Advancing Health Podcast

00:00:00:00 - 00:00:22:06
Tom Haederle
Welcome to Advancing Health. The leadership baton has passed into new hands at the American Hospital Association. In this month's Leadership Dialog podcast, Meet AHA President and CEO Steve Walsh, who describes his career path, his passion for health care, and his vision for supporting America's hospitals and health systems.

00:00:22:08 - 00:00:43:13
Marc Boom, M.D.
Greetings and thank you everyone for joining us today. I'm Mark Boom, I'm the president and CEO of Houston Methodist, and I'm the board chair of the American Hospital Association. As we continue our monthly discussions, we're going to shift our focus because today I am joined by AHA's new president and CEO, Steve Walsh. As you all know, Rick Pollack retired last month after several decades of wonderful leadership.

00:00:43:15 - 00:01:07:10
Marc Boom, M.D.
Rick reinforced AHA's strong foundation as a trusted voice and advocate for health care providers across the country. And as someone serving on the AHA board and participating in the selection of Rick's successor, I can tell you that the board has full confidence in Steve stepping into this role. And we're so excited about what is ahead for the AHA. Since Steve is now really entering, I guess, about his second month at the AHA

00:01:07:12 - 00:01:12:10
Marc Boom, M.D.
we thought this platform would be a great way to introduce him to all of you. So, Steve, welcome.

00:01:12:12 - 00:01:13:16
Steve Walsh
Thank you, Dr. Boom.

00:01:13:18 - 00:01:30:12
Marc Boom, M.D.
Steve, instead of me reading through what is a very impressive bio, I'd love to do this a bit less formally. Our viewers like to know a little bit about our guests, so I'd like to begin by asking to share a little bit about yourself, your career journey, what brought you this point, major influences, your life, etc.

00:01:30:14 - 00:01:48:18
Steve Walsh
Thanks. And you know, thanks to you and the board for the faith and the confidence in me, and certainly to my friend Rick for a tremendous career and would an exceptional person and benefit he's been to me through this transition. So appreciate all of his work and the legacy that he leaves behind at AHA. But, I'm excited to be here.

00:01:48:18 - 00:02:09:02
Steve Walsh
You know, as you well know, I'm from a a city north of Boston. A little gritty city called Lynn, Massachusetts. And, I grew up in a household that I, I felt like was at the intersection of health care and politics. You know, my mother was a nurse who then ultimately ran for city council, and she served for 22 years before moving on to work at our local health center.

00:02:09:04 - 00:02:28:13
Steve Walsh
And she really taught us the importance of health care, but also what it means to a community and the importance of public service. I was able to follow in her footsteps and run for a state representative, where I served six terms in the Massachusetts legislature and ultimately was honored to chair healthcare finance there. And our world kind of changed.

00:02:28:13 - 00:02:56:03
Steve Walsh
We had had one son, our oldest and then had twins and our twin B, Miles, was born with a heart condition. And that was really the change for me, where the public policy that I was working in healthcare became the vocation of healthcare and, ultimately left elected office to work with hospitals in Massachusetts and try to have a deeper understanding of the challenges that that all of our hospital leaders face.

00:02:56:03 - 00:03:19:12
Steve Walsh
I mean, thankfully, Miles is healthy 15 year old today. He's had ten open heart surgeries and, lived with him for 130 nights in the hospital he was born in. And kind of gave me a love of hospitals. I just kind of loved watching how they work and visiting them and really trying to understand how they best can serve patients and the communities that they reside in.

00:03:19:12 - 00:03:50:08
Steve Walsh
And so, you know, this has been really the honor of a lifetime to have an opportunity here. After the legislature, I served at the Massachusetts Health and Hospital Association for a decade and got to see firsthand the important work that all of you do each and every day. Having a chance to work with all of you and our local colleagues through the Covid 19 pandemic and our workforce shortage, financial pressures, it just shows what hospitals mean to their community and what can happen when we work together.

00:03:50:08 - 00:03:55:12
Steve Walsh
And that's just the kind of excitement and energy that, you know, I want to be able to bring to this role.

00:03:55:14 - 00:04:17:09
Marc Boom, M.D.
Well, I love your story. I'm so sorry you had to go through that 130 nights and that your son had to have ten, ten surgeries. But thank goodness for the amazing people in hospitals who were able to care for him and bring him to the point where he's now a thriving, healthy 15 year old boy, right? Probably making you pull your hair out a little bit like most 15 year-olds do, I suspect.

00:04:17:09 - 00:04:28:16
Marc Boom, M.D.
So love to have that story. And your grounding to the passion and purpose of why we're all in healthcare. That means a lot to us with you helping lead the hospital association.

00:04:28:18 - 00:04:49:14
Steve Walsh
Yeah. He's a goalie on his high school JV soccer team now, you know, couldn't be a happier kid. He reminds us every day the miracles that are that our members perform for the patients that they serve. So you're right. It keeps us grounded, puts everything perspective and, frankly, just shows how important it is that we preserve the mission of what all of our members are working towards every day.

00:04:49:16 - 00:05:13:03
Marc Boom, M.D.
Amen. And there's stories like him over and over and over, across our hospitals, across this great United States and these wonderful hospitals and teams. So we're so grateful to all of them. So speaking of that, then as we look to enhance our field, our profession, to really focus our sacred mission of caring for people like your son and so many others, what are your immediate priorities and goals that you have set as you step into this role

00:05:13:07 - 00:05:15:14
Marc Boom, M.D.
to lead the American Hospital Association?

00:05:15:16 - 00:05:36:15
Steve Walsh
Well, the first goal is really pretty simple is to continue to serve the mission of AHA and how hospitals do what they do best, serve the patients and communities. And, our members do it better than anyone else. But the priority to reach that goal is really to listen, listen to our members, listen to the AHA staff, our elected leaders in DC and around the country.

00:05:36:17 - 00:05:55:02
Steve Walsh
There are so many exciting opportunities ahead for our field and for our hospitals. But I'm trying to reduce that or I try to resist that initial temptation to move too quickly and really want to understand the pressures that all of you are facing so that we can craft a good strategic plan for our future.

00:05:55:07 - 00:05:58:17
Marc Boom, M.D.
So you've already been on a listening tour, I understand, right?

00:05:58:19 - 00:06:18:07
Steve Walsh
Yeah, I've done, Georgia, Wyoming. The team in Chicago, the team in DC, Ohio. And you know, it continues, on to California and Texas in the next couple weeks. And it's just so exciting to be able to see what's happening out in communities and how people are continuing to do extraordinary work each and every day.

00:06:18:07 - 00:06:31:17
Steve Walsh
And as you well know, and you've been in a number of and run them successfully, you've been in one hospital, you've been in one hospital. You know, they're all so unique in the services that they provide, the constituencies that they serve, and really how they run and operate within their local community.

00:06:31:19 - 00:06:46:13
Marc Boom, M.D.
Yeah, I know you and I were just a couple of weeks ago at the health systems meeting and that we had many leaders of a whole bunch of health systems there. I know you've already been to a couple of the regional policy boards as well, so if you haven't had a chance yet, people are listening today to meet Steve.

00:06:46:13 - 00:07:11:18
Marc Boom, M.D.
I know you will soon. And one of the things I love about you is how well you listen and, and are willing to hear differences of opinion and then embrace those differences of opinion, which there inevitably are. So, you know, there's many great things we do. There's also many challenges we face as a field. Talk about what you see right now as some of the greatest opportunities and also then some, some of the challenges.

00:07:11:20 - 00:07:31:04
Steve Walsh
It's a great question. And I you mentioned the difference of opinion. And, you know, I think similar to you and the team at AHA and the board that's currently comprised there, we love those differences, right? They make us better. I mean, those good conversations, that good dialog around the table, a little bit of healthy disagreement for the greater good.

00:07:31:08 - 00:07:59:06
Steve Walsh
It goes a long way to crafting better policy, better practices and ultimately better outcomes. You know, but we are facing challenges. I see the biggest challenge today is kind of creating the time and space for our hospitals to innovate and lead on what's next, right? There are so many challenges on the day to day among our hospital community, that I think the future of our health care delivery system is literally hanging in the balance.

00:07:59:08 - 00:08:19:23
Steve Walsh
But folks are so focused on the mission of the moment that it's really hard to look ahead and say how can we change the trajectory of healthcare? We all know it's expensive. We all know that it's crowding out other things for working families. And we all know our hospitals are under a lot of financial pressures and workforce pressures.

00:08:20:01 - 00:08:29:14
Steve Walsh
But I actually think our hospital community is the one that can solve it and innovative and create an opportunity for what the next generation of health care is going to look like in this country.

00:08:29:16 - 00:08:54:06
Marc Boom, M.D.
You say that very, very well. And there's sort of a balance of things that I hear in your statement for the hospitals themselves, ourselves. But also from the association standpoint, which is there's a blocking and tackling in the short term issues. We've got to deal with the, you know, the effects of and hopefully mitigation of the OBBA. We've got 340B to deal with if we get sight neutral, a bunch of other things like that that are dynamics that we're dealing with.

00:08:54:08 - 00:09:20:19
Marc Boom, M.D.
And we got to play long ball also at the same time, right. Because we all recognize that the system and I mean the broad US health care system as it's designed today and with some of the demographic changes that we're just seeing the beginning of right now and many other dynamics out there that probably this is not a sustainable structure and that I think I hear you say what I would say, which is the most logical conveners for that long ball, for that conversation, for that

00:09:20:19 - 00:09:31:22
Marc Boom, M.D.
how do you redesign things in a way that's sustainable are the hospitals and health systems and the clinicians who work within them. Because we are the people who are closest to the American people.

00:09:32:00 - 00:09:53:02
Steve Walsh
Yeah, there's no doubt about it. I mean, you know, you've heard me say before, the one thing that we all share in common is at some point, we're all patients. And so I have a firm belief that every person in an elected or appointed position of authority in this country wants the best for the patients that we serve. Might get mad at different ways and have different kind of approaches to it,

00:09:53:04 - 00:10:10:14
Steve Walsh
but this system was created 65 years ago, right? Where, you know, it hasn't necessarily evolved. And so there's going to be some fits and starts on the evolution of where we go from here. But the major difference, and this is the point that I think we have to convey to our elected leaders who I know want to do the right thing.

00:10:10:16 - 00:10:32:06
Steve Walsh
You all hospital leaders see these problems before anybody else does. You understand them better than anybody else. So it puts our hospital community in the best position to solve them. And I think AHA's job is to make sure that our members have the room and the resources and the voice to lead that conversation.

00:10:32:08 - 00:10:57:12
Marc Boom, M.D.
Perfect. Well, and within those members, we're very diverse. You know, all the way from rural to urban to safety net to governmental to, you know, many types of different hospitals, large, large systems, all the way down to tiny, small frontline critical access hospitals, etc., etc. and everybody in between. We all share the same common noble purpose, which is to care for humanity.

00:10:57:12 - 00:11:14:23
Marc Boom, M.D.
And so we have that in common. But sometimes there are differences and some things are good for some, not as good for others. How do you see that challenge, playing itself out? And how do we elevate our collective voice even when we have some of those differences?

00:11:15:01 - 00:11:36:14
Steve Walsh
This is the hardest question that we in the association world will ever answer. And I think that under your leadership and under the board's leadership, I see this board as a group that's ready to have that conversation. Access in the middle of the country might be that people can't get to care where access on the coast might be, that people can't get in to receive that care.

00:11:36:16 - 00:11:54:20
Steve Walsh
There are different problems, but we want the same thing. And I think for our hospital members, it's trying to recognize that having unity of the field doesn't necessarily mean we have consensus, right? It means that we're unified at our common goal. And I always, you know, talked about the four seasons principle. At the end of the four seasons,

00:11:54:22 - 00:12:18:12
Steve Walsh
are we better off than we were at the beginning? Every person might not win on every issue. But cumulatively, after we've run a cycle, can we say we're better off than where we started and kind of be in it for the common good and have people trust that, hey, if I'm going to give up a little something today, I know that tomorrow there may be an issue or might then it be more beneficial to me than it is some of my colleagues around the country.

00:12:18:12 - 00:12:47:08
Steve Walsh
And you talked about it at the system leaders retreat. We have a very real problem where we have some very large systems and some very small rural hospitals. They want the same things, but oftentimes are operating without the same resources. And that's going to be something we have to grapple with. But the major difference between all of the other folks that are coming into community to provide care that aren't connected to the hospital community, they don't have the same commitment to the city that they're in, the town they're in, the area that they're in.

00:12:47:10 - 00:13:14:02
Steve Walsh
They don't have the same philanthropic approach to the way they do business. They don't provide the same community benefit. And so we ought to make job number one, trying to preserve the way our hospitals have contributed and how our communities have benefited from their presence for 100 and something years. I mean, that's really the secret sauce that hospitals have that no one else will ever replicate. One: they don't want to, they're not willing to make that commitment.

00:13:14:04 - 00:13:32:23
Steve Walsh
It's a different goal. And I think our goal makes a lot of sense. And we start to explain that to the patients and the people that use our services. They get it. They know their local hospital community, they know their local hospital leaders. And I don't think anybody else can replicate that. And if that means we have to convince some of our colleagues that we have to play the long game and make some difficult choices for the greater good,

00:13:33:01 - 00:13:40:10
Steve Walsh
I know under your leadership, you'll work very hard to do that, and the rest of the board will as well. And I like our chances to get to a very positive place.

00:13:40:12 - 00:13:58:17
Marc Boom, M.D.
But the alternatives, of course, try to do nothing and just maintain the status quo. That probably is going to collapse under its own weight at some point in time. And so I think all of us are behind you in saying, let's find those proactive solutions that can help human beings that we care for. So you came from Massachusetts.

00:13:58:19 - 00:14:15:22
Marc Boom, M.D.
And, you know, Massachusetts is very different than how big, I don't know, Texas, for example, and very different than California and etc., etc.. right. We've got all the great states, yet you have quite a bit of national experience as well. Talk a little bit about being involved across the different state associations.

00:14:16:00 - 00:14:47:09
Steve Walsh
Yeah. Well, I've really learned so much from, from my colleagues in other state associations. We share a national group together and get together twice a year. And, you know, frankly, I've learned more from my colleagues around the country than from anyone else throughout my career. I mean, they're doing some amazing things. And when we think about some of the challenge federally, right, the only way to really make positive change is by creating allies and by having broad based groups that come together for the common good.

00:14:47:09 - 00:15:07:06
Steve Walsh
The same thing that I would ask of our members is what I would expect for myself. So when, you know, we were going through some of the challenges and looking at the impacts of federal changes, we're working with Colorado and Texas and South Carolina because, again, we all want the same thing. I said, you know, look, I fully appreciate I was born in Massachusetts.

00:15:07:06 - 00:15:25:04
Steve Walsh
You know, where were the first two places I went after I was, you know, fortunate enough to get this role? Georgia and Wyoming. We talked about that, I mean, I want to make sure that we're learning from all of our colleagues around the country. And I've worked really hard over the course of the last few years through our national group to make those connections and make those networks.

00:15:25:04 - 00:15:46:15
Steve Walsh
And I think the really good leaders, you certainly being one of them, understand a simple fact. We're in the people business more than anything else. It's about relationships. And I really have an intellectual curiosity about my colleagues, about the people that serve, about how they've achieved their success. And I think every conversation is an opportunity to learn. And so I love traveling around the country.

00:15:46:15 - 00:16:08:21
Steve Walsh
I love traveling and working with my colleagues on things that, you know, are interstate. I mean, the reality of care, and you see it with the payer groups, you see it with farmer, and you see with providers. We're not isolated to one state anymore. Things are happening over state lines. And, we have a responsibility to work with people around the country for success and ultimately for survival.

00:16:08:23 - 00:16:44:17
Marc Boom, M.D.
One of the things we did very significantly, is obviously check you out during the interview process, everything else. One of the things that always resonated with me a lot was as I talk to other leaders across multiple states, and very different states than, than, than Massachusetts, very similar in some ways to Massachusetts. To a "t" they told me how collegial you were, how able you were to work across party lines to see those differences, to embrace those differences of small state, big state, rural state, urban area, etc., etc., and embrace those and run with those and see those as a strength.

00:16:44:17 - 00:17:02:22
Marc Boom, M.D.
So I think the AHA under your leadership is going to be in a very, very good place going forward. So I want to bring things to a close, chat with you all afternoon here but I know people are going to need to move on. But I want to give you an opportunity to give me any of your final thoughts and particularly what excites you most as we look to navigate this future together?

00:17:03:00 - 00:17:23:17
Steve Walsh
Yeah. Well, first and foremost, just thank you again, both for the opportunity today and ultimately for, you know, this career opportunity which I'm so honored and privileged to be able to serve the AHA the and the board and your teams. You know, to think about the through line, about what really excites me about working in health care,

00:17:23:19 - 00:17:24:23
Steve Walsh
It's as I just said,

00:17:25:03 - 00:17:26:09
Marc Boom, M.D.
It's the people.

00:17:26:11 - 00:17:50:06
Steve Walsh
It's the staff at AHA. It's my colleagues around the country. It's you. It's the board of trustees. It's the people in our hospitals that show up every single day to care for our patients and live out the AHA mission. We always had a saying in my house growing up, always show up. And as you and I have talked about in a job of this magnitude, it means something different now.

00:17:50:06 - 00:18:11:22
Steve Walsh
It doesn't necessarily always show up in in person everywhere. It's too big, but it's always show up to bring our best for the people that rely on us every day to give them an opportunity to be successful. And I really believe if we keep investing in people, investing in our teams and showing up for people and really listening to them, that there's nothing we won't be able to do.

00:18:11:22 - 00:18:27:13
Steve Walsh
And I think the next iteration of health care is going to be done by us or to us. And I really trust the minds in the room at the AGA, the board of trustees and around the country that are delivering care every day to craft something that works for the people in this country and the patients that we serve.

00:18:27:13 - 00:18:52:02
Steve Walsh
And ultimately that makes healthcare, you know, the highest quality you possibly can at the most affordable price we can deliver it. I think that's our mission. That's our goal. And I think we're up for the challenge. And so I'm really excited about it. And I really, as I said to you, when you first called me about the role, you know, I want to go to work every day and work hard to be able to fulfill that mission for the AHA the people that rely on us for care because oftentimes they don't have anywhere else to turn.

00:18:52:02 - 00:19:12:14
Marc Boom, M.D.
That's a wonderful way to bring things to a close today. Really noble and magnificent aspirational goals there. And, and I have no doubt that under your leadership, the American Hospital Association is going to be wildly successful. And as you said, we're going to do things to help improve the care of people in the United States and beyond.

00:19:12:14 - 00:19:29:11
Marc Boom, M.D.
And I am just delighted to have spent this time with you, Steve. I know the rest of the field is so excited as well. So thank you to all of them and to our viewers. Thank you for finding the time to listen or watch today, and I'll be back next month for another leadership dialog conversation. Thank you so much.

00:19:29:13 - 00:19:37:21
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:00 - 00:00:20:15
Tom Haederle
Welcome to Advancing Hell. Law enforcement's ongoing battle against healthcare cybercrime requires a strategic mix of offense and defense. As we hear in today's podcast, this approach has scored some important victories lately and reminded bad cyber actors there is no such thing as a safe harbor.

00:00:20:17 - 00:00:50:13
John Riggi
Welcome to Advancing Health. I'm John Riggi, your national advisor for cybersecurity and risk at the American Hospital Association. There have been thousands of ransomware and data theft attacks targeting U.S. healthcare over the last several years, compromising millions of U.S. citizens personal health care data and unfortunately, disrupting life saving care delivery during these high impact ransomware attacks, which delay and disrupt health care delivery.

00:00:50:16 - 00:01:24:19
John Riggi
Folks, when that happens, let's be clear: these are not data theft crimes. They are threat to life crimes. The FBI recently released its new cyber strategy based on four key pillars focused on disrupting adversaries, supporting victims, strengthening partnerships, including with the private sector, and building the capabilities this mission demands. This strategy builds upon key FBI initiatives such as operation Winter Shield and Operation Riptide, as well as partnerships with the private sector, including healthcare.

00:01:24:22 - 00:01:54:12
John Riggi
Joining me again today is my good friend and colleague Brett Leatherman, assistant director of the FBI Cyber Division, to talk about new FBI cyber strategy, how it helps supporting healthcare in key takeaways every healthcare leader needs to know to protect their organization. He's got well over 20 years of experience leading these really high impact, innovative strategies to help reduce cyber risk that we all face as a nation.

00:01:54:13 - 00:02:01:18
John Riggi
Brett, thanks for joining us today.

00:02:01:18 - 00:02:03:24
Brett Leatherman
John, it was great working with you. Years ago, and it's equally great working with you today, thanks to you and the AHA for having me on.

00:02:03:27 - 00:02:36:04
John Riggi
Thanks, Brett. So since we last spoke in January, just a few things have changed. We went to war with Iran. Iran retaliated fairly quickly with cyber attacks against a mission critical third party provider having pretty significant impact across the sector. Since then, we've also had multiple health care third party providers attacked with innovative technological attacks. And quite frankly, deception types attacks. The standard vishing and phishing and certain groups have become very effective at that.

00:02:36:06 - 00:03:03:12
John Riggi
And then, of course, we have the development and discussion debate over frontier AI models. So the FBI, since that time releasing operation Winter Shield, the defensive strategy. It was great to see you all launch Operation Riptide, the complementary offensive initiative. Brett, could you talk to us a little bit about Operation Riptide and some of the results you've seen?

00:03:03:28 - 00:03:32:04
Brett Leatherman
Yeah, thanks, John. Operation Riptide was a 60 day push by the FBI to really implement the president's executive order on cybercrime and cyber enabled fraud - EO 14390, which was really focused on mitigating the risk to the homeland from cyber criminals and cyber fraudsters. During that 60 day push, the FBI Cyber Division partnered with the FBI's Criminal Division. There's four operational divisions in the FBI.

00:03:32:06 - 00:03:59:12
Brett Leatherman
Cybercrime falls under the cyber division and cyber enabled fraud under the criminal division. And together we did a push over 60 days to impose cost on malicious cyber actors domestically and abroad. So that 60 day push was compelling in that we conducted 13 joint sequenced operations against malicious cyber actors. We conducted over 200 arrests of cybercrime and cyber enabled fraud actors.

00:03:59:15 - 00:04:25:16
Brett Leatherman
We saw 50 plus additional subjects charged. Six alleged cybercriminal actors extradited back to the United States to face charges here, as well as numerous domain and infrastructure takedowns of malicious bad actors. So that is taking the fight to the bad guys and removing their capacity and capability to continue to conduct those attacks against healthcare and critical infrastructure here in the US.

00:04:25:18 - 00:04:54:15
John Riggi
Thanks for that summary. Really a remarkable operation. Often within cyber operations, I often get the question, why can't the FBI just arrest these folks? And traditionally the answer has been, they're beyond the reach of U.S. law enforcement countries like Russia, China and North Korea, in Iran providing safe harbor for these groups. So it's really extraordinary for me to hear you say we made 200 arrests, multiple extraditions, which used to be the exception.

00:04:54:22 - 00:05:21:13
John Riggi
And I know that's not done alone. Obviously, working with international partners and private sector probably helping in some capacity to feed that intelligence to all of you and the disruption of the infrastructure, technical and financial, huge impact, just as we used to see in counterterrorism days. Brett, you've heard me often say we can't win on defense alone. And I think Operation Riptide really exemplifies the offensive piece.

00:05:21:16 - 00:05:26:25
John Riggi
How do we work together going forward in the future? And why can't we win on defense alone?

00:05:26:28 - 00:06:02:29
Brett Leatherman
Yeah, that's a great point. And listen, as a 23 year plus FBI special agent, I love nothing more than holding actors accountable in a court of law. Arrests matter. But like you said,  often that's not always possible. You know, some of these subjects sit in sanctuary countries that just don't cooperate with U.S. law. And that really is the FBI cyber strategy that we released just a few weeks ago is focused on imposing cost, supporting victims, increasing the impact through partnerships, enhancing the FBI cyber capabilities because deterrence comes through a lot of these joint sequenced operations that we talk about.

00:06:03:00 - 00:06:20:25
Brett Leatherman
So even when we can't get to the actors themselves, we can often get to their infrastructure, we can get to their money, we can get to their tools. And any one of those that we remove as part of one of these operations are impactful, but the more of those we remove in any one operation is even more impactful to victims as well.

00:06:20:27 - 00:06:45:08
Brett Leatherman
And partnerships are key to that. There's two kinds of partnerships we look at. Number one, victims of cyber crime. Reaching out to the FBI quickly help us to see adversary infrastructure and move upstream against the actors themselves. And my team's hear me say that a lot. We've got to move upstream and we've got to do it quickly. That can only happen when victims report to us and they report to us quickly.

00:06:45:10 - 00:07:09:21
Brett Leatherman
The second kind of engagement we see is operational partners who sit in industry. Those who are able to take action in their own environments because of the telemetry they see or the infrastructure they operate. At the same time, we take action, and that's equally important to us to join forces and do that work simultaneously to have outsized impact on the actors.

00:07:09:24 - 00:07:15:19
Brett Leatherman
Our goal is to reduce gaps between us in those industry partners on both fronts.

00:07:15:22 - 00:07:34:11
John Riggi
It's great to hear you talk in those terms about beyond just threat information sharing, right? The old cliché, we used to say it's still valid, but, you know, establish a relationship with your local FBI. We got that. We're way beyond that. What we're talking about here now is not just threat information sharing, but operational engagement with the private sector.

00:07:34:16 - 00:08:02:19
John Riggi
Vast amount - as you know and you astutely leverage - vast amount of technical expertise, technical capability lies in the private sector. You know what I really find, I think, fascinating, an example for the rest of government, quite frankly, is that you operationalize the strategy really before even announcing it. You did operation Winter shield. We're going to help tell victims, tell potential victims, the whole country how to best defend against cyber attacks.

00:08:02:23 - 00:08:26:22
John Riggi
Ten practices under operation Winter shield. Pretty common sense, but you distilled it down. Let's do these things on defense. And knowing that defense alone will not prevent all the attacks, you followed with the complementary operation of Operation Riptide, then issued the strategy, said, here's the strategy and we're already doing it. So my hat's off to you in the entire FBI for doing that, taking that action.

00:08:26:29 - 00:08:39:05
John Riggi
Could you go into a little bit more about disruption strategies and wherever you could add a little more detail about the pillars and how you're working with private sector?

00:08:39:07 - 00:09:03:19
Brett Leatherman
Yeah, that's a great point. So pillar one is investigate, disrupt and impose cost on cyber adversaries. That's kind of what you're talking about in the disruption space. And what this really was is a codification of what we were already doing. Let me just give you some color to that. For the last 18 months, in particular, FBI cyber teams alone have charged 497 hackers.

00:09:03:19 - 00:09:06:17
Brett Leatherman
That's a significant increase year over year. That is a tremendous number.

00:09:06:17 - 00:09:13:19
John Riggi
I don't think in the time I was in the FBI, which was 28 years, and of course cyber was I've ever heard those kind of numbers.

00:09:13:22 - 00:09:42:12
Brett Leatherman
Yep. And equally important is the disruptions, not just the charges, but 476 malicious cyber operations that we disrupted. Thirty-four cyber criminal enterprises dismantled. That is just on kind of that threat side. Look at the extraditions. 50 cyber actors extradited. That's a 32% increase year over year, which means there is no safe harbor. And John, I love the slogan of Operation Riptide, which is no safe harbor.

00:09:42:12 - 00:10:02:23
Brett Leatherman
And what we meant was to convey and signal to the actors that this FBI strategy gives you no safe harbor. We will work with traditional and nontraditional partners to hold you accountable domestically and abroad, but to also, again, go after the infrastructure and the underlying ecosystem that you use to attack the United States.

00:10:02:25 - 00:10:20:19
John Riggi
Great explanation about that. I love the slogan as well. No safe harbor, because unfortunately, when I, you know, I speak to a lot of people around the country. I always say that one of the impediments for the FBI and the government to go after these bad guys is they're being provided safe harbor by Russia, China, North Korea and Iran.

00:10:20:23 - 00:10:55:06
John Riggi
So it's great to see you're taking that away from them. And you're implementing a strategy we use quite a bit in counterterrorism as well, in the sense that if we cannot put hands on them, we don't rely just on law enforcement actions. We work with partners across the intelligence community, foreign partners, to conduct disruptive, offensive cyber operations. And again, if we can't reach you and put handcuffs on you, we're going to, as you just said, take away your infrastructure, financial, technical in perhaps human through other arrests or cooperating witnesses that come forward.

00:10:55:10 - 00:11:08:00
John Riggi
I loved your message, talking about some of the recent arrests, pointing out to the bad guys that, hey, these folks that we have our hands on will probably act in their best interest and they may be telling us about you.

00:11:08:03 - 00:11:27:17
Brett Leatherman
I love that part of it. Right. You know, we recently announced a video message related to our work with Dutch authorities. And again, that's going to the partnerships, working with the Dutch. That's part of the best athlete model that the FBI cyber strategy talks about. And it's the FBI supporting the Dutch to get to where they need to charge

00:11:27:17 - 00:11:54:04
Brett Leatherman
In that case, a key administrator of Shiny Hunters, a very impactful group right now. They were able to arrest them, and we were very supportive of kind of their work to do that in filling the gap intelligence gaps that they had. But in the message, I shifted to talk to the rest of the group to say, listen, there are things that you see that maybe the public doesn't see - actions that the FBI takes covertly, that maybe the public is not aware of.

00:11:54:06 - 00:12:15:28
Brett Leatherman
And those are signs that we are moving upstream and identifying who you are. And that's part of my goal is there so much psychological impact to patients of hospitals, to people whose surgeries were canceled when a cyber attack prevents that. It's time to turn the tables on the bad guys and to say, listen, it's only a matter of time.

00:12:15:29 - 00:12:35:27
Brett Leatherman
Our teams have gotten exceptionally good at attribution. If you look at what we did against Lock Bit and Hive and all these ecosystems that thought they were impermeable by law enforcement, we dismantled them. And the same thing is going to be true of Shiny and some of the other groups as well. We're going to continue to pursue them aggressively under this strategy.

00:12:35:28 - 00:12:39:13
Brett Leatherman
And they need to take note that the teams are looking for them.

00:12:39:19 - 00:13:01:25
John Riggi
Thanks, Brett. You know, it's just a great direct message to the bad guys. It shows the government that you and all of FBI are very aggressive, and you're not going to let their bad actions, they're really sometimes evil actions when they threaten lives as we've seen with ransomware attacks on hospitals go unanswered. Go unaccounted for. And you know what else I love?

00:13:01:25 - 00:13:20:29
John Riggi
We said in the in your video message, is you said to the private sector very directly, we need you in this fight. And I know you obviously very well and I've worked with you obviously right up through this last weekend we had another major incident. You answered the call on Saturday night and help us understand what's going on.

00:13:21:06 - 00:13:41:18
John Riggi
The fact that that you will provide information back to the private sector, and you were very candid what you had and what you didn't have over the weekend. So that allowed me to inform the entire sector. So we appreciate that. And again, if there's anything else you'd like to add in your last phrase there about, on that video, we need you in this fight.

00:13:41:21 - 00:13:41:29

00:13:42:00 - 00:14:03:09
Brett Leatherman
Yeah. I think that's so important. And thank you, by the way, for engaging us over the weekend and providing some tipping information, because to us getting that that intelligence from industry is incredibly important. But yes, bilateral sharing is important. We are actor focused, victim centric and partner driven. And that's kind of really all three of those are important to us.

00:14:03:11 - 00:14:22:24
Brett Leatherman
And what I frequently say here when I talk to industry partners, whether it's at the board of directors level, the C-suite executive or the folks who are fighting in the trenches on the cyber defense side is: unfortunately for good or for bad, generally for bad, you've been drafted into this fight. It was not your choice to get drafted into the cyber fight.

00:14:22:24 - 00:14:43:09
Brett Leatherman
There is no other discipline the FBI does - counterterrorism, counterintelligence, criminal investigations - where we need industry as an equal partner in this fight, but we do in industry. And so you've been drafted. Unfortunately, you've been drafted, now we all need to step up and work together and trust each other. And trust is built before the crisis. And that's where we're looking to build that trust now.

00:14:43:09 - 00:14:59:13
Brett Leatherman
It's spent during crisis. It's built before the crisis. So we really appreciate the partnership with the AHA, and we want to model that across the sectors out there as well, the various sectors of critical infrastructure, so that we can have equally impactful relationships in every sector.

00:14:59:16 - 00:15:18:12
John Riggi
Brett, last question here. How do you see the threat evolving 2027? Obviously with China, frontier AI models, adversaries trying to use them? We're trying to use them to defend against them. Where do you see again, it's hard to think what we're going to happen next month. But how do you see the threat of in 2027?

00:15:18:18 - 00:15:47:10
Brett Leatherman
Yeah, sophistication was is going to be there. But really where everybody listening to this should think is compression of time frames to conduct cyber effects, meaning the bad guys are not going to look to leverage zero days. We talk a lot about AI development of zero days and sophisticated attacks. Right now where we're at, in the coming months, where we're at is the bad guys are going to look at the fundamentals of cybersecurity and exploiting those quicker in ways that are more impactful.

00:15:47:12 - 00:16:08:07
Brett Leatherman
So things like Winter shield still apply today. I would encourage the audience to still go to FBI.gov/Wintershield and look at those ten controls that we recommended, because AI is going to allow the adversary to move more quickly through those controls. Just a few weeks ago, NSA released a cybersecurity hygiene guide, which is very similar to Winter Shield.

00:16:08:07 - 00:16:33:16
Brett Leatherman
It talks about the controls that adversaries are using. NSA actually used AI to red team and understand the controls that are most needed today to defend against these AI based attacks. And not surprisingly, a lot of those aligned to Winter Shield. So if the nation's signals intelligence agency and the nation's domestic law enforcement and intelligence service are telling you these are the things that matter in the next few months, that's where you should focus.

00:16:33:16 - 00:16:38:12
Brett Leatherman
Because even with AI driven attacks, it's those fundamentals that really matter.

00:16:38:15 - 00:16:57:17
John Riggi
Thanks, Brett. Totally agreed. When folks come to me and say, John, where do we start? Or which practices and said, folks, you don't have to spend a lot of time doing this. Hundreds if not thousands of analysts across government have already done that work. They've reviewed thousands of cases, thousands of incidents, and they have access to classified intelligence.

00:16:57:17 - 00:17:19:11
John Riggi
And they say these are the best practices that help reduce risk. Start there. That's what I always tell them. Brett, so much going on and we won't keep you any longer. But I wanted to thank you personally. You, all the men and women in the cyber division and in the FBI for what you do every day to defend our networks, to defend our way of life, and to keep this country safe.

00:17:19:15 - 00:17:20:10
John Riggi
Great to see you.

00:17:20:17 - 00:17:23:05
Brett Leatherman
Good seeing you. Thanks, John.

00:00:00:01 - 00:00:22:28
Tom Haederle
Welcome to Advancing Health. Telemedicine is helping reduce disparities in care by expanding access to specialty expertise for geographically isolated patients. As we hear in this podcast, virtual access to expert consultants has been transformative for patients at a 14 bed hospital on a well-known island, bringing high quality care closer to home.

00:00:23:00 - 00:00:47:03
Sonia Malik
Welcome to Advancing Health. My name is Sonia Malik, senior director of operations for the Division of Health Outcomes and Care Transformation at the American Hospital Association. Today, I'm very excited to be joined by Amy Lee, president and chief operating officer at Nantucket Cottage Hospital. Nantucket Cottage Hospital has been featured in our newly released "Economic Impact of Disparities and Health Outcomes Resource Guide."

00:00:47:06 - 00:01:01:27
Sonia Malik
The guide explores data driven strategies organizations are using to identify gaps in care, improve health outcomes, and reduce the financial burden associated with those disparities. Very excited to continue the conversation and welcome to the podcast, Amy.

00:01:01:29 - 00:01:03:07
Amy Lee
Glad to be here.

00:01:03:10 - 00:01:13:27
Sonia Malik
Well, to start, could you introduce yourself? Tell us a little bit more about your role at Nantucket Cottage Hospital, and tell our listeners what it's like to deliver health care in a unique island community like Nantucket.

00:01:14:03 - 00:01:35:13
Amy Lee
Sure. So like we said, I'm Amy Lee. I'm the president and chief operating officer for Nantucket Cottage Hospital. We're a small 14 bed community hospital on an island 30 miles out to sea. So we are of a very unique location, and it really challenges what we can and cannot do. However, I'm very proud to say that we can take care of almost everything that walks through our doors.

00:01:35:13 - 00:01:52:00
Amy Lee
We only transport 3% of patients off island. We've really focused on what we can do very well, and then those partnerships that help us take care of our patients. Because there's always the challenges of getting off island. There's no bridge to the mainland. So we are very isolated a lot of the year.

00:01:52:03 - 00:02:12:04
Sonia Malik
Talking a little bit more about the communities and, you know, the community and the patients and families that you are serving. What challenges have those families in your community historically faced when accessing neonatal or pediatric specialty care? And how has the tele-newborn program helped address those challenges?

00:02:12:06 - 00:02:36:27
Amy Lee
Yeah. You know, it's interesting being on Nantucket. Again, we're 30 miles out to sea. So it really makes it interesting on how you provide care. And even when you need to transport someone off. This past week is a great example of that. We have four labor and delivery rooms. And yet we had six C-sections within four days. It's a very challenging game of okay, who goes where and how do we take care of these patients?

00:02:36:29 - 00:02:54:23
Amy Lee
And most of the time we know who's walking through our door and who needs care. But, you know, you can't trust a baby all the time. And they come when they want to come. And so we've had a surge, and we have really had to figure out how to balance that. So it's not just, you know, the prenatal care and the people that are on island.

00:02:54:23 - 00:03:19:24
Amy Lee
It's also our visitors and not knowing exactly what their histories are. So we really have to be prepared for everything. And our relationship with Mass General Brigham and the ability to have the tele-nicu and the tele-newborn program really expands that care so that we have the ability to care for patients who wouldn't normally stay on an island for the delivery, you know, because you just never know if you can get off due to weather, transportation issues, all those things.

00:03:19:27 - 00:03:26:18
Sonia Malik
Right. And I guess I should backtrack a little. Can you tell us a little bit more about the actual program and what your partnerships are?

00:03:26:21 - 00:03:52:04
Amy Lee
So Nantucket is part of Mass General Brigham, and that gives us significant access to a lot of specialties. As it is, we bring about 40 specialties on island, but we also have access to the tele programs to other specialties like tele-nicu and tele-newborn. What that does is it brings an entire team of specialists into the room while we're having these high, high risk cases.

00:03:52:06 - 00:04:06:28
Amy Lee
So that way we can really make sure we're monitoring and taking care of those patients the best way we can. Again, you just don't know when those babies are going to come all the time. And so we have to be prepared. You know, the ultimate goal would be that some of those high risk works are not performed here on island.

00:04:07:00 - 00:04:27:29
Amy Lee
But you know, it's not up to us. And so we need to make sure that we have those resources available for our, our providers. It also helps us with recruitment because our staff and our physicians really feel have that comfort level, knowing that they have the support of the specialists and whatnot who are there when we really need them.

00:04:28:04 - 00:04:50:15
Sonia Malik
Right. And, you know, that's one of the other things that I'm sure our listeners would be interested in hearing about in terms of how it impacts your physicians, your providers and the care teams. So, you know, just thinking about workforce and all the shortages and limited access to specialists that a lot of rural hospitals also experience when they're trying to deliver specialty services.

00:04:50:17 - 00:05:08:07
Sonia Malik
How has the tele-newborn program helped your local care teams feel more confident in managing these cases closer to home? And if there is one - I know you were starting to reference one before - could you share a patient or family story that really illustrates this, this impact of this work?

00:05:08:10 - 00:05:29:22
Amy Lee
So, you know, the technology really matters because it provides that level of comfort for providers, like I said before, but it also gives the family the ability to really have access to the team that they know, their providers here on island, and then that highly specialized expertise so that they don't have to leave the island and it balances that for them.

00:05:29:28 - 00:05:48:07
Amy Lee
What I really like about this is it really helps support our physicians, our nurses and our clinical staff care for their patients because this is a very highly personal thing. We live on an island that's only 49 square miles. Everyone knows everyone. And so there's a level of passion that is there because this is their friend, their neighbor, their relative.

00:05:48:10 - 00:06:11:04
Amy Lee
And it's really a close personal connection. But, you know, in a rural community hospital, it's not realistic to have every specialty available. So tele-newborn gives that local team that immediate access to the neonatologist when they need that higher level of expertise. It also gives a second set of eyes, you know, to make sure that we have the best possible care for that patient.

00:06:11:06 - 00:06:28:01
Amy Lee
And so it allows for the provider and for the family to have that, that sense of comfort, because they know that someone else is also paying attention to that baby and that mother. We have lots of really great stories of patients that have been born on island, and a lot of them can stay and some of them have to be transported off.

00:06:28:01 - 00:06:54:17
Amy Lee
But that relationship has really given us that ability to take care of the patient. A baby might have an unexpected issue shortly after delivery, and instead of immediately assuming that baby has to leave the island, the team can connect with the neonatologist, evaluate the situation together, and make a more informed decision. It allows the family to have comfort, too, knowing that it's not just the single set of eyes, but it's also someone else who's looking at that baby and really evaluating what that baby needs.

00:06:54:22 - 00:07:26:06
Amy Lee
Sometimes the right answer is transfer, but other times it's the baby can safely stay here on island where their support system is. And from a workforce perspective, it's really important because we have to retain and recruit very, very talented clinicians. And being able to say that you can practice in a rural community hospital, but having that connection to that higher level of care at your fingertips is incredibly important, because it gives them that sense of comfort, and it's really a meaningful part of creating an environment where our clinicians are supported professionally.

00:07:26:09 - 00:07:46:04
Sonia Malik
That's amazing. Yeah. That personal touch, you know, and that comfort of knowing, okay, I can connect to a specialist. There is this kind of broader network that we can kind of tap into to make sure that we're receiving the best high quality care possible. So I'm sure that's super impactful. Thanks for sharing. I'm thinking beyond the tele-newborn program.

00:07:46:05 - 00:08:05:00
Sonia Malik
Curious about how Nantucket Cottage Hospital is leveraging telehealth and other service areas, you know, to address broader access challenges across the community. So what impact have some of these efforts had on patient access, on care delivery and the overall cost of care?

00:08:05:03 - 00:08:35:13
Amy Lee
You know, we think about telehealth as a tool, just one tool within a much broader access strategy because it's not really about replacing that in-person care, but it's about deciding which care truly needs to happen somewhere else and what can be done here on island. Mass General Brigham has really given us that ability to expand what we can provide. And virtual consults extend that specialty expertise within our hospital, not just for our patients, but also for our caregivers, because a lot of times, having a full time specialist on island, it's just not practical.

00:08:35:13 - 00:09:05:03
Amy Lee
We wouldn't have enough volume for them. But, you know, we use telehealth in neurology. Tele-stroke. Tele-newborn. Dermatology. There's so many different applications, and especially if we have a talented staff here on island that connects with that specialist on the other end, it allows us to really expand what we can do. So we really make sure that we have that type of connectivity in our primary care, in our urgent access, the visiting specialists, and then, you know, the approximately 40 specialists that we bring on island.

00:09:05:06 - 00:09:09:16
Amy Lee
So it really allows us to have a very dynamic care model.

00:09:09:18 - 00:09:29:03
Sonia Malik
Yeah, that's so interesting. And the other thing that I was curious about was how do you use data to determine, you know, which specialties need extra attention or what your community needs, you know, super curious about which data sets you use or how you work in partnership with other organizations to gather that data.

00:09:29:05 - 00:09:47:15
Amy Lee
You know, we actually work with other organizations quite a bit because we have such a population shift. We have a seasonal population that goes up over 100,000 in the summer, for example. So we really are working with other organizations to make sure there's that continuity of care. But we look at our referral patterns, we look at what patients are asking for.

00:09:47:16 - 00:10:05:06
Amy Lee
We really go in-depth with our providers to see what they're asking for, too, because, you know, sometimes in primary care, the physician or the nurse practitioner, they feel like, okay, you know, I'm primary care, I'm the family medicine provider. So I really need to take care of this wide range. But when you have that conversation and say, what can we do to make your life easier?

00:10:05:06 - 00:10:24:04
Amy Lee
And they say, well, if we could have this specialty taking care of this part of the care, that would really take a big load off my plate that I can focus on other ways. And so using all of that information really helps us leverage what the telehealth play that we need is and how we can expand that range.

00:10:24:06 - 00:10:45:17
Amy Lee
It also helps us avoid unnecessary transfers and costs for the patient. You know, if, for example, they might need to go off island for a procedure or a surgery that we don't do here, but then the follow up can be done. That really helps keep the cost down for the patient, but also make sure that they are maintaining that care and following up so that nothing falls through the cracks.

00:10:45:18 - 00:10:51:03
Amy Lee
So a lot of times that's a benefit for both the provider and the patient.

00:10:51:05 - 00:11:14:22
Sonia Malik
Yeah. And I'm glad that you provided that information because that's exactly where I was going. I was super curious about okay, so what are ways that you can track how it helps the overall cost of care, how we're trying to reduce some of those cost drivers, whether it means preventable utilization or, making sure that you catch things on time to avoid higher costs in the future.

00:11:14:24 - 00:11:36:04
Amy Lee
We've definitely utilized the tele programs, you know, even for wound care, for example. The technology is so good that they can have that camera looking at that wound and have the specialist on the other end, and then have our wound care team here following up and making sure that the patient's getting what they need. Again, it's that second set of eyes.

00:11:36:04 - 00:11:58:15
Amy Lee
It's that expertise, especially if there's something that we don't see very often, those high risk, low volume things that really allow us to expand what we can do and not send somebody off of the island. Our strategy really truly,  it's not about hollowing out what we can do, but it's really making sure that we are supporting what we can do and giving it the best possible outcome.

00:11:58:17 - 00:12:20:23
Sonia Malik
I love that, yes. Thank you for sharing. So as health care leaders work to improve outcomes while managing costs, what lessons from your own organization's experience would you share with other organizations seeking to address unique access challenges and improve care for underserved or hard to reach populations?

00:12:20:25 - 00:12:43:06
Amy Lee
I think one of the things that we've shifted in our thinking is it's not always about efficiency. You know, in a in a rural area like ours, you know, some services don't have a huge volume or a huge benefit to the system, but looking at it and how it impacts life on the island or for those patients - and there are things that we can do that will make that so much better -

00:12:43:06 - 00:13:05:05
Amy Lee
it really helps the patient. It helps our community. But then if you're looking long term, it also, you know, it can result in, less delayed care, less transfers and really helps us take a holistic approach to taking care of the patient. So we look at every service, every request that we get and we really evaluate, can we do this well?

00:13:05:12 - 00:13:18:09
Amy Lee
And if we can do it well, how should we do it? Is it a partnership? Is it completely done on island, or is it something that really has a creative twist to it that makes it beneficial for both the patient and the hospital?

00:13:18:11 - 00:13:28:12
Sonia Malik
Yep. True intentionality keeping the patient and the providers in the center of the care. I think that's super important. Do you want to shine a light on anything else that you are doing?

00:13:28:19 - 00:13:47:28
Amy Lee
One of the things that we are very proud of is how connected and how passionate our staff are. They really are truly connected to the mission of our of our hospital, and it's because they feel it. I mean, this is such a small community. They understand that everything they do has an impact and they really have ownership of that.

00:13:47:29 - 00:14:07:21
Amy Lee
And we've tried to make it so that, you know, when someone has an idea or a thought process on how we can do it better or what we should be doing, we really respond to that and make sure that if we can do it, we will. And if we can't, we explain the why. And that, again, has really promoted the ownership and the accountability of our people.

00:14:07:23 - 00:14:28:00
Amy Lee
You feel that. You feel that when you walk through our doors and you know, you're talking to our staff. This is their hospital, this is their community, and they are going to do whatever they can to take care of their hospital and their community. Success for us is not about the geography. We don't let geography determine the quality of the care someone receives.

00:14:28:01 - 00:14:32:13
Amy Lee
It's all about the people and how we can creatively take care of our patients.

00:14:32:16 - 00:14:57:12
Sonia Malik
Amy, thank you so much for joining us today and for sharing your insights and experiences from Nantucket Cottage Hospital. We appreciate the important work that you and your team are doing every day to improve access to care for your patients and families in your community. To learn more, Nantucket Cottage Hospital's tele-newborn program is featured as an innovation Spotlight in the AHA's "Economic Impact of Disparities in Health Outcomes Resource Guide," which is available on the AHA website.

00:14:57:17 - 00:15:06:10
Sonia Malik
Thank you so much for listening, and we hope that you will join us for future conversations highlighting innovative approaches to improving health outcomes and access to care.

00:15:06:12 - 00:15:14:29
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.

00:00:00:02 - 00:00:23:04
Tom Haederle
Welcome to Advancing Health. It's been two years since Hurricane Helene unleashed deadly flooding and catastrophic destruction across the southeastern United States, while also disrupting a critical medical supply chain that impacted the rest of the country. In today's podcast, hear how Advocate Health stepped up to meet a moment that no one saw coming.

00:00:23:07 - 00:00:47:02
Chris DeRienzo, M.D.
Hi again, everyone, this is Dr. Chris DeRienzo. I serve as the American Hospital Association's chief physician executive. Welcome back to the podcast, where I get to have conversations with chief physicians from across America and ask them more or less five questions. Today, I am really excited because we get to talk with someone who's just down the road from me in North Carolina, Dr. Betty Chu, who serves as the chief medical officer of Advocate Health.

00:00:47:02 - 00:00:49:20
Chris DeRienzo, M.D.
Dr. Chu, thank you so much for joining the podcast.

00:00:49:27 - 00:00:52:07
Betty Chu, M.D.
Thank you so much for having me. It's great to be here.

00:00:52:14 - 00:01:13:18
Chris DeRienzo, M.D.
Well, instead of starting with telling us a little bit about you or about Advocate Health, I just want to jump right in because you were about a year into your role when disaster struck in western North Carolina. I was at the AHA when Hurricane Helene rolled through the country. It led to disruptions nationwide on things like IV fluids and whatnot.

00:01:13:19 - 00:01:20:06
Chris DeRienzo, M.D.
Take us into that moment. One year into the role of serving all the communities that you serve. What was it like?

00:01:20:08 - 00:01:43:22
Betty Chu, M.D.
I think, like most executives at a company, when something that catastrophic had happen, happens in an area that's you're serving for a patient perspective, the first thing you consider is what is my role as leader? You know, what is my what does my team need? What do our, you know, 170,000 team members need in that moment? And what can I uniquely contribute in that moment?

00:01:43:22 - 00:02:11:14
Betty Chu, M.D.
And so, because I had experience in my last organization from a command perspective during Covid, and then in my current role, work closely with emergency management, that seemed like an opportune time to utilize skills that I had learned in my past role, but also really take into consideration that partnership with supply chain, which was very, very critical in managing the crisis. But also the partnership with operations. At that time too,

00:02:11:15 - 00:02:31:20
Betty Chu, M.D.
we were not very old as a company, as an enterprise, having come together. So Advocate Aurora Wake Forest Atrium is one entity. So really thinking through at an enterprise level, what does the organization need in order to be successful? And some of that is just getting that situational awareness of what's happening on the ground.

00:02:31:22 - 00:02:58:18
Chris DeRienzo, M.D.
You brought two things up there that anyone who is trying to operate through the disaster that was that hurricane, who wasn't based in western North Carolina, or that part of Appalachia where it was just total decimation. And we've heard lots of stories about the folks who were who were directly in it. But the second and third order effects reverberated throughout healthcare. Perhaps the biggest of which was right at that intersection of the supply chain and emergency management.

00:02:58:19 - 00:03:19:27
Chris DeRienzo, M.D.
And as folks know, there was an IV fluid factory that was more or less wiped out. And it produced something like 60 to 70% of the IV fluids used in certain kinds of IV fluid and certain kinds of procedures throughout the country. And so how did you lead the team through responding to that, that dual crisis?

00:03:20:00 - 00:03:52:22
Betty Chu, M.D.
Well, I'll say a few things. One, our leadership in North Carolina, in particular, some of our leaders, like Dr. McElwee and others who had been very actively involved historically in hurricanes, as you know, Chris, because you're from North Carolina. This is not an uncommon activity to prepare for a hurricane, to deal with the aftermath of hurricane. So, of course, on the ground, because that area where the Baxter plant is not far from our facilities, there was a lot of interest and desire in going out there to help - physically going out there to help - that plant, to help

00:03:52:24 - 00:04:15:28
Betty Chu, M.D.
of course the citizens that were impacted in North Carolina. And so there was a community structure for North Carolina in particular that was helping on that effort. Of course, your comment about the supply relating packs of the plant impacted every health system in the country, ours no differently. And we had a very heavy dependance on Baxter. And I think it was a more like 70-80% dependance on Baxter.

00:04:16:00 - 00:04:48:18
Betty Chu, M.D.
And so that IV fluid shortage was simply from an enterprise level, because that was going to impact the safety, the care delivery for all of our patients. And we had an opportunity to really work collaboratively together as a company to solve for that. And that was where an enterprise wide incident command really came into place. So we were running an operational command in North Carolina, really to help from a hurricane response perspective and to help those facilities, not only our own, but is, you know, the state initiates a pretty robust response.

00:04:48:19 - 00:05:06:07
Betty Chu, M.D.
And then added to that, we had an enterprise command, as you mentioned, that I led that helped really deal with the conservation efforts and all the activity that you put into play to make sure that we had enough IV fluids at all of our facilities in all of our states because of the shortage.

00:05:06:09 - 00:05:28:10
Chris DeRienzo, M.D.
And you're exactly right, Betty. When I think about the sort of one two punch that that was the hurricane, there's the operational impact on areas who were devastated. But then because that that factory was in the line of the storm, the impact of this hurricane was felt nationwide. There wasn't a hospital that I spoke to in the fall and winter of 2024 that was not impacted.

00:05:28:10 - 00:05:48:24
Chris DeRienzo, M.D.
And you've referenced a couple of times now, this enterprise wide approach. Let's take a step back and just help our listeners understand when you say enterprise at Advocate, what does that look like? How many communities do you serve? How many states are you covering and what are the logistics that you're trying to manage over the enterprises footprint here?

00:05:48:25 - 00:06:14:14
Betty Chu, M.D.
Sure. So Advocate Health, we are in six states. We have 170,000 teammates. We're divided now - at that time you were divided into two regions - now we're divided into three divisions that are state based divisions. And the impact of that in terms of our 6 million patients that we serve. So whether it's ambulatory inpatient visits. I think to your point, that was what was the most remarkable thing about this incident

00:06:14:14 - 00:06:36:02
Betty Chu, M.D.
or, if we project forward to some of the things that are happening with supplied related challenges across the across the country, even in current day, is, is that it doesn't impact us in one facility. Again, like a tornado or hurricane or one in or midnight, or even an infectious disease outbreak that might often happen in one geographic area.

00:06:36:04 - 00:07:07:26
Betty Chu, M.D.
But these supply chain impacts, especially as we go to more dependance on single source vendors, as we go towards more standardization, it can have a pretty profound impact on our ability to deliver care. So, you know, I always think about a command center is fundamental. Its primary goal is, of course, to patient safe. And as a result of that, how quickly can we communicate an action plan and our activities in a large organization to solve problems all the way down to the user level, to the front line?

00:07:07:28 - 00:07:32:04
Betty Chu, M.D.
How quickly can a nurse or physician change their practices? In this circumstance, how do we go from a three liter IV bag that urology case to one liter IV bag a rocket case? How do we go from immediate IV hydration to a patient university department to oral hydration first, and do that at scale so that everybody can understand what the message is and what understand what we're supposed to do.

00:07:32:07 - 00:07:47:18
Betty Chu, M.D.
That's the value of an organized command structure is really our ability to come up with a design, you know, the new design, the innovation, and then funnel that down into the operational units as quickly as we can so that we can achieve the value of that change.

00:07:47:24 - 00:08:08:12
Chris DeRienzo, M.D.
You all responded to, to Hurricane Helene in such a terrific way, but that is not the only opportunity that you've had to leverage this kind of enterprise wide approach to solving challenges. Advocate Health was recognized as a finalist this past year in the AHA's Quest for Quality Award. That award program is really quite prestigious.

00:08:08:12 - 00:08:39:03
Chris DeRienzo, M.D.
It was, I think, one previous winner's congressperson referenced it as the Stanley Cup for hospitals. And you joined us there to help tell the story about that same enterprise wide approach to driving improvements in quality and safety. Take us back to the beginning of that journey when you joined Advocate, and how you begin to bring those pieces together and drive the same kind of change from the enterprise level all the way down to the pointy end of the stick in healthcare, where we're delivering care to patients.

00:08:39:06 - 00:09:06:01
Betty Chu, M.D.
Well, I think it starts with probably, like you and many other folks, a desire to use your skills to serve the most to none people. And when I came from Henry Ford Healthcare, amazing career, an amazing culture, I really thought the opportunity to join this newly formed entity, six states. And as you know, Chris, a lot of the conversation in healthcare is that we get bigger, but our quality doesn't improve, our safety doesn't improve.

00:09:06:02 - 00:09:45:04
Betty Chu, M.D.
A lot of my desire was to disprove that construct. Because if we can spread innovation improvement at scale, we should theoretically be able to improve more lives, decrease mortality. And so but we also have to measure that. So I think that's one of the challenges. And what I loved about the AHA Quest for Quality Prize and the award and the process, whether we won or we didn't win, although we were very proud to be a finalist, was that it forced us to tell those narratives and stories and then take some, you know, hard looks at ourselves on what we have or have not pulled together as an organization to create one advocate on behalf of our

00:09:45:04 - 00:10:12:03
Betty Chu, M.D.
patients. And what it leads to is, again, internal discipline around creating that standardization, creating one framework, creating standardized wiring and plumbing. Because in our health systems, we have a lot of solos. We have a silo of patient experience, we might have a silo that's doing work in the community. If we are all communicating with each other inside of our own organization, we can really move the needle on outcomes and health outcomes.

00:10:12:07 - 00:10:29:21
Betty Chu, M.D.
So that actually application too, it wasn't just about safety, it wasn't just about quality. It was really this holistic view. And I feel like we were just getting started in the journey. But it was a good, disciplined approach to thinking about how far we've come.

00:10:29:24 - 00:10:52:24
Chris DeRienzo, M.D.
I'll say two things, Betty. First, I was part of a health system several years ago that that also applied for that process, for the quest for Quality Prize and was also recognized as a finalist. So be really proud of that, because there are something like 5,000 hospitals and health system members of the AHA in the country. And I think this year there was one winner and three finalists, and you all knocked it out of the park.

00:10:52:25 - 00:11:17:07
Chris DeRienzo, M.D.
And I would expect nothing less than you to say, but of course, we're still at the beginning of their journey. Because every great leader I know who drives improvement and who drives change is never satisfied with where they are. Yes, we celebrate success and we absolutely need to do that. But one of my favorite quotes comes from Sister Catherine McAuley, who founded the Sisters of Mercy movement in Ireland like 200 years ago.

00:11:17:10 - 00:11:34:18
Chris DeRienzo, M.D.
And when asked how she did it, her answer was the simplest and most practical lesson I know is to resolve to be good today and better tomorrow. And you are leading the way at Advocate to better tomorrow. Share some of the outcomes, the stuff that that knocked our socks off in the application that you've led. There are many of them.

00:11:34:18 - 00:11:38:28
Chris DeRienzo, M.D.
But just sepsis, hypertension, diabetes or a few that come to mind for me.

00:11:39:01 - 00:12:00:09
Betty Chu, M.D.
You know, since we've come together as an organization we've had a 14% reduction in mortality. We had started with five Leapfrogging hospitals. We have 27, and that's just in three years. So what I'm proud about with that is we have our internal measures, mortality compared to ourselves. And we have our external measures that are benchmarked, of course, to other organizations or CMS

00:12:00:09 - 00:12:23:16
Betty Chu, M.D.
number of stars.  Four or five stars hospitals is going up. If we look at our U.S. News and World Report recognitions, we're increasing that number as well to not only again, internally, but externally. We're seeing that improvement. We've had a reduction in hospital infections. We've had a significant improvement in sepsis mortality through sepsis compliance. It's not, you know, it's not magic right?

00:12:23:18 - 00:12:48:02
Betty Chu, M.D.
It's that higher liability principle of design implementation and sustainability. You don't need to redesign the sepsis, we just need to do it every single time. And that's really, really, really hard. Huge kudos to our people. And alongside of that we've had some great team engagement. We continue to have tremendous team engagement, which to me is the secret sauce,

00:12:48:03 - 00:13:11:00
Betty Chu, M.D.
right? Behind any improvement activity is how do our teammates feel? Do they feel heard? Can they contribute? Do they have capacity for improvement? So I'm really thrilled to be partner with my nursing executives and the chief physician executive, who are working on a lot of those things to help free up that capacity for our clinicians.

00:13:11:02 - 00:13:33:12
Chris DeRienzo, M.D.
And there's pretty strong data that that when those measures rise around our team member engagement, that our patients feel it, too. And so kudos to you. And again, I just want to thank you so much for being willing to share your experiences leading your career and especially at Advocate. Congratulations on all of the outcomes that you've reached to date.

00:13:33:13 - 00:14:01:22
Chris DeRienzo, M.D.
I know they will be not the last time that we are hearing celebrations about the great work happening at Advocate under your leadership, but to listeners who are tuning in, and we have folks every week who tune in to the podcast from every conceivable kind of role in healthcare: small, independent, critical access hospitals in rural parts of America, frontier parts of America, folks in big academics, early career folks who maybe are clinicians who want to work in leadership but aren't exactly sure where to start.

00:14:01:22 - 00:14:24:00
Chris DeRienzo, M.D.
So the question I'd like to end with is, given all that you know and all the experience you have had as the chief medical officer for one of America's largest health systems, for those listening today who are perhaps closer to the beginning of their journey, what one piece of advice would you give them? Looking through the aperture that you see now that that is the best chance they have to get started on the right foot?

00:14:24:06 - 00:14:52:06
Betty Chu, M.D.
What I have learned is that there is a lot of pain in the world, and all of our responsibility is to understand other people's pain and try to work to solve for it. And that requires active listening, that requires deeply listening to other people and reacting and responding to what it is that they need. I think that's, you know, you've heard it called the servant leader or selfless leader.

00:14:52:08 - 00:15:12:15
Betty Chu, M.D.
I will say it's as simple as that. It's as simple as deeply listening to others and not listening to respond, listening to really understand what it is that people need. And as you figure that out and if you can solve for that, you will be successful, because that need is constantly changing. But it is something that I believe has served me well.

00:15:12:15 - 00:15:26:24
Betty Chu, M.D.
I've really tried to understand what is needed in society, what is needed from our patients, what is needed from our communities, what is needed from our nurses and our doctors. And I've tried to respond.

00:15:26:26 - 00:15:44:06
Chris DeRienzo, M.D.
I've spoken to a lot of people on this podcast, Dr. Chew, and that I think is one of the most profound answers I've ever gotten to that question. What you spoke to really cuts deep to who we are as people. And, you know, as folks, I think I would describe us as kindred spirits in the world of quality and safety, focusing on data.

00:15:44:07 - 00:16:01:28
Chris DeRienzo, M.D.
Yes, we have to focus on data. But man, you know, we can only move numbers so far if folks aren't feeling part of that process. So I just congratulate you so much. Thank you so much for spending time with us today. You're an amazing guest. And thank you listeners for joining in. Once again, this is Dr. Chris DeRienzo.

00:16:01:28 - 00:16:04:25
Chris DeRienzo, M.D.
We'll see you next time.

00:16:04:27 - 00:16:13:18
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.