All right, good morning, everyone. Thank you so much for the opportunity to come and speak here. So yes, why would a critical organization structure, a critical organization, appeal to APPs, Advanced Practice Providers, RNs, pharmacists, and all the different service lines that come and touch us in the ICU? I have nothing to declare, no disclosures, no conflicts of interest with this talk. And I'd like to be able to talk to you about some background of mine and us here at Emory in critical care for context, talk about some of the perceived benefits from our perspective, talk about some of the concerns, and then share a little bit of our experience, especially here during the pandemic, which are relevant. So as Craig mentioned, at the Emory Critical Care Center, I'm privileged to be able to serve as the chief advanced practice provider, where we have 80 attending physicians, 210 advanced practice providers, collectively ACNPs and PAs, 230 respiratory therapists, and 1,500 critical care nurses. This is across 17 different units across six campuses. In Atlanta, including the medical intensive care units, surgical intensive care units, neurocritical care, cardiothoracic and cardiovascular ICUs, as well as coronary care units, and some mixed, come to the ICU if you're sick, come all ICUs. In January of 2018, in critical care medicine, some of my esteemed colleagues here on stage wrote critical care organizations, business of critical care, and value performance building. And in that, they concluded that a CCO that incorporates functional, clinical, horizontal, and vertical integration for ICU patients and survivors, aligns strategy and operations with those of the parent health system, and encompasses knowledge on finance and risk, will be better positioned to succeed in a value-based world. So what does that mean for us at the bedside? Nurses, APPs, pharmacists, all the teams that come and touch the patients, well, we're used to this multidisciplinary, inclusionary approach, right? We take, for instance, rounds, multidisciplinary rounds. We are used to, if we think about the light entering into the prism going outwards, and if we look at that backwards, right, we are used to the idea, on an everyday basis, of coming together, multiple teams coming together, presenting what they can, being able to then put it together, and send it outwards towards better patient care. So can we take that, and magnify that, and look at it from the point of view of a larger organization, CCO structure? So some of the benefits of a CCO from the point of view of the APP, of the nurse, of the pharmacist, of all of the teams that come to the ICU. There's an improved resource utilization, consolidation of these resources. There's the ability to standardize, as Dr. Cooper-Smith mentioned, standardize the quality that's being put out there across disciplines. There's improved communication and the ability of achieving ease of dissemination of all the information, the knowledge, the innovation, and again, we saw that, especially during the pandemic, when we needed to be able to very quickly have quick turnaround, and be able to share this system-wide. Thank you. There was a perceived reduction in duplicating efforts. We didn't want to figure out that we were 69% on our way towards a path of completion, and then find out at the last minute that, oh, wait a minute, something else was happening right next door, and we didn't know, and I wish we would've kind of worked together. And then, of course, there's comfort in numbers, the sense of belonging, the ability to kind of know that we're, as the phrase goes, we're in this with other people, we're going through it together, we're not just by ourselves, and this, in turn, helps with recruitment and retention of staff. There's the economies of scale, the ability to have, as was mentioned before, the cost of the work and the cost savings, cost control, through greater efficiency in our efforts. Some of the concerns with CCOs really stem from a preference for traditional departmental silos. There's a fear that there may be a discouragement of individual advancement. We're too big, we're too inefficient, and now we are in the middle of something where I'm worried I might get forgotten about or lost. A decreased individual autonomy, program autonomy. For APPs and nurses, this applies in the sense that we're worried, again, that we are not going to be able to shine and be noticed for the things that we are specifically working on, specifically doing. And salary disparities across departments. This, I think, is less of an issue for allied health and nursing because our parent organizations are very good at being able to identify lattice structures and advancement ladders independent of the, or in a larger scale rather than specifically within the organization. Thank you. So finally, our experience in the Critical Care Center during the pandemic. Lots of interesting things that we learned and we wanted to share with you. As you can imagine, we had to do things that required a quick turnover. We had to be able to respond to needs from the system, stressors that were coming upon us, but we had to figure out a way to not only have a quick turnaround in our responses but also implement system-wide integration and immediate implementation. And in order to do that, we had to have broad communication amongst not only service lines but multiple disciplines, and we had to be able to share our innovations, our inventive solutions. If we are using baby monitors to interact with the people at the bedside in this ICU, in this hospital, we need to let other people know that this is happening. If we are doing this innovation, if we are implementing this kind of workaround, let's get it out there, let's share it with folks. Broader communication and the dissemination of this information really was achieved with town halls that we implemented. These were initially weekly. Thankfully, they are less so now, but at the height of it, we invited anyone and everyone who was involved in critical care, anybody, from C-suites to respiratory therapy, clinicians, consulting services, APPs, nurses, nutritional support, the list goes on and on. Anyone who wanted to hear about what is happening in critical care in all the ICUs, both individual as well as collective. That gave folks a place, a venue, a time, a predictable place to go to to say, okay, I know I am being looped in, informed, and then we invited the reality. It was information, it was dissemination of real-time information, it was statistics, it was talking about resource utilization, talking about ventilators, talking about CRRT machines, talking about staff, what's happening with our MD staffing, our APP staffing, our nursing staffing, our respiratory therapy, our pharmacy, what are our challenges, what's our boots on the ground, and what's coming next week. That was then also tied into the realities, the stories, the wins, the losses, what's happening, quotes, actual dissemination of real-time data, real-time stories, real-time emotions, such that the hope was people walked away from that saying, okay, there's transparency, there's up-to-date, reliable information that I'm able to walk away with, not just with what's affecting me, but what's affecting other professions, other people around me. That was predictable, and that was disseminated in a way where we can come back weekly and whenever needed. Again, improved resource utilization. We could talk about the equipment, what was going where, what was needed where, who was going where, how were we able to staff the holes, staff the emergencies, get things done, get things covered, being able to say, okay, if we don't have enough, we are going to stretch ratios. If you're used to covering 10 patients, you are now going to cover 20 because we just don't have the staff. And being able to say, okay, we're bracing for impact, we are bracing for this, this is happening here, it's likely gonna happen here. So the ability to be able to disseminate information widely. Ease of movement of staff, again. And then to be able to create and track quality standards across the center, system-wide, to be able to share this information with everyone who wanted to know, our administrative colleagues, senior administration. This was very, very challenging, but also very well thought out and well disseminated across the center. This eventually leads to an enhanced, efficient patient care experience, we hope. And in turn, not only hopefully provides an improved patient satisfaction, but also employee engagement. And eventually a value-added contribution. You know, in closing, if I'm a new staff PA and I'm coming into an organization, I can ask myself, do I want to work in a small silo department where I don't have the, I may not necessarily have the confidence that everything I'm doing is being noticed by the bigger organization? Or do I want something that is larger and matrixed? One would guess larger, but there's a caveat. We wanna make sure that there is maximal efficiency and that efficiency is being recognized and it's a churning machine and there's conversation and there's collaboration and there's evidence of cross-pollination and dissemination of information. Oh, that's all I got. Thank you very much.

Critical Care Organization

healthcare industry

resource utilization

quality standardization

communication