The Year of the Nurse & the Importance of Nursing Innovation

Podcast Transcript

Will Morris, MD:  Good afternoon. This is will Morris with me is my cohost Akhil Saklecha. And today we have a tremendous panel. We have Dr. Kelly Hancock, who is the newly appointed Chief Caregiver Officer and joined with her is Dr. Nancy Albert, who is the Associate Chief Nursing Officer and Head of Nursing Research and Innovation. Kelly and Nancy, thank you so much for joining us today.

Kelly Hancock, DNP, RN:  Thank you for allowing us to be here.

Akhil Saklecha, MD:  So we'd love to start out with some brief introductions of both of you. You guys both have such tremendous backgrounds and it would be nice to hear maybe from you first Kelly, and then you Nancy a bit about yourself and specifically what you're doing now.

Kelly:  Sure. So I'll start. Again, this is Kelly Hancock. So I've been in our organization for the last 27 years. I've been the system Chief Nursing Officer for Cleveland Clinic since 2012. And then as of last week, as already mentioned I've nearly been appointed to the first ever position of its kind at the Cleveland Clinic named the Chief Caregiver Officer. So this position was created in mind to create an alignment really of all aspects of caregiver engagement in our organization with a specific focus on enhancing the unique team-based culture that Cleveland Clinic is known for. So this role, in fact, this office will serve as a unified approach to all of our caregiver and our workforce needs. So it's a thrilling opportunity for me and for organization to build on the great work of our culture and move it forward.

Akhil:  Thank you and Nancy.

Nancy Albert, RN, PhD:  Thanks. I’m Nancy Albert and as already mentioned, I'm the Associate Chief for Nursing Research and Innovation. I've been with the Cleveland Clinic for 30 years and in my role since 2004, and in my role it is to assure that we have the infrastructure and the resources that match a culture of inquiry, which has which Cleveland Clinic has been well known for. And also an innovation culture that are both so very important in any profession. From a nursing standpoint, we know that nurses need to identify problems and issues. Certainly we need to ask questions and we need to verbalize ideas. Nurses also need support and guidance to navigate our complex healthcare systems and in research our ethics and compliance rules that protect human subjects. We know we have many opportunities to build capacity for a better tomorrow in healthcare. And we have a lot of nursing caregivers who can help foster new knowledge and bring innovative ideas to life. So in the office that I am over the goal is to work with all caregivers throughout the system and to really help bring innovative ideas forward.

Will:  Well, first of all, what's remarkable 27 years and 30 years. Akhil has been here for the equivalent of, I think maybe five minutes. So I'll, I'll, I'll steal the first question. You know, Kelly, I think, you know, you know, given your long years kind of over 11,000 nurses and now 66 plus thousand caregivers, tell us how you kind of approach that. I mean that, that's such a mind boggling number and, you know, you know, what a tremendous recognition for you. But at the same time I would love to kind of pick your brain and kind of, how are you thinking about this new, exciting challenge and chapter?

Kelly:  You know, I come with a nice foundation from a systemized approach from nursing. So of those 68,000 caregivers, 29,000 of which are nursing caregivers. And with the idea of having one Cleveland Clinic, I think that the Nursing Institute really embodies that given all the work and the structure that we have done. So I imagine that this office is really taking some of those experiences and learnings that we've had from really evolving and developing the Nursing Institute and apply where appropriate to the entire organization. And so I'm really looking forward to, you know, working with so many of our colleagues across the system. More importantly, getting feedback from our caregivers on how we could make this the best place, not only to deliver healthcare, but also to work in healthcare.

Akhil:  So, Kelly, maybe more specifically, I'm, I'm curious as to whether the employees that you're looking for, do they dictate the culture that we have or is it the culture that dictates the type of employee.

Kelly:  So, I think it’s a hybrid. I think obviously our organization is founded on, you know, the mission of our organization, which is true today. And I think all of the work that we've done to date has really been on the shoulders of many giants. And so moving forward, we need to continue to build on that great work, as well as continue to get the feedback from our caregivers. As you both know, we recently concluded our caregiver pulse survey to have a better understanding from our caregivers in particular, how we supported them as an organization during this pandemic, but really there's also overall questions in there to get their feedback about how do they feel about working at the Cleveland Clinic and annually as we do this, as you know, we take that feedback and we look to see where there's, what's working well and how we can continue to improve and build on that culture. So I really do believe that the hybrid approach with many solutions to help support that.

Will:  Yeah. And I think that the reality of, of being in healthcare, we have to evolve and change. And so most roles in the evolution of what we'd say is, you know, human resources or talent management. And certainly, you know, you pinpointed this concept of teamwork and collaboration. What's the role of, of innovation or just the idea of ideation? And you know, what I like to say is being, you know, perpetually dissatisfied with the status quo, right? We can always do better. How do you, how do you impact, you know, 68,000 employees to kind of get that esprit de corps?

Kelly:  Well, that's a great question. I think when you think about, you know, and I'll use a recent example, you know, during this pandemic here our caregivers continually, you know, thought about ways to be innovative and creative, as you know, and from a nursing standpoint, one of the things that they did was create ways to care for patients while also being mindful of our PPE use. And I know Nancy will go into it, but one of our advanced practice nurses developed a medical device allowed for that less donning and doffing of our PPE. And we shared that example in a recent conversation with Dr. Mihaljevic, our president and CEO, and it was shared, you know, via the entire health system and sharing those types of ideas that happens to be a nursing example with the rest of our caregivers. I mean, makes them think that, you know, I can do that too. My voice can be heard. I have an idea of how to problem solve. I could, you know, utilize that to make this a better practice and deliver care and to continue to tell those stories. I mean, Nancy, would you agree with me?

Nancy:  Yes. I agree completely. I think that, you know, we have a lot of employees and I think my philosophy is that every employee that works at Cleveland Clinic, no matter what roles are in, has ideas, has ideas about how to make their job easier, how to make their job quicker, how to be more efficient, how to get better outcomes. And oftentimes they're afraid to mention it to others. What we've done in Cleveland Clinic is set up systems and processes to encourage people, to bring their voice forward. And then once they do bring their voice forward, we don't, we, we take it, we help them out. We, you know, hold their hand and drag them along. And, and they're passionate about their idea, but they don't always know what the resources are to bring it forward, taking the next step in not being fearful of raising it up for being afraid, somebody's going to think it's silly or, you know, or they won't like it. But, but being, being willing to take those next steps can really make a difference.

Akhil:  You know Nancy, I think you're, you're spot on it. It, it reminds me of a, of something that once happened to me. It's funny because I relayed this to my friends and family. I'm an ER doctor and one of the hallmarks are that we are nothing without our nurses and I, I was on a plane. There was a, there was an emergency there and, and you quickly realize that you really need your partner nurse to help. And it's a team effort that we have in the ER, is so important. And when I, when I look at innovation I'm curious as to how you cultivate that culture of innovation and how you, you know, you mentioned getting them to be comfortable in speaking up and feeling that their ideas are important. I see it a lot in the ER, where I, where I'm familiar, but how do you get them to actually be comfortable and think and ideate and think about innovation as opposed to the normal work that everyone does?

Nancy:  Right. Well, from my perspective, I do believe it starts at the top. And from the, from the top of the nursing perspective, you know, Kelly has been a firm supporter in in the innovation process, understanding that it takes time, it takes effort, it takes resources and it takes her talking the talk and facilitating innovation knowledge and information to all of the employees within the nursing Institute. So that culture is really, really important. So at least for, I'll give you an example of managers. We all know that managers are in a wonderfully awkward spot sometimes where they're so extremely busy, they're dealing with all of the clinical work of their unit or work area. And then they're dealing with all of the stuff that comes at them from higher leadership. So they're kind of in the middle of every scenario. And if somebody presents to them an idea, they may not know where to go with it, what to do with it, how to deal with it. And they may be thinking in the back of their mind, I don't even have time to figure this out for my nurse or my employee. So by having a culture of innovation, we're able to put those resources in place. So now managers or whomever the leader is can say, go talk to Nancy's team, or this is what you need to do. And it takes them, it gives them relief and it also helps their employees be more satisfied with their job because they know somebody's listening and somebody's giving them direction about what to do with what the next steps are.

Kelly:  Now, along those lines, too, you know, just to build on Nancy's comments. I totally agree, you know, to, to have a culture of innovation or to foster that culture. And to keep that, when I think at the, of my new role, in the broader perspective, it's also about creating a culture that's inclusive, right? So as Nancy mentioned, it's important to listen. And if you think about our work here at the Clinic, I think it's really, it should be a priority for all of us when we come to work every day to feel and be safe to our true self, right. And that means that people should be free to speak up because we know that people have diversity of thoughts and opinions, and we know that diversity fuels innovation. So I think, you know, we're so fortunate that we have so many different caregivers in our, our organization and so many different backgrounds and viewpoints that meet our patient's unique healthcare needs and challenges. And I think we need to be open to new ideas. We need to listen to one another. We need to respect value and celebrate when these people have these ideas or caregivers, because we know that each one of them can have an opportunity to make a positive impact. It doesn't have to be the latest and greatest medical device that's going to make that impact. It could be a simple solution. It should be really incorporated in every facet of what we do each and every day in our organization.

Will:  I could not, I mean, listening to this gets me so excited cause you know, what I'm hearing is it's, it's way, way beyond just supporting innovation. You've really kind of created a culture of psychological safety. The right thing might be a better process, a workflow, a device, or a safety issue. And, and I think, you know, while we titled this podcast, you know, really a celebration of, of caregiver innovation, it really is you know, to me, a celebration of, of kind of caregiver, empowerment and support. And, and, and I love you know, how, how both of you kind of articulated, you know, your vision and how you've kind of cultivated that, that culture. We need that.

Kelly:  And I think we do. And then I think as healthcare continues to, you know, change and transform, we know that's a team sport. We know that each and every one of us, every team member needs to think differently and be able to be agile. Perhaps we need to move into new roles, care delivery models. We just need to think differently about how we can impact here. And that will come with innovation and inclusiveness and creating that culture that we want all our caregivers to excel in.

Akhil:  So I have a question I it's more around say idea generation. Do you find that the problem they're facing and they're solving it, or, or do you find that there's some, there, there might be a different way that that might be going on, which is more around structure, which is they run into the problem over and over and over. And they, they, they try to fix that ongoing problem. And they find that it's, it's something that is meaningful and bugging them consistently versus more of a eureka moment.

Nancy:  I really think it's both. So you know, ideas come from everywhere and in some cases it may be they're driving home and they're getting the 2020 perspective of what happened that day. And they go, why didn't I do this? Or how could I have done this better? Or why didn't I think of this while I was at work? And whenever that keeps happening perpetually, then hopefully they come forward and say, okay, I've got an idea. But oftentimes I think nurses are trying to just make something better and they may come up with that eureka moment as well and say, let's try this. And if they really are passionate about whatever this is, then they bring it forward to us and we help them to navigate it and cultivate it in a way that it really does answer the question they have or fix this problem they have. And it does it in a way that's feasible practical and has value. And so I think really there's so many different reasons why innovation moves forward. We have other people who will attend a creativity session and they'll literally walk in and say, I don't know why I'm here. My boss told me to come and before the end of the three-hour session or four-hour session, they're the ones going, Oh my God, this was the best day I've had in a long time. This was so much fun. And I got to use my brain power in a different way. So I think there's a lot of different ways that ideas move forward.

Kelly:  I agree.

Will:  So, so it sounds like, yeah, no, that's fascinating Nancy, cause it sounds like the output isn't necessarily just the solution, but it actually just might be the experience itself, which engenders engagement, satisfaction, and, you know you know, Kelly, you'd mentioned that the Press Ganey at the end of the day, if people feel like their voice matters and they feel you know, included in a culture of inclusiveness that is value in and of itself.

Nancy:  Yeah. I can tell you, we have a nurse at South Point, one of our smaller hospitals, who has submitted at least, Oh, I want to say nine invention disclosure forms. So she's gone through the process. None of them have made it to fruition yet, but she keeps trying. She just submitted another one to us last week that we, we submitted on where to CC Innovations Office. And I think it's important for her to know that we're listening and that, you know, if she keeps trying, we're going to hit that magic ticket at some point. But she's very engaged and she's very creative in her thinking. And we have been fostering that all this time.

Kelly:  I think when you think about, you know, particularly as working in healthcare today and you think about no matter what you do, you know, how many robots did you face during your shift or during the last week? And you think about from a caregiver perspective, what were they? And I think that critical creative thinking that we do to work through them is I think our innovation instinct coming through just like that nurse Nancy described. And I think often without people knowing it, it marks the first steps and really bringing innovation to life.

Nancy:  I was going to say, the other really cool thing about innovation is often we work collaboratively with others or maybe an engineer involved or a nutritionist involved or a pharmacy involved. And so you're getting the collective wisdom of many people and it's so much fun to build on somebody's idea in a way that's going to bring new importance to it. And so maybe that somebody comes up with the idea, but then all of the feedback you get around, you really helps to hone it in a way that you may not have thought about it initially, but it makes it better. It makes it more valuable. And not only does that nurse or the person who started the idea process see the value of that collaborative process going on. But the end result is they are very proud of what comes out of it.

Will:  The process and the journey, as well as the destination that that's important. I wonder if you could reflect on, on kind of HighLine you know, while it's an amazing solution. What I think is more amazing is actually the story. And I think our listeners would love to kind of hear the story. Cause you mentioned perseverance. This wasn't just an idea or a technology that was invented for COVID my understanding it was before COVID and help us walk, walk through that story. Cause I think it's really worthy of hearing.

Nancy:  Okay. So this is a really an interesting story that Jane has. So our inventor is a pediatric advanced practice nurse and you know, she's dealing with little people all day long, but they have long IV tubing because it turns out IV tubing is not size corrected. It's one size fits all. And so in her clinical practice, she's got pictures. I mean, she's, she's probably saved one hundred different pictures of kids walking in hallways, sitting on lawns, being in wagons. And the tubing is always on the floor. The parents are trying to hold it. Nurses are trying to hold it, it's getting caught in the IV pole wheel. So she came up with this great invention, which we named HighLine and it initially it was meant for two purposes, pediatric kids so they could ambulate and adults mainly in the cancer area because they are usually healthy otherwise, other than their chemotherapy going on at that movement and were hoping they could get up and move around and not have to be stuck in a chair or in a bed. And so we were going through the IRB to assess the value of the HighLine in those two patient populations when COVID hit. And one of our CNS nurses Myra noticed in general that we were trying to move our IV pumps outside the door to save on PPE and Jane’s, like I've got the solution and she literally ran to my office and said, Nancy, “we've got a solution to a big problem going on.” And the funny thing was I'm on some critical care medicine listservs because I'm a member of those organizations. And I was reading through the listservs people, trying to come up with solutions to keep IV tubing safe because it was dragging on the floor when it was, when we were using extensions in the ICU. And so I connected with Kelly connected with Cleveland Clinic Innovations. And I have to give Cleveland Clinic Innovations a ton of credit for helping really, for us to navigate the process of moving this forward and for actually helping us to prototype a better solution that we came up with initially, because in an ICU world, you don't just have one IV, you may have five or six or seven lines. And so we needed to morph the innovation in a way to make it important to our ICU colleagues. And then even to fast forward, just for a second here. So I got a call, the Head of Radiology says we need these down in our MRI area because there's no metal in them and they could use them in imaging. And so we'll find new ways to use this. So once COVID is over, I believe this is still going to be a very important innovation that just for our kids or, or patients we want to get up walking in the hallway. We already have found that the solution works well in the neonatal ICU as well for a completely different reason because of the height of the cribs and trying to get the IV tubing out of the cribs. So we're finding new solutions to that are finding out that this solution has new advantages for other populations as well.

Akhil:  It's a phenomenal story I think, and so applicable to what's going on, that faces us today. So, so Kelly, I have a question for you, which we touched upon this earlier. Nurses are our caregivers that interact the most with patients and they devote themselves the most of the patients. What does it mean to you that 2020 was named the year of the nurses?

Kelly:  Well, it means quite a bit. So as you know, the world health organization designated 2020 the year the nurse, and it was really to honor the 200th birthday of Florence Nightingale, who's the founder of modern nursing and also to celebrate all that nurses do. So, as I said before, you know, when this year started, had no idea what was ahead of us you know, but I'm delighted that, you know, and one of the reflections that I have particularly up until this point is particularly about our nurses here in Cleveland Clinic and really across the country are really, they, they’re rising to the challenge. You know, it's not over it. They've really demonstrated, demonstrated why they've chose nursing as a profession. And it's just really been remarkable for me, their commitment to continuing to deliver the safest, highest quality care, you know, the innovation that we just spoke of, but really the confidence that they have, many of us have gone out rounding in our different units and just have I continue to be inspired and have so much gratitude just for what they do each and every day in preparing for this pandemic. Another thing that has struck me is that luckily here in Northeast Ohio and in Florida, we did not see the number of hospitalized patients that was predicted. So, but as you know, in the meantime, we continue to prepare and get people ready for that surge of patients and people did so with grace and professionalism and floated outside their comfort zone. And one thing that struck me as well is that when we did not see those high number of patients hospitalized, our caregivers quickly answered a call that we put out this witnessing their, their tireless efforts to go out and care for patients and just, and care for their colleagues was just really a tremendous gift for me. And again, I just think it illustrates, you know, more now, more than ever, why 2020 is so important to be the year of the nurse.

Will:  Well, thank you so much, Kelly and Nancy. I mean it certainly while celebration of, of, of nursing and all of the amazing outcomes, it's a celebration of, of both your leadership and Kelly, you know, this new role is exciting. And actually, I think again, reflects the innovation culture at the Clinic and a natural evolution that at the end of the day, every caregiver has an opportunity to shape and impact the way we deliver care. And I hope, you know, Nancy, your esprit de corps and your enthusiasm that you have and the infrastructure that you have deployed throughout nursing also can then be extrapolated and extended to every caregiver. Because at the end of the day, you know, to me, innovation does not lie within a profession or a role, or it is agnostic. I just to humbly thank you both, you know, for your leadership. But also your partnership with this office. It is the team of teams and we would be, you know, without any you know, game-changing innovation and care delivery systems without your partnership and leadership. So on behalf of Akhil and myself, you know, we wish to say, thank you. We look forward to doing a future podcast potentially and hearing the year of the caregiver and really understanding how that expansive role could, could go. So I thank you Akhil, last words?

Akhil:  I think Will you said it all.

Will:   Typical. Oh, well, thank you both.

Kelly:  Thank you both. Thank you, Nancy.