Advancing Health Podcast

00:00:00:16 - 00:00:35:06
Tom Haederle
It's been about 17 months since the official end of the Covid 19 pandemic, but its effect on caregivers - stress, burnout, anxiety - remains. In Chicago, Northwestern Medicine has created a continuum of innovative mental health support programs that not only encourage its staff to seek out needed help, but also make a point of addressing the stigma that still holds too many caregivers back from taking care of themselves.

00:00:35:08 - 00:01:12:12
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle, with AHA communications. Creating mental health support resources is one thing. Getting people to take advantage of them can be an uphill climb. In today's podcast hosted by Rebecca Chickey, senior director of Behavioral Health Services with the AHA, and Emma Jellen, a former associate director with the American Psychiatric Association Foundation, we hear from Northwestern's chief wellness officer about how his organization raised awareness of access to its mental and behavioral health support services, and what other health systems can learn from Northwestern's example.

00:01:12:15 - 00:01:14:14
Tom Haederle
And now to Rebecca.

00:01:14:16 - 00:01:27:07
Rebecca Chickey
Thank you Tom. Indeed, it's a great honor to be here with Emma Jellen from the American Psychiatric Association Foundation and Dr. Gaurava Agarwal from Northwestern Medicine. Emma, I think you have the first question.

00:01:27:14 - 00:01:49:05
Emma Jellen
Yeah. Thanks so much, Rebecca, and thank you so much for having me here today. Dr. Agarwal, I wonder if you could just, talk a little bit about why and how Northwestern Medicine decided to build such a multifaceted offering of well-being programs and policies that really promote access to mental health care for your health care workforce.

00:01:49:07 - 00:02:08:29
Gaurava Agarwal, M.D.
I'd love to, Emma. Thank you, and thank you, Rebecca, for having me as well. You know, I think for those who don't know, I'm a psychiatrist, and I serve as our chief wellness executive in Northwestern Medicine. And as I took on these wellness roles, I initially sort of ran from focusing on the mental health aspects

00:02:09:01 - 00:02:31:29
Gaurava Agarwal, M.D.
related to wellness, to be honest with you. I really wanted people to understand that we were here to address some of the systemic issues that impact our well-being. And this was before the pandemic. And then as we sort of went through the pandemic, it was pretty clear that, A, some of the systemic issues, were going to have to be put on the backburner a little bit.

00:02:31:29 - 00:02:57:12
Gaurava Agarwal, M.D.
There was too much change going on. To be able to truly do other system redesign in the midst of a pandemic. And B, it was clear that we were seeing all the data that showed the mental health impacts of the pandemic on our health care workforce. And, we have tried to organize our wellbeing program to make sure that folks have resources at the sort of prevention level, you know, hopefully before they have issues.

00:02:57:14 - 00:03:29:00
Gaurava Agarwal, M.D.
But we realized we had to bulk up our resources available to individuals experiencing distress, due to the pandemic, things like burnout, trauma, etc.. And then we also needed to enhance our resources for folks whose distress had actually progressed on to actual mental health conditions such as depression, anxiety, post-traumatic stress disorder, etc.. That was really the genesis of, hey, how do we take a comprehensive look at making sure that the that our workforce has resources available to everyone of those levels?

00:03:29:03 - 00:03:51:02
Rebecca Chickey
I think the last time you and I met and talked, you had six or seven programs that were part of this multifaceted approach. Could you take a few minutes and maybe share with the listeners descriptions of one or two or three of the programs to give them a sense of the diversity and the different types of audiences that you're trying to meet their needs.

00:03:51:04 - 00:04:10:04
Gaurava Agarwal, M.D.
Sure. Happy to do so. And the reason we did that is what we have found is it's hard, even when we do things, it's hard for our workforce to tell us, oh, you guys did that? I didn't know about that. And for us, that is disappointing, of course because if we build them but they don't know about it, no one's going to be utilizing them.

00:04:10:04 - 00:04:32:05
Gaurava Agarwal, M.D.
And so we have tried to figure out what will increase the likelihood of our workforce knowing about things, so that they can use them. And, and for us, one of those things that helps us hopefully have greater penetration of awareness is having campaigns. Right? If we do one thing sometimes that can get lost in the shuffle.

00:04:32:05 - 00:04:55:19
Gaurava Agarwal, M.D.
And to your point, Rebecca, that one thing may be more applicable to one job family or another. When we do campaigns, we're able to have broader communications because maybe not everything will hit you, but at least some things will. And something will resonate or something will say, hey, this is something that I need. And so we said, if we're going to do this, let's, let's try to do a couple of these things at the same time

00:04:55:19 - 00:05:22:12
Gaurava Agarwal, M.D.
so we could truly launch a campaign and raise awareness about how the organization takes mental health seriously, and we support you seriously. So for us, again, using that rubric of wanting to bolster resources in the distress zone, we initially spent, time creating a peer support program. And that peer support program was initially for attending physicians.

00:05:22:15 - 00:05:48:22
Gaurava Agarwal, M.D.
And over time, that peer support program has increased to be available to our APPs, our nurses, our pharmacists and our residents and trainees. And so, as we saw the benefit of peer support and how it can help in someone's really acute time of need, we realized this is a great program for lots of different folks who may experience adverse events or medical errors or near misses at the bedside.

00:05:48:25 - 00:06:13:00
Gaurava Agarwal, M.D.
In addition, we expanded what peer support can support around. And so historically, these things are around those issues of adverse events or medical errors. But we wanted what we were seeing, particularly during the pandemic and frankly, unfortunately this continued, was incivility at the bedside. And so we created a trauma informed peer support program that supported around discrimination and bias at the bedside by patients and visitors.

00:06:13:05 - 00:06:43:28
Gaurava Agarwal, M.D.
And that was a big escalation. And that's, a program we call P2P Safer. You know, it's to provide a safer program, a safer environment for our health care workforce. In that same distress bucket w2e also launched coaching, particularly coaching around burnout, imposter phenomenon, etc., for our trainees, residents and fellows. And that program for us really provided many of the skills that I wish I had had as a resident and fellow.

00:06:43:29 - 00:07:04:11
Gaurava Agarwal, M.D.
You know, the medicine in some ways was the easy part. It's how do you continue to develop your professional identity, how do you balance your work and life in a different way? So that coaching program was something that we're really, really proud of. At the tertiary level, that final level where distress has progressed to disease, we took a nudge from other groups and said, hey, you know what?

00:07:04:11 - 00:07:36:12
Gaurava Agarwal, M.D.
EAP is not enough and you need to look at your EAPs. And so we did. And what we said is, hey, what do we know about how many sessions it takes to improve anxiety and depression. And so we increased, we picked a new EAP and we increased the number of visits our entire workforce would have by 33%, for any incident that they would have, which, to me and my specialty aligned better with how long it generally takes to feel better from mild to moderate depression.

00:07:36:14 - 00:08:01:29
Gaurava Agarwal, M.D.
We looked at the diversity of the therapists that were available to our workforce. Obviously when there is race concordance or ethnic concordance that can be a big increase in the desire for people to utilize the services that they feel understood or they feel like their therapist gives them. And we felt like, our prior vendor, we didn't feel like we had the diversity to offer our diverse workforce.

00:08:02:02 - 00:08:03:22
Gaurava Agarwal, M.D.
And so we enhanced that.

00:08:03:25 - 00:08:30:08
Rebecca Chickey
That's exceptional. I was just going to say, you truly offered the listeners what the definition is of multifaceted. Not only do you describe three different programs and approaches, but then within each program, customizing it to better meet the needs of the type of workforce and, and the diversity of our current workforce. So thank you. Emma, I think you have another question for him now.

00:08:30:10 - 00:09:00:19
Emma Jellen
Yeah. I mean, I was just going to say, wow. Like I've heard you talk about all the work you've done and the policies and systems changes you've made, to really create this culture of well-being and this campaign at Northwestern. But every time I hear it, I remain impressed. And I have to assume that perhaps a listener who has clicked on this podcast has a vested interest or is about to embark or has already embarked on this journey

00:09:00:21 - 00:09:23:19
Emma Jellen
as well. And perhaps after you listing all of the programs there, they might see this as a little bit daunting. But we know that you're not the first institution to do something like this, but we really hope you're not the last, right? So I wonder if you can share a little bit about the journey, where you started.

00:09:23:21 - 00:09:35:24
Emma Jellen
And, you know, maybe put people's minds at ease about the process or at least let them know what they're in for, just so we see more uptick and more implementation and adaptation of things that exist.

00:09:35:26 - 00:10:01:06
Gaurava Agarwal, M.D.
Yeah, I think that's a really good point. And I want to be clear. All these things sound like, you know, you had a master plan when you started, but, you know, we were just putting one foot in front of the other. And the peer support program started off as a single program in a single department. We have a Scholars of Wellness program, and one of our scholars, created a peer support program in the Ob-Gyn department of one of our hospitals.

00:10:01:07 - 00:10:21:12
Gaurava Agarwal, M.D.
That's where this started. And as we learned about the value that peer support can provide and how one would stand up a program in that one department, that one department turned into a hospital. And then as we figured out how you spread to a hospital, that one hospital turned into 11. And that was all for docs and then all the docs,

00:10:21:12 - 00:10:41:17
Gaurava Agarwal, M.D.
we understood what to do for the APPs. The APPs turned into the nurses, the nurses turned into the pharmacist, and the pharmacist turned into the trainees. And so I don't believe in sort of trying to do it all at once, because generally when I've tried to do that, I do nothing. And so I just we just try to continue to, to grow and provide as many resources we can.

00:10:41:20 - 00:11:10:09
Gaurava Agarwal, M.D.
One program that I didn't mention, earlier, that was a big part of this. And if you have to start somewhere, you know, we all have to sort of show utilization, an impact. And the truth is, we can build all this stuff, but people may not utilize it because they don't feel safe to utilize it because, historically, there has been A) stigma, and B) real repercussions for seeking out mental health care, for health care workers that are worried about licensure issues.

00:11:10:09 - 00:11:34:20
Gaurava Agarwal, M.D.
And so, we used the Dr. Lorna Breen Foundation audit toolkit to help change the language on our credentialing forms to make sure that there would be no stigma for seeking out mental health care. And that was in conjunction with the state of Illinois. Also changing, their verbiage on their licensure, because obviously you sort of have to do both.

00:11:34:20 - 00:11:54:03
Gaurava Agarwal, M.D.
Otherwise it's still important to do it locally. But when you have it both, that's when the research shows that our health care workers are more likely to utilize these sorts of resources. We made those changes incredibly easy in some ways. I don't like to say any change is easy, but it was easy in the sense that we had the playbook on how to do it.

00:11:54:06 - 00:12:19:08
Gaurava Agarwal, M.D.
And then we communicated it to folks to say, hey, we're, we're doing things and we're serious about this. And, I think that builds trust, so that the, the other stuff also can be heard in the vein of, hey, you know what? Now I can use that stuff. And so that's where I would say you should always start just because it'll be difficult to sustain other things if people don't feel like they can use the resources that you provide them.

00:12:19:08 - 00:12:47:22
Emma Jellen
So I've had the privilege and pleasure of working with you for about, I don't know, two and a half, almost three years now, longer than that with the center. But, two and a half, almost three years now on, the APA Foundation Center for Workplace Mental Health Frontline Connect initiative. And you know we recently released our toolkit Improving Mental Health Care for Clinicians: Leading Interventions for your Workforce, which you can find at Frontlineconnect.org.

00:12:47:24 - 00:13:24:10
Emma Jellen
But I wonder if you can share and speak to those folks who are like you, who are a leader at a hospital health system or a health care institution who are, you know, a chief wellness officer who are largely responsible for the mental health and well-being of their workforce. I wonder if you could speak to them and talk a little bit about what the toolkit we created together is, and how they can find value in it as they again embark or continue or, you know, this journey to really just increase access to mental health care for those who need it.

00:13:24:12 - 00:13:48:09
Gaurava Agarwal, M.D.
Absolutely. And, you know, it's been my pleasure to work on Frontline Connect. And what I would say is for me in the role I sit, we spent quite a bit of time, I would say over a decade, sort of saying what needs to happen, and why does it need to happen? Action needs to be taking around wellness and mental health for our workforce.

00:13:48:11 - 00:14:06:21
Gaurava Agarwal, M.D.
What I was looking for, and what sort of drew me to the project was how and what. I'm a coach. And so how and what are the questions I care about. What are people actually able to do in the real world? What are they already doing that they've stood up that's making a difference?

00:14:06:23 - 00:14:28:15
Gaurava Agarwal, M.D.
And that's what we try to do with this virtual video toolkit - I just didn't have time to read 300 pages, I just got to be honest with you. I wanted 15 minutes for someone to give me the seed of an idea of a program that they're using, because I can't - none of us, I think, can adopt a program just out of the box.

00:14:28:22 - 00:14:48:16
Gaurava Agarwal, M.D.
We all have our own cultures. We all have our own resources. We all have our own leadership. And so I don't need you to tell me every single detail because it's not going to matter to me. It won't work that way for me. I just need some of the basic ideas of what are sort of these programs that could address "X" problem?

00:14:48:18 - 00:15:18:07
Gaurava Agarwal, M.D.
And once I hear that, I can then take it through my lens and say, for us, we do have this need or actually, you know, we're doing okay on that thing, but if we have that need, how can I take the broad strokes of this program and apply it to my needs here at Northwestern? As you know, we identified the sort of exemplars across the country of people doing programs or having resources that were broadly available that we wanted people to know about, that we wanted to raise awareness about that.

00:15:18:07 - 00:15:39:14
Gaurava Agarwal, M.D.
We get a chance to help our colleagues show up about their programs. And they were really gracious in sharing their programs, how they launched it, some of the key learnings from their launches. And as we continue to record more and more of these video case studies, I found that, hey, you know what? Like, why can't we do four or five of these?

00:15:39:17 - 00:15:56:24
Gaurava Agarwal, M.D.
We're pretty close and we know something about a little bit about a lot of these. And so can we take that next step. And you've heard me talk about the influence of positive peer pressures. I can get competitive. And if I'm like, hey, this other health care system is doing this, why not us?

00:15:56:27 - 00:16:09:00
Gaurava Agarwal, M.D.
That fuels me. And, I believe that if, frankly, I use positive pressure on myself without knowing it. And in a nutshell, to do some of these social programs all at once in the campaign that I mentioned.

00:16:09:02 - 00:16:32:04
Rebecca Chickey
I so agree with you. I love the toolkit. I was honored to be present with the official launching of the toolkit and the fact that you can have digestible, inspirational knowledge transferred to you in a 5 to 10 minute video if they're even that long in some cases. It's just wonderful. And it is the environment that we live in now.

00:16:32:06 - 00:16:58:23
Rebecca Chickey
We are all fast paced and so bite sized learning is wonderful. Now the reason we're doing this podcast: bite sized learning. So as we bring the podcast to a close, this is always a challenging question so get ready. This is your Jeopardy question. If you had to pick, what are the three things that you want the listeners to really lock in on that you've said today, that you've shared today, you know, is it the toolkit that is a phenomenal resource to inspire?

00:16:58:25 - 00:17:06:24
Rebecca Chickey
Is it if you just start at one small unit, at one hospital, you can grow from there.

00:17:06:27 - 00:17:27:22
Gaurava Agarwal, M.D.
I think for me, the first one is sometimes what I hear is people say, I think we're doing alright on mental health. Okay, that's too broad to me. What do you mean by that? Which level of prevention are we talking about? Are we talking about prevention at that primary level? Are we talking about you have good amount of resources at that distress level?

00:17:27:25 - 00:17:52:21
Gaurava Agarwal, M.D.
Have you really checked to see if your folks in your workforce have good access to mental health care for mental health conditions? And how do you know? And so, really assessing current state and the spectrum of needs as it relates to wellness and mental health conditions, I think is important. Because what I think you might find is you are probably doing great in one of those buckets, maybe two of those buckets.

00:17:52:21 - 00:18:11:10
Gaurava Agarwal, M.D.
But I don't know that many people that are doing great in every single bucket and even us, there's still gaps for us. And so you have to know where you're at and where you really are sparse in your resources, because to me that's where you have, you know, the opportunity for the greatest impact. So that would be number one.

00:18:11:12 - 00:18:35:27
Gaurava Agarwal, M.D.
Number two, I'm biased, but I do hope the people look at Frontline Connect. There's a lot of people's good work there. And I believe in acceleration. And, I don't really believe that my brain needs to be that smart. I should be learning from the best of other people. And I think it'll accelerate your journey about the options out there and the places where you may be able to make a difference.

00:18:35:27 - 00:18:52:27
Gaurava Agarwal, M.D.
Even if after you do step one, you say, oh, I think I'm doing okay. Then if you see some of these and issues like, oh, you know what, I actually don't have any of those thing that may actually remind you to take a look at, you know, at the same you don't know what you don't know, you don't know what's out there.

00:18:52:29 - 00:19:12:19
Gaurava Agarwal, M.D.
And so it'll be hard to judge what are some of the gaps with that without looking at some of these best practices? Number three, I would say this is the time. What I failed to mention earlier is we had looked at changing our credentialing language five years ago, and I couldn't get it done. I couldn't figure out how to do it.

00:19:12:19 - 00:19:38:24
Gaurava Agarwal, M.D.
I couldn't really figure out who the players were. I don't know if it was top of mind for people. This is a different time. And so for those of you that have maybe tried some of this stuff in the past and it's been shot down or there's been blocks or barriers, timing is everything in change management. And so this is the time to take a look because what the disaster psychiatrist and psychologist will tell you is that it's not during the pandemic, it's not during a disaster that this stuff matters.

00:19:38:26 - 00:20:20:27
Gaurava Agarwal, M.D.
It's the aftermath where especially the folks that actually experienced and responded to disasters - in this case the pandemic - actually feel it. And long after society has moved on, the folks that actually responded, whether it's military or in our case the health care workforce, that's when these symptoms emerge. And so recovery is needed and potentially treatment is needed now. And so making sure that, you know, we don't get sort of seduced or trapped in this idea of, oh, the pandemic's long over, this is what we know about pandemic recovery or disaster recovery, I should say, is this is the time where those symptoms need to be, we need to be able to

00:20:20:27 - 00:20:25:19
Gaurava Agarwal, M.D.
look out for them and, aggressively provide the resources to treat them because they are treatable.

00:20:25:22 - 00:20:47:19
Rebecca Chickey
The time is now. If there is a sliver of a silver lining of the pandemic, I think it is that it really has opened people's eyes. It's reduced some of the stigma. And it's also focused on the true need for these services across the board, but particularly for our health care workforce who are on the front lines every single day.

00:20:47:21 - 00:21:08:14
Rebecca Chickey
So Dr. Gaurav Agarwal and Emma Jellen, thank you so much for being here today. And then for additional resources from the AHA, go to AHA.org/behavioral health. Thank you for your time and expertise and for the great work that you do each and every day. Gratitude.

00:21:08:16 - 00:21:16:26
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.

00:00:00:12 - 00:00:25:10
Tom Haederle
Chester County Hospital in suburban Philadelphia tells a story that most hospitals and health systems can relate to. It was clear to care providers that disparate outcomes for patients were driven by barriers to care, such as food insecurity and transportation issues. The outcomes gap was especially noticeable in its Ob-Gyn clinic, which serves uninsured and underinsured women, most of whom self-identify as Hispanic.

00:00:25:13 - 00:00:41:16
Tom Haederle
So the hospital, a member of Penn Medicine, took steps to close that gap. And it all began with dialog.

00:00:41:19 - 00:01:07:18
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In observance of National Hispanic Heritage Month, today's podcast, hosted by Julia Resnick, director of Strategic initiatives with the AHA, takes a look at how bilingual volunteers fanned out across Chester County Hospital's service area to hear firsthand how maternal and infant support services could be improved.

00:01:07:21 - 00:01:09:20
Tom Haederle
And now to Julia.

00:01:09:22 - 00:01:22:17
Julia Resnick
Jen, Katie, thank you so much for joining me today. For our listeners at home, I'd love to start by having each of you introduce yourselves. So can you talk a little bit about your professional background and your areas of interest and expertise?

00:01:22:19 - 00:01:48:00
Jennifer Cohen, M.D.
Sure. Thanks so much for having us on. Really appreciate the opportunity. So my name is Jen Cohen. I'm the medical director of the CHOP NICU in King of Prussia currently. And, previously, my role at Penn Medicine, Chester County, was the medical director of the NICU there, as well as medical director of the maternal child service line for quality and safety.

00:01:48:02 - 00:01:49:09
Julia Resnick
How about you, Katie?

00:01:49:12 - 00:02:07:16
Katie Costantini
Hi, Julia. Thank you so much for having us today. Like Dr. Cohen said, my name is Katie Costantini, and I am the director of maternal child services at Chester County Hospital. I am a nurse by background and I have had a variety of leadership and clinical roles in Penn Medicine over the last 20 years.

00:02:07:18 - 00:02:20:06
Julia Resnick
Wonderful. So tell me a little bit about Chester County Hospital and the community you serve. Particularly, what are some of the maternal health challenges, that your community experiences? Katie, why don't you start this one.

00:02:20:09 - 00:02:46:27
Katie Costantini
Sure. So at Chester County Hospital we are a 330-bed community hospital within Penn Medicine. So our hospital is located in southeastern Pennsylvania. We have a variety of service lines. Our maternal child service line takes care of women across the continuum. We have about 3000, a little over 3000 deliveries per year. Within our service line, we also have an Ob-Gyn clinic.

00:02:47:00 - 00:03:11:11
Katie Costantini
So our Ob-Gyn clinic serves the uninsured and underinsured women of Chester County. In our clinic, about 95% of those patients identify as Hispanic and are primarily Spanish speaking. These patients have a variety of challenges in obtaining health care. Their major challenges are related to transportation barriers as well as food insecurity.

00:03:11:13 - 00:03:22:06
Julia Resnick
And so then when you're looking at health disparities, both for the pregnant person and the infants, what kind of disparities and outcomes are you seeing for that population?

00:03:22:08 - 00:03:45:26
Katie Costantini
Some of the disparities that we've seen were a difference in our outcomes, specifically in our postpartum complication rates. So team was feeling that perhaps we had a difference in outcomes. Postpartum infection rates, increase in maternal morbidity and mortality in our Hispanic patients. And so we took an opportunity to go to the data and look at the data and the data confirmed that much.

00:03:45:28 - 00:03:58:00
Julia Resnick
And I know we've been seeing a lot of headlines recently about people not accessing prenatal care. And that's one of the reasons we're seeing some disparate outcomes. What are you seeing in your community?

00:03:58:02 - 00:04:19:25
Katie Costantini
We have an interdisciplinary team, many of which are bilingual, actually have developed great relationships with our community. That being said, our patients still struggle to sometimes get to their appointments, right? So some of those transportation barriers that I mentioned, it makes it hard for patients, you know, to schedule a month out when their next appointment is going to be and then to actually be able to go to that appointment.

00:04:19:27 - 00:04:22:02
Katie Costantini
So we still see that as a major barrier.

00:04:22:05 - 00:04:30:04
Julia Resnick
That takes us to your efforts on what you're doing to improve outcomes for those Hispanic moms and their babies. So can you talk about the initiative that you're working on?

00:04:30:07 - 00:04:58:17
Jennifer Cohen, M.D.
As Katie mentioned, we initially perceived through from our staff and our medical team that there perhaps was a difference in outcomes for our Hispanic population. And as part of Penn Medicine, one of our service line goals is to look at health equity and work on disparities across our health system. Really, locally, for us, we focused on our Hispanic population

00:04:58:17 - 00:05:24:09
Jennifer Cohen, M.D.
given that about over 20% of our births in our Hispanic population and in Chester County. It's a community that we are really dedicated to serving as well. So that really brought us back to the data where we saw that, in fact, there was some disparities in health outcomes when we look specifically at postpartum complications in our moms.

00:05:24:11 - 00:05:56:05
Jennifer Cohen, M.D.
And what that refers to is, things like postpartum infections as well as postpartum hemorrhage. Our first looked was to look at the data, and then our second pass was really to talk to our staff, including nurses, the medical team, social work, our interpreter services, and certainly all of our women's clinic team members. And what we recognized that we needed to do was really to start looking at our care model.

00:05:56:12 - 00:06:05:25
Jennifer Cohen, M.D.
And, of course, as important is really to go to the voice of the patient as well, and to make sure that we're understanding where the barriers might lie.

00:06:05:28 - 00:06:09:21
Julia Resnick
So once you started engaging your patients there, what did you learn from them?

00:06:09:24 - 00:06:49:24
Jennifer Cohen, M.D.
Our first challenge was really to determine how best to get to that voice. Given that there are some language challenges or some language barriers as well as cultural challenges. So that we could be sure to get honest and accurate answers from our families. So we recognized quickly that our need to engage our patient and family advocacy team, and we're able to partner really well with them so that we could leverage their relationship with families and patients to be able to get really, great truthful answers from our families.

00:06:49:26 - 00:07:21:05
Jennifer Cohen, M.D.
Our first step with that was to pair volunteers, English and bilingual volunteers, to go interview postpartum moms before discharge to find out from them if they experienced any barriers during their inpatient hospital stay and to review with them whether there were any concerns, whether it was, for medical care or cultural or any other challenges that they may have experienced.

00:07:21:08 - 00:07:50:13
Jennifer Cohen, M.D.
Those interviews were then followed up a week later with a phone call by the same volunteer team, really to continue that relationship with the patient, as well as to be able to review with them if they had been able to retain the information that was given to them at the time of discharge in terms of postpartum care and any concerns to look for in their postpartum recovery.

00:07:50:15 - 00:08:26:04
Jennifer Cohen, M.D.
We learned some really important information from those interviews and follow up calls. In the initial interviews that were performed with our volunteers, they reviewed with families and moms how much they retained from the medical information of what to look for, for postpartum concerns. And we found that about 14% of those families could not recall any of the information that was given to them at that time, which was certainly, you know, a concern that was raised for us.

00:08:26:04 - 00:08:46:12
Jennifer Cohen, M.D.
And we saw that big care gap, right there. Also interesting was, in our follow up calls in a week, we saw that number rise to 38% of families who could not recall any information that had been given to them. So that was a very loud signal to us that we need to really address those communication gaps.

00:08:46:15 - 00:09:15:09
Katie Costantini
One of the things I'll just add to what Jen shared is the final part of obtaining our patient feedback in this project was recognizing that when you're doing health equity work, you really need to meet patients where they are. And that's not within the four walls of our hospital, right. And so the decision was made to really get pull together a team, a bilingual team that could go out into some of our community churches and meet with some of our Hispanic patients in an area where, you know, they trust the community,

00:09:15:09 - 00:09:31:05
Katie Costantini
they trust the environment as the final step in obtaining meaningful feedback about how we were performing as a hospital and then what we could do to help improve care for the future for other families. And that was really meaningful, and I think really gave us the actionable items to put a program in place.

00:09:31:07 - 00:09:44:08
Julia Resnick
So you've gathered all this feedback from your providers, from your patients, from your community members, to all inform the programs that you're putting together. So can you tell me about the program and walk me through what it is and how it works?

00:09:44:11 - 00:10:02:28
Katie Costantini
So it's really a multifaceted program. There's multiple elements, some that we were able to put in place right away and others that it's been a journey to really put in place to help improve care for our patients. One of the first things we did was partner with the Chester County Food Bank to put a food pantry in place within the hospital, very close to the clinic.

00:10:03:00 - 00:10:36:21
Katie Costantini
So that way to address some of the food insecurity, when patients come in to their prenatal appointments, if they feel they're not able to access food for themselves or their family, we're able to extend them home from that appointment with a bag of food from that food pantry. We also expanded our in-person interpreter services, as well as added an on call interpreter for circumstances that come up, because one of the biggest "aha" moments for us in obtaining patient feedback was really the impact of having an in-person interpreter versus some type of other technology for interpretation.

00:10:36:21 - 00:10:59:08
Katie Costantini
So we expanded those hours. We also started offering prenatal tours to our Hispanic patients, so they have an opportunity to see the maternity floor and the department before they come in to have their baby, to help build that trust, because trust came up time and time again in doing these interviews. So to help kind of bridge that gap, we now offer prenatal tours.

00:10:59:08 - 00:11:18:20
Katie Costantini
They've been very successful. There are often patients out there touring the units with one of our bilingual volunteers. So it's someone that can speak to them in their own language. They feel comfortable, they can ask the questions. They can meet some of the staff members before they come in to have their baby. And then one of the other things we did was increase our social worker hours.

00:11:18:20 - 00:11:32:11
Katie Costantini
So we traditionally had one social worker covering the service, now we have two full time social workers to really help fill the gap, set up our patients across the continuum with more comprehensive services, not just during the time that they're here to deliver.

00:11:32:13 - 00:11:42:21
Julia Resnick
That's really wonderful. And Jen had talked about, you know, retaining information when they go home. Have you thought about how you're communicating differently with your patients so that those messages stick?

00:11:42:24 - 00:12:02:00
Katie Costantini
Yes. So a few things we've done. So we've made sure all of our educational materials are available in Spanish, making sure we're sending information home with patients that actually resonates with them. We also started changing our teaching style. So we learned a lot through this process. In the Hispanic culture it's not so much like a fact-based learning,

00:12:02:00 - 00:12:15:26
Katie Costantini
it's more of a storytelling and really incorporating the entire family. So, you know, patients shared with us that they were a lot more likely to listen to their mom or grandmother for advice than they were advice coming from a health care provider.

00:12:16:01 - 00:12:27:12
Julia Resnick
That's wonderful. Really think about how you engage the whole family and that whole circle of support. So it's not just, you know, mom who's responsible, but the whole family. Jen, anything else you want to add about the program?

00:12:27:15 - 00:12:47:24
Jennifer Cohen, M.D.
Katie alluded to one of the other signals that we saw was food insecurity, and we were able to address that directly with setting up a food pantry, partnering with the Chester County Food Bank. We have a little annex as well up in the NICU, of a food pantry that's a little more accessible to families with longer term stays there.

00:12:47:26 - 00:13:13:25
Jennifer Cohen, M.D.
And a project that we had started in the NICU, was a pilot of doing more comprehensive screening for social determinants of health and screening all of our families on admission to the NICU. What we saw is, as that project spread throughout the service line, is that our Hispanic population certainly has more food insecurity than we even had recognized initially in our first work.

00:13:13:27 - 00:13:32:24
Jennifer Cohen, M.D.
So that's something that we're currently able to, you know, really start addressing in in a deeper way. And we have been able to see some impacts in the stories that we've heard from our families, how having that access in a respectful and positive way to be able to help these families from day-to-day.

00:13:32:26 - 00:13:46:16
Julia Resnick
Wonderful. So let's talk a little more about impact. So you're doing all this really fantastic work thinking about how do you do wraparound services for your patients, but how are you measuring the impact? How do you know you're making progress?

00:13:46:18 - 00:14:18:05
Jennifer Cohen, M.D.
We have been tracking very carefully our postpartum outcome data and we have seen a really nice trend in a decrease of postpartum complications in our Hispanic maternal population. So from the start of our project where we saw a signal, compared to the rest of the population, we been able to see that decrease by more than half and been able to keep that sustained as well.

00:14:18:10 - 00:14:35:03
Jennifer Cohen, M.D.
What we have learned in a deeper way is the importance of looking at outcomes by ethnic and racial backgrounds to look for those disparities, because otherwise, if we don't look we won't see the signals and we won't be able to tease out the importance of focusing on a specific population.

00:14:35:04 - 00:14:49:23
Katie Costantini
The other thing I'll mention just to add to what Jen said, was the other way we know we are doing better is our patients are telling us. So patients who've been here before had a baby with us before are telling us there's a difference in how you're providing care and it has made an impact on us.

00:14:49:29 - 00:14:52:21
Katie Costantini
And we're telling our friends to come deliver it with you, too.

00:14:52:24 - 00:15:09:00
Julia Resnick
That is wonderful. I want to thank both of you for taking the time to tell us about this work. But mostly I want to thank you, Jen and Katie, for the work that you do every day to serve the patients in your community. Really making a difference. And I think this is one of those bright lights in the world of maternal health.

00:15:09:02 - 00:15:17:03
Julia Resnick
And we look forward to being able to share your story more widely with our members and the whole health care field at large. So thank you both so much.

00:15:17:05 - 00:15:18:17
Katie Costantini
Thank you so much for this opportunity.

00:15:18:22 - 00:15:20:23
Jennifer Cohen, M.D.
Yeah. Thanks so much.

00:15:20:25 - 00:15:29:06
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.

00:00:00:04 - 00:00:36:12
Tom Haederle
During the past several years, a growing number of hospitals and health systems have ramped up their diversity, equity, and inclusion efforts with focus and intentionality. While each organization charts its own unique DEI path, most of them, like New Jersey's Hackensack Meridian Health, have found that being able to track their effectiveness at the intersection of quality, patient safety, and health equity with measurable, reliable data is making a big difference.

00:00:36:14 - 00:01:09:22
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Hackensack Meridian Health's DEI effort has made good use of several important tools, including guidance provided by the AHA's Health Equity Roadmap. It's also developed advanced metric dashboards that allow it to precisely gauge what's working and what can be improved. We learn more in today's podcast hosted by Joy Lewis, senior vice president of health equity strategies and executive director of Institute for Diversity and Health Equity.

00:01:09:25 - 00:01:21:13
Tom Haederle
Joy is joined by two experts from Hackensack Meridian Health. Avonia Richardson Miller is senior vice president and chief diversity officer and Dr. Rajan Gurunathan is a vice president.

00:01:21:16 - 00:01:46:29
Joy Lewis
Why don't we talk about how you got started? How did your organization begin its health equity journey? Essentially with a leaning towards what prompted you to even want to launch this work, and maybe a little bit in your response about how you initially identified where there were gaps, where those inequities existed across patient populations in your system?

00:01:47:02 - 00:01:50:25
Avonia Richardson-Miller
Hello, Joy, and thank you so much for this opportunity.

00:01:50:28 - 00:02:20:16
Avonia Richardson-Miller
First, let me say that I am so proud of the strides that Hackensack Meridian Health has made through years to address health equity. I want to say we've been on this journey for some time. We continue to build on the great work that has happened historically across our organization. But what has changed is our degree of strategic focus and intentionality around this work.

00:02:20:19 - 00:03:08:14
Avonia Richardson-Miller
And I attribute that change to several things occurring, including some very key external factors. In 2020, unfortunately, as a nation, as a world, we witnessed the brutal murder of George Floyd while in police custody, playing out on television before our eyes, sparking a global movement that spanned 60 countries in seven continents. This was the largest racial justice movement since the civil rights movement. And this took place in the backdrop of Covid, a global pandemic that laid bare the critical health disparities existing in our marginalized and under-resourced and underrepresented communities.

00:03:08:16 - 00:03:44:06
Avonia Richardson-Miller
And Hackensack Meridian Health, located in New Jersey, which is one of the most diverse states in the nation - we were at the epicenter of this pandemic, right? In 2021, the CDC declares racism is a serious threat to public health. Also in 2021, 60 Minutes actually aired a special segment on race and health, and they were highlighting a research from Harvard University where the findings revealed that more than 200 Black Americans died each day because of the corrosive impact of racism.

00:03:44:07 - 00:04:07:21
Avonia Richardson-Miller
So all of this really resonated with our leadership, strengthening our commitment to make a difference and address health equity through living our mission. Our mission is to transform health care and be a leader of positive change. So here's just a few of the actions that was taken. One of the first things is that our CEO, Robert Garrett, signed the CEO Action Pledge.

00:04:07:26 - 00:04:32:10
Avonia Richardson-Miller
He joined over 2,500 CEOs across the nation. It's the largest business initiative that's focusing on advancing DEI. And then within HMH created the role of the chief diversity officer and elevated that reporting structure to be a direct report to himself, the CEO. So I'm proud to be the first to serve in that capacity. We were formerly diversity and inclusion.

00:04:32:14 - 00:04:57:28
Avonia Richardson-Miller
So our scope also expanded with that to include equity. And so we would then have leadership and oversight to drive a network level health equity strategy, which I will add was an area of opportunity that had been identified in the most recent AHA survey. With that we created first thing, an effective DEI governance structure with stakeholders from all across the organization.

00:04:58:03 - 00:05:26:18
Avonia Richardson-Miller
That included a committee that was focused on health equity and our collaboration with our quality team, which Dr. Gurunathan leads a great deal of that work. AHA at the time also launched the Equity Roadmap, and we had the privilege to collaborate with you to actually pilot the health equity transformation assessment. And we partnered through our flagship hospital, Hackensack University Medical Center.

00:05:26:25 - 00:05:32:10
Avonia Richardson-Miller
At that time, we were able to recognize the great value that that tool provides.

00:05:32:17 - 00:05:44:06
Joy Lewis
I guess I just wanted to interject and really call out those accelerators that you pointed to over the 2020, 2021, but also how mission aligned.

00:05:44:07 - 00:05:44:19
Avonia Richardson-Miller
Yes.

00:05:44:19 - 00:05:55:00
Joy Lewis
this work is right. Absolutely. And having the sponsorship from the highest levels within your health system that it's really that trifecta.

00:05:55:00 - 00:06:03:01
Joy Lewis
The combination of all of that that has probably been really instrumental. And then having the support from the association.

00:06:03:01 - 00:06:03:06
Avonia Richardson-Miller
Yeah.

00:06:03:13 - 00:06:16:11
Joy Lewis
With the development, I mean, you got in on the ground floor helping us to actually craft that assessment to benefit the field. So thanks again for that. But it sounds like it's really this multi-factor...you know,

00:06:16:17 - 00:06:17:08
Avonia Richardson-Miller
It is.

00:06:17:11 - 00:06:33:11
Avonia Richardson-Miller
Let me just say that it started even at the highest level of our organization at the level of our board. That's critical. So that is really where it starts. And then our CEO.. and really do believe that it has to be top down and bottom up, inclusive of everyone.

00:06:33:13 - 00:06:41:24
Joy Lewis
So Dr. Gurunathan, I guess I would ask, how has the strategy that Avonia just walked us through

00:06:41:29 - 00:07:05:21
Joy Lewis
How is that evolved over time? And maybe since quality is a key area, a cornerstone, and we are often talking about the intersection of quality, patient safety and health equity. How do you leverage data? I know our point of view at the AHA is that data is an important starting point. You need to know your organizational story as it pertains to the data.

00:07:05:23 - 00:07:26:16
Rajan Gurunathan, M.D.
Yeah, I think data has been a central issue for us for a couple of different reasons, right? So number one really is understanding that in this context of the DEI quality landscape, you need a lot of context. And so just one set of numbers without any context can really actually be off-putting in some ways. Right. And throw people sort of that general track.

00:07:26:16 - 00:07:56:18
Rajan Gurunathan, M.D.
Right. So one thing we accepted very early on from a data perspective is we needed some sort of governance and quality mechanism in the beginning to make sure that data was collected in a reasonable and appropriate way. And there was training and competency around some of the things that we wanted to capture. And then we also wanted to make sure that once that information came in, that we were able to use it, first off, to understand our populations, like you said, because many of our interventions are really organized around the needs of our sites and their communities.

00:07:56:25 - 00:08:22:22
Rajan Gurunathan, M.D.
So they're heavily influenced by demographics and they're heavily influenced by the community needs assessment framework of the social determinants of health. And so once we established let's get good data, right, then it was what type of data? And that data again started with just understanding who we're serving. And that really helped frame out a lot of our efforts because we realized, you know, as a network we're over 50% women in terms of patient mix.

00:08:22:24 - 00:08:43:24
Rajan Gurunathan, M.D.
We have several sites that are highly geriatric, and we have several pockets of real diverse language levels, and we have several pockets which are much more homogeneous, but means that it's even more critical that data framework of understanding who we are was really important. And the last piece I think that really helps make it actionable is to make it as self-service as possible.

00:08:43:26 - 00:09:09:20
Rajan Gurunathan, M.D.
And so we really were very intentional, as Avonia said, about figuring out how we could make our data platforms, which are cloud platforms, be able to stratify all of our information. So anything we want to be able to look at, we should be able to look at with this particular type of lens. And so as we build out our data platform, having that in there and having it self-service where any leader in their department could be able to click through their quality metrics and goals and be able to stratify them immediately and see their population.

00:09:09:27 - 00:09:16:03
Rajan Gurunathan, M.D.
That's been very powerful and helping promote what we want to work on, how you can follow it, and tools to do it.

00:09:16:06 - 00:09:40:10
Joy Lewis
No that makes sense. I think the ability to self-interrogate and slice and dice your data across what you just described gender, age, language preferences, race and ethnicity and all of those dimensions of diversity. And also looking at the social drivers of health. That's exactly the direction that we've got to take this work. You mentioned that you've made it self-service.

00:09:40:10 - 00:09:47:27
Joy Lewis
So does this mean you've created dashboards or some way to track and monitor the progress?

00:09:48:00 - 00:10:09:11
Rajan Gurunathan, M.D.
Yeah, absolutely. So we've created a series of dashboards actually. And so some of them are large scale dashboards which again let us look at the whole network, right. Demographics of the network, right. Race, ethnicity payer etc.. And then there's some specific ones that relate to cultural competence, right? To be able to look at that. And so how often are we properly documenting preferred language,

00:10:09:11 - 00:10:30:09
Rajan Gurunathan, M.D.
For example? How often are we offering interpreter services, documenting interpreter services in the right fashion, and how often are we providing discharge instructions, for example, or other materials in preferred language? So there's a set of cultural competence dashboards that are also very relevant. And lastly, I think, you know, the idea that we look at this as a care for all kind of initiative, right?

00:10:30:09 - 00:10:46:13
Rajan Gurunathan, M.D.
But at the same time, you can't ignore the fact that there are certain populations which in the literature are full of disparities. And so for us to have eyes on those populations of maternal health, behavioral health, pediatrics and cancer. And for those, I think it's looking at the process of care as well as the outcome.

00:10:46:15 - 00:10:55:24
Avonia Richardson-Miller
Dr. Gurunathan, maybe speak a little bit about the one link dashboard too, because that was a major advancement with us too, looking at health equity.

00:10:55:26 - 00:11:14:07
Rajan Gurunathan, M.D.
100%. And that was really driven by Avonia and several other high level leaders in our organization to be able to start bringing equity and safety into the same conversation. In terms of our event reporting system, we should be able to have the same visibility and the same lenses on those events, just as we do on other types of outcomes and goals.

00:11:14:11 - 00:11:30:15
Rajan Gurunathan, M.D.
And so again, we can now stratify our event reporting system with similar fashion. And so there's a lot of power in that, you know, both on the front end and the back end, right. So bringing all those data points together helps round out our view on where we need to improve and where are the gaps, as you were describing.

00:11:30:18 - 00:11:35:25
Joy Lewis
And creating that larger context. As you mentioned earlier.

00:11:35:28 - 00:12:03:20
Chris DeRienzo, M.D.
Thank you for tuning in to this episode of Safety Speaks, the podcast series dedicated to patient safety, brought to you by the American Hospital Association. I'm Dr. Chris DeRienzo, AHA’s chief physician executive and a champion of the AHA Patient Safety Initiative. AHA's Patient Safety Initiative is a collaborative, data driven effort that lifts up the voices of individual hospitals and health systems into the national patient safety conversation.

00:12:03:22 - 00:12:35:21
Chris DeRienzo, M.D.
We strive to catalyze and connect health care professionals like you across America in your efforts to innovate and improve, and to bolster public trust in hospitals and health systems by helping you share your successes. For more information and to join the 1,500 other hospitals already involved, visit aha.org/patientsafety or click on the link in the podcast description. Stay tuned to hear more about the incredible work of members of the AHA's Patient Safety Initiative.

00:12:35:23 - 00:12:42:17
Chris DeRienzo, M.D.
Remember - together, we can make health care safer for everyone.

00:12:42:19 - 00:13:04:22
Joy Lewis
Before I move back, Avonia, are you reporting out these data and your progress to internal stakeholders? How does it bubble up to the board level at the board table? And have you gone as far as sharing any of these data with your community partners as well? Just curious about that.

00:13:04:24 - 00:13:07:25
Avonia Richardson-Miller
Absolutely. It does get shared with the board

00:13:07:25 - 00:13:31:25
Avonia Richardson-Miller
and actually Dr. Gurunathan coordinates presents to the quality committee. And then we also have an executive DEI council that's chaired by our CEO has many stakeholders across the organization a part of that. So it's regularly reported out there as well. And then whenever we're speaking we may reference some of it not, you know, not our whole dashboard report, but certain things that we're speaking to.

00:13:31:25 - 00:13:33:26
Avonia Richardson-Miller
We may speak to some of that data there.

00:13:33:28 - 00:13:40:27
Joy Lewis
What a strong signal of support, though, to have your CEO as the chair of your DEI council.

00:13:40:27 - 00:13:43:24
Avonia Richardson-Miller
Absolutely. He is our biggest champion.

00:13:43:28 - 00:13:48:19
Joy Lewis
Yes. This is what you need. Okay. Over to you, Dr. Gurunathan.

00:13:48:21 - 00:14:11:14
Rajan Gurunathan, M.D.
No, I completely agree. And I think having that level of leadership, acceptance and accountability and the empowerment of the rest of us to operationalize that strategy has really allowed the organization, I think, to take this battleship in an ocean kind of issue. I think, you know, really with a lot of steam. So I think, to the point that Avonia was making about all the way, you know, the governance structure and the data, certainly it goes all the way to the board.

00:14:11:15 - 00:14:31:26
Rajan Gurunathan, M.D.
And what I especially like is that we've been able to align all of it, right? And so it's not just random data at random meetings. It's information about the same kinds of things. It's information about the same kinds of populations that we're interested in. Information about the same processes of care around cultural competence and communication with patients in the same way.

00:14:31:28 - 00:14:44:03
Rajan Gurunathan, M.D.
So I think what's been especially valuable for me in this is, is seeing how when you stack all those things together, that you can actually move the needle, and it doesn't seem so much like a series of one-offs.

00:14:44:05 - 00:15:05:16
Avonia Richardson-Miller
I think to what Dr. Gurunathan was saying, what the beauty of it is it's not the check the box of the extra thing that we need to do to say that we're doing health equity, right. Our aim is that it's the lens by which we approach all things. And also the fact that it's everybody's work and everybody has accountability for this.

00:15:05:21 - 00:15:12:18
Avonia Richardson-Miller
Whatever role you have in an organization, whatever department, there is a DEI lens on it, too.

00:15:12:20 - 00:15:19:05
Joy Lewis
Sounds consistent with the way we think about it at the AHA both on the clinical side and the operational side.

00:15:19:06 - 00:15:20:14
Avonia Richardson-Miller
Absolutely.

00:15:20:19 - 00:15:27:02
Joy Lewis
Because to your point, everyone should begin to see him or herself as an equity influencer from wherever they sit.

00:15:27:05 - 00:15:27:24
Avonia Richardson-Miller
Absolutely.

00:15:27:27 - 00:15:38:22
Joy Lewis
Inspire others to take action and to really coalesce around that, that North Star, which is equitable care, safe care for all.

00:15:38:24 - 00:16:04:26
Joy Lewis
We didn't talk much about the role of community and how you're collaborating with your community partners to ensure that whatever the solutions are that you're developing are being done in a collaborative, very intentional way. I think that's amiss, Dr. Gurunathan, when you said the secret sauce, you know, you just described, I think another component of that secret sauce is the collaboration with the community.

00:16:04:28 - 00:16:34:28
Avonia Richardson-Miller
Absolutely. And so we have defined at the highest level four pillars to drive our efforts for DEI and health equity. Number one: being focus on patient care and outcomes. Number two: on community. Number three: on our workforce, right? We want to make sure representation matters. And then supplier diversity is a fourth one. And that one because that drives jobs.

00:16:35:01 - 00:16:59:23
Avonia Richardson-Miller
That drives wealth. That drives sustainable communities. And that's just the four high level buckets. We are doing some work in the space of community and for example, our community health needs assessment. The most recent one that was done has been done completely through the lens of health equity. And then our social determinants of health space, where Dr. Nicole Harris-Hollingsworth leads this area -

00:17:00:00 - 00:17:20:23
Avonia Richardson-Miller
over 4 million screenings have been conducted. Five million referrals. And what has been incorporated now is the closed loop reporting for that system. And so those are referrals that are going out to agencies that are aligned with the type of work that we do. And that's driving where some of our focus is around those community collaborations.

00:17:20:25 - 00:17:46:18
Rajan Gurunathan, M.D.
I would look at those community aspects again with two sort of buckets. Right? I think certainly the community needs assessment helps frame out our data context in a particular way, right. Because it establishes links between the services and the services provided and needed. And I think also we've got a robust network of community health workers that actually partner with us, who are actively out in the community and engaged not only with our patients, but with, you know, patients that don't even follow with us.

00:17:46:20 - 00:18:04:00
Joy Lewis
That's right. We're learning more and more about the value of the role of the community health worker as a real, integral part of the care team. Are there any final thoughts you want to leave with our audience today? Because I've been inspired by the good work that you're leading on the ground there in New Jersey.

00:18:04:03 - 00:18:11:29
Avonia Richardson-Miller
I think it's important to just know that you have to start the work and you start wherever you are.

00:18:12:00 - 00:18:44:19
Avonia Richardson-Miller
That's where you start. Your journey is going to be unique to you in your system, right? We're all at different places on this journey and across different domains and areas. And the engagement of others, and also understanding that this work cannot be done alone, and definitely not by any one particular department. And so for us in 2021, we started as basic in one of the areas, as far as doing training around how to collect real and social data.

00:18:44:21 - 00:19:08:18
Avonia Richardson-Miller
But in the short amount of time, Dr. Gurunathan has really described where we've come along that continuum with data, because I believe in our baseline assessments of the HETA we were exploring, we fell in the category of exploring consistent with where most of our hospitals are. So yeah, you're not alone. But now we are far beyond that to get mission accreditation in a very short time.

00:19:08:18 - 00:19:09:27
Joy Lewis
Yes. So it's doable.

00:19:10:01 - 00:19:13:02
Avonia Richardson-Miller
And that's due to partnership with our IT department.

00:19:13:05 - 00:19:15:19
Joy Lewis
Great. And you Dr. Gurunathan.

00:19:15:21 - 00:19:35:16
Rajan Gurunathan, M.D.
Yeah, I think Avonia said it very well. I think you know my three words or three lines of advice - hashtags would be, you know, just start for sure. I think that's just, you know, the number one. I think the idea of being collaborative, as Avonia mentioned, because it affects all aspects of the organization. And then lastly, be intentional because you don't have to cut it off all at once.

00:19:35:16 - 00:19:40:27
Rajan Gurunathan, M.D.
And then I think, just figure out what's important to you and the people you serve. And there's clearly room for gains.

00:19:41:00 - 00:19:45:00
Joy Lewis
Excellent. So thank you, thank you, thank you for being here.

00:19:45:02 - 00:19:46:09
Avonia Richardson-Miller
Joy, can I add one more thing?

00:19:46:09 - 00:19:47:01
Joy Lewis
Sure.

00:19:47:03 - 00:20:02:13
Avonia Richardson-Miller
Don't think that you have to reinvent the wheel. Use the resources that are out there. Yes. And I'm talking about the Equity Roadmap. And then all of the resources that Joint Commission has also identified.

00:20:02:15 - 00:20:10:23
Joy Lewis
I think you're spot on. That's one of our key lessons that we want to leave with our audience is you don't have to feel like you're alone in this.

00:20:10:25 - 00:20:32:21
Joy Lewis
There are others who you can beg, borrow and steal from. The AHA has done a lot of the heavy lifting for you, so please, this is a member benefit, frankly. So why not lean into the Health Equity Roadmap and other tools and resources that might be there at your disposal from, as you mentioned, Avonia to the Joint Commission and other spaces.

00:20:32:21 - 00:20:35:25
Joy Lewis
So thank you again and keep up the good work.

00:20:36:01 - 00:20:41:03
Avonia Richardson-Miller
Thank you. And you too, because we are, as you say, borrow, steal. We're doing that from AHA.

00:20:41:05 - 00:20:43:08
Joy Lewis
We're in this together.

00:20:43:10 - 00:20:43:28
Avonia Richardson-Miller
Thank you.

00:20:44:00 - 00:20:44:10
Rajan Gurunathan, M.D.
Thank you.

00:20:44:12 - 00:20:45:24
Joy Lewis
Take care.

00:20:45:27 - 00:20:54:07
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.

00:00:00:05 - 00:00:28:06
Tom Haederle
Every parent wants their child to be healthy. But that is not always the case. Some kids are considered to have medical complexity, multiple conditions that require a lot of health care. Meeting the needs of those kids and their families can be challenging, especially when trying to coordinate care between several providers and specialists.

00:00:28:08 - 00:00:47:28
Tom Haederle
Welcome to another episode of Caring for Our Kids, a limited podcast series from Advancing Health. I'm Tom Haederle with AHA communications. Today you'll hear how Children's Hospital Colorado has designed team-based, coordinated care to make care seamless for medically complex kids and their families.

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SFX
Children playing

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SFX
Children talking

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SFX
Children talking

00:00:54:07 - 00:01:17:10
Julia Resnick
Having a child is an act of optimism. We go into parenthood with the highest expectations. We imagine them running, jumping. And above all else, we hope that our kids will be born healthy so that they can fulfill all the dreams we have for them. But that dream is not the reality for many families that have children with special medical needs.

00:01:17:12 - 00:01:44:12
Julia Resnick
19% of kids living in the United States, more than 14 million children total, have health care needs that require specialized care. That is where pediatric hospitals come in. The U.S. has over 200 pediatric hospitals that are dedicated to advancing the health of the nation's 73-million children. Welcome to Caring for Our kids. I'm Julia Resnick, director of strategic initiatives at the American Hospital Association.

00:01:44:14 - 00:02:11:25
Julia Resnick
In today's episode, we're focusing on caring for children with medical complexity. About 1% of kids are considered to have medical complexity, which means they have multiple severe chronic health conditions resulting in significant health service needs, functional limitations and high health care use. Caregivers of kids with medical complexity often struggle with the fragmentation of their children's medical services. Children's Colorado is aiming to change that.

00:02:11:28 - 00:02:39:19
Julia Resnick
They are dedicated to making care seamless and coordinated for medically complex kids and their families through their multidisciplinary clinic located at the Anschutz Medical Campus in Aurora, Colorado. To learn more, I spoke with two leaders from Children's Colorado. Suzy Jaeger is the chief patient experience and access officer. She was joined by Dr. Glenn Furuta, a pediatric gastroenterologist who serves as the section head of pediatric gastroenterology and hepatology.

00:02:39:21 - 00:02:41:07
Julia Resnick
Here's Suzy.

00:02:41:10 - 00:03:05:05
Suzy Jaeger
We opened our multidisciplinary clinic back in 2015, and this was after we had conducted an exhaustive search around the country, working with other children's hospitals and adult hospitals and trying to figure out what is the best way to care for highly complex patients in a multidisciplinary setting, especially patients who travel a long distance to visit with us and then go back to their own communities.

00:03:05:05 - 00:03:26:11
Suzy Jaeger
How can we provide that array of services in a way that's convenient for families? That we are able to provide them with timely access to care, and certainly the latest cutting edge type of care that's based upon evidence-based research. So, we settled on the model that we have in place today. It's about a 24,000 square foot clinic facility.

00:03:26:13 - 00:03:50:00
Suzy Jaeger
It includes 26 exam rooms and ten consult rooms. It also includes two large provider teamwork areas, where there are more than 20 workstations in each of those areas, so accommodates a large number of staff. We also have two observation and evaluation rooms. We provide a really nice family lounge to families. They're here for a long time. When they're here for a visit, and it's usually a full day, if not more.

00:03:50:07 - 00:04:14:02
Suzy Jaeger
And so we provide some space for them to get away from the clinical setting and relax and be with their families. They also can use that space to interact with other families who are there for similar reasons. And then of course because we're a children's hospital, we have to include play areas. So there's three really nice play areas for kids to be able to utilize, not just our patients, but the siblings that often times will travel with patients for this type of care.

00:04:14:04 - 00:04:33:08
Suzy Jaeger
So we really designed this space around trying to provide an optimal way to coordinate care for children that have complex needs. We have 78 different multidisciplinary clinics that currently meet in that space, and in 2023, we provided care to more than 12,500 patients and their families.

00:04:33:10 - 00:04:35:07
Julia Resnick
Here's Dr. Faruta

00:04:35:10 - 00:05:15:27
Glenn Furuta, M.D.
2006 I imagined in Boston that we really needed to do better, and how can we take better care of our patients who have a group of diseases called eosinophilic GI diseases? And those patients suffer from not only intestinal inflammation  with allergic problems, but food allergies, and they have feeding problems and nutritional problems. If you can imagine someone would need to come in and out to different offices over a number of different visits, 8 to 10 visits, and then have probably more importantly, all of those providers communicate to establish a centralized plan to help take care of that,

00:05:15:27 - 00:05:45:16
Glenn Furuta, M.D.
that's challenging. And so when I met with Suzy and others here at the hospital, I was like, this is what I would like to do. And they're like, well, guess what? We're doing that right now. And we have been able to care for patients from 40 states, from four different countries now who come here to receive that kind of care where we can really have an immediate discussion to share the expertise in providing the best care that we can.

00:05:45:18 - 00:05:49:22
Jill Tappert
Do you want to try to say that again more clearly, or do you want me to repeat after you?

00:05:49:24 - 00:05:50:21
Abigail Tappert
After me.

00:05:50:23 - 00:05:51:12
Jill Tappert
Yeah. You sure?

00:05:51:16 - 00:05:52:25
Abigail Tappert
I sure.

00:05:52:27 - 00:06:05:29
Julia Resnick
This is Abigail Tappert and her mom, Jill. Abigail is now 20 years old with complex medical needs. She's a patient at the multidisciplinary clinic at Children's Colorado. Here's Jill, Abigail's mom.

00:06:06:01 - 00:06:21:17
Jill Tappert
Abigail's voice sometimes is harder to understand than others. She wants me to repeat what she said. So Abigail said that she is humorous, courageous, adventurous, and mischievous.

00:06:21:19 - 00:06:30:06
Abigail Tappert
I like to do Pokémon Go walks and drives with Geneva and Mom.

00:06:30:09 - 00:06:35:24
Jill Tappert
I like to do Pokémon Go walks and drives with Geneva and Mom.

00:06:39:18 - 00:06:44:02
Abigail Tappert
I wish everybody had a chance to go to Children’s.

00:06:44:04 - 00:07:07:00
Jill Tappert
I wish everybody had a chance to go to Children's. We are family of four from Boulder. So we're fortunate to be able to have just a one hour drive to receive care at Children's Colorado. We've known since Abigail was very young, certainly before grade school, that she didn't seem the same as her peers with autism. There was another layer, but we didn't have the words, we didn't have the vocabulary.

00:07:07:03 - 00:07:27:01
Jill Tappert
And then when she was a young teen, her medical status deteriorated. And at the time, we didn't know why. And there were a lot of things happening all at one time. In the beginning of that time period, we had trouble getting the care she needed. No one knew what was going on. No one could see the big picture except me, and I didn't necessarily have all the words in the vocabulary.

00:07:27:03 - 00:07:46:27
Jill Tappert
And then Abigail got into the special care clinic here at Children's, and I do not think it's exaggerating to say it was literally life saving. Got a pediatrician at a very high level who was looking at me with all of this - at all the symptoms that were crossing a whole bunch of different disciplines and needed to be looked at together.

00:07:46:29 - 00:08:09:17
Jill Tappert
And then she got all of those different specialties, all those different doctors literally in one room. I'll tell you from the patient care perspective, it made all the difference. One of the things that was happening was dysphasia or difficulty swallowing, and that got Abigail to see Dr. Furuta and the diagnosed with eosinophilic esophagitis. It's quite a mouthful, EOE.

00:08:09:19 - 00:08:33:17
Jill Tappert
And then ultimately to be seen in the GEDP multidisciplinary clinic. After her EOE was in remission, she still had a number of symptoms throughout the day, all day. The dysphagia, the difficulty swallowing. And by bringing in those other specialties, the allergist recommended just a regular plain old over-the-counter allergy medication when those symptoms were spiking in the spring and fall.

00:08:33:19 - 00:08:58:05
Jill Tappert
Those additional eyes looking at it from a different perspective - that made a significant difference. Along the same lines, having access to a nutritionist and feeding specialist have also made a big difference, both in safety and in her overall nutrition. That pediatrician at the top of that, at the top of the triangle with me trying to see the big picture connecting dots as she always was, was well, have you looked at this yet?

00:08:58:07 - 00:09:25:25
Jill Tappert
No, we hadn't. And we pursued a new possibility. And it turned out Abby does have something called POTS: positional orthostatic tachycardia syndrome, which in her case is relatively simple to treat. And when we figured that out and started treating that, Abigail's migraines went away. And that had not been simple to treat. And there's no way we would have figured that out without someone who was doing that team approach,

00:09:25:27 - 00:09:32:06
Jill Tappert
looking at all of the things across the different specialties and troubleshooting right beside me.

00:09:32:09 - 00:09:58:01
Julia Resnick
All kids deserve the best care, and Children's Colorado has made the investment in designing a system that can meet the needs of even the most medically complex children. By co-locating specialists and building a culture of team-based care, they're improving outcomes and the patient experience for the children and families they serve. Since Doctor Furuta and Suzy have been there from the start, they shed light onto what it takes to get a clinic like this off the ground.

00:09:58:04 - 00:10:24:11
Glenn Furuta, M.D.
Every other month, someone comes from somewhere else to visit us to see what we do and how we do it. Before they come, I always tell them, make sure you've had a conversation with your institution because what you're going to see it's...it's really fantastic, but it's going to require some infrastructure and dedication. One of the things that I thought about when we were starting this was you need to have institutional commitment and you need to have leadership.

00:10:24:13 - 00:10:57:15
Glenn Furuta, M.D.
And those two things together really will help make this happen. It's just kind of dreamlike, to be honest, because it's exactly what I've always thought about wanting to do, to make sure that we could serve patients in a way that they had the expertise present and available, that the providers themselves were able to feel fulfilled in what they're doing in a way they had not been able to do before, that we're able to have that immediate impact but then also create some really innovative research studies that can be impactful afterwards also.

00:10:57:15 - 00:11:08:22
Glenn Furuta, M.D.
So it's not just the four walls of Children's. We want to spread care outside of here, too, in a way that's going to be impactful other places. It's yeah, exactly what I had always wanted to do.

00:11:08:24 - 00:11:31:09
Suzy Jaeger
If you think about this from a patient family perspective, it's so much better. The outcomes are so much better. The costs are reduced. The amount of time that they have to spend in the hospital is reduced. It provides the primary care physician who's going to be responsible for this child once they return home with the comprehensive plan, detailed information about the results of the consult and the next steps and so forth.

00:11:31:09 - 00:11:53:03
Suzy Jaeger
So, I mean, it's the kind of program that may not make the most sense financially, but from the perspective of patient family experience, it clearly is the right approach to take. And it also requires, you know, a big commitment, 24,000 square feet. We wish we had more space. We're lucky we have 24,000. We're making, good use of every inch of that space.

00:11:53:03 - 00:12:16:00
Suzy Jaeger
But that's a big commitment of space within our facility to, dedicate to this type of care. But we think it's the right thing to do, and we continue to hear from patients and families and their providers out in the community how much they appreciate and value the service, so that's our guiding light. And, that is what will keep us committed to continuing to provide these types of services well into the future.

00:12:16:02 - 00:12:41:29
Julia Resnick
Thank you to Suzy Jaeger and Dr. Glenn Furuta for your efforts to provide the highest quality team-based care for medically complex kids. And to Abigail and Jill Tappert, so appreciate you sharing your family's story with us. AHA's growing library of resources on child and adolescent health can be found at aha.org/mch.

00:12:42:01 - 00:12:50:13
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.

00:00:00:13 - 00:00:24:06
Tom Haederle
Improving patient safety is every caregiver's concern. While each hospital customizes its patient safety efforts and strategies to best meet the needs of the patients and communities it serves, certain practices hold promise to help just about everyone.

00:00:24:09 - 00:01:00:04
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this month's Leadership Dialogue series podcast hosted by Dr. Joanne Conroy, CEO and president of Dartmouth Health and 2024 board chair of the American Hospital Association, we hear from Dr. Steven Diaz, chief medical officer at MaineGeneral Health in Augusta and an AHA board member, about how things like accountability, prioritizing teamwork, overcoming barriers and using artificial intelligence are helping to deliver quality care that is safer than ever.

00:01:00:07 - 00:01:01:21
Tom Haederle
Let's join them.

00:01:01:24 - 00:01:34:25
Joanne Conroy, M.D.
Thank you for joining us today for another AHA Leadership Dialogue discussion. It's great to be with you. I'm Joanne Conroy, CEO and president of Dartmouth Health and the current chair of the American Hospital Association Board of Trustees. You can tell that I have some laryngitis, but I am delighted that I don't have to do a lot of the talking because I'm going to be joined by Dr. Steve Diaz, who is chief medical officer of MaineGeneral Health.

00:01:34:27 - 00:02:20:11
Joanne Conroy, M.D.
MaineGeneral Health is a comprehensive, nonprofit health system located in Augusta, Maine. And in addition to serving as chief medical officer, Steve is an emergency medicine physician by training and is deeply involved in many of MaineGeneral's health care quality and safety initiatives. Earlier this month, the AHA released a new report showing that hospital and health system performance on key patient safety and quality measures was better in the first quarter of 2024 than it was before the COVID-19 pandemic, and that hospitals made these improvements while caring for patients with more significant health care needs.

00:02:20:13 - 00:02:52:18
Joanne Conroy, M.D.
Last year, the AHA launched a national initiative to reaffirm our leadership and commitment to patient safety. AHA's Patient Safety Initiative is guided by a clinical advisory panel and a strategic advisory group. They focus on reducing patient harms, increasing health equity, and improving public trust. But before we jump into our discussion and my questions, Steve, our audience really wants to know about our speakers.

00:02:52:19 - 00:03:02:23
Joanne Conroy, M.D.
So can you share some information about your background and how you got to MaineGeneral, and how that's affected your approach to patient safety?

00:03:02:25 - 00:03:22:13
Steven Diaz, M.D.
Thank you. Joanne. Glad to join you today. I started in healthcare prior to medical school. I was an EMS at work in Sacramento, Sacramento Ambulance and decided I would take the plunge going to medical school. And I, growing up in California, I decided to have an East Coast experience. I went to Cornell New York hospital

00:03:22:15 - 00:03:45:26
Steven Diaz, M.D.
thinking after that, I go back to California. I was somewhat wayward, took a year off and taught there, and then decided to do family medicine training to start with and would go to a rural area -  again, to grow up and figure out what I wanted to do for my life. So I said that I would go to Maine for three years 31 years ago. Finished my training and then went into emergency medicine and grandfathered into that a long time ago.

00:03:45:28 - 00:04:19:01
Steven Diaz, M.D.
And then became involved in disaster EMS and emergency medicine on my way to becoming an administrator for MaineGeneral. It's interesting. I think prior to medical school, having that EMS experience was key. We worked in teams. We've always thought we worked in teams, we've really strived to work in teams. And I see the thing that I focused on at MaineGeneral is flattening the hierarchy and moving things so that we're all taking care of patients in a coordinated fashion rather than everybody having a different care plan, if you will.

00:04:19:04 - 00:04:38:21
Joanne Conroy, M.D.
So, Steve and I share an affection for the state of Maine. My family grew up in rural Maine. But why patient safety? Because emergency medicine...you know, you can take many paths after training in that specialty. But why was safety such a passion for you?

00:04:38:23 - 00:05:03:13
Steven Diaz, M.D.
Safety is such as a passion because in emergency medicine, the times that we get involved in high acuity situations, it's not as common as taking care of amateur sense of conditions or even intermediate medical conditions. Because of that, when we do critical care in emergency medicine, it's not the most common thing we do. With our central line intubations, using vasoactive drugs or other things that are very aggressive

00:05:03:20 - 00:05:25:05
Steven Diaz, M.D.
you have to be sure that the whole team is ready for that. Today, of course, we all have, you know, care bundles and team practice in Stemi care, sepsis, stroke and trauma  - all the time sensitive conditions. But that was not the way it was 30 years ago. One of the roles I had early in my career here in Maine was I was the medical director for Maine Emergency Medical Services,

00:05:25:07 - 00:05:46:16
Steven Diaz, M.D.
so the state medical director. And we worked to have state protocols for Stemicare for ER to cath lab. We work to have state protocols for stroke care. Prior to my time there, we had state protocols for trauma care. And now sepsis care. Again having state protocols or state initiatives that starts with  EMS will hopefully change that curve as well.

00:05:46:18 - 00:05:59:11
Steven Diaz, M.D.
So it appealed to me because you have to plan for it. You have to have teamwork. Be critical of yourselves, both individually and as a team in order to improve the care and the outcomes of the patients we serve. So that's why emergency medicine, it called to me.

00:05:59:13 - 00:06:20:19
Joanne Conroy, M.D.
Now, you trained in a rural area. You know, that's gotta be different than delivering emergency care in an urban area. What are the challenges that you've run into really in rural Maine, where most of the hospitals are critical access hospitals, except for a handful of quaternary care facilities?

00:06:20:21 - 00:06:44:04
Steven Diaz, M.D.
I think the biggest issue in rural emergency medicine care is you don't have the consultants at your fingertips, if you will. Whether it's trauma, stroke, heart attacks or Stemis, you might have to be creative on how you get those patients the care they need and find your consultants. I think in many ways, I was fortunate that I was EMS medical director for Maine early on because I met a lot of people across all the systems.

00:06:44:06 - 00:07:03:29
Steven Diaz, M.D.
And again, the goal here was to have a system of care so no matter where you went, you'd have the same care. So let me give you an example. When I was a young ER doctor and I had somebody with a SD elevation, myocardial infarction or a heart attack in front of me, that referral centers of cath labs who did interventional cardiology had three different protocols.

00:07:04:01 - 00:07:25:21
Steven Diaz, M.D.
And so I had different colored folders - we all did in our E.R., depending on which tertiary care center they chose. And so, and heaven forbid that you picked the wrong folder color and someone changed their mind or there wasn't bed availability. Nuances were no significant, but they were nuances. And so, we work to have that really ironed out.

00:07:25:24 - 00:07:47:04
Steven Diaz, M.D.
And I think that is the same discussion you have with stroke care, although that have been helped by other entities having some standardized protocols, but then having the consultants know who you are and where you call them. Interestingly enough, my preferred shift was the weekend overnight shifts in the ER, it just seemed to be a shift that went by quickly.

00:07:47:06 - 00:08:04:05
Steven Diaz, M.D.
Lots of teamwork. No offense, less suits around. But also made it so that I really had to know my consultants and know where I was going. In rural emergency medicine, rural states and or rural health care in general, again, you have to know where you're going to go because you may not have a lot of things in-house.

00:08:04:07 - 00:08:13:03
Steven Diaz, M.D.
And that was true 30 years ago as and it's still true today. Making it more important that we know our networks of care and our consultants.

00:08:13:06 - 00:08:23:12
Joanne Conroy, M.D.
So, you know, there's a lot of conversation about AI. Is AI going to improve safety, do you think, or is it going to jeopardize that?

00:08:23:14 - 00:08:52:20
Steven Diaz, M.D.
It's funny when you talk about AI and or even machine language, I think of "2001 A Space Odyssey." How the computer taking over everything or, Star Trek with the little device. I don't think that's how I see AI helping us. We spend a lot of time outside of the diagnostic and patient-facing time to get people on a care plan, talking about things over and over again in order to help them.

00:08:52:20 - 00:09:25:00
Steven Diaz, M.D.
And I think that's where AI could help us. If you have somebody getting a procedure or going on chemotherapy or who has other complex medical conditions, informed consent to ongoing education could be a boon for AI that identifies, you know, people with heart failure and which class they're in what they need as education. AI could say well, hold on, once you're done with them in the office, you know, you can send them this or they'll be identified by AI to receive these education, either online or print, depending on how they learn best.

00:09:25:03 - 00:09:39:21
Steven Diaz, M.D.
And it's always available to them. And we'll check in with them. It sounds like it'll be perhaps a cure management, but it's even beyond that because it'll speak to them in a way or then you can test them so they get the information the best way they get it. Right now all those things are done by people.

00:09:39:23 - 00:09:59:07
Steven Diaz, M.D.
You know, it's not the decision, it's the NPA or it's the nurse or the care manager. And they're all, we're all happy to do it. But none of us had that conversation once. Oncology is my favorite example of this. If you see an oncologist and you're told you have something that usually happens in the first few minutes and the next 15, 20 minutes, no offense,

00:09:59:07 - 00:10:18:09
Steven Diaz, M.D.
the patient and family don't hear anything else. Yeah, and that'll be me, if I remember. You know, there's no way I'm gonna remember anything past whatever they tell me that just shifted my whole world. But wouldn't it be great, though, if someone had a link, that was identified for them? Or AI can help answer their questions and gets information back from them

00:10:18:09 - 00:10:30:03
Steven Diaz, M.D.
that's given to the care team to help create the right message for them. That'd be incredible. That would be role changing, giving people back time, to not be burdened by the admission.

00:10:30:08 - 00:11:02:06
Joanne Conroy, M.D.
So it's almost personalizing their treatment plan. You know, we actually do videotape on your phone, our visits. So patients actually can refer to the conversation later 'cause you're absolutely right, Steve. After they hear that they have a diagnosis of cancer, they don't hear anything else. And all that important information is lost. Let's talk a little bit about AI in like, record abstraction.

00:11:02:09 - 00:11:27:25
Joanne Conroy, M.D.
Remember when we started using algorithms to oversee our ICU care? We identified that there were some early warning signs so we could anticipate when somebody might be unstable before they actually became unstable. What do you think about using AI for chart abstraction and kind of identifying things that are very difficult for our chart of structures currently pick up?

00:11:27:27 - 00:11:46:24
Steven Diaz, M.D.
I think they'd be ideal. Right now, you know, we spend a lot of administrative time either at the physician level MPPA coder, biller, trying to find those magic words that people are looking for in order to determine your risk stratification and thus your billing and even quality metrics at the back end. It shouldn't be a game, right?

00:11:47:01 - 00:12:03:02
Steven Diaz, M.D.
We should be able to say, I remember early on as a young doctor when I kept saying, urosepsis. I got the nastygram saying, no, you mean UTI with sepsis? You know, very specific words. So AI should be able to help with that, to be able to take the human element out of it.

00:12:03:02 - 00:12:32:04
Steven Diaz, M.D.
Let us practice and talk and then make the crosswalk so that it gets categorized the correct way and in the correct format. To me, that's a yeah, another easy lift. I've seen the products, I've been demo'ed by some of our younger medical staff who have me as a patient, and they're the doctor, and we just have a conversation and they hit a button and it can either generate a consult note, the agent P, the soap note, you know, and it's better than anything we could have delivered or dictated.

00:12:32:06 - 00:12:42:06
Steven Diaz, M.D.
And so, yeah, we do think there's a way coming that will make it more compliant and hopefully, again, get some of that red tape, some of the administrative burden out of health care.

00:12:42:09 - 00:13:05:02
Joanne Conroy, M.D.
Let's talk a little bit about safety and how we create community partners. Because patient safety is of great interest to people in our communities. And you live in a community like mine that people come up to you in the grocery store and in a coffee shop, and safety is probably one of the number one things that our patients worry about.

00:13:05:04 - 00:13:14:08
Joanne Conroy, M.D.
How do you actually engage the community so you have internal and external partners that are working on safety across the community?

00:13:14:11 - 00:13:39:17
Steven Diaz, M.D.
I will take an example in the behavioral health addiction medicine realm. When I was a young ER doc here, again, decades ago, the contract in the community for behavioral health is very strong. And today all those community partners are under duress. We actually surveyed them about two years ago on the Pediatric Realm Tracker. How we bolster more, resources for people who would need help in either mental health or addiction medicine services.

00:13:39:19 - 00:13:59:12
Steven Diaz, M.D.
And I would just say that everybody needs more help. And so we convened from that discussion, a small conference, that it's now an ongoing symposium where we try to bring all our partners together to discuss this openly. How are we sharing patients, what's the best way to go forward? Where should we go speak to the community,

00:13:59:18 - 00:14:33:26
Steven Diaz, M.D.
who's our audience? And so that's one small example of taking a piece of what we have to try to do more with it. It's not surprising that was spurned by the adolescent mental health crisis that's sweeping the nation that's also linked to suicide. So that was sort of the call to arms for that. I take that same paradigm, and that is sort of how we go out there to meet people where they live, whether it's behavioral health, CHF, COPD, there's a lot of community partners that we need to intersect with in order for the people to have the care they need, because we can't do it all alone.

00:14:33:28 - 00:14:45:15
Joanne Conroy, M.D.
Especially in rural America. We figured out that, our external partners are really important in actually keeping our community healthy and keeping our community safe.

00:14:45:18 - 00:14:46:08
Steven Diaz, M.D.
Right.

00:14:46:10 - 00:15:06:13
Joanne Conroy, M.D.
I want to thank you, Steve, and I want to apologize for our audience for having laryngitis today. But Steve did most of the talking, and I thank him for that. We appreciate you sharing your valuable expertise and insights. Thank you very much from rural Hanover, New Hampshire, to rural Augusta, Maine.

00:15:06:16 - 00:15:14:26
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.