Latest / Becker’s Healthcare Podcast / Driving Nurse Engagement and Throughput Innovation at Maimonides with Frankie Hamilton

Transcript

Driving Nurse Engagement and Throughput Innovation at Maimonides with Frankie Hamilton · Becker’s Healthcare Podcast

• 0:00
  Hi, everyone. This is Erica Carbajal with Becker's
• 0:03
  Hospital Review. Thank you so much for tuning
• 0:05
  in to this episode of the Becker's Healthcare
• 0:08
  Podcast.
• 0:09
  Today, we're joined by Frankie Hamilton,
• 0:12
  vice president of nursing operations
• 0:14
  at My Minaitis Medical Center in New York.
• 0:17
  Frankie, welcome. Welcome. Thank you so much for
• 0:19
  taking the time.
• 0:21
  Thank you. Thank you for having me, Erica.
• 0:22
  I appreciate it. Yeah. Pleasure to have you
• 0:25
  on today. Do you wanna start by sharing
• 0:27
  a little bit about
• 0:29
  your role, your organization, and the scope of
• 0:32
  your work?
• 0:33
  Sure.
• 0:34
  So I joined the Maimonides
• 0:36
  team about almost a year ago in March
• 0:39
  2025.
• 0:40
  I came here, in the role of vice
• 0:42
  president of nursing operations, which is a title
• 0:45
  that was, I think, newer to the organization.
• 0:48
  And in my role, I oversee
• 0:50
  nine medicine units
• 0:52
  as well as our dialysis unit, which only
• 0:55
  covers
• 0:56
  inpatients. We don't have,
• 0:59
  outpatient services for Dallas at the moment.
• 1:01
  I also cover the nursing administration office, which
• 1:05
  houses our float pools
• 1:07
  as well as our nursing administrative directors who
• 1:10
  keep the hospital running on the evening, night,
• 1:13
  and weekend shifts.
• 1:15
  And I also
• 1:16
  sort of am in charge of special nursing
• 1:18
  projects and initiatives that come up throughout
• 1:22
  the course of our daily operations.
• 1:24
  And,
• 1:25
  so that includes, like, working with some vendors
• 1:28
  and bringing new products. And, of course, that's
• 1:30
  in collaboration with all of our other nursing
• 1:33
  departments, quality department,
• 1:35
  nursing practice and innovation, nursing education.
• 1:38
  So my job is definitely not siloed for
• 1:40
  sure.
• 1:41
  And then I also will be in charge
• 1:43
  of our ANCC
• 1:44
  magnet
• 1:45
  designation application
• 1:47
  project
• 1:48
  slash initiative, which we will be applying
• 1:51
  for magnet designation
• 1:53
  soon,
• 1:55
  possibly within the the next year or two.
• 1:58
  And, I will be that will be under
• 2:00
  my book of work as well. So we'll
• 2:02
  be hiring
• 2:03
  a magnet program director,
• 2:05
  and
• 2:06
  I'll be working on our entire magnet journey
• 2:09
  alongside
• 2:10
  whoever is chosen for that for that role.
• 2:13
  Yeah. Thanks, Frankie. Well, congrats on on almost
• 2:16
  a year here.
• 2:17
  I I know you you oversee a lot,
• 2:19
  and I know you mentioned your role isn't
• 2:21
  siloed, and it certainly sounds that way. And
• 2:24
  I know magnet designation is is no small
• 2:26
  feat. There's so much work that that goes
• 2:28
  into
• 2:29
  applying for those and achieving that that designee.
• 2:32
  So thank you for sharing that helpful context.
• 2:36
  Frankie, I know you you mentioned you are
• 2:38
  coming up on a year. So what was
• 2:40
  maybe the most important initiative you've led since
• 2:43
  you've joined?
• 2:44
  What what was it, and what were some
• 2:45
  of the results?
• 2:47
  Sure.
• 2:48
  So
• 2:50
  for me, I guess, I have worked night
• 2:52
  shift for a lot of my nursing career.
• 2:54
  I've worked night shift many years as a
• 2:56
  clinical bedside nurse
• 2:58
  and then also
• 2:59
  when I have held roles in nursing administration
• 3:02
  as an assistant director
• 3:04
  for nursing or nursing administrator
• 3:06
  where I covered the hospital on the night
• 3:08
  shift. And since that team reports up through
• 3:11
  me,
• 3:12
  I noticed that there were some areas of
• 3:14
  opportunity that we could really work on improving
• 3:18
  and streamlining communication
• 3:20
  between
• 3:21
  the different departments on the night shift. So,
• 3:24
  you know, after really kind of learning the
• 3:26
  ways of the land here at Maimonides and
• 3:28
  understanding where there were areas of growth, I
• 3:32
  realized that there was opportunity to implement
• 3:35
  a night shift safety huddle.
• 3:37
  So there was already a safety huddle in
• 3:39
  place for the day shift,
• 3:41
  and that takes place every morning with all
• 3:43
  the the department leadership
• 3:45
  from all the different disciplines,
• 3:47
  ancillary departments,
• 3:48
  nursing, physicians.
• 3:50
  And, you know, the whole point
• 3:52
  of that safety huddle is to escalate any
• 3:55
  concerns that might need to be addressed immediately
• 3:58
  throughout that day to make sure that there
• 4:00
  are safety measures in place and to make
• 4:02
  sure that things that are, you know, barriers
• 4:05
  or challenges
• 4:06
  are taken care of and remediated as expeditiously
• 4:09
  as possible.
• 4:10
  So we were missing that on the night
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  shift. So when I spoke with our CNO,
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  he was 100%
• 4:16
  behind
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  initiating the same type of Huddl and mirror
• 4:20
  mirroring that for the night shift. So I
• 4:22
  think that's one of the initiatives that I'm
• 4:24
  most proud of is bringing that sort of
• 4:27
  communication platform
• 4:29
  to the night shift so that we have
• 4:31
  a similar type of structure and process in
• 4:34
  place
• 4:34
  where the interdisciplinary teams can come together,
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  the nursing teams, you know, nursing leaders who
• 4:41
  work at night
• 4:42
  as well as engineering and environmental services and
• 4:46
  biomed,
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  where they can come together and report out
• 4:49
  on their areas any barriers or challenges they
• 4:52
  might be experiencing
• 4:53
  that are gonna impact patient care or patient
• 4:55
  flow or or operations.
• 4:58
  So, you know, from that, I think there
• 5:00
  has been better engagement from the night shift,
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  and
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  I think the night shift have
• 5:06
  appreciated the better communication
• 5:08
  coming from those different departments because sometimes,
• 5:10
  you know, as a night shift a former
• 5:12
  night shift nurse myself,
• 5:14
  sometimes night shift can feel left out. And
• 5:16
  so I think this 09:30PM
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  Huddl brings people together,
• 5:21
  establishes
• 5:22
  relationships,
• 5:23
  which is really important for the night shift
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  when there are less people around. You wanna
• 5:27
  know the people who are there and the
• 5:29
  players that are gonna be able to help
• 5:31
  you out in the different departments.
• 5:32
  So I think I've seen a lot of
• 5:34
  success and heard anecdotally from the nursing administrative
• 5:37
  directors who cover the night shift as nurse
• 5:40
  leaders as well as the different team members
• 5:42
  who are part of the Huddl that this
• 5:44
  new platform
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  has helped to streamline communication,
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  to enhance,
• 5:49
  you know, throughput, and to just bring awareness
• 5:52
  to the current state of affairs of things
• 5:54
  happening on the night shift that are possibly
• 5:57
  gonna impact
• 5:58
  the the the workflows for the staff. So
• 6:01
  it's been really successful, and we are gonna
• 6:04
  continue that. It happens on the weekends as
• 6:06
  well on Saturday and Sunday morning and night.
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  So there's continuity
• 6:11
  of communication
• 6:12
  throughout all shifts. And I think that's really
• 6:15
  you know, as we know in health care,
• 6:17
  most errors are
• 6:19
  caused by lack of communication or miscommunication.
• 6:22
  So in this case, this platform has
• 6:25
  served to,
• 6:27
  you know, really try to enhance
• 6:29
  the dialogue between teams. So I'm really proud
• 6:31
  of it, and, looking forward to its continued
• 6:34
  success as we continue on.
• 6:36
  Yeah. Frank, you, what a great initiative. I
• 6:38
  mean, see safety held, I know, are so
• 6:40
  important. So it's great to hear that they've
• 6:42
  been in place on night shift too and
• 6:44
  that it is improving engagement
• 6:46
  among the night shift staff, and I imagine
• 6:48
  just
• 6:49
  improving overall, like,
• 6:53
  communication in terms of shift changes. I know
• 6:55
  that's another area of
• 6:57
  concern, and that can be a challenge. So
• 6:58
  I imagine being able to just have that
• 7:00
  space and time to talk through
• 7:03
  what's happening, have more awareness on challenges that
• 7:05
  might need to be addressed just trickles into
• 7:08
  the whole rest of the
• 7:10
  shift and the following people who are gonna
• 7:13
  be coming in and taking over after those
• 7:15
  shifts too.
• 7:17
  Absolutely.
• 7:18
  And even anything happening, oh, we're gonna have
• 7:21
  be shutting down the tube station, you know,
• 7:23
  at this time or during this day. Just
• 7:25
  those types of informational things are important for
• 7:28
  the night shift, so they also feel connected
• 7:30
  and they know what's happening.
• 7:31
  Yeah. Definitely has a big impact on continuity.
• 7:34
  Well, Frankie, looking ahead, what is maybe a
• 7:37
  big priority or a headwind that you're encountering
• 7:41
  or planning expecting to encounter this year?
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  So for for us,
• 7:48
  for for nursing,
• 7:50
  one area that we're doing really well on
• 7:52
  is nurse retention. You know, as a nurse
• 7:53
  leader, there's these buckets that you're always focused
• 7:56
  on.
• 7:57
  One of them is always staffing to make
• 7:59
  sure that we have the right staff in
• 8:01
  place to serve the needs of our community.
• 8:03
  You know, at Maimonides, we are outperforming
• 8:07
  the nation in terms of nurse retention, and
• 8:09
  we're doing really well with that, which is
• 8:10
  phenomenal.
• 8:11
  And we're really excited and proud of that
• 8:13
  as well. So that's one thing that we
• 8:15
  don't need to focus on as much. You
• 8:18
  know, we
• 8:19
  are, of course, working on always improving nurse
• 8:21
  engagement,
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  and that's one of the areas that I
• 8:24
  always like to focus on. And that includes
• 8:27
  just for all shifts, so day and night
• 8:29
  shift. And and, again, not to be
• 8:32
  I'm not biased, but as a former night
• 8:35
  shift nurse, you know, I I do recognize
• 8:37
  the challenges of some night shift staff feeling
• 8:40
  disconnected.
• 8:41
  So I do prioritize making sure
• 8:44
  that the night shift do feel like they
• 8:46
  are part of the team and that they
• 8:47
  are feeling valued and seen and appreciated in
• 8:50
  addition to the day shift. So engagement is
• 8:52
  definitely one of the areas I'm gonna be
• 8:56
  focusing on for this next year. And, again,
• 8:58
  it's gonna be focusing on all areas and
• 9:01
  departments within nursing, including night shift. So, for
• 9:04
  example, we had a Valentine's Day nighttime celebration,
• 9:08
  last week with, cookies and karaoke, which was
• 9:11
  super fun, and it was a huge turnout.
• 9:14
  And it was just really great to see
• 9:16
  the night shift show up and show out
• 9:18
  and really have a good time. And that's
• 9:21
  an area that I wanna make sure I
• 9:23
  continue to look at because
• 9:25
  you need to bring joy into the workplace,
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  and health care is just such a dynamic
• 9:30
  and ever evolving and quite honestly challenging environment
• 9:34
  to work in. So without having those fun
• 9:37
  things incorporated, you know, it can become really
• 9:40
  burdensome. So,
• 9:42
  trying to encourage staff to get involved,
• 9:45
  to join our professional governance councils, to have
• 9:48
  their voices heard, to really increase nursing's sense
• 9:52
  of autonomy
• 9:53
  and engagement and belonging. And so that's one
• 9:56
  area that we're definitely gonna be looking at.
• 9:59
  The other area, of course, is nursing quality,
• 10:01
  and we continue
• 10:03
  to focus on the standard nursing quality metrics,
• 10:06
  our hospital acquired pressure injuries,
• 10:09
  our catheter associated UTIs,
• 10:12
  our central line associated bloodstream infections,
• 10:15
  and our patient falls. So we have really
• 10:17
  made
• 10:18
  wonderful strides in our quality metrics,
• 10:21
  but the work is never done, and it's
• 10:23
  always it's continuous process improvement.
• 10:26
  So we are gonna be continuing to focus
• 10:29
  on our quality goals as we continue on
• 10:32
  this,
• 10:33
  this new year
• 10:34
  and make sure that we are doing even
• 10:36
  better than we did last year, and there's
• 10:38
  always room for improvement. So, you know, making
• 10:41
  sure the nurses you know, we're gonna look
• 10:43
  at implementing champion models so that we have
• 10:45
  our falls champions and we have our CLABSI
• 10:48
  champions and make sure that the nurses
• 10:50
  are feeling empowered and, also engaged
• 10:54
  in the work that they're doing to prevent
• 10:57
  hospital acquired infections.
• 10:59
  And then the third area that I would
• 11:00
  say we're really gonna be looking at is
• 11:02
  our patient experience.
• 11:04
  So we, you know, we are doing pretty
• 11:06
  well with patient experience metrics
• 11:08
  in relation to the Brooklyn hospitals,
• 11:11
  but we wanna make sure that we're still
• 11:13
  striving to improve.
• 11:14
  So with that, we're gonna be looking at
• 11:17
  enhancing nurse leader rounding
• 11:19
  on both the day shift and the night
• 11:21
  shift, which we're hoping will identify
• 11:24
  barriers or things that are
• 11:27
  impacting patient satisfaction
• 11:29
  early in their stay so we can remedy
• 11:31
  those and take care of them immediately
• 11:34
  and prevent that from showing up on the
• 11:37
  survey at the end when they're discharged and
• 11:38
  it's too late to intervene.
• 11:40
  So, you know, I think those are the
• 11:42
  three buckets that we're definitely gonna be putting
• 11:45
  a lot of our energy towards to improve
• 11:47
  our patients'
• 11:49
  happiness and satisfaction with our hospital experience
• 11:52
  as well as their their quality outcomes.
• 11:55
  Yeah. Frankie, three really important areas. And I
• 11:58
  think what you mentioned about nurse engagement,
• 12:01
  it's interesting because it feels like that piece
• 12:04
  really runs through all the rest. Like, being
• 12:06
  able to, you know, move the needle on
• 12:08
  patient experience and quality all really kind of
• 12:11
  bolts back to to nurse engagement in the
• 12:13
  first place. So I thought that that was
• 12:14
  just interesting.
• 12:16
  And I know
• 12:17
  nurse engagement and just participation on committees and
• 12:21
  governance councils can can be a challenge in
• 12:23
  certain areas, especially
• 12:24
  when it comes to night nurses too and,
• 12:27
  hospitals and health systems kind of looking at
• 12:29
  different
• 12:30
  ways to to structure things and give folks
• 12:33
  more flexibility to participate in some of these
• 12:35
  things. So I was curious if you could
• 12:38
  follow-up on that just in terms of
• 12:40
  are you looking at any
• 12:42
  specific ways
• 12:43
  to get night nurses more involved on certain
• 12:46
  things, especially,
• 12:47
  you know, governance
• 12:49
  councils?
• 12:50
  Oh, absolutely. Yeah. So, you know, we do
• 12:52
  have some nurse leaders who are in charge
• 12:55
  of the professional governance councils, and there are
• 12:57
  two that are in charge of the night
• 12:59
  shift council specifically.
• 13:00
  And they hold them via Webex
• 13:03
  to allow
• 13:04
  staff to log in from home, or if
• 13:07
  they're on the unit, they can log in
• 13:08
  from the unit. So trying to offer
• 13:12
  that that hybrid, you know, in person Webex
• 13:15
  platform,
• 13:17
  really
• 13:18
  enhances participation
• 13:20
  because people can either log in and listen
• 13:22
  passively,
• 13:23
  or they can log in and be active
• 13:25
  participants
• 13:26
  either from, you know, the nurses' station or
• 13:29
  from home. So that was one of the
• 13:32
  suggestions from the night from the night shift
• 13:34
  staff themselves
• 13:35
  to allow
• 13:36
  the Webex option so that people would attend
• 13:39
  if they wanted to and if they happen
• 13:41
  to not be working that
• 13:42
  night. And, also just offering people opportunity to
• 13:47
  to join these meetings if it's extra time.
• 13:49
  So, you know, maybe they can book a
• 13:52
  shift, and they'll work the night shift. But
• 13:55
  if the council is meeting, maybe they'll be
• 13:57
  nonproductive, and they'll be part of the meeting.
• 13:59
  And then the rest of their shift, they
• 14:00
  can help do chart audits, or they can
• 14:02
  do chart reviews and
• 14:05
  do some teaching to their colleagues or things
• 14:07
  of that nature. So trying to be flexible
• 14:10
  and creative in the way that
• 14:12
  we schedule our staff so that we do
• 14:15
  have maximum participation,
• 14:17
  for the for the night shift specifically,
• 14:19
  but the same applies for the day shift.
• 14:21
  So if people wanna come in for the
• 14:22
  day shift on days when we have meetings,
• 14:25
  they can participate in whatever councils they are
• 14:28
  a part of, and then they can do
• 14:30
  ad hoc things like chart reviews or, you
• 14:32
  know, patient rounding or whatever creative ideas our
• 14:36
  nurse leaders can come up with to make
• 14:38
  them be,
• 14:39
  active part of the team for that day
• 14:41
  and not necessarily taking a patient assignment so
• 14:43
  that they're able to focus on the meetings
• 14:45
  and really be part of the
• 14:48
  their the voice that they're wanting to share
• 14:50
  for those council meetings as well as be
• 14:52
  helpful to their teams at large.
• 14:55
  Yeah. Sure. That's great. Thanks, Frankie.
• 14:58
  Well, I wanted to ask you too just
• 14:59
  about something we've been following a lot of
• 15:02
  in the news, which is
• 15:04
  the lapse of ACA
• 15:05
  premium tax credits
• 15:07
  and looming cuts to Medicaid with both of
• 15:10
  those, and be hearing from a lot of
• 15:12
  hospital leaders about how they're anticipating a rise
• 15:14
  in uninsured patients and potentially more strain on
• 15:18
  their emergency departments.
• 15:19
  So I was curious to hear from you
• 15:21
  on how MyEminities
• 15:23
  is preparing to care for a spike in
• 15:25
  uninsured and underinsured patients from a clinical or
• 15:28
  operational standpoint.
• 15:30
  Sure. So, yeah, that's definitely
• 15:32
  a challenge that we're all bracing for.
• 15:35
  And,
• 15:37
  a lot of the work that we're
• 15:39
  that we're doing is really focused on throughput.
• 15:42
  So we know that, you know, with more
• 15:44
  uninsured
• 15:45
  patients, they're usually gonna delay coming to the
• 15:47
  hospital for as long as they possibly can.
• 15:50
  Unfortunately, that means when they get to the
• 15:52
  hospital, if they really need to get seen
• 15:54
  and treated, they're probably gonna arrive sicker, and
• 15:57
  they're probably gonna require admission. Right? So there's
• 16:00
  a few things that we're working on that
• 16:01
  we've been doing to try to enhance throughput.
• 16:05
  Our ED is already busy as it is,
• 16:07
  and, you know, we just survived the strike,
• 16:10
  obviously, as you're aware of in New York
• 16:12
  City. We were expecting to get some overflow
• 16:15
  of patients from other hospitals locally.
• 16:17
  However, that did not really impact our operations
• 16:20
  too much,
• 16:21
  but we did just have a really tough
• 16:23
  flu season. So we did just have extreme
• 16:27
  surges in patient volume in the EV that
• 16:29
  we're still navigating actively.
• 16:31
  But part of our book of work in
• 16:33
  addressing EV volumes, which, again, we're gonna probably
• 16:36
  see increased due to
• 16:39
  more uninsured patients
• 16:40
  or and, you know, it's it's really we're
• 16:42
  gonna be working on getting patients out of
• 16:44
  the hospital
• 16:45
  as soon as possible
• 16:47
  when it's safe,
• 16:48
  and to make sure that they were continuing
• 16:50
  their care outside so that they don't get
• 16:52
  readmitted. So if we can get patients out
• 16:54
  of a hospital sooner who don't need to
• 16:57
  be here any longer, then we can get
• 16:58
  those patients up from the ED to those
• 17:01
  beds.
• 17:02
  And then if we can keep those patients
• 17:03
  who've been discharged out of the hospital and
• 17:05
  keep them safe at home, then, of course,
• 17:08
  we're hopefully not gonna see them be readmitted,
• 17:10
  and then that should hopefully,
• 17:13
  you know, reduce our ED volumes ultimately in
• 17:16
  the long run.
• 17:17
  So we do have tasks for us on
• 17:19
  length of stay.
• 17:21
  I personally am part of a nursing strategic,
• 17:24
  group work group related to length of stay
• 17:26
  with one of my other VPs of cardiology,
• 17:29
  And so we are implementing
• 17:31
  some nurse driven checklists
• 17:33
  to be able to,
• 17:35
  enhance our awareness of what are the outstanding
• 17:39
  or pending
• 17:40
  things needed for someone to be discharged So
• 17:43
  that our bed expediters and I'm not sure
• 17:45
  if you're familiar with that term, but we
• 17:47
  have,
• 17:48
  bed expediters for each division, and they're pretty
• 17:50
  much in charge of rounding on all the
• 17:52
  units within their area
• 17:54
  to see who's planned for discharge and to
• 17:56
  try to make sure that they get all
• 17:58
  of their milestones checked off so they can
• 18:01
  actually be discharged for that day. So we're
• 18:03
  gonna be working with them to implement a
• 18:05
  new
• 18:06
  nurse driven checklist that they will be in
• 18:09
  charge of, and that will have all of
• 18:11
  the elements that are required for discharge,
• 18:14
  and they'll be able to check off for
• 18:16
  most patients who are leaving that day and
• 18:18
  engage with teams who
• 18:21
  need to
• 18:22
  be escalated to. So if they're pending an
• 18:24
  X-ray before discharge or if they're pending an
• 18:26
  echo, like, they'll be able to escalate to
• 18:28
  those areas to get that done so we
• 18:30
  can really streamline the discharge process.
• 18:33
  So there's a lot of nursing related work
• 18:35
  being done to improve earlier discharges. You know,
• 18:38
  our our industry standard is discharged before noon.
• 18:42
  We do decently well with that, but I
• 18:44
  think with our new nursing,
• 18:47
  strategic initiatives, we're gonna be seeing more DBNs
• 18:51
  as they are abbreviated,
• 18:52
  and then that will hopefully help throughput from
• 18:54
  the ED.
• 18:55
  And then on the
• 18:57
  other end of it, we are partnering with
• 19:00
  outside organizations.
• 19:01
  One of them is called MyLaurel,
• 19:03
  and they are helpful in
• 19:06
  they do follow-up care. So when the patients
• 19:08
  are discharged,
• 19:09
  this company, you know, has a nurse follow
• 19:11
  them at home
• 19:13
  and ensure that the patients are, you know,
• 19:16
  asymptomatic
• 19:16
  or taking their medications,
• 19:18
  complying with their treatment regimens,
• 19:21
  and the goal
• 19:22
  for them is to prevent readmission.
• 19:24
  And that, again, trickles back to us to
• 19:26
  prevent unnecessary ED visits, which will hopefully
• 19:30
  allow there to be more space for the
• 19:32
  increased volume of patients that we might see
• 19:34
  due to the higher,
• 19:36
  rates of uninsured patients in the community. So
• 19:38
  I think those are some of the initiatives
• 19:40
  that we're working.
• 19:42
  Yeah. No. Definitely. It sounds like if anything,
• 19:45
  you know, any additional
• 19:47
  ED strain,
• 19:48
  that comes through, you know, potentially more patients
• 19:51
  is just has really elevated
• 19:53
  length of stay work and and up throughput
• 19:55
  operational efficiency work. So it's interesting to hear
• 19:58
  logistics of how all of that connects.
• 20:02
  Yeah. And there's just one more thing that
• 20:03
  I do wanna mention regarding our staff.
• 20:06
  So I think, you know,
• 20:07
  again, with uninsured patients who might be coming
• 20:10
  to the hospital late, who might be getting
• 20:12
  diagnosed with illnesses that they may have been
• 20:15
  ignoring for some time, there's a chance that
• 20:17
  we are we're gonna be seeing sicker patients
• 20:19
  and with that, more complex
• 20:22
  needs.
• 20:23
  And so for our staff, we need to
• 20:25
  make sure that they are prepared
• 20:26
  for the potential of you know, there's always
• 20:28
  the
• 20:29
  the possibility of moral distress. So when we
• 20:31
  feel like
• 20:32
  we have patients that we're we really wanna
• 20:35
  help and get what they need, but there
• 20:37
  are systemic
• 20:39
  barriers related to insurance or placement issues
• 20:43
  or or social determinants of health and things
• 20:45
  of that nature. Our staff can sometimes feel
• 20:47
  a little bit defeated. So I think one
• 20:49
  of our other areas we can't forget about
• 20:51
  is our workforce and making sure that they're
• 20:54
  prepared for, you know, compassion fatigue and for
• 20:58
  the feeling that maybe they're they're not seeing
• 21:01
  the outcomes that they would like to see
• 21:03
  for all of their patients
• 21:05
  and making sure we have really good debriefing
• 21:08
  structures set up. So if there's a difficult
• 21:10
  case in the hospital where maybe ethics is
• 21:12
  involved, that we have that platform available for
• 21:15
  the staff to come together and debrief and
• 21:17
  talk about their feelings. We do have team
• 21:19
  Lavender here, which is a phenomenal support
• 21:23
  structure that's led by our HR department.
• 21:26
  And, you know, we actually just called one
• 21:28
  yesterday
• 21:29
  for our staff that went through a challenging
• 21:31
  patient situation.
• 21:33
  So I think I I would be remiss
• 21:35
  if I didn't also say that one of
• 21:37
  our areas of focus will be on our
• 21:39
  on our nursing staff and our frontline staff
• 21:41
  to make sure that they are prepared for
• 21:43
  the challenges that might be coming down the
• 21:44
  pike.
• 21:46
  Yeah. No. Such an important to point to,
• 21:48
  especially as with the potential for seeing patients
• 21:50
  who are higher acuity coming in. Well, Frankie,
• 21:53
  thank you so much for your time today.
• 21:55
  It was a pleasure to connect and hear
• 21:57
  about some of the work you're leading at
• 21:58
  My Monites.