eMagazine June 2023

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OUR PEOPLE, OUR MISSION Global Health eMagazine June 2023 Nursing Division A Note from the Editor: Catherine G Winkler, PhD, MPH, APRN-BC Director of the Nuvance Health Global Health Program Nursing Division Strengthening Healthcare Systems Strong healthcare systems are needed for all people to achieve timely access to quality healthcare to promote, restore and maintain health. Improving healthcare systems In the USA as well as on a global level requires administrators and healthcare leaders to take a hard look at the delivery of care, the cost of care, the timeliness of care and “the caring” in healthcare. Perspective Global Health Academy Highlights Reflections Welcome Global Local Hispanic and Latinx Communities Voices of Ugandan Students Global Health Mental Health Art to Rwmind Us of Who We Can Be Our Beautiful Planet Innovation and Technology Nursing Division Women’s Health Education Among the Letters Announcements Article of the Month Video of the Month Congratulations Phoro News Calendar of Events Resources After the pandemic, change has been necessary on behalf of all healthcare providers in the delivery of care, the content of care and the timeliness of that care. Front line providers needed to don extra gear, change protocols, use resources differently and reprioritize their work with staff levels low and with care complicated by isolation and uncertainty. Patients and their families also needed to make ongoing changes since the pandemic by making careful decisions about whether they should seek care, when to seek care, how to seek care, and from what source in what venue would accessing this care be possible. Healthcare systems and administrators have changed too – but it requires more effort because they need to recognize problems and develop strategies, quick responses, and activities to allow providers to do their work effectively, and to sustain positive changes now through the next pandemic or crisis. Healthcare organizations and their leaders need to meet the needs of their staff and the patients that they provide healthcare to every day. Delivery of care needs to be available and timely. Often with large healthcare systems that span across a state or states that have set themselves up with service lines designed to manage expensive disease states such as orthopedics or cardiovascular care - lose sight of what services their communities need that may be lost leaders financially but are vital to the local people such as pediatric services or primary care. A shift should happen to review the community needs and then formulate a plan about how to access it. Does it make sense to have telemedicine visits, clinic, or home visits? Then once decided, look beyond the hired call service that may pick up the call in 30 seconds but still struggles to get a patient seen within a month. Community connectivity is needed to ensure that in addition to service lines, rapid response, urgent care, emergency care, and primary care are offered and accessible locally. Where is the care in healthcare? Care needs to be cost-effective but should also be safe and convenient for the patient that needs an outpatient procedure. Perhaps a cholecystectomy can be done same day, but in thinking about the secondary consequences of that surgery and the issues with urinary retention or symptom management – does it seem like a good idea to have the 75 year old patient need to follow up on Friday evening after the procedure in the ED as their only course of action available to have a urinary catheter placed or ongoing nausea treated? This happens often, and patients bear the burden of an ED visit with the associated health risk and cost. Where is the care in healthcare? Patients who are 10 minutes before going into surgery should not have to find their credit card in their clothes that have already been placed in the pre-op locker to pay an out-of-pocket expense to the hospital before they are wheeled into the OR. Perhaps this could have been considered the week before so that the frightened patient is not further troubled. After that the same restructuring of finances would make sense without asking the parents of a sick child going in at 5 in the morning for an invasive procedure to also pay for the estimated cost of care. Where is the care in healthcare? 30
OUR PEOPLE, OUR MISSION Global Health eMagazine June 2023 Communication and transparency need to be either reinstated or developed post pandemic. With the primary care physician replaced in the hospital setting by hospitalist and intensivist along with snfist - then without timely communication and perfect electronic medical records that are secure and available-important information is lost, gaps in care occur and patients and the families suffer the consequences. A phone call or an in-person visit is best and should be done in addition to information provided in a patient portal. Some patients have 5-10 portals they need to manage and still data is missing or lost. Access to care and coordination of that care needs to be done across platforms and locations. Where is the care in healthcare? Environment of care needs to be upgraded with more privacy, that’s accessible space to meet the needs of a child, a person who uses a wheelchair, or a person with blindness or a hearing deficit and with resources and clean areas available to promote a patient’s independence, confidence, safety, and health while enabling front line healthcare providers to do their work. Healthcare administrators need to support the advancement of science with time for providers to conduct research, review literature and consult with colleagues. The interconnectedness of the world requires administrators and leaders to strengthen partnerships with colleagues across the world, as well as down the street and around the corner to improve public policy, encourage advocacy, and work on screening, health promotion and disease prevention. There are major changes in patterns and trajectories of health, disease, and aging and to improve and sustain change, healthcare leaders must adapt now to the changing world to ensure that the care is reinstated in healthcare and that it is sustainable. Perspective Global Health Academy Highlights Reflections Welcome Global Local Hispanic and Latinx Communities Voices of Ugandan Students Global Health Mental Health Art to Rwmind Us of Who We Can Be Our Beautiful Planet Innovation and Technology Nursing Division Women’s Health Education Among the Letters Announcements Article of the Month Video of the Month Congratulations Phoro News Calendar of Events Resources Comments Written by Mary Kincart, MS, RN Dr. Winkler has provided a candid and comprehensive look at the challenges in healthcare we face as a nation and worldwide. The work to restore healthcare systems has been greatly impacted socially, emotionally, physically, and financially by the Covid pandemic. In many ways healthcare has experienced great setbacks and in other ways we have learned to be nimbler, more resilient, and more innovative. Treatment of chronic illnesses and preventative health measures were suspended during the acute phase of the pandemic, leading to a backlog of unaddressed healthcare needs by many. In addition, the nation is experiencing a significant influx of migrants from other countries, placing an even greater strain on an already vulnerable system, and greatly impacting access to care. The loss of healthcare providers and staff, from illness and/or burnout, as well as the massive financial impacts on hospitals, practices and healthcare facilities, compel healthcare leaders to address these challenges in new and innovative ways. The past several years have forced us to think differently about how we deliver healthcare. Specialists such as Intensivists and Critical Care Nurses provided virtual guidance to ICUs to support care to a greater number of patients. Virtual visits became the “norm” for addressing the needs of patients with chronic illnesses as well as those that needed non acute medical attention. Pop-up mobile testing and vaccine stations were implemented. These are only a few examples of the capabilities of healthcare leaders that will prove to be invaluable as we work towards strengthening our Healthcare Systems in the future. In a recent publication by Forbes contributor Bernard Marr, Dec 6, 2022, Mr. Marr provides an overview of trends that are addressing some of the challenges described in Dr. Winkler’s article. Mr. Marr describes the many uses of artificial intelligence in healthcare delivery. He gives examples such as remote surgery, virtual hospital wards, virtual homecare and the building of online communities linked to specific health conditions that can provide information, education, and support. The public has already integrated the use of wearable medical devices to monitor health and track sleep patterns, activity, vitals signs, blood pressure, and EKGs to aid in the management of chronic medical conditions. Financial recovery also requires resiliency and innovation. Administrators and Leaders must support the optimization of private and Medicare/Medicaid value-based care models without further burdening the frontline providers and staff. Embracing the opportunities made available through technology and artificial intelligence affords our healthcare systems the ability to move forward and gain advances in healthcare. 31
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