Advancing Health Podcast

00;00;00;20 - 00;00;24;04
Tom Haederle
Novelist and humorist Mark Twain once observed, if we were meant to talk more than listen, we'd have two mouths and one ear. True in his lifetime and just as true today. In order for the American Hospital Association to be the most effective voice it can be for members, it needs to listen to their concerns. That means personal visits and face to face conversations with the leaders of hospitals and health systems across America,

00;00;24;06 - 00;00;47;23
Tom Haederle
hearing firsthand how they are addressing the challenges and opportunities in our rapidly changing field. It's incredibly important work and a big part of the job for Dr. Chris DeRienzo, the AHA's chief physician executive.

00;00;47;25 - 00;01;12;17
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. As a neonatalogist who has cared for some of the tiniest patients in a hospital, Dr. Chris DeRienzo learned early on there is no substitute for spending time with the patient first hand. In 16 months with the AHA he's traveled to 27 states and racked up 400,000 sky miles
00;01;12;18 - 00;01;36;03
Tom Haederle
putting that principle into action. In this podcast, Dr. DeRienzo shares with the AHA's Elisa Arespacochaga, vice president for clinical affairs and workforce, what he has heard and learned from spending a significant amount of time visiting with members. One key takeaway? It's clear there will never be a one size fits all solution that works for everyone to solve the challenges we face in health care.

00;01;36;05 - 00;01;37;14
Tom Haederle
Let's join them.

00;01;37;16 - 00;01;57;26
Elisa Arespacochaga
Thanks, Tom. I'm Elisa Arespacochaga, AHA vice president of clinical affairs and workforce. And today I'm really excited to talk with AHA's chief physician executive, Chris DeRienzo, who spends a good amount of his time around the country meeting with many of our members and understanding both the challenges and the opportunities that they're presented with. So I'm really excited to hear about his work.

00;01;57;27 - 00;02;07;07
Elisa Arespacochaga
So, Chris, I know you came to this from one of our member hospitals. Can you give just the thumbnail sketch of how you got from there to here?

00;02;07;09 - 00;02;27;10
Chris DeRienzo, M.D.
You bet, Elisa. And always a pleasure to get to join our podcast. And this I'm hoping will be the first in a series of conversations that we get to have with members and listeners about, what, frankly, is the best part of my job. And that is getting to, to travel this country and to be with our hospitals and the people who work within them.

00;02;27;13 - 00;02;46;12
Chris DeRienzo, M.D.
So I'm a neonatologist clinically. I spent the last ten years working in chief physician roles in health systems in North Carolina. In the western part of the state and middle of the state, in urban and rural community, academic, investor owned and nonprofit. And so I really, really got, how to run health systems in North Carolina.

00;02;46;14 - 00;03;02;21
Chris DeRienzo, M.D.
But back when I was interviewing for this role, I made sure to, to be really clear about the fact that that doesn't mean that I understood what it was like to lead in health care all over the country. and so that's what led me to, the kind of conversation we get to have today.

00;03;02;24 - 00;03;21;09
Chris DeRienzo, M.D.
I've been lucky now to be part of the AHA team for about 16 months. And as you know, in the 16 months, so far, I've been to 27 states that and, have earned something like 400,000 frequent flier miles on American Airlines. And so that's a lot of travel. We get to see a lot of the country.

00;03;21;14 - 00;03;28;09
Chris DeRienzo, M.D.
So really excited to get to spend some time with you today talking about the kind of things that we learned while out visiting with our members.

00;03;28;12 - 00;03;53;26
Elisa Arespacochaga
Absolutely. And I agree, it definitely is one of my favorite parts of my job is getting to see the both the impact we can have and then how our members are doing so many amazing, innovative things. So you've gone from the very micro environment of care delivery and taking care of some of our tiniest patients to a very macro view of what's the operational policy?

00;03;53;26 - 00;04;10;25
Elisa Arespacochaga
The organizational needs? And now a national agenda looking at care delivery and patient safety. What are the things you carry with you that are key lessons, even from those days of taking care of those tiny infants too, that help you do your work?

00;04;10;28 - 00;04;30;27
Chris DeRienzo, M.D.
Yeah, Elisa. There are many but I'll just share one for the context of this podcast. One thing that you learn really quickly as a pediatric resident and frankly, as a neonatologist, is when the nurse at the bedside gives you a call and says, there's something going on, you go and see the patient.

00;04;30;29 - 00;04;49;07
Chris DeRienzo, M.D.
And that in part is, is because, you know, the level of experience in those team members who spends you know, every hour at a bedside, they really get to know what's going on there. And one thing I learned in clinical practice is... There's a lot you can manage by phone, don't get me wrong.

00;04;49;09 - 00;05;12;21
Chris DeRienzo, M.D.
But in order to really get a feel for the situation as your partner is seeing it firsthand, you gotta go and see the patient. And sometimes when you go and see the patient you can be reassuring. And sometimes your level of energy very rapidly escalates. Frankly, the same is true in leadership. And the same is true for understanding what health care looks like all over this country.

00;05;12;24 - 00;05;38;13
Chris DeRienzo, M.D.
So as it relates to what we're doing here at AHA, we are incredibly lucky to get to speak for our members, in the halls of Congress, the White House, other members of the administration, and also to a variety of national media outlets. And as I've learned in the time I've spent at the association, in order to do that job really well, it also means we have to spend a significant amount of time visiting with our members.

00;05;38;16 - 00;05;50;07
Chris DeRienzo, M.D.
And they thankfully invite us into their professional homes. So we get to go to their hospitals, and really see what it is like to live their lives and to serve their communities firsthand.

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Elisa Arespacochaga
Absolutely. I completely agree. I think getting to not only hear their stories, but then make them part of what you get to share on a national level is, is really important. As part of your travels, you're really learning a lot about some of the approaches organizations are taking to address the tsunami of change that's coming towards them, whether it's the changing demographics of their communities, the workforce shortages they may be plagued by, or some of the challenges related to how they support technology.

00;06;21;23 - 00;06;33;12
Elisa Arespacochaga
How are you finding leaders staying hopeful and then what are some of the approaches they're taking to really bring their teams along and help support them as they go through this change?

00;06;33;14 - 00;06;54;11
Chris DeRienzo, M.D.
Yeah, I think one thing that's become incredibly clear to me is that there is never going to be one solution that will work to solve the challenges we face in health care all over this country. And I'll give you a couple of examples. We know that today we're experiencing a real challenge when it comes to labor and delivery around the country.

00;06;54;11 - 00;07;25;05
Chris DeRienzo, M.D.
We know that there are shifting demographics in America today that's leading to changes in birth rates. We know that our workforce kind of recruitment and retention perspective is incredibly challenged, especially in labor and delivery. And we know that the financing system is problematic with nearly 50% of deliveries in this country covered by Medicaid, and Medicaid being a provider that rarely even covers the cost of the services we provide. That has frankly led to a perfect storm of challenges.

00;07;25;07 - 00;07;56;03
Chris DeRienzo, M.D.
And when I've gone to visit different parts of the country, the ways the folks are solving them look very different. There are some places in, for example, northeastern part of Kansas, where the medical staff consists of four full spectrum family medicine physicians. And preserving, access to labor and delivery in that community looks wildly different than in, say, other parts of incredibly rural parts of the Dakotas or in some of the urban core centers, where workforce is still a really problematic challenge.

00;07;56;06 - 00;08;21;02
Chris DeRienzo, M.D.
But what I see from a hopeful perspective are the innovations that are happening within those local centers, and being able to innovate around what is the right resources to serve our community. In Iowa, for example, I was able to see some events, that innovation at work. As there's some grants funded by state government that have allowed for centers of excellence to pop up in certain communities.

00;08;21;04 - 00;08;47;11
Chris DeRienzo, M.D.
And that that is the kind of spark that educates us at a national level, around what are the kind of things that we can we can help solve for nationally? And where do we need to help lift up stories of what's working within local communities so that our health systems, who really are embedded in and integrated with the communities they serve, can look to apply those lessons, as best as they can, within their unique circumstances.

00;08;47;13 - 00;09;06;26
Elisa Arespacochaga
Agree that the ability to share those stories of what different organizations have brought together to make this work, no one is going to pick it up and do it exactly the same, but it's going to inspire a thought, an idea: hey, maybe we could...that I love to see. I love to see where people can take this.

00;09;06;26 - 00;09;16;25
Elisa Arespacochaga
Because if nothing else that I've learned in my own travels is that there's no one in health care who doesn't pretty much want to be there, because they have just a burning desire to help.

00;09;17;01 - 00;09;42;10
Chris DeRienzo, M.D.
Elisa, that's exactly right. And I think that we're challenged by the experiences through which we've lived. I've been fortunate to live in North Carolina, in communities large enough to have multiple pediatricians, because there are so many children in the counties that I've lived in. But I've gotten to visit counties who when you combine the populations of four counties together, you still don't have enough children just to be able to have one pediatrician there.

00;09;42;12 - 00;10;04;04
Chris DeRienzo, M.D.
and I think it's challenging when, you know, at a national level, a lot of the folks who engage in those conversations about what is health care look like, they've never seen that environment, much less, you know, lived through it. And so it's easier for me as a double board certified pediatric and neonatologist, to have one definition of what I think access looks like.

00;10;04;04 - 00;10;22;05
Chris DeRienzo, M.D.
But when you get out into other parts of the country and you get that sense for this community is different, that the nature of access to care here is different. We have to think differently about projecting subspecialty expertise from other centers in order to get it here. It really does reframe the way you think about the conversation.

00;10;22;10 - 00;10;32;01
Elisa Arespacochaga
I still will never forget the day I learned from one of our members in a very rural area that helicopters only fly about 150 miles before they need to refuel.

00;10;32;06 - 00;10;32;20
Chris DeRienzo, M.D.
That's right.

00;10;32;23 - 00;10;52;10
Elisa Arespacochaga
That's why he used a fixed wing air ambulance to transport patients who needed more care than he could provide. It was a very humbling moment for someone who grew up in the middle of a city. So let's dig into that a little bit, because you've clearly seen organizations where you can have sub-subspecialties, you know, right there at the bedside in minutes to

00;10;52;10 - 00;11;00;24
Elisa Arespacochaga
the hospital you just mentioned with a medical staff of four people. How do you see some of the field evolving to address this challenge?

00;11;00;27 - 00;11;24;26
Chris DeRienzo, M.D.
Yeah, I think there are a lot of different ways that I've seen hospitals and health systems approach that, in part because in some cases, one of the great values of an integrated delivery system, means that you can have sort of centralized subspecialty expertise within your own health system and project it, either via telepresence or via physical presence into those communities.

00;11;24;26 - 00;11;44;28
Chris DeRienzo, M.D.
So some systems approach this by having rotating specialists, you know, who are spending perhaps most of their time within a tertiary center in a larger community. But then or taking clinics, one day a week or two days a month or one day a month, even, within a more rural site than maybe a couple hours away.

00;11;45;00 - 00;12;23;16
Chris DeRienzo, M.D.
Others like Dartmouth up in New Hampshire are able to project subspecialty expertise from their academic center into many of their rural partners, via telepresence in other parts of the state. We see that with the folks at Sanford Health up in the Dakotas, where through a pop-up telemedicine site, they are able to see pediatric subspecialty patients in a local, small, office that's in a downtown of maybe a thousand people, that otherwise would require their family to drive 1100 miles roundtrip into Fargo to be able to see that team.

00;12;23;16 - 00;12;58;23
Chris DeRienzo, M.D.
And then I got to see this in one critical access hospital, again, staffed by family medicine, physicians, terrific doctors in the emergency department. But they're not trained in trauma to the level of, say, a Level One trauma center is as though they had in their emergency department rooms. There were two rooms, and on the walls of each room was a massive television. And a partnership, I would say at the press of a button they could bring in the EM boarded physicians who have recent trauma experience for the incredibly rare time at that emergency department sees, you know, a very significant trauma patient.

00;12;58;26 - 00;13;21;01
Chris DeRienzo, M.D.
And while they can drill on it and they can practice, you know, having that partner, that subspecialty partner, be able to look in and and walk through that case with you, that's an enormous benefit. And again, goes back to the kinds of local innovation that we see all across the country within AHA's members. And I know you've seen some examples of this firsthand as well.

00;13;21;03 - 00;13;46;23
Elisa Arespacochaga
Absolutely. The one that comes to mind was at the Children's Hospital in Colorado, where they created a multi-specialty clinic series so that they could bring for patients who in many cases, were driving from 1 or 2 states away. They could come and see all of the clinicians they needed to see for their child's care without having to spend, you know, a week going from appointment to appointment.

00;13;46;23 - 00;13;53;10
Elisa Arespacochaga
Everybody was together and it was focused on what that child needed. I just love that they centered it on the child.

00;13;53;12 - 00;14;20;05
Chris DeRienzo, M.D.
And to be able to do that in that children's hospital required and significant amount of resource. And we know that health systems rely on many different sources of funding streams in order to make that happen. And that hospital - I remember that visit vividly, because I was envious of that clinic space that they had so many resources that they could pull together in that one space.

00;14;20;05 - 00;14;27;11
Chris DeRienzo, M.D.
And you're right. Put the patient at the center and be able to serve these kids who really, really needed that subspecialty help.

00;14;27;13 - 00;15;07;08
Elisa Arespacochaga
So as you think about this and now, you know, think through sort of your own training and how you went through and learned how to care for the kids that were in your care, how do you think the training of our future clinicians and I mean that broadly, not just physicians, needs to start to shift so that they're ready to go not only to an academic center down the street to practice where they can call and have 20 people come consult to practicing in those locations where they may not have that physical presence, but they may have another way to interact with, the subspecialties they need.

00;15;07;11 - 00;15;34;20
Chris DeRienzo, M.D.
I think the training needs to evolve right along with the practice, as it has for generations. But the kind of evolution that's empowered by technology today is really important. I remember eons ago when I was a NICU fellow and we would fly out to some of the rural places where preemies would be born, and we would join the helicopter team on the flight, because sometimes you would need someone who is skilled in intubating a really tiny baby or managing pulmonary hypertension.

00;15;34;23 - 00;16;04;05
Chris DeRienzo, M.D.
But that the phone calls that we would get, we would be managing via phone. Now, much of that management can happen via telemedicine. And so, figuring out how to expose trainees to those kinds of tele-consults, especially within, you know, an integrated system. I remember the first time as a neonatologist I was requested to have tele-privileges, which was within one integrated health system that had a remote labor and delivery service up in the mountains.

00;16;04;08 - 00;16;20;13
Chris DeRienzo, M.D.
And for the first time, we had the technical capability to not just get on the phone with the team who was there in the delivery, but also beam in and be able to get visual on the resuscitation as well. That was a huge leap. And that was you know, almost ten years ago now.

00;16;20;16 - 00;16;41;02
Chris DeRienzo, M.D.
And so today's trainees are growing up in an environment where that's increasingly becoming a kind of part of the expected table stakes - is being able to not only manage in person, but support via some kind of telepresence. We're seeing it in the physician world - and absolutely, I know our partners at AONL - are seeing that in the nursing role, too.

00;16;41;04 - 00;16;56;00
Elisa Arespacochaga
Was really, excited to hear about some of the work that, Providence in particular had done and actually, through their virtual nursing were able to catch a patient who was exhibiting signs of a stroke.

00;16;56;01 - 00;16;56;25
Chris DeRienzo, M.D.
Wow.

00;16;56;27 - 00;17;14;21
Elisa Arespacochaga
That's how good their cameras and their interactions are, virtually to be able to call the bedside team, bring them in, and address that patient's needs immediately. Something that might not have been caught as fast had the virtual nurse not been having a conversation.

00;17;14;23 - 00;17;36;07
Chris DeRienzo, M.D.
It's this kind of innovation. And I know we share this opinion that it's both - when you're approaching it from both a patient centered perspective and from the notion that, we know we're in the middle of a workforce crisis, one that we cannot recruit our way out of, and that we must be able to innovate around how to project workforce experience in different ways.

00;17;36;07 - 00;17;43;18
Chris DeRienzo, M.D.
It's just such a great example of ways that our members are innovating. And I love the chance here to get to lift them up.

00;17;43;20 - 00;17;51;21
Elisa Arespacochaga
Well, Chris, I really enjoyed getting a chance to hear about some of the places that you've been, some of the things you've seen, and I look forward to where your travels take you next.

00;17;51;24 - 00;18;24;04
Chris DeRienzo, M.D.
It's a lot of fun, Elisa. And I say it all the time, I'm frankly the luckiest doctor in America to get to do this work. I cannot count the number of states that I get to visit over the coming months. But I'm really excited every time that that I do. Again, because when we see what's going on at the frontlines, it helps us not only connect hospitals with each other because there's so much learning that we can we can do across the field and but also informs the work that we do, on their behalf as an association in so many ways.

00;18;24;04 - 00;18;29;00
Chris DeRienzo, M.D.
I'm so grateful to them, so grateful to you, and to the folks who've been listening.

00;18;29;02 - 00;18;46;08
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;17 - 00;00;32;26
Tom Haederle
Health care providers know that access to care poses a big problem for many people who need it. The issue is often transportation, but there can also be behavioral, financial, and psychological barriers that prevent patients from setting foot inside the walls of a hospital. The answer? Bringing needed medical care to communities, clinics and neighborhoods that put it within reach of everyone.

00;00;32;29 - 00;01;07;16
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Sentara Health leaves no stone unturned in its quest to tackle the social determinants of health head-on and expand access to care in the communities it serves in thoughtful and creative ways. If you can't make it to the hospital, hospital services will come to you: via neighborhood clinics, mobile vans, even a geographic information system that helps identify populations with the greatest needs and insufficient access to health care and community services.

00;01;07;18 - 00;01;21;22
Tom Haederle
Joining me to share more about Sentara's formula for success is Iris Lundy, vice president of health equity and a person with very deep ties to the community she is passionate about helping. Iris, thank you for joining me today on Advancing Health.

00;01;21;24 - 00;01;23;18
Iris Lundy, RN
Thanks, Tom. So happy to be here.

00;01;23;20 - 00;01;49;02
Tom Haederle
Let me plunge right in. Among other things, you are a nurse, a mother, grandmother, an Army veteran and a colon cancer survivor. And I think all of those experiences have really helped you connect in different ways to families and communities and the health care system itself. So, in terms of your personal journey, maybe you can share a little bit with our listeners about your passion to promote health equity within historically marginalized and rural communities?

00;01;49;04 - 00;02;30;24
Iris Lundy, RN
Sure. You know, for those who may not see us, I am a black female. And when I think about just things that happen in our community and to me personally or to my family, it resonates. And it does - it makes me want to do more. Prior to my cancer diagnosis, I lost both of my parents to preventable diseases and I have seen other family members suffer from things that in this day and age, we should not have to based on education and just things that we could be helping to provide.

00;02;30;27 - 00;02;52;06
Iris Lundy, RN
So as for me, you know, as a cancer survivor, my journey was a little...it didn't flow like someone would normally expect. I didn't just wake up and see bleeding and say, oh, this shouldn't happen. Nor was I at an age where I should be getting a colonoscopy yet. So for me, things happened a little bit differently.

00;02;52;06 - 00;03;18;04
Iris Lundy, RN
And, when I was trying to explain to my then care team what was happening with me, it's as if they were not hearing me. And then I am a nurse, as you said, and I'm sharing what I am experiencing. But they're going down the track, but they're never really hearing me. That's my perception of that. And so finally I got with a physician.

00;03;18;04 - 00;03;29;22
Iris Lundy, RN
He says, I'm going to get you better. I am going to figure out what's happening with me. And he did, and he ordered a colonoscopy. And that's when it was determined I had colon cancer.

00;03;29;25 - 00;03;51;07
Tom Haederle
I say, you know, the word that really leaps out, what you just said is preventable. You use that in reference to your parents passing and perhaps your own diagnosis. What is the prescription for that? How do you move the system in a way that preventable medical conditions are found sooner and acted upon sooner?

00;03;51;09 - 00;04;25;01
Iris Lundy, RN
Yeah. I think we have to take the care where the people are. And we have to take them and and educate people in in a space that is physically and psychologically safe to them. Have a conversation about what is happening in our community. Hear what they're saying. Let's share with them the data we're seeing. And then let's share what we could do together to change some of this and let people make an informed decision.

00;04;25;01 - 00;04;28;17
Iris Lundy, RN
I mean, I have found that to be so successful.

00;04;28;19 - 00;04;50;26
Tom Haederle
I think every hospital and health system leader that we ever talked to on this podcast has made the same point that nobody does this alone. Everybody to be successful needs a community partner of some kind. So if you can take a minute to explain a little bit more about who Sentara works with in the Norfolk area and how you build those community partnerships that makes such a difference.

00;04;50;29 - 00;05;16;09
Iris Lundy, RN
Sure. You know, I think one of the things you have to do is identify the voices in the community that are trusted by the community. That's very important. We have found that whether it's in the neighborhood, there is always an informal leader there. We work with those individuals. We work with, certainly our health departments, other academic institutions, those kind of things.

00;05;16;10 - 00;05;40;06
Iris Lundy, RN
We certainly work with our HBCUs here. We have a medical school. We work with them. We also work with organizations like NAACP, Urban League, and other community-based organizations such as the food Bank, the YMCA. We do a lot of work with them. For mental wellness there are community based organizations that we work with also.

00;05;40;13 - 00;05;48;21
Iris Lundy, RN
We understand we need all of our partners coming to the table if we're going to truly impact and improve the health of our community.

00;05;48;23 - 00;05;57;13
Tom Haederle
And what are some of the specific tools that Sentara is using to do that, to bring access to care to the community where people are, meet them where they are?

00;05;57;16 - 00;06;16;23
Iris Lundy, RN
Well, one, we went in and we talked to people say, hey, tell us what you need. And as they're sharing what the need is and what's missing, and we're looking at data, then we begin to take mobile RVs so that we could go at a time that was important to the community. On days that are important to the community.

00;06;17;01 - 00;06;40;00
Iris Lundy, RN
If you're working 9-5, it's kind of hard to get in there. So sometimes we have to go on off hours or the weekend so that we can meet the needs of the community. How do we show up and meet people where they are? And then there are places where we have more traditional things, right? So we've actually put a clinic in one of our homeless shelters, but we've also put a clinic in the bottom of an apartment with wraparound services that are there

00;06;40;00 - 00;06;43;15
Iris Lundy, RN
so it's accessible to those who live in that community.

00;06;43;17 - 00;07;07;08
Tom Haederle
So much more convenient, we think, for people that otherwise would have a difficult time getting to the hospital or to a clinic that was downtown or far away or something. One thing I did want to ask about, and I mentioned this at the top, but I really would love some more information about it, is the use of the Geographic Information System technology to pinpoint and prioritize populations, with the greatest needs.

00;07;07;11 - 00;07;09;05
Tom Haederle
How does that work, exactly?

00;07;09;07 - 00;07;31;12
Iris Lundy, RN
I think geospatial mapping was a game changer for us. One, because you're able to visualize you can share data very quickly with whoever you're trying to talk to. So what we did was we put data, all types of data right in there so we could get a better picture. But we also looked at those social determinants, what we call the social drivers in there

00;07;31;12 - 00;07;56;08
Iris Lundy, RN
also, we overlaid that. And if I wanted to look at chronic conditions I could look at that. If I wanted to know where I could slice the data any way I want to get a better picture. And then based on that, you can help me prioritize. So I'll give you an example. We were looking at breast cancer screenings and we wanted to understand where do we need to educate and take our mobile mammovan.

00;07;56;10 - 00;08;25;07
Iris Lundy, RN
So when they did that for us, they could tell me who had not had a mammogram done in two or more years  - highlights stuff on my map. So it shows me where we should go for education and then where we could take our mobile mammovan, you know, to provide those services. We work very closely with the analytics IT team for that type of service, but we also work with our oncology service line for that.

00;08;25;09 - 00;08;42;17
Iris Lundy, RN
More importantly, I think, is that we work with those community-based organizations. They host us at their sites, so that we can maximize and get the people there and get the word out that, hey, we're going to be here providing this particular service.

00;08;42;20 - 00;08;51;17
Tom Haederle
What is an amazing and effective tool that is. But the patients are de-identified in this system? You said you can slice-and-dice the data.

00;08;51;19 - 00;09;04;27
Iris Lundy, RN
Absolutely. Yeah, we're able to protect privacy, but we can get down to the neighborhood level for us so that we can see that if we were going to share it, you would not be able to tell who's living where.

00;09;05;00 - 00;09;23;01
Tom Haederle
You know, I was thinking hospitals and health systems across the country are trying different things to move care beyond the four walls and into neighborhoods and clinics and reach people where they are. But in the end, I think, doesn't each individual have to decide for themselves how much time and effort they're willing to put into their own care?

00;09;23;04 - 00;09;38;29
Tom Haederle
I mean, it's a decision every person I think has to you either commit or you don't, or maybe you go halfway. But how do you persuade people in the end that they have to be co-partners in their own health care and work with Sentara and all the other the good things you're doing to make this happen.

00;09;39;01 - 00;09;56;14
Iris Lundy, RN
I think honestly it's not a lot of persuasion you have to do. I think part of it is, is that people did not have the access. And as you know, that is one of those determinants. And so if we provide access, if we make it easy for you to be able to do it, people are more likely to do it.

00;09;56;16 - 00;10;10;27
Iris Lundy, RN
It is hard to leave your job and understand you're going to miss hours of work when you feel okay. But if I say we're going to pull up there and we only need you to step out for 15-20 minutes, that's a game changer.

00;10;10;29 - 00;10;23;20
Tom Haederle
And if it involves a follow up visit, you know, if something is found, say, on a site clinic check, and but you're invited to come into the hospital for further testing, are people willing to do that? Take that next step, follow up?

00;10;23;23 - 00;10;40;26
Iris Lundy, RN
Absolutely. And I think it's because again, we're providing wraparound services. So we have community health workers. They walk you through your process. So it's really not like you're left alone. You don't have to figure out how do you navigate the system. We're helping you with that piece.

00;10;40;29 - 00;10;54;22
Tom Haederle
That's phenomenal. You've got every important base covered, it sounds like. Where do you see your efforts going in the future? I mean, you've done so much so quickly and come so far. Where would you like to expand? What else would you like to do?

00;10;54;24 - 00;11;24;01
Iris Lundy, RN
I would love to see, you know, the landscape of medicine is changing, and we are seeing that particularly when you're looking at cancers and other things that disparately impact Black and Brown and other historically marginalized or minoritized communities, we're seeing that things are increasing. So as things are increasing, us looking at that and being able to pivot to include that.

00;11;24;03 - 00;11;48;25
Iris Lundy, RN
The other thing is, is that what we may see on the horizon is a health system may look a little different than what the community sees. So we have to make sure that we're fluid enough so that we're taking into account what the community has identified as important to them, because if my blood pressure isn't bothering me, I may not find that as important.

00;11;48;25 - 00;12;07;17
Iris Lundy, RN
But the stress of not having a job or not having a livable wage, those things are important. So we're also coming along in that vein also to see how we help, right? Because we understand that it's more than just a medical help. We got to help with those other pieces also.

00;12;07;19 - 00;12;24;04
Tom Haederle
Based on your experience so far and Sentara's experiences as a health system and the things that you're trying to do, what advice would you give to your peers in the field who might be trying to do the same thing in their city or their neighborhood? What have you learned that you'd like to pass on?

00;12;24;06 - 00;12;56;21
Iris Lundy, RN
I think one of the things that was most successful for us was going into the community and having very real and very raw conversations and listening to the community and coming back. So we have their qualitative data, their lived experience. We come back, we're looking at our data, all of the different points that we can pull together. And then it helps us paint a better picture of what is happening. And then going back to the community to say, here's what we heard from you.

00;12;56;24 - 00;13;17;24
Iris Lundy, RN
Here's what we're also seeing. Does this fit with your lived experience and then how do we together move forward? Because I think if we can identify the common goal between the two of us, we can lay everything else aside and work toward that. And that has been very successful for us.

00;13;17;26 - 00;13;33;17
Tom Haederle
Quick follow up on that. Sometimes, I guess there has been a disconnect between what a care team might think a community is asking for, but then when you hear their voices and people say, no, what we really need is this it may not fit with what the assumptions were starting out.

00;13;33;20 - 00;14;01;16
Iris Lundy, RN
Absolutely. Absolutely. I mean, that that does happen. We were working with the school system, and sometimes you think, well, you know, this is the concern of the school. No, the school was very concerned about how do we make sure that, when a child doesn't have clean uniforms, we can wash them and get something back on that child so that they feel, you know, that we are treating them  - the little person - with dignity, respect and compassion.

00;14;01;18 - 00;14;26;15
Iris Lundy, RN
That was our most immediate need. We needed to make sure that we could address that need, and then we could have a larger conversation about...we understand that some children may start school late because they don't have their well child visit done, all of their immunizations. How do we partner with you and parents so that we can get children in school when they need to be?

00;14;26;18 - 00;14;38;15
Tom Haederle
Is there anything that I haven't asked about that you'd like to share in this podcast, in terms of what you've learned, or what you would like people to know about the whole effort to move a health care into the community.

00;14;38;17 - 00;15;04;18
Iris Lundy, RN
Tom, I think one of the things that we've learned is that, there are a lot of things that come at people quite frequently, and rapidly. And so how do we help them address those things? So when you're thinking about employment, thinking about food scarcity, some of those kind of things, and how do we break this cycle of poverty, right?

00;15;04;20 - 00;15;29;07
Iris Lundy, RN
How do we help people get to that next step in their journey? So we're doing that around scholarships. We have those kind of programs. We work with schools. We're doing things so we can get young people interested in STEM programs. We're doing all kinds of things so that we can prepare our communities to move forward. And we're doing this work with them, not for them.

00;15;29;14 - 00;15;32;11
Iris Lundy, RN
We are truly their neighbor.

00;15;32;13 - 00;15;52;18
Tom Haederle
It sounds like you're going so far beyond strictly medical health, you know, in so many ways. And that seems to be the key to turn entire communities around. Well, thank you so much for your time and explaining some of the wonderful things that Sentara is doing in the Norfolk area, which I guess could be replicated pretty much anywhere if people have the resources and the mission drive to do it.

00;15;52;20 - 00;16;17;04
Tom Haederle
Again, you have been hearing Iris Lundy, who is vice president of health equity with Sentara Health, that's in Norfolk, Virginia, talking about the wonderful ways in which her organization is moving access to care beyond hospital walls and out into the communities that it serves. 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;15 - 00;00;45;02
Tom Haederle
As many hospital and health system leaders look for solutions to address the root causes of violence in their organizations and communities, some AHA members have already figured out how to make their organizations a safer and more peaceful environment in which to receive care. As we observe AHA's 8th annual #HAVhope today, we look to Pennsylvania-based WellSpan Health to share how the implementation of their Behavioral Health Emergency Response Team has successfully de-escalated incidents of workplace violence by 75% since 2019.

00;00;45;04 - 00;01;11;21
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast hosted by Jordan Steiger, senior program manager of Clinical Affairs and Workforce with the AHA, she is joined by Dr. Kenneth Rogers, who shares how WellSpan health is leading the way in implementing training and increasing capacity for their team members to respond to situations that could result in violence.

00;01;11;23 - 00;01;17;23
Tom Haederle
Dr. Rogers is vice president and chief medical officer of behavioral health at WellSpan Health.

00;01;17;26 - 00;01;30;22
Jordan Steiger
So Dr. Rogers, thank you so much for joining us today. We're really excited to learn more about your work, given that workplace violence is, you know, a problem that a lot of our hospitals and health systems across the country are dealing with.

00;01;30;24 - 00;01;47;12
Kenneth Rogers, M.D.
Yeah, you know, it is a huge issue everywhere. Violence against healthcare professionals is going up substantially over time. And so it is such a huge issue, especially post-Covid, with everybody being frustrated, upset about things. And just on edge.

00;01;47;15 - 00;01;59;00
Jordan Steiger
Absolutely. I know that that will resonate with a lot of our listeners. So before we get started learning about your work, I'd love for you to tell us a little bit about WellSpan Health and just your role within your health care system.

00;01;59;03 - 00;02;29;23
Kenneth Rogers, M.D.
Sure. WellSpan health is a health system with about 20,000 employees. We're located in south-central Pennsylvania. We cover five counties in that area. Comprehensive integrated delivery system in those five hospitals: Behavioral health. We have inpatient services. We have emergency room services. We have Philhaven Hospital, which is a freestanding psychiatric hospital with 137 beds, about total, about 200 beds across the entire system for behavioral health.

00;02;29;25 - 00;02;32;24
Jordan Steiger
That's great. And what is your role within the system?

00;02;32;26 - 00;02;35;22
Kenneth Rogers, M.D.
So my role is the chief medical officer for Behavioral Health.

00;02;35;25 - 00;02;39;05
Jordan Steiger
For Behavioral Health. And you are a physician, correct?

00;02;39;12 - 00;02;41;09
Kenneth Rogers, M.D.
I'm an adult child and adolescent psychiatrist.

00;02;41;10 - 00;03;02;14
Jordan Steiger
Wonderful. Okay. So I know we're here today to talk about the success that WellSpan has had in de-escalating issues of workplace violence. But before we do that, I would really like to learn just about, you know, your own personal perspective as both a psychiatrist and an administrator. What led you to being so passionate about this work?

00;03;02;17 - 00;03;33;28
Kenneth Rogers, M.D.
So I spent the first part of my career in corrections. A lot of work in juvenile justice. And so one of the things that you learn in juvenile justice is really de-escalation, trying to keep environment safe and really just trying to really think about the environment almost constantly. And so as I progressed throughout my career and working on inpatient child units and in other kinds of settings, you sit there and you look at situations where you're saying that could have been handled so much better.

00;03;34;03 - 00;04;01;05
Kenneth Rogers, M.D.
And a situation escalated that really didn't have to escalate. And one of my positions I had before this was at Parkland Hospital in Dallas. And in Parkland, there was a huge initiative around workplace violence, largely because it's a city-based hospital. There's a mixed population. There's really not a majority population. And so there was a lot of work that was being done in the largest emergency room in the United States around

00;04;01;05 - 00;04;17;29
Kenneth Rogers, M.D.
how do we think about cultural issues? And in those cultural issues, how do we think about workplace violence issues that really arise out of things that people aren't really thinking about, because the perspectives are just so different between the two individuals that often are involved in the situation.

00;04;18;02 - 00;04;29;16
Jordan Steiger
I mean, that makes a lot of sense. I think that context, you know, in the care environment is so important. And I think a lot of this can often arise from just misunderstandings and miscommunications between people.

00;04;29;19 - 00;04;35;02
Kenneth Rogers, M.D.
Absolutely. The vast majority of them are simply misunderstandings or lack of communication.

00;04;35;04 - 00;04;40;05
Jordan Steiger
Right. Which seems like it should be a simple thing to fix, but we know that that's not always the case, right?

00;04;40;12 - 00;04;43;24
Kenneth Rogers, M.D.
When people are stressed, communication is usually the first thing to go.

00;04;43;29 - 00;05;05;13
Jordan Steiger
Exactly, exactly. So since you've been at WellSpan, I think this has been since the beginning of 2019, if I'm remembering correctly. You've implemented what you're calling the Behavioral Health Emergency Response Team, but we'll call it BERT for today because that's a little easier to say. And you've been able to successfully de-escalate workplace violence incidents by 75%.

00;05;05;13 - 00;05;06;09
Jordan Steiger
Is that right?

00;05;06;11 - 00;05;06;24
Kenneth Rogers, M.D.
That's correct.

00;05;07;01 - 00;05;11;24
Jordan Steiger
Tell me about that. Tell me how this got started and how you've had such success.

00;05;11;27 - 00;05;37;14
Kenneth Rogers, M.D.
So the BERT team has actually been around for a while. And initially it was a very nursing driven model that really focused on inpatient care and trying to figure out how do we help nurses on inpatient units do a better job. My background is largely from emergency departments. I've spent most of my career working in and out of various emergency departments as a consulting psychiatrist.

00;05;37;16 - 00;06;02;04
Kenneth Rogers, M.D.
And so when I arrived, a thing that became increasingly clear was there were issues on the floor, but a lot of our workplace violence issues were actually happening in our emergency departments. It was happening in places outside of kind of your traditional patient in bed kind of situation, whether it was with families, whether it was with staff members getting into disagreements with each other.

00;06;02;06 - 00;06;22;06
Kenneth Rogers, M.D.
Those are some of the areas where I felt that it was really a problem. And so as we kind of looked at and talked through some of this and we looked at the training we gave a lot of our mental health professionals, we felt like this is something that we could really roll out to the system in general, so that folks had a greater capacity to be able to actually engage in de-escalating situations.

00;06;22;09 - 00;06;30;00
Jordan Steiger
That sounds great. So it sounds like this is a nursing led initiative, or has that changed at all, as it's evolved over time.

00;06;30;02 - 00;06;48;24
Kenneth Rogers, M.D.
Still tends to be largely nursing driven. for most of the inpatient work. However, in the emergency departments and some of the other areas, there are lots of other people that tend to be more involved, especially mental health professionals. Some of our behavioral health counselors, which are master's level clinicians, that are engaged in a lot of that work.

00;06;48;24 - 00;06;55;15
Kenneth Rogers, M.D.
And so trying to really be more specific based on the areas where people are located.

00;06;55;18 - 00;07;07;13
Jordan Steiger
That's great. It's always important, I think, to bring up the workforce, you know, because a lot of, hospitals and health systems are struggling with workforce issues right now. So trying to think about who is involved, who it takes to make this successful.

00;07;07;17 - 00;07;08;16
Kenneth Rogers, M.D.
Absolutely.

00;07;08;18 - 00;07;30;12
Jordan Steiger
So you mentioned, you know, the on the floor professionals, those master's level clinicians, those nurses, the people that are really doing this de-escalation. But let's talk about leadership and leadership buy-in. Obviously you as the CMO for behavioral health know that de-escalation works. You know, this is a practice that is evidence based that shows a lot of success.

00;07;30;19 - 00;07;34;11
Jordan Steiger
But how did you get other leaders in your organization on board with this?

00;07;34;13 - 00;07;58;16
Kenneth Rogers, M.D.
You know, it really wasn't me trying to get other leaders in the organization engaged. It was the leaders of the organization saying that, Ken, you need to be engaged. Because it becomes increasingly clear, if you're the CEO of a health system, that you've got employees getting hurt. You've got a clear vision that they're folks that their morale is dropping, they're frustrated about coming to work.

00;07;58;16 - 00;08;25;13
Kenneth Rogers, M.D.
They don't find the joy at work anymore, and nobody wants to go to work to be attacked by a patient or a family member. And so that, I think, was the vision that our senior leadership of the organization was seeing. And it was really their vision to say, you know, we need to do what we need to do to figure out how to make our employees feel safe, how to help them and enjoy work and help to send a message that this is a safe place to be.

00;08;25;15 - 00;08;56;04
Kenneth Rogers, M.D.
And so that was where we kind of started this entire process from. And I think the other driver was looking at our emergency departments, which were increasingly busy. We had a lot more boarders at that particular point in time. And as people are staying in emergency departments for, you know, days on end, looking at four walls and you already have some degree of agitation in the background, it leads to issues that you just, you know, shouldn't have in hospitals.

00;08;56;04 - 00;09;05;27
Kenneth Rogers, M.D.
And so there was kind of this buy-in from kind of everybody in the organization from almost day one. This is definitely something that we should address and do something about.

00;09;05;29 - 00;09;29;08
Jordan Steiger
That's great that everybody's on the same page. And I mean, you bring up a lot of really important issues. You know, the joy in work, decreasing burnout, you know, increasing worker well-being. Those are all things that I think we all care about right now, especially as you know, we know that that has kind of ebbed and flowed a little bit over the course of, you know, caring for people through Covid and, you know, kind of this period that we're in right now.

00;09;29;08 - 00;09;37;16
Jordan Steiger
So I think that that's, thinking about this not only from how this benefits your patient population, but also your workforce, I think is really, really important.

00;09;37;17 - 00;09;38;20
Kenneth Rogers, M.D.
Absolutely.

00;09;38;22 - 00;09;50;15
Jordan Steiger
So walk us through maybe a patient situation, de-identified, obviously, but something that sticks out to you that, where this BERT program really was successful.

00;09;50;17 - 00;10;12;05
Kenneth Rogers, M.D.
Sure. I can think of many examples, but I'll give you one that I really think encompasses kind of lots of issues. And this one actually happened on an obstetric service. I had a patient that was there with her family from a Latino background. And if you look at the situation, she spoke relatively good English.

00;10;12;07 - 00;10;39;12
Kenneth Rogers, M.D.
It seemed like she was understanding things, but there was this sense that she was getting increasingly frustrated. And so BERT ended up getting called because she, the husband, the nursing staff, things just seemed to really blow up. She was getting angry, loud, volatile. What's happening here? And so there was a sense that there were risks to the nurses she's about to deliver

00;10;39;12 - 00;11;07;16
Kenneth Rogers, M.D.
so there's risks to the baby. Husband's there, so you know what's really going on? So you arrive in a situation and what was, I think, apparently clear from day one, from moment one, is that you had a person whose English skills weren't great. And so there were pieces of things that she could communicate outward but didn't necessarily fully understand especially in a health care context.

00;11;07;19 - 00;11;31;27
Kenneth Rogers, M.D.
And so some of the health care discussions that were occurring weren't really clear. Her husband was less fluent than she was, and so she was trying to translate things that she was understanding to him, and he really wasn't understanding. And so you had this family that was sitting there frustrating because of lack of communication. And so the intervention had nothing to do with medications or anything.

00;11;31;29 - 00;12;01;00
Kenneth Rogers, M.D.
It had to do with, let's get a translator or someone who is Spanish speaking, to help really work the family through what's happening next so they could become much more engaged and involved in their care and feel more empowered. And so that was actually the intervention that BERT did for that particular day. It seems relatively simple, but it's things like that in a health care context that happen all the time.

00;12;01;04 - 00;12;14;03
Kenneth Rogers, M.D.
People are busy, nurses are busy trying to get things done. Doctors are getting in and out and doing rounds and so people don't pick up on the fact that the patient may not be fully understanding what's going on. So are there things that we can do differently?

00;12;14;05 - 00;12;36;02
Jordan Steiger
I really love that you use that example, because I think oftentimes when we think about, you know, de-escalating situations, we think of a situation of violence. And this is not something that required any kind of intervention in that perspective. It was just really taking that moment, like you said, to understand the patient's needs and course correct. Right. So I think that's a great example.

00;12;36;09 - 00;13;05;18
Kenneth Rogers, M.D.
Right. And so in that particular situation, I think there were really a number of super positive things that happened. One, the nurse that actually did the birth call recognized that things were escalating before they really got to kind of that violence place. So that was the number one thing. I think the other thing was the level of support that she felt to be able to do that, because having done a lot of work to make people feel comfortable that, you know, if you need help, just call.

00;13;05;20 - 00;13;26;22
Kenneth Rogers, M.D.
And so there wasn't a hesitance to do so. But then there were also people that could respond relatively quickly. And having the resources and understanding of those resources to be able to provide them in real time to the staff and patients. Because that was a situation that could have spiraled out of control very quickly, because you could see that the family was getting increasingly upset.

00;13;26;24 - 00;13;41;28
Kenneth Rogers, M.D.
The staff was a little nervous and scared, and you put those two things together and it doesn't lead to a great outcome. But, able to get her calm pretty quickly. Family was actually happy with the situation and the rest of the delivery went smoothly.

00;13;42;04 - 00;13;56;18
Jordan Steiger
Sounds like best case scenario. And again, a great example of why a program like this in your hospital can really be beneficial. One thing I'm realizing I didn't ask you that I think our listeners would be curious about is how are people trained to be on the BERT team?

00;13;56;20 - 00;14;45;00
Kenneth Rogers, M.D.
Our behavioral health professionals working on any behavioral health unit, inpatient or outpatient, go through a three day mandatory training. And in that three day training, the first portion of it is really looking at the phases of escalation and de-escalation and being able to recognize when somebody's at really low level and when they're kind of going up to some of the higher levels and looking at de-escalation techniques to be able to get them to that place. Day two and three are looking at more mental health based interventions and trying to think about more hands on figuring out how do you get people really calm when they're beyond, the place that they can be

00;14;45;00 - 00;15;20;08
Kenneth Rogers, M.D.
de-escalated. So what we've done with BERT is really trying to make sure every employee in the health system gets at least part of day one, so every employee is able to recognize the levels of escalation, levels of de-escalation, and some basic skills to be able to do that. Then for people that are going to do more mental health or BERT related work is really thinking about day two of a lot of that work where you're getting some more in-depth skills to be able to manage some of those more difficult situations.

00;15;20;10 - 00;15;43;25
Jordan Steiger
That makes sense. I love that you focus on giving training to all of your workforce and then, you know, really kind of, focusing in on those behavioral health providers. That's great. So I think, Dr. Rogers, your example of your program is truly one of the best that I've heard of across the country. I mean, being able to de-escalate, you know, violent situations by 75% is pretty incredible.

00;15;43;28 - 00;15;53;20
Jordan Steiger
So if another, hospital or health system is maybe inspired by this conversation to think about this in their own, you know, care setting, what advice would you give them?

00;15;53;23 - 00;16;17;18
Kenneth Rogers, M.D.
So I do think that it's important to make it part of your culture. Because one of the things, for example, that you want is to make sure that the folks that are going to respond to any kind of aggressive incident have training in how to manage it. So, for example, if you think about security force, for example, a lot of security officers aren't really trained in de-escalation in a hospital setting.

00;16;17;20 - 00;16;45;07
Kenneth Rogers, M.D.
They're really trained to manage situations really well. But if you've got somebody that's really in distress in the hospital situation, that training may not work, but security's often the first folks that we're going to call. So making sure that those folks are able to incorporate those de-escalation skills into what they're what they're doing. I think the second thing that's really important is to look at the administrative culture. We started talking about earlier,

00;16;45;09 - 00;17;15;01
Kenneth Rogers, M.D.
what's the buy in? Some hospitals and clinics find themselves really engaged in behavioral health work. It's what they do. They feel very comfortable with it. Others really want to keep it at arm's length. And so trying to develop a culture where responding to behavioral issues becomes the norm and people can do that compassionately and do it without becoming frustrated very easily because it's very patient-centered work.

00;17;15;01 - 00;17;38;01
Kenneth Rogers, M.D.
And I think the more people understand the patient centered-ness of what we do, the more people are able to really, really engage and be a lot more, lot more involved. And then the third piece I think that's important is to look at the outcomes for staff. If you think about trying to retain staff, trying to train new staff, that's one of the hardest things for health systems to do.

00;17;38;05 - 00;17;57;27
Kenneth Rogers, M.D.
And so trying to think about the return on investment, even if you feel like the time for training, the extra effort we're putting into it may not be worth it. If you're able to retain additional staff members and not have to retrain, I think that's definitely one of them. One of the huge benefits.

00;17;58;00 - 00;18;14;01
Jordan Steiger
Absolutely. Thank you so much for, you know, sharing those quick pieces of advice and your wisdom about this work. I think that you really are kind of leading the way in terms of the outcomes you've been able to achieve. And so we're really, really appreciative that you were able to come share with us today.

00;18;14;04 - 00;18;16;11
Kenneth Rogers, M.D.
Thank you so much. I appreciate you having me.

00;18;16;13 - 00;18;24;23
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;20 - 00;00;23;16
Tom Haederle
Despite being educated, prepared and committed to doing everything it could to defend against a cyberattack, it happened anyway. When hackers breached the system of San Diego-based Scripps Health three years ago, the incursion forced Scripps to temporarily shut down some of its systems, leaving trauma surgeons, for example, wondering whether it was safe to treat patients without access to their electronic health records.

00;00;23;18 - 00;00;38;28
Tom Haederle
But even after the immediate attack was contained, cybercriminals caused a second set of problems.

00;00;39;00 - 00;01;00;11
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Hospitals and health systems have their hands full coping with the scary reality of a ransomware attack. But on top of that, there are civil liability concerns that limit how much information hospital leaders may share with the public and the media about what's going on.

00;01;00;13 - 00;01;30;13
Tom Haederle
A false step could lead to lawsuits or government sanctions. In the second of this two-part podcast, Chris Van Gorder, president and CEO of Scripps Health, explores with John Riggi, AHA's national advisor for Cybersecurity and Risk, how his organization responded when cybercriminals attacked. They discuss the need for cybersecurity standards and safe harbor protection from the federal government, so that care providers can focus on mitigating cyber attacks and protecting patient safety without having to look over their shoulders.

00;01;30;15 - 00;01;58;11
John Riggi
Ransomware attacks targeting hospitals, health systems and our mission critical third party service providers such as Change Healthcare have increased over 300% over the last three years, according to HHS and the FBI. Today, I am so very pleased and privileged to have my good friend and colleague here with us today to discuss this issue. Chris Van Gorder, president and CEO of Scripps Health in San Diego.

00;01;58;14 - 00;02;08;26
John Riggi
Chris, so, again, I commend you for speaking publicly today. One of the things you have done recently is published an article. Is there any other perspectives you'd like to share from the article?

00;02;08;29 - 00;02;28;23
Chris Van Gorder
Well, again, I think my big ones are, you know, hospitals do need to be prepared. And we need to bring our systems up to the highest standards that need to be established for us as to what those are. And they need to flex with time. There's going to be new technology. The ASAC at the FBI said he says, look, he says bad guys, this is their fulltime job.

00;02;28;29 - 00;02;53;07
Chris Van Gorder
That's all they do. They're busy, you know, thinking how are they going to, you know, change their systems to be able to defeat everything you put in to protect yourself. Right. And he says, whatever you do, don't be mad at yourself. You could not have protected yourself from this attack. And from that point on, the FBI gave us enormous support, enormous advice, positive advice.

00;02;53;09 - 00;03;13;24
Chris Van Gorder
And they've stayed in touch with us over the years after that to let us know where they can...obviously they can't violate any kind of confidential information and share that. But they've allowed us to know that the information we shared with them was and has been useful. We dumped everything. You know, we told them right off the bat, you tell us what you want.

00;03;13;26 - 00;03;36;08
Chris Van Gorder
We will give it to you. Right? Because if this information helps protect another organization downstream, then that's what we ought to be doing. And so, you know, I think they're fabulous. That's the one agency I can tell you that, I felt had our back during the entire incident and afterwards. I can't say that for anybody else other than the people we hired to help us.

00;03;36;11 - 00;04;02;28
Chris Van Gorder
And there are some great companies, you know, Mandiant, CrowdStrike and others that were wonderful in terms of coming in and helping support my team to clean the systems up. And today we have literally, you know, not only do we have state of the art CrowdStrike and other things monitoring the systems, we keep obviously everything up to date, but we have individuals outside of our organization watching the activity inside our system for the behavioral things.

00;04;03;03 - 00;04;23;28
Chris Van Gorder
So all of those types of things so that if somebody does get in and we're watching how people are acting inside the system, which can be an indicator. So I don't know what else we could do to protect ourselves. And I'm not going to fool myself ever again to believe that it couldn't happen again. And so, I think we need to take this on as a country in a much bigger way than we have.

00;04;24;00 - 00;04;36;04
Chris Van Gorder
And it's happening every day. Our country is being attacked by criminals, protected by what I would call rogue countries. And we've got to do something about that.

00;04;36;06 - 00;05;02;17
John Riggi
Thanks, Chris. Totally agree with you. The attacks are continuing. It's pretty clear to me. I'll offer my opinion that Russia, China, North Korea and Iran are using criminal cyber groups as proxies for their own national interests. And quite frankly, as you said, when this is clearly a national security incident, a national security threat. When an attack occurs, broadly threatens public health and safety

00;05;02;20 - 00;05;23;12
John Riggi
that is an act of cyberterrorism, and we need to respond appropriately. Again, we can prepare as much as we possibly can, but ultimately we need the government to do much more on offense as well. Chris, is there - you know, again, we've had a great conversation. We talked a lot about your perspective. And thank you for being so candid and direct with us today.

00;05;23;13 - 00;05;45;04
John Riggi
I think it will be very helpful for our members. By the way, I is a former FBI agent and the FBI appreciate your comments. And there is no doubt, Chris, I have no doubt that the information you provided was instrumental in the publication of National Threat Intelligence in the weeks and months following your attack. And without attribution, of course, to you

00;05;45;06 - 00;06;17;26
John Riggi
I have no doubt that information helped prevent other attacks. So again, the example you set, leadership example, is really something that I wish many others would emulate. And others are trying to do the right thing, but often they are hindered by advice from outside counsel. Chris, last question. Knowing what you know now, having gone through the experience that you did - painful, years long - what are some of the things you wished you had known beforehand?

00;06;17;28 - 00;06;20;01
John Riggi
You wish that someone had told you?

00;06;20;03 - 00;06;40;27
Chris Van Gorder
Maybe it's good, maybe it's bad. Health care workers are heroic. This is the positive side of it. I mean, any time we see bad things that happen: COVID, we had doctors and nurses and technicians afraid for their own lives, and they came to work every day in those early stages, not knowing whether or not the protective gear would protect them or not.

00;06;41;00 - 00;07;04;09
Chris Van Gorder
We saw the same thing in the cyber attack. The doctors, nurses, they all rallied. Not only during the time of the attack, going to paper, using runners to get information from one place to another, running lab specimens to our central lab, waiting for the lab results, and then driving them back to the hospital. Everything slowed down.

00;07;04;11 - 00;07;24;21
Chris Van Gorder
But the patients were cared for. Well, I was invited to a meeting at the local FBI office to just talk to them about that. And the one thing they were saying, they flat out asked they could people have died in this attack? And I said, yes, they could have. And that seemed to elevate the entire issue for them to a much higher level than just a property crime attack.

00;07;24;24 - 00;07;47;19
Chris Van Gorder
This could be murder, international murder. And, you know, I don't think I ever thought about it quite that way until we were victimized. For months afterwards, because everything we had on paper now, we had to put back into the digital. And the cost implications were absolutely enormous. If we were not a financially strong organization, it could have bankrupted us easily.

00;07;47;19 - 00;08;05;26
Chris Van Gorder
And I would tell you, if the same thing happened to a small rural hospital, they would never have opened up again. They would have gone bankrupt and not been able to open up. So, the resources need to be available for smaller organizations that just don't have the capabilities of a health care system like Scripps. There needs to be funding made available. As it is right now

00;08;06;03 - 00;08;28;16
Chris Van Gorder
we're underfunded, as we know, by Medicare and Medicaid nationally. Right? And if you happen to have a poor payer mix, there's no way in the world you're investing in the necessary cybersecurity, in the systems and people to be able to protect your organization. You will eventually be a victim. Those resources we truly want to protect those hospitals, and we want to save lives.

00;08;28;22 - 00;08;50;05
Chris Van Gorder
The resources have to be made available, particularly to the smaller hospitals and rural hospitals. The systems and facilities that just don't have the resources to be able to do that. We have to take this on. If we want to defeat this, we have to take it on as a country and not as an individual hospital, trying to find the best way it can to protect itself.

00;08;50;07 - 00;09;09;06
Chris Van Gorder
And so maybe my last comment to you, John, is to thank the American Hospital Association and you for bringing attention to this on a daily basis to Congress, to our executive branch, And, you know, doing a podcast like this and keeping it going because everybody out there that hasn't been attacked is sitting there going, I hope it never happens to me.

00;09;09;08 - 00;09;28;23
Chris Van Gorder
So one thing I learned maybe that I should have is I should have had the mindset of it will happen to me and I need to do whatever is necessary to make sure the system's prepared. The drills. You know, I wish we'd done more drills ahead of time on paper. I wish we had extended the downtime from an hour or two to 12 hours

00;09;28;25 - 00;09;49;27
Chris Van Gorder
so that we had more practice doing that. I wish we thought through what do we do if we're down for three weeks, four weeks, five weeks, you know, how are we going to treat patients to make sure that nobody dies on our watch? If I had the knowledge of the experience I had beforehand, there's no doubt I would have done some things differently during the attack.

00;09;49;29 - 00;10;14;12
Chris Van Gorder
And I wish we had ability now to be able to share this experience more widely and safely so that, you know, when there is a victim out there that organizations like ours who have gone through it could provide help to them without them fearing additional liability, without me feeling like I'm risking our own organization, getting involved somehow in litigation because we just went out there to try to help.

00;10;14;19 - 00;10;24;09
Chris Van Gorder
There needs to be some form of attorney-client protection or government protection for organizations like ours to share and help each other when they're in trouble.

00;10;24;11 - 00;10;51;14
John Riggi
Thank you. Chris. One, I appreciate your kind and gracious comments. We are working very hard and the government has taken action. Now the FBI and DOJ officially classify ransomware attacks against hospitals as threat to life crimes. And DOJ classifies these attacks at the same investigative priority as terrorist attacks. Thank you again for your words of wisdom as a victim, as a victim organization to share and help others learn.

00;10;51;17 - 00;11;13;28
John Riggi
And finally, Chris, thank you for your leadership on this and so many other issues. And again, ultimately trying to, as we do in law enforcement, trying to protect and serve at the same time. So we want to close out this podcast in a special thank you to all our frontline health care providers, our frontline health care heroes who every day care for patients and serve their communities.

00;11;14;04 - 00;11;26;12
John Riggi
And thank you to all our network defenders, for what you do every day to protect our health care organizations. This has been John Riggi, your national advisor for cybersecurity and risk. Stay safe everyone.

00;11;26;15 - 00;11;34;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.