Bill Klaproth (Host): Welcome to the ASHRM Podcast,
made possible by the American Society for Healthcare Risk Management to support
efforts to advance safe and trusted healthcare through enterprise risk
management. You can visit ashrm.org, that's A-S-H-R-M.org/membership, to learn
more and to become an ASHRM member. I'm Bill Klaproth.

Host: This podcast is part of ASHRM's healthcare risk
management week. Learn more at ashrm.org/resources/hrm-week. On this podcast,
we're talking about bringing the hospital home, how we must rethink the norms
of healthcare. So, let's talk with Grace Walker, Medically Home's Group Senior
Director of Safety and Reliability. Grace, welcome to the ASHRM Podcast. Glad
you're here. So, let's jump right in with our first question. Can you tell us
what is Hospital-at-Home?

Grace Walker: Right. That's a great question. A lot
of people are asking it right now. Right now, the agreed definition, and I say
agreed definition, because this was aligned on with 37 different countries that
are also building this type of model, this hospital home is really an acute
clinical service that takes staff equipment, technologies, medications, skills,
all usually provided in traditional brick and mortar hospitals, and delivers
that hospital-level of care to people in their homes or in nursing homes. In
short, it substitutes for acute inpatient hospital care.

Host: So Grace, Hospital-at-Home sounds pretty
expansive. What are the limitations? What doesn't it do?

Grace Walker: Well, in short, it's not outpatient
care, what's typically defined as outpatient care. So, it is not hospital
prevention program, it is not community-based chronic disease management
programs nor is it solely remote telemonitoring or telemedicine. It's not a day
facility treatment environment. It's not primary home care. It's not community
nursing or skilled home healthcare. So, there's a lot of things that it's not.
It gives you a better understanding of what it is when you carve out and really
understand. It is focused solely on acute inpatient hospital care needs. It's
just done in a different environment. That environment is people's residences.

Host: Right. So, why are health systems leveraging
this model now?

Grace Walker: Well, you may be surprised to learn
that really isn't a new thing. We can track this all the way back, this
movement, this model, all the way back to the early 1960s with Hospital-at-Home
programs launching in France, followed shortly by Canada, Australia, New
Zealand, Spain. The United Kingdom got on board as well. It didn't really come
to the US until the early '90s, early mid-'90s with John Hopkins launching
their program in '94. And then, we saw several other small programs developed
in the VAs and in other primary hospital locations all the way up through the
early 2000s.

So sadly, most of the US programs, they never saw
significant growth or scaling of their services pre-2020, a.k.a. pre-pandemic.
But within the first year or even within the very first few months of
COVID-19's impact on the US, we, and I am truly using that collective sense of
we so that there wasn't enough beds in our traditional brick and mortar
hospitals, there wasn't enough infrastructure to get critical medical supplies
to those who most needed it. And within the community, there wasn't a strong
feeling of safety. What would or possibly could occur if someone had to go to
the brick and mortar hospital was really up in the air. There was a lot of
fear, a lot of tension, a lot of stress. So, we all saw and heard countless
stories of a patient's health failing, sometimes to terminal ends sadly,
because we didn't have beds and patients were too scared to come.

Host: So, it seems like the Hospital-at-Home would
present several opportunities. Could you tell us what those opportunities are?

Grace Walker: Well, I will say one of the big
opportunities is really learning the power of it, right? Pre-pandemic, we saw
very small test of change pilot programs. We saw success, but we really didn't
see or have the opportunity to see it scaled. In short, three years later, we
now know without a doubt things that we've long suspected. So, we now know
patients prefer to be home even as hospitals are in capacity. We now know that
we can safely deliver high quality care in the home with virtual and in-person
care teams, that collaborative effort. And we now know that patients and
caregivers feel prioritized and restored within this care model, really being
able to regain agency of their own health.

Host: So then, the benefits seem like they're there,
but what are some of the challenges in setting up these types of programs?

Grace Walker: Sure. So, the biggest challenges really
arise from not yet knowing what we don't know. So if you need to set up a
Hospital-at-Home program, how are you going to do that? How are you going to
staff it? Who should be involved? Hospital-at-Home programs really leverage
team members not typically seen in traditional hospitals, some of those such as
the paramedics or mobile integrated health team that go into the patient's home
and really are the hands for the patients, for the caregivers within that
environment. Not having the security of being able to sprint down the hall to
the supply cabinets and grab whatever's needed for the patient, all of that has
to be pre-thought out, scheduled and made available. And then, the last thing
as one of the challenges is how do we ensure good connection with the patients.
That can be from a practice and relational way, but it also can be from the
technology that we're leveraging. Do we have a robust consumer-friendly
technology setup that allows the patients to really easily connect to us as
easily as pushing a button?

Host: I can understand where this would be a unique
scenario for risk professionals. So, what should a risk professional be
thinking about if or when their associated healthcare system chooses to explore
this Hospital-at-Home model?

Grace Walker: Right. Well, first of all, I really do
encourage every risk professional to be aware, to be learning, to be thinking
about not if, but when their healthcare system says, "Let's go do
this." The first thing I would say is really be prepared to think outside
of the box. This Hospital-at-Home model, at least for now, is really living
within a pre-regulatory space. That means the federal and state governments as
well as the accrediting bodies and organizations are also in a time of
learning. So, I would really encourage health and risk professionals to be
prepared to learn. Collect, trend, and analyze their data. You will be asked
for receipts. We all know that's coming. We will be asked for, "Hey, where
is the proof? Where is the value?" And we really want to be prepared to be
able to speak to that, so that when the regulatory environment does begin to
shelter this model as an official, "Yes, this is great quality care and
we're going to do it full," we really understand what's necessary for
that.

And the last thing I would say is really to keep the
patient, the family and their environment of care, just squarely centered
within your vision when developing any kind of recommendations, processes or
tools. And challenge that really should be called out here is that there is the
risk of making translational assumptions between models and the healthcare
provided in a traditional brick and mortar space does not necessarily have the
same processes or requirements as those performed within the patient's home.
So, you need to think through things such as your tools, your response teams,
how you select and place the patient, even the environment of care.

Host: So, you say it's not a matter of if, it's a
definite when. So, we certainly have enough data to show us that this is
definitely happening. People do need to start thinking about this now. Is that
right?

Grace Walker: True. Right now, I believe the majority
of states, we have definitely crossed the midmark, have actually issued CMS
waivers or have aligned with a CMS waiver, so that Hospital-at-Home care can be
delivered. And it's really just really understanding how should we best do this
before we fully write the rules.

Host: Absolutely. And then from a patient safety and
nurse perspective, what is your experience with these types of programs?

Grace Walker: I love that. I love that question
because so often we fail to ask providers about their experience. And that's
really forgetting or really not acknowledging the value of their participation,
the necessity of them within the cycle and their perspective of what should and
shouldn't be done, right?

So, I'll answer those in order for you, okay? So from
patient safety perspective, I really think the traditional brick and mortar
hospitals introduce a lot of risk to the patients. This is not news. This is
well known. The number of errors that someone can intersect with within a
hospital is frankly overwhelming. There's also the really overstretched,
under-resourced burnt out team members. And then, there is the practice really
of constantly centering the needs and the priorities of the system and not the
individual. So from a patient safety lens, the home allows you to really undo
or reverse some of that. So from a nurse's perspective, the home is where the
patient lives and heals. Now, once you're discharged from the hospital, you
typically go home, you try to catch up on all the rest you've missed, try to
have a full meal that's appetizing and of your preference, and you try to spend
time with your loved ones. I want to know as a nurse why we can't do that while
a patient is hospitalized. And within this model, we can help the patient
really prioritize their needs on their journey to out of being sick into being
well.

So in short, I am a full spectrum of experience, right?
Myself, a patient at times. In short, if I had to be hospitalized today,
knowing everything that I know about the system, how it works, its strengths,
its opportunities, if I had to be hospitalized, I didn't require urgent
surgery, I didn't require trauma care or ICU level care, I would absolutely
choose to be hospitalized at home.

Host: And as you mentioned, it seems like a majority
of patients do prefer this. And I like how you say home is where the patient
heals. That really brings it home. Grace, I want to thank you so much for your
time. As we wrap up, last question, is there anything you want to add?

Grace Walker: I would challenge one thing as we're
rethinking this norm, we can also really consider this as an opportunity to be
able to begin to repair the patient-provider relationships. We can do that by
prioritizing what is really important to both groups, safe, equitable, high
quality care that actually improves the patient's overall health outcomes. A
little tongue in cheek here, it's really hard to get a nosocomial infection
when you're not in the hospital. And it's also really difficult for a provider
to be able to influence for the positive the patient's health if the only place
we ever see the patient is within our own environment that's designed around
the environment's needs, not the patient's needs. So, I really think this is a
fantastic opportunity for everyone, especially the patients and the providers
who are working in the model. And I would encourage everyone to be prepared for
not if, but when.

Host: That is right. Not if, but when. And I like how
you said this is a real opportunity to repair the patient provider
relationship. So, this is a benefit in many ways. Well, Grace, thank you so
much for your time in informing us about this. knowing the ins and outs,
especially when it comes to risk management. Grace, thank you again for your
time. We appreciate it.

Grace Walker: Bill, it's been a pleasure. Thank you
again for the invite.

Host: And once again, that's Grace Walker. And join
the American Society for Healthcare Risk Management in celebrating HRM Week,
June 19th through the 23rd, 2023. This annual event held in the third week of
June is the time to show your appreciation for healthcare risk professionals in
your organization and your community. For more information, visit
ashrm.org/resources/hrm-week. In addition, ASHRM is accepting nominations for
the ASHRM Healthcare Risk Management Professional of the Year Award. Just go to
ashrm.org/education/risk-management-award. And if you found this podcast
helpful, we ask you to share it on your social channels and check out the full
podcast library for topics of interest to you. I'm Bill Klaproth. Thanks for listening.