1 00:00:00,240 --> 00:00:03,220 Imagine this, you're at the Hyatt Regency Chicago 2 00:00:03,520 --> 00:00:05,859 surrounded by the top minds in the ambulatory 3 00:00:06,160 --> 00:00:07,540 surgery center industry. 4 00:00:07,919 --> 00:00:10,960 Welcome to the Becker's 30th annual meeting, the 5 00:00:10,960 --> 00:00:14,259 business and operations of ASCs from October 30th 6 00:00:14,355 --> 00:00:16,214 to November 2, 2024. 7 00:00:16,994 --> 00:00:19,554 Picture the excitement as you collect business cards 8 00:00:19,554 --> 00:00:22,855 from over a 1000 executive level attendees forging 9 00:00:22,914 --> 00:00:23,974 priceless connections. 10 00:00:24,434 --> 00:00:27,094 Feel the buzz of conversations as you participate 11 00:00:27,234 --> 00:00:29,969 in more than 60 sessions led by over 12 00:00:30,849 --> 00:00:33,030 225 elite ASC speakers. 13 00:00:33,649 --> 00:00:37,090 Envision yourself gaining actionable insights on topics like 14 00:00:37,090 --> 00:00:38,390 private equity strategies, 15 00:00:38,929 --> 00:00:43,030 ASC business growth, and innovations in spine, orthopedics, 16 00:00:43,635 --> 00:00:45,734 GI, ophthalmology, and cardiology. 17 00:00:46,354 --> 00:00:49,954 Now imagine yourself listening to inspiring keynotes from 18 00:00:49,954 --> 00:00:53,094 hall of fame boxing world champion, Lila Ali, 19 00:00:53,155 --> 00:00:56,879 and professional basketball player, Caitlin Clark. Their stories 20 00:00:56,879 --> 00:00:59,199 will motivate you to take your business to 21 00:00:59,199 --> 00:01:01,600 new heights. You'll leave with a wealth of 22 00:01:01,600 --> 00:01:03,920 knowledge and a network of connections to help 23 00:01:03,920 --> 00:01:06,719 lead your ASC into the next year. Don't 24 00:01:06,719 --> 00:01:09,700 miss out. Get registered today. Visit beckershospitalreviewdot 25 00:01:10,954 --> 00:01:12,715 com and click on the events page to 26 00:01:12,715 --> 00:01:15,135 find the conference website. That's the beckershospitalreview.com 27 00:01:17,114 --> 00:01:19,135 events page. See you in Chicago. 28 00:01:20,715 --> 00:01:23,135 This is Alan Condon with the Becker's podcast. 29 00:01:23,420 --> 00:01:26,239 I'm delighted to be joined today by Anthony 30 00:01:26,299 --> 00:01:29,840 Mulholland, who's the chief nursing officer of ambulatory 31 00:01:30,060 --> 00:01:33,280 services at Oregon Health and Science University. 32 00:01:33,899 --> 00:01:35,739 Anthony, a pleasure to have you you do 33 00:01:35,739 --> 00:01:37,519 on the podcast for the first time. 34 00:01:38,084 --> 00:01:40,165 Really delighted to have you on and pick 35 00:01:40,165 --> 00:01:41,444 your brains a little bit about some of 36 00:01:41,444 --> 00:01:42,805 the trends and some of the things you're 37 00:01:42,805 --> 00:01:44,185 following in health care today. 38 00:01:44,484 --> 00:01:46,885 But before we do, I'd love to hand 39 00:01:46,885 --> 00:01:48,805 the floor over to you just to hear 40 00:01:48,805 --> 00:01:50,724 a little bit more about your background and, 41 00:01:50,724 --> 00:01:52,185 of course, your role at OHSU. 42 00:01:53,260 --> 00:01:55,579 Yeah. Thank you so much, Alan. Thanks for 43 00:01:55,579 --> 00:01:57,500 inviting me. It's really a pleasure to be 44 00:01:57,500 --> 00:01:59,659 here with you. So, yeah, as you said, 45 00:01:59,659 --> 00:02:01,659 my name is Anthony, and I serve as 46 00:02:01,659 --> 00:02:04,379 the vice president and chief nursing officer of 47 00:02:04,379 --> 00:02:04,879 ambulatory 48 00:02:05,180 --> 00:02:05,680 services 49 00:02:06,140 --> 00:02:08,959 at Oregon Health Science University in Portland, Oregon. 50 00:02:09,305 --> 00:02:11,224 I've been a nurse for a little over 51 00:02:11,224 --> 00:02:13,245 22 years now. Hard to believe. 52 00:02:13,705 --> 00:02:15,965 My nursing career began in 2002 53 00:02:16,425 --> 00:02:19,405 when I graduated with my bachelor's degree from 54 00:02:19,544 --> 00:02:21,805 Cal State University in Long Beach, 55 00:02:22,120 --> 00:02:24,280 And I entered the workforce as a new 56 00:02:24,280 --> 00:02:26,780 grad in the trauma intensive care unit 57 00:02:27,080 --> 00:02:29,319 at one of LA County's level 1 trauma 58 00:02:29,319 --> 00:02:32,040 centers. This is where my journey toward nursing 59 00:02:32,040 --> 00:02:33,340 leadership really began. 60 00:02:33,800 --> 00:02:36,115 It was at this time that questions sort 61 00:02:36,115 --> 00:02:38,134 of began to formulate in my mind. 62 00:02:38,435 --> 00:02:40,514 How can I I love bedside nursing, but 63 00:02:40,514 --> 00:02:42,594 how can I make a bigger impact on 64 00:02:42,594 --> 00:02:43,574 nursing practice 65 00:02:44,514 --> 00:02:47,495 and health outcomes beyond the individual to, like, 66 00:02:47,555 --> 00:02:48,294 the population 67 00:02:48,675 --> 00:02:49,175 level? 68 00:02:49,500 --> 00:02:51,419 And even more globally? How can I make 69 00:02:51,419 --> 00:02:53,199 a bigger impact on health care? 70 00:02:53,659 --> 00:02:55,180 So from there, I made my way to 71 00:02:55,180 --> 00:02:57,739 Oregon and began to find ways in my 72 00:02:57,739 --> 00:02:59,519 organization to make those impacts. 73 00:03:00,139 --> 00:03:01,680 I served as a cardiovascular 74 00:03:01,979 --> 00:03:04,219 intensive care staff nurse where I took on 75 00:03:04,219 --> 00:03:06,835 leadership roles. I was a charge nurse, a 76 00:03:06,835 --> 00:03:07,335 preceptor, 77 00:03:08,034 --> 00:03:10,514 was involved in shared governance, and then even 78 00:03:10,514 --> 00:03:12,995 became a charter member of our rapid response 79 00:03:12,995 --> 00:03:14,754 team back when that was a new concept 80 00:03:14,754 --> 00:03:15,735 in health care. 81 00:03:16,435 --> 00:03:18,675 I really loved serving in that role, and 82 00:03:18,675 --> 00:03:21,074 I kept having this gnawing feeling that there 83 00:03:21,074 --> 00:03:23,450 was something still out there for me. I 84 00:03:23,450 --> 00:03:26,250 remember vividly, Alan, it was during the middle 85 00:03:26,250 --> 00:03:28,030 of one of my shifts at the bedside 86 00:03:28,330 --> 00:03:31,050 where this mental map of my purpose just 87 00:03:31,050 --> 00:03:33,610 sort of became clear. It was that night 88 00:03:33,610 --> 00:03:35,530 at work because I was working on night 89 00:03:35,530 --> 00:03:36,590 shift that I 90 00:03:36,995 --> 00:03:39,094 saw a move into formal leadership 91 00:03:39,474 --> 00:03:41,635 being the path for me, and I needed 92 00:03:41,635 --> 00:03:43,635 to really make some moves to make some 93 00:03:43,635 --> 00:03:46,294 bigger global impacts in health care and nursing. 94 00:03:46,754 --> 00:03:48,915 So when I left the bedside, I moved 95 00:03:48,915 --> 00:03:52,080 into what my organization called the administrator on 96 00:03:52,080 --> 00:03:52,900 duty role, 97 00:03:53,280 --> 00:03:56,319 commonly known as the nursing shift supervisor and 98 00:03:56,319 --> 00:03:57,139 other organizations. 99 00:03:58,080 --> 00:04:00,159 And now that was a really fun job. 100 00:04:00,159 --> 00:04:03,460 In this role, I really mastered leading hospital 101 00:04:03,520 --> 00:04:06,344 operations, and I got to advocate for and 102 00:04:06,344 --> 00:04:08,284 work with really vulnerable patients 103 00:04:08,584 --> 00:04:10,525 and families and their loved ones. 104 00:04:11,144 --> 00:04:12,984 And then I got my master's degree in 105 00:04:12,984 --> 00:04:16,185 health systems and organizational leadership and moved into 106 00:04:16,185 --> 00:04:17,725 a nurse manager role, 107 00:04:18,080 --> 00:04:19,220 leading to cardiovascular 108 00:04:19,759 --> 00:04:21,139 intermediate care units. 109 00:04:21,520 --> 00:04:23,439 And I'll tell you that was one of 110 00:04:23,439 --> 00:04:26,080 the toughest but most rewarding roles that I've 111 00:04:26,080 --> 00:04:28,720 had in health care. As a nurse manager, 112 00:04:28,720 --> 00:04:32,064 I had this incredible opportunity to impact the 113 00:04:32,064 --> 00:04:34,485 lives of those that I was leading directly 114 00:04:34,625 --> 00:04:36,485 and the patients that I was serving. 115 00:04:36,944 --> 00:04:39,584 And it was a wonderful environment for really 116 00:04:39,584 --> 00:04:41,925 supporting and elevating nursing practice. 117 00:04:42,704 --> 00:04:45,779 And then, in 2018, I became a service 118 00:04:45,779 --> 00:04:47,860 line director, the director for our heart and 119 00:04:47,860 --> 00:04:49,639 vascular service line at OHSU, 120 00:04:50,420 --> 00:04:53,160 and, gained some extraordinary new experiences 121 00:04:53,779 --> 00:04:54,919 leading procedural 122 00:04:55,220 --> 00:04:58,100 inpatient and outpatient units, as well as doing 123 00:04:58,100 --> 00:05:00,419 a lot of population specific work within my 124 00:05:00,419 --> 00:05:02,375 organization and out in my community. 125 00:05:03,235 --> 00:05:05,154 And then finally, here we are today. 126 00:05:05,555 --> 00:05:08,595 Recently we restructured the nurse executive leadership group 127 00:05:08,595 --> 00:05:11,954 at OHSU and our chief nurse executive had 128 00:05:11,954 --> 00:05:14,620 the foresight to see the need for creating 129 00:05:14,620 --> 00:05:17,720 a chief nurse officer role for ambulatory services, 130 00:05:18,019 --> 00:05:20,259 a role that hadn't existed previously in our 131 00:05:20,259 --> 00:05:20,759 organization. 132 00:05:21,220 --> 00:05:23,800 And I'm proudly serving in that role now. 133 00:05:24,019 --> 00:05:26,625 I'm about 7 months into it and it's 134 00:05:26,704 --> 00:05:28,545 been great to begin to make those more 135 00:05:28,545 --> 00:05:31,584 global impacts that I remember longing for 2 136 00:05:31,584 --> 00:05:33,685 decades ago when I began my career. 137 00:05:34,944 --> 00:05:37,745 Fantastic. I mean, like you said, a wealth 138 00:05:37,745 --> 00:05:40,225 of experience, more than 22 years serving in 139 00:05:40,225 --> 00:05:42,800 rolling from trauma care right up through the 140 00:05:42,879 --> 00:05:44,020 through nursing leadership. 141 00:05:44,480 --> 00:05:46,319 So no better man to to speak to 142 00:05:46,319 --> 00:05:47,839 about some of the trends that you're watching 143 00:05:47,839 --> 00:05:50,560 today. So I'd love to hear, as in 144 00:05:50,560 --> 00:05:51,540 your role now, 145 00:05:52,000 --> 00:05:54,639 what are 2 to 3 trends that you're 146 00:05:54,639 --> 00:05:57,415 really paying close attention to in health care 147 00:05:57,415 --> 00:05:57,995 and why? 148 00:05:58,615 --> 00:06:00,775 Yeah. Thanks for that question. You know, when 149 00:06:00,775 --> 00:06:03,014 I think about the trends that I'm most 150 00:06:03,014 --> 00:06:06,155 excited about, I I really think about innovation. 151 00:06:06,295 --> 00:06:07,915 Like, they're centered around innovation. 152 00:06:08,615 --> 00:06:10,694 I mean, look, we're in a challenging time 153 00:06:10,694 --> 00:06:12,939 in health care right now. There's so much 154 00:06:12,939 --> 00:06:14,000 financial instability. 155 00:06:14,699 --> 00:06:17,420 We're in an error era of like mergers 156 00:06:17,420 --> 00:06:18,240 and acquisitions, 157 00:06:18,779 --> 00:06:22,460 workforce constraints, and real challenges associated with access 158 00:06:22,460 --> 00:06:25,120 to care. So I think about that when 159 00:06:25,125 --> 00:06:27,865 I think about the trends that are innovative, 160 00:06:28,404 --> 00:06:30,185 it's care model redesign, 161 00:06:30,884 --> 00:06:32,105 leveraging technology, 162 00:06:32,805 --> 00:06:35,545 and then changing the infrastructure of care delivery. 163 00:06:35,925 --> 00:06:38,264 So for example, with care model redesign, 164 00:06:39,040 --> 00:06:41,439 thinking about how we can leverage the resources 165 00:06:41,439 --> 00:06:43,759 that we have today to provide care for 166 00:06:43,759 --> 00:06:45,839 the patients in front of us and those 167 00:06:45,839 --> 00:06:48,480 that are seeking entry into our into our 168 00:06:48,480 --> 00:06:48,980 systems. 169 00:06:49,520 --> 00:06:52,020 A quick quick example of that in ambulatory 170 00:06:52,319 --> 00:06:53,939 nursing that I'm thinking about 171 00:06:54,365 --> 00:06:56,764 is top of scope or top of licensed 172 00:06:56,764 --> 00:06:57,264 care. 173 00:06:57,725 --> 00:06:59,725 One of the things I've been encountering in 174 00:06:59,725 --> 00:07:01,564 the past 7 months in my new role 175 00:07:01,564 --> 00:07:04,145 is that we have this really great opportunity 176 00:07:04,285 --> 00:07:06,605 for nurses to deliver care in ways that 177 00:07:06,605 --> 00:07:08,545 really improves access for patients. 178 00:07:09,079 --> 00:07:11,399 For example, we do have nurse visits in 179 00:07:11,399 --> 00:07:13,980 our ambulatory practices, but they're underutilized 180 00:07:14,360 --> 00:07:16,680 and not well known of. We can really 181 00:07:16,680 --> 00:07:18,439 make an impact if we clear the path 182 00:07:18,439 --> 00:07:20,360 to allow our clinicians to practice at the 183 00:07:20,360 --> 00:07:23,180 top of their scope and contribute to that 184 00:07:23,480 --> 00:07:24,615 access to care. 185 00:07:25,254 --> 00:07:27,834 And then as I said, 2nd, leveraging technology. 186 00:07:27,974 --> 00:07:31,014 I was recently at the Epic user group 187 00:07:31,014 --> 00:07:31,995 meeting conference, 188 00:07:32,375 --> 00:07:34,375 and I really got to see some great 189 00:07:34,375 --> 00:07:35,595 examples of generative 190 00:07:35,974 --> 00:07:39,029 AI being used in innovative ways that helps 191 00:07:39,029 --> 00:07:41,269 to support the work of our clinicians. And 192 00:07:41,269 --> 00:07:42,810 everybody's talking about 193 00:07:43,589 --> 00:07:45,669 technology right now. It's one of the trends 194 00:07:45,669 --> 00:07:48,229 in health care. So I'm really excited about 195 00:07:48,229 --> 00:07:52,004 things like AI scribes and AI charting and 196 00:07:52,165 --> 00:07:55,845 pace patient messaging that's that's really aided by 197 00:07:55,845 --> 00:07:57,305 that artificial intelligence. 198 00:07:57,925 --> 00:07:59,865 Each of these assistive documentation 199 00:08:00,165 --> 00:08:03,865 innovations really shorten the amount of time clinicians 200 00:08:04,259 --> 00:08:06,199 spend documenting in the medical record 201 00:08:06,500 --> 00:08:08,899 and gives them time, frees them up to 202 00:08:08,899 --> 00:08:12,259 really address patient care needs and improve that 203 00:08:12,259 --> 00:08:13,399 care that they're providing. 204 00:08:13,860 --> 00:08:16,819 And then finally, that changing infrastructure of care 205 00:08:16,819 --> 00:08:17,319 delivery. 206 00:08:18,014 --> 00:08:20,595 It might not be really thought of primarily 207 00:08:20,654 --> 00:08:21,475 as an innovation, 208 00:08:21,935 --> 00:08:24,595 but more survival because of all of 209 00:08:24,975 --> 00:08:27,535 the insecurity in the market today. But, hey, 210 00:08:27,535 --> 00:08:29,694 it's, you know, during times, Alan, a great 211 00:08:29,694 --> 00:08:32,009 pressure that we have to really innovate to 212 00:08:32,009 --> 00:08:34,490 survive. And so I really do see, you 213 00:08:34,490 --> 00:08:37,289 know, vertical alignment as the future of health 214 00:08:37,289 --> 00:08:38,669 care and innovation. 215 00:08:39,209 --> 00:08:40,970 Right? It's an the innovation here, I think, 216 00:08:40,970 --> 00:08:44,004 is moving from that single hospital centric care 217 00:08:44,004 --> 00:08:44,904 delivery model 218 00:08:45,284 --> 00:08:47,924 to more of an ecosystem of hospitals and 219 00:08:47,924 --> 00:08:50,184 care centers within one system. 220 00:08:50,565 --> 00:08:53,284 Each of them working toward a singular vision 221 00:08:53,284 --> 00:08:56,324 for for care and access and improving outcomes 222 00:08:56,324 --> 00:08:56,985 for patients. 223 00:08:57,879 --> 00:08:59,240 So those are some of the trends that 224 00:08:59,240 --> 00:09:00,839 I'm following right now. I think, you know, 225 00:09:00,839 --> 00:09:03,079 as health care leaders, these are the things 226 00:09:03,079 --> 00:09:05,179 that many of us are thinking about. 227 00:09:05,879 --> 00:09:07,480 Yeah. I think, you know, it's fascinating to 228 00:09:07,480 --> 00:09:09,799 kinda get your perspective on broad overview and 229 00:09:09,799 --> 00:09:12,059 some of those things you're close closely following. 230 00:09:12,384 --> 00:09:14,065 I just wanted to quick follow-up on the 231 00:09:14,065 --> 00:09:15,904 last trend that you mentioned, just in terms 232 00:09:15,904 --> 00:09:18,704 of that changing infrastructure of care delivery, the 233 00:09:18,704 --> 00:09:21,424 vertical alignment in health care. You talked about, 234 00:09:21,424 --> 00:09:23,105 obviously, a big trend that we're seeing across 235 00:09:23,105 --> 00:09:24,784 the board is M and A. Mhmm. I 236 00:09:24,784 --> 00:09:25,605 know OHSU 237 00:09:25,985 --> 00:09:28,120 is potentially involved one with Legacy Legacy Health 238 00:09:28,120 --> 00:09:30,039 as well, but would love to get your 239 00:09:30,039 --> 00:09:32,360 your insights, any deeper insights there in terms 240 00:09:32,360 --> 00:09:34,679 of that changing infrastructure of care delivery and 241 00:09:34,679 --> 00:09:36,139 how you're approaching that at OHSU? 242 00:09:37,000 --> 00:09:38,679 Yeah. One of the things that I'm excited 243 00:09:38,679 --> 00:09:40,600 about with, you know, what's on the horizon 244 00:09:40,600 --> 00:09:43,524 for OHSU and Legacy Health is that it 245 00:09:43,524 --> 00:09:46,105 really improves access to care for Oregonians. 246 00:09:46,725 --> 00:09:49,945 Now we'll go at OHSU from 3 hospitals 247 00:09:50,325 --> 00:09:52,184 and a collection of ambulatory 248 00:09:53,125 --> 00:09:54,184 sites to 249 00:10:03,460 --> 00:10:05,620 improving access to patients will really be able 250 00:10:05,620 --> 00:10:08,500 to re be realized because we won't be 251 00:10:08,500 --> 00:10:09,000 centered 252 00:10:09,544 --> 00:10:12,365 primarily in the Portland metro area, but rather 253 00:10:12,584 --> 00:10:15,065 really spread throughout the state to be able 254 00:10:15,065 --> 00:10:16,684 to be a catchment for patients 255 00:10:17,065 --> 00:10:18,605 in a smaller communities 256 00:10:19,464 --> 00:10:22,024 and in areas where they might not have 257 00:10:22,024 --> 00:10:23,725 the greatest access to care 258 00:10:24,039 --> 00:10:25,879 traditionally. So this is, you know, one of 259 00:10:25,879 --> 00:10:27,799 the ways that I think hospitals or health 260 00:10:27,799 --> 00:10:30,679 care systems are thinking about making big impacts, 261 00:10:30,679 --> 00:10:32,600 and it's certainly how we're thinking about that 262 00:10:32,600 --> 00:10:35,179 in our organization. So it's an exciting time. 263 00:10:35,799 --> 00:10:38,440 Yeah. Absolutely. We've been paying very close attention 264 00:10:38,440 --> 00:10:41,105 to the the signing of the definitive agreement 265 00:10:41,105 --> 00:10:42,865 and how that's kinda moving forward over the 266 00:10:42,865 --> 00:10:44,625 last couple of months. And, yeah, I look 267 00:10:44,625 --> 00:10:45,904 forward to seeing what comes with it in 268 00:10:45,904 --> 00:10:48,384 the next coming quarters or so. Anthony, one 269 00:10:48,384 --> 00:10:50,384 other thing I wanted to to follow-up on. 270 00:10:50,384 --> 00:10:52,565 You you talked to earlier on, you'd mentioned, 271 00:10:52,820 --> 00:10:54,339 you know, no secret to you or any 272 00:10:54,339 --> 00:10:56,019 of our our listeners here in terms of 273 00:10:56,019 --> 00:10:59,379 the workforce constraints or nursing shortages in the 274 00:10:59,379 --> 00:10:59,879 field. 275 00:11:00,580 --> 00:11:02,919 Our veterans clinical team had 276 00:11:03,299 --> 00:11:05,000 covered a a recent report 277 00:11:05,455 --> 00:11:08,575 from Mercer that showed that nursing assistants face 278 00:11:08,575 --> 00:11:10,674 the greatest projected deficits 279 00:11:11,054 --> 00:11:14,115 over any other health care application by 2028. 280 00:11:14,735 --> 00:11:16,495 It looks to just get your perspective in 281 00:11:16,495 --> 00:11:19,250 terms of, is this a real core priority 282 00:11:19,250 --> 00:11:22,550 area for recruitment and retention at your system 283 00:11:22,769 --> 00:11:23,429 and why? 284 00:11:24,529 --> 00:11:27,830 Indeed. We are finding that it is 285 00:11:28,290 --> 00:11:28,790 increasingly 286 00:11:29,170 --> 00:11:32,290 difficult to fill these types of supportive roles 287 00:11:32,290 --> 00:11:33,990 in our health care systems, 288 00:11:34,394 --> 00:11:36,235 And we're doing a lot of work to 289 00:11:36,235 --> 00:11:37,375 try to address that, 290 00:11:38,475 --> 00:11:40,014 you know, recruitment incentives 291 00:11:40,394 --> 00:11:42,715 and really making sure that we're paying attention 292 00:11:42,715 --> 00:11:46,075 to how we're marketing our healthcare system to 293 00:11:46,075 --> 00:11:47,535 attract the right talent. 294 00:11:47,899 --> 00:11:49,899 But that's just not going to be enough. 295 00:11:49,899 --> 00:11:53,019 There are fewer individuals entering into these types 296 00:11:53,019 --> 00:11:55,259 of roles. And so we really have to 297 00:11:55,259 --> 00:11:57,580 think about how we can innovate our care 298 00:11:57,580 --> 00:11:58,639 delivery models 299 00:11:59,100 --> 00:12:01,040 so that we can impact 300 00:12:01,644 --> 00:12:04,865 outcomes of care for patients that doesn't rely 301 00:12:05,084 --> 00:12:08,784 on a workforce that just isn't there anymore, 302 00:12:08,845 --> 00:12:10,464 or is really dwindling. 303 00:12:10,845 --> 00:12:14,384 So in our organization, we're doing things like 304 00:12:14,730 --> 00:12:17,289 hospital at home and other types of virtual 305 00:12:17,289 --> 00:12:19,629 care, virtual intensive care units, 306 00:12:20,169 --> 00:12:23,129 and thinking about how we can design care 307 00:12:23,129 --> 00:12:26,029 delivery so that we can ensure that 308 00:12:26,409 --> 00:12:28,909 nurses and all of our practitioners 309 00:12:29,544 --> 00:12:32,024 have the support that they need, but they're, 310 00:12:32,024 --> 00:12:35,465 we're working smarter and not harder. Right? Those 311 00:12:35,465 --> 00:12:36,825 are, those are some of the, some of 312 00:12:36,825 --> 00:12:38,764 the things we're thinking about in our organization. 313 00:12:38,825 --> 00:12:40,985 It's been a real challenge to recruit into 314 00:12:40,985 --> 00:12:43,220 those types of roles. And then ambulatory 315 00:12:43,600 --> 00:12:46,080 specifically, we use a lot of medical assistance 316 00:12:46,080 --> 00:12:47,919 and that's a you know, think about the 317 00:12:47,919 --> 00:12:51,440 hospital, the nursing assistant in ambulatory. It's the 318 00:12:51,440 --> 00:12:54,320 medical assistant and we face, similar challenges out 319 00:12:54,320 --> 00:12:54,980 in ambulatory 320 00:12:55,279 --> 00:12:57,945 care. And so we're thinking a lot about 321 00:12:57,945 --> 00:12:59,625 the role of the nurse and how the 322 00:12:59,625 --> 00:13:02,184 nurse can really support transitions of care for 323 00:13:02,184 --> 00:13:05,404 patients and take on some of those functions 324 00:13:05,544 --> 00:13:07,544 that are at the top of their scope 325 00:13:07,544 --> 00:13:08,204 to really 326 00:13:08,504 --> 00:13:10,284 address the needs of the patients 327 00:13:10,664 --> 00:13:12,044 as they enter our systems. 328 00:13:13,029 --> 00:13:15,110 Mhmm. Yeah. Yeah. It was such a big 329 00:13:15,110 --> 00:13:17,269 challenge in the in the field across the 330 00:13:17,269 --> 00:13:19,589 country, but interesting to hear about how how 331 00:13:19,589 --> 00:13:20,649 o h u OHSU, 332 00:13:21,029 --> 00:13:23,669 excuse me, is particularly addressing that. Anthony, I 333 00:13:23,669 --> 00:13:25,429 wanted to flip the script a little bit 334 00:13:25,429 --> 00:13:26,409 away from challenges. 335 00:13:26,964 --> 00:13:28,644 To hear a little bit about what's most 336 00:13:28,644 --> 00:13:30,164 exciting to you right now when you think 337 00:13:30,164 --> 00:13:31,544 about the future of health care. 338 00:13:31,924 --> 00:13:34,725 Yeah. Thanks. You know, I'm I'm excited about, 339 00:13:35,365 --> 00:13:37,605 the things that address the challenges. You know, 340 00:13:37,605 --> 00:13:39,524 when I think about the top challenges that 341 00:13:39,524 --> 00:13:40,620 we're up against, it's 342 00:13:41,179 --> 00:13:42,799 caring for an aging population, 343 00:13:43,339 --> 00:13:43,839 transitioning 344 00:13:44,220 --> 00:13:47,120 from an overreliance on acute care to managing 345 00:13:47,179 --> 00:13:49,740 population health. That's really exciting to me as 346 00:13:49,740 --> 00:13:51,039 an ambulatory leader, 347 00:13:51,419 --> 00:13:54,299 achieving health equity and then navigating those post 348 00:13:54,299 --> 00:13:56,080 COVID impacts on our workforce, 349 00:13:56,565 --> 00:13:57,065 specifically 350 00:13:57,524 --> 00:13:59,065 staffing and safety. So, 351 00:13:59,445 --> 00:14:02,004 you know, I'm an ambulatory chief nursing officer, 352 00:14:02,004 --> 00:14:04,165 so it probably won't surprise you when I 353 00:14:04,165 --> 00:14:06,485 say that what I'm most excited about is 354 00:14:06,485 --> 00:14:08,644 how nursing can make an impact in these 355 00:14:08,644 --> 00:14:09,625 specific areas. 356 00:14:10,019 --> 00:14:12,100 You know? Right. I think the nurse in 357 00:14:12,100 --> 00:14:14,740 the community is so well poised to address 358 00:14:14,740 --> 00:14:17,240 the complex needs of our aging population. 359 00:14:18,259 --> 00:14:20,340 I'm you know, I have great examples every 360 00:14:20,340 --> 00:14:21,240 day. I'm inspired 361 00:14:21,540 --> 00:14:23,940 by these examples that I see. I witness 362 00:14:23,940 --> 00:14:24,440 nurses 363 00:14:25,154 --> 00:14:28,195 with their interventions, keeping patients thriving in their 364 00:14:28,195 --> 00:14:28,934 own communities, 365 00:14:29,794 --> 00:14:31,955 helping them to navigate the plans of care 366 00:14:31,955 --> 00:14:33,955 that keep them healthy and out of the 367 00:14:33,955 --> 00:14:36,195 hospital. Right? And the last thing we need 368 00:14:36,195 --> 00:14:39,235 is patients coming to our emergency departments, which 369 00:14:39,235 --> 00:14:42,809 are really overcrowded and burdened by boarding patients. 370 00:14:43,269 --> 00:14:45,350 Our nurses are really making an impact on 371 00:14:45,350 --> 00:14:48,870 this transition from overreliance on acute care to 372 00:14:48,870 --> 00:14:50,490 population health management. 373 00:14:51,350 --> 00:14:54,330 And then nurses and ambulatory settings are addressing 374 00:14:54,389 --> 00:14:56,704 the social determinants of health that are, you 375 00:14:56,704 --> 00:14:58,945 know, they're developing plans of care that are 376 00:14:58,945 --> 00:15:01,524 individualized to patients facing social 377 00:15:01,904 --> 00:15:03,605 and racial and structural disparities. 378 00:15:04,865 --> 00:15:07,605 Nurses have and are thinking creatively 379 00:15:08,384 --> 00:15:09,524 and then developing 380 00:15:09,985 --> 00:15:12,320 they're they're having these experiences and then they're 381 00:15:12,320 --> 00:15:13,220 thinking creatively 382 00:15:13,759 --> 00:15:15,679 about how to develop these plans of care 383 00:15:15,679 --> 00:15:18,100 to keep patients with those unique needs 384 00:15:18,480 --> 00:15:18,980 thriving. 385 00:15:19,360 --> 00:15:22,080 Say, for example, patients facing housing or food 386 00:15:22,080 --> 00:15:24,865 and food insecurity and how nurses are making 387 00:15:24,865 --> 00:15:27,024 an impact for them and keeping them healthy 388 00:15:27,024 --> 00:15:28,404 well and out of the hospital. 389 00:15:29,184 --> 00:15:31,345 And then in terms of addressing those workforce 390 00:15:31,345 --> 00:15:34,164 challenges around resource utilization and safety, 391 00:15:34,625 --> 00:15:36,225 I think the voice of the nurse is 392 00:15:36,225 --> 00:15:37,605 really powerful here. 393 00:15:38,139 --> 00:15:40,699 I'm excited about what we're doing in our 394 00:15:40,699 --> 00:15:44,079 organization and, this movement across nursing 395 00:15:44,459 --> 00:15:47,980 to leverage professional governance, this transition from shared 396 00:15:47,980 --> 00:15:50,320 governance to professional governance and nursing 397 00:15:50,634 --> 00:15:53,434 to keep folks like me, the nurse executive 398 00:15:53,434 --> 00:15:54,894 as nurse executive 399 00:15:55,595 --> 00:15:56,654 and other leaders, 400 00:15:57,834 --> 00:16:00,794 in conversation with our nurses to address some 401 00:16:00,794 --> 00:16:02,634 of these problems, they can help us address 402 00:16:02,634 --> 00:16:03,615 some of these problems. 403 00:16:04,009 --> 00:16:06,970 But for example, in my organization specifically, we 404 00:16:06,970 --> 00:16:09,149 rely on the voice of our clinical nurses, 405 00:16:09,450 --> 00:16:11,769 on our staffing committees and our councils and 406 00:16:11,769 --> 00:16:12,990 in our safety councils. 407 00:16:13,450 --> 00:16:15,950 They really help us to translate their experiences 408 00:16:16,169 --> 00:16:16,909 at the frontline, 409 00:16:17,465 --> 00:16:19,065 and then that helps us to shape our 410 00:16:19,065 --> 00:16:21,565 policies that we use to manage our resources 411 00:16:21,625 --> 00:16:23,804 and then keep our practice environment safe. 412 00:16:24,665 --> 00:16:27,225 Mhmm. Yeah. And certainly certainly a lot to 413 00:16:27,225 --> 00:16:29,490 be excited about, like you've mentioned. But 414 00:16:29,970 --> 00:16:31,970 lastly, I wanted to go back to ties 415 00:16:31,970 --> 00:16:33,490 into what you just mentioned at the start 416 00:16:33,490 --> 00:16:36,129 of that question was you mentioned that nurses 417 00:16:36,129 --> 00:16:39,169 really focusing nurses in ambulatory really focusing on 418 00:16:39,169 --> 00:16:42,129 population health, social determinants of health, some of 419 00:16:42,129 --> 00:16:44,209 these initiatives. I'd love to hear a little 420 00:16:44,209 --> 00:16:46,684 bit more about how you're thinking about ambulatory 421 00:16:46,745 --> 00:16:49,084 growth over the next 12 to 24 months. 422 00:16:49,625 --> 00:16:52,584 Yeah. Indeed. You know, I think we're it's 423 00:16:52,584 --> 00:16:55,004 an exciting time to be working in ambulatory 424 00:16:55,304 --> 00:16:57,144 care. Right? I mean, as I talked about, 425 00:16:57,144 --> 00:16:59,700 we're facing some real challenges in health care, 426 00:17:00,019 --> 00:17:02,580 specifically around access and the financial health of 427 00:17:02,580 --> 00:17:04,740 our organization. So, you know, the out of 428 00:17:04,740 --> 00:17:09,140 hospital landscape is changing. And, selfishly, again, this 429 00:17:09,140 --> 00:17:10,420 is a great time for me to be 430 00:17:10,420 --> 00:17:13,160 where I'm at. Outpatient care is the fastest 431 00:17:13,265 --> 00:17:15,845 growing segment of the health care industry, and 432 00:17:16,065 --> 00:17:18,225 this type of care delivery really brings high 433 00:17:18,225 --> 00:17:20,965 margins to our organization. So that's great too. 434 00:17:21,265 --> 00:17:23,585 I think we're gonna continue to see growth 435 00:17:23,585 --> 00:17:24,884 in ambulatory 436 00:17:25,184 --> 00:17:27,045 surgery centers, for example. 437 00:17:27,549 --> 00:17:30,430 That's great news for those organizations that have 438 00:17:30,430 --> 00:17:32,430 ambulatory surgery, and I promise I'm gonna get 439 00:17:32,430 --> 00:17:33,890 to nursing here in just a second. 440 00:17:34,509 --> 00:17:37,070 More and more procedures are definitely moving to 441 00:17:37,070 --> 00:17:39,950 those day stay visits that add value to 442 00:17:39,950 --> 00:17:42,049 our consumers, our patients. And so, 443 00:17:42,355 --> 00:17:44,774 you know, weaving nursing back into the forecast, 444 00:17:45,075 --> 00:17:47,154 I think the role of the ambulatory nurse 445 00:17:47,154 --> 00:17:48,694 is gonna continue to evolve. 446 00:17:49,075 --> 00:17:51,234 I'm, you know, thrilled to be seeing the 447 00:17:51,234 --> 00:17:54,274 shift of this collective mindset in health care 448 00:17:54,274 --> 00:17:55,174 that emphasizes 449 00:17:55,554 --> 00:17:56,054 preventative 450 00:17:56,690 --> 00:17:57,190 population, 451 00:17:57,569 --> 00:17:58,950 chronic disease management, 452 00:17:59,569 --> 00:18:01,509 and supporting our aging population. 453 00:18:02,210 --> 00:18:04,210 And with that, there's, of course, gonna be 454 00:18:04,210 --> 00:18:07,890 an increasing demand for skilled nursing professionals who 455 00:18:07,890 --> 00:18:09,990 can really deliver high quality care 456 00:18:10,355 --> 00:18:13,394 outside of traditional hospital settings. So it's a 457 00:18:13,394 --> 00:18:16,515 great time for nursing in ambulatory settings. It's 458 00:18:16,515 --> 00:18:18,215 a great time to be a nurse leader 459 00:18:18,275 --> 00:18:20,215 in an ambulatory area because, 460 00:18:20,994 --> 00:18:23,234 quite frankly, it's the future of health care 461 00:18:23,234 --> 00:18:24,615 if I could put it so simply. 462 00:18:25,829 --> 00:18:28,150 Yeah. I mean, like you said, a really 463 00:18:28,150 --> 00:18:30,710 a really exciting time to be working a 464 00:18:30,710 --> 00:18:33,269 leader in the ambulatory sector, a really exciting 465 00:18:33,269 --> 00:18:36,470 time at OHSU in particular with everything going 466 00:18:36,470 --> 00:18:37,369 on. Anthony, 467 00:18:37,909 --> 00:18:40,230 really, really fascinating discussion. A real pleasure to 468 00:18:40,230 --> 00:18:41,744 have you on the podcast with us today, 469 00:18:41,744 --> 00:18:43,184 and I look forward to connecting with you 470 00:18:43,184 --> 00:18:44,085 again down the line. 471 00:18:44,625 --> 00:18:46,305 Alan, hey. Thanks so much. Have a great 472 00:18:46,305 --> 00:18:47,684 day, and enjoy your weekend.