Using Frontline Staff to Transform the Patient Experience

00:00:00:25 - 00:00:20:03
Tom Haederle
Welcome to Advancing Health. Sometimes making a difference in a patient's life starts with noticing a need or asking a question. Today, we explore how Duke Health is tapping into the insights and compassion of frontline staff through its Frontline Liaison Network.

00:00:20:05 - 00:00:41:29
Julia Resnick
Hello, and welcome to Advancing Health. I'm your host, Julia Resnick, senior director of Health Outcomes and Care Transformation here at the American Hospital Association. Today, we'll be talking about how to engage frontline staff and screening patients for social needs. I am so pleased to be joined by Dr. Erica Taylor. She is an orthopedic surgeon and the vice president of Health Equity at Duke Health.

00:00:42:01 - 00:00:44:09
Julia Resnick
Dr. Taylor, welcome to the podcast.

00:00:44:11 - 00:00:56:01
Erica Taylor, M.D.
Thank you for having me. It's really a privilege and an honor to be able to talk about not only the screening and why it matters, but also how we activate teens to be part of our solutions.

00:00:56:06 - 00:01:09:10
Julia Resnick
Absolutely. Just really excited to have you here to have this conversation. So to start, I think it would be really helpful for our listeners to understand what challenges you were seeing at Duke Health that inspired you to develop this frontline liaison network.

00:01:09:12 - 00:01:33:18
Erica Taylor, M.D.
Yes. Thank you for that. I love a good origin story and this one is no exception. One thing I should mention I am also a practicing orthopedic surgeon, so I'm in my 14th year of practice as a hand and wrist orthopedic surgeon, which means I spend quite a bit of time really on what we would term the front line of care.

00:01:33:18 - 00:02:01:09
Erica Taylor, M.D.
The point of care and understanding both as a clinician leader and as someone who's practicing how the decisions we make at the top, if you will, really translate to application for our patients and our teams. And so the challenge that was happening not just at Duke Health, but really beyond, was a lot of change, a lot of rapid growth, a lot of rapid decision making.

00:02:01:11 - 00:02:26:19
Erica Taylor, M.D.
And while there were quite a few voices in many different rooms, a perspective that was consistently missing or should I say an expertise that wasn't always present was that of our clinic staff. And by clinic staff I'm referring to our medical assistants, the team members at the front, our nurses, the team members who are X-ray techs and athletic trainers.

00:02:26:23 - 00:02:57:06
Erica Taylor, M.D.
And I noticed that we had created frameworks for quality, for culture, for patient safety in order to translate decisions to the point of care. But there really wasn't an opportunity to do that when it comes to advancing health. When it came to ensuring all of our communities, all of our patients from all geographies and backgrounds were really experiencing care in the way that would lead to their optimal levels of health.

00:02:57:09 - 00:03:18:11
Erica Taylor, M.D.
And so the interesting part of the origin is that I was in a presentation learning about a liaison program for quality, and I leaned into one of my other colleagues and I said to him, you know, we should really create a version like that for social drivers and then health, etc.. And he leaned back to me and he said, do it.

00:03:18:13 - 00:03:52:13
Erica Taylor, M.D.
And so that's where it was born. And the reason the origin story matters is because as people hopefully try to create similar programs in their own environment, there's not a need to start from scratch. We often are doing things correctly and effectively, but perhaps could apply it more broadly. And so this is an example of where there was a gap and whose expertise we were gleaning from, and then a gap in how we were delivering the solutions to the patients, particularly the patients who needed them the most.

00:03:52:16 - 00:04:06:28
Julia Resnick
I love a good origin story, and that just so perfectly illustrates why this program is so important. I'd love your perspective on what do you what do you think frontline providers see that others don't and that they can use to support patients?

00:04:07:00 - 00:04:40:27
Erica Taylor, M.D.
Yeah. So one of one of my favorite things to do as a leader is really dive deep into clinical operations. There's many reasons for that. I am a stickler on efficiency and utilization. And are we really delivering practical care that can be replicated and sustained longitudinally? And so one of the areas that as clinicians, as leaders that we often don't see is practical implementation. The best of ideas and the best of vision can be articulated,

00:04:40:28 - 00:05:08:19
Erica Taylor, M.D.
we can have campaigns around them, but if they can not actually be supported by the right systems and processes, then the impact is minimal. And so what our frontline staff and again I'm using that term, you know, rather broadly - understand there's some nuances with it. But one thing that they can offer is really honest perspective and experience to tell us what worked, what didn't work and how it could work better.

00:05:08:22 - 00:05:33:09
Erica Taylor, M.D.
And they do it in such a way because not only are they on the front line, but they have a relationship with patients that many people don't have, and they're often the first and the last team members to touch our patients. They're often the first people to hear from our patients. They hear the feedback in the experiential data that doesn't make it into the survey, right?

00:05:33:11 - 00:05:52:23
Erica Taylor, M.D.
Doesn't make it into Press Ganey, and so this is where I really value not only perspectives but I call it expertise. And so what the liaison program does and what was always intended to do was to not just listen, but to follow that with action and improvement.

00:05:52:29 - 00:05:57:29
Julia Resnick
So can you talk a little bit more about how the liaison program works in practice?

00:05:58:01 - 00:06:30:13
Erica Taylor, M.D.
Yeah. So this is this is interesting. And I'm definitely smiling thinking back to when I first proposed the format. And as I said earlier, I wanted to take a little bit of what was working in similar network programs, albeit in different domains. And one of the things that consistently was valuable was allotting a specific amount of time in a consistent way for education around the topic, to the clinic staff team members, to the liaisons.

00:06:30:18 - 00:07:01:25
Erica Taylor, M.D.
And so the way I offered this was that once a month for an hour, I will host a meeting. And because we're very widespread, we're big health system with multiple ambulatory clinics. I will do this virtually. And for the first 20 minutes, I'll teach something around the dynamics and the intricacies of advancing health. But then another 20 minutes will be spent really reviewing what policies, what new changes, what workflow opportunities there are.

00:07:01:28 - 00:07:45:00
Erica Taylor, M.D.
And then the last 20 minutes of the hour, I'll just listen and not listen just to say I listen, but I'll actively listen and we'll have an exchange that is productive and honest and advances us forward. Now, my initial vision when I proposed this was that out of our inventory clinics at the time, there were about 80 or so, and now we definitely have over 100. Maybe ten, maybe 12 clinics would identify a liaison, would sign this commitment form, and I will teach these 10 or 12 people, and we'll go from there. Within two weeks of offering this opportunity, over 8,100% of our clinics had identified a liaison to represent them in this capacity.

00:07:45:03 - 00:08:04:10
Erica Taylor, M.D.
And, you know, as someone who is really, really a fan of entrepreneurship and innovation, there are times where you do have a solution, but you don't realize how important it was. And that was a testament to the need. And so, again, true to my commitment, the way it works is once a month I will teach the liaisons and they'll teach me back.

00:08:04:16 - 00:08:31:09
Erica Taylor, M.D.
But importantly, they receive the content in a way that is digestible and applicable to the rest of their teams. In the next day of their huddles, they'll share it. So a little bit of a teach the teacher or train the trainer, and then we will circle back the following month and address any barriers or opportunities that arose. And we are now in our fourth year of doing this program.

00:08:31:11 - 00:08:35:18
Erica Taylor, M.D.
And I just see the benefits multiply each and every month.

00:08:35:21 - 00:08:54:01
Julia Resnick
I love that, and it's so incredible when you think there might just be a tiny bit of interest but really, people have such a deep and passionate commitment to supporting patients that are really just becomes a groundswell. So congratulations on that. On that topic, are there any stories you can share that really illustrate how this program works?

00:08:54:04 - 00:09:17:00
Erica Taylor, M.D.
Oh my goodness. Yes. Thank you for that. I have so many stories. I'll share one or two. So as I mentioned before, I will, you know, meet with liaisons as a whole. And afterwards, if they have a solution they want to talk about further, we can meet them between. But for the most part, I just see them that one time.

00:09:17:03 - 00:09:40:22
Erica Taylor, M.D.
Well, one day I received an email from one of the liaisons, unsolicited, unprompted. And it is an email that I actually share anytime someone asked me to share a story. And she wrote about a patient who had come to their clinic, who needed help paying their medical bills, and as they dove deeper and asked the patient questions, said, well, you know what?

00:09:40:24 - 00:10:12:23
Erica Taylor, M.D.
I really don't even understand what all my doctors do and who I'm supposed to see. I need help understanding my medications. I need help with transportation. And so in that moment, the liaison and another member of her team who worked at the front desk went through the social drivers of health screening questionnaire with the patient, identified what they needed, put in a referral to our central resources hub, and then also gave them the number for county services for things that fell without the community based resource list.

00:10:12:25 - 00:10:44:25
Erica Taylor, M.D.
And when she composes this email to me, she writes the statement, this is very important. This is the first time that this team member and I had ever been involved in this process, and we became very emotional. Thank you to Duke Health. Thank you to the program. I am proud to work here. And the reason I bring this up as a story, and there's so many variations of this that I could share if we have more time, which we don't, is that this is more than connecting patients to resources.

00:10:44:25 - 00:11:30:29
Erica Taylor, M.D.
This is more than amplifying perspectives. What we are doing is connecting the most valuable resource, our clinic staff members, to the mission. And if you look at where health systems may miss the mark when it comes to retention, when it comes to development is often identified as not connecting their individual team members to their mission. And this is an example of what can happen when you just give someone the tools and the agency to create progress, to create solutions on their own, and they can take it to places that we can't, as leaders oftentimes do.

00:11:31:00 - 00:11:52:04
Erica Taylor, M.D.
And so I share that story. There are numerous others where, unbeknownst to me, supply chain had an opportunity to add something to a formulary and a liaison picked that up. Other things that are so granular, they don't make it to the PowerPoint deck. And so those are the types of stories that, if I ever wondered, are we making a difference?

00:11:52:10 - 00:11:54:09
Erica Taylor, M.D.
I think back to those.

00:11:54:11 - 00:12:18:05
Julia Resnick
I think that was just a really powerful reminder that people are experts in their own spaces and can connect with patients from wherever they sit, that they don't have to be a doctor or a nurse or a clinician. But even those frontline folks can see patients and connect with them and help them. And I think it's just like really connects back to why people work in healthcare, that they can help their patients from wherever they are.

00:12:18:07 - 00:12:47:17
Erica Taylor, M.D.
Absolutely. And, you know, the interesting thing about that particular team member is she was the financial care counselor, which we term FCC. And so before that, she had no background or training in this. And since she wrote that, she's entered into nursing school. And it's again, this is just one example and one factor to her decision to identify her leadership capabilities and take it to a different level.

00:12:47:19 - 00:13:01:06
Julia Resnick
So I'm sure that some of our listeners are now thinking about what it would take to set up a frontline liaison network at their hospitals. So over the course of implementing this, what have you learned and what advice do you have for hospitals who'd like to do something similar?

00:13:01:09 - 00:13:43:15
Erica Taylor, M.D.
Yes. That's a really important question. You know, I, I love hearing great ideas. And sometimes you hear them and you're excited and you're inspired and then you wonder, wait, how is that going to work back in my place and what do I need? And so the first thing that I would suggest to other systems and hospitals and even the ambulatory specialty care world that's considering this would be to take a beat, take a moment and really listen to what your clinic staff members are seeing and what they need to help you do your job.

00:13:43:17 - 00:14:11:23
Erica Taylor, M.D.
It is an interesting concept that we don't talk about enough is that many of our team members, myself included, are here to help the organization, that we have a servant leadership mentality where we want to use our time and talents to help to contribute, and we want that contribution to be valuable. To assume that there's a certain solution that your team members need would be a bit of a misstep

00:14:11:23 - 00:14:44:05
Erica Taylor, M.D.
and so the first thing I would advise is listen to your clinic staff in a productive capacity that allows them to co-create the future with you. When you do that, actively listen and have this bidirectional exchange you might find that the liaison program is exactly what you need to create. And if that is true, then the next step would be ensuring that you have not just the capacity to do it, but also someone who is empowered as a leader to really commit to this.

00:14:44:07 - 00:15:22:15
Erica Taylor, M.D.
Now, what's interesting, because I do get the question, how much time is required for this? How much of a impact would this be to our clinic workflow? The only time commitment for your liaison is one hour per month. It's about repurposing their time for ultimate downstream benefit to the environment and to the patients and communities we serve. So the first thing actively listen. Hear what solutions could be co-created and then ensure you have the capacity coupled with the expertise to deliver on this type of network.

00:15:22:17 - 00:15:37:12
Julia Resnick
Well that's just fantastic. Thank you so much for sharing this work. Thank you for championing it in your hospital and building this incredible network. It's such a powerful tool to support patients in your community, and I just really appreciate you sharing with us.

00:15:37:15 - 00:15:48:00
Erica Taylor, M.D.
Thank you so much. It's been amazing to be able to disseminate this in many different places, and I look forward to seeing what becomes of it.

00:15:48:03 - 00:15:56:18
Tom Haederle
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