Advancing Health Podcast

00:00:00:02 - 00:00:22:28
Tom Haederle
Welcome to Advancing Health. People facing psychiatric or substance use disorders have enough to deal with without the added burden of shame or stigma attached to their challenge. Today, we hear about the power of a large health care organization that's decided to push back against stigma and the difference it's making.

00:00:23:01 - 00:00:50:25
Rebecca Chickey
My name is Rebecca Chickey, and I'm the vice president of behavioral health and trustee services for the American Hospital Association. It's my honor today to be joined by three exceptional behavioral health leaders from CommonSpirit. Dr. Sapra, who is the system vice president for behavioral health, Kathy Krebs-Dean, who is director of behavioral health expansion and development, and Robin Conyers, vice president of CHI’s Behavioral Health.

00:00:50:28 - 00:01:16:29
Rebecca Chickey
Thank you so much for joining us here today to talk about your incredible stigma reduction campaign as it relates to the stigma surrounding psychiatric and substance use disorders. The treatments for those and the individuals who suffer well from those conditions. So, Dr. Sapra, I'm going to ask you to kick us off for those people for whom CommonSpirit is a term they'd never heard,

00:01:17:02 - 00:01:31:12
Rebecca Chickey
doubtful if they're in the health care field. But sometimes we get non-health care, listeners to our podcast. Tell us about CommonSpirit's footprint. Just give the listeners a sense of when I say CommonSpirit, what that means.

00:01:31:15 - 00:01:57:00
Manish Sapra, M.D.
Yeah. So, CommonSpirit is one of the largest health systems in the country. It was formed in 2019 with the alignment of Catholic Health Initiatives, or  with CHI and Dignity Health. And together, these institutions bring over 150 years of combined experience, with focus on providing compassionate health care, especially to vulnerable populations. We have a broad national reach.

00:01:57:02 - 00:02:18:22
Manish Sapra, M.D.
Approximately 1 in 4 Americans live within the CommonSpirit service areas. And we operate over 160 hospitals in 24 states. Our national footprint and the dedication to our core priorities, like compassionate care, high quality health services, and social justice position us uniquely to confront behavioral health disparities.

00:02:18:25 - 00:02:41:29
Rebecca Chickey
I really appreciate the fact that you continue to talk about the mission and vision, and how because of that CommonSpirit has dedicated a number of resources related to behavioral health. So I'm going to turn to Kathy, though, because today, the focus of our podcast is really the journey that CommonSpirit has been on to reduce the stigma surrounding behavioral health.

00:02:42:01 - 00:02:52:06
Rebecca Chickey
And, Kathy, I'm going to put you on the spot, ask you to share, you know, why did CommonSpirit make such a strategic investment in an anti-stigma campaign?

00:02:52:08 - 00:03:03:28
Kathy Krebs-Dean
This is a system wide effort to address and reduce the stigma that's associated with substance use disorder. And it's intended to improve patient care and outcomes. It has three main components.

00:03:04:06 - 00:03:31:16
Kathy Krebs-Dean
First and foremost, there is a data driven foundation. We surveyed over 500 providers to get a sense of knowledge, attitudes and beliefs. And the results that we obtained confirm there's a high recognition of substance use disorder as a medical condition and strong support for medication assisted treatment, and also help to inform some of the targeted interventions that we're doing including our anti-stigma education campaign.

00:03:31:18 - 00:04:02:00
Kathy Krebs-Dean
So that campaign has been phenomenally well embraced by our associates and providers. It's a voluntary training and, we also have a train the trainor component so that there's an opportunity to help us scale this further. There's aspects that include impactful storytelling. So we created a video series to share the powerful impact of stigma and its reduction from the perspective of both patients and then also from providers.

00:04:02:03 - 00:04:26:16
Kathy Krebs-Dean
And, we're also dovetailing with some of the work that we're doing around the clinical care. So there's an intersection with some of our community commitments, such as increasing access to care to our emergency department, addiction care, for people that are impacted by opioid use disorder. And then last but not least, we have this focus on language and culture that's woven in.

00:04:26:19 - 00:04:41:26
Kathy Krebs-Dean
And this is made possible through our partnership with the American Hospital Association and the 'People Matter Words Matter' campaign. And that's all about promoting consistent use of non-judgmental language across our facilities and then upholding this culture of understanding and support.

00:04:41:29 - 00:05:03:21
Rebecca Chickey
There is such a broad swath and different types of stigma as Dr. Sapra mentioned earlier, I think that makes so much sense to focus on one core piece and make an impact on reducing the stigma around addiction, because I do believe in many cases and perhaps your survey showed this - be interesting to know if it did - that

00:05:03:23 - 00:05:28:24
Rebecca Chickey
often there's more stigma around addiction or substance use disorders than, let's say, major depression or anxiety. If that is the case, then you picked a tough nut to crack, as they say. And, just really, I'm so grateful that your going down that that journey. I'd also like to thank you for mentioning People Matter, Words Matter.

00:05:28:25 - 00:06:05:25
Rebecca Chickey
That was an initiative that the American Hospital Association started back in 2021. It's a series of posters. The first one surrounded on people first language and the importance of that. We worked with member organizations around the country to create these posters, to help educate around what words or phrases are stigmatizing and perpetuate that, and then offering solutions and alternatives for our own workforce to know so that they can choose their words and use their words more carefully to reduce the stigma.

00:06:05:28 - 00:06:29:21
Manish Sapra, M.D.
Yeah, I think it's really goes back to the values that I was describing, right. And, you know, I feel like how we ended up here is understanding the value  of large organizations inability to affect stigma. And, you know, to understand that we probably just need to understand stigma a little bit more. You know, stigma comes in multiple layers or contexts.

00:06:29:23 - 00:06:57:06
Manish Sapra, M.D.
For example, this cultural stigma that we all sort of know, which is societal or community beliefs, values and traditions that view mental health as shameful, taboo or sign of weakness. And there is institutional stigma, right? Or a structural stigma that affects policies and laws and regulations which may lead to like lower funding of mental health, whether it's research or services or within the organization, you know, helping grow these services.

00:06:57:09 - 00:07:19:25
Manish Sapra, M.D.
There's, of course, the interpersonal stigma that we feel towards, you know, family, friends or coworkers. Even into professional stigma, right, where for folks who have had a history of mental illness working together with us, I think the employers or organizations have a lot of responsibility in busting the stigma. CommonSpirit really looked at it as an institutional priority.

00:07:20:03 - 00:07:37:29
Manish Sapra, M.D.
And again, as a responsibility of what a large organization, especially in health care, which is providing behavioral health, which includes substance use, as you said earlier and took that initiative. And I'll ask, Kathy to chime in here and just give us the history of when this program started about three years ago.

00:07:38:02 - 00:08:15:07
Kathy Krebs-Dean
Well, I would say that this work has been deeply aligned with our mission, our focus on compassion and our tagline: Hello, Human Kindness. There's no greater kindness than fostering a culture of non-judgment. So it definitely supports a culture that is supportive not only of our patients, our providers, but also our wider communities that we serve. And then there's been this catalyst from our philanthropic partners, this investment in helping to create and sustain this work over the last three years.

00:08:15:09 - 00:08:39:13
Kathy Krebs-Dean
And they helped us to create, for instance, some wonderful content, the video series on the impacts of anti-stigma and the reduction of that. The training program that we're utilizing. So all this has helped to create this momentum, and this interest across our system and then finally, without a doubt, it's been incredible to see the passion of our associates and our providers.

00:08:39:16 - 00:09:00:12
Kathy Krebs-Dean
This has been sort of a bit of a grassroots movement in that it's, been widely embraced by people. And I think it's because of the fact that many people have been personally impacted by substance use disorder. They realize just how widespread it is and how, how it impacts so many lives. And there's a lot of enthusiasm about being part of this transformative work.

00:09:00:15 - 00:09:19:26
Kathy Krebs-Dean
And that manifests in ways like some participating in training, some teaching the training, and then, utilizing our videos as as reflection and in meetings and that sort of thing. So it's been incredibly impactful. And I think we've been seeing a lot of interest in continuing the work.

00:09:19:28 - 00:09:23:08
Rebecca Chickey
Thank you for making that idea kind of come alive

00:09:23:11 - 00:09:49:08
Rebecca Chickey
across the footprint of CommonSpirit, because that's where the real work is, in your organizations, in your hospitals, day in, day out. And to see it spread across the country. Robyn, let's turn to you now. Cathy described the overall anti-stigma campaign across the footprint of CommonSpirit. But it's my understanding that it was really your grassroots efforts in your own organization

00:09:49:08 - 00:10:17:26
Rebecca Chickey
that really was where this initiative was given birth, as they say. So can you help the listeners understand how AHA's People Matter, Words Matter substance use disorder posters have been used? What that looks like, physically, would they see posters? Would it be on screenshots? Really help paint a picture for the listeners - how you rolled this out at your own organization?

00:10:17:29 - 00:10:37:25
Robin Conyers
Sure. So being members of the AHA and having the listservs and the communication come out, we heard about, People Matter, Words Matter initiative. And I was just so intrigued by the impact that it could have within our organization and really even beyond. In behavioral health, we're always looking for ways to educate and to break down stigma.

00:10:37:27 - 00:11:15:15
Robin Conyers
And these posters, the series of posters that have come out and have continued to be refined over the years are just such a simplistic way to educate and to bring it into a layperson's terms, if you will, of being able to have conversations. And so as I was reading these posters, obviously overseeing behavioral services in the Omaha, Nebraska area and southwest Iowa, this was an easy way to work within our organization to say, hey, we're a large footprint of behavioral health, but yet we know behavioral health patients see primary care, they see ObGyn, they see orthopedics.

00:11:15:15 - 00:11:36:17
Robin Conyers
They have, you know, oncology and a variety of areas. And is there a way that we can speak these words and this platform of the emphasis that people matter, words matter. Again, such simplicity that the AHA came up with, how can we work with outside behavioral health with our partners to educate? And so I met actually met with our vice presidents of patient care,

00:11:36:17 - 00:11:58:22
Robin Conyers
so our chief nurses within the organization to see if they had an interest in owning that for their campuses or within our primary health clinics. I met with our marketing teams, and what we ended up doing with our marketing teams was we partnered with AHA to - all of a series of posters - to put the AHA logo if you will, along with our CHI health logo on the bottom of the posters

00:11:58:22 - 00:12:19:05
Robin Conyers
so that show in partnership of this work that's together. And then we also paired the variety of the posters with the months. So there's a eating disorder month, there's mental health awareness month, there's posters specific to suicide awareness. So there's pertinent p posters that align very nicely with, if you will, areas of the month of focus across the country.

00:12:19:05 - 00:12:47:14
Robin Conyers
And so, as we put those posters together, we tied them, if you will, with a focus of the month, a topic of the month that paired well. And then we also designed the ability for posters, table tents in the dining areas. The other unique thing that we did within our marketing department is recognizing that perhaps a poster of focusing on eating disorders may not be top of mind that patients or families are coming in for treatment in regards to orthopedics, but they're seeing their orthopedic provider, if you will, in their clinic.

00:12:47:16 - 00:13:04:18
Robin Conyers
Yet recognizing they could put those posters up in those clinics so that individuals could see them while they're waiting for their provider to come in. But it allowed the nimbleness too for those clinic leaders to pick the posters that are pertinent to their areas. So we're not putting something up that really has not no applicability to the patients they're serving.

00:13:04:21 - 00:13:26:15
Robin Conyers
But there are other broader topics of recognizing caring for the caregivers, suicidality, substance use disorders that could have applicability across the board. So we started that grassroots, really in the Omaha area, piloted it, met with our executive leaders, within CommonSpirit Health in the behavioral health service line, talked about how this could have a broad implication within all of CommonSpirit Health, if you will.

00:13:26:17 - 00:13:48:11
Robin Conyers
And so then what we did was we worked with our national teams, took those posters, and we have them now digitally readily available for any leader within CommonSpirit Health can go in, pick whatever subject they want, whatever poster they want, and they can also then choose their markets or the their name of their hospital or their clinic, and they can put that at the bottom of their poster as well.

00:13:48:11 - 00:14:14:03
Robin Conyers
So it shows a nice collaboration amongst the AHA initiative and tying it into with the department, if you will, in market that we're in. So because as Dr. Sapra talked earlier about our broad brush and where we're at within, across the country, to this day by launching that beyond just the Omaha, Nebraska - Council Bluffs Iowa market, we have over 2000, materials that have been downloaded within CommonSpirit Health.

00:14:14:03 - 00:14:25:20
Robin Conyers
So we have a broad brush across the country, that really has a vested interest in adopting these materials as well. So it has grown way beyond just the Nebraska-Iowa markets.

00:14:25:23 - 00:14:36:05
Rebecca Chickey
So, Robin, now that the initiative has been in place for a year or more, what impact have you seen? Has there been a change in culture?

00:14:36:08 - 00:14:43:13
Rebecca Chickey
A change in tone? Have you seen people actually using the different words that are suggested on the posters?

00:14:43:15 - 00:15:00:23
Robin Conyers
The visibility alone, if you're in an elevator, reading the information that's there while you're waiting for, you know, to go up and down the floors or you're waiting for your provider to come in your clinic setting. I actually was just in my primary care clinic last week, and as I was sitting for the provider to walk in, I look to the right and there's a poster on the door.

00:15:00:26 - 00:15:22:24
Robin Conyers
But I have had nurses across our organization actually not in behavioral health, but when we posted these out on the internet and again and they're available. I have had nurses email and just say thank you, you know, I don't work in behavioral health, but I do care for behavioral health patients in critical care or in you know, the NICU or excuse me, in OB or in the emergency department.

00:15:22:24 - 00:15:41:05
Robin Conyers
And this was such an easy tool for me. I had no idea that that I was being kind of disrespectful in some ways of not being conscious of the words I was choosing. So, for example, of saying that, well, the patient's an addict, that person is an addict. Well, actually, we're encouraging to say this person has a substance use disorder.

00:15:41:06 - 00:15:58:11
Robin Conyers
And one has said, and when I give report, when a patient's going forward to critical care to detox or they're going up to behavioral health because they have suicide ideation and maybe have a substance use component to the treatment, I have found myself saying, now there you have substance use disorders. I don't refer them. This is an addict that now has to be detox.

00:15:58:11 - 00:16:06:07
Robin Conyers
So just that shift in nomenclature in words matters. And it gives me goosebumps to think to hear that.

00:16:06:09 - 00:16:28:18
Rebecca Chickey
So as we bring this podcast to a close, I'd love to have each of you think about what call to action you would suggest for the listeners. What should they do? What first step or second step should they take to perhaps go on their own anti-stigma or stigma reduction journey at their own hospital or health system?

00:16:28:21 - 00:17:01:00
Manish Sapra, M.D.
There are ways to address this, issue of stigma. And large employers, especially in health care space, have that responsibility to do that. And there are ways that that they can create a culture, the language, the culture of well-being and treating each other kindly and with awareness of these you know, illnesses in a way that we can bring that whole culture of compassionate care.

00:17:01:02 - 00:17:24:17
Manish Sapra, M.D.
And also when we're dealing with each other as health care workers, that we are being kind and compassionate. And there are initiatives that can be very effective in this space. So I think the call to action is do to see that this works. And it is a responsibility of our large organizations to take this on.

00:17:25:16 - 00:17:55:25
Kathy Krebs-Dean
One of the first steps would be recognize stigma associated with substance use disorder as something that can impede a person's progress in seeking the care that they need. It's a condition that impacts millions of people every year. And when we are more supportive and recognize substance use disorder as a medical condition versus something like a moral failing, we know that people are more apt to get the care that they need.

00:17:55:27 - 00:18:14:08
Robin Conyers
When I think about caring for individuals that have substance use disorder or mental health challenges, I think that nobody woke up one morning and said, okay, Lauren, hand it down to me, I want the substance use disorder. I want to be called an addict. I want to have those suicidal thoughts. I want people to be afraid of me. I want people to judge me

00:18:14:08 - 00:18:35:19
Robin Conyers
because it's all my fault that I've lost my job, or I'm homeless, or because of choices that I've made. Nobody woke up and said, hand me that. I want to be stigmatized in that way, or to be thought of in a different light. And yet it's our job to be able to recognize that mental illness, substance use disorders has no demographics.

00:18:35:21 - 00:19:11:15
Robin Conyers
It has no impact on age. It has no impact on career. We see it all across the board. And so the ability to just be kind to one another and to have a curiosity in how we care for people as whole, not just as patients, but people as whole. So to be curious in the way of how you can self educate so that when your friends, your family members, your colleagues are reaching out to you in times of, of struggle or in times of sadness or feeling hopeless, the ability to just in a very simple way, to be curious, and how to educate yourself so that you can show it better for them.

00:19:11:18 - 00:19:22:17
Robin Conyers
And the People Matter, Words Matter campaign is again, as I mentioned, it's a very simplistic, non-confrontational way to, if not this, do that.

00:19:22:19 - 00:19:36:27
Rebecca Chickey
Well, thank you very much. Thank you for partnering in this effort. Thank you for, as they say, taking the ball and running with it. Really appreciate the inspiration that you've shared for our listeners today to take a look at People Matter,

00:19:36:27 - 00:19:58:13
Rebecca Chickey
Words Matter as one way of beginning to reduce the stigma, in this case around substance use disorders. But whatever they might want to go on their journey. You're changing culture one word at a time, and that is difficult work. So, applause and thank you for being here with us today.

00:19:58:15 - 00:20:06:26
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00;00;00;04 - 00;00;13;24
Tom Haederle
Welcome to Advancing Health. Coming up in today's podcast, why isn't a normal phase of life that affects all women met with more understanding and attention by the medical community?

00;00;13;27 - 00;00;39;23
Julia Resnick
All women who are fortunate enough to live till middle age experienced menopause. Yet for something that impacts half the population, menopause remains one of the most overlooked areas in health care. It's time for that to change. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. On today's episode, I'll be talking with two leaders in menopause research and practice from University of Illinois at Chicago's College of Medicine.

00;00;39;25 - 00;01;03;22
Julia Resnick
Dr. Pauline Mackie is a professor of psychiatry, psychology and obstetrics and gynecology. And Dr. Makeba Williams is a professor in the Department of Obstetrics and Gynecology. Together, they are the leaders of the Center for Health Awareness and Research on Menopause. Also known as CHARM. We'll be discussing why menopause awareness matters and how hospitals can step up to provide better, more responsive care to women as they age.

00;01;03;25 - 00;01;10;13
Julia Resnick
So let's get right into it. Dr. Williams, Professor Maki, thank you so much for being here for this conversation.

00;01;10;15 - 00;01;12;08
Makeba Williams, M.D.
Thank you so much for having us.

00;01;12;10 - 00;01;13;17
Pauline Maki, Ph.D.
It's great to be with you.

00;01;13;20 - 00;01;26;18
Julia Resnick
So let's do a little bit of level setting for our listeners. How does menopause affect women's health as they age and why should health systems and clinicians be paying closer attention to it? Dr. Williams, let's start with you.

00;01;26;20 - 00;02;04;23
Makeba Williams, M.D.
We know that about 1.5 million women will become menopausal every year, and that's half of the world's population. Menopause follows the aging ovary and we see declines in many of those hormones, namely estrogen. Estrogen has an important role throughout the body, binding to more than 300 receptor sites. And as a consequence of the changes in hormones, the changes in estrogen, and the eventual decline, we can see changes throughout many of the organ systems within the body.

00;02;04;26 - 00;02;40;28
Makeba Williams, M.D.
We see changes to our cardiovascular systems, our neurocognitive systems, our muscles, our bones, our urinary systems, brain mood, you name it. There can be many changes. And these changes also present at a critical, pivotal time in a woman's life. And we see this as a window of opportunity to optimize health, to optimize and minimize disease - states that may present during this critical midlife window.

00;02;40;29 - 00;02;54;23
Makeba Williams, M.D.
So this is an important area of health because these symptoms, unaddressed symptoms, can impact overall quality of life, well-being and have social and economic consequences as well.

00;02;54;25 - 00;02;57;16
Julia Resnick
Professor Maki, anything you want to add to that?

00;02;57;18 - 00;03;13;06
Pauline Maki, Ph.D.
I think it's really important for women, both in their immediate lives - what can I do right now to feel better - and also to understand the long term consequences of the decisions that we make at this point in our lives for our long term health.

00;03;13;08 - 00;03;22;19
Julia Resnick
Half of the population experiences this, and it seems like right now menopause is kind of having a bit of a moment in public conversation. Why do you think that is?

00;03;22;22 - 00;03;58;11
Pauline Maki, Ph.D.
I think most of this started when there was an introduction of the first FDA approved, highly effective non-hormonal medication for hot flashes. And with that came advertising at the Super Bowl and the Golden Globes. And people were like, what is VMS?" Paired with that was a highly influential article that came out in the New York Times Sunday Magazine saying, women have been misled about menopause.

00;03;58;13 - 00;04;30;18
Pauline Maki, Ph.D.
And that was the number one gifted article of all articles in The New York Times that year. So women were asking questions. There was a new solution that might have addressed women's fears about using hormone therapy and possible risks to their health. And we hit it. And I would say it's beyond a moment now. It is everywhere. And I think that's a beautiful thing because we're not feeling the stigma that we used to feel about menopause.

00;04;30;19 - 00;04;40;08
Pauline Maki, Ph.D.
We're having the conversation. So now we just need to meet the questions with the appropriate evidence-based answers.

00;04;40;10 - 00;05;07;12
Julia Resnick
Yeah, and I've definitely noticed that too. Like talks of the estrogen sticker are everywhere. And you know, 40 isn't old anymore. It's our generation who's using Instagram and all the other social media to elevate these issues beyond just medical encounters with doctors. Despite all of this, I know there continue to be gaps in awareness in research. So what do you think those gaps are and how can we help fill them?

00;05;07;14 - 00;05;46;21
Makeba Williams, M.D.
Well, we certainly see that there are gaps in medical education, medical training that have left many clinicians, whether it's a physician, a physical therapist across the healthcare spectrum have been left underprepared to meet this increased awareness, the increased demand and self-advocacy that we see many women and patients expressing during this time period. We know that we have to work really hard to meet those existing gaps in medical education and training, so that we are better providing care for women.

00;05;46;23 - 00;06;01;24
Makeba Williams, M.D.
Additionally, we know that there's more research. My colleague Dr. Maki can certainly address that, but there are some clinical and research questions that we also need to be answering while we are meeting these unmet needs and training.

00;06;01;26 - 00;06;04;29
Julia Resnick
Professor Maki, can you talk a little bit about what those are?

00;06;05;02 - 00;06;35;16
Pauline Maki, Ph.D.
It's important firstly to recognize that we do know a lot about menopause. I think we hear, oh, we don't know anything about menopause. And that's just not true. We have guidelines that are, you know, 3 to 4 inches thick because of the amount of evidence-based information we have on menopause. And of course, we need to know more. We know a lot from the Gold Standard Natural history study, which is the study of women's health across the nation, or SWAN.

00;06;35;18 - 00;06;57;11
Pauline Maki, Ph.D.
And that really told us what happens to our bodies that's due to menopause versus the fact that we're getting older versus a combination of the two really important information for women to know. Because if a symptom or a change is menopause related versus if it's aging related, sometimes that can tell us that the treatment is different depending on the cause, right?

00;06;57;11 - 00;07;24;24
Pauline Maki, Ph.D.
So that's really important. But that study was initiated back in the mid 1990s. And our population has changed. Thankfully our scientific methods have changed. They've gotten better. And we also have a better sense of what biomarkers. What should we be measuring in the blood? What should we be measuring in my own work in the brain, for example? And so I think we're ready for an overhaul of kind of the next generation of science on this area.

00;07;24;25 - 00;07;55;15
Pauline Maki, Ph.D.
And in addition, we have some really important clinical questions, a lot of questions about hormone therapy. I think we have a very good understanding of what it's good for and what it's not good for. We have perhaps less of an understanding of the perimenopause. This really for some women and not for all, clearly, 29% of women sail through menopause without a problem, but for some women the perimenopause is really problematic and you know, we don't have any FDA approved medications for symptoms in the perimenopause.

00;07;55;15 - 00;08;13;03
Pauline Maki, Ph.D.
So I think that in particular is an unmet need in women's health. What's the best way to treat the perimenopausal woman who is having a new onset of cognitive symptoms or mood symptoms. How do we best help women along the life course of the menopause transition?

00;08;13;06 - 00;08;30;03
Julia Resnick
Absolutely. And how do we help women so they don't have to suffer through this period of several years? I'm sure that there are differences in how people experience menopause in different communities, in different populations. Can you speak to that at all? And what factors might drive those differences?

00;08;30;06 - 00;09;02;09
Makeba Williams, M.D.
The study of women's health across the nation was a multi-site, multi ethnic cohort study that looked at various groups of women: Chinese women, African American women, Hispanic women, as well as white women to detect differences and how women were transitioning into menopause. We looked at seven different cities across the nation. Cities like Chicago, Detroit, Pittsburgh, Newark, Oakland and Los Angeles.

00;09;02;10 - 00;09;40;01
Makeba Williams, M.D.
And from this study, we gleaned that while menopause is a universal event experienced by women who live long enough with their ovaries, the ways in which these women experience it is very unique. So we saw some differences. Where we saw that women of color, African-American women will experience these hot flashes and night sweats for a longer duration. In fact, it was about ten years compared to white women who experienced these symptoms for 6.4 years.

00;09;40;03 - 00;10;07;19
Makeba Williams, M.D.
We saw differences not only in the duration of symptoms, but also in the intensity as well as the frequency. And though this study is more than 30 years old, we are continuing to glean differences and there is more yet to be learned, because that was seven cities across the country. And we know that the demographics of our country have changed.

00;10;07;19 - 00;10;21;02
Makeba Williams, M.D.
So there is much more to learn. But we know that this is a very unique experience, and we need to pay attention to those cultural factors that drive these differences.

00;10;21;04 - 00;10;38;11
Julia Resnick
My one sentence takeaway is that women are complex, and the experience of being a woman differs by woman. Care needs to be individualized to that person. So I want to make sure we talk about CHARM, the center that the two of you lead. Can you tell us about what that is and what you're learning through it?

00;10;38;13 - 00;11;05;12
Pauline Maki, Ph.D.
So the Center for Health Awareness and Research on Menopause was launched last March in an effort to really consolidate everything that we've been doing in this arena in those mission areas. So we've been raising awareness both individually and through our engagement with different societies. Dr. Williams is the president-elect of the Menopause Society. I'm the past president of that organization.

00;11;05;13 - 00;11;37;12
Pauline Maki, Ph.D.
I'm also the current general secretary of the International Menopause Society. And so it's really important that we have these academic medical society partnerships and raising awareness. And we also recognize that the University of Illinois, Chicago, we serve the underserved in Chicago. And so consistent with our mission, we want to do a lot of awareness raising and research and education that address our patient population's needs.

00;11;37;14 - 00;12;01;06
Pauline Maki, Ph.D.
And this is who we focus on in our studies. This is who we focus on in our educational efforts as well. So we want to continue the research that we've been doing -imagine now for more than 25 years of continuous NIH funding. So we're considered old guard. We've been doing this, it's our bread and butter for quite a long time.

00;12;01;09 - 00;12;41;29
Pauline Maki, Ph.D.
And as one of the largest medical schools in the nation, we're in the top three depending on the year. We have a responsibility to make up for these decades of lack of education. And so we're really paving the way, leading efforts to get funding to introduce the medical school curriculum that all of our medical students need, so that the kinds of stopgap measures that Dr. Williams mentioned, you know, training current providers in the field can really be something we do for just a few years so that the actual training is integrated more into medical school and residency training.

00;12;41;29 - 00;12;52;17
Pauline Maki, Ph.D.
So we have an active portfolio of research and activities in all of those mission areas in an attempt just to do better by women.

00;12;52;20 - 00;12;55;28
Julia Resnick
Fantastic. Dr. Williams, anything you want to add?

00;12;56;00 - 00;13;28;23
Makeba Williams, M.D.
You talked about health care system access. One of our initiatives in CHARM is to look at our clinical care delivery models. With increasing demand for menopause care among women and providers that have been underprepared, this presents a challenge, a challenge to access. When we look at where our gaps in care, it would be accessing providers who are certified menopause providers who have been appropriately trained.

00;13;29;00 - 00;14;07;01
Makeba Williams, M.D.
And so while we are working on training and educating the workforce, we're also looking at deploying creative clinical models that can scale the access gaps. Looking at how do we deploy care right at the point of need in the way that communities need that. That might look like shared medical appointments or group medical appointments so that we can deliver community based cares. Working with community health workers, using innovative technologies and telehealth to meet the rural needs of menopause women.

00;14;07;02 - 00;14;17;09
Makeba Williams, M.D.
So that is part of what we do at CHARM is to serve as a think tank, a testing ground for these innovative care delivery models.

00;14;17;12 - 00;14;37;26
Julia Resnick
So you are clearly looking towards the future of health care in your work, whether it's those care models or training the next generation of the workforce. So as you look ahead to the next to the next guard of menopause care and advocacy, how would you like to see care evolve? And also, what is one thing that you want women to understand about this stage of their lives?

00;14;37;29 - 00;15;12;07
Makeba Williams, M.D.
Certainly, we need to get menopause care out of silos. Menopause is it cuts across organ systems as we talked about, and it can't be relegated just to the obstetrician or gynecologist. We need the dermatologist on board. We need the physical therapists on board, the pharmacists on board, so we need to make sure this care is recognized and delivered across specialties and across disciplines.

00;15;12;08 - 00;15;50;07
Makeba Williams, M.D.
So raising that awareness is critically important so that we can have an all hands on deck situation when it comes to menopause. And I would also like to see that the those experiencing menopause see this as an opportunity to optimize health. Women are going to spend more than 40% of their lives during this time period. So recognition by health care providers and those who are experiencing menopause of the grand opportunity we have to improve health overall is essential.

00;15;50;07 - 00;15;53;03
Makeba Williams, M.D.
And what I would like to see in our future.

00;15;53;06 - 00;15;55;25
Julia Resnick
Fantastic. And Professor Maki?

00;15;55;27 - 00;16;20;17
Pauline Maki, Ph.D.
I couldn't agree more with that. You know, menopause care should be primary care. It's a universal phenomenon for women, right? So that's how we view menopause care at term. But at the same time, we know that if you're a woman with a clotting disorder or with a history of breast cancer, you need a professional like Dr. Williams who really knows how to treat these special and more complicated cases.

00;16;20;17 - 00;16;57;18
Pauline Maki, Ph.D.
So we envision a future where women will be referred when necessary to a menopause specialist, but that really the workforce will be trained en masse to do better by women and to understand the basics of menopause care. This is critically important. I see two technological advances that will help women. There are new technologies that will allow women to measure hormonal dynamics in their home environment, to wear, you know, sensors and wearable devices that will be able to feed objective data forward to their providers to help in their care.

00;16;57;21 - 00;17;28;20
Pauline Maki, Ph.D.
I think we need to be united on the types of symptoms and systems that we measure routinely in women and understand, are we making a difference? We need to measure menopause care effectiveness and to deploy models that really show a high return on investment, both for women's overall well-being and for a hospital system writ large. Because the World Economic Forum estimates that it's $128 billion opportunity in GDP annually.

00;17;28;20 - 00;17;52;27
Pauline Maki, Ph.D.
Imagine that. That's the cost of menopause, largely because women are not performing as well at work and presenteeism and absenteeism become issues. So even if one isn't like we are a cheerleader for women's health, there's just a strong economic argument to be made here. And so we need investment from all sectors.

00;17;53;00 - 00;18;09;24
Julia Resnick
Well, thank you both for being such incredible trailblazers in this field, for raising awareness, for training the next generation of the workforce, so that all women can live long and healthy lives. I really appreciate your sharing your expertise with us. And thank you. Thank you for being here.

00;18;09;26 - 00;18;11;24
Makeba Williams, M.D.
Thank you for having us.

00;18;11;24 - 00;18;14;22
Pauline Maki, Ph.D.
Thank you. It's been great to be with you today.

00;18;14;24 - 00;18;23;05
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:03 - 00:00:13:18
Tom Haederle
Welcome to Advancing Health. Trauma is not a word we hope to associate with childbirth, but it is a reality for many new moms. And it's time we pay attention to it.

00:00:13:20 - 00:00:39:14
Julia Resnick
Welcome to today's episode of Advancing Health. I'm your host, Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. Childbirth is usually a joyful occasion, but for some women, it's the beginning of something much more complicated. Even when parents bring home a healthy baby, the birth experience can be traumatic. And when that trauma goes unrecognized or untreated, it can have lasting impacts on both physical and mental health.

00:00:39:17 - 00:01:01:06
Julia Resnick
Today, I'm talking with the directors of Oregon Health and Sciences University's Perinatal Trauma clinic. Doctors Katie Au and Katherine Jorda will explore how trauma shows up during pregnancy, birth and postpartum, and what it takes to build a model of care that better supports healing and recovery. So let's jump right in. Dr. Au, Dr. Jorda, I'm so happy to be here with both of you today.

00:01:01:08 - 00:01:05:15
Julia Resnick
To start, can you help us better understand what perinatal trauma is?

00:01:05:18 - 00:01:27:15
Katie Au, M.D.
Yeah, I'm happy to start. Thank you so much for having us. It's really a pleasure to be here today. So perinatal trauma can really encompass someone that's had a traumatic birth experience. Which about 1 in 3 parents, are considering their birth experience to be traumatic. So that's a lot of pregnant people and new parents.

00:01:27:18 - 00:01:40:10
Katie Au, M.D.
And about 10% of birthing patients go on to develop the perinatal PTSD, which is like a little bit more of a persisting condition, that can affect folks postpartum and sometimes years after the event.

00:01:40:13 - 00:01:48:00
Julia Resnick
That is a huge proportion of people who give birth. And yet, as a society, I feel like we barely talk about this.

00:01:48:02 - 00:02:13:15
Katie Au, M.D.
Yeah, I would definitely say that that's true. And if we think about, you know, pregnancy and birth, it is one of the most monumental milestones in someone's life. Everyone remembers the moment that they became a parent or met their new baby. And the majority of pregnant patients are people that are young and that are healthy and have never needed to be in a hospital or have an IV, or maybe have never had a surgery before.

00:02:13:17 - 00:02:36:03
Katie Au, M.D.
And many of those things can happen in the childbirth process. And so, a lot of those things can be unexpected. Most people, when they become pregnant, don't anticipate having a complication or something that is difficult or challenging in their birth. And so it's hard to prepare for those things. And for many folks, it's the very first time that they have interacted in the medical system in this way.

00:02:36:03 - 00:02:51:27
Katie Au, M.D.
And it can be extremely challenging. And, when you experience those things at the very same time as becoming a parent for the first time, it can feel really isolating and, you know, be an extreme challenge, in the journey of becoming a new parent.

00:02:51:29 - 00:02:54:27
Julia Resnick
Absolutely. Dr. Jorda, anything you want to add there?

00:02:54:29 - 00:03:17:05
Katherine Jorda, M.D.
I do think some of the societal norms around pregnancy and birth are very rosy, and I do think it makes it hard when a patient finds that their experience is not rosy. They're like, what just happened? Has this ever happened to anybody else? This was not my expectation. And it can come out of left field for a lot of patients.

00:03:17:12 - 00:03:38:23
Julia Resnick
Yeah, I think a lot of people are not prepared that pregnancy and giving birth is really a major medical event. And so when something does go wrong, they feel like it's abnormal when actually it's more the norm. So when we talk about perinatal trauma, it can really look different from person to person. So what are some of the ways that it shows up both during pregnancy and during postpartum?

00:03:38:25 - 00:03:59:12
Katherine Jorda, M.D.
Yeah, I think for a lot of patients, it can come up in a lot of different ways. I think patients who have had a traumatic birth sometimes don't even want to get pregnant at all. They don't necessarily want to come back to the hospital or the clinic where they had a traumatic birth, so they might be lost to follow up.

00:03:59:17 - 00:04:10:22
Katherine Jorda, M.D.
And if they do decide to get pregnant, they might be very hesitant to interact with medical system again after a prior negative experience.

00:04:10:24 - 00:04:13:29
Julia Resnick
Dr. Au, anything you want to add there?

00:04:14:02 - 00:04:36:17
Katie Au, M.D.
I would say that, you know, having a perinatal mood issue can be really common. But that can also be common with a birth that goes really well without complications. So for some patients, we see postpartum blues or anxiety or postpartum depression. With perinatal PTSD, we often see patients that have symptoms that last longer than a month postpartum.

00:04:36:17 - 00:05:01:26
Katie Au, M.D.
The perinatal PTSD symptoms, often show up as reliving a traumatic event or having some more intrusive thoughts, or maybe nightmares. Many folks have trouble with sleep and might have avoidant behavior. And sometimes we see folks that really have trouble bonding with their infant and their child, and those can persist throughout the that first year, that first postpartum year of life.

00:05:01:28 - 00:05:17:27
Katie Au, M.D.
But often many years afterwards. And it's not infrequent that Dr. Jorda I see patients who maybe have changed plans for their families or have decided to delay childbearing, or maybe just have their one child because they're still affected by their symptoms many years out.

00:05:18:00 - 00:05:28:25
Julia Resnick
So I know that your perinatal trauma clinic is one of only a few of its kind in our country. Can you walk us through how the clinic works? What it's like for patients who come to you for care?

00:05:28:27 - 00:05:56:00
Katherine Jorda, M.D.
Sure. Kind of started a few years ago. Both Doctor Au and I worked at the Portland Veterans Administration's hospital. And so unfortunately, a lot of veterans have experienced military sexual trauma. And we had to learn about trauma informed care, which is a framework of taking care of patients, recognizing that prior traumatic experiences might be impacting their current physical and mental health.

00:05:56:05 - 00:06:28:03
Katherine Jorda, M.D.
But we received a lot of on the job training and experience there, and it wasn't really a part of our formal medical student or OBGYN resident curriculum. And we took care of a lot of patients and realized, gosh, there is a role for trauma informed care, too, in obstetrics. Let's set that up. We submitted a grant to start our clinic, and we made the case that patients who've had a traumatic birth need more of a multidisciplinary approach.

00:06:28:06 - 00:06:59:19
Katherine Jorda, M.D.
We are lucky at our institution that we have a robust reproductive psychiatry department, and so patients who've had a traumatic birth would go see our psychiatry colleagues, and then they would see us in obstetrics for either pregnancy care or postpartum. But we found that they were having to tell their story multiple times to different providers. And sometimes patients would ask me about mental health issues that I could try to field, but didn't have as much experience as my psychiatry colleagues.

00:06:59:21 - 00:07:43:06
Katherine Jorda, M.D.
And the same for my psychiatry colleagues. They'd get questions about their birth, and they were like, I just don't feel equipped to answer that. And gosh, could we get all the same players in the room so that the patient could share their story just one time and have both kind of aspects weighed in. And so we started a multidisciplinary clinic where we see patients who have had a history of a traumatic birth or delivery planning and we see them in our clinic, both general OBGYN, myself or Dr. Au, and one of our reproductive psychiatrists or psychologists all together in the same room to do a longer more comprehensive visit.

00:07:43:13 - 00:07:58:28
Katherine Jorda, M.D.
So typically, these visits are twice as long as our routine prenatal care, because we found that we needed the time to delve into both an obstetric history and psychiatric history and develop a plan for the future pregnancy.

00:07:59:01 - 00:08:02:10
Julia Resnick
That's wonderful. Dr. Au, anything else?

00:08:02:12 - 00:08:44:06
Katie Au, M.D.
Yeah, I would just say that, you know, we find that medical care is so siloed and it's like that in so many different specialties or aspects of care. And that's the same for reproductive health and mental health care. And, you know, Dr. Jorda and I would frequently see patients postpartum who really wanted to talk about how it felt to have postpartum hemorrhage or to have an unplanned C-section, and were really good at talking about why someone had extra bleeding or what exactly was happening in the room during their C-section, but not as well equipped to handle the mental health aspects and help folks process that.

00:08:44:08 - 00:09:06:17
Katie Au, M.D.
Same for a reproductive psychiatrist. They're so wonderful at, you know, accessing those mental health resources and tools and making sure that patients are safe and have a plan for follow up. But they didn't really understand why someone had a hemorrhage or why someone had an unexpected C-section and had a hard time answering questions that the patient would naturally have about, you know, will this happen to me again?

00:09:06:19 - 00:09:31:27
Katie Au, M.D.
What would it look like if I got pregnant again? And we just found it to be so incredibly valuable to all be in a room together where we could go through someone's birth experience if or when they feel ready and answer all their questions about what happened during their labor or their birth, or why certain things happen the way that they did, and real time be able to support them best in a mental health capacity.

00:09:32:00 - 00:10:07:18
Katie Au, M.D.
So it just felt really nice to be able to bring those services to patients at the same time. And as Dr. Jorda mentioned, you know, not having people have to relive their trauma multiple times and tell their story to numerous people, was extremely valuable. And I think that's been one of the strengths of our program is that we've identified a safe space so that patients know that they can have someone who's both knowledgeable about the obstetric details, and then also someone who is attentive to the mental health aspect of care, because really, birth trauma is all encompassing like that.

00:10:07:18 - 00:10:11:11
Katie Au, M.D.
And we needed a space to be able to address all of those things at the same time.

00:10:11:13 - 00:10:25:24
Julia Resnick
Absolutely. And I can imagine that there is a like, you need to rebuild trust with patients so that they're trusting the medical system again. What does it take to create that trust and sense of safety, so that you're not just retraumatizing someone with their next birth?

00:10:25:26 - 00:10:50:05
Katie Au, M.D.
I think it all stems with having an open mind and not being defensive about the care that someone has had, or the outcome that someone has had. You know, I can't tell you how many times Dr. Jorda and I will see a patient and they feel really guilty saying that they had trauma related to their birth, or that they were disappointed in their experience because maybe their baby was perfectly fine and very healthy, and they were perfectly fine too.

00:10:50:05 - 00:11:08:09
Katie Au, M.D.
But that doesn't change the fact that the C-section was really hard or really traumatic. And someone feels guilty for sharing those thoughts, or feeling like it was a traumatic experience when, you know, family members will say, but you're healthy and your baby is healthy and your baby's fine, and you guys are both alive, so it's okay.

00:11:08:16 - 00:11:29:10
Katie Au, M.D.
It just brushes off those complex feelings that people have, because you can be really happy about an outcome, and you can really love your family and really love your baby. And you could at the same time be very traumatized by the experience. And both of those things can be true. And I think it just starts with acknowledging that and letting patients know that those things can both be true.

00:11:29:10 - 00:11:34:20
Katie Au, M.D.
And you recognize that you understand that, and you're here to help them.

00:11:34:23 - 00:11:51:27
Julia Resnick
Really normalizing their experience. Hopefully that helps with some of that guilt. So I'd love to talk a little bit about the impact that you've seen. Either through data you're collecting or patient stories. It really illustrates the difference about what this type of care can make for patients.

00:11:51:27 - 00:12:18:20
Katherine Jorda, M.D.
I can think of one patient who is a nurse by training and had a traumatic birth and delivery. We were seeing her for postpartum care and kind of processing all of that, and she had so much guilt about it. She's like, I'm part of the medical field, and I thought that knowing how the medical field works, I should be able to advocate for myself.

00:12:18:20 - 00:12:38:03
Katherine Jorda, M.D.
And I'm a nurse. I advocate for patients all the time. But when you're a patient and you're laboring and you're trying to push out a baby, I mean, those are a lot of identities colliding, and it can be really hard to advocate for yourself, even if you know what the medical system is like and you are a patient.

00:12:38:11 - 00:12:42:00
Katherine Jorda, M.D.
And our patient population often doesn't necessarily interact with

00:12:42:07 - 00:13:13:05
Katherine Jorda, M.D.
the medical system unless they're giving birth. And so I think it can be a really unfamiliar position for patients that can be very, very challenging to navigate. There's also that element of during my pregnancy I had control, I could exercise, I could, you know, optimize my health in preparation for this pregnancy and birth. But now I'm trusting these individuals in this hospital that I may or may not know the delivery team, to help me get through this.

00:13:13:05 - 00:13:40:03
Katherine Jorda, M.D.
And so when things start to go sideways or, gosh, this C-section for this reason wasn't part of the plan or expectation, it can be very difficult for patients. And so as we talked about this person's experience, we tried to normalize and share that. Yeah, maybe you are a nurse, but you're not a nurse and you're a patient at that time, right?

00:13:40:03 - 00:14:03:26
Katherine Jorda, M.D.
Like you can't have such high expectations for yourself and, try to kind of lift that guilt and kind of put it in a perspective. And so we were able to talk and plan for the next pregnancy. And when patients see us, they can continue seeing us for routine prenatal care. Or it can be a one time consultation to develop a trauma informed care plan.

00:14:03:28 - 00:14:25:05
Katherine Jorda, M.D.
So this patient continued on with us and we were able to be there for this patient's delivery and see them postpartum. And it was just really nice for her to have that shorthand of, hey, I've shared my experience with this team. They know what were the activating factors, they know what was hard for me as a nurse.

00:14:25:10 - 00:14:34:10
Katherine Jorda, M.D.
And here's what we did as a team, and here's a plan, and here's how we can kind of mitigate some of those things that had come up in her prior delivery.

00:14:34:13 - 00:14:53:02
Julia Resnick
That is a really powerful example of you know, what happens when you can integrate behavioral health and physical health. It's better for everyone. So not all hospitals are so fortunate to have a perinatal trauma clinic like yours. So for those who don't, what are some practical ways that providers can recognize and respond to trauma?

00:14:53:04 - 00:15:18:20
Katie Au, M.D.
You know, I think it really goes back to naming it, calling it out, recognizing it and asking about it. So, I mean, if, you know, 1 in 3 birthing patients is experiencing some amount of trauma or dissatisfaction with their birth, that's many of the patients that we're seeing. So we need to ask about it. We need to, you know, it's pretty routine to do, you know, anxiety, depression, mood screening and postpartum visits.

00:15:18:20 - 00:15:41:10
Katie Au, M.D.
But I wouldn't say that it's routine for everyone to be asking how a patient's birth experience was like, how satisfied were you with your care? Are you having trouble sleeping? Does it make it difficult to think about a next pregnancy? But I, I think we should be asking those questions and making sure that patients questions are answered about their birth experience as well.

00:15:41:12 - 00:16:04:12
Katie Au, M.D.
I can't tell you how many times we've seen a patient who you know is scared to get pregnant again. But if someone had just explained what it was that happened to them last time, and that that's not likely to recur again, or you know, even just understanding what it was that they went through their mind is sort of blown in a way that they're like, wow, I had no idea that that was, you know, something that likely wouldn't happen to me again.

00:16:04:12 - 00:16:30:28
Katie Au, M.D.
And I think about pregnancy in the future in a completely different way. So I think talking about it, you know, recognizing it, I mean, it's something that's just so common and yet there are so few people addressing it. It's a disservice to birthing families. And we really need to be addressing these things. And from a systemic perspective, thinking about how do we prevent birth trauma and how do we treat it in a respectful and compassionate way?

00:16:31:00 - 00:16:55:07
Julia Resnick
And I am sure if there are any new parents who are listening to this who have had a traumatic birth experience, they will feel less alone. And hopefully providers will hear this and realize that there are some straightforward things they can do to help their patients feel safer to create better birth experiences for everyone. So Dr. Au, Dr. Jorda, thank you both so much for the work that you do for your patients, for sharing your expertise with us.

00:16:55:09 - 00:16:59:03
Julia Resnick
This has been a really great conversation and I just appreciate both of you.

00:16:59:05 - 00:17:00:11
Katie Au, M.D.
Thank you so much.

00:17:00:13 - 00:17:01:23
Katherine Jorda, M.D.
Thank you.

00:17:01:25 - 00:17:10:06
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.

00:00:00:01 - 00:00:19:12
Tom Haederle
Welcome to Advancing Health. Indiana faces a shortage of approximately 4,300 nurses. Today, we hear how a remarkable example of public and private sector generosity has combined to train and retain the nurses Hoosiers rely on.

00:00:19:15 - 00:00:44:09
Tom Haederle
Hello, friends. I'm Tom Haederle, senior communication specialist with the American Hospital Association. And I'm very pleased today to welcome two guests who will tell us how Indiana has jumpstarted its effort to train new nurses and close the gap between demand and supply in the state. Denzil Ross is president of Indiana University Health, South Region, and Erik Coyne is chancellor of Ivy Tech Community College. That is in Bloomington.

00:00:44:12 - 00:00:47:10
Tom Haederle
Gentlemen, thank you both for joining me on advancing health today.

00:00:47:12 - 00:00:48:14
Denzil Ross
Great to be here.

00:00:48:17 - 00:00:49:16
Erik Coyne, JD
Thanks, Tom.

00:00:49:18 - 00:01:04:28
Tom Haederle
Well, let's jump in. Eric, maybe we could start with you. Ivy Tech Community College's Bloomington campus has been a significant pipeline for the nursing workforce in southern Indiana for some time, and now you've got some resources to become an even bigger one. So in a nutshell, what's changed?

00:01:05:01 - 00:01:33:22
Erik Coyne, JD
Well, the collaboration with IU Health is a huge part. They've provided grant money in the past and continue to support us. We've been able to expand and move our nursing facilities. We've renovated and just really built up. We've doubled our bed spaces for training. We've added more simulation labs. So we've really created the, you know, the educational capacity.

00:01:33:25 - 00:01:54:08
Erik Coyne, JD
And then we work really closely with IU Health on the clinical opportunities. Where do those lie? Where are those? And we found, frankly, that we've really maximized our opportunity throughout the course of the day where we're trying some other things. We're still trying to find, you know, that kind of goal, but we're always going the last mile to find those extra clinical opportunities.

00:01:54:08 - 00:02:17:20
Erik Coyne, JD
But really the opportunity was and continues to be in the evening and on weekends. And so really excited. Last year we launched a pilot program for 20 transitioning nurses. So LPNs or military medics or paramedics to transition into the RN program. So it's a one year program and we moved it to the evening, because frankly, there was no education happening at that time.

00:02:17:25 - 00:02:35:00
Erik Coyne, JD
So we had capacity in the evening. So, we're really excited about that program. The first cohort will be wrapping up this summer and we'll obviously be taking all the data from that and seeing how it did and seeing where we can grow. And as a result of that, we've actually found that we can grow our LPN day program.

00:02:35:06 - 00:02:50:11
Erik Coyne, JD
It's interesting how the things kind of, you know, one thing leads to another and we're really excited with the collaboration we've had with IU health and the opportunities that it's presented. Be remiss if I didn't say that we've had some generous donors who really supported us along the way.

00:02:50:13 - 00:03:06:17
Tom Haederle
Yeah. I'd like to follow up on that a little bit, especially from IU Health's point of view. From where you stand, Denzil, what's driving some of the philanthropy and the support here? Have you been hearing from residents in the area that there just weren't enough nurses and it was getting to be a problem and something had to be done?

00:03:06:17 - 00:03:09:00
Tom Haederle
Or really, what was the impetus behind this?

00:03:09:02 - 00:03:40:27
Denzil Ross
Yeah. You know, that this topic of the nursing shortage has been a national topic for quite some time and, we hear very presently so in Indiana. And specifically in the South region. And through this transformational gift from the Fergusons, who are longtime Bloomington residents, they were motivated through the idea that through their investments, coupled with IU Health's support, Indiana can train more nurses by building on the strong foundation that's already in place.

00:03:40:27 - 00:04:07:15
Denzil Ross
We have, a number of hospitals across the state, and we all struggle like our competitors and other health care systems with how do we find nurses? With that continuing to be a challenge with the support of, these gifts coming in, we are now able to say, let's do something about it. Let's own the problem and let's start to build and improve

00:04:07:17 - 00:04:45:10
Denzil Ross
our pipeline. I think the inception of this investment and other investments with Ivy Tech - the Fergusons, their connection has been through their friendship with another philanthropist, Lee J. Marchant, whose transformational gift to Ivy Tech, Bloomington, established the Lee J. Marchant School of Nursing. And that included early support for the nursing program. Now, with this donation, this gift, we're able as Eric mentioned, to take that, expand it even further and really focus on building our own pipeline over the course of the next coming years.

00:04:45:12 - 00:05:06:22
Tom Haederle
If I understand it right, a big part of the focus of the whole thing is to keep it local, in a sense. You want to train people who are Hoosiers, ideally, and who want to stay in this state and live their lives there and plant their roots there. So really, maybe both of you could address how is that working out and why is it important to sort of keep everything, you know, keep it in the backyard to the extent that you can.

00:05:06:25 - 00:05:30:16
Erik Coyne, JD
You know, we're a community college and we support our community, and we see that 85 plus percent of our students across the board tend to stay in our region. And so as we think about the nursing shortage in particular, and I know this was top of mind for the Fergusons as they were thinking about this gift, how do we incentivize, how do we keep those students in our region?

00:05:30:18 - 00:05:50:22
Erik Coyne, JD
What can we do to, you know, provide support for them? And this gift obviously is really going to transform how we're able to do that and how we're able to support them. It's a two part gift. One part is on the operational side, it'll help offset salaries and equipment. And another side of that is scholarships.

00:05:50:22 - 00:06:08:09
Erik Coyne, JD
And so it's going to really help grow some of the support we can give our students in the region. And I think, you know, they can stay here and work here. Obviously there's a connection. My mom was a long time nurse in Bloomington. I was born here. My dad was on the Monroe County hospital board for a long time.

00:06:08:09 - 00:06:29:05
Erik Coyne, JD
So it's a real personal thing for me. But it's really cool when you walk in and you're being treated by someone you know. It is just such a difference when you walk in and it's someone you know, you knew their parents or even their grandparents. How cool is that? That's the community we want to inspire here. I mean, I still hear from people who tell me about my mom treated them and that is pretty cool.

00:06:29:05 - 00:06:41:14
Erik Coyne, JD
And so if we can continue that for generations and make that sustainable and and financially feasible, not just for them, but also for, you know, our local medical suppliers and hospitals and that's terrific.

00:06:41:16 - 00:07:04:09
Denzil Ross
And I think that's the beauty of who we are. And, at IU Health in Indiana and particularly in the South region, we have a number of critical access hospitals that help and support those rural areas. And then within our Bloomington facility, I think that's what really gives the impact to who we are and how we serve our community.

00:07:04:12 - 00:07:27:25
Denzil Ross
A lot of what Eric mentioned is what we pride ourselves on. It's really and truly the community serving the community. So it's not uncommon, like Eric mentioned, that you go into one of our hospitals and you see a friendly face, whether that be the provider, the nurse, APP, the team member greeting you at the door. Those are your neighbors.

00:07:27:25 - 00:07:48:01
Denzil Ross
Those are the people that your kids play soccer with. Those are the people that you spend time, you walk into a restaurant and you see them. And so, I think that's the beauty of this, is that from our perspective, we get to grow that pipeline. But as a health care provider, we're not just talking about filling the gap.

00:07:48:01 - 00:08:16:19
Denzil Ross
We're also talking about retention. And we know if we have staff, particularly here in this scenario, nurses who train here, who are from here, there's a better chance that they stay here in the long run. And that just gives us stability or recruitment. It gives us stability in our outcomes because now we could build and grow programs.

00:08:16:19 - 00:08:44:24
Denzil Ross
The nursing staff knows the physicians' staff and all the other providers, and it just builds a great outcome, quality outcome for who we are and how we serve the community. One of the things we are also really excited about, we are very conscious of the fact that as a new nurse coming out of your educational program, it could be somewhat scary going into the field to care for patients.

00:08:45:01 - 00:09:29:17
Denzil Ross
And for that reason, we have a really strong and robust first year nursing residency program that is really focused on how do we help and support that first time nurse transition from the educational space to how they become a caregiver. And so we're really proud of that. Really excited about having more and more nurses go through that. And we have seen that be a really vital piece of our ability to retain nurses and get them to the level of care that they want to be, whether it's inpatient med surge, they want to be critical care, ICU, emergency medicine or outside of our surgical and procedural spaces.

00:09:29:17 - 00:09:31:05
Denzil Ross
So we're really proud of that.

00:09:31:07 - 00:09:58:13
Tom Haederle
That is absolutely one of the most impressive things, I think, about what you're doing. I wanted to follow up a little bit on something you mentioned earlier, which is just the advantage of, with this money, this grant money, and being able to expand your capabilities for training and how that plays out on the weekend and evening classes. Opening this, you know, nurse training offered to people that maybe want to do it, but just, you know, had full time jobs or for whatever reason, couldn't take advantage of that.

00:09:58:13 - 00:10:01:15
Tom Haederle
So how is that working out? I'd like both your thoughts on that.

00:10:01:15 - 00:10:32:05
Erik Coyne, JD
Our evening cohort that we have right now, we're seeing most of them are full time employees, many of them at IU health. And they have families. And so getting back to school was just a challenge. And having an evening option really just opens it up. I know one of my early degrees after college, I had to do a nights and weekends kind of thing, and it's a challenge to work all day and then race over to class and study all evening.

00:10:32:07 - 00:10:47:20
Erik Coyne, JD
And your weekends get sucked up with more classes and studying. So what I like about it is it's a one year transition program. So it's, it's, you know, can you do it for a year? Give us a year, right? And they can talk to their families and they can plan for it and they can set it up.

00:10:47:20 - 00:11:06:14
Erik Coyne, JD
So I think it's been really transformational for those folks in that current cohort. And one day down the road, we do look to expand it. We're going to take the data from this first year and see how the second year goes. And at some point about halfway through the second year cohort, we'll really be able to make a determination if we're able to grow.

00:11:06:17 - 00:11:27:21
Erik Coyne, JD
As you can imagine, whenever you start something new, it's always a little bit of a challenge. The no knowns and the unknown unknowns, but, working through that. But for the students in the class, I think it's really been just an opportunity that they otherwise wouldn't have. We actually have folks who have been driving in from outside our region because it's an opportunity here that they didn't get elsewhere.

00:11:27:23 - 00:12:07:11
Denzil Ross
Yeah. I think when you really think about it, you know, everything is changing around us and the way people work is also changing around us. The way people learn and go back to school is also changing. And, kudos to Eric and his team for really seeing that change. And, attacking this head on with this new program that we can offer members in the community the opportunity to go to school and work, take care of themselves, take care of their family in a way with a schedule that works for what's ideal for them and their family.

00:12:07:14 - 00:12:32:22
Denzil Ross
I think it gives the opportunity for us to improve or broaden that number of people who now have the opportunity to go back and learn because they're working during the day. Right? They're taking care of themselves, their families. And now this opportunity, this option just opens the door to a whole new set, hopefully interested parties.

00:12:32:22 - 00:12:44:18
Denzil Ross
So we're really excited about the benefit that we'll see, both for Ivy Tech, the hospital at the end of their program. And really what the impact could mean to the community.

00:12:44:21 - 00:13:02:11
Tom Haederle
I came across an article recently, just a few days ago that put me in mind of, of our conversation right now. And I just wanted to bring it up and get your thoughts on this, because I thought it was really interesting. It was in the Wall Street Journal. It was an article ran on April 1st, and the title was "Nursing is the Surefire New Path to American Prosperity."

00:13:02:11 - 00:13:23:25
Tom Haederle
That was the name of the article. I just wonder if that's something that in your experience, have you seen that? Do you think that idea that health care or nursing specifically is now a path to a better life is really starting to take, take hold and, you know, become more widely believed among young people and, and if so, what implications does that have for training programs like yours?

00:13:23:28 - 00:13:54:03
Denzil Ross
Hospitals are very intricate. And there are many aspects of when we think about health care or health and wellness that the nursing occupation plays a very big part. Many times we just think about within the four walls of the hospital, right. Emergency department, inpatient setting, operating rooms. But there are so many opportunities that there are paths within that nursing field.

00:13:54:06 - 00:14:25:05
Denzil Ross
And the more and more that we can educate people about what can be, you know, and give a different perspective sometimes to what a nurse could be and what they do. The path to then to that next step, third or fourth step out from just becoming a registered nurse. There's opportunities there as well. We have fully embraced nurse practitioners in our model of how we care as physician extenders.

00:14:25:07 - 00:14:49:27
Denzil Ross
And they all were exposed to different specialties, different area areas of care as nurses and said, hey, I want to go the next step. And after becoming and RN, there are so many paths to how you continue to grow, opportunities to expand. And of course, we see salaries that come to match that as well.

00:14:50:00 - 00:15:04:10
Denzil Ross
So I definitely think that it's a great starting ground that opens a wide array of opportunity within the health care field, not just the hospital, but with the health care field as a whole.

00:15:04:13 - 00:15:30:09
Erik Coyne, JD
Yeah, we're seeing that play out on the training side. Our nursing program and a few of our other health care programs are competitive programs. At a community college, vast majority of your programs are open access, open enrollment. But our health care programs are highly competitive. The salaries, the outcomes, the career opportunities. One thing I love is the chief nurse at IU Health Wilmington is an Ivy tech grad.

00:15:30:09 - 00:15:48:00
Erik Coyne, JD
Then she went on further and, and now is the chief nurse over at the hospital. I mean, it's fantastic. And we see it with, you know, respiratory therapy. We see it with radiation therapy, all of our other health care programs that we have. We're starting to really see growth and interest.

00:15:48:00 - 00:16:05:22
Erik Coyne, JD
And the retention is there, too. Students in those programs tend to stay in those programs. You know, they worked hard to get into them. And so they're going to stay and they're going to get through. They're not easy. They're tough programs. And we hold our students to a high standard, but they need it. And, it's great. For many

00:16:05:22 - 00:16:34:24
Erik Coyne, JD
it's a, you know, first generation student. This is going to be transformational for their family. This is like generational change that's occurring here. And so that that is really huge and really impactful. We're really excited, especially with our various cohorts we have going on. Every term, we have a cohort starting. So applications are always flowing. Feel free to visit us at Ivy tech.edu/nursing and you'll learn all about how to apply and what you need to do to get started.

00:16:34:27 - 00:16:53:05
Tom Haederle
It's so exciting what you're doing, and I can't congratulate you enough for not only making the difference in the lives of patients by providing trained caregivers that they need, but as you just mentioned, maybe, you know, opening up new paths and, you know, leading people to a better life and doing something, giving them an expanded opportunity to do something they love to do.

00:16:53:05 - 00:17:11:21
Tom Haederle
So I'd like to thank you both for being on Advancing Health today and sharing your thoughts about the value of philanthropy and the value of expanded training and flexibility and how nurses are trained. But most of all, really what you're doing on behalf of the people of southern Indiana, your patients, that's just so, so remarkable and so impressive.

00:17:11:23 - 00:17:14:06
Tom Haederle
So thank you so much again. Really appreciate it.

00:17:14:09 - 00:17:25:00
Denzil Ross
Thanks, Tom. Thanks for having us. And really looking forward to working with Ivy Tech here to make this come to fruition. This has been a long time coming, our relationship that, we're glad that we're here.

00:17:25:03 - 00:17:36:12
Erik Coyne, JD
Yeah. Thank you, Tom. And I'd like to real quick, thanks to IU Health, thanks to the Ferguson family, Connie and Steve, for making this a reality and really moving the needle for our students in the region. So thank you.

00:17:36:15 - 00:17:44:25
Tom Haederle
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