Latest / Becker’s Healthcare - Clinical Leadership Podcast / Driving Nursing Innovation and Throughput Excellence at SUNY Upstate with Scott Jessie

Transcript

Driving Nursing Innovation and Throughput Excellence at SUNY Upstate with Scott Jessie · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
  The most important health care decisions don't happen
• 0:05
  in isolation.
• 0:06
  They happen when leaders come together.
• 0:08
  Becker's sixteenth annual meeting brings together more than
• 0:11
  3,500
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  hospital and health system executives this April in
• 0:15
  Chicago.
• 0:16
  With 800 speakers from Ascension,
• 0:18
  Cleveland Clinic, CommonSpirit and more, the conversations get
• 0:22
  real. Leaders will share how their scenario planning
• 0:24
  for policy shifts, breaking through value based care
• 0:27
  barriers, and building clinical teams that translate
• 0:46
  This is Laura Dierda with the Becker's Healthcare
• 0:48
  podcast. I'm thrilled today to be joined by
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  Scott Jesse, chief nursing officer at SUNY Upstate
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  University Hospital.
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  Scott, it's a pleasure to have you on
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  the podcast today.
• 0:58
  Thanks for having me, Laura.
• 1:01
  Absolutely. Now I am looking forward to our
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  discussion and really learning more about some of
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  the things you're doing at SUNY Upstate as
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  well as your perspective on growth and and
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  development in the future. But before we dive
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  in, can you tell us a little bit
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  more about yourself and student SUNY Upstate?
• 1:16
  Absolutely.
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  Very excited to do that. So my name
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  is Scott Jesse. I am the chief nursing
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  officer here at SUNY Upstate Medical University.
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  We are a large academic medical center with
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  a community hospital and a children's hospital as
• 1:27
  well.
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  We are right smack dab in the middle
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  of Upstate New York.
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  And we cover a huge geographic area all
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  the way from Canada to Pennsylvania.
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  We cover about 2,000,000 lives. We have a
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  large,
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  hospital presence, the largest in the region, and
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  we have a large ambulatory practice and footprint
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  as well.
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  We're actually the second busiest trauma center in
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  the state. We're a level one adult and
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  pedes trauma center and a burn center among
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  many other specialty,
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  care things that we provide.
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  We're also part of SUNY,
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  which is the State University of New York.
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  It's actually the largest public,
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  education system in the country for higher education.
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  There's 64 campuses, and we are one of
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  three SUNY hospitals, which we take a lot
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  of pride in.
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  We have a college of medicine, college of
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  nursing, college of graduate studies, and a college
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  of health professions as well.
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  And my division in particular,
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  we have about 3,500 FT feet feet feet
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  feet feet feet feet feet feet feet feet
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  feet feet feet feet feet feet feet feet
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  feet feet feet Es. We're the biggest part
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  of the hospital workforce.
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  We take a lot of pride in that.
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  We take a lot of pride in the
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  care that we deliver. We are magnet designated.
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  We just got our second magnet designation,
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  last month. That was quite a process. I'm
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  very, very excited to celebrate that as well.
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  That's incredible. And what a great honor and
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  recognition to have that magnet design designation.
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  Congratulations.
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  And I I can imagine
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  that was a huge part of, what you
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  you were working on last year. But, you
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  know, when you think about the different initiatives
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  that go into all of those things, what
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  was the most important one that you led?
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  What did you do and what were the
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  results?
• 2:54
  Yeah. That's that's a great question. No. I
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  mean, as as a as a overall achievement,
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  certainly, our magnet redesignation was our biggest goal
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  for the year,
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  and we achieved that. And it was
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  certainly a lot of work, but,
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  it's it's rewarding going through your magnet process
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  to really be able to highlight and show
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  the incredible work your team does every day,
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  day in and day out, and that consistency
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  they have.
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  It's just remarkable. We got our first designation
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  during the peak of COVID.
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  So our magnet survey and the process was
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  all done virtually, and we got to do
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  it all in person this time. And it
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  was wonderful,
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  to really be able to show off what
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  Upstate Nursing does. So that was amazing.
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  For the year, though, we focused on, picking
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  ones really hard, I guess, but,
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  I'll I'll maybe highlight two quickly.
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  We focused on a couple of things. We
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  built out our throughput operations center, which is
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  very excited about our throughput operations center. It's
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  like a,
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  NASA mission control, honestly. It's off-site.
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  It's about 2,500
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  square feet, and it's where all of our
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  transfer center bed management and our virtual nursing
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  activity
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  operates out of.
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  We started in-depth working on the concepts of
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  a transfer center in the late twenty teens,
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  like 2018,
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  2019,
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  when COVID happened in life. But,
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  we actually started
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  a a pop up command center, operation center
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  during COVID. We just took over a 10
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  by 12 foot conference room, put a bunch
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  of computers in there, and kinda started doing
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  the work as a proof of concept.
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  It proved to be very valuable,
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  so we fully committed to building out a
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  a really nice space to do this work.
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  And now,
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  this space has a whole wall of very
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  large monitors that show all sorts of throughput
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  movement and activity in real time throughout our
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  whole organization. There's live stream cameras that show
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  our helipad and our emergency department entrances.
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  We have an EMS dispatcher in there, our
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  bed managers who manage all the patient placement
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  work out of that center, and our transfer
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  center nurses.
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  One of the beautiful things about
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  that activity is they all work next to
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  each other, so they can have real time
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  conversations. When the transfer center gets a call
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  about acute transfer, the bed manager can listen
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  and see what's going on, and they actually
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  have different colored lights that can clue in.
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  The transfer center nurse can turn on their
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  lights so that the bed manager knows they
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  should be paying attention to that call to
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  start doing some work behind the scenes. So
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  it can really help save a lot of
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  time. They also help manage,
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  and address where we should dispatch our EVS
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  services when we're in a really acute pinch,
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  which bed should get cleaned first, etcetera.
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  And then our virtual nurses work out of
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  there as well.
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  And one of the other neat features out
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  of out of the transfer center or the
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  throughput operation center is we have a dock
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  that works,
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  twenty four hours a day. We have a
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  dock on, and we actually call them the
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  talk dock.
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  And they help with all of our transfers
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  and talk with all the incoming,
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  physicians
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  and providers that are looking for a higher
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  level of care.
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  So it has helped to really streamline a
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  lot of the things we do and raised
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  a lot of visibility of different places that
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  we can shave minutes, and minutes matter.
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  It doesn't sound like a lot, but when
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  you add up those minutes, you get to
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  be saving days and days and days a
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  month of bedtime, and it really helps improve
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  efficiency and increase capacity across our system. So
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  that was one of our most exciting efforts.
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  That was a lot of years of planning
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  to get the throughput operation center open, but
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  we are so proud of it. And, it
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  has become quite
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  a a popular place in our organization. People
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  travel out there to see it all the
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  time because it's such a neat operational activity.
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  The other thing that I would say, we
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  spent a lot of time and effort on
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  was kicking off kind of our homegrown virtual
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  nursing effort.
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  We started slow and simple
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  with that process, and we started with,
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  virtual discharges,
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  across the system, and then we added in
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  virtual admissions.
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  We have a small team, about five FTEs
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  of nurses who do this right now, and
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  they focus on ED patients,
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  for the admissions. And then, discharges are screened
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  by the floor nurses. They connect with the
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  virtual nurses and the people who are eligible
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  for virtual discharge potentially get the virtual discharge.
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  We have seen some great results even though
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  we're doing this early on, and we haven't
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  done it with a big,
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  capital investment in terms of,
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  technology. We use our EPIC system, and we
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  actually use the patient's own device. We send
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  them a text message as they open the
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  link, and they're able to do their virtual,
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  meeting with the nurse. But we've seen on
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  the
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  discharge side, we're seeing a savings of about
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  forty minutes of bedtime bedside time for the
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  nurses. And on the admission side, we're seeing
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  a savings of about thirty minutes of bedside
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  nurse time.
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  And it's a very different experience when you're
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  on a busy,
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  especially med surg unit and you you know,
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  the evening shift work, all of the admissions
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  come. And having your patients come up with
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  their admission work done is a very different
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  experience than having to do all of that
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  work when they arrive. So it's a big
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  improvement for staff satisfaction and efficiency, and the
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  quality of the work is really good. We've
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  actually seen we've been tracking our readmission rates
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  for our virtual discharges, and the readmission rates
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  for virtual discharges are about half the rate
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  of a regular in person discharge, believe it
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  or not, because the nurses have, the time
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  to go into the chart and really thoroughly
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  evaluate everything from a discharge perspective. And they
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  before they even begin with the patient, they
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  clarify and correct any issues or follow-up with
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  the provider if there's not questions on medications,
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  etcetera. So it's it's really thorough, and it's
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  quite high quality. We're really proud of that
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  team.
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  And the fact that they get to work
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  out of the throughput center with all their
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  other colleagues really has, been wonderful for us
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  as a system.
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  That's really cool to hear about. I think
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  all of the technology integration into the care
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  setting, it seems like it's making a big
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  difference on a variety of fronts, both for
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  the providers as well as the patients and
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  making sure things are moving efficiently and being
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  able to deliver the best care possible. And
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  I think especially when you're talking about the
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  virtual nursing, I know a lot of organizations
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  have been trying to stand that up in
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  a more significant way and and put the
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  right investments there. And so it seems like
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  you've been able to make progress there, which
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  is exciting to see. I'm curious. Looking ahead,
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  what are some of the big priorities as
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  well as headwinds that you're focused on?
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  Sure. So, we definitely are looking to expand
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  our virtual program.
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  That's that's one of the priorities we will
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  have carrying on for the next couple years
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  most likely. We wanna be able to do
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  more services with our virtual nurses. We're looking
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  at, doing some med reconciliation
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  efforts,
• 9:11
  being an expert on call nurse resource to
• 9:13
  a newer nurse who has questions before they
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  go to do a procedure or, talk with
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  a patient,
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  perhaps doing some dual sign offs for medications
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  for high risk medications,
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  integrating our rover work with Epic into our
• 9:25
  virtual nursing system, and also partnering with other
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  services,
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  perhaps virtual
• 9:30
  case management access to patients,
• 9:33
  pharmacy being able to virtually pop into a
• 9:35
  room. So we don't see it just as
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  a nursing initiative across the system. We started
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  out that way, but we definitely see that
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  it will likely expand.
• 9:41
  And we certainly know that we will have
• 9:43
  to invest in the capital and the infrastructure
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  at some point to really do this well
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  with the cameras in the rooms and things
• 9:49
  like that. That's kind of the longer term
• 9:51
  plan. So we're excited about that for sure.
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  Few other things across the system that we're
• 9:56
  definitely gonna focus on.
• 9:58
  We have an amazing chief quality officer, and
• 10:00
  he is determined to get us to four
• 10:02
  and then five stars.
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  We're a three star organization currently and super
• 10:06
  excited where we're at. We've made a lot
• 10:07
  of improvement.
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  We are on the trajectory to get there,
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  so that's that's an exciting focus for us
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  as well. And then I think like
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  everybody else in the country, we all have
• 10:18
  our eye on what's gonna happen with, finances
• 10:21
  and reimbursement and h r one bill and,
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  you know, what's what's the real impact going
• 10:26
  to be?
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  In New York state, in particular,
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  labor costs since 2022 have gone up about
• 10:33
  23%
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  well outpacing one reimbursement and two inflation.
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  So our labor costs are a big, big
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  deal for us. But with the HR one
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  bill and the end of ACA subsidies and
• 10:43
  the impact of that, we're looking at what
• 10:45
  everybody's looking at. How much more uncompensated care
• 10:48
  is there gonna be? How much more,
• 10:50
  lost revenue will there will there be? Just
• 10:52
  the other day, I read a report from,
• 10:54
  the Robert Woods Johnson Foundation that suggested
• 10:57
  up to 32,000,000,000 in lost revenue and up
• 10:59
  to 6,300,000,000.0
• 11:01
  in,
• 11:02
  new uncompensated care.
• 11:04
  In New York, that's that's a scary thing
• 11:06
  to hear about for sure, and I think
• 11:07
  that's true of everybody across the country.
• 11:10
  In New York, the about half of the
• 11:12
  hospitals in the state are at a zero
• 11:13
  or negative margin already.
• 11:16
  And 70% of those hospitals across the state
• 11:18
  of all the hospitals have reported that they
• 11:20
  don't really have the margins to sustain or
• 11:23
  increase the capacity to provide more care across
• 11:25
  the region.
• 11:26
  60% of the rural hospitals in our state
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  are at risk of closure.
• 11:30
  So there's a lot of concern.
• 11:32
  In in New York, the estimate is about
• 11:34
  one point five million people may end up
• 11:36
  uninsured
• 11:37
  with changes with the ACA subsidies.
• 11:40
  That's a lot more people,
• 11:41
  to potentially be seeking uncompensated care in emergency
• 11:45
  departments. Our emergency departments already suffer from significant
• 11:48
  overcrowding and capacity challenges, certainly in the larger
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  areas of the state.
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  So to think about that many more people
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  perhaps seeking ED care as their only source
• 11:57
  of care is gonna be a concern for
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  everybody.
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  So all of the all of the financial
• 12:02
  risk that's out there is a big deal
• 12:05
  for everyone in health care. I think every
• 12:07
  system in the country has got their eye
• 12:08
  on it. I know there's proposed legislation,
• 12:11
  to perhaps bring back ACA subsidies. The house
• 12:14
  has passed a resolution. The senate's working on,
• 12:16
  their own version right now, but nobody knows
• 12:18
  where that's gonna end up. And it is
• 12:20
  a real risk for sure.
• 12:22
  And then I think the other big
• 12:24
  big thing for us, that we know we
• 12:27
  have to continue to tackle is workforce shortage.
• 12:29
  The nursing workforce, obviously, as a chief nursing
• 12:32
  officer, I pay a lot of attention to
• 12:33
  that topic.
• 12:34
  It's significant.
• 12:36
  And we know that,
• 12:37
  you know, in five years, shortage is estimated
• 12:40
  to be about 250,000
• 12:41
  nurses. In ten years, it drops to about
• 12:44
  a 150,000,
• 12:45
  but we gotta get through those five and
• 12:46
  ten years. And that's a big shortage. But
• 12:49
  we really also are paying a lot of
• 12:50
  attention to seeing,
• 12:52
  our hospitalists, for example. There's a huge shortage
• 12:55
  of hospitalists nationally.
• 12:57
  In ten years, they're estimating, like, a 21%
• 13:00
  shortage of hospitals across the country. And in
• 13:03
  many hospitals, ours included, our hospitals carry the
• 13:05
  largest load of patients. We also see shortages
• 13:08
  across anesthesia, radiology. Anesthesia's,
• 13:11
  like, projected to be, like, a 20% shortage
• 13:14
  within the next ten years. That's crippling. Every
• 13:16
  hospital in the country obviously needs anesthesia, needs
• 13:19
  radiology. So these huge physician shortages
• 13:22
  are just compounding and worsening
• 13:24
  the workforce issues that health care is seeing.
• 13:26
  There's no doubt about that.
• 13:29
  Some good news
• 13:30
  maybe, with that, though, is, the advanced practice
• 13:33
  roles are doing well, and there actually is
• 13:36
  going to be if if there is such
• 13:38
  a thing, a surplus in health care workforce,
• 13:40
  I've never really quite seen that, but at
• 13:42
  least the government's projecting there's going to be
• 13:44
  a decent supply of nurse practitioners, physician's assistants,
• 13:47
  and CRNAs, which is huge given the anesthesia
• 13:50
  shortage,
• 13:51
  over the next five to ten years. So
• 13:52
  they will have ops help offset some of
• 13:55
  that. But those are real risks for all
• 13:58
  health care organizations
• 13:59
  across the board and for access and just
• 14:01
  the quality of care that people are gonna
• 14:03
  be able to get. You know, if if
• 14:04
  we we can't do procedures and surgeries without
• 14:06
  anesthesiologists
• 14:07
  or CRNAs. So those are huge things that
• 14:10
  are kinda on our our radar. Those are
• 14:12
  headwinds we know we're facing as we go
• 14:13
  into the next year and years to come.
• 14:17
  That's fascinating to hear. And I know that
• 14:18
  provider shortage, you know, is definitely a huge,
• 14:21
  huge challenge across the board. I think when
• 14:23
  you're looking at that and, you know, the
• 14:25
  last couple of minutes here, what do you
• 14:27
  think the hardest thing you'll have to do
• 14:29
  will be in the next year as well
• 14:30
  as where as you're seeing growth come from?
• 14:32
  Yeah. Sure.
• 14:34
  So we have
• 14:35
  a hard thing and a growth thing tied
• 14:36
  together. We were very lucky. Last year well,
• 14:39
  it was last year now. 2025.
• 14:41
  We were given 450
• 14:44
  $450,000,000
• 14:45
  from the state to build a new emergency
• 14:47
  department and burn unit,
• 14:48
  as part of our organization.
• 14:50
  That's the largest single site project we've ever
• 14:52
  had in our organization,
• 14:54
  and our current emergency department is woefully undersized.
• 14:56
  So that is a major major focus for
• 14:59
  us, as we project out next this year
• 15:02
  and into the next five years of building
• 15:04
  that out. It will change the region for
• 15:06
  sure when it comes to all different aspects
• 15:09
  of how people seek care, get care, and
• 15:10
  what our organization can do for the region.
• 15:12
  So we're very excited about that. But it's
• 15:14
  gonna be intense work. There's no doubt. We
• 15:17
  also in Upstate New York, we,
• 15:19
  in the next five years, are going to
• 15:21
  have,
• 15:22
  a tremendous
• 15:23
  investment in capital and a construction project by
• 15:26
  Micron, the microchip company, who is investing $100,000,000,000
• 15:30
  to build four micro, microchip
• 15:32
  fabrication
• 15:33
  plants, about 10 miles north of Syracuse right
• 15:36
  here where we are. It's gonna bring about
• 15:39
  50,000 jobs and somewhere between 85 to a
• 15:42
  100,000 people to the region. So our region
• 15:45
  is preparing for this tremendous growth of people
• 15:48
  and the need for the infrastructure to support
• 15:50
  that. And part of that infrastructure is health
• 15:52
  care. Right? And it's not gonna be just
• 15:54
  us. It'll be all the health care, providers
• 15:56
  in our region meeting those needs, but that's
• 15:58
  gonna require growth. So we're thinking a lot
• 16:01
  about, our ambulatory
• 16:03
  plans, how and where we can position ourselves
• 16:05
  from ambulatory perspective
• 16:07
  to continue to meet the need, one, for
• 16:08
  the shift from inpatient to outpatient care that
• 16:10
  is ongoing
• 16:12
  and for this new need that is coming,
• 16:14
  in particular for the children that are gonna
• 16:16
  come to the region with their families from
• 16:18
  that. We we are
• 16:20
  almost exclusively the pediatric provider, certainly for acute
• 16:23
  care and a lot of our ambulatory care.
• 16:25
  So we know we'll have to grow in
• 16:27
  that aspect, but we're gonna have to match
• 16:28
  the growth needs
• 16:30
  and meet those growth needs for adults as
• 16:32
  well. So we have a lot of thought
• 16:33
  about how we will plan to do that
• 16:35
  from, an ambulatory
• 16:37
  footprint and perspective.
• 16:39
  And like many other things we're we're focused
• 16:41
  on, we have a hospital home program we're
• 16:43
  looking to grow.
• 16:44
  Our virtual nursing, like I said, we're looking
• 16:46
  to expand. We have a pretty robust AI
• 16:48
  program. We use drones for quite a bit
• 16:50
  of things. We deliver meds to beds via
• 16:51
  drone in our organization.
• 16:53
  And we're building a new lab off-site where
• 16:55
  we actually are gonna fly specimens from our
• 16:57
  hospitals to the lab, which is pretty cool.
• 16:59
  We're excited about that. So we have a
• 17:01
  lot going on. We're a pretty innovative and
• 17:02
  very neat organization. Our CEO, doctor Corona,
• 17:05
  pushes us constantly to, push the envelope and
• 17:08
  think of how we can do things different.
• 17:09
  We take a lot of pride in that.
• 17:12
  Absolutely. That's so wonderful to hear. Scott, thank
• 17:14
  you so much for joining us on the
• 17:16
  podcast today. This has been an amazing conversation,
• 17:18
  and I look forward to seeing you at
• 17:19
  our annual meeting in April. I know that
• 17:21
  you'll be speaking on a panel, and we
• 17:22
  can dig deeper into many of these themes
• 17:24
  and, just continue to to grow and and
• 17:26
  connect and learn from each other. So I'm
• 17:28
  looking forward to it. I am as well.
• 17:30
  It's gonna be a great time. Thanks for
• 17:32
  having me.
• 17:41
  Me.