Advancing Health Podcast

00:00:00:03 - 00:00:23:09
Tom Haederle
Welcome to Advancing Health. In this first leadership dialogue podcast of the year, Dr. Marc Boom, president and CEO of Houston Methodist and the 2026 Board Chair of the American Hospital Association, speaks with a top leader at the Joint Commission about the factors that drive organizational innovation.

00:00:23:12 - 00:00:51:28
Marc Boom, M.D.
Well, greetings, everybody, and thank you so much for joining me today. I'm Dr. Marc Boom. I'm here with you today as I am privileged to start serving my term as the board chair of the American Hospital Association for 2026. This is a great honor, great privilege, and it's something I take very seriously. And I can't think of a more interesting time and an opportunity with more promise than leading the American Hospital Association's members, who work every single day to make health care better for all Americans.

00:00:52:00 - 00:01:12:03
Marc Boom, M.D.
Part of this new role is making sure we are continuously learning, and I believe these leadership dialog series are a great way to listen to and learn from others as a strategy to always seek to be better and better informed. To give a little background on me and my experience leading a hospital system since this is our first podcast.

00:01:12:06 - 00:01:36:27
Marc Boom, M.D.
I've been very fortunate to be at Houston Methodist now for 28 years, almost 29 years. I've been privileged to be CEO for the last 14 years or so. We're a very large organization, 35,000 employees, flagship Academic Medical center, the Texas Medical Center, and seven network hospitals that span throughout the greater Houston area. We have an active research institute, GME programs, etc..

00:01:36:29 - 00:01:57:27
Marc Boom, M.D.
And today, as we start this series and really wanted to focus on a foundational element, which is innovation. Because I believe this is a critical skill set for hospital leaders today. And so we're going to weave that theme throughout the year, along with a lot of other things. At Houston Methodist, innovation has been part of our DNA for a long time.

00:01:57:27 - 00:02:19:03
Marc Boom, M.D.
And we've really pushed it very hard, rethinking how we do things, being more agile in what we do, and trying technologies like virtual nursing, ambient listening in the operating rooms, wearable technologies. We have a saying at Houston Methodist when we try new technologies: we will succeed fast or we will fail fast. We also have two guiding principles for innovation.

00:02:19:06 - 00:02:41:23
Marc Boom, M.D.
The first is to obsessively focus on the needs of our patients, families and communities. That's why we are innovating. But a very close second is to make the lives of our clinicians and employees easier, so we can free them up to do what humans do best, which is actually the personal interaction in health care and what really connects them to the people we serve.

00:02:41:25 - 00:03:11:12
Marc Boom, M.D.
And I know that trying new and innovative solutions is nothing new for my guest today. I'm very pleased today to be joined by Dr. Jim Merlino, who was recently appointed a couple of months ago to serve as the chief operating officer of the Joint Commission. Prior to stepping into that new role, he served as the organization's chief innovation officer. And before that, he was the chief clinical transformation officer at the Cleveland Clinic, where he oversaw strategy, business development, safety, quality, patient experience, and continuous improvement.

00:03:11:14 - 00:03:21:04
Marc Boom, M.D.
So his experience and expertise make him a perfect guest for today's discussion. So let's welcome Dr. Jim Merlino, and let's jump on into our discussion. Jim, welcome.

00:03:21:07 - 00:03:31:25
James Merlino, M.D.
Thank you. Marc. Honored to be here. And congratulations becoming the chair of the American Hospital Association. Can't think of a better person. To be leading that organization in times like this.

00:03:31:27 - 00:03:51:16
Marc Boom, M.D.
Well, thank you very much. It's great to see here. Now, if my memory serves correctly, it's been a while, but the very first time we actually met was regarding institutional culture. So I know you think a lot about culture and you know the importance of culture, so I'd love to get your thoughts around that. How important is it when you're tackling innovation?

00:03:51:16 - 00:03:58:04
Marc Boom, M.D.
How do you use culture to drive quality safety, service, innovation. How do you do that?

00:03:58:06 - 00:04:23:00
James Merlino, M.D.
Yeah, well it is absolutely essential. And you know, when you first asked me to participate in this conversation, my initial thought was you know, I'm being questioned by a person that understands this better than I do because, you know, we first met when I was the chief experience officer for Cleveland Clinic under Toby Cosgrove, and we came to Houston Methodist to talk to you and talk to the team to learn about how you leverage culture to really build an incredible organization.

00:04:23:00 - 00:04:45:27
James Merlino, M.D.
And I remember we were touring the basement, and you showed me the floodgates and told me a story about how the hospital flooded after the hurricane and how you use that as a as a rallying point to really start to rebuild the organization. You know, I think in my career and I think you see it across the country, certainly within your organization, if you don't tackle the culture of an organization, particularly in health care, you're never going to achieve any of your goals.

00:04:46:05 - 00:05:01:29
James Merlino, M.D.
It is really foundational. You still have a saying, the clinic has a saying that, you know, if you don't, it's kind of like, how do you drive safe, high quality, patient centered care? You tackle your people and you make sure that they have the tools they need, that they are coming to work engaged, they love their job,

00:05:01:29 - 00:05:22:06
James Merlino, M.D.
they're feeling satisfied. You're meeting their needs. If you don't focus on that - organizations don't focus on that - you're never going to achieve your goals. That's essential for not only the basic elements, the table stakes and health care, but if you want to create an organization, particularly in health care, that's focused on trying to do new things and innovate, you need to harvest those ideas from your people, right?

00:05:22:06 - 00:05:29:15
James Merlino, M.D.
That's where the best ideas come from. The people that work in your organization, working closely with the people you serve, your patients and families.

00:05:29:18 - 00:05:33:27
Marc Boom, M.D.
That's great. So what do you do specifically to build that culture of innovation?

00:05:33:29 - 00:05:55:26
James Merlino, M.D.
Number one, I think we have to get leaders to recognize that culture is actually something you can develop. It's not something that just exists. You can invest in your culture. You can shape your culture. You can have your leaders help to define it and to grow it and to transform it. So investing in your people and your people development is a really critical component of it. Including measuring engagement, right?

00:05:55:26 - 00:06:19:25
James Merlino, M.D.
Are you ensuring that you're understanding what's important your people's minds? The second thing is giving them opportunities. And you talked about this at Houston Methodist, right? It's not the or, it's the and. It's like we need you to deliver great care, and we want to make sure that we're listening to you to harvest the information that we need to be able to build the organization that we want to deliver that great care.

00:06:19:28 - 00:06:39:23
James Merlino, M.D.
So I think it's a component of investing in your people, recognizing that culture is something that can be shaped, it can be molded, it can be developed, it can be improved. And giving your people the tools and the opportunities to speak up, to engage in that innovative culture, to share their ideas, to share their thoughts, to provide feedback.

00:06:39:23 - 00:06:46:03
James Merlino, M.D.
Those are two essential elements that I think health care leaders across the industry need to recognize.

00:06:46:06 - 00:07:03:29
James Merlino, M.D.
I think that's spot on. I always talk about intentionality. It is intentional. Culture is something, whether you're talking about any aspect of a culture, when you are intentional about what you do, you get the culture you want. When you don't have that intentionality, you don't get the culture you want. Unless you're lucky. And so that's critically important.

00:07:03:29 - 00:07:22:02
James Merlino, M.D.
So, okay, you've got the culture and you work on the culture, you build that, you work with your people. Now, you really talking about some of the technologies and how those intersect. And some of those technologies are so exciting. Some of these are kind of scary at the same time, right? What do you see as the opportunities at the intersection between technology and health care for our future?

00:07:22:08 - 00:07:27:15
Marc Boom, M.D.
I'd love to hear the thoughts about, you know, how that interplays with the Joint Commission as well.

00:07:27:18 - 00:07:57:23
James Merlino, M.D.
Well, you know, it's interesting because I think technology has always been with us in health care in some form. If you look at the innovations of the last 100 years in medicine alone, right? There's been tremendous advances. And now in the last few decades, those advances have just been accelerating where the curve is nearly straight up. But when you think about what we have with us today in terms of artificial intelligence, machine learning, etc., the opportunity to take new technology, new ideas and apply that to what we do is really unlimited.

00:07:57:23 - 00:08:16:04
James Merlino, M.D.
I mean, you are doing it now at Houston Methodist as well as others. I recently had the opportunity to visit your flagship and look at some of the things you're doing. And I think the exciting thing about technology today is that we really have an opportunity to use those new technologies to help liberate our people. Exactly what you said, right?

00:08:16:04 - 00:08:42:28
James Merlino, M.D.
We want to get people back to the personal touch of caregiving, AI. Machine learning, I don't think I hope will never replace the human touch, the human component, but it should be able to help the human component to be able to deliver that personalized care that people need in their healing process. I think from a Joint Commission standpoint, from the perspective of AI, you and I cannot imagine what AI is going to do for health care in ten years.

00:08:42:28 - 00:09:01:00
James Merlino, M.D.
I mean, when I was in college, right, my cell phone was, you know, it's five times the size of my current computer that I'm on, right? And now think about it, right. We are walking around with very sophisticated, very powerful computers in our palms. We could have never imagined that back when we were in college or high school.

00:09:01:02 - 00:09:30:21
James Merlino, M.D.
So I don't think we can really imagine how AI is going to transform, how technology is going to transform what we have in front of us for an opportunity. Our perspective is we can't regulate AI, right? We want to unleash the power that AI and technology can bring to benefit patients, and also to benefit caregivers. Our perspective is, you know, let's provide guidance on what you should be thinking about, because, as you know, in health care, particularly in your role at the AHA, is there's the haves and the have nots.

00:09:30:21 - 00:09:49:17
James Merlino, M.D.
There are big organizations that can invest in technology and resources, like yours. And then there's small organizations. We want to make sure that we're providing guidance on what people should be thinking about. We don't want to be saying, here's what you need to do, because the last thing we want to do is stifle the innovation that people can have with this technology.

00:09:49:23 - 00:09:57:03
James Merlino, M.D.
We just want to make sure that people are thinking about what's important for their organization and to protect patients. That's kind of our thinking about this.

00:09:57:05 - 00:10:14:09
Marc Boom, M.D.
So we talked about that foundation of culture and innovation within, but some innovation comes from outside, and is how we implement and how we move quickly with it. Talk about the partnerships that need to be part of the equation when we're thinking about innovation in health care.

00:10:14:12 - 00:10:34:08
James Merlino, M.D.
I think that sometimes organizations look at what they're doing and think that the best things happen here, right? And one of the things that I learned in the various roles that I've been fortunate to have in my career is that there's a lot of great things happening out in the market, and we should take advantage of learning from others and seeing what others are doing.

00:10:34:15 - 00:11:08:27
James Merlino, M.D.
To understand whether I could apply for what we're doing, apply to what we're doing or not, right? Learn from each other, share information. That's what our opportunity is. I think that if we look too much internally only and that look to partners, then we're going to be blinded by what the potential is. And I think about organizations like ours, like the American Hospital Association, the ability for us to lever these platforms to ensure that organizations have access to information, to have access to best practices, to be able to see what others are doing is really unlimited.

00:11:08:27 - 00:11:18:12
James Merlino, M.D.
And that's our opportunity is to help those organizations get exposure to that and get access to that so that they can judge for themselves whether the think is something they can use.

00:11:18:14 - 00:11:37:03
Marc Boom, M.D.
When you're judging those, what are you really jazzed up about? What makes you excited about the future of technology and what how big do you think this impact is? Put that in, I guess in in the scope of other big innovations within health care, how what's the potential opportunity here? What are the big exciting things coming down the pike?

00:11:37:06 - 00:12:06:10
James Merlino, M.D.
I think it's unlimited. I mean, again, going back to my comment earlier about what's our imagination to be able to say what it looks like in ten years, I don't think we can imagine that. Right? I think that it is limited by only our imagination, what we think we can bring to it. When you consider the advances in technology and the advances in disease treatment, just in my medical career alone. When I was a medical student, right, think about it - half the medicine wards were filled with people dying of AIDS.

00:12:06:12 - 00:12:29:16
James Merlino, M.D.
Today, HIV is a chronic medical condition and people are treating it with basically no detectable virus in their blood. And AIDS is nearly nonexistent in the United States. I mean, that's an amazing technological leap in terms of treatment in medicine. And I think the limit for what technology, whether it's science or AI or other things, can bring to medicine?

00:12:29:19 - 00:12:35:19
James Merlino, M.D.
There's no limit, right? I can't imagine the ability of what it's going to bring to the field.

00:12:35:21 - 00:12:52:02
Marc Boom, M.D.
Is there any particular challenge problem that you come across with the Joint Commission? You look into so many hospitals, as you mentioned, from really the entire spectrum of size that you wish technology could be brought to bear to fix first?

00:12:52:05 - 00:13:21:08
James Merlino, M.D.
For me, and this is a personal perspective, it's a little bit about what you touched on earlier, right? It's how you lift the burden from caregivers? You know, in some ways, technology has created a burden. I think about the electronic medical record. My wife is the chief medical informatics officer for the Cleveland Clinic. And her and the team spent a lot of effort helping physicians understand how to use the EMR as a tool in their workflow to deliver better care and reduce burden.

00:13:21:15 - 00:13:47:11
James Merlino, M.D.
Right. But if you look at the rollout of the electronic health record across the United States, across the world, when it started, what we did was we took the technology and we put it on top of bad processes. And now you had two things that weren't working well together. It was only after you think about how you get it to work more closely, how you evolve your workflows to get it to work more efficiently, to get it to work in a way that benefits caregivers and patients.

00:13:47:13 - 00:14:15:25
James Merlino, M.D.
I think that as we roll out new technologies, we look at new opportunities, we have to be mindful of how is it going to impact the caregivers, right? Ensuring that the promise of reduction of burden is reality and is going to impact them in a way that benefits their delivery of care and ultimately benefits patients. But I think that is what's really most important for me is how do you get to lift the burden for caregivers and ultimately improve the delivery of the care that they're doing.

00:14:15:27 - 00:14:39:14
Marc Boom, M.D.
I think that's spot on. That's why that was the second of our sort of philosophical aims with technology, because we all know burnout is a very real thing. We all know many of the things that cause burnout are - as our chief physician executive calls it - the pebbles in the shoe, they're the irritating things that just kind of get at you and over time just even get worse and worse, as if it was a pebble in a shoe.

00:14:39:15 - 00:15:01:00
Marc Boom, M.D.
Yet technology can take so much of that away. And when you put the patient at the center and you think about that one on one relationship or those close personal relationships, I'm a primary care physician, so that's important to me as well. I think technology has the dramatic potential that enable it. The other thing I'd probably throw in there, and I'd love to hear your thoughts about that.

00:15:01:03 - 00:15:19:08
Marc Boom, M.D.
I think one of the big challenges we face in health care, if not maybe the biggest existential question is affordability. For me, it's the big A right now. To be honest, I'm not sure much of technology has ever really improved affordability and health care, but I think we're on the cusp where that could happen. Do you agree with that?

00:15:19:09 - 00:15:27:28
Marc Boom, M.D.
Is that something plausible that we could actually help end some of the cost curve, make health care more affordable by implementing technology appropriately?

00:15:28:00 - 00:15:50:00
James Merlino, M.D.
I agree, and I think it's true. And particularly if you consider access issues. When you look across the country, you know, you have tremendous opportunities to improve access in rural health, for instance. And I think technology is a way to extend that delivery of care into communities, into areas that don't have the resources that you see in the big cities and urban areas with big systems.

00:15:50:03 - 00:16:03:27
James Merlino, M.D.
And, you know, we should be thinking about how we use technology to extend in those areas. Coming back to the issue of adoption, you know, I think that the pebble in the shoe analogy is a great line. I'm going to steal that.

00:16:03:27 - 00:16:07:15
Marc Boom, M.D.
Steal away. I stole it from our chief physician executive. So it's just breaking down the chain here.

00:16:07:17 - 00:16:28:26
James Merlino, M.D.
But think about it. If we're going to be successful at implementing technology, we should look to the challenges we've had in the past with technology implementation, right? and ensure that as we're leveraging new technologies, particularly AI, we're using our people, our physicians, our nurses, other professionals and health care to really help us understand how to apply it appropriately.

00:16:29:02 - 00:16:49:06
James Merlino, M.D.
Right? Because I think sometimes we lose track of that. Right? People are sitting in the ivory tower. They want to implement something that seems really exciting and really new, but we have to remember that we're giving this to the people that are delivering the care. We want to make sure that we're levering them to help us understand not only the best uses for it, but actually how to implement it.

00:16:49:08 - 00:17:08:04
Marc Boom, M.D.
Well, that's great. Thank you, Joe. I mean, this is exactly why I asked you and I'm so thankful that you agreed to be the first guest this year on this series is because I know you understand the inner workings of this and obviously have had a huge impact in your career at the Cleveland Clinic and now a huge impact across so many hospitals with the Joint Commission.

00:17:08:04 - 00:17:17:22
Marc Boom, M.D.
So thank you very much. Very insightful conversation. I enjoyed it a great deal, and thank you for everything you do in service of humanity through your through your roles.

00:17:17:24 - 00:17:25:18
James Merlino, M.D.
Well, thank you very much for having me. And I appreciate the conversation and look forward to the great things you're going to do at the American Hospital Association.

00:17:25:20 - 00:17:36:05
Marc Boom, M.D.
Thanks so much. Well, everybody, thank you so much. I hope you enjoyed this as much as I did. And thanks for taking your time to listen. We'll be back next month for another Leadership Dialog conversation.

00:17:36:08 - 00:17:43:14
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever

00:17:43:14 - 00:17:44:18
Tom Haederle
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00:00:00:08 - 00:00:17:06
Tom Haederle
Welcome to Advancing Health. Today, we learn from the experts how physical security is a necessary component of cyber security, and why they have added the misuse of AI by bad actors to the list of cyber threats facing health care providers.

00:00:17:09 - 00:00:47:01
John Riggi
Hello everybody. My name is John Riggi. I'm national advisor for Cybersecurity and Risk at the American Hospital Association. So pleased to be joined by my good friend today, Larry Pierce, who is the director of cybersecurity, information security officer for Atlantic Health. And folks, believe it or not, Larry has been at the same organization, Atlantic Health, for almost 40 years in various forms of information technology and cybersecurity,

00:00:47:02 - 00:01:10:13
John Riggi
really as the field evolved. So, Larry, so good to have you here today, especially as cyber threats of all types are increasing dramatically. Third party risk is a major issue that we're facing. In fact, quite frankly, it is the most prominent source of all cyber risk that we face in health care. AI is everywhere and on everything.

00:01:10:14 - 00:01:36:20
John Riggi
So we'll talk a little bit about that as well. Unfortunately, the risks that we as hospitals and health systems face and our patients face are not just the virtual threats. Unfortunately, there's been a dramatic rise in physical threats and attacks and violence against hospitals and health systems. And there is a nexus, a connection between the physical threats and the cyber threats.

00:01:36:22 - 00:01:48:10
John Riggi
From your perspective, Larry, having dealing with a very busy organization, a busy emergency department - how do you feel that the physical threats and the cyber threats intersect?

00:01:48:12 - 00:02:07:12
Larry Pierce
I think in many cases, you know, with the exception of when you're dealing with nation state threat actors who, you know, like the state thousands and thousands and thousands of miles away from you, there are a lot of things to your point that we need to be concerned about. It seems like there's an uptick in physical violence within in health care organizations.

00:02:07:15 - 00:02:33:03
Larry Pierce
You know, when you talk about physical security, we're looking at things that, you know, the intersection with cybersecurity would be an unsecured laptop, right? that may not be encrypted for one reason or another. That's really security 101 is ensuring that your mobile devices that are within the organization are always encrypted. So in the event that they walk out of the org or they're stolen, that they really turn into a brick.

00:02:33:06 - 00:02:56:27
Larry Pierce
But there are some vendor supplied systems that we have out there that may not employ the same technology. So data centers and server environments within the main hospital, we don't have a lot of data centers that are in the hospital anymore, but your server rooms and network closets, there could be a lot of damage caused in those areas if somebody happened to go in there with nefarious purpose

00:02:57:00 - 00:03:16:20
Larry Pierce
they weren't meant to be in there. That could cause us a lot of hardship. We rely on the security cameras that we have throughout the hospital system right now in physical security monitoring those. In the event that something happened, we can always go back to those and look and see what's happening. So operational technology is something we take very seriously here.

00:03:16:20 - 00:03:35:15
Larry Pierce
It's something that we work closely with our partners in emergency management, physical security and even law enforcement at the local, county, state and federal level. So up to including the FBI, Homeland Security, prosecutor's offices, local law enforcement.

00:03:35:18 - 00:04:03:18
John Riggi
You know, when I think about this, the intersection of physical threats and cyber security, you know, we always talk about ransomware attacks as being a threat to patient safety and really a threat to life crime. And I would venture and proffer that a ransomware attack in itself could be viewed as a violent crime. We tell the federal government all the time, if you do something that puts people in physical harm, risk of physical harm, then that's a violent crime.

00:04:03:23 - 00:04:22:20
John Riggi
So that's one of the one of the things we're pushing the government to understand as well. And they do. They do, quite frankly, as you know, with the FBI. So let's, let's talk back about here on the health care landscape and a little bit about what everybody else is talking about, AI. right? So talking about cyber, we've talked about physical threats, AI, everything.

00:04:22:27 - 00:04:41:10
John Riggi
So is AI is evolving and widespread implementation we have in health care happening quickly, really quickly. This has a lot of risks and rewards as we know. What do you see from your perspective, the emerging risks of this widespread and perhaps overly optimistic adoption of AI in health care?

00:04:41:12 - 00:05:00:19
Larry Pierce
AI is obviously not going to become it has to become a game changer for health care and many other industries. Contrary to what some people that you know aren't in the technology field that I speak with on a regular basis outside of work or even inside of work, and they ask me, you know, AI thing that's going on right now, is it here to stay?

00:05:00:19 - 00:05:25:14
Larry Pierce
Is it just a fad that's going to kind of come and go? My answer it's been very, very consistent with that. AI is here to stay. Depending on how you use it, whether we're leveraging it internally for protective technologies or whether we're using it to better patient outcomes. Those are some of the things that we are doing internally.

00:05:25:16 - 00:05:50:12
Larry Pierce
But I think in using AI in an ethical manner, we need to ensure that we are taking a very cautious approach with that. I don't think has demonstrated quite yet that it can take the place of a human to make a medical diagnosis, for example. We're not that far along. I'm not saying we may not get there at some point, but I don't think I was ever

00:05:50:12 - 00:06:11:21
Larry Pierce
billed - and I would I would argue this point, you know, unless I'm convinced otherwise years from now - not necessarily made to take the place of a human in every case. Is it going to limit some jobs? Absolutely. But, you know, in the health care space, we are seeing more and more platforms that are coming in. And I'm not just talking about security technologies.

00:06:11:22 - 00:06:38:03
Larry Pierce
These are third party systems that we're employing that are either incumbent systems that we've had here for a while that are starting to adopt more AI technology, and companies that are AI centric and completely involved with AI, and we're bringing them on board as well. So for us, again, very cautious approach, and we have a very rigid onboarding process for these AI technologies.

00:06:38:03 - 00:06:59:05
Larry Pierce
So it all starts with the governance process. And is there a need for it? Do we have the dollars? Because health care is getting squeezed quite a bit right now. From a monetary perspective, we're not getting the same reimbursements that we had once before. We're spending a lot more money than we ever had to before. These fancy AI technologies and everything else, they come with a price tag.

00:06:59:07 - 00:07:23:21
Larry Pierce
So in adopting these, we need to make sure that we're doing it ethically, responsibly. So we have a an AI committee that partners with - and it's not just the most important thing - it just fits in with everything else very nicely. So we do a full architecture and design. We do an assessment. We do a complete comprehensive cybersecurity review.

00:07:23:23 - 00:07:42:21
Larry Pierce
It all comes down to risk. And I'm not the final say when it comes to that. There are, you know, executive leaders within the org that will either accept risk or not accept the risk. But they are certainly informed when that comes along. We also have our team members or employees that are using AI right now.

00:07:42:23 - 00:08:14:20
Larry Pierce
Beyond just the medical side of the house, AI is being used to craft more business friendly emails. It's being used to develop algorithms associated with a better presentation. So we don't want, you know, an AI platform such as OpenAI, ChatGPT, Gemini. It should be able to have the ability to ingest spreadsheets that are our proprietary information, may contain, you know, many, many elements of PHI, PII.

00:08:14:22 - 00:08:36:03
Larry Pierce
We don't want to put that into their learning module because they all give you the caveat if you look at their privacy statements and policies, they could use this information almost indefinitely to train their models. Well, if their information is to be compromised and we've got over 500 records in there that were put in to come up with something, it's going to cause a breach situation for us that we don't want.

00:08:36:05 - 00:08:58:27
Larry Pierce
We've employed, you know, our content filtering, our DLP technologies are all trained at this point to significantly restrict what people can do with AI to prevent them from getting themselves in trouble. More importantly, from landing Atlantic Health in the news because of something that was an unintended consequence.

00:08:59:00 - 00:09:29:07
John Riggi
So again, AI is here to stay. It's an almost everything we use. It's not necessarily new technology coming into the organization. There are a lot of existing programs, of course, like Microsoft and Google that add AI features. So that governance council that you spoke about is extremely important, not only to assess new AI technology coming into the organization, but to identify instances where it is now been added to existing software and technology within organizations.

00:09:29:10 - 00:09:53:28
John Riggi
Just saw another report this week that corrupted data, PDFs and emails which are already in networks, are then consumed by AI, legitimately looking for responses or answers to questions, queries submitted to it, but it unwittingly sucks in malicious data and perhaps malware that's already within, present and within the environment and produces it as part of its response.

00:09:54:00 - 00:09:58:06
John Riggi
So really, lots of complications and dealing with AI as we go forward.

00:09:58:10 - 00:10:17:17
Larry Pierce
Threat actors are leveraging AI right now, which is something that we continue to try keeping up with. There's a lot of security technologies that are evolving that are coming up with protections for that, which is great. But one of the things I'll bring up, and it's pretty common, I think a lot of people have heard of it: What are, you know, what is your biggest concern with AI?

00:10:17:20 - 00:10:42:18
Larry Pierce
More sophisticated and realistic phishing emails that are coming in. The telltale signs of a phishing email coming in and there's a lot of email securities out there and other cyber technologies that do a very good job at looking at, you know, what we equate to millions or tens of millions of emails every month to come in, and we have to block the most malicious emails that come in are all the malicious emails that come into the organization.

00:10:42:20 - 00:11:04:25
Larry Pierce
They're using these emails to come up with verbiage that we would normally point to as this is a yellow flag or a red flag. It's not there anymore. Look at the deepfakes that are coming out right now that AI is doing. They are very, very realistic. The other phishings that AI is being used for. It started out as general phishing emails.

00:11:04:25 - 00:11:37:29
Larry Pierce
that went to an audience of a thousand or more people. And just like, if 1 or 2 people click on it, it was worthwhile for the threat actor. Then it evolved to spear phishing. Very targeted going to one person. Now you've got smishing, you've got phishing, you've got quishing. We're seeing all of that internally here. And there's a lot of technologies that really aren't from an educational perspective or detective perspective, able to really latch on to these and be able to prevent them from getting to the people that may get hooked on.

00:11:38:02 - 00:11:59:27
John Riggi
All great points about the ubiquitous use of AI in hospitals and health systems. I totally agree it's only going to accelerate. And again, lots of good will come from it. But we also have to think of AI representing a type of third party risk. We know in health care, third party risk is the major source of cyber risk that we are exposed to.

00:12:00:00 - 00:12:21:29
John Riggi
The data holds that change health care are increasing reliance on outside third party technology, service providers and supply chain. So AI again, is a major third party risk included in all the other third party risks. So as a growing concern, how does Atlantic Health approach third party risk management?

00:12:22:01 - 00:12:44:03
Larry Pierce
So third party risk is, you know, it's near and dear to me because if I look at our application portfolio and understand that we have 750 or so applications that are currently in use at Atlantic, whenever we're going to onboard a new technology or review an incumbent vendor that's been here for a while, we have that same rigid process in place.

00:12:44:03 - 00:13:01:25
Larry Pierce
So it starts with governance and is there truly a need for it? Financially, do we have the money for that? Is it budgeted? Is there going to be a return on investment or not? I mean, why do we need the product is what it comes down to. Then we need to go to the nuts and bolts of what does the assessment look like for this?

00:13:01:25 - 00:13:25:23
Larry Pierce
We do a full architecture and design for everything. A full security review. As I believe I mentioned before, we have an RFI process that we send to the third party. It's about 150 questions that they have to answer in there that allows our teams to be able to determine whether this is something that meets our minimum baseline security controls.

00:13:25:25 - 00:13:45:12
Larry Pierce
So as we look at a lot of these products that we're evaluating now, let me rewind 10 or 15 years ago. We had a lot of on prem data centers, so whether it was within one of your own facilities or it was a co-location. Everything was basically on prem to a certain extent. So we had control physical control of all the security associated with that.

00:13:45:14 - 00:14:15:01
Larry Pierce
That was on us. As we evolve and migrate to third parties, which is, you know, that is the trend, it's moving in that direction. It has been moving there. A lot of companies are already 80, 90% of the way there at this point. We are, I would say, shedding some of that responsibility. But with that comes the fact that we are now relying on the security posture of that third party that we are entrusting with what may be our crown jewels.

00:14:15:03 - 00:14:25:18
Larry Pierce
And for us in the health care world, that is our PHI, the protected health information of our patients, which is central to what we do as a business.

00:14:25:21 - 00:14:47:06
John Riggi
This mass migration to the cloud has been very good economically and for business processes, but it's created a different type of risk. We've talked a lot about AI and cyber threats and physical threats, operational technology. What do you see in the next year? Couple of years? The trends in cybersecurity and health care and potential threats?

00:14:47:08 - 00:15:07:25
Larry Pierce
I think a lot of the same threats that you see today, they're going to remain. You know, the phishing emails, the other ishings that we talked about. I think they're going to continue to evolve. They're going to be more sophisticated, more believable. The nefarious threat actors that we all deal with, unfortunately, too often are going to build their capabilities on these.

00:15:07:25 - 00:15:33:16
Larry Pierce
They're going to be tougher for technology companies. And that's what it's always been. And, you know, we are trying to stay one step ahead of our adversaries. And it just seems like unfortunately, it's the other way around. They're staying one step ahead of us in many cases. There needs to be a level of vigilance within your organization. You need to continue to be mindful and ensure that your third parties and your own people continue to watch the shop.

00:15:33:18 - 00:15:53:24
Larry Pierce
When I started my career, PCs weren't even part of the landscape here at Atlantic. So you look at how far we've evolved. I think we'll be having an entirely different conversation five years from now. We'll be talking about things that I won't even say were top of mind, things that weren't even in our minds today that they're going to change.

00:15:53:27 - 00:16:23:21
Larry Pierce
I'm hoping that security technologies will continue to evolve, that they're going to get better, more comprehensive. And I'm hoping that there is, you know, work done by the federal government and other areas of the world to make it more difficult for these threat actors to do what they do to, you know, there are greater consequences for them. Most of these people right now, we can't go after them, unfortunately, when they cause us millions and millions of dollars of heartache because of something.

00:16:23:29 - 00:16:41:04
Larry Pierce
So I'm hoping that you get better with legislation and some of the strong work that you're doing, you know, with your counterparts. We're going to become more and more reliant on technology. And I'm just hoping we have the right technical safeguards in place to prevent some of the attacks.

00:16:41:06 - 00:17:01:17
John Riggi
Thank you, Larry. Very well said. And thank you for your service in helping defend health care networks, your patients in the communities that you serve. I also want to thank all our viewers for what you do every day to defend networks, care for patients and serve your communities. This has been John Rigi from the American Hospital Association, national advisor for Cybersecurity and Risk.

00:17:01:17 - 00:17:09:19
John Riggi
If you'd like to learn more about cybersecurity and risk, please visit our website at aha.org/cybersecurity.

00:17:09:21 - 00:17:18:02
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.

00:00:01:02 - 00:00:27:10
Tom Haederle
Welcome to Advancing Health. Providing effective and efficiently targeted behavioral health services to a widely diverse community is no easy task. Today, we hear how a California based health system relies on accurate data collection and community partnerships to pinpoint where services are needed and how it's making a measurable difference.

00:00:27:12 - 00:00:48:03
Jordan Steiger
My name is Jordan Steiger, and I am the AHA director of Behavioral Health and Violence Prevention. I'm really excited to be joined today by Jesse Tamplen, who is the executive administrator of Behavioral Health and the vice president of continuous performance improvement and patient care coordination at John Muir Health, and Jamie Amosu, who is the director of Community Health Improvement.

00:00:48:05 - 00:01:02:06
Jordan Steiger
They've done a lot of work from community based programs to programs within their hospital system. And so we're really excited to see how they are leading the way, and hopefully others can learn from the work that they've been doing. So Jesse and Jamie, thank you so much for being here with us today.

00:01:02:09 - 00:01:03:00
Jesse Tamplen
Pleasure, Jordan.

00:01:03:07 - 00:01:04:18
Jamie Elmasu
Thank you for having us.

00:01:04:20 - 00:01:16:15
Jordan Steiger
To get us started, I would love for you to just tell the audience a little bit about your roles at John Muir Health, what you do and what your community is like and what your patients are like that you serve. Jesse, let's start with you.

00:01:16:17 - 00:01:38:29
Jesse Tamplen
Perfect. Jesse Champlin, the vice president of patient care coordination, continuous performance improvement. And for this conversation, the executive administrator of behavioral health. I oversee all behavioral health across John Muir. And for those of you who don't know, John Muir is an independent health care system about 30 miles east of San Francisco. We're a three hospital system.

00:01:38:29 - 00:02:13:28
Jesse Tamplen
That's two acute care medical centers. And then a psychiatric hospital. And then we have a large outpatient footprint with ambulatory care, including behavioral health. I work with the teams, not only the behavioral health teams, but all of the health care teams to really integrate behavioral health so that we can provide a whole person care model to really support our community and our patients where they're at, and to make sure that they have access to lifesaving behavioral health care in our acute psychiatric hospital that serves children, adolescents, adults and older adults.

00:02:14:01 - 00:02:35:23
Jesse Tamplen
One of our distinct factors about John Muir behavioral health is for our psychiatric hospital. We have some of the most under 12 and under 18 beds in California. So not only are we a local destination of care, but really a center of excellence across the whole state, and many times outside of the state.

00:02:35:25 - 00:02:50:19
Jordan Steiger
Amazing. You said so many things I want to get back to in this conversation. And I also want to just highlight that Jesse is a member of AHA's Committee on Behavioral Health. And he knows his stuff in behavioral health so that he's a great person to learn from today. Jamie, tell us a little bit about you.

00:02:50:21 - 00:03:22:15
Jamie Elmasu
Yes. Thanks, Jordan. So my name is Jamie Amosu, and I'm the director of community health improvement at John Muir Health. And, you know my role really is focused externally, mostly and primarily, on the geographies that we serve, which cover and span all of Contra Costa County, northern Alameda County as well as the Tri-Valley area. And so, just to give a little glimpse into the geography of John Muir, health, and what's really important to note is that our the communities that we serve are vastly diverse in terms of income, status, race, ethnicity and the likes.

00:03:22:15 - 00:03:32:15
Jamie Elmasu
And so when we're talking about different approaches to behavioral health and mental health strategies, it really does, depend on the types of populations that we're intending to serve.

00:03:32:18 - 00:03:43:04
Jordan Steiger
That's great. And I think you're setting the stage really well for this first question here. So I know that your community health assessment identified behavioral health as a top priority for your community. Is that right?

00:03:43:06 - 00:04:14:12
Jamie Elmasu
That's correct. Well, it's really unique is that I've actually been working at John Muir Health for 12 years. And we conduct a community health needs assessment cycle every three years. And in my entire time that I've been here, behavioral health has been the at least at the top three identified community priority needs. And so I think that's really important to really call out because behavioral health - although we are innovative in our strategies and our approaches to address behavioral health needs in the community - the need still exists, right?

00:04:14:12 - 00:04:32:04
Jordan Steiger
We know behavioral health doesn't discriminate, and it is present in every community, and it shows up for different people in different ways. But knowing this and knowing that this has been something that has kind of shown up over and over. How did you start like bringing those services to the community? What was your first step?

00:04:32:06 - 00:04:51:00
Jamie Elmasu
Yeah, I mean, so the CHNA is a really intentional approach, right? So not only is it intentional, it's also very widespread in terms of how we gather data, how we report on the data and how decisions are being made. So it's actually a process where we collaborate with the other non-for-profit health systems in our area.

00:04:51:02 - 00:05:21:09
Jamie Elmasu
We conduct focus groups with community members. We conduct key informant interviews with stakeholders across our service area. And we look at data, right? So when we look at data, when it comes to county resources, school district resources, and many, many others and all of that is compiled into a really robust assessment where we actually identify those community needs, priority areas, and then we can look in and see specifically geographically or population wise, which communities are in need of services.

00:05:21:11 - 00:05:42:04
Jamie Elmasu
And then when it comes back to actually creating our implementation strategy, what we do is we actually create different approaches based on the communities that we're speaking about, right? And it's not that John Muir Health is here designing approaches that we are now telling the community to implement. It's actually in partnership with nonprofit organizations. And I think that's really key.

00:05:42:07 - 00:06:04:29
Jamie Elmasu
And so we've created, you know, really various opportunities, right? So whether it is let's say, for example, a community based, nontraditional approach, right. Like a premature community health worker approach. We have several partnerships, actually, where we help fund and provide grants for those organizations to actually disseminate, you know, these very nontraditional approaches to mental health interventions.

00:06:05:02 - 00:06:34:17
Jamie Elmasu
And that really targets, you know, certain communities that maybe don't have access to traditional health care, utilizes more of a group approach, a lay health worker approach model that's actually very effective. So we've had research studies actually done on some of our community health worker programs in partnership with Monument Impact, a local nonprofit organization. And it actually has statistically significant results in terms of reduction of anxiety, of stress and of depression in the communities that we're serving

00:06:34:17 - 00:06:42:16
Jamie Elmasu
and that program specifically, we actually celebrated, it's ten years, so a full decade in partnership with that program.

00:06:42:18 - 00:07:03:26
Jordan Steiger
I mean, congratulations on ten years. I think ten years in any program is incredible. And especially something that is so focused on community and you know, driven by those community partners, I think is really something to be proud of. Jesse, I'm sure that you have played a big role alongside Jamie, in helping kind of shape this behavioral health, you know, approach in the community.

00:07:03:27 - 00:07:06:10
Jordan Steiger
So tell us a little bit about what you've done.

00:07:06:12 - 00:07:28:06
Jesse Tamplen
I worked very closely with Jamie. One of the elements about a community health needs assessment, especially when you're a nonprofit, it's how are we elevating the health of the community in the local environment that we're in. And so as a hospital and a treatment providers, we also have that number one responsibility of making sure that we're providing that life saving care and that quality of care

00:07:28:11 - 00:07:50:07
Jesse Tamplen
when people come into our outpatient as well as our inpatient. So it's a very nice synergistic combination where Jamie and I get together with the community stakeholders, look at our needs assessment. We have a board that oversees that community health needs assessment. And then we really look at where do we have the biggest health disparities in the community?

00:07:50:13 - 00:08:13:17
Jesse Tamplen
Where do we find that we can support that community that does not have needed services if it be in schools or unhoused? If it's for communities that are further away from a metropolitan area so that we're really looking at creating an ecosystem. I think one of the unique things when we talk about behavioral health is it is the most stigmatized diagnosis that we have.

00:08:13:19 - 00:08:36:12
Jesse Tamplen
And as students when you talk about behavioral health, people will go into some social aspects of behavioral health. But Jordan, as you said, behavioral health is regardless of socioeconomic status, the nice area that when we work with Jamie and the community health needs assessment, not only are we providing those essential services out in the community, but we're helping to stigma-bust the stigma around behavioral health.

00:08:36:19 - 00:09:09:03
Jesse Tamplen
So when we create this ecosystem, focus on the whole person care, it's not only the individual outcomes that we're looking at, but we're helping to elevate behavioral health, decrease that stigma so people will access those services if it's in, you know, the languages that they speak or just going to seek care. And I think that's one of the big things that my partnership with Jamie really focuses on being operational at the community health needs assessment is ensuring that everything that we do is decreasing stigma and increasing access to lifesaving care.

00:09:09:05 - 00:09:30:09
Jamie Elmasu
And if I can add some further color to that, I love what you're saying about ecosystems. And I think what we really do with our community health improvement initiatives is we go to maybe sometimes untraditional locations, right? So, for example, we are recently starting a partnership with the East Bay center for Performing Arts. Some people might say, okay, why are you partnering with an arts center?

00:09:30:09 - 00:09:55:02
Jamie Elmasu
This is an arts youth center based in Richmond, California. And my answer is because the need is high and what are we doing? We're actually helping them build their infrastructure to create more on site, licensed clinical social workers so that all of the children that are accessing the services at the East Bay center for Performing Arts, they actually have with embedded within their programing direct access to these social services.

00:09:55:05 - 00:10:16:19
Jamie Elmasu
And I think just by you know, helping shape that model at a center like this, in a high need area, that's really what we're talking about when it comes to ecosystem. And then secondarily, you know, it's other sites. So for example, we're deeply invested in the city of Antioch, that's in Contra Costa County as well, there are reported, you know, high rates of violence in Antioch.

00:10:16:19 - 00:10:37:17
Jamie Elmasu
So what we've actually invested in is actually hiring and helping support mental health therapists. These are licensed therapists to be onsite at the schools in the Antioch Unified School District, and then in partnership with other health systems, they've actually help support, you know, wellness rooms and trauma informed specialists that are also onsite in the school district for the year.

00:10:37:24 - 00:10:55:09
Jamie Elmasu
So it's really around, you know, shaping that ecosystem, whether it's at the school level, at the hospital level, with the nonprofit organizations and how we do it, how do we adjust? How do we actually ask our partnerships and ask the collaboratives that we work with what iterations do we need to actually meet the needs of the community?

00:10:55:16 - 00:11:22:24
Jordan Steiger
And you're both bringing up so many important things with this topic. So I think, Jesse, I mean, bringing up the topic of stigma, I feel like you can't talk about behavioral health without talking about stigma. And I think, Jamie, some of those examples that you just provided really purposefully or maybe not even, you know, purposefully decrease stigma in so many ways when you're just in the community, you are just there and you are part of it and it's, you know, people can get the care that they need without having to go see a provider.

00:11:22:26 - 00:11:39:25
Jordan Steiger
It's where they need it and when they need it. And I think that is so key. And one thing you both have talked a lot about is just these partnerships that you have internally. It sounds like across your system and then of course in the community. How did you get buy in for those partnerships, especially with the community partners?

00:11:39:27 - 00:12:01:29
Jamie Elmasu
Gosh, how do we get buy-in? I think it's a long history, right? It's a long history of relationship building and really gaining trust with community partners. I'd like to say that our partnership model with nonprofit organizations in our area is very strong. And it's because we listen. So we have a grantmaking portfolio. So we are providing grant funding to nonprofit organizations.

00:12:02:02 - 00:12:27:05
Jamie Elmasu
But it doesn't stop there. And I think that's really what sets John Muir Health apart from other health systems, really, is that our partnerships with nonprofit organizations, we also provide many in-kind services where for example, we'll bring our family medicine residents to nonprofit organizations on site to offer some sort of an intervention, whether it's health education or foot screenings or, you know, ask a doctor stations, things like that.

00:12:27:12 - 00:12:51:04
Jamie Elmasu
We've gone to Mental Health Connections, which is previously known as Putnam Clubhouse. But we've had this very robust partnership with Mental Health Connections over the years. And our family residents, they actually circulate there and they provide health education lectures to the clients of mental health connections about, you know, medication management, sleep hygiene, any topics of interest to the client based

00:12:51:07 - 00:12:52:24
Jamie Elmasu
at the organization.

00:12:52:26 - 00:13:15:20
Jesse Tamplen
Jamie does an incredible job in creating those external partnerships, and she has that grantmaking portfolio. So she's able to fund many services which can help align those, you know, partnerships. But, you know, having John Muir be a nonprofit health care system, we spend a lot of time with our operational leaders and our clinicians joining community groups.

00:13:15:20 - 00:13:38:12
Jesse Tamplen
So I'll give you an example. We have people on the Concord Chamber of Commerce. We work with our fire departments. We work with our school districts, part of the California Hospital Association, you know, working in the Tri-Valley region, where Jamie was discussing, making sure that there's grants coming on. We're supporting that grant award process for other organizations, their community needs assessment.

00:13:38:12 - 00:14:11:00
Jesse Tamplen
And I think that's critical when you look at behavioral health operational leaders. Because stigma is reduced when people see not only people who have mental health challenges speak up and, you know, do something different, but also people who are leading those services, taking their time to work with the chief of police. So many times, both at Walnut Creek and Concord, two local cities, they've held their staff meetings at our outpatient behavioral health before, so that they can see our clinicians, get to know them

00:14:11:05 - 00:14:33:18
Jesse Tamplen
and that's where we really look at decreasing the stigma. And when you look at what are the results of stigma in the United States, we know people with a serious mental illness are dying 25 years younger than the average population, but they're not dying due to their mental illness. This is where the stigma comes in. They're dying due to cardiovascular disease, obesity and diabetes.

00:14:33:20 - 00:14:58:11
Jesse Tamplen
And as a nonprofit health system, we are perfectly positioned to be able to treat those conditions because it's part of that whole person care model that we know if we can get them into access their mental health conditions and we can stabilize that life saving treatment, we then can get them to primary care in other groups where we can give back years of life and quality of life.

00:14:58:14 - 00:15:25:07
Jordan Steiger
That makes so much sense, Jesse. And I mean, I hear from both of you, I think just kind of key takeaways from this discussion. It sounds like using that positionality in your community as an anchor institution and as, you know, a leader in the community to make sure that we are doing what we can as hospitals and health systems to decrease that stigma to, you know, extend the hand first and get, you know, get those partnerships moving, really listen to the community and what they need.

00:15:25:09 - 00:15:42:13
Jordan Steiger
It sounds like you are doing all the right things, and you are setting such a great example. Thank you so much, both of you, for being here today. And I'm sure our listeners are going to have a lot of takeaways that they can start thinking about at their own organizations. So again, thank you for being here.

00:15:42:16 - 00:15:50:28
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.

00:00:01:06 - 00:00:31:02
Tom Haederle
Welcome to Advancing Health. Being your best at anything usually boils down to practice, practice and practice. All across rural Iowa, first responders and other health care professionals are getting in that critical practice to improve patient outcomes, and the training that makes it possible is delivered right to their doorstep.

00:00:31:05 - 00:01:07:29
Tom Haederle
I'm Tom Haederle senior communications specialist with the American Hospital Association, and I'm delighted today to welcome two health care professionals to introduce us to Simulation in Motion, Iowa. That's a mobile clinical education initiative that delivers on-site simulation training to EMS providers and others who provide care to the about 43% of Iowans who live in rural areas. Joining me today to talk about this are Dr. Jacinda Bunch, an assistant professor at the Iowa College of Nursing, and senior advisor to the SIM in Motion Iowa program, and Tina Eden, who is CEO of Virginia Gay Hospital in Vinton, Iowa.

00:01:08:02 - 00:01:11:18
Tom Haederle
Tina and Jacinta, thank you so much for joining me on Advancing Health today.

00:01:11:21 - 00:01:12:27
Jacinda Bunch, Ph.D., R.N.
Thank you for having us.

00:01:12:29 - 00:01:13:23
Tina Eden, R.N.
Thank you.

00:01:13:25 - 00:01:27:01
Tom Haederle
Well, let me start with you, Jacinda. Maybe you could take a whack at this first. I'm sure that my introduction did not do full justice to this wonderful program. So what needs was it designed to meet? And what kinds of medical scenarios do the care teams get to practice?

00:01:27:03 - 00:01:59:26
Jacinda Bunch, Ph.D., R.N.
So Simulation in Motion Iowa or SIM Iowa, is a mobile simulation program where we have three trucks that we take across the entire state. We allow health care providers to practice to take care of our simulated patients. They can provide care for patients they don't see very often. They can take care of patients in new settings. It's a way to test new protocols and really just to refine the care that they're providing, across the state to really improve patient outcomes.

00:02:00:02 - 00:02:33:28
Jacinda Bunch, Ph.D., R.N.
And we really designed this because in rural Iowa, access to simulation education is a challenge. It's expensive. It requires special training to really do it well. And we all know that resources are somewhat limited in our rural areas. So this provides both EMS providers and hospitals with the opportunity to have their staff go through simulation education to really enhance the care that they're providing across the entire state, regardless of where they live.

00:02:34:00 - 00:02:36:05
Tom Haederle
How realistic are the scenarios?

00:02:36:08 - 00:02:59:28
Jacinda Bunch, Ph.D., R.N.
So we work together with both the hospitals and the EMS providers to really design the scenarios to best fit their location, what they're seeing and the things that they feel that they need to work on the most. We can do medical scenarios. We can do trauma scenarios. We have simulators that are adult, pediatric, infant and then a neonate, a 25 week premature baby.

00:03:00:00 - 00:03:24:19
Jacinda Bunch, Ph.D., R.N.
So we can really do almost any type of medical or trauma scenario. And then we also work to make sure that the scenarios match the local protocols. So we're going to ask you to use the same medications that you have access to, the same equipment, and really follow your protocols rather than having you do something if you travel to a mobile SIM center that might not match what you do locally.

00:03:24:21 - 00:03:35:29
Tom Haederle
And I guess in some cases, the EMS teams or the people that are getting the training or working on - I don't want to call them crash test dummies because I know they're not - but they're human bodies in a sense, right, that they get to do some of these things on?

00:03:36:01 - 00:04:03:17
Jacinda Bunch, Ph.D., R.N.
Yes. So our simulators are basically mini-computers. So they're little robots. They have heart sounds. They have lung sounds. You can take pulses, you can give them medications. We can amputate an arm and have arterial bleeding that they need to control. We can change heart rhythms based on medications that are given. So we really can create almost any medical or trauma scenario.

00:04:03:21 - 00:04:14:25
Jacinda Bunch, Ph.D., R.N.
We try to make it as realistic as possible. Again, we want to put the learner in that environment that they would be caring for a live patient and really try to recreate as much of that as we can.

00:04:14:28 - 00:04:25:17
Tom Haederle
Wow, that's really impressive. Tina, if I could get your thoughts as the CEO of a hospital and boss of some of the care teams that have received this training, how did it work out for your folks?

00:04:25:19 - 00:04:51:09
Tina Eden, R.N.
Really, with any simulation, muscle memory is so important to build confidence in our staff. Some of the experiences they have with the simulation mannequins are those that it would take a year in their training to receive that same experience. And so it's really invaluable. It does provide a lot of confidence and just creates more of a teamwork environment.

00:04:51:09 - 00:04:56:05
Tina Eden, R.N.
They do work with a group of other individuals when they go through their simulations.

00:04:56:07 - 00:05:13:20
Tom Haederle
Sort of circling back to some of the most valuable services that the program offers, I understand that, 32 of Iowa's counties are considered maternal care deserts, meaning they lack adequate labor delivery, postpartum care services. How has Sim-Iowa helped in that particular sphere?

00:05:13:23 - 00:05:40:12
Tina Eden, R.N.
At Virginia Gay hospital, we did actually have a maternal child simulation lab come as well as SIM-Iowa. In working with those pediatric patients, it's really important our staff just don't have the pediatric experience. And working in a critical access E.R., you can see anything on any given day. So it's really important to have that in lab experience to handle those situations,

00:05:40:12 - 00:05:43:06
Tina Eden, R.N.
everything from a burn to a crush injury.

00:05:43:08 - 00:06:07:10
Tom Haederle
SIM-Iowa, as I understand it, has now visited, I believe, all 99 counties in Iowa. I think some of the most important lessons learned in the field have not necessarily been hands on operations and emergency response, but more having to do with emergency protocols and things like that. Can you both speak to that aspect of the training and maybe not, you know, if it's not treating a patient who is up on a stretcher

00:06:07:15 - 00:06:14:18
Tom Haederle
what are some of the other big lessons and takeaways that that the care teams have benefited from as the program goes around the state?

00:06:14:20 - 00:06:34:26
Jacinda Bunch, Ph.D., R.N.
I know a couple of things that we have experienced with our educators is when we go into a either an EMS agency or a hospital and we're working with scenarios that they don't see very often, they may have read those protocols multiple times, but to really pull them out and go through the steps, do we really have this medication in stock?

00:06:34:26 - 00:06:58:10
Jacinda Bunch, Ph.D., R.N.
Does everyone know where it is? How do we access it? What about this piece of equipment that we don't pull out very often? Have we really had the chance to use it hands on? Does everyone know how to work it well? Tina mentioned that muscle memory...to actually get your hands on it and do the tasks and provide the care and use the equipment, especially when it's something that we may not see as often.

00:06:58:13 - 00:07:20:01
Jacinda Bunch, Ph.D., R.N.
So that has been a huge piece. Our EMS folks bring their bags in so they are going through their own jump bags and finding their equipment and pulling out those things that maybe they don't see very often. And we also are able to take our mannequins inside the hospital so that they are also providing care in the same location that they will be with a live patient.

00:07:20:03 - 00:07:50:16
Tina Eden, R.N.
We were able to do an onsite airway training with SIM-Iowa where they actually came into our emergency department and worked on difficult innovations with our E.R. staff, including our physicians and physician assistants, as well as our nursing staff. We were also able to do emergency procedures in their unit, and that's something that we would only use in an extreme emergency, and our staff weren't comfortable.

00:07:50:19 - 00:08:06:23
Tom Haederle
The program was recently gifted with, I think, more than $5 million in investment by the Wellmark Foundation to expand the reach and frequency of the training. I wonder if you both could speak to what the plans are for this funding. How do you see it helping and benefiting patients around the state?

00:08:06:26 - 00:08:32:06
Jacinda Bunch, Ph.D., R.N.
Well, the focus of this particular gift from the Wellmark Foundation is really has a focus on our rural hospitals and EMS providers. So what this gift is able to provide is two trainings every year for our rural and mixed urban rural counties. So those are our emergency departments' primary focus. So it's maybe a medical scenario in the E.R., like sepsis.

00:08:32:06 - 00:08:57:21
Jacinda Bunch, Ph.D., R.N.
It might be a trauma like a motor vehicle accident. But they will receive two of these trainings. And those costs are covered by the gift from the Wellmark Foundation. And then in addition, the maternal care desert counties are also provided one obstetric emergency training. And that is delivered in partnership with the IPQCC, which is the Iowa Perinatal Quality Care Collaborative.

00:08:57:23 - 00:09:11:08
Jacinda Bunch, Ph.D., R.N.
And so our educators are working together. We go out jointly and provide this education in the maternal care deserts. And the Wellmark Foundation is paying for these trainings to occur over five years.

00:09:11:11 - 00:09:27:07
Tom Haederle
That's fantastic. Is it your sense that there's a great appetite for this? Maybe, Tina, you can speak to that because you're one of the hospitals who have benefited from the training. Do you have the sense from your own folks that, wow, this was fantastic. You know, a great, great use of our time, and we'd love to see them come back and do more of this kind of work?

00:09:27:09 - 00:09:49:02
Tina Eden, R.N.
Absolutely. It's very engaging for the staff. They get to do those hands on skills that they may not necessarily do. And a lot of the apprehension that new staff will have working in the emergency department is they just haven't seen something before. So it really provides that access to think through, talk through, and work through an emergency situation.

00:09:49:05 - 00:10:04:24
Tom Haederle
I don't know this for sure, but this is the only program that I'm aware of in Iowa that is set up to do what it does and organized like this. If another state is considering doing something similar, what advice would both of you have in terms of what you've learned so far and what you know works?

00:10:04:26 - 00:10:30:19
Jacinda Bunch, Ph.D., R.N.
I would say from launching this program, some of the things that we learned and actually did were to partner with a state that was already doing something similar. The Helmsley Foundation, Helmsley Charitable Trust, provided the initial start-up funding for this program, and they have done so in four other states. Each of us run our programs just a little bit differently, but we collaborated with them and we learned from them.

00:10:30:19 - 00:10:54:12
Jacinda Bunch, Ph.D., R.N.
We learned the mistakes they made and also the things that they did well. And then really just getting out and talking to providers across the state to hospitals, to EMS agencies and finding out what their needs specifically are. We don't want to come in and say, you need A, B, and C, we want to know what you need, and then we can provide that for you.

00:10:54:14 - 00:10:56:21
Tom Haederle
Got it. Tina, any final thoughts?

00:10:56:23 - 00:11:07:21
Tina Eden, R.N.
If there are other facilities that haven't used SIM-Iowa, I would recommend it. It's been very time valuable and well worth the cost of training your staff.

00:11:07:24 - 00:11:17:21
Tom Haederle
It sounds like a marvelous program and really impressive. Thank you so much for spending some time with me on Advancing Health today to talk about this and share your insights and your knowledge.

00:11:17:23 - 00:11:18:14
Tina Eden, R.N.
Thank you.

00:11:18:17 - 00:11:20:02
Jacinda Bunch, Ph.D., R.N.
Thank you.

00:11:20:04 - 00:11:28:15
Tom Haederle
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