Advancing Health Podcast

00:00:00:06 - 00:00:30:16
Tom Haederle
When you are the health care destination for five rural counties in northeast Texas, your operational strategies have a lot of impact on patient lives. For Titus Regional Medical Center, 174-bed independent hospital, the driving operational strategy, or principle, is an unshakable commitment to health equity in all its forms.

00:00:30:18 - 00:01:08:27
Tom Haederle
Welcome to Advancing Health, the podcast of the American Hospital Association. I'm Tom Haederle with AHA  Communications. Health equity is a journey. Each hospital or health system pursues this goal in its own way, according to the needs of the communities it serves. In today's podcast, a sort of audio case study hosted by Jackie Hunter, vice president of health equity strategies with the AHA’s Institute for Diversity and Health Equity, we learn how the Institute's Health Equity Roadmap, currently used by 720 hospitals nationwide, has helped Titus Regional design a system of individualized care that relies on data to deliver impressive results.

00:01:09:00 - 00:01:10:13
Tom Haederle
Here's Jackie.

00:01:10:15 - 00:01:25:18
Jackie Hunter
So I would like to welcome today Terry Scoggin, the chief executive officer of Titus Regional Medical Center, a joint commission accredited 174-bed independent rural hospital system serving the northeast Texas area. Welcome, Terry.

00:01:25:20 - 00:01:32:26
Terry Scoggin
Thank you so much for having me. So glad to be a part of this program and talking about rural health care and health equity in rural communities as well.

00:01:33:01 - 00:01:38:17
Jackie Hunter
So let's get started. How does health equity fit into your organization's strategic priorities?

00:01:38:20 - 00:01:58:21
Terry Scoggin
It's the foundation of what we do. On a daily basis, health equity impacts everything there is about health care. In a rural community, especially in northeast Texas, we're 60 miles from the Arkansas border, the Oklahoma border and the Louisiana border on I-30. We're 45 to 50 miles from a health system equivalent in every direction. So our county is 32,000 people.

00:01:58:22 - 00:02:27:14
Terry Scoggin
We're surrounded by four counties that don't have a hospital. So we have about 82,000 people. We are the independent health system for those five counties. And in northeast Texas, health equity is one of the driving factors in health. So when you see all the analysis and you talk to people, 80% of a person's health is determined by those health equity factors, whether it be in Texas, the non-medical drivers of health, or across the rest of the nation when they call it social determinants of health.

00:02:27:17 - 00:02:53:28
Terry Scoggin
Those are the driving factors in health. So health equity is so much deeper than just diversity, equity, inclusion. But it really gets into what are the individualized needs of that patient and how do you affect it. So from our strategy perspective that's how we build our strategy. Trying to understand the needs of our community, of our physicians, of our team members, and all of those things for the individualized care of each one of them.

00:02:54:04 - 00:03:10:16
Jackie Hunter
So it sounds like you are doing some great work in that space. And, you know, thanks for sharing that information with us. So I know you're very familiar with our Health Equity Roadmap. What has been your experience with the Roadmap thus far? And in particular, how does it align with your current organization’s strategic plan that you mentioned?

00:03:10:22 - 00:03:33:09
Terry Scoggin
So from a Roadmap perspective, we've had the opportunity the last few years to go through the process, have our data submitted, then review our results. We've been lucky enough to participate with the American Hospital Association and the different regional parts of AHA to really analyze health equity and listen to podcasts and websites and all those different resources that AHA makes available. Podcasts like this one.

00:03:33:09 - 00:04:05:21
Terry Scoggin
And we learned so much about health equity, but we've used that Roadmap to kind of really do the drivers of health. And I encourage anybody who's going to look at that Roadmap, those drivers are the ones that I've really found valuable to us. So when you look at the levers and the summary of levers of transformation that the Roadmap has, I think you're going to find some great foundations for strategies, for milestones, for action items that you, as a health entity, can take into, that are going to have a dramatic impact on your daily work.

00:04:05:23 - 00:04:29:12
Jackie Hunter
That's great. And I'll chat a little bit about, you know, our Health Equity Roadmap. In March 2022, the AHA launched the Health Equity Roadmap. And it's a national initiative to help drive the improvement in health care outcomes, health equity, diversity and inclusion. Right now, we have about 720 member hospitals that have completed the health equity transformation assessment. Oftentimes we reference as the HETA.

00:04:29:14 - 00:04:56:08
Jackie Hunter
This electronic tool serves not only as diagnostic, but also to assess the current state, of health equity as a baseline for continuous improvement, helping organizations like yourself become more equitable and inclusive. The journey towards health equity doesn't end with assessment, as you already referenced. After completing the HETA, members receive a comprehensive profile and links to assess the transformation action planners, which sometimes we call TAPs.

00:04:56:11 - 00:05:20:27
Jackie Hunter
Additionally, all members participating in the Health Equity Roadmap are invited to join the journey, a virtual community designed to support ongoing efforts in health equity transformation. So we really appreciate your involvement within the HETA, as well as being a champion for this work. How did you leverage the data collected through the HETA, and corresponding results to inform your actions?

00:05:21:00 - 00:05:39:09
Terry Scoggin
As far as using the data, it was amazing just to see how the data was put together in the HETA analysis. It's not what I was expecting. We talk about expectations and we talk about the data. I was expecting it to be something about more like a community health needs assessment. And I want to talk to our peers and other people who are taking this assessment.

00:05:39:11 - 00:06:01:27
Terry Scoggin
It's not what it is. It's not a CHNA. This is a way of really breaking down how are you looking at diversity, equity, inclusion across your health system, across your community, and really looking into deep into your foundation? I was very surprised by the data and how it was put in a way that we could use it, whether it be policies, whether it be committee structures.

00:06:02:00 - 00:06:19:06
Terry Scoggin
And then, especially in our strategic, you asked earlier about that strategic priorities. It's critical when we look at the mission and the vision of our community, vital independent rural health system, that we understand the health equity impact on each one of those milestones that we put in place.

00:06:19:14 - 00:06:37:09
Jackie Hunter
That's great. And I know, you know, earlier during my introduction, I talked about you all being a joint accredited, you know, with The Joint Commission. I'd like to chat a little bit about that. So what impact do you hope this will have on your accreditation and compliance with The Joint Commission, as well as the Center for Medicare and Medicaid Services?

00:06:37:12 - 00:07:00:12
Terry Scoggin
We were accredited or surveyed in 2023 now by The Joint Commission. And during the end of Covid, we went through this process and went through the playbook and did our first really analysis from a health equity standpoint, and we realized how many gaps we had. And I’m truly appreciative of AHA. And I've shared that with many of my colleagues of the AHA, how it prepped us for what we didn't know.

00:07:00:14 - 00:07:22:18
Terry Scoggin
We were looking at health equity so wrong. Health equity is not just race or it's just not diversity and inclusion. Health equity is so much more. And going through this Roadmap and going through this assessment, we are able to look at so many different areas of it, and what it really made us focus on is data. And there's a lot of things

00:07:22:18 - 00:07:40:06
Terry Scoggin
in there you start asking yourself, let's get into the data. I had the opportunity with the AHA to go through a cohort a couple of years ago as well, and we were able to access some tools, and we use one of those tools that really gets into the socioeconomic and really the health equity matrix and indexes for your community. And that's, we started pulling data.

00:07:40:06 - 00:08:04:26
Terry Scoggin
I'm a CPA by background, I love numbers. I'm probably not the guy you want to invite to dinner and have to the cocktail party. But I love data. And when we really what was encouraged through this analysis is we started pulling data and it wasn't just pulling ethnicity and race and stuff. We were looking at all the different segments in our community, insured and uninsured, race, ethnicity, religion, uninsured.

00:08:04:28 - 00:08:31:18
Terry Scoggin
We're working. We don't have insurance, but we have commercial insurance, Medicare, Medicaid, all those different aspects that you break down when you start looking at it. We're 47% Hispanic in our county, 43% white, 9% African American. Really breaking in what does it look like in the census areas of our county? The life expectancy in the north part of our city was almost 12 years higher than the south part of our community.

00:08:31:21 - 00:08:48:29
Terry Scoggin
That is right next to one of our manufacturing plants. Those are the types of things when you start looking at health equity and you really break down the segments in your community, there's so many segments. And one of the levers that it talks about in here, and I think I hear all the time from AHA, is talking about individualized care.

00:08:49:01 - 00:09:16:24
Terry Scoggin
If you are not treating each patient from an individualized needs point of view, you're missing it. You're not providing the care that they need. It's not just we treat everybody this way. That's wrong. The health equity lens that we're trying to put on it really focused on in this assessment, is really trying to say, what are the individual needs of that segment and more importantly, what's the individualized needs of that patient and their family and how can we meet it?

00:09:16:24 - 00:09:34:03
Terry Scoggin
So from a Joint Commission standpoint, when they came last January, they said, okay, what are you doing with health equity? And I said, okay, here we go. How much time do you have? Here's all these slides that we worked on. We've broken down this our social vulnerability index. This is our uninsured rates. This is how it is for our prenatal group.

00:09:34:03 - 00:09:53:15
Terry Scoggin
Here's what is for geriatric population. We were able to show all the segments of our population that they looked at. And then they looked at my board members and said, okay, what do y'all know about this stuff? And we, part of our board package every month, I have a section of the board meeting that's focused on health equity, something educational, or some facts about health equity.

00:09:53:18 - 00:10:16:00
Terry Scoggin
It may be something we got from AHA. It might be some data we want to look at. That's the difference. And so when my board members started saying the same thing that I was saying, and then they looked in our board reports, they were like, okay, we get it now. I will tell you this, I was impressed by Joint Commission, and I would encourage my peers and colleagues across the health care industry to be prepared.

00:10:16:00 - 00:10:33:00
Terry Scoggin
I think Joint Commission has it right. If we're going to make a difference in the lives of people across the United States, we have to focus on health equity. And I think the things that a Joint Commission are asking and the data they're asking for, and they're wanting to see it in your board reports, they’re wanting to see it in your strategic initiatives

00:10:33:00 - 00:10:40:06
Terry Scoggin
as you talked about earlier, I think they've got it right, and I'm excited for what CMS is doing and what Joint Commission's doing related to health equity.

00:10:40:12 - 00:10:47:03
Jackie Hunter
What are some early lessons on how the Health Equity Roadmap has influenced and transformed the culture within your organization?

00:10:47:05 - 00:11:05:13
Terry Scoggin
From a culture standpoint, I think the Health Equity Roadmap has allowed us to see the data, to see the information. Once you see this, you can't unsee it. And that's a difference that I've had over the last four or five years. And I appreciate AHA for the opportunity they've given me to participate in these things and try and ,once you see it, you can't unsee it.

00:11:05:17 - 00:11:25:03
Terry Scoggin
Once you see the inequities in health care or the inequities caused by our own actions and our own policies, you don't unsee it. And when you look at this data in a rural community, it's different because that's not a number. That's not a percentage. I know who that person is. I know who that segment is. I know where they go to church.

00:11:25:06 - 00:11:47:06
Terry Scoggin
I know where they live. I understand that they don't have the exercise things in that part of the community. So the difference is really from our standpoint where it's influenced in our organization is we've seen the data and once you've seen it, you cannot unsee it. And I think we're challenging ourselves, whatever it is, if it's a committee, if it's a group task force, who's on it?

00:11:47:08 - 00:12:05:29
Terry Scoggin
Do we have enough men and women? Do we have enough of the age groups? Do we have enough of the different race and ethnicity? Have we considered our gay-lesbian community? Have we considered our uninsured community? All the different things. I think that's one of the things I've loved about this is it's opened our eyes and we're asking questions and we're having conversations.

00:12:06:01 - 00:12:29:08
Terry Scoggin
Rural is one of the inequities in health care, and being in rural is a health inequity. And I think those are the things we've got to talk about. Whether it's at the Texas Hospital Association or the American Hospital Association, you know, we asked ourselves, do we have the right mix on this committee? I think the AHA does a great job of trying to balance all the different measures of health equity, and they put a committee or a group together.

00:12:29:08 - 00:12:46:08
Terry Scoggin
And it's exciting to listen to some of these, you know, some of the ambassadors of health equity, when we come to some of these meetings. I think we have to continue to do it, whether it be our small organizations, our regional, our state. We have to focus to ensure that we're not creating an environment that is detrimental to health equity.

00:12:46:10 - 00:12:52:13
Jackie Hunter
That's great. No. Wow. That was powerful. And you know, with that, how do you expect this cultural shift to be sustainable?

00:12:52:15 - 00:13:08:02
Terry Scoggin
That's the hard part. How do you keep it sustainable? That's where it's going to be very difficult. But you know, where I think it is, and this is the discussions we've had in Texas over the last few months with the Texas Organization of Rural & Community Hospitals, TORCH, and also the Texas Hospital Association. This is where we need to talk to our legislatures.

00:13:08:09 - 00:13:28:25
Terry Scoggin
This is where we need to talk when we're lobbying for additional funds. You know, we struggle from a health care perspective, especially with the payers. The payers, for the most part, are for-profit companies, and they have lobby groups that are talking about all the bad things that are going on in health care. We've got to turn it on its side and say, okay, what are you doing about the uninsured population?

00:13:28:25 - 00:13:44:18
Terry Scoggin
What are you doing about this segment? How are you addressing health equity? These are the things when you talk to your legislatures, when you talk to the people in the Senate and the Congress and the state legislatures, that's the stuff that's going to make a difference. And I think there's funds out there. We just need to put money in the right place.

00:13:44:21 - 00:14:08:13
Terry Scoggin
And I think if we start focusing more dollars on initiatives related to health equity, we will be able to mitigate a lot of unnecessary health spend. And I know that's not a popular statement, but I believe it. The money's there. It's just going to wrong places. So using these health equity data that you talked about, I think we can use those numbers and statistics to really once you see it, you're not going to unsee this.

00:14:08:15 - 00:14:32:04
Jackie Hunter
You know Terry, this was great. It was great chatting with you. You know, definitely have me fired up and really appreciate the hard work. And thanks for continuing to be a champion for us in this work. And, you know, thank you for sharing your insights and experiences with us today. And hopefully this will also help our rural counterparts, navigate through the HETA, and just want to again, thank you so much for your time and continue to do the great work in your rural setting.

00:14:32:06 - 00:14:33:08
Jackie Hunter
Thank you Terry.

00:14:33:10 - 00:14:35:03
Terry Scoggin
Thank you.

00:14:35:05 - 00:14:43:16
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.

00:00:00:07 - 00:00:23:11
Tom Haederle
The overall aging of America affects health care as much as any other field. For example, more than 60% of our currently practicing psychiatrists - who provide a significant portion of behavioral health services to patients - are over age 55 and are likely to retire within the next decade. So, how to recruit, train, and retain enough people to meet the future demand for behavioral health services in our nation?

00:00:23:13 - 00:00:35:09
Tom Haederle
Integration may hold the key.

00:00:35:12 - 00:01:02:16
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast, hosted by Rebecca Chickey, senior director of behavioral health services with AHA, we hear how the dismantling of the traditional silos between behavioral health and primary care practice benefit patient and provider alike. Her guest is Dylan Panuska, a clinical psychologist and manager of behavioral health integration with Endeavor Health in Illinois.

00:01:02:19 - 00:01:13:09
Tom Haederle
Dr. Panuska shares real world examples of how integration can increase workforce productivity, satisfaction, and retention for both primary care and behavioral health clinicians.

00:01:13:12 - 00:01:40:21
Rebecca Chickey
Dylan, thank you for being here today with us. To set the tone, can you please share just the workforce shortage realities in the behavioral health workforce? Maybe provide a couple of examples of what's going on in your own organizations. Challenges around recruitment, retention, worker satisfaction. Just give a sense to the audience of the realities that are going on in the field right now.

00:01:40:24 - 00:02:13:05
Dylan Panuska, PsyD
So health care is stressful, right? And takes a special set of characteristics in a person to be drawn to that field. And the workforce shortage is also really coming about from just  - particularly in behavioral health - a huge increase in demand for behavioral health services, where, I mean, really, there's just simply not enough behavioral health professionals across the spectrum to meet the demand, particularly staying within traditional models of care.

00:02:13:07 - 00:02:47:03
Dylan Panuska, PsyD
I came across one thing in my research for the podcast: that in 2021, the American Association of Medical Colleges reported specifically for within Illinois that we had the capacity to meet just 24% of the mental health need in the state with its current workforce. That is staggering. Really alarming. Within Leonard Oaks and Endeavor Health, there's not necessarily something that as far as the workforce shortage goes, that makes us unique and not feeling that.

00:02:47:05 - 00:03:07:01
Dylan Panuska, PsyD
And I think as an industry, it's really about looking at what are some different solutions and innovations that we can implement to better meet the demand for services, while also keeping retention and increasing recruitment of qualified practitioners.

00:03:07:04 - 00:03:30:08
Rebecca Chickey
And I think that's what we're here today to discuss. That is one of those solutions, not the sole solution by any means, but one of the solutions is the value of integrating physical and behavioral health care, and how that can help with workforce satisfaction, recruitment and retention. And I'll add another really just soul-settling statistic to the one that you shared.

00:03:30:08 - 00:04:01:15
Rebecca Chickey
And that is over 60% of our current psychiatrists, and admittedly, behavioral health work is done by a broad team of individuals in the field, whether it's psychologist, social workers, counselors, marriage and family therapists. So we're not just speaking about psychiatrists, but just in that one specialty area, 60% are age 55 or older. And while not everyone wants to retire at 65, a lot do.

00:04:01:17 - 00:04:23:20
Rebecca Chickey
So just looking out over the next decade, there could be a significant drop off in the current workforce. I know you've had some experience at Linden Oaks, which is now part of Endeavor Health, integrating physical and behavioral health. Can you share how you've seen it help improve worker satisfaction and retention of those workers?

00:04:23:22 - 00:04:55:15
Dylan Panuska, PsyD
So I had the distinct privilege and opportunity to grow our behavioral integration program over the last ten years with Linden Oaks and Endeavor Health. I was fortunate enough to be that original pilot person for it. So one of the areas that behavioral integration really helps with retention and recruitment is through each role, being able to practice within their scope and better supporting other disciplines.

00:04:55:17 - 00:05:34:23
Dylan Panuska, PsyD
I describe it this way often where, really the magic of behavioral health integration is the patient is able to receive both their behavioral health care and their primary care within the same setting. And when you have satisfied patients, you also have more engaged physicians, therapists, psychiatrists across the board. One of the other big areas that BHI, or behavioral health integration really helps with is it enhances the patient care team and system of care where you can work smarter, not harder.

00:05:34:25 - 00:06:00:21
Rebecca Chickey
So let me dig into that last point just a little bit. Working smarter, not harder. That seems to me that's a way to increase productivity. Not only can the behavioral health team be able to practice their full scope of practice to their full license, but they can be able to better support their other clinicians and health care workers that are working with the patient.

00:06:00:23 - 00:06:09:14
Rebecca Chickey
Is that what really helps productivity? Is it also maybe that satisfaction drives productivity? What's your opinion?

00:06:09:17 - 00:06:54:07
Dylan Panuska, PsyD
Another really important part of it is a lot of patients present in primary care with some component of either psychosocial stressor or behavioral health condition present. By having both of those disciplines in one place, it really keeps a busy clinic working efficiently while also providing high quality patient care. I have two examples just from the past month where patients present in primary care with some sort of behavioral health crisis or they're identified as having some degree of suicidal ideation.

00:06:54:09 - 00:07:21:17
Dylan Panuska, PsyD
And when you have behavioral health right on site to be able to come in for a warm handoff, help with the assessment and evaluation recommendation for next steps, that one helps reduce sort of emotional load or burden on the primary care physician and primary care team, helps make sure the patient is navigated to the most appropriate and safest level of care.

00:07:21:19 - 00:07:41:21
Dylan Panuska, PsyD
And you have the behavioral health expert right on site to help direct those pieces. It's a really fun role reversal, I guess is how I'll describe it, where that behavioral health professional is really helping navigate and guide that patient experience and safety of care.

00:07:41:23 - 00:08:13:09
Rebecca Chickey
So I don't want to put words in your mouth. Keep me honest here, Dylan. Please. But I think it's an interconnectedness that integration provides between meeting the patient's needs...having the clinicians whether they're the primary care clinician or the behavioral health clinician, be able to work together to meet those needs and not have that frustration of the physical health need isn't being met, or the mental health need or substance use disorder need for treatment isn't being met.

00:08:13:16 - 00:08:26:09
Rebecca Chickey
That it's that interconnectedness and the ability to treat the whole person that's a key factor in driving improve satisfaction and productivity because you feel better about the job you're doing.

00:08:26:12 - 00:08:56:18
Dylan Panuska, PsyD
Absolutely. And when we're able to have that like multi-disciplinary approach and easy access of communicating, you know, for primary care, that's what behavioral health and with behavioral health have, you know, of course, having greater access to the primary care physician in the primary care team, coordination ends up being just so much easier where historically health care has functioned in big silos.

00:08:56:21 - 00:09:40:16
Dylan Panuska, PsyD
And so it's been hard to, you know, for primary care to know what behavioral health doing and vice versa. And from a predictive standpoint, it can help reduce like duplicative work. And then also it's making sure that the correct role or person is helping a patient navigate one of their needs. So as a psychologist, I'm going to be much more tapped into not only the resources that are available to a patient from a behavioral health standpoint within our own behavioral health Linden Oaks and Denver Health System, but also what other resources and opportunities are available to the patient within the community and how to help get them connected.

00:09:40:18 - 00:10:17:15
Dylan Panuska, PsyD
The other thing that, I'll say a lot about behavioral health integration, particularly in busy primary care practice, is we give the gift of time. When there's a behavioral health component that can, you know, really take a lot more time to fully and adequately address. And primary care physicians and mid-level NP, PAs' schedules are overloaded. Back to that idea of, you know, workforce and not having enough primary care physicians either. When you have psychology or social work professional counselors on site, that warm handoff takes place.

00:10:17:18 - 00:11:06:09
Dylan Panuska, PsyD
So we sort of step in, and help navigate and manage behavioral health needs. And the primary care physician is able to move on and stay within the bounds of their schedule, also leading to happy physicians. So EPIC, our most common EMR, but they have a term they call "pajama time." So, it's time spent from health care providers outside of office hours in EPIC documenting, responding to in-baskets, things along those lines. When behavioral health is onsite and integrated it can help reduce that amount of pajama time or time spent outside of the office, not just from a pure time in-basket or documenting standpoint, but we all get into

00:11:06:09 - 00:11:31:09
Dylan Panuska, PsyD
this field because we're compassionate and trying to help people. And so the mental load of wanting to navigate somebody and not knowing how to do that weighs on people. And so now they have, immediate access to the team members that can really help offload or unload that burden that they've really historically have carried.

00:11:31:11 - 00:11:54:09
Rebecca Chickey
That's great. I think one of the things I would say is that the magic of integration. I'm loving this work, Dylan. I'm going to use it over and over. The magic of integration is to allow time for all of the individuals involved in the treatment of a patient to decompress. They may still have pajama time but it's not going to be spent on the EMR, so that's a good thing.

00:11:54:11 - 00:12:13:16
Rebecca Chickey
So just got a call from a primary care physician who's leading a small but mighty multi-specialty in primary care. I mean, so family medicine, internal medicine, etc. They're considering embracing integrated care to convince them to do so.

00:12:13:18 - 00:12:47:16
Dylan Panuska, PsyD
In my experience in growing behavioral health integration at Endeavor Health and Linden Oaks, where I've been mostly successful is in starting with the why we should integrate. And when you're able to start with why and have you know, solid, positive, patient stories to help support that, that's really where it starts to sell itself. At the beginning of it when we were looking for a pilot, it's like primary care is designed for, well, primary care.

00:12:47:19 - 00:13:17:24
Dylan Panuska, PsyD
What if we bring on these patients with behavioral health conditions to the practice and back to the why. It was, well, they're already there adding behavioral integration. The why to it is really to help better treat and improve the lives of patients through whole person care. And then one of the other things I'll say is behavioral health integration is hard.

00:13:17:26 - 00:13:58:01
Dylan Panuska, PsyD
But that's okay because hard things are hard. Or the other way I usually describe it is primary care was not designed with behavioral health in mind. So it requires somebody and a team of people to be very persistent and clearly communicating and engaging all of the stakeholders along the way. And one of the things that can be challenging in behavioral integration is really everybody has to be engaged and shift their idea of how both primary care and behavioral health meet the patient's needs, including the patient.

00:13:58:04 - 00:14:20:14
Dylan Panuska, PsyD
It is not a traditional model of behavioral health, and it is so much more than just a brief solution focused individual therapy. And what's really amazing is when you bring these two pieces together, it really ends up being more than the sum of its parts.

00:14:20:16 - 00:14:48:19
Rebecca Chickey
Integration is more than the sum of its parts. Integration improves outcomes. It's a magic that can give the gift of time. The gift of time goes to all of those involved in the treatment program, but to the patient as well, because when they're able to have more time to live a healthier, productive life, that is, as my father used to say, without your health, you have nothing. Having better health,

00:14:48:25 - 00:15:01:20
Rebecca Chickey
it's priceless. We can't put a price tag on that. So, Dylan, thank you so much for sharing your expertise and time with us here today. We're very grateful to you and to your team and, keep up the great work.

00:15:01:23 - 00:15:09:00
Dylan Panuska, PsyD
My pleasure. Thank you for having me and can't imagine practicing psychology any other way.

00:15:09:02 - 00:15:17:12
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.

00:00:00:15 - 00:00:24:01
Tom Haederle
The culture of research teams tends to reflect embedded biases about leadership, representation and inclusion. It takes an intentional choice to pivot toward more equitable teams, where power and decision making are shared, more diverse perspectives are represented, and all team members feel seen and heard. That's why a national nonprofit has released a new Roadmap for Researchers to help advance equitable research.

00:00:24:03 - 00:00:46:02
Tom Haederle
The roadmap suggests ways to promote equity in 10 steps across the research life cycle, and it's already making a difference in health systems, nonprofits, trade associations and academic research teams.

00:00:46:05 - 00:01:15:15
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. AcademyHealth is a DC-based nonprofit that has created a sort of how-to guide, designed to provide cohesion and a sense of shared mission for health equity researchers and advocates. As we learn in this podcast hosted by Joy Lewis, executive director of the AHA’s Institute for Diversity and Health Equity, the roadmap’s influence is already being felt across a variety of workplaces.

00:01:15:18 - 00:01:23:23
Tom Haederle
Joy's guest is Margo Edmunds, director of the Academy Center on Diversity, Inclusion and Minority Engagement. And now to Joy.

00:01:23:25 - 00:02:01:01
Joy Lewis
I am excited to discuss this new resource that AcademyHealth released earlier this year in April for the health services research community. And it's called the Roadmap for Researchers. And the goal here is that it provides actionable, evidence-based guidance on advancing racial equity perspectives in health systems and policy research. And if I'm remembering correctly, the roadmap is not intended to be didactic, but rather to be used as a tool as researchers are really planning and designing their studies.

00:02:01:04 - 00:02:26:28
Joy Lewis
And it builds in some accountability around ensuring that these perspectives, the racial equity lens is applied to the research. So with that being said, I do want to invite you. I'm super familiar with Academy Health from over the years, but I wondered if you wanted to start by sharing just briefly for our listeners, what AcademyHealth is for those who might be less familiar with your organization.

00:02:27:00 - 00:02:53:03
Margo Edmunds, Ph.D.
Absolutely, happy to start there, and it's great to see you, Joy, and I really appreciate the invitation to talk about the roadmap. AcademyHealth is a DC-based national nonprofit organization with individual and organizational members from both public and private sectors, and a portfolio of grants and contracts that translate health systems research into policy and practice in health care and health.

00:02:53:05 - 00:02:59:02
Margo Edmunds, Ph.D.
So very broad mission of translating research findings so that they can be useful and actionable.

00:02:59:04 - 00:03:23:25
Joy Lewis
Right. I like to talk about that as the real world implications or the real world application, rather, of the research. So that the research isn't sitting on a shelf somewhere, but it's being put into, into action. So talk a little bit more about the background, the vision for the roadmap, what was happening at Academy Health, what led to the development of this tool?

00:03:23:28 - 00:03:49:21
Margo Edmunds, Ph.D.
Well, it's a great question. It actually took about 10 years to evolve. You probably know the history that the AcademyHealth Board of Directors in 2014 decided that it was important for AcademyHealth to start diversifying the workforce and providing scholarships and stipends for emerging researchers who might not have their own grant portfolio yet. And who wanted to be researchers and who were promising.

00:03:49:24 - 00:04:12:28
Margo Edmunds, Ph.D.
And so the Aetna Foundation when Anne Beal, Dr. Anne Beal was president of the Aetna Foundation. They gave a grant for AcademyHealth to do a competitive process and identify some of these emerging folks who are actually still very active in AcademyHealth. People like Rachel Hardeman and Jameta Barlow and Reggie Tucker-Seeley started with us 10 years ago.

00:04:13:00 - 00:04:33:04
Margo Edmunds, Ph.D.
And to diversify the workforce with folks like this and then began to bring them together once a year for a networking reception. And over the years, we've now grown to about 400 people and their mentors, who come to a party reception every year, it’s turned into more of a party as it's gone along.

00:04:33:10 - 00:04:36:05
Joy Lewis
Who's going to say no to an AcademyHealth party, right?

00:04:36:06 - 00:04:36:19
Margo Edmunds, Ph.D.
Oh my goodness.

00:04:37:11 - 00:04:55:01
Margo Edmunds, Ph.D.
We just had our most recent one was in Baltimore and it just rocked. So it's a very nice opportunity for people to meet each other in a not always quiet, but in a safer space, where everybody is there because they believe in mentoring and believe in what we're trying to do. So that has been going on for 10 years.

00:04:55:01 - 00:05:19:21
Margo Edmunds, Ph.D.
But we also realized that AcademyHealth wanted to provide a different kind of leadership and take our work to another level. And that happened particularly in 2020. We were working with the Robert Wood Johnson Foundation on an advisory group report about what we could do to help the field become more diverse and more culturally competent and more engaged with communities, really change our culture.

00:05:19:24 - 00:05:48:00
Margo Edmunds, Ph.D.
So we released a report in 2021, and among the recommendations were, y'all need to get out there and help people be better at the way that they interact with communities. And be more authentic and really learn what a lot of these communities and individuals have been dealing with for a long time. And not turn away and not just keep documenting disparities. You know, particularly right now when we're having this pushback,

00:05:48:02 - 00:06:07:02
Margo Edmunds, Ph.D.
I think it's really challenging us to articulate who we want to be and how we want to be with each other. So that's where this roadmap came. I was getting a lot of calls from people, and I felt I can't keep answering individual calls as efficiently as I might be able to write something. So I'm a former professor, so I wrote a 10-step process.

00:06:07:05 - 00:06:20:20
Margo Edmunds, Ph.D.
And the first step is get your team in a room and look around and see if you have the right people in the room. It's very practical advice. Just has a list of questions for people to consider. We don't tell them what to do, we just say, here's how to think about it.

00:06:20:22 - 00:06:47:26
Joy Lewis
But you were able to get your, to your point, your leadership, your thought leadership, your point of view out there in the world for others to really, consider how they might adopt and utilize the resources you're putting in front of them. So, could you go one step further in providing an example of how an organization or a researcher would in fact utilize this resource?

00:06:47:29 - 00:07:07:10
Margo Edmunds, Ph.D.
Well, we're finding out about that Joy, because more and more folks are beginning to use it. Thanks to you and to the Collaborative, I think we have more people joining all the time. But Indiana University, for example, Saint Louis University and Medical University of South Carolina, are all using it as core curriculum in their policy classes.

00:07:07:13 - 00:07:27:14
Margo Edmunds, Ph.D.
So this is how to do the right kind of research. This is how to do racial equity research. And NCQA, Rachel Harrington was one of the reviewers. And so she has been very helpful and using it at NCQA with her teams and the equity teams, and the other folks who may be new to the area and less comfortable, afraid they're going to make a mistake.

00:07:27:17 - 00:07:57:14
Margo Edmunds, Ph.D.
Altarum Institute, which is a contract research organization in Northern Virginia. Altarum has a page on their website, and they are also using it with their staff, and with teams of folks. So I think it could be used across settings. We're not sure how it's being used in clinical settings yet, but we think, you know, we tried to chunk the material into 15-minute segments, knowing that that's about how long somebody might have a break, and they could read a couple pages and think about some questions.

00:07:57:14 - 00:08:03:27
Margo Edmunds, Ph.D.
So it's meant to be versatile, practical and kind of in the eyes of the beholder, if you know what I mean.

00:08:03:29 - 00:08:31:24
Joy Lewis
Right, right, right. And I'm glad to hear you're moving further upstream to academia and in the classroom environment. With that, you mentioned the Health Equity Strategic Learning Collaborative that we stood up here. The association, which is exactly, you know, the audience you would be targeting for this kind of a resource. These are health services researchers who are focused on health equity, specifically.

00:08:32:02 - 00:09:00:27
Joy Lewis
And we have a particular focus on even going one step further and really trying to find those researchers of color who are proximate to many of the research opportunities in the health equity space, and who really would benefit from having this network where, frankly, historically, much of their research might not have as much visibility or as much of an opportunity to be really put into action in mainstream.

00:09:00:27 - 00:09:19:19
Joy Lewis
So, you've been active at that table. Really appreciate your partnership. And so I wondered if you would share with our listenership, what are some of the benefits of being a part of the Health Equity Strategic Learning, you know, Collaborative.

00:09:19:22 - 00:09:39:18
Margo Edmunds, Ph.D.
Thank you for asking, Joy, because I've been wanting to thank you over and over again, for inviting me to be part of the Collaborative, because it meant a lot to me, not just for the networking and for the safe space to talk to other people, but it was an endorsement of the work. And I think a lot of us, we talk about this, how isolating it can be to do equity work.

00:09:39:18 - 00:09:59:02
Margo Edmunds, Ph.D.
You don't feel, especially if you don't have a team of folks or you don't have the kind of the team that you want, or enough resources. And so I think that the time I've spent with the Collaborative has been well spent. I feel like it's a time when I can see people I've known for years, like, don't get to see often enough.

00:09:59:02 - 00:10:23:25
Margo Edmunds, Ph.D.
But it's also a place where there's a common understanding that it's important to continue this work, even when it's challenging. In fact, the more challenging it gets, we have to take care of ourselves and not burnout. But we also need to continually renew our commitment. And that's a really great place to do it. And it also has been the very first place where I spoke publicly about the roadmap outside of AcademyHealth.

00:10:24:02 - 00:10:30:09
Margo Edmunds, Ph.D.
And I've gotten great responses from the colleagues that you invited to be part of the network. So thank you for doing them.

00:10:30:16 - 00:10:56:23
Joy Lewis
No. Great. We're looking forward to really learning also from the researchers in that network, how much more can the Collaborative bring benefit to them? We certainly see it as bi-directional. So thanks for putting this resource in their hand. Are there any other initiatives or offerings or spinoffs that you see coming out of the research roadmap?

00:10:56:25 - 00:11:23:03
Margo Edmunds, Ph.D.
We’ve been doing some word-of-mouth dissemination and trying to collect stories so that we know how people are finding this helpful and where they like us to push in another direction. But one thing that I initiated, you know, kind of a, I like online tools and I like open access. So we have, again, with support from the Robert Wood Johnson Foundation, we have an equity and innovation resource hub, which you can find at the AcademyHealth website.

00:11:23:10 - 00:11:53:01
Margo Edmunds, Ph.D.
But these are meant to be companion documents. And former professor I'm thinking about you want something that's online with a lot of deep content. It's got 25 pages, I think of resources of peer-reviewed articles and playbooks and lots of other resources that people can use. The Equity and Innovation Resource Hub is searchable by media, so if you want a video to show in your class or at your staff meeting, you can go find a video that's related to kind of introducing the content.

00:11:53:01 - 00:12:14:03
Margo Edmunds, Ph.D.
And we also have infographics and playbooks and peer-reviewed articles and great literature and other resources that have been vetted and are curated by Academy Health. So I think a lot of people, when they start thinking, oh my goodness, I'm teaching a health equity course, where am I going to start? We want to have vetted and curated that material so that they know where to start.

00:12:14:05 - 00:12:36:25
Joy Lewis
No, that's awesome. Thanks for doing that heavy lifting up front for folks. So with this particular resource though, the Roadmap for Researchers, what is your hope, right, in terms of how this could potentially change the design of health services research, potentially lead to better health policy, even.

00:12:36:25 - 00:12:49:16
Margo Edmunds, Ph.D.
So, my hope would be for 10 years from now that the field will have evolved to a much more inclusive and representative group of people who really value diversity.

00:12:49:18 - 00:12:54:03
Joy Lewis
Diversity of all, all kinds, diversity in its broadest definition.

00:12:54:06 - 00:13:22:00
Margo Edmunds, Ph.D.
I've talked with some of our folks who work on the Hill and work in different kinds of environments, and I think that health equity or equity are the terms that seem to be the most acceptable. When you talk about multicultural and actually, you know, multi in many ways, multi-lived experience, people who are coming from first generation backgrounds into the research community, that they will feel that they have the kind of support and acknowledgment and then they're valued.

00:13:22:03 - 00:13:43:05
Margo Edmunds, Ph.D.
And I think if we can acknowledge that people's backgrounds and where they came from and what their parents did and what languages are spoken at home, but also what might have happened to them on the way to work, you know, you might have gotten some side eyes from people. You might, I mean, this is a very common experience that I think a lot of white people do not have and do not appreciate and don't acknowledge.

00:13:43:07 - 00:14:04:26
Margo Edmunds, Ph.D.
So my hope would be that in 10 years there's been enough personal transformation and insight and behavior change that everybody would feel welcome. Ten years is pretty fast, but I know people can change. I'm originally a clinical psychologist, as you know, and I know that people can change, and I know the cultures can change. And sometimes in a very short period of time.

00:14:04:28 - 00:14:23:01
Joy Lewis
While you've leaned into hope in its strongest definition, HOPE, all caps, because that's hope that you're leaving with us, Margo. I trust your hope becomes a reality because I think we could all, you know, lift all boats as we go here.

00:14:23:01 - 00:14:51:16
Margo Edmunds, Ph.D.
Well, we need each other to do that, Joy. You know, and that's why I'm, again, really pleased and honored and grateful that you created the network. Because it's important, I think, for all of us to use the platforms that we have and use our voice in the most effective way possible. And I've seen people in the network, talking about things that I have not heard about before, the work that they're doing in their own institutions, and how thoroughly it can be done when you have the support system to do it.

00:14:51:16 - 00:14:52:24
Margo Edmunds, Ph.D.
It's amazing.

00:14:52:26 - 00:15:13:06
Joy Lewis
Well, thank you, and thanks for, spending some time with me this afternoon as we really lean into helping our health services researchers writ large, really navigate the roadmap and think about its application to their upcoming body of work. So thank you so much, Margo.

00:15:13:13 - 00:15:16:28
Margo Edmunds, Ph.D.
Thank you for the opportunity, Joy. Great to see you.

00:15:17:01 - 00:15:25:12
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.

00:00:00:08 - 00:00:31:11
Tom Haederle
Hospital and health system care teams provide amazing care to countless patients every minute of every day. But they are human and mistakes do happen. No one pretends otherwise. If an error is discovered, it's important that anyone feel comfortable reporting it and sharing that information with a patient as well. Sometimes saying sorry the right way makes all the difference.

00:00:31:14 - 00:01:17:26
Tom Haederle
Welcome to Advancing Health, the podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. CommonSpirit Health, a vast network of more than 2600 care sites spread across 22 states, has worked to adopt an organizational culture of transparency and compassionate communication. In fact, it created a toolkit around that effort that anyone can adopt. As we hear in this final episode of AHA's Safety Speak series, hosted by Joy Lewis, senior vice president of health equity strategies and executive director of AHA's Institute for Diversity and Health Equity, a feeling of psychological safety not only benefits patients, but impacts equity internally within the organization by allowing anyone to freely speak up, regardless of role or department.

00:01:17:29 - 00:01:28:21
Tom Haederle
Her two guests from CommonSpirit are Beth Miller, system director for patient safety performance improvement, and Austin Peterson, system director, patient harm prevention.

00:01:28:24 - 00:02:00:10
Joy Lewis
CommonSpirit Team, Beth and Austin, thank you so much for being here with me today and welcome to Safety Speaks. I really am looking forward to exploring this topic of CANDOR and how accessible it is as we think about advancing equitable care, and I think we should start really just with setting the stage. I think CANDOR is familiar to those folks who work in the quality improvement and patient safety space.

00:02:00:10 - 00:02:19:14
Joy Lewis
It's familiar language to them. But others of our listeners may be wondering what exactly is CANDOR, which stands for Communication and Optimal Resolution Approach. So can you just elaborate on what exactly CANDOR is. Let's pitch that to you, Austin.

00:02:19:16 - 00:02:28:09
Austin Peterson
Sure. I'd be more than happy to. So there's a couple of different ways to pronounce CANDOR. Some people might call it a SCRP or communication resolution program.

00:02:28:09 - 00:02:57:17
Austin Peterson
We just adopted the agency for Health Care, Research and Quality and Language of CANDOR, as you alluded, is a communication and optimal resolution program. And really, it's a patient safety program to help health care organizations respond transparently and effectively to adverse events when they reach our patients. The key components of it is really emphasizing early communication, providing a thorough event review, utilizing RCA squared, and providing resolution.

00:02:57:19 - 00:03:17:05
Austin Peterson
And this whole program is about fostering trust, not just with our patients and families, but also with our staff members if they make a mistake that leads to a potential CANDOR event. And the ultimate goal is to try to make what's right that we can with our patients and families but also improve our health care system so it doesn't happen to anyone else.

00:03:17:07 - 00:03:52:16
Austin Peterson
And I'd just like to take a moment and start by saying I'd be remiss by not acknowledging some key individuals in our industry who has developed this transparency movement of communicating events to our patients and families. And the list I'm going to say is not exhaustive, and I apologize in advance for missing anyone critical. But our work at CommonSpirit Health has been built on many others, such as Dr. Lucian Lee. Dr. Tim McDonald and Rick Boothman with their Seven Pillars, and Dr. Tom Gallagher and his studies advocating that patients and families value compassionate communication and an honest apology post error.

00:03:52:18 - 00:04:33:24
Austin Peterson
And also our patient advocates who keep us honest in the health care industry. But I want to shift again to discuss the agency for Health Care, Research and Quality, who developed CANDOR with some key individuals within our organization, Linda Ubaldi and Dr. Morelli at Dignity Health and also Barbara Pelletreau, who ensured CANDOR was successfully adopted across all Dignity Health and now CommonSpirit Health before her retirement. As a health care organization that collaborated with AHRQ, and they have contributed to the creation and the refinement of the CANDOR toolkit that is open access and free for everyone to adopt. The collaboration of all, providing insights and feedback based on our experiences with our patient safety leaders and

00:04:33:24 - 00:04:41:11
Austin Peterson
communication practices. And it really helped shape the toolkit's content and implementation strategies that exist today.

00:04:41:13 - 00:05:10:27
Joy Lewis
Well, thank you so much for that context. And I would imagine CANDOR is something we can all get behind, because what you just outlined for listeners is really a level of humility that the health care system brings to the patient care experience and really focusing on being transparent and learning and improving, and to all of that and really creating an environment of trust.

00:05:10:29 - 00:05:23:13
Joy Lewis
So can you go a little bit further and talk a little bit more about how you implemented the CANDOR approach inside and across such a large system?

00:05:23:15 - 00:05:35:03
Austin Peterson
You know, with any large projects such as this, it really needs to be led by our executive leaders who say that this is the right thing to do and get behind it, to push all of us in that direction.

00:05:35:03 - 00:05:59:27
Austin Peterson
Again, that was led by Barbara Pelletreau and Dr. Robert Weaver. Initially because we were smaller at Dignity Health, we had the opportunity of providing these two-day workshops where key leaders of the hospital would be our chief nurse, chief medical officer, quality directors, patient safety leaders. Our claim leads who get together and they learn about the principles and foundations of CANDOR while also practicing that empathetic communication.

00:06:00:00 - 00:06:24:13
Austin Peterson
Now, with the merger of us becoming CommonSpirit Health spread across 22 states, 150 facilities and 2600 care sites, it is impossible to do that two-day workshop. And Covid really forced us in a new direction due to constraints on providing education in a new way, and we did this via electronically using Zoom, having four-hour sessions of going through the whole training and people practicing.

00:06:24:13 - 00:06:45:02
Austin Peterson
But it's really hard pulling our leaders away for that long of a time when they need to be with our frontline staff and our patients and our families. So we've revolutionized what we do, and now we provide this in a learning management system and four self-paced modules that all of our leaders go through. And we say all of the leaders, if you're in the leadership capacity, we recommend that you go through CANDOR.

00:06:45:04 - 00:07:08:02
Austin Peterson
That is completed by having a live practicum where Beth and I reinforce the training with experiential learning. And we've also rolled out an advanced CANDOR series where we include many unique scenarios that our leaders come across. And as you alluded to, we've trained a lot of people. To date, our organization - we've trained over 1,300 leaders, including our physicians. And we're continuing to push to ensure that everyone receives this training.

00:07:08:04 - 00:07:08:27
Joy Lewis
That's massive.

00:07:08:27 - 00:07:11:04
Joy Lewis
You're really doing this work at scale.

00:07:11:06 - 00:07:34:09
Joy Lewis
And it's really interesting how you've evolved your approach pre-Covid and post-Covid. But at the end of the day, it sounds like transformational leadership is what's really needed to move the needle here. So talk about that transformation. How has the CANDOR training program transformed your organization's approach to patient safety and equity? Beth, can you elaborate on that?

00:07:34:12 - 00:08:01:02
Beth Miller
I love that question, Joy, and I think it's an important one. But I think to try to sum it up is that CANDOR's success really ultimately relies upon robust event reporting. You know, people have to feel free and comfortable to report safety events, you know, quickly and often in order for those things to get escalated. And then for the CANDOR program to effectively be implemented and launched, and for all of those pieces to start to come together.

00:08:01:05 - 00:08:35:25
Beth Miller
So really, our organizational culture plays a big part in the ability to achieve any of this. You know, we have to know about events in order to then act. And, CommonSpirit has invested heavily in establishing psychological safety in order to make it easier and then safer for teams to speak up and report. And I feel like this is where CANDOR really impacts equity internally within our organization, is that psychological safety really seeks to ensure that everyone feels safe and comfortable speaking up, regardless of their role, regardless of their department and where they sit and within the organization.

00:08:35:28 - 00:08:47:07
Beth Miller
And so we feel like it's been an important aspect of equity internally as we work with our teams to try to help improve internal communication. But then obviously it also does affect our patients as well.

00:08:47:10 - 00:09:13:06
Joy Lewis
Right. But you've done a really good job it sounds like of having your workforce, each member of your workforce, regardless of where they sit inside the organization, to see themselves as a health equity influencer, if you will. We always talk about how culture eats strategy all day, right? All the time. So you've also invested in creating that culture of safety where people feel comfortable speaking up.

00:09:13:08 - 00:09:30:03
Joy Lewis
I imagine you're tracking and leveraging data and analytics to really inform and drive your actions in this space. What tools -dashboards, scorecards? What are your mechanisms for tracking progress and outcomes?

00:09:30:06 - 00:09:58:25
Beth Miller
Great question. And again I would say we're using all of those things. We're using various reports, dashboards, we've customized and again invested heavily in all of our different analytic tools to make sure that we're using what we have available to us. But then layering on that CANDOR lens to see how the things that we're currently measuring, we can then also include specific elements of CANDOR in those measurement principles.

00:09:58:27 - 00:10:20:03
Beth Miller
And so we do - we use a ton of various scorecards, dashboards that we develop internally in connection with our event reporting system, so that that way we can make sure that data is shared appropriately with various stakeholders at different levels in the organization. You know, with an organization as large as ours, data sharing amongst the different layers, you know, can be quite a challenge.

00:10:20:09 - 00:10:41:13
Beth Miller
But we've spent a lot of time with our teams developing those specific things so that it can be shared effectively, but also in a more simple fashion, so it's a little easier to understand. Data is a powerful tool, but it's only as effective as someone can understand it. And so we spent a lot of time making sure that it's displayed and presented in a way that's easy to digest.

00:10:41:19 - 00:10:43:23
Beth Miller
So then people know how to act upon it.

00:10:43:25 - 00:10:59:02
Joy Lewis
Can you share a little bit more about the different audiences that you're reporting out to it? Does it go all the way up to the board? Are you sharing this information with community leaders, community stakeholders, internally, who are your target audience?

00:10:59:04 - 00:11:25:10
Beth Miller
Honestly, it's a bit difficult to answer because we try to customize various reports and information based on that particular audience. So the information, you know, shared with a patient safety quality leader is really going to focus on how they impact the work, versus information shared with, you know, an executive leader is then going to focus, maybe in a slightly different area with relation to how they impact the work.

00:11:25:10 - 00:11:38:24
Beth Miller
So the data does, you know, look a little different depending upon what your role is in the organization. But it all comes from the same place. So it's the same information just presented in a slightly different way depending upon the role.

00:11:38:26 - 00:12:06:18

Thank you for tuning in to this episode of Safety Speaks, the podcast series dedicated to patient safety, brought to you by the American Hospital Association. I'm Dr. Chris DeRienzo the AHA’s chief physician executive and a champion of AHA Patient Safety Initiative. AHA’s Patient Safety Initiative is a collaborative data driven effort that lifts up the voices of individual hospitals and health systems into the national patient safety conversation.

00:12:06:20 - 00:12:38:19
Chris DeRienzo, M.D.
We strive to catalyze and connect health care professionals like you across America in your efforts to innovate and improve, and to bolster public trust in hospitals and health systems by helping you share your successes. For more information and to join the 1,500 other hospitals already involved, visit aha.org/patient safety or click on the link in the podcast description. Stay tuned to hear more about the incredible work of members of the HHS Patient Safety Initiative.

00:12:38:21 - 00:12:45:28
Chris DeRienzo, M.D.
Remember, together we can make health care safer for everyone.

00:12:46:00 - 00:13:07:05
Joy Lewis
Once you have those data, the goal of course, is to make the data actionable, right? So can you talk a little bit more about how implementing this CANDOR training program has actually yielded a positive outcome on your patient safety incidences. How are the trend lines shaping up for you? Austin, what do you think about that?

00:13:07:07 - 00:13:11:15
Austin Peterson
So I will say that safety is a moving target.

00:13:11:17 - 00:13:29:21
Austin Peterson
You know, initially we started with the IOM and the 44,098 deaths per year. And then we get better ways of looking at what is a safety event is and we see that the numbers jumped up to 220 to 440,000, which is the third leading cause of death in the United States. You know, so we put in checklists, we put in standardization.

00:13:29:21 - 00:13:42:13
Austin Peterson
We're able to reduce CAUTI, CLABSI, BTEs. That's great but that's only one part of patient care. What else is out there that we can continue to move? So I'm going to say that is a constant moving target as we learn more as we go there.

00:13:42:16 - 00:13:50:03
Austin Peterson
That's a really good point. We never say, you've achieved health equity because there is no endpoint, right?

00:13:50:10 - 00:14:19:19
Joy Lewis
There's this constant journey that you're on, to refine, to iterate, to do better. And so I would imagine when we look at the triad of quality patient safety and health equity, it's kind of that same mantra. You're always working at it. You're always looking to improve and do better. Now that you've really, you know, gotten folks on board, how do you plan to sustain your current efforts and maybe even build on those efforts?

00:14:19:19 - 00:14:25:02
Joy Lewis
So you've got some wins. How are you going to sustain those wins and bring others along?

00:14:25:05 - 00:14:49:29
Beth Miller
I love that question. I think sustainability really of any program is always, always a challenge. Lots of competing priorities. You know, it's obviously a heavy lift to get things going, but it's almost even more difficult to keep it going. But I think that there's some really exciting developments in the health care landscape, you know, especially recently in the last year that will help CANDOR to sustain and then even maybe even be more in the focus in the future.

00:14:50:00 - 00:15:13:27
Beth Miller
You know, one of the things that is top of mind is the patient safety structural measures recently passed by CMS. It directly addresses CANDOR, specifically in domain number four. And so we're excited about that. You know, focus that's being put into play. Because I think it's going to help allow our sites who have had that long standing history of CANDOR to be recognized in a different way for their efforts.

00:15:13:29 - 00:15:40:13
Beth Miller
But it also helps as an organization to help really look at those additional feedback loops that maybe we need to strengthen, which then will help with sustainability. And I also wanted to mention, you know, the AHA's focus on health equity, I also think is a great contributor to helping with sustainability of the program, because the AHA is demonstrating, you know, that this focus and our work and our mission as an organization is relevant, and there's still a lot of work needed in the industry.

00:15:40:13 - 00:15:43:28
Beth Miller
So I think both of those things will really help with sustainability.

00:15:44:01 - 00:16:10:11
Joy Lewis
Yeah, I think you're spot on. They complement each other well. And I do want to recognize CommonSpirit Health for the great deal of work that you've engaged with us around our health equity roadmap, and congratulate you for having all 142 of your eligible hospitals participate with our HETA, or Health Equity Transformation Assessment and continuing to do the great work of doing equity, as I like to say.

00:16:10:14 - 00:16:29:15
Joy Lewis
So I thank you both for joining us today and for sharing your expertise and your on the ground experience in implementing a CANDOR strategy to address patient safety outcomes. Keep up the good work. Thank you for being so dedicated and innovative in your approaches.

00:16:29:18 - 00:16:38:00
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.