Latest / Becker’s Healthcare Podcast / Team Based Care, APP Growth, and AI Innovation at Stanford Health Care with Clair Kuriakose

Transcript

Team Based Care, APP Growth, and AI Innovation at Stanford Health Care with Clair Kuriakose · Becker’s Healthcare Podcast

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  This is Laura Dirda with the Becker's Healthcare
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  podcast. I'm thrilled today to be joined by
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  Claire Koryakos,
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  vice president and chief advanced practice officer at
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  Stanford Healthcare. Claire, it's a pleasure to have
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  you on the podcast today. Thank you, Laura.
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  It's really great to be here. Absolutely. Now
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  I'm excited for our conversation because
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  I know it's just such a fascinating time
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  in health care today and truly to dig
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  into, the advanced practice space is going to
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  be an incredible opportunity to share your perspective,
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  with our broader audience as well as some
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  of the really cool things you're doing at
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  Stanford HealthCare. So I'm excited to dig in.
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  But before we do, can you tell us
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  a little bit more about yourself and Stanford?
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  Yeah. Absolutely.
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  So as you mentioned, my name is Claire
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  Kriakos.
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  I am the vice president and chief advanced
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  practice officer at Stanford HealthCare.
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  And Stanford is a premier academic medical center
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  here in the San Francisco Bay Area.
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  We have a veterinary hospital as well as
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  a community hospital in a very large
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  ambulatory
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  footprint all over the Bay Area.
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  I've been now at Stanford for close to
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  twelve years, and the role that I'm in
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  today is actually an inaugural role within our
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  organization.
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  And it really stemmed from this large growth
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  or,
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  yeah, this quick rapid growth of APPs within
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  our organization and
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  really understanding the value that APPs have from
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  a strategic standpoint
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  in how we deliver care for our patients.
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  It's been really exciting. The scope of my
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  role is really the professional practice and the
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  workforce strategy
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  for advanced practice providers, which is a term
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  that we use for nurse practitioners,
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  physician associates, clinical nurse specialists,
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  as well as certified registered nurse anesthetist.
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  But we have a close 2,000 APPs in
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  our organization. So it's been
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  really fun and a great way to really,
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  delineate what the role can do for our
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  organization and mostly for our patients.
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  Absolutely. I think that's fascinating, especially
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  considering I know, APPs have had a continuing
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  to elevated role, within the health care system
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  and journey that patients go on. And so,
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  it's amazing to see that, you know, you
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  being in this position with Stanford,
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  how they're looking at this and taking it
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  seriously.
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  Now when you think about the last year,
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  what is one of the most important initiatives
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  that you led? What did you do, and
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  what were the results?
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  Yeah. I think I love that question because
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  as we think about kind of this evolution
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  of advanced practice, one of the things that
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  I am really proud of within our organization
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  is our intentionality
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  and emphasis
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  on team based care.
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  Stanford Health Care, these past couple of years,
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  have been really thoughtful about what does that
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  mean and how can team based care bring
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  value to our patients. You know, there's really
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  evolving demands
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  from our patients. Access is a challenge, efficiency,
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  patient experience. And as we focus on those
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  things, we as an organization have been really
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  intentional about what team based care and what
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  is the right care model
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  for our patients.
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  And we've developed
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  different structures, MGTs,
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  around care models, and that has really helped
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  us to think about how do we leverage
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  each team member within a care team so
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  we can meet all those needs for our
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  patients, improving access.
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  And just this past year, this is actually
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  continued work that we're we're gonna be continuing
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  to focus on over the next couple of
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  years. But
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  in just the just this past year, we've
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  been able to see an improvement
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  of seventeen percent in our ambulatory
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  APP visits. And this really goes to show
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  the collaboration
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  and partnership with our physicians, our nurses, our
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  APPs, the operations team
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  to really work together
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  to best improve better improve the care that
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  we're giving our patients.
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  I love that. I I think it's so
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  critical to have that type of collaboration and
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  be able to think differently about how,
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  each member of the care team is contributing
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  and what will have the biggest impact on
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  outcomes and improvements in the last year. And
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  so, that's really amazing to see. And as
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  you're going through this process, you know, having
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  that improved 70%,
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  in the APP visits, is there anything you
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  had to adjust about,
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  you know, the the team or workforce expectations
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  or anything else, to kind of go along
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  with this transformation and make sure that, you
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  know, your team was able to meet that
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  capacity and continue to provide a great experience
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  for patients?
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  Yeah. Absolutely. It's obviously a heavy lift and
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  takes,
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  collaboration and partnership with so many leaders and
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  frontline clinicians. And it was really about education
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  around the role, around competencies,
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  and working together,
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  not just internally, but also communicating to our
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  patients and having role delineation,
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  expectation management on when they're gonna be seeing
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  an advanced practice provider and when will they
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  see a physician. So it really takes a
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  lot of thought and intention. And if we
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  do it collaboratively,
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  it can be tremendously
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  successful and have better access and outcomes for
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  our patients.
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  Got it. That's so helpful to know and,
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  you know, a great insight, in terms of
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  how you're building the program there and continue
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  to,
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  elevate patient care. Now looking ahead for 2026,
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  what are some of the big priorities and
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  headwinds that you're focused on?
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  Yeah. You know, I I think 2026
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  is going to be a very interesting year.
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  And I think we have the opportunity to
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  really reimagine
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  how care is delivered by, again, some of
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  this care model work, thinking about every single
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  team member and how we can do that,
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  especially with some of the financial headwinds that
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  we're seeing, the reimbursement
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  changes.
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  I think it will allow us to really,
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  be innovative and creative
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  and really reimagine
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  how we deliver care, and I think that's
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  exciting.
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  And as my goal is that we do
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  this while keeping the patient at the center
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  of all of these efforts and making sure
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  we're still we're we are providing the best
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  highly
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  high quality care for our patients.
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  That makes a lot of sense. And, you
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  know, you touched on a little bit, but
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  I know financial
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  challenges are,
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  a breast for almost every health system in
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  the hospital across the country. And thinking through,
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  you know, how, you can be innovative and
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  be creative and, tap into the potential for
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  so many of your different team members in
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  in a variety of ways. What are you
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  doing at Stanford? And when you're working with
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  your,
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  your leadership team as well as the those
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  on the front lines, how do you make
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  sure you're unlocking
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  all of that potential and creativity
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  in in really,
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  putting forward, you know, what health care is
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  gonna transform into over the next several years?
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  Yeah. You know, that's a really great question.
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  I think, really, as health care leaders, it's
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  having that innovative
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  mindset.
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  One powerful tool that we utilize at Stanford
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  Health Care is our shared leadership structure. And
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  it would be no surprise to you, but
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  the folks who have the best ideas are
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  actually our frontline
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  clinicians and staff. And so we utilize our
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  nursing shared leadership, our APP shared leadership structure,
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  really to make sure the voice of our
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  frontline clinicians are heard, and they are involved
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  in creating
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  the innovative,
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  solutions
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  to help solve for the problems that we're
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  facing
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  and leveraging them on different task forces and
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  committees,
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  thinking about AI and how that will help
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  transform and help improve the care that they're
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  delivering. But I the ultimate
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  resource or,
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  the expert is really the clinicians, the frontline
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  team. And so we do spend a lot
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  of time and energy making sure that the
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  their voices are heard and part of this
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  problem solving.
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  Absolutely. I love that. And and it's just,
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  you know, a a great kind of approach
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  to having those voices from the front lines
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  bubble up and and be front and center
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  in the transformation process.
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  Now what do you think the hardest thing
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  you'll have to do in the coming year
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  will be?
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  So, you know, I'm I'm I'm sure we're
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  not different from other AMCs in this, but
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  one of the
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  biggest challenges that we have right now is
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  really the through our capacity demands and the
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  strain that we have and,
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  whether it is through our ED volume and
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  our surgical volume. There's this tremendous demand for
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  inpatient
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  beds. And so as an organization,
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  we are working hard on looking at being
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  more efficient, enhancing our throughput,
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  decreasing our length of stay as appropriate,
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  looking at how we can,
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  discharge patients more efficiently and effectively.
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  So this is a key priority for us
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  and a really hard problem to solve overnight
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  as you can imagine.
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  And our goal is to make sure that
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  the patients get the care
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  they need in the right place. And one
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  major initiative that we launched just a couple
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  of months ago is Stanford Health Care at
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  Home.
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  This is a program,
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  an APP led,
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  virtual visits for patients where we are able
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  to provide care at the comfort of their
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  own homes. And this these are services that
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  we typically have provided
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  while they were inpatient. And this this program
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  has been immensely successful in really
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  creating capacity, but also from a patient satisfaction
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  stand and getting them to their,
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  families and friends sooner, and it's also helped
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  us create capacity for our organization.
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  So I think this year, we'll continue
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  to double down on efforts like this, thinking
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  about how as a team we can collaborate,
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  again, leveraging every single clinical team member to
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  think about how we can be more efficient,
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  to best take care of our patients and
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  create efficient throughput and capacity.
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  That makes a ton of sense. And, you
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  know, it is really cool to hear how
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  you're tackling some of those capacity issues because
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  you're right. I mean, you know, AMC's plus
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  community hospitals and and more have really experienced
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  a huge influx of patients and trying to
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  figure out how to,
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  manage all of that is just going to
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  continue to be a struggle, it seems like,
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  over the next several years. And so the
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  idea of bringing more of that, Stanford Healthcare
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  at home and those APP led virtual visits,
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  I can imagine, are critical not only to
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  expanding access, but also, you know, doing that
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  in a,
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  efficient and cost effective way.
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  Exactly. And I think one thing that folks,
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  well, most people are starting to realize, right,
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  when we focus on inpatient, it quickly translates
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  over to outpatient as well. And, you know,
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  what can we do even in the ambulatory
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  setting
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  to limit unnecessary ED visits? Right? So we
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  are focusing on readmissions and same day clinics
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  to make sure that our patients get the
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  right type of care that they need in
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  the right setting. And so focusing on these
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  ambulatory clinics along with the inpatient efficiency metrics
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  have been really helpful.
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  Absolutely. Absolutely. That is amazing to hear. Now,
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  before we wrap up, I wanted to ask
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  about growth too. Where are you seeing some
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  of the best, opportunities for organizational growth?
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  You know, I I think we alluded to
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  this a little bit earlier, but, really, from
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  a health care perspective, I think the transformation
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  or how AI is really gonna continue
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  transforming health care is one of the key
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  opportunities
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  that we have. I am incredibly
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  impressed by Stanford Health Care and the position
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  that we have taken
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  in really building a governance structure and ethical
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  frameworks around
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  AI integration in health care. I think that
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  is a fundamental piece that as clinicians, we
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  wanna make sure is occurring and,
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  making sure that patients are really the center
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  of AI integration, and clinical safety remains the
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  the highest priority.
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  And with that type of framework and governance
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  structure, there's so much that we can do.
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  The opportunities are really endless.
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  We recently launched an AI scribe,
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  both in our ambulatory setting, and we're about
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  to launch it in our inpatient setting. And
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  just from some of the early data shows
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  some efficiency gained for our clinicians, but also
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  also just a decrease in cognitive load
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  in relation to clinical documentation. So there's just
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  so many different innovative AI models and that
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  I believe that we can integrate into health
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  care today, but it requires
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  a appropriate clinically appropriate governance structure, and I
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  am so incredibly proud
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  of how we do that here at Stanford.
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  That's amazing. Claire, thank you so much for
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  joining us on the podcast today. This has
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  been such a fascinating conversation. I'm inspired by
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  all the work that you're doing at Stanford
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  HealthCare.
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  You know, we look forward to continuing the
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  conversation in the future.
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  I know that you'll be speaking at our
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  annual meeting, and so I'll be excited to
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  see you then and really be able to
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  catch up. Thank you, Laura. I really appreciate
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  your time and the opportunity.