← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
C.J. Marbley, Chief Nursing Officer at University Medical Center New Orleans and Chief Nursing Officer and Chief Operating Officer at New Orleans East Hospital within LCMC Health
00:23:50
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:33]
B
This is Laura Dardo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by CJ Marbali, Chief Nursing Officer at the University Medical Center New Orleans and Chief Nursing Officer as well as Chief Operating Officer at New Orleans East Hospital, LCMC Health. C.J. it's a pleasure to have you on the podcast today.
- [00:51]
C
Thank you. I'm excited about being here.
- [00:54]
B
Absolutely. Now, I'm looking forward to our discussion and learning a little bit more about some of the great things you're doing at the hospital and, you know, truly how you're thinking about the future, growth and development and more. But before we dive in, can you tell me a little bit more about yourself and the hospital?
- [01:09]
C
Sure thing. So I have been a nurse for 32 years now. I was trained at Howard University in Washington, D.C. and then started off as a trauma nurse, adult, and then pediatric trauma, moved on to the icu. I've been an ER director, an ICU director, a periop and surgical services director, and the senior director in all those areas also. And then I became the Chief Nursing Officer at New Orleans East Hospital in 2017, took over the COO role also in 2020. And then I became I took on a dual role at the second hospital at University Medical center in 2023, at the end of 2023. So it's been two years there. And then I was initially as VP and then became CNO in August of this year. So I'm excited about the work that both hospitals do. New Orleans Youth Hospital is a vital community hospital. It is a, you know, really focus on access and equity and making sure that we have the right care right where people need it in the East New Orleans area. So we're excited about being able to provide vital care for a community that went nine years after Katrina without a hospital. So to bring that back to the community was really big then. University Medical center is the large academic medical center. It's a safety net hospital for not only the region and around New Orleans, but also the state of Louisiana. We are also the only trauma center comprehensive Stroke center and certified burn center, all three in one in the Gulf South. So we're excited about bringing that expertise to a safety net hospital and to the region, to the state. We have two large academic partners. There we go. We train physicians from Tulane University and LSU at the same hospital, and then we train every other discipline in healthcare at that hospital also. So it's the largest training facility in the state, and we're so excited about the access it provides for our community members and the vital research and advanced care that provided there.
- [03:45]
B
That's amazing to hear and, you know, what a great experience that you've gotten over your career and cool to see how you've been able to continue to work your way up and add responsibilities and grow. Did you imagine when you first started off in the healthcare space that you would rise into the leadership position that you have and continue to make strides in impact at the executive level?
- [04:07]
C
I did not. I really didn't. I really. When I started off, I just really wanted to be a good nurse. My mom was a lpn, and she got the opportunity coming out of East Texas to become an LPN and really changed the course of our family. And when I came out, I just always, you know, learned from her. You just want to be a really good nurse. And so that's all I wanted to do. I wanted. I came out and I wanted the experienced nurses who have been there for a while to say, you know, look at me one day, say, hey, you know what? You're a really good nurse. That was my goal, really, and just to take care of people and really make an impact in people's lives every day. You know, we grew up saying that we want to do stuff, do things, or do have a career that makes an impact. And in nursing, you get to do that every single day. And so I was just enjoying that for, wow, maybe 10 years or so. And then I was asked by one of my mentors if I could help them out and just take a temporary role as a manager. I was like, sure, I'm. I'll help out, you know, and two years later, they like, why don't you just take the take, keep the job permanently. I was like, no, I'm fine. I don't want. And my wife convinced me to, like, listen to him and, like, listen to the offer. So they made an offer I couldn't refuse, and I got into management. And then what I found is the same care and concern and advocacy that I had for my patients. I was now able to give that to my staff and that's how I really transition. It's really able to keep the passion up and, you know, keep my motivation going. And it's always been, that's always my, my motivation is really around advocacy and care for the staff and the community that we serve. Make sure the staff have everything they need to be experts and provide the highest level of care for the community we serve. Because most of the places I've been has been serving a disadvantaged community.
- [06:20]
B
Well, that's amazing to hear and you know, what a great story to inspire you to grow and develop and take that leap and take those leadership positions. Now, in thinking about the last year or so, what is the most impactful initiative or project that you led?
- [06:37]
C
The last year has been, it's been quite a year, you know, so in New Orleans, we start off the year with the, the terrorist attack, the, the mass casualty event in the French Quarter in New Orleans on the, on January 1st. And that really shook our community. But I was so proud of our staff because we had drilled this many times and we were prepared. But being prepared and going through it, you realize how important we are to the community. And we took our patients not only from all over the city, but from all over the world because it was New Year's Eve, it was New Orleans, we had the Sugar bowl in town and we had patients from all over the people from all over the world in the French court at the time. And so it was that start off the year really made us focus on what we, the core of what we do. And I couldn't be more proud of the staff and how they responded then helping the families reconnect with their, with the patients and then being able to be there and provide counseling for those who lost their loved ones, that was big. We did all that at University Medical Center. We were the place not only for the traumas, but also for the family reunification. So that start off the year and then we really turned our focus on increasing access to care because we know that we have these specialties at the hospitals and we have capacity to take care of, take the sickest of the sick in the state. We've tried to increase our throughput for the hospital and increase our ability to accept patients transfers in. So, you know, two and a half years ago when we first started LA University Medical center, we were, we were probably at a 70 high 70s, low 80s percent acceptance rate for transfers. And we realized that we need to get better at that. So we've increased our census about 130 beds. We've increased our transfers. Now that we accept, 96% of all transfer requests come into the hospital. And we also are able to, we were able to decrease our length of stay by a day. So all that helps in increasing access not only for our community right around us, but also from the whole state being able to transfer patients into the hospital. So I think that's really made a difference in the health and well being of the state and really stands up to our mission. We are University Medical center is the hospital that took the place of Charity Hospital that was destroyed during Katrina. And so we're just, we're still the same, you know, MPI number. We're still. The spirit of Charity still is alive and well in at University Medical Center. And we still, you know, we debate with Bellevue, who's the oldest hospital in the country, but we're still with oldest continuous serving hospital in the country. And, and so we know the importance that we are to this region into the Gulf South. So we try to increase our capacity to serve more people.
- [10:28]
B
I love that. And especially impressive to hear that you've been increasing your census 130 beds is a lot. And then being able to take additional transfer requests, especially at a time right now when so many hospitals and leaders I talk to are really at capacity and you know, stressing about some of those access issues, trying to, you know, go to great lengths in order to bring in additional access to their patient base. It's really cool to hear how you've been able to do that and continue to provide a great quality care and service to the community.
- [11:01]
C
Yeah, it's been, it's been exciting. It's been a busy time, but it's been really good. We, you know, good thing about it is that we start off the year with over 100 external contract nurses working and now we're down to about 30 and we expect that that's going to decrease significantly over the next 90 days also. So we've been able to recruit, grow our own staff throughout our nurse tech programs that we have in partnership with the schools, with local nursing schools here and really provide a place where we can learn, nurses can learn and grow.
- [11:43]
B
That's amazing. I guess looking ahead into next year, are there any other big priorities or headwinds that you have your eye on?
- [11:51]
C
The biggest things for next year is, you know, we're going to focus on throughput, making sure that we, we can, you know, lower our length of stay by another day. We can, we can accept, we can keep accepting more and more patients. We can see another almost 500 patients a month just by lowering the length of stay by one day. So that provides us more access to care. The other things, we see that there's a need in our community for more inpatient behavioral health. We have a large behavior health inpatient unit. We have 60 beds at university medical center, and then we have a behavioral health ER at the hospital also. But we see that we are still having to move patients outside of the region to provide inpatient care. So we're going to open up partner between the two hospitals and open up another 28 beds at New Orleans east hospital this year for inpatient behavior health, adult inpatient behavior health. So I think that's going to make a difference in keeping people who are in crisis in their community so that families can stay connected with them. We think that's really, really important. We're also expanding our cancer service on the road to NCI destination. But we think that by expanding, we're doubling our clinic beds and cancer. Our cancer service, we're doubling our infusion beds, and then we're also starting bone marrow transplant service there. So, you know, in the. We're just a few miles away from what's called cancer alley in Louisiana. So we want to be the place where those patients can get seen early, early diagnosis and get the most cutting edge treatment for cancer to increase their survivability of diseases.
- [14:00]
B
Absolutely. That's amazing here. And especially the cancer treatment programs are so critical right now. I know that it's a huge need within the broader population. So that's great to know that you're expanding and able to achieve those great clinical outcomes. And I wanted to go back just a minute to something you said at the beginning of this conversation. Was looking at, you know, the throughput and being able to accept about 500 more patients per month by lowering that length of stay by just one day. I'm curious, when you look at that, lowering the length of stay, how are you thinking about doing that? How have you been successful in the past? Is there anything new you're trying in the new year?
- [14:41]
C
Yeah, so we. One of the things that we started this year is we started a. A discharge lounge, so a place where patients can go and wait for discharge out of the hospital. So it makes it convenient for us to start to turn beds quicker on day of discharge. We've also started to. We have what's called lightning rounds, where every day we meet with one of the academic teams, either LSU or Tulane, and look at to forecast discharges ahead. So we do that with our case management team. And the academic teams meet every day to make sure that we're planning ahead so we can prepare those things early. And so we're not delaying discharge by just sometimes those minor things we need to get in place. The other thing we're looking at is making sure that patients have the right follow up care that they need. So we're planning their after visits, the clinic visits upon discharge. So they're getting connected to care and they're done bouncing back to the hospital when they leave. Those have been the major initiatives that has really helped us to improve our throughput. We have a throughput coordinator who that's his only focus is our throughput measures. So he partners with case management, partner with our assistant CMO and really look at how we can any of the bottlenecks in the system and how we can resolve them. So every day we're looking at that, not only doing the lightning rounds, but also in the afternoons if we see that the bottlenecks happening, we'll get together again at 3, 3:30 and look at how we can eliminate those bottlenecks.
- [16:38]
B
Got it. That's really helpful to understand. Thank you for digging a little bit deeper there. Now I know heading into the next year too, there will be a lot of different things happening. So what do you think the hardest thing you'll have to do will be in the coming year?
- [16:52]
C
You know, the thing that I, I'm trying to really focus on, I don't think it'll be hard. I think the thing we're focused on next year is really just improving our quality and how we take care of patients and really getting back to being excellent at the basics of nursing care. And then the other part is trying to, because we have a young staff and really reconnecting our nurses with their why and why they got into the profession and reminding them that that is the reason they come to work every day. I think and you know, post Covid, we tend to drifted away from that some. As I talk to every year, every semester I go to talk to the nursing students, our community, the graduates and really, you know, trying to remind them that this nursing is a calling and is a calling that will, you know, really provide satisfaction. A career that enhances your life and it can be your life's work. If you focus on the calling and the care we provide and the advocacy efficacy we provide for patients. If you focus on other things like, you know, pay and aesthetics and you know, all the things that are not perfect in nursing, it can be a rough ride. And I think we've you know, do some social media things, do some, you know, labor disputes across the country and things of that nature. People have gotten into, you know, talking about what's bad about nursing. And nursing has been the most trusted profession for years and years and years. So is it perfect? No. But it is an incredible opportunity to have, you know, a lifetime of work that's meaningful. And you know, even if you focus on that, all those other things will come. I tell them all those other things come. Nursing has made me probably the most successful person in my family, but I never focus on the success of that. I've always focused on the, the calling and the mission. And if you, if you always have that, the why at your center, you'll learn, you'll learn to love nursing throughout this, the third, like I have for the 32 years I've been in it. So I, so that's what, that's one of the big messages. You know, folks, don't be excellent at the basics this year. Make sure that we're providing the highest quality of care. We know that we can do the complex things well. Let's make sure that we're doing the basics well and then returning to the why.
- [20:04]
B
I love that. Wow, that's so inspiring to think about and especially as you mentioned, being able to stay focused. That meaning the mission of what nurses can do and the impact that they have on their communities and patients. It's just incredible to think about that opportunity and continue to have a career and build a career and be successful in a variety of fronts. I know, like you said, there's so much happening in the space today and so much opportunity to get distracted. But you know, staying focused and really understanding how special health care is is just a great opportunity, I think. You know, when you look at growth and development for the next year, where do you see some of additional opportunities coming from? How is LCMC Health thinking about growth over the next 24 to months or so?
- [20:52]
C
Well, you know, for LCMC Health has been a mission of making sure we're providing care for all communities. So you know, it's one of the few health systems birthed out of children's hospital. So we, we have the safety net hospital for children in the state and for adults in the state. So access and care and connection to community is always going to be our focus. So as we move forward, you know, really growing our ambulatory and community based access points will be key to make sure we providing the right care at the right place for community members so they don't have to search is they have the, they have the right connection to care right in their community. And then really looking at our nurse and physician partnerships, making sure that we are working as a dyad as we move forward and building that into the culture and the fabric of what we do as we train so many new learners at our facilities, we want to make sure that we're training that dyad is important as we move forward, even in, even in training. And then lastly, you know, I've mentioned earlier, behavioral health, we have the largest behavioral health platform in the region and we want looking to expand that. We know that behavioral health and mental health, emotional health is important these days, where everyone, we see the negative impacts of it on the news often, but we know how much it can destroy families if it's not taken care of. So we want to make sure that we continue to expand that platform in the region and then also look at post acute partnerships in the area to make sure that as patients leave the hospital that they're going to the right facilities to recover some more if they're not ready to go home.
- [22:58]
B
That's fascinating to hear. CJ thank you so much for joining us on the podcast today. This has been a really amazing discussion. I look forward to seeing you again soon. And I know you'll be speaking at our annual meeting in April, which will be a great chance to catch up and continue this conversation, as well as dig even a little bit deeper into some of the processes and systems you've put into place for the successful expanding capacity and growth and development of your nursing team. So I'm looking forward to that and seeing you soon.
- [23:26]
C
Thank you very much. I appreciate the opportunity.