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Join nurse executives Linda Knodel and Karlene Kerfoot as they share their 45 years of experience in health care administration. In this insightful podcast, they discuss the urgent challenges facing health care organizations, the power of data connectivity in improving operations, the role of AI as a health care copilot, and the importance of federal legislation in driving change.

Linda Knodel and Karlene Kerfoot are nurse executives.

They discuss the KevinMD article, “Unleashing the power of optimized operations, data connectivity, and technology for unparalleled patient care.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Linda Knodel and Karlene Kerfoot. They are both nurse executives. Today’s KevinMD article is titled “Unleashing the power of optimized operations, data connectivity, and technology for unparalleled patient care.” Linda and Karlene, welcome to the show.

Linda Knodel: Thank you, Kevin.

Kevin Pho: So I’m going to ask each of you to briefly share your story and journey, and then we’ll talk about your article. Linda, why don’t you go first?

Linda Knodel: Absolutely. Thank you again for the opportunity. With over 49 years of health care experience, I have served in acute care, in ambulatory care and in post-acute care. For the last 20-some years, I’ve been a system chief nurse executive at very large systems across the United States, and what that has afforded me is the ability, as a nurse executive, to sit at tables where executives who are nurses have not sat before. We’ve been able to influence not only at the local, regional and national levels, but at the political level as well.

Kevin Pho: So, Linda, just to follow up on that, give an example of how you, as a nurse, have influenced decision-making at any of the institutions you’ve worked with.

Linda Knodel: One great example is that I ran a dialysis unit, and patients were traveling 200 and 300 miles three times a week for their dialysis treatment. I went to the CEO and said, “This just isn’t right. We need to develop satellite dialysis centers.” That CEO was not only a mentor of mine, but he understood how important patient care and the voice of the nurse were. He said, “Go ahead and do it.” Today, and as you well know, the incidence of chronic kidney failure has increased, those dialysis units are there in the communities. Patients can still live and work in their communities, and the travel has been eliminated.

Kevin Pho: All right. Karlene, just briefly share your story and journey to where you are today.

Karlene Kerfoot: Well, I came to nursing by kind of a circuitous route. There are different kinds of leadership career modes, and I am the circular one, the spiral one. I didn’t go this way or that way; I went in a spiral sort of way. I came to nursing as a second career. The first career I really wanted was to be an ambassador and join the American Foreign Service, and I was fascinated with Afghanistan, so my first major was political science. At the end of the equivalent of three years, I wrote for applications, and they said, “Well, we don’t take women in the American Foreign Service. We have some secretarial positions, but you can’t travel with those.” And I thought, “What is this?” Of course, I grew up on a farm, and I could do anything on a farm. It never dawned on me that there were things men did and things women did. So I thought, “OK, well, I want to travel, so I’ll go into nursing.”

So I spent the next three years getting prepared to become a nurse, which was a great decision, a great decision, and I don’t regret any of the time I spent taking all those extra courses that I wouldn’t have taken if I had not been a nurse. From there I moved into clinical positions, because I really wanted to credential myself as a clinician, but I kept getting tapped on the shoulder: “Don’t you want this nurse manager job? Don’t you want this director job? Don’t you want this? Don’t you want that?” So I moved into leadership sort of accidentally, by not planning a career, but oh my gosh, it’s been wonderful, wonderful, wonderful.

Like Linda, I was the chief nursing officer and patient care officer, and we had lots of different titles, for large integrated systems. The good news about working in an integrated system is that it’s a challenge to bring diverse people together, but boy, it’s so much fun when you do it, and you can get great patient outcomes. Then about 10 years ago I took a turn and decided to go into the vendor community, into technology. Technology has always been a love of mine, and I developed different things like scheduling systems. Then I had the opportunity to work for API as their chief nursing officer, and that’s what I’ve been doing for the past 10 years. For the last three years I’ve been the chief nursing officer for symplr, which is a collection of several different companies that work together to make sure operations can be seamless for the people out there on the front line. So it’s been a very interesting life and an interesting career, certainly not the one most people go through. It’s been different, which is great.

Kevin Pho: Now, Karlene, for the clinical nurses who may be listening to this episode who want to make change on a more macro level, and perhaps move into a leadership role, what kind of advice do you have for them?

Karlene Kerfoot: Well, I think the first thing, in terms of leadership, is to get your experience. You can learn a lot in school, but if you take what you learn in school and apply it to your experience and your job, then you really can do things. I also think you need to take a job not necessarily for what it’s going to do for your career, but for the people you’re going to work with, because I have learned so much from working with hotshot people that I would not have had the opportunity to learn if I had said, “Well, I’ve got to be here, and then I’ve got to be at a bigger hospital, and a bigger one, and a bigger one.” If you can really work to ask, “Who do I need to work with next to learn what I don’t know as well as I need to?” and make decisions that way, then you become kind of a Renaissance person who knows a lot about different pieces of leadership, versus a single function. That prepares you for the future, because the future is going to be very diverse and very different from what we have now. It’s not going to be that linear, single-function thing, so the more experiences you have, the easier it’s going to be for you to move in.

Kevin Pho: All right, let’s talk about the KevinMD article. Today it’s titled “Unleashing the power of optimized operations, data connectivity, and technology for unparalleled patient care.” Linda, how did this article come together?

Linda Knodel: Well, I have the privilege of serving on the executive council for symplr, and over the last two years of being on this executive council I’ve been able to learn about the number of systems that symplr has and is able to provide to consumers and the health care community. If you were to walk into a hospital right now, there would be 50 to 75 different systems operating all the time within the hospital. What symplr has done, and I believe they have a very, very strong niche, is that they have the ability to connect these systems, because with the best-of-breed model, those systems don’t always connect.

What I’ve been able to talk about is what I’ll call CNO math. An example was a pediatric department. We had 40 or 45 nurses on the pediatric department, and we were always short-staffed. We were paying extra for overtime, we were calling in people on their days off and we were using travelers. One day I sat down and said, “There’s got to be a way to figure this out. What is going on?” Because our HR system didn’t speak to the staffing and scheduling system, which didn’t speak to the clinical system that describes the patient care needs. At the end of the day, what we found out was that 30 of those nurses had been on that unit for more than 32 years, so they were eligible for one to two weeks more vacation. We also saw an increased rate of surgical operations occurring, so that would be an additional six-plus weeks off. At the end of the day, the math demonstrated that we needed seven more FTEs to be able to operate during these peaks and valleys. And you don’t use the midnight census to drive your staffing; your busiest time is probably between 4 and 8.

So it’s really about having access to systems, and that’s what I saw that symplr has. I was just so passionate about it that I said, “We’ve got to talk about this more,” and about the impact interoperability has on the lives of those we care for. It is not going to get any simpler going forward. It is going to become more and more complex, and unless we’ve got systems that work with us and for us, we won’t be able to survive.

Kevin Pho: So, Linda, to follow up on that, what you described, I’m sure, is replicated in hospitals across the country, each hospital having dozens and dozens of different systems that don’t talk to one another. How did it get this way? Why is the technology infrastructure in a lot of hospitals so fragmented? How did we get to this point?

Linda Knodel: Well, I think it’s because health care systems were developed around the finance model. When we looked at what kinds of systems existed, they were finance-based systems. Then, as clinical systems began to evolve, and I’m going to call on Karlene, because she’s been in that space longer than I have, the best-of-breed model was the model of choice. If you had a radiology system you wanted, that’s the system you got, but it did not talk to the laboratory system or the finance system or the human resource system. So I think the modeling of technology adoption and development is a relatively 20-year-old science for us in health care, and I would say that evolution is really the driver.

Kevin Pho: So, Karlene, when it comes to technological innovations in the health care space, and I’m certainly no stranger to that from the EMR side, there’s a lot of tension between those two worlds. How can you implement successful IT solutions in a health care setting? So many companies and so many people have tried and failed. What differentiates a successful IT implementation from one that’s less successful?

Karlene Kerfoot: I think if we take our cues from what we’ve done with the electronic health record, there are a lot of opportunities there, because I can remember when we had disparate systems. You had an ER system, an OR system and a med-surg system, and they didn’t talk to each other, so a nurse had to go into three or four different systems to move a patient. Then we put them on one platform and got them all talking to each other. We haven’t done that yet with operations. If a nurse manager wants to staff and schedule, they have the workforce solution, but if they want to look at outcomes, they have to go into the quality system and a bunch of other systems on their own, because it’s not integrated the way the clinical systems are. So we have models out there; we just have to do it.

I think Linda is absolutely brilliant in what she’s saying, because she talks about the need for a collaborative structure where the nurse leaders can sit down with the supply chain people, the chief medical officer and the chief technology officer and identify how we can make all this stuff talk to each other, so the person at the front line doesn’t have to do it. If you look at a nurse manager, they have to go through six or eight disparate systems to staff and schedule. It shouldn’t be that way. They should be able to go to one system that talks to all these different things and get the work done. But as Linda says, we have to have those collaborative structures to build the connectivity we need for the future. We’re on the brink of that, we’re about there, but boy, we’ve got to go faster, because we’re losing too many practitioners. They aren’t sticking, because the technology burden is just doing them in.

Kevin Pho: So, Karlene, what exactly are the pain points and friction points preventing this interoperability on the operations side?

Karlene Kerfoot: Well, I think one point, as Linda notes, is that you’ve got to get people to sit down, talk to each other and walk in other people’s shoes. We just did an interesting study, the Compass survey. We asked IT people what their perceptions of different things were, and we asked the clinical people what their perceptions were. The IT people thought that the clinical people really liked the systems a lot. The clinical people said, “No, we’ve got problems here.” That was new information, because they hadn’t sat down, as Linda talks about, to compare notes and come up with a common view, a commonsense view of where we need to go. So one of the problems is that we’re organized in silos in organizations, and that’s just got to go. It’s just got to go. We have to follow Linda’s lead and build those collaborative structures to get people talking together.

Kevin Pho: So, Linda, you’ve been involved in many health care institutions. Are you saying that these collaborative meetings, where one department talks to another, are currently not commonplace, and that’s preventing us from seeing the speed of implementation you would like to see?

Linda Knodel: I would say you’re absolutely spot on. Not only have we developed and grown up in silos, but we’ve also not done a good job at what I would refer to as shared leadership. What are our shared priorities? Do we sit down with the radiology department, the laboratory department and the C-suite and ensure that there is connectivity between the strategic priorities? What are our goals, and how do we measure them collectively, as opposed to as independent departments?

Kevin Pho: Linda, in the article you mentioned the influence of artificial intelligence, which has certainly been in the news for the greater part of a year. Tell us how that influences trends going forward.

Linda Knodel: Well, I oftentimes speak in parables or stories, and the story that comes to mind when you ask that kind of question is this: When a nurse performs a procedure and documents it in the medical record, or a medication is administered and it’s in the medical record, there’s the ability to pull that data to demonstrate, at the individual level, the level of competence and the level of assurance that we are compliant with our systems, that we’re charging the right thing for the right IV insertion that was done. It also demonstrates the level of acuity the patients have. So artificial intelligence, when used for the purpose of assuring we’re doing the right thing, and assuring that we’ve got big data that helps drive decisions in a collective manner, to me is our future, and with these interoperability capabilities, that’s where we’ll be able to further influence artificial intelligence.

Kevin Pho: We’re talking to Linda Knodel and Karlene Kerfoot. They are nurse executives. Today’s KevinMD article is titled “Unleashing the power of optimized operations, data connectivity, and technology for unparalleled patient care.” Now I’m going to ask each of you for some of your take-home messages for the KevinMD audience, and maybe you could include what we have to look forward to on the data operations side. Karlene, why don’t you go first?

Karlene Kerfoot: I think we have a huge opportunity to look at data operations and connectivity, and at taking work out of the system, to, quote unquote, cure many of the problems we have. If you look at why nurses and physicians are leaving, oftentimes the number two or number three reason is technology burden, and we create that technology burden because we don’t have systems, as Linda talks about, that connect with each other. If you look at our survey, it’s apparent that we can give a lot of time back to physicians, nurses and clinicians if we take a lot of that chaos out of the system. In fact, the estimates are as much as 20 percent for a clinical nurse, if they didn’t have to deal with all the chaos, and sometimes even more than that for a nurse manager.

So the point is that we have to get busy. We look at hiring more people and new models of care, but the root cause is what people have to do. Take away all that garbage and simplify their work, and if you simplify it, then they enjoy their work, and they want to stick and they want to stay. But if you don’t do that, and you just keep piling on more and more technology that doesn’t talk to each other and doesn’t help them, then they say, “I’m out of here. I’m not going to do it.” So we have a huge opportunity right now to think differently and to think about technology as an enabler. As Linda says, technology should be our co-pilot, not the director, not the captain, not what drives everything, but the co-pilot that works with us and helps make things different. What that means is that clinicians really have to understand some of the technology, so they can make recommendations to vendors and also make strong recommendations to the organization about how we can get back 20 percent or 30 percent of people’s time. And then our staffing issues are somewhat solved; people will want to stick more.

Kevin Pho: Linda, why don’t you end with your take-home messages for the KevinMD audience?

Linda Knodel: Absolutely. First of all, we’ve got a very large system here that we’re talking about. It’s very large, but we also don’t have the time to allow that boat to turn very slowly. We need to be far more nimble. I would say, number one, as a leader, be sure your balance is the best possible. Second, keep your priorities focused. Is it technology? Is it development? Keep your priorities at the forefront. And then I always say, love life, because you need to love life as well as what you do in life. We get this one chance, so let’s do the best we can with what we’ve got. Communicate and collaborate with your professional colleagues.

Kevin Pho: Linda and Karlene, thank you so much for sharing your time and insight, and thanks again for coming on the show.

Karlene Kerfoot: Thank you, Kevin.