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.

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More than one in every three Americans had their health care records stolen or compromised in 2023, creating threats to hospitals and health systems across the nation. For cybercriminals, the backdoor into the protected systems of hospitals and health systems often comes via a third party. In this first of a two-part conversation, Providence’s Adam Zoller, chief information security officer, and Katie Adams, cybersecurity director of clinical technology services, discuss the potential cyberthreats posed by third parties, and prevention strategies to keep organizations secure and alert.


 

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00:00:00:18 - 00:00:25:06
Tom Haederle
More than one in every three Americans had their health care records stolen or compromised last year, making 2023 the worst year on record for cyber attacks against the health care field. So far, that is, if anyone thought 2024 would turn out better, February's cyberattack against Change Health Care - still causing widespread problems throughout the health care system - does not seem like a promising start for improvement.

00:00:25:08 - 00:00:43:09
Tom Haederle
When such cybercrimes occur, however, it's easy to lose sight of the fact that hospitals are not the primary source of data theft attacks.

00:00:43:12 - 00:01:19:10
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. For the bad guys, the backdoor into the protected systems of hospitals and health systems often comes via a third party. That could be a business associate, solution provider or some other entity. In this podcast, hosted by John Riggi, the AHA’s National Advisor for Cybersecurity and Risk, we learn more about the risks posed by third parties from two cybersecurity experts with Providence, a large not for profit health care system operating multiple hospitals and medical clinics across seven states.

00:01:19:13 - 00:01:53:00
John Riggi
Thanks, Tom. Thanks for everybody joining again today for hopefully another very interesting podcast. And we have some very special guests here with us today. We have Adam Zoller, the chief information security officer from Providence. And we also have Katie Adams, the cybersecurity director for clinical technology services at Providence. Adam, great to have you here with us. Well-known, well-respected within the entire cybersecurity community, long history in technology, including with the U.S. Army, as I recall.

00:01:53:03 - 00:01:56:01
John Riggi
Adam, could you tell us a little bit about your background?

00:01:56:03 - 00:02:19:17
Adam Zoller
Thanks, John. Really happy to be here and thank you for the kind words. Adam Zoller, like you said, I'm the CSO at Providence and I've been with Providence for about four and a half years. And prior to that, I was in the U.S. federal government space, both on the government employee side of the house and in the consulting side of the house, doing cybersecurity for the federal government, what's now the CISA organization, and then pivoted over into the commercial sector.

00:02:19:17 - 00:02:28:04
Adam Zoller
I served several years at General Electric in various roles in various companies under GE, and like I said, now at Providence. Happy to be here.

00:02:28:06 - 00:02:42:01
John Riggi
Great. Thanks. Great to have you here, Adam. And Katie, great to have you here as well. I know you've got a tremendously difficult job, as all of us do, but especially you in the medical device space. Could you tell us a little bit about your background?

00:02:42:03 - 00:03:04:09
Katie Adams
Absolutely, John. Thanks so much for the opportunity. So my name is Katie Adams and I am the director of cybersecurity for Clinical Technology Services here at Providence. And I'm actually relatively new to the cybersecurity world. So I've worked at Providence in project management and health care operations for a little over 12 years now and just stepped into this role in the last year and a half or so.

00:03:04:11 - 00:03:13:27
Katie Adams
In my role, I really work to bridge the gap between technology and patient care to promote cybersecurity throughout the organization. So looking forward to the conversation.

00:03:14:00 - 00:03:45:28
John Riggi
Thank you, Katie. Again, great to have you here. And this is a very, very timely conversation that we're about to have. Fortunately and unfortunately, as I said, your expertise is in high demand right now. And this is a very significant area of interest, specially when it comes to third party risk, which we'll be talking about today. And let me back up a little bit and talk about 2023 in the types of attacks we've seen in the volume and sophistication of these attacks and the attack vectors.

00:03:46:00 - 00:04:30:09
John Riggi
So 2023, unfortunately, is the worst year on record for cyber attacks targeting health care in hospitals, specifically. Largest number of protected health information data breaches ever. 126 million Americans had their health care records stolen or compromised last year. Ransomware attacks up 300%. Ransomware attacks accompanied by data theft as well, and of course, data extortion attacks. The ransomware attacks are the type of cyberattacks we're most concerned about because they result in, as we've seen over and over again, significant disruption and delay to health care delivery, risking patient safety.

00:04:30:11 - 00:05:06:07
John Riggi
But, you know, when I look at the numbers, Adam, Katie, there's a lot of stories behind the numbers. You dig deeper, you realize one: hospitals are not the primary source of data theft attacks. It's actually business associates, third parties and other types of health care providers. And you dig a little further and you see that not only is it the business associates that are being targeted quite heavily, it's third party technology and solution providers that are often the attack vector and the source of technical vulnerabilities which lead to other types of attacks.

00:05:06:09 - 00:05:27:00
John Riggi
And unfortunately, 2024 is not shaping up to be any better than 2023. Lots of reasons for that. Let's take a deeper dive on third party risk management and especially in organization, your side. Adam, if I could start with you. How does third party risk manifest itself in a hospital system the size of Providence?

00:05:27:02 - 00:05:51:25
Adam Zoller
Yeah, that's a great question. You know, as you mentioned, you know, hospital systems, health care providers were incredibly reliant on third parties to deliver critical services to our patients. Especially in Providence's case, the communities that we serve within and the poor and the vulnerable. And this results in these attacks against third parties and the risk results in lost productivity, both on the clinical side but also on the IT and security team side.

00:05:51:27 - 00:06:29:02
Adam Zoller
I spend a tremendous amount of my time and my team spends a tremendous amount of their time both assessing and addressing third party security risk before third parties are onboarded. And then after the third parties are onboarded, we spend a tremendous amount of time managing risk. As you mentioned, a lot of these attacks are coming in through the third party angle, whether it's reportable events like data theft events impacting business associates, or the regulatory risks that third parties introduce in our ecosystem or managing reputational impact, the third parties that introduce risk in our organization or get compromised managing that reputational impact, the results of that.

00:06:29:04 - 00:06:51:03
Adam Zoller
And then of course, the direct incident side of the house. From a third party perspective, we deal with a number of third party incidents. Like you said, 2023 was kind of a standout year when it comes to incident volume. In 2024, we're seeing, if not the same incident volume, but in the first couple of months and, you know, an increase in the first couple of months as far as incident volume is concerned.

00:06:51:06 - 00:07:14:15
Adam Zoller
And we're seeing incidents occur that span the entire gamut of types of incidents. You can imagine things like data theft, data loss that require us to report to regulators or impactful incidents like ransomware events that impact third parties. And these ransomware events can result in anywhere between, you know, a week of downtime for that particular third party, to upward of a month of downtime for that third party.

00:07:14:15 - 00:07:21:17
Adam Zoller
And when you're talking critical services that clinicians rely upon to deliver care, that can be very impactful.

00:07:21:19 - 00:07:41:17
John Riggi
Yeah, thank you for that, Adam. Absolutely right. And again, we've seen the impacts that ransomware attacks have on third parties. As you said, if they are mission critical or as I say, life critical in some instances, the bad guys have figured out, again, we're talking bad guys that are primarily based in Russia when it comes to ransomware groups.

00:07:41:24 - 00:08:07:03
John Riggi
They understand if they attack a key third party strategic node, let's say like an oncology software provider or a timekeeping service or many other or a quote-unquote "secure file transfer system," they know that gives them access to many organizations and the disruption is magnified, thereby forcing that third party in a very difficult position, perhaps to pay the ransom.

00:08:07:06 - 00:08:18:18
John Riggi
So we talked about clinical impact, Katie, that's your life and your world. Talk to us about how third party risk manifests itself on the clinical side of Providence.

00:08:18:20 - 00:08:39:02
Katie Adams
Yeah, absolutely, John. I think just to add on to what Adam was saying, you know, it really takes a village to deliver quality health care to our patients and our communities. And when third party systems go down, whether that's inside of Providence or whether it's vendors that are delivering critical care and critical services to our patients and our caregivers, it has a big impact on the organization.

00:08:39:02 - 00:08:55:29
Katie Adams
You know, we're looking at rescheduling patients for critical appointments. You know, you mentioned oncology patients. In the cancer space those treatments are really time sensitive. And so if we need to end up delaying their care as the result of a cybersecurity incident, it's a significant impact on our patients and our organization.

00:08:56:02 - 00:09:20:21
John Riggi
Yeah, thanks Katie again for pointing that out. It is the delay disruption to health care delivery by these cyberattacks which creates the risk to patient safety. I say this all the time to anybody who listen, including my current and former colleagues at the FBI and across across all government agencies. A ransomware attack on a hospital or one of our mission critical third party providers is not a data theft crime.

00:09:20:21 - 00:09:44:25
John Riggi
It is not a white collar crime. It is a threat to life crime. We understand the impacts. We see them constantly. Adam, going to get back to you for a minute. So Providence, massive system, multibillion dollar multi-state system. And I would assume that you all should not have any issues dealing with third parties at all, that you have it all under control, you have everything you need.

00:09:44:28 - 00:09:57:13
John Riggi
And those third parties simply adhere to any request you make. I don't think that's the case. But, so given your size, let's talk about how do you manage third party supplier risk at scale?

00:09:57:16 - 00:10:16:05
Adam Zoller
Yeah, you know, Providence, like other hospital systems, deals with a lot of the same sort of issues and incidents I would imagine that we're seeing sector-wide. So when we talk about managing third party supplier risk at scale, I think it's, you know, there's aspects of the people side of the house which I won't really touch on, but process certainly.

00:10:16:07 - 00:10:46:08
Adam Zoller
And then on the technical front, managing technical risks that third parties introduce also comes into play. So I think where I would start is, number one, just generally speaking, kind of on the people and process side: consolidation of roles and responsibilities when it comes to how you manage third party risk in a health care system. We've consolidated at Providence all the roles and responsibilities for clinical engineering under one accountable leader in that accountable leader roles up to the same accountable leader as cybersecurity at Providence.

00:10:46:08 - 00:11:16:27
Adam Zoller
So my boss, BJ Moore, the CIO, a huge proponent of cybersecurity and of managing clinical risk, is now accountable for both the clinical aspects of device management and engineering, but then also the cybersecurity aspects of the clinical device space and the third party applications space. And by having that consolidated level of roles and responsibilities up to one accountable leader, then you don't run into the same prioritization issues that I think a lot of my brethren in the space are are dealing with.

00:11:17:00 - 00:11:38:14
Adam Zoller
I would say also a security culture. A lot of security organizations kind of operate in the shadows and don't like to share their priorities or don't like to share the compensating controls that they have in place for cybersecurity or don't like to, frankly, share that we're having cybersecurity incidents very openly that are targeting either clinical devices or third party applications or third party services.

00:11:38:16 - 00:12:04:01
Adam Zoller
And we've taken a bit of a different approach at Providence. And that's an approach of not necessarily oversharing because there is risk to oversharing, but sharing with the appropriate level of individuals in our organization that we are facing cyber events and what we're doing specifically about the cyber events and what we're doing specifically to manage the risks. And I would also just generally say it's easier to catch issues on the way in than manage issues that are already in your environment.

00:12:04:01 - 00:12:29:11
Adam Zoller
And what I mean by that is having strong controls for vendor onboarding and third party risk assessments and architecture assessments upfront so that you're managing the risks that you accept when the vendors get onboarded into your ecosystem versus having to go play catch up and clean up after the fact makes it much, much easier. To that end, centralizing purchasing power in your organization is going to be a strong lever that you can pull to manage the risk that you're bringing into your environment.

00:12:29:11 - 00:12:48:12
Adam Zoller
Because if somebody in your in the field can't go out and buy whatever they want without going through the security process, that's going to prevent a lot of security risk from being inherited to your system. And then also, I would say just lastly, proactively address vendor security challenges and challenge the vendors when they come to you with proposed solutions that are insecure.

00:12:48:15 - 00:13:18:02
John Riggi
Thanks, Adam, for that. Couple of key points you mentioned. I think they're worth repeating. One, the consolidation of clinical engineering and cybersecurity under the same accountable leader, the chief information officer. We have seen a lot of institutions moving to that model to eliminate the gap. Quite frankly, we have seen in the other all the other alternate structure where clinical engineering biomed are totally separate, not managed by a chief information officer.

00:13:18:04 - 00:13:38:12
John Riggi
There is a gap in communication and visibility to the vulnerabilities even in inventory networks and so forth that the bad guys exploit. They have exploited very frequently. Katie, what are your thoughts on all of that Adam, you know, gave us a great overview picture. How does that impact you directly?

00:13:38:14 - 00:14:03:16
Katie Adams
Yeah, absolutely. John Well, I actually wanted to go back to, I think part of your original question that's really important to call out is how do we manage risk at scale? You know, Providence is a really large nonprofit health care organization with over 52 hospitals and and over a thousand clinics spread across seven different states. And especially because we are a health system that has combined several different smaller systems over time to become the organization we are today,

00:14:03:18 - 00:14:32:25
Katie Adams
we have a wide range of vendors, specifically in the medical device space. Different makes, different models. And so as we think about third party risk, really trying to manage and oversee all of those different permutations becomes quite complex quite quickly. And I think an additional layer that Adam was speaking to earlier is really a lot of these medical devices are so specialized from a clinical standpoint that there may often be only one or two vendors in the market that are even making this type of machine to deliver the clinical care that we need.

00:14:32:28 - 00:14:45:03
Katie Adams
And so in that case, it's really imperative that that vendor take cybersecurity quite seriously because there aren't a lot of other alternatives for us to look toward to be able to still deliver that same care to our patients.

00:14:45:06 - 00:15:14:15
John Riggi
Right. And again, I think you have some unique challenges as large as you are. There's often that misperception out there that, you know, they're large. They, again, have all the resources. They don't have the same challenges as other systems. But you have different challenges. As you said, you were formed by the acquisition of many other systems that did not have the same controls, perhaps in place, and the policies and in the wide array of vendors that you have to now deal with.

00:15:14:18 - 00:15:23:03
John Riggi
Adam, back to you. What types of incidents or events have you faced over the past several years and especially those that relate to third parties?

00:15:23:05 - 00:15:42:01
Adam Zoller
Yeah, I think if you can imagine it, we've probably faced that. And you know, Katie's also on the front line of this and and helping us remediate once we do get hit by these is attacks. But as you mentioned, John, earlier, I mean, we're seeing an unprecedented level of attacks across the health care industry and we're on the receiving end of a lot of those attacks at Providence.

00:15:42:01 - 00:16:06:23
Adam Zoller
So, you know, external attackers trying to commit payer provider fraud, you know, on the less impactful, I guess, the business operations side of the house. But, you know, just as impactful when you look at financial implications of being able to steal money that's due to a hospital systems from our payers. So we've seen a lot of fraud attempts, a lot of social engineering enabled fraud attempts, targeting our hospital system and the payers that we work with.

00:16:06:26 - 00:16:34:01
Adam Zoller
We've also seen attempted ransomware attacks. You know, knock on wood, we've been able to stay ahead of these ransomware attackers through, you know, really doubling down on doing the basics well at Providence and being very proactive in the way that we deal with managing security risk. We've also seen external attackers targeting our data for data theft purposes, you know, sometimes in conjunction with or I suspect, to be in conjunction with ransomware attacks.

00:16:34:04 - 00:16:55:09
Adam Zoller
We've also seen denial of service attacks. Those still exist and they're still being perpetrated by activist groups worldwide. We've had vendors on the third party side of the house bringing in infected laptops into our environment to perform maintenance on clinical devices and then introducing malware into our environment as a result of that infected laptop being plugged into a system.

00:16:55:12 - 00:17:17:10
Adam Zoller
We've also had third parties being hit by just about everything that I've talked about thus far, but I'll kind of zone in on number one: third parties being hit by ransomware. We've had some third parties that we rely on for clinical services that have been hit by ransomware attacks in the last several years. And as I mentioned before, those ransomware attacks have knocked these third parties offline for in some cases over a month.

00:17:17:16 - 00:17:38:24
Adam Zoller
And you can imagine that can be very, very impactful for a hospital system that's reliant on, for example, a third party to do lab work that gets hit by ransomware. And then we have to figure out where are we going to get that lab work done and then go forward. How do we work with that third party going forward to make sure that we're not accepting an inordinate amount of cyber risk by continuing to do business with that third party?

00:17:38:26 - 00:18:04:15
Adam Zoller
And then lastly, we've had third parties hit with data theft and use third parties as business associate are oftentimes then collaborating with us where we're both kind of on the hook to regulators to report these incidents and make sure that the victims of these incidents, the patients that that we care for, get notified that they were victim of a data theft event and then provide them with potentially credit monitoring or identity identity theft monitoring.

00:18:04:17 - 00:18:15:23
John Riggi
Yeah. Thank you, Adam. Clearly, the risk from your business associates transfers to you. But it's not just the technical risk. Legal and regulatory risk. All of that.

00:18:15:26 - 00:18:24:08
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.

Investing in the health and well-being of communities is a core mission for all hospitals and health systems. Their community investment can take many forms, including new housing programs, transportation outlets for patients and on-site daycare facilities. In this conversation, Joanne M. Conroy, M.D., CEO and president of Dartmouth Health and 2024 Chair of AHA's Board, talks with David Zuckerman, president and founder of the Healthcare Anchor Network, to discuss the ways that anchor organizations are creating community outreach, and how impact investing is making a huge difference for economic development.


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00:00:00:27 - 00:00:31:21
Tom Haederle
Improving and investing in the health and wellbeing of communities is a core mission of hospitals. Whether it's working with partners to support new programs in housing, transportation, daycare or anything else, it all comes down to meeting the needs of people. It's been said before, but bears repeating: Hospitals and health systems are truly anchors of their communities.

00:00:31:24 - 00:01:04:23
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. In this month's Leadership Dialog Series podcast, Dr. Joanne Conroy, CEO and president of Dartmouth Health in rural New Hampshire and 2024 board chair of the American Hospital Association, is speaking with David Zuckerman, founder and president of the Health Care Anchor Network. David is a national thought leader on the role of health systems as anchor organizations in building healthier communities through impact investing and inclusive economic development.

00:01:04:25 - 00:01:13:03
Tom Haederle
As he says, "We talk about big ideas in this country. I needed to see a path to bringing them to reality." Let's join them.

00:01:13:06 - 00:01:44:02
Joanne Conroy, M.D.
Thank you for joining us today for another Leadership Dialogue discussion. I'm Joann Conroy, CEO and president of Dartmouth Health and the current chair of the American Hospital Association Board of Trustees. I'm really looking forward to our conversation today as we speak with a national expert, David Zuckerman, about his insights and perspectives around a core mission in health care, improving and investing in the health and well-being of our communities.

00:01:44:04 - 00:02:17:06
Joanne Conroy, M.D.
There is a broad lack of understanding about how hospitals and health systems provide benefits to their communities outside the world class care we deliver within our walls. The truth is, there's a lot of great work being done in the field outside the bricks and mortar. We partner with, and we invest in communities, in the businesses and the communities in the nonprofits that are our partners and others to make sure that those we serve have the best chance to thrive and live healthy lives.

00:02:17:09 - 00:02:44:13
Joanne Conroy, M.D.
Our goal is not only to ensure our community members have access to needed medical services, but they also benefit from our investments. We've taken this mission to heart with the launch of the 2022 Center for Rural Health Equity up here at Dartmouth Health, whose mission is to give voice to the communities about what they need most to thrive and then to invest in those mutually beneficial ideas.

00:02:44:20 - 00:03:17:02
Joanne Conroy, M.D.
Health does begin by investing in the community and critical resources such as housing, transportation, daycare and most importantly, in the people in our communities. At Dartmouth Health, like other organizations, we're deeply committed to meeting the unique needs of our patients and our community, and we're doing so through pursuit of anchor designation status. Now I get to introduce David Zuckerman, who's president and founder of the Health Care Anchor Network, to discuss this concept further.

00:03:17:07 - 00:03:46:02
Joanne Conroy, M.D.
David is a national thought leader and is incredibly passionate about the role of health systems as anchor institutions and our important work in building community wealth and inclusive economic development. So, David, you work with health systems across the country that have adopted the anchor mission framework, and the numbers are growing of hospitals and health systems that are committed to helping you with this work.

00:03:46:05 - 00:03:49:09
Joanne Conroy, M.D.
How did you get started on this path?

00:03:49:12 - 00:04:14:08
David Zuckerman
I've been on this path for a bit more than a decade, and it really started with looking at what are some of the big ideas out there that are rooted in community that really could get at addressing the deep racial and economic inequities within our society. We often talk about really big ideas in this country. And for me, I needed to see a path to bringing them to reality.

00:04:14:11 - 00:04:57:17
David Zuckerman
And what really attracts me to this idea of the anchor mission and the role that anchor institutions can play in their communities, and in particular, the role health systems can play as anchor institutions is that it's a deeply practical framework with transformative possibilities. And for the last decade plus, I've been researching what are some of these examples and helping other health systems not only understand what are some of the best practices in how they can leverage their hiring practices or their purchasing or their investment, but how to make it a holistic strategy that really can allow for the full expression of this idea become a reality within communities across the country.

00:04:57:18 - 00:05:27:17
David Zuckerman
And so I've been researching it, but I also think I'm a passionate advocate for what I think is the transformative potential of this idea. Around 2017 had the opportunity to bring health systems together to say, Can we do more than just look at examples from across the country? Is there an opportunity to learn together, identify gaps so we can scale solutions to? And that became the healthcare anchor network, which had 11 co-founding systems.

00:05:27:19 - 00:05:55:08
David Zuckerman
Dartmouth Hitchcock at the time, a couple months later became one of our early members of the Health Care Anchor Network. And we've grown today to to 75 members from across the country, representing just under 40% of of health care and our independent 501-C3. So am excited about that journey and really think there's so much more we can do and we're just really in the early days of what this idea could look like.

00:05:55:10 - 00:06:13:07
Joanne Conroy, M.D.
So I've started a few not-for-profits and it is hard work. So what were you doing when this became a glimmer in your eye to actually bring it to fruition? So where did you start thinking about launching something like this?

00:06:13:09 - 00:06:36:09
David Zuckerman
Yeah, so fortunately I didn't have to do it completely from scratch. I started as a employee at the Democracy Collaborative, which was a think and do tank, which talked about big ideas for how to make more equitable the political economy of the US and part of that did the do part was what are the role of large institutions and communities.

00:06:36:09 - 00:07:02:20
David Zuckerman
And so really within that organization, I had the chance to begin to do the research, begin to build the relationships. I was really asked to build the strategy for how to engage health care. And then fortunately, we had some champions within health care systems across the country, within Kaiser Permanente, Trinity Health, CommonSpirit Health that saw the potential of this idea and said, okay, we need to form a national conversation.

00:07:02:20 - 00:07:25:05
David Zuckerman
We need the Democracy Collaborative to be the backbone. And then after the Health Care Anchor Network was formed, really with the support and collaboration of those those health systems, we then had a very quick timetable during the middle of the pandemic to spin the organization out as its own standalone nonprofit. And so that happened over the course of 2021

00:07:25:05 - 00:07:52:24
David Zuckerman
and since January 2022, we've been fully independent. So excited to now be able to fully focus on how do we scale this idea within health care and also encourage health care to think about its role within its communities to bring along other anchors, to create local collaboratives that can accomplish this work in place and really ensure that, you know, of course, no one institution can solve issues of poverty and racial inequities on their own.

00:07:52:24 - 00:08:17:21
David Zuckerman
It takes all of us, and we believe that the Health Care Anchor Network that health systems need to be the tip of that spear, but they need to be working with higher ed. They need to be working with public institutions, community foundations, other institutions to share that principles of being an economic engine or having significant resources they can leverage as well as a nonprofit or public mission.

00:08:17:21 - 00:08:26:14
David Zuckerman
And I believe the combination of those two just allows an organization to think long term in a way that it might not be able to otherwise.

00:08:26:16 - 00:08:39:14
Joanne Conroy, M.D.
There have been some amazing things that your members have done. Talk about a couple of them that have really impressed you in terms of the impact that they've had on the community.

00:08:39:17 - 00:09:05:14
David Zuckerman
Yeah. So where to start, right? I mean, if I don't name some, I might get in trouble. Name a few that really come to mind as I think powerful examples of what this work could look like. One is work that was done in Cleveland, Ohio, over the last decade, in which Cleveland Clinic University hospitals, again working with Cleveland Foundation, other partners said, you know, we have supply chain needs, we have a business problem.

00:09:05:16 - 00:09:36:04
David Zuckerman
And we also can use that as an opportunity to think about incredible social impact we can have at the same time. And coming out of that process was a recognition that commercial laundry, a critical supply chain for every health system in the country, is a very problematic industry. There are very few suppliers. The quality is suspect often. And could you create a community rooted solution that also provided jobs for those that were justice involved, individuals who have a difficult time getting jobs elsewhere,

00:09:36:06 - 00:09:57:23
David Zuckerman
right? But they need a second chance. Can you ensure that those jobs were living wage and had health insurance again, bringing people into the commercial payer system? Can you actually have a profit sharing strategy? So they're not just living paycheck to paycheck, but have an opportunity to build wealth? And can this commercial scale laundry also have sustainability principles?

00:09:57:23 - 00:10:17:27
David Zuckerman
Because that was an important priority of Cleveland Clinic University hospitals to reduce their climate footprint. And so coming out of that process was an effort to create what's now known as the Evergreen Cooperatives, starting with a commercial scale entree that employs more than 200 people, has all of those benefits that I listed. And I think that's the principle of

00:10:17:27 - 00:10:40:28
David Zuckerman
what can happen when organizations collaborate and it's rooted around a business need that needs to be solved. But there are creative people thinking about what is the additional social impact that we can have at this moment in time. Right? They could have just gone with the traditional commercial laundry. Instead it's an impact for community transformation. So that and now other organizations, other are looking at adopting that.

00:10:41:01 - 00:11:06:03
David Zuckerman
Just the other day there was an article in the Chicago Press how Rush is adapting that model for their community. Also looking at commercial scale laundry, but putting it within a larger incubator that's going to have four companies that are minority-owned and have other types of businesses that will serve the West Side of Chicago and hopefully be a catalyst for transformation for that community.

00:11:06:03 - 00:11:11:15
David Zuckerman
So that's one I think really powerful example on the supply chain side.

00:11:11:18 - 00:11:30:19
Joanne Conroy, M.D.
So talk a little bit about, but on the food insecurity side, because I think there are a number of hospitals and health systems that have identified that as a community need and somehow marry that with their either growth strategy or their clinical strategy.

00:11:30:21 - 00:12:06:17
David Zuckerman
Yeah. So I think core to the anchor strategy is where are there business pain points or that intersect with community priorities and what is an overlapping strategy that can address both? And so on the food insecurity side, where we've seen that most show up is around the opportunity to leverage investment, impact investment. And that's I know something that Dartmouth Health has really been a leader on around impact investment in affordable housing.

00:12:06:19 - 00:12:39:25
David Zuckerman
But on the food security side, we've seen a number of health systems see this as a way to get more dollars to support grocery stores coming into communities. Boston Medical Center has provide a low interest patient loan to minority-owned grocery store operator to come into a community that didn't have that food access. Hawaii Pacific Health has provided capital to support the growth of local food entrepreneurs.

00:12:39:27 - 00:13:10:20
David Zuckerman
And so in this way, these aren't these are charitable donations. These are investments to grow the local food ecosystem and also support communities that have historically lacked resources. There have been some organizations that have thought more upstream about their grant-making. And my perspective is that's really important. And there's never enough grant dollars to go around, which is why thinking about impact investing and leveraging the balance sheet in other ways is really an important strategy that organizations should consider.

00:13:10:20 - 00:13:39:18
David Zuckerman
But you have organizations like Promedica that saw this as an opportunity to attract a large philanthropic supporter to help create a grocery store that actually Promedica still owns. And I think that's a powerful example of, again, how do we think creatively about how do we address these gaps with sustainable solutions right? The goal there is for that grocery store to break even, make a small profit.

00:13:39:18 - 00:14:09:03
David Zuckerman
It's a very tough business, actually used to serve on the board of a food co-op here in Takoma Park, Maryland. It's a very tough business, very small margins. But at the same time, it's an important amenity that every community needs if we're going to address issues of food insecurity. University Hospitals in Cleveland, as part of our buildout of one of their facilities, that they went through a very intentional process to get community input on, make sure it really met community needs from a clinical perspective.

00:14:09:06 - 00:14:37:27
David Zuckerman
Also heard that it would be really important that it had a grocery store sited nearby. And so as part of that project, they recruited a grocery vendor that was locally owned to open a grocery store, basically adjacent. So I think there's a lot of different ways health systems can do this beyond just writing a check for a food pharmacy or beyond just providing a subsidy that really looks at sustainable interventions over the long term in their communities.

00:14:37:29 - 00:15:02:16
Joanne Conroy, M.D.
Yeah, I remember hearing about Promedica's grocery store that was in the first floor of the new building that they built, and they purposefully put their corporate offices downtown in one of the most economically disadvantaged areas, which has a huge impact in terms of the availability of jobs, but also making that space really an important community resource.

00:15:02:19 - 00:15:46:15
Joanne Conroy, M.D.
So why don't you talk a little bit about impact investing, because I think that's something that is a kind of a unique conversation that the Health Anchor Network has really encouraged, number one. And number two, talk a little bit about we have so much backlash on really ethics-based investing. I see coming down the pike as everything kind of comes under scrutiny. And it feels like the way you're approaching this is much more sustainable than other organizations, investment firms approaches to their investing because yours is an investment that actually creates wealth for the community.

00:15:46:17 - 00:16:10:08
David Zuckerman
And I think the power of it is that it's so linked to the mandate and the community health needs assessment. What we're trying to solve with these investments is showing up in every organizations community health needs assessment, whether it's lack of access to affordable housing, economic opportunity, food insecurity. And so I think health care has a really strong rationale for why to make targeted investments.

00:16:10:10 - 00:16:36:00
David Zuckerman
It also aligns and connects the dots between community health, diversity, equity and inclusion, sustainability, civic responsibility, social impact. So that's why I think the power of the anchor mission is not necessarily coming to replace the strategic priorities the organization has, but really to connect the dots more intentionally across the different areas that organizations are putting resources, but they're not necessarily always aligning them.

00:16:36:02 - 00:17:00:11
David Zuckerman
They're often very siloed. And I think the opportunity here is how to especially again, to your point, very tight margins in health care. So we can't afford to be using resources inefficiently. We can't afford to be siloed when we should be aligned. And that's what I think the anchor mission allows. So I think with impact investment, when I think of it first and foremost, it's a place-based strategy. And it's focused on the places that health care knows

00:17:00:11 - 00:17:21:14
David Zuckerman
there are health disparities. And from there is then thinking about, okay, how do we leverage the balance sheet? So, you as a health care organization have to hold reserves. There are you know, it's important to your bond rating. It's important to ensure when there's a downturn that you can plug any gaps in your fiscal budget. It has to happen.

00:17:21:21 - 00:17:57:02
David Zuckerman
At the same time, those dollars can be serving double duty in terms of also being put to work in your community. So they still give you a financial return, but also have a social impact. And the way I think about it is: we are asking our health systems to consider allocating 1% out their reserves. And that would be, from my perspective, puts you within the leaders across the country and the amount of financial return you're giving up on 1% is really a rounding error over the long term for an organization, but it's a game changer for a community.

00:17:57:04 - 00:18:26:12
David Zuckerman
And I look at the example of what you guys have done in New Hampshire with the New Hampshire Community Loan Fund, Right? It's a very reputable organization. You're not going to lose your money and you're really providing critical dollars that are going to touch every part of the communities you serve with health care. And that, I think, is and is a low hanging fruit type strategy that many organizations can start with, which is, okay, here's a very reputable community development financial institution, other type of loan fund.

00:18:26:18 - 00:18:45:29
David Zuckerman
We know we're going to get our money back. We know we're going to get a financial return and we know we're going to get reportable metrics as that we helped create this many affordable housing units in our community. We help finance this grocery store there. We helped allow this child care center to open over there, this community center to open over here.

00:18:46:04 - 00:19:16:02
David Zuckerman
So we know that. But then the next level is while you're thinking about those early stage investments, are what are the type of collaborative investments that might be a little bit more difficult to pull off, but incredibly catalytic. And I think about that as being the Upper Valley Community Loan Fund that you've all supported equally, being an example of how to do this in a rural community, bringing together many mission focused individuals that all had very critical business needs, right?

00:19:16:02 - 00:19:55:00
David Zuckerman
They needed to have housing not just for community members, but for their customer base, in your case, your patients and also their employees. So I think health care in particular, very focused on people, patients, community and investment is an area especially you think about affordable housing that's really providing a solution to all three. And so I think it's it's an area that health systems, as they look at the dollars they have, this is one in which there is a lot of gain that can be created in a short period of time versus some of the other strategies that we talked about.

00:19:55:03 - 00:20:19:17
Joanne Conroy, M.D.
Yeah, you're right. That actually was not a difficult lift, but it did take us about five years to work with the CEO Council for Vital Communities, which is our group of employers across the Upper Valley, to get them to a place where they said, yes, we're all going to commit and everybody didn't commit equal amounts because some of us are bigger than other organizations.

00:20:19:17 - 00:20:49:16
Joanne Conroy, M.D.
But everybody did commit something. And then using a few sharp elbows to bring some people into the fold, that should have been in there. And they're happy they joined. Now, once you get it going, it is incredibly successful. And we've had a number of developers that will commit to building low income housing, and low income is not as low as it was years ago, but housing at a certain percentage of our employees can actually afford.

00:20:49:21 - 00:21:02:12
Joanne Conroy, M.D.
So I think the next step that we're into, though, is single family homes. And how do you create homeownership? Because that's actually when you start to see the multipliers, I believe.

00:21:02:14 - 00:21:23:12
David Zuckerman
And I think to your point that took five years. And that's one of the more complicated investment strategies that are out there, right? The effort to make a loan with the New Hampshire County Loan fund was, you know, yes, there's always that conversation, getting everyone comfortable with the idea. But once you get the organizational buy-in, it can move very quickly and you can deploy those dollars.

00:21:23:12 - 00:21:45:10
David Zuckerman
And I think that's that's kind of the spectrum of way organizations can consider getting started with the impact investment. I think just two things that I would add to that is we actually just had an article in The New York Times just the other day looking at the landscape of organizations supporting housing and the Health Care Anchor Network.

00:21:45:10 - 00:22:07:14
David Zuckerman
Most of the health systems in the nation that are doing this impact investing strategy participate in Health Care Anchor network. It's still a relatively small number. It's about 20 that have some type of active impact investing strategy. And those 20 have deployed over the last couple of years about $600 million to these impact investments, of which about 450 million is for housing.

00:22:07:16 - 00:22:24:00
David Zuckerman
That sounds like a lot of money, but it's actually really a small percentage of the overall investable assets. And institutions have, which for me means that that opportunity is so much greater than what's already been done. And that's what I get excited about.

00:22:24:02 - 00:23:00:10
Joanne Conroy, M.D.
So for our final question, I'm asking you to share your insights on collaboration. And you articulated this before that, you know, no health system, no matter how well funded or well organized we are, we can't solve social problems alone. It really takes a broad network of community partners in order to do that. So what do you think is the most effective way for organizations to identify other interested organizations to partner, collaborate with, with community partners in this work?

00:23:00:12 - 00:23:27:17
David Zuckerman
I think it's a combination of getting out there and talking to them and getting out there and listening to them. We are working with an organization called Center for Community Investment, and it's a cohort within the Health Care Anchor Network. And so we've taken four of our health systems that are at that point of where they've gotten buy-in and they've gotten allocation and they want to build the pipeline of projects and we're taking them through an 18 month learning process on how to do that.

00:23:27:19 - 00:23:55:19
David Zuckerman
And key to that is getting out there and building those community relationships. And we help organizations understand who they could meet with, whether that's just getting a list of community development, financial institutions in their community, whether that's time to meet with community development corporations, other nonprofits that have been focused on community development and transformation. And I think what's important, at least with this tool that we're talking about today, is making clear that it's not a grant.

00:23:55:22 - 00:24:04:10
David Zuckerman
These are dollars your institution expects to get back and you're looking for partners that will help you find projects that are investable.

00:24:04:13 - 00:24:24:04
Joanne Conroy, M.D.
It was really great, David, to hear your insights and the work you're doing in our field and on behalf of the American Hospital Association and Dartmouth Health and all of us in health care, I want to thank you for joining me today for this discussion and sharing your valuable insights. And my thanks to all of you for finding time to listen.

00:24:24:07 - 00:24:28:18
Joanne Conroy, M.D.
I'll be back next month for another Leadership Dialogue. Thank you.

00:24:28:20 - 00:24:37:00
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

In the health care field, women occupy only 15% of C-suite executive positions, and for women of color that percentage is even smaller. The importance of gender and racial diversity in health care leadership is clearer than ever, and organizations dedicated to equity in executive roles are building successful visions for the future. In this conversation, Roxie Wells, M.D., senior vice president chief physician executive and strategy officer with Novant Health Coastal Market, discusses her long journey to and through the health care C-suite, and the importance of mentoring young women leaders through the glass ceiling and beyond.


 

View Transcript
 

00;00;00;22 - 00;00;30;29
Tom Haederle
It's well known that women make 80% of the health care decisions in the United States. Yet they occupy only 15% of executive C-suite positions. And for women of color, that ratio is even smaller. The importance of gender diversity in health care leadership is clearer than ever. And the glass ceiling, while still there, can be broken.

00;00;31;02 - 00;00;56;26
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. March is Women's History Month, a good time to celebrate ambitious, talented and successful women who serve in executive positions in health care. One such trailblazer is Dr. Roxie Wells, senior vice president, chief physician executive and strategy officer with Novant Health Coastal Region in North Carolina.

00;00;56;29 - 00;01;17;29
Tom Haederle
She is also a past member of the AHA Board of Trustees. In this podcast, hosted by Ogechi Emechebe, senior communication specialist with AHA's Institute for Diversity in Health Equity, Dr. Wells talks about her long journey from her childhood in rural Alabama and how mentors, inspiration and hard work brought her to where she is today.

00;01;18;02 - 00;01;23;12
Ogechi Emechebe
Thank you so much for joining me today. Before we get started, just tell me how you're doing so far.

00;01;23;15 - 00;01;34;09
Roxie Wells, M.D.
I am doing well. It's beautiful here in Wilmington, North Carolina. The sun is shining. It's a beautiful city. I couldn't ask for more. So I'm doing extremely well. How about you?

00;01;34;11 - 00;01;54;20
Ogechi Emechebe
I'm doing great. Thank you. So I'm glad to hear you're having really sunny weather. It's a little bit rainy over here, but we'll make it. We're really excited to have you today because the conversation is going to discuss the importance of gender diversity and health care leadership, specifically women in C-suite positions. So currently, about 15% of health care system CEOs are women.

00;01;54;22 - 00;02;08;15
Ogechi Emechebe
And you are a family medicine physician and also the senior vice president, physician executive and strategy officer at Novant Health Coastal Market. Can you walk us through your journey into health care and what inspired you to enter the field?

00;02;08;17 - 00;02;34;05
Roxie Wells, M.D.
Sure, I'm happy to do so. You know, years ago, I grew up in a rural community in Alabama. My mom served as a midwife for a large percentage of the African-American moms who were delivering in my town. She was actually trained...Back in the day, you could be trained as an apprentice by the family physician in towns and rural communities.

00;02;34;05 - 00;02;58;04
Roxie Wells, M.D.
And so she was trained by the family physician there. And I remember from being a very small child, seeing her leave and go to attend these deliveries. And as I got older, I recognized what she was doing and the importance of it. And then as I aged even more, even some of my peers were babies that she had delivered while I was small.

00;02;58;04 - 00;03;43;25
Roxie Wells, M.D.
And so it just kind of made me really think about health care as a career choice. Although I did not understand at the time that I could actually become a physician because there weren't physicians of color in my town, and I don't recall having women physicians in my town. It wasn't until I moved to a larger city in Alabama and then here in North Carolina that I really saw women physicians in action and women physicians of color in this career and that's sort of how I got into health care and how I became a physician, was just really recognizing that it was truly an option for me.

00;03;44;00 - 00;04;28;26
Roxie Wells, M.D.
It was something I've always wanted to do. I just didn't necessarily have the path to it. And so once I was able to be mentored by individuals at my university or individuals in my circle, I decided it is something I could do. And so I attended medical school at East Carolina University in Greenville, North Carolina. After I left there, I did my residency actually down here in Wilmington at Coastal Family Medicine and then went to practice at a rural community with the hopes that my being in that rural community would be another way for young people to see me and know what their possibilities could be.

00;04;28;29 - 00;04;51;06
Ogechi Emechebe
That's really great. So you said that you really didn't see women who looked like you or women in general until you got to Alabama and North Carolina. Then you started connecting with women who mentored you and prepared you to come into this position currently. So can you describe more about that mentorship and how did they prepare you and guide you to make sure that you are not only just breaking barriers, but you have a seat at the table?

00;04;51;09 - 00;05;28;02
Roxie Wells, M.D.
Well, you know, some of those women weren't necessarily physicians, but they were leaders in their fields, in their own right. And so they sort of transferred that leadership to me and they, I think, saw something in me that kind of piqued their interest in the things that we see when we look at leaders are people who are potential leaders and something about me stood out for them and they just started to mentor me and introduce me to people who were in the medical field and who were in the institutions of higher learning that could connect me.

00;05;28;05 - 00;05;54;29
Roxie Wells, M.D.
You know, a mentor at my HBCU Fayetteville State University here in Fayetteville, North Carolina, was one of the first African-American women to graduate with a Ph.D. from UNC-Chapel Hill. I mean, really, what better mentor could you have than Valeria Fleming, who had a Ph.D. in biomolecular science and who served as a mentor and as a teacher for me.

00;05;55;06 - 00;06;15;15
Roxie Wells, M.D.
I remember her calling me one day, and that's before we had cell phones. I didn't make it to class one day, and she called me and she said, Miss Wells, did you miss my class today? And I said, "well, yes, ma'am." And she said, "were you dead?" Well, no. She said, "well, that won't happen again, will it?" And I said, absolutely not.

00;06;15;16 - 00;06;28;09
Roxie Wells, M.D.
And it's that type of intentionality that actually helped propel me to become a physician. And to really think about leadership the way I think about it today.

00;06;28;11 - 00;06;33;24
Ogechi Emechebe
That's such an excellent story. I love that example about your professor holding you accountable. I liked that.

00;06;33;27 - 00;06;58;14
Roxie Wells, M.D.
She held me accountable and recently we just lost her about a week or two ago. But she held student accountable her entire career. She was tall and statuesque and just brilliant and smart and just exuded everything that you would want to be. And so she just kind of drew you in and you wanted to make her proud and you wanted to do the right thing.

00;06;58;14 - 00;07;07;02
Roxie Wells, M.D.
And she just mentored tons of young women and men, really through sciences and health care.

00;07;07;04 - 00;07;30;28
Ogechi Emechebe
So going off of that, it looks like you're really following her footsteps because let's talk now about the roundtable for black women CEOs. So I will give our listeners a quick summary about it. So in 2022, the AHA and IFDHE launched a roundtable for black women CEOs to promote impactful relationships and amplify the voices of black women who support hospitals and health systems

00;07;31;01 - 00;07;52;20
Ogechi Emechebe
as CEOs to grow. So this group offers a safe space for black women to learn, share their experiences, and also be really safe in an environment where they may not be able to share these experiences in a universal setting. So up to date, there are almost 30 members. I know you were instrumental behind the formation of the group. Can you tell us more about how this came about?

00;07;52;22 - 00;08;25;15
Roxie Wells, M.D.
Sure. Happy to do so. You know, I sat on the AHA Board of Trustees for three years and really started to ask the question, are there black women, other black women CEOs in this country? And if so, where are they and who are they? And really just set out to really find them. I basically wanted to look for a community where I felt safe and felt comfortable sharing vulnerabilities that I felt.

00;08;25;17 - 00;08;56;11
Roxie Wells, M.D.
Being able to ask questions, being able to really have unencumbered discussions about equal pay or any type of biases that that I may have noticed or that other women may have noticed. And really just asked AHA leadership about opening or forming this group. And when we first set out to really see who was out there, I think we started with about 17 women.

00;08;56;19 - 00;09;35;16
Roxie Wells, M.D.
And I'm going to tell you, we received photos and bios from them and the team at AHA sent them over to me for me to look at them. And when I first opened that email and started to look at those pictures, it became really emotional for me because I'm looking at a group of beautiful, powerful, thoughtful women in their own right who have risen through the ranks in various ways, some directly, some through circuitous routes, and that they are just performing very well in our field.

00;09;35;16 - 00;10;01;02
Roxie Wells, M.D.
And it was just an emotional experience for me. And so when we all came together for the first time at the AHA Annual Meeting about two years ago, we met for about an hour and a half and the emotion in the room was palpable. And that just made me realize the importance of forming that group. And we've continued to meet.

00;10;01;02 - 00;10;29;16
Roxie Wells, M.D.
We meet for business meetings four times a year, and in between we have social happy hours virtually. Two of our business meetings are in person, one at the Annual Meeting and one at the summer Leadership Meeting, and then the others are virtual. And we want to really look at ways to think about how we might improve quality of care for women of color.

00;10;29;23 - 00;11;12;10
Roxie Wells, M.D.
Think about how we may ask or teach people or lead people to stronger personal advocacy for themselves. Really think about personal well-being. Think about connecting with other women who may have some of the same challenges that you're having in your work roles or what have you. So it has been just a phenomenal opportunity to get to know amazing women who have storied careers in their own right and to really just celebrate all of the wonderful things that they're doing and then really to offer them a place of solace if it's needed.

00;11;12;12 - 00;11;35;20
Ogechi Emechebe
I really like that. So you said that this group has been very impactful and it's giving these women a space to just, you know, be vulnerable and share their - pretty much challenges and experiences in this field. Can you share some tips or advice that you have given them or some challenges that they're facing as black women in these roles

00;11;35;20 - 00;11;41;22
Ogechi Emechebe
and how do you all ensure that you can persevere through some of the barriers that you navigate?

00;11;41;25 - 00;12;26;00
Roxie Wells, M.D.
You know, let's make no mistake about it. They pour into me as much as I share with them. There's certainly a spirit of reciprocity in this group. You know, we discuss things from, I've had discussions about equal pay. Maybe the woman was a president of a hospital in a health system. How do you have the conversation with your system CEO about equal pay? Other things might include workforce issues and you're trying to figure out how to navigate the difficulty that we all are facing from workforce issues and making sure that our leadership teams are doing the things that they're supposed to do.

00;12;26;07 - 00;12;52;06
Roxie Wells, M.D.
When you have to have crucial conversations with individuals, whether that's a crucial conversation upstream to your system CEO or those people you report to, or whether they're crucial conversations to people who report to you. How to work through that and how to have those conversations in a way that really gets you to the place that you want to be with those individuals.

00;12;52;09 - 00;13;26;06
Roxie Wells, M.D.
So our conversations and discussions really, I mean, they range from personal: We've had members who have had personal issues, personal health scares and just talking about talking through that and what that looks like. So it really has become a community of women that not only share work and career concerns or challenges or experiences, but also talk about those personal things, well-being.

00;13;26;06 - 00;13;57;08
Roxie Wells, M.D.
How do you take care of yourself? What are the things that you do to really fuel yourself that's outside of your work life? How do you stay connected to your family? Understanding that many of us feel that there are extra hurdles that we sometimes have to jump to perform at the level that people would expect us to perform, although that may be higher than others.

00;13;57;10 - 00;14;29;28
Roxie Wells, M.D.
How do we stay true to self? How do we maintain those family and personal relationships? And how do we keep them separate from our work career goals and aspirations? And so we talk about things like that. And so it has been a wonderful experience. Our happy hours are really just to come together and laugh and celebrate each other. You know, everybody's on LinkedIn and you see all the great work that everybody's doing.

00;14;29;28 - 00;14;49;22
Roxie Wells, M.D.
And to be able to celebrate that, to be able to celebrate when one of our members are listed as the top 20 of something by Modern Health care or whomever. You know, we just want to celebrate those things and let those women know that you are phenomenal. We believe in the work that you're doing and we're here to support you.

00;14;49;25 - 00;15;22;01
Ogechi Emechebe
I really like that. It's key on being supportive of each other. So do you see a vision for the roundtable expanding beyond AHA? Essentially, do you see a vision for this being the blueprint for other systems or organizations to follow where they can offer a space for women or women of color to network with each other and amplify their voices, to not only develop a pipeline of diverse women leaders, but just to ensure that they feel supported and heard and that they can have just someone to lean on when they need it.

00;15;22;03 - 00;16;09;00
Roxie Wells, M.D.
I absolutely do. I think that it can certainly be cascaded throughout our field from the national level at AHA to the state associations, to different health systems or what have you. I mean we here at Novant, we have business groups of all types that fit this and we do have one for women of color. And absolutely, I think it's a great tool that can be mimicked throughout our field that would be helpful for women in general, and particularly women of color who who want to ascend to leadership roles. From an AHA perspective,

00;16;09;00 - 00;16;41;02
Roxie Wells, M.D.
right now, it's mostly CEOs or presidents or administrators. But I would love to see in the future other leadership roles actually become a part of the group at AHA. I'd love to see the expansion there, but we chose to start with the CEO, administrator, president, executive vice president role so that we could actually pull it together, make it succinct and really grow from that standpoint.

00;16;41;04 - 00;16;58;24
Roxie Wells, M.D.
Understanding that a smaller group giving thought to how we expand this would be best. And so I certainly hope in the future that we will expand beyond that CEO, president or administrator role and go to other roles within the C-suite.

00;16;58;27 - 00;17;12;16
Ogechi Emechebe
So can you tell me, given where you are today and then just looking back on your childhood from when you saw your mom, you know, working in the field, what have you learned along the way that you wish someone prepared you for?

00;17;12;19 - 00;17;47;12
Roxie Wells, M.D.
You know, that's a great question. I would actually think that ascending to leadership positions isn't as easy as people think it is. And especially for women and especially for women of color. You know, all hiring and mentoring leaders aren't as progressive as they purport to be. And what we do know is that is easier in most cases for people to mentor people like themselves.

00;17;47;14 - 00;18;22;01
Roxie Wells, M.D.
So when I talk about them not being as progressive as they purport to be, it's just easier for people to, again, just mentor people that are like themselves, people that look like them of the same gender or what have you have the same likes or what have you. And so I've found that it's somewhat difficult to break through that glass ceiling because there are still biases that are out there that prohibit movement past certain rungs on the ladder.

00;18;22;08 - 00;19;08;07
Roxie Wells, M.D.
But I do believe that, you know, the goal is to find people who are intentional and who are committed to ensuring that diverse leadership structure. And I've been blessed to have people who have been committed to and intentional about my success, whether they be coaches, whether they be mentors, whether they are friends who have had storied careers. The women in the roundtable have, you know, just pushed me to be a better version of myself. And then not only that, I think it's important to take all of those things that we've been given and lend them to others and to serve as coaches and mentors and friends, to those who are who are interested in becoming

00;19;08;07 - 00;19;10;24
Roxie Wells, M.D.
leaders in health care.

00;19;10;26 - 00;19;32;29
Ogechi Emechebe
So I really like your quote about finding people that are intentional about your success. And I think that leads into my next question about: do you think there is a role that men can play, if any, to ensure that they create a safe, friendly environment for women to thrive in? Because women can be doing the work to be mentoring each other and making sure that they are creating a support system.

00;19;32;29 - 00;19;43;29
Ogechi Emechebe
But if a lot of these positions are still held by men or trying to break these biases, what role can men play to make sure that they're also creating a safe space for women to thrive and succeed in?

00;19;44;01 - 00;20;08;00
Roxie Wells, M.D.
I think that's an excellent question, and I do think that there is a role for men to play to ensure that that women succeed in leadership roles in health care. And I've been fortunate again, some of the people that I mentioned before who have been instrumental in my leadership journey have been men, men of color, black men, white men have been very, very instrumental for me.

00;20;08;00 - 00;20;33;18
Roxie Wells, M.D.
But I think that you mentioned earlier that health care CEOs, only about 15% are women, the other 85% are men. But we do know, according to the U.S. Department of Labor, that 80% of health care decisions are made by women. And if that's the case, that it kind of seems a little uneven. So I do think that there are things that they can do.

00;20;33;18 - 00;21;04;24
Roxie Wells, M.D.
First of all, treat women as equals. Secondly, make sure that you are a proponent of equal pay for women, for equal work. Being coaches and mentors. And if a leader doesn't have the bandwidth to be a coach, pay for or sponsor a coach for women in your organization. So sponsorship is important. Being an ally is important and really calling out recognized, unfair, biased treatment.

00;21;05;01 - 00;21;32;29
Roxie Wells, M.D.
Walk the talk, right? Just don't talk about I am fair or what have you. But when you're around peers and you're hearing things that aren't necessarily appropriate, have those conversations. Call those people out. Bring those people back to a place of understanding that equity, equality is is important. Help them to understand the roles that women play in health care.

00;21;33;00 - 00;22;02;10
Roxie Wells, M.D.
We know that 70% of the health care workforce is composed of women. So we need to make sure that we are looking at that when we're talking about equity. Other things might be flexibility, making sure that you understand that the roles of women are often times much different than those of men outside of the workforce. And so what the expectations are for me at home might be different from the expectations from my male counterpart.

00;22;02;13 - 00;22;22;18
Roxie Wells, M.D.
I'm not asking asking for special treatment, but asking for flexibility. Go outside of yourself and go outside of the box and talk to various people in your organizations and see if you can build leadership bandwidth from individuals throughout your organization.

00;22;22;21 - 00;22;39;22
Ogechi Emechebe
That's a great answer. I really like that. I do think that men do play an instrumental role in ensuring that women thrive. So just having that collaborative partnership is key for everyone's success, really. So that is all I have for you, Dr. Wells. Are there any closing thoughts or comments you would like to add?

00;22;39;24 - 00;23;25;25
Roxie Wells, M.D.
Really, just to remind everybody that I was doing a little bit of research before this and looking at the population of the world in general. And it's 50-50. And so really thinking about if we are going to move forward in health care, if we're going to decrease the cost of health care, to include not just from a financial perspective, but from morbidity and mortality, we really need to be inclusive in making sure that the highest levels of leadership in health care are inclusive and quite diverse, because we all have different perspectives, we all come from different backgrounds, and having all of those individuals at the table just makes us better as a field.

00;23;25;29 - 00;23;39;14
Roxie Wells, M.D.
So I would encourage my colleagues across the country to just be intentional and intent upon making sure that there's diversity at the highest levels of leadership and your organizations.

00;23;39;16 - 00;23;46;15
Ogechi Emechebe
I love it. I really appreciate your time, Dr. Wells, and thank you so much for this powerful and informative podcast.

00;23;46;17 - 00;23;54;29
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

The 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.

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