Advancing Health Podcast

00;00;00;04 - 00;00;13;24
Tom Haederle
Welcome to Advancing Health. Coming up in today's podcast, why isn't a normal phase of life that affects all women met with more understanding and attention by the medical community?

00;00;13;27 - 00;00;39;23
Julia Resnick
All women who are fortunate enough to live till middle age experienced menopause. Yet for something that impacts half the population, menopause remains one of the most overlooked areas in health care. It's time for that to change. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. On today's episode, I'll be talking with two leaders in menopause research and practice from University of Illinois at Chicago's College of Medicine.

00;00;39;25 - 00;01;03;22
Julia Resnick
Dr. Pauline Mackie is a professor of psychiatry, psychology and obstetrics and gynecology. And Dr. Makeba Williams is a professor in the Department of Obstetrics and Gynecology. Together, they are the leaders of the Center for Health Awareness and Research on Menopause. Also known as CHARM. We'll be discussing why menopause awareness matters and how hospitals can step up to provide better, more responsive care to women as they age.

00;01;03;25 - 00;01;10;13
Julia Resnick
So let's get right into it. Dr. Williams, Professor Maki, thank you so much for being here for this conversation.

00;01;10;15 - 00;01;12;08
Makeba Williams, M.D.
Thank you so much for having us.

00;01;12;10 - 00;01;13;17
Pauline Maki, Ph.D.
It's great to be with you.

00;01;13;20 - 00;01;26;18
Julia Resnick
So let's do a little bit of level setting for our listeners. How does menopause affect women's health as they age and why should health systems and clinicians be paying closer attention to it? Dr. Williams, let's start with you.

00;01;26;20 - 00;02;04;23
Makeba Williams, M.D.
We know that about 1.5 million women will become menopausal every year, and that's half of the world's population. Menopause follows the aging ovary and we see declines in many of those hormones, namely estrogen. Estrogen has an important role throughout the body, binding to more than 300 receptor sites. And as a consequence of the changes in hormones, the changes in estrogen, and the eventual decline, we can see changes throughout many of the organ systems within the body.

00;02;04;26 - 00;02;40;28
Makeba Williams, M.D.
We see changes to our cardiovascular systems, our neurocognitive systems, our muscles, our bones, our urinary systems, brain mood, you name it. There can be many changes. And these changes also present at a critical, pivotal time in a woman's life. And we see this as a window of opportunity to optimize health, to optimize and minimize disease - states that may present during this critical midlife window.

00;02;40;29 - 00;02;54;23
Makeba Williams, M.D.
So this is an important area of health because these symptoms, unaddressed symptoms, can impact overall quality of life, well-being and have social and economic consequences as well.

00;02;54;25 - 00;02;57;16
Julia Resnick
Professor Maki, anything you want to add to that?

00;02;57;18 - 00;03;13;06
Pauline Maki, Ph.D.
I think it's really important for women, both in their immediate lives - what can I do right now to feel better - and also to understand the long term consequences of the decisions that we make at this point in our lives for our long term health.

00;03;13;08 - 00;03;22;19
Julia Resnick
Half of the population experiences this, and it seems like right now menopause is kind of having a bit of a moment in public conversation. Why do you think that is?

00;03;22;22 - 00;03;58;11
Pauline Maki, Ph.D.
I think most of this started when there was an introduction of the first FDA approved, highly effective non-hormonal medication for hot flashes. And with that came advertising at the Super Bowl and the Golden Globes. And people were like, what is VMS?" Paired with that was a highly influential article that came out in the New York Times Sunday Magazine saying, women have been misled about menopause.

00;03;58;13 - 00;04;30;18
Pauline Maki, Ph.D.
And that was the number one gifted article of all articles in The New York Times that year. So women were asking questions. There was a new solution that might have addressed women's fears about using hormone therapy and possible risks to their health. And we hit it. And I would say it's beyond a moment now. It is everywhere. And I think that's a beautiful thing because we're not feeling the stigma that we used to feel about menopause.

00;04;30;19 - 00;04;40;08
Pauline Maki, Ph.D.
We're having the conversation. So now we just need to meet the questions with the appropriate evidence-based answers.

00;04;40;10 - 00;05;07;12
Julia Resnick
Yeah, and I've definitely noticed that too. Like talks of the estrogen sticker are everywhere. And you know, 40 isn't old anymore. It's our generation who's using Instagram and all the other social media to elevate these issues beyond just medical encounters with doctors. Despite all of this, I know there continue to be gaps in awareness in research. So what do you think those gaps are and how can we help fill them?

00;05;07;14 - 00;05;46;21
Makeba Williams, M.D.
Well, we certainly see that there are gaps in medical education, medical training that have left many clinicians, whether it's a physician, a physical therapist across the healthcare spectrum have been left underprepared to meet this increased awareness, the increased demand and self-advocacy that we see many women and patients expressing during this time period. We know that we have to work really hard to meet those existing gaps in medical education and training, so that we are better providing care for women.

00;05;46;23 - 00;06;01;24
Makeba Williams, M.D.
Additionally, we know that there's more research. My colleague Dr. Maki can certainly address that, but there are some clinical and research questions that we also need to be answering while we are meeting these unmet needs and training.

00;06;01;26 - 00;06;04;29
Julia Resnick
Professor Maki, can you talk a little bit about what those are?

00;06;05;02 - 00;06;35;16
Pauline Maki, Ph.D.
It's important firstly to recognize that we do know a lot about menopause. I think we hear, oh, we don't know anything about menopause. And that's just not true. We have guidelines that are, you know, 3 to 4 inches thick because of the amount of evidence-based information we have on menopause. And of course, we need to know more. We know a lot from the Gold Standard Natural history study, which is the study of women's health across the nation, or SWAN.

00;06;35;18 - 00;06;57;11
Pauline Maki, Ph.D.
And that really told us what happens to our bodies that's due to menopause versus the fact that we're getting older versus a combination of the two really important information for women to know. Because if a symptom or a change is menopause related versus if it's aging related, sometimes that can tell us that the treatment is different depending on the cause, right?

00;06;57;11 - 00;07;24;24
Pauline Maki, Ph.D.
So that's really important. But that study was initiated back in the mid 1990s. And our population has changed. Thankfully our scientific methods have changed. They've gotten better. And we also have a better sense of what biomarkers. What should we be measuring in the blood? What should we be measuring in my own work in the brain, for example? And so I think we're ready for an overhaul of kind of the next generation of science on this area.

00;07;24;25 - 00;07;55;15
Pauline Maki, Ph.D.
And in addition, we have some really important clinical questions, a lot of questions about hormone therapy. I think we have a very good understanding of what it's good for and what it's not good for. We have perhaps less of an understanding of the perimenopause. This really for some women and not for all, clearly, 29% of women sail through menopause without a problem, but for some women the perimenopause is really problematic and you know, we don't have any FDA approved medications for symptoms in the perimenopause.

00;07;55;15 - 00;08;13;03
Pauline Maki, Ph.D.
So I think that in particular is an unmet need in women's health. What's the best way to treat the perimenopausal woman who is having a new onset of cognitive symptoms or mood symptoms. How do we best help women along the life course of the menopause transition?

00;08;13;06 - 00;08;30;03
Julia Resnick
Absolutely. And how do we help women so they don't have to suffer through this period of several years? I'm sure that there are differences in how people experience menopause in different communities, in different populations. Can you speak to that at all? And what factors might drive those differences?

00;08;30;06 - 00;09;02;09
Makeba Williams, M.D.
The study of women's health across the nation was a multi-site, multi ethnic cohort study that looked at various groups of women: Chinese women, African American women, Hispanic women, as well as white women to detect differences and how women were transitioning into menopause. We looked at seven different cities across the nation. Cities like Chicago, Detroit, Pittsburgh, Newark, Oakland and Los Angeles.

00;09;02;10 - 00;09;40;01
Makeba Williams, M.D.
And from this study, we gleaned that while menopause is a universal event experienced by women who live long enough with their ovaries, the ways in which these women experience it is very unique. So we saw some differences. Where we saw that women of color, African-American women will experience these hot flashes and night sweats for a longer duration. In fact, it was about ten years compared to white women who experienced these symptoms for 6.4 years.

00;09;40;03 - 00;10;07;19
Makeba Williams, M.D.
We saw differences not only in the duration of symptoms, but also in the intensity as well as the frequency. And though this study is more than 30 years old, we are continuing to glean differences and there is more yet to be learned, because that was seven cities across the country. And we know that the demographics of our country have changed.

00;10;07;19 - 00;10;21;02
Makeba Williams, M.D.
So there is much more to learn. But we know that this is a very unique experience, and we need to pay attention to those cultural factors that drive these differences.

00;10;21;04 - 00;10;38;11
Julia Resnick
My one sentence takeaway is that women are complex, and the experience of being a woman differs by woman. Care needs to be individualized to that person. So I want to make sure we talk about CHARM, the center that the two of you lead. Can you tell us about what that is and what you're learning through it?

00;10;38;13 - 00;11;05;12
Pauline Maki, Ph.D.
So the Center for Health Awareness and Research on Menopause was launched last March in an effort to really consolidate everything that we've been doing in this arena in those mission areas. So we've been raising awareness both individually and through our engagement with different societies. Dr. Williams is the president-elect of the Menopause Society. I'm the past president of that organization.

00;11;05;13 - 00;11;37;12
Pauline Maki, Ph.D.
I'm also the current general secretary of the International Menopause Society. And so it's really important that we have these academic medical society partnerships and raising awareness. And we also recognize that the University of Illinois, Chicago, we serve the underserved in Chicago. And so consistent with our mission, we want to do a lot of awareness raising and research and education that address our patient population's needs.

00;11;37;14 - 00;12;01;06
Pauline Maki, Ph.D.
And this is who we focus on in our studies. This is who we focus on in our educational efforts as well. So we want to continue the research that we've been doing -imagine now for more than 25 years of continuous NIH funding. So we're considered old guard. We've been doing this, it's our bread and butter for quite a long time.

00;12;01;09 - 00;12;41;29
Pauline Maki, Ph.D.
And as one of the largest medical schools in the nation, we're in the top three depending on the year. We have a responsibility to make up for these decades of lack of education. And so we're really paving the way, leading efforts to get funding to introduce the medical school curriculum that all of our medical students need, so that the kinds of stopgap measures that Dr. Williams mentioned, you know, training current providers in the field can really be something we do for just a few years so that the actual training is integrated more into medical school and residency training.

00;12;41;29 - 00;12;52;17
Pauline Maki, Ph.D.
So we have an active portfolio of research and activities in all of those mission areas in an attempt just to do better by women.

00;12;52;20 - 00;12;55;28
Julia Resnick
Fantastic. Dr. Williams, anything you want to add?

00;12;56;00 - 00;13;28;23
Makeba Williams, M.D.
You talked about health care system access. One of our initiatives in CHARM is to look at our clinical care delivery models. With increasing demand for menopause care among women and providers that have been underprepared, this presents a challenge, a challenge to access. When we look at where our gaps in care, it would be accessing providers who are certified menopause providers who have been appropriately trained.

00;13;29;00 - 00;14;07;01
Makeba Williams, M.D.
And so while we are working on training and educating the workforce, we're also looking at deploying creative clinical models that can scale the access gaps. Looking at how do we deploy care right at the point of need in the way that communities need that. That might look like shared medical appointments or group medical appointments so that we can deliver community based cares. Working with community health workers, using innovative technologies and telehealth to meet the rural needs of menopause women.

00;14;07;02 - 00;14;17;09
Makeba Williams, M.D.
So that is part of what we do at CHARM is to serve as a think tank, a testing ground for these innovative care delivery models.

00;14;17;12 - 00;14;37;26
Julia Resnick
So you are clearly looking towards the future of health care in your work, whether it's those care models or training the next generation of the workforce. So as you look ahead to the next to the next guard of menopause care and advocacy, how would you like to see care evolve? And also, what is one thing that you want women to understand about this stage of their lives?

00;14;37;29 - 00;15;12;07
Makeba Williams, M.D.
Certainly, we need to get menopause care out of silos. Menopause is it cuts across organ systems as we talked about, and it can't be relegated just to the obstetrician or gynecologist. We need the dermatologist on board. We need the physical therapists on board, the pharmacists on board, so we need to make sure this care is recognized and delivered across specialties and across disciplines.

00;15;12;08 - 00;15;50;07
Makeba Williams, M.D.
So raising that awareness is critically important so that we can have an all hands on deck situation when it comes to menopause. And I would also like to see that the those experiencing menopause see this as an opportunity to optimize health. Women are going to spend more than 40% of their lives during this time period. So recognition by health care providers and those who are experiencing menopause of the grand opportunity we have to improve health overall is essential.

00;15;50;07 - 00;15;53;03
Makeba Williams, M.D.
And what I would like to see in our future.

00;15;53;06 - 00;15;55;25
Julia Resnick
Fantastic. And Professor Maki?

00;15;55;27 - 00;16;20;17
Pauline Maki, Ph.D.
I couldn't agree more with that. You know, menopause care should be primary care. It's a universal phenomenon for women, right? So that's how we view menopause care at term. But at the same time, we know that if you're a woman with a clotting disorder or with a history of breast cancer, you need a professional like Dr. Williams who really knows how to treat these special and more complicated cases.

00;16;20;17 - 00;16;57;18
Pauline Maki, Ph.D.
So we envision a future where women will be referred when necessary to a menopause specialist, but that really the workforce will be trained en masse to do better by women and to understand the basics of menopause care. This is critically important. I see two technological advances that will help women. There are new technologies that will allow women to measure hormonal dynamics in their home environment, to wear, you know, sensors and wearable devices that will be able to feed objective data forward to their providers to help in their care.

00;16;57;21 - 00;17;28;20
Pauline Maki, Ph.D.
I think we need to be united on the types of symptoms and systems that we measure routinely in women and understand, are we making a difference? We need to measure menopause care effectiveness and to deploy models that really show a high return on investment, both for women's overall well-being and for a hospital system writ large. Because the World Economic Forum estimates that it's $128 billion opportunity in GDP annually.

00;17;28;20 - 00;17;52;27
Pauline Maki, Ph.D.
Imagine that. That's the cost of menopause, largely because women are not performing as well at work and presenteeism and absenteeism become issues. So even if one isn't like we are a cheerleader for women's health, there's just a strong economic argument to be made here. And so we need investment from all sectors.

00;17;53;00 - 00;18;09;24
Julia Resnick
Well, thank you both for being such incredible trailblazers in this field, for raising awareness, for training the next generation of the workforce, so that all women can live long and healthy lives. I really appreciate your sharing your expertise with us. And thank you. Thank you for being here.

00;18;09;26 - 00;18;11;24
Makeba Williams, M.D.
Thank you for having us.

00;18;11;24 - 00;18;14;22
Pauline Maki, Ph.D.
Thank you. It's been great to be with you today.

00;18;14;24 - 00;18;23;05
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:03 - 00:00:13:18
Tom Haederle
Welcome to Advancing Health. Trauma is not a word we hope to associate with childbirth, but it is a reality for many new moms. And it's time we pay attention to it.

00:00:13:20 - 00:00:39:14
Julia Resnick
Welcome to today's episode of Advancing Health. I'm your host, Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. Childbirth is usually a joyful occasion, but for some women, it's the beginning of something much more complicated. Even when parents bring home a healthy baby, the birth experience can be traumatic. And when that trauma goes unrecognized or untreated, it can have lasting impacts on both physical and mental health.

00:00:39:17 - 00:01:01:06
Julia Resnick
Today, I'm talking with the directors of Oregon Health and Sciences University's Perinatal Trauma clinic. Doctors Katie Au and Katherine Jorda will explore how trauma shows up during pregnancy, birth and postpartum, and what it takes to build a model of care that better supports healing and recovery. So let's jump right in. Dr. Au, Dr. Jorda, I'm so happy to be here with both of you today.

00:01:01:08 - 00:01:05:15
Julia Resnick
To start, can you help us better understand what perinatal trauma is?

00:01:05:18 - 00:01:27:15
Katie Au, M.D.
Yeah, I'm happy to start. Thank you so much for having us. It's really a pleasure to be here today. So perinatal trauma can really encompass someone that's had a traumatic birth experience. Which about 1 in 3 parents, are considering their birth experience to be traumatic. So that's a lot of pregnant people and new parents.

00:01:27:18 - 00:01:40:10
Katie Au, M.D.
And about 10% of birthing patients go on to develop the perinatal PTSD, which is like a little bit more of a persisting condition, that can affect folks postpartum and sometimes years after the event.

00:01:40:13 - 00:01:48:00
Julia Resnick
That is a huge proportion of people who give birth. And yet, as a society, I feel like we barely talk about this.

00:01:48:02 - 00:02:13:15
Katie Au, M.D.
Yeah, I would definitely say that that's true. And if we think about, you know, pregnancy and birth, it is one of the most monumental milestones in someone's life. Everyone remembers the moment that they became a parent or met their new baby. And the majority of pregnant patients are people that are young and that are healthy and have never needed to be in a hospital or have an IV, or maybe have never had a surgery before.

00:02:13:17 - 00:02:36:03
Katie Au, M.D.
And many of those things can happen in the childbirth process. And so, a lot of those things can be unexpected. Most people, when they become pregnant, don't anticipate having a complication or something that is difficult or challenging in their birth. And so it's hard to prepare for those things. And for many folks, it's the very first time that they have interacted in the medical system in this way.

00:02:36:03 - 00:02:51:27
Katie Au, M.D.
And it can be extremely challenging. And, when you experience those things at the very same time as becoming a parent for the first time, it can feel really isolating and, you know, be an extreme challenge, in the journey of becoming a new parent.

00:02:51:29 - 00:02:54:27
Julia Resnick
Absolutely. Dr. Jorda, anything you want to add there?

00:02:54:29 - 00:03:17:05
Katherine Jorda, M.D.
I do think some of the societal norms around pregnancy and birth are very rosy, and I do think it makes it hard when a patient finds that their experience is not rosy. They're like, what just happened? Has this ever happened to anybody else? This was not my expectation. And it can come out of left field for a lot of patients.

00:03:17:12 - 00:03:38:23
Julia Resnick
Yeah, I think a lot of people are not prepared that pregnancy and giving birth is really a major medical event. And so when something does go wrong, they feel like it's abnormal when actually it's more the norm. So when we talk about perinatal trauma, it can really look different from person to person. So what are some of the ways that it shows up both during pregnancy and during postpartum?

00:03:38:25 - 00:03:59:12
Katherine Jorda, M.D.
Yeah, I think for a lot of patients, it can come up in a lot of different ways. I think patients who have had a traumatic birth sometimes don't even want to get pregnant at all. They don't necessarily want to come back to the hospital or the clinic where they had a traumatic birth, so they might be lost to follow up.

00:03:59:17 - 00:04:10:22
Katherine Jorda, M.D.
And if they do decide to get pregnant, they might be very hesitant to interact with medical system again after a prior negative experience.

00:04:10:24 - 00:04:13:29
Julia Resnick
Dr. Au, anything you want to add there?

00:04:14:02 - 00:04:36:17
Katie Au, M.D.
I would say that, you know, having a perinatal mood issue can be really common. But that can also be common with a birth that goes really well without complications. So for some patients, we see postpartum blues or anxiety or postpartum depression. With perinatal PTSD, we often see patients that have symptoms that last longer than a month postpartum.

00:04:36:17 - 00:05:01:26
Katie Au, M.D.
The perinatal PTSD symptoms, often show up as reliving a traumatic event or having some more intrusive thoughts, or maybe nightmares. Many folks have trouble with sleep and might have avoidant behavior. And sometimes we see folks that really have trouble bonding with their infant and their child, and those can persist throughout the that first year, that first postpartum year of life.

00:05:01:28 - 00:05:17:27
Katie Au, M.D.
But often many years afterwards. And it's not infrequent that Dr. Jorda I see patients who maybe have changed plans for their families or have decided to delay childbearing, or maybe just have their one child because they're still affected by their symptoms many years out.

00:05:18:00 - 00:05:28:25
Julia Resnick
So I know that your perinatal trauma clinic is one of only a few of its kind in our country. Can you walk us through how the clinic works? What it's like for patients who come to you for care?

00:05:28:27 - 00:05:56:00
Katherine Jorda, M.D.
Sure. Kind of started a few years ago. Both Doctor Au and I worked at the Portland Veterans Administration's hospital. And so unfortunately, a lot of veterans have experienced military sexual trauma. And we had to learn about trauma informed care, which is a framework of taking care of patients, recognizing that prior traumatic experiences might be impacting their current physical and mental health.

00:05:56:05 - 00:06:28:03
Katherine Jorda, M.D.
But we received a lot of on the job training and experience there, and it wasn't really a part of our formal medical student or OBGYN resident curriculum. And we took care of a lot of patients and realized, gosh, there is a role for trauma informed care, too, in obstetrics. Let's set that up. We submitted a grant to start our clinic, and we made the case that patients who've had a traumatic birth need more of a multidisciplinary approach.

00:06:28:06 - 00:06:59:19
Katherine Jorda, M.D.
We are lucky at our institution that we have a robust reproductive psychiatry department, and so patients who've had a traumatic birth would go see our psychiatry colleagues, and then they would see us in obstetrics for either pregnancy care or postpartum. But we found that they were having to tell their story multiple times to different providers. And sometimes patients would ask me about mental health issues that I could try to field, but didn't have as much experience as my psychiatry colleagues.

00:06:59:21 - 00:07:43:06
Katherine Jorda, M.D.
And the same for my psychiatry colleagues. They'd get questions about their birth, and they were like, I just don't feel equipped to answer that. And gosh, could we get all the same players in the room so that the patient could share their story just one time and have both kind of aspects weighed in. And so we started a multidisciplinary clinic where we see patients who have had a history of a traumatic birth or delivery planning and we see them in our clinic, both general OBGYN, myself or Dr. Au, and one of our reproductive psychiatrists or psychologists all together in the same room to do a longer more comprehensive visit.

00:07:43:13 - 00:07:58:28
Katherine Jorda, M.D.
So typically, these visits are twice as long as our routine prenatal care, because we found that we needed the time to delve into both an obstetric history and psychiatric history and develop a plan for the future pregnancy.

00:07:59:01 - 00:08:02:10
Julia Resnick
That's wonderful. Dr. Au, anything else?

00:08:02:12 - 00:08:44:06
Katie Au, M.D.
Yeah, I would just say that, you know, we find that medical care is so siloed and it's like that in so many different specialties or aspects of care. And that's the same for reproductive health and mental health care. And, you know, Dr. Jorda and I would frequently see patients postpartum who really wanted to talk about how it felt to have postpartum hemorrhage or to have an unplanned C-section, and were really good at talking about why someone had extra bleeding or what exactly was happening in the room during their C-section, but not as well equipped to handle the mental health aspects and help folks process that.

00:08:44:08 - 00:09:06:17
Katie Au, M.D.
Same for a reproductive psychiatrist. They're so wonderful at, you know, accessing those mental health resources and tools and making sure that patients are safe and have a plan for follow up. But they didn't really understand why someone had a hemorrhage or why someone had an unexpected C-section and had a hard time answering questions that the patient would naturally have about, you know, will this happen to me again?

00:09:06:19 - 00:09:31:27
Katie Au, M.D.
What would it look like if I got pregnant again? And we just found it to be so incredibly valuable to all be in a room together where we could go through someone's birth experience if or when they feel ready and answer all their questions about what happened during their labor or their birth, or why certain things happen the way that they did, and real time be able to support them best in a mental health capacity.

00:09:32:00 - 00:10:07:18
Katie Au, M.D.
So it just felt really nice to be able to bring those services to patients at the same time. And as Dr. Jorda mentioned, you know, not having people have to relive their trauma multiple times and tell their story to numerous people, was extremely valuable. And I think that's been one of the strengths of our program is that we've identified a safe space so that patients know that they can have someone who's both knowledgeable about the obstetric details, and then also someone who is attentive to the mental health aspect of care, because really, birth trauma is all encompassing like that.

00:10:07:18 - 00:10:11:11
Katie Au, M.D.
And we needed a space to be able to address all of those things at the same time.

00:10:11:13 - 00:10:25:24
Julia Resnick
Absolutely. And I can imagine that there is a like, you need to rebuild trust with patients so that they're trusting the medical system again. What does it take to create that trust and sense of safety, so that you're not just retraumatizing someone with their next birth?

00:10:25:26 - 00:10:50:05
Katie Au, M.D.
I think it all stems with having an open mind and not being defensive about the care that someone has had, or the outcome that someone has had. You know, I can't tell you how many times Dr. Jorda and I will see a patient and they feel really guilty saying that they had trauma related to their birth, or that they were disappointed in their experience because maybe their baby was perfectly fine and very healthy, and they were perfectly fine too.

00:10:50:05 - 00:11:08:09
Katie Au, M.D.
But that doesn't change the fact that the C-section was really hard or really traumatic. And someone feels guilty for sharing those thoughts, or feeling like it was a traumatic experience when, you know, family members will say, but you're healthy and your baby is healthy and your baby's fine, and you guys are both alive, so it's okay.

00:11:08:16 - 00:11:29:10
Katie Au, M.D.
It just brushes off those complex feelings that people have, because you can be really happy about an outcome, and you can really love your family and really love your baby. And you could at the same time be very traumatized by the experience. And both of those things can be true. And I think it just starts with acknowledging that and letting patients know that those things can both be true.

00:11:29:10 - 00:11:34:20
Katie Au, M.D.
And you recognize that you understand that, and you're here to help them.

00:11:34:23 - 00:11:51:27
Julia Resnick
Really normalizing their experience. Hopefully that helps with some of that guilt. So I'd love to talk a little bit about the impact that you've seen. Either through data you're collecting or patient stories. It really illustrates the difference about what this type of care can make for patients.

00:11:51:27 - 00:12:18:20
Katherine Jorda, M.D.
I can think of one patient who is a nurse by training and had a traumatic birth and delivery. We were seeing her for postpartum care and kind of processing all of that, and she had so much guilt about it. She's like, I'm part of the medical field, and I thought that knowing how the medical field works, I should be able to advocate for myself.

00:12:18:20 - 00:12:38:03
Katherine Jorda, M.D.
And I'm a nurse. I advocate for patients all the time. But when you're a patient and you're laboring and you're trying to push out a baby, I mean, those are a lot of identities colliding, and it can be really hard to advocate for yourself, even if you know what the medical system is like and you are a patient.

00:12:38:11 - 00:12:42:00
Katherine Jorda, M.D.
And our patient population often doesn't necessarily interact with

00:12:42:07 - 00:13:13:05
Katherine Jorda, M.D.
the medical system unless they're giving birth. And so I think it can be a really unfamiliar position for patients that can be very, very challenging to navigate. There's also that element of during my pregnancy I had control, I could exercise, I could, you know, optimize my health in preparation for this pregnancy and birth. But now I'm trusting these individuals in this hospital that I may or may not know the delivery team, to help me get through this.

00:13:13:05 - 00:13:40:03
Katherine Jorda, M.D.
And so when things start to go sideways or, gosh, this C-section for this reason wasn't part of the plan or expectation, it can be very difficult for patients. And so as we talked about this person's experience, we tried to normalize and share that. Yeah, maybe you are a nurse, but you're not a nurse and you're a patient at that time, right?

00:13:40:03 - 00:14:03:26
Katherine Jorda, M.D.
Like you can't have such high expectations for yourself and, try to kind of lift that guilt and kind of put it in a perspective. And so we were able to talk and plan for the next pregnancy. And when patients see us, they can continue seeing us for routine prenatal care. Or it can be a one time consultation to develop a trauma informed care plan.

00:14:03:28 - 00:14:25:05
Katherine Jorda, M.D.
So this patient continued on with us and we were able to be there for this patient's delivery and see them postpartum. And it was just really nice for her to have that shorthand of, hey, I've shared my experience with this team. They know what were the activating factors, they know what was hard for me as a nurse.

00:14:25:10 - 00:14:34:10
Katherine Jorda, M.D.
And here's what we did as a team, and here's a plan, and here's how we can kind of mitigate some of those things that had come up in her prior delivery.

00:14:34:13 - 00:14:53:02
Julia Resnick
That is a really powerful example of you know, what happens when you can integrate behavioral health and physical health. It's better for everyone. So not all hospitals are so fortunate to have a perinatal trauma clinic like yours. So for those who don't, what are some practical ways that providers can recognize and respond to trauma?

00:14:53:04 - 00:15:18:20
Katie Au, M.D.
You know, I think it really goes back to naming it, calling it out, recognizing it and asking about it. So, I mean, if, you know, 1 in 3 birthing patients is experiencing some amount of trauma or dissatisfaction with their birth, that's many of the patients that we're seeing. So we need to ask about it. We need to, you know, it's pretty routine to do, you know, anxiety, depression, mood screening and postpartum visits.

00:15:18:20 - 00:15:41:10
Katie Au, M.D.
But I wouldn't say that it's routine for everyone to be asking how a patient's birth experience was like, how satisfied were you with your care? Are you having trouble sleeping? Does it make it difficult to think about a next pregnancy? But I, I think we should be asking those questions and making sure that patients questions are answered about their birth experience as well.

00:15:41:12 - 00:16:04:12
Katie Au, M.D.
I can't tell you how many times we've seen a patient who you know is scared to get pregnant again. But if someone had just explained what it was that happened to them last time, and that that's not likely to recur again, or you know, even just understanding what it was that they went through their mind is sort of blown in a way that they're like, wow, I had no idea that that was, you know, something that likely wouldn't happen to me again.

00:16:04:12 - 00:16:30:28
Katie Au, M.D.
And I think about pregnancy in the future in a completely different way. So I think talking about it, you know, recognizing it, I mean, it's something that's just so common and yet there are so few people addressing it. It's a disservice to birthing families. And we really need to be addressing these things. And from a systemic perspective, thinking about how do we prevent birth trauma and how do we treat it in a respectful and compassionate way?

00:16:31:00 - 00:16:55:07
Julia Resnick
And I am sure if there are any new parents who are listening to this who have had a traumatic birth experience, they will feel less alone. And hopefully providers will hear this and realize that there are some straightforward things they can do to help their patients feel safer to create better birth experiences for everyone. So Dr. Au, Dr. Jorda, thank you both so much for the work that you do for your patients, for sharing your expertise with us.

00:16:55:09 - 00:16:59:03
Julia Resnick
This has been a really great conversation and I just appreciate both of you.

00:16:59:05 - 00:17:00:11
Katie Au, M.D.
Thank you so much.

00:17:00:13 - 00:17:01:23
Katherine Jorda, M.D.
Thank you.

00:17:01:25 - 00:17:10:06
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.

00:00:00:01 - 00:00:19:12
Tom Haederle
Welcome to Advancing Health. Indiana faces a shortage of approximately 4,300 nurses. Today, we hear how a remarkable example of public and private sector generosity has combined to train and retain the nurses Hoosiers rely on.

00:00:19:15 - 00:00:44:09
Tom Haederle
Hello, friends. I'm Tom Haederle, senior communication specialist with the American Hospital Association. And I'm very pleased today to welcome two guests who will tell us how Indiana has jumpstarted its effort to train new nurses and close the gap between demand and supply in the state. Denzil Ross is president of Indiana University Health, South Region, and Erik Coyne is chancellor of Ivy Tech Community College. That is in Bloomington.

00:00:44:12 - 00:00:47:10
Tom Haederle
Gentlemen, thank you both for joining me on advancing health today.

00:00:47:12 - 00:00:48:14
Denzil Ross
Great to be here.

00:00:48:17 - 00:00:49:16
Erik Coyne, JD
Thanks, Tom.

00:00:49:18 - 00:01:04:28
Tom Haederle
Well, let's jump in. Eric, maybe we could start with you. Ivy Tech Community College's Bloomington campus has been a significant pipeline for the nursing workforce in southern Indiana for some time, and now you've got some resources to become an even bigger one. So in a nutshell, what's changed?

00:01:05:01 - 00:01:33:22
Erik Coyne, JD
Well, the collaboration with IU Health is a huge part. They've provided grant money in the past and continue to support us. We've been able to expand and move our nursing facilities. We've renovated and just really built up. We've doubled our bed spaces for training. We've added more simulation labs. So we've really created the, you know, the educational capacity.

00:01:33:25 - 00:01:54:08
Erik Coyne, JD
And then we work really closely with IU Health on the clinical opportunities. Where do those lie? Where are those? And we found, frankly, that we've really maximized our opportunity throughout the course of the day where we're trying some other things. We're still trying to find, you know, that kind of goal, but we're always going the last mile to find those extra clinical opportunities.

00:01:54:08 - 00:02:17:20
Erik Coyne, JD
But really the opportunity was and continues to be in the evening and on weekends. And so really excited. Last year we launched a pilot program for 20 transitioning nurses. So LPNs or military medics or paramedics to transition into the RN program. So it's a one year program and we moved it to the evening, because frankly, there was no education happening at that time.

00:02:17:25 - 00:02:35:00
Erik Coyne, JD
So we had capacity in the evening. So, we're really excited about that program. The first cohort will be wrapping up this summer and we'll obviously be taking all the data from that and seeing how it did and seeing where we can grow. And as a result of that, we've actually found that we can grow our LPN day program.

00:02:35:06 - 00:02:50:11
Erik Coyne, JD
It's interesting how the things kind of, you know, one thing leads to another and we're really excited with the collaboration we've had with IU health and the opportunities that it's presented. Be remiss if I didn't say that we've had some generous donors who really supported us along the way.

00:02:50:13 - 00:03:06:17
Tom Haederle
Yeah. I'd like to follow up on that a little bit, especially from IU Health's point of view. From where you stand, Denzil, what's driving some of the philanthropy and the support here? Have you been hearing from residents in the area that there just weren't enough nurses and it was getting to be a problem and something had to be done?

00:03:06:17 - 00:03:09:00
Tom Haederle
Or really, what was the impetus behind this?

00:03:09:02 - 00:03:40:27
Denzil Ross
Yeah. You know, that this topic of the nursing shortage has been a national topic for quite some time and, we hear very presently so in Indiana. And specifically in the South region. And through this transformational gift from the Fergusons, who are longtime Bloomington residents, they were motivated through the idea that through their investments, coupled with IU Health's support, Indiana can train more nurses by building on the strong foundation that's already in place.

00:03:40:27 - 00:04:07:15
Denzil Ross
We have, a number of hospitals across the state, and we all struggle like our competitors and other health care systems with how do we find nurses? With that continuing to be a challenge with the support of, these gifts coming in, we are now able to say, let's do something about it. Let's own the problem and let's start to build and improve

00:04:07:17 - 00:04:45:10
Denzil Ross
our pipeline. I think the inception of this investment and other investments with Ivy Tech - the Fergusons, their connection has been through their friendship with another philanthropist, Lee J. Marchant, whose transformational gift to Ivy Tech, Bloomington, established the Lee J. Marchant School of Nursing. And that included early support for the nursing program. Now, with this donation, this gift, we're able as Eric mentioned, to take that, expand it even further and really focus on building our own pipeline over the course of the next coming years.

00:04:45:12 - 00:05:06:22
Tom Haederle
If I understand it right, a big part of the focus of the whole thing is to keep it local, in a sense. You want to train people who are Hoosiers, ideally, and who want to stay in this state and live their lives there and plant their roots there. So really, maybe both of you could address how is that working out and why is it important to sort of keep everything, you know, keep it in the backyard to the extent that you can.

00:05:06:25 - 00:05:30:16
Erik Coyne, JD
You know, we're a community college and we support our community, and we see that 85 plus percent of our students across the board tend to stay in our region. And so as we think about the nursing shortage in particular, and I know this was top of mind for the Fergusons as they were thinking about this gift, how do we incentivize, how do we keep those students in our region?

00:05:30:18 - 00:05:50:22
Erik Coyne, JD
What can we do to, you know, provide support for them? And this gift obviously is really going to transform how we're able to do that and how we're able to support them. It's a two part gift. One part is on the operational side, it'll help offset salaries and equipment. And another side of that is scholarships.

00:05:50:22 - 00:06:08:09
Erik Coyne, JD
And so it's going to really help grow some of the support we can give our students in the region. And I think, you know, they can stay here and work here. Obviously there's a connection. My mom was a long time nurse in Bloomington. I was born here. My dad was on the Monroe County hospital board for a long time.

00:06:08:09 - 00:06:29:05
Erik Coyne, JD
So it's a real personal thing for me. But it's really cool when you walk in and you're being treated by someone you know. It is just such a difference when you walk in and it's someone you know, you knew their parents or even their grandparents. How cool is that? That's the community we want to inspire here. I mean, I still hear from people who tell me about my mom treated them and that is pretty cool.

00:06:29:05 - 00:06:41:14
Erik Coyne, JD
And so if we can continue that for generations and make that sustainable and and financially feasible, not just for them, but also for, you know, our local medical suppliers and hospitals and that's terrific.

00:06:41:16 - 00:07:04:09
Denzil Ross
And I think that's the beauty of who we are. And, at IU Health in Indiana and particularly in the South region, we have a number of critical access hospitals that help and support those rural areas. And then within our Bloomington facility, I think that's what really gives the impact to who we are and how we serve our community.

00:07:04:12 - 00:07:27:25
Denzil Ross
A lot of what Eric mentioned is what we pride ourselves on. It's really and truly the community serving the community. So it's not uncommon, like Eric mentioned, that you go into one of our hospitals and you see a friendly face, whether that be the provider, the nurse, APP, the team member greeting you at the door. Those are your neighbors.

00:07:27:25 - 00:07:48:01
Denzil Ross
Those are the people that your kids play soccer with. Those are the people that you spend time, you walk into a restaurant and you see them. And so, I think that's the beauty of this, is that from our perspective, we get to grow that pipeline. But as a health care provider, we're not just talking about filling the gap.

00:07:48:01 - 00:08:16:19
Denzil Ross
We're also talking about retention. And we know if we have staff, particularly here in this scenario, nurses who train here, who are from here, there's a better chance that they stay here in the long run. And that just gives us stability or recruitment. It gives us stability in our outcomes because now we could build and grow programs.

00:08:16:19 - 00:08:44:24
Denzil Ross
The nursing staff knows the physicians' staff and all the other providers, and it just builds a great outcome, quality outcome for who we are and how we serve the community. One of the things we are also really excited about, we are very conscious of the fact that as a new nurse coming out of your educational program, it could be somewhat scary going into the field to care for patients.

00:08:45:01 - 00:09:29:17
Denzil Ross
And for that reason, we have a really strong and robust first year nursing residency program that is really focused on how do we help and support that first time nurse transition from the educational space to how they become a caregiver. And so we're really proud of that. Really excited about having more and more nurses go through that. And we have seen that be a really vital piece of our ability to retain nurses and get them to the level of care that they want to be, whether it's inpatient med surge, they want to be critical care, ICU, emergency medicine or outside of our surgical and procedural spaces.

00:09:29:17 - 00:09:31:05
Denzil Ross
So we're really proud of that.

00:09:31:07 - 00:09:58:13
Tom Haederle
That is absolutely one of the most impressive things, I think, about what you're doing. I wanted to follow up a little bit on something you mentioned earlier, which is just the advantage of, with this money, this grant money, and being able to expand your capabilities for training and how that plays out on the weekend and evening classes. Opening this, you know, nurse training offered to people that maybe want to do it, but just, you know, had full time jobs or for whatever reason, couldn't take advantage of that.

00:09:58:13 - 00:10:01:15
Tom Haederle
So how is that working out? I'd like both your thoughts on that.

00:10:01:15 - 00:10:32:05
Erik Coyne, JD
Our evening cohort that we have right now, we're seeing most of them are full time employees, many of them at IU health. And they have families. And so getting back to school was just a challenge. And having an evening option really just opens it up. I know one of my early degrees after college, I had to do a nights and weekends kind of thing, and it's a challenge to work all day and then race over to class and study all evening.

00:10:32:07 - 00:10:47:20
Erik Coyne, JD
And your weekends get sucked up with more classes and studying. So what I like about it is it's a one year transition program. So it's, it's, you know, can you do it for a year? Give us a year, right? And they can talk to their families and they can plan for it and they can set it up.

00:10:47:20 - 00:11:06:14
Erik Coyne, JD
So I think it's been really transformational for those folks in that current cohort. And one day down the road, we do look to expand it. We're going to take the data from this first year and see how the second year goes. And at some point about halfway through the second year cohort, we'll really be able to make a determination if we're able to grow.

00:11:06:17 - 00:11:27:21
Erik Coyne, JD
As you can imagine, whenever you start something new, it's always a little bit of a challenge. The no knowns and the unknown unknowns, but, working through that. But for the students in the class, I think it's really been just an opportunity that they otherwise wouldn't have. We actually have folks who have been driving in from outside our region because it's an opportunity here that they didn't get elsewhere.

00:11:27:23 - 00:12:07:11
Denzil Ross
Yeah. I think when you really think about it, you know, everything is changing around us and the way people work is also changing around us. The way people learn and go back to school is also changing. And, kudos to Eric and his team for really seeing that change. And, attacking this head on with this new program that we can offer members in the community the opportunity to go to school and work, take care of themselves, take care of their family in a way with a schedule that works for what's ideal for them and their family.

00:12:07:14 - 00:12:32:22
Denzil Ross
I think it gives the opportunity for us to improve or broaden that number of people who now have the opportunity to go back and learn because they're working during the day. Right? They're taking care of themselves, their families. And now this opportunity, this option just opens the door to a whole new set, hopefully interested parties.

00:12:32:22 - 00:12:44:18
Denzil Ross
So we're really excited about the benefit that we'll see, both for Ivy Tech, the hospital at the end of their program. And really what the impact could mean to the community.

00:12:44:21 - 00:13:02:11
Tom Haederle
I came across an article recently, just a few days ago that put me in mind of, of our conversation right now. And I just wanted to bring it up and get your thoughts on this, because I thought it was really interesting. It was in the Wall Street Journal. It was an article ran on April 1st, and the title was "Nursing is the Surefire New Path to American Prosperity."

00:13:02:11 - 00:13:23:25
Tom Haederle
That was the name of the article. I just wonder if that's something that in your experience, have you seen that? Do you think that idea that health care or nursing specifically is now a path to a better life is really starting to take, take hold and, you know, become more widely believed among young people and, and if so, what implications does that have for training programs like yours?

00:13:23:28 - 00:13:54:03
Denzil Ross
Hospitals are very intricate. And there are many aspects of when we think about health care or health and wellness that the nursing occupation plays a very big part. Many times we just think about within the four walls of the hospital, right. Emergency department, inpatient setting, operating rooms. But there are so many opportunities that there are paths within that nursing field.

00:13:54:06 - 00:14:25:05
Denzil Ross
And the more and more that we can educate people about what can be, you know, and give a different perspective sometimes to what a nurse could be and what they do. The path to then to that next step, third or fourth step out from just becoming a registered nurse. There's opportunities there as well. We have fully embraced nurse practitioners in our model of how we care as physician extenders.

00:14:25:07 - 00:14:49:27
Denzil Ross
And they all were exposed to different specialties, different area areas of care as nurses and said, hey, I want to go the next step. And after becoming and RN, there are so many paths to how you continue to grow, opportunities to expand. And of course, we see salaries that come to match that as well.

00:14:50:00 - 00:15:04:10
Denzil Ross
So I definitely think that it's a great starting ground that opens a wide array of opportunity within the health care field, not just the hospital, but with the health care field as a whole.

00:15:04:13 - 00:15:30:09
Erik Coyne, JD
Yeah, we're seeing that play out on the training side. Our nursing program and a few of our other health care programs are competitive programs. At a community college, vast majority of your programs are open access, open enrollment. But our health care programs are highly competitive. The salaries, the outcomes, the career opportunities. One thing I love is the chief nurse at IU Health Wilmington is an Ivy tech grad.

00:15:30:09 - 00:15:48:00
Erik Coyne, JD
Then she went on further and, and now is the chief nurse over at the hospital. I mean, it's fantastic. And we see it with, you know, respiratory therapy. We see it with radiation therapy, all of our other health care programs that we have. We're starting to really see growth and interest.

00:15:48:00 - 00:16:05:22
Erik Coyne, JD
And the retention is there, too. Students in those programs tend to stay in those programs. You know, they worked hard to get into them. And so they're going to stay and they're going to get through. They're not easy. They're tough programs. And we hold our students to a high standard, but they need it. And, it's great. For many

00:16:05:22 - 00:16:34:24
Erik Coyne, JD
it's a, you know, first generation student. This is going to be transformational for their family. This is like generational change that's occurring here. And so that that is really huge and really impactful. We're really excited, especially with our various cohorts we have going on. Every term, we have a cohort starting. So applications are always flowing. Feel free to visit us at Ivy tech.edu/nursing and you'll learn all about how to apply and what you need to do to get started.

00:16:34:27 - 00:16:53:05
Tom Haederle
It's so exciting what you're doing, and I can't congratulate you enough for not only making the difference in the lives of patients by providing trained caregivers that they need, but as you just mentioned, maybe, you know, opening up new paths and, you know, leading people to a better life and doing something, giving them an expanded opportunity to do something they love to do.

00:16:53:05 - 00:17:11:21
Tom Haederle
So I'd like to thank you both for being on Advancing Health today and sharing your thoughts about the value of philanthropy and the value of expanded training and flexibility and how nurses are trained. But most of all, really what you're doing on behalf of the people of southern Indiana, your patients, that's just so, so remarkable and so impressive.

00:17:11:23 - 00:17:14:06
Tom Haederle
So thank you so much again. Really appreciate it.

00:17:14:09 - 00:17:25:00
Denzil Ross
Thanks, Tom. Thanks for having us. And really looking forward to working with Ivy Tech here to make this come to fruition. This has been a long time coming, our relationship that, we're glad that we're here.

00:17:25:03 - 00:17:36:12
Erik Coyne, JD
Yeah. Thank you, Tom. And I'd like to real quick, thanks to IU Health, thanks to the Ferguson family, Connie and Steve, for making this a reality and really moving the needle for our students in the region. So thank you.

00:17:36:15 - 00:17:44:25
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.

00:00:00:00 - 00:00:13:22
Tom Haederle
Welcome to Advancing Health. Helping a child grow into a strong and healthy adult isn't always easy. Today, we hear from a large urban care provider that's taken on the challenge.

00:00:13:24 - 00:00:39:28
Tom Haederle
Hello friends! I'm Tom Haederle, senior communication specialist with the American Hospital Association. If you've ever come across this quote: "individually, we are one drop. Together, we are an ocean," then you'll understand what drives the Ann and Robert H. Lurie Children's Hospital of Chicago to forge some of the most amazing examples of strong community collaboration found anywhere. The breadth of Lurie Children's Hospital's work in supporting kids is just incredible.

00:00:40:06 - 00:00:55:24
Tom Haederle
Much of it falls under the umbrella of the hospital's Patrick M. Magoon Institute for Healthy Communities. So it's an honor today to welcome Mary Kate Daley, senior vice president and chief of community health for the McGoon Institute, to our podcast today. Mary Kate, thanks so much for coming on Advancing Health.

00:00:55:26 - 00:00:57:05
Mary Kate Daly
Thanks for having me, Tom.

00:00:57:08 - 00:01:19:24
Tom Haederle
Let me do a little scene setting here for our listeners. Working with community partners, the Magoon Institute supports dozens of initiatives that help kids - across nutrition, behavioral health, car seat safety, and many other things. So I'm just naming a few. So I guess Mary Kate, let's sort of start with...how would you, what ties all this together, the menu of things that that the MaGoon Institute supports?

00:01:19:24 - 00:01:26:08
Tom Haederle
And how would you describe the hospital's philosophy when it comes to working with outside partners to improve the lives of kids?

00:01:26:11 - 00:01:50:29
Mary Kate Daly
Well, Lurie Children's has been engaged in community health programs for many, many years. Like most hospitals our mission is to improve the health of people and in our case, specifically of children. And more and more, we are learning that health is more than health care. So we have to do the absolute best job we can when these young people show up at our doors and need care.

00:01:51:01 - 00:02:12:18
Mary Kate Daly
However, it's just as important to be working with community partners around for us, the city of Chicago, to be improving health of young people in their own communities where they live, where they go to school, where they play. So I think philosophically, that's a key part of who we are and what we value. It's a key part of our mission.

00:02:12:19 - 00:02:21:02
Mary Kate Daly
Our mission pillars include clinical care, research, education and advocacy. And community health is a key part of advocacy.

00:02:21:04 - 00:02:35:18
Tom Haederle
I don't think anybody would argue with the notion that there are many kinds of challenges facing kids today, especially in underserved communities. So how do you prioritize the needs and decide which ones should receive your attention and help with resources?

00:02:35:21 - 00:03:03:15
Mary Kate Daly
I think the framework that has really helped us a lot, and probably some of my other colleagues around the country working at hospitals would agree is the community health needs assessment. So when the Affordable Care Act passed 15 years ago, one of the requirements it included is for hospitals to conduct community health needs assessments every three years and then to use those assessments to develop corresponding implementation strategies.

00:03:03:18 - 00:03:33:00
Mary Kate Daly
So we have come to embrace this requirement. We actually love it. For us, this is a great opportunity to really take a step back and dig into tons of data, community health data, patient data and really listen, conducting surveys and listening sessions and focus groups and really trying to understand what are the most significant health challenges for young people in the city of Chicago, particularly those living in our disinvested communities?

00:03:33:02 - 00:03:55:11
Mary Kate Daly
So once we have that assessment and all that data, then we gather our internal clinical experts, our public health experts, as well as external partners, and we ask some key questions. You have to put these questions through sort of a filter like so we say 'okay, where when we look at all these needs. Where does Lurie Children's have unique expertise

00:03:55:14 - 00:04:17:15
Mary Kate Daly
to address these issues'? Who are the community partners and organizations that are already on the ground doing this great work? And what would be the best way for us to partner with them, learn from them, and then see if together we can impact some of these challenges. How can we develop or advance these programs and policies to make progress on these issues?

00:04:17:17 - 00:04:47:10
Mary Kate Daly
And a key thing is to recognize that a lot of these issues are very complex. They are entrenched. They're rooted in generations. But we have to think about how can we come together to try to address them. And then another key thing, we are an academic medical center and we need to make sure that there is solid evaluation for all of these kinds of programs, so that we're making the impact that we want to be making, and that the community expects of us.

00:04:47:12 - 00:05:11:24
Mary Kate Daly
So this is a process that happens every three years. That's kind of our step back big picture look. And then between those cycles, that's when we're constantly kind of shifting and making small tweaks here and there to different programs in order to respond to what we're seeing in evaluations and new challenges that come along. So that framework has been very helpful to us because it is a very challenging question.

00:05:11:26 - 00:05:13:13
Mary Kate Daly
There's a lot of needs.

00:05:13:15 - 00:05:29:06
Tom Haederle
And when you reach out, having identified a need to reach out to a potential partner, what, just the reception at the other end generally like, yes, we'd love to work with you guys. It's great to collaborate with a hospital. Or are there ever any, you know, turf or jurisdiction sorts of sensitivities around these things?

00:05:29:08 - 00:05:50:20
Mary Kate Daly
I think all of those things can happen sometimes. As soon as we call or someone introduces us to a new partner, they're instantly eager. And I think in those cases, I think a lot of it is when people involved in that organization have had positive clinical experiences at our hospital, and so they've come to trust us in a different way.

00:05:50:22 - 00:06:16:27
Mary Kate Daly
And then the idea of maybe working together in this new way, they may be more open to that. At the same time, there are certainly organizations that have not had positive experiences in these partnership kinds of opportunities. And so, understandably, they're a little bit more hesitant. And I think what we've found works best in that situation is to just start small and start slow.

00:06:16:29 - 00:06:39:05
Mary Kate Daly
And we understand that we need to kind of carefully do this. So let's start with just like a little small thing that we're going to do. And then let's over time build up that trust. And I think when that happens too, there's new opportunities that emerge that we might have not even realized we could have worked together on when we were first introduced to this partner.

00:06:39:08 - 00:06:55:29
Mary Kate Daly
The key thing there is we have certain expertise and they have certain expertise, and the magic's going to happen when we come together in a real and genuine way. But, you know, respecting the strengths that we both bring to a partnership is essential.

00:06:56:02 - 00:07:12:02
Tom Haederle
Great point. And actually to to pull the on that thread a little bit. What are some examples of the magic that has happened? Know when you think about, you know, great examples of partnerships that have made a difference and really measurably helped the lives of kids in Chicago? What are some examples that come to mind?

00:07:12:04 - 00:07:32:08
Mary Kate Daly
So the first one I want to share is a program called the Juvenile Justice Collaborative. This is a great example because I think it shows how a hospital can take a skill that we already have, and you can apply it to community health needs. It also shows the importance of community partnerships and like true partnership in the development and maintenance of these programs.

00:07:32:09 - 00:08:01:06
Mary Kate Daly
So the Juvenile Justice Collaborative, this is a program that provides care coordination and social support to youth involved in our justice system. So in Chicago, in Cook County, our courts and states' attorneys, they can refer young people to this program as an alternative to detention. So this was something where we took what we know about clinical care coordination, and then tried to apply it to a new population of young people.

00:08:01:14 - 00:08:30:09
Mary Kate Daly
After these young people get referred, they work. Then we do a very significant intake process to really understand what the challenges this young person is facing. And then we refer them to the appropriate service providers in our network. And then these providers, they provide the service directly to the young people, but they're also helping to shape the program as it evolves, as we see new challenges, as we may need new partners.

00:08:30:11 - 00:08:55:12
Mary Kate Daly
And then we also have an external evaluation of this program. And we recently, shared the results of an external evaluation that showed that this kind of approach really does help not only lower recidivism, which is an important goal, but it also improves the health and well-being of the young people themselves. So that's kind of a good example of how we take something we know as a hospital and apply it elsewhere.

00:08:55:17 - 00:09:15:14
Mary Kate Daly
Another totally different example. This one is a big project. It's been years in the making. But it's really on the cusp of becoming a reality and we're so excited about it. And this is called the Austin Hope center. So this one goes back, kind of building on what we were talking about before, about how do you start a relationship with a new partner.

00:09:15:14 - 00:09:40:29
Mary Kate Daly
So this one, during the pandemic, we met leaders at a church in one of our disinvested communities, its called Lively Stone Church in Missionary Baptist Church in Austin. And the pastor there and the staff, they were struggling with the mental health needs of young people. And so we kind of started with them working on some smaller projects where we could work together, get to know each other, build some trust.

00:09:41:02 - 00:10:06:01
Mary Kate Daly
Years later, where we are today is that we're actually getting ready to open up a new building with them in a few months. So they had formed a community development corporation. So they are going to be owning the building. Lurie Children's is a tenant. That's very important because we want the economic development in our disinvested communities to be owned from people within that community.

00:10:06:03 - 00:10:27:14
Mary Kate Daly
So we are the tenant. However, we're a very active tenant and, we've really been working alongside them from the very beginning to create this space. So in this new building, we will provide some outpatient clinical care and behavioral health services. And then this is going to be the hub for all of our community health work on the west side of Chicago.

00:10:27:17 - 00:10:49:17
Mary Kate Daly
So we'll have a community conference room, a teen lounge. We'll have an early childhood room. And our goal here is for everyone in the building to work together, our clinicians, our community health experts, the other tenants in the building. The goal here is that this building helps to address the health of young people in this community in a more holistic way.

00:10:49:19 - 00:11:06:11
Mary Kate Daly
So this is an example, and it's an extreme example, because I know not every partnership leads to a building, but, to kind of how we can start small to address a significant need that a partner is having and how that can kind of grow over time. And evolve into something really exciting.

00:11:06:13 - 00:11:21:25
Tom Haederle
Mary Kate, those are a couple of wonderful examples of collaborations that work. What qualities make for an outstanding collaboration partner as you consider partnering with, you know, with a private entity to to do something to help kids, what are you looking for in who you choose to collaborate with?

00:11:21:27 - 00:11:47:04
Mary Kate Daly
Well, we've talked a bit about the importance of trust. That's first and foremost, and that ability to be able to build that, whether that's right away or over time, that's critical. Another important quality we found is organizations who are innovative. So Chicago, as with others, we're blessed with many strong community organizations who are always looking at new ways to solve old problems.

00:11:47:06 - 00:12:07:17
Mary Kate Daly
And so that's really key for us when we have a partner that's excited about thinking differently and open to new thoughts and ways of doing things. And then the third thing, really, I think for me is we found with partners, they do have to understand our limitations. Because as hospitals we can be a little bit more conservative.

00:12:07:17 - 00:12:28:17
Mary Kate Daly
We can be a little bit slower. I think a lot of our community partners are so nimble and so flexible, and we found that it's best when we can find partners who understand we're going to do our best to meet them there. But sometimes our processes take a little bit longer and that can mean contracts or evaluations or things like that.

00:12:28:19 - 00:12:34:17
Mary Kate Daly
I think important to find those partners who are open to that and flexible, and understanding of that.

00:12:34:19 - 00:12:49:03
Tom Haederle
Thank you. That's a great answer. And I think those are also some important takeaways for your peers out in the field who may look at Lurie and think, oh boy, we'd like to do something like they're doing, but what do we need to know in advance? And you've really touched on some important things to keep in mind. Any final thoughts?

00:12:49:03 - 00:12:51:20
Tom Haederle
Anything we haven't talked about that you'd like to mention?

00:12:51:22 - 00:13:14:15
Mary Kate Daly
I think one other key element, really, just as you're thinking about what you know, what peers can learn. I think when it comes to these community health programs, the leadership support is critical. We're fortunate to have this in spades at Lurie Children's. Our previous CEO, for whom the McGoon Institute is named, actually, he was always supportive of this work.

00:13:14:15 - 00:13:36:09
Mary Kate Daly
And then our current CEO and the senior team, they've really embraced advocacy and community health as a key part of our mission and strategy. Our CEO speaks better than I do about the importance of going upstream and addressing health challenges in young people before they become adults. And, he and our other leaders ensure that this work remains priority.

00:13:36:11 - 00:13:47:21
Mary Kate Daly
Engaging our board, philanthropic partners and all the members of our team that are out there doing this work every day. So I think to keep it sustainable, that's a really key element.

00:13:47:23 - 00:14:08:06
Tom Haederle
Well, you speak pretty well yourself about the mission and really, really present it in a wonderful light. So, Mary Kate, thank you so much for your time today and appearing on, Advancing Health and more for your phenomenal work in changing so many lives for the better among the the young kids in Chicago. So, good luck and congratulations on all the great work you're doing.

00:14:08:09 - 00:14:11:13
Mary Kate Daly
Thank you very much. Thanks for everything you're doing.

00:14:11:15 - 00:14:19:26
Tom Haederle
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