1 00:00:05,155 --> 00:00:07,205 - This is the Becker's Healthcare Podcast created 2 00:00:07,205 --> 00:00:08,365 by the team of Becker's Healthcare, 3 00:00:08,485 --> 00:00:10,245 a multimedia company devoted to the people 4 00:00:10,265 --> 00:00:11,565 who power us healthcare. 5 00:00:11,835 --> 00:00:14,645 Four new 15 minute episodes are released daily containing 6 00:00:14,845 --> 00:00:16,605 industry news analysis and thought leadership. 7 00:00:16,605 --> 00:00:19,485 From powerful healthcare decision makers Support our show 8 00:00:19,625 --> 00:00:22,445 by leaving it a five star rating and review on Apple Podcast 9 00:00:22,665 --> 00:00:23,925 or other platforms you use. 10 00:00:24,075 --> 00:00:25,925 It's a chance to tell us what you like about the show 11 00:00:25,945 --> 00:00:27,165 and act on your feedback. 12 00:00:27,165 --> 00:00:29,125 Thanks for listening. Now here's the episode. 13 00:00:30,555 --> 00:00:31,685 - Welcome everyone, 14 00:00:31,685 --> 00:00:33,485 to the Becker's Healthcare podcast series. 15 00:00:33,685 --> 00:00:36,285 I am Ryan Mohammed re and moderator with Becker's Healthcare 16 00:00:36,745 --> 00:00:39,285 and I'm absolutely so thrilled to have with me today. 17 00:00:39,305 --> 00:00:41,445 Andrea Hauser, chief Nursing Officer 18 00:00:41,585 --> 00:00:44,565 and vice president of Acute Care lacrosse nursing at 19 00:00:44,565 --> 00:00:45,685 Gundersen Health System. 20 00:00:45,985 --> 00:00:47,445 Andrea, it's very nice to have you on the 21 00:00:47,445 --> 00:00:48,485 podcast today. How are you? 22 00:00:49,305 --> 00:00:51,805 - I'm great, thank you. I'm very excited to be here. 23 00:00:52,275 --> 00:00:54,125 - Yeah, I'm very excited to talk with you today. 24 00:00:54,385 --> 00:00:55,925 Um, but to get us started, 25 00:00:55,935 --> 00:00:57,805 would you mind please introducing yourself 26 00:00:57,805 --> 00:00:59,245 and telling us a bit about your background? 27 00:01:00,105 --> 00:01:02,525 - Yes, of course. I am a registered nurse 28 00:01:02,525 --> 00:01:04,365 and as you said, I'm the Chief nursing officer 29 00:01:04,465 --> 00:01:06,325 and vice president of acute care nursing 30 00:01:06,785 --> 00:01:08,685 for the Gunderson region of Bellin 31 00:01:08,685 --> 00:01:09,725 and Gunderson Health System. 32 00:01:10,125 --> 00:01:13,645 I have been with the Gunderson Health System for 21 years 33 00:01:13,665 --> 00:01:16,245 and have loved mostly every minute of it 34 00:01:16,705 --> 00:01:19,205 and I'm really excited to be partnering with Bellin 35 00:01:19,205 --> 00:01:20,205 and I'm excited to share 36 00:01:20,205 --> 00:01:22,005 that we are actually coming up on our one year 37 00:01:22,275 --> 00:01:23,765 anniversary as a health system. 38 00:01:24,345 --> 00:01:26,645 So Bellin Gunderson is a not-for-profit 39 00:01:26,865 --> 00:01:28,485 community-focused healthcare network. 40 00:01:28,825 --> 00:01:30,205 We have headquarters in Green Bay 41 00:01:30,205 --> 00:01:32,125 and La Crosse, Wisconsin, serving patients 42 00:01:32,125 --> 00:01:33,245 with our 11 hospitals 43 00:01:33,245 --> 00:01:37,245 and more than 100 clinic locations in Wisconsin, Minnesota, 44 00:01:37,295 --> 00:01:38,645 upper Michigan and Iowa. 45 00:01:40,985 --> 00:01:42,195 - Wonderful. Thank you so much 46 00:01:42,195 --> 00:01:43,315 for giving us that background. 47 00:01:43,495 --> 00:01:45,675 So with all you're doing right now, 48 00:01:45,855 --> 00:01:47,755 can you tell me your most successful project 49 00:01:47,935 --> 00:01:49,555 or initiative from the last year? 50 00:01:49,865 --> 00:01:51,395 What issues were you trying to solve 51 00:01:51,495 --> 00:01:52,915 and also what drove the success? 52 00:01:54,485 --> 00:01:58,335 - Sure. So one of our most successful initiatives 53 00:01:58,525 --> 00:02:00,655 that will continue is our internal 54 00:02:00,715 --> 00:02:04,095 and external work to redesign the care surrounding one 55 00:02:04,095 --> 00:02:06,295 of our, of our most vulnerable populations. 56 00:02:06,715 --> 00:02:09,575 And this is our aging population who have more 57 00:02:09,575 --> 00:02:11,375 and more chronic disease and less 58 00:02:11,395 --> 00:02:12,615 and less available support. 59 00:02:13,315 --> 00:02:14,495 So what was the problem? 60 00:02:15,475 --> 00:02:17,335 We were faced with consistent barriers 61 00:02:17,475 --> 00:02:19,455 to accessing post-acute care placement, 62 00:02:20,055 --> 00:02:22,375 specifically long-term care and skilled nursing beds. 63 00:02:22,835 --> 00:02:26,815 LA Cross County where Gunderson is located lost 40% 64 00:02:26,995 --> 00:02:30,175 of our skilled nursing beds in the last 10 years. 65 00:02:31,125 --> 00:02:33,695 Nursing home staffing continues to be a challenge 66 00:02:33,715 --> 00:02:35,255 to our partners in being able 67 00:02:35,255 --> 00:02:37,975 to maximize the nursing home beds available in our region, 68 00:02:39,135 --> 00:02:40,455 ultimately turning hallways 69 00:02:40,455 --> 00:02:42,655 of previous care spaces into storage rooms. 70 00:02:43,795 --> 00:02:46,045 It's no secret our population is aging quickly. 71 00:02:46,055 --> 00:02:47,525 While resources are dwindling, 72 00:02:48,825 --> 00:02:52,005 the situation not only impacts the health of the patient 73 00:02:52,065 --> 00:02:54,285 and family awaiting transition to post-acute care, 74 00:02:54,705 --> 00:02:56,445 but it impacts others who are seeking care 75 00:02:56,625 --> 00:02:58,205 as bed availability is limited 76 00:02:58,585 --> 00:03:00,365 and creates a need to divert patients 77 00:03:00,545 --> 00:03:03,245 to other healthcare facilities that are far from home. 78 00:03:04,105 --> 00:03:07,885 In the fall of 2022, on many days, 40 79 00:03:07,985 --> 00:03:10,925 of our 185, so 22% 80 00:03:11,105 --> 00:03:14,605 of our medical surgical hospital beds were holding patients 81 00:03:14,605 --> 00:03:15,845 who are medically stable 82 00:03:16,385 --> 00:03:19,325 but awaiting a post-acute bed to open. 83 00:03:20,425 --> 00:03:21,445 So what did we do? 84 00:03:22,345 --> 00:03:25,765 We pulled on multiple threads to approach this complex issue 85 00:03:25,765 --> 00:03:27,285 and I'm only providing just a couple 86 00:03:27,305 --> 00:03:30,085 of the examples in our own walls. 87 00:03:30,225 --> 00:03:32,405 We found that we were lacking a standard of care 88 00:03:32,405 --> 00:03:33,885 for patients with dementia 89 00:03:34,265 --> 00:03:37,965 and that this often led to increased behavioral escalation 90 00:03:38,505 --> 00:03:40,565 as well as increased length of stay 91 00:03:40,625 --> 00:03:44,325 and created even more difficulty in securing post-acute 92 00:03:44,325 --> 00:03:46,445 placement for this specific population. 93 00:03:47,305 --> 00:03:48,565 We really looked internally 94 00:03:49,065 --> 00:03:52,125 and we researched best practices, completed site visits 95 00:03:52,125 --> 00:03:55,605 with successful dementia units, created focused education 96 00:03:55,625 --> 00:03:59,085 for internal staff and transformed our physical dementia 97 00:03:59,085 --> 00:04:02,165 care space to provide dementia friendly features. 98 00:04:03,185 --> 00:04:07,005 We created a hospital geriatric clinician consult service 99 00:04:07,505 --> 00:04:10,565 to help standardize the very special care for this subset 100 00:04:10,565 --> 00:04:13,965 of patients with dementia where behaviors were significant. 101 00:04:14,915 --> 00:04:17,925 This type of care looks much different from other attending 102 00:04:18,165 --> 00:04:21,645 hospital services by which detailed behavior tracking in 103 00:04:21,925 --> 00:04:24,205 patients is key to assisting these patients. 104 00:04:25,105 --> 00:04:27,285 In the four months since implementing the changes, 105 00:04:27,825 --> 00:04:30,965 we have reduced the need to use medications to deescalate, 106 00:04:31,175 --> 00:04:32,365 deescalate behaviors 107 00:04:32,785 --> 00:04:37,645 and have reduced length of stay from 5.4 days to 4.7 days. 108 00:04:37,985 --> 00:04:41,045 And we are extremely proud of the care we are providing. 109 00:04:42,065 --> 00:04:43,965 We feel better prepared as we know 110 00:04:43,965 --> 00:04:46,285 that there are 7 million people living in the US 111 00:04:46,285 --> 00:04:48,725 with dementia and that this number continues 112 00:04:48,725 --> 00:04:51,705 to rise externally. 113 00:04:52,005 --> 00:04:53,665 We work to build relationships 114 00:04:53,735 --> 00:04:55,945 with local skilled nursing facilities 115 00:04:56,285 --> 00:04:58,145 and collaborated with them to rent 116 00:04:58,285 --> 00:05:00,985 and reopen beds which had been previously 117 00:05:00,985 --> 00:05:02,105 turned into storage rooms. 118 00:05:03,085 --> 00:05:05,985 We currently rent 27 beds from three facilities, 119 00:05:06,605 --> 00:05:09,465 and this partnership is beyond renting beds. 120 00:05:09,805 --> 00:05:12,345 We are creating a relationship where we take care 121 00:05:12,345 --> 00:05:13,545 of these patients together. 122 00:05:15,285 --> 00:05:16,545 Our new average number 123 00:05:16,605 --> 00:05:20,345 of stable patients awaiting post-acute placement is now 124 00:05:20,345 --> 00:05:23,985 closer to 20, so cut nearly in half from a year ago. 125 00:05:25,915 --> 00:05:28,975 Lastly, we are building relationships with our county 126 00:05:29,155 --> 00:05:33,255 and state leadership to break down barriers related 127 00:05:33,315 --> 00:05:36,095 to the guardianship process In Wisconsin. 128 00:05:36,325 --> 00:05:38,135 When a patient is incapacitated 129 00:05:38,195 --> 00:05:41,255 and unable to make decisions, it is our courts 130 00:05:41,255 --> 00:05:42,895 who must appoint a guardian to do so. 131 00:05:42,955 --> 00:05:44,935 If one had not been named in a power of attorney, 132 00:05:45,965 --> 00:05:48,295 this process can take anywhere from four 133 00:05:48,295 --> 00:05:50,895 to six weeks in which the patient stays in the acute 134 00:05:51,375 --> 00:05:54,095 hospital space awaiting the decisions to be made. 135 00:05:54,835 --> 00:05:56,935 We are working both at the county level, 136 00:05:57,225 --> 00:05:59,445 but also with Wisconsin state legislators 137 00:05:59,445 --> 00:06:03,285 to move forward led legislation that would allow next of kin 138 00:06:03,285 --> 00:06:04,845 to assist with the decision making. 139 00:06:05,585 --> 00:06:07,805 And these are just a few of the examples of 140 00:06:07,865 --> 00:06:09,405 how we are working together 141 00:06:09,785 --> 00:06:11,765 to make sure we are taking really great care 142 00:06:11,825 --> 00:06:14,325 of our super special aging population. 143 00:06:15,385 --> 00:06:16,915 - Wonderful. Thank you so much 144 00:06:16,935 --> 00:06:19,155 for giving the us those examples. 145 00:06:19,455 --> 00:06:22,435 Really, really helpful. Um, as you know, 146 00:06:22,455 --> 00:06:24,315 the clinical workforce has changed a lot 147 00:06:24,335 --> 00:06:25,435 in the last few years. 148 00:06:26,095 --> 00:06:29,835 Um, pretty much everyone in in healthcare is still talking 149 00:06:29,835 --> 00:06:31,515 about the issues coming from that. 150 00:06:31,905 --> 00:06:33,915 What challenges are you still facing 151 00:06:34,055 --> 00:06:35,995 and how do you see the clinical workforce evolving? 152 00:06:37,645 --> 00:06:41,125 - I think as it relates to this topic of post-acute care 153 00:06:41,265 --> 00:06:45,405 and really looking at our population who is aging, coming in 154 00:06:45,405 --> 00:06:47,485 with more complex issues, having less 155 00:06:47,485 --> 00:06:51,245 and less support, this problem will really take an effort 156 00:06:51,245 --> 00:06:53,565 from everyone in the healthcare workforce, 157 00:06:54,115 --> 00:06:56,965 from the frontline to the c-suite all banding together. 158 00:06:57,355 --> 00:06:59,845 It's really looking at understanding the landscape 159 00:06:59,845 --> 00:07:04,165 and really looking at, um, socioeconomic demographic 160 00:07:04,875 --> 00:07:07,805 data to see what is in your, um, 161 00:07:07,955 --> 00:07:10,525 what is coming down the pike in terms of what will change, 162 00:07:10,525 --> 00:07:13,485 how you need to respond to take better care of our patients. 163 00:07:13,825 --> 00:07:16,085 So it's really understanding that landscape. 164 00:07:16,665 --> 00:07:17,725 Um, in our region, 165 00:07:18,345 --> 00:07:21,405 we have really remodeled our workforce again by adding on 166 00:07:21,405 --> 00:07:24,325 that geriatric clinician, really changing the way 167 00:07:24,325 --> 00:07:25,565 that we take care of this patient. 168 00:07:25,785 --> 00:07:28,325 Uh, one of the patient populations impacted by this, 169 00:07:28,905 --> 00:07:31,605 but we've also prioritized this work 170 00:07:32,545 --> 00:07:36,045 and we have segmented this work out into a separate area 171 00:07:36,045 --> 00:07:39,085 of responsibility that is led by specific 172 00:07:39,645 --> 00:07:42,005 clinical administrative and strategic leaders. 173 00:07:42,385 --> 00:07:43,565 And what this has done, 174 00:07:43,565 --> 00:07:45,765 this has helped kept the relationships tight, 175 00:07:46,225 --> 00:07:48,845 it has helped us keep an eye on improvements needed 176 00:07:49,305 --> 00:07:51,765 and really helps us celebrate the small wins along the way. 177 00:07:51,825 --> 00:07:54,125 And I am so, so thankful for these teams 178 00:07:54,545 --> 00:07:55,765 as we keep improving. 179 00:07:57,335 --> 00:07:59,385 - Yeah, absolutely, definitely essential to, 180 00:07:59,605 --> 00:08:00,985 uh, to improve growth. 181 00:08:01,605 --> 00:08:03,545 And before I let you go, the last thing I wanted 182 00:08:03,545 --> 00:08:05,265 to ask you is what is your best advice 183 00:08:05,685 --> 00:08:07,825 for aspiring physician and nurse leaders 184 00:08:09,815 --> 00:08:10,815 - Leaders? 185 00:08:10,815 --> 00:08:13,905 My advice is to learn how to improve not only in your walls, 186 00:08:14,285 --> 00:08:17,025 but how to partner outside of your walls 187 00:08:17,125 --> 00:08:19,385 to improve the entire landscape of 188 00:08:19,385 --> 00:08:22,905 how healthcare is delivered, be it schools, county, 189 00:08:23,035 --> 00:08:25,265 other healthcare organizations, your state 190 00:08:25,265 --> 00:08:28,505 and federal government, really learning how to advocate. 191 00:08:29,585 --> 00:08:32,385 I would give advice to aspiring physician 192 00:08:32,385 --> 00:08:35,145 and nurse leaders to surround yourself with a genius 193 00:08:35,325 --> 00:08:36,665 of various disciplines. 194 00:08:37,325 --> 00:08:40,905 We have amazing people from social services, strategy, 195 00:08:41,135 --> 00:08:42,265 therapies, finance, 196 00:08:42,615 --> 00:08:45,625 that can help us solve these really complex problems. 197 00:08:45,965 --> 00:08:48,465 So really my advice is branch out 198 00:08:48,525 --> 00:08:50,465 to truly evolve the care that we deliver. 199 00:08:52,525 --> 00:08:55,115 - Great advice. Thank you so much for those final thoughts. 200 00:08:55,315 --> 00:08:56,805 This has been an amazing 201 00:08:56,865 --> 00:08:59,325 and informative, uh, informative discussion truly. 202 00:08:59,425 --> 00:09:00,725 So again, I wanna thank you so much 203 00:09:00,725 --> 00:09:01,965 for coming on Becker's Healthcare 204 00:09:02,265 --> 00:09:04,005 and I look forward to connecting with you again soon. 205 00:09:04,415 --> 00:09:06,805 Thank you. Have a great day. 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