Advancing Health Podcast

00:00:00:08 - 00:00:17:06
Tom Haederle
Welcome to Advancing Health. Today, we learn from the experts how physical security is a necessary component of cyber security, and why they have added the misuse of AI by bad actors to the list of cyber threats facing health care providers.

00:00:17:09 - 00:00:47:01
John Riggi
Hello everybody. My name is John Riggi. I'm national advisor for Cybersecurity and Risk at the American Hospital Association. So pleased to be joined by my good friend today, Larry Pierce, who is the director of cybersecurity, information security officer for Atlantic Health. And folks, believe it or not, Larry has been at the same organization, Atlantic Health, for almost 40 years in various forms of information technology and cybersecurity,

00:00:47:02 - 00:01:10:13
John Riggi
really as the field evolved. So, Larry, so good to have you here today, especially as cyber threats of all types are increasing dramatically. Third party risk is a major issue that we're facing. In fact, quite frankly, it is the most prominent source of all cyber risk that we face in health care. AI is everywhere and on everything.

00:01:10:14 - 00:01:36:20
John Riggi
So we'll talk a little bit about that as well. Unfortunately, the risks that we as hospitals and health systems face and our patients face are not just the virtual threats. Unfortunately, there's been a dramatic rise in physical threats and attacks and violence against hospitals and health systems. And there is a nexus, a connection between the physical threats and the cyber threats.

00:01:36:22 - 00:01:48:10
John Riggi
From your perspective, Larry, having dealing with a very busy organization, a busy emergency department - how do you feel that the physical threats and the cyber threats intersect?

00:01:48:12 - 00:02:07:12
Larry Pierce
I think in many cases, you know, with the exception of when you're dealing with nation state threat actors who, you know, like the state thousands and thousands and thousands of miles away from you, there are a lot of things to your point that we need to be concerned about. It seems like there's an uptick in physical violence within in health care organizations.

00:02:07:15 - 00:02:33:03
Larry Pierce
You know, when you talk about physical security, we're looking at things that, you know, the intersection with cybersecurity would be an unsecured laptop, right? that may not be encrypted for one reason or another. That's really security 101 is ensuring that your mobile devices that are within the organization are always encrypted. So in the event that they walk out of the org or they're stolen, that they really turn into a brick.

00:02:33:06 - 00:02:56:27
Larry Pierce
But there are some vendor supplied systems that we have out there that may not employ the same technology. So data centers and server environments within the main hospital, we don't have a lot of data centers that are in the hospital anymore, but your server rooms and network closets, there could be a lot of damage caused in those areas if somebody happened to go in there with nefarious purpose

00:02:57:00 - 00:03:16:20
Larry Pierce
they weren't meant to be in there. That could cause us a lot of hardship. We rely on the security cameras that we have throughout the hospital system right now in physical security monitoring those. In the event that something happened, we can always go back to those and look and see what's happening. So operational technology is something we take very seriously here.

00:03:16:20 - 00:03:35:15
Larry Pierce
It's something that we work closely with our partners in emergency management, physical security and even law enforcement at the local, county, state and federal level. So up to including the FBI, Homeland Security, prosecutor's offices, local law enforcement.

00:03:35:18 - 00:04:03:18
John Riggi
You know, when I think about this, the intersection of physical threats and cyber security, you know, we always talk about ransomware attacks as being a threat to patient safety and really a threat to life crime. And I would venture and proffer that a ransomware attack in itself could be viewed as a violent crime. We tell the federal government all the time, if you do something that puts people in physical harm, risk of physical harm, then that's a violent crime.

00:04:03:23 - 00:04:22:20
John Riggi
So that's one of the one of the things we're pushing the government to understand as well. And they do. They do, quite frankly, as you know, with the FBI. So let's, let's talk back about here on the health care landscape and a little bit about what everybody else is talking about, AI. right? So talking about cyber, we've talked about physical threats, AI, everything.

00:04:22:27 - 00:04:41:10
John Riggi
So is AI is evolving and widespread implementation we have in health care happening quickly, really quickly. This has a lot of risks and rewards as we know. What do you see from your perspective, the emerging risks of this widespread and perhaps overly optimistic adoption of AI in health care?

00:04:41:12 - 00:05:00:19
Larry Pierce
AI is obviously not going to become it has to become a game changer for health care and many other industries. Contrary to what some people that you know aren't in the technology field that I speak with on a regular basis outside of work or even inside of work, and they ask me, you know, AI thing that's going on right now, is it here to stay?

00:05:00:19 - 00:05:25:14
Larry Pierce
Is it just a fad that's going to kind of come and go? My answer it's been very, very consistent with that. AI is here to stay. Depending on how you use it, whether we're leveraging it internally for protective technologies or whether we're using it to better patient outcomes. Those are some of the things that we are doing internally.

00:05:25:16 - 00:05:50:12
Larry Pierce
But I think in using AI in an ethical manner, we need to ensure that we are taking a very cautious approach with that. I don't think has demonstrated quite yet that it can take the place of a human to make a medical diagnosis, for example. We're not that far along. I'm not saying we may not get there at some point, but I don't think I was ever

00:05:50:12 - 00:06:11:21
Larry Pierce
billed - and I would I would argue this point, you know, unless I'm convinced otherwise years from now - not necessarily made to take the place of a human in every case. Is it going to limit some jobs? Absolutely. But, you know, in the health care space, we are seeing more and more platforms that are coming in. And I'm not just talking about security technologies.

00:06:11:22 - 00:06:38:03
Larry Pierce
These are third party systems that we're employing that are either incumbent systems that we've had here for a while that are starting to adopt more AI technology, and companies that are AI centric and completely involved with AI, and we're bringing them on board as well. So for us, again, very cautious approach, and we have a very rigid onboarding process for these AI technologies.

00:06:38:03 - 00:06:59:05
Larry Pierce
So it all starts with the governance process. And is there a need for it? Do we have the dollars? Because health care is getting squeezed quite a bit right now. From a monetary perspective, we're not getting the same reimbursements that we had once before. We're spending a lot more money than we ever had to before. These fancy AI technologies and everything else, they come with a price tag.

00:06:59:07 - 00:07:23:21
Larry Pierce
So in adopting these, we need to make sure that we're doing it ethically, responsibly. So we have a an AI committee that partners with - and it's not just the most important thing - it just fits in with everything else very nicely. So we do a full architecture and design. We do an assessment. We do a complete comprehensive cybersecurity review.

00:07:23:23 - 00:07:42:21
Larry Pierce
It all comes down to risk. And I'm not the final say when it comes to that. There are, you know, executive leaders within the org that will either accept risk or not accept the risk. But they are certainly informed when that comes along. We also have our team members or employees that are using AI right now.

00:07:42:23 - 00:08:14:20
Larry Pierce
Beyond just the medical side of the house, AI is being used to craft more business friendly emails. It's being used to develop algorithms associated with a better presentation. So we don't want, you know, an AI platform such as OpenAI, ChatGPT, Gemini. It should be able to have the ability to ingest spreadsheets that are our proprietary information, may contain, you know, many, many elements of PHI, PII.

00:08:14:22 - 00:08:36:03
Larry Pierce
We don't want to put that into their learning module because they all give you the caveat if you look at their privacy statements and policies, they could use this information almost indefinitely to train their models. Well, if their information is to be compromised and we've got over 500 records in there that were put in to come up with something, it's going to cause a breach situation for us that we don't want.

00:08:36:05 - 00:08:58:27
Larry Pierce
We've employed, you know, our content filtering, our DLP technologies are all trained at this point to significantly restrict what people can do with AI to prevent them from getting themselves in trouble. More importantly, from landing Atlantic Health in the news because of something that was an unintended consequence.

00:08:59:00 - 00:09:29:07
John Riggi
So again, AI is here to stay. It's an almost everything we use. It's not necessarily new technology coming into the organization. There are a lot of existing programs, of course, like Microsoft and Google that add AI features. So that governance council that you spoke about is extremely important, not only to assess new AI technology coming into the organization, but to identify instances where it is now been added to existing software and technology within organizations.

00:09:29:10 - 00:09:53:28
John Riggi
Just saw another report this week that corrupted data, PDFs and emails which are already in networks, are then consumed by AI, legitimately looking for responses or answers to questions, queries submitted to it, but it unwittingly sucks in malicious data and perhaps malware that's already within, present and within the environment and produces it as part of its response.

00:09:54:00 - 00:09:58:06
John Riggi
So really, lots of complications and dealing with AI as we go forward.

00:09:58:10 - 00:10:17:17
Larry Pierce
Threat actors are leveraging AI right now, which is something that we continue to try keeping up with. There's a lot of security technologies that are evolving that are coming up with protections for that, which is great. But one of the things I'll bring up, and it's pretty common, I think a lot of people have heard of it: What are, you know, what is your biggest concern with AI?

00:10:17:20 - 00:10:42:18
Larry Pierce
More sophisticated and realistic phishing emails that are coming in. The telltale signs of a phishing email coming in and there's a lot of email securities out there and other cyber technologies that do a very good job at looking at, you know, what we equate to millions or tens of millions of emails every month to come in, and we have to block the most malicious emails that come in are all the malicious emails that come into the organization.

00:10:42:20 - 00:11:04:25
Larry Pierce
They're using these emails to come up with verbiage that we would normally point to as this is a yellow flag or a red flag. It's not there anymore. Look at the deepfakes that are coming out right now that AI is doing. They are very, very realistic. The other phishings that AI is being used for. It started out as general phishing emails.

00:11:04:25 - 00:11:37:29
Larry Pierce
that went to an audience of a thousand or more people. And just like, if 1 or 2 people click on it, it was worthwhile for the threat actor. Then it evolved to spear phishing. Very targeted going to one person. Now you've got smishing, you've got phishing, you've got quishing. We're seeing all of that internally here. And there's a lot of technologies that really aren't from an educational perspective or detective perspective, able to really latch on to these and be able to prevent them from getting to the people that may get hooked on.

00:11:38:02 - 00:11:59:27
John Riggi
All great points about the ubiquitous use of AI in hospitals and health systems. I totally agree it's only going to accelerate. And again, lots of good will come from it. But we also have to think of AI representing a type of third party risk. We know in health care, third party risk is the major source of cyber risk that we are exposed to.

00:12:00:00 - 00:12:21:29
John Riggi
The data holds that change health care are increasing reliance on outside third party technology, service providers and supply chain. So AI again, is a major third party risk included in all the other third party risks. So as a growing concern, how does Atlantic Health approach third party risk management?

00:12:22:01 - 00:12:44:03
Larry Pierce
So third party risk is, you know, it's near and dear to me because if I look at our application portfolio and understand that we have 750 or so applications that are currently in use at Atlantic, whenever we're going to onboard a new technology or review an incumbent vendor that's been here for a while, we have that same rigid process in place.

00:12:44:03 - 00:13:01:25
Larry Pierce
So it starts with governance and is there truly a need for it? Financially, do we have the money for that? Is it budgeted? Is there going to be a return on investment or not? I mean, why do we need the product is what it comes down to. Then we need to go to the nuts and bolts of what does the assessment look like for this?

00:13:01:25 - 00:13:25:23
Larry Pierce
We do a full architecture and design for everything. A full security review. As I believe I mentioned before, we have an RFI process that we send to the third party. It's about 150 questions that they have to answer in there that allows our teams to be able to determine whether this is something that meets our minimum baseline security controls.

00:13:25:25 - 00:13:45:12
Larry Pierce
So as we look at a lot of these products that we're evaluating now, let me rewind 10 or 15 years ago. We had a lot of on prem data centers, so whether it was within one of your own facilities or it was a co-location. Everything was basically on prem to a certain extent. So we had control physical control of all the security associated with that.

00:13:45:14 - 00:14:15:01
Larry Pierce
That was on us. As we evolve and migrate to third parties, which is, you know, that is the trend, it's moving in that direction. It has been moving there. A lot of companies are already 80, 90% of the way there at this point. We are, I would say, shedding some of that responsibility. But with that comes the fact that we are now relying on the security posture of that third party that we are entrusting with what may be our crown jewels.

00:14:15:03 - 00:14:25:18
Larry Pierce
And for us in the health care world, that is our PHI, the protected health information of our patients, which is central to what we do as a business.

00:14:25:21 - 00:14:47:06
John Riggi
This mass migration to the cloud has been very good economically and for business processes, but it's created a different type of risk. We've talked a lot about AI and cyber threats and physical threats, operational technology. What do you see in the next year? Couple of years? The trends in cybersecurity and health care and potential threats?

00:14:47:08 - 00:15:07:25
Larry Pierce
I think a lot of the same threats that you see today, they're going to remain. You know, the phishing emails, the other ishings that we talked about. I think they're going to continue to evolve. They're going to be more sophisticated, more believable. The nefarious threat actors that we all deal with, unfortunately, too often are going to build their capabilities on these.

00:15:07:25 - 00:15:33:16
Larry Pierce
They're going to be tougher for technology companies. And that's what it's always been. And, you know, we are trying to stay one step ahead of our adversaries. And it just seems like unfortunately, it's the other way around. They're staying one step ahead of us in many cases. There needs to be a level of vigilance within your organization. You need to continue to be mindful and ensure that your third parties and your own people continue to watch the shop.

00:15:33:18 - 00:15:53:24
Larry Pierce
When I started my career, PCs weren't even part of the landscape here at Atlantic. So you look at how far we've evolved. I think we'll be having an entirely different conversation five years from now. We'll be talking about things that I won't even say were top of mind, things that weren't even in our minds today that they're going to change.

00:15:53:27 - 00:16:23:21
Larry Pierce
I'm hoping that security technologies will continue to evolve, that they're going to get better, more comprehensive. And I'm hoping that there is, you know, work done by the federal government and other areas of the world to make it more difficult for these threat actors to do what they do to, you know, there are greater consequences for them. Most of these people right now, we can't go after them, unfortunately, when they cause us millions and millions of dollars of heartache because of something.

00:16:23:29 - 00:16:41:04
Larry Pierce
So I'm hoping that you get better with legislation and some of the strong work that you're doing, you know, with your counterparts. We're going to become more and more reliant on technology. And I'm just hoping we have the right technical safeguards in place to prevent some of the attacks.

00:16:41:06 - 00:17:01:17
John Riggi
Thank you, Larry. Very well said. And thank you for your service in helping defend health care networks, your patients in the communities that you serve. I also want to thank all our viewers for what you do every day to defend networks, care for patients and serve your communities. This has been John Rigi from the American Hospital Association, national advisor for Cybersecurity and Risk.

00:17:01:17 - 00:17:09:19
John Riggi
If you'd like to learn more about cybersecurity and risk, please visit our website at aha.org/cybersecurity.

00:17:09:21 - 00:17:18:02
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:02 - 00:00:27:10
Tom Haederle
Welcome to Advancing Health. Providing effective and efficiently targeted behavioral health services to a widely diverse community is no easy task. Today, we hear how a California based health system relies on accurate data collection and community partnerships to pinpoint where services are needed and how it's making a measurable difference.

00:00:27:12 - 00:00:48:03
Jordan Steiger
My name is Jordan Steiger, and I am the AHA director of Behavioral Health and Violence Prevention. I'm really excited to be joined today by Jesse Tamplen, who is the executive administrator of Behavioral Health and the vice president of continuous performance improvement and patient care coordination at John Muir Health, and Jamie Amosu, who is the director of Community Health Improvement.

00:00:48:05 - 00:01:02:06
Jordan Steiger
They've done a lot of work from community based programs to programs within their hospital system. And so we're really excited to see how they are leading the way, and hopefully others can learn from the work that they've been doing. So Jesse and Jamie, thank you so much for being here with us today.

00:01:02:09 - 00:01:03:00
Jesse Tamplen
Pleasure, Jordan.

00:01:03:07 - 00:01:04:18
Jamie Elmasu
Thank you for having us.

00:01:04:20 - 00:01:16:15
Jordan Steiger
To get us started, I would love for you to just tell the audience a little bit about your roles at John Muir Health, what you do and what your community is like and what your patients are like that you serve. Jesse, let's start with you.

00:01:16:17 - 00:01:38:29
Jesse Tamplen
Perfect. Jesse Champlin, the vice president of patient care coordination, continuous performance improvement. And for this conversation, the executive administrator of behavioral health. I oversee all behavioral health across John Muir. And for those of you who don't know, John Muir is an independent health care system about 30 miles east of San Francisco. We're a three hospital system.

00:01:38:29 - 00:02:13:28
Jesse Tamplen
That's two acute care medical centers. And then a psychiatric hospital. And then we have a large outpatient footprint with ambulatory care, including behavioral health. I work with the teams, not only the behavioral health teams, but all of the health care teams to really integrate behavioral health so that we can provide a whole person care model to really support our community and our patients where they're at, and to make sure that they have access to lifesaving behavioral health care in our acute psychiatric hospital that serves children, adolescents, adults and older adults.

00:02:14:01 - 00:02:35:23
Jesse Tamplen
One of our distinct factors about John Muir behavioral health is for our psychiatric hospital. We have some of the most under 12 and under 18 beds in California. So not only are we a local destination of care, but really a center of excellence across the whole state, and many times outside of the state.

00:02:35:25 - 00:02:50:19
Jordan Steiger
Amazing. You said so many things I want to get back to in this conversation. And I also want to just highlight that Jesse is a member of AHA's Committee on Behavioral Health. And he knows his stuff in behavioral health so that he's a great person to learn from today. Jamie, tell us a little bit about you.

00:02:50:21 - 00:03:22:15
Jamie Elmasu
Yes. Thanks, Jordan. So my name is Jamie Amosu, and I'm the director of community health improvement at John Muir Health. And, you know my role really is focused externally, mostly and primarily, on the geographies that we serve, which cover and span all of Contra Costa County, northern Alameda County as well as the Tri-Valley area. And so, just to give a little glimpse into the geography of John Muir, health, and what's really important to note is that our the communities that we serve are vastly diverse in terms of income, status, race, ethnicity and the likes.

00:03:22:15 - 00:03:32:15
Jamie Elmasu
And so when we're talking about different approaches to behavioral health and mental health strategies, it really does, depend on the types of populations that we're intending to serve.

00:03:32:18 - 00:03:43:04
Jordan Steiger
That's great. And I think you're setting the stage really well for this first question here. So I know that your community health assessment identified behavioral health as a top priority for your community. Is that right?

00:03:43:06 - 00:04:14:12
Jamie Elmasu
That's correct. Well, it's really unique is that I've actually been working at John Muir Health for 12 years. And we conduct a community health needs assessment cycle every three years. And in my entire time that I've been here, behavioral health has been the at least at the top three identified community priority needs. And so I think that's really important to really call out because behavioral health - although we are innovative in our strategies and our approaches to address behavioral health needs in the community - the need still exists, right?

00:04:14:12 - 00:04:32:04
Jordan Steiger
We know behavioral health doesn't discriminate, and it is present in every community, and it shows up for different people in different ways. But knowing this and knowing that this has been something that has kind of shown up over and over. How did you start like bringing those services to the community? What was your first step?

00:04:32:06 - 00:04:51:00
Jamie Elmasu
Yeah, I mean, so the CHNA is a really intentional approach, right? So not only is it intentional, it's also very widespread in terms of how we gather data, how we report on the data and how decisions are being made. So it's actually a process where we collaborate with the other non-for-profit health systems in our area.

00:04:51:02 - 00:05:21:09
Jamie Elmasu
We conduct focus groups with community members. We conduct key informant interviews with stakeholders across our service area. And we look at data, right? So when we look at data, when it comes to county resources, school district resources, and many, many others and all of that is compiled into a really robust assessment where we actually identify those community needs, priority areas, and then we can look in and see specifically geographically or population wise, which communities are in need of services.

00:05:21:11 - 00:05:42:04
Jamie Elmasu
And then when it comes back to actually creating our implementation strategy, what we do is we actually create different approaches based on the communities that we're speaking about, right? And it's not that John Muir Health is here designing approaches that we are now telling the community to implement. It's actually in partnership with nonprofit organizations. And I think that's really key.

00:05:42:07 - 00:06:04:29
Jamie Elmasu
And so we've created, you know, really various opportunities, right? So whether it is let's say, for example, a community based, nontraditional approach, right. Like a premature community health worker approach. We have several partnerships, actually, where we help fund and provide grants for those organizations to actually disseminate, you know, these very nontraditional approaches to mental health interventions.

00:06:05:02 - 00:06:34:17
Jamie Elmasu
And that really targets, you know, certain communities that maybe don't have access to traditional health care, utilizes more of a group approach, a lay health worker approach model that's actually very effective. So we've had research studies actually done on some of our community health worker programs in partnership with Monument Impact, a local nonprofit organization. And it actually has statistically significant results in terms of reduction of anxiety, of stress and of depression in the communities that we're serving

00:06:34:17 - 00:06:42:16
Jamie Elmasu
and that program specifically, we actually celebrated, it's ten years, so a full decade in partnership with that program.

00:06:42:18 - 00:07:03:26
Jordan Steiger
I mean, congratulations on ten years. I think ten years in any program is incredible. And especially something that is so focused on community and you know, driven by those community partners, I think is really something to be proud of. Jesse, I'm sure that you have played a big role alongside Jamie, in helping kind of shape this behavioral health, you know, approach in the community.

00:07:03:27 - 00:07:06:10
Jordan Steiger
So tell us a little bit about what you've done.

00:07:06:12 - 00:07:28:06
Jesse Tamplen
I worked very closely with Jamie. One of the elements about a community health needs assessment, especially when you're a nonprofit, it's how are we elevating the health of the community in the local environment that we're in. And so as a hospital and a treatment providers, we also have that number one responsibility of making sure that we're providing that life saving care and that quality of care

00:07:28:11 - 00:07:50:07
Jesse Tamplen
when people come into our outpatient as well as our inpatient. So it's a very nice synergistic combination where Jamie and I get together with the community stakeholders, look at our needs assessment. We have a board that oversees that community health needs assessment. And then we really look at where do we have the biggest health disparities in the community?

00:07:50:13 - 00:08:13:17
Jesse Tamplen
Where do we find that we can support that community that does not have needed services if it be in schools or unhoused? If it's for communities that are further away from a metropolitan area so that we're really looking at creating an ecosystem. I think one of the unique things when we talk about behavioral health is it is the most stigmatized diagnosis that we have.

00:08:13:19 - 00:08:36:12
Jesse Tamplen
And as students when you talk about behavioral health, people will go into some social aspects of behavioral health. But Jordan, as you said, behavioral health is regardless of socioeconomic status, the nice area that when we work with Jamie and the community health needs assessment, not only are we providing those essential services out in the community, but we're helping to stigma-bust the stigma around behavioral health.

00:08:36:19 - 00:09:09:03
Jesse Tamplen
So when we create this ecosystem, focus on the whole person care, it's not only the individual outcomes that we're looking at, but we're helping to elevate behavioral health, decrease that stigma so people will access those services if it's in, you know, the languages that they speak or just going to seek care. And I think that's one of the big things that my partnership with Jamie really focuses on being operational at the community health needs assessment is ensuring that everything that we do is decreasing stigma and increasing access to lifesaving care.

00:09:09:05 - 00:09:30:09
Jamie Elmasu
And if I can add some further color to that, I love what you're saying about ecosystems. And I think what we really do with our community health improvement initiatives is we go to maybe sometimes untraditional locations, right? So, for example, we are recently starting a partnership with the East Bay center for Performing Arts. Some people might say, okay, why are you partnering with an arts center?

00:09:30:09 - 00:09:55:02
Jamie Elmasu
This is an arts youth center based in Richmond, California. And my answer is because the need is high and what are we doing? We're actually helping them build their infrastructure to create more on site, licensed clinical social workers so that all of the children that are accessing the services at the East Bay center for Performing Arts, they actually have with embedded within their programing direct access to these social services.

00:09:55:05 - 00:10:16:19
Jamie Elmasu
And I think just by you know, helping shape that model at a center like this, in a high need area, that's really what we're talking about when it comes to ecosystem. And then secondarily, you know, it's other sites. So for example, we're deeply invested in the city of Antioch, that's in Contra Costa County as well, there are reported, you know, high rates of violence in Antioch.

00:10:16:19 - 00:10:37:17
Jamie Elmasu
So what we've actually invested in is actually hiring and helping support mental health therapists. These are licensed therapists to be onsite at the schools in the Antioch Unified School District, and then in partnership with other health systems, they've actually help support, you know, wellness rooms and trauma informed specialists that are also onsite in the school district for the year.

00:10:37:24 - 00:10:55:09
Jamie Elmasu
So it's really around, you know, shaping that ecosystem, whether it's at the school level, at the hospital level, with the nonprofit organizations and how we do it, how do we adjust? How do we actually ask our partnerships and ask the collaboratives that we work with what iterations do we need to actually meet the needs of the community?

00:10:55:16 - 00:11:22:24
Jordan Steiger
And you're both bringing up so many important things with this topic. So I think, Jesse, I mean, bringing up the topic of stigma, I feel like you can't talk about behavioral health without talking about stigma. And I think, Jamie, some of those examples that you just provided really purposefully or maybe not even, you know, purposefully decrease stigma in so many ways when you're just in the community, you are just there and you are part of it and it's, you know, people can get the care that they need without having to go see a provider.

00:11:22:26 - 00:11:39:25
Jordan Steiger
It's where they need it and when they need it. And I think that is so key. And one thing you both have talked a lot about is just these partnerships that you have internally. It sounds like across your system and then of course in the community. How did you get buy in for those partnerships, especially with the community partners?

00:11:39:27 - 00:12:01:29
Jamie Elmasu
Gosh, how do we get buy-in? I think it's a long history, right? It's a long history of relationship building and really gaining trust with community partners. I'd like to say that our partnership model with nonprofit organizations in our area is very strong. And it's because we listen. So we have a grantmaking portfolio. So we are providing grant funding to nonprofit organizations.

00:12:02:02 - 00:12:27:05
Jamie Elmasu
But it doesn't stop there. And I think that's really what sets John Muir Health apart from other health systems, really, is that our partnerships with nonprofit organizations, we also provide many in-kind services where for example, we'll bring our family medicine residents to nonprofit organizations on site to offer some sort of an intervention, whether it's health education or foot screenings or, you know, ask a doctor stations, things like that.

00:12:27:12 - 00:12:51:04
Jamie Elmasu
We've gone to Mental Health Connections, which is previously known as Putnam Clubhouse. But we've had this very robust partnership with Mental Health Connections over the years. And our family residents, they actually circulate there and they provide health education lectures to the clients of mental health connections about, you know, medication management, sleep hygiene, any topics of interest to the client based

00:12:51:07 - 00:12:52:24
Jamie Elmasu
at the organization.

00:12:52:26 - 00:13:15:20
Jesse Tamplen
Jamie does an incredible job in creating those external partnerships, and she has that grantmaking portfolio. So she's able to fund many services which can help align those, you know, partnerships. But, you know, having John Muir be a nonprofit health care system, we spend a lot of time with our operational leaders and our clinicians joining community groups.

00:13:15:20 - 00:13:38:12
Jesse Tamplen
So I'll give you an example. We have people on the Concord Chamber of Commerce. We work with our fire departments. We work with our school districts, part of the California Hospital Association, you know, working in the Tri-Valley region, where Jamie was discussing, making sure that there's grants coming on. We're supporting that grant award process for other organizations, their community needs assessment.

00:13:38:12 - 00:14:11:00
Jesse Tamplen
And I think that's critical when you look at behavioral health operational leaders. Because stigma is reduced when people see not only people who have mental health challenges speak up and, you know, do something different, but also people who are leading those services, taking their time to work with the chief of police. So many times, both at Walnut Creek and Concord, two local cities, they've held their staff meetings at our outpatient behavioral health before, so that they can see our clinicians, get to know them

00:14:11:05 - 00:14:33:18
Jesse Tamplen
and that's where we really look at decreasing the stigma. And when you look at what are the results of stigma in the United States, we know people with a serious mental illness are dying 25 years younger than the average population, but they're not dying due to their mental illness. This is where the stigma comes in. They're dying due to cardiovascular disease, obesity and diabetes.

00:14:33:20 - 00:14:58:11
Jesse Tamplen
And as a nonprofit health system, we are perfectly positioned to be able to treat those conditions because it's part of that whole person care model that we know if we can get them into access their mental health conditions and we can stabilize that life saving treatment, we then can get them to primary care in other groups where we can give back years of life and quality of life.

00:14:58:14 - 00:15:25:07
Jordan Steiger
That makes so much sense, Jesse. And I mean, I hear from both of you, I think just kind of key takeaways from this discussion. It sounds like using that positionality in your community as an anchor institution and as, you know, a leader in the community to make sure that we are doing what we can as hospitals and health systems to decrease that stigma to, you know, extend the hand first and get, you know, get those partnerships moving, really listen to the community and what they need.

00:15:25:09 - 00:15:42:13
Jordan Steiger
It sounds like you are doing all the right things, and you are setting such a great example. Thank you so much, both of you, for being here today. And I'm sure our listeners are going to have a lot of takeaways that they can start thinking about at their own organizations. So again, thank you for being here.

00:15:42:16 - 00:15:50:28
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:06 - 00:00:31:02
Tom Haederle
Welcome to Advancing Health. Being your best at anything usually boils down to practice, practice and practice. All across rural Iowa, first responders and other health care professionals are getting in that critical practice to improve patient outcomes, and the training that makes it possible is delivered right to their doorstep.

00:00:31:05 - 00:01:07:29
Tom Haederle
I'm Tom Haederle senior communications specialist with the American Hospital Association, and I'm delighted today to welcome two health care professionals to introduce us to Simulation in Motion, Iowa. That's a mobile clinical education initiative that delivers on-site simulation training to EMS providers and others who provide care to the about 43% of Iowans who live in rural areas. Joining me today to talk about this are Dr. Jacinda Bunch, an assistant professor at the Iowa College of Nursing, and senior advisor to the SIM in Motion Iowa program, and Tina Eden, who is CEO of Virginia Gay Hospital in Vinton, Iowa.

00:01:08:02 - 00:01:11:18
Tom Haederle
Tina and Jacinta, thank you so much for joining me on Advancing Health today.

00:01:11:21 - 00:01:12:27
Jacinda Bunch, Ph.D., R.N.
Thank you for having us.

00:01:12:29 - 00:01:13:23
Tina Eden, R.N.
Thank you.

00:01:13:25 - 00:01:27:01
Tom Haederle
Well, let me start with you, Jacinda. Maybe you could take a whack at this first. I'm sure that my introduction did not do full justice to this wonderful program. So what needs was it designed to meet? And what kinds of medical scenarios do the care teams get to practice?

00:01:27:03 - 00:01:59:26
Jacinda Bunch, Ph.D., R.N.
So Simulation in Motion Iowa or SIM Iowa, is a mobile simulation program where we have three trucks that we take across the entire state. We allow health care providers to practice to take care of our simulated patients. They can provide care for patients they don't see very often. They can take care of patients in new settings. It's a way to test new protocols and really just to refine the care that they're providing, across the state to really improve patient outcomes.

00:02:00:02 - 00:02:33:28
Jacinda Bunch, Ph.D., R.N.
And we really designed this because in rural Iowa, access to simulation education is a challenge. It's expensive. It requires special training to really do it well. And we all know that resources are somewhat limited in our rural areas. So this provides both EMS providers and hospitals with the opportunity to have their staff go through simulation education to really enhance the care that they're providing across the entire state, regardless of where they live.

00:02:34:00 - 00:02:36:05
Tom Haederle
How realistic are the scenarios?

00:02:36:08 - 00:02:59:28
Jacinda Bunch, Ph.D., R.N.
So we work together with both the hospitals and the EMS providers to really design the scenarios to best fit their location, what they're seeing and the things that they feel that they need to work on the most. We can do medical scenarios. We can do trauma scenarios. We have simulators that are adult, pediatric, infant and then a neonate, a 25 week premature baby.

00:03:00:00 - 00:03:24:19
Jacinda Bunch, Ph.D., R.N.
So we can really do almost any type of medical or trauma scenario. And then we also work to make sure that the scenarios match the local protocols. So we're going to ask you to use the same medications that you have access to, the same equipment, and really follow your protocols rather than having you do something if you travel to a mobile SIM center that might not match what you do locally.

00:03:24:21 - 00:03:35:29
Tom Haederle
And I guess in some cases, the EMS teams or the people that are getting the training or working on - I don't want to call them crash test dummies because I know they're not - but they're human bodies in a sense, right, that they get to do some of these things on?

00:03:36:01 - 00:04:03:17
Jacinda Bunch, Ph.D., R.N.
Yes. So our simulators are basically mini-computers. So they're little robots. They have heart sounds. They have lung sounds. You can take pulses, you can give them medications. We can amputate an arm and have arterial bleeding that they need to control. We can change heart rhythms based on medications that are given. So we really can create almost any medical or trauma scenario.

00:04:03:21 - 00:04:14:25
Jacinda Bunch, Ph.D., R.N.
We try to make it as realistic as possible. Again, we want to put the learner in that environment that they would be caring for a live patient and really try to recreate as much of that as we can.

00:04:14:28 - 00:04:25:17
Tom Haederle
Wow, that's really impressive. Tina, if I could get your thoughts as the CEO of a hospital and boss of some of the care teams that have received this training, how did it work out for your folks?

00:04:25:19 - 00:04:51:09
Tina Eden, R.N.
Really, with any simulation, muscle memory is so important to build confidence in our staff. Some of the experiences they have with the simulation mannequins are those that it would take a year in their training to receive that same experience. And so it's really invaluable. It does provide a lot of confidence and just creates more of a teamwork environment.

00:04:51:09 - 00:04:56:05
Tina Eden, R.N.
They do work with a group of other individuals when they go through their simulations.

00:04:56:07 - 00:05:13:20
Tom Haederle
Sort of circling back to some of the most valuable services that the program offers, I understand that, 32 of Iowa's counties are considered maternal care deserts, meaning they lack adequate labor delivery, postpartum care services. How has Sim-Iowa helped in that particular sphere?

00:05:13:23 - 00:05:40:12
Tina Eden, R.N.
At Virginia Gay hospital, we did actually have a maternal child simulation lab come as well as SIM-Iowa. In working with those pediatric patients, it's really important our staff just don't have the pediatric experience. And working in a critical access E.R., you can see anything on any given day. So it's really important to have that in lab experience to handle those situations,

00:05:40:12 - 00:05:43:06
Tina Eden, R.N.
everything from a burn to a crush injury.

00:05:43:08 - 00:06:07:10
Tom Haederle
SIM-Iowa, as I understand it, has now visited, I believe, all 99 counties in Iowa. I think some of the most important lessons learned in the field have not necessarily been hands on operations and emergency response, but more having to do with emergency protocols and things like that. Can you both speak to that aspect of the training and maybe not, you know, if it's not treating a patient who is up on a stretcher

00:06:07:15 - 00:06:14:18
Tom Haederle
what are some of the other big lessons and takeaways that that the care teams have benefited from as the program goes around the state?

00:06:14:20 - 00:06:34:26
Jacinda Bunch, Ph.D., R.N.
I know a couple of things that we have experienced with our educators is when we go into a either an EMS agency or a hospital and we're working with scenarios that they don't see very often, they may have read those protocols multiple times, but to really pull them out and go through the steps, do we really have this medication in stock?

00:06:34:26 - 00:06:58:10
Jacinda Bunch, Ph.D., R.N.
Does everyone know where it is? How do we access it? What about this piece of equipment that we don't pull out very often? Have we really had the chance to use it hands on? Does everyone know how to work it well? Tina mentioned that muscle memory...to actually get your hands on it and do the tasks and provide the care and use the equipment, especially when it's something that we may not see as often.

00:06:58:13 - 00:07:20:01
Jacinda Bunch, Ph.D., R.N.
So that has been a huge piece. Our EMS folks bring their bags in so they are going through their own jump bags and finding their equipment and pulling out those things that maybe they don't see very often. And we also are able to take our mannequins inside the hospital so that they are also providing care in the same location that they will be with a live patient.

00:07:20:03 - 00:07:50:16
Tina Eden, R.N.
We were able to do an onsite airway training with SIM-Iowa where they actually came into our emergency department and worked on difficult innovations with our E.R. staff, including our physicians and physician assistants, as well as our nursing staff. We were also able to do emergency procedures in their unit, and that's something that we would only use in an extreme emergency, and our staff weren't comfortable.

00:07:50:19 - 00:08:06:23
Tom Haederle
The program was recently gifted with, I think, more than $5 million in investment by the Wellmark Foundation to expand the reach and frequency of the training. I wonder if you both could speak to what the plans are for this funding. How do you see it helping and benefiting patients around the state?

00:08:06:26 - 00:08:32:06
Jacinda Bunch, Ph.D., R.N.
Well, the focus of this particular gift from the Wellmark Foundation is really has a focus on our rural hospitals and EMS providers. So what this gift is able to provide is two trainings every year for our rural and mixed urban rural counties. So those are our emergency departments' primary focus. So it's maybe a medical scenario in the E.R., like sepsis.

00:08:32:06 - 00:08:57:21
Jacinda Bunch, Ph.D., R.N.
It might be a trauma like a motor vehicle accident. But they will receive two of these trainings. And those costs are covered by the gift from the Wellmark Foundation. And then in addition, the maternal care desert counties are also provided one obstetric emergency training. And that is delivered in partnership with the IPQCC, which is the Iowa Perinatal Quality Care Collaborative.

00:08:57:23 - 00:09:11:08
Jacinda Bunch, Ph.D., R.N.
And so our educators are working together. We go out jointly and provide this education in the maternal care deserts. And the Wellmark Foundation is paying for these trainings to occur over five years.

00:09:11:11 - 00:09:27:07
Tom Haederle
That's fantastic. Is it your sense that there's a great appetite for this? Maybe, Tina, you can speak to that because you're one of the hospitals who have benefited from the training. Do you have the sense from your own folks that, wow, this was fantastic. You know, a great, great use of our time, and we'd love to see them come back and do more of this kind of work?

00:09:27:09 - 00:09:49:02
Tina Eden, R.N.
Absolutely. It's very engaging for the staff. They get to do those hands on skills that they may not necessarily do. And a lot of the apprehension that new staff will have working in the emergency department is they just haven't seen something before. So it really provides that access to think through, talk through, and work through an emergency situation.

00:09:49:05 - 00:10:04:24
Tom Haederle
I don't know this for sure, but this is the only program that I'm aware of in Iowa that is set up to do what it does and organized like this. If another state is considering doing something similar, what advice would both of you have in terms of what you've learned so far and what you know works?

00:10:04:26 - 00:10:30:19
Jacinda Bunch, Ph.D., R.N.
I would say from launching this program, some of the things that we learned and actually did were to partner with a state that was already doing something similar. The Helmsley Foundation, Helmsley Charitable Trust, provided the initial start-up funding for this program, and they have done so in four other states. Each of us run our programs just a little bit differently, but we collaborated with them and we learned from them.

00:10:30:19 - 00:10:54:12
Jacinda Bunch, Ph.D., R.N.
We learned the mistakes they made and also the things that they did well. And then really just getting out and talking to providers across the state to hospitals, to EMS agencies and finding out what their needs specifically are. We don't want to come in and say, you need A, B, and C, we want to know what you need, and then we can provide that for you.

00:10:54:14 - 00:10:56:21
Tom Haederle
Got it. Tina, any final thoughts?

00:10:56:23 - 00:11:07:21
Tina Eden, R.N.
If there are other facilities that haven't used SIM-Iowa, I would recommend it. It's been very time valuable and well worth the cost of training your staff.

00:11:07:24 - 00:11:17:21
Tom Haederle
It sounds like a marvelous program and really impressive. Thank you so much for spending some time with me on Advancing Health today to talk about this and share your insights and your knowledge.

00:11:17:23 - 00:11:18:14
Tina Eden, R.N.
Thank you.

00:11:18:17 - 00:11:20:02
Jacinda Bunch, Ph.D., R.N.
Thank you.

00:11:20:04 - 00:11:28:15
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:06 - 00:00:24:03
Tom Haederle
Welcome to Advancing Health. Nearly ten years ago, Hartford HealthCare set out to achieve an "A" rating in patient safety across all its hospitals. Well, it nailed that goal and then some, as we hear in this discussion about the determined pursuit of health care excellence.

00:00:24:06 - 00:00:59:18
Kristin Preihs
Hi everyone. I'm Kristin Preihs, vice president with Health Research and Educational Trust at American Hospital Association, and I am so excited today. We get to celebrate something that is truly special: excellence, innovation, and leadership in health care all in one conversation. This year I had the absolute privilege, oh my goodness, to be onsite as a member of the Quest for Quality Prize, which is a very specific prize that AHA provides to winners in patient safety and quality who are doing incredible work across the country in not only achieving clinical outcomes and reducing cost, but most importantly, sharing that message with others as well.

00:00:59:21 - 00:01:22:10
Kristin Preihs
So we're here to spotlight the 2025 winner of the American Hospital Association Quest for Quality Prize: Hartford HealthCare. Joining us today, it is my honor to introduce Stephanie Calcasola, chief quality officer at Hartford HealthCare and a true powerhouse. I have seen her in action in quality and patient safety and she brings clarity and purpose to everything that she does.

00:01:22:17 - 00:01:25:13
Kristin Preihs
Stephanie, welcome so much to the show. We're glad to have you.

00:01:25:15 - 00:01:42:05
Stephanie Calcasola, R.N.
Well, thank you, Kristin, it's an honor to be here with you today representing Hartford HealthCare. And boy, are we just so thrilled and proud to have won the Quest for Quality Award for 2025. It's an honor that we continue to share across our integrated system.

00:01:42:08 - 00:02:04:14
Kristin Preihs
Well, why don't we go back to 2017 when Hartford HealthCare set a bold and ambitious goal - was certainly an interesting time given what happened two years later for all hospitals to achieve an A rating in patient safety from Leapfrog, something that is uncommon and unheard of nowadays. What drove this commitment, and why was it such a pivotal moment for the organization?

00:02:04:16 - 00:02:33:10
Stephanie Calcasola, R.N.
A great question. And so in 2017, it wasn't that high reliability and patient safety was not there as part of our true north. But we really had an intentional reset, our commitment to patient safety. And we as an integrated system, still relatively new, growing our acquisitions across the state of Connecticut, knowing that access is important, but access to quality, excellent care is the true north.

00:02:33:12 - 00:03:03:17
Stephanie Calcasola, R.N.
And so we selected Leapfrog as one way to understand our performance. And when we started this journey, we had seven hospitals, five Cs, a D, and one B. And so what better way to instill that sense of high reliability, a culture that's driven around learning and improvement. And so we set a bold target that we would achieve Leapfrog A grade for patient safety across our all our hospitals.

00:03:03:19 - 00:03:05:22
Stephanie Calcasola, R.N.
And we're very proud that we were able to achieve that.

00:03:05:29 - 00:03:25:00
Kristin Preihs
That bold target was met. And then some, certainly is evidenced through Leapfrog and the many best practices that I know hospitals all over the country come to you guys with asking to learn more and how they can replicate. I love this next part, and I remember it from when I was onsite with you all. You've rolled out something called the Safety Starts with Me across the entire system.

00:03:25:06 - 00:03:33:26
Kristin Preihs
Can you tell us a little bit about this program, how it came to life, what it's all about, what motivated it, and how it really took off across your entire system to date?

00:03:33:28 - 00:04:00:21
Stephanie Calcasola, R.N.
So Safety Starts with Me is Hartford Health Care's branded high reliability program. Let me go back into our history a bit to bring us then to today. In the state of Connecticut, the Connecticut Hospital Association created a convening model for all the hospitals to commit to being an organization that trains in high reliability. And that happened in 2011, and it was a very well engaging activity for all the hospitals.

00:04:00:23 - 00:04:45:03
Stephanie Calcasola, R.N.
It was camaraderie. The patient at the center, a commitment to patient safety, aspirationally to do no harm. And that had been part of our natural thread of our organization. What we realized, though, was that we needed a bit of a, again, a reset or a reboot, and we reevaluated our training, rebranded it as Safety Starts with Me. And although high reliability training and historically was in more complex situations, acute care hospitals, there was an executive commitment to roll out high reliability across the full integrated network for inventory settings, hospital settings, medical groups, our joint ventures.

00:04:45:06 - 00:05:04:02
Stephanie Calcasola, R.N.
And so that Safety Starts With Me is now embedded in our new colleague orientation. And it's a program we get on day two for anyone who enters as a colleague for us. And so that's, I think, the pivotal commitment or the pivotal moment that Hartford HealthCare recognize that high reliability is not a one and done. It

00:05:04:02 - 00:05:15:05
Stephanie Calcasola, R.N.
is actually a muscle that you work and a memory and you learn it. And that commitment to have the program, it Starts With Me embodied that all colleagues have a role in high reliability.

00:05:15:08 - 00:05:39:27
Kristin Preihs
And what a powerful message, whether it's an orientation, hearing it for the first time to, you know, being there for a long time. But making sure that that resonates for the work that you do every single day, and I think brings so much meaning and value back to the workforce. On my own site visit there, one thing that I thought was absolutely transformational was how it also translated to some of the technology improvements that you guys have.

00:05:40:03 - 00:05:49:03
Kristin Preihs
So can you tell us a little bit about how you wove that into some of your technology-enabled solutions as it relates to simulation and other practices to improve patient care?

00:05:49:06 - 00:06:23:24
Stephanie Calcasola, R.N.
Sure. I'm so proud to share this work. We have a center of education simulation. We call it CESI: Center for Education, Simulation and Innovation. It's over 20 plus years as an innovation center simulation center. It's one of the largest in the nation's, if not internationally. It's 50,000ft². It allows for training in surgeries, procedures, robotics, but it also is set up to train and simulation of patient and family and clinician experiences.

00:06:23:27 - 00:06:54:18
Stephanie Calcasola, R.N.
We use this, the CESI center for high reliability reinforcement. How do you ensure a good time out? How do you make sure a good checklist is being performed during the peri-op period. So it goes from the gamut of how do you train with people and what is that human element that we want to hardwire to the actual how do you do simulation and procedures and surgeries so that when clinicians, physicians, nurses are actively caring for patients, they've already been trained in a simulated environment.

00:06:54:26 - 00:07:20:16
Stephanie Calcasola, R.N.
We now have a simulation center in our east region of the state, a partnership with our Eastern Connecticut State University. So we want that to be the standard for all. We can't brag enough about our Center for Education and Simulation. It has been such a profound resource. It continues to grow and be just a cornerstone to how we ensure safe, reliable, and excellent care.

00:07:20:19 - 00:07:40:15
Kristin Preihs
I think brag you should. Loudly and proudly. There's so much that you guys are doing that others are learning from. And I want to also add an addition on top of some of the simulation rollout, which is the clinical care redesign program. First of all, absolutely genius. You're improving quality, you're saving money, and you're making care better for patients.

00:07:40:17 - 00:07:58:08
Kristin Preihs
Basically, the health care version of cleaning out your closet and finding out you've been hoarding six versions of the same sweater. So kudos, because I think it's just an exceptional idea. Can you talk a little bit about the program, and what was the toughest part about pulling this off, about rolling this out? Because I know there was a lot that went into it to build up to some incredible success.

00:07:58:10 - 00:08:39:18
Stephanie Calcasola, R.N.
Absolutely. So our clinical care redesign began early in 2016-2017 with the understanding that we know there's waste in health care. And so how can Hartford HealthCare be responsible and begin understanding what is our role, and how do we actually provide evidence-based care that's affordable and of highest quality? And so clinical care redesign is really the engagement of clinicians, physicians, nurses, understanding what the evidence is suggesting or published as what is that work we should be doing, which includes variation or reducing variation of overuse or misuse.

00:08:39:20 - 00:08:59:24
Stephanie Calcasola, R.N.
And then the third is to understand the cost implications. And if you follow the evidence, generally there's cost savings. And so we wanted to understand initially that this is not a cost savings program. It's actually an evidence based program of quality and safety that we know we can generate savings when you follow the care that's of the highest quality.

00:08:59:26 - 00:09:24:17
Stephanie Calcasola, R.N.
So that was probably the biggest kind of getting the momentum and the buy-in from the colleagues to understand that this is not a cost cutting program, but this is actually around providing care that's standard, that is reducing variation and removing the cost. So I want to kind of give you that context. And our first real big year, we had $28 million removed in fiscal year '23.

00:09:24:19 - 00:09:49:27
Stephanie Calcasola, R.N.
In '24, $58 million. Wow. At the end of 25 fiscal year, upwards of $88 million. And there's a few areas that it impacts. One is on obviously reducing care variation, things like even just staplers that we use in the O.R. How do we understand what we need for the surgeon, but also what we can use to maximize contracts and purchase power.

00:09:50:00 - 00:10:15:00
Stephanie Calcasola, R.N.
But there has been a whole partnership, and I would be remiss if I did not call out our supply chain leaders who partner with our vendors and really helped with aggregate contracting that also helped with some of this. You know, everyone needs to be paid, but we all also need to work toward what's affordability. Our clinical councils, which are chaired by physicians and clinicians and administrators to help kind of remove barriers.

00:10:15:02 - 00:10:42:15
Stephanie Calcasola, R.N.
We have emergency department councils, hospital medicine, critical care. That collective energy of those experts in the room are really the secret to the success, because that's how we work within the clinical areas partnering with supply chain, partnering with administration and using obviously data, right? to understand where we can improve. I'll pause there because I could go on and on, and that's a little bit of a flavor of what a clinical care redesign is for

00:10:42:15 - 00:10:44:02
Stephanie Calcasola, R.N.
us at Hartford Health Care.

00:10:44:04 - 00:11:04:04
Kristin Preihs
I think that's quite a bit. And you've shared some of your secret sauce at Hartford, which I know many will appreciate and benefit from. And kind of going along that same vein and taking a step back, you've shared so many great examples. If someone is beginning an evolution of their quest for quality or of their quality for patient safety, what are some of the things that you would suggest they start with?

00:11:04:04 - 00:11:13:04
Kristin Preihs
What are the non-negotiables you must have in place that others who are looking to do similar things that you guys have done at Hartford really begin to explore and lean into?

00:11:13:06 - 00:11:57:00
Stephanie Calcasola, R.N.
You have to have a culture that's supportive of learning. But even above that, you have to have executives that are directing and aligning so there's one strategic priority. And what is most important providing care is around excellence, zero harm, patient safety. I would say that executive sponsorship, that alignment and then a culture where our 48,000 colleagues are committed to every day, just like Safety Starts With Me, that I will make impact individually on however I am part of Hartford HealthCare, whether I'm in the offices or I'm the one responsible for cleaning the room, I'm the one, you know, helping patients pay their bills.

00:11:57:02 - 00:12:23:23
Stephanie Calcasola, R.N.
All of that has impact around an organization's strategic alignment. As an improvement advisor, I would be remiss if I didn't say what you need to do, you need to measure. So, I would say data is very important, transparency. And, you know, what does transparency look like? That means you're sharing with your boards and your executive teams, and it's cascading through your huddle boards to the staff where our performance actually is.

00:12:23:25 - 00:12:54:05
Stephanie Calcasola, R.N.
So how are we doing with hospital acquired infections? How well are we using our safety event reporting system? What is our response rate? How well do we manage and comply to best bundles for infection prevention? Those are all quantifiable data points that will engage the teams that are working in the front with our patients and families. So I think transparency in data and an improvement model. I'm in my ninth year and what's impressed me then and what impresses me today is that there's an operating model.

00:12:54:05 - 00:13:13:26
Stephanie Calcasola, R.N.
It's our people promise. And that really is around how we show up with our leadership behaviors. We have ascribed set of behaviors very much aligned with high reliability. We have a way to do improvement work with a lean, you know, improvement model. And then we have leaders that commit and feel privileged to be able to be in this job, to do this every day.

00:13:13:26 - 00:13:36:29
Stephanie Calcasola, R.N.
And I think that is what drives an organization to success. The patients at the center with our colleagues and culture. And then there's a pursuit that we can get better at this. Every day I'm coming to work, and I know my colleagues are that this could be my mother, my friend, my husband. We want that care to be consistent, excellent and reliable every time.

00:13:37:01 - 00:14:05:09
Kristin Preihs
Thank you, Stephanie, for this incredible conversation and for your leadership at Hartford. And just want to echo how much we're so appreciative of what you've done for Quest for Quality, what you've shared for others to learn from and will continue to do so as there's so many great examples to continue off of this conversation. For those that are listening, I hope this conversation sparked some ideas about how you can strengthen quality and patient safety in your own organizations, and maybe even take a bold step or two and maybe brag a bit to Stephanie said

00:14:05:09 - 00:14:20:09
Kristin Preihs
if you're doing things that are incredible and making an impact on the field. If you're thinking about applying for the Quest for Quality Prize, please check out the AHA website for all the details on how to get started. And if you'd like to learn more about the AHA Quest for Quality Prize, please click on the link in the show notes.

00:14:20:12 - 00:14:27:06
Kristin Preihs
Thank you so much for tuning in. Keep doing the good work everyone and take care of each other. And as always, be safe and well.

00:14:27:09 - 00:14:35:21
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.