Advanced Mobile Communications: A CNO Perspective

In this episode, we talk with Nat’e Guyton, Chief Nursing Officer (CNO) of Spok, a global leader in healthcare communications striving to improve care collaboration. Nat’e has a long resume of professional and academic accomplishments including a Doctor of Philosophy in Management, Organizational Leadership & Development, a Masters of Science in Nursing, and service as the Chief Clinical Informatics Officer at Trinity Health. As a nurse, a CNO, and a leading expert with a unique perspective healthcare, health IT & clinical communication technology, Nat’e takes us on whirlwind tour of the current landscape and exciting opportunities for the future.

Dr. Dave Levin: Welcome to 4 X 4 Health sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I am your host Dr. Dave Levin. Today I’m talking with Nat’e Guyton, Chief Nursing Officer at Spok. Nat’e is a nurse and clinical leader with over 15 years of healthcare experience. She joined, Spok after serving as the Chief Clinical Informatics Officer at the Trinity Health Mercy Health System where she directed information technology integrations, oversaw clinical workflow redesigns and served in multiple advisory roles throughout the system. Dr. Guyton has also served in a variety of health system leadership roles and as a certified critical care nurse with multiple degrees including Bachelor and Master of Science and Nursing, Postmaster certificates in healthcare administration and healthcare informatics and a Doctor of Philosophy and Management in Organizational Leadership and Development. This you can tell from this intro, she’s got both the academic credentials and the street cred that comes from practical application and real-world problem-solving. Welcome to 4 x 4 Health, Nat’e.

Nat’e Guyton, PdD: Thank you so much, Dave and you know, I love it. The street cred and the academic piece so and, and that’s what I’m out there doing, you know. Just really trying to be the voice of nursing or just bridge the connection between healthcare and IT with that particular focus on nursing. So, I appreciate that intro.

Dave: Well, and it’s true. I mean my own experiences that if you’re going to really get things done in life, you need some of both. You need the theory, but you need the practice too. Let’s just keep right on going here and take a few more minutes and tell us a little bit more about yourself and your organization, Nat’e.

Nat’e: Yeah so, I am proud to serve as the Chief Nurse Officer. Like you said, there’s different levels of years of experience. My background really, I love operations. You know, I love lean six sigma, I love workflows and design and really, I love innovation, right and bring a new and improved products to our patients and nurses and our nurse leaders. So, at Spok, we are the leader in clinical communication solution. So, that is a mouthful, right and so people say, well, what is it that you really do? So, we deliver clinical information, you know, so lab information, alerts and alarms to care teams, when and where it matters most. So, we’re very diverse and how we deliver that communication. So, when I say that, I mean we’re device agnostic but really our goal is to improve our patient outcomes. So, how do we do that, one, we enhance workflows for our clinicians, right. Getting that communication back to our doctors, our nurses, radiologists, lab technicians, pharmacists, right. We support administrative compliance, right, two, and again, provide a better experience for our patients. So, at Spok, we work with, you know, the EHRs, we’re kind of the extender of the EHRs, if you will and what we’d like to say, you know, we’ve kind of coined this phrase recently, we are the system of action. So, when we look at Ethic, you know, we look at Cerner and some of those other EHRs, they are here to stay, they serve a purpose and as clinicians, we become familiar with them, but we’ve also become familiar with them being the system of record, right, data collection. So, at Spok what we like to do as the extenders of communication, we take that information right, we distil it and we allow our clinicians to be actionable. We provide actionable information so they can get quick safe care to the patient.

Dave: Well, this theme of actual information I think has come up in almost every podcast in this series and I want to come back to that in a minute and I want to talk a little bit more about interrelationships between workflow and technology book but before we go there, you skipped over yourself a little bit in this introduction and I’m not surprised you’re a modest person but take a minute and tell us a little bit about your background, you’re kind of an unusual figure in our world and I think that’s interesting and important.

Nat’e: Yeah so, you know, really, I’ll go back to the beginning. You know, I was raised by my grandmother who was a unit clerk in a hospital for 40 years and so I used to go to the hospital after school and I said, you know, it has to be a better way, right and you know, I was young, I was 15, 16, 17, right out of high school. I went to nursing school, graduated in four years from Widener University and my background was really cardiac nursing and so I went into cardiac critical care. Then I worked at Temple University Hospital and my first leadership job, I was a clinical nurse specialist in the cardiac department, and I was there for nine months and they asked me to take over the unit from a nurse manager perspective. So, of course, you know, well we do, we move into the unit. I became a nurse manager and that was really my leadership journey. So, my first manager role was at Temple University Hospital, right, imagine that. You know, I am very young. I think I was maybe 24 years old. I’m a manager of a unit. You know, I had 70 direct reports and it was kind of trial by fire, but I learned how to work hard, right. I learned how to get the commitment of my team, I learned how to innovate, you know, sometimes you have to work without the right things, or the appropriate resources and you had to make things happen. Also learn operation strategy and how to really develop a team for success. So, that begin like I said, my management journey. I went from there to a director of operations and nursing then a chief nurse officer. Spent time in a Mercy Health Trinity Health System as a Chief Nurse Officer and about the time when meaningful use was really heating up, they asked me, you know, can you be the Chief Clinical Informatics Officer because what I had done is really look at some of our technology systems as a Chief Nurse Officer and improve them and again, in my role as the Chief Nurse Officer, I went back and I said, listen, I understand technology, it’s going to be the wave of the future. So, I went back to school and I got my Postmasters in Healthcare Technology, but little did I know it would become a career path for me. You know, I just thought, oh, okay, as a leader, I need to know what I’m talking about, right. I need to be able to walk and talk and walk the talk. So, I went back and got my postmasters in Healthcare Technology. I did some cool things within our system for our ED and charge capture and improving some of our technology systems there and then I moved into the Chief Clinical Informatics role. I was really a partner with our CIO and we kind of rolled out CPOE meaningful use, building a technology team, educating our physicians and nurses across the system. So, in two years, we went live with CPOE, we updated our platform and we achieve meaningful use across four hospitals.

Dave: That’s phenomenal and it’s like I said, you’ve got the academic credentials, but you’ve got the street cred here too and there’s a couple of things that jump out at me in this story. In some ways it’s a classic story for a lot of us in informatics, we started just practicing medicine. A few of us either stumbled into or aspired or were promoted into operational roles, leadership roles and then somewhere along the way we recognize boy, technologies are really key enabler here. This is a piece of the puzzle that I either want to understand more or I want to be playing in that sandbox as well. My own experiences, those leaders make some of the best leaders in innovation because they really do get the people process and the technology altogether.

Nat’e: Yes, and to your point Dave, I think what was also an advantage, knowing that you’re talking about the people knowing the organization, knowing the front-line staff, so I had developed a sense of trust, right and credibility where adoption was a little bit more, you know, it was no easier. When I was able to stand up there and educate them and be one of them and then also say, you know, rather we sink or swim, we’re going to do this together and I’ll make sure, you know, we’ll be able to utilize or leverage this technology to be doing better things for our patients. So, just having that again, when you can say that street cred, I think is very important and sometimes as nurses, we miss that because we’re looking to technology leaders in the organization to lead that.

Dave: Well and so, and this is the last point I wanted to make and connect back to some things you said earlier. It fascinated me that so much of your introduction, you talked about workflow and technology was kind of the last part of it. Now, I happen to think that’s exactly right, and the idea is you should know the problem you’re trying to solve and the capabilities you need and then you’re back into the technology requirements. It feels like to me very often organizations either skip that workflow process or it’s an afterthought. Tell me a little bit more about your thinking around that and then we’re gonna go deeper into the rest of your work.

Nat’e: Right. Well, it’s interesting, Dave. I have a Webinar that I’ve done and even a presentation that I’ve done at AONE as well and I’ll talk about mobility strategy for an example and so when we go out and we look at mobility and we think about, okay, what does that mean, that to us in a hospital setting, it means, okay, what kind of cell phone we’re going to give to the nurses or what kind of device we’ll give to the docs, right and in my communication, in my presentation, I’ll talk about seven components to a workflow mobility strategy and the last point is selecting the device. The first point is understanding the workflow of your doctor, of your nurse, of your respiratory therapist, anyone in your hospital that she wants to give a device to. You want to understand the workflow because understanding the workflow will give me context clues if you will to select the device that’s appropriate for that particular skill set, right or clinician but to your point, we do it backwards. We go and we have a device off is what I call it, right.

Dave: Yep, that’s right.

Nat’e: We put like 10 devices in a room and we ask the nurses and the doctors to look at them and test it and then we say, okay, we’re going to go with this device not knowing that after we spend millions of dollars on the device that it doesn’t have all the tools we need, right.

Dave: That’s right.

Nat’e: So, now we have to go and retrofit it and we’ve done that so many times with technology. So, understanding the roles and the workflows as it aligns to any technology, our primary and vital to success and adoption.

Dave: I think that’s right. I mean the best people I’ve worked with, the best projects I’ve been on, they always take a go slow to go fast approach. They slow down, let’s be really thoughtful about what we’re trying to accomplish here, how it is going to actually work and then we’ll get into the, if you will, the fun or sexier part about the devices and the rest of it. I’ve watched this play out Dave’s opinion, but I’ve watched this play out in population health, I think is a really good example. We saw this rush to population health, and I swear many organizations thought population health equals buying a pop health platform and I think those have largely been a bust because they didn’t really know what’s the problem we’re trying to solve, how will we organize our staff to do this work? A hundred other things that are far more important than the particular software platform.

Nat’e: Right, right and also, you know, to your point around that pop health and if we did buy a pop health platform, how does it really, you know, integrate, how does it really work with what we already have?

Dave: That’s right.

Nat’e: Will we be asking our clinicians to, you know, text, you know, make different suggestions and use different devices to just complete one event and so clinicians don’t have time for that. They don’t have time to use multiple devices to do one interaction or exchange and care.

Dave: Right. Well, I want to go to the next question. I have a feeling this may be a hard one for you given everything you’re involved in but what’s the most important or interesting thing that you’re working on right now?

Nat’e: So, again I’m glad we weren’t talking about workflows because it is really, we are working on supporting nursing workflows that are cantered around communication, right. So, getting the right person, getting the right alert, right. So, we’re focusing on, if we start to give nurses more alerts through cardiac rhythms or cardiac monitoring or ventilators, you know, how do we do that and decrease alert and alarm fatigue, right. So, we’re working on nursing workflows as it relates to clinical and active surveillance, right. Again, filtering those noise alarms by getting those right alarms that are high volume, high risk to the nurse and or if the nurse doesn’t need to get those alerts and alarm, how do we filter them and escalate them to other people on a care team members. So, our goal is to prioritize alerts and alarms and/or communication so the nurses can be informed and provide care. So, really Spok, we spent a lot of time focusing on the physician workflow and the physician platform and rightfully so. Now, we’re looking to ensure that inter-professional communication, knowing that nurses and physicians do not communicate the same way.

Dave: Right. Well, it’s supportive of this move towards more team care and more as their teams as well. Yeah, I’d like to drill into this system little further because you’ve had a ringside seat at seeing this done poorly and done well. Take this example of alarms and actual information and if you will give us a little contrast, share with us some bad things, you’ve seen some distressing things and what is good or even great look like.

Nat’e: Right, so again and let me just start with the good and the great, right versus the bad. Again, understanding the complexity and the diversity of the way in which a nurse communicate or would like to receive alarms, right. So, in doing that, understanding how is it different in a critical care unit versus a med-surge unit versus you know, maybe an ED, right or an O.R. So, you have to understand the different complexities of the unit and the timing, right. The other piece around the nursing workflow as it relates to just communication is nurses. They can have sometimes two to 22 patients or within a shift, right. So, imagine getting alerts and alarms for every one of those patients for everything. So, again we talk about this real-time health system and which is great, but we have to be sure that we’re getting and we’re filtering out the noise, you know, nurses are not getting alarms from the cardiac monitor because the patient has brushed her teeth but we’re really getting the alerts and alarms that are real, that the nurse can you know, act upon and that we have a history of those alarms that the nurse may be can go back and look at those. So, I think understanding which department they’re in, filtering out the appropriate alarms and alerts and given the nurse the opportunity to see kind of a historical trend.

Dave: I think that’s terrific. This is a theme that I’ve thought about someone had written about before and I call it personalized health IT for clinicians. So, we talk about personalized medicine and precision medicine and that’s great but I think we also have to start to think harder about how we personalize our IT in the way you described, I mean frankly, when you’ve seen one nurse on one shift, you’ve seen one nurse on one shift and maybe not even that and so this idea that as we get better at user interface design, better at workflow, better at understanding human factors within health care, these systems are going to become increasingly personalized to roles into individuals and into the work in front of them at that moment in time. I know it’s a kind of crazy vision right now, but I believe that’s where we have to get to and you’re pointing us in that direction.

Nat’e: Right, I agree, and you know, some people may say, listen, you know, are we ready for that? I mean we look at our, the generation of our nurses, right. You know, there, it’s wide, it’s diverse. In healthcare, we tend to believe that nurses or clinicians are not ready to jump into that advanced IT right, world and we say, you know, well, will the average nurse want to be involved in personalized IT but also go back to our personal iPhones. If you give the nurse the ability to configure, you know, at a level what alerts they may need to have, what alarms they may need to have and implement their personalized workflow just like they do with apps, right. If we go into our own personal iPhones, everyone has changed their settings. You know, we are used to adding apps to our phones. There is a personalized touch to how we interact with our everyday cell phones and I think that can translate to what we do in the healthcare environment. We as healthcare leaders just have to trust that they’re ready to do that.

Dave: Well, I think that’s true and I know you’re the one that’s supposed to do the pet peeve on this show but I’m going to do what you’ve triggered one of mine and this is one of my pet peeves when people say doctors and nurses don’t like technology and I say bull, have you been in an ICU, have you been in an O.R? They love technology. What they don’t like is crappy technology and I’m afraid the first generation of health IT and you know I, I bear some responsibility for this too. I’m not just pointing a finger. This is not that great. It’s not that they’re technology adverse quite the opposite but they got hard jobs to do and not a lot of time to do it man and they need technology that’s going to enhance a them not, not get in the way and I’m sure you would agree with that.

Nat’e: Yes, yes, yes. So, personalized IT is the right way and then it goes to your point around what’s the bad way? Well, the bad way is what we’ve, you know, what we’ve done, you know, and again, we live and we learn but we’ve created these clunky systems where you say, you have to do A, B, and C and X, Y and Z, and it’s not natural to a clinician’s workflow and so anything that’s not natural is going to impede or hinder what they’re doing and guess what, they’re not going to use it or they’re not going to use it correctly or they’re not going to use it or optimize it to what the technologists or the vendor has designed it as. They’re not going to you know, really leverage it, leverage the technology and I think that’s what we’re seeing now but what I want to warn us against is we’ve learned, we’ve lived this EHR you know, implementation. We should not take those same behaviours into this next phase of the mobile world and then so here’s my projection. I think that we’re going to be getting rid of these computers on wheels. There is not going to be computers. I mean look at our homes now. We’ve all had computers, then we had the laptops, then we had the iPads and now everyone has transitioned to the phone. The same thing is going to happen in your health care system. So, be smart around, how can we personalize that and how can we get ready now for this mobile wave of how we’re going to be interacting with technology.

Dave: Well, I think that’s spot on and, and if you look internationally, China, India, other countries, they pretty much skipped the desktop stage and went right to mobile. So, you can almost see our future in some ways if you look at those. If you’ve just joined us, you’re listening to 4 x 4 Health and we’re talking with Dr. Nat’e Guyton, Chief Nursing Officer at Spok. Nat’e, for this next question, I always remind my guests, this is a PG-13 show, so please keep it family friendly but what’s your pet peeve or favourite rant these days?

Nat’e: Well, and you know it’s funny because my team would say, yes, this is true. My pet peeve is not having a nurse or nurse leader at the table. Everywhere I go everywhere, and I mean, I’m at hospitals across the United States and when I say a nurse at the table, I mean from day one when we’re talking about technology. Today, I would even go into hospitals and I will meet with the CIO or the CTO and they’ll say, well, we’ll get the nurse after we decide this or we’re kind of gun shy and you know, we set up a meeting and they said, well, the nurses on vacation this week, you know, we’re making multi-billion-dollar decisions that will affect and impact every clinician and patient in our hospital. So, my pet peeve is that we do not look at technology like we look at patient engagement and patient satisfaction. It is a job for all of us. So, my goal, right as, as a nurse leader, not only at my organization but in the profession of nursing is the empower our nurses and nurse leaders to not be gun shy and a shy away from technology because remember Dave, you know, when we went to school, we didn’t have informatics as an elective. You know, we didn’t have the computers. So, I do understand that there is a reservation from some of our nurse leaders and so what we’ve done is we’ve created the CNIO role and we gave responsibility to them and we are still not at the table because we’re waiting for the CNIO to be there but I want to encourage all of our leaders across the table, whether they’re CEOs or CIOs or CTOs, we have to engage and include nurse leaders from the beginning.

Dave: Oh, I don’t think that’s a terrific one and I’m, you got me fired up. So, I’m going to build on this one. I mean, I think this extends to all the different stakeholders in the team. So, nursing for sure but our pharmacist, physical therapy and the list goes on and on and of course, you know, the doctors as well and I suspect that you’re like me, a pretty much now I can walk into an organization and in about five minutes I can figure out is this an organization that’s doing IT too? It’s staff or with their staff and doing it too, I’m just doesn’t work very well and so I’m right there with you and I would even go a step further. I’ve seen organizations that try to use managers and others as proxies for front line staff and they certainly have a role to play but if you don’t have actual front line, sharp end of the stick, folks involved in those discussions too, you’re going to miss important things because they know how the work actually gets done every day. Whereas managers and I’ve been one myself, sometimes it’s work as imagined then rather than how it’s actually done. So, well, that’s a, that’s obviously as you said, you got these spun up here, so, I love that. So, for our last question today, you’ve got a lot of experience, you’ve seen a lot of things. What’s your most sage advice for us? Nat’e: I would encourage everyone to ensure that they have an information technology strategy because Dave, I still see out there that there is no strategic plan and I mean multi-year, you know, that is aligned with your organizational strategy and that strategic plan should include your EHR which we made huge investments in but they evolve, they develop, we’re optimizing those. There should be a multi-year strategy. It should also include your communication strategy, right. So again, that’s where companies like Spok fit in as we compliment the EHR. What is that communication strategy? We shouldn’t wait so there’s a complaint from someone or someone say, well I like to have X product. We should have a multiyear strategy. The other pieces, your mobility strategy, don’t let this mobility wave happen to you, right. We’re going to go to the phones. People are using Google glasses. You know, we’re talking about Alexa and Siri and utilizing them in the health care study, right. So, understanding and then also last but not least, your infrastructure strategy should be aligned with that. You know, what kind of devices, do we have the appropriate coverage as we put more and more people on mobile devices, do we have the bandwidth, right, within our organization and then again, where Sansoro comes in, what is the integration of all of that, you know, because how are we going to, you know, we still have that kind of aspiration of what does inter-operability look like, right but really how are we going to integrate to all of these systems, so it becomes seamless on the account of our end users and really produce patient outcomes that are better than what we had before we made the multi-billion-dollar technology investments.

Dave: Well, I think that’s great and we also need integration that will scale it as reliable and, and all the other things. The other theme that has come up around that relates to this is the imperative for better governance within organizations and the alignment of the operational governance with the IT governance and you know, frankly, I think most organizations didn’t have very strong organizational governance to begin with. Many developed some IT governance particularly around these large EHR projects but now you’ve got to bring them together. They have to mash in and align within reinforce each other and so agree with everything you’ve said, and I would add this is an additional challenge and an important enabler of doing what you say, which is first, what the heck are we trying to accomplish here as an organization? Then we’ll back into the strategies that get there and the technology that enabled the strategy.

Nat’e: And, to your point, Dave, the charge of this governance committee, if you will, if there is a committee, with again, a strong leadership could be to develop that multi-year strategy, own that strategy, finance, support and be accountable to the organization for the outcomes.

Dave: Well, I think that’s right and boy, so much of what we’ve talked about today is about interdisciplinary and multidisciplinary work across multiple dimensions, isn’t it?

Nat’e: Yes, yes.

Dave: Well, thank you. We’ve been talking with Dr. Nat’e Guyton, Chief Nursing Officer at Spok. Nat’e, thanks for joining us today. You gave us a real tour de force on boy, too many subjects to list here, so thank you.

Nat’e: Thank you so much, thank you for having me, Dave. It’s been a pleasure, but I think one takeaway for me that, that you got me fired up about is personalized IT.

Dave: Well, there you go, and I would say, and I would not mad as a plug but Spok is in an ideal position to lead the charge around some of this. So, get back to work, we need you.

Nat’e: Thank you, have a good one.

Dave: You’ve been listening to 4 x 4 health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I hope you’ll join us next time for another 4 x 4 discussion with healthcare innovators. Until then, I’m your host doctor Dave Levin, thanks for listening.