Complexity to Clarity: Mapping Virtual Nursing for Change Webinar

Kayla Hayward: Welcome everyone to today’s webinar. This is Kayla Hayward with the American Hospital Association, and I’m pleased to be moderating today’s webinar, Complexity to Clarity, Mapping Virtual Nursing for Change. Today’s event is sponsored by Tegria. We’ll begin today’s webinar with a presentation, and we’ll have time at the end of the hour for a question and answer session. 

You can submit any questions you have throughout the webinar by selecting the Q&A feature you see on your screen. We like the session to be interactive, so we are looking forward to hearing your questions. If at any time you’re having trouble with audio, please try refreshing your browser. You may also submit any technical questions into the Q&A box. At this time, I’d like to thank today’s webinar sponsor, Tegria. Healthcare is complex. 

But making improvements doesn’t have to be. Join us today for a dynamic conversation on how healthcare teams are using experience alignment tools to drive real lasting change across their organizations. In today’s webinar, you’ll learn how visual tools like journey maps and service blueprints support effective transparency, collaboration, and prioritization from different levels of detail and perspective. 

Apply to the critical and emerging strategy of virtual nursing, learn how investing and experience alignment can be useful at different phases of the journey to bring clarity and cohesion, resulting in a higher degree of sustained success. These tools help you see the big picture and the little details, revealing bottlenecks, inconsistencies, and opportunities hiding in plain sight. 

At this time, I’m pleased to introduce today’s speakers. 

Erika Smith, Executive Director of Transformation and Integration with Froedtert ThedaCare Health. Kristal Whittmann, Director of Access and Experience with Tegria. And Anna Schwinn, Healthcare Service Designer with Tegria. A warm welcome to all of our speakers today. I’ll now hand it over to Erika to begin today’s presentation. Welcome, Erika. 

Erika Smith: Thank you, Kayla. We’re excited to be here and I’m excited to share a little bit about my health systems journey, ongoing journey with virtual nursing. And we hope that this team will also be able to at the end of this webinar assess where these experience alignment tools could be leveraged to drive value and system-wide change applied to something like a transformational project such as virtual nursing. 

So first, we’ll start with our why. And me and my team tend to get involved in work within the organization that is complex, that spans multiple departments, and is a strategic imperative that we have never done before. So that’s really when the Transformation and Integration Office team members get involved. And one of the primary places to start as we think about strategies that we’re prioritizing, putting effort behind us, is making sure that we’re able to articulate why this is important. And when I entered into this work about a year ago, it was already something that our health systems had been dabbling in. But I found that everyone I talked to about virtual nursing, both the why and the what, were sometimes talking past one another. We were using different language and we hadn’t fully aligned on sort of the key problems to solve. And so that was sort of our first step in this work is really helping to understand from the internal and external landscape of why we should care about virtual nursing. So this slide really represents how we landed on our why is about our team and it’s sort of serving multiple purposes, right? As we think about the team needs in our hospital environments today.

We have significant workforce challenges that virtual nursing can be a solution or a catalyst for. We know that we have nursing shortages, not just in the state of Wisconsin, but nationally. We also know that we have retention issues. So both burnout and that some of our younger workforce is also leaving the profession at a higher rate than even some of our more tenured staff. 

And so this is resulting in what’s being described as a complexity gap where we have experienced staff leaving the workforce and newer team members that need coaching and support. So all of this sort of why virtual nursing, it’s about supporting our workforce and having a sustainable, safe workforce. All while we’re knowing that we have increasing capacity ⁓ needs on the acute care side. We have increasing demand for beds. 

We as a system are trying to increase our acute care capacity, as well as, you know, in Wisconsin in particular, we have an aging population. And so the folks that are gonna take those beds that are gonna need care are rising in acuity. And so this strategy, as we sort of dove into seeking to understand and aligning on common language really came forward as a strategy for multiple potential desires, right?  

So, we want an optimized care team that’s practicing at the top of scope. We want to be able to address real workforce shortages and retaining our current staff while we’re expanding acute care and really seeing an enhancement in our adoption of digital and virtual tools in acute care environments. 

So that’s a resounding hopefully why for you to get excited about. But when we think about what is virtual nursing, it’s still something that conceptually oftentimes you can think about. And this schematic I think helps put out sort of the obvious tenants of what must remain within our bedside care teams and what could be shifted to virtual. But in a sentence, virtual nursing is really about delivering patient-centered care and services from a remote or virtual location that can help augment our bedside care team members. The sort of features in the Venn diagram here aren’t incredibly specific, right? So we think about what could be done virtually, what has to be done at the bedside, and then there’s quite a bit of overlap. And so when we were facing, sort of getting into specifics in our system, it was important to sort of start with the high level schematic and then really be able to articulate and focus on some of the foundational strategies also listed below. So what is that value proposition that we’re seeking? What are these team-based models that we need to develop? And then how will we help make these workflows easy and technology enabled? 

And so again, we kind of wanted to look at the market to say, well, what are other systems doing in this space? And really kind of dive into example models out there in the literature. And what we noticed is that there’s sort of two organizing foci emerging, where you can see systems that are really trying to lift and shift tasks from the bedside to a virtual team, as well as those that are really focused and centered on being more there for support, coaching, surveillance, et cetera. And so we sort of organized our initial sort of outcomes map in this functional versus care partner space. And I think what’s really exciting is that when you think about the domains of how we measure value across care quality, across experience, across efficiency, there’s proven value in both sort of columns. And these are big reputable systems that have been at this work. So it’s exciting to sort of be able to see that we’re seeing real value out there in the health system ecosystem. I’d love to invite Kristal to the conversation here as I know she has also done work across the nation in the virtual nursing landscape. 

Kristal Wittmann: Thanks, Erika. Yeah. You know, what these statistics support and what we’re seeing in the industry around virtual nursing really is the potential, as you mentioned, as a retention and development play. It’s not really about increasing ratios in meds or specialty units. It’s really, you know, quality of care, lifting and shifting some of the work strategy off of the bedside nurse. However, you may see some reduction in contracted staff and there’s some associated savings there. It depends on a lot of different factors. Like, are you only using contracted staff at night? And maybe your virtual nursing program isn’t going to function overnight. It’s only during the day. So there’s a lot of nuance to it. 

But Erika you also mentioned that nurses under 35 are leaving at four times the rate of their over 50 peers. So you just really want to hone in on that statistic. It’s unprecedented. We don’t see that in other careers across healthcare and other industries. So when the job feels more like surviving than caring for people, the younger nurses are leaving more quickly. So I think that we can restore some of that joy in nursing. And this is one of the plays that can help us do that. And I think that if we do it thoughtfully, we can see that dynamic change. 

Erika Smith: Thank you. So again, I said our health system has been at this in earnest for about a year. And so just want to share a little bit about our journey to develop that cohesive strategy. So again, we sort of started with our why, we looked to the market to understand models out there. And then we really brought together a team of more frontline nurse leaders to help us sort of do a deeper dive in these various capabilities or programs that could be sort of labeled as virtual nursing. We focused on 14 potential capabilities and really did a lot of discussion and mapping of those. And then within that nursing team, prioritize sort of the top 50%. We sort of stayed with that functional care partner, but you can see we had some that we thought kind of really met the mark of both. It sort of offered both a lift and shift of a task, but also an opportunity to offer coaching for a more junior workforce, et cetera. We then really wanted to engage a more diverse audience as we thought about prioritization. And so we had a virtual nursing summit that the team then did sort of posters and we did a gallery walk focused on that click down of our top seven to make sure that we were thinking and prioritizing engaging stakeholders from different perspectives. 

And then we were able to kind of take all of that feedback and start to think pragmatically about, okay, we want to move this into a phase towards implementation. How do we think about what can we do now? As I mentioned earlier, both regions in our system had been doing elements of virtual care and virtual nursing. And so we had some competency to build from, but we also wanted to, you know, kind of accelerate and be able to do things in the near term with a little bit more planning and resources. 

And then we also kind of knew that there were things that we wanted to keep our eye on, but that we would need either a more significant technology investment in, or were capabilities that we wanted to watch. We wanted to see how the market evolved. And so we bucketed our sort of implementation strategy into a now near and far framework. 

And then we continued to sort of go at this work. And so I wanted to just share one more click deeper of how we’ve then sort of said, okay, we’ve got our strategy outlined. How do we really continue to advance this? And so we bifurcated our teams in a way that we wanted there to be consistent focus on as we think about the bigger play for an investment and a more innovative care model that might require a new technology or specific change in roles that we have a team kind of focused on vendors and solutions that could help us. And then at the bottom, and I’m sure Anna’s bringing our slides back up, we had sort of that implemented iterate section where we said, we know we had started some work in admissions. We can continue that. We can continue to learn. We had started some work in tele-observation and monitoring models. And so we have two different regions that also had different top priorities. And so it was important for us to kind of allow for continued iteration and implementation with the models that we had while we were doing thoughtful due diligence around bigger investments in technology and other solutions. 

I think the I’ll just go on the next slide that I have on my other screen here is, you know, right now then where we’re at is we have a variety of opportunities that we’re facing, right? We have an opportunity to think big picture and make sure that as we look at making a more significant investment or a more disruptive change play that we can match our priorities and the care model we want to build to the solutions in the market. 

We also have been sort of more narrowly engaged, I would say, with our core nursing executives and a few other teams. And now’s the time that if we’re going to ask for bigger investments of our organization, we need to engage a broader executive team on that plan. I mentioned that we have a focus on implementing now work. And one exciting thing that I think that has led us to is this is not only about sort of standardizing flow, that does come as a benefit, but it’s also improving. Our CNIO in one of our regions has done a great job in sort of as we’ve looked at admission processes, being able to reduce unnecessary questions and improve the workflow holistically so that as we shift work from a bedside to a virtual team, it’s actually an even better process for all. We’ve been inclusive and specific. So when we think about scope here, we started really with acute care nursing, but we know that if we’re going to make investments or adjustments that we need to think more broadly about other care team members that could leverage virtual tools or that become part of this team more holistically. And then as we think about what we are hoping to achieve in the near term, especially, we need to have empowered owners at that local level that are ready and excited to, you know, sort of way in and help in the design, but also adopt and be, you know, sort of able to learn ⁓ the new workflow. So when we think about change management, we’re sort of weaving in how do we make sure that we’re able to do that well. So this is a bit of kind of what we’re facing today. And I’m really excited to turn it back over to Kristal to kind of walk us through a little bit of what are some of those next steps. 

And how can these approaches and investment and experience be leveraged to support transformational efforts like this across different perspectives? 

Kristal Wittmann: Thanks, Erika. I appreciate it. Very well said. So today I’m going to tell you about four different nurses who are likely very similar to nurses that you have in your organization. And then I’m going to talk a little bit about systemic thinking before I turn it over to Anna to discuss the tool set. So this is Marie. I think we all know a Marie. She’s a nurse leader. 

She’s the kind of leader that has a foot in both worlds. She understands day-to-day reality on the floor, is a master at putting out fires, and can probably step into any care situation, put her gloves on, roll up her sleeves, and do the job. But she’s also accountable for strategic priorities, like throughput, quality, and nurse retention. So what keeps Marie up at night? 

It’s not just about those metrics. It’s the feeling that her nurses are burning out before they even get a chance to grow in their roles and become key contributors that the organization needs before they can become experts or inspire team members. So Marie is asking, how do we make this place somewhere people want to stay? How do we show that we are truly investing in our nurses, not just through words, but through actions? And maybe most critically, how do we make the case for transformation when the value isn’t always immediately visible on a spreadsheet? 

So let’s talk about Jen. She’s the nurse that every unit is hoping for. She’s skilled, she’s experienced, she’s trusted by patients and her fellow team members. But lately, something’s different. She is exhausted, she’s bogged down with day-to-day tasks, she’s watching the new nurses within her department struggle, all while she herself is being pulled in 10 different directions. She has got good ideas, but there’s no time to bring them to life. Jen wants to lead, but without time and support, the enthusiasm is turning into frustration. And here’s the hard truth. If we lose Jen, we lose not just a great nurse, but the ultimate role model. 

So what does Marie think? She sees this. She hired Jen. She brought Jen onto the team. She watched her grow and develop into the all star nurse that she is. And now she’s wondering how do we keep her or bring her back to being engaged? And how do we protect the part of her role that really gives her joy and doesn’t drain her? 

And now I’ll zoom in on Toby. He is the lovable guy everybody wants to bring onto their team. He’s a new nurse. He’s energetic. He’s compassionate. The patients love him, but he’s also overwhelmed and he has some gaps and he’s aware of those gaps, which gives him a little bit of a shot to his confidence level. He wants to learn but there’s never enough time or support because everyone else is busy. So Marie watches him and thinks, we need him to succeed because we need him to turn into our next gen. We have to set Toby up to thrive or we won’t be able to retain him. So she asks herself, how do we build a structure that grows Toby’s confidence instead of eroding it? 

How do we make space for the mentorship that needs to happen when everyone else is stretched so thin? And maybe most importantly, how do we make sure Toby doesn’t lose the spark that brought him here in the first place? 

And lastly, we have Betsy. Everybody also loves Betsy. She’s the grandmother that we love and care for. She’s the kind of nurse who knows every hallway, everything about the system, and has experienced every single patient type, all of the different personas. She, a while ago, transitioned into quality because bedside nursing was just becoming too physically demanding but she has found herself still remaining unfulfilled. She misses the purpose and the connection and the impact that she used to make at the bedside. So now Marie knows, because they’re friends, that Betsy’s thinking about retirement. And she knows also that Betsy will not be happy unless she’s contributing and making people’s lives better. 

So she thinks, how can we tap into Betsy’s expertise in a way that energizes her, supports the team, lets us retain her wisdom at the bedside, even if she’s not physically present? That’s the big part of what virtual nursing can help unlock. 

Now here I’m gonna tell you a little bit about systemic thinking. So bear with me for a moment on these slides. last four were a little bit more fun, but this is also really important. So we have the full inner workings of a healthcare delivery system here. The system that creates experience. Experience isn’t built at the surface. It’s generated by the structures underneath it. 

And this is where systemic thinking becomes essential. Because in a system, no outcome exists in isolation. When we take a system lens, we stop asking, how do we make patients happier? And start asking, how do we design every part of that foundational system to support excellent care? Things like quality and service. How do we develop support and personalized care delivery through people, process, and technology? That directly influences our care team satisfaction and not vaguely. When we invest in intuitive workflows, effective delivery tools, digital tools, and supportive structures, our care teams thrive. 

I’m personally in the process of publishing my doctoral level research and have found that perceived ease of use and perceived usefulness of digital tools and workflows correlates with increased technology adoption and directly influences the quality of physician and patient interactions. So when we don’t intentionally design these things, things like frustration, inefficiency, and burnout are soon to follow. All of it ripples outward into retention and productivity, which are both critical for maintaining consistency and effectiveness at the bedside. 

Do we see the downstream impact on care experience? How do we see that? Anna will tell you in a few moments. What patients feel is an outcome. It’s not a starting point. So if you’re only measuring patient satisfaction, you’re seeing the symptom, not the system. This model helps connect those invisible layers of work, digital alignment, how we design workflows, how we’re enabling our care teams, back to the measurable outcomes that we care about. It’s a reminder that if we want better experience, we have to build better systems. 

And this builds on what we were just talking about. So if you take a view out from the inner engine of the healthcare delivery system, this next layer shows us how the engine fuels those meaningful outcomes, both for the patient and the organization. So because experience doesn’t stop at satisfaction and neither should our strategy, when care teams are supported and empowered, through quality processes, smart tools and aligned operations, we see better care interactions. And that translates to improved treatment compliance, stronger health outcomes and more holistic human-centered care. That’s where patient satisfaction shows us, not as a soft metric, but as an indicator that the system is working the way it should. But again, we don’t stop there.  

Satisfied patients become loyal consumers. They return, they refer others, they build strong relationships with our health systems. And with that comes trust. Loyalty is powerful. It improves engagement, protects reputation, and ultimately drives growth and fidelity. A sustainable model for delivering exceptional care. And running through all of this is leadership alignment. That’s what keeps the engine running clean. I know Erika has some important thoughts on leadership alignment, so I’m going to ask her to speak a little bit about that. 

Erika Smith: Thanks, Kristal. Yeah, I think, you know, the great thing about systems thinking is it allows you to kind of zoom out and be able to sort of see the interdependencies and connect, as Kristal was saying, to, you know, how this process over here results in this outcome. 

But it can also be a little overwhelming and it can lead to challenges of where do we start when we think about surfacing challenges or pain points. And so that is where I think that top line of leadership vision and alignment and making sure that leaders are willing to sort of make investments here and then provide direction and clarity on where the focus should be first. 

So I think it can be both if you’re a leader and you’re listening to this, this is a call to action. And if you’re supporting of leaders, it’s really about how do you bring your leadership team along and make sure that there is the ability for them to sort of see the value here and then help provide clarity as to where to focus and how do we make meaningful change with all of this beautiful mapping that 

Kristal and Anna will go into in more detail. 

Kristal Wittmann: Thanks, Erika. Yeah, so this model, you’ll notice in this version that we’ve added a North Star to this model to explain just what Erika was saying. 

This framework can serve as your North Star through your transformational efforts. It’s not just a visual, it’s a directional tool. It’s a way of keeping our transformation efforts aligned to what matters most, the outcomes for the patients and a sustainable system. So we’re not just talking about theoretical outcomes though, we’re talking about measurable ones.  

You’ll notice that when we improve communications and align digital tools in the real workflow to real workflow needs, we can help reduce errors, no shows and administrative burden. A strong patient experience culture doesn’t just feel good. It can boost morale and it can help reduce turnover costs. And these are proven statistics. This is not conjecture. So, and in today’s workforce climate, all of this is critical. Positive experiences, increased return visits and referrals, which means we’re not constantly spending to reacquire the same patients, all resulting in financial impact. Up to 30 % of CMS value-based payments are now tied to HCAHPS scores. And hospitals with superior experience scores can see up to 50 % higher margins. 

You’ll look at this and see the dark purple as patient satisfaction and patient loyalty are the most important thing on this. But don’t lose sight of the left side. Remember, care experience and our staff experience, how we’re retaining them, how we’re growing them is a symbiotic relationship. It’s what drives those dark purple boxes, which helps drive growth and fidelity. 

Now we can go to the next one. So this alignment work is so hard, but it’s also so necessary. Much of the value we’re trying to create in healthcare is what we usually call soft value, like trust, emotional safety, and confidence. But as you’ve seen, those soft elements are what ultimately drive hard outcomes, quality, satisfaction, retention, and financial performance. 

The challenge is that people are the hardest part of the system. They’re human. We’re emotional. We’re unpredictable. Standard improvement tools like Lean and Six Sigma help reduce waste, and they’re great tools. I’ve used them before in the past. They still have a place in this industry, but they’re also not built to understand the human experience. That’s why we need a different set of tools, one that brings in the human layer into view and helps us design around them, not despite them. And that’s where I’ll hand it over to Anna to walk us through how experience alignment tools will help us with this project. 

Anna Schwinn: Hello, everyone. I’m Anna. I’m the healthcare service designer for Tegria. And I’m here to talk about some of my favorite tools for navigating really big complex problem space and transformation. So first, the problem. Health care services and experiences are inherently complex, and they can be intangible and abstract. 

They’re shaped by intricate layers of people, process, and technologies. They’re delivered through a network of specialized functions and departments, each with its own priorities, language, and ways of thinking. And they’re deployed across a system of facilities, floors, and units with local cultures and processes and infrastructure and technology. So as a result, it can be very difficult for different functions and teams to collaborate. 

There’s a ton of data, but a lack of integration and solutioning can be really inefficient. Multiple teams may be addressing different parts of the same problem at the same time and local solutioning can produce additional unforeseen complexities and pain points. So it can feel like playing whack-a-mole trying to transform a healthcare system. So how do we get everybody on the same page and speaking the same language? 

And how can we measure the value of the opportunity? And how can we leverage the power of our brilliant functional experts to solve human-centered problems systemically and collaboratively? So that’s where experience alignment tools come into play. These are tools that are basically visualization tools that center experiences of humans in your system. 

They do a couple things. First, they align your multifunctional teams on the human-centered big picture. They help you establish where you are now, the current state experience and how well it serves the humans involved, what the pain points and gaps are. It helps you establish where you’re going to go. The experience you want to deliver, it helps you to define and articulate and socialize what success is and what it looks like. 

And then it also helps you make the case for change. It helps you make the case for the costs, helps you understand the cost of standing still and it helps you understand the value opportunity of transformation. And while it’s doing all of this, it can help you facilitate these big changes effectively, efficiently and probably most importantly, while reducing risk through system visibility. 

So in short, experience alignment tools give us a big picture to ensure that we’re solving the right problems that we’re solving strategically and with full visibility to everything going on. And this is where I bring up this quote, a problem well stated is a problem half solved. This is nearly 100 years old as a quote, and it very much resonates with me. It’s very helpful to think of experience alignment tools as visualized problem statements for really complex dynamic and abstract problem spaces. So we’ll talk today about two main types of experience alignment tools, journey maps, which you might have heard of, and service blueprints, which you may have not. And to caveat all of this discussion, first, these are two examples of many possible tools and strategies for visualizing systems and services and experiences so that they could be understood across teams. They are not standalone items. They are paired with different methodologies to support alignment throughout different project phases. And they’re flexible. They’re designed for the problem at hand. So they can be flexible in terms of structure, in terms of level of fidelity and also in terms of the type of content and context that they’re surfacing. And we’ll see some examples of that later. But just to quickly align journey maps, they’re visual representations of a person’s journey, their emotions, and they tend to use empathy to articulate a problem at many levels. Service blueprints, on the other hand, are big pictures of services. 

They serve as visual representations of a person navigating a flow or service. And they articulate service delivery at many levels of people, process, and technology. So moving forward, this is just a slide to show different phases of experience alignment across a transformative process. As I said, they’re useful at different phases and they can serve in many different capacities during the phase. In research, they help you align on the current state problem. They help you socialize. In development, they help you to visualize and share, socialize the future state. And then in implementation, they give you a plan, literally a blueprint on how to get there. And I’m going to pass it over to Erika for a moment to add some color here. 

Erika, please take it away. 

Erika Smith: Thanks, Anna. I just wanted to add, think in my experience facilitating transformation, oftentimes our team is not the deep content experts, right? But we are a voice for risk mitigation, communication, transparency in the organization. And what I get excited about in the investment of these, building out these tools is that they are sort of a sustainable placemat that can serve your journey and can really help be a place where iteration happens, where training can be built from, and where you can align sort of, right, executives all the way to frontline nursing unit-based workflows. And so I think of it as, Anna said this, right, risk mitigation, transparency, and being flexible that it can be a capability as a system you bring into your own and that can live on and help be sort of that sustainable foundation for future work. 

Anna Schwinn: Thank you, Erika. So exciting stuff for sure. So moving on, first we’re going to talk a little bit about journey frameworks because we’re taking a systems approach. So acute care is a complex end-to-end service. How do we make it more manageable to solve while keeping the system in mind? And this is where journey frameworks are very helpful. So in implementing virtual nursing, we must consider two primary groups of humans. 

First, we have the patients. And the patients are at the center of what our people, processes, and technology come together to deliver. So in this case, journey frameworks organize complex journeys and services into helpful, manageable structures. It’s like taking your service and creating high-level journeys that are comprised of journey segments. So think about macro journeys and micro journeys. 

This helps transformation by making your big experience more modular so that you can align journey segments to business goals, metrics, and initiatives in progress, and so that you can solve by phase. And it does this while helping you keep the big picture in mind. So on the right, you’ll see a high level structure. It’s not filled in. This is something you can take back to your system and fill out on your own if you’d like but you can see the alignment of pain points and gaps, metrics and initiatives in process with these high level journey phases. It’s really meant to be the zoomed out picture. And then here is a demonstration of a very high level acute care journey from the patient’s perspective. So while procedures or staff involved with the patient journey may vary depending on the unit or facility, the high level journey essentially looks like this. 

And very quickly, I’m sharing this view because journey frameworks like this help us orient on the patient experience, which in turns helps us collect current state pain points and gaps, identify ways to improve our patient experience and seamlessness between all of these different phases. And it also helps us keep an eye on how we can set our patients up for success post discharge. 

But patients are not our only critical human group. We’re talking about nurses. We spent a lot of time setting up that discussion. So I hope we’re talking about them too. The patient experiences are highly dependent on nurses and the nurse experience, and the tools they have to do their job. So again, to bring it back to the service delivery framework, Kristal did a fabulous job of talking about how the tools, people, process, and technology set our nurses up for success for a more satisfying experience for greater retention and productivity, and help them to deliver a better care experience to our patients. So again, just reminding everybody of our players here, we have Marie, our nurse leader, Jen, our mid-career bedside nurse, Toby, our new nurse, and Betsy, who is currently in quality control. So it’s…what we’re doing is we’re starting with them. So while these may not represent all of the nurses you may have within a system, they serve as very helpful archetypes for our discussion moving forward. And then this is just to help everybody align on the nurse experience in a day in the life of a nurse. So you’ll see similar phases to the patient framework, and that’s intentional. 

You can start to understand the modularity of using nurse experience frameworks to kind of break down the experience so that it can be seen through multiple, so that these journeys can be seen through multiple frameworks. So you can start to have conversations about how to set nurses up for success during these phases or as they transition between, and you can start to focus on their pain points and gaps as they serve patients. So you’re not just, you know, collecting patient pain points and solving for those. This allows you to focus on the nurses specifically. And you’re probably thinking, Anna, those frameworks are blank. Again, I’m presenting them as high level structures. They’re critical for transformation. They’re here to help put more detailed journeys into context. And I really wanted to demonstrate how little journeys can fit in a big framework. 

But I wanted to share this as an image of a framework filled in. You can see the modularity across the phases. And you can see how a view like this would allow you to kind of determine where you want to start, how you want to prioritize. And so you can start to connect upstream activities with downstream impacts. So just as an example of a higher level detail. So we’re here to talk about journey maps. 

When we want to zoom in from these big frameworks, to a higher level of detail, we use a journey map. Once again, these are visual representations of the step a person takes to achieve a specific objective. And because we’re taking a nurse focus, this journey is from Toby’s perspective as a nurse on a busy unit. On the right, you’ll see the anatomy of the journey map, the high level journey structure, the nurse narrative. 

We use iconography to communicate some themes throughout the journey, as well as nurse specific pain points. And the bottom here, you see this little scale of nurse emotional status throughout the journey. So you can see at a high level what themes are popping up throughout and how Toby feels as a result of different activities and actions taking place. 

Moving on to the next slide. So in our scenario, a map like this would be produced through workshops or interviews with many Tobys or Jens, because they’re the experts in the experience. Maps can also be made to show the experience from Jen’s perspective, a day in the life of Jen. The nurse narratives are at the top of the journey with themes and pain points to solve for an emotional status. 

Just going through very quickly, Toby visits the patient in the morning. He enters the room, writes down his name on the board, checks in with the patient, but he realizes he’s forgotten an important part of the patient’s plan and he must go to the computer in the room to search for the missing information. You’ll see this icon showing that there’s a delay in activity. And at the bottom, and I have to go back a slide. 

You’ll see that the pain points here are that Toby lacks experience and knowledge to navigate check-in without repeatedly referencing the chart. And this takes away valuable time from the patient. We cover med check. Toby struggles to quickly find a second nurse in quality. Jen pulls Toby aside because she found a critical lab was not drawn before medication was administered. And you can see the drop in emotional status due to Toby’s confidence. And then with questions being answered, Toby wants and needs coaching on interacting with the patient, but nurses are just not available. Maps like this are great because you can socialize these tools across the system. You can get additional feedback and you can ensure the problems that are featuring as pain points on these are the ones that we wanna solve for in future states. And we can do this for both the nurse and patient frameworks. 

And sharing this just as another example, it’s in the slide so you can read it at a higher level of detail later. But this represents the current state discharge journey from Toby’s lens. You can see that there are necessary costs associated and quality issues. So we have these different journey maps. Imagine we have a set of these that go across the nurse and patient framework. Now, now what do we do? 

From here, you socialize them across your organization. You get feedback from nurses in system facilities and units. You gather additional pain points. And your leadership can help to prioritize which ones we’re going to solve. And this is very beneficial from Marie’s perspective. The nurses are engaged with solving the problem. They feel empowered and they feel seen and heard because everybody, including leadership, can see what they’re dealing with and what their pain points are. 

So now everybody’s aligned on the problem. We can start developing the solution. Imagine in our scenario, we’ve gotten together a bunch of nurses, a bunch of gens. They’re aligned on the problems to solve through these socialized journey maps. Now using a service blueprint as a framework, these nurses can start to envision the future state service. So a service blueprint, once again, is a visual representation of a person navigating a flow with all the supporting service delivery components. 

So rather than focus on emotional status and pain points, this tool focuses on how the service functions, what the patient can see front stage, which is this top of the map, what is happening backstage to support that. And there can be additional swim lanes of supporting technology and information, important regulations involved and metrics that you might want to keep an eye on. 

So in this case, because it’s very early, we’re focusing on how the service will function, how it will look and feel, the critical enabling technology, as well as the value we gain with virtual nursing, beat by beat throughout this process. And just sharing this very briefly, this is the Future State Morning Check-in New Nurse Service Blueprint featuring our characters, Toby is the new bedside nurse and Betsy as a virtual nurse. 

You’ll see these green stars here as different phases in this very short journey that the team believes will be especially beneficial for someone like Toby. So rather than Toby going back and forth and referencing thing on the computer, he calls into Betsy as part of walking into the room and he’s working with Betsy to get through check-in. Betsy backstage is capturing information from the room. 

Well, Toby is getting time with the patient and is able to focus on being a bedside nurse. And meanwhile, Betsy is ensuring quality bases are covered and advancing discharge planning. Along the journey, you’ll see microphones, speakers, and a camera so that you can see what specific technology is needed to enable all of this. you know, perhaps if ⁓ you’ve got a site that doesn’t have cameras, it shows how they can implement parts of these journeys at a time. 

And then lastly, let’s see. So really, I guess the thing to note here is that in this model, Betsy is not a replacement of Toby’s knowledge. She’s there to help him become the nurse that everybody, including Toby, wants him to be. She’s there for support. And then I have one more example, but I’ll let you look at this on your own in detail. I’ve included a version of this for discharge also. 

Service blueprints like this illustrate how a new virtual nursing capacity could function and the value of the future state. It makes them effective for engaging and empowering nurses and care teams to design their own experiences. It’s very helpful for socializing the concept for feedback, identifying risks, understanding where there may be gaps in implementation beyond what leadership may have foreseen. 

It also helps to start conversations around technology partners. It promotes discussions with vendors and it helps you test the service locally so that you can refine the design. So this can be a very helpful view even though it is very narrative. And then the last thing I just want to show is a different version of this. So this represents a service that has been tested. 

This would be the type of service blueprint that you would use to quickly scale a service after you’ve determined what it is and you’ve defined it and tested it. And you can tell the difference between that because it’s not so much about socialization, it’s about operation. And it involves supporting information rather than value, supporting technology as well as metrics that you may be trying to hit with a service. So I’ll let you review this later on your own.  

Please follow up with questions if you have them. But that is the end of my portion and I will be handing it back over to Kristal. 

Kristal Wittmann: Thanks, Anna. That was the speed version of Anna’s presentation. So if you have questions, she’s happy to chat with you at any time. But just want to talk a little bit more about Marie, Jen, Toby, and Betsy. So what we’ve shown you today is how we think you can begin solving for all of them together. When we realign the system with intention, when we 

bringing these experience alignment tools into transformation. And when we design for the people, not just the process, we can unlock a future state where Jen feels supported, Toby gains confidence, Betsy gets to stay engaged, and Marie finally sees a path forward and hopefully can get some sleep. That’s how we create a system where nurses feel seen, supported, and energized and I’ll leave it with Erika to bring us home before our Q&A session. 

Erika Smith: Thanks, Kristal. So in the end of my section earlier, those colorful bubbles were there really sort of showing how even with sort of the work we done upfront, there’s still opportunities and challenges that we face. And so we wanted to sort of, again, sort of match those opportunities here with how you might apply it to these tools. So really around that high fidelity, big picture, engaging executives on future investments all the way to empowering ownership and adoption for a defined workflow and a training tool. And so very relevant and could be applied to other large transformational change that you’re seeking to do in your health system. 

Anna Schwinn: And with that, we’ll turn it back over to Kayla for questions. 

Kayla Hayward: Great, thank you so much, Anna. Yes, so we will now begin the Q&A portion of today’s event. As a reminder to our audience, you may submit a question for our speakers using the Q &A feature on your screen. Our speakers will answer as many questions as possible in the time remaining. Any questions that are unable to be answered will be shared with our speakers for follow-up offline. So I will kick things off with the first question here. How can these tools be used with frontline nurses in a time efficient way to ensure their voice is being incorporated? 

Anna Schwinn: I can give it a shot. So I think the superpower of these tools is that the experts in their nurses are the experts in their own experiences and the services that they provide. And the opportunity of experience alignment tools and these frameworks, such as service blueprints, is that they can be used paired with workshops, working sessions, as collaborative tools, as collaborative framework so that nurses can really design their own experiences. And I’m not quite sure, I don’t have the sighting on me, but generally, services that are designed by the people who actually provide them tend to function better from engineering and manufacturing, and it is practice to work with people on an assembly line to help them design their own tools, their own processes, and their own quality processes. So does that work for you, Kristal? 

Kristal Wittmann: Yeah, absolutely. 

Kayla Hayward: Great, thank you. Next question here. What approaches to prioritization have been used so far to accelerate this work? And how do these tools help in navigating those conversations? 

Erika Smith: Yeah, I’ll speak a little bit to our journey. Right. think as Anna was alluding to, we intentionally started from the nursing leadership perspective and sort of that more frontline manager that is closer to the bedside to help us think about the reality of all of these different capabilities that are out there in the literature. And then what are the key challenges that our health system is facing or that our bedside teams are facing? And that was a way to get an initial cut. 

And then quite literally we did like a, you know, gallery walk and engaged team members on their perspective as we shared our drill downs on the capabilities that we had taken that first 50 % cut for. I will say, I think these tools could allow for a different approach and probably a more systematic approach. If you think about being able to map the system more holistically. And as Anna said, some of the tools you can sort of already have, what are those KPIs that we’re saying we want higher quality care or shorter length of stay, but if we already have like top decile length of stay, we might not get a lot more bang for our buck there. And so it could allow for and facilitate different conversations and different areas of focus as we think about. 

There’s so much good work to do here. And so where do we start? 

Kayla Hayward: Great, thank you. OK, another question in the chat. How are team members selected for virtual nursing? 

Kristal Wittmann: I’ll speak really quickly and then turn it over to Erika. It really depends, I think, on the approach you take. Is it hybrid? Are you hiring your own staff or contracted service? What are what’s the care model you’re trying to employ? Are you doing admin and discharge? Are you doing a quality like sepsis monitoring program? Like, what are you trying to do? So it really depends. But Erika, what what did you have to add? 

Erika Smith: Yeah, I think that is philosophically exactly the right approach. You want to make sure you’re matching the sort of tasks that you’re asking with the right skill set. We at Froedtert ThedaCare had the benefit of having a legacy nursing EICU team that was already centralized. And so we’ve been able to leverage that team to help us in some of our smaller initial pilots. 

But I’ll say, right, like you probably don’t need ICU trained nurses doing admission assessments long-term. And so that is kind of that consideration of as we think about where we want to expand, what is that skill set? And then I would just say, I think some of the most successful models I’ve learned of in this journey is when you can actually have a trusted bedside resource also be represented virtually. So it really offers offers an opportunity if you design it that way to allow for right at the gate trust by building in some of those workflows and that cross pollination as a as an approach. 

Kayla Hayward: Great. One last question here. How can small rural healthcare organizations leverage this work to help their patients and staff on a much smaller scale? 

Erika Smith: We have an interesting mix within our health system where we have large academic medical centers, some smaller community hospitals, and then some smaller rural critical access hospitals. And so that’s where when you think about the problems to solve, they can look very diverse and different. And we’ve been trying to be thoughtful and inclusive in that way. 

But yeah, to Kristal’s point, one of the things that we started with in the admissions assessment space was we had iPads and we wanted it to be sort of visually appealing and technology enabled. And we found that that was a challenge to consistently adopt at that bedside team level. And so we were able to leverage the telephone. We continue to find some success. So not ideal in terms of great engaging experience, but has been something that we have been able to use to be able to test this model and how do we shift that work to a centralized virtual team and start to build trust in some of those handoffs. And patient feedback has been willing to engage with us in that journey as well. So I do think that’s one model. 

The other space that I would say we’re interested in is when you do have that centralized team that can help survey or keep an eye on patients, it can help with things like falls and recent transfers from a higher acuity environment to a lower acuity environment ⁓ and support of some of those more junior staff that might be working in those environments. So there’s been a lot of thought in our planning to how do we support both small rural and large academic. 

Kayla Hayward: Wonderful. Thanks, Erika. That does conclude the time we have today for questions. So I’d like to take this time to thank our speakers for their time and excellent presentation today. And thank you again to our sponsor, Tegria. In the next few days, all attendees will receive an email that will include a link to the archived webinar session. We also welcome you to complete the post-webinar survey. 

Thank you again for joining us today. Have a great afternoon. Thank you.