Advancing Health Podcast

00:00:01:00 - 00:00:21:06
Tom Haederle
Welcome to Advancing Health. Homes built before 1978 did not have the prohibition against the use of lead based paint that's in place today. Let's hear what one proactive city is doing to protect its residents against this environmental danger.

00:00:21:09 - 00:00:50:03
Tom Haederle
Hi everyone. I'm Tom Haederle, senior communication specialist with the American Hospital Association. Thank you so much for joining us today. We've all heard the phrase "get the lead out," meaning get moving, pick up the pace. But in Cleveland, Ohio, those words have a more literal meaning. Our two guests today will talk about the massive effort to reduce and eliminate lead poisoning in the city's population, especially among kids who are four times more likely to have elevated levels of lead in their blood than the national average.

00:00:50:05 - 00:01:03:04
Tom Haederle
So joining me to talk about this effort are two experts from Cleveland Clinic. Vickie Johnson, executive vice president and chief community officer and pediatrician Dr. Roopa Thakur. Thank you both for joining me on Advancing Health today. Appreciate you being here.

00:01:03:10 - 00:01:05:02
Vickie Johnson
We're glad to be here.

00:01:05:04 - 00:01:21:12
Tom Haederle
Well, Vicki, maybe we can start with you to bring this into focus. A lot of people may assume that the problem of lead poisoning is a thing of the past. Why is the problem of exposure to lead in the environment so acute in Cleveland, to the point where it's become Cleveland Clinic's top priority for community health?

00:01:21:14 - 00:01:59:12
Vickie Johnson
It is our number one public health priority, because 90% of Cleveland's homes were built before 1978, which means that lead is in the paint in the homes. And as the home deteriorates, it's likely to poison those children living in the homes. So we talk about this as a public health crisis with a housing solution. So often the solution isn't very clear on so many issues, but this is one where we know where the problem is, and we have an ability to partner with others to address it.

00:01:59:14 - 00:02:08:29
Tom Haederle
Is it a matter of the deterioration of the paint itself as time goes on that releases more and more lead into the environment or into the atmosphere? Is that what's going on?

00:02:09:01 - 00:02:34:13
Roopa Thakur, M.D.
Yes, exactly. So, paint deteriorates over time, especially in areas of high friction. So if you think about a door frames, window sills, areas where you're opening and closing a lot, areas that are tread on a lot. So porches and decks are a common source in Ohio. But as the paint chips or rubs off, it creates lead dust that then settles on the floor or settles on the carpet.

00:02:34:15 - 00:02:40:24
Roopa Thakur, M.D.
And then our little ones, who are playing on those floors pick up that lead dust and either inhale or ingest it.

00:02:40:26 - 00:02:49:05
Tom Haederle
So it's really everywhere. And Dr. Thakur, what is the effect of high levels of lead exposure on the human body and particularly in children?

00:02:49:07 - 00:03:09:18
Roopa Thakur, M.D.
Yeah. So we think about our little ones, especially at one and two years old, because that's when their brains are actively growing. We know from the CDC that even the lowest levels of lead exposure can damage the brain and nervous system, can slow growth and development, and can lead to learning and behavior problems. So it can definitely prevent children from getting to their full potential.

00:03:09:27 - 00:03:20:15
Roopa Thakur, M.D.
But we also can see - because lead affects every single organ system in the body - we might see bone problems, we might see kidney problems, liver problems, heart problems as an effect of lead poisoning.

00:03:20:17 - 00:03:31:22
Tom Haederle -
Are the effects less dramatic on full grown adults? If somebody moves into a house, you know, in midlife that happens to be a house built before 1978, are they at the same level of risk or not so much?

00:03:31:24 - 00:03:41:03
Roopa Thakur, M.D.
We definitely can see health effects in adults, but because the brain has kind of fully grown by then, the effects are different. We don't tend to see those same lifelong effects.

00:03:41:05 - 00:03:54:28
Tom Haederle
I know that Cleveland Clinic recently pledged $55 million to the Let's Save Cleveland Coalition and the United Way of Greater Cleveland. How will these funds be used to address the problem of lead exposure in people's homes? What's the plan for the money?

00:03:55:00 - 00:04:22:19
Vickie Johnson
So it's been about three years since we've made that commitment. And we worked with the Lead Safe Coalition to identify the greatest need. So the dollars primarily are allocated to remove the lead from the house. Primarily. But we also have other initiatives such as workforce development, marketing evaluation. We have a budget for that. And most excitingly, we have a budget for childcare centers.

00:04:22:26 - 00:04:39:08
Vickie Johnson
Once we got involved in the coalition, we thought, yes, kids live in homes, but also little ones who go to childcare spend as much time during the week there as they do at home. And that's when we launched the Let's Save Childcare Center initiative.

00:04:39:10 - 00:04:46:09
Tom Haederle
Are these grants that people have to apply for, or how would they go about getting some of that available money to do the clean up?

00:04:46:11 - 00:05:13:13
Vickie Johnson
Absolutely. Yes. There are grants and there's also incentives. As you can imagine, even when resources are available, it takes time to educate the public that the funds are available, that there's an issue that can be resolved. In many cases, we're talking about a landlord and not necessarily a homeowner. So it's different in terms of how you need to engage with those different populations, the homeowner versus the landlord.

00:05:13:20 - 00:05:39:16
Vickie Johnson
Resources are available as incentives. If you apply for Let's Save Cleveland dollars, which is a grant, then there's an incentive available for you just to get utilization increase so that we can address the issue. This is a sense of urgency, and we want every child in the city of Cleveland, you know, for us, as a beginning. We also collaborate with partners on a county level.

00:05:39:16 - 00:05:46:28
Vickie Johnson
But we want every child to live in a lead safe environment for the reasons that Dr. Thakur explained just a moment ago.

00:05:47:01 - 00:05:56:03
Tom Haederle
In terms of what actually needs to be done, is it painting over that original layer of dangerous paint, or does it physically have to be stripped from the wall and replaced entirely?

00:05:56:05 - 00:06:30:10
Vickie Johnson
It's both. So in Cleveland, we have two different approaches. It's making a unit lead safe, which is encapsulating. Yes, you can paint over with the special paint and we can wrap an area that has paint with aluminum or vinyl, if you think about outside a home. And we can also replace and tear out, which is more lead free than let's say, can you put a brand new deck on the porch as opposed to scraping, painting, which you would then have to repeat every couple of years?

00:06:30:15 - 00:06:47:20
Vickie Johnson
So it's two different approaches. It really depends on the state, the current state of the unit as to which method is best. We believe that lead safe is best for the immediate. And then when we can make units lead free as well.

00:06:47:22 - 00:07:09:09
Tom Haederle
A question for both of you. The immediate goal, of course, is to improve the environment and make it healthier, and especially for young kids who are still developing. What are some of the other benefits that we realize from dealing with this problem in terms of health care, lost earnings, societal costs that that have spiraled, I guess, because of the prevalence of lead in the city's homes?

00:07:09:11 - 00:07:43:27
Roopa Thakur, M.D.
So there's actually been a study done by Case Western Reserve University a few years ago that looked at the downstream effects of lead poisoning in our community's children. And what they found was that when you look at the dollars spent on various therapies that those children require over time, if you look at the public benefit spending on some of the services that those patients require as they become adolescents or young adults, many of them deal with homelessness, unemployment, they have several mental health issues and ADHD that can affect their ability to be to remain employed.

00:07:43:29 - 00:08:03:24
Roopa Thakur, M.D.
And so when we think about the long term spending on those public benefits as well as then, you know, there is a subset that is at higher risk for incarceration or juvenile detention, and we look at the spending there. Their data showed that each dollar invested in lead poisoning prevention can have as much as $220 return on investment.

00:08:03:27 - 00:08:17:06
Tom Haederle
Wow. That's impressive. Dr. Thakur, I wonder, is there any reason to think that there will ever be an effective treatment for the damage caused by chronic lead exposure? Or will prevention always remain the best solution?

00:08:17:09 - 00:08:36:01
Roopa Thakur, M.D.
Prevention is our best option. As far as we know, there is no cure for lead poisoning. Once it's happened, we can try to mediate results as best as we can with the therapies that we can provide, such as occupational, physical or speech therapy. But there's no way to reverse the damage that's been done.

00:08:36:03 - 00:08:56:01
Tom Haederle
Sobering message. Final question for both of you. And I know this is not a box checked, this is not a done initiative. But what you've learned so far, and what Cleveland Clinic's experience has been in helping the city deal with this problem. What advice would you have for other health systems across the country that may be looking at the same problem?

00:08:56:01 - 00:08:58:24
Tom Haederle
And also considering, you know, how do we tackle this?

00:08:58:26 - 00:09:27:06
Vickie Johnson
This work takes a long time, and we need to be patient with the results that we hope for. For example, Cleveland has over $100 million available with all of the investors. It's not just Cleveland Clinic. They're other partners that are involved. And so we thought for once, money resources was not an issue. So we just thought that people would run in and take advantage of these resources.

00:09:27:06 - 00:09:50:20
Vickie Johnson
And in a couple of years and five years, we thought our problem would be fixed. And that is not the case. That's not the case. In fact, only a small percent of the resources overall for the Let's Save home piece of it - not testing, not screening, not marketing, not evaluation. A a small percent of the resources have been utilized.

00:09:50:24 - 00:10:19:00
Vickie Johnson
We're still trying to educate the population on the danger of lead poisoning and we're taking different approaches to deal with this. Knocking on doors, going to war club meetings, working with the faith community, childcare centers, state, county, city, public housing, you name it. Everyone is trying to address the issue. There are over 400 members in the coalition.

00:10:19:02 - 00:10:39:14
Vickie Johnson
And when I say members, these are representatives of organizations. So we have thousands of people who are working together on this policy, government. We're trying and we're not satisfied with where we are today, but we're all committed to stay until we accomplish our goal.

00:10:39:17 - 00:10:47:25
Tom Haederle
It sounds like the takeaway message here is there's also a big messaging dimension to this whole initiative that people have to pay attention to.

00:10:47:28 - 00:11:08:00
Roopa Thakur, M.D.
I'll add to that as well, that, you know, Vicky's talking about partnerships. When we think about what we knew about lead poisoning in Cleveland 15 years ago, compared to what we know now, a lot of that required breaking down barriers between all the different silos that we're working on this separately. So our public health departments had the data.

00:11:08:03 - 00:11:16:25
Roopa Thakur, M.D.
We knew clinically what was happening with our patients. But to bridge the gap, to understand well, where is the lead coming from? It takes a lot of people working together.

00:11:16:27 - 00:11:33:18
Tom Haederle
Well, thank you so much for helping shed some light on a very serious problem that is probably more widespread than most people are aware of in other cities as well. Thank you so much again for being on Advancing Health today, and best of luck in this important work you're doing as you work to improve the health of the people of Cleveland.

00:11:33:20 - 00:11:42:01
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 - 00:00:17:08
Tom Haederle
Welcome to Advancing Health. When it comes to treating children's diabetes, the old saying that two heads are better than one has been put into practice with impressive results, as we learn in this podcast.

00:00:17:11 - 00:00:39:08
Tom Haederle
Hi everyone. I'm Tom Haederle senior communications specialist with the American Hospital Association, and really glad that you're along with us today. I'm going to start this podcast with a quote: "Prevention is always the way to go. If we can equip families with knowledge, support and community, we change health trajectories for life." So, those words are referring to childhood type two diabetes,

00:00:39:08 - 00:00:59:29
Tom Haederle
and they come from one of our guests today, Matthew Edwards, a certified diabetes care and education specialist at Children's Wisconsin Diabetes Prevention Clinic. And we're really pleased to also have Matt's colleague, Dr. Elizabeth Dabrowski, who is a pediatric endocrinologist at Children's Wisconsin, with us as well. So thank you again for coming on Advancing Health today. Really appreciate your being here.

00:01:00:01 - 00:01:13:09
Tom Haederle
A couple of years ago, when Children's Wisconsin opened its new diabetes prevention clinic, it seems like it decided to come at the problem a little bit differently than it has in the past. What can you tell us about that? Maybe Matt, if you take the first crack at that?

00:01:13:12 - 00:01:39:14
Matthew Edwards
Yeah. I think what we saw was a gap in our care. We had patients who had these comorbidities that were finding their ways to maybe our diabetes clinic or to our new kids clinic, but we were getting referrals from patients who maybe just had elevated BMI and not comorbidities to go along with it. And we just wanted to find a home for these patients before they ended up in those other clinics with the comorbidities.

00:01:39:17 - 00:01:45:02
Tom Haederle
So what was the treatment approach from the outset that was it was doing things a little more innovatively, shall we say?

00:01:45:09 - 00:02:06:00
Matthew Edwards
Yeah, we wanted closer contact points. There's several programs that have existed that showed more close contact with these patients leads to greater outcomes. And we knew we wanted to pair with our endocrinologist because their insight is just so helpful. We've got these other modalities of care that we can use now that are at our fingertips, that we can provide these patients with.

00:02:06:02 - 00:02:25:24
Matthew Edwards
And then we knew we also wanted to add some movement component with our physical therapist. That's really the piece that has been a little lacking in our program. And more recently, within the last two years, we've been able to refer a number of our diabetes patients and our prevention patients to physical therapy. And the relationship has been really great working with them.

00:02:25:26 - 00:02:38:29
Tom Haederle
Doctor Dombrowski, combining treatment for children's type two diabetes from endocrinologists and dieticians at the same time seems like a logical thing to do. Why wasn't it standard practice in the first place all along?

00:02:39:01 - 00:03:01:12
Elizabeth Dabrowski, MD
I think in part because usually by the time kids we get to the diabetes clinic, they already had type two diabetes, the horse was out of the barn. And we've been seeing, especially with the advent of GLP medications and new medications that were previously only FDA approved in adults are now FDA approved in children, some for weight and some for type two diabetes management.

00:03:01:19 - 00:03:33:09
Elizabeth Dabrowski, MD
We were seeing more referrals of kids for pre-diabetes or their labs were a little abnormal, but they didn't have diabetes yet. And we did not in standard practice have dietitians in our clinic. I think if we're looking at changing lifestyle they are the most important people to have with us. And then if we're looking at deconditioning and physical activity, that's why our physical therapists are wonderful, coming up with exercise regimens for kids that work for them, meeting them where they're at, teaching them a safe way to start.

00:03:33:11 - 00:03:40:06
Elizabeth Dabrowski, MD
And I think all of that's more important than what I can do. And so that's really why we tried to bring all these groups together.

00:03:40:08 - 00:03:53:28
Tom Haederle
So from a young patient's point of view, what is the hospital experience like when they when they come to Children's? If you could maybe walk us through a typical day, the kind of care they get, who they're seeing, what kind of advice they're getting, what would that look like?

00:03:54:00 - 00:04:19:02
Elizabeth Dabrowski, MD
So the way our clinic is set up, they'll be seen by endocrinologist first. That hospital is actually very kid friendly. My kids actually really enjoy their visits here. And so we'll see them. We'll get a general idea of history, medical problems, family history, all of the general stuff you talk with your physician about. And then we'll talk a little bit about diet and exercise, what the patient's goals are, what their concerns are and why they're there.

00:04:19:03 - 00:04:34:07
Elizabeth Dabrowski, MD
I don't like to focus on weight. I don't like to focus on a number I like to see. What are your goals as your goal? To be able to play like one of my little kids, he wants to be on the football team, and they told him he cannot be on the football team where he's at right now.

00:04:34:07 - 00:04:39:20
Elizabeth Dabrowski, MD
And so, okay, how do we get to that goal? And we'll meet my goal in the background at the same time.

00:04:39:22 - 00:04:46:16
Tom Haederle
It sounds like you're really making a point to stay away from any negative messaging about their condition or like you say, weight or anything else like that.

00:04:46:18 - 00:04:47:27
Elizabeth Dabrowski, MD
Correct? Yes.

00:04:48:00 - 00:04:55:24
Tom Haederle
What kind of diet advice are kids hearing and are they hearing it for the first time? Maybe you know something that they should have been hearing all along.

00:04:55:26 - 00:05:13:21
Matthew Edwards
Yeah, I think absolutely. A lot of times our patients are hearing our message for the first time because I think it goes beyond that. Typical eat healthy, more fruits, more, more vegetables kind of messaging. We really individualize our approach for our patients. When the dietitian hops into the visit, they'll do what's called the 24 hour recall

00:05:13:21 - 00:05:34:04
Matthew Edwards
where we get a sense of what this patient's day looks like. Are they eating breakfast, lunch, dinner? Where are those meals happening and what are the portions or typical foods look like? And we also do talk a great deal about physical activity. We'll talk about sleep. We'll talk about hydration. We'll talk about stressors or other things that might impact their food choices or food decisions, their health environment.

00:05:34:06 - 00:05:54:07
Matthew Edwards
We often cover social determinants of health, access to healthy foods and healthy fruits, vegetables, those kind of things. And so it's much greater than just kind of healthy eating. It's how do you take some knowledge and apply it to a glucose environment or a blood sugar environment to help your body stay in regulation?

00:05:54:09 - 00:06:09:25
Tom Haederle
Does it ever feel like you're fighting an uphill battle? And I only ask that because, you know, there is so much - I think we all admit this - there's so much sugar and garbage and junk in the typical American diet that it's very difficult, I would think, to wall off, you know, especially a young person from those influences.

00:06:09:25 - 00:06:11:28
Tom Haederle
So how do you handle that part of it?

00:06:12:00 - 00:06:31:02
Matthew Edwards
It's extremely difficult. I think it's important to meet the families where they're at. Maybe not every meal is ideal, but could we have an optimized snack or an optimized meal at certain times of the day? Can we focus more on satiety or filling foods? Maybe not changing the foods that are on their plate, but what is that composition look like?

00:06:31:02 - 00:06:44:06
Matthew Edwards
Can we decrease the amount of less filling foods like grains and increase the filling foods like proteins, fruits and vegetables or fibrous foods? And it's just really meeting the patients where they're at and individualizing their approach.

00:06:44:09 - 00:07:03:02
Elizabeth Dabrowski, MD
I think a big part also is the family approach. And so I'm not asking my patients to do anything that I don't already do in my house. And I'm also, you know, if Mom and dad aren't doing it, the child is not going to do it. And so one of our big things is juice. My personal take, no one needs juice.

00:07:03:04 - 00:07:19:06
Elizabeth Dabrowski, MD
It is not a healthy option. And so if  - the kid you're buying juice and the kid's drinking the whole bottle in two days - let's just not buy it anymore. I had one little kid. I must have seen him last October because I told the mom my approach to Halloween candy and all of that. And the next visit, I saw him.

00:07:19:06 - 00:07:34:17
Elizabeth Dabrowski, MD
I was like, oh my gosh, you're doing so well. Why did you change it? She's like, well, you mentioned how you just limit the snacks in your house to a few days a week, like the really sugary things, you still get them, but it's limited. And she's like, that's all we did. It's not that simple all the time, by any means.

00:07:34:17 - 00:08:05:28
Elizabeth Dabrowski, MD
But that one just stuck out because I was like, oh, I didn't even realize I was helping there. But, I think meeting them where they're at, trying not to make anything off limits because then you're going to limit, limit, limit and then overdo it. And so just like Matt said, talking about portions, talking about how much carbohydrates versus protein and all of that, or when you're talking about snacks, kids who are having chips three times a day, oh, like maybe replace one with a fruit and one with salted popcorn or something a little better, but maybe not what we all see

00:08:05:28 - 00:08:09:13
Elizabeth Dabrowski, MD
as great. It still makes a big difference overall.

00:08:09:16 - 00:08:29:19
Tom Haederle
And I imagine in some cases you're really working not just to change an individual's behavior, but that of their family or their peer group or whoever or whoever they're spending time with. In the first two years the program served approximately 200 children, and not one of the program's participants went on to develop a type two diabetes diagnosis, which is remarkable.

00:08:29:22 - 00:08:32:21
Tom Haederle
Did you anticipate such a record of success?

00:08:32:23 - 00:09:06:19
Matthew Edwards
I don't think so. It's been really hopeful to see that kind of results. Now, the one caveat I can put on that result is that there may be patients that have been lost to follow up, that we don't know if they've now experience a diagnosis of diabetes. So I want to just put that out there. But I would say that, you know, we see so much success in this program for those patients that really invest in the long term follow up plan with this kind of clinic. Because again, the more contact points we have with the patient and with the family, the better the results that we're seeing.

00:09:06:21 - 00:09:30:23
Elizabeth Dabrowski, MD
We really created the clinic to fill a need. And we just I went in with zero expectations. I really wanted to see what would work for families. We have these kids getting referred to a lot of subspecialists, a lot of different places. And when we're looking at causes of excess weight and all of that, there's a lot of social determinants of health that go into that that may limit their ability to come to appointments or to miss that much work to go to appointments.

00:09:30:26 - 00:09:44:25
Elizabeth Dabrowski, MD
So seeing how much we could bundle things in one appointment or add some virtual touchpoints or things like that where kids weren't missing as much school, parents weren't missing work, we were hoping to get more of those touchpoints in. So it looks like it's helping.

00:09:45:02 - 00:10:03:25
Tom Haederle
Yeah. You must be encouraged by the success you've seen so far. It's wonderful. Any final thoughts about maybe what your peers, another health system or hospital could take away from your experience so far in terms of your patient population, what you've seen work? What would you say to somebody, another hospital, say, that's considering doing something similar?

00:10:03:27 - 00:10:27:06
Elizabeth Dabrowski, MD
I'd say don't take no for an answer. If you see a need that's there for patients, you just keep asking and asking and asking until you get what you think is best for them and until you get the care from external sources and dieticians, physical therapists. We're talking about getting some other people into our clinic to serve some of those other needs our patients may have.

00:10:27:09 - 00:10:30:13
Elizabeth Dabrowski, MD
I'd say just keep chipping away until you get the "yes."

00:10:30:16 - 00:10:35:10
Tom Haederle
Great advice. Matt, any final thoughts? Anything we haven't discussed so far that you want to touch on?

00:10:35:12 - 00:10:59:14
Matthew Edwards
Yeah, I just have one analogy that I do want to really sneak in here. And just to highlight the benefit of a prevention clinic. It's something that I remember from being an intern, during my internship. And one of the mentors that I had at the time said, prevention is like a bridge over a river. And that bridge is broken and people are crossing the bridge and they're falling into the river and they're heading downstream.

00:10:59:16 - 00:11:24:28
Matthew Edwards
Now, our diabetes clinic is the river. We're pouring in tons of resources and tons of effort to relieve this metabolic syndrome. But I just think about the benefit of preventing people from going into that river and having to struggle and having to pour all those resources in. To me, that's what our prevention clinic is, is where we're preventing them from going into the river and turning that life trajectory around.

00:11:25:00 - 00:11:39:14
Tom Haederle
Well, that's a wonderful image to end our discussion on. Thank you so much. I appreciate your time this afternoon and your excellent work on behalf of your patients. It's really inspiring. So thanks again for appearing on Advancing Health and good luck continuing with your great work.

00:11:39:17 - 00:11:40:08
Matthew Edwards
Thank you.

00:11:40:10 - 00:11:41:13
Elizabeth Dabrowski, MD
Thank you.

00:11:41:15 - 00:11:49:26
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.

00:00:00:28 - 00:00:23:27
Tom Haederle
Welcome to Advancing Health. Philanthropic support of a hospital or health system can support tactical investments that will impact a community for years to come. In today's podcast, we hear how CommonSpirit Health leveraged its donor support to create a plan that helps unlock other investments that continue to drive the mission.

00:00:24:00 - 00:00:51:12
Sue Ellen Wagner
Welcome to Advancing Health. My name is Sue Ellen Wagner, vice president of trustee services with the American Hospital Association. Very happy to have with us today leadership from CommonSpirit. Specifically, we have Daniel Morissette, senior executive vice president and chief financial officer. And Nancy Bussani, executive vice president and chief financial officer and president of the Common Spirit Health Foundation.

00:00:51:15 - 00:00:54:15
Sue Ellen Wagner
Dan and Nancy, very happy to have you with me today.

00:00:54:18 - 00:00:56:00
Daniel Morissette, MBA
We're thrilled to be here.

00:00:56:03 - 00:00:57:13
Nancy Bussani
Thank you, Sue Ellen.

00:00:57:16 - 00:01:15:23
Sue Ellen Wagner
Philanthropy can have a huge impact in helping a hospital or a health system achieve its mission of caring for patients, while also supporting operations. What role is philanthropy playing right now in health care? And can you talk about what is happening at Common Spirit?

00:01:15:26 - 00:01:46:20
Daniel Morissette, MBA
Thank you so much for that question. I guess to I can summarize it briefly first by saying it plays a huge role in helping us achieve our strategic capital and operational objectives. And so the money that we receive from our various philanthropic sources really does make a dramatic impact on funding our mission and doing the strategic initiatives that we have ongoing of providing even cash flow support to some of our important endeavors.

00:01:46:23 - 00:02:05:22
Daniel Morissette, MBA
And as you know, in today's health care environment, it is I can't recall a time where it's been more challenging, just from a pure operation standpoint. So, at CommonSpirit, Nancy'll go into this some, CommonSpirit has made just a dramatic effect on our various communities.

00:02:05:24 - 00:02:32:06
Nancy Bussani
Well, thank you, Dan. And I know our goal when we raise funds is to make sure they really make a difference for the health system. Last year we raised about $360 million, which was really in a very challenging environment where there was some volatility in donor sense of how they want to give. And we did it in an environment where we had to streamline, where we really had to look at how do we make sure that we're as efficient as possible.

00:02:32:06 - 00:02:56:03
Nancy Bussani
So we have we had a return on investment about $5.25, so that every dollar that came in, really provided $5.25 back to CommonSpirit. But that's only as good as where it goes. So I think the strategy of making sure it goes for the most critical programs and equipment and facility is really one of the most important things we're focused on right now.

00:02:56:05 - 00:03:22:17
Daniel Morissette, MBA
I'll just add to what Nancy said. You know, $360 million does make a really big difference for us at CommonSpirit Health. But it is important that we think about the fact that, you know, our alternative sources of revenue. You know, like such as patient care revenue, we would need to generate much, much more than the $360 million to actually have the same impact on our margins.

00:03:22:19 - 00:03:49:03
Daniel Morissette, MBA
So, you know, reverting to my CFO background, when you look at patient care revenue, we would need to generate about, oh, $100 or so in patient revenue just to net about $4 after you're done with all the expenses. But as Nancy said, when we look at it from a philanthropy standpoint, for every hundred dollars that we're able to receive, we do net about $81.

00:03:49:06 - 00:04:18:21
Daniel Morissette, MBA
You know, it really does have a big impact, particularly on the, you know, community based programs and initiatives that we have in our various markets. Therefore, I just want to mention that philanthropy is just a huge piece of what we need to do to be more and more effective from an operational and financial standpoint. And so it's been just a thrill for me to be part of our growing enterprise here, because it is so critical to what our mission is.

00:04:18:23 - 00:04:47:12
Daniel Morissette, MBA
You know, it is important to add that, you know, philanthropic funds have become a pretty significant data point when we meet with our outside investors, with bond rating agencies and the like. Because it is one way to help assess the strength that the health system's creditworthiness and its bond rating. But also it does help to know that the donors have confidence in us and the value we're bringing to our community.

00:04:47:19 - 00:05:20:08
Daniel Morissette, MBA
So the dollar amount really does make a difference from the, you know, just a pure financial and operational standpoint, because it is an alternative revenue stream that is, of course, less sensitive to the volatile environments we deal with, like payer mix and reimbursement pressure and fluctuating volumes. So, you know, philanthropy oftentimes does offset some of our debt funded capital project. Therefore it does reduce our leverage as well as strengthen our balance sheet.

00:05:20:11 - 00:05:43:21
Sue Ellen Wagner
Very important points about the value of philanthropy. Just to expand a little bit on what you both talked about. Philanthropy can be a strategic investment, and it has the value beyond the dollars raised. You both mentioned that a little bit. Can you expand a little bit and talk about why health care leaders should view philanthropy as a strategic investment, in addition to what you've already said?

00:05:43:24 - 00:06:13:29
Daniel Morissette, MBA
Well, first of all, we have so many projects in the large health system like we have even being a community based health system. And so we have both immediate needs. And I've always asked Nancy whatever she can do to get us unrestricted gifts that we could apply. It is important that we align our operational and our strategic leaders, partner closely with our philanthropy team so we can make sure the donations we receive do have the greatest impact possible.

00:06:14:02 - 00:06:46:23
Nancy Bussani
I think you can tell Sue Ellen how lucky I am to have a CFO that understands the nuances of philanthropy that, you know, donors at the end of the day are going to give where they're most passionate. But I do believe donors want to make the biggest impact for their entire community. And so when philanthropy teams have a seat at the table with their strategy leaders, with their hospital presidents, with their executive leadership, they can listen and understand where that strategy is driving the most critical investments.

00:06:46:25 - 00:07:19:17
Nancy Bussani
And it's those conversations with our donors that help to make for the best match. So when they do give, they understand how they're making the biggest impact. So we really do work hard to make sure that our leaders - we have 80 foundations throughout all CommonSpirit. They each have a seat at the table with their leadership team so that they can listen, they can learn, and they can understand how to have those important conversations with donors to make sure those dollars make the biggest difference they can.

00:07:19:17 - 00:07:46:24
Nancy Bussani
So it's not just about the volume, it's about the purpose. And to me, that only happens if your philanthropy leaders are sitting at the table listening to those conversations. Dan and I have had a lot of conversations about the timing of that, too. How do you have those conversations at the right time? And he's been - well, I'll let you talk about that, Dan, because you've been really helpful in helping us to determine when philanthropy needs to be brought in.

00:07:46:26 - 00:08:07:20
Daniel Morissette, MBA
You know, Nancy, that's a great point. Certainly I agree with that, right? We know that the timing is really important because, you know, if you engage the donors too early in the process and then somehow we decide for various reasons that the project doesn't go forward, you know, it can create some negative feelings in the, you know, in our donor community.

00:08:07:23 - 00:08:32:14
Daniel Morissette, MBA
And then, of course, on the flip side, if you wait too long and the major project is already up and going, you know, most donors feel like their support might really be needed. So, you know, we are continually encouraging our strategy and finance teams to include philanthropy, you know, so that we can all get, you know, better at finding that balance of the, you know, the desires of the donors.

00:08:32:16 - 00:08:55:27
Daniel Morissette, MBA
I'd like to point out that how critical philanthropy can be to innovation for a major health system like ours, as well as for the future of health care. Philanthropy can really help support to make a difference in from an innovation standpoint. Certainly we as a mission based health system, are fully devoted to serving everyone in our communities. Certainly

00:08:55:27 - 00:09:19:04
Daniel Morissette, MBA
we have a unique, strong focus on those who are most vulnerable. But with the health care dollars so tight right now, we often do wish to rely on our donors, whether they be individual corporations, foundations, government agencies, you name it. You know, to invest in our vision for what innovative programs or research is going to make a difference in the future.

00:09:19:06 - 00:09:29:15
Daniel Morissette, MBA
You know, you can be our most dedicated, long term connected donors that will walk with us to launch high risk but hopefully super high reward projects.

00:09:29:17 - 00:09:53:07
Sue Ellen Wagner
Thank you so much. Nancy, you talked a little bit about the importance of having a seat at the table. Successful philanthropic initiatives really need the support of the board and executive leaders, and I believe that equates to having a seat at the table. Can you talk about, both of you, what are the ways you see boards and leaders fitting into your philanthropic investments?

00:09:53:10 - 00:10:24:11
Nancy Bussani
Yeah, absolutely. Well, I want to start by saying that our CEO Wright Lassiter, has been very supportive of the importance of philanthropy, and he plays a really strong role in it. He serves not only as the CEO for CommonSpirit, but he's also the CEO for our national foundation. And that sends a really strong message to our boards that we have the attention and the investment of the leadership. We have throughout all of our 80 foundations about 1500 local board directors.

00:10:24:13 - 00:10:58:26
Nancy Bussani
And so it really is that connection between our philanthropy leaders understanding the strategy, being able to articulate it, and then taking that back to those board directors and helping them be our advocates. They can only help us as much as we give them the information to help us. So being able to have kind of those succinct messages about what really is going to move the hospital forward in their community, what's going to make us be able to provide the best clinical, excellent care to everyone?

00:10:58:28 - 00:11:22:27
Nancy Bussani
Because, as you heard Dan say, we have a lot of hospitals in very vulnerable communities. But our goal isn't just to open the doors and have access. It's to make sure that everyone has the best care. And that's where our donors come in. They can make the difference between, you know, covering our costs and creating great investments in the innovative programs that really make us excellent.

00:11:23:00 - 00:11:48:02
Nancy Bussani
We can't do that without the boards. Their voices really help to expand. So you take in a community, two or three executives in the philanthropy leaders, and then you maximize that by 20 or 30 people on the board who typically are very influential people in their communities. That's where we start seeing true visibility and awareness and believe in the work we're trying to do.

00:11:48:02 - 00:11:56:06
Nancy Bussani
So I can't overestimate the value that our board directors have in making these investments a reality and the right investments.

00:11:56:09 - 00:11:59:20
Sue Ellen Wagner
And, Dan, do you want to elaborate any more on that point?

00:11:59:22 - 00:12:39:05
Daniel Morissette, MBA
Just really briefly, thank you. You know, over the years, I've gotten more and more involved in partnering with our philanthropy teams and making sure that all of our local chief financial officers, for example, at our hospitals and within our regions - they do know the importance of putting every dollar raised, you know, into action. So I consistently discussed philanthropy and in our regular meetings, but also through issue a quarterly memo to all the CFOs to share how critical it is for them to work with their philanthropic leaders to get the funds transferred so that we can put it to good use.

00:12:39:08 - 00:12:47:02
Daniel Morissette, MBA
And this certainly helps our philanthropy leaders by having an equal partner on the financial and operational side of the hospitals.

00:12:47:04 - 00:13:18:18
Nancy Bussani
And that's information that - when that doesn't happen, Sue Ellen, if you don't have a CFO that partners with you that way, sometimes our dollars don't get put into action as quickly as we need. We cannot go back to donors and to boards and show the impact of their investments if that doesn't happen. And so it's such a critical bridge for us to be able to say, not just raise the money, but to demonstrate back to those who were generous to us how we used it and the impact that made.

00:13:18:18 - 00:13:40:20
Nancy Bussani
And so sometimes it's this financial partnership that allows that to happen. You know, with everything going on that's not always the top priority for a CFO to make sure those dollars get transferred to cover all of those costs that   those dollars will help to support. And it really doesn't allow us to feedback to the board what's happening in their communities if we don't have that partnership.

00:13:40:20 - 00:13:45:29
Nancy Bussani
So it really has changed how we work with our CFOs throughout all of the hospitals.

00:13:46:00 - 00:14:24:21
Sue Ellen Wagner
I love those final words. Thank you. Well, Dan and Nancy, thank you so much for being with me today. You've talked a lot about the importance of not only your CEO partnership, but your CFO partnership. So I think our listeners have a lot to learn about that. And really, given the complex environment that we're in, still being able to get that return on investment for your philanthropic dollars is really important so that you can continue to fund your innovations and your initiatives. And getting that board to, you know, be supportive and participating in the philanthropic initiatives, I think is really important.

00:14:24:21 - 00:14:29:01
Sue Ellen Wagner
So thank you both. Really appreciate all of your great information.

00:14:29:03 - 00:14:37:15
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.

00:00:01:02 - 00:00:23:23
Tom Haederle
Welcome to Advancing Health. Philanthropy supporting hospitals and health systems doesn't spring out of nowhere. It's nurtured and sustained by building a culture of giving. In today's podcast, we learn more about how to create that culture and why it's so important to get employee engagement and buy in.

00:00:23:25 - 00:00:56:22
Sue Ellen Wagner
Hi everyone. Welcome to Advancing Health. I'm Sue Ellen Wagner, vice president of trustee engagement and strategy with the American Hospital Association. I'm very happy to have leadership from Sanford Health with me for this podcast, and I'm pleased to be speaking with Bill Gassen, president and chief executive officer, and Deb Koski, chief philanthropy officer. Philanthropy, as you know, can have a huge impact in helping a hospital or a health system achieve its mission of caring for patients while supporting operations.

00:00:56:24 - 00:01:06:12
Sue Ellen Wagner
What role is philanthropy playing right now in health care? And if you could also include the role that its playing in Sanford Health, that would be great. Bill, let's start with you.

00:01:06:14 - 00:01:23:14
Bill Gassen
Sounds great. Well, thank you for the opportunity to meet with you. It's a pleasure to be here with my colleague, Deb Koski, as we have the opportunity to really share the power of philanthropy and really, especially what that means for us in health care across this country, but really specifically what it means for us in Sanford Health.

00:01:23:16 - 00:01:55:29
Bill Gassen
And I'll start with this. Philanthropy is a really critical lever that gives us a distinct advantage in living out our mission. At Sanford Health our mission is to care, comfort, and cure. And we do that through a variety of different capabilities and characteristics. But a major way in which we fuel those characteristics and those different capabilities of Sanford Health is really by bringing alongside philanthropy. And philanthropy does a whole lot more than just help fuel it from a financial perspective.

00:01:56:02 - 00:02:29:05
Bill Gassen
But as Deb leads the foundation for us at Sanford Health, and she knows best, it also helps galvanize our communities. Community based, not for profits. Our constituents are our patients and the communities that we have the privilege of serving. And philanthropy allows everybody to be a part of that mission. So even if you're not one of the individuals who's been called to serve at the bedside, that you're not one of the individuals that's providing direct patient care, you can be a part of fulfilling that mission in the community by giving philanthropically.

00:02:29:05 - 00:02:53:04
Bill Gassen
And as Deb knows best, whether it's $1 or whether it's many, many more dollars, you're making a difference with those dollars and you're helping us meet our patients where they are at. And it's a critical part of allowing us to be able to do the things that we do, especially on a limited budget. We always say for us at Sanford Health and really for the entire field, for our hospitals and our health systems,

00:02:53:11 - 00:03:17:24
Bill Gassen
the needs are infinite, but the resources are finite. And one of the ways that we're able to do more with what we have is because of philanthropy. And the opportunity, again, to be able to mobilize communities, to be able to bring people inside the mission is something that not only helps us meet the needs from a financial perspective, but it also makes a big difference for our caregivers as well, too.

00:03:17:27 - 00:03:29:00
Bill Gassen
When our caregivers know that community leaders are behind them and they're giving with their time, they're giving with their talents, and they're giving with their earthly treasures, that makes a difference for them as well, too.

00:03:29:03 - 00:03:58:13
Deb Koski
Really well said, Bill. I think one of the things that I'm most proud of is how we have engaged our communities. We really have patients and community leaders and businesses really rally around Sanford Health in every community that we are in. And that's everything from, you know, guardian angel type gratitude that's expressed by patients to attending our events, listening to radio or video on our social channels.

00:03:58:13 - 00:04:22:27
Deb Koski
So we just have amazing engagement by our communities. And Bill is right. We have about 20,000 active donors who are giving every year from, you know, a dollar per pay period to seven figure gifts. So we just really have the spectrum of people who support us and I think, you know, rallying around our mission of to care comfort and cure, has been a real, a real rallying cry for people.

00:04:23:02 - 00:04:42:07
Deb Koski
They resonate with that. And they're really proud to be affiliated with Sanford Health and helping us accelerate all those great things and the, frankly, the access they have to health care. We're very rural, but we have access to amazing health care here in the Midwest, in the Sanford footprint. And people are grateful for that and they want to support it.

00:04:42:09 - 00:05:13:24
Bill Gassen
Deb, maybe one other thing I would add to that is, the other thing that philanthropy allows us to do is to really tell the story. And this day and age we know how critically important it is to make sure that we're getting the message out to the people in our communities, to our patients, to the individuals who are part of our care teams that are working with us day in and day out and really across this country. So people know and understand how important the work of our hospitals and our health systems really are as part of that critical infrastructure to this country.

00:05:13:26 - 00:05:39:07
Sue Ellen Wagner
I think it's great that you talked about telling the hospital story and how it's important for everyone who gives to see themselves as part of that story. So thank you so much for sharing that. Let's move on and let's talk about the culture of giving. Why is it important to support the culture of giving? And how does the board and leadership really begin this kind of culture?

00:05:39:09 - 00:05:42:04
Sue Ellen Wagner
Bill, if we start with you again, that would be great.

00:05:42:07 - 00:06:14:15
Bill Gassen
Yeah. So I would say this: from a cultural perspective, it's vital that our leadership, that our board members, whether they're local board of directors, whether it's our, board of trustees that oversees the entirety of our organization. For them to be able to set that example - which I am so grateful that they do - that so many of our leaders across this organization not only lead with their voices, but they lead with their actions.

00:06:14:17 - 00:06:31:27
Bill Gassen
And they're at the front lines of a lot of that giving. And an important part of that, again, is that it helps everybody know and understand that they get to be a part of that mission, that they get to be a part of making a difference and allowing us to be able to do more with the resources that we have today.

00:06:32:00 - 00:06:58:12
Bill Gassen
It again, it's, a real strong - and we say this oftentimes at Sanford Health - that it helps us all come together to drive that common culture that says that we know how important the work is, and everybody gets to be a part of that work whether you are somebody who's caring for a patient or whether you're somebody who's caring for those who care for our patients. And by joining in and being a part of philanthropy, you get to be a part of that.

00:06:58:15 - 00:07:26:03
Bill Gassen
And we believe that when that happens, there's a level of fulfillment that happens for the individual. We know that it makes a difference to be able to give. We know that that helps change hearts and it changes minds. Giving begets giving, which is another really important principle. Deb talks about this, better than anybody that as we see individuals in our community step up to make major financial contributions, that that doesn't quiet other giving.

00:07:26:05 - 00:07:40:17
Bill Gassen
We don't see community members say, well, I'm not going to give because Deb's giving and she's taking care of those needs. But instead we really see it as a mobilizing force where more individuals start to give as well, because they want to be a part of that.

00:07:40:19 - 00:07:44:16
Sue Ellen Wagner
Deb, would you like to elaborate a little more from your perspective?

00:07:44:19 - 00:08:02:15
Deb Koski
Yes, I would, I'm really excited to talk about this, frankly, because I think Sanford Health does this really well. Our leaders just incredible in the support that they provide. And Bill is too humble to say this, but one of his first acts when he became our CEO five years ago was to make a gift himself, he and his family.

00:08:02:17 - 00:08:28:05
Deb Koski
I've been here about over 20 years, and so I can say with sincerity that that kind of leadership has completely changed the culture of giving that Sanford Health. Currently today, the C-suite - so all of Bill's direct reports - 100% of them are giving. They do that because they want to. They attend almost every signature event. We have an organization which is quite a feat because we are spread out geographically.

00:08:28:07 - 00:08:50:27
Deb Koski
They have to travel to go to signature events in all of our markets, but they go, and they give proudly. That has cascaded now to where we have 90% of our VP's and above giving. Also influenced our physicians. We have almost 50% of our physicians giving, which I think is incredible. And I know in the industry that that's, that's a pretty impressive number.

00:08:51:00 - 00:09:05:10
Deb Koski
Over 30% of our employees are giving, including our good Sam facilities. So we just have incredible engagement. We've also seen, ironically, our NPS scores rise. And I really believe that that's because they feel like they're part of something.

00:09:05:12 - 00:09:31:08
Bill Gassen
You know, one of the things that Deb has done so well over the last 20 years is that she has made sure that she's leveraging philanthropy to really connect people to the mission. Whether you're part of the organization and you're one of the non-clinical members who is connecting into that mission, whether you're a patient, we have many of our patients and their lives have been transformed by the care that's been delivered, and they want to be a part of that moving forward.

00:09:31:10 - 00:09:49:07
Bill Gassen
And then we have members of the community that know how critically important it is, the work that we do, and how important it is to have our hospitals and our health systems there 24 by seven, 365 days out of the year. But I think one of the ways that Deb has probably done this best is her team is embedded in our operational teams.

00:09:49:09 - 00:10:26:20
Bill Gassen
And so the giving that happens, the initiatives that are underway and those campaigns are all connected right into those operational priorities. So there's no daylight between the priorities for what we're doing at the Sanford Health Foundation and what's happening in each one of our medical centers. Each one of our clinics, our long term care facilities. And to have that seamless connection not only creates the best results for the hospitals and the health systems themselves, but it also makes sure that there's a great level of connectivity to the mission, and that the individuals in the community really do feel that they're a part of those care teams.

00:10:26:22 - 00:10:44:06
Sue Ellen Wagner
Any final thoughts that either of you would like to share to give our listeners, you know, any additional information to help them either begin a philanthropy strategy or enhance their own philanthropy strategy? You've given a lot of information, but I'm sure there's a couple of things that both of you can add.

00:10:44:08 - 00:11:11:17
Deb Koski
Like I said, it really has to start from the top in my opinion. So you have to embrace philanthropy. You have to talk about it. Our chief financial officer talks about philanthropy being one of the three legs of the stool in terms of revenue to the organization and the bottom line. And while that's a lot of pressure to be, you know, lifted up like that, it also validates the importance of it.

00:11:11:17 - 00:11:31:09
Deb Koski
And it has really, frankly, motivated my team to work harder, do everything they can to bring in dollars to the organization. We have been made to feel like we make a difference. The work we do truly is helping us provide a better level of care to our patients, and our employees.

00:11:31:12 - 00:12:00:24
Bill Gassen
As hospitals and health systems, we can't forget that one of the most significant advantages that we have on our side, especially when it comes to philanthropy, is that we have an unassailable cause: to be there for every individual, regardless of their ability to pay, no matter whether they are living in some of our most densely populated urban communities, or whether they are in some of the most rural or frontier communities that are geographically isolated,

00:12:00:27 - 00:12:32:01
Bill Gassen
hospitals and health systems like Sanford Health are here to meet their needs. And I would be remiss, any time we at Sanford Health have the opportunity to talk about philanthropy, to not lift up health care's greatest philanthropist: our namesake and our most significant benefactor, Mr. Danny Sanford. As we sit here today in 2025, Mr. Sanford has already given $1.5 billion to Sanford Health to help do exactly what Deb's talked about.

00:12:32:03 - 00:13:10:16
Bill Gassen
It's been a catalyst allowing us to advance care in communities that we could have never done that in. So for us, we always talked about at Sanford Health that giving begets other giving. And we have seen that happen. And so to know that when we have the ability to go to philanthropists or potential philanthropists to say, we want you to be a part of our mission, to know that we're asking for them to come alongside in a partner in some of the most rewarding work that could possibly exist is something that should embolden us to go out, to be able to engage other people.

00:13:10:18 - 00:13:24:21
Bill Gassen
And Deb knows this as well as anybody. Time and time and time again, we have our donors come back to us and say, thank you. Thank you for giving me the opportunity to be a part of the mission at Sanford Health.

00:13:24:23 - 00:13:44:27
Sue Ellen Wagner
Thank you, Bill and Deb, for being with us today. Clearly, Sanford Health is a leading practice in philanthropy and I think a lot of what you shared, leveraging the philanthropy to connect to your mission involving the leadership and your employees, has gone such a long way to your successes. Thank you again for being with us.

00:13:45:03 - 00:13:45:23
Bill Gassen
Thank you.

00:13:45:26 - 00:13:47:06
Deb Koski
Thank you so much.

00:13:47:09 - 00:13:55:20
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.

00:00:01:01 - 00:00:26:18
Tom Haederle
Welcome to Advancing Health. We love them. We need them. In fact, we can't do without them. But keeping America's nurses engaged and supported and doing what they love and were trained to do has been a challenge for many hospitals and health systems. Today, we get some tips from New York City's biggest health system on its amazing progress in nurse retention over the past several years.

00:00:26:21 - 00:00:46:03
Elisa Arespacochaga
Welcome to Advancing Health. I’m Elisa Arespacochaga, group vice president for clinical affairs and workforce at the American Hospital Association. And I'm delighted to be joined by Natalia Cineas, senior vice president and chief nursing executive for NYC Health + Hospitals to talk about the amazing work they've been doing and their progress on nurse retention. So welcome.

00:00:46:06 - 00:00:48:05
Natalia Cineas, R.N.
Thank you so much. Thank you for having me.

00:00:48:08 - 00:01:07:08
Elisa Arespacochaga
All right, let's get into it. You started a little bit ahead of the curve in terms of when people were starting to focus on nurse retention and how to keep your team intact. But what prompted you and the organization to say, hey, this is a problem and this is where we need to put our attention?

00:01:07:10 - 00:01:49:14
Natalia Cineas, R.N.
Sure. So when I was appointed in 2019, the data really led us to focusing on retention. We had a turnover rate of 46%. And as you can imagine, you know, that was really shocking. And so at the time, we decided to focus on establishing a nurse residency program. I then hired an amazing senior director of professional practice for nursing that really helped put together not only the nurse residency program, but also spearhead over 200 professional governance councils that we now have throughout our entire enterprise.

00:01:49:14 - 00:02:01:21
Natalia Cineas, R.N.
And I think those two programs were truly the catalysts of our work as it entails surrounding nursing retention. But that was in 2019. You are correct.

00:02:01:24 - 00:02:20:17
Elisa Arespacochaga
So you really double down on engagement, like, let's get these nursing teams fully engaged in the work that we're doing and let them tell us what are the things that we need to do. As a new leader, that must have been a bit of a tough challenge to say, hey, you know what? Something's not working, tell me what you think.

00:02:20:20 - 00:02:53:23
Natalia Cineas, R.N.
Actually, it was exciting. You know, I've always been a leader that believes in the power of our frontline. And so establishing structural empowerment and that infrastructure was actually really exciting. And I think hearing from our nurses, understanding what they wanted to see, partnering with our labor unions was the answer, really, to ensuring that our nurses were engaged and we were establishing programs that they found meaningful.

00:02:53:25 - 00:03:20:15
Natalia Cineas, R.N.
And to your point, you know, giving them an opportunity to have their voices heard. And I think, you know, it was really important at the time to educate our leaders about the importance of listening to frontline. And I think that was a learning curve. But we've succeeded, and now we have a positive practice environment where we have five Pathway to Excellence designated sites, two with distinction.

00:03:20:18 - 00:03:34:15
Natalia Cineas, R.N.
And that designation really focuses on a positive practice environment. So to me, that's indicative of the work that we have done over the last six years to focus on engagement and retention.

00:03:34:17 - 00:03:37:02
Elisa Arespacochaga
That's awesome. So where are your numbers today?

00:03:37:05 - 00:04:10:10
Natalia Cineas, R.N.
So our turnover rate is now 7%, which is phenomenal. Yeah. We've come a long, long way for our staff nurses. We've hired over 3,000 nurses not long ago, and we continue to monitor those numbers. But we were so proud because of the nurse residency program, because of our professional governance councils, because of the amazing fellowship programs that we've established to train our new nurses and our clinical ladder program.

00:04:10:10 - 00:04:49:18
Natalia Cineas, R.N.
A lot of professional development programs have been established in the last six years and that we now see that our turnover rate is 7%. And that is because of the commitment of the entire C-suite here at New York City Health + Hospitals. I have to give credit to our president and CEO, Dr. Mitchell Katz. He would say he loves nurses, and we believe it because he has been our number one supporter with the city of New York to ensure that our nurses have great contracts, that have also been combined with the amazing programs that we've implemented to see this remarkable result.

00:04:49:21 - 00:05:15:29
Elisa Arespacochaga
That is amazing. That is - just to put it into perspective, significantly below in fact, less than half of the national number of turnover rate. So that is amazing. I love that, one of the programs you've mentioned a couple times is that nurse residency program, because we know that new nurses, particularly those who were trained during the pandemic who might have had less clinical exposure, that that turnover rate is through the roof.

00:05:15:29 - 00:05:37:02
Elisa Arespacochaga
And it's a challenge to help them understand what does this job look like when they're ready to start it? So, can you tell me a little bit about how you've not only helped them figure out how to grow from 'I'm a brand new nurse - to I'm a nurse who knows what I'm doing in this organization.' But how have you been able to help them see pathways for them to stay?

00:05:37:05 - 00:06:11:25
Natalia Cineas, R.N.
Excellent question. So I have to give credit to our amazing team at our corporate office and also our nurse leaders across the entire system that support our nurses in the nurse residency program. We've had over 2000 participants to date, over 1000 graduates. And I think that during the nurse residency program, we educate our nurses about a) the importance of the health system that they selected to begin their careers, or whether they're new to nursing or new to their specialty.

00:06:11:28 - 00:06:36:24
Natalia Cineas, R.N.
You know, we definitely have conversation about the importance of our mission here at New York City Health + Hospitals to really care for the underserved, and they understand the importance of that, the significance of that. I think they believe in our mission and our vision. And we educate them on the opportunities in the ways to transition within the profession when they are employees of New York City Health + Hospitals.

00:06:36:24 - 00:07:06:09
Natalia Cineas, R.N.
And I think that's been really important. And we talk to them about how they can get connected with other opportunities, how they can become part of the different councils so that they continue to grow and develop professionally. But also once they graduate from the nurse residency program we created something here at New York City Health + Hospitals which is really unique that many systems do not have, and I don't think any system has, quite frankly, is the mentorship opportunity.

00:07:06:09 - 00:07:33:05
Natalia Cineas, R.N.
So when they graduate from our nurse residency program, they are able to become mentors to their peers to really talk about the first year of practice and, you know, to give guidance to others. And we're really excited about that program where we're using an AI platform to pair a mentor with mentee of the nurse residency program graduates. And that has been just phenomenal.

00:07:33:06 - 00:07:51:23
Natalia Cineas, R.N.
We've had over 100 mentors now, who come back to support other peers. And I think that's just one of the ways that we continue to retain our nurses by, you know, educating them that while they are new, there's so many ways they can contribute within nursing here at Health + Hospitals.

00:07:51:26 - 00:08:16:00
Elisa Arespacochaga
I love that because, I mean, if you're tapping into what is in a nurse's genetics, it is about caring for other people. So the ability to then say immediately, not only are you trained and are you in a good place to take care of your patients, but here, you know, let's connect you with some of your colleagues. Let's have that best friend at work who you know, you are helping through the same path that you had to tread, I love that.

00:08:16:02 - 00:08:34:08
Elisa Arespacochaga
So what are some of the lessons that you learned along the way? Because, you know, you started this in 2019 and then there was a pandemic. And then, you know, the whole world changed. So what are some of the things that you either started and stopped or changed or moved along the way? Lessons learned that you want to share with our listeners?

00:08:34:10 - 00:09:03:28
Natalia Cineas, R.N.
I think the one lesson I've learned is the importance of communication and staying connected with those doing the work. And, you know, I think back to Covid 19 and the fact that we continued to run our nurse residency program to give our nurses a safe space to ask questions, to share whether or not they were afraid of being in the front lines and providing them support. Just to remain consistent, to remain visible has really been key.

00:09:03:28 - 00:09:23:07
Natalia Cineas, R.N.
And we said it already today. But I think the importance of listening, listening to others and that's one thing that I do in all of our programs, whether it's fireside chat with our front line, whether it's a leadership townhall. Just listening to our community of nurses this year has been really, really important. And I think that's why we're seeing our success.

00:09:23:08 - 00:09:40:22
Natalia Cineas, R.N.
I think that's why our nurses are staying as they believe not only in the mission and our vision, but also they know that they are part of the fabric that makes us great and that they are part of the solution to continuing to provide excellent care to our patients.

00:09:40:24 - 00:09:59:02
Elisa Arespacochaga
That sounds amazing. And it sounds like they believe in you, Natalia, that you're part of this solution. You're there to serve them in the way they are there to serve their patients. And I think there's no higher compliment for a leader than to know that. Thank you so much for joining me today, for sharing the amazing work that you've been able to do.

00:09:59:02 - 00:10:08:20
Elisa Arespacochaga
And I wish you continued good luck with all of this work. And I look forward to interviewing you again in a year and finding out what else you've been able to solve.

00:10:08:22 - 00:10:10:06
Natalia Cineas, R.N.
Thank you so much.

00:10:10:08 - 00:10:18:19
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.