Latest / Becker’s Healthcare Podcast / Molly Moran, Associate Vice President of Ambulatory Nursing at Rush University Medical Center

Transcript

Molly Moran, Associate Vice President of Ambulatory Nursing at Rush University Medical Center · Becker’s Healthcare 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
0:12
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 Dierdahl with the Becker's Healthcare
0:48
podcast. I'm thrilled today to be joined by
0:50
Molly Moran, associate vice president of ambulatory nursing
0:53
at Rush University Medical Center. Molly, it's a
0:55
pleasure to have you on the podcast today.
0:57
Thank you so much for having me.
1:00
Absolutely. Now I'm excited for our conversation because
1:03
I know there's so much happening in the
1:04
healthcare space, and you're particularly,
1:07
interested in learning more about your focus on
1:09
nursing and especially in the ambulatory setting as
1:12
I know more,
1:14
cases are are going into that space and
1:15
more patients are being served in that space,
1:17
and so it'll be interesting to hear your
1:19
perspective. But before we dig in, can you
1:20
tell us a little bit more about yourself
1:22
and and Rush?
1:24
Absolutely.
1:25
So I am a doctorally prepared registered nurse,
1:28
and as you said, I serve as the
1:30
associate vice president of ambulatory nursing for the
1:32
Rush Medical Group, which is part of the
1:35
larger university
1:36
at Rush University System for Health.
1:39
So rush is a leading academic health system
1:42
based in Chicago.
1:44
And we've been recognized
1:46
nationally for excellence in quality and safety and
1:48
outcomes,
1:49
including,
1:50
having been,
1:52
recognized by us news and world report for
1:55
best hospitals honor roll and have also been
1:58
designated as one of the top performing academic
2:00
medical centers in the country by Visiend.
2:04
In my role in particular,
2:06
I lead ambulatory nursing practice across,
2:09
very complex multi specialty medical group.
2:13
We have more than 100 sites from Aurora,
2:16
Illinois to Munster, Indiana,
2:18
and collectively
2:19
serve more than 2,000,000 patients every year.
2:23
My work in particular sits really where clinical
2:26
practice operations,
2:28
quality and strategy
2:29
intersect.
2:31
And I, I love my work and find
2:33
it very meaningful and impactful because it's really
2:36
where decisions translate most directly into safer patient
2:40
care,
2:41
better outcomes, and a more supported workforce.
2:46
Over the past several years, our organization has
2:48
been integrating
2:49
multiple legacy medical groups, which I know is
2:52
not uncommon in, today's ambulatory landscape.
2:56
And so as many may know, each of
2:58
those medical groups come with their distinct cultures,
3:01
their workflows
3:02
approaches to nursing practice,
3:04
which for me is,
3:06
exciting,
3:07
but also creates
3:08
a significant complexity,
3:10
but a powerful opportunity to really define how
3:13
ambulatory nursing delivers value at scale.
3:20
That's fascinating to hear, you know, truly,
3:22
important to have that type of lens and
3:25
opportunity to access point for patients.
3:27
I'm curious, what are some of the trends
3:29
that you're watching currently?
3:31
So there are many trends that I'm currently
3:34
watching,
3:35
but the one that is first and foremost
3:37
really is the economic and policy environment.
3:41
For me, it's really driving everything.
3:44
As many in healthcare are acutely aware, rising
3:48
healthcare premiums and the ongoing federal changes
3:51
are drastically
3:52
reshaping our public health systems and destabilizing
3:56
coverage.
3:57
For many of our families. The question isn't
4:00
which plan to choose anymore. It's whether they
4:03
can afford insurance at all.
4:05
And at rush, we see this reality every
4:07
day.
4:09
Many of our practices
4:10
sit on Chicago's West Side, which is a
4:13
community that has faced
4:15
decades of socioeconomic
4:17
disadvantage.
4:18
There have been a number of studies done
4:20
that show that the life expectancy
4:22
on the West Side Of Chicago
4:24
is several years shorter than a neighborhood just
4:27
a few miles away.
4:29
And what that really has shown us and
4:32
and what that translates to today is that
4:35
these gaps aren't always about geography. It's about
4:39
the structural inequities
4:41
for patients. It's been showing up as delayed
4:44
care,
4:45
missed preventative services, medication, non adherence,
4:48
and then more advanced
4:50
diseases that easily could have been prevented or
4:54
had better outcomes had they been caught early.
4:57
So what I'm really watching is how these
5:00
additional barriers
5:02
around
5:03
economic and policy environment
5:06
is going to show up on a larger
5:09
scale because we know that Chicago's West Side
5:12
is not an isolated story.
5:15
It really for me is an early and
5:17
amplified signal of what policy shifts rising costs
5:21
and coverage instability
5:22
are creating for communities across the country
5:28
for me. As we look at ambulatory settings
5:32
and emergency
5:34
departments,
5:35
then we really have to think about
5:37
how are patients
5:38
accessing these resources.
5:41
Ambulatory clinics, urgent cares, EDs are becoming the
5:45
first and sometimes the only point of contact
5:48
for patients who navigate coverage and stability and
5:52
the strained public health resources.
5:55
In my role, I'm especially attuned to this
5:58
because that raises the stakes for quality, safety,
6:01
and reliability in ambulatory care. We've really begun
6:02
to
6:14
When coverage
6:16
When coverage is unstable,
6:18
access is about whether the patients can safely
6:21
navigate the system at all.
6:24
So this is why timely
6:26
clinical decision making, appropriate triage, and continuity between
6:30
visits are no longer optional. They're essential, which
6:33
really
6:34
raises the stakes and raises the bars for
6:36
medical groups.
6:38
But this is what I think is so
6:40
unique and what I'm watching
6:43
in terms of trends in the ambulatory
6:45
space.
6:47
This is a great opportunity
6:49
for nursing to not just step in, but
6:51
to lead.
6:53
Ambulatory
6:54
nursing in our medical group is now central
6:57
to improving access. And this
7:00
is most predominantly
7:01
seen through telephone triage,
7:04
work that we've done around care coordination,
7:07
and then lastly, around proactive outreach.
7:11
Our models are based on best practices that
7:13
can be found in different medical groups across
7:16
the country
7:18
and in each of those,
7:21
organizations
7:22
and, and including ours, we have found that
7:25
through intentional
7:26
infusion of nursing care, we can avoid unnecessary
7:30
emergency visits.
7:32
We'll really ensuring that those who need
7:34
in person care, get it at the right
7:36
time and in the right setting
7:41
At rush, as I said, we've really
7:44
leaned into this reality and have,
7:46
watched nursing take the lead in several of
7:50
these areas.
7:52
One that I really would like to highlight
7:55
is our nurse led telephone triage, which is
7:57
now core to our primary care delivery model.
8:01
It's not a side service or or nice
8:04
to have.
8:06
We have really
8:07
worked to utilize evidence based protocols,
8:11
clarify our escalation
8:13
pathways,
8:14
and combine both strong competency oversight with clinical
8:18
quality outcomes
8:19
to enable our registered nurses to practice at
8:22
the top of their license.
8:24
And I will say the impact has been
8:27
significant.
8:29
Year over year, we have seen a drastic
8:32
reduction in unnecessary
8:34
emergency
8:35
department utilization.
8:36
And over the past four years have actually
8:38
seen, more than a 60%
8:41
decrease
8:42
in that unnecessary
8:43
ED utilization.
8:45
We have seen a higher conversion to urgent
8:48
care and virtual urgent care visits
8:52
and faster direction for patients who have high
8:54
risk symptoms.
8:56
We've also seen,
8:58
interestingly enough, a large portion of patients who
9:02
choose to still come in for a primary
9:04
care visit.
9:06
And this has been especially interesting to watch.
9:09
These are patients that likely would have gone
9:12
to the ed or urgent care simply for
9:14
that in person reassurance.
9:16
And by offloading
9:18
a lot of the work from the clinic
9:20
into the telephone triage
9:22
space, we've created capacity for these patients to
9:25
be seen,
9:26
and without undue burden in, in some of
9:29
these,
9:30
other
9:31
clinical care areas
9:37
for me.
9:38
As I said, the takeaway is, is pretty
9:40
simple that nurse led telephone triage isn't a
9:44
nice to have anymore. It's really foundational to
9:47
our care delivery model.
9:49
It has shown to improve safety, preserve that
9:52
capacity,
9:53
and then really in our patient
9:56
population has helped to operationalize
9:58
equity
9:59
by meeting patients where they are, especially
10:03
when access is most fragile in some of
10:05
our high risk clinics.
10:11
So we know that registered nurses play a
10:13
critical role in health promotion and early identification
10:16
of opportunity, whether that's driving proactive outreach, closing
10:20
care
10:21
gaps, shifting care upstream.
10:24
But that understanding has really shaped how we
10:27
redesigned
10:28
care.
10:29
And I'm not just talking about telephone triage.
10:33
We have really doubled down and we have
10:36
looked at,
10:37
in centralized and standardized
10:39
visits such as our annual wellness visits and
10:42
our transitions of care management visits across the
10:45
system.
10:46
And this wasn't a compliance exercise, but really
10:49
thinking about these visits as essential touch points
10:53
for prevention and continuity.
10:56
And so in doing this, we've really created
10:58
consistent workflows,
11:00
aligned scheduling resources,
11:02
made the visits more predictable, timely, and ultimately
11:06
easier for the patients to access.
11:09
At the same time, we've recognized that patient
11:12
experience
11:13
and patient care management
11:15
increasingly
11:16
is happening outside the exam room.
11:19
So we also doubled down on my chart
11:21
responsiveness,
11:22
both in speed and in quality.
11:24
Both are absolutely critical and you can't have
11:27
one without the other
11:29
Because every message, in my opinion, is an
11:32
opportunity for us to build trust with our
11:34
patients.
11:36
And in creating
11:38
standard operating procedures
11:40
and monitoring the quality of those messages going
11:43
out to the patients,
11:44
we've seen a tremendous impact.
11:47
Our RN and ma communication scores over the
11:50
past eighteen months have increased from 94.8
11:53
to 96.3.
11:55
And for multiple quarters, we've been outperforming the
11:58
upper control limit.
12:01
I think that's one of the things I'm
12:02
most proud of,
12:04
because that's not reliability
12:07
and that's a system that's working as intended
12:09
for the patient.
12:13
The other thing I will say,
12:15
is
12:16
as we're watching this with, with trends,
12:19
you know, I've talked a lot about what
12:21
we're doing within our medical group,
12:23
but as you zoom out, these examples
12:27
really become more important.
12:29
As we look at the federal policy shifts,
12:31
the public health priorities and the funding changes,
12:35
they're placing greater responsibility
12:37
on ambulatory practices
12:40
to manage population health far beyond the walls
12:43
of the clinic.
12:44
Practices are being asked to not only address
12:46
medical leave, but also
12:49
the downstream effects of social risk, coverage, and
12:51
stability, and then our limited community resources.
12:56
So things such as leader standard work, structured
12:59
rounding, closed loop communication, and evidence based protocols
13:03
really aren't
13:04
bureaucracy.
13:05
It's the foundation for the safe, predictable care
13:08
when everything else feels uncertain.
13:11
And And I think we've seen, a large
13:13
shift
13:14
at the national level for what it means
13:17
to be a healthcare leader in today's environment.
13:22
And so I'll say the last trend that
13:25
I'm watching really is about workforce stability.
13:29
It's inseparable from quality.
13:32
And this, in my opinion is because as
13:34
patient complexity grows and coverage instability
13:37
persists,
13:38
the demands on the ambulatory teams are only
13:41
going to increase.
13:43
And so for me, high reliability
13:46
isn't about
13:48
just what we achieve, but having that supported
13:52
engaged workforce
13:53
and that consistent leadership presence.
13:57
So for me, the, the message is clear.
13:59
It's really about ambulatory quality
14:02
no longer being secondary.
14:05
It is central to delivering that safe, reliable,
14:08
and equitable care as economic and policy pressures
14:11
reshape the healthcare landscape.
14:17
That's such great perspective, and I really appreciate
14:20
you talking through so many of these different
14:23
trends,
14:24
that are really surfacing as being so important
14:26
for the nursing workforce and the clinical workforce
14:30
in general. I know health care is changing
14:32
and transforming in so many different ways to
14:34
make sure there's access points across the board
14:36
for leaders
14:38
in patients, as they're coming into
14:41
the health care system and are needing to
14:42
refine their journeys. And so it's incredible to
14:45
hear more about what Roche has been able
14:47
to do to be more responsive and and
14:49
more attentive to those patients as well as
14:51
lean into the evidence based protocol so that
14:53
they can achieve better outcomes even as, health
14:57
care becomes more complex. So when you're looking
15:00
ahead, what are you most focused on and
15:01
excited about? And and could you tell me
15:03
a little bit more about, you know, something
15:05
you're most proud of from the last six
15:07
to eighteen months or so?
15:09
Yeah. Absolutely.
15:11
So as I mentioned,
15:13
we are integrating
15:14
legacy medical groups into
15:17
one system.
15:19
And I will say
15:21
what has been what I'm most focused on
15:23
is that integration, but it's also what I'm
15:25
most excited about. And that's because I feel
15:28
like we've really intentionally
15:31
begun to redesign ambulatory
15:33
nursing,
15:34
not just taking what is best from each
15:37
of the legacy medical groups, but really at
15:40
times hitting pause to understand
15:43
what is needed
15:44
by our patients today. And what do we
15:47
think they're going to need in ten, fifteen,
15:49
twenty years?
15:51
And how do we build that?
15:54
I focus a lot in my current role
15:57
on, primary care and that's because what we're
16:00
seeing is patients are living longer with multiple
16:03
chronic conditions.
16:05
They're often navigating care across not just primary
16:08
care, but specialty care, diagnostics,
16:11
community resources, if they're available.
16:15
And that level of complexity
16:17
really requires far more than episodic visit, which
16:20
is traditionally
16:22
what ambulatory has been built on.
16:26
What we're seeing today and what I think
16:28
we're going to continue to see into the
16:30
future
16:31
is that it requires care coordination,
16:34
consistent follow-up,
16:35
and it requires clinical judgment between those appointments
16:39
to determine the next best course of action.
16:42
And I feel like over the last twelve
16:44
to eighteen months, we've really leaned into the
16:47
idea that registered nurses in the clinic
16:50
are no longer just a support function, but
16:53
they're a critical strategy
16:55
for how we improve that patient
16:57
outcome,
16:58
the access to care, and overall care coordination.
17:03
What I will say though is, this hasn't
17:05
been without its challenges.
17:08
Historically, ambulatory
17:09
operated,
17:11
in a as a private practice or with
17:13
a private practice mindset. And, again, really,
17:17
in terms of episodic
17:19
care
17:20
and staffing models have historically been built around
17:23
that reality.
17:25
One of the things as
17:27
we're looking back to the past six to
17:30
eighteen months is
17:32
really starting to dismantle
17:35
the idea of plug in place staffing models,
17:39
because the work is no longer as predictable
17:42
or transactional.
17:44
And so it's really, as we look ahead,
17:46
what I'm excited about is
17:48
asking the question
17:50
or or not asking the question, I should
17:52
say, how many registered nurses or medical assistants
17:55
do we need? But instead reframing the question
17:59
to say,
18:00
what is the work and who is best
18:02
equipped to do it?
18:04
And that shift is really going to require
18:06
us to break away from those rigid role
18:08
definitions,
18:09
to think creatively about skill mix,
18:13
to introduce
18:14
healthcare professions that maybe have not historically practiced
18:18
in the ambulatory
18:31
amplify
18:32
the patient experience and outcomes. And amplify the
18:34
patient experience and outcomes.
18:39
I will say,
18:40
one of the things that I'm also, you
18:42
know, is most proud of over the last
18:45
six to eighteen months. And, and again, continuing
18:48
to look ahead
18:49
is how we're moving from,
18:52
historically fragmented
18:54
practice into a more intentional
18:56
system level approach to ambulatory nursing.
19:00
Some of that,
19:01
has been natural with the integration,
19:05
But more often than not, it's intentional,
19:08
and it requires
19:09
a
19:10
near daily recommitment of every leader and in
19:13
particular nurse leader in ambulatory
19:17
to help redefine what excellence looks like, to
19:20
align those leadership structures,
19:22
and to put leader standard work that is
19:25
focused on nursing
19:27
in place so that both our leaders and
19:29
frontline teams don't feel like they have to
19:32
constantly reinvent that wheel.
19:36
That has changed the way that we have
19:38
thought about,
19:40
how we deploy our nurses,
19:42
where they're working, and and what the work
19:44
is that they're doing in the clinic.
19:47
We've seen this particularly,
19:50
change
19:51
as we've expanded the role of the nurse
19:53
navigator
19:54
across several of our service lines.
19:57
So the nurse navigator role has historically,
20:01
been well defined within the oncology patient population,
20:05
but has had growing traction in other specialty
20:09
care populations.
20:11
And we've seen this really take off and
20:14
help us reimagine
20:16
what it means
20:17
to coordinate care across the continuum,
20:21
what the inpatient and ambulatory partnership
20:24
looks like, and redefine
20:26
roles and responsibilities
20:28
for things such as discharge in a way
20:30
that six months ago,
20:33
twelve months ago, we weren't having those conversations.
20:38
Finally, I'm really proud of how ambulatory
20:41
nursing
20:42
has been positioned as a strategic partner in
20:45
value based care.
20:47
Whether it's nurse navigation,
20:49
expanded telephone triage, or some of our proactive
20:52
disease management,
20:54
we're seeing and measuring the direct impact nurses
20:57
have on access, experience,
20:59
and financial sustainability.
21:03
Nursing led work is no longer viewed as
21:05
ancillary. It's increasingly
21:07
recognized as essential to how we manage our
21:10
populations,
21:11
prevent avoidable utilization,
21:13
and deliver high quality scale, care at scale.
21:17
So that cultural shift supported by real outcomes
21:21
has been incredibly energizing for our team and
21:23
reinforces
21:24
to me why this work matters so deeply.
21:30
Absolutely.
21:32
I think that's such a great point. And,
21:34
you know, really looking at how that nursing
21:36
workforce has shifted and how you've been able
21:39
to change
21:40
as the environment has changed as you've gotten
21:42
more information and more data and more access
21:44
points and, you know, truly leaning into more
21:47
of the value of care.
21:49
I I just think it's really fascinating and
21:51
incredible. And, you know, from your perspective,
21:54
as you've made this transition, what has helped
21:57
it along the way? I know any kind
21:58
of change can be a challenge and especially,
22:01
you know, when there are long standing patterns
22:04
and traditions within certain,
22:06
workflows or or clinical mindsets. And so how
22:09
have you been able to work with the
22:11
teams to help them,
22:13
make these changes and really improve the way
22:15
that you're looking at at patient care because
22:17
of it? That's a really great question.
22:21
I have been very blessed throughout my career
22:24
to have
22:25
strong mentors, many of whom are nurse leaders
22:29
themselves,
22:30
other
22:31
mentors who are in different health care disciplines.
22:35
And I have learned from them that what
22:38
is most important is to be intentional
22:40
in how you lead,
22:42
especially in times of change.
22:45
And one of the things,
22:47
that I go back to often,
22:49
my team knows, and those who work with
22:52
me frequently know that I am, often referencing
22:56
the Ted Lasso line of be curious, not
22:59
judgmental.
23:01
And for me as I'm
23:03
leading change as within my team or within
23:06
a department,
23:07
I feel like it's especially relevant in healthcare
23:10
today
23:11
to keep that mindset
23:13
Because
23:14
when performance engagement or outcomes fall short, it
23:18
can be really easy to make assumptions
23:20
or default to blame.
23:23
But
23:24
if we're really going to
23:26
change the way that we deliver care, we
23:29
have to create a space of curiosity
23:33
to understand what's actually happening,
23:36
what barriers exist and what our teams need
23:38
to be successful.
23:40
And in my experience,
23:42
and again,
23:43
so grateful for the mentors that I've had,
23:45
who have actively
23:47
taught me,
23:49
to have that curious mindset,
23:51
it has strengthened relationships,
23:53
but it's also led to more sustainable
23:56
and meaningful improvement.
24:02
That's so helpful to understand.
24:04
And I I I love that idea of
24:06
just continuing to be curious, nonjudgmental,
24:08
and,
24:09
leaning towards the things that are gonna make
24:10
the biggest difference for the patients in the
24:12
space. Now before we wrap up here, what
24:14
advice would you give evolving leaders as they're
24:17
continuing to grow and develop in their own
24:19
organization?
24:22
I think that is a great question.
24:25
First, what I would say is
24:27
leaders, regardless of your level of experience,
24:31
collectively,
24:32
we need to recognize that the strategies that
24:35
worked
24:36
in the February, February and tens will not
24:39
carry us forward.
24:41
Our patients are more complex.
24:43
Our teams are stretched.
24:45
Expectations around access, quality, and value, they're fundamentally
24:49
different than they were
24:51
five, ten, or twenty years ago.
24:53
And so simply asking people to work harder
24:57
or laying on more processes is not going
24:59
to solve today's challenges.
25:02
Evolving leaders must be willing to question those
25:05
legacy models to let go of those sacred
25:08
cows and the way that we've always done
25:10
it,
25:12
and then really
25:13
redesign both care and leadership practices with intention.
25:19
And so with that, I would encourage all
25:21
leaders to be bold and innovative in how
25:24
they lead.
25:26
I will tell you that doesn't always mean
25:29
big flashy initiatives.
25:32
It can be something as seemingly mundane
25:35
as being disciplined about your standard work
25:38
about
25:39
really digging into the data to use it
25:42
thoughtfully,
25:43
or it can be truly transformational
25:45
such as empowering,
25:47
in my case, nurses,
25:49
but all of our frontline teams
25:51
to really practice at the top of their
25:53
license and to be willing to
25:56
bet on an approach,
25:58
even when the path isn't perfectly clear.
26:02
But likewise, we also have to be willing
26:04
to say that something that we tried isn't
26:07
working and we need to go back to
26:08
the drawing board
26:10
because
26:11
what I would share with any leader is
26:14
that leadership isn't just about decisions.
26:17
It's about what you pay attention to. It's
26:20
about what you tolerate
26:21
and what you consistently
26:23
reinforce.
26:24
And so for me, when leaders combine curiosity
26:28
with courage and show up with that intention,
26:31
you can create cultures where patients and teams
26:34
can truly thrive.
26:36
And that's where I have learned
26:38
leadership has that lasting impact.
26:43
I love that. Molly, thank you so much
26:45
for joining us on the podcast today. This
26:47
has been such a fascinating conversation and fantastic,
26:51
perspective, and I look forward to connecting with
26:53
you again soon.
26:55
Thank you so much, Laura. I appreciate it.