A National Staffing Emergency in Rural Health Care

00;00;00;26 - 00;00;22;20
Tom Haederle
In your combined years of experience, have you ever met a workforce challenge of the magnitude we currently face? That blunt question posed by John Supplitt, senior director of AHA’s Rural Health Services, to three veteran CEOs of rural hospitals and health systems, drives this podcast discussion of how to handle what everyone acknowledges is a national staffing emergency facing rural providers.

00;00;22;23 - 00;01;00;13
Tom Haederle
The panel's answers and their ideas about how to retain rural health care professionals and attract new ones hold profound implications for the roughly 20% of Americans who rely on their services. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Retaining skilled health care workers in rural settings is more difficult than ever before.

00;01;00;15 - 00;01;23;26
Tom Haederle
There are many reasons for this, not the least of which is competition. Too many badly-needed health care pros are leaving the bedside to pursue other local options, including manufacturing, the hospitality field, even Walmart. The rise in remote work makes things even tougher. Rural health care providers have not thrown in the towel and are strategizing new ways to keep their people and groom a younger workforce for the future.

00;01;23;28 - 00;01;34;23
Tom Haederle
As one CEO puts it, we've got to do a better job of convincing young people that health care is a rewarding career. With that, let's join John and his guests.

00;01;34;24 - 00;02;05;07
John Supplitt
Good day, I'm John Supplitt, senior director of AHA Rural Health Services. And today, we’ll be discussing the chronic workforce shortage that’s plaguing rural hospitals across the country, and the potential solutions to this problem. I'm joined by three rural hospital CEOs who form our panel, and they are Kevin Stansbury, CEO, Lincoln Health, a 15-bed critical access hospital in Hugo, Colorado, located on the high plains midway between Denver and the Nebraska state line.

00;02;05;09 - 00;02;29;05
John Supplitt
Debra Rudquist, who's president of Amery Hospital and Clinic, and this is a 16-bed critical access hospital located in Wisconsin’s dairy land about an hour east of Saint Paul, Minnesota. And Karen Cheeseman, CEO of Mackinac Straits Health System in St. Ignace, a 15-bed critical access hospital with five clinics located in Michigan's Upper Peninsula. Welcome, Kevin, Debra, and Karen to our podcast.

00;02;29;09 - 00;02;30;09
Kevin Stansbury
Thank you, John.

00;02;30;12 - 00;02;31;21
Karen Cheeseman
Thank you, John. Thanks for having us.

00;02;31;26 - 00;02;32;22
Karen Cheeseman
Thank you, John.

00;02;32;24 - 00;03;05;00
John Supplitt
Health care careers are often a calling and a qualified, engaged and a diverse workforce is at the heart of America's health care system. However, and as you know, long-billed structural changes combined with the profound toll of COVID-19, have left rural hospitals and health systems, including post-acute care and behavioral health providers facing a national staffing emergency. Now, in your combined years of experience, have you ever met a workforce challenge of the magnitude that we currently face? Kevin?

00;03;05;25 - 00;03;18;07
Kevin Stansbury
Absolutely not. I've been in this business almost 40 years, and the combination of COVID with the rapid retirement of the boomer generation has really caused employment stresses unlike anything I've ever seen before.

00;03;18;09 - 00;03;18;23
John Supplitt
Karen?

00;03;18;28 - 00;03;24;16
Karen Cheeseman
John, I've not in my 20 plus years. These are unprecedented times, not experienced anything like it.

00;03;24;20 - 00;03;25;11
John Supplitt
How about you, Debra?

00;03;25;16 - 00;03;30;12
Debra Rudquist
No, absolutely not. In a 40-year career. I have not seen anything like it.

00;03;30;14 - 00;03;36;02
John Supplitt
So in this time of scarcity, from whom do you see the greatest competition for your employees? Debra?

00;03;36;23 - 00;03;52;17
Debra Rudquist

Well, John, that really depends on the type of employee. For example, our service workers, we are finding more intense competition from the manufacturing industry in our area. We have a number of them and they're paying very good wages. Also, the Walmarts of the world are competition for us.

00;03;52;20 - 00;03;53;24
John Supplitt
Yeah, the box stores. Karen?

00;03;54;01 - 00;04;10;22
Karen Cheeseman
For me in my area John I live in a highly-driven tourism area and we are experiencing a lot of competition right now in the hospitality field in which we haven't in the past. So competing, as Debra said, in those areas for our support teams has become a real challenge.

00;04;10;23 - 00;04;11;15
John Supplitt
How about you Kevin?

00;04;11;17 - 00;04;11;25
Kevin Stansbury
It's a combination

00;04;12;13 - 00;04;38;21
Kevin Stansbury
of things. This is a new economy that we're operating in and there's a lot more remote opportunities for people to live in rural and work really around the globe. So we're facing competition from employers around the world for the same employees that we used to be able to capture around being one of the larger employers. The other dynamic that's happening is we all live relatively close to the city and the competition for staff in the city is really increasing dramatically.

00;04;38;22 - 00;04;51;06
Kevin Stansbury
So wages are rising very rapidly. We just don't have the reserves to keep up with that. So folks that want to leave for higher pay can find a job in the city within an hour and a half with no problem whatsoever.

00;04;51;07 - 00;05;19;16
John Supplitt
Well, and it's interesting when you think about it, three different communities, three different perspectives, and you're experiencing this competition in three different ways. And I'm sure that's going to resonate with the folks who are listening. So there are several fundamental factors that are shaping the workforce, including continuing shortages of health care workers, the massive turnover, the need to support health workers, mental and physical well-being, inflation, demographic shifts, consumer expectations, the role of technology, reshaping care delivery.

00;05;19;16 - 00;05;28;15
John Supplitt
All these factors are really influencing the shape of the workforce moving forward. What are the forces that are driving the workforce challenges in your organizations? Kevin?

00;05;29;06 - 00;05;49;01
Kevin Stansbury
I think it starts with everything that we talked about in the previous question, but there's also this issue of health care. We've got to do a better job of educating young folks, junior high kids, high school kids, that health care is a rewarding career. Too often, as I speak to young people, one of the first things they talk about is I want to become a YouTuber.

00;05;49;02 - 00;05;59;07
Kevin Stansbury
So there's this idea of the Internet economy has really changed things a lot, and we have to think differently and how we approach young people to attract them into health care.

00;05;59;10 - 00;06;00;02
John Supplitt
How about you Karen?

00;06;00;09 - 00;06;20;12
Karen Cheeseman
One of the things we're really working on, John, is how we partner in a different way with our educational partners throughout the area. So how do we work collaboratively for them to build the programs that that we need to support the workforce? And once they're built, how do we sustain them so that we can continue to meet the supply and demand of the workforce?

00;06;20;13 - 00;06;27;28
John Supplitt
So you've got a four year university, you’re on the Upper Peninsula, four-year university to the north, a community college to the south. How are you working with them?

00;06;28;03 - 00;06;50;14
Karen Cheeseman
Correct. We're spending more time than we have in the past. We've always had the relationships and now we're really looking to have different levels of conversation. So pre-pandemic professionals had a calling to come in to health care, and now I feel as if there's a real level of hesitation, as John said, how do we get them back in, encourage them that these are rewarding and fulfilling careers?

00;06;50;21 - 00;06;59;26
John Supplitt
Debra let me aim this one at you. In which areas or services are you experiencing the greatest workforce shortages and to what do you attribute that problem?

00;07;00;05 - 00;07;26;02
Debra Rudquist
So certainly in our professional types of positions, primarily certified medical assistants, LPNs, R.N.s. We're also seeing intense competition and shortages for lab techs, radiology techs. So most of those areas that require technical and professional degrees, we are experiencing severe shortages. And so as Kevin and Karen have pointed out, we're looking at some very flexible work options.

00;07;26;02 - 00;07;48;14
Debra Rudquist
We're doing pipeline strategies. But one of the things I wanted to mention is how we've had to change in the way that we offer flexible options for our team members. We used to for our certified medical assistance, which is one of the areas of greatest shortage for us in our clinics. We used to primarily hire them to be full time and that meant a four ten-hour workweek, ten-hour day, four days a week.

00;07;48;21 - 00;07;58;03
Debra Rudquist
And now we're asking them what they want to work and trying to be very flexible and give them the types of hours when we can that meet the needs of they and their families.

00;07;58;05 - 00;08;21;05
Kevin Stansbury
Yeah, I agree with that, Debra, that the age of the 12-hour shift or the three eight-hour shifts is over and we have to be much more flexible in accommodating employees’ lifestyles and offering more flexible work assignments. The other thing I would say back to what Karen was saying on the relationship with the education programs, we have to get into our secondary schools, the junior high and the high schools.

00;08;21;08 - 00;08;43;00
Kevin Stansbury
We did a study of the high schools that serve our area. We found that there wasn't a single program, high school that was offering high school-level anatomy and physiology. Really tough to get kids to follow a health care career if they haven't been exposed to those sciences in school. So we hired a teacher to help the schools to rove around to the schools to offer those kinds of programs.

00;08;43;02 - 00;08;50;13
Kevin Stansbury
We have to get much more creative in what we do to extend that from the junior high level all the way up through the four-year education and beyond.

00;08;50;18 - 00;09;02;02
John Supplitt
And so when you're addressing this, it's not just support services and dietary, environmental, but it's also for clinicians, physicians, nurses, professionally-trained and certified clinicians.

00;09;02;08 - 00;09;03;03
Kevin Stansbury
That's correct.

00;09;03;06 - 00;09;03;27
Karen Cheeseman
It sure is.

00;09;03;29 - 00;09;04;22
Debra Rudquist
Absolutely.

00;09;05;00 - 00;09;28;07
John Supplitt
We often hear that to manage the shortage, health care organizations have to focus on programs to boost retention, to take a fresh approach to the skills and the current talent optimization, improve employee engagement, and then ensure the best experience for new staff during recruiting and onboarding. So in what ways have you responded to the need to refresh your approach to recruitment,

00;09;28;09 - 00;09;30;12
John Supplitt
onboarding, and retention of staff? Debra?

00;09;31;02 - 00;09;58;00
Debra Rudquist
Yes, so we invested in a full-time recruiter. We found that we were not aggressive enough in our workforce outreach, and so we now have a full-time recruiter who's in the schools, who's working with the local colleges, and we're very much quicker. We're using social media, we are making offers, same day interviews, we're offering orientation more often and just trying to be very quick and fast in the hiring process.

00;09;58;06 - 00;09;59;00
John Supplitt
Karen?

00;09;59;03 - 00;10;24;18
Karen Cheeseman
Similar to Debra, we're doing some of the things she mentioned and we're also looking as to how we grow our own internally. Again, looking at the supply and demand, what can we do internally? One of the things most recently we've done is we've launched an M.A. medical assistant apprenticeship program and that gives us a lot of flexibility in terms of how we grow and shape those individuals coming into health care.

00;10;24;22 - 00;10;25;16
John Supplitt
Kevin?

00;10;25;16 - 00;10;44;07
Kevin Stansbury
Yeah, I think this is an area where rural actually has an advantage over our larger colleagues in the urban areas. Culture trumps everything, John, and we have the opportunity within rural to really focus on retention and it's a lot easier to keep someone than to hire somebody in. So we're spending more time really talking with our employees about what it is that they need.

00;10;44;07 - 00;11;02;08
Kevin Stansbury
Becoming more engaged as both Debra and Karen referenced. We've got to figure out a way to create an environment where employees really do feel like they're fulfilling the mission of the local hospital. That's easier to do in the rural areas because so often the local folks were born in that hospital or their grandfather worked there or their grandmother.

00;11;02;11 - 00;11;13;10
Kevin Stansbury
So really building that culture of we're serving our community and the neighbors that they've lived with their entire lives really, really helps to kind of build your own, culture trumps everything.

00;11;13;13 - 00;11;20;17
John Supplitt
That does to give us an advantage for sure. I have to ask, is how you're addressing the mental health needs of your caregivers and staff? Debra?

00;11;21;12 - 00;11;38;24
Debra Rudquist
Yes, throughout the pandemic we were very creative and had a number of programs. We had stations or areas at each of our sites where people could decompress. And after that time, we've continued many of those. We have what we call “be well” programs and “be well” moments. And so we build into our daily huddles these “be well” moments.

00;11;38;24 - 00;11;55;01
Debra Rudquist
We actually have a catalog that managers can use of “be well” moments, that can be anything from short meditation to stretching. And so really focusing on those “be well” moments and offering, of course, the employee assistance program when it seems appropriate.

00;11;55;07 - 00;11;55;18
John Supplitt
Kevin?

00;11;55;25 - 00;12;23;13
Kevin Stansbury
Exactly. As Debra was just saying, we've invested in an app, a wellness app that we allow our staff to use for free. We allow their families to access it up to five members of their family, gives them a variety of resources to manage stress or depression, anxiety, financial counseling, health education programs, exercise programs, weight loss. So really trying to engage more and more outside of what normally we would worry about as employers.

00;12;23;16 - 00;12;30;06
Kevin Stansbury
We're really looking at the total health of the employee in order to keep them more engaged with their organization.

00;12;30;08 - 00;12;58;12
Karen Cheeseman
Similar for us, and I think it's important to recognize it's not a one size fits all, you know, model. I think we really have to recognize throughout the past three years what our employees have been through and how we respond appropriately to those situations. Perhaps, let's take childcare for a moment, right. In looking at our younger workforce and the constraints they face today with the lack of childcare and how that impacts their ability to get to and from work.

00;12;58;19 - 00;13;16;16
Karen Cheeseman
Many of our employees are caring for aging parents, so how do we take those things that are outside the typical norm right of the workday but recognize the importance they play in the employee's success and contributions to the organization and how do we help and support?

00;13;16;18 - 00;13;38;10
John Supplitt
Great. And we've touched on this already, but I want to dig a little deeper with respect to how you're motivated to look at new approaches toward introducing health care careers to the community. We've talked about apprenticeships, Karen, and tapping into the schools, high schools and middle schools. Have you explored new career paths to recruit employees in your organizations, and if so, what and why?

00;13;38;10 - 00;13;42;15
John Supplitt
And Karen, you mentioned apprenticeships. Maybe you can explain on that a little bit for us.

00;13;42;18 - 00;14;03;03
Karen Cheeseman
Sure. That was one of the areas that we were really struggling with and just didn't have the resources locally to support the program. So we spoke with another rural partner who had implemented it just over the past year and really learned what does it take, what type of resources do we need, what does it require of our leaders to support?

00;14;03;06 - 00;14;27;11
Karen Cheeseman
And our leaders became very engaged and jumped in at the opportunity to do that, because oftentimes we do have these programs available. The employees that are going through them, the students, rather, at the other locations, the competition's just too great. So if we can get them in the door early and get them exposed to our culture as Kevin mentioned, let them go and try out different areas and explore what we have.

00;14;27;13 - 00;14;32;25
Karen Cheeseman
I just think we have an earlier buy-in and our chance of success is greater.

00;14;32;27 - 00;14;51;08
Kevin Stansbury
You know, building on that, I think one of the important things and Karen, I agree, we've done a lot of the same things in terms of building apprenticeship programs. We've also had to invest more in leadership training and helping our existing staff understand what it means to be a mentor to a young person and what are the skills that they need to have.

00;14;51;10 - 00;15;06;03
Kevin Stansbury
We don't want to really encourage young people to come into our organization and then met with a resistant staff. So they really had to open up and we have to do more to train them on what's expected of them and helping to develop the future of our workforce.

00;15;06;06 - 00;15;34;14
Debra Rudquist
Yes. So in addition to clinical rotations, preceptorships, apprenticeships, another innovative program that we developed was a scholarship program for young people in our area who were not able to afford that one or two year of tuition. And so we, together with our foundation now fund two to four scholarships each year, and those are up to $10,000. And those recipients will have a guaranteed job with us after they complete their education.

00;15;34;20 - 00;15;42;18
John Supplitt
I have to say, the innovation that's coming from the three of you is pretty remarkable in terms of the way you're tackling this experience. Karen, you had a thought?

00;15;42;21 - 00;16;06;07
Karen Cheeseman
I think I wanted to add John is we were finding that our turnover in the first year as we brought new nursing staff in, that turnover was greater in the first year of employment. And so we really stepped back and said, what can we do differently during that time frame? And we partnered with our educational partners again and looked at and really developed a nurse resiliency program.

00;16;06;10 - 00;16;25;06
Karen Cheeseman
And so what that does throughout that first year is it establishes regular check-ins with the nursing team members. And if there are things that are getting slightly off course, it gives us an opportunity to have that check-in in that regular conversation to make sure that we can address any concerns early on.

00;16;25;13 - 00;16;37;06
John Supplitt
Have any of you looked at extending your workforce to include direct care workers such as personal care aides or community health workers or community connectors as an extension of your workforce? Debra?

00;16;37;28 - 00;16;44;25
Debra Rudquist
Not currently, but we've been exploring the idea of a community health worker, and that is something I have a great interest in pursuing.

00;16;45;00 - 00;16;45;10
John Supplitt
Kevin?

00;16;45;16 - 00;17;10;07
Kevin Stansbury
I agree. We've been evaluating different ways to get community paramedicine out into the community more doing wellness checks on our elderly residents, making sure that they're safe at home if we discharge them, how are we following up? How are they making sure that they're getting to their doctor's appointment or getting their prescription filled? And in the remote area in which we live, where it's often necessary to drive 40 or 50 miles to get to the next house,

00;17;10;09 - 00;17;19;18
Kevin Stansbury
we've really tried to figure out what's the best way to do that. And leveraging telemedicine, even if it's just a phone call, has really helped to reach out and do more.

00;17;19;18 - 00;17;47;29
John Supplitt
And that was the next area I wanted to explore. As we're looking at technology and telemedicine robots, any automation that's going to improve the productivity of our staff, including clinical documentations and artificial intelligence to expedite decision-making, it can't substitute for caregivers, but it can enhance their ability to practice efficiently. So do you see a more permanent role for the use of technology in your organizations

00;17;47;29 - 00;17;49;01
John Supplitt
and how would that occur? Kevin?

00;17;49;23 - 00;18;11;01
Kevin Stansbury
Again, back to the community paramedicine. I'm a big fan of our patient monitoring where if we can evaluate what's going on with a patient's blood sugar or their blood pressure, we can track that more regularly on a daily basis and then look when a patient might be starting to decline and then intervene quicker rather than waiting for them to just come to the emergency department.

00;18;11;03 - 00;18;18;24
Kevin Stansbury
So that's one small area where I think in rural that kind of technology is perfectly adapted for the environments in which we live.

00;18;18;29 - 00;18;20;23
John Supplitt
Do you see technology being a solution? Karen?

00;18;21;10 - 00;18;41;23
Karen Cheeseman
I sure do John. One of the things we are preparing to launch here later this summer is a telehospitalist program that will serve our hospitals. So, you know, when you look out in the ability for the rural areas to recruit and retain hospitalists for the lower volume census that we tend to run in the smaller critical access hospitals.

00;18;41;25 - 00;19;09;07
Karen Cheeseman
And you know, you look at the expense that you incur and it's really not doable anymore. So we're looking at how we leverage the technology to support that need remotely. And we're seeing and learning from our partners who have launched this already that they're seeing improvements in admissions and improvements in response times and the overall quality. So I think this is just one example of how we leverage technology moving forward.

00;19;09;14 - 00;19;09;24
John Supplitt
Debra?

00;19;09;29 - 00;19;30;18
Debra Rudquist
Yes. So in addition to telehospitals, virtual visits, all of those things that we've all been working on throughout the pandemic, two innovative areas that we've explored, and one of them we've launched is a telerespiratory therapy service. So one of the areas of greatest workforce shortages for us has been respiratory therapy, and that became very acute during the pandemic.

00;19;30;20 - 00;19;50;03
Debra Rudquist
And so we contracted and we work with a company now for the off hours and the weekends that we have respiratory therapy through the use of telemedicine so our nurses can consult with a respiratory therapist. And that then requires us not to have a respiratory therapist on call. That was one of the biggest issues, was finding people who would do quite a bit of call.

00;19;50;04 - 00;20;07;00
Debra Rudquist
So that was an innovative program we began about a year ago. Thing that we're working on right now is what we call teledoc. It's a service that will allow us to connect with the neonatologists in the Twin Cities. So we continue to maintain an obstetrics programs — very difficult in our environment. I'm sure it is for you as well.

00;20;07;00 - 00;20;23;26
Debra Rudquist
We have just about 80 to 100 deliveries a year, but given our location, we feel that that's an important service to continue. And so having that connection, that real-time connection with the neonatologist available has been a real comfort to our family medicine physicians who do obstetrics.

00;20;24;02 - 00;20;24;14
John Supplitt
Kevin?

00;20;24;16 - 00;20;49;16
Kevin Stansbury
Yeah, I completely agree with that. There's a whole range of specialties that we're now going to be able to make available in our hospital, whether it's telestroke, telehospitalists, teleneonatology. The other thing though, I think going the other way out to our patients’ behavioral health, telemedicine has been a huge boon for behavioral health, especially in rural areas where the stigma of having someone's vehicle parked outside the mental health clinic is a restrictor for them accessing that care.

00;20;49;18 - 00;20;55;18
Kevin Stansbury
If they can make that call from home or off of their cell phone, then that really helps to improve care and access.

00;20;55;20 - 00;20;56;03
John Supplitt
Karen?

00;20;56;10 - 00;21;25;14
Karen Cheeseman
One other thing I would add that we're currently looking at, we're partnering with our group and that supplies our ER physician coverage. And they just recently rolled out an artificial intelligence model that allows them to accurately predict volumes in the emergency room, and so as we look at models like that and we look at nursing resources in how we staff our units, that's something we'll be taking a close look at and in endeavoring upon here in the future.

00;21;25;17 - 00;21;43;06
Karen Cheeseman
So, for example, if we look at an ER time that's predicted to have a lower volume, perhaps I can take that nurse and work with our team to shift that nurse to a different area that may have a greater need on a given area. So really we’re looking at efficiencies and how we move those resources appropriately to meet the needs of the care team.

00;21;43;13 - 00;22;03;04
John Supplitt
You know, this has just been a fascinating discussion on an extremely important subject and I think what we've come to conclude is that the landscape has shifted significantly. But it didn't just happen overnight. It was accelerated by the COVID pandemic, but it has been building for some time. And now it's really in front of us.

00;22;03;04 - 00;22;28;29
John Supplitt
And so it is calling upon us to make some very creative and innovative solutions to a problem that has to be fixed in order for us to continue to deliver the highest quality of care to the people who live in our rural communities. Thank you very much for sharing your insights. Is there a final message that you would like to share with our listeners with respect to the way in which you're approaching workforce and how you see it moving in the next few years?

00;22;29;06 - 00;22;29;18
John Supplitt
Kevin?

00;22;29;23 - 00;22;49;16
Kevin Stansbury
Again, I think rural has an advantage in that we tend to be more nimble. We can take creative ideas and operationalize them very, very quickly and we have the ability to reach out and connect with our employees on a more personal basis. And so I think we need to leverage that advantage to really make workforce success going forward in rural areas.

00;22;49;19 - 00;23;08;17
Karen Cheeseman
I would add on to Kevin's comments, I think that collaboration is more important than ever to sit back and think, well, this is how we've always done it is no longer the case. I think it requires a very collaborative effort and you've got to step outside your comfort zone. These are very different times. And how do we work through them?

00;23;08;19 - 00;23;17;25
Karen Cheeseman
Our communities rely on us. It's our mission, right, to provide that care in our community. And it's going to take a very concerted effort here over the next several years.

00;23;17;28 - 00;23;35;07
Debra Rudquist
I think that growing our own has the major emphasis in our rural areas. It's going to be critical and we have plenty of examples in our medical center where we have staff who started as a dietary aid, patient access assistant, CNA who've now completed their careers and professional degrees.

00;23;35;09 - 00;23;44;10
Debra Rudquist

And that's through our support of that, through assistance with tuition reimbursement and through the pipeline strategies of getting into the high schools and even the middle schools.

00;23;44;14 - 00;24;08;29
John Supplitt
Well, this has been a great discussion of the magnitude of the challenges being faced by rural hospitals and the way that you have stepped up to meet these challenges through your resourcefulness and innovation. I want to thank my guests, Kevin Stansbury, CEO, Lincoln Health, Hugo, Colorado. Debra Rudquist, president Amery Hospital and Clinic in Wisconsin. And Karen Cheeseman, CEO of Mackinac Straits Health System in St. Ignace, Michigan.

00;24;09;01 - 00;24;32;10
John Supplitt
Your perspectives on the workforce crisis, its sources and solutions are much appreciated. And as rural hospitals continue to battle with these workforce challenges, we're going to be looking to you and your colleagues for continued insights into what works and how we can improve access, quality and outcomes for our patients and the communities we serve. I'm John Supplitt, senior director of Rural Health Services.

00;24;32;12 - 00;24;38;08
John Supplitt
Thank you for listening. This has been an Advancing Health podcast from the American Hospital Association.