Advancing Health Podcast

Advancing Health is the American Hospital Association’s award-winning podcast series. Featuring conversations with hospital and health system leaders and front-line staff, Advancing Health shines a light on the most pressing health care issues impacting patients, caregivers and communities.

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What if the key to transforming patient experience starts with your workforce? In this conversation, Nell Buhlman, chief administrative officer and head of strategy at Press Ganey, and Chris DeRienzo, M.D., chief physician executive at the American Hospital Association, explore the data-backed connection between employee engagement and patient outcomes. With real examples — from transformation teams to leadership engagement — Nell and Chris highlight how intentional culture building translates to measurable gains in safety, trust and patient satisfaction.


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00:00:00:29 - 00:00:29:15
Tom Haederle
Welcome to Advancing Health. In health care, there is a very strong link between positive employee engagement and positive patient engagement, experience and outcomes. Hear some of the reasons why in this podcast hosted by Elisa Arespacochaga, AHA's vice president of Clinical Affairs and Workforce. This podcast was recorded at the American Hospital Association's 2025 Leadership Summit in Nashville, Tennessee.

00:00:29:17 - 00:00:54:19
Elisa Arespacochaga
I'm really excited to be here today with two leaders in the field and really enjoy a conversation with Nell Buhlman at Press Ganey and my colleague Chris DeRienzo to really talk about the connection between employee engagement and patient engagement and experience. Over the past year, we've had such a great time building a partnership with the team at Press Ganey to get at the heart of that connection and help hospitals and health systems build

00:00:55:20 - 00:01:12:09
Elisa Arespacochaga
the engagement with their team and ultimately drive increased patient engagement and experience. So Nell, I'm going to start with my first question for you. What are the facts on the ground? What are you seeing? What is the data saying? How tight is this connection and how important should this be to our members?

00:01:12:10 - 00:01:31:24
Nell Buhlman
So, great opening question. Really glad to be here with both of you. This has been a fun year of getting to know each other better and partnering on papers and blogs. In terms of what we see in the data, at Press Ganey we measure patient experience for a good chunk of the provider industry, about 70%. We do workforce engagement for 40% of the industry.

00:01:31:24 - 00:01:53:29
Nell Buhlman
So we have a ton of data that we can bring together and look at the relationships and at the outcome level, as we think about engagement being an outcome and we think about the two outcome indicators in patient experience, which are really likelihood to recommend and overall rating of care. There's a very strong association between employee engagement and patient engagement or patient experience of care.

00:01:54:06 - 00:02:14:01
Nell Buhlman
So much so that if you look at quartile performance and workforce engagement and quartile performance and patient experience, organizations in the top quartile for workforce engagement are most likely three times likely to be in the top quartile for patient experience, it's almost a perfect stair step from lowest quartile to top quartile.

00:02:14:03 - 00:02:29:09
Chris DeRienzo, M.D.
Now, I've looked at those graphs more times than I can count, and it's the one that about safety culture that always sticks with me because you've got you got this one visual that, like the arrows diverge and isn't it like a delta between the 97th and the second percentile?

00:02:29:09 - 00:02:50:29
Nell Buhlman
You got a great memory. Better than I do, I'd say. Yeah, that's exactly right. Which, you know, you bring up a really important point there, Chris, which is if you think about a couple of things - the component parts of workforce experience, like engagement is one of them, but it's how the organization is thinking about engaging their people, what matters to their people, what matters to people at the frontline versus a little bit further back?

00:02:51:04 - 00:03:20:04
Nell Buhlman
Safety is essential. Clinicians, everybody in health care, they want to know the care is safe. They want to know the organization is committed to high quality care. We have this sort of visual concept that we lay out when we're talking about the relationship between these domains that I referred to as sort of the flywheel, the flywheel effect of employee experience, which component parts of that, of course, engagement of the workforce, and also the degree to which they feel safe themselves and that the care is safe.

00:03:20:11 - 00:03:48:22
Nell Buhlman
And I call that the mini flywheel. And when you get momentum with that mini flywheel, people feeling set up for success and engaged in their work, it powers the larger flywheel of patient outcomes. So safety outcomes, quality outcomes, patient experience outcomes, and business outcomes on that big flywheel of, you know, is the care being delivered efficiently? Are organizations able to be profitable so they can plow those profits back into augmenting the services they provide to their communities?

00:03:48:29 - 00:04:07:21
Elisa Arespacochaga
I mean, it's at its heart, basic human nature, right? If other people care about things, then suddenly more people want to care about those things, and the more you can get that momentum going of just engagement and wanting to care about it. Because every clinician I know, you know, mortgage some part of their 20s to really focus on

00:04:07:21 - 00:04:08:24
Nell Buhlman
100%.

00:04:09:01 - 00:04:20:20
Elisa Arespacochaga
providing that care to others. So having a cohort of people, a team you're working with that cares about what they're doing and wants it to be the best possible, it just inspires you to do more.

00:04:20:22 - 00:04:24:21
Chris DeRienzo, M.D.
22 to 33. That's my mortgage.

00:04:24:23 - 00:04:27:21
Nell Buhlman
An extended mortgage!

00:04:27:24 - 00:04:50:21
Elisa Arespacochaga
So let's talk about one of the things that to me is really key to doing this well. Because you can have a charismatic leader, you can have an inspired team. But if it isn't easy to do the right thing, if you don't have that infrastructure in the organization that supports engagement...if you make it hard for people to do that right thing, it makes it that much harder to keep it up, to keep that enthusiasm going.

00:04:50:26 - 00:04:57:26
Elisa Arespacochaga
So what are some of the things you all are seeing that are helping support everybody rowing in the same direction?

00:04:57:28 - 00:05:29:28
Nell Buhlman
I'd say one of the most important elements is identifying the goal. What is it that we are trying to do? How does it align to organizational strategy? And does it factor in what matters to the people who are doing the work, the people who are delivering the care, whether they are right at the bedside or they're further away from the bedside, those at the bedside standing on their shoulders, so to speak. Aligning to strategy, making clear how it aligns to strategy, and anchoring it in the values of the organization, and making sure that the behaviors that are expected are aligned to those values.

00:05:30:04 - 00:05:50:12
Nell Buhlman
That there's accountability to those behaviors. So, those are some of the foundational sort of strategic elements of it. And then the rest of the infrastructure, I think, you know, is aligned around do people know what they're supposed to do? Have they been trained? Are we measuring things appropriately? What are the different facets, the different components of the strategy that are going to enable success?

00:05:50:12 - 00:05:54:27
Nell Buhlman
And how do we hardwire those things so that we're delivering reliably on them?

00:05:54:29 - 00:06:27:25
Chris DeRienzo, M.D.
One thing, Nell, that I would add, is we've been lucky to work together since at least December. And I remember we had an opportunity to bring several hospitals and health systems into a room, all of whom were really showing top level performance, top box performance for both their workforce experience and their patient experience. And it struck me that this kind of infrastructure that didn't require you to be a very large, multi-state, you know, multi-system entity down to a single hospital in Appalachian Ohio, up to those sizes -

00:06:27:25 - 00:06:33:24
Chris DeRienzo, M.D.
they were kinds of infrastructure that worked. And Elisa, you tell a story of one of those that I just always love to hear.

00:06:33:27 - 00:06:57:09
Elisa Arespacochaga
Now have to remember which story that is. But yeah, there's a lot of underlying infrastructure of making sure that everyone is on the same page. There are a couple of everything from the very simple to from a CEO whose name was Cliff and felt moved to tell his team what he was thinking about on the regular and writing this newsletter

00:06:57:09 - 00:07:25:21
Elisa Arespacochaga
that was both very personal, but also very connecting to the community and calling it Cliff Notes, which to me is just one of the most heartwarming opportunities. Obviously, not every CEO is going to be named Cliff. You have to come up with the individual connection, but looking for opportunities to truly and authentically connect with everyone on the team, whether you're in the same building with them or whether you're across states from them looking for those opportunities that give you that authentic voice

00:07:25:21 - 00:07:56:25
Elisa Arespacochaga
I think and that authentic connection to your team. Because everyone really does want the same things, and identifying what that road looks like and where you want to go and where you are today are so important to that. So just to dig in a little bit more on some of those top performers and our conversations to really understand what they do differently. It was interesting to me that as we went through those conversations with them, there were some sort of key approaches that they all had that, as I described, are very tactical.

00:07:56:25 - 00:08:09:06
Elisa Arespacochaga
Everything from making sure they're communicating in different ways and very authentically. But what were some of the ones that struck you all as really neat tactics to make that engagement hit home?

00:08:09:09 - 00:08:45:08
Chris DeRienzo, M.D.
Yeah, Alyssa, I'll lead with one. And it's about connect to purpose. You know, I've heard experience described as how we deliver on our brand. And I'm a doctor, not a marketing person. But I've also heard brand described as the promise that we make, the reason that people come to see us and drive past other places. When I heard that, I thought back to the first health system I worked at outside of fellowship over ten years ago, and during orientation, our chief operating officer told every single person who worked for this health system, you have two jobs. And job number one is to do whatever it is we hired you to do, be it as a

00:08:45:08 - 00:09:06:23
Chris DeRienzo, M.D.
neonatologist or as an EVS technician or revenue cycle employee, and do it as well as you possibly can. Job number two is help us figure out how to make it better. And our purpose, our core brand was improvement. That we knew we were doing well but our commitment to the community was we are always working to get better and that had to be ingrained in our DNA.

00:09:06:23 - 00:09:30:13
Chris DeRienzo, M.D.
So she did a spectacular job, starting with orientation and even before orientation in terms of hiring the right people for whom that purpose really connected, that helped then build an infrastructure that we can rely on. But connect to purpose was the one that really resonated loudest with me and again, that works just as well for a critical access hospital in Oklahoma as it does for large multi-state systems here in Tennessee.

00:09:30:20 - 00:09:44:09
Nell Buhlman
Chris, that's really interesting because she's actually when I hear you tell that story, and it's not the first time I've heard it's such a good story, she's doing a couple of things there, maybe three good things there, and I'm sure she does lots of great things. But, one of them is - with the idea of connecting to purpose

00:09:44:09 - 00:10:07:06
Nell Buhlman
so first, like articulating what the purpose is. Everyone understood because she said the same thing to everyone. So everyone understood. So having that narrative, expressing it in a way that transcends all roles in the organization is essential. That's how you connect to purpose. And then the other thing is there's another element we saw among those organizations that we brought together in December is the idea of two way communication.

00:10:07:06 - 00:10:26:24
Nell Buhlman
Right off the bat, that CEO was opening up the door to two way communication, not just this is how you're going to do it. I'm going to tell you how you're going to do it, but I want to hear from you how to make it better. So that two way communication was there. There's no better way to show respect to people than by inviting them to contribute to adding additional value.

00:10:27:00 - 00:10:47:14
Nell Buhlman
Finding improvement and respect is the number one driver of engagement nationally, at every organization locally. It's not one of those things that sometimes shows up as a key driver and sometimes shows up as like the third driver, it's always the number one key driver. So she was doing that too. And then this idea of the work mattering is really essential as well.

00:10:47:16 - 00:11:07:14
Elisa Arespacochaga
And I love that. One of the other examples that stuck with me was this one organization that created what they referred to as transformation teams, where they went to the frontline because it was closest to the problem or probably closest to the solution, and pulled together frontline teams on focused priorities that they all had agreed upon as an organization

00:11:07:14 - 00:11:24:29
Elisa Arespacochaga
that led directly to their strategy. But then they went to the people doing the work and said, be part of our transformation team. Help us make this change. So that communication was just reinforced between leadership and the frontline, but also was giving this group both the respect and a voice in how their work was going to move forward.

00:11:24:29 - 00:11:48:18
Nell Buhlman
And building trust, and building trust so essential. And the idea of teams is also essential. Individual contributors can only create so much value. When you have people working together in teams, you have this exponentially greater value because it's a flywheel unto itself. It gets momentum, it's self-reinforcing. And we talk a lot about the idea of in health care

00:11:48:18 - 00:11:57:16
Nell Buhlman
it's not just a team sport, it's a team of team sport. And you have to have intersections and collaboration and coordination across multiple teams to really get it right.

00:11:57:18 - 00:12:22:04
Elisa Arespacochaga
And Chris has heard this, but I still quote it quite often. The first day of one of my calculus classes in college, professor came in and wrote on the board, two plus two equals five and asked us to prove it. And I said, well, for sufficiently large values of two, that's accurate. So, I think that's entirely what we're trying to build in health care is where it's sufficiently large values of two to be able to be five.

00:12:22:04 - 00:12:22:24
Elisa Arespacochaga
when we're two plus two.

00:12:22:24 - 00:12:45:14
Nell Buhlman
Exactly right. Exactly right. And to make the connection back to patient experience: Among the key drivers for patients to give highest marks for likelihood to recommend or overall rating of care is their perception of the degree to which teams worked well together to care for them. It is the number one key driver for achieving high performance and likelihood to recommend across all settings of care.

00:12:45:16 - 00:13:01:05
Nell Buhlman
Did the care team work well together to care for me? Which is interesting because it shows that patients are alert to team dynamics and interpersonal competencies in ways that maybe we didn't imagine previously, or maybe weren't even really true previously, but it certainly is today.

00:13:01:07 - 00:13:15:10
Elisa Arespacochaga
Well, I just want to thank you, Chris and Nell, for joining me on for this brief conversation. I look forward to so much more work together, because this intersection is one that both I'm passionate about, and I think we can really help the field move forward.

00:13:15:12 - 00:13:23:22
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.

What does it take to become a truly age-friendly hospital? In this conversation, Shelley Hart, R.N., clinical nurse specialist at Froedtert Menomonee Falls Hospital, explores the hospital's inspiring journey toward delivering exceptional care for older adults. Through innovative delirium prevention programs, goals of care conversations, and simple acts of human connection, Shelley shares how the team is creating a hospital experience centered on dignity and purpose.


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00:00:01:02 - 00:00:26:02
Tom Haederle
Welcome to Advancing Health. About a decade ago, Froedtert Menomonee Falls Hospital in Wisconsin decided to focus on improving care and services for its geriatric population of patients. In today's podcast, we learn more from a Froedtert clinical nurse specialist about how its age-friendly journey is advancing the quality of care for older adults.

00:00:26:04 - 00:00:43:01
Jen Braun
Hi everyone! I'm Jen Braun, director of workforce and organizational development at the American Hospital Association, and my guest today is Shelly Hart, who's the clinical nurse specialist at Froedtert Menominee Falls Hospital. Thanks for joining me, Shelly. I was wondering if you could share a little bit about yourself and what you do at Froedtert.

00:00:43:04 - 00:00:59:23
Shelley Hart, R.N.
As you said, I'm a clinical nurse specialist, and I've worked at Froedtert Menomonee Falls Hospital for many decades. I have geriatric background. And so I was very instrumental in when we started to develop our age-friendly status.

00:01:00:00 - 00:01:06:04
Jen Braun
So tell me a little bit more about how your organization began their age-friendly journey.

00:01:06:07 - 00:01:46:23
Shelley Hart, R.N.
I will tell you a little story because it started many, many years ago - right around 2015, 2016 - when we decided we needed to develop an ACE unit. And at that point we thought we needed to do lots of different things to be much more attuned to our geriatric patient population. So, at that point, we started training using our niche protocols and our nursing assistants and RNs learned a lot about geriatric assessments, protocols, discharge planning, etc. and then we also put into place a lot of other protocols for the providers to use.

00:01:46:25 - 00:02:31:21
Shelley Hart, R.N.
We are very fortunate because of our pharmacists and how we have lots of medication guidelines and other daily work that they do supporting age-friendly geriatric patient populations. And we also roped in our geriatricians and they were very supportive and did a lot of work, preparing us. So when we started looking at all of these protocols, everything that we're doing in terms of 4Ms, with mentation, with mobility, with medication and what matters, we had a lot of things already in place that we just had to pull together and look at how we were doing with that.

00:02:31:22 - 00:02:46:06
Shelley Hart, R.N.
How could we do better, and how could we spread this to other areas in the hospital and make this really well received by everybody and make an impact? And so that led us to our age-friendly journey.

00:02:46:08 - 00:03:04:03
Jen Braun
That's amazing. So it sounds like you had a lot of the pieces in place for the 4Ms, which you mentioned were what matters medications, mentation and mobility. And you just had to kind of button them up a little bit. What were some of the interventions, though, that you, that you made to help provide that age-friendly care?

00:03:04:09 - 00:03:30:12
Shelley Hart, R.N.
And that is really, you know, one of the really great pieces about using the 4Ms framework, because you can integrate that into lots of existing things you're already doing. So, for example, what matters in our organization as we really are leveraging our providers when they're talking about goals of care with patients. And they already had a smart phrase that was developed for that.

00:03:30:13 - 00:04:00:29
Shelley Hart, R.N.
So we harnessed that. We also tightened up our medication review, all the daily work our pharmacists are doing. We're really grateful that they use our Beers list criteria and all of the work when they are calling about deprescribing or changing dosing of different medications. I do have to say we did tighten up, you know, our mobility screening, mobility activities, delirium screening and delirium activities.

00:04:00:29 - 00:04:27:05
Shelley Hart, R.N.
And I if I could, I'd like to just explain a little bit more about our mentation and how we have a really robust delirium prevention group within our system and also within our community hospital of Menominee Falls. And, we've just developed some education around that, doing education posts every 1 to 2 weeks so everybody can look at that.

00:04:27:08 - 00:04:53:29
Shelley Hart, R.N.
We also developed a delirium champion program. So now we have unit champions coming. And there's many stories I could share about the delirium champions and all the work they're doing. This is just within the last year or so. We're also just celebrated our delirium awareness day. We took a wellness cart around the hospital. We talked about delirium awareness, delirium prevention, extremely well received.

00:04:54:00 - 00:05:04:24
Shelley Hart, R.N.
So that was with ED, ICU, our stepdown units and all of that surge. So those are all activities we've been doing that just keep spreading age-friendly.

00:05:04:26 - 00:05:25:27
Jen Braun
That's incredible. You've mentioned so many strategies that you've employed. And you know, health care is a team sport. And there are sounds like many, many, many teams involved, many stakeholders. So how did you get engagement and ownership with some of those key stakeholders or what strategies did you employ?

00:05:25:29 - 00:05:59:10
Shelley Hart, R.N.
We are really lucky because our executives actually talked about: You know what? There's this age-friendly action community going on. You guys have a lot of experience with this. You're really subject matter experts, and I'm talking about myself and our director, Sheri Katzer. Would you guys like to lead this work and include our geriatricians and our subject matter expert pharmacists and all of our interdisciplinary therapists?

00:05:59:10 - 00:06:19:21
Shelley Hart, R.N.
And we're like, sure, let's do it. So that was, you know, coming from executives as well as one of our vice presidents. What is their length of stay? How can we make it the best for them meeting their needs? Just employing all those and that's how we actually were propelled into doing the age-friendly submission.

00:06:19:25 - 00:06:34:11
Jen Braun
So it sounds like you had a lot of leadership support from the jump. Did you have any stakeholders who are a bit challenging to get, you know, over the curve there, or what did you specifically do to, do any outreach to them?

00:06:34:14 - 00:07:00:06
Shelley Hart, R.N.
I do think as a group meeting understanding age-friendly, really, and doing a gap analysis. What do we have? What are we working towards? Helping people understand what is what matters mean? What is the medication piece mean? What does mentation piece mean? What does this actually mean in your work? In your daily work? How can we quantify that?

00:07:00:09 - 00:07:09:08
Shelley Hart, R.N.
How can we make it work and improve it? And how can we spread it to the hospital? And at this point, we want to spread it into the system. And what's the next steps for that?

00:07:09:15 - 00:07:12:06
Jen Braun
And so, speaking of, what are the next steps for that?

00:07:12:08 - 00:07:38:13
Shelley Hart, R.N.
And you know, it's great that we're here and there's people really looking forward to us bringing back all the information from today. We really want to talk about dashboards, metrics, quantifying data. We're looking at the CMS, age-friendly measure. How is that impacting things? What can we do to improve? Let's set us up for success. And of course, the patient. That, you know, that's the primary center of everything.

00:07:38:15 - 00:07:49:13
Jen Braun
So how is participating in an AHA age-friendly health systems action community contributed to your work or Froedtert'success?

00:07:49:15 - 00:08:18:25
Shelley Hart, R.N.
Lots and lots of older adults come into the hospital, so we want to make it the best experience for them. We want to make it, what matters to them a lot. A lot of dignity involved in what's going on for the patient, what's going on for their family. And, really, that helps with success of the organization in terms of the patient satisfaction, family satisfaction, all the health care workers working best practice.

00:08:18:27 - 00:08:37:01
Shelley Hart, R.N.
And it's every patient, every time. So it's really an exciting time. And I think everybody should take advantage of age-friendly because there's energy in it. So that's a big piece of it too, is you focus the energy on age-friendly and we're all working towards the same goal.

00:08:37:04 - 00:08:46:24
Jen Braun
You mentioned some of the impacts that you've seen from delivering age-friendly care. Are there any impacts that you want to specifically call out that you're really proud of?

00:08:46:26 - 00:09:12:02
Shelley Hart, R.N.
Well, there's a lot of patient stories I could go into about how training of nurses, training of nursing assistants, providers, and how they centered care around what matters to the patient. From you know, couples that are in the hospital in different places at the same time and how we're getting them together for lunch and people making that happen.

00:09:12:04 - 00:09:33:25
Shelley Hart, R.N.
Families, you know, thinking, you know, mom hasn't been doing so well over the course of the months. Can I talk about this? We need to really talk about this and someone listening and say, yeah, let's get together. We're going to have a family meeting about this, and they get the right players involved to make it best for the patient.

00:09:33:27 - 00:09:42:14
Shelley Hart, R.N.
Those are just a couple, like, stories that happen all the time, and that is not possible unless you're all in sync.

00:09:42:17 - 00:09:57:03
Jen Braun
So, Shelly, I just want to thank you for sharing all the work that Froedtert has done, and you have done to implement the 4Ms at your system to ensure that older adults are receiving quality care. So I really want to thank you for sharing your story and your time here today.

00:09:57:06 - 00:10:03:04
Shelley Hart, R.N.
You're very welcome. I am really happy to be here and to share stories.

00:10:03:07 - 00:10:11:18
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

The 4Ms framework that supports age-friendly health care for older patients continues to expand in hospitals and health systems across the nation. In this conversation, Carolyn Bogard, DNP, R.N., director of care coordination and palliative care at El Camino Health, talks about her system’s use of data to harness the passion that care providers feel for improving outcomes and streamlining care delivery for older adults.


View Transcript
 

00:00:01:06 - 00:00:23:22
Tom Haederle
Welcome to Advancing Health. The 4Ms are the core components of Age-Friendly health systems that aim to improve the quality of care for older adults. Today, we hear from California-based El Camino Health about how its adoption of the forums has produced measurable improvements for the older people it serves.

00:00:23:24 - 00:00:40:20
Raahat Ansari
Hi everyone. We're here in Chicago at AHA’s Advancing Age-Friendly Care Convening. I'm Raahat Ansari, senior program manager at the American Hospital Association. Today I'm here and joined by Carolyn Bogard from El Camino Hospital. Thank you so much for being here with us today.

00:00:40:23 - 00:00:43:19
Carolyn Bogard, R.N.
Thank you for having me. I'm so excited to be here.

00:00:43:22 - 00:01:06:18
Raahat Ansari
Great. So we wanted to take some time to understand your Age-Friendly journey and how you implemented the 4M's framework at your organization. And I'll just take a quick moment for those listeners who might be new to this work to explain that the 4Ms is: what matters, medication, mentation and mobility, and applying that care to older adults. So can you tell us how it got started?

00:01:06:20 - 00:01:29:09
Carolyn Bogard, R.N.
Absolutely. And again, thank you so much for having me and for this opportunity. I'm so proud to talk about the work being done at El Camino Health, and where we're at on our journey. We are still in the beginning phases of our journey and the 4M implementation at El Camino Health - it actually started with the leadership of one nurse.

00:01:29:15 - 00:02:02:08
Carolyn Bogard, R.N.
This nurse was making advances in her unit to implement an evidence based project, and her passion was really around delivering Age-Friendly care to older adults. And through her work and collaboration with pharmacy and our Epic analysts and other interdisciplinary team members, she was able to advance and roll out the 4M's on this medical unit within El Camino Health.

00:02:02:11 - 00:02:14:15
Raahat Ansari
It's amazing to hear. I just want to share that we do hear that a lot of organizations get started with this by one single individual championing this work, so I'm super excited to hear that that's the story at your organization.

00:02:14:18 - 00:02:37:21
Carolyn Bogard, R.N.
Oh, thank you so much. Yeah, we're super proud of her. And she continues to be a steadfast advocate for this work and continues to be so passionate about it and deeply involved with rolling out the 4Ms further throughout our health system. We certainly saw the impact in the benefits of rolling out the 4Ms and of this Age-Friendly health initiative.

00:02:37:24 - 00:02:47:22
Raahat Ansari
Did you see some outcomes and did you have data and what did you do with that data? And I wonder, were you able to share that with your leadership if you needed some help with leadership buy in?

00:02:47:29 - 00:03:26:18
Carolyn Bogard, R.N.
Yes. One of the things that we helped to do to advance this work, one of the first things is really to pull some of the data. And some of the data already on this unit was around high patient engagement scores and also the volume of older adults within this specific unit. We knew through the Age-Friendly initiative and the work with the IHI and American Hospital Association that rolling out the 4Ms within a health system impacts length of stay, readmissions, falls and other patient health outcomes and health system outcomes, too.

00:03:26:21 - 00:03:52:29
Carolyn Bogard, R.N.
And we were able to bring this information in this data to our chief nursing officer. And we began conversations around how can we expand this initiative throughout our health care organization? So, she was extremely supportive and excited and passionate around this work as well. And then it was a matter of identifying next steps.

00:03:53:03 - 00:03:58:09
Raahat Ansari
So it was the data that got your chief nursing officer on board. Did I hear that correctly?

00:03:58:09 - 00:04:32:15
Carolyn Bogard, R.N.
I think it was the data and also her passion around it. And I think what I've seen is there is a lot of health care providers passionate about caring for older adults. And I think the 4M framework really helps to create a platform for where to focus that passion and energy to help produce really tangible outcomes and help to really streamline health care delivery for the older adults in our health systems.

00:04:32:17 - 00:04:43:17
Raahat Ansari
So I'm hearing a little bit of outcomes across the board. So there were definitely some positive patient outcomes. And from what you just shared right now, there were some positive provider outcomes.

00:04:43:19 - 00:05:21:09
Carolyn Bogard, R.N.
Well, I think certainly our providers are interested in continuing to advance this work. I think from the pilot phases and initial rollout of the 4Ms and this unit, the nurses in particular in this area found the work to be important and meaningful. And recognized the value that this work can have for their patients. And, you know, one thing that we did within our health system, when we're talking a little bit about scope and spread and how to really expand this work is, where do you begin?

00:05:21:15 - 00:05:52:05
Carolyn Bogard, R.N.
We had some success on this medical unit within our health system. What nursing leaders, what key stakeholders within the health system do we need to further expand? And we are so thankful to have the executive support that we do. Because our CNO knows exactly who to pull into the conversation. And one of the stakeholders that was really helpful with advancing these conversations is our process improvement adviser.

00:05:52:07 - 00:06:19:20
Carolyn Bogard, R.N.
And we really started by identifying what problem are we trying to solve, and then really doing a value stream about current processes within our health care organization. And what do we need to do to further expand some of this work? And some of the things that we identified right off the bat is identifying some programmatic leadership.

00:06:19:23 - 00:06:48:24
Carolyn Bogard, R.N.
Who's in charge of further expanding this, this, health care initiative? And also, where can we get consistent data from? Data can help tell your story and we know that this is an important story to tell, both to our patients and our health system. And we were lucky enough to work with a fantastic data analyst within our health care organization and he helped to develop an Age-Friendly dashboard.

00:06:48:27 - 00:07:29:12
Carolyn Bogard, R.N.
It's still in the beginning stages because sometimes there's so much data you can get paralyzed. And so we have to really think about what data do we need and how do we act upon the data that we have. Part of the initial data collection was around our patient population. You know, better understanding who are we caring for in our health system, identifying certainly ages and demographics and what service lines are these patients on based on that data that's helping to inform us around which units will we spread to next?

00:07:29:14 - 00:07:45:24
Raahat Ansari
I think that makes perfect sense. And one question that I want to ask you that I imagine some of our listeners might have of you is do you have any tips that you could share that you used to get that leadership buy in? We all know how important that is to leverage.

00:07:45:27 - 00:08:30:04
Carolyn Bogard, R.N.
Well, I'm so thankful to have regular and consistent communication with my executive and that alone gives me a pathway to communicate where we need help and what type of support that we need. And through that support and engagement and ongoing communication, we were able to develop a plan. Now, the plan did not develop overnight. It took probably three months from that initial conversation to even get a quorum of nursing directors across the organization in one room, with the process improvement advisory to talk a little bit about Age-Friendly care within our health care organization.

00:08:30:04 - 00:08:35:16
Raahat Ansari
And that's a success in and of itself, right? And get have all the stakeholders in one room to talk about that.

00:08:35:16 - 00:09:13:09
Carolyn Bogard, R.N.
Definitely. And when we had these initial conversations, everyone had different thoughts and ideas and opinions and observations about what was going well within the organization and what could be improved. And following that, we completed an A3, which is really a, you know, a systematic way to tackle a problem. And through input in discussion and these observations from all the nurse leaders, we were really able to see what areas are we doing well in and what areas can we improve in.

00:09:13:12 - 00:09:39:05
Carolyn Bogard, R.N.
And because we did have the 4M framework already rolled out on one unit, we weren't starting from scratch. We already had a pilot unit that implemented the 4Ms and was successful with that. So it was really more about building upon that success. Now we're at a spot as we think a little bit more about spread and scale across the organization.

00:09:39:08 - 00:09:51:03
Carolyn Bogard, R.N.
How do we dive a little bit deeper into each M, and how do we gain further engagement from members of the interdisciplinary team?

00:09:51:06 - 00:10:05:06
Raahat Ansari
And I do hear another challenge from some organizations about breaking down those silos and having that those interdisciplinary conversations. Any advice that you could share and how you successfully made that happen at your organization?

00:10:05:09 - 00:10:29:19
Carolyn Bogard, R.N.
Oh, yeah. Thank you so much for that question. And I would just add, being here at this forum, it's just so fantastic because even just today, I learned different ideas from different folks within the community. So one of the areas that we talked about was how do we get that buy-in and collaboration from members of the interdisciplinary team?

00:10:29:21 - 00:11:04:27
Carolyn Bogard, R.N.
Being that it's, you know, pharmacy or rehab services, case management, social worker, even our physicians, and certainly one of the best practices that was identified is really trying to find a champion in each area. And in my experience and observations, I have seen some passion out there about delivering high quality care to our older adult patient population. So at least within my health system, I don't have to look too far for individuals that are interested in advancing this work.

00:11:05:00 - 00:11:32:02
Raahat Ansari
When we started this work, that provider re-engagement and that spark, that passion that really was reignited when providers were working towards implementing the 4Ms framework into a patient care plan - that was something we were not expecting to see. So I really appreciate that you're saying that it's not hard to find, because we have seen that in real life when we have new teams come and join the action

00:11:32:02 - 00:11:50:00
Raahat Ansari
communities a little unsure of what to expect, what they're going to get out of it. And come two, three months into this, we've got a whole host of providers from all different disciplines who are really excited and passionate about being able to implement this work with their patients. So just wanted to highlight that point. Thank you for bringing that up.

00:11:50:06 - 00:12:08:15
Carolyn Bogard, R.N.
Oh you're welcome. And actually to your exact point, I have been part of the action community intermittently, throughout a number of years based on various jobs that I've had. And I get it. Caring for older adults, it is a passion of mine and it's such a privilege to be able to continue to be part of this work.

00:12:08:18 - 00:12:46:11
Carolyn Bogard, R.N.
But I would even think 5 to 7 years ago, people were just better understanding the importance of delivering high quality, reliable care to older adults. And even in that short period of time, I feel as if I have seen some reinvigoration in interest into this real specialty area of medicine. It's fantastic because it really does take a village, and an interdisciplinary team to provide holistic care to our patients, certainly within the hospital setting, but also across the care continuum.

00:12:46:14 - 00:13:03:09
Raahat Ansari
And so what I'm hearing is you have nailed it at this at this one site, you are done and done. Just kidding. Because that work is never done, right? But you've made some really good strides at one care site and you're moving to expand to other care sites within your organization. And that is fantastic news and something to celebrate.

00:13:03:11 - 00:13:05:06
Raahat Ansari
Thank you again for being here with us today.

00:13:05:09 - 00:13:08:05
Carolyn Bogard, R.N.
Thank you. It's been an honor and a pleasure.

00:13:08:07 - 00:13:16:18
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

The passage of the One Big Beautiful Bill Act will present many policy changes and challenges for America's hospitals and health systems. In this Leadership Dialogue conversation, Tina Freese Decker, president and CEO of Corewell Health and 2025 AHA board chair, talks with Rick Pollack, president and CEO of the American Hospital Association, about the sweeping impacts this legislation will have in the health care field. They break down the $900 billion in Medicaid and ACA marketplace cuts, the real-world effects on communities, and the behind-the-scenes advocacy that helped blunt even deeper damage.

This podcast was recorded on July 11, 2025


 

Cyberattacks on hospitals are urgent threats to patient safety, care delivery and public trust. In this conversation, Ajay Gupta, board chair of Trinity Health Mid-Atlantic and CEO of HSR.health, speaks about the vital role hospital boards play in preparing for and responding to cyber incidents. What strategic questions should boards be asking, and how can cyber preparedness make or break a hospital’s ability to deliver care when it matters most?


View Transcript

00:00:01:06 - 00:00:23:23
Tom Haederle
Welcome to Advancing Health. Cyberattacks directed against hospitals continue to increase, and many cyber threats quickly escalate into a governance and patient safety issue. In today's podcast, we learn about how board members can educate themselves and prepare to help their organizations face these threats.

00:00:23:25 - 00:00:48:15
Sue Ellen Wagner
I am Sue Ellen Wagner, vice president of Trustee Engagement and Strategy at the American Hospital Association. I'm delighted to be with Ajay Gupta today. He is the board chair of Trinity Health Mid-Atlantic and Holy Cross Health, and he's also the co-founder and CEO of hsr.health. It's nice to have you with us, Ajay, today to talk about cybersecurity and what trustees need to know.

00:00:48:18 - 00:01:08:16
Sue Ellen Wagner
I am hoping this podcast will be a nice 101 for board members to educate them about [what] their role is in cybersecurity, and what they should know to prepare for a cyber incident should one occur at their hospital or health system. Ajay, you have both business experience in the cyber industry and you're also a board member.

00:01:08:19 - 00:01:38:14
Sue Ellen Wagner
So your insight will be very valuable to our members and our listeners. Cybersecurity vulnerable cities and intrusions really do pose significant risks to hospitals and health systems, and the threats continue to increase each year. It's important for trustees to be ready should an incident happen at their hospital or health system. So, Ajay, can you tell us what trustees should know to be prepared should an incident occur?

00:01:38:16 - 00:02:04:04
Ajay Gupta
Thank you, Sue Ellen. It's great to be here with you today. And thank you for this question. It's a great overall question for a 101. I wish there could be a short answer, right? You only need to know a couple of things for cybersecurity. It's unfortunately not quite like that. I think the first place to start is to recognize that cybersecurity is a technical issue, and it's always really been thought of as something that IT would handle.

00:02:04:06 - 00:02:31:12
Ajay Gupta
But today we need to know that given how much of our care delivery relies on IT systems, should those systems become unavailable, whether due to a cyberattack or any cause - it very quickly becomes a patient safety and governance issue. As such, trustees need to ensure hospitals are prepared. And for cyber, preparation means can our clinical teams continue to provide care if systems go offline?

00:02:31:15 - 00:02:53:12
Ajay Gupta
The board's role is to provide oversight and confirm the organization is ready, not just to defend against the cyber attack, but also to operate through one safely. But this starts by understanding what the nature of our IT infrastructure is and how stable is it? How secure is it? Are we comparing ourselves against benchmarks? What measures are we taking to ensure its security,

00:02:53:12 - 00:03:15:09
Ajay Gupta
and are those measures tested? Are our IT and cybersecurity departments aware of the trends the security of the industry is facing overall from a cyber threat landscape? Because that will depend and it will influence what kind of measures we take in the defense and in the resilience during the middle of the year of an incident. I hope that's a good starting point for discussion.

00:03:15:12 - 00:03:34:25
Sue Ellen Wagner
It's a great starting point and cyber security is very complicated. You had mentioned, you know, patient safety and quality, which are very important. How do trustees know if their hospital or health system is secure to continue to operate and provide that clinical care that's safe should a breach really occur?

00:03:34:27 - 00:04:11:00
Ajay Gupta
Well, if a breach has occurred, Suellen, by definition, the system is not secure at that moment, unfortunately. But to more broadly respond to your question, trustees need to ask about the resilience of the IT systems in the face of a possible cyberattack. That's really the question that we need to say. Unfortunately, we are operating in an environment where some level of cyberattack, whether an overt attack from a bad actor or even just the system's combination of users across the spectrum and anything else causes an IT issue that brings systems down.

00:04:11:06 - 00:04:32:29
Ajay Gupta
We need to know how resilient we are in any and all of those systems. And the only way to know if operations can continue during a breach is to experience continuing during a breach. Of course, we don't want that. So we have to do the next best thing: testing, preparation and practice. All of that is more and more important.

00:04:33:06 - 00:04:59:24
Ajay Gupta
That means having an incident response plan in place, which is not terribly unlike plans we may have - we likely have - in place for a natural disaster, or if there is a an expected surge in trauma. We have plans in place for surge and we need to have a cyber plan in place as well. This is a plan that lets everyone know what to do exactly during a cyber event, without any confusion or momentary disarray, because we know that can cause patient harm.

00:04:59:27 - 00:05:27:15
Ajay Gupta
Our critical care workflows like medication administration, lab orders, and surgical schedules operational without digital systems. Do clinicians know how to access key information when digital systems go down? And do clinicians remember how to treat patients when they don't have access to all of the digital sources of information, like lab reports or film that they do typically use in the course of patient care.

00:05:27:18 - 00:05:29:20
Ajay Gupta
That's a big, big issue as well.

00:05:29:22 - 00:05:55:10
Sue Ellen Wagner
Well, relying on the digital world that we live in today is something that we're all used to. You had mentioned that, you know, most trustees won't have an idea of what a cyber security incident is until it actually happens to them. So preparing is really difficult. And I think that's something none of us want as board members. Can you explain to trustees the impact that that breach will have and what their role specifically should be?

00:05:55:10 - 00:06:01:21
Sue Ellen Wagner
Because management leadership has one role, the board has another. So can you just kind of describe that?

00:06:01:24 - 00:06:26:06
Ajay Gupta
It's important to remember that a breach is more than a tech failure. It is a system failure. It's a failure of our system and ability to deliver care. As such, trustees will have a specific role. A breach can paralyze care delivery, right? Shutting down systems, delaying surgeries, leaving clinicians without access to medical records. This means patients may not receive the care they need, the care they trust us to provide.

00:06:26:09 - 00:06:53:14
Ajay Gupta
It's important for trustees to know and understand that while the fault is not ours, the fault resides entirely with cyber criminals who perform the attack. But patients don't see the hackers. They see us. And so they see us as unable to provide the care they need when they need it. And this is a stain on our reputation. That is a critical thing for the boards and trustees to recognize.

00:06:53:16 - 00:07:15:12
Ajay Gupta
Breaches trigger reputational damage as well as regulatory damage and a financial fallout. For instance, health systems may face fines, according to the breach. The average cost of a cyber breach was reported at just under 10,000,000 in 2024, as reported by IBM, which was less than 2023 when it was reported at 11 million. However, I don't think that we can plan for that trend to continue.

00:07:15:16 - 00:07:43:03
Ajay Gupta
Trustees have to lead from the front by ensuring the organization is prepared with strong cyber governance, risk management practices and a culture of preparedness in place. Our role is to ask strategic questions and ensure readiness, and that we are able to continue serving patients and to recover swiftly, regardless of the situation. We need to make sure that we have the experts ready to act on our behalf in a cyber attack.

00:07:43:10 - 00:07:57:12
Ajay Gupta
Technical experts who can respond to the technical details and dimensions of the attack, as well as legal and communication experts that can help us communicate and handle some of the regulatory and legal fallout that may follow a cyber attack.

00:07:57:14 - 00:08:17:22
Sue Ellen Wagner
So I hope our listeners never have to deal with a cyber incident. We obviously can't control whether that will happen or not. So I'm hoping that this is really helpful for folks. I think if they listen to it, they can actually start asking their leadership if they don't have a plan to develop a plan, or the board should know what the plan is and what their role is.

00:08:17:22 - 00:08:28:24
Sue Ellen Wagner
So Ajay, the last question, can you highlight some of the key takeaways for our listeners, some nuggets of information that they should just, you know, take away from this podcast to prepare themselves?

00:08:28:26 - 00:08:53:25
Ajay Gupta
Absolutely. One thing I want to mention, what you just said is that we can't control. That's true, we can't. We can't control the weather. Yet hospitals and health systems in a hurricane prone region certainly know to prepare for a hurricane, right? In that same sense, hospitals have to be prepared for this. Cybersecurity is a patient safety issue because, as I said, we use technology in everything we do in a hospital today almost,

00:08:53:28 - 00:09:14:19
Ajay Gupta
or it seems. If it's a patient safety issue, it's a governance issue and the trustees have to be involved. The impact is very real. Any event that can halt care and erode trust and cost millions of dollars has to be of great concern. Continuity demands preparation. Again, just like we practice our surge plans, we practice our hurricane plans.

00:09:14:25 - 00:09:35:06
Ajay Gupta
We have to develop and practice technical continuity plans from a cyber breach perspective. And trustees must lead. Our role is oversight, which means we have to ensure management has thought through all aspects from defense against attack, resilience in the face of attack and addressing the potential fallout after the attack.

00:09:35:09 - 00:09:55:29
Sue Ellen Wagner
So thank you, Ajay. In addition to this podcast, AHA Trustee Services does have a few resources to help boards prepare should a cyber incident occur. So trustees should visit trustees.aha.org to access the resources. Ajay, I want to thank you so much for sharing your expertise with us.

00:09:56:02 - 00:09:59:11
Ajay Gupta
Thank you, Sue Ellen. It's great to be here.

00:09:59:13 - 00:10:07:24
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.

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