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Don't miss out. Get registered today. Visit beckershospitalreviewdot com and click on the events page to find the conference website. That's the beckershospitalreview.com events page. See you in Chicago. This is Alan Condon with the Becker's podcast. I'm delighted to be joined today by Anthony Mulholland, who's the chief nursing officer of ambulatory services at Oregon Health and Science University. Anthony, a pleasure to have you you do on the podcast for the first time. Really delighted to have you on and pick your brains a little bit about some of the trends and some of the things you're following in health care today. But before we do, I'd love to hand the floor over to you just to hear a little bit more about your background and, of course, your role at OHSU. Yeah. Thank you so much, Alan. Thanks for inviting me. It's really a pleasure to be here with you. So, yeah, as you said, my name is Anthony, and I serve as the vice president and chief nursing officer of ambulatory services at Oregon Health Science University in Portland, Oregon. I've been a nurse for a little over 22 years now. Hard to believe. My nursing career began in 2002 when I graduated with my bachelor's degree from Cal State University in Long Beach, And I entered the workforce as a new grad in the trauma intensive care unit at one of LA County's level 1 trauma centers. This is where my journey toward nursing leadership really began. It was at this time that questions sort of began to formulate in my mind. How can I I love bedside nursing, but how can I make a bigger impact on nursing practice and health outcomes beyond the individual to, like, the population level? And even more globally? How can I make a bigger impact on health care? So from there, I made my way to Oregon and began to find ways in my organization to make those impacts. I served as a cardiovascular intensive care staff nurse where I took on leadership roles. I was a charge nurse, a preceptor, was involved in shared governance, and then even became a charter member of our rapid response team back when that was a new concept in health care. I really loved serving in that role, and I kept having this gnawing feeling that there was something still out there for me. I remember vividly, Alan, it was during the middle of one of my shifts at the bedside where this mental map of my purpose just sort of became clear. It was that night at work because I was working on night shift that I saw a move into formal leadership being the path for me, and I needed to really make some moves to make some bigger global impacts in health care and nursing. So when I left the bedside, I moved into what my organization called the administrator on duty role, commonly known as the nursing shift supervisor and other organizations. And now that was a really fun job. In this role, I really mastered leading hospital operations, and I got to advocate for and work with really vulnerable patients and families and their loved ones. And then I got my master's degree in health systems and organizational leadership and moved into a nurse manager role, leading to cardiovascular intermediate care units. And I'll tell you that was one of the toughest but most rewarding roles that I've had in health care. As a nurse manager, I had this incredible opportunity to impact the lives of those that I was leading directly and the patients that I was serving. And it was a wonderful environment for really supporting and elevating nursing practice. And then, in 2018, I became a service line director, the director for our heart and vascular service line at OHSU, and, gained some extraordinary new experiences leading procedural inpatient and outpatient units, as well as doing a lot of population specific work within my organization and out in my community. And then finally, here we are today. Recently we restructured the nurse executive leadership group at OHSU and our chief nurse executive had the foresight to see the need for creating a chief nurse officer role for ambulatory services, a role that hadn't existed previously in our organization. And I'm proudly serving in that role now. I'm about 7 months into it and it's been great to begin to make those more global impacts that I remember longing for 2 decades ago when I began my career. Fantastic. I mean, like you said, a wealth of experience, more than 22 years serving in rolling from trauma care right up through the through nursing leadership. So no better man to to speak to about some of the trends that you're watching today. So I'd love to hear, as in your role now, what are 2 to 3 trends that you're really paying close attention to in health care and why? Yeah. Thanks for that question. You know, when I think about the trends that I'm most excited about, I I really think about innovation. Like, they're centered around innovation. I mean, look, we're in a challenging time in health care right now. There's so much financial instability. We're in an error era of like mergers and acquisitions, workforce constraints, and real challenges associated with access to care. So I think about that when I think about the trends that are innovative, it's care model redesign, leveraging technology, and then changing the infrastructure of care delivery. So for example, with care model redesign, thinking about how we can leverage the resources that we have today to provide care for the patients in front of us and those that are seeking entry into our into our systems. A quick quick example of that in ambulatory nursing that I'm thinking about is top of scope or top of licensed care. One of the things I've been encountering in the past 7 months in my new role is that we have this really great opportunity for nurses to deliver care in ways that really improves access for patients. For example, we do have nurse visits in our ambulatory practices, but they're underutilized and not well known of. We can really make an impact if we clear the path to allow our clinicians to practice at the top of their scope and contribute to that access to care. And then as I said, 2nd, leveraging technology. I was recently at the Epic user group meeting conference, and I really got to see some great examples of generative AI being used in innovative ways that helps to support the work of our clinicians. And everybody's talking about technology right now. It's one of the trends in health care. So I'm really excited about things like AI scribes and AI charting and pace patient messaging that's that's really aided by that artificial intelligence. Each of these assistive documentation innovations really shorten the amount of time clinicians spend documenting in the medical record and gives them time, frees them up to really address patient care needs and improve that care that they're providing. And then finally, that changing infrastructure of care delivery. It might not be really thought of primarily as an innovation, but more survival because of all of the insecurity in the market today. But, hey, it's, you know, during times, Alan, a great pressure that we have to really innovate to survive. And so I really do see, you know, vertical alignment as the future of health care and innovation. Right? It's an the innovation here, I think, is moving from that single hospital centric care delivery model to more of an ecosystem of hospitals and care centers within one system. Each of them working toward a singular vision for for care and access and improving outcomes for patients. So those are some of the trends that I'm following right now. I think, you know, as health care leaders, these are the things that many of us are thinking about. Yeah. I think, you know, it's fascinating to kinda get your perspective on broad overview and some of those things you're close closely following. I just wanted to quick follow-up on the last trend that you mentioned, just in terms of that changing infrastructure of care delivery, the vertical alignment in health care. You talked about, obviously, a big trend that we're seeing across the board is M and A. Mhmm. I know OHSU is potentially involved one with Legacy Legacy Health as well, but would love to get your your insights, any deeper insights there in terms of that changing infrastructure of care delivery and how you're approaching that at OHSU? Yeah. One of the things that I'm excited about with, you know, what's on the horizon for OHSU and Legacy Health is that it really improves access to care for Oregonians. Now we'll go at OHSU from 3 hospitals and a collection of ambulatory sites to improving access to patients will really be able to re be realized because we won't be centered primarily in the Portland metro area, but rather really spread throughout the state to be able to be a catchment for patients in a smaller communities and in areas where they might not have the greatest access to care traditionally. So this is, you know, one of the ways that I think hospitals or health care systems are thinking about making big impacts, and it's certainly how we're thinking about that in our organization. So it's an exciting time. Yeah. Absolutely. We've been paying very close attention to the the signing of the definitive agreement and how that's kinda moving forward over the last couple of months. And, yeah, I look forward to seeing what comes with it in the next coming quarters or so. Anthony, one other thing I wanted to to follow-up on. You you talked to earlier on, you'd mentioned, you know, no secret to you or any of our our listeners here in terms of the workforce constraints or nursing shortages in the field. Our veterans clinical team had covered a a recent report from Mercer that showed that nursing assistants face the greatest projected deficits over any other health care application by 2028. It looks to just get your perspective in terms of, is this a real core priority area for recruitment and retention at your system and why? Indeed. We are finding that it is increasingly difficult to fill these types of supportive roles in our health care systems, And we're doing a lot of work to try to address that, you know, recruitment incentives and really making sure that we're paying attention to how we're marketing our healthcare system to attract the right talent. But that's just not going to be enough. There are fewer individuals entering into these types of roles. And so we really have to think about how we can innovate our care delivery models so that we can impact outcomes of care for patients that doesn't rely on a workforce that just isn't there anymore, or is really dwindling. So in our organization, we're doing things like hospital at home and other types of virtual care, virtual intensive care units, and thinking about how we can design care delivery so that we can ensure that nurses and all of our practitioners have the support that they need, but they're, we're working smarter and not harder. Right? Those are, those are some of the, some of the things we're thinking about in our organization. It's been a real challenge to recruit into those types of roles. And then ambulatory specifically, we use a lot of medical assistance and that's a you know, think about the hospital, the nursing assistant in ambulatory. It's the medical assistant and we face, similar challenges out in ambulatory care. And so we're thinking a lot about the role of the nurse and how the nurse can really support transitions of care for patients and take on some of those functions that are at the top of their scope to really address the needs of the patients as they enter our systems. Mhmm. Yeah. Yeah. It was such a big challenge in the in the field across the country, but interesting to hear about how how o h u OHSU, excuse me, is particularly addressing that. Anthony, I wanted to flip the script a little bit away from challenges. To hear a little bit about what's most exciting to you right now when you think about the future of health care. Yeah. Thanks. You know, I'm I'm excited about, the things that address the challenges. You know, when I think about the top challenges that we're up against, it's caring for an aging population, transitioning from an overreliance on acute care to managing population health. That's really exciting to me as an ambulatory leader, achieving health equity and then navigating those post COVID impacts on our workforce, specifically staffing and safety. So, you know, I'm an ambulatory chief nursing officer, so it probably won't surprise you when I say that what I'm most excited about is how nursing can make an impact in these specific areas. You know? Right. I think the nurse in the community is so well poised to address the complex needs of our aging population. I'm you know, I have great examples every day. I'm inspired by these examples that I see. I witness nurses with their interventions, keeping patients thriving in their own communities, helping them to navigate the plans of care that keep them healthy and out of the hospital. Right? And the last thing we need is patients coming to our emergency departments, which are really overcrowded and burdened by boarding patients. Our nurses are really making an impact on this transition from overreliance on acute care to population health management. And then nurses and ambulatory settings are addressing the social determinants of health that are, you know, they're developing plans of care that are individualized to patients facing social and racial and structural disparities. Nurses have and are thinking creatively and then developing they're they're having these experiences and then they're thinking creatively about how to develop these plans of care to keep patients with those unique needs thriving. Say, for example, patients facing housing or food and food insecurity and how nurses are making an impact for them and keeping them healthy well and out of the hospital. And then in terms of addressing those workforce challenges around resource utilization and safety, I think the voice of the nurse is really powerful here. I'm excited about what we're doing in our organization and, this movement across nursing to leverage professional governance, this transition from shared governance to professional governance and nursing to keep folks like me, the nurse executive as nurse executive and other leaders, in conversation with our nurses to address some of these problems, they can help us address some of these problems. But for example, in my organization specifically, we rely on the voice of our clinical nurses, on our staffing committees and our councils and in our safety councils. They really help us to translate their experiences at the frontline, and then that helps us to shape our policies that we use to manage our resources and then keep our practice environment safe. Mhmm. Yeah. And certainly certainly a lot to be excited about, like you've mentioned. But lastly, I wanted to go back to ties into what you just mentioned at the start of that question was you mentioned that nurses really focusing nurses in ambulatory really focusing on population health, social determinants of health, some of these initiatives. I'd love to hear a little bit more about how you're thinking about ambulatory growth over the next 12 to 24 months. Yeah. Indeed. You know, I think we're it's an exciting time to be working in ambulatory care. Right? I mean, as I talked about, we're facing some real challenges in health care, specifically around access and the financial health of our organization. So, you know, the out of hospital landscape is changing. And, selfishly, again, this is a great time for me to be where I'm at. Outpatient care is the fastest growing segment of the health care industry, and this type of care delivery really brings high margins to our organization. So that's great too. I think we're gonna continue to see growth in ambulatory surgery centers, for example. That's great news for those organizations that have ambulatory surgery, and I promise I'm gonna get to nursing here in just a second. More and more procedures are definitely moving to those day stay visits that add value to our consumers, our patients. And so, you know, weaving nursing back into the forecast, I think the role of the ambulatory nurse is gonna continue to evolve. I'm, you know, thrilled to be seeing the shift of this collective mindset in health care that emphasizes preventative population, chronic disease management, and supporting our aging population. And with that, there's, of course, gonna be an increasing demand for skilled nursing professionals who can really deliver high quality care outside of traditional hospital settings. So it's a great time for nursing in ambulatory settings. It's a great time to be a nurse leader in an ambulatory area because, quite frankly, it's the future of health care if I could put it so simply. Yeah. I mean, like you said, a really a really exciting time to be working a leader in the ambulatory sector, a really exciting time at OHSU in particular with everything going on. Anthony, really, really fascinating discussion. A real pleasure to have you on the podcast with us today, and I look forward to connecting with you again down the line. Alan, hey. Thanks so much. Have a great day, and enjoy your weekend.