The Healthcare Leadership Experience

As healthcare continues to move through a challenging transition, Ronnie Kinsey explains to Jim Cagliostro how he works with healthcare leaders to surpass their greatest goals and resolve leadership gaps. Episode Introduction Ronnie highlights the importance of exposing clinicians to the business side of healthcare, how ‘’one to one to one up’’ leadership can lead to multiple gaps of ‘’abyss potential’’, and why people must prioritize behavior and check things at the door. He also explains why all leaders should consider an outside resource for support, why coaching is not therapy, and how attitude is key to successfully nurturing leaders. Show Topics Healthcare has to incorporate the business side The challenge of one to one to one up leadership Promotion can result in leadership gaps Behavioral procedures take priority in healthcare The impact of culture in filling gaps Developing leaders comes down to personality and attitude Frontline employees can resolve hospital painpoints 04:19 Healthcare has to incorporate the business side Ronnie said that clinicians must be prepared for the business side of healthcare at an earlier stage. ‘’There are so many people who got into healthcare with the idea of delivering care. They wanted care. But then you and I have had conversations. You're doing the business side of healthcare now as well. There is the whole business side of healthcare, which cannot be ignored. I think that clinicians schools could probably potentially do a better job of preparing clinicians for the business side of healthcare. Because …..if the bills aren't paid and if there's not access to plan for growing for the future, we've got a problem. So that's got to be there, but I think that it has to be really ingrained into the clinician earlier on. That would be one of my big asks for the new educational shift is that clinicians just be much more attuned to the business side of healthcare. Definitely don't lose the caring side, but be aware of the business side.’’ 07:30 The challenge of one to one to one up leadership Ronnie explained gaps happen when people leave as most hospitals only have one leader on the frontlines. ‘’You on average have one leader per category of management. So the front lines, whatever, until you get up to the C-suite and it's divided other ways. So say you have one leader that you report to, then that's at one level and that leader reports up to another leader at another level. So it's generally a one to one to one up. Well, what if that chain breaks and one of those ones goes out? There's a break. There's no extra time to fill in for that missing person per se. And again, remember we just said it takes about four months to replace them. Well, how to bring the next person up to speed, how to even try to get them close to knowing the personalities that play on that particular whatever we want to call it, the ward, the unit, the floor, the department, service line, you can name that. So look already where the gap comes in. So then from the front line, some people are wondering, "Well, who do I go to?" Okay. We can give them names, we can give them a title and that's fine. That person doesn't have extra time for you. They already have their financial responsibilities because they're in leadership…. So now are they short of resource? Where do they go? There tends to not be just so many extra hands sitting around waiting to help out because systems are really under constraints overall, especially after COVID, right? We're under a whole new redefinition of the healthcare system. It's been coming, I'll say it's for sure been coming since EHR. Well, it became no exception after COVID. … I can make that example at every level, all the way up.’’ 10:12 Promotion can lead to healthcare leadership gaps Ronnie explained why promotion can result in a cycle of resentment and resistance if clinicians aren’t prepared. ‘’And again, leaders aren't necessarily born, but leaders...

Healthcare marketing has seen a shift from ‘’patient’’ to ‘’consumer’’ in recent years. Doug Pohl explains to Jim Cagliostro how a focus on heart and emotions can help to reconnect hospitals with their patients. Episode Introduction Doug explains why hospitals need to prioritize ‘’humanity’’ over the bottom line, how to become a two-way mirror to build patient relationships, and why Business 101 is all about listening. He also shares how his experience as a singer/songwriter helped him to understand the power of storytelling, and why true leadership is about helping people climb the ladder. Show Topics Hospitals need to focus on humanity in marketing Losing the community connection Healthcare marketing is a two-way mirror Business 101: It’s about listening Tapping into the power of storytelling Leadership is about helping people climb the ladder 06:54 Hospitals need to focus on humanity in marketing Doug explained why the shift to ‘’consumers’’ from ‘’patients’’ creates a deeper problem. ‘’I feel like a lot of them are doing a decent job, in that there's been this shift to people, you can't necessarily even call them patients yet, but to view them as consumers. So, they market to us as consumers. And I get that, and I think it's effective in some ways, but my personal view is if we're treating people as healthcare consumers, there's a deeper problem that we're not addressing. And I think to ignore that is a long-term mistake. So, I think it's really important that we focus on people's humanity and do it in some powerful ways. You and I talked previously, there's some commercials out there that tap into the emotions of what people are feeling when they go into a hospital, whether as a patient or a loved one or whatever the situation is, a clinician, whoever. Everyone has these strong emotions that come with them into a healthcare facility. And understanding those, having genuine empathy, feels like a weak word these days because we use it so often. But genuine concern for those feelings and for those people and wanting to help in real ways, even if it means less efficient business or a lower bottom line, but focusing on the heart and the emotions, I think is really the best path forward for marketing. And in my opinion, for operations in general.’’ 09:13 Losing the community connection Doug said the acquisition of a smaller hospital by a larger system pushes patients aside. ‘’ I think it sort of starts in-house with a disconnect with the clinicians and administrators and everybody who works in that system at that regional hospital, where they feel less of a connection with their organization, they feel like things are being imposed on them by the mothership, and all of a sudden everything's changed. They feel a disconnect. They feel pushed aside. They feel like they're not as important as they should be, and perhaps as they used to be. And I think there's a trickle-down that comes from that. They pass on those feelings to the community, whether in the hospital or outside in their personal lives. It does change how people feel subconsciously, at least. I live in a small community, and we do have a small regional hospital that's connected to a larger one, but we're friends with the nurses and the doctors. We see them out in town and at the gym, and we talk to them, we hear their struggles, and we hear how tough it is for them. And so, these feelings are being shared in the community, and it does impact you as a patient that when it's your turn, you go and you know what people are going through, and there's this sort of inherent disdain for the organization as a whole because of it.’’ 12:36 Healthcare marketing is a two-way mirror Doug explained why every brand needs to reflect the audience back to themselves. ‘’In marketing, our job as a brand, any brand is to be a mirror, but it's sort of a two-way mirror. So, we want to reflect the audience back to themselves. The things that bother them, their...

Lauren Pasquale Bartlett is the first Chief Marketing Officer at Ingenovis Health, healthcare workforce solutions providers. Here, she shares how hospitals can benefit from a clear purpose, and how to achieve it. Episode Introduction Lauren discusses how purpose is every organization’s North Star, how it creates passion and reveals the survey that shows people prioritize purpose over profit She also shares Ingenovis’ ACT (Advocacy, Careers, Tools) program, discusses the rationale behind ‘’building a home for healthcare talent,’’ explains why support from the C-Suite is vital to achieve purpose, and outlines how leading by example can impact an entire organization. Show Topics The purpose of Ingenovis Health Highlighting the human element of healthcare Bringing your purpose and mission statement together The common challenges of achieving buy-in How to bring purpose to life Leading by example and leaning into purpose 01:54 The purpose of Ingenovis Health Lauren explained how Ingenovis Health became one of the largest healthcare staffing companies. ‘’… I'll start with Ingenovis Health because it's kind of new to the market. Ingenovis Health was founded in early 2021 with the merger of four leading healthcare talent providers, and at the time, that was Fastaff and U.S. Nursing, Trustaff Travel Nursing and CardioSolution. So those four companies came together in the early of 2021, and we've since acquired three more. So now Ingenovis Health is one of the largest healthcare staffing companies in the industry. We're about a $2 billion company placing around 10,000 doctors, nurses and allied professionals in positions nationwide. They're mostly travel positions, Jim, temporary positions, some permanent, but really, really large reach in who we place in our clients nationwide. As Chief Marketing Officer, I'm responsible for the marketing, the brand, the communications, and as the first chief marketing officer of Ingenovis Health, I also had the unique opportunity to contribute to the development of the purpose and the mission for the new organization.‘’ 04:04 Highlighting the human element of healthcare Lauren said we need to be aware of the impact of ongoing trauma on frontline employees, especially after the pandemic. ‘’…we have to just keep the human element at the core of it. And you know better than anybody, when you think about how much the nurses are dealing with from long shifts to understaffed units, lack of PPE during COVID, I think you could easily disassociate yourself from the idea that those are real people with their own lives and families, and they're dedicating so much of their energy and their attention to their patients. So it really is a very human industry, and you have to, again, keep them at the core of it. One of the things about our nurses, our doctors, our allies, is that they're just experiencing stuff that other people don't experience in their jobs. So they're seeing a lot of death, particularly during COVID. They're experiencing traumatic events along the way, and oftentimes they're called to come back in on days off, even though they haven't really had a sufficient break just because there's not enough help. So you really have to keep thinking of them as you define purpose in anything that impacts the healthcare industry.’’ 10:34: Bringing your purpose and mission statement together Lauren illustrated how Ingenovis Health linked their purpose and mission statement in a post-Covid context. ‘’The mission statement for Ingenovis Health is that we create ecosystems where healthcare talent can grow, thrive, and deliver the best patient care. And so as I was mentioning before, another thing that was coming out of COVID was you'd find a nurse or a doctor who had just done 18 months of COVID assignments back-to-back and really needed a break. And so through the merger of our seven different companies, we provide those opportunities that they can choose based on where they are in...

Growing numbers of nurses are struggling with the demands of their profession. Jenny Finnell explains the benefits of mentorship and the expanding mission of Nurses Teach Nurses to Jim Cagliostro. Episode Introduction Jenny shares her foundational belief in ‘’paying it forward’’, how everyone has a role to play in mentorship, why nurses need a safe zone, and the impact of the pandemic on burnout. She also highlights the financial benefits for hospitals supporting mentorship, her global vision for Nurses Teach Nurses, and why a 45% rise in demand for advanced practice nurses reinforces the urgent need for support. Show Topics Journey to CEO and Founder of Nurses Teach Nurses The reality of a career in nursing Providing a safe zone for struggling nurses Learning to cope with suffering and death How the pandemic contributed to burnout Encouraging nurses into mentorship The benefits of mentorship for hospitals 02:35 Journey to CEO and founder of CRNA School Prep Academy and Nurses Teach Nurses, Jenny explained how Nurses Teach Nurses grew out of community. ‘’I've been an anesthesia provider now for nine years. Prior to that, I was a medical ICU nurse for three years. I've been in the realm of nursing for 14 years in total. Back in 2018, I actually got on social media for the first time since prior to grad school and I called myself Jenny CRNA, and I started getting direct messages on, "Hey, I've been facing a lot of setbacks and failures. Can you help coach me on how to get into CNA school?" I started doing that and I handed out my cell phone was chit chatting with people, probably about 10 or 15 people when I actually decided, "Wow, this is getting to be a lot. Let's make a Facebook group so I can talk to everyone at once. I'm kind of a broken record sometimes, so that way I can say one thing and have everyone hear it." I had a network, I had a community. I knew program faculty, I knew a lot of CRNAs, a lot of CNA leaders. I really pooled on my community to really help these nurses. They were finding a lot of success and just overjoyed with the help they were receiving. Before I know it, that group grew to 6,000 people. I was finding myself spending a lot of time mentoring and coaching, and that's when I started CRNA School Prep Academy because I was kind of burning myself out, if I'm being honest. I was working 40 hours a week, had two little kids and spending 20 hours teaching for free. I'm like, "Wow, I really want to do this, but how can I monetize my time?" CRNA School Prep Academy was born and where Nurses Teach Nurses comes into play is I've been doing CRNA School Prep Academy and mentoring for three years now and we've mentored over 5,000 ICU nurses and went through the pandemic during all that time.’’ 08:13 The reality of a career in nursing Jenny said nurses are the only people who relate to the needs of other nurses. ‘’…I think what's hard is the reason why I like the concept of Nurses Teach Nurses is no one can really truly understand the footsteps of a nurse unless you have been there. It's like being at war and being in the trenches with someone else. You understand what it's like, and that's what nurses need. They need that relatability piece. They need their peers to fall back on for that support. I knew now was the time, because I don't want to see this happen to our profession. I want to see a big change happen in a big way. Sometimes I think I'm crazy for dreaming up all the things that I hope to accomplish. I think a lot of people are stepping up to the plate, but we have to try to tackle this big problem in our country. We're all going to be in big trouble. We rely on nurses for healthcare, and we need to help them flourish in this profession, not deter them and help them leave, which is all we've been doing. While this is not one thing fixes all, I do think providing support and mentorship and career opportunities, career advancement opportunities, connection with community,...

High levels of government funding means that the value of healthcare fraud runs into billions of dollars annually. Attorney Jonathan Tycko discusses his role in representing whistleblowers, with Jim Cagliostro. Episode Introduction Jonathan explains why the value of healthcare related cases under the False Claims Act ($1.8 billion recovered in 2022) represents only a fraction of the real total, why most people are reluctant to become whistleblowers, and shares the universal mistake all health systems make. He also urges hospitals to focus on mission over money and explains why compliance isn’t the enemy of healthcare. Show Topics Representing whistleblowers in qui tam lawsuits Understanding healthcare fraud Analyzing statistics in healthcare fraud Whistleblowers share key characteristics The risks of becoming a whistleblower Compliance should not be seen as a problem Hospitals must focus on mission, not money 02:46 Representing whistleblowers in qui tam lawsuits Jonathan explained his move into the healthcare niche, and the meaning of ‘’qui tam.’’ ‘’This particular practice that I'm in now where I represent whistleblowers for reasons we can get into as we go along here, tends to be very focused in the healthcare sector….about 15 years ago, I got a call from a person who was involved in one of these cases and he says, "I'm a relator in a qui tam lawsuit and I'm looking for a new lawyer to help me with an appeal." And I said, "I don't even know what those words mean." Even though I had been practicing law for about 15 years at that point I had never heard of these kinds of cases before. It is really a very niche practice, there are very few of them. But I took his case and through that really learned a little bit about the False Claims Act, which is the statute we operate under mostly. And just got really interested in it from that one case. And then slowly over time started to look for other opportunities to represent clients in that area. Did a little marketing and so forth and over time built up the practice. And now this is almost exclusively what I do as a lawyer, which is representing whistleblowers in what are called qui tam lawsuits, which is where a whistleblower is bringing a claim for some type of fraud, where the fraud is really committed on somebody else, usually the government or government programs. But it is brought by a private whistleblower that is specifically authorized by certain laws.’’ 06:03 Understanding healthcare fraud Jonathan said any type of fraud in healthcare is likely to fall within the False Claims Act due to the extent of government funding. ‘’Well, at a very high level of generality, it's just what it says. It's any type of fraud scheme that is impacting the healthcare system. What we're focused on a little bit more specifically is, like I said, there's this statute called the False Claims Act, which makes it illegal to basically commit fraud on the government or on programs that are funded with government dollars. And as you know, obviously a huge percentage of healthcare spending is funded through Medicare, Medicaid, Tricare, the VA system, and these are all programs that are covered by the False Claims Act. So any type of fraudulent conduct or unlawful conduct that is widespread and that impacts the healthcare industry is likely to cross paths with the False Claims Act because of all those government dollars that are used to fund our healthcare system. And so any sort of fraud... And I can run through a whole bunch of different categories and give you some sense of what the types of cases are, but pretty much any type of fraud that is ongoing in the healthcare industry is likely to also violate the False Claims Act. And so a whistleblower, somebody who has non-public information about that fraud, is a potential whistleblower under that statute.’’ 07:45 Analyzing statistics in healthcare fraud Jonathan said that the high levels of healthcare spend makes it...

US healthcare costs are the highest in the world, yet health outcomes lag behind other countries. Preston Alexander shares his mission to prioritize patient care and clinicians over profit with Jim Cagliostro. Episode Introduction Preston explains that the principal issue with US healthcare is its profit-driven approach, why healthcare must be a forward-thinking Netflix, rather than an obsolete Blockbuster, and why the nursing shortage is the result of a broken system. He also emphasizes how understanding the line item hospital costs can significantly benefit clinicians, and the importance of an empathetic mindset. Show Topics The current path of healthcare is unsustainable Turn the ship around or build a new one? Clinicians need to understand the business of healthcare The ability to analyze financial statements is an invaluable skill Hospitals benefit from having clinicians in leadership roles Preparing clinicians for leadership 06:08 The current path of healthcare is unsustainable Preston said the profit driven nature of healthcare is leading to higher costs and poorer outcomes. ‘’. .. I think the primary issue that I see is that, and you talk about systems level problems, is our healthcare system operates within a much broader context. The context being a system of capitalism. And it was created in a way, in more modern times, I suppose, if you want to look at it that way, to maximize profits. And all the systems we've designed have created a little bit of a bifurcated system whereby you have wealthy individuals who are covered by insurance and can afford all the out-of-pocket fees and charges they have to pay if they need healthcare. And then the rest of the population who's functionally uninsured or underinsured or doesn't have insurance at all, and then what they can access. So, if you wanted to just really take one big giant swath, like what's the problem in healthcare, is that it's fundamentally profit driven first, and healthcare fundamentally is a function that can't be delivered appropriately to everyone with profit being its primary driver and outcome. We see examples of it all over the place. You have insurers who are supposed to help you avoid catastrophic costs related to healthcare, who make... United Health Group, I think in 2022 profited $20 billion or something like that. So you're just talking about outrageous numbers. It made, I was just looking at their financials this morning actually, $340 billion in revenue. And it's like, what are we getting for it? More expensive treatments, more cost, worse outcomes, lower life expectancy, less access, more people left behind by financial design.’’ 09:51 Turn the ship around, or build a new one? Preston said the broken healthcare system is the cause of the nursing shortage, but change is possible. ‘’… I am still going to believe, and I'm probably wrong, but that we can turn the ship because systems are what drives everything.... It's what we see with all the nursing shortages right now. We don't really have a shortage of talent, but we have a brokenness of systems. Today, we're 300,000 nurses short. If I gave you 300,000 nurses tomorrow, we'd be short again within a year or two because the systems are broken. You can't just throw good people into a broken system. But people design systems, people can change systems. So with that sort of premise foundation, the ship could be turned. We could turn the Titanic, but it's going to take leadership, it's going to take people at the top, it's going to take bottoms-up approach. It's going to take a lot. It's not an easy thing to do, neither is building a new one. But that's the alternative. We can try our hardest and get our CEOs on board or the people in charge or mutiny so they have to listen to us or whatever the things are. Or you can say, we're going to just do something different, not to minimize it in any way, but we're going to make Blockbuster obsolete. We're going to be Netflix. We're...

Giving nurses a voice in healthcare is the mission of Rebecca Love, Chief Clinical Officer at IntelyCare & President of SONSIEL. Here she explains why to Jim Cagliostro, and how a hackathon changed her life. Episode Introduction In a powerful conversation, Rebecca discusses the impact of the Woodhull study, plummeting post-Covid retention rates in nursing, and how the perception of nursing as ‘’cost’’ is damaging to healthcare. She also reveals the imminent launch of the Commission for Reimbursement, why every hospital should run a hackathon, and how encouraging others raises the voices of the entire nursing profession. Show Topics How a hackathon changed Rebecca’s life Nurses as innovators: changing the perception The findings of the Woodhull study The real reason nurse retention levels are falling Gaining a voice during the pandemic Advice for the C-Suite: Run a hackathon Encouraging nurses into leadership 04:25 How a hackathon changed Rebecca’s life Rebecca described her experience of being a nurse in a room full of decision makers. ‘’… It was at a hospital in Boston. I'll never forget crossing into it being the nurse, not knowing anybody there. And everybody in Boston was there. All of the major tech startup CEOs, the CEO of the hospital, all the doctors, engineers, scientists, everybody was in this room, hundreds of people. And that's when I walked around and I realized there were no other nurses in that room, James. I was like, "Oh my God, I'm not supposed to be here as a nurse, this is where the decision-makers are." We feel this way constantly as nurses, we know everybody that makes all the decisions are in rooms that we're not in. But nobody asked me to leave that weekend, James, and I ended up joining a team, and that's when my whole life changed because we were sitting in these rooms where we were hashing out. I had a doctor and my team, I had an engineer and an occupational therapist. I had a scientist, were all in there. And in walked the CEO of the hospital and he literally sat down next to me and he said, "So, tell us what is your problem and what's your solution that you're fixing?" And this gentleman, our physician starts talking like, "Well, here's the problem and here's how we're going to solve it on the floor." And I'm squirming, right. Because I'm hearing this doctor explain a solution that's not going to work. So, I finally speak up and I say, "That's not how it's done on the hospital floor. If we do it that way, it's just going to create more work for the nurses." And they looked at each other and the CEO looks at me and goes, "Well, how did I not know that's not how it worked on the floor of the hospital?" And I said, "Well, did you ever ask a nurse?" And they started laughing. So then, I started laughing because I didn't really know what was funny. And then, I realized they thought it was funny to have ever thought about asking a nurse how they should solve these problems.’’ 07:22 Nurses as innovators: changing the perception Rebecca explained how SONSIEL (Society of Nurse Scientists, Innovators, Entrepreneurs and Leaders) evolved out of her first nurse hackathon. ‘’And that's when I hypothesized, oh my God, if we had nurse hackathons, we could change the future of healthcare because nurses have the practical knowledge and experience that they are closest to the problem. That if they were given the opportunity a team to be heard and seen and built towards the solution, we could solve all of the insanity that we live every day as nurses that we could fix healthcare. So, I went on, and that was the story. We finally, after 200 phone calls connected with the dean at Northeastern, Nancy Hanrahan didn't hang up the phone on me and she said, "Next summer, Rebecca, I'm running a conference on innovation entrepreneurship. Why don't you run a hackathon?" …. And I said, "Sure, I've been through a hackathon. I'll run one for you." And just jumped in. And that event, that nurse hackathon...

Every year, nearly 800,000 people in the United States have a stroke. Listen in to a Stroke Coordinator on how his role helps to save lives, transform patient care, and reduce costs. Episode Introduction Monte explains why data abstraction is the biggest part of a stroke coordinator’s role, the importance of maintaining patient focus and why ‘’responsibility without authority’’ means teamwork and communication are vital. He also highlights his unique position in understanding the time sensitive nature of treating stroke patients, and how patient arrival time dropped by 100 minutes following a community awareness campaign. Show Topics Data abstraction is the biggest factor for a stroke coordinator Ensuring patient follow-up for better patient care Making a difference as a stroke coordinator The ads that transformed patient education Why teamwork and communication is a must The cost savings benefits of hiring a stroke coordinator Leadership is about helping others to succeed 07:47 Data abstraction is the biggest factor for a stroke coordinator Monte explained the ‘’life-changing’’ impact of data abstraction on his role and ability to improve patient care. ‘’The largest part of being a stroke coordinator is data abstraction. There is tons of data abstraction. It's incredibly time-consuming. There's information that I have to gather on every single patient that arrives with stroke-like symptoms. That is probably two to three times the amount of patients that actually become stroke patients. So it's a huge number of patients. So every code stroke in the hospital, which sometimes there's two, three, four a day, those are patients that I have to do data abstraction on. Then I also have to understand how the data determines opportunities for improvement, and that was something I was so completely unaware of as a regular nurse. I was just working in the hospital. Data seemed, it used to make me angry when someone would come at me with data because I'm like, "I don't care about your data. All I care about is the patient. So then I learned that data actually drives this change, and so I learned how data drives the change, and it's been really, really fascinating and very life-changing for me and being able to look at things and say, "Oh, here's where we can make improvements for these patients." 11:15 Ensuring patient follow-up for better patient care Monte said that arranging neurology appointments for all stroke and TIA patients was another key element of the stroke coordinator’s role. ‘’Right now we're providing neurology appointments for all of our stroke and TIA patients. So I spend a lot of time going back and forth with their office to create those appointments and tracking those. There's just tons of tracking of everything. …..that's something …. that we just started doing this last year. We just started doing the TIA patients first, and then we added all the stroke patients in. So that way they have follow up outside of the hospital once they go home. Because a lot of people went home and they didn't follow up with someone and we found that if we create their appointment for them before they leave or even shortly after they leave, then they're more likely to go to the appointment.’’ 12:44 Making a difference as a stroke coordinator Monte said the stroke coordinator is vital for stroke centers to receive certification and in ensuring rapid treatment of patients. ‘’Well, number one, the easiest one to tell you is to be a designated stroke receiving center by the county. We have to be a stroke certified hospital, so we can't lose that certification. So in other words, in order to be that receiving center, what a designated receiving center is? Well, when someone picks up the phone and calls 911 and the patient has stroke-like symptoms, they immediately go to our hospital if it's the closest hospital to them because we are the stroke center. Now in Monterey, two of them, and one is on the west side of...

Viz.ai is a tech company on a mission to fundamentally improve how healthcare is delivered through AI. Senior Director of Global Clinical Affairs, Moleen Madziva shares strategy and insights with Jim Cagliostro. Episode Introduction As AI continues to reshape healthcare, Moleen explains how Viz’s cloud based system drives efficiencies in patient care, and reveals the unique mobile app with a critical impact on surgeon decision making. She also explains why hospitals must allow the data to lead, how Viz.ai systems work in parallel with clinical workflow and why ‘’kindness wins’ permeates the company’s approach to building relationships. Show Topics How our lived experiences shape healthcare leadershipDetecting disease on a medical image with AI Enhancing patient care with a mobile app Allowing the data to leadThe importance of human connectionInspiring change with personal integrity Getting everyone on the same page 05:04 How our lived experiences shape healthcare leadership Moleen recalled how her community upbringing taught her the real meaning of wealth and empowered her for her role at Viz.ai. ‘’I was born and raised in Zimbabwe in Southern Africa, so shout out to all my fellow Zimbabweans out there. We are really flying the Zimbabwe flag high. I'm based out here in the US and currently living in Southern California. I was raised in a small village called Macheke and I really lived under communitarian community that really honored what it meant to have each other's back. It wasn't until much later as I was growing up that I realized how wealthy and how rich I was because my upbringing was really filled with so much love and care and really nourishing me with culture that has really been shaping generations for so many centuries, but in such a way that even now as someone in technology and clinical research, I realize that all of those lessons have really empowered me for the type of leader that I am, but also for how I visualize doing ethical clinical science.’’ 07:56 Detecting disease on a medical image with AI Moleen explained how Viz.ai’s cloud based system drives care efficiencies. ‘’So our mission at Viz is to bring lifesaving treatments to patients. …So think of it this way, when a patient comes into the ER for example, they get a medical image like a CT scan. That image actually is shipped to the Viz system that sits in the cloud, and from there it is processed and almost pretty much in real time the care coordination team, the physicians and everyone else in that system is able to get the notification for them to be able to start deciding what to do for the patient. One of the things that we're talking about when we say we drive efficiency in care is that we are bringing all the key stakeholders for that care coordination in one place, in a HIPAA-compliant platform where everyone can communicate and be able to really drive efficiency in how patients are cared for. So that's one piece.’’ 10:18 Enhancing patient care with a mobile app Moleen explained how the Viz app enables surgeons to make critical decisions from anywhere in the world. ‘’So we have a mobile app also it's available through the web where the rest of the team that's actually put onto to the Viz system are able to see within their clinical hospital system what they need to be doing for the patients that they get the notifications for. So in many ways it's really more about bringing key stakeholders into one place so that they can actually be able to efficiently make decisions. Think of it this way, let's just say that a very key surgeon is not on campus at the time and they're away somewhere, but a critical case that is come through. Instead of waiting for the surgeon to drive all the way back to the hospital and make some decisions, after looking at a case on a computer on campus, they can actually make that decision from wherever they are in the world, 24/7 by actually being able to access the Viz app on their...

Changing times require a change in mindset. Episode Introduction The pandemic forced health systems to explore new ways of delivering care and education. Rhone shares the benefits of LinkedIn as a mindset platform, the skills unique to Nursing Practitioners and how students in search of preceptorships can benefit by taking the ‘’cookie basket to the clinic’’. He also explains why telepsychiatry provides patients a safe space and extols the power of servant leadership. Show Topics Changing your mindset: LinkedIn as a daily platform Overcoming the stigma of online learning for Nurse Practitioners Responding to the preceptorships crisis The benefits of hiring Nurse Practitioners Telehealth is a mindset shift Leadership lessons – getting in front of the problem 12:31 Changing your mindset: LinkedIn as a daily platform Rhone described how LinkedIn provides a platform to highlight the benefits of changing your mindset. ‘’….. it kind of reflects probably what my true passion really is and it's teaching, it's coaching, it's advising, it's helping others, all high performing professionals, but especially nurses, nurse practitioners, to really find their true profession and their true passion and where they want to go in their profession. So basically in LinkedIn, I just started writing, it's my daily writing platform, and I got to the point where I just want to write about what I'm just obsessed about, and I'm obsessed about nurses leveraging our skills and ability and our knowledge to become creators in this digital era because we have this whole new world to us and there's so much burnout and stress and pain among healthcare professionals. And I'm not trying to pull anybody away from the bedside, I honor the bedside, it's a necessary position. I honor those that are doing it, but I just want to make sure that I am illustrating to my audience options. And, the main start is you have to change your mindset, that's where it all begins. All the technology, all the toys, all the tricks are not going to do you a bit of good until you really change that mindset and say, "Hey, not only can I do this, but I have so many resources as a nurse or any healthcare professional, that there's a whole world out there that would love to take advantage of that knowledge, and I have this tunnel vision that all I can do is bedside, administration, education." So, that's really all about. So I post on LinkedIn, I post pretty much every day. I invite anybody that wants to follow along, please do. I talk about mindset. I talk about very tactical tricks and tips on how to promote yourself online, how to find your niche, how to build an online business, those sorts of subjects.’’ 15:55 Overcoming the stigma of online learning for Nursing Practitioners Rhone said that the pandemic ‘’normalized’’ online learning and the didactic portion is delivered online. ‘’But in terms of delivering our didactics online, communicating online, using Zoom, using online learning management systems, we were ready to go at the graduate nursing program and we were ready to really bring that skillset, and we were kind of the bullied kid in the corner that got to say, "Hey, now you need us. Now you need online education." And so what I would say mainly, especially to employers, to hospital systems, there's always been sort of a stigma about online. And, we've had to defend that and a little bit less now because of COVID, honestly, because so many people did it and it got normalized, but I will say don't necessarily be frightened off by that online if you see that related to a graduate school. Like all education programs, there can be some variance in quality. We have accreditation programs that really work to make sure that that variance in quality is very narrow. We always work to have high quality graduates. And then within all the schools I've ever worked, there is strong quality improvement mindsets involved there. So, your one big trend though is...

Learn about HeartFlow, the technology revolutionizing precision heart care. Episode Introduction Heart disease is the leading cause of death in the US. HeartFlow’s non-invasive, cutting edge technology aims to improve the patient experience and make cardiovascular care easier for physicians. Topics include, the barriers to obtaining an accurate diagnosis of coronary artery disease (CAD), condensing the patient experience into a single CAT scan, the data supporting the new technology, and why 80% of the top 50 heart hospitals in the US use HeartFlow. Show Topics The challenge of diagnosing CAD 12:00 The challenge of diagnosing CAD Lauren highlighted the difficulty in getting an accurate diagnosis for the causes of chest pain with existing processes. ‘’….heart disease is the number one killer of all Americans. One in every four deaths is going to be related to heart disease. And when someone has stable chest pain, so I'm not talking about MI, the big MIs, those are going to go right to the cath lab or surgery, but when someone has stable chest pain, historically this would trigger a clinician to order a stress test, whether that be exercise, an echo, there's different nuclear scans, all of which have their right place within the medical field and can be very useful. However, specifically for coronary artery disease, these tests show areas of decreased blood flow in a particular area of the heart, or raw motion abnormalities. But it's not clearly answering the question at hand, which is, "Do I have coronary artery disease that is causing my chest pain? Where? Which artery? Is it several? Is it just one? At what spot?" When you want to ask these specific questions, those tests really don't answer those questions. And in fact, 20 to 30% of the time when you go for these tests, they are inconclusive or can give a false reading. So that's pretty concerning. That was surprising to me, personally.’’ 13:30 Invasive treatments impact the patient experience Lauren said that over half of patients undergo diagnostic cardiac catheterization unnecessarily. ‘’Imagine you have this chest pain and they say, "Oh, we don't know what it is," or, "Looks great." Then something bad happens or looks bad and you end up with further testing that ends up being nothing. So usually it starts with some type of non-invasive test. If the chest pain continues, then the patient would typically be sent for an invasive cardiac catheterization. We're using needles catheters, it's usually in the groin or the arm, dye and radiation are administered. You shoot that dye and you can visualize the coronary arteries on a 2D image that looks like an x-ray in the cath lab. And that's often the gold standard of historically ruling out, that true coronary artery disease, yes or no. Another surprising thing I found when I came to HeartFlow, 60% of the time when patients go for this invasive test, the coronaries are found to not be obstructed. More than half. More than half of the people going to get a diagnostic cardiac catheterization, either they find nothing or they find something that can't be intervened. So you have a ton of patients in a healthcare system getting tests that may not be helpful in their diagnosis for creating a treatment plan. And this causes a real strain on the patient experience, so they're getting bopped around from test to test, not quite getting their answers yet. Staffing, huge issue right now. Costs to the healthcare system, accuracy of the diagnosis, like you mentioned with your family member, and ultimately the outcomes. There is a problem that we are definitely trying to solve here.’’ 16:30 Condensing the patient journey into one CAT scan Lauren explained the proposed new testing pathway with HeartFlow and the benefits to the patient experience. ‘’HeartFlow, it takes the coronary CT angiogram, so a CAT scan of coronary arteries, which is then analyzed by our proprietary software to provide non-invasive CT...

Discover six ‘’better than best’’ practices in cost savings for hospitals. Episode Introduction Adopting new habits can reap significant cost savings rewards. Lisa introduces six proven best practices including, creating an Accelerating Cost Savings team, why hospitals should follow the cost savings ‘’yellow brick road’’, and why frontline employees are your best source of innovation. Lisa also cites Tom Cruise as an illustration of how hospitals can benefit from cost reduction experts and reveals why reducing waste and understanding variation is the new area to uncover cost savings. Show Topics Creating an Accelerating Cost Savings team 01:54 Creating an Accelerating Cost Savings team Lisa said the creation of a leadership team for cost savings must include key department leaders, not just the CFO and their team. ‘’One of the best practices from the field that I have been involved with over the number of years, but particularly in the last two years that's been particularly successful during this challenging time, is creating a leadership approach to cost savings….. I've taken some wording from different hospitals that have used a version of this. We kind of created our own now, but it's called Accelerating Cost Savings team. So having an accelerating cost savings team and this team just can't be the CFO. The CFO does absolutely need to be involved but this needs to be a leadership team that consists of a CNO, the CFO, the Chief Medical Officer, VP of Supply Chain, VP of Performance Improvement, and key department leaders that come in and out of the group as needed. And this doesn't have to be an overbearing, "Oh, it's another meeting." This is a weekly meeting. It's usually kind of in conjunction with an outside partner. We've done this work and it's been really effective and I think from the feedback we get from hospitals and why these teams have been so successful in pulling together these cost savings initiatives and achieving tremendous outcomes is having a trusted partner as part of the team. And I'm soon going to be finishing up on lessons learned from one of these teams and we've had the opportunity to interview everybody on the team and get their feedback. We asked them 10 questions and we've pulled it all together and it's going to be really interesting research, but I do feel like having this team, even if they can meet, be a conference call, even if it's 45 minutes a week, I will tell you that it's transformative.’’ 07:49 The vital role of a cost savings roadmap Lisa cited Keith Cunningham’s philosophy of following the ‘’yellow brick road’’ to cost savings to achieve your goal. ‘’Number two is to have a detailed cost saving strategy, a roadmap. We work on these cost saving strategies and roadmaps for our clients and they take a totally different approach or a totally different and totally different outcome versus those hospitals that just say, "Okay, our strategy for this year is we need to take out $40 million and that's our goal and we're going to take out $40 million. Go do it. Go find it." And it's departments it's kind of divvied up. And that's a really hard way, I think to go about it. These goals are just getting bigger and bigger. So better than best practices. Have a strategy, sit down, spend the two or three days, bring somebody in that can lead the initiative and kind of pull it all together.Have a roadmap, this playbook that now you know, what's going to happen in January? What's going to happen in February? Where are we going to look for savings and which departments? It's not a broad takeout 5%. These are the areas we're really going to focus on and this is how we're going to do it. And this is...really going to focus on. And this is how we're going to do it and this is who's going to do it. I'm going to cite Keith Cunningham again. I just recently went to one of his training programs, it's called Plan or Get Slaughtered. It's amazing. I highly recommend that to those...

The top healthcare cost savings strategies for 2023. Episode Introduction As hospitals struggle with spiraling costs, Lisa Miller reveals seven key ways to save money in the next 12 months. Topics Include how ‘’flickering’’ helps to reflect on cost initiatives, the need for a Chief Expense Officer, the midterm contract reviews that helped to save one hospital over $19 million, and how data creates a 14% cost shift when presented to physicians. Show Topics Adopt a comprehensive approach to cost savings Hospitals need a Vice-President of Costs (or equivalent) Successful contract management requires a mid-term review strategyThe benefits of zero based budgeting Insource versus outsourcingRaising physician cost awarenessCreating a cost-conscious culture in hospitals O1:30 Adopt a comprehensive approach to cost savings Lisa challenged hospitals on how much insight they have into their cost savings projects. ‘’So what I mean by this is today, if you're a C-suite leader or you're a supply chain leader, if you wanted to know every single cost savings project that's going on in your organization, could you open up an Excel, some kind of dashboard, platform or something, and have line of sight into every single one? And my experience has said, when I've asked that question, that 100% have said, "No. We do not house every single initiative that's going on in the organization." And I think that bringing these initiatives all together so you get a complete picture with complete visibility, cohesiveness, understanding what's going on, and of course that terrible A-word which is accountability, bringing it all together, we'll have just another level of savings because you just have a complete view. And so I challenge anyone that's listening to the podcast today… I'm going to tell you that the effort to just house everything together is literally ... game changing for a lot of reasons. And I'll talk about those for a moment. But I want to give you one more nuanced thought…..Could you go back 12 months or go back in the last six months and say, "Okay, what are all the initiatives we worked on and what will be completed?.....my number one advice is to pull those projects together…. get a complete picture, invest in that time.’’ #2 Hospitals need a Vice President of Costs (or equivalent) 09:00 Lisa explained why every health system would benefit from a position that focuses on costs ‘’This vice president of costs or this person who just focuses on costs where they can have line of sight to everybody and they work with everybody. …. last month, just by accident, I came across somebody, and I'm hoping that I get that person on this podcast soon…they do have a title and I've researched it since then. And there's a few of these titles out there. The title is Chief Expense Officer. I've taken an excerpt from their LinkedIn page and it says, "Senior leader collaborating with the health systems' clinical and administrative leadership to identify opportunities to create value." There's also this really great line, and I think I'm going to say this super slow. I might repeat it. It says, "Leveraging experience in expense management and analytics to reduce waste and unwarranted variation and eliminate excess cost. Leveraging experience in expense management and analytics to reduce waste and unwarranted variation and eliminate excess cost." .. their job is a Chief Expense Officer. So I feel like that's an innovation for hospitals. Again, an innovation is a process. It's a way to think about their business, a new position, right? Innovative positions. And I think that Chief Expense Officer is an innovative position. And I had in years past said there really needs to be this Vice President of Cost or of Costing or Cost Structure. But you can have a VP of Expense, but this, another CEO, Chief Expense Officer, I think makes a whole lot of sense.’’ 12:00 Successful contract management requires a midterm review...

Lisa Miller shares her experience of successful hospital cost savings projects from the past 12 months and looks ahead to 2023. Episode Introduction Lisa Miller shares her experience of successful hospital cost savings projects from the past 12 months and looks ahead to 2023. Topics Include. the need to set big stretch goals, how dysfunctional teams affect change management projects, the in-depth cost analysis that saved jobs at one hospital, when people would ‘’rather be rich than right’’, and why the ‘’tsunami’’ of inflation is still healthcare’s #1 priority in cost management. Show Topics 01:33 Healthcare’s approach to marketing needs to change Lisa Larter said businesses and hospitals must focus on the things they can control, rather than media negativity. ‘’…one of my insights is the marketing landscape has changed significantly in 2022, and things that once worked no longer work. And so whether you're a hospital who has a marketing team or you're an entrepreneur or a small business owner, the way that you approach marketing needs to really change. You can't do what you used to do to get the results that you want, because what used to work isn't working. And there's an expression out there that if you just try harder at something that doesn't work, it doesn't make it work. So it's really a time for innovative thinking when it comes to marketing. The second thing that I would say that I've noticed in 2022 is too many people are listening to the media, and they're buying into doom and gloom instead of taking charge of what possibilities are out there. I think that people forget the media gets paid for clicks, and they get paid for impressions and eyeballs and all of that stuff. And so when people read headlines in the media about the recession and they start to panic and worry about things, instead of getting into a place of "How can I make changes? How can I improve my business, how can I improve my profitability? What is within my control?" I feel that they're missing opportunities. So I see a lot of people that are almost immobilized by what they see in the media, instead of taking control of the so many things that they still have control of. So those would be the two things that I've really noticed this year.’’ 08:33 Huge cost savings are still available for hospitals Lisa Miller shared a ‘’wow experience’ of how digging deep into cost saving prevented job losses at one hospital. ‘’I absolutely, unequivocally know there's opportunity in costs. And our clients are achieving unprecedented cost savings in almost every single area. And what I think is very interesting is we're finding big savings. And it's not because these initiatives weren't done prior or people aren't good at what they do, I just feel like we're going deeper. We're taking more time. There's a lot of AI and technology, and we have technology too, but nothing replaces human thinking, a human review, expertise. And we're finding just enormous amount to take out in cost. So I feel like that's an opportunity. It shouldn't be perceived as a downer. Like, "Oh, we've got to have a cost review." And I think really we need to flip the script on it. And I think there's opportunities to connect growth, connect employees and morale and have a culture around that. One of the things that happened last year, I had a number of these situations happen, but we had one, it was really unique. We had uncovered a couple of line items that happened to just fall off contract. We were just, and this is a very advanced health system, very smart people, and it was just this odd connection issue. And it just turned out to have a several hundred thousand dollars savings. And when we achieved it, we brought it to the department leader. The leader was about to have to lay off three people in their department. And these were just, I think it was an environmental service department. And because of that savings, he did not have to lay off anybody. …. it's a...

Explore the impact of the written word and what it means for healthcare. Episode Introduction In this episode, Lisa Miller, Managing Director at SpendMend, interviewed Brian Morgan to learn more about the principles and mission of Think Deeply, Write Clearly. Topics include the impact of language and communication on business credibility, why comprehension of the written word belongs only to the reader, how better communication could improve healthcare, and why innovation isn’t always exclusively about technology. Show Topics 06:24 Why we’re good at writing, but terrible at thinking for writing. Brian explained how the language and communication we use can create a business credibility or cultural problem. ‘'…..we can run through life where we have provable statements that are not useful statements. And we aren't very good at saying, "Well, wait. What is this problem in its entirety? What are all of the factors that go into that problem? What are all the factors that go into that decision? And then, how do we curate all of that information down to show not what we believe, but why we believe that to be true and a trustworthy decision for you?" And that would be the same in real estate as it would be in a hospital as it is for somebody working on their marketing or anything else. How do we create trustworthy conclusions, where people see the transparent assessment as opposed to hide the transparent assessment because there's a certain amount of data that is not realistically supporting facts….there are cultural ramifications for this. And so I would say as a rule, we have not treated language and writing and communication with nearly the business credibility problem that it creates or the economic problem that it creates, and certainly, the cultural problem that it creates…We're very good at writing, but we're terrible at thinking for writing. So I decided to take that on.’’ 09:30 Solving the challenges in the drafting stage Brian noted that templates must help people think well, rather than short-cut the critical thinking process. ‘’…there are a ton of factors that go into that drafting stage that we hardly ever talk about, and many of them are just business process communication things. For instance, what would normally happen is somebody says, "Well, we have a template for that." And so we say, "Well, okay. That's fine. Let's grab the template." And the template is going to say something like "insert site description here." Well, there's a lot of ways you can write a site description. And the client wants it a certain way, and somebody who's been in the business for six months who's drafting this document because they're inexpensive and we think that that's the way to use money and usability well, is to have that person draft the document. And that person drafts it the way they want it. And now the manager and the editor are going to spend a ton of expensive time fixing that and reframing that site description. And so, all of a sudden we're at, "Well, now we have to talk about factors and we have to talk about checking in and we have to talk about are these templates actually helping people think critically about the problem, or are these templates just rote things that we say, 'Well, if you follow this, everything's going to be fine.'" And if you asked any company across this country, they would all say, "Our templates are not helping people think well. We're trying to shortcut critical thinking with our templates and it shows up in the end product, that we have a short-cutted critical thinking process here." 14:11 Comprehension belongs to the reader alone Brian explained why it is only the reader’s comprehension that matters. ‘’We are writing as if we have to provide the decision-making information. And that is true, except we're missing one big part of it, which I'm now going to mention. The writer never, ever, ever gets to comprehend for the reader. Comprehension is completely...

The role of a nurse coach and her impact on the nursing community. Episode Introduction In this episode, Jim Cagliostro, VIE Healthcare’s Clinical Operations Performance Improvement Expert, interviewed Alexcie Sanchez to learn more about nurse coaches. Topics include, taking a more holistic approach to health and wellbeing, the growing need for nurse coaches, the positive impact of nurse coaching on burnout, and why nurse coaches are a ‘’shining light’’ in healthcare. Show Topics What is a nurse coach? Exploring available options for nurse coaches Partnering with a nurse coach is a powerful experienceCovid-19 – a tipping point in self-careCoping with burnout during a crisisUtilizing nurse coaches in a hospital benefits everyone 02:14 What is a nurse coach? Alexcie explained that a nurse coach works with any individual who wants to improve their health and wellbeing. ‘’….simply put, a nurse coach is a registered nurse who has specialized training in the art of coaching. We're trained to use a holistic approach, so I love to use the phrase a whole person approach. We really look at the individual's life when it comes to caring for an individual. So their lifestyle, their daily activities, their food intake, sleep habits, everything when it comes to caring for an individual, and I always want to make it clear right off the bat too, because we're called nurse coaches, we don't actually just work with nurses. It just means that we're nurses that are specialized in coaching. So nurse coaches work with anybody and everybody that has any desire to make a change.’’ 03:28 Exploring available options for nurse coaches Alexcie shared the options open to nurse coaches, from hospitals to private companies, emphasizing that working with a nurse coach not a one-time encounter. ‘’I have my own private practices as a nurse coach. So I work virtually with individuals. If they're local, I'll work with them. If they want to meet in person, I can do that. But basically, nurse coaches can have their own private practice. They're hired by insurance companies to help patients manage chronic or new acute illnesses, especially if it's like a terminal illness. They can provide that emotional support to them and their families. Nurse coaches can be hired by organizations and companies to promote just overall health and wellbeing, which helps not just the employees but the organization in general. And then nurse coaches can also work for hospitals where they not only help the patients while using that holistic approach, but also helping the staff and the employees of the hospital as well. So nurse coaches can really work in any sort of environment. They can work at clinics in doctor's offices, they can work for themselves. It's just really a matter of who they desire to work with and what sort of environment they'd like to work in…..It normally wouldn't be a one time encounter, it will be an encounter that lasts over weeks to months depending on the person's desires.’’ 12:15 Partnering with a nurse coach is a powerful experience Alexcie said our minds can dictate our behavior. Nurse coaches encourage accountability and offer reassurance. ‘’…anyone that is desiring to make any change in their life can reach out to a nurse coach. Whether it is health or disease related or not. We're really also trained in that mindset modification. Our minds, our thoughts really dictate a lot of our behaviors. So I know we often feel like we can do things on our own, but with a partner, whether it's for accountability reasons, reassurance advice, sharing your journey with a nurse coach can be a really powerful experience. And many nurse coaches specialize in certain niches. So for example, maybe you're a med-surge nurse or a PCU nurse and you're really well versed in type 2 diabetes and you love that education. There's nurse coaches out there that specialize in just working with individuals with type 2 diabetes to help them manage or...

Health equity and caring for people with intellectual disabilities. Episode Introduction In this episode, Jim Cagliostro, VIE Healthcare’s Clinical Operations Performance Improvement Expert, interviewed Nate Myers to discuss his experience serving adults with autism. Topics include the motivation behind Nate’s move to Keystone, the goal to provide health equity for people with autism, the growing demand for medical experts and advocates in the field, and the ‘’Platinum Rule’’ of Keystone Human Services. Show Topics Working towards healing and wellness by focusing on strengths 03:08 Working towards healing and wellness by focusing on strengths Nate said his decision to become a nurse was influenced by understanding that everyone deserves positive relationships and experiences. ‘’I'm pretty patient, I'm good at keeping a positive regard and encouraging others, so it just seemed to work. And I quickly developed an understanding and appreciation that every person desires and deserves everything good in life, to be understood, to be appreciated, to be independent as possible, do things that they enjoy, have positive relationships and be healthy. So that's the same for people with intellectual disabilities or autism. Of course, they want those things just like everyone else does. And so I learned a lot about what it means to be a human, and deciding to become a nurse was kind of just an extension of what it means to care for someone who's in a vulnerable position for sure but also working towards healing and wellness and focusing on strengths and not weaknesses. So all that kind of came together in my decision to be a nurse. And actually, when I told my wife, "I think I want to go to nursing school," she was like, "Yes, that's perfect. Go for it." So she was always an encourager for me and rooted me through a lot of the difficult aspects of becoming a nurse.’’ 07:49 ‘’We grow the most when we’re stretched’’ Nate said that asking lots of questions helped him to develop a keen understanding of the nursing basics. ‘’I think that's really important when you're in nursing is to challenge yourself. And I remember, going back to that encouragement from my wife, I remember when I started in the ICU, I felt so new and like I was in over my head. And my wife reminded me, we often grow the most when we're stretched, when we feel stretched. And so I've remembered that. I've taught that to other people. And I just remember every time I face a challenge that I'm stretching and I'm growing at the same time. So I think that's important to remember on anyone's journey. But in all those settings, I developed kind of a keen understanding of all the basics of nursing: physical assessment, clinical skills, differential diagnoses, how to do patient education, just working with people. And I always ask questions of all the physicians. Probably people got tired of me asking tons of questions.’’ 09:36: Providing community support to adults living with autism Nate explained how his nursing background helps to provide medical care in the community for individuals with more complex needs. ‘’The majority of our participants actually live in home and community setting, meaning they're living independently or with a roommate or with family, with their parents. We do also have some care dependent individuals. They receive 24/7 support just based on their support needs. And I was kind of pulled in, I think, primarily because some of those medically complex folks, they just needed a nurse to join the multidisciplinary team to assist all the staff and the leadership in what to do with those individuals. So yeah, so that's a little about my experience. And I really feel like the role that I'm in now really blends some of those skills with just my personality and all my interests in a unique way. And I think at the very heart of nursing as a profession is a desire to optimize health and wellness for each patient. So I feel...

How SpendMend's Explanted Medical Device Warranty Credit Tracking solution helps hospitals to avoid costly fees and penalties. Episode Introduction In this episode, Lisa Miller, founder of VIE Healthcare and CEO of Spendmend ,and Jim Cagliostro, VIE’s Clinical Operations Performance Improvement Expert, interviewed Al Brander to explore in detail the challenges and financial risks of managing medical device warranties. Topics include the risk of ‘’Medicare fraud’’, how hospitals are throwing away cash, why financial and legal responsibility lies with the explanting hospital, and a detailed presentation on the compliance and revenue benefits of SpendMend’s innovative software solution. Show Topics Background to the Explanted Medical Device Warranty Credit Tracking solution The risk-reward element that helps hospitals to avoid penalties and add revenue The high risk of financial penalties for failure to comply Mock audits are invaluable for hospitals in this low frequency/high risk areas The simple shipping label that keeps vendors accountable How SpendMend’s software provides audit defense Understanding revenue benefits at a glance Main Topics 04:43 Background to the Explanted Medical Device Warranty Credit Tracking solution Al explained that when a device fails, hospitals have a responsibility to return it to the manufacturer to obtain warranty credits. ‘’…there are all kinds of great implants that we put into people to make their lives better, the most common of which is a pacemaker, but there's all kinds of neural stimulators, total joints, all of these items. And so interestingly, all of them come with kind of a warranty. They're expected to last for a certain amount of time, but all of us have cell phones, so we understand that batteries and motherboards don't always last as long as they're supposed to. And so for years, CMS, the Center for Medicare and Medicaid Services, is the primary buyer of these things because most of them go into our elderly patients. And so CMS realized that "hey, we pay for the first device to get put in and then if it does fail, we pay for the second device to get put in and the hospitals are supposed to be sending back these devices, back to the manufacturer to see if there's a warranty." When the hospital gets that money, well really it's not their money, it's CMS’s money. And so the new standards came out in the late 2000's, actually. And what the expectation was is, when there's a device that fails, for whatever reason there's a malfunction or patient morbidity that happens because of that device, when it gets switched out, hospitals are expected to send it back to the manufacturer and pursue those warranty credits.’’ 06:05 The risk-reward aspect that helps hospitals to avoid penalties and add revenue Al said that hospitals could be literally throwing away cash by failing to return medical devices under warranty. ‘’In order to incentivize hospitals to do this every time, they've said, "Hey look, if that warranty credit is 50% or more of the replacement cost of that device, then send it back to us. But anything that's 49% or below you guys get to keep. We know we've paid for the full cost of the device, but that additional 49% is yours because you've gone through the effort to return it….the first part to remember about these is that probably 90% of the warranties are going to be below those 50% threshold. So this is just money that the hospital gets to keep. And I can tell you as a bedside nurse, there was a huge reliance on the vendor rep and just asking them, "Hey, do we need to send this back for warranty?", "Is this under recall?" Because in the heat of the moment, in that case I would have no idea. And so if the rep said no, I would throw that device into the biohazard bag, literally throwing cash in the trash can. Because these devices could have anything from a $3000 to a $15,000 warranty credit on them.’’ 07:53 The high risk of...

The reality of life as a Travel Nurse and the impact of the nursing shortage. Episode Introduction The shortage of nurses in healthcare was exacerbated by Covid. In this episode, Jim Cagliostro, VIE’s Clinical Operations Performance Improvement Expert, interviewed Rex Hartman, to explore the factors that fueled his decisions to become a Travel Nurse. The conversation was wide and varied, covering topics including the impact of an aging nursing population on healthcare, why nursing is no longer a priority for young people, and the benefits and risks to hospitals of hiring traveling staff. Show Topics Working in ICU through Covid-19 The decision to become a Travel Nurse The retiring Baby Boomer generation affects the nursing shortage Why young people are turning away from nursing as a career option How hospitals benefit from Travel Nurses The health systems providing their own in-house travel staff Potential risks of hiring traveling nurses Main Topics 06:24 Working in ICU through COVID-19 Rex shared the reality of working in ICU during a pandemic. ‘’When COVID-19 hit, about a month in in South Florida, when we started seeing cases, out of nowhere, my hospital administration came to me and said, "Oh, by the way, starting tomorrow, you're going back full-time to the ICU to take full assignments." That was just a little bit of a shock. It would be as if anyone working in a clinical area all of a sudden said, "You're going back to another clinical area without any forewarning or discussion." ……For about a month and a half, ICU was full. Everyone was freaking out a little bit. If we can all remember back those two years ago, the PPE shortage and all the other types of mask shortages where we started re-wearing PPE and everything like that, we clinically started to do things that we knew were no-nos and boo-boos, but a lot of things happened across the nation where infectious disease protocols that had been set up and established for over that decade that I've been in healthcare, well, now we're re-wearing and sanitizing our PPE because there's a shortage, and I can't help but wonder how much of that created other issues for our population.’’ 07:45 The decision to become a Travel Nurse Rex said that variety and compensation were two key factors in his decision to become a Travel Nurse. ‘’And from that period of time, if you're working in full-time ICU or somewhere in the hospital, even if you're in ancillary services, you're in surgical services, departments are getting shut down. Workflow is being stopped. And then you hear the travelers coming in by the droves. You see them, and they're like, "Hey, where are you from?" Maybe you've never met... I had never really met or worked with travel nurses until they came to the ICU. And they started to tell me, "This is what I do. This is how I work. This is how I structure my entire life." And man, if that didn't sound, first of all, a whole lot more interesting, as far as the variety of labor you can get into, the different clinical areas you can travel to and different hospitals, different regions if you're into that, but also we can't underscore enough: there was crazy amounts of money being thrown around for travel nurses in 2020. And I'm not saying that I'm not a loyal person to my community, but if you want to pay me to do the same job about four or five times more, I'm hard-pressed to say no, especially if I know I'm not breaking any laws to get it.’’ 11:39 The retiring Baby Boomer generation affects the nursing shortage Rex commented that the large numbers of nurses retiring will hit the healthcare sector hard in two ways. ‘’A couple of additional factors that you didn't mention is that we have an aged nurse population, and this isn't just in nursing. This actually spans, I think, almost every major industry in the nation right now. As the Baby Boomer generation retires, multiple...

The challenges of hiring healthcare workers in the wake of ‘’The Great Resignation.’’ Episode Introduction Demand for urgent care has intensified since 2020. In this episode, Jim Cagliostro, VIE’s Clinical Operations Performance Improvement Expert, interviewed Creston Tate to explore the impact of the pandemic, the growing demand for urgent care facilities, the reasons behind the ‘’Great Resignation’’, and the need to adapt to a shrinking talent pool. Show Topics The growing demand for urgent care. How the ‘’Great Resignation’’ affects patients. Reimbursement and the Walmart/Amazon challenge. Flexible schedules are essential to attract the right people. The shrinking candidate pool. Ensuring safety means urgent care sites may close temporarily. 02:13 The growing demand for urgent care. Creston highlighted the exponential growth in demand for urgent care in the past 6 years. ‘’My experience grew, my appreciation for medicine grew, my appreciation for the urgent care world, I call it the episodic world of medicine really grew too. There's clearly a huge gap in care for this particular type of patient that isn't being provided in the outpatient world. I did that for 17 years and just about six years ago, I transitioned into more of an outpatient urgent care directorship through my current healthcare system and have really enjoyed the growth that we have had, which is probably somewhere around the 12 to 13% growth rate per year in urgent care. As we started with five and now we're opening up our 15th urgent care this year with record volumes. I've seen it in the inpatient world, in the emergency room, and now I'm seeing it in the outpatient world and I'm bringing it all together and it's been fun to see that happen…..With the influx of patients to emergency departments and the overcrowding of EDs and wait times, perhaps some of your listeners have actually unfortunately experienced a 10 or 12-hour wait in emergency departments, it's just not fun. It's been estimated that even up to 50 to 60% of ED visits could have been handled outside of the emergency department, if the resources were there. I think that's where urgent cares and primary care providers can step in, if there's enough providers and enough access available for that. I've seen a huge switch. I know that for us, we open 12 hours a day. I think if we opened 18, we would have just as big a volume as we do now, if not larger.’’ 06:08 How the ‘’Great Resignation’’ affects patients. Creston explained the difference between unfilled jobs in the healthcare sector versus vacancies in retail. ‘’Whether you go to a restaurant or you go to a convenience store, it seems like there's a paucity of workers. Despite the published low unemployment rate, it does seem like there's a lot of jobs that just aren't being filled. You take that for what it's worth, but clearly healthcare, maybe isn't affected more as far as numbers, but what I will say, Jim, is that healthcare is affected more impactfully because it is an essential piece of our fabric. If we don't have the right number of healthcare workers, people's health suffers. If we don't have enough people working at a Walmart, well, you might just have to search around for something a little longer yourself or wait in line a little bit longer, or maybe the shelves aren't stocked as readily as you would like them to be. The impact there is certainly felt more if somebody can't get their diabetic medication or their follow-up or their blood work or that CAT scan that they've been looking for to follow that tumor, than if somebody is simply shopping for material goods. I do agree with you, the resignation as it's been called, we've seen it. We certainly in our healthcare system have seen it tremendously. What I will say is that we haven't seen a tremendous loss of... And again, I'll speak from my own personal experience. In the urgent cares that I work in I don't think...