Mark This! Podcast, Episode 17, TeleNutrition
Host: Heather Dotchel, Corporate Communications
Guests: Nakia Spencer-Graham, National Director of Clinical Nutrition Development and Deployment for Healthcare+ and Jessica Leonard, Regional Director of Clinical Nutrition Development and Deployment
It is time to Mark This, a podcast in which we peel back the corporate curtain to reveal the cool and innovative people, programs, and projects that are happening all over Aramark's varied lines of business.
I'm Heather Dotchel. As a member of Aramark's communications team, I see and hear amazing things that are happening across our company every day. These remarkable initiatives happen because we have remarkable people behind them, building opportunity, building innovation, and building community.
Today we are exploring of technology service, to remotely connect our highly skilled clinical dietitians with hospital patients through cloud-based technologies. Our guests are Nakia Spencer-Graham, national nutrition director, and Jessica Leonard, regional nutrition director who are with Aramark's Healthcare plus.
Nakia, tell us a little bit about yourself please.
Nakia Spencer-Graham (01:05):
Thank you so much. Well, my title is National Director of Clinical Nutrition Development and Deployment. I always say that's one of the longest titles in Healthcare Plus. But I've been a dietitian going on 26 years, and every time I say that, it blows my mind. I guess they say time flies when you're having fun.
I have been with Aramark going on 18 years. I did work as a bedside dietitian in large teaching facilities, but my first management gig was with Aramark, and I've been with Aramark ever since. I've worked in large teaching environments, medium hospital environments, have been a general manager over the entire house, so patient dining, clinical, retail, catering.
And then, really my passion is clinical nutrition, so my management career does span that in assistant director of patient services roles. I've worked as a field channel manager helping accounts with some of their operational needs, guiding them based upon my learnings as an operator and past lives, a brand manager developing programs for both patient dining and clinical nutrition, more of a marketing platform.
And now as the national director, I lead a team of incredible regional directors that create the tools and resources our RDs use to care for patients, and our managers use to lead them and ensure regulatory compliance.
Well then, let's move on to one of your regional nutrition directors. Jessica, we'd love to know more about you.
Hi, Heather. Hello, everyone. I'm Jessica Leonard. I have been a registered dietitian for over a decade now, and like Nakia, I can't believe the last 10, 11 years have gone where they've gone. I have worked during that time in long-term care, in inpatient acute care, and even outpatient settings as a dietitian. Including diabetes, general medical nutrition therapy, and even bariatric surgical centers of excellence. So a little bit of everything.
Experiencing all of that brought me to Aramark eight years ago. Started as a clinical dietitian and clinical nutrition manager in rural Pennsylvania. Wonderful learning experience that was a stepping stone to becoming a general manager with Aramark at a 500-bed hospital in the Virginia markets, where I was able to oversee retail, patient dining, catering, our brand outlets, and also clinical. So kept my hand in that.
But at night I decided to complete my MBA, because I wasn't busy enough, and that was a whirlwind. But that management degree really taught me that I wanted to do more. I wanted to help more people, and I wanted to do that still in the clinical space, and feel like I was helping a patient, even though I was managing.
And then this role with the Nakia's team as the regional director of clinical nutrition development and deployment for the Northeast and South Mid-Atlantic regions, very long title again, came open. And what it meant was that not only would I get to develop programs, but I would get to travel, and work with our field teams, and cover the area all the way from Maine to Florida and over to Arkansas.
So I still get to work with our teams on the ground, and bring them relevant programs. And one of those relevant programs that I've been working on for the past two years as the project lead is our telehealth program that we are going to talk about today. And I'm so excited to teach you all about it.
All right, fantastic. So we are remotely connecting our vast network of skilled clinical dietitians with hospital patients, and that is really, really cool. Nakia, what services can we offer patients?
Nakia Spencer-Graham (04:44):
So that's a great question, and I am so pleased to answer that. We're always incredibly proud of the great work our large network of RDs are achieving to positively impact our patient outcomes. And one of the things that we always strive to do is to ensure that our clinical dietitians have the tools, the resources, the solutions that they need to care for those patients.
And telehealth really allows us to provide them an innovative solution, to still be very engaged at the bedside. And one thing people always ask us is, how does that really work? And what did they do?
Well, they're able to complete nutrition assessments just as if they were at the patient bedside. Follow-up assessments, diet education based on the prescribed diet order, and then also patient family member interaction as well. Many of our patients do have caregivers, their caregiver's at the bedside, and we're able to interact with them as well.
The one thing that people are curious about is, what does that interaction look like beyond the bedside? Well, our RDs are able to participate in rounds and care plan meetings through the telehealth devices, and so they're still a very engaged part of the medical team. So when we look at what the differences are between bedside and virtual, we're still neck-and-neck in our ability to provide that awesome patient care. And so we're very excited about this opportunity to give some flexibility to our care environments.
How does the technology work to make that happen, Jessica?
In conjunction with our Aramark telehealth program, any technology, as long as it is HIPAA compliant and has two-way audiovisual capabilities, can be used. That means that our dieticians can speak verbally to the patients in real-time, and see them in real-time. Think FaceTiming with your family members, or using Teams at work. It's the same technology that our dieticians are using to talk to patients.
The technology for the program can be owned by one of our clients. Or if the client doesn't have that technology, they can leverage Aramark's partnership with our third party vendor to bring that new service to their location.
The device itself can look different depending on your location needs. It can be a rolling cart, just rolling the person right in, saying hi, just as if a person was walking in the room. It could be a small mounted device, or integrated into the patient TV that's already hanging on the wall. It could also be as simple as an iPad or a Microsoft tablet, just like the one you have at home, that could be mounted on a rolling cart, or that the patient could hold onto and talk to their provider.
So there are many things that the technology could look like, and they all have their individual nuances, but we have a kind of standard practice for how we use those with our patients.
So let's take the example of the rolling cart, because that's what we see most of our locations using at this point. Plus that does help with infection control, we don't have patients touching devices and holding them in their beds. So what would happen is, a member of the medical team that's on-site would roll the cart into the patient room.
The dietician, who could be sitting at home or in a larger hospital, just like one of our locations where they have a large facility and they have a critical access hospital that's two hours away. They call into that rolling cart device from the large hospital to the critical access hospital, and save their dieticians over a two-hour round trip to provide care to that patient. Plus, it means the patient gets their care faster, and especially if they're going home, helps them get out the door and backs of feeling better in their own space.
And that same thing happens with our telehealth technology. The dietician clicks on the device in the application, there's a virtual knock at the patient door, and they can choose to start that session with the dietician. The dietician then completes their assessment by talking to the patient, but also looking at the patient.
The camera technology on these devices is so great that you can zoom in, if there was a nurse in the room for example, you could zoom in and see the small writing on the bottom of their badge. So we are still able to physically assess our patients as dieticians, as well as talk to them during this process.
Once we finish our assessment we say our goodbyes and we hang up, just like we would close that door, and the dietician can then document in the electronic medical record. It truly is almost as simple as making that FaceTime or Teams call that we do every day.
That's a really great and clear explanation. Thank you for that. What was the genesis of this idea? I suspect it ties into our whole patient, all of us are caregivers philosophy that Healthcare-Plus has embraced. Nakia, can you elaborate on this?
Nakia Spencer-Graham (09:45):
Oh, yes. As a dietician, that's a very layered question. I really would like to get into the details. Anyone who knows a dietician, we get all the way into the details, but I'm going to stay at a very high level. And as caregivers at heart, we are always looking for ways to impact our patient outcomes. That is what drives us day-to-day at the bedside.
And from a development phase or development state, we are looking for efficient ways to do that for our clinicians that are regulatory compliant and innovative. And with all of our programs that we developed, including telehealth, we start with insights.
Really, what does the literature tell us? We're kind of academic in keeping that in mind. What does the literature say about the future of clinical nutrition services and where that's going? What are our patient needs? What are our clients looking for? Specifically clients looking to address social determinants of health, meeting patients where they are, where their care is needed.
And then, what is the marketplace telling us about where the profession of clinical nutrition is going into the future? So keeping all of that in mind.
And then also looking at how do our peers, our physicians, the nurses and other multidisciplinary team members utilize technology? Well, physicians have been doing this for some time, so why not us? Enter into the telehealth space to really help our clients address the needs of the patients in their environments?
And so we are so excited to be able to address that, specifically social determinants of health. It's more than a hot topic, it's a real experience. I myself, with my father, have experienced that in a rural setting, being able to get the care that's needed instead of life-lighting him to another facility where he could get that care.
And so, one thing that we always think about is the entire life cycle of development. And the genesis of that comes from really great minds getting together, our field members providing input and insight into the needs of what's happening in our client environment, and then us developing against that, testing and learning what that will look like. And then being able to put out a good, sustainable program that can be hardwired in various environments in a very flexible way.
Telehealth really does extend the care of a clinical dietitian beyond just the bedside. Like Jessica said, we are able to provide care from, let's say a larger facility to a smaller facility within the same system, helping to expand the care and with an economies of scale mindset. So that's the genesis of how we arrived at this place, and we're so excited to be here.
So the potential for us to just cover the needs of our patients across the country is vast. But how does this work from state to state? Aren't health regulations different in each? Jessica, can you take that on?
Heather, you are so right when you make that statement, and I don't know if you know how true that is. But those regulations or rules that providers like dietitians must follow for the services that we provide to our patients, they're controlled by the federal government all the way down to the state level. And every one of them can make any decision they want on what those rules are. That's okay. We just had to incorporate all of those into the development of our telehealth program.
Telehealth, like I said, is controlled from the top-down. So we have the Center for Medicare and Medicaid services, or CMS. We have our state Medicaid's, and then you have your private insurance payers that we also have to take into consideration. But fortunately, they have some agreements where they're like, we're going to follow the Medicaid rules. And they don't try to make up too many of their own, so that's a positive.
What we do have to take into consideration, even though those private payers are following Medicaid, is that the rules that Medicaid states, and even federal government have had in place for years, were changed by the public health emergency brought in due to the COVID-19 pandemic.
The good thing about those rules and regulations from the public health emergency is that they expanded telehealth, and how, when, and where we were able to provide that care. If we look back, dieticians have actually been able to provide telehealth since 2002.
Which, I can't even imagine FaceTiming in 2002. I think I had this old Nokia phone with a Scooby Doo cover on it at that point. Not even a thought that we would be FaceTiming, let alone talking to our patients in a hospital bed today. That's outside the realm of what I could comprehend in 2002.
But in 2019, 20, and to today, we have those expanded regulations. We don't know at the end of this calendar year, 2024, if CMS and our states are going to continue to allow these expanded telehealth rules to stay in place. So our Aramark program is built on all of the gold standards that were in place prior to the pandemic.
So even if those rules go away, what our client sites are doing will be regulatory compliant. Because we've taken into account what the federal government and what the states had in place back then, and now.
We also took into account that from state to state, dieticians, because they're credential medical providers, have to have licenses just like physicians. Unfortunately, those don't cross state lines. You have to go to each individual state at this point and get your license. And so for a dietician to provide telehealth, they need to have a license in the state where the patient is located.
So I'm located in Virginia, but if my patient was located in Texas, I would need to have a license in Texas, not necessarily Virginia. Plus, I'm going to be taking care of patients here too, then I'll get that one.
But we pulled in those state regulations, those federal regulations, dietician licensure. And then the certifying bodies for our hospitals, those third-party vendors that hospitals pay to come in and make sure they're meeting all of those rules so that they can get paid by the federal government, we took those regulations, compiled them, and got them vetted.
There was no wiggle-room, from a regulatory standpoint, that we wouldn't be missing a beat, and that our clients and our dieticians would be able to provide the care that our patients need.
All right, well that is very thorough and in incredible to hear. I'd like to pivot a little bit. So we've talked about the benefits for our patients. There's clearly benefits for the healthcare system. What opportunity does this offer dieticians, Nakia?
Nakia Spencer-Graham (16:40):
Well, dieticians eventually are going to be coming at a premium. And I'm just going to talk a little bit about what the market landscape has been telling us about clinical dieticians.
First, the public health emergency really did teach us a lot about clinical dieticians. We were at the bedside with our peers in the healthcare space. Some were remote at that time, before the public health emergency, and some were working in those hospitals.
And just like other employees, clinical dieticians that are working and practicing at the top of their license, also are rethinking things. So it's trying to look at work-life balance and opportunities for growth, learning, things of that nature.
So what telehealth allows us to do is attract those potential senior RDs that are retiring out of the profession, but want to keep their toe in and just practice from time to time at a consultant basis for our new grads. Which, there are less students actually entering the profession to become a registered dietician. Therefore, we will be a scarce resource.
This allows us to attract those individuals, because they were already in an educational hybrid space, in a virtual space, throughout their educational experience. They might have been part of that class of covid students. And so they have a understanding of that virtual interaction, and their application of it could be a quicker solution, especially when we're trying to fill a position pretty quickly.
But telehealth allows for work-life balance, of course, for our clinicians, for our leaders to be able to think through offering solutions around their staffing, and scheduling, and flexibility. But then it allows us to recruit and retain those clinicians that are looking for that.
And one thing that we were curious about is, what does the profession tell us? And so we attended a conference in October. We attended several sessions around recruitment, retention, what are RDs looking for?
And telehealth actually, all of the things that were discussed really did reinforce our vision around telehealth. Which is, work-life balance. They still want to practice at the top of their game. They still want to be the most extreme medical professionals running great care. But then, how can I do it in a more flexible way that allows me to meet the needs of my family, my personal desires, and then my professional desires? And so we're very excited for that.
And the other thing that clinicians are always wanting to do is to be of service. To make sure that we're meeting those patients where they are, and addressing things that need to be addressed in a timely manner. And especially in those rural environments.
So we're always solving, as clinical dietitians, we're looking for ways to solve, and we're looking for ways to get to our patients, and this really does allow us to do that.
So we piloted this at University Medical Center in Lubbock, Texas. What success have they seen? Jessica, could you explain more?
I love to tell this story. It's almost serendipitous in the way that it happened. We were 16 months into this project, and finally felt like we were ready to go with a pilot. And we were looking for the perfect spot, starting to have those feeling out conversations.
And the leadership at this location came to us and said, "We have this wonderful dietitian whose husband needs to relocate for 11 months to do his medical schooling, and then she's going to come back. We don't want to lose her." As Nakia said, the dietitian market is tough. It's hard to find people. There's just, number-wise, not enough dietitians for the positions that we have.
And these leaders were like, we need to keep her. Does Aramark have a program? Do they have anything that they can offer us that we can make this work, where she can relocate with her husband and not have to be separated, or we don't have to be separated from her? Because we want to keep her.
And we said, "You know what? We do. It is going to be brand new. You're going to be the first person to ever do this for Aramark. We're going to ask you to give us lots of feedback, and talk to us at least once a week." And maybe a little more than they bargained for.
But they were like, "Yes, this is what we need. Thank you for taking our call. Thank you for this answer." Before they even knew what it was.
So I thought, okay, if we are having this impact on one person, what's this going to be like when we go to replicate it? So we had our dietitian who was going to get ready to move, and we needed to work through our Aramark program.
We do have a set process that every location has to go through because of those regulatory-required items, as well as to make sure that our dietitians are set up for success, and know how to provide care via telehealth. Because many of us didn't have it in our internship.
Starting in that 2020 time, some have. But for me, 11, 12 years ago? It's something that I hadn't thought of, or wasn't available to me to practice on. So we wanted to have those learning pieces in place.
The team at our location was able to work through all of that in six weeks, which is fantastic. When I went into this, the timeline in my mind was two, three months, what's this going to look like?
To get that feedback from them that we were able to check the boxes with us, we were able to check the box with our client because they were excited. Our medical team, everyone was so ready for this and accepting that they were able to do it in six weeks, and that was fantastic.
There have been questions as we've moved through that process of, what about the other dietitians? Because I do want to mention them. We had one dietitian who was going to be able to work remote, and everyone else was still going to be on-site. How would they take that? They were ecstatic. They have her be part of their meetings while she's on the screen. The dietitians are the ones responsible for wheeling her into the room.
Because it meant that, number one, they didn't have to take on her extra work if her position was open. And two, because she's working in a pediatric ICU, which is a highly-skilled and trained position, they didn't have to find a dietitian for that, which would be more difficult than finding one for just a general position because of the specialization.
What it meant to that dietitian is that Aramark was really showing their, "We are all caregivers," mantra in real life. Because it doesn't just apply to our patients. It applies to our employees, and giving them that work-life balance to be the caregiver that they need to be for the patients.
So positive emotional outcome, positive outcomes for the team. And those are all feel-good, and I know it's a great story, but we had some numbers too. Some positive number, hard data outcomes that came out of it.
At the location, they were able to use a rolling device that their client owned, so they had a very minimal expense to bring that to fruition. With that minimal expense, it meant they got to have savings, like we said, on keeping their dietitian.
They didn't have to have a recruiting expense, pay any of those bonuses that they might've needed to bring someone in, or pay for expensive contract labor that can be three times the cost of a regular dietitian. And were able to see upwards of an $80,000 savings from six weeks of work that they would've spent in a six-month timeframe.
The dietitian herself was actually able to see 10% more patients via telehealth than she was able to do in-person. Because more of her time, 10% more of her time, was spent on that direct care. Right there, talking to the patient, being at them with the bedside, even though virtually. And in this case with flowers on her head. Because she's in the pediatric ICU, the medical team thought, let's jazz this up.
So the kids love to see her, and they actually attached flowers to the top of the cart, which is adorable to see. There's a picture of them, the whole medical team, doctors, nurses, pharmacists, all crowded around the device with the dietitian on the screen, and the flowers on her head. It's quite possibly my favorite thing to come out of this.
But the numbers don't lie. Data is always good feedback. We saw savings. We saw more patients getting the care they need. We saw more time being spent with their patients. And we saw a happy client, a happy dietitian, a happy leadership team, and happy, healthy kids.
Well, that seems to be the perfect note to wrap this up on. Would you like to know more about Healthcare Plus's offerings? Visit our newsroom on Aramark.com to access more information.
Nakia and Jessica, thank you so much for joining us today. And thanks to our listeners for being part of our conversation here at Mark This.
