Advancing Health Podcast

00:00:01:06 - 00:00:27:13
Tom Haederle
Happy Holidays from the American Hospital Association and thanks for listening to the AHA’s Advancing Health podcast. As we wind up 2025, we wanted to highlight some of our most notable episodes from the past year. First up, a selection from Bridging Distances with AI and Telemedicine - a discussion between AHA's chief physician executive Dr. Chris DeRienzo and Dr. David Newman, chief medical officer for virtual care with Sanford Health.

00:00:27:16 - 00:00:49:27
Tom Haederle
Advancing health will return with a new schedule in 2026, so be sure to look for new episodes every Monday and Wednesday wherever you get your podcasts. In the meantime, enjoy these podcast highlights and we hope you and your family have a safe and wonderful holiday and a Happy New Year!

00:00:50:00 - 00:01:11:04
Chris DeRienzo, M.D.
So for you all, innovation is really grounded in your need to serve your population. So remind our listeners a little bit about Sanford Health and the populations you serve and why innovation has been so core to what you do from the beginning.

David Newman, M.D.
Yeah, so at Sanford Health we're the nation's largest rural health care system. We range all the way from Wyoming to Michigan.

00:01:11:12 - 00:01:37:19
David Newman, M.D.
We have lots of hospitals. We have got big hospitals. We've got small hospitals. We've got critical access hospitals.  We've got clinics. We've got a health network. We've got a nursing home. One thing that we don't have though, is a problem that a lot of rural America has is enough providers. We realize that we have to jump to innovative care models to survive because our patients really need.

Chris DeRienzo, M.D.
Well, it's innovative care models and you need providers, but you also have patients who are spread far and wide.

00:01:37:20 - 00:02:00:25
Chris DeRienzo, M.D.
I mean, you all were incredibly generous with your time. We spent some time together in the fall and you showed me what it really is like in parts of rural North Dakota where your patients live. Talk to us about that. And then you will return to given that this is who you all serve, and it really is a sacred mission that you have, the kinds of innovative approaches that you're taking both with virtual care and with AI.

00:02:00:28 - 00:02:20:17
David Newman, M.D.
Yeah. So I say rural, I mean really rural. So in, North Dakota, I live in Fargo, North Dakota. I'm the only andrologist for the state of North Dakota. And Fargo is on the eastern part of the state. And, a lot of my patients come from western North Dakota or even Montana. It is a 400 mile drive

00:02:20:18 - 00:02:47:17
David Newman, M.D.
one way to get to see me.

Chris DeRienzo, M.D. 
Whoa.

David Newman, M.D.
And oftentimes it's for a 15 minute appointment.

Chris DeRienzo, M.D.
Oh my goodness.

David Newman, M.D.
And so if they're coming to see me for their hypogonadism or infertility or another thing, I'm the only option in town. You can imagine how frustrating it is if there's a blizzard, or even if there's not a blizzard for them to have to drive that far, take a day off of work, have multiple tanks of gas yet, to miss time away from their loved ones to do something that can be easily done virtually.

00:02:47:20 - 00:03:02:22
Chris DeRienzo, M.D.
And that might even be two days, because I could imagine, you know, if that's an appointment you've been waiting on and you described a little bit about what you do. But remind our listeners what an andrologist is in just a moment.  

David Newman, M.D.
Yeah, yeah. You know, I mean I would drive 400 miles and spend the night just so I don't I don't miss that.

00:03:02:22 - 00:03:23:21
David Newman, M.D.
That can be such a key conversation in in a family's life. Right. Absolutely. Yeah. So andrology is sex hormone. So it's a lot of if your testosterone is low or if you're having troubles reproducing. Yeah. From a health perspective, even having one provider like that in that part of North Dakota is great, but you need to reach a massively spread out population.

00:03:23:21 - 00:03:45:03
Chris DeRienzo, M.D.
So, obviously you're the CMO of virtual care. Let's talk a little bit about how Sanford and you think about the kinds of virtual care options that allow a provider with your experience to reach people who are hundreds, if not a thousand miles away.

David Newman, M.D.
Yeah. So we've really been listening to patients and what they want. So one of the big things we heard is that they don't want to be transferred to our flagship hospital.

00:03:45:04 - 00:04:03:14
David Newman, M.D.
So we've got lots and smaller hospitals that feed the larger hospitals. One of the big issues is the lack of some of the pediatric subspecialties in the smaller hospitals. So for example, pediatric infectious disease. If a patient needs a pediatric infectious disease consult, they often had to be transferred to Fargo or Sioux Falls for the higher level of care.

00:04:03:15 - 00:04:33:01
Chris DeRienzo, M.D.
Wow.

David Newman, M.D.
You can think about as a parent, if your child is transferred, you're missing work. You have other children that you can't attend to. It's a big burden. So now leveraging technology and leveraging virtual care, we can beam our own providers, our own pediatric infectious disease doctors into their hospitals. We can keep the patients there. Sometimes you can just see how relieved the patients are knowing that they're not going to be transferred and knowing that they still get the same high quality specialty care in their hometown hospital.

00:04:33:05 - 00:04:58:08
Chris DeRienzo, M.D.
Let's talk a little bit about follow up, because it's not just in-hospital care. And we got to visit Dickinson, North Dakota. And one reason that that you all took me there is that it made national news. The virtual care setup that you had in Dickinson was such that patients who had  - pediatric patients actually - who had, you know, chronic conditions that were requiring them to drive a 1100 miles round trip to see subspecialists... you could now set them up in that building.

00:04:58:08 - 00:05:14:19
Chris DeRienzo, M.D.
So now maybe it's an hour's drive from the ranch that they live in Dickinson rather than seven hours each way. That doesn't happen accidentally. You've got to be very sensible about designing a system to work like that. How do you do it?

David Newman, M.D.
Yeah. So a lot of it is what the patient wants and from provider buy-in.

00:05:14:19 - 00:05:31:19
David Newman, M.D.
And so we've had some champions that have had driven this. And we have failed fast on a lot of these models that didn't work. For our hub and spoke model a patient, it's the easy button for the patient. So if they're not tech savvy they can go to the clinic. They can have a nurse and room them in a regular exam room, and then the provider beams into the room.

00:05:31:19 - 00:05:47:19
David Newman, M.D.
So it's just like a normal visit. One of the great things about that is they're already there for labs. So if a patient needs an X-ray, they're there. Yeah. If they need blood tests, they're there. And it is their trusted provider. Those labs are going to go straight to their basket and they're going to have follow up there.

00:05:47:19 - 00:06:09:03
David Newman, M.D.
So it's defragmentizing care.

Chris DeRienzo, M.D.
I love this example because medicine is always a spectrum. Neonatologist, endocrinologist. You know I see babies at the super, you know critical hyper acute end of the spectrum. And you know, at the follow up care. And telemedicine is no different, right? There are telemedicine visits you can do in a patient's home with the technology that just exists on their phone.

00:06:09:03 - 00:06:27:10
Chris DeRienzo, M.D.
But these kinds of visits that we're describing here, you need really special setup so that, for example, a pediatric pulmonologist can know what they need to know about, you know, a child who has a chronic condition, to say, no, you're good. You don't have to make the thousand mile round trip drive this month. That's sort of one part of an innovation.

00:06:27:17 - 00:06:47:06
Chris DeRienzo, M.D.
We're both here at this conference and innovation takes lots of forms. I know you all are early users of any number of AI enabled solutions. Where are you seeing an impact today, either for your physicians and APPs or for patients? Yeah.

David Newman, M.D.
So one of the best use cases of AI that I've seen in my career has been artificial intelligence for diabetes.

00:06:47:06 - 00:07:06:03
David Newman, M.D.
In my previous career, I treated a lot of type one diabetes, and patients had an insulin pump, which you can imagine is like a cell phone that they wear in their belt that talks to a sensor, which is a sticker on your skin that continuously checks your blood glucose. There is an artificial intelligence algorithm that tells you when you need more insulin and when you need less insulin, and it will do it for you.

00:07:06:03 - 00:07:27:28
Chris DeRienzo, M.D.
Wow.

David Newman, M.D.
It's the easy button. So that was really cool technology that came out several years ago, but the software was clunky, so they had to come to a major diabetes center to have it downloaded.

Chris DeRienzo, M.D.
Okay.

David Newman, M.D.
With our feedback, a lot of the companies have been able to bring this into the patient's home. So there's an app or a program on their home computer that they can use, and we can do all their work virtually.

00:07:28:03 - 00:07:44:14
David Newman, M.D.
So for a condition like type one diabetes, that is like a part time job.

Chris DeRienzo, M.D.
Yeah.

It is four hours a day. We have completely revolutionized it. So sometimes I see a patient once a year for their type one diabetes.

Chris DeRienzo, M.D. 
Once a year?

David Newman, M.D.
Yeah. So it's partnering with the technology.

00:07:44:16 - 00:08:07:11
Tom Haederle
Next, a selection from "Being Okay with Not Being Okay: Destigmatizing Mental Health for Health Care Workers." Your host is Rebecca Chickey, senior director of behavioral health with AHA, talking with Corey Feist, co-founder of the Dr. Lorna Breen Heroes Foundation, and Tiffany Lyttle, director of cultural integration with Centra Health.

00:08:07:13 - 00:08:26:07
Rebecca Chickey
Of course, some of the listeners may not understand when you say removing the barriers to access for mental health care. They may think they're working in hospitals and health systems, so of course they have access to mental health care. Can you go a little deeper on that and describe some of those barriers that you're trying to remove and mitigate?

00:08:26:10 - 00:08:54:10
Corey Feist
And it's a great point, Rebecca, because when my sister in law took her life in April of 2020, I had been in health care for many dozens of years, actually, many decades, I should say. And I was a leader at University of Virginia Health System. Yet I wasn't a clinician, and so I was completely unaware of the stigma as well as the professional barriers and really potentially penalties that health care professionals in the United States have.

00:08:54:12 - 00:09:40:02
Corey Feist
These mostly appear in the form of overly invasive and really inappropriate questions that clinicians are asked about whether they've ever been diagnosed or treated for mental illness, whether they've gone to therapy. And these are the same questions that my sister in law was terrified that she would have to respond to following a singular mental health episode. And so what we have been able to do at the Lorna Breen Foundation, through our All In Coalition and Caring for Caregivers, is to get tools to the front lines, whether it's a licensing board that's asking these questions, or hospitals who ask these questions most commonly in credentialing applications. And have them change those questions and then importantly, communicate

00:09:40:02 - 00:10:02:16
Corey Feist
the changes to the workforce. As I sit here with you today, there are 1.5 million health workers in the United States that are benefiting from the changes that we've made, which we hold out in the All in Well-Being First for Health Care Champions Challenge for licensing and credentialing badge that we give out to hospitals, as well as the licensing boards for doing that important work.

00:10:02:19 - 00:10:11:19
Rebecca Chickey
Thank you. I mean, I don't think many of the listeners may have realized that those questions where: have you ever, as you noted, have you ever been treated?

00:10:11:21 - 00:10:35:24
Corey Feist
And if I could just add one thing, because the American Hospital Association a couple of years ago published their first ever suicide prevention guide at least the first ever that I'm aware of. And in that suicide prevention guide, you identified three key drivers of suicide among health workers. And the first one that you all identified is this concern around the loss of license and credentials associated with the stigma for mental health care.

00:10:36:00 - 00:10:52:10
Corey Feist
So we know that for Laura, this wasn't just an isolated incident. And it's something that we hear from health workers all over the United States that they are fearful for these repercussions. And so we need to do something about it and address it, which is what we've done across the country. And we've made great strides.

00:10:52:15 - 00:11:16:18
Rebecca Chickey
Thanks for mentioning that. There's a variety of, drivers for this concern and this stigma. So thank you. I want to turn now towards another thing that you mentioned earlier, Corey, and that is working with states, working with large health systems in order to advance this in their own organizations and across a particular geography or a regional area.

00:11:16:21 - 00:11:25:12
Dave Newman, M.D.
And I'm going to call out specifically the Caring for Virginia Caregivers work. Can you describe that a little bit? And then we'll bring Tiffany into the conversation.

00:11:25:15 - 00:11:52:22
Corey Feist
Absolutely. Two seconds of background. When the president of the United States signed into law the Dr. Lorna Breen Health Care Provider Protection Act, it created two spheres of programs. And one of those sphere of programs was learning materials for health care leaders to address the root cause of burnout, as well as mental health challenges. That was called the Impact Well-Being guide, which was led by the CDC and our All in Coalition provided guidance on it.

00:11:52:24 - 00:12:21:14
Corey Feist
What we heard from the large health system across the country that was implementing the guide is they like to do this work together in a learning collaborative and they need some help. And so caring for Virginia's caregivers, caring for North Carolina's caregivers, caring for New Jersey's caregivers, and now caring for Wisconsin's caregivers are all efforts for us to take organizations through the phases of work from the Impact Wellbeing guide, and that begins by addressing these mental health barriers.

00:12:21:20 - 00:12:45:22
Corey Feist
It then moves towards education of ten person teams across health systems to address the issues at the root cause and become educated about the solutions. And then finally culminates in a learning collaborative focused on an operational initiative that drives burnout. And that's what we've done with Tiffany and the team in Virginia, now North Carolina, New Jersey and recently expanded into Wisconsin.

00:12:45:25 - 00:12:56:21
Rebecca Chickey
That's fantastic. Tiffany, I bet the question on many listeners minds is, why did Centra decide to join the work of All In, of Caring for Virginia Caregivers?

00:12:56:23 - 00:13:31:09
Tiffany Lyttle, R.N.
At the time, we had some really innovative leaders that understood that well-being wasn't just a nicety, but rather a necessity for us to drive health care forward not only to our communities, but also to our health care workers. So 2019, we really start pulling together the evidence base for this work. And what we saw is that health care workers were far more likely to suffer from depression, to have thoughts of suicidal ideation, to have bio psychosocial disturbances, and of course, use substances to help them cope with their roles.

00:13:31:11 - 00:13:50:11
Tiffany Lyttle, R.N.
But we had never provided health care workers with the avenues, tools and support that they needed to be able to speak up and say, hey, we need help for coping with, you know, the very large burden of taking care of our communities and health care in the United States. Those were all published before 2019. So, of course, you know what happened after a 2019,

00:13:50:11 - 00:14:22:12
Tiffany Lyttle, R.N.
we went into a global pandemic. So we really need to find avenues that we could help support our health care team members. Not only address their own well-being so that they can carry that forward, but also not place calluses where we should have compassion because we were facing a compassion crisis, right? And when we tell people, you know, you have to be strong, you have to be confident and yes, we are all of those things, but we also have to deal with very messy, beautiful situations of life and humanity, and that can take a toll on us.

00:14:22:15 - 00:14:44:16
Tiffany Lyttle, R.N.
It can leave echoes and it can leave scars, but we are well-practiced in taking care of code situations. I mean, if you think about a code situation, we are practiced, rehearsed, we simulate it, we educate to it. We certify to it every single year. We have avenues and tools to help us be better at coding situations and situations of that nature.

00:14:44:19 - 00:15:00:13
Tiffany Lyttle, R.N.
What do we have in place for taking care of ourselves? Nothing. We don't teach that in school. We don't simulate that. We don't go over it. We don't get certified to it. I mean, now we are starting to see some certifications for health care organizations come through. But that was about the time that we found the Lorna Breen foundation.

00:15:00:13 - 00:15:18:12
Tiffany Lyttle, R.N.
And what perfect timing, you know, that we really needed to find a place for getting those tools, for helping support us in that work and removing the stigma. And I have to say, that's been one of the most important parts of engaging in our health care workforce as well-being is destigmatizing health care.

00:15:18:15 - 00:15:26:27
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.

00:00:01:03 - 00:00:34:22
Tom Haederle
Welcome to Advancing Health. In the final Leadership Dialog podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the outgoing 2025 board chair of the American Hospital Association, she introduces her successor, Dr. Marc Boom, president and CEO of Houston Methodist, who will chair the AHA board in 2026. Give a listen as these two prominent health care leaders discuss the state of the field and the landscape ahead.

00:00:35:00 - 00:00:56:14
Tina Freese Decker
Thank you, everyone for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and the board chair of the American Hospital Association for 2025. It is really hard to believe that this is my last time hosting a Leadership Dialogue as chair. I have learned so much from talking to our guests this year, and I hope that you have found our conversations insightful. Today,

00:00:56:16 - 00:01:15:21
Tina Freese Decker
I am so delighted to introduce Dr. Marc Boom, who will not only serve as your host for the Leadership Dialogue series next year, but who will be serving as the chair of the American Hospital Association Board of Trustees beginning in January. And I'm so excited to pass the baton off to you. Marc serves as president CEO of Houston Methodist.

00:01:15:21 - 00:01:40:08
Tina Freese Decker
Houston Methodist is comprised of a leading academic medical center and seven community hospitals serving the Greater Houston area in Texas. But I wanted to start out with the fact that he was the very first guest on the Leadership Dialog series back when it was launched in 2020. And it only seems fitting that as we begin the passing the baton, that you join us again as a guest so that our listeners can get to know a little bit about you as we look ahead to next year.

00:01:40:10 - 00:01:42:11
Tina Freese Decker
So welcome, Mark. We're so glad that you're here.

00:01:42:16 - 00:01:44:13
Marc Boom, M.D.
It's wonderful to be here. Thank you.

00:01:44:15 - 00:02:03:08
Tina Freese Decker
Marc, this year has certainly had many challenges. Tell us some of the challenges and successes that you've seen at Houston Methodist in 2025. One of the things I love about you and what you've done is you really focus on notable innovations and progress, and I think that can come together and showcase what we need to do across the health care field

00:02:03:09 - 00:02:06:05
Tina Freese Decker
as part of the association. So tell us about those.

00:02:06:07 - 00:02:24:06
Marc Boom, M.D.
It's been an exciting year, but, you know, a bumpy year, right? We all know that. And so, you know, there's almost this dichotomy at times. You know, I'm a physician, as you heard, primary care physician. I went into the management side right at the beginning of my career. Still practice a tiny bit today, really, because I'm passionate about the people we serve.

00:02:24:08 - 00:02:40:03
Marc Boom, M.D.
We call it at Houston Methodist six simple words. It's unparalleled safety, quality, service and innovation. I'll talk about "and" in a second. The philosophy is always, if you focus on the fundamentals, the awards will follow. I mean, it's not and it's not about the awards, but it's about what they mean, right? So, been very proud of our team.

00:02:40:08 - 00:02:55:19
Marc Boom, M.D.
The dashboard we used the most is through Vizient. And all seven of our hospitals were in their top group: the main hospital academic, also number three out of 118 hospitals. We had another one that was number two in its group. We had another couple, that number one, two and four in their group. And we're really proud of that.

00:02:55:21 - 00:03:16:13
Marc Boom, M.D.
It's just the consistent outcomes, and you don't get there without making it a great place to work. And I firmly believe you build the culture. You get the right people in place, you engage them with the beautiful work that we're all doing and bring passion and purpose. When they do great things happen. And so Forbes put us is the number three large employer in the country, which, you know, I was pinching myself.

00:03:16:13 - 00:03:35:15
Marc Boom, M.D.
It was really neat. Our employee engagement is 97%. And that's what kind of leads to those. When Forbes did innovation companies. we're number 35 of all companies. It's actually the highest health system. And in the top 50 was us and Mayo and Mass General Brigham. So really proud of that. We opened our seventh hospital, our seventh network hospital.

00:03:35:15 - 00:03:59:21
Marc Boom, M.D.
We have the flagship. We have seven network hospitals within LTAC and of course a huge physician organization, academic enterprise and things. We built it as a hospital of the future. And literally from the ground up, rethinking how we do things and using it as our proving ground. We've been very, very aggressive in innovation in very good ways. Because I think we are at a really pivotal point, and the philosophy we have is all the innovation we put in,

00:03:59:21 - 00:04:20:02
Marc Boom, M.D.
number one, obsessively focus on what our patients and communities need. But number two, and really close is how do you connect the people who work in health care more tightly to the patients? How do you get rid of the things that nobody really needs to do, that you don't need a human being to do? And let's get human beings doing the things that human beings need to be doing.

00:04:20:02 - 00:04:41:09
Marc Boom, M.D.
And so that's been a big part of our philosophy. We have cameras in every single room across our entire system is wired, and with cameras. We do virtual ICU, we do virtual nursing. We do telemonitoring, we do telepharmacy. We do telepsych. We do telestroke. All of our telemetry. We do sitters, we do virtual hospitalist now and on and on.

00:04:41:09 - 00:05:00:19
Marc Boom, M.D.
And even piloting very new models of nursing there. One of the ones this year that we started, which it's kind of like one of those you kick yourself like, we should have done this sooner because we have all that infrastructure. Our rapid response and code teams now start virtually. If you're that nurse and you're there and you say uh oh, I need help and somebody needs a rapid response or, you know, God forbid, it's a code.

00:05:00:21 - 00:05:17:13
Marc Boom, M.D.
Literally at the press of a button, you have expertise there with you. And of course, then everybody's coming and converging like you would do in those situations. But we all know in these big facilities that's 5 or 10 minutes sometimes, or 2 or 3, four minutes, whatever that is, it's instant and we're seeing, you know, real time impact of that and many, many things.

00:05:17:13 - 00:05:20:06
Marc Boom, M.D.
And we're very dedicated to the innovation side of things.

00:05:20:08 - 00:05:42:10
Tina Freese Decker
That's phenomenal. And it is where the field is going. So I really appreciate how you how you've focused on all the different elements quality, experience, team member engagement and then the innovation and always doing it so there's better, more extraordinary, you know, better for the people that we're serving. So well done. What do you think we've done well as a field?

00:05:42:10 - 00:05:44:10
Tina Freese Decker
What's worked and what hasn't?

00:05:44:12 - 00:06:04:09
Marc Boom, M.D.
Health care and I we always need to remind ourselves this, because it's a noble field. It's a sacred calling. We are so privileged to be in health care. I wouldn't want to work anywhere else. Our hospitals, our health systems, they are pillars of their communities. Many times they're the largest, if not one of the largest employers in Greater Houston.

00:06:04:09 - 00:06:27:00
Marc Boom, M.D.
For example, three of the top five largest employers of people who live here  - ExxonMobil, it's based here. But, you know, there are people all over the world. But the people in Houston, three of the five are health systems in Greater Houston, 8.1 million people now across greater Houston. And so we impact our community so positively in so very many ways, and, of course, take responsibility for the health of this community.

00:06:27:00 - 00:06:55:11
Marc Boom, M.D.
So that's something we should all be proud of. We always have to hold our heads up high. We always have to remind people of that as well. It is key that we continue as health systems to thrive. I have a philosophy and I alluded to it earlier. I talked about the unparalleled safety, quality, service and innovation. Well, we've used that for well over a decade, probably a dozen years now, but about 7 or 8 years in, I kind of had this "aha" moment that said, you know, I've been paying attention to five words, but not the "and" and actually the and is a really, really critical word.

00:06:55:11 - 00:07:22:10
Marc Boom, M.D.
And so we capitalized in that statement and we use that as sort of an I use that big time as a philosophy. You need to go into solving problems and you're working with other people thinking like "and" not thinking like "or." So it's not, well, we can do this, but then this is going to suffer. It's no, our job is to figure the art and science and management, leadership and clinical care and everything else is to say, how do we get it all? Patients don't want us to say, yeah, we'll make it safe

00:07:22:10 - 00:07:40:17
Marc Boom, M.D.
but you know what? We won't be that innovative or, you know, your service will be lousy but we'll make it safe. You know what? If they want all of it, they deserve all of it is what they what they deserve. So we need to demand that of our of ourselves. It's also a philosophy that says we make the best decisions and problems get solved with that attitude.

00:07:40:19 - 00:07:57:23
Marc Boom, M.D.
And when we listen, when we work with other people, when we hear from people who are not like us, they don't look like us. They didn't grow up like us. They don't think like us. And you bring different people to the table and you actually figure it out, right? You come to compromise, you come to consensus, you move things forward.

00:07:58:01 - 00:08:23:06
Marc Boom, M.D.
And that's where the best decisions happen. And that's a challenge. On one hand, we intuitively understand that. T word "and" is used fourth most in the English language. The word "or" is 31st. It's the same similar directionality every language. But on the other hand it's not really human nature sometimes. And right? We have a process whereby it's often let's think about us, let's not think about others or let's think about our position.

00:08:23:06 - 00:08:43:22
Marc Boom, M.D.
Let's not hear the other position. And so one of the things we don't do as well, and I think we need to focus on as a profession, as a field. And then we need to demand that of all of the pieces of the system that we work with is that we work together to find solutions. The last thing I'll say is I also have a saying that I'm well-known for, which is don't let the lines cross.

00:08:43:22 - 00:08:58:06
Marc Boom, M.D.
And that's like, you know, on a very literal basis, okay? If you've got a revenue curve, an expense curve, they need to be parallel or better, or you got an issue and you're issue may be 15 years out, 20 years out. If it's just a tiny bit, it may be three days out. If it's really bad. Right?

00:08:58:08 - 00:09:16:15
Marc Boom, M.D.
But it's more of a philosophy which says tackle issues soon, not late. Don't let them get out of hand. And so we want to as a hospital profession, be part of the societal solution to some of the problems we have in health care by finding those early moves that we can make to not let some things get out of hand that we see out there.

00:09:16:15 - 00:09:19:01
Marc Boom, M.D.
And I think that's how we need to focus.

00:09:19:03 - 00:09:24:19
Tina Freese Decker
So I can already tell that next year you're going to bring so many philosophies and we're all going to be starting them out.

00:09:25:01 - 00:09:40:06
Marc Boom, M.D.
I remember a few years, I had a few sayings here... Let's see if you want to go far, go together. If you if you know if you want to go fast go alone. And I love that saying. And do the hard things. And you really have helped us do that.

00:09:40:08 - 00:09:56:18
Tina Freese Decker
Yeah. No, I think it's fantastic. So I look forward to hearing more of your philosophy statements. You mentioned that you are psyched and you're humble to be the AHA chair next year. What are some of your priorities as you think about 2026? What do you think we should be focused on as health care leaders?

00:09:56:20 - 00:10:14:22
Marc Boom, M.D.
Well, some of it, you know, I've already touched on is, is that philosophy. Because when we tackle it with those philosophies and we work and we listen to everybody, right? We are a very broad based association. There are hospitals of every characteristic across the country. They're all critically important. Sometimes things are good for this group, not good for that group.

00:10:14:22 - 00:10:37:10
Marc Boom, M.D.
But we need to find those solutions that move all of us forward and most importantly, really stabilize the system and move a system in the United States forward. But of course, you know, we all we all recently heard the news that Rick Pollack has chosen to retire. Forty three years at the AHA, I mean, talk about dedicating one's life to a noble profession.

00:10:37:10 - 00:10:59:17
Marc Boom, M.D.
I mean, everything I was talking about - that sacred calling. He has enabled so much development across our profession. Ten years as president. Talk about somebody with impact. I mean, he's been dedicated, tireless. He's so smart. He's grounded. He's a great listener. And, you know, one of my favorite quotes from Martin Luther King is that a genuine leader is not a searcher for consensus, but a molder of consensus.

00:10:59:17 - 00:11:16:17
Marc Boom, M.D.
And he understands that that he brings people together. And, I mean, I watch him oftentimes synopsis what we did and synthesize what we did. It's like, wow, how did he do that? And so he's incredible. And so we want to celebrate him, right? He deserves it. He's too humble to want to be celebrated, but sorry, Rick, I know you're listening

00:11:16:17 - 00:11:34:01
Marc Boom, M.D.
nw we're going to celebrate you this year as well. But of course the golden is to make sure we recruit somebody of his caliber and, thank you to you and Bill Gassen for chairing the search committee, of which I'm a member and a number of other people are. We're going to make that process obviously very inclusive.

00:11:34:01 - 00:11:54:08
Marc Boom, M.D.
We're going to listen, we're going to engage. We're going to work with people across our profession, across hospitals and hire somebody of Rick's caliber, which is no easy task, obviously, but I'm sure we can do it. You know, I use a couple sports analogy. If you're running right, this is like run through the tape. So, you know that none of this means that 2026 is some sort of, you know, let's pause here.

00:11:54:08 - 00:12:21:04
Marc Boom, M.D.
Not at all, right? We are running through the tape. Use another analogy. It's going to be really smooth baton pass. If you look at the story I like to tell here is about the men's and women's 4x4 hundred relay teams in the U.S. I mean, they've been absolutely dominant since 1972. And yet both men and women, the men have won ten out of 13 of those with the gold and the women have won nine out of 13, all the rest of the women were silvers, and the men had a couple where they didn't place.

0:12:21:06 - 00:12:41:16
Marc Boom, M.D.
And if you look at when they don't place, it's a baton pass. And so, you know, when you look at all those other times, they practice and practice and practice that baton pass and it makes sure it's a smooth baton pass. That is far and away the number one priority. But again, make no mistake, that is making sure that we don't lose a step through this process.

00:12:41:18 - 00:12:49:09
Tina Freese Decker
You're exactly right. And we will find somebody wonderful. They will not be Rick. But like you said, Rick, we are going to celebrate you even if you don't want us to.

00:12:49:09 - 00:12:51:05
Marc Boom, M.D.
Exactly.

00:12:51:07 - 00:12:57:19
Tina Freese Decker
When you think about 2026, what are you most excited for and what have you been most proud of in the past year?

00:12:57:20 - 00:13:18:00
Marc Boom, M.D.
I mean, excited to tackle some, you know, real problems. I think that and philosophy. We need to take and and tackle affordability. right? That is the big burning question that's out there. And I honestly I think, you know, because hospitals are sort of the locus of all these costs, we tend to get unfairly branded with the, you know, we're the problem.

00:13:18:00 - 00:13:40:00
Marc Boom, M.D.
But if you really step out, you look at the inflationary rates and the contract rates and things we get. We're like not even getting inflationary increases. And if you look at the cost of health care overall over the last decade and you look at the rate of increase, it's not much above the rate of inflation. That's the hard work of physicians and hospitals that have made that happen, right?

00:13:40:00 - 00:13:57:05
Marc Boom, M.D.
So we're a locus of the cost, but we're not the real reason. Doesn't mean we don't have things we can and should do, let me be clear. So we need to be focusing together and bringing and mindset about affordability, meaning we have to work with - as hospitals - we need to work with pharma. We need to work with supply chain.

00:13:57:05 - 00:14:17:07
Marc Boom, M.D.
We need to work with the payers. We need to work obviously with government. We look with patients and patient advocates to say, how do we think about this differently? Make sure we preserve the functionality we have and get better outcomes for society and help with health care affordability? So when I'm I'll tie that with some what I'm most excited about.

00:14:17:09 - 00:14:35:13
Marc Boom, M.D.
Two key things one, we've already touched on digital innovation. Years ago in my career, I got quoted once in the Houston Chronicle when I was a reporter, was there kind of making a comment that, you know, the unfortunate thing is, you know, back then it was all about electronic health records, and it was about which one was sort of the least onerous right, for us.

00:14:35:15 - 00:14:57:21
Marc Boom, M.D.
And a big part of that was they didn't connect our clinicians to the patients. And they actually added cost, as has so much innovation. I think digital innovation can bend the cost curve. It has to bend the cost curve. We're looking at the next quarter century of massive growth in Medicare enrollees, particularly the oldest Medicare enrollees who need the most health care with like almost no change in the working population.

00:14:57:23 - 00:15:17:05
Marc Boom, M.D.
You know, if you look at the last couple hundred years, biggest impact we've had is with infectious disease, right? First recognizing germ theory and then vaccines and antibiotics and clean water. I mean, all of those have saved hundreds of millions of lives. And then, of course, some other key things like imaging, anesthesia, fluid management and things like that.

00:15:17:07 - 00:15:37:15
Marc Boom, M.D.
I actually think we are on the cusp where digital innovation could actually have that same kind of impact. The knowledge base, it gives the knowledge on my shoulder, the connecting people, all the different things. So that's one. And the other is just the new therapeutics that are coming. I mean, the ability to cure diseases that we never dreamed we could cure.

00:15:37:17 - 00:16:03:10
Marc Boom, M.D.
The, you know, obviously, the ability to manipulate the immune system, Car-T therapy, cellular therapies, all of these things are paradigm shifts. And we need to focus on cost as we look at those. If pharma comes in and says, hey, it saves society, you know, $3 million if we can cure Alzheimer's disease or pick your disease, right? And then they say, so we want to charge 90% of that, which is what happened with hepatitis C, it doesn't work.

00:16:03:15 - 00:16:15:20
Marc Boom, M.D.
So we all have to work together and say we can use these new technologies, we can use these new drugs and other things like that. And it's paradigm shift, I mean, and not only that, you can improve health span and not just lifespan.

00:16:15:21 - 00:16:39:19
Tina Freese Decker
I'm so looking forward to that. And I agree with you that there's so much potential coming forward that we'll be able to embrace, and it will transform the health care field significantly, and it will transform health for individuals. And that's what I'm most excited about too. And thank you so much for your service. I am looking forward to seeing you, thrive and help our, association thrive as well.

00:16:39:19 - 00:17:11:07
Tina Freese Decker
And so thank you so much for spending time with us. I know that we are in great hands next year with your leadership. And to all of our listeners, it's been a privilege serving as the AHA's board chair this past year and leading this Leadership Dialog with all of you. I remain very optimistic about the future and confident in our ability as a field to meet the challenges that are ahead of us and to make sure that we are always focused on the people that we are serving and helping them have either unparalleled or extraordinary outcomes as they come forward.

00:17:11:09 - 00:17:24:22
Tina Freese Decker
So thank you so much for all that you do in our field. As it's holiday season, I just want to express my gratitude, and I know Marc shares in this gratitude for everything that you do to take care of people in your community. Have a wonderful day.

00:17:25:00 - 00:17:33:09
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:05 - 00:00:23:06
Tom Haederle
Welcome to Advancing Health. At a time when reliance on lifesaving drugs plays a more important role than ever in patient care, nearly one third of America's pharmacies have closed since 2010. In today's podcast, we learn about one forward thinking health system is doing about it.

00:00:23:08 - 00:00:43:29
Chris DeRienzo, M.D.
Hi everyone, this is Dr. Chris DeRienzo. I am the chief physician executive for the American Hospital Association. Welcome to this episode of our Advancing Health podcast. You know, we haven't had a chance on this podcast to talk about the crucial role that pharmacies play in caring for people, for patients all across the country. But today is the day.

00:00:44:02 - 00:01:03:13
Chris DeRienzo, M.D.
I am very excited to welcome John Pastor. He is not only the president of Fairview Pharmacy Services, he is also a pharmacist himself. And I'm excited to welcome John to the podcast, because we have a lot of learning to do around pharmacies and the challenges that folks are facing with access in the country. So, John, welcome to the podcast.

00:01:03:16 - 00:01:05:16
John Pastor
Great. Thanks so much for having me.

00:01:05:19 - 00:01:18:01
Chris DeRienzo, M.D.
And Fairview actually is a health system who just won one of the AHA's most prestigious awards, the 2025 Foster McGaw Award. And John, thank you for joining us and congratulations.

00:01:18:03 - 00:01:31:17
John Pastor
Thanks so much. I can speak on behalf of Fairview Pharmacy Services and Fairview Health Services, and just say how proud we are to be the 2025 recipient of this award and what it means for us in serving our communities.

00:01:31:19 - 00:01:43:27
Chris DeRienzo, M.D.
You know, John, I wonder maybe we can start our conversation with just giving listeners a sense of the role that pharmacies play in the access continuum to care, and perhaps even locally, to you all up in Minnesota.

00:01:43:29 - 00:02:06:25
John Pastor
In some instances, the pharmacy is the first point of health care access for many people. It's the point of health care that they access most frequently, oftentimes more than they're seeing their primary or specialty care physicians, and certainly more than they're seeking hospital care in most cases. The concern is, is that we've seen pharmacies all across the country close at an alarming rate.

00:02:06:27 - 00:02:14:18
John Pastor
And so access is a challenge for many, even in some large urban and metropolitan areas, not just in our rural communities.

00:02:14:20 - 00:02:36:21
Chris DeRienzo, M.D.
You know, you're exactly right. There are some numbers around that that between 2010 and 2021, nearly 30% of pharmacies around the country closed. And I spend a lot of my time on the road. And sometimes, you know, if you're visiting a small town in rural America, there might only be one pharmacy. And so if that closes, we're talking about not just access to care, but access to medications.

00:02:36:24 - 00:02:56:21
John Pastor
Yeah. That's correct. And I think in the state of Minnesota, we've seen that number be even higher for independent pharmacies, a little bit lower perhaps for our chain pharmacy partners. But that number is just alarming. And there's certain parts of the state where people may have to drive, you know, 40 or 50 or 60 miles to get to a pharmacy

00:02:56:21 - 00:02:58:04
John Pastor
in some cases.

00:02:58:06 - 00:03:12:19
Chris DeRienzo, M.D.
That's a multi-hour round trip just to get the prescription for your heart medicine or your neurologic medicine. And we know that with America's aging population, the number of Americans who are on one or more drugs only continues to go up.

00:03:12:21 - 00:03:34:11
John Pastor
Drug therapy continues to grow every year as more and more new, you know, medications are identified and approved by the FDA for use to treat conditions that in some cases couldn't be treated before. So drug therapy continues to increase, is sort of a mainstay of treating many, both acute as well as chronic diseases.

00:03:34:14 - 00:03:54:26
Chris DeRienzo, M.D.
You know, I'm a neonatologist and you couldn't be more right. There are things that we can treat today that the ten, 20, 30 years ago were not problems that we could help patients solve. But in order for the medication to work, first you've got to be able to take it. And again, this is a not only a national challenge, but one it sounds like that has been particularly acute

00:03:54:27 - 00:03:57:08
Chris DeRienzo, M.D.
where were you all are located up in Minnesota.

00:03:57:10 - 00:03:58:15
John Pastor
Yeah, that's correct.

00:03:58:17 - 00:04:09:08
Chris DeRienzo, M.D.
Well, tell us a little bit about the challenge that that specifically your health system faced. And, you know, where did you turn to try to begin solving that challenge for the communities that you serve?

00:04:09:10 - 00:04:41:24
John Pastor
Well, we started with, you know, pharmacy services in our system back as early as 1990, when we had our first retail pharmacy in Edina, Minnesota, and we were providing retail pharmacy services and home infusion services out of that pharmacy. But over the last 35 years, the business has grown and clearly has transformed quite some time ago from being, you know, a prescription dispensing business or a medication dispensing business to a provision of care and focused on outcomes business.

00:04:41:26 - 00:05:10:16
John Pastor
So not only has our volume grown over 35 years, but the scope of our work has grown exponentially in how we contribute to the care and the outcomes of patients. Frankly, we had to build a new, central services facility for our corporate pharmacy location, which houses many of our essential pharmacy functions, including our specialty and mail services pharmacy, our home infusion pharmacy, our compounding pharmacy, and our wholesale pharmacy.

00:05:10:18 - 00:05:17:05
John Pastor
Because that growth was occurring at such an alarming rate, we simply didn't have the space to continue to expand.

00:05:17:07 - 00:05:33:13
Chris DeRienzo, M.D.
That is a wide range of services that you're describing. You know, when I think of a pharmacy, it's I get a prescription from my doctor, I go to the pharmacy, it comes in a little orange, you know, pill bottle. And then and I bring it home. But you're describing what what sounds like a much broader range of services that your patients are needing.

00:05:33:13 - 00:05:36:15
Chris DeRienzo, M.D.
And it sounds like struggling to find access to elsewhere.

00:05:36:18 - 00:05:47:12
John Pastor
Correct. And what I didn't even include in those numbers is we have 26 retail pharmacies in our community, and we also provide the pharmacy services across our 11 hospital locations.

00:05:47:14 - 00:06:05:11
Chris DeRienzo, M.D.
Wow. So let me rewind for a second. You operate 26 retail pharmacies totally separate from the hospitals, and then you have the internal pharmacy as well that not only, I imagine provides the medications that hospitalized patients need, but then offer some connectivity to when they get discharged.

00:06:05:13 - 00:06:17:02
John Pastor
Correct. Correct. To the point of clarification, some of those retail pharmacies are actually located in our hospitals and serve as a discharge pharmacy, as well as a community pharmacy for people that live in the area.

00:06:17:04 - 00:06:26:17
Chris DeRienzo, M.D.
Fascinating. I haven't heard of this model being, you know, deployed at this level of scale too much around the country. What prompted you all to go down this road and how's it going?

00:06:26:19 - 00:06:49:08
John Pastor
Say it first, it's going very well. As I mentioned, we continue to grow from both a volume and a scope year over year. And that's in part just due to organic growth internally within our health system. But also as we talked about earlier, just the pressures in the community with access to pharmacy services from some of our, you know, other pharmacy partners out there.

00:06:49:10 - 00:07:00:11
John Pastor
But the growth has continued year over year, and we've had to continue to evolve and change our footprint and expand our footprint in many cases in order to meet the needs of our patients.

00:07:00:13 - 00:07:14:22
Chris DeRienzo, M.D.
And so when you're planning for those needs, because these kinds of physical plants, for lack of a better word for them, they don't just magically pop up overnight. You know, it takes a lot of planning and effort and logistics to make them happen.

00:07:14:24 - 00:07:40:17
John Pastor
The previous location that we were in from a central services facility we had been in since 2001, and I think we actually started with about 15,000ft². And by the time we started our move this fall to a new location, we were using at that original location about 105-110,000ft². So that's over the period of about 23 or so years.

00:07:40:19 - 00:07:59:20
John Pastor
The location we moved into, we built within tension based on our current and anticipated future needs. There's a 150,000 square foot facility, and we're using a little over 90% of it right now, with the rest of it being intentionally shelled out for strategic growth in the future.

00:07:59:22 - 00:08:06:15
Chris DeRienzo, M.D.
Goodness, you're already at 90% capacity within this brand new space that you've built.

00:08:06:18 - 00:08:20:17
John Pastor
And it's built again with intention. So it's built for efficiency and designed to make it convenient and accessible for patients that come here. But as well, our staff, who, you know, do a lot of work inside the four walls.

00:08:20:20 - 00:08:42:17
Chris DeRienzo, M.D.
We were talking about this a little bit earlier, that it's an interesting space for a health system to be in. When you're talking about, you know, sort of the core of hospital and even ambulatory services. Operating pharmacies at this scale, and the production needed to go into that is fairly unique. But you all obviously have a firm belief in why this is a space you need to be in.

00:08:42:19 - 00:09:14:12
John Pastor
We've learned over the years that it's important for us to provide all the pharmacy care for our patients. Keeping our health system patients within Fairview is very important from an outcome standpoint, a patient satisfaction standpoint, and frankly, it makes it easier for our providers to do their work, too. Our physicians and our advanced practice providers being able to, you know, have access to the records that our pharmacies keep, as well as us be able to see the records that they have in the electronic medical record.

00:09:14:14 - 00:09:33:13
Chris DeRienzo, M.D.
Well, I certainly worry that that I have had, you know, as a neonatologist, if you're discharging a baby home and they need to be on, you know, multiple medications, which frequently they're not on for the rest of their life. But if they're not taking it in those immediate months after discharge, it can be pretty challenging. But, getting access to the you know, was the prescription filled?

00:09:33:13 - 00:09:48:23
Chris DeRienzo, M.D.
Was it then dispensed? Are they taking it? Are they refilling it? That that can frequently be challenging to secure. You want to avoid that patient not being able to access this one medication that without it ultimately leads to them needing to be hospitalized again, right?

00:09:48:26 - 00:10:09:03
John Pastor
Yeah. And a great example I could give you is a physician discharging a patient from one of our hospitals can send a referral to our home infusion team. Maybe that individual needs antibiotics. Maybe they need I.V. or parenteral nutrition for some period of time. And they have access to all of the records that the pharmacy has in terms of progress

00:10:09:03 - 00:10:25:27
John Pastor
notes - notes that the nurse who goes into the home and completes the infusion would put into the record. And so that type of I'll call it seamless care for the patient, but as well as our providers too, being able to have that level of seamless sort of transition is important.

00:10:26:00 - 00:10:39:03
Chris DeRienzo, M.D.
Well, obviously y'all have done an enormous amount of work to build this program and to serve the community the way you are. Looking through the windshield, where do you see your efforts continuing to go over the next several years?

00:10:39:06 - 00:11:02:26
John Pastor
I think our primary focus over the next several years is to continue to build in processes that we can automate. And by that, I mean we've already done a really good job, I think, automating our dispensing process at our new facility. We have some state of the art equipment. More importantly, we have a lot of, I'll say, kind of behind the scenes functions that need help with even further automation.

00:11:02:26 - 00:11:22:20
John Pastor
So our, you know, our business office, our revenue cycle team that manage that. Folks that do prior authorizations with our payers and insurance companies, many of those things we need to continue to further automate to make it more efficient so we can handle the growth and the volume that we expect to continue to get.

00:11:22:23 - 00:11:43:06
Chris DeRienzo, M.D.
Yeah, I mean, it sounds like a demand that isn't going down anytime soon. And recognizing that a lot of our listeners are folks who are operators in hospitals today. What one piece of advice would you give to them when they're looking at the needs of their community? They're saying, man, what the folks at Fairview are doing to close this pharmacy gap makes a lot of sense to us.

00:11:43:11 - 00:11:51:17
Chris DeRienzo, M.D.
But I want to learn more. What would be your first point of reference for folks to learn more about how they might could bring a similar service to their community?

00:11:51:19 - 00:12:20:21
John Pastor
Yeah, that's a great question. I think first and foremost, you know, making sure you're meeting the needs internally for your internal patients, right?
Make sure you're able to capture and provide all the pharmacy services that your internal health system or hospital patients need. But then, doing a community assessment. What's the unmet need in your community? Where are those pharmacy deserts as they describe where people just don't have access to a community pharmacy?

00:12:20:23 - 00:12:49:01
John Pastor
And I'll add one other layer to that is where people don't have access to a specialty pharmacy or home infusion or infusion services. Those gaps exist, too. And frankly, we fill a lot of specialty medications for patients outside of our health system. From the specialty pharmacy standpoint, it's nearly half of our prescription volume comes from external to our own health system, much of it locally, but actually across all 50 states in the US.

00:12:49:04 - 00:12:50:06
Chris DeRienzo, M.D.
All 50 states.

00:12:50:13 - 00:12:52:00
John Pastor
All 50 states, yup.

00:12:52:03 - 00:13:10:27
Chris DeRienzo, M.D.
You heard it here first, folks. Up in Minnesota, they are serving the folks in Alaska and Hawaii. That is fascinating. Well, John, this has been a real privilege again, thank you for helping me and our listeners learn more about the role that access to pharmacy and pharmacy services plays in the community. Congratulations on everything that y'all are doing.

00:13:11:01 - 00:13:14:08
Chris DeRienzo, M.D.
We can't wait to stay tuned and hear how it keeps going.

00:13:14:11 - 00:13:17:24
John Pastor
Well, thanks so much for having me on. It's been great talking with you today.

00:13:17:27 - 00:13:19:07
Chris DeRienzo, M.D.
Thanks so much.

00:13:19:09 - 00:13:27:21
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.

00:00:00:27 - 00:00:28:03
Tom Haederle
Welcome to Advancing Health. Being a doctor, both at the bedside and around the boardroom table often means channeling two different skill sets. And as we hear in this podcast, the successful physician leader must learn how to bridge the gaps in knowledge, exposure and experience needed to cross the bridge from clinical practice to leadership and master the art of social capital along the way.

00:00:28:06 - 00:00:55:14
Chris DeRienzo, M.D.
Hi everyone! Welcome to this episode of our podcast. I'm Dr. Chris DeRienzo and it is my true honor to welcome a long time mentor and friend to the podcast, Dr. Tom Lee. Dr. Lee is not only the chief medical officer of Press Ganey, he's the editor in chief of NEJM Catalyst. He's a practicing primary care doc. Got to know him many years ago through connections in the Asheville area.

00:00:55:16 - 00:01:05:24
Chris DeRienzo, M.D.
Tom is here to talk to us today about the intersection of social capital, and the AHA's physician leadership framework, which was just published. Tom, thank you so much again for joining us.

00:01:05:27 - 00:01:10:14
Thomas Lee, M.D.
I'm delighted to be here, Chris. And every time I talk with you, I learn stuff, too.

00:01:10:16 - 00:01:39:12
Chris DeRienzo, M.D.
Likewise, sir. As we get started, it would be good to note for listeners that the paper that I'm referencing, AHA's physician leadership framework - it was published in NEJM Catalyst earlier this year. We have links available to it and so you can read it at will, but at its core has been a challenge that we've wrestled with for some time. Which is there's a gap between, what we know it takes to be an excellent clinician, an outstanding bedside physician,

00:01:39:14 - 00:01:51:12
Chris DeRienzo, M.D.
and what it takes to become an outstanding physician leader. And Tom, that's a gap that you've explored for decades, not only in your research, but also as the editor in chief of NEJM Catalyst.

00:01:51:15 - 00:02:13:13
Thomas Lee, M.D.
Yeah. And these questions are interesting. I mean, they're core to our jobs. We have to actually deal with the situations were working hard is not enough, where it's not clear exactly what we should do. How do you figure out what we should do and how do we do it? That is the nature of the jobs of being a physician leader today.

00:02:13:15 - 00:02:36:21
Chris DeRienzo, M.D.
Working harder is something we've relied on for a long time in health care, and we've thought that we need a hero. And there are absolutely heroes in health care. But your construct of social capital is one that I think we should explore for listeners of the podcast, because the way it intersects with the bridges that we built in that framework, I think are not only interesting but important.

00:02:36:28 - 00:02:45:11
Chris DeRienzo, M.D.
And so perhaps you can just take a moment for listeners who aren't yet familiar with social capital to give them a sense of what it means and how do we develop it?

00:02:45:13 - 00:03:08:12
Thomas Lee, M.D.
Well, the concepts aren't really new or foreign, and they're going to feel very comfortable to everyone listening to this podcast. The different is framing it in a way where we approach it in a tough minded, businesslike way. You know, capital is anything that helps you improve. It helps you be better than your competitors, help you be better than yourself next year.

00:03:08:14 - 00:03:36:00
Thomas Lee, M.D.
Financial capital are the financial resources that enable you to do things you couldn't otherwise do. Human capital or the people with the expertise around you that help you do things you couldn't otherwise do. But social capital is how those people work with each other and with their infrastructure that enables you to do things you couldn't otherwise do. Social capital is based upon currencies like trust and respect and teamwork.

00:03:36:08 - 00:04:00:13
Thomas Lee, M.D.
These are things we're all for, but building them as opposed to just being grateful when we have them, that's what I'm suggesting we ought to all be doing. Getting tough minded like the CFO is about financial capital and building teamwork and trust in high reliability. I think we can do that work, and I don't think it will be annoying.

00:04:00:13 - 00:04:02:15
Thomas Lee, M.D.
I think it'll make our lives better.

00:04:02:17 - 00:04:28:20
Chris DeRienzo, M.D.
Not only make our lives better, but, but lead to better outcomes. In order to get there, though, that requires some intentionality. Relying on working harder is in some ways a simple answer, but reconfiguring a system to enable teamwork, to enable high reliability, I love the way that you frame that. It's like a book that I read recently by the person who founded Panera that that there are things that emerge from the system.

00:04:28:21 - 00:04:43:28
Chris DeRienzo, M.D.
Profits emerge from a high functioning system that is differentiated against other folks operating in that market. You describe teamwork and high reliability as secondary effects of high functioning social capital. Am I getting that right?

00:04:44:01 - 00:05:10:08
Thomas Lee, M.D.
Very much so. But to really have a great team...many of us have been on great teams and we know it took work to get there. It takes sacrifice, sacrifice of some of your autonomy to get there. It means having norms, behavioral norms and enforcement mechanisms for the norms so that if someone isn't being a good team member, they hear about it.

00:05:10:15 - 00:05:35:20
Thomas Lee, M.D.
We don't just say anything. I mean, just very recently, one of my colleagues was saying in the emergency department, you can see everything. You can see who's behaving like a jerk. And he said, do we say anything? And he said, hardly ever. But if you're being tough minded about social capital, you give your colleagues feedback. I know that's uncomfortable.

00:05:35:22 - 00:05:51:22
Thomas Lee, M.D.
But getting into that kind of culture where people give each other feedback on what will make us all better collectively for our patients and for the way we feel coming to work. That is what we're talking about here.

00:05:51:25 - 00:06:18:21
Chris DeRienzo, M.D.
And it's foundationally a different way of thinking than sometimes we would historically apply to physician training. I like to describe for folks that in the medical education world, we are taught to sit on top of a pyramid, and there's a whole lot of weight that sits on our shoulders. The order carries our signature. Our professional license is on the line for the decisions that we make, the patients and their families outcomes

00:06:18:24 - 00:06:50:01
Chris DeRienzo, M.D.
we are personally responsible for. And when that's the world that you've lived in for decades, and you envisioned the pyramid this way, it's pretty hard to invert it. Many folks do. But, it strikes me that leading teams in health care and the getting to the right side of the framework that that we described in our paper is fully grounded in that construct of social capital. That we have to realize that we may be an expert in the things in which we are expert, but that doesn't make us an expert in everything.

00:06:50:03 - 00:07:13:00
Thomas Lee, M.D.
Well, you know, instead of picturing pyramids, but I encourage our audience to think about is think about social network diagrams, you know, web of nodes. Some people right in the middle of things, connected to everyone. Some people just on the edges, you know maybe loosely connected, if at all. And the truth of the matter is, we're all in social networks.

00:07:13:03 - 00:07:43:27
Thomas Lee, M.D.
And social capital means making those social networks more effective, making them stronger, making the connections real among everyone and making them compelling. And then spreading the right norms and values across those connections so that the team can be more effective. And so the teams can interact so that the organization can be more effective. It is real work, but it's cool work, actually.

00:07:43:29 - 00:08:06:16
Chris DeRienzo, M.D.
It can be fun. And, you know, it strikes me that for a long time physician leaders have somewhat informally relied on that social capital to accrete some of the knowledge that it takes to move from outstanding practicing physician to outstanding physician leader. I'll give you one example. I don't have an MBA or an MHA. I learned about EBIDTA from my CFO.

00:08:06:18 - 00:08:28:16
Chris DeRienzo, M.D.
EBIDTA, which for those who don't yet know, is, a commonly used finance abbreviation for earnings before interest, depreciation, taxes and amortization. And when I was in my first C-suite level role as a physician leader, that CFO sat down with me every month and walked their income statement and our balance sheet. So I not only accreted knowledge

00:08:28:16 - 00:08:52:07
Chris DeRienzo, M.D.
and in the framework we describe sort of three gaps. There's a knowledge gap, but then there's an exposure gap. We have to get exposed to how that applies in a hospital and health system. And then ultimately, in order to be able to own that skillset, we need some experience in being accountable for it. And for me, my CFO was a node in that network who was willing to sit down and share with me enough -

00:08:52:13 - 00:09:02:04
Chris DeRienzo, M.D.
I'm never going to refinance bonds - but I know enough now to be a competent operator. And you're exactly right. That is a outcome of social capital.

00:09:02:06 - 00:09:41:29
Chris DeRienzo, M.D.
And I think that the framework that you recently wrote about, breaking down the types of work it takes is a great framework. And, I admire your clear thinking. And it's so much more sophisticated than the advice I was thinking about, which is telling the audience, go watch the TV show The Pit and, the HBO show about the emergency department and watch how over the course of season one, the 15 episodes, the relationships, they get stronger and stronger among the people down in the emergency department together where people are ready to do whatever it takes.

00:09:42:06 - 00:10:11:19
Thomas Lee, M.D.
They're not thinking about their job description. They're doing whatever it takes. They're actually building social capital, including the part where they're sitting on a park bench sharing beer from a cooler in the next to the last episode of the season. So even though they make a big joke about Press Ganey in the first ten minutes and despite that start, it's a fantastic show that captures something what leaders in who are physicians can do and should do.

00:10:11:21 - 00:10:32:12
Chris DeRienzo, M.D.
And that's the kind of experience that I think we are accustomed to clinically having. Some folks have shared, you know, it gets lonely because you're used to - when you're a neonatologist like me, a primary care doc like you, an ER doc, a trauma doc, you know, you get this team camaraderie that builds when you go through those kinds of really hard things together.

00:10:32:16 - 00:10:55:01
Chris DeRienzo, M.D.
It's a different kind of a team when you're sitting around the health system CEO's table, because frequently you're the last doctor left at the party, unless the CEO also happens to be a doctor. And it takes a different degree of intentionality to find ways to connect and as you pointed out, crucially, to build some informal opportunities to relate to each other as people.

00:10:55:04 - 00:11:29:17
Thomas Lee, M.D.
Well, you know, actually, I've an article that'll be coming out soon with Dr. Ale Quiroga, a physician who's the CEO at Children's Mercy Hospital in Kansas City. And what we write about is how the way clinicians think it may be very appropriate for the kind of management challenges that we face in health care today. Because clinicians like us, you know, we're used to complex situations where the right thing to do may not be clear, but we try things and we get some data and we modify things.

00:11:29:24 - 00:11:58:15
Thomas Lee, M.D.
And, you know, we iterate. We're constantly gathering information. Now, that kind of approach to complex patients, for example, that may be more the right thing for complex problems like overcrowded hospitals, overcrowded emergency departments flow through a system more so than complicated management strategy. You know, complicated tasks. There's many people must do many things, but it's pretty clear everyone's got a job,

00:11:58:15 - 00:12:17:10
Thomas Lee, M.D.
do your job. You need those kind, that kind of approach. But it only takes you so far with the kind of complex challenges we have today. So I do think that thinking like a clinician, Ale and I have an article coming out very soon making the case: yeah, we need to do that more in our management life too.

00:12:17:12 - 00:12:43:01
Chris DeRienzo, M.D.
I look forward to reading that. And if anything, Tom, looking back over the papers you've written, many have a degree of foresight that one historically might one only apply to Nostradamus. And I'd like to close on one of those quotes. And this was from ten years ago. You wrote in New England Journal of Medicine that we believe "social capital is likely to be even more important than financial capital in the era ahead.

00:12:43:04 - 00:13:01:15
Chris DeRienzo, M.D.
After all, one can go to the bank to borrow money, but there is nowhere to go to borrow trust, teamwork, reliability, and the desire to innovate and improve." You said that ten years ago. It feels just as relevant today, but I wanted to give you just a chance to share with listeners a closing thought.

00:13:01:17 - 00:13:31:08
Thomas Lee, M.D.
Thanks. Chris and I do still feel that way, and even more so. Because I'm not naive about money, but I know the limits of what money can do. You can get money from the outside, but you can't get teamwork and trust and high reliability and safety. You know, you've got to build that from the inside. And our organizations are not going to differentiate themselves from other organizations on the basis of who can borrow the most money.

00:13:31:14 - 00:14:05:10
Thomas Lee, M.D.
They're not going to differentiate themselves on the basis of who has the best AI. You know, you've got to be competitive and all these things. But where will differentiate ourselves is how we work together. That will enable us to hold on to great employees, and that will enable us to hold on to our patients as well. So I really think that focusing on social capital, how we work together, that is every bit as strategic and really more so than financial capital issues alone.

00:14:05:12 - 00:14:21:19
Chris DeRienzo, M.D.
You know, health care is and will always be a uniquely human experience. And in the words of Tom Lee, you can buy things, but you can't buy trust. You've got to build it. Thank you so much for spending time with us on the podcast, Tom. It is it is really one of the honors of my career.

00:14:21:21 - 00:14:30:02
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.

00:00:01:00 - 00:00:28:18
Tom Haederle
Welcome to Advancing Health. Western Wisconsin Health recently put a lot of care, planning and resources into expanding its maternal care services for the rural population it serves. Was it successful? Well, the hospital CEO jokes that she took on a little bit of market research herself by having her own child at the hospital and checking out the experience from a patient's point of view.

00:00:28:20 - 00:00:54:01
Julia Resnick
Hi, I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. I'm so excited to be here today with Eilidh Pederson CEO of Western Wisconsin Health. Today we're going to discuss rural maternal health. As many rural hospitals are shutting their labor and delivery services, some are doubling down. Eilidh’s hospital is one of the ones that's expanding their maternity care for their community and for their patients.

00:00:54:03 - 00:01:06:15
Julia Resnick
And Eilidh has a special connection to share. So let's get right into it. Eilidh thank you so much for joining me for this conversation. To kick things off, can you tell me more about your hospital and the community that you serve?

00:01:06:17 - 00:01:35:06
Eilidh Pederson
Yes. Thank you, Julia, for having me. Thank you to the AHA. My name is Eilidh Pederson. I'm the CEO with Western Wisconsin Health, and we are Critical Access Hospital in Baldwin, Wisconsin. We serve a rural community and we serve as a safety net hospital to both our community and to our region. We employ about 500 people and offer a full breadth of service, focusing on a holistic approach to health care and meeting patients where they are.

00:01:35:08 - 00:01:39:15
Julia Resnick
Fantastic. And tell me more about your family and raising your family in Baldwin.

00:01:39:18 - 00:02:11:19
Eilidh Pederson
So now I have four kids. Very excited to share my pregnancy journey with you with my most recent baby. She was the latest addition to four kids. Two boys, two girls. And I absolutely love raising a family in Baldwin. I think there's nothing better than raising your children in a rural community. Having an opportunity to really get to deeply know people, both people with whom you're raising children at the same time, but also meeting and getting to know people who use and benefit from your hospital services.

00:02:11:21 - 00:02:37:27
Eilidh Pederson
I personally love that opportunity to meet patients in the grocery store, at the local football game, or my family at our hockey games, or big hockey players. And so that opportunity to get to know people outside of just when they're sick and when they're in the hospital, when they're feeling their best out in the community, I think is the absolute best thing about serving as a leader in a rural hospital and living in a rural community.

00:02:38:00 - 00:02:43:29
Julia Resnick
That's so special that you get to see your patients when they're healthy and out of the hospital and back to their day to day lives.

00:02:44:02 - 00:03:07:22
Eilidh Pederson
Yes, yes. I think it also is really what contributes to the quality of medicine and rural communities. There's nowhere to hide if something doesn't go well, if there is displeasure about a service, you're going to hear about it again at the grocery store, at the football game, at church, at the hockey game. And that high level of accountability translates into quality outcomes.

00:03:07:22 - 00:03:13:06
Eilidh Pederson
So it makes a difference to, to live and work in the same community.

00:03:13:08 - 00:03:20:20
Julia Resnick
Absolutely. So tell me about what maternity care is like in your community, all the way from prenatal care through postpartum care.

00:03:20:22 - 00:03:50:12
Eilidh Pederson
So all things encompassing, maternal and child health are really a staple in our hospital. We've made a conscious decision that these are foundational programs to us. So we offer prenatal care, through midwives, certified nurse midwives, obstetricians and family medicine physicians with obstetrical care as part of their training and their service. So the prenatal journey starts there. Patients have an option to see any of those providers.

00:03:50:12 - 00:04:12:28
Eilidh Pederson
It's their choice. Part of our very focused approach to medicine here. Patients are in control. They lead their own show. We're here to support and care for them. So the prenatal care journey starts there, and we see patients through anti-partum visits, and we see for them through their ultrasounds. All of their lab work is done within our hospital.

00:04:13:00 - 00:04:36:10
Eilidh Pederson
And then there's the birth experience that happens in our labor and delivery unit. We are now a seven bed obstetrical care unit where we deliver patients, either vaginally or through C-section. And then once those patients are born, we're there to be serve as their medical home. So on the pediatric side, we have two pediatricians. One specializes in developmental pediatrics.

00:04:36:10 - 00:05:00:23
Eilidh Pederson
So for our patients who have developmental needs, we have onsite pediatric care for patients in need of those services. We have a pediatric nurse practitioner. And then we have family medicine providers who also meet the needs of our pediatric patients. And we really want to be that wraparound service for a patient's life span. So through the birth through childhood and all the way throughout all stages of life, we want to be here for our patients.

00:05:00:28 - 00:05:11:18
Julia Resnick
And it's one thing to talk about pregnancy care in the abstract. It's another when you are the hospital CEO who's getting your pregnancy care at your own hospital. So can you talk about that experience?

00:05:11:21 - 00:05:35:27
Eilidh Pederson
It is just an absolute joy to have my own child at this hospital. One of the things that we do here for all patients is we sign kind of a quasi birth certificate. It's not an official birth certificate, but it's a welcome to the world. We put the baby's footprint on it. It's one of my favorite parts of the job is I get to personally sign all of those welcome to the world, through our hospital.

00:05:35:28 - 00:05:58:01
Eilidh Pederson
And so it was really special and fun too. I had my own baby, and I got my own certificate that I signed welcoming my baby into the world. Being able to experience prenatal care here, I went the midwifery route and had an absolute wonderful experience through prenatal care, sharing and the joys of practice with that personalized approach of a nurse midwife.

00:05:58:04 - 00:06:22:09
Eilidh Pederson
Then, through the labor experience to a nurse midwife by my side, we expanded our hospital a year and a half ago, and to be able to be in a room that we worked hard to bring on site for patients in need. Was great to see every aspect of that design come to life as a patient, to see firsthand why we built it that way.

00:06:22:12 - 00:06:38:11
Eilidh Pederson
All of the funds that we raised to bring that to life. Again, just to experience that firsthand was great. And nothing beats the joy of welcoming a child into the world. And to get to do it in my hospital is beyond words, how special that was.

00:06:38:13 - 00:06:42:26
Julia Resnick
Being a patient in your hospital, how did it make you think about care differently?

00:06:42:28 - 00:07:14:10
Eilidh Pederson
You know you have more vision as an administrator on what you think that care journey should look like. Of course you do that in partnership with physicians, providers, nurses, all of the, caretakers who are closest to the work. And that vision you hope you plan, you prepare that that aligns with reality. And so I joke that this was one way to do market research to determine, okay, did all of that planning go according to plan and a real life experience?

00:07:14:10 - 00:07:33:16
Eilidh Pederson
And I will say, for the most part, it did. It went exactly as we planned and prepared that it should, with few exceptions, and I'm happy to share those exceptions. But it was great to see that vision that we had, that plan of care come to life and to experience that as a patient. I'm thinking, you know, okay, this is what should happen next.

00:07:33:17 - 00:07:41:25
Eilidh Pederson
This is what we plan for. This is what it should look like. And really in every aspect, it it basically did, which was wonderful to experience firsthand as a patient.

00:07:41:28 - 00:07:47:13
Julia Resnick
Yeah. What were those exceptions and how are you thinking about changing things based on those?

00:07:47:15 - 00:08:05:22
Eilidh Pederson
You know, you can't predict some of these things, but I was glad to see how it played out. So this was a unique birth experience and that there was a storm coming when I went into labor. And, my midwife who is as great of a midwife as she is, storm tracker said, “okay, Allie, I need you to be prepared.

00:08:05:24 - 00:08:21:27
Eilidh Pederson
There's a storm coming. I think it's going to hit about 10 p.m..”And that's right around the time when your baby is going to be born. And I said, Sarah, how do you know this? I know you're a great midwife, but how do you also track storms? And she said, “in my spare time, I track the weather and I know there's a storm coming.

00:08:21:27 - 00:08:41:23
Eilidh Pederson
And so we need to prepare you.” Sure enough, I was ready to push at 10 p.m., right? At that time, all of the power went out in the hospital. We had a huge storm. Indeed. Power went out. We were on backup generator power. And so it was this dual thought, I need to have this baby right now.

00:08:41:23 - 00:09:03:00
Eilidh Pederson
And I'm also very curious to see how our emergency preparedness planning is going to work in this moment. Minutes before the power went out, the team moved everything to the red outlets, which are the outlets that make sure that when generator power comes on, all of the monitors and equipment still works the way that it should. They did this quietly, discreetly.

00:09:03:00 - 00:09:32:17
Eilidh Pederson
I, of course, knew what they were doing. My husband had no idea, which is what you want. It happened seamlessly. It was clear that our emergency preparedness planning went the way that it should. Everything functioned. Indeed, when the power went out a few minutes later and was able to safely and healthily deliver my baby girl in the midst of a storm with no power, only operating on generator power, the team knew the emergency preparedness policies training was effective.

00:09:32:20 - 00:10:03:21
Eilidh Pederson
The power was out until the next morning at 7 a.m., so we had a full evening of without, regular power. The hospital was still able to deliver many babies that night. The other unique thing about the experience that I thought about differently as a patient is when our OB rooms are full, which they often are because of the need in the community, we have to move patients to either a triage room or, to, a postpartum care room.

00:10:03:23 - 00:10:30:20
Eilidh Pederson
And we do this routinely. And as we plan for this, you know, I thought, okay, well, this won't be a big deal to families. They'll understand. We've got a patient coming in who needs a labor and delivery room. But as I experience that as a patient, I saw firsthand the challenges of moving everything. You know, the new baby, the partner, all of the mountains of things you have, and doing that at 3 a.m., was not an ideal time.

00:10:30:22 - 00:10:41:00
Eilidh Pederson
And so I saw firsthand that we can probably do that in a better way. So the market research continued with how do we interact with our patients better when those needs arise?

00:10:41:03 - 00:10:57:03
Julia Resnick
That is such a helpful learning that I think you can only realize by being in it. So I want to talk about rural maternal health generally. So many rural hospitals are being forced to close their labor and delivery services. While you all seem to be expanding, how do you do that?

00:10:57:05 - 00:11:27:07
Eilidh Pederson
We've made an investment and a commitment to sustaining rural obstetrical care. Despite all odds. We've really taken it as our personal mission that when others close, we have to be there for those communities in need. How do we do that? Number one, quality of care. That's the foundational aspect of this training, making sure that we know our patients needs because of that relationship, to be there to deliver the best care possible.

00:11:27:10 - 00:11:55:03
Eilidh Pederson
We have a 4% C-section rate. So clearly that foundational level of quality care rings true. Number two is workforce making sure that we have a diverse, sustainable workforce to meet the varied needs of our patients. And that's why we employ certified nurse midwives, obstetricians, family medicine physicians with OB, so we can have a variety and enough caregivers to meet the needs of our patients.

00:11:55:06 - 00:12:19:02
Eilidh Pederson
And then number three is advocacy work that needs to continue so that our government partners, our community partners, know the challenges that we endure and know how they best can support rural hospitals to stay open. And our minds, those are the keys to success. And that's our daily mantra. And how do we do this? How do we keep our doors open and do it well?

00:12:19:05 - 00:12:28:07
Julia Resnick
And as labor and delivery departments around you are closing their services, how are you adapting to meet not just the needs of patients in Baldwin, but in the communities that are around you?

00:12:28:09 - 00:12:48:24
Eilidh Pederson
The thoughts that we have as we work to adapt to the changing landscape and the ever growing needs, goes back to what I shared earlier. Number one workforce. We need more caregivers and providers to do this work. And the number two is increasing our space. Just a year and a half ago, we doubled the size of our labor and delivery unit.

00:12:48:24 - 00:13:10:06
Eilidh Pederson
And we're already pushing up against those limits. I personally had to move as a patient because we had more patients coming in to deliver. We need more space. And that's why as part of our five year strategic plan in this hospital, we intend to add yet again, more space, more clinical space to meet the needs of our growing region.

00:13:10:08 - 00:13:29:01
Eilidh Pederson
I think we do this and can do this well because we're local, we're independent, we're very accountable to our community. And it highlights why it's so important for rural, independent hospitals to stay open, because they keep these things at the heart of their work, keeping labor and delivery open.

00:13:29:03 - 00:13:54:25
Julia Resnick
Absolutely. And it's just such a powerful story for how you can have rural medicine really serving the needs of the community and providing high quality care that even the CEO or be willing to have her baby at. And listeners, I've met that baby and she is adorable. So congratulations on your new little one. Thank you so much for the work that you do every day for your community, and I just really appreciate you sharing your story with our listeners.

00:13:54:27 - 00:13:57:12
Eilidh Pederson
My pleasure. Thank you for having me.

00:13:57:15 - 00:14:05:26
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.