Cheryl Field On 5 Things We Must Do To Improve the US Healthcare System
An Interview With Jake Frankel
Collecting data on social determinants of health such that we can better understand the impact of these metrics on the lifelong health of humans and better support those with inequalities earlier in the human lifecycle.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Cheryl Field, MRN, RN.
Cheryl Field, a seasoned nursing professional with over three decades of experience, specializes in post-acute rehabilitation, with specialization in analytics, compliance, quality, and reimbursement. Cheryl has served in many roles from clinical director to principal product manager. Cheryl is a dynamic speaker, having presented at state and national conventions, simplifying complex healthcare challenges through engaging stories and analogies. Certified in Rehabilitation Nursing and AI from MIT, Cheryl holds degrees from the University of Rochester and Boston College, fostering a successful career in senior care alongside her 30-year marriage to her childhood sweetheart, Ted, and raising their three children.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
As a young girl I had a close experience helping my maternal grandmother with nightly routines as she battled with end stage emphysema. She lived a 3 minute walk from my home. I became passionate about senior care, working as a nurse for 14 years then moving into clinical informatics. Providing tools to be used by nurses- that’s passion at scale.
Can you share the most interesting story that happened to you since you began your career?
The most interesting story that happened to me may also be one of the most pivotal stories in my career. This occurred during an interview I was having with the chief technology officer for a potential position in a startup. I had been working in the subacute skilled nursing space for about 7 years and I had within my role as a Medicare nurse specialist established several systems for auditing nurse documentation for compliance with Medicare skilled level of care requirements. I had developed systems for manually checking data that was both entered in narrative format as well as data that was entered into the minimum data set in digital format. During the interview the chief technology officer informed me that these systems were in fact going to be automated and that in my new role in clinical informatics we would be building software that automated the way I as a nurse was thinking. It was both a pivotal and very powerful moment in my career. Reflecting on it now I realized that the intelligence and the systems that nurses have developed in specialty practice are the intellectual property which make up the backbone of many technology platforms and software as a service platforms when put to good use. This became the moment where I transitioned from direct care as a nurse to clinical informatics work and building products that would be used by nurses in the skilled space at scale.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
The funniest mistake I made was applying to the wrong college, getting accepted and a scholarship, and realizing on the first day I was at the wrong school — BUT oh the so right school! In my day we did all college applications by hand. I had heard of a great school for undergrad pre-med in Rochester NY- while I meant to apply to RIT, my guidance counselor gave me the packet for the U of R. This was the best mistake I’ve ever made.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I was a junior in nursing college when my advisor said these words to me.“If you don’t take care of yourself no one else will” I had been feeling ill over a week and was still continuing to drag myself to class and clinical until I passed out in a class probably from dehydration. These were very powerful words. Words that I think caregivers and nurses amongst others need to really heed and find very difficult to do so. The best way that I teach this lesson is by using an analogy of a cell phone in today’s world. When I would talk with my staff about their own ability to come into work making sure they were functioning with a fully charged battery and we know that our cell phones function best with positive battery charge. Caregiver burnout is real. When I design care plans for seniors and their family members who are oftentimes their caregivers from the very beginning of that plan I talk about moments of recharging and providing outside services to the family to make sure that the caregiver can recharge. And I typically quote my college advisor and remind them that the only person who is able to take care of them it’s themselves.
How would you define an “excellent healthcare provider”?
Excellence for providers must include the triple aim, quality, satisfaction and cost containment practices; probably in that order of priority. How each of those metrics gets measured can vary from state, pair, and population. Today an excellent health care provider needs to look at the quality, satisfaction and cost containment practices not only of the care they provide to their patients but also the well-being that they provide to their staffing.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader?
Can you explain why you like them? I am a bit of a podcast addict- so I won’t be able to choose one. In fact- as a lifelong learner, and striving for equity in perspective I would recommend diving into a topic from many “voices”. Senior Care and caregiver advocacy, Medicare and Managed care information and resource groups inspire me- I see the providers of care having paid professionals as their rep, and payers have the same, but the patients in senior care are thrown into an ever changing healthcare system without a professional by their side. I like to listen, amplify, and contribute content that makes seniors feel like they have an expert on their team, guiding them along the way.
Are you working on any exciting new projects now? How do you think that will help people?
My full time role in SaaS is focused on the responsible use of AI in healthcare. As a nurse I serve a critical role both as a subject matter expert and an enablement specialist within the largest healthcare technology company serving seniors in the northeast. In 2023 I authored a best-selling book! A healthcare guide for aging adults written for the 60 million Americans over the age of 65 and the caregivers or adult children of those seniors. I see a big gap in advocacy for 4 seniors and I wrote this book to help them master the transitions that are required when you have a change in health and need to move through the healthcare system from an emergency room to a hospital to rehab and back home. The healthcare providers have experts called case managers who advocate for them, the health plans have their own expert case managers, and yet the patients who enter our health care system don’t have an expert at their elbow. As the baby boomers continue to age into their senior or golden years having a very practical guide is an invaluable tool. Every one of us who knows someone over the age of 65 should be recommending this resource.
Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
I’m actually not as shocked to see the rankings among the US healthcare system. These are metrics that I have looked at over the course of my career. I think that there may be many root causes as to why our outcomes in care are so poor and fundamental to those causes I believe is the commercialization of health care outcomes. The motivation of individual providers have been centered around utilization of services and not necessarily on Wellness outcomes of the person being served. Recent changes over the last five to 10 years and an increase in programs which incentivize care coordination and value based care payment programs are encouraging siloed providers to work together for the first time in the US health care systems history. Rather than thinking it’s every man for themselves and trying to take as many dollars out of the system value based programming helps providers to look at the overall outcomes of care including not only the well-being of the member but also the overall satisfaction with the care that was received as well as the cost containment of those care services. Increase in collaboration, more interoperability and sharing of information can reduce waste and misinformation which can result in either increased spending or missed opportunity to have early identification and early treatment of a problem. More emphasis on coordination of services for specialty populations would help with this. Unfortunately, the staffing crisis in the health care system in different pockets of the care delivery system are creating the weak links. And we know that we’re only as good as our weakest link.
As a “healthcare insider”, If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system?
Five things that need to change to improve the overall health care system- That’s a hard question.
1) The first is interoperability and payment for interoperability, not just expecting capitalization to create a network of information infrastructure where all populations can be served equally. Seems like a simple statement to make, it’s quite technically difficult to do and requires investments in infrastructure across the healthcare system in its entirety. For me personally I have seen the pitfalls of a system that is not connected where information does not flow, and the results of those disconnected systems often show as medication errors in the forms of omissions. In fact I’ve never had a loved one in a hospital or skilled nursing facility that hasn’t had at least one medication error during a care transition from hospital to facility or facility to home. As an advocate for patience, interoperability and the use of technology can greatly enhance medication administration and its safe use.
2) Investments in workforce from initial education to ongoing education, wellness concerns, higher salaries, and more support from administration on the needs of the workforce. Geriatricians in both medicine and nursing are going to be in very high demand in the next 5–15 years as the boomers age past age 80. This concerns me as I see nurses who are my peers who are leaving the hospital and bedside at an earlier than normal retirement age. It’s a conversation amongst universities that offer nursing programs as they watch admission numbers drop. And the media stories which focus on nurse burnout rates and the overall professional experience of nurses in health care which sheds important stories, but also discourages young men and women from entering the practice.
3) Thinking differently about the health of populations and investing in services which can treat in place, more virtual options, Covid certainly helped with this but there is so much more that can be done. Large health plans offering virtual physician services are growing, and these additional services make a big impact in one person’s willingness to seek care early in an illness cycle and two making it logistically easier for 4 people in rural areas where changes in the health care systems infrastructure have resulted in closing hospitals and clinics. This comes under the general guidance of meeting people where they are at and many of our citizens are dispersed through different pockets and cultural concentrations throughout the United states. Having technology be a platform where they can easily receive care that feels culturally acceptable and equitable to them is important.
4) Collecting data on social determinants of health such that we can better understand the impact of these metrics on the lifelong health of humans and better support those with inequalities earlier in the human lifecycle.
5) I think the last area that I’ll mention will be the use of artificial intelligence and its responsible implementation into the healthcare continuum. This is an area that is changing fast, has tremendous potential to bring efficiencies and intelligent insights to practitioners. This will require the voices of physician nurse leaders to be involved with setting policy and practice standards for the utilization of responsible artificial intelligent models in support of clinical decision making not in place of it. I think this area is one where we don’t really know the full potential impact but I think it’s really huge.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
I may be overly optimistic but I think there’s a lot that individuals, corporations and communities can do to manifest these changes. And I remind myself that you really can lead from any seat that you have in your organization.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?
The COVID-19 pandemic created a terrible traumatic impact for Americans in every aspect of the healthcare system including the hospitals. The healthcare system of course initially struggled with a lack of complete knowledge from an infection prevention and control perspective around COVID-19 the necessary precautions the needed personal protective equipment for our workforce and the shortage of proper equipment which the pandemic saw surge early in its on set. Prior to the availability of vaccinations and the collective cohort of knowledge around this virus and its mutations as a human race we were knocked down. Correcting these kinds of issues moving forward could actually be achieved by a couple of the changes we talked about earlier, one being interoperability and the ability to share information more seamlessly across providers without requiring manual manipulation by humans. And the second piece is leveraging artificial intelligence and large language models which can and have very quickly consumed information as we were learning about the pandemic so that care practices and care policies could be adapted and more readily communicated to the workforce. I think the US healthcare system as I mentioned earlier has a fundamental flaw by being rooted in for profit commercial models. Organizations which are owned by investor groups have the constant tension of profits over outcomes, including “people’’. The private equity space is quite complex, and from what I know since covid there has been tremendous growth of private equity ownership of physician groups. Some of that ownership has been by corporations like CVS, UnitedHealth. Others are private equity firms looking to flip the business at a high profit. The rate of consolidation has accelerated without evidence that these systems improve care outcomes.
How do you think we can address the problem of physician shortages?
I think that if you look across physician practice groups you’ll find that there’s shortages in some areas of specialization and access providers and other areas of specialization some of which is driven by the physicians schedule and fee service. For example boutique clinics that are only open 12 hours a day and have no night call and no night rotation may be more appealing to physicians from a quality of life perspective than working in an emergency department that never closes. My perspective on physician coverage in the geriatric space is really where I have more awareness. My whole career I’ve been grateful to work with physicians who specialize in geriatric medicine and there’s always been a shortage of them. The more complex senior care becomes and the less control the physician has over the number of visits per day ETC will continue to drive providers out of the geriatric medicine specialty.
How do you think we can address the issue of physician diversity?
Oh this is a BIG question! The answers I believe are rooted in years of ethnic and racial inequalities and will take years to turn around. I suspect some of the problems with physician recruitment and diverse physician groups are the same with nursing. Although with physician education being so very expensive and prominent medical schools lacking diversity I think the physician problem is a bit more complex. Programs which incentivize and support education of physicians who practice in rural markets as well as physicians who practice in segments of the health care like senior care where the reimbursement coming from predominantly federal and or managed care organizations and that funding being limited is less lucrative as a career path for a physician. Considering the amount of debt most physicians take on to complete their education often they are looking for more lucrative specialty practice areas. The lack of diversity amongst the physician workforce in both racial and gender perspectives we’ll take intention and time to overcome young persons’ need to see role models in order to believe in themselves.
How do you think we can address the issue of physician and nurse burnout?
Preventing burnout for any clinician is a paramount importance today. The COVID pandemic certainly drove thousands of dedicated providers into professional burnout and many of those same providers experienced extreme trauma during the COVID-19 pandemic. Colleagues and friends described terrible isolation, suffering, an emotional distress which was experienced by both the patients and the health care workers at the time. I think preventing burnout requires an awareness that the pace at which certain Specialties like the emergency room and intensive care settings function are highly problematic to the human nervous system and can create chronic distress leading to burnout. I think there’s a lot to learn from other professions where high stress work settings are tempered, looking at longer shift rotations, more time off in between the ability to leverage mental health counseling and crisis counseling after a particularly challenging shift should be available to both physicians and nurses but oftentimes are not. Ironically these services are often offered only during the daytime hours and not available off shift evenings nights when providers may be off and actually need access to additional supportive services. Looping back to advice I received as an undergraduate nursing student, I think providers need to be reminded that it is their job to help take care of themselves. And the system around them needs to be changed so that when someone speaks up and expresses a need for self-care they’re not facing a punitive system. I also think that more intentional investments could be made towards self-care for nurses and physicians as well as acknowledging time within their profession for both skill acquisition and career enhancement. Through my work in publishing prepared! A healthcare guide for aging adults I have met several nurse leaders who are organizing a conference for nurses aboard a cruise ship in April. The concept being that nurses need to get out into nature amongst the sunshine and the trade winds as part of their self-care they also need to learn skills in areas like meditation relaxation proper nutrition supplements hydration key areas where if ignored their own bodies breakdown. I’m excited for the opportunity to be a speaker among the power up nursing crews in the career care track as well as a transformational health care track. Addressing the trauma that nurses and doctors have experienced and working to help heal those traumas are one of many interventions to begin to cope with and.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
It sounds really cliche, however I do believe that kindness and being intentionally kind, not even randomly kind but actually going out of your way to be of some service each day to another human. In my professional sphere I’m typically interacting with nurse leaders and aging older Americans. Both of these groups face an uphill climb each day. Being intentionally kind is a movement that if every person under the age of 65 would look for an opportunity to be of a small service to an American over the age of 65 the way our human condition is experienced would change. Our older Americans need to feel a sense of purpose and they have so much to give back, so much wisdom, so much advice, so much perspective that younger Americans could benefit from. I think the more opportunity for multi generational interaction that is intentional the better both generations would be. Intentional kindness doesn’t have to be hard. There are several groups in social media where questions are asked each day, and by simply having the knowledge and being willing to share that knowledge with others I can help answer those questions. As an example the Medicare versus managed care chaos for people turning or over 65 is an area where my expertise can help reduce anxiety and fear among older Americans. It’s an area where I like to volunteer and do local presentations at libraries and senior centers during the fall open enrollment period. Not only do I get the positive feeling of helping another human being, I also am continuously learning as questions which come from real world experiences keep me informed of how changes in the health care system create misunderstandings and therefore become a part of future topics and presentations. You’ve heard it said it’s better to give than to receive and when it comes to kindness I couldn’t agree more.
How can our readers further follow your work online?
I exercise my voice primarily in LinkedIn communities and groups as well as within Facebook. I do a little bit on Instagram but I find that professionally the conversations and the voices are amplified in the LinkedIn and Facebook community groups. So people can find me on LinkedIn and Facebook.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
