The Balance Between Standardized and Personalized Care: An Interview With AACN CEO Dana Woods

Jul 01, 2021

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In 10 minutes a great nurse knows more about you than your family does. That's personalization.

At the 2020 Leadership in the Age of Personalization (LAOP) Virtual Summit, AACN CEO Dana Woods joined other healthcare leaders to discuss how the pandemic and social justice crises have accelerated the drive to a person-centered approach to healthcare delivery. “All of us share this vision to create a healthcare system that's driven by the needs of patients and their families,” Woods says. “But our current system isn’t built to do this reliably and effectively.” Woods and LAOP host Glenn Llopis, best-selling author and Forbes contributing writer, explore how healthcare can help us reclaim our humanity.

Glenn Llopis: Now I'd like to introduce you to Dana Woods. As the chief executive officer of the American Association of Critical-Care Nurses (AACN), Dana Woods partners with the organization's boards of directors to provide leadership and strategic vision for AACN and AACN Certification Corporation. Hi, Dana. Great to have you.

Dana Woods: Great to be here. Thanks for inviting me, Glenn.

Glenn Llopis: Let's face it: The reason you're here is that you're going to share the realities of all those people that we've been talking about that have been saving lives on the front end, that most people don't even know what they do, how they've done it and how it's actually impacting their own personal lives.

One thing that I've learned throughout this pandemic is that most people in any organization don't really know what anybody's really accountable for within their organizations. We see titles and functions before we see the individuals and the humans behind the titles and functions. That's an example of the limitations brought upon by standardization. We often see the perceptions of people as individuals, not the individuals that they truly are. So who are the individuals that have served as critical care nurses? The heroes in healthcare on the front lines of this pandemic. What have we learned from their stories that can help healthcare find the right balance between standardization and personalization, Dana?

Dana Woods: I love how you frame that, Glenn. I think all of us are really familiar with the nurses. At least we think we are, and they've been ranked the most trusted professionals in the Gallup poll for 19 years in a row now. And yet, unless you are a nurse, I think it can be really hard to understand the true nature of the role. You asked who these professionals on the front lines are, and I'd love to introduce you to a few of them and make this really personal from the start.

Let me introduce you to four of the half-million critical care nurses in the U.S. Like their colleagues, these four nurses take care of the most vulnerable patients in our healthcare system, including those with COVID-19. I'd like you to meet Jamie, Vincent, Tina and Sanders. They're all nurses from the New Orleans area. They're taking care of patients with COVID. One of these nurses, Tina, became a COVID patient herself in the course of this pandemic. These are photos taken for a project called Dear Nurses. It's a collaboration between our organization and Dear World, which is a group who brings stories to life, using what they call brain tattoos, which is what you see written all over the arms, hands and necks of these nurses. Their photos and their stories along with 50 other nurses are online now, if you want to check it out. We actually worked with Dear World to get these nurses together during the height of the spring surge in New Orleans, the first wave. At the end of this year, their stories will be expanded upon in a mini documentry that Dear World is producing to honor them.

Glenn Llopis: Wow, powerful.

Dana Woods: Yes, all the stories are. In Jamie's case, like all of us, she has a healthy respect for this wily virus and is concerned about contracting it herself or worse yet spreading it to her children. But unlike most of us, she is with people day in and day out who have COVID-19. She's providing advanced therapies to keep them alive and serving as their sole support system in some cases, as families weren't allowed to visit. Which brings me to your second question, which was something like, "How can these nurses’ stories help us find the right balance between standardization and personalization?" Well, Jamie's Dear World story, which is online, focuses on her close bond with this one patient who was a rock star maître d’ in New Orleans. There are famous restaurants in New Orleans, and he was the maître d’ of one of these.

He had a huge following and he received mountains of get well cards. One day she read a bunch of these cards to him while he was fighting for his life, and it was a fight, unfortunately, that he ultimately lost after 50 days in the hospital. Unbeknownst to anyone, this ended up being his last day, and she was sitting with him reading these cards at a time when he hadn't seen visitors in weeks. That's a very different kind of care than implementing standardized clinical protocols to manage potent drugs or mechanical ventilation. That act is just as vital as a nursing practice, precisely because it personalized that patient's care to what mattered to him most, to Dr. Jack Cox's [former senior healthcare executive] point early this morning. It was a time that happened to precede the patient’s death by just hours. And, I think about that and I think about how important it was that this gentleman knew he was loved before he died.

That is personalization. That is the nursing I know. Nurses are just amazing people, and Jamie's telling of their story gives us a glimpse into how I see nurses, which is really sort of this fulcrum where standardization and personalization are balanced as needed, which is different for every patient. Nurses meet us where we are, right? They know the science, but they have to know the art of knowing us as people. They practice by scientific evidence and standards and all that good stuff, but they have to create this intimate relationship at warp speed. I once heard someone say that in 10 minutes a great nurse knows more about you than your family does. I think about it and that's personalization.

Glenn Llopis: I think you have brought us a tone, a sense of emotion into the discussion and, you know, healthcare providers in their many silos have created these subcultures — we've discussed this — that promote tribalism and we've rewarded each of these tribes to contribute to the efficiency machine whose mission is to save lives. Now, patient centricity has only been at the core of a healthcare provider’s mission when it complies with the industrial model of standardization, which ironically has been discussed a lot today. That has historically rewarded volume more than value. Is healthcare's tipping point in danger of moving further away from patient centricity in its pursuit of transformation? Are we solving for the right requirements to put the patients first? Why can't we rely on traditional standards to healthcare delivery in their current form to meet today's transformational needs that are being defined by the forces of today's age of personalization? A lot there to process. What's on your mind?

Dana Woods: Yes, that's a lot, but I think it comes down to a couple of core things and I'll try to get to those. But, let me start with the encouraging thing, which is, I think all of us share this vision to create a healthcare system that's driven by the needs of patients and their families. If this is what we're solving for though, I think we'd all also agree, and we've heard that throughout the day that our current system isn't built to do this reliably and effectively. The system still acts like we're solving for efficiency and profit margins, not for meeting patient needs and not always for supporting the well-being of caregivers, which of course is especially vital right now. Business can't be the leading motive. People, individuals must be, because hospitals, and in the case of the nurses I work with, hospitals are about humans like Jamie caring for other humans like us. Yet, we've molded so much of this construct around that industrial model.

It can feel like patients are units of inventory, throughput to be managed, and nurses and other professionals continue to feel like machines purchased to generate productivity. I wonder, "How is this our model? Where did that start?" As I said earlier, in 10 minutes a great nurse knows more about you than your family does, and a nurse should know more about you than anyone else on the healthcare team, because that's the way the nurse-patient relationship works. It's part of the nurses’ code of ethics to know us well enough to advocate for our unique needs being met. This pandemic has amplified the shortcomings, as we've all talked about, of treating healthcare as if it were a factory. It's also generated a lot of great innovation. Industrial productivity models just weren't built for variations like we see in humans, patient to patient, even when we're not in the throes of a pandemic.

Then we threw in this task of donning and doffing PPE, and the psychological toll of caring for such sick patients with a disease we still don't know a lot about. We can understand why professionals on the front lines are exhausted and fearing this next wave. Jamie's story, I think, reminds us that a patient nearing the end of life without family present isn't predictable. It's not a process that can be standardized. We want patients whose time has come to have a good death, according to their wishes, not an efficient death. We know people die on their own timetable. The important measure is the experience we deliver, not the labor hours it took to get there, and I can talk a lot about this.

Glenn Llopis: Dana, you've made it crystal clear that again, if the systems don't change, the behaviors will stay the same. But also you've made it clear that there must be a fundamental change in how we do business. How do we solve for human dignity as much as our brand? How do we create the environment and the conditions to see people and know them as individuals?

I think we spend more time with people at the top rather than turning the model around and asking the people to touch the business, to lead the transformation and to allow people at the top to listen, learn and observe. That's the message that you've really created with your remarks today. So I thank you for that, Dana. Really quick, 30 seconds: Where's the hope as we face the daunting challenge of transforming this complex system that was designed for care and not prevention and wellness?

Dana Woods: Well, I think we've heard a lot of hope today. For me, the hope lies within us. The fact that we're talking about this today and that all of us who do this noble and important work for humans with humans, guess what? We have a leg up, we are human. We know how we would want to be treated if we were lying in that hospital bed, and it is not an easy problem. It will take a lifetime to solve, but we can transform this by solving what we're supposed to be solving for. I think we have some great insight today on why positive social impact has to be the goal, not a tiny bottom line or lean manufacturing.