Advancing Health Podcast

00:00:01:02 - 00:00:27:10
Tom Haederle
Welcome to Advancing Health. Providing effective and efficiently targeted behavioral health services to a widely diverse community is no easy task. Today, we hear how a California based health system relies on accurate data collection and community partnerships to pinpoint where services are needed and how it's making a measurable difference.

00:00:27:12 - 00:00:48:03
Jordan Steiger
My name is Jordan Steiger, and I am the AHA director of Behavioral Health and Violence Prevention. I'm really excited to be joined today by Jesse Tamplen, who is the executive administrator of Behavioral Health and the vice president of continuous performance improvement and patient care coordination at John Muir Health, and Jamie Amosu, who is the director of Community Health Improvement.

00:00:48:05 - 00:01:02:06
Jordan Steiger
They've done a lot of work from community based programs to programs within their hospital system. And so we're really excited to see how they are leading the way, and hopefully others can learn from the work that they've been doing. So Jesse and Jamie, thank you so much for being here with us today.

00:01:02:09 - 00:01:03:00
Jesse Tamplen
Pleasure, Jordan.

00:01:03:07 - 00:01:04:18
Jamie Elmasu
Thank you for having us.

00:01:04:20 - 00:01:16:15
Jordan Steiger
To get us started, I would love for you to just tell the audience a little bit about your roles at John Muir Health, what you do and what your community is like and what your patients are like that you serve. Jesse, let's start with you.

00:01:16:17 - 00:01:38:29
Jesse Tamplen
Perfect. Jesse Champlin, the vice president of patient care coordination, continuous performance improvement. And for this conversation, the executive administrator of behavioral health. I oversee all behavioral health across John Muir. And for those of you who don't know, John Muir is an independent health care system about 30 miles east of San Francisco. We're a three hospital system.

00:01:38:29 - 00:02:13:28
Jesse Tamplen
That's two acute care medical centers. And then a psychiatric hospital. And then we have a large outpatient footprint with ambulatory care, including behavioral health. I work with the teams, not only the behavioral health teams, but all of the health care teams to really integrate behavioral health so that we can provide a whole person care model to really support our community and our patients where they're at, and to make sure that they have access to lifesaving behavioral health care in our acute psychiatric hospital that serves children, adolescents, adults and older adults.

00:02:14:01 - 00:02:35:23
Jesse Tamplen
One of our distinct factors about John Muir behavioral health is for our psychiatric hospital. We have some of the most under 12 and under 18 beds in California. So not only are we a local destination of care, but really a center of excellence across the whole state, and many times outside of the state.

00:02:35:25 - 00:02:50:19
Jordan Steiger
Amazing. You said so many things I want to get back to in this conversation. And I also want to just highlight that Jesse is a member of AHA's Committee on Behavioral Health. And he knows his stuff in behavioral health so that he's a great person to learn from today. Jamie, tell us a little bit about you.

00:02:50:21 - 00:03:22:15
Jamie Elmasu
Yes. Thanks, Jordan. So my name is Jamie Amosu, and I'm the director of community health improvement at John Muir Health. And, you know my role really is focused externally, mostly and primarily, on the geographies that we serve, which cover and span all of Contra Costa County, northern Alameda County as well as the Tri-Valley area. And so, just to give a little glimpse into the geography of John Muir, health, and what's really important to note is that our the communities that we serve are vastly diverse in terms of income, status, race, ethnicity and the likes.

00:03:22:15 - 00:03:32:15
Jamie Elmasu
And so when we're talking about different approaches to behavioral health and mental health strategies, it really does, depend on the types of populations that we're intending to serve.

00:03:32:18 - 00:03:43:04
Jordan Steiger
That's great. And I think you're setting the stage really well for this first question here. So I know that your community health assessment identified behavioral health as a top priority for your community. Is that right?

00:03:43:06 - 00:04:14:12
Jamie Elmasu
That's correct. Well, it's really unique is that I've actually been working at John Muir Health for 12 years. And we conduct a community health needs assessment cycle every three years. And in my entire time that I've been here, behavioral health has been the at least at the top three identified community priority needs. And so I think that's really important to really call out because behavioral health - although we are innovative in our strategies and our approaches to address behavioral health needs in the community - the need still exists, right?

00:04:14:12 - 00:04:32:04
Jordan Steiger
We know behavioral health doesn't discriminate, and it is present in every community, and it shows up for different people in different ways. But knowing this and knowing that this has been something that has kind of shown up over and over. How did you start like bringing those services to the community? What was your first step?

00:04:32:06 - 00:04:51:00
Jamie Elmasu
Yeah, I mean, so the CHNA is a really intentional approach, right? So not only is it intentional, it's also very widespread in terms of how we gather data, how we report on the data and how decisions are being made. So it's actually a process where we collaborate with the other non-for-profit health systems in our area.

00:04:51:02 - 00:05:21:09
Jamie Elmasu
We conduct focus groups with community members. We conduct key informant interviews with stakeholders across our service area. And we look at data, right? So when we look at data, when it comes to county resources, school district resources, and many, many others and all of that is compiled into a really robust assessment where we actually identify those community needs, priority areas, and then we can look in and see specifically geographically or population wise, which communities are in need of services.

00:05:21:11 - 00:05:42:04
Jamie Elmasu
And then when it comes back to actually creating our implementation strategy, what we do is we actually create different approaches based on the communities that we're speaking about, right? And it's not that John Muir Health is here designing approaches that we are now telling the community to implement. It's actually in partnership with nonprofit organizations. And I think that's really key.

00:05:42:07 - 00:06:04:29
Jamie Elmasu
And so we've created, you know, really various opportunities, right? So whether it is let's say, for example, a community based, nontraditional approach, right. Like a premature community health worker approach. We have several partnerships, actually, where we help fund and provide grants for those organizations to actually disseminate, you know, these very nontraditional approaches to mental health interventions.

00:06:05:02 - 00:06:34:17
Jamie Elmasu
And that really targets, you know, certain communities that maybe don't have access to traditional health care, utilizes more of a group approach, a lay health worker approach model that's actually very effective. So we've had research studies actually done on some of our community health worker programs in partnership with Monument Impact, a local nonprofit organization. And it actually has statistically significant results in terms of reduction of anxiety, of stress and of depression in the communities that we're serving

00:06:34:17 - 00:06:42:16
Jamie Elmasu
and that program specifically, we actually celebrated, it's ten years, so a full decade in partnership with that program.

00:06:42:18 - 00:07:03:26
Jordan Steiger
I mean, congratulations on ten years. I think ten years in any program is incredible. And especially something that is so focused on community and you know, driven by those community partners, I think is really something to be proud of. Jesse, I'm sure that you have played a big role alongside Jamie, in helping kind of shape this behavioral health, you know, approach in the community.

00:07:03:27 - 00:07:06:10
Jordan Steiger
So tell us a little bit about what you've done.

00:07:06:12 - 00:07:28:06
Jesse Tamplen
I worked very closely with Jamie. One of the elements about a community health needs assessment, especially when you're a nonprofit, it's how are we elevating the health of the community in the local environment that we're in. And so as a hospital and a treatment providers, we also have that number one responsibility of making sure that we're providing that life saving care and that quality of care

00:07:28:11 - 00:07:50:07
Jesse Tamplen
when people come into our outpatient as well as our inpatient. So it's a very nice synergistic combination where Jamie and I get together with the community stakeholders, look at our needs assessment. We have a board that oversees that community health needs assessment. And then we really look at where do we have the biggest health disparities in the community?

00:07:50:13 - 00:08:13:17
Jesse Tamplen
Where do we find that we can support that community that does not have needed services if it be in schools or unhoused? If it's for communities that are further away from a metropolitan area so that we're really looking at creating an ecosystem. I think one of the unique things when we talk about behavioral health is it is the most stigmatized diagnosis that we have.

00:08:13:19 - 00:08:36:12
Jesse Tamplen
And as students when you talk about behavioral health, people will go into some social aspects of behavioral health. But Jordan, as you said, behavioral health is regardless of socioeconomic status, the nice area that when we work with Jamie and the community health needs assessment, not only are we providing those essential services out in the community, but we're helping to stigma-bust the stigma around behavioral health.

00:08:36:19 - 00:09:09:03
Jesse Tamplen
So when we create this ecosystem, focus on the whole person care, it's not only the individual outcomes that we're looking at, but we're helping to elevate behavioral health, decrease that stigma so people will access those services if it's in, you know, the languages that they speak or just going to seek care. And I think that's one of the big things that my partnership with Jamie really focuses on being operational at the community health needs assessment is ensuring that everything that we do is decreasing stigma and increasing access to lifesaving care.

00:09:09:05 - 00:09:30:09
Jamie Elmasu
And if I can add some further color to that, I love what you're saying about ecosystems. And I think what we really do with our community health improvement initiatives is we go to maybe sometimes untraditional locations, right? So, for example, we are recently starting a partnership with the East Bay center for Performing Arts. Some people might say, okay, why are you partnering with an arts center?

00:09:30:09 - 00:09:55:02
Jamie Elmasu
This is an arts youth center based in Richmond, California. And my answer is because the need is high and what are we doing? We're actually helping them build their infrastructure to create more on site, licensed clinical social workers so that all of the children that are accessing the services at the East Bay center for Performing Arts, they actually have with embedded within their programing direct access to these social services.

00:09:55:05 - 00:10:16:19
Jamie Elmasu
And I think just by you know, helping shape that model at a center like this, in a high need area, that's really what we're talking about when it comes to ecosystem. And then secondarily, you know, it's other sites. So for example, we're deeply invested in the city of Antioch, that's in Contra Costa County as well, there are reported, you know, high rates of violence in Antioch.

00:10:16:19 - 00:10:37:17
Jamie Elmasu
So what we've actually invested in is actually hiring and helping support mental health therapists. These are licensed therapists to be onsite at the schools in the Antioch Unified School District, and then in partnership with other health systems, they've actually help support, you know, wellness rooms and trauma informed specialists that are also onsite in the school district for the year.

00:10:37:24 - 00:10:55:09
Jamie Elmasu
So it's really around, you know, shaping that ecosystem, whether it's at the school level, at the hospital level, with the nonprofit organizations and how we do it, how do we adjust? How do we actually ask our partnerships and ask the collaboratives that we work with what iterations do we need to actually meet the needs of the community?

00:10:55:16 - 00:11:22:24
Jordan Steiger
And you're both bringing up so many important things with this topic. So I think, Jesse, I mean, bringing up the topic of stigma, I feel like you can't talk about behavioral health without talking about stigma. And I think, Jamie, some of those examples that you just provided really purposefully or maybe not even, you know, purposefully decrease stigma in so many ways when you're just in the community, you are just there and you are part of it and it's, you know, people can get the care that they need without having to go see a provider.

00:11:22:26 - 00:11:39:25
Jordan Steiger
It's where they need it and when they need it. And I think that is so key. And one thing you both have talked a lot about is just these partnerships that you have internally. It sounds like across your system and then of course in the community. How did you get buy in for those partnerships, especially with the community partners?

00:11:39:27 - 00:12:01:29
Jamie Elmasu
Gosh, how do we get buy-in? I think it's a long history, right? It's a long history of relationship building and really gaining trust with community partners. I'd like to say that our partnership model with nonprofit organizations in our area is very strong. And it's because we listen. So we have a grantmaking portfolio. So we are providing grant funding to nonprofit organizations.

00:12:02:02 - 00:12:27:05
Jamie Elmasu
But it doesn't stop there. And I think that's really what sets John Muir Health apart from other health systems, really, is that our partnerships with nonprofit organizations, we also provide many in-kind services where for example, we'll bring our family medicine residents to nonprofit organizations on site to offer some sort of an intervention, whether it's health education or foot screenings or, you know, ask a doctor stations, things like that.

00:12:27:12 - 00:12:51:04
Jamie Elmasu
We've gone to Mental Health Connections, which is previously known as Putnam Clubhouse. But we've had this very robust partnership with Mental Health Connections over the years. And our family residents, they actually circulate there and they provide health education lectures to the clients of mental health connections about, you know, medication management, sleep hygiene, any topics of interest to the client based

00:12:51:07 - 00:12:52:24
Jamie Elmasu
at the organization.

00:12:52:26 - 00:13:15:20
Jesse Tamplen
Jamie does an incredible job in creating those external partnerships, and she has that grantmaking portfolio. So she's able to fund many services which can help align those, you know, partnerships. But, you know, having John Muir be a nonprofit health care system, we spend a lot of time with our operational leaders and our clinicians joining community groups.

00:13:15:20 - 00:13:38:12
Jesse Tamplen
So I'll give you an example. We have people on the Concord Chamber of Commerce. We work with our fire departments. We work with our school districts, part of the California Hospital Association, you know, working in the Tri-Valley region, where Jamie was discussing, making sure that there's grants coming on. We're supporting that grant award process for other organizations, their community needs assessment.

00:13:38:12 - 00:14:11:00
Jesse Tamplen
And I think that's critical when you look at behavioral health operational leaders. Because stigma is reduced when people see not only people who have mental health challenges speak up and, you know, do something different, but also people who are leading those services, taking their time to work with the chief of police. So many times, both at Walnut Creek and Concord, two local cities, they've held their staff meetings at our outpatient behavioral health before, so that they can see our clinicians, get to know them

00:14:11:05 - 00:14:33:18
Jesse Tamplen
and that's where we really look at decreasing the stigma. And when you look at what are the results of stigma in the United States, we know people with a serious mental illness are dying 25 years younger than the average population, but they're not dying due to their mental illness. This is where the stigma comes in. They're dying due to cardiovascular disease, obesity and diabetes.

00:14:33:20 - 00:14:58:11
Jesse Tamplen
And as a nonprofit health system, we are perfectly positioned to be able to treat those conditions because it's part of that whole person care model that we know if we can get them into access their mental health conditions and we can stabilize that life saving treatment, we then can get them to primary care in other groups where we can give back years of life and quality of life.

00:14:58:14 - 00:15:25:07
Jordan Steiger
That makes so much sense, Jesse. And I mean, I hear from both of you, I think just kind of key takeaways from this discussion. It sounds like using that positionality in your community as an anchor institution and as, you know, a leader in the community to make sure that we are doing what we can as hospitals and health systems to decrease that stigma to, you know, extend the hand first and get, you know, get those partnerships moving, really listen to the community and what they need.

00:15:25:09 - 00:15:42:13
Jordan Steiger
It sounds like you are doing all the right things, and you are setting such a great example. Thank you so much, both of you, for being here today. And I'm sure our listeners are going to have a lot of takeaways that they can start thinking about at their own organizations. So again, thank you for being here.

00:15:42:16 - 00:15:50:28
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:06 - 00:00:31:02
Tom Haederle
Welcome to Advancing Health. Being your best at anything usually boils down to practice, practice and practice. All across rural Iowa, first responders and other health care professionals are getting in that critical practice to improve patient outcomes, and the training that makes it possible is delivered right to their doorstep.

00:00:31:05 - 00:01:07:29
Tom Haederle
I'm Tom Haederle senior communications specialist with the American Hospital Association, and I'm delighted today to welcome two health care professionals to introduce us to Simulation in Motion, Iowa. That's a mobile clinical education initiative that delivers on-site simulation training to EMS providers and others who provide care to the about 43% of Iowans who live in rural areas. Joining me today to talk about this are Dr. Jacinda Bunch, an assistant professor at the Iowa College of Nursing, and senior advisor to the SIM in Motion Iowa program, and Tina Eden, who is CEO of Virginia Gay Hospital in Vinton, Iowa.

00:01:08:02 - 00:01:11:18
Tom Haederle
Tina and Jacinta, thank you so much for joining me on Advancing Health today.

00:01:11:21 - 00:01:12:27
Jacinda Bunch, Ph.D., R.N.
Thank you for having us.

00:01:12:29 - 00:01:13:23
Tina Eden, R.N.
Thank you.

00:01:13:25 - 00:01:27:01
Tom Haederle
Well, let me start with you, Jacinda. Maybe you could take a whack at this first. I'm sure that my introduction did not do full justice to this wonderful program. So what needs was it designed to meet? And what kinds of medical scenarios do the care teams get to practice?

00:01:27:03 - 00:01:59:26
Jacinda Bunch, Ph.D., R.N.
So Simulation in Motion Iowa or SIM Iowa, is a mobile simulation program where we have three trucks that we take across the entire state. We allow health care providers to practice to take care of our simulated patients. They can provide care for patients they don't see very often. They can take care of patients in new settings. It's a way to test new protocols and really just to refine the care that they're providing, across the state to really improve patient outcomes.

00:02:00:02 - 00:02:33:28
Jacinda Bunch, Ph.D., R.N.
And we really designed this because in rural Iowa, access to simulation education is a challenge. It's expensive. It requires special training to really do it well. And we all know that resources are somewhat limited in our rural areas. So this provides both EMS providers and hospitals with the opportunity to have their staff go through simulation education to really enhance the care that they're providing across the entire state, regardless of where they live.

00:02:34:00 - 00:02:36:05
Tom Haederle
How realistic are the scenarios?

00:02:36:08 - 00:02:59:28
Jacinda Bunch, Ph.D., R.N.
So we work together with both the hospitals and the EMS providers to really design the scenarios to best fit their location, what they're seeing and the things that they feel that they need to work on the most. We can do medical scenarios. We can do trauma scenarios. We have simulators that are adult, pediatric, infant and then a neonate, a 25 week premature baby.

00:03:00:00 - 00:03:24:19
Jacinda Bunch, Ph.D., R.N.
So we can really do almost any type of medical or trauma scenario. And then we also work to make sure that the scenarios match the local protocols. So we're going to ask you to use the same medications that you have access to, the same equipment, and really follow your protocols rather than having you do something if you travel to a mobile SIM center that might not match what you do locally.

00:03:24:21 - 00:03:35:29
Tom Haederle
And I guess in some cases, the EMS teams or the people that are getting the training or working on - I don't want to call them crash test dummies because I know they're not - but they're human bodies in a sense, right, that they get to do some of these things on?

00:03:36:01 - 00:04:03:17
Jacinda Bunch, Ph.D., R.N.
Yes. So our simulators are basically mini-computers. So they're little robots. They have heart sounds. They have lung sounds. You can take pulses, you can give them medications. We can amputate an arm and have arterial bleeding that they need to control. We can change heart rhythms based on medications that are given. So we really can create almost any medical or trauma scenario.

00:04:03:21 - 00:04:14:25
Jacinda Bunch, Ph.D., R.N.
We try to make it as realistic as possible. Again, we want to put the learner in that environment that they would be caring for a live patient and really try to recreate as much of that as we can.

00:04:14:28 - 00:04:25:17
Tom Haederle
Wow, that's really impressive. Tina, if I could get your thoughts as the CEO of a hospital and boss of some of the care teams that have received this training, how did it work out for your folks?

00:04:25:19 - 00:04:51:09
Tina Eden, R.N.
Really, with any simulation, muscle memory is so important to build confidence in our staff. Some of the experiences they have with the simulation mannequins are those that it would take a year in their training to receive that same experience. And so it's really invaluable. It does provide a lot of confidence and just creates more of a teamwork environment.

00:04:51:09 - 00:04:56:05
Tina Eden, R.N.
They do work with a group of other individuals when they go through their simulations.

00:04:56:07 - 00:05:13:20
Tom Haederle
Sort of circling back to some of the most valuable services that the program offers, I understand that, 32 of Iowa's counties are considered maternal care deserts, meaning they lack adequate labor delivery, postpartum care services. How has Sim-Iowa helped in that particular sphere?

00:05:13:23 - 00:05:40:12
Tina Eden, R.N.
At Virginia Gay hospital, we did actually have a maternal child simulation lab come as well as SIM-Iowa. In working with those pediatric patients, it's really important our staff just don't have the pediatric experience. And working in a critical access E.R., you can see anything on any given day. So it's really important to have that in lab experience to handle those situations,

00:05:40:12 - 00:05:43:06
Tina Eden, R.N.
everything from a burn to a crush injury.

00:05:43:08 - 00:06:07:10
Tom Haederle
SIM-Iowa, as I understand it, has now visited, I believe, all 99 counties in Iowa. I think some of the most important lessons learned in the field have not necessarily been hands on operations and emergency response, but more having to do with emergency protocols and things like that. Can you both speak to that aspect of the training and maybe not, you know, if it's not treating a patient who is up on a stretcher

00:06:07:15 - 00:06:14:18
Tom Haederle
what are some of the other big lessons and takeaways that that the care teams have benefited from as the program goes around the state?

00:06:14:20 - 00:06:34:26
Jacinda Bunch, Ph.D., R.N.
I know a couple of things that we have experienced with our educators is when we go into a either an EMS agency or a hospital and we're working with scenarios that they don't see very often, they may have read those protocols multiple times, but to really pull them out and go through the steps, do we really have this medication in stock?

00:06:34:26 - 00:06:58:10
Jacinda Bunch, Ph.D., R.N.
Does everyone know where it is? How do we access it? What about this piece of equipment that we don't pull out very often? Have we really had the chance to use it hands on? Does everyone know how to work it well? Tina mentioned that muscle memory...to actually get your hands on it and do the tasks and provide the care and use the equipment, especially when it's something that we may not see as often.

00:06:58:13 - 00:07:20:01
Jacinda Bunch, Ph.D., R.N.
So that has been a huge piece. Our EMS folks bring their bags in so they are going through their own jump bags and finding their equipment and pulling out those things that maybe they don't see very often. And we also are able to take our mannequins inside the hospital so that they are also providing care in the same location that they will be with a live patient.

00:07:20:03 - 00:07:50:16
Tina Eden, R.N.
We were able to do an onsite airway training with SIM-Iowa where they actually came into our emergency department and worked on difficult innovations with our E.R. staff, including our physicians and physician assistants, as well as our nursing staff. We were also able to do emergency procedures in their unit, and that's something that we would only use in an extreme emergency, and our staff weren't comfortable.

00:07:50:19 - 00:08:06:23
Tom Haederle
The program was recently gifted with, I think, more than $5 million in investment by the Wellmark Foundation to expand the reach and frequency of the training. I wonder if you both could speak to what the plans are for this funding. How do you see it helping and benefiting patients around the state?

00:08:06:26 - 00:08:32:06
Jacinda Bunch, Ph.D., R.N.
Well, the focus of this particular gift from the Wellmark Foundation is really has a focus on our rural hospitals and EMS providers. So what this gift is able to provide is two trainings every year for our rural and mixed urban rural counties. So those are our emergency departments' primary focus. So it's maybe a medical scenario in the E.R., like sepsis.

00:08:32:06 - 00:08:57:21
Jacinda Bunch, Ph.D., R.N.
It might be a trauma like a motor vehicle accident. But they will receive two of these trainings. And those costs are covered by the gift from the Wellmark Foundation. And then in addition, the maternal care desert counties are also provided one obstetric emergency training. And that is delivered in partnership with the IPQCC, which is the Iowa Perinatal Quality Care Collaborative.

00:08:57:23 - 00:09:11:08
Jacinda Bunch, Ph.D., R.N.
And so our educators are working together. We go out jointly and provide this education in the maternal care deserts. And the Wellmark Foundation is paying for these trainings to occur over five years.

00:09:11:11 - 00:09:27:07
Tom Haederle
That's fantastic. Is it your sense that there's a great appetite for this? Maybe, Tina, you can speak to that because you're one of the hospitals who have benefited from the training. Do you have the sense from your own folks that, wow, this was fantastic. You know, a great, great use of our time, and we'd love to see them come back and do more of this kind of work?

00:09:27:09 - 00:09:49:02
Tina Eden, R.N.
Absolutely. It's very engaging for the staff. They get to do those hands on skills that they may not necessarily do. And a lot of the apprehension that new staff will have working in the emergency department is they just haven't seen something before. So it really provides that access to think through, talk through, and work through an emergency situation.

00:09:49:05 - 00:10:04:24
Tom Haederle
I don't know this for sure, but this is the only program that I'm aware of in Iowa that is set up to do what it does and organized like this. If another state is considering doing something similar, what advice would both of you have in terms of what you've learned so far and what you know works?

00:10:04:26 - 00:10:30:19
Jacinda Bunch, Ph.D., R.N.
I would say from launching this program, some of the things that we learned and actually did were to partner with a state that was already doing something similar. The Helmsley Foundation, Helmsley Charitable Trust, provided the initial start-up funding for this program, and they have done so in four other states. Each of us run our programs just a little bit differently, but we collaborated with them and we learned from them.

00:10:30:19 - 00:10:54:12
Jacinda Bunch, Ph.D., R.N.
We learned the mistakes they made and also the things that they did well. And then really just getting out and talking to providers across the state to hospitals, to EMS agencies and finding out what their needs specifically are. We don't want to come in and say, you need A, B, and C, we want to know what you need, and then we can provide that for you.

00:10:54:14 - 00:10:56:21
Tom Haederle
Got it. Tina, any final thoughts?

00:10:56:23 - 00:11:07:21
Tina Eden, R.N.
If there are other facilities that haven't used SIM-Iowa, I would recommend it. It's been very time valuable and well worth the cost of training your staff.

00:11:07:24 - 00:11:17:21
Tom Haederle
It sounds like a marvelous program and really impressive. Thank you so much for spending some time with me on Advancing Health today to talk about this and share your insights and your knowledge.

00:11:17:23 - 00:11:18:14
Tina Eden, R.N.
Thank you.

00:11:18:17 - 00:11:20:02
Jacinda Bunch, Ph.D., R.N.
Thank you.

00:11:20:04 - 00:11:28:15
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:06 - 00:00:24:03
Tom Haederle
Welcome to Advancing Health. Nearly ten years ago, Hartford HealthCare set out to achieve an "A" rating in patient safety across all its hospitals. Well, it nailed that goal and then some, as we hear in this discussion about the determined pursuit of health care excellence.

00:00:24:06 - 00:00:59:18
Kristin Preihs
Hi everyone. I'm Kristin Preihs, vice president with Health Research and Educational Trust at American Hospital Association, and I am so excited today. We get to celebrate something that is truly special: excellence, innovation, and leadership in health care all in one conversation. This year I had the absolute privilege, oh my goodness, to be onsite as a member of the Quest for Quality Prize, which is a very specific prize that AHA provides to winners in patient safety and quality who are doing incredible work across the country in not only achieving clinical outcomes and reducing cost, but most importantly, sharing that message with others as well.

00:00:59:21 - 00:01:22:10
Kristin Preihs
So we're here to spotlight the 2025 winner of the American Hospital Association Quest for Quality Prize: Hartford HealthCare. Joining us today, it is my honor to introduce Stephanie Calcasola, chief quality officer at Hartford HealthCare and a true powerhouse. I have seen her in action in quality and patient safety and she brings clarity and purpose to everything that she does.

00:01:22:17 - 00:01:25:13
Kristin Preihs
Stephanie, welcome so much to the show. We're glad to have you.

00:01:25:15 - 00:01:42:05
Stephanie Calcasola, R.N.
Well, thank you, Kristin, it's an honor to be here with you today representing Hartford HealthCare. And boy, are we just so thrilled and proud to have won the Quest for Quality Award for 2025. It's an honor that we continue to share across our integrated system.

00:01:42:08 - 00:02:04:14
Kristin Preihs
Well, why don't we go back to 2017 when Hartford HealthCare set a bold and ambitious goal - was certainly an interesting time given what happened two years later for all hospitals to achieve an A rating in patient safety from Leapfrog, something that is uncommon and unheard of nowadays. What drove this commitment, and why was it such a pivotal moment for the organization?

00:02:04:16 - 00:02:33:10
Stephanie Calcasola, R.N.
A great question. And so in 2017, it wasn't that high reliability and patient safety was not there as part of our true north. But we really had an intentional reset, our commitment to patient safety. And we as an integrated system, still relatively new, growing our acquisitions across the state of Connecticut, knowing that access is important, but access to quality, excellent care is the true north.

00:02:33:12 - 00:03:03:17
Stephanie Calcasola, R.N.
And so we selected Leapfrog as one way to understand our performance. And when we started this journey, we had seven hospitals, five Cs, a D, and one B. And so what better way to instill that sense of high reliability, a culture that's driven around learning and improvement. And so we set a bold target that we would achieve Leapfrog A grade for patient safety across our all our hospitals.

00:03:03:19 - 00:03:05:22
Stephanie Calcasola, R.N.
And we're very proud that we were able to achieve that.

00:03:05:29 - 00:03:25:00
Kristin Preihs
That bold target was met. And then some, certainly is evidenced through Leapfrog and the many best practices that I know hospitals all over the country come to you guys with asking to learn more and how they can replicate. I love this next part, and I remember it from when I was onsite with you all. You've rolled out something called the Safety Starts with Me across the entire system.

00:03:25:06 - 00:03:33:26
Kristin Preihs
Can you tell us a little bit about this program, how it came to life, what it's all about, what motivated it, and how it really took off across your entire system to date?

00:03:33:28 - 00:04:00:21
Stephanie Calcasola, R.N.
So Safety Starts with Me is Hartford Health Care's branded high reliability program. Let me go back into our history a bit to bring us then to today. In the state of Connecticut, the Connecticut Hospital Association created a convening model for all the hospitals to commit to being an organization that trains in high reliability. And that happened in 2011, and it was a very well engaging activity for all the hospitals.

00:04:00:23 - 00:04:45:03
Stephanie Calcasola, R.N.
It was camaraderie. The patient at the center, a commitment to patient safety, aspirationally to do no harm. And that had been part of our natural thread of our organization. What we realized, though, was that we needed a bit of a, again, a reset or a reboot, and we reevaluated our training, rebranded it as Safety Starts with Me. And although high reliability training and historically was in more complex situations, acute care hospitals, there was an executive commitment to roll out high reliability across the full integrated network for inventory settings, hospital settings, medical groups, our joint ventures.

00:04:45:06 - 00:05:04:02
Stephanie Calcasola, R.N.
And so that Safety Starts With Me is now embedded in our new colleague orientation. And it's a program we get on day two for anyone who enters as a colleague for us. And so that's, I think, the pivotal commitment or the pivotal moment that Hartford HealthCare recognize that high reliability is not a one and done. It

00:05:04:02 - 00:05:15:05
Stephanie Calcasola, R.N.
is actually a muscle that you work and a memory and you learn it. And that commitment to have the program, it Starts With Me embodied that all colleagues have a role in high reliability.

00:05:15:08 - 00:05:39:27
Kristin Preihs
And what a powerful message, whether it's an orientation, hearing it for the first time to, you know, being there for a long time. But making sure that that resonates for the work that you do every single day, and I think brings so much meaning and value back to the workforce. On my own site visit there, one thing that I thought was absolutely transformational was how it also translated to some of the technology improvements that you guys have.

00:05:40:03 - 00:05:49:03
Kristin Preihs
So can you tell us a little bit about how you wove that into some of your technology-enabled solutions as it relates to simulation and other practices to improve patient care?

00:05:49:06 - 00:06:23:24
Stephanie Calcasola, R.N.
Sure. I'm so proud to share this work. We have a center of education simulation. We call it CESI: Center for Education, Simulation and Innovation. It's over 20 plus years as an innovation center simulation center. It's one of the largest in the nation's, if not internationally. It's 50,000ft². It allows for training in surgeries, procedures, robotics, but it also is set up to train and simulation of patient and family and clinician experiences.

00:06:23:27 - 00:06:54:18
Stephanie Calcasola, R.N.
We use this, the CESI center for high reliability reinforcement. How do you ensure a good time out? How do you make sure a good checklist is being performed during the peri-op period. So it goes from the gamut of how do you train with people and what is that human element that we want to hardwire to the actual how do you do simulation and procedures and surgeries so that when clinicians, physicians, nurses are actively caring for patients, they've already been trained in a simulated environment.

00:06:54:26 - 00:07:20:16
Stephanie Calcasola, R.N.
We now have a simulation center in our east region of the state, a partnership with our Eastern Connecticut State University. So we want that to be the standard for all. We can't brag enough about our Center for Education and Simulation. It has been such a profound resource. It continues to grow and be just a cornerstone to how we ensure safe, reliable, and excellent care.

00:07:20:19 - 00:07:40:15
Kristin Preihs
I think brag you should. Loudly and proudly. There's so much that you guys are doing that others are learning from. And I want to also add an addition on top of some of the simulation rollout, which is the clinical care redesign program. First of all, absolutely genius. You're improving quality, you're saving money, and you're making care better for patients.

00:07:40:17 - 00:07:58:08
Kristin Preihs
Basically, the health care version of cleaning out your closet and finding out you've been hoarding six versions of the same sweater. So kudos, because I think it's just an exceptional idea. Can you talk a little bit about the program, and what was the toughest part about pulling this off, about rolling this out? Because I know there was a lot that went into it to build up to some incredible success.

00:07:58:10 - 00:08:39:18
Stephanie Calcasola, R.N.
Absolutely. So our clinical care redesign began early in 2016-2017 with the understanding that we know there's waste in health care. And so how can Hartford HealthCare be responsible and begin understanding what is our role, and how do we actually provide evidence-based care that's affordable and of highest quality? And so clinical care redesign is really the engagement of clinicians, physicians, nurses, understanding what the evidence is suggesting or published as what is that work we should be doing, which includes variation or reducing variation of overuse or misuse.

00:08:39:20 - 00:08:59:24
Stephanie Calcasola, R.N.
And then the third is to understand the cost implications. And if you follow the evidence, generally there's cost savings. And so we wanted to understand initially that this is not a cost savings program. It's actually an evidence based program of quality and safety that we know we can generate savings when you follow the care that's of the highest quality.

00:08:59:26 - 00:09:24:17
Stephanie Calcasola, R.N.
So that was probably the biggest kind of getting the momentum and the buy-in from the colleagues to understand that this is not a cost cutting program, but this is actually around providing care that's standard, that is reducing variation and removing the cost. So I want to kind of give you that context. And our first real big year, we had $28 million removed in fiscal year '23.

00:09:24:19 - 00:09:49:27
Stephanie Calcasola, R.N.
In '24, $58 million. Wow. At the end of 25 fiscal year, upwards of $88 million. And there's a few areas that it impacts. One is on obviously reducing care variation, things like even just staplers that we use in the O.R. How do we understand what we need for the surgeon, but also what we can use to maximize contracts and purchase power.

00:09:50:00 - 00:10:15:00
Stephanie Calcasola, R.N.
But there has been a whole partnership, and I would be remiss if I did not call out our supply chain leaders who partner with our vendors and really helped with aggregate contracting that also helped with some of this. You know, everyone needs to be paid, but we all also need to work toward what's affordability. Our clinical councils, which are chaired by physicians and clinicians and administrators to help kind of remove barriers.

00:10:15:02 - 00:10:42:15
Stephanie Calcasola, R.N.
We have emergency department councils, hospital medicine, critical care. That collective energy of those experts in the room are really the secret to the success, because that's how we work within the clinical areas partnering with supply chain, partnering with administration and using obviously data, right? to understand where we can improve. I'll pause there because I could go on and on, and that's a little bit of a flavor of what a clinical care redesign is for

00:10:42:15 - 00:10:44:02
Stephanie Calcasola, R.N.
us at Hartford Health Care.

00:10:44:04 - 00:11:04:04
Kristin Preihs
I think that's quite a bit. And you've shared some of your secret sauce at Hartford, which I know many will appreciate and benefit from. And kind of going along that same vein and taking a step back, you've shared so many great examples. If someone is beginning an evolution of their quest for quality or of their quality for patient safety, what are some of the things that you would suggest they start with?

00:11:04:04 - 00:11:13:04
Kristin Preihs
What are the non-negotiables you must have in place that others who are looking to do similar things that you guys have done at Hartford really begin to explore and lean into?

00:11:13:06 - 00:11:57:00
Stephanie Calcasola, R.N.
You have to have a culture that's supportive of learning. But even above that, you have to have executives that are directing and aligning so there's one strategic priority. And what is most important providing care is around excellence, zero harm, patient safety. I would say that executive sponsorship, that alignment and then a culture where our 48,000 colleagues are committed to every day, just like Safety Starts With Me, that I will make impact individually on however I am part of Hartford HealthCare, whether I'm in the offices or I'm the one responsible for cleaning the room, I'm the one, you know, helping patients pay their bills.

00:11:57:02 - 00:12:23:23
Stephanie Calcasola, R.N.
All of that has impact around an organization's strategic alignment. As an improvement advisor, I would be remiss if I didn't say what you need to do, you need to measure. So, I would say data is very important, transparency. And, you know, what does transparency look like? That means you're sharing with your boards and your executive teams, and it's cascading through your huddle boards to the staff where our performance actually is.

00:12:23:25 - 00:12:54:05
Stephanie Calcasola, R.N.
So how are we doing with hospital acquired infections? How well are we using our safety event reporting system? What is our response rate? How well do we manage and comply to best bundles for infection prevention? Those are all quantifiable data points that will engage the teams that are working in the front with our patients and families. So I think transparency in data and an improvement model. I'm in my ninth year and what's impressed me then and what impresses me today is that there's an operating model.

00:12:54:05 - 00:13:13:26
Stephanie Calcasola, R.N.
It's our people promise. And that really is around how we show up with our leadership behaviors. We have ascribed set of behaviors very much aligned with high reliability. We have a way to do improvement work with a lean, you know, improvement model. And then we have leaders that commit and feel privileged to be able to be in this job, to do this every day.

00:13:13:26 - 00:13:36:29
Stephanie Calcasola, R.N.
And I think that is what drives an organization to success. The patients at the center with our colleagues and culture. And then there's a pursuit that we can get better at this. Every day I'm coming to work, and I know my colleagues are that this could be my mother, my friend, my husband. We want that care to be consistent, excellent and reliable every time.

00:13:37:01 - 00:14:05:09
Kristin Preihs
Thank you, Stephanie, for this incredible conversation and for your leadership at Hartford. And just want to echo how much we're so appreciative of what you've done for Quest for Quality, what you've shared for others to learn from and will continue to do so as there's so many great examples to continue off of this conversation. For those that are listening, I hope this conversation sparked some ideas about how you can strengthen quality and patient safety in your own organizations, and maybe even take a bold step or two and maybe brag a bit to Stephanie said

00:14:05:09 - 00:14:20:09
Kristin Preihs
if you're doing things that are incredible and making an impact on the field. If you're thinking about applying for the Quest for Quality Prize, please check out the AHA website for all the details on how to get started. And if you'd like to learn more about the AHA Quest for Quality Prize, please click on the link in the show notes.

00:14:20:12 - 00:14:27:06
Kristin Preihs
Thank you so much for tuning in. Keep doing the good work everyone and take care of each other. And as always, be safe and well.

00:14:27:09 - 00:14:35:21
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:02 - 00:00:22:23
Tom Haederle
Welcome to Advancing Health. What is virtual nursing and what does it offer patients and bedside care teams? Henry Ford Health is exploring those answers right now, and already finding out that integrating cameras, mics and other technology into their system is driving nursing excellence.

00:00:22:25 - 00:00:39:10
Elisa Arespacochaga
I'm Elisa Arespacochaga, AHA’s group vice president for clinical affairs and workforce, and I'm joined today by Wendy Kim, vice president and chief nursing officer of the central market at Henry Ford Health, to talk about how they are using virtual nursing to support patients and bedside teams. Wendy, first of all, welcome to the podcast.

00:00:39:18 - 00:00:40:13
Wendy Kim, DNP, R.N.
Thank you.

00:00:40:15 - 00:00:44:03
Elisa Arespacochaga
Tell me a little bit about you and your role at Henry Ford.

00:00:44:05 - 00:01:01:00
Wendy Kim, DNP, R.N.
So my role here is I'm the vice president and chief nursing officer. I've been with the organization 12 years, and in my role as the chief nursing officer for the last ten years. Been in health care for some time. I always hate to say how long, but.

00:01:01:02 - 00:01:25:11
Elisa Arespacochaga
I understand that, I have, one of my colleagues said she was born a nurse. Really interested to hear a little bit about the virtual nursing approach Henry Ford has taken. There's been a proliferation, particularly since the pandemic, of different approaches. The workforce shortages have not gone away. They continue to challenge us. But every virtual nurse program I've seen and heard about has had a little bit of a different approach and answering a slightly different need.

00:01:25:17 - 00:01:31:04
Elisa Arespacochaga
So can you tell me a little bit about how your program evolved and what you were trying to solve for?

00:01:31:06 - 00:01:55:09
Wendy Kim, DNP, R.N.
Yeah, I think it's all the above of what you just said. We are facing those same challenges with workforce shortage, burnout and so we've had to look at different models of care from even at the bedside team based nursing versus primary nursing. So it only made sense that we had to look at a way that would complement the bedside nurse.

00:01:55:12 - 00:02:14:28
Wendy Kim, DNP, R.N.
It in no way was going to replace the bedside nurse, but we needed to look at it from a retention standpoint, a recruitment standpoint. We needed to look at all those possibilities of how it might influence, you know, our abilities to retain our staff and provide support.

00:02:15:01 - 00:02:29:07
Elisa Arespacochaga
And I know one of your first pilot sites was, in fact, a little bit of more rural location at Jackson. Can you tell me a little bit about some of the unique challenges of rolling out a technological solution in a rural hospital?

00:02:29:10 - 00:02:58:18
Wendy Kim, DNP, R.N.
Well, I don't think that, you know, the location really, from my perspective, really makes a difference. You know, it was really about engaging our teams in this process, making sure that we had all the things associated with change management and, engaging the teams early on. And then making sure that, you know, our workflows aligned with the nursing expectations of what they thought

00:02:58:24 - 00:03:24:17
Wendy Kim, DNP, R.N.
you know, the virtual nurse could do for them. So it didn't really matter about our location. We are a level two trauma center. So we have specialty services such as cardiac and structural heart programs, neurosurgery, orthopedics, etc. And we are since 2018, we built a new patient tower. And so we offer all private rooms on our inpatient areas.

00:03:24:18 - 00:03:52:27
Wendy Kim, DNP, R.N.
So this is just a supplement, a compliment, to our workforce. We have, you know, great detail and attention to safety and quality. We're a second designation of magnet. We just received that again this year. So this just made sense that this was going to continue to drive nursing support and nursing excellence and experience of our patients.

00:03:52:27 - 00:04:05:28
Wendy Kim, DNP, R.N.
So it just made sense that this was the next step. And we're early adopters here in Jackson. We're always looking for the, you know, the innovation and the technology to support our teams. So we were all on board.

00:04:06:00 - 00:04:28:07
Elisa Arespacochaga
So tell me a little bit about rolling out that technology, because one of the challenges is making sure you obviously, it sounds like you had that frontline team on board from the beginning, helping you to understand what's the right technology, how to roll it out, how to be effective. But how have you kept them engaged in the work and in helping to lead what works and what doesn't?

00:04:28:07 - 00:04:33:03
Elisa Arespacochaga
Because what I think works for a frontline nurse is not going to be what they think works.

00:04:33:05 - 00:04:57:12
Wendy Kim, DNP, R.N.
Exactly. And initially, you know, I think probably there's other articles that state this too is that just give us the nurses at the bedside. That's what we want. And that was really the initial reaction. But you know, once we got them engaged and involved, we talked to them about what's their burdens. And a lot of it is that administrative burden.

00:04:57:15 - 00:05:23:08
Wendy Kim, DNP, R.N.
You know, the admission process, the discharge process, the rounding, the safety rounds. And so, you know, that's how we started. We started with them. We started with the bedside. Tell us what you want. And we want to make sure that what we thought was the best strategy and approach aligned with their expectations. Additionally, we used them as the virtual nurse.

00:05:23:08 - 00:05:50:22
Wendy Kim, DNP, R.N.
So for those that wanted to participate in it, they were in that command center. They were the ones working through the kinks and the problems to, you know, identify, oh, this is working or this isn't working. I think we should do it this way. That's where the buy in came from. And we continued to meet with them on a weekly basis just to, to do check ins and it was an iterative process.

00:05:50:22 - 00:05:59:20
Wendy Kim, DNP, R.N.
I mean, we kept changing and modifying, but it was based on their feedback. And I think that that's what was the huge success.

00:05:59:22 - 00:06:04:06
Elisa Arespacochaga
Oh, absolutely. It was their program. It wasn't yours anymore.

00:06:04:06 - 00:06:05:02
Wendy Kim, DNP, R.N.
Right.

00:06:05:04 - 00:06:26:00
Elisa Arespacochaga
And I know in some of the work that you've been doing, not only are you using the technology you have, you know, the cameras and microphones and all the ways to interact virtually, but you're also incorporating AI and other technologies into that frontline delivery and supporting the team in doing that. Can you talk a little bit about how that works

00:06:26:03 - 00:06:27:21
Elisa Arespacochaga
in your organization.

00:06:27:24 - 00:06:58:06
Wendy Kim, DNP, R.N.
We haven't maximized,optimize the technology yet. You know, we just began house wide with 220 cameras September 1st. And so we've only really been in this for three months. Housewife. We launched with 220 cameras. Our acute cares about 325. We didn't go in our ICUs yet, so we haven't even begun to understand what the capabilities are with this technology.

00:06:58:08 - 00:07:29:22
Wendy Kim, DNP, R.N.
Yes, there's this ambient light, our technology, and that's our next step. So what that technology does, and I am no expert with technology. I depend on everybody else to help me with that. But it has a way of scanning the room. There's also technology with this about ambient listening. So you know what is the, possibilities with narrating care and this technology taking that's kind of like the scribes that we use, right?

00:07:29:22 - 00:07:52:17
Wendy Kim, DNP, R.N.
But this will be our scribe, and then we can go into their record and validate it. So it's just reducing that administrative burden. It's also you know, supporting our safety efforts. You know, the last three months we've reduced our patient falls with injury and with severe injury. In fact, the last three months we've not had severe injury at all.

00:07:52:19 - 00:08:22:07
Wendy Kim, DNP, R.N.
So once we introduce this lidar technology, I think even falls in general will be reduced. So very exciting. You know, even as it learns the room for pressure injury reduction has that patient turned. There's also other opportunities with the technology around care coordination. If you as a family member can't be present at the bedside, how do we link you like you linked me today, right?

00:08:22:09 - 00:08:34:18
Wendy Kim, DNP, R.N.
Connecting me into the room and having that conversation with you as the patient and the physician and the care team. So we have just begun, and we haven't tapped into all its potential.

00:08:34:20 - 00:08:58:29
Elisa Arespacochaga
And I love that you're looking for every possible opportunity to do that. Being able to be present for a discharge, even when you're a thousand miles away, has got to be such a comfort to family members and to others, and being able to bring that whole team and really help coordinate the care I think is wonderful. What's something that surprised you in this rollout as you were thinking about, you know, okay, well, here's what could go wrong,

00:08:58:29 - 00:09:04:05
Elisa Arespacochaga
here’s what could go really great. Was there something that caught you completely by surprise?

00:09:04:07 - 00:09:38:19
Wendy Kim, DNP, R.N.
I don't think anything caught me by surprise. I think the excitement of recognizing its potential, its possibilities, and I think that the nursing staff are now recognizing how this is giving more time to them to be at the bedside. So the uplift is what I guess is so surprising and really enjoyable to watch as these nurses continue to modify and change.

00:09:38:20 - 00:10:04:13
Wendy Kim, DNP, R.N.
You know, we have a patient callback system that we are using, and it tells us how well we did with discharge instructions and medication reconciliation and patient education. We get that data, we receive that. And we're modifying even how we interact with the patients at discharge, whether it's teach back, making sure that they, you know, understand their instructions.

00:10:04:14 - 00:10:43:26
Wendy Kim, DNP, R.N.
So it's just been so uplifting to see the results and to see how this is really supporting patient care and meeting the needs of both patient and staff. So nothing surprising. I think it's more so just seeing the engagement and the recruitment was easy for these roles. We have kind of a hybrid model. We use some nurses that we transitioned from their prior roles into this role, and then we still use bedside nurses as well so they can rotate and just get a change of pace.

00:10:44:03 - 00:10:53:10
Wendy Kim, DNP, R.N.
So all positive. I think initially, yeah, there was a little bit of apprehension, but it's just sailed.

00:10:53:12 - 00:11:08:24
Elisa Arespacochaga
That's awesome. So not so much surprises delight. It sounds like it's really been a delightful process for others who are embarking on their own virtual nursing solution to answer the challenge they're having, what advice would you give?

00:11:08:26 - 00:11:36:12
Wendy Kim, DNP, R.N.
Evaluate all the technology, all the possibilities and what systems that you currently have and how it's going to complement most. Have electronic health records of some sort and other platforms from a patient education or TV or television type technologies. So look at the interoperability. I think that that's a piece to it and the companies engagement with you.

00:11:36:15 - 00:12:00:28
Wendy Kim, DNP, R.N.
But then when it gets down to the teams and getting this implemented, it's just working directly with those that are going to be impacted. Nurses, providers, patients. You know, we did a lot of education across the health care team as well as the community. So you have to spend some time on making sure that you educated everyone.

00:12:01:00 - 00:12:10:19
Elisa Arespacochaga
Absolutely. Well Wendy, thank you so much for sharing your program with me. And, I can't wait to see where you've taken the technology, even in 3 to 6 more months.

00:12:10:22 - 00:12:12:21
Wendy Kim, DNP, R.N.
Thank you.

00:12:12:24 - 00:12:21:05
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:06 - 00:00:27:13
Tom Haederle
Happy Holidays from the American Hospital Association and thanks for listening to the AHA’s Advancing Health podcast. As we wind up 2025, we wanted to highlight some of our most notable episodes from the past year. First up, a selection from Bridging Distances with AI and Telemedicine - a discussion between AHA's chief physician executive Dr. Chris DeRienzo and Dr. David Newman, chief medical officer for virtual care with Sanford Health.

00:00:27:16 - 00:00:49:27
Tom Haederle
Advancing health will return with a new schedule in 2026, so be sure to look for new episodes every Monday and Wednesday wherever you get your podcasts. In the meantime, enjoy these podcast highlights and we hope you and your family have a safe and wonderful holiday and a Happy New Year!

00:00:50:00 - 00:01:11:04
Chris DeRienzo, M.D.
So for you all, innovation is really grounded in your need to serve your population. So remind our listeners a little bit about Sanford Health and the populations you serve and why innovation has been so core to what you do from the beginning.

David Newman, M.D.
Yeah, so at Sanford Health we're the nation's largest rural health care system. We range all the way from Wyoming to Michigan.

00:01:11:12 - 00:01:37:19
David Newman, M.D.
We have lots of hospitals. We have got big hospitals. We've got small hospitals. We've got critical access hospitals.  We've got clinics. We've got a health network. We've got a nursing home. One thing that we don't have though, is a problem that a lot of rural America has is enough providers. We realize that we have to jump to innovative care models to survive because our patients really need.

Chris DeRienzo, M.D.
Well, it's innovative care models and you need providers, but you also have patients who are spread far and wide.

00:01:37:20 - 00:02:00:25
Chris DeRienzo, M.D.
I mean, you all were incredibly generous with your time. We spent some time together in the fall and you showed me what it really is like in parts of rural North Dakota where your patients live. Talk to us about that. And then you will return to given that this is who you all serve, and it really is a sacred mission that you have, the kinds of innovative approaches that you're taking both with virtual care and with AI.

00:02:00:28 - 00:02:20:17
David Newman, M.D.
Yeah. So I say rural, I mean really rural. So in, North Dakota, I live in Fargo, North Dakota. I'm the only andrologist for the state of North Dakota. And Fargo is on the eastern part of the state. And, a lot of my patients come from western North Dakota or even Montana. It is a 400 mile drive

00:02:20:18 - 00:02:47:17
David Newman, M.D.
one way to get to see me.

Chris DeRienzo, M.D. 
Whoa.

David Newman, M.D.
And oftentimes it's for a 15 minute appointment.

Chris DeRienzo, M.D.
Oh my goodness.

David Newman, M.D.
And so if they're coming to see me for their hypogonadism or infertility or another thing, I'm the only option in town. You can imagine how frustrating it is if there's a blizzard, or even if there's not a blizzard for them to have to drive that far, take a day off of work, have multiple tanks of gas yet, to miss time away from their loved ones to do something that can be easily done virtually.

00:02:47:20 - 00:03:02:22
Chris DeRienzo, M.D.
And that might even be two days, because I could imagine, you know, if that's an appointment you've been waiting on and you described a little bit about what you do. But remind our listeners what an andrologist is in just a moment.  

David Newman, M.D.
Yeah, yeah. You know, I mean I would drive 400 miles and spend the night just so I don't I don't miss that.

00:03:02:22 - 00:03:23:21
David Newman, M.D.
That can be such a key conversation in in a family's life. Right. Absolutely. Yeah. So andrology is sex hormone. So it's a lot of if your testosterone is low or if you're having troubles reproducing. Yeah. From a health perspective, even having one provider like that in that part of North Dakota is great, but you need to reach a massively spread out population.

00:03:23:21 - 00:03:45:03
Chris DeRienzo, M.D.
So, obviously you're the CMO of virtual care. Let's talk a little bit about how Sanford and you think about the kinds of virtual care options that allow a provider with your experience to reach people who are hundreds, if not a thousand miles away.

David Newman, M.D.
Yeah. So we've really been listening to patients and what they want. So one of the big things we heard is that they don't want to be transferred to our flagship hospital.

00:03:45:04 - 00:04:03:14
David Newman, M.D.
So we've got lots and smaller hospitals that feed the larger hospitals. One of the big issues is the lack of some of the pediatric subspecialties in the smaller hospitals. So for example, pediatric infectious disease. If a patient needs a pediatric infectious disease consult, they often had to be transferred to Fargo or Sioux Falls for the higher level of care.

00:04:03:15 - 00:04:33:01
Chris DeRienzo, M.D.
Wow.

David Newman, M.D.
You can think about as a parent, if your child is transferred, you're missing work. You have other children that you can't attend to. It's a big burden. So now leveraging technology and leveraging virtual care, we can beam our own providers, our own pediatric infectious disease doctors into their hospitals. We can keep the patients there. Sometimes you can just see how relieved the patients are knowing that they're not going to be transferred and knowing that they still get the same high quality specialty care in their hometown hospital.

00:04:33:05 - 00:04:58:08
Chris DeRienzo, M.D.
Let's talk a little bit about follow up, because it's not just in-hospital care. And we got to visit Dickinson, North Dakota. And one reason that that you all took me there is that it made national news. The virtual care setup that you had in Dickinson was such that patients who had  - pediatric patients actually - who had, you know, chronic conditions that were requiring them to drive a 1100 miles round trip to see subspecialists... you could now set them up in that building.

00:04:58:08 - 00:05:14:19
Chris DeRienzo, M.D.
So now maybe it's an hour's drive from the ranch that they live in Dickinson rather than seven hours each way. That doesn't happen accidentally. You've got to be very sensible about designing a system to work like that. How do you do it?

David Newman, M.D.
Yeah. So a lot of it is what the patient wants and from provider buy-in.

00:05:14:19 - 00:05:31:19
David Newman, M.D.
And so we've had some champions that have had driven this. And we have failed fast on a lot of these models that didn't work. For our hub and spoke model a patient, it's the easy button for the patient. So if they're not tech savvy they can go to the clinic. They can have a nurse and room them in a regular exam room, and then the provider beams into the room.

00:05:31:19 - 00:05:47:19
David Newman, M.D.
So it's just like a normal visit. One of the great things about that is they're already there for labs. So if a patient needs an X-ray, they're there. Yeah. If they need blood tests, they're there. And it is their trusted provider. Those labs are going to go straight to their basket and they're going to have follow up there.

00:05:47:19 - 00:06:09:03
David Newman, M.D.
So it's defragmentizing care.

Chris DeRienzo, M.D.
I love this example because medicine is always a spectrum. Neonatologist, endocrinologist. You know I see babies at the super, you know critical hyper acute end of the spectrum. And you know, at the follow up care. And telemedicine is no different, right? There are telemedicine visits you can do in a patient's home with the technology that just exists on their phone.

00:06:09:03 - 00:06:27:10
Chris DeRienzo, M.D.
But these kinds of visits that we're describing here, you need really special setup so that, for example, a pediatric pulmonologist can know what they need to know about, you know, a child who has a chronic condition, to say, no, you're good. You don't have to make the thousand mile round trip drive this month. That's sort of one part of an innovation.

00:06:27:17 - 00:06:47:06
Chris DeRienzo, M.D.
We're both here at this conference and innovation takes lots of forms. I know you all are early users of any number of AI enabled solutions. Where are you seeing an impact today, either for your physicians and APPs or for patients? Yeah.

David Newman, M.D.
So one of the best use cases of AI that I've seen in my career has been artificial intelligence for diabetes.

00:06:47:06 - 00:07:06:03
David Newman, M.D.
In my previous career, I treated a lot of type one diabetes, and patients had an insulin pump, which you can imagine is like a cell phone that they wear in their belt that talks to a sensor, which is a sticker on your skin that continuously checks your blood glucose. There is an artificial intelligence algorithm that tells you when you need more insulin and when you need less insulin, and it will do it for you.

00:07:06:03 - 00:07:27:28
Chris DeRienzo, M.D.
Wow.

David Newman, M.D.
It's the easy button. So that was really cool technology that came out several years ago, but the software was clunky, so they had to come to a major diabetes center to have it downloaded.

Chris DeRienzo, M.D.
Okay.

David Newman, M.D.
With our feedback, a lot of the companies have been able to bring this into the patient's home. So there's an app or a program on their home computer that they can use, and we can do all their work virtually.

00:07:28:03 - 00:07:44:14
David Newman, M.D.
So for a condition like type one diabetes, that is like a part time job.

Chris DeRienzo, M.D.
Yeah.

It is four hours a day. We have completely revolutionized it. So sometimes I see a patient once a year for their type one diabetes.

Chris DeRienzo, M.D. 
Once a year?

David Newman, M.D.
Yeah. So it's partnering with the technology.

00:07:44:16 - 00:08:07:11
Tom Haederle
Next, a selection from "Being Okay with Not Being Okay: Destigmatizing Mental Health for Health Care Workers." Your host is Rebecca Chickey, senior director of behavioral health with AHA, talking with Corey Feist, co-founder of the Dr. Lorna Breen Heroes Foundation, and Tiffany Lyttle, director of cultural integration with Centra Health.

00:08:07:13 - 00:08:26:07
Rebecca Chickey
Of course, some of the listeners may not understand when you say removing the barriers to access for mental health care. They may think they're working in hospitals and health systems, so of course they have access to mental health care. Can you go a little deeper on that and describe some of those barriers that you're trying to remove and mitigate?

00:08:26:10 - 00:08:54:10
Corey Feist
And it's a great point, Rebecca, because when my sister in law took her life in April of 2020, I had been in health care for many dozens of years, actually, many decades, I should say. And I was a leader at University of Virginia Health System. Yet I wasn't a clinician, and so I was completely unaware of the stigma as well as the professional barriers and really potentially penalties that health care professionals in the United States have.

00:08:54:12 - 00:09:40:02
Corey Feist
These mostly appear in the form of overly invasive and really inappropriate questions that clinicians are asked about whether they've ever been diagnosed or treated for mental illness, whether they've gone to therapy. And these are the same questions that my sister in law was terrified that she would have to respond to following a singular mental health episode. And so what we have been able to do at the Lorna Breen Foundation, through our All In Coalition and Caring for Caregivers, is to get tools to the front lines, whether it's a licensing board that's asking these questions, or hospitals who ask these questions most commonly in credentialing applications. And have them change those questions and then importantly, communicate

00:09:40:02 - 00:10:02:16
Corey Feist
the changes to the workforce. As I sit here with you today, there are 1.5 million health workers in the United States that are benefiting from the changes that we've made, which we hold out in the All in Well-Being First for Health Care Champions Challenge for licensing and credentialing badge that we give out to hospitals, as well as the licensing boards for doing that important work.

00:10:02:19 - 00:10:11:19
Rebecca Chickey
Thank you. I mean, I don't think many of the listeners may have realized that those questions where: have you ever, as you noted, have you ever been treated?

00:10:11:21 - 00:10:35:24
Corey Feist
And if I could just add one thing, because the American Hospital Association a couple of years ago published their first ever suicide prevention guide at least the first ever that I'm aware of. And in that suicide prevention guide, you identified three key drivers of suicide among health workers. And the first one that you all identified is this concern around the loss of license and credentials associated with the stigma for mental health care.

00:10:36:00 - 00:10:52:10
Corey Feist
So we know that for Laura, this wasn't just an isolated incident. And it's something that we hear from health workers all over the United States that they are fearful for these repercussions. And so we need to do something about it and address it, which is what we've done across the country. And we've made great strides.

00:10:52:15 - 00:11:16:18
Rebecca Chickey
Thanks for mentioning that. There's a variety of, drivers for this concern and this stigma. So thank you. I want to turn now towards another thing that you mentioned earlier, Corey, and that is working with states, working with large health systems in order to advance this in their own organizations and across a particular geography or a regional area.

00:11:16:21 - 00:11:25:12
Dave Newman, M.D.
And I'm going to call out specifically the Caring for Virginia Caregivers work. Can you describe that a little bit? And then we'll bring Tiffany into the conversation.

00:11:25:15 - 00:11:52:22
Corey Feist
Absolutely. Two seconds of background. When the president of the United States signed into law the Dr. Lorna Breen Health Care Provider Protection Act, it created two spheres of programs. And one of those sphere of programs was learning materials for health care leaders to address the root cause of burnout, as well as mental health challenges. That was called the Impact Well-Being guide, which was led by the CDC and our All in Coalition provided guidance on it.

00:11:52:24 - 00:12:21:14
Corey Feist
What we heard from the large health system across the country that was implementing the guide is they like to do this work together in a learning collaborative and they need some help. And so caring for Virginia's caregivers, caring for North Carolina's caregivers, caring for New Jersey's caregivers, and now caring for Wisconsin's caregivers are all efforts for us to take organizations through the phases of work from the Impact Wellbeing guide, and that begins by addressing these mental health barriers.

00:12:21:20 - 00:12:45:22
Corey Feist
It then moves towards education of ten person teams across health systems to address the issues at the root cause and become educated about the solutions. And then finally culminates in a learning collaborative focused on an operational initiative that drives burnout. And that's what we've done with Tiffany and the team in Virginia, now North Carolina, New Jersey and recently expanded into Wisconsin.

00:12:45:25 - 00:12:56:21
Rebecca Chickey
That's fantastic. Tiffany, I bet the question on many listeners minds is, why did Centra decide to join the work of All In, of Caring for Virginia Caregivers?

00:12:56:23 - 00:13:31:09
Tiffany Lyttle, R.N.
At the time, we had some really innovative leaders that understood that well-being wasn't just a nicety, but rather a necessity for us to drive health care forward not only to our communities, but also to our health care workers. So 2019, we really start pulling together the evidence base for this work. And what we saw is that health care workers were far more likely to suffer from depression, to have thoughts of suicidal ideation, to have bio psychosocial disturbances, and of course, use substances to help them cope with their roles.

00:13:31:11 - 00:13:50:11
Tiffany Lyttle, R.N.
But we had never provided health care workers with the avenues, tools and support that they needed to be able to speak up and say, hey, we need help for coping with, you know, the very large burden of taking care of our communities and health care in the United States. Those were all published before 2019. So, of course, you know what happened after a 2019,

00:13:50:11 - 00:14:22:12
Tiffany Lyttle, R.N.
we went into a global pandemic. So we really need to find avenues that we could help support our health care team members. Not only address their own well-being so that they can carry that forward, but also not place calluses where we should have compassion because we were facing a compassion crisis, right? And when we tell people, you know, you have to be strong, you have to be confident and yes, we are all of those things, but we also have to deal with very messy, beautiful situations of life and humanity, and that can take a toll on us.

00:14:22:15 - 00:14:44:16
Tiffany Lyttle, R.N.
It can leave echoes and it can leave scars, but we are well-practiced in taking care of code situations. I mean, if you think about a code situation, we are practiced, rehearsed, we simulate it, we educate to it. We certify to it every single year. We have avenues and tools to help us be better at coding situations and situations of that nature.

00:14:44:19 - 00:15:00:13
Tiffany Lyttle, R.N.
What do we have in place for taking care of ourselves? Nothing. We don't teach that in school. We don't simulate that. We don't go over it. We don't get certified to it. I mean, now we are starting to see some certifications for health care organizations come through. But that was about the time that we found the Lorna Breen foundation.

00:15:00:13 - 00:15:18:12
Tiffany Lyttle, R.N.
And what perfect timing, you know, that we really needed to find a place for getting those tools, for helping support us in that work and removing the stigma. And I have to say, that's been one of the most important parts of engaging in our health care workforce as well-being is destigmatizing health care.

00:15:18:15 - 00:15:26:27
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.