Advancing Health Podcast

00:00:00:13 - 00:00:26:21
Tom Haederle
Whether it's flying an airliner, coaching a football team, or running a hospital or health system, the skills and experiences of the people at the helm make a big difference in the success of the journey. That's why the recruitment and diversity of composition of the Board of Trustees is vitally important.

00:00:26:23 - 00:00:52:02
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Everyone uses health care a little differently. And the board that brings a wider range of viewpoints to its oversight of a hospital or health system is better positioned to meet the variety of patients' needs as we hear today's podcast hosted by Sue Ellen Wagner, vice president of trustee engagement and strategy with the AHA.

00:00:52:05 - 00:00:54:03
Tom Haederle
Sue Ellen, over to you.

00:00:54:06 - 00:01:12:23
Sue Ellen Wagner
Thank you Tom. I'm happy to be with Schonay Barnett-Jones, trustee at Children's National Hospital in Washington, D.C. Schonay is also a member of the American Hospital Board and the AHA's Committee on Governance. Schonay, It's great to be with you at the AHA 2024 Leadership Summit.

00:01:12:24 - 00:01:14:18
Schonay Barnett-Jones
Thank you for inviting me.

00:01:14:21 - 00:01:45:17
Sue Ellen Wagner
Our topic today is board recruitment. Board recruitment is an important part of good governance. The composition of a board is a major factor in board effectiveness. And diversity is an important strength. When I mention diversity, I'm referring to gender, age, race, experience, disability, etc. According to the AHA's 2022 Governance Trends reports, hospitals and health systems are making some progress on gender diversity, but need to improve on recruiting younger trustees.

00:01:45:19 - 00:01:55:13
Sue Ellen Wagner
And when I say younger, I'm referring to people 50 years and younger. Can you comment on the importance of board recruitment and having diversity be part of the recruitment process?

00:01:55:15 - 00:02:18:20
Schonay Barnett-Jones
Absolutely. Firstly, I'd like to commend boards who are continuing their diversity journey. This is hard and intentional work, but it makes a difference in the level of effectiveness to support organizational and community needs. Generally speaking, as you know, boards traditionally consisted of an older demographic with the same experiences and in many cases, same gender, race, and level of financial contribution.

00:02:18:22 - 00:02:42:20
Schonay Barnett-Jones
Board recruitment is important to ensure an infusion of new ideas, levels of experience and to maintain sustainability in the marketplace. And having a diverse or provide space for varying perspectives to be heard because everyone uses healthcare differently. What we understand is that Gen Z, Gen X, and millennials view health care through a tech lens. They want everything online.

00:02:42:20 - 00:03:17:07
Schonay Barnett-Jones
They want it quickly and readily available. But their expectations of how health care should work for them are very different from their parent's generation. So in order for boards to better support our organizations, we must be reflective of our communities and this younger demographic in particular. We can't get their input unless they're invited to participate. We must keep in mind also that they may not have the financial wherewithal for charitable contributions at the level that most boards are, but they bring talent and they bring commitment, and those are very valuable assets to any board.

00:03:17:13 - 00:03:44:05
Sue Ellen Wagner
I agree with that. Thank you. Hospitals and health systems are often challenged with recruiting new board members for a few reasons. Some of those you just mentioned, one being competing for board members with other organizations in the community. And then second, being a hospital or health system board requires significant dedication of time. Can you respond to these challenges and how hospitals and health systems can overcome these challenges?

00:03:44:06 - 00:04:09:10
Schonay Barnett-Jones
Yes. It's important to cultivate your own board talent. Hospitals and health systems have so many community touchpoints that really just go untapped. We don't look at all of the community assets that we have. I would look to the community-based organizations, professional organizations and internally for recommendations. Also to ask your current board members to access to their networks.

00:04:09:12 - 00:04:36:24
Schonay Barnett-Jones
I joined the Children's National Hospital Board at age 42. I was by far the youngest board member there. However, prior to that, I had been actively engaged in committee work and chairing the Patient and Family Advisory Council, but only because my daughter's nurse invited me to participate. Wow. So my experience is lived experience. My daughter Olivia is post-cardiac transplant, and we have spent a significant amount of time in hospital settings.

00:04:36:26 - 00:05:06:00
Schonay Barnett-Jones
So my contributions to the board table are really a lens through that of a consumer and the voice of patients and families. But to your second point, board work grows legs. And anyone who is on a board understands exactly what I mean. And so your members often end up on multiple committees with varying time needs. So you really have to be honest upfront about the time commitment and the expectations so the candidates can make good decisions regarding their ability to serve.

00:05:06:02 - 00:05:11:06
Schonay Barnett-Jones
And then you also have to be very creative with scheduling and the use of technology to support your members.

00:05:11:08 - 00:05:14:17
Sue Ellen Wagner
Great points. Time is of the essence.

00:05:14:18 - 00:05:15:21
Schonay Barnett-Jones
Absolutely.

00:05:15:24 - 00:05:19:28
Sue Ellen Wagner
Can you share some board recruitment strategies that will be helpful to others?

00:05:20:01 - 00:05:43:25
Schonay Barnett-Jones
Yes. Yes. Firstly, I think you have to understand your current board landscape so you know where your gaps are and don't end up with a mini law firm on your board. I have a colleague who mentioned that he had 16 attorneys on his board, and I said, you actually have a law firm, that's not a board. And so we joke about that, but I think he is in the process of trying to make some changes to that.

00:05:43:27 - 00:06:15:21
Schonay Barnett-Jones
But in all seriousness, you must diversify your recruitment team and those persons who vote on your board candidates to add balance to the process. The diversity lens should permeate throughout your recruitment process, and not to be solely focused on your candidates. Based on your board's needs matrix, recruitment should be from various industries obviously, community partners and consumers. But I think that diversifying the recruitment team is key and is a linchpin in the entire process.

00:06:15:23 - 00:06:21:23
Sue Ellen Wagner
Yeah, really good points, Schonay, is there any additional information that you want to provide to our listeners?

00:06:21:26 - 00:06:46:13
Schonay Barnett-Jones
You have to be intentional about your diversity efforts. It is hard work. It is not the easiest path to take and not to give up because it gets hard. But really dig in and know that at the end of that journey that you will have far reaching impacts and to your organization and your community, and those decisions will transform health care for those people in your community.

00:06:46:15 - 00:06:54:22
Schonay Barnett-Jones
So I think that you have to just really continue to work at it, keep your efforts up and continue to move forward.

00:06:54:25 - 00:07:02:10
Sue Ellen Wagner
Excellent point. Schonay, thank you for your time during this podcast. AHA appreciates your leadership and the insights you shared.

00:07:02:14 - 00:07:04:01
Schonay Barnett-Jones
Thank you so much for having me. Have a great day.

00:07:04:01 - 00:07:05:22
Sue Ellen Wagner
You too.

00:07:05:24 - 00:07:14:05
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:00 - 00:00:24:22
Tom Haederle
The nation's hospitals and health systems are still adjusting to the disruption in the production and supply of vital intravenous or IV fluids that many patients depend on, as Hurricane Helene damaged the plant that is the leading producer of these fluids. It's still undetermined when full production capacity will be resumed. In the meantime, we are reminded of the fragile supply chain that delivers many of the essentials of patient care and the need for a plan if things go awry.

00:00:37:01 - 00:01:11:17
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. In this podcast, we learn more about the need to create a conservation plan for not only IV fluids, but for every critical patient resource that could be threatened by a disaster, natural or otherwise. Host Michael Schiller is executive director of the Association of Health Care Resource and Materials Management (AHRMM), a part of the American Hospital Association, and he's joined in this discussion by Michael Ganio, senior director of pharmacy practice and quality with the American Society of Health-System Pharmacists (ASHP).

00:01:11:20 - 00:01:13:01
Tom Haederle
Now  to Mike Schiller.

00:01:13:04 - 00:01:36:07
Michael Schiller
Michael, it's great to have you here with us today. Let's talk a little bit about some of the weather patterns here that are affecting the health care supply chain. There's certainly a lot of factors that are affecting the health care supply chain, at least certainly in this post-pandemic environment. But as of late, we've had a couple of hurricanes that have really disrupted our IV supply chain and our IV solution supply chain.

00:01:36:07 - 00:01:53:25
Michael Schiller
And this is a great reminder. Not that we need these, but that these storms can certainly jeopardize the availability of the critical patient supplies that we need on a day-to-day basis. From a conservation strategy standpoint, Michael, what advice would you share with our listeners today?

00:01:53:28 - 00:02:23:15
Michael Ganio
Well, I think one, understanding the severity of the shortage, that's the first thing that needs to be done. Take inventory of your stock and understand how many days supply you have on hand. I think most organizations have done that. But an adequate conservation plan really goes further. And where can we cut back on use? And these large volume fluids are a little unique because in some hospitals, pharmacy manages some of the supply.

00:02:23:18 - 00:02:40:19
Michael Ganio
And in other hospitals pharmacy isn't, they're a little more hands off with things that go directly to nursing units. So I think the, you know, the thing caregivers need to keep in mind as they develop their own plans is where are these solutions coming in to the hospital? How are they being used? How can they be conserved?

00:02:40:22 - 00:03:03:13
Michael Ganio
And as you noted, this is not the first time this has happened. And whether it's major storms, which we all know are expected to continue as the Gulf stays warm and there's other threats to the supply chain. You know, we have put out conservation strategies. This is the third time now we've done this — the second time for large volume fluids, and we've done it once for small volume fluids.

00:03:03:13 - 00:03:16:25
Michael Ganio
So it's really important that caregivers have a framework for conservation of really any critical resource. And there are a lot of resources out there to do that. But in this instance, for the fluids, it's important to recognize where all those fluids are in the health system.

00:03:16:27 - 00:03:25:15
Michael Schiller
You know, you talked about utilization and understanding your utilization. That reminds me of a term that we used during the Covid pandemic: burn rate.

00:03:25:17 - 00:03:25:27
Michael Ganio
Yes.

00:03:26:01 - 00:03:46:00
Michael Schiller
And, I don't know about you, but this situation sure seems a bit Covid-esque to me, with what we're what we're going through. So you talked a bit about, conservation strategies. Can we dig into that a little bit more and share with us what the basic elements of a sound plan for the management and conservation of fluid shortages would look like?

00:03:46:06 - 00:04:11:27
Michael Ganio
Yeah. First, again, understanding where utilization is and then I recommend kind of a tiered approach to something like this. You know, you have your worst case scenario where maybe you're canceling some of those elective procedures, but then you have less invasive and less clinically disruptive strategies. And that may be alternative sources. With pharmacy, we know that, there's a whole sector of outsourcing facilities that can compound drugs.

00:04:12:00 - 00:04:33:03
Michael Ganio
That's going to be a little bit challenging with some of these large volume drugs, just because the supplies needed are also in short supply. But there are other things like turning down your KVO rates. So sometimes IVs are running just for the sake of having something running into an infusion catheter so that the catheter doesn't include.

00:04:33:06 - 00:05:02:04
Michael Ganio
Well, it's not always necessary. You can flush occasionally through that catheter to keep the vein open. And it's not really that invasive clinically to a patient to stop those IV fluids. So there are different tiers and approaches to doing this. And I think when you talk about implementing these strategies and looking at these different tiers, you can use this ethical framework to look for where can we do the most good as far as conservation with the least harm as far as disrupting patient care.

00:05:02:10 - 00:05:09:18
Michael Ganio
That's a really good place to start for any shortage, really. But especially these large volume fluids that are everywhere in our hospitals.

00:05:09:20 - 00:05:19:28
Michael Schiller
So you've mentioned the large volume fluids. Are there going to be different approaches from a conservation strategy when we're looking at large volume products versus some of the smaller volume products?

00:05:20:01 - 00:05:43:10
Michael Ganio
Yeah. And let's step back a second. So small volume, this is defined by the United States Pharmacopeia. So small volume is anything under 250 mls. Usually those are used to deliver medications. So a 100 ml bag with a gram of an antibiotic in it, or 250 ml bag could also be used for for infusing an antibiotic.

00:05:43:13 - 00:06:19:15
Michael Ganio
But when we start getting these 500 and 1 liter bag sizes, we're usually talking about hydration, things used during surgeries. This particular shortage also is affecting irrigation solutions. So some of the things that are used in the ORs, there's different strategies for managing these. A lot of the small volume parenterals that were in short supply after Maria hit Puerto Rico, coincidentally also a Baxter facility, nurses were standing at the bedside and administering through a syringe some of these antibiotics, rather than putting the antibiotic into a 100 ml bag and infusing it.  That doesn't really work for hydration.

00:06:19:19 - 00:06:37:16
Michael Ganio
It may, in some specific instances where you can take a liter bag, draw out a bunch of 50 ml syringes, and use a syringe pump to provide that KVO rate at 25 ml an hour, potentially, during a procedure or something like that. But in general, we're managing these very differently.

00:06:37:18 - 00:07:00:12
Michael Schiller
In any type of emergent situation like we're experiencing, communication is critical, and we often say that you need to really overcommunicate in these types of situations, in these types of environments. How would you recommend organizations communicate changes, shortage management, distribution, utilization management, action planning and adjustments to their stakeholders?

00:07:00:14 - 00:07:24:01
Michael Ganio
Yeah, I completely agree overcommunication to the point where it's in your email. It pops up on the electronic health record. If it's an order or something that's applicable to the clinician. Huddles are a great way to make sure communication occurs just in time for that shift. So as nurses start their shift, there's a huddle. The nurse manager, whoever's leading, shares that information right there.

00:07:24:01 - 00:07:55:11
Michael Ganio
It's timely. There are other ways to communicate within the health system but use multiple modalities because this is a safety issue. The Institution for Safe Medication Practices collects data on medication errors in general, but they also will track during a drug shortage. And we know that drug shortages can lead to error and harm. Well, about 15 years ago, there were a few fatalities associated with improper conversion of hydromorphone to morphine, and vice versa during injectable opioid shortages.

00:07:55:14 - 00:08:16:04
Michael Ganio
So it's very important that everyone is on the same page as far as the strategy. And it's also critical because some of these things can change week to week. So what was true yesterday is not going to be true next week. And it's also important to know that some clinicians work in different hospitals. And so when you go from one hospital, if they're floating to another hospital they may have different policies.

00:08:16:11 - 00:08:36:02
Michael Ganio
So overcommunication is never a bad thing. But when possible make it really, really difficult to do the wrong thing. Meaning if you can put hard stops into the electronic health record and into your infusion pumps, a lot of hospitals use smart pumps now. Find ways to make it very difficult to make an error and implement those strategies.

00:08:36:07 - 00:08:56:09
Michael Schiller
Yeah, I've heard of some organizations actually using the internet as one of those modalities, because to your point, this is such a dynamic environment that we're in, and there's so many different messages out there in the field that people become very quickly confused as to which is the most accurate message versus those that they may be, should not pay as much attention to.

00:08:56:15 - 00:08:58:12
Michael Schiller
So great advice.

00:08:58:15 - 00:09:13:27
Michael Ganio
That's a good point with the internet too. You know, you can point things to the internet so you have one single source of truth. If you put a policy in an email and someone reads it after coming back from vacation, there might be four more emails changing what was in that policy. So, you know, keeping a single source of truth somewhere is a great idea.

00:09:14:00 - 00:09:37:14
Michael Schiller
Yeah, yeah, single source of truth, that is absolutely the right approach. You know, overall, we've talked about the situation that's created the current environment that we're in. Right. The situation that we're faced with. But overall, how can the health care field, all of the stakeholders that comprise the health care field, how can we prepare for events like this one, now,

00:09:37:14 - 00:09:48:14
Michael Schiller
and for those that will happen in the future. What's the most important thing to know and maybe some of the other, other ideas or suggestions you might have for us.

00:09:48:18 - 00:10:08:27
Michael Ganio
Yeah, I think first and foremost, lessons learned from the past, right. So we've been through Covid-19, the pandemic, the supply chain challenges there. You know, specific to pharmacy and drugs, as I mentioned, this is not the first time we've had fluid shortages. A little over a year ago, we were grappling with chemotherapy shortages. There have been injectable opioid shortages in the past.

00:10:09:00 - 00:10:32:03
Michael Ganio
So applying lessons learned moving forward. Well, just the next time you go through this, this process, you've gone through a few iterations, you fine tuned whatever has worked to manage the shortages, knowing that this is not going away. You know, whether it's large storms, whether it's recalls of drugs, whether, you know, for other equipments and supplies outside of the pharmacy department.

00:10:32:03 - 00:10:53:11
Michael Ganio
This is not an isolated incident. And while it feels that way, while we're in the moment, when you look at your you zoom out and you see 20 years or so of history, realizing that we need to have a plan, maybe after this event, you debrief and with a leadership team, risk management, pharmacy leadership, supply chain, leadership, get everyone.

00:10:53:13 - 00:10:56:27
Michael Ganio
What did we learn? What can we put into policy to be prepared for the next time?

00:10:56:28 - 00:11:18:06
Michael Schiller
Great advice. I know that we've seen conservation strategies include clinical practice review, clinical practice changes. And what's interesting is those changes that were put into effect during the time of the shortage remain in place long after the shortage has dissipated, right. And we've got ample supply back into the health care supply chain.

00:11:18:09 - 00:11:37:28
Michael Ganio
Yeah. Sometimes we identify waste, you know, and that's, this is a I hate to call a silver lining to shortages, but, you know, there are research articles that get published and find out that this particular chemotherapy regimen is just as effective without a particular drug, you know, so over time, we do gain knowledge from these shortages and supply chain disruptions.

00:11:38:05 - 00:11:42:16
Michael Schiller
Well Michael thanks for your time today. It's been great talking with you. Appreciate your insights.

00:11:42:16 - 00:11:44:29
Michael Ganio
Yeah. Thank you. Appreciate having me on the podcast.

00:11:45:03 - 00:11:53:15
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.

00:00:00:17 - 00:00:32:13
Tom Haederle
Customers climb into the chair at the All in the Wrists barber shop in Indianapolis for a haircut and a beard trim, but they leave the shop with so much more, such as a blood pressure check for hypertension or important resources for those seeking child care, facing transportation issues or people who need clothing. This beloved community barber shop redefines the meaning of customer service.

00:00:32:15 - 00:01:01:23
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Barbershops are traditional gathering places and information hubs for the African-American community. That's why Marvin Taylor, the owner of All in the Wrists, was happy to participate in a program from Indiana University Health led by their chief equity officer, Dr. Brownsyne Tucker-Edmonds, that places community health workers inside barber shops to educate the public about their vital health statistics.

00:01:01:25 - 00:01:14:17
Tom Haederle
Let's give a listen in this three way conversation with Dr. Tucker-Edmonds and Joy Lewis, senior vice president of health equity strategies and executive director of the Institute for Diversity and Health Equity.

00:01:14:20 - 00:01:49:00
Joy Lewis
Marvin, I want to kick things off with you and talk about your love of barbering and barbershops. Even as a young person, young, how you idolized barbers and frankly, how barbershops have been a sanctuary for black men in the African-American community. It's an information hub, right? So how did you combine your passion for barbering with prevention of illness and promotion of wellness?

00:01:49:06 - 00:01:53:06
Joy Lewis
How did those two come together for you?

00:01:53:09 - 00:02:13:10
Marvin Taylor
Well, I knew at a very young age I wanted to be a barber. When I graduated high school, I went to barber school. I became a barber. I landed in a really great barber shop with an awesome mentor, and I worked with him for 20 years, from 1996 to 2016. And this gentleman taught me how to be a servant of the community.

00:02:13:13 - 00:02:35:29
Marvin Taylor
And it wasn't until after he passed that I incorporated health and wellness. So before the health and wellness aspect began, I was always serving the community as a barber, doing things, cooking for the community, helping the unhoused, just being a resource, you know? He taught me that in order to be great, you have to greatly serve.

00:02:36:01 - 00:02:57:09
Marvin Taylor
And so I was doing that for a very long time. One day I was in the barber shop and there was a gentleman named Calvin. I was cutting his hair and he was talking to me about hypertension and high blood pressure. My mother and father both suffer from hypertension. And so he proposed the iHEART Initiative program, and I was on board.

00:02:57:09 - 00:03:15:28
Marvin Taylor
As soon as he told me about it, I was like, whatever I can do to be a resource and help the community, because there are a lot of people in the neighborhood of my barber shop that are medically underserved, unsheltered. So this was a perfect opportunity for IU Health and myself to collaborate to help some of those people.

00:03:16:00 - 00:03:40:04
Joy Lewis
Wow. So you're really leaning into the role as a servant leader, I think is what you're describing. Recognizing the needs of the community where you're operating your business. But right outside your doors are folks who are unhoused and a population that truly would not have access to preventive care.

00:03:40:04 - 00:04:08:05
Marvin Taylor
And those numbers are growing. As I look out my door, 2016 when I first opened up, we had about 4 or 5 people who were just outside hanging out, didn't have anywhere to go, didn't have access to resources. Here we are to 2024. And that number, we're at 30 or 40 people that are just outside, you know, and those people need access to medical home housing and different things like that.

00:04:08:05 - 00:04:10:25
Marvin Taylor
So those numbers are definitely growing.

00:04:10:27 - 00:04:39:17
Joy Lewis
So Marvin, you mentioned the iHEART program, Dr. Tucker-Edmonds, you want to get in now - I know IU Health has a mission to make Indiana one of the healthiest states in the nation, something folks can get behind, right. I would imagine that the community's role in achieving this goal, this mission, is critical. You can't do it without engaging community voices.

00:04:39:17 - 00:04:59:13
Brownsyne Tucker Edmonds, M.D.
So partnering with folks like Marvin and the barbershop I would assume is a part of your strategy to execute on that mission. So what is the iHeart program that Marvin mentioned? And then how have partnerships and really community engagement played a role to advance this goal?

00:04:59:15 - 00:05:05:01
Brownsyne Tucker Edmonds, M.D.
Yeah, I mean, to start just in terms of iHeart, it's an acronym...

00:05:05:01 - 00:05:54:02
Brownsyne Tucker Edmonds, M.D.
always have to write it down. I love to make acronyms and then I forget what they mean. And it's Indianapolis health equity access, outreach and treatment, effectively as a community health worker led intervention. It's a place-based effort. We identified three anchor communities, really kind of mapping out overlaying cardiovascular disease morbidity and, racial disparity and social need to really identify three neighborhoods that had particularly, I think, high need and the opportunity for high impact to really partner with those communities, with community based organizations, with, you know, community businesses to really deploy a screening, outreach and navigation program

00:05:54:09 - 00:06:19:09
Brownsyne Tucker Edmonds, M.D.
organized around cardiovascular health. And the reason I add the navigation is consider the screening and referral piece has been shown to not be as effective. The really critical point is how do we kind of close the loop? How do we help ensure, you know, that, folks are getting to care? And we screened for cardiovascular risk as well as social determinants, drivers, impediments  - your word of choice - of health.

00:06:19:12 - 00:06:48:27
Brownsyne Tucker Edmonds, M.D.
And then we help to try to navigate people to resources to meet medical and social needs. That's iHEART in a nutshell. But in terms of the community partnership elements, I mean, they're vital. I mean, to the point, I mean, Marvin has been an amazing partner. And I think what's so critical is the fact that you really have to kind of move into the spaces, the places that work with the people that are already trusted, that are already serving,

00:06:48:27 - 00:07:11:21
Brownsyne Tucker Edmonds, M.D.
right, sort of day to day. And the barriers to accessing health care in particular are significant. We just realized it's going to require that we move models of care and points of access beyond our four walls. It can't continue to be if we build it, they will come. And so moving into the community setting and working with those trusted leaders and individuals is key.

00:07:11:21 - 00:07:33:01
Brownsyne Tucker Edmonds, M.D.
And that's been really, a point of success for us. Partnering with barbershops, partnering with congregations, showing up in food pantries, showing up at the Urban League. I mean those places where people with needs are. And that's where we show up, and that's how we try to deliver this intervention and this opportunity to improve health care access.

00:07:33:03 - 00:08:04:00
Joy Lewis
It sounds like you're leveraging the Social Vulnerability Index, right, to identify where the needs are. Otherwise, many of these communities would go unnoticed, right. And then you're showing up. You're going to where those individuals are and you're providing the care on their terms in their communities, working alongside trusted partners in the community. So there are several components to your strategy.

00:08:04:03 - 00:08:35:25
Joy Lewis
Just a few data points I want to throw at you that I came across in preparing for this conversation today, is that the iHEART program launched only a year and a half ago, January 2023, and since then you have already completed nearly 3,000 blood pressure screenings and nearly 3,500 social needs screenings in barbershops like Marvin's and food pantries and other neighborhoods where you're going to really bring the care to the community.

00:08:35:29 - 00:08:40:14
Joy Lewis
How did you spread and scale this initiative so quickly?

00:08:40:16 - 00:08:57:23
Brownsyne Tucker Edmonds, M.D.
I mean, I think it speaks to a couple of things. So we set out actually with the goal of screening 10% of the adult population in our anchor communities of to be about 1,400, screenings over three years. So you can see that we are, like, way out over our pace.

00:08:57:26 - 00:09:20:25
Brownsyne Tucker Edmonds, M.D.
I think it boils down to three things. One is that I think it just speaks to the need. I mean, part of is that we did initially identified disinvested areas where I think that there is, really significant sort of, need. I think it speaks to a great partnership. We work very closely, really hand-in-hand with our team.

00:09:20:25 - 00:09:40:15
Brownsyne Tucker Edmonds, M.D.
This our community health team led by Nicole Wilson here at IU Health, and they are on roller skates. They are out with, you know, in sort of settings, with our community partners providing events, screenings, multiple kind of times a week in different settings. And with a model that's really intentional. It's not a lot of one offs.

00:09:40:15 - 00:10:01:13
Brownsyne Tucker Edmonds, M.D.
And I think this is where you also get the numbers and the build is that we decided we wanted to do an embedded model, a longitudinal model. So we're not just like here today, gone tomorrow. We're here every week, right. Like so those partnerships that we've said we're going to be at this pantry, you know, these two days a month or every single week, we're going to be at Marvin's on a certain date.

00:10:01:13 - 00:10:33:07
Brownsyne Tucker Edmonds, M.D.
So then, people also can know and share that, like, we're going to be back and that, you know, you can sort of build those relationships over time. And the last piece is actually our partners. I mean, we just have tremendous partners. And, you know, Marvin is so special in the way that he has already built trust and relationship in his community that, you know, the folks who are unhoused, kind of on his block when he comes out and says, come get your blood pressure  they come.

00:10:33:09 - 00:10:45:21
Brownsyne Tucker Edmonds, M.D.
So I think that, you know, we've been intentional about figuring out the right partners. And that I think is also critical, to kind of the success and the quick spread of the program.

00:10:45:24 - 00:10:58:17
Joy Lewis
And certainly consistent with Marvin earlier point around the demand growing. Initially, you said what, Marvin, there were 4 or 5 folks outside your door, and now there are 30 plus.

00:10:58:19 - 00:11:28:07
Joy Lewis
I guess what are some of the challenges? What are some of the biggest challenges you've run into in terms of getting folks to say, yes, Marvin, I know you're a trusted voice. You're a trusted resource in the community, but a part of this work, you know, sometimes is not having access, but also not having education around what preventive care should look like or how it could be beneficial to one's overall health status and well-being.

00:11:28:09 - 00:11:35:12
Joy Lewis
So do you bring folks in kicking and screaming, or do people kind of respond when you say, come on in here?

00:11:35:14 - 00:11:54:21
Marvin Taylor
Well, I think that I've been in the community for so long. I grew up in this neighborhood. I'll give you an example today, it's about 96 degrees. We put out two cases of ice water. I just set them out on the corner and everybody to walk fast to get water. So I have a repeat service to the community.

00:11:54:21 - 00:12:15:27
Marvin Taylor
I'm consistent. And so I've built a really great bridge of trust between this community and my barbershop. Once we partner with IU, they said this and I, and I really have to say this, and I don't think they get enough credit, but the community health workers who IU have, they do an amazing job.

00:12:15:27 - 00:12:35:20
Marvin Taylor
And not only - so they kind of piggyback off of the trust that I've built with this community. And now the CHW's from IU Health are building independent relationships. And so now there are times when I don't even have to go outside and say, hey, it's blood pressure day. When those guys pull up and they're coming in there, it's blood pressure day.

00:12:35:20 - 00:12:52:00
Marvin Taylor
So they come in on their own. And sometimes I had to go out and, you know, give a little nudge, come on. I'll do it because the barbershop is such a resource. And like I said, the CHWs who are here every other Tuesday and every Thursday, they do an amazing job.

00:12:52:03 - 00:12:59:29
Joy Lewis
I'm curious for both of you: what has surprised you the most about this program since it's its launch?

00:13:00:01 - 00:13:19:25
Brownsyne Tucker Edmonds, M.D.
We had mapped at a population level like what the cardiovascular kind of morbidity rates and things were in the communities that we were going to engage. And I knew, and I know, right, I know the disproportionate burden of disease, particularly among black Americans in terms of cardiovascular disease, hypertensive disease.

00:13:19:27 - 00:13:39:19
Brownsyne Tucker Edmonds, M.D.
But actually in our first  - I think it was the first three months of our experience and actually even out until today - our most recent sort of data that we've captured in our barbershops, you know, we're seeing like upwards of 80% of patrons that are coming in that are, you know, screen positive that have blood pressure coming in over 130, over 80.

00:13:39:21 - 00:14:01:15
Brownsyne Tucker Edmonds, M.D.
And even if we use the 140 over 90 cut off, it's like, roughly like half of the population, which if you look at that by comparison to the distribution of this disease in the general population, those are extraordinarily high rates. I was surprised by that degree of sort of unmet need, frankly. Because when we asked people, have you did, you know, like, has anybody told you that before?

00:14:01:15 - 00:14:29:02
Brownsyne Tucker Edmonds, M.D.
And I know some people maybe. But really we're finding almost 40, 50 percent, you know, high numbers of folks who are also like the first time that they were told that. And so to me, it speaks to really reaching those folks who haven't had access points, haven't had care. Now, some of that may be reflected by this relationship to the unhoused population, but I think just in general, with our screening more broadly, we're seeing really high rates speaking to really high need.

00:14:29:04 - 00:15:05:08
Brownsyne Tucker Edmonds, M.D.
But I also think it speaks to the opportunity for great impact.

Joy Lewis
Once you've screened these individuals, how are you getting them into routine care?

Brownsyne Tucker Edmonds, M.D.
You know, well, I don't know if our listeners do, but the barbershop is a really relatively established these barbershop, sort of outreach models are really established models for public health outreach. I think where we were trying to kind of move the needle or kind of just move that conversation forward post-pandemic, is because it had some studies that its shown that if you had like a pharmacist, you know, if you had someone on site who could prescribe, then that gave you the opportunity to do longitudinal kind of follow

00:15:05:08 - 00:15:30:00
Brownsyne Tucker Edmonds, M.D.
up and care management for folks who are identified with disease on site. You know, after the pandemic, we had the learnings around telehealth, and we also have the constraints, frankly, around sort of staffing models. So we were trying to find out, could we put a community health worker in that setting and then leverage sort of virtual care access to be able to try to connect people to care.

00:15:30:00 - 00:15:48:15
Brownsyne Tucker Edmonds, M.D.
So that's a model that we are kind of trying or piloting in our barbershop environment. There's a lot of learning to be done there. There's privacy considerations for really vulnerable folks who may not have telephones, you know, so trying to figure out if that's a viable model. I mean, that's really the question.

00:15:48:18 - 00:15:57:21
Joy Lewis
I'm going to wrap things up with Marvin here and just give you an opportunity to share with our listeners again, a little bit more about your passion for this work.

00:15:57:23 - 00:16:06:27
Joy Lewis
If you want to talk about what surprised you and looking ahead again, 2.0, how would you define success? What does that look like?

00:16:06:29 - 00:16:27:11
Marvin Taylor
With all the work that we've done, there's still so much more that we need to do. I see us every day, whether IU is here or not. We're reaching people. People are getting informed about their numbers, about cholesterol. And there are so many other access points that IU Health offers in terms of housing and food, things like that.

00:16:27:11 - 00:16:45:24
Marvin Taylor
So there's so many things that we're going to do. One of the biggest challenges was, and I think I may have said this a while back, was the cholesterol A1C checks with the finger prick of the needle. I was like, that's probably not going to fly. Everybody gets it done. Everybody loves it. So I thought that would be one of the most challenging things.

00:16:45:24 - 00:17:03:10
Marvin Taylor
But, we just kind of skated right past that. And I'd like to end just by saying it's been an honor and a pleasure to be a part of this program because I really enjoy serving the community in any way that I can. So it's really been an eye opener for me. I've learned a lot more about hypertension.

00:17:03:12 - 00:17:12:21
Marvin Taylor
We're doing great things, and I hope that we continue to expand and continue to help people and give people access to health care and the things that they may need.

00:17:12:24 - 00:17:43:19
Joy Lewis
Awesome. That's a great note to end on. So looking forward to further iteration of this work within your community there, working in partnership with IU health. And hopefully through this conversation we can inspire hospitals and health systems all over this country to think about these kinds of offerings and partnerships and how to establish effective community engagement models that have the potential to create better access to improve the health.

00:17:43:25 - 00:17:52:18
Joy Lewis
Health is the goal, really. So thank you for all you do day in and day out to advance health for the communities you serve.

00:17:52:20 - 00:18:01:01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:03 - 00:00:23:18
Tom Haederle
The connection between a hospital and the community it serves is special. Working together, hospitals and communities can enhance the environment where people live, work and play. In 1986, the American Hospital Association created the Foster G. McGaw Prize to recognize hospitals and health systems that stand out through their efforts to improve the health and wellbeing of everyone in their communities.

00:00:23:21 - 00:00:45:22
Tom Haederle
The prize is generously sponsored by the Baxter International Foundation. Join us today to hear from the two prize finalists for 2024, who are notching up the bar for excellence in community support.

00:00:45:25 - 00:01:18:25
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. At the AHA Leadership Summit in July, we recognized one winner and two finalists as recipients of the Foster G. McGaw Prize. The overall winner was Boston Medical Center. In this podcast hosted by Nancy Meyers, vice president for Leadership and System Innovation with AHA’s Center for Health Innovation, we learn more about the innovative programs from the two prize finalists that have made such a positive difference in the lives of the people they serve.

00:01:18:27 - 00:01:30:25
Tom Haederle
Andy Nieto is director of community health outreach and marketing with NewYork-Presbyterian, and Jamie Ketas is vice president for population health with Englewood Health in New Jersey. And now, here's Nancy.

00:01:30:27 - 00:01:57:25
Nancy Meyers
Jamie and Andy, thanks for joining me today. Love to have this conversation from our two Foster McGaw finalists. Jamie, I'd like to start with you. Englewood Health has taken an integrated approach to your population health strategy for several years now, where you've really looked at how you're caring for patients and redesigning care, and how you're working in community to drive health outcomes in general as part of an integrated structure and strategy.

00:01:57:26 - 00:02:01:29
Nancy Meyers
Can you talk about that a little bit, and how have you gotten to this point?

00:02:02:06 - 00:02:21:02
Jamie Ketas
Sure. I think when we were forming our population health department, we sort of had to organize our own thoughts about what populations we were trying to keep healthy. And we really focus on three. One is our patients, right? Our attributed lives and all of our various value-based programs. The communities we serve is the second, and then the third is really the Englewood Health team members.

00:02:21:04 - 00:02:42:15
Jamie Ketas
And when you think about all three of those groups, they all intersect and overlap, right? We have employees who live in the area, right, who are our patients. And so the philosophy has been the same. We take the same approach as we look at what we're trying to do. And understanding, as we all do now, the impact cultural differences as well as societal drivers of health have on outcomes.

00:02:42:18 - 00:03:09:13
Jamie Ketas
We design targeted interventions. So we partner with the community organizations and social service agencies to co-develop programs that leverage the strengths of both sides. So we provide the health care expertise. We bring that to the table, and they provide access to the populations we're trying to reach, as well as the local resources, right. So we don't have our own food pharmacy, FARM at Englewood, but we certainly have great relationships with all the food pantries in the area.

00:03:09:16 - 00:03:25:18
Nancy Meyers
And how have you, as you've brought the strategy together, how are you changing the way or evolving the way that you're gaining input from your patients, from your community, from your team members to help you form that strategy?

00:03:25:19 - 00:03:42:23
Jamie Ketas
Right. So there's universal truths to everything, but at the same time you need the data. And so I think where we've struggled in the past, really the community health needs assessment, we do that every three years. And it's difficult because you don't have the same data set over time. So what we really are trying to do is be data driven in our approach using the clinical data that we have.

00:03:42:24 - 00:03:58:26
Jamie Ketas
So we've been adding additional screenings, substance use disorder screenings, SDOH screenings. So all of the information, let the patients self-report and tell us. Right. And the same thing is going to apply to the community and to our team members. No one is exempt from these issues.

00:03:58:28 - 00:04:24:17
Nancy Meyers
Great. Andy, turning to you, I'd love to hear about how NewYork-Presbyterian is thinking about really bringing in community assessment and community strategies as a foundation to the organization's overall strategic plan. How is that evolving and how are you integrating your view of community as you think about all of the work that you do to deliver care?

00:04:24:19 - 00:04:52:29
Andy Nieto
Yeah, it's interesting because the community work that NewYork-Presbyterian started over 25 years ago with a lot of work that was done in collaboration with our community partners to develop that relationship, that trust between the two of us. And over time, the hospital became much more involved in some of the work that we're doing through the community health needs assessment is done every three years, but also through a Center for Health Justice that was created about four years ago.

00:04:53:02 - 00:05:20:03
Andy Nieto
That really drives a lot of the work that's happening at NYP throughout our network. The Dalio Center for Health Justice is now a central hub where a lot of the thinking regarding what we should be doing to address health disparities is really happening. And together with the Center for Health, for Community Navigation and some of the other organizations that are part of the are the hospital network,

00:05:20:10 - 00:05:39:21
Andy Nieto
together we're thinking about how we structure some of the work and more collaboratively within the organization. And so I think we've come a long way in the last 25 years. And, you know, the creation of the Dalio Center I think was a strong message that for NYP, health justice is something that is extremely important.

00:05:39:23 - 00:05:43:09
Nancy Meyers
And what was the impetus for the creation of that center?

00:05:43:12 - 00:06:05:03
Andy Nieto
I think that we wanted to have a central organization that would kind of think through these issues, so that would bring all the different partners together. The Division of Community Population Health, which is the division that I oversee that does most of the programing out in the community, together with Department of Community and Government Affairs and the Dalio Center for Health Justice -

00:06:05:05 - 00:06:24:09
Andy Nieto
together, we are thinking about what are some of the needs in the community? What are some of the needs within the organization? I'll give you an example. Social determinants of health is something that is extremely important in addressing some of the disparities that are happening. So in the hospital now, we question all our patients for social determinants of health.

00:06:24:09 - 00:06:51:01
Andy Nieto
We screen them for social determinants of health. And that drives a lot of the work that we do as we identify some of the needs. Before the pandemic happened, we were already surveying our patients for social determinants. We identify food insecurity as a huge issue. 30% of our patients were food insecure. And so we began to create programs that address food insecurity.

00:06:51:03 - 00:07:10:21
Andy Nieto
And so by screening patients for the social determinants of health in the emergency room, in the clinics, it gives you a great idea of what's happening to your own patients together with the evaluation we do outside of the hospital. But for our patients, that's a good way to really understand what's happening with them.

00:07:10:24 - 00:07:34:09
Nancy Meyers
I'd like to ask you to reflect, as well, on how your interactions with the community organizations and the community members that you serve has evolved over the last few years, and maybe even especially over the course of the last few, with the pandemic to be more of co-design of programs and strategy. How does that happen for you that others could follow?

00:07:34:15 - 00:08:02:07
Andy Nieto
Co-design is interesting, right? Because that's our model. We do co-design with all our programs, but co-design requires that you have trust in the community. Trust is not gained in three months. Trust is gained over years of really developing programs. And really, when you say co-design, it's not coming to the organization and telling them what you think the problems are, but asking them what they think some of the issues are.

00:08:02:10 - 00:08:40:05
Andy Nieto
And I think hospitals sometimes feel like they can begin a program in the community because they've identified a certain issue and they want to go into the community, build something, and it's important for you to first go out and listen to the community and hear what they have to say. One community organizer told me once, when I introduce one of our researchers to the community organizations and he wanted to do NIH grant and the community leader told them, we don't want to be subjects, we want to be co-leaders in these grants.

00:08:40:07 - 00:08:52:09
Andy Nieto
So it's important for us to really understand that the community is not there just for us to introduce what we think is important for them, but co-design with them, whatever the issues are.

00:08:52:12 - 00:09:19:07
Nancy Meyers
And that involves the hospital or health system trusting the community, right, as well as gaining the trust of the community. So, Jamie, this is an area where Englewood has also really excelled, I think, in, in co-developing programs for some of the unique populations that you're serving people might be surprised by. You want to talk about one or two of the examples of how you, over the years, co-developed programs.

00:09:19:07 - 00:09:37:00
Jamie Ketas
Sure. I think one of the longest standing examples we have was about 30 years ago. The Jehovah's Witness population approached us at Englewood and really was in, had a huge barrier to care, and a lot of clinicians were unwilling or afraid of the liability of taking care of patients for whom blood is not an option. And this was something.

00:09:37:00 - 00:10:04:24
Jamie Ketas
It was new. And our approach has always been we don't duplicate, right. So we looked around and indeed it was an area that needed to be filled. And so we partnered with them and over the years really have built a trust that now we can use that trust to not just deliver the great, excellent care that's evolved over those 30 years where almost nobody gets transfusions in certain areas now, through the patient blood management principles that were born at Englewood, just by nature of our experience.

00:10:05:01 - 00:10:24:25
Jamie Ketas
But it's also a vehicle by which we can give information to this population, because now they trust us. And so as we all in our population health mission are trying to push to prevention and screening and prevent the need for a bloodless surgery, we can use the trust we've built with that community. Another example is the Korean Health and Wellness Center, where this was a population -

00:10:24:26 - 00:10:42:10
Jamie Ketas
Northern new Jersey has a very large and growing Korean-speaking population. And that was another barrier to care, right? They could not navigate literally, logistically, and also to get the information to them on what they should be getting and how to get it was a real barrier for these patients getting the care they needed. So we're doing the same thing.

00:10:42:10 - 00:10:52:06
Jamie Ketas
We sort of are following the example of the Jehovah's Witness population and the bloodless patients to move towards continuing to use vehicles to get not just care, but information to the populations that need it.

00:10:52:08 - 00:11:14:10
Nancy Meyers
Last question I have, I think, for both of you, is in order to do this great work that each of you are leading as a subject matter experts in your organizations, you have to have empowerment within your organization from your senior leadership, and they have to give power to you and to the community through you in order to get these programs done.

00:11:14:11 - 00:11:34:08
Nancy Meyers
I'm wondering, based on your years of experience, what do you think are one or two qualities that you've seen develop in your organization in terms of your support from senior leadership, that you would suggest that other organizations focus on or consider? How have they empowered you?

00:11:34:11 - 00:11:49:10
Jamie Ketas
So I would say at Englewood, you know, we are relatively small. We're an independent system still. And I think that there's trust, right? I think trust is really at the heart of everything. So there has to be trust at the team that the resources we put towards this are going to be used in a strategic way.

00:11:49:10 - 00:12:07:17
Jamie Ketas
Right? We're not going to go and develop a program or try to implement something that's not going to be well received by the community that we're trying to reach. We're not duplicating efforts, right. We're trying to supplement. And I think the trust that we're going to do the work in advance to make sure that whatever, wherever we put our resources right, they're not unlimited.

00:12:07:24 - 00:12:27:06
Jamie Ketas
So how do you do this in a way to drive outcomes? And our CEO is very fond of saying the good business and it's good business, right? And so for us to continue to flourish and to be a trusted health care partner for all the communities we serve, we have to be flexible, nimble, right? During the pandemic, we'd gone on weekly phone calls with all the community service agencies.

00:12:27:06 - 00:12:35:18
Jamie Ketas
What do you guys need? How can we help? Where are you guys coming from? What do you have to share? How do we do all this together and just being willing to collaborate at every level.

00:12:35:21 - 00:12:40:07
Nancy Meyers
Andy, how about at New York Presbyterian? How has the leadership been supportive of this work?

00:12:40:07 - 00:13:05:11
Andy Nieto
So obviously, we're a huge organization in New York City, but we have a CEO that is committed to this work, who knows about our work, who speaks about our work and who gives us the resources we need for us to be able to do this work. Our CEO can get up and talk about our Lang Medical Youth program, which is a program that brings sixth graders into the hospital, who spend six years with us.

00:13:05:13 - 00:13:39:01
Andy Nieto
We help them get into good high schools, good colleges, and many of them come back as employees of the hospital. Many are nurses and physicians, and these are kids from the inner cities who probably would not have had. And Dr. Corwin, who's our CEO, will speak about the program like he knows the program really well. More recently, we had an interview with two of our Lang graduates. One is an MP working in one of our pediatric floors, and the other one is a program manager who runs one of our programs.

00:13:39:03 - 00:13:50:03
Andy Nieto
And Dr. Corwin speaks to them and talks to them and can talk about these programs, you know, in a way that a CEO who's running a multibillion dollar organization is just amazing to hear.

00:13:50:05 - 00:14:11:24
Nancy Meyers
That's great. Well, on behalf of AHA, I want to thank both of you for the work that you're leading within your organizations and thank your organizations, Englewood Health and New York Presbyterian, for being leaders and being shining examples for others when it comes to investing in and developing your communities. So thank you, thank you, thank you.

00:14:11:27 - 00:14:20:07
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.

00:00:00:16 - 00:00:35:06
Tom Haederle
It's been about 17 months since the official end of the Covid 19 pandemic, but its effect on caregivers - stress, burnout, anxiety - remains. In Chicago, Northwestern Medicine has created a continuum of innovative mental health support programs that not only encourage its staff to seek out needed help, but also make a point of addressing the stigma that still holds too many caregivers back from taking care of themselves.

00:00:35:08 - 00:01:12:12
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle, with AHA communications. Creating mental health support resources is one thing. Getting people to take advantage of them can be an uphill climb. In today's podcast hosted by Rebecca Chickey, senior director of Behavioral Health Services with the AHA, and Emma Jellen, a former associate director with the American Psychiatric Association Foundation, we hear from Northwestern's chief wellness officer about how his organization raised awareness of access to its mental and behavioral health support services, and what other health systems can learn from Northwestern's example.

00:01:12:15 - 00:01:14:14
Tom Haederle
And now to Rebecca.

00:01:14:16 - 00:01:27:07
Rebecca Chickey
Thank you Tom. Indeed, it's a great honor to be here with Emma Jellen from the American Psychiatric Association Foundation and Dr. Gaurava Agarwal from Northwestern Medicine. Emma, I think you have the first question.

00:01:27:14 - 00:01:49:05
Emma Jellen
Yeah. Thanks so much, Rebecca, and thank you so much for having me here today. Dr. Agarwal, I wonder if you could just, talk a little bit about why and how Northwestern Medicine decided to build such a multifaceted offering of well-being programs and policies that really promote access to mental health care for your health care workforce.

00:01:49:07 - 00:02:08:29
Gaurava Agarwal, M.D.
I'd love to, Emma. Thank you, and thank you, Rebecca, for having me as well. You know, I think for those who don't know, I'm a psychiatrist, and I serve as our chief wellness executive in Northwestern Medicine. And as I took on these wellness roles, I initially sort of ran from focusing on the mental health aspects

00:02:09:01 - 00:02:31:29
Gaurava Agarwal, M.D.
related to wellness, to be honest with you. I really wanted people to understand that we were here to address some of the systemic issues that impact our well-being. And this was before the pandemic. And then as we sort of went through the pandemic, it was pretty clear that, A, some of the systemic issues, were going to have to be put on the backburner a little bit.

00:02:31:29 - 00:02:57:12
Gaurava Agarwal, M.D.
There was too much change going on. To be able to truly do other system redesign in the midst of a pandemic. And B, it was clear that we were seeing all the data that showed the mental health impacts of the pandemic on our health care workforce. And, we have tried to organize our wellbeing program to make sure that folks have resources at the sort of prevention level, you know, hopefully before they have issues.

00:02:57:14 - 00:03:29:00
Gaurava Agarwal, M.D.
But we realized we had to bulk up our resources available to individuals experiencing distress, due to the pandemic, things like burnout, trauma, etc.. And then we also needed to enhance our resources for folks whose distress had actually progressed on to actual mental health conditions such as depression, anxiety, post-traumatic stress disorder, etc.. That was really the genesis of, hey, how do we take a comprehensive look at making sure that the that our workforce has resources available to everyone of those levels?

00:03:29:03 - 00:03:51:02
Rebecca Chickey
I think the last time you and I met and talked, you had six or seven programs that were part of this multifaceted approach. Could you take a few minutes and maybe share with the listeners descriptions of one or two or three of the programs to give them a sense of the diversity and the different types of audiences that you're trying to meet their needs.

00:03:51:04 - 00:04:10:04
Gaurava Agarwal, M.D.
Sure. Happy to do so. And the reason we did that is what we have found is it's hard, even when we do things, it's hard for our workforce to tell us, oh, you guys did that? I didn't know about that. And for us, that is disappointing, of course because if we build them but they don't know about it, no one's going to be utilizing them.

00:04:10:04 - 00:04:32:05
Gaurava Agarwal, M.D.
And so we have tried to figure out what will increase the likelihood of our workforce knowing about things, so that they can use them. And, and for us, one of those things that helps us hopefully have greater penetration of awareness is having campaigns. Right? If we do one thing sometimes that can get lost in the shuffle.

00:04:32:05 - 00:04:55:19
Gaurava Agarwal, M.D.
And to your point, Rebecca, that one thing may be more applicable to one job family or another. When we do campaigns, we're able to have broader communications because maybe not everything will hit you, but at least some things will. And something will resonate or something will say, hey, this is something that I need. And so we said, if we're going to do this, let's, let's try to do a couple of these things at the same time

00:04:55:19 - 00:05:22:12
Gaurava Agarwal, M.D.
so we could truly launch a campaign and raise awareness about how the organization takes mental health seriously, and we support you seriously. So for us, again, using that rubric of wanting to bolster resources in the distress zone, we initially spent, time creating a peer support program. And that peer support program was initially for attending physicians.

00:05:22:15 - 00:05:48:22
Gaurava Agarwal, M.D.
And over time, that peer support program has increased to be available to our APPs, our nurses, our pharmacists and our residents and trainees. And so, as we saw the benefit of peer support and how it can help in someone's really acute time of need, we realized this is a great program for lots of different folks who may experience adverse events or medical errors or near misses at the bedside.

00:05:48:25 - 00:06:13:00
Gaurava Agarwal, M.D.
In addition, we expanded what peer support can support around. And so historically, these things are around those issues of adverse events or medical errors. But we wanted what we were seeing, particularly during the pandemic and frankly, unfortunately this continued, was incivility at the bedside. And so we created a trauma informed peer support program that supported around discrimination and bias at the bedside by patients and visitors.

00:06:13:05 - 00:06:43:28
Gaurava Agarwal, M.D.
And that was a big escalation. And that's, a program we call P2P Safer. You know, it's to provide a safer program, a safer environment for our health care workforce. In that same distress bucket w2e also launched coaching, particularly coaching around burnout, imposter phenomenon, etc., for our trainees, residents and fellows. And that program for us really provided many of the skills that I wish I had had as a resident and fellow.

00:06:43:29 - 00:07:04:11
Gaurava Agarwal, M.D.
You know, the medicine in some ways was the easy part. It's how do you continue to develop your professional identity, how do you balance your work and life in a different way? So that coaching program was something that we're really, really proud of. At the tertiary level, that final level where distress has progressed to disease, we took a nudge from other groups and said, hey, you know what?

00:07:04:11 - 00:07:36:12
Gaurava Agarwal, M.D.
EAP is not enough and you need to look at your EAPs. And so we did. And what we said is, hey, what do we know about how many sessions it takes to improve anxiety and depression. And so we increased, we picked a new EAP and we increased the number of visits our entire workforce would have by 33%, for any incident that they would have, which, to me and my specialty aligned better with how long it generally takes to feel better from mild to moderate depression.

00:07:36:14 - 00:08:01:29
Gaurava Agarwal, M.D.
We looked at the diversity of the therapists that were available to our workforce. Obviously when there is race concordance or ethnic concordance that can be a big increase in the desire for people to utilize the services that they feel understood or they feel like their therapist gives them. And we felt like, our prior vendor, we didn't feel like we had the diversity to offer our diverse workforce.

00:08:02:02 - 00:08:03:22
Gaurava Agarwal, M.D.
And so we enhanced that.

00:08:03:25 - 00:08:30:08
Rebecca Chickey
That's exceptional. I was just going to say, you truly offered the listeners what the definition is of multifaceted. Not only do you describe three different programs and approaches, but then within each program, customizing it to better meet the needs of the type of workforce and, and the diversity of our current workforce. So thank you. Emma, I think you have another question for him now.

00:08:30:10 - 00:09:00:19
Emma Jellen
Yeah. I mean, I was just going to say, wow. Like I've heard you talk about all the work you've done and the policies and systems changes you've made, to really create this culture of well-being and this campaign at Northwestern. But every time I hear it, I remain impressed. And I have to assume that perhaps a listener who has clicked on this podcast has a vested interest or is about to embark or has already embarked on this journey

00:09:00:21 - 00:09:23:19
Emma Jellen
as well. And perhaps after you listing all of the programs there, they might see this as a little bit daunting. But we know that you're not the first institution to do something like this, but we really hope you're not the last, right? So I wonder if you can share a little bit about the journey, where you started.

00:09:23:21 - 00:09:35:24
Emma Jellen
And, you know, maybe put people's minds at ease about the process or at least let them know what they're in for, just so we see more uptick and more implementation and adaptation of things that exist.

00:09:35:26 - 00:10:01:06
Gaurava Agarwal, M.D.
Yeah, I think that's a really good point. And I want to be clear. All these things sound like, you know, you had a master plan when you started, but, you know, we were just putting one foot in front of the other. And the peer support program started off as a single program in a single department. We have a Scholars of Wellness program, and one of our scholars, created a peer support program in the Ob-Gyn department of one of our hospitals.

00:10:01:07 - 00:10:21:12
Gaurava Agarwal, M.D.
That's where this started. And as we learned about the value that peer support can provide and how one would stand up a program in that one department, that one department turned into a hospital. And then as we figured out how you spread to a hospital, that one hospital turned into 11. And that was all for docs and then all the docs,

00:10:21:12 - 00:10:41:17
Gaurava Agarwal, M.D.
we understood what to do for the APPs. The APPs turned into the nurses, the nurses turned into the pharmacist, and the pharmacist turned into the trainees. And so I don't believe in sort of trying to do it all at once, because generally when I've tried to do that, I do nothing. And so I just we just try to continue to, to grow and provide as many resources we can.

00:10:41:20 - 00:11:10:09
Gaurava Agarwal, M.D.
One program that I didn't mention, earlier, that was a big part of this. And if you have to start somewhere, you know, we all have to sort of show utilization, an impact. And the truth is, we can build all this stuff, but people may not utilize it because they don't feel safe to utilize it because, historically, there has been A) stigma, and B) real repercussions for seeking out mental health care, for health care workers that are worried about licensure issues.

00:11:10:09 - 00:11:34:20
Gaurava Agarwal, M.D.
And so, we used the Dr. Lorna Breen Foundation audit toolkit to help change the language on our credentialing forms to make sure that there would be no stigma for seeking out mental health care. And that was in conjunction with the state of Illinois. Also changing, their verbiage on their licensure, because obviously you sort of have to do both.

00:11:34:20 - 00:11:54:03
Gaurava Agarwal, M.D.
Otherwise it's still important to do it locally. But when you have it both, that's when the research shows that our health care workers are more likely to utilize these sorts of resources. We made those changes incredibly easy in some ways. I don't like to say any change is easy, but it was easy in the sense that we had the playbook on how to do it.

00:11:54:06 - 00:12:19:08
Gaurava Agarwal, M.D.
And then we communicated it to folks to say, hey, we're, we're doing things and we're serious about this. And, I think that builds trust, so that the, the other stuff also can be heard in the vein of, hey, you know what? Now I can use that stuff. And so that's where I would say you should always start just because it'll be difficult to sustain other things if people don't feel like they can use the resources that you provide them.

00:12:19:08 - 00:12:47:22
Emma Jellen
So I've had the privilege and pleasure of working with you for about, I don't know, two and a half, almost three years now, longer than that with the center. But, two and a half, almost three years now on, the APA Foundation Center for Workplace Mental Health Frontline Connect initiative. And you know we recently released our toolkit Improving Mental Health Care for Clinicians: Leading Interventions for your Workforce, which you can find at Frontlineconnect.org.

00:12:47:24 - 00:13:24:10
Emma Jellen
But I wonder if you can share and speak to those folks who are like you, who are a leader at a hospital health system or a health care institution who are, you know, a chief wellness officer who are largely responsible for the mental health and well-being of their workforce. I wonder if you could speak to them and talk a little bit about what the toolkit we created together is, and how they can find value in it as they again embark or continue or, you know, this journey to really just increase access to mental health care for those who need it.

00:13:24:12 - 00:13:48:09
Gaurava Agarwal, M.D.
Absolutely. And, you know, it's been my pleasure to work on Frontline Connect. And what I would say is for me in the role I sit, we spent quite a bit of time, I would say over a decade, sort of saying what needs to happen, and why does it need to happen? Action needs to be taking around wellness and mental health for our workforce.

00:13:48:11 - 00:14:06:21
Gaurava Agarwal, M.D.
What I was looking for, and what sort of drew me to the project was how and what. I'm a coach. And so how and what are the questions I care about. What are people actually able to do in the real world? What are they already doing that they've stood up that's making a difference?

00:14:06:23 - 00:14:28:15
Gaurava Agarwal, M.D.
And that's what we try to do with this virtual video toolkit - I just didn't have time to read 300 pages, I just got to be honest with you. I wanted 15 minutes for someone to give me the seed of an idea of a program that they're using, because I can't - none of us, I think, can adopt a program just out of the box.

00:14:28:22 - 00:14:48:16
Gaurava Agarwal, M.D.
We all have our own cultures. We all have our own resources. We all have our own leadership. And so I don't need you to tell me every single detail because it's not going to matter to me. It won't work that way for me. I just need some of the basic ideas of what are sort of these programs that could address "X" problem?

00:14:48:18 - 00:15:18:07
Gaurava Agarwal, M.D.
And once I hear that, I can then take it through my lens and say, for us, we do have this need or actually, you know, we're doing okay on that thing, but if we have that need, how can I take the broad strokes of this program and apply it to my needs here at Northwestern? As you know, we identified the sort of exemplars across the country of people doing programs or having resources that were broadly available that we wanted people to know about, that we wanted to raise awareness about that.

00:15:18:07 - 00:15:39:14
Gaurava Agarwal, M.D.
We get a chance to help our colleagues show up about their programs. And they were really gracious in sharing their programs, how they launched it, some of the key learnings from their launches. And as we continue to record more and more of these video case studies, I found that, hey, you know what? Like, why can't we do four or five of these?

00:15:39:17 - 00:15:56:24
Gaurava Agarwal, M.D.
We're pretty close and we know something about a little bit about a lot of these. And so can we take that next step. And you've heard me talk about the influence of positive peer pressures. I can get competitive. And if I'm like, hey, this other health care system is doing this, why not us?

00:15:56:27 - 00:16:09:00
Gaurava Agarwal, M.D.
That fuels me. And, I believe that if, frankly, I use positive pressure on myself without knowing it. And in a nutshell, to do some of these social programs all at once in the campaign that I mentioned.

00:16:09:02 - 00:16:32:04
Rebecca Chickey
I so agree with you. I love the toolkit. I was honored to be present with the official launching of the toolkit and the fact that you can have digestible, inspirational knowledge transferred to you in a 5 to 10 minute video if they're even that long in some cases. It's just wonderful. And it is the environment that we live in now.

00:16:32:06 - 00:16:58:23
Rebecca Chickey
We are all fast paced and so bite sized learning is wonderful. Now the reason we're doing this podcast: bite sized learning. So as we bring the podcast to a close, this is always a challenging question so get ready. This is your Jeopardy question. If you had to pick, what are the three things that you want the listeners to really lock in on that you've said today, that you've shared today, you know, is it the toolkit that is a phenomenal resource to inspire?

00:16:58:25 - 00:17:06:24
Rebecca Chickey
Is it if you just start at one small unit, at one hospital, you can grow from there.

00:17:06:27 - 00:17:27:22
Gaurava Agarwal, M.D.
I think for me, the first one is sometimes what I hear is people say, I think we're doing alright on mental health. Okay, that's too broad to me. What do you mean by that? Which level of prevention are we talking about? Are we talking about prevention at that primary level? Are we talking about you have good amount of resources at that distress level?

00:17:27:25 - 00:17:52:21
Gaurava Agarwal, M.D.
Have you really checked to see if your folks in your workforce have good access to mental health care for mental health conditions? And how do you know? And so, really assessing current state and the spectrum of needs as it relates to wellness and mental health conditions, I think is important. Because what I think you might find is you are probably doing great in one of those buckets, maybe two of those buckets.

00:17:52:21 - 00:18:11:10
Gaurava Agarwal, M.D.
But I don't know that many people that are doing great in every single bucket and even us, there's still gaps for us. And so you have to know where you're at and where you really are sparse in your resources, because to me that's where you have, you know, the opportunity for the greatest impact. So that would be number one.

00:18:11:12 - 00:18:35:27
Gaurava Agarwal, M.D.
Number two, I'm biased, but I do hope the people look at Frontline Connect. There's a lot of people's good work there. And I believe in acceleration. And, I don't really believe that my brain needs to be that smart. I should be learning from the best of other people. And I think it'll accelerate your journey about the options out there and the places where you may be able to make a difference.

00:18:35:27 - 00:18:52:27
Gaurava Agarwal, M.D.
Even if after you do step one, you say, oh, I think I'm doing okay. Then if you see some of these and issues like, oh, you know what, I actually don't have any of those thing that may actually remind you to take a look at, you know, at the same you don't know what you don't know, you don't know what's out there.

00:18:52:29 - 00:19:12:19
Gaurava Agarwal, M.D.
And so it'll be hard to judge what are some of the gaps with that without looking at some of these best practices? Number three, I would say this is the time. What I failed to mention earlier is we had looked at changing our credentialing language five years ago, and I couldn't get it done. I couldn't figure out how to do it.

00:19:12:19 - 00:19:38:24
Gaurava Agarwal, M.D.
I couldn't really figure out who the players were. I don't know if it was top of mind for people. This is a different time. And so for those of you that have maybe tried some of this stuff in the past and it's been shot down or there's been blocks or barriers, timing is everything in change management. And so this is the time to take a look because what the disaster psychiatrist and psychologist will tell you is that it's not during the pandemic, it's not during a disaster that this stuff matters.

00:19:38:26 - 00:20:20:27
Gaurava Agarwal, M.D.
It's the aftermath where especially the folks that actually experienced and responded to disasters - in this case the pandemic - actually feel it. And long after society has moved on, the folks that actually responded, whether it's military or in our case the health care workforce, that's when these symptoms emerge. And so recovery is needed and potentially treatment is needed now. And so making sure that, you know, we don't get sort of seduced or trapped in this idea of, oh, the pandemic's long over, this is what we know about pandemic recovery or disaster recovery, I should say, is this is the time where those symptoms need to be, we need to be able to

00:20:20:27 - 00:20:25:19
Gaurava Agarwal, M.D.
look out for them and, aggressively provide the resources to treat them because they are treatable.

00:20:25:22 - 00:20:47:19
Rebecca Chickey
The time is now. If there is a sliver of a silver lining of the pandemic, I think it is that it really has opened people's eyes. It's reduced some of the stigma. And it's also focused on the true need for these services across the board, but particularly for our health care workforce who are on the front lines every single day.

00:20:47:21 - 00:21:08:14
Rebecca Chickey
So Dr. Gaurav Agarwal and Emma Jellen, thank you so much for being here today. And then for additional resources from the AHA, go to AHA.org/behavioral health. Thank you for your time and expertise and for the great work that you do each and every day. Gratitude.

00:21:08:16 - 00:21:16:26
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.