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Interview In Action: Stopping Nursing Violence Through Ambient Tech with Lisbeth Votruba

[00:00:00] We want to thank our partner, Avasure. Over 1, 100 hospitals are using Avasure's virtual care platform to engage with patients, optimize staffing, and seamlessly blend Remote and in person treatment at scale, drive measurable outcomes and augment clinicians with an AI powered solution that deeply integrates into your clinical workflows.

Aversure offers virtual care solutions supported by a secure, scalable infrastructure that helps you to lead your organization into a future where cutting edge technology is at your fingertips. and Compassionate Care Converge. For more information, check them out at thisweekhealth. com slash Avisure.

I'm Drex DeFord, a recovering healthcare CIO and longtime cyber advisor for some of the world's most innovative cybersecurity companies, and now I'm president of CyberRisk. At this week, health and the 229 project where we're dedicated to transforming health care one connection at a time. Our interview and action series [00:01:00] allows us to catch up with health care leaders throughout the industry and hear about the important work they've been focusing on lately.

Now onto the interview.

Drex DeFord: (Interview 1) Hey everyone, I'm Drex and, I'm really excited today to have on the program Lisbeth Votruba, who is the Chief Clinical Officer at Asure. hi Lisbeth. I'm glad you're here. Me too. there's a lot of really interesting stuff going on in healthcare. You guys are leading a lot of that at Avature. let's start a little bit though, tell me a little bit about your background and how you made your way into this kind of amazing leadership role at Avature. And one of the things I was really impressed by when I did a little research on you, yesterday is that you're a third generation nurse, so this really is the family business for you. tell me more about your background.

lisbeth Votruba: yes, I am a third generation nurse and I have the image of my grandmother and my mother in their, like nursing caps, right above my computer in my office, my office, to remind me of my legacy [00:02:00] and to make sure I'm honoring that. so I've had very non-traditional, career path in nursing. Which is one of the things I love about it and what I tell young nurses is you never know where you can go with this. And so I'm an example of that. it took me seven years to finish my bachelor's degree because I started as a music major, as a harpist. Yeah. And then kind of meandered and had to pay my way through school.

And I finally got there and, I've worked as a nurse in the ICU, for about. Almost 10 years. And then I was a magnet program director and clinical nurse specialist at a Trinity Hospital in Grand Rapids. And that is where I had kind of a career changing serendipity, innovation moment.

Mm-hmm. kind of the origins of virtual sitting comes from. when we opened a new tower. And then from that led me to now be the chief clinical officer of a large tech company for [00:03:00] the last 10 years.

Drex DeFord: Wow. Exciting. And I mean, I think the, you know, this is the, it is the beauty of sort of taking advantage of the opportunities that come up and not having a really specific career plan.

'cause you don't know what kind of the world's gonna deal you. So you've really shown a lot of that flexibility in taking advantage of the stuff that's just sort of happened.

lisbeth Votruba: I was gonna be a nurse anesthetist by the time I was 30, so I had a plan. It's just I was open to, changing my path.

Yeah,

Drex DeFord: absolutely. This side open

lisbeth Votruba: to opportunities. Yeah.

Drex DeFord: what Mike Tyson says. Something to the effect of like, everybody has a plan until they get punched in the face. Yeah. There's a, there's, that's a good

lisbeth Votruba: motto. Thanks Drex.

Drex DeFord: There's some really amazing stuff, going on in health systems right now and the re-imagining of care. you are leading a lot of that work, Absu on behalf of nurses, but on behalf of healthcare, kind of in general. So tell me about the people process, [00:04:00] technology combination. How you're transforming the care environment, supporting new staffing models, all that kind of work that you're involved in right now.

lisbeth Votruba: Yeah, I think when people think about sort of that smart room of the future or the futuristic care, they think of sleek and high tech, like minority report kind of thing, right? And, that is, what it is. But as a third generation nurse, what excites me though? Is how tech can allow us to return to something more timeless. that attentive, personalized human care where the technology is almost like oxygen, you don't even realize it's there, but it really supports caregivers in getting back to the kind of joyful care that maybe my grandmother and mother did. without having to document and have a screen between themselves and their patients.

Drex DeFord: I mean,

ultimately here it kind of sounds like you're driving some really, empowering [00:05:00] innovation for nurses at the bedside. You're giving them capabilities that, Make them more efficient without distracting them as you sort of talked about. and we need nurses. I mean, look, this is my own opinion too, right?

I'm married to a nurse, but I think we need nurses to drive a lot of the innovation that we need to do in healthcare, you've been a huge advocate for that. Tell me about that sort of work that you're also doing.

lisbeth Votruba: Yeah. Nurses are always voted the most trusted profession every year in Gallup. But we have not historically, always been the most influential influence Doesn't sort of match that reputation along with our numbers, like 3.5 million. so we are a very powerful force and, I'm just seeing signs that are encouraging to me that nurses and other clinicians as well are taking the lead and shaping technology and shaping care delivery change. one is, the American [00:06:00] Organization for Nursing Leadership. I am actually running for president of AONL, right now. so appreciate you interviewing me during this two week. Yeah, of course. but that's an organization of 9,000 nursing leaders across the country and that I'm really engaged with that one because that's where I believe we can make this shift. From being only trusted to being influential. the American Telemedicine Association is really embracing this as well. I'm on their, center of Digital Excellence, which is a, a really broad coalition of health systems that are leading in virtual care. Mm-hmm. And, nurses, physicians, operators, it's led by a nurse, Alyssa Baker, and we're diving into 65 clinically integrated use cases and taking the expertise of these leading health systems to create benchmarks for those, which is, there's a big gap there. So that's just one example, but there are a lot of. Organizations [00:07:00] and coalitions forming, that are remembering to include and even be led by nurses.

Drex DeFord: It's interesting, right? I mean, medicine's a team sport. Absolutely. And like you, I have spent 30 plus years of my career, in a hospital as a Chief Information Officer. And I can tell you, like, I think, most doctors would probably admit that the whole machine runs because of the nurses. the things that happen, the way that patients are taken care of most of the time is spent, with nurses. And, , here's a few of the things that I hear a lot. As I sit around with my local nurse mafia, and talk about the clinical environment, in a lot of cases in the old school kind of environment that still exists in a lot of places today. nurses often don't feel supported. Sometimes it can even be a physically threatening, Place to work depending on what could be the mix of patients and families and other things that are going on, it all adds to a new level [00:08:00] of stress that I've not really seen in the past. It seems like the last couple of years it has really sort of rolled into a crescendo.

How are you helping make that world better for nurses? Where, all of these concerns are kind of, boiling right now.

lisbeth Votruba: just yesterday I was meeting with the system chief nursing officer and a system chief security officer, for a large Midwest health system.

We were talking about workplace violence and they shared with us a story of one patient that was stuck in their care for 90 days, who was extremely violent. but there weren't the right community resources for that patient. So then the hospital often is left holding the bag. And, that patient was responsible for 80% of, injuries that occurred in the hospital during 90 days.

Oh my gosh. And, then immense property damage as well. That room after that patient was finally [00:09:00] placed, that they had to take the room offline, to repair the room damage. So, I mean, that's an extreme example, but I think, that our emergency departments are already very pressured. Taking care of behavioral health patients. and then there's a new executive order, Increasing the requirements for involuntary holds in hospitals kind of are being left with this responsibility. So that is only going to increase. And there are a few ways that, Virtual care can help support. I published a research on this a few years ago, kind of taking, data that we compiled from 75 health systems about, the kind of verbal and physical threats that occur in the patient room. And that, with virtual sitting actually can help, protect staff, not just patient safety, but staff safety as well. nursing assistants or sitters, are the most at risk for, and this is according to the Bureau of Labor [00:10:00] Statistics, most at risk for intentional violent, injuries in the workplace, that cause time to be taken off. so nursing assistants, it's almost, unethical to put them in harm's way as a sitter for a violent patient.

Yeah but also nurses need that extra set of eyes and futuristically, what's very exciting too, is a wake word. So if you have a virtual care platform. In the patient room, and I mean a virtual care platform with capital P. it can be ambiently listening for a wake word, like please call a Code Gray, or Bert's team, which is behavioral, emergency response team. and then also, um, AI can be used in two ways with computer vision to detect, potential escalation and behaviors and listening for, words or phrases, that indicate potential violence. So, instead of having badges that like, are like heavy and pull on the [00:11:00] nurses and who's got your badge and, or buttons installed in the walls the virtual care offers I think, some really more elegant solutions to keep staff safe.

Drex DeFord: that's amazing. the great thing about virtual care is that I think the people who are, in the control center, wherever that might be, can be there for you when you need help. with the patient clinically, but in these situations they can be there to kind of witness what's going on, record what's going on, and call people on your behalf and create that sense of urgency so that pressure's, definitely there and I know a lot of nurses are, are dealing with it. let me ask you, one more question, and this is really just kind of tied to all of this. the emotional wellbeing of nurses. we talked about all the stress, the drive for innovation to help them do the things that they're there to do. I mean, you all are, Especially sort of wired to take care of people. And so that whole approach to your job is [00:12:00] in a lot of ways what makes you special, I think in health systems. It takes a lot out of you. And so the kind of things that we can do with tech or other innovation to improve your emotional wellbeing as a nurse turns out to be, critically important.

Do you hear those kinds of things from nurses who have gone through these sorts of, AvaSure installations or ambient installations or other things? Is, are those the kinds of things that you see in studies and in your field work too?

lisbeth Votruba: Absolutely. You've touched on a topic that's really close to my heart, and I had a mentor tell me, the nursing profession is going to shape you and you have a duty to shape the profession. so I, I also am very active in, nurses in recovery, because nurses are just as vulnerable to anybody else to kind of deal with that kind of stress, or have substance use disorder and other things. So. I am, in recovery myself. I'm over 10 years sober now, and do rely [00:13:00] on, a support group of healthcare providers in my community, which are all over the country, and it's just kind of a special bond that we have because of exactly what you said, those special extra pressures. and then as part of that, a few years ago. I, was appointed by Michigan Board of Nursing to represent nurses on Michigan's health provider recovery program, which is a state run program that really supports all healthcare providers who are, struggling with substance use or mental health issues, and one, continue to safely practice. so most states have a program like that and, So I think I have a duty beyond my day job and we are doing things in virtual care to prevent traumatic incidents, but then like, we all are contributing beyond that, as well. And so, love that you brought that up. And, and nurses are especially vulnerable in some ways because of that, caring to the [00:14:00] point of neglect of our own wellbeing.

Drex DeFord: Great conversation. Elizabeth Lizabeth Vitruba, the Chief Clinical Officer at Avasure. I'm really glad that, we had a chance to chat today.

lisbeth Votruba: Me too.

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