did you find? What were the themes that you found?

Tracy: 

Well, we went to more than three, right? Cheryl though? 

Cheryl:

Yeah, we ended up going to more than three after the first one. We quickly realized that this was, maybe we were maybe a little bit flippant and not understanding the complete problem. We thought we knew the depth of the issues and the depth of what we were going to be dealing with. But what we realized quickly and also the response that we had to our visit made us realize that we needed to go to more of our organization. So ultimately we went to 11 of our facilities. The facilities that were larger and medium sized are the facilities that we went to. That being said, because we have a standardized environment, the things that we did for those 11 was for everyone. So from the very beginning when we started responding to the things that the nurses were telling us, it not only was helping that facility, but those to come, those that we were going to visit, those that we didn't visit. So everyone got to benefit from those visits.

Joni:

So you ended up with 10 or 11 contracts then, I guess?

Cheryl:

Yeah. Yeah, that's what we did. And in those sessions, going back to your first question, the key themes that came away from those sessions were they kind of went down to about five, basically hardware and software function. Nurses deal with technology. I don't think there's much that they are not using technology in their daily work, the PCA pumps, their phones, their devices that they're using, the bladder scanners, all of these different things is technology and how good it's working, how bad it's working, how it's incorporated into your workflow makes a difference, right? Usability and clicks. I think that's kind of where our EHR had kind of guided us to initially when we were talking with them was those were the focuses that we went in with thinking, oh, we're going to fix the usability and clicks and then that's going to make all things better. Well, that certainly was a theme, and we kind of put those things in a just do it pile, I like to say, and you'll hear us talk about that here in just a little bit generally. 

Tracy: 

I was going to say with the usability and clicks, I think the thing that was the quick wins that you just identified is that repetitive scattered workflow, the cumbersome clicking around in flow sheets. Those are the things that I think were the quick wins in usability that really helped gain the buy-in for the more difficult work that we're still doing today. 

Joni:

Absolutely. 

Tracy:

So yeah, and I think you're going to move into daily processes… 

Cheryl: 

Daily processes. That is what Tracy just kind of alluded to is the more difficult work. Some of these things that are foundational to the day-to-day work of a nurse. We talked about handoffs, ED to inpatient, and shift to shift. That is a very important step in a nurse's day and very difficult to get your arms around as to all of the issues that make it so difficult and what are our solutions that we could put into place to help that. Onboarding and training is another situation. I think every organization probably would have this in their things that they would love to improve. Now, not saying that Mercy hasn't done their due diligence in trying to do training, but not only are we talking about the training within your organization, but the training that the nurses were receiving outside of your organization. So those new nurses that were coming from the COVID situation where they couldn't go into the hospital, couldn't observe, couldn't do the clinical foundation, things that they are normally able to do, those nurses came out not having the same understanding potentially as nurses previous to that. So we were dealing with that and we still deal with that today along with all of the changes that happen based on anything, regulations needing to change a particular workflow, this product changed, got a new ID type of ID or anything. All those different things. You have all these different things. All of those things really make onboarding and training. I think it's going to be on everyone's topic no matter how much work that you've done.

Tracy: 

And I think that could be its own project, really onboarding and ongoing training, its own domain, its own KPIs. One of the things that I would like to call out with this one that we saw was this culture of personal practice. And we still think about that a lot. Cheryl and I talk about this all the time around my personal practice. If we've ever been deposed as a registered nurse, we're going to document more. And that is something that takes a lot of time and effort to talk through. And it is certainly foundational to our efficiency work that sometimes documenting more is not always the best case.

Joni:

Yes, good perspective. Absolutely. So you've mentioned hardware and software, usability and clicks, daily processes and onboarding and training. What was your fifth theme?

Cheryl: 

The regulatory and quality measures. So I think everyone has this that they could talk about as well. And this was also the reason why after our first session, we kind of already mentioned this, that we started including those leaders into our process. Because like Tracy already said, we wanted to make sure that they knew the direction, what we were talking about, because we could make up all sorts of things in our silo with nursing, but if we didn't have their buy-in and that ultimately we were going to have better outcomes if we did this work, then we were going to be doing this for moot point, there would be no reason to do it. So that was also the reason why we started including those individuals in our sessions after the first site. 

And so there's all sorts of things related to that, right? Lots of documentation. Many times you're documenting to make a report work essentially. Many times you did the work and you are just documenting it because you're told to document it. It's really not necessarily improving the care of the patient. And I laid it out there. That's probably a tough statement to say we all are in that scenario. It happens all the time and we're doing it for the right reasons. Nobody is doing this because they want someone to do extra work or we're all doing it for the right reasons. These regulations are in place for a reason, and we all try to find our way in which to handle them. So those were our five things. And from those five things, we developed a contract. I've kind of talked about the contract in which at first we gave them a draft just to kind of have them ask us for them to tell us, is this right? Are we heading down the right way? And then we quickly tried to have them do what we would call our final contract or their executive summary within a week.

We really tried to give a quick turnaround to these things because what we also noticed, especially maybe not the first one, because all of those individuals at our first site, I remember them introducing themselves to us, and many of them had been leaders for less than three months. Many had been leaders. I mean, it was a very quick young group. They were excited. They hadn't been jaded yet. 

Joni:

Yes. That's awesome. Right? 

Cheryl: 

Yeah. So they were just happy that we were there. 

Joni: 

I love it. And what can you help us with?

Cheryl:

Exactly that young professional or the tenured professional, the empowerment to take hold of your practice of nursing within your four walls. That was really profound for me when we sat in the facilities listening to how our leaders were overcome with being felt put upon and not having a voice. 

Joni:

That's great. 

Cheryl: 

And this was a project that gave that voice and it was replicable from team to team, regardless of your tenure, just that empowerment. “It's time. We're here to help. We're standing behind you and let's do it together.”

What was funny in the first site, they were very excited, very hopeful. Let me just say there, our next site had a more tenured group that Tracy was trying to allude to. And I can say I'm a jaded nurse. And so they've been around the block and they know and projects have come and gone, right? You've all said you're going to do something for us, right? Show me and I'll believe it. And it was all over their faces. All over their faces. Yeah. We've been there, we've done that. And so we knew each site kind of gave us a different perspective, which also kind of told us that we needed to go to more sites. So the second site was more tenured, but it taught us that we needed to make sure and do what we say we're going to do and quickly, which led to the “just do it” things like I'm documenting call light within place in five different spaces within the EHR,

Joni:

Painful. Why do we do that?

Cheryl:

Why do we do that? Good question. Why do we do that? And it's really a symptom of, I like to use a Frankenstein. We have a Frankenstein system where over the years we've added these different pieces to solve a problem, but we never actually removed any of the prior solutions. We just kept adding, adding, adding, adding, adding. And so these “just do it” things like, okay, that really made sense. It didn't require us going and investigating anything that just made sense to make it one spot. And so when we started to do these quick things, these were the quick nuisance things that the nurses were frustrated with. They got excited. Even those tenured nurses got excited.

Joni: 

Oh, I'm sure. I'm sure. I mean, I just appreciate your transparency and your vulnerability because you're right. These are hard things for us to talk about. They are not unique to Mercy Health. It's something that we all live through in all of our healthcare systems. And you're right, I love your Frankenstein sort of model and perspective. I kind of grew up learning about it as a Christmas tree. We just keep adding ornaments and ornaments and ornaments. It's just the Christmas tree syndrome and we never subtract from it. So I mean, to me, the excitement, because I've been a nurse for 21 years too, and I can easily imagine from both perspectives what it's like as a leader to step into a room with very experienced nurses who have seen all of those “flavor of the month” projects come and go and all of that kind of stuff. But Tracy too, when we as nurses really own our practice and when leaders set the vision and also the accountability in a system to say, this is our practice and we are going to investigate why we do this or why don't we do this? I mean, that sort of changes the culture. It changes the tone of work and care. That's a big deal.

Tracy: 

It's a big deal. It is a big deal. And Joni, For years, I think the profession of nursing has always stood up and said, “Well, if you need somebody to do it, we'll do it.” Because at the heart of what we do, we take care of our patients and families. So we'll do it. We'll do it. So all of it together really did create the environment of “put upon” right, the realness of what you see when you walk the corridors of the hallways. You stand in a clinic room, you stand in the ED, you see it. And we know, and I love what you said, Joni being real, and Cheryl and I share in that realness because if we don't, we're just not going to have the credibility. And that means a lot to us. We are first and foremost nurses, and we are not going to do anything without you and without your voice. We want you to tell us the realness because we're going to be real right back. 

Joni:

That's so good. That is so good. Thank you for that. So let's see. You've already talked about involving multiple stakeholders. That's certainly evidence-based practice. Any other things that you can think of on how you approached a Project ANEW from an evidence-based practice perspective in particular with partnering with colleagues and following the evidence in your decision making?

Tracy: 

Absolutely. So we are blessed to have Jill Seys, who is our friend and colleague leading us at Mercy through the Center of Evidence-Based Practice. 

Joni: 

Love that. 

Tracy: 

We have a partnership with The Ohio State University. And as we sit here today, more than 200 of our fellow colleagues are going through one more round of learning of the EBP process.

Joni: 

Amazing.

Tracy: 

If you're not familiar with this process, Joni, and if your colleagues are not familiar with this process, the Helene Fuld National Health Trust through The Ohio State offers a very disciplined, rigorous approach to how nurses can use evidence. And we're not just talking about an article, we're talking about a process by which we use rigorous review of literature, evidence, articles, books, articles, peer reviewed, randomized controlled studies, all of it. And we put that in a synthesis table, so we're no longer throwing spaghetti on the wall. And one of the things, I love this acronym, thank you to The Ohio State University and Jill Seys “GROSS - Get Rid of Stupid Stuff.” And that's what we're doing. We're getting rid of stupid stuff that duplicates documentation. So very excited to be incorporating that process. 

Joni: 

That is so great. Mention a synthesis table to me and you just make my heart flutter. Oh my goodness. And when nurses, when it's the nurses who are putting their hands on the patients who are understanding the evidence, again, to me that's just one more layer of us owning our practice. You spoke to this so that we don't feel like things are being done to us. We're owning our practice. That is absolutely beautiful. And the way I think it should be done in an organization just transfuse it and infuse it throughout your entire organization. That's great.

Tracy: 

Absolutely. Let's stop doing the things that we've always done and start doing the things that are evidence-based.

Joni:

Right? It's really hard to argue with the evidence as well. So when you put it out there, it really is hard to argue with that. So those naysayers that if it's a lot different from how you're currently doing it, it's really hard to be against evidence. It's not a personal opinion. We've done this rigorous review. This is what it shows us that we need to do. This is what we should be doing. 

Tracy: 

That's right. Let's follow the evidence for sure. 

Joni:

So how long have you been doing Project ANEW now? I apologize. I forgot when you said you started. 

Tracy: 

Almost two years. 

Joni: 

So a while now. And what have you seen as a result of Project ANEW? What are some of your key outcomes and milestones? Maybe talk about some of your KPIs. How do you measure this?

Cheryl: 

We had several things to measure us by. One of the things that we mentioned early is our Epic vendor, Epic EHR. They came to us with all of these numbers that they had already created, which was an excellent way to kind of tell our progress through this whole thing. So in the beginning, we were running about 142 minutes in the electronic health record. Some of our nurses were spending upwards over 220, 240 minutes. Many of them waiting to the end of the shift to do their documentation. So you can imagine how much time that they were spending after their shift. And since then, we've really come down about 30 minutes from that. So we've really done a lot of work. And these are things that when you go back and look at them, because now we're working on the really hard stuff, Joni. The “just do its” that we talked about, the simple stuff that didn't really require a rigorous review of evidence. Yeah, those easy pieces, those love, those are the things that really dropped that value down. So we've used tools that our Epic vendor has provided us, as well as some of our own information that we got from nurses. “These are the things that are bugging us. Please help us with that.” And that information together really helped to do that. To start with. So we have those numbers and then Tracy, talk about the Arch Collaborative:

Tracy: 

Sure, absolutely. So we belong to Arch Collaborative, and it's a consortium that we are members of along with multiple health systems across the country. And their primary purpose is to help inform us how our clinicians perceive the use of our EHR. And for the purposes of this project, we looked at nurse satisfaction. So how happy are nurses with Epic, which happens to be our EHR vendor along with many others across the world? 

Joni:

Absolutely. 

Tracy: 

And our goal was really to increase their happiness by 15%. And we're like, is this too high? Is this too low? We've never done anything like this before. And we are happy to announce that we exceeded that we were at, and this is the truth of it, the 41st percentile in nursing satisfaction with our EHR across this consortium, 41st percent. Well, we strive for excellence, and I have a feeling that most healthcare systems do. We weren't happy with that number, but today, after a year with this survey, we are above the 62nd percentile. So we did move the needle quite a bit. We were very happy with that, moving the needle. But it still informs us, Joni, we have a lot of work to do. We want to be above the 90th percentile. We want to be best in class, and we want to continue to listen to the nurses. We want to continue to hear the pain points. Cheryl talked about it already. We're doing some really, really hard workflows. We are undoing 10 years of workflows. We just did that implementation, what Cheryl? Within the last 120 days? And that was difficult. We went back to the evidence. So we will continue with these measures of success. My point, however, is that we're going to make ourselves a little bit stronger in our goals. So in the next 12 months, not only do we want to see our increase in our happiness, the bounce in the step, how nurses perceive our EHR decrease time that we spend documenting, but also see that correlation to our patient outcomes.

Joni: 

Wow. It reminds me, I have a colleague who often says things like, and this reminds me of Mercy Health. You're pleased with the progress, but not satisfied with your position. Pleased with the progress, but not satisfied with your position.

Tracy: 

There you go.

Cheryl:

And I do want to be upfront too. So we did have one KPI in relation to latency that we did not budge the needle on at all. We thought that if we improved the amount of time that the nurse spent in the electronic health record, that that would also improve the latency. But what we've discovered is that really is not, at least at Mercy is not one did not mean the other. We thought it would. So we did not move the dime on that. Did not move that at all. We are still 96 minutes from assessment to documentation. And so we have work to do. So I want to be upfront and obvious to people. It wasn't all just a bed of roses and we're all still fine and dandy.

There's lots of work to accomplish, and I believe it tells us the direction that we need to go. I think the failures tell us the direction that we need to go as well as the successes tell us the direction that we need to go and we need to continue this work and it may change our approach, the things that we are looking at. One of the things that just came up since Christmas, literally, and I think this is probably the same for other organizations, is how does generative AI fit into your organization? 

Joni:

Totally. 

Cheryl:

I mean, let's put a buzzword out there right now. Okay,

Joni:

Yeah.

Cheryl:

How does that fit? So we've been going along all nice, and here comes generative AI, right? And now figure out what you want to do with that. What we do know is that we want to use nurses to help guide us and how that fits into their workflow. We're not going to drop those principles, even though this is something new that there may not be any evidence to guide us on this because it is so new. But we do know we want to use nurses to help guide us into this. 

Joni: 

That is so important, Cheryl.

Tracy:

That approach that we have taken that day in the life of understanding the Mercy nurse branding, how we go about our work and planning. It's so important to carry forward. So I am thrilled that we are here able to share our story, Joni, because if there's one thing that we've learned and that is true in the evidence, let's do it with nurses, alongside nurses with nurses that are true leaders in the space that we need them to be. We think about Maslow's hierarchy of needs, reestablishing that base. Cheryl just tipped on the tippy top self-actualization, that buzzword “generative AI.” Everybody's going to want to go there, but not only learn from ourselves, let's learn externally, which is in the importance of these discussions, Joni, that we can share our story and hear other stories too.

Joni:

Yes, absolutely. That is so good. Tracy and Cheryl, and you mentioned, I love that you shared the wrestling with the latency KPI, because let's be real, none of us ever have 100% success with our KPIs all the time. And as you are definitely a leader among healthcare systems working in this space and sharing your KPIs and sharing your experience. So thank you for even contributing to the evidence through this podcast because while it's hard to find some of this in the literature today, we can at least turn to a podcast and other nurse leaders can reach out to you and learn from you. But there's a reason that it's hard because you're going first, right? You're kind of chopping down the forest for the rest of us. So thank you for doing that and for forging the way. You've already talked about generative AI as kind of a next step in Project ANEW and making sure that nurses are a part of that. That is so important. As I'm teaching nurse executives about generative AI and being at the table, it's clear that many healthcare systems don't have nurses at the table. So thank you for having nurses at the table to own nursing practice in Mercy Health. 

Cheryl: 

Wouldn't have it any other way, Joni. We wouldn't. And we're just so blessed that we are given the opportunity within our health system to make it happen.

Joni:

Wow. So incredible. So incredible. You have dropped some great information. I always ask our guests a couple of closing questions because Tracy and Cheryl, you are just fabulous leaders. I love the way that you think about nursing and nurses. And so I'm always curious what other leaders read or do to sharpen their skills. What are you two doing to learn about these days? What are you reading? It can be professional or not, but how do you feed your mind and your body and your soul these days?

Cheryl:

So we just came back from HIMSS and at the HIMSS conference there was a nursing informatics day. And at that particular portion of the conference, there was a gentleman there that was speaking, Tom Lawry, and he really inspired me with his approach on how he feels that healthcare should approach AI. I think the buzz of HIMSS was about generative AI and how it fits into healthcare. He's written a couple of books, and I'm reading, trying to read one of those right now called Hacking Healthcare. And it's all about how AI can fit into the healthcare process. But it's really good, I think it's a quick read. He's inspiring to me. He said all the right words that I wanted to hear, and maybe we just have the same mindset, but that's one thing I've been doing lately. I know Tracy and myself have signed up for a couple of courses, to get ourselves more knowledgeable about generative AI and how it fits so that when we speak in scenarios like this that we know a little bit about what we're talking about. 

Joni:

I love that. Tracy. I think that's good enough for me. What do you do? I'm sure you're doing a lot.

Tracy:

Well, Cheryl, we always are, right? So for me, I went back to a book that I once read, but I'm reading it again because I recognized on this call, newness, forging ahead in space that is untapped. Let's center my thoughts around The Design of Everyday Things by Donald A. Norman. So he is a cognitive workflow engineer. That's how I'm going to frame him as I like to think of him because his work is foundational to understanding cognitive human interaction with technology. And we started out this discussion with why did we do Project ANEW? And it really was to understand how our brain can intersect with technology and provide the most satisfying work environment. And that's what Project ANEW has done for us. But now why I am reading the book over is because we have this new space, generative ai, and so how are we going to be able to think about that cognitive human interaction with technology in this advent of the newest technology? And honestly, Joni, I wanted to learn about GPUs and CPUs, and Cheryl's heard all about this. I'm like, alright, I'm going to go to the people that make the chips, make the processing units to understand the power so I can really understand and it's all about my mind, right? It's all about wanting to understand more. So I am rereading his book and I hope I come through with a new theme. But foundationally, I am a nursing workflow engineer, and that's exactly what his book is all about, is how we engineer in our specialty and our discipline and apply that.

Joni:

Oh, that's so good. So Tracy or Cheryl, what would you like to handoff to nurse leaders at all levels and in every setting today?

Cheryl:

I have something I always try to say every time. And Tracy, you can have something. “Take off your suit. Take off your suit and go visit your nurses.”

Joni:

Oh, good.

Cheryl:

Be your own undercover boss. They're not going to know who you are. I'm going to tell you that right now. They're not going to know who you are. They don't pay attention to email or anything. So just go show up and just walk down the hallways without your suit, put your scrubs on and just kind of pick up on what's going on in your organization. I'm not saying no leader does that. I'm just saying every leader should take time to do that. Town hall meetings are great, but nurses don't attend town hall meetings. They're spending too much time where we want them to be. We want them to be at the bedside. That's where they want to be. So you need to go where they are at and then you'll get a sense of how your organization is really doing. If you do that. 

Tracy: 

And that risk and taking off your suit leads to what I always think that we can share in every hospital and health system, all processes can be improved. So, one time I was traveling with my husband and we went through a brewery tour and we were with some friends and I'm like, “Oh, so this is how you can do this and this and this and this.” And it was all about the process. So embracing the role of nurse informaticists who understand process, they understand the environment of nurses and they understand being a nurse because we are one. And so we are workflow engineers with a strong healthcare process that can improve workflows. So that's what I would love to impart to your listeners today, that with nurses, for nurses by nurses and nurse informaticists or workflow engineers, and Cheryl and I are want to be right there with you, helping you make a process that can be improved to improve outcomes for our nurses, but ultimately our patients, those we serve.

Joni:

That is good stuff. Cheryl and Tracy, good stuff. Where can people connect with you or follow you? Because I know people want to learn from you more after this.

Cheryl:

We're both on LinkedIn. Yeah. My last name is spelled with one “N”. So if you go looking for D-E-N-N-I-S-O-N, you're not going to find it. But D-E-N-I-S-O-N. Yes. We're both on LinkedIn and yeah, we're here to uplift the profession of nursing. So we're willing to speak to anyone who wants to listen. That is my goal. Before I retire, either I'm going to die or people are going to be uplifting the profession of nursing.

Joni:

I had a little tear in the corners of my eyes. It's so great because I mean, you really do exude a love for our profession and for our colleagues. So thank you everyone. Please go and find Cheryl Denison and Tracy Breece on LinkedIn to continue the conversations. Mercy Health and nurse leaders and colleagues there are leading the way in transforming nursing care and work. 

Tracy, Cheryl, I love the way that your leadership view has shifted and has changed care and continues to focus on nurses and nursing to improve care at Mercy Health. It is clear that you have great leadership vision, you have tactics in place. You are amplifying the voice of your nurses. You are shifting your culture, and that changes the way that we provide care. So I have no doubt that nurses are proud to be at Mercy Health. So thank you for leading the way in Mercy Health, but also in our greater profession. I am so glad that I got to share this space with you today. Thank you.

Tracy:

Our pleasure. And thank you for having us and we'll come back anytime to share our story where we've been. Over the course, where we're going to be and where we've been. 

Joni: 

It’s a date for sure.

Cheryl:

Thanks Joni.