Team Up to Tackle Care Redesign

By Eric Wicklund

Trinity Health is taking a team approach in redesigning care delivery inside the hospital, using a three-person model that includes nurses, nursing assistants, and virtual care technology.

Gay Landstrom, RN, PhD, NEA-BC, FAONL, FACHE, FAAN, chief nursing officer for the Michigan-based health system with 92 hospitals in 22 states, says the model, piloted in the summer of 2022 and is now live in roughly 40 sites, addresses not only the growing shortage of skilled nurses but a need to reduce complicated workflows that negatively affect patient care and staff morale.

“We realized that we needed to create teams,” she says. “This is a fundamental change to how we [deliver] patient care.”

Health systems across the country are turning to a variety of tools and strategies, many of them centered on virtual nursing. While the emphasis is on making the most of the shrinking nursing workforce by reducing stressful workflows, these programs are also increasingly targeting clinical outcomes, ranging from reduced length of stay to improved monitoring and patient engagement. And at a time when ROI for these programs hasn’t yet been proven, the more achievable benchmarks the better.

Landstrom says the driving force behind Trinity Health Together Team Virtual Connected Care is a shortage of nurses who want to work in acute care settings. To address this, the health system “tried a lot of things,” she says, from robots to scribes, before settling on a team-based approach.

Trinity’s three-person strategy is unique. The floor team consists of a nurse and either an LPN or CNA, with the former handling the nursing duties at the bedside and the latter doing tasks that don’t require an RN. The third team member, a veteran nurse, is in the telehealth center, monitoring patients and assisting the bedside team (as well as doctors) with documentation and consults.

Landstrom says leadership did a lot of research prior to launching the program and found that 40% of the tasks done by nurses on the floor can be done by someone other than an RN. Teaming a nurse with an LPN/CNA, she says, enables the nurse to work at the top of his or her license.

The virtual nurse, meanwhile, sits in the background, offering support when needed, answering calls from patients, and keeping watch over several rooms. Their tasks include documenting, monitoring, assisting with handoffs, rounding, working with doctors during examinations, and helping patients to understand doctors’ comments.

“There’s a great deal [of task] that a virtual nurse can do,” Landstrom says. “More than we thought they could. And they function here as a team.”

Indeed, one of the challenges to creating this model, says Murielle Beene, DNP, MBA, MPH, MS, RN-BC, PMP, FAAN, FAMIA, Trinity Health’s senior vice president and chief health informatics officer, is recruiting the LPNs and CNAs. As a result, Trinity has been working on updating its nurse assistant development program and has been in touch with nursing schools to determine how to bring more people into the workforce.

As for the technology, Beene said the health system “had to buy a lot of TVs” to establish the right platform for the virtual nursing component. While some health systems use tablets or telemedicine carts, an increasing number are using TVs built specifically for the healthcare setting and providing both entertainment and clinical services, ranging from audio-visual conferencing to access to resources and education.

“Technology assessments are vital” to establishing a good base for the program, Beene says. “It’s very important that we have seamless integration, and that was a challenge.”

Beyond the technology, both Beene and Landstrom say the biggest challenge to making this program work is change management. Redesigning inpatient care management is a drastic adjustment in how things are typically done inside a hospital, and it’s safe to say not everyone will be receptive to the changes from the outset. Executives need to map out these changes and lead staff through them, identifying the pain points and the benefits.

Skepticism “was expected,” adds Beene, though management underestimated how much resistance they encountered.

“You don’t just drop this [new program] in and then leave,” she says. “This has to be part of the culture, and it involves a transformation of the mindset.”

Beene and Landstrom also found that coming into each hospital with a one-size-fits-all program was not working, and that each hospital not only had different strengths and needs, but different methods. That meant understanding the unique workflows and talents in each hospital and leaving enough room in the program model to adjust accordingly.

Likewise, Landstrom says, the three-person model “is not a model for all clinical areas.” She says it has shown value in med-surg, telemetry, and step-down care, but doesn’t quite fit on other wings of the hospital.

“We’ll be developing other models like this,” she says.

Landstrom also says it’s too early to determine ROI for this platform. While staff support and retention is an important goal, that alone probably won’t sustain the program. By charting clinical outcomes and aiming for pain points in monitoring, charting in the medical record, and patient discharge and room turnover times, she’s hoping the benefits will materialize in better patient outcomes, a shorter length of stay, and cost savings.

“It’s really a new way of thinking how we go about taking care of our patients,” says Beene.

Editor’s note: Landstrom and Beene are part of Mastermind, a new program developed by HealthLeaders to gain a better understanding of the virtual nursing landscape. They and executives from 11 other healthcare organizations across the country will be meeting over the next few months in a virtual panel setting to discuss challenges and benefits to the virtual nursing format, which will convene for a live event next year to develop best practices.

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, Telehealth, Supply Chain and Pharma for HealthLeaders.