Advancing Health Podcast

00;00;01;02 - 00;00;28;12
Tom Haederle
Welcome to Advancing Health. An effective cyber attack against a large hospital, especially a ransomware attack, often has a cascading effect on nearby hospitals as well, who may depend on the operational readiness of their bigger brethren. Experts call it a regional blast radius, and in this podcast, we learn how the Texas Hospital Association has stepped up with its members to meet that challenge.

00;00;28;15 - 00;01;01;01
John Riggi
Hello, everyone. Welcome to Advancing Health. This is John Riggi, your National Advisor for Cybersecurity and Risk at the American Hospital Association. I am so pleased and privileged to be here with my good friend and colleague, Fernando Martinez. Fernando is the Texas Hospital Association's chief digital officer. Fernando is also a former hospital CIO and chief information security officer. He's a certified IT security professional and a professional educator who's worked with some of the largest health care systems in the country.

00;01;01;04 - 00;01;19;17
John Riggi
Fernando has been with the Texas Hospital Association for over 11 years, and he's been an adjunct professor at Florida International University College of Business for over 15 years. Fernando, as I mentioned, so great to have you here, be on this podcast with me and talk about a great partnership.

00;01;19;20 - 00;01;21;00
Fernando Martinez, Ph.D.
Thank you John. My pleasure.

00;01;21;03 - 00;02;03;16
John Riggi
We've worked so closely with the Texas Hospital Association over the years with doing workshops, regional tabletop exercises and other educational events. And as we often discuss and as you've heard me say many, many times, cyber risk is an enterprise risk issue. But first and foremost, it is a risk to patient care and patient safety. We emphasize that hospitals should prepare for clinical continuity to mitigate the impact of a cyber outage, but also to understand what the regional impact would be to care delivery and the disruption to care delivery if a particular hospital is struck with a ransomware attack.

00;02;03;19 - 00;02;23;21
John Riggi
So our joint events focused on regional cyber incident response scenarios, just as we would all prepare for a regional physical disaster. From your perspective, how does this partnership enhance hospital resilience and patient safety across Texas?

00;02;23;24 - 00;02;55;20
Fernando Martinez, Ph.D.
Well, I have to tell you, I recall the first time that I heard you use the phrase "regional blast radius" I think this is the way you refer to it. And I thought to myself, well, you know, much of what we're doing to help our member hospitals prepare is really focused on individual hospital performance and intra-hospital performance, but really not something looking at the true operational impact to hospitals that would result as a result of a cyber incident.

00;02;55;22 - 00;03;24;12
Fernando Martinez, Ph.D.
And it's such an appropriate way to look at it, even more importantly than an individual hospital being prepared for incident response. It's really important to consider the impact that a hospital would have to endure, should they be the ones that are impacted or should any of the adjacent or in the same catchment area of patient care hospitals be affected the same way.

00;03;24;12 - 00;03;48;08
Fernando Martinez, Ph.D.
So they could be the source of the disruption and they could be the downstream recipients of the disruption. So the whole approach is quite brilliant, and I'm glad that we've been able to take that model to our hospitals in Texas. This is especially true because Texas has a lot of areas that are generally referred to as white space.

00;03;48;10 - 00;03;57;27
Fernando Martinez, Ph.D.
You'll have one level two or level one trauma hospital and ten, 12, or 15 smaller hospitals dependent on it.

00;03;58;00 - 00;04;30;03
John Riggi
Appreciate that, Fernando. And yes, unfortunately we have learned from the hundreds, hundreds of cyber attacks, but particularly the ransomware attacks, which caused victim organizations to disconnect from the internet and shut down their networks, ultimately resulting in, yes, as you indicated this is what we call ransomware blast radius. Victim is hit, but then there are cascading shockwaves throughout the entire region as patients and ambulances are diverted to surrounding hospitals.

00;04;30;06 - 00;05;00;02
John Riggi
And again, some of these surrounding hospitals, as you said, depend on the availability of the technology, whether it's the electronic medical record or linear accelerators that deliver radiation oncology of that victim organization. And with your help, we came to understand that, you know, we don't really need to develop a whole new series and set of rules and structure to develop cyber incident response plans on a regional basis.

00;05;00;02 - 00;05;25;19
John Riggi
They already exist to a certain extent. And, Fernando, your example of that white space. Unfortunately, we've had a couple of major ransomware attacks against level one trauma centers in Texas within in the past year. And I recall speaking to the CEOs and saying they were very concerned, saying, John, the next nearest level one trauma center is 400 miles from here.

00;05;25;21 - 00;05;46;29
John Riggi
So really placing not only just the patients, but entire communities at risk, really becoming a state issue as well. In Texas, again, very forward leaning on a lot of cyber issues and best practices. I understand Texas has established a cyber command. What does that entail and how does it support hospitals?

00;05;47;01 - 00;06;25;20
Fernando Martinez, Ph.D.
The Cyber Command was established in Texas, very forward looking position that the state of Texas government took, which is to build a consolidated  - at a state level - a consolidated threat intelligence, cyber readiness incident response organization that would support all of the government activities of the State of Texas. Texas has always had a cyber response organization but it's been part of the larger Texas Department of Information Resources organization.

00;06;25;22 - 00;06;59;05
Fernando Martinez, Ph.D.
What this piece of legislation, which was signed into law by the governor in June of this year as a result of the legislative session - House Bill 150...What they did is they appropriated, and this is all public domain information, they appropriated $135 million and took the cyber resources that are spread across several organizations, including Texas DIR, consolidated them into one cyber command for the state of Texas.

00;06;59;05 - 00;07;35;04
Fernando Martinez, Ph.D.
And so the idea here is to provide a baseline for cyber preparedness, for cyber threat analysis and threat intelligence and incident response. And then in doing so establish policy standards. That body is actually empowered with rulemaking. The chief is appointed by the governor. So it's a very forward thinking governance architecture and structure around cyber. Although it's initially the scope of command is limited to state government.

00;07;35;06 - 00;08;10;00
Fernando Martinez, Ph.D.
It does incorporate services that can be used in public sector education, higher ed in particular, but also public sector education and other public sector organizations like municipalities, city governments, down to and extending to critical infrastructure vertical departments that might be water power, a number of other sectors. So very forward leaning, forward thinking steps being taken to approach this at a state level.

00;08;10;02 - 00;08;36;25
John Riggi
Really a model for all states. And again, Texas being leader in this area. So Texas and through the Texas Hospital Association is leading in other ways, and with our work at the American Hospital Association we have joined forces with you to develop these regional tabletop exercises. Fernando, from your perspective, could you tell us what these regional tabletop exercises look like?

00;08;36;27 - 00;09;04;24
Fernando Martinez, Ph.D.
Sure. So the idea that you take a regional hospital, a level two, level one, trauma hospital that has a community relationship with ten, 12 or 15 smaller critical access or rural hospitals. We converge them. We bring them together into a day long activity, where is the primary dependency being the level two or the level one trauma center

00;09;04;26 - 00;09;41;07
Fernando Martinez, Ph.D.
suffers an incident, a cyber incident of some sort that interrupts the service that these downstream hospitals need that are required for life safety care to patients in their communities. And these are primarily non-IT executives that are brought together, operational clinical operations, hospital operations, emergency preparedness. By bringing those individuals from all the different hospitals together, they have an opportunity to flesh out the circumstances that they might have to confront.

00;09;41;09 - 00;10;07;27
Fernando Martinez, Ph.D.
You mentioned earlier, the fact that if a level two or a level one trauma center goes down, now you're talking about potentially transporting patients instead of transporting them 45 minutes, 30 minutes or an hour away. Now you've he's looking at 2 or 3 hours, which in the cases that that would have catastrophic consequences in terms of patient outcomes and clinical care and clinical safety.

00;10;08;00 - 00;10;32;11
Fernando Martinez, Ph.D.
They have been very effective in bringing those individuals together to talk about how it is that they would work together. What are the alternatives? How would they address incident response? How would they leverage each other's resources? As simple as how would they communicate with each other? That's proven to be very effective. The exercise we did last year was remarkable

00;10;32;13 - 00;11;04;09
Fernando Martinez, Ph.D.
inasmuch as there actually was two days before the exercise, there actually was a level one trauma center hospital upstream that went down and affected the actual host hospital that was in fact upstream from the small hospital. So we know that the threat is real. And we know that this is a very effective way to bring many hospital executives together to consider obstacles that they would not necessarily contend with during their traditional

00;11;04;15 - 00;11;09;19
Fernando Martinez, Ph.D.
standalone emergency preparedness exercise. Brilliant approach on the part of AHA.

00;11;09;21 - 00;11;32;14
John Riggi
Thank you for that, Fernando, truly a great partnership with THA. And you know, when we did that exercise, many thought that the exercise and the news of the ransomware attack upstream was all somehow connected. Very unfortunate coincidence that it happened at that time. But talk about a sense of realism to really conduct an exercise during the heat of battle

00;11;32;14 - 00;11;49;03
John Riggi
in a sense. What do you think, Fernando? Again, having been there now for several of these exercises, helping me moderate these, what do you think some of the key lessons learned are from these exercise? And how do you think these exercise build trust and coordination across the attendees?

00;11;49;05 - 00;12;17;22
Fernando Martinez, Ph.D.
Well, first of all, communication was the key takeaway. A lot of the hospital executives, from a risk averse point of view, a lot of the hospital executives look at cyber incidents as something that they don't want to communicate to anyone else for a variety of reasons, many of them prompted by being legally discreet and not disclosing information that might jeopardize the organization.

00;12;17;24 - 00;12;56;09
Fernando Martinez, Ph.D.
Unfortunately, when you look at emergency preparedness, other types of emergency response circumstances, whether it's mass casualty or acts of nature, the communication protocols were all there so that organizations can notify each other. But where cyber incidents are concerned, something as simple as just communicating indicators of compromise, right? Techniques and tactics. Those are bits of information that would help downstream organizations potentially identify if there was a threat that was being directed at them, so that they would avoid the same set of circumstances.

00;12;56;12 - 00;13;30;08
Fernando Martinez, Ph.D.
And that's not there. So one of the big takeaways was hospitals need to develop these communication pathways that will allow them to share a small amount of information, just sufficient information without disclosing more detail than they need, disclosing the fact that there is an incident underway, that there are some of the indicators of compromise are XYZ, so that the adjacent hospitals have the opportunity to prepare to look for and potentially avoid being victims.

00;13;30;10 - 00;13;42;26
Fernando Martinez, Ph.D.
I can assure you that the bad guys are sharing information the moment that they exploit one organization, then they know regionally that they can go to other organizations with similar success.

00;13;42;29 - 00;14;18;09
John Riggi
Communication, within the organization with their peer organizations in region, with the federal government, with the state. Really crucial during these exercise, although there is this tension between trying to preserve confidentiality, risk of civil liability and potential regulatory liability, all these factors tend to shape an organization's outlook. But with education they understand they can mitigate all those risks and develop these trusted relationships which will not expose them to legal and regulatory risk,

00;14;18;09 - 00;14;45;07
John Riggi
again, if they have these preexisting relationships in agreements in place. Fernando, I view the work being done at the Texas Hospital Association quite frankly as a model for other states. And I just want to let you know I value your partnership and your capabilities and all that you do, not only for all the hospitals in the state of Texas, how you've been contributing on the national level as well, helping me, helping AHA to do our job for national benefit.

00;14;45;10 - 00;15;03;28
John Riggi
So thank you again, Fernando, your partnership, your friendship and all that you do. And thanks to all our listeners for all that you do every day to defend networks, care for patients and serve your communities. This has been John Riggi, your National Advisor for Cybersecurity and Risk.

00;15;04;00 - 00;15;12;11
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:28 - 00:00:34:10
Tom Haederle
Welcome to Advancing Health. Artificial intelligence and advances in digital technology give care providers more and better tools for patient care than ever before. In this month's Leadership Dialogue podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the American Hospital Association, we hear from one expert on harvesting the potential of so many new technologies to deliver better, safer and more accessible care for patients and communities.

00:00:34:13 - 00:00:53:19
Tina Freese Decker
Hello everyone. Thank you so much for joining us today. I'm Tina Freese Decker, president CEO for Corewell Health. And I'm also the board chair for the American Hospital Association. We know that there are many pressures and challenges facing our hospitals and our health systems, but there's also never been a better time to truly transform how we care for people.

00:00:53:21 - 00:01:15:03
Tina Freese Decker
I believe that AI and other technology innovations play an important role in this transformation, which is why I'm so excited to explore this topic today. With so many tools and technologies out there, it can be difficult to really focus on what delivers that value to the patients, to our communities. That's why I'm so pleased to be joined by Dr. Jackie

00:01:15:03 - 00:01:36:20
Tina Freese Decker
Gerhart, chief medical officer of Epic, to ensure that we talk about these opportunities for health care. In addition to her role at Epic, Jackie is also a practicing family medicine clinician, so she can give her firsthand perspective on how she sees technological advances improving care for her patients. So, Jackie, thank you so much for joining us today.

00:01:36:20 - 00:01:55:09
Tina Freese Decker
We are so appreciative of all you do for Epic, but then also what you do to serve people in your community. And it's been a pleasure knowing you throughout the years in various areas, but it's wonderful to be able to talk to you today. When you think about the possibilities ahead for us, especially as it relates to technology and all these things that you can learn from,

00:01:55:12 - 00:01:58:09
Tina Freese Decker
what area do you think we have the greatest potential?

00:01:58:12 - 00:02:27:15
Jackie Gerhart, M.D.
Potential as a an interesting term, because I think it's kind of two different things. There's the part of it that is the option for transformation. And then there's the part, as you mentioned earlier, that's really practical and being able to be applied now. So I do think that AI, the use of agents, the use of bringing that technology into medicine, both the care of medicine and the transformation of new medicine is going to be a game changer, just like the internet was transformational.

00:02:27:15 - 00:02:45:13
Jackie Gerhart, M.D.
I think this age of AI and AI agents is also transformational. I think in terms of practical, one of the things we struggle with in health care is being able to evaluate different tools, understand are they going to be useful for our populations, or are they going to be tuned for our specific populations we're caring for? What do we already have?

00:02:45:16 - 00:03:04:27
Jackie Gerhart, M.D.
What do we still need to purchase? So I think there's so many pieces out there right now, especially within the AI sphere, to help us answer patient messages as clinicians to help patients be better informed about their care, to be able to use their patient portal - Epic's is called my chart - to try to better inform them of what's coming up next.

00:03:04:27 - 00:03:18:29
Jackie Gerhart, M.D.
So I think, well, the transformation part is absolutely AI and AI agents and that future.  I think just digital health in general, we can't forget that that's something that's already bringing us together with things like telemedicine and care from your phone.

00:03:19:01 - 00:03:43:04
Tina Freese Decker
I think that's absolutely correct. That is the digital piece to this, how we design it. And we can't design it based on the paper model into a digital model. It's truly transforming. I also think the key element is we need to be clear about the problem we're trying to solve. There's so many shiny objects that are out there that can distract us, and we must be laser focused on that solution that we're trying to solve.

00:03:43:06 - 00:04:02:19
Tina Freese Decker
Otherwise we can get very distracted. So when you think about that, you know, we have to evaluate all of these new technologies, this transformation, It's important to evaluate the cost and the benefits of those new innovations. What are some of the criteria that you believe hospitals health systems should keep in mind when we look at those opportunities?

00:04:02:25 - 00:04:07:06
Tina Freese Decker
And do you see major barriers when we adopt the new technologies?

00:04:07:08 - 00:04:24:23
Jackie Gerhart, M.D.
Yeah. Great question. You hit the nail on the head. It's absolutely everyone is inundated with new shiny technologies. And I think the very first question, as you put it is what is our problem that we're trying to solve? And then I think the second is do we already have technology that could actually be solving this better than we're using it?

00:04:24:23 - 00:04:43:12
Jackie Gerhart, M.D.
Is there something in workflow that we're not optimizing? Is there is it a people or human factors issue and not even a technology issue? So first, evaluating what the problem is and then seeing where within the workflow, literally studying how is it that this could either be more efficient or more effective. And then I would say, just like I was talking about before, there's digital health,

00:04:43:12 - 00:05:00:28
Jackie Gerhart, M.D.
there's AI. Evaluate if there's already a digital health solution that may be lower cost than the cost and compute of an AI solution. And see also if you already have it. One of the things we noticed with hospitals is that they have technology that they've already purchased, and they may just not be optimizing it or have even turned it on.

00:05:01:02 - 00:05:20:14
Jackie Gerhart, M.D.
One of the hardest things we do at Epic is we create software and we created a, you know, a very fast clip trying to keep everyone up to date with the best and greatest. But if they don't turn it on, or if they don't fully optimize it or help train their users, then it really isn't allowing for that technology to get to the point where it's actually being optimized.

00:05:20:16 - 00:05:55:18
Jackie Gerhart, M.D.
So after all of those questions, then when you get to the AI question and in terms of what's cost effective and what's not, oftentimes we see people do one of two things. They'll either kind of do a pilot and then learn if it's the right technology and then try to expand from there. But we've actually found that sometimes some of the greatest technology solutions are caught in this "death by pilot" cycle, where in reality, if you're able to if you've seen another organization already do it and you're able to apply those results to your organization, you may not need to do a full randomized controlled trial or a full study of it.

00:05:55:18 - 00:06:15:12
Jackie Gerhart, M.D.
Just make sure that it really fits in with your clinicians, your workflow, and your patient population. Be sure to test it locally and understand that it's going to actually be effective. And then and then go for it and be a little bit bold about this, because this is a technology that's actually really changing and advancing care. And we have the opportunity to have that now.

00:06:15:15 - 00:06:42:08
Tina Freese Decker
So as a physician, I'm curious to know what you've, seen over, you know, your eight years, really practicing in that area and maybe even before in your, in your education training and what you're excited about coming forward to make it easier. And then any advice you have for us as we implement these things and ensure, you know, the whole goal is to make it easier for our physicians and clinicians to provide the care and easier for patients to receive the care.

00:06:42:10 - 00:06:44:19
Tina Freese Decker
What advice do you have for how we would implement it?

00:06:44:21 - 00:07:17:02
Jackie Gerhart, M.D.
Yeah. Great question. So I practiced for about eight years and then started at Epic. And I've been at Epic for about eight years. I remember this - man, probably in maybe 2015 or so, I had a patient who I was doing a physical exam on, on the exam table in my practice. And I was examining her thyroid and I found a small lump on one side. And I wanted to finish her exam, but I also wanted to order a ultrasound and think about if I need a needle biopsy and also see if she had a prior TSH and all of these different things that were both passive and active.

00:07:17:02 - 00:07:42:21
Jackie Gerhart, M.D.
And I felt myself hamstrung to this one point in the exam room thinking, okay, do I turn to the computer? Wouldn't it be great if something could kind of bring this all together, a technology, perhaps. And she and I were going back and forth and saying, you know, wouldn't it be nice if I could just say, in this case, I was using Epic, so hey Epic, order a TSH and follow up in two weeks, and if the TSH is elevated, let's go ahead and do for an ultrasound.

00:07:42:27 - 00:08:03:06
Jackie Gerhart, M.D.
And then, by the way, you know, record this into my notes and also give me some decision support as to, you know, what is going to be covered by her insurance, etc.. And, she was a little bit of a tech nerd so we geeked out about it for a while, and it really got me thinking, as one of the reasons for me wanting to get into tech is that yes,

00:08:03:06 - 00:08:30:00
Jackie Gerhart, M.D.
I love patient care, and I can have such a good impact on the people in front of me. But if there's a way to truly transform medicine, to try to make it both easier on clinicians and also more practical for just getting access to care and being able to democratize care, then that's really the secret sauce. We just had our users group meeting, UGM, a few weeks ago, and I was so thrilled because it was kind of this, way that we embodied everything I was hoping for all those years ago.

00:08:30:04 - 00:08:46:27
Jackie Gerhart, M.D.
We showed how a patient with their, My Chart can go in and actually speak and ask questions to be able to create a patient agenda. So instead of a patient coming in to me and me saying, hey, what brings you in or what else? And then having my hand on the door and leaving and being like, oh, there's one more thing.

00:08:47:03 - 00:09:25:18
Jackie Gerhart, M.D.
I can actually pace the visit by having the patient tell me specifically what it is that they want to accomplish. And then on the clinician side, we have art, which is the AI for clinicians, and that then in real time can go through the patient agenda and choose each topic. So say the first is hypertension. It can bring up to me a summary of all of the hypertension information that's in the chart, as well as blood pressure cuff information that they may have from home, and even help me with decision support, using real world evidence, and actually looking at that person themselves, how old they are, what they've tried before and

00:09:25:18 - 00:09:32:05
Jackie Gerhart, M.D.
help me decide what might be the best course of action for this person with all of the tools that I have in my tool belt.

00:09:32:07 - 00:09:50:06
Tina Freese Decker
Do you see patients readily engaging in this? And do you see the potential for the use of technology and the things that allow us to do, like sharing the agenda, changing patient behavior to more healthier behaviors?

00:09:50:09 - 00:10:16:02
Jackie Gerhart, M.D.
Yes. So I think I discussed some stuff in the exam room. And I think that's really important for change in behavior and treatment. But really again, it's those in between spaces that actually have the biggest opportunity for changing behavior I think. And so I've loved how some of the technology we're using again, going back to just digital health, I was speaking about how wearables can help affect people's behavior.

00:10:16:05 - 00:10:40:06
Jackie Gerhart, M.D.
And what's interesting is we have, a website called Epic research.org where we study different questions of Cosmos, which is a real world evidence, platform. And one of the questions that I had asked was: in patients that are wearing a prescribed continuous glucose monitor, in those patients, pre-diabetic, just wearing it to try to improve their health - in those patients,

00:10:40:06 - 00:10:57:28
Jackie Gerhart, M.D.
Does their A-1C change? And it turns out over all of those patients, it didn't have a statistically significant change. That was actually surprising to me because I thought behavior would change enough. But then as I went back, I thought, you know what? I'm asking the wrong question. It's not whether the A1C, which is a measure for diabetes, is really the question.

00:10:57:28 - 00:11:27:10
Jackie Gerhart, M.D.
It's while the rest of their lifestyle, what's their BMI? Are they getting heart disease? How is their hypertension? All of the other things that we need to look at to determine if something is actually changing behavior? Because the behavioral change actually might be the thing that we should be measuring. And it brings me to this thought of - traditionally in medicine we've thought of things like labs or treatments or medications, and it's very, very much been sort of like a medication focused career.

00:11:27:15 - 00:11:46:13
Jackie Gerhart, M.D.
And I really think we have the opportunity now to further expand that into person-focused career and really have it be you tell me what it is that you're coming in for. Maybe it's you just want to make it down the aisle, and so I need to help you with your knee pain. Maybe it's not that I need to, you know, fix what is on my agenda, but it's actually what's on your agenda.

00:11:46:15 - 00:11:54:07
Tina Freese Decker
That's fantastic. That's really good. So I'm going to close today with just asking you about what you're most excited about when it comes to innovation and transformation.

00:11:54:13 - 00:11:58:10
Jackie Gerhart, M.D.
I'll go second, why don't you tell me what you think you're most excited about? Oh, I love it.

00:11:58:10 - 00:12:22:17
Tina Freese Decker
Oh, I love it, how you turning it over to me! I'm really excited about the potential that we can create. Yeah. I think that there's so much opportunity for harnessing some of the new technologies and artificial intelligence, but really seeing the impact to patients. Yeah, I was just in talking to some of our teams the other day and hearing about the amazing progress we've had.

00:12:22:24 - 00:12:51:29
Tina Freese Decker
When you talk about surgery, when you when you talk about the research elements and we're just at the cusp. I mean, you feel like you've made so much progress, but there's so much more that we can do. And that's what gets me excited. And really the impact is back to patient care. I was just rounding and met one of our patients, and he had an essential tremor. And he couldn't sign his name for 30 years.

00:12:52:01 - 00:13:22:06
Tina Freese Decker
And so he did a focused ultrasound procedure where we, you know, have you have a laser focus as part of the brain heated up to 58°C, which is like 130 plus degrees Fahrenheit. And after the procedure, he could draw a straight line, he could sign his name. And he sent us a handwritten note, a two page handwritten note that he wasn't able to do before, detailing his gratitude and how he can now hold a cup of coffee and drink from it.

00:13:22:10 - 00:13:32:22
Tina Freese Decker
So that is the incredible piece that I see. You know why I'm in health care and what I'm so excited about, to see the progress that we can make and the impact we can have on people.

00:13:32:25 - 00:13:58:18
Jackie Gerhart, M.D.
I love that story. That's beautiful. I completely agree. It centers around the patient. In addition to specific patient care, I'm thinking also about sort of the broad population health and what can this do to advance medicine. And I think as clinicians, we tend to think about the information that we put into a record or the information we gather, and we see that as part of the health care visit.

00:13:58:18 - 00:14:25:25
Jackie Gerhart, M.D.
But then it's kind of put into the background. And I really think that data isn't the exhaust of health care, but instead it needs to be the fuel for personalized medicine. And as we start to learn from these journeys, and AI can learn from these journeys more quickly than humans can, we actually can figure out how to personalize medicine, advance new cures, figure out how to research things more quickly, and hopefully get that out to people.

00:14:25:27 - 00:14:41:05
Jackie Gerhart, M.D.
One of the things people have is, they're curious. They want to know what's going on and how that can be fixed or helped. And I think as that curiosity grows, we have more and more tools to help inform and democratize data for patients and also inform personalized care.

00:14:41:07 - 00:14:51:11
Tina Freese Decker
Our health is an every day, every minute sort of thing. It's really important that we connect all of that data, and we give people the tools that they need so that they can reach their health outcomes and their goals.

00:14:51:11 - 00:14:52:18
Jackie Gerhart, M.D.
That they want to achieve.

00:14:52:20 - 00:15:05:23
Tina Freese Decker
Jackie, thank you so much for your time today, for sharing your insights and expertise, for caring for our communities and for being so active and a supporter with Epic and partnering with the American Hospital Association.

00:15:05:25 - 00:15:08:11
Jackie Gerhart, M.D.
Yes. Thank you. It's been a joy. I thank you so much.

00:15:08:13 - 00:15:17:02
Tina Freese Decker
And thank you to all of our viewers for finding the time to tune in. We will be back next month for another Leadership Dialog conversation. Have a wonderful day.

00:15:17:04 - 00:15:25:15
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:27 - 00:00:28:01
Tom Haederle
Welcome to Advancing health. The rapidly changing health care environment makes long term strategic planning difficult, and as a result, more hospitals than ever are weaving philanthropic support into their plans and goals. The AHA is pleased to bring you this podcast series on the important strategic role philanthropic initiatives play in helping to deliver the care that patients and communities depend on.

00:00:28:04 - 00:00:52:25
Michelle Hood, FACHE
I'm Michelle Hood, I'm the executive vice president and chief operating officer for the American Hospital Association. Welcome to the first of a four-part Advancing Health podcast series to discuss the important strategic role philanthropic initiatives play in achieving a hospital or health system's vision and mission to provide patient care, support their local communities, and increase employee satisfaction and engagement.

00:00:52:27 - 00:01:21:20
Michelle Hood, FACHE
In this series, AHA is partnering with the Association of Healthcare Philanthropy. And joining me today is Alice Ayres, president and chief executive officer with the Association of Healthcare Philanthropy. The remaining episodes will focus on discussions on specific health philanthropic themes with the chief philanthropy officers and key C-suite leaders at Sanford Health, CommonSpirit and Inova. So let's get to it.

00:01:21:22 - 00:01:22:28
Michelle Hood, FACHE
How are you today, Alice?

00:01:23:05 - 00:01:32:27
Alice Ayres
I'm great. Michelle, thank you so much for having me. And I'm so excited about this series. I really think we're all going to learn just a ton from these great leaders, and I'm super excited to have this conversation with you.

00:01:33:03 - 00:02:01:27
Michelle Hood, FACHE
Yeah, it's a great topic. It's a really important part of, leading our hospitals and health systems today. So we're really pleased to be partnering with you. So let's start with the question around the fact that our hospitals and health systems are really shifting their strategic priorities seems like almost daily, weekly these days, very difficult to write a long term strategic plan and stay with it because the environment is changing

00:02:01:27 - 00:02:34:07
Michelle Hood, FACHE
so much. And the rapid advancement of clinical advances in science is contributing, but also the business challenges that our hospitals and health systems are facing. So I know that the field is looking at very different avenues to support their priorities. And one of these shifts is really incorporating philanthropy into the hospital's strategic plan. Tell us how you think about it from incorporating philanthropy approach into strategy.

00:02:34:09 - 00:02:52:25
Alice Ayres
Yeah. Thank you. This is such an important question because you're right. What's going on at the moment in terms of financials as well as just strategic priorities, is it feels like it's sort of a constantly changing situation. And you know, philanthropy has always been an important part of the revenue stream that comes into hospitals and health systems.

00:02:52:25 - 00:03:11:16
Alice Ayres
But as we sort of look at this moving forward, we feel like it's even more important than it ever has been before. And that's for a couple of reasons. The first is that years past, we've had a question as to whether or not it was something that was measurable and countable, and whether we could count on it. We could set it as part of our strategic plan.

00:03:11:19 - 00:03:30:02
Alice Ayres
But the reality is these days our chief philanthropy officers and their teams are following really careful quantitative numbers in order to understand exactly how much money is coming in and how it's all going to play out. And so we can count on these revenue streams. We can sort of begin to bake them into the financial side of things.

00:03:30:04 - 00:03:56:07
Alice Ayres
But I think your question is even more important than that, which is how you get to the strategy side. The reason that it's so important to incorporate the act of and the group of people who are bringing in the money that says, you know, sort of the philanthropic team, the foundation team, is because when you set strategy and you think about strategic priorities, you want to make sure that the community voice is brought into those strategic priorities.

00:03:56:13 - 00:04:17:13
Alice Ayres
And who better than the foundation who are constantly out talking to the community, working with their own volunteers, working with lots of other people in the community. And who better to sit at that table and say, well, gosh, you know, we're talking about funding that priority by doing X. But I actually know that there are people in the community that would get behind an idea like that and would be really excited about it.

00:04:17:21 - 00:04:46:12
Alice Ayres
So if we have enough time and we have the ability to talk to those donors and work with them, then maybe we can actually fund this not through the operational budget, but instead through philanthropic support. So there are lots of reasons to do it. I had a really wonderful conversation once with the former CEO at Intermountain. And he said, I always want the chief philanthropy officer at my executive leadership table because they're the ones that have that voice of the community.

00:04:46:12 - 00:04:55:00
Alice Ayres
They're the ones that can say, you know what? I'm hearing this isn't important, or I'm hearing this is critical and it's not in our strategic plan, and we need to think about that, too.

00:04:55:03 - 00:05:17:05
Michelle Hood, FACHE
I think that to make it work for philanthropy really to be woven into strategy and operations, there has to be that presence of the leader of the foundation with the rest of the C-suite, right? And that has not always been the case. It's really been kind of a separate thing and even to the point where the foundation typically has its own board.

00:05:17:05 - 00:05:25:01
Michelle Hood, FACHE
So integrating the foundation board with the hospital or health system board and having that cross communication and looking for opportunity.

00:05:25:04 - 00:05:47:06
Alice Ayres
Yeah, I would say about half of the hospital and health systems across the country have a separate foundation rather than having the fundraising team as part of sort of the department of the hospital. But even those that have that separate foundation often are sort of integrated into the C-suite on purpose. And I think it's a goal that we all ought to have.

00:05:47:09 - 00:06:28:14
Alice Ayres
Because the other thing that we found and we're writing a piece for one of your publications on the subject that's coming up in the next month, I think, or two. One of the things that we've found is that when the leadership both volunteer and employed of the hospital - so the C-suite, the fiduciary board - those people who are seen in the community as the leaders of the organization, when they give at 100%, it actually increases the overall likelihood of the hospital or health system being a high performer in our philanthropic data, because it's a message to the community that the people who know the organization best are putting their money where their mouth is.

00:06:28:14 - 00:06:48:21
Alice Ayres
They are supporting the organization in that way. So I think, you know, it's partly that, it's partly just building a culture of gratitude. And you can't do that without the leadership really being a part of it and understanding, you know, why it is that we encourage gratitude and why it is that we encourage patients to be able to share how they feel and sometimes share their financial support as well.

00:06:48:27 - 00:06:57:13
Alice Ayres
But it has to start with there being a deep partnership between the chief philanthropy officer and the other C-suite members. Without that, the rest of it doesn't happen.

00:06:57:16 - 00:07:12:22
Michelle Hood, FACHE
Talking about from the standpoint of starting with that relationship, what would you tell a hospital or a health system who really is just getting started with integration of philanthropy with strategy and operations? Where do they start?

00:07:12:25 - 00:07:32:16
Alice Ayres
I think they start with just getting to know each other and figuring out what it is that they can do for the philanthropy team, and vice versa. When I talk to chief philanthropy officers who are just beginning to step into this kind of a role and be brought into these kinds of conversations. One of the things I say is you've got to figure out what's in it for them.

00:07:32:16 - 00:07:51:24
Alice Ayres
So you have to begin to share with them how you can help them, and how the fact that you're sitting at that table can change the ways in which they do their jobs. And so it's important, I think, for there to be an understanding across these different functions as to what the up at night issues are, what the things are that people are worrying about.

00:07:51:27 - 00:08:15:26
Alice Ayres
And one of the things that I, I mostly see with our membership is they're super creative. And so if they can understand what the issues are in any given situation, frequently they're able to sort of think through whether there are creative solutions that involve donors or involve the community. So giving them the space and the information to be able to be that kind of creative is really important.

00:08:15:28 - 00:08:37:09
Alice Ayres
And I think just, you know, giving the space for the philanthropy team to talk about what's going on in the community and what's going on with their donors and the kinds of ways that that the other leaders can support them is also really important. During Covid, we saw a lot of videos and webinars where like the chief philanthropy officer or the chief medical officer would do a briefing for donors.

00:08:37:09 - 00:08:57:12
Alice Ayres
And I think those kinds of things are super helpful because donors feel like they're a part of what's happening. So it doesn't have to be that, you know, the chief medical officer sits down with a donor during the middle of a conversation around an ask. It alleviates a lot of fears when they understand that that the chief philanthropy officer is unlikely to ask them to help with the ask.

00:08:57:15 - 00:09:01:23
Alice Ayres
They just want the help of getting donors to be closer to the organization.

00:09:01:25 - 00:09:11:12
Michelle Hood, FACHE
Yeah, that was my experience as well. The C-suite is glad to ride along if you will, but they typically do not want to do the ask.

00:09:11:20 - 00:09:38:12
Alice Ayres
Even the foundation boards sometimes are uncomfortable with it. And when I'm speaking to foundation boards, one of the first things I say is listen, the philanthropy team, the foundation team are the experts in this work. And so they're going to do the ask. They don't want you to do the ask. They just want your help opening doors and sharing information and sort of bringing the donor into what's going on in the organization, and then let the expert do the ask because they know what they're doing.

00:09:38:14 - 00:09:50:13
Michelle Hood, FACHE
Right, and capitalize on those relationships that the leaders have with the various members of the community and community organizations and looking for nontraditional sources of philanthropic giving.

00:09:50:13 - 00:10:07:04
Alice Ayres
You did this. I know you were a big supporter of your chief philanthropy officer when you were at the hospital. Did you find that people were nervous or were they excited to be a part of these things or somewhere in between? You know, from your perspective, what helps get a C-suite excited about this?

00:10:07:06 - 00:10:28:17
Michelle Hood, FACHE
Yeah, I think it depends upon the individual. I had a chief medical officer who loved this stuff, and so we tapped him quite often. He had those patient relationships and so forth. So that was an added plus as well. So, I think it just depends on where people's comfort levels are. But as you said, let the experts do the work that they do.

00:10:28:24 - 00:11:06:04
Michelle Hood, FACHE
If you just say, we just need your presence, even just your presence can kind of go a long way. Health care, we've been talking about transformation for decades, maybe more so in the last decade with that little hiccup of Covid in the middle of it. But, you know, transformation is incremental, it feels like sometimes. But I feel like philanthropy, because of the creativity associated with the profession, really has the ability to contribute to transformation, bringing forth, you know, bold ideas and opening unusual doors for participation.

00:11:06:04 - 00:11:15:00
Michelle Hood, FACHE
We all want to partner with our communities in different ways. Talk to me a little bit about how you see philanthropy supporting transformation.

00:11:15:02 - 00:11:40:29
Alice Ayres
Yeah. It's interesting. I think there are a couple of different answers to that question. The first is that I think during the pandemic, we saw donors changing their perspectives on the kinds of things they'd support. And I think what that did was open up the foundation team, the philanthropy team, to understand that they could talk to donors about things that maybe they hadn't ever imagined they could before.

00:11:41:02 - 00:12:06:03
Alice Ayres
So examples of that were, you know, there were donors coming out of the woodwork wanting to give to employee assistance funds or to behavioral health, which is something that donors were more reticent to give to before the pandemic and now are very much interested in. Donors - you know, there was enough of a stigma so that donors didn't want to put their names on certain buildings or, you know, in on service lines that had to do with behavioral health.

00:12:06:05 - 00:12:26:02
Alice Ayres
Not true anymore. But it also allowed our teams to think about mobile units and access and equity in ways that perhaps we hadn't had quite as much of a forcing function before, because we knew that we couldn't get people to the hospital, we knew that we needed to meet them where they were, and donors were there for that, too.

00:12:26:03 - 00:12:49:08
Alice Ayres
They were very eager to be supportive. And so I think there was sort of this moment where we moved. We'll always have grateful patients as a big part of our donor base, but we also sort of moved into a space where suddenly we were able to think more about community partnerships and about donors who cared about the community in ways that maybe they had not ever associated with hospital work before.

00:12:49:08 - 00:12:53:06
Alice Ayres
But they were beginning to understand that the hospital was a big part of that.

00:12:53:09 - 00:13:11:02
Michelle Hood, FACHE
That's a great wrap for us, I think today, and thinking about the future and when, you know, certain doors close, other doors open, and there we go. So thank you so much for being with us today and being ready to kick off this important series. We look forward to working with you in the future.

00:13:11:04 - 00:13:17:04
Alice Ayres
Thank you. Me too. I appreciate all that you guys do. You have a lot on your plates and it's great that you're highlighting this.

00:13:17:06 - 00:13:25:18
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:00 - 00:00:26:28
Tom Haederle
Welcome to Advancing Health. Traditionally, health care providers have been very hesitant to seek help for the burnout and mental health challenges that many of them face. That is changing for the better, as we hear on this podcast about efforts to destigmatize seeking mental health services for our care providers, about being okay with not being okay.

00:00:27:00 - 00:01:04:17
Rebecca Chickey
Welcome to Advancing Health. I'm Rebecca Chickey, the senior director of behavioral health at the American Hospital Association, and it is my honor today to be joined by Corey Feist, the CEO and co-founder of the Dr. Lorna Breen Heroes Foundation, and Tiffany Lyttle, R.N. and director of cultural integration for Centra Health. Today, we are going to talk about the ways that hospitals, health systems and even states and regions can get involved to reduce the stigma and improve access to mental health care services for all our health care workers.

00:01:04:19 - 00:01:16:25
Rebecca Chickey
Corey, I'm going to direct my first series of questions to you. Quite honestly, tell our listeners what is the mission and vision of the Dr. Lorna Breen Foundation and why was it founded?

00:01:16:27 - 00:01:38:04
Corey Feist
Thanks for having us today, Rebecca. We are so grateful for the support of the American Hospital Association in our work. The Lorna Breen Foundation was created in the summer of 2020 following the death of my sister in law, Dr. Lorna Breen, who was an emergency medicine physician in New York City and a leader at New York Presbyterian Hospital.

00:01:38:06 - 00:01:52:05
Corey Feist
Our mission is to support the well-being and job satisfaction of all health workers in the United States. We envision a world where seeking mental health care is viewed as a sign of strength for our health care workers.

00:01:52:07 - 00:02:15:15
Rebecca Chickey
That's an incredibly powerful mission and a beautiful vision of the future. I know that the Dr. Lorna Breen Foundation is not doing this alone. In fact, I believe there is an organization and AHA is part of it called All In: Caring for Caregivers. Can you describe the relationship between the Dr. Lorna Breen Foundation and All In?

00:02:15:18 - 00:02:39:10
Corey Feist
Absolutely. And as you noted, the AHA been a really important partner of ours. With my background as a health care leader, I noticed that there are few silos at health care. And so one of our primary goals at the Lorna Breen Foundation was to bring together health care organizations in an interdisciplinary way. To wrap our arms around the mental health and well-being of our workforce.

00:02:39:12 - 00:03:09:06
Corey Feist
So in the spring of 2021, we created a coalition called All in Wellbeing First for Health Care, whose focus was really to break down those barriers to mental health access and to accelerate solutions to this growing burnout and mental health challenge that the health care workforce had. As part of the work of the All In Coalition, we created All In: Caring for caregivers, which is a technical assistance program which has three main phases.

00:03:09:09 - 00:03:31:27
Corey Feist
First, to remove barriers to mental health access. The second is to educate health care leaders on what they can do in their sphere of influence and control about addressing well-being from a systems perspective as well as an individual perspective. And then it culminates in a year long learning collaborative. We do this work focused on getting at the root cause of many of these issues.

00:03:31:28 - 00:03:53:21
Corey Feist
We do it in an interdisciplinary way, and we try to bring together states or large metro areas of hospital systems and their teams to do this work in a very transparent way so that their workforce can see the work is being done, and so they can learn from each other about evolving best practices. And that's how we met Tiffany.

00:03:53:23 - 00:04:11:26
Rebecca Chickey
That's wonderful. Tiffany, I can't wait to get to you for a couple. I have a couple more questions for Corey first. Of course, some of the listeners may not understand when you say removing the barriers to access for mental health care, they may think: they're working in hospitals and health systems so of course they have access to mental health care.

00:04:11:27 - 00:04:18:06
Rebecca Chickey
Can you go a little deeper on that and describe some of those barriers that you're trying to remove and mitigate?

00:04:18:09 - 00:04:46:09
Corey Feist
And it's a great point, Rebecca, because when my sister in law took her life in April of 2020, I had been in health care for many dozens of years, actually, many decades, I should say. And I was a leader at University of Virginia Health System. Yet I wasn't a clinician, and so I was completely unaware of the stigma as well as the professional barriers and really potentially penalties that health care professionals in the United States have.

00:04:46:11 - 00:05:32:00
Corey Feist
These mostly appear in the form of overly invasive and really inappropriate questions that clinicians are asked about whether they've ever been diagnosed or treated for mental illness, whether they've gone to therapy. And these are the same questions that my sister in law was terrified that she would have to respond to following a singular mental health episode. And so what we have been able to do at the Lorna Brain Foundation, through our All In Coalition and Caring for Caregivers, is to get tools to the front lines, whether it's a licensing board that's asking these questions, or hospitals who ask these questions, most commonly in credentialing applications, and have them change those questions and then importantly, communicate

00:05:32:00 - 00:05:54:14
Corey Feist
the changes to the workforce. As I sit here with you today, there are 1.5 million health workers in the United States that are benefiting from the changes that we've made, which we hold out in the All In Well Being First for Health Care Champions Challenge for licensing and credentialing badge that we give out to hospitals, as well as the licensing boards for doing that important work.

00:05:54:17 - 00:06:03:17
Rebecca Chickey
Thank you. I mean, I don't think many of the listeners may have realized that those questions where have you ever, as you noted, have you ever been treated?

00:06:03:19 - 00:06:27:23
Corey Feist
And if I could just add one thing, because the American Hospital Association a couple of years ago published their first ever suicide prevention guide, at least the first ever that I'm aware of. And in that suicide prevention guide, you identified three key drivers of suicide among health workers. And the first one that you all identified is this concern around the loss of license and credentials associated with the stigma for mental health care?

00:06:27:29 - 00:06:44:09
Corey Feist
So we know that for Laura, this wasn't just an isolated incident. And it's something that we hear from health workers all over the United States that they are fearful for these repercussions. And so we need to do something about it and address it, which is what we've done across the country. We've made great strides.

00:06:44:14 - 00:07:12:29
Rebecca Chickey
Thanks for mentioning that. There's a variety of drivers for this concern and this stigma. So thank you. I want to turn now towards another thing that you mentioned earlier, Corey. And that is working with states, working with large health systems in order to advance this in their own organizations and across a particular geography or a regional area. And I'm going to call out specifically the caring for Virginia caregivers work.

00:07:12:29 - 00:07:17:11
Rebecca Chickey
Can you describe that a little bit? And then we'll bring Tiffany into the conversation.

00:07:17:13 - 00:07:44:21
Corey Feist
Absolutely. Two seconds of background. When the president of the United States signed into law the Dr. Lorna Breen Health Care Provider Protection Act, it created two spheres of programs. And one of those sphere of programs was learning materials for health care leaders to address the root cause of burnout, as well as mental health challenges. That was called the Impact Wellbeing Guide, which was led by the CDC and our All In coalition provided guidance on it.

00:07:44:23 - 00:08:08:27
Corey Feist
What we heard from the large health system across the country that was implementing the guide is they'd like to do this work together in a learning collaborative and they need some help. And so caring for Virginia's caregivers, caring for North Carolina's caregivers, caring for New Jersey's caregivers, and now caring for Wisconsin's caregivers are all efforts for us to take organizations through the phases of work, from the impact Well-Being guide.

00:08:09:00 - 00:08:37:21
Corey Feist
And that's begins by addressing these mental health barriers. It then moves towards education of ten person teams across health systems to address the issues at the root cause and become educated about the solutions. And then finally culminates in a learning collaborative focused on an operational initiative that drives burnout. And that's what we've done with Tiffany and the team in Virginia, now North Carolina, New Jersey, and recently expanded into Wisconsin.

00:08:37:23 - 00:08:48:19
Rebecca Chickey
That's fantastic. Tiffany, I bet the question on many listeners minds is, why did Centra decide to join the work of All In of caring for Virginia caregivers?

00:08:48:21 - 00:09:23:06
Tiffany Lyttle, R.N.
At the time, we had some really innovative leaders that understood that well-being wasn't just a nicety, but rather a necessity for us to drive health care forward not only to our communities, but also to our health care workers. So 2019, we really start pulling together the evidence base for this work. And what we saw is that health care workers were far more likely to suffer from depression, to have thoughts of suicidal ideation, to have bio-psychosocial disturbances, and of course, use substances to help them cope with their roles.

00:09:23:09 - 00:09:42:09
Tiffany Lyttle, R.N.
But we had never provided health care workers with the avenues, tools and support that they needed to be able to speak up and say, hey, we need help for coping with, you know, the very large burden of taking care of our communities and health care in the United States. Those were all published before 2019. So of course, you know what happened after 2019,

00:09:42:09 - 00:10:12:17
Tiffany Lyttle, R.N.
we went into a global pandemic. So we really need to find avenues that we could help support our health care team members - not only address their own well-being so that they can carry that forward, but also not place calluses where we should have compassion because we were facing a compassion crisis, right? And when we tell people, you know, you have to be strong, you have to be confident and yes, we are all of those things, but we also have to deal with very messy, beautiful situations of life and humanity.

00:10:12:19 - 00:10:36:15
Tiffany Lyttle, R.N.
And that can take a toll on us. It can leave echoes and it can leave scars. But we are well-practiced in taking care of code situations. I mean, if you think about a code situation, we are practice, rehearse, we simulate it, we educate to it. We certify to it every single year. We have avenues and tools to help us be better at coding situations and situations of that nature.

00:10:36:18 - 00:10:52:12
Tiffany Lyttle, R.N.
What do we have in place for taking care of ourselves? Nothing. We don't teach that in school. We don't simulate that. We don't go over it. We don't get certified to it. I mean, now we are starting to see some certifications for health care organizations come through. But that was about the time that we found the Lorna Breen Foundation.

00:10:52:12 - 00:11:13:07
Tiffany Lyttle, R.N.
And what perfect timing, you know, that we really needed to find a place for getting those tools, for helping support us in that work and removing the stigma. And I have to say, that's been one of the most important parts of engaging in our health care workforce as well-being is destigmatizing health care. Destigmatizing being okay with being not okay.

00:11:13:09 - 00:11:33:01
Tiffany Lyttle, R.N.
You know, it's okay for us not to come out of a situation at work and feel not okay about it. We have to be able to have those avenues, and when we stigmatize it and put licensing questions like, have you ever seen anyone for mental health resources? Or in the nursing realm, which is where I live, where our CNOs actually have to report this to the Board of Nursing.

00:11:33:09 - 00:11:43:24
Tiffany Lyttle, R.N.
You know, when we have those stigmatizing questions, we are putting that barrier in place and saying it's not okay for you to get help, you know, because then we're going to question your entire life, your livelihood and how you perform.

00:11:43:26 - 00:11:53:10
Rebecca Chickey
Can you give the listeners a little bit more about...you describe the journey well, but who led this journey? Was it your C-suite leadership? Where did that backing come from?

00:11:53:12 - 00:12:20:05
Tiffany Lyttle, R.N.
We have wonderful champions here in our C-suite. At the time that I was actually hired into this role, my original oral was patient education and nurse wellness. So it was really leading the work with nurses and how we were engaged and we published research. Our CNIO was actually one that that led this effort to make sure that our nurses were healthy and well, because, you know, the national data is that we are hemorrhaging new nurses at a rate of one in three, in their first year, will leave the profession altogether.

00:12:20:07 - 00:12:54:19
Tiffany Lyttle, R.N.
So what can we do to support that work of us being healthy and well and really figure out what those drivers are? So as we engaged in this journey, we started seeing really positive things like retention, engagement and, you know, better quality of work and, you know, better patient experience scores and better engagement scores. And we saw our nurses that were travelers even wanting to stay in Virginia, in rural Virginia, that, you know, not going to these major cities because they said, you know, this is the first place I've been where I feel healthy, where I feel like I can actually get the help that I need.

00:12:54:21 - 00:13:17:13
Rebecca Chickey
So I will tell you that back to your title, Director of Cultural Integration. It sounds like the impacts that you've been seeing as you just described are really that you have created a culture that not only better supports the mental well-being of the nursing and other clinical staff, and I'm assuming administrative staff as well. But at the same time, you are, having a positive -

00:13:17:15 - 00:13:40:09
Rebecca Chickey
and let's talk about the positive financial return on investment, because what it takes to recruit a new nurse and train them, or any new clinician or health care worker is a significant cost. And it's a lost opportunity cost of retaining those who often leave. So it's having multitudes of impact if I hear you correctly.

00:13:40:11 - 00:13:57:29
Tiffany Lyttle, R.N.
Yes, absolutely. Not only with engagement, but also our patient experience. You know, if you think about it on Maslow's hierarchy of needs, you know, if you are struggling with just physical safety, you're not going to find enrichment. That's not going to be part of your day. Your day is going to be: I need food, shelter and water, and I need to not be hit.

00:13:58:01 - 00:14:22:21
Tiffany Lyttle, R.N.
So actually, we contributed to the suicide prevention workbook. We actually have the piece on, how do we respond to workplace violence? Because that is one of our drivers for burnout in health care communities. But even in addition to that, SHRM put out a study. It's part of their civility work and their scorecards. Incivility in the workplace is costing $2 billion a day in the United States.

00:14:22:24 - 00:14:41:26
Tiffany Lyttle, R.N.
$2 billion a day. You know, we can't possibly engage with innovations, creativity, open communication, safety, even. You know, this all ties back to wellness. So when I started off by saying that it's a necessity, it's not a nicety. A lot of people hear well-being and they're like, oh, that's nice. You know, it's really nice that our nurses get it.

00:14:41:26 - 00:15:00:21
Tiffany Lyttle, R.N.
Or our physicians, you know, they get an opportunity to talk about what's going on in their lives, but it's so much more foundational than that. If you aren't healthy and, well, you aren't engaging in all those things that we need to engage in because we are stronger together if we're working towards things like recreating health care and making it accessible to everyone.

00:15:00:24 - 00:15:11:09
Tiffany Lyttle, R.N.
So it's not just how it plays out for our community members and how they are treated, it's also how we treat each other and how we are healthy enough to even engage in that work.

00:15:11:12 - 00:15:38:29
Rebecca Chickey
So many positive impacts of this work. Thanks to both of you for being willing to share your time and expertise with me, with the listeners for this podcast, and I encourage everyone to go to the Dr. Lorna Breen Foundation website and get involved, get engaged and change the culture of your organization and remove those barriers and stigma for the health care workforce who may need mental health treatment.

00:15:39:01 - 00:15:47:12
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:10 - 00:00:31:17
Tom Haederle
Welcome to Advancing Health. The impact of artificial intelligence is showing across nearly every aspect of health care delivery today, and continues to grow in reach and importance. In the second of this two part podcast on patient safety, we hear from a major health system about its steady integration of AI, how to govern it, and lessons learned from putting AI to work across many of its systems.

00:00:31:19 - 00:01:03:21
Chris DeRienzo, M.D.
Welcome back. This is part two of a terrific conversation with Dr. Randy Fagan from HCA. Again, I'm Dr. Chris DeRienzo, the chief physician executive for the American Hospital Association. Dr. Fagan serves as the chief quality officer of HCA Healthcare. And part one of this podcast went really deep on patient safety and how HCA is both thinking about and acting on patient safety at a scale that is incredibly challenging to rival within the American health care ecosystem.

00:01:03:28 - 00:01:29:07
Chris DeRienzo, M.D.
We got into a conversation around AI enabled technologies on patient safety, and it made us wonder, there's a deeper conversation we should probably have around AI. And really, I think that starts with governance, because I've got to imagine when you're talking about something like 190 hospitals, across 2000-ish other rooftops, that you have no shortage of people wanting to utilize AI in their workflows.

00:01:29:07 - 00:01:33:00
Chris DeRienzo, M.D.
And that's got to require a pretty significant governance arm.

00:01:33:02 - 00:02:01:10
Randy Fagin, M.D.
You're 100% correct. And, you know, we've put into place a pretty robust governance structure that goes beyond just our clinical leaders. It involves all of our functional areas from operations, finance, marketing, development, supply chain, you name it, we've included those folks to be a part of the table because it's important, as we look at the use cases, that we're looking at each use case through all lenses.

00:02:01:12 - 00:02:28:29
Randy Fagin, M.D.
As we prioritize use cases, we look at them quantitatively based off of the risk and the opportunity in each one. You know, it's interesting, as we've looked at the opportunities, it's not always about average performance or going from this average to this average. One of the greatest opportunities that AI offers us the opportunity - and it doesn't matter which lane we're in, whether it's operational efficiencies or clinical performance - it's about variance reduction.

00:02:29:06 - 00:02:57:20
Randy Fagin, M.D.
And, you know, being able to reduce variance is one of the, I think, most powerful things that AI can do for us inside the clinical space. When we look at areas to prioritize, we look at where we have areas of high variance, whether it's variance by clinician experience, variance by patient presentation, variance by geography. How can we reduce variance to try to improve the consistency with which we deliver care to our patients?

00:02:57:22 - 00:03:17:16
Chris DeRienzo, M.D.
I love the focus on variance. One mentor of mine that framed it this way that when you're looking at a challenge, you have to ask yourself, is this a batting average problem, or is this a slugging percentage problem? Because sometimes you're right. I've got to move, you know, a whole big boat from below the Mendoza Line, which is 200

00:03:17:16 - 00:03:36:18
Chris DeRienzo, M.D.
in baseball, for those who are baseball fans, to 300. But sometimes, it's I just need seven more homeruns or I need to not strike out 17 times. And it sounds like you're taking a version of that approach that is not baseball related to health care. And I love that thinking because it really does branch into very different pathways.

00:03:36:20 - 00:04:06:19
Randy Fagin, M.D.
100% agreed. And as we do that, one of the critical things that is kind of the next layer beyond governance is who you involve. And it's critical that we involve frontline staff early, the people who are closest to the work being done. It validates the problem and ensures the relevance and buy in. And as smart as the executive team may be, it is critical that we get the people closest to the work involved early in the process to help to shape that work.

00:04:06:21 - 00:04:22:27
Chris DeRienzo, M.D.
For those who are listening only and not seeing me nod my head as vigorously as the head can be nodded right now, I just want to narrate that for you. Because I remember like, ten years ago, we had developed this terrific machine learning model to predict readmissions in the health system I was working at the time.

00:04:23:03 - 00:04:36:27
Chris DeRienzo, M.D.
We spent nine months in development. Like, the numbers on the model were terrific. And then we showed it to the people who are going to use it, and they said, what's this? We don't need this. And by the way, I don't want to use that. It took us a whole nother nine months to walk through the people side.

00:04:36:27 - 00:04:45:02
Chris DeRienzo, M.D.
So that is a lesson that you learned exactly once in your career. And it sounds like it's being put to use by your group at HCA.

00:04:45:04 - 00:05:01:24
Randy Fagin, M.D.
Agreed. And as you bring those folks forward, one of the things that we try to make sure we're focusing on is augmentation, not necessarily automation. How do we enhance human decision making, not replace it? Especially in the clinical space, we think that's a very important decision point.

00:05:01:26 - 00:05:33:06
Chris DeRienzo, M.D.
Yeah. There are there's a great article that was in Axios a few months ago that the two editors of Axios wrote together about the impact of AI on their own professional infrastructure. They recommended all leaders ask themselves the question, what are the things that I and my team need to do to be incredibly successful? And then ask the follow up question, how can AI either automate some portion of that so I can focus my human time on a different part that's going to make a big difference?

00:05:33:12 - 00:05:44:11
Chris DeRienzo, M.D.
Do you have some specific examples, Randy, about how you're seeing that put to use and how perhaps those ideas have flown through the governance process and then into action?

00:05:44:13 - 00:06:11:05
Randy Fagin, M.D.
Yeah, there's a few areas that we've addressed. I'd mentioned in the last episode, working towards being able to reduce variance in the way that we staff our nursing units. And it sounds kind of banal, but it's remarkable when you think about the variance in how we staff those based off the individual who's staffing it and the time it takes them to do that.

00:06:11:07 - 00:06:21:18
Randy Fagin, M.D.
It is incredible. And by offloading that burden from them, it allows them to actually lead rather than spend hours of their day managing a schedule.

00:06:21:20 - 00:06:49:16
Chris DeRienzo, M.D.
The staffing example is fascinating because I interviewed Dr. Schlosser two years ago, and, Mike Schlosser, for those who didn't listen to episode one, is one of the HCA leaders who helped drive this technological transformation across the enterprise. And I remember him describing that nursing model in some detail, because the number and degree of variables about weekend option versus not weekend option - Tuesdays and not Fridays.

00:06:49:24 - 00:07:09:14
Chris DeRienzo, M.D.
And for a human to try to manage - your nursing unit can have hundreds of nurses - who you're trying to mix and match in a way that meets personal lives as best as possible with patient and clinical needs. This is exactly the kind of problem that AI is built to solve, because AI find patterns and helps develop the solution, right?

00:07:09:14 - 00:07:38:08
Randy Fagin, M.D.
And on the clinical side too of that, Chris, you know, this isn't just an exercise in how do you staff a nursing unit with the right number of humans for the number of patients that are there? There's the ability as you head further down that road to say what kind of patients are on that unit today on this shift, at this moment? Disease states, resource intensivity, and then try to match that up with a dynamic of nurses who meet those needs.

00:07:38:11 - 00:08:18:11
Randy Fagin, M.D.
You don't want to staff an entire unit with all new grads, nor do you necessarily want an entire unit of all 20 year experience nurses. How do we create the right dynamic of skill sets and experiences to meet the needs of the patients? There's a clinical value in the work that's done beyond just the offloading of that administrative burden from folks. You know, on the offloading administrative burden, I know a lot of folks have been using AI as a vehicle to assist with documentation where physicians, nurses, PAs, whoever, can just talk and patients can just talk, and that information is then aggregated and then put into the medical record in a way that

00:08:18:11 - 00:08:56:02
Randy Fagin, M.D.
it is consumable and it understands nuance. It understands context and it plugs things in regardless of the order in which you ask the questions, it plugs it into your documentation. And the idea of creating a greater level of completeness of our electronic health record has an incredible value to us. I mean, one, - on the on the administrative burden side - it can remove literally hours worth of work of our physicians who need to be entering the information, editing the information, signing off on the information, all of that stuff

00:08:56:02 - 00:09:18:07
Randy Fagin, M.D.
that's just an administrative burden. It literally can offload hours of it. Also, when you think about having a more accurate, complete medical record, the ability to transfer knowledge from shift to shift, and the ability to make clinical decisions based off the complexities of the individual. It's just better for patients. And I really see a value in that space.

00:09:18:12 - 00:09:40:23
Randy Fagin, M.D.
And that's another one that we're exploring and pursuing is we've got an entire cohort of physicians, both ER physicians and hospitalists. We're exploring the cardiac space as well in Texas. That was our pilot area in the Dallas area that have been utilizing this and helping us to learn. How do we allow this to give time back to the doctors, more time at the bedside, less time at the computer?

00:09:40:25 - 00:09:52:17
Randy Fagin, M.D.
At the same time, enhance the information that is able to be transferred shift a shift, and the information that's utilized by each shift for clinical decision making. It's a really exciting space.

00:09:52:19 - 00:10:21:19
Chris DeRienzo, M.D.
Ambient AI, the technology that you're referencing, and there are a variety of companies who are in that space is one reason that when I talk to trainees so folks in medical school or residency or nursing school, I say, folks, you have picked the best possible time to go into medicine or nursing or health care in general, because you and I trained on paper, and we were walking around units with giant charts and and writing orders in triplicate, and then our entire world got electronified.

00:10:21:21 - 00:10:41:03
Chris DeRienzo, M.D.
And in doing so, we pulled people away from face time with patients. And I see the value in all of that structured data. And my background is a CQO as well, on a much smaller scale than you. So I love the fact that we now, thanks to the, the electronicification of health care have all of the structure, data and the metrics.

00:10:41:03 - 00:11:06:29
Chris DeRienzo, M.D.
But my gosh, we transferred such face to face to face to screen time that this ambient technology is giving it back. It really is a way not only to, as you indicated, improve documentation, which has never been anyone's favorite part of their job, but also, improve the experience of our workforce. It is such a crucial thing to focus on while we are in the midst of a workforce crisis that we will never be able to recruit our way out of.

00:11:06:29 - 00:11:08:02
Randy Fagin, M.D.
Completely agree with you, Chris.

00:11:08:04 - 00:11:37:06
Chris DeRienzo, M.D.
I think we've got time for one last question, and I'm just wondering, obviously you all have had a number of successful implementations. You've probably had some that, tried and were cut off. What other, you know, single biggest lesson would you have steering the AI ship at, you know, the, the 190 plus hospital entity that is is HCA health care or folks listening in who are perhaps trying to do the same thing within their own communities.

00:11:37:08 - 00:11:57:13
Randy Fagin, M.D.
I would tell you one of the most important things that folks can do. One - well, there's a couple of things. You asked for one, I'm going to give you more than one. We'll take it. One is, you know, make sure that, you know, if you're the clinical leader trying to use AI to advance care in your space, bring together a team that isn't just clinical.

00:11:57:13 - 00:12:15:24
Randy Fagin, M.D.
You have to have all different lines of sight to really solve these problems. Second, you want to define a single high impact problem that has a low risk, if you don't get it right. You want to make sure that if you fail, you're going to fail safely in this. And then the last thing, don't start with vendor selection.

00:12:16:01 - 00:12:28:12
Randy Fagin, M.D.
You know, that becomes a solution looking for a problem. You need to first identify the problem you're trying to solve, and then identify the solution that best allows you to solve for that.

00:12:28:12 - 00:12:44:23
Chris DeRienzo, M.D.
Wise words, and ones that I think could be applied just as easily in a critical access hospital in Oregon as they can to a multistate system like HCA Dr. Fagan, it is been a privilege. And again, my guess is we'll be asking you back again sometime in the future. Thanks for spending time with us today.

00:12:44:23 - 00:12:46:03
Randy Fagin, M.D.
Chris, an absolute privilege. Anytime.

00:12:46:09 - 00:12:48:24
Chris DeRienzo, M.D.
Thank you. Take care everyone.

00:12:48:27 - 00:12:57:09
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.