Gary DiPersi, RN, MBAHA, FACHE, CENP, serves as System Director of Nursing Operations and Performance Improvement for CHRISTUS Health.
On April 8th, Gary will give a presentation on "CHRISTUS Integrated Care: Dealing with the RN Shortage" at Becker's Hospital Review 11th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place on April 6-9, 2020 in Chicago.
To learn more about the conference and Gary's session, click here.
Question: What, from your perspective, is the biggest challenge about the future of work for hospitals, and what can they do about it? (i.e. automation, desire for more flexibility, clinician shortages, etc.)?
Gary DiPersi: Physicians have long recognized the need to extend their reach as a way to manage the increased patient load, acuity of the patients and the ongoing shortage of physicians. Physicians have accomplished this in a number of ways, including with the use of physician assistants. Within the nursing division, CHRISTUS Health had long since come to a similar realization and in 2017 established the CHRISTUS Integrated Care model.
The shortage of registered nurses is expected to worsen over the next decade as more than a million RNs are projected to retire, the need for nurses increases as the last the baby boomers reach retirement age, 13% of newly licensed RNs change professions after their first year and the ability of nursing schools to meet the need actually decreases. Compounding the issue are a care delivery model and some hospital operational decisions that have promoted a practice which stretches this already scare resource into activities which are neither clinical in nature nor at the top of the RN’s clinical practice expectations. Within this context, nurse leaders, as their physician counterparts, must innovate new care delivery models that allow for other types of nursing roles, i.e. vocational nurses, in order to, again, place the RN practice at the top of their license and focus the RN on patient-centered activities.
Q: How can hospitals reconcile the need to maintain inpatient volumes with the mission to keep people healthier and out of the hospital?
GD: As the overall population grows and the nation’s population ages, there will continue to be a need for acute, hospital-based care. The question is, what will that acute care population look like in the future? We’ve already witnessed the steady increased acuity of our acute care patients over the last several decades. There will be some decrease in volume over time, and there should be. What will continue is the ever-increasing patient acuity.
Do we, as a health system or individual hospital, have an obligation to the health and wellness of the populations we serve? Yes, we absolutely do. Health systems must improve our ability to manage and then improve upon the health of a population, especially as those patients who are acute enough to require those services will depend upon the hospital to be that crucial facilitator between their acute care stay and their transition back to wellness.
Q: What's one lesson you learned early in your career that has helped you lead in healthcare?
GD: Having gone straight from nursing school to a critical care unit in what was then an 850-bed hospital, I learned right away that there will always be someone with more experience, more knowledge, and more expertise than me. This was actually a comforting insight. As my career progressed over the years, those times when I didn’t feel as though I had to be the smartest person the room, has been the most rewarding.
There is a tremendous amount of talent in healthcare and a lot of it is present in those that are closest to work. As a leader, it isn’t enough though just to recognize the talent in the room. I have a responsibility to not only create an environment where that talent is able to express itself through new and creative ideas but to help see those ideas through to fruition. What this means in a practical sense is that a leader must bring those closest to work to the table, listen to and openly discuss their ideas, implement them where possible and remove any barriers to their success.
Q: Healthcare has had calls for disruption, innovation and transformation for years now. Do you feel we are seeing that change? Why or why not?
GD: There are some sectors of healthcare that can experience rapid—which in healthcare is a relative term—disruption and innovation. Neurostimulation for Parkinson’s patients or targeted treatments for cancer cells are two easy examples. Advances in imaging or virtual care are two others. What’s harder to recognize are the incremental innovations or the transformations that are years in the making—those things that don’t have the flash and pizzazz of new cancer treatment, yet they can have a dramatic impact on the quality of care and the patient experience. For example, the slow but steady march toward zero harm or decreased sepsis mortality doesn’t lend itself to rapid dramatic disruptions in how care is delivered.
Even disruptive ideas, such as the new care delivery model being piloted at CHRISTUS Health, need to be undertaken with a deliberate, step-by-step approach. Changes in our care delivery model or a sepsis bundle involve changes in clinical practice where roles and responsibilities need to be carefully considered. It’s still innovation; it’s just deliberate, incremental innovation. Too much is at stake where it comes to our patients to not be deliberate and thoughtful in our approach.