Advancing Health Podcast

00;00;01;05 - 00;00;48;18
Tom Haederle
Fast, accurate, effective. Three words that should drive the public communications strategy of health organizations in times of crisis or emergency. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications,.Phelps Health, based in Rolla, Missouri, has some experience in disseminating critical information to wide audiences during emergencies or disasters, not to mention building trust, loyalty and brand awareness in the process.

00;00;48;21 - 00;01;16;13
Tom Haederle
Joining AHA senior Director John Supplitt today are two leaders from Phelps Health. Somer Overshon is Associate Vice President of Strategic Communications and Paige Marsolais-Heitman is director of Marketing and Public Relations. The group will discuss proven strategies for successful risk communication during crises which can be adopted by other health care organizations. Today's episode is brought to us via the Convening Leaders for Emergency and Response Initiative.

00;01;16;15 - 00;01;25;20
Tom Haederle
That's a funded partnership between HS Health Research and Educational Trust and the Administration for Strategic Preparedness and Response.

00;01;25;22 - 00;01;39;08
John Supplitt
I'm John Supplitt, senior director of AHA Rural Health Services, and it's my pleasure to introduce you to Somer Overshon and Paige Marsolais-Heitman from Phelps Health in Rolla, Missouri. Welcome, Somer and Paige.

00;01;39;10 - 00;01;41;08
Somer Overshon
Hello. So glad to be here today.

00;01;41;19 - 00;01;44;12
Paige Marsolais-Heitman
Yeah, good morning or good afternoon. We're excited to be here.

00;01;44;23 - 00;02;11;23
John Supplitt
Great! Let me provide our listeners with some background. Phelps Health serves over 200,000 residents across a six county area. It's county owned and an elected board, but it's not tax supported. Sole community Rural Referral Center of 242 beds, with multiple clinics employing more than 1900 people, including 100 plus providers, offering a vast array of primary and specialty services.

00;02;11;25 - 00;02;26;02
John Supplitt
Of course, this makes you a bit bigger, a little more robust than your neighboring critical access hospitals. Does the community expect more from Phelps, given your resources than perhaps from other rural hospitals? Somer, what are your thoughts?

00;02;26;04 - 00;02;47;16
Somer Overshon
I would say yes, in that we are certainly the largest employer in the region. I think that we are looked to to provide the health care services in this area. So we really do pride ourselves on offering the best possible services we can to the people who are living in our rural communities.

00;02;47;19 - 00;02;56;22
John Supplitt
And would you consider disaster planning in emergency preparedness among those things that the community expects that they might not expect from other smaller hospitals?

00;02;56;25 - 00;03;34;01
Somer Overshon
I don't know that necessarily. The community even realizes that we even think about this stuff. I think that the fact that we're having a conversation about it today is great because we just unfortunately don't live in an environment anymore where we can't consider the possibility that a crisis may occur. So whether or not the community is aware that we have this type of planning going on, I think it doesn't really matter because at the end of the day, I feel proud that we are being proactive enough to do what we need to do and respond in the way that we need to respond so that the people that we serve are getting the information that they need.

00;03;34;26 - 00;03;56;09
John Supplitt
And of course, we all share the concept that it's essential to what we do, especially in terms of natural disaster planning or a medical surge, any of the things that may come forward for which we have to be prepared for, especially as a rural referral center. But I want to begin at the beginning here and that's regarding disaster planning and emergency preparedness.

00;03;56;11 - 00;04;05;07
John Supplitt
Who uses risk communications and to whom are you speaking? That is, who's the audience? Somer, why don't you start?

00;04;05;09 - 00;04;27;14
Somer Overshon
I would say that risk communications really involve almost everybody. So it's looking at individuals, it's looking at organizations, it's looking at groups of people. The fact is, is that people just need to be thinking more about it. I don't know that there is much awareness of what work needs to be done ahead of time then when you are actually in a crisis.

00;04;27;14 - 00;04;53;06
Somer Overshon
So what risk communication does is really focused on preparation. This is the time that you are spending 90% of the time, I would say is in preparation for something that could possibly occur. Now, here's the difference between risk communications and crisis communications. And I think people don't really know what that difference is. So let me share that. A risk is an event that could occur, but it doesn't necessarily mean that it will.

00;04;53;13 - 00;05;19;26
Somer Overshon
There's potential for it, but it may not come to fruition, whereas a crisis is an event that has occurred, You are in the middle of it and you're having to deal with the aftermath of it. So it is very different. I feel that with risk communication, the key here is really doing that preparation work because when you get into the middle of a crisis, you're not going to have time to go back and try to do and gather all of these things together.

00;05;20;03 - 00;05;50;18
Somer Overshon
You really have to act at that point. So I would encourage people to really start thinking about what types of risk is your organization going to have? It could be financial, it could be legal working in health care, it could be a patient issue or a HIPAA violation. We really don't know. There's a vast array of things that could go wrong, really be thinking about what your organization specifically may be inclined to have happen, and then start focusing on how you would address those situations ahead of time.

00;05;50;18 - 00;05;59;22
Somer Overshon
So that when you are in the middle of an actual crisis, you can really focus on getting the information out that you've already prepared to the people that need to know it.

00;05;59;24 - 00;06;15;04
John Supplitt
Well, thanks, Somer. So much of the disaster management cycle is about preparing and planning then and as communication professionals. Somer, who is the emergency management team at Phelps? And then how do you work together?

00;06;15;07 - 00;06;49;05
Somer Overshon
We call it our emergency operations center and the individuals that are part of this group come together and work ahead of time. We really try to reenact potential situations that could go that could occur, rather, And these are some tabletop exercises that we do. We may work through some sort of active shooter situation, a mass casualty situation, maybe it's a cybersecurity situation or like we've recently went through some sort of health and wellness or pandemic sort of situation.

00;06;49;07 - 00;07;17;10
Somer Overshon
So there's a multitude of people that represent on this committee. And basically it is when a crisis occurs, normal operations are going to shut down, so the emergency operations are going to take over. So everything that normally happens within our organization stops and all operations are funneled through this team. So you have your infinite commander who is really leading all of the initiatives, everything that's going on and happening.

00;07;17;12 - 00;07;42;05
Somer Overshon
They are making sure that all of their all of the people that are reporting up to them are getting the things done that they need to get done. They're really focused on operations. You have people from facilities, you have people from security, you have people from your nursing unit. And again, we are a little bit bigger. So some of these departments may be outside of the scope of maybe every health care organization, smaller health care organization.

00;07;42;05 - 00;08;09;13
Somer Overshon
But nevertheless, you're going to have somebody with strong operations knowledge as your Incident Command. You're going to have somebody that's going to handle facilities and security and things of that nature. You're going to have your IT component, so people that are handling all of your information technology situations. And then the part where I come in is that I am the primary information officer or the public information officer, CIO for short.

00;08;09;15 - 00;08;32;24
Somer Overshon
And my role within the emergency operations center is to really coordinate and lead the development and the dissemination, I would say, of communication strategies that we need to convey. This is critical information that we need to get out either to our internal audience or our external audience or goal. So all of the information that is coming in and from the organization is coming through me.

00;08;32;27 - 00;09;00;29
Somer Overshon
So I serve in that capacity. Page is my backup when I'm not able to to perform in that manner. And then I'm also going to work with key stakeholders to develop crisis communication plans. We're going to establish protocols for communicating with the media because that's another aspect that you've got to consider. And then we're also going to start monitoring and responding to rumors and misinformation, because in the middle of a crisis, there are going to be rumors and misinformation circulating and you want to try to get ahead of that as well.

00;09;01;01 - 00;09;19;19
John Supplitt
Great. Thanks very much, Somer.  At our recent Rural Health Care Leadership Conference, we convened leaders for emergency response and you presented on establishing trust strategies for rural health care communications during a crisis. Paige, what makes this so important? How is trust earned?

00;09;19;21 - 00;09;41;07
Paige Marsolais-Heitman
Yeah, that's a great question. How is trust earned and why is it so important? I'm going to start off with the first section of that. How is trust earn process earn with all of those different stakeholders, whether it's community members or your employees themselves, by communicating consistently and authentically and also truthfully with your brand. It's really important regardless of what type of organization you have.

00;09;41;07 - 00;10;01;26
Somer Overshon
And I know we're health care specific to make sure that you're hitting those three points so that you build that relationship ahead of time with all of those different stakeholders. Now, the reason for us is so important whenever we talk about crisis communications is you have that free established relationship built so people look to you as a source of truth and knowledge.

00;10;01;29 - 00;10;12;26
John Supplitt
Thanks so much. And then within the context of the framework you use during COVID 19, Somer, tell us what it was that you used and and why it was so important.

00;10;12;29 - 00;10;38;25
Somer Overshon
Sure. So the framework with that we used is called the message map and really, if there's one thing that I would have people take away from this conversation today on how to start their own communications plan, it is to utilize a message map. And what a message map is, it's a tool that ensures that you have the right messaging ready for your audience and that the messages that you're using are consistent and easily understandable.

00;10;38;27 - 00;11;07;27
Somer Overshon
So when you are working through this message map, you are making sure and really allowing you and your team and ultimately your organization to move quickly. So when it comes to communicating out that information, you're able to move out and pull yourself out front and establish yourself as the authority page referenced earlier with that, establishing trust. So having a message map ready ahead of time  - and this is when I go back to that preparation piece - this is what I'm talking about.

00;11;07;27 - 00;11;34;07
Somer Overshon
Having these message maps readily available will allow you to really almost, I would hope, decrease the initial stress and panic that you may experience as the primary spokesperson for an organization in a crisis on how you are going to respond and what you're going to say. At this point in a crisis, you really shouldn't be thinking about what are you going to say or how you're going to respond?

00;11;34;09 - 00;11;37;06
Somer Overshon
Because frankly, if you are, it's really too late.

00;11;37;12 - 00;12;06;03
John Supplitt
And that's important advice. And we're going to come back to that again a little bit later. What I want to talk about now is that strong cross-sector partnership that's necessary to support a more coordinated response and recovery, while also providing value to all that are involved outside of an emergency. And Paige, are there certain risk communication strategies that you used during your response to COVID 19 that are being integrated into your organization's emergency plans or protocols for future emergencies?

00;12;06;05 - 00;12;29;05
Paige Marsolais-Heitman
Absolutely. There are like summaries that if you take any anything from this, it's to start the conversation today and to start having those meetings with those different key stakeholders. Outside of COVID 19, what we really learned is that while we were able to respond efficiently and quickly and in a consistent, authentic manner, we still weren't as prepared as we even wanted to be.

00;12;29;12 - 00;12;49;15
Paige Marsolais-Heitman
One of the huge takeaways from us is that we are now in the process of developing a very robust risk communication strategy and framework, and that's really for us going to serve as what I'm going to call an evergreen toolkit that we continue to go back to. So for example, within that toolkit, we might be talking about tornadoes or an active shooter drill.

00;12;49;22 - 00;13;11;13
Paige Marsolais-Heitman
So what we'll be able to do is define all of those different outlets, whether it be additional like newspapers or radio or digital, like we're doing social media ads, maybe we're putting out posts or podcasts to communicate all that information. So for us, it's a work in progress. But our biggest takeaway is to start building that framework now so we can be prepared.

00;13;11;15 - 00;13;34;11
John Supplitt
Great. Thanks very much. I want to go back to the conversation we were having about scale, and many rural hospitals and health systems lack the resources and staff like you have at Phelps Health. For example, Somer, you’re a PIO, and we know that small community hospitals, critical access hospitals won't be able to staff at that level. So I want to know where should they begin?

00;13;34;13 - 00;13;40;11
John Supplitt
What is fundamental for success in a disaster management and emergency preparedness scheme?

00;13;40;13 - 00;14;06;01
Somer Overshon
I would say for rural hospitals and health systems that are small and have limited resources available, I think a great starting place would be to start establishing those strong relationships with your local groups and organizations ahead of time as well. So think about the people that are going to be responding to the crisis and/or working alongside of you should a crisis occur in your organization.

00;14;06;04 - 00;14;26;17
Somer Overshon
So these are individuals that are going to be your local health department, your police, your fire, EMS, all of those entities are going to be working heavily to get through this crisis with you. Reach out to those people and find out who they are ahead of time. Again, the last thing you want to do is be in the middle of a crisis.

00;14;26;17 - 00;14;46;17
Somer Overshon
And if you keep stressing this enough because you don't want to be calling somewhere the day of and not really know who you need to talk to you. By that point, all of those things that you put in place, you need to clearly understand who you're communicating with and they know who you are as well so they can reach out to you deep and collaborate and coordinate on your information.

00;14;46;19 - 00;14;59;26
John Supplitt
Great. Thanks very much. And so reflecting then on your experiences over these past three years, Somer, can you share with our listeners what you've learned that may shape your approach towards risk communications for the next disaster or emergency?

00;14;59;29 - 00;15;18;13
Somer Overshon
Of course. And I want to reiterate what Paige said to you, that it is a work in progress. You know, we are talking today about this and we may be ahead of some organizations, but we are by no means to a point where I feel like, okay, I feel good about this. I think there's always work to be done with this.

00;15;18;13 - 00;15;42;18
Somer Overshon
I think there's always going to be revisions to this and I just hope that people start taking it seriously because it does need to be an ongoing part of thinking through what and how you are going to respond. So I would say that really think about who your audience is going to be if you were to have a crisis.

00;15;42;20 - 00;16;04;19
Somer Overshon
Think about all of those people and what they want to hear or how they like to receive their information. I like to think of my mom or my grandparents. We work in health care. We're used to certain terminology. Your average person is not. So if my mom was going to receive information that I am trying to really make sure that people understand, how would she understand it?

00;16;04;23 - 00;16;41;07
Somer Overshon
So take it down to that level and then also really think about coordination between departments within your organization. Not only do you need to have strong communicators that are leading your external efforts, but you also need health care leaders put in place that can communicate effectively with that person who is trying to disseminate that information. So as CIO, I really rely on all of these other department directors to get me the information that I needed a timely manner so that I can then push it out where I need to push it out.

00;16;41;10 - 00;17;16;02
Somer Overshon
You also want to really look at technology like Paige has mentioned and think about the platforms that people like to receive their information on certain demographics prefer certain ways of getting their information, think through all of those areas. And then really focus on preparedness again. I feel like I keep saying the same things, but I think it's so important to really invest in training and preparation and you're really going to be able to strengthen everything as a whole because you're going to feel more confident should something occur because you're already you've already gone through these scenarios.

00;17;16;02 - 00;17;30;25
Somer Overshon
Now, that doesn't mean that during a crisis it's going to play out exactly the way you planned for in your little notebook or whatever you have. But it does mean that you have some framework that you can make modifications to. And then quickly push out.

00;17;30;27 - 00;17;58;07
John Supplitt
Somer, that's very good advice from lessons learned during the COVID 19 pandemic. I want to thank our leaders from Phelps Health, our subject matter experts. Somer Overshon, associate vice president of Strategic Communications, and Paige Marsolais-Heitman , director of Marketing and Public Relations. This is John Supplitt And you've been listening to Strengthen Risk Communications and Rural Health Care for Emergency Response and AHA Advancing Health Podcast.

00;17;58;11 - 00;18;33;18
Tom Haederle
Presented as part of Cooperative Agreement 5 HITEP210047-02-00, funded by the Department of Health and Human Services’ Administration for Strategic Preparedness and Response (ASPR). The Health Research & Educational Trust, an American Hospital Association 501(c)(3) nonprofit subsidiary, is a proud partner of this Cooperative Agreement. The contents of this webpage are solely the responsibility of the Health Research & Educational Trust and its partners and do not necessarily represent the official policies or views of the Department of Health and Human Services or of the Administration for Strategic Preparedness and Response. Further, any mention of trade names, commercial practices, or organizations does not imply endorsement by the U.S. Government.

00;00;01;02 - 00;00;39;02
Tom Haederle
If you drew up a list of the most pressing priorities for hospitals and health systems right now, environmental sustainability probably wouldn't sit at the top. Or even the top five. Nevertheless, there is growing awareness in the health care field that becoming a better steward of the environment is something well within the capabilities of most health care givers. In fact, it benefits the overall mission in ways we often don't think about.

00;00;39;05 - 00;01;05;05
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. In this talk with an AHA policy expert, one environmental officer whose health care organization has been paying close attention to environmental sustainability and reducing its carbon footprint since the 1990s, frames it this way: It's part of our work, not additional work. Let's learn more.

00;01;05;07 - 00;01;20;20
Mark Howell
Hi, my name is Mark Howell and I'm a director of Policy and Patient Safety at the AHA. As part of that portfolio, I help the AJ and its members as we take steps to become better stewards of the environment. I'm fortunate enough to be joined for a few minutes by Tony Denton to talk about the role of hospitals in this space.

00;01;20;23 - 00;01;29;22
Mark Howell
Tony works for UM Health at the University of Michigan, where he serves as senior Vice President and Chief Environmental, Social and Governance officer. Tony, thanks for taking a few minutes of our time.

00;01;29;24 - 00;01;30;13
Tony Denton
My pleasure.

00;01;30;19 - 00;01;51;29
Mark Howell
We all know hospitals and health systems have a wide array of challenges they're navigating right now, so adding environmental sustainability to the list can seem daunting. That said, much of the work hospitals can do around environmental sustainability can be beneficial to the organization and used to supplement already ongoing initiatives like engaging the workforce, taking active steps to close the health equity gap, and even generating financial savings.

00;01;52;05 - 00;02;08;13
Mark Howell
Yet even more at its core, this work seems to link directly to the mission statements that guide our hospital and health systems. Can you explain how UM's environmental sustainability work is founded in your organization's mission and provide some insight into how the work directly supports UM's other ongoing priorities?

00;02;08;20 - 00;02;32;06
Tony Denton
Sure. Our journey really started in the mid-nineties when we removed our incinerator with great concern about air quality and air pollution. And from there we became very committed to what we called environmental stewardship. In looking at different ways that we could uphold our principles as an organization to recycle, to reuse and reduce waste in the environment with an emphasis on landfill.

00;02;32;08 - 00;03;05;07
Tony Denton
So for many years, we participated in efforts to recycle anything that we could recycle to make sure that it didn't wind up in the landfill. We participated with what was then health care without harm. Now practice green health to gain more knowledge, to share lessons and best practices, to reinforce our commitment to the environment. Since then, I would say over the last few years, the university has taken quite a hold on trying to reduce the carbon footprint and to address issues related to climate change.

00;03;05;15 - 00;03;32;27
Tony Denton
And with that, UVM Health and Michigan Medicine shares that commitment. So we've gone to what I call carbon neutrality, environmental sustainability 2.0 to line up with our mission, vision and values, which for us is first, do no harm, which is our credo that we track every day in taking care of patients. We've been very intentional with our communications about the contribution that health care provides towards climate change and extreme weather events given that health care is such a high intensity, a user of energy.

00;03;33;05 - 00;03;53;21
Tony Denton
So we've embraced what we call advancing health to serve Michigan and the world. To understand that we have to find a better balance with regards to how we manage the environment to save the planet. In addition to saving lives through the expertise of our physicians, clinicians and other health care staff.

00;03;53;23 - 00;04;14;11
Mark Howell
Thanks, Tony. That's really fascinating and impressive. And, you know, as the AHA has really gotten involved in this work, we've been trying to work with members that are really far down their journey, right? To learn from them, to get that expertise, that experience to help our hospitals and health systems that are just starting on this journey, right? Trying to figure out what the next step or what the first step for them is.

00;04;14;14 - 00;04;30;26
Mark Howell
Can you briefly tell us a little bit about how you amrs approaching this work? What are some of the practical things you're doing now? Obviously, an SVP that's focused on this work shows that the leadership structure is engaged, the board is engaged and they're interested. Can you tell us a little bit about some of the other work you're doing in this space?

00;04;30;26 - 00;04;39;14
Mark Howell
And then do you have any recommendations or tips for organizations that are just getting started? How do you elevate this work? How do you really get going and get the organization behind you?

00;04;39;15 - 00;05;06;07
Tony Denton
I think the framework starts with a consciousness as being good corporate citizens that we all have a responsibility to do whatever we can to to save the planet and we look at it as being a part of our work, not additional work. And by that I mean organizations are comprised of its people and behaviors related to practices that help to save the planet and to be environmentally responsible are habits that people can practice at home.

00;05;06;14 - 00;05;38;09
Tony Denton
So we want people to practice safe environmental practices at home and community as well as at work. Our responsibility as an anchor institution, meaning a major provider and major employer, is to provide examples to lead the way by demonstrating what can be done, small ideas or large. I talked about recycling. We recycle materials of all kinds. In the last year, 2022, it was 1.5 million tons of different materials, from batteries to cardboard to two pallets, paper, you name it.

00;05;38;15 - 00;06;03;11
Tony Denton
We also are looking at energy efficiencies, large investments in terms of our building construction. We're committed to lead certification, we're building a new hospital. The goal is to go to platinum. And with that it does require more resources. But we think the return on investment is significant because we'll be 20% more efficient than state standards with regards to building efficiencies, which helps to reduce the carbon footprint.

00;06;03;13 - 00;06;29;15
Tony Denton
So I think that there are other easy examples like changing lights to LED lights from incandescent. The payback is within about two years or so to reduce the cost, which helps the operating margin, which are dollars that one can reinvest in the mission of the hospital. I think that we're finding through just creative brainstorming that there are a number of ideas that can happen with very little cost.

00;06;29;17 - 00;06;37;13
Tony Denton
So, there's no good reason why you wouldn't do something that would be better for the environment. To help you with your economics and to be a good corporate citizen.

00;06;37;20 - 00;07;00;16
Mark Howell
Tony, you mentioned ROI. And we get that question a lot as we're trying to to talk to our members about why you should do this. And the financial savings can be significant. I'm wondering, though, in the process of discussing our ally with your leadership, with the board, what other returns on investment are there? So is your workforce overly excited and engaged in this work?

00;07;00;16 - 00;07;08;23
Mark Howell
How is the community responding? Are you seeing those those things that you can't quantify financially but are demonstrating a real impact locally for you?

00;07;08;29 - 00;07;29;06
Tony Denton
I think so. When we do things that benefit the community, our organization's culture is one of engagement. And people do get excited because they see a way that they can make a difference. So there's, I think, a high sense of passion for working in an organization where they're trying to make a difference and we want people to be part of a team.

00;07;29;12 - 00;07;55;21
Tony Denton
That means we participate at all levels and we're active and creating ideas, and we hold leadership accountable for listening to those ideas and to discussing them to help make them happen, especially if there are very few barriers to do so. I think that in the world of workforce shortages, the culture of an organization is so important and people are choosing where to work based on the values that an employer has.

00;07;55;27 - 00;08;17;19
Tony Denton
And so that creates another value added aspect to what I call being on the right side of right when it comes to trying to save the planet, because we're trying to do that. Obviously, to have something available for future generations for all of us. So I think that there's excitement in that regard. I can't say that people are overly excited, which I think is what you said.

00;08;17;25 - 00;08;41;18
Tony Denton
I think that, you know, there's always change and we have to explain why change is important as leaders. But at the same time, I would say that we are in receipt of a lot of advocacy from employees asking, what are we doing? And so I think that there's a marriage in thought, in mind and spirit about trying to once again make a difference because we have that responsibility to community.

00;08;41;21 - 00;08;57;17
Mark Howell
Tony, I want to thank you so much for spending some time with us and giving us some insight into what you UM is doing here. I know that as we move forward, the American Hospital Association is going to continue to be engaged in this work. And we look forward to to looking to your leadership and your organization's leadership to take examples and really act on them.

00;08;57;17 - 00;09;03;20
Mark Howell
So I want to thank you, and I'd like to thank the listeners for taking the time to engage in this discussion with us. See you again next time.

00;00;01;03 - 00;00;40;16
Tom Haederle
Sometimes you hear a fact so startling that you ask yourself, can that really be true? Here is such a fact. And yes, it's true. A health care worker has a higher chance of being exposed to violence than a prison guard or a police officer. Stunning, but accurate. And the question is, what can be done about it? Welcome to Advancing Health, a podcast from the American Hospital Association.

00;00;40;19 - 00;01;08;06
Tom Haederle
I'm Tom Haederle with AHA Communications. A survey of 1000 caregivers in April of 2022 found that 92% had directly experienced or witnessed workplace violence. The problem has been growing exponentially for years and prompted the AHA to create #HAVhope Day, a National Day of Awareness to highlight how America's hospitals and health systems combat violence in their workplaces and communities.

00;01;08;09 - 00;01;26;09
Tom Haederle
In today's podcast, Laura Castellanos, associate director of Hospitals Against Violence with AHA explores some of the ways health care leaders are tackling the problem of workplace aggression. Her guest is Dr. Ronald Paulus, president and CEO of Mirabel Health. Let's join them.

00;01;26;11 - 00;01;58;01
Laura Castellanos
Since the pandemic, the prevalence of workplace violence in health care has grown. Begging the question what can we do to mitigate it? I am Laura Castellanos associate director of Hospitals Against Violence for the AHA. It is very timely that I'm joined by Dr. Ronald Paulus, Ron is a strategic advisor for Commure StrongLine and former president and CEO of Mission Health, as well as former chief administrative officer and CIO for Geisinger Health System.

00;01;58;03 - 00;02;21;27
Laura Castellanos
Today, we will discuss the unfortunate growth of workplace violence in health care, including its financial, organizational and clinical consequences. Mitigating violence and investing in workplace safety initiatives and have an exponential impact on caregivers, patients and health care organizations. Ron, I'm glad to be back with you.

00;02;21;29 - 00;02;23;29
Ronald Paulus
My pleasure. Thanks for having me.

00;02;24;02 - 00;02;35;05
Laura Castellanos
So let's get started with today's discussion about learning about your health care background, your organization, and how you support AHA member hospitals and health systems.

00;02;35;07 - 00;03;10;00
Ronald Paulus
Well, again, it's a pleasure to be here. And you gave a good chunk of my background. Thanks for doing that. Today I'm here because I have a relentless passion to help keep health care team members safe, and I continue that work as an advisor to Commure Strongline. Strongline is a solution that enables each individual staff member to have a personal panic button that connects through low energy Bluetooth to a Wi-Fi network and can send alerts to PROXIMO, colleagues, security subscribers and so forth.

00;03;10;01 - 00;03;12;07
Ronald Paulus
So that's what the solution does.

00;03;12;10 - 00;03;27;20
Laura Castellanos
But definitely passionate about this topic. For years I've talked about it. And you know to set the stage for today's topic, let's talk about how workplace violence is impacting hospitals and health systems. Give me your take on that.

00;03;27;23 - 00;03;58;05
Ronald Paulus
Yeah. So I wish I had a better take. You know, last year was a year that spotlighted the insidious undercurrent and dire consequences of workplace violence in health care. And it honestly, it pains me to share that the numbers are truly staggering. A thousand caregivers were surveyed about their experience with workplace violence during April in 2022, and 92% of those surveyed caregivers shared that they had either directly experienced or witnessed workplace violence.

00;03;58;07 - 00;04;22;29
Ronald Paulus
Laura That's stunning. And the sad reality is that health care workers are nearly five times more likely to be the victim of workplace violence than those working in other industries. Tragedy in Atlanta is just one of a myriad of examples. Think about this, Laura. A health care worker has a higher chance of being exposed to violence than a prison guard or a police officer.

00;04;23;02 - 00;04;51;13
Ronald Paulus
And I know a lot of people don't think this is a really big issue, or maybe they think it only happens within behavioral health units or emergency departments. But real world data from Strongline customers tell us from tens of thousands of caregivers that more than 60% of all incidents happen outside of those areas. And those include hallways, cafeterias, ambulatory centers, billing offices and more ... essentially everywhere and anywhere.

00;04;51;15 - 00;05;14;14
Ronald Paulus
So not surprising given that reality, the health and well-being of our workforce, the exact people who we depend upon to take care of us when we're at our most vulnerable point of being ill is declining. And the surgeon general recently issued an advisory on health care workforce burnout citing unsafe conditions is one factor. That's the reality of where we are.

00;05;14;17 - 00;05;36;24
Laura Castellanos
It is a dire reality. And thank you for for setting that stage. So let's start breaking it down. And I think an important topic to cover is the cost, right? The cost of this violence on our hospitals and health system. Our caregivers, our patients pretty much overall the health system. So what can you share with us about the cost of this violence?

00;05;36;26 - 00;05;57;13
Ronald Paulus
I'm so glad you asked that question, Laura, because it's exactly the right one to ask. So often we focus on what is the cost of our investments to mitigate workplace violence. And we know it's our first priority in a professional and ethical obligation as leaders to keep our patients and team members safe. And without a doubt, that is singularly important.

00;05;57;15 - 00;06;20;29
Ronald Paulus
But the reality is that the hidden but very real costs of workplace violence are hiding in plain sight. And my experience is that most hospitals have no idea what their true costs of workplace violence are. And that's because they don't have the data to track incidents or severity. They're often unaware of the downstream costs. They just don't realize how pervasive the issue is.

00;06;21;01 - 00;06;49;16
Ronald Paulus
I say that without judgment because the person I'm describing was me. I was clueless about this issue when I first became the CEO of Mission Health in North Carolina, although I'd experience workplace violence personally as a clinician. It just wasn't top of mind. And that was until my world changed. When I was the CEO at Mission, I would routinely do focus groups with nurses and other caregivers, and at the end of the session I would always ask, Hey, what else is on your mind that we haven't spoken about?

00;06;49;19 - 00;07;09;04
Ronald Paulus
And then back to back focus groups, a nurse said, We don't feel safe at work. And I was shocked. And frankly, I was ashamed. And I used those feelings to push me to develop a deep understanding of this issue, to make all the evidence based interventions that I could. And that's what ultimately led me to where I am today.

00;07;09;06 - 00;07;32;21
Ronald Paulus
But getting to the core of your question. Workplace violence costs are multifactorial, starting with staff. A recent McKinsey survey found that a safe work environment was literally the number one most cited factor influencing nurses decisions about whether to stay or leave their job. And that same study found that one out of every three nurses actually intends to leave their role within the next three years.

00;07;32;24 - 00;07;58;05
Ronald Paulus
That alone tells us that the safeness of our work environment is paramount. Nationally, average workplace turnover is about 20%, with vacancy rates stuck in the 15% range. Another recent study by Epic Research found that there's been a 56% increase in shifts filled by nurses with less than one year of experience. These are nurses who are new to our industry and new to their jobs and who need extra support.

00;07;58;08 - 00;08;23;20
Ronald Paulus
So given all the investments that we make in recruiting and hiring and training and supporting, we need to have confidence that these team members will ultimately choose to stay in that role. And if they don't, the cost to replace just one nurse averages more than $50,000. Traveler nurses cost an extra $150,000 on average per year. And something else that people don't really appreciate:

00;08;23;22 - 00;08;53;13
Ronald Paulus
Days lost from work due to workplace violence are huge. Up to 13% of all non vacation days relate directly to workplace violence. And it doesn't stop there. Typical workplace violence OSHA fines exceed $100,000. And jury awards - when an organization is found guilty of not taking appropriate steps to keep team members safe average more than $3 million. So when people are thinking about making an investment to create a safer workplace.

00;08;53;15 - 00;09;07;24
Ronald Paulus
Framing it as simply, you know, yet another new expense when my budget is already tied is both inaccurate and counterproductive. The reality is it's a strategic investment with a highly positive ROI.

00;09;07;27 - 00;09;32;27
Laura Castellanos
Well, you definitely shared some staggering statistics, and thank you for sharing your story, your perspective, and obviously what drives this passion. You know, you even expand it to talk about the impact it has on the workforce. So let's talk about what are some ways that hospitals and health systems are currently investing in their workforce safety initiatives, keeping their workforce safe?

00;09;32;29 - 00;09;36;14
Laura Castellanos
And what evidence supports these strategies?

00;09;36;16 - 00;10;01;17
Ronald Paulus
Yeah, I've spent more than a decade trying to understand the answer to that question, and I hope I've contributed to some of what's out there. As you know, the AHA, you all have several tools available to support hospitals, including your toolkit for mitigating workplace violence and your guide for developing a workplace violence program. And so I want to applaud that work and encourage everyone to review those materials.

00;10;01;19 - 00;10;28;02
Ronald Paulus
And in January of this last year, The Joint Commission announced new standards across three domains that should help guide interventions. One, The Joint Commission says around environment of care that you have to initially assess your physical environment, looking for difficult areas to visualize staff and unlock entries and that kind of thing. Importantly, use data to guide where the highest risks are and where exposures occur and to whom.

00;10;28;05 - 00;11;00;05
Ronald Paulus
Now, this is exactly what we did in patient safety. So every health system needs to track incidents and rates of workplace violence occurrence. IHHSS has put forward a detailed framework for doing this. But just as a practical example, at mission, we use a workplace violence scale that began with unwanted verbal contact, progressed to verbal abuse and to unwanted physical touching on to physical assault, then to physical assault with injury, and finally to physical assault with injury and time lost from work.

00;11;00;08 - 00;11;25;25
Ronald Paulus
But whatever scale you choose, you need to strongly and repetitively encourage and reward reporting, because despite the statistics that I shared, 70% of all incidents go unreported. From a human resource perspective, The Joint Commission says that you should regularly survey your staff about their perceptions of safety, both as a baseline measure and across time and violence prevention, training and de-escalation is essential.

00;11;25;27 - 00;11;47;25
Ronald Paulus
At the time of hire and annually at least thereafter, per The Joint Commission standards. And let me be clear about something this training isn't like watch a PowerPoint and check the box kind of exercise. It needs to include de-escalation roleplaying and trauma informed care education, at least for the most vulnerable workers. So that's where the data map and should guide your interventions.

00;11;47;28 - 00;12;13;16
Ronald Paulus
And because staff need to practice and experience what de-escalation feels like to be comfortable doing it when it counts, they have to do that role play. Another intervention is behavioral emergency response teams. These are dedicated professionals that parallel our rapid response teams for medical escalations. We created one of the first in the nation at Michigan when I was there, and we did an AJ webinar on that very topic.

00;12;13;18 - 00;12;51;09
Ronald Paulus
These are now a best practice for behavioral escalations. From a leadership perspective, you need to develop an interdisciplinary committee specifically focused on workplace violence. That should include a broad swath of stakeholders from your clinical security admin, ambulatory, offsite operations, and this leadership focus and accountability is the secret sauce. It's exactly what it took for the patient safety movement to finally pick up steam and with the right leadership, we bring together the tools, techniques, technologies that will reduce this epidemic to a more manageable level.

00;12;51;11 - 00;13;20;02
Laura Castellanos
Let me do a quick follow up on your last comment about the patient safety movement. And I know you and I have talked about how workplace and workforce safety should truly be part of this larger framework of quality and safety because we've learned so much. Can you just share your insights as to how we can begin to leverage systems to learn from other systems to create safety?

00;13;20;04 - 00;13;47;14
Ronald Paulus
Yeah, you know, just harkening back to that patient safety moment, we can't repeat how long it took us to get our act together. It was more than a decade from the publication of "To Err is Human," which you'll recall flagged that as a health care profession, we killed at least 100,000 people per year. But it took a long time and it wasn't a total value-based purchasing took a foothold that things really began to accelerate.

00;13;47;16 - 00;14;11;29
Ronald Paulus
And the good news here, relative to the intersection between safety for patients and for staff is that they're correlated. So I feel like with so many of these statistics that I've been giving, I might be depressing everyone. So let me give you some good information. What we know is when the workplace is safe for team members, both patients and staff do better.

00;14;12;02 - 00;14;40;28
Ronald Paulus
Data from Press Ganey show that when staff do feel safe, patient outcomes improve and they're more engaged. So specifically, feeling safe is correlated with a 22% higher CMS hospital quality star rating, a 52% lower rate of nurse perceived mis-care. That's a key marker for patient safety and a 27% higher job enjoyment. So these are tied together and it starts with collecting the data.

00;14;41;01 - 00;14;49;00
Ronald Paulus
It starts with encouraging reporting, just like I did with patient safety. And we can make a difference if we focus on those things.

00;14;49;02 - 00;15;13;22
Laura Castellanos
Well, thank you so much for sharing. So let's give a message to how hospital leaders and executives -  as you mentioned, it's the secret sauce, right? So how can they collaborate to mitigate this violence and most importantly, support their workforce? We know that through the pandemic and through everything that has been escalating our workforce needs more support.

00;15;13;27 - 00;15;14;07
Ronald Paulus
Yes.

00;15;14;09 - 00;15;17;26
Laura Castellanos
What message do you have for leaders and executives?

00;15;17;28 - 00;15;46;25
Ronald Paulus
Yeah, I'm going to repeat that. I think that leadership focus and accountability around this topic is the secret sauce. This is not something that can't be managed and controlled and mitigated. You know, we used to think that surgical wound infections and retained sponges and all this stuff was just part of the process. It doesn't have to be. Leadership needs to bring together the tools, techniques and technologies to reduce and seek to eliminate this totally unacceptable epidemic.

00;15;46;28 - 00;16;12;10
Ronald Paulus
That's a repeat of what I was saying. In this fight to stop workplace violence, every one of us has a role to play. And measurable progress can be achieved if we get collaborative buy in from across the organization. Leaders have to set the tone around its importance, the need for reporting, the investments that are made in and tools and technologies to keep people safe.

00;16;12;17 - 00;16;38;01
Ronald Paulus
And they need to view and articulate those as what they are. Investments with a return on investment that manifest in both better patient outcomes and staff outcomes in addition to a measurable financial return. So as leaders, keeping our patients and team members safe must be our number one priority. And I know that we can collectively make a difference and turn this tide as an industry together.

00;16;38;01 - 00;16;57;06
Ronald Paulus
We've done it before. We did it with patient safety, no matter how long it took. We did it with COVID. And I'm 100% confident that we can do this again. So this is the time to stand up, acknowledge the problem, and apply what we know how to do to make an impact for our team members and our patients.

00;16;57;08 - 00;17;01;00
Ronald Paulus
It's not just the right thing to do. It's the right investment to make.

00;17;01;02 - 00;17;23;28
Laura Castellanos
Well, I applaud your efforts and your passion for this work. And please do know you're making an impact. I appreciate you sharing your insights. Definitely learned a lot. And what a packed podcast. There's so much information and what you share, and I'm sure we'll be able to share more with our listeners. So Ron, thank you so much for joining the podcast and sharing your takeaways with other AHA listeners.

00;17;24;03 - 00;17;34;06
Laura Castellanos
So for our listeners, if you'd like to learn more, please visit AHA.org/HAV. Thanks for listening.

00;00;00;29 - 00;00;49;18
Tom Haederle
America's health care workers are the backbone of hospitals and health systems and our most precious resource. Without a strong and resilient workforce, our system of patient care collapses. It's as simple as that. Welcome to Advancing Health, a podcast brought to you by the American Hospital Association. I'm Tom Haederle with AHA Communications. The numbers aren't pretty. More than 100,000 nurses left the profession in 2021, and the nation faces a projected shortage of up to 124,000 physicians by 2034.

00;00;50;05 - 00;01;15;08
Tom Haederle
Bold and innovative approaches are needed to support current staff, attract the workers to meet the health care demands of today, and design the care delivery models of tomorrow. Join us to hear valuable insights on the practical recommendations outlined in the AHA's 2023 Health Care Workforce Scan, designed to help organizations think and act innovatively to support, retain and recruit staff.

00;01;16;14 - 00;01;35;21
Elisa Arespacochaga
Hello, I'm Elisa Arespacochaga, vice president of Clinical Affairs and workforce for the American Hospital Association. With me today are Ron Werft, president and CEO with Cottage Health and chair of AHA’s board level Task Force on Workforce. And Felicia Sadler, vice president of Quality with Relias. Welcome to both of you. And thank you so much for joining me.

00;01;36;08 - 00;01;37;16
Ron Werft
Thank you. Happy to be here.

00;01;37;23 - 00;01;38;08
Felicia Sadler
Yes.

00;01;38;17 - 00;02;02;09
Elisa Arespacochaga
All right. We're here to talk about the health care workforce scan, which really focuses on three critical workforce challenges we are seeing confronting our members. And I know you're experiencing in the field and really how we can think about some of the strategies to address these challenges. Now, I know you are both working very deeply on these, both through the aging task force and in your own organizations.

00;02;02;19 - 00;02;24;05
Elisa Arespacochaga
But let me just quickly recap the three areas that we're focused on. The first is reconnecting clinicians to purpose. We know very much the value that that brings and the fact that in most cases, those who are in health care are there because they really believe in the work. The second is to think about how we can provide support, training and the technology that we all need

00;02;24;05 - 00;02;47;18
Elisa Arespacochaga
to thrive in the different care delivery environments and some of the changes and challenges we've all been seeing. And the last is really how to recruit innovatively and really invest in retention and building that pipeline for the future. So let me start out with you, Ron, to tell me a little bit about what you're seeing and how you're seeing these challenges really affect the field.

00;02;47;19 - 00;02;50;15
Elisa Arespacochaga
As you know, you're on the front lines of providing care.

00;02;50;29 - 00;03;17;21
Ron Werft
Thanks, Elisa. You know, we're talking about reconnecting to purpose here. And I would just make the observation that our staff, our health care clinicians and support staff, they are still connected to purpose. It's just become very, very hard. You know, our staff has been through ... more has been asked of them by society and by our organizations than really should be expected for anyone.

00;03;17;21 - 00;03;49;24
Ron Werft
We all know the story. They've gone from PPE to isolation units to visitor restrictions. And I think all of that has had the effect of a loss of human connection. And so as we think about how to reconnect, it's not so much finding their passion because they all share this core value of compassion and all they want to do is to have the resources and the environment in which to provide the very best possible care that they can.

00;03;50;16 - 00;04;14;06
Ron Werft
So we need to support that and find ways to support and strengthen that connection back to purpose. So what you know, what we're seeing around the country and in our own organization are a number of approaches that I think the first and foremost, it will vary by generation and by institution. And so the most important thing is to ask our staff what is important to them.

00;04;14;24 - 00;04;45;27
Ron Werft
And for us, we hear that recognition and celebration and hearing the stories is very, very important. And so we ask how how can we best do that? And we follow their lead on that. Secondly, there's the sense of finding ways to do meaningful work. And as the National Academy of Medicine says, get rid of stupid stuff. So how do you how how can we maximize their time doing what they do best and what they love the most?

00;04;46;13 - 00;05;08;17
Ron Werft
And then lastly, really addressing issues of burnout, providing mental health support beyond EAP for our staff and making sure we provide a safe environment with the rise that we've seen in workplace violence. So those are just some of the things that I know our organizations are all focused on and working on. And again, it's really about culture and listening to our people.

00;05;09;02 - 00;05;27;28
Elisa Arespacochaga
Couldn't agree more. I think you're right. They certainly were the ones who ran into the fire from the beginning of the pandemic and continue to do so in ways that we can support them in being able to do that work. Felicia, I know you trained as a nurse and this is something you feel passionate about. How are you seeing this affect the field?

00;05;28;24 - 00;05;53;09
Felicia Sadler
Absolutely. And thank you, Elisa. This is it's really interesting because we're in unprecedented times coming through. We're coming out of the pandemic and we're seeing some of the fallout and the consequences of that during the pandemic and during times of crisis. It was really, you know, as Ron alluded to, you know, there is connecting that passion. It's really reconnecting.

00;05;53;09 - 00;06;14;04
Felicia Sadler
Absolutely, that passion to purpose. Sometimes that gets lost in amidst the crisis and amidst the fires that, you know, that that folks were dealing with, if you will. So rediscovering and helping them to rediscover and getting back to that one on one, the reason they chose the profession. I know I was committed very early on at a very early age.

00;06;14;04 - 00;06;32;00
Felicia Sadler
I wanted to help people and that I didn't know really how to do that. I just knew I wanted to go into health care, to be able to accomplish that. And it was through the training and education that I was able to see that that path very clearly. So I think it's just reconnecting them back to the foundational principles that we all started from.

00;06;32;13 - 00;06;54;07
Felicia Sadler
And then also reconnecting them to their their the patient experience. You know, we have technology. We have other components that come into play. But certainly making sure that there is that, you know, as Ron alluded to, the human connection, which we know can impact patient safety and quality. Recognition as a huge driver, but also providing the meaningful recognition.

00;06;54;07 - 00;07;16;21
Felicia Sadler
I know I as as a frontline nurse, always appreciated when they were specific in that recognition and acknowledgment and expression of that gratitude. And that the difference I made that day on that shift with that patient in that same place, I think as specific as we can get with the recognition certainly helps not only for individuals but for teens, and it can be very empowering.

00;07;17;04 - 00;07;44;28
Ron Werft
Now, I had a an opportunity just last night to participate in the awarding of a Daisy Award to one of our emergency department nurses at one of our hospitals. And what is clear in these honoring ceremonies is there's a there's a important story, an inspiring story that's told. There is somebody who is honored for really for their their passion and sometimes often going above and beyond.

00;07;45;09 - 00;08;08;03
Ron Werft
But what was clear is that when we honor, in this case a nurse, when we honor a nurse, we honor all nurses. And I think there was as much joy and all of the other staff members who were there for that event as there was for the recipient. And so those are really important events to to formalize and and do on a frequent basis.

00;08;08;23 - 00;08;34;03
Elisa Arespacochaga
And I think they really support that connection not only to the leadership, but then between and among coworkers. So I think that's a really good point, and let me use that as a good way to transition into my next question, which is really about some of the things that both the pandemic and we have put in the way of some of those human connections.  As an industry, not had a great relationship with technology.

00;08;34;20 - 00;09;02;09
Elisa Arespacochaga
There are studies that show we actually lost productivity when we brought in various technologies along the years. So understanding how to best use technology, not only just for technology's sake, but to help support our teams in the midst of the changes that are happening, the needs to move to different solutions to take care of our patients because we don't have the same numbers and complements of caregivers.

00;09;02;25 - 00;09;14;09
Elisa Arespacochaga
How are you seeing and Ron, again, I'll start with you seeing technology and other resources in your organization helping to support your care teams in doing what they need to do.

00;09;14;29 - 00;09;44;29
Ron Werft
Yeah, I would say we're really at the very beginning stages of using technology in the context of supporting our workforce. You know, there's been incredible technology in medicine and in our health care organizations. But the focus, the objective has been very different from supporting our staff. Obviously, the focus has been on medical advances. It's been on timely access to health information and data, interoperability.

00;09;45;13 - 00;10;16;06
Ron Werf
And then, you know, EHRs hours and ERPs. When you think about the purpose of all of the above, incredible medical advances in device technology, minimally invasive access safety has been a focus. You know, pop ups that prevent and help us avoid the medical errors. I would say that none of these are focused on helping people maximize what they would define as meaningful work.

00;10;16;21 - 00;10;43;21
Ron Werft
Dr. Tait Shanafelt at Stanford. This is really important work that he does on burnout and he has found that if you can just increase the percent of time that someone spends on what they would define as meaningful work from 20 to 30%, you make a dramatic reduction in burnout for that individual. So I think we just need to partner with technology with a different objective in mind.

00;10;43;21 - 00;11;04;21
Ron Werft
Now we need to part with technology to find ways to not move people away from the bedside or away from the patient. The health information is very, very important, but we have to have as a focus and work with our tech partners on ways to get back to the first conversation about meaningful work and connecting to purpose.

00;11;04;21 - 00;11;47;28
Ron Werft
And I don't think we've really scratched the surface on that yet. I'll just say that the pandemic has really been very important. It has been the acceleration of virtual care and the use of and the acceptance of virtual care. So when we think about our workforce who may have left the bedside, many of them, to the extent that we can partner with technology, which is moving rapidly in response to a consumer movement, to make sure that our staff have more flexibility and the opportunity, if not working at the bedside, to continue to fulfill their passion in doing patient care virtually or in other ways.

00;11;47;28 - 00;11;50;05
Ron Werft
So I think we have a real opportunity there.

00;11;50;13 - 00;12;15;10
Elisa Arespacochaga
Yeah, I think there's been a very big shift in where we all feel comfortable with technology and even, you know, comfort with video calls and all of these other things that felt like they should be on The Jetsons and nowhere else. But I think there's a lot of opportunity, but there's also a lot of need to focus. As you mentioned, on focus on what we're trying to do with this technology most effectively.

00;12;15;19 - 00;12;24;29
Elisa Arespacochaga
So, Felicia, let me ask you, what are you seeing in terms of the best uses and best ways to bring that technology into your organization and into your work?

00;12;25;16 - 00;13;03;21
Felicia Sadler
That is a great question, and I totally agree. We've brought you know, the pandemic has brought about the embracing and expansion of technology like never before in health care and in new ways, innovative ways of utilizing technology to improve access to care, improve care, quality, streamline processes, make it more efficient. And that's really where I see that organizations have have included this as part of their strategic growth and priority is looking at how can we standardize, how can we streamline workflows to make it easier to do business and easier to work all the way to the front lines for our our staff.

00;13;04;10 - 00;13;42;27
Felicia Sadler
We've seen benefits that were realized very early on with the expand quick expansion and the use of technology when we went to virtual ICU use or virtual preceptors. One key realization and one thing that I witnessed personally was really helping assisting organizations in transitioning across specialties in times of crisis. And we're still still seeing some of that where there's an opportunity, especially to address workforce shortages around cross-training, upskilling, ensuring that they have everything they need to be able to be competent and safe, and they're using technology to do that.

00;13;43;18 - 00;14;06;22
Felicia Sadler
And it's become is being hardwired in the organization to really meet the staffing demands. So I think that there's opportunities to continue to expand that. And as we think about these increased competencies around virtual, you know, telehealth, telemedicine, if you will, a hospital at home and so forth, increasing the ability to measure those competencies, ensuring they have the education and training that they need via technology.

00;14;07;03 - 00;14;37;29
Elisa Arespacochaga
Absolutely. We need to be able to deliver some of that education, as you know, in the moment. And I think technology has helped us to be able to do that effectively. So let me pivot just a little bit to some of the work that has been done. And I know it's been every organization has had to get creative in understanding how they best could support their teams from some of the things we discussed around well-being, supporting their mental health, addressing some of the increases in violence.

00;14;38;14 - 00;15;01;17
Elisa Arespacochaga
But we've also had to think differently about how we both recruit and retain both the next generation but also the current generation of those who current generations who are in our workforce. Understanding what are the benefits structures that make sense? What are the things that people actually would like back from their organization? What does that relationship look like?

00;15;01;17 - 00;15;26;29
Elisa Arespacochaga
And I know, Ron, you touched on a couple and Felicia, that focus on additional training, additional education, what else can you know, my organization helped me be able to do? I think there are a lot of opportunities now, and given some of the challenges that we've had with the workforce shortages, I think we all need to think about how can we bring people in and make sure that we are building that robust pipeline.

00;15;27;01 - 00;15;47;20
Elisa Arespacochaga
So Felicia, let me start with you. In terms of those opportunities to educate, to train. How are you seeing not only keeping the workforce we have, bringing in new folks, but then helping those who are maybe in high school or grade schools think about a career in health care that isn't just a doctor or a nurse.

00;15;48;13 - 00;16;12;28
Felicia Sadler
I love that question because that's actually a trend that we're seeing organizations go across the country and it really is in line with with really reaching out in their communities, diving deep into the the community where you're actually exposing them to health care in general at the high school level. I know in my own experience I had a vocational industrial, you know, Club of America.

00;16;12;28 - 00;16;33;07
Felicia Sadler
I was part of a health occupations education program within our high school. It was through that program I was first exposed to health care and what the opportunities were that that afforded. In addition, I had a recruiter come from a nursing school to visit us as part of that program where you have different folks from the community come forward.

00;16;33;21 - 00;17;04;01
Felicia Sadler
And I really it really engaged me. And there was a tremendous interest in how can I be part of this community. This is this seems like a great way that I can help people. And that's really what pulled me into the pipeline early on. And I think we do have that opportunity to really revisit. In addition, I think health systems are for forming academic partnerships with local communities alike across the world of academia to really help build a community or a workforce community.

00;17;04;01 - 00;17;12;04
Felicia Sadler
If you will. And because health care is one of the largest contributors to the economy locally as well as nationally. So I think there are opportunities there as well.

00;17;12;24 - 00;17;19;03
Elisa Arespacochaga
Ron, your thoughts on how we grow both keep the folks we have and then really make sure we have the folks we need in the future.

00;17;19;26 - 00;17;54;03
Ron Werft
Yeah, I think that's really the kind of the near, now, and far of our challenge here is focusing right now on making sure that we retain our staff and give them the support that they need to continue to thrive in this health care environment. And as Felicia said, that we think really strategically about the the academic pipeline and start early and make sure that we're messaging to youth really the benefits of committing your your your professional lives to a health care career.

00;17;54;12 - 00;18;14;14
Ron Werft
And there are many just, you know, locally. And what I've heard from other task force members and elsewhere around the country: clearly start with compensation and benefits. It's a tough market. We know that labor costs are increasing at a very challenging financial time for hospitals and health systems and yet we have to get that part right.

00;18;14;14 - 00;18;37;02
Ron Werft
It's sort of the bottom rung on an Maslow's need. And so we just have to get that part right and we have to think a little bit differently about that because as you said, Elisa, we have four or five different generational cohorts within our organizations and where one population is going to feel that child care access is critically important.

00;18;37;21 - 00;19;03;17
Ron Werft
Let's say the baby boomer generation who are still actively contributing, they need more flexibility, maybe need to go part time, maybe need to move to a virtual option. So we need to be much more flexible in terms of our benefit and support structures. I think that one of the advantages that we have in health care is that there are tremendous growth opportunities within health care.

00;19;03;17 - 00;19;29;01
Ron Werft
And so I know that right now we're mapping career paths that start with community health workers and go all the way to RN. We're mapping 20 different career paths this year. And we're starting with our local health health academy at one of the local high schools here, which is becoming, as Felicia said, much more common practice around the country. As we look at the different generations, again, we need to understand the different needs that they have.

00;19;29;08 - 00;19;55;16
Ron Werft
I know that for some in our organizations, just the focus on diversity and equity and inclusion as is very, very important to some. So the advent of employee resource groups that can help people thrive and feel included as part of the health care team is very, very important.

00;19;55;16 - 00;20;19;17
Ron Werft
For us, shared governance is a critical foundation for our work here, and we have systems to make sure that every voice has an opportunity to contribute. And frankly, the ideas that come from our frontline staff are far better when it comes to workflow and workforce, I'll say, than the ones made in my office, certainly. And so, so important to listen to that.

00;20;20;17 - 00;20;50;06
Ron Werft
Lastly on that, I'll just say that workplace violence has escalated dramatically for a number of reasons. And so our staff have dealt with push back on mask mandates and visitor restrictions and all that they've had to deal with. And we've seen a significant increase in workplace violence. So providing a safe, secure facility ... that's on the agenda of many of our networking meetings, our state association meetings, our national meetings.

00;20;50;16 - 00;21;17;22
Ron Werft
And there are some important solutions there that can be as simple as safe escorts to parking lots and better lighting. So, again, it really important to hear: what do your staff say is important for them to feel that they're in a safe environment? And our ability to respond quickly to that and make those changes sends a very powerful message that they are supported and safe in our environment.

00;21;18;15 - 00;21;40;23
Ron Werft
So that's a long answer, Elisa, to your question about how we retain people, and I think we just have to do all of those things and we shall cover the the academic pipeline very, very, very well. I know for us, these are going to be local and regional solutions by and large, and there's tremendous variability across the country and supply and demand coming out of our professional schools.

00;21;41;12 - 00;22;02;23
Ron Werft
And so just our local experience has been that we are partnering with ten local colleges and ten local health systems. And just through that work, we found out that there was a 3 to 1 ratio on the number of new grads we all hire each year. These are nursing grads, and the number that are graduating from these local schools.

00;22;02;23 - 00;22;32;00
Ron Werft
And so it just elevates the argument for and the opportunities for local partnerships that expand classroom space and perhaps have partnerships with our staff and their faculty and importantly, increase clinical rotations so we can increase that enrollment. Lot of people still interested in health care. 92,000 qualified applicants to nursing school last year didn't get in, not because they weren't interested or weren't qualified.

00;22;32;00 - 00;22;42;27
Ron Werft
We didn't have space for them. So high level of interest. That's the good news. We got to figure out how to get them in these schools and and taking care of our communities.

00;22;43;25 - 00;23;10;03
Felicia Sadler
Elisa, I'd like to add to the retention component that you had mentioned you now in addressing the needs of the workforce regarding the training education, how can we better retain our workforce? I also wanted to add to this around taking a proactive approach. We think about acclimating to the culture, the environment. Having an effective onboarding process is absolutely critical because we know that leads to improved retention and decreased turnover.

00;23;10;14 - 00;23;47;17
Felicia Sadler
Part of that is really emphasized. We think about the importance of providing robust and personal, personalized experience, if you will, beginning with this effective onboarding process and then providing solutions and resources around that. We know that we can improve in our satisfaction, communication, increase critical thinking through content, personalized learning, as well as improved performance and knowledge. We were able to demonstrate that in the work we did with Virginia Mason Franciscan Health, which is part of CommonSpirit, for example, is a great example of using competency assessments as well as personalized solutions to demonstrate those outcomes.

00;23;47;24 - 00;24;14;00
Felicia Sadler
One other note I wanted to mention around effective onboarding was the work at Memorial Hermann around effectively transitioning to practice, which is so critical for new grads today and being able to personalize that experience through data driven, personalized coaching for new hires. Personalization, especially when we think about across generations, is absolutely critical because you're actually speaking to the unique needs of that learner and then being able to provide include well-being, patient safety, career growth opportunities as Ron alluded to.

00;24;14;00 - 00;24;24;03
Felicia Sadler
In addition, I've seen fellowships, mentorships, programs being developed to support them even beyond year one to support and grow the workforce.

00;24;24;18 - 00;24;41;01
Elisa Arespacochaga
I think that's key. We no longer can have just one way for everyone to learn. We have to have opportunities for them to learn that work for them. Well, as we wrap up, can I just see if there's anything else that we haven't covered that you want to touch on before we wrap up? Ron, let's start with you.

00;24;41;16 - 00;25;09;11
Ron Werft
I would just add to two comments, really. One is following on Felicia's last comments, and it is the need to provide scholarship support for our staff to give them those growth opportunities. And certainly what we've seen is a significant increase in the interest of philanthropists to support those activities. So I think there's a real opportunity to get our community involved.

00;25;10;02 - 00;25;39;11
Ron Werft
They have you know, we've gone from banging pots and pans in New York to posters at our hospitals and health care heroes. And now I think there are real ways we can engage our communities in supporting our staff. And they really want to do that. So that's an important linkage. And the other thing I would just mention that we haven't touched on yet is that the retention of our staff is often times heavily driven by their support for and appreciation of their manager.

00;25;39;29 - 00;26;05;00
Ron Werft
And so the importance of supporting our our management team, elevating the role of preceptors, maybe moving from preceptor to mentor. So there's an ongoing relationship there. I've seen good examples of that. I think those are really important - I'll say tools to use - but just smart things to do that will keep our staff really engaged and supported in our organizations.

00;26;05;18 - 00;26;33;22
Ron Werft
I would really encourage everybody to make sure that they take advantage to the resources that are available at AHA. I've been so impressed and being involved with this workforce task force with the contributions of the staff are enormous. And by accessing this information on the AHA website, you're you're provided access not only to work done by the AHA, but work that's done by many other organizations for which the AHA serves as a clearinghouse.

00;26;34;00 - 00;26;38;27
Ron Werft
It's really important and valuable information for all of us. I'd encourage you to take a look.

00;26;39;18 - 00;26;43;12
Elisa Arespacochaga
Wonderful. Felicia, anything else to add now?

00;26;43;12 - 00;27;16;07
Felicia Sadler
I completely agree. Just a few things. And we think about building a culture of retention. I think all these key components certainly play into that. The Workforce Scan provides several key strategies to really improve retention, proven impact retention. And I think health care is really a journey. We are headed in the right direction. Of course, we have arisen from an unprecedented pandemic better, more agile, taking those lessons learned forward and then the meaningful strategies really needed to address our workforce.

00;27;16;07 - 00;27;29;15
Felicia Sadler
I think the organizations can definitely find those in the workforce scan. We are improving patient safety. Certainly that's a key focus while developing stronger collaborative partnerships and expansions in our communities, in the communities we serve.

00;27;30;12 - 00;27;58;09
Elisa Arespacochaga
Well, thank you both so much for joining me today and sharing your insights. If you'd like to learn more about the latest health care workforce trends, be sure to check out the AHA’s 2023 Health Care Workforce Scan on aha.org/aha-workforce-scan. The 2023 AHA Health Care Workforce Scan is sponsored by Relias. To learn more about Relias, please visit www.relias.org

00;00;01;02 - 00;00;28;06
Tom Haederle
The shortage of health care workers in America is not news, but the shortage of behavioral health care professionals is especially acute. And that's even truer in rural areas. As one expert says, If you thought it was bad before the pandemic, we've got a new definition of dire over the past two and a half years. But the scarcity of qualified professionals hasn't stopped some rural care providers from recruiting, training and retaining behavioral health specialists with some success.

00;00;32;13 - 00;00;59;01
Tom Haederle
Welcome to Community Cornerstones: Conversations with Rural Hospitals in America. A new series from the American Hospital Association. I'm Tom Haederle with AHA Communications. The state of Iowa didn't have a reputation as a magnet for psychiatrists or other mental health professionals just starting out on their careers. But in recent years, Iowa has chosen to fund the expansion of psychiatric residency programs, now numbering about 20 across the state.

00;00;59;11 - 00;01;11;17
Tom Haederle
Iowa is investing in the training and retention of future psychiatrists who want to be change agents and who are passionate about working with underserved populations. Hear how it's all working out in this podcast discussion.

00;01;12;12 - 00;01;34;21
Rebecca Chickey
Hi, this is Rebecca Chickey, senior director of behavioral health services for the American Hospital Association. And it's my honor today to be joined by Dr. Jodi Tate, who is the clinical professor, as well as vice chair for education and director of the Intellectual Disabilities and Mental Illness Program at the University of Iowa Health Care in Iowa City, Iowa.

00;01;35;10 - 00;02;06;11
Rebecca Chickey
Jodi, thank you for being here with us today. I had the honor, since I'm at the AHA Health Care Rural Leadership Conference, being on a work session where you spoke about improving behavioral health workforce and services in a rural state. I have to tell you, the room was packed because if we thought the shortage of behavioral health workers prior to COVID was dire, we got a new definition of dire in the last two and a half years.

00;02;06;27 - 00;02;24;05
Rebecca Chickey
So for the benefit of the listeners and those who aren't here at the Rural Leadership Conference, could you describe for me, can you tell me about how you have expanded the psychiatric residency programs, particularly in the rural parts of Iowa?

00;02;24;09 - 00;03;01;08
Jodi Tate
Well, thank you very much for having me. And we are very lucky in the state of Iowa that our government has been extremely supportive in expanding our residency program into rural parts of the state. And in 2019, our governor allocated funds to expand our residency program. And Dr. Shay Jorgensen, who was a resident when this was all going down, has taken on the lead and has developed a rural psychiatry track from our in our residency program.

00;03;01;08 - 00;03;32;24
Jodi Tate
And she graduated from the University of Iowa and moved to Mason City. She grew up in rural Iowa, and her dream was to return to rural Iowa. But she wanted to have a connection with academic medicine and expand psychiatry throughout the state. So she has been a trailblazer in making that happen. And this is the third year where she has two residents per year in the psychiatry residency program.

00;03;33;14 - 00;04;04;02
Jodi Tate
And so that's going amazingly well. She is also single handedly developing substance use treatments and treatments in rural Iowa with her connections. And so we she's gotten that off the ground. And then our state last year provided more funding to expand our residency training program even further, funding for up to 12 additional residents per year, which is huge.

00;04;04;03 - 00;04;31;17
Jodi Tate
Right now we have nine per year, phenomenal. And so I was in a different position when this funding came down and I was very excited about the possibilities of changing psychiatry across the state of Iowa and improving services to underserved populations wherever they are. And I went to medical school in a rural state and spent time in rural areas and had that experience as well.

00;04;31;18 - 00;05;02;19
Jodi Tate
So I'm trying to figure out how to expand our residency program even further, which is challenging because part of the state appropriation bill that funds this new addition mandates that the residents spend time in locations that are in rural Iowa. It's a mandate. And many of these specific locations where they mandate that we have to be ... there isn't the capacity, there aren't physicians or there's not the capacity of the current physicians to have residents.

00;05;02;22 - 00;05;23;23
Jodi Tate
So they have the capacity to teach the residents. So we wouldn't be able to receive ACGME accreditation to expand our residency training program. So we're having to be really creative about how we go about doing that. And the thing that I have learned through this process in meeting with folks at these institutions is everyone is passionate about this.

00;05;23;23 - 00;06;04;01
Jodi Tate
Everybody wants to improve psychiatric care, but there's just a limited resource. So what we've decided to do is to develop a public psychiatry fellowship program in Iowa, and there are about 20 public psychiatry fellowship programs across the state, and most of these are in urban areas. So not sure how it's going to go in a rural area, but I'm very hopeful that it will be successful. The way that the Public Psychiatry Fellowship works in with expanding the residency is that these fellows will have graduated residency program already so they can practice independently and they can supervise residents.

00;06;04;18 - 00;06;55;23
Jodi Tate
The fellowship gives them extra training and exposure to learning more about our health care system, learning more about being a change agent, about social determinants of health and our hope is that we recruit psychiatrists to do this fellowship that are really passionate about underserved populations and who will be future change agents in improving our health care system. And these fellows would spend time at these sites that are mandated for our residents to be, and then we'd slowly create a culture of education and excitement in these rural areas, which in turn would allow us to have residents there, which hopefully would in turn, the residents would stay there and they would be physicians there in rural

00;06;55;23 - 00;07;01;14
Jodi Tate
Iowa. So that was a very long answer to your question, but it is a long process.

00;07;02;20 - 00;07;14;01
Rebecca Chickey
No, that was excellent. But for perhaps some of our non-health care listeners, could you describe or articulate what ACT is as well as a ACGME.

00;07;14;09 - 00;07;41;27
Jodi Tate
ACT: Assertive Community Treatment. Dr. Williams talked about that at our talk earlier today. So it is a treatment for individuals with chronic severe mental illness that live in the community, that have multiple hospitalizations, interactions with the legal system, lots of complications. So essentially, it's a it's an inpatient team that goes out in the community and takes care of patients in the community.

00;07;41;27 - 00;07;47;18
Jodi Tate
Evidence based treatment that shows to improve outcomes for people with serious mental illness, including schizophrenia.

00;07;47;27 - 00;07;59;25
Rebecca Chickey
And I think it's also been proven to reduce the number of readmissions and the number of visits to emergency rooms and all of that, as well as be able to meet the patient where they are in their own home.

00;08;00;04 - 00;08;27;19
Jodi Tate
We do not need any more evidence that ACT works. It works. You know, the challenges in rural areas. And Dr. Williams talked eloquently about that. And Dr. Jorgensen actually has started an ACT program in rural Iowa. And she has you know, she's running the rural track that we talked about earlier, expanding the psych residency program. So she's exposing residents, psych residents to the ACT program.

00;08;27;20 - 00;08;48;00
Rebecca Chickey
Yeah. Gotcha. Yeah. Can you go back and and tell me a little bit about the psych residency sort of structure? There's four years to the program, is that correct? I'm hoping I'm going to get this right for ACGME: the American College of Graduate Medical Education, correct? Right. Yeah. So before you can even go on this journey, you have to go through a process where you get their blessing.

00;08;48;00 - 00;09;09;24
Rebecca Chickey
And it's not a one stop process, is it? So, you know, just at a high level, you don't have to give us each step. But what did you have to go through in order to be able to move this program forward? And then how is it structured? Because if you are in rural areas, you know, how are they connecting back to, you know, sort of the mega metro centers, you know?

00;09;10;05 - 00;09;11;28
Rebecca Chickey
So how is that structured? Two questions.

00;09;12;09 - 00;09;38;14
Jodi Tate
So Dr. Jorgensen did that already for the rural track. So we have two additional residents right now. And to get ASCGME accreditation, essentially you have to meet a whole bunch of requirements about space, about faculty, about time, about learning. And it's not easy. And Dr. Jorgensen accomplished that, got the accreditation for that. And it's a long process, so it can take up to a year to get all that done.

00;09;38;14 - 00;09;44;20
Rebecca Chickey
It's just good for the listeners to hear, you know, and know what's realistic. Yes. It's not going to be a fix in six weeks.

00;09;44;21 - 00;10;12;17
Jodi Tate
No, this is a very long process. Okay. Yeah. And the ACG acknowledges an understands that we as a state, as a country, need to do better in educating our physicians in rural America. And they've created a think tank for rural and medically underserved populations to try to determine how they can help states develop programs and reach ACGME accreditation and given all the strict requirements.

00;10;12;28 - 00;10;15;18
Jodi Tate
But that is just started. So they're just trying to figure that out now.

00;10;15;24 - 00;10;29;27
Rebecca Chickey
Gotcha. So what about the structure of the residency program? You said that is underway and I think you have had six residents go through so far or are in the process of going through? What's the first year, second or third year, fourth year look like for them?

00;10;30;03 - 00;11;03;17
Jodi Tate
Yes. So, again, this is Dr. Jorgensen's area and this is all her developing this. So there so I hope I'm going to get this right. But their first year they do a primary care rotation in rural Iowa. And then their second year, they have three months of electives that are all in rural areas. And then their third year they have a telesite clinic to a rural area. And then their fourth year they can do any of those electives that I just mentioned.

00;11;03;29 - 00;11;26;03
Jodi Tate
And she is currently working with other parts of the state to expand and rural locations for residents. So that's our current state. Our future state will be to develop our residency program even further and there will be a lot of collaboration between Dr. Jorgensen's program and what we decide to do in the future with expanding throughout the state.

00;11;26;15 - 00;11;48;25
Rebecca Chickey
Well, and also through the fellowships that you're just now establishing in terms of what does this look like and feel like in rural America? Right, Right. So thank you for being on what I often call the bleeding edge of innovation. So it's not always comfortable and but but often, you know, thank heavens for the Wright brothers who were the first people to go up in that plane.

00;11;48;25 - 00;12;08;26
Rebecca Chickey
Right. You're the first person to try to do this in rural America through the fellowships. So you've mentioned a couple of times that the government of Iowa has been incredibly supportive. And you even mentioned that the governor, I think, had put forward a we can do better than this for individuals with mental illness and substance use disorders in our state.

00;12;09;05 - 00;12;13;24
Rebecca Chickey
Its really it's been the state legislature to some degree that's been driving this?

00;12;13;24 - 00;12;32;05
Jodi Tate
It has. It's been the state legislature that's been driving it. So they advocated strongly for it. It was the number one priority for for folks, and they made it happen. So it came from them. So the academic world can't claim any pats on the back for that one.

00;12;32;08 - 00;12;49;22
Rebecca Chickey
Well, you had to be ready to catch the ball when they threw it to you, right? Yeah, right. You know, I think you get a little street cred there. The other thing I was wondering, I think in the breakout session I heard you say that for the new 12 slots that the state is actually funding $100,000 per residency slot.

00;12;49;22 - 00;13;15;09
Rebecca Chickey
Is that correct? Yep. So just to give the listeners that sense, that may not cover all of the cost of a residency, but it certainly covers a significant part of it. So just know that your state legislature should be in contact with the Iowa State Legislature to be inspired for helping us get more health care workers. In terms of the key success elements,

00;13;15;22 - 00;13;39;26
Rebecca Chickey
based on your experience with the psych residency program under Dr. Jorgensen's leadership and passion for this and now looking at the psychiatric fellowship programs which will once achieved, have dual role, they'll have that fellowship and also will be, you know, at the same time as they go through the fellowship, are able to oversee the residency slots. What do you think are some of the key success elements that got this off the ground?

00;13;40;09 - 00;13;45;07
Rebecca Chickey
Certainly Dr. Jorgensen deserves a bright star, but were there other elements in addition to that?

00;13;45;13 - 00;14;22;13
Jodi Tate
Well, I think willing is to collaborate and communicate across different organizations. It always comes down to communication and collaboration. So I have met a lot of new people during this adventure and finding out that we all share something in common and that's trying to improve health, mental health care to Iowans. And so I think willingness to collaborate, willingness to communicate, willingness to think big, but then also realize, okay, well, this is our big end dream, but what are the steps we have to get to do that?

00;14;22;25 - 00;14;40;24
Jodi Tate
And is it going to be perfect starting out? Probably not. But let's just go and let's try it. So I think collaboration and communication and willingness to to try and to think and then willingness to actually make it happen and put the hard work in to make it happen.

00;14;41;00 - 00;14;50;00
Rebecca Chickey
And I thought I heard in there the ability to pivot. Yes. In case it's not going to be exactly going in the direction that you dreamed of initially. Okay.

00;14;50;07 - 00;14;55;07
Jodi Tate
Right. Who knows where this will end up, But we've got to start trying to figure it out. Yeah.

00;14;55;18 - 00;15;17;24
Rebecca Chickey
So let me ask you this two last questions. One, if you had to pick the biggest barrier that you overcame or went around or underneath, what would that be? Something for people to learn from your lessons, your own experience, so they can see the barrier is there and perhaps prepare better for it?

00;15;18;06 - 00;15;46;07
Jodi Tate
Well, I wish Dr. Jorgensen was up here because she's actually gotten over all those hurdles and her program is off the ground. And I'm just in the early stages of doing this next phase. But but I would say that the biggest hurdle so far has been getting everybody together here to talk, to have a similar vision, even though that vision may be not exactly clear, but at least something that everyone can agree on.

00;15;46;07 - 00;15;57;24
Jodi Tate
And I think we're still working on that. But I think having something that the group can agree on is where we need to go. So I would say I'm in the middle stages of that.

00;15;58;12 - 00;16;01;09
Rebecca Chickey
But you're building the foundation for the collaboration.

00;16;01;12 - 00;16;01;26
Jodi Tate
Thank you.

00;16;01;26 - 00;16;07;01
Rebecca Chickey
Yes, that sounds like. Right. Yeah. And that's not easy work because it means relationships, right?

00;16;07;01 - 00;16;08;16
Jodi Tate
It's all about building relationships. Yeah.

00;16;08;16 - 00;16;35;01
Rebecca Chickey
And learning the things about the other organizations that you didn't know were struggles or challenges. And they for you. Yeah. All right. So we are going to wrap this up. Are there a couple of things that you want to leave the listeners with that might inspire them to say, Hey, I'm going to start talking to my state representative and see if we can get something off the ground or I'm going to talk to my local academic medical center, something to inspire them as we close this out.

00;16;35;13 - 00;16;58;22
Jodi Tate
Yeah, I think at least for some of us that have been in the mental health system for a long time, it's hard sometimes not to think there's so many problems that we can't overcome. But I think that we have to keep optimism and keep some idealism that, you know, I've lost some of that. But to keep it that, you know, that we can fix this or we could please try to fix this.

00;16;59;09 - 00;17;18;22
Jodi Tate
And there is hope. And if we work together and we get the right type of people together that are passionate about mental health care and are passionate about making changes, then it can happen. So never give up hope and always keep trying.

00;17;19;00 - 00;17;28;16
Rebecca Chickey
That's exceptional. And I do believe that the Generation Z and all of those the millennials, they are going to demand.

00;17;28;29 - 00;17;29;10
Jodi Tate
Good.

00;17;29;20 - 00;17;42;11
Rebecca Chickey
Treatment for their entire for their whole self, right? Just like the surgeon general said, you know, there is no complete good health without good mental health. So hopefully we have a lot of champions coming behind you and I.

00;17;42;11 - 00;17;44;11
Jodi Tate
Yes. So we need them. We need them.

00;17;44;12 - 00;17;50;12
Rebecca Chickey
Keep the optimism going. And thank you so much, Dr. Tate. This has been a joy and thank you for the work you're doing.

00;17;50;14 - 00;17;50;29
Jodi Tate
Thank you.