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This is Alan Condon with the Becker's podcast.
I'm delighted to be joined today by Anthony
Mulholland, who's the chief nursing officer of ambulatory
services at Oregon Health and Science University.
Anthony, a pleasure to have you you do
on the podcast for the first time.
Really delighted to have you on and pick
your brains a little bit about some of
the trends and some of the things you're
following in health care today.
But before we do, I'd love to hand
the floor over to you just to hear
a little bit more about your background and,
of course, your role at OHSU.
Yeah. Thank you so much, Alan. Thanks for
inviting me. It's really a pleasure to be
here with you. So, yeah, as you said,
my name is Anthony, and I serve as
the vice president and chief nursing officer of
ambulatory
services
at Oregon Health Science University in Portland, Oregon.
I've been a nurse for a little over
22 years now. Hard to believe.
My nursing career began in 2002
when I graduated with my bachelor's degree from
Cal State University in Long Beach,
And I entered the workforce as a new
grad in the trauma intensive care unit
at one of LA County's level 1 trauma
centers. This is where my journey toward nursing
leadership really began.
It was at this time that questions sort
of began to formulate in my mind.
How can I I love bedside nursing, but
how can I make a bigger impact on
nursing practice
and health outcomes beyond the individual to, like,
the population
level?
And even more globally? How can I make
a bigger impact on health care?
So from there, I made my way to
Oregon and began to find ways in my
organization to make those impacts.
I served as a cardiovascular
intensive care staff nurse where I took on
leadership roles. I was a charge nurse, a
preceptor,
was involved in shared governance, and then even
became a charter member of our rapid response
team back when that was a new concept
in health care.
I really loved serving in that role, and
I kept having this gnawing feeling that there
was something still out there for me. I
remember vividly, Alan, it was during the middle
of one of my shifts at the bedside
where this mental map of my purpose just
sort of became clear. It was that night
at work because I was working on night
shift that I
saw a move into formal leadership
being the path for me, and I needed
to really make some moves to make some
bigger global impacts in health care and nursing.
So when I left the bedside, I moved
into what my organization called the administrator on
duty role,
commonly known as the nursing shift supervisor and
other organizations.
And now that was a really fun job.
In this role, I really mastered leading hospital
operations, and I got to advocate for and
work with really vulnerable patients
and families and their loved ones.
And then I got my master's degree in
health systems and organizational leadership and moved into
a nurse manager role,
leading to cardiovascular
intermediate care units.
And I'll tell you that was one of
the toughest but most rewarding roles that I've
had in health care. As a nurse manager,
I had this incredible opportunity to impact the
lives of those that I was leading directly
and the patients that I was serving.
And it was a wonderful environment for really
supporting and elevating nursing practice.
And then, in 2018, I became a service
line director, the director for our heart and
vascular service line at OHSU,
and, gained some extraordinary new experiences
leading procedural
inpatient and outpatient units, as well as doing
a lot of population specific work within my
organization and out in my community.
And then finally, here we are today.
Recently we restructured the nurse executive leadership group
at OHSU and our chief nurse executive had
the foresight to see the need for creating
a chief nurse officer role for ambulatory services,
a role that hadn't existed previously in our
organization.
And I'm proudly serving in that role now.
I'm about 7 months into it and it's
been great to begin to make those more
global impacts that I remember longing for 2
decades ago when I began my career.
Fantastic. I mean, like you said, a wealth
of experience, more than 22 years serving in
rolling from trauma care right up through the
through nursing leadership.
So no better man to to speak to
about some of the trends that you're watching
today. So I'd love to hear, as in
your role now,
what are 2 to 3 trends that you're
really paying close attention to in health care
and why?
Yeah. Thanks for that question. You know, when
I think about the trends that I'm most
excited about, I I really think about innovation.
Like, they're centered around innovation.
I mean, look, we're in a challenging time
in health care right now. There's so much
financial instability.
We're in an error era of like mergers
and acquisitions,
workforce constraints, and real challenges associated with access
to care. So I think about that when
I think about the trends that are innovative,
it's care model redesign,
leveraging technology,
and then changing the infrastructure of care delivery.
So for example, with care model redesign,
thinking about how we can leverage the resources
that we have today to provide care for
the patients in front of us and those
that are seeking entry into our into our
systems.
A quick quick example of that in ambulatory
nursing that I'm thinking about
is top of scope or top of licensed
care.
One of the things I've been encountering in
the past 7 months in my new role
is that we have this really great opportunity
for nurses to deliver care in ways that
really improves access for patients.
For example, we do have nurse visits in
our ambulatory practices, but they're underutilized
and not well known of. We can really
make an impact if we clear the path
to allow our clinicians to practice at the
top of their scope and contribute to that
access to care.
And then as I said, 2nd, leveraging technology.
I was recently at the Epic user group
meeting conference,
and I really got to see some great
examples of generative
AI being used in innovative ways that helps
to support the work of our clinicians. And
everybody's talking about
technology right now. It's one of the trends
in health care. So I'm really excited about
things like AI scribes and AI charting and
pace patient messaging that's that's really aided by
that artificial intelligence.
Each of these assistive documentation
innovations really shorten the amount of time clinicians
spend documenting in the medical record
and gives them time, frees them up to
really address patient care needs and improve that
care that they're providing.
And then finally, that changing infrastructure of care
delivery.
It might not be really thought of primarily
as an innovation,
but more survival because of all of
the insecurity in the market today. But, hey,
it's, you know, during times, Alan, a great
pressure that we have to really innovate to
survive. And so I really do see, you
know, vertical alignment as the future of health
care and innovation.
Right? It's an the innovation here, I think,
is moving from that single hospital centric care
delivery model
to more of an ecosystem of hospitals and
care centers within one system.
Each of them working toward a singular vision
for for care and access and improving outcomes
for patients.
So those are some of the trends that
I'm following right now. I think, you know,
as health care leaders, these are the things
that many of us are thinking about.
Yeah. I think, you know, it's fascinating to
kinda get your perspective on broad overview and
some of those things you're close closely following.
I just wanted to quick follow-up on the
last trend that you mentioned, just in terms
of that changing infrastructure of care delivery, the
vertical alignment in health care. You talked about,
obviously, a big trend that we're seeing across
the board is M and A. Mhmm. I
know OHSU
is potentially involved one with Legacy Legacy Health
as well, but would love to get your
your insights, any deeper insights there in terms
of that changing infrastructure of care delivery and
how you're approaching that at OHSU?
Yeah. One of the things that I'm excited
about with, you know, what's on the horizon
for OHSU and Legacy Health is that it
really improves access to care for Oregonians.
Now we'll go at OHSU from 3 hospitals
and a collection of ambulatory
sites to
improving access to patients will really be able
to re be realized because we won't be
centered
primarily in the Portland metro area, but rather
really spread throughout the state to be able
to be a catchment for patients
in a smaller communities
and in areas where they might not have
the greatest access to care
traditionally. So this is, you know, one of
the ways that I think hospitals or health
care systems are thinking about making big impacts,
and it's certainly how we're thinking about that
in our organization. So it's an exciting time.
Yeah. Absolutely. We've been paying very close attention
to the the signing of the definitive agreement
and how that's kinda moving forward over the
last couple of months. And, yeah, I look
forward to seeing what comes with it in
the next coming quarters or so. Anthony, one
other thing I wanted to to follow-up on.
You you talked to earlier on, you'd mentioned,
you know, no secret to you or any
of our our listeners here in terms of
the workforce constraints or nursing shortages in the
field.
Our veterans clinical team had
covered a a recent report
from Mercer that showed that nursing assistants face
the greatest projected deficits
over any other health care application by 2028.
It looks to just get your perspective in
terms of, is this a real core priority
area for recruitment and retention at your system
and why?
Indeed. We are finding that it is
increasingly
difficult to fill these types of supportive roles
in our health care systems,
And we're doing a lot of work to
try to address that,
you know, recruitment incentives
and really making sure that we're paying attention
to how we're marketing our healthcare system to
attract the right talent.
But that's just not going to be enough.
There are fewer individuals entering into these types
of roles. And so we really have to
think about how we can innovate our care
delivery models
so that we can impact
outcomes of care for patients that doesn't rely
on a workforce that just isn't there anymore,
or is really dwindling.
So in our organization, we're doing things like
hospital at home and other types of virtual
care, virtual intensive care units,
and thinking about how we can design care
delivery so that we can ensure that
nurses and all of our practitioners
have the support that they need, but they're,
we're working smarter and not harder. Right? Those
are, those are some of the, some of
the things we're thinking about in our organization.
It's been a real challenge to recruit into
those types of roles. And then ambulatory
specifically, we use a lot of medical assistance
and that's a you know, think about the
hospital, the nursing assistant in ambulatory. It's the
medical assistant and we face, similar challenges out
in ambulatory
care. And so we're thinking a lot about
the role of the nurse and how the
nurse can really support transitions of care for
patients and take on some of those functions
that are at the top of their scope
to really
address the needs of the patients
as they enter our systems.
Mhmm. Yeah. Yeah. It was such a big
challenge in the in the field across the
country, but interesting to hear about how how
o h u OHSU,
excuse me, is particularly addressing that. Anthony, I
wanted to flip the script a little bit
away from challenges.
To hear a little bit about what's most
exciting to you right now when you think
about the future of health care.
Yeah. Thanks. You know, I'm I'm excited about,
the things that address the challenges. You know,
when I think about the top challenges that
we're up against, it's
caring for an aging population,
transitioning
from an overreliance on acute care to managing
population health. That's really exciting to me as
an ambulatory leader,
achieving health equity and then navigating those post
COVID impacts on our workforce,
specifically
staffing and safety. So,
you know, I'm an ambulatory chief nursing officer,
so it probably won't surprise you when I
say that what I'm most excited about is
how nursing can make an impact in these
specific areas.
You know? Right. I think the nurse in
the community is so well poised to address
the complex needs of our aging population.
I'm you know, I have great examples every
day. I'm inspired
by these examples that I see. I witness
nurses
with their interventions, keeping patients thriving in their
own communities,
helping them to navigate the plans of care
that keep them healthy and out of the
hospital. Right? And the last thing we need
is patients coming to our emergency departments, which
are really overcrowded and burdened by boarding patients.
Our nurses are really making an impact on
this transition from overreliance on acute care to
population health management.
And then nurses and ambulatory settings are addressing
the social determinants of health that are, you
know, they're developing plans of care that are
individualized to patients facing social
and racial and structural disparities.
Nurses have and are thinking creatively
and then developing
they're they're having these experiences and then they're
thinking creatively
about how to develop these plans of care
to keep patients with those unique needs
thriving.
Say, for example, patients facing housing or food
and food insecurity and how nurses are making
an impact for them and keeping them healthy
well and out of the hospital.
And then in terms of addressing those workforce
challenges around resource utilization and safety,
I think the voice of the nurse is
really powerful here.
I'm excited about what we're doing in our
organization and, this movement across nursing
to leverage professional governance, this transition from shared
governance to professional governance and nursing
to keep folks like me, the nurse executive
as nurse executive
and other leaders,
in conversation with our nurses to address some
of these problems, they can help us address
some of these problems.
But for example, in my organization specifically, we
rely on the voice of our clinical nurses,
on our staffing committees and our councils and
in our safety councils.
They really help us to translate their experiences
at the frontline,
and then that helps us to shape our
policies that we use to manage our resources
and then keep our practice environment safe.
Mhmm. Yeah. And certainly certainly a lot to
be excited about, like you've mentioned. But
lastly, I wanted to go back to ties
into what you just mentioned at the start
of that question was you mentioned that nurses
really focusing nurses in ambulatory really focusing on
population health, social determinants of health, some of
these initiatives. I'd love to hear a little
bit more about how you're thinking about ambulatory
growth over the next 12 to 24 months.
Yeah. Indeed. You know, I think we're it's
an exciting time to be working in ambulatory
care. Right? I mean, as I talked about,
we're facing some real challenges in health care,
specifically around access and the financial health of
our organization. So, you know, the out of
hospital landscape is changing. And, selfishly, again, this
is a great time for me to be
where I'm at. Outpatient care is the fastest
growing segment of the health care industry, and
this type of care delivery really brings high
margins to our organization. So that's great too.
I think we're gonna continue to see growth
in ambulatory
surgery centers, for example.
That's great news for those organizations that have
ambulatory surgery, and I promise I'm gonna get
to nursing here in just a second.
More and more procedures are definitely moving to
those day stay visits that add value to
our consumers, our patients. And so,
you know, weaving nursing back into the forecast,
I think the role of the ambulatory nurse
is gonna continue to evolve.
I'm, you know, thrilled to be seeing the
shift of this collective mindset in health care
that emphasizes
preventative
population,
chronic disease management,
and supporting our aging population.
And with that, there's, of course, gonna be
an increasing demand for skilled nursing professionals who
can really deliver high quality care
outside of traditional hospital settings. So it's a
great time for nursing in ambulatory settings. It's
a great time to be a nurse leader
in an ambulatory area because,
quite frankly, it's the future of health care
if I could put it so simply.
Yeah. I mean, like you said, a really
a really exciting time to be working a
leader in the ambulatory sector, a really exciting
time at OHSU in particular with everything going
on. Anthony,
really, really fascinating discussion. A real pleasure to
have you on the podcast with us today,
and I look forward to connecting with you
again down the line.
Alan, hey. Thanks so much. Have a great
day, and enjoy your weekend.