Magic Out of Madness: Signature HealthCARE, Brickyard and the Future of Clinical Innovation

Skilled nursing operators are facing madness — the bombardment of new tech, staff burnout, as well as intense and even ageist regulations and payment rates — yet there is a way to drive clinical innovation and create magic for residents.

That’s according to Arif Nazir, chief medical officer at Signature HealthCARE and CEO of Signature’s nurse practitioner enterprise.

Nazir and Brickyard Healthcare Chief Strategy Officer Wanda Prince believe staff burnout, out-of-touch policymakers and time consuming, tedious workflows are the biggest barriers to clinical innovation in the sector.


The two leaders spoke about progressive clinical endeavors – technology-related and not – at Skilled Nursing News’ Clinical Conference on May 5.

In fact, Nazir and Prince made it a point to say medical innovation in the space is not always a tech product or app. Innovation is defined by its end result – if an improved workflow saves time and caregiver bandwidth, it’s an innovation.

“The best thing Signature did was invest in an innovative mindset,” said Nazir. Such a mindset means implementation “etiquette,” he said, and paying attention to the intended and unintended consequences of innovation.


Signature’s research institute was created to make meaning out of the “bombardment of technology innovation at us and our staff,” explained Nazir. A panel made up of nurses, operators, legal compliance officers and Nazir himself aims to “make some magic out of this madness,” he added.

Redefining innovation

Signature has invested and implemented clinical innovations by way of its Signature Research Institute, Nazir said.

The institute’s teamacts as a filter for the influx of tech advancements presented to the sector.

One partnership borne from the institute was with Chicago, Ill.-based BASE10 Genetics, Nazir said, which helped Signature streamline and automate Covid testing and reporting to CMS based on each state’s individual regulations.

BASE10’s data platform helps nursing homes keep pace with disease management, including tracking Covid test statuses. The platform took “a million headaches” away from Signature staff, Nazir added.

“Can you just imagine how much work was taken away from the nurses and the administrators who can do the real job of touching the patient, listening to their voice? I think that was a huge success,” said Nazir.

Prince also emphasized that innovation does not always mean tech, pointing to rounds of care much like what patients might see in a hospital, but for short-stay patients.

Wanda Prince speaks at CLINICAL, by Robotoaster for AMN

Brickyard has had its eye on a rehabilitation facility that has been doing hospital-like rounds of care for several years now, Prince said, although the facility was unnamed.

Such rounds are led by a physician or nurse practitioner (NP) and include a certified nursing assistant (CNA), social services and – this is key – the resident’s family.

“Family members could come in and hear the discussion, with the patient’s permission, about their care and what the discharge plan is and what the medications are, and any concerns, just talk about those concerns right there,” said Prince.

Plans like this took a back seat during the onset of Covid, Prince said, but involving family in discharge plan discussions has led to a significant reduction in unplanned hospital readmissions, improved patient outcomes and quality measures.

“Nurses are innovators. We always have been and innovation does not require technology,” she added. “The primary thing I would offer is that [innovation]cannot increase frustration. It cannot take one additional second or minute out of a nurse’s day.”

If technology is implemented as a form of innovation, it has to be intuitive, Prince said. It cannot cause additional frustration among staff, and there cannot be “workarounds” that would cause significant concern.

Nazir likened technology to the “icing” on an innovation cake; innovative processes and good communication are already baked into the foundation before leadership adds tech.

Patient, staff perspective and innovation

Prince said there is “nothing more important” than the resident’s perspective – that includes their perspective on implementing prospective technology.

In turn, the perspective of the bedside caregiver is another indicator of successful innovation, she added.

“I totally agree that the patient voice cannot be lost, the resident voice and family voice cannot be lost … we are distracting our staff from listening to that voice,” explained Nazir.

Improving resident life starts with letting direct care staff focus more on the bedside, he said.

“The problem occurs when we get in the way of the magic at the bedside, when we tell people too much about their job. We tell them too many tasks, how to do their job, and the magic is lost,” said Nazir.

Tedious workflows get in the way of capturing the patient voice, Nazir said, with all of the regulatory and other burdens placed on SNF workers’ shoulders.

That goes for policymakers too, Nazir said, who require an increasing amount of documentation attached to quality measures. Burdening nursing homes with massive documentation and regulatory requirements while offering paltry payment rates is a reflection of ageism, he believes.

“It’s really policymakers, it’s ageism. Secondarily, we don’t have enough time in that framework. We don’t have enough staff and we will never have enough staff within that framework. Nothing is ever going to be enough,” said Nazir, referring to the constantly moving federal and state goalposts for the sector.

Nazir urged those in the sector, government entities and the public to rethink the “carrot and stick performance,” and believe that direct care staff are in the sector with good intentions. He believes a more collaborative relationship between government entities and the skilled nursing sector will help SNF staff, leadership, and nursing home residents overall.

“I think it’s a whole mindset,” added Nazir.

Companies featured in this article: