Chair File: Leadership Dialogue — Reflecting on What’s Next in Health Care with Joanne Conroy, M.D., of Dartmouth Health

00;00;00;24 - 00;00;36;08
Tom Haederle
Challenges and opportunities. Hospitals and health systems face plenty of both as 2023 winds down and we head into a new year. Workforce issues, financial sustainability, new technology. These are but a few of the realities confronting health care providers and leaders in the near future and beyond. And as you'll hear in this podcast, bold leadership and new thinking are needed in the health care field as never before.

00;00;36;10 - 00;01;09;29
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Every January 1st, the baton is officially handed off. The chair of the Board of Trustees of the American Hospital Association rotates as the one year term ends for the outgoing chair and begins for their successor. In today's podcast, the incoming and outgoing chairs of AHA -both highly respected leaders of major health systems - share their insights, hopes and plans for the health care field on the cusp of a new year.

00;01;10;02 - 00;01;32;09
John Haupert
Thank you, everyone, for joining me today for another Leadership Dialog session. I'm John Haupert, president and CEO of Grady Health System in Atlanta, Georgia. And I also have the honor of serving the AHA as chair. Today, I am very pleased to introduce Dr. Joanne Conroy, president and CEO of Dartmouth Health. Hello, Joanne. Welcome.

00;01;32;12 - 00;01;34;01
Joanne Conroy M.D.
Hi, John. Thank you.

00;01;34;04 - 00;02;08;12
John Haupert
Dartmouth Health is New Hampshire's only academic health system, the state's largest private employer, and serves a population of 1.9 million patients across New England. The system includes a network of hospitals, including a children's hospital, a comprehensive cancer center, clinics providing ambulatory services across the region, specialty practice areas, home health and hospice services, and includes a lot of rural health services in that market.

00;02;08;14 - 00;02;43;12
John Haupert
Joanne has been credited with overseeing significant positive changes within the organization since she assumed the role in 2017. She has moved Dartmouth Health to continue broadening its service to New Hampshire and Vermont, communities through partnerships and collaborations in both states. Joanne is a committed leader in advancing equity in the workplace and is also co-founder of Women in Impact, a nonpartizan group of female health care leaders representing all sectors of the health care industry across the nation.

00;02;43;14 - 00;03;09;23
John Haupert
While this is my last time hosting one of these discussions as chair of AHA, Dr. Conroy will be picking them up as she steps into the role of HRA Board chair beginning in January. And trust me, AHA will be in great hands. So thank you, Joanne, for joining us. I guess this is kind of us passing the baton, so to speak, but we'll go ahead and jump right in with our first question for you.

00;03;09;25 - 00;03;20;29
John Haupert
As is often the case when we get ready to turn the calendar and begin a new year, I will ask you to reflect back on the past year. What have been some of the biggest challenges you've seen?

00;03;21;01 - 00;03;54;24
Joanne Conroy M.D.
I think we see the same challenges that health care leaders across the country are seeing, which is the paucity of workforce. We have the fortunate but maybe unfortunate distinction of being one of the three oldest states in the nation. New Hampshire, Vermont and Maine, I think are one, two and three. But our order changes a little bit, and as people age, they require more kind of patient facing services and we haven't solved that yet.

00;03;54;27 - 00;04;21;09
Joanne Conroy M.D.
After the pandemic, when so many people left the workforce, even though the wages have increased, those people have not returned to the workforce. So thinking long term, we're thinking about how do we fill the gaps. But certainly the last year has been focused on how do we create a different type of workplace for our employees to bring them back into the workforce.

00;04;21;11 - 00;04;42;12
Joanne Conroy M.D.
I never thought I would be thinking about childcare and housing, but I am supporting housing and I'm creating child care teams to make sure that women can actually reenter the workforce. And given the fact that 85% of our workforce is female and they're a critically important part of the services we deliver.

00;04;42;14 - 00;05;11;12
John Haupert
Well, I would love for you to expand a little bit on what you're doing about the workplace, because I know you well enough to know how employee provider-centric you are, which is incredible. But the issue you brought up about child care is really overwhelming at this point. I just learned from one of our employees that for her two children, to be in daycare is almost $3,000 a month.

00;05;11;14 - 00;05;29;14
John Haupert
So you think about how much someone has to earn to make that even make sense. And I think that really is keeping people from coming back to the workforce. So is there any other innovations you're looking at or progress you think is being made at Dartmouth around enhancing the work environment?

00;05;29;16 - 00;05;56;14
Joanne Conroy M.D.
Yes. Let me focus first on child care. So we are working with a college because between the college, Dartmouth College and Dartmouth Health, we employ a significant number of people in what we call the Upper Valley, which is the Connecticut River Valley that encompasses both Vermont and New Hampshire. But their workforce lives generally in that area for the Lebanon campus activities.

00;05;56;16 - 00;06;23;25
Joanne Conroy M.D.
And we've identified a couple important issues. It's not necessarily about facilities because we all get stuck on, you know, should we spend ten or $12 million to build the facility? We have actually open slots in facilities, but we don't have the staff to staff them. And every state has different regulations in terms of how you actually appropriately staff these facilities.

00;06;23;27 - 00;06;49;29
Joanne Conroy M.D.
Like in New Hampshire, there's a certification process, but we need to train more people. So we have actually set up a program with one of our early childhood education groups in the Upper Valley to train 12 people every eight weeks to actually become childcare providers. And childcare providers earn close to $57,000 a year when they work for us.

00;06;50;00 - 00;07;18;04
Joanne Conroy M.D.
They're a critically important part of the services we deliver, and they're actually very skilled. They're not babysitters. They're early childhood educators. The second thing we're doing is encouraging people to actually establish programs in their home because not everybody really wants to drop their child off at a daycare facility. Some like the smaller home settings. So we're hoping to actually train another hundred people to actually develop facilities in their own home.

00;07;18;04 - 00;07;41;06
Joanne Conroy M.D.
And we give them the infrastructure on how to run a business, how to pay taxes on the business, how to provide the appropriate environment. We even give them small grants to build a wall or build a bathroom, things that they need in order to have a viable business. So it is not just building a building, it's actually investing in the people.

00;07;41;08 - 00;08;07;06
Joanne Conroy M.D.
And we have a full court press on that. And we have two people who are dedicated to just making sure that initiative moves forward. The second thing is housing. You know, all of us are in areas of the country where housing is far more expensive than it ever was before. And the stickiness you need to keep people, especially in rural America, is they don't want to live in an apartment forever.

00;08;07;09 - 00;08;27;19
Joanne Conroy M.D.
They want to own something. They want to own a condo, and then they want to own a single family home and they begin their families. And that's where you keep them for 20 or 25 years. So we're actually using some of our land and working with private developers to build single family homes within ten miles of the facility.

00;08;27;21 - 00;08;54;28
Joanne Conroy M.D.
And we are encouraging everybody else to participate with us. I would say developers in this area are starting to build more. So we probably have 2000 housing units coming on the market this year. It's great. We've been waving the flag for four or five years, but you know, we've convinced everybody there's a market up here. So we're starting to see some movement. I think less so maybe in a urban place like Atlanta,

00;08;54;28 - 00;09;23;26
Joanne Conroy M.D.
but up here, it's going to change the environment. When you bring 6 to 10,000 more families into the environment, it's going to change, I think, all for the good. Small towns that were struggling will thrive in a different way. And you have the opportunity to create a much more diverse community, which is something that is really important for recruiting diverse workforce.

00;09;23;29 - 00;09;54;18
John Haupert
Well, I am blown away and incredibly impressed with what you're doing. Both of those issues are so real in so many parts of the country. But man, you're really doing it really well and I applaud you for that. Now, you and I are going to talk a little bit about the higher side of our our field, which is how we are doing nationally, how our field is doing, what health care looks like in a somewhat post-pandemic world.

00;09;54;20 - 00;10;00;22
John Haupert
But what do you think as a field? We're doing well and what are we not doing so well?

00;10;00;25 - 00;10;32;27
Joanne Conroy M.D.
So I've thought about this a lot. Number one, what we're not doing well is probably telling everybody what we're doing really well. And when I think about the fact that we are the safety net in so many ways for our communities, and I'm not sure they completely appreciate that. And when we start struggling or when the health system in the community has these stress fractures, you know, the services that people depend on go away.

00;10;32;29 - 00;11;07;26
Joanne Conroy M.D.
EMS, your medications that are ready within, you know, an hour, medications that are, you know, needed for urgent needs are available 24/7. We needed to have surgery. You don't have to wait months because they don't have available staff to staff all their operating rooms. I mean, those are examples of stress fractures that create inconveniences on one hand, but they create real medical emergencies on the other hand.

00;11;07;29 - 00;11;33;13
Joanne Conroy M.D.
So I think we need to do a much better job telling people that we've actually assumed responsibility for a lot of societal issues that are probably not our responsibility, but they're there in the community. We see they need to be addressed. We know that they have a direct relationship to the health of the community. So we're stepping in there.

00;11;33;16 - 00;12;01;14
Joanne Conroy M.D.
I think we need to be louder about that. And also encourage other members of the community to participate. We actually have our local businesses that are really right here with us on housing and on child care. But we probably need nationally insurers and large employers to also be our partners in this. None of these problems can be solved by one segment of the industry alone.

00;12;01;14 - 00;12;11;17
Joanne Conroy M.D.
We all need to work together on it. And one would hope that would dispense with some finger pointing and we can start focusing on taking care of people now.

00;12;11;17 - 00;12;15;11
John Haupert
That's great. So what do you think we're doing reall well?

00;12;15;14 - 00;12;55;05
Joanne Conroy M.D.
You know what we have done an amazing job. I'm continuing to deliver care under environmental circumstances that other industries would have left the market. You know, how many other industries have had double digit increases in their hourly wage costs and yet still stick in the market? How many industries have lost their workforce in certain areas and figured out how to cross-train people rather than abandoning that service altogether?

00;12;55;07 - 00;13;26;01
Joanne Conroy M.D.
You know how many other industries have actually expanded what they offer people in an environment where we're not getting paid any more for what we're doing. And I think we're actually doing that really well in really challenging economic environments. And whenever I describe how we navigate the finances of health care to anybody who's in business or investment capital, they're like, well, that's crazy.

00;13;26;01 - 00;13;41;20
Joanne Conroy M.D.
That model doesn't work. But if we don't make it work, the people that suffer are the people in our communities. They're our patients. They're our own family members and they're our neighbors. So we have to figure it out.

00;13;41;23 - 00;14;04;12
John Haupert
I love what you said about our, you know, the the payment model and how convoluted this has all become. I was in a discussion yesterday with several of our board members, and one of them asked me a question about how Medicaid and Medicare work in Georgia. And I said, well, that's about a two-year advanced degree program, if you really want to know.

00;14;04;12 - 00;14;26;01
John Haupert
But I'll give you the highlights. And at the end of it, of course, they looked at me and said, you know, that's the most messed up thing I've ever heard. And I said, Well, that's how it's evolved, that's how it's been created. It's difficult to unwind, but there are many parts of this system of ours that we are unwinding and things I think that we are improving.

00;14;26;03 - 00;14;45;02
John Haupert
So let me ask you, as you're coming in, as the chair of AHA, what what are you hoping under your leadership that you and the AHA can accomplish and or focus on more or less than we have in the past?

00;14;45;04 - 00;15;15;14
Joanne Conroy M.D.
So there are two buckets. One is safety, both patient safety and employee safety. We are constantly on a journey to improve the care that we offer in our facilities for patients, and it always needs to be kind of that guiding North Star. Because people depend on us to have a certain level of quality control within every organization so they know when they go there, they don't have to worry about not being safe.

00;15;15;16 - 00;15;49;00
Joanne Conroy M.D.
And on the flipside, we've got to also create an organization that feels safer for our employees. The rising incidents of violence in hospitals from not just patients, but family members probably reflects the free floating anger and anxiety out in the community. But when it comes into our facility, it endangers patients and endangers people that are just trying to take care of people in need.

00;15;49;02 - 00;16;16;09
Joanne Conroy M.D.
And I think we need to double down on really making people aware that this is unacceptable and that people need to bring their best self to work. I tell my employees that all the time, but patients have family members need to bring their best self to the hospital, where we need to focus on the main thing, which is actually taking care of their family member.

00;16;16;12 - 00;16;46;20
Joanne Conroy M.D.
So, safety in our environments is a top priority. I would say the second thing is innovation. And I think we're at a little bit of an inflection point with the introduction of AI. Most of us just think it's really very fancy medical scribe, but generative artificial intelligence is going to allow us to really look at how we do our work and replace our vacancies with technology.

00;16;46;25 - 00;17;24;20
Joanne Conroy M.D.
When you look at the scope of what generative AI can do for our organizations, not eliminating those interfaces where you need a person delivering the care, but a lot of the back office activity, generative AI, is actually probably going to do that more efficiently and more effectively and less expensively. And we've just got to figure out how do we work it into our workflow and how do we kind of get on the train that I think is going to bring tremendous value to our communities.

00;17;24;23 - 00;17;43;14
Joanne Conroy M.D.
I know there's a lot of suspicion, I know there's a lot of questions, but we need to be a part of that every time we experiment with a generative AI, it's got to give value back to the community about understanding what it can and can't do. And we need to be full participants of that.

00;17;43;16 - 00;18;13;19
John Haupert
Well, I totally agree with you. And as you as you mentioned, there is speculation, but I'm glad you brought that up on a larger scale and something that the AHA has to really focus on, because I think there is a big advantage to sharing best practices as AI begins to expand how A.I. is used in the back office revenue cycle, how it's used to help us better diagnose and treat.

00;18;13;21 - 00;18;37;21
John Haupert
That is one of my hopes that we can identify things like sepsis sooner, faster and but having 5500 different hospitals figuring that out for themselves probably isn't the way we want to go. But we do want best practices to come forward. I imagine organizations like yours and mine that are academic medical centers will be on the front line of that.

00;18;37;23 - 00;18;48;01
John Haupert
And I personally, just as you said, I'm looking forward to what we can do to improve patient outcomes, but also improve the efficiency of our system.

00;18;48;03 - 00;19;14;13
Joanne Conroy M.D.
I was in a perioperative executive committee this morning and we're talking about block scheduling. I mean, how many of us spend hours and hours talking about who gets what surgical block? I'm sitting in that meeting saying, I think AI could probably accomplish this in 4 hours, which we have spent thousands of hours examining. The complexity of it is kind of perfect for that type of application.

00;19;14;16 - 00;19;35;20
John Haupert
No, absolutely. Because the man hours it takes to figure out, okay, which specialty did what and so much of it is so manual. I love your example because I've spent 34 years in meetings talking about block scheduling and who gets what, and then then dealing with the aftermath of who didn't get what they want. So that's a good, that's a good one.

00;19;35;20 - 00;19;39;18
John Haupert
That's a good one. Let me let me know when you got that one done.

00;19;39;21 - 00;19;41;24
Joanne Conroy M.D.
I will.

00;19;41;26 - 00;19;55;01
John Haupert
So it's time for us to wrap up, but I always like to end on a positive note. We all know that health care is evolving at a rapid pace. So tell us, what are you most excited about?

00;19;55;03 - 00;20;35;11
Joanne Conroy M.D.
You know what? I am most excited about the new generation of both workers and patients that are helping us redefine how we're delivering care. Our workers are really interested in work-life balance and having almost a gig economy approach to how they work their shifts. And it's making us rethink the old traditional 12 hour shifts for nurses. I have a niece that's a nurse and I have a traveling nurse living in the third floor of my house, and they work really, really hard.

00;20;35;18 - 00;20;57;25
Joanne Conroy M.D.
Those 12 hour shifts are rough, and how could you actually do your scheduling to accommodate people that want 12 hour shifts, but also people at 10 or 8. And again, I think we can probably do this and may help us with the scheduling, but is something that will accommodate our employees and again, bring more people into the workplace.

00;20;57;27 - 00;21;22;25
Joanne Conroy M.D.
But I think our patients are redefining the interface. They are looking for actually a lot more virtual care and convenience is a top priority for a lot of them. You know, they'll take an appointment with an advanced practice provider if they can get it within a day or two rather than work waiting two weeks to see a physician.

00;21;22;28 - 00;21;45;03
Joanne Conroy M.D.
And they understand that they're being cared for by a team and they trust us to deliver that continuity and quality of care that they have always received, but in a different form. And I think that's only going to be a bigger, bigger part of what we're doing. And I think we're going to see a lot of this explode over the next year.

00;21;45;06 - 00;22;13;06
John Haupert
Well-said. Very well said. And, you know, the issue of in our field where we over the years have been quite paternalistic about how people work and in dictating what that looks like, that I've seen a lot of change in that over my entire career. And here at Grady, we are very open to four hour shifts, six hour shifts, eight hour shifts, ten hour shifts, 12 hour shifts.

00;22;13;12 - 00;22;39;01
John Haupert
And we are learning better how to make that work. But that's so attractive to employees who are looking for that flexibility because 12 hour shifts don't always fit into people's lives well. And so, yeah, I'm glad to hear that. Very much so. So Joanne, thank you again for joining me today and for sharing your insight. Your perspective is always helpful.

00;22;39;01 - 00;23;09;28
John Haupert
And again, the role of board chair is in very capable hands, your very capable hands. So thank you, one last time for me to everyone who has joined these leadership round episodes this year. As I said, when we first began this year, there's great value in listening and learning from one another. And I know those valuable lessons will continue next year as Joanne takes the reins of hosting these peer to peer discussions as AHA board chair. I hope you'll continue to tune in.

00;23;10;00 - 00;23;14;03
John Haupert
I know I will. Until then, stay safe and be well.

00;23;14;05 - 00;23;16;23
Joanne Conroy M.D.
Thank you. You're leaving some big shoes to fill.