Dr. Mike Smith (Host): This is Transformational Pediatrics. I'm Dr. Mike. And with me today is Dr. Alejandro Quiroga, the President and CEO of Children's Mercy. In this episode, we explore the topic from fiction to focus, how Children's Mercy re-engineered nursing workflows with Helen. Allie, welcome to the show. Of course, that's what you told me to call you. That's what you're known by. I'm excited to learn about what exactly this app is. So, tell us about the Helen app, what is it, and what drove Children's Mercy to implement it?

Dr. Alejandro Quiroga: Well, thank you so much for having us and to think about this great innovation talked about in this podcast. So when you think about the Helen app, it's really less about the technology and more about technology enabling people in a high acuity setting of healthcare to work not only at top of license, but give them space to be able to perform all their duties, making the job doable, which is something that is not always there.

We've seen hard burnout in healthcare. We see shortages in nurses and physicians, and they're about to get worse. And the way to solve this problem is just not going to be enough for us to train more people and attract more people into the field, we need to do that, but we really need to redistribute some of the jobs and tasks that happens in a hospital to make the job more possible. And that's exactly what Helen does. So, let me explain what it is.

On any given day the amount of time that specifically a nurse in a med-surg unit will dedicate to nursing task only is like about 30%, which I hope that's a shock, because that is like what we really need nurses for. Then, the rest of the day is a lot of things that other people can do. And we also don't have enough data to track this on a daily basis in a hospital. Most hospitals, I am willing to bet don't have that data. The only data that they have is ratios and maybe a little bit of acuity.

So, what we did is we bypass the nurse call button. Like, this is a technology that has not evolved in the past 100 years, right? It started with a little bell and like now it's electronic, and in the best case setting has a speaker now. But it goes to the same person. It is a nurse or a nurse tech. And what we do is like give the patient an iPad or an app that they can now solicit from a concierge person that someone that works for Helen, we call them Helen concierges. And they have about 800 types of commands at their hands where they don't need a nurse. And we also give an app to the nurses to have on their phone to request things from the concierge people and from other type of ancillary units in the hospital-- people like transportation, people like environmental services, people like supply chain. And what this does is it creates a more modern communication in a hospital.

When I talk about Helen, it's really funny, because this is something that I would expect that hospitals operate like this, but hospitals still operate in a very manual and archaic way. So, what we did is just brought us to the modern world. People use apps and connect things. And what it has given us is giving nurses in our hands at least one hour of time per shift.

Host: Yeah. So, we're talking about-- so, Helen is services like "I need another pair of socks," or "I need more pillows" or "My bed's not going up and down correctly," stuff like that.

Dr. Alejandro Quiroga: Yes. From a patient perspective like, my TV tube is not working, water, things that you don't need a nurse to get to you.

Host: So, you surprised me a little bit when you said a nurse right now-- like, well, I guess in the older system-- a nurse only spent maybe 30% of the time doing the tasks that the nurse is certified to do. I mean, 70% of the nurses' time was more of these concierge services. Is that correct?

Dr. Alejandro Quiroga: Not all is concierge services. That is a good point of clarification. In that 70%, there is documentation, there is all sorts of other things. Our hypothesis is how can we get that 70% change that ratio? So like, maybe it's 50% or 60% of the time you're doing nursing stuff, which nurses love to do that. That's not the part that burns them out. What is burning them out is this cognitive load where you are getting pinged by a pager, a cell phone, overhead page, all sorts of things that are happening. And you don't have a way to react fast to all of that. And there's no compilation of curation of what gets to you and what doesn't get to you.

So, what we're trying to do is take away from that cognitive load and allow you to do your job. So yes, that is a surprise, and it should be a surprise. Because I think instead of trying to like double the workforce, we should try to double the time that nurses are doing nursing work.

Host: I think you're right. You're onto something here, without a doubt. So, how do you assess the app's impact? Are you looking at operational outcomes, clinical outcomes? How are you assessing this?

Dr. Alejandro Quiroga: It's a great question, and it's a really hard question, and we've been wrestling with that a lot. There's multiple measurements that we have. And that is also what's very novel. And it's harder for us to explain to the community. But we're measuring from steps that the concierge are doing to how fast they're picking up the task to the number of tasks. And we're translating that into nursing time at the same time that you have to look into nursing retention, nursing satisfaction, patient satisfaction, and so on. And what we can see is all of those scores go up significantly.

Host: One question I want to ask is really, I guess, related to kind of risk. So now, you have, you know, maybe some non-trained people who are in the hospital floor who are coming in and out of rooms. Was there any issue with that? Any risk that you took on to save nurses some of this time?

Dr. Alejandro Quiroga: So, there's no risk. First of all, these people are highly trained in hospitality. So, they undergo the Ritz Carlton type of training, Disney type training. And there's rules. They are not allowed to touch patients. And that was very clear. Like, they're not allowed to mobilize patients. We have to train them in regulations, HIPAA, we have to train them in what can they say, what they cannot say. So, we took away anything that it could be clinical, and that is very important. It did not allow for like any scope creep and just keep them focused on hospitality.

And that is not uncommon for hospitals, right? We have environmental services people that we have to train them in all of these rules, but they're like not going to walk in the room, and it's like, "Okay, let me help you with, you know, your oxygen." That's obviously not, right, or mobilize a patient. You have to understand the patient condition to know how much you can mobilize someone or not. So, this is very de-risk from that perspective, and we've never had a problem.

Host: Yeah, I am curious how long have you been using this app now?

Dr. Alejandro Quiroga: I think like our pilot here, it's probably now four months, something along those lines. And it is working really well.

Host: I was going to ask. So, what kind of feedback are you getting? Not just from the nurses though, I'm also interested in what the patients and the family of the patents are saying.

Dr. Alejandro Quiroga: This is a game-changer. And I mean, first, it was designed to help nurses, and it does. And when my team rounds, when I round and we talk and interact with the nurses, plus the comments that we've gotten, informal feedback forms, it is a little bit interesting to me. Because first of all, there's a recognition that this is a little bit of a, "Duh, of course." Of course, this works. And at the same time, it's so intuitive or so counterintuitive to what the industry does. That in a way, it's special on its own from that perspective. So, great feedback, making the job doable, making the job possible, saving significant amount of time, allowing more time to connect with the patients and the family, making it more meaningful. And from the family's perspective, the same thing.

One thing that happens in hospitals that every healthcare leader should be working on that. And this is unfortunately very relatable. When you are in a hospital, whether it's a children's hospital, adult hospital, and I've led both, patents are concerned about the state of mind of their care team. What I mean by that is it won't be unusual for someone to be thinking, "How's my nurse doing today?" That's not okay. That is a failure of the system, right? We have normalized this burnout. And we have made this job so not doable that patients know and you are in this moment in your life where you are very vulnerable, and it should be all about you. And healthcare makes it about healthcare. And you should be there in that bed thinking about "Hey, I need a glass of water," and that will make my healing journey better, that should be the only thing that matters. But what we do in healthcare is like, "Buddy, you don't understand. The guy in the other room is dying." And that's like true, but how we can create a system where that tension doesn't exist. And Helen alleviates that.

Host: You're making a fantastic point, right? I've been a patient before. I'm a doctor, but I've also been a patient. I've been in the hospital. And I remember times wanting a glass of water, but not wanting to bother my nurse. I would literally, like, want that water. I'll be going, "Yeah. But he didn't look like he was having a good day. He seemed a little rushed and stiff, so I'm going to leave him alone."

Dr. Alejandro Quiroga: Exactly. And we need to take that away from that interaction And by the way, the nurses are also trained to triage clinically. I'm a physician. You're a physician. We're trained clinically, right? "Hey, the other guy's dying. We're going to pay more attention to that right now. You're fine. It is not like we're neglecting you. But if you want water and the other guy's dying, we are going to prioritize the guy dying, right?" There's no argument there.

But then, the healthcare systems have not figured out how to make it about you. What Helen does is it makes it about you. Because the Helen concierge, they're not thinking about acuity. They're not thinking about triaging. It's all about hospitality. And so, when you need a glass of water, what we're measuring is how fast does that glass of water get to you? And were they nice and were they smiling and were they appropriate? We're measuring the right things there. And they have no other pressure than that. Are they helping their nurses? Are they helping the patents? And there's this lubrication layer of hospitality that did not exist, and healthcare systems have not figured a way to make that fiscally responsible. And we think we're into something.

Host: I think you are too. Again, this is fascinating to me. Are you aware of how many other hospital systems are using a Helen app or a Helen-like app?

Dr. Alejandro Quiroga: Yes. One other hospital system right now, maybe two. I will say that the other hospital system that is using it, I used to be the president and I implemented it there.

Host: So, you've been all over this. You're right because, you know, at one end, I find it fascinating in how obviously you have a vision for this. But yet, it is kind of like a duh moment. Of course, we should have an app like this.

Dr. Alejandro Quiroga: Of course, right. Of course, it should be about the patients. Of course, the clinicians should be doing clinical triage and seeing acuity. And of course, we should try to save time to nurses and make that 30% bigger. It makes sense. It works. But when you look a this from an orthodoxy perspective in healthcare, healthcare as an industry cannot make sense of this. Clinicians can, patents can, and that's the only thing that matters to us.

Host: Yeah, this has been fantastic. I'm really excited to hear that Children's Mercy is using such an app. I think this obviously the outcomes, as you continue this for many more months, It's obvious the outcomes are going to be very positive across the board. I don't see how it couldn't be.

Dr. Alejandro Quiroga: The questions are going to be about the financial modeling of this, and that's going to be for healthcare administrators. And we're going to prove that that is a very narrow lens, and that the ROI has multiple facets. And this is going to be very fiscally responsible. And when we are in a position where we can outrecruit anybody else, because we're doing what's right, when we're in that position when we have better outcomes because we're doing what's right and we're supporting the teams, and we have a vision for how healthcare looks so differently, there's a great financial model behind that.

Host: Again, fantastic. I'm very happy that you're doing this, that Children's Mercy is leading the way. Any last words for the listening audience?

Dr. Alejandro Quiroga: Well, I'll say thank you for listening to this. If you got so far, like you are very into the weeds of what Helen is and like you are getting a flavor for what we're doing here at Children's Mercy, we are dreaming big and we're caring for the sickest kids of this community in ways that Helen just shows you the surface of that iceberg. We are deeply committed to doing what's right in healthcare.

Host: That was Dr. Alejandro Quiroga, President and CEO of Children's Mercy. For more information, visit childrensmercy.org. If you enjoyed this podcast, please share it on your social channels and explore our entire podcast library for more topics of interest to you. This is Transformational Pediatrics. I'm Dr. Mike. Thanks for listening.