Christie: Hi, I'm Christie Kerner, the COO over at Medplace. On this podcast, we are excited to bring you information that is relevant to risk managers, or anyone really tackling the challenges around quality and risk in the healthcare space. Today, I am delighted that we get to have a chat with Adrienne Fugett. She is our VP of Clinical Operations here at Medplace. Interestingly, she was actually one of the very first team members that we brought onto the team because our dedication to having deep empathy for what goes on in the lives and in the needs of our customers is of utmost importance to us. And, if I'm honest, I don't think we could have found a better person than Adrienne for this, because you have quite the background. Adrienne, I am excited to dive into a little bit of this. So for those that don't know you, you're kind of a triple threat here. To start, you have spent a lot of years as an actual practicing nurse, tell us a little bit about a couple of the areas that you were practicing?
01:06
Adrienne: Sure. I was mainly in the medical ICU. So I took care of patients that were obviously there on a ventilator, with any kind of chronic illnesses, chronic heart disease, attempted suicide, with medications, you know, really intense, not your everyday kind of medicine. I also did a little bit in the ER, but mainly my career centered around the medical ICU units. And then of course, I've been on the other side of the administrative side in risk and quality as well.
01:40
Christie: So you were in situations with everything coming at you from every direction. Being that type of nurse made you have to level up in your understanding of all the different aspects of medicine and how they played together and how you can use this entire network of team members to help patients. Then you went into administration around quality and risk. So you also have that perspective. And then you also took an especially thorough track to understand the legal side of things. Tell us a little bit about that.
02:10
Adrienne: Yeah. So new in my career, about four years into my nursing career at the bedside in the medical ICU, I became, I always had an interest in the legal field. In fact, before I majored in nursing, I had a real interest in the legal field. And what I started seeing in my practice at the bedside is there were a lot of patient complaints that tended to center around a lack of communication. The complaints medically that I was seeing were not necessarily meritorious, as far as the care. But they were typically centered around a lack of communication with the family or with the patient where the family wasn't really understanding the breadth and depth of the disease process and what was going on with their patient. What I kept seeing happening was this frustration level build up, right, because the nurses at the bedside all the time. So I would see these frustration levels build up and then come to the point of a complaint that would go to the risk department and sometimes even go to legal. That became a really interesting path to me so I decided to get an education in paralegal certification. There are programs that will prepare you for that and that's the route that I took, I actually went to a paralegal school, it was nine months full time post baccalaureate program, and it was taught by attorneys. So it was Monday through Thursday, eight to five, then I would work on the weekends in the ICU. And it really immersed me in the understanding of the basic rules of civil procedure, law in general, basic contract law, all those basics, but it prepared me to be able to speak that language with the attorneys understand what they needed from me, and then for them to be able to get from me what they needed as well as far as the medical piece.
04:16
Christie: You did dive very deeply across all three parts of this arena; as a practicing nurse, an administrator in the hospital setting, and then also being that paralegal that is able to understand now how to bring it all together.
It's an interesting note that it was sometimes even just a failure point around communication that can that would start some of these [legal problems], so I understand your passion to help. At Medplace, we are always on a mission to remove friction, and to make everyone's lives better in this process of helping people find medical experts for things like case reviews or peer reviews. So let's dive into it.
Place yourself back in the shoes of a risk professional. What do you wish when you were in that role that you knew? Or what advice would you have for them? In today's world, oftentimes what they're doing to be able to get that second perspective; that medical expert taking a look at a case review, specifically. Let's start with that example. They're reaching out to their law firm, because something has escalated. So what's happening beyond the curtain there? You've seen both sides. Help them understand how their law firms recruit experts, and then leverage their insights for cases.
05:41
In a law firm that specializes in med malpractice, you typically have a registered nurse, not always, but that is the goal and the desire. That registered nurse is tasked with finding the appropriate expert. As that nurse you can use your own colleagues, your network that you have for you, but sometimes you might be in a different practice area. So you find yourself as the nurse paralegal, reaching out doing cold calling, trying to find the appropriate expert to review a case.
There are different ways in a law firm that you'll do that. But as you can already imagine, it's time consuming. So you can go and look at articles that are related to the particular type of medical issue that you're needing, and you can go into the bibliography, find those physicians that seem like they may be ideal to be able to apply into those issues. Then you start reaching out to them.
It's not as quick as you think. Sometimes you get really lucky and you might find someone in two or three days using that method. Sometimes it can be two or three weeks, I've worked cases before, where we had to partner with co-defendant law firms, because we were unable to secure an expert. So we had to pool all of our resources together with the other RN paralegals, and try and find them.
A lot of these physician experts are extremely busy. And, when they get a letter or a phone call from a law firm, their initial reaction is they just, you know, hang up! Or they just don’t respond. But yet, when you're speaking, as you get to know the experts, most of them have a real interest in doing this kind of work. So being able to create an environment, which I think we've done here at Med place where you've got practicing physicians coming to the table that want to dip their toe into the waters, you're already way ahead of the game. For me, coming to Medplace already having that background that I just shared with you that sometimes you have to search and search and you have to partner with the co-defendant law firm, being able to have this at your fingertips is really more efficient, and more practical for getting these reviews done and putting everybody back together, as best as you can, from a potential complaint or harm event.
08:21
Christie: This is interesting in the fact that if we just really get down to the actual process side of it, on one hand, there's never a point in which in which we are excited about giving our legal team something to do that's going to require tons and tons of time, right? Because that adds up really fast. They're very specialized in what they do. But, when looking for a medical expert, we really don't want to be just Googling who's a local neurologist, right? The short path to that isn't really necessarily going to get us the quality and what you described as the full process that you use makes sense that it would be pretty intensive.
When looking for who are the actual experts, leaning into the word expert, we need to be thinking about who we should really be seeking that second perspective from when we're putting a serious investment in looking at how did we care for a patient and how can we do right by them. I see your point there that that is a heavy lift for a one-time situation, which is why med place came to be. We look at that and know that we can create that network of experts that can offer a more efficient level of return off of the investment put in finding them.
09:40
Adrienne: Yeah. 100%.
09:43
Christie: Let's go back in time again, so say you do all of that outreach, and you spend all that time. You're probably having to bill a client for that time because there's no other way that that makes sense. And as for getting the doctor to call you back, it's not necessarily intuitive for them to know that when the law firm reaches out, this is going to be a really cool thing that they want to jump into. Right? Did you find that you usually got your first, second, or third choice all the time? Or was it a bit of a mishmash on who you even get to work with?
10:17
Adrienne: No, you didn't always get the first person that you reached out to. Sometimes it took several different experts you had to reach out to in order for you to get someone to call you back. And then you had to discuss the basic findings of the case, see if they're interested, see, if they have the time, make sure there's no conflicts. And all of that takes a certain amount of time, like you said, that adds up. You know, as far as billing to the client,
10:51
Christie: If you're reaching out to a doctor, and it happens to be their first time doing something like this did you find yourself kind of trying to provide some kind of like training or, you know, helping them understand how to think about providing a perspective like this?
11:07
Adrienne: Sometimes you would come across an expert that had that experience, and then sometimes you didn't. Let's say that you get them to review the case, and they don't do a great job, or it doesn't click for them, or they can't be supportive of the care, which is fine, right? Because that's what you want – an unbiased review. So sometimes you spend all that time, and you still don't find the right expert. Again, we're adding time to a process that's already very time intensive, as far as it comes from the law firm. And the training is very limited, because we're moving very quickly, because in a law firm, the nurse paralegal has got several cases; your caseload, as a nurse, can be anywhere from 50 to 75 cases at any given time. They're in different stages, but it's still a big caseload that you still have throughout the day, throughout your month, your week, whatever, where you're still addressing all of these different cases. So it can stretch out a review into three months, when it really only should be taking a couple of weeks.
12:27
Christie: That's something that we can't overlook the impact of because we always have limited resources from a budgetary perspective so we're mindful of how we're expending those. But back to the fact that the whole point here is, how are we helping these humans. Delaying something by three months when they're already in an uncomfortable state, is never really going to help the situation. It's beyond financial.
12:56
Adrienne: It is. Yeah, it is. And, it’s hard for the healthcare provider, too. I've been on many webinars where you hear physicians talk about how having a legal matter over their head affects their practice and their ability to focus. In fact, my ex-husband was a physician and was named in a suit. I've lived with it personally and I've seen how it affects a caregiver. So you've got that piece on the physician that's trying to give care, and then you've got the patient who feels that they need support, they need help, they've been wrong, there's been negligent care. You're just stretching out that entire process for everybody. At some point, that that rubber band is going to snap and break.
13:48
Christie: That makes a lot of sense. Innovation is something that will continue to hit every area of life for us as humans, but I think it's especially lovely when innovation hits an area that we can really make a difference in the lives of humans.
Let's now fast forward to what you're doing here at Medplace. When you think about all the experiences you've had, what was important to you in how you built out the clinical operations team at Medplace? And how do you feel like that's changing the way that we are able to help this entire ecosystem?
14:29
Adrienne: A couple of things that came to me right away when I met with the CEO, Jerrod, for the first time, were my ability to have empathy for the attorneys and the claims consultants and then my ability to have empathy for the health care providers because I've walked basically in both of those paths. It was really important to me to be part of creating a company that could help effectively provide experts that were going to give you a non-biased view to what was going on with this patient complaint or this harm event. And to be able to do it in a way that was had a decent timeframe around it; three days or three weeks versus three months, that sort of thing. That was hugely important to me, and then being able to provide an opportunity for healthcare providers to monetize their expertise away from their bedside.
I will tell you, one little thing that we haven't touched on that I think is important is everybody in health care, physicians, nurses, people giving care, we tend to burn out a lot quicker now. When I first started as a nurse, a seasoned nurse was considered 8-10 years, a seasoned nurse now is 2 years. People in health care are burning out much more quickly. And that has a potential negative effect for all of us. When we lose experienced physicians and nurses that affects the kind of care that we receive as patients. So being able to provide this opportunity at Medplace where you can monetize your expertise away from the bedside, and be so excited about your expertise and the care that you give, that when you go back to give care, you're like, oh my gosh, this is so interesting. I'm taking what I'm learning from these cases, and I'm applying it to the care that I give now. And, I'm helping my peers and my colleagues, all of that came together for me like an aha moment. I'm very passionate about answering the questions on the call for both the claims consultants and the attorneys. How can I help you? How can I make this better? And also preparing a work environment that has good pay and good respect for your expertise, as a health care provider. I think being able to meld those two things together can make medicine better. I hear experts talk about that. I've heard nurses tell me, this has changed how I give care. I've heard physicians tell me, this changes how I give care, it makes it better.
17:23
Christie: That's real impact. It's really terrific. We have a unique opportunity to contribute in a way that sincerely aims to improve healthcare.
Adrienne, thanks for spending a few minutes with me today. I'm sure we'll get a chance to dive into some other topics over time. If any of our audience that are thinking about how to improve their processes, either someone from a legal firm, or a risk management professional, or a doctor that's interested in being a part of a network like this and helping us serve on our mission to find better doctors and get better insights... they can reach out to you can't they?
Adrienne: Yes, anytime.
