How APPs Can Ease the Healthcare Workforce Crisis

00:00:00:02 - 00:00:18:06
Tom Haederle
Welcome to Advancing Health. Advanced Practice Professionals - or APPs - perform many duties similar to physicians and are an increasingly important part of the health care ecosystem. Which is why the right leadership is needed to guide this critical part of the health care workforce.

00:00:18:08 - 00:00:40:02
Elisa Arespacochaga
Hello, I'm Elisa Arespacochaga, group vice president of clinical affairs and workforce at the AHA. Today, I'm really pleased to be joined by Leslie Clayton, program director for APP service at M Health Fairview and chair of AHA’s APP Leadership Advisory Group. We're here to talk about the role of APP leadership, how it is evolved and why it is increasingly important in today's health care environment.

00:00:40:03 - 00:00:55:21
Elisa Arespacochaga
So welcome, Leslie, and to get us started, can you introduce yourself and tell us a little bit about your current role? I'd love to hear sort of your journey into leadership as a practicing clinician, and what drew you to the work and how it's shaped your leadership APP approach?

00:00:55:25 - 00:01:22:13
Leslie Clayton
Sure. Thanks for having me. It's nice to be here. So my leadership evolution really came from genetic makeup. My mom was an RN. My dad was a process improvement guy. I spent most of my childhood really interested in how do I make something better, because I was watching them do it and I saw the impact it was having. And I think that's probably what drew me into becoming a PA was it was an opportunity to make things better through a great variety of creative opportunities.

00:01:22:15 - 00:01:51:27
Leslie Clayton
My leadership journey really evolved throughout childhood and being a student. Even as a PA student, I served on my state academy PA board as a student director. And it's where I learned that if you really wanted to be a fully well-rounded medical professional, you needed to have an understanding of the other aspects of how medicine is practiced. And that led me to state academy roles, serving as legislative chair, president, and then national roles, where I served for the last seven years as one of the speakers of the House of Delegates for the American Academy of Physician Associates.

00:01:51:28 - 00:02:12:10
Leslie Clayton
And I'm now honored to serve as the president-elect. It's through the legislative work, through that parliamentarian speaker of the house process work, that I was able to deploy those skills to help with care innovation, with care model design. And so that's what my current role is as the program director of advanced practice for a large academic health system.

00:02:12:15 - 00:02:31:03
Leslie Clayton
My role reaches across all 11 of our hospitals and our multitude of outpatient clinics in any area or aspect where nurse practitioners, PAs, clinical nurse specialists, nurse midwives and CRNAs are functioning. That's work that I have some implication or work to participate in.

00:02:31:07 - 00:02:43:20
Elisa Arespacochaga
That's great to hear. So for those who may be a little less familiar with the role, how do you define APP, specifically leadership, and why is it such an important part of health care organizations today?

00:02:43:27 - 00:03:12:21
Leslie Clayton
Yeah. Advanced Practice Providers being PAs and advanced practice nurses, really are sort of the undiscovered country at this point in our healthcare evolution. As health care changes, we really need to utilize our workforces as to their full extent. And if you don't have good leadership over a certain workforce, you're not going to deploy them properly. So an APP executive leader really should be focused on things like strategic and organizational implementation, not so much the daily task management or schedule setting up. APP

00:03:12:22 - 00:03:37:26
Leslie Clayton
executive leaders really should be focusing on sort of the broader workforce planning, professional development, quality safety initiatives, regulatory compliance, onboarding, privileging, credentialing, all of those aspects that really come into the professional deployment of a group of workers. We're talking about 40 to 50% of health care professionals now inside of our health systems. And if we don't have proper leadership of them, we're not going to have proper deployment of them.

00:03:37:27 - 00:03:59:10
Leslie Clayton
And that's why APP leadership over PAs and advanced practice nurses is really going to be influential in how care is delivered, and how those models are designed to really meet the needs of patients. We need to be focusing on what does the patient need and who's the right person to provide that. More so on sort of constructs of task management and hierarchy.

00:03:59:13 - 00:04:22:13
Elisa Arespacochaga
Couldn't agree more. We certainly know the demographics are against us. We need every human who's willing to go and care for others to be part of that team and to work as effectively as they can. And I think there's this whole hierarchy    and structure for medicine, and there's a whole hierarchy and structure for nurses. And APPs are somewhere in between. They're pieces of both of those structures, but they need a structure of their own.

00:04:22:18 - 00:04:41:20
Elisa Arespacochaga
Now, those structures can look very different from one health system to another, depending on what that health system is providing, who their teams are. What are some of the different ways you've seen those structures grow up, and what are a few of the characteristics or approaches that you feel are key to really be effective?

00:04:41:22 - 00:05:00:18
Leslie Clayton
Yeah, and there is no one size fits all model because every health system is shaped differently. Every construct is different. Every state has different regulatory practices. And that's going to have influence on how you set up an APP leadership structure. You know, we're very fond around the AHA of saying structure matters and process matters, but culture eats it all for lunch.

00:05:00:20 - 00:05:35:10
Leslie Clayton
And that's true when it comes to APP leadership as well. You've got to support the role across disciplines, in an environment where the PAs and the APRNs, the leadership is going to be empowered to actually contribute to the changes and the evolution of health care. The APP leadership role really needs to be put in a position at the executive level where anytime we're talking about workforce development or how do we meet the needs of a patient, you're including your advanced practice providers in that conversation. We have to fully contribute to patient care through those organizational strategies.

00:05:35:10 - 00:05:49:10
Leslie Clayton
And it's not really who's in charge. It's what does the patient need and how do we get the workforce arranged around the needs of that patient. And APP leaders are essential in designing that new system.

00:05:49:13 - 00:06:09:25
Elisa Arespacochaga
Couldn't agree more. I think that's the bottom line of this, is that we have we're good at putting some friction in the system. And how can we make it frictionless, or at least as close to frictionless as we can, both for the patient and for those providers, so that they are doing the job that they train to do and best supporting the community that they're there to serve.

00:06:09:27 - 00:06:20:09
Elisa Arespacochaga
So as we think about sort of the future and where health care is going, why is investing in APP leadership more important than ever right now?

00:06:20:12 - 00:06:48:10
Leslie Clayton
Because patients need care and we need everybody at the table ready to provide that care. That's the simple tie it up tight. But the reality is we're facing unprecedented challenges. We've got physician shortages that are not getting better. They're only getting worse. We've got workforce burnout, increased complexity of care and financial pressures. And APPs are really the uniquely positioned to be flexible, adaptable in that care model need to meet the what the patients are really seeking.

00:06:48:10 - 00:07:08:27
Leslie Clayton
So some of the tips and tricks that I would put forward for people that are looking at developing their APP leadership, is that you've got to include them at the executive level. They've got to be part of the strategic planning. You've got to invest in them. You've got to create some leadership development programs, and you've got to really emphasize that innovation is what we're looking for, because this is an untapped workforce.

00:07:08:28 - 00:07:32:10
Leslie Clayton
And if we really empower and put a culture in place where invention and looking for new ways to solve problems, you're really going to get the best advantage out of your advanced practice provider leadership. And you've got to foster collaborative models where physicians, PAs, advanced practice nurses, nurses, administrators, and everybody are working together in partnership to meet patient care needs.

00:07:32:10 - 00:07:39:28
Leslie Clayton
That's the organizations that are going to be successful, is the ones that brings everybody to the table with the focus of how do we deliver care smarter.

00:07:40:01 - 00:08:03:13
Elisa Arespacochaga
I love that, and I want to double click on the part about education. Leadership, I believe very strongly is a skill you learn, you hone, you train. It's not something you're born with. And I think it's really important to highlight the clinicians aren't trained to be leaders, that there is a process to learning how to lead others, how to deploy people, how to do all that work.

00:08:03:14 - 00:08:07:21
Elisa Arespacochaga
Any gems you want to share from your own leadership journey as to how to do that well?

00:08:07:28 - 00:08:26:22
Leslie Clayton
I would say that the alphabet after your name isn't the determining factor as to whether you're a leader or not. I would say asking questions and being curious is a key component to being a strong leader and knowing when you have something to share. Share it honestly. Share it openly with the intent of making things better.

00:08:26:25 - 00:08:46:26
Elisa Arespacochaga
As you're working with health system leaders in your own work and across your national role, what would you really like health system leaders to prioritize as they think about the care delivery models of the future, and how to make sure that APPs and all of the clinicians that are working in it are at the table and in those conversations?

00:08:47:02 - 00:09:10:14
Leslie Clayton
Yeah, I would say that we need to change the mindset that PAs and advanced practice nurses are not task managers. They are care providers. They are people who render care, generate revenue and change systems because the patients require us to do so. That's why our professions exist, is because patients needed care. In the 1960s, that's when we were developed and it couldn't be more true than it is now.

00:09:10:14 - 00:09:18:20
Leslie Clayton
And now is the time to leverage the capacity of our flexibility and adaptability to really move health care forward so our patients are getting seen.

00:09:18:22 - 00:09:37:01
Elisa Arespacochaga
Leslie, thank you so much for all the work that you do. Both chairing the committee, the advisory group, chairing the national level work that you do, as well as the local work you do to care for your patients and continue to do that at M Health Fairview. So thank you so much.

00:09:37:03 - 00:09:45:25
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on APPle Podcasts, Spotify, or wherever you get your podcasts.