← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Hasan B. Alam, Surgeon-in-Chief at Northwestern Memorial Hospital and Chair of the Department of Surgery at the Feinberg School of Medicine at Northwestern University
00:27:15
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- [00:02]
Becker's Healthcare Announcer
The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit, and more, the conversations get real. Leaders will share how their scenario planning for policy shifts brief breaking through value based care barriers and building clinical teams that translate new ideas into real world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
- [00:46]
Laura Deardle
This is Laura Deardle with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Molly Moran, Associate Vice President of Ambulatory Nursing at Rush University Medical Center. Molly, it's a pleasure to have you on the podcast today.
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Molly Moran
Thank you so much for having me.
- [01:01]
Laura Deardle
Absolutely. Now I'm excited for our conversation because I know there's so much happening in the healthcare space and particularly interested in learning more about your focus on nursing and especially in the ambulatory setting. As I know more cases are going into that space and more patients are being served in that space and so it'll be interesting to hear your perspective. But before we dig in, can you tell us a little bit more about yourself and brush?
- [01:24]
Molly Moran
Absolutely. I am a doctorally prepared registered nurse and as you said, I serve as the Associate Vice President of Ambulatory Nursing for the Rush Medical Group, which is part of the larger University Rush University System for Health. Rush is a leading academic health system based in Chicago and we've been recognized nationally for excellence in quality in safety and outcomes and including having been recognized by U.S. news World Report for Best Hospitals Honor Roll and have also been designated as one of the top performing academic medical centers in the country by Vizient. In my role in particular, I lead ambulatory nursing practice across a very complex multispecialty medical group. We have more than 100 sites from Aurora, Illinois to Munster, Indiana and collectively serve more than 2 million patients every year. My work in particular sits really where clinical practice, operations, quality and strategy intersect. I love my work and find it very meaningful and impactful because it's really where decisions translate most directly into safer patient care, better outcomes, and a more supported workforce. Over the past several years, our organization has been integrating multiple legacy medical groups, which I know is not uncommon in today's ambulatory landscape. And so as many may know, each of those medical groups come with their distinct cultures, their workflows, approaches to nursing practice, which for me is exciting, but also creates a significant complexity but a powerful opportunity to really define how ambulatory nursing delivers value at scale.
- [03:20]
Laura Deardle
That's fascinating to hear, Truly important to have that type of lens and opportunity and access point for patients. I'm curious, what are some of the trends that you're watching currently?
- [03:32]
Molly Moran
So there are many trends that I'm currently watching, but the one that is first and foremost really is the economic and policy environment. For me, it's really driving everything. As many in healthcare are acutely aware, rising health care premiums and the ongoing federal changes are drastically reshaping our public health systems and destabilizing coverage for many of our families. The question isn't which plan to choose anymore, it's whether they can afford insurance at all. And at rush, we see this reality every day. Many of our practices sit on Chicago's west side, which is a community that has faced decades of socioeconomic disadvantage. There have been a number of studies done that show that the life expectancy on the west side of Chicago is several years shorter than in neighborhoods just a few miles away. What that really has shown us and what that translates to today is that these gaps aren't always about geography. It's about the structural inequities for patients. It's been showing up as delayed care, missed preventative services, medication, non adherence, and then more advanced diseases that easily could have been prevented or had better outcomes had they been caught early. So what I'm really watching is how these additional barriers around economic and policy environment is going to show up on a larger scale because we know that Chicago's west side is not an isolated story. It really, for me, is an early and amplified signal of what policy shifts, rising costs, and coverage instability are creating for communities across the country. For me, as we look at ambulatory settings and emergency departments, then we really have to think about how are patients accessing these resources? Ambulatory clinics, urgent cares, EDs are becoming the first and sometimes the only point of contact for patients who navigate coverage instability and the strained public health resources. In my role, I'm especially attuned to this because that raises the stakes for quality, safety and reliability in ambulatory care. We've really begun to think differently and talk differently about access. It isn't just a scheduling issue anymore. It's a core quality issue. When coverage is unstable, access is about whether the patients can safely navigate the system at all. So this is why timely clinical decision making, appropriate triage, and continuity between visits are no longer optional. They're essential, which really raises the stakes and raises the bars for medical groups. But this is what I think is so unique and what I'm watching currently in terms of trends in the ambulatory space. This is a great opportunity for nursing to not just step in, but to lead. Ambulatory nursing in our medical group is now central to improving access and this is most predominantly seen through telephone triage work that we've done around care coordination and then lastly around proactive outreach. Our models are based on best practices that can be found in different medical groups across the country and in each of those organizations, and including ours, we have found that through intentional infusion of nursing care, we can avoid unnecessary emergency visits while really ensuring that those who need in person care get it at the right time and in the right setting. At Rush, as I said, we've really leaned into this reality and have watched nursing take the lead in several of these areas. One that I really would like to highlight is our nurse led telephone triage which is now core to our primary care delivery model. It's not a side service or nice to have. We have really worked to utilize evidence based protocols, clarify our escalation pathways and combine both strong competency oversight with clinical quality outcomes to enable our registered nurses to practice at the top of their license. And I will say the impact has been significant. Year over year we have seen a drastic reduction in unnecessary emergency department utilization and over the past four years have actually seen more than a 60% decrease in that unnecessary ED utilization. We have seen a higher conversion to urgent care and virtual urgent care visits and faster direction for patients who have high risk symptoms. We've also seen, interestingly enough, a large portion of patients who choose to still come in for a primary care visit and this has been especially interesting to watch. These are patients that likely would have gone to the ED or urgent care simply for that in person reassurance. And by offloading a lot of the work from the clinic into the telephone triage space, we've created capacity for these patients to be seen and without undue burden in some of these other clinical care areas. For me, as I said, the takeaway is pretty simple. That nurse led telephone triage isn't a nice to have anymore. It's really foundational to our care delivery model. It has shown to improve safety, preserve that capacity, then really in our patient population has helped to operationalize equity by meeting patients where they are, especially when access is most fragile in some of our high risk clinics. So we know that registered nurses play a critical role in health promotion and early identification of opportunity, whether that's driving proactive outreach, closing care gaps, shifting care upstream. But that understanding has really shaped how we redesigned care. And I'm not just talking about telephone triage. We have really doubled down and we have looked at and centralized and standardized visits, such as our annual wellness visits and our transitions of care management visits across the system. And this wasn't a compliance exercise, but really thinking about these visits as essential touch points for prevention and continuity. And so in doing this, we've really created consistent workflows, aligned scheduling resources made the visits more predictable, timely and ultimately easier for the patients to access. At the same time, we've recognized that patient experience and patient care management increasingly is happening outside the exam room. So we also doubled down on MyChart responsiveness, both in speed and in quality. Both are absolutely critical. And you can't have one without the other. Because every message, in my opinion, is an opportunity for us to build trust with our patients. And in creating standard operating procedures and monitoring the quality of those messages going out to the patients, we've seen a tremendous impact. Our RN and MA communication scores over the past 18 months have increased from 94.8 to 96.3. And for multiple quarters we've been outperforming the upper control limit. I think that's one of the things I'm most proud of because that's not reliability and that's a system that's working as intended for the patient. The other thing I will say is as we're watching this with trends, I've talked a lot about what we're doing within our medical group, but as you zoom out, these examples really become more important as we look at the federal policy shifts, the public health priorities and the funding changes, they're placing greater responsibility on ambulatory practices to manage population health far beyond the walls of the clinic. Practices are being asked to not only address medical leave, but also the downstream effects of social risk, coverage instability, and then our limited community resources. So things such as leader standard work, structured rounding, closed loop communication and evidence based protocols really aren't a bureaucracy. It's the foundation for the safe, predictable care when everything else feels uncertain. And I think we've seen a large shift at the national level for what it means to be a health care leader and in today's environment. And so I'll say the last trend that I'm watching really is about workforce stability. It's inseparable from quality. And this, in my opinion, is because as patient complexity grows and coverage Instability persists. The demands on the ambulatory teams are only going to increase. And so for me, high reliability isn't about just what we achieve, but having that supported, engaged workforce and that consistent leadership presence. So for me, the message is clear. It's really about ambulatory quality no longer being secondary. It is central to delivering that safe, reliable and equitable care as economic and policy pressures reshape the healthcare landscape.
- [14:18]
Laura Deardle
That's such great perspective and I really appreciate you talking through so many of these different trends that are really surfacing as being so important for the nursing workforce and the clinical workforce in general. I know healthcare is changing and transforming in so many different ways to make sure there's access points across the board for leaders and patients as they're coming into the healthcare system and are needing to refine their journeys. And so it's incredible to hear more about what Rush has been able to do to be more responsive and more attentive to those patients, as well as lean into the evidence based protocols so that they can achieve better outcomes even as healthcare becomes more complex. So when you're looking ahead, what are you most focused on and excited about? And could you tell me a little bit more about, you know, something you're most proud of from the last six to 18 months or so?
- [15:10]
Molly Moran
Absolutely. So as I mentioned, we are integrating legacy medical groups into one system. And I will say what has been, what I'm most focused on is that integration. But it's also what I'm most excited about. And that's because I feel like we've really intentionally begun to redesign ambulatory nursing. Not just taking what is best from each of the legacy medical groups, but really at times hitting pause to understand what is needed by our patients today and what do we think they're going to need in 10, 15, 20 years and how do we build that? I focus a lot in my current role on primary care, and that's because what we're seeing is patients are living longer with multiple chronic conditions. They're often navigating care across not just primary care, but specialty care, diagnostics, community resources if they're available. And that level of complexity really requires far more than episodic visit, which is traditionally what ambulatory has been built on. What we're seeing today, and what I think we're going to continue to see into the future is that it requires care coordination, consistent follow up, and it requires clinical judgment between those appointments and determine the next best course of action. And I feel like over the last 12 to 18 months, we've really leaned into the idea that registered nurses in the clinic are no longer just a support function, but they're a critical strategy for how we improve that patient outcome, the access to care and overall care coordination. What I will say though is this hasn't been without its challenges. Historically ambulatory operated as a private practice or with a private practice mindset. And again, really in terms of episodic care, staffing models have historically been built around that reality. One of the things as we're looking back to the past six, 18 months, is really starting to dismantle the idea of plug and play staffing models because the work is no longer as predictable or transactional. And so it's really, as we look ahead, what I'm excited about is asking the question, or not asking the question, I should say, of how many registered nurses or medical assistants do we need, but instead reframing the question to say what is the work and who is best equipped to do it? And that shift is really going to require us to break away from those rigid role definitions, to think creatively about skill mix, to introduce healthcare professions that maybe have not historically practiced in the ambulatory space, and then really to leverage an individual's experience and licensure in a way that complements the rest of the care team so that we can reduce redundancies and amplify the patient experience and outcomes. I will say one of the things that I'm also, you know, is most proud of over the last six to 18 months, and again continuing to look ahead, is how we're moving from historically fragmented practice into a more intentional, system level approach to ambulatory nursing. Some of that has been natural with the integration, but more often than not it's intentional and it requires a near daily recommitment of every leader, and in particular nurse leader in ambulatory, to help redefine what excellence looks like, to align those leadership structures and, and to put leader standard work that is focused on nursing in place so that both our leaders and frontline teams don't feel like they have to constantly reinvent that wheel. That has changed the way that we have thought about how we deploy our nurses, where they're working and what the work is that they're doing in the clinic. We've seen this particularly change as we've expanded the role of the nurse navigator across several of our service lines. So the nurse navigator role has historically been well defined within the oncology patient population, but has had growing traction in other specialty care populations. And we've seen this really take off and help us reimagine what it means to coordinate care across the continuum, what the inpatient and ambulatory partnership looks like, and redefine roles and responsibilities for things such as discharge in a way that six months ago, 12 months ago, we weren't having those conversations. Finally, I'm really proud of how ambulatory nursing has been positioned as a strategic partner in value based care. Whether it's nurse navigation, expanded telephone triage, or some of our proactive disease management, we're seeing and measuring the direct impact nurses have on access, experience and financial sustainability. Nursing led work is no longer viewed as ancillary, is increasingly recognized as essential to how we manage our populations, prevent avoidable utilization and deliver high quality scale care at scale. So that cultural shift supported by real outcomes has been incredibly energizing for our team and reinforces to me why this work matters so deeply.
- [21:31]
Laura Deardle
Absolutely. I think that's such a great point. And you know, really looking at how that nursing workforce has shifted and how you've been able to change as the environment has changed, as you, you've gotten more information and more data, more access points, and truly leaning into more of the value of care, I just think is really fascinating and incredible. And from your perspective as you've made this transition, what has helped it along the way? I know any kind of change can be a challenge and especially when there are longstanding patterns and traditions within certain workflows or clinical mindsets. And so. So how have you been able to work with the teams to help them make these changes and really improve the way that you're looking at patient care because of it?
- [22:19]
Molly Moran
That's a really great question. I have been very blessed throughout my career to have strong mentors, many of whom are nurse leaders themselves, other mentors who are in different healthcare disciplines. And I have learned from them that what is most important is to be intentional in how you lead, especially in times of change. And one of the things that I go back to often my team knows, and those who work with me frequently know that I am often referencing the TED Lasso line of be curious, not judgmental. And for me, as I'm leading change as within my team or within a department, I feel like it's especially relevant in health care today to keep that mindset. Because when performance, engagement or outcomes fall short, it can be really easy to make assumptions or default to blame. But if we're really going to change the way that we deliver care, we have to create a space of curiosity to understand what's actually happening, what barriers exist and what our teams need to be successful. And in my experience, and again, so grateful for the mentors that I've had who have actively taught me to have that curious mindset. It has strengthened relationships, but it's also led to more sustainable and meaningful improvement.
- [24:02]
Laura Deardle
That's so helpful to understand. And I love that idea of just continuing to be curious, non judgmental and leaning towards the things that are going to make the biggest difference for the patients in the space. Now, before we wrap up here, what advice would you give evolving leaders as they're continuing to grow and develop in their own organization?
- [24:23]
Molly Moran
I think that is a great question. First, what I would say is leaders, regardless of your level of experience, collectively we need to recognize that the strategies that worked in the 2000s, 2000s and tens will not carry us forward. Our patients are more complex. Our teams are stretched expectations around access, quality and value. They're fundamentally different than they were 5, 10, or 20 years ago. And so simply asking people to work harder or laying on more processes is not going to solve today's challenges. Evolving leaders must be willing to question those legacy models, to let go of those sacred cows and the way that we've always done it, and then really redesign both care and leadership practices with intention. And so with that, I would encourage all leaders to be bold and innovative in how they lead. I will tell you that doesn't always mean big flashy initiatives. It can be something as seemingly mundane as being disciplined about your standard work, about really digging into the data to use it thoughtfully, or it can be truly transformational, such as empowering, in my case, nurses. But all of our frontline teams to really practice at the top of their license and to be willing to bet on an approach even when the path isn't perfectly clear. But likewise, we also have to be willing to say that something that we tried isn't working and we need to go back to the drawing board. Because what I would share with any leader is that leadership isn't just about decisions. It's about what you pay attention to. It's about what you tolerate and what you consistently reinforce. For me, when leaders combine curiosity with courage and show up with that intention, you can create cultures where patients and teams can truly thrive. And that's where I have learned leadership has that lasting impact.
- [26:44]
Laura Deardle
I love that. Molly, thank you so much for joining us on the podcast today. This has been such a fascinating conversation and fantastic perspective and I look forward to connecting with you again soon.
- [26:55]
Molly Moran
Thank you so much Laura. I appreciate it.