(Part 2) Future Healthcare Models: The Evolving Role of Nurses in Advancing Patient-Centered Care
Guest Overview:
Dr. Clipper is the founder of Innovation Advantage, a consultancy that focuses on helping health care organizations adopt innovative approaches. She is a trailblazer in her industry and was the first Vice President of Innovation at the American Nurses Association. Dr. Clipper is the sole nurse member of the HIMSS Innovation Board of Advisors and is a start-up coach for MATTER international health tech accelerator.
Her recent book, “The Innovation Handbook”, is a pragmatic guide and toolkit that seeks to enlighten nurse leaders as they evolve through the current healthcare crisis.
Memorable Quotes:
“There are not and will not be enough nurses. It looks as though we're starting to see that same issue emerge with physicians. So if that's the case, we have to identify. What technology we are going to work with and collaborate around the design of this technology so that it actually safely helps us. Fewer of us care for patients. And I see a tremendous opportunity to use not only augmented intelligence, but service robots.” - Dr. Clipper
And particularly if there are any small startups out there, I think that there are opportunities to think about. How do we educate families and how do we provide resources for lay people?
Show Links:
Innovation Advantage: www.innovationadvantage.com
Innovation Handbook: https://www.sigmamarketplace.org/the-innovation-handbook
Transcript:
Intro - 00:00:04: Welcome to The Factor, a global medical device podcast series powered by Agilis by Kymanox. Today, we're back for part two of our conversation with Dr. Bonnie Clipper, Founder of Innovation Advantage, and Denise Wagner, Senior Director of Human Factors and Usability Engineering at Agilis by kymanox. In part one, Denise and Dr. Clipper discussed innovation in nursing and the potential transformation of healthcare through technology. Today, they continue the conversation, discussing the nursing shortage and how nursing is handled much differently outside of the United States. Here's Denise.
Denise Wagner - 00:00:42: So one thing that I've been thinking a lot about lately is you talked about getting the input of nurses and doing ethnographic research, being in the hospital, understanding those clinical flows. And, you know, I've done some of this work in Europe and Australia and the US and in the UK. And one thing that I've thought about throughout my career is. The lack of standardization of healthcare in the US can become a bit of a hurdle, right? So if you're a medical device manufacturer and you want to sell everywhere in the US, not just one hospital system, but it's some kind of system or product, then you need to talk to a wide range of hospitals and nurses and hospitals and surgeons and hospitals and central processing within hospital systems because we lack that standardization. Would you agree with that? Or is there more standardization than I'm aware of?
Dr. Bonnie Clipper - 00:01:49: I think you're spot on. I think, you know. If I, I've been in healthcare for about 35 years, longer than sometimes I care to remember. When you think about it. For me, way back when I was a baby nurse in my first hospital. There was zero standardization because every physician did what they wanted. They had their own orders. You did it their way for Dr. X and Dr. Z and Dr. A and Dr. B. Everyone was different. Then we started to work, take baby steps and work towards order sets. And that brings us closer, yet there is a tremendous amount of variation still in order sets because you can cross out and delete and add and substitute and supplement and all of these things and sometimes it's for very good reason. Right, I'm not saying that we never want to move away from standardized processes because sometimes we absolutely need to customized care for patients. So I think that that's exactly right. Yet when you start to strip away a lot of what is customized, I think there's probably a base layer or a framework of things that could be standardized across. Everything, whether it's a post-op patient, a new admit for pneumonia, stroke, admit what whatever. And we have seen some of this work begin to emerge with things like Get With The Guidelines or other kinds of processes that have been put in place where we're surveying hospitals and health systems on their ability to create standards of care. And stick to those, adhere to those, and then provide outcomes. So I think we are getting there. There still is a tremendous amount of variation. One of the areas that I see this is when I go into ORs, I can see how many custom packs they still have. So some organizations have done an incredibly great job of scaled back. And they have standard packs and you can add a couple of different things. If you're a surgeon in the OR. And some organizations still have a tremendous amount of custom packs. So that's just one little snapshot, but I do believe there's opportunity. I would even say within nursing. There's still tremendous amount of opportunity. And one of the places that I see this is when I go start working with organizations around virtual nursing. There's a lot of interface that has to happen in the EHR. Because the virtual nurse is documenting almost simultaneous in the EHR patient record as the nurse who are the boot's on the ground. The originating nurse. So we have to really get into the EHR and play with it. And almost no matter who the vendor is, whether it's Epic, Meditech, Cerner. There are, of course, out-of-the-box versions, and then there's a lot of deep customization. Almost every organization does a tremendous amount of customization. And again, I'm not arguing with the logic there. However, as we customize more and more. It makes it difficult to harvest data across the country, because attributes, fields, everything looks different. So from a data hygiene perspective, an apple isn't an apple. Which might be a Granny Smith or Macintosh or Conzi depending on what organization you're in. And that just requires a lot of effort later.
Denise Wagner - 00:05:17: Yeah, exactly. And I just, you know. I can't imagine nurses and healthcare professionals that then may leave one position and they go to the next. And now, even though they have all the education and all this great experience, now all different, maybe a different EHR system, and this company uses all different medical devices because they've relied on different suppliers and constantly new tech is brought into hospitals. Who do you think is responsible for training healthcare professionals on the new medical technology that's brought into their healthcare system? Is that the manufacturer? Is that the hospital? How do we handle that?
Dr. Bonnie Clipper - 00:06:05: I think the answer is yes to all the above. So there's different kinds of training. I think it was just in an organization this past week. So we're bringing on board some new technology for them. The company that produces the technology. Absolutely should have a training plan, training people, training program. That onus should be on them. To show people how to safely utilize that equipment. Certainly because I have experience as a chief nursing officer, I always want more versus less from vendors. So I would expect them to be on site. Zoom isn't always enough, right? We need people depending on what this is, depending on how it interacts or touches a patient. Depending on how much honestly we spent with the company. My expectations are I want people in sight, you know, on site to help do hand holding and teaching. That's important to understand the equipment. How to operate it safely. What it does, what it doesn't do, how do we clean it, how do we care for it, all of those things should come from the vendor. When it comes to the application of this product in terms of our workflows. How we're going to use it. Where we see it to be a value. That's on the part of the hospital or the system. Right? Because there should be a problem as you said, an unmet need. There should be a problem that they decided that needed to be solved. Which is why they went about acquiring technology. And I think it's a match. It's a little bit of a marriage. The company should want people to know how to safely. And properly utilize their technology and the organization that spent the money. Should want to be sure that people are utilizing it at the right time, on the right patients, in the right place, in the right way. And gaining the benefit. Or the return on that investment. That they made when they acquired the technology. So I think it's both.
Denise Wagner - 00:08:05: Yeah, and then what would you have or what do healthcare providers, what medium of training do they prefer once that maybe that clinical representative from the manufacturer comes into the hospital, does a training event face to face, and then you hire more nurses, more doctors, more physician assistants since that initial training because you constantly have an influx of new people and maybe people are on vacation? What do you suggest for that, for that ongoing education of new personnel and refresher training? With you, suggest.
Dr. Bonnie Clipper - 00:08:46: Yep, so I'm going to tell you there's been a process in place forever and it generally works. Okay, right, and that is you create one of the things that a vendor would do is to create super users. So that means you, and you know this model, it's an old model, we train those people. Extra good, right? And when new hires come on board, we have super users that can actually educate the new hires that come on board. And really make sure that they understand how to use the equipment and where we use it, etcetera. I would challenge that though, and I would tell you that there's an opportunity for disruption in this. And that is we have virtual reality now. So I do some work with a company that has amazing VR tech and they build assets. That vendors can use. And you load all the training into the headset and the organizations get the headsets, right? The vendors provide the headsets, the organization has those. So whenever new people come on board. You are actually feeling as though you are right there in the thick of it in that scenario, doing the training. So I think we have to move the way that we've been training people in the past. We also realize that some hospitals and health systems. Have trimmed back their educators. So in some places they aren't as robust as they used to. But we do need to make sure that any time we're putting anything in front of or near a patient. It's safe and people know how to use it and what it does and what it doesn't do.
Denise Wagner - 00:10:17: Right. And yeah, I've been involved in the development of VR and AR for training for healthcare professionals as well. So I was wondering, you know, if you were going to go there. Also, I just heard from, from nurses, you know, and I've seen on YouTube, I'm sure you have to the videos that nurses have produced on how to optimize a certain clinical flow or basically a training video they produce for other nurses.
Dr. Bonnie Clipper - 00:10:42: They're doing it for themselves.
Denise Wagner - 00:10:44: Exactly. Exactly. So, yeah, that's, that's just very, very interesting. And what other? You know, it can be technology trends, socioeconomic trends. What other concerns do you have for healthcare? In the next decade, in the next day?
Dr. Bonnie Clipper - 00:11:06: Well, you know, I think we need to get our act together and figure out where we're going and what it's gonna look like. It's gonna look entirely different than it does today. We don't always have control over that, particularly when you think about the workforce. There are not and will not be enough nurses. It looks as though we're starting to see that same issue emerge with physicians. So if that's the case, we have to identify. What technology we are going to work with and collaborate around the design of this technology so that it actually safely helps us. Fewer of us care for patients. And I see a tremendous opportunity to use not only augmented intelligence, but service robots. The telehealth and virtual care technology. As a force multiplier, it's going to allow us to have the humans. That have to be involved. We can't give away everything we do to technology. Technology can't apply critical thinking in the way that every patient is completely different. It can't help us with creativity. But it certainly can, you know, help identify. What are the top 10 or 20 resources or pieces of research that we need to read as we're building this new model, right? So it can help provide us with quite a bit, can help us with outlines, it can help us do a tremendous amount of work. I think that's going to be very important. The other thing is that we are going to continue to see AI being built into everything that we do, whether it's diagnostics, therapeutics. At EHR. And much of this care. Give her perspective, particularly in the world of nursing. We have to go back and start educating people. Middle school, high school, college about what AI does for us and how it will assist us. We also have to be aware of the blind spots, the biases, the algorithms are only as good as the humans that built them. So we really need to have people understand that you just can't trust 100% of this stuff, right? It makes mistakes, it hallucinates, it has issues. So we have to have people in the workforce that understand that. Yes, we are going to have no choice but to lean very, very heavily into it and utilize it.
Denise Wagner - 00:13:24: So I have just another concern. You've mentioned several times throughout the conversation that we've had today about the nursing shortage. And so one trend I wanted to get your thoughts on that I've noticed is that more and more care is being pushed to the home. More and more care is being pushed to the patient at home, maybe that patient's caregivers at home. And that can be a very diverse population because we've spent a lot of time talking about technology, but those lay caregivers and those patients may have a sixth grade education, a high school education, a PhD, they may be a healthcare provider themselves. So do you have any concerns about pushing more and more care to the patient and their caregivers? And how do we alleviate those concerns?
Dr. Bonnie Clipper - 00:14:24: So first let me flip that and reframe it for you. We are one of the only countries that does not use the family as caregivers. Okay. So I do some work in Europe and in, in European cultures, in many Asian cultures. And it is very common for the family to be the caregivers. You go to the physician, you go to the doctor when you're sick, they do something for you and you come back home and the family cares for you. So some of this is uniquely American. That we don't have the time or have the skills or have the interest to care for our family members. That is going to change. Simply because there isn't. There aren't other people to do that care anymore. Right. And, and acuity is going to dictate who is inside the walls of a hospital. And the majority of patients are gonna receive care at home. With assistive technologies to support that care. I see it as a good thing, quite honestly. And if you think about it, Certainly for me, I even remember back to it was just two generations, my grandparents' generation. Where you didn't go to the hospital, but rather you worked with your physician. You got prescriptions and your family did care for you. At home. Whether it was, you know, helping you with your ADLs while you were not well or had a surgery or a broken this or a broken that. It hasn't been this long that we have shifted into going to the hospital or hiring caregivers. We are going to swing back simply because there aren't enough humans anymore to do that. I see it as a good thing. Where I think there are opportunities. And particularly if there are any small startups out there, I think that there are opportunities to think about. How do we educate families and how do we provide resources for lay people? Around what it is we're asking them to do. Especially when patients are now home. Being supported and supplemented by people that are not trained healthcare professionals.
Denise Wagner - 00:16:33: Yeah, that's kind of what I wanted to tease out is, depending on the illness, depending on that care level that's required, and then depending on the devices and technology that's being sent home with that patient for a caregiver to learn how to use and help apply on their loved one, that's, I wanted to kind of tease out what you thought about. I think that could be a breakthrough service or a product offering where they focus on training up laypeople on how to use advanced technology that's sent to the home. Like, are we adequately preparing them and educating them? Because even, you know, dialysis machines, wound therapy machines, all of these things are getting more and more complex in their design that we send home with people.
Dr. Bonnie Clipper - 00:17:24: Well, complex yet more simple. So home dialysis is a huge thing right now.
Denise Wagner - 00:17:28: Yes.
Dr. Bonnie Clipper - 00:17:28: And there is a very appropriate patient population that can absolutely manage their dialysis at home now.
Denise Wagner - 00:17:35: Right, rather than having to be transported to a care facility.
Dr. Bonnie Clipper - 00:17:40: Or to go Monday, Wednesday, and Friday. To sit in their chair for three hours. And then miss that much work, right? So absolutely that makes all the sense in the world that with the appropriate patients, we push dialysis patient care home. I'm also going to give you something that's kind of a corollary in a backwards way. So if you think about it, if a patient has diabetes and they're doing their home glucometer checks, they're poking their finger. They're using their glucometer. Couple times today. When you come to the hospital. We pretend like you're not doing that on your own and we stick your finger. And we do your Accu-Chek and we document it. Three or four times a day. Right? The same thing is now happening with patients that have the digital glucometers, whether it's the Free Spirit or the Dexcom, some of the others. Literally at home you're doing this. It is real time tracking your blood glucose, adjustments to insulin if you take them through an insulin pump. Sometimes they're even Bluetooth together. But when you come in the hospital, we take all that independence away.
Denise Wagner - 00:18:47: Yes, I heard that on one of your podcasts, actually, one of your guests saying that she was injured and in the hospital, and all of a sudden, she could just imagine nurses being called to her room to do the things that she did for herself every day.
Dr. Bonnie Clipper - 00:19:02: Absolutely, so we create work for ourselves that we do not need to be doing. Now, I was in a very, very large organization that was working on changing not only their own internal policies about glucose monitoring for diabetic patients. The issue that they ran into. Is the regulatory body clear? Who basically said that lab values, particularly when you look at things like glucometers, have to be done by a lab that is validated. Right. So some of this and I'm not pretending I'm the expert here, but some of these things we have to tease apart. And figure out if it's good enough for patients to monitor at home. And care for themselves either through insulin or orally manage your diabetes or other ways. Then what changes the minute they walk in a hospital? That we take that away from them. So sure, we should know if they're taking insulin, how much and what kind. We also should understand the medications and perhaps be the ones that administer it. I don't know, maybe that needs to change too. But there are things that we pile on ourselves that we don't need to. So if we flip that. And allowed patients to care for themselves. In the ways that they already know how. There is a lot of that already going on in our communities. Right? We have patients that are on home dialysis. We have patients that, you know. Millions and millions of patients that manage diabetes and insulin pumps every day. We have patients that manage peritoneal dialysis. We have patients that manage home infusions. With the assistance of someone else. But we have to think about how do we not take everything back over that we simply don't have the manpower of the workforce to support? So. All of that, Denise, for me. Says, I think that patients receiving care in their homes. Makes a tremendous amount of sense. With technology that can assure. It's safe. Do we know what meds they're taking, when they're taking them? There are programs that help us do that. Do we know what their needs are? Are there ways to tie in something like an emergency number or a, literally a call light in the patient's home. There are systems that do that. We have the ability to utilize stethoscopes, blood pressure machines, scales. Um, everything, literally out of scope. I mean we can do all of that digitally and have it fed back to a provider. Through the internet, through wifi, through cellular, we can use that. So we have to learn to adopt. Those kind of things because we are going to see more patients being pushed home.
Denise Wagner - 00:21:43: Yeah, and so it's a more distributed care model. And as long as we have that assistive technology, maybe it also, you know, free up the healthcare providers for the more critical things that patients can't do at home. And then also gets them a little more, I think ownership, right? Over their recovery, over their disease management. Would you also agree with that?
Dr. Bonnie Clipper - 00:22:07: Well, that's another thing that feels very uniquely American, is that if we are told that we probably should consider losing a little weight or not smoking or getting more exercise you know we say we're gonna make the decision to do we wanna do yet when we find ourselves in a position of having some health issues, all of a sudden we want people's help, right. So I think we're going to have to figure out what's the balance there. I don't know, I am not the expert in that space. You're really now talking a whole lot about. More education starting at a very young age. You're talking about community health models that we have under invested in for years. So. I think there is a lot of opportunity to really look at longevity in a very different way, probably starting at birth. And certainly that's not my expertise, but I absolutely see more technology helping us with that.
Denise Wagner - 00:23:01: Yeah, and I think these are just more areas for startups to get involved in. And we've already seen kind of a proliferation of, I would say, behavioral management with apps, right? For quitting smoking, weights, maintaining your weights, right, all of those things to try to help move towards that healthy lifestyle to kind of prevent disease rather than so much focus on healthcare after disease onset. So, yeah.
Dr. Bonnie Clipper - 00:23:30: Absolutely.
Denise Wagner - 00:23:31: So, any other topics that you want to touch upon or anything before we close?
Dr. Bonnie Clipper - 00:23:41: You know, I think, the technology is going to continue to come at us at a very fast rate. So I would just encourage people. Understand what technology is out there. That means it's incumbent upon us to do a lot of reading so that we're really up to date with what is coming. And you know, also that means the pros and cons of it because it's probably at some point. We're going to see it in our organization. So I do think that that is going to be incredibly important. And if you identify opportunities, problems, gaps, needs that aren't met, I think that's important to think about in terms of how do we solve those.
Denise Wagner - 00:24:19: Absolutely. Well, it has been an absolute pleasure speaking to you. One of our guests that I think we just are have so many synergies in what we do. So I really want to thank you for joining me today. It was a great conversation.
Dr. Bonnie Clipper - 00:24:36: Thanks, Denise.
Outro - 00:24:43: That was Denise Wagner and Dr. Bonnie Clipper. You can find Dr. Clipper at innovationadvantage.com and from there, you can check out all of her books and find even more podcasts she's been on. Thank you so much for listening to or watching this episode. Please subscribe or follow this podcast in whatever app you're using right now, or follow Agilis by Kymanox on LinkedIn for all updates. This episode was edited and produced by Earfluence. We'll talk with you again soon on The Factor.
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