1 00:00:00,235 --> 00:00:02,565 - This is Laura Dedo with the Becker's Healthcare Podcast. 2 00:00:03,185 --> 00:00:05,085 I'm thrilled today to be joined by Erin Keefe, 3 00:00:05,175 --> 00:00:07,125 chief Nurse Executive Officer at St. 4 00:00:07,125 --> 00:00:08,125 Bernadine Medical Center. 5 00:00:08,395 --> 00:00:10,285 Erin, it's a pleasure to have you on the podcast today. 6 00:00:11,385 --> 00:00:14,125 - Yes, thank you for inviting me. I'm excited to be here. 7 00:00:15,475 --> 00:00:17,195 - Absolutely. And I'm excited for our conversation, too. 8 00:00:17,395 --> 00:00:19,395 I think it'll be really amazing 9 00:00:19,535 --> 00:00:21,315 to hear more about what you're doing at St. 10 00:00:21,315 --> 00:00:23,675 Bernard Medical Center, um, with your nursing team 11 00:00:23,695 --> 00:00:24,995 and really some of the big trends 12 00:00:24,995 --> 00:00:26,075 and issues that you're following. 13 00:00:26,095 --> 00:00:27,795 But before we dive into my questions, 14 00:00:28,135 --> 00:00:29,195 can you tell me a little bit more 15 00:00:29,195 --> 00:00:30,435 about yourself and your background? 16 00:00:32,045 --> 00:00:35,225 - Um, sure. I have been a registered nurse for 17 00:00:35,735 --> 00:00:39,065 over 30 years, and I actually, um, 18 00:00:39,305 --> 00:00:42,705 I did my initial undergrad education in Canada, which is 19 00:00:42,705 --> 00:00:47,585 where I grew up, and I moved to the US in, uh, 1995 20 00:00:48,205 --> 00:00:51,825 and, um, have been here for most of that time. 21 00:00:52,345 --> 00:00:54,625 I, I went back for, for a period of a couple of years, 22 00:00:54,765 --> 00:00:58,705 but I, I worked in six different states 23 00:00:59,245 --> 00:01:03,185 and, uh, a variety of different clinical areas primarily, 24 00:01:03,845 --> 00:01:07,025 uh, critical care, so ICUs and emergency departments. 25 00:01:07,605 --> 00:01:11,825 Um, but I also, um, spent some time working in ambulatory 26 00:01:12,525 --> 00:01:14,985 as well as perioperative leadership. 27 00:01:15,685 --> 00:01:19,585 And, uh, I've been in a leadership role, um, 28 00:01:20,085 --> 00:01:21,345 for over 15 years 29 00:01:21,965 --> 00:01:26,105 and, uh, um, very lucky to, um, to be 30 00:01:26,105 --> 00:01:27,345 where I am right now. 31 00:01:27,585 --> 00:01:29,025 I think, um, St. 32 00:01:29,025 --> 00:01:33,905 Berna Medical Center is a 342 bed, uh, acute care 33 00:01:34,625 --> 00:01:36,505 facility in San Bernardino, California. 34 00:01:37,345 --> 00:01:42,305 A very vulnerable, uh, community underserved population, uh, 35 00:01:42,395 --> 00:01:46,385 where, uh, you know, we have been, um, doing a lot of work 36 00:01:46,685 --> 00:01:50,985 to try and improve the health of this community and, um, 37 00:01:51,645 --> 00:01:54,105 and, and provide a great place for medical care. 38 00:01:55,025 --> 00:01:57,205 Uh, we're doing a lot of great things here, I think. 39 00:01:57,425 --> 00:02:01,025 Uh, but I'm biased of course, so that's me. 40 00:02:02,335 --> 00:02:04,545 - Fantastic. And, and I, I think that's amazing 41 00:02:04,655 --> 00:02:06,505 what great experiences that you've had in 42 00:02:06,565 --> 00:02:09,865 so many different aspects of healthcare, um, you know, in, 43 00:02:09,865 --> 00:02:11,305 in especially serving underserved 44 00:02:11,335 --> 00:02:12,985 populations is so important. 45 00:02:13,525 --> 00:02:15,865 Um, so I wanna dig in here a little bit deeper. 46 00:02:15,935 --> 00:02:17,785 What are some of your top priorities right now? 47 00:02:17,785 --> 00:02:19,665 What do you really have top of mind? 48 00:02:21,355 --> 00:02:26,255 - You know, it's, um, not, not very much different from 49 00:02:26,255 --> 00:02:28,455 what I think everyone else is, is going through. 50 00:02:29,155 --> 00:02:32,055 You know, we're still, um, in recovery phase, 51 00:02:32,325 --> 00:02:34,695 even though we like to think the pandemic is 52 00:02:34,695 --> 00:02:35,775 behind us completely. 53 00:02:36,435 --> 00:02:40,695 Um, we've, we've had a huge focus on stabilization 54 00:02:40,955 --> 00:02:45,095 and rebuilding our staffing pools, so, uh, a lot of work 55 00:02:45,095 --> 00:02:46,575 with our local universities 56 00:02:47,155 --> 00:02:51,575 and colleges to improve, uh, the pipeline for new nurses. 57 00:02:52,435 --> 00:02:57,135 Um, we've adopted the system, uh, nurse, uh, 58 00:02:57,455 --> 00:02:59,525 residency program for new graduates, 59 00:03:00,025 --> 00:03:03,685 and we also, um, are continuing our, um, new 60 00:03:03,685 --> 00:03:06,365 to service line residencies for nurses that are already here 61 00:03:06,365 --> 00:03:09,365 with us, uh, that maybe want to try a new, uh, 62 00:03:09,445 --> 00:03:10,765 a new area of practice. 63 00:03:11,145 --> 00:03:13,245 And, uh, that helps us, obviously 64 00:03:13,245 --> 00:03:16,445 with decreasing our turnover, keeping our staff here. 65 00:03:17,145 --> 00:03:21,645 Um, we've also, uh, had a huge focus on staff wellbeing, 66 00:03:21,945 --> 00:03:23,245 uh, staff and positions. 67 00:03:23,865 --> 00:03:28,325 Um, there, there is that lingering impact from the pandemic 68 00:03:28,355 --> 00:03:30,485 that just, it took a huge emotional toll 69 00:03:31,025 --> 00:03:34,685 and, um, we are very lucky to be able 70 00:03:34,685 --> 00:03:39,125 to have on site, um, a, a therapist who works 71 00:03:39,125 --> 00:03:40,845 with our staff both individually 72 00:03:40,845 --> 00:03:43,405 and in groups, um, as part 73 00:03:43,405 --> 00:03:45,045 of our employee assistance program. 74 00:03:45,545 --> 00:03:48,485 And, uh, so that, that remains a high focus for us. 75 00:03:48,905 --> 00:03:51,965 And then sustainable growth for, for the organization. 76 00:03:52,865 --> 00:03:56,245 Uh, healthcare, the landscape continues to shift 77 00:03:56,705 --> 00:04:00,805 and, um, it becomes more challenging with, with payers. 78 00:04:01,145 --> 00:04:03,685 And, uh, so we are, again, 79 00:04:03,685 --> 00:04:05,525 we serve an underserved population 80 00:04:05,525 --> 00:04:08,445 and how can we sustain for the long term into the future? 81 00:04:10,195 --> 00:04:11,335 - That's such a great point. 82 00:04:11,515 --> 00:04:15,015 And, and definitely, um, having that ability to, um, 83 00:04:15,265 --> 00:04:17,055 understand the workforce, understand 84 00:04:17,085 --> 00:04:18,895 what the clinical teams are going through, 85 00:04:18,915 --> 00:04:21,295 and then provide, uh, some of that support 86 00:04:21,395 --> 00:04:23,575 and some of the recovery that they need in order 87 00:04:23,595 --> 00:04:27,295 to really get into a space where, um, you know, you're able 88 00:04:27,295 --> 00:04:29,815 to provide care for the communities that they need. 89 00:04:30,475 --> 00:04:32,695 And, you know, when you talk about being able 90 00:04:32,815 --> 00:04:34,695 to decrease staff turnover, um, 91 00:04:34,715 --> 00:04:37,815 and really be, you know, have a, a great pipeline 92 00:04:37,815 --> 00:04:39,295 of talent coming in and 93 00:04:39,295 --> 00:04:42,215 unless something a lot of hospitals aspire to, I, 94 00:04:42,275 --> 00:04:46,055 is there anything that you've, um, done recently to try 95 00:04:46,055 --> 00:04:47,215 to tackle some of those challenges? 96 00:04:47,295 --> 00:04:48,535 I know you mentioned, um, 97 00:04:48,555 --> 00:04:51,255 having a therapist on site and some other things. 98 00:04:51,435 --> 00:04:53,495 Um, um, you know, is there anything else that you're doing 99 00:04:53,515 --> 00:04:55,575 to try to reduce that turnover rate? 100 00:04:57,475 --> 00:04:58,815 - Uh, um, one thing that 101 00:04:59,935 --> 00:05:02,015 geographically our facility's located for those 102 00:05:02,035 --> 00:05:03,775 who are familiar with, um, 103 00:05:04,055 --> 00:05:05,655 Southern California in the Inland Empire, 104 00:05:05,655 --> 00:05:06,655 it's a bit isolated 105 00:05:07,515 --> 00:05:11,135 and, uh, it, it, it's not a place where a lot of people want 106 00:05:11,135 --> 00:05:12,775 to necessarily relocate to. 107 00:05:13,435 --> 00:05:16,335 So for, from a turnover perspective, when we're hiring, 108 00:05:16,465 --> 00:05:17,975 we're looking at people that, 109 00:05:18,245 --> 00:05:20,455 that are somewhat familiar with the area. 110 00:05:20,955 --> 00:05:22,735 Uh, you know, San Bernardino's, 111 00:05:22,975 --> 00:05:25,495 I think the largest county in the United States. 112 00:05:26,075 --> 00:05:28,895 Uh, so there's a lot of, of, uh, square footage 113 00:05:28,955 --> 00:05:32,735 and square mileage for people to move around in. 114 00:05:33,315 --> 00:05:37,615 Um, we have made, um, relationships with a couple 115 00:05:37,635 --> 00:05:40,815 of our local universities to do dedicated cohorts 116 00:05:41,075 --> 00:05:44,135 for students, so they do their entire program 117 00:05:44,565 --> 00:05:46,335 with the exception of the service lines 118 00:05:46,335 --> 00:05:48,735 that we do not offer here, like pediatrics. 119 00:05:49,195 --> 00:05:51,535 Uh, they spend their entire, um, 120 00:05:52,085 --> 00:05:55,415 four year program doing their clinicals with us, and, 121 00:05:55,595 --> 00:05:56,655 and that allows them 122 00:05:56,655 --> 00:06:00,845 to get a true feel if the culture here works for them, uh, 123 00:06:00,905 --> 00:06:01,925 and, and vice versa. 124 00:06:02,305 --> 00:06:05,125 And, and it just, it's a better onboarding. 125 00:06:05,515 --> 00:06:06,965 They know what they're getting into. 126 00:06:07,075 --> 00:06:09,005 They're not starting at a facility 127 00:06:09,005 --> 00:06:10,165 where they don't know the people, 128 00:06:10,165 --> 00:06:12,365 they don't know the physicians or the practices. 129 00:06:13,225 --> 00:06:17,525 And, um, that has had a huge impact, uh, for us to, 130 00:06:17,545 --> 00:06:19,285 to work on decreasing our turnover. 131 00:06:19,825 --> 00:06:22,965 Um, you know, we obviously are still, uh, 132 00:06:23,285 --> 00:06:26,885 figuring out the new landscape with, um, the, 133 00:06:26,885 --> 00:06:28,205 the newer generations wanting 134 00:06:28,205 --> 00:06:29,445 to move around a little bit more. 135 00:06:29,545 --> 00:06:31,605 So our turnover's a little higher than we would like it 136 00:06:31,605 --> 00:06:34,765 to be, but our vacancy rate is currently at 4%. 137 00:06:34,905 --> 00:06:38,285 So, um, you know, it, it's starting that, starting 138 00:06:38,285 --> 00:06:40,325 that process has made an impact. 139 00:06:43,195 --> 00:06:45,455 - That's great to hear. Thank you so much for, um, 140 00:06:45,455 --> 00:06:47,135 digging one bit deeper into that. 141 00:06:47,435 --> 00:06:49,615 Now, I'm wondering too, when you look into the future, 142 00:06:49,915 --> 00:06:51,775 how will, um, the hospital grow 143 00:06:51,835 --> 00:06:53,735 and evolve over the next two to three years? 144 00:06:54,205 --> 00:06:56,695 What do you really see as being, uh, on the horizon? 145 00:06:59,235 --> 00:07:02,855 - You know, I think, um, looking 146 00:07:02,955 --> 00:07:04,735 to the future things will continue 147 00:07:04,735 --> 00:07:07,175 to shift into the outpatient ambulatory world. 148 00:07:08,035 --> 00:07:12,495 And you know, for us, we're exploring, um, the potentials 149 00:07:12,495 --> 00:07:15,375 of an FQHC just to better serve our community. 150 00:07:15,955 --> 00:07:18,175 We currently have, uh, this great, 151 00:07:18,475 --> 00:07:20,015 we call it our transition clinic, 152 00:07:20,115 --> 00:07:23,055 but it's, um, it's a follow-up clinic for patients who 153 00:07:23,605 --> 00:07:24,615 have been discharged 154 00:07:24,755 --> 00:07:27,415 and can't get into see either their primary care 155 00:07:27,475 --> 00:07:30,295 or their specialty physician, um, within 156 00:07:30,295 --> 00:07:32,615 that first week following discharge. 157 00:07:33,555 --> 00:07:35,175 And so we've started that process 158 00:07:35,435 --> 00:07:38,335 and it's had a huge impact on decreasing our readmissions. 159 00:07:38,795 --> 00:07:40,335 Uh, but again, as we start 160 00:07:40,335 --> 00:07:43,015 to move things further into the outpatient world, 161 00:07:43,075 --> 00:07:47,615 we think having better access, um, to either primary care 162 00:07:47,675 --> 00:07:52,255 or follow-up care, um, surgeries are moving out. 163 00:07:52,555 --> 00:07:54,495 Uh, and so I think you're going to see a lot 164 00:07:54,495 --> 00:07:57,415 of organizations, um, having more partnerships 165 00:07:57,415 --> 00:07:59,055 with ASCs and things like that. 166 00:07:59,875 --> 00:08:03,935 And, um, and so for us it's really looking at the services 167 00:08:03,935 --> 00:08:06,855 that we're offering, what is the need of the community? 168 00:08:07,195 --> 00:08:08,975 Do we need to add or change things? 169 00:08:09,475 --> 00:08:12,615 And of course, we're part of Common Spirit Health, which is, 170 00:08:12,875 --> 00:08:16,215 you know, the largest not-for-profit, um, in the country. 171 00:08:16,755 --> 00:08:20,495 And, and so there's also making sure that we align with, 172 00:08:20,565 --> 00:08:21,935 with the system strategy 173 00:08:23,275 --> 00:08:26,775 and, uh, that we're all moving in that, that one same 174 00:08:27,235 --> 00:08:28,335 or similar direction. 175 00:08:31,005 --> 00:08:32,625 - Got it. That makes a lot of sense and, 176 00:08:32,625 --> 00:08:35,185 and definitely, you know, is, um, so important 177 00:08:35,285 --> 00:08:37,785 as you mentioned, to be able to, um, 178 00:08:37,895 --> 00:08:40,585 have those partnerships go to the outpatient setting and, 179 00:08:40,605 --> 00:08:41,625 and really being in the most 180 00:08:41,865 --> 00:08:43,025 efficient and effective site of care. 181 00:08:43,685 --> 00:08:46,865 Uh, before we wrap up here, I'm wondering what is one change 182 00:08:46,865 --> 00:08:49,025 that you or your team has made, um, recently 183 00:08:49,025 --> 00:08:50,265 that yielded great results? 184 00:08:51,765 --> 00:08:55,685 - You know, it was, um, the one thing I think that has, has 185 00:08:56,235 --> 00:09:00,845 touched every point of this facility, of this hospital, um, 186 00:09:01,505 --> 00:09:04,285 it was a few years ago actually, the region, uh, 187 00:09:04,375 --> 00:09:07,205 facilities adopted the principles of high reliability. 188 00:09:07,945 --> 00:09:11,805 And so it has changed how we speak to each other, uh, 189 00:09:11,865 --> 00:09:15,685 how we look at things from every level of the facility. 190 00:09:16,145 --> 00:09:21,045 And it, it has had a direct positive impact in, um, 191 00:09:21,345 --> 00:09:24,605 the day-to-day workflows as well as patient outcomes. 192 00:09:25,265 --> 00:09:27,965 Uh, we've been able to improve, you know, our, 193 00:09:28,025 --> 00:09:31,245 our quality scores, uh, leapfrog, 194 00:09:31,935 --> 00:09:34,565 we've achieved an a, uh, we were up 195 00:09:34,565 --> 00:09:36,965 to a CMS four star rating, and, 196 00:09:37,105 --> 00:09:39,405 and I really do put it all back to 197 00:09:39,975 --> 00:09:42,485 those principles being transparent 198 00:09:42,985 --> 00:09:46,165 and seeking solution, um, for, 199 00:09:46,265 --> 00:09:48,365 for just every challenge that comes our way. 200 00:09:48,665 --> 00:09:52,125 And, uh, so if there's ever any, anyone listening 201 00:09:52,185 --> 00:09:56,685 who is thinking about it, uh, for us it has been a true, 202 00:09:56,985 --> 00:09:58,605 um, life altering journey 203 00:09:58,665 --> 00:10:00,405 for our staff and for our patients. 204 00:10:02,625 --> 00:10:05,505 - I love that. Um, you know, having that high reliability, 205 00:10:05,725 --> 00:10:07,105 um, you know, and, 206 00:10:07,125 --> 00:10:10,025 and really looking at where that can make a big difference, 207 00:10:10,025 --> 00:10:12,985 as you said, clinically, as well as, um, within the teams. 208 00:10:13,265 --> 00:10:15,905 I can imagine. Um, just really it instills a sense of pride 209 00:10:15,905 --> 00:10:18,465 and also a culture that can be really positive, um, 210 00:10:18,685 --> 00:10:20,225 for the organization overall. 211 00:10:21,835 --> 00:10:23,365 - Yeah, it's a, it's a game changer 212 00:10:23,705 --> 00:10:26,405 and, uh, you know, we live it, it's, uh, a lot 213 00:10:26,405 --> 00:10:29,605 of times you get sort of wrapped up into some, 214 00:10:29,605 --> 00:10:31,925 sometimes they call it like the flavor of the month or, 215 00:10:31,985 --> 00:10:33,245 or something new and shiny, 216 00:10:33,385 --> 00:10:37,445 but this was, was very thoughtfully rolled out, um, 217 00:10:38,065 --> 00:10:42,525 not just to staff, but also to the physicians and, um, and, 218 00:10:42,525 --> 00:10:43,965 and it has changed the way we all 219 00:10:44,325 --> 00:10:45,525 practice and for the better. 220 00:10:47,125 --> 00:10:48,565 - Excellent. Well, Aaron, thank you so much 221 00:10:48,565 --> 00:10:50,045 for joining us on the podcast today. 222 00:10:50,275 --> 00:10:52,645 This has been such a fan, fascinating discussion 223 00:10:52,645 --> 00:10:54,485 and I look forward to connecting with you again soon. 224 00:10:55,375 --> 00:10:57,365 - Thank you so much for your time. I appreciate it.