Peer-to-Peer Solutions for a Healthy Workforce: Lessons from NYC Health + Hospitals

00:00:00:19 - 00:00:25:16
Tom Haederle
In recent years, and especially since the pandemic, we've been paying a lot more attention to the mental and physical well-being of the nation's caregivers. Many hospitals and health systems have put wellbeing initiatives in place, designed to shore up and support their workforces who give so much to their patients every day. It's a trend that's time has come. But implementing programs to make a difference across very large organizations is a particular challenge.

00:00:25:18 - 00:00:40:28
Tom Haederle
Stay with us and hear how one very large organization has tackled it successfully.

00:00:41:01 - 00:01:14:00
Tom Haederle
Welcome to Advancing Health, the podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. With 45,000 employees serving patients in more than 70 care locations across the five boroughs of New York City, New York City Health + Hospitals is the largest municipal health care delivery system in the United States. Helping Healers Heal is the name of its peer-to-peer network that supports its vast workforce, helping doctors, nurses, and care teams across all of its service lines stay healthy and operating at peak performance.

00:01:14:03 - 00:01:29:12
Tom Haederle
In this podcast, Jeremy Segall, who oversees the initiative, says his approach to looking out for the well-being of so many employees is guided by a simple philosophy. In his words, "we can no longer split who we are personally from who we are professionally."

00:01:29:14 - 00:01:49:22
Elisa Arespacochaga
Thanks, Tom. I’m Elisa Arespacochaga, AHA vice president of Clinical Affairs and workforce, and I'm excited to be joined today by Jeremy Segall, assistant vice president and system chief wellness officer at New York City Health + Hospitals. And today, we're talking about his work in wellbeing and how he's used his background to really lead wellbeing across a very broad, very diverse system.

00:01:49:24 - 00:01:55:21
Elisa Arespacochaga
So, Jeremy, just to get started, tell me a little bit about yourself and your role at New York City Health + Hospitals.

00:01:55:24 - 00:02:12:22
Jeremy Segall
Well, first and foremost, thank you so much for for having me. Truly, it's a pleasure and privilege to be here to share not only my personal story as the inaugural systems chief finance officer at NYC Health + Hospitals, but to also talk about NYC Health + Hospitals wellbeing journey. And it definitely has been one, to say the least

00:02:12:28 - 00:02:43:17
Jeremy Segall
as I became the system chief wellness officer in practically March of 2020. My name is Jeremy Segall. I am the assistant vice president and system chief wellness officer, but I actually oversee the human experience continuum. For those that are not familiar with the terminology, I oversee, really the broad spectrum of how we not only care for the workforce, wellbeing and wellness initiatives for the system, the teams and the individuals that, kindly work for our system but also oversee employee engagement.

00:02:43:19 - 00:03:10:03
Jeremy Segall
But I also oversee patient, resident and community experience as well. My journey started at NYC Health + Hospitals a little over 14 years ago. I'm a licensed creative arts therapist by trade. I was working psychiatric inpatient service for many years, and, slowly but surely found myself in performance improvement, for behavioral transformation. When district was coming down the line, to really match and meet some of the state needs for behavioral health services.

00:03:10:10 - 00:03:31:27
Jeremy Segall
And with my experience in performance improvement, they actually brought me over to be one of the first directors of performance improvement over an entire facility. This was Kings County, in East Flatbush, Brooklyn. And so I did performance improvement for many years there before I was again promoted to central office now, about almost eight years ago, to oversee performance improvement for the entire acute care service line.

00:03:32:00 - 00:03:52:25
Jeremy Segall
So all 11 hospitals - was overseeing quality improvement programing there. That actually led me into wellness. As our newest administration came in a little over six years ago. With it, ad this was brought over by Dr. Mitchell Katz, our current president and CEO. and then Dr. Eric Wei, our senior vice president, over the office of quality, safety and system chief quality officer.

00:03:53:03 - 00:04:16:16
Jeremy Segall
They brought with them helping healers heal from L.A. County, USC, which is the second largest public health care system. And we see NYC Health + Hospitals as the largest municipal public health care delivery system in the nation. And they had already started a second victim response initiative there. One of the first top down initiatives, because they wanted to put emphasis back on the most important asset, which was the people, so that we could take care of them so that they could then take care of the system.

00:04:16:23 - 00:04:39:20
Jeremy Segall
And because I have a behavioral background and am a licensed clinician and still practice clinically four nights a week, and because I was doing system transformation and change management through performance improvements, they thought I was the perfect person to co-lead, this project at first. And it really began to, to evolve over time. As the pandemic was upon us,

00:04:39:22 - 00:05:07:17
Jeremy Segall
it was February, and I was practicing clinically. And that week, all nine of the patients had started to talk about Covid 19 in their individual sessions. And so I came back to Eric and I said, hey, I think we should probably start talking a little bit more, in our psychological and emotional debrief process, which is known as Helping Healers Heal, brand term for our wellness program, also known as H3 debrief, which is a non-clinical intervention.

00:05:07:17 - 00:05:25:08
Jeremy Segall
It's about empathetic listening, compassionate caregiving for the caregivers. But just a way for us to talk more about what's the experience that they're having so that we can also share resources. So, I start to say, should we be having some system debriefs around this? We all knew that we were preparing for emergency management  - was already on top of it.

00:05:25:10 - 00:05:45:13
Jeremy Segall
And then a few weeks later, stay at home orders. And so I became the central critical response lead as part of our emergency management command center, for the entire public health care delivery system spanning all five boroughs, all care settings and service lines. So that's how I was unofficially brought into the role. And then officially, position was created.

00:05:45:13 - 00:05:47:03
Jeremy Segall
And here I am today.

00:05:47:05 - 00:06:08:13
Elisa Arespacochaga
Wow. So two comments that immediately come to mind. You clearly get more hours in the day than the average person or something. Given your, expansive role. But timing is really everything. You certainly landed with both feet very much in the deep end. You mentioned a few things that are part of your program and part of the wellbeing effort you've been leading.

00:06:08:15 - 00:06:16:05
Elisa Arespacochaga
As you were sort of talking at, you grew with it. You created it as you were going. But can you tell me a little bit about what it encompasses now?

00:06:16:07 - 00:06:39:18
Jeremy Segall
Yeah, absolutely. I think we were flying the plane as we were building it, as cliche as that sounds, for many, many years, specifically at the onset of the pandemic. But we were really, really, lucky, if you will, to have the foundational elements of the Helping Healers Heal program already established as of 2018. From 2018 to now, it has really evolved and transformed over time.

00:06:39:20 - 00:06:58:06
Jeremy Segall
And so, as I mentioned, it first came to the system as a second victim response initiative. It was based off of Dr. Susan Scott 4U team. So pretty much like a rapid response team. If there was ever a sentinel event or an adverse patient, outcome or experience, we would wraparound support services for individuals and teams. And that took off.

00:06:58:12 - 00:07:24:01
Jeremy Segall
We built 18 Helping Healers Heal teams across all service lines, training up helping initial leads, what we call peer support champions. Anyone could get involved because it was a peer support network is peer-to-peers, you know, really listening to each other and providing guidance and support. And so over time, from 2018 to 2019 further evolved into something that was a little bit more inclusive of just the general experience of the health care workers.

00:07:24:01 - 00:07:54:13
Jeremy Segall
So we started to talk more about general compassion fatigue and burnout and vicarious traumatization. And we started to change the nomenclature to not just be around risk or error as second victimization, sometimes, you know, is more connected with. You know, there's a story here. Obviously I have a quality assurance and improvement background. So as I was really looking at a lot of the trends of what debriefs were about, and all we do is document quality assurance data in terms of how long are the debriefs, what were they requested on behalf of? Things of that nature?

00:07:54:16 - 00:08:14:03
Jeremy Segall
We're never actually documenting what specifically's going on or who we're speaking with, so on and so forth. And there was a story that came up that a debrief was requested on a labor and delivery unit at one of our facilities, and that had nothing to do with patient care, or a shoulder dysplasia or maternal child loss or scary event that shook the staff.

00:08:14:04 - 00:08:41:15
Jeremy Segall
It was actually about a nurse that had worked there for over 20 years that, unfortunately was diagnosed with terminal stage 4 cancer, and that it was her last shift. And the staff knew that after her last shift, they would most likely never see her again. And so they wanted a group debrief to just talk through their experience. And that was the moment the light went off for myself and our HB3 steering team, for the system, which was we can no longer split who we are personally from who we are professionally.

00:08:41:17 - 00:09:03:17
Jeremy Segall
And whatever happens in and around our life, our experience affects how we care for patients. And we have to be able to care for ourselves in those moments. And so that's really what helped us further evolve it. And then boom, the pandemic was upon us. And of course, we had to then really shift gears to be about critical and crisis response, universal individualized traumatization.

00:09:03:22 - 00:09:18:11
Jeremy Segall
And so for the first two years of the pandemic, we were really focusing on that, as well as stress on the continuum that we learned from the US Department of Defense that was supporting us, throughout that very uncertain time. And then it was around late 2022, that we said we can no longer be about firefighting.

00:09:18:11 - 00:09:37:18
Jeremy Segall
We can no longer just be about crisis, right? Wellbeing cannot just be about when the pot is boiling over and it's too late. It has to be something that we can get in front of. And so that's where we started to say, let's let's be proactive here. Let's be preventative and let's start thinking about wellness holistically. Because wellness is not just about mental health.

00:09:37:18 - 00:09:51:23
Jeremy Segall
And I'm a licensed psychotherapist in the state of New York, right. Mental health is very important, but it is not all of wellbeing. And we don't have the medicalized wellbeing, nor should we.

Jeremy Segall
So we decided to create that holistic, proactive, preventative model. And we created an alignment to the eight dimensions of wellbeing. And now there's many more dimensions that are being published upon.

00:09:55:22 - 00:10:19:16
Jeremy Segall
But we really choose to focus on emotional, environmental, intellectual, financial, occupational, physiological, social and spiritual well-being. And aligning free, or subsidized as well as confidential private programing for all workforce members to be able to, you know, feel taken care of and to be supported. So the program is really evolved into that. And our interventions also really evolved.

00:10:19:16 - 00:10:41:12
Jeremy Segall
So while we first started helping in this field to be about emotional and psychological support debriefing, - nonclinical again, led by peers - we then changed our approach. We knew that people couldn't get off the floors for the pandemic. So we started proactive unit-based wellness rounds to collect the temperature, to share resources knowing that the two biggest barriers to wellbeing is number one, stigmatization.

00:10:41:12 - 00:11:01:25
Jeremy Segall
And number two, not knowing what's available. And so those proactive wellness rounds, we've done over 40,000 since 2020, has really made a difference in terms of how people access support services. And then that's what also gave birth to our wellness rooms, as well as many other, approaches to wellness events. So some people don't like to talk about their wellbeing.

00:11:01:25 - 00:11:22:18
Jeremy Segall
Some people need to process and express it non-verbally. So as a licensed creative arts therapist myself, and having the largest complement of licensed creative arts therapist in the nation working for a public system, having psychologists and social workers, arts and medicine programing, we started to put together wellness events, using the healing mediums of art practice for support, for staff.

00:11:22:20 - 00:11:44:00
Jeremy Segall
And so that really was incredibly, successful. It's actually the highest rated intervention that the workforce enjoys. And we've done almost 6,000 wellness events since 2020. And then we also obviously had a training approach change and how we could really create pedestrian approaches, if you will, to understanding how to be and feel well and how to spot when someone is not.

00:11:44:06 - 00:11:55:25
Jeremy Segall
And then, of course, now we're doing, tailored retreats for both engagement well-being. So I could talk for hours just on that alone. But one thing I do have to say is it is available to all because we have to have equity and well-being.

00:11:55:27 - 00:12:18:09
Elisa Arespacochaga
Oh, absolutely. And I love the idea that, you really took your own background and brought it to the breadth of resources that you're offering, because each person is going to be different, is going to need different things. And really creating that space for everyone to be able to express themselves as works best, I love that. So let me pick up on that idea.

00:12:18:11 - 00:12:40:27
Elisa Arespacochaga
I mean, you really you grew up in patient safety and quality and improvement, and you've integrated that into your wellbeing program, marrying to the quality and patient safety structure of the organization. Because among other things, and I know when we talked earlier, you mentioned this, you're doing this on grant funding, shoestring and, a wing and a prayer, largely.

00:12:40:27 - 00:12:42:19
Jeremy Segall
A zero operating dollar budget.

00:12:42:22 - 00:12:56:17
Elisa Arespacochaga
Absolutely. So can you talk a little bit about how you've made those connections to be able to offer this across 11 hospitals and really tie it to the work of performance improvement across the system?

00:12:56:20 - 00:13:17:12
Jeremy Segall
Yeah, absolutely. So just a few things about NYC Health + Hospitals. It has 11 acute care hospitals. We have five post-acute long term nursing care facilities. We have what's called Gotham Health, which is our ambulatory care for UHC network, of over 13 large diagnostic centers and up to 70 satellite clinics. We oversee emergency medical practices. We have correctional services

00:13:17:12 - 00:13:40:26
Jeremy Segall
so overseeing the jail systems, health and well-being programing for persons in custody. We have community care and home health services. We have urgent virtual express care as well as in-person express care. And, we also have a central office service line. So all of our well-being programing has to, because that's the right thing to do across all service lines, all departments, all disciplines and all tours.

00:13:40:26 - 00:13:59:21
Jeremy Segall
So it's not just hospitals. And so, you know, you can't really have quality, you can't have patient safety if you don't have wellness. I mean that's the preceptor for all things. So at NYC Health + Hospitals our business case is: the healthier you are, the more engaged you are. The more engaged you are, the higher the quality and safe patient care we deliver.

00:13:59:21 - 00:14:26:08
Jeremy Segall
And then we'll meet the needs and satisfy our, our patient residency populations' expectations. And so, you know, the business case is in terms of health and well-being, if we see, hear  honor, recognize and respect our workforce and also destigmatize utilization of services and also provide time and encouragement to utilize those services, the healthier the staff will be, hopefully both inside and outside of work.

00:14:26:11 - 00:14:42:02
Jeremy Segall
When they are healthy, then they can be more engaged. And often people think employer engagement is about, oh, did they go above and beyond the call of duty? Engagement is: do you remember why you fell in love with health care in the first place? Do you remember why you chose NYC Health + Hospitals or just the helping professions in the first place?

00:14:42:04 - 00:14:59:01
Jeremy Segall
Are you able to see the difference you make? Do you remember why you like the work that you do through the veil of stress that we experience? There are ample bio-psychosocial, spiritual stressors day in and day out in health care, but an engaged employee is able to cope through those and move through them and see the greater good of what they're doing.

00:14:59:03 - 00:15:15:13
Jeremy Segall
Not only because it aligns with their own mission and purpose within themselves as an individual, but then it aligns the mission, vision, and values of NYC + Hospitals. That's what engages employees. And then we know that an engaged employee is three times more likely to have a near miss or an early catch, which translates to patient safety.

00:15:15:16 - 00:15:52:02
Jeremy Segall
And then of course, the higher quality safe care, the better we're going to support our patient populations that are part of our treatment team as we see it. And then hopefully we're also doing with more compassion, empathy because we're well, which then meets their needs. And then they rate and recommend our services. That's the business case. And that's that beautiful loop reminding us of what the internal I would say, I guess intrinsic, and extrinsic reward systems are of being a health care worker. But in terms of quality and patient safety and how wellness has been integrated, I've always seen that wellness is what establishes psychological safety. And without psychological safety, we

00:15:52:02 - 00:16:17:17
Jeremy Segall
cannot have people that are willing to speak up to say that there was a mistake or there was an error, that they see something and are saying something without fear of punitive practice or retaliation, right? So the more that we could create a culture of compassion, the more that we can create a culture of comfort and the more that staff feel taken care of, they'll want to actually take better care of their team, of the system and take greater pride in the work that they're doing.

00:16:17:21 - 00:16:49:12
Jeremy Segall
So I don't think you can have PDSA cycles. I don't think you can have, you know, test of change and a change management framework without psychological safety and you can't have psychological safety without wellbeing. A large part of the core of patient safety is teamness, cohesion, communication. And you can't necessarily have teams steps, let's say, and a patient safety framework or toolkit if you don't have healthy communication, healthy engagement with team because there's trust and respect and value.

00:16:49:17 - 00:16:57:08
Jeremy Segall
And so wellness really establishes and nurtures that culture. So I actually don't see them very separate from each other.

00:16:57:10 - 00:17:21:21
Elisa Arespacochaga
Couldn't agree more. And having gotten to hear you speak on the work that you've done, that was really the first thing that that really grabbed my attention and intrigued me, because you're one of the few chief wellness officers who isn't coming from the physician ranks, who is coming from that therapy background and really that understanding, that is maybe a little bit different than some of your physician colleagues.

00:17:21:26 - 00:17:31:20
Elisa Arespacochaga
So can you talk just a little bit about how that you've brought that, lens that with which you look at the world, focused on therapy into your work?

00:17:31:23 - 00:17:48:00
Jeremy Segall
You know, it's interesting, when I first became chief wellness officer, everyone kept calling me doctor. And I was like, no, no, no, definitely not a doctor. But I am a drama therapist. And, you know, like, what is drama therapy? And so licensed creative arts therapy obviously is a licensed psychotherapeutic practice that is licensed in the state of New York.

00:17:48:02 - 00:18:12:00
Jeremy Segall
There are five licensed modalities. It is a clinical practice. It is a treatment approach, goals and objectives, just like any other modality, or anything under the umbrella of psychotherapeutic services, CBT, DBT, trademark therapy. The great thing about the arts is when you are creating you are not destroying, and when you're creating, you have opportunities to also heal in that process.

00:18:12:07 - 00:18:30:19
Jeremy Segall
And so I have this lens, of how do we create a safe play space as a drama therapist for us to all get back in touch with who we are as people to express that out and to have that reflected back to us because everything is a mirror. And so, to be honest, I don't necessarily believe that a chief wellness officer has to be a physician.

00:18:30:21 - 00:18:59:02
Jeremy Segall
I believe that anyone with social and emotional intelligence and anyone that has the hope or intention that wellness can thrive in a very challenging environment and can strategically, methodologically approach it, can succeed in this position. So I do believe that we're going to see chief wellness officers, social workers, licensed creative arts therapists, psychologists, nurses, doctors, and other administrators that potentially understand how important it is and have the nature and demeanor that that can really partner well with it.

00:18:59:04 - 00:19:20:09
Jeremy Segall
You know, the thing about chief wellness officers being physicians is: there's a reason for it because we are still losing every single day one doctor to death by suicide. Still, to this day, if you are a female identifying physician you are almost 2.5 times more likely to die than the general populace. If you're a male identifying physician, you're about 1.3 times more likely to die by suicide.

00:19:20:09 - 00:19:44:09
Jeremy Segall
It is an epidemic. For medical school, 3 to 4 hundred doctors are being wiped out a year. And so I understand why chief health officers had to start as physicians and physicians generally have a great overview or oversight and understanding of of health care delivery systems and services. But we never want well-being to be about only providers of care. APP or nurses or whatnot.

00:19:44:16 - 00:20:18:26
Jeremy Segall
You know, the whole thing about, wellness, there needs to be representation in wellbeing spaces and there needs to be equitability in wellness spaces. And I already mentioned that it should be available to all non clinicians and clinicians. It doesn't matter who you are as a health care worker. You deserve that support. And so by coming into this role you know I think why it's worked well thus far is because I have the ability through performance improvements and QI principles that I was practicing and working on in the health care delivery system for many years prior, that I was able to turn vision and strategy into execution.

00:20:18:28 - 00:20:46:25
Jeremy Segall
The key to any successful chief wellness officer is can you have an enterprise service line, sight team, and individual approach to well-being and programing and that you can actually turn that into fruition and something that's tangible, concrete and measurable. So I believe anyone can really be a chief wellness officer as long as they're willing to mitigate and prevent risk and to turn those strategies into something that is understood by the staff, why its so needed and invaluable.

00:20:47:03 - 00:21:14:10
Jeremy Segall
And I would also say, I think being a psychotherapist and how it is helped me as a chief wellness officer, because I don't just sit in an office and create, you know, talks and PowerPoints and strategic plans and put together surveys. I am actually at the sites. I am actually conducting psychotherapeutic support services for the system in non-clinical intervention approaches like those debriefs I mentioned being in the wellness rooms, actually offering support.

00:21:14:10 - 00:21:51:10
Jeremy Segall
Yesterday I did a two hour retreat, for a finance department that was struggling. It's about doing the work, rolling up your sleeves and being with the people to learn from them. And not just through survey responses, but from touch points, actually visibility and transparency. And again, being a psychotherapist, I'm able to sit in discomfort. And anyone that is going to be chief wellness officer has to sit with the turbulence of well-being, in a very uncertain health care climate, whether you're in a public sector or private sector, whether you're a safety net hospital system or not, there's a lot of discomfort that you have to tolerate and be able to support from, a

00:21:51:11 - 00:21:56:24
Jeremy Segall
strategic enterprise level, from a business level, but also from a person to person level.

00:21:56:27 - 00:22:21:17
Elisa Arespacochaga
And it sounds like really you not only walk the walk on the ground with your teams, but very much are thinking about this from the perspective of the entire team supports your entire community. And so, you know, whether it's the person delivering the food or the front desk or the clinician who's providing the care, everyone needs to be in a place where they can support the community they're trying to serve.

00:22:21:17 - 00:22:38:02
Elisa Arespacochaga
So, Jeremy, I can't thank you enough for joining us and for sharing your story and the work that you're doing. And I want to continue to check in with you and see what else you've created. And, you know, built for your community. And as a native New Yorker, I very much appreciate it.

00:22:38:04 - 00:22:43:12
Jeremy Segall
Thank you so much. It honestly is such a pleasure and privilege.

00:22:43:15 - 00:22:51:25
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.