Workplace violence prevention requires a proactive approach that disrupts the pathway to violence, according to this CNO.
HealthLeaders spoke to Michele Szkolnicki, senior vice president and chief nursing officer at the Penn State Health Milton S. Hershey Medical Center, about staffing challenges and workplace violence, and what health systems can do to address those issues. Tune in to hear her insights.
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William Sheahan of MedStar Health, a participant in the HealthLeaders Mastermind program, says healthcare leaders need to look beyond the technology and prepare doctors and nurses for new workflows
AI may truly be a transformative technology, but its integration into clinical care needs to be managed well before the technology is even introduced.
"How do we get our people, our nurses, our doctors, our clinicians, our revenue cycle teams, to understand how the technology supports the future of their work?" asks William Sheahan, SVP and Chief Innovation Officer at MedStar Health and executive director of the MedStar Institute for Innovation. "We can't just focus on deploying the fun new technology and expect that organically it's going to change your business, right?"
Sheahan, a participant in HealthLeaders' Mastermind program on AI in clinical care, says healthcare leaders need to focus on change management as they embrace AI. That means not only working to bring current doctors and nurses up to speed with the technology, but looking to medical schools to make sure the next generation is prepared for an AI-infused workplace.
William Sheahan, SVP and Chief Innovation Officer at MedStar Health and executive director of the MedStar Institute for Innovation. Photo courtesy MedStar Health.
"We have the imperative to swim upstream, into undergraduate medical education, in nursing schools and medical schools, and insert some of this foundational education," he says.
Sheahan says MedStar Health is pursuing an AI strategy that recognizes how the technology will change healthcare delivery, which includes the effect on the provider as well as the patient. As such, the ROI of a new tool or program looks beyond financial costs to include clinical outcomes and provider wellbeing.
That means getting buy-in from all parties, especially clinicians. Sheahan says innovation leads like to participate in town halls with system physicians to introduce new tools like ambient AI, giving them a chance to ask questions and try out the technology before it's added to their toolkit. The idea, he says, is to include clinicians in the planning so that they're invested in the process from the start.
"This isn't forced change," he points out.
Instead, he says, it's organizational change. That's what comes with a holistic technology that is being embraced by consumers as well as clinicians. Organizations that aren't already properly pursuing this in-demand innovation may otherwise be forced to react rather than act with the times.
With national issues like workforce shortages, cost concerns and increased competition for the patient/consumer plaguing the industry, healthcare leaders are challenged to hit the ground running with AI. Sheahan says he, like any other innovation executive, is excited about the potential for AI to improve clinical care, but they still need to plan out the process and understand the outcomes.
That includes understanding how data is gathered, stored and managed, processes that certainly need to be modernized. Health systems and hospitals have long been gathering data without fully understanding its potential uses. AI promises to make the best use of that data if it's guided and governed properly.
While some health systems have created AI committees or even C-suite roles to manage AI, Sheahan says separating AI from other innovative strategies can hinder progress. He's more supportive of integrating AI governance into existing management structures. In many cases, he says, a new AI tool can have multiple benefits across different departments—like an ambient listening tool that not only improves clinician note-taking but helps the rev cycle department improve coding.
"AI as a technology shouldn't be governed entirely differently than other technologies," he says.
As for the future of AI in the clinical space, Sheahan envisions an AI-enabled operating system serving the enterprise, responding to queries from pretty much anyone within the health system. The platform might help doctors map the best care plan for patients, give nurses direction on inpatient care, help the rev cycle management team deal with a prior authorization or denial, or even map out the best route for a patient to a specialist appointment across town.
"We want to show the many groups that can benefit from AI why and how to use it to make themselves more efficient," Sheahan said. "Ultimately, that is what is going to deliver ROI over time. We can make our business more efficient if we're all in this together."
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Some of the obvious solutions for health systems are not even options for rural hospitals, says this CNO.
On this episode of HL Shorts, we hear from Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, about how the healthcare needs of rural communities differ from those in urban areas.
At Phelps Health, the goal is to create support systems for nurses and to embrace technology, says this CNO.
HealthLeaders spoke to Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, about rural healthcare challenges and how Phelps Health is tackling recruitment, retention, and new innovation. Tune in to hear her insights.
The 8-year Innovation in Behavioral Health (IBH) Model focuses on care integration and coordination, alongside screening for health inequities, to bridge behavioral and primary care services.
Federal officials have launched a new behavioral health program aimed at creating care management programs for Medicare and Medicaid patients dealing with severe mental health conditions and substance abuse disorder (SUD).
The Centers for Medicare & Medicaid Services (CMS) Innovation in Behavioral Health (IBH) Model seeks to bridge the gap between behavioral health and primary care by enabling specialty behavioral health practices, including community mental health centers, opioid treatment programs and private or public practices, to create interprofessional care teams to coordinate care.
The goal of the new program is to improve care and outcomes for the estimated 25% of all Medicare patients experiencing mental illness and the 40% of Medicaid patients dealing with a mental illness or SUD. Those patients often face barriers accessing care, resulting in poor health outcomes, and either don’t get care or wind up in emergency rooms.
The eight-year program will be launched through state Medicaid agencies in Michigan, New York, Oklahoma and South Carolina.
“Specialty behavioral health practices will be responsible for conducting screenings and assessments of behavioral and physical health, and health-related social needs, offering treatment as appropriate within their scope of practice, providing closed-loop referrals to other primary care providers, specialists, and community-based resources, and monitoring ongoing conditions,” CMS said in its announcement. “Since people with moderate to severe behavioral health conditions frequently visit behavioral health settings, this approach uses the behavioral health setting as a point of entry to identify and secure further care and facilitate close collaboration with primary and specialty care providers.”
While the practices will be developing care integration and care management strategies, they’ll also target health inequities through screenings for social determinants of health (SDOH).
“Practice participants are required to create a health equity plan (HEP) using a needs assessment of the population they serve,” CMS said. “The HEP should detail steps that practice participants will take to address the population needs and stipulate how the practice participant will address disparities that disproportionately impact their service populations.”
Additionally, the IBH Model will require practice participants to annually screen and monitor patients for underlying and/or unmet health-related social needs and make necessary referrals to other health care providers or local safety-net services,” the agency continued. “The required care management component will help ensure that eligible individuals receive the services needed to address their health-related social needs.”
They’ll also be supported with targeted investments in health information technology to improve quality reporting and data sharing.
Prior to joining TMC, Hipp served as chief financial officer for Banner University Medicine Tucson. He has also held finance leadership positions with Loyola Medicine and WellPoint.
Right off the bat, Hipp says he was excited to jump into his new position and knew he was stepping into a quality-driven organization.
"TMC is a leader in these areas, providing excellent quality, high patient experience," he says.
"You've got a dedicated community that is hugely supportive of Tucson Medical Center and what we mean to the community then drives the financials."
There's much that goes into ensuring quality from a health system, and Hipp says one thing he found and loved at TMC was that the organization has a good grip on how to pivot and adapt when needed.
"Just when you think you kind of figure something out, whether it's through legislation or a pandemic or anything else, it throws you a curveball and you're constantly trying to figure out what kind of curveballs are coming next," he says. "Having that basic block and tackling technique, I believe that TMC has that basic act of tackling down really well."
Quality comes first, and finances will follow, Hipp explains.
One piece of Hipp's financial strategy at TMC is looking at operations through a service line perspective. To do this, there must be service line alignment and a strategic arrangement. CFOs should examine what a community really needs and then think about those needs through a service line lens.
A second piece is staying on top of payer tactics. Hipp says health systems don't always have the luxury of margins to fall back on, so CFOs must work with payers to not only get them more engaged on denials, but also with peer reviews to be able to stick to their prior authorizations.
"It's a two-edged sword," he says. "You're losing on the revenue side and then your cost to collect goes way up because you have to invest resources in the revenue cycle side to track that down and to monitor that."
Partners, Not Employees
One consistent theme amongst finance leaders' goals and strategies this year has been collaboration; it's vital for health systems, particularly in finance. CFOs must make sure they are not making decisions in a vacuum and include other valuable perspectives from clinical teams that will affect patient care.
"I see finance's role as more of a consultative type approach, where we can present data to the chair or the physician leadership," Hipp says.
Hipp says healthcare finance must move on from the dictatorial type of reporting and strategizing that may have dominated in the past, and into an era of close-knit collaboration that brings invaluable insight to the discussion.
Physicians and nurses have the expertise and the scientific mindset to think through operational challenges. Hipp recalled a memory from his time working at Loyola that put physicians' work and dedication in perspective.
"Probably 10 years ago, when I was at Loyola, I was kind of stuck in traffic getting to an 8 a.m. meeting," he says. "It was a surgical clinical program meeting. It was one of those mornings where just everything was just kind of going wrong, and you're irritated when you walk in. Then we get to the meeting. We're in this room. The lead person on the physician side wasn't there. We're like, ‘Oh, god, what's going on?' He walks in 15 minutes later. He still has his scrubs on and he has blood on his scrubs. He said, ‘We had a tough night last night. We just had a double lung transplant.'"
Moments like this, Hipp says, put the value of physicians' work into perspective. To make the most informed clinical financial decisions, clinicians need to be at the table.
"And you think that you're so important with what you're trying to do?" he says. "But if you don't have that collaboration with those physicians then you're not going to be successful."
CNOs should gear up for the next wave of nursing challenges in 2025.
2024 was filled with many challenges for CNOs and other nursing leaders, and while many of the same ones will continue, there will be new trends and obstacles that leaders will face.
The health system plans to expand community sites and services, beef up its chronic care management and SDOH programs, add 1,000 new employees and build a new hospital to replace the aging Advocate Trinity Hospital.
Advocate Health Care has announced an ambitious expansion into Chicago’s South Side to the tune of $1 billion.
The Illinois-based arm of the national Advocate Health network, the third largest in the country, is planning to invest $300 million in a new lakefront hospital to replace the 115-year-old Advocate Trinity Hospital. In addition, it plans to spend more than $500 million on expanded outpatient care through community programs and services, $200 million on new hospital and outpatient services addressing chronic disease and social determinants of health, and $25 million on workforce development programs.
"We have built a model that gets at the heart of chronic disease and wellness through much greater access to extensive prevention, health management tools and education designed to help South Side residents live their healthiest lives," Michelle Blakely, PhD, President of Advocate Trinity Hospital, said in a press release. "We need to provide the community with the necessary resources to stay well – where we live, work, play and worship – and that takes a comprehensive plan."
The focus of the expansion is on community health and wellness, and represents one of the largest investment ever by a health system. Executives say the plan was forged over the past year through more than 20 listening sessions with South Side residents. It addresses "significant health inequities" in those neighborhoods, including four times as many deaths due to diabetes as the North Side.
Among the planned investments:
Adding capacity to accommodate 85,000 new appointments per year.
Establishing 10 new Advocate Health Care Neighborhood Care locations.
Redesigning the health system’s financial assistance program to ensure that no one goes without care.
Launching a mobile medicine unit to provide primary care services.
Expanding access to pharmacy services, including free prescription programs.
Expanding the Advocate Food Farmacy program.
Expanding access to pre- and post-natal care.
The new hospital, to be built on 23 acres of land that now houses a former U.S. Steel Works complex, will feature 52 beds, 36 medical surgery beds, four ICU beds, eight dedicated observation beds, and a four-bed dialysis unit. It will also house a cardiac catheterization lab, enhanced testing and imaging services and a 16-bed Emergency Department. Once the new hospital is open, the old hospital will be demolished and replaced by green space.
The health system’s workforce development plans include adding 1,000 new positions within the next three years, as well as job forums and a mobile recruitment van to connect with students and others in the community.
Students know they want to be in service of people, but they don't necessarily know they want to be doctors, says this CMO.
On this episode of HL Shorts, we hear from Dr. Lindsay Mazotti, chief medical officer of medical education and science at Sutter Health, about how CMOs can build pipelines for residents into the healthcare industry to attract new physicians. Tune in to hear her insights.
While many challenges are the same in rural healthcare, the available solutions can be vastly different, according to this CNO.
Health systems of all shapes and sizes are dealing with significant challenges, from staffing shortages to workplace violence, to implementing new technologies.
However, not all hospitals are starting on equal footing.
In rural communities, the challenges go deeper. According to a 2024 report from Chartis, 50% of rural hospitals in the United States are operating in the red, and since 2010, 167 rural hospitals have either closed or moved away from inpatient care.
Rural hospital closures have large impacts on their communities, and CNOs must work to prevent that and maintain patient access to care.
Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, has first-hand experience with the issues facing rural healthcare settings. Phelps Health is located in Rolla, Missouri, which is about two hours from all the major urban areas in Missouri, including St. Louis, Springfield, and Columbia. The health system serves six counties and about 250,000 patients.
Rural vs. urban: What’s the difference?
According to Brookshire-Heavin, the care needs of the rural community are very similar, and include chronic disease, heart disease, obesity, and lack of education and primary care prioritization.
The real difference lies in accessibility and the lack of resources to address those concerns.
"A lot of our residents…have no transportation to get to healthcare," Brookshire-Heavin said. "We don't have public transportation, we don't have a bus, we don't have the subway, we don't have things like that, so that's a challenge."
Even accessibility solutions that more urban health systems use, such as telemedicine, are not options for more rural areas, Brookshire-Heaven explained.
"Maybe if you were going to use telemedicine to serve some remote population, some of our community members don't have reliable Internet access," Brookshire-Heavin said, "so things like that are not even an option."
When it comes to nursing in the rural environment, the philosophy has had to change over the years. According to Brookshire-Heavin, the idea of hiring experienced or specialized nurses is no longer feasible. Phelps Health is focused on partnerships with local colleges, nursing schools, and nursing programs to find ways to get students to join the team.
"What we have found is our workforce is primarily unexperienced new graduate nurses that we have to provide experience to," Brookshire-Heavin said. "We changed our mindset from 'we're going to hire and look for all these experienced individuals,' because they're not there for us, to 'let's grow programs to grow experience and make new nurses.'"
At Phelps Health, the goal is to create support systems, new training programs, and extended training to start new graduates in specialty areas, along with programs that get students involved before they become nurses. Brookshire-Heavin detailed the internship program that pays students to come do their internships at the health system, which has been increasing the number of new graduate nurses entering the workforce.
"We're also seeing those nursing students [do] better on state boards," Brookshire-Heavin said. "They are more successful at one year for retention, [and] when we look at retention, we're seeing that rate increase as well."
Talking costs
Finances in general are a challenge in rural health systems and hospitals, and in the case of technology, Brookshire-Heavin explained that it boils down to a lack of resources to invest.
"You don't have extra to invest in those types of programs," Brookshire-Heavin said. "You are truly trying to keep up with operations and equipment purchases for capital budget, and things just to keep operations going and up to date."
Even for larger health systems, it’s difficult to find the funding for new cutting-edge technologies, and CFOs take convincing. In the rural setting, Brookshire-Heavin says the challenge depends on the financial status of the organization.
"We're very fortunate and we do have resources that we can dedicate to that," Brookshire-Heavin said. "Our organization has really embraced technology, and we do try to look at using technology to do things better."
Brookshire-Heavin recommends partnering with other members of the C-Suite to advocate for innovation.
"As a CNO, I think a big part of that is my relationship and partnership with our CFO to really be able to communicate the needs and the vision," Brookshire-Heavin said, "and the financial case for why this may have cost up front, but what value does it bring in the long run."
Advocating for the community
In terms of community needs, many patients in rural areas lack the resources and ability to invest in their health and wellness, such as public transportation to the hospital. According to Brookshire-Heavin, this issue requires CNOs to have an awareness of legislation and relationships with policy makers and lawmakers.
"We have a government affairs department," Brookshire-Heavin said, "and so I do talk with them and stay in the loop of legislation that's coming, discussions that are happening with legislators, [and I] answer questions and get involved."
Brookshire-Heavin emphasized staying up to date with local organizations and opportunities that can provide more funding.
"I try to stay active with MHA information about legislation, legislative issues," Brookshire-Heavin said, "but also [I look] at grant opportunities and ways to fund programs that we may otherwise not be able to do."
CNOs in rural areas should stick together as well, according to Brookshire-Heavin, and discuss the issues that are confronting their communities. Connections and relationships with other leaders in other organizations are just as important as connections within the CNO's own organization. Brookshire-Heavin also recommends staying current and challenging rigid ways of thinking.
"I think there's a uniqueness about rural healthcare, I find it very rewarding," Brookshire-Heavin said, "but I also think it's important to think outside the box, and try not to be limited by the ruralness of the area you're in."
