Advancing Health Podcast

00:00:00:03 - 00:00:17:05
Tom Haederle
Welcome to Advancing Health. Today we hear about how one health system has adapted elements of the National Hospitals Against Violence initiative to achieve a safer environment for both its workforce and for patients and families.

00:00:17:07 - 00:00:37:23
Jordan Steiger
Welcome to Advancing Health. My name is Jordan Steiger, and I'm the director of behavioral health and violence prevention at the AHA. I'm joined today by Tom Ahr, the senior vice president and chief human resources officer at Hospital Sisters Health System. And he is a member of the AHA’s Hospitals Against Violence Advisory Group as of this year. So, Tom, welcome.

00:00:38:04 - 00:00:38:21
Thomas Ahr
Thank you.

00:00:38:23 - 00:01:12:07
Jordan Steiger
Tom and his organization have been really instrumental in advancing safety and preventing workplace violence across the entire system. He and his team have done some incredible work, especially over the last few years, that the AHA has been privileged to kind of learn about and see grow. And we thought this was a great opportunity today to share this with our membership, because I think there's a lot of really, really good lessons learned, especially around things about coordinating violence prevention efforts across an entire system, improving outcomes for the workforce, and then, of course, for patients and families.

00:01:12:13 - 00:01:19:13
Jordan Steiger
So, Tom, to get us started today, can you just tell us a little bit about Hospital Sisters Health System and your role in the organization?

00:01:19:15 - 00:01:43:18
Thomas Ahr
Thank you Jordan. Hospital Sisters Health System is a Catholic health care organization. We're based in Springfield, Illinois. We have three primary locations. One is on the Illinois side of Saint Louis, one is in the greater central Illinois area. And then we also have hospitals and other care delivery settings in the Green Bay, Wisconsin area. We have 13 hospitals, and I am the chief human resources officer, HSHS.

00:01:43:20 - 00:02:05:22
Jordan Steiger
Great. And I think coming at this problem of workplace violence from that chief human resources officer position really positions you well to make impact across the entire system. And a lot of times we see clinicians taking on that role. And I think, you know, having you especially come on to our Advisory Group as a CHRO is really, we're really excited about that.

00:02:06:00 - 00:02:34:09
Thomas Ahr
I tell you, first, I'm very glad to be on the Advisory Group, but it's really interesting to see all the different roles and expertises that are involved in this really complex topic. And I think it speaks to the complexity of the issue at hand. As an HR professional for my career, we spend a great deal of time looking at what the experience of our employees and colleagues are and how we can optimize that. And what we recognize as of many organizations, in particular, health care organizations,

00:02:34:11 - 00:02:52:21
Thomas Ahr
violence at work is becoming too prevalent, and it was really harming our people and harming their ability to do what they came to health care to do, which is to provide care for others. So we see it, part and parcel with the work that we do to try to create positive work environments for everyone who is working here.

00:02:52:23 - 00:03:07:02
Thomas Ahr
And so naturally, and our organization fits into the HR space, but I can see where it fits into safety, security, nursing, other critical areas just as easily. Just happen to be one that that really gained traction for us at HSHS.

00:03:07:04 - 00:03:29:02
Jordan Steiger
No, that makes a lot of sense. And I think you mentioned it takes that interdisciplinary approach to really make this work and to enhance safety. I know that you and your organization have been doing a ton of work over the last few years, especially. And that's not to say you weren't doing this before, but you've really made huge strides on improving safety and kind of enhancing your programing around workplace violence.

00:03:29:03 - 00:03:37:22
Jordan Steiger
So tell us a little bit just about how you got started on this path and what was important to you as you were thinking about expanding some of your work?

00:03:38:00 - 00:04:08:09
Thomas Ahr
What was important to us was, was individual safety at work. And then we recognized that coming up with kind of individual solutions wasn't going to solve the problem, because it's so big and we're all feeling it, okay. And so we recognized the need for kind of systemic solutions for a dedicated effort to it. We had a no shortage of individuals, working very hard teams working very, very hard in response to it, to these situations.

00:04:08:11 - 00:04:29:22
Thomas Ahr
But we recognized we need more than that. As a leadership team, we're observing this. We were witnessing what was happening. We just recognized the need for more comprehensive solution, which really happened about 18 months ago for us. It's really when we decided to get serious around what we're going to do. And that initiated a number of activities that have led us to where we are today.

00:04:30:00 - 00:04:46:22
Jordan Steiger
So just to mention and build on what Tom was just talking about, we do have a case study coming out. The companion to this podcast, that is going to go into a lot more detail about some of the programs and approaches that Tom is discussing today. So if you're curious about anything, he's mentioning, that's a really good place to start.

00:04:47:01 - 00:05:08:20
Jordan Steiger
But thank you for, you know, telling us a little bit more about kind of what you're thinking was around that. One thing that has really stuck out to me, I think in all the work you've done, especially in the last 18 or so months, is your focus on prevention and training. So not just waiting for an event to happen, but really trying to empower your workforce to mitigate those events before they actually occur.

00:05:08:22 - 00:05:17:07
Jordan Steiger
What have you been doing to help your staff, you know, recognize signs of trauma, maybe identify behavioral health needs, things like that.

00:05:17:09 - 00:05:45:20
Thomas Ahr
The instances of violence are occurring every day and they're easy to see. And we do respond to those. And those are, what kind of gets the headlines in there. But what we've also recognized is that folks are living in, through trauma in other ways, and we need to spend the time to understand what it means to provide care in an environment where you may be, someone who was, is in other violent environments or is carrying other trauma with them.

00:05:45:21 - 00:06:03:05
Thomas Ahr
And so we look at it on both lenses, both that acute in-the-instant moment, but also what someone may be bringing to work. And we think around, you know, just some of the kind of core elements of trauma-informed care, but really recognizing and responding when we see these things occurring. So how do we actually do that?

00:06:03:05 - 00:06:25:19
Thomas Ahr
I mean, it's easy to say. We're big proponents here of a concept called mental health first aid. And actually, as we started this year, while we've had hundreds of leaders and colleagues take that certification, we have made that mandatory for all leaders, within our ministry. We want our leadership team, and we make available to all of our colleagues and our external partners as well.

00:06:25:21 - 00:06:56:07
Thomas Ahr
We want them to be able to recognize when someone may be suffering. It could be work-related. But I'll tell you, it's also home-related, community-related. And we want them to recognize that so they can help that person get to kind of on a healing path, whatever that might be for them. Certainly, mental health first aid isn't around providing that long term treatment, but at least recognizing when there may be a situation that can be addressed by addressing it, makes the colleague, makes the work environment, stronger.

00:06:56:08 - 00:07:03:22
Thomas Ahr
Is something that we want to give to all of our leaders so that as part of their role in managing others, they're looking after their welfare.

00:07:04:00 - 00:07:22:03
Jordan Steiger
I think that makes a lot of sense. And just like you said, that empowerment to understand that, like you are seeing someone on their worst day at their worst time, and that doesn't excuse violence, but it certainly, you know, helps you understand where they're coming from, maybe a little bit more. And that that leads to prevention, I think in some, some cases at least.

00:07:22:04 - 00:07:45:14
Thomas Ahr
You know, I think it does. And you try to think through, not only is it around recognizing it in someone on your team, but maybe even recognize it on that family member who's coming in, okay. And so it causes a different set of initial reactions there. And we think that's valuable, that you have that, that even if it's just a momentary pause to think about what is going on here,that's so preventative.

00:07:45:16 - 00:07:58:05
Thomas Ahr
Things can escalate very quickly. We, as do many other organizations, have de-escalation training and things on those, those rights. But this adds another layer to that that we think has been very beneficial for us.

00:07:58:07 - 00:08:13:06
Jordan Steiger
Absolutely. And I mean, mental health first aid is something that is out there in every community. And I think a really smart approach for your system to take, it's accessible. And it's evidence-based and we know it works. So I think that's an awesome example to share with other members.

00:08:13:08 - 00:08:33:12
Thomas Ahr
And I'll add to it, which is, from an HR guy here, it's not often that you get to offer a class or a program and you have waitlists. We do. And, so we don't have to promote it. It's being filled every time that we offer it. Matter of fact, we just going through what our schedule is for the rest of the first six months of the year.

00:08:33:12 - 00:08:51:14
Thomas Ahr
And we're full. We're thrilled for that. But it's one of the few things where people are asking to sign up. And when they walk out, they're sharing with others. So I encourage people to consider this as a great alternative and a great vehicle for this type of learning, and for the support you may want to provide within your hospitals.

00:08:51:16 - 00:09:10:22
Jordan Steiger
Absolutely. I think that's great advice to share. We know, though, that as much as we want to focus on prevention and everything,  that there are still going to be incidents, unfortunately, that happen. But I think the way that you and your team have kind of put some supports in place for your staff after incidents of violence is pretty incredible.

00:09:11:00 - 00:09:18:04
Jordan Steiger
So I was wondering if you could share a little bit about some of the work you've done to really support your staff after they experience violence?

00:09:18:06 - 00:09:37:11
Thomas Ahr
Yeah, I think the first and foremost thing that we have to do is to make sure that we're recognizing it when it happens. And so we put in a number of different processes and tools to make sure that it's initiating the next level of process, next level of action that occurs there. And those are very exciting, what we're doing.

00:09:37:11 - 00:09:58:12
Thomas Ahr
I'll share those with you in just a moment. But we need to make sure that that's getting entered into our systems and so that we can we can take action there. The thing that is kind of the most heartwarming of it all for us is recognizing that, particularly when violence happens at work, we do not want to re-traumatize that individual.

00:09:58:14 - 00:10:23:22
Thomas Ahr
And sometimes they need a little time away. And make sense if you are slapped or punched or something of that nature, I ask you to come right back to work. Probably isn't the best care solution that we could deliver in the moment, and certainly isn't respectful of the conditions that that colleague is facing. So we instituted last year, a different classification of time off, healing time away.

00:10:24:00 - 00:10:53:06
Thomas Ahr
And, much like many of you may have bereavement models or other of these kind of short-term periods of time where folks can take time away. We have funded and made available at this classification. So if someone needs the afternoon or the evening to reground themselves, or perhaps they need the next day off before they're ready to come back in there, they can take advantage of that without having to take time off for their vacation or their holiday or otherwise.

00:10:53:08 - 00:11:15:12
Thomas Ahr
I believe that we had an example right before the holidays, that it would have been a choice between taking holiday time away with their family or coming back to work and not being ready to do so. This was a fantastic bridge for them. You know, we had a concern that it might be overused and and it really it's not, it's been pretty, judiciously used, but we've had a number, I'll say it's more than

00:11:15:15 - 00:11:34:08
Thomas Ahr
I can count on my 10 fingers of times of which we've used it, and it's been of great value to those individuals. It's a terrific thing that we've done for them. And, and it really sets the stage better for their re-acclimation to work and for them to recognize their colleagues, to recognize that we do value and respect them.

00:11:34:10 - 00:11:50:17
Thomas Ahr
And knowing that this can be difficult. Now we do other things as well. I mean, we have, kind of care kits and, toolkits for leaders on how to check in with others. I already mentioned the mental health first aid to see if there's any lingering topics related to that.

00:11:50:19 - 00:11:59:10
Thomas Ahr
Care for colleagues is super important, and that's where we spend a lot of our time in the event these things occur. And we're not naive to believe that they're not occurring.

00:11:59:12 - 00:12:30:11
Jordan Steiger
I love this example, and I'm so glad you brought it up. If you didn't, I was going to ask you about it because I think this is something that other systems can really emulate. Like you said, everyone has a bereavement policy and, you know, others have maybe volunteer time away, things like that. You know, this is I think putting something in place really sends such a strong message to your workforce that you respect them as, you know, professionals, you respect their mental health, and their well-being, and you want them to be at their best so they can provide the best care to your patients, too.

00:12:30:13 - 00:12:50:15
Jordan Steiger
I have not heard of other hospital systems doing this. They might be out there. But I think this is a really, really shareable model. I'm so excited that you brought it up so others can learn from it. You mentioned a few things, like you wanting to make sure that, like, things are being reported and, you know, recorded as quickly as possible, you know, like events.

00:12:50:15 - 00:13:01:15
Jordan Steiger
How are you using that data and reporting and maybe even enhancing the amount of reporting? Because we hear from members a lot that, these events are kind of going unreported.

00:13:01:16 - 00:13:24:01
Thomas Ahr
Yeah. It's kind of hard to manage something that you don't understand how frequently they're occurring, and we know they're occurring. We know that they're occurring twice a day, okay. And I would not have known that otherwise. Now, this is the spectrum of different types of ways in which  violence is lived, okay. And so it's not always just the punch in the face.

00:13:24:01 - 00:13:46:18
Thomas Ahr
It could be other things as well. It could be harassment and bullying, lots of other different types of activities that really harm the individual. We do ask and we reinforce with our colleagues, with our leaders — report it. We need to know. And it's given us some great insights into certain things like, which units, at which type of day, which circumstance.

00:13:46:18 - 00:14:09:05
Thomas Ahr
For some reason, it's Thursdays, you know what are these things that are happening which allow us then to do other things with that, like, well, do we need to do different types of resource deployment? Are there certain conditions in place that are causing this to occur? How do we address those? We do meet monthly on this at a global level to say, what are we seeing and what should we do based on that.

00:14:09:05 - 00:14:28:17
Thomas Ahr
And that's with our security team. That's with our care delivery teams, just different groups across the organization. We say now that we know this, our quality teams, our risks teams, now that we know this — what should we do differently to try to prevent or try to mitigate, and try to address, what is going to be going on in our buildings.

00:14:28:19 - 00:14:43:21
Thomas Ahr
The more that we found as you do with many kind of quality events, the more that you you ask for reporting, the more that you get. This is always a good thing. We'd rather know than not know. And so we follow that same path that you would see as many quality folks and with more.

00:14:43:23 - 00:15:00:06
Thomas Ahr
And you want to get more of those so you can have good information to use to decide, what do we need to do? And what we need to do could be some of those examples that I just shared. But also, bigger picture things like advocacy, and speaking with  lawmakers and otherwise and law enforcement officials.

00:15:00:08 - 00:15:06:06
Thomas Ahr
How can we make changes that can support the care delivery that we want to support in our buildings?

00:15:06:08 - 00:15:25:06
Jordan Steiger
Absolutely. I'm glad you brought up thinking about partnerships and advocacy. I think that's such a key part of all of this. And, you know, one hospital or hospital system can't fix this problem alone. But it sounds like you're using the information you have to really make some positive changes. It's interesting how you say, you know, Thursdays for some reason.

00:15:25:08 - 00:15:41:13
Jordan Steiger
I don't know why, but I mean, that's good that you know that. And you can, you know, look at your work, you know, your staffing and understand how you can keep people safer. So that's awesome. As we're kind of winding down here, what is something that you're really proud of in all this work that you've done?

00:15:41:15 - 00:16:05:21
Thomas Ahr
I'm most proud of the way that the entire organization has leaned into it. And, we have monthly all-leadership meetings. Last calendar year, three of those meetings were dedicated to this topic. And usually there's two or three topics in those meetings. So it wasn't a one-time, here's an important initiative, let's everyone get on board.

00:16:05:23 - 00:16:33:23
Thomas Ahr
It is reinforced with regularity. I'm proud of our whole organization for saying this is a real concern, and we are focused on it for the long term. I'll say, secondly, the work that was done by our colleagues to help to rework our patient visitor code of conduct was transformational for us. It gave them a tool in the moment that they could use to change behaviors as they're occurring.

00:16:34:01 - 00:16:50:00
Thomas Ahr
And so I'm really proud that we were able to do that and to see it, when I round I go and look for that, is it visible? Is it viewable? Do the staff know where to find that? Have they had conversations with folks when they need to use it? Inevitably I do hear stories of it being used.

00:16:50:01 - 00:17:10:00
Thomas Ahr
So that shows that it's less of someone from the HR team in a corporate office doing something, to it is a tool that is practiced and is has having an effect in there. So it's very satisfying to see that occurring and knowing that's contributing to kind of de-escalating some of the issues that we're facing.

00:17:10:02 - 00:17:24:23
Jordan Steiger
I mean, it sounds like your whole system and workforce has really embraced this idea of safety. And I mean, that sounds like it's really coming from you and your team and your leadership and and going throughout the whole organization. So that's something I think to be extremely proud of.

00:17:25:01 - 00:17:44:07
Thomas Ahr
We have work to do. You know, violence is at epidemic levels in our society. And that's unfortunate. So we have to remain vigilant in it. I wouldn't say that we've got it right. We still are continuing to work on many different aspects of it, but we're proud to kind of turn the corner to say it's less of a program and more of a way in which we work,

00:17:44:07 - 00:17:46:07
Thomas Ahr
and that everyone's involved in it.

00:17:46:09 - 00:17:57:23
Jordan Steiger
I love tha. That's exactly what we should all be aiming for. Tom, thank you so much for being here with us today. It was a joy to learn a little bit more about your work, and I'm sure our membership is going to feel the same.

00:17:58:01 - 00:18:00:13
Thomas Ahr
Thank you, Jordan. Good luck to everyone.

00:18:00:15 - 00:18:08:22
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.

00;00;00;01 - 00;00;17;26
Tom Haederle
Welcome to Advancing Health. In this second of a two part podcast, FBI leaders share details of a new national effort involving everyone to help defend against the latest malicious cyber threats that continue to plague all sectors of society.

00;00;17;28 - 00;00;48;13
John Riggi
Hello everyone. This is John Riggi, your national advisor for Cybersecurity and Risk at the American Hospital Association. Welcome back for part two of our conversation with FBI Cyber Division Assistant Director Brett Leatherman and FBI Office of Private Sector Assistant Director Gretchen Burrier to discuss all things cyber information sharing and AI. So, Brett, back to our discussion. We talked a little bit about the nation-state threats to criminal groups,

00;00;48;13 - 00;00;58;26
John Riggi
but some of the groups that are actually being used as proxies and being directed by nation-states. Can you tell us a little bit more about that connection?

00;00;58;28 - 00;01;29;11
Brett Leatherman
Yeah, we're really focused, John, on the blended threat right now. And that is, how nation-states are leveraging criminal groups and/or industry in their country to help facilitate their cyber network operations directed at the United States. And so we talked a little bit earlier about the PRC and this whole of society approach that they take. We have named companies in China who have helped procure access to US networks as a result of their hacking campaigns.

00;01;29;11 - 00;02;01;12
Brett Leatherman
Flack's Typhoon is an example of that, where they leveraged Integrity Technology Group, a company within China, to provide access to networks here in the United States. Assault Typhoon, one of the most consequential, the most consequential cyber espionage campaign launched against the United States was facilitated by multiple companies in China. And so we continue to see this blended threat where nation-states use these companies to facilitate that access, but they also work within the criminal ecosystem as well.

00;02;01;14 - 00;02;22;06
Brett Leatherman
DPRK is a great example of that, where they continue to do cryptocurrency thefts or place IT workers in networks here in the United States, remote IT workers. These groups are very aligned with criminal groups to understand tactics, techniques and procedures and how they can advance their geopolitical ambitions.

00;02;22;08 - 00;02;49;21
John Riggi
And we know first hand of the North Korean remote IT worker threat. Almost weekly, I received some report from a hospital or health system that they identified a suspicious remote IT worker and have limited their access, actually actually ended their access. And of course, we're concerned with the fact they have access, they're raising funds for their programs back in North Korea, potentially even nuclear weapons programs.

00;02;49;27 - 00;03;09;10
John Riggi
But the fact they have that access to steal data and/or deliver malware. Can you talk to us a little bit about threat hunting? What do you think some of the best practices are to identify the threats as well, in case they were already in our networks, both from the criminal hacker perspective and, from the nation-state perspective?

00;03;09;12 - 00;03;36;26
Brett Leatherman
Yeah. Well, first and foremost, we should be looking at the indicators of compromise that the FBI and our partners put out on a regular basis to identify where those emerging cyber threats are. So it's incredibly important to look at those joint cybersecurity advisories that we put out there that help you understand both the technical information and the contextual information to hunt through your environment and try to detect an adversary or to block at your perimeter some of the things that we see.

00;03;36;29 - 00;04;14;09
Brett Leatherman
But, you know, no podcast in today's day and age is complete without talking a little bit about artificial intelligence. We saw in November of this past year, Anthropic put out an advisory about the PRC's use of Claude, their artificial intelligence platform, to target industry. And what Anthropic put out was that 80 to 90% of the kill chain activity that happened there, from reconnaissance to identification of targeting to lateral movement, privilege escalation was done agentically through AI.

00;04;14;11 - 00;04;54;24
Brett Leatherman
And we've got to start to employ similar capabilities defensively to look at deviations in behavior. And that's where we have to move. And I know that no organization in health care is likely ready to apply artificial intelligence to the totality of its infrastructure. It's just too, too soon to do that. But there are ways that we can start surrounding key user accounts that have privileged access, key network devices or key data stores within our environments, and we can start to pull the logs off of those environments, run them through approved artificial intelligence devices to try to find those anomalies in behavior.

00;04;54;24 - 00;05;07;14
Brett Leatherman
And so behavior based detection is kind of the wave of the future. We're doing it now, but we have to do it much more efficiently through artificial intelligence. And we can start with baby steps doing that.

00;05;07;16 - 00;05;32;18
John Riggi
There is in a presentation, a discussion I have with leaders in the health care field where AI does not enter into the conversation. We talk about how the bad guys are very nimble and absolutely very quick to adopt AI. Takes us more time. Obviously we have to test it. We have to ensure that it does not corrupt our data or expose us to security and privacy issues for that data.

00;05;32;21 - 00;05;55;08
John Riggi
But I've always said I 100% agree with you, Brett, AI is fueling the next generation of the cyber arms race. We are not just at the beginning. We are, I think beyond that. And we've got to make sure we are using AI in our defensive measures just as the bad guys, as you said in the Anthropic report, which we published, are already using it to conduct these attacks.

00;05;55;10 - 00;06;18;21
John Riggi
Gretchen, the American Hospital Association, I've had this tremendous opportunity to work together with the FBI for the last several years. I've heard you describe our ongoing information exchange as the gold standard for private sector relationships. From your and the FBI's point of view, could you tell us why you believe that and what you believe the successes of our relationship have been?

00;06;18;24 - 00;06;41;27
Gretchen Burrier
Yeah, absolutely, John. You know, I do describe our relationship with the American Hospital Association as the gold standard because it reflects exactly what effective public private partnerships should look like. And I do talk about it all the time. I even brought it up at the SAC conference recently. But first, it is built on consistency and trust, right? We're not only meeting when there's a crisis and it is not transactional.

00;06;41;29 - 00;07;08;08
Gretchen Burrier
We have an established cadence of engagement that allows for real dialog with hospital CEOs and our FBI senior leaders. And to me, that continuity builds confidence on both sides. And second, right? It's genuinely two way. Hospitals are on the front lines of cyber threats, ransomware, foreign adversary activity. What they share with us helps the FDIC trends earlier and warn others before the damage spreads.

00;07;08;10 - 00;07;33;23
Gretchen Burrier
And in turn, the FBI has an ongoing dialog with them to ensure they're tracking various threats. What I see is the real roll up your sleeves, get to work action on challenges impacting this country's national security. And most importantly, John, the life of patients. I can't thank AHA and our nation's hospitals enough for the work that they do and for the willingness to lean in and work with us in the FBI.

00;07;33;25 - 00;07;47;14
Gretchen Burrier
I really think it's the combination of trust, continuity and real world impact where we're collaborating together on reports or other real time threats. That's why I consider it the gold standard.

00;07;47;17 - 00;08;12;02
John Riggi
Thank you, Gretchen. And to your point, we look not only to just meet and exchange information, but we've developed these ongoing projects. What will we do? What will we produce? And we will measure our impact on helping defend the health care sector. So again, thank you and your team so much for that. Now we have a great relationship at the national level which benefits the entire field.

00;08;12;04 - 00;08;21;29
John Riggi
But there's over 5,000 plus hospitals out there. How can hospitals on a local and regional level establish productive relationships with the FBI?

00;08;22;01 - 00;08;41;00
Gretchen Burrier
Sure. Look, hospitals can establish a relationship with the FBI by reaching out to their local FBI field office and asking for the private sector coordinator. And, of course, John, you're a great resource as well from your time in the Bureau. And I know that if any hospital reached out to you, I know you would assist them with an introduction as well.

00;08;41;03 - 00;08;50;04
Gretchen Burrier
And of course, at the end of the day, the Office of Private Sector, we also will get everyone connected with who they need to be connected with for whatever reason.

00;08;50;06 - 00;09;18;06
John Riggi
And again, we can't emphasize that enough. The FBI is always predisposed to help. And, one thing I do want to point out by contacting the FBI does not somehow place you at risk of regulatory exposure. The FBI is not a regulatory agency. Their job is to help you all recover from the attacks, to try to discover attribution, and really to provide you assistance during an attack.

00;09;18;08 - 00;09;33;01
John Riggi
Brett and Gretchen, what do you think the best way for the field, the hospital field, health care field is to contact the FBI in a true cyber emergency, like a ransomware attack, which is causing ambulance diversions.

00;09;33;03 - 00;09;50;26
Brett Leatherman
I know Gretchen mentioned, reach out to your local field office, and that is the best way to reach out. Now, we prefer to talk to you before a crisis happens. So I encourage everybody to reach out and get to know your private sector coordinator like Gretchen mentioned, as well as your cyber supervisor in your local field office.

00;09;50;28 - 00;10;17;23
Brett Leatherman
We take a victim-centric approach in everything we do. Our job in FBI Cyber Division is to impose cost on state and criminal adversaries. But an equal mission is to provide significant support and assistance to victims of cybercrime. And we can do that best when we have an established relationship with you. And that is through the private sector coordinator and your local cyber squad in your local field office.

00;10;17;23 - 00;10;42;08
Brett Leatherman
So, I would reach out in advance to have those conversations. But even if you don't have that relationship and you do suffer a cyber incident, reach out, have that conversation. There is value in bringing the FBI in. We protect information when it comes in. It's protected under law enforcement investigations. We don't share information that we get pursuant to those investigations with regulators.

00;10;42;08 - 00;11;06;29
Brett Leatherman
We don't make that information available publicly. We are bound by the Victims Rights Act, and we treat victims like victims. That is always been a part of our DNA and will always be a part of our DNA. The other thing that that does, though, is it allows an organization to reach out, say, this is what we're seeing. We have we have this particular ransomware attack in our environment.

00;11;07;01 - 00;11;34;01
Brett Leatherman
These are the IOCs, the indicators of compromise we see. And in the FBI, we can run that through our law enforcement holdings. We can check with our intelligence community partners. We have 22 cyber assistant legal attachés globally who sit with foreign partners. We can run those things through foreign partner visibility, and we can come back and we can provide additional information that helps with threat hunt containment and eradication activity.

00;11;34;01 - 00;12;00;25
Brett Leatherman
So as much as we want to pivot upstream against the actors, we also want to help organizations in containing the threat and getting back on their feet to help patients, which is the core mission of the hospitals. So, really, that is part of the value that we bring to reaching out. Every one of our 56 field offices have a cyber task force that is comprised of federal, state and local law enforcement partners, and they're there to help.

00;12;00;28 - 00;12;31;15
John Riggi
Such key points, Brett. And again, I think one of the key points that you made was the fact that by contacting your local FBI office doesn't mean that you'll just get the resources of that local office, perhaps in a remote area. It unlocks the resources of the entire US federal government and allied partners. All the agencies, all the intelligence communities will be notified of the attack, and then their resources and information will be brought to bear to assist your hospital.

00;12;31;15 - 00;12;50;13
John Riggi
Whether you're a multi state, multi-billion dollar system covering millions or lives, or you're a ten-bed critical access in a very remote area where the next nearest available hospital is 100 miles away. Gretchen, anything else to add on how our hospitals should contact the FBI during a cyber emergency?

00;12;50;15 - 00;13;11;03
Gretchen Burrier
You know, I think Brett said it perfectly. I would just again encourage you to reach out if you don't have that relationship and start building it today, because if a cyber incident hasn't happened, it probably will, unfortunately. And this way you've got a contact and hopefully that individual's contact information is in your cell phone. You can call them immediately

00;13;11;03 - 00;13;15;27
Gretchen Burrier
so no time is lost, because time is critical in an incident.

00;13;15;29 - 00;13;34;26
Brett Leatherman
Yeah. John, I would just add to what Gretchen was saying there that, it starts with the conversation and think about it that way. Because the FBI teams at the private sector coordinator level, the cyber level, even the special agents in charge and the assistant special agents in charge were happy to have a conversation. And there's no commitment beyond that.

00;13;34;26 - 00;14;02;10
Brett Leatherman
You don't have to feel like you're now committed to providing very sensitive information to the FBI. We're never going to ask for patient information or sensitive information. What we ask for is fully aligned with threat pursuit and victim response, and that is, you know, anonymized indicators of compromise, not PHI or anything like that. And so I would encourage folks, if you have questions, reach out, have that conversation to start with.

00;14;02;10 - 00;14;04;08
Brett Leatherman
And it's as easy as that.

00;14;04;11 - 00;14;30;24
John Riggi
Totally agree, Brett. And during that conversations folks will come to see the FBI are human. They're good folks. They want to help, such as yourselves. And it'll help allay some of those fears. Perhaps the legal folks might need to be involved to just assure them that you don't collect PHI. You don't need that. You don't need access to the service, and you would never tell a hospital not to restore because it's pending your criminal investigation.

00;14;30;26 - 00;14;39;17
John Riggi
So in a sense, the rules of engagement can kind of be worked out ahead of time. You don't want to have those questions during an emergency.

00;14;39;23 - 00;15;04;00
Brett Leatherman
To your point, like you brought up legal counsel. That is incredibly important in today's environment. It is often outside counsel in coordination with inside counsel, who kind of control the flow of data and information. And so the earlier you as a chief information security officer or network defender can have those conversations with your counsel and encourage them to engage the FBI in advance,

00;15;04;02 - 00;15;20;06
Brett Leatherman
the more ready you will be to share and receive intelligence on day one should there be a breach. And so incredibly important point is that counsel plays an a very important role in the bilateral sharing of information. And so bring them into those conversations early.

00;15;20;08 - 00;15;47;03
John Riggi
Absolutely agreed. And again, sensitizing them and helping them become comfortable to the relationship to the information sharing can certainly expedite recovery, quite frankly, with the assistance of the FBI and the federal government, Brett and Gretchen, want to thank you again for being here today, sharing your very important and salient points with us today for the benefit of the entire field, our patients and the nation.

00;15;47;03 - 00;16;07;27
John Riggi
And thank you both for what you do, and all the men and women in the FBI, every day to protect the nation and to our health care providers. Thank you for what you do every day to defend networks and care for patients and serve our communities. This has been John Riggi, your national advisor for Cybersecurity and Risk at the American Hospital Association.

00;16;07;29 - 00;16;10;12
John Riggi
Stay safe everyone.

00;16;10;15 - 00;16;18;24
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00;00;00;04 - 00;00;16;07
Tom Haederle
Welcome to Advancing Health. Coming up in part one of this special two part conversation with FBI leaders, we learn about Operation Winter Shield, the FBI's new 60 day nationwide effort to protect against cybercrime.

00;00;16;10 - 00;00;43;24
John Riggi
Hello, everybody. I'm John Riggi, your national advisor for Cybersecurity and Risk at the American Hospital Association. What a great conversation we have lined up for you today. So proud and privileged to have two of my very good friends from the FBI here with me today to talk about the latest cyber threats and what we can do to help defend against the threats and how we share information with the FBI for the greater good.

00;00;43;27 - 00;01;03;26
John Riggi
So here with me today is my good friend, longtime friend, FBI Assistant Director Brett Leatherman, who leads the FBI's cyber division. We also have my longtime and good friend, FBI Assistant Director Gretchen Burrier who leads the Office of Private Sector. Thank you both for being here today.

00;01;03;28 - 00;01;05;15
Brett Leatherman
Thanks, John. Happy to be here.

00;01;05;18 - 00;01;09;16
Gretchen Burrier
Yeah. John, thank you so much for having us. It's really great to be here today.

00;01;09;18 - 00;01;19;23
John Riggi
Great to have you, Gretchen and Brett. Brett and I actually worked together in cyber division over ten years ago. Seems like a lifetime ago, right, Brett? So much has changed. Yeah.

00;01;19;26 - 00;01;22;01
Brett Leatherman
A lot changes in cyber in ten years.

00;01;22;03 - 00;01;45;00
John Riggi
Right! Sometimes it seems like in ten minutes, it changes. Brett, if I could start off with you - again, thank you for being here. And, coincidentally, at the time of this recording, you and the FBI have announced the launch of Operation Winter shield. Could you tell us a little bit about that and why it's relevant for the nation's hospitals?

00;01;45;02 - 00;02;15;06
Brett Leatherman
Thanks, John, and thanks for the invite to participate in the podcast. Operation Winter shield launched February 1st and it's a 60 day campaign to defend the homeland against malicious cyber activity. What's unique about Operation Winter shield is most FBI enforcement action or operations involves federal, state and local partners in support of, you know, reducing violent crime or some sort of enforcement action that the FBI has jurisdiction in.

00;02;15;08 - 00;02;55;21
Brett Leatherman
Operation Winter Shield is different in that it requires all of us, everybody listening to this podcast, to come together and work together to reduce risks to critical infrastructure, to health care and to the homeland from both state  and criminal cyber actors. So what it does is it distills the FBI's visibility in this space, pursuant to our law enforcement and intelligence community mission, into the top ten controls that we recommend organizations apply to their environments. Based on that work that we do,  today 95% of the breaches continue to exploit one of these controls, at least one of these controls.

00;02;55;23 - 00;03;26;23
Brett Leatherman
And so we believe that really spending the next 60 days firming up the ability to defend against these attacks by advertising these controls to Fortune 100 organizations, down to small mom and pop businesses, and especially in health care, can measurably move the needle and increasing resilience against these cyber attacks. The one thing I would add is that we know that nation states in general who target us now use a whole of society approach to target the homeland through these cyber operations.

00;03;26;23 - 00;03;37;14
Brett Leatherman
And this requires a whole of society approach to defending it. And this is meant to pull all of us together in support of that national defense and national security mission.

00;03;37;17 - 00;03;59;21
John Riggi
You and I have chatted many, many times - and Gretchen, over the years - of the value of private sector cooperation. I love this expression whole of society. We used to talk about a whole of government approach. But you're absolutely right. Private sector must be a partner with the government on these task forces to help defend the nation. Whole of nation, whole of society approach.

00;03;59;23 - 00;04;10;07
John Riggi
Brett, getting back to Operation Winter shield just briefly, could you give us a sampling of let's say, maybe the top five controls that you think all critical infrastructure should implement?

00;04;10;10 - 00;04;39;23
Brett Leatherman
Yeah. And none of these are going to come to a surprise to many folks, right? The issue is we continue to see the actors exploiting these. So things like adopting phish resistant authentication - incredibly important. Implementing a risk based vulnerability management program. Incredibly important. We continue to see nation state actors targeting end of life edge devices. So one of the controls is understanding how to track and retire end of life technology on a defined schedule.

00;04;39;23 - 00;05;03;22
Brett Leatherman
And for health care, that's incredibly important. Health care continues to be, you know, according to a lot of reporting out there, the number one targeted entity within critical infrastructure, I saw one report that showed the average cost of a data breach within health care is $7.42 million. And so there's a low tolerance for downtime because there is patient and life safety implications.

00;05;03;22 - 00;05;21;02
Brett Leatherman
So, for example, control number six within Winter Shield is maintain offline in immutable backups. That is incredibly important for health care when it comes to resiliency in being able to get, you know, health and safety data in systems back online during a breach.

00;05;21;04 - 00;05;46;00
John Riggi
Totally agreed, Brett. In fact, when the AHA, myself worked with the previous administration to help develop the cybersecurity performance goals version 1.0, what we did is we looked at the threat reporting coming from the FBI. And so as I said, let's look at how we are getting beat. And it's the same controls that, that you just described as the best mitigating practices. Challenge for us in health care for all our listeners,

00;05;46;00 - 00;06;10;05
John Riggi
you all know this better than I, is the financial constraints that we are faced with as well. We know what to do. This reinforcement from the FBI really gives validation to that, but within an operating environment under severe financial pressure. Brett, you just mentioned the nation-states. Talk to us a little bit about China and their typhoon campaigns targeting critical infrastructure.

00;06;10;07 - 00;06;30;16
Brett Leatherman
Yeah, we talked about these end of life devices. And if you look at Vault Typhoon, Flax Typhoon, both campaigns between 2024 and 2025 that are PRC sponsored campaigns, they target those end of life devices. The reason they do that is those devices sit here in the United States. They're global botnets, but the ones that are have real impact

00;06;30;16 - 00;06;57;25
Brett Leatherman
here are devices that sit here in the US. They sit on trusted IP space within the United States, meaning the actors can quickly pivot from that space to target other organizations like health care. So the PRC understands that the path of least resistance is the way to go. They don't want to deploy their most sophisticated capabilities when they can start to target things that these controls are meant to address.

00;06;58;01 - 00;07;10;18
Brett Leatherman
You know, it's incredibly important that we come together and really understand how we plug those gaps in our exposed infrastructure to reduce the likelihood of compromise.

00;07;10;20 - 00;07;31;06
John Riggi
Really key point you made. China and Russia around North Korea as sophisticated as they may be, they're not using highly sophisticated zero days to attack us. That's why these basic controls are so important to help mitigate the threat. Getting back to nation-states a little bit, we talked about China. What about Russia, Iran and North Korea?

00;07;31;09 - 00;07;57;14
Brett Leatherman
Yeah. Critical infrastructure is a target for each of those entities for a variety of different reasons. Number one, for organizations who want to pre-place capability in the United States, health care is a key area to do that, right. And so the electric grid, the financial services sector, health care, all of those areas would have real impact should a nation-state decide to launch some sort of cyber attack against the homeland.

00;07;57;14 - 00;08;23;09
Brett Leatherman
And so each of these nation-states possess different capabilities in this space, but each of them will also follow the model of that path of least resistance. And it doesn't matter if these are actors sitting in Iran, if they're actors sitting in North Korea, in Russia or China, they're going to continue to target credentials, stolen credentials, for example, to get into environments where there's no multi-factor authentication.

00;08;23;09 - 00;08;41;03
Brett Leatherman
So if there is remote access to your environment, every one of these state actors on top of criminal actors are going to target that. Same with the end of life devices. They're going to target those because they're easy to get into. And so each of these actors are sophisticated, but often they won't take the sophisticated way

00;08;41;03 - 00;08;43;09
Brett Leatherman
in if they can target one of these controls.

00;08;43;11 - 00;09;10;14
John Riggi
Great points. And again, pointing out to everyone at this time of the really increased geopolitical tensions, with all of these nations China, Russia, Iran, North Korea. Understanding that they do possess first world, highly sophisticated cyber capabilities. And the question is, will they use that against us or some proxy at their direction to launch some type of un-attributable attack, things we're all concerned about.

00;09;10;21 - 00;09;44;28
John Riggi
But I appreciated your advisory in early December, talking about pro-Russian hacktivists being directed by the Russian military intelligence service, the GRU. We in health care and hospitals need to understand the geopolitical risk environment because it directly translates to cyber risk. Brett, last question for you at this moment. We talked about the disruption to health care delivery by particularly these Russian-based or Russian speaking ransomware groups that disrupt and delay healthcare delivery, posing a direct risk to patient and community safety.

00;09;45;01 - 00;09;53;08
John Riggi
Can you talk to us a little bit about the most significant Russian groups or ransomware groups that the FBI's tracking at the moment?

00;09;53;10 - 00;10;19;06
Brett Leatherman
I appreciate that question because the, ransomware groups operating globally, continue to target the underlying ecosystem of health care. Meaning, where they can identify points of targeting that is not just one hospital, but has cascading impact across health care, hospitals, pharmaceuticals, they'll target that. And so we've seen attacks in the past. Change Healthcare as an example.

00;10;19;12 - 00;10;41;26
Brett Leatherman
So these supply chain breaches are incredibly important. And that goes back to one of our Winter Shield advisory statements, which is to analyze third party risk, to understand the third party's web access to your data in your systems and your networks and work with them to build resilience there. It's incredibly important that we also assess detection capability.

00;10;41;26 - 00;11;05;28
Brett Leatherman
We're so focused sometimes on prevention, and we do want to prevent cyber attacks from happening. But we've also got to detect the adversary when they get in. We can't stop them 100% of the time. And these groups are very good at in some cases, for example, scattered spider socially engineering their way into our helpdesk, getting legitimate credentials and getting into our environments.

00;11;06;00 - 00;11;26;18
Brett Leatherman
So if we can focus on detecting them earlier, it's incredibly impactful to reducing that blast radius. In health care, I think it's over 270 days on average it takes right now to detect an actor in a health care environment. And so we've got to reduce that dwell time significantly.

00;11;26;21 - 00;11;51;22
John Riggi
Totally agreed, Brett. And this again, the continuing threats that we face wholesale here, third party risk is a major area of risk exposure we talk about constantly. We can do the best we can to defend our own systems and networks. Then we get exposed to these third party technology and service providers and supply chain. Gretchen, turning to you, given all these threats that Brett just described,

00;11;51;23 - 00;12;00;16
John Riggi
can you tell us about your division's extremely important mission in helping carry these threats and the value of information sharing with the private sector?

00;12;00;18 - 00;12;24;23
Gretchen Burrier
Absolutely. And first, John, it's a privilege to be on your podcast. I love listening to it regularly. So to be on your show, it's very exciting. But to answer your question, you know, the reality today is that the front lines of national security, they're increasingly running through the private sector, whether it's cyber intrusions, ransomware, intellectual property or, you know, foreign malign influence.

00;12;24;25 - 00;12;51;17
Gretchen Burrier
U.S. companies are often the first to see these threats and sometimes the first to feel the impact. So the mission and focus of my team and the FBI's Office of Private Sector is to make sure these companies don't face those threats alone. We serve as the connecting bridge between the FBI's operational divisions and the businesses that own and operate, you know, the systems, the data and infrastructure our country relies on.

00;12;51;19 - 00;13;11;20
Gretchen Burrier
And if you don't know who to connect within the FBI, you can reach out to our team and we'll make sure you get the help you need. We also have in the FBI private sector coordinators, at least one in every field office across the country. You can pick up the phone, call the field office and ask to speak to the private sector coordinator for help and assistance.

00;13;11;23 - 00;13;43;28
Gretchen Burrier
They're the best at what they do, and they fully believe in partnering with industry. And just to touch on your comments about, you know, information sharing. It's at the heart of what we do and it's at the heart of our work. When companies share what they're seeing with the FBI, whether that's a suspicious cyber incident or unusual activity on their networks, Brett's team can connect the dots across sectors and across investigations, and that allows the FBI to provide contacts to warn others, disrupt adversaries, and in many cases, prevent the next victim.

00;13;44;00 - 00;14;11;19
Gretchen Burrier
And at the same time, you know, OPS is dedicated to giving value back through threat briefings, various engagements, webinars, other tailored information so that companies can make better risk decisions in real time. And we do this, of course, in coordination with our operational divisions. Just to give a quick plug too, we have two key partnership programs to the Office of Private Sector, the Domestic Security Alliance Council and Infoguard.

00;14;11;22 - 00;14;32;10
Gretchen Burrier
And those wishing to learn more can visit dsac.gov and info guard.org. Brett and I really do see this is a two way partnership. And John, I know you do as well. And when the private sector and the FBI work together, we're faster, we're more resilient, and we make it harder for criminals and foreign adversaries to succeed.

00;14;32;12 - 00;14;57;21
John Riggi
Thank you Gretchen. Appreciate your continued support. And for all of the private sector coordinators in the field, everywhere we go and we go a lot of places to help hospitals, we invite the FBI, we invite CISA, we invite Secret Service. The Office of Private Sector coordinators have been outstanding. Just recently, I did a four hour exercise for the leadership of one of the largest health systems in the country.

00;14;57;21 - 00;15;22;11
John Riggi
Over 100 C-suite executives there. Two FBI agents from the local field office stayed the entire time and really contributed significantly. So you talk about the partnership. It is real world, side-by-side. And the reality is a lot of the expertise and experience and evidence and Intel lies with the private sector on our networks. So it really is a tremendous partnership.

00;15;22;13 - 00;15;45;04
John Riggi
Brett and Gretchen, thanks for an amazing conversation. We have so much more to discuss. I think what we're going to do is part two of this amazing conversation. So for our listeners, stay tuned for part two. Until then, Brett and Gretchen, thank you and all the men and women of the FBI for what you do every day to secure our nation and health care. And to all our frontline health care heroes

00;15;45;04 - 00;15;54;03
John Riggi
thank you for what you do every day to defend our networks, care for our patients, and serve our communities. Stay safe everyone.

00;15;54;05 - 00;16;02;17
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:06 - 00:00:16:14
Tom Haederle
Welcome to Advancing Health. CommonSpirit Health is a 2025 finalist for the American Hospital Association's prestigious Quest for Quality Prize. Stay with us and learn more about its winning formula for advancing health.

00:00:16:16 - 00:00:54:13
Kristin Preihs
Hi everyone, I'm Kristin Preihs and welcome to our Quest for Quality episode, where we highlight leaders in health care who are transforming the field through innovation, quality, and patient centered care. Today, we are shining a spotlight on an organization making a big impact at scale. CommonSpirit health, the 2025 finalist of the AHA's Quest for Quality Prize. The prize itself is a prestigious award that highlights hospitals and health care systems doing incredible work in leadership and innovation for others to learn from. And most importantly, they are delivering safe, patient centered and family centered care, partnering with communities to improve patient and safety outcomes.

00:00:54:16 - 00:01:22:29
Kristin Preihs
So today joining us is Dr. Thomas McGinn, a senior executive vice president and chief physician executive at CommonSpirit Health. Tom oversees clinical activities across the system, leads clinical service lines including population health, quality based programings, and supports academic partnerships and research, and is a practicing internal medicine physician and nationally recognized researcher. He's advanced evidence based care across the spectrum, and we are so honored to have him here today.

00:01:23:03 - 00:01:24:00
Kristin Preihs
Welcome.

00:01:24:02 - 00:01:36:05
Thomas McGinn, M.D., MPH
Thank you so much for having me. It's just a real thrill to talk about, you know, the efforts of our team across all of CommonSpirit. We're very proud of the work that we do. So thank you for giving me the opportunity to talk about those efforts and having me here.

00:01:36:08 - 00:01:51:17
Kristin Preihs
Well, you are certainly a leader who I think many can learn from with what you've done at CommonSpirit. So let's start there. I know when I was fortunate to be able to see a little bit of what CommonSpirit has done on our Quest for Quality site visit, you demonstrated some significant leadership with you and your team.

00:01:51:22 - 00:01:56:22
Kristin Preihs
Can you talk a little bit about leadership and quality and patient safety and what that means for the realm of today?

00:01:56:24 - 00:02:16:01
Thomas McGinn, M.D., MPH
So we're a large distributed health system. We're in multiple states, just continuously. So it's a little bit interesting to do this, but I think at each level of our organization, whether it's in our markets or our hospitals, in our regions - at the national level, you know, quality, safety and highest standards have been adopted and are constantly talked about at

00:02:16:01 - 00:02:41:00
Thomas McGinn, M.D., MPH
every executive meeting, every local meeting. And I think when you visited us, you know, from the AHA - which by the way, was an amazing opportunity for us to really, you know, look at what we were doing, think about that thoroughly and actually have experts come in and reflect on our work. Just the process itself was so beneficial and our teams were just excited that they were being looked at, seen and recognized whether we won or not.

00:02:41:00 - 00:02:59:09
Thomas McGinn, M.D., MPH
So the process itself is amazing. I really want to thank the AHA for actually giving us that opportunity. But what was fun for us at that visit was we had our board members there. We were in a local hospital and we could see very clearly what the board was thinking and what the community level people were doing. It was connected.

00:02:59:12 - 00:03:16:06
Thomas McGinn, M.D., MPH
And when you were at a system of this size, that doesn't always happen. You know, we didn't rehearse. It was just the culture from A to Z, from national to market was talking about quality, safety and high standards, reducing variability. And it was it was very evident. It was very exciting for me to see.

00:03:16:14 - 00:03:35:24
Kristin Preihs
Well, I think that's an important piece to talk about and really lean into it at such a large system, how leadership is aligned and scaffolded across all of your different locations and sites. It's something that certainly came across loud and clear at our site visit. And one of the things that we were fortunate to talk about with you and your team was also the evolution of technology, including AI.

00:03:35:24 - 00:04:00:06
Kristin Preihs
But certainly beyond that and how the field has shifted and predictive analytics and technology enabled solutions that improve patient safety. And how, as a leader, you have to identify and lean into areas to engage in that work to improve the broader support of patients, but certainly also engage with the workforce as well. So can you talk a little bit about the evolution of CommonSpirit's technology and how that's had an impact on patient safety and quality?

00:04:00:09 - 00:04:19:05
Thomas McGinn, M.D., MPH
You know, you said all the right things. I think that technology is a double-edged sword. You could jump too quick, the new shiny item, you know what's happening. And when you're this large, you have to be a little bit cautious what you're going to adopt and then disseminate. So we have a very, well-organized governance structure that has everything from legal to finance to clinical.

00:04:19:07 - 00:04:42:07
Thomas McGinn, M.D., MPH
As we adopt, particularly the AI space, it's happening so rapidly. We have weekly meetings as we look at different things coming at us. And of course, as you can imagine, everybody approaches us to say, hey, we've got the best solution for you. And having that ability to do that rapid cycle is critically important. We think about this in the lens of is this back office, front office, is this clinical decision making?

00:04:42:07 - 00:05:01:06
Thomas McGinn, M.D., MPH
Is it prognostic indicators? And depending on what pocket we put it in, we have a different level of scrutiny or evidence that we demand before we actually start even piloting something. So you've got to be eager but cautious at the same time. And that's kind of the trick. So I'm happy to meet people, hear their ideas. But then we do quick notes,

00:05:01:06 - 00:05:02:12
Thomas McGinn, M.D., MPH
we call them.

00:05:02:14 - 00:05:25:22
Kristin Preihs
I love your note on eager but cautious. And I think that's incredibly important for technology and equally for innovation, as I think patenting work is looking differently across the field as, of course, technology, but also really thinking about how you in a culture that continues to evolve so quickly, also allow for a culture of innovation, of spreading of ideas from the front line, from the board to the bedside.

00:05:25:29 - 00:05:55:19
Kristin Preihs
So can you also - you're kind of using and leaning into that phrase, just think about how you create an infrastructure of innovation and how then you scaffold that across the data, resources and technology that you guys all have in place. Because I believe when I was on site, I notated that there was 17 different EHRs feeding into your central quality measure repository, which is significant from a management and an incredibly impressive based on the clinical results that we all seen.

00:05:55:24 - 00:06:04:04
Kristin Preihs
Because you guys have a strong system, I think for others to learn from, for how you idiate and also lean into opportunities to innovate.

00:06:04:06 - 00:06:19:25
Thomas McGinn, M.D., MPH
We have a little bit of a mantra where we're all going to do the same process, we're going to adopt the same technology and we're going to use the same KPIs. So if you think about that process, technology, KPIs, if you're all thinking now, it takes a while to get there. But as we move forward, that's our goal.

00:06:19:27 - 00:06:42:18
Thomas McGinn, M.D., MPH
And if you're on the same process, the same technology, measuring the same KPIs, you can quickly and efficiently adopt new best practices and disseminate those. But if you're on different processes and have different technologies and you're all measuring things in different ways, that is a very difficult position to be in. So that is sort of our North Star. You know, this issue of the EHRs

00:06:42:18 - 00:07:01:20
Thomas McGinn, M.D., MPH
and we have 17 and I really thank my IT colleagues because we are rolling out one EHR. Every six months, we're kind of reducing that variability and the fragmentation of our data. However, at the same time, we have to win today and be excellent today, even though it's going to be 2 to 3 year roadmap. And that's all the hard work that you just talked about.

00:07:01:20 - 00:07:27:15
Thomas McGinn, M.D., MPH
The data normalization, the proper use of dashboards, which really to me means clinicians are in the moment thinking about what that dashboard should look like to help them. We often get dashboards, we're like, this doesn't help me. So how are the clinicians iterating on those dashboards? I've never had a dashboard that was done. I mean, if you're really working with a dashboard, there's a back and forth with the clinical frontlines about how it's being used, what's not being used.

00:07:27:18 - 00:07:41:11
Thomas McGinn, M.D., MPH
So it's a lot of hard work. The first win makes the second win easier and the third one even easier. You know, that normalization process gets a little bit easier every time you do it. And then hopefully on the back end we're reducing the amount of EMRs we're doing so it even gets easier.

00:07:41:13 - 00:08:04:11
Kristin Preihs
And I think what you're describing also really lends into the broader environment you've all built around creating a culture of continuous improvement. That you identify something, you try it, you iterate, you learn what happened, and you continue the cycle from there. And we all certainly felt that while we were on site that folks were interested able, based on data to try new things and to identify different solutions.

00:08:04:14 - 00:08:21:12
Kristin Preihs
Can you also talk about, again, based on your size, how that culture of continuous improvement, in addition to identifying and making improvements across dashboards, really went to the culture that is very evident at CommonSpirit of continuous quality improvement and using data to inform improvements for culture.

00:08:21:15 - 00:08:45:00
Thomas McGinn, M.D., MPH
One good example that pops to mind is the RPA process that we have on screening for cancer. And this again, same process, same technology, same KPIs. A group in the Pacific Northwest. We have five regions. We're looking at the big three cancers: breast, colon and lung cancer screening and how constant changes were happening in the screening guidelines.

00:08:45:05 - 00:09:12:19
Thomas McGinn, M.D., MPH
So some were age, genetics, family history, all these things were changing. And a busy, you know, primary care provider was having a hard time. These bots actually scrub the charts pre-visit and look for the different risk factors and hand up to the primary care provider. Would you like to send this screening colonoscopy, this mammogram? And we just saw a huge lift in our calling, particularly in colonoscopy which is one of the more difficult areas to kind of break into.

00:09:12:21 - 00:09:34:01
Thomas McGinn, M.D., MPH
So we got together and we decided, okay, this is best practice. How do we now take that from...actually, it was an Epic environment to a Cerner environment to other environments. And now we're rolling that out across the entire health system and that just gets all of our people so excited, right? Because we're sharing best practices, we're learning from each other and we're saving lives, you know, in a real, real, concrete, measurable way.

00:09:34:04 - 00:09:44:09
Thomas McGinn, M.D., MPH
And once you get a win like that, the next one is like, okay, let's do it again. The hard work of data normalization, technology shifts, people kind of push through those things and get excited.

00:09:44:12 - 00:10:02:02
Kristin Preihs
Certainly agree. And it's such a good example for the field to learn from. Technically process and people where to start and how to continue to scale up your quality management system from there. Your organization is so incredible, and I think there's so many facets that the realm of quality can learn from in the field.

00:10:02:03 - 00:10:19:07
Kristin Preihs
And as you went through the site visit, as you mentioned, and prepared for the Quest for Quality award, I'd love to hear from you advice you have for future leaders in the field, future organizations, as they consider or are just beginning their own quest towards excellence on what you might recommend as they continue that journey.

00:10:19:09 - 00:10:44:23
Thomas McGinn, M.D., MPH
I would strongly encourage, no matter where you are in your journey, to think about participating in this process, because I think the process onto itself is a learning curve for everybody. And it enables you to get feedback from AHA and from other experts around the country. And actually some of the feedback is like, honestly, some of our feedback, I was like, wow, I don't know, were that good, which is really nice to have, right?

00:10:44:23 - 00:11:02:02
Thomas McGinn, M.D., MPH
Someone said, you know, you're pretty good. And we're like, oh, I didn't know we were that good. And obviously then you get feedback on where you could you can make some improvements and some changes. And I think that process is invaluable. Because how often do you get an objective. And what's the downside of participating? It's very little,

00:11:02:02 - 00:11:11:19
Thomas McGinn, M.D., MPH
right? It's not like a rating agency or you know, it's not US news, but it's really looking at you and trying to trying to help you get better and smarter.

00:11:11:21 - 00:11:42:18
Kristin Preihs
Thank you so much, Tom. It's been fantastic having you and hearing your perspective on leading quality and safety, and certainly on innovation at CommonSpirit. The work you and your teams are doing from improving patient safety outcomes to implementing system wide solutions is nothing short of remarkable. Truly, it's been energizing to hear how from leadership to technology to data to continuous quality improvement, you all are a good point to reference as excellence and for others to pick up the phone and learn a little bit more.

00:11:42:20 - 00:12:01:04
Kristin Preihs
And if the quest for quality prize is on your radar, check out the AHA website or the show notes to learn how your organization could be recognized for its impact. On behalf of AHA, I just want to say thank you for taking the time on this podcast. Thank you for applying for and being awarded the Quest for Quality as a runner up, and we can't wait to hear more from you in the future.

00:12:01:06 - 00:12:18:23
Thomas McGinn, M.D., MPH
Again, I want to thank you for, you know, letting me have the opportunity to talk about my amazing team and all the frontline workers, our nurses, all the staff across all of CommonSpirit, you know, hats off to them for jumping on board and really tackling this as one CommonSpirit, as one big health system.

00:12:18:26 - 00:12:27:06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:00 - 00:00:13:14
Tom Haederle
Welcome to Advancing Health. Coming up on today's episode, a look at the immense value that peer support specialists provide in many health care settings.

00:00:13:16 - 00:00:39:16
Rebecca Chickey
I'm Rebecca Chickey, the vice president of Behavioral Health and Trustee Services at the American Hospital Association, and it is my honor today to be joined by Zelia Baugh, the senior vice president of behavioral health at JPS Health Network, and Melanie Cooper, a peer support specialist at JPS Health Network. We are going to speak today about the incredible value and role of peer support specialists.

00:00:39:18 - 00:00:56:13
Rebecca Chickey
And so, Zelia, I'm going to turn to you first. I want the listeners to have an understanding of what JPS Health is. What's your footprint? What type of organization hospital health system are you? Give them a little bit of background so they'll have some context.

00:00:56:15 - 00:01:30:18
Zelia Baugh
Thank you Rebecca, and we appreciate you having this on this podcast to share the great works that peer support specialists do for us. JPS Health Network is a safety net hospital located in Fort Worth, Texas. And we are in Tarrant County, which is one of the fastest growing counties in the country. We are a Level One trauma center, a Level Four maternal care center, and we have a large community health presence as well as large residency programs.

00:01:30:18 - 00:01:36:08
Zelia Baugh
We are a learning institution. And then we have a very large behavioral health division.

00:01:36:10 - 00:01:57:01
Rebecca Chickey
So JPS Health, as you and I have talked about, has made a strategic investment in hiring peer support specialists. For the listeners, can you first of all tell them what a peer support specialist is, you know, from the broad perspective, and then also, what was your plan and actually why you went down this journey.

00:01:57:01 - 00:02:01:12
Rebecca Chickey
And then we'll hear from Melanie, who's going to bring all of that to life.

00:02:01:15 - 00:02:33:09
Zelia Baugh
Absolutely. So in JPS we do employ peer support specialist. We, have 14 peer support specialists here in behavioral health. And a peer support specialist is a person that has lived experience with either mental illness or substance use disorders or both. And we utilize our peer support specialists in all areas of our division. So we have peer support specialists in our inpatient psych units.

00:02:33:11 - 00:03:09:12
Zelia Baugh
We have peer support specialists in our outpatient clinics. And we have peer support specialists in our psychiatric emergency center. And they provide different functions in each area. They do groups. They do individuals. They meet with all new patients that are admitted to our inpatient units to help answer their questions about what's going on. The group routines, the unit routines, also to get to know the patients so that they can help them navigate once they are discharged from our inpatient program.

00:03:09:15 - 00:03:39:04
Zelia Baugh
They also provide navigation for resources out in the community beyond what JPS has to offer. They help our patients get access to social determinants of health like housing, food, medicine, transportation. All those typical barriers are patients face in trying to get help. They help direct our patients towards those resources to be able to be successful once they discharge.

00:03:39:06 - 00:04:12:26
Zelia Baugh
They also are a huge part of our transition coordinator program. And that program is where we have licensed, as well as peer support specialists contacting all patients discharged from our psych emergency center and our inpatient program in order to help them navigate once they're out in the community and help get them to treatment. So if they have an outpatient appointment with us or someone else and they don't have a RA, we will help get them a RA if they can't pay for their medications.

00:04:12:28 - 00:04:42:12
Zelia Baugh
Our peer support specialists are able to set up for them to get a medication voucher, to have their medicines paid for, and if they need help with job force training. Our peer support specialists know how to set them up for that with resources here in our county. And that program, as a result of our peer support specialists and licensed clinicians, is very intensive with specific touch points throughout a six month to a one year time frame with all of those patients.

00:04:42:15 - 00:05:17:20
Zelia Baugh
Last year, our behavioral health inpatient readmission rate was 5.03%. It is primarily due to the wonderful navigation work and touchpoints and supportive services once our patients leave the inpatient setting. Because the one thing our peer support specialists do with our patients that just I love, the first thing they see is hope when they come in because there's someone right in front of them with lived experience that's in recovery now, and they're helping people.

00:05:17:22 - 00:05:41:18
Rebecca Chickey
That is just such a breadth and depth of offerings that the peer support specialists can do. And so I'm wondering, does the state of Texas, I realize you're in Texas and probably they're 50 different flavors of what peer support specialists are required to do in terms of training, in terms of certification. But what are the specifics for the state of Texas in terms of certification

00:05:41:18 - 00:05:46:22
Rebecca Chickey
and what does JPS look for when you're hiring a peer support specialist?

00:05:46:24 - 00:06:26:28
Zelia Baugh
So the state of Texas has a certified, peer support recovery certification. We love to hire folks that are already certified as a peer support specialist, but if they don't have that certification, we help pay for their training to end to get to that certification. And what we look for in a peer support specialist is someone that has a track record of their recovery, so to speak, and someone that has a great personality. Because you can teach the task to anybody, but you can't teach the people stuff.

00:06:27:00 - 00:06:42:00
Zelia Baugh
The people stuff, really in the personality and attitude is the first thing we look for. And the second thing is their depth of recovery. And the third thing would be certification. And if they don't have it, we get it for them.

00:06:42:02 - 00:07:06:12
Rebecca Chickey
Well, since I had the honor of meeting Melanie before we started recording this podcast, that's a nice transition because she definitely has the heart and the personality. So Melanie, I'm going to turn to you now. Zelia mentioned some of the tasks and the work that you do, which is quite broad. Just kind of describe the life of a peer support specialist as you've lived it at JPS.

00:07:06:14 - 00:07:30:19
Melanie Cooper
Sure. Thank you, Rebecca, and thank you, Zelia for the wonderful introduction. So life as a peer support specialist - we stay pretty busy here. We have as Zelia mentioned, four of our inpatient units, as well as our local commitment alternative unit, which is our long term. They have state beds. We have peer support specialists on every unit.

00:07:30:24 - 00:07:51:24
Melanie Cooper
There's sometimes there's two of us. It just kind of depends on the units. We meet the patients where they're at. So we have what's called an interdisciplinary interview. And we go in and we find out not necessarily what may be brought them here, but challenges they have. What barriers do they have? What are their goals? Learning about them

00:07:51:24 - 00:08:23:06
Melanie Cooper
as a person that they are. Who they are, what they love to do. And we also help with the risk of readmission. Like Zelia also stated, we also do a readmission survey. And this is when a patient comes in within 30 days or less of their last inpatient stay here at JPS. And we find out, you know, what's something differently that they like to work on? How can they stay out of the hospital? Making sure they have those wellness tools, setting up that crisis planning.

00:08:23:08 - 00:08:51:02
Melanie Cooper
You know, it's basically what they want in their own recovery. We also share our recovery stories. We have peer support specialists in our wonderful psychiatric emergency center here at JPS. And I love we share our stories there. We share our stories on all the inpatient units, and we rotate so all the patients get to hear our wonderful recovery stories, how we walk a life in wellness, what we do to stay well.

00:08:51:09 - 00:09:19:03
Melanie Cooper
Challenges. Barriers. Things that we're still going through because we know recovery is ongoing. It's a journey. It's something that you just don't get to forget about one day. It's something that you have to work on every single day is working on that self. In our psychiatric emergency center, we have peer support specialists that work with the discharges. Those are the discharges that are going home as well as discharges that may be coming to our inpatient unit.

00:09:19:06 - 00:09:41:09
Melanie Cooper
With that being said, the discharges going home, we make sure they're equipped with those resources, those things like Zelia mentioned in the community, making sure if they're discharging to a shelter, making sure, you know, they have, a ride for that, making sure there's some sort of warm handoff for that, making sure they have a safe discharge plan, a place to go. For those coming inpatient,

00:09:41:09 - 00:10:00:12
Melanie Cooper
we talk a little bit about the experience of what to expect next. What's it going to be like? We talked a little bit about their treatment team. They're going to have a peer support specialist. They're going to have a social worker assigned to them. They're going to have groups during the day. We do lead the groups on the inpatient units as well.

00:10:00:12 - 00:10:25:12
Melanie Cooper
They're all recovery focused, recovery driven. And that's what I love about it. And this gives patients the idea of maybe to try some own ideas of what they might want to do for their own wellness, their own recovery. We also meet with the discharges, people that come in to the hospital right before they discharge. We usually meet with them 24 to 40 hours prior to their discharge date.

00:10:25:18 - 00:10:48:02
Melanie Cooper
We make sure we're working. We're collaborating with the social worker, the doctor, making sure they have all the tools they need in their wellness toolbox to make sure they're well equipped to go home, making sure they have that crisis planning set. Not only our contact numbers, but our 988 numbers, 911, making sure they know they can come back to the psychiatric emergency center.

00:10:48:02 - 00:11:13:10
Melanie Cooper
This is what we're here for. So we do as well treatment team. So this is where we collectively work as a team. This is where the peer support specialist is involved. The social worker, the doctor, the residents, the psychiatrist, the nurse, and of course, their lovely peer support specialists. And we meet with them to basically find out how they feel like they're progressing in treatment.

00:11:13:13 - 00:11:43:09
Melanie Cooper
If there's any type of medication management, you know, how are the medications working for you if they're taking medications. Because everybody's journey is different. We don't push recovery on anyone. It's what they want. We don't talk about you should take medications. It's what works best for you because we believe that person individually knows what's best for them. We also help build that bridge where there's sometimes that gap between the social worker and the doctor and the nurse.

00:11:43:09 - 00:11:50:22
Melanie Cooper
So we are constantly rebuilding that and making sure we're all meeting at that one place, and that's meeting the patient's needs.

00:11:50:24 - 00:12:10:25
Rebecca Chickey
You just summarized what was in my head. Sometimes I think organizations are concerned that if they bring peer support specialists on, it may compete with some of the work the existing staff have. And you said the word more than once, and that is collaboration. And another way to say collaboration is we work in a team.

00:12:10:27 - 00:12:34:01
Rebecca Chickey
Thank you. Melanie, first of all, for the work that you do and the joy and the hope that you bring to individuals lives. Zelia, I'm going to ask you for the people that are listening, that are on the fence, that are thinking about, should we go on this journey to hire a peer support specialist or at least begin looking into is that right for our organization?

00:12:34:04 - 00:12:39:03
Rebecca Chickey
What sort of call to action would you have or what guidance would you provide them?

00:12:39:05 - 00:13:02:00
Zelia Baugh
Every institution needs to look at meeting your patients where they are. And whether you have behavioral health in your health system or not, you can still utilize peer support specialists in your medical emergency center. You can utilize them in your case management office and doing follow up phone calls and navigation for those patients that are going to come to your health system.

00:13:02:03 - 00:13:36:22
Zelia Baugh
You may not have behavioral health officially in your health system, but you have behavioral health patients in your health system. And many times, those are the patients that are coming back in less than 30 days. And what can be done to try to stop that revolving door, to give a patient the best chance for recovery? Peer support specialists are an untapped resource that I think is well overdue in all hospital settings, whether it's somebody that is a cancer survivor, heart attack survivor or whatever.

00:13:36:25 - 00:13:43:25
Zelia Baugh
These people have life experience and hope to share to help people where they are.

00:13:43:27 - 00:14:11:14
Rebecca Chickey
That's beautiful, inspirational, and I hope just by listening to this podcast, it will become actionable for our hospitals and health systems. So thanks to both of you today, again for the work you do day in, day out at JPS. And thank you so much for your willingness to, share your time and expertise with us and inspire others and also teach others about this valuable role on the behavioral health team.

00:14:11:16 - 00:14:13:03
Zelia Baugh
Thank you for having us.

00:14:13:06 - 00:14:14:17
Melanie Cooper
Thank you.

00:14:14:20 - 00:14:23:00
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.