Mobilizing the 4Ms: How El Camino Health is Transforming Age-Friendly Care

00:00:01:06 - 00:00:23:22
Tom Haederle
Welcome to Advancing Health. The 4Ms are the core components of Age-Friendly health systems that aim to improve the quality of care for older adults. Today, we hear from California-based El Camino Health about how its adoption of the forums has produced measurable improvements for the older people it serves.

00:00:23:24 - 00:00:40:20
Raahat Ansari
Hi everyone. We're here in Chicago at AHA’s Advancing Age-Friendly Care Convening. I'm Raahat Ansari, senior program manager at the American Hospital Association. Today I'm here and joined by Carolyn Bogard from El Camino Hospital. Thank you so much for being here with us today.

00:00:40:23 - 00:00:43:19
Carolyn Bogard, R.N.
Thank you for having me. I'm so excited to be here.

00:00:43:22 - 00:01:06:18
Raahat Ansari
Great. So we wanted to take some time to understand your Age-Friendly journey and how you implemented the 4M's framework at your organization. And I'll just take a quick moment for those listeners who might be new to this work to explain that the 4Ms is: what matters, medication, mentation and mobility, and applying that care to older adults. So can you tell us how it got started?

00:01:06:20 - 00:01:29:09
Carolyn Bogard, R.N.
Absolutely. And again, thank you so much for having me and for this opportunity. I'm so proud to talk about the work being done at El Camino Health, and where we're at on our journey. We are still in the beginning phases of our journey and the 4M implementation at El Camino Health - it actually started with the leadership of one nurse.

00:01:29:15 - 00:02:02:08
Carolyn Bogard, R.N.
This nurse was making advances in her unit to implement an evidence based project, and her passion was really around delivering Age-Friendly care to older adults. And through her work and collaboration with pharmacy and our Epic analysts and other interdisciplinary team members, she was able to advance and roll out the 4M's on this medical unit within El Camino Health.

00:02:02:11 - 00:02:14:15
Raahat Ansari
It's amazing to hear. I just want to share that we do hear that a lot of organizations get started with this by one single individual championing this work, so I'm super excited to hear that that's the story at your organization.

00:02:14:18 - 00:02:37:21
Carolyn Bogard, R.N.
Oh, thank you so much. Yeah, we're super proud of her. And she continues to be a steadfast advocate for this work and continues to be so passionate about it and deeply involved with rolling out the 4Ms further throughout our health system. We certainly saw the impact in the benefits of rolling out the 4Ms and of this Age-Friendly health initiative.

00:02:37:24 - 00:02:47:22
Raahat Ansari
Did you see some outcomes and did you have data and what did you do with that data? And I wonder, were you able to share that with your leadership if you needed some help with leadership buy in?

00:02:47:29 - 00:03:26:18
Carolyn Bogard, R.N.
Yes. One of the things that we helped to do to advance this work, one of the first things is really to pull some of the data. And some of the data already on this unit was around high patient engagement scores and also the volume of older adults within this specific unit. We knew through the Age-Friendly initiative and the work with the IHI and American Hospital Association that rolling out the 4Ms within a health system impacts length of stay, readmissions, falls and other patient health outcomes and health system outcomes, too.

00:03:26:21 - 00:03:52:29
Carolyn Bogard, R.N.
And we were able to bring this information in this data to our chief nursing officer. And we began conversations around how can we expand this initiative throughout our health care organization? So, she was extremely supportive and excited and passionate around this work as well. And then it was a matter of identifying next steps.

00:03:53:03 - 00:03:58:09
Raahat Ansari
So it was the data that got your chief nursing officer on board. Did I hear that correctly?

00:03:58:09 - 00:04:32:15
Carolyn Bogard, R.N.
I think it was the data and also her passion around it. And I think what I've seen is there is a lot of health care providers passionate about caring for older adults. And I think the 4M framework really helps to create a platform for where to focus that passion and energy to help produce really tangible outcomes and help to really streamline health care delivery for the older adults in our health systems.

00:04:32:17 - 00:04:43:17
Raahat Ansari
So I'm hearing a little bit of outcomes across the board. So there were definitely some positive patient outcomes. And from what you just shared right now, there were some positive provider outcomes.

00:04:43:19 - 00:05:21:09
Carolyn Bogard, R.N.
Well, I think certainly our providers are interested in continuing to advance this work. I think from the pilot phases and initial rollout of the 4Ms and this unit, the nurses in particular in this area found the work to be important and meaningful. And recognized the value that this work can have for their patients. And, you know, one thing that we did within our health system, when we're talking a little bit about scope and spread and how to really expand this work is, where do you begin?

00:05:21:15 - 00:05:52:05
Carolyn Bogard, R.N.
We had some success on this medical unit within our health system. What nursing leaders, what key stakeholders within the health system do we need to further expand? And we are so thankful to have the executive support that we do. Because our CNO knows exactly who to pull into the conversation. And one of the stakeholders that was really helpful with advancing these conversations is our process improvement adviser.

00:05:52:07 - 00:06:19:20
Carolyn Bogard, R.N.
And we really started by identifying what problem are we trying to solve, and then really doing a value stream about current processes within our health care organization. And what do we need to do to further expand some of this work? And some of the things that we identified right off the bat is identifying some programmatic leadership.

00:06:19:23 - 00:06:48:24
Carolyn Bogard, R.N.
Who's in charge of further expanding this, this, health care initiative? And also, where can we get consistent data from? Data can help tell your story and we know that this is an important story to tell, both to our patients and our health system. And we were lucky enough to work with a fantastic data analyst within our health care organization and he helped to develop an Age-Friendly dashboard.

00:06:48:27 - 00:07:29:12
Carolyn Bogard, R.N.
It's still in the beginning stages because sometimes there's so much data you can get paralyzed. And so we have to really think about what data do we need and how do we act upon the data that we have. Part of the initial data collection was around our patient population. You know, better understanding who are we caring for in our health system, identifying certainly ages and demographics and what service lines are these patients on based on that data that's helping to inform us around which units will we spread to next?

00:07:29:14 - 00:07:45:24
Raahat Ansari
I think that makes perfect sense. And one question that I want to ask you that I imagine some of our listeners might have of you is do you have any tips that you could share that you used to get that leadership buy in? We all know how important that is to leverage.

00:07:45:27 - 00:08:30:04
Carolyn Bogard, R.N.
Well, I'm so thankful to have regular and consistent communication with my executive and that alone gives me a pathway to communicate where we need help and what type of support that we need. And through that support and engagement and ongoing communication, we were able to develop a plan. Now, the plan did not develop overnight. It took probably three months from that initial conversation to even get a quorum of nursing directors across the organization in one room, with the process improvement advisory to talk a little bit about Age-Friendly care within our health care organization.

00:08:30:04 - 00:08:35:16
Raahat Ansari
And that's a success in and of itself, right? And get have all the stakeholders in one room to talk about that.

00:08:35:16 - 00:09:13:09
Carolyn Bogard, R.N.
Definitely. And when we had these initial conversations, everyone had different thoughts and ideas and opinions and observations about what was going well within the organization and what could be improved. And following that, we completed an A3, which is really a, you know, a systematic way to tackle a problem. And through input in discussion and these observations from all the nurse leaders, we were really able to see what areas are we doing well in and what areas can we improve in.

00:09:13:12 - 00:09:39:05
Carolyn Bogard, R.N.
And because we did have the 4M framework already rolled out on one unit, we weren't starting from scratch. We already had a pilot unit that implemented the 4Ms and was successful with that. So it was really more about building upon that success. Now we're at a spot as we think a little bit more about spread and scale across the organization.

00:09:39:08 - 00:09:51:03
Carolyn Bogard, R.N.
How do we dive a little bit deeper into each M, and how do we gain further engagement from members of the interdisciplinary team?

00:09:51:06 - 00:10:05:06
Raahat Ansari
And I do hear another challenge from some organizations about breaking down those silos and having that those interdisciplinary conversations. Any advice that you could share and how you successfully made that happen at your organization?

00:10:05:09 - 00:10:29:19
Carolyn Bogard, R.N.
Oh, yeah. Thank you so much for that question. And I would just add, being here at this forum, it's just so fantastic because even just today, I learned different ideas from different folks within the community. So one of the areas that we talked about was how do we get that buy-in and collaboration from members of the interdisciplinary team?

00:10:29:21 - 00:11:04:27
Carolyn Bogard, R.N.
Being that it's, you know, pharmacy or rehab services, case management, social worker, even our physicians, and certainly one of the best practices that was identified is really trying to find a champion in each area. And in my experience and observations, I have seen some passion out there about delivering high quality care to our older adult patient population. So at least within my health system, I don't have to look too far for individuals that are interested in advancing this work.

00:11:05:00 - 00:11:32:02
Raahat Ansari
When we started this work, that provider re-engagement and that spark, that passion that really was reignited when providers were working towards implementing the 4Ms framework into a patient care plan - that was something we were not expecting to see. So I really appreciate that you're saying that it's not hard to find, because we have seen that in real life when we have new teams come and join the action

00:11:32:02 - 00:11:50:00
Raahat Ansari
communities a little unsure of what to expect, what they're going to get out of it. And come two, three months into this, we've got a whole host of providers from all different disciplines who are really excited and passionate about being able to implement this work with their patients. So just wanted to highlight that point. Thank you for bringing that up.

00:11:50:06 - 00:12:08:15
Carolyn Bogard, R.N.
Oh you're welcome. And actually to your exact point, I have been part of the action community intermittently, throughout a number of years based on various jobs that I've had. And I get it. Caring for older adults, it is a passion of mine and it's such a privilege to be able to continue to be part of this work.

00:12:08:18 - 00:12:46:11
Carolyn Bogard, R.N.
But I would even think 5 to 7 years ago, people were just better understanding the importance of delivering high quality, reliable care to older adults. And even in that short period of time, I feel as if I have seen some reinvigoration in interest into this real specialty area of medicine. It's fantastic because it really does take a village, and an interdisciplinary team to provide holistic care to our patients, certainly within the hospital setting, but also across the care continuum.

00:12:46:14 - 00:13:03:09
Raahat Ansari
And so what I'm hearing is you have nailed it at this at this one site, you are done and done. Just kidding. Because that work is never done, right? But you've made some really good strides at one care site and you're moving to expand to other care sites within your organization. And that is fantastic news and something to celebrate.

00:13:03:11 - 00:13:05:06
Raahat Ansari
Thank you again for being here with us today.

00:13:05:09 - 00:13:08:05
Carolyn Bogard, R.N.
Thank you. It's been an honor and a pleasure.

00:13:08:07 - 00:13:16:18
Tom Haederle
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