Spirit of Service: From the Experience of a Healthcare Army Veteran with Louis Stout, Chief Nursing Officer & Healthcare Executive : Audio automatically transcribed by Sonix

Spirit of Service: From the Experience of a Healthcare Army Veteran with Louis Stout, Chief Nursing Officer & Healthcare Executive : this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Saul Marquez:
Hey, everybody! Saul Marquez here with the Outcomes Rocket, and welcome back to the podcast. Today, I am thoroughly privileged to be with an outstanding nurse leader, I’m with the outstanding Louis Stout. He was formerly the chief nursing officer and deputy commander for health readiness at the Madigan Army Medical Center, and a longstanding career in the military as a nurse, uh, nurse leader, that’s 30 plus years having served, so first of all, just a huge thank you, Lou, for the work that you’ve done, not only for our country but for the health of those serving this country, can’t tell you how grateful I am and how grateful the listeners are to have you here on our podcast. You’ve done so much in your career, so I’m excited about diving into some of those things today and also on some of your thoughts on the role of nursing within healthcare and maybe even the role of the army and what we could do to make healthcare better. So, Lou, why don’t you? Why don’t you go ahead and fill in any of the details of the bio that maybe you feel are most important and then we’ll get going? Welcome!

Louis Stout:
Yeah, thanks. I really appreciate it, appreciate the opportunity, spend a little bit of time with you and your listeners. Nursing as a career, you know, wasn’t really sure where I would end up, you know, many years ago, I was interested in, you know, some aspect of service, and healthcare definitely drew my attention and wasn’t really sure where I would end up, and the military came along while I was in college and they offered me a scholarship at the time and I thought I’d give this a try for a couple of years and maybe then go get a real job. And I signed up for four years and next thing I knew four years came and went, and it was 10 years and I thought, well, I can, you know, military retirements at 20 and a 20, I was still absolutely enjoying it, traveling the world and meeting people from everywhere, from all over our country and other countries as well and healthcare providers, and next thing I knew I was at 30 years in the military, that’s a mandatory retirement, so.

Saul Marquez:
Wow!

Louis Stout:
Yeah. They said it’s time to retire, and now I’m looking for that next step in my healthcare journey as a healthcare executive so that I can continue to serve and continue to lead and learn from others.

Saul Marquez:
It’s so amazing. I mean, your career is so, so cool. I mean, you’ve done so many great things from here in this country to Korea, to, you know, serving abroad and Afghanistan as the chief nurse and chief of clinical operations and even in Germany, so I mean, the amount of experience that you have had, Lou, is, it’s just incredible to me and I think to a lot of the people listening here. So really, you know, I guess I’m personally curious as you’ve made your tour across the globe and now back, what’s been maybe a common theme that you’ve seen in the role of nursing when it comes to healthcare?

Louis Stout:
I think, you know, when you’re in the military, it’s, you tend to really want to focus on on your own service, and I learned early on that that really did make a difference between the Army, Navy, and Air Force, healthcare is healthcare. And then from that, whether it’s military or civilian, as we say or I say in the military, you know, healthcare doesn’t wear a uniform. So, you know, a patient is a patient and a healthcare provider is a healthcare provider, so military or civilian, and then yeah, working with, I was stationed in Korea and stationed in Germany and working with a lot of different NATO countries, and I went down to Greece and spent some time in their field hospital and we did a, a large exercise in Romania with the Balkan Medical Task Force and Romanians and Bulgarians and Hungary and as a Polish medical team, and I had an opportunity to go and teach in South Africa, for the South African Military Health Service and everywhere we went, it was, it was the same. It was, you know, just the spirit of service caring for those in need, and there, really has not been much difference and just a great opportunity to learn from others and see, see their approach to healthcare, some of the products that they used or slightly different, but the bottom line was taking care of that person in need, that was sitting there in front of you, from combat deployments, from our patients being our service members and service members from other countries as well as local citizens, it was really, it didn’t even matter what the language was. We actually, when we were in Iraq, put together a patient satisfaction survey and had it translated to Arabic so that we could ask them for their feedback. We truly wanted to know what their experience was and how they felt about it. And they were, they were surprised that the Americans we’re asking and so we had our bilingual translators ask them the questions and translate it so that we could truly get a feel for what it meant to them and how their healthcare experience was, and we gained an incredible amount of goodwill and they truly understood that we meant it. We asked them the questions, we wanted to know the answers and we wanted to make a difference.

Saul Marquez:
Now, that’s fantastic. You know, it does come down to that. You know, it’s, it’s the human aspects of caring and, you know, getting beyond the, that patient feel, it’s like you’re a human here, you know, and I like how you said it, you know, healthcare has no uniform. And so what is it, that thing, Lou, that inspired your work, this lifelong work in healthcare?

Louis Stout:
I think, you know, it starts with where you grow up, the culture that you’re in. Obviously, my family, you know, I think we, we first start there and my parents growing up volunteered as emergency medical technicians, it was not their background, but that’s something that they wanted to do is, it was an all-volunteer ambulance. And so I spent years watching them in their spare time, my dad worked full time and then would work nights and weekends to volunteer for the ambulance. And then my older sister went into nursing and she shared a lot with me about her perspective of it as I was looking for, to make a decision on schooling. And I think that’s definitely what got me started in nursing school was just her experience and her, you know, her, her genuineness towards, you know, taking care of others. And you know, I saw in that a career where, you know, like I, that’s where I felt like it started, it’s just taking care of other people and offering those in need. And I learned a lot of my initial experience just being on an ambulance with my parents and my older sister and, you know, going to a motor vehicle crash and in the middle of the night and some deserted expressway or back road and seeing people truly in need, and we were it. We were, were the ones that showed up and, you know, gave that initial care and got them to the ambulance, to the hospital. That’s where, I think, what sparked my passion for having that training. And then to follow that on, there was a time in my career when it came full circle and I was on the burn flight team for the, for the U.S. Army, for, for many years, transporting burn casualties from primarily from Germany down to Texas. And there was a time where I really, I stopped and paused and thought and we were in the back of some aircraft somewhere over the Atlantic. And it was, it was me and my patients, and I could just stop and say to myself, now I know, I know what I know, and you can, you can be fairly confident at times, but when you’re in the back of an aircraft and you can’t, you can’t pull over, you can’t phone a friend, it’s, it’s you and the patient. And then that’s, that’s when you know that everything that you train for is, is worth it and you can share that expertise with those in need.

Saul Marquez:
Yeah. And how long is that flight?

Louis Stout:
It is 11 hours and 50 minutes from Frankfurt, actually out of Ramstein Air Base to San Antonio. If we get a direct flight, it is, it is one critical care shift, just the flight. So our average flight was, or our average mission time was about 60 hours. So it was about two and a half days total from the time we went wheels up out of Texas to Germany, got the casualty, evaluated them, package them and transport them back, our average time was two and a half days.

Saul Marquez:
Wow. And are you guys? I mean, like I’ve heard stories like these flights are rough like, you know? Is it comfortable up there when, when you’re traveling with the patient? Or is it? Is it pretty sparse?

Louis Stout:
Yeah, I guess, like most things, it’s, it’s how you define it. And.

Saul Marquez:
Yeah.

Louis Stout:
You know, a friend of mine said to me one time, he said, it’s amazing what we get used to. And I thought because we were having a conversation about something and we’re just kind of describing it. And when I stopped and thought about it, I was like, You know what? Other people probably wouldn’t understand what we do or why we do it, and then there’s other things that other people do. And I just, I can’t completely comprehend it. But yeap, the back in the aircraft, there’s not much in there and you have your, the litters and you put everything in some big pelican, tough boxes, and that’s, that’s all the medical equipment that you need. And the biggest thing that you need is between your ears. And here, you take that wherever you go.

Saul Marquez:
That’s awesome, man. That is amazing. Just picture you back there, you know, taking care of somebody that really needs help, and, you know, it doesn’t matter, right? Like, you got what you need between your ears, and oftentimes we could get a little comfortable with where we’re at. And I think, you know this message to everybody listening, you know, likely in the civilian world, you know? Have you gotten too comfortable? You know, are you, are you not thinking about the most essential things that rest between your ears like Louis is mentioning to us? I think this is a great reminder to all of us that, hey, you know, let’s not take things for granted, let’s, let’s work with what we’ve got here. You know, I think what nurses, in general, have to offer a great, but as a nurse leader, Louis, what would you say you and your teams provide to the healthcare system in a way that’s unique or better than a lot of things out there?

Louis Stout:
Yeah. I don’t think we ever like to say things that we do things better. You know, it’s, it’s innovative. There’s one thing about conflict and deployments through military history is it’s a required adaptation from the Revolutionary War, the Civil War, and clearing casualties from the battlefield. You know, they, they started taking carts out there and moving them back. And it was, it requires thought, you know, requires to do things differently, it’s unfortunate that it has it happens. But from that, it forces us in some way to come up with new techniques. So air vac system, that, that developed from the military and moving people from one area of the battlefield to another, now, it’s certainly, it’s everywhere around the world to move casualties to the highest level trauma center that you can get them to, and then, there’s some areas of the world where they take it forward. So they actually have adapted their ambulance rigs to carry pretty much everything that they need from the emergency room and then they start treatment out there at the scene. It’s, innovation requires thought. One of the things in this conflict early on in Iraq and Afghanistan, we started getting a lot of casualties with amputees and lower limb amputees, prosthetics were pretty good, but they made a lot of changes to them, and so that, now they can move in multiple planes instead of just being a fixed prosthetic. And so they just worked on making it smaller, lighter, more adaptable, and more realistic. And then one of the challenges was to, and they actually challenge the industry, they said, we want you to make an upper limb prosthetic where the grip can be so sensitive that we can pick up a grape. And that was probably one of the toughest things was, you know, you look at a prosthetic and they would, the casualty would look at it, they’d have the prosthetic on, they go to pick it up and they just squish it. So how can you make it so responsive that as you start to apply pressure on a grape, it’s enough pressure to pick it up, but not too much pressure that you that you crush it? And know that.

Saul Marquez:
Yeah.

Louis Stout:
That took some motivation to develop that, that feedback mechanism.

Saul Marquez:
Lou, and you know, it’s, gosh, I mean, with some of these examples that you mentioned, it is really being in the front lines and having that necessity that drives the innovation, right? And like this grape example, I mean, how are you going to do that unless you truly actually need it in the line of fire?

Louis Stout:
Yeah, its requirements and you know, we don’t develop these things until there’s truly a need for it and look at what’s going on right now with the COVID vaccine and turning into a global pandemic, and they said not only do we need a few vaccines, but we need now that they’ve given over eight and a half billion, nine billion vaccines, which is just a phenomenal amount in little over a year. So it required new technology and the ability to mass produce and transport around the world. So, you know, it’s not just the military, but the military and the civilians, it’s why I say healthcare doesn’t have, wear a uniform, it’s, you know, healthcare is healthcare and where there’s needs, we need to come up with new and better ways to offer that, that service and with what’s been going on recently, it’s been incredibly difficult on our healthcare team. We, you know, service providers, overall, they’ve been leaving the career field just because it is, it has been so hard on them for such a prolonged period of time, there’s only so much you can continue to do. So know not just nurses and some physicians, but people that work in other areas of the service industry you know, restaurants, hotels, you know, there are, there’s a lot of workers that have have walked away from it just because it’s been so difficult to continue to offer that, that spirit for such a prolonged period of time when everybody’s under such strain.

Saul Marquez:
Yeah, you know, and it’s one of the biggest issues right now too, right, Lou? Its staff shortages, it’s supply chain constraints, it’s the domino effect that’s been created by, by COVID and its impacts on our overall economy. To your point, it’s beyond healthcare, right? It just it has spilled over to so many different fields. What would you say is the biggest setback you’ve experienced and what’s the key there? Is it what we’re going through now, is, is it something different?

Louis Stout:
I think, I think now these current times have been some of the most challenging. There’s such a need for healthcare to be delivered, but it’s so difficult to deliver it. So, you know, it shocked a lot of people. Now, almost two years ago, when they started laying off furloughing healthcare workers because a lot of them were were surgical services. So when that got put on hold, elective procedures got put on hold. They didn’t, they weren’t doing them, the surgical teams just weren’t needed. And it seems so ironic to, you know, until perioperative staff are like, well, we don’t have the income, we’re not generating revenue. And so we have to furlough you. And yet on the other side, we’ve got other people where the overtime was unsustainable and the shortages were dangerous at times, you know, just, you need a full healthcare team, and when you don’t have that, then everyone’s at risk because, you know, the patient errors or things get missed. So it has become a difficult time to get the right resources and the right place at the right time and to be adaptive or responsive quickly enough, as things change and they just continue to change.

Saul Marquez:
Yeah, it is a big challenge. You know, for those of you listening, thinking through this as well, you know, gosh, I mean, what’s the answer? Lou, I mean, how do we, because we’re not, we’re not, it’s not done yet. I mean, we’re in the middle of it. What can we do?

Louis Stout:
Yeah, that’s the biggest question. How do we move resources as I think probably one of the hardest things with this situation has been the length of the hospital stay. And that’s, 30 years ago when I started out, and before that, the average length of a hospital stay was, you know, I’m just, I’m just throwing out a number here, but let’s say it was like a week, five, six, seven days for, for many things you came in, you were there, you had your procedure, you stayed for quite some time afterwards. And that has just steadily changed where there’s a lot more things that are done laparoscopically and so many procedures now are outpatient or if you do stay, it’s overnight. And now with COVID, you know, people come in and and stay. My background, my specialty area is burn carend from that patient model, we are very used to it. Your average hospital stay is one to two hospital days for every percent burned. So if you have somebody with a 40 percent burn, they’re going to be in the hospital for, on average, 40 to 80 days. That’s.

Saul Marquez:
Wow.

Louis Stout:
That’s expected. So you expect them to be there and to stay there while they go through the healthcare system. But in other areas, it’s just the whole healthcare model has moved away from that, where it’s rapid admission, the procedure discharge because you want them home. Hospitals are full of sick people, so the quicker I can get you home, the better for all of us. But in this case, with severe hypoxia and just the debilitation from this disease process, people come in they, they need to stay for quite some time. And the other thing is if, if I send you home, you’re at risk to just continue to transmit COVID to others. So it’s not the model that we have right now. And the other area that’s been struggling with this has been behavioral health for many years. We used to have institutions and literally we used to institutionalize people, and that was found to just be not the right approach to behavioral health. So those mental health facilities were pretty much gotten rid of. But then what they found was there’s not a specialty area to, to put these patients into, where they can get that focus for their unique healthcare needs and just putting them in with other patients is not the benefit for everyone. So it’s been steady ongoing change as well over the past many years is to develop respectable facilities where behavioral health patients can go and receive the unique care that they need, in the unique setting that they need, in a safe environment other than being out on the street somewhere so.

Saul Marquez:
Yeah, no, great great call, … I think ultimately you called it, right? It’s that need to increase the, our capability, I think and in the home, how do we care for people in the home, right? There’s been a big shift to ASCs, ambulatory surgical centers doing a lot of these these orthopedic procedures there and laparoscopic procedures, like you mentioned, keeping folks out of the, out of the hospital, especially today and now, how do we support these people outside? I think herein lies the opportunity to scale, the power of physicians and nurses outside, and that’s a big opportunity, you know? So from my perspective, I get excited about this idea of changing where care is delivered. What are you most excited about?

Louis Stout:
I think one of the big opportunities right now is to really look at the healthcare team, and I think, the military is great, when I was in a corps several years ago, our facilitator asked the question is the military a profession or a bureaucracy? And a group of leaders had a very spirited discussion for some time because it’s, it’s both and it’s, it’s easy to add on additional tasks is very difficult to remove some of those tasks to take the time to say, OK, what? What do we no longer need? What no longer serves us? And I’ve seen in a lot of facilities where because we have added tasks, we add more professionals and so more registered nurses, more advanced practice nurses, more physicians because we’ve added administrative tasks and somebody really needs to take the time to say, OK, what should be done by somebody else? You know, our administrative personnel are incredibly important at what we do and from billing and coding and just running the clinical facility, a lot of it’s being done also by the healthcare providers, and I think there’s a lot of opportunity there to redefine the team and restructure and to free up our clinicians to do more of the direct clinical tasks and remove a lot of that redundant administrative tasks. I often, I get frustrated when somebody comes up with something new and gee whiz, and it’s electronic or it’s digital, and just for the sake of replacing a piece of paper, well, piece of paper has worked absolutely fine for, for many years, and then they can’t figure out why their electronic system doesn’t work. They’re just spinning around trying to fix it, as opposed to saying, hey, you know what? Let’s go back to the basics. What works? What works is that piece of equipment you’re carrying around between your ears, and that’s, that’s what’s really going to make a difference. And one of my personal goals as a nursing leader is to take every opportunity to free up the nursing staff to be at the bedside. What can I do to remove an administrative tasks that allows you to spend more time with your patient, with our patient?

Saul Marquez:
I love that. And you know what, Lou? It’s so simple. I mean, it’s simply said, it’s not as simply done, but the opportunity that, that this, you know, strategy that you’re moving forward with is huge for the level of care, but also the, the well-being of the actual caregiver. You know, when we think about the quadruple aim, that’s like crystally important as everything else that that we’re doing. So I love it. Thank you so much for sharing that. Lou, just incredible. I want to thank you for today. The time just flew. I’m looking at the clock here before we conclude, why don’t you leave us with the closing thought and then the best place that the listeners could get in touch with you or continue the conversation, whether it’s LinkedIn or your email or whatever you choose.

Louis Stout:
I think one of the things that I’ve focused on as a leader recently, I’ve had a lot of opportunity to work with some fantastic organizational developers, and we spent quite a bit of time working with the team to first understand yourself so that you better understand others. And when you get the opportunity to work through that as a team and see how your other teammates work through a question, then you really understand what their thought process is and how they arrive at their conclusion. And I think once you understand that, then you can work more effectively together. One of the things that I’ve worked with with my managers and some of my employees is to spend that time with them outside of the office, as I refer to it as hallway mentoring, where you can spend that time together in just talking about your profession, talking about the organization, talking about their needs in an area that’s not designated for something else, an office or a conference room. And that’s when they truly understand that it’s about us, not only some location where we are, it’s about us and when decisions need to be made, it’s in our best interest. It may not be what we always want, but it’s in our best interest for us and for the organization, and I think when people understand that, that it’s not just policies that are coming from the C-suite and without an understanding of what the effect is, then they know that it’s being done for the good of our whole organization and our patients. So, you know, if people want to get in touch with me, the best place is probably on LinkedIn. I can certainly be found on there under Louis Stout. And you know, I’ve increased my network a lot over the past couple of years, and it’s been incredibly helpful just to get in touch with people all over the country and all over the world and share a little bit of our expertise with each other. And I’ve learned so much from all these amazing leaders that are everywhere around us.

Saul Marquez:
Lou, well, I want to say thank you. And these, hallway, the hallway mentoring that you mentioned, you know, being, connecting with people outside the office, super powerful and on the, on the networking thing, folks, make sure you connect with Lou because I mean, just an incredible thought leader and incredible nurse executive and certainly somebody that I think could offer a lot of value to you and the work that you guys do, no matter what sector of healthcare you’re in. So connect with him. Lou, I just want to say thank you for the work that you’ve done and that you continue to do, and I appreciate you sharing your story here on the Outcomes Rocket.

Louis Stout:
Thank you very much. Again, I really appreciate this opportunity, it’s been terrific.

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