Advancing Health Podcast

00:00:00:01 - 00:00:18:12
Tom Haederle
Welcome to Advancing Health. As health care evolves to meet the needs of patients today, providers are finding that breaking down barriers between disciplines, scrapping separate medical training programs in favor of an integrated approach is improving access to care.

00:00:18:15 - 00:00:59:05
Elisa Arespacochaga
This is Elisa Arespacochaga, group vice president at the American Hospital Association. We know that practiced well, health care is a team sport, yet we still maintain very separate training programs that can sometimes reduce that ability to build team muscle early. I'm very excited to share with you today my conversation with our two guests, Dr. Jeremy Fish, founding director of the John Muir Health Family Medicine Residency, and Dr. Pilar Corcoran-Lozano, Behavioral Health Corps faculty and supervising psychologist of the Co-Training Program, about how they've not only integrated physical and behavioral health in their residency clinic to improve access to care, but how they've integrated the training programs to truly build teams

00:00:59:05 - 00:01:04:12
Elisa Arespacochaga
from day one. So first of all, thank you so much for joining me and sharing your story.

00:01:04:15 - 00:01:05:21
Jeremy Fish, M.D.
Thanks for having us.

00:01:05:23 - 00:01:07:06
Pilar Corcoran-Lozano, PsyD
Thanks for having us.

00:01:07:08 - 00:01:22:28
Elisa Arespacochaga
Dr. Fish, I'm going to start with you. As a family medicine physician, you started down this path. You've been a residency director. You thought about, okay, how can we make this better? What made you say, you know what we need? We need clinical psychologists and we need to train them here.

00:01:23:01 - 00:01:43:01
Jeremy Fish, M.D.
Yeah, well, it's been a long journey because I practiced for many years in a county based health system. We did have some behavioral health folks in the residency that I trained at over at Contra Costa. And what I learned was, there's a whole lot of care that I'm not a real expert at providing. And yet the need is constant.

00:01:43:04 - 00:02:10:00
Jeremy Fish, M.D.
And I found myself virtually getting kind of quasi-psychological support and behavioral health support, in ways that I felt very ineffective. And I really didn't find that comfortable for me because I really enjoy as a family physician, being able to help people across a full spectrum of needs. And yet I found there often we fell short. So I had some exposure to the model of behavioral health folks being in primary care during my training.

00:02:10:02 - 00:02:32:19
Jeremy Fish, M.D.
Family medicine is unique in that way in that we have behavioral health faculty who are actually teaching us. When I came to John Muir, we really wanted to do something even more advanced. And the reason for that is that I really felt this was a need that was there every time I was in clinic. And so that the residents, every time they're in clinic and they need that help, I wanted them to have that support.

00:02:32:21 - 00:02:54:03
Jeremy Fish, M.D.
And so when we set out to establish an advanced primary care practice in our residency program, the first initiative I really had was to fully establish a partnership with the Behavioral Health Educational Program. And that's how I met Dr. Corcoran-Lozano. She was one of our first students to come in to that early iteration of our program.

00:02:54:06 - 00:03:21:15
Jeremy Fish, M.D.
It was initially a kind of mix of LMFTs - license and marriage and family therapists, as well as PsyD students. We eventually, under the leadership of Dr. Heidi Joshi, who was a PsyD expert,  who had a lot of experience with building PsyD programs that we fully went into the PsyD level program because in many ways they are the highest level skilled across all payers.

00:03:21:16 - 00:03:45:01
Jeremy Fish, M.D.
They can also bill all payers. And so that really kind of solidified that what we needed to do was really build the leaders of the future for primary care behavioral health integration. And so when we established a program at John Muir, that has now become our model of co-training in this way. Because we also found, you know, when we're young, when I was younger, I was more open to a lot of different things.

00:03:45:03 - 00:04:06:12
Jeremy Fish, M.D.
And I just think using the youthful energy and the desire, I think the Gen Z and you know, millennials, they really enjoy team-based training. They like to rely on other professionals so I think it really also provided the opportunity for getting the relationships developed early in training, where then they would have an expectation of working with behavioral health folks in their careers.

00:04:06:14 - 00:04:34:22
Elisa Arespacochaga
I love that. Dr. Lozono, can you tell me a little bit. From your perspective, you're coming from a training program that often isn't co-located with family medicine, residency, or physician residency programs. How did you, get to this path - as Dr. Fisher mentioned, you were one of the early students - but how did you help bring in your own students and adjust them to the workflow of a traditional physician residency?

00:04:34:24 - 00:05:04:22
Pilar Corcoran-Lozano, PsyD
Behavioral health providers, mental health providers and family physicians, they're trained in silos. Like we learn about a specific discipline, for example, by reading about it, by seeing videos. And so a big part of my own training was having the opportunity to be in a learning environment that really fostered teamwork, which this residency did. And so it allowed me to be vulnerable.

00:05:04:23 - 00:05:15:25
Pilar Corcoran-Lozano, PsyD
It allowed me to kind of rely on other team members. It allowed me to know the limits of my own knowledge, so that way I could rely on another discipline.

00:05:15:27 - 00:05:37:29
Jeremy Fish, M.D.
Yeah. And I think as you mentioned, really establishing a culture of learning and health care, we are always learning, but we don't necessarily do it in a conscious way. And learning to be team members is really tough. I think the key word to use there was making yourselves vulnerable. It is hard to make yourself vulnerable within your profession.

00:05:38:02 - 00:06:06:08
Jeremy Fish, M.D.
It is even more challenging to make yourself vulnerable across professions. And early on, we had some challenges. And yet, Dr. Corcoran-Lozano saw enough in that to come back. She first came as a doctoral student, returned as a postdoctoral student, and then became a faculty member and now a supervising faculty. So she's a perfect example of the evolution of the comfort that people get over time in doing this.

00:06:06:09 - 00:06:07:20
Jeremy Fish, M.D.
But it's not easy.

00:06:07:23 - 00:06:29:14
Pilar Corcoran-Lozano, PsyD
It's not easy. And it appears, and maybe it seems simple, to just be able to like work as a team. Like that sounds wonderful and great. And really, it's a huge cultural shift of putting two different disciplines that are trained vastly different and then putting them together and telling them, support this patient.

00:06:29:16 - 00:06:57:26
Elisa Arespacochaga
What I love about the work that you've done with this integration, and Dr. Lozano, I'm going to ask you to talk a little bit about this, because I know this is obviously from the behavioral health side a huge need. Not that there isn't a need for access to care from every angle, but especially behavioral health needs. How is this integration really driving that ability for all the patients you see in clinic to have access to not only the physical health support they need, but the mental health support they need?

00:06:57:28 - 00:07:19:12
Pilar Corcoran-Lozano, PsyD
So one thing that we actually offer in clinic is what is referred to as warm handoffs. And so these are we have one of our behavioral health providers sitting in the same exact room as the medical learners, the medical residents. And so we have our ear open and we're listening to things that are related to possibly behavioral health.

00:07:19:19 - 00:07:48:10
Pilar Corcoran-Lozano, PsyD
And we are a resource for people. And so being in that room allows us to have same day visits with patients. Many times in this setting, we are the first face related to mental health or behavioral health that a patient may interface. And so there's definitely stigma still related to mental health and behavioral health. And so lessening that stigma might just be like, hey, would you like to talk to Dr. Pilar?

00:07:48:12 - 00:08:13:04
Pilar Corcoran-Lozano, PsyD
She can come in and kind of meet with you same day, can be very beneficial. And so one is we're addressing those needs. So we're lessening the barriers, the stigma related to mental health. As well as, where in that visit we might teach something to that patient. We may talk a little bit about therapy or resources, give them a skill that they can take home with them.

00:08:13:06 - 00:08:30:14
Pilar Corcoran-Lozano, PsyD
And we can also schedule same day. Before they leave, they already have an appointment with a mental health provider. They might have met that mental health provider already, so that already lessens the kind of the fear, maybe, that might be like, who am I going to be meeting? So...

00:08:30:17 - 00:08:52:16
Jeremy Fish, M.D.
Yeah. And if I might add to that, because I think it just really is the centerpiece. It took us nearly two years to come up to a joint agreement that warm handoffs would be the key priority, in part because it really brought up that almost everything involved, you know, where is the privacy there? And in a stigmatized industry, privacy is paramount.

00:08:52:18 - 00:09:15:19
Jeremy Fish, M.D.
Right. So you're taking people who have to come in very quickly in a few minutes. Are they going to do it inside the same room that the doctor was there? Or are we going to put the patient in a different room? So you've got to go, you know, there's workflow issues that have to be addressed. And it was very challenging for them to come in with only a brief like, what do I do in a few minutes to establish rapport?

00:09:15:21 - 00:09:47:07
Jeremy Fish, M.D.
That kind of that's a real primary care challenge, because often in behavioral health, you're spending weeks to months developing that trust. And so what's enough trust in just a few minutes? And that's we found bringing them into the room right away and then addressing the workflow needs, was vitally important. Because if you look at a traditional primary care setting, you're talking about maybe 10% of patients will actually make their first referral to a behavioral health practice

00:09:47:12 - 00:10:17:09
Jeremy Fish, M.D.
that's not integrated inside of the practice. I mean, it's just profoundly different, the follow through, right? And so we really wanted to achieve in the in the realm of 90 to 100% of that first visit. And so it took us a couple of years to come to a joint agreement on that. And once we did that, that really established for the residents and the faculty to see the behavioral health folks as a really readily available resource, that help them relieve their stress.

00:10:17:13 - 00:10:42:15
Jeremy Fish, M.D.
Not only is it better care for the patients, it's actually the mental and behavioral well-being of the physicians improves and the staff in the practice. Because the sense of efficacy, we're doing good work. We're actually helping people because people with unmet mental and behavioral health needs can make very unusual demands on a practice. And, and have behavioral issues that can be very stressful to a practice.

00:10:42:19 - 00:11:00:27
Jeremy Fish, M.D.
So having professionals who really know how to help us manage that is extraordinarily effective. And we saw that particularly during Covid, where there were high levels of distress going on. We were so grateful having the behavioral health folks there to help us do the assessments and make sure we could actually do the right thing for these patients.

00:11:00:29 - 00:11:18:25
Elisa Arespacochaga
You know, absolutely. And I think my last question that I want to ask you both to comment on, and I'll start with you, Dr. Fish. You're building an army of residents who think now full spectrum family medicine is not just, you know, family medicine plus OB, it's family medicine plus behavioral health plus OB plus being part of a team.

00:11:18:27 - 00:11:30:05
Elisa Arespacochaga
What lessons are some of your residents telling you they're taking away into their careers? And, you know, now you've graduated a couple of classes. They're starting to demand these things in their attending positions.

00:11:30:08 - 00:11:55:07
Jeremy Fish, M.D.
Yeah. And there's a there's a tension with that because definitely we've gotten feedback from our residents, how essential it is, how much they enjoy the partnership that they develop, particularly with the co-learners. They consider them fellow residents, right, that they are part of our residency training program. And so those relationships and the depth of those relationships give our residents a great deal of confidence in the care of patients that they have.

00:11:55:07 - 00:12:16:19
Jeremy Fish, M.D.
So they're very appreciative of the fact that they're very comfortable doing testing, like PHQ9 and how to how to use that sort of assessment around a depressed patient to determine what to do, that there are alternatives to medications, because we face this all the time, where patients through stigma don't want to take medicines either, because that medicine means they have a disease they don't want to have.

00:12:16:22 - 00:12:40:06
Jeremy Fish, M.D.
They don't want to necessarily acknowledge that they're depressed or anxious. And so having alternative treatments for those patients where they can work through cognitive behavioral therapy or some other mechanism, really helps broaden the comfort of our residents. So there's lots of things we can do for people who are struggling with these challenges. And they tell us, you know, if we were not to have this, they can't imagine what that is like.

00:12:40:06 - 00:13:03:23
Jeremy Fish, M.D.
And so then when they're going on to their careers, this has created a attention point in the in the systems that they've gone on to work and where they are saying, hey, Dr. Fish, I'm at this new place that will go unnamed and I can't even get a psychiatry consultation. It's just really hard. And so now I'm using all the skills, but I'm worried I'm going to burn out, because everybody's sending me their behavioral health patients.

00:13:03:23 - 00:13:21:00
Jeremy Fish, M.D.
And I said, yes, this is part of the symptoms. And this is part of why we do leadership development is we want you to learn how to work within your system to say, hey, this does work because there's a lot of, misinformation out there. Because it's challenging to do this, a lot of health administrators will say, oh, it can't be done.

00:13:21:00 - 00:13:38:22
Jeremy Fish, M.D.
We tried that in, you know, 2004 and it didn't work. There's a lot of that in health care. And I understand that. When something takes two years to get it working well, it's hard for a health system to have that kind of patience to get there. So there's a lot of misinformation that this can't be done.

00:13:38:22 - 00:14:00:05
Jeremy Fish, M.D.
And so part of our mission is to help people understand it can be done and then part of our training for our residents is you need to be that leader who goes to the meetings and says, here's something we could do that I've seen, because when you've have a lived experience of something, you're a much more persuasive and compelling narrative giver on the value of it.

00:14:00:08 - 00:14:03:19
Elisa Arespacochaga
Dr. Corcoran-Lozano, I would love to hear your last thoughts on this.

00:14:03:21 - 00:14:30:24
Pilar Corcoran-Lozano, PsyD
I think it actually goes down to the need. There's the need for patient care. However, since we're talking about a residency clinic, we're talking about folks that are in training and there's a need there. There's a need that I am sitting across from a patient in an exam room, and they have feelings and they're crying, and they just got a new diagnosis.

00:14:30:24 - 00:14:54:18
Pilar Corcoran-Lozano, PsyD
Or maybe they're having a difficult time taking their medications every day. And that can be medications for anything. And so they're sitting there struggling perhaps like how do I communicate with this particular patient? How do I talk to them about medication adherence or asking about what are some of the reasons or barriers for them not to take their medications?

00:14:54:18 - 00:15:20:18
Pilar Corcoran-Lozano, PsyD
And that's just one example. And so we're here for that need to help support and teach these residents. They're able to have these difficult conversations with patients. They're able to actually treat the whole person, right? Because they, they recognize - and something that we really kind of stress here - is that we have this thing that is in between our head and our body, and that is referred to as a neck.

00:15:20:21 - 00:15:39:19
Pilar Corcoran-Lozano, PsyD
And that is because we are our mind and body are connected like we are all whole people and we're complex. And so it's really about meeting the needs of the learners and the patients. And so also teaching the next generation of psychology trainees on how to do that.

00:15:39:21 - 00:15:59:28
Elisa Arespacochaga
Absolutely. Well, I want to thank you both for joining me today for sharing about your program. I love the work that you have put into not saying yes in the face of maybe a few too many no's and continuing to push to bring together the care you knew needed to be provided as a team sport in your clinics.

00:15:59:28 - 00:16:02:06
Elisa Arespacochaga
So thank you both for joining me.

00:16:02:08 - 00:16:10:18
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:00 - 00:00:19:09
Tom Haederle
Welcome to Advancing Health. Every day, hospitals across America are taking a journey together with community partners that enrich and advance health. These inspiring collaborations are what the American Hospital Association honors each year with its Foster G. McGaw Prize.

00:00:19:11 - 00:00:39:19
Tom Haederle
Hi everyone. I'm Tom Haederle, senior communication specialist with the American Hospital Association, and I'm very pleased to welcome today Doug Brown, a partner with Manatt Health in Boston, a former AHA Board of Trustees member and the current chair of the American Hospital Association's Foster G. McGaw Prize Committee. Doug, thanks so much for joining me on Advancing Health today.

00:00:39:27 - 00:00:41:10
Doug Brown
My pleasure. Tom, good to be here.

00:00:41:16 - 00:00:55:07
Tom Haederle
You know, the Foster G. McGaw Prize probably doesn't have the fame that the Nobel Prize does, so for the uninitiated, tell me a little bit about what the prize is, why it was created and designed to honor.

00:00:55:09 - 00:01:26:07
Doug Brown
Well, we're on a quest to make it as famous as the Nobel Prize. So, thank you for the question. So it goes back to 1986, when it was founded. So this will be the 40th year of the prize, and it was founded after an amazing individual by the name of Foster McGaw, who started the American Hospital Supply Company in 1922, which is about the same time my grandfather started a paper business on the North Shore of Boston.

00:01:26:07 - 00:01:50:09
Doug Brown
So it's, it has a special place in my heart. That company, Foster McGaw's, went on to be one of the largest companies in the country and set the standard for the hospital supply industry. It was characterized by high quality standards and high ethical standards. And Foster McGaw became a very noted philanthropist in many different communities.

00:01:50:09 - 00:02:15:18
Doug Brown
And in 1986, when he died, the Baxter Foundation, the Baxter International had acquired the American Hospital Supply Company in 1985, and the Baxter Foundation and the American Hospital Association got together to develop this prize in his honor for all that he believed in. And it's been going strong for 40 years. So what is the prize for?

00:02:15:22 - 00:02:44:00
Doug Brown
Basically awarded to an outstanding hospital in the country that distinguished itself through innovative ways of getting outside its walls, to improving the health and well-being of its community. You know, hospitals are so incredibly linked with their communities. They're very often the largest employers. And we want to acknowledge and award the great work that hospitals are doing in their communities.

00:02:44:00 - 00:02:45:14
Doug Brown
And that's what this is all about.

00:02:45:17 - 00:03:01:10
Tom Haederle
The ultimate goal, I guess, of any hospital collaboration with a community organization is to improve patient care and advance health overall. What are some of the kinds of things that, that a hospital can do better working in tandem with a community organization that can then it can do on its own?

00:03:01:13 - 00:03:26:15
Doug Brown
Yeah. Well, it's a great question, Tom. And, you know, I think people often don't appreciate that the great care that hospitals provide inside the walls make up only about 20% of our health, right? Now when we need it, it's critically important. But 80% of what makes up a human being's health has to do with what is called social drivers of health.

00:03:26:15 - 00:03:59:24
Doug Brown
And those are all the things that happen outside of hospital walls, like your economic level, your education level, the built environment in your community, whether there a walkable paths, the safety of your neighborhood, your access to healthy food. And so, because hospitals are focused on improving the health of their communities, they're increasingly understanding that it's necessary for hospitals not only to provide great care when patients need it, but to get outside their walls and address these social drivers of health.

00:03:59:27 - 00:04:33:13
Doug Brown
And that's exactly what these innovative hospitals are doing. They are addressing the built environment by working with the community to build playgrounds and community gathering centers. They're addressing food insecurity by developing food as medicine programs. They're helping vulnerable communities navigate the system, and they're doing things like looking to particular aspects of that community that had been left behind in terms of economic development and have become incredibly socially vulnerable.

00:04:33:16 - 00:04:44:24
Doug Brown
And they're hiring from those communities and giving individuals jobs and opportunity for economic mobility, which at the end of the day, is probably the single biggest driver of someone's health.

00:04:44:27 - 00:04:59:25
Tom Haederle
Yeah, there are some amazing examples of innovation and creativity in play across the country right now. There are so many great examples of work going on. I know there were a significant number of applicants for our 2026 prize this year. What does the committee look for?

00:04:59:28 - 00:05:26:26
Doug Brown
So we look for a number of things. And you're right, there are a number of great hospitals doing great things. But I think what we look for most is authenticity. We want to see hospitals that aren't necessarily doing this for marketing purposes or to get headlines, but because they authentically and genuinely believe in improving the health of their communities.

00:05:26:29 - 00:05:57:09
Doug Brown
We'd like to see a longstanding track record of having done this for a long time. We'd like to see hospitals that don't look at themselves as the all knowing partner who will come and do things for a community, but rather as a convener, as an entity that that looks to do things with the community, to collaborate, to get the community's ideas and to really work together on improving health and well-being in that community.

00:05:57:11 - 00:06:17:23
Doug Brown
And I think we like to see innovation, you know, we want to see organizations that are kind of leaning in to trying new and different ways of engaging and connecting with their community, and be willing to take risk and make a commitment to reaching out and helping health in a way that is not, you know, as traditionally thought of.

00:06:17:25 - 00:06:30:00
Tom Haederle
Totally makes sense. You know, you've touched on this already, but I was just thinking, as you as you lead the committee in reviewing these applications, what are some of the examples, that you have seen in the in the review process that really leap out at you?

00:06:30:07 - 00:07:06:27
Doug Brown
Yeah. We're not ready to announce this year's winners. They will be, it's under lock and seal. They'll be announced in July at the American Hospital Association Leadership Summit, which is in Denver this year. And there will be one winner announced. But we also celebrate the finalists. There will be three other finalists. All were outstanding. And I will tell you, we visited these organizations in October and we have an incredible committee, made up of some of the best and brightest minds in in health care in terms of community health from great organizations.

00:07:06:27 - 00:07:28:24
Doug Brown
And we crisscrossed the country this year, did site visits. I think we traveled 7,000 miles, hit four cities. We took a seven hour bus ride. And it's some of the best work I do, I have to say I absolutely love it. It's so inspiring. And it's inspiring because we sit with a half a day and we hear from the organization and most importantly, we hear from the community.

00:07:28:24 - 00:07:58:26
Doug Brown
Community groups show up. They talk to us from their perspective of what the hospital is doing, what it means to them as individuals and as members of the community. And, you know, I'll just say, Tom, that, you know, hospital employees are beleaguered these days. It's a really tough time to be in health care. And I think we often forget that hospitals continue to do amazing things that don't necessarily get headlines, that don't necessarily get much fanfare, but are critical for turning around communities.

00:07:59:02 - 00:08:22:12
Doug Brown
So this year, we saw some great examples. One hospital developed this adaptive sports program for children with very severe physical limitations that normally couldn't participate in activities. And this allows them to actually ski downhill, to engage in rock climbing, and to do water skiing, all with the help of the staff. Makes a huge difference in the lives of these children.

00:08:22:14 - 00:08:54:00
Doug Brown
Another hospital we visited basically established a program for teens to do clinical rotations in the hospital, to meet with staff, to talk to them, to hear about their stories, to observe surgeries and to develop some of the soft skills that are necessary to make them future leaders in health care. Another one we visited really focused on the built environment, knowing that it has a huge impact on health, whether people can get outside and walk and experience nature is a huge factor in their health.

00:08:54:00 - 00:09:18:02
Doug Brown
And this particular hospital was in a rural community with a lot of outdoor nature trails, and they created a whole wayfinding system for their outdoor trails to make them easier and more accessible for members of the community. They also engaged children in designing and building a new playground so that they could actually get ideas from children and what would be best, which we thought was so innovative.

00:09:18:02 - 00:09:44:15
Doug Brown
And they've developed a amazing art program in their community that features consequential men and women throughout history in their community, in big murals. To kind of lift up these stories for the community are just a few of the examples we saw this year. I could go on and on. There were so many great stories, but those are just a few of the types of things we see in these organizations.

00:09:44:17 - 00:09:56:05
Tom Haederle
You know, I was just thinking, I think every hospital wants to be a cornerstone of their community through strategic collaborations with community organizations. And I wonder what are some of the characteristics of those hospitals that do it best?

00:09:56:07 - 00:10:29:01
Doug Brown
Yeah, that's a great question. And I think what I see, Tom, and, you know, I spent 20 years at an academic medical center before coming to my current job as a partner at Manatt Health, and I now work with academic, medical centers and hospitals around the country. And I think, though, the issue that that I see most often is that it's just such a tough environment and when it does get tough and it's no one can fault an organization for kind of like narrowing your focus and really focusing on making ends meet and the bottom line.

00:10:29:03 - 00:10:56:18
Doug Brown
And so to me, what distinguishes the truly great organizations are those that do that well - I mean no margin, no mission - so you have to run and operate things well, but have this deep ethic of understanding that nonprofit hospitals, they have stakeholders, not shareholders. So they are they are literally owned by the community. They're community resources.

00:10:56:18 - 00:11:23:13
Doug Brown
And they make it as part of their reason for being. It becomes a philosophy of the organization that we are deeply committed, not only to provide outstanding care for patients who come in our doors, but also to address all people outside our doors and in our communities, to help focus on their well-being and their health and that we are inextricably linked with our communities.

00:11:23:15 - 00:11:48:09
Doug Brown
You know it when you see it. As I say, we have these amazing site visits. We see great things, but we can spot when an organization really has it, you know, deeply ingrained into their bones. And that's what we're trying to inspire others to emulate. And that's what we're trying to award. I should mention that there are great benefits to winning this prize or to just being a finalist, frankly.

00:11:48:11 - 00:12:07:01
Doug Brown
You know, if you're a finalist, you get a site visit. And, you know, when I was at UMass Memorial, we were a finalist, like 2 or 3 times. We never won it. But I'll tell you, those site visits was some of the best times. We had board members come, and it's a way that the organization can actually hear from the community all the great things they're doing.

00:12:07:01 - 00:12:33:06
Doug Brown
So it's a little bit of a revival feeling and that in and of itself is tremendously rewarding for organizations. But if you're a finalist, you get a $10,000 prize. You get a video made that is shown at the AHA Leadership Summit. You have a beautiful brochure made highlighting your accomplishments. And if you are the ultimate winner, the prize is $100,000 to commit to your community in whatever way you choose.

00:12:33:06 - 00:12:45:07
Doug Brown
So there are really some, some nice benefits that both Baxter and the AHA have put toward this to really acknowledge and recognize this, this greatness and community health.

00:12:45:09 - 00:13:05:07
Tom Haederle
Well, I hope our discussion has convinced a few people to think about applying if they haven't before. And hopefully drive applications for this prestigious honor. And so the place to start to do that would be, to visit the website at www.aha.org/fostermcgaw. And that's one word.

00:13:05:07 - 00:13:19:19
Tom Haederle
Foster McGraw. Doug, thank you so much for walking us through the process, for chairing the prize committee, and for all you do to call out the phenomenal work that goes on among hospitals, collaborating with community partners each day. Really appreciate your time. Thank you so much.

00:13:19:22 - 00:13:23:00
Doug Brown
My pleasure. Tom, thanks so much for having me.

00:13:23:03 - 00:13:31:13
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 - 00:00:23:02
Tom Haederle
Welcome to Advancing Health. In February's Leadership Dialogue podcast, Dr. Marc Boom, president and CEO of Houston Methodist and the 2026 Board chair of the American Hospital Association, speaks with a top rural health care leader about how creativity and excellence can address the unique challenges facing rural providers.

00:00:23:05 - 00:00:44:06
Marc Boom, M.D.
Well, greetings and thank you, everybody for joining me today. I'm Marc Boom. I'm the president and CEO of Houston Methodist, and I'm excited to be the chair of the, American Hospital Association this year. As I mentioned during my first leadership dialog in January, I believe innovation is just a critically important part of ensuring that patient care is absolutely unparalleled.

00:00:44:09 - 00:01:09:02
Marc Boom, M.D.
So my plan to hopefully weave innovation as a theme throughout each of these discussions. And so today we're doing exactly that again, but this time through the lens of a rural hospital leader. I know that all of our colleagues, whether they're leaders of big health systems or small independent hospitals, are committed to innovating to deliver the best possible care to the people they serve and also navigating big changes and challenges in our field.

00:01:09:04 - 00:01:42:03
Marc Boom, M.D.
And we know that when it comes to challenges, the leaders of our rural hospitals, frankly, have a whole extra degree of complexity. I mean, recruiting staff. The administrative and reimbursement challenges, transportation, just to name a few. And I know I'm anticipating our guest today will share that amidst those challenges, many opportunities for growth and innovation. You know, just, two weeks ago, I attended the AHA's Rural Health Care Leadership Conference, and I was totally energized by the sessions and the discussions that were there on building innovative approaches to transformative care delivery.

00:01:42:05 - 00:02:11:15
Marc Boom, M.D.
So today, we have as our guest, Mark Boucot. Mark is the president and chief executive officer of Potomac Valley Hospital in Kaiser, West Virginia. He attended the conference as well. I met and chatted with him there because he was the recipient of the AHA’s Rural Hospital Excellence in Innovation Award. That's an award that recognizes rural hospitals that demonstrate responsiveness, creativity, and excellence in developing or sustaining programs that address the unique challenges that face rural and frontier communities.

00:02:11:15 - 00:02:14:26
Marc Boom, M.D.
So, Mark, welcome today. I'm glad to have you here.

00:02:14:29 - 00:02:17:17
Mark Boucot
Well, thank you for having me. I'm honored to be here.

00:02:17:20 - 00:02:35:24
Marc Boom, M.D.
And we'll keep it nice and confusing with two Marks today. And maybe we'll pronounce them slightly differently. Mine's with the C, yours is with a K, but it is great to have a fellow Mark here for our podcast today. So I want to dive right in. And first off, I know Potomac Valley Hospital, which you lead, is part of WVU medicine.

00:02:35:27 - 00:02:45:03
Marc Boom, M.D.
Which, if I'm not mistaken, you are a 25 bed critical access hospital. So let me start. Tell me a little bit more about the hospital and the community you serve.

00:02:45:03 - 00:03:11:18
Mark Boucot
Yeah that's correct. We're a 25 bed, critical access hospital. Although you'd be very surprised about the amazing array of services that we provide there. The hospital, basically has, general surgery, orthopedics, very strong orthopedics program, along with multiple specialty services. We opened a hematology oncology center there in our geography to serve the patients that we were blessed to take care of.

00:03:11:21 - 00:03:36:28
Mark Boucot
We have, urology. We have along with that. We have colorectal surgery, we have pain management. So there's a there's a pretty vast array of services. We serve a market area of really I think it's a three county area that that comes to the hospital, our community near Potomac Valley Hospital, about 50,000 residents. But we serve a much broader area.

00:03:36:28 - 00:04:06:07
Mark Boucot
People come from about an hour away. And really, I think one of the things that I for me, that is a hallmark of our organization is, is that we have adopted a mission statement that we care for every patient like we would our own family. And so with that as our Northstar, we are able to innovate and develop patient care services for our community, always knowing that we're going to care for them, we're going to include them, we're going to incorporate their needs

00:04:06:07 - 00:04:09:18
Mark Boucot
most importantly, because everything that we do is for them.

00:04:09:20 - 00:04:31:19
Marc Boom, M.D.
I'd love to hear about your technology journey. We believe, and that's why I'm weaving this in these series that, you know, innovating through technology can really transform innovation. And when you talk about that Northstar, which I love of it's all about the patients, right? That's why we're all in health care. I assume when you're looking at technology as a critical access hospital, it's all about the patient, how you do that.

00:04:31:19 - 00:04:39:11
Marc Boom, M.D.
So how do you think about, technology solutions, the infrastructure improvements, care management, all of the above, in that setting?

00:04:39:13 - 00:05:10:16
Mark Boucot
Yeah. Like most organizations, we have a pretty strong governance infrastructure around the development of our technology services. We're blessed to be part of WVU medicine. And because of that, we are able to have advancements in technology that many small organizations that are independent or standalone don't get the opportunity to have. But we've integrated AI into our physician practices and it's one of the most amazing things for them because they're direct face to face care now is much different.

00:05:10:23 - 00:05:33:26
Mark Boucot
So we're serving the patient more than the computer, in that environment. And as we build and grow, we think our way through and develop strategies that would enable us to really provide the academic medical center level of care at our small hospital. And I think that that has been a hallmark of how we decide what we're going to do and how we're going to move forward.

00:05:33:28 - 00:05:55:07
Marc Boom, M.D.
And we'll pull that thread a little bit. So you say, as part of WVU medicine, we have many critical access hospitals out there, as you alluded to, that are standalone on their own. I'm sure you think about that. I know there's pros, I know there's cons, but how would you approach that if you didn't have the WVU medicine as that, as that kind of feeder of some of those technologies?

00:05:55:09 - 00:06:24:28
Mark Boucot
A great example is this program that we were recognized for with the virtual ICU program. Very low cost infrastructure, just with some very simple tablets. We implemented a virtual ICU program where we were able to care for patients. We partnered with a large organization, which is Ruby Memorial, part of our own health system. But you could do that with any other academic medical center that you work with.

00:06:25:00 - 00:06:56:21
Mark Boucot
And basically what we do is we created a partnership where they can monitor our patients. The surgical intensivist in their ICU and critical care intensivist can care for our patients through just a very simple virtual hook up. This, this infrastructure actually, I think cost about $5,400 to implement. So it doesn't have to be rocket science. And it doesn't always have to be complicated in order to be successful.

00:06:56:26 - 00:07:21:12
Mark Boucot
I would also say for me, I've been the independent organization, and we had to make some decisions about making sure that what we provide is as close to the state of the art as we can possibly get. And even so, I would say the most important thing for us is that nothing is going to take away from the face to face care for the patients with our providers.

00:07:21:15 - 00:07:42:14
Mark Boucot
And so we try to enable them to be able to to care. And so even with some when we had antiquated technology or antiquated IT systems, we still were able to utilize Dragon and other scribing techniques that would try to keep the providers as close to the bedside as possible.

00:07:42:17 - 00:08:00:03
Marc Boom, M.D.
So you have 25 beds. You described obviously a lot of very key specialists and talented people there. In those 25, in any given time, how many people are in the ICU? I'm just trying to parse out a little bit more how you know, what you won the award for and exactly what you're doing so it can inspire some others.

00:08:00:05 - 00:08:21:09
Mark Boucot
When I started there, the ICU was closed and all of the equipment was draped with towels or sheets. Basically, the light hadn't been turned on for about 18 months leading up to this. I think we just decided that no matter what, this ICU needs to be open, it needs to be open for this community. And so we're going to figure out a way to make it work.

00:08:21:11 - 00:08:45:15
Mark Boucot
And, we took this pilot program to the health system and said, look, you know, hey, if we're able to partner with you, what that will also help us do is keep our patients local so that we don't have to transfer as many patients out, which would help the health system with overcrowding and very high centers, which is what we are all living through today.

00:08:45:18 - 00:09:10:16
Mark Boucot
We opened up the ICU. Basically, we had to make some investments in equipment, new IV pumps, made sure the beds, everything was working properly. And once we implemented the virtual ICU program with the health system, we found that it created an environment where the hospitalist felt much more safe and secure and supported to be able to admit more patients.

00:09:10:16 - 00:09:22:21
Mark Boucot
And therefore, it drove the census up quite a bit. So when we started, there was an ADC average daily census of two patients who were in the hospital on my first day and in

00:09:22:22 - 00:09:24:21
Marc Boom, M.D.
Hospital overall or in the ICU?

00:09:24:24 - 00:09:26:02
Mark Boucot
Yes, in the entire 25 bed hospital..

00:09:26:02 - 00:09:28:04
Marc Boom, M.D.
Okay. Yeah, that's a small

00:09:28:07 - 00:09:56:14
Mark Boucot
Yeah, there was it was pretty empty. And so now I would say a good 70 to 80 days a year we're at 100% occupancy. The ICU is always full now at this point. And, you know, we combined this implementation for virtual ICU, which is different than an EICU. And we combined it with a pretty rigorous performance improvement in our emergency department.

00:09:56:16 - 00:10:16:25
Mark Boucot
We've got our door to doc time down around ten minutes. And we've got our door to bed time within like four minutes. So basically when you come in, you register, you go right to a bed. And so that requires a pretty significant community of people that are working together to make sure that the rooms are turning over fast.

00:10:16:27 - 00:10:41:29
Mark Boucot
And we went from about 12,000 visits in the emergency department a year, five years ago. We're up now around 22,000 visits in that same emergency department. So obviously we're expanding. We're investing in the community and growing and developing. But we had to create the service that people wanted. And people do want convenience. They want they don't want long wait times in the emergency department.

00:10:42:00 - 00:10:55:26
Mark Boucot
I think that combined with the virtual ICU, meaning that they would then be admissions in a way to create the admissions into the facility, those two things combined were pretty significant change initiatives.

00:10:55:28 - 00:11:03:01
Marc Boom, M.D.
So you must have gotten really positive feedback from the community, I would imagine, in terms of that ability to stay local.

00:11:03:03 - 00:11:37:23
Mark Boucot
Oh my goodness. Yes. The community is rallied around the hospital. When we have events, we just had a ribbon cutting for a new building. Honestly, it was standing room only. The community has been wonderful and I think every like every community, our community just desire to have a great hospital and one that they could rely on. And I think that this program and our service and our] caring toward really wanting to just do the right thing and always be that that organization that would care for every patient, like your own family.

00:11:37:25 - 00:12:09:03
Mark Boucot
That is our North Star. So those things resonate with people. They resonate with the employees that work here and our reputation built. I didn't have to do a lot of advertising. It really happened by word of mouth, just by the fact that we were a different organization. And it's funny, Mark, I'll tell you, one of the things that was really interesting is just renovating and putting in new flooring and painting walls and making the place look different also created a lot of excitement in the community that they knew a new day was coming.

00:12:09:06 - 00:12:13:17
Mark Boucot
There was going to be care and investment back in the local hospital.

00:12:13:19 - 00:12:38:17
Marc Boom, M.D.
So this is really a win for everybody. The community loves it. The patients get really top notch care. The doctors there feel more comfortable taking care of somebody sicker, knowing they have probably pretty immediate back up to make decisions and manage critical patients. And it decompresses some of the referral center that. So when you do have somebody you need to move or other places need to move somebody because they still need that referral center, it's more likely to get them in there, I suspect.

00:12:38:17 - 00:12:41:05
Marc Boom, M.D.
So it's been a it's been a win on all rounds.

00:12:41:07 - 00:13:01:26
Mark Boucot
It's a win win all the way around. And I'll tell you, one of the one of the unique things is, is that our physicians, who were the hospitalist team, once they really started admitting patients and they started to feel more secure by having that safety net with a virtual ICU, because if the patient ever then decompensated, they could just go right into the virtual ICU.

00:13:01:26 - 00:13:25:04
Mark Boucot
They'd get additional help in a consult. Once that happened, it's interesting - there began to be mutual learning in both directions. And our health system is so awesome in that, there's a great deal of humility on both sides of our organizations that they actually learn some things from our hospitalists and our hospitals learned a lot from them.

00:13:25:04 - 00:13:34:15
Mark Boucot
So it was a great mutual learning opportunity and just a really wonderful partnership of working together in a really positive way.

00:13:34:17 - 00:13:52:18
Marc Boom, M.D.
Hospitals always, I think, are pillars in their community. But in a rural environment, when you have a hospital that the people can be proud of, I mean, they rally around and it's such a core part as an employer, as a caregiver, I mean, so critical to the United States that we have amazing rural hospitals like yours.

00:13:52:20 - 00:14:11:13
Mark Boucot
Oh, thank you for saying that. And I would say it's very important that we continue to support our rural hospitals and our local hospitals. This hospital, just by simply growing and having a Northstar of caring for patients and opening practices and bringing a lot of different specialists in. Again, that list I gave you is just a short list.

00:14:11:15 - 00:14:41:08
Mark Boucot
Those things are really important. Also for the economic engine of the community, this hospital created 300 jobs in the town of in Mineral County and in the town of Kaiser. So that we, you know, we have a bigger tax base. As an organization, we have come a long way. And I think this is an important part of the American Hospital Association with the work that the hospital association is doing to really help hospitals be strong and be healthy,

00:14:41:11 - 00:14:59:25
Mark Boucot
it's just amazing work. And like you said on the stage, it's God's work to make sure that we're caring for patients and that we're really doing the work that is healing and helping people. And so I've never actually worked a day in my life, to be honest with you, because I was doing what I was called to do in my life.

00:14:59:28 - 00:15:13:16
Marc Boom, M.D.
That's great. That's amazing. Well, you know, let me ask you this then, for the next aspiring rural hospital leader who wants to implement some of these, any lessons learned? And then what's next? I mean, where are you going next from an innovation standpoint?

00:15:13:18 - 00:15:33:21
Mark Boucot
Yeah. Thank you. I think from a lessons learned perspective, I think that one of the things that I would say for me is just making sure that I always approach things with an open heart and an open ear and an open mind, the way that I conceive things as a leader doesn't always mean that's the right way to do things.

00:15:33:23 - 00:15:58:27
Mark Boucot
We had some big lessons learned, I think, also around technology, what we expected for it to cost and what it had to be. No, actually, it didn't need to be like $1 million price tag on this. And we actually were able to implement this just by opening various portions of EPIC and then also utilizing simple tablets.

00:15:58:29 - 00:16:20:17
Mark Boucot
And I think that, you know, sometimes we think it's a much bigger obstacle to jump than it actually is. And I think once we believed we could do it, we could. There was nothing that could stop us. So I think as soon as we had the faith in ourselves and that we learned that we can do it.

00:16:20:20 - 00:16:46:10
Mark Boucot
We did do it and we did accomplish it. I think for our future, we're going to continue to grow the utilization of AI and to really try to keep the documentation work that's being done through AI and through a bridge. And the technology that we have today keeps that physicians much more happy and satisfied with their care, because they're really spending time with their patients now versus serving a computer.

00:16:46:13 - 00:16:57:19
Mark Boucot
I think that's been a wonderful thing for us. And I would say that making the investment in technology is really paramount to where to success in today's world.

00:16:57:21 - 00:17:15:15
Marc Boom, M.D.
You're working towards that NorthStar. You're seeing it as never working a day in your life. This is a very impressive program. I see 100% even more in detail now why you've won this award, and I think it's an inspiration in many other hospitals. So thank you for your time today. Thank you for your perspective and your commitment.

00:17:15:15 - 00:17:33:03
Marc Boom, M.D.
I really appreciate you being here. And as I close, I want to amplify a comment that I made at the Rural Conference. I was glad you were listening when you said the God's word part. And that's really we need to work together as hospital leaders to be defined not by the challenges we face, but instead by how we overcome them.

00:17:33:03 - 00:17:46:04
Marc Boom, M.D.
And that's precisely what you have done. And congratulations to you and you and your team. Thank you, everybody, for finding some time today to listen. We'll be back next month for another Leadership Dialog conversation. Thanks so much.

00:17:46:06 - 00:17:54:17
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 - 00:00:18:15
Tom Haederle
Welcome to Advancing Health. In the second of a two part conversation, we take a deeper dive into what hospitals and health systems can learn from an initiative from Georgia that's made tremendous progress in improving access to pediatric care closer to home.

00:00:18:18 - 00:00:46:15
Elisa Arespacochaga
Hi, I'm Elisa Arespacochaga from the American Hospital Association. And welcome back to part two of our conversation with Dr. Jean Sumner, dean of the Mercer University School of Medicine, and Marc Welsh from Children's Health Care of Atlanta. We're here talking about the partnership they have made to support health care in rural Georgia. We're going to dive a little bit deeper today on how they're supporting the care of today, the pipeline for the future, and some advice for you on how you might create one of these in your community.

00:00:46:17 - 00:01:13:17
Elisa Arespacochaga
Let me ask you, Marc, to then tell us a little bit about you guys have both hinted at the work that you're doing to build scholarships. We know that obviously supporting clinician training is amazing and absolutely necessary, but also takes time, right? You know, you don't grow a physician overnight. So can you tell me a little bit about how you've started prioritizing which of those roles you're focused on and how you're supplementing that pipeline of clinicians and again, that full team across rural areas.

00:01:18:21 - 00:01:45:01
Marc Welsh
There are a number of young people who are from rural communities who are receiving their medical education and are in many cases, the best candidates to return home to truly return home, to communities. And so we have in the pipeline right now 27 scholars. The first two will be in community this year. And so later this year, we will have our first two scholars who've completed residency and will return to rural communities to provide pediatric care.

00:01:45:03 - 00:02:05:07
Marc Welsh
And we're excited about that. I think this is what we look for in terms of a sustainable solution. When we thought about this at the beginning, it would have been easy for Children's to swoop into the community, do some work and then leave. And that community would have been, you know, better for it in the moment, but in the long run, that would not have created the change across the state that I think both myself and Doctor Sumner hoped to see. And so this opportunity presented us, this avenue for us to really build a sustainable workforce across the state. And these pediatricians will be exactly that. We started out with young people that were at all different years of their training, and that was a goal to accelerate how quickly we could get folks into community.

00:02:27:18 - 00:02:43:09
Marc Welsh
And now that pipeline is really strong, and we will introduce a next set of scholars in the coming months to continue that. So it's a really an exciting opportunity for us to ensure that those over 60 counties without a pediatrician will have one in the future.

00:02:43:12 - 00:03:09:19
Elisa Arespacochaga
That's amazing. Dr. Sumner, can you talk a little bit about the impact those scholarships have had on your classes and your students to be able to really accelerate that return back to to home? I know in so many states. The work that has really helped is when they've recruited from those rural areas to go back to those rural areas, because if you never lived there, it may be intimidating to move to a rural area.

00:03:09:21 - 00:03:36:09
Jean Sumner, M.D.
I think the scholarships are critically important, but I think it is even more important to pick the right student and then give the scholarship. You want a happy doctor, you want a doctor who feels called to that. I think there's no better job in the world in being a small town doctor. I spent my life there, and these young people that are carefully selected, interviewed by committee proved ... and we track them for years. They have opportunity through their school, through their years here to visit children's, develop alliances with subspecialists and people who may support them ten years from now, or who may be able to answer a call and have a relationship with them. So we give them incredible opportunities, but we pick the right student. The scholarship makes it possible because they very commonly come from people of lower socioeconomic status or lower income.

00:04:10:02 - 00:04:33:24
Jean Sumner, M.D.
The first one of the scholars this year, when he finishes, we'll go back to his home county that I believe never had a pediatrician -- and still doesn't. He will be the first pediatrician. So I think that that's the shining light. As time goes on, there's an army behind him that will come. And the second scholar that we named has not made up her mind finally, but I suspect she will be in an area of great need. But they commit willingly at something they won't. And all we do is try to make it easier for them.

00:04:43:15 - 00:05:06:11
Elisa Arespacochaga
I imagine that, yeah, they are. They want to see the community they grew up in just be better and have more access to care. And I love that connection. Marc, can you talk a little bit about what it's like for your clinicians at Children's to now have this network of folks that they are communicating with and supporting and being able to keep those kids not having to.

00:05:06:11 - 00:05:16:20
Elisa Arespacochaga
And I've driven in Atlanta traffic, man, I don't want to go back. So how do you keep those kids in their communities and keep that connection going and feeling supported there?

00:05:16:23 - 00:05:41:05
Marc Welsh
You know, I would say that the feedback here has been amazing. When we announced this work and began to share with our physicians across the system the excitement and energy and desire to participate and contribute to the work, was just overwhelming. And because I think for every one of our physicians, for every physician that goes, I would argue, into pediatrics, they go into it for a very specific reason. And that desire is purely to make an impact on the lives of kids, and for them to be able to be connected to impact communities across our state who otherwise are not having those resources, it fills their cup and it makes them better physicians. And they want to be connected to these young people who will return to community.

00:06:02:03 - 00:06:18:27
Marc Welsh
When those young people come to Children's for their rotations to learn, we have a long line of folks who want to engage them and want to be supportive of them. When we go to the Scholars Luncheon every year. It is the most amazing feeling to see those young people and to really energize us in the work that we do.

00:06:18:29 - 00:06:36:20
Marc Welsh
And so I will tell you that it has been a huge, huge win for us in respect to just morale amongst our physicians and employees, to know that we are committed to making this impact. And for us at Children's, it really allows us to fulfill our mission, ensuring that kids across the state have access to the best possible care.

00:06:36:22 - 00:06:52:15
Elisa Arespacochaga
I'm going to ask you both and Dr. Sumner, I'll start with you. The organizations that are listening to this aren't going to replicate exactly what you did, because they're not in your shoes, but they're going to hear something that's going to spark, a line of thought or a person they may not have thought to reach out to. So I'd ask, what advice would you have for an organization? In your case, Doctor Sumner, a medical school, and in your it a children's hospital. Subspecialty programs. What advice would you have for those listening if they want to create something like this?

00:07:08:27 - 00:07:32:18
Jean Sumner, M.D.
Well, first and foremost, understand the problem you're trying to solve. Understand the need. Understand the complexity of it if it's rural health, understand the complexity. It's not simple. And we say children are not little adults; well, rural communities aren't little cities. And there's a different it's a different place. People would come and they would run a clinic for three months and it was great and then they disappear, or they had a grant and they came and did research. And the community never heard from the research, but they see it written up somewhere. And so a lot of trust has been lost. And I honestly think part of that is academia, that we want them, that change the world. But we don't realize we're taking people who are human like us, and they want to be part of it, and they want to build trust with their providers.

00:07:57:00 - 00:08:17:21
Jean Sumner, M.D.
So we usually go when we go out to a community that has a need, we find out what they want, what they need, how can we help you and we say, "If we're going to commit to something in that community, you can't run us off unless you want us to leave. We're here. We'll find a way. We'll bring in partners to help."

00:08:17:23 - 00:08:41:04
Jean Sumner, M.D.
What we heard on all our counties is they have to have health care. They have to have care for their families because you don't have industry or economic development or education without good health care. So I would encourage anybody to do a little work in knowing the problem and knowing ... don't take the community as an equal part of that.

00:08:41:06 - 00:09:03:27
Jean Sumner, M.D.
This is an effort with Children's Healthcare Atlanta and Mercer University and then every county that we serve in a little different way, we're a little different in every county. We base it on need. They don't need something, we don't bring it to them. If they want something, we try to find it. Even if we can't provide it ourselves, we get a partner who can provide it.

00:09:03:29 - 00:09:31:08
Jean Sumner, M.D.
But having a physician in a rural community is important. Having colleagues who answer the phone at 2 a.m. when you've got a child dying in your E.R., is equally important. And it allows that young person to go there. Those communities want to have trust in their health system and yet many of them have lost trust. So it takes us time to convince them that we're there to stay.
And once we become true partners, the needle moves and that's the magic of it. We do what we say. We don't let them down. If we find that we can't do something, we tell them. But we value that third partner in this, and that is the community and being true to our word. So I would say, if you're the institution and you want to solve this problem, find out exactly what the problem is, understand it fully, go down and talk to the human beings you're going to be dealing with. Find out what they need, what their priorities are, and start there.

00:10:04:14 - 00:10:05:15
Elisa Arespacochaga
I love that. Marc?

00:10:05:17 - 00:10:26:27
Marc Welsh
Yeah, I mean Doctor Sumner said it so well, and I think I would sum that up for us is humility. I mean, it is the willingness to see folks who are collaborating as equal partners in advancing this work, of seeking to understand the needs of those communities and letting them guide you, letting them invite you in, and not assuming that you know better.

00:10:27:00 - 00:10:54:07
Marc Welsh
I think what I've learned more than anything else through this journey is that we have a lot of expertise here at children's, but there's a lot of things we can learn and have learned from our rural communities. From the way that, you know, health care has to be approached from what folks know on the ground. And so having that humility -- coupling that humility with trust and trust and empowerment of others to carry out the work. For us at Children's, we came into this with really two things: We said, "We want to lend our expertise and we want to lend the resources needed for this to work. But beyond that, we have to trust our partners to carry out the work that is important to them and entrust these communities to know what is best for their community." That is vitally important. We cannot look at these things through a city lens. I think we fail if we go into it with that mindset. And so I would implore anyone who's interested in this type of work to enter it with humility, to enter it with a desire to empower others to carry out what is best for their communities.

00:11:29:04 - 00:11:54:26
Elisa Arespacochaga
I love that this is about you have some expertise that can help support that community. let them guide you to what it is that they most need and how best to employ it. Well, thank you both for both the work that you've done and the humility and trust you brought to it. And I can't wait to hear about the hundreds of pediatricians across Georgia that will be serving in the next decade.

00:11:54:29 - 00:12:04:23
Jean Sumner, M.D.
I've worked in rural health my whole life, and I am so excited that if we can affect these families and these kids, we're going to have a healthier, rural Georgia.

00:12:04:25 - 00:12:13:06
Tom Haederle
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