Advancing Health Podcast

00;00;00;01 - 00;00;19;04
Tom Haederle
Welcome to Advancing Health. Many a parent has wondered what's really going on inside the head of their beloved teenager. As we hear in this podcast, a new predictive tool helps answer that question and can flag teens at elevated risk for developing a psychiatric illness in the near future.

00;00;19;06 - 00;00;41;25
Jordan Steiger
Hi everyone, and welcome to the Advancing Health Podcast. My name is Jordan Steiger, and I'm the director of Behavioral Health and Violence Prevention at the American Hospital Association. I'm joined today by Dr. Jonathan Posner, who is the J.P. Gibbons Distinguished Professor of Psychiatry, and Dr. Matthew Englehard, the assistant professor of biostatistics and bioinformatics, both at Duke University School of Medicine.

00;00;41;26 - 00;00;46;11
Jordan Steiger
So, Dr. Posner and Dr. Englehard, thank you so much for being here today.

00;00;46;14 - 00;00;47;18
Jonathan Posner, M.D.
Thanks for having us.

00;00;47;20 - 00;00;48;29
Matthew Engelhard, M.D., Ph.D.
Yeah, thanks for having us.

00;00;49;05 - 00;01;07;02
Jordan Steiger
We're really excited to talk about the work you're doing. This is a little bit different of a topic that I think we usually have on our Advancing Health podcast, more kind of focused on the research and what could be coming down the pike in terms of behavioral health. So I'm really, really excited to share everything with our membership today that you've been working on.

00;01;07;02 - 00;01;25;23
Jordan Steiger
I would love for you to just tell the audience a little bit about what you do, the Duke predictive model of Adolescent Mental Health, or we'll call it the Duke PMA. To shorten that a little bit on this podcast and just tell us what this tool is, who it's for and what it can do. Dr. Posner, why don't you get us started with this one?

00;01;25;29 - 00;01;54;27
Jonathan Posner, M.D.
So we designed the Duke PMA to be able to automate the assessment of psychiatric risk in teenagers. So essentially what the tool does is it can identify which teenagers are most likely to develop a psychiatric illness within the next 12 months. And it does that by using pretty standard questionnaires that can easily be collected in a primary care setting.

00;01;55;02 - 00;02;15;13
Jonathan Posner, M.D.
And then not only does it tell you who's at risk, but it also tells you what's contributing to that risk. So as an example, let's say I am a pediatrician and I'm about to evaluate a 14 year old. I might only have 5 or 10 minutes with that kid, and it's not enough time to do a thorough psychiatric assessment.

00;02;15;15 - 00;02;42;19
Jonathan Posner, M.D.
But the Duke PMA will automate that for me, and it will tell me that the kid that I'm evaluating who seems stable today, actually has an 80% chance, or a 90% chance of developing a psychiatric illness in the next year. And a key contributor to that might be poor sleep. So as the pediatrician, if I can get that kid sleeping better today, I might be able to prevent him from ever developing a psychiatric condition.

00;02;42;21 - 00;02;58;01
Jordan Steiger
Wow. So that could be transformative for adolescent behavioral health. That's really incredible. You mentioned sleep is maybe one of the predictors. And I know in our conversations you've said that's a pretty significant predictor. What are some of the others?

00;02;58;03 - 00;03;25;22
Jonathan Posner, M.D.
So we looked at a bunch of different factors that relate to psychiatric risk. And so some of the other contributors are things like conflict within the family, the school setting, some demographic features, a history of childhood adversity and family history of psychiatric illness. So some of them are things that we could - that are modifiable, that a physician could say, okay, I'm going to try to intervene on that.

00;03;25;25 - 00;03;30;29
Jonathan Posner, M.D.
Other things, like family history of psychiatric illness are more challenging to intervene on.

00;03;31;02 - 00;03;40;00
Jordan Steiger
Absolutely. But that does give the clinician a great opportunity, at least to get ahead of it and start intervening early. And it sounds like that really is the goal of this work.

00;03;40;05 - 00;03;48;02
Jonathan Posner, M.D.
That's right. Yeah. The goal is really to move psychiatry into a model that's much more proactive and preventative.

00;03;48;05 - 00;03;58;14
Jordan Steiger
Dr. Englehard, tell us a little bit more, just why AI tools? What is the most transformative thing about using AI tools like this to predict mental health before symptoms appear?

00;03;58;16 - 00;04;22;04
Matthew Engelhard, M.D., Ph.D
Yeah. So I think I think AI tools are really good at figuring out what in a specific type of information ends up being predictive. So compared to more traditional models, I think of them as being able to, you know, extract all of that signal. And when you couple these tools with a really large data set like the one we've been working with, which is coming out of the Adolescent Brain Cognitive Development study, it really enhances our ability to do that.

00;04;22;04 - 00;04;51;19
Matthew Engelhard, M.D., Ph.D
So first and foremost, it's about just sort of being able to pull as much predictive power as we can. At the same time, AI tools are really good at being able to combine different types of information together to say sort of what is what is shared between this questionnaire and this questionnaire and this questionnaire, and what is distinct between them and being able to draw on those individually and together again, to enhance our ability to make the best predictions that we can.

00;04;51;26 - 00;05;05;12
Jordan Steiger
That makes total sense, and I think it would be great - I probably should have started with this. Can we tell the audience a little bit about where you're at in your research and just this whole work? It sounds like you've done quite a bit already to show that this model is really impactful.

00;05;05;15 - 00;05;29;16
Matthew Engelhard, M.D., Ph.D
So we've already developed our model, and it's a matter of making sure that this model, that we have everything in place so that this model can reach as many people as possible. So we're really careful about making sure that our model is what we call generalizable, that we've built it in this this study, which is intended to be which is nationally representative, but it doesn't include everyone.

00;05;29;18 - 00;05;52;01
Matthew Engelhard, M.D., Ph.D
Right. We want to make sure that we've built it in this particular study, and now we have a system that we're confident is going to be able to work for everyone across the United States, regardless of what region they're part of,  regardless of their demographic background, and even regardless of some of the specific data collection practices that might be in place where they receive their care.

00;05;52;01 - 00;06;08;18
Matthew Engelhard, M.D., Ph.D
So right now, we're in a phase where we're getting ready to take our model that we've built and to validate it in a bunch of different rural communities and in several states. But before we do that, we're making absolutely sure that it is going to work effectively for everybody.

00;06;08;26 - 00;06;27;25
Jordan Steiger
That makes total sense. And I think going into rural communities, you know, presents such an opportunity to expand access to care, make sure that we're focusing in on that prevention aspect a little bit. But tell us a little bit more about that, Dr. Posner. Maybe just why you're starting to test in these rural areas and what's next in terms of that?

00;06;28;01 - 00;07;07;05
Jonathan Posner, M.D.
Yeah, I mean, one of the key motivators in developing the PMA was to try to make psychiatric assessment much more efficient by automating the process. The availability of mental health providers across the boards is extremely limited. But then if you go into rural areas, the problem is even more severe. So the reason why we wanted to bring the Duke PMA to rural communities is for exactly that reason, that that the availability of providers is so limited in those communities that we thought the Duke PMA could be particularly helpful in that setting.

00;07;07;13 - 00;07;26;12
Jordan Steiger
I was thinking about the workforce aspect as you both were talking about this, and just how that can, I'm sure, really, really help clinicians in these areas that maybe don't have the time, you know, to spend with the kids that really need the help and the mental health support, you know, or they might not catch something that's happening because they don't have the time.

00;07;26;15 - 00;07;42;24
Jonathan Posner, M.D.
Yeah, I think that that is really a huge factor in that we're not making the claim that the Duke PMA could do an assessment better than a trained professional, it's just that it can do it much more efficiently. And those trained professionals aren't available in lots of settings.

00;07;42;26 - 00;08;02;14
Jordan Steiger
Absolutely. It's an additional tool for trained professionals to use. Thinking about how this is going to play out in a real world clinic setting in some of these rural communities. What do we think? I know we just talked about workforce and expanding access, but some of those other big opportunities and maybe some of the challenges that might arise in practice.

00;08;02;17 - 00;08;32;22
Jonathan Posner, M.D.
One of the big opportunities that I would see is for this to become a standard part of a pediatric assessment. So the comparison that I like to use is with cardiac risk. So essentially all adults in the US get screened for cardiac risk, for cardiovascular disease. And then the risk gets tracked over time. And the goal is to intervene well in advance of anyone ever having a heart attack for example.

00;08;32;24 - 00;08;51;01
Jonathan Posner, M.D.
And so we would we would love to see something similar to that with mental health risk, so that kids are identified as being high risk before the conditions have really taken root. And the earlier we can intervene, our chances of being able to help these kids is substantially higher.

00;08;51;07 - 00;09;06;22
Jordan Steiger
Absolutely. And, you know, walk me through before we go to maybe some of the challenges, say a child is identified as having a risk for sleep. Let's use that as the example because we brought it up earlier. What happens after that? Just tell me kind of walk me through the clinical process after that.

00;09;06;25 - 00;09;29;04
Jonathan Posner, M.D.
So fortunately with sleep, we have really good evidence based interventions that can help kids sleep better. So depending on the setting and the community and the availability, being able to refer that child for a psychotherapy to address poor sleep would be one natural route to go.

00;09;29;06 - 00;09;41;14
Jordan Steiger
The reason I'm asking that, I guess, is I'm thinking about these rural communities that might not always have the resources available to kind of refer to those additional services. So I'm, I guess thinking about challenges and maybe some of that.

00;09;41;22 - 00;10;08;08
Jonathan Posner, M.D.
Yeah, I think no, it's a great point. One of the things that that Matt and I have talked a lot about is we would ideally love to be able to bring the Duke PMA to schools, because that's where kids are. But one of the challenges of that is that, you know, the last thing we want to do is identify a child at being high risk, but then not having any resources for them, not being able to refer them to a provider.

00;10;08;09 - 00;10;30;03
Jonathan Posner, M.D.
So by working within primary care settings, they'll at least be partnered immediately with a medical team. And some of the interventions can be pretty straightforward. So for example, with sleep, talking to the child and talking to the family about better sleep hygiene, better sleep habits that could actually go a long way and doesn't require a separate referral.

00;10;30;06 - 00;10;35;18
Jordan Steiger
No, absolutely. That's a great point. Dr. Englehart, what do you think about challenges and opportunities?

00;10;35;20 - 00;10;57;05
Matthew Engelhard, M.D., Ph.D
Gosh, we have so many opportunities to make an impact here and so many opportunities to get more and more sophisticated in our ability to perform this work. So I think being able to connect with the schools is a tremendous opportunity. We also see there's an opportunity in being able to understand the device use component of the picture here.

00;10;57;07 - 00;11;23;24
Matthew Engelhard, M.D., Ph.D
How do you how do adolescents use of their digital devices? How does that contribute to some of the development of mental health distress that we're seeing? And then how can we in turn interpret information coming from those devices to help us intervene again? Another opportunity that we're really excited about is that as part of the work that we're working on now, we're going to be collecting information about home environments as well.

00;11;24;00 - 00;11;58;20
Matthew Engelhard, M.D., Ph.D
So this is drawing on research that we've been engaged in for a while now to understand relationships between different personal environments over the course of the day, and different health risks that individuals might be exposed to. And it's known that there are relationships between aspects of home environments and adolescent mental health. But we have the opportunity to work with adolescents and their parents to document different components of home environments and understand again how that relates in turn to the mental health picture, and maybe to make recommendations along those lines as well.

00;11;58;21 - 00;12;18;28
Matthew Engelhard, M.D., Ph.D
I think I would also add one more, which is that we've mentioned the importance of sleep, which has already come up, and I think we're very excited about the opportunity to put that knowledge to use and understand whether we can, in fact, use our model to identify children that are at high risk of worsening mental health because of their sleep, at least in part.

00;12;19;04 - 00;12;29;13
Matthew Engelhard, M.D., Ph.D
And to see if intervening on sleep, giving them some actionable recommendations to change sleep patterns, as I think Jonathan mentioned, whether that can indeed move the needle for those kids.

00;12;29;15 - 00;12;50;26
Jordan Steiger
That makes total sense. And, you know, thinking about teenagers to in the home environment, I feel like that's really, really important, thinking about mental health. And, you know, you bring up your personal device used to and I think that's another fascinating thing. I'll be curious to follow your work and see what comes of that, because we know that's a huge component in the way mental health kind of manifests for kids these days.

00;12;50;28 - 00;13;06;24
Jordan Steiger
Tell me a little bit more about what the Duke PMA can be used for. Like, is this a universal tool to predict mental illness kind of across the spectrum of different disorders that children can experience? Or is this really focused in on just a few different things?

00;13;06;26 - 00;13;35;04
Jonathan Posner, M.D.
Yeah, it's a great it's a great question. And what it actually predicts is something called a P factor, which is a global measure of mental illness. So it essentially encompasses risk for the full spectrum of psychiatric disorders. And one of the reasons why we chose the P factor is because if it was specific to a predicting risk for one disorder, its utility would be much more limited.

00;13;35;05 - 00;14;00;12
Jonathan Posner, M.D.
So, for example, if it predicted development of bipolar disorder, that would still be useful. But the number of teenagers that you could use it with would be also very limited. By using a global measure, it can be applied essentially to all kids. We're working to make it as user friendly as possible, so the entire battery of questions are being put onto an iPad.

00;14;00;20 - 00;14;21;11
Jonathan Posner, M.D.
So in theory, a family comes to their primary care clinic, and while they're in the waiting room, they could be handed the iPad, answer all the questions, and then the risk prediction and the profile would then be fed forward to the clinician who's about to see them. In the current version of the tool to complete all the questions,

00;14;21;12 - 00;14;41;15
Jonathan Posner, M.D.
it probably takes about half an hour. And that's one thing that we're really focused on, is to try to get the assessment down to as short as possible so that families could complete it in say, ten minutes, rather than 30 minutes. And so what we're trying to do is to limit the number of questions while still maintaining the predictive power.

00;14;41;15 - 00;14;44;07
Jonathan Posner, M.D.
And that's an active area of work for us.

00;14;44;10 - 00;15;06;26
Matthew Engelhard, M.D., Ph.D
And I would add that from the AI perspective, I think one of the reasons we've been so successful in doing something that is, is new here is the fact that in focusing broadly on all these different pathologies, we've really enhanced our ability to learn about relationships between general psychopathology and all of these different types of predictive features that we've talked about.

00;15;06;28 - 00;15;19;05
Matthew Engelhard, M.D., Ph.D
So, you know, it puts us in a position to give people the help they need. It's also enhanced our ability to understand what risk factors contribute.

00;15;19;06 - 00;15;43;02
Jordan Steiger
So I know we all are in the world right now where everybody is talking about AI constantly. And I think AI and mental health is a really hot topic right now. I know a lot of our members at the AHA are really kind of trying to understand and consider how they can incorporate more AI, you know, predictive models and all sorts of different things that you all know much more about than I do.

00;15;43;02 - 00;16;00;03
Jordan Steiger
But a lot of the audience on this podcast is hospital leaders. So if they're listening and thinking, how can I do this at my organization? How can I get something like the Duke PMA in, you know, for my primary care clinics or psychiatric clinics for kids? What would you tell them?

00;16;00;06 - 00;16;23;11
Matthew Engelhard, M.D., Ph.D
Well, first, first I would tell them, we're always happy to engage with folks that are interested in getting connected on this. So happy to talk to specific individuals who might like to adopt some of this technology. Thinking about interest in AI broadly, AI is so many different things. I mean, I think we're in an era where people think of ChatGPT and other chatbots as being synonymous with AI in some ways.

00;16;23;11 - 00;16;51;06
Matthew Engelhard, M.D., Ph.D
And I would say that this is a little bit different. I mean, when we talk about AI, we're thinking more broadly about systems that are used to make sense of data to understand patterns and data, in this case, patterns that help us understand, again, who's at greatest likelihood of being in mental health distress. So we're thinking of sort of AI in a broad versus a narrow sense here, and how to get this kind of technology up and running at a particular institution.

00;16;51;09 - 00;17;15;11
Matthew Engelhard, M.D., Ph.D
There is institutional know how that is, that is required. But we are doing everything we can to make this tool as broadly accessible as possible. Our model is in fact available in a public repository right now, and we are happy to work with folks to think about how they might take the publicly facing resources that we've made available and put it to work toward a specific use case.

00;17;15;14 - 00;17;34;18
Jordan Steiger
Thank you both so much for being here today. I think this is such a great opportunity just to share some of the really innovative work that's coming out of Duke right now and, you know, spreading across the country. I think this is just an incredible example of how we can kind of get ahead of the mental health crisis that we are all hearing about and experiencing every day.

00;17;34;18 - 00;17;40;03
Jordan Steiger
So thank you both for the work that you're doing to make mental health care better for people all across the country.

00;17;40;11 - 00;17;43;28
Jonathan Posner, M.D.
Absolutely. Thank you for having us and for your great questions.

00;17;44;02 - 00;17;46;04
Matthew Engelhard, M.D., Ph.D
It's been a pleasure. Thanks for having us.

00;17;46;07 - 00;17;54;29
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;09 - 00;00;17;07
Tom Haederle
Welcome to Advancing Health. Members of hospital boards have a wide portfolio of responsibilities. Still, there are five things every board member should know about quality and patient safety, and we hear what they are in today's podcast.

00;00;17;10 - 00;00;49;21
Rebecca Chickey
My name is Rebecca Chickey and I am the vice president of Behavioral Health and Trustee Services at the American Hospital Association. And it is my honor today to be joined by Dr. Elizabeth Mort. She is the vice president and chief medical officer for the Joint Commission. In this role, Liz serves as a primary voice for patient quality and safety, and as a key liaison between the Joint Commission and the health care quality and safety community, and works closely with health care organizations on accreditation processes.

00;00;49;21 - 00;01;12;26
Rebecca Chickey
Dr. Mort is also the editor in chief of the Joint Commission Journal on Patient Safety and Quality. Prior to joining the Joint Commission, she served as the senior vice president of Quality and Safety and the chief quality officer at Massachusetts General Hospital for ten years, and she's also served on AHA's Committee on Clinical Leadership. Dr. Mort, thank you for being here today.

00;01;13;02 - 00;01;15;28
Elizabeth Mort, M.D.
Rebecca, it's a pleasure. Thank you so much for having me.

00;01;15;29 - 00;01;47;17
Rebecca Chickey
Well, I also want to thank you not only for the time you're going to spend with us today on this podcast, but you've just recently written an article that's going to be featured in the May edition of AHA's Trustee Insights newsletter. In that article, you really described what a board, an overall board, the full board needs to know about running a quality committee. And you provided five recommendations to elevate the impact of the quality committee, particularly during times of financial and operational challenges.

00;01;47;22 - 00;02;03;15
Rebecca Chickey
So the focus of our podcast today is really going to be on those five things that all board members need to know about quality and patient safety, including how that relates to Joint Commission surveys and resulting reports. Are you game?

00;02;03;23 - 00;02;05;06
Elizabeth Mort, M.D.
Game. Game on.

00;02;05;07 - 00;02;24;20
Rebecca Chickey
Wonderful. So we'll start with this. If you can simply list the top five things that you think all board members should know about quality and patient safety. Give maybe a high level 1 or 2 sentences about what that means. And then we'll go back and dig into each of those five.

00;02;24;22 - 00;02;51;24
Elizabeth Mort, M.D.
Absolutely. You know, just to reinforce what you said, Rebecca, a focus on quality is more important now than ever during these difficult times. There are so many competing demands for boards to focus on. It's a great time to think, how are we focusing on quality and how can we even do a better job? So the five things that I've outlined for that charge really, focus on quality, is to really own the charter.

00;02;51;24 - 00;03;18;25
Elizabeth Mort, M.D.
And what do I mean by that? Boards have charters. If you have a quality committee, it likely has a charter. And what we need these individuals to do is realize that they can move from generally understanding quality, thinking about quality as an abstract fiduciary, going from that stance to being more active, really put that quality committee to work.

00;03;18;27 - 00;03;48;20
Elizabeth Mort, M.D.
The second one is really the board needs to understand what the organization has as an operating system to ensure the quality assurance and performance improvement is happening. So many of you are probably familiar with the fact that the Centers for Medicare and Medicaid Services refer to this as quality assurance and performance improvement. For board members listening, you've probably heard that acronym.

00;03;48;23 - 00;04;12;06
Elizabeth Mort, M.D.
You've probably seen org charts, but do you really know how it works? And it's often a committee that goes parallel to an operational org chart. And it's more than just looking at the org chart and seeing various things in boxes. Now is the time to really understand its function. Is it functioning well and is it getting the results it should?

00;04;12;12 - 00;04;31;17
Elizabeth Mort, M.D.
The third thing I would say is that you really need to know your quality metrics and then ask what's missing? Quality measures over the last 20 years have escalated at a very, very rapid pace, and many board members are accustomed to looking at financial reports and looking to the bottom right and seeing whether things are positive or negative in parentheses or not.

00;04;31;20 - 00;05;00;10
Elizabeth Mort, M.D.
Quality measurement, unfortunately, is not as easy to summarize. So orgs make choices about what they put on the reports that they show the board. And you have to understand what those measures are and probe. But you also need to ask, what aren't you measuring? What are you worried about? So it's really being much more involved, I would say, and understanding and helping to support choice of measures and improvement of measures.

00;05;00;14 - 00;05;27;27
Elizabeth Mort, M.D.
So the fourth one is this: make risk decisions explicit and transparent. What do I mean by that? Organizations have lots of things that they might want to implement, they might want to resource. Even if they had all the resources you can't implement everything all at once. So whether it's because of bandwidth resources, both organizations are constantly making decisions about, go with this one,

00;05;27;28 - 00;05;51;18
Elizabeth Mort, M.D.
don't go with that one. I would encourage boards to think, particularly during this time when resources are constrained to find out what wasn't put on the list, why it wasn't put on the list, and that what risks patient safety risk, quality risk are associated with delays or discarding things. That isn't often done, and we call that transparent risk assessment.

00;05;51;18 - 00;06;15;27
Elizabeth Mort, M.D.
It's really very important. And I think it's particularly important when clearly resources do not allow organizations to do everything they want. It just simply not possible in today's world. The last one relates to accreditation. I would say boards really need to lean more into accreditation, and they should expect continuous readiness. Accreditation organizations come into your organizations on a periodic basis.

00;06;15;29 - 00;06;48;12
Elizabeth Mort, M.D.
They give you some feedback, and those organizations expect you to be monitoring that, managing that, improving that continuously. And I have seen boards be disappointed when they weren't really aware of that obligation. And a survey might be every three years; I work at the Joint Commission. Our standard surveys are every three years. But the point is that even though you may be only visited on site on a periodic basis, you are responsible for fixing things that were cited.

00;06;48;12 - 00;06;59;19
Elizabeth Mort, M.D.
And if they come back, it bounces back to the board. So you really have to understand your accountability for accreditation. You're not going to get quarterly measures unless you do something yourself. So we'll talk more about that.

00;06;59;21 - 00;07;35;09
Rebecca Chickey
Thank you. Liz I'm going to go back up to number one, which you said is called Own the Charter. Really own it. The question I'd love you to dig into a little bit more there is,  governance... there's always a balance between for governance roles to be ensuring organizational health and not getting into the day to day operations. Give an example of something that would be on the ensuring organizational health as it relates to patient safety and quality, but that can be active without getting stepping over that line into operations.

00;07;35;15 - 00;07;57;11
Elizabeth Mort, M.D.
It's a fine line, obviously, and one that, you know, governance and management - that fine line needs to be walked carefully. I do think being a more active quality committee or being having the board being more active in a quality capacity in these times can be done without getting into management. And it's really about in general surfacing where the issues are.

00;07;57;14 - 00;08;23;26
Elizabeth Mort, M.D.
So, you know, find the issues, have management share the issues. Don't tell management how to solve the issues, but expect management to come back with progress. So it's more of a, you know, what's going wrong? How can I help? Expect that from your management teams and then have them be accountable for reports and tracking the improvements. So you know, oftentimes what boards will get in their quality committee are report outs.

00;08;23;27 - 00;08;45;23
Elizabeth Mort, M.D.
Here's how we're doing on med errors. Here's how we're doing on infections here. Here's how we're doing on falls. And I think then the more active board stance in times like these is, well, you're doing well in these metrics. These are these are not doing well. What's your plan? What's your time frame? Do you have the resources you need? If the answers are we have a plan.

00;08;45;23 - 00;09;11;29
Elizabeth Mort, M.D.
We have a timeline. We have the resources. Then say, well, when will you be back to show me, show us the results? So it's really being more active and supporting them. And some of that is actually asking why they're not where they want to be on a performance metric. So the leaning in of the board is really about activating and encouraging improvement, trying to get take barriers away rather than solve the problems tactically or from a management perspective.

00;09;11;29 - 00;09;35;11
Rebecca Chickey
And that leads me into - because I think all of these are interconnected. As they are asking these questions, do you see that as a way for them to better understand the quality operating system or the copy? Is that really a way of being active, is a way of, you know, rolling up your sleeves and understanding better how the quality process works at their organization?

00;09;35;16 - 00;09;56;15
Elizabeth Mort, M.D.
Well, it could be certainly, depending upon what the report out comes back at and who gives it. I think that's a really interesting question, is that could you ask a board member, committee member? Could we could we say, you know, when you come back, I'd really love to know how you collaborate. It could be a quality leader, for example, or a chief nurse or a chief medical officer giving a report out at a board meeting.

00;09;56;22 - 00;10;18;29
Elizabeth Mort, M.D.
But it might have something to do with medication errors, or it might have something to do with high level disinfection. And to really understand how the leaders of quality who are often in that space. CNO, CMO, CQO, regulatory leaders, those are the people that often show up at these meetings, but the people doing the work are the ones who are in operations.

00;10;18;29 - 00;10;33;00
Elizabeth Mort, M.D.
And how does that all work? So one thing to consider would be a board member could say, when you come back with the report, I'd love you to consider bringing those folks who are actually on the front lines and hearing from them as to what the barriers are.

00;10;33;07 - 00;10;58;00
Rebecca Chickey
That's excellent. I'm going to ask you for the third measure, or the third recommendation that you noted, and that is to know the quality metrics. Then ask what's missing? I think for all of us not knowing what we don't know, that is one of the biggest concerns, because there's always something that we don't know. So what are some questions that they might ask beyond what's missing?

00;10;58;00 - 00;11;05;27
Rebecca Chickey
Or are there any things that you've seen over the last many years in quality and patient safety, where things get left off?

00;11;06;03 - 00;11;35;09
Elizabeth Mort, M.D.
Yeah. You know, it's an interesting history over the last 20 years. You know, if you think back, we used to just have Medicare mortality rates, and now we have so many measures that span impatient. There are a lot of ambulatory measures now. And the whole concept of a dashboard is not to flood it with so many measures that it becomes an eye chart and you lose the forest through the trees. But find measures that are important to the organization's health, to monitor the health and make some choices about that.

00;11;35;11 - 00;12;03;23
Elizabeth Mort, M.D.
People do it different ways. Organizations do it different ways. But no organization would put every measure on a dashboard. What I might do is if I were, you know, designing a sort of an approach is I would have boards get some basic information about what we can measure in health care and who's asking organizations to measure it. Because, you know, there's government, right?

00;12;03;23 - 00;12;26;02
Elizabeth Mort, M.D.
There's CMS, commercial payers are asking to be measuring a lot of things. There's groups like Leapfrog. There are groups like, well, Joint Commission. We ask for some measures. We try to align very closely with CMS for reduced burden. US News is out there. We have Newsweek, but there are lots of things out there. And my goodness, how are you going to decide what's important.

00;12;26;06 - 00;13;01;08
Elizabeth Mort, M.D.
So I think educating boards about what's out there, then putting out for the boards, even recommendations, these are the things we think are most important, but also committing to monitor what's not being shown. So that you have sort of a sort of behind the scenes detail list of measures that are being tracked. Because some of those measures are presented to the organization, some have to be collected by the organization, but somebody should be tracking the other measures that aren't on the dashboard.

00;13;01;10 - 00;13;09;02
Rebecca Chickey
It just doesn't have to always be reported out to the board unless a certain threshold is reached where it has risen to a level of concern.

00;13;09;03 - 00;13;22;27
Elizabeth Mort, M.D.
And then the board should say, well, listen, you know, if you watch those others, you know, and if one is one is a trigger, I want to hear about it. So that's one way to do it. There are just so many measures right now, and there's a lot of conversation in the industry about, do we have enough measures?

00;13;22;29 - 00;13;41;17
Elizabeth Mort, M.D.
Are we doing the right thing? And I imagine that this will evolve. There is not one good solid, you know, bottom line measure, unfortunately. That would be very, very nice. Many people have asked me, you know, inpatient mortality adjusted for risk and all these things. It just doesn't cut it as an overall measure like in a financial report.

00;13;41;17 - 00;14;03;24
Elizabeth Mort, M.D.
So boards need that education. And I think it's education that's worth taking time to provide. There are things that we worry about in health care that don't have measures despite all these measures. So another question I would suggest boards ask their staff, the management is,  okay, so we got the measures. We see where you're doing well. We see where you're not.

00;14;03;24 - 00;14;23;22
Elizabeth Mort, M.D.
You're going to watch these other measures and escalate problems. We've got that covered. What else keeps you up at night? Because not everything that's important from a patient safety risk perspective actually has a measure. And those risks need to be transmitted and talked about not on a dashboard, but they need to be talked about. So I just didn't want to leave that out.

00;14;23;22 - 00;14;24;25
Elizabeth Mort, M.D.
That's super important to.

00;14;24;26 - 00;14;52;02
Rebecca Chickey
That is also related to your fourth recommendation around making risk decisions explicit and transparent. You're making decisions and not reporting those out may have risks that need to be understood. And that's where I circle back to your point about continuing to educate the board members about this whole process. I'll tell a quick story about my own two children.

00;14;52;02 - 00;15;10;04
Rebecca Chickey
When I would pick them up from school, I would always before they wanted to game or start talking about something. They had to say, what was one good thing that happened today, and what was one bad thing that happened today? It has brought them into adulthood. And somebody else told me this. This was not an original idea, but it's brought them to adulthood.

00;15;10;05 - 00;15;34;19
Rebecca Chickey
Being able to share with us the bad things that happened in their life. And that's not easy. And I think enforcing and strengthening the importance of being transparent with the decisions that are difficult, that are complex, that have to be made to let the board know what the risks are. Because they may have a perspective that is different.

00;15;34;21 - 00;15;56;01
Elizabeth Mort, M.D.
Yeah, that's a great story. And I think it relates also to the tracking of the metrics. I've seen organizations, they get some scores on something. The scores aren't good. They think, I'm going to fix this before I share it. Not the way to go. I think, you know, you need to be you need to be monitoring metrics and you need to be on top of them.

00;15;56;01 - 00;16;12;21
Elizabeth Mort, M.D.
But oftentimes if things are not going in the way you want, it can't be fixed by one person. It needs a team. And that you know what you had your kids do, which is you know what didn't go well, that gave them the muscle memory and the comfort and the reflexes to be able to say, hey, I need help.

00;16;12;21 - 00;16;24;10
Elizabeth Mort, M.D.
So, you know, never worry alone is something that I've heard said by lots of people. And I would just say, don't, you know, encourage your management, staff, board members to not sit on things. We're here to help.

00;16;24;16 - 00;16;38;06
Rebecca Chickey
As we come to the fifth one, which specifically, you said the committee should lean into accreditation and expect continuous readiness. Can you help the listeners know what is continuous readiness? What do you mean when you say that?

00;16;38;10 - 00;17;05;25
Elizabeth Mort, M.D.
So continuous readiness is a term in this case that is referring to the next patient getting high quality, safe, compassionate, appropriate care, continuously being ready for that. But it also can be referring to being ready for the next time somebody comes to your organization to make sure that you're providing for the next patient, for every patient, safe, high quality, continuous, compassionate care.

00;17;05;27 - 00;17;36;09
Elizabeth Mort, M.D.
With respect to accreditation and the Joint Commission, I'll use that as the example. That's my organization. Our traditional surveys are every three years. We go into hospitals every three years. And as I mentioned in my opening comments, there are options for more continuous touchpoints. But the survey itself is sporadic. And what I would encourage and what I did in my old organization is set up a surveillance program so that you're monitoring all the things that CMS and your accrediting organization -

00;17;36;09 - 00;18;00;24
Elizabeth Mort, M.D.
in our case, it was the joint Commission - you're monitoring to make sure those things happen every day for every patient. So continuous readiness for all patients, continuous readiness for the next survey. That's extremely important. And I'll just share that you all remember Covid. And you know when Covid happened at its peak some things had to get back-burnered while we just struggled to make sure that we could get a bed for every single patient and needed one.

00;18;00;24 - 00;18;22;04
Elizabeth Mort, M.D.
We all did that. We all remember that. And as things quieted down, the very first thing I said we needed to put back in our armamentarium of tactics to provide high quality, safe care. The very first thing I said we needed to do is put back that surveillance of continuous readiness. And it's a monitoring system. And basically teams go and they use tools.

00;18;22;05 - 00;18;55;08
Elizabeth Mort, M.D.
Joint Commission has a great tool, a tracer tool, and they're going through the hospital and they're looking for things. They're looking for evidence of infection control, medication management, clean environment. Safe environment. Are your emergency equipment... are your cold carts ready? Are timeouts being done? And those things are being done in a continuous way. Surveillance. And you get the data. I think boards should expect that their organizations are not just waiting for the next survey, but they are ready for the next patient.

00;18;55;14 - 00;19;25;08
Rebecca Chickey
That helps tremendously. Your recommendations are own the charter, really own it. Be active, not passive. Understand the quality operating system and your organization's approach to QAPI, know the quality metrics and then ask what's missing. Make risk decisions explicit and transparent, and the board and the quality committee should lean into accreditation and expect continuous readiness as you just described.

00;19;25;10 - 00;19;51;10
Rebecca Chickey
Liz, Dr. Mort. Thank you so much for sharing your time, your expertise, providing guidance. Health care is complex, but the mission is health care, and that involves being able to deliver high quality care for each and every patient we serve. And the words you've shared here with the listeners today will inspire others to take a more active engagement if they're serving on a board.

00;19;51;11 - 00;19;52;24
Rebecca Chickey
Thank you so much.

00;19;52;26 - 00;19;54;27
Elizabeth Mort, M.D.
My pleasure. Thank you.

00;19;55;00 - 00;20;03;23
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.

00:00:00:08 - 00:00:22:19
Tom Haederle
Welcome to Advancing Health. Roughly 50% of victims of violence develop depression or PTSD afterwards. Today, we hear how Penn Medicine's Violence Recovery Program offers psychosocial support and individualized interventions that accelerate the path to healing.

00:00:22:21 - 00:00:43:25
Jordan Steiger
My name is Jordan Steiger, and I am the director of Behavioral Health and Violence Prevention at the American Hospital Association. I'm really excited for this episode today. I am joined by Dr. Elinore Kaufmann, who is the medical director of the Penn Trauma Recovery Program, and by Michele Volpe, who is the chief operating officer of the University of Pennsylvania Health System.

00:00:43:25 - 00:01:05:07
Jordan Steiger
And we're going to discuss today the Penn Trauma Violence Recovery Program, which is a hospital based violence intervention program based at the Level One Trauma Center at Penn Presbyterian Medical Center in Philadelphia. We're going to learn more today about what an HBV VIP actually is. For those that don't know and discuss how senior leaders can lend their support to these programs.

00:01:05:08 - 00:01:08:24
Jordan Steiger
So, Dr. Kaufman and Michelle, thank you so much for being here today.

00:01:08:28 - 00:01:09:24
Elinore Kaufman, M.D.
You're welcome.

00:01:09:27 - 00:01:10:28
Michele Volpe
Thank you so much.

00:01:11:00 - 00:01:24:12
Jordan Steiger
So, before we dive into the details of your program and talking about some more information, Dr. Kaufmann, can you just explain to our listeners what a hospital based violence intervention program is and tell us a little bit more about your program?

00:01:24:16 - 00:01:53:13
Michele Volpe
Yeah, absolutely. Patients who are injured through interpersonal violence, community violence, often really struggle with their recovery after injury. They face a lot. They have physical injuries, of course, which is what I'm trained to focus on as a trauma surgeon. But they also have to grapple with the mental health consequences of being hurt in that way. So we know that about 50% of people go on to develop depression and/or PTSD.

00:01:53:15 - 00:02:18:09
Michele Volpe
Community violence is also very tied to social factors - poverty and discrimination, lack of access. So our patients come in with a lot of adversity, and then the experience of injury can make it worse. Hospital based violence intervention programs have been around for about 25 years. Ours is relatively new, but these programs exist to provide dedicated support to survivors of violence.

00:02:18:15 - 00:02:43:25
Michele Volpe
We work with credible messengers who have a shared background and set of experiences can really connect to our patients. They provide psychosocial support and an enormous amount of case management and navigation of hospital health system, community municipal resources to try to get patients all of the things, all of the components that they need to make as full a recovery as possible.

00:02:43:28 - 00:02:52:19
Jordan Steiger
So walk me through what that looks like. So say you have a patient that's coming in that you're treating as the trauma surgeon. Tell me what happens after the surgery.

00:02:52:21 - 00:03:21:22
Michele Volpe
Yeah. So in our program, our frontline workers are called violence recovery specialists. And they try to meet with any patient who's affected by violence as soon as possible after the patient is stabilized. They generally start by just trying to connect with them, build rapport, let the patient know what the program is, what resources are available to them, and every patient really receives an individualized intervention.

00:03:21:22 - 00:03:44:21
Michele Volpe
So many patients, like I mentioned, have mental health care needs. And we have therapists who work with our program who are accessible to our patients. Many patients struggle with housing or need to relocate for their safety. So our violence recovery specialists are really experts at walking patients through working with relocation agencies through the Philadelphia city government, for example.

00:03:44:28 - 00:04:15:21
Michele Volpe
Those are two of the most common needs that our patients have, but it ranges from getting people back to school, getting people job training, replacing things that were lost, like patients' driver's licenses and phones and identification. It really runs the gamut. So our violence recovery specialists start working with patients as soon as possible after injury. But what makes the program or programs like this really special is how long the relationship can last.

00:04:15:21 - 00:04:42:20
Michele Volpe
So when I take care of a patient, they get through their hospitalization, they get through their surgery, they recover, they leave the hospital, they go home, ideally. Maybe I see them in the office once or twice to check on their healing. Our violence recovery specialists are working with patients. They're connecting with them twice a week, every week, sometimes every day, depending on the patients need for months after injury oftentimes until patients are really back on their feet.

00:04:42:20 - 00:04:51:04
Michele Volpe
So they really help bridge that gap between the acute hospitalization and the community and true recovery.

00:04:51:07 - 00:05:11:06
Jordan Steiger
That makes total sense. It sounds really like this HBPIBV model is that bridge between community and hospital and trying to fill that gap between. So I'd love to hear - maybe Michelle, we can start with you - why is this an issue that health systems should care about? And why is this not just a community issue? Why should hospitals be involved?

00:05:11:08 - 00:05:52:04
Elinore Kaufman, M.D.
So violence touches everyone. It affects everyone. The victim obviously, of the of the violence, their family, friends, the community, but also staff. Every trauma patient that comes in to our trauma center is an emotional experience for our staff. Across the board, physicians, nurses, and they take our staff, takes every death personally as well as every success. Meaning a patient, a trauma patient, gets through an awful experience.

00:05:52:07 - 00:06:23:26
Elinore Kaufman, M.D.
They have a long way forward in terms of their recovery. They take that personally, I hear that. I hear that all the time from members of our trauma team. The health system is also a part of the community, particularly where Presbyterian is located in West Philadelphia. Although Presbyterian treats many, many patients from well outside of the West Philadelphia community, many trauma patients are from

00:06:23:27 - 00:06:58:08
Elinore Kaufman, M.D.
our West Philadelphia neighborhoods and/or surrounding neighborhoods. Trauma victims are frequently known by community members. Not only are they frightened about what has happened in their community, but they are also very concerned about the recovery for a member of their community. This program is one that helps trauma victims heal. It helps them in a way where at some point they can -

00:06:58:09 - 00:07:13:05
Elinore Kaufman, M.D.
I don't mean just physically return to their community - but emotionally return to their community and contribute to their community once again, and many times in a way much more significant than they had previously.

00:07:13:06 - 00:07:16:10
Jordan Steiger
That makes a lot of sense. Elinore, anything to add to that?

00:07:16:16 - 00:07:36:18
Michele Volpe
When we started our program in 2021, it was new to Penn, and although it was an established model, we were really looking to see how it would go here. It's been wonderful with patients, but our program and our team has also been so welcomed by staff across the board. And, you know, our primary mode is that we pick patients up on the trauma service

00:07:36:18 - 00:08:08:24
Michele Volpe
of course, like I was saying. But we get referrals from social work, certainly, but also from physical therapy, from OBGYN, from family medicine. And I think it really speaks to how much staff and clinicians recognize the need, recognize their community members, like Michelle was saying, and how much they welcome having those additional resources to offer. I think it's a little bit of an antidote to some of the burnout that we experience when we're taking care of problems that on some level, we really can't fix.

00:08:08:24 - 00:08:32:15
Michele Volpe
So I think it helps us and it helps the health system reach further into the community and go that extra mile. The other thing I would add that we haven't talked about is one of the reasons that programs like ours were started is because of the challenge of recurrent violent injury. So violence, like other medical problems, like heart disease, like stroke, can become a recurrent disease.

00:08:32:15 - 00:09:02:10
Michele Volpe
So patients had risk factors beforehand. And now they have more risk factors. And there's very few things that's worse as a clinician, as a trauma surgeon than to take excellent care of a patient and then see them come back with the same or worse injuries, of course. Programs like this have been shown to reduce recurrent violent injury dramatically in some studies where a quarter of people were coming back, now it's down to 5%. Where 10% of people were coming back,

00:09:02:13 - 00:09:32:21
Michele Volpe
in some studies it's down to 0%. I always get anxious when I quote our numbers, because I worry about the next person and wanting to protect them, but we've seen similar effects here. That's good for patients, it's good for staff. And, you know, I will have to acknowledge that it's good for the economics of health care as well. Hospitalization that we can prevent is money we can save and use for other necessary care.

00:09:32:25 - 00:09:34:24
Michele Volpe
So it's really good for us all around.

00:09:34:25 - 00:09:54:16
Jordan Steiger
Thank you for sharing those statistics. I mean, hearing that, you know, that recurrent, you know, time back in the hospital can get down to 5% or 0% in different studies is really, really incredible. And you did touch on the financial piece, which I'm sure is something that people listening to this might be worrying and wondering about, you know, how would I start this at my organization?

00:09:54:16 - 00:10:06:12
Jordan Steiger
How much does this cost? And I think, Michelle, you can really give some insight as the COO of your health system. Tell me a little bit about why making this kind of investment matters to you and matters to your system.

00:10:06:14 - 00:10:33:01
Elinore Kaufman, M.D.
It matters because it is an investment in people. And when you invest in people, it is a benefit that gives back time and time and time again. Employees, those who have supported trauma patients, not just those who have supported trauma patients, but, you know, many across the system, they see the work that that is being done in this program.

00:10:33:01 - 00:11:06:15
Elinore Kaufman, M.D.
And they recognize, you know, that Penn has stepped up and it has made a commitment in people. And when you see that a commitment in people is being made. I mean, now I'm speaking for myself, you know, that makes me feel as though I'm with a health system that really cares. Also, Elinore shared that this program has shown, I mean, statistically, to help reduce violence in the future.

00:11:06:19 - 00:11:36:19
Elinore Kaufman, M.D.
Those individuals who go through this program, they are many times over individuals that will not again get involved in similar types of situations. And that's a benefit, obviously, to the community. It's a benefit to the hospital, but it's also a benefit in terms of, you know, health care costs, right? I would also say that this commitment is one that staff takes very seriously.

00:11:36:20 - 00:12:11:21
Elinore Kaufman, M.D.
I've been in a number of sessions where Eleanor and her team members have spoken, and I'm telling you, there's not a dry eye in the room. Stories are brought forward, individuals who have had some very serious things happen to them. They've been able to recover physically, but then seeing that they were able to recover and/or are recovering emotionally, holding down meaningful jobs, the value of that is almost priceless.

00:12:11:24 - 00:12:15:03
Jordan Steiger
I mean, absolutely. And, Elinore, do you have anything to add to that?

00:12:15:07 - 00:12:42:03
Michele Volpe
I mean, I could talk about this all day. I'm a researcher as well, and I love the numbers. But one of the great privileges that I have in working with this program is all the stories that I get to hear. And so there's a lot of challenges that I hear about as well. But when I hear a patient say, you know, this program was the thing that got me to go out of the house because I was having such severe hypervigilance and PTSD symptoms.

00:12:42:04 - 00:13:07:06
Michele Volpe
This program kept me from going back to selling drugs when I thought that might have been my only option. This program encouraged me to encourage my friends and family not to go look for the person who hurt me, not to get involved in retaliatory violence. Working with my violence recovery specialist made me realize I want to get back in school.

00:13:07:13 - 00:13:28:02
Michele Volpe
We hear these stories time and time again and like I said, we hear other more challenging stories too. But our patients give us these gifts over and over again of resilience and hope and encouragement, and to be able to support that from our side is really special. And I think, like Michelle said, it's another way of caring about them.

00:13:28:02 - 00:13:31:06
Michele Volpe
And they feel that and they know that and they believe in it.

00:13:31:10 - 00:13:50:18
Jordan Steiger
Yeah, that investment in whole person care, I think, is just so palpable. And hearing the way both of you are talking about this and I mean, just thinking about them in every aspect of their life, not just their health care, I think it's something we can all aspire to that are listening today. So I think that's incredible, incredible work that you're doing.

00:13:50:20 - 00:13:59:25
Jordan Steiger
If somebody is listening to this and maybe feels inspired to look into this for their own organization, what would you tell them? What's your big piece of advice?

00:13:59:27 - 00:14:24:08
Michele Volpe
Like I mentioned, programs like this have been around for about 25 years. Ours started in 2021. The national organization that provides training and support and structure for programs like this is called the HAVI, the Health Care Alliance for Violence Intervention. So that's a great resource if you want to learn more about HVIPS or you're thinking about starting a program.

00:14:24:10 - 00:14:46:08
Michele Volpe
When I was thinking about starting this program, I was strongly and immediately encouraged by community members that I talked to, by staff members that I talked to. So I think if you if you get out in your community, it will be easy for people to recognize the need and the opportunity. Like I said, I can talk about this all day, and I think anybody who works with this program will.

00:14:46:08 - 00:14:54:04
Michele Volpe
So I'm certainly happy to be a resource with whatever I know. And I think anybody in a similar program wants to share.

00:14:54:07 - 00:15:47:26
Elinore Kaufman, M.D.
I would add that particularly if you have a trauma program that you almost cannot not do this, you must do this. It's so important. And I've learned this from Elinore and her team. It is just so important to heal both the physical and the emotional. And the emotional goes, you know, just beyond psychological, right? This investment is necessary to be able to have a full trauma program, and one that just doesn't fix the physical injuries, but goes well beyond that and provides a significant healing.

00:15:47:28 - 00:16:08:28
Jordan Steiger
Absolutely. And AHA is a member of the HAVI as well. I'll echo that it's a great resource and we can definitely link to the HAVI's website in the description so people can access that information. If I could add my own lesson learned from listening to you, I think one thing I really want to point out to our listeners is that we have a great combination of leaders here.

00:16:08:28 - 00:16:28:27
Jordan Steiger
We have, you know, our trauma surgeon who leads the program, and we have our COO. And I think having both of you engaged and as passionate as you are about this work really has helped it move forward. You are doing incredible work and we are just so, you know, happy and proud that you are members of AHA and willing to share your story with us.

00:16:29:00 - 00:16:31:06
Jordan Steiger
So thank you both so much for being here.

00:16:31:12 - 00:16:33:08
Michele Volpe
Thank you so much for having us.

00:16:33:10 - 00:16:35:13
Elinore Kaufman, M.D.
Yes. Thank you.

00:16:35:15 - 00:16:44:10
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 - 00:00:17:21
Tom Haederle
Welcome to Advancing Health. For families living in poverty, health care can take a back seat in the list of daily priorities. Today we hear about a remarkable partnership in Kansas City that is turning that paradigm around by bringing care to kids.

00:00:17:23 - 00:00:44:21
Julia Resnick
When families are navigating poverty, accessing health care can become just one more challenge in an already complex system. That's why reducing those barriers and bringing care closer to where families are matters so much. In today's episode of Advancing Health, I'm joined by leaders from two organizations working together to do just that for children in Kansas City. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association.

00:00:44:23 - 00:01:08:13
Julia Resnick
I'm talking with Dr. Alejandro Quiroga, president and CEO of Children's Mercy Kansas City, and Mary Esselman, president and CEO of Operation Breakthrough. Together, their partnership embeds pediatric care within a trusted community setting, bringing services closer to the children and families that need them most. Ale, Mary, thank you so much for joining me today to talk about this remarkable partnership.

00:01:08:15 - 00:01:09:19
Mary Esselman
Excited to be here.

00:01:09:21 - 00:01:12:10
Alejandro Quiroga, M.D.
Thank you for having us, Julia. Very excited to be here.

00:01:12:12 - 00:01:22:14
Julia Resnick
So for listeners who are unfamiliar with Kansas City, what does it look like to grow up as a kid in the community you serve, particularly related to factors that influence those kids health?

00:01:22:16 - 00:01:45:06
Mary Esselman
Well, I'd love to jump in on this one because I think if you can just picture where we're located, it really gives you an idea. We're located at the corner of 31st and Troost, which is always been known as the dividing line in Kansas City, not only in terms of prosperity, but also in terms of race. So you're looking at a community that has had a long period of time in which there they've been underserved.

00:01:45:09 - 00:01:48:03
Mary Esselman
And so that kind of gives you a visual.

00:01:48:05 - 00:01:49:26
Julia Resnick
Ale, anything you want to add?

00:01:49:28 - 00:02:12:11
Alejandro Quiroga, M.D.
I mean, I think where our community has come through is like many communities in the US. I think we're talking about Kansas City, but like everything that we're going to say, it's something that can be translated to any community in the US. And therefore the responsibility of local leaders, local partnerships to make sure that we serve them in the same way.

00:02:12:13 - 00:02:19:02
Julia Resnick
So what are some of those barriers that families face when it comes to health and education and economic opportunity?

00:02:19:05 - 00:02:39:11
Mary Esselman
Well, I think one thing you can look at is like in in Kansas City, only 18% of jobs can be reached in about 90 minutes. So you can already think about childcare access, transportation. I know, over the last 20 years, I mean food access and food scarcity goes up and down. We do a bus tour called The City.

00:02:39:11 - 00:02:56:28
Mary Esselman
You Never See. And one of the things we ask people to look at is like, as you're driving around the east side, like, where would you get groceries, you know? How would you access services if you didn't have transportation? And I think when you have those kinds of fundamental needs that are missing, health care can oftentimes take a backseat.

00:02:57:02 - 00:03:11:06
Mary Esselman
So instead of creating a proactive culture of health, it's reactive. You're only going when it's absolutely necessary. And then it tends to be to the emergency room, not a trusted physician or health care partner.

00:03:11:08 - 00:03:31:18
Julia Resnick
Yeah. And I think all of that just impacts the long term health of kids and families in your community. Which brings us to the topic of our conversation, which is really Operation Breakthrough. So I've had the privilege of visiting, but I know that many of our listeners have not. So, Mary, can you tell us what it is and how it was designed to meet the needs of kids and families in Kansas City?

00:03:31:20 - 00:03:54:17
Mary Esselman
Well, this year is actually our 55th year, hard to believe. But it actually started in a living room. Two nuns were teaching on the east side. And, you know, they had school aged kids, but parents were like, if we just had someone to watch our younger children, we could work. And so they thought, we can do this. And so four in the living room turned to 40 to 400, and today it's over 780 children and families that are served.

00:03:54:17 - 00:04:10:02
Mary Esselman
But what makes it unique is the fact that it's not just about education or care, it's about social services and health. And that's what I think, where you see that uniqueness going from cradle to career and this tight knit community and everything we do is based on relationships.

00:04:10:05 - 00:04:13:16
Julia Resnick
Fantastic. Ale, anything you want to add there?

00:04:13:18 - 00:04:33:05
Alejandro Quiroga, M.D.
I'll tell you, when I first got to Kansas City, I got the call from Mary. And of course, my team told me that you have to go visit. And it's the most I mean, it's a jewel in the middle of Kansas City of something that is so hard to describe. But when I did tour, my first tour, we walked through it.

00:04:33:05 - 00:04:59:07
Alejandro Quiroga, M.D.
And you see a classroom, then you're all of a sudden across a hallway and you're in the middle of a clinic. Then you cross a bridge and you're in workshop where there's welding of cars that people are learning trades, and everybody is all around this pantry. There's volunteers. It is the most purposeful place that you can see to help this community.

00:04:59:10 - 00:05:11:27
Alejandro Quiroga, M.D.
And as you will hear from Mary, it's actually doing that job. But through relationships in an extremely meaningful way. So it's is a very unique model that more communities should have.

00:05:12:00 - 00:05:32:29
Julia Resnick
Yeah. And when I visited, I was also blown away by, you know, the hydroponic gardens and kids learning how to run restaurants alongside early childhood education, just like how incredible that you've created that space for kids to learn and feel safe and grow. So I want to talk a little bit about the partnership between Children's Mercy and Operation Breakthrough.

00:05:33:01 - 00:05:41:03
Julia Resnick
Can you talk about how that started, and how you realized that bringing health care directly into the community could really make an impact?

00:05:41:05 - 00:05:57:19
Mary Esselman
Well, our founders, you know, Sister Verna was like a little firecracker. You know, if she thought we needed something, she just started it, and she might start it with the volunteer. And then she'd find a way to get everyone who can. And so it actually started 30 years ago, where she said, we have got to have a nurse.

00:05:57:21 - 00:06:35:27
Mary Esselman
And so, you know, what is now an office used to be the place where the nurse was, and we could start to really be more proactive. And then in 2008, we got to do an expansion, and then we got the full clinic. And that's been amazing. And then when you kind of track forward a little bit, which I think was one of the most important things we did is in 2013, we formed a partnership for Resilient Families, and it's something that happens quarterly between, Children's Mercy and ourselves. And everybody from the top of the organization to those directly practicing with families, get together to really talk about how do we help families and what

00:06:35:27 - 00:06:42:18
Mary Esselman
are the current pressing issues that we need to address together to encourage that culture of health for our families.

00:06:42:20 - 00:06:48:13
Julia Resnick
So talk to me a little bit about what the clinic looks like and how does it work. Like, walk me through it.

00:06:48:16 - 00:07:03:19
Mary Esselman
Well, so when you come in, it's like, right front and center. And when the beauty of is it's not just for kids here, although we have plenty of them, it's also for the community. So imagine if you're here for early care and education and then you go off to school, and you may not stay in the program for before and after school.

00:07:03:26 - 00:07:25:29
Mary Esselman
A lot of those families still come here because of those relationships. So you can come in and the clinic is there, they've got core exam rooms. I mean, there's someone that goes and walks kids from class, an amazing telehealth model that keeps parents working. And, you know, one of our biggest challenges for our parents is oftentimes their jobs don't have benefits or accrued time off.

00:07:25:29 - 00:07:44:12
Mary Esselman
And so just making a health appointment, you know, can put their job at risk. And so we were seeing a lot of missed appointments. And now Children's Mercy contacts the supervisor wants to know we're going to need mom for a few minutes to step aside. And, we're seeing a lot more of our preventative care happening, but it's a great space.

00:07:44:12 - 00:08:00:15
Mary Esselman
It's front and center, but it doesn't stop in the doors of the clinic. One of the things I love the most is the fact that there's a school nurse. She makes over 5,000 classroom visits a year. We're actually talking about a second nurse because we just opened the school and, you know, realizing that we have a lot more money.

00:08:00:15 - 00:08:21:27
Mary Esselman
But imagine when every day you're seeing a nurse,  suddenly sometimes there's a lack of trust, especially for underserved in underserved communities. But when you're building those relationships as a child and a parent and you have the freedom to ask questions, not just when you're sick, I think it changes everything. So there's just a lot of little pieces.

00:08:22:02 - 00:08:41:20
Mary Esselman
Children, staff from across the hospital pop in on Monday. Word on the street so they can help do other things. And I will say during Covid, we wouldn't have been able to stay open the whole time if we hadn't had Children's Mercy, because the minute that we thought there might be a symptom, we were able to do that testing and keep everyone safe.

00:08:41:22 - 00:08:49:17
Mary Esselman
And even beforehand, just the idea of washing hands and all of the things that we need people to know. Children's was there, hand-in-hand.

00:08:49:19 - 00:08:58:27
Julia Resnick
And, you know, I think it's pretty unique to have a hospital that's so deeply embedded in community. Ale, can you can you share your perspective on that?

00:08:58:29 - 00:09:32:28
Alejandro Quiroga, M.D.
We've been here for 129 years. And for the first 50 years, we operated in the same way that Operation Breakthrough came about. Very organic. One of our founders was a surgeon, the other under was a dentist. And imagine two very strong women with a conviction that pediatric care has to be different. And before they have the right to vote, they founded a hospital before they have the right to practice in the same way that they males did,

00:09:33:00 - 00:09:58:06
Alejandro Quiroga, M.D.
they found that a hospital. And for the first 50 years not a single bill came out of our institution. So when you're asking, like how these two organizations came together. Like, that's not the question. Nothing would have stopped these two organizations coming together and being embedded, because our missions are so similar. We see the world so like alike, of course, we came about. Pediatric health care is quite comprehensive.

00:09:58:07 - 00:10:24:06
Alejandro Quiroga, M.D.
You can go from these type of partnerships to then you're talking about cardiac transplants. And they're all different. And you take different muscles, have different understandings and you have to have the right focus to know where to put your resources and what is being covered by other, partners in the community or other organizations. And I think that's what we're doing here.

00:10:24:09 - 00:10:26:01
Julia Resnick
Mary, anything you want to add?

00:10:26:03 - 00:11:01:03
Mary Esselman
I think it's pretty amazing when you have organizations that have been around this long and you still have those original missions intact that. And I love when you talk about relationships, because in both organizations, everything we do coalesces around building relationships, and you can really see it. The other thing I think for those listening, I think it's important is it shows that you can take, you know, a large hospital system and you can take a smaller, nimble nonprofit and you can find ways - I feel like it doesn't matter what the barriers we encounter.

00:11:01:03 - 00:11:12:22
Mary Esselman
We find ways to, work through them. And I think that's what it takes when you look at the length of our partnership and how we continue to grow and thrive.

00:11:12:25 - 00:11:25:27
Julia Resnick
I love that everything is built on relationships and trust. But really, just like when it gets down to it, what are those elements that you need to get this kind of community clinic running and running smoothly for as long as you have?

00:11:25:29 - 00:11:46:19
Alejandro Quiroga, M.D.
The funding part is really difficult, right? You have to think about how do you allocate funding to that. And that comes in a partnership. We raise funds together, we raise funds separately, we allocate different budgets. And it's a tough conversation. And that's where most of these partnerships will start. You have to be fueled by the mission, but you have to find the funding to be able to do this.

00:11:46:22 - 00:12:10:02
Alejandro Quiroga, M.D.
And this will not be a typical PNO. And most health care systems would get stuck there. So what is the return on investment here? And you have to see the return on investment beyond just a very plain ROI. You have to see moms being able to work. How does this have community benefit in a way that is not traditional?

00:12:10:05 - 00:12:24:06
Julia Resnick
And I'm sure that you see the impact of this every day, whether it is in those health outcomes, whether it's mom being able to work. Do you have any stories about a child or a family that really, reflects why this is so important?

00:12:24:09 - 00:12:44:26
Mary Esselman
One that comes to mind just because we've been talking about it recently is, you know, we get a lot of children that have really high health needs. I mean, when you think about, sometimes it's environmental, sometimes it's multi-generational. And so the ability to be able to serve children with high needs, we had, we had a baby who's now in kindergarten.

00:12:44:29 - 00:13:05:04
Mary Esselman
So you can imagine, I mean, this has been over a span, but, you know, failure to thrive, leading to couldn't digest, produce a lot of medical needs. You can imagine a classroom teacher and the fear that goes with trying to make sure we're providing adequate care and to be able to have a nurse to come in and help with that and be there day to day through that process.

00:13:05:11 - 00:13:26:26
Mary Esselman
And then be able to share jointly when that feeding tube comes out five years later. I mean, those are the kinds of stories, I think, that, really showcase not only from a medical perspective, but just relationships, that create trust amongst children, families, health care workers. What does it take to make this type of a partnership? I think it takes patience.

00:13:26:26 - 00:13:45:23
Mary Esselman
You know, I'm never that patient. So like when I have an idea, I'm ready to like, charge in and make it happen. And I think in both our cases, like the desire and the want is always there. But the mechanics of getting there can be difficult. And I have a little grid on my wall that says find the third way.

00:13:45:23 - 00:14:07:00
Mary Esselman
And I always laugh because sometimes we're on the 30th way, but I feel like we always stick it out and find a way to make it work, because I think we make it sound really easy, but there's we both live in the in the world of licensing and rules. And so as much as we might want something, we still have to make it happen within those boundaries.

00:14:07:00 - 00:14:33:22
Mary Esselman
And I love the fact that we all are back at the table at our meetings as we're working on things. And I love that, you know, I talked about the partnership for Resilient Families, but we also have a weekly call with direct providers. So we're really navigating what's trending in terms of health challenges. How do we communicate it where there isn't a lot of health and literacy and families and to work together on those.

00:14:33:25 - 00:14:54:29
Mary Esselman
And then I think it makes a robust environment for residents. They have made it a priority to have all of their pediatric residents spend two days here. So they're really feeling firsthand how important health is and doing it directly with populations that aren't taking place kind of in a sterile clinic room.

00:14:55:01 - 00:15:05:24
Julia Resnick
You've both been doing this for a while. I'd love to hear your advice to other hospitals, to other community based organizations that are thinking about embarking on this sort of partnership.

00:15:05:27 - 00:15:31:19
Alejandro Quiroga, M.D.
I think when you live within a large health care system, people will see that as a soft call or something that is like a given. The literature will tell you that that is not the case. If you want to get these things, you have to first build trust, build a relationship, get alignment. And you know there is a system of doing that.

00:15:31:22 - 00:15:55:00
Alejandro Quiroga, M.D.
This has falling into an organic way, but we have developed it systems that reinforce that relationship. Relationships have an ROI. Aligning missions across what's important and then using those relationships to deliver better care will have an ROI for the community. You're going to have to be creative, kind of have to think different, but you have to push yourself to do so.

00:15:55:02 - 00:15:57:26
Julia Resnick
Absolutely, Mary, take us home.

00:15:57:28 - 00:16:16:01
Mary Esselman
So for those of the thinking we could do this and you can, it might start out small, but if you're really persistent and you really believe in it, I think I would always say don't wait because you can plan for years and life will have changed three times since then. I think you just have to you have to step in and start.

00:16:16:04 - 00:16:36:26
Mary Esselman
And then I think you have to be willing to engage up and down through the hospital. It can't just be the clinic director. It can't just be the nurse. It has to be something that's shared across the organizations. And it will change the ability to ensure that kids are meeting developmental milestones when you see these kinds of partnerships.

00:16:36:28 - 00:16:54:25
Julia Resnick
And I think that, you know, when you have your missions aligned and you're both committed to the relationship and working through the challenges, you are just a fabulous example of what you can build. So Mary, Ale, thank you both for being here and sharing this work with us and for the work that you both do every day to help the kids of Kansas City.

00:16:54:27 - 00:17:03:09
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.

00:00:00:02 - 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.