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Becker’s Healthcare Podcast
Integrating Nursing Teams and Strengthening Care Transitions at Jefferson Health with Kate FitzPatrick
00:15:32
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies, and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit Beckershospital Review.com and click on the events tab in the upper right.
- [00:38]
B
Hi, everyone. You are listening to the Beckers Healthcare Podcast. I'm Erica Carbajal with the Becker's Hospital Review team. And today I'm very excited to be joined by Kate Fitzpatrick, chief nurse executive at Jefferson Health. Kate, so happy to have you on today. Thanks for being here.
- [00:56]
C
Oh, Erica, it's my pleasure. Great to be with you.
- [00:58]
B
Yeah, welcome. Well, Kate, can you start off by telling our listeners what your top priority as CNO of Jefferson Health is this year? What's something you're hoping to make some meaningful progress on by year's end?
- [01:12]
C
Yeah, I would say it's always hard to pick one top priority. I would say it doesn't matter what year it is. The top priority is always going to be safe, quality, personalized care. But I would say given where Jefferson Health is in their journey, we've recently expanded in the last year and a half, and we grew from a 17 hospital health system to now 33 hospitals. And so one of the really important things on the horizon for the coming year is to continue the horizontal integration work. So really trying to bring together structures across our 33 hospital system so that we can be as effective and as efficient as we can. And there's a lot that goes into that in terms of bringing people together, bringing teams together. We have new geography, so trying to make all that come together in a meaningful way is a top priority for me.
- [02:14]
B
Yeah, sure. No small beat. A big merger there. Well, Kate, I know Jefferson has been doing a lot of work to strengthen partnerships with federally qualified health centers and other community organizations to help keep vulnerable patients connected to care, especially with some policy changes on the horizon that could increase the number of uninsured patients. I know. I've talked to Dr. Yahia quite a bit about this, so I just wanted to follow up. How are you thinking about that challenge, particularly from a nurse leadership perspective, and what role do nurses play in those community partnerships and in helping patients stay connected to the appropriate levels of care?
- [02:53]
C
Yeah, it's such an important thing for us to be Thinking about one of the things that we're really, I think fortunate is the great partnerships and relationships we have in Philadelphia and across Jefferson with our federally qualified health centers. One of the things I think about is the patients treated at federally qualified health centers. They flow in many directions so they cross multiple organizations within the Jefferson system. We are cross referring all the time. And I see nurses as pivotal in the journey of patients outside the hospital, especially as they're being treated in federally qualified health centers and in our ed. So thinking about things like how nurses are critical in the communication and translation between settings to make sure that we have the right level of reconciliation and communication around care plans. Nurses are exquisite around the relationships. They will understand probably at a deep level what patient's insurance status is and what that means and what that might be restricting or enhancing about the things resources they can access. So I think they also educate patients, I think quite a bit about understanding with some of the policy changes you mentioned what might change at the patient level, what might be new requirements around paperwork and things that patients have to submit to access care. So nurses will be a center point, I think, in helping translate that to help patients navigate that, help patients be attentive to the things that are going to be really important for them to make sure they get the care need. So I think it's, you know, it's something that's top of mind for me and it's going to continue to evolve as we, you know, as the landscape evolves. Yeah.
- [04:51]
B
Kate, I think it's interesting too to hear about nurses role in the education piece, especially with all of the changes happening around Medicaid and you know, so much of that could potentially be logistical errors and having nurses step up and helping patients navigate just the logistical side to ensure they can stay connected to their insurance status. You know, if it is a logistical issue,
- [05:17]
C
well, you know, one. Erica, I'll just add there is. We're fortunate as an enterprise to have, you know, an integrated health system, a health plan and a university having access to the experts in our health plan. One of the things we've talked about recently is how we can bolster the education we provide for nurses and nurse leaders about understanding insurance and understanding the impacts to patients and how we can better support patients given all the changes that are in front of us.
- [05:46]
B
Yeah, certainly it's important piece. Kate, I wanted to chat with you too about Jefferson's nursing seal team. I know it's gotten a lot of attention just as a way to reduce agency reliance while also supporting units with less experienced staff. It's been a really important effort over the past few years that's shown a lot of great results that we've covered. So as you scale that model now with the integration with Lee Valley Health network across the 30 plus hospital system, what are some of the biggest lessons so far? And do you see this kind of flexible workforce model becoming a more permanent feature of how health systems actually structure their nursing teams?
- [06:26]
C
Yeah, I think the SEAL team has been just a remarkable part of our work workforce optimization strategy for sure. And I think we've had many lessons that we've learned over the years since we've launched it and are relearning and trying to leverage and remind ourselves as we grow into the Lehigh Valley. But I think a couple of things that I would say in terms of lessons. One is just reminding everyone about the clarity and purpose of the SEAL team and this flexible workforce. They're really most effective when they are positioned as short term, more stabilizing resource and not a replacement for core unit staffing. And I think that's been an education point and I think experience on that team matters as much as the flexibility. So as we've looked at our experience level across the system for our registered nurses, really this ability to pair highly experienced nurses with those units or those clinics or areas that have a higher proportion of newer staff is, I think, a real benefit for us. It's not just filling shifts, it's. It's being able to provide real time mentoring and helping to model clinical judgment and reinforcing standards of care, especially when units are under strain. So that's been a real important lesson for us, that it's not just the flexibility, it's the level of experience. And prioritizing how we deploy the team, I would say is really important. And then we've really tried to be very responsive to our regional chief nurses and our local teams around what they want to see. As we grow the SEAL team or modify the SEAL team, one of the things we've heard is just readjusting the complement of nurses that work off shifts and weekends and bolstering some of the team in terms of specialty backgrounds like critical care. We've certainly spent a lot of time to make sure that as we think of the complement of that team, that we're being responsive and addressing the things that are, you know, the people that we're serving really need or see as their, their top priorities.
- [08:38]
B
Yeah, Kate. And I imagine that just, you know, being so intentional with the experience level of nurses who are on that SEAL team goes such a long way and also helping improve engagement among newer nurses and confidence and being able to have that at the bedside, especially in units where a good portion of staff are novice nurses.
- [08:59]
C
Absolutely. Right now, across our system, roughly 55% of our nurses are less than five years experience. So that's really significant. And so we're really intentional as we think about system wide strategies like the SEAL team to consider that and how do we support retention, how do we help those nurses to thrive? You know, and ultimately it's about supporting, you know, safe patient care. So it's been a tremendous resource for us.
- [09:27]
B
Yeah. Kate, One of the things too that recently in the last few months I feel like has increasingly come up in conversations, especially with clinical leaders, chief nursing officers and medical officers are just breakdowns in the transition from hospital to the next point of care as a growing challenge. So whether it's related to timely follow up or medication access, those communication breakdowns seem to be a growing challenge. Where do you see the biggest gap today between discharge and the next touch point in care in a patient's care? And how can nursing maybe help close it?
- [10:05]
C
Yeah, it's such a great question. And I also have care management as part of my portfolio for this system. So I spend a lot of time thinking about this exact question. I think there's a number of things where I see big gaps. One is education, one is communication, I would say follow through. And the last is really our ability to meet patients where they are. And as I think about those things, I think nurses play a tremendous role in helping us close those gaps. So thinking about unique roles for nurses, for example, transitional care nurses, nurse navigators who can help with appointments, follow up tracking plans after discharge and making sure patients are adhering to those, keeping the connection between primary care and specialists and helping coordinate that for patients, tracking patients that are at higher risk after discharge, and then just more operationally and concrete building into the whole discharge process, making sure that we have people, particularly nurses, play an important role here, leading post discharge charge follow up calls to make sure that we're clarifying discharge instructions. People understand the medications they're on, they know the signs to look for any complications that might come up and how they can avoid unnecessary or avoidable emergency department visits. So those are all things that I think nurses play a critical role in. And then I think one of the things in particular that we've seen that's a challenge is really in the whole realm of medication reconciliation, we have patients that are on lots of medications, some complex medications, so really making sure that we support patients to understand their medication regimen, they have the right access to the medications they need and helping them connect their resources if they don't. So there's a lot of things, and I would say the last thing is in the comment I made about meeting patients where they are. I do think we will continue to leverage technology, things like remote patient monitoring, helping patients use the patient portal, coordination of telehealth connections. And nurses can play and do play a critical role in helping patients navigate that. But it also helps us meet patients where they are. So those are some of the things I've thought about around care management, some of the gaps we're continuing to close.
- [12:41]
B
Yeah, definitely a multipronged approach there.
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C
Yeah.
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B
Kate, to close us out. What's one policy shift or workforce trends you believe could have the biggest effect on the nation's nursing workforce in the next three to five years? Maybe something leaders should be paying closer attention to right now.
- [12:59]
C
You know, I again this was, it's hard to think of just one, but I would say that one of the things that we've kept a close eye on is, you know, the workforce. Obviously we've made tremendous strides at Jefferson around our workforce, but we have to stay vigilant about the workforce moving forward. And it really, it's sustaining the workforce gains that we've made. But we've got to continue to redesign the model. So what's the care delivery team around the patient given the projections we know in terms of longer term pipeline for nurses, for patient care, techs for certified nursing assistants. So looking at the teams around the patients and saying we're going to have to continue to redesign what that looks like. And I think the strategic question is no longer how many nurses are needed, but really it's more about how nursing work is going to be optimally designed and deployed. And so I think that's something we're all going to have to continue to pay attention to. And there's so much, I think exciting things that are on the horizon around workforce in terms of how we're already using hybrid virtual roles, how we've done some really creative work on redesigning and upskilling patient people who are patient facing on our teams right now. So I think that that's all going to continue. I think we're going to see more around exciting enhancements, tech enabled care, things like ambient listening that's going to help our clinicians be more efficient and effective and take away some of their task burden. So I think for me it's really, really going to be about the workforce gain, sustaining those and continuing to redesign the model as we move forward.
- [14:47]
B
Yeah, Kate, I think so. Spot on. I know we just one of my colleagues just covered a story sort of similar just looking at workforce strategy and touched on a lot of this just in terms of redesigning the care delivery model. Like the workforce strategy has really shifted away from hiring and kind of competitive, competitive hiring and more. So how do we ensure that the folks we have are practicing at the top of their license? We're utilizing technology to the best of our ability and reducing that reliance on contract work as well. So really interesting points there. Well, Kate, thank you so much for joining me on the podcast today. Really appreciated your time and I know our audience will appreciate your insights.
- [15:28]
C
Oh, it was great. Thank you so much. Erica.