Advancing Health Podcast

00:00:00:10 - 00:00:14:21
Tom Haederle
Welcome to Advancing Health. Improving maternal health takes more than one type of provider. Learn how multidisciplinary teams are breaking down silos to support healthier pregnancies and better outcomes.

00:00:14:24 - 00:00:32:19
Julia Resnick
Welcome to Advancing Health. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. I'm here with Kardie Tobb from Cone Health. She's a cardiologist and works in obstetrics. And we're going to talk about team based care so that women can have better pregnancy outcomes. Kardie, thank you so much for being here.

00:00:32:21 - 00:00:37:26
Kardie Tobb, DO
Thank you for having me. It's such an honor. I am looking forward to this conversation.

00:00:37:27 - 00:00:42:18
Julia Resnick
Same. Can you tell our listeners a little bit about who you are and your role at your hospital?

00:00:42:19 - 00:01:07:13
Kardie Tobb, DO
Sure. Of course. So I am a trained cardiologist. Preventive cardiologist. I focus in on women with cardiovascular disease in pregnancy. So a term that we call cardio obstetrics. And I am in Greensboro, North Carolina. I work with a health system here, and we have been able to be fortunate for me to lead our initiative to develop our cardio obstetrics program.

00:01:07:13 - 00:01:22:17
Kardie Tobb, DO
And it's exciting to be able to work across dimensions of health specialties with the OBs, the maternal fetal medicine specialist, anesthesiologist and our nurses, and take care of patients to make sure they're having better outcomes.

00:01:22:18 - 00:01:37:22
Julia Resnick
So cardio obstetrics, I think by nature is kind of a interdisciplinary model of care. So can you talk about how you're thinking about that, that level of team based care? And really what prompted you to redesign how pregnancy care works at your hospital?

00:01:37:24 - 00:02:14:05
Kardie Tobb, DO
So let me tell you, it is really everything stemmed from looking at what our national data is showing. Maternal mortality, we're in a crisis and in different pockets of where we are in the country. We have to be thinking along the lines of team based care. So when I started fellowship, initially, I thought I was going to be a interventional cardiologist, and I was feeling pretty good about that until I started to look at my mentor, who was in women's health and started to look at the burden of women with heart disease and pregnancy and thought that I was going to pivot.

00:02:14:05 - 00:02:45:26
Kardie Tobb, DO
And I'm so glad I did, because now I have a fulfilling career where I'm not only caring for these women, but I have colleagues that we think about it together. So at Cone Health, with our interdisciplinary cardiac obstetrics team, what we have is a team of people: OB, MFM, anesthesiologist, pharmacist, social worker, nurses that we really discuss what the outcome or what that delivery plan and what the care plan is doing in pregnancy of a woman who has high risk cardiovascular diseases.

00:02:45:26 - 00:03:09:06
Kardie Tobb, DO
By that I mean like women who've had a heart attack, who've had heart failure, who've had strokes, who actually have high chronic hypertension that's really not controlled during that time, diabetes. And you name it. And we really do a good job to talking to each other. I'm really intentional to say talking to each other because all health systems have cardiologists.

00:03:09:08 - 00:03:28:26
Kardie Tobb, DO
Most health systems, I should say, because some of our hospitals may or may not have OBs, have an anesthesiologist, but most of them work in silo. And that's why I'm so proud that wit our cardio-obstetrics program, we're able to have this interdisciplinary conversation that we can make sure our patients are well cared for.

00:03:28:28 - 00:03:38:15
Julia Resnick
That's fantastic. And especially, you know, knowing that cardiology issues are one of the major causes of maternal morbidity and mortality. Like it makes so much sense to start there.

00:03:38:16 - 00:03:58:21
Kardie Tobb, DO
It is, it is. For many years we've had the traditional care where we think reproductive care years and pregnancy years is for the OB. But what we're seeing now, the trend with women having babies in older years, some of them have developed heart disease, some of them have inheritable heart disease, some of them have congenital heart disease. It's a problem.

00:03:58:21 - 00:04:05:16
Kardie Tobb, DO
So cardiologists, we need to understand that this is our problem too, to help solve.

00:04:05:18 - 00:04:23:22
Julia Resnick
Right. And I think, like we've been hearing that so many women are sicker when they become pregnant, which just means that their pregnancies are higher risk for themselves, higher risk for their babies. So like, how can we think more holistically about like, preconception care to put women on a pathway to healthier pregnancies?

00:04:23:28 - 00:04:54:10
Kardie Tobb, DO
This is one of my advocacy, Julia, to be honest with you, because a lot of time we now think about the pregnancy care and we don't think about the mother before the pregnancy care. And we don't educate women enough for them to understand that they need to declare their intentions of wanting to give birth, because once that's known, and we don't also talk enough with the primary providers to help women declare their intentions of being pregnant.

00:04:54:10 - 00:05:13:09
Kardie Tobb, DO
Because once the intentions is known, the rest of it is easy, because then you start asking questions about family history, about the woman's own history. So imagine a 42 year old woman who desires to get pregnant, but was diagnosed with high blood pressure ten years ago and may or may not be treated. And she wants to have a baby.

00:05:13:10 - 00:05:31:18
Kardie Tobb, DO
She needs to know that we need to look at those blood pressures, needs to know that her blood pressure needs to be optimized as opposed to - she gets pregnant, she's very happy because she's planned her life, she planned her career and now she's starting her family. And then by her 12 weeks of pregnancy, her blood pressure is 160 over 90.

00:05:31:19 - 00:05:54:14
Kardie Tobb, DO
That is devastating because there is a risk that she could lose the baby. And there's also that problem that not only losing a baby, her complications that are associated with it, not just during that time of the loss or the potential loss or during that time, years later. So we need to - it should really become a part of how we care for reproductive women.

00:05:54:15 - 00:05:59:14
Kardie Tobb, DO
Asking them about declaring intentions because there are some women who don't want babies and its okay.

00:05:59:18 - 00:06:12:25
Julia Resnick
Absolutely. And I feel like we're going to become evangelists for this. Like, how can we how can we better educate women about their health before they get pregnant to set them up for a lifetime of health, whether or not they decide to have a baby.

00:06:12:25 - 00:06:39:19
Kardie Tobb, DO
And I will be there, there with you. Trust me, because the advocacy and I think that I have dedicated my career to just this one thing. Making sure that women understand their heart health, their overall wellness. And then when it comes to trying to have a baby, we need to, as a country, not just as where I practice Greensboro or not just as Chicago or Philadelphia or Alabama.

00:06:39:19 - 00:07:04:06
Kardie Tobb, DO
We need to, as a country, start thinking about the wellness of women health, period. There's been a huge transformation in the education of women across the country, but there are still a lot of work to do. Because when we see women, sometimes we think breast cancer number one killer. But that is not true. Heart disease number one killer. Reproductive years, heart disease number one killer leading causes.

00:07:04:10 - 00:07:11:20
Julia Resnick
Yeah. And when we think about young women, they usually think that they can't have heart disease because they're too young and they're too healthy. But that's not true.

00:07:11:20 - 00:07:34:01
Kardie Tobb, DO
That is not true. Young people in general feel that we're indispensable,  we're not. There are lots of ways that young people can have heart disease. Genetically, high cholesterol, thinking about heart disease or inherited genetically. So I think it should start from the younger years, because people are thinking that heart disease is not something for the young, especially in women.

00:07:34:01 - 00:07:46:26
Kardie Tobb, DO
We look at it in post-menopausal stages. That is not true. We start from a younger age, knowing the blood pressure, thinking about if you want to have a baby with that desire for your work and things like that.

00:07:46:27 - 00:08:02:28
Julia Resnick
I do want to go back to the pregnancy conversation. So from the patient's perspective, when they're part of this interdisciplinary model of care, who are they seeing as part of those, their care team? And how do the how does the flow work for them, and how does it differ from traditional pregnancy care?

00:08:03:02 - 00:08:27:18
Kardie Tobb, DO
So the OB is the driver of the care team. The OB is the one that's going to identify when cardiology coming, OB's going to identify when a behavior specialist coming. So it's almost OBs are captain of the ship. But being in that model where we're not siloed anymore and we're making sure that the patients know when they need to be referred, the patients are screened.

00:08:27:18 - 00:08:51:22
Kardie Tobb, DO
And I think the big part of that care model is not necessarily always seeing the patient, but always having a conversation during those roundtable, because we can't have a multidisciplinary clinic in all states or all places, because when you think about the payers and all, how that works, but we can have a roundtable where we can discuss every patient, every problem and come up with a joint solution.

00:08:51:23 - 00:08:55:18
Julia Resnick
And can you talk more about those roundtables and who's involved and how that guides care?

00:08:55:19 - 00:09:20:12
Kardie Tobb, DO
So what happens - we have patients based on our history, what they have. And a lot of times the identification comes from our OB team. And sometimes if they see a cardiologist first like myself, and we have a group of a list of those patients, and then who's on those roundtable discussions are the cardiologists. Sometimes our advanced heart failure team members, because we have women whose EFs are low and need (?) heart failure.

00:09:20:13 - 00:09:49:25
Kardie Tobb, DO
Our pharmacist, our obstetrician gynecologist, our maternal fetal medicine team member, our nurse and leadership's from the discharge areas to the labor wards. Our social workers, our pharmacist, and we pull people in as we need. And what we do, we look at the individual, we look at their chronic disease processes. We look at what is needed, what is needed in terms of clinical care and social needs, not as we think about it as providers, doctors.

00:09:49:25 - 00:10:07:14
Kardie Tobb, DO
And we say, oh, this is what we know. We'll look at it from my holistic standpoint. What they need to have a safe delivery in terms of treatment prenatally and what they need to have a postpartum stay and be very comfortable at home and making sure they're not leaving their baby to come back for a readmission.

00:10:07:14 - 00:10:22:21
Julia Resnick
That's incredible. And I just want to close with your words of advice. So if our listeners were to take one action to think about how they could improve pregnancy outcomes for women in their communities, what would be your one piece of advice for them?

00:10:22:24 - 00:10:43:28
Kardie Tobb, DO
So start from an enterprise level and talk to healthcare executives and say, from the care of a pregnant woman or a reproductive age woman is not based on the OB or the nurse. It starts from the CEO, who really pushes the initiative of making sure that we look at data on maternal health, not just from the race, ethnicity, language.

00:10:44:00 - 00:11:09:18
Kardie Tobb, DO
Make sure we understand the gaps and really build bridges to help close those gaps. And then I'll talk to the clinicians. It's not about us as physicians or providers, it's about the patient. So we need to align and have conversations with our other subspecialties to make sure that we're aligning on better outcomes and not work in silo. And then I would talk to the patients and say that, have a conversation with your provider.

00:11:09:18 - 00:11:32:07
Kardie Tobb, DO
If you're a reproductive age woman who wants to be have an intention of having a baby, who wants to be pregnant, understand your health because a healthy woman would carry a healthy baby. And once you can do that, push until you find a person is going to help you. And then optimize your health if you have chronic disease before you get pregnant, it makes for a much more healthier pregnancy.

00:11:32:14 - 00:11:44:06
Julia Resnick
Those are wise words for leaders, providers, and patients. So Kardie, thank you so much for joining me for this conversation. I am so inspired by the work you do, and look forward to seeing how it continues to develop and grow.

00:11:44:13 - 00:11:47:21
Kardie Tobb, DO
Thanks for having me. It's always a pleasure.

00:11:47:24 - 00:11:56:15
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:03 - 00:00:19:06
Tom Haederle
Welcome to Advancing Health. Medical complications at birth can sometimes prevent new parents from holding their babies and beginning the bonding process right away. Today, we hear about how one major health system encourages other ways newborns and new parents can start to connect from birth.

00:00:19:08 - 00:00:46:00
Julie Kim
Welcome to Advancing Health. I'm Julie Kim, director for the Division of Health Outcomes and Care Transformation here at the American Hospital Association. Picture this: your baby is just hours old, hooked up to monitors in an NICU, and you're standing at the bedside not knowing what you're allowed to do. That's where today's conversation about health literacy begins. Joining me are Gabriela Jimenez Thompson, program lead for NYC Health and Hospitals Bellevue,

00:00:46:01 - 00:00:54:03
Julie Kim
Our Story Begins program. And, Liliana Escobar Bellevue had an NICU nurse. Gabriela, Liliana, thanks so much for being here.

00:00:54:07 - 00:00:56:25
Liliana Escobar
Thank you for having us.

00:00:56:26 - 00:01:05:26
Julie Kim
Of course. Let's dive right in. Gabriela, could you start by telling us more about Our Story Begins program? What inspired it and what it looks like in practice?

00:01:05:28 - 00:01:25:26
Gabriela Jimenez Thompson
Yes. Of course. So Our tory begins. Started out of a dream to create equity. So we are a part of the recharge and remodel at Children of Bellevue. Reach out and read where we promote early development and early literacy as a standard part of wild child care. We noticed that the NICU babies didn't have this chance to have access to resources.

00:01:25:27 - 00:01:52:03
Gabriela Jimenez Thompson
So our story begins was born. We wanted to make sure that caregivers knew that their voice was just as important at every point of their child's life, and then a very important part of their child's care. So through nurse education, babies are receiving books at admission every month that they're also receiving care within the NICU and also once at discharge to make sure that they have all the resources they need to make sure that their language and cognitive development is fully operational.

00:01:52:07 - 00:02:02:27
Julie Kim
That's great. And Liliana, from a clinical perspective, what does that critical window of bonding look like in the NICU, and why is that so important to support families during that time?

00:02:03:03 - 00:02:27:26
Liliana Escobar
This is the one that is very important for every newborn, not just for patients. You know, that first touch, that first voice they listened to. It just gets very difficult when the patient comes in the night because you're taking the patient away from the mom. Sometimes they're not able to hold them right away. So how we encourage this in the night is, you know, we offer skin to skin as soon as possible when the patient is stable.

00:02:28:01 - 00:02:44:06
Liliana Escobar
If they're not able to do skin to skin, we offer touch like soft touch for the babies. And now we have the problem I started begins, which is also one thing that parents can do to create that bonding during this critical period.

00:02:44:08 - 00:02:57:09
Julie Kim
That's great. And I see families often feel helpless when they can't hold their baby. So with this program, could you talk a little bit more about the role that it creates to their child's care?

00:02:57:12 - 00:03:23:16
Liliana Escobar
Yes. I think this program allows the parents to be more of a caregiver instead of just an observer. They come to the NICU and they see the nurses, the doctors doing all this medical procedures on your patient and you know, they feel helpless and having a story begin. It gives them a purpose. It makes them part of the plan of care, having something to do and knowing that they can do something for the baby that's going to help them in the long run.

00:03:23:19 - 00:03:36:22
Julie Kim
Back to you, Gabriela. I remember you mentioning the living room language right when talking with the families. So could you tell us a little bit more about what does that mean in practice, and why does it matter in a clinical setting like the NICU?

00:03:36:25 - 00:03:59:26
Gabriela Jimenez Thompson
Absolutely. I think I also will build on the point of this is a very vulnerable time for these parents. They're coming in with new sounds, new like a completely new environment that they've never been exposed to before. They're extremely concerned about their child's well-being, being able to ground them in these everyday routines that they will hopefully do once the baby's discharge of talking, reading and singing to their baby is such a pivotal part.

00:03:59:28 - 00:04:25:27
Gabriela Jimenez Thompson
We also know that babies look for these characters, and that's why we want to bring it back to living room language, because the word that they heard every single day and their mother's womb is something that they're looking for in this environment as well. Living room language is intended to take away the medical jargon, remembering that we are all human beings and sometimes need that human to human interaction to really understand what is going on.

00:04:25:28 - 00:04:45:28
Gabriela Jimenez Thompson
Our story begins give our parents an opportunity to recognize that every single day that you talk to your child, it gives them a point of comfort. There's a lot of medical jargon that will be going on around them, but this gives them an opportunity to remember that their voice does have power. And also if they have questions, they should ask them and also understand what is going on with their child.

00:04:45:28 - 00:04:54:19
Gabriela Jimenez Thompson
I know that a lot of moms will ask about their child's weight, how they're growing, how they're changing, and sometimes it's great to just hear it in everyday language.

00:05:12:01 - 00:05:31:12
Liliana Escobar
You know, in the Nike is the baby is not just our patient. Like the parent is also our patient. So we also have to attend to them, making them feel confident that they can participate in the care of their patient, helping them recognize that, you know they're essential for the baby's care. If we all usually tell them nobody knows your baby more than you.

00:05:31:13 - 00:05:53:21
Liliana Escobar
Right. And we try to create that confidence in them, you know, giving them education, making it, helping them participate in what they can, even if it's just changing a diaper, taking a temperature, knowing your baby stress, learning how to calm him. You know, you might not be able to do any medical, but there's things that your baby needs are very important also.

00:05:53:22 - 00:06:14:09
Liliana Escobar
And, you know, helping them succeed in their care. And then you and, you know, confidence. It takes time to build especially, you know, you get a 25 week or 600 grammar. The parents are scared and it's just having to build that confidence over time, planning everything that we're doing. Why is your baby getting this medication, answering any questions they have?

00:06:14:12 - 00:06:31:19
Liliana Escobar
Helping encourage and participation on rounds every day so they can ask questions just to the nurses, the medical team, every provider and creating that trust with the family. So you know, they feel empowered that they can ask questions and participate every time, every day.

00:06:31:21 - 00:06:55:24
Julie Kim
Super important. I believe that it's one thing to design a program like this, and it's also another to see it actually reach families at scale. So let's talk numbers and impact that this program has had. So to my understanding that our story begins program has reached 72% of all NICU admissions. Gabriella, what does that kind of reach mean for families at Bellevue and what's driven that uptake?

00:06:55:26 - 00:07:23:25
Gabriela Jimenez Thompson
It definitely takes a village to raise a child. You see it every day. And then you from nurses to parents to social workers to like everybody is really considering the importance of these children, making sure that they have all of the protective factors to ensure their success and hopeful discharge. The 72% was people wanting to see these babies have this wonderful interaction with their parents.

00:07:23:25 - 00:07:59:13
Gabriela Jimenez Thompson
It took educating the nurses on the impact of early literacy and child development, specifically neonatal, and it also took a lot of reinforcement and reminders. We've been able to share upwards of 735 books, so it does take a lot of attention to detail, but when you see the atmosphere that it helped create, it's offered a positive moment for nurses to be able to give this book to this family and not necessarily just talk about the medical complexities of their child, but they also just get to relate on a human to human level.

00:07:59:13 - 00:08:28:18
Gabriela Jimenez Thompson
I think the biggest driver of this work has been relational health, especially early relational health of thinking about what do these babies need in order to really thrive? Lifelong. So I think that connection, intention and very calculated research to make sure that this initiative is the most impactful, not just developmentally speaking, but also up to date on all of the latest information that could be available to families.

00:08:28:20 - 00:08:44:21
Julie Kim
That's great. Thank you for sharing that. And a question for you. And perhaps to the both of you, is there a patient or family story that has stayed with you since the launch of this program, one that may illustrate why this work truly matters?

00:08:44:23 - 00:09:15:22
Liliana Escobar
I think the whole program itself has created a change in our unit. How parents and then you. From what I remember, one of our patients who had a very premature baby, very small. At first he was very scared to touch him. You know, we encouraged for her to read as a first thing, to bond. Little by little, she started putting her hands in the giraffe and the isolate, touching the baby until we were able to have her hold the baby for the first time, even when the patient was intubated, on a ventilator.

00:09:15:22 - 00:09:30:20
Liliana Escobar
And even then she, like, let me read the book where we holding the baby? And, you know, that made me feel like so important. Like reading the book really connects the mom, the parents, other family to the baby.

00:09:30:22 - 00:09:51:00
Gabriela Jimenez Thompson
Of course, there was an again, most babies have very complex conditions and sometimes they'll be there for upwards of four months. And there was a family who ended up having a baby who was admitted for six months into the unit. The first book that she got, she did not want to hear anything outside of the fact if her child was going to be okay.

00:09:51:01 - 00:10:14:01
Gabriela Jimenez Thompson
So she was very reserved, didn't really want to think anything else out of this moment. It was extremely stressful, so she just couldn't see forward. By month two and three, she started to actually gravitate towards the books and started to read to her child. And then over time, she actually told me that one of her favorite books, the popular song, was something that she did every single day.

00:10:14:01 - 00:10:30:27
Gabriela Jimenez Thompson
And at the day of discharge, she actually cried to me and she said, this reminded me that I am a mom and I need to show up every day. And no matter how hard it was, this gave me the grounding to know this is just a moment of my child's life, and I will be able to give him all of this loving care afterwards.

00:10:30:27 - 00:11:00:07
Gabriela Jimenez Thompson
As to. And it's my responsibility as a parent to focus on this moment. And she was grateful for the nurses who constantly encouraged her. And for each moment that she was in this stressful headspace, she would allow herself to pull the book out to give herself a break to remember. Although this is stressful, I can remember that I'm bonding with my child, and that's the most important part of this program, is hearing that from families and knowing that in this stressful time, this gave them a chance to just focus on that connection that they're longing for.

00:11:00:07 - 00:11:01:07
Gabriela Jimenez Thompson
Ultimately.

00:11:01:13 - 00:11:22:12
Julie Kim
I know our listeners can't see us right now, but I'm smiling ear to ear to that heartwarming story. Thank you both for sharing that. And I believe there is a chain of events here, right? Or connection that is to be made. And that's the human to human connection being intentional, being consistent. And it's all surrounded with with love.

00:11:22:13 - 00:11:37:03
Julie Kim
It sounds like. And this kind of impact says a lot about where this program is also headed for the future. So before we close I want to out a little bit. So what outcomes right are you hoping to measure as the program grows.

00:11:37:06 - 00:12:05:24
Gabriela Jimenez Thompson
So we're measuring several things. One, of course we want to ensure that every baby gets their books when they're emitted into the NICU alongside their nurse education. But on a larger scope, we're hoping to bring back volunteer readers to make sure that there's this interaction that can happen to everybody, regardless of their parents ability to visit them. And in addition, there's limited gaps of research, actually, to talk about the importance of just vocal infant directed stimulation within the NICU.

00:12:05:24 - 00:12:31:09
Gabriela Jimenez Thompson
And we know that it's very important. Babies get desensitized to hearing all the beep, beep and all the voices talking around them. But we do know that when our voice and our name is called for, we're able to tune into that. So we want to really focus on making sure that the visibility and the importance of these child directed interactions are a standard part of, well, child care and make you care hopefully going forward.

00:12:31:10 - 00:12:46:25
Gabriela Jimenez Thompson
And that's what we're hopeful for, is making sure that resources are available to families, regardless of their native speaking language, and if they need literacy resources that they can be available. If you want to show that storytelling is a powerful tool to help encourage healthy development.

00:12:47:02 - 00:12:59:10
Julie Kim
Great. And the last question here I have for you is if you could leave health care leaders, right, with one message about the importance of health literacy, what would it be? And Lilliana, let's start with you.

00:12:59:13 - 00:13:34:15
Liliana Escobar
Sure, Julie. I think it's just understanding that literacy is not just about speaking simple words. It's making sure that every patient understands their plan of care right now, today, tomorrow. And they feel informed, respected and empower that they can make decision about what their care is. You know, it's not just let me give you a pamphlet that speaks simple language, is making sure that their understanding and everyone is, no matter your background, your education level or your language, and just making sure that this is not just one person job, it's a whole health system.

00:13:34:20 - 00:13:42:19
Liliana Escobar
Just making sure that every person gets that opportunity to feel that empowerment in decision making, in their care.

00:13:42:21 - 00:13:45:02
Julie Kim
Great. Thanks, Liliana. Gabriella.

00:13:45:04 - 00:14:01:02
Gabriela Jimenez Thompson
There's a lot of power and connection and remembering that we are all just human. And sometimes it takes a moment and a present time. I know we always have a long to do list, but spending that extra moment with a family does go a long way. I think one of the most important things to is we want to be proactive, not reactive.

00:14:01:03 - 00:14:21:16
Gabriela Jimenez Thompson
So making resources available to help maybe create a safety net for these families. And if you are able to do so, whether that be giving them information that can help them be prepared for tomorrow, or maybe even something that can help them get through today, it's a very important thing than having to think about the possibility that they're going to be in a situation that they're unable to respond to.

00:14:21:18 - 00:14:39:18
Gabriela Jimenez Thompson
One resource that actually one of my moms told me she's like, please make sure you highlight and share his pathways. Org after discharge, we make sure that families have resources so that they can keep track of their child's development. And if they're noticing something that isn't necessarily up to the typical milestone, they can notify their doctors because they are their strongest advocate.

00:14:39:19 - 00:14:51:01
Gabriela Jimenez Thompson
I think allowing ourselves to remember that our families patients are their own advocates, so we should listen to any concerns that they have and give them the resources proactively to make sure they have all the care they need.

00:14:51:03 - 00:15:11:14
Julie Kim
Very important. Well, Gabriela Liliana, thank you both for your time today. We look forward to the continued success of this program. And to our listeners, we hope that this conversation sparked a question worth asking. What does health literacy look like at your organization? And we'll leave you with that. Thank you so much for tuning in today.

00:15:11:16 - 00:15:20:08
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:03 - 00:00:17:10
Tom Haederle
Welcome to Advancing Health. Health care is both a science and an art. In this podcast, we hear the powerful story of a hospital and a caregiver who wisely recognized that patients and families also play a role in shaping successful care.

00:00:17:13 - 00:00:42:07
Kristin Priehs
Hi everyone. I'm Kristin Priehs, vice president of American Hospital Association and Health Research and Educational Trust, and I am so excited for today's conversation. Today, we're diving into a topic that is foundational to quality in health care, but one that is also evolving quickly: the role of patients and families in shaping care. We often talk about patient engagement and many organizations that are doing incredible work across the field.

00:00:42:07 - 00:01:05:02
Kristin Priehs
But through our work for the Quest for Quality, we're seeing some opportunities to change and advance the field. My partner here today has spent a lot of time with me on the road at site visits across the country, identifying and evaluating Quest for Quality site visits. And it's become clear that there is a significant opportunity to engage patients differently in the conversation and begin partnering with them in the way that care is designed, delivered and improved.

00:01:05:02 - 00:01:33:18
Kristin Priehs
So I'm joined today by someone who brings both a depth of expertise and a powerful personal perspective to this conversation. Caroline DeLongchamps, program director of Patient and Family Centered care at the Medical University of South Carolina Health System. Caroline has spent over a decade leading patient and family care efforts at the system level, and she's also been part of our Quest for Quality work, helping evaluate what leading organizations are doing in practice.

00:01:33:19 - 00:01:45:28
Kristin Priehs
So, Caroline, we're so glad you're here. I'm personally so glad you're here. I've known you personally for quite some time, and I've heard a bit about your journey. Can you share a little bit about the passion that you have for this work and how you got started?

00:01:46:01 - 00:02:08:19
Caroline DeLongchamps
Thank you, and thanks for having me, Kristen. It's a joy to be here. So what brought me to the work is a personal story. My son was 11 months old. I have three boys. My son Sam was 11 months old when he was struck by a car in our family driveway. I was in the front yard with my three and a half year old son, waiting for my eight year old son to get off of the school bus.

00:02:08:21 - 00:02:29:27
Caroline DeLongchamps
Every afternoon was a little bit like a party. All the kids get off the school bus and the parents come and get them, and this day was no different. I went to get the mail out of the mailbox, and when I looked up, I realized that Sam had escaped from his little plastic minivan where he had been playing, and my girlfriend had gone to leave, but she pulled in the driveway to do so.

00:02:30:00 - 00:02:49:20
Caroline DeLongchamps
And so when I looked up, his head was under the front right tire of an SUV. My first instinct was to try and pull him out from under the tires. Unsuccessful. My second instinct was to try and lift the vehicle off of him, which, looking back, doesn't make any sense. But eventually, you know, she got out to see where she was and got back in the car and backed up.

00:02:49:20 - 00:03:09:26
Caroline DeLongchamps
And I only share that to say this wasn't a brief moment in time. It was several moments in time, and we drove to the nearest emergency department where they really couldn't do anything for him except administer oxygen and call for a rig that brought us downtown to the peninsula and to the Medical University of South Carolina. There he was triaged and intubated.

00:03:09:26 - 00:03:35:14
Caroline DeLongchamps
They were ready and waiting for us. He was triaged and intubated. And then I looked around that room and saw tears from several of the folks caring for him, and knew we were in big trouble. Stan presented with skull orbital facial fractures and by frontal contusions and intracranial hemorrhage. He was transferred upstairs to the pediatric ICU. We were separated, and that separation allowed enough time for kind of like, the PTSD to sink in.

00:03:35:14 - 00:03:53:14
Caroline DeLongchamps
And so I could see and hear that you were talking if you were standing in front of me. But I couldn't actually make out the words. And I was scared because I know I was about to get really important information about his life that I quite literally would not be able to understand. And that is exactly what happened. Came out of the back door and she brought my husband and I in, and she left me sitting three feet at the foot of bed ten.

00:03:53:15 - 00:04:11:03
Caroline DeLongchamps
And I did not like his what I saw lying in bed ten. It didn't resemble Sam, but the bedside nurse picked up on what was going on, and she came three feet to the foot of the bed, and she took my hand, and she tucked it up underneath her arm and gave me a fist pump. No words, just a fist bump.

00:04:11:03 - 00:04:32:19
Caroline DeLongchamps
But to me, it felt like that fist pump was saying, I got you. If you even think about going down, I got you. And then she walked to the head of the bed and she said, I need you to talk to him right now. He needs to hear your voice, not mine. I'm only a stranger. And I think that triggered something in my brain that let me know I had a job to do.

00:04:32:20 - 00:04:49:07
Caroline DeLongchamps
And then she said, this blue tube is a ventilator, and it's allowing his major organs to rest while we do the hard work for him. And this little tube coming out of the top of his head is called a ventricular, and we're pulling the blood off of his brain as fast as we can to help alleviate what will certainly be significant brain damage.

00:04:49:09 - 00:05:12:14
Caroline DeLongchamps
And all the while, this nurse, Lisa, was taking care of a critically ill, dying patient while literally and figuratively holding me up with the other one. And I just share that brief story to say that Lisa was the most powerful human being I'd ever met up to that point in my life. This act of taking my hand and tucking it up underneath her arm changed the way my husband and I viewed our role at the bedside

00:05:12:18 - 00:05:33:08
Caroline DeLongchamps
throughout the duration of his care. I knew I had a job to do. This pump engaged my brain in a different way that engaging us and including us in what was going on with him, I really believed, wasn't just a nice thing to do. It really helped change the outcome. I like to think that we had a part of what was ended up being a successful outcome.

00:05:33:08 - 00:05:43:28
Caroline DeLongchamps
He was expected to herniate. We were told he probably would not survive, but he did survive. And I like to think that it was because of the partnership that was created in the moment that he was admitted.

00:05:44:01 - 00:06:12:24
Kristin Priehs
First, thank you for sharing that story. Hearing you go through it is incredibly powerful and personal and that it's led you to the champion that you are for so many others. It's just an incredible asset. So I just wanted to say thank you first and foremost again. I know, after being out in the field with you for now, several years, I've seen some of that passion come through as we're talking to hospitals of all different sizes and types across the country for the AHA Quest for Quality Award.

00:06:12:24 - 00:06:29:24
Kristin Priehs
And I want to pull up one of the last points that you made about it felt like a true partnership, because I think having the patient engaged with hospitals and health care systems at all different disciplines as a partner is incredibly powerful from the example that you shared. So can you talk a little bit now that you're in this field as what that looks like?

00:06:29:26 - 00:06:56:09
Caroline DeLongchamps
I love these site visits. It's been such a gift for me to be a part of this prize committee. The site visits continually remind me that excellence is it doesn't show up in a in a single program or a metric or a presentation. It's revealed in the consistency that we see between what an organization says it values and what we see and what folks actually experience.

00:06:56:09 - 00:07:22:19
Caroline DeLongchamps
And I mean both their employees and their patients and families experience. And so from a patient and family centered care perspective, the question isn't whether or not patients and families are present, or even patients and family advisors are present, but whether they're partners, and that distinction is what I think separates the good organizations from the truly exceptional organizations, because we're getting more mature about this.

00:07:22:20 - 00:07:47:08
Caroline DeLongchamps
A lot of people can say, we have a PFAC, but what are you doing with your Patient and Family Advisory Council? So what's really fun about that is while the committee evaluates strategy and operations and outcomes and process improvement, I feel like my role is to assess whether that the quality is being achieved with patients and families, rather than just for patients and families.

00:07:47:12 - 00:08:15:03
Kristin Priehs
That's perfect. And having seen so many hospitals that are on their own Quest for Quality really listen to you and your own perspective on these site visits, I think has been groundbreaking. You have been such an advocate for how this field is evolving and going beyond patient and family engagement, and PFAC specifically into a much deeper partnership. I'd love to hear from you, because we talk so much about quality roles all the way from the board to the bedside, where you're seeing leadership engagement, specifically in patient engagement.

00:08:15:03 - 00:08:24:15
Kristin Priehs
And how do hospitals do that sustainably as they have new leaders that come on board or as leaders are really developing what their patient engagement strategy looks like and patient partnership.

00:08:24:18 - 00:08:45:03
Caroline DeLongchamps
You can put anything on paper, but it's different when you see it in action. And what I look and listen for is are they talking about it? Are they talking about patient and family centered care? And again, not just patient engagement. The terminology "patient engagement" is funny to me because it sounds to me like it means the patient is supposed to do something.

00:08:45:04 - 00:09:14:21
Caroline DeLongchamps
The patient is supposed to engage in their care? And it's not the patient's responsibility. It's our responsibility as a provider, as a health care system, to lean in, not to sit on the trash can in the room and say, what's your favorite color? What did you do this summer? But to meaningfully and intentionally lean in and ask questions. I'm constantly distinguishing in my organization at least, the difference between patient and family centered care and patient and family advisory councils, and those get used interchangeably a lot.

00:09:14:22 - 00:09:36:15
Caroline DeLongchamps
Patient and family center care is the culture of creating these mutually beneficial partnerships, not just what's good for patients and families. It has to work for providers and others as well. So we can we can partner in the in the delivery of care. So how do we do bedside shift report and physician rounds and how are our leaders holding us accountable for those things that make us a patient and family centered care organization?

00:09:36:15 - 00:10:02:13
Caroline DeLongchamps
And then how do we partner with patients and families in the planning and evaluation of care? And that's where your patient and family advisory councils come in. And again, anybody can have a patient and family advisory council. But how are you utilizing your PFAC, or Patient and Family Advisory Council? And it can be a grassroots effort. It was a grassroots effort in our organization for quite some time, but at some point it has to be it has to come from leadership.

00:10:02:13 - 00:10:20:25
Caroline DeLongchamps
They have to talk about it. They have to utilize it. They have to cascade it to their leaders and make sure that folks are utilizing that. Because to create effective councils, it can't just be bringing the patient perspective in. And that's where I think my voice is helpful or my ear is helpful on some of these site visits

00:10:20:25 - 00:10:47:20
Caroline DeLongchamps
is that - sure you have a council. How are you orienting them to the organization? So they're bringing their patient perspective, but it's really your job as an organization to add layers to that perspective, to help teach them who you are as a health care system so that they can become effective advisors. So you're really adding on to that perspective so that they can inform you about what's next.

00:10:47:26 - 00:11:07:02
Kristin Priehs
I love that, and as we think about leadership specifically, there's a lot that leaders are handling right now. And at the core of it should and always is patient care. And I know one of the things that is a very deep conversation and an evolving one is around the role of technology in patient care. Patients have more information at their fingertips than they ever have.

00:11:07:08 - 00:11:29:15
Kristin Priehs
We're now seeing how predictive analytics and AI and EHR coordination, virtual care is all evolving quickly. So can you tell us from the patient centered care perspective, with the patient being a true partner with hospitals and health care systems, how is technology evolving to ensure that they are true partners at the table and decisions that affect their care?

00:11:29:18 - 00:11:52:24
Caroline DeLongchamps
It takes me back to an example that came out of Covid, which I'm not equating Covid to AI, but what happened during Covid is we had a leader in our organization say, wow, things are changing rapidly right now and we are going to make mistakes. I am certain of that. But in order to course correct very quickly, the monthly PFAC meetings are not enough.

00:11:52:24 - 00:12:14:20
Caroline DeLongchamps
I want to make sure I'm engaging with patients and families on a regular basis. So he set up weekly calls with our members of our Patient and Family Advisory Council just to make sure he knew what was happening on the front line. And he heard from a parent who said, I brought my child in for a Covid test in preparation for a heart cath, and we were separated.

00:12:14:22 - 00:12:35:03
Caroline DeLongchamps
And I understand the reason for the separation. I have heard that in PFAC meetings,  you guys have educated me about - we're trying to reduce the risk of transmission of this very scary virus. But I live with my daughter, and if I'm willing to assume that risk, I can help reduce the risk to one of your very precious, precious nurses who we really need to come back to work tomorrow.

00:12:35:06 - 00:13:07:19
Caroline DeLongchamps
That was a really important example because we changed a policy immediately following that. So I think when it comes to AI, it's important to remember that patients and families are not the end users of AI. They are the stakeholders. So if you're establishing AI committees or you're working on things about what this is going to look like for your organization, embed your patient and family advisors on those teams at the beginning before the decisions are being made, so that they're a part of that, so that they're partnering with you and that you're building trust.

00:13:07:19 - 00:13:22:02
Caroline DeLongchamps
And that's what AI is supposed to do. It's supposed to reduce burden. If AI is creating time for providers so that they can have face to face conversations, build trust and create connections, then we're on the right track. But if it's not doing that, then we're missing the mark.

00:13:22:06 - 00:13:41:15
Kristin Priehs
Well, we're certainly not missing the mark when it comes to you being on the Quest for Quality committee. So thank you for that. This is, as always, been one of the most energizing and thoughtful conversations that I've had. I thank you again for sharing your history and your story and where you see patient engagement and partnership going, because I think the field will always have a lot to learn from you.

00:13:41:20 - 00:14:05:04
Kristin Priehs
One of my biggest takeaways is that the work is not about checking boxes. It's so much more about having the right structures in place, the right leadership, and really ensuring we're creating cultures where patients, families and caregivers are truly partners in designing care. And health care continues to evolve, especially with new technology and innovation. The opportunity is really in being intentional about bringing those voices into the process from the start.

00:14:05:04 - 00:14:23:20
Kristin Priehs
And for those listening, I really encourage you all to really think about how patients are being engaged in your own organization and move beyond engagement to true partnerships in meaningful way that continue to improve care. So, Caroline, thank you so much for your leadership and for sharing your perspective with us today. And thank you to all of you for listening.

00:14:23:20 - 00:14:25:24
Kristin Priehs
We will see you next time.

00:14:25:26 - 00:14:34:19
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.

00:00:00:07 - 00:00:18:25
Tom Haederle
Welcome to advancing health. Healthcare and the state of medicine in general has made remarkable progress across many fronts in the past couple of decades. Delivering to patients on all that potential and promise is a separate challenge, one that Jefferson Health is tackling head on.

00:00:18:27 - 00:00:39:24
Chris DeRienzo, M.D.
Thank you, everyone, for joining us on another episode of Advancing Health. I'm Dr. Chris DeRienzo, AHA's chief physician executive, and today I get to talk to someone I have known for 20 years. We were kids together in medicine way back in the day. Today, he's the president of Jefferson Health. Baligh, thank you so much for joining the podcast.

00:00:39:26 - 00:00:43:20
Baligh Yehia, M.D.
Thanks, Chris. It's great to be with you and good to see you again.

00:00:43:21 - 00:00:56:26
Chris DeRienzo, M.D.
Always, my friend. We know that Jefferson Health has gone through a lot of evolution in the past few years. I want to start by asking you to tell us a little bit about the various communities that you serve and about Jefferson Health.

00:00:56:28 - 00:01:28:16
Baligh Yehia, M.D.
Jefferson is going through a lot of changes, but it's been around for more than 200 years. And the exciting parts about Jefferson are we bring together 200 plus year university, medical college, nursing, all the health professions, as well as a really robust undergrad program with the health system that's now 33 hospitals across eastern PA and southern new Jersey, and a health plan with more than 400,000 covered lives, primarily in Medicaid, Medicare Advantage, and ACA.

00:01:28:16 - 00:02:07:09
Baligh Yehia, M.D.
And that's the special thing about Jefferson and why I love the work that we do, is really how do you connect the academic and research mission with the clinical care and also the payer side. And it creates for unique opportunities. Just last year, we hired about a thousand individuals that graduated from our university into the health care system. Pipeline programs, whether it's nursing or pharmacy or all kinds of different technologists, being able to actually train at the university and then be able to work in the health system is a great way to keep people in the community and also to provide upward mobility.

00:02:07:09 - 00:02:28:10
Baligh Yehia, M.D.
And then similarly, on the health plan side, we overlap on thousands and thousands of patients and thinking about how we can deliver a better care in the context of value. And that stuff is really, really exciting. It's that intersectionality between those three different areas where we see some uniqueness that maybe isn't seen in other health care systems.

00:02:28:16 - 00:02:51:06
Chris DeRienzo, M.D.
We know that with that kind of great opportunities, there are also challenges that health systems face. It is not an easy operating environment, and especially as a health system that is growing and is continuing to integrate across all of your operating areas and the communities that you serve. What would you tell listeners are some of the biggest challenges that you, as the president of that health system, are trying to solve today?

00:02:51:08 - 00:03:21:09
Baligh Yehia, M.D.
You know, for us, there's probably a few that come top of mind. I think health care is changing very rapidly in some ways amazingly exciting. When you think about the type of therapies that are coming down the pike, when you look at immunotherapies, gene therapies, things that we weren't even thinking were possible 5 or 10 years ago. You know, we're doing treatments for sickle cell disease that if you've ever taken care of someone or had it yourself, very challenging, hard condition.

00:03:21:09 - 00:03:49:17
Baligh Yehia, M.D.
And now there's a way that you can actually live without having any of those complications. I mean, that's pretty amazing. Very different than when I trained as a resident. Similarly, all the technology changes that are happening. So there's that context of how do we adapt to changing technologies and changing therapies. But across that is really this bigger and bigger divide between what it costs to deliver care and then what you get paid to deliver that care.

00:03:49:18 - 00:04:12:12
Baligh Yehia, M.D.
And that's what I see in general as one of our biggest challenges, particularly in Pennsylvania and in southern new Jersey, where, you know, our imperative is deliver high quality, high value care. But every day it seems like there's different type of policies coming out from payers. It seems like there's a lot of challenges from pharmaceutical companies for different programs.

00:04:12:12 - 00:04:32:12
Baligh Yehia, M.D.
And, you know, that's one of the things that I think a lot about is how do we make sure that we close that gap between what it takes to make sure that we deliver exceptional care and take care of our employees and support the communities, while at the same time knowing that there's revenue issues that come from both federal, state and commercial payers.

00:04:32:14 - 00:05:09:27
Chris DeRienzo, M.D.
It's certainly a challenge that's faced in Pennsylvania and in in health systems across the country. You described a multi-part mission given Jefferson Health's academic mission, your research mission, your community mission. We had conversations with a few other physician leaders a couple of months ago, actually, about how to bridge those massive novel innovations on the research side. Gene editing therapies with the functional challenge of implementing in largely a community health system, because while we have these academic centers, most of health care is delivered in community hospitals and in practices across the country.

00:05:09:27 - 00:05:33:16
Chris DeRienzo, M.D.
So given the footprint that you described and the impressive amount of infrastructure that Jefferson has, what are you doing to meet that? The challenge not only of ensuring sustainability of operations, especially in communities that otherwise may not have access to care, but also to bring that leading edge innovation as far out to people across the states that you serve.

00:05:33:19 - 00:05:56:10
Baligh Yehia, M.D.
You know, I think that's like a critical question. And, you know, at the heart of it, it comes down to access. And here at Jefferson Health, we have a bold goal to be the most accessible system in our region and ultimately in the country. And when you think about our footprint of hospitals and clinics, as I mentioned there's 33 of them, but we don't do every service at every single location.

00:05:56:10 - 00:06:22:19
Baligh Yehia, M.D.
And so then the question becomes, how do you reach people in rural communities, which we serve in the middle of the state to highly urban communities like in Philadelphia? And that's the power of being part of a network. And so for us, as we think about how we evolve and change, it's really around our service lines and our clinical programs, and we've challenged our teams to think differently about access.

00:06:22:19 - 00:06:45:21
Baligh Yehia, M.D.
And I'll give you an example. One of the most challenging diagnoses you can get or give to a patient if you're a caregiver is one of, hey, we think you might have cancer or we're seeing something that doesn't look right. Typically, then you go and have to get different tests and find appointments. And during that time period, there's a ton of worry. There's a lot of uncertainty and concern

00:06:45:21 - 00:07:12:26
Baligh Yehia, M.D.
and so we've pushed our team and said, how do we remove that? And we created a program our same day, next day cancer program. We're actually able to see new cancer diagnoses within 1.4 days at Jefferson. And it's mostly virtual. It extends into the evening hours as well as on Saturdays. And we're able to provide some comfort and most importantly, take away some of that uncertainty about what's the next step and where do we go from here.

00:07:12:26 - 00:07:32:07
Baligh Yehia, M.D.
And when we first talked with a team, it seemed almost impossible, like, how can you actually do that? And we worked to create the right model. We set it on top of our clinics versus trying to embed it in the clinics. And that's been widely, wildly successful. And we've seen many patients go through that program, more than 2000.

00:07:32:12 - 00:07:52:04
Baligh Yehia, M.D.
We've seen a faster time to chemotherapy and surgery. And as I said, there's that intangible piece of mind that comes. And so we've been asking each of our different services to think about things like that. How can you push differently? Our virtual primary care program, which now represents more than 10% of all of our primary care visits -

00:07:52:04 - 00:08:14:16
Baligh Yehia, M.D.
we have to double the program because of the amount of interest in it. And then we also have home based care where we're actually getting into people's homes to help provide that. So I think when it gets to these novel therapies, I think virtual is our friend. And the concept of being able to rotate clinicians, be able to meet people where they are in their communities is really, really important.

00:08:14:16 - 00:08:36:04
Baligh Yehia, M.D.
That's something that's really exciting around being part of a network like Jefferson is whether you're in Schuylkill County or in the Poconos or in Scranton, you can enroll in our clinical trials that are coming out of Philadelphia or out of Allentown. Or you can get access to a world class and novel therapies that wasn't available to those communities before.

00:08:36:04 - 00:08:52:07
Baligh Yehia, M.D.
And it's really about connecting the dots through that system. So, you know, access continues to be something that we've talked about for decades now, and it's something that we'll continue to work on. But I think we're making some head away here in some of the programs we've developed.

00:08:52:09 - 00:09:17:12
Chris DeRienzo, M.D.
Well, given as long as I have known you, it is no surprise to me, Baligh, that if I were to summarize what I just heard, in short, it's meeting an intersection of innovation and implementation. I was on a very special episode of this podcast recently with three of the coolest physicians not named Baligh Yehia in America. That was with Jackie Gerhart from Epic, Tom McGinn from CommonSpirit and Zia Ager from the West Health Institute.

00:09:17:12 - 00:09:48:01
Chris DeRienzo, M.D.
And we were trying to envision what our profession looks like in 20 years as we walk through this era of AI enabled technology change. And one of the things that came up, you just reinforced, which is sometimes we can think about access differently. If I think about the patients who I remember seeing in pediatric residency, newly diagnosed cancer, there's a subset of those patients who it's truly an ontological emergency, and they have to be admitted to a hospital immediately.

00:09:48:08 - 00:10:10:19
Chris DeRienzo, M.D.
Perhaps they have something like leukemia and they're in a leukemic crisis. But for many of them, what they need first is a conversation. And we know that there are ways that we can enable those conversations with an expert in the field to talk me through what happens next. That doesn't require a hospital stay. It may not even require going to the E.R. or coming to an office.

00:10:10:20 - 00:10:27:19
Chris DeRienzo, M.D.
And as we enable clinicians to deliver care and to use their expertise at the top of their license in different ways, we can solve for access differently. And so the next question I typically ask guests, how's it going? It sounds like it's going pretty darn well.

00:10:27:21 - 00:10:48:13
Baligh Yehia, M.D.
Yeah. And I think like I said, it's an issue that's been facing medicine for a long time. And it's multifactorial. We talk about physician and nursing shortages. We talk about disparities in care and how do you get access to treatments in one location to another. And so, you know, those still exist. But we are making progress.

00:10:48:13 - 00:11:10:22
Baligh Yehia, M.D.
And I think that's really exciting when I hear stories of individuals that might not be able to access novel therapies. You know, we just started a new program where we're screening for cancer in the ERs. And one of my colleagues sent me a note last night. The program just started. We've scheduled 80 colonoscopies. We've had four done.

00:11:10:22 - 00:11:30:03
Baligh Yehia, M.D.
And one of them, we've diagnosed someone with a mass already. And that's someone that probably was not seeing primary care. Came into the air for something different. It's not an emergency. So typically E.R. doctors and teams are not screening for cancer. And so it's things like that that in my mind are being able to meet people where they are.

00:11:30:04 - 00:11:56:28
Baligh Yehia, M.D.
It sounds very simple, but that's an example. They're there waiting to be seen or in the room, and our team is able to talk to them and then evaluate them, get them scheduled and go from there. And the other cool thing is that that patient was a member of a health plan. And so that's kind of neat where you see win, win, win for most importantly, helping the patient and their family, providing better care and then also improving the lives of those in our health plan.

00:11:57:01 - 00:12:18:25
Chris DeRienzo, M.D.
We have time for exactly one more question, and I'm torn because again, we've known each other for 20 years. And there are a lot of things that are just as true then as today. But I'm going to have to pen that question for another time, because what our listeners tell us they most appreciate about our podcasts are we get to talk to fascinating people like you.

00:12:18:27 - 00:12:46:06
Chris DeRienzo, M.D.
And some of them come from academic systems, some from community systems, some are investor owned or nonprofit or public health systems. And the biggest question that they always want to know is, it's amazing that you're doing this great work at Jefferson, but what advice would you give to me if I'm running a critical access hospital in Mississippi, or I'm at a small academic health system in Oregon? You know, you're doing this amazing work at the intersection of innovation and implementation to expand access.

00:12:46:06 - 00:12:49:28
Chris DeRienzo, M.D.
What first step should I be taking back home?

00:12:50:01 - 00:13:12:08
Baligh Yehia, M.D.
You know, I think that's beautifully said and asked is that, you know, we serve so many diverse communities, so different settings across this great country. And so for me, I would say be curious. Because there isn't really just a playbook that you can lift and shift. Maybe there's a baseline that you can start with that has to be adapted.

00:13:12:08 - 00:13:43:08
Baligh Yehia, M.D.
But be curious. Ask patients, ask your patient family advisory councils, talk to your frontline staff. And again, it sounds basic, but that's what we do. And that's how we learn and make sure that as we deploy and implement programs, it actually sticks. And that's the one thing we are so prone, I think, to help. And sometimes that comes in the form of solving very quickly and taking time to really sit with the problem that you're trying to solve, understand the problem you're trying to solve.

00:13:43:09 - 00:13:59:12
Baligh Yehia, M.D.
Talk to people about it. That planning, that discovery, that being curious goes a long, long way to executing on something that is efficient and that actually achieves what you're trying to achieve. So that's what I would say is just stay curious.

00:13:59:16 - 00:14:22:28
Chris DeRienzo, M.D.
Very well said. If I've learned one thing in nearly four years at the age, and I've been to every conceivable kind of hospital in every conceivable kind of community in this country, it's while the role of hospitals look different from community to community, because every community is different, that connection points and understanding of this is where I can best support my community needs is a common thread throughout.

00:14:23:01 - 00:14:33:07
Chris DeRienzo, M.D.
As expected Baligh, it has been so much fun catching up with you. Congratulations on all the amazing work happening up in Philly and across your region. And thank you again to listeners for tuning in.

00:14:33:14 - 00:14:35:20
Baligh Yehia, M.D.
Pleasure. Thanks for having me.

00:14:35:22 - 00:14:44:18
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:03 - 00:00:15:28
Tom Haederle
Welcome to Advancing Health. The evolution of Age Friendly health initiatives continues to spread across our health care landscape. In this podcast, we learn more about how to plant them deep, help them grow and measure their success.

00:00:16:01 - 00:00:41:07
Marie Cleary-Fishman, R.N.
My name is Marie Cleary Fishman. I'm a senior advisor to the president of Health Research and Educational Trust. Nurse by birth at this point in life and really happy to be here to talk with these great folks this morning from Northwell Health. And we are going to have a conversation around large scale initiatives such as Age Friendly and implementing that within a hospital or health care system.

00:00:41:07 - 00:01:07:27
Marie Cleary-Fishman, R.N.
And it can also apply to other patient safety initiatives that you or your organization might be working on. So I am honored to welcome our guests today. We have Michele Frankel, who is the regional CFO, chief financial officer. And then we have Susan Kwiatek, who is the vice president of Aging and Supportive Care and also in charge of the Institute for Healthy Aging.

00:01:07:28 - 00:01:29:24
Marie Cleary-Fishman, R.N.
So I'm going to turn to Michele and Susan, and I'm going to ask you to introduce yourself. Tell us a little bit about your roles, because they are so, so special in your organization. And then we'll go on and have a little bit of discussion about the things that you have found to be such priorities and that have really helped you be successful.

00:01:29:24 - 00:01:31:25
Marie Cleary-Fishman, R.N.
So, Michele, do you want to start?

00:01:31:26 - 00:02:11:01
Michele Frankel
Sure. Thank you for having me. I'm Michele Frankel. I'm currently the deputy market president for the eastern market of Northwell Health, which encompasses eight hospitals and a couple of hundred ambulatory practices. But for the majority of my career, I've been in a variety of finance roles and most recently, the regional CFO for the eastern market. In that capacity, responsible for managing the budgets of these institutes and implementing strategy and business plans to support the strategy in order to ensure that we are able to provide the services to the communities that we serve.

00:02:11:01 - 00:02:21:13
Michele Frankel
And I've been lucky enough to be involved in many big scale initiatives, one of which was the Institute for the Aging and expanding that initiative across our organization.

00:02:21:15 - 00:02:25:13
Marie Cleary-Fishman, R.N.
That's great, Michele. Thank you. Susan, would you like to do the same thing?

00:02:25:15 - 00:02:43:09
Susan Kwiatek, DNP
I'm Susan Kwiatek. I'm the VP for Aging and supportive Care. I'm a nurse by background, and I have been working in the Age Friendly space since 2019 and more recently in the Institute for Healthy Aging that we recently launched last year.

00:02:43:12 - 00:02:58:15
Marie Cleary-Fishman, R.N.
So you've both mentioned the Institute for Aging. Let's start just by having a bit of a conversation about how that came to be, who started, who brought it in, and how did how did it get brought to life in your organization?

00:02:58:20 - 00:03:36:13
Susan Kwiatek, DNP
So when we began this work in 2019, we began by rolling out the IHI 4M framework. And as we rolled this out from hospital to hospital and standardized practices, we quickly realized, and when I say we, the executive leadership and in particular, Dr. Maria Carney, who was our chief of the Division of Geriatrics and Palliative Care at the time. And she really had this vision that we have to back this up to healthy aging, and that we also need to expand our efforts to caregivers.

00:03:36:13 - 00:03:49:08
Susan Kwiatek, DNP
And that really is what gave birth to the recognition that we need an aging institute so that we can really cover caregivers and cover healthy aging as well.

00:03:49:13 - 00:04:12:08
Marie Cleary-Fishman, R.N.
And that's a great example of how the C-suite and leaders were involved from the very beginning. So I think that's important. Michele, I'd just like to call out a little bit and ask the question about what involvement the CFO, either you or local CFOs, what kinds of responsibility or involvement did they have in bringing the Institute for Aging to life?

00:04:12:14 - 00:04:45:04
Michele Frankel
So once the journey started, Susan had reached out to me for support in putting quantitative metrics around the return on investment on this initiative. And we worked closely together on the types of metrics that would be a result of this initiative, of which included reduction in length of stay, reduction and falls, reduction in readmissions. However, when Susan and I spoke, thankfully we had a long history together of working together, so we knew how we needed to get to where we wanted to go.

00:04:45:06 - 00:05:22:01
Michele Frankel
We recognized that there were multiple initiatives going on in the health system that impacted all those very same metrics, so we had to really narrow down the population of who we were looking at to compare those specific metrics relative to the patient demographic and diagnoses that these patients had. So Susan and I worked together with our back end data analytics and finance team to pull the data in the right way and to begin to show the first site where we rolled this out, the improvements that were had and to tie dollars to them.

00:05:22:07 - 00:05:50:18
Susan Kwiatek, DNP
So we've done this analysis three years in a row, and we've seen the same trend with the top three DRGs. And that is reductions in length of stay for sepsis, for respiratory infections and for heart failure and shock. We were able to then put what the cost avoidance is for the length of stay reductions in all of those three DRGs. And then it also frees up beds.

00:05:50:18 - 00:05:53:25
Susan Kwiatek, DNP
So it also contributes to efficiency.

00:05:53:26 - 00:06:23:04
Marie Cleary-Fishman, R.N.
It's great, I hear those steep criteria being brought in there safe, effective, efficient, equitable, patient centered and caregiver centered care. So I think that's very exciting. So you two have a really strong connected relationship between a clinical role and more of a finance or marketing engagement kind of role. And I'm just curious like what's the what's the glue that really keeps pulling the two of you back together

00:06:23:04 - 00:06:28:03
Marie Cleary-Fishman, R.N.
in this kind of work, because I think that there's something special there.

00:06:28:06 - 00:06:52:08
Michele Frankel
As I mentioned, my history in this organization is in finance, and I'll say that the majority of it up until 2008 was in what I'll call back end finance, you know, really, you know, churning out numbers and analysis, not in hospitals, not face to face with where the patient care is being provided. And my first job in a hospital was where Susan at the time was the chief nursing officer.

00:06:52:08 - 00:07:29:18
Michele Frankel
And I went in as the site CFO, and I had never worked inside of the hospital before. So I had a lot to learn, and I really learned all I know about nursing in a hospital from Susan. And Susan eventually became the president of that hospital as well. So we worked very closely together, you know, not just on budgets every year for the hospital, but on new programs and new initiatives and how we would build up business plans to support what the hospital was trying to accomplish, whether it be for a new program or for efficiencies and cost savings without compromising care.

00:07:29:22 - 00:07:58:03
Michele Frankel
And I think that the glue for Susan and me, and in general whenever we're working on a project, is that finance and clinical and operations, we all need to work very collaboratively together and really listen and hear from the other parties what is needed. And then the finance person can help translate that into a business plan to advocate and get, you know, the mission accomplished in a cost effective way.

00:07:58:06 - 00:08:00:21
Marie Cleary-Fishman, R.N.
Susan, anything you want to add to that?

00:08:00:24 - 00:08:30:00
Susan Kwiatek, DNP
We really learned to speak each other's language. So Michele took the time to learn all about nursing, whether it was nursing, physical therapy, dietary, radiology. She really took the time to learn what it really takes for those departments to operate efficiently. And I learned from her how we really can work with the finances to make the staffing plans effective.

00:08:30:02 - 00:08:48:03
Marie Cleary-Fishman, R.N.
I mean, you're getting it the idea there of walking in each other's shoes, right? Not just doing your part and walking away, but really figuring out what is it that makes the other person tick, what do they need? And if we want to use the 4Ms, we can say what matters to each of you, right? You've taken the time to find that out.

00:08:48:03 - 00:09:16:09
Marie Cleary-Fishman, R.N.
And I think that's really important because everything else goes through that lens. So living what we're practicing, right? And that's really, really important. How are you continuing to keep the board of trustees engaged in this activity? It sounds like they've been very involved and very supportive. How are you keeping that spirit going and that alive, so that you continue to get the support needed for this work?

00:09:16:14 - 00:09:44:21
Susan Kwiatek, DNP
First of all, the board is very involved and very engaged in knowing what our metrics are. What's our patient satisfaction? What are our quality issues? What's happening at each of the hospitals? And we're accountable to report metrics up to the board. An example that I can give you is that we've really been reducing length of stay, reducing readmissions, increasing the patient satisfaction.

00:09:44:21 - 00:10:29:11
Susan Kwiatek, DNP
And in several of our hospitals, in the patients age 65 and older, we know that we've always done well with patient satisfaction, but not so much in the older population. So we've really put a focus there and we're seeing those scores improve as well. We also have hospitals and one in particular, the example, the early adopter that started out by implementing the 4Ms started out with niche recognition, which they're at exemplar now, magnet with distinction, geriatric emergency department accreditation at the gold level and then to the Baldrige Award at the national level.

00:10:29:12 - 00:10:37:15
Susan Kwiatek, DNP
So this is really all examples of what the board wants us all to strive for and looks closely at.

00:10:37:19 - 00:10:58:12
Marie Cleary-Fishman, R.N.
Well, congratulations on all those achievements. And that's a great success. So thank you for sharing that. Let me ask a question about front line engagement. Can you tell me how does the frontline get to experience the involvement of the board or the C-suite? How does that get to the folks that are actually doing the hands-on care?

00:10:58:14 - 00:11:25:06
Susan Kwiatek, DNP
So I think there's a lot of communication upward and downward in our organization. The frontline staff know that the board is looking at dashboards, and they also know that the board is approving budgets. All budgets go to the board on an annual basis, and I know that they feel it in this way as well because the involvement is there.

00:11:25:07 - 00:11:37:21
Susan Kwiatek, DNP
Also, there was an aging summit that was held, and there were people from all levels of the organization invited to that summit, and we had board members present for that.

00:11:37:27 - 00:11:45:18
Marie Cleary-Fishman, R.N.
Oh, that's great. That's a nice another nice idea of how to engage folks and get them to meet each other. So that's terrific.

00:11:45:25 - 00:12:14:25
Michele Frankel
And I'll just add to Susan's point is the way our organization is structured lends itself to the vertical communication. We're a very large organization. We span a pretty large geography. But in terms of the mission and the priorities and rolling out initiatives, we have a structure in place that goes regionally market based geography. And then within our market structure, then we have a way to communicate to our hospitals.

00:12:14:25 - 00:12:38:16
Michele Frankel
And then within each hospital, there's a communication pathway down to all the frontline workers, clinical and non, many times together. And then in addition there's rounding that goes on the floors on a regular basis of senior leadership, both from the hospital and the market and the system to, you know, ensure that everybody is engaged and sing from the same song sheet.

00:12:38:17 - 00:12:43:01
Michele Frankel
So there are many mechanisms of communication vertically.

00:12:43:03 - 00:13:03:16
Marie Cleary-Fishman, R.N.
That really gets to the issue of culture, right? And how you have alignment. The other thing that it gets to which, you know, my colleagues all laugh at me is I frequently say structure plus process gives us outcome, right. So you have structures in place and then put those processes. But that's I think that's a really important point.

00:13:03:16 - 00:13:21:25
Marie Cleary-Fishman, R.N.
And if we're missing that structure we may have all the processes in place. But if we don't have structure which can mean staffing the right people in the right place, the right equipment, all of those things, then we can do all we want with process, and we're still not going to quite get to our outcomes. So really important point.

00:13:21:26 - 00:13:51:18
Susan Kwiatek, DNP
To that up/down process that Michele just described - but for Age Friendly, we have a specific process for Age Friendly as well. We have our Age Friendly teams at each hospital. The steering committees are the executive leadership of each hospital. And then the Age Friendly teams have people that report into a collaborative care council, where they are sharing best practices and presenting on them and presenting their PDSA cycles.

00:13:51:18 - 00:14:03:03
Susan Kwiatek, DNP
And then that committee has a leadership that reports to executive leadership of the health system. So it's really a robust process.

00:14:03:06 - 00:14:28:02
Marie Cleary-Fishman, R.N.
So I'm going to ask one last question. And that is, if you were with another organization, what would be one action item that you could say to the leaders of another organization? If you do this, you know you will find success with the work you're doing. And I know narrowing it down to one is kind of tough, but what would be that really important

00:14:28:02 - 00:14:30:20
Marie Cleary-Fishman, R.N.
one thing that you'd like to say to folks?

00:14:30:22 - 00:14:56:21
Michele Frankel
I think that no matter what you're trying to accomplish in an organization, it requires a wide array of experts in different parts, whether it be clinical, operational, financial, board level, executive leadership. And I think that everyone has to recognize that they need to listen and learn from the rest of the stakeholders to really understand the what, the why.

00:14:56:21 - 00:15:14:14
Michele Frankel
And then we can all work together on who and how we get things done to achieve what we're trying to achieve. And I think, you know, even though we're such a large organization, we have pockets of experts in all of these arenas. And if you leverage all the right people, we can really accomplish anything.

00:15:14:21 - 00:15:16:28
Marie Cleary-Fishman, R.N.
Well said. Susan.

00:15:17:01 - 00:15:33:12
Susan Kwiatek, DNP
I would say that Age Friendly is a team sport, and every discipline in the health care organization needs to be involved, since that's really along the line of what Michele said. The icing on the cake, then, is when you have leadership support.

00:15:33:14 - 00:16:01:20
Marie Cleary-Fishman, R.N.
Well, congratulations on all the great work that you're doing, that you've done and continue to do. We've talked about some really important concepts here that everybody should think about. Age Friendly implementation doesn't happen in a silo, just as both Susan and Michele said. And I think that if we really want to engage this and, and make it part of the culture, and we have to think about those things, we have to think about governance and the involvement there.

00:16:01:20 - 00:16:28:02
Marie Cleary-Fishman, R.N.
It's really, really difficult to move a large scale initiative like this forward without that governance engagement. And then and that includes, of course, the C-suite as well, engaging with the board. So that's really critical to the success. I think the other thing we talked about today a little bit is system design, right. You need to be conscious and think about how are you putting your system together, how does that work in your organization.

00:16:28:02 - 00:16:53:15
Marie Cleary-Fishman, R.N.
And that builds on culture. I think that's really important. The next is the care delivery, and that's really where the 4Ms come into play. And that's a care model for taking care of folks that are aging. In the 4Ms work, it is 65 and older. But as we think about aging, this model, when we talk about the things can be used for any other large scale initiative that might be a care model as well.

00:16:53:15 - 00:17:18:07
Marie Cleary-Fishman, R.N.
So thinking about the care delivery system and then acknowledging and thinking about what is the performance improvement methodology used in the organization. We don't have to be prescriptive about that. We know that our members across the nation use lots of different models, high reliability, PDSA, all different things that they can use. And so it's fine for them to use that model. And then to involve the patients and the caregivers,

00:17:18:08 - 00:17:43:26
Marie Cleary-Fishman, R.N.
right? That's critical because all of this is work being done to improve life. And we really thank Northwell Health for the amazing work that you've been doing, and specifically to Michele and Susan for their great teamwork and the example they've been able to share with you today. If you're interested in getting involved in Age Friendly, please go to the AHA Age Friendly website and you can sign up for the Action Communities.

00:17:43:26 - 00:18:12:09
Marie Cleary-Fishman, R.N.
Those are free. There's no cost to them. Both the American Hospital Association and the Institute for Healthcare Improvement share the action community activities. We do one that starts in the fall. The Institute for Health Care Improvement starts theirs in the spring. They are the same. We stay very closely aligned so that the members can make their choice based on their strategic plan and what timing works best for them, so please consider joining one of them.

00:18:12:12 - 00:18:24:20
Marie Cleary-Fishman, R.N.
We have lots of case studies and information on the website, and certainly you will see Northwell there. Thank you so much for your time today and for all that you do.

00:18:24:22 - 00:18:33:12
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.