Advancing Health Podcast

Advancing Health is the American Hospital Association’s podcast series. Podcasts will feature conversations with hospital and health system leaders on a variety of issues that impact patients and communities. Look for new episodes directly from your mobile device wherever you get your podcasts. You can also listen to the podcasts directly by clicking below.

Latest Podcasts

The number of adults age 65 or older will reach about 95 million in the United States by the year 2060. Hospital emergency departments will need to showcase their flexibility by adapting models of care to address the unique care needs of older adults. In this conversation, Julie Dye, clinical nurse specialist in geriatrics at Sharp Grossmont Hospital, discusses the benefits of participating in the Geriatric Emergency Department Accreditation program and the Age-Friendly Health Systems initiative. She describes how Sharp Grossmont blends case worker skills and clinical expertise to identify gaps in care for older adult patients. For more information on Age-Friendly Health Systems, visit AHA.org/agefriendly.


View Transcript
 

00;00;00;21 - 00;00;24;12
Tom Haederle
The population of older adults will exceed 95 million in the United States by the year 2060. As Americans age, our emergency departments need to adapt their models of care to address the unique needs of older adults.

00;00;24;14 - 00;00;55;01
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Age Friendly Health Systems, an initiative of the John Hartford Foundation and Institute for Health Care Improvement, in partnership with the Age and the Catholic Health Association of the United States, is a movement that aims to enhance care for all older adults by implementing the 4Ms framework that's focused on what matters to the patient, their medications, mentation and mobility.

00;00;55;04 - 00;01;23;10
Tom Haederle
Julie Dye clinical nurse specialist in geriatrics at Sharp Grossmont Hospital, shares the benefits of participating in the age friendly health systems and geriatric emergency department accreditation programs to identify gaps in care that improve the experience for patients 65 and older and their caregivers. Sharp Grossmont’s supportive leadership team provided the emergency department with the staff and resources to treat the whole person, by blending case worker skills and clinical expertise.

00;01;23;13 - 00;01;39;25
Tom Haederle
In this conversation with Marie Cleary-Fishman, vice president of Clinical Quality at AHA, Julie discusses staff buy-in asking "what matters" to patients and leveraging trusted community partnerships to better serve the population of older adults in the San Diego area.

00;01;39;27 - 00;02;00;29
Marie Cleary-Fishman
While Julie, thank you for joining us today. This is really exciting. As so many people know, age friendly is near and dear to my heart and I'm hopeful that by the time I need to show up in someone's emergency department that all the emergency departments are geriatric emergency departments and our hospitals are age-friendly. So that's a great goal for everyone.

00;02;01;01 - 00;02;19;00
Marie Cleary-Fishman
So maybe could you start a little bit by giving us an overview of how your journey started with age-friendly and where you sort of picked the geriatric emergency department to start with and just give a little overview and then we can dive into some of the more specific areas for our audience.

00;02;19;03 - 00;02;40;25
Julie Dye
Absolutely. I'm really lucky. Our administration is very forward thinking and they oddly brought it to us. In 2019 at the end of the year, they said there's this geriatric accreditation for the emergency departments we should look at. And so we started looking at parts and pieces and thought, well, we're already doing all these things, I don't know that we need it.

00;02;40;27 - 00;03;06;16
Julie Dye
But then once we did a deeper dive and getting our clinical informatics team on board right away, we were like, this is definitely not happening the way I think people thought it was happening or the way it was envisioned. We started realizing there were large gaps in care and that was right before COVID. So we had actually started toward our geriatric accreditation and then of course, COVID hit.

00;03;06;18 - 00;03;36;00
Julie Dye
So again, I think we're I just am so appreciative to our leadership. Most places, understandably stop projects because of COVID. You know, everybody was really short on resources, so you know, we really had a difficult time during COVID, but our administration said, no, we need to keep pushing forward and actually go for gold because this is the heaviest hit population and the caregivers are often also older adults and really need, you know, a ton of support.

00;03;36;00 - 00;03;56;10
Julie Dye
So where we had recognized gaps before, that might have been cracks during COVID, it suddenly was just, you know, these Grand Canyon size gaps in care and issues. So we started to go for our gold in 2020. It was funny, the team started off pretty small where we were like, okay, well, we need a pharmacist and maybe a social worker.

00;03;56;10 - 00;04;16;19
Julie Dye
And then it became what we need these guys and therapies and we need these nurse navigators. And it's now grown to this just enormous team of people to make this go. So it's really been a fantastic journey. And then we had discovered the age friendly initiative through the American College for Emergency Physicians and thought, gosh, that adds another layer.

00;04;16;19 - 00;04;43;18
Julie Dye
We're already doing the medications, the mentation and mobility. But we were interested in the "what matters" piece. It's such an important thing that doesn't tend to get addressed in the emergency department. You know, we're pretty pragmatic that way. You come in, you're here for your broken toe or you're here for your heart attack, and we're here to fix those things and really trying to marry that that social and psychologic and that whole person with that medical complaint make sure that we're doing all those things.

00;04;43;18 - 00;05;05;00
Julie Dye
And so we really discovered some interesting things through going through the age friendly journey and adding that extra layer that ended up being really important and again allowed us many actionable items and allowed us to involve other teams. And so it's really been a wonderful marriage of all these different interdisciplinary teams, and it's been fun to see how it's grown out now into the community as well.

00;05;05;02 - 00;05;12;16
Marie Cleary-Fishman
Well, you have just touched on so many key, important things. I feel like we could be here for a long time going through them all.

00;05;12;18 - 00;05;13;00
Julie Dye
Legitimately.

00;05;13;00 - 00;05;32;17
Marie Cleary-Fishman
And and one of them, I just want to pause and say, because I know as time goes on, maybe we don't hear this as often, but thank you so much to your team and everyone at Sharpe Grossman who worked so diligently for all of our patients during COVID, and especially for those geriatric patients, because it was particularly difficult for them.

00;05;32;20 - 00;05;54;07
Marie Cleary-Fishman
And I love the fact that you hit on the "what matters," because so many people were separated from their caregivers or separated from their families, and it made it really difficult. Could we pause on the "what matters" for just a few minutes and maybe for our audience? You could just just describe "what matters" a little bit more a little bit more depth for the audience.

00;05;54;07 - 00;06;00;12
Marie Cleary-Fishman
And then I just want to talk a little bit more about it. But if you could start with a description, that would be great.

00;06;00;14 - 00;06;32;17
Julie Dye
Absolutely. So we ended up choosing "what matters" in life and what matters. This visit, we always have to marry it a little bit with what are we going to do with the information and how can we make it comfortable for the patient. That was a big lesson we learned is sure, they're a little off put sometimes by the questioning, and so we had to learn how to script it such that we're earning trust, that we're, you know, explaining what are we going to do with this information, you know, once we get those things asked.

00;06;32;19 - 00;07;01;01
Julie Dye
So we chose those two questions to give us a really good idea of, you know, where are you at in life? When was a good day for you? What does that look like? What are your goals? Those really big questions. And then what really matters to you this visit and how can we marry those two questions? And so oddly, that ended up being a big part of our program because it forced us to start at the beginning of the visit with "are we even having the right conversations as far as what care looks like?"

00;07;01;02 - 00;07;22;28
Julie Dye
And in some cases we discovered, you know, we've had patients who've said, I just want to be done. Yeah, I'm not eating because I don't want to go to the doctor anymore. I'm tired of suffering with these symptoms and things. We were able to loop in teams more toward that end versus, you know, let's go to cath lab or let's go to surgery or let's go here.

00;07;23;03 - 00;07;45;01
Julie Dye
Being able to do a better assessment of what their goals are and marry those things. And in some cases that looks more like, you know, depression from needing social support. I'm losing my house, I can't pay my bills, things like that. So then we're able to say, okay, well, yeah, let's fix your medical issue today, but let's also get these other things in to make life easier, help you be independent longer.

00;07;45;03 - 00;08;07;07
Julie Dye
So asking those questions has been a huge part of the program that we really weren't anticipating would be as important as it is. It's also given us actionable information where we've been able to create community partnerships. So for instance, what matters in life is often people's animals. And for these people, sometimes those animals are legitimately children for them.

00;08;07;10 - 00;08;25;26
Julie Dye
So we were finding that patients with AMA from the emergency department and from the hospital because they were worried no one would be there to take care of their pets. And so we were able to partner with the Humane Society and say, you know, if you can provide us emergency animal services, we can encourage these people to stay and get appropriate treatment.

00;08;25;26 - 00;08;47;00
Julie Dye
So it really did have actionable outcomes for us and really helped us understand the right teams and the right resources to involve, you know, early on in the visit, help get the provider on board. This is what the patient really wants. These are the conversations we need to be having versus, jumping immediately to how do we fix the medical problem if that makes sense?

00;08;47;03 - 00;09;04;27
Marie Cleary-Fishman
it makes so much sense. And I think the the fact that you worked with out in the community to find a partner that would help, I mean, you know, as an animal lover and someone who's getting older and I think, boy, I better make plans for those animals. But making that connection for people is so important.

00;09;05;03 - 00;09;08;27
Marie Cleary-Fishman
There's a whole other case study there Julie for us to look at.

00;09;09;04 - 00;09;33;13
Julie Dye
Well, and honestly, I'm so lucky. We have the Senior Community Resource Center run by Dan and Natalie and Loraine and they are an amazing community resource because it isn't just a list of, oh, here's a list of numbers where you can get meals. These are all vetted resources. They have personal relationships with people. They can really tell you, you should use Right At Home.

00;09;33;13 - 00;09;55;10
Julie Dye
You should use these following services because we have good relationships with them and we know you're likely to have a good outcome versus, we went to Google and we found that these following people, you know, are helpful with home health and, you know, or helpful with yard work or things like that. We can really tell them, Hey, we feel really good about these resources.

00;09;55;13 - 00;10;01;28
Julie Dye
We can help you, we can call you back and see how you're doing. We're incredibly lucky to have that community resource center here at Sharp.

00;10;02;01 - 00;10;30;09
Marie Cleary-Fishman
That's great. That's so, so amazing. Now, let me ask you a little bit more about that, but I want to take it in another direction, and that is toward the workforce. So as you're talking and you know, my nursing background and I think about being back at the bedside or back in my role in quality and tell me a little bit about how the "what matters" helps with the workforce or if it does, you know, we hear reports and you made the comment about this started before COVID and it kept going.

00;10;30;09 - 00;10;41;10
Marie Cleary-Fishman
It was one of the things we've heard that over and over from folks. This is one of the initiatives that people felt they could keep going with during COVID. Tell me a little bit about what this does for the workforce.

00;10;41;12 - 00;11;07;03
Julie Dye
It's interesting that you should say that. I wasn't sure how they would receive it. Most of my nursing career we've been in a nursing role and social work is in a social work role. So we're we're pretty siloed. And so what I'm loving about this and really what the nursing staff has reported back, especially the nurses that work in this capacity, is they really have enjoyed learning about the case management and social work role.

00;11;07;06 - 00;11;35;25
Julie Dye
What they're starting to realize is if the person can't comply for social reasons, whether those are psychiatric, cognitive, financial, you know, there's so many reasons that people struggle, then they simply can't be compliant with their medical care. And so you'll just continue to see them, you know, come back to the emergency department often in worse shape. And that's been a frustrating thing for nursing, is the patient will come in, we'll do all these great medical things.

00;11;35;25 - 00;11;59;05
Julie Dye
We send them off into the community, they come right back. And it's a simple question. Did you fill your antibiotics? Did you fill your heart failure medication? Well, no. Gosh, I noticed you were here earlier this week for having high blood sugar. Did you know how to use your pens? Well, no. So realizing while we physically have them here and we can see them, they have difficulty seeing, hearing things like that, realizing we need to bring the care to them.

00;11;59;05 - 00;12;14;02
Julie Dye
So if we have them in a gurney here in the emergency department, this is the time to assess for all that whole spectrum of things to make sure they can be successful at discharge. You know, do they have all the things that they need? Do they have the education they need? Do they have a scale? Do they have a blood pressure cuff?

00;12;14;02 - 00;12;34;28
Julie Dye
Do they have the things that they would need to be successful? So I think it took a minute for the nursing staff to start realizing, you know, am I doing a full assessment of this person and then adding that piece in, are we even having the right conversations? Okay, you may have all of this adjuncts, but are you tired of living with heart failure or your symptoms are poorly controlled?

00;12;35;05 - 00;12;55;12
Julie Dye
What really matters to you? Does it matter that you get to go on that trip to Maui? You know, is that more important than spending a night in the hospital on observation just to make sure everything stays stable for the next 24 or 48 hours? Those kinds of things are really important conversations, especially when it comes down to holidays or things like that.

00;12;55;14 - 00;13;21;14
Julie Dye
We started discovering, especially during COVID, where people were very, you know, the hospitals were on lockdown. These people were spending what was quite possibly their last holidays here alone. Maybe that wasn't their goal. Many of these patients would rather be at home, even if that meant an impact to their physical outcome that was more important to them. So asking that question helped us really understand what their goals would be and make sure that we're aligning with that.

00;13;21;17 - 00;13;37;27
Marie Cleary-Fishman
I love that detail in that at the point is so, so important. You know, what do you want to spend your last time doing? And is it sitting in a hospital? Is it sitting right? Where is it? What do you want to do? I mean, if we all thought about that on a personal level and then applied it, my dad's 92.

00;13;37;27 - 00;13;56;17
Marie Cleary-Fishman
We live he lives with us. And I certainly know it's not in a hospital, even though, you know, he loves the fact that I'm a nurse, but it's not where he wants to spend his time. So that's a really important thing and that's important for the workforce. And I love the fact that that message has gotten through. You have a GEM nurse?

00;13;56;19 - 00;13;57;06
Julie Dye
Correct.

00;13;57;11 - 00;14;06;09
Marie Cleary-Fishman
Can can you talk a little bit about that role for people so that we have an understanding of what that is and what are some of the things that position does?

00;14;06;11 - 00;14;33;28
Julie Dye
That role is a game changer, honestly. So it's geriatric emergency medicine and we actually recruited from our staff. So what we wanted was people who were passionate about marrying again, that case management, social work side with the nursing side and really being essentially a hub or a nurse navigator. So we recruited from the staff. We had a whole list of interview questions and things we really wanted to get to the bottom of.

00;14;34;01 - 00;14;53;14
Julie Dye
What did they hope to accomplish with the role? What did they want to learn from the role? Most of the people who applied had been a caregiver in some form or fashion and realized how impossibly hard it is to be a caregiver and the amount of caregiver strain. Right. And that's often what brings people to the emergency department is they are unpaid, untrained.

00;14;53;16 - 00;15;14;24
Julie Dye
San Diego is one of the most expensive cities in the union. Everyone is struggling so much, but you don't know what you don't know. And so you just keep struggling at home until you're finally like, I can't do it another second. And then you come to it ED and you're suddenly tapped out. So we really wanted to grab nurses who understood what that's like for caregivers.

00;15;14;26 - 00;15;35;14
Julie Dye
Some people have chronic illnesses themselves and know how much of a strain that is to manage things like diabetes or, you know, where it's just a constant daily battle to stay healthy yourself. So it was really a great thing to have these guys on board who were excited about the work, really wanted to learn how to marry those two things.

00;15;35;17 - 00;15;45;29
Julie Dye
And again, I can't say enough great things about our leadership. So they gave us a full time equivalent for this role, seven days a week. It's really remarkable.

00;15;46;02 - 00;15;46;29
Marie Cleary-Fishman
That's amazing.

00;15;46;29 - 00;16;04;28
Julie Dye
And it's a game changer. Honestly. Initially the providers weren't sure what to make of it. Like, who's this person talking to me about these things? And the nursing staff will get frustrated if there's not a GEM there where they can use them as a resource. So that's been a lovely thing to have, you know, evolved out of this.

00;16;05;01 - 00;16;29;02
Julie Dye
But they have their own workstation. We do a lot of work through Microsoft teams, which is nice because we can have living documents there that people can update. So we actually have a live link with our community Resource Center. Again, essentially when somebody checks into the emergency department, every nurse here does a quick functional assessment called the Ihsaa or identification of Seniors at Risk assessment.

00;16;29;05 - 00;16;51;13
Julie Dye
This helps us understand because 65 is pretty young, a lot of 65 year olds are very functional, healthy, working, golfing. We want to make sure that we're targeting resources to people that are really starting to struggle, and sometimes that's just not obvious. So we do that. These guys look for people who've been here within 30 days, chief complaints that are concerning, things like that.

00;16;51;15 - 00;17;12;20
Julie Dye
So they go out and perform a comprehensive geriatric assessment that has many parts and pieces that you're aware of, and they take the information from those things and then start calling these interdisciplinary teams. So that might be our ED case manager, that might be therapies where it's like, gosh, this was just a simple trip and fall. They look really good, their x rays are negative.

00;17;12;20 - 00;17;31;05
Julie Dye
Could we send them home with durable medical equipment versus admitting them for OBS? You know, in some cases that's like, gosh, we've noticed you've been here for DKA, you know, twice this month. Let's have the diabetes educator come see you or let's have dietary come see you and see if we can close some of those gaps. Maybe you need home health.

00;17;31;05 - 00;17;49;01
Julie Dye
We've done some partnerships that way that have been really exciting. So these guys are very much in a hub nurse navigator position of, gosh, this person's been here for heart failure several times. Maybe the heart failure clinic would be the right bridge to cardiology for these guys. And so they'll take that whole assessment, go back to the provider.

00;17;49;04 - 00;18;08;02
Julie Dye
These are the things we've found. I feel really comfortable with them going home with resources or gosh, this person's just not safe at home. We really do need to admit and figure out what's next. So that navigator position is irreplaceable. That's great. And the last thing they do is they call the patients back after discharge and check on them, which has been a lovely adjunct.

00;18;08;02 - 00;18;16;05
Julie Dye
It's the patients love getting called and it allows us to identify gaps out in the community before it becomes a crisis where they have to come right back in.

00;18;16;08 - 00;18;36;24
Marie Cleary-Fishman
Somebody is there to check in on them. That's awesome. That's really love it. I love hearing about that position. So I know we get close on time and I really want us to be able to talk for for a longer time. One thing I want to talk about is dissemination and spread through an organization. So let's let's circle down to that area.

00;18;36;24 - 00;19;01;00
Marie Cleary-Fishman
And I'd like to hear a little bit about your experience and what you think is key to have in position when an organization wants to look at spreading this, spreading age friendly, doing they're Geriatric ED. Give me a little bit of your sense and experience. And what do you think leads to success in an organization that wants to spread?

00;19;01;03 - 00;19;27;21
Julie Dye
I think honestly, it really is resource heavy, but it does come back and help you via improved care, patient SAT, things like that. We have so much throughput pressure in the emergency department, so many issues with boarding and certainly that affects geriatrics the heaviest. Boarding is just so bad for them. So it is really nice to have separate resources where this is their only job.

00;19;27;21 - 00;19;46;10
Julie Dye
They can go in, do a quick assessment, handoff to somebody else to be able to fill those gaps. We did try initially with the geriatric emergency nurse to do everything themselves. So they would do the full med rec, call you know, Sureccripts, call the pharmacy, call the family, do all these different things, try to call the physician.

00;19;46;12 - 00;20;15;25
Julie Dye
And they were seeing, you know, two patients, the whole shift. They're just very complicated patients. So investing those resources is scary for organizations, understandably, and everybody is hurting. But it really does help provide that total picture. You have the experts working on each of their parts and pieces, so you feel really good about that discharge. You know, if it's something where we're on the fence, we know physical therapy has done the exact same evaluation they would do inpatient.

00;20;15;25 - 00;20;33;06
Julie Dye
So we feel really good about, hey, this person could have a modified walk or go home or we can hook them up with home health. We have some great partnerships and we know they'll get seen right away. And so some of those things helps everybody feel better about the plan of care, including the patients, we're respecting what they want.

00;20;33;06 - 00;20;52;23
Julie Dye
If they're saying, Gosh, this is how I always look when I walk, I have Parkinson's. I'm not going to look like I walked when I was 20. But I feel comfortable going home. We feel comfortable supporting their goals. So that part, I think is really important, is having that administrative support and that willingness to put that resource behind this program.

00;20;52;26 - 00;20;58;02
Julie Dye
But it really does pay off in spades later on, if that makes sense.

00;20;58;05 - 00;21;16;28
Marie Cleary-Fishman
That does make sense. It really does. And I'm going to circle back and I think we'll you know, kind of bring things to a close on this topic because you've said it several times and that is the support and the involvement of your leadership. And it just sounds like that's an amazing kind of thing. And can you define leadership for you?

00;21;16;28 - 00;21;37;05
Marie Cleary-Fishman
When you say your leadership, can you tell me a little bit about what that means to you? Does it does it go all the way up the C-suite? Does it involve the board? Can you give us a little bit of a sense of what leadership means? Because I think it's so different for everybody. And I also think that the model of how leadership gets involved can be so different.

00;21;37;05 - 00;21;39;25
Marie Cleary-Fishman
So give me a little bit of info about that.

00;21;39;27 - 00;22;03;29
Julie Dye
Completely agree. So we're really lucky. Our CNO and really our CEO are really the ones who wanted to spearhead this in the first place, based on their knowledge and their past experiences and knowing that this large volume of people was expected to come. They have a lot of forethought to realize this is the growing population and this is where the need is at.

00;22;04;01 - 00;22;32;05
Julie Dye
So it was really easy to support their vision as well. To your point, though, we have an interesting situation at Grossmont. We're a public-private partnership. So we are partnered with this foundation that is amazing as well. They really want to help support us. We do report outs to them. They support us with funds, in some cases. They they're very supportive of our work too, and they're very invested in what do we bring to the community.

00;22;32;07 - 00;22;59;25
Julie Dye
So they want to see us out there providing free classes, our community Resource Center here at Sharp Grossmont provides free classes for caregivers on how to do caregiver mechanics, how to support them psychologically, because being a caregiver is just so psychologically heavy. All those types of things have been supported by our leadership. They've given us that FTE, they've given us money, they've helped us improve the environment of care.

00;22;59;25 - 00;23;21;29
Julie Dye
They've allowed us to repaint, add dimmer switches, add different equipment, they've allowed us to hold classes, we hold community clinics and get togethers for free. Those things are all supported by our foundation, the board, our C-suite level. I mean, we are on a first name basis with these people. They've always had an open door policy with us if we're concerned about something.

00;23;22;01 - 00;23;42;03
Julie Dye
And I think that part is irreplaceable as well. They're it's very much they're very close to us, in other words, versus, you know, being somebody who sits in an office across town and I wouldn't be able to pick them out of a lineup. We're really have a close partnership, which I think is irreplaceable, and that helps support our local ED leadership as well.

00;23;42;03 - 00;24;06;17
Julie Dye
Our directors have been amazing. They are very responsive to anything that we need. Our ED manager is amazing. So we really have a ton of support for the program and I just honestly don't think we could do it without that, especially knowing how strongly, how much pressure they have to address throughput and make sure all of their other metrics are being met.

00;24;06;19 - 00;24;12;04
Julie Dye
The fact that they're still have so much support for us is just amazing and irreplaceable, frankly.

00;24;12;06 - 00;24;33;28
Marie Cleary-Fishman
Well, that's a great message, Julie, and I think that's a great place for us to end our conversation today, even though I'd love to keep going. We'll go get have more conversations at another time. But congratulations to your leadership as well as to your Frontline team and everyone in between on achieving the successes in age friendly health care and that you have at Sharp Grossmont.

00;24;33;28 - 00;24;44;01
Marie Cleary-Fishman
And for working with us and for being willing to share this message and this story across the nation, we're very grateful for you. And thank you so much.

00;24;44;04 - 00;24;52;16
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.

Employee vacancies have hit the health care field hard, making it difficult to consistently provide the high-quality care communities expect from their hospitals and health systems. Dartmouth Health faced this problem head-on, establishing a robust set of apprenticeships and career pathway training programs to ensure their workforce is being professionally developed, and most importantly, retained. In this conversation, Carolyn Isabelle, director of workforce development at Dartmouth Health, discusses the health system's numerous approaches to recruitment, and the successful strategies that support a healthy and engaged workforce.



 

 

View Transcript
 

00:00:00:26 - 00:00:40:11
Tom Haederle
We often focus on physician and nursing vacancies when discussing the shortages in the health care workforce. But Dartmouth Health recognizes that providing high quality care to their patients comes from developing both a clinical and a non-clinical workforce. As New Hampshire's largest private employer, serving nearly 2 million patients across New England through a network of hospitals and services, Dartmouth Health has established a robust set of apprenticeships and career pathway training programs to ensure a dedicated workforce now and for the future.

00:00:40:14 - 00:01:08:15
Tom Haederle
Welcome to Advancing Health, the podcast brought to you by the American Hospital Association. I'm Tom Haederle with AHA Communications. In today's episode, Elisa Arespacochaga, AHA’s vice president of Clinical Affairs and Workforce, sits down with Carolyn Isabelle, director of workforce development at Dartmouth Health, to discuss its approach to recruiting and retaining both for clinical and non-clinical roles within its workforce, making sure that patient and community needs are met.

00:01:08:17 - 00:01:35:17
Elisa Arespacochaga
Thanks, Tom. I'm Elisa Arespacochaga, vice president of Clinical Affairs and Workforce at the AHA, and today I'm really excited to be joined by Carolyn Isabelle, director of Workforce Development at Dartmouth Health. Today, we're really going to talk about how Dartmouth Health develops not only their current team members, but starts bringing in new team members in both clinical and non-clinical roles and enhances their experience to keep them in the organization and really help them grow professionally.

00:01:35:20 - 00:01:40:23
Elisa Arespacochaga
So, Carolyn thank you. And to get started, tell me a little bit about yourself and Dartmouth Health.

00:01:40:25 - 00:02:04:26
Carolyn Isabelle
It's wonderful to be here with you today. As you mentioned, I'm Carolyn Isabelle and I lead the workforce development function for the health system. And Dartmouth Health is a system of community hospitals, clinics and health care services across New Hampshire and Vermont. And our main academic medical center is located in Lebanon, New Hampshire. We are the state's largest employer with just over 14,000 employees.

00:02:04:28 - 00:02:27:25
Carolyn Isabelle
And I think one thing that really sets our system apart is that we are located in a really rural part of our state. So the majority of our workforce actually is coming between 30 and 60 minutes each day. We also don't necessarily have a large local talent pool to be able to draw on as we look to staff and recruit for our facilities.

00:02:27:27 - 00:02:55:04
Elisa Arespacochaga
You definitely have some additional challenges. I know when I've spoken to you in the past, you have a number of different training programs, career pathways within your organizations, both to bring in those new team members, but also to take the team members you have currently and continue to grow them throughout their career so that once, you know, you're sort of in the door at Dartmouth Health, you'll do everything you can to support those team members to retire from Dartmouth Health.

00:02:55:06 - 00:02:59:01
Elisa Arespacochaga
Can you share just a quick overview of some of those programs you have in place?

00:02:59:03 - 00:03:25:20
Carolyn Isabelle
Definitely. This is very near and dear to my heart. I've actually been a part of our workforce development team for just about ten years now, and a big part of our work has been operating The Dartmouth health workforce Readiness Institute. And this is an internally run licensed career school where we provide training programs for people looking to start or continue their career in health care. Through the career school

00:03:25:21 - 00:04:05:18
Carolyn Isabelle
we offer six different training programs and they're all structured a little bit different based on the profession. But we offer training for medical assistance, pharmacy technicians, surgical technologists, licensed nurse assistants, ophthalmic assistants and phlebotomist. Within those programs, three of those are actually registered apprenticeship tracks. So that's where you are doing some of the the course or the skill building and then you're learning on the job in the year that follows. In addition to some of the training programs that we offer through the Workforce Readiness Institute, we also have a number of training programs that allow people to advance their career.

00:04:05:19 - 00:04:34:11
Carolyn Isabelle
This could be a second step, but where we partner with an academic institution for a more specialized allied health technician role and the doctor content or the coursework is actually completed online through our college partner and all of the clinical training happens in our Dartmouth Health facilities. At the end of the training year, individuals complete the licensing or certification exam and transition to a full time permanent role as part of our workforce.

00:04:34:14 - 00:05:00:14
Carolyn Isabelle
Some of the really fundamental pieces of all of our programs, whether they be our training programs, apprenticeships or advanced career training pathways, is that these are paid training programs leading to full time benefited roles in our workforce. And I think as we think about all of these programs, our goal really is to help you to train and build the skills you need for today while positioning for future career growth in the health care industry.

00:05:00:17 - 00:05:26:05
Elisa Arespacochaga
That's great. So you're really partnering very closely with understanding what are the positions you need not only today but into the future so that you can start to position your own team members to fill those. So, I know you briefly mentioned one of the ways you supported some of this development was through apprenticeship programs, and I know there are a number of different ways to do that, whether it's your registered apprenticeship programs that are registered with your state and federally.

00:05:26:05 - 00:05:39:12
Elisa Arespacochaga
There are different advancement training programs, as you mentioned, where you move people clinically. How have you sort of decided which ones work best and how you pick which programs you should invest in?

00:05:39:15 - 00:06:08:22
Carolyn Isabelle
It's really important when we look at what the right training intervention is and working with our operational teams and departments. So kind of first and foremost, we're looking for roles where there's kind of a volume need. So for example, in all of our inpatient units, we are very reliant and have great demand for licensed nursing assistants. And so understanding that we're going to need kind of a steady influx of people joining the teams across the health system,

00:06:08:24 - 00:06:33:03
Carolyn Isabelle
that's an ideal place for us to layer in a training intervention and be able to bring people in by cohort to have them kind of train, prepare and then enter their new role. There are in some of the more specialized areas where the team and the capacity to train is much less. For example, in our medical laboratory, we have the ability there to take a much smaller cohort.

00:06:33:03 - 00:07:01:12
Carolyn Isabelle
So that's where one of the advanced pathway programs makes more sense, where we partner with an outside academic partner and then just do the clinical training internally. So I think it's really important to be able to assess kind of what is our internal training capacity, what is the demand for roles and the hiring cadence that we need to meet and that helps to inform on our end kind of what the right intervention is going to be. With our registered apprenticeship programs

00:07:01:12 - 00:07:35:27
Carolyn Isabelle
the model that we've really looked at is being able to layer the coursework or the skill development upfront in their training program with the understanding that they're going to build that foundational skillset. And we try to do that as rapidly as possible so that you can reach the point of certification and directly enter the workforce. We then understand that the proficiency and the true confidence in your role is going to be developed on the job with the support of a mentor or a preceptor, as well as the leadership team in that operational department.

00:07:36:00 - 00:07:58:11
Carolyn Isabelle
So it takes about a year through any one of our apprenticeship programs to really build that proficiency. But we've established both technical and professional competencies that all of our apprentices are evaluated on monthly with their supervisors, which keeps them really closely connected to their training plan and on a great path towards advancement.

00:07:58:14 - 00:08:20:07
Elisa Arespacochaga
I love the way you describe that. It really sounds like you wrap around each of your trainees, your learners, in a way that helps them really succeed in their programs. So it sounds like there's a ton of support. Let me ask you a little bit about both some of your greatest successes, but also some of the challenges that got in your way as you started to build some of these programs.

00:08:20:10 - 00:08:39:14
Carolyn Isabelle
Sure. I think there's two things that kind of stand out. In addition to the fact that over the last ten years, we've seen over 1200 people come through our training programs and directly enter our Dartmouth Health workforce. But when I think about the kind of the structure of our programs and what has set some of them apart, there are a couple of things.

00:08:39:21 - 00:09:10:27
Carolyn Isabelle
One, not only do we focus on the technical skill development, but we also focus on the professional development. Really, when we thought about our workforce and we looked at kind of what was setting someone up for success, most of the time, if they were not successful on the job, it was not necessarily tied to the technical skills. So in each of our apprenticeship programs, we have layered in a professional development curriculum that really focuses on the skills - we call them the power skills - that will set you up for success.

00:09:10:27 - 00:09:37:08
Carolyn Isabelle
And this comes back to communication, accepting and receiving and giving feedback. Your decision making, understanding kind of your own code of morals and ethics, but being able to really kind of start to define your own kind of brand as an employee and what you want to be known for as you enter the workforce has really been, I think, an element that added strength to our programs and set people up for long term success.

00:09:37:10 - 00:10:03:12
Carolyn Isabelle
The second thing that I'll mention is that again, with our apprenticeship programs, we have a long standing partnership with one of our regional colleges, Colby Sawyer College. And not only are they the Dartmouth Health Nursing School, but they've also worked with us in our apprenticeship programs to be able to provide a path to an associate's degree. And so, again, this is really unique in a lot of the workforce models that have been established.

00:10:03:15 - 00:10:26:21
Carolyn Isabelle
But students that are enrolled in our apprenticeship programs, they are earning direct college credit for their coursework as well as additional credit throughout their apprenticeship year. At the end of their program, they need to complete their remaining liberal education courses and they graduate with their associate's degree in health science. Almost all of this can be done at no cost to the individual.

00:10:26:21 - 00:10:34:09
Carolyn Isabelle
And again, it comes back to that underlying principle of setting you up for long term success in the health care industry.

00:10:34:12 - 00:10:56:15
Elisa Arespacochaga
That sounds amazing. Talk to me a little bit about some of the work that you do in addition to the training programs to help people sort of navigate where their next career opportunity is and how they can take advantage of those educational resources to start to identify their next step and their next step, hopefully within Dartmouth Health.

00:10:56:17 - 00:11:17:01
Carolyn Isabelle
What we've learned kind of going through this is that while someone has come in through one of our training programs, it's somewhat of an intense experience, and they are really focused on the immediate goal that's directly in front of them. So whether that's completing their medical assistant certification or their surgical technologist certification, that's where their mind is at

00:11:17:02 - 00:11:40:05
Carolyn Isabelle
and that's what they're they're really focused on. They're not necessarily always open and ready to be thinking about nursing school down the road, but we are thinking about that for them and with them. And so we've really been trying to think about where are the right intervals and when to engage with our alumni network to help them stay connected to next step opportunities within our health system.

00:11:40:07 - 00:11:56:19
Carolyn Isabelle
So while we may touch on those things throughout their training program, just to kind of plant the seed and have them build some awareness, it's really kind of as they get through their apprenticeship and starting to kind of open up and see the possibility and be ready to start thinking about what they need to do for next steps.

00:11:56:21 - 00:12:12:27
Carolyn Isabelle
We have a couple of career counseling and navigation services that we do make available to our employees. Again, just to help them get connected to the right programs, the right opportunity, any grants, scholarships and funding that could be available to make things possible, too.

00:12:12:29 - 00:12:38:09
Elisa Arespacochaga
Just sounds like such a great way to keep people engaged beyond the program in the time that they're spending in that sort of intense environment. So, as you think about this work and across the country who are looking for ways to develop their own workforces in both urban and rural environments, what is some of the advice you would share with your colleagues who are thinking, I need to create more programs like this?

00:12:38:12 - 00:13:00:08
Carolyn Isabelle
I can think of a lot of advice because after ten years of doing this, we've tried things in many, many different ways. And I think that's kind of the beauty of it. And what I will say and really give credit to the leadership team at Dartmouth Health. They've given us permission to try some different strategies and to build on what works and to pull back if something doesn't.

00:13:00:13 - 00:13:31:02
Carolyn Isabelle
But that's okay. We just don't always know exactly what the right intervention is going to be, but we'll usually get there. I think one really important factor is being able to have a committed operational partner. And when you are looking at establishing a training intervention, really understanding what is not only going to be needed in the training program and what skills need to be developed, but also what the plan is going to be when they start in their new role and what support will be needed to help people really kind of transition to practice.

00:13:31:05 - 00:13:58:07
Carolyn Isabelle
So that I think is probably one of the key kind of drivers of success long term. And then I think really making sure that when you're develop in the program, you're doing it in a way that can meet the students where they're at. In a lot of our classroom environments, we have a really diverse group of students, so we have individuals that have just graduated high school, but also many that are returning to the workforce or transitioning to health care from another industry.

00:13:58:09 - 00:14:25:23
Carolyn Isabelle
Also, often times there are students enrolled that have not been in a classroom environment for many, many years. So really thinking about how you tell your tailor your instruction and your your program content to to meet the needs of a professional learner and to think about how you can break that content down, incorporate technology, but also a lot of hands-on learning techniques that can connect the content to the individual.

00:14:25:27 - 00:14:32:25
Carolyn Isabelle
I think those really are kind of two pieces of advice that I would give as as you think about structuring some of these programs.

00:14:32:28 - 00:14:46:22
Elisa Arespacochaga
Well, Caroline, I want to thank you for sharing your expertise and all of the efforts you have made throughout this last decade of work at Dartmouth Health and all of the great work you're doing with your community. Thanks so much for sharing it with our listeners.

00:14:46:24 - 00:14:50:13
Carolyn Isabelle
You're very welcome. It was wonderful to be a part of the show today.

00:14:50:15 - 00:14:58:27
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.

For decades, Metropolitan Anchor Hospitals (MAHs) have provided critical health care and social services to diverse populations in the nation’s cities. MAHs and health systems, like NYC Health + Hospitals, are foundational to their community, providing comprehensive, equity-focused care. In this conversation, Deborah Brown, senior vice president of external and regulatory affairs at NYC Health + Hospitals, discusses innovative solutions to common MAH challenges, and the many ways in which the massive public health system meets its mission of taking care of every patient who walks in their doors.


View Transcript
 

00;00;00;21 - 00;00;24;25
Tom Haederle
The crowds, the skyscrapers, the excitement. Everything about New York City has always seemed magnified, bigger than life. That's equally true of New York City's Health + Hospitals, also known as H and H -the Big Apple's public health system that is the largest of its kind in the country. Extending comprehensive care to everyone, regardless of their ability to pay, with dignity and respect, is just part of its vast mission.

00;00;24;28 - 00;00;48;09
Tom Haederle
Systems like H and H serve as anchors within their community, providing care and being active community members. And while each metropolitan anchor hospital serves a unique role within its community, the challenges these hospitals face are common.

00;00;48;12 - 00;01;09;22
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. With the mission of taking care of every patient who walks in their doors, New York City Health + Hospitals deals every day with challenges that affect most care providers, but on a larger scale. The system has also come up with some innovative solutions to these challenges,

00;01;09;22 - 00;01;37;05
Tom Haederle
for example, an effective program to recruit and retain badly needed behavioral health professionals. In this podcast, Deborah Brown, senior vice president of External and Regulatory Affairs and Communications at New York City Health + Hospitals, is speaking with Ben Finder, vice president of Coverage Policy with the AHA, about the current trends and developments in the field and the many ways in which the massive public health system lives up to its responsibility to patients and the communities it serves.

00;01;37;07 - 00;01;45;22
Tom Haederle
They also discuss why metropolitan anchor hospitals like New York City Health + Hospitals need more federal recognition and support.

00;01;45;24 - 00;01;55;03
Ben Finder
Deborah, thank you for joining me this morning. I'm wondering if we can start our conversation by talking a little bit about your hospital and health system and NYC H + H and the patients and the communities that you serve.

00;01;55;05 - 00;02;15;03
Deborah Brown
Absolutely. First of all, thank you for having me. Thank you for having us. We always are proud to tell the story of H + H. So, New York City Health + Hospitals also known as H + H. We are New York City's public health care system. We are the largest municipal health care system in the country. We have 11 hospital sites, acutes.

00;02;15;08 - 00;02;45;16
Deborah Brown
We have five post-acutes, including one LPN. We have about 30 clinics in our FQHC, which is called Gotham. We provide all of the health care services on Rikers Island. We provide services through our homecare agency and we also have an insurance plan, Metroplus Health as a subsidiary. So our goal is to be a fully integrated system. We are a safety net system and proud to be one.

00;02;45;18 - 00;03;10;20
Deborah Brown
We are here to serve anyone who needs care, regardless of ability to pay, regardless of income, regardless of insurance status. What that means really is that we have 70% either Medicaid or uninsured patients, inverting the conventional wisdom of what a pyramid should be. We're actually relatively small on Medicare side, relatively small on commercial insurance.

00;03;10;22 - 00;03;22;10
Ben Finder
So you're in people's homes or in people's lives that are the cards that they carry. You're the places they go to. With all of that experience, I wonder if you could tell me a little bit about the trends that you've seen in recent years in terms of the patients and the community's needs?

00;03;22;13 - 00;03;44;01
Deborah Brown
Absolutely. I mean, I think it's no secret that we're all facing a behavioral health crisis, and I think that is potentially born of COVID, but it is also just the reality of where we are no matter how we got here. So one of the things that we are really focused on is ensuring that there is behavioral health and ensuring that there is behavioral health accessible to all.

00;03;44;04 - 00;04;15;13
Deborah Brown
We are the largest provider of behavioral health services in New York City. We're also the largest provider for people experiencing homelessness. And there is certainly an overlap in that population. We are looking at how we can continue to augment our excellent behavioral health care staff. That includes we've developed our own privately funded support program to support loan forgiveness for behavioral health workers who agreed to a three-year commitment in our system.

00;04;15;15 - 00;04;27;17
Deborah Brown
And we're very grateful to outside donations that help make that possible. We're working with the state on any number of ways to ensure that we have behavioral health beds open. It is an enormous priority for our system.

00;04;27;19 - 00;04;43;27
Ben Finder
The loan forgiveness program sounds really interesting. So you're trying to address the needs of your patients in the community in terms of behavioral health care needs, which are trying to help make the workforce more robust. And we've heard so much about workforce issues for the last couple of years. I wonder if you could tell me a little bit more about how that program works.

00;04;43;29 - 00;05;04;07
Deborah Brown
Absolutely. Again, first of all, you know, a lot of gratitude to private donors who supported us in this. And just to put in a little plug: though we are a public health care system and a public benefit corporation, we're also a tax exempt organization. Thus, we can accept donations in a way that I think conventionally people don't think that government agencies can.

00;05;04;13 - 00;05;38;16
Deborah Brown
And that's really helpful. And actually, philanthropy is one of the things in my portfolio. So what we did with this private donor is we set up a program whereby they donated a certain amount of money. We then can allocate that to behavioral health workers, either those we are recruiting or those we're either trying to retain. And we have a committee that sort of selects the people based on a series of criteria, and then we can provide support between $30,000 and $50,000 for each worker.

00;05;38;19 - 00;05;59;06
Deborah Brown
So it's not going to take care of their entire debt, but it might just be that little kind of tipping point that allows them to stay in our job. Because the reality is the work they do for us is very hard work. It is often physically taxing work, and we want to create the kind of stickiness that helps them help our communities, right?

00;05;59;07 - 00;06;15;11
Deborah Brown
They want to do this work. They've chosen to be here. We're incredibly grateful for that. And so and yet we need them. Without our workers, we can't provide services that our community needs. So we're doing lots of things to try to encourage our workers to stay. It's certainly a challenge.

00;06;15;14 - 00;06;33;07
Ben Finder
It's clear to me that the staff in the hospital itself are very mission driven, supporting the community and the patients. That's at the first priority of everyone's mind. I wonder if we can switch gears a little bit. You talked about the hospitals. About 70% of your patients are on Medicaid. With most of the patients you seen being covered by Medicaid or being uninsured,

00;06;33;10 - 00;06;41;28
Ben Finder
can you talk a little bit about how this program helps your patients or how it supports your patients? And how important these programs, Medicaid program is for H + H.?

00;06;42;00 - 00;07;09;05
Deborah Brown
We are happy to practice in a state where we do have a relatively generous Medicaid program. However, that program still pays hospitals 30% less than the cost of care. And we always say we give 100% to our patients, our Medicaid patients, all patients. We hope that our state program can cover that cost of care. So we are working with our associations, with hospitals across the state on an ongoing advocacy campaign to get to that 100% cost of care.

00;07;09;08 - 00;07;31;24
Deborah Brown
And that's, of course, a financial issue, but it's also an equity issue. We want to make sure that our patients who work through the Medicaid program get care through the Medicaid program, through providers like ours, that we have all the resources that we need to continue to care for them in a high quality and accessible way. Our Medicaid program is key to everything that we do.

00;07;32;01 - 00;08;02;03
Deborah Brown
We are very lucky to be in New York State where there is a robust Medicaid program, but even there, Medicaid only covers 70% of the cost of care. So we're always seeking Medicaid expansion to make it bigger, better, stronger, more rewarding. We are also heavily reliant and not ashamed to say it on DSH payments. Those federal this payments are enormously important, and that view has been - remains - our number one advocacy priority in D.C. and will be you know, we appreciate the ongoing postponements of those DSH cuts.

00;08;02;03 - 00;08;25;08
Deborah Brown
We would love to get rid of them altogether. The other thing that we do have, which I think is really exciting, as I said, it's a 70% that is both Medicaid and uninsured people who are unable to access insurance. One thing that we have is a direct access program called NYC Care, and we set that up with New York City probably about four years ago now.

00;08;25;11 - 00;08;51;09
Deborah Brown
And it allows people who don't have insurance to come into our system, as they always would. They get a card, they get assigned to a primary care physician. They're guaranteed a first appointment with Medicare within two weeks. And it really becomes a direct pathway to create that longitudinal primary and preventative care that is so important - and for some people that they have not had the opportunity to access.

00;08;51;11 - 00;09;06;25
Deborah Brown
We are at about the 120,000 mark in terms of patients. It's been incredibly exciting and rewarding. It really exemplifies how we try to serve our community with dignity, with compassion and with access.

00;09;06;27 - 00;09;32;03
Ben Finder
Wow. 120,000 patients is really something to be proud of. One of the things that we've all learned about is the Medicaid redeterminations, right? That's become a hot topic over the last year. So this was the support that Congress provided during the pandemic was to not require states to conduct these eligibility redeterminations. And now, as we unwind ourselves from the public health emergency, we're having to conduct redeterminations and our goal forms renewals for many of the Medicaid beneficiaries.

00;09;32;05 - 00;09;35;16
Ben Finder
Can you talk a little bit about how this has affected H + H?

00;09;35;19 - 00;09;55;23
Deborah Brown
Yeah, I mean, I think again, we're really we're really grateful to the federal government and we're really grateful to the state for their kind of operational support on this. You know, we've been doing kind of a long, a long ball program to make sure that people are aware and to make sure that we can get people recertified. We're at about 80%, which I think is really good.

00;09;55;23 - 00;10;04;01
Deborah Brown
And I think slightly above the national average. And, you know, it's something frankly, we're just grinding on. It is so important for our patients, so important for us.

00;10;04;04 - 00;10;22;02
Ben Finder
Great to hear about how you're engaging with the patients and trying to connect them or keep them connected with their coverage. You talked a little bit about Medicaid DSH. I think we know that historically Medicaid and Medicare have paid hospitals less than the cost of providing care for their beneficiaries. How does that shortfall affect H +H?

00;10;22;05 - 00;10;47;17
Deborah Brown
It's a great question. I mean, the reality is, as a public health care provider, which we are proud to be, we don't necessarily have all the bells and whistles. That doesn't mean it's not great care. It is. It doesn't mean it's not great staff. It is. But there are certain things, you know, we fill a different role in the ecosystem than some of the better resourced, more commercially reliant private hospitals.

00;10;47;17 - 00;11;05;28
Deborah Brown
And that's OK. We are proud of what we do. And so I think for us, it's always a matter of identifying what is the patient need, what is the community need, how do we best serve it? How do we do so in a way that is not just respectful and compassionate for our patients, but also for our staff?

00;11;06;00 - 00;11;25;11
Deborah Brown
And it's, you know, that's kind of the ballgame. We are never going to be in a position where we are anything but heavily Medicaid reliant. We love it, commercial insurance. We want more commercial insurance. We think that, you know, we have so much to offer. We welcome those patients. But we're also very mindful of the reality.

00;11;25;13 - 00;11;41;04
Ben Finder
The last few years have been incredibly challenging for the hospital field with record inflation, rising costs. You've talked a little bit about the workforce issues that you face and the COVID 19 pandemic. Can you share what specific workforce issues or staffing and financial challenges H + H is experiencing?

00;11;41;07 - 00;12;04;09
Deborah Brown
I mean, I think we're in many ways probably similar to a lot of AHA members, which is we are concerned about behavioral health workforce, we are concerned about nurses. Traveling nursing is a phenomenon that really took off during the pandemic and God bless them, everyone needed them. I think now what we really want to do is try to convert some of our temporary nurses or ideally all of them to permanent staff.

00;12;04;09 - 00;12;19;13
Deborah Brown
And we have a really kind of dedicated initiative on that. Our chief nursing officer is excellent and we're really having success there. Our nurses are in many ways the backbone of our system and we want them to be at home with us.

00;12;19;15 - 00;12;37;11
Ben Finder
We talked a little bit a minute ago just about commercial insurance rates and how they help support some hospitals. Your hospital relies mostly on Medicaid, which we knew historically pays less than the cost. I wonder if you could talk a little bit about the gaps that that causes and how you patch some of those gaps without having a commercially covered population to rely on?

00;12;37;13 - 00;13;02;09
Deborah Brown
Yeah, it's a great question. I think part of it is identifying what our priorities are and where we're going to put our resources. You know, we're not here or able to create a surplus. So when the dollars in our dollars out on patient care, on our staff, identifying, as I said, what communities need and trying to fill those holes. We are lucky enough to enjoy some support from private donors.

00;13;02;11 - 00;13;22;20
Deborah Brown
You know, it's it's a different model for us, right? A lot of private donations are based on a grateful patient model, which is wonderful. Our patients are largely not people who would have the means, even if they're delighted with the care. And I think many are. It's just sort of a different paradigm. So we are really creative. We try to we really creative in our fundraising.

00;13;22;20 - 00;13;43;07
Deborah Brown
We are really lucky that we have donors who understand that we are immodestly vital to New York City, vital to our our New York City functioning in a little "d" democratic way. Often That, I think, is what compels people to join in our mission and support us. And we're very grateful for that.

00;13;43;09 - 00;13;59;19
Ben Finder
You talked a lot about the population in the city and being vital to the city. I wonder if you could talk about some of the challenges of providing both clinical and non-clinical care to an urban population. You talked a little bit about housing instability. Are there other challenges that your population faces?

00;13;59;21 - 00;14;21;00
Deborah Brown
Yeah, and actually, I want to stay on housing for a second. One of the things that we are doing and this is really a priority project for Dr. Mitch Katz, our CEO, who is my boss, is we've created a Housing for Health program, which is we're taking unused lands on our campuses. As I said, we have 11 hospitals sites around the city.

00;14;21;06 - 00;14;48;07
Deborah Brown
Some of them are quite large and have areas that we can kind of leverage. We're using those areas to partner with nonprofit developers, nonprofits service providers and our city colleagues at HPD, which is the Housing Preservation and Development Agency, to work with us on financing the models. And we create supportive housing, supportive and affordable housing specifically to serve our patients.

00;14;48;10 - 00;15;07;25
Deborah Brown
I don't know what it's like nationwide, but at least in New York City, there is often a gap whereby a patient who has significant medical needs, they don't need to be in a hospital. They're not right for a SNF, nor are they right for a homeless shelter. Homeless shelter does many great things, but it doesn't necessarily provide the medical, the ongoing medical care that someone needs.

00;15;07;28 - 00;15;32;03
Deborah Brown
So we're trying to really fill that gap again that we've identified as a need for our patients. We're not going to be the city's largest real estate developer, but we have two major projects in the queue right now. We've done about three to this point, maybe more to this point. And it's really something that I think is a differentiating factor in a way in which we really try to engage in self-help for our patients.

00;15;32;05 - 00;15;42;18
Ben Finder
It's incredible to hear the different ways that hospitals and health systems have evolved beyond just providing care within the four walls. Are there any other programs that you want to talk about or would highlight for us?

00;15;42;21 - 00;16;10;24
Deborah Brown
Yeah, for sure. So we have a program called SHOW, which is street health outreach and wellness, and these are mobile vans that are developed to provide health care to people experiencing homelessness. They go to certain identified corners. There's sort of a route and they are there. They are meant to be reliable. It allowed us to access more people to provide COVID vaccinations during the beginning of the, I guess, the heavy points of the pandemic.

00;16;11;01 - 00;16;34;17
Deborah Brown
But it's also really blossomed into developing ongoing longitudinal primary care relationships, trying to get people in to see doctors because it becomes a trusted part of the community. And it does, you know, wound care. We've done A1C, there's a whole kind of suite of services that can be provided and that's something that didn't exist before. We're really, really proud of that.

00;16;34;19 - 00;16;54;12
Deborah Brown
We have one of the largest community health worker programs, or I should say, hospital based community health workers in the country. We have over 250 CHWs and they are really members of our communities. It's really important to us that we kind of retain that organic nature, not create too many barriers for CHWs to come in and work with us.

00;16;54;17 - 00;17;07;22
Deborah Brown
And that sort of lived experience can often help people as they're trying to find housing, as they're trying to find legal assistance, financial assistance. Those are the things that often our patients need in sort of a wraparound way.

00;17;07;25 - 00;17;35;26
Ben Finder
Your commitment to the mission and improving the health and well-being of your patients and community is really inspiring. You're doing all of this on on Medicaid, predominantly Medicaid reimbursements. I wonder if you could talk a little bit about the Metropolitan Anchor Hospital proposal, which AHA asking Congress for. This is a proposal that Congress would create a specific designation for hospitals like yours that are serving urban communities, that are serving patients that are predominately covered by Medicaid, Medicare, or are uninsured.

00;17;35;28 - 00;17;46;09
Ben Finder
Can you talk a little bit about as an integrated health system in New York City, supporting neighborhoods across all five boroughs and the diverse population? How would this designation be helpful to your organization and your community?

00;17;46;12 - 00;18;17;29
Deborah Brown
To be blunt, any additional funding is going to be helpful for us, particularly funding that doesn't disrupt our DSH allocation, doesn't kind of get in the way of existing existing funds. And that's something that's been really important, I know, to the AHA and all of us participating in developing this kind of model. So I think A) it's just the flat out funds is really important, but also really identifying who we are and what we do and that we are essential for health care delivery.

00;18;17;29 - 00;18;41;27
Deborah Brown
And we are lucky enough to to provide that essential role in New York City. But we've got peers all around the country doing this great work. And I think for not only the AHA, but, of course, Congress to recognize the importance of what we do and to codify that. I think that is really helpful financially. I think that is really helpful for sort of a reputational and almost emotional validation.

00;18;42;00 - 00;18;53;00
Deborah Brown
It's hard stuff. Not not what I do. It is hard stuff what our doctors and nurses and social workers and techs do. And having that recognized is really important.

00;18;53;03 - 00;18;56;29
Ben Finder
What should lawmakers in Congress know about metropolitan anchor hospitals?

00;18;57;01 - 00;19;27;24
Deborah Brown
It's a great question. We are really special places and we're lucky enough to have great relationships. An incredible New York City delegation or specifically the delegation that that represents H + H. They're just wonderful and supportive. I can't say enough good things about about our champions in D.C. But we always try to get them out to our facilities. We always try to get their staff out to the facilities because there is something incredibly sort of magical and humbling, I think, about being in our places.

00;19;27;24 - 00;19;52;19
Deborah Brown
Our staff is unbelievable. Our people, you know, the people care so much about patients, you know, sometimes in a lighthearted way. I know what we do is very serious. And there might be kind of a misperception that we're doom and gloom all the time, like we're human beings interacting with other human beings, and our facilities are really special places.

00;19;52;20 - 00;20;19;22
Deborah Brown
One of the things I love about our system is, as I said, we have 11 acute care sites and each of them is really organically representational of our community. It is really important for us to try to hire from the community. It's something that we are very successful in doing. We really serve as, as the designation says, as anchors for our community, not just as health care providers, but as employers, as sort of trusted agents as part of the culture.

00;20;19;25 - 00;20;25;18
Deborah Brown
Please come down. Well, we'll tour you through everything you want to see and just show you how special it is.

00;20;25;20 - 00;20;33;11
Ben Finder
An anchor is part of the culture and the community. I wonder if if we could end on a what are you most hopeful about in the in health care and in the future?

00;20;33;14 - 00;20;55;15
Deborah Brown
I'm really excited that there is kind of a growing understanding of the importance of social care needs. And I will shout out our state and CMS for the development of our new waiver, which is really about health equity and really about social care needs. This is work that again, sort of bubbles up organically in what we do.

00;20;55;15 - 00;21;25;18
Deborah Brown
And I'm using the royal we. The much more important people are the people doing the actual health care delivery in our facilities. But to understand that giving someone a prescription. It's wonderful. We want people to primary care. We want people to have preventative care. But there are a lot of aspects to health and to wellness even So, the fact that we're really seeing a commitment in funding and in action to those kind of services, that is super exciting.

00;21;25;18 - 00;21;45;01
Deborah Brown
We are big believers in value based care. Even as a safety net hospital, it is something that is very important to us. So that ongoing march is something that is exciting to us. I think there's a lot of opportunities for collaboration and innovation and just being able to continue to serve our patients is a privilege.

00;21;45;04 - 00;21;52;18
Ben Finder
Well, Deborah, it's been wonderful to learn more about H + H and the work that your hospital health systems are doing in your communities. Thank you again for joining me today.

00;21;52;20 - 00;21;55;06
Deborah Brown
Thank you so much for spotlighting us.

00;21;55;09 - 00;22;03;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.

Without a strong and healthy workforce, providing exceptional health care will always be difficult. Addressing the root causes of emerging and continuing workforce issues will always remain a top priority for the AHA and its members. In this conversation, Ron Werft, president and CEO of Cottage Health, and Felicia Sadler, vice president of quality at Relias, discuss the valuable insights and real-world approaches outlined in the 2024 AHA Health Care Workforce Scan, which helps organizations reimagine, redesign and transform their workforce strategies.


 

View Transcript
 

00;00;00;18 - 00;00;17;27
Tom Haederle
Health care is about taking care of people, and that's difficult to achieve without a strong and healthy workforce.

00;00;17;29 - 00;00;42;24
Tom Haederle
Welcome to Advancing Health, a podcast brought to you by the American Hospital Association. I'm Tom Haederle, with AHA communications. Delivering high quality, compassionate care to the communities we serve remains the top priority of the AHA and our members, and our ability to provide that care depends on a strong, well-supported workforce. To that end, we must address the root causes of emerging and continuing workforce issues,

00;00;42;26 - 00;01;02;14
Tom Haederle
then implement thoughtful and sustainable solutions for improvement. Join us to hear valuable insights and real world approaches outlined in the 2024 AHA Health Care Workforce Scan to help organizations re-imagine, redesign and transform workforce strategies to support, retain and recruit staff.

00;01;02;16 - 00;01;24;02
Elisa Arespacochaga
Thanks, Tom. I’m Elisa Arespacochaga, vice president of Clinical Affairs and Workforce with the American Hospital Association. Joining me again this year to share their insights on workforce trends are Ron Werft, president and chief executive officer of Cottage Health, who chaired the AHA's Board Task Force on Workforce. And Felicia Sadler, vice president of Quality with Relias. Welcome to you both.

00;01;24;02 - 00;01;26;01
Elisa Arespacochaga
And thank you again for joining me.

00;01;26;04 - 00;01;27;11
Ron Werft
Happy to be here. Thank you.

00;01;27;14 - 00;01;28;02
Felicia Sadler
Thank you.

00;01;28;09 - 00;02;01;12
Elisa Arespacochaga
So we're here to talk about workforce and in particular the AHA's 2024 Health Care Workforce Scan, which focuses on three critical workforce challenges confronting hospitals and health system. First, providing high quality care with a changing clinical workforce  - sort of shifting faster and further than we ever have before. Second, building a sustainable and adaptable talent pipeline. And three, what I often refer to as the table stakes work, which is supporting the well-being, satisfaction and safety of the team that comes to work every day.

00;02;01;14 - 00;02;18;02
Elisa Arespacochaga
So, Ron, I'm going to start with you. How are you seeing your colleagues and how are you tackling some of these challenges and maintaining the effort in the dedication to continue to do these this work and these address these foundational challenges?

00;02;18;05 - 00;02;41;25
Ron Werft
You know, I think that we've certainly seen some improvement across the industry, really. Employment's back to levels pre-pandemic and of course, the demand for patient care is back where it was before as well. Contract labor is down. The amount that we're paying for contract labor is down. We're seeing some reductions in turnover in various regions of the country as well.

00;02;42;01 - 00;03;03;10
Ron Werft
So there are some reasons to be hopeful. I would just say that it's really important that we keep our eye on this one. Because as we know, it is top of the list for CEO concerns across the country. And I think it's the sort of thing that if you see some incremental improvement, you might think that you can move on to other things.

00;03;03;10 - 00;03;19;18
Ron Werft
But that isn't the case. And certainly the colleagues that I have the good fortune to interact with, they're continuing to take it very, very seriously in both not so much a crisis anymore, but seeing it as a mid-and-a-long term challenge that is really important for us to address.

00;03;19;21 - 00;03;44;22
Elisa Arespacochaga
Absolutely. And I know throughout the task force work, we spent a lot of time thinking about both the upcoming challenge of increased patient care, smaller numbers of providers and how we sort of manage for that. So I think we sort of define this as a math problem going forward. So Felicia, would love to hear your thoughts on what you're seeing around the field as well.

00;03;44;24 - 00;04;18;24
Felicia Sadler
I couldn't agree with Ron more. We think about the crisis that we just went through, the pandemic, unprecedented times. It certainly disrupted so many so many things. As we think about what organizations really need to do and what we've seen them doing around reimagining, redesigning and really leading transformation within their systems. It becomes critical. And as we think about high reliability focused organizations, you know, sustainability is also a big factor and something that's vital.

00;04;18;27 - 00;04;40;15
Felicia Sadler
We get to that, that moment. We think, okay, we're past the crisis. The numbers are looking better, what can we move on to next? And workforce has always been something that has been a challenge as we think about health care, but even more so now when we think about the shortage that we've just encountered and certainly in certain parts of the region that are still encountering.

00;04;40;15 - 00;04;52;29
Felicia Sadler
So commitment to sustainability, high reliability, understanding what's working, lessons learned, what hasn't worked well and moving forward with the strategic plan focused long term.

00;04;53;02 - 00;05;22;10
Ron Werft
You know, I'll add, if I may, I think that the workforce or HR section of our strategic plans, if it even was in there, was not front and center. I know we've just gone through the next iteration of our formal strategic planning process. Our board approved a workforce development plan that's five years long, and it's actually patterned after the work that the American Hospital Association did.

00;05;22;12 - 00;05;38;11
Ron Werft
But it's no longer just a way to get our mission accomplished and to get the daily needs met. It's really part of our strategic thinking now. Just important that we see it in that context.

00;05;38;13 - 00;06;14;12
Elisa Arespacochaga
And I think that really feeds into my next question, which is that I think we're no longer looking at pretty much anything since the pandemic in the same way that we did before. So we're thinking about redesigning care delivery, thinking about different staffing models. We're trying to build the plane as we're flying it. And while it's already trying to do a couple of loop-de-loops on the way, we're really trying to think through with maybe in some cases a smaller staff how do we do this differently and how do we bring technology into that?

00;06;14;14 - 00;06;31;19
Elisa Arespacochaga
So Ron, I'd love to hear sort of your thoughts about how you're keeping your eye on all sort of three of those: the idea of the workforce, what technology you might bring in, and then how you manage all of this in the current financial environment.

00;06;31;21 - 00;07;09;26
Ron Werft
Just before talking about some of the things that we're seeing here and in our region, I'll just speak to the fact that nationally organizations are in very different places depending on their size, their scope, their balance sheet as to what extent they can actually invest in technology and take some risks in new care delivery models. And so I just want to make that point that going to some national meetings, you might be sitting next to somebody who has an innovation center and is able to invest a lot into new models.

00;07;09;29 - 00;07;39;23
Ron Werft
You might also be sitting next to somebody on the other side who is still really struggling to make sure that their ER is staffed today. I think it's important and this is one of the things that AHA is so very good at is creating resources that meet each of us where we are. And just really express my appreciation to AHA for offering something for small rural hospitals, for large urban centers, for multi-hospital systems and small systems like ours.

00;07;39;26 - 00;08;19;03
Ron Werft
What we're seeing, I think, is well known to really all those who might be tuning into this. We're seeing a change in how we view technology, period. The technology is not certainly not there any longer is technology sake. We're really seeing it not only as a way to improve the quality of care along the lines, points that you made, Felicia, but also embracing technology as a way to provide support for our caregivers in ways that allow them to maximize the time they're spending doing meaningful work.

00;08;19;06 - 00;08;50;07
Ron Werft
So we had a chance last year to meet with some of the leading EHR vendors, and it's very clear that we have their attention now on focusing some of their energy into creating ways to minimize documentation time. To implement methods for ambient notes. Examples like that. And you know, we're seeing virtual nursing or as some prefer to call it - nursing virtually, and the expanded use of telemedicine, particularly into behavioral health.

00;08;50;09 - 00;08;54;02
Ron Werft
So those would just be some of the examples that come to mind.

00;08;54;05 - 00;09;01;29
Elisa Arespacochaga
Felicia, from your perspective, I'd love to hear how you're seeing some of the the changes in how we're taking care of our our teams.

00;09;02;02 - 00;09;31;07
Felicia Sadler
So as great as technology is, is become even more important today and become more embraced, if you will, in health care in so many ways. I think that's a place for innovation to really thrive. We are seeing and the report, the 2024 health care work force scan noted this. The prevalence of using it in staffing models, projective analysis around acuity and being able to align the staff, the work force, to the acuity of the patients.

00;09;31;08 - 00;09;55;14
Felicia Sadler
I'm really looking at those resource hours so they can be more lean, focused, if you will, but also effective. And the patient experience is there. We're all about providing high quality care and ensuring that we have the highest quality patient experience and certainly that does positively impact outcomes. So ensuring our workforce is aligned and ready is a key component.

00;09;55;17 - 00;10;24;10
Felicia Sadler
Understanding the virtual nursing, thinking about expanded uses around virtual preceptors, potentially with your more seasoned nurses on those night shifts where you may have less experienced nurses is another thought. We have several organizations mentioned in the workforce scan around some of the innovation that they're able to do and have done with great outcomes, all the way from your smaller facilities to your larger health systems, who have more resources and an expanded applicant pool, if you will.

00;10;24;10 - 00;10;30;03
Felicia Sadler
So a lot going on out there in the world around recruitment and in innovation.

00;10;30;05 - 00;10;51;17
Elisa Arespacochaga
Really appreciate that. Let me dig in on that a little bit. And Ron, you said this in your opening, that health care employment has rebounded to pre-pandemic levels, although I think we may might have pointed out that pre-pandemic we weren't doing great. We were already seeing some shortages. So continuing to look for ways to bring more people in or how to do things in different ways.

00;10;51;20 - 00;11;12;04
Elisa Arespacochaga
But I want you to talk a little bit about some of the work you've done and what you're seeing others do to not only think about, okay, we're going to put up a job opening and see who comes, but really working with your community to grow and recruit and really retain your team and build that pipeline for the long term.

00;11;12;07 - 00;11;49;10
Ron Werft
Again, I'll refer back to the the workforce scan as a great document for this section as well with a lot of really good ideas in there. Just here locally in our situation: In looking for what might be non-traditional sources of employees who may become future licensed caregivers. One example would be kind of marrying our work with getting at health inequities and outreach into our community and the use of community health workers in that regard.

00;11;49;12 - 00;12;21;25
Ron Werft
And now equipping them with the resources, the understanding of how they can grow their careers into the future. So it taps into a part of our community that we may not have tapped into effectively before and gives them the tools to  grow their career in a different way. The recent announcement of these Bloomberg grants was very interesting in terms of supporting health systems, partnering with high schools for high school career academies.

00;12;21;27 - 00;12;46;17
Ron Werft
And we've had a health care academy at one of the local high schools here for about 20 years. But I think that it's an amazing opportunity to inform - and really you need to start before high school - but to inform seventh and eighth graders about health careers and then reinforce that for those who want to enter into a health careers academy.

00;12;46;19 - 00;13;14;23
Ron Werft
Ours has been primarily nursing focused here, but we're thinking very differently now about educating them on and helping them fast-track into other post-graduate work that will result in them being clinical scientists or on a different level, maybe an EMT route as well. We're seeing also with our local colleges and universities, we're fortunate to have quite a few of them here on the central coast of California,

00;13;14;25 - 00;13;37;16
Ron Werft
we're partnering with them to expand enrollment in the programs they already have and also working with them to expand the program offerings that they have. We're working with an organization now to expand their their PA program, for example, which is not something we had thought of before. So we're seeing growth in the enrollment and growth in the number of programs.

00;13;37;16 - 00;13;44;28
Ron Werft
And for us, that's serving as a very important pipeline for their graduates into our system.

00;13;45;01 - 00;14;08;13
Elisa Arespacochaga
I love that you have so many different ways into the community and different connections. Felicia, you mentioned specifically the idea of looking for ways to take some of those more experienced nurses to help support the newer nurses who may be struggling to find their footing. Can you talk a little bit about what you're seeing in terms of building that pipeline really as robustly as possible.

00;14;08;16 - 00;14;43;19
Felicia Sadler
During the pandemic we lost over a hundred, I believe, was 100,000 registered nurses, and we saw some of the emergence of bringing seasoned nurses back into the workforce as virtual preceptors. Many of them had burned out during the pandemic and being able to bring them out in a new and different way was almost refreshing to them. They could still be part of without feeling guilty of kind of missing out, if you will, on patient care, but be part of something bigger, if you will, and really supporting those new nurses who also had some gaps in their programs.

00;14;43;19 - 00;15;06;16
Felicia Sadler
Many of them graduated early. Many of them did not have their clinical experience that they would typically get in their senior practicum, if you will. And so those were opportunities for the preceptors to really partner with, with newer nurses while supporting them on those shifts, the night shifts where there are less resources. I think, too, bringing them back in the telehealth mode as well.

00;15;06;16 - 00;15;29;00
Felicia Sadler
We have a lot of nurses. There's more seasoned, experienced nurses can come back in that way, as well, as they are entering back into the workforce. I want to touch a little bit too on the interprofessional component, because that's critically important as we think about Team Steps, as we think about interprofessional communication, interprofessional teamwork as it relates to the patient care experience.

00;15;29;03 - 00;15;40;12
Felicia Sadler
That's something we're seeing. And really there's a need to be fostered through a program like Team Steps that can be very helpful to kind of bring teams together as we think about focusing on high quality care.

00;15;40;14 - 00;16;15;16
Elisa Arespacochaga
We not only look for opportunities to educate these teams together, but help them function as an expert team. Speaking of the expert team, our goal really has always been to not only build a health care system where we can take care of our communities, but to ensure - and more than ever now - that our team that comes to that through our doors every day, whether virtually or physically, is well, that they are engaged, that they are safe, that they feel like they are doing, as Ron, you said, meaningful work.

00;16;15;18 - 00;16;39;00
Elisa Arespacochaga
And I know this is a major priority for nearly everyone I speak to. And I know there is work going on, but I'd love to hear from your perspective sort of what some of the opportunities are. They range from technology to things as simple as...Ron, I'm going to call you out here writing amazingly sweet notes to your team to thank them for things.

00;16;39;08 - 00;16;49;03
Elisa Arespacochaga
That personal touch makes a huge difference to the team that you're working with. So, Ron, you want to share a little bit about what you're doing and what you're seeing in the field.

00;16;49;05 - 00;17;11;29
Ron Werft
This is so critically important to our success going forward. We can find all the best technology that these companies are able to produce and they're wonderful ideas. You said at the top of the hour here, Elisa, we have a math problem. And that means that we're going to have to do significant care redesign.

00;17;12;01 - 00;17;41;02
Ron Werft
So we're not going to be successful at redesigning care if it isn't our frontline staff who are actually redesigning care. And so that means really creating a culture where staff are motivated to be engaged, enjoy being engaged and share the rewards of being engaged in an organization that is helping to solve their problems and most importantly, helping them take care of their patients.

00;17;41;02 - 00;18;08;25
Ron Werft
So in our organization, we many years ago made a serious commitment to shared governance. It's a fundamental part of our culture, and it started with conversations and nursing. But to nursing's credit, they very quickly pointed out that it was going to be so much more successful if it engaged the entire organization. So we have a shared governance. According to counsel,

00;18;08;25 - 00;18;34;18
Ron Werft
it has representation from throughout the organization. There's very little that goes on here that frontline staff haven't either asked for, recommended or made better. Ideas that we might have in my office are always made better by engaging the staff. So it's very complex. We have a broad age range. We have different demographics in terms of race and ethnicity.

00;18;34;20 - 00;19;08;22
Ron Werft
We have people who have no children to small children, to parents who need their help at the other end of life. And so I think some of the approaches would be implementing employee resource groups and listening to staff. So just creating mechanisms where you actually listen to what their needs are and what their ideas are. You wind up creating a culture of innovation that really makes this journey toward care redesign much faster and helps with also enormously with retention.

00;19;08;22 - 00;19;42;17
Ron Werft
People want to be a part of an organization where they can make a meaningful difference. You learn a lot, and it's very important that when you hear these ideas, acting on them quickly speaks volumes to the staff. So whether it's housing or child care or it might be various elements of the compensation structure for premium pay for things that that they think important that you might not have thought are important to addressing issues.

00;19;42;24 - 00;19;54;07
Ron Werft
Again, important to listen to them and important to act very quickly. And that word gets spread out through the organization very quickly. It makes people more inclined to give their ideas the next time.

00;19;54;10 - 00;20;01;04
Elisa Arespacochaga
I think letting people know you heard them makes a huge difference. Felicia, your experience.

00;20;01;06 - 00;20;32;11
Felicia Sadler
I love exactly what Ron just said because building the foundational trust is so critical to any kind of change, leading any kind of innovation. You build that trust by listening and by acting. There may be some things that will take a little bit longer to act upon, but by sharing those quick wins and meeting some immediate needs with urgency is absolutely key to really building trust and really sharing some transparency in that.

00;20;32;11 - 00;20;58;00
Felicia Sadler
So that is fantastic. It also can help some of the initiatives that you're bringing in around physical safety is so important to a health care workforce. Creating that cycle, not only physical safety but psychological safety. And in this day and age, when there's already increased burnout, there are statistics in this report that talk about the levels of burnout and the levels of concern, the increased incivility and bullying.

00;20;58;03 - 00;21;17;10
Felicia Sadler
It's becoming even more so much more than it was when I was starting out in my career, more than 30 years ago. I think it's taken a toll on the workforce in helping them to feel not only physically safe, but providing that psychological safety within a health system can be certainly important through trust and transparency.

00;21;17;12 - 00;21;43;18
Ron Werft
Yeah, that's so true. I'm just thinking of some of the ideas around addressing workplace violence that have come into fruition here that come directly from frontline staff. I mentioned the weapons detection system that we now have that, as it turns out discovered there were a lot more weapons coming into the organization than we realized. So that was a great recommendation by staff.

00;21;43;21 - 00;22;10;10
Ron Werft
We also have a K-9 program for security and have for many, many years. And all these years of having a K-9 program that has been very effective in just bringing what could be a very volatile situation, making it quiet very quickly, our security officers have only issued the command twice in 20 years with that program. Again, an idea from staff that has been very effective here.

00;22;10;13 - 00;22;36;25
Ron Werft
And then just reminding our patients and visitors that our staff are real people. One of the great ideas that emerged was we have some posters and banners throughout the hospital now that show, with their permission, a staff member. It might be, let's say, a staff nurse in the emergency department and scrubs and right next to that picture is a picture of her as a soccer mom.

00;22;36;28 - 00;22;53;23
Ron Werft
And it says, you know, I'm a UC Santa Barbara graduate soccer mom. I'm also your nurse today. And so it just sort of helps make people real in front of their patients and family members. And that was important to staff, too, to tell that story.

00;22;53;26 - 00;23;28;07
Elisa Arespacochaga
I love that example. And such one that's from the staff and back to our very early discussion, one that doesn't require a huge financial commitment from the organization but does help us get back to humans caring for humans. Ron and Felicia, thank you again so much for joining me today. You covered and touched on just a few of the topics and a couple of the statistics that are available in the AHA health care workforce scan, which is based on a review of many reports and studies and data sources from across the country.

00;23;28;07 - 00;23;58;02
Elisa Arespacochaga
And it provides valuable insights and practical recommendations to help organizations think innovatively and act boldly to support, retain and recruit their staff. I encourage folks if they want to learn more about the AHA Workforce Scan, you can find it online at www.aha.org/aha-workforce-scan. And I want to point out that the workforce scan is made possible by and sponsored by Relias.

00;23;58;07 - 00;24;05;15
Elisa Arespacochaga
To learn more about Relias. please visit www.relias.com. Thanks so much for joining us.

00;24;05;18 - 00;24;13;29
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and read us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

After launching in November 2022, it took ChatGPT just two months to become the fastest growing consumer app in history — proof of the rapid adoption of AI technology. In this conversation, three experts from the American Hospital Association discuss the game-changing applications of ChatGPT and AI for health care data analytics, and some of the potential pitfalls.


View Transcript
 

00;00;00;01 - 00;00;34;20
Tom Haederle
After launching in November 2022, it took ChatGPT just two months to become the fastest growing consumer app in history, gaining over 100 million users at an unprecedented rate. ChatGPT is perhaps the most prominent example, but certainly not the only one, of how artificial intelligence — or AI — is rapidly changing the world and the health care field along with it.

00;00;34;22 - 00;01;08;10
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. These days, our ability to process and analyze enormous volumes of data in new and innovative ways is evolving at warp speed. And AI is at the forefront. What are the implications for health care? Where is all of this going? In this podcast, three experts from the American Hospital Association discuss the game-changing practical applications of ChatGPT and AI for health care data analytics, and the potential pitfalls.

00;01;08;12 - 00;01;20;09
Tom Haederle
Host Stephen Hughes is director of health IT policy for the AHA. Brian Klein-Qiu and John Allison are both associate directors of health analytics policy. Let's join Stephen, Brian and John.

00;01;20;11 - 00;01;47;09
Stephen Hughes
Let's step back for a second to talk about how we got here. With less than 15 months ago, the world changed when ChatGPT kind of just crashed through the room, right? And all of a sudden added AI to the zeitgeist, catching a lot of us off guard. Now, as we know, AI has been in the health care space for decades right? There's diagnostics and in revenue cycle and in several areas, there's been tremendous advancement and practical application.

00;01;47;15 - 00;02;11;00
Stephen Hughes
But ChatGPT really accelerated and changed the way we think about it. It's changing the regulatory conversation around it. It's changed the way that every CEO and every board now is thinking about it. So we step back for a second to talk about what you guys do in data and analytics. There is a Brian and a John that works in some form or another for most health systems, right?

00;02;11;01 - 00;02;39;07
Stephen Hughes
We call them different things. It might be performance improvement team, it might be data analytics team. You know, it might be part of the strategy team. But one way or another, most health systems, whether they're doing it internally or thinking about it through partnerships or consultants, are looking at how they use data, how to analyze data, and how do they either improve patient outcomes or make themselves more competitive, make themselves more efficient.

00;02;39;10 - 00;02;51;26
Stephen Hughes
So Brian and John, let's talk a little bit about what you guys do, and then we're going to talk a little bit about how you guys were using AI and how it was valuable to you and how I think it'll be useful to our members.

00;02;51;28 - 00;03;10;27
John Allison
So, yeah, I'm John Allison. I think the most succinct way to describe what I do, at least the way that I approach my job is, my goal is to really tell compelling stories about hospitals, to advocate well for them. And one of the tools in my toolbag to do that is data, right? There's a lot of it out there.

00;03;10;29 - 00;03;28;10
John Allison
Being able to understand it, being able to make sense of the anecdotes, for example, which is oftentimes really how you're learning, is you're hearing from members or other hospitals being able to kind of convert that into something that's maybe more compelling. It's really important.

00;03;28;12 - 00;03;46;11
Stephen Hughes
Right. I think you guys would agree that health care is unique among all sectors in terms of just the sheer volume of data, right, that you have. I talked at the beginning about, you know, finding use out of that data. But there's a lot of noise inside, right, because it's just by the nature of what we do.

00;03;46;11 - 00;04;08;09
Stephen Hughes
By the nature of patient care, there's just a tremendous volume of data that's captured. And Brian, could you talk a little bit about the the different languages around data? One of the challenges here is that it's you know, it's like there's all this data and there's like several different languages that are being spoken in terms of how that data is understood and analyzed.

00;04;08;16 - 00;04;34;19
Brian Klein-Qiu
Yeah, absolutely. So the most common data analysis or data science languages are going to be your typical languages like Python or R. For historical institutionalized reasons, SAS still kind of has a large, large stranglehold over health care policy data. So, for example, most Medicare claims, a lot of these files they come in SAS formats. It's still kind of the lingua franca in our industry.

00;04;34;21 - 00;04;53;04
Brian Klein-Qiu
That's kind of a challenge because there's not a lot of SAS programmers these days, and that's kind of a hard, hard barrier to access for people to be able to interact with claims data. When you add in the fact that a lot of these data analysts, data scientists, they're not specifically gearing up to work in health care policy the way that John and I work.

00;04;53;12 - 00;04;59;08
Brian Klein-Qiu
What that means is you're going to get a lot of great analysts and programmers who have no prior experience with SAS.

00;04;59;11 - 00;05;08;13
Stephen Hughes
Now, fast forward a little bit. So, Brian, when you came in, tell a little about the story of like you've had a little bit of SAS background, but...

00;05;08;16 - 00;05;09;21
Brian Klein-Qiu
Actually it's opposite.

00;05;09;21 - 00;05;10;12
Stephen Hughes
Oh it's the other way around.

00;05;10;14 - 00;05;12;15
Brian Klein-Qiu
I have a lot of SAS background.

00;05;12;17 - 00;05;13;04
Stephen Hughes
Right, right, right.

00;05;13;11 - 00;05;36;02
Brian Klein-Qiu
I have not touched Python and R in maybe five or six years because I've been living in the SAS world. So when I joined AHA in July 2023, I'm part of the new health care policy data team and our manager I think in week one or two he sits me down and says, "Hey Brian, there's this really complex data project that John is handling right now.

00;05;36;06 - 00;05;58;15
Brian Klein-Qiu
Can you take a look at all of the complex great code that John's been writing and try to contribute to it?" And if this was July 2022 before ChatGPT came out, I would have had to tell Aaron, "So, you know, Python's on my resume. But the thing about that is I'm still going to need three weeks to make sense of what John's writing."

00;05;58;15 - 00;06;01;02
Stephen Hughes
And maybe a class. And maybe do a lot of Googling.

00;06;01;02 - 00;06;32;08
Brian Klein-Qiu
John's going to have to see me down. But because it's July 2023 and not 2022 ChatGPT is out. And I can tell Aaron, yeah no problem. So John hands me off the code base that he's been working on. I feed literally everything that's not sensitive into ChatGPT. And because I have experience with programing languages, I knew Python in the past, I'm able to pick it up pretty easily with the help of ChatGPT explaining to me what these specific lines do, what the overall structure is and all of that.

00;06;32;11 - 00;06;38;26
Brian Klein-Qiu
So literally from day one, I'm able to plug in and contribute to what John's been handling for I don't know what, the last six months?

00;06;38;29 - 00;06;53;12
John Allison
Yeah, I mean, I would say not only contribute to it, but just like make it better really quickly. Like I remember some of that code you were sending to me and as we were working on and I was like, wow, this is a really good idea. Like, I hadn't thought to do it this way.

00;06;53;12 - 00;07;13;04
John Allison
And, you know, and I think probably the thing to like underscore there is for data analysts, ChatGPT is really quickly becoming a must have in your quiver. It might be the quiver. It is so important for data analysts in terms of like in the toolbag you reach into when you're doing your job.

00;07;13;07 - 00;07;34;22
Brian Klein-Qiu
Oh absolutely. Health care policy, you are working with really a diverse array of languages. But you kind of develop an expertise in one and you kind of just have to make do with whatever knowledge you can get to parse through all the other projects. For example, claims are going to be mostly in SAS files. If you do data and analysis or processing

00;07;34;25 - 00;07;53;04
Brian Klein-Qiu
a lot of people like to use Python for that. But if you look at the claim prices for like how consumers actually prices claims, all those source files are in Java. So if you can have a tool like ChatGPT that can help you process these very different languages easily, that's an incredible boost to productivity.

00;07;53;07 - 00;08;12;22
Stephen Hughes
And there's a couple of important points here. And one, to extend the metaphor of languages out. You know, effectively you have a Rosetta Stone, right? That's understanding these languages. We have two different languages we started with, so we're extending the metaphor out. We've got, you know, Mandarin and English. Now if you're adding Java on top, you're adding, okay, French, right?

00;08;12;29 - 00;08;23;20
Stephen Hughes
We keep adding more and more languages, more and more expertise, more and more time. And someone who's not familiar with something...so ChatGPT effectively was acting as that kind of universal translator.

00;08;23;27 - 00;08;43;17
John Allison
What ChatGPT does is it says, okay, so maybe maybe you weren't as strong at learning programing languages or Java or whatever it is. ChatGPT's going help you get there in a way that I would have said... you talked about weeks to get caught up. That's because you had some experience with some of these languages before.

00;08;43;19 - 00;09;07;19
John Allison
For someone who doesn't you're talking years, right? And so that's where most of the data analysts that would be listening to this or that are if you're a health system C-suite, that would be working for you. Fifteen years ago, ten years ago, even five years ago, it probably took them years and years and years of not only learning the language but getting really comfortable in it, learning how to use it to become the data analyst that they are.

00;09;07;20 - 00;09;09;00
John Allison
It takes years.

00;09;09;02 - 00;09;27;27
Stephen Hughes
So there's this concept of upskilling, right? I know this is a concern with with CEOs everywhere in health systems now that are thinking about, you know, applications and investment in AI. And it's an important piece because a lot of again, let's go back to 2022. It's you know, the AI is coming for our jobs.

00;09;28;00 - 00;09;55;19
Stephen Hughes
You know, there's the crisis, right? We've now gone to this idea of it's not taking jobs. It's making individuals better at their jobs. It's you know, like in our case, like in the AHA's case, rather than having to hire two more Brians or a John and two more Brians, right. I'm now able to take Brian and John and upskill them to a point where I'm getting much more productivity out of two individuals by upskilling.

00;09;55;25 - 00;10;21;13
John Allison
I think with something like ChatGPT that years of like building up this experience and skillset to be able to tackle the problem has really been ameliorated. And to the extent that if I'm an analyst and I'm working at the AHA, which I am, and there's a question, a big question that we have something we want to answer on a topic that maybe not all people have talked about yet, and there's some data out there, but it's just huge.

00;10;21;14 - 00;10;47;18
John Allison
We don't understand it. Instead of me thinking, well, that's a waste of my time. I shouldn't be actually trying to answer that question. Instead, I'm thinking, okay, with ChatGPT, I feel reasonably confident that I can take something that's currently incredibly difficult to understand and I don't have a ton of background in. And I can still ask this big question from the data and reasonably expect to get an answer and not take years to do it.

00;10;47;20 - 00;11;16;04
John Allison
That's just hard to underscore how game-changing that is, at least from my perspective. Whereas before I would have asked a really good question about my data, like what is what is driving this this trend that we're seeing in health care and hospital utilization and things like that. And while the datasets might have been available to me, a lot of them aren't, by the way, but the ones that are publicly available, I might have just shied away from asking questions like, well, I don't have the next ten weeks to devote to this.

00;11;16;06 - 00;11;18;25
John Allison
And nowadays I would say that's a week at most.

00;11;18;27 - 00;11;33;18
Stephen Hughes
But then the other part of which I think again, would resonate with with most health systems is this idea of like they've got a lot of data, that's not the problem. They've captured all kinds of data, it's just in all different places. You have a lot that's in the HR. You have a lot that may have predated the HR.

00;11;33;20 - 00;11;57;06
Stephen Hughes
That you've been hanging on to for, you know, for years for regulatory reasons, but are you actually making a use out of it to create, again, better outcomes, other business opportunities? Who knows? And then sometimes again, there are disparate sources, right? What if you acquired another health system that has a different EHR. You acquired a practice or partnering with a practice, and they've got again, it's a different EHR, or god forbid, paper.

00;11;57;09 - 00;12;18;00
Stephen Hughes
How am I bringing this all in? Or what tools am I bringing in? And in most cases, those answers are going to be, I have a very hard time doing that internally, right? I'm going to have to you know, I'm going to have to either move all of this to some cloud-based service which costs, security risks associated with it.

00;12;18;02 - 00;12;40;09
Stephen Hughes
Time. When am I going to get value back out of this as opposed to, hey, this is my data and now I can take a very narrow approach to my data and solve problems and get value out of my data with my staff inside a health system, right. Which is going to cut the security risk problem. The cost concerns, the do I bring in consultants?

00;12;40;09 - 00;12;49;18
Stephen Hughes
Do I you know, all these other issues? I can actually start solving these problems internally because I have tools like, you know, GPT.

00;12;49;25 - 00;13;26;02
John Allison
Probably something to underscore is if you're looking for an application of AI and you're like, well, I'm not a huge health system. I don't have these resources to spend on these more clinically-based AI applications or maybe even some sort of, you know, chat bot thing, things that maybe are more business-oriented, consumer-facing potentially. A really low, an area of a lot of low-hanging fruit for the use and practical application of AI tools like ChatGPT is going to be data analysis, frankly, and some people might find that boring, other people might find that exciting.

00;13;26;04 - 00;13;52;08
John Allison
I think that's important to contextualize, it's something that ChatGPT does pretty darn well compared to a lot of the other things that it does. It's going to help you think through data problems comparatively pretty, pretty well. And I would say if you're looking for a place to kind of grow your hospital or your health system, whatever it is that your business you're working in, it'd be to be thinking about how to apply these tools to data problems.

00;13;52;08 - 00;14;10;08
John Allison
If your analytics department, your data analysis teams, the people that are helping with decision support, business intelligence, whatever it is, that's the group out of anyone in an organization that I would think would be leading the charge, in a very I hate to use this word because we're in D.C., but in a very grassroots way.

00;14;10;15 - 00;14;15;28
John Allison
You're not being told to do it. It's very organic. This is making me better at my job.

00;14;16;00 - 00;14;45;19
Stephen Hughes
And yes, it starts in data. But I think that, you know, your insight there, John, is good. And I think it's applicable really to even outside of data analytics, right? The idea that the use case came out organically by need. So it's, and I think if there's a lesson there and there's marching orders to then take out, you know, really any level of management in the health system that maybe listening to this all the way up to senior executives and board members is, worry less about trying to shoehorn a solution into the organization.

00;14;45;21 - 00;15;01;19
Stephen Hughes
It's go down to the practitioners, right? Go to your people in the front lines, go to your experts and ask them about how they could use it. And that's where I think you're going to get the most effective, you know, examples and the most effective tools are going to emerge from that.

00;15;01;22 - 00;15;11;13
Brian Klein-Qiu
It's true that this is an incredible tool and you can solve so many issues and increases productivity so much in the hands of somebody who is competent and somebody who is...

00;15;11;13 - 00;15;34;16
Stephen Hughes
In the hands of someone who is competent. Right. You have to have a baseline, competent person to start with that you're upskilling as opposed to...what you're not doing with ChatGBT or really with AI in general. And this is you could extend this metaphor out to the kind of the absurd level of you're not going to turn somebody who didn't go to medical school into a radiologist because they're using an AI tool to look at diagnostic images.

00;15;34;16 - 00;15;55;28
Stephen Hughes
You get you start with a radiologist, add the AI on to that and they get much more productive and much more effective at picking up abnormalities in a mammogram. Just like you take someone who's got good or at least a basis with understanding data languages and good analytical skills, add AI, they're going to be much better at doing decision support.

00;15;55;28 - 00;16;01;03
Brian Klein-Qiu
Exactly. And the criteria for evaluating who's good at analysis has changed with AI.

00;16;01;06 - 00;16;17;21
Stephen Hughes
I'm glad you brought this up, too. So we're not just sounding like that we're a bunch of just ChatGPT and AI cheerleaders, right? There's always a downside with technology. So let's talk a little bit about the quality measures. So how do we do that with ChatGPT and data analytics? How do you apply that safety criteria?

00;16;17;21 - 00;16;19;10
Stephen Hughes
What are the tests or what are the outcomes?

00;16;19;10 - 00;16;40;22
Brian Klein-Qiu
Yeah, that's a good question and that's you hit on a really, really crucial thing because that's something especially in fields like health care systems or health policy in general, there's not a lot of that kind of thinking. A lot of people a lot of organizations, a lot of agencies are not concerned with how do we know that these numbers are right, how we know that these algorithms are correct and we see how many mistakes CMS makes all the time.

00;16;40;24 - 00;17;01;19
Brian Klein-Qiu
It's not limited to CMS. All agencies and companies do that. But one thing that I find shocking and that we need now more than ever is there's no emphasis in the interview process for a lot of these places on how do you sense check your numbers in a project. It's all what are the results of the projects? Give me examples of projects you've done and it's never

00;17;01;26 - 00;17;25;13
Brian Klein-Qiu
how did you know that your project was correct? Explain to me your benchmark process. Explain to me how you were able to contextualize the numbers you got. The answers to those questions are much more indicative of how meticulous someone is and how analytical someone is. Than them being able to list five languages on their resume and say, okay, I created this algorithm and it gave me this many charts.

00;17;25;20 - 00;17;25;27
Brian Klein-Qiu
Here you go.

00;17;25;28 - 00;17;40;08
Stephen Hughes
So would you be saying in a way that the way to actually make sure that you're you're using GPT safely and effectively is to actually double-down on your people hiring process.

00;17;40;10 - 00;17;43;13
Brian Klein-Qiu
Or instill a culture. Instill a culture that is much more...

00;17;43;13 - 00;17;44;16
Stephen Hughes
Get very human centered.

00;17;44;16 - 00;17;46;01
Brian Klein-Qiu
Yeah, right, right.

00;17;46;06 - 00;18;01;04
Stephen Hughes
Interesting. So to ensure quality it's make sure that you're being careful about your your hiring practice,s right, and instilling a culture of quality and you know high levels of ethics in those who are using the applications.

00;18;01;11 - 00;18;15;14
Brian Klein-Qiu
The number one thing you can do if you've already hired a person to improve the culture of checking the quality is just literally ask, how do you contextualize these numbers with other entities' numbers? Can you think outside of GPT, are you right externalizing everything you do?

00;18;15;19 - 00;18;39;15
Stephen Hughes
I love that. To actually ultimately control quality in GPT or tools like GPT think outside of GPT and in the end AI is a piece of technology. Really what we should be thinking about in health systems is a thoughtful application of technology. This is just one more thoughtful application of technology. Overall, I think it's connecting back to what Brian was saying, which again connects us back to the human-centered nature of this.

00;18;39;21 - 00;19;02;05
Stephen Hughes
You know that ultimately the quality control check for, you know, use of AI in data analytics and decision support is do you have a culture of quality, right? Do you have a culture of peer checking around what you're doing? You know, ultimately to get the most out of AI, across the system, across health care, is encourage a culture of innovation and creativity, right?

00;19;02;05 - 00;19;13;06
Stephen Hughes
Know the tools are out there. Encourage people not to be afraid of it. Go look at it and suggest things. You be amazed what you might find. Well, guys, I think that's all the time we have. I really appreciate it. John, Brian, thanks so much.

00;19;13;09 - 00;19;14;16
Brian Klein-Qiu
Thank you. Pleasure to be here.

AHA Advancing Health Podcasts logo

Subscribe to Advancing Health

Apple Podcasts icon logo
Spotify icon logo
Google Podcasts icon
Stitcher icon logo
RSS Feed Icon

Featured Podcasts


AHA Members: Listen to Advancing Health Podcasts on the My AHA Connect App

The AHA keeps you updated on the latest Advancing Health podcasts through the My AHA Connect app for your phone or tablet. Just click on the Media tab, and you can listen to the entire podcast series. It is ideal for listening while you commute, exercise, or just enjoy a few free minutes in your day.

Download My AHA Connect Today!

Download on the App Store Badge logo

Get it on Google Play

Innovators Connection

Hear industry leaders sharing new knowledge, fresh ideas, and creative solutions from Leadership Summit.

Podcast Series

Latest

For hospitals and health systems of every size and location, it’s critically important to adapt to the needs of their communities.
This special series explores the medical complications that can accompany pregnancy, successful prenatal and postpartum treatment programs, and how hospitals and health systems are addressing the social needs of new mothers.
Hospitals and health systems are rightly called cornerstones of their communities, and none take that mission more seriously than Advocate Health.
In this conversation, Bryan Smith, recently retired section chief of the Cyber Criminal Operations Section with the FBI, discusses how the Bureau tackles the huge challenge of protecting the nation's caregivers from these attacks, and how partnerships are crucial in prevailing against cybercriminals.
In 2023, the U.S. Surgeon General issued a shocking 80-plus page advisory declaring loneliness and social isolation as reaching epidemic levels in American society.
Chief Wellness Officers are an essential part of a health care worker's mental and physical support structure, providing opportunities and resources whenever needed.
Half of all Medicare beneficiaries get their benefits through Medicare Advantage (MA) plans, which are offered by private companies and in theory should provide the same level of coverage of traditional Medicare.
The influx of artificial intelligence (AI) in health care is here to stay, yet there is considerable debate about the best and most effective ways to safely employ it.
This special series explores the medical complications that can accompany pregnancy, successful prenatal and postpartum treatment programs, and how hospitals and health systems are addressing the social needs of new mothers.
The COVID pandemic has been a health care game changer, and its lasting effect on care teams accelerated issues like burnout and the need to address well-being.