Advancing Health Podcast

00:00:01:00 - 00:00:26:28
Tom Haederle
Welcome to Advancing Health. Traditionally, health care providers have been very hesitant to seek help for the burnout and mental health challenges that many of them face. That is changing for the better, as we hear on this podcast about efforts to destigmatize seeking mental health services for our care providers, about being okay with not being okay.

00:00:27:00 - 00:01:04:17
Rebecca Chickey
Welcome to Advancing Health. I'm Rebecca Chickey, the senior director of behavioral health at the American Hospital Association, and it is my honor today to be joined by Corey Feist, the CEO and co-founder of the Dr. Lorna Breen Heroes Foundation, and Tiffany Lyttle, R.N. and director of cultural integration for Centra Health. Today, we are going to talk about the ways that hospitals, health systems and even states and regions can get involved to reduce the stigma and improve access to mental health care services for all our health care workers.

00:01:04:19 - 00:01:16:25
Rebecca Chickey
Corey, I'm going to direct my first series of questions to you. Quite honestly, tell our listeners what is the mission and vision of the Dr. Lorna Breen Foundation and why was it founded?

00:01:16:27 - 00:01:38:04
Corey Feist
Thanks for having us today, Rebecca. We are so grateful for the support of the American Hospital Association in our work. The Lorna Breen Foundation was created in the summer of 2020 following the death of my sister in law, Dr. Lorna Breen, who was an emergency medicine physician in New York City and a leader at New York Presbyterian Hospital.

00:01:38:06 - 00:01:52:05
Corey Feist
Our mission is to support the well-being and job satisfaction of all health workers in the United States. We envision a world where seeking mental health care is viewed as a sign of strength for our health care workers.

00:01:52:07 - 00:02:15:15
Rebecca Chickey
That's an incredibly powerful mission and a beautiful vision of the future. I know that the Dr. Lorna Breen Foundation is not doing this alone. In fact, I believe there is an organization and AHA is part of it called All In: Caring for Caregivers. Can you describe the relationship between the Dr. Lorna Breen Foundation and All In?

00:02:15:18 - 00:02:39:10
Corey Feist
Absolutely. And as you noted, the AHA been a really important partner of ours. With my background as a health care leader, I noticed that there are few silos at health care. And so one of our primary goals at the Lorna Breen Foundation was to bring together health care organizations in an interdisciplinary way. To wrap our arms around the mental health and well-being of our workforce.

00:02:39:12 - 00:03:09:06
Corey Feist
So in the spring of 2021, we created a coalition called All in Wellbeing First for Health Care, whose focus was really to break down those barriers to mental health access and to accelerate solutions to this growing burnout and mental health challenge that the health care workforce had. As part of the work of the All In Coalition, we created All In: Caring for caregivers, which is a technical assistance program which has three main phases.

00:03:09:09 - 00:03:31:27
Corey Feist
First, to remove barriers to mental health access. The second is to educate health care leaders on what they can do in their sphere of influence and control about addressing well-being from a systems perspective as well as an individual perspective. And then it culminates in a year long learning collaborative. We do this work focused on getting at the root cause of many of these issues.

00:03:31:28 - 00:03:53:21
Corey Feist
We do it in an interdisciplinary way, and we try to bring together states or large metro areas of hospital systems and their teams to do this work in a very transparent way so that their workforce can see the work is being done, and so they can learn from each other about evolving best practices. And that's how we met Tiffany.

00:03:53:23 - 00:04:11:26
Rebecca Chickey
That's wonderful. Tiffany, I can't wait to get to you for a couple. I have a couple more questions for Corey first. Of course, some of the listeners may not understand when you say removing the barriers to access for mental health care, they may think: they're working in hospitals and health systems so of course they have access to mental health care.

00:04:11:27 - 00:04:18:06
Rebecca Chickey
Can you go a little deeper on that and describe some of those barriers that you're trying to remove and mitigate?

00:04:18:09 - 00:04:46:09
Corey Feist
And it's a great point, Rebecca, because when my sister in law took her life in April of 2020, I had been in health care for many dozens of years, actually, many decades, I should say. And I was a leader at University of Virginia Health System. Yet I wasn't a clinician, and so I was completely unaware of the stigma as well as the professional barriers and really potentially penalties that health care professionals in the United States have.

00:04:46:11 - 00:05:32:00
Corey Feist
These mostly appear in the form of overly invasive and really inappropriate questions that clinicians are asked about whether they've ever been diagnosed or treated for mental illness, whether they've gone to therapy. And these are the same questions that my sister in law was terrified that she would have to respond to following a singular mental health episode. And so what we have been able to do at the Lorna Brain Foundation, through our All In Coalition and Caring for Caregivers, is to get tools to the front lines, whether it's a licensing board that's asking these questions, or hospitals who ask these questions, most commonly in credentialing applications, and have them change those questions and then importantly, communicate

00:05:32:00 - 00:05:54:14
Corey Feist
the changes to the workforce. As I sit here with you today, there are 1.5 million health workers in the United States that are benefiting from the changes that we've made, which we hold out in the All In Well Being First for Health Care Champions Challenge for licensing and credentialing badge that we give out to hospitals, as well as the licensing boards for doing that important work.

00:05:54:17 - 00:06:03:17
Rebecca Chickey
Thank you. I mean, I don't think many of the listeners may have realized that those questions where have you ever, as you noted, have you ever been treated?

00:06:03:19 - 00:06:27:23
Corey Feist
And if I could just add one thing, because the American Hospital Association a couple of years ago published their first ever suicide prevention guide, at least the first ever that I'm aware of. And in that suicide prevention guide, you identified three key drivers of suicide among health workers. And the first one that you all identified is this concern around the loss of license and credentials associated with the stigma for mental health care?

00:06:27:29 - 00:06:44:09
Corey Feist
So we know that for Laura, this wasn't just an isolated incident. And it's something that we hear from health workers all over the United States that they are fearful for these repercussions. And so we need to do something about it and address it, which is what we've done across the country. We've made great strides.

00:06:44:14 - 00:07:12:29
Rebecca Chickey
Thanks for mentioning that. There's a variety of drivers for this concern and this stigma. So thank you. I want to turn now towards another thing that you mentioned earlier, Corey. And that is working with states, working with large health systems in order to advance this in their own organizations and across a particular geography or a regional area. And I'm going to call out specifically the caring for Virginia caregivers work.

00:07:12:29 - 00:07:17:11
Rebecca Chickey
Can you describe that a little bit? And then we'll bring Tiffany into the conversation.

00:07:17:13 - 00:07:44:21
Corey Feist
Absolutely. Two seconds of background. When the president of the United States signed into law the Dr. Lorna Breen Health Care Provider Protection Act, it created two spheres of programs. And one of those sphere of programs was learning materials for health care leaders to address the root cause of burnout, as well as mental health challenges. That was called the Impact Wellbeing Guide, which was led by the CDC and our All In coalition provided guidance on it.

00:07:44:23 - 00:08:08:27
Corey Feist
What we heard from the large health system across the country that was implementing the guide is they'd like to do this work together in a learning collaborative and they need some help. And so caring for Virginia's caregivers, caring for North Carolina's caregivers, caring for New Jersey's caregivers, and now caring for Wisconsin's caregivers are all efforts for us to take organizations through the phases of work, from the impact Well-Being guide.

00:08:09:00 - 00:08:37:21
Corey Feist
And that's begins by addressing these mental health barriers. It then moves towards education of ten person teams across health systems to address the issues at the root cause and become educated about the solutions. And then finally culminates in a learning collaborative focused on an operational initiative that drives burnout. And that's what we've done with Tiffany and the team in Virginia, now North Carolina, New Jersey, and recently expanded into Wisconsin.

00:08:37:23 - 00:08:48:19
Rebecca Chickey
That's fantastic. Tiffany, I bet the question on many listeners minds is, why did Centra decide to join the work of All In of caring for Virginia caregivers?

00:08:48:21 - 00:09:23:06
Tiffany Lyttle, R.N.
At the time, we had some really innovative leaders that understood that well-being wasn't just a nicety, but rather a necessity for us to drive health care forward not only to our communities, but also to our health care workers. So 2019, we really start pulling together the evidence base for this work. And what we saw is that health care workers were far more likely to suffer from depression, to have thoughts of suicidal ideation, to have bio-psychosocial disturbances, and of course, use substances to help them cope with their roles.

00:09:23:09 - 00:09:42:09
Tiffany Lyttle, R.N.
But we had never provided health care workers with the avenues, tools and support that they needed to be able to speak up and say, hey, we need help for coping with, you know, the very large burden of taking care of our communities and health care in the United States. Those were all published before 2019. So of course, you know what happened after 2019,

00:09:42:09 - 00:10:12:17
Tiffany Lyttle, R.N.
we went into a global pandemic. So we really need to find avenues that we could help support our health care team members - not only address their own well-being so that they can carry that forward, but also not place calluses where we should have compassion because we were facing a compassion crisis, right? And when we tell people, you know, you have to be strong, you have to be confident and yes, we are all of those things, but we also have to deal with very messy, beautiful situations of life and humanity.

00:10:12:19 - 00:10:36:15
Tiffany Lyttle, R.N.
And that can take a toll on us. It can leave echoes and it can leave scars. But we are well-practiced in taking care of code situations. I mean, if you think about a code situation, we are practice, rehearse, we simulate it, we educate to it. We certify to it every single year. We have avenues and tools to help us be better at coding situations and situations of that nature.

00:10:36:18 - 00:10:52:12
Tiffany Lyttle, R.N.
What do we have in place for taking care of ourselves? Nothing. We don't teach that in school. We don't simulate that. We don't go over it. We don't get certified to it. I mean, now we are starting to see some certifications for health care organizations come through. But that was about the time that we found the Lorna Breen Foundation.

00:10:52:12 - 00:11:13:07
Tiffany Lyttle, R.N.
And what perfect timing, you know, that we really needed to find a place for getting those tools, for helping support us in that work and removing the stigma. And I have to say, that's been one of the most important parts of engaging in our health care workforce as well-being is destigmatizing health care. Destigmatizing being okay with being not okay.

00:11:13:09 - 00:11:33:01
Tiffany Lyttle, R.N.
You know, it's okay for us not to come out of a situation at work and feel not okay about it. We have to be able to have those avenues, and when we stigmatize it and put licensing questions like, have you ever seen anyone for mental health resources? Or in the nursing realm, which is where I live, where our CNOs actually have to report this to the Board of Nursing.

00:11:33:09 - 00:11:43:24
Tiffany Lyttle, R.N.
You know, when we have those stigmatizing questions, we are putting that barrier in place and saying it's not okay for you to get help, you know, because then we're going to question your entire life, your livelihood and how you perform.

00:11:43:26 - 00:11:53:10
Rebecca Chickey
Can you give the listeners a little bit more about...you describe the journey well, but who led this journey? Was it your C-suite leadership? Where did that backing come from?

00:11:53:12 - 00:12:20:05
Tiffany Lyttle, R.N.
We have wonderful champions here in our C-suite. At the time that I was actually hired into this role, my original oral was patient education and nurse wellness. So it was really leading the work with nurses and how we were engaged and we published research. Our CNIO was actually one that that led this effort to make sure that our nurses were healthy and well, because, you know, the national data is that we are hemorrhaging new nurses at a rate of one in three, in their first year, will leave the profession altogether.

00:12:20:07 - 00:12:54:19
Tiffany Lyttle, R.N.
So what can we do to support that work of us being healthy and well and really figure out what those drivers are? So as we engaged in this journey, we started seeing really positive things like retention, engagement and, you know, better quality of work and, you know, better patient experience scores and better engagement scores. And we saw our nurses that were travelers even wanting to stay in Virginia, in rural Virginia, that, you know, not going to these major cities because they said, you know, this is the first place I've been where I feel healthy, where I feel like I can actually get the help that I need.

00:12:54:21 - 00:13:17:13
Rebecca Chickey
So I will tell you that back to your title, Director of Cultural Integration. It sounds like the impacts that you've been seeing as you just described are really that you have created a culture that not only better supports the mental well-being of the nursing and other clinical staff, and I'm assuming administrative staff as well. But at the same time, you are, having a positive -

00:13:17:15 - 00:13:40:09
Rebecca Chickey
and let's talk about the positive financial return on investment, because what it takes to recruit a new nurse and train them, or any new clinician or health care worker is a significant cost. And it's a lost opportunity cost of retaining those who often leave. So it's having multitudes of impact if I hear you correctly.

00:13:40:11 - 00:13:57:29
Tiffany Lyttle, R.N.
Yes, absolutely. Not only with engagement, but also our patient experience. You know, if you think about it on Maslow's hierarchy of needs, you know, if you are struggling with just physical safety, you're not going to find enrichment. That's not going to be part of your day. Your day is going to be: I need food, shelter and water, and I need to not be hit.

00:13:58:01 - 00:14:22:21
Tiffany Lyttle, R.N.
So actually, we contributed to the suicide prevention workbook. We actually have the piece on, how do we respond to workplace violence? Because that is one of our drivers for burnout in health care communities. But even in addition to that, SHRM put out a study. It's part of their civility work and their scorecards. Incivility in the workplace is costing $2 billion a day in the United States.

00:14:22:24 - 00:14:41:26
Tiffany Lyttle, R.N.
$2 billion a day. You know, we can't possibly engage with innovations, creativity, open communication, safety, even. You know, this all ties back to wellness. So when I started off by saying that it's a necessity, it's not a nicety. A lot of people hear well-being and they're like, oh, that's nice. You know, it's really nice that our nurses get it.

00:14:41:26 - 00:15:00:21
Tiffany Lyttle, R.N.
Or our physicians, you know, they get an opportunity to talk about what's going on in their lives, but it's so much more foundational than that. If you aren't healthy and, well, you aren't engaging in all those things that we need to engage in because we are stronger together if we're working towards things like recreating health care and making it accessible to everyone.

00:15:00:24 - 00:15:11:09
Tiffany Lyttle, R.N.
So it's not just how it plays out for our community members and how they are treated, it's also how we treat each other and how we are healthy enough to even engage in that work.

00:15:11:12 - 00:15:38:29
Rebecca Chickey
So many positive impacts of this work. Thanks to both of you for being willing to share your time and expertise with me, with the listeners for this podcast, and I encourage everyone to go to the Dr. Lorna Breen Foundation website and get involved, get engaged and change the culture of your organization and remove those barriers and stigma for the health care workforce who may need mental health treatment.

00:15:39:01 - 00:15:47:12
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:10 - 00:00:31:17
Tom Haederle
Welcome to Advancing Health. The impact of artificial intelligence is showing across nearly every aspect of health care delivery today, and continues to grow in reach and importance. In the second of this two part podcast on patient safety, we hear from a major health system about its steady integration of AI, how to govern it, and lessons learned from putting AI to work across many of its systems.

00:00:31:19 - 00:01:03:21
Chris DeRienzo, M.D.
Welcome back. This is part two of a terrific conversation with Dr. Randy Fagan from HCA. Again, I'm Dr. Chris DeRienzo, the chief physician executive for the American Hospital Association. Dr. Fagan serves as the chief quality officer of HCA Healthcare. And part one of this podcast went really deep on patient safety and how HCA is both thinking about and acting on patient safety at a scale that is incredibly challenging to rival within the American health care ecosystem.

00:01:03:28 - 00:01:29:07
Chris DeRienzo, M.D.
We got into a conversation around AI enabled technologies on patient safety, and it made us wonder, there's a deeper conversation we should probably have around AI. And really, I think that starts with governance, because I've got to imagine when you're talking about something like 190 hospitals, across 2000-ish other rooftops, that you have no shortage of people wanting to utilize AI in their workflows.

00:01:29:07 - 00:01:33:00
Chris DeRienzo, M.D.
And that's got to require a pretty significant governance arm.

00:01:33:02 - 00:02:01:10
Randy Fagin, M.D.
You're 100% correct. And, you know, we've put into place a pretty robust governance structure that goes beyond just our clinical leaders. It involves all of our functional areas from operations, finance, marketing, development, supply chain, you name it, we've included those folks to be a part of the table because it's important, as we look at the use cases, that we're looking at each use case through all lenses.

00:02:01:12 - 00:02:28:29
Randy Fagin, M.D.
As we prioritize use cases, we look at them quantitatively based off of the risk and the opportunity in each one. You know, it's interesting, as we've looked at the opportunities, it's not always about average performance or going from this average to this average. One of the greatest opportunities that AI offers us the opportunity - and it doesn't matter which lane we're in, whether it's operational efficiencies or clinical performance - it's about variance reduction.

00:02:29:06 - 00:02:57:20
Randy Fagin, M.D.
And, you know, being able to reduce variance is one of the, I think, most powerful things that AI can do for us inside the clinical space. When we look at areas to prioritize, we look at where we have areas of high variance, whether it's variance by clinician experience, variance by patient presentation, variance by geography. How can we reduce variance to try to improve the consistency with which we deliver care to our patients?

00:02:57:22 - 00:03:17:16
Chris DeRienzo, M.D.
I love the focus on variance. One mentor of mine that framed it this way that when you're looking at a challenge, you have to ask yourself, is this a batting average problem, or is this a slugging percentage problem? Because sometimes you're right. I've got to move, you know, a whole big boat from below the Mendoza Line, which is 200

00:03:17:16 - 00:03:36:18
Chris DeRienzo, M.D.
in baseball, for those who are baseball fans, to 300. But sometimes, it's I just need seven more homeruns or I need to not strike out 17 times. And it sounds like you're taking a version of that approach that is not baseball related to health care. And I love that thinking because it really does branch into very different pathways.

00:03:36:20 - 00:04:06:19
Randy Fagin, M.D.
100% agreed. And as we do that, one of the critical things that is kind of the next layer beyond governance is who you involve. And it's critical that we involve frontline staff early, the people who are closest to the work being done. It validates the problem and ensures the relevance and buy in. And as smart as the executive team may be, it is critical that we get the people closest to the work involved early in the process to help to shape that work.

00:04:06:21 - 00:04:22:27
Chris DeRienzo, M.D.
For those who are listening only and not seeing me nod my head as vigorously as the head can be nodded right now, I just want to narrate that for you. Because I remember like, ten years ago, we had developed this terrific machine learning model to predict readmissions in the health system I was working at the time.

00:04:23:03 - 00:04:36:27
Chris DeRienzo, M.D.
We spent nine months in development. Like, the numbers on the model were terrific. And then we showed it to the people who are going to use it, and they said, what's this? We don't need this. And by the way, I don't want to use that. It took us a whole nother nine months to walk through the people side.

00:04:36:27 - 00:04:45:02
Chris DeRienzo, M.D.
So that is a lesson that you learned exactly once in your career. And it sounds like it's being put to use by your group at HCA.

00:04:45:04 - 00:05:01:24
Randy Fagin, M.D.
Agreed. And as you bring those folks forward, one of the things that we try to make sure we're focusing on is augmentation, not necessarily automation. How do we enhance human decision making, not replace it? Especially in the clinical space, we think that's a very important decision point.

00:05:01:26 - 00:05:33:06
Chris DeRienzo, M.D.
Yeah. There are there's a great article that was in Axios a few months ago that the two editors of Axios wrote together about the impact of AI on their own professional infrastructure. They recommended all leaders ask themselves the question, what are the things that I and my team need to do to be incredibly successful? And then ask the follow up question, how can AI either automate some portion of that so I can focus my human time on a different part that's going to make a big difference?

00:05:33:12 - 00:05:44:11
Chris DeRienzo, M.D.
Do you have some specific examples, Randy, about how you're seeing that put to use and how perhaps those ideas have flown through the governance process and then into action?

00:05:44:13 - 00:06:11:05
Randy Fagin, M.D.
Yeah, there's a few areas that we've addressed. I'd mentioned in the last episode, working towards being able to reduce variance in the way that we staff our nursing units. And it sounds kind of banal, but it's remarkable when you think about the variance in how we staff those based off the individual who's staffing it and the time it takes them to do that.

00:06:11:07 - 00:06:21:18
Randy Fagin, M.D.
It is incredible. And by offloading that burden from them, it allows them to actually lead rather than spend hours of their day managing a schedule.

00:06:21:20 - 00:06:49:16
Chris DeRienzo, M.D.
The staffing example is fascinating because I interviewed Dr. Schlosser two years ago, and, Mike Schlosser, for those who didn't listen to episode one, is one of the HCA leaders who helped drive this technological transformation across the enterprise. And I remember him describing that nursing model in some detail, because the number and degree of variables about weekend option versus not weekend option - Tuesdays and not Fridays.

00:06:49:24 - 00:07:09:14
Chris DeRienzo, M.D.
And for a human to try to manage - your nursing unit can have hundreds of nurses - who you're trying to mix and match in a way that meets personal lives as best as possible with patient and clinical needs. This is exactly the kind of problem that AI is built to solve, because AI find patterns and helps develop the solution, right?

00:07:09:14 - 00:07:38:08
Randy Fagin, M.D.
And on the clinical side too of that, Chris, you know, this isn't just an exercise in how do you staff a nursing unit with the right number of humans for the number of patients that are there? There's the ability as you head further down that road to say what kind of patients are on that unit today on this shift, at this moment? Disease states, resource intensivity, and then try to match that up with a dynamic of nurses who meet those needs.

00:07:38:11 - 00:08:18:11
Randy Fagin, M.D.
You don't want to staff an entire unit with all new grads, nor do you necessarily want an entire unit of all 20 year experience nurses. How do we create the right dynamic of skill sets and experiences to meet the needs of the patients? There's a clinical value in the work that's done beyond just the offloading of that administrative burden from folks. You know, on the offloading administrative burden, I know a lot of folks have been using AI as a vehicle to assist with documentation where physicians, nurses, PAs, whoever, can just talk and patients can just talk, and that information is then aggregated and then put into the medical record in a way that

00:08:18:11 - 00:08:56:02
Randy Fagin, M.D.
it is consumable and it understands nuance. It understands context and it plugs things in regardless of the order in which you ask the questions, it plugs it into your documentation. And the idea of creating a greater level of completeness of our electronic health record has an incredible value to us. I mean, one, - on the on the administrative burden side - it can remove literally hours worth of work of our physicians who need to be entering the information, editing the information, signing off on the information, all of that stuff

00:08:56:02 - 00:09:18:07
Randy Fagin, M.D.
that's just an administrative burden. It literally can offload hours of it. Also, when you think about having a more accurate, complete medical record, the ability to transfer knowledge from shift to shift, and the ability to make clinical decisions based off the complexities of the individual. It's just better for patients. And I really see a value in that space.

00:09:18:12 - 00:09:40:23
Randy Fagin, M.D.
And that's another one that we're exploring and pursuing is we've got an entire cohort of physicians, both ER physicians and hospitalists. We're exploring the cardiac space as well in Texas. That was our pilot area in the Dallas area that have been utilizing this and helping us to learn. How do we allow this to give time back to the doctors, more time at the bedside, less time at the computer?

00:09:40:25 - 00:09:52:17
Randy Fagin, M.D.
At the same time, enhance the information that is able to be transferred shift a shift, and the information that's utilized by each shift for clinical decision making. It's a really exciting space.

00:09:52:19 - 00:10:21:19
Chris DeRienzo, M.D.
Ambient AI, the technology that you're referencing, and there are a variety of companies who are in that space is one reason that when I talk to trainees so folks in medical school or residency or nursing school, I say, folks, you have picked the best possible time to go into medicine or nursing or health care in general, because you and I trained on paper, and we were walking around units with giant charts and and writing orders in triplicate, and then our entire world got electronified.

00:10:21:21 - 00:10:41:03
Chris DeRienzo, M.D.
And in doing so, we pulled people away from face time with patients. And I see the value in all of that structured data. And my background is a CQO as well, on a much smaller scale than you. So I love the fact that we now, thanks to the, the electronicification of health care have all of the structure, data and the metrics.

00:10:41:03 - 00:11:06:29
Chris DeRienzo, M.D.
But my gosh, we transferred such face to face to face to screen time that this ambient technology is giving it back. It really is a way not only to, as you indicated, improve documentation, which has never been anyone's favorite part of their job, but also, improve the experience of our workforce. It is such a crucial thing to focus on while we are in the midst of a workforce crisis that we will never be able to recruit our way out of.

00:11:06:29 - 00:11:08:02
Randy Fagin, M.D.
Completely agree with you, Chris.

00:11:08:04 - 00:11:37:06
Chris DeRienzo, M.D.
I think we've got time for one last question, and I'm just wondering, obviously you all have had a number of successful implementations. You've probably had some that, tried and were cut off. What other, you know, single biggest lesson would you have steering the AI ship at, you know, the, the 190 plus hospital entity that is is HCA health care or folks listening in who are perhaps trying to do the same thing within their own communities.

00:11:37:08 - 00:11:57:13
Randy Fagin, M.D.
I would tell you one of the most important things that folks can do. One - well, there's a couple of things. You asked for one, I'm going to give you more than one. We'll take it. One is, you know, make sure that, you know, if you're the clinical leader trying to use AI to advance care in your space, bring together a team that isn't just clinical.

00:11:57:13 - 00:12:15:24
Randy Fagin, M.D.
You have to have all different lines of sight to really solve these problems. Second, you want to define a single high impact problem that has a low risk, if you don't get it right. You want to make sure that if you fail, you're going to fail safely in this. And then the last thing, don't start with vendor selection.

00:12:16:01 - 00:12:28:12
Randy Fagin, M.D.
You know, that becomes a solution looking for a problem. You need to first identify the problem you're trying to solve, and then identify the solution that best allows you to solve for that.

00:12:28:12 - 00:12:44:23
Chris DeRienzo, M.D.
Wise words, and ones that I think could be applied just as easily in a critical access hospital in Oregon as they can to a multistate system like HCA Dr. Fagan, it is been a privilege. And again, my guess is we'll be asking you back again sometime in the future. Thanks for spending time with us today.

00:12:44:23 - 00:12:46:03
Randy Fagin, M.D.
Chris, an absolute privilege. Anytime.

00:12:46:09 - 00:12:48:24
Chris DeRienzo, M.D.
Thank you. Take care everyone.

00:12:48:27 - 00:12:57:09
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:02 - 00:00:28:09
Tom Haederle
Welcome to Advancing Health. You can't go any higher than your performance in safety. As we hear in the first of this two part podcast, HCA’s patient safety journey has taken it to some unusual places to study other recipes for success, including industrial manufacturers and even a military base, as well as a close look at what AI has to offer.

00:00:28:11 - 00:00:55:10
Chris DeRienzo, M.D.
Welcome folks, to another episode of our podcast. I'm Dr. Christie DeRienzo, the chief physician executive for the American Hospital Association. And time for a quick moment of transparency: when we started recording today's podcast, we thought it was only going to be one episode, but it turned out that getting to spend time with Dr. Randy Fagan, who's the chief quality officer for HCA Healthcare, meant that we had a lot more to talk about than we could pack into our typical 12 to 15 minute episode.

00:00:55:10 - 00:01:13:02
Chris DeRienzo, M.D.
So you are about to listen to episode one of a two part series. And I would really encourage you to listen to now but also stay tuned, because part two is pretty exciting as well. Joining us for a conversation around patient safety and AI. Randy, thanks so much for joining us and welcome to the podcast.

00:01:13:05 - 00:01:14:18
Randy Fagin, M.D.
It's absolutely a pleasure.

00:01:14:21 - 00:01:34:24
Chris DeRienzo, M.D.
Well, I think before we jump into the main meat of the story, it's important for listeners to get a sense of exactly the degree of scope and scale that you are working with when you talk about being the CQO for HCA. Could we just start there and tell folks a little bit about you, your work and how you're approaching it across the country?

00:01:34:26 - 00:02:07:24
Randy Fagin, M.D.
Sure. So HCA Healthcare, which some folks may or may not be familiar with, it's about 2000 points of care. Just under 200 of them are hospitals. The remainder are ASCs, freestanding EDs, urgent care as physician clinics, imaging. And, we're about half of the U.S. states have an HCA presence in them. So as we think about the work that we do, it touches a fairly broad swath of both geographies as well as from rural to urban.

00:02:07:24 - 00:02:36:06
Randy Fagin, M.D.
So different levels of communities that we serve in terms of resource intensivity kind of across the spectrum. And in the chief quality officer role, when they formed this role, it's a brand new role that we didn't have until they moved me into it in January of this year - we pulled a number of areas together under a single construct to provide greater efficiency and hopefully a force multiplier effect in terms of the impact we can have broadly across the organization.

00:02:36:06 - 00:03:06:12
Randy Fagin, M.D.
So there were well but independently managed areas of patient safety, medication compliance, regulatory readiness, regulatory response, research, clinical advisory services or service lines, clinical excellence research and kind of background work, medication management and all these things were brought together into a construct that now is our quality group division, whatever you want to call it. And it's really focused in four core areas.

00:03:06:13 - 00:03:06:24
Chris DeRienzo, M.D.
Okay.

00:03:07:00 - 00:03:28:22
Randy Fagin, M.D.
One is in patient safety. The other is in regulatory compliance. The third is in our clinical service lines and the outcomes we're looking to drive through that. And then the fourth is what I call have claims insights and research. So how do we look at everything from medical liability to scanning the horizon from the political environment policy;

00:03:29:09 - 00:03:44:15
Randy Fagin, M.D.
federal or state legal changes, competitive changes, business changes, economic changes? How do we scan that horizon and use those signals as a way to inform our clinical strategy? So those are the four big pillars inside of the body of work that I oversee.

00:03:44:17 - 00:04:11:03
Chris DeRienzo, M.D.
Well let's go a level deeper there. Specifically, I want to make sure we get to how you all are using AI enabled solutions on your journey to drive improvements and safety. But we are both physicians and patient safety is kind of built into the core of what we do. And in conversations you and I have had, you think a little bit differently about patient safety and how it relates more broadly to the quality umbrella than the other folks who I have spoken with.

00:04:11:03 - 00:04:16:22
Chris DeRienzo, M.D.
So let's go there for a moment and then we'll, we'll sort of blow out and go big picture.

00:04:16:24 - 00:04:40:06
Randy Fagin, M.D.
So from a safety perspective, I mean, I kind of go back to our pillars that I mentioned of patient safety, regulatory compliance, clinical service line performance and then kind of call claims kind of medical liability as an entity of itself. I mean, safety is foundational. Like you cannot achieve regulatory compliance without a foundation of safety. Absent safety, your clinical outcomes cannot be what they need to be.

00:04:40:12 - 00:05:09:07
Randy Fagin, M.D.
And with safety events you're going to have higher, you know, medical liability claims against you. Safety becomes the ceiling that everything else kind of bumps itself up against. And you can't go any higher than your performance in safety. It's a limiting re-agent or a governor on the engine, so to speak, for all the others. And it's interesting, you know, on our journey, you know, we as an enterprise, I mean, we perform on par with and in many cases better than national averages when you look at our industry, health care and safety.

00:05:09:09 - 00:05:34:20
Randy Fagin, M.D.
But if you think broadly about safety, there are industries that are substantively better than health care when it comes to safety. High speed rail, chemical manufacturing, general mechanical manufacturing, oil and gas, military aviation. They're 10, 20, a hundred, a thousand-fold better if you look at the literature in terms of their safety performance. And we could say we're different. I'm not sure how different we are.

00:05:34:23 - 00:05:55:29
Randy Fagin, M.D.
At the very least, what I can say is there are scalable and industry agnostic lessons that we can and should learn from these high performers that can be applied into health care, applied into our hospitals in a way that doesn't need to change our operating models. It just needs to be embedded in the way that we work.

00:05:56:02 - 00:06:17:05
Chris DeRienzo, M.D.
Well, let's talk about how you how you develop those insights, because I agree, as you've indicated, the health care field was slower to the party. on the safety movement than, you know, industrial engineering and other areas. Obviously, we work with people. Health care is and will always be a uniquely human experience. But I love that

00:06:17:05 - 00:06:35:04
Chris DeRienzo, M.D.
before we talk technology, you have done a pretty deep, intensive effort to understand the people and process components of these fields that have been, using this more structured approach to safety for decades longer than health care. How have you approached that and what have you learned?

00:06:35:06 - 00:06:57:10
Randy Fagin, M.D.
In addition to about a dozen books and about as many reams of paper of printed articles later, we actually aggregated all those learnings and then said, which industries, based off of what we've learned, based off of the theory and practical application - who should we learn from? So we, contacted, a number of different industries that we went on field trips.

00:06:57:10 - 00:07:18:26
Randy Fagin, M.D.
We got together a core team that involved everybody from our safety to HR to our ethics compliance to nursing, I mean, a broad swath of our business. We all got together and we went on field trips. We spent time with GE manufacturing in Waukesha, Wisconsin at their CT manufacturing plant. We spent time on the manufacturing floor with them.

00:07:19:01 - 00:07:42:27
Randy Fagin, M.D.
Visit DuPont Chemical in Wilmington, Delaware, and went to their manufacturing site and spent time on their floors. We went and visited the 160th Airborne Division, which is a special forces unit that they do, helicopter based delivery of special forces - humans - into and out of the most dangerous places in the world at night, like that's what they do.

00:07:42:29 - 00:08:08:22
Randy Fagin, M.D.
We've talked to the Defense Health Agency. We've talked to Virginia Mason on the health care side. We've tried to spend time physically with and most often onsite with people who have created substantive levels of safety and performance and reliability to see what we can learn and how can we take those things that they do and bring that practical application back to health care.

00:08:08:24 - 00:08:42:12
Chris DeRienzo, M.D.
But, you know, one of the core areas of conversation for, for this particular podcast is technology. We know looking across the health care ecosystem that AI enabled solutions are not just showing promise, they're now proving outcomes. I know, you joined us on stage at AHA's Leadership Summit some time ago and to talk about some of those. But before we get to specific use cases, how are you now bringing this technology pillar and specifically AI enabled technology into that, that sort of multi-part approach to driving improvement in patient safety?

00:08:42:15 - 00:09:09:21
Randy Fagin, M.D.
It's interesting, I think, Chris, that AI almost becomes a not just an enabler, but I think it is going to accelerate our ability and maybe even create an ability we wouldn't otherwise have to embed some of these practices in our own organization. You know, for example, one of the things that these high reliability safety organizations do extremely well is they move upstream on their measurements.

00:09:09:21 - 00:09:43:20
Randy Fagin, M.D.
They don't just look at the thing that happened, the mortality, the fall, the pressure ulcer, the complication. They move upstream from that to the near misses, the behaviors, the environment. How do you measure the compliance with environmental safety measures, with behavioral safety processes with near misses? And moving upstream from measurement is challenging, honestly, because there's a hospital system wired to measure all those downstream events, we're literally not wired to measure a lot of those upstream events.

00:09:43:23 - 00:10:09:28
Randy Fagin, M.D.
And I believe that AI is going to give us a foundation to be able to measure some of the things that otherwise we wouldn't be able to measure. There is a lot of "if, then" pattern recognition and behaviors in signals that we are collecting that when aggregated by AI, serve as that upstream measure that we otherwise wouldn't have access to by any other means.

00:10:10:00 - 00:10:36:07
Chris DeRienzo, M.D.
I love that point. You know, I remember being a NICU fellow. And the NICU that I trained in had something like 65, 70 beds. And I remember thinking to myself, I met like the sickest kids bedside right now, but I wish that there was some kind of technology that wasn't relying on individual humans to be heroic, to recognize which kids is the next bedside that I'm going to be at, and is there anything we can do about it beforehand?

00:10:36:15 - 00:10:54:19
Chris DeRienzo, M.D.
And you're right, I think that is the promise of both this predictive technology, but also we see that the generative technology being adopted in a number of use cases. Are there use cases that you all are working with today across the HCA landscape that you think are worth highlighting for our listeners?

00:10:54:21 - 00:11:22:11
Randy Fagin, M.D.
Yeah. So we started where most folks start, which is, I'll call it the Safe Zone. Like we start with those areas that are low risk for our enterprise, which means not clinical, not patient care. Those are the higher risks. So we started in areas of workflow inefficiencies. Staff scheduling, that those sort of things that create cognitive and administrative burden that can be offloaded in a way that makes it more efficient and more consistent.

00:11:22:11 - 00:11:47:09
Randy Fagin, M.D.
So that's where we started. Where we're moving to, and we actually have inside of HCA Healthcare, a digital transformation innovation arm of the company - Dr. Michael Schlosser, one of my colleagues, leads that body of work. And a number of us, myself included, serve as business unit owners over sectors of it. So one of the business units that I sit over as a sponsor is clinical AI.

00:11:47:12 - 00:12:14:03
Randy Fagin, M.D.
You know, how do we use signals from our environments to inform decision making? And I think that last point of informing decision making is a really important one. We do not see AI as a replacement for decision making. This is not going to tell a doctor what they should or shouldn't do. This is not going to, you know, force algorithmic approaches to environments that require a level of expertise

00:12:14:03 - 00:12:40:15
Randy Fagin, M.D.
and a person who's been trained in the care of that patient, that specialty, to make that final decision. But I do believe, and we've seen already that AI is a vehicle for us to, I'll say democratize understanding of certain concepts that may have varying levels of understanding based on the experience of the individual. And by democratizing understanding, if you reduce the variance in the knowledge base, you reduce the variance in decision making.

00:12:40:17 - 00:13:03:26
Randy Fagin, M.D.
And if you reduce the variance in decision making, you reduce the variance in outcomes. And one of the areas that we've started in this space clinically is in partnership with GE Healthcare and building out a vehicle for measuring fetal heart rate tracings. And in an oversimplified way, there's fetal heart rate tracings, and you know this better than I do, fetal heart rate things that are it's totally fine.

00:13:03:26 - 00:13:34:18
Randy Fagin, M.D.
All is good. There's tracings there that are "this is really bad. Intervene quickly." And then there's a bunch of stuff in the middle. And it literally is like a bell curve where the lion's share of it is kind of like, it's not good, it's not bad, we need to keep an eye on this. So we've been actually training an AI algorithm, and it's being submitted for FDA approval to be able to recognize those ones that are in the middle and swing them to the left or to the right and say, are these more likely to be something we don't need to worry about?

00:13:34:18 - 00:14:00:07
Randy Fagin, M.D.
Or are is more likely something we do need to worry about? And by doing that, empower physicians with the knowledge to make more informed decisions that are less dependent on their individual experience and more dependent on their knowledge and expertise. And I think that's a remarkable and important way that we can impact... well, I mean you know, certainly as a neonatologist, one of our most vulnerable populations.

00:14:00:07 - 00:14:31:22
Chris DeRienzo, M.D.
Most definitely, Randy. And, you know, when I think about what you're describing, what it solves for is there would never be enough human workforce to be able to watch every single one of those strips over thousands of hours, over thousands of patients, to be able to identify those, those patterns. And that is where AI is making a difference today, is helping with pattern recognition and consuming and monitoring reams of data right now, which is staying as data and not being transformed into information.

00:14:31:24 - 00:14:49:04
Chris DeRienzo, M.D.
And it comes as no surprise to me that that you all are leading the way in trying to help drive the bus to a place where this AI enabled technology is making a difference not just for patients, but for our workforce. And, Dr. Fagan, it has been a real privilege. Thank you again for joining us on the podcast.

00:14:49:04 - 00:14:59:22
Chris DeRienzo, M.D.
We will clearly want to ask you back, as you have brought the AI technology through all the processes it needs to go to because I'm confident the outcomes are going to be a pretty significant in a few years.

00:15:00:00 - 00:15:25:15
Randy Fagin, M.D.
Well, thank you, Chris. And we are excited about the journey and committed to sharing our learnings with others. One of the things that we feel very strongly about is those things that we learned to do, not just once but at scale, are things that need to be shared broadly with the enterprise, kind of writ large, to ensure that everybody benefits from the from this body of work, because at the end of the day, we're all caring for our communities and we need to do this together.

00:15:25:17 - 00:15:39:11
Chris DeRienzo, M.D.
You know, I think that's where we're going to have to leave it for the end of part one. We got to have some suspense for folks to build into the next part of our conversation. So, thanks for listening today. And stay tuned because the next episode is going to drop very soon.

00:15:39:13 - 00:15:47:25
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:00 - 00:00:33:17
Tom Haederle
Welcome to Advancing Health. It's a sad reality that the health care professionals in the business of healing others are among those likeliest to face violence in the workplace. In today's podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board chair of the American Hospital Association, she speaks with one of our nation's most prominent nursing advocates about the best ways to protect the health care teams who do so much for their patients.

00:00:33:19 - 00:01:00:03
Tina Freese Decker
Well, hello, everyone. Thank you so much for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and board chair for the American Hospital Association. Our topic today is a serious one: workplace safety for our health care professionals. Threats of violence in any capacity are never okay. And it is so disappointing that we live in a world where this is a reality and we have to talk about it.

00:01:00:06 - 00:01:35:00
Tina Freese Decker
Workplace violence has become an urgent and pressing concern that impacts the physical and emotional well-being of our teams, the people taking care of people. Health care workers are five times more likely to experience workplace violence that other workers, from verbal aggression to outright physical attacks. Hospitals and health systems are focusing on security, training and violence prevention programs so that we can continue providing the best quality care possible in an environment that is safe for our team members, as well as safe for our patients and families.

00:01:35:03 - 00:02:01:07
Tina Freese Decker
So for our conversation today, I am so pleased to be joined by Claire Zangerle. Claire serves in the dual role of chief executive officer of AONL which is American Organization for Nursing leadership, as well as American Hospital Association senior vice president and chief nurse executive. Claire has been a lifelong advocate for nurses and nurse leaders, holding the role of chief nursing officer at Allegheny Health Network and Cleveland Clinic

00:02:01:13 - 00:02:08:10
Tina Freese Decker
before joining the AHA and AONL team. So welcome Claire. I am so happy that you are joining us today.

00:02:08:12 - 00:02:13:25
Claire Zangerle, DNP, R.N.
Thank you, Tina, and thanks for bringing this topic to the forefront. It is such an important topic.

00:02:13:27 - 00:02:23:14
Tina Freese Decker
So to set the stage, Claire, is there a story or a reason why you are so passionate about this important topic for our field? Besides the obvious?

00:02:23:21 - 00:03:09:01
Claire Zangerle, DNP, R.N.
Yeah, and the obvious is there. But I can tell you, my first job in nursing was in a trauma unit. And it seems like most violence happens in violent, caring areas, which sometimes is considered behavioral health or trauma units. They're high risk areas, they're areas of great concern. But as we know today, violence happens everywhere. But when I was a nurse in a trauma unit in Houston, I experienced some significant pushback and trauma from patients who came in and they were part of gang organizations and things like that, that they really made us fear for our own safety in the hospital.

00:03:09:09 - 00:03:37:02
Claire Zangerle, DNP, R.N.
And a lot of times, when we were caring for these patients, we also had to care for ourselves because we didn't know what was coming next. We didn't know if the violence that was happening in the streets was going to be brought into our nursing unit. And a lot of times it was. We were very fortunate to have wonderful support from our police force within the unit, but it was not something that we could predict, and that was

00:03:37:02 - 00:04:02:10
Claire Zangerle, DNP, R.N.
the scary part. And as a new nurse, it really informed what I thought was an important aspect of practice and making sure that we felt safe in the environment where we worked, no matter where we worked. Because once those patients were cared for and moved to other areas within the hospital, sometimes that violence followed them and sometimes the threat of that violence followed them.

00:04:02:12 - 00:04:11:00
Claire Zangerle, DNP, R.N.
So that's had a big impact on me, as a new nurse and has stuck with me throughout my nursing practice and into leadership.

00:04:11:03 - 00:04:37:13
Tina Freese Decker
Absolutely. That is scary. And it's stress invoking. And that isn't good for any of our health either. So very challenging. I'm sure nursing has its rewards and taking care of patients. But then the fear and then the actual violence, that's something that no one should go through. So looking back at your career and your experiences, how can our hospital field best collaborate to make our environments safer for our team members?

00:04:37:15 - 00:04:40:17
Tina Freese Decker
Are there any best practices that come to your mind?

00:04:40:19 - 00:05:21:21
Claire Zangerle, DNP, R.N.
Yeah. You know, we talk a lot because I am a nurse. I talk a lot about violence against nurses and everything, but it's the whole team. In every unit, every care setting, no matter whether it's acute care, ambulatory post-acute care, there is more than just the nurse there. It's an entire team. In thinking about how we can keep that entire team safe is, I think, a focus of a lot of the things that I've seen, a lot of the initiatives that have happened with the escalation in violence. I can tell you an experience for me, when I was the chief nurse executive at Allegheny Health Network in Pittsburgh, we recognized

00:05:21:27 - 00:05:49:07
Claire Zangerle, DNP, R.N.
the need for an increased security force. Now, a lot of hospitals had, well, you know, security companies that would come in and they would they would be the security company. But having a true certified police force is a totally different game. And that was a very important thing that Allegheny Health Network and Highmark Health, which was our parent company, did for us at Allegheny Health Network.

00:05:49:07 - 00:06:26:26
Claire Zangerle, DNP, R.N.
And here's what made a huge difference. Those police officers didn't just sit in an office watching cameras all day. They walked the beat. That's what we called it, walking the beat, essentially. They walked the nursing units. They had presence. And it almost felt like as if we were in a city. They were walking the neighborhoods, getting to know the staff, getting to demonstrate presence on units. That helped just the collateral benefit of the de-escalation of any type of issue that would happen between families that had issues

00:06:26:26 - 00:06:58:08
Claire Zangerle, DNP, R.N.
you know, because there's a lot of family dynamics that go on in some of these nursing units, especially when a loved one is ill. Just that presence of having those police officers around, that immediate feeling of safety, gave us all great collateral benefits. And we loved that. And I encourage all organizations to take that tact, because a hospital is a neighborhood, a hospital is a big city and there's different neighborhoods, which are the different units and the different care settings within that same facility.

00:06:58:10 - 00:07:28:08
Tina Freese Decker
I agree, having well-trained security and having them be part of our team is so important to really know what's going on. And so it's also there's a comfort and willingness to call them whenever you need help, even if it's something you need to stand close to your own kids, there's something happening. So having the security forces, having dogs in places, having other security elements is critical for all of our hospitals and clinics, to make sure that we're taking care of our patients.

00:07:28:10 - 00:07:35:19
Tina Freese Decker
Well, we're talking about best practices. Are there any AHA or AONL or any other resources that you want to mention for this?

00:07:35:21 - 00:08:03:06
Claire Zangerle, DNP, R.N.
AHA has a lot of resources. There are toolkits. There are guiding principles. We have the Hospitals Against Violence initiative. Raising the awareness of the resources that are there is something that both AHA and AONL do well. And I would encourage all members to take a moment to go to both of our websites and look for those resources, and it depends on what you need.

00:08:03:10 - 00:08:46:02
Claire Zangerle, DNP, R.N.
I would say that there is something on either or both of those websites that are chock full of resources. If there's something you need, it's there. And if there's something that you don't see there, I would love to hear what you need that we can explore and pull in together. AONL is focusing on incivility and bullying in the workplace with our Healthy Work Environment Committee, because that is an element of workplace violence that sometimes is overlooked, and sometimes it's about accountability and making sure that we address those uncivil behaviors, the bullying behavior, because that is the beginning of violence. Violence is on a continuum,

00:08:46:05 - 00:09:05:23
Claire Zangerle, DNP, R.N.
that's where it might start. And that's something that we're addressing. We work with the Emergency Nurses Association to come up with guiding principles in the toolkit. The American Hospital Association has toolkits on their site as well. So I would say that there are a lot of resources out there for our members.

00:09:05:25 - 00:09:21:02
Tina Freese Decker
So let's talk about team member well-being. Given our ever present challenges and delivering care, which are now coupled with those increasing acts of violence, how can we best support our team members safety and their overall well-being?

00:09:21:04 - 00:09:49:10
Claire Zangerle, DNP, R.N.
The first thing is, is that no team member should go to work scared for themselves. They should not be scared of the environment that they're going into. That is not a way to work and they do not have to tolerate that. A lot of times when we have an event and we're talking to a team member after the event, they kind of brush it off and say, well, this is just part of my job because this happens all the time.

00:09:49:13 - 00:10:15:10
Claire Zangerle, DNP, R.N.
It's not supposed to be part of your job. If something happens, report it, don't tolerate it, have zero tolerance for yourself as an employee, and leaders have zero tolerance. Zero tolerance for those coming into the hospital and committing those violent acts against our health care workers and the incivility and bullying within our own health systems and within our own employee base.

00:10:15:12 - 00:10:33:21
Claire Zangerle, DNP, R.N.
The work environment is so important. We spend so many hours a day at work that we want to feel safe going to work. We want to feel safe in the place where we work. We also want to feel safe as we're going from parking our cars or riding the shuttle bus to and from work. There's got to be adequate lighting.

00:10:33:21 - 00:10:49:28
Claire Zangerle, DNP, R.N.
We have to feel safe because we're a 24/7 operation in our acute care facilities. Some people come in the dark and they leave in the dark and they want to feel safe. So I think that has a huge impact on whether people decide to stay in the environment where they work or they leave.

00:10:50:04 - 00:10:58:23
Claire Zangerle, DNP, R.N.
And I think it's incumbent upon us as leaders and incumbent upon organizations to ensure the safety of employees.

00:10:58:25 - 00:11:21:00
Tina Freese Decker
There's so many things we can do for all the things you mentioned, like lighting is critical. Rides to cars. I know that many of our organizations have apps for mental health as well. Also, training for self-defense and how to how to navigate in different situations. My last question is just for part of AHA and AONL,

00:11:21:00 - 00:11:28:20
Tina Freese Decker
can you share a little bit about what is being done from an advocacy perspective, and how we can all join together to support those efforts?

00:11:28:23 - 00:12:02:07
Claire Zangerle, DNP, R.N.
Yes. What we do know is that other industries have federal protections against violence in their own work settings. A good example of that is airline workers, airport workers. It's a federal offense to enact violence against those workers. We don't have that in health care. That is something that we are focused on. There is legislation in the House right now that has been reintroduced because it was introduced many years ago and never moved forward.

00:12:02:12 - 00:12:29:05
Claire Zangerle, DNP, R.N.
But those that introduced it before have retired. And there are a new group of legislators that have taken up the mantle and said it should be a federal offense to commit an act of violence against a health care worker. Now, is that 100% going to stop people from doing that? No, but we know it's a mitigation tactic. We know that it's that it's something that will get offenders attention.

00:12:29:07 - 00:12:54:12
Claire Zangerle, DNP, R.N.
And right now it is around May of this year it was reintroduced and it's moving through the legislative process. AHA and AONL wholeheartedly support the passage of this act. It's called the SAVE, S-A-V-E Act. And we are excited and, focused on getting this passed so that we can have federal protections for our health care workers.

00:12:54:15 - 00:13:13:00
Tina Freese Decker
Thank you so much, Claire, for your time today, for sharing your insights and for all the work that AONL and AHA are doing to support our teams and our nursing leaders and all those in our hospitals facilities. As Claire mentioned, if there is something missing from the website, feel free to reach out to say I have another question,

00:13:13:00 - 00:13:31:19
Tina Freese Decker
I want to know where this is. We also could use all of your support on advocacy for the SAVE Act as we look at the federal perspective, also in our states. So thank you so much, Claire, for joining us. And thank you to all of you, our viewers and listeners for finding the time to tune in. We will be back next month for another Leadership Dialog conversation.

00:13:31:22 - 00:13:40:02
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:00 - 00:00:26:07
Tom Haederle
Welcome to Advancing Health. Here is a health statistic that hasn't changed in an amazing 75 years. Since 1950, cardiac issues, specifically heart disease, have remained the leading cause of death in the United States. But in Colorado, one hospital is using an innovative new tool to chip away at that stubborn reality.

00:00:26:10 - 00:00:49:06
Tom Haederle
I'm Tom Haederle, senior communications specialist with the American Hospital Association. Glad you can join us. And I'm also really pleased that Josh Neff could join us. Josh is president of Mercy Hospital in Durango, Colorado, an area of the state known as the Four Corners region, and is here today to talk about how Mercy is using a cutting edge communications tool called Pulsara to assist patients who are dealing with cardiac issues.

00:00:49:08 - 00:00:53:09
Tom Haederle
Josh, thank you so much for joining me on Advancing Health today. Really appreciate you being here.

00:00:53:12 - 00:00:59:11
Josh Neff
Yeah. Tom. it's a pleasure. It's a great opportunity to talk about some really great things we're doing in southern Colorado for cardiac care.

00:00:59:13 - 00:01:03:23
Tom Haederle
Well, let's start with the basics. What is Pulsara? And how is Mercy Hospital using it?

00:01:03:26 - 00:01:41:12
Josh Neff
So Pulsara is ultimately a field to hospital communication tool. And we've got a large and remote area. Sometimes our response times are lengthy in southern Colorado, especially in the Four Corners area we've got a lot of mountain passes. When it's, when it's snowy, it creates some really delayed times getting critical patients to the hospital. And so Pulsara is really a way for us to connect and communicate with our pre-hospital providers across our seven counties that we serve in southern Colorado and northern New Mexico, where for patients who are having chest pain and cardiac related issues, EMS has progressed over the last decade or two, and we've now got paramedics and other

00:01:41:12 - 00:01:58:10
Josh Neff
folks that are doing 12 lead EKGs in the field, as soon as they arrive at the patient. And that's a really important thing for us to know and understand. How do we get that EKG to a cardiologist that's at a hospital 20 or 30 miles away, or maybe more? And so Pulsara really bridges that gap for us.

00:01:58:13 - 00:02:29:26
Josh Neff
It allows those pre-hospital teams to transmit that EKG in a HIPAA compliant manner directly to the cardiologist on call. And that cardiologist then is able to help the pre-hospital team manage that patient clinically. That also allows us to be more prepared if that patient is actually having a STEMI or a heart attack. It allows us to have our teams ready and prepared so that that patient goes directly to the cath lab and undergoes cardiac treatment in a shorter period of time.

00:02:29:29 - 00:02:48:11
Tom Haederle
Take us inside the ambulance itself if you would for a minute. So you've got a patient in there who's having a cardiac issue enroute to the hospital. Could be a long drive ahead. What is happening in the ambulance itself and how are EKG and other vital signs - how is that all being monitored and transmitted? How does that happen?

00:02:48:13 - 00:03:13:21
Josh Neff
There's both Bluetooth and direct wired technology capability between. Basically it's transmitted over cell service. And even in the remote areas where cell service is a little bit patchy, the Pulsara system is accumulating this data in the background. And as soon as it hits a signal, it automatically transmits which allows that pre-hospital team, those paramedics and EMTs to be focused on working on that patient and providing care.

00:03:13:21 - 00:03:28:23
Josh Neff
As a former pre-hospital guy - so as a ground paramedic and a flight paramedic way back in the day - we didn't have this technology and it's really comforting for the team to be able to know that they've got a group of specialists just at their fingertips that can help us and help them care for that patient.

00:03:28:23 - 00:03:47:17
Josh Neff
And so basically, they get the machines hooked up. Pulsara can connect directly to their cardiac monitors. And so it feeds through that system and electronically can transmit a wide amount of data to us and to our caregivers that are that are at Mercy Hospital ready and waiting for that patient to come in.

00:03:47:20 - 00:03:53:03
Tom Haederle
And so what do they do with that information? Once it is transmitted? That helps with treatment plans?

00:03:53:03 - 00:04:10:08
Josh Neff
It does. So during the day, we've got our cath lab. We have two cath labs at Mercy Hospital. We're the only cath lab program in the southern part of the state and serving northern New Mexico. And so we've got folks on call or in the department every day. However, if it's after 5 or 6:00 at night, we've got an on call team.

00:04:10:10 - 00:04:30:13
Josh Neff
The goal is really with this to reduce the amount of time from first medical contact to device. And device is kind of that reperfusion or the treatment time that's tracked by all of the accrediting agencies. We know that the earlier we perfuse an artery, it leads to better outcomes. And that's both in-hospital mortality as well as long term recovery.

00:04:30:13 - 00:05:04:12
Josh Neff
And so what it allows us to do specifically at Mercy - before implementing Pulsara are we had about 130 minutes from first medical contact to reperfusion times. I mean, our cardiology team has worked with Los Pinos CMS, Pagosa Springs Hospital, Upper Piney EMS, all Durango Fire Department, and a number of other agencies. This year, since we've implemented Pulsara, we've been able to reduce that time from first medical contact to perfusion from 130 minutes to 84 minutes.

00:05:04:12 - 00:05:32:15
Josh Neff
So we've seen a 35% decrease in time, because typically what would happen is that patient would come to the ER, they'd have a repeat EKG, yes, you're having a STEMI. We should have the cardiac team here. You need to go to the cath lab. They'd have to, you know, drive in from where they were. And so what this has allowed us to do is our cardiologist directly receives this EKG on a cell phone, is able to interpret the EKG, and he or she makes the call in real time.

00:05:32:17 - 00:05:42:20
Josh Neff
This patient's having a STEMI. Hits the button, alerts our cardiac teams. And so that patient can come directly to the cath lab and undergo treatment immediately.

00:05:42:22 - 00:05:54:00
Tom Haederle
That's remarkable. And being able to shave that much time off from the older way of doing things prior to Pulsara, what kind of results has that yielded so far in terms of patient outcomes?

00:05:54:02 - 00:06:14:01
Josh Neff
So we know that that time is tissue. We are in the process of tracking the official data. What I can tell you anecdotally is we're seeing patients with shorter hospital stays getting back home and back to work and back to play in a shorter amount of time. And we're seeing better outcomes clinically for them as well.

00:06:14:06 - 00:06:26:07
Tom Haederle
That's just amazing. What kind of training is involved in using the Pulsara system, both for Mercy Hospital, ambulance employees, EMS people...is it a complicated thing to get the hang of, or not really?

00:06:26:10 - 00:06:46:21
Josh Neff
It is not. If you can operate your social media apps on your cell phone, you can understand and operate Pulsara. It is that simple. It's intuitive. It knows how to store the information, what to send. And so when those pre-hospital folks hit that send button, it just automatically alerts the team that's on the receiving end of it.

00:06:46:21 - 00:06:59:16
Josh Neff
So those folks who have the same Pulsara on their communication devices. They get an alert, they can go right in and tap the picture, look at the EKG. They can look at vital signs, a number of different things. So it is very easy to use.

00:06:59:19 - 00:07:05:26
Tom Haederle
What about the cost involved? Is that something that is within the budget, would you say, of many hospitals or health systems?

00:07:05:29 - 00:07:21:09
Josh Neff
Yeah, it is, it is not an overtly expensive investment. And it's an investment in clinical care and quality outcomes. So it made all the sense in the world for us to do it. We know that if we can save one life over the course of a period of time, then those investments are well worth it.

00:07:21:09 - 00:07:31:01
Josh Neff
But, I would say to any hospital CEO as well as the EMS programs that are out there, it is an affordable program that you can and you can easily integrate.

00:07:31:04 - 00:07:39:23
Tom Haederle
Would it be as helpful, do you think, for hospitals in more urban areas that really aren't looking at the same transport times, you know, with that patient in the ambulance?

00:07:39:26 - 00:07:57:02
Josh Neff
I think it could be used widely across all markets. I mean, I was in on the Denver Front Range before I moved to Durango. And, you know, it may take you 45 minutes to go 6 or 7 miles if you hit traffic wrong or there's a wreck. And so time is still tissue, and it's still important for those patients to receive timely care as well.

00:07:57:02 - 00:08:14:27
Josh Neff
And so it extends our ability for our cardiac specialists to have eyes and ears in the field, in the ambulance and understand what's going on with the patient. It allows our clinical teams to be thinking about, you know, what kind of STEMI does this look like? What should we be prepared for when this patient comes in the door?

00:08:15:00 - 00:08:34:02
Josh Neff
You can have a heart attack and still have pretty stable vital signs. You can also have a heart attack and be really, really sick with unstable vital signs. And so being able to communicate that to our team just allows them to mentally prepare for what's about to come through the door. You know, listen, I was doing pre-hospital care in the early and mid 90s

00:08:34:05 - 00:08:52:27
Josh Neff
And we didn't have this technology and we serviced some real markets. And, this would have been a game changer back then. I know for sure that this technology is saving lives and impacting the people who live and work in my community, and that's important to me. That's why I'm passionate about being the CEO of this hospital.

00:08:52:29 - 00:09:01:19
Josh Neff
That's our role in this world, is to make sure that we're taking great care of our community in a way that's meaningful, and this is just another tool in our toolbox that allows us to do that.

00:09:01:22 - 00:09:11:25
Tom Haederle
Well, thank you so much for your description of what it offers and how you're putting it to use. And, and thank you for the great care that you're offering your patients every single day. Really appreciate you being on Advancing Health today.

00:09:11:28 - 00:09:15:17
Josh Neff
Yeah, it's a pleasure. Thanks for asking us to talk about this.

00:09:15:19 - 00:09:24:01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.