Sanford Health recently tapped Scott Wooten, FACHE, MBA, as its new CFO. Wooten chatted with associate content manager Amanda Norris about how he plans to foster long-term success for the organization, as well as how he plans to make investments in growing its workforce—specifically in its graduate medical education program
This CNE has advice on how to create and foster a more diverse workforce.
On this week’s episode of HL Shorts, we hear from Dr. D’Andre Carpenter, Senior Vice President and Chief Nursing Executive at Allina Health, about strategies to improve recruiting and retention efforts by including diversity, equity, and inclusion (DEI) principles into the workplace culture.
What are some of the strategies CNOs can take to embed DEI into recruitment and retention culture?
I'm getting inspired by some work that I did at my previous system, [including] some [ideas] that we're talking about here at this system around promoting internal equity for team members that already exist in our organization.
We look at our supportive staff, our EVS transport, food and nutrition staff, that work elbow to elbow with our clinicians every day. A lot of them have aspirations of becoming clinicians, and [we look at if] we are being intentional about providing and setting up those pathway programs for them to be able to propel themselves into a clinical career, if that's what they desire to do. I think that's one that's just really low hanging fruit and easy, and it promotes internal equity in your organization.
You know, you're treating your family members that are local to your workforce as a part of the team and helping them grow their profession, [which is] another way to recruit and retain staff.
Participating providers will receive federal support for integrating mental and physical healthcare services in team-based care
The Centers for Medicare & Medicaid Services is launching a new model to test the integration of mental health and primary care services, giving healthcare organization an opportunity to leverage new strategies and technologies in a team-based care approach.
The Innovation in Behavioral Health (IBH) Model will be tested through the CMS Innovation Center (CMI), which will align Medicare and Medicaid reimbursements through state-based programs. The idea is to create a care management plan for patients living with mental health issues and/or substance use disorder that incorporates mental and physical healthcare.
“The systems of care to address physical and behavioral health conditions have historically been siloed, but there is a direct correlation between people with mental health conditions or substance use disorder and poor physical health,” CMS Deputy Administrator and Innovation Center Director Liz Fowler said in a press release issued Friday. “This model will bring historically siloed parts of the health system together to provide whole-person care--designed to keep people out of the emergency department, ensuring better care management and coordination, and improving their overall health.”
The eight-year program will launch this fall in as many as eight states. CMS is expected to release a Notice of Funding Opportunity sometime this spring.
The model lends federal support and funding to a concept being tested by healthcare organizations across the country. Faced with an onslaught of patients living with behavioral health issues and a shortage of resources, providers are turning to team-based care to give these patients a more comprehensive care plan. The team-based approach also supports the theory that many behavioral and substance abuse issues stem from or are exacerbated by other health concerns, including chronic conditions.
The model also enables providers to fold in services and resources that address barriers to care, or social determinants of health (SDOH), to affect many underserved patients, especially those in Medicare and Medicaid programs.
“Addressing the nation’s behavioral health crisis remains a key priority for CMS,” CMS Administrator Chiquita Brooks-LaSure said in the press release. “Through this model, CMS will support behavioral health practices to provide integrated care and help meet people’s behavioral and physical health and health-related social needs, like housing, food, and transportation, all of which can negatively impact a person’s ability to manage their care.”
CMS officials say the model will incentivize participating providers “to work collaboratively to screen, assess, and coordinate between individuals’ physical and behavioral health needs.” The model also gives providers a chance to use virtual and digital health technologies to improve access to treatment and support services.
Start small to grow sustainably, and keep the right people plugged in, say CNOs and CNIOs in the know.
With nursing tech disruption at a fever pitch, savvy CNOs and CNIOs are putting their heads together to ensure their investments make real impact. And there’s one place in particular where they’re setting their sights.
“I think virtual nursing is definitely on the mind of every CNO, or it should be,” says Natalie Nicholson, DNP, MBA, RN, CENP, NEA-BC, associate chief nursing officer at Denver Health, which has more than 8,000 employees across its main hospital and nearly 40 additional care locations. The organization identified a virtual nursing vendor through an RFP process and plans to roll out its program this year.
Nicholson and her team are not alone. Two-thirds of U.S. chief nursing officers are already interested in, researching, or deploying virtual nursing, says Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN, founder and CEO of Innovation Advantage, a healthcare innovation consultancy specializing in the model.
Driving the trend is an aging population who’s requiring more care and a shortage of clinicians to provide it.
“It’s no surprise that nursing has taken a major hit with COVID in terms of staffing,” says Kathi Zarubi, DNP, MBA, RN, senior vice president and chief nursing officer at HonorHealth, which has six hospitals and more than 70 additional care locations throughout Arizona. “All hospitals in the country are trying to figure out how to safely staff.”
Zarubi sees virtual nursing as a key part of the solution, and she has led her organization in launching a pilot at one of their Phoenix medical centers in December.
Denver Health and HonorHealth’s CNO-CNIO teams share what it takes to stand up and evolve a virtual nursing program that fosters quality care and human connection from both sides of the screen.
On Team Nursing 2.0
In virtual nursing, a remote clinician can handle administrative duties that, though essential, could take time and energy away from bedside care. Zarubi says these duties often include admission or discharge documentation, as well as patient education about things like a new medication’s side effects. It’s the power of two nurses, one at the bedside and the other on the screen, combining brain power and bandwidth to better patient care.
Virtual nursing could represent the next evolution of team nursing, CNOs and CNIOs say. The context has changed significantly since the model emerged in the 1950s.
When deciding whether and how to implement virtual nursing, center your north star, CNOs and CNIOs say. Hint: It should involve high-quality care and safety.
Other objectives may include nurse recruitment, retention, and efficiency, as well as cost.
“Health systems across the nation are in financial burdens right now,” Nicholson says.
From there, Zarubi says, be sure to ask the right questions, such as “How do I retain these very precious nurses, and how do we make the work enjoyable and not a burden?”
With these big-picture considerations in mind, look to prospective end-users—both nurses and patients—to shape strategy.
With five of its six hospitals Magnet-recognized, HonorHealth already had a framework in place for sourcing input on its pilot plans, Zarubi says.
“Magnet is really a structure that supports the individual bedside nurse having a large say in how things function and the governance of care,” she says.
At HonorHealth, that looks like a transformation office that Larson co-leads with nursing colleagues to create technology solutions that support organizational strategy. Outputs flow monthly to a nursing informatics council, where, in any given meeting, about 50–60 frontline staff, clinical directors, and CNOs across care settings and locations weigh options and make decisions. For larger-scale initiatives, Larson taps a clinical technology experience council, another multidisciplinary body that brings physicians, nurses, and other clinicians to the table to help decide whether solutions under consideration should move forward.
“We really want it to work for the organization, and not just today, but in the long haul,” Zarubi says. “So these kinds of councils allow us to take a look at those technologies from that standpoint and get all the users at the table to provide their input.”
The same goes for gathering input from patients and their loved ones through a dedicated advisory council, which has been a fixture “for many years,” she says.
“Measuring the patient perspective, and the actual patient and family experience with any new technology, to me, is very important,” she says.
On Winning Hearts and Minds
Beyond empowering end users to define priorities and make decisions, CNOs and CNIOs can set programs up for success by addressing concerns head on.
“We’re not eliminating nurses by any means,” Zarubi says. “That is not the goal. The goal is to supplement the care and provide an even better experience for our patients.”
It’s also important to find champions to reinforce this message.
“It’s a win, and we've experienced that over the years with any new technology or any new piece of equipment,” Nicholson says. Some of Denver Health’s nurses also work at a nearby hospital that’s implemented virtual nursing and have been singing that program’s praises.
“Those nurses are like, ‘It’s amazing, you'll love it,’ ” she says.
The good news is that the state of nursing today means fear of the unknown is often tempered with such excitement.
“Because the nurse market is so positive, I don't think nurses are as fearful for their positions as they probably would be for other positions,” says Nicole Myers, MSN, RNC, associate chief nursing informatics officer at Denver Health.
On Choosing the Right Tech
Once the vision is set, it’s time to talk tech. Myers recommends using a roadmap to visualize initiatives coming down the pike, how they roll up to organizational goals, and whether new or existing technology might enable their success through well-sequenced actions.
For virtual nursing programs, selecting the right vendor is a crucial step. Here, CNOs and CNIOs say, focus on the seamlessness of integration with current EHR software.
Denver Health, which uses Epic, closely vetted companies that responded to their RFP to ensure implementation and maintenance wouldn’t require outsized IT effort or additional personnel, Myers says. Such technical debt is not always on a CNO’s radar, but it should be, especially given the financial strain so many are feeling.
Similarly, think long and hard about which premium features are nice-to-haves, rather than day-one musts.
“We don’t truly need every bell and whistle, and I think the nurses would agree with that on the floor,” Myers says.
Also, look at the backend to ensure prospective software offers helpful analytics, Larson says.
“Does it support our processes?” she asks. “Are we getting the output in the data that we're looking for?”
On Starting Small to Grow Sustainability
When it’s time to pilot, the prevailing advice is to start small.
That approach “allows time for change to be adapted, and to be accepted, and then start rolling it out into other areas,” Nicholson says. She and Myers plan to preempt virtual nursing services like admissions and discharges with virtual sitter services.
Zarubi and Larson are taking a similar tack. They launched their program on a single floor at one of their medical centers last month, and the laser focus has allowed them to expand quickly to all three floors earmarked for the pilot. Now, they’re refining based on early learnings and planning a full study on their nurses’ experience.
Although they’re still crunching the numbers, early signs point to improved patient experience. They’re hopeful about nurse retention, too.
“We’re trying to find that magic balance for that bedside nurse to try to get them to really enjoy their nursing experience and to home in on why they went into nursing to begin with,” Zarubi explains.
On Making Virtual Nurses Feel at Home
When laying plans, don’t forget about the people behind the screen, CNOs and CNIOs advise.
Nicholson likes the requirement she’s seen for virtual nurses to have at least three years of hands-on experience.
“I think that's fantastic; more would even be better,” she says. “There is a level of maturity and understanding when you've been in nursing for three to five years, and you can pick up on things that a new nurse takes a little bit more time to learn or recognize. It’s just experience. It’s just miles.”
In this way, the model also shows promise for mentorship by empowering veteran nurses who may not want or be able to work on the floor to impart wisdom to recent graduates at the bedside.
“They can present and have their clinical skills, or their clinical brains, shared with newer nurses and teach them and also be taking care of patients,” Nicholson says.
That’s why virtual nurses should be treated like part of the team. Even though HonorHealth’s remote partners are based outside Arizona, Zarubi and Larson onboard them “like they’re our own employees so they understand our goals and our values, our vision, our mission.”
That ethos carries all the way through to their virtual background, which displays the HonorHealth logo.
“It provides that seamless experience that they are one of our members of the care team,” Larson explains.
It also reinforces the humanity of it all.
“We don't want robotic nurses,” Zarubi says. “We want real life human beings that have a human connection.”
This leader discusses how to bridge the gap between health systems and unions.
Recently, there has been an increase in nursing strikes and union activity throughout the United States.
Nurses are frustrated, and the recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.
To get the bigger picture, we sat down with Katie Boston-Leary, Director of Nursing Programs at the American Nurses Association, to discuss the underlying causes of strikes and how to communicate with unions to achieve better outcomes.
Healthcare CFOs know the pandemic cost them big, but now there's a number attached for one state.
After years of tight margins made worse by the pandemic, many hospitals are beginning to feel a measure of relief. But how much financial strain did the pandemic really put on hospitals and health systems?
In Pennsylvania, it was $8.1 billion worth of strife.
You read that right. The total COVID-19 related expenses and lost revenue reported by Pennsylvania hospitals and health systems between January 2020 and December 2022 were $8.1 billion, according to the report by The Pennsylvania Health Care Cost Containment Council and The Hospital and Healthsystem Association of Pennsylvania.
While this report only spotlighted Pennsylvania, there are a few key insights that are applicable to CFOs nationwide.
So what was the true financial impact?
As mentioned, Pennsylvania hospitals and health systems reported a staggering $8.1 billion in total COVID-19-related expenses and lost revenue during the pandemic.
Although most hospitals and health systems remained financially stable due to COVID relief funds, those funds have since dried up while the same challenges still exist.
Of this sum, COVID-19 staffing costs emerged as the most significant expenditure, reaching $1.3 billion. According to the report, other costs included:
Testing expenses: $374 million
Supplies and equipment expenses: $679 million
Construction expenses: $28 million
Housing care expenses: $9 million
Other expenses: $434 million
Revenue loss: $5.3 billion
When it comes to the staffing costs, the amount highlights the immense financial strain incurred by hospitals in responding to the staffing demands posed by the pandemic. CFOs still need to scrutinize these figures to gain a nuanced understanding of where financial resources were concentrated and explore avenues for financial resilience moving forward.
The report also shed light on how the pandemic has exacerbated workforce shortages in Pennsylvania's healthcare sector.
Hospitals reported an average statewide vacancy rate of over 30% for key clinical positions, such as registered nurses, nursing support staff, and medical assistants, by the end of 2022.
This intensification of workforce shortages continues to pose an ongoing challenge to hospitals, hindering their ability to provide comprehensive care and potentially impacting patient outcomes. And as we know, these staffing shortages have been the catalyst to the increasing number of workforce strikes.
As mentioned, CFOs must strategize to address staffing shortages, focusing on recruitment, retention, and workforce optimization.
But what about other states?
A previous study showed that COVID-19 care prompted higher operating expenses and rapidly escalating labor costs for CFOs nationwide. In fact, hospitals in the United States experienced a total loss of over $200 billion because of an estimated 45% decrease in operating revenue just between March and June of 2020.
Pennsylvania's data through 2022 gives healthcare CFOs across the nation a granular look into these costs, providing valuable insights into the continued long-term financial repercussions of the pandemic.
The report's focus on COVID-19-related expenses and lost revenue underscores the continued need for robust financial planning and risk management, especially as many CFOs are still clawing their way out of the red.
CFOs should conduct thorough audits of their institutions' pandemic-related financial data, identifying areas for potential cost containment and revenue enhancement. Leveraging data can not only assist CFOs in forecasting future financial scenarios and implementing proactive measures, but help them push their current margins in the right direction.
Two leaders share their insights and strategies to help CNOs work together with staff and problem solve.
Right now, it seems like every day there are new cases of nurses striking or unionizing at health systems all across the country.
Nurses are frustrated, and the recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.
Here's what CNOs should know about preparing for strikes.
With competition from disruptors increasing and the industry under pressure to make healthcare more convenient and less expensive, health system leaders need to take CES seriously. Here are a few takeaways from the recent event
As CES 2024 slides into the rear-view mirror, here are some of the key takeaways for health system executives who either attended the show or kept track of the goings-on from a distance.
Keeping the Consumer in the Loop
CES is all about the consumer experience, a strategy that many healthcare organizations have been slow to embrace. But with HCAHPS scores and Joint Commission reviews giving more weight to the consumer experience, the emphasis for healthcare leaders is not only in improving consumer engagement but creating a dynamic that allows providers and patients to work together on care management.
(Of course, one of the enduring ironies of healthcare conferences is that while the patient is becoming more of an active participant in the industry, very few patients are actually invited to these conferences.)
CES does have the advantage in that everything is geared toward the consumer, so all the technologies on display—in the area designated for digital health as well as in all the other halls—are designed to be sold to the consumer. In digital health, that means creating a marketable product that a consumer will be interested in buying and using, which again isn’t a strong point of clinical grade devices or platforms. In fact, the healthcare industry has long struggled to bridge that gap between consumer-friendly and clinically relevant technology.
But the stakes are higher now, thanks to Amazon, Walmart, Apple, Walgreens, and others who are taking the consumer experience in other industries (like retail, banking, and travel) and applying lessons learned to healthcare. Health system executives need to pay attention to those trends and take a look at wearables, consumer-facing apps, smart home technology, and other products that can allow them to make a connection with their patients and improve care.
Creating a Connected Health Experience
Smart technology was all the rage at CES, from toilets and showers to beds and pillows to refrigerators and ovens to, believe it or not, grills, patio furniture and fireplaces, birdhouses, exercise equipment, and beer-making and bartending machines (thankfully, sex technology seemed to be on the way out this year). In short, data is king, and anything that can gather data on the user experience and use that data to make the experience better is in play.
No more so than in healthcare, where doctors and nurses are coordinating and managing more care based on data outside the electronic health record. The shift away from episodic care and toward value-based care means that providers (and payers) are interested in the entire patient journey, and health and wellness are part of that ecosystem. They need to collect data from the patient’s everyday life and experiences, from the home to the office to the school to the car and everywhere in between.
Health system executives looking at this shifting landscape need to understand not only the technology available for gathering and disseminating data but the platforms needed to connect those disparate devices and points. This puts an emphasis on infrastructure management and interoperability. It’s nice to have a bed and a toilet that can tell you how a person is sleeping and, ahem, pooping, but is that data being transmitted seamlessly back to doctors who can use it to improve care?
Homing in on … the Home
One of the bigger themes in healthcare is the shift from the hospital to the home, or the understanding that healthcare can be delivered in locations outside the traditional care setting At CES, the focus was on technology and smart home products that could help consumers improve their health and wellness.
At the Digital Health Summit, the focus shifted to how a tech-enabled home could help healthcare providers improve monitoring and care delivery. That might include the Hospital at Home strategy, in which health systems provide both in-person and virtual care at home for patients who would otherwise be in a hospital. But it also offers opportunities for health systems to gather and use data from the home setting to manage and coordinate care, working with consumers to prevent serious health issues from cropping up.
The key is in understanding what the consumer wants out of healthcare.
“It’s life care,” Leslie Saxon, MD, executive director of the USC Center for Body Computing and a professor of medicine at USC’s Keck School of Medicine, said during a panel discussion on healthcare in the home. “Traditional medical care [providers] have to believe that the patient is the consumer. … And the people who are going to drive this market are the patients.”
All in on AI
As with every other conference over the past year, AI was a part of almost every conversation and panel presentation at CES.
A lot of the talk in the digital health space centered on how the technology could make things easier for consumers to access healthcare services. Integrating AI tools into the back end can help match consumers to the right resources, selecting the appropriate care providers and locations, while also speeding up the registration and insurance/payment processes. AI has the ability to sort through large amounts of data, speeding up the process and taking pressure off nurses and other office staff.
The technology will be particularly helpful in gathering and sorting data coming from devices and other locations outside the healthcare setting. Roughly 80% of that data is unstructured, and needs a little coaxing to be able to fit into the medical record, where providers can use it to improve care pathways.
“I think the greatest advance that we are going to see in the next few years is the ability to take unstructured data and use it,” Lee Schwamm, MD, SVP and chief digital health officer at the Yale New Haven System and associate dean of digital strategy and transformation at the Yake School of Medicine, said during a panel on AI and the future of healthcare.
Simplicity Matters
Above all else, CES was about consumer convenience, and the key to digital health success will lie in making healthcare access as convenient as possible for consumers. That means embracing tech tools and platforms that make the process intuitive.
“Healthcare is more confusing, more complex, and more costly than ever before,” Glen Tullman, the former Allscripts executive who launched a digital health startup focused on chronic care management and now fronts Transcarent, said during a closing session with billionaire businessman Mark Cuban.
That’s why disruptors like Amazon, Walgreens, and Cuban’s own Cost Plus Drug Company are drawing consumers away from traditional healthcare organizations amid what some are calling the “battle for primary care.” They’re cutting through the complexity and using technology to give consumers what they want in an easy format.
Phil Wright, CEO of Memorial Regional Hospital South, joins HealthLeaders strategy editor Jay Asser for a discussion on altering approaches to solve workforce challenges and his leadership style in his first few months on the job.
CNOs must be ready to strategize and solve key issues in nursing this year.
On this week’s episode of HL Shorts, we hear from Lisa Dolan, Senior Vice President and Chief Nursing Officer at Ardent Health Services, about the top five challenges CNOs are facing in the new year. Tune in to hear her insights.
What do you predict will be the top 5 biggest challenges in nursing in 2024?
Dolan: Well, of course, at the top of the list is just the supply of nurses. The demand is far outpacing the supply. So that'll be a key piece.
Second to that is stabilization of support roles. As nursing becomes more and more taxed, it's especially important that we have a support team around the nurse. We're finding it more and more difficult to be competitive in our staffing of support roles. That's a that's a key worry and concern as well.
I think another key piece is innovation. There's so much great innovation going on, but how we incorporate that so that it's helpful to the nurse and not adding additional burden to the nurse is especially important.
Frontline nursing leaders and being able to retain the nursing leader. That's a very difficult position, in fact, I always say it's one of the toughest positions in the hospital. Being able to retain and support those frontline leaders will be key.
And then last but not least is really just burnout in general of the clinical staff. The roles are so difficult at times, and so [having] a healthy work environment for people to feel comfortable and not experience the rate of burnout that they have over the past several years [will be critical].
