Hospitals Against Violence | #HAVhopeco

00:00:00:09 - 00:00:36:07
Tom Haederle
Clean air, peace and quiet, and quick access to outdoor activities are among the draws of practicing health care in a rural setting. On the flip side, issues such as housing, transportation and affordable childcare remain challenges for all rural hospitals and health systems, and affect their ability to attract and retain top talent. Stay with us to hear how the leader of the most rural academic medical center in the country has faced those issues and produced solutions that work.

00:00:36:09 - 00:01:01:06
Tom Haederle
Welcome to Advancing Health, the podcast of the American Hospital Association. I'm Tom Haederle with AHA Communications. Dr. Joanne Conroy is CEO and president of Dartmouth Health in New Hampshire, and the 2024 chair of the AHA Board of Trustees. In this podcast hosted by Shannon Wu, director of payment policy with the AHA, we learn more about Dartmouth Health's winning recipe for hiring and keeping talented health care professionals.

00:01:01:13 - 00:01:05:29
Tom Haederle
Ideas that could work just about anywhere. Now to Shannon.

00:01:06:01 - 00:01:21:26
Shannon Wu
Joanne, thanks so much for joining us on the podcast today. Before we get into the topic of rural health care delivery, please tell us a little bit about yourself and your journey to becoming the CEO and president of Dartmouth Health and the 2024 board chair for the AHA.

00:01:21:28 - 00:01:45:09
Joanne Conroy, M.D.
Thanks, Shannon, and it's great to be here. I've been at Dartmouth Health since 2017, and my path here was a little bit circuitous. I started my career in South Carolina at the Medical University of South Carolina, where I spent about 21 years. After that, I went to Atlantic Health in northern New Jersey and spent about eight years there.

00:01:45:09 - 00:02:17:09
Joanne Conroy, M.D.
And that was actually a great experience, kind of contrasting academic medicine in a kind of a regional institution, to going to northern New Jersey, where you had all the influences of metro New York. After eight years at Atlantic, I went to the AAMC, the Association of American Medical Colleges, where I was their chief health care officer. And that was really great because I really got to see policy and the impact of policy on practice, and I was actually there,

00:02:17:16 - 00:02:47:29
Joanne Conroy, M.D.
I started in the fall of 2008, just as Obama was getting elected, and all the buzz around Affordable Care Act and the contributions that many organizations had to drafting, that was really, really fascinating. After six years, I took a role at the Lahey Clinic. I was the president of the Lahey Clinic, and it had just become part of a larger organization called Lahey Health.

00:02:48:01 - 00:03:15:18
Joanne Conroy, M.D.
And you know, I actually love the clinic model where everybody's paycheck is written by the same person. It's a real great way to really align across the organization. But I was contacted about the role at Dartmouth, which again is a Clinic member, the Hitchcock Clinic has been in place for close to 100 years. I interviewed and they offered me the job, and I came up in 2017.

00:03:15:20 - 00:03:34:17
Joanne Conroy, M.D.
I've had the opportunity to have really a great kind of experience in almost every different type of health care system. And then when I was at the AAMC, I got to look under the hood of 185 teaching hospitals, which really gives you a perspective about the differences across the country.

00:03:34:24 - 00:03:49:18
Shannon Wu
Yeah, you're right. That is such a varied set of experiences you've had. I understand that you are one of the most rural academic health systems in the country. Please tell us a little bit more about Dartmouth Health and the rural population specifically that you serve.

00:03:49:20 - 00:04:15:17
Joanne Conroy, M.D.
You're right. We are the most rural academic medical center in the country. And people say, well, how do you know that? They actually see how many people live within 30 miles of the academic medical center. And we have only 170,000 people within 30 miles of Dartmouth Hitchcock Medical Center, which is our academic site. And the next most rural is Mayo, which has about 230,000 people.

00:04:15:19 - 00:04:54:25
Joanne Conroy, M.D.
And then you have a number of organizations like University of Virginia, Carilion Clinic, that actually have small city populations. I would say, Dartmouth Hitchcock, when you kind of think about how did we get here? And really we sit on 200 acres, and you wouldn't even be able to see us from the highway. And yet, when you turn down the roads that bring you to the institution, all of a sudden you have over two million square feet of research infrastructure, clinical services, outpatient services, as well as the Hitchcock Clinic offices.

00:04:54:27 - 00:05:34:23
Joanne Conroy, M.D.
And, you know, people drive two, three hours here to get their care. Rural health care in New England is probably different than rural health care in the Midwest, which is different from rural health care in the Southwest. They all have a little different flavor, but they all share many of the same challenges. When you think about the importance, however, 20% of people in the U.S. get their care from rural hospitals, and we have made a commitment to actually supporting what we call the rural safety net, which bridges New Hampshire and Vermont.

00:05:34:25 - 00:05:46:23
Joanne Conroy, M.D.
That's been the focus of not only the hospitals that we bring into our network, but also the services we invest in to allow care to be delivered locally and for people to stay in their communities.

00:05:46:25 - 00:06:11:15
Shannon Wu
Yeah, that's great. And let's dig into some of the challenges, that comes with serving patients in rural communities. We know that health care workforce has experienced many challenges, especially during this past few years. There's both a nursing and physician shortage, and it must be very tough to recruit and retain the clinical workforce that you need, in such a rural footprint.

00:06:11:17 - 00:06:15:16
Shannon Wu
What have you done at Dartmouth Health to address some of these staffing challenges?

00:06:15:18 - 00:06:38:18
Joanne Conroy, M.D.
So, yes, and no. So yes, it's a challenge, but there is a certain type of person that actually wants to live and work in a place like Dartmouth Hitchcock. So let me first talk about our attitude towards remote work. We took all of our jobs at the academic medical center and decided which ones were going to be permanently remote.

00:06:38:21 - 00:07:01:11
Joanne Conroy, M.D.
This was probably a year, a year and a half into the pandemic, and we have close to 2,500 people that are permanently remote. We employ people in 35 states, which makes some of our tax people a little bit crazy because we have to, you know, make sure that we adhere to the employment law in every single state and file all the forms.

00:07:01:14 - 00:07:24:05
Joanne Conroy, M.D.
But what it does allow us to do is actually find talent all across the country and actually leverage that talent. So our performance network is scattered across the country, but we have incredibly talented people that we could not recruit if they actually had to be within, you know, 45 minutes of Dartmouth Hitchcock in order to be on site.

00:07:24:08 - 00:07:45:24
Joanne Conroy, M.D.
And another thing we found out is that often we have professional marriages, and in rural America, it's not just the person you're recruiting, it's their partner as well. And they have to find gainful employment. So a lot of this is solved by really remote work and really getting good at remote work. The second thing are nurses and physicians.

00:07:45:27 - 00:08:08:03
Joanne Conroy, M.D.
And, you know, people love working up here. I mean, if you love really being in the outdoors, we are literally 15 minutes away from a ski slope, and in five minutes you could be on your bike mountain biking, and a lot of people do ride to work, and a lot of people have kayaks on the top of their car.

00:08:08:03 - 00:08:33:12
Joanne Conroy, M.D.
And, you know, it's less than 10 minutes and you're flipping that into the water, so you can actually really enjoy the outdoors here and don't have to travel two or three hours to do that. You're actually living in this wonderful place. Unfortunately, our issues are the same across the country. Housing, transportation, childcare services, all the things that are less of a challenge in the city.

00:08:33:15 - 00:09:00:08
Joanne Conroy, M.D.
We actually are subsidizing housing for our clinical frontline providers. And we've been talking about building housing. It's just it's that bad. Now, we know that once we start doing it, everybody else in the community is going to say, that's not a bad idea. How can we actually use the same approach to actually developing workforce housing? I would say that we invest in transportation.

00:09:00:11 - 00:09:27:08
Joanne Conroy, M.D.
We know that not everybody wants to drive to work, so we actually support a lot of our local transportation systems from our small city hubs where most of our employees come from. And finally, childcare. You know what distresses me the most is 10% of all the women that left the workforce during the pandemic have not come back. For many of them, it's a lack of affordable and accessible childcare.

00:09:27:10 - 00:10:01:26
Joanne Conroy, M.D.
So we've invested a tremendous amount of time and effort to actually educating more early childhood educators so they can either participate in the large centers we have, and we have a number of them, and or start small businesses in their home where they can take care of kids in their home. And, you know, my hope is this way we make it easier for women to come back into the workforce because we're 85% female, and we know that having 10% of that workforce not be available is a huge issue for us.

00:10:01:28 - 00:10:07:09
Joanne Conroy, M.D.
But, you know, those are the challenges that they face in many other rural areas of the country.

00:10:07:12 - 00:10:35:00
Shannon Wu
As you alluded to, social drivers of health have also become more recognized as a major contributing factor to overall health. And as you've just mentioned, as really Dartmouth Health as the anchor institution for your community. Like many other hospitals and health systems, it is committed to promoting well-being and addressing societal factors that influence health. You had mentioned, you know, your investments in transportation and childcare services and housing.

00:10:35:03 - 00:10:46:19
Shannon Wu
How are hospitals and health systems working with community partners to address these social drivers of health in Dartmouth in particular, and other conversations you've had with other rural health leaders?

00:10:46:22 - 00:11:14:23
Joanne Conroy, M.D.
Well, we have a Center for Advancing Rural Health Equity, which is really focused on operationalizing how do you improve health? Over half the people on the board are actually community health organizations, housing authority, food banks, you know, people that are living every day trying to actually improve the conditions in which people live that are critical to maintaining their health.

00:11:14:25 - 00:11:51:08
Joanne Conroy, M.D.
They actually did a really interesting study about three or four years ago, where they identified the decrease in average lifespan from Hanover to Lebanon to Grantham to Newport to Claremont, and the difference between Hanover and Claremont, which are probably only separated by 20 miles, is about 15 years. When you look at the, you know, the drivers of health, they're actually very different in those communities.

00:11:51:10 - 00:12:20:09
Joanne Conroy, M.D.
The Hanover community is populated with a lot of professionals from Dartmouth Hitchcock, and also professionals from the college. And Claremont, it's an old mill town, and a lot of people that get the work done every day, but often in blue collar jobs or jobs that don't pay as much. And we look at the correlates between income, education, access to care.

00:12:20:12 - 00:12:55:27
Joanne Conroy, M.D.
There's a huge difference. What's great is today we actually celebrated the fact that that hospital in that community is actually joining us. And our hope is that that hospital that's anchored in the community and using all of our resources in terms of expertise, our telehealth, our back office resources, so that organization can actually have a greater return on the community investment and then reinvest it in their facilities and programs, will ultimately improve the health of the community at large.

00:12:56:00 - 00:13:20:01
Shannon Wu
That's great to hear. The next question is going to be a two-part question and how we talked about some of this, but what are some of the other challenges you see that face rural hospitals and providers, in delivering care to their patients? But then, hopefully to end on a positive note, what innovations and opportunities are you seeing in this space as well?

00:13:20:03 - 00:13:46:19
Joanne Conroy, M.D.
We have actually looked at hospital at home frequently. It is hard to do it in a rural community when internet is spotty, questionable, consistent electrical and water sources. We talk about how do we deliver care in the homes differently. We do have a visiting nurse and hospice association, and I've actually gone on a lot of their intakes.

00:13:46:19 - 00:14:15:26
Joanne Conroy, M.D.
And I'm so impressed how they just kind of take the patients where they are and say, how can we actually appreciate this environment so this patient can get better and will no longer need our services. So those are some of the really unusual challenges. On the flip side, we have some remarkable innovations. We have a super strong, telehealth program.

00:14:16:01 - 00:14:50:02
Joanne Conroy, M.D.
It's interesting, it’s provider to provider. So we actually provide the care to outpatient clinics, to hospitals, to physicians’ offices. And a lot of that is so people don't feel like they have to refer everybody to the academic medical center. But if they have a simple question or want some guidance in terms of how to deliver care to that patient in their rural office or in their rural hospital, that we can actually give them the answer right away, and that patient can have some resolution of what their care plan is going to be.

00:14:50:04 - 00:15:26:13
Joanne Conroy, M.D.
We also have a lot of physicians that do a lot of traveling. They get in their cars and they work in clinics. Often our emergency room physicians travel all over our rural network, and that actually allows for a great exchange of ideas between the physicians that are at those facility, interacting with physicians from the academic medical center. And, you know, it's an incredibly positive relationship that actually enhances the systemness that we have, and actually improves the ability of people to actually keep people in their community.

00:15:26:15 - 00:15:55:00
Joanne Conroy, M.D.
And finally, we used ECHO, the ECHO program a lot during the pandemic, not only to educate people about COVID, but we actually have used it on all the specific disease challenges we face in the communities: substance use disorder, stroke, cardiovascular disease, liver disease. So people in the community feel like they get the resources they need to care for patients.

00:15:55:03 - 00:16:27:16
Joanne Conroy, M.D.
And, you know, after the Dobbs decision, we're offering ECHO programs through emergency rooms across the country because with the diminution of women's reproductive health services and maternity services across the state, we know that many of these patients are going to be going to emergency rooms. And those emergency room providers are ill equipped necessarily to take care of women in active labor, or a woman whose pregnancy is at risk.

00:16:27:18 - 00:16:41:20
Joanne Conroy, M.D.
So we have an OB kind of Maternity 101 for our emergency rooms. And our hope is this will help people stabilize those mothers before they needed to be transported to the academic medical center.

00:16:41:22 - 00:17:13:09
Shannon Wu
Well, thank you very much for sharing what you and Dartmouth Health are doing in providing care, for patients in your rural communities and sharing some of the innovations and opportunities you see that other providers, can take on as well. Before we wrap up, Joanne, I wanted to mention to our listeners that you and the CEOs from MaineHealth and the UVM Health Network will be presenting at the AHA Rural Health Conference in February 2025, in San Antonio, Texas.

00:17:13:11 - 00:17:32:03
Shannon Wu
We're very thrilled that you'll all be there to discuss the topic of rural health delivery. So thank you for your time, Joanne, in joining us in San Antonio. And we hope everyone who is listening will also consider heading to Texas for that event. So once again, thank you very much, Joanne, for being there. And thank you to our listeners.

00:17:32:05 - 00:17:34:26
Joanne Conroy, M.D.
Thank you, Shannon. It's great to be here.

00:17:34:28 - 00:17:43:10
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:09 - 00:00:21:21
Tom Haederle
Distance and lack of transportation. Obtaining a prescription and then paying for it. These are just some of the challenges that make accessing mental health and addiction services especially difficult in rural communities.

00:00:21:24 - 00:00:43:01
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Access to quality care in rural communities often presents problems that defy easy solutions. Still, there are workarounds, as we learn in this podcast hosted by Rebecca Chickey, the AHA's senior director for clinical affairs and workforce.

00:00:43:04 - 00:01:06:17
Rebecca Chickey
Indeed, it's an honor to be here today with Brenda Romero. I have known her for over a decade now. She is a past member of AHA's Committee on Behavioral Health, our national advisory committee that helps us with our advocacy and policy, as well as resource work. And that's why Brenda is here today as a CEO of a small rural hospital in New Mexico.

00:01:06:19 - 00:01:31:21
Rebecca Chickey
She has a great deal of experience, some of which she's going to share with you here today about improving access to mental health and addiction services in a small rural community. So, Brenda, welcome. Thank you for sharing your time and expertise. My first question to you is, what are a couple of the biggest challenges to accessing behavioral health in a rural community?

00:01:31:25 - 00:01:37:09
Rebecca Chickey
For those many, many listeners who live in an urban, metropolitan area, help them understand.

00:01:37:11 - 00:02:09:20
Brenda Romero
The first issue is access to the care in that rural communities don't usually have taxis. Transportation is an issue. And for people who are suffering from this illness, they're usually couch surfing or living out in the streets. And so finding them and getting them to the care is usually the first issue that we encounter. And the second is getting them the medication. The cost

00:02:09:20 - 00:02:38:15
Brenda Romero
of the medication can be up to $500 a month. And getting them the prescriptions is one thing, but then getting them the medications is another. Usually people with that presentation don't have a payor source, and so then it would require somebody giving them that money and willing to support that every single month. In order to increase compliance with medication treatment

00:02:38:20 - 00:03:03:26
Brenda Romero
we have started using some medications, like Brixadi, that we can give in the ER or in our infusion center, and it'll last a whole month. And we're using that type of medication for pregnant women that present and that we're not sure if we're going to see again for some time. And so that's been helpful.

00:03:03:28 - 00:03:27:15
Rebecca Chickey
So I'm going to hit home with a couple of things that you said for people who live in Chicago or New York or even Nashville, Tennessee, where I lived for a number of years. The fact that there's not a taxi is really sort of like, what? And I suppose that same lack of transportation services, you don't have an abundance of Uber drivers or Lyft drivers in your community either, right?

00:03:27:16 - 00:03:53:11
Brenda Romero
No, it's not available. And when you're talking about where these patients need to come from, we are in Espanola and there's about, there's less than 10,000 people that actually live in the city. And then there's Rio Arriba county, and it can be 100 miles to one of the borders. So we're talking about they come from surrounding communities. So it's not like somebody can walk there.

00:03:53:13 - 00:03:55:13
Brenda Romero
They need to find a ride.

00:03:55:15 - 00:04:18:17
Rebecca Chickey
And so that means relying on family or friends who may or may not also have transportation services. So just that physical capability of getting to the hospital or the emergency room is a challenge that many of our listeners probably can't imagine, but I can. Having grown up in rural Alabama, when EMS tried to get to my father, they couldn't find the house because there was no GPS at that time.

00:04:18:19 - 00:04:49:26
Rebecca Chickey
The next thing that you mentioned is the cost of the medications. So that's not unique to mental health. There always seems to be an article in the news or a discussion somewhere about the cost of medications, but these medications are for our most fragile patient populations because they often, and please correct me if I'm wrong, but they often have physical comorbidities as a result of or perhaps one of the reasons that they may be self-medicating with substances.

00:04:50:03 - 00:04:56:29
Rebecca Chickey
So their physical health and their mental health are often fragile and being challenged. Is that an accurate statement?

00:04:57:01 - 00:04:58:09
Brenda Romero
Yes.

00:04:58:11 - 00:05:16:02
Rebecca Chickey
And so because of that, tell me why it's so important to be able to provide a medication that lasts for a month. Is that to know that you don't have to worry after that because of compliance issues, because the patients are actually going to, they don't have to worry about that then.

00:05:16:05 - 00:05:48:23
Brenda Romero
Yes, it's not only compliance, but it's actually getting the medication. And so usually they don't have a payor source so they don't have Medicaid. And if they have Medicare due to a disability, they usually haven't signed up for part D or any of the other parts that they need to get payment for the medications, for prescriptions. And so if they were to try to go get their medications and be compliant with that, most times they wouldn't even get the medications because they can't pay for them.

00:05:48:26 - 00:06:07:24
Brenda Romero
And if a family member is willing to start them on it, like pay for the first month, it's pretty hard to get somebody to commit to just continue to pay for that. In order to get them on Medicaid, they would have to then get all the paperwork in order to apply. And they can apply online.

00:06:07:24 - 00:06:28:24
Brenda Romero
But some of these older folks don't have the capacity to be able to do that. They don't have the phone. They don't have the experience with getting on a website and filling in all the information that they need. And some of that information that they might need is to upload a copy of the birth certificate, and they might not have the birth certificate.

00:06:28:26 - 00:06:37:12
Brenda Romero
So the barriers are huge for them. They can't get there. And so I think that...

00:06:37:15 - 00:06:40:28
Rebecca Chickey
So what's your solution? What have you been creating, what have you been innovating.

00:06:40:28 - 00:07:01:18
Brenda Romero
So what we've done is we've started the treatment in the emergency room and then following them up in the clinic. And if we can get them started on medication, then we can buy more time to work with peer counselors, to work with case managers to help them get what they need in place in order to continue the treatment.

00:07:01:21 - 00:07:29:00
Brenda Romero
We are also encouraging the homeless shelters to work with the homeless population and to get them to our E.R. if they can do that. Presbyterian Healthcare Services, organization I work for, is now also asking if our paramedics can start giving out some of the medication when they respond to a call, if the patient is willing to start the treatment at the time.

00:07:29:07 - 00:07:37:17
Brenda Romero
So we're trying to figure out how to get the medications to folks where we can, even if they can't afford to do it.

00:07:37:19 - 00:08:04:08
Rebecca Chickey
So it sounds like you're taking advantage of every opportunity where there's a touchpoint with a patient that has this need. Yes. That's phenomenal. It's, I think, a broader sense of patient-centered care. You're going to where the patients are and providing the services. So do you think this innovative idea is replicable? Can it be implemented by other organizations in a similar crisis situation?

00:08:04:08 - 00:08:11:23
Rebecca Chickey
I would say because the challenges that you described almost seem insurmountable. But do you think others could replicate it?

00:08:12:00 - 00:08:35:21
Brenda Romero
Yes. Also, keeping in mind that, especially at the beginning, they're not going to have a payor source, right? So we're going to have to start that and not be reimbursed for that. But it makes a huge difference, not only most importantly to that person's life. Right? Like, who wants to be suffering like that? And then it starts improving their participation in society

00:08:35:21 - 00:09:02:27
Brenda Romero
and with their family members. And in our area it's a very family-oriented area, and most people who don't have a place to live will have a place to live if they sober up. And so reuniting those patients with their families is just, it would be an amazing thing to do. And then their reentry into their communities would be another win for everybody, right?

00:09:03:00 - 00:09:25:08
Brenda Romero
And makes it a safer place for the patient and for the communities that they live in. And so I think it's very, very important. I think it's worth it to everybody. There's something in it for everyone. And I think that one way to start is to assess what the barriers are, what are the barriers that those patients in your community are experiencing.

00:09:25:08 - 00:09:37:07
Brenda Romero
Because as you said, bigger communities have transportation. They have other ways to get around. So the patients in their community might not have the same barriers that we have in ours.

00:09:37:14 - 00:09:59:26
Rebecca Chickey
Yeah. As you were describing the long-term impact of this, if an individual gets on a medication that helps them remain sober for a month, then that gives them hope, then they may be able to get traction to go back and live with their family. Then they may be able to get a job. And that is something that is priceless, right?

00:09:59:29 - 00:10:26:15
Rebecca Chickey
You can't really put a price on giving someone their humanity back. But at the same time, the reality is that often no margin, no mission. So I realized that this is a new innovative initiative that you undertake, and so you probably haven't, you don't have hard data on that. But I would assume that what you're hoping is that you're going to see fewer emergency room visits, which we all know are costly.

00:10:26:17 - 00:10:54:12
Rebecca Chickey
I assume that you're going to have less use of emergency services outside, sending someone out to rescue someone who is in a crisis from a substance use disorder. And perhaps even you will see a reduction long term in things like cirrhosis, in things like congestive heart failure, in wound care for individuals, depending upon what the substance is. Is that what you're hoping for in the long run?

00:10:54:15 - 00:11:21:19
Brenda Romero
Yes. But most importantly, saving people, saving people's lives, right? They are at risk of death every day, premature death every day. And there's a lot of violence that's, you know, associated with this diagnosis. And so not only the patient's life, but their family and friends and other community members walking around. I mean, it would improve all of that also.

00:11:21:21 - 00:11:33:08
Rebecca Chickey
So it's a population health approach, I agree. Thank you. So much, one, for the work that you're doing. Boots on the ground, making a difference in individuals' lives. And thank you for sharing that inspiration with us here today.

00:11:33:10 - 00:11:34:27
Brenda Romero
Thank you.

00:11:35:00 - 00:11:43:10
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00;00;00;14 - 00;00;24;21
Tom Haederle
The reality of today's health care workforce is this demand outstrips supply. So every health care employer knows it's more important than ever to support their people and give them good reasons to stay not just surviving, but thriving.

00;00;24;23 - 00;00;53;05
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. For rural health care providers, especially, building and sustaining a strong and vibrant workforce that can meet the community's needs is paramount. In this podcast, recorded for the ages 2024 Rural Health Care Leadership Conference, we learn how the use of team steps and other tools has made a big difference for one rural system in Washington state, says today's guest.

00;00;53;13 - 00;00;57;08
Tom Haederle
The well-being of our team is foundational to everything we do.

00;00;57;10 - 00;01;19;05
Elisa Arespacochaga
Hi, I'm Elisa Arespacochaga vice president for clinical affairs and workforce, and today I'm joined by Brandie Manuel, chief patient safety and quality officer at Jefferson Healthcare in Port Townsend, Washington. We're talking about supporting the current health care workforce so that they can move from surviving to thriving. So, Brandie, let's start with tell me a little bit about yourself and your role at Jefferson.

00;01;19;08 - 00;01;39;26
Brandie Manuel
Thanks. I am a registered nurse. My background and I have been with Jefferson Healthcare for about 11 years. I started there as the Director of Patient Safety and Quality, and my role has evolved over time, and my interest in workforce development and supporting our workforce really goes back to wanting to provide the best patient outcomes for our community.

00;01;39;26 - 00;01;44;07
Brandie Manuel
And that's hard to do when you don't have an engaged team to take care of them.

00;01;44;09 - 00;02;12;06
Elisa Arespacochaga
Absolutely. So you're at a rural organization, but you still have to coordinate care across a huge area with a number of different partners across the continuum, some of which may be a boat ride away, some which may be several hours in a car away, all of which have an impact on the well-being of your team. So how do you coordinate some of that work to make sure that all the good you're doing for your own team continues to spread across that continuum?

00;02;12;09 - 00;02;36;00
Brandie Manuel
I think it has to do with how well we are collaborating with our external partners, as well as how well we're managing the work internally. So we've developed relationships with our paramedics. We have developed a community peer medicine program to look at fall prevention in older adults, and then we also work collaboratively with several of our partners, both across the water and even right next door.

00;02;36;02 - 00;03;02;02
Elisa Arespacochaga
That's great. So your organization, you've really understood that during the pandemic, you've really needed to help your own team thrive, because there weren't a lot of other people you could bring in. Tell me a little bit about how you really leveraged some of the work around teamwork. I know you were a big proponent of TeamSTEPPs and team training, which I am as well, but how did you leverage that work to really help your organization thrive?

00;03;02;05 - 00;03;23;07
Brandie Manuel
I think for us, we started TeamSTEPPs several years before the pandemic, which was fortunate because the tools and strategies really helped as we were navigating through that. So implementing and hardwiring things like huddles, briefs and debriefs, making sure that there's role clarity on the team and just really helping our teams use those tools to operate at the highest level that they could.

00;03;23;10 - 00;03;44;27
Brandie Manuel
Became critical during the pandemic, especially when you didn't know everybody that you were working with. We went from knowing every face in the hallway to having travelers, which we had never done before, and hiring new faces that were now covered by masks and no benefit of real social interaction outside of work. So having strong team skills and communication became pretty important.

00;03;45;00 - 00;04;09;15
Elisa Arespacochaga
And for those who don't know, TeamSTEPPs really is a rubric to take that team of experts and make them an expert team. And I love that definition, because it really is about how do you get everybody on the same page quickly? Tell me a little bit about what's up next in your plans and how you're going to sustain some of the improvements you've made in terms of really helping your teams gel and supporting them in their well-being?

00;04;09;17 - 00;04;28;21
Brandie Manuel
Yeah, we've just restarted TeamSTEPPS in person, so we did the updated curriculum, a new master trainer course in the fourth quarter. We have some new trainers coming in, and we're introducing the training as a hybrid option. So both kind of for people who've already taken it and want a refresher, but also for those who it's brand new for.

00;04;28;23 - 00;05;00;17
Brandie Manuel
And then looking at how we can embed those tools and strategies into our daily work even more than we have already, as well as our onboarding and sort of training that in addition to the work that we're doing to introduce those same tools and strategies to our medical directors and our medical staff leaders and head down the path of providing leadership tools and training for our physicians who are in leadership positions, maybe for the first time, and kind of introduce them to some of the same things we have done for our directors, managers and supervisors.

00;05;00;19 - 00;05;19;07
Elisa Arespacochaga
That's great. I know you've got a lot of different wellbeing sort of threads that are woven throughout. Can you just make that connection a little more? And I know you, you believe it. It's why you do this work. The connection between the well-being of your team and your your title. Chief patient safety and Quality Officer.

00;05;19;10 - 00;05;43;08
Brandie Manuel
The well-being of our teams really is foundational to everything we do. And for us, our mission really is to hold the trust of our community. And that starts with the people who are caring for them when they walk through the doors. So it really is personal, and it really is important that we are taking care of each other first and that our team as a whole is engaged in well and enjoying the work that they're doing.

00;05;43;11 - 00;05;47;29
Brandie Manuel
So we feel like that's really the first piece to then taking great care of our patients.

00;05;48;02 - 00;05;52;22
Elisa Arespacochaga
Absolutely. Especially since most of your patients are your your neighbors.

00;05;52;25 - 00;05;54;28
Brandie Manuel
And in some case, our coworkers.

00;05;55;00 - 00;06;15;27
Elisa Arespacochaga
Absolutely. All right. So let me wrap up with the question about what advice would you give to leaders who are looking to address organizational well-being, who may be thinking, there's too much, there's too much I've got to do to make this, to change our culture, to move our work. What are some of the things that you tried that really helped?

00;06;15;29 - 00;06;49;23
Brandie Manuel
I think starting small and really recognizing that you're probably already doing some of the things already. So things like rounding on your team, rounding with purpose, starting with some of the tools that they teach in team steps, which I am just I've seen the evidence, but I've also seen it work for us. So spending some time getting to know the people if you don't already, getting to know the people that you work with, getting to hear what matters most to them, it may surprise you and spend more time being out and experiencing what it is that they're seeing every day.

00;06;49;25 - 00;06;59;24
Elisa Arespacochaga
Brandi, thank you so much for both the work that you do and the care you're taking of your team. I think it's a wonderful opportunity, and I know you're continuing to spread it to the next generation.

00;06;59;26 - 00;07;01;12
Brandie Manuel
Thank you for having me.

00;07;01;14 - 00;07;09;24
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.