Episode Transcript
[00:00:02] Speaker A: Welcome to PG Pulse Press Ganey's podcast on all things healthcare, tech and human experience. In this podcast, we'll be joined by some of the best and brightest minds in the industry to discuss challenges, share insights, and innovate the future of healthcare. Thanks for tuning in. We hope you enjoy the conversation.
[00:00:21] Speaker B: I'm Jeff Doucet Press Ganey's Chief Nursing Officer, and I could not be more thrilled to have a remarkable guest with me today. We my dear friend and colleague, Dr. Betty Jo Rachio, who is executive Vice President and Chief Nursing Officer at Advocate Health.
It's so great to always have a conversation with you because you are so incredibly inspiring and you always make me feel like there's so many more things I could and should be doing. So really excited to have you with us today.
[00:00:47] Speaker C: Well, right back at you, Jeff. I am so excited to be here with you today and we're gonna have a great conversation.
[00:00:53] Speaker B: Thank you. I really appreciate it. One of the things I've always admired about you is the ability that you have to just think in ways that I just don't see a lot of leaders thinking and really being innovative and forward thinking about how do we take kind of where we've arrived in healthcare over the last five or six years and really kind of reset the playbooks and completely out of. I hate the term out of the box, but completely like out of the ballpark thinking, I'll say.
So you've talked, and we've talked a little bit over the years about the importance of recognizing the critical role that nurses play in transformation. So I just love for you to expand on why you think that's such a critical piece of what we need to do right now.
[00:01:43] Speaker C: Well, first of all, I think nurses are perfectly positioned to think about things in new ways. We understand our history, we understand where we've been. We also understand we have to move forward in a different way. And I think the pandemic really highlighted that. And when you take a look at what nurse want today, it wasn't what they wanted when we graduated from nursing school.
And as leaders, our duty is to make sure they are happy, healthy, and love their profession. And today, I think we have a little bit of work to do. And thinking out of the box is going to be essential because what got us here will not get us into the next 10 years.
[00:02:21] Speaker B: Yeah, it's so interesting, you know, when you frame it that way and think about, you know, what nurses were having in their work environments, but pre pandemic, they didn't really want and I think that for my own experience, as you know, I was a hospital CNO at the time of all of that.
It was, I think, the great reset and the ability to really look differently. And I was in a group yesterday where we were talking about this, that we stopped having meetings, we stopped doing stuff that wasn't important, that we really were able to focus on our workforce in a way that we've never done before.
How do we get back to that place where leaders really can be present with their staff and really making those changes happen, do you think?
[00:03:09] Speaker C: Well, first of all, for me, it starts with our strategic plan every year. And so let's not bite off more than we can chew for a year. I think that puts us into a frenzy, trying to hit, I hate to say it, goals that we set up for ourselves.
And, I mean, we're like. We can be our own worst enemy, let's be honest. And it comes from a love of wanting to do more. But I would say targeting what we're gonna do and understanding the order of things. And I'd rather get more done on one specific thing in a year than look at five things that we never quite accomplished to full fruition. So for me, it's about narrowing that down. And I'm gonna say one more thing, Jeff.
It's about having a great team around you. So as the chief nurse executive, my role is to work not in the now. It's to look at that near pivot and then look at five years down the road and stay ahead of things. And oftentimes we get drugged back into the now because our teams don't have direct focus. And listening to the front lines, there's nothing more powerful than rounding. As a chief nurse executive, you know, I know you did this. You're such a people person and really listening not just for what they're saying, but what they're indicating to you. And the pandemic was something that they showed us loud and clear what they wanted. And we are listening, but we have to listen in a way that we can accomplish it.
[00:04:31] Speaker B: Yeah.
And you know, you're absolutely right. That time that you spend with frontline staff, mid level leaders, even your senior leaders, as you're rounding, for me, that was how I derived my energy. Like when it was a rough day or I was feeling like I was really low in the tank, that that's where I wanted to spend my time. I know that's really important to you as well.
[00:04:52] Speaker C: It is. Because you can see a lot, you can hear a lot, and you experience what they're experiencing. I mean, I still practice, Jeff, as a nurse anesthetist, and one of the reasons I do that is I want to be next to patients. But it doesn't make sense daily for me to be up next to patients. I've got to understand what my team, my staff, and what the nurses are going through.
[00:05:12] Speaker B: Well, you jumped a little bit ahead in my list of admiration for you, because one of the things I was going to talk about with you that I absolutely love, and I literally think I talk about this specifically about you two to three times a week when I'm with different leaders across the country. You have figured out the way to do what many physician leaders do, and that is stay very connected to your clinical practice.
How do you think? Well, first of all, I know you think it's important, so I was going to ask you, do you think it's important? But how do you think we get nurse leaders there, that there's something that they could do that is more connected to the operation than, you know, once a quarter, I'm gonna go spend four hours shadowing somebody on a unit.
[00:05:57] Speaker C: Well, I do know nurse leaders that do this, but it's hard. It has to be carved out in your daily standard work. Your weekly standard work, whatever you're doing. And here's what I'll say. I've never given up my practice. I mean, I started right in leadership a ways back. We won't talk about the number. We won't talk about the number of years, but I mean. And I never gave it up the whole time. And I think you have to stay engaged with it the whole time. So having the right leader who supports it. I've been lucky enough in my career. My leaders have said it's important to you, it's important to the organization that you stay connected. And I've always carved out time. Now it may be two times a month, but at the end of the day, I'm still connected at the front lines. Actual practice and nurse leaders could do this. It's just again, we get so busy, our standard work isn't carved out and our leaders. Right. Put a lot on us.
And so having your leader supported is key.
[00:06:48] Speaker B: Yeah, and I'll say, I mean, for myself, like, even if I were able to do that, I think there'd have to be some refreshing that would happen before I get out there because, you know, I'm still of the multicolored pen charting generation.
[00:07:00] Speaker C: So we could go back. I think we're headed back to that. You'll Be right there.
[00:07:03] Speaker B: Yes, I think so, too. Oh, my gosh. Well, in a recent conversation that I heard that you had either read it or in a podcast, you talked a lot about the healthy nursing workforce really being one that's flexible, focused on critical thinking, supported by efficient workflows, and backed by strong organizational support.
I think all of those things obviously are critically important. But as you think about those four key elements, what does that look like at Advocate Health and how you're leading in this new role that you're in?
[00:07:39] Speaker C: Yeah, it's interesting going to a new organization because you did certain things in your last organization that you want to bring across learnings, the things you wouldn't repeat. Right. Any good leader also realizes you learn the most from failing, right?
[00:07:52] Speaker B: 100%.
[00:07:54] Speaker C: And I think it's about organizing your team to be able to do this work. And it is totally different thinking. And you have to understand what the nursing workforce wants today. You have HR has to be by your side compensation. Your leader has to be on board. And I'll tell you, technology has to be involved. And without technology, it becomes more burdensome on our nurse managers. And we cannot have that, because if I look at one group of leaders that is doing more than I could probably handle, it's the nurse manager. And so how do we make it palatable for them to be able to execute on the strategy? So you have to keep all that in mind. You also have to build a team that's bent towards understanding technology. And to be honest with you, I wouldn't have taken a position that didn't have that bend, that organizational bend. It's really hard as the nurse leader to come in from the side if the organization doesn't want to accept a technology stack that can actually get us moving forward in nursing. So I had that when I interviewed. It's one of the things I looked for, and they have it in spades.
[00:08:56] Speaker B: That's amazing. That's amazing. And I think too, like, when we think about what we're developing to help all nurse leaders and all leaders across the organization, my conversation at our design tables at Press Ganey is really about how do we reduce this cognitive burden that exists in on leaders with multiple systems to look at.
And that's like, the beauty of what we're designing in this HX platform.
We did a focus group with our user experience team of nurse managers and nurse leaders, and, you know, our president and COO jokes that he doesn't really want any tech advice from anybody that isn't wearing a hoodie. Under 30 years old and has big, chunky headphones and, you know, and it was a whole team of folks like that who'd never worked in a hospital and got to listen to what nurse managers go through every day and just kind of the look of shock and awe on their face and some of the things my heart was just like pouring out through this zoom focus group. For these managers who are just completely overwhelmed, how do you think about that development process for them and in your organization?
[00:10:03] Speaker C: So we work with a couple of outside groups and I will tell you, any technology that we look at that the nurse manager is going to have to touch, we want them involved in it as well as the front lines. We want them together.
And we're starting to develop nurse managers in a completely different way than we have in the past. So when you look at professional development for specifically that group, everybody needs professional development, but this group needs to understand the importance of being with their staff, listening to their staff, and they need tools that allow them to spend time with the staff. You remember the days when nurse managers were doing audits, payroll, they were doing back office functions. Those administrative tasks now layer on all the analytics we expect them to look at to run their units. I always say, you're the president of your unit. Like, if you want to make any change in an organization, don't start at the top. Start at the level that can actually help the people on the ground make changes in the right way. And so when we add more stuff onto them, all we're doing is confusing our direction to them on where we want them to focus. So what I've been so impressed about, it's the way that you're looking at delivering analytics, and I would say in our organizations and any outside company you're looking at partnering with, make sure that it's not just numbers and things that nurse managers have to, in their mind, put together. It's got to be information. You've got to take the analytics, transfer it to an operational focus, and then deliver it in a way that they can consume it and really make changes at the front lines. And we're doing that with every single way in advocate that we look at our tech stack and our analytics stack. So I love what you're doing. I saw some new things around NDNQI that I am very, very excited about. And we need it and we don't have it in advocate yet. So we'll be connecting.
[00:11:51] Speaker B: Well, I love it and I appreciate that because the team that works behind the scenes on all that, they don't get a ton of recognition from especially our clients because everyone's kind of behind the scenes making it happen. But I'll tell you the kind of interactive chat functionality that we released in the hub this week where, you know, a nurse manager could say, tell me about my clabsees or my Cauti's and just type that in. And then you get all of the analytics that you need, the best practice guidelines, all the things to make sure that you're doing, all the things you should be doing, you know, will be really at their fingertips. So I'm so excited about all of those types of things.
[00:12:24] Speaker C: And you know what, Jeff? I want to use it at my meetings.
[00:12:26] Speaker B: So.
[00:12:26] Speaker C: So I don't want it buried clear down at the nurse manager level either. I want their leaders and their leaders to be able to see like we're gonna use this technology to our maximum capability throughout every single leadership level. Because then they get the message like, this is important. And so I'm so excited about it. Cause I could see how I could use it to drive it down. And when I'm rounding out there, you're on a unit, you pull it up and you can be like, tell me about this. Like, you could have meaningful conversation around the data and the analytics. And I think that's what brings it home for people.
[00:12:58] Speaker B: There's still, believe it or not, a lot of organizations that I visit that I still, I sit down at the table to review quality with them or we're helping them on their HRO journey and I get a big static, printed out PowerPoint slide deck of, you know, data that's a couple months old. And just like you were saying, you know, can you imagine being in a board meeting and a board member asks a question about what's happening and you just type it in the chatbot and it pulls up all your data. Data from multiple different systems.
[00:13:24] Speaker C: Yes. This is so, okay, this is the most exciting thing. This is how you can help people. And this is why, just going to give you a little kudos. You're great in your role because you get this. You understand you're leading the organization in a way that we can use it. And you get those are the partners that we're looking for out there.
Because if not, we end up having to figure out with our teams how to make it into what you probably should have already done. So having a chief nursing officer at Press Ganey that is well respected, that does get down to the front lines and can relate to where we're at is it's like solid gold for us.
[00:13:59] Speaker B: Oh, my gosh. Well, I mean, I'd like to stop the podcast right here and now because, you know, I idolize you and thank the world of you, so that's such a compliment. So thank you. I appreciate that. One of the things I remember one of our first conversations in a previous role that you were in and you were so, so excited about some of the work that you were doing around innovations and staffing and new models of care. And we've got a panel coming up, so that'll be also be recorded a little bit later this morning. And so if you're interested in the panel, make sure you watch that. But can you talk just a little bit about how you think about staffing and resources?
Because for me, that conversation that you and I had, and you probably don't even remember, but several years ago, it still sticks with me about balancing workload and having people come when they want to be there and how you get the work done. And would you just talk a little bit about that?
[00:14:54] Speaker C: Sure. First of all, I think a five year plan for any chief nurse executive should be focused on three things, and I call it the three W's. Workforce, workflows, work environment. And when you look at those three things, people always say, well, where are you starting, Betty Jo? Like, what do you. It's a lot of work. I'm starting with workforce because guess who has to carry out workflows and work environment has to be done according to what our people need. And at the end of the day, you have to have enough people at the bedside regardless of how you look at your care delivery model. And there are many different ways. And here's what I tell people when you're looking at workforce, your care delivery model, structure. We've been working on Skillmix, you know, all the things that we've been working on. I think it's gonna take doing it in a very automated way that allows the workforce to have maximum flexibility. So this is another pain point that can come for the nurse managers because they want a schedule that is fully focused and loaded and they're ready to go. Why do they want that? Because the schedule's much easier than daily staffing. And we know this, right, because you're looking for people all the time. And so opening up a flexible workforce layer is 100% key.
And the way you look at workforce matters. So today we look at core part time, full time.
A lot of us have agency filling in the gap, but in that middle layer, that's where the Magic happens. And it's. I call it the flex layer, and it's our regional float pools, our local float pools. It's also this concept, and you can call it whatever you want, gig nursing workforce, per diem. It's those people that are going to give you occasional hours with some regularity that we can push shifts to. It's not that we're not gonna staff them in the normal way. We're not gonna make phone calls anymore. But the nurse manager knows the certain percentage of hours and this is where the analytics are important. They can see on their unit how much they're filling in each of those layers. So they can still count on the flex layer without locking them in to that schedule. Right? So regional flipples and local flipples, we still schedule, right? They're benefited, but that gig nursing workforce might be coming from a hospital where somebody's working full or part time and they give you their extra hours and then they get into your culture. And then if you have a great culture, they want to stay with you. It's. It's important for not only daily staffing, but recruiting and getting your culture lined up. Now they're fully employed. So I get quality, right? I get people moving in and out of your organization. But they have all your competencies, they're fully employed.
They're just allowed to be on a platform that offers them flexibility. And then your core who pick up your incentive shifts are on that same platform. And so everybody's kind of leveling. The way we look at that, that's really a flex shift. A core doesn't have to do it right. They don't have to give you overtime, they don't have to pick up an additional shift. But done with a technology stack that enhances it is key. And it opens up a world of flexible layer with technology that you wouldn't normally see and gives the nurse manager analytics that they didn't have before done, right? And so I'm so passionate about it because it opens up the world for us. And here's the thing, nurse managers and I will even say some chief nurse executives want to lock people in.
Our workforce doesn't want to lock in anymore. So incentivize where you need them to go. Like, look at where you're offering incentives. And maybe on a Saturday night, there's a higher incentive than on a Tuesday day shift. And that's hard to do without some technology to help you and some predictive analytics.
But once you get that, you've really got some secret sauce for not only helping the workforce. But getting your shifts filled, how do.
[00:18:39] Speaker B: You get that to scale in an organization that's your size, like spanning multiple states, multiple regions. Some have better workforce options and pipelines than others. So how do you even start to think about that in your role?
[00:18:53] Speaker C: So you have to get yourself leveled on some standard work. And so one of the first things is looking at your job descriptions because you have to be able to pull nurses in in a certain way. And there's a couple pieces of technology along with some standard work you have to do. So you're narrowing down job descriptions. Does it really matter that you have an ED nurse lined out in all their duties and an ICU nurse, It all needs critical care skills, right? So looking at skills, not job descriptions, because nurses again, don't want to function in a very linear manner. If they are an ICU nurse, they may be willing with the right competencies to work icu, maybe step down, possibly med surg. If we can get that, I'm sure we'll get to that. But straightening kind of that workload out, they will be willing if they have all the competencies and we can transfer those sets into a technology they could be willing to pick up for the right price. And we're spending the money anyway. I tell people. So we're spending it. It's not like I'm asking you to spend different, more money, right. Actually it ends up being less money, but more focused. And it's interesting. We're actually accomplishing what the workforce wants and then exactly what we need to be able to move forward. And the other thing I'll say is it does require some technology. So everybody's working on apps these days. Do you know anybody that can't work a smartphone? Even our parents, they're working off of apps to get things done. So it's an app based. You need to look at it in an app based program so people can how they conduct their life. They can conduct picking up their shift. So you do need a staffing and scheduling system that has a good API, both into it and out of it. And you need a nurse credentialing system. And there's this magic sauce is that nurse credentialing system. Because today it's done in an HR system according to job descriptions. That's why the skill set and having a credentialing system that has their license, all their competencies, all of their certifications and it gives you a, it gives the chief nurse executive a really nice view of their workforce for today. It's kind of A hunt and peck thing in some systems.
[00:20:55] Speaker B: So I love that though. And you know, again, I just think back to the my early days as a nurse manager with those Ansys sheets printed out and my pencil everywhere trying to count numbers and hand type my needs list in word perfect. You know, I'm just really aging myself.
[00:21:11] Speaker C: I did the same thing.
[00:21:12] Speaker B: We've come a long way.
[00:21:13] Speaker C: We have. Remember the triphones we used to chart on like we went electronic. But we're not taking the full advantage of, I think, what we have today or thinking about it and how we can make lives easier along the whole continuum.
[00:21:25] Speaker B: Well, and I think too, you know, most electronic records were originally designed to be a physician documentation tool related to billing and you know, the last organization that I was with before Press Khini, remember sitting down with the nursing informatics specialist and talking about the utilization of fields that were in the new patient, new admission assessment. And you know, there were two pages of fields that nobody ever used and nobody ever, you know, clicked on or filled out or whatever. And so we were like, well, why do we even have them? Let's just take them away and see what happens if, you know, nobody says anything. And of course, sure enough, nobody, you know, said, oh, well, I'm missing two pages of the. Essentially we want to do this when. Bring it back, bring it back anyways. So sometimes we make it way more complicated, I think, than it needs to be.
[00:22:15] Speaker C: I agree. And I want to make a comment here about our EHR driving our nursing workflows. When you think about it, the nurse works in the EHR more than any other specialty or complement we are in it. It's actually driving us instead of us working and designing what we need according to the nursing process. Right. And so when we added it in, all we did was said, nurses pick this up. But where we are today is we don't have the luxury of letting it drive us. We have to figure out in workflows how to have that help us be more efficient.
[00:22:49] Speaker B: Yeah, I think too, ambient listening is really going to be the game changer coupled with really good AI because I think about how we talk about compassion, caring and empathy and communication when we're working with our clients and helping people think differently about that. And can you imagine in the it's happening now in some organizations, but to be fully adopted in the not too distant future, certainly while we're still working, that a nurse is actually having a conversation with a patient, talking about what they're finding, how they're doing the assessment and in the background, the electronic medical record is picking all of that up and you've got to 90% completed documentation from having a meaningful conversation with a patient versus standing behind a computer saying, do you have chest pain now? You know, whatever, like it's happening today.
[00:23:41] Speaker C: I think that's what makes me most excited about AI, is that it can allow us to spend more time with our patients, done correctly and worked into workflows. And to do that, you need nurses developing this. You don't want me, who doesn't do it every day to figure this out. But getting down to the front lines and one of the things that I'm doing, and this may be a helpful hint in my professional governance model, I have a subsection that's focusing on technology and analytics from the frontline level and they are designing the future at advocate with technology, partners with. And one of the things we're going to be doing is watching their satisfaction, their engagement and our patient experience. So the data that you're bringing out of Press Ganey, fuels us to do the right thing in the right way for our frontlines.
[00:24:27] Speaker B: I absolutely love it. Absolutely love it. We have to bring this to a close. Although I could sit here and talk to you all day long, but you have said like so many things today that I think are gonna really help nurse leaders across the country who are listening to this. But before we wrap, I always like to ask the question, if there were one thing that you could wave the magic wand or snap your fingers and fix today, what would that be?
[00:24:56] Speaker C: Our biggest, most wicked problem, I think today is cognitive workload, both at the front lines and at that nurse manager level. If we could fix that today, our workforce would feel better. And I get up every day no matter what I'm doing now. Near, far, technology doesn't matter. I do it with the bend of sending people home after a 12 hour shift feeling as good as or better than when they came in. And I think that is cognitive workload and their perception of it.
[00:25:26] Speaker B: I love that.
You know, it's funny, as a complete side note, I'm not gonna have that song from Titanic in my head for the rest of the day. Near, far, wherever you are. And every time I hear it, I'm gonna think about you. So, okay, so the last thing I'm gonna ask you is for the one piece of advice that you would give to an organizational leader who really wants to improve what's happening with their workforce. What do you think is the best piece of advice that you could offer around the workforce?
[00:25:58] Speaker C: Engagement I would say keep dreaming with your frontline staff on a better world, because that's the only way we're going to be able to move ourselves forward. But do it with your frontline. No matter what level you're at in nursing leadership, stay connected to what's going on and be able to translate that into the work that the whole organization pays attention to.
[00:26:22] Speaker B: Well, I don't think we could have ended on a better note than that, and I hope everybody now understands why I was so excited to have you as my guest today because you are such an inspirational leader. And I literally think about the conversations that I have with you on a daily basis to try to help other nurse leaders learn from your great successes. So thank you so much for joining us today and for all of your leadership in shaping the future of nursing. It truly has been my pleasure and honor to have you here on our podcast. And thank you all for listening and tuning in to this episode of the PG Pulse. We hope today's conversations inspire you to take action and in support of the incredible nurses in your organizations. Thanks again, Betty Jo. Really appreciate it.
[00:27:06] Speaker C: Thank you, Jeff, you're so energizing. You've really influenced my career and I appreciate you.
[00:27:11] Speaker B: Thank you. Likewise.
[00:27:13] Speaker A: That's a wrap. Thank you for joining us today and special thanks to our guests for sharing their time and insights. Stay tuned for our next episode, which will be released soon. In the meantime, visit our website, where you'll find more information on the human experience and a lot more.
