Leadership Dialogue Series: At the Intersection of Technology and Nursing With Advocate Health

00:00:01:06 - 00:00:25:13
Tom Haederle
Nursing is a fast changing profession, requiring adaptability and their willingness to embrace new care models, new technologies and new ways of handling traditional duties such as medical charting. The exhilarating pace of change comes with questions. With each new step, nursing leaders ask, Does this make sense? Will it make patient care more efficient and improve outcomes? How will it impact the nursing experience for caregivers?

00:00:25:15 - 00:01:08:04
Tom Haederle
In the next few minutes, you'll hear two senior health care leaders dive into the trends and developments that are already altering the face of nursing. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. On this Leadership Dialogue series podcast, John Haupert, AHA board chair and president and CEO of Grady Health, is in dialog with Mary Beth Kingston, executive vice president and chief nursing officer at Advocate Health.

00:01:08:06 - 00:01:35:14
Tom Haederle
Kingston is an AHA board member and also a past president of the American Organization for Nursing Leadership. Haupert and Kingston discuss the role of artificial intelligence, predictive modeling, ambient listening technology and other tools that are already impacting nursing and the delivery of health care in general. As Kingston says, it's important for us not to fight technology. It's about being able to provide care in a more efficient and effective way.

00:01:35:16 - 00:02:04:06
John Haupert
Thank you, everyone, for joining me today for another leadership dialog session. I'm John Haupert, president and CEO of Grady Health System and board chair of the American Hospital Association. For those of you who tune in regularly, you will remember that I had the opportunity to speak with the dynamic team from UAB Health and the University of Alabama Birmingham a few months ago about how they are partnering to bolster their nursing pipeline in their local market.

00:02:04:09 - 00:02:32:15
John Haupert
And today I'm joined by a colleague and friend, Mary Beth Kingston, for a related conversation. Specifically, we will talk about nursing leadership trends and strategies that can be impactful at the hospital field as we continue to look for new approaches to address ongoing workforce challenges. Which I know we're all experiencing. Mary Beth is executive vice president and chief nursing officer at Advocate Health.

00:02:32:18 - 00:03:04:24
John Haupert
Advocate Health is an integrated health system comprised of 67 hospitals, more than 1000 sites of care located in six states. The health system has over 150,000 teammates, including nearly 42,000 nurses. That leadership alone gives Mary Beth a unique perspective and expertise, but she is also a past president of the American Organization of Nurse Leaders and now serves as a fellow board member.

00:03:04:26 - 00:03:10:05
John Haupert
So with that, please join me in welcoming Mary Beth Kingston. Welcome, Mary Beth.

00:03:10:07 - 00:03:13:01
Mary Beth Kingston
Thanks, John. I'm thrilled to be here today.

00:03:13:04 - 00:03:28:18
John Haupert
Good to see you. So let's dive in. Let's start with a general question about what you are seeing. What are some of the nursing trends you're seeing with an advocate such as new care models, locations of care, telehealth, those types of things?

00:03:28:21 - 00:03:49:24
Mary Beth Kingston
Well, you know, it's interesting. I think we've been focusing a lot recently on nursing and nursing care models and delivery of care. But I like to think of nursing within the greater context of the health care system. So when I think of new care models, I don't just focus on nursing, even though I'll give some examples of things we and others are doing.

00:03:50:01 - 00:04:11:09
Mary Beth Kingston
But I do think it's important for us to say, how does this fit into the larger health care system delivery and the changes that we believe we know has to happen? One example is really tapping into nursing as we all work to close the gaps in health equity. I don't think we really harness the power of nursing in being able to reach that goal.

00:04:11:10 - 00:04:31:14
Mary Beth Kingston
So that's that's one big area that I'm currently focusing on. So if you go back and think about some of the things we're doing and others are doing, the most important thing for me as I think about it is to take a step back and look at the work that needs to be done. And this probably goes for general care delivery as well as nursing.

00:04:31:18 - 00:05:00:11
Mary Beth Kingston
But who's doing the work and what is that work? So I get very nervous when we see new technology, when we say, Oh, this is great, and we keep adding it to what we're currently doing because I think that just adds unneeded complexity to care delivery. So looking at the work that needs to be done, one thing we've done is we've brought some folks in to just sit and watch what nurses are doing, in this case, particularly in the inpatient setting.

00:05:00:13 - 00:05:22:02
Mary Beth Kingston
And we did this years ago nationally in transforming care at the bedside. But we didn't really focus on technology in that. And so I think that's going to be the difference. So what is the work? And if a manager, for example, is doing a certain type of work, would that be automated? What could easily be automated or what should someone else be doing?

00:05:22:05 - 00:05:47:15
Mary Beth Kingston
Because right now, in the beginning, I think we've got to look at efficiency and effectiveness in a lot of our care areas. So with that being said, there are some technology things that I'm excited about as well. Obviously, artificial intelligence is a big issue and we have begun to look at some algorithms for different care processes, but also looking at them for nursing as well.

00:05:47:17 - 00:06:09:12
Mary Beth Kingston
And a lot of this we were doing earlier more predictive modeling. But in terms of helping us prioritize the care that needs to be delivered. Another area in the efficiency and effectiveness arena is the ambient listening technology that's out there, and our physicians have really started looking at that. And I wave my hand and say, wait a minute, what about us?

00:06:09:14 - 00:06:32:18
Mary Beth Kingston
So that while you are talking, this technology is creating your notes and at times looking at potentially whether it can even help with your flow charts and those kind of things, really decreasing the documentation time. Bcause no one wants to spend a lot of time sitting at the computer documenting. And there are many other things we're doing to decrease documentation time.

00:06:32:23 - 00:06:57:19
Mary Beth Kingston
Simple technologies and again, automating things when we can. The other area, and I think you've heard this from probably a ton of people is virtual nursing. And I do think that virtual nursing has tremendous promise. I'm not sure it's going to help us in a great way in terms of filling the big gap when we don't have enough nurses.

00:06:57:21 - 00:07:20:18
Mary Beth Kingston
I do think it helps a little bit there, but there's a number of other areas where I think it's tremendously helpful. It does extend nursing. Some units, and particularly in my health care system where we're rotating nurses through on it, more of a unit based model. I think that helps with retention and it helps give people just kind of a bigger picture.

00:07:20:21 - 00:07:56:17
Mary Beth Kingston
And it's been demonstrated in my organization, again to improve patient experience with more touches. So it helps a bit with the staffing issues, but it certainly has other benefits and I think we're just beginning to learn more about that. Robots are another area. I had the opportunity to visit Christiana Care and saw Robot in action. I think this technology has potential in terms of gathering and doing some different types of tasks, but I think we need to really work with that and make sure it fits into the workflow and to be open to that.

00:07:56:20 - 00:08:22:01
Mary Beth Kingston
And then two last things I'll add because I'm giving you a laundry list here. The hospital at home and remote monitoring. I do believe that these two areas are going to dramatically change the way we deliver care and being able to monitor people and improve their health, but also, you know, be able to manage chronic illnesses in a better way and trying to figure out where the nurses role is

00:08:22:01 - 00:08:44:04
Mary Beth Kingston
and all of that is something we're doing right now. But we've got a very robust hospital at home program. The other big trend is flexibility and autonomy of nurses. I mean, we have a workforce that is saying, hey, we need more flexibility in our work. We want to have, you know, not just an input, but we want to be responsible for our practice.

00:08:44:06 - 00:08:53:24
Mary Beth Kingston
And I think we're going to have to really pay and we need to pay attention to those types of trends that are out there as well. Long winded answer!

00:08:53:27 - 00:09:14:26
John Haupert
No. Great answer. Perfect answer. Thank you so much. And you know, it's interesting, we talk about all the technology, which I agree with you, some of it's going to be very beneficial. Some may just be additive, which we don't want to do. Right. But then that last one you heard about autonomy and flexibility is just a huge, huge issue that we have to be responsive to.

00:09:14:26 - 00:09:35:20
John Haupert
You and I can remember back long enough when we were pretty rigid when it came to nursing shifts and how many hours people worked. And now we're finding that so many nurses want to be parents. So they have the flexibility and we have to accommodate that. We have to be able to work with people to be a flexible work environment, to provide that freedom to people.

00:09:35:22 - 00:09:36:25
John Haupert
That's so important.

00:09:36:27 - 00:10:03:00
Mary Beth Kingston
It is so true. I'm thinking of a conversation I had yesterday, and I don't want this to mean that people are sleeping on the jobs at night shift, but we have a lot of people who are working that are really tired and fatigued and particularly people on night shift. And there's some research out there that shows that if you take catnaps, a short catnap, that your productivity and your energy level increases or at least you have less fatigue.

00:10:03:02 - 00:10:10:19
Mary Beth Kingston
And I mean, remember, if you fell asleep years ago, back when I remember, if you look at that and closed your eyes, you were gone.

00:10:10:22 - 00:10:11:24
John Haupert
That's right.

00:10:11:26 - 00:10:22:26
Mary Beth Kingston
So are there ways to build in healthful practices that help people as they're providing care and yet don't have a negative effect on the quality?

00:10:22:28 - 00:10:33:24
John Haupert
Absolutely right. And, you know, I've read that same research and I actually have tried that. And it does help, does work out pretty well. And you'll be glad to know no one's tried to fire me up for doing it.

00:10:33:24 - 00:10:34:17
Mary Beth Kingston
So great.

00:10:34:22 - 00:11:03:01
John Haupert
Thing. So as you think about all of those different improvements or opportunities to assist in improving the care model and to lessen the burden on nursing, what do we need to do to support our teams and build a more robust workforce in the future? And how can we as hospitals and health systems, rethink workflow and specific care team models to support different care models?

00:11:03:03 - 00:11:28:17
Mary Beth Kingston
Yeah, I mean, my primary thing, I'll probably say this throughout our discussion today is to actively seek out nurses and others at the point of care. Many times they have the ideas and potential solutions. So engaging, but actively seeking out individuals that are there I think is probably my top strategy that I would follow. I also think it's important for us not to fight technology.

00:11:28:17 - 00:11:56:02
Mary Beth Kingston
I mean, there are many things that I've had to learn on the the latter end of my career. We have to work really hard to ensure that the entire workforce, not just our newer, younger workforce, but the entire workforce, is embracing and looking at the opportunies, even in terms of delivering excellent nursing care virtually. We may not have enough nurses, but integrating technology is not about replacing physicians.

00:11:56:02 - 00:12:20:20
Mary Beth Kingston
It's about being able to provide care in a more efficient and effective way. I also think we have to understand that some of the things that we're talking about, again, virtual, this is different than providing direct patient care. And we saw that during the pandemic with virtual visits, that our patient experience decreased a bit. Because folks were not used to doing care virtually.

00:12:20:22 - 00:12:43:14
Mary Beth Kingston
And I think that we shouldn't assume that everyone just can jump into this and be really good at it. What are the things that make a difference? So I think training and understanding what those differences are will be really important. I speak for myself here. I need to expand my knowledge of artificial intelligence, what that is, how we use it.

00:12:43:15 - 00:13:18:12
Mary Beth Kingston
And that's one of my goals in my organization is to just begin to talk about it so we understand what the potential might be. Not fitting something into our workflow, but looking at the work that needs to be done and how this would enhance it. Another really important thing, I think, is education. We have so many issues with clinical sites and I recently saw some data on nursing and the enrollments. And the data showed that we are seeing some increases year over year with the exception of the inpatient setting.

00:13:18:14 - 00:13:42:15
Mary Beth Kingston
And so I do think that's an area that we're going to need to focus on and we can talk about work environment. But I also think that technology, we can incorporate that into all of our education using virtual reality and team based learning opportunities that are now available. So there are a few different ways that I think we can help nurses and support them as we look at different models of care.

00:13:42:17 - 00:13:55:06
John Haupert
Now, that's very good, wrapping our hands around what AI is going to mean in care delivery. I know here at Grady we use AI currently to assist with identifying potential patients who are becoming septic.

00:13:55:08 - 00:13:55:18
Mary Beth Kingston
Right.

00:13:55:19 - 00:14:17:19
John Haupert
Works behind the scenes. And there's a notification system to physicians about things. I've been reading about what it could do to greatly reduce some of the routine work that nurses and others do may be very promising. I'm hoping we can reduce the number of tasks a nurse has to do in a given day because it's just endless.

00:14:17:21 - 00:14:38:04
Mary Beth Kingston
Right. And I think, John, that that we've moved into this task oriented area that if you ask any nurse, that's not a rewarding place to be, to have a checklist and be checking everything off as opposed to really focusing on the whole person. And I think as we talk about helping people connect to purpose, that's an important thing to remember.

00:14:38:06 - 00:15:08:15
John Haupert
Yeah, And one other thing you mentioned about clinical sites. I really do feel that an area where our field needs to step up. I've already shared with Mary Beth a situation that occurred here in Atlanta with one of our largest nursing schools that had to significantly limit the enrollment in their BSN program because of clinical sites. And when we became aware of that, we agreed to become their exclusive clinical site provider with instructors and even with a simulation lab.

00:15:08:18 - 00:15:29:07
John Haupert
And we've been able to increase their BSN enrollment from 80 per year now to 250 per year. And we will get to the point where it will be 500 per year. So I think hospitals need to understand what the needs are with the colleges in their market. In this situation the college didn't come to us to talk about it until it was in a pretty bad situation.

00:15:29:07 - 00:15:36:06
John Haupert
And so I've now taken a real interest in making sure we're working with the nursing schools to assist where we can.

00:15:36:09 - 00:15:53:01
Mary Beth Kingston
That's such an important point. We need to have a partnership and clinical sites and its content and all of those things. But clinical sites and faculty are two areas that we partner very successfully with, with a number of schools.

00:15:53:03 - 00:16:17:05
John Haupert
Let's shift the question just a little bit here. And I know this is something you think about often, but we all know that well-being and satisfaction of our health care workforce has taken on a whole new level of emphasis over the past several years. Yeah, and it's not just what happened during the pandemic, but so many different social issues and global issues that are impacting how people think and feel.

00:16:17:07 - 00:16:24:27
John Haupert
What do you think we need to be doing as a field to help support the well-being of our associates?

00:16:24:29 - 00:16:47:25
Mary Beth Kingston
Yeah, I wish there was one answer to that. You know, it's so different for each person too. But there are some things I think that obviously we can do. The first and I think I've sort of alluded to this, is focusing on that work environment. When I do rounds and especially when I ran it during COVID, people were just so stressed and I would say, you know, where are you getting your support from?

00:16:48:02 - 00:17:28:15
Mary Beth Kingston
And invariably they would point to their coworker that means people I work with, it's my immediate leader. And so I think we've got to invest in leadership, number one. And number two, one thing that we have found to be very successful are peer support programs. So focusing on training of a wide variety of individuals from any nursing, environmental services, physicians...  and doing some training with them, not for them to be the counselor, if you will. But for them to be able to be aware of the folks they're working with and who might be struggling and to help them connect with resources.

00:17:28:15 - 00:17:54:17
Mary Beth Kingston
And there's more to it than that. There's the whole trauma informed care approach. But I do think that building strong teams and supporting leaders in departments, in units, whatever setting you're practicing in is probably number one. Recognition is really important. And I just was at a recognition event for nurses, and I'm telling you, talk about reconnecting to purpose, which is another strategy.

00:17:54:23 - 00:18:21:15
Mary Beth Kingston
We went around and asked each nurse how long they'd been with the organization. They were all being honored for something specific and what motivated them. Each story was just more powerful than the one before, and everyone was just very grateful for the recognition. As long as it's meaningful recognition, I think that's another important piece. We can talk at some point about this

00:18:21:15 - 00:18:46:28
Mary Beth Kingston
but addressing workplace violence again, that ties into the environment. We do know that that has increased and there's lots of strategies we need to employ for that. I would also say providing opportunities for growth and development. One of the things that you'll hear me say often is that what I find satisfying about work is when I'm in a situation where I'm learning and I'm contributing my talents.

00:18:46:28 - 00:19:05:05
Mary Beth Kingston
So I might use my talents in this role and am I continuing to learn? And that to me is a great job then. But you don't have a career path. Are we identifying kind of your unique talents and ensuring that you're able to use them at work and and where do you want to go and how can we help get you there?

00:19:05:06 - 00:19:07:17
Mary Beth Kingston
I think that's another important piece.

00:19:07:19 - 00:19:17:04
John Haupert
And that's great. You kind of touched on our next topic, but I know you are very engaged in the AHA's Hospitals Against Violence Initiative.

00:19:17:07 - 00:19:18:01
Mary Beth Kingston
Mm hmm.

00:19:18:03 - 00:19:32:24
John Haupert
So can you share with us what you're doing is advocate in regard to raising awareness, supporting staff, and any new policies or practices that you've implemented to help our nurses and entire workforce be safe.

00:19:32:26 - 00:19:58:21
Mary Beth Kingston
Well, you know, I can talk about this for a long time. But I do think it starts with leadership and the board. So ensuring that everyone is aware of the issue and is supportive of strategies to decrease violence and in communicating that to all of those that are that are providing care, it also, in my mind, should not be separated from the overall safety program.

00:19:58:22 - 00:20:31:06
Mary Beth Kingston
So we've very much focused on patient safety, which obviously is job one. But workforce safety is a piece of that and we know that if people don't feel safe, they're less likely to be able to provide that safety to patients as well. So it all ties together. Strategies are different, but it should be viewed together. So we do a lot of work with trauma informed care, understanding where patients are coming from so that we can understand how they may react in certain situations.

00:20:31:08 - 00:21:02:12
Mary Beth Kingston
And we do training with that and also de-escalation training. So I do feel that it's important to give people the tools kind of in the prevention area. Risk and threat assessment. So this is obviously the partnership with your public safety team or security. However you refer to that group that is so critical. But looking at the environment and where we have issues, but also even more important now is identifying when there's a potential threat.

00:21:02:14 - 00:21:28:03
Mary Beth Kingston
Following up on that and developing a plan to deal with that. In the prevention area, we're also doing, I think, really good work on clinical assessment. What are some tools that remove bias where you're looking at a patient and identifying cues, physical and emotional cues, and then having a plan of care that goes along with that. So we don't want to identify something and not be able to do something about it.

00:21:28:06 - 00:21:52:26
Mary Beth Kingston
Then there's a number of tactics. Folks will go back and forth on metal detectors. They are useful in some situations. And then also weapons detection, which is a little bit different with new technology coming out. Certainly many folks have been moving toward that mobile buttons, the duress buttons that you can really add to get help. So there's lots of technology there, too.

00:21:52:28 - 00:22:12:08
Mary Beth Kingston
And then I'll just add support if something does occur. But I do think that the most important thing is to create that culture where people are identifying when something is unsafe, raising issues, having the correct training, and then having the support you need to develop a good plan of care when you identify a potential threat or behavioral issue.

00:22:12:10 - 00:22:34:22
John Haupert
There's several things you mentioned in that that I just want to reiterate. If members of our audience haven't done any study or research on trauma informed care, I'd encourage you to. It really does change the way we look at what lived experience has been of our patients and how that lived experience is influencing how they may be interacting with us today.

00:22:34:24 - 00:22:58:11
John Haupert
Of course, de-escalation training is essential. Once individuals know how to de-escalate a situation, it's less likely to become an issue. And I highly subscribed for those. And then you mentioned the weapons detection systems. We have moved to wide use of that new technology and that is a huge plus compared to old metal detectors, much less invasive to the individual.

00:22:58:14 - 00:23:22:23
John Haupert
Most of the time they don't even know it's running as they walk into the building. And then the very few people that it will identify, you just say, come over here a second and have a chat and check their purse or whatever, and it's just much less invasive. So great job all the way there. So you mentioned a little earlier, and this will be my last question, but it's really back to this nursing leadership and governance issue.

00:23:22:25 - 00:23:41:28
John Haupert
And I wondered if you would mind sharing with us key leadership practices or key leadership competencies that you think are essential today to build a strong culture that encourages decision making and creating strong team based care?

00:23:42:00 - 00:24:28:26
Mary Beth Kingston
Yeah, I'm a huge proponent now. We call it shared governance, but there's a move and we'll probably move in that direction to professional governance. And to me, that ability to have nurses have oversight of their own practice, it creates so much more engagement. I've talked a lot about this where as nurses bring forward things and we need - I meet with our shared governance leaders and I have had our CEOs, we have co-CEOs, have had our CEOs asked to meet with chair governance leaders or asked their view on certain things, and then connecting those dots back so that people see, even if you're not active in that, that your representative on that unit is soliciting

00:24:28:26 - 00:24:54:26
Mary Beth Kingston
information and then can bring information back. It's such a powerful strategy when it's done right. So I once read it was one of the Harvard Business Reviews for going through cadres change, and it said, you really need an army to really do transformative change. And so to me, shared governance, there's a top down and a bottom up. But then there's also this army that extends out.

00:24:54:28 - 00:25:18:15
Mary Beth Kingston
And so the messages are clear and you're still getting input and new ideas. So I think you have to be a leader that values that and isn't totally top down leader. But having a strong process there I think is critical. The other thing I'll just mention, John, that I worry about a bit, and that is our leaders at the point of care.

00:25:18:18 - 00:25:39:21
Mary Beth Kingston
We've had this huge shift. We're doing a lot of work right now on how do we reduce the burden for that nurse manager. And during the pandemic, when more folks went remote, a lot of work shifted to the manager, and we still haven't peeled all that back yet. And some of the things could be small, but they're incremental.

00:25:39:27 - 00:26:02:13
Mary Beth Kingston
And so now all of a sudden, you know, all maybe maybe you've got to check for serial numbers or you've got to help get access to whatever. And you add all of those tasks on. And then as I mentioned, that support that the manager, that environment that they want to be out there creating becomes very difficult because you've got this whole list of other things that you need to do.

00:26:02:14 - 00:26:19:05
Mary Beth Kingston
So I think investing in our leaders at the point of care so that they are comfortable having an open, transparent interactions with their team and supporting their team, I think is probably that and shared governance are probably the two most important things we could be doing.

00:26:19:07 - 00:26:32:10
John Haupert
Great, great. Thank you for that very much. Thank you all for joining me today. Mary Beth, thank you as always. It's a joy to be able to share ideas with you. I have appreciated being able to do that over the last few years.

00:26:32:12 - 00:26:33:19
Mary Beth Kingston
Thank you, John

00:26:33:21 - 00:26:57:18
John Haupert
And I appreciate you sharing your great insights. And again, I encourage all of our viewers to explore the workforce resources available through AHA and through the American Organization of Nurse Leaders, as you consider your own workforce strategies and partnerships. Until next time. Thank you to everyone for joining us today. I hope you'll be back for next month's Leadership Dialog.

00:26:57:20 - 00:26:58:18
John Haupert
Thank you.

00:26:58:21 - 00:26:59:07
Mary Beth Kingston
Thank you.