Healthcare reimagined from the inside out
Top nursing officials discuss how the pandemic has impacted health systems and what to expect in the future of healthcare
The Kansas City Business Journal recently brought together four top nursing officials who talked about how the pandemic has impacted health systems, what to expect for future care, and how hospitals plan to serve an aging, anxious and demanding population.
When Amber Boes graduated from nursing school almost 20 years ago, she was told that 2020 would bring the largest nursing shortage ever. Of course, no one then knew that the year also would bring a pandemic.
“It really put us in a difficult spot,” said Boes, chief nursing executive for HCA Midwest Health.
Yet, as local nursing leaders emerge from the turbulence of the pandemic, they’re hopeful. They’ve scavenged surprising lessons about innovation and flexibility of care. They’re rethinking the ways in which they bring new nurses into the profession, help current nurses thrive in their careers, and meet evolving needs in health care. New, collaborative ideas are emerging quickly, and the potential is huge, according to a panel of four top nursing officers, hosted by McCownGordon Construction.
Still, underlying all that potential is a philosophy that has stood the test of time.
Leading nurses well also means caring for them as individuals and freeing them up for the work they love best: caring for patients.
“If we continue to focus on that as leaders, and get at the heart of health care — which has gotten us through these last couple of years — I think it’s going to be pretty impressive what we as a group of health care individuals can do moving forward,” Boes said.
Meeting needs on emerging fronts
Even as the health care sector attempts to catch its breath, it faces several converging factors: an aging population, a youth mental health crisis, and a lack of behavioral health resources.
Moderator Derek Kautio, who leads the healthcare market for McCownGordon, noted that within a couple of decades, people older than 65 will outnumber children under 18 for the first time in U.S. history.
That portends more management of chronic conditions and an increase in dementia-related diseases.
It also means delivering health care differently, with a focus on prolonging health and wellness. That keeps aging patients out of facilities and at home — where they usually want to be — for as long as possible.
Space and cost constraints necessitate creative, convenient options: home health, telehealth, hospitals at home, and many other yet-to-be-imagined models, panelists said.
“Not everybody wants to come to the brick and mortar that we’ve designated as health care,” said Christine Courtney, chief nursing officer for Olathe Health.
Similarly, traditional health care models can’t sufficiently meet mental and behavioral health needs.
In October, the American Academy of Pediatrics declared a national state of emergency in children’s mental health. The pandemic had exacerbated an already concerning number of struggling young people.
“This is a crisis for us,” said Tangula Taylor, senior vice president and chief nursing officer for Children’s Mercy. “Any given day and point in time, we have children coming into our emergency department who have escalated behaviors.”
Children’s hospitals, as reported through the Children’s Hospital Association, are seeing triple-digit increases in suicidal ideations among teenagers, and about 20 percent of youths during a year will have some sort of mental illness situation or condition, Taylor said.
While Children’s Mercy provides excellent medical care many patients with behavioral health needs require longer-term solutions, she said. Hospitals are trying to rethink processes and incorporate clinicians trained in mental health therapies, but they know they’re only one piece of a solution that will take a village.
Similarly, middle-aged patients dealing with behavioral health challenges — often exacerbated by chemical dependency — are difficult to care for and require lengthy stays.
“The beds just aren’t there,” Boes said.
However, new approaches have proven effective. Intensive outpatient centers have helped cut the number of behavioral health patients in emergency rooms nearly in half. The additional freedoms possible in such facilities are more therapeutic and calming for patients.
Broadly, panelists said, mental health must become a normal part of the care continuum.
Building a pipeline of caregivers
The past couple of years have brought an upheaval in health care. Nurses have retired, moved, and quit, and some are grappling with their own mental traumas after the toll of the pandemic. Yet safe and effective care must continue.
The national turnover rate for nurses was 16 percent pre-pandemic; the latest figure Boes saw was 22 percent. But health systems are pursuing solutions.
At HCA Midwest Health, a part of national healthcare leader HCA Healthcare, the system has leveraged best practice to use various levels of nurses to the full extent of their licensures, Boes said. The health system also pays for education to help them advance their careers. Nurse extern programs, which give nursing students on-the-job experience, prove mutually beneficial. HCA Midwest Health also has collaborated with nursing schools — including their own Research College of Nursing — to enhance recruiting, open more schools, expand classes and build the pipeline of nurses.
The broad acceptance of virtual work has helped, including roles such as telehealth, admissions, medications and more. Nurses later in their careers can work virtually — a hybrid option that is less physically demanding and may let them delay retirement, said Susie Krug, chief nursing officer at Saint Luke’s East Hospital.
When experienced nurses are just a phone call away, newer nurses can get advice and support to do their jobs more confidently and effectively.
Hospitals also are finding ways to train workers within their walls, Taylor said.
The potential in telehealth
A few years ago, people who needed health care but didn’t have a convenient way to get it often ended up in the emergency room — even for primary care issues. But providers are trying to make health care more convenient and accessible, Krug said.
“Giving them broader access points has helped them and us,” she said.
Previously, providers worried patients wouldn’t feel satisfied with virtual care. But it has proven a great experience all around.
Patients can be met where they’re at — and where they’re most comfortable. Job, family, transportation and other barriers become less disruptive. And by minimizing stress, providers can get the most accurate picture of a patient’s health, Courtney said.
“Telehealth is a huge tool,” she said. “Even now, it’s just the tip of the iceberg. There’s so much more to leverage.”
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