CNOs and CFOs must learn to speak each other's language, says this nurse leader.

On this episode of HL Shorts, we hear from Katie Boston-Leary, director of nursing programs at the American Nurses Association, about how CNOs and CFOs can better communicate with each other. Tune in to hear her insights.

A new report shows that lowering nurse manager span of control improves clinical and financial outcomes.

Amid high burnout and turnover rates, nurse leaders should take a closer look at a key piece of the workforce puzzle: nurse managers.

Nurse managers need time and support from leadership to complete their tasks. According to a report published by the American Organization for Nursing Leadership (AONL) and Laudio, this could be accomplished by lowering span of control.

Span of control refers to the number of employees that nurse managers are in charge of supervising. According to the report, the median span of control for nurse managers is 46 employees, but 25% of all inpatient nurse managers have spans of control higher than 78.

The problem

According to Rudy Jackson, senior vice president and CNE at UW Health and a HealthLeaders Exchange member, nurse managers often have to perform many different duties. As a result, they’re often stretched thin.

"We put so much incredible pressure on our nurse managers to manage finances, culture, patient experience, quality, [and] keep turnover rates [and] length of stay down," Jackson said. "Yet we have all of these things that we put on their shoulders before they're able to get those things done."

Jackson said UW Health is making a significant investment in reducing span of control for nurse leaders. They’re looking at metrics like total headcount per nurse manager vs. how many pilots they are working on, as well as workforce diversity.

Jackson said a recent study has helped the health system understand what “we can eliminate off their plate” to make their jobs easier.

High spans of control also impact turnover rates.

According to the report, managers with higher spans of control face more turnover costs and incremental overtime.

Nurse managers are often swamped with busy work, leaving little time for job development. Jackson said that with more time, nurse managers could develop relationships with their teams, improve quality outcomes, improve the patient experience, and ultimately reduce costs, turnover and vacancy rates.

"What I need are leaders," Jackson said, "and reducing that span of control is going to allow us to move those individuals into a leadership role where they're truly able to guide their teams." 

The solution

The ultimate goal of lowering span of control is to give time back to nurse managers while also keeping costs down.

The report says that a financial case can be made for reducing span of control, when possible, even if it means splitting larger departments into smaller ones. According to the report, leaders should consider reducing or reallocating administrative tasks to offload the nurse manager's burden, while leveraging technology.

Additionally, the report says that giving more time to nurse managers to meaningfully interact with staff lowers RN turnover rates, which in turn lowers hiring costs.  

To Jackson, the answer to this issue will vary depending on the size of a health system and its resources.

"When you look at the control data for an organization like UW Health and you compare us to others, we do have a lot of resources that support our managers," Jackson said.

"It's a matter of trying to understand what exactly are those individual things that are impacting our leaders," Jackson continued, "and how can I leverage technology to offset some of that burden?"

UW Health developed a nurse manager council so that nurse managers have a venue to voice innovative solutions, questions, problems, and concerns. Jackson said UW Health will soon be conducting time studies with managers across the health system to better understand where nurse managers are spending their time.

"One of the solutions I heard recently from a CNE was [that they] give [their] managers a day off once a week, and … in theory, that would work pretty well," Jackson said. "The reality is that the work doesn't stop."

"As CNEs, we need to start thinking about innovative solutions, leveraging technology, offering the appropriate support," Jackson said, "but [doing] so in a manner that doesn't add additional cost to organizations that already exist on razor thin margins."

What about assistant nurse managers?

According to the report, the assistant nurse manager plays a critical role in this strategy.

The study found that 56% of nurse managers are supported by at least one nurse manager. Of that number, 4% of nurse managers have all team members reporting to the assistant nurse manager and 18% share the direct reports, while 78% have all team members as their direct reports, without including the assistant nurse manager.

The report says that RN turnover is lower when assistant nurse managers are part of high span of control teams, which ultimately reduces costs. However, the data also shows that too many assistant managers can become counterproductive and lead to high turnover, possibly because roles are less clear.

Jackson has experienced working in environments with and without assistant nurse managers, and UW Health is now trying something new.

"What we've challenged our team with is start looking within," Jackson said. "What resources do we have internally that can allow us to start to decrease that administrative burden to those managers so that we can get them out of their office and elevate the roles of some of the others?"

UW Health deploys full-time charge nurses called care team leaders (CTLs). Jackson said they are looking at how CTLs can help offload the burden from nurse managers.

UW Health is also leveraging technology to help with administrative burdens.

"We're looking at technology to remove the burden of scheduling," Jackson said. "We've got to be able to put pressure on our IT departments to find those solutions that help nurses and help the organization make our leaders more efficient, [and] support our nurses even better."

In health systems where creating new roles is not possible, Jackson recommended making existing roles more supportive to the nurse managers.

"I think there's a lot of different ways to utilize the assistant manager role," Jackson said, "but I don’t think we need to be stuck with the solution that the assistant manager is the only way we're going to fix the manager span of control."

A new survey highlights the importance of being prepared to deal with a cyberattack and data breach.

With cyberattacks in healthcare on the rise, it’s vital that practices have security measures in place to protect patient data.

Yet, only 63% of organizations have a cybersecurity plan in place, according to a survey by Software Advice, which means many are vulnerable to potentially crippling attacks that can be costly and damaging to patient trust.

The survey fielded answers from 296 respondents with IT management, data security, data management, security training or audit responsibilities at healthcare organizations around the country.

The data revealed that half of organizations have experienced a data breach, with 32% dealing with one in the past three years.

More than one in four practices (42%) has experienced a ransomware attack, with nearly half (48%) reporting the attack impacted customer data, while 27% said it impacted patient care.

After a ransomware attack has taken place, a third of respondents (34%) failed to recover patient data from their attackers.

With 55% of practices allowing access to more data than employees need to their job, it introduces greater human error into the mix.

To counter the increase in threats, CEOs at both provider and payer organizations must take a proactive approach to cybersecurity.

That includes putting preventative measures in place, such as more training for employees handling data to help them identify scams and attacks, as well as limiting certain data to the employees that need it.

Preventative measures, however, aren’t effective for attacks that have already happened, which is why it’s crucial for CEOs to implement a response plan “that includes defined roles and responsibilities, communication protocols, and a prioritization list,” the report said.

Not every organization that is prepared to prevent and respond to a cyberattack will be safe though.

Banner Health’s next CEO, Amy Perry, recently told HealthLeaders that it’s difficult to protect yourself again bad actors that are coming at you from all different angles.

"Do I see a solution? Not an easy solution,” Perry said. “All of the health systems, including Banner, have multiple, multiple investments in protection. But again, moving at the speed that the people that are working on the other side of this in the dark corners of the world, I think we've got a long way to go before we figure out how we keep ourselves safer every day.”

One of the biggest challenges when implementing virtual nursing programs is determining which metrics to use to measure ROI.

Jason Atkins, vice president and chief clinical informatics officer at Emory Healthcare, outlined how the Atlanta-based health system is implementing virtual nursing and the five metrics they use to measure the success of their program.

Atkins is a part of the HealthLeaders Virtual Nursing Mastermind program, in which several health systems are discussing the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.

Metrics

The first metric, according to Atkins, is nurse satisfaction and nurse engagement. This data is collected via surveys that go out to the nurses.

"We do pulse surveys to make sure that we're asking questions around, 'Do you have the tools you need for your work?’ and, ’'Do you have the staffing and resources that you need for your work?'" Atkins said.

The second is patient satisfaction. Patients must be made aware of the cameras and what their interactions will be with the virtual nurse.

Atkins said that explaining the virtual nursing process to the patients will gain their trust and engagement.

"We really want to make sure that we're explaining the why behind this to our patients," Atkins said, "because they're going to see a camera in their room and that could certainly give someone a sense of privacy invasion."

Length of stay is the third metric. The virtual nurses are completing discharge planning, education, and facilitation, and according to Atkins, they are the link to the interdisciplinary rounding process to make sure that milestones and barriers are worked before discharge day.

"Making sure we've got prescriptions set up, we've got their med reconciliation done, we've got all their discharge milestones such as transport or subacute care." Atkins said. "All of that stuff should help decrease our length of stay."

The fourth metric is readmission rates, which are often dependent on discharges, education, and follow-up planning.

"Making sure that the patients who are discharged have their follow-up appointments before they ever leave the hospital," Atkins said, "so they can get that good continuity of care and not get readmitted to the hospital."

The fifth and final metric is cost and productivity. Atkins explained that the goal is to offload the burden of care from the bedside nurse, while making sure that there is a return on investment.

"It's not just adding on new staffing or thinking about how [to] increase the ratios on the nurses," Atkins said. "It's really about a return on investment based on those other metrics [and] hopefully quality of care improvements as well."

The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program. Please join the community at our LinkedIn page.

To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.

Automakers are applying the smart home concept to the automobile, with plans to include sensors that can track a driver’s physical and mental health

The next healthcare access point for providers could be the car.

General Motors is seeking a patent for technology inside the automobile that tracks a driver’s behavior and health through sensors, according to Autoblog.com. The technology could help to identify drivers who are impaired or affected by a wide range of health concerns, ranging from drugs and alcohol to issues with mental acuity, breathing, blood pressure, or blood sugar.

The company’s plans, which have been ongoing since at least 2022, are to create a tech platform inside the car that establishes a profile of the driver’s habits, called a “vehicle occupant mental well-being assessment.” The platform would then identify any trends that fall outside the norm and use “counter-measure deployment,” which would range from asking the driver to perform a “mental health exercise,” calling family members or a trained professional, or even taking control of the car.

The idea isn’t exactly new. Automotive displays at CES in Las Vegas have for many years hinted at or even featured prototype sensors and technology aimed at tracking the driver’s health. Cars can now be fitted with technology that prevents a driver under the influence of alcohol from starting the car.

The effort has ties to the remote patient monitoring movement, in which healthcare providers are looking to track patients and provide on-demand services outside the hospital, clinic or doctor’s office. And with programs like Lake Nona’s WHIT House in Florida targeting smart home concepts, automakers are aiming to do the same thing with their newest vehicles.

Aside from tracking people with substance abuse issues, healthcare providers and public health advocates say the technology could address accidents each year linked to driver distress, such as mental health issues, blood pressure, diabetes, cardiac issues, even allergic reactions. While those accidents only represent about 2% of all crashes in the U.S. each year, according to data compiled by the U.S. Department of Transportation, 84% of those are caused by medical emergencies that could potentially be detected and prevented.

Ideally, the technology might someday be used to identify hazards to drivers, like smog or high pollen counts for people with respiratory issues, or direct (or even steer) drivers to a nearby healthcare site in an emergency.

Several carmakers are giving health and wellness tools a serious look. In the past few years Mazda, Audi, and Toyota have said they are working on next-generation cars armed with a wide variety of sensors, including ECG sensors in the steering wheel and earpieces designed to measure a driver’s impairment.

And back in 2011, the Ford Motor Company announced partnerships with digital health companies WellDoc, Medtronic, and SDI Health to include health and wellness connectivity solutions on the Ford SYNC platform.

“We want to broaden the paradigm, transforming SYNC into a tool that can improve people’s lives as well as the driving experience,” Paul Mascarenas, chief technology and vice president of Ford Research and Innovation, said in a May 2011 press release.

The company also announced plans to embed sensors in the seats to monitor a person’s heart rate, though by 2015 the company had ditched those plans. And while the latest SYNC platform offers integration with apps, no mention is made of health and wellness monitoring.

In many cases, automakers have abandoned these plans on the idea that wearables would do a much better job monitoring drivers, as well as passengers. But the fact that GM is taking an active look at the technology means they haven’t given up on the idea.

The old ways of growing the nursing workforce are no longer working, so it’s time for some new strategies.

The greatest challenge facing nursing leaders today is workforce development. Health systems are in dire need of solutions that improve both recruitment and retention.

These challenges come at a time when workplace violence is as prevalent as ever, and burnout is cited as a huge reason for nurse leader turnover. Virtual nursing and other new technologies like AI have also had an impact on the workforce and need to be considered when strategizing.

Here are four ways CNOs can move forward and build a strong, healthy, and happy workforce.

Click here to read the accompanying cover story. 

Florida has become the first state to allow doctors to perform cesarean sections outside of hospitals, siding with a private equity-owned physicians group that says the change will lower costs and give pregnant women the homier birthing atmosphere that many desire.

But the hospital industry and the nation’s leading obstetricians’ association say that even though some Florida hospitals have closed their maternity wards in recent years, performing C-sections in doctor-run clinics will increase the risks for women and babies when complications arise.

“A pregnant patient that is considered low-risk in one moment can suddenly need lifesaving care in the next,” Cole Greves, an Orlando perinatologist who chairs the Florida chapter of the American College of Obstetricians and Gynecologists, said in an email to KFF Health News. The new birth clinics, “even with increased regulation, cannot guarantee the level of safety patients would receive within a hospital.”

This spring, a law was enacted allowing “advanced birth centers,” where physicians can deliver babies vaginally or by C-section to women deemed at low risk of complications. Women would be able to stay overnight at the clinics.

Women’s Care Enterprises, a private equity-owned physicians group with locations mostly in Florida along with California and Kentucky, lobbied the state legislature to make the change. BC Partners, a London-based investment firm, bought Women’s Care in 2020.

“We have patients who don’t want to deliver in a hospital, and that breaks our heart,” said Stephen Snow, who recently retired as an OB-GYN with Women’s Care and testified before the Florida Legislature advocating for the change in 2018.

Brittany Miller, vice president of strategic initiatives with Women’s Care, said the group would not comment on the issue.

Health experts are leery.

“What this looks like is a poor substitute for quality obstetrical care effectively being billed as something that gives people more choices,” said Alice Abernathy, an assistant professor of obstetrics and gynecology at the University of Pennsylvania Perelman School of Medicine. “This feels like a bad band-aid on a chronic issue that will make outcomes worse rather than better,” Abernathy said.

Nearly one-third of U.S. births occur via C-section, the surgical delivery of a baby through an incision in the mother’s abdomen and uterus. Generally, doctors use the procedure when they believe it is safer than vaginal delivery for the parent, the baby, or both. Such medical decisions can take place months before birth, or in an emergency.

Florida state Sen. Gayle Harrell, the Republican who sponsored the birth center bill, said having a C-section outside of a hospital may seem like a radical change, but so was the opening of outpatient surgery centers in the late 1980s.

Harrell, who managed her husband’s OB-GYN practice, said birth centers will have to meet the same high standards for staffing, infection control, and other aspects as those at outpatient surgery centers.

“Given where we are with the need, and maternity deserts across the state, this is something that will help us and help moms get the best care,” she said.

Seventeen hospitals in the state have closed their maternity units since 2019, with many citing low insurance reimbursement and high malpractice costs, according to the Florida Hospital Association.

Mary Mayhew, CEO of the Florida Hospital Association, said it is wrong to compare birth centers to ambulatory surgery centers because of the many risks associated with C-sections, such as hemorrhaging.

The Florida law requires advanced birth centers to have a transfer agreement with a hospital, but it does not dictate where the facilities can open nor their proximity to a hospital.

“We have serious concerns about the impact this model has on our collective efforts to improve maternal and infant health,” Mayhew said. “Our hospitals do not see this in the best interest of providing quality and safety in labor and delivery.”

Despite its opposition to the new birth centers, the Florida Hospital Association did not fight passage of the overall bill because it also included a major increase in the amount Medicaid pays hospitals for maternity care.

Mayhew said it is unlikely that the birth centers would help address care shortages. Hospitals are already struggling with a shortage of OB-GYNs, she said, and it is unrealistic to expect advanced birth centers to open in rural areas with a large proportion of people on Medicaid, which pays the lowest reimbursement for labor and delivery care.

It is unclear whether insurers will cover the advanced birth centers, though most insurers and Medicaid cover care at midwife-run birth centers. The advanced birth centers will not accept emergency walk-ins and will treat only patients whose insurance contracts with the facilities, making them in-network.

Snow, the retired OB-GYN with Women’s Care, said the group plans to open an advanced birth center in the Tampa or Orlando area.

The advanced birth center concept is an improvement on midwife care that enables deliveries outside of hospitals, he said, as the centers allow women to stay overnight and, if necessary, offer anesthesia and C-sections.

Snow acknowledged that, with a private equity firm invested in Women’s Care, the birth center idea is also about making money. But he said hospitals have the same profit incentive and, like midwives, likely oppose the idea of centers that can provide C-sections because they could cut into hospital revenue.

“We are trying to reduce the cost of medicine, and this would be more cost-effective and more pleasant for patients,” he said.

Kate Bauer, executive director of the American Association of Birth Centers, said patients could confuse advanced birth centers with the existing, free-standing birth centers for low-risk births that have been run by midwives for decades. There are currently 31 licensed birth centers in Florida and 411 free-standing birth centers in the United States, she said.

“This is a radical departure from the standard of care,” Bauer said. “It’s a bad idea,” she said, because it could increase risks to mom and baby.

No other state allows C-sections outside of hospitals. The only facility that offers similar care is a birth clinic in Wichita, Kansas, which is connected by a short walkway to a hospital, Wesley Medical Center.

The clinic provides “hotel-like” maternity suites where staffers deliver about 100 babies a month, compared with 500 per month in the hospital itself.

Morgan Tracy, a maternity nurse navigator at the center, said the concept works largely because the hospital and birthing suites can share staff and pharmacy access, plus patients can be quickly transferred to the main hospital if complications arise.

“The beauty is there are team members on both sides of the street,” Tracy said.

by Phil Galewitz, KFF Health News May 28, 2024

As health systems shift more care services to the patient's home, they're looking at drones to solve key supply chain challenges

Health systems and hospitals are turning to drones to address supply chain care gaps—including challenges that both providers and patients face in accessing drugs and other medical supplies.

In the latest example, the Mayo Clinic has announced a partnership with Zipline to integrate drone deliveries into its Advanced Care at Home program. The deal aims to improve care management for the home-based acute care program by giving providers quick access to medical supplies. Mass General Brigham unveiled similar plans in January when it announced a partnership with Canadian drone company Draganfly.

The Mayo Clinic announcement, which covers the health system’s campuses in Rochester, Minnesota, and Jacksonville, Florida, adds heft to the concept of using drones to deliver medical supplies, a use case that has already seen success in other parts of the world. Several U.S. health systems, including Intermountain Health, Michigan Medicine, WakeMed Health and Hospitals, and Rady Children’s Hospital, are either using drones or have tested their use, and Amazon Pharmacy launched a drone delivery service last year in College Station, Texas.

Just last month, Houston’s Memorial Hermann Health System announced a partnership with Zipline to deliver specialty prescriptions and medical supplies to patients’ homes beginning in 2026.

“As a system, we are continuously seeking ways to improve the patient experience and bring greater health and value to the communities we serve,” Alec King, Memorial Hermann’s executive vice president and chief financial officer, said in a press release. “Zipline provides an innovative solution to helping our patients access the medications they need, quickly and conveniently, at no added cost to them.”

Drones have been on the fringe of the healthcare space for several years, usually showing up in small pilot programs aimed at improving delivery of time-sensitive supplies between two health system sites or from a health system to a patient’s home and vice versa. The use case aims to address delays or slow deliveries caused by geography, weather, traffic, or transportation issues as well as giving patients access to tests, medicine, and vaccines in their homes rather than making them travel to a hospital or clinic.

In January, Axios called 2024 a “breakout year for delivery drones,” noting that the Federal Aviation Administration eased the rules last fall to allow some companies to fly drones beyond the visual lines of sight, called BVLOS. That opened the door to companies like Zipline, Amazon, and Wing (part of the Alphabet stable) expanding their services. The FAA is expected to create standards for BVLOS operations in the near future.

The Mass General Brigham and Mayo Clinic programs represent a different use case. Both health systems plan to use drones to transport medical supplies to and from the homes of patients in acute hospital at home programs. Those programs, which have gained traction since the pandemic, require hospitals to combine digital health and telehealth services with in-person care for patients in their homes, as an alternative to in-patient care.

The complexity of the program might mean that drones would be used almost every day to send medical supplies to the patient’s home and/or transport tests and specimens from the home back to the hospital.

“At Mass General Brigham, we are looking at the future of healthcare, and part of that vision is taking care of patients in the comfort of their homes,” David Levine, MD, MPH, MA, clinical director of research and development for the Mass General Brigham Healthcare at Home program, said in a press release. “In accomplishing this at scale, we understand that we need to continue to evolve our processes to support home-based care. These types of technological solutions allow us the opportunity to create a paradigm shift in our care delivery.”