Advancing Health Podcast

00:00:00:03 - 00:00:17:10
Tom Haederle
Welcome to Advancing Health. Health care is both a science and an art. In this podcast, we hear the powerful story of a hospital and a caregiver who wisely recognized that patients and families also play a role in shaping successful care.

00:00:17:13 - 00:00:42:07
Kristin Priehs
Hi everyone. I'm Kristin Priehs, vice president of American Hospital Association and Health Research and Educational Trust, and I am so excited for today's conversation. Today, we're diving into a topic that is foundational to quality in health care, but one that is also evolving quickly: the role of patients and families in shaping care. We often talk about patient engagement and many organizations that are doing incredible work across the field.

00:00:42:07 - 00:01:05:02
Kristin Priehs
But through our work for the Quest for Quality, we're seeing some opportunities to change and advance the field. My partner here today has spent a lot of time with me on the road at site visits across the country, identifying and evaluating Quest for Quality site visits. And it's become clear that there is a significant opportunity to engage patients differently in the conversation and begin partnering with them in the way that care is designed, delivered and improved.

00:01:05:02 - 00:01:33:18
Kristin Priehs
So I'm joined today by someone who brings both a depth of expertise and a powerful personal perspective to this conversation. Caroline DeLongchamps, program director of Patient and Family Centered care at the Medical University of South Carolina Health System. Caroline has spent over a decade leading patient and family care efforts at the system level, and she's also been part of our Quest for Quality work, helping evaluate what leading organizations are doing in practice.

00:01:33:19 - 00:01:45:28
Kristin Priehs
So, Caroline, we're so glad you're here. I'm personally so glad you're here. I've known you personally for quite some time, and I've heard a bit about your journey. Can you share a little bit about the passion that you have for this work and how you got started?

00:01:46:01 - 00:02:08:19
Caroline DeLongchamps
Thank you, and thanks for having me, Kristen. It's a joy to be here. So what brought me to the work is a personal story. My son was 11 months old. I have three boys. My son Sam was 11 months old when he was struck by a car in our family driveway. I was in the front yard with my three and a half year old son, waiting for my eight year old son to get off of the school bus.

00:02:08:21 - 00:02:29:27
Caroline DeLongchamps
Every afternoon was a little bit like a party. All the kids get off the school bus and the parents come and get them, and this day was no different. I went to get the mail out of the mailbox, and when I looked up, I realized that Sam had escaped from his little plastic minivan where he had been playing, and my girlfriend had gone to leave, but she pulled in the driveway to do so.

00:02:30:00 - 00:02:49:20
Caroline DeLongchamps
And so when I looked up, his head was under the front right tire of an SUV. My first instinct was to try and pull him out from under the tires. Unsuccessful. My second instinct was to try and lift the vehicle off of him, which, looking back, doesn't make any sense. But eventually, you know, she got out to see where she was and got back in the car and backed up.

00:02:49:20 - 00:03:09:26
Caroline DeLongchamps
And I only share that to say this wasn't a brief moment in time. It was several moments in time, and we drove to the nearest emergency department where they really couldn't do anything for him except administer oxygen and call for a rig that brought us downtown to the peninsula and to the Medical University of South Carolina. There he was triaged and intubated.

00:03:09:26 - 00:03:35:14
Caroline DeLongchamps
They were ready and waiting for us. He was triaged and intubated. And then I looked around that room and saw tears from several of the folks caring for him, and knew we were in big trouble. Stan presented with skull orbital facial fractures and by frontal contusions and intracranial hemorrhage. He was transferred upstairs to the pediatric ICU. We were separated, and that separation allowed enough time for kind of like, the PTSD to sink in.

00:03:35:14 - 00:03:53:14
Caroline DeLongchamps
And so I could see and hear that you were talking if you were standing in front of me. But I couldn't actually make out the words. And I was scared because I know I was about to get really important information about his life that I quite literally would not be able to understand. And that is exactly what happened. Came out of the back door and she brought my husband and I in, and she left me sitting three feet at the foot of bed ten.

00:03:53:15 - 00:04:11:03
Caroline DeLongchamps
And I did not like his what I saw lying in bed ten. It didn't resemble Sam, but the bedside nurse picked up on what was going on, and she came three feet to the foot of the bed, and she took my hand, and she tucked it up underneath her arm and gave me a fist pump. No words, just a fist bump.

00:04:11:03 - 00:04:32:19
Caroline DeLongchamps
But to me, it felt like that fist pump was saying, I got you. If you even think about going down, I got you. And then she walked to the head of the bed and she said, I need you to talk to him right now. He needs to hear your voice, not mine. I'm only a stranger. And I think that triggered something in my brain that let me know I had a job to do.

00:04:32:20 - 00:04:49:07
Caroline DeLongchamps
And then she said, this blue tube is a ventilator, and it's allowing his major organs to rest while we do the hard work for him. And this little tube coming out of the top of his head is called a ventricular, and we're pulling the blood off of his brain as fast as we can to help alleviate what will certainly be significant brain damage.

00:04:49:09 - 00:05:12:14
Caroline DeLongchamps
And all the while, this nurse, Lisa, was taking care of a critically ill, dying patient while literally and figuratively holding me up with the other one. And I just share that brief story to say that Lisa was the most powerful human being I'd ever met up to that point in my life. This act of taking my hand and tucking it up underneath her arm changed the way my husband and I viewed our role at the bedside

00:05:12:18 - 00:05:33:08
Caroline DeLongchamps
throughout the duration of his care. I knew I had a job to do. This pump engaged my brain in a different way that engaging us and including us in what was going on with him, I really believed, wasn't just a nice thing to do. It really helped change the outcome. I like to think that we had a part of what was ended up being a successful outcome.

00:05:33:08 - 00:05:43:28
Caroline DeLongchamps
He was expected to herniate. We were told he probably would not survive, but he did survive. And I like to think that it was because of the partnership that was created in the moment that he was admitted.

00:05:44:01 - 00:06:12:24
Kristin Priehs
First, thank you for sharing that story. Hearing you go through it is incredibly powerful and personal and that it's led you to the champion that you are for so many others. It's just an incredible asset. So I just wanted to say thank you first and foremost again. I know, after being out in the field with you for now, several years, I've seen some of that passion come through as we're talking to hospitals of all different sizes and types across the country for the AHA Quest for Quality Award.

00:06:12:24 - 00:06:29:24
Kristin Priehs
And I want to pull up one of the last points that you made about it felt like a true partnership, because I think having the patient engaged with hospitals and health care systems at all different disciplines as a partner is incredibly powerful from the example that you shared. So can you talk a little bit now that you're in this field as what that looks like?

00:06:29:26 - 00:06:56:09
Caroline DeLongchamps
I love these site visits. It's been such a gift for me to be a part of this prize committee. The site visits continually remind me that excellence is it doesn't show up in a in a single program or a metric or a presentation. It's revealed in the consistency that we see between what an organization says it values and what we see and what folks actually experience.

00:06:56:09 - 00:07:22:19
Caroline DeLongchamps
And I mean both their employees and their patients and families experience. And so from a patient and family centered care perspective, the question isn't whether or not patients and families are present, or even patients and family advisors are present, but whether they're partners, and that distinction is what I think separates the good organizations from the truly exceptional organizations, because we're getting more mature about this.

00:07:22:20 - 00:07:47:08
Caroline DeLongchamps
A lot of people can say, we have a PFAC, but what are you doing with your Patient and Family Advisory Council? So what's really fun about that is while the committee evaluates strategy and operations and outcomes and process improvement, I feel like my role is to assess whether that the quality is being achieved with patients and families, rather than just for patients and families.

00:07:47:12 - 00:08:15:03
Kristin Priehs
That's perfect. And having seen so many hospitals that are on their own Quest for Quality really listen to you and your own perspective on these site visits, I think has been groundbreaking. You have been such an advocate for how this field is evolving and going beyond patient and family engagement, and PFAC specifically into a much deeper partnership. I'd love to hear from you, because we talk so much about quality roles all the way from the board to the bedside, where you're seeing leadership engagement, specifically in patient engagement.

00:08:15:03 - 00:08:24:15
Kristin Priehs
And how do hospitals do that sustainably as they have new leaders that come on board or as leaders are really developing what their patient engagement strategy looks like and patient partnership.

00:08:24:18 - 00:08:45:03
Caroline DeLongchamps
You can put anything on paper, but it's different when you see it in action. And what I look and listen for is are they talking about it? Are they talking about patient and family centered care? And again, not just patient engagement. The terminology "patient engagement" is funny to me because it sounds to me like it means the patient is supposed to do something.

00:08:45:04 - 00:09:14:21
Caroline DeLongchamps
The patient is supposed to engage in their care? And it's not the patient's responsibility. It's our responsibility as a provider, as a health care system, to lean in, not to sit on the trash can in the room and say, what's your favorite color? What did you do this summer? But to meaningfully and intentionally lean in and ask questions. I'm constantly distinguishing in my organization at least, the difference between patient and family centered care and patient and family advisory councils, and those get used interchangeably a lot.

00:09:14:22 - 00:09:36:15
Caroline DeLongchamps
Patient and family center care is the culture of creating these mutually beneficial partnerships, not just what's good for patients and families. It has to work for providers and others as well. So we can we can partner in the in the delivery of care. So how do we do bedside shift report and physician rounds and how are our leaders holding us accountable for those things that make us a patient and family centered care organization?

00:09:36:15 - 00:10:02:13
Caroline DeLongchamps
And then how do we partner with patients and families in the planning and evaluation of care? And that's where your patient and family advisory councils come in. And again, anybody can have a patient and family advisory council. But how are you utilizing your PFAC, or Patient and Family Advisory Council? And it can be a grassroots effort. It was a grassroots effort in our organization for quite some time, but at some point it has to be it has to come from leadership.

00:10:02:13 - 00:10:20:25
Caroline DeLongchamps
They have to talk about it. They have to utilize it. They have to cascade it to their leaders and make sure that folks are utilizing that. Because to create effective councils, it can't just be bringing the patient perspective in. And that's where I think my voice is helpful or my ear is helpful on some of these site visits

00:10:20:25 - 00:10:47:20
Caroline DeLongchamps
is that - sure you have a council. How are you orienting them to the organization? So they're bringing their patient perspective, but it's really your job as an organization to add layers to that perspective, to help teach them who you are as a health care system so that they can become effective advisors. So you're really adding on to that perspective so that they can inform you about what's next.

00:10:47:26 - 00:11:07:02
Kristin Priehs
I love that, and as we think about leadership specifically, there's a lot that leaders are handling right now. And at the core of it should and always is patient care. And I know one of the things that is a very deep conversation and an evolving one is around the role of technology in patient care. Patients have more information at their fingertips than they ever have.

00:11:07:08 - 00:11:29:15
Kristin Priehs
We're now seeing how predictive analytics and AI and EHR coordination, virtual care is all evolving quickly. So can you tell us from the patient centered care perspective, with the patient being a true partner with hospitals and health care systems, how is technology evolving to ensure that they are true partners at the table and decisions that affect their care?

00:11:29:18 - 00:11:52:24
Caroline DeLongchamps
It takes me back to an example that came out of Covid, which I'm not equating Covid to AI, but what happened during Covid is we had a leader in our organization say, wow, things are changing rapidly right now and we are going to make mistakes. I am certain of that. But in order to course correct very quickly, the monthly PFAC meetings are not enough.

00:11:52:24 - 00:12:14:20
Caroline DeLongchamps
I want to make sure I'm engaging with patients and families on a regular basis. So he set up weekly calls with our members of our Patient and Family Advisory Council just to make sure he knew what was happening on the front line. And he heard from a parent who said, I brought my child in for a Covid test in preparation for a heart cath, and we were separated.

00:12:14:22 - 00:12:35:03
Caroline DeLongchamps
And I understand the reason for the separation. I have heard that in PFAC meetings,  you guys have educated me about - we're trying to reduce the risk of transmission of this very scary virus. But I live with my daughter, and if I'm willing to assume that risk, I can help reduce the risk to one of your very precious, precious nurses who we really need to come back to work tomorrow.

00:12:35:06 - 00:13:07:19
Caroline DeLongchamps
That was a really important example because we changed a policy immediately following that. So I think when it comes to AI, it's important to remember that patients and families are not the end users of AI. They are the stakeholders. So if you're establishing AI committees or you're working on things about what this is going to look like for your organization, embed your patient and family advisors on those teams at the beginning before the decisions are being made, so that they're a part of that, so that they're partnering with you and that you're building trust.

00:13:07:19 - 00:13:22:02
Caroline DeLongchamps
And that's what AI is supposed to do. It's supposed to reduce burden. If AI is creating time for providers so that they can have face to face conversations, build trust and create connections, then we're on the right track. But if it's not doing that, then we're missing the mark.

00:13:22:06 - 00:13:41:15
Kristin Priehs
Well, we're certainly not missing the mark when it comes to you being on the Quest for Quality committee. So thank you for that. This is, as always, been one of the most energizing and thoughtful conversations that I've had. I thank you again for sharing your history and your story and where you see patient engagement and partnership going, because I think the field will always have a lot to learn from you.

00:13:41:20 - 00:14:05:04
Kristin Priehs
One of my biggest takeaways is that the work is not about checking boxes. It's so much more about having the right structures in place, the right leadership, and really ensuring we're creating cultures where patients, families and caregivers are truly partners in designing care. And health care continues to evolve, especially with new technology and innovation. The opportunity is really in being intentional about bringing those voices into the process from the start.

00:14:05:04 - 00:14:23:20
Kristin Priehs
And for those listening, I really encourage you all to really think about how patients are being engaged in your own organization and move beyond engagement to true partnerships in meaningful way that continue to improve care. So, Caroline, thank you so much for your leadership and for sharing your perspective with us today. And thank you to all of you for listening.

00:14:23:20 - 00:14:25:24
Kristin Priehs
We will see you next time.

00:14:25:26 - 00:14:34:19
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:07 - 00:00:18:25
Tom Haederle
Welcome to advancing health. Healthcare and the state of medicine in general has made remarkable progress across many fronts in the past couple of decades. Delivering to patients on all that potential and promise is a separate challenge, one that Jefferson Health is tackling head on.

00:00:18:27 - 00:00:39:24
Chris DeRienzo, M.D.
Thank you, everyone, for joining us on another episode of Advancing Health. I'm Dr. Chris DeRienzo, AHA's chief physician executive, and today I get to talk to someone I have known for 20 years. We were kids together in medicine way back in the day. Today, he's the president of Jefferson Health. Baligh, thank you so much for joining the podcast.

00:00:39:26 - 00:00:43:20
Baligh Yehia, M.D.
Thanks, Chris. It's great to be with you and good to see you again.

00:00:43:21 - 00:00:56:26
Chris DeRienzo, M.D.
Always, my friend. We know that Jefferson Health has gone through a lot of evolution in the past few years. I want to start by asking you to tell us a little bit about the various communities that you serve and about Jefferson Health.

00:00:56:28 - 00:01:28:16
Baligh Yehia, M.D.
Jefferson is going through a lot of changes, but it's been around for more than 200 years. And the exciting parts about Jefferson are we bring together 200 plus year university, medical college, nursing, all the health professions, as well as a really robust undergrad program with the health system that's now 33 hospitals across eastern PA and southern new Jersey, and a health plan with more than 400,000 covered lives, primarily in Medicaid, Medicare Advantage, and ACA.

00:01:28:16 - 00:02:07:09
Baligh Yehia, M.D.
And that's the special thing about Jefferson and why I love the work that we do, is really how do you connect the academic and research mission with the clinical care and also the payer side. And it creates for unique opportunities. Just last year, we hired about a thousand individuals that graduated from our university into the health care system. Pipeline programs, whether it's nursing or pharmacy or all kinds of different technologists, being able to actually train at the university and then be able to work in the health system is a great way to keep people in the community and also to provide upward mobility.

00:02:07:09 - 00:02:28:10
Baligh Yehia, M.D.
And then similarly, on the health plan side, we overlap on thousands and thousands of patients and thinking about how we can deliver a better care in the context of value. And that stuff is really, really exciting. It's that intersectionality between those three different areas where we see some uniqueness that maybe isn't seen in other health care systems.

00:02:28:16 - 00:02:51:06
Chris DeRienzo, M.D.
We know that with that kind of great opportunities, there are also challenges that health systems face. It is not an easy operating environment, and especially as a health system that is growing and is continuing to integrate across all of your operating areas and the communities that you serve. What would you tell listeners are some of the biggest challenges that you, as the president of that health system, are trying to solve today?

00:02:51:08 - 00:03:21:09
Baligh Yehia, M.D.
You know, for us, there's probably a few that come top of mind. I think health care is changing very rapidly in some ways amazingly exciting. When you think about the type of therapies that are coming down the pike, when you look at immunotherapies, gene therapies, things that we weren't even thinking were possible 5 or 10 years ago. You know, we're doing treatments for sickle cell disease that if you've ever taken care of someone or had it yourself, very challenging, hard condition.

00:03:21:09 - 00:03:49:17
Baligh Yehia, M.D.
And now there's a way that you can actually live without having any of those complications. I mean, that's pretty amazing. Very different than when I trained as a resident. Similarly, all the technology changes that are happening. So there's that context of how do we adapt to changing technologies and changing therapies. But across that is really this bigger and bigger divide between what it costs to deliver care and then what you get paid to deliver that care.

00:03:49:18 - 00:04:12:12
Baligh Yehia, M.D.
And that's what I see in general as one of our biggest challenges, particularly in Pennsylvania and in southern new Jersey, where, you know, our imperative is deliver high quality, high value care. But every day it seems like there's different type of policies coming out from payers. It seems like there's a lot of challenges from pharmaceutical companies for different programs.

00:04:12:12 - 00:04:32:12
Baligh Yehia, M.D.
And, you know, that's one of the things that I think a lot about is how do we make sure that we close that gap between what it takes to make sure that we deliver exceptional care and take care of our employees and support the communities, while at the same time knowing that there's revenue issues that come from both federal, state and commercial payers.

00:04:32:14 - 00:05:09:27
Chris DeRienzo, M.D.
It's certainly a challenge that's faced in Pennsylvania and in in health systems across the country. You described a multi-part mission given Jefferson Health's academic mission, your research mission, your community mission. We had conversations with a few other physician leaders a couple of months ago, actually, about how to bridge those massive novel innovations on the research side. Gene editing therapies with the functional challenge of implementing in largely a community health system, because while we have these academic centers, most of health care is delivered in community hospitals and in practices across the country.

00:05:09:27 - 00:05:33:16
Chris DeRienzo, M.D.
So given the footprint that you described and the impressive amount of infrastructure that Jefferson has, what are you doing to meet that? The challenge not only of ensuring sustainability of operations, especially in communities that otherwise may not have access to care, but also to bring that leading edge innovation as far out to people across the states that you serve.

00:05:33:19 - 00:05:56:10
Baligh Yehia, M.D.
You know, I think that's like a critical question. And, you know, at the heart of it, it comes down to access. And here at Jefferson Health, we have a bold goal to be the most accessible system in our region and ultimately in the country. And when you think about our footprint of hospitals and clinics, as I mentioned there's 33 of them, but we don't do every service at every single location.

00:05:56:10 - 00:06:22:19
Baligh Yehia, M.D.
And so then the question becomes, how do you reach people in rural communities, which we serve in the middle of the state to highly urban communities like in Philadelphia? And that's the power of being part of a network. And so for us, as we think about how we evolve and change, it's really around our service lines and our clinical programs, and we've challenged our teams to think differently about access.

00:06:22:19 - 00:06:45:21
Baligh Yehia, M.D.
And I'll give you an example. One of the most challenging diagnoses you can get or give to a patient if you're a caregiver is one of, hey, we think you might have cancer or we're seeing something that doesn't look right. Typically, then you go and have to get different tests and find appointments. And during that time period, there's a ton of worry. There's a lot of uncertainty and concern

00:06:45:21 - 00:07:12:26
Baligh Yehia, M.D.
and so we've pushed our team and said, how do we remove that? And we created a program our same day, next day cancer program. We're actually able to see new cancer diagnoses within 1.4 days at Jefferson. And it's mostly virtual. It extends into the evening hours as well as on Saturdays. And we're able to provide some comfort and most importantly, take away some of that uncertainty about what's the next step and where do we go from here.

00:07:12:26 - 00:07:32:07
Baligh Yehia, M.D.
And when we first talked with a team, it seemed almost impossible, like, how can you actually do that? And we worked to create the right model. We set it on top of our clinics versus trying to embed it in the clinics. And that's been widely, wildly successful. And we've seen many patients go through that program, more than 2000.

00:07:32:12 - 00:07:52:04
Baligh Yehia, M.D.
We've seen a faster time to chemotherapy and surgery. And as I said, there's that intangible piece of mind that comes. And so we've been asking each of our different services to think about things like that. How can you push differently? Our virtual primary care program, which now represents more than 10% of all of our primary care visits -

00:07:52:04 - 00:08:14:16
Baligh Yehia, M.D.
we have to double the program because of the amount of interest in it. And then we also have home based care where we're actually getting into people's homes to help provide that. So I think when it gets to these novel therapies, I think virtual is our friend. And the concept of being able to rotate clinicians, be able to meet people where they are in their communities is really, really important.

00:08:14:16 - 00:08:36:04
Baligh Yehia, M.D.
That's something that's really exciting around being part of a network like Jefferson is whether you're in Schuylkill County or in the Poconos or in Scranton, you can enroll in our clinical trials that are coming out of Philadelphia or out of Allentown. Or you can get access to a world class and novel therapies that wasn't available to those communities before.

00:08:36:04 - 00:08:52:07
Baligh Yehia, M.D.
And it's really about connecting the dots through that system. So, you know, access continues to be something that we've talked about for decades now, and it's something that we'll continue to work on. But I think we're making some head away here in some of the programs we've developed.

00:08:52:09 - 00:09:17:12
Chris DeRienzo, M.D.
Well, given as long as I have known you, it is no surprise to me, Baligh, that if I were to summarize what I just heard, in short, it's meeting an intersection of innovation and implementation. I was on a very special episode of this podcast recently with three of the coolest physicians not named Baligh Yehia in America. That was with Jackie Gerhart from Epic, Tom McGinn from CommonSpirit and Zia Ager from the West Health Institute.

00:09:17:12 - 00:09:48:01
Chris DeRienzo, M.D.
And we were trying to envision what our profession looks like in 20 years as we walk through this era of AI enabled technology change. And one of the things that came up, you just reinforced, which is sometimes we can think about access differently. If I think about the patients who I remember seeing in pediatric residency, newly diagnosed cancer, there's a subset of those patients who it's truly an ontological emergency, and they have to be admitted to a hospital immediately.

00:09:48:08 - 00:10:10:19
Chris DeRienzo, M.D.
Perhaps they have something like leukemia and they're in a leukemic crisis. But for many of them, what they need first is a conversation. And we know that there are ways that we can enable those conversations with an expert in the field to talk me through what happens next. That doesn't require a hospital stay. It may not even require going to the E.R. or coming to an office.

00:10:10:20 - 00:10:27:19
Chris DeRienzo, M.D.
And as we enable clinicians to deliver care and to use their expertise at the top of their license in different ways, we can solve for access differently. And so the next question I typically ask guests, how's it going? It sounds like it's going pretty darn well.

00:10:27:21 - 00:10:48:13
Baligh Yehia, M.D.
Yeah. And I think like I said, it's an issue that's been facing medicine for a long time. And it's multifactorial. We talk about physician and nursing shortages. We talk about disparities in care and how do you get access to treatments in one location to another. And so, you know, those still exist. But we are making progress.

00:10:48:13 - 00:11:10:22
Baligh Yehia, M.D.
And I think that's really exciting when I hear stories of individuals that might not be able to access novel therapies. You know, we just started a new program where we're screening for cancer in the ERs. And one of my colleagues sent me a note last night. The program just started. We've scheduled 80 colonoscopies. We've had four done.

00:11:10:22 - 00:11:30:03
Baligh Yehia, M.D.
And one of them, we've diagnosed someone with a mass already. And that's someone that probably was not seeing primary care. Came into the air for something different. It's not an emergency. So typically E.R. doctors and teams are not screening for cancer. And so it's things like that that in my mind are being able to meet people where they are.

00:11:30:04 - 00:11:56:28
Baligh Yehia, M.D.
It sounds very simple, but that's an example. They're there waiting to be seen or in the room, and our team is able to talk to them and then evaluate them, get them scheduled and go from there. And the other cool thing is that that patient was a member of a health plan. And so that's kind of neat where you see win, win, win for most importantly, helping the patient and their family, providing better care and then also improving the lives of those in our health plan.

00:11:57:01 - 00:12:18:25
Chris DeRienzo, M.D.
We have time for exactly one more question, and I'm torn because again, we've known each other for 20 years. And there are a lot of things that are just as true then as today. But I'm going to have to pen that question for another time, because what our listeners tell us they most appreciate about our podcasts are we get to talk to fascinating people like you.

00:12:18:27 - 00:12:46:06
Chris DeRienzo, M.D.
And some of them come from academic systems, some from community systems, some are investor owned or nonprofit or public health systems. And the biggest question that they always want to know is, it's amazing that you're doing this great work at Jefferson, but what advice would you give to me if I'm running a critical access hospital in Mississippi, or I'm at a small academic health system in Oregon? You know, you're doing this amazing work at the intersection of innovation and implementation to expand access.

00:12:46:06 - 00:12:49:28
Chris DeRienzo, M.D.
What first step should I be taking back home?

00:12:50:01 - 00:13:12:08
Baligh Yehia, M.D.
You know, I think that's beautifully said and asked is that, you know, we serve so many diverse communities, so different settings across this great country. And so for me, I would say be curious. Because there isn't really just a playbook that you can lift and shift. Maybe there's a baseline that you can start with that has to be adapted.

00:13:12:08 - 00:13:43:08
Baligh Yehia, M.D.
But be curious. Ask patients, ask your patient family advisory councils, talk to your frontline staff. And again, it sounds basic, but that's what we do. And that's how we learn and make sure that as we deploy and implement programs, it actually sticks. And that's the one thing we are so prone, I think, to help. And sometimes that comes in the form of solving very quickly and taking time to really sit with the problem that you're trying to solve, understand the problem you're trying to solve.

00:13:43:09 - 00:13:59:12
Baligh Yehia, M.D.
Talk to people about it. That planning, that discovery, that being curious goes a long, long way to executing on something that is efficient and that actually achieves what you're trying to achieve. So that's what I would say is just stay curious.

00:13:59:16 - 00:14:22:28
Chris DeRienzo, M.D.
Very well said. If I've learned one thing in nearly four years at the age, and I've been to every conceivable kind of hospital in every conceivable kind of community in this country, it's while the role of hospitals look different from community to community, because every community is different, that connection points and understanding of this is where I can best support my community needs is a common thread throughout.

00:14:23:01 - 00:14:33:07
Chris DeRienzo, M.D.
As expected Baligh, it has been so much fun catching up with you. Congratulations on all the amazing work happening up in Philly and across your region. And thank you again to listeners for tuning in.

00:14:33:14 - 00:14:35:20
Baligh Yehia, M.D.
Pleasure. Thanks for having me.

00:14:35:22 - 00:14:44:18
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:03 - 00:00:15:28
Tom Haederle
Welcome to Advancing Health. The evolution of Age Friendly health initiatives continues to spread across our health care landscape. In this podcast, we learn more about how to plant them deep, help them grow and measure their success.

00:00:16:01 - 00:00:41:07
Marie Cleary-Fishman, R.N.
My name is Marie Cleary Fishman. I'm a senior advisor to the president of Health Research and Educational Trust. Nurse by birth at this point in life and really happy to be here to talk with these great folks this morning from Northwell Health. And we are going to have a conversation around large scale initiatives such as Age Friendly and implementing that within a hospital or health care system.

00:00:41:07 - 00:01:07:27
Marie Cleary-Fishman, R.N.
And it can also apply to other patient safety initiatives that you or your organization might be working on. So I am honored to welcome our guests today. We have Michele Frankel, who is the regional CFO, chief financial officer. And then we have Susan Kwiatek, who is the vice president of Aging and Supportive Care and also in charge of the Institute for Healthy Aging.

00:01:07:28 - 00:01:29:24
Marie Cleary-Fishman, R.N.
So I'm going to turn to Michele and Susan, and I'm going to ask you to introduce yourself. Tell us a little bit about your roles, because they are so, so special in your organization. And then we'll go on and have a little bit of discussion about the things that you have found to be such priorities and that have really helped you be successful.

00:01:29:24 - 00:01:31:25
Marie Cleary-Fishman, R.N.
So, Michele, do you want to start?

00:01:31:26 - 00:02:11:01
Michele Frankel
Sure. Thank you for having me. I'm Michele Frankel. I'm currently the deputy market president for the eastern market of Northwell Health, which encompasses eight hospitals and a couple of hundred ambulatory practices. But for the majority of my career, I've been in a variety of finance roles and most recently, the regional CFO for the eastern market. In that capacity, responsible for managing the budgets of these institutes and implementing strategy and business plans to support the strategy in order to ensure that we are able to provide the services to the communities that we serve.

00:02:11:01 - 00:02:21:13
Michele Frankel
And I've been lucky enough to be involved in many big scale initiatives, one of which was the Institute for the Aging and expanding that initiative across our organization.

00:02:21:15 - 00:02:25:13
Marie Cleary-Fishman, R.N.
That's great, Michele. Thank you. Susan, would you like to do the same thing?

00:02:25:15 - 00:02:43:09
Susan Kwiatek, DNP
I'm Susan Kwiatek. I'm the VP for Aging and supportive Care. I'm a nurse by background, and I have been working in the Age Friendly space since 2019 and more recently in the Institute for Healthy Aging that we recently launched last year.

00:02:43:12 - 00:02:58:15
Marie Cleary-Fishman, R.N.
So you've both mentioned the Institute for Aging. Let's start just by having a bit of a conversation about how that came to be, who started, who brought it in, and how did how did it get brought to life in your organization?

00:02:58:20 - 00:03:36:13
Susan Kwiatek, DNP
So when we began this work in 2019, we began by rolling out the IHI 4M framework. And as we rolled this out from hospital to hospital and standardized practices, we quickly realized, and when I say we, the executive leadership and in particular, Dr. Maria Carney, who was our chief of the Division of Geriatrics and Palliative Care at the time. And she really had this vision that we have to back this up to healthy aging, and that we also need to expand our efforts to caregivers.

00:03:36:13 - 00:03:49:08
Susan Kwiatek, DNP
And that really is what gave birth to the recognition that we need an aging institute so that we can really cover caregivers and cover healthy aging as well.

00:03:49:13 - 00:04:12:08
Marie Cleary-Fishman, R.N.
And that's a great example of how the C-suite and leaders were involved from the very beginning. So I think that's important. Michele, I'd just like to call out a little bit and ask the question about what involvement the CFO, either you or local CFOs, what kinds of responsibility or involvement did they have in bringing the Institute for Aging to life?

00:04:12:14 - 00:04:45:04
Michele Frankel
So once the journey started, Susan had reached out to me for support in putting quantitative metrics around the return on investment on this initiative. And we worked closely together on the types of metrics that would be a result of this initiative, of which included reduction in length of stay, reduction and falls, reduction in readmissions. However, when Susan and I spoke, thankfully we had a long history together of working together, so we knew how we needed to get to where we wanted to go.

00:04:45:06 - 00:05:22:01
Michele Frankel
We recognized that there were multiple initiatives going on in the health system that impacted all those very same metrics, so we had to really narrow down the population of who we were looking at to compare those specific metrics relative to the patient demographic and diagnoses that these patients had. So Susan and I worked together with our back end data analytics and finance team to pull the data in the right way and to begin to show the first site where we rolled this out, the improvements that were had and to tie dollars to them.

00:05:22:07 - 00:05:50:18
Susan Kwiatek, DNP
So we've done this analysis three years in a row, and we've seen the same trend with the top three DRGs. And that is reductions in length of stay for sepsis, for respiratory infections and for heart failure and shock. We were able to then put what the cost avoidance is for the length of stay reductions in all of those three DRGs. And then it also frees up beds.

00:05:50:18 - 00:05:53:25
Susan Kwiatek, DNP
So it also contributes to efficiency.

00:05:53:26 - 00:06:23:04
Marie Cleary-Fishman, R.N.
It's great, I hear those steep criteria being brought in there safe, effective, efficient, equitable, patient centered and caregiver centered care. So I think that's very exciting. So you two have a really strong connected relationship between a clinical role and more of a finance or marketing engagement kind of role. And I'm just curious like what's the what's the glue that really keeps pulling the two of you back together

00:06:23:04 - 00:06:28:03
Marie Cleary-Fishman, R.N.
in this kind of work, because I think that there's something special there.

00:06:28:06 - 00:06:52:08
Michele Frankel
As I mentioned, my history in this organization is in finance, and I'll say that the majority of it up until 2008 was in what I'll call back end finance, you know, really, you know, churning out numbers and analysis, not in hospitals, not face to face with where the patient care is being provided. And my first job in a hospital was where Susan at the time was the chief nursing officer.

00:06:52:08 - 00:07:29:18
Michele Frankel
And I went in as the site CFO, and I had never worked inside of the hospital before. So I had a lot to learn, and I really learned all I know about nursing in a hospital from Susan. And Susan eventually became the president of that hospital as well. So we worked very closely together, you know, not just on budgets every year for the hospital, but on new programs and new initiatives and how we would build up business plans to support what the hospital was trying to accomplish, whether it be for a new program or for efficiencies and cost savings without compromising care.

00:07:29:22 - 00:07:58:03
Michele Frankel
And I think that the glue for Susan and me, and in general whenever we're working on a project, is that finance and clinical and operations, we all need to work very collaboratively together and really listen and hear from the other parties what is needed. And then the finance person can help translate that into a business plan to advocate and get, you know, the mission accomplished in a cost effective way.

00:07:58:06 - 00:08:00:21
Marie Cleary-Fishman, R.N.
Susan, anything you want to add to that?

00:08:00:24 - 00:08:30:00
Susan Kwiatek, DNP
We really learned to speak each other's language. So Michele took the time to learn all about nursing, whether it was nursing, physical therapy, dietary, radiology. She really took the time to learn what it really takes for those departments to operate efficiently. And I learned from her how we really can work with the finances to make the staffing plans effective.

00:08:30:02 - 00:08:48:03
Marie Cleary-Fishman, R.N.
I mean, you're getting it the idea there of walking in each other's shoes, right? Not just doing your part and walking away, but really figuring out what is it that makes the other person tick, what do they need? And if we want to use the 4Ms, we can say what matters to each of you, right? You've taken the time to find that out.

00:08:48:03 - 00:09:16:09
Marie Cleary-Fishman, R.N.
And I think that's really important because everything else goes through that lens. So living what we're practicing, right? And that's really, really important. How are you continuing to keep the board of trustees engaged in this activity? It sounds like they've been very involved and very supportive. How are you keeping that spirit going and that alive, so that you continue to get the support needed for this work?

00:09:16:14 - 00:09:44:21
Susan Kwiatek, DNP
First of all, the board is very involved and very engaged in knowing what our metrics are. What's our patient satisfaction? What are our quality issues? What's happening at each of the hospitals? And we're accountable to report metrics up to the board. An example that I can give you is that we've really been reducing length of stay, reducing readmissions, increasing the patient satisfaction.

00:09:44:21 - 00:10:29:11
Susan Kwiatek, DNP
And in several of our hospitals, in the patients age 65 and older, we know that we've always done well with patient satisfaction, but not so much in the older population. So we've really put a focus there and we're seeing those scores improve as well. We also have hospitals and one in particular, the example, the early adopter that started out by implementing the 4Ms started out with niche recognition, which they're at exemplar now, magnet with distinction, geriatric emergency department accreditation at the gold level and then to the Baldrige Award at the national level.

00:10:29:12 - 00:10:37:15
Susan Kwiatek, DNP
So this is really all examples of what the board wants us all to strive for and looks closely at.

00:10:37:19 - 00:10:58:12
Marie Cleary-Fishman, R.N.
Well, congratulations on all those achievements. And that's a great success. So thank you for sharing that. Let me ask a question about front line engagement. Can you tell me how does the frontline get to experience the involvement of the board or the C-suite? How does that get to the folks that are actually doing the hands-on care?

00:10:58:14 - 00:11:25:06
Susan Kwiatek, DNP
So I think there's a lot of communication upward and downward in our organization. The frontline staff know that the board is looking at dashboards, and they also know that the board is approving budgets. All budgets go to the board on an annual basis, and I know that they feel it in this way as well because the involvement is there.

00:11:25:07 - 00:11:37:21
Susan Kwiatek, DNP
Also, there was an aging summit that was held, and there were people from all levels of the organization invited to that summit, and we had board members present for that.

00:11:37:27 - 00:11:45:18
Marie Cleary-Fishman, R.N.
Oh, that's great. That's a nice another nice idea of how to engage folks and get them to meet each other. So that's terrific.

00:11:45:25 - 00:12:14:25
Michele Frankel
And I'll just add to Susan's point is the way our organization is structured lends itself to the vertical communication. We're a very large organization. We span a pretty large geography. But in terms of the mission and the priorities and rolling out initiatives, we have a structure in place that goes regionally market based geography. And then within our market structure, then we have a way to communicate to our hospitals.

00:12:14:25 - 00:12:38:16
Michele Frankel
And then within each hospital, there's a communication pathway down to all the frontline workers, clinical and non, many times together. And then in addition there's rounding that goes on the floors on a regular basis of senior leadership, both from the hospital and the market and the system to, you know, ensure that everybody is engaged and sing from the same song sheet.

00:12:38:17 - 00:12:43:01
Michele Frankel
So there are many mechanisms of communication vertically.

00:12:43:03 - 00:13:03:16
Marie Cleary-Fishman, R.N.
That really gets to the issue of culture, right? And how you have alignment. The other thing that it gets to which, you know, my colleagues all laugh at me is I frequently say structure plus process gives us outcome, right. So you have structures in place and then put those processes. But that's I think that's a really important point.

00:13:03:16 - 00:13:21:25
Marie Cleary-Fishman, R.N.
And if we're missing that structure we may have all the processes in place. But if we don't have structure which can mean staffing the right people in the right place, the right equipment, all of those things, then we can do all we want with process, and we're still not going to quite get to our outcomes. So really important point.

00:13:21:26 - 00:13:51:18
Susan Kwiatek, DNP
To that up/down process that Michele just described - but for Age Friendly, we have a specific process for Age Friendly as well. We have our Age Friendly teams at each hospital. The steering committees are the executive leadership of each hospital. And then the Age Friendly teams have people that report into a collaborative care council, where they are sharing best practices and presenting on them and presenting their PDSA cycles.

00:13:51:18 - 00:14:03:03
Susan Kwiatek, DNP
And then that committee has a leadership that reports to executive leadership of the health system. So it's really a robust process.

00:14:03:06 - 00:14:28:02
Marie Cleary-Fishman, R.N.
So I'm going to ask one last question. And that is, if you were with another organization, what would be one action item that you could say to the leaders of another organization? If you do this, you know you will find success with the work you're doing. And I know narrowing it down to one is kind of tough, but what would be that really important

00:14:28:02 - 00:14:30:20
Marie Cleary-Fishman, R.N.
one thing that you'd like to say to folks?

00:14:30:22 - 00:14:56:21
Michele Frankel
I think that no matter what you're trying to accomplish in an organization, it requires a wide array of experts in different parts, whether it be clinical, operational, financial, board level, executive leadership. And I think that everyone has to recognize that they need to listen and learn from the rest of the stakeholders to really understand the what, the why.

00:14:56:21 - 00:15:14:14
Michele Frankel
And then we can all work together on who and how we get things done to achieve what we're trying to achieve. And I think, you know, even though we're such a large organization, we have pockets of experts in all of these arenas. And if you leverage all the right people, we can really accomplish anything.

00:15:14:21 - 00:15:16:28
Marie Cleary-Fishman, R.N.
Well said. Susan.

00:15:17:01 - 00:15:33:12
Susan Kwiatek, DNP
I would say that Age Friendly is a team sport, and every discipline in the health care organization needs to be involved, since that's really along the line of what Michele said. The icing on the cake, then, is when you have leadership support.

00:15:33:14 - 00:16:01:20
Marie Cleary-Fishman, R.N.
Well, congratulations on all the great work that you're doing, that you've done and continue to do. We've talked about some really important concepts here that everybody should think about. Age Friendly implementation doesn't happen in a silo, just as both Susan and Michele said. And I think that if we really want to engage this and, and make it part of the culture, and we have to think about those things, we have to think about governance and the involvement there.

00:16:01:20 - 00:16:28:02
Marie Cleary-Fishman, R.N.
It's really, really difficult to move a large scale initiative like this forward without that governance engagement. And then and that includes, of course, the C-suite as well, engaging with the board. So that's really critical to the success. I think the other thing we talked about today a little bit is system design, right. You need to be conscious and think about how are you putting your system together, how does that work in your organization.

00:16:28:02 - 00:16:53:15
Marie Cleary-Fishman, R.N.
And that builds on culture. I think that's really important. The next is the care delivery, and that's really where the 4Ms come into play. And that's a care model for taking care of folks that are aging. In the 4Ms work, it is 65 and older. But as we think about aging, this model, when we talk about the things can be used for any other large scale initiative that might be a care model as well.

00:16:53:15 - 00:17:18:07
Marie Cleary-Fishman, R.N.
So thinking about the care delivery system and then acknowledging and thinking about what is the performance improvement methodology used in the organization. We don't have to be prescriptive about that. We know that our members across the nation use lots of different models, high reliability, PDSA, all different things that they can use. And so it's fine for them to use that model. And then to involve the patients and the caregivers,

00:17:18:08 - 00:17:43:26
Marie Cleary-Fishman, R.N.
right? That's critical because all of this is work being done to improve life. And we really thank Northwell Health for the amazing work that you've been doing, and specifically to Michele and Susan for their great teamwork and the example they've been able to share with you today. If you're interested in getting involved in Age Friendly, please go to the AHA Age Friendly website and you can sign up for the Action Communities.

00:17:43:26 - 00:18:12:09
Marie Cleary-Fishman, R.N.
Those are free. There's no cost to them. Both the American Hospital Association and the Institute for Healthcare Improvement share the action community activities. We do one that starts in the fall. The Institute for Health Care Improvement starts theirs in the spring. They are the same. We stay very closely aligned so that the members can make their choice based on their strategic plan and what timing works best for them, so please consider joining one of them.

00:18:12:12 - 00:18:24:20
Marie Cleary-Fishman, R.N.
We have lots of case studies and information on the website, and certainly you will see Northwell there. Thank you so much for your time today and for all that you do.

00:18:24:22 - 00:18:33:12
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:19:13
Tom Haederle
Welcome to Advancing Health. When seeking care today, patients don't want a digital visit with their care provider to be a completely different experience from an in-person one. Hear how Sutter Health is working to ensure the care experience is seamless, no matter how it's delivered.

00:00:19:15 - 00:00:46:22
Kristin Preihs
Welcome to Advancing Health, the podcast from the American Hospital Association. I'm your host, Kristin Preihs, vice president of Health Research and Educational Trust, the 501 C3 affiliate at American Hospital Association. Throughout my role, I have had the privilege of working with hospitals and health care systems across the country that are testing, scaling, and implementing incredible work in improving care, strengthening the workforce, and advancing patient experience.

00:00:46:25 - 00:01:19:14
Kristin Preihs
Today, we're talking about what it means to design health care around the people we serve and how technology can help create care that is more connected, more personalized, and ultimately more human. I'm excited to welcome today Jennifer Bollinger, chief consumer and brand officer at Sutter Health. Jennifer leads Sutter's consumer strategy, brand, digital experience and patient engagement efforts, helping shape how one of the nation's leading health systems delivers care across every single touchpoint, which is pretty significant work.

00:01:19:19 - 00:01:43:08
Kristin Preihs
Jennifer was recently recognized by Reuters as one of its trailblazing Women in Healthcare. She brought a consumer first mindset into health care, challenging traditional thinking across the board about how patients experience care and helping lead a transformation focused on seamless and connected experiences. So, Jennifer, welcome to Advancing Health. It is wonderful to have you.

00:01:43:10 - 00:01:45:02
Jennifer Bollinger
Thank you. Happy to be here.

00:01:45:04 - 00:02:08:16
Kristin Preihs
Well, I've read quite a few of your past recordings and interviews with folks, and you have such an amazing and unique background when it comes to patient experience. And one particular area that I caught as I was looking at some of your past press releases, is the process and the concept of digital ecosystems. Am I saying that correctly?

00:02:08:18 - 00:02:09:14
Jennifer Bollinger
That's right. Yep.

00:02:09:15 - 00:02:30:20
Kristin Preihs
And I haven't heard that term in the field, but it resonates for where we are right now as a country with the evolutions in technology, patient understanding and the development of outcomes and integrated patient care. So for listeners who might not be familiar with the term and with the concept, can you give us a little bit of background about its origin story and how that relates to your background?

00:02:30:22 - 00:02:54:10
Jennifer Bollinger
So I would say it's definitely a term that I made up and cobbled together, and then it got some traction, but it was back when I was trying to explain to the organization that I was with previously and I do use it at Sutter as well, you know, to describe the fact that when patients show up for care, they don't leave all their consumer expectations at home.

00:02:54:10 - 00:03:19:12
Jennifer Bollinger
They have the same expectations of us that they have of every other industry. And every other industry has gotten really good about enabling patients to move back and forth between the in-person or physical experience and the digital experience, and then really using that digital to connect the in between. So at Sutter, part of what we talk about is we want to deliver, you know, a seamless digital experience.

00:03:19:12 - 00:03:42:13
Jennifer Bollinger
We don't want people to have to do rework in person or to have completely different experiences digitally and in person. And we really focus on making sure that all of our patients are connected to us digitally, because that's what enables us to improve their navigation or communicate with them during the wait times, or communicate with them after the discharge.

00:03:42:14 - 00:03:56:18
Jennifer Bollinger
I mean, the experience with us really needs to be thought about in a 360 degree view, instead of just when they come in for a lab and leave. I mean, we want a relationship. And so that's really what the digital experience is about.

00:03:56:19 - 00:04:24:17
Kristin Preihs
Well, and it's a very comprehensive approach. And right now consumers and patients at large are much more involved, interested and aware of what their care can and should look like. So I really love how you've developed this more integrated 360 approach, because I think it really aligns with not only the demand that we're seeing from patients in the expectation of what their care should be like, but the integration with the systems that are evolving, that already exist so that they're truly integrated.

00:04:24:19 - 00:04:43:03
Kristin Preihs
And something that I saw is that Sutter's patient experience scores are exceptional, and that's a difficult thing to do, especially across a multisystem hospital. So can you talk a little bit about that evolution and why specifically you see Sutter as driving such high patient satisfaction scores.

00:04:43:10 - 00:05:06:19
Jennifer Bollinger
First of all, I wouldn't say they are as high as we would like them to be. Our aspiration is to be top decile rank in every category, and we're not there yet. However, we've made a significant amount of progress since we've been here, and I think a big part of that is not only the amazing leaders and care team members that we have here who really prioritize experience.

00:05:06:21 - 00:05:30:27
Jennifer Bollinger
It's also something that probably is near and dear to your heart. We do a lot of direct voice of consumer research to understand not only - and this is beyond the surveys - to not only understand what the expectations are, but if a patient could build something, how would they build it. And so we use evidence-based practices. We use a number of tools that many health systems use.

00:05:30:27 - 00:05:51:25
Jennifer Bollinger
But I think what's differentiated is that we really make it clear that what we want is for our team members to relentlessly eliminate friction, get the whole job done, is what we call it. Like don't just do your part of the job and say, well, that's somebody else's job. You know, we want people to get in for primary care and specialty care.

00:05:51:26 - 00:06:14:25
Jennifer Bollinger
We want them to have a great experience across every care setting. And then we have more data on people than pretty much any other industry. So how do we use that to anticipate future needs? So it's, you know, welcoming people, eliminating the friction, get the whole job done for them and then go a step further and then and think about what they're going to need next.

00:06:14:26 - 00:06:54:10
Kristin Preihs
Yeah. And I think eliminating friction is a really important piece, especially as we engage the patient, because having them be part of care decision making, even in thinking about how large systems engage patients on the whole by way of doing so, actually eliminates friction, because then you don't have to guess. You have the patient advising exactly what they hope their experience to be, and can design around that as what is most valuable in experiencing patient care, so that from an end user point of view and from a care coordination view, that experience achieves quality and is easier for then a provider to then move around that process, which is a win-win overall.

00:06:54:14 - 00:07:16:28
Kristin Preihs
The other thing that I just wanted to touch on is there's a deep integration of use in technology as you've described, to ensure that there is that patient integration in improved patient outcome experience. But technology is changing rapidly. What we saw two weeks ago is even different from what we're seeing today around topics in AI and governance, and even engagement of patients, and how technology is informing their care.

00:07:16:28 - 00:07:29:14
Kristin Preihs
And to your earlier point, how they're engaging in their care even when they're home and not in a clinical office. So from your perspective, how is technology evolving patient care and where do you see that going for the future?

00:07:29:16 - 00:07:59:08
Jennifer Bollinger
So I think our focus is really around reducing the administrative burden on both patients and the care teams. You know, health care and care are uniquely human and will always be uniquely human. The role of technology is how do we make it easier and more connected and stitch together and really take some of that administrative burden off of care teams so that the connections that they make can be more human?

00:07:59:08 - 00:08:08:08
Jennifer Bollinger
So that's how we think about it. How does technology free up the humans to be even more human as they're delivering care?

00:08:08:12 - 00:08:20:03
Kristin Preihs
And as a follow up to that, are there certain technologies that you're looking at that you can assess are truly solving a problem, and how do you approach that at Sutter?

00:08:20:06 - 00:08:41:02
Jennifer Bollinger
So I would say we're Epic first. So we always look to see if there's a tool within Epic, which usually there is, and maybe we just don't have it deployed in the right way. Or maybe we need to help co-develop it or redesign it. I mean, we did work with Epic and we were the first to launch Emmy, which is a virtual assistant that lives in your chart.

00:08:41:06 - 00:09:04:16
Jennifer Bollinger
We knew that patients were going outside of health care in ChatGPT and other places to ask questions about their health. This gives you that same opportunity, but it answers the questions within the context of your own record. So based on family history or based on conditions or results that you may have already received. So it's super valuable. So, that's what I'm saying,

00:09:04:18 - 00:09:24:00
Jennifer Bollinger
like we would certainly go Epic first. And then, you know, there are definitely other partners that we've brought in. Like a bridge, that ambient listening, which really helps the care team members not have to document, not have their attention distracted by the technology and really be able to focus on the patient.

00:09:24:01 - 00:09:47:01
Kristin Preihs
And Emmy at Epic is a really great example of ensuring that technology is really organized in that 360 way around a patient in decision making. They can ensure scheduling. They can ask questions directly to the provider at a time that best suits them. So that's a, I think, just a really great example of how the field is evolving and how Sutter is really looking at EHR optimization focused on the patient.

00:09:47:01 - 00:10:10:01
Kristin Preihs
And going back to one of your earlier comments that healthcare is inherently human, and it's also incredibly evolving in terms of technology solutions. So can you give some advice, especially since you're so patient centric and acknowledge the evolutions that are occurring on what should stay the same in healthcare and what needs to evolve to ensure that patient is continuing to receive that quality care?

00:10:10:04 - 00:10:34:07
Jennifer Bollinger
So I would say what is central to healthcare is the relationship between the patient and the physician or the patient and the caregiver. We cannot disrupt that. Anything we do cannot drive a wedge or disconnect that. And I would say future generations, that's going to be a struggle because they are very much about episodic, convenient, not looking to develop that relationship.

00:10:34:07 - 00:11:03:16
Jennifer Bollinger
I really think, we really think that ongoing relationship and that continuity of care is super important. So I just say if you think about other industries, things that move somebody along more seamlessly in a process and help them navigate and help get questions answered, but cannot and do not disrupt that relationship are super important. And that actually has another benefit, which is we've got to make sure there continues to be joy in the practice of medicine.

00:11:03:16 - 00:11:21:00
Jennifer Bollinger
And that is what people got into medicine to do is to build those relationships, take care of people. So if technology can enable that without interfering, I think we would have more joy in medicine again too.

00:11:21:07 - 00:11:42:20
Kristin Preihs
Well, I think that is a pretty fantastic point. And it sounds like Sutter has a clear plan for how to ensure that joy is continually given to its workforce and that patients are at the center. I had the opportunity to look at your Destination 2030 plan, and so there is clearly a plan in place to ensure that evolutions continue in line with what we know is most valued in health care.

00:11:42:22 - 00:11:54:00
Kristin Preihs
Can I ask you to give a few minutes on the Destination 2030 plan? And within that, even ask what excites you most as you look at this plan and think about the future for health care?

00:11:54:02 - 00:12:25:18
Jennifer Bollinger
Sure. So the plan is meant to set a clear vision for every single stakeholder involved in health care. So patients, physicians, our employees at large, and really clearly defining what we think it means to be the best in each of those buckets, I would say, you know, some of them cross over. So that digital experience, we're really looking at that for both the patients and care team members and employees across the organization.

00:12:25:20 - 00:12:57:27
Jennifer Bollinger
How are we using technology to allow the right human connections when we need to, and then take that burden off? You know, I think also as care moves more and more into ambulatory and outpatient settings and even into the home, that digital connectivity is going to be even more important, not only between the patients and the system, but the patient and actually their care team, because we're going to be developing new models at a pretty rapid pace.

00:12:57:27 - 00:13:11:25
Jennifer Bollinger
And I don't mean that we have it in the works. I'm just saying this is what I'm anticipating, and we're going to have to rely on that connectivity that, you know, consumers have gotten really comfortable with. And we're going to have to get comfortable with bringing it into this space.

00:13:11:27 - 00:13:31:02
Kristin Preihs
I think we're all going to be getting a lot more comfortable in the road ahead, because there's certainly a lot of evolution coming. And Sutter's has a plan and are very fortunate to have you at the helm. I wanted to thank you, Jennifer, for joining us today and for sharing your perspective on building a health care experience that is both innovative and, most importantly, inherently human.

00:13:31:03 - 00:13:46:18
Kristin Preihs
Congratulations again on the well-deserved recognition by Reuters. And thank you for the leadership that you're providing at Sutter Health. Also, thank you to our listeners for joining us for another episode of Advancing Health. Be sure to subscribe wherever you listen to podcasts, and we'll see you next time.

00:13:46:20 - 00:13:55:14
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:08 - 00:00:19:09
Tom Haederle
Welcome to Advancing Health. How will AI impact the practice of medicine? The most accurate answer is sooner than you think. Join us today for a different kind of podcast as four physicians discuss what AI holds for medicine, for patients and for themselves.

00:00:19:12 - 00:00:53:12
Chris DeRienzo, M.D.
Welcome everyone to a very special episode of the AHA’s Advancing Health podcast. I’m Dr. Chris DeRienzo , the chief physician executive of the AHA, and I am the luckiest human being on earth today because I am in a room with three of the most interesting doctors in the United States of America. I'm going to ask each of them to introduce themselves quickly, and then we have prepared a one of a kind podcast for you that imagined us to be sitting around one of our kitchen tables over a beer, talking about how AI will impact the practice of medicine over the course of each of our careers.

00:00:53:16 - 00:00:57:09
Chris DeRienzo, M.D.
But first, you got to get to know who these folks are, and so Tom, we'll come to you.

00:00:57:12 - 00:01:04:04
Thomas McGinn, M.D.
How you doing? Tom McGinn, I'm a general internist, and I'm the chief physician executive officer at CommonSpirit Health.

00:01:04:12 - 00:01:06:00
Chris DeRienzo, M.D.
Wonderful, Jackie, to you.

00:01:06:06 - 00:01:10:07
Jackie Gerhart, M.D.
Jackie Gerhart. I'm a family medicine physician at Epic and still practice.

00:01:10:14 - 00:01:11:08
Chris DeRienzo, M.D.
And Zia.

00:01:11:10 - 00:01:15:28
Zia Agha, M.D.
I'm also a general internist, and I'm the chief medical officer at West Health.

00:01:16:02 - 00:01:41:27
Chris DeRienzo, M.D.
And you also live in beautiful San Diego. And so for listeners, I want you to put your imaginary hats on and imagine that you are staring out at the lovely Pacific Ocean. It is an absolutely gorgeous view, and we're just sitting reflecting on the era that we're living through right now, but also what's to come. One of the most frequent questions I get asked when I'm on the road visiting with AHA members is, as a doctor, how do you think your life will change with AI?

00:01:41:27 - 00:02:00:19
Chris DeRienzo, M.D.
And I've got to call it maybe 20 years left in the arc of an average career. And what I typically answer them is faster than you think. I remember one year ago I was doing a panel with this amazing CMO who told me, look, right now we're just beginning to get ambient into our systems and it works great.

00:02:00:19 - 00:02:17:27
Chris DeRienzo, M.D.
And I asked him, how long do you think until not only is ambient documentation listening to the conversation, the beginning to prompt questions based on having reviewed the entire medical record. You think it's three years? Five years, he said. Nine months. And I said, Dave, you got to be you got to be joking me. And here we are about a year later

00:02:17:27 - 00:02:30:08
Chris DeRienzo, M.D.
and he was totally right. So my top line answer is, I think it's going to change the practice of medicine quicker than most folks appreciate. But I'm wondering what you all think. And Zia, I see you looking intently at me. So I want to come to you first.

00:02:30:09 - 00:02:54:25
Zia Agha, M.D.
I think, Chris, the speed of innovation and the speed of change is truly breathtaking. I mean, I remember when EHRs were introduced or barcode technology introduced in the hospital, it was a decade long implementation. I think we're seeing AI go from 40% respondents in the AHA survey to now 81% in one year. So it is definitely catching on really fast.

00:02:54:26 - 00:03:04:10
Zia Agha, M.D.
It's also catching on really fast on the patient side. In our own survey with Gallup, 1 in 4 patients are using AI either before or after a clinical visit.

00:03:04:18 - 00:03:25:06
Thomas McGinn, M.D.
I mean, 100% agree, I think. But I do like to kind of pause a little bit and say, I think what I see now hopefully, and is augmentation of - not replacement. And I think that's a big question mark that everyone has, is this replacing you know, physicians, nurses, APPs? Look the ambient scribing - everyone talks about this now

00:03:25:06 - 00:03:46:19
Thomas McGinn, M.D.
and it it's the first time I've seen physicians banging on my door to get new technology. And they want to change. So I think that's fascinating to see them actually want to do this. And we also realize what we've done to physicians over the years with data entry and documentation that this is really a difficult situation, and we're finally have a relief for them.

00:03:46:21 - 00:03:56:07
Thomas McGinn, M.D.
Now, the question is, will they turn around from their computer and look their patients in the eyes, particularly the young physicians, might be anchored on their laptops and not sure how to turn around. So it'll be interesting to see what happens there.

00:03:56:10 - 00:04:15:04
Jackie Gerhart, M.D.
That's a really good point. I think in taking a step back, we've all heard that different clinicians might be having some kind of an identity crisis, and I think you're speaking to that. But as I've looked at my colleagues, it's more of an identity curiosity. I'm curious what it's going to be like for medical students in the next few years.

00:04:15:06 - 00:04:38:02
Jackie Gerhart, M.D.
I'm excited about what it is for me right now. When I went into medicine, thinking I would do whether that was, you know, a lot of documentation, whether it was curating on pre-rounds and then on rounds and then on post-rounds and so forth, some of the burden has really been alleviated. And I'm finding that there's kind of two types of AI that I'm seeing.

00:04:38:02 - 00:04:55:18
Jackie Gerhart, M.D.
The first is something that relieves friction and really reduces burden. And that's great. And the other is one that's really advancing medicine and trying to help us diagnose faster, treat faster, treat better. And really, I think the best AI is what's combining both of those. And that's what I'm most excited about.

00:04:55:19 - 00:05:07:07
Chris DeRienzo, M.D.
You lift up something that I think about a lot, and I was having this conversation with my eighth grader not too long ago. We were doing her math homework and she said, dad, why do I have to learn this? I will never be without technology and..

00:05:07:07 - 00:05:07:25
Thomas McGinn, M.D.
Scary question, really!

00:05:07:26 - 00:05:31:16
Chris DeRienzo, M.D.
I feel like that's sort of the conversation we're having in many professions, but certainly in the in the profession of medicine, I don't know that memorizing the Krebs cycle should be a gate by which we, we ask students to, to pass through their, their medical careers. But at the same time, I don't think we've answered if we don't make sure you memorize the Krebs cycle, how do you understand what a urine organic acid deficiency actually is?

00:05:31:18 - 00:05:35:08
Chris DeRienzo, M.D.
And I feel like this is kind of one of our biggest challenges right now.

00:05:35:10 - 00:05:51:02
Thomas McGinn, M.D.
The term I'm very worried about, and I think, you know, we're talking about, hey, what's this great thing going to look like in ten years from now? The question is from here to ten years. A lot of things to figure out and de-skilling is the big one for me. And, you know, we - CommonSpirit has, you know, two major academic hubs.

00:05:51:03 - 00:06:09:00
Thomas McGinn, M.D.
I'm a professor at Baylor. I work with the students, I make rounds, and I get worried when I ask people like, what's in that, that order you just put? It's a bundled, it's a bundled order, and they don't know what's in the order because it's bundled. That's not AI, that's just the bundled order. Now when I ask them, well, what's in that AI thing you just ordered?

00:06:09:00 - 00:06:19:08
Thomas McGinn, M.D.
And they can't unwrap it and understand all the different moving parts and the implications, that's a little bit of a concern. So de-skilling is something that we're really focused on.

00:06:19:10 - 00:06:25:26
Jackie Gerhart, M.D.
Interesting. You said de-skilling in the same conversation I often hear never skilling and is correct cycle.

00:06:26:03 - 00:06:28:02
Thomas McGinn, M.D.
That's right. Never skill? Absolutely.

00:06:28:06 - 00:06:48:00
Jackie Gerhart, M.D.
If you think about it, a few of us learn to do blood draws. We've learned to do multiple procedures that we probably never do anymore, even for me in primary care. As we go more virtual, a lot of the learnings that we had were around how do you do the perfect physical exam, and what does technology do to actually enhance the physical exam that you had before?

00:06:48:01 - 00:07:07:14
Jackie Gerhart, M.D.
And I think it's done remarkable things. And in many cases we're trying to figure out what technology to augment humans. But I do still think there's this never skilling component of what are the things that we actually can take away from the physician that maybe just were there because of legacy purposes or because that's how it always was done?

00:07:07:18 - 00:07:27:02
Jackie Gerhart, M.D.
And yeah, I feel like there's this we have this concept of eliminate, automate and rebalance, which is if you can just get rid of the work period, not put it on someone else, but just get rid of it, period. Maybe give it to AI, just get a better workflow and get it out of the system immediately. That's kind of the question I ask before I even start using a certain technology.

00:07:27:03 - 00:07:29:04
Jackie Gerhart, M.D.
Do I even need to be doing this in the first place?

00:07:29:10 - 00:07:46:06
Zia Agha, M.D.
I think I want to take the conversation outside of the patient-physician encounter, because we've talked about that a lot. You know, we see patients and then we say, okay, come back in six months and they say okay, he's going to be fine for six months. What happens when something goes wrong in between? And I think that's really where the opportunity is.

00:07:46:08 - 00:07:53:20
Zia Agha, M.D.
How do we use these technologies to sort of keep our patients tethered to the healthcare system and be proactive?

00:07:53:22 - 00:08:12:27
Thomas McGinn, M.D.
We have a connection centers. We have five hubs to the country that are really well done. They reach out to patients and now we're automating auto reach outs. One vendor did come to me,  an AI vendor to show me these outreaches to patients who you can model they might be at risk. Think of an older woman with multiple chronic illnesses just discharged a few months ago.

00:08:13:00 - 00:08:29:04
Thomas McGinn, M.D.
The conversation the AI tool had with the patient was unbelievable, but it was really the purpose would be augmenting between the visits, touching base, looking for signals, and just comforting patients that, you know, hey, just checking in. You just had surgery. You want to make sure you're doing okay.

00:08:29:07 - 00:08:55:06
Chris DeRienzo, M.D.
I think we're centering on something that that, to me, is a fundamental aspect of how the practice of medicine will change. And that's there are things that we've never had the bandwidth to do that are now doable. And given the nature of the workforce crisis we face, with 12,000 people turning 65 in America every single day, and the population pyramid that we had in the 1960s narrowing itself to more of a population pillar, we never will have enough people to do these things.

00:08:55:06 - 00:09:18:04
Chris DeRienzo, M.D.
So technology can allow us to do things we've never done. But it also means, and you hit on this a little bit, Jackie, that there is some things that maybe we don't have to do anymore. And I think the open question, I think about my life as a neonatologist. I don't think that, you know, robots are going to be putting in central lines in the next five years, but 20 years from now, maybe, maybe.

00:09:18:06 - 00:09:37:07
Chris DeRienzo, M.D.
And so what am I doing as a neonatologist if, you know, five years from now, I don't have to be doing what I remember doing as a medical student like you go into the manual chart writing the vital signs. You know, that same shift is transitioning from the electronic space to the physical space in the course of our professional careers.

00:09:37:09 - 00:10:02:24
Thomas McGinn, M.D.
I worry a little bit about this. This never skilling thing is fascinating to me, because training in a big county hospital and putting IVs in patients that were very difficult to access veins, and then an IV team came in and suddenly took over. I mean, it's a different - it's not a bot - but it's...Actually I think we didn't we missed a lot of moments with our patients sitting with them, trying to put an IV in the middle of the night doing work like that.

00:10:02:26 - 00:10:08:01
Thomas McGinn, M.D.
There's some things you lose in that process, so particularly around the patient.

00:10:08:08 - 00:10:29:12
Jackie Gerhart, M.D.
I love the idea of giving back a certain amount of time, or maybe even freeing up time that you never had in the first place. And what will you do with that time? There's been a couple of surveys on would you see another patient? Would you learn more? Would you actually eat or go to the bathroom? I think some of those are just, you know, it speaks to the survival that a lot of us are feeling.

00:10:29:12 - 00:10:50:25
Jackie Gerhart, M.D.
And how does one survive? For me, for example, I started out in general what some might consider country practice, family medicine, where I did inpatient, outpatient, OB, nursing home. Followed all of the same folks that were in my panel and really knew them by name. And I think your point is a good one that, you know, as we take away the administrative burden of what does that mean

00:10:50:25 - 00:11:15:01
Jackie Gerhart, M.D.
to bring you back to your patient, is what other things are there that the patients actually want that we haven't really been listening to? We're still in this age of where, you know, whether it be fee for service or whether it be in front of the patient or whether it be in an institution. I think there's this concept of asking patients how they want their health to be, what their goals are, and who do they want to be tethered with, who is their care team now?

00:11:15:01 - 00:11:18:22
Jackie Gerhart, M.D.
And that might look very different now in the age of AI than it did before.

00:11:18:25 - 00:11:42:15
Thomas McGinn, M.D.
Well, when you listen to these conversations with the AI tools, patients love them. The one thing you'll hear me say when I talk AI, we're rolling out ambient scribing across the system. We as leaders in healthcare cannot make this a throughput engine only. We need to look at the moment of care and are we enhancing it and not just ratcheting up the RVUs only?

00:11:42:16 - 00:11:46:10
Thomas McGinn, M.D.
I mean, you may get 1 or 2 visits in, but you'll also get better visits.

00:11:46:13 - 00:12:17:24
Chris DeRienzo, M.D.
I did a panel not too long ago with the CEO for a large multi-state health system, and he described the primary ROI that their system was measuring on an ambulatory AI rollout for ambient for physician APP documentation was the experience of a clinician and the experience of the patient, because they recognized that the generation we have all lived through has layered technologic burden on as we digitized a manual process, and that we've now spent a good ten years realizing that need to be optimized.

00:12:17:24 - 00:12:48:02
Chris DeRienzo, M.D.
And so we're working through that optimization. But at the same time, anything we can do to relieve some of that burden gives us back time for what, at least for me, have been the most meaningful moments of my clinical career. And I can remember sitting with human to human, having these conversations, making hard decisions. To me, that's my hope for the next 20 years, is that the physicians who are not even in medical school yet, because I guess 20 years from now, there would probably be preschoolers right now or something like that.

00:12:48:02 - 00:13:00:12
Chris DeRienzo, M.D.
So, so the four year old preschool classes, who will be graduating medical students when I am finishing my career, that that most of their time will get to be in those impactful relational settings.

00:13:00:13 - 00:13:22:19
Jackie Gerhart, M.D.
And maybe the measurement changes as we think about - sometimes I'll look at the term to work at the top of your license, and I like that term because I think it tries to imagine what it is that when we're doing our best work. But inherently in that term is the word license. And working at the top of your license means that you literally are getting licensed by an exam that probably was created before AI.

00:13:22:20 - 00:13:47:04
Jackie Gerhart, M.D.
And so what does that mean for your skill set? I think for me, I highly value if I were on a medical school admissions committee, I would value curiosity and judgment and ability to communicate. I think we as clinicians need to be thinking more about how do we take science and be able to translate it and amplify it to the rest of the public so that they can really make decisions?

00:13:47:04 - 00:14:06:09
Jackie Gerhart, M.D.
And I think in this age of democratization of data, when patients have all of this information in front of them, we can really be a helpful guide, not someone that tries to push it aside, but someone that really brings it into how we're going to advance medicine and have individualized, personalized care that can be done faster and more effectively.

00:14:06:13 - 00:14:25:15
Chris DeRienzo, M.D.
So I've got to ask, just like closing thoughts, because we talked our viewers, our listeners through some pretty interesting rollers here over the last nearly 20 minutes. What gives you the most hope about the rest of the arcs of our career? If you had to just sum it up in one thing, Tom, what gives you the most hope?

00:14:25:18 - 00:14:50:24
Thomas McGinn, M.D.
Well, I think we've been talking about this. I think this will free up clinicians to be with their patients. And I use the word caring very intentionally. So I think we've somehow, through our productivity mindsets, kind of knocked caring out of a lot of the health system. And by caring really wanting to be with the patient and care with them in their entire journey.

00:14:50:26 - 00:14:57:12
Thomas McGinn, M.D.
I hope, I really hope this helps us be with them in their journey, because the journey is not a visit.

00:14:57:16 - 00:15:14:25
Zia Agha, M.D.
Couldn't agree more. I think the key word is we are all caregivers and I think if these tools can help us be better caregivers to help our patients. You know, we work at rest with a lot of older adults and sort of dignity, with respect and with the right outcomes is so important.

00:15:14:26 - 00:15:16:17
Chris DeRienzo, M.D.
Jackie, last word comes to you.

00:15:16:18 - 00:15:41:07
Jackie Gerhart, M.D.
I'm really hopeful about reimagining what it means to have health and health care. And for a long time we've thought about it as something that you physically go to. You do a physical exam, you physically go to appointment, maybe even a virtual appointment. But I really liked the discussion we had around this continuous care. And most of the points that patients have in their life and their well-being are not going to be in front of a clinician or a doctor or a hospital.

00:15:41:07 - 00:15:50:06
Jackie Gerhart, M.D.
And so how do we respect those? And in the age of AI, having that be part of the care team and really help them get to what they want for their lives is very promising.

00:15:50:07 - 00:15:54:20
Chris DeRienzo, M.D.
I promised you a conversation with three of the most interesting physicians in the world.

00:15:54:21 - 00:15:56:19
Thomas McGinn, M.D.
You're the fourth one,

00:15:56:20 - 00:15:57:15
Thomas McGinn, M.D.
yes, please, Chris!

00:15:57:18 - 00:16:06:09
Chris DeRienzo, M.D.
You all are far too kind. I promised you a fascinating conversation. This more than delivered and we so appreciate it. Thank you all for listening until next time.

00:16:06:12 - 00:16:15:06
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.