Advancing Health Podcast

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:15:06:12 - 00:15:14:29
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:16:04:27 - 00:16:13:18
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:02 - 00:00:18:19
Tom Haederle
Welcome to Advancing Health. Differences in health outcomes affect patients and communities, but also contribute to lost workforce productivity and hundreds of billions of dollars in avoidable health care spending. More health care leaders are recognizing these challenges and taking action.

00:00:18:21 - 00:00:48:25
Joy Rhoden
This is Joy Rhoden, senior vice president for the Division of Health Outcomes and Care Transformation at the American Hospital Association. And today, we're going to be talking about the economic impact of disparities in health outcomes. Health disparities have long been recognized for their impact on patient outcomes, but we know that they also carry significant macroeconomic and microeconomic impacts and consequences.

00:00:48:27 - 00:01:25:10
Joy Rhoden
At the macro level, I'd like to share just a few findings from our research as we developed this guide for the field. The data from 2022 show that national analyzes estimate that disparities in health outcomes are associated with approximately $320 billion dollars - with a B - in excess health care spending each year, with projections indicating that this figure could actually rise to $1 trillion dollars by 2040 if disparities remain unaddressed.

00:01:25:12 - 00:02:03:09
Joy Rhoden
I don't think this is a problem we can ignore. So our members often ask why, in a resource constrained environment, should they pay attention to and invest in strategies that will reduce health disparities? And today I am joined by Brian Peters, chief executive officer of the Michigan Health and Hospital Association. Brian and I will discuss how health disparities not only impact health outcomes at the individual level, they drive avoidable costs across health care systems.

00:02:03:09 - 00:02:29:08
Joy Rhoden
They reduce workforce productivity and lead to excess health care spending and expenditures for individuals, families and society writ large. Brian, thank you for joining me today. And I'd like to invite you to introduce yourself a little bit better than I did and share just a bit about the work you're leading in Michigan.

00:02:29:10 - 00:02:54:04
Brian Peters
Well, thank you, Joy, it's a pleasure to join you today and talk about this very important subject. The Michigan Health and Hospital Association has been around for a while. We just celebrated our 100 year anniversary a few years ago, and we've been a very strong advocate for literally every hospital and health system in the state of Michigan. They are all engaged members in good standing of our association.

00:02:54:04 - 00:03:22:20
Brian Peters
And we partner with the American Hospital Association, both on the advocacy up front, but also on a number of other issues outside of the public policy arena as well. And our mission is very straightforward. We advance the health of individuals and communities, and that's a mission that's very consistent, almost identical with the American Hospital Association. And I think that's given us a really excellent platform to collaborate on this work.

00:03:22:21 - 00:03:42:26
Brian Peters
I will tell you that it has been a great privilege for me to serve at the MHA for now 37 years, the last 11 as CEO, and to serve on the American Hospital Association board as well, with some really remarkable leaders. And I'm just so proud of the work that we're able to do together.

00:03:43:03 - 00:04:12:06
Joy Rhoden
Well, thank you so much for your strong leadership and certainly for the tight coordination that we enjoy with you and your other state hospital association peers, you know, really leading the charge to improve the conditions so that our hospitals can continue doing the good work that they do for the communities they serve. So to get us started, we often think about health disparities in terms of patient level outcomes.

00:04:12:06 - 00:04:38:14
Joy Rhoden
And we talk a lot about the moral imperative to act. I think an underexplored area, Brian, is the economic impact of those same disparities. And so I wonder if you could shed some light on why you think health care leaders should pay attention to the financial considerations that can sometimes be overlooked?

00:04:38:16 - 00:05:00:18
Brian Peters
Well, there's no question this should be a main focus. And, you know, I'm someone that always looks at the optimistic view anytime we're dealing with major challenges. And so as you know, Joy, both for the American Hospital Association, for the Michigan Health and Hospital Association, and frankly, for our colleagues all over the country. What is the hot topic, if you will,

00:05:00:19 - 00:05:27:06
Brian Peters
right now? It is an election year topic, and that is the topic of affordability. And I think we're all wringing our hands about this issue. And, you know, we've been called to task. Why are health care costs so high? I think we've been given a gift, quite honestly. This is my optimistic view because this new conversation on affordability, it's shining a very bright light on the underlying factors.

00:05:27:06 - 00:05:54:14
Brian Peters
And what I'm getting at here is when we talk about disparities and as you said, the economic impact of disparities. Now we have the full attention of everybody from, you know, our own membership to elected officials, the media and the business community to talk about the role that economic impact plays when it comes to these issues of disparities.

00:05:54:14 - 00:06:13:08
Brian Peters
We can make that very close connection. And so this is an opportunity that we don't want to squander. And I'm very pleased to see the American Hospital Association wading in in a very significant way. And with this new report, I think it's going to really help our efforts in a significant way.

00:06:13:15 - 00:06:43:22
Joy Rhoden
Thanks. Thanks for that, Ryan. I think to your point, we're bringing everyone in under the tent, now, when you start to talk about the finances as well. But let's remember that the backdrop for much of this conversation around affordability, as you just called out, is a resource constrained environment, right? So hospitals are facing increasing pressure to improve their outcomes and manage costs.

00:06:43:25 - 00:07:21:24
Joy Rhoden
And as I pointed out earlier, you know, it's growing exponentially at the macro level to it's at a pace that's just not sustainable. Healthcare is inching close to 20% of GDP. So something's got to give. What do you say - and you started to talk about some of the root causes - what's behind the affordability challenge. What are some of the benefits that accrue when hospitals and health system leaders start to really pay attention to variation in care and variation in health outcomes, and work to close those gaps?

00:07:22:01 - 00:07:48:27
Brian Peters
Right. You know, we've said for many years that high quality health care costs less in the long run. So that, for example, anytime you avoid a medication error or a wrong side surgery, or you avoid a readmission because you've done a really good job managing that post discharge process, you're going to ultimately create a better outcome for the patient, but you're going to save cost as well.

00:07:48:27 - 00:08:17:06
Brian Peters
And I think that the similar concept applies here. In other words, if we can do a better job of addressing health disparities and do that in a proactive way as opposed to just dealing with problems once they show up in the hospital emergency room, which is the model that unfortunately we have in many places today, I think we're going to clearly create better outcomes for patients, but we're also going to help to bend the cost curve as well.

00:08:17:06 - 00:08:46:14
Brian Peters
This is the ultimate win-win, and I think that's a message that we have to convey effectively and consistently to all of the audiences who are part of this conversation. That's really the challenge before us. I think the AHA and the state associations, because as we know that the states are often the laboratory for reform, not only in health care, but in terms of any public policy challenge.

00:08:46:16 - 00:08:56:14
Brian Peters
And, you know, we have the resources at our disposal to make our voices heard and to tell this story. That's really what this this will entail.

00:08:56:15 - 00:09:06:21
Joy Rhoden
And I presume when you talk about a proactive approach, you're really leaning into a data informed approach, right?

00:09:06:25 - 00:09:30:28
Brian Peters
Data has to play a role. It has to play a role. We found that, by the way, through our efforts at the MHA Keystone Center for Safety and Quality. It starts with data. You have to measure outcomes. You have to measure process so that you have a baseline, so that you understand where the challenges are. And then you can track your progress and you can identify where things are working and where things aren't working.

00:09:30:28 - 00:09:58:00
Brian Peters
And so that data is critically important. You're absolutely correct. And it helps to tell a story. And I've always been one who says when you're advocating. And that could mean advocacy at the state or federal level in the political environment. But frankly, it could mean advocacy with our constituencies at the local level. You have to have data and stories, right?

00:09:58:02 - 00:10:20:29
Brian Peters
You cannot you cannot have one without the other, because data on its own can be misleading. Stories without data to support them can be misleading. So you really do need to have both. And I think we have both. I think we have to do a better job collecting meaningful data and disseminating it. But clearly those two things are important.

00:10:21:00 - 00:10:43:22
Joy Rhoden
I think you're right, Brian. I actually don't think we have a shortage of data. The challenge becomes how do you make those data actionable, right, to drive the improvements that you're after. So we spend the first half of the year developing this guide that we've been referencing on this, in this conversation, a guide on the economic impact of disparities in health outcomes.

00:10:43:22 - 00:11:15:21
Joy Rhoden
And I have to say, it's a better deliverable because of the insights we received from you and your peers on the Divisions Advisory Council. In your opinion, what are some practical ways hospital leaders can use the insights from this new resource to make the case, right, for investing in strategies and interventions, and the right dosage of those interventions that will focus on the reduction of health disparities.

00:11:15:24 - 00:11:41:24
Brian Peters
Well, in my mind, there's a two part challenge here. I think the first challenge is you have to win the home field advantage first, meaning you have to rally your own organization, the key leaders and the frontline caregivers in your own organization to let them know this is a priority for us. From this moment forward, this is now a priority with all that that entails.

00:11:41:24 - 00:12:06:21
Brian Peters
Meaning it's going to be a standing agenda item at our governing board meetings. We're going to have, to your point, actionable data that we're tracking. And we're holding supervisors and managers accountable for our progress so that you have everyone on the team pulling in the same direction. I think the resource guide that the AHA has pulled together and enjoy you in the team have done a great job in that regard.

00:12:06:22 - 00:12:30:20
Brian Peters
What I like is you spotlight some of the AHA members across the country who are doing some, some really neat things, and there will be many other similar examples where we can learn from each other. So you can you can share some of those learned experiences, but winning that home field advantage first and then from there, I think it's bringing in your key partners in the community.

00:12:30:20 - 00:12:53:03
Brian Peters
Because one thing we have learned without question in doing this work is you cannot move the needle by working in a silo. It will not happen. You know, when you're addressing disparities and all of the issues related to housing and transportation and language barriers and food insecurity and all the rest, we have to work with key partners in the community.

00:12:53:03 - 00:13:17:25
Brian Peters
And I really think about the business community as we're making this case, because you think about this fact - and you know this, Joy - so many of the people that we're talking about here that we want to serve in a better way, in a more proactive way, they could be better, more engaged and consistent participants in the workforce if they're healthy.

00:13:17:27 - 00:13:30:22
Joy Rhoden
As we wrap up, I guess I'd ask you for one key takeaway you hope our listeners will remember about the connection between health disparities and economic impact.

00:13:30:25 - 00:13:55:02
Brian Peters
Well, there's an absolutely significant and direct correlation between the two. We have to understand that and embrace it and tell that story and tell it very, very consistently. I really believe that in our very complex world of health care, we cannot move the needle on any of our challenges if we don't make it clear that this is a priority.

00:13:55:02 - 00:14:20:06
Brian Peters
And so I think what the AHA is doing in this work is stating that case for this as a priority. I think our leadership around the country has to follow suit. We have to speak with a united voice, and we have to bring in key partners who understand the only way we're going to create economic viability in our communities throughout the country,

00:14:20:06 - 00:14:42:16
Brian Peters
the only way we're going to start to bend the healthcare cost curve is to embrace this work, the work of health outcomes, particularly when it comes to underserved communities, and embracing all of these social drivers of health status. We can do better. We know we can. And I'm excited about this work that lies ahead.

00:14:42:19 - 00:15:15:01
Joy Rhoden
Super excited about the possibilities that lie ahead. To your point, Brian, for hospitals to do this work in partnership with others, I mean, at the end of the day, I can think of very many examples where the hospital actually ought not be in the driver's seat, but maybe serving more of that role as a as a convener, if you will, to bring together all of the assets that the community possesses, all of the other key stakeholders to design for the health of that community, right?

00:15:15:02 - 00:15:39:08
Joy Rhoden
And so if we multiply that across the various many communities that our members serve, we will be making a really good deposit towards a more a healthier environment for all, which is the goal, right? At the end of the day, the AHA's vision is of a just society of healthy communities where all individuals reach their highest potential for health.

00:15:39:08 - 00:16:01:22
Joy Rhoden
And so that really is our tall order. So I want to thank you for joining us and for sitting down with me today and providing your insights on this, on this topic. And I want to let the folks who are listening know that the new resource guide is available on the AHA's website, and we will also link to the guide in the podcast description.

00:16:01:22 - 00:16:05:24
Joy Rhoden
So thanks again and thanks for being with me, Brian.

00:16:05:26 - 00:16:10:08
Brian Peters
Joy, what a great pleasure. Thank you. I look forward to continuing our work together.

00:16:10:10 - 00:16:12:00
Joy Rhoden
Take care.

00:16:12:02 - 00:16:20:26
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:07 - 00:00:19:08
Tom Haederle
Welcome to Advancing Health. Florida's high proportion of older health care patients are being cared for by an aging health care workforce as well. Hear what one farsighted caregiver is doing to train younger workers and keep the people needed to meet future health care needs.

00:00:19:10 - 00:00:41:07
Elisa Arespacochaga
Hello, I'm Elisa Arespacochaga, AHA’s group vice president for clinical affairs and workforce. I'm delighted to be joined today by Nikki Daily, chief team resources officer at BayCare Health System in Florida. Today, we're going to be talking about how BayCare has developed partnerships, both inside their organization and with their community, to strengthen and grow their workforce for now and well into the future.

00:00:41:07 - 00:00:46:03
Elisa Arespacochaga
So, Nikki, thanks for joining me. And can you tell me a little bit about your role in BayCare?

00:00:46:10 - 00:01:09:16
Nikki Daily
Sure. Well, I'm very happy to be here. Again, I'm Nikki Daily, I'm our chief team resources officer. We are a large academic health system in west central Florida. I have been with the system 28 years, so this topic is very near and dear to my heart, being that I spent my career and have experienced and benefited from workforce development programs.

00:01:09:21 - 00:01:34:00
Elisa Arespacochaga
That's wonderful. It's always nice to have someone who's been through the programs, but also then helping to give back and develop them. Now we know that the demographic challenges that are coming at us as healthcare, as everyone trying to support the workforce with an aging workforce, increasing number of community members seeking care. How did you were you looking at this for BayCare and for your community?

00:01:34:02 - 00:02:00:27
Nikki Daily
Being in Florida, we're feeling this pinch quite acutely. We have over 1,000 people moving into Florida every single day, and 20% of those people are over the age of 65. At the same time, our workforce is aging. 13% of our team members are over age 60. And we do know that fewer people are coming into the workforce. So really coming up with programs that will allow us to fill those gaps.

00:02:00:27 - 00:02:16:03
Nikki Daily
At the same time, having those team members who are working towards retirement have a plan and a program to hand off that knowledge that they've gained was really important to BayCare as we were formulating our workforce strategy.

00:02:16:05 - 00:02:34:08
Elisa Arespacochaga
I know you looked at building programs both inside BayCare with the team you have, as you mentioned, but then also looking for ways to support your community and keep folks local, but also support those folks who are local to your community in advancing their careers. How did you manage to address both at the same time?

00:02:34:10 - 00:02:59:06
Nikki Daily
It is a partnership and a collaboration from all angles. So building workforce programs that one, meet the business needs and also focus on supporting the communities that we serve was really essential. The first thing that we look at is meeting those team members where they are. So we need to make sure these workforce development programs start at a level where they feel it's attainable and can grow.

00:02:59:08 - 00:03:28:16
Nikki Daily
Understanding the capabilities we have within the organization and having really good relationships with community partners, be it other workforce development programs, colleges, technical programs is essential to making this happen. A really great example is a surgical tech apprenticeship that we are just getting ready to launch. It's been in development for quite some time, but it is closing a gap for surgical texts, which there are a shortage of.

00:03:28:19 - 00:03:50:09
Nikki Daily
Also, it requires partnership with a local technical college, building programs and having preceptors within our organization. And it allows team members to continue to grow and become surgical techs without having to leave the workforce. They can do this on their job. We're really focusing on those programs that meet all the needs together.

00:03:50:12 - 00:04:07:22
Elisa Arespacochaga
I love that, and especially I mean, you can have the greatest surgeons in the world, but if you don't have the O.R. ready, if you don't have those support team members available and ready to join the workforce and continue in growing their own careers, those surgeons aren't going to be able to do what they need to do.

00:04:07:24 - 00:04:34:10
Elisa Arespacochaga
Absolutely. So I know you have built a series of approaches because of course, there's no one workforce approach. One is your surgical tech program. But can you tell me a little bit about the work you've done to work with your current team members and say, those in maybe entry level positions that might want to grow into something else, and how you've adapted all of the resources you offer to those needs.

00:04:34:18 - 00:04:58:24
Nikki Daily
Absolutely. So we've worked really hard to develop career pathways, and those are really roadmaps that show our team members each step that they need to take to get to what their dream job may be. And we've done this in both clinical and non-clinical fields. Something like food and environmental services, which are a very common entry level job in our organization,

00:04:58:24 - 00:05:21:25
Nikki Daily
we provided career pathways that show what knowledge and skills they need to grow to other roles. We even noticed through that work that we had a gap with helping people get a high school diploma. They can get that first level job without a diploma, but if they wanted to grow, they needed a high school diploma. So we just introduced a high school diploma program where we've graduated 31 team members.

00:05:21:27 - 00:05:50:01
Nikki Daily
We also have within nursing, for example, different pathways because every person's journey is different. Some may start as a patient care tech and go right into nursing school. And they can. We have earn as you learn programs which help support training. Also understanding not everybody can leave the workplace to get their education. So it supports that. We also have pathways where some people might want to be a practical nurse first.

00:05:50:01 - 00:06:00:14
Nikki Daily
So we have partnerships with technical colleges and we have that journey as well. And then it takes them into internships and ultimately becoming a registered nurse.

00:06:00:20 - 00:06:27:13
Elisa Arespacochaga
I love that you've got these pathways, and then you're supporting your team members in helping them work through what's the right path for me, what are the options and how can I continue to do the job that I'm doing but also move forward? Can you tell me a little bit about  - it doesn't sound like there is a typical trajectory - but what would a trajectory look like for one of your trainees, and how they can then start to look at that portfolio of options available to them?

00:06:27:16 - 00:06:45:16
Nikki Daily
There isn't any one path, but typically we look at what that entry level role might be. Sometimes we get phone calls from people through our recruiters who are looking to get into healthcare, and we would pry. So if they ultimately want to be a nurse, they haven't had any experience or exposure, we might make them a nurse helper.

00:06:45:16 - 00:07:10:14
Nikki Daily
So that puts them on a patient care unit. They get to watch and observe what the team, the care team is doing and how they do their work. So from that nurse helper job, some might decide to go into a patient care tech. Others through that may have gotten exposure to other positions like imaging, radiology techs, respiratory therapists and decide to take those journeys as well.

00:07:10:14 - 00:07:36:13
Nikki Daily
So from there, that's where those career pathways are really important, because it would show them if that person decided they wanted to be a radiology tech. We have technologist assistants that they could take that nurse help or the skills that they learned there, and then move over and become a technologist assistant while they prepare for imaging or radiology school or what their next step might be.

00:07:36:20 - 00:07:56:14
Elisa Arespacochaga
I love that that you really are looking for ways to stack those credentials and just add to their knowledge base, and not have to go back and start at the beginning for the next level of schooling. Can you add a little bit of color on the non-clinical pathways? Because I think we have a lot of folks are looking for what are those clinical pathways

00:07:56:14 - 00:08:06:13
Elisa Arespacochaga
and certainly we need every clinician we can get. But what are some of the roles where I don't think most people think are in hospitals that you've been working on?

00:08:06:15 - 00:08:34:25
Nikki Daily
Yes. It takes every type of role to contribute to making our health care system successful. A lot of people want to work in healthcare but not be a clinician. So we do have pathways in areas like registration. So it really is important, I think, as people are looking at a career in healthcare or a hospital system, they have transferable skills like customer service, computer skills, organization skills.

00:08:34:25 - 00:09:12:21
Nikki Daily
So we see a lot of people come in to registration positions or billing positions, and from there they start to gain that knowledge and that experience. We can have pathways that show them how they can, if they really love that work, how they can grow those skills, expand them and move into leadership, or if they are looking to grow those skills and move into another area, things like registration and the skills that you learn there can transfer into medical offices, in a medical office rep position and other forward facing roles that we have.

00:09:12:23 - 00:09:34:06
Elisa Arespacochaga
Let's talk a little bit about how you involved your team and those departments that you worked with in building these programs, and especially attacking the culture that that may not be so open sometimes, but really creating a welcoming community to new roles, new team members, to training people. How did you accomplish that?

00:09:34:08 - 00:09:58:10
Nikki Daily
So first and foremost, our culture is so important to us. We are recognized as a top workplace. We are very passionate about having the right people who want to work here. We want to first ensure we get the right people. We really do work together. We have engaged our leaders. We have educators within our department and educators in the community, as well as program graduates.

00:09:58:10 - 00:10:23:13
Nikki Daily
We want to hear back from people who have been through the program to understand what works, what doesn't work, what we may need to do to evolve and change as we're putting together the programs that we need. Sometimes you have to publicize the work we're doing. A great example that Maria is our amazing manager of workforce development, who is really the person behind a lot of these programs. She said

00:10:23:14 - 00:10:55:24
Nikki Daily
digging into the data, we saw dosimetrists, which is a job where we don't have that many of them, but over half of them are preparing for retirement. Well, we weren't aware of that. You know, she and the leader have connected. They're having conversations about what we can do to now put a focus on ensuring we have a pipeline to either grow people into that or partner with colleges and universities where we can do internships and bring people, introduce them to our organization so we can ensure that we fill those gaps.

00:10:55:24 - 00:11:00:15
Nikki Daily
So really, it's that constant partnership and collaboration.

00:11:00:18 - 00:11:16:14
Elisa Arespacochaga
That's awesome. So what advice do you have to those who are listening about how to both build internally, but then reach to your communities to encourage people to apply into the system and show them that these pathways exist?

00:11:16:16 - 00:11:40:18
Nikki Daily
Absolutely. My advice is to start looking at the job board, to go to career fairs. So BayCare has career fairs where we invite people from the community to come in. There are recruiters present. There are leaders present over different areas so they can have conversations and learn about those roles. And don't make assumptions that you have to come in already knowing what to do.

00:11:40:19 - 00:12:00:03
Nikki Daily
That's what these programs are for. We want people to not come to BayCare for a job, but to understand they really can grow into their full career. So understand what your skills are and what you're good at, and some transferable skills you may have. Start to apply for roles that you qualify for, but then understand once you get in the system,

00:12:00:03 - 00:12:06:03
Nikki Daily
we have so many programs to help you grow and support you to move into your dream job.

00:12:06:10 - 00:12:12:27
Elisa Arespacochaga
I love that. Anything I didn't ask about your programs that you want to make sure to share for our listeners.

00:12:13:04 - 00:12:35:20
Nikki Daily
It's something we're very, very proud of. It is a continuous effort and journey. We look at the data every single quarter. We're always looking at developing and evolving our workforce strategy. And it really is a partnership and a desire from all levels. It can't be run just by team resources. We need that buy-in a partnership from the departments.

00:12:35:20 - 00:12:46:25
Nikki Daily
We need to have great relationships with our community partners to ensure that we're having these people trained and have the opportunities to grow into these really important, critical health care careers.

00:12:46:26 - 00:13:04:24
Elisa Arespacochaga
Well, Nikki, thank you so much for sharing the work that you are clearly very passionate about and all of the amazing work at BayCare that you've done to grow and keep and really encourage your team members to live up to their fullest potential in healthcare. I really love that we have such a strong community at your organization.

00:13:05:00 - 00:13:07:18
Nikki Daily
Thank you so much. I appreciate you having me.

00:13:07:20 - 00:13:16:14
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.