1 00:00:00,080 --> 00:00:02,980 Hi, everyone. This is Erica Carbajal with Becker's 2 00:00:03,040 --> 00:00:05,599 Hospital Review. Thank you so much for tuning 3 00:00:05,599 --> 00:00:08,259 in to this episode of the Becker's Healthcare 4 00:00:08,320 --> 00:00:08,820 Podcast. 5 00:00:09,519 --> 00:00:11,859 Today, we're joined by Frankie Hamilton, 6 00:00:12,160 --> 00:00:14,259 vice president of nursing operations 7 00:00:14,705 --> 00:00:17,445 at My Minaitis Medical Center in New York. 8 00:00:17,585 --> 00:00:19,984 Frankie, welcome. Welcome. Thank you so much for 9 00:00:19,984 --> 00:00:20,885 taking the time. 10 00:00:21,344 --> 00:00:22,864 Thank you. Thank you for having me, Erica. 11 00:00:22,864 --> 00:00:25,505 I appreciate it. Yeah. Pleasure to have you 12 00:00:25,505 --> 00:00:27,824 on today. Do you wanna start by sharing 13 00:00:27,824 --> 00:00:29,204 a little bit about 14 00:00:29,559 --> 00:00:32,039 your role, your organization, and the scope of 15 00:00:32,039 --> 00:00:32,700 your work? 16 00:00:33,640 --> 00:00:34,140 Sure. 17 00:00:34,520 --> 00:00:36,059 So I joined the Maimonides 18 00:00:36,439 --> 00:00:39,409 team about almost a year ago in March 19 00:00:39,409 --> 00:00:40,140 2025. 20 00:00:40,439 --> 00:00:42,359 I came here, in the role of vice 21 00:00:42,359 --> 00:00:45,284 president of nursing operations, which is a title 22 00:00:45,284 --> 00:00:47,304 that was, I think, newer to the organization. 23 00:00:48,085 --> 00:00:50,424 And in my role, I oversee 24 00:00:50,804 --> 00:00:52,344 nine medicine units 25 00:00:52,804 --> 00:00:55,445 as well as our dialysis unit, which only 26 00:00:55,445 --> 00:00:55,945 covers 27 00:00:56,725 --> 00:00:58,344 inpatients. We don't have, 28 00:00:59,079 --> 00:01:01,340 outpatient services for Dallas at the moment. 29 00:01:01,799 --> 00:01:05,099 I also cover the nursing administration office, which 30 00:01:05,319 --> 00:01:06,859 houses our float pools 31 00:01:07,239 --> 00:01:10,759 as well as our nursing administrative directors who 32 00:01:10,759 --> 00:01:13,479 keep the hospital running on the evening, night, 33 00:01:13,479 --> 00:01:14,415 and weekend shifts. 34 00:01:15,215 --> 00:01:16,275 And I also 35 00:01:16,895 --> 00:01:18,734 sort of am in charge of special nursing 36 00:01:18,734 --> 00:01:21,474 projects and initiatives that come up throughout 37 00:01:22,094 --> 00:01:24,034 the course of our daily operations. 38 00:01:24,734 --> 00:01:25,234 And, 39 00:01:25,855 --> 00:01:28,114 so that includes, like, working with some vendors 40 00:01:28,255 --> 00:01:30,909 and bringing new products. And, of course, that's 41 00:01:30,909 --> 00:01:33,390 in collaboration with all of our other nursing 42 00:01:33,390 --> 00:01:35,010 departments, quality department, 43 00:01:35,549 --> 00:01:38,049 nursing practice and innovation, nursing education. 44 00:01:38,590 --> 00:01:40,829 So my job is definitely not siloed for 45 00:01:40,829 --> 00:01:41,329 sure. 46 00:01:41,635 --> 00:01:43,634 And then I also will be in charge 47 00:01:43,634 --> 00:01:44,534 of our ANCC 48 00:01:44,834 --> 00:01:45,334 magnet 49 00:01:45,715 --> 00:01:46,935 designation application 50 00:01:47,474 --> 00:01:47,974 project 51 00:01:48,515 --> 00:01:51,094 slash initiative, which we will be applying 52 00:01:51,555 --> 00:01:52,854 for magnet designation 53 00:01:53,795 --> 00:01:54,034 soon, 54 00:01:55,319 --> 00:01:57,819 possibly within the the next year or two. 55 00:01:58,120 --> 00:02:00,760 And, I will be that will be under 56 00:02:00,760 --> 00:02:02,520 my book of work as well. So we'll 57 00:02:02,520 --> 00:02:03,180 be hiring 58 00:02:03,480 --> 00:02:04,859 a magnet program director, 59 00:02:05,319 --> 00:02:05,819 and 60 00:02:06,200 --> 00:02:09,080 I'll be working on our entire magnet journey 61 00:02:09,080 --> 00:02:09,580 alongside 62 00:02:10,275 --> 00:02:12,694 whoever is chosen for that for that role. 63 00:02:13,794 --> 00:02:16,675 Yeah. Thanks, Frankie. Well, congrats on on almost 64 00:02:16,675 --> 00:02:17,555 a year here. 65 00:02:17,955 --> 00:02:19,715 I I know you you oversee a lot, 66 00:02:19,715 --> 00:02:21,474 and I know you mentioned your role isn't 67 00:02:21,474 --> 00:02:24,639 siloed, and it certainly sounds that way. And 68 00:02:24,639 --> 00:02:26,719 I know magnet designation is is no small 69 00:02:26,719 --> 00:02:28,560 feat. There's so much work that that goes 70 00:02:28,560 --> 00:02:29,060 into 71 00:02:29,520 --> 00:02:32,099 applying for those and achieving that that designee. 72 00:02:32,159 --> 00:02:34,819 So thank you for sharing that helpful context. 73 00:02:36,135 --> 00:02:38,055 Frankie, I know you you mentioned you are 74 00:02:38,055 --> 00:02:40,375 coming up on a year. So what was 75 00:02:40,375 --> 00:02:43,014 maybe the most important initiative you've led since 76 00:02:43,014 --> 00:02:43,754 you've joined? 77 00:02:44,375 --> 00:02:45,974 What what was it, and what were some 78 00:02:45,974 --> 00:02:46,635 of the results? 79 00:02:47,814 --> 00:02:48,314 Sure. 80 00:02:48,694 --> 00:02:49,194 So 81 00:02:50,099 --> 00:02:52,340 for me, I guess, I have worked night 82 00:02:52,340 --> 00:02:54,280 shift for a lot of my nursing career. 83 00:02:54,500 --> 00:02:56,659 I've worked night shift many years as a 84 00:02:56,659 --> 00:02:58,039 clinical bedside nurse 85 00:02:58,340 --> 00:02:59,319 and then also 86 00:02:59,620 --> 00:03:02,199 when I have held roles in nursing administration 87 00:03:02,995 --> 00:03:03,735 as an assistant director 88 00:03:04,115 --> 00:03:06,215 for nursing or nursing administrator 89 00:03:06,835 --> 00:03:08,835 where I covered the hospital on the night 90 00:03:08,835 --> 00:03:11,555 shift. And since that team reports up through 91 00:03:11,555 --> 00:03:12,055 me, 92 00:03:12,594 --> 00:03:14,754 I noticed that there were some areas of 93 00:03:14,754 --> 00:03:17,969 opportunity that we could really work on improving 94 00:03:18,030 --> 00:03:19,250 and streamlining communication 95 00:03:20,110 --> 00:03:20,610 between 96 00:03:21,310 --> 00:03:24,349 the different departments on the night shift. So, 97 00:03:24,349 --> 00:03:26,750 you know, after really kind of learning the 98 00:03:26,750 --> 00:03:28,750 ways of the land here at Maimonides and 99 00:03:28,750 --> 00:03:32,365 understanding where there were areas of growth, I 100 00:03:32,365 --> 00:03:34,864 realized that there was opportunity to implement 101 00:03:35,164 --> 00:03:37,185 a night shift safety huddle. 102 00:03:37,485 --> 00:03:39,645 So there was already a safety huddle in 103 00:03:39,645 --> 00:03:41,025 place for the day shift, 104 00:03:41,324 --> 00:03:43,485 and that takes place every morning with all 105 00:03:43,485 --> 00:03:44,864 the the department leadership 106 00:03:45,250 --> 00:03:46,550 from all the different disciplines, 107 00:03:47,250 --> 00:03:48,389 ancillary departments, 108 00:03:48,689 --> 00:03:49,909 nursing, physicians. 109 00:03:50,449 --> 00:03:51,989 And, you know, the whole point 110 00:03:52,289 --> 00:03:55,090 of that safety huddle is to escalate any 111 00:03:55,090 --> 00:03:58,150 concerns that might need to be addressed immediately 112 00:03:58,289 --> 00:04:00,645 throughout that day to make sure that there 113 00:04:00,645 --> 00:04:02,405 are safety measures in place and to make 114 00:04:02,405 --> 00:04:05,465 sure that things that are, you know, barriers 115 00:04:05,525 --> 00:04:06,185 or challenges 116 00:04:06,724 --> 00:04:09,145 are taken care of and remediated as expeditiously 117 00:04:09,365 --> 00:04:10,025 as possible. 118 00:04:10,564 --> 00:04:12,245 So we were missing that on the night 119 00:04:12,245 --> 00:04:14,344 shift. So when I spoke with our CNO, 120 00:04:14,879 --> 00:04:16,259 he was 100% 121 00:04:16,319 --> 00:04:16,819 behind 122 00:04:17,279 --> 00:04:20,160 initiating the same type of Huddl and mirror 123 00:04:20,319 --> 00:04:22,720 mirroring that for the night shift. So I 124 00:04:22,720 --> 00:04:24,560 think that's one of the initiatives that I'm 125 00:04:24,560 --> 00:04:27,439 most proud of is bringing that sort of 126 00:04:27,439 --> 00:04:28,660 communication platform 127 00:04:29,235 --> 00:04:31,555 to the night shift so that we have 128 00:04:31,555 --> 00:04:34,115 a similar type of structure and process in 129 00:04:34,115 --> 00:04:34,615 place 130 00:04:34,915 --> 00:04:37,495 where the interdisciplinary teams can come together, 131 00:04:38,274 --> 00:04:41,475 the nursing teams, you know, nursing leaders who 132 00:04:41,475 --> 00:04:42,294 work at night 133 00:04:42,649 --> 00:04:46,089 as well as engineering and environmental services and 134 00:04:46,089 --> 00:04:46,589 biomed, 135 00:04:46,970 --> 00:04:49,289 where they can come together and report out 136 00:04:49,289 --> 00:04:52,089 on their areas any barriers or challenges they 137 00:04:52,089 --> 00:04:52,909 might be experiencing 138 00:04:53,289 --> 00:04:55,689 that are gonna impact patient care or patient 139 00:04:55,689 --> 00:04:57,310 flow or or operations. 140 00:04:58,004 --> 00:05:00,004 So, you know, from that, I think there 141 00:05:00,004 --> 00:05:02,985 has been better engagement from the night shift, 142 00:05:03,045 --> 00:05:03,545 and 143 00:05:04,085 --> 00:05:05,625 I think the night shift have 144 00:05:06,405 --> 00:05:07,865 appreciated the better communication 145 00:05:08,485 --> 00:05:10,665 coming from those different departments because sometimes, 146 00:05:10,970 --> 00:05:12,650 you know, as a night shift a former 147 00:05:12,650 --> 00:05:14,030 night shift nurse myself, 148 00:05:14,490 --> 00:05:16,810 sometimes night shift can feel left out. And 149 00:05:16,810 --> 00:05:18,810 so I think this 09:30PM 150 00:05:18,810 --> 00:05:20,509 Huddl brings people together, 151 00:05:21,370 --> 00:05:21,870 establishes 152 00:05:22,410 --> 00:05:22,910 relationships, 153 00:05:23,375 --> 00:05:25,615 which is really important for the night shift 154 00:05:25,615 --> 00:05:27,775 when there are less people around. You wanna 155 00:05:27,775 --> 00:05:29,455 know the people who are there and the 156 00:05:29,455 --> 00:05:31,134 players that are gonna be able to help 157 00:05:31,134 --> 00:05:32,595 you out in the different departments. 158 00:05:32,895 --> 00:05:34,175 So I think I've seen a lot of 159 00:05:34,175 --> 00:05:37,629 success and heard anecdotally from the nursing administrative 160 00:05:37,689 --> 00:05:40,250 directors who cover the night shift as nurse 161 00:05:40,250 --> 00:05:42,490 leaders as well as the different team members 162 00:05:42,490 --> 00:05:44,569 who are part of the Huddl that this 163 00:05:44,569 --> 00:05:45,310 new platform 164 00:05:45,689 --> 00:05:47,470 has helped to streamline communication, 165 00:05:48,250 --> 00:05:48,990 to enhance, 166 00:05:49,404 --> 00:05:52,225 you know, throughput, and to just bring awareness 167 00:05:52,444 --> 00:05:54,925 to the current state of affairs of things 168 00:05:54,925 --> 00:05:57,324 happening on the night shift that are possibly 169 00:05:57,324 --> 00:05:58,064 gonna impact 170 00:05:58,604 --> 00:06:01,264 the the the workflows for the staff. So 171 00:06:01,579 --> 00:06:04,699 it's been really successful, and we are gonna 172 00:06:04,699 --> 00:06:06,779 continue that. It happens on the weekends as 173 00:06:06,779 --> 00:06:09,439 well on Saturday and Sunday morning and night. 174 00:06:09,500 --> 00:06:10,560 So there's continuity 175 00:06:11,180 --> 00:06:12,000 of communication 176 00:06:12,779 --> 00:06:15,274 throughout all shifts. And I think that's really 177 00:06:15,354 --> 00:06:16,974 you know, as we know in health care, 178 00:06:17,274 --> 00:06:18,654 most errors are 179 00:06:19,115 --> 00:06:21,615 caused by lack of communication or miscommunication. 180 00:06:22,394 --> 00:06:24,814 So in this case, this platform has 181 00:06:25,274 --> 00:06:26,334 served to, 182 00:06:27,100 --> 00:06:28,639 you know, really try to enhance 183 00:06:29,259 --> 00:06:31,819 the dialogue between teams. So I'm really proud 184 00:06:31,819 --> 00:06:34,459 of it, and, looking forward to its continued 185 00:06:34,459 --> 00:06:36,000 success as we continue on. 186 00:06:36,620 --> 00:06:38,300 Yeah. Frank, you, what a great initiative. I 187 00:06:38,300 --> 00:06:40,220 mean, see safety held, I know, are so 188 00:06:40,220 --> 00:06:42,704 important. So it's great to hear that they've 189 00:06:42,704 --> 00:06:44,225 been in place on night shift too and 190 00:06:44,225 --> 00:06:45,764 that it is improving engagement 191 00:06:46,064 --> 00:06:48,865 among the night shift staff, and I imagine 192 00:06:48,865 --> 00:06:49,365 just 193 00:06:49,745 --> 00:06:51,044 improving overall, like, 194 00:06:53,024 --> 00:06:55,670 communication in terms of shift changes. I know 195 00:06:55,670 --> 00:06:56,970 that's another area of 196 00:06:57,270 --> 00:06:58,949 concern, and that can be a challenge. So 197 00:06:58,949 --> 00:07:00,629 I imagine being able to just have that 198 00:07:00,629 --> 00:07:02,649 space and time to talk through 199 00:07:03,029 --> 00:07:05,670 what's happening, have more awareness on challenges that 200 00:07:05,670 --> 00:07:08,410 might need to be addressed just trickles into 201 00:07:08,550 --> 00:07:10,330 the whole rest of the 202 00:07:10,845 --> 00:07:13,004 shift and the following people who are gonna 203 00:07:13,004 --> 00:07:15,805 be coming in and taking over after those 204 00:07:15,805 --> 00:07:16,625 shifts too. 205 00:07:17,165 --> 00:07:17,665 Absolutely. 206 00:07:18,444 --> 00:07:21,085 And even anything happening, oh, we're gonna have 207 00:07:21,165 --> 00:07:23,425 be shutting down the tube station, you know, 208 00:07:23,485 --> 00:07:25,930 at this time or during this day. Just 209 00:07:25,930 --> 00:07:28,329 those types of informational things are important for 210 00:07:28,329 --> 00:07:30,009 the night shift, so they also feel connected 211 00:07:30,009 --> 00:07:31,149 and they know what's happening. 212 00:07:31,689 --> 00:07:33,790 Yeah. Definitely has a big impact on continuity. 213 00:07:34,810 --> 00:07:37,529 Well, Frankie, looking ahead, what is maybe a 214 00:07:37,529 --> 00:07:41,194 big priority or a headwind that you're encountering 215 00:07:41,415 --> 00:07:44,475 or planning expecting to encounter this year? 216 00:07:46,055 --> 00:07:47,675 So for for us, 217 00:07:48,214 --> 00:07:49,435 for for nursing, 218 00:07:50,250 --> 00:07:52,170 one area that we're doing really well on 219 00:07:52,170 --> 00:07:53,930 is nurse retention. You know, as a nurse 220 00:07:53,930 --> 00:07:56,490 leader, there's these buckets that you're always focused 221 00:07:56,490 --> 00:07:56,990 on. 222 00:07:57,370 --> 00:07:59,529 One of them is always staffing to make 223 00:07:59,529 --> 00:08:01,210 sure that we have the right staff in 224 00:08:01,210 --> 00:08:03,150 place to serve the needs of our community. 225 00:08:03,514 --> 00:08:06,095 You know, at Maimonides, we are outperforming 226 00:08:07,115 --> 00:08:09,115 the nation in terms of nurse retention, and 227 00:08:09,115 --> 00:08:10,954 we're doing really well with that, which is 228 00:08:10,954 --> 00:08:11,454 phenomenal. 229 00:08:11,754 --> 00:08:13,595 And we're really excited and proud of that 230 00:08:13,595 --> 00:08:15,834 as well. So that's one thing that we 231 00:08:15,834 --> 00:08:18,120 don't need to focus on as much. You 232 00:08:18,120 --> 00:08:18,779 know, we 233 00:08:19,160 --> 00:08:21,959 are, of course, working on always improving nurse 234 00:08:21,959 --> 00:08:22,459 engagement, 235 00:08:22,920 --> 00:08:24,600 and that's one of the areas that I 236 00:08:24,600 --> 00:08:26,939 always like to focus on. And that includes 237 00:08:27,000 --> 00:08:29,800 just for all shifts, so day and night 238 00:08:29,800 --> 00:08:31,800 shift. And and, again, not to be 239 00:08:32,894 --> 00:08:35,055 I'm not biased, but as a former night 240 00:08:35,055 --> 00:08:37,394 shift nurse, you know, I I do recognize 241 00:08:37,535 --> 00:08:40,355 the challenges of some night shift staff feeling 242 00:08:40,415 --> 00:08:40,915 disconnected. 243 00:08:41,455 --> 00:08:43,875 So I do prioritize making sure 244 00:08:44,175 --> 00:08:46,095 that the night shift do feel like they 245 00:08:46,095 --> 00:08:47,820 are part of the team and that they 246 00:08:47,820 --> 00:08:50,300 are feeling valued and seen and appreciated in 247 00:08:50,300 --> 00:08:52,940 addition to the day shift. So engagement is 248 00:08:52,940 --> 00:08:56,220 definitely one of the areas I'm gonna be 249 00:08:56,220 --> 00:08:58,940 focusing on for this next year. And, again, 250 00:08:58,940 --> 00:09:01,855 it's gonna be focusing on all areas and 251 00:09:01,855 --> 00:09:04,654 departments within nursing, including night shift. So, for 252 00:09:04,654 --> 00:09:08,115 example, we had a Valentine's Day nighttime celebration, 253 00:09:08,975 --> 00:09:11,695 last week with, cookies and karaoke, which was 254 00:09:11,695 --> 00:09:14,035 super fun, and it was a huge turnout. 255 00:09:14,549 --> 00:09:16,389 And it was just really great to see 256 00:09:16,389 --> 00:09:18,710 the night shift show up and show out 257 00:09:18,710 --> 00:09:21,350 and really have a good time. And that's 258 00:09:21,350 --> 00:09:23,110 an area that I wanna make sure I 259 00:09:23,110 --> 00:09:25,129 continue to look at because 260 00:09:25,590 --> 00:09:27,610 you need to bring joy into the workplace, 261 00:09:27,894 --> 00:09:29,914 and health care is just such a dynamic 262 00:09:30,294 --> 00:09:34,134 and ever evolving and quite honestly challenging environment 263 00:09:34,134 --> 00:09:37,414 to work in. So without having those fun 264 00:09:37,414 --> 00:09:40,154 things incorporated, you know, it can become really 265 00:09:40,375 --> 00:09:41,595 burdensome. So, 266 00:09:42,450 --> 00:09:45,029 trying to encourage staff to get involved, 267 00:09:45,570 --> 00:09:48,850 to join our professional governance councils, to have 268 00:09:48,850 --> 00:09:52,210 their voices heard, to really increase nursing's sense 269 00:09:52,210 --> 00:09:52,950 of autonomy 270 00:09:53,490 --> 00:09:56,175 and engagement and belonging. And so that's one 271 00:09:56,175 --> 00:09:58,514 area that we're definitely gonna be looking at. 272 00:09:59,055 --> 00:10:01,475 The other area, of course, is nursing quality, 273 00:10:01,855 --> 00:10:02,915 and we continue 274 00:10:03,535 --> 00:10:06,754 to focus on the standard nursing quality metrics, 275 00:10:06,975 --> 00:10:09,075 our hospital acquired pressure injuries, 276 00:10:09,679 --> 00:10:11,620 our catheter associated UTIs, 277 00:10:12,079 --> 00:10:14,339 our central line associated bloodstream infections, 278 00:10:15,039 --> 00:10:17,759 and our patient falls. So we have really 279 00:10:17,759 --> 00:10:18,259 made 280 00:10:18,720 --> 00:10:21,059 wonderful strides in our quality metrics, 281 00:10:21,440 --> 00:10:23,519 but the work is never done, and it's 282 00:10:23,519 --> 00:10:26,105 always it's continuous process improvement. 283 00:10:26,725 --> 00:10:29,044 So we are gonna be continuing to focus 284 00:10:29,044 --> 00:10:32,004 on our quality goals as we continue on 285 00:10:32,004 --> 00:10:32,404 this, 286 00:10:33,125 --> 00:10:34,105 this new year 287 00:10:34,485 --> 00:10:36,725 and make sure that we are doing even 288 00:10:36,725 --> 00:10:38,830 better than we did last year, and there's 289 00:10:38,830 --> 00:10:41,549 always room for improvement. So, you know, making 290 00:10:41,549 --> 00:10:43,230 sure the nurses you know, we're gonna look 291 00:10:43,230 --> 00:10:45,870 at implementing champion models so that we have 292 00:10:45,870 --> 00:10:48,529 our falls champions and we have our CLABSI 293 00:10:48,589 --> 00:10:50,370 champions and make sure that the nurses 294 00:10:50,830 --> 00:10:53,809 are feeling empowered and, also engaged 295 00:10:54,455 --> 00:10:56,955 in the work that they're doing to prevent 296 00:10:57,254 --> 00:10:58,475 hospital acquired infections. 297 00:10:59,174 --> 00:11:00,934 And then the third area that I would 298 00:11:00,934 --> 00:11:02,855 say we're really gonna be looking at is 299 00:11:02,855 --> 00:11:03,915 our patient experience. 300 00:11:04,615 --> 00:11:06,695 So we, you know, we are doing pretty 301 00:11:06,695 --> 00:11:08,554 well with patient experience metrics 302 00:11:08,919 --> 00:11:10,940 in relation to the Brooklyn hospitals, 303 00:11:11,639 --> 00:11:13,320 but we wanna make sure that we're still 304 00:11:13,320 --> 00:11:14,379 striving to improve. 305 00:11:14,759 --> 00:11:17,639 So with that, we're gonna be looking at 306 00:11:17,639 --> 00:11:19,419 enhancing nurse leader rounding 307 00:11:19,720 --> 00:11:21,240 on both the day shift and the night 308 00:11:21,240 --> 00:11:23,565 shift, which we're hoping will identify 309 00:11:24,424 --> 00:11:26,684 barriers or things that are 310 00:11:27,384 --> 00:11:29,004 impacting patient satisfaction 311 00:11:29,465 --> 00:11:31,945 early in their stay so we can remedy 312 00:11:31,945 --> 00:11:34,524 those and take care of them immediately 313 00:11:34,985 --> 00:11:37,129 and prevent that from showing up on the 314 00:11:37,129 --> 00:11:38,889 survey at the end when they're discharged and 315 00:11:38,889 --> 00:11:40,509 it's too late to intervene. 316 00:11:40,809 --> 00:11:42,649 So, you know, I think those are the 317 00:11:42,649 --> 00:11:45,209 three buckets that we're definitely gonna be putting 318 00:11:45,209 --> 00:11:47,709 a lot of our energy towards to improve 319 00:11:47,769 --> 00:11:48,509 our patients' 320 00:11:49,384 --> 00:11:52,044 happiness and satisfaction with our hospital experience 321 00:11:52,345 --> 00:11:54,764 as well as their their quality outcomes. 322 00:11:55,945 --> 00:11:58,184 Yeah. Frankie, three really important areas. And I 323 00:11:58,184 --> 00:12:00,524 think what you mentioned about nurse engagement, 324 00:12:01,065 --> 00:12:03,940 it's interesting because it feels like that piece 325 00:12:04,000 --> 00:12:06,399 really runs through all the rest. Like, being 326 00:12:06,399 --> 00:12:08,720 able to, you know, move the needle on 327 00:12:08,720 --> 00:12:11,200 patient experience and quality all really kind of 328 00:12:11,200 --> 00:12:13,279 bolts back to to nurse engagement in the 329 00:12:13,279 --> 00:12:14,799 first place. So I thought that that was 330 00:12:14,799 --> 00:12:15,539 just interesting. 331 00:12:16,639 --> 00:12:17,460 And I know 332 00:12:17,934 --> 00:12:21,055 nurse engagement and just participation on committees and 333 00:12:21,055 --> 00:12:23,295 governance councils can can be a challenge in 334 00:12:23,295 --> 00:12:24,514 certain areas, especially 335 00:12:24,894 --> 00:12:27,315 when it comes to night nurses too and, 336 00:12:27,855 --> 00:12:29,774 hospitals and health systems kind of looking at 337 00:12:29,774 --> 00:12:30,274 different 338 00:12:30,870 --> 00:12:33,750 ways to to structure things and give folks 339 00:12:33,750 --> 00:12:35,990 more flexibility to participate in some of these 340 00:12:35,990 --> 00:12:38,149 things. So I was curious if you could 341 00:12:38,149 --> 00:12:40,090 follow-up on that just in terms of 342 00:12:40,470 --> 00:12:41,769 are you looking at any 343 00:12:42,549 --> 00:12:43,365 specific ways 344 00:12:43,845 --> 00:12:46,245 to get night nurses more involved on certain 345 00:12:46,245 --> 00:12:47,065 things, especially, 346 00:12:47,445 --> 00:12:48,664 you know, governance 347 00:12:49,044 --> 00:12:49,544 councils? 348 00:12:50,565 --> 00:12:52,964 Oh, absolutely. Yeah. So, you know, we do 349 00:12:52,964 --> 00:12:55,205 have some nurse leaders who are in charge 350 00:12:55,205 --> 00:12:57,779 of the professional governance councils, and there are 351 00:12:57,779 --> 00:12:59,220 two that are in charge of the night 352 00:12:59,220 --> 00:13:00,360 shift council specifically. 353 00:13:00,980 --> 00:13:03,159 And they hold them via Webex 354 00:13:03,460 --> 00:13:04,279 to allow 355 00:13:04,659 --> 00:13:07,139 staff to log in from home, or if 356 00:13:07,139 --> 00:13:08,580 they're on the unit, they can log in 357 00:13:08,580 --> 00:13:11,240 from the unit. So trying to offer 358 00:13:12,634 --> 00:13:15,294 that that hybrid, you know, in person Webex 359 00:13:15,914 --> 00:13:16,414 platform, 360 00:13:17,274 --> 00:13:17,774 really 361 00:13:18,394 --> 00:13:19,615 enhances participation 362 00:13:20,154 --> 00:13:22,954 because people can either log in and listen 363 00:13:22,954 --> 00:13:23,454 passively, 364 00:13:23,914 --> 00:13:25,834 or they can log in and be active 365 00:13:25,834 --> 00:13:26,334 participants 366 00:13:26,990 --> 00:13:29,950 either from, you know, the nurses' station or 367 00:13:29,950 --> 00:13:32,289 from home. So that was one of the 368 00:13:32,589 --> 00:13:34,509 suggestions from the night from the night shift 369 00:13:34,509 --> 00:13:35,250 staff themselves 370 00:13:35,709 --> 00:13:36,450 to allow 371 00:13:36,990 --> 00:13:39,615 the Webex option so that people would attend 372 00:13:39,615 --> 00:13:41,054 if they wanted to and if they happen 373 00:13:41,054 --> 00:13:42,514 to not be working that 374 00:13:42,894 --> 00:13:46,434 night. And, also just offering people opportunity to 375 00:13:47,054 --> 00:13:49,695 to join these meetings if it's extra time. 376 00:13:49,695 --> 00:13:52,495 So, you know, maybe they can book a 377 00:13:52,495 --> 00:13:55,009 shift, and they'll work the night shift. But 378 00:13:55,009 --> 00:13:57,009 if the council is meeting, maybe they'll be 379 00:13:57,009 --> 00:13:59,330 nonproductive, and they'll be part of the meeting. 380 00:13:59,330 --> 00:14:00,529 And then the rest of their shift, they 381 00:14:00,529 --> 00:14:02,450 can help do chart audits, or they can 382 00:14:02,450 --> 00:14:04,629 do chart reviews and 383 00:14:05,009 --> 00:14:07,875 do some teaching to their colleagues or things 384 00:14:07,875 --> 00:14:09,815 of that nature. So trying to be flexible 385 00:14:10,195 --> 00:14:11,894 and creative in the way that 386 00:14:12,434 --> 00:14:14,934 we schedule our staff so that we do 387 00:14:15,235 --> 00:14:16,774 have maximum participation, 388 00:14:17,634 --> 00:14:19,334 for the for the night shift specifically, 389 00:14:19,700 --> 00:14:21,299 but the same applies for the day shift. 390 00:14:21,299 --> 00:14:22,820 So if people wanna come in for the 391 00:14:22,820 --> 00:14:25,720 day shift on days when we have meetings, 392 00:14:25,940 --> 00:14:28,179 they can participate in whatever councils they are 393 00:14:28,179 --> 00:14:30,259 a part of, and then they can do 394 00:14:30,259 --> 00:14:32,965 ad hoc things like chart reviews or, you 395 00:14:32,965 --> 00:14:36,245 know, patient rounding or whatever creative ideas our 396 00:14:36,245 --> 00:14:38,085 nurse leaders can come up with to make 397 00:14:38,085 --> 00:14:38,884 them be, 398 00:14:39,445 --> 00:14:41,365 active part of the team for that day 399 00:14:41,365 --> 00:14:43,845 and not necessarily taking a patient assignment so 400 00:14:43,845 --> 00:14:45,764 that they're able to focus on the meetings 401 00:14:45,764 --> 00:14:47,865 and really be part of the 402 00:14:48,350 --> 00:14:50,529 their the voice that they're wanting to share 403 00:14:50,670 --> 00:14:52,750 for those council meetings as well as be 404 00:14:52,750 --> 00:14:54,610 helpful to their teams at large. 405 00:14:55,550 --> 00:14:57,649 Yeah. Sure. That's great. Thanks, Frankie. 406 00:14:58,269 --> 00:14:59,870 Well, I wanted to ask you too just 407 00:14:59,870 --> 00:15:02,269 about something we've been following a lot of 408 00:15:02,269 --> 00:15:03,649 in the news, which is 409 00:15:04,304 --> 00:15:05,605 the lapse of ACA 410 00:15:05,985 --> 00:15:07,205 premium tax credits 411 00:15:07,985 --> 00:15:10,304 and looming cuts to Medicaid with both of 412 00:15:10,304 --> 00:15:12,304 those, and be hearing from a lot of 413 00:15:12,304 --> 00:15:14,865 hospital leaders about how they're anticipating a rise 414 00:15:14,865 --> 00:15:18,144 in uninsured patients and potentially more strain on 415 00:15:18,144 --> 00:15:19,365 their emergency departments. 416 00:15:19,990 --> 00:15:21,509 So I was curious to hear from you 417 00:15:21,509 --> 00:15:22,649 on how MyEminities 418 00:15:23,110 --> 00:15:25,370 is preparing to care for a spike in 419 00:15:25,509 --> 00:15:28,230 uninsured and underinsured patients from a clinical or 420 00:15:28,230 --> 00:15:29,290 operational standpoint. 421 00:15:30,309 --> 00:15:32,009 Sure. So, yeah, that's definitely 422 00:15:32,549 --> 00:15:35,049 a challenge that we're all bracing for. 423 00:15:35,414 --> 00:15:35,914 And, 424 00:15:37,014 --> 00:15:39,034 a lot of the work that we're 425 00:15:39,414 --> 00:15:42,075 that we're doing is really focused on throughput. 426 00:15:42,455 --> 00:15:44,134 So we know that, you know, with more 427 00:15:44,134 --> 00:15:44,634 uninsured 428 00:15:45,014 --> 00:15:47,654 patients, they're usually gonna delay coming to the 429 00:15:47,654 --> 00:15:49,995 hospital for as long as they possibly can. 430 00:15:50,399 --> 00:15:52,000 Unfortunately, that means when they get to the 431 00:15:52,000 --> 00:15:54,159 hospital, if they really need to get seen 432 00:15:54,159 --> 00:15:57,039 and treated, they're probably gonna arrive sicker, and 433 00:15:57,039 --> 00:16:00,000 they're probably gonna require admission. Right? So there's 434 00:16:00,000 --> 00:16:01,679 a few things that we're working on that 435 00:16:01,679 --> 00:16:04,500 we've been doing to try to enhance throughput. 436 00:16:05,345 --> 00:16:07,684 Our ED is already busy as it is, 437 00:16:07,985 --> 00:16:10,544 and, you know, we just survived the strike, 438 00:16:10,544 --> 00:16:12,384 obviously, as you're aware of in New York 439 00:16:12,384 --> 00:16:15,424 City. We were expecting to get some overflow 440 00:16:15,424 --> 00:16:17,444 of patients from other hospitals locally. 441 00:16:17,889 --> 00:16:20,470 However, that did not really impact our operations 442 00:16:20,769 --> 00:16:21,350 too much, 443 00:16:21,809 --> 00:16:23,970 but we did just have a really tough 444 00:16:23,970 --> 00:16:27,169 flu season. So we did just have extreme 445 00:16:27,169 --> 00:16:29,329 surges in patient volume in the EV that 446 00:16:29,329 --> 00:16:30,949 we're still navigating actively. 447 00:16:31,585 --> 00:16:33,424 But part of our book of work in 448 00:16:33,424 --> 00:16:36,705 addressing EV volumes, which, again, we're gonna probably 449 00:16:36,705 --> 00:16:38,565 see increased due to 450 00:16:39,024 --> 00:16:40,565 more uninsured patients 451 00:16:40,945 --> 00:16:42,544 or and, you know, it's it's really we're 452 00:16:42,544 --> 00:16:44,544 gonna be working on getting patients out of 453 00:16:44,544 --> 00:16:45,205 the hospital 454 00:16:45,585 --> 00:16:46,725 as soon as possible 455 00:16:47,210 --> 00:16:48,110 when it's safe, 456 00:16:48,490 --> 00:16:50,169 and to make sure that they were continuing 457 00:16:50,169 --> 00:16:52,570 their care outside so that they don't get 458 00:16:52,570 --> 00:16:54,649 readmitted. So if we can get patients out 459 00:16:54,649 --> 00:16:57,129 of a hospital sooner who don't need to 460 00:16:57,129 --> 00:16:58,970 be here any longer, then we can get 461 00:16:58,970 --> 00:17:01,129 those patients up from the ED to those 462 00:17:01,129 --> 00:17:01,629 beds. 463 00:17:02,054 --> 00:17:03,495 And then if we can keep those patients 464 00:17:03,495 --> 00:17:05,974 who've been discharged out of the hospital and 465 00:17:05,974 --> 00:17:08,214 keep them safe at home, then, of course, 466 00:17:08,214 --> 00:17:10,474 we're hopefully not gonna see them be readmitted, 467 00:17:10,855 --> 00:17:12,634 and then that should hopefully, 468 00:17:13,174 --> 00:17:16,214 you know, reduce our ED volumes ultimately in 469 00:17:16,214 --> 00:17:17,035 the long run. 470 00:17:17,349 --> 00:17:19,669 So we do have tasks for us on 471 00:17:19,669 --> 00:17:20,569 length of stay. 472 00:17:21,109 --> 00:17:23,609 I personally am part of a nursing strategic, 473 00:17:24,309 --> 00:17:26,710 group work group related to length of stay 474 00:17:26,710 --> 00:17:29,129 with one of my other VPs of cardiology, 475 00:17:29,674 --> 00:17:31,134 And so we are implementing 476 00:17:31,835 --> 00:17:33,454 some nurse driven checklists 477 00:17:33,835 --> 00:17:34,894 to be able to, 478 00:17:35,674 --> 00:17:39,534 enhance our awareness of what are the outstanding 479 00:17:39,674 --> 00:17:40,335 or pending 480 00:17:40,954 --> 00:17:43,289 things needed for someone to be discharged So 481 00:17:43,289 --> 00:17:45,289 that our bed expediters and I'm not sure 482 00:17:45,289 --> 00:17:47,369 if you're familiar with that term, but we 483 00:17:47,369 --> 00:17:47,690 have, 484 00:17:48,170 --> 00:17:50,809 bed expediters for each division, and they're pretty 485 00:17:50,809 --> 00:17:52,490 much in charge of rounding on all the 486 00:17:52,490 --> 00:17:53,869 units within their area 487 00:17:54,330 --> 00:17:56,865 to see who's planned for discharge and to 488 00:17:56,865 --> 00:17:58,545 try to make sure that they get all 489 00:17:58,545 --> 00:18:01,105 of their milestones checked off so they can 490 00:18:01,105 --> 00:18:03,825 actually be discharged for that day. So we're 491 00:18:03,825 --> 00:18:05,984 gonna be working with them to implement a 492 00:18:05,984 --> 00:18:06,484 new 493 00:18:06,865 --> 00:18:09,424 nurse driven checklist that they will be in 494 00:18:09,424 --> 00:18:11,910 charge of, and that will have all of 495 00:18:11,910 --> 00:18:14,329 the elements that are required for discharge, 496 00:18:14,630 --> 00:18:16,230 and they'll be able to check off for 497 00:18:16,230 --> 00:18:18,809 most patients who are leaving that day and 498 00:18:18,950 --> 00:18:20,650 engage with teams who 499 00:18:21,029 --> 00:18:21,849 need to 500 00:18:22,150 --> 00:18:24,224 be escalated to. So if they're pending an 501 00:18:24,224 --> 00:18:26,785 X-ray before discharge or if they're pending an 502 00:18:26,785 --> 00:18:28,705 echo, like, they'll be able to escalate to 503 00:18:28,705 --> 00:18:30,705 those areas to get that done so we 504 00:18:30,705 --> 00:18:32,724 can really streamline the discharge process. 505 00:18:33,184 --> 00:18:35,825 So there's a lot of nursing related work 506 00:18:35,825 --> 00:18:38,759 being done to improve earlier discharges. You know, 507 00:18:38,759 --> 00:18:41,579 our our industry standard is discharged before noon. 508 00:18:42,200 --> 00:18:44,919 We do decently well with that, but I 509 00:18:44,919 --> 00:18:46,700 think with our new nursing, 510 00:18:47,720 --> 00:18:51,045 strategic initiatives, we're gonna be seeing more DBNs 511 00:18:51,105 --> 00:18:52,325 as they are abbreviated, 512 00:18:52,704 --> 00:18:54,704 and then that will hopefully help throughput from 513 00:18:54,704 --> 00:18:55,445 the ED. 514 00:18:55,825 --> 00:18:57,445 And then on the 515 00:18:57,825 --> 00:19:00,384 other end of it, we are partnering with 516 00:19:00,384 --> 00:19:01,445 outside organizations. 517 00:19:01,825 --> 00:19:03,285 One of them is called MyLaurel, 518 00:19:03,859 --> 00:19:05,880 and they are helpful in 519 00:19:06,180 --> 00:19:08,180 they do follow-up care. So when the patients 520 00:19:08,180 --> 00:19:08,840 are discharged, 521 00:19:09,539 --> 00:19:11,940 this company, you know, has a nurse follow 522 00:19:11,940 --> 00:19:12,759 them at home 523 00:19:13,059 --> 00:19:16,019 and ensure that the patients are, you know, 524 00:19:16,019 --> 00:19:16,519 asymptomatic 525 00:19:16,980 --> 00:19:18,515 or taking their medications, 526 00:19:18,815 --> 00:19:20,755 complying with their treatment regimens, 527 00:19:21,134 --> 00:19:21,875 and the goal 528 00:19:22,255 --> 00:19:23,875 for them is to prevent readmission. 529 00:19:24,255 --> 00:19:26,734 And that, again, trickles back to us to 530 00:19:26,734 --> 00:19:29,715 prevent unnecessary ED visits, which will hopefully 531 00:19:30,039 --> 00:19:32,220 allow there to be more space for the 532 00:19:32,279 --> 00:19:34,539 increased volume of patients that we might see 533 00:19:34,759 --> 00:19:35,980 due to the higher, 534 00:19:36,519 --> 00:19:38,920 rates of uninsured patients in the community. So 535 00:19:38,920 --> 00:19:40,279 I think those are some of the initiatives 536 00:19:40,279 --> 00:19:41,099 that we're working. 537 00:19:42,375 --> 00:19:45,434 Yeah. No. Definitely. It sounds like if anything, 538 00:19:45,734 --> 00:19:47,195 you know, any additional 539 00:19:47,815 --> 00:19:48,615 ED strain, 540 00:19:48,934 --> 00:19:51,674 that comes through, you know, potentially more patients 541 00:19:51,974 --> 00:19:53,434 is just has really elevated 542 00:19:53,894 --> 00:19:55,835 length of stay work and and up throughput 543 00:19:55,894 --> 00:19:58,559 operational efficiency work. So it's interesting to hear 544 00:19:58,559 --> 00:20:01,460 logistics of how all of that connects. 545 00:20:02,240 --> 00:20:03,440 Yeah. And there's just one more thing that 546 00:20:03,440 --> 00:20:05,779 I do wanna mention regarding our staff. 547 00:20:06,160 --> 00:20:07,299 So I think, you know, 548 00:20:07,759 --> 00:20:10,160 again, with uninsured patients who might be coming 549 00:20:10,160 --> 00:20:12,319 to the hospital late, who might be getting 550 00:20:12,319 --> 00:20:15,575 diagnosed with illnesses that they may have been 551 00:20:15,575 --> 00:20:17,974 ignoring for some time, there's a chance that 552 00:20:17,974 --> 00:20:19,894 we are we're gonna be seeing sicker patients 553 00:20:19,894 --> 00:20:21,835 and with that, more complex 554 00:20:22,214 --> 00:20:22,714 needs. 555 00:20:23,095 --> 00:20:25,095 And so for our staff, we need to 556 00:20:25,095 --> 00:20:26,474 make sure that they are prepared 557 00:20:26,779 --> 00:20:28,460 for the potential of you know, there's always 558 00:20:28,460 --> 00:20:28,960 the 559 00:20:29,419 --> 00:20:31,819 the possibility of moral distress. So when we 560 00:20:31,819 --> 00:20:32,559 feel like 561 00:20:32,940 --> 00:20:35,179 we have patients that we're we really wanna 562 00:20:35,179 --> 00:20:37,819 help and get what they need, but there 563 00:20:37,819 --> 00:20:38,559 are systemic 564 00:20:39,505 --> 00:20:42,565 barriers related to insurance or placement issues 565 00:20:43,025 --> 00:20:45,184 or or social determinants of health and things 566 00:20:45,184 --> 00:20:47,585 of that nature. Our staff can sometimes feel 567 00:20:47,585 --> 00:20:49,664 a little bit defeated. So I think one 568 00:20:49,664 --> 00:20:51,984 of our other areas we can't forget about 569 00:20:51,984 --> 00:20:54,599 is our workforce and making sure that they're 570 00:20:54,599 --> 00:20:58,220 prepared for, you know, compassion fatigue and for 571 00:20:58,680 --> 00:21:01,720 the feeling that maybe they're they're not seeing 572 00:21:01,720 --> 00:21:03,319 the outcomes that they would like to see 573 00:21:03,319 --> 00:21:04,619 for all of their patients 574 00:21:05,000 --> 00:21:07,420 and making sure we have really good debriefing 575 00:21:08,384 --> 00:21:10,305 structures set up. So if there's a difficult 576 00:21:10,305 --> 00:21:12,305 case in the hospital where maybe ethics is 577 00:21:12,305 --> 00:21:15,505 involved, that we have that platform available for 578 00:21:15,505 --> 00:21:17,585 the staff to come together and debrief and 579 00:21:17,585 --> 00:21:19,825 talk about their feelings. We do have team 580 00:21:19,825 --> 00:21:22,964 Lavender here, which is a phenomenal support 581 00:21:23,419 --> 00:21:26,240 structure that's led by our HR department. 582 00:21:26,700 --> 00:21:28,700 And, you know, we actually just called one 583 00:21:28,700 --> 00:21:29,200 yesterday 584 00:21:29,500 --> 00:21:31,839 for our staff that went through a challenging 585 00:21:31,980 --> 00:21:32,880 patient situation. 586 00:21:33,419 --> 00:21:35,099 So I think I I would be remiss 587 00:21:35,099 --> 00:21:37,345 if I didn't also say that one of 588 00:21:37,345 --> 00:21:39,184 our areas of focus will be on our 589 00:21:39,184 --> 00:21:41,184 on our nursing staff and our frontline staff 590 00:21:41,184 --> 00:21:43,025 to make sure that they are prepared for 591 00:21:43,025 --> 00:21:44,704 the challenges that might be coming down the 592 00:21:44,704 --> 00:21:45,204 pike. 593 00:21:46,144 --> 00:21:48,304 Yeah. No. Such an important to point to, 594 00:21:48,304 --> 00:21:50,650 especially as with the potential for seeing patients 595 00:21:50,650 --> 00:21:53,789 who are higher acuity coming in. Well, Frankie, 596 00:21:53,850 --> 00:21:55,610 thank you so much for your time today. 597 00:21:55,610 --> 00:21:57,210 It was a pleasure to connect and hear 598 00:21:57,210 --> 00:21:58,970 about some of the work you're leading at 599 00:21:58,970 --> 00:21:59,710 My Monites.