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- Welcome everyone,
to the Becker's Healthcare podcast series.
I am Ryan Mohammed re and moderator with Becker's Healthcare
and I'm absolutely so thrilled to have with me today.
Andrea Hauser, chief Nursing Officer
and vice president of Acute Care lacrosse nursing at
Gundersen Health System.
Andrea, it's very nice to have you on the
podcast today. How are you?
- I'm great, thank you. I'm very excited to be here.
- Yeah, I'm very excited to talk with you today.
Um, but to get us started,
would you mind please introducing yourself
and telling us a bit about your background?
- Yes, of course. I am a registered nurse
and as you said, I'm the Chief nursing officer
and vice president of acute care nursing
for the Gunderson region of Bellin
and Gunderson Health System.
I have been with the Gunderson Health System for 21 years
and have loved mostly every minute of it
and I'm really excited to be partnering with Bellin
and I'm excited to share
that we are actually coming up on our one year
anniversary as a health system.
So Bellin Gunderson is a not-for-profit
community-focused healthcare network.
We have headquarters in Green Bay
and La Crosse, Wisconsin, serving patients
with our 11 hospitals
and more than 100 clinic locations in Wisconsin, Minnesota,
upper Michigan and Iowa.
- Wonderful. Thank you so much
for giving us that background.
So with all you're doing right now,
can you tell me your most successful project
or initiative from the last year?
What issues were you trying to solve
and also what drove the success?
- Sure. So one of our most successful initiatives
that will continue is our internal
and external work to redesign the care surrounding one
of our, of our most vulnerable populations.
And this is our aging population who have more
and more chronic disease and less
and less available support.
So what was the problem?
We were faced with consistent barriers
to accessing post-acute care placement,
specifically long-term care and skilled nursing beds.
LA Cross County where Gunderson is located lost 40%
of our skilled nursing beds in the last 10 years.
Nursing home staffing continues to be a challenge
to our partners in being able
to maximize the nursing home beds available in our region,
ultimately turning hallways
of previous care spaces into storage rooms.
It's no secret our population is aging quickly.
While resources are dwindling,
the situation not only impacts the health of the patient
and family awaiting transition to post-acute care,
but it impacts others who are seeking care
as bed availability is limited
and creates a need to divert patients
to other healthcare facilities that are far from home.
In the fall of 2022, on many days, 40
of our 185, so 22%
of our medical surgical hospital beds were holding patients
who are medically stable
but awaiting a post-acute bed to open.
So what did we do?
We pulled on multiple threads to approach this complex issue
and I'm only providing just a couple
of the examples in our own walls.
We found that we were lacking a standard of care
for patients with dementia
and that this often led to increased behavioral escalation
as well as increased length of stay
and created even more difficulty in securing post-acute
placement for this specific population.
We really looked internally
and we researched best practices, completed site visits
with successful dementia units, created focused education
for internal staff and transformed our physical dementia
care space to provide dementia friendly features.
We created a hospital geriatric clinician consult service
to help standardize the very special care for this subset
of patients with dementia where behaviors were significant.
This type of care looks much different from other attending
hospital services by which detailed behavior tracking in
patients is key to assisting these patients.
In the four months since implementing the changes,
we have reduced the need to use medications to deescalate,
deescalate behaviors
and have reduced length of stay from 5.4 days to 4.7 days.
And we are extremely proud of the care we are providing.
We feel better prepared as we know
that there are 7 million people living in the US
with dementia and that this number continues
to rise externally.
We work to build relationships
with local skilled nursing facilities
and collaborated with them to rent
and reopen beds which had been previously
turned into storage rooms.
We currently rent 27 beds from three facilities,
and this partnership is beyond renting beds.
We are creating a relationship where we take care
of these patients together.
Our new average number
of stable patients awaiting post-acute placement is now
closer to 20, so cut nearly in half from a year ago.
Lastly, we are building relationships with our county
and state leadership to break down barriers related
to the guardianship process In Wisconsin.
When a patient is incapacitated
and unable to make decisions, it is our courts
who must appoint a guardian to do so.
If one had not been named in a power of attorney,
this process can take anywhere from four
to six weeks in which the patient stays in the acute
hospital space awaiting the decisions to be made.
We are working both at the county level,
but also with Wisconsin state legislators
to move forward led legislation that would allow next of kin
to assist with the decision making.
And these are just a few of the examples of
how we are working together
to make sure we are taking really great care
of our super special aging population.
- Wonderful. Thank you so much
for giving the us those examples.
Really, really helpful. Um, as you know,
the clinical workforce has changed a lot
in the last few years.
Um, pretty much everyone in in healthcare is still talking
about the issues coming from that.
What challenges are you still facing
and how do you see the clinical workforce evolving?
- I think as it relates to this topic of post-acute care
and really looking at our population who is aging, coming in
with more complex issues, having less
and less support, this problem will really take an effort
from everyone in the healthcare workforce,
from the frontline to the c-suite all banding together.
It's really looking at understanding the landscape
and really looking at, um, socioeconomic demographic
data to see what is in your, um,
what is coming down the pike in terms of what will change,
how you need to respond to take better care of our patients.
So it's really understanding that landscape.
Um, in our region,
we have really remodeled our workforce again by adding on
that geriatric clinician, really changing the way
that we take care of this patient.
Uh, one of the patient populations impacted by this,
but we've also prioritized this work
and we have segmented this work out into a separate area
of responsibility that is led by specific
clinical administrative and strategic leaders.
And what this has done,
this has helped kept the relationships tight,
it has helped us keep an eye on improvements needed
and really helps us celebrate the small wins along the way.
And I am so, so thankful for these teams
as we keep improving.
- Yeah, absolutely, definitely essential to,
uh, to improve growth.
And before I let you go, the last thing I wanted
to ask you is what is your best advice
for aspiring physician and nurse leaders
- Leaders?
My advice is to learn how to improve not only in your walls,
but how to partner outside of your walls
to improve the entire landscape of
how healthcare is delivered, be it schools, county,
other healthcare organizations, your state
and federal government, really learning how to advocate.
I would give advice to aspiring physician
and nurse leaders to surround yourself with a genius
of various disciplines.
We have amazing people from social services, strategy,
therapies, finance,
that can help us solve these really complex problems.
So really my advice is branch out
to truly evolve the care that we deliver.
- Great advice. Thank you so much for those final thoughts.
This has been an amazing
and informative, uh, informative discussion truly.
So again, I wanna thank you so much
for coming on Becker's Healthcare
and I look forward to connecting with you again soon.
Thank you. Have a great day. You too.
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