HIStalk Interviews Beth Pickard, President and CEO, Clairvia

Beth Pickard is president and CEO of Clairvia of Durham, NC.

Tell me about yourself and about Clairvia.

I’ve been in the staff management business for health care organizations my entire career, going on 25-plus years, implementing software solutions to improve the staffing and hospital organization. Clairvia is the second company that I’ve managed in staffing. We’re seeing staffing management being transformed into new staffing practices. This company is focused on the patient experience and the value that staffing brings to that patient experience.

Give me the elevator speech definition of Care Value Management.

Care Value Management is a transformational solution that bridges the gap by linking workforce management to the patient experience. It integrates the patient’s condition to the care levels that are required to move each patient through the hospital organization to the best possible outcomes.

In the old days, resource allocation or staff management meant a rigid model based on acuity or historical trends. How is real-time staff resource allocation different?

The biggest difference is that the data is real time now. Historically, it was retrospective or just looking at the next shift.

All of our solution sets are utilized by clinicians at the bedside. That’s a core strength of our technologies as well.

The third piece is that we never linked the value those resources brought to improving the patient’s movement through the organization. In other words, we always predicted or planned for the next shift, but what we hadn’t done is look at, “Are these staffing levels actually making the patient better quicker or moving them through the organization with a better experience?” It was more in terms of looking at what staff we needed versus were those staff members really impacting the patient’s care.

Success used to be measured by simply getting through the shift with the predicted low staffing number, regardless of the clinical result.

What’s really changed is the value-based proposition. We have to start looking at what improves quality and cost, and obviously staff resources. We have to start looking at what care models do improve quality or how they impact cost or the patient experience.

How is your system used in the management of a typical nurse shift? 

A patient comes into an organization. We immediately put them on a plan of care based off of their reimbursable working DRG. At all points in time of rounding and working with that patient, we know in our minds what that patient’s planned movement through the organization is.

It changes as their condition changes. At all times, the collaborative team is working towards whether or not that patient is moving to expected outcomes and moving to their expected discharge date in the system.

Think of it as managing to a flow and ensuring that the resources are available at all points in time so that that flow is complete or as it’s happening or occurring as planned. As charge nurses and caregivers are planning for those patient needs, they do interdisciplinary rounds. They’re managing to that expected progress as well as assigning caregivers who will actually provide the care for those expected events.

Are your prospective customers already doing that process of managing to an expected outcome and discharge date, or is that a concept you have to sell them on?

Absolutely. I would say that the technology enables the process. Typically we find that the planned discharge dates are managed in silos of organizations or departments within the hospital. The technology enables everyone to have more of a collaborative approach. That’s one of the transformational processes that occurs.

Almost everyone is looking for ways to ensure that the patient tracks or moves through the organization to the reimbursable plan for cost as well as having a good experience. I would say that it’s not something that we’ve had to sell. I think we are one of the few systems out there that as we’re tracking to the length of stay, we’ve linked the staffing component to that management. They are fully integrated and affect each other. You have to have the resources available and working to impact the length of stay management. 

We have both of those pieces. It is the key and the value of the system. You’ll find people that have one or the other, but there hasn’t been another technology that has linked the two together.

Hospitals are always transferring patients for many reasons, not all of which are clinical in nature, without really considering the skills and staffing levels on the receiving unit. Can your system help make the transfer process more efficient?

Absolutely. One of the first things it does is to get patients in the correct location. We’re very much linked into capacity management. As you’re looking for available beds, you’re also checking to be sure that — based on their progression of care and their planned care – patients are being placed in the right area.

That’s the number one most expensive error that organizations make: getting them from the ER to the correct care area. Then once they’re in that care area, we obviously have already assigned and have waiting the correct resources to provide that care. 

If you’re moving them from the ER to the ICU, we start looking at well how’s that patient been tracking through the ICU to ensure that they also move in a timely manner from the ICU, which is a high-resource cost, to routine care. But most importantly, that their outcomes are also good and their condition is also what we would consider ready to move to that next level of care.

A lot of hospitals have bought bed-tracking type applications. Do you see this as the level above those systems?

Patient flow is one piece. But with patient flow, you have to see whether the staffing is available to move that patient where they need to go. Is the unit staffed to transfer them from one area to the other? Without the complete staffing area, you’re missing a key piece.

But the second most important piece that I remind people about is that this is an outcomes system. That’s where our success is really driven. We’re tracking which patients are moving to the best outcome, because at the end of the day, it’s not always a good idea to move people faster through an organization. 

We talk more about optimizing. What’s most important is that at each point in time of their stay, they’re achieving the desired level of wellness or the desired outcome. I think that’s a key and critical component in a value-based organization or an accountable care organization.

You just landed a large customer in Sutter. What are their plans for your products?

The key to their implementation was to leverage existing clinical data. When people ask me why didn’t we do this 25 years ago like I wish we did, I say we really didn’t have the clinical data available to track whether or not the patients’ progression or health-wellness was improving. 

The key for Sutter was that it managed and evaluated the outcomes of each of their patients and ensured that the resources were available for safe, effective care. Very key to the implementation is the clinical integration and leveraging the rich clinical data that they’re getting through their Epic implementation.

What kind of success metrics do they have?

At each of point along the way, we’ll look at total resource cost, length of stay or patient cost by DRG, NDNQI outcomes, employee satisfaction, position satisfaction, and patient satisfaction outcomes. With all of our implementations, we benchmark those indicators and then track them post-implementation to assure that our clients really get the results that they technology should provide them.

States like California where Sutter is located is have mandated nurse staffing levels. Do you think those requirements do enough to ensure that patients have access to the care they need?

States like California have mandated staffing levels are because there’s never been a way to measure whether or not staffing levels really affected patient care. In California, what we’ll be able to do is see which staffing levels have the associated better outcome.

We’ll get past strict ratio staffing, which basically says that since we don’t know what staffing levels produce the best outcomes, we’re going to mandate them. We’ll collect data that will show which models of care or which ratios provide the best patient experience or best patient’s stay or quality by patient population.

You can imagine the data that we now have by patient population and staffing ratios is going to provide us the evidence for new models of care and staffing. That’s how we’re going to get better. We’re not going to get better with just looking at whether or not we’re using outside agency use or overtime costs.

Most hospitals have already done what I call the “squeezing” in their staff resources. We must look at are the staffing levels that actually making most patients get better. That’s where our technology solutions are going to help move organizations. California is a very good area for needing the technology.

Other than the technology readiness that enabled the real-time use of data, how do you think the political and the healthcare delivery climate is to come up with a potential way to introduce new models?

I think they’re going to have to. Very little is written about how hospitals are going to save dollars or show efficiencies.

With 60- 70% of their cost being staffing, they’re going to have to look at new ways of doing things to get better. Not only for efficiency of the care, but to retain and attract the best talent. Hospitals that are providing and managing their patients to good quality outcomes will attract the best talent — not only nurses and caregivers, but physicians.

Those are the hospitals that are going to be ready for what we know already to be an acute shortage of talent over the next several years. I see it as a way of retaining and tracking the best talent, as well as providing the good patient experience.

One solution companies came up with was the shift-bidding model to use your own experienced employees who wanted to work extra shifts. How are hospitals using your shift-bidding application?

It’s absolutely popular. It’s used by 100% of our clients. Employee self-service eliminates the paper in the scheduling and staffing process because you close the loop between signing up and posting shifts. It absolutely has enabled our clients to move from a paper-intensive process to paperless. 

A second benefit is that it definitely improved employee satisfaction. Staff love it. Employees, especially new nurses, want to work for organizations that allows that communication and transparency in the scheduling and staffing process. Employee satisfaction and moving to a paperless process have been enabled through those types of technologies.

I’ve not seen a time where so many people at the top are saying that nurses should have a voice on determining how healthcare delivery should change. As a nurse, what do you think of that?

In my entire career, it’s the most exciting work that I’ve been involved with. We’re finally focused on what brings value to the patient’s care or the patient’s experience. We know patient care brings value, including both the medical and nursing or caregiver care. 

To finally be in a place where we have data available to affect and make those decisions to improve patient care is a good time. It has been extremely rewarding to work with the clients we’re implementing.