Advancing Health Podcast

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.

00:00:00:28 - 00:00:22:08
Tom Haederle
Welcome to Advancing Health. Practice makes perfect, the saying goes. And that's true in many things: sports, music and medicine too. In this podcast, we explore the shared commitment between Laerdal Medical and Advocate Health to advancing patient safety through the power of simulation.

00:00:22:10 - 00:00:52:13
Chandler Carter
Hello, and welcome to Advancing Health. I'm Chandler Carter, program manager at the American Hospital Association, and today I'm excited to be joined by Kelly Sabah, associate vice president of simulation at Advocate Health, as well as Brian Bjorn, patient safety manager at Laerdal Medical. We're so glad to have you both with us today. Your perspectives on simulation and patient safety, clinical quality and workforce readiness are incredibly valuable, and I know that our listeners will benefit from hearing your perspectives.

00:00:52:15 - 00:00:58:20
Chandler Carter
To start us off, I'd love to learn a bit more about your backgrounds in simulation. So, Kelly, why don't we start with you?

00:00:58:23 - 00:01:05:13
Kelley Sava
Sure, absolutely. So before we get started, I just want to say happy healthcare simulation week. I was during SIM week, so.

00:01:05:13 - 00:01:07:18
Chandler Carter
It's just very timely, I like that.

00:01:07:21 - 00:01:32:12
Kelley Sava
So I'm a nurse by background. I started in pediatric nursing, and became a nurse practitioner. I started working in hospitals and having played competitive team sports as a kid, I really had this desire and love for teamwork and communication. And that was really a passion of mine. And getting into hospital based nursing, I found that I was able to use a lot of those skills in a hospital based setting, which was really exciting.

00:01:32:12 - 00:01:56:20
Kelley Sava
And then fast forward a little bit and I became an educator, an advanced practice nurse educator within a pediatric realm. And shortly after I took that role, simulator, a Laerdal simulator showed up at my door and it got delivered to my doorstep. And so I was tagged, and said well, I got delivered it here so you're going to be the one that's going to figure out how we're going to utilize this amazing tool.

00:01:56:20 - 00:02:37:06
Kelley Sava
And so the rest was history. I started using it and fell in love with the opportunity to really, you know look at teamwork and communication within the health care setting. And from there, I was completely sold. You know, as a pediatric nurse, saw a lot of clinical situations and opportunities for improvements in how we provide safe care. Our organization then took a huge dive into patient safety, really launching high reliability and patient safety as a huge initiative within the organization. And part of their strategy and philosophy was launching a simulation program across the enterprise.

00:02:37:08 - 00:03:03:03
Kelley Sava
And at that time it was Illinois. It was our Illinois sites. And so I was fortunate enough to become the director of that program when it was just myself and our safety leaders that were fearlessly dedicated to this journey of high reliability. And from there, I my passion grew even more as to how we could utilize simulation to really make an impact for our patients.

00:03:03:05 - 00:03:21:26
Chandler Carter
That is incredible. Thank you so much for sharing, Kelly, and also bringing awareness to Patient Safety Simulation Week. Brian, as patient safety manager at Laerdal, can you tell us a bit about your background and some of the simulation work that you do with Laerdal, including the accelerate programing that Kelly just mentioned?

00:03:21:28 - 00:03:41:09
Brian Bjoern, M.D.
Absolutely. And let me just pause for a second, and thank you for having us on the podcast. We're excited to be part of this. My background is actually not so much in simulation. I'm a public health physician by training and have spent most of my career in safety and quality roles for working for hospitals and health systems, here in the US and in Scandinavia.

00:03:41:12 - 00:04:05:02
Brian Bjoern, M.D.
And at Laerdal I'm using that that background and quality and safety to really try to augment what we do already with our hospital customers. And we like to think of simulation and how it relates to patient safety as kind of  - there are three tiers to this. And the two first is I'm going to talk about what probably most hospitals that do simulation think of when they think patient safety and simulation, which is does you individual skills.

00:04:05:02 - 00:04:21:15
Brian Bjoern, M.D.
So that could be something like, you know, using a task trainer to learn how to insert an IV. That's important. And I think that does contribute to patient safety that we can practice that on a simulator where rather than on a patient. The second level is when we come together as a team. We all have our individual skills down.

00:04:21:15 - 00:04:40:00
Brian Bjoern, M.D.
Now, we need to figure out how to work together as a team. Most of us do not have that opportunity in school. So that really is on hospitals to figure out how can we do that. So training, practicing, high acuity, time critical scenarios as a team, I think is that is that second tier of simulation.

00:04:40:02 - 00:04:58:21
Brian Bjoern, M.D.
And then the third tier is kind of thinking a little bit more about how does the whole system work together. So using simulation really to drive quality projects forward and to use it as a tool to find the holes in the Swiss cheese, like we would say in patient safety, or figure out how to close the holes in the cheese.

00:04:58:24 - 00:05:18:08
Brian Bjoern, M.D.
The Laerdal accelerate program is an attempt to help hospitals with that approach by providing simulation in a box, really. It's a program that we developed now a handful of years ago that allow customers to have us run simulations on their behalf. So we really just need to know what's the clinical topic you want to practice?

00:05:18:08 - 00:05:46:15
Brian Bjoern, M.D.
How many people do we need to get through this, and when do you want to do it? And we come on site and run simulations for you. We bring in all the equipment an educator, Simtech, and we run the simulations. And when we're done, we you know, clean up, pack up, go home. And a couple of weeks later, we reconvene to talk about, what we call the progress report, which is how we translate all the thousands of data points we capture during those simulations into actionable insights so that we leave you with something that you, you know, get a snapshot of

00:05:46:15 - 00:05:53:05
Brian Bjoern, M.D.
what did you do well? Where is there some room for improvement? And how can, how could this data help you in that?

00:05:53:07 - 00:06:16:29
Chandler Carter
And for a lot of our members, I think one of the challenges is moving from concept into application. We know that Advocate Health represents a very diverse number of hospitals and care settings. Can you tell us what's worked well in securing buy in from different levels, from the executive team to frontline teams? And how have you really helped to make simulation a part of each institution's day to day practices for patient safety?

00:06:17:02 - 00:06:34:08
Kelley Sava
Yeah, absolutely. So I'm going to focus my answer on some of the work that has gone on in the Midwest, because we've just had a longer standing opportunity to build that culture in that space. And so we started out really with gaining buy in from our highest levels. And so we had, our patient safety leader.

00:06:34:08 - 00:06:55:25
Kelley Sava
And at that point in time, our system chief medical officer, who were very passionate about high reliability and safety and how simulation was going to impact, right? They helped us at the highest level get that word out. And our president at the time bought in 100%. We were able to gain that buy in at that level. The site level was very different.

00:06:55:25 - 00:07:25:09
Kelley Sava
And translating that desire from an enterprise or system level into the sites...it's a challenge because every hospital, as you know, has a different culture, different, right? We all have these cultures and behaviors that we follow together as a system. But when you really get into each of those sites, there's a different flavor to that. And so we really had to tailor our approach to each of those different cultures and flavors, if you will, at each of those sites.

00:07:25:09 - 00:07:42:29
Kelley Sava
And so our approach really varied. At some sites, our leaders, you know, we were able to meet with our leaders. And as long as we could get the leaders to understand the why and we could speak the language and find out what was important for them, we were able to get in the door and they were able to help us move forward.

00:07:43:01 - 00:07:59:03
Kelley Sava
I always use the question, what keeps you up at night? And that was the question that I would ask the leaders, and if we could get to something that was sort of on their plate or was causing them concern, we would be really successful. And we had other sites where the leaders, you know, they were like this is all great.

00:07:59:10 - 00:08:21:13
Kelley Sava
And that's where it kind of stopped. Right? Like these are sometimes, you know, hospitals that had different priorities or whatever. And in those situations we went more grassroots. So we changed our approach in those situations. And we would go into unit and we would work with the more local leaders, the managers and the supervisors and do simulations and get these great stories that they would then escalate up.

00:08:21:16 - 00:08:38:18
Kelley Sava
And so when they would escalate those stories up to those executives, then they would come back to us and say, we need a simulation here because our teams need it. Here's what happened in our unit. We would go, yes, we've worked very closely with your team. We're so grateful for their engagement. And let's spread this out, right?

00:08:38:21 - 00:09:08:10
Kelley Sava
What we had to do is be really flexible and fluid about how we engaged each of those sites to really get simulation embedded into their culture. We also worked really tightly with patient safety, right? So at a system level, we had really tight relationships. I still matrix report to our patient safety leader. And so having that relationship also helped us have an influencer within each of the sites already embedded, which was very helpful.

00:09:08:12 - 00:09:32:13
Chandler Carter
I love that idea. And I've heard that echoed across some of our member hospitals as well, having that champion of sorts, to help kind of progress the work in simulation. Which brings me to Brian. From your perspective, working with an organization that has done tremendous work in the world of simulation. What are your thoughts on how hospitals and health systems that can really build a culture that values and trust simulation as a strategic

00:09:32:13 - 00:09:33:00
Chandler Carter
tool to advance patient safety?

00:09:35:06 - 00:09:57:16
Brian Bjoern, M.D.
Buy-in at all levels is so important. But particular and this is true for any project, program, initiative in our organization, you need the executive team on board with this. They need to be present. They need to be supportive. That's the old saying that attention is the currency of leadership. And if you do not have the attention of leadership on this, you're not going to make that the kind of progress that Advocate has shown is possible.

00:09:57:18 - 00:10:17:25
Brian Bjoern, M.D.
And I think to some extent, really the biggest challenge is to get our senior leaders, our executives in health care, to understand that simulation is not just a great educational tool. It can do so much more. When I talk to hospital leaders, I often run into to people who think of simulation that's something that happens over in education.

00:10:17:28 - 00:10:44:08
Brian Bjoern, M.D.
They don't even, you know, connect the dots that they have this great tool and resource in-house that they can use to accelerate their safety and quality work. And I would argue that that simulation really can help build and maintain a culture of safety, because everything we do in simulation revolves around this idea of creating a safe space for learning and for failing, and without risking any harm to the organization or to our patients.

00:10:44:11 - 00:11:05:27
Chandler Carter
Thank you so much, Brian. Kelly, so we know at Advocate we know that simulation is very heavily embedded into how your systems improve care continuously. Can you share how you specifically use simulation to help uncover any communication breakdowns, any safety gaps, or any system level risks, before they begin to impact patient care or escalate?

00:11:06:03 - 00:11:28:25
Kelley Sava
Absolutely. I have a lot of stories about how we've utilized the tool in that way. So early on when we were getting our feet wet we were doing mockups, emergency resuscitation. The one thing everybody understood ubiquitously about simulation was a mock code doing CPR, emergency response. Everybody understood that. So we started there naturally. Just that's what people wanted.

00:11:29:01 - 00:11:59:26
Kelley Sava
And in doing so across our hospital system and doing it at different hospitals, we noticed very quickly that there was some trends in how care gaps were being identified within these events, and we identified that roles and responsibilities, while they're well laid out for the American Heart Association, how that translates into some of these hospitals that maybe have fewer resources than are identified in the guidelines or have way more resources than are identified in the guidelines, how does that translate?

00:11:59:29 - 00:12:33:22
Kelley Sava
And then other additional roles that right, maybe needed wayfinding and things like that. It just there wasn't very clear, delineation with what that we were seeing translate into care. We were seeing opportunities around our crash carts and how they were organized, what supplies were on the crash carts, what supplies weren't on the crash carts. Did teams know how to access the medications or access the supplies that they needed? And then also identifying that in some of our hospitals, we had up to four different types of defibrillators depending on the different units.

00:12:33:22 - 00:12:56:12
Kelley Sava
And one code team that was having to know how to use this equipment across multiple locations within their own building. And so we were able to escalate all of that to the system level. And we actually were able to, with the partnership of our patient safety team and our executive leaders to form a committee that really looked at practice within Code Blue.

00:12:56:12 - 00:13:15:16
Kelley Sava
And there was a new policy written. There was standardization defibrillators across the entire system, all of these things that then got put in place because of these findings. We were able to kind of tie it all together and then look to make sure post implementation that we weren't continuing to see those types of events.

00:13:15:18 - 00:13:36:23
Chandler Carter
I think that's an excellent example of how simulation can really reveal some of those hidden vulnerabilities that exist within complex health systems. So that's incredible. So as a follow up, Kelly, you've often described simulation as a space where people can learn, reflect and speak up. How have you used simulation to really foster psychological safety within your organization?

00:13:36:26 - 00:13:58:24
Kelley Sava
Yeah. So I think simulation has a natural ability to do this when we're bringing teams together and really having our front line teams in a safe spaces, as Brian spoke about, where they're able to talk through the care that they provide. Normally you provide the care in your unit and then you go on to the next thing you have to do, right?

00:13:58:24 - 00:14:26:00
Kelley Sava
Like we don't stop and really think about how in debrief every interaction, every process every single day. And so bringing our teams together and really providing that safe space for those opportunities is really important. And it allows for us to build trust. A recent example, and I just found out about this when we are in the midst of a huge safety project at one of our hospitals, they're opening a brand new tower.

00:14:26:03 - 00:14:55:18
Kelley Sava
In that process, they're having one unit that was not a tele unit is now going to be a telemetry unit. And so part of the testing that we did when we went in there was to combine this unit that was non telemetry and help combine training with them and our central tally center to do some training together so that they could better understand the process of central tele, that they could, you know, be able to learn those processes and workflows and escalations and things like that.

00:14:55:18 - 00:15:16:10
Chandler Carter
Incredibly important, incredibly important. And I think we're seeing now in the current health care landscape and the dynamic things are shifting rapidly. So I always like to look at things from a broader picture and implications for the future in the field in general. Brian, I can pitch this one to you. So as we look into the future, what role do you see simulation playing in hospitals?

00:15:16:13 - 00:15:22:08
Chandler Carter
In meeting the growing complexity of care, evolving technology and overall workforce readiness?

00:15:22:10 - 00:15:48:00
Brian Bjoern, M.D.
I think actually, that simulation might be, one of the things that that, you know, determine whether you're able to survive in the environment we are heading into. We recently were at AHA Leadership Summit, and the message we heard universally from the executives in attendance was that with the cuts to Medicaid that came with the OBBBA, there's just no way we can get away with incremental changes anymore.

00:15:48:04 - 00:16:16:29
Brian Bjoern, M.D.
We will need to fundamentally change how health care is delivered. And I think simulation can really be a crucial tool to get that right. Again, the whole premise of simulation is that it's a chance for us to practice and learn at very low, sometimes even no risk. So using simulation to test out different approaches, to use it to solicit feedback from patients, caregivers, providers and staff, I think will allow hospitals to adapt to this new environment much more quickly.

00:16:17:04 - 00:16:21:21
Brian Bjoern, M.D.
There's a lot of opportunity for using simulation in health care more than we already do.

00:16:21:24 - 00:16:34:14
Chandler Carter
Absolutely. I couldn't agree more, and I appreciate you both for taking the time to come and speak with us today on Advancing Health, not just for sharing your expertise today but for bringing such energy and insight into this conversation.

00:16:34:16 - 00:16:35:18
Brian Bjoern, M.D.
Thank you for having us.

00:16:35:21 - 00:16:37:18
Kelley Sava
Thank you so much.

00:16:37:20 - 00:16:46:01
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.

00:00:00:29 - 00:00:26:09
Tom Haederle
Welcome to Advancing Health. As America's population ages, hospitals and health systems are working to meet the evolving needs of older patients and provide care that enhances quality of life. Today, we highlight how West Health Institute and Sharp HealthCare are partnering to advance older adult care and the power of asking one simple question: what matters to you?

00:00:26:12 - 00:00:50:04
Marie Cleary-Fishman
Hi, everybody. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Marie Cleary-Fishman, the vice president of clinical quality for Health Research and Educational Trust. And I'm here today with Doctor John Zifferblatt, chief strategy officer at West Health, and Dr. Diane Wintz, the trauma program director, critical care specialist at Sharp Memorial Hospital in California.

00:00:50:06 - 00:01:00:15
Marie Cleary-Fishman
John, I'd like to start with you a little bit, and if you could tell me a little bit about your role at West Health and, and just a little bit of what West Health is all about.

00:01:00:18 - 00:01:30:03
Jon Zifferblatt, M.D.
Sure. Thank you too, Marie. Thank you for having me here. So, I'm the chief strategy officer at West Health. West Health, you know, named for Gary and Mary West, our founders. We are here in San Diego, but it is named for founders Gary and Mary West, who have also given us our mission, which is to advance affordability and models of health care that promote independence, high quality of life and dignity for older adults, and ultimately for us all.

00:01:30:06 - 00:02:01:00
Jon Zifferblatt, M.D.
My role is to overlook the portfolio work that we do and make sure it ladders up to create impact at scale. And when we say West Health, what we really mean is the several organizations that all work together. There is the West Health Foundation, but largely that foundation does its work through, funding and arms, legs and brains of the West Health Policy Center in Washington, D.C., where we advance smart policy, and the West Health Institute here in San Diego, where we collaborate with health systems.

00:02:01:00 - 00:02:11:18
Jon Zifferblatt, M.D.
There's just 40 of us. So we can only be a catalyst and work with health systems to work together with them, and try to effect change at scale.

00:02:11:25 - 00:02:29:20
Marie Cleary-Fishman
That's great, John. And that's, that's really important information and very important to how we get work done in hospitals, in health systems and in health care today. So share with me a little bit about your connection and tie to Sharp. And what does that look like?

00:02:29:22 - 00:02:53:13
Jon Zifferblatt, M.D.
Absolutely. We worked with Sharp and other systems here in San Diego. We originally did some work  - we have a body of work in geriatric emergency departments, and we did some wonderful work with the county of San Diego, where every health system in San Diego other than military, was accredited as a geriatric emergency department. And we obviously know Sharp by its reputation.

00:02:53:15 - 00:03:11:18
Jon Zifferblatt, M.D.
And, in the wake of that work, Sharp approached us, Diane approached us with some really exciting possibilities. And she'll share more I'm sure, about the details of that, but I just want to share at a high level. When we spoke with Sharp and Diane, it was clear that they had their ducks in a row.

00:03:11:18 - 00:03:29:08
Jon Zifferblatt, M.D.
They had buy in, they had metrics that they wanted to advance. They had a passionate and capable champion and really support from the clinical staff all the way up to the carpeted part of the hospital. So that's how we came to advance this work that we'll be talking about today.

00:03:29:11 - 00:03:51:01
Marie Cleary-Fishman
John, those are really important things to point out. And I think that the governing board, the C-suite, and I like how you said the carpeted areas of the hospital. So thank you for pointing that out. Diane, I'm going to ask you to tell me just a little bit about the journey that Sharp Memorial has been on and how you got to where you are today.

00:03:51:03 - 00:04:18:25
Diane Wintz, M.D.
Like John said, we presented to West Health back in 2021. And at the time, the country was going through Covid pandemic as the entire world was going through. And we had a durable, sustainable program that we were running. It had started on trauma, I'm the trauma medical director at Sharp Memorial Hospital, which is a level two ACS verified Center.

00:04:18:27 - 00:04:51:20
Diane Wintz, M.D.
But what we had seen similar across the country is that the number of patients 65 and older is growing, and I think it's going to continue that way for some time. And we needed a way specifically on trauma to manage the acute process of injury. And that potential threat to functional independence. And so we began a small pilot or soft launch program on a single unit in our hospital.

00:04:51:22 - 00:05:22:14
Diane Wintz, M.D.
It was the trauma unit, and we targeted patients who are 65 and older for very aggressive, functional and cognitive rehabilitation after injury. And that program enrolled 83 patients, and it had significant results with delirium mitigation, sleep/wake hygiene, out of bed mobility and discharge back to home, which is what people want. They don't necessarily want to be out of their homes to recover.

00:05:22:16 - 00:05:56:00
Diane Wintz, M.D.
And once we saw those results, we were able to take this and say, well, maybe there's a pathway for medical patients and maybe there's a pathway for surgical patients. And we begin to grow those things with our collaboration through West Health. And so for the past three years, we've been completing national level milestones to complete these very aggressive but also very durable and sustainable processes that could be used anywhere.

00:05:56:03 - 00:06:21:29
Marie Cleary-Fishman
I've done some homework over the weekend, and so I had a chance to go to your website and really look at some of the information and the materials that's there. So your generational health program, Sharp Memorial has that in place. And I wonder if you could describe that a little bit and help our audience understand what is that cover, what is it involving and...

00:06:22:01 - 00:07:10:16
Diane Wintz, M.D.
Yeah, it's really amazing at this point, what we've been able to accomplish, because where we started as just a little program on a trauma unit is now a hospital wide and going system. So generational health is an umbrella term. It encompasses all the pieces of the program that we do from the very beginning in the geriatric accredited emergency department that John mentioned, all the way through community. It includes advanced illness management, which is a nursing team that comes and talks about goals of care, advance care planning processes or future hospitalizations, or how to prevent it, and ensuring that your needs are met, and that we really heard and understood what matters to you.

00:07:10:18 - 00:07:39:17
Diane Wintz, M.D.
We have an appropriate care committee that deals with families, patients, where there might be a misunderstanding about the level of care or what's being offered. We have geriatric surgery which is another American College of Surgeons verified level one program. So this addresses surgical patients with vulnerability or social determinants of health who are going for operations. And they are age 75 and older.

00:07:39:23 - 00:08:14:15
Diane Wintz, M.D.
We also have a community piece where we go out. We provide education resources to all of our community partners. And then most importantly is the healthy aging, which is the inpatient program. This is an age friendly program. It was modeled after John A. Hartford Foundation, IHI. And it really prioritizes what we call 4Ms: mobility, medication management, mentation, which includes like the aspiration precautions and the cognitive and the delirium mitigation.

00:08:14:18 - 00:08:25:04
Diane Wintz, M.D.
And then what matters most? What are we doing in this hospitalization? What's important to you? What goals are you trying to accomplish, and how can we help you get there?

00:08:25:06 - 00:08:57:26
Marie Cleary-Fishman
That's amazing. I know that Sharp Memorial has a track record of coming up with innovations and for creating innovation that helps advance patient care. So I'm not surprised to hear you have such a comprehensive of approach to the area of aging. And as you rightfully said, the number of aging in our country is growing significantly. And so things that our hospitals and health systems can put in place to help integrate these pieces and really look at things through that lens of what matters, is so important.

00:08:57:27 - 00:09:21:06
Marie Cleary-Fishman
It really is important so that that care that we give to those older Americans really is focused on what's important to them and what matters in their life. And it helps us, as caregivers provide care that is something that advances and helps their life and makes them feel better. So, kudos to that broad perspective that you're bringing. That's really amazing.

00:09:21:13 - 00:09:33:12
Marie Cleary-Fishman
Maybe Dr. Wintz, you can talk to this just a little bit. And it's the idea of the medical inflection point of care. If you can give us a little bit of your insight and thought around that concept and what that might mean.

00:09:33:14 - 00:10:04:05
Diane Wintz, M.D.
Yeah. Well, I think you made a great point. You know, it comes down to what's important to someone. So medical inflection is the time on the health care journey where the hospital doesn't offer a therapeutic or diagnostic solution. That the needs or the interests of that person are to remain in place, to age in place. And the hospital doesn't really enhance that quality or quantity of life.

00:10:04:05 - 00:10:17:20
Diane Wintz, M.D.
And it's different for everybody. It's not based on age. It's not even based on frailty. It's based really on what matters to you and what can be accomplished in your current environment.

00:10:17:22 - 00:10:41:08
Marie Cleary-Fishman
That is so important. And I have used that. I can't even begin to tell you all of my dad's stories, but, we have used that to make care decisions, to help him make his care decisions because he is cognitively intact and capable of making those decisions himself. But I think that's a concept we really do need to focus on in health care, and that is through that lens of what matters.

00:10:41:11 - 00:10:50:20
Marie Cleary-Fishman
John, can you give us a little of your thoughts on that concept? Because, as the what matters comes so important and I know it's important to West Health as well.

00:10:50:22 - 00:11:16:06
Jon Zifferblatt, M.D.
Absolutely. And I think, you know, I'll take the perspective that it's kind of a beautiful thing. Because what matters to patients and practitioners, I daresay, is really also greatly overlaps with what matters to health systems, right? You know, older adults and all of us want to walk into the hospital if we have to walk in and we want to walk out. And we'd like to do that in an expeditious manner. And we'd like to do it as healthy as possible.

00:11:16:08 - 00:11:37:28
Jon Zifferblatt, M.D.
That's what health systems want. I mean, when we think about what's on the minds of those that run health systems and health systems leadership, it's to think about things like length of stay. Especially these days where you see the how many systems lines out the door in the ED. People waiting for beds, transfers, scheduled procedures having to be rescheduled or delayed.

00:11:38:01 - 00:12:03:08
Jon Zifferblatt, M.D.
Everybody would love to see beds being used in the optimal manner. And part of getting that right, part of getting a good case mix index and really tuning length of stay is allowing older adults the ability to really have that stay be optimized for them, and that gets them out and back in an independent life, in their community sooner and happier with greater satisfaction.

00:12:03:08 - 00:12:05:28
Jon Zifferblatt, M.D.
So wonderful to see the concordance of what matters.

00:12:06:00 - 00:12:30:23
Marie Cleary-Fishman
I love what you just said, the concordance of what matters. That's just perfect wording for that concept. And really, I've been in the position of having those conversations with caregivers. So Diane, help me think about or understand how you at Sharp Memorial, how you create the environment, how you create the culture within a system.

00:12:30:23 - 00:12:43:19
Marie Cleary-Fishman
And you clearly have a system, a continuum of care that you're working for. So how do you look at building systems that make it easier for those that are providing care to really understand the what matters?

00:12:43:25 - 00:13:15:23
Diane Wintz, M.D.
Well, it starts at the top, but we have a very receptive administration. We have an administration that's very accessible and also goes on a first name basis. So it's very comfortable to voice a concern or to be interested in something. And I think this collaboration with West Health is one of the best examples of how administrations really drive ships by stepping back and allowing leaders to take the reins.

00:13:15:29 - 00:13:44:11
Diane Wintz, M.D.
This is what happens, is that, you know, we had stories, we had patient examples that were really critical where we could have done better, and we shared those stories. And then we engaged frontline staff who had interest in what we were doing, self-identified, and we welcomed them onto their team to start that planning process. So that we could move forward with a bigger picture.

00:13:44:13 - 00:14:10:27
Diane Wintz, M.D.
One of the examples that I give is the gentleman who fell in his garden, and he was the family patriarch. And he came in with a few rib fractures, a minor injury and in most cases. And for him, unfortunately, he got into this cycle where he needed pain medication and then he was too groggy to participate. And then because he didn't participate, he was in bed.

00:14:10:27 - 00:14:31:08
Diane Wintz, M.D.
And because he was in bed, he lost strength. And this just- it was a cat chasing its tail, trying to get on top of the problem so that we could get him better. And based on his outcomes, you know, we took that back to the group and we said, we have to do better. We have to already be prepared for what's going to happen.

00:14:31:08 - 00:15:12:28
Diane Wintz, M.D.
We have to be ready to manage pain in such a way that we don't get into this cycle, that this doesn't happen to someone. It's a lot of things that we talked about on this call. It's bringing those personal examples and making that impact. And someone saying, you know, that resonates with me because I took care of someone and they have this story and, and really using those stories to build that impact, to build that need to build the interest and then to come up with a product that is really doable, doesn't take a ton of extra time, doesn't need a lot of extra training to do it.

00:15:13:00 - 00:15:16:15
Diane Wintz, M.D.
It's just really a shift of mindset.

00:15:16:17 - 00:15:38:03
Marie Cleary-Fishman
I think you're so right. And I think we have opportunities to bring the family caregivers, whoever that might be, and the clinicians and the clinical teams sort of together looking through that what matter lens, right? Because, you know, one thing might matter to the caregiver, one thing might matter to the clinicians. Well, do they - is that checkpoint of what matters-

00:15:38:03 - 00:16:06:00
Marie Cleary-Fishman
do they align with what that patient person who's in the bed wants? And I think that's something that's really important. John, West Health is really committed to this and really believers. We had another panel with you and we talked about the C-suite, the board involvement, and how important that is to going forward. Can you talk a bit about the sustainability of this model or the spread of it?

00:16:06:00 - 00:16:08:19
Marie Cleary-Fishman
And how does West Health look at that?

00:16:08:21 - 00:16:30:12
Jon Zifferblatt, M.D.
Sure. Happy to share. And I'll also add an observation about the wonderful work going on in Charlotte. When you heard Diane talking about the things that they've brought to bear and the multifaceted components they put into that product, if you will, there wasn't a new drug that they needed to have been discovered. There wasn't some new miraculous technology that didn't exist a year ago.

00:16:30:14 - 00:16:53:22
Jon Zifferblatt, M.D.
This is about operational innovation, right? This is about bringing together pieces that already exist, putting it together in new ways, doing some, you know, staff training. There's you know, and culture change, as you said. But all of these things are there. They need to be catalyzed. The incentives have to be in the right place. But this is not net new technology, new innovation.

00:16:53:22 - 00:17:12:18
Jon Zifferblatt, M.D.
We have the pieces now and we can do them. And that's part of how we think about catalyzing the scale and spread of this. There's multiple ways we can do it. One of the, you know, more simple and straightforward ways is we amplify the work. We take beacons of success and houses of excellence like Sharp Memorial and Sharp Health

00:17:12:18 - 00:17:39:07
Jon Zifferblatt, M.D.
that are doing it well. And share and spread that, break it down into the components that allowed for that success and enable those that are leading that success to share that as well. So obviously there's vectors to do that. And then there's other ways that we can try to catalyze that success. We can do it at a policy level, but we also can create the right environment where things like this can take root and spread.

00:17:39:09 - 00:18:03:12
Jon Zifferblatt, M.D.
And we're big believers in the marketplace. So how are the things that we're discussing here business friendly? How do they support hospitals as they move forward with their missions? How is there a marketplace of vendors? We were recently at a meeting and you were there, Marie, where we were talking about things like this and we had participation from technology vendors, large and small.

00:18:03:14 - 00:18:24:18
Jon Zifferblatt, M.D.
And not, you know, it wasn't a sales platform for them, but it was really a way for them to understand what is necessary. How does technology enable these things? Some of the things that Diane's been talking about have been greatly enabled by EHR builds and configurations. Other technologies, algorithms that identify the right patients to select for these interventions.

00:18:24:20 - 00:18:47:27
Jon Zifferblatt, M.D.
All of these things require a robust and healthy marketplace of technology. No philanthropy is going to come up with the right puzzle pieces, or even a single health system won't. The market will create them. But I think it's helpful to provide to the market: what does success look like? What are the guardrails? How are we who are delivering care of those who are delivering care, doing it?

00:18:47:27 - 00:19:06:05
Jon Zifferblatt, M.D.
And how are we who are enabling them thinking about this? And so for West Health, I think we're, you know, an honest broker, a neutral party, you know, we're nonpartisan, we're not a vendor. And so we try to showcase all of these things to allow both policy and the marketplace to come together to move these things forward.

00:19:06:08 - 00:19:25:06
Marie Cleary-Fishman
Well that's great, John, I love that. And yes, that was an amazing conference, an opportunity to see all of this in action. So that was really great.
Diane, thank you so much. And John, thank you for all of the things West Health does and the opportunity that we get to work with both of you.

00:19:25:08 - 00:19:33:19
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.

00:00:00:27 - 00:00:28:25
Tom Haederle
Welcome to Advancing Health. Changes and challenges. That pretty well sums up the state of American health care in the last quarter of 2025. In this month's Leadership Dialog podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the American Hospital Association, we get a briefing from Stacey Hughes, AHA’s executive vice president of government relations and public policy, on the outlook for ending the government shutdown that began October 1st...

00:00:28:27 - 00:00:40:19
Tom Haederle
insights on what's expected on the legislative front for the remainder of the year...and an update on a host of issues important to the field.

00:00:40:22 - 00:00:59:26
Tina Freese Decker
Thank you, everyone for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and the board chair for the American Hospital Association. I did my first leadership dialogue with Stacey Hughes, and there have been so many new changes and challenges, opportunities, developments since January that I felt that it was the right time to bring Stacey back for an update.

00:00:59:29 - 00:01:21:17
Tina Freese Decker
I can't wait to hear your insights, Stacey, on all that is playing out in Washington, D.C. and how the American Hospital Association is continuing to advance this work on behalf of our field. So, you and I have had lots of conversations over the past year. I am so grateful for your expertise. And just understanding what it feels like, what it's about, and what we should be doing as we go forward.

00:01:21:19 - 00:01:35:22
Tina Freese Decker
So let's start with what is top of mind for many of us, the current federal government shutdown. Can you give us a sense of how this government shutdown is the same or different from previous times? What do you think's going to happen?

00:01:35:24 - 00:01:55:22
Stacey Hughes
I'm so grateful that you invited me, and it's so fun to talk to you always and appreciate your leadership through all these different this this year for sure and heading into Q4, which is nice, but still a lot of challenges. So yeah, to your point, the shutdown, what is different? One, it's a full shutdown. The last shutdown in 2018 and 19, Tina, was a partial. And HHS was funded.

00:01:55:23 - 00:02:19:23
Stacey Hughes
Department of Defense was funded. This is a 100% shutdown of full government. And so that's really different.  I think second, one of the reasons a government shutdown, which I know we'll talk more about, is the concern Democrats have and want to use this opportunity to have leverage to get Republicans to support extending the EPTCs. I say that's a second difference in that this is going to play out in real time.

00:02:19:24 - 00:02:39:18
Stacey Hughes
You know, as we're speaking now and 21 days from now during this shutdown, or maybe it reopens, people are going to get their notices about their premium subsidies and those that have gone away during this time. So you've got sort of this dramatic dynamic that Democrats are kind of banking on so that people, everyday Americans, understand what a shutdown is.

00:02:39:18 - 00:02:57:13
Stacey Hughes
So for those two reasons it's very different. I will say in a lot of people ask me, how will it end? And, really nobody knows. I'll just add a few more facts about kind of this particular shutdown. You know, in terms of where we are, they've got about five payroll periods that are going to be coming up that are important.

00:02:57:13 - 00:03:20:17
Stacey Hughes
One I think it's been highly reported, which is the active military paycheck stops on October 15th. The second full government federal government employee paychecks stops between the 20th and 31st. Senate employees stop the 20th. You know, go down the line.  October 31st, the House employees stop receiving their paycheck. So that's kind of a an important mash up right there in terms of will that be impactful?

00:03:20:24 - 00:03:40:25
Stacey Hughes
They are moving money around to try to protect the WIC program. That funding is also expired. So there could be some action forcing events. I will say the president is going to be in Israel this weekend, rightly so, for an important ceasefire. And that's going to really occupy the news cycle till Tuesday. So I think we get back here Tuesday and we're kind of still stymied, Tina.

00:03:40:28 - 00:03:53:13
Stacey Hughes
So I don't know how this ends, but both sides feel like they're doing well. And I think frankly starting Tuesday it's a test of political stamina. You know, which party can withstand the things we just talked about.

00:03:53:15 - 00:03:56:24
Tina Freese Decker
Right. And it's challenging because all of those impact people.

00:03:56:26 - 00:03:57:09
Stacey Hughes
That's right.

00:03:57:16 - 00:04:01:25
Tina Freese Decker
The people, the federal workers. So on. And so what's a way to get unstuck from that?

00:04:02:01 - 00:04:27:08
Stacey Hughes
For sure. And I think for us, you know, because it is the Department of HHS, we also have some things that are affecting rural patients, in particular the telehealth pieces. As you know, that program expired September 30th when the CR was unsuccessful. And so did hospital at home. And, you know, that does affect real lives. According to CMS, there are about 1200 patients that were in the system during that month, between about 419 hospitals.

00:04:27:08 - 00:04:39:26
Stacey Hughes
And those patients, almost all had to be moved under the fact that the program was no longer authorized. So we feel it a little bit more than we normally would acutely. And with some of these programs not on the mandatory side, but it is real life implications.

00:04:39:28 - 00:04:56:11
Tina Freese Decker
True. So you mentioned this before. One of the sticking points is the enhanced premium tax credits, which, you know, expire at the end of the year. Why is extending those tax credits so important for hospitals and our members people? And what do you think is going to happen with those?

00:04:56:13 - 00:05:23:01
Stacey Hughes
Yeah. Boy, that's there's a great question. A couple things. Certainly we just came off the OBBA debate, right? And that already includes scoring estimates that up to 10 million people will be displaced from coverage over the next ten years. If you were to lose the enhanced subsidies which were part of President Biden's Inflation Reduction Act, as well as his American Rescue Plan, if those were to expire, you would see at least another 5 million individuals that would go from insured to uninsured status.

00:05:23:03 - 00:05:46:03
Stacey Hughes
But in addition, you know, under the four years of these enhanced subsidies, about 10 million people have come on the rolls and it's a substantial part of their ability to afford their care. 19 or 20 million people will see some reduction in their actual subsidy to pay for their premiums. And even if you get some of it, some people say a $12 differential to be the choice of staying covered or not covered.

00:05:46:06 - 00:06:06:19
Stacey Hughes
So that's number one was to create more people who are uninsured that would come through our doors. But importantly, also in terms of our own fiscal health, you know, we would estimate that's about a $28 billion loss of our ability to continue to provide services over the next ten years. So it's very real to hospitals in terms of what it would mean to our overall day-to-day ability to serve patients.

00:06:06:21 - 00:06:31:29
Tina Freese Decker
Right. And it is impacting in communities where we have payers offering the products and some not offering the products. So it's a very dynamic time happening on the ground. But then also what will happen in D.C. So thanks for that update. There are some more things from a comprehensive health care package that come together, such as structural changes to how pharmacy benefit managers operate or changes to Medicare Advantage.

00:06:32:02 - 00:06:36:24
Tina Freese Decker
What do you think is going to be put together in that sort of comprehensive package?

00:06:36:27 - 00:06:56:13
Stacey Hughes
Let's talk about the health part first. I guess I'll say that's where the PBM reform really does lie, and there's probably a combination of MA with regulatory and Hill. But right now is so acrimonious, Tina, I think while there was a lot of bipartisan support for both of those, I think that until they resolve this issue, it is going to be very difficult to restart those bipartisan conversations.

00:06:56:13 - 00:07:19:13
Stacey Hughes
And frankly, the longer this goes on, I think the more it will, you know, spoil the waters for those kind of conversations. In terms of, you know, is there an opportunity in December, you know, we would hope so. As you know, there was some significant proposals, ones that you mentioned, that were left on the cutting room floor last December when we had the health care, you know, end of year package and some other priorities on community health centers in May, as you mentioned.

00:07:19:13 - 00:07:43:15
Stacey Hughes
And so I think there's an opportunity, but it may actually bleed into next year. It's going to be solely dependent on the appropriations process. And once we open the government back up and there's a bipartisan solution for that, the question is how long, right? Is it a bipartisan solution just till next March? And normally our priorities and those types of priorities tend to travel just the length of the amount of time of the continuing resolution.

00:07:43:15 - 00:07:58:07
Stacey Hughes
So I'm not so sure when we'll be at that point of having more permanent PBM reform or MA reform. But the good news is I think the commitment to those are high. So we'll see if they revisit it. But I think they'll pick up where they left off once we can get the appropriations settled.

00:07:58:09 - 00:08:17:15
Tina Freese Decker
Okay. So you talked a little bit about December. I know the American Hospital Association has a full end of the year list of priority items. What are some of those other key issues that your team is tracking? And, you know, immigration, H-1B visa exemptions, maybe some of those. What are you thinking about that that we should be mindful of?

00:08:17:22 - 00:08:41:12
Stacey Hughes
There's no shortage of issues and it's real diverse. You know, I'll start with immigration. You know, I think everyone saw tension around the president's proclamation a couple weeks ago around adding a $100,000 fee going forward, the companies who are sponsoring H-1B visa applicants. And so on that one, we're looking and working very hard with the administration to try to seek exemption for health care workers. And that would be every clinical aspect, right?

00:08:41:12 - 00:09:02:26
Stacey Hughes
It would be lab technicians, physicians, nurses. You know, we are probably only 4.2% or 5% of the total of H-1B visas. So we're hopeful with the demonstrated workforce shortages that exist that we can have a good chance of leaning on the administration to be thoughtful about the exemption process for health care workers, that's number one. Tariffs,

00:09:02:26 - 00:09:29:05
Stacey Hughes
I think you mentioned to me that continues to be an area of concern. You know, we've engaged very significantly with some of the other stakeholders, obviously  AbbeMed and some of the other organizations. But for us, you know, a significant part of our PPE, which the president has now threatened a tariff on. Medical devices, which he's just renewed, a threat that an investigation about foreign and national security around tariffs, all of those really impact our domestic supply chain, our ability to access products.

00:09:29:05 - 00:09:48:07
Stacey Hughes
So those two are, you know, I wouldn't say left field, but they continue to occupy a lot of our bandwidth in trying to get some remedies for those two issues. Not to mention we're in that statutory rulemaking season. You know, we're in the part of this of the rule-making process. Our comments have been submitted but the government shut down. But the statutory rules still need to be addressed and worked on.

00:09:48:07 - 00:10:06:27
Stacey Hughes
This is when we spend our time with all the agency leaders, both political and career, and make our case coming off of our submitted comments and the field's comments. So a lot of challenges there, including some proposals on price transparency, obviously 340B, 340B obviously separate from the rule. There's the rebate model.

00:10:06:27 - 00:10:13:05
Stacey Hughes
So a lot is going to occupy our time and trying to influence these next 2 or 3 months for the year , Tina.

00:10:13:07 - 00:10:36:06
Tina Freese Decker
So, Stacy, my final question for you is, you know, you've been in this field for a long time. You know the players, you know the process. What advice can you give to our members as we're hearing about it, navigating through it, trying to be active with our government relations teams and legislative leaders and administrative leaders. What advice can you give to us that we should be doing?

00:10:36:09 - 00:10:53:02
Stacey Hughes
I just think it's engage. Engage, engage, engage. And I think that, you know, while it's a new, you know, group of single party leaders that are in town, I think everyone appreciates being able to hear our story and telling it well and telling it well with data, with real life consequences. And so I think just don't take your foot off the pedal on that.

00:10:53:02 - 00:11:09:12
Stacey Hughes
You know, the whole field really rose up in a way to tell Congress and the executive branch about the impact of the Medicaid cuts that were being considered. And I think we've got to continue to do that as we try to mitigate some of these issues and also make sure we're telling our story where we're innovating. Where we're creating efficiencies.

00:11:09:15 - 00:11:19:11
Stacey Hughes
What we're doing that is helpful in chronic disease. You know, we have a positive story to tell as well. And I think you'll find some, some people are really interested in what we can be doing to help improve health care.

00:11:19:14 - 00:11:38:26
Tina Freese Decker
I think that's a great reminder, Stacy. Of all the positive stories that we have, I was just rounding in one of our hospitals and I'm so impressed by what is happening. There's so many things that are happening to improve patient care that many people, including our legislative leaders, need to understand and recognize and know that they impact that our ability to provide that.

00:11:38:29 - 00:11:51:16
Tina Freese Decker
So thank you so much, Stacy, for your time today, for all of the work you and your team do on behalf of our field. And thank you so much for finding the time to listen to us. We'll be back next month for another Leadership Dialog conversation.

00:11:51:18 - 00:11:53:18
Stacey Hughes
Thank you Tina, appreciate your time.

00:11:53:21 - 00:12:02:03
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.