Innovation Stories

Martha Buckner, PhD, RN, Associate Dean of Nursing, Belmont University
Sandy Murabito, EdD, RN, Director of Undergraduate Nursing, Belmont University
Samantha Straton, BSN, RN, Chief Nursing Officer, Ascension Saint Thomas Hospital West
Norman Wells, MA, BSN, RN, Director of Nursing, Ascension, Saint Thomas Hospital West

Belmont University School of Nursing (SON) and Ascension Saint Thomas Hospital West (STHW) are long term partners in educating the next generation of nurses in Nashville, Tennessee. When the COVID-19 pandemic caused the closing of clinical sites to nursing students, these two partners leveraged guidance from leading nursing organizations to establish an innovative model for clinical nursing education during a pandemic.

With support at all levels of both organizations, leaders from these two institutions formed a team which met regularly during April and May 2020.  The team designed clinical experiences in which students were employed as nurse interns functioning in an expanded student nurse role on designated units. The internship was considered a modified Dedicated Education Unit (DEU). The students were directly supervised by Ascension STHW RN preceptors on specifically designated units.   Belmont University SON faculty visited regularly to evaluate student progress, support preceptors, and troubleshoot concerns. Students rotated through medical-surgical, mother-baby, and intensive care. Students helped meet challenging work-force needs, gained valuable clinical experiences, and earned income while being full time students.

In the span of two months, Ascension STHW leaders were able to get buy-in from senior leaders and negotiate HR, payroll, workflow, scheduling, and liability issues. A virtual student Q&A session hosted jointly by Belmont and Ascension STHW allowed students to hear about the opportunity and apply for the internship. Following a virtual interview process conducted by Ascension STHW, twenty participants were selected. Orientation was held in early June and between June and December 2020, 20 students rotated among the various units gaining a total of 300 hours of clinical experiences for their academic nursing courses. Simultaneously, Belmont leaders provided a half-day preceptor training for selected Ascension STHW preceptors and recruited faculty to provide oversight of the clinical experience. In a post-experience survey, both students and faculty rated this as a strongly positive experience in terms of overall quality, acquisition of psychomotor skills, improved time management, realistic appreciation of the RN role, improved communication with the health care team, and overall readiness for practice. One student commented, “Compared to my peers who were not in the partnership, I gained so much more hands on experience…Once I began the partnership, I was able to pass meds (alongside my RN preceptor) every single shift for every patient. I gained so much experience with time management, passing meds, drawing up meds, hanging primaries/secondaries, Foley insertions, and other skills that would not have been available to me in a traditional clinical group of 6 students.”

While scheduling issues and other challenges existed for Belmont & Ascension St. Thomas West, leaders of both facilities demonstrated strong commitment to the modified DEU pilot by helping students, faculty, preceptors, and administrators overcome barriers. Of the twenty students in the partnership, all were offered RN positions upon graduation and ten accepted those positions. Some participants declined the STHW residency offer, preferring to return to their home towns. The ten students who accepted offers have now completed several months of employment. Anecdotal reports indicate the new graduate residents have experienced a shorter orientation time and are thriving in their roles. This is an exciting new model for academic-practice partnership and one that this team hopes to replicate.

The Belmont SON-Ascension Saint Thomas West team presented a one-hour continuing education session “Taking Aim at Good Teaching: Inside Academic-Practice Partnerships” sponsored by the National Leagues for Nursing.

Michelle Adyniec, RN, BSN, Clinical Manager, Care Management Initiatives
Dayna Fondell, MSN, RN, Senior Manager, Clinical Redesign Initiatives
Jeneen Skinner, LPN, Senior Clinical Manager, Care Management Initiatives
Camden Coalition of Healthcare Providers
Camden, NJ

Camden is a ten square mile city in New Jersey with a population of approximately 80,000 people. It is home to the Camden Coalition of Healthcare Providers—aka the Camden Coalition—an innovative non-profit organization that builds partnerships to improve the health and well-being of people with complex health and social needs. The Camden Coalition operates care management programs, hosts the Camden Coalition Health Information Exchange, and engages in care redesign with local partners.

The Camden County Department of Health, Volunteers of America, and the Camden Coalition partnered to provide temporary housing in a hotel for people experiencing homelessness who were awaiting COVID-19 test results, or who had tested positive and were required to quarantine. Three nurses from the Camden Coalition, Jeneen, Michelle, and Dayna, provided medical care for individuals staying at the hotel.

How did you go about providing care for people temporarily living in a hotel?

Michelle: “As a nurse, it’s in our bones to think about how to keep people safe. My first thought was, how do we keep people safe while living in a hotel, and how do we reduce harm?”

Jeneen: “We divided up calling each one of our community partners every day to give them an update about how things were going for individual patients, but also overall. It was a lot of work, but it was important to keep collaboration going for our patients.”

What innovations did you see emerge?

Dayna: “As a result of the pandemic, national policy changes allowed for virtual initiation of buprenorphine/suboxone. This change not only impacted our ability to make sure patients in the hotel had the Substance Use Disorder support they needed, but it also has broad impacts across our community. The response to COVID in general has created an opportunity for many providers to think more about harm reduction, and how access to buprenorphine may be helpful to people wherever they are along their addiction journey. We do not know what long-term changes will come from this, but it will be interesting to see it evolve.”

Michelle: “There’s such a push for nurses to become mini-doctors, but we’ve got skills as nurses that we can develop on our own. As a nurse on the floor, you’re expected to be the point person for a patient’s care. It’s natural to collaborate with everyone. We know how to pull people together. I wish nursing would cultivate and teach that skillset more.”

What gaps became clear to you?

Michelle: “It’s amazing to me anyone ever gets medication. The hours of calling to follow up about medication was the most time-consuming part of the care coordination we did for people.”

Jeneen: “Where are all the mental health services?”

Dayna: “We pulled together housing for people who needed it; why can’t we do this when there’s not a public health emergency?”

What helped you to make it through the long hours?

Jeneen: “I had to address my own fears about engaging with people who potentially had COVID. We had to lean on each other. On the days that I thought I couldn’t keep going, Michelle and Dayna would be there.”

Michelle: “The ‘sisterhood of nursing.’ As a fellow nurse, Jeneen understood better than anyone. Talking to her at the end of the day was a lifeline.”

What is the story you think needs to be told after being on frontlines over the last few months?

Dayna: “We saw the willingness to collaborate across the board. This crisis created a sense of community.”

Jeneen: “What does a person need to stay well? It took an entire community to keep people well. The Camden Coalition couldn’t have done this alone: social services, primary care offices, specialty offices, pharmacists, transportation, food—it took everyone.”

Debbie Gregory, DNP, RN
Senior Clinical Consultant
Co-founder of the Nursing Institute for Healthcare Design (NIHD)
Smith Seckman Reid, Inc. (SSR)
Nashville, TN

Debbie Gregory provided her expertise on a collaborative effort aimed at transforming the Music City Center in Nashville, Tennessee, into a 1,600-bed surge facility for COVID-19 patients. The plan was to get the facility up and running within 6-8 weeks after the first team meeting on April 5, just as the number of COVID-19 cases began increasing.

Gregory shared with project team members—who included state officials, administrators from Vanderbilt University Medical Center and other health care systems, and construction experts—numerous resources and best practices she had collected when she first learned of a nationwide effort to convert convention centers into field hospitals. Using her nursing and design knowledge, she offered strategies to address staffing needs and workflows, as well as processes related to safety and infection control.

Together the team looked at creating different types of rooms to isolate patients, determining air handling systems, transforming public restrooms into patient and staff restrooms, and identifying where to locate electrical and data sources. Their plan also included how to safely control entries and exits into the facility, as well as designing spaces for workers to change clothes and shower.

Development Director, Community
HKS Architects

The onslaught of the COVID-19 pandemic calls for an all-hands-on-deck approach, not only for health professionals but for architects, engineers, and nurse design experts as well. It also requires that typical business silos and competitiveness be put aside. The goal is to provide solutions to relieve pressure on hospitals and staff so they can focus on higher acuity patients requiring vital life support systems.

Jennie’s 20 years of experience in the health design industry provided her with the expertise needed to work with architects, hospital administrators, and researchers to quickly turn non-traditional building types into alternate care locations.   

The HKS team immediately identified places such as schools, hotels and public assembly spaces that could be used for patient care.  They studied COVID-19—its cause and the impacts on a person’s health—to determine the patient population best suited for an alternate care site.

Using the CDC patient tier framework, HKS identified low acuity patients as being the ideal patient population for these environments. Patient types included:

• Suspected of being a COVID-19 carrier
• Confirmed positive but not presenting with severe symptoms
• Positive and living with someone in a high-risk population; positive
• Living alone and unable to care for themselves
• Recovering and still requiring sequestration.

Keeping the evidence-based principles for health design in mind such as patient experience, patient and staff safety, good air quality, lighting, and other design domains, HKS worked with architectural specialist to determine how to convert spaces to provide patient care and patient care support. 

Jennie and her team used the lean framework for the basic flows of health care to inform and validate that their approach for patient care operations would be appropriate for these low acuity patients.  These included the workflow of the providers, patient movement, access to medications, food, equipment and supplies, internal and external communication, along with waste removal. 

Letting go of preconceived notions of how care spaces should look and function created innovative possibilities. A hotel or a school is not ideal for patient care, yet it is better than sitting in a loud, brightly lit hallway in an emergency room chair, or in a tent.

COVID-19 has accelerated the pace of change.  Going forward, city planners may consider including schools, hotels, and large assembly spaces in their annual emergency planning. In addition, existing barriers to using technology for patient care have been removed, allowing for a new wave of possibilities. Imagine robots that clean spaces and inform the public about safe health practices; new ventilators and types of face masks; or antiseptics spraying from our mobile devices.

Without question, this pandemic has been devastating for many families and the mental toll on health workers and others will require time to heal. But Jennie learned that by working adeptly and collaboratively, realistic solutions can be designed that can help save lives and keep health care workers safe now, and in the future.

Design Researcher
HGA
Washington, DC

Terri Zborowsky is a nurse and design researcher at HGA, a multidisciplinary design firm rooted in architecture and engineering. Terri believes that the pandemic has permanently changed the way we look at staff spaces. On issues ranging from staff safety—including possible COVID-19 infection and death—to respite and break areas, frontline staff will now be at the table when design decisions are made.

In response to the shortage of hospital beds resulting from the coronavirus pandemic, HGA, in collaboration with The Boldt Company, recently created a prefabricated patient room solution called STAAT Mod™ (strategic, temporary, acuity-adaptable treatment module) for rapid deployment nationwide. Health care experts, including critical care nurses trained in COVID-19 protocols, a specialist in hospital environment infection control, and Lean process improvement engineers specializing in rapid construction and delivery, developed and tested the design using virtual reality (VR) simulation exercises.

In honor of the work being done by frontline staff—and in observance of the Year of the Nurse—HGA is rolling out a special series of publications on the ‘Impact of the Nurse on the Design of Healthcare Spaces.’ This will include interviews with frontline nurses on how COVID-19 has affected their well-being and how designers can help to provide areas of respite or frontline design elements to enhance their safety and security. Interviews will be posted on HGA’s website and shared on social media as each nurse is honored for their contribution.

Terri: “As design researchers, we will be adding additional staff wellbeing questions to our standardized questionnaire to better understand the impact that design has on the work environment of nurses. And finally, we will be elevating the need for staff respite spaces when working with our design teams and clients. We will never forget the sacrifice frontline staff have made and will forever advocate for their health and wellbeing.”

Director Health Facilities Space and Equipment Planning
Fraser Health Facilities Management
Fraser Health Authority
Surrey, BC Canada

Cathy’s equipment planning team works with the critical care network (CCN) across the region to bring oversight and organization to the borrowing, procuring and placement of additional equipment across the Health Authority as they continue to develop and roll out their pandemic plan.

This work helps account for equipment costs associated with the pandemic and ensures that same equipment gets back to its rightful owner once it is no longer needed. Alongside a clinical facilities planner, Cathy works with clinical teams at the CCN to ensure that the repurposed treatment spaces on units are safe, and that the various sites are all coordinating with each other.

She has worked to ensure that there is an adequate chain of command, and that it is communicated effectively. To that end daily check-ins with—and communication out to—teams, is vital.

Director, Planning Design and Construction
Atrium Health
Charlotte, NC

A member of the alternative care locations task force, Sarah Francis evaluates potential health care sites in the Charlotte, North Carolina area as possibly locations for additional beds—outside of traditional hospital walls—in case of a COVID-19 surge.

The task force has considered existing ambulatory health clinics, tent set-ups, and a building that formerly held a nursing school—all with an eye toward ensuring any potential site could be efficiently and affordably redesigned to provide patients with safe care.

Atrium Health’s existing partnerships with contractors, designers, and vendors meant they were able to mobilize quickly and create a new space at the soon-to-be demolished Carolinas College of Health Sciences—which would feature walls with a bank of outlets, bathrooms, and handwashing stations.

Sarah also focused on the various factors that are required for patient care delivery in a self-contained site, including maintaining proper levels of critical medications, systems to dispense those medications, portable X-ray machines, as well as measures to ensure patient privacy and clean patient areas.

Executive Director of Strategic Management
Cone Health
Greensboro, NC

Karin Henderson is a nurse who leads major construction and design projects along with other strategic initiatives for Cone Health. As part of her health system’s response to the pandemic, she was asked to draw upon her experience as an ICU nurse and construction leader to transform an existing vacated women’s hospital into an ICU-level facility. Karin led an interdisciplinary team to complete the planning, design, and repurposing work for the transition.

In four weeks, the team transformed a maternity care facility into a campus equipped to meet the unique needs of COVID-19 patients including over 100 negative pressure rooms and capability to support 96 ventilators. 

The area that previously held NICU patients in a ward setting was transformed into 3 bed co-horted spaces that allowed staff to care for these intensive care patients efficiently and safely. In addition to creating a space to treat patients, the transformation was designed to meet the safety, infection prevention, and unique work needs of the nurses, respiratory therapists, and full care team who would be located there.

Small changes to the built environment, such as changing keypads into electronic sensors to allow doors to open without staff touching the surfaces, reflect the detailed planning meant to keep staff safe. New approaches to providing negative pressure environments allowed staff breaks from wearing PPE and supported staff well-being in a highly stressful environment.

Henderson’s leadership fostered an inclusive culture at Cone Health, which empowered front-line leaders and staff to contribute to the design and creation of the new facility.  This enabled a rapid transformation of a 176,000 square foot campus into a new care venue that optimizes care delivery processes for clinical teams and meets current and projected COVID-19 care needs for the community.

Tracey Smith, DNP
Executive Director of The Office of Community Initiatives and Complex Care
Southern Illinois University School of Medicine
Springfield, IL

As a doctoral nurse, Tracey Smith has led public health initiatives across Central and Southern Illinois for more than two decades. When news of the COVID crisis began to spread, Tracey activated response teams of community health workers, nurses, and behavioural health specialists across the lower part of the state. Attuned to the medical, social, and emotional needs of her patients, Tracey developed a model to uniquely address the physical, social, and emotional needs of people in the communities she serves.

Tracey: “First and foremost, we had to design a strategy to provide care for people who may be infected with COVID to keep people home as long as possible and keep our communities safe, but the impact of the pandemic affects more than people experiencing symptoms of the virus. People are out of work and running low on food. People are in their homes trying to navigate their chronic diseases, and not able to afford their medication. People are suffering with anxiety and mental health issues. Ultimately, I knew our strategy had to be bigger than treating those who were sick. We had to rethink our definition of vulnerable. Right now, a lot of us are vulnerable, even if we're not sick.”

The State of Illinois awarded The SIU School of Medicine millions of dollars to implement Tracey's model of interdisciplinary teams across Central and Southern Illinois. Active today, there are 62 workers in 66 counties across the lower part of the state providing care to an area with a population of over 2 million people.

Dionne Duplantier, Nurse Practitioner
Ready Responders
New Orleans, MA

Dionne Duplantier is the type of nurse practitioner people wish could care for them and everyone they know. Her early experience in emergency departments and advanced cardiac medicine taught Dionne that providing excellent care is about treating a patient’s mental and social health, as well as their physical ailments.

Her drive to think differently about patient care led her to make the leap outside of more traditional health care settings and join a new venture capital company, Ready Responders, as one of its first clinicians.

At its core, the Ready model empowers nurses, paramedics, and EMTs—aka Responders—to practice at the top of their license and deliver on-demand care backed by certified clinicians through telehealth. Dionne’s early influence is apparent in Ready’s patient-first approach.

Because Ready Responders is a technology-forward company with extensive experience in telehealth, they were well-prepared with the pandemic, which saw their call volume triple.

Dionne: “Shortly into the crisis, we began offering in-home testing, which is such an amazing and unprecedented service for those unable to seek traditional care or testing, and for those generally marginalized by society. Our goal is, and always has been, to lessen the burden on the emergency departments and the health care system. The role we have played, and the capacity in which we continue to serve, has never been more important in my opinion.”

Misty Chambers, MSN, RN
Clinical Operations and Design Specialist
ESa
Nashville, TN

Misty Chambers serves on the crisis management leadership team of the national architectural firm, ESa, which largely designs hospitals and other healthcare facilities. 

In response to the COVID-19 pandemic, Misty and other crisis management team members put into motion a preparedness plan to address the safety and needs of staff and clients in the event of significant emergencies.

ESa professionals also fielded calls from health care clients, advising them on how to safely convert non-patient spaces to patient spaces, as well as creating units with higher air exchanges and adding negative pressure rooms. The top issue has been determining how to safely manage patients from increasing capacity, to selecting appropriate materials, and making design recommendations that support infection control and prevention.

Misty has focused on collecting data on design best practices and innovations from architects and designers involved in the COVID-19 response so that information could be shared with other health care facilities. She has also helped organize the distribution of 3-D printed face shields manufactured by ESa architects and other local partners to help meet the demand for PPE at area healthcare facilities.

Nurse Consultant
Avanti Architecture
Pittsburgh, PA

Sandie Colatrella is a nurse consultant in a health care architecture firm, where she specializes in space planning, regulatory compliance, and patient safety, including infection control for design and construction projects. Sandie contributed to the development of an emergency plan during the 2015 Ebola outbreak, and she applied that experience to COVID-19.  Since the onset of the pandemic, she has worked on multiple projects including:

• Converting existing patient rooms in nursing homes, hospitals, and Intensive Care Units for use as isolation rooms for confirmed positive patients
• Revisions to standard patient rooms to house patients that have risk exposures but have not tested positive
• Providing recommendations for revisions to operating room spaces for use for procedures on confirmed positive patients
• Inter-facility transport and triage of infected patients
• Revisions to morgues for post-mortem services
• Consulting on environmental services, terminal cleaning and medical waste disposal
• Revisions to ICRA precautions for essential construction projects within occupied healthcare facilities

As part of an interdisciplinary team, she has worked with hospitals, nursing homes, the Pennsylvania Department of Health & Emergency Management, Public Health Officers, CDC Consultants, and subject matter experts to assist in the development of plans to provide emergency care and treatment. 

Her experience as a legal nurse consultant, combined with the application of her practice in the built environment, makes Sandie a unique advocate for risk mitigation and the creation of safe spaces for both patients and health care professionals. 

Merida Brimhall, RN, Manager for ACO Transformation and Care Management
Erin Naharang, RN, Manager for ACO Transformation and Care Management
Tad Comeau, RN, Director for ACO Transformation and Care Management 
Boston Medical Center Health System
Boston, MA

Tad, Merida, and Erin want to acknowledge gratitude for their fellow colleagues Deb Goldfarb (Social Work Leader) and Tia Sommerville (Community Health Worker leader) who work alongside them to ensure their patients and staff stay mentally and physically healthy.

Before COVID hit, Erin, Tad, and Merida filled huge leadership shoes: 26 interdisciplinary, complex care management teams of pharmacists, community health workers, nurses, and social workers report to them, and care for Boston’s most vulnerable.

Merida: “Right now, we are doing grocery deliveries, getting people masks, doing regular check-ins to identify medical and social gaps: transportation, food, housing---we’re working with people on all of it.”

When COVID infection rates began to rise throughout the city, the contagion within homeless shelters became a concern; BMC stepped in to help set up a respite unit for individuals who could not safely shelter in place. Merida and Erin were asked to lead the development of nurses’ roles for this unit and oversee the discharge planning team.

Erin: “Very quickly we had to stand up a whole unit from scratch to meet demand. There’s a sense of camaraderie about being willing to step up and do whatever it takes. Today, people in that unit are getting good care. It all came together.”

Other leaders may have aimed to simply survive the crisis. Instead, Erin, Tad, and Merida are leading through the crisis. They check-in two times per week with their sixty staff: a true commitment amidst their other responsibilities: 

Tad: “In times like this, all the history of transparent communication and good will builds up. Now, when we ask them to make a change, they know it comes from a well-intentioned place. Our teams trust us.” 

Merida: “We’re getting to know our teams on so much more of a personal level; Something I’ve learned through this crisis is a sense of shared humanity.”

Partner
NBBJ Architects
Washington, DC

Teri Oelrich is a nurse and partner at design and architectural firm NBBJ. She has served as a firm leader during the pandemic, helping to define strategy and clinical expertise to health care systems working to address the demands of COVID-19.

Her team provides analytical tools, a website forum to connect suppliers and health facilities in need, and plans the conversion of non-hospital spaces to makeshift inpatient units.

One analytical tool, the COVID-19 Inpatient Bed Demand Calculator, was developed pro bono for hospitals to understand the potential impact on their bed capacity given the varying impacts of newly admitted patients. The first version of the tool was launched early in March as nurses and health care workers around the country raced to flatten the curve.

Since then, Terri’s team has launched two more iterations based on feedback from hospitals. The tool is now being used by hospitals to understand when they can bring back elective cases without potentially over occupying their facility. Collaboration and understanding of immediate needs have been key, especially for access, egress, bed modeling, and setting up tents. The tool can be accessed at https://www.consulting.nbbjsites.com/covid-19-tools.

Terri: “I am so proud of our team to come together and quickly help so many of our clients, I may not be on the frontline, but I can help those who are there!” 

Carolyn Chandler, Nurse Practitioner
Fabiana Saad, Nurse Practitioner
Firefly Health
Boston, MA

Carolyn Chandler and Fabiana Saad are nurse practitioners (NP) and primary care providers (PCPs).

Many health care systems and providers scrambled to stand up telehealth during the early days of the pandemic. However, at Firefly Health—a Massachusetts-based virtual-first primary care and behavioral health company—Carolyn, Fabiana, and the Firefly clinical team were at the forefront of a ground-breaking telehealth model.

Fabiana: “In other practices, NPs often see overflow. Firefly is trying to have NPs be the PCP. We are not the backup. We’re the frontrunners.” 

Because Firefly skipped the “scramble to telehealth” phase, they were able to put together a comprehensive action plan as the coronavirus began to spread across the globe.

Carolyn: “In the beginning, crafting triage protocols, processes, and screening tools required a lot of thought. We had to reconcile guidelines from multiple sources that kept changing. Since testing supplies were limited, we were faced with making strategic decisions about who we’d send for testing and who we wouldn’t.”

Managing preventative care alongside life-threatening COVID-19 symptoms is critical as the world continues to reel from the pandemic’s impact.

Carolyn: “For a lot of people, texting us via our app to have reassurance is comforting. In a time like this, it’s easy to just focus on the data and numbers and forget about patient experience. As nurses, that’s what we’re good at.” 

Fabiana: “People are now somewhat forced to see providers virtually; I hope this changes the conversation around healthcare delivery norms. Why not just start new and teach people a different model?” 

Megan Williams, MSN, RN, CNL
Director of Complex Care
Regional One Health
Memphis, TN

Megan Williams is a clinical nurse leader at Regional One Health, a safety-net hospital in Memphis, TN. When the pandemic began, in addition to her regular duties overseeing care for uninsured people experiencing high hospital utilization, Megan was put in charge of employee COVID testing for Regional One Health—no small task. 

Megan: “Since COVID started, I find I’m getting pulled into projects that are outside of Complex Care, because people in the system recognize I can see through a vision to successful implementation. As a clinical nurse leader, all the skillsets I learned are exactly what I needed to lead in this crisis: How to operationalize processes, how to build teams, how to create change and move quickly, how to improve processes once they’re going, and pivot when they’re not working. I was overwhelmed at first, but with great leadership support I thought, ‘I’m a nurse---I was called to do this. I’m ready.”

Megan notes her COVID duties are not unique. Throughout the Regional One Health system—and all over the country—nurses are leading key initiatives, from phone triage for COVID testing, Emergency Department triage, disaster preparedness, and the critical supply group. As a result, most of these nurses are working more than full-time hours per week.

Megan: “We’re a safety net hospital. Everyone is working to make sure our community stays safe, and that keeps me going.”

Anne Montera, MHL, BSN, RN
Director of Integration, Hippo Health
President, Caring Anne Consulting
Eagle County, CO

Anne has been a public health nurse, policy advocate, and partner with the Emergency Medical Services (EMS) Community in Eagle County, Colorado for decades.

Anne: “Eagle County was hit very early in the COVID crisis. We started seeing the same per capita rates of infection as New York City.”

Eagle County had limited PPE and faced projections that 40% of the local healthcare workers would be infected.

Anne saw a moment of alignment.

Anne: “I’ve been working with EMS systems on a recent policy change called ET3, which allows EMS to bill for ‘treatment in place,’ instead of only receiving payment for transporting a patient to the hospital. I’d also been working with a primary-care technology platform, Hippo Health, in my consulting practice. I knew it could be converted to use for public health, and the new ET3 parameters would allow us to bill for these visits.”

Anne brought together EMS, Hippo Health, the ET3 policy guidelines to stand up a new model of care for her county.

Today, for non-acute 911 calls, Eagle County EMS dispatches to a patient’s home, and conducts a virtual visit using the Hippo Health telemedicine platform while sitting outside.

Anne: “Besides caring for patients, my priority was to take care of our providers. I did 1:1 education with all the paramedics in the county to get them bought in. It takes the eye of a nurse to understand everything a person needs to feel cared for. Everybody is scared, but to date, Eagle County has not had a single infected EMS provider.”

Milagros “Millie” Elia, MA, APRN, ANP-BC,
Founder and CEO, M. Elia Wellness
Michelle Sparrow, MBA, RN
Adjunct Faculty/Co-Director - Quality and Patient Safety, University of Pennsylvania

As the pandemic was just beginning, two nurses happened to be on the same SONSIEL (Society of Nurse Scientists Innovators Entrepreneurs and Leaders) conference call. One heard the other’s call for help about a community neither of them are from, but felt instantly connected with: Navajo Nation.

Millie: “The sound of Michelle’s voice on the call had such a sense of urgency. It was her tone that caught my attention. After the call, I reached out and just said: You don’t know me, but I heard you, and I want to help.” Michelle’s problem was a good match for Millie, who has spent her career as a staunch healthcare activist. Millie leads a company devoted to educating on the intersection of healthcare disparities and the natural environment.

In 2019, Michelle Sparrow worked for Penn Medicine as the Associate Chief Operating Officer of Radiation Oncology in Philadelphia, PA. In 2019, a collaboration between Penn Medicine and Cancer Support Community, brought Michelle to Tuba City Hospital, a 73-bed hospital located on Navajo Nation in Arizona, to consult with their clinical team on providing cancer care.

Michelle: “Most people don’t know Navajo Nation has a population of about 200,000 people and is approximately the size of the state of West Virginia. Tuba City has the only cancer center on American Indian soil on the United States and they have six chemo chairs. I saw this and felt ashamed this was happening in America.”

Millie: “Michelle started to tell me things I didn’t know: 38% of American Indian homes lack water, 32% have no electricity, 60% lack telephone and internet. When you start to think about the impact of those numbers in the context of a pandemic, it’s devastating.”

Officially appointed by President Nez of Navajo Nation, as a “friend of Tuba City,” Michelle used creative tactics, like reaching out to non-traditional suppliers of essentials like hand sanitizer and masks, to ask for help. She secured substantial supplies, like PPE and handsanitizer amidst world-wide supply shortages. Michelle: “I had to get really creative about who I reached out to. It was about being able to tell the story of Navajo Nation to a person on the other end of the line. The story moved people to act.”

Meanwhile, Millie reached out to personal contacts within her oncology nursing associations, as well as virtual strangers in her LinkedIn network she thought could help, starting those conversations by saying, “You don’t know me, but---,” followed by sharing the story of the American Indians.

Millie: “The story spoke to me. I was moved beyond myself to do something. This is the story of a million hands, a million nurses, a million people who stopped to say ‘what is happening’?” Millie has since connected with several major national organizations to facilitate the provision of ongoing relief support in the form of much needed additional PPE, an onsite grocery, and large scale fundraising efforts.

One such organization is the Society for Integrative Oncology (SIO) which she belongs to.

Millie was able to arrange a virtual meeting between SIO leadership and Tuba City’s Regional Healthcare Corporation that resulted in monetary donations, upcoming events to highlight the culture of the American Indians, free virtual wellness sessions for staff,  and a collaboration in applying for a federal grant for telemedicine services to Navajo Nation. All parties have come to the table with no promise of funding or recognition. Once they heard the story, they felt compelled to help.

Michelle: “The staff at Tuba City tell me that when these supplies, or services arrive for their staff, they feel like other Americans care about them. They tell me they feel less alone.”

There is still work to be done: as of July 5, 2020, Navajo Nation has 7,840 diagnosed COVID cases. It has become one of the highest epicenters of infection in the country.