Rae Woods (00:02):
From Advisory Board, we are bringing you Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. Healthcare is commemorating National Nurses' Week by celebrating and acknowledging nurses' contributions, something frankly we need to be doing all the time. Nurses are essential to the entire healthcare ecosystem. So, it's no surprise that recent data show that the workforce shortage, particularly among nurses, is the number one issue for executives. Leaders recognize that a workforce shortage isn't just a problem for RNs or for the HR department. It's a system-wide problem that will impact nearly every part of an organization, including quality and safety.

(00:52):
That's why in today's episode, I've brought two leaders from University Hospitals. Peter Pronovost is the Chief Quality and Clinical Transformation Officer. Michelle Hereford serves as Chief Nursing Executive. Together, they're going to discuss the complexity of grappling with nursing shortages and why we need to reimagine the work that nurses do. But before we talk to them, I want to bring in Advisory Board's own Chief Nursing Officer, Carol Boston, to get the scope of what's happening in the industry. She's going to share some new data for 2023 and explain why the work being done at University Hospitals caught her attention. Hey, Carol. Welcome back to Radio Advisory.

Carol Boston (01:32):
Great to be with you, Rae.

Rae Woods (01:48):
So we know that the last few years have been challenging, to say the least, for the nursing workforce. It's something that you and I have talked about on this podcast quite a bit. My question to you today is, are any of those pressures getting better? What are you hearing from the industry?

Carol Boston (02:05):
Well, to answer that question, we need to look at the latest data, both the NSI survey of providers reporting updated turnover and shortage statistics that was just released, as well as Advisory Board's survey of nurse leaders reporting top RN workforce concerns requiring investments in 2023. Taken together, these two surveys provide some good news as well as some bad news. Good news is this, overall, our turnover has decreased a lot, like almost 5%, which is great.

Rae Woods (02:36):
Oh, wow.

Carol Boston (02:36):
Yeah, and it demonstrates that some of our early retention strategies like upping compensation, greater scheduling flexibility, even internal travel agencies are working.

Rae Woods (02:47):
Okay, but what's the bad news?

Carol Boston (02:49):
Well, other data is problematic despite some good news. We can't get too complacent here. For example, despite overall, our turnover decreasing, novice or first year turnover is up again. With baby boomer retirements looming, we need to dig even deeper into turning this trajectory around. Novice nurses are our future. Also, time to fill vacant RN positions in acute care is up substantially and nurse burnout remains unresolved with reports now directly linking quality and safety being impacted.

Rae Woods (03:27):
What scares me about the bad news that you just shared is that this is all happening at the same time as organizations tell us that they want to increase the size of their workforce.

Carol Boston (03:38):
That's right. That's exactly what the NSI data reflects. Even though the nurse leaders' number one workforce concern as reflected in our survey is a complete lack of qualified nurse candidates available to hire in many markets across the country. So, you can see the disconnect here. Also, providers are reporting their intent to use the same high level of travelers in 2023 as they did last year, which isn't financially sustainable as everybody is aware.

Rae Woods (04:10):
So even though there's some good news that you shared at the top of this conversation, because there are just no nurses left to recruit, leaders are stuck bleeding the same amount of money that they have been over the last couple of years.

Carol Boston (04:23):
Brutal statement, Rae, but I would agree with you completely.

Rae Woods (04:27):
You mentioned that overall turnover is down because of the good work that organizations have done. They have responded to the things we've been telling them to do over the last couple of years, like increasing compensation, like more flexibility and so on and so forth, but the data tells me that we have to do more to stabilize the workforce. So, Carol, what are we missing?

Carol Boston (04:47):
Well, novice nurses are our future, Rae. We've got to lean into the unique needs of this unique employee population even more so than we have done in the past. The data provides us a sobering reminder of that, but really important here, redesigning the work of the registered nurse in acute care is becoming mission critical, which includes top of license support, getting rid of work that gets in the way of efficiency, quality and safety, and really leveraging technology to automate what could be automated.

(05:22):
All of which can provide the opportunity for nurses to focus on the work that really matters and what's most meaningful to them. I would say that beyond model pilots, we have got to scale this work at a pace far greater than what we've been doing over the past year. I know that this is hard to do, but in my travels, I do work with a lot of system executives that are rolling up their sleeves and addressing this mandate head on, including my colleagues at University Hospitals Cleveland, which I'm thrilled to have joining us today.

Rae Woods (05:55):
Yeah, let's turn it over to Peter and Michelle to tell their story. Hi, Michelle. Hi, Peter. Thanks for coming on Radio Advisory.

Michelle Hereford (06:04):
Hello, Rae.

Peter Pronovost (06:06):
Hi, Rae.

Rae Woods (06:07):
So I know both of your titles technically, what they are on paper, but I wonder, can you share with me and our audience a little bit more about what you do at University Hospitals in your specific positions, but also how you work together?

Michelle Hereford (06:23):
So as you know Rae, I'm the Assistant Chief Nurse Executive and I'm responsible for the oversight of our quality of our vertical, which includes nursing, nursing caregivers, advanced practice providers, respiratory therapy, environmental services, and food and nutrition professionals. Peter and I have had great opportunity to work together. Definitely during these challenging times, it was necessary for the two of us come together and align on the work ahead. We think alike, but we think differently.

Rae Woods (06:57):
Yeah, nursing executive. Peter, what's a Quality and Transformation Officer?

Peter Pronovost (07:02):
Maybe it's better called a chief instigating officer. So, the quality piece is relatively straightforward. It's responsible for safety, experience, clinical integration. The transformation is you essentially think of it as a couple roles. One is running our ACO and our employee health plan to make sure that it's maximized value and then importantly, helping evolve the organization to maximize value. So, this evolution for all the care we do to make sure it's the highest value possible. Obviously, in that role, nurses play such an important role in the care delivery that Michelle and I are joined at the hip for so many things.

Rae Woods (07:44):
One of the ways that you are joined at the hip is helping to solve the workforce crisis. I would like to believe that you can solve that for the world for us. Can you add that to your to-do list?

Peter Pronovost (07:57):
We're working on it.

Rae Woods (07:58):
But at least starting to address it at your home system at University Hospitals. I want to have a moment of vulnerability actually with the two of you. There's a lot of talk about what the crisis means, what shortages mean. There's a lot of fear around nursing shortages, workforce shortages starting to impact actual patient safety. Is that something that we should merely be afraid of or is that something that is already happening?

Peter Pronovost (08:25):
Rae, from my perspective, it's already happening and the national data is bearing that out. There's been several studies showing that the rates of complications have gone up pretty dramatically. I mean, pressure injuries are up nearly 70% and there's a variety of reasons for that, but without a doubt, both staff shortages, so we have high ratios, and inexperienced staff contribute to that as well as having agency staff who don't know your culture or your protocols.

Michelle Hereford (08:57):
Rae, it is real. It is real. There was a time that many organizations would not admit that, but this is real. I'm sure it keeps many leaders, many caregivers, and others up at night. I'm proud and happy to say working with Peter is great, but UHN, UH overall has placed a tremendous focus on our workforce. It's not just the things that you probably read about in the paper. It's the needs of our workforce. The workforce has changed, people have changed, and we must change with them.

Rae Woods (09:32):
We absolutely must change with them. One of the changes that I am so happy that we're starting to see is executives like you coming together and saying, "You know what? This is not just a nursing problem. This is not just a problem for that cost center over there. This is a problem for our entire enterprise. This is certainly a problem for quality and safety. This is something that we need to get the best of our leaders working on together." So I want you to go into a little bit more depth about the two of you. You've got this shared problem. You've said that you can be joined at the hip together. What does partnership look like for your two teams and for you two personally to start to solve this workforce crisis?

Peter Pronovost (10:11):
One, it begins with us trusting each other immensely and focusing on the work rather than our responsibility. I'll give you an example with Michelle's managers all the time. I mean, we're one team and Michelle meets with the clinical transformation and our care managers as she redesigns care models all the time. We're all aligned around giving the best care possible. Those are I think some pretty concrete examples of how this deep trust between us removes any territorial or hierarchy about, "What are you doing in my space?"

Rae Woods (10:47):
I love that. No silos.

Michelle Hereford (10:49):
That's the key actually, being able to trust each other, identify that there is a common goal, common concern. The way we work together is definitely a reflection on mutual respect that must exist in any relationship, but it sets an example for the rest of the organization and for those that work directly with us. One of the things I would also share with you that I think and I know actually makes this team, and specifically Peter and I, a great team, other than being kindred spirits, we talk about that all the time, but we both always want to know why. Why has this occurred?

Rae Woods (11:33):
What is your answer to that? When you say this, I'm assuming you mean why are nurses suffering.

Michelle Hereford (11:39):
Or if there was an event, what are the details?

Rae Woods (11:45):
Like an actual safety event?

Michelle Hereford (11:46):
Correct. As you continue to peel that onion and it's a continuous peeling, you get to the source of the true why. Not always what we see that is, and Peter and I have the same philosophy around that.

Rae Woods (12:05):
I think this is how the two of you have come to at least a starting place in starting to work to reduce the staffing shortage, both in terms of number of people, in terms of people that are embedded in the culture, and Peter, as you said, in terms of the right expertise at the right place. I think where you landed is a place that a lot of nurses would be happy about, which is the unbelievable administrative burden that is on frankly all clinicians but is particularly true at the bedside.

(12:36):
We know that a ton of below license work just gets shoveled to bedside nurses. I'm assuming that as you're peeling back the layers of the onion, getting to that why, that's an area of focus for both of your departments where the nurses are suffering and also we're starting to actually see some real safety issues. Is that how you came to that initial first step?

Peter Pronovost (13:01):
Yeah, Rae, you're so spot on and it's insightful. You know what? Michelle's done brilliant work of retention and paying bonuses and all that great blocking and tackling that needed to be done. But Michelle and I were both aligned with, as you said, a lot of the nursing work that they do doesn't need it to be due. So, we said, "How could we systematically address that?" So I had facilitated a discussion with about 55 of our nurse managers and several frontline staff and asked them a series of questions about, "Which policies do we have does the burden exceed the benefit?"

(13:40):
Then once they listed those, how much time do you spend doing that per patient and how many times per patient day does it need to be done? Then we added, "Is it a CMS policy? Is it a joint commission or DMV, or is it our own policy?" There's a couple stunning things that came out of that was they summed it up to be 60% of nurse's time, six-zero. I mean, it was unbelievable.

Rae Woods (14:07):
Oh, my goodness.

Peter Pronovost (14:09):
The vast majority of them were our own internal policies that we over the years accumulated a whole lot of policies. There were some that were CMS and the team was excited. We arranged calls with CMS leadership that they presented some of the things that they wanted change like the nursing care plan. CMS was highly responsive and it was quite energizing for them. Most of them were around frequency of documentation. We've changed about 70 policies, but those 70 policies were embedded in nearly 2,000 order sets.

Rae Woods (14:45):
Oh, my God.

Peter Pronovost (14:46):
So we're now going through each of the order sets to take out that waste of time, but I can tell you the nurses are just energized about this work. I mean, they really are excited about the potential to free up that amount of time for them.

Rae Woods (14:59):
Well, even back to the idea of the partnership, imagine there's a world where you are sitting down with these 50 nurses, you said there were nurse managers.

Peter Pronovost (15:07):
Correct.

Rae Woods (15:08):
Even the signal value alone of saying, "I'm here too. I'm the chief clinical transformation quality officer, and we believe that this is actually going to be a quality safety problem and we're also here to help you." Even just that signal value of you coming together I think is an important piece of this story.

Peter Pronovost (15:27):
After we did this, literally, there was giddy energy in the room when they were buzzing and saying, "Oh, imagine if we do this." One of the managers said, "Peter, this is really strange. We have a policy review meeting every month where we ask about policies that need to be changed and we haven't had any agenda items and now we've just identified 60% of our time." So I questioned them. I said, "So let's unpack that. Why do you think that is?" I think they said once when you work in an environment, you just get used to it the way it is. In safety, we call it normalization of deviance. The second is we weren't confident that we would get things changed, that we would have people who'd be real [inaudible 00:16:14].

(16:15):
Tapping into that, I think it's probably a universal feeling across nurses, because for too long, their voices haven't been heard. So, signaling that "Hey, you come up with ideas, your voice will be heard," as Michelle and I say, this leadership style that we are implementing is completely moving away from command and control towards unleashing and inspiring people. You come up with ideas. Our job is to knock the barriers down to put those ideas into place.

Rae Woods (16:43):
Yeah. So, let's talk about that. So, you've identified all of this non-value added work up to 60% of a nurse's time. Where do you go from there to start saying, "We've not just heard the problem," because I guarantee you, even long before this, Michelle was hearing that problem from a lot of frontline nurses. Every nurse can attest to that who's listening to this episode. Where do you go from, "All right, we've identified all this non-value added work"? What's the next step to actually getting that off of the nurse's plate? It sounds like your first step, it's actually an interesting one, which is not let's delegate that to someone else, but let's just not do it.

Peter Pronovost (17:18):
So the steps we went through is first, we revised our policies. So, like Michelle said, why? We assumed when the policy was put into place, it was wise and was defending against some risk. So, we partnered one of these nurse leaders who wanted to revise it with the person who created the policy in the first place and with our educators and said, "Okay, are you okay with changing this? Does this change make sense?" Every one of them, they're like, "Yeah, totally makes sense. We're in a different time. We don't need to do this."

(17:51):
But then once we changed it, the hard work, Rae, was all of those policies were embedded in order sets. So, you'll do vital signs Q2. We don't really need to do that, or you'll document this. So, we have to go find every one of those order sets that needs to be changed to take it out. That's the work that we're doing right now.

Rae Woods (18:12):
So before we get to the order sets, I want to ask, was there really no pushback to eliminating these things?

Peter Pronovost (18:18):
There's a few to say, "Okay, does this really make sense?", but always looked at and the risk benefit ratio of, "Okay, this is where we are right now and this is the time we've spent documenting." Rae, we've pushed joint commission and DMV were when CMS or DMV or joint commission are ambiguous about what's required, our legal and compliance people tend to err on the side of conservativeness, right?

Rae Woods (18:45):
Sure.

Peter Pronovost (18:45):
So some of this was in the face of ambiguity, we were really, really cautious and now we're saying, "Okay, well, we probably were too cautious. We don't need to err on that much anymore."

Rae Woods (18:56):
But I think people would be surprised to hear that from a quality and safety officer. I wonder if you can give me an example of one of these things, Michelle, I'm not sure if you have an example, of something that was set out by UH or CMS or what have you that you decided this isn't actually valuable for us to do. The risk benefit is just not there. We're going to eliminate this.

Michelle Hereford (19:15):
The thing that comes top of mind is documentation, and we all had the experience during COVID and the recognition that the type of documentation, the amount of documentation may not be truly what's needed in order to deliver care at this highest quality state. So, we spent some time reevaluating whether or not we needed to reinstitute, I'll call it the burden of some of that extra documentation. We have found ourselves in a crisis mode. We removed it, we reinstituted it, and then we found ourselves again in a situation where we removed the requirements that demand I should say that was placed on us. Clearly, we know and we believe and we will work with others to remove unnecessary documentation. It's really important.

(20:12):
I did want to elaborate on one other item just to make a point around how did we get here. So, talking about policies, I'd like us to keep in mind that often what happens is we create pathways to accomplishing whatever we need to accomplish, and then something changes, whether it's a new requirement, whether it's a new standard, whether it is something probably as simple as the structure of a unit, the reporting relationships.

Peter Pronovost (20:50):
Or a bad event happened.

Michelle Hereford (20:51):
Or a bad event happens, but something happens. Sometimes we get very connected to the work that we've created in the past and we do not sunset things well.

Rae Woods (21:05):
No, we do not. We do not.

Michelle Hereford (21:07):
So before you know it, you have a policy on top of a policy embedded in a policy, embedded in a policy, or an order set. Letting go of that and having a process of how to go back and reevaluate when change needs to occur is really what's important.

Rae Woods (21:25):
Before you even get to the order sets piece, how long did this take? This does not sound like an easy task.

Peter Pronovost (21:34):
No, it wasn't. So, the 60% amazingly was literally one-hour brainstorming that half was out on policy and the other half was on what technologies could we use to take work away. Then we went through prioritizing which ones waste the most time and then which ones are also the most feasible to change because as you said, I mean we selected ones that weren't going to be controversial. So, you may have seen those grids where you plot things on impact and effort.

Rae Woods (22:05):
Yes, classic Advisory Board move.

Peter Pronovost (22:07):
Yes. So, we focused on that biggest time wasters and that there was going to be little controversy. Most of those were, as Michelle said, around either frequency or elements of documentation. Okay, sure, we can get around that. Then once we prioritize those, that's when we started pulling together Michelle's educator who produced a lot of the policy, our nurse who runs policy, the nurse who runs our magnet program, and then whoever produced that policy in the first place.

(22:44):
Sometimes it was one of those people, other times it was different to then make sure people were comfortable about changing it and then took it to a policy group to get it revised. So, that was probably... Michelle, what do you think? ... maybe three months to get that done. So, still relatively short, but a pretty intense and structured piece of work where we followed it through.

Rae Woods (23:06):
Now, you're in the midst of the next phase, which is actually changing it in the order sets.

Peter Pronovost (23:11):
That's exactly right.

Rae Woods (23:12):
Tell us about how this process works, the work that's gone into it, and I'm assuming you've had to partner with some other folks for this part of the process.

Peter Pronovost (23:22):
One of our nurse leaders is an IT leader, so she helped now lead that next phase to say, "Okay, how are we going to do this?" We got with our IT leadership to put a process of screening these order sets. Our current EMR doesn't make it easy, Rae, because it's really hard to screen for an individual order. We could search order sets, but not necessarily individual orders. I know there's some technology out there that allows you to do that, so we're literally going through that process of going through, as I mentioned, it's a little under 2,000 order sets to make sure that we take these policies that are wasteful of staff time out.

Rae Woods (25:08):
We've been talking thus far about eliminating non-value adding work. The other side of the coin is delegating and saying who or what else could do this work. Peter, you just mentioned in that initial brainstorm there was excitement around the role of technology. What kinds of work can technology do to take work off of the nurse's plate, especially at the bedside?

Peter Pronovost (25:35):
Yeah, Rae, this I think is one of the underinvested and under focused areas in addition to the... I think every hospital should do this policy exercise we did. I mean, where else could you get 60% of a nursing time or think about expand your nursing workforce by 60% and you're the culprit? Yeah, but the technologies, I think there's a couple. One is nurses hunting for supplies. They spend 24% of their time pretty much at every hospital, and there's technologies to solve that. Another is documentation. We put so much focus on physician documentation and getting scribes or technology, but nurses and even nurses aide or PCNA spend a ton of time documenting. That should just be a huge focus for technology. Any vital signs or labs should be automatically documented. I mean that's just a waste.

(26:28):
There's technology that can do that, but then even the clinical documentation could be automated. Another one, Rae, that we've experimented with is nurses double checking medicines. I mean, it's not very accurate and it takes a ton of time and there's prototypes out there that you could just have a computer confirm that the dose of heparin change is right or the narcotic dose is accurate, that it doesn't need to be manual. So, I think there's a ton of work that with some focus could be automated.

Rae Woods (27:00):
Michelle, how did the nurses react to this particular idea to having technology come in and take on some of these tasks?

Michelle Hereford (27:08):
What we actually titled and incorporating supported technology-

Rae Woods (27:13):
I like that.

Michelle Hereford (27:15):
... it's really to support the care team.

Rae Woods (27:16):
That's right.

Michelle Hereford (27:18):
Peter don't knows, we all talk a lot about language and it's important that I would say the world understands that this isn't all removing the work from the nurse. It's supporting that entire care team, so that there are items that no longer are actually to be carried out perhaps by the nurse. But at the same time, there are other things that are created that may be carried out by other nurses. So, I'll give you a perfect example. We piloted virtual admission nurse and a virtual discharge nurse. That's work that still needs to occur.

(27:57):
However, rather than it being a direct one-on-one interaction with the assigned nurse of the day, we elected to see as if we could virtually work with nurses from a remote environment who could spend that 30 to 45 minutes doing an admission, overview and assessment, providing discharge instructions, all of which supports the care team, supports the assigned nurse. I think that's an important aspect of this.

Rae Woods (28:34):
They're doing this from home.

Michelle Hereford (28:35):
They can do it from home. They may be assigned to a centralized location. It's a perfect opportunity perhaps for a nurse who is in a different time in her career, someone who may be retired, maybe a working mom or stay-at-home mom. So, great opportunities and that's what we do. We create opportunities, open the door and walk.

Rae Woods (29:01):
I wonder if you've gotten this pushback though, because when I often talk about particularly technology that is making work more efficient, taking work off folks plates so that they can be more efficient, the pushback that I tend to hear from caregivers and providers themselves is, "Oh, that's because you just want more work out of me. Yeah, you're going to take all this stuff off my plate, but it's because you want me to hit the gas and see more patients and do more and get more out of me." Is that a concern that you've heard or how have you addressed that?

Michelle Hereford (29:33):
Believe it or not, Rae, you will think that maybe UH is just a different beast or animal. It's not resonating in that bashing.

Rae Woods (29:42):
Admittedly, I tend to hear this more from physicians than any other member of the care team.

Peter Pronovost (29:47):
Rae, as Michelle said, we're not getting the pushback. What I think is legitimate is in the past, there's been tons of technologies that promise to take work away from the nurse and they've all added to the burden.

Rae Woods (30:02):
Yes, I've been down this road before and it was not helpful.

Peter Pronovost (30:06):
Glucose checks or whatever. You know what I mean? Oh, some administrator says, "I'm going to get your productivity up." They weren't tested with the nurses. It has horrible usability and it almost always adds to the work. So, I think the difference in this approach was the nurses prioritize these work areas. They said this is a problem. As we look for technologies, they will be the ones leading it. I mean, it's not going to be handing out a glucometer and saying, "Oh, look, I've just solved all your problems," and the nurse scratched their head saying, "No, this is terrible."

Rae Woods (30:38):
My favorite part about this story is that you did not default to bringing in more people. I still think that's how most of our leaders are thinking. We just need to delegate off of the nurse's plate, who is the next human being that we can bring in to do this, which we know is extraordinarily difficult in the workforce crisis that we're facing, because whether it's a medical assistant or a CNA or whoever it is, we're seeing those people leave healthcare entirely because they can make more money, have an easier job, and get a manager track at Starbucks or Chipotle or Panera or whatever it might be. I love that in your examples, we have not actually talked about in this conversation delegating to other people. We've talked about eliminating tasks and using technology.

Michelle Hereford (31:28):
That's correct. Not so much delegating but sharing tasks.

Rae Woods (31:31):
Yes. Thinking about the whole care team in a holistic way as opposed to just pushing things downhill, downhill, which is whoever is at the end of that road is going to suffer. For a long time, that person was the nurse, but it's going to be someone, which is why I like this approach so much. I wonder if you can speak directly to our listeners for a moment. They're thinking about this idea. Maybe they're inspired by your story. What lessons have you learned from your partnership that you want to tell others to convince them to come together like you have and address the workforce crisis as a shared problem, not merely a nursing problem?

Peter Pronovost (32:11):
This is both a humbling and hopeful story. The humbling part is what we live every day with burnout and unsafe things. The hopeful part is think about how much better we're going to be if you can take even of that 60% out. I mean, that's breathtaking, right? If you can free up that amount of time to do work and the nurses sense joy in this, my sense is if we do the technology pieces that we mentioned, it's easily 50% of staff's time that could be freed up to better care for people or get more balanced workloads.

(32:49):
So, what I would say is go start talking to your nurses or get an executive team to say, "What are your own policies that are burdensome and the burden exceeds the benefits? What technologies might you do to really truly take away work and then make sure that you actually implement them?"

Michelle Hereford (33:08):
Peter and I again share the same philosophy around many things. Healthcare is a team sport. Care delivery is a team sport. It's not one discipline's problem in isolation. Having the recognition of that is really important, but hearing it is one thing. How we go out and demonstrate it is something else. So, Peter and Michelle walk together, talk together, round together. That's important.

(33:42):
I think the other thing that's important for us to take some time to also talk about, because I know we've talked about technology and I'll call it alleviating some of the burdens, but I don't think we should leave the conversation without understanding technology and removing items from the list, if you will, do not substitute for the true healing power that we have as individuals. It's genuine caring, respectful discussions, and we can't underestimate that. Technology is supportive and it's helpful, but technology will not address that trivial power that we all have.

Peter Pronovost (34:31):
Michelle, just building upon that, you'll see how we're kindred spirits. A lot of our transformation work, what we say the purpose of it is, and it's a beautiful concept, is to leverage the power of love within and between people to radically transform health and healthcare. Once you tap that powerful force, I mean it is the most powerful force in the world.

Rae Woods (34:55):
Well, on that note, before we close this episode, what other things do you want to see our listeners do to support and frankly to celebrate nurses?

Michelle Hereford (35:07):
There's a tremendous amount of work ahead of us. What Peter and I are talking about is it's just a little chip off this overall iceberg. One of the things that we recognize as an organization is first, it is important to listen to the people who are closest to patient care. Peter elaborated on that. Then we decided that as we listened to people, we needed to bring the people together so that you form that team and the team problem solves together. We created an opportunity for those teams to be creative and think about what needs to happen moving forward. So, it's almost like you have a whiteboard of blank sheet of paper and the dream comes to reality.

Rae Woods (36:00):
Then think about all the other things, other challenges that you can apply that framework to. I love that.

Peter Pronovost (36:06):
There's some proof points that what we're doing is really working. I mean, the University Hospitals last year won the American Hospital Association's Quest for Quality Award, not for any one measure, but for our leadership approach to getting to zero harm. Despite these ratios and harm going up in the country and no doubt we have our flaws, but our harms almost all led by nurses have gone down dramatically. We've in the spite of these crises implemented a mobility program led by nurses going through the roof, a med safety program, Zero Harm. The way we approach these is this model of transformation. I mentioned the purpose about drawing the power of love is what we call believe, belong, build.

(36:58):
Look at the beliefs that we can get to zero harm. Then the belief of our leaders, as Michelle said, is to honor the wisdom of the frontline people. In other words, your job is to unleash and inspire, not to command and control. Belong is building structures where we can have the free flow of ideas. So, we're a three-hospital system. For all of these harm things, nurses are leading system-wide efforts that some of our critical access hospitals are giving tips to our main academic hospital. There's just this profound respect.

(37:32):
Michelle's job and my job is to create the culture that honors those wisdom, but then just let the team share ideas and then building our management systems when we found those practices that work, we deploy them at scale. So, it's a pretty magical formula once you tap into it.

Rae Woods (37:49):
Well, I'm certainly inspired by this and I know others will be as well. So, thank you for coming on Radio Advisory and thank you for all that you do for nurses and for the healthcare profession.

Michelle Hereford (37:59):
Thank you.

Peter Pronovost (38:01):
Thanks for having us, Rae.

Rae Woods (38:07):
This conversation underscores just how important it is for leaders to work together to make progress on some of our most common and complex challenges, but I want to make sure you're not just focusing on supporting nurses this week or this month. If we are going to get ahead of this problem, we've got to start addressing the root cause issues that are impacting the workforce. That means we need to reduce the administrative burden of medicine and frankly, we need to make the work better. Remember, as always, we are here to help.

(38:50):
As you celebrate the nurses in your life during National Nurses' Month, check out our clinical workforce playlist to learn more about how you can support them year round. You can find that link in our show notes. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review.

(39:10):
Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Katy Anderson, Kristin Meyers, and Atticus Raasch. The episode was edited by Dan Tayag with technical support by Chris Phelps and Joe Shrum. Additional support was provided by Carol Boston, Carson Sisk, and Leanne Elston. Thanks for listening.