Advancing Health Podcast

00:00:00:16 - 00:00:24:26
Tom Haederle
Advancing health equity is a key priority for the American Hospital Association and the American Medical Association. Both organizations have many initiatives and programs underway to support these efforts. But this work is challenging on many fronts.

00:00:24:28 - 00:00:48:18
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. This podcast features a conversation between the AHA's Joy Lewis, senior vice president of health equity strategies and executive director of the Institute for Diversity and Health Equity, and Dr. Aletha Maybank, senior vice president and chief health equity officer for the American Medical Association.

0:00:48:20 - 00:00:57:00
Tom Haederle
Hear them discuss some of the top challenges and opportunities for advancing this pivotal work. And now, let's turn it over to Joy.

00:00:57:02 - 00:00:58:20
Joy Lewis
Is it fine to call you Aletha?

0:00:58:23 - 00:01:01:17
Aletha Maybank, M.D.
That is fine. Okay. Absolutely.

00:01:01:19 - 00:01:24:21
Joy Lewis
It's such a pleasure to have you here with me today. I've literally been waiting for this conversation for quite some time. And then you penned this...this piece we're going to talk about that was published in the New England Journal of Medicine in March, I think it was. And that accelerated our conversation today. But thank you for joining me.

00:01:24:24 - 00:01:56:28
Joy Lewis
And just for our audience, a little bit about your career that has spanned quite a few inaugural leadership roles, including the role you currently occupy as the chief health equity officer at the American Medical Association. You were also the founding deputy commissioner for the Center for Health Equity at New York City Department of Health and Mental Hygiene. And the founding director at the Office of Minority Health in the Suffolk County Department of Health Services.

00:01:57:00 - 00:02:27:20
Joy Lewis
You've taught medical and public health students on constructs related to health inequities, topics such as public health leadership and management, physician advocacy. I know that's a real area of emphasis for you. And community organizing and health. Maybe we can start by looking at, you know, given your background and experience in DEI and health equity, you, like many of us, are, really in a tough position right now.

00:02:27:22 - 00:02:59:22
Joy Lewis
Our nation is seeing significant backlash efforts toward DEI efforts, across the board, frankly. And as I mentioned you took pen to paper and, you wrote a piece entitled, “The Plight of DEI Leaders: Heavy Expectations and Limited Protection.” And in that piece, you shared quite a bit about your personal experiences, about the attacks, the criticisms you're facing as a leader in this space.

00:02:59:22 - 00:03:23:09
Joy Lewis
So let's start with something a bit closer in and a little more personal about how are you feeling and how are you coping with the demands of your role and the broader political environment within which we find ourselves, and maybe touch a little bit on why now? Why did you choose to write this piece at this particular time?

0:03:23:12 - 00:03:43:14
Aletha Maybank, M.D.
Sure. Thanks, Joy, for having me on. Great to be in conversation and share space with you all the time, because I think that's an important part of how we cope. Truthfully, to be in community with one another, sometimes. And it helps support our own kind of experience to have shared validity of what we are going through.

0:03:43:15 - 00:04:09:03
Aletha Maybank, M.D.
You know, in this environment, though, there's so much, you know, and there's so much, so many constant reminders of how people don't fully value other people. And for all these reasons that, you know, I just sometimes, you know, I could say, of course, I understand some historical nature and context and stories that people have been told.

0:04:09:05 - 00:04:36:13
Aletha Maybank, M.D.
But, you know, when you're not rooted in that way. And I wasn't raised in that way, and it's still just so hard to want to even understand, you know, especially when people are harmed. And I, you know, the context of people being harmed should be appalling for all of us. But it's not. That just becomes exhausting. And you may have heard me say before, I feel now, especially at this point in my career, I didn't feel it as much earlier.

00:04:36:13 - 00:05:14:26
Aletha Maybank, M.D.
But I’m paid to convince people to care about the humanity of others. Is really my overarching role because that's at the core of it. If we all actually valued each other and even in not understanding each other, knowing we don't know what we don't know. So a lot of my work is really in creating those kind of environments of which that happens, like I believe in the context of proximity. And that in order to actually get to that space of, of seeing and understanding being proximate to someone you know, Bryan Stevenson talks about that.

00:05:14:26 - 00:05:30:09
Aletha Maybank, M.D.
Many people have talked about that. I think about, again, how I was raised by my mother. She, you know, grew up poor in another country but ended up having a, you know, a decent amount of privilege here because of the work she put it in her. She's a smart, brilliant person,so was able to create a lot for me.

00:05:30:14 - 00:05:49:10
Aletha Maybank, M.D.
I did not grow up in the way that she did, and she recognized that and said, I can't have this, I don’t know if it's a false sense, but I need to have a more global sense of the realities of others. And so she would place me in the people's homes that did not have what we have. You know, and so I learned a lot about that and as a context growing up.

00:05:49:10 - 00:06:07:06
Aletha Maybank, M.D.
But that's important in the work that we do. We talk a lot about the data pieces, which are important terms of accountability and seeing change over time. But I don't feel that that's the point of which people actually change their will and want to do better and be better and lead better. And so that's where I come back to

00:06:07:06 - 00:06:37:15
Aletha Maybank, M.D.
I feel like a large part of my role is convincing people to see the humanity and to care about others in ways that are different than their own self-interest. And I wrote that piece, you know, in all honesty, because I was feeling a lot of pressure, from within institution, outside of institution, not really being, not knowing if people really see the complexity of the experience.

00:06:37:17 - 00:06:53:14
Aletha Maybank, M.D.
And I knew just based on what was happening already and the kind of the news stream, folks like you who I was in conversation with. And so I wanted to create this space where I was going to kind of speak to it. The first iteration of this was actually a love letter. And it was a love letter to

00:06:53:15 - 00:06:54:08
Joy Lewis
To yourself.

00:06:54:09 - 00:07:15:26
Aletha Maybank, M.D.
No, a love letter to DEI colleagues across the country. Okay. With a different frame that was a little bit more and it started off more so kind of I see you, I feel you, you know, and it was more directed towards, you know, the leaders themselves. Now there's a secondary piece of that to how it turned out to be when I had to condense it, because of where it ended up being published.

00:07:16:01 - 00:07:35:17
Aletha Maybank, M.D.
So I, you know, I wrote it because I felt the desire, one, to be in like solidarity with many of us doing this work. I wanted you all to be seen and heard in a way that typically people are not talking about it and people aren't asking us really how it is. There are a lot of assumptions being made.

00:07:35:19 - 00:08:18:28
Joy Lewis
Wow. There's so much there, so much to unpack, starting from even your land of origin, at least in terms of your mom's history and where she's from. And, you know, I actually come from a very similar experience as being born and raised in Jamaica, where being black is actually celebrated. Right? The vast majority of Jamaicans look like me, and when you're the predominant culture — and granted there's white Jamaicans, Indian Jamaicans, Chinese Jamaicans — but the motto there, the Jamaican motto is "out of many one people."

00:08:19:00 - 00:08:43:05
Joy Lewis
So everyone actually sees themselves first as Jamaican. It was shocking when I at 14 years old, came to Brooklyn and granted, there's quite a Caribbean community there. But quickly I started to realize it's a different game. It's a different way in which the dominant culture relates to black Americans.

00:08:43:07 - 00:09:07:14
Aletha Maybank, M.D.
When you see yourself as presidents, doctors, all the rest, there's nothing telling you can't be or can't do, right. But when you get to an American society, no matter, even if you're in a predominantly black community or neighborhood, the structures and the systems and all these institutions that we work with, the work that we are doing, continually tells us we're not present, we're not seen, we're there in limited numbers.

00:09:07:16 - 00:09:34:01
Joy Lewis
Well, thanks for taking, carving out some time. It sounds like it was cathartic for you to actually write this piece. And it's been well received by those of us in this space alongside working alongside you and others. So in the article, you mentioned that DEI leaders cannot be held accountable for their institutions’ decisions, right? Specifically, you have,

00:09:34:01 - 00:10:01:14
Joy Lewis
“But higherDEI leaders cannot be held personally accountable for their institutions’ decisions. We are being scapegoated for our institutions’ decisions. While we have no power to make these decisions on our institutions’ behalf.” So can you provide a little more insight? And, what were you thinking as you were reflecting on being scapegoated? What in fact should DEI leaders be responsible for?

00:10:01:15 - 00:10:21:04
Joy Lewis
Because it's certainly a mixed bag out there. And if you can share with our listeners a little bit more about your vision for our role to work behind the scenes where we're really trying to change people's hearts and minds, which is a tall order.

00:10:21:07 - 00:10:42:01
Aletha Maybank, M.D.
It's a very tall order. But and because all these are very personal, because it's all about value, it's all about how we value people. Correct. So what I meant at that moment, I was getting a lot of, you know, the hardest part is when you feel like you're misunderstood. And when you work in an institution like the ones we work in, there are a lot of assumptions.

00:10:42:03 - 00:11:02:16
Aletha Maybank, M.D.
Unless you know me personally, you know, and you know how I show up and you know my level of courage and my level of, you know, being very direct. And I am not my institution. You know, I am Aletha Maybank who is our chief health equity officer. Do I have influence at certain points? Absolutely. But I am not over the power of my institution.

00:11:02:23 - 00:11:32:17
Aletha Maybank, M.D.
My institution has a board. It has a House of Delegates. There's an executive vice president. I'm supporting and working on behalf of these members and responding to policy that's passed. I don't create policy. I don't create statements or positions. And to get held accountable for it. And that's what was happening, and is happening was really hard because whether I align with positions or not, it's not my decision.

00:11:32:17 - 00:11:55:00
Aletha Maybank, M.D.
And as an individual, it's really hard to take on the burden of an institution that's been around for over 175 years plus. I would be held accountable for the work that I'm to do. My work was to facilitate a process to begin to embed equity into the entirety of the enterprise of the American Medical Association. And that has been my work really in my former roles as well.

00:11:55:02 - 00:12:12:26
Aletha Maybank, M.D.
And so following that roadmap, that usually means I need to create a strategic plan of some sort and create a team that can help do that, but also work with others across the entire enterprise. It's not just about me and my team, it's about also how I manage up and how I manage across and how I work with colleagues.

00:12:12:28 - 00:12:27:13
Aletha Maybank, M.D.
That's the nature of my work. How well I facilitate my, this process and help support creating and contributing to the culture, the policies and the practices within the institution and how we measure them.

00:12:27:13 - 00:12:55:06
Joy Lewis
You know, for you, it's 175 years, for me, we just celebrated 125 years last year. I mean, there's legacies, legacy thinking. There are structures in place that support the fact that we've been around this long, right. And so it is certainly a challenge. And for those who think we are not being disruptive enough, right,

00:12:55:06 - 00:12:59:27
Joy Lewis
it's just it's hard to hear that.

00:13:00:00 - 00:13:23:12
Aletha Maybank, M.D.
It is hard. And I think in the article I made sure, I want to acknowledge the role and the critical nature of our external organizing. That is paramount. It is absolutely paramount. We have changed and movements have been structure of change because of the organizing that happens locally in our communities, nationally, on a consistent day to day basis.

00:13:23:12 - 00:13:44:18
Aletha Maybank, M.D.
The shoulders that we stand on. And because these institutions were not set up for us or by us, and most people who have been historically marginalized or colonized, we have to stop some level of the bleeding because these institutions weren't set up, they were harming us. And so we need to be here on this inside. And this is a hard part of the work

00:13:44:18 - 00:13:57:15
Aletha Maybank, M.D.
truthfully. I don't feel this is a healthy work to doing equity work on the, that's what I've learned at this point in my career. I'm not saying it's not necessary, but I'm also clear it's also not fully healthy.

00:13:57:18 - 00:14:08:28
Joy Lewis
I think I've also heard you say just in our conversations, you know, here and there, that you, you actually look forward to a day where our roles would not need to exist.

00:14:09:02 - 00:14:28:23
Aletha Maybank, M.D.
Yeah. That's with anything and these aren’t, we aren't new to these roles, right. Roles probably came around in the ‘60s as civil rights you know. And then they started to hire the first of everything, you know, first blacks of everything to be in this, these institutions maybe a little bit before that. But you know, then you start to see the evolution and you have these laws and structures are passed.

00:14:28:23 - 00:14:59:13
Aletha Maybank, M.D.
Somebody had to do the work of ensuring equal opportunity and access, that is afforded to us, you know, through civil rights law. But nobody ever really fully thought about the harm that's caused by all this. I think it was a good thing at one level. But these roles haven't fully evolved to a level of understanding and structure that more has to be in place to protect the individuals and those who are doing this work within the institution.

0:14:59:15 - 00:15:12:17
Joy Lewis
So leaning into that a little bit more, how can these institutions protect us and help us feel safe when the there's this noise all around?

00:15:12:19 - 00:15:41:11
Aletha Maybank, M.D.
Right. A couple examples and I'll start first with kind of, you know, the frameworks that are used. And I believe we should have frameworks that we use to, or plans whatever you want to say, that are built on some previous models that have existed. And so I've in our strategic plan and I mentioned, you know, that we've used the Government Alliance for Racial Equity that's been in evolution in development for over 20 plus years

00:15:41:13 - 00:16:17:17
Aletha Maybank, M.D.
as a foundation. Just so that there's a level of consistency around the communication, people, staff are able to understand and buy into it. The part that has always been missing is the trauma-informed piece to it. And so I do believe and so we added that kind of around it, I would say California Department of Health has probably done some of the best work around ensuring that when they implement models of equity and frameworks within their institution, they're also building in trauma-informed systems and supports and ensuring that there's training from across as it relates to trauma-informed support, so that that safety . . .

00:16:17:20 - 00:16:27:05
Aletha Maybank, M.D.
And I don't want to say, I think these institutions become more safe. I don't want, there's no ultimate safe within this in a context of these institutions.

00:16:27:05 - 00:16:28:20
Joy Lewis
It's a continuum, right? Yeah.

00:16:28:20 - 00:16:50:13
Aletha Maybank, M.D.
And I think, yeah, you know, we can create safer environments where people feel more included and they can show up as themselves and be themselves, and be responsive. So that's just, that's one thing. I think the other critical nature is, is top level leadership. If top level leadership is not on board with any of this, I don't see a point in doing any of this work, period.

00:16:50:15 - 00:16:51:24
Joy Lewis
Couldn't agree more.

00:16:51:27 - 00:17:22:08
Aletha Maybank, M.D.
It doesn't work. You know, I think the ability to that leadership then to create spaces or to allow their teams to have space and to develop space that inform some level of what is happening in terms of culture at the institution is absolutely critical also. Because again, you're getting ideas again from the folks who are most proximate to the experience of what it means to be an employee.

00:17:22:08 - 00:17:42:04
Aletha Maybank, M.D.
It's different. My experience is way different than other staff members. Like, I understand where I'm positioned. I am at a position of power to some level and a large level, truthfully, compared to most team members. Now, I'm not saying I have...as I've mentioned, I'm very clear about my limits, very clear.

0:17:42:09 - 00:17:45:23
Joy Lewis
But there's influence that you can, you can certainly wield.

00:17:45:26 - 00:18:00:29
Aletha Maybank, M.D.
Absolutely. And so we have, you know, we have to do all that. But that's important, the leadership showing up and creating that space, having that consistency, communicating around it as well, not making assumptions that people know what it is. You have to have the comms plan.

00:18:01:01 - 00:18:03:13
Joy Lewis
And you have to be redundant in your communication around it.

00:18:03:13 - 00:18:22:02
Aletha Maybank, M.D.
That's right. Yeah. And so those are the things — that's kind of at the organizational space now for us who are doing, you know, more specifically for us is doing this work because that's all helpful for our work. Right? That's all helpful for how we were able to lead in this work. How the employees are helps us, right?

00:18:22:05 - 00:18:41:08
Aletha Maybank, M.D.
Because who could who do people come to, you know, when there are problems? I'm sure you have heard many things that aren't particularly job-related to the role of, you know, chief health equity officers to some level. But you've heard, I'm sure, many complaints because you become the safe person that folks want to come to. Right.

00:18:41:10 - 00:18:51:19
Aletha Maybank, M.D.
And if the institution is not showing up, the systems aren't working for staff, they're going to come to us and that burns us out. We have to hear all these stories and we don't know what to do with them half the time.

0:18:51:20 - 00:19:05:20
Joy Lewis
No, you're spot on. Yeah. So you need the environment to beripe to do this work and to be supporting the work and to be supportive of the leaders who are, who are occupying these roles.

00:19:05:22 - 00:19:40:09
Aletha Maybank, M.D.
It's the context of physician burnout, right? If you think about it in that way, right. It's the same thing system, structures, culture. Does it work for patients? It's not going to work for our physicians, right. Or other health care workers and providers. They're going to burn out. But the one other thing that I'll say in terms of protections is now, in light of getting death threats, and I know several of us have been in this space, I think, you know, there has to be the responsiveness and ability for our own kind of HR security department, whatever it is, that if we need security detail, we need safety plans,

00:19:40:09 - 00:19:42:08
Aletha Maybank, M.D.
that needs to be provided as well.

00:19:42:10 - 00:19:53:12
Joy Lewis
That's right. So down to the very granular tactical like, yes, some folks may need protection outside of the workforce, outside of the workplace.

00:19:53:14 - 00:19:54:00
Aletha Maybank, M.D.
Absolutely.

00:19:54:05 - 00:20:26:23
Joy Lewis
So one of the things I think I struggle with is not having folks show up for usright? So having to be that person at the table who consistently raises the equity considerations into whatever the conversation is that we're having. And, you know, I guess some of our critics would say that's a failure of on our part to, to embed equity into whatever the organization's doing.

00:20:26:25 - 00:20:55:19
Joy Lewis
You and I know that is not — again, the system is designed to produce the results it's producing. So how do you get colleagues to be more than allies? But to actually own some of this work in a way that's meaningful and impactful to, to move the needle? What guidance would you offer up? In terms of taking actions and not waiting for the perfect evidence to act?

00:20:55:22 - 00:21:17:00
Aletha Maybank, M.D.
Well, there's two quick two questions in that, but the first, this is where a top-level leadership is critical. And because I've been to several different institutions with different types of leadership, I understand the critical nature of when you have a leader that really holds your own colleagues accountable. You know, I've been in situations where I didn't have to do . . . that wasn't my role.

0:21:17:03 - 00:21:40:08
Aletha Maybank, M.D.
My role was to establish the framework and the process to embed equity, not have to actually hold the accountability of my colleagues. And, you know, some of that is done now. But the challenge, if that's not done at the leadership level, the reality is not everybody wants to do this work. That's just real, right? So we have to accept that.

00:21:40:08 - 00:22:07:15
Aletha Maybank, M.D.
So if we really are committed as an institution, then it's going to require somebody other than me who's the boss of other folks to hold people accountable. The other part of it, what I found is the better my relationship is with and I'm talking about individual colleagues, the more likely they are to show up with me. Now, some people are going to do that naturally, like they're just going to do that.

00:22:07:15 - 00:22:24:27
Aletha Maybank, M.D.
And I've had that. I've had that where I am, I've had that before. But I realize the more tense my relationship is with somebody, the more resistance it is, the harder it is to get them. And so I, you know, there's a part of me and it's hard because I have to care about the entirety of the institution.

00:22:24:29 - 00:22:56:29
Aletha Maybank, M.D.
But there's a part of me that at this point, I'm exhausted. And so I'm going to go to naturally, the folks who are ready and willing and just going to show up and step up, because that's where I have, that's where my energy, that's what I can handle right now. It's hard to continually fight folks, and it might not feel like a literal fight, but to constantly push up against resistance that can show up in so many different ways.

00:22:57:01 - 00:23:25:27
Aletha Maybank, M.D.
And that's the other part of it that folks don't realize it. Like people can resist with a smile on their face and the decisions and what you get blocked out of. And you know it's very isolating, as I know many of us have experienced. And you just get to a point where you almost sometimes question like, why are we doing this work?

00:23:25:27 - 00:23:47:16
Aletha Maybank, M.D.
You know, I understand the why, but there's an element of like, why? Like there's just it feels just so harmful and so frustrating, you know? But you have to then remember that there were harder fight, people were fighting harder fights than we are. And so that's kind of the obligation to it and also the hope of it, right?

00:23:47:16 - 00:24:16:00
Aletha Maybank, M.D.
. Because we know that their work and efforts did help, did help things get better from the inside and outside. And so we are here, just as you said, continuing that legacy with the same hope that what we put forward is going to help people overall, everybody, not just even a singular group of people, but it's going to help everybody because it's going to help our society, it's going to help culture, and it's going to help the human condition and way of being.

00:24:16:00 - 00:24:24:15
Aletha Maybank, M.D.
And so, you know, that's I don't know what helps you kind of move forward. But that's what I know . . .

00:24:24:18 - 00:24:42:03
Joy Lewis
That North Star around,you know, making lives better, creating better conditions for people to show up in their own lives and be able to have access to those opportunities that are going to yield the outcomes that they want personally for, for themselves, for their families, for their communities.

00:24:42:03 - 00:24:42:28
Aletha Maybank, M.D.
We have to believe it.

00:24:43:01 - 00:24:43:24
Joy Lewis
We have to believe that.

00:24:43:24 - 00:25:02:01
Aletha Maybank, M.D.
I only believe it because it's happened in the past, that's for me. You know, I only believe that that is possible because I have read, seen, witnessed it happen in the past across legacies and generations. Other than that, I don't know why I would believe it.

00:25:02:03 - 00:25:25:04
Joy Lewis
Yeah. One of the things I'm compelled by is this notion of doing the work of equity coalition style. That's something I can get excited about. No, no one entity has all the answers. None of us in and of ourselves are going to be able to move the needle in a way that is, as significant as we say we want as a society.

00:25:25:04 - 00:25:50:00
Joy Lewis
So you have been behind the rise to health coalition: AMA, IHI, other partners, including the AHA. Can you say a little bit more about the power of coalitions to actually sustain the work that is happening today for future generations? How do you lean into coalitions to make that happen?

00:25:50:03 - 00:26:16:28
Aletha Maybank, M.D.
Yeah. So and I thank you for the question, because I'm also like really digging into making sure that when people when we say coalition, coalition could just mean a group of people coming together. But it's not just that. That's not how change happens. There's a context. I used to teach community organizing and health to public health students through Meredith McClure's book. And you mentioned it just a second ago.

00:26:17:01 - 00:26:42:00
Aletha Maybank, M.D.
Anything that has produced change and any group of people have used tactics and strategies as it relates to community organizing, no matter who it is, right? And I think that's poorly realized and understood by those who are not community organizers. Organized medicine gets it because that's what organized medicine is. It's organizing, right? Yeah. And what is organizing about?

00:26:42:00 - 00:27:13:14
Aletha Maybank, M.D.
It's building power with people so that people pay attention to the power. People pay attention to power, financial power, political power, collective power, people power. That's part of the point of being organized is to build power. And so to me, that's the nature of what a coalition at this day and age needs to be about, not just a group of organizations that come together in their individual contexts, have different ideas, but how do we build power to create and produce change?

00:27:13:16 - 00:27:32:14
Aletha Maybank, M.D.
How do you build power so that people pay attention to you and you become a relevant entity, so that what you say and your influence is critical? That's the nature of AMA and AHA, right? You know, there's so much power, whether it's financial power, political power or financial power, I would say, and so we have a lot of influence.

00:27:32:14 - 00:27:41:03
Aletha Maybank, M.D.
So people listen to us whether I would or not. I'm just saying they respond to that. Certain structures respond to that. Not everybody listens to us.

00:27:41:10 - 00:27:43:09
Joy Lewis
But we're seen as relevant.

00:27:43:11 - 00:27:50:20
Aletha Maybank, M.D.
To a certain segment of people. For those other people who hold power in political spaces. We're not seen as relevant to everyone.

00:27:50:23 - 00:27:51:18
Joy Lewis
Exactly.

00:27:51:18 - 00:28:20:25
Aletha Maybank, M.D.
If we are not meeting their needs. So I say that the coalition, to me, the vision is like, again, the opportunity to build power, the opportunity to be in community and the opportunity and you have to communicate within the context of that community, want to learn from one another and what we can do at our individual institutions. But then ultimately, collectively, what can we do to push, to advocate and to create changes that are structural?

00:28:20:28 - 00:28:40:29
Aletha Maybank, M.D.
You know, and so that is absolutely needed. And then there's this other word of solidarity that's also been a little bit challenged in my vocabulary, and me trying to understand what it means to, to be that and what it means. And there are a lot of different, you know, there's different contexts to that. I recognize our theories around it.

00:28:40:29 - 00:29:01:20
Aletha Maybank, M.D.
But the ability to be in solidarity for me means we have a similar vision and outcome. But we may not have the same like theory of change in tactics all the time, but there is a time where we need to come together for certain aspects of it, to push something forward, which means sometimes we may have to let something go.

00:29:01:23 - 00:29:29:16
Joy Lewis
So I'm going to give you the last word. I mean, there have been several nuggets here along the way. And so I wonder, is there any last, you know, reflection from the piece you wrote from just thinking about the larger societal pressures, the political environment, you know, the space with in which we find ourselves today.

00:29:29:19 - 00:29:37:00
Joy Lewis
Any words of encouragement for your colleagues who are doing this very difficult work?

00:29:37:02 - 00:30:21:11
Aletha Maybank, M.D.
Well, if it's for my colleagues, my DEI colleagues, 'cause the audience matters, right? I understand when decisions have to be made, because I also think there's a certain point in time if you are not healthy, we have to do what's best for ourselves at the same time. And I say that because I think we need that as, not that people are going to just jump all of a sudden, but to just have that relief and give yourself permission that what you're experiencing is real and you shouldn't have to necessarily suffer through it at this given time, you know. And it's up to you at

00:30:21:11 - 00:30:45:08
Aletha Maybank, M.D.
whatever point in time you want to be committed to it still. And that's fine if you want to stay. You know, nobody should knock anybody for their choices around how we do — or maybe not how we do but if we choose to do this work or not. And then I would say just for the larger context, there's no question that we all need to figure out how we're showing up at this moment in time.

00:30:45:10 - 00:30:55:12
Joy Lewis
Well, I can't thank you enough for your time spent today. It has been, hopefully reflective for you and instructive for our listeners.

00:30:55:15 - 00:31:03:25
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.

00:00:00:17 - 00:00:40:01
Tom Haederle
Hospitals strive every single day to improve the quality of the patient experience. The American Hospital Association's Quest for Quality prize, first awarded in 2002, recognizes exceptional health care, leadership and innovation in improving quality and advancing health in America's communities. In this podcast, Meet the winner and three finalists for the 2024 Quest for Quality Prize, and learn more about what these true health champions are doing to advance quality, safety and community health.

00:00:40:04 - 00:01:08:27
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. The winner of the 2024 AHA Quest for Quality prize is WellSpan Health in York, Pennsylvania. The three finalists acknowledged for their excellent work are Carilion Clinic in Roanoke, Virginia, Jefferson Health in Philadelphia, and MUSC Health in Charleston, South Carolina. We hope you'll take a few minutes to listen and learn more about their innovative work.

00:01:09:02 - 00:01:16:03
Tom Haederle
And the AHA invites you to apply for the 2025 Quest for Quality Award by September 13th.

00:01:16:06 - 00:01:41:05
Akin Demehin
Welcome to the Advancing Health podcast. My name is Akin Demehin, senior director for quality and patient safety policy at the American Hospital Association. We're coming to you live from the AHA Leadership Summit in San Diego, and I have the privilege of having the opportunity to speak with the awardees for this year's AHA Quest for Quality prize. So I'm going to ask the awardees to introduce themselves very briefly before we dive into the conversation.

00:01:41:07 - 00:01:45:28
Michael Seim, M.D.
Hi, I'm Mike Seim. I'm the senior vice president and chief quality officer for WellSpan health.

00:01:46:00 - 00:01:52:29
Suzy Kraemer, M.D.
Hi there. I'm Suzy Kraemer. I'm a general internist, and I'm the vice president and chief quality officer at Carilion Clinic.

00:01:53:02 - 00:01:59:08
Anthony Poole
Hey, I'm Anthony Poole. I'm the system director for quality assessment, performance improvement at the Medical University of South Carolina.

00:01:59:11 - 00:02:05:10
Trish Henwood, M.D.
Good afternoon, Trish Henwood. I am executive vice president, chief clinical officer for Jefferson Health in the Philadelphia area.

00:02:05:12 - 00:02:27:29
Akin Demehin
Great. First of all, congratulations to all four of your organizations for really providing an exemplar for the entire hospital and health system field around how to advance quality, safety and health equity. So we have a few questions for you about your approach to quality. The process of going through the award application, and so forth. So let's start with your quality journey.

00:02:27:29 - 00:02:38:24
Akin Demehin
And Dr. Seim, I'll start with you. Could you tell us about one of the more challenging aspects of your quality and patient safety journey, and a little bit about how your organization overcame it.

00:02:38:27 - 00:03:04:20
Michael Seim, M.D.
So like many organizations, we came together through a series of affiliations. And what that did was it brought us multiple different approaches to quality improvement and patient safety. So we felt it was really important to align our strategy early in the process. So for our health system, it started with our board of directors. So we really engaged our board of directors in helping us select lean management as our continuous improvement methodology.

00:03:04:23 - 00:03:29:06
Michael Seim, M.D.
We began by actually setting measurable outcome goals at the board level to drive quality and safety, and to improve the overall health of our populations. We really focus on three key areas. We set the aspirational goal to be the safest health system to receive care, the safest health system to work for. And third, we really committed to decreasing disparities in life expectancy.

00:03:29:09 - 00:03:56:09
Michael Seim, M.D.
So our board committed to that and committed to allowing us to perceive those bold visions, but having yearly accountability and measurable outcome goals to drive success. So we trained all 23,000 team members in lean management. We started doing methodology. We foresees to solve every problem to root and sharing broadly across the health system. So those were the guiding principles that led us on our journey.

00:03:56:12 - 00:04:22:25
Suzy Kraemer, M.D.
Well, at Carilion Clinic, what I noticed when I came into my position about four years ago was my clinical observations as a position, I saw great care being provided, but those same great outcomes weren't being reflected in maybe some of the publicly reported programs. And it really caused me as a clinician to continue to observe, continue to understand and study what the gaps were.

00:04:22:27 - 00:05:00:24
Suzy Kraemer, M.D.
And what I realized was that it was going to be essential to create a better structure for that great care to be realized and to make it more efficient, more effective. We really leaned into what we call a project economy. We expanded our team with project management and process improvement experts. And through that, we were able to support physicians and nurses working at the frontlines in their roles to achieve substantial and sustaining outcomes with the goals that define excellent care.

00:05:00:27 - 00:05:26:06
Anthony Poole
At MUSC health, I think one of the things that I can echo what Doctor Seim said about integrating health systems - so over the past six years brought on several new health systems that have established cultures already. And so starting to meet early and often as a quality team and with our leadership about the things that we have hardwired and meeting with their existing quality structures about areas where we overlap and similarities, and also some things that are going to change as we become one health system.

00:05:26:08 - 00:05:43:18
Anthony Poole
Another thing is, in the post-pandemic world, really a lot of changes in leadership, from nursing to different clinical skill set to operational. And so how are we continuing to keep things hardwired that ten years ago were very hard wired into a health system? Now we're having to do a lot more training early and often and keep those things top of mind.

00:05:43:21 - 00:06:03:14
Trish Henwood, M.D.
Similarly for Jefferson, I think in piggybacking on the comments from my colleagues, we came together from a series of mergers over a period of time. And really over the last four years, we've focused on creating a unified platform for the work that we're doing in quality safety, patient experience, health equity and population health. And we've put internal branding to that.

00:06:03:14 - 00:06:34:27
Trish Henwood, M.D.
We call that the on-point program. And that's really what we look at as our clinical operating system for how we focus on unifying the organization around the goals that we have in these areas. Again, goals that we work with our board in terms of coming up with the top priorities for the organization and thinking about how we can put the resources and the focus of the entire organization into that space, and really think about how we can redesign or design systems, depending on where we have processes in place to help support our people in delivering the best care possible for our patients and for our community.

00:06:35:00 - 00:07:08:17
Akin Demehin
Dr. Henwood, your comment really leads us into our second topic of conversation, and that really is engaging the workforce in this critically important quality, safety and health equity work. And one of the things we often hear from our members is just how critical the role of trust is in the success of those programs. And I think what stood out to the award selection committee about your organizations this year is every unit they visited, they saw, wow, the level of trust in the organization and its process for addressing quality issues is so high.

00:07:08:20 - 00:07:15:02
Akin Demehin
So I wonder if each of you could tell us a little bit about your approach to building that trust among your workforce? What did it take to get there?

00:07:15:04 - 00:07:41:02
Michael Seim, M.D.
So at WellSpan, it really started with the pandemic, and we were hit very hard throughout the pandemic, and we actually had to really concentrate on how we can work with and engage our team members. And part of that was actually listening. So we held many listening sessions to understand accountability and just culture and true empathy for our team members.

00:07:41:04 - 00:08:16:27
Michael Seim, M.D.
So we worked really hard to build that culture where people understood it wasn't punitive. And that actually I talked about this a little bit earlier, but we rebranded our whole patient reporting. Our major shift was changing from a reactive process to really engaging our teams to be proactive in trying to identify errors before they hit my patient. So moving from a safety first to a safety two organization and then moving from a leading root cause analysis to success analysis and really actually celebrating when people identify a problem before it ever happens.

00:08:16:29 - 00:08:41:24
Michael Seim, M.D.
So really moving to changing from like a reporting process to making everyone own safety and putting it as first priority in their organization. So we really doubled in on being the safest health system to receive care and then to work at. So we really wanted to balance for us the importance of team member safety along with patient safety, because you can't have one without the other.

00:08:41:26 - 00:08:52:21
Michael Seim, M.D.
So really trying to have our team members see that we're committed to their well-being as well as the care they provide our patients. And I think that went a long way to building trust.

00:08:52:23 - 00:09:19:27
Suzy Kraemer, M.D.
Well, I think you're going to continue to hear really similar approaches. I will say that that trust was already there long before I came to Carilion Clinic. And so I was in the role of only having to continue to build on that trust and prove to the team members that these weren't metrics we were chasing, but these were lives that we were improving - both our team members well-being in the workplace, as well as the outcomes for our patients.

00:09:19:29 - 00:09:49:03
Suzy Kraemer, M.D.
And you do that by pausing and celebrating the wins, by ensuring that you're kind and empathetic in your approaches. As a leader, my job is to remove barriers and to again permit those teams to excel at being so patient-centered. And now they can also achieve those outcomes that are the critical measures of how we measure success in health care.

00:09:49:06 - 00:10:08:29
Anthony Poole
At MUSC Health, quality trust starts at day one. When they come for orientation, they're not just watching videos of the CEO talking about the culture and things. They're really seeing it. They're hearing from chief quality officers and other key quality and safety leaders. So not only the CQO's, but the leader for our patient family advisory council or patient safety officer or risk management leaders.

00:10:09:05 - 00:10:26:21
Anthony Poole
And then when they get out of orientation and they get on their units, they're seeing leaders being present. They're seeing quality and safety rounds happening in each of the units, ambulatory, inpatient, and really eliciting open ended feedback from our care team members, making sure that everyone understands that their voice matters and really counts toward the changes that we're trying to implement.

00:10:26:22 - 00:10:43:18
Anthony Poole
You get a lot of information from your employees in those first 90 days. You know, are the things that we're preaching at orientation - are we seeing them when you get out onto the units? And as we've shared already, just really creating a just culture where reporting is encouraged and we learn from opportunities and it's really collaborative and multidisciplinary.

00:10:43:18 - 00:10:55:02
Anthony Poole
So whether you are a member of the EBS staff or you're a nursing unit leader, we want to make sure that you understand reporting is not punitive, but really encouraging that making your voice heard and counts.

00:10:55:05 - 00:11:14:04
Trish Henwood, M.D.
Just to add on to my colleague's comments, I think that we similarly at Jefferson Health have that foundational focus and safety, believing that we need to have that and the safety for our patients and again, the safety for our staff. We have a lot of focus on our great catch program and making sure that our teams know that we want to hear about opportunities to fix the system.

00:11:14:08 - 00:11:38:02
Trish Henwood, M.D.
We have a system safety huddle process where we take that information from those great catches and opportunities to fix the system and do that rapidly, and then bring that back to the frontline. So that helps us build the rapport and the understanding that we're asking our team members to take time to let us know when there's opportunities to improve the system, but that we're also focus on improving the system so they can focus on delivering the safest, highest quality care.

00:11:38:04 - 00:12:02:07
Trish Henwood, M.D.
The clinician well-being considerations are also quite significant for us in thinking about how we can make sure that we're demonstrating the value to all of our stakeholders in the health care ecosystem. So knowing that we're supporting our clinicians, again in optimizing the system, how they work in the EHR, where we can reduce best practice alerts instead of add them, for example, so that we can make sure that they can focus on delivering care for our patients and community.

00:12:02:10 - 00:12:22:12
Akin Demehin
Terrific. We are all gathered because you all are awardees of our Quest for Quality Prize. And so I was wondering if you could reflect a little bit on the process of applying for that award. What was the value of going through the award process to your organization, and did you learn anything about your organization in going through that process?

00:12:22:15 - 00:12:52:27
Michael Seim, M.D.
I think any time you give your team the opportunity to reflect on the work they're doing, it actually inspires them to work to a common goal. So what was really important to me and my team as we were looking at that is how are we integrated into our communities? So, who are a key community partners? How are they helping us drive quality and what programs do we excel in, and then what are our opportunities, even still, to figure out how we can make health care more accessible, affordable?

00:12:53:00 - 00:13:20:11
Michael Seim, M.D.
And really, it was an opportunity to sit back and reflect. And we used it as part of our annual planning process too for our group, to say this is where we see ourselves excelling, and this is where we have an opportunity even to go deeper into a topic. So I would just encourage everyone to fill out either the AHA Roadmap for Health Equity or to look at the Quest for Quality prize, because it really does give you the opportunity to assess how your program is doing in all of these key areas of health care.

00:13:20:13 - 00:13:42:05
Suzy Kraemer, M.D.
Absolutely, Michael. The application is an assessment tool. And in addition to reflecting, you can I mean, all of us has had to design a strategy to be able to achieve these outcomes. And so to see it objectively in front of you, the areas where you're clearly excelling and where you still have room to improve was very, very helpful.

00:13:42:08 - 00:14:09:08
Suzy Kraemer, M.D.
And then during the site visit, to have the opportunity to be in the room where all these teams came together. And for many of the aspects, I don't have oversight on the community health team, but it also inspired new ideas of how we're going to be working together for additional initiatives to serve our patients in their communities. And again, it was more than just what you've already achieved.

00:14:09:09 - 00:14:16:28
Suzy Kraemer, M.D.
It helped us build frameworks and really substantial goals for where we went ahead in the future.

00:14:17:01 - 00:14:32:24
Anthony Poole
So the great thing about the application process is it, as my colleagues have shared, it causes all to come together and really look at all the work that we're doing. As busy leaders, we don't take the time to really look in the mirror. You know, we all are in the weeds and on the grind of our day-to-day, the things that we're directly responsible for.

00:14:32:24 - 00:14:56:13
Anthony Poole
So MUSC, when we came together and we looked at what is the QUAI structure look like, what does our safety structure look like, our health equity approach, patient family Advisory Council? It was great because we had to put all that together into one document and really gave us an opportunity to look and say, wow, the collective body of work is really, really impactful, and just being recognized for it on the national level is such an accomplishment to the work that collaboratively the teams have been able to do.

00:14:56:15 - 00:15:23:22
Suzy Kraemer, M.D.
And then, if I could add, it was also very validating. We all know that performance in these publicly reported programs - I mean it's a currency of success. And to be recognized for this journey validated the investment, the restructuring, the accountability conversations, all the cheerleading, and it provided us even more momentum as we continue to look at the future.

00:15:23:24 - 00:16:00:07
Trish Henwood, M.D.
Just to build upon that, I fully agree that it was very validating and then also galvanizing process for the teams, both in putting together the application and having the Quest for Quality team come to the site visit. I think it really helped us at Jefferson reflect on how we are truly focused on being a learning organization and truly focused on continuous improvement, and that we know there's always opportunities to continue to improve, but the unifying platform that we have with the on point program and pulling together all of these different teams that contributed to the comprehensive application that we pulled together, I think does help us exemplify that

00:16:00:07 - 00:16:22:07
Trish Henwood, M.D.
our focus on quality and safety, health equity, patient experience, as our top strategic priorities are indeed the focus of the entire team. It's not the office of the chief quality or chief clinical officer, but was really the entire organization coming together for the application and for the site visit. And I think really exemplifying that that's how we do the work on the daily, that it's really an all organization focus on quality and safety.

00:16:22:09 - 00:16:41:05
Akin Demehin
Terrific. So we have a couple minutes left together, and I'm just going to open this question up to anyone who wants to answer. As you reflect on your really extraordinary work on quality and patient safety, do you have any sort of parting wisdom for folks out there who are looking to maybe take their quality and safety efforts to the next level?

00:16:41:06 - 00:16:42:23
Akin Demehin
What advice might you have for them?

00:16:42:26 - 00:17:03:15
Michael Seim, M.D.
I'll give the advice to making sure you have a clear objective in your program. So ours is all in about improving life expectancy. So everything we do, we measure based on that. So we use actuarial tables and other things to help us measure success. So examples would be, we committed to being at or above the 90th percentile for all populations,

00:17:03:15 - 00:17:32:11
Michael Seim, M.D.
for breast and colorectal cancer screening to start with. We saw that in 18 months we increased the number of people screened by over 25,000 patients. And when we calculate out, that's over 4000 years of life saved. And over 370 people who didn't die from breast or colorectal cancer. So as we continue to share our story, it's also engaging our communities and others to really help meet us at that goal of we want to eliminate disparities by zip code.

00:17:32:11 - 00:17:46:11
Michael Seim, M.D.
So we've mapped our entire market to understand where people don't live as long. So that's our North Star. In every program we're doing, we're measuring the how can we help increase the number of years of life saved and decrease the number of preventable deaths?

00:17:46:14 - 00:18:20:10
Suzy Kraemer, M.D.
I don't think I could have said it any better than that. Always keeping the message patient-centered and translating what a mortality index improvement means in real lives, whether the by week, by month, by quarter. That was a consistent message, but also from a strategy standpoint, as we all know, there's multiple opportunities where improvement can be focused. And it requires the leadership to determine where to deploy a finite amount of resource.

00:18:20:12 - 00:18:47:24
Suzy Kraemer, M.D.
And we always had the saying in our team meetings, you know, focus on everything, accomplish nothing. And we had to remain very, very focused, very strategic so that we could make the games turn it into our day to day operations and approach to quality and safety. And then we could expand our skill set, expand our focus to continue to achieve outcomes at a faster pace

00:18:47:26 - 00:18:50:17
Suzy Kraemer, M.D.
had we focused on everything at once.

00:18:50:24 - 00:19:23:02
Trish Henwood, M.D.
I think that's a key consideration in the quality space. We know that there are hundreds of metrics and innumerable programs that govern us from the standpoint of publicly reported programs, government programs. But the prioritization that you just heard from my colleagues is definitely been key for us in thinking about making sure that we're focused on what matters most, making sure that our entire team knows what matters most, making sure that we're thinking about how we create environment in the health care ecosystem where everyone can thrive, and understanding all those different stakeholders' perspectives on those key priority areas.

00:19:23:02 - 00:19:32:15
Trish Henwood, M.D.
So while focusing in, we're looking at things then more holistically and how we can design those. So I think overall the theme of prioritization and the structure to be able to deliver that.

00:19:32:17 - 00:19:49:17
Anthony Poole
One thing I always say in quality leadership is don't be afraid to set audacious goals. You know, if we can't be the quality leaders who are really raising the bar and the expectations then no one else in the organization is going to going to jump on board with it. So being able to set those audacious goals and then also just networking. AHA is a great opportunity,

00:19:49:17 - 00:20:05:19
Anthony Poole
I've really enjoyed a few days here. I'm learning and collaborating with other health systems who are doing things in ways that are different than yours. And this morning at breakfast, I sat with a nursing leader who I was telling about our multidisciplinary team that we have in the QAPI belt. So myself being a physician assistant, I've got nurses on my team.

00:20:05:19 - 00:20:27:28
Anthony Poole
We have pharmacists do what they're mph, we have a physical therapist, everybody creating different viewpoints and stuff. Whereas in some systems its very nursing focused and leadership quality, it's quality. Oh, it goes to nursing and stuff. So really talking with other leaders in health systems that are doing the things that you hope to do and just having that humility to say, okay, how can I learn from and develop best practices based off of what other leaders are doing?

00:20:28:00 - 00:20:41:24
Akin Demehin
I know we're just scratching the surface of the incredible work you all are doing, but thank you for taking the time to take us inside your quality journey a little bit. Congratulations to all of your organizations again for your extraordinary work, and thank you for listening.

00:20:41:26 - 00:20:50:06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:22 - 00:00:24:23
Tom Haederle
There is no shortage of cyber criminals hard at work today attacking hospitals and health systems with ransomware, malware and other weapons to extort payment by shutting down vital systems and putting patient care and safety at risk. Unfortunately, there is a shortage of cyber defense warriors in health care with the skills and training to fend off such attacks. As the number of cyber incidents climbs each year,

00:00:24:24 - 00:00:39:20
Tom Haederle
it's clear we urgently need to build a cyber-ready health care workforce.

00:00:39:22 - 00:01:13:13
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. While we've seen some growth of interest in cybersecurity as a discipline, demand still outpaces supply of people who are equipped to defend hospital and health care internal systems against cyber attacks. The shortage is especially acute for rural care providers. Today's podcast invites three experts to share their insights on "reskilling" and other methods that can help develop and sustain a health care workforce that is ready for today's challenges.

00:01:13:15 - 00:01:36:28
Bill Klaproth
I'm Bill Klaproth. With me is Laura Kreofsky, Microsoft cybersecurity program for rural hospital strategy lead. We also have Josh Heisman, national managing director, security technical sales (Microsoft). And of course, we have John Riggi, national advisor for cybersecurity and risk for the American Hospital Association. Laura, Josh and John are joining us today to discuss building a cyber-ready healthcare workforce.

00:01:37:00 - 00:01:39:16
Bill Klaproth
Laura, Josh and John, thanks for being here.

00:01:39:22 - 00:01:42:25
John Riggi
Thanks, Bill. Great to see you again and great to be here.

00:01:42:27 - 00:01:43:27
Bill Klaproth
Thank you John.

00:01:44:00 - 00:01:45:12
Laura Kreofsky
Yeah. This is a pleasure. Thanks.

00:01:45:16 - 00:01:46:12
Bill Klaproth
Thanks, Laura. Yeah.

00:01:46:15 - 00:01:47:25
Josh Heizman
I appreciate you having us, definitely.

00:01:47:26 - 00:02:04:11
Bill Klaproth
Thank you, Josh. So this is a really an important topic. And of course, we're hearing more and more about cyber risk all the time. And, John, I've read many articles highlighting the cybersecurity talent gap, especially in health care. So how bad is it and how did we get here?

00:02:04:14 - 00:02:38:24
John Riggi
Well, thanks for that, Bill. It is very significant, that gap. And there's a number of reasons for that. One, cybersecurity had not really been emphasized as part of the STEM curriculum over the years. And quite frankly, as society and as industries have made greater use of network and internet connective technology, quite frankly, has provided more opportunities for the bad guys - foreign based hackers - to try to penetrate our organizations and steal sensitive data and, of course, conduct these debilitating ransomware attacks.

00:02:38:27 - 00:02:49:01
John Riggi
So part of this huge demand, this gap is based on all these increased attacks that we're facing right now. So we're trying to catch up and the bad guys are outpacing us at the moment, unfortunately.

00:02:49:01 - 00:02:51:18
Bill Klaproth
Unfortunately is right. And Josh?

00:02:51:20 - 00:03:03:16
Josh Heisman
Yeah. And I think it's also important to note, you know, even the largest organizations out there, the most mature, struggle to recruit and retain cyber talent today. So we're seeing it at all sides of organizations, but particularly the smaller ones.

00:03:03:18 - 00:03:10:09
Bill Klaproth
So it sounds like we need to catch up here. We need to build more awareness for cyber security professionals. Would that be fair to say, John?

00:03:10:11 - 00:03:31:05
John Riggi
Absolutely. And I think as these attacks increase, the only silver lining is that it is drawing more attention to cyber security and not only in terms of the threat, but as a discipline, what we can all do. And we're receiving a lot of interest, even from clinicians now, who are interested in understanding how they can contribute to cyber security.

00:03:31:07 - 00:03:48:27
Bill Klaproth
Absolutely. And, Laura, well, cyber security risk is pervasive in health care, studies have shown rural hospitals are often further at risk. So how can I focus on cyber security skilling and talent development help lower that heightened risk profile unique to rural providers?

00:03:49:03 - 00:04:07:25
Laura Kreofsky
Yeah, Bill, you are spot on. They are, I think, in many ways at higher risk. Right? Oftentimes it's just hard to get that level of talent that we need in those communities and keep it. I think that's a big part of it. Oftentimes those rural hospitals are dealing with older legacy systems, right, that they struggle more to keep up with.

00:04:08:02 - 00:04:23:06
Laura Kreofsky
And quite often the IT staff in those rural hospitals is lean and mean. And those individuals are wearing a lot of hats. And it's really hard when you're a jack of all trades to really develop and hone those cybersecurity skills.

00:04:23:06 - 00:04:27:25
Bill Klaproth
And I would think with the budget pressures that are on rural hospitals, that's got to play into it as well.

00:04:27:27 - 00:04:36:19
Laura Kreofsky
It does. Absolutely. Although I played like everywhere in health care, there is a growing understanding and appreciation of the need to invest in this area.

00:04:36:21 - 00:04:37:13
Bill Klaproth
Yeah. John, your thoughts.

00:04:37:13 - 00:05:10:07
John Riggi
Yeah. Bill, as Laura said there's definitely a resource gap out in those rural hospitals especially. And it's not only just human and the technical resource, as Laura mentioned, financial. Some of these hospitals strive just to break even. And if they're making a margin, it's razor thin, maybe 1% margin just to keep the operations going. And as I always point out to folks who say, well, that's question why don't hospitals invest more in cyber security, divert some of all the funding that comes from the government Medicaid.

00:05:10:09 - 00:05:29:14
John Riggi
And I point out hospitals are not cybersecurity companies. Job one is to take care of patients and save lives. We know that if we invested every single dollar that we make providing care for patients in cybersecurity, we still not would be 100% safe from cyber attacks.

00:05:29:16 - 00:05:38:06
Bill Klaproth
So let me ask all three of you this. Josh, let me start with you. What are some initiatives then that you've heard of that are helping close this talent gap?

00:05:38:08 - 00:06:01:18
Josh Heizman
Yeah. And then I think it's important to look outside of just the health care vertical, right? I mean, even in public education, for example, you're seeing the same types of shortages in school districts, for example, in rural communities. But I think it's important to work with public education, community colleges, right, for skilling the kind of next generation, but also look at initiatives to retool and reskill existing staff, right, to support those career pivots.

00:06:01:21 - 00:06:20:23
Josh Heizman
Even looking at your clinicians in some cases who are interested in pivoting into the cybersecurity roles, they bring an invaluable perspective to those roles, too. So I think that's important as well. But, you know, there's a lot of high tech programs out there. I mentioned in public education that historically focus on engineering roles. I think computer science that are starting to retool into cybersecurity.

00:06:20:23 - 00:06:29:09
Josh Heizman
So, you know, these organizations can partner with those educational institutions and help guide that curriculum to make it successful. And, again, kind of build that next generation.

00:06:29:16 - 00:06:30:25
Bill Klaproth
Absolutely, Laura?

00:06:30:27 - 00:06:53:06
Laura Kreofsky
Yeah, I think there's a number of ways we can do better and that we need to do better. At Microsoft, there's a program called Textbook, and it really works across rural communities to nurture and find funding for training programs for new students or for reskilling. And it's brought like 3,500 jobs to these rural communities in about 7 or 8.

00:06:53:09 - 00:07:17:17
Laura Kreofsky
And we need to do more of that. And we John and I talked this morning about private public collaboration in some of these areas. We need to continue to do that. One of the things I found really interesting in my role is I've talked to a lot of firms that in cybersecurity. There are a lot of very seasoned professionals out there that really want to do mentoring and help grow the next generation and to build those programs up.

00:07:17:20 - 00:07:44:21
Laura Kreofsky
I think that's a real opportunity. It's really unique. And I think the last part is like my perception, having a lot of nieces and nephews who are college age is that they're not there's not an awareness that this is a whole industry, right? And they're put off by, oh my God, you've got to be so technical. I mean, it does require some obviously gaining technical skills, but a spirit of inquiry and good problem solving is really, I think, the heart of a lot of what we need these cyber analysts and these cyber professionals for.

00:07:44:25 - 00:08:07:15
Josh Heizman
I was actually sharing with Laura earlier, my own wife used to be a med tech and worked in labs and hospitals, and now she's in the governance, risk and compliance space. And she's not super technical, right? But she is a very strong cybersecurity practitioner, despite not having those technical skills. So it's important for folks to know you don't have to have been a network engineer for 20 years to go into cybersecurity.

00:08:07:19 - 00:08:28:21
John Riggi
In fact, there's many layers of cybersecurity. Myself, I'm the national advisor for Cybersecurity and Risk. I don't have a deep technical background, but what my background is having come from the FBI and run some national cyber programs - I look at the risk from a very strategic perspective. I understand who the bad guys are, and I know how to disrupt them, and I know what'll work against them.

00:08:28:23 - 00:09:00:23
John Riggi
And so really thinking about multi-layered recruitment approach for cyber security professionals and also attaching a mission to it. Again, from my government service days and helping folks know that, hey, it's not just sitting in a room coding all day. You're doing something that's very important and will help protect hospitals. Now, in fact, I'll just tell a quick little story here: I was at doing a tabletop exercise for a hospital association, as I do quite often, and I come to a key point in the exercise and I point to this individual, this gentleman and

00:09:00:24 - 00:09:17:20
John Riggi
I say, so what do you think about this big decision that had to be made as well? I don't know, I'm just the IT guy. And I said, you're not just the IT guy. You are a network defender. You help defend patients and communities by what you do. He looked up. He said, you know what?

00:09:17:22 - 00:09:25:18
John Riggi
And I would do this. We're going to pull the plug on the internet, and we're going to go to our emergency action plan, helping folks understand how really important thing.

00:09:25:23 - 00:09:27:14
Bill Klaproth
Is reframing the issue. Exactly.

00:09:27:17 - 00:09:46:19
Josh Heisman
Yeah, I'd actually like to add on to that. You know, it's interesting. I manage a lot of technical specialists at Microsoft within the security space, and we are focused on the health care and life sciences vertical. And they feel a calling and a mission being in that role, specifically working with these customers, right? It's very meaningful to them. And that's why they feel fulfillment is because of that mission.

00:09:46:20 - 00:09:48:13
Josh Heizman
So, John, I think that's an excellent point.

00:09:48:16 - 00:10:12:08
Bill Klaproth
I like how you said there's a multi-layered recruitment approach going on, and it sounds like that's what we need to build awareness to get new people into this field. Okay, so let's switch to AI. We often, you know, AI is everywhere. You hear it all the time. And knowing that cyber and I are often symbiotic, both positively and negatively, should training programs provide blended curriculums then in these areas?

00:10:12:08 - 00:10:13:12
Bill Klaproth
Josh, let's start with you.

00:10:13:13 - 00:10:37:00
Josh Heizman
Absolutely. Here's the bottom line. The attackers are using AI, right? They're using it in their offensive measures. So we have to as defenders leverage AI as well. And so, absolutely it's integral to that skilling. You know I mentioned the technical folks I work with the manage even are retooling and skilling their credentialing and making that pivot. So it's absolutely it's here again -they have those tool sets.

00:10:37:00 - 00:10:45:10
Josh Heizman
We have to use those tool sets. Imagine a professional football game right where a team doesn't step up to that next level of skill sets. It's available to their competitors, right?

00:10:45:13 - 00:10:48:05
Laura Kreofsky
Or they only played offense. No defense. Exactly.

00:10:48:06 - 00:10:53:13
Josh Heizman
Yeah, exactly. So yeah, absolutely. AI is part and parcel of any curriculum.

00:10:53:15 - 00:10:54:16
Bill Klaproth
Yeah. Laura.

00:10:54:18 - 00:11:16:26
Laura Kreofsky
Yeah I would agree. And really when you think about it, you think about AI and what we need at the front line are prompt engineers. Right. And what is that besides inquiry and problem solving, which I think are core skills and, you know, a really attuned to, to individuals with deep technical expertise or with broader interests. So I do think they're inextricably linked.

00:11:17:03 - 00:11:21:08
Laura Kreofsky
And as educators, we should look to do that holistically.

00:11:21:10 - 00:11:34:21
Josh Heizman
It's funny you say that, Laura, because searching is a skill, right? We're talking about Google and Bing as a verb, right? Be able to search and write a proper search term. And same thing with writing a prompt, right? For AI. You have to ask good questions to get good results.

00:11:34:26 - 00:11:41:14
Bill Klaproth
Do you think folding AI into this will make it more appealing to future cybersecurity risk professionals?

00:11:41:19 - 00:11:43:26
Josh Heizman
Absolutely. Absolutely. I mean, you know, look.

00:11:43:26 - 00:11:49:00
Bill Klaproth
I it's a little more sexy, more fun. Hey, okay, I can do this, right?

00:11:49:02 - 00:11:49:24
Josh Heizman
Yeah, absolutely.

00:11:49:26 - 00:11:57:29
Bill Klaproth
For sure. So, Laura, is there something else we should be doing? We talked about some initiatives that are taking place, but what should we be doing more of?

00:11:58:01 - 00:12:17:10
Laura Kreofsky
Well, I do think it comes down to more partnerships and what we're doing, Microsoft is doing with the AHA and the White House to help secure rural hospitals, I think is a real a really good start, and we need more of that. We need more mentorship for seasoned professionals. We need more innovative programs. And what we really need -

00:12:17:12 - 00:12:34:29
Laura Kreofsky
Bill and Josh and I've talked about this - is we've got this chicken and egg thing going where you can't get a job till you've got experience and you can't get experience until you have a job. So we need to make some very practical and high value learning opportunities that are translatable and elevate professionals in this field.

00:12:35:01 - 00:12:58:07
John Riggi
No, I totally agree. So beyond the education piece, I think what's come out of the partnership that we have with Microsoft is really a shining example of how government, private sector interests, advocacy groups like ours can all come together to work on a problem, help solve a problem for the mutual benefit, not only for mutual benefit, but for the greater good, literally for the greater good.

00:12:58:09 - 00:13:25:00
John Riggi
When I was having some discussions debate with senior policymakers at the white House and they said, you know, you hospitals need to implement these cybersecurity standards. And we were talking about the same issue, same resources, funding. And literally I happen to say to this individual, why don't we get Microsoft and other organizations to donate or provide nonprofit pricing the way they do for other industries to help

00:13:25:00 - 00:13:42:23
John Riggi
fill that resource gap that you just told me the government can't fill. So instead of just looking at this from a policy issue, whole of government is we are used to say, when I was in government, it's a whole of nation approach. Everyone has to come together, work on a common problem. We all depend on hospitals no matter what.

00:13:42:24 - 00:13:49:18
John Riggi
No matter where we live. And just in like my counterterrorism days, we got to understand the threat. We've got to come together as a nation on this.

00:13:49:21 - 00:14:06:28
Josh Heizman
And I would be remiss if I didn't bring up the technological solution to all of this, too, right? It doesn't solve everything. It's certainly a people problem. But we just talked about AI, right? Microsoft, of course. Copilot for security. We have a almost imagine a really smart friend there on the side, kind of guiding you through what to look for and how to solve problems.

00:14:06:28 - 00:14:25:13
Josh Heizman
And we're seeing this from across the industry. But it's important. There's so much noise out there, right? There's so much signal, as we call it, coming in from different sources of security, that it becomes a scale issue for humans to keep up. And so not just AI, but looking at a platform approach to security and how do we integrate all that.

00:14:25:13 - 00:14:42:27
Josh Heizman
And I remember doing swivel chair between 50 different solutions, right? And trying to piecemeal, you know, I think about more and I think I mentioned in my role on the HOA board, right? My local HOA, we have cameras and card access and we have an incident. They're not integrated, right. So it's a manual process to go kind of link the two together.

00:14:42:27 - 00:14:52:16
Josh Heizman
And we're just now moving to a vendor that automatically does that for us, right? So it's so important to have those pieces tied together and have that systemic approach.

00:14:52:18 - 00:15:05:25
Bill Klaproth
Absolutely. Well this has been a great discussion. I want to thank all three of you. Before we wrap up, I'd like to get some final thoughts from each of you. John, let's start with you. Anything else you want to add as we finish up talking about building a cyber ready health care workforce?

00:15:05:26 - 00:15:31:15
John Riggi
Well, again, I think we have to understand how important cyber security roles are. Recent events, CrowdStrike, the issue that happened there, not related, not malicious, not a malicious attack, but it shows how dependent we are on the availability of technology. We have to understand that these attacks are increasing. We've had change health care that hit us earlier this year on how dependent we are on the availability of technology.

00:15:31:17 - 00:15:46:05
John Riggi
So this is...these threats are not going away. The use of AI will accelerate these threats, quite frankly, but it'll also could accelerate our capability to defend against them. So there's a mission here. It's not just a field of work.

00:15:46:10 - 00:15:50:29
Bill Klaproth
Yeah. Dependent and vulnerable at the same time. Vulnerable exactly at the same time. Laura.

00:15:50:29 - 00:16:11:05
Laura Kreofsky
Final thoughts? Yeah, I think about this. You know, I spend a lot of time working in rural hospitals and in the safety net. And I think they, as we've talked about our particular really vulnerable and, you know, we're going to do need to do more from a resourcing, from a funding standpoint to support them. Because as we talk about it's not an if question.

00:16:11:05 - 00:16:21:18
Laura Kreofsky
It's a when question for every health care organization. And so we need to look at those organizations as a vulnerable link in a very large ecosystem.

00:16:21:20 - 00:16:26:27
Bill Klaproth
It's not an if, it's a when. That's a great way to put it. And Josh, final thoughts from you.

00:16:27:00 - 00:16:42:29
Josh Heizman
I just want to re-emphasize that point about reskilling - you know, existing folks, right? Just because I have seen so many examples of success of that, I did it myself again working in public education. I was in it and then pivoted and brought that perspective. And having been a classroom teacher, right? And then working at a school district in IT.

00:16:43:06 - 00:17:01:16
Josh Heizman
So again, my sister is a nurse practitioner, and we've had conversations. She's asked me questions before about, hey, that'd be interesting to pivot over to cybersecurity, right? So again, it's not just looking at those old school IT folks that somehow that that's that is your only talent pool for these roles. I would really open up the field for that.

00:17:01:18 - 00:17:20:12
Bill Klaproth
Absolutely. Look elsewhere and you never know who's going to raise their hand, as you said earlier, we need people to start raising their hand. Laura, Josh and John, thank you so much for joining us today at our podcast table at the 2024 AHA Leadership Summit. Once again, we have Laura Karaoke, Josh Heisman and John Riggi. Thank you again to learn more.

00:17:20:12 - 00:17:34:10
John Riggi
I'll be remiss if I don't take a moment to just thank you, Josh, Laura and Microsoft for answering the call for assistance to help defend the nation's rural hospitals. We appreciate it as an association. We appreciate it as a nation.

00:17:34:11 - 00:17:35:07
Josh Heizman
Thank you. Thank you, John.

00:17:35:07 - 00:17:48:26
Bill Klaproth
Agreed and very well said. And for more information on this, please email MRHTP@microsoft.com. That's MRHTP@microsoft.com. Thanks for listening.

00:17:48:28 - 00:17:57:09
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.

00:00:00:15 - 00:00:35:29
Tom Haederle
Hospital admission rates for people who come to the emergency department are much higher if that person is also dealing with a behavioral health condition. But many patients with behavioral health issues don't necessarily need to be admitted as an inpatient. It may not be the best course of treatment for them, and it also costs much more. That's why Maryland-based Sheppard Pratt has been road testing mobile behavioral health services, and the experiment is paying off.

00:00:36:01 - 00:01:12:22
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Two clinicians and a vehicle. That's the model Sheppard Pratt uses as its behavioral health experts have begun to visit patients in their homes or other places that don't require a visit to the hospital. In this podcast, Jordan Steiger, senior program manager of Clinical Affairs and Workforce with the AHA, is in discussion with Jason Melegari, director of clinical services at Sheppard Pratt, about how its mobile Behavioral Health Initiative continues to make a positive difference for the people and communities it serves.

00:01:12:25 - 00:01:14:15
Tom Haederle
Let's join Jordan.

00:01:14:17 - 00:01:23:20
Jordan Steiger
Jason, thank you so much for joining us this morning at the AHA Leadership Summit. We're so happy to have you here and to learn a little bit more about some of the work you're doing.

00:01:23:22 - 00:01:25:04
Jason Melegari, R.N.
It's a pleasure. Thank you Jordan.

00:01:25:06 - 00:01:33:22
Jordan Steiger
Great. So I know that you work at our member hospital, Sheppard Pratt in Maryland. Tell the listeners a little bit about your role and what you do.

00:01:33:25 - 00:02:03:03
Jason Melegari, R.N.
Sure. I am part of the consulting arm of Shepherd Pratt. I'm director of clinical services, so I provide subject matter expertise when it relates to really anything clinical. But I think my areas of real passion are issues related to regulatory concerns, accreditation, but also clinical programing, training, education, workforce development, as well as just general health care operations.

00:02:03:05 - 00:02:19:09
Jordan Steiger
So all of those things that kind of touch behavioral health and touch other parts of health care too. But those are the big ones there. So I know that one of the things that you've worked on lately is bringing mobile crisis services to communities around you as part of your consulting role. Is that right?

00:02:19:12 - 00:02:51:04
Jason Melegari, R.N.
Certainly that's something that we are really trying to build and get people on board with crisis services, because you can only add so many more beds to a community. And oftentimes we find that communities have kind of over bedded. When we look at admission rates to behavioral health hospitals, sometimes you can compared it - if we were to admit every patient that walked into an emergency department with chest pain.

00:02:51:07 - 00:03:11:02
Jason Melegari, R.N.
Now the rates of admission there, that's around 12 to 17%, whereas sometimes we're admitting upwards of 50 to 80% of folks that come into an ED with a behavioral health concern. Or even come in with some other concern, and it ends up being a behavioral health admission.

00:03:11:03 - 00:03:11:25
Jordan Steiger
Absolutely.

00:03:11:26 - 00:03:39:22
Jason Melegari, R.N.
So in order to kind of grab those before they come in, one could probably reduce admission rates by 25%. And a big part of that is mobile crisis, where you're bringing the talents of those clinicians to the individual. And I think that I'm very passionate about crisis service. A crisis service doesn't always just have to encompass behavioral health because it's a crisis.

00:03:39:22 - 00:04:01:14
Jason Melegari, R.N.
And it doesn't have to necessarily be a behavioral health crisis. But mobile crisis clinicians are trained in dealing with a variety of issues. I don't want to compare it to a home health type of experience, but it is bringing that care to the home, to an organization, it's just wherever the crisis is happening.

00:04:01:14 - 00:04:08:21
Jordan Steiger
Just in that community space, wherever somebody needs help, you're sending those clinicians out to them instead of them coming to the hospital.

00:04:08:27 - 00:04:43:16
Jason Melegari, R.N.
Exactly. You know, and sometimes it does result in a need for that individual to get further care, but it doesn't have to be in a hospital. I think that trying to find things like Shepherd Pratt does, like urgent care spaces or crisis residential services, where folks can be in a controlled environment for 1 to 4 weeks. It depends on the situation, but I think the biggest problem facing the crisis is a issue of reimbursement.

00:04:43:18 - 00:04:47:17
Jordan Steiger
That was going to be one of my questions. Yes. How do we pay for this?

00:04:47:20 - 00:05:04:02
Jason Melegari, R.N.
Well, there are states that are getting on board with paying for that, and it's mostly through Medicaid type of programs or grant funding. But we all know that that's kind of unsustainable for a long period of time.

00:05:04:02 - 00:05:04:22
Jordan Steiger
Definitely.

00:05:04:26 - 00:05:31:02
Jason Melegari, R.N.
And, you know, while the Medicaid population certainly has a large proportion of folks that are in need, there's lots of us that have commercial insurances that aren't recognizing these crisis episodes either. So oftentimes and those just go unfunded because certainly we're not going to care for them. We're going to provide that service. But yeah. Is it an issue of sustainability.

00:05:31:05 - 00:05:35:12
Jason Melegari, R.N.
And that does affect how we're going to develop that workforce too.

00:05:35:16 - 00:05:45:18
Jordan Steiger
Absolutely. So would you encourage listeners to maybe look at their state regulations and reimburse kind of policies and see if this is something they could do in their own communities?

00:05:45:26 - 00:05:58:02
Jason Melegari, R.N.
I think people really need to advocate, whether it be through city, county, states or federal organizations, to talk about how this, you know, this actually saves money.

00:05:58:05 - 00:05:58:29
Jordan Steiger
Absolutely.

00:05:59:03 - 00:06:31:10
Jason Melegari, R.N.
You know, a one time say, three-hour interaction with an individual, let's just say it's $1,000. Whereas going to the ED, usually, I think the American College of Emergency Physicians says a behavioral health episode in an ED cost nearly $2,500. Plus then the ensuing admission, which might be to be very conservative, $1,000 a day for 4 to 5 days.

00:06:31:13 - 00:06:40:09
Jason Melegari, R.N.
So with it is a considerable savings and the individual in crisis gets to possibly resolve that crisis in a friendlier environment.

00:06:40:15 - 00:06:57:21
Jordan Steiger
And, you know, divert that admission, which I know is a good thing for the patient. It's good for their support system, and it's good for our hospitals, too, if we don't need to have people sitting in the ED waiting for behavioral health care. And, you know, we know that that has become such a thing that people are trying to figure out.

00:06:57:23 - 00:07:21:23
Jason Melegari, R.N.
Absolutely. And, you know, just the environment in the ED is not conducive to a behavioral health claim in any way. And often it has that iatrogenic effect of making them more anxious and then just that fact leading to admission just because they're there. And maybe they were only seeking help to get a prescription refill or school or something like that, that all of that happens with those clients.

00:07:21:24 - 00:07:31:22
Jordan Steiger
Exactly, exactly. So walk me through what a typical patient interaction would look like. Say somebody calls the their crisis number in their community. What happens next?

00:07:31:24 - 00:08:02:17
Jason Melegari, R.N.
So let's assume from a mobile crisis standpoint, sure. A team of clinicians or you know, I think one of the more exciting things is to have peers also interact in that. So generally you'd want two people and the models that we're trying to create have a peer involved and a clinician that doesn't have to be necessarily a licensed clinician depending on the state and or reimburse guidelines, but then going to meet that individual.

00:08:02:20 - 00:08:39:00
Jason Melegari, R.N.
Sometimes there is a law enforcement portion of that. Sometimes they initiate that. But let's say that they didn't. And then just really finding out what that crisis is, trying to find support systems that may be already there or helping them to make a safety plan, call people, seeing if there's a way to get there, if they have a physician involvement or a therapist involved in their treatment, seeing if they can also be involved in that interaction in some way doesn't have to necessarily be in person.

00:08:39:05 - 00:09:02:11
Jason Melegari, R.N.
Sure. But really trying to find connections. That's what really is the most important part, is the connection. When you lack connection, then without that support, oftentimes it tends to start rolling downhill, but helping them build the connections, whether they're there or not. It's one of the most important things a mobile crisis clinician can do.

00:09:02:13 - 00:09:22:03
Jordan Steiger
That makes a lot of sense. And just making sure that that patient or that person just really gets to the place that they need to be in, whether it's seeing their PCP or seeing their psychiatrist or maybe they don't need anything, maybe they just needed somebody to talk to in that moment and they're okay. So having that moment just to say, what do you actually need, I think is so important.

00:09:22:06 - 00:09:43:04
Jason Melegari, R.N.
Yeah, I think one of the better stories I've heard in this is from, I think a crisis team in Pennsylvania is that they were called to a crisis. And it was a working mother that had 3 or 4 children and had a long day at work. And her crisis was that she didn't have anything to feed her kids dinner.

00:09:43:06 - 00:10:07:18
Jason Melegari, R.N.
Crisis was easily solved by the team. It ordered pizza for the family, and who knows what that would have led to possibly in an hour or 2 or 3. But that was that person's crisis. And again, we don't have to look at it necessarily all the time from a behavioral health standpoint. But we know that crises often develop into that.

00:10:07:21 - 00:10:29:15
Jordan Steiger
Absolutely. I think that's a great example to share. To show that to somebody doesn't have to be in, you know, a psychiatric episode to need a service like this. It could be something as simple as needing to feed their kids. So I think that's a beautiful example to share. One thing you brought up was the use of peer supporters, and I think that that is something that we all need to start exploring in behavioral health a little bit more.

00:10:29:20 - 00:10:41:22
Jordan Steiger
So I just wanted to flag that as we were talking. That stuck out to me, and I'm sure stuck out to some of our listeners, because we know that peers are just able to connect in a way that's different than a clinician or other people a lot of the time.

00:10:41:24 - 00:11:17:00
Jason Melegari, R.N.
Absolutely. You know, having that shared experience is crucial. And I find that peers are often able to defuse crises situations so much better than those of us that don't have that shared experience. Also, recovery coaches, certainly in that realm as well. And I think that in many settings, especially emergency departments, they are able to divert patients in a way and to find them the services they need in a much more efficient manner.

00:11:17:03 - 00:11:38:21
Jordan Steiger
Absolutely. So you're really making the case here for mobile crisis service and support. So I'm hearing you say that it's a cost diversion. We can keep people out of the ED and out of inpatient care, especially when they might not necessarily need that level of care. We're hearing that we can address some of those social drivers of health which we know affect health overall.

00:11:38:21 - 00:11:51:20
Jordan Steiger
So I mean, I think the case is there for communities investing in this. What advice would you give maybe a new hospital system or community that's looking to develop their mobile crisis services?

00:11:51:22 - 00:12:19:15
Jason Melegari, R.N.
My plan for folks that don't have any, and this is kind of more related to the hospital system. So great. What I suggest is you know, because it's very low overhead, you need two clinicians and a vehicle. Oftentimes, I suggest that those folks can even be based in your emergency department. And when they're not seeing folks in the community, they could help see people in the emergency department.

00:12:19:17 - 00:12:49:02
Jason Melegari, R.N.
So starting it could be, you know, a very easy task. It's really recruiting the right people for it is probably the hardest part of it. And then just slowly building that up, finding what area that you're going to serve. Make it small. And as your clinicians get more comfortable with it, increase that. Maybe you're just going to do it between - if you're in that health system - maybe you're going to do it between your hospitals or even PCP offices.

00:12:49:05 - 00:13:09:18
Jason Melegari, R.N.
So there's lots of, I think, innovative ways to do it that serve your system first as well as your community then. Usually I would say that starting slow on perhaps in the afternoon and hours is where I think that or finding out when your behavior.

00:13:09:18 - 00:13:10:29
Jordan Steiger
When the need is the highest.

00:13:10:29 - 00:13:18:05
Jason Melegari, R.N.
Yeah, exactly. And then expanding it further. Don't start out with a 24 hour service because you're going to stumble and fall.

00:13:18:05 - 00:13:32:25
Jordan Steiger
Sounds overwhelming to start, definitely! That's good advice. I think starting small and just focusing on the need of your hospital system and then kind of letting that overflow into what is the need of your community and kind of connecting those dots, it sounds like.

00:13:32:28 - 00:13:37:01
Jason Melegari, R.N.
During this time, you're going to have to explore the reimbursement process.

00:13:37:02 - 00:13:37:20
Jordan Steiger
Definitely.

00:13:37:20 - 00:13:55:09
Jason Melegari, R.N.
So if you're looking how you can just serve your health system, you are going to save system dollars whether or not you're going to be reimbursed. So I think that's the smart way to begin, at least for a health system. For a community, yes, it's going to take a little more because you're going to have to look for grants.

00:13:55:09 - 00:14:10:22
Jason Melegari, R.N.
But they are plenty out there and some are reimbursing very well after you are accepted for that RFP or however, the community is doing it. But for a hospital system, I think that you could start right away.

00:14:10:24 - 00:14:22:18
Jordan Steiger
That sounds like a call to action if I've ever heard one. So Jason, thank you so much for joining us and sharing a little bit more. Are there any places that you would recommend people looking if they're wanting more information about this?

00:14:22:20 - 00:14:39:21
Jason Melegari, R.N.
Certainly there is a crisis...SAMHSA and I think that just looking for other communities in hospitals that are already utilizing the service and just asking them questions. I find that I do that a lot and I find that they're very open.

00:14:39:23 - 00:14:46:11
Jordan Steiger
Awesome. Well, thank you again for joining us, and I'm looking forward to having this information shared with our membership.

00:14:46:14 - 00:14:48:21
Jason Melegari, R.N.
Thank you very much, Jordan, I appreciate it.

00:14:48:23 - 00:14:57:03
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.

00:00:00:18 - 00:00:21:24
Tom Haederle
In 2020, Boston Medical Center took a hard look at the data and was forced to conclude that its best efforts to close disparities in health outcomes among its patient population were not really making a difference. So, BMC went back to the drawing board, conducting a long and thorough review across all its systems of why such gaps remained and how they could be addressed.

00:00:21:27 - 00:00:41:12
Tom Haederle
The result was a new approach that not only helped close disparities among different groups, but has also been recognized with one of the most prestigious awards in the health care field.

00:00:41:14 - 00:01:18:22
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Boston Medical Center is the winner of the AHA's 2024 Foster G. McGaw Prize, which recognizes hospital efforts to improve the health and well-being of everyone in their communities. In this podcast hosted by Nancy Meyers, AHA's vice president for Leadership and System Innovation, we hear from Dr. Thea James, vice president of mission with Boston Medical Center, about how BMC's creation of the Health Equity Accelerator helped lead the way to achieving health justice in the communities it serves.

00:01:18:25 - 00:01:27:05
Tom Haederle
This podcast was recorded in San Diego at the American Hospital Association's annual Leadership Summit. Now let's join Nancy.

00:01:27:08 - 00:01:52:08
Nancy Foster
So, Dr. James, the Foster McGaw committee members were really impressed with BMC’s approach to addressing disparities in health and health care, not just as a separate thing, but as a foundation to the overall strategy of BMC in general. So talk about how the organization has made that shift to really incorporating equity as the foundation of everything that you do.

00:01:52:10 - 00:02:39:21
Thea James, M.D.
Thank you for that question, Nancy. I think what happened is, you know, we serve a population that disparities are front and center all day, every day. And we also have for decades created lots of different programs to address some of the challenges that our patients have. But I think in 2020, when so many things sort of emerged and people became more aware of - and you remember, there were so many people across all sectors who were coming out with commitments to equity statements. And honestly, to our credit and to our CEO and our executive vice president at that time -

00:02:39:23 - 00:03:08:14
Thea James, M.D.
to their credit, they said we're not gonna do that. We're absolutely not going to do that. And I think they said that because they were reflecting on all the work we had done, all the programs we've created to address the challenges of our patients, many that have been even disseminated across the country. When they looked at clinical outcomes data for Boston from a demographic perspective, none of which was surprising

00:03:08:14 - 00:03:29:20
Thea James, M.D.
if you really think about it. I mean, you really think about it, it doesn't matter what you measure. You already know who's going to do worse if you look at it from a demographic perspective. And I think that fact and all the work that we've been doing for so many decades and all the work we've been doing, was having no impact on that data.

00:03:29:22 - 00:04:08:19
Thea James, M.D.
I think that made them say, we're missing something. And so what they decided to do instead of coming up with an equity statement, was to look inside our own house and look across the entire enterprise, looking at clinical work, inpatient, outpatient, education, research, human resources, even public safety, and look for disparities with an intentionality to interrogate the disparities back to the root cause, and also to use the subjects of the data to help us interpret it and to help us with implementing approaches to close the data.

00:04:08:21 - 00:04:33:01
Thea James, M.D.
You know, many people study disparities, but never with any intentionality to close the data and close the gaps in the disparities. And so that's what they did. And we did that. We looked at more than 100 analyzes because, you know, we collect data anyway. We have a data warehouse. They broke us up into four work groups, six work groups covering those areas

00:04:33:01 - 00:05:04:01
Thea James, M.D.
I named in the beginning. There was a great deal of accountability involved. Each work group was led by an executive sponsor. We met about 3 or 4 times a week and once a month at a two-hour round table, and everyone had to report out on their work. And what we did was to identify which disparities we were going to work on, closing over the next 12 to 24 months, using that model that actually had been established by some work done by ObGyn.

00:05:04:04 - 00:05:09:13
Thea James, M.D.
And that's how we got to here. And they've turned out to be proofs of concept. They're working.

00:05:09:16 - 00:05:33:03
Nancy Foster
You know, and it strikes me you talked about doing it in 2020, which was post the murder of George Floyd, which spurred many folks to relook at how they were addressing equity. And it also happened to be in the middle of a pandemic. Exactly. How did that shape the work that you did, or did it kind of shape the or give impetus to the work as well?

00:05:33:09 - 00:05:57:23
Thea James, M.D.
Well, the pandemic was so revealing. It was really revealing. I mean, it revealed things to people that people don't question. People acknowledge - well, they don't acknowledge it, but they accept it as a natural order of things. And it really isn't. They don't question it. In fact, if anyone suggests addressing it, people will say things quickly like, you can't boil the ocean.

00:05:57:26 - 00:06:00:24
Thea James, M.D.
And we just decided not to accept that.

00:06:00:27 - 00:06:29:09
Nancy Foster
Yeah, it's hard when you're feeling so overwhelmed to take on something that feels new or goes deeper. So it's very impressive that you had leadership that made that decision to go that way. And so that's led to the creation of what you refer to as your Health Equity Accelerator. Yes. Which is kind of the organizing unit or part of BMC that has come out of this work.

00:06:29:10 - 00:06:37:08
Nancy Foster
So talk a little bit about what is that and how is it organized and how does it fuel the focus at BMC.

00:06:37:10 - 00:07:07:07
Thea James, M.D.
So, you know, once we identified all those disparities, and deciding that we wanted to address these with intentionality to close the gaps. The first thing we did was to set a principles of engagement. They said that nothing that already exists is immune to being questioned. They said we were all going to be on our own journeys, but that we would hold each other accountable and where mistakes were made and that we would look for opportunities to learn.

00:07:07:10 - 00:07:30:25
Thea James, M.D.
And once we decided all of these things, we had to figure out a way of operationalizing this work. And the first thing it did, they put us in a room for a couple of days with a facilitator. That's how we came up with the name Health Equity Accelerator. And it's all about health justice. And it operates a bit like a hub and spoke, but it has different sort of components to it.

00:07:30:26 - 00:08:00:02
Thea James, M.D.
You know there's research. We also have fellows, health equity fellows because once we identified, the first thing we did also was to identify the highest clinical areas, the clinical areas that had the highest levels of disparities. And, you know, interrogating and back to the inequities that were leading to disparities. We involve the patients to help us choose which order we would launch each of those vertical clinical areas.

00:08:00:04 - 00:08:24:12
Thea James, M.D.
Another thing we did, not only having them interpret the data, but also help us to identify what's most pressing and choosing them in that order. So the first thing we did was maternal health. As I said, ObGyn did that really identifying a root cause of a disparity in how quickly doctors were taking pregnant women to C-section who had hypertension in pregnancy.

00:08:24:15 - 00:08:50:21
Thea James, M.D.
And what they found was remarkable and literally the way that we supported them was through project managers and that type thing, because it required the support that they would need is through project management and a really robust analytics team, data analytics team that has been incredible. And also doing this work quickly, which is where the word accelerator came from.

00:08:50:21 - 00:09:17:04
Thea James, M.D.
We didn't want to study and restudy and restudy over years. We wanted to quickly get to the root cause of things. And I think the efficiency we found in interrogating back to root cause, having the subjects of the data interpret what the data meant, and also using them to implement ways to address what we saw, just got us to an answer and outcomes very, very quickly.

00:09:17:04 - 00:09:44:10
Thea James, M.D.
When I say outcomes, I'm talking about closing these gaps. And then we use the same approach with diabetes because that was the next pillar. And actually our community patient advisors chose that as the next vertical. And we use continuous glucose monitors. We used people who are like navigators and also did testing on people in terms of depression scores.

00:09:44:17 - 00:10:10:09
Thea James, M.D.
Depression scores were really high, and mainly because people were depressed over not being able to manage their diabetes, but through the interventions that we used, 39% of the people in that cohort reduced their A1Cs in just six months. And again, just attacking this and addressing this with intentionality, you design it to do what you want to know, what you want to learn.

00:10:10:09 - 00:10:21:21
Thea James, M.D.
And when you do that, it actually happens. It happens not only quickly, but also you're more likely to get it right the first time around based upon what they tell you. What the people, the patients in the cohort tell you.

00:10:21:24 - 00:10:54:25
Nancy Foster
Yeah. So I want to ask a little bit more about that, because I think what we recognized in the committee as we were doing the site visit at Boston Medical Center, is the relationship that you have with your patients, with your community is quite unique, and I think that a lot of folks are understanding and wanting to draw patients, family members, community into that strategic process at earlier points and have them be at the table throughout the entire process, but are maybe wondering how to do that.

00:10:54:26 - 00:11:10:26
Nancy Foster
So if you were talking to folks across the country at other hospitals or health systems, what are some practical tips that you would suggest that they think about as they're trying to bring those folks that they are serving to the table to help design the programs?

00:11:10:27 - 00:11:30:24
Thea James, M.D.
Sure. So, number one, I think you have to give up power. I hate to call it power, but that's essentially what it is. And that's the way you're taught in medical education. I mean, you just have to relinquish that and not be paternalistic, like we can be. Not think we know why these things aren't working for people and allow them to lead us.

00:11:30:27 - 00:11:59:18
Thea James, M.D.
The second thing I would say is, you know, we had Petrina Martin Cherry, our vice president of community engagement and external affairs, who has a very, very unique way of connecting people, bringing people together. She did a lot of work like that during the pandemic, connecting our leaders in the hospital, including like our operations people, strategy, people with leaders in the community to identify new sites for vaccinations, for example.

00:11:59:21 - 00:12:30:12
Thea James, M.D.
But she just does this job in a very, very different way. Like what she will always say is that many hospitals support communities by checking boxes, writing checks. And this type thing depends on what you're writing for, of course. But what we do is engage with the community and work with them as equal partners in this space. And people learn to trust you when you're asking them, you know, to lead the way, lead the process, and be a partner with you at the table.

00:12:30:18 - 00:12:32:02
Thea James, M.D.
That makes a difference.

00:12:32:04 - 00:12:42:14
Nancy Foster
And you do a great job of trusting the community to lead you in the direction that also makes sense for the organization. I think that's where folks are a little concerned.

00:12:42:18 - 00:13:06:19
Thea James, M.D.
Allowing people to have agency. Yeah, it's unique, but I will also say that Boston Medical Center has always been a place that does things in a very different way. You know, they're generally bold in how we make moves, and a lot of that has to do with being an essential hospital. You know, you are often working under the same pressures that our patients work under. Particularly, the ways in which we are reimbursed.

00:13:06:20 - 00:13:30:09
Thea James, M.D.
Similarly, we have cliff effects similarly, and it's a bit of what happens when you have a population like that, that you decide that you want to work with and want to take care of, and so you actually have some of the same challenges that they have. But we don't accept them as they are. We really, again, just reject this whole notion of you can't boil the ocean.

00:13:30:11 - 00:13:45:20
Nancy Foster
Well, we want to thank you again on behalf of AHA. Thanks to BMC for the work that you do every day, and also for the example that you provide to other health system leaders across the country. And congratulations again on winning this year's Foster McGaw Prize.

00:13:45:20 - 00:14:03:04
Thea James, M.D.
Thank you so much. Can I say one last thing? You may. In order for you to be able to do anything like that, it has to come from the top. It has to be a commitment coming from the top. And that is what's enabled us to do this as well. Thank you so much. We appreciate it.

00:14:03:07 - 00:14:11:17
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.