Advancing Health Podcast

00:00:01:01 - 00:00:26:18
Tom Haederle
Welcome to Advancing Health. We love them. We need them. In fact, we can't do without them. But keeping America's nurses engaged and supported and doing what they love and were trained to do has been a challenge for many hospitals and health systems. Today, we get some tips from New York City's biggest health system on its amazing progress in nurse retention over the past several years.

00:00:26:21 - 00:00:46:03
Elisa Arespacochaga
Welcome to Advancing Health. I’m Elisa Arespacochaga, group vice president for clinical affairs and workforce at the American Hospital Association. And I'm delighted to be joined by Natalia Cineas, senior vice president and chief nursing executive for NYC Health + Hospitals to talk about the amazing work they've been doing and their progress on nurse retention. So welcome.

00:00:46:06 - 00:00:48:05
Natalia Cineas, R.N.
Thank you so much. Thank you for having me.

00:00:48:08 - 00:01:07:08
Elisa Arespacochaga
All right, let's get into it. You started a little bit ahead of the curve in terms of when people were starting to focus on nurse retention and how to keep your team intact. But what prompted you and the organization to say, hey, this is a problem and this is where we need to put our attention?

00:01:07:10 - 00:01:49:14
Natalia Cineas, R.N.
Sure. So when I was appointed in 2019, the data really led us to focusing on retention. We had a turnover rate of 46%. And as you can imagine, you know, that was really shocking. And so at the time, we decided to focus on establishing a nurse residency program. I then hired an amazing senior director of professional practice for nursing that really helped put together not only the nurse residency program, but also spearhead over 200 professional governance councils that we now have throughout our entire enterprise.

00:01:49:14 - 00:02:01:21
Natalia Cineas, R.N.
And I think those two programs were truly the catalysts of our work as it entails surrounding nursing retention. But that was in 2019. You are correct.

00:02:01:24 - 00:02:20:17
Elisa Arespacochaga
So you really double down on engagement, like, let's get these nursing teams fully engaged in the work that we're doing and let them tell us what are the things that we need to do. As a new leader, that must have been a bit of a tough challenge to say, hey, you know what? Something's not working, tell me what you think.

00:02:20:20 - 00:02:53:23
Natalia Cineas, R.N.
Actually, it was exciting. You know, I've always been a leader that believes in the power of our frontline. And so establishing structural empowerment and that infrastructure was actually really exciting. And I think hearing from our nurses, understanding what they wanted to see, partnering with our labor unions was the answer, really, to ensuring that our nurses were engaged and we were establishing programs that they found meaningful.

00:02:53:25 - 00:03:20:15
Natalia Cineas, R.N.
And to your point, you know, giving them an opportunity to have their voices heard. And I think, you know, it was really important at the time to educate our leaders about the importance of listening to frontline. And I think that was a learning curve. But we've succeeded, and now we have a positive practice environment where we have five Pathway to Excellence designated sites, two with distinction.

00:03:20:18 - 00:03:34:15
Natalia Cineas, R.N.
And that designation really focuses on a positive practice environment. So to me, that's indicative of the work that we have done over the last six years to focus on engagement and retention.

00:03:34:17 - 00:03:37:02
Elisa Arespacochaga
That's awesome. So where are your numbers today?

00:03:37:05 - 00:04:10:10
Natalia Cineas, R.N.
So our turnover rate is now 7%, which is phenomenal. Yeah. We've come a long, long way for our staff nurses. We've hired over 3,000 nurses not long ago, and we continue to monitor those numbers. But we were so proud because of the nurse residency program, because of our professional governance councils, because of the amazing fellowship programs that we've established to train our new nurses and our clinical ladder program.

00:04:10:10 - 00:04:49:18
Natalia Cineas, R.N.
A lot of professional development programs have been established in the last six years and that we now see that our turnover rate is 7%. And that is because of the commitment of the entire C-suite here at New York City Health + Hospitals. I have to give credit to our president and CEO, Dr. Mitchell Katz. He would say he loves nurses, and we believe it because he has been our number one supporter with the city of New York to ensure that our nurses have great contracts, that have also been combined with the amazing programs that we've implemented to see this remarkable result.

00:04:49:21 - 00:05:15:29
Elisa Arespacochaga
That is amazing. That is - just to put it into perspective, significantly below in fact, less than half of the national number of turnover rate. So that is amazing. I love that, one of the programs you've mentioned a couple times is that nurse residency program, because we know that new nurses, particularly those who were trained during the pandemic who might have had less clinical exposure, that that turnover rate is through the roof.

00:05:15:29 - 00:05:37:02
Elisa Arespacochaga
And it's a challenge to help them understand what does this job look like when they're ready to start it? So, can you tell me a little bit about how you've not only helped them figure out how to grow from 'I'm a brand new nurse - to I'm a nurse who knows what I'm doing in this organization.' But how have you been able to help them see pathways for them to stay?

00:05:37:05 - 00:06:11:25
Natalia Cineas, R.N.
Excellent question. So I have to give credit to our amazing team at our corporate office and also our nurse leaders across the entire system that support our nurses in the nurse residency program. We've had over 2000 participants to date, over 1000 graduates. And I think that during the nurse residency program, we educate our nurses about a) the importance of the health system that they selected to begin their careers, or whether they're new to nursing or new to their specialty.

00:06:11:28 - 00:06:36:24
Natalia Cineas, R.N.
You know, we definitely have conversation about the importance of our mission here at New York City Health + Hospitals to really care for the underserved, and they understand the importance of that, the significance of that. I think they believe in our mission and our vision. And we educate them on the opportunities in the ways to transition within the profession when they are employees of New York City Health + Hospitals.

00:06:36:24 - 00:07:06:09
Natalia Cineas, R.N.
And I think that's been really important. And we talk to them about how they can get connected with other opportunities, how they can become part of the different councils so that they continue to grow and develop professionally. But also once they graduate from the nurse residency program we created something here at New York City Health + Hospitals which is really unique that many systems do not have, and I don't think any system has, quite frankly, is the mentorship opportunity.

00:07:06:09 - 00:07:33:05
Natalia Cineas, R.N.
So when they graduate from our nurse residency program, they are able to become mentors to their peers to really talk about the first year of practice and, you know, to give guidance to others. And we're really excited about that program where we're using an AI platform to pair a mentor with mentee of the nurse residency program graduates. And that has been just phenomenal.

00:07:33:06 - 00:07:51:23
Natalia Cineas, R.N.
We've had over 100 mentors now, who come back to support other peers. And I think that's just one of the ways that we continue to retain our nurses by, you know, educating them that while they are new, there's so many ways they can contribute within nursing here at Health + Hospitals.

00:07:51:26 - 00:08:16:00
Elisa Arespacochaga
I love that because, I mean, if you're tapping into what is in a nurse's genetics, it is about caring for other people. So the ability to then say immediately, not only are you trained and are you in a good place to take care of your patients, but here, you know, let's connect you with some of your colleagues. Let's have that best friend at work who you know, you are helping through the same path that you had to tread, I love that.

00:08:16:02 - 00:08:34:08
Elisa Arespacochaga
So what are some of the lessons that you learned along the way? Because, you know, you started this in 2019 and then there was a pandemic. And then, you know, the whole world changed. So what are some of the things that you either started and stopped or changed or moved along the way? Lessons learned that you want to share with our listeners?

00:08:34:10 - 00:09:03:28
Natalia Cineas, R.N.
I think the one lesson I've learned is the importance of communication and staying connected with those doing the work. And, you know, I think back to Covid 19 and the fact that we continued to run our nurse residency program to give our nurses a safe space to ask questions, to share whether or not they were afraid of being in the front lines and providing them support. Just to remain consistent, to remain visible has really been key.

00:09:03:28 - 00:09:23:07
Natalia Cineas, R.N.
And we said it already today. But I think the importance of listening, listening to others and that's one thing that I do in all of our programs, whether it's fireside chat with our front line, whether it's a leadership townhall. Just listening to our community of nurses this year has been really, really important. And I think that's why we're seeing our success.

00:09:23:08 - 00:09:40:22
Natalia Cineas, R.N.
I think that's why our nurses are staying as they believe not only in the mission and our vision, but also they know that they are part of the fabric that makes us great and that they are part of the solution to continuing to provide excellent care to our patients.

00:09:40:24 - 00:09:59:02
Elisa Arespacochaga
That sounds amazing. And it sounds like they believe in you, Natalia, that you're part of this solution. You're there to serve them in the way they are there to serve their patients. And I think there's no higher compliment for a leader than to know that. Thank you so much for joining me today, for sharing the amazing work that you've been able to do.

00:09:59:02 - 00:10:08:20
Elisa Arespacochaga
And I wish you continued good luck with all of this work. And I look forward to interviewing you again in a year and finding out what else you've been able to solve.

00:10:08:22 - 00:10:10:06
Natalia Cineas, R.N.
Thank you so much.

00:10:10:08 - 00:10:18:19
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.

00:00:00:28 - 00:00:22:08
Tom Haederle
Welcome to Advancing Health. Practice makes perfect, the saying goes. And that's true in many things: sports, music and medicine too. In this podcast, we explore the shared commitment between Laerdal Medical and Advocate Health to advancing patient safety through the power of simulation.

00:00:22:10 - 00:00:52:13
Chandler Carter
Hello, and welcome to Advancing Health. I'm Chandler Carter, program manager at the American Hospital Association, and today I'm excited to be joined by Kelly Sabah, associate vice president of simulation at Advocate Health, as well as Brian Bjorn, patient safety manager at Laerdal Medical. We're so glad to have you both with us today. Your perspectives on simulation and patient safety, clinical quality and workforce readiness are incredibly valuable, and I know that our listeners will benefit from hearing your perspectives.

00:00:52:15 - 00:00:58:20
Chandler Carter
To start us off, I'd love to learn a bit more about your backgrounds in simulation. So, Kelly, why don't we start with you?

00:00:58:23 - 00:01:05:13
Kelley Sava
Sure, absolutely. So before we get started, I just want to say happy healthcare simulation week. I was during SIM week, so.

00:01:05:13 - 00:01:07:18
Chandler Carter
It's just very timely, I like that.

00:01:07:21 - 00:01:32:12
Kelley Sava
So I'm a nurse by background. I started in pediatric nursing, and became a nurse practitioner. I started working in hospitals and having played competitive team sports as a kid, I really had this desire and love for teamwork and communication. And that was really a passion of mine. And getting into hospital based nursing, I found that I was able to use a lot of those skills in a hospital based setting, which was really exciting.

00:01:32:12 - 00:01:56:20
Kelley Sava
And then fast forward a little bit and I became an educator, an advanced practice nurse educator within a pediatric realm. And shortly after I took that role, simulator, a Laerdal simulator showed up at my door and it got delivered to my doorstep. And so I was tagged, and said well, I got delivered it here so you're going to be the one that's going to figure out how we're going to utilize this amazing tool.

00:01:56:20 - 00:02:37:06
Kelley Sava
And so the rest was history. I started using it and fell in love with the opportunity to really, you know look at teamwork and communication within the health care setting. And from there, I was completely sold. You know, as a pediatric nurse, saw a lot of clinical situations and opportunities for improvements in how we provide safe care. Our organization then took a huge dive into patient safety, really launching high reliability and patient safety as a huge initiative within the organization. And part of their strategy and philosophy was launching a simulation program across the enterprise.

00:02:37:08 - 00:03:03:03
Kelley Sava
And at that time it was Illinois. It was our Illinois sites. And so I was fortunate enough to become the director of that program when it was just myself and our safety leaders that were fearlessly dedicated to this journey of high reliability. And from there, I my passion grew even more as to how we could utilize simulation to really make an impact for our patients.

00:03:03:05 - 00:03:21:26
Chandler Carter
That is incredible. Thank you so much for sharing, Kelly, and also bringing awareness to Patient Safety Simulation Week. Brian, as patient safety manager at Laerdal, can you tell us a bit about your background and some of the simulation work that you do with Laerdal, including the accelerate programing that Kelly just mentioned?

00:03:21:28 - 00:03:41:09
Brian Bjoern, M.D.
Absolutely. And let me just pause for a second, and thank you for having us on the podcast. We're excited to be part of this. My background is actually not so much in simulation. I'm a public health physician by training and have spent most of my career in safety and quality roles for working for hospitals and health systems, here in the US and in Scandinavia.

00:03:41:12 - 00:04:05:02
Brian Bjoern, M.D.
And at Laerdal I'm using that that background and quality and safety to really try to augment what we do already with our hospital customers. And we like to think of simulation and how it relates to patient safety as kind of  - there are three tiers to this. And the two first is I'm going to talk about what probably most hospitals that do simulation think of when they think patient safety and simulation, which is does you individual skills.

00:04:05:02 - 00:04:21:15
Brian Bjoern, M.D.
So that could be something like, you know, using a task trainer to learn how to insert an IV. That's important. And I think that does contribute to patient safety that we can practice that on a simulator where rather than on a patient. The second level is when we come together as a team. We all have our individual skills down.

00:04:21:15 - 00:04:40:00
Brian Bjoern, M.D.
Now, we need to figure out how to work together as a team. Most of us do not have that opportunity in school. So that really is on hospitals to figure out how can we do that. So training, practicing, high acuity, time critical scenarios as a team, I think is that is that second tier of simulation.

00:04:40:02 - 00:04:58:21
Brian Bjoern, M.D.
And then the third tier is kind of thinking a little bit more about how does the whole system work together. So using simulation really to drive quality projects forward and to use it as a tool to find the holes in the Swiss cheese, like we would say in patient safety, or figure out how to close the holes in the cheese.

00:04:58:24 - 00:05:18:08
Brian Bjoern, M.D.
The Laerdal accelerate program is an attempt to help hospitals with that approach by providing simulation in a box, really. It's a program that we developed now a handful of years ago that allow customers to have us run simulations on their behalf. So we really just need to know what's the clinical topic you want to practice?

00:05:18:08 - 00:05:46:15
Brian Bjoern, M.D.
How many people do we need to get through this, and when do you want to do it? And we come on site and run simulations for you. We bring in all the equipment an educator, Simtech, and we run the simulations. And when we're done, we you know, clean up, pack up, go home. And a couple of weeks later, we reconvene to talk about, what we call the progress report, which is how we translate all the thousands of data points we capture during those simulations into actionable insights so that we leave you with something that you, you know, get a snapshot of

00:05:46:15 - 00:05:53:05
Brian Bjoern, M.D.
what did you do well? Where is there some room for improvement? And how can, how could this data help you in that?

00:05:53:07 - 00:06:16:29
Chandler Carter
And for a lot of our members, I think one of the challenges is moving from concept into application. We know that Advocate Health represents a very diverse number of hospitals and care settings. Can you tell us what's worked well in securing buy in from different levels, from the executive team to frontline teams? And how have you really helped to make simulation a part of each institution's day to day practices for patient safety?

00:06:17:02 - 00:06:34:08
Kelley Sava
Yeah, absolutely. So I'm going to focus my answer on some of the work that has gone on in the Midwest, because we've just had a longer standing opportunity to build that culture in that space. And so we started out really with gaining buy in from our highest levels. And so we had, our patient safety leader.

00:06:34:08 - 00:06:55:25
Kelley Sava
And at that point in time, our system chief medical officer, who were very passionate about high reliability and safety and how simulation was going to impact, right? They helped us at the highest level get that word out. And our president at the time bought in 100%. We were able to gain that buy in at that level. The site level was very different.

00:06:55:25 - 00:07:25:09
Kelley Sava
And translating that desire from an enterprise or system level into the sites...it's a challenge because every hospital, as you know, has a different culture, different, right? We all have these cultures and behaviors that we follow together as a system. But when you really get into each of those sites, there's a different flavor to that. And so we really had to tailor our approach to each of those different cultures and flavors, if you will, at each of those sites.

00:07:25:09 - 00:07:42:29
Kelley Sava
And so our approach really varied. At some sites, our leaders, you know, we were able to meet with our leaders. And as long as we could get the leaders to understand the why and we could speak the language and find out what was important for them, we were able to get in the door and they were able to help us move forward.

00:07:43:01 - 00:07:59:03
Kelley Sava
I always use the question, what keeps you up at night? And that was the question that I would ask the leaders, and if we could get to something that was sort of on their plate or was causing them concern, we would be really successful. And we had other sites where the leaders, you know, they were like this is all great.

00:07:59:10 - 00:08:21:13
Kelley Sava
And that's where it kind of stopped. Right? Like these are sometimes, you know, hospitals that had different priorities or whatever. And in those situations we went more grassroots. So we changed our approach in those situations. And we would go into unit and we would work with the more local leaders, the managers and the supervisors and do simulations and get these great stories that they would then escalate up.

00:08:21:16 - 00:08:38:18
Kelley Sava
And so when they would escalate those stories up to those executives, then they would come back to us and say, we need a simulation here because our teams need it. Here's what happened in our unit. We would go, yes, we've worked very closely with your team. We're so grateful for their engagement. And let's spread this out, right?

00:08:38:21 - 00:09:08:10
Kelley Sava
What we had to do is be really flexible and fluid about how we engaged each of those sites to really get simulation embedded into their culture. We also worked really tightly with patient safety, right? So at a system level, we had really tight relationships. I still matrix report to our patient safety leader. And so having that relationship also helped us have an influencer within each of the sites already embedded, which was very helpful.

00:09:08:12 - 00:09:32:13
Chandler Carter
I love that idea. And I've heard that echoed across some of our member hospitals as well, having that champion of sorts, to help kind of progress the work in simulation. Which brings me to Brian. From your perspective, working with an organization that has done tremendous work in the world of simulation. What are your thoughts on how hospitals and health systems that can really build a culture that values and trust simulation as a strategic

00:09:32:13 - 00:09:33:00
Chandler Carter
tool to advance patient safety?

00:09:35:06 - 00:09:57:16
Brian Bjoern, M.D.
Buy-in at all levels is so important. But particular and this is true for any project, program, initiative in our organization, you need the executive team on board with this. They need to be present. They need to be supportive. That's the old saying that attention is the currency of leadership. And if you do not have the attention of leadership on this, you're not going to make that the kind of progress that Advocate has shown is possible.

00:09:57:18 - 00:10:17:25
Brian Bjoern, M.D.
And I think to some extent, really the biggest challenge is to get our senior leaders, our executives in health care, to understand that simulation is not just a great educational tool. It can do so much more. When I talk to hospital leaders, I often run into to people who think of simulation that's something that happens over in education.

00:10:17:28 - 00:10:44:08
Brian Bjoern, M.D.
They don't even, you know, connect the dots that they have this great tool and resource in-house that they can use to accelerate their safety and quality work. And I would argue that that simulation really can help build and maintain a culture of safety, because everything we do in simulation revolves around this idea of creating a safe space for learning and for failing, and without risking any harm to the organization or to our patients.

00:10:44:11 - 00:11:05:27
Chandler Carter
Thank you so much, Brian. Kelly, so we know at Advocate we know that simulation is very heavily embedded into how your systems improve care continuously. Can you share how you specifically use simulation to help uncover any communication breakdowns, any safety gaps, or any system level risks, before they begin to impact patient care or escalate?

00:11:06:03 - 00:11:28:25
Kelley Sava
Absolutely. I have a lot of stories about how we've utilized the tool in that way. So early on when we were getting our feet wet we were doing mockups, emergency resuscitation. The one thing everybody understood ubiquitously about simulation was a mock code doing CPR, emergency response. Everybody understood that. So we started there naturally. Just that's what people wanted.

00:11:29:01 - 00:11:59:26
Kelley Sava
And in doing so across our hospital system and doing it at different hospitals, we noticed very quickly that there was some trends in how care gaps were being identified within these events, and we identified that roles and responsibilities, while they're well laid out for the American Heart Association, how that translates into some of these hospitals that maybe have fewer resources than are identified in the guidelines or have way more resources than are identified in the guidelines, how does that translate?

00:11:59:29 - 00:12:33:22
Kelley Sava
And then other additional roles that right, maybe needed wayfinding and things like that. It just there wasn't very clear, delineation with what that we were seeing translate into care. We were seeing opportunities around our crash carts and how they were organized, what supplies were on the crash carts, what supplies weren't on the crash carts. Did teams know how to access the medications or access the supplies that they needed? And then also identifying that in some of our hospitals, we had up to four different types of defibrillators depending on the different units.

00:12:33:22 - 00:12:56:12
Kelley Sava
And one code team that was having to know how to use this equipment across multiple locations within their own building. And so we were able to escalate all of that to the system level. And we actually were able to, with the partnership of our patient safety team and our executive leaders to form a committee that really looked at practice within Code Blue.

00:12:56:12 - 00:13:15:16
Kelley Sava
And there was a new policy written. There was standardization defibrillators across the entire system, all of these things that then got put in place because of these findings. We were able to kind of tie it all together and then look to make sure post implementation that we weren't continuing to see those types of events.

00:13:15:18 - 00:13:36:23
Chandler Carter
I think that's an excellent example of how simulation can really reveal some of those hidden vulnerabilities that exist within complex health systems. So that's incredible. So as a follow up, Kelly, you've often described simulation as a space where people can learn, reflect and speak up. How have you used simulation to really foster psychological safety within your organization?

00:13:36:26 - 00:13:58:24
Kelley Sava
Yeah. So I think simulation has a natural ability to do this when we're bringing teams together and really having our front line teams in a safe spaces, as Brian spoke about, where they're able to talk through the care that they provide. Normally you provide the care in your unit and then you go on to the next thing you have to do, right?

00:13:58:24 - 00:14:26:00
Kelley Sava
Like we don't stop and really think about how in debrief every interaction, every process every single day. And so bringing our teams together and really providing that safe space for those opportunities is really important. And it allows for us to build trust. A recent example, and I just found out about this when we are in the midst of a huge safety project at one of our hospitals, they're opening a brand new tower.

00:14:26:03 - 00:14:55:18
Kelley Sava
In that process, they're having one unit that was not a tele unit is now going to be a telemetry unit. And so part of the testing that we did when we went in there was to combine this unit that was non telemetry and help combine training with them and our central tally center to do some training together so that they could better understand the process of central tele, that they could, you know, be able to learn those processes and workflows and escalations and things like that.

00:14:55:18 - 00:15:16:10
Chandler Carter
Incredibly important, incredibly important. And I think we're seeing now in the current health care landscape and the dynamic things are shifting rapidly. So I always like to look at things from a broader picture and implications for the future in the field in general. Brian, I can pitch this one to you. So as we look into the future, what role do you see simulation playing in hospitals?

00:15:16:13 - 00:15:22:08
Chandler Carter
In meeting the growing complexity of care, evolving technology and overall workforce readiness?

00:15:22:10 - 00:15:48:00
Brian Bjoern, M.D.
I think actually, that simulation might be, one of the things that that, you know, determine whether you're able to survive in the environment we are heading into. We recently were at AHA Leadership Summit, and the message we heard universally from the executives in attendance was that with the cuts to Medicaid that came with the OBBBA, there's just no way we can get away with incremental changes anymore.

00:15:48:04 - 00:16:16:29
Brian Bjoern, M.D.
We will need to fundamentally change how health care is delivered. And I think simulation can really be a crucial tool to get that right. Again, the whole premise of simulation is that it's a chance for us to practice and learn at very low, sometimes even no risk. So using simulation to test out different approaches, to use it to solicit feedback from patients, caregivers, providers and staff, I think will allow hospitals to adapt to this new environment much more quickly.

00:16:17:04 - 00:16:21:21
Brian Bjoern, M.D.
There's a lot of opportunity for using simulation in health care more than we already do.

00:16:21:24 - 00:16:34:14
Chandler Carter
Absolutely. I couldn't agree more, and I appreciate you both for taking the time to come and speak with us today on Advancing Health, not just for sharing your expertise today but for bringing such energy and insight into this conversation.

00:16:34:16 - 00:16:35:18
Brian Bjoern, M.D.
Thank you for having us.

00:16:35:21 - 00:16:37:18
Kelley Sava
Thank you so much.

00:16:37:20 - 00:16:46:01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:29 - 00:00:26:09
Tom Haederle
Welcome to Advancing Health. As America's population ages, hospitals and health systems are working to meet the evolving needs of older patients and provide care that enhances quality of life. Today, we highlight how West Health Institute and Sharp HealthCare are partnering to advance older adult care and the power of asking one simple question: what matters to you?

00:00:26:12 - 00:00:50:04
Marie Cleary-Fishman
Hi, everybody. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Marie Cleary-Fishman, the vice president of clinical quality for Health Research and Educational Trust. And I'm here today with Doctor John Zifferblatt, chief strategy officer at West Health, and Dr. Diane Wintz, the trauma program director, critical care specialist at Sharp Memorial Hospital in California.

00:00:50:06 - 00:01:00:15
Marie Cleary-Fishman
John, I'd like to start with you a little bit, and if you could tell me a little bit about your role at West Health and, and just a little bit of what West Health is all about.

00:01:00:18 - 00:01:30:03
Jon Zifferblatt, M.D.
Sure. Thank you too, Marie. Thank you for having me here. So, I'm the chief strategy officer at West Health. West Health, you know, named for Gary and Mary West, our founders. We are here in San Diego, but it is named for founders Gary and Mary West, who have also given us our mission, which is to advance affordability and models of health care that promote independence, high quality of life and dignity for older adults, and ultimately for us all.

00:01:30:06 - 00:02:01:00
Jon Zifferblatt, M.D.
My role is to overlook the portfolio work that we do and make sure it ladders up to create impact at scale. And when we say West Health, what we really mean is the several organizations that all work together. There is the West Health Foundation, but largely that foundation does its work through, funding and arms, legs and brains of the West Health Policy Center in Washington, D.C., where we advance smart policy, and the West Health Institute here in San Diego, where we collaborate with health systems.

00:02:01:00 - 00:02:11:18
Jon Zifferblatt, M.D.
There's just 40 of us. So we can only be a catalyst and work with health systems to work together with them, and try to effect change at scale.

00:02:11:25 - 00:02:29:20
Marie Cleary-Fishman
That's great, John. And that's, that's really important information and very important to how we get work done in hospitals, in health systems and in health care today. So share with me a little bit about your connection and tie to Sharp. And what does that look like?

00:02:29:22 - 00:02:53:13
Jon Zifferblatt, M.D.
Absolutely. We worked with Sharp and other systems here in San Diego. We originally did some work  - we have a body of work in geriatric emergency departments, and we did some wonderful work with the county of San Diego, where every health system in San Diego other than military, was accredited as a geriatric emergency department. And we obviously know Sharp by its reputation.

00:02:53:15 - 00:03:11:18
Jon Zifferblatt, M.D.
And, in the wake of that work, Sharp approached us, Diane approached us with some really exciting possibilities. And she'll share more I'm sure, about the details of that, but I just want to share at a high level. When we spoke with Sharp and Diane, it was clear that they had their ducks in a row.

00:03:11:18 - 00:03:29:08
Jon Zifferblatt, M.D.
They had buy in, they had metrics that they wanted to advance. They had a passionate and capable champion and really support from the clinical staff all the way up to the carpeted part of the hospital. So that's how we came to advance this work that we'll be talking about today.

00:03:29:11 - 00:03:51:01
Marie Cleary-Fishman
John, those are really important things to point out. And I think that the governing board, the C-suite, and I like how you said the carpeted areas of the hospital. So thank you for pointing that out. Diane, I'm going to ask you to tell me just a little bit about the journey that Sharp Memorial has been on and how you got to where you are today.

00:03:51:03 - 00:04:18:25
Diane Wintz, M.D.
Like John said, we presented to West Health back in 2021. And at the time, the country was going through Covid pandemic as the entire world was going through. And we had a durable, sustainable program that we were running. It had started on trauma, I'm the trauma medical director at Sharp Memorial Hospital, which is a level two ACS verified Center.

00:04:18:27 - 00:04:51:20
Diane Wintz, M.D.
But what we had seen similar across the country is that the number of patients 65 and older is growing, and I think it's going to continue that way for some time. And we needed a way specifically on trauma to manage the acute process of injury. And that potential threat to functional independence. And so we began a small pilot or soft launch program on a single unit in our hospital.

00:04:51:22 - 00:05:22:14
Diane Wintz, M.D.
It was the trauma unit, and we targeted patients who are 65 and older for very aggressive, functional and cognitive rehabilitation after injury. And that program enrolled 83 patients, and it had significant results with delirium mitigation, sleep/wake hygiene, out of bed mobility and discharge back to home, which is what people want. They don't necessarily want to be out of their homes to recover.

00:05:22:16 - 00:05:56:00
Diane Wintz, M.D.
And once we saw those results, we were able to take this and say, well, maybe there's a pathway for medical patients and maybe there's a pathway for surgical patients. And we begin to grow those things with our collaboration through West Health. And so for the past three years, we've been completing national level milestones to complete these very aggressive but also very durable and sustainable processes that could be used anywhere.

00:05:56:03 - 00:06:21:29
Marie Cleary-Fishman
I've done some homework over the weekend, and so I had a chance to go to your website and really look at some of the information and the materials that's there. So your generational health program, Sharp Memorial has that in place. And I wonder if you could describe that a little bit and help our audience understand what is that cover, what is it involving and...

00:06:22:01 - 00:07:10:16
Diane Wintz, M.D.
Yeah, it's really amazing at this point, what we've been able to accomplish, because where we started as just a little program on a trauma unit is now a hospital wide and going system. So generational health is an umbrella term. It encompasses all the pieces of the program that we do from the very beginning in the geriatric accredited emergency department that John mentioned, all the way through community. It includes advanced illness management, which is a nursing team that comes and talks about goals of care, advance care planning processes or future hospitalizations, or how to prevent it, and ensuring that your needs are met, and that we really heard and understood what matters to you.

00:07:10:18 - 00:07:39:17
Diane Wintz, M.D.
We have an appropriate care committee that deals with families, patients, where there might be a misunderstanding about the level of care or what's being offered. We have geriatric surgery which is another American College of Surgeons verified level one program. So this addresses surgical patients with vulnerability or social determinants of health who are going for operations. And they are age 75 and older.

00:07:39:23 - 00:08:14:15
Diane Wintz, M.D.
We also have a community piece where we go out. We provide education resources to all of our community partners. And then most importantly is the healthy aging, which is the inpatient program. This is an age friendly program. It was modeled after John A. Hartford Foundation, IHI. And it really prioritizes what we call 4Ms: mobility, medication management, mentation, which includes like the aspiration precautions and the cognitive and the delirium mitigation.

00:08:14:18 - 00:08:25:04
Diane Wintz, M.D.
And then what matters most? What are we doing in this hospitalization? What's important to you? What goals are you trying to accomplish, and how can we help you get there?

00:08:25:06 - 00:08:57:26
Marie Cleary-Fishman
That's amazing. I know that Sharp Memorial has a track record of coming up with innovations and for creating innovation that helps advance patient care. So I'm not surprised to hear you have such a comprehensive of approach to the area of aging. And as you rightfully said, the number of aging in our country is growing significantly. And so things that our hospitals and health systems can put in place to help integrate these pieces and really look at things through that lens of what matters, is so important.

00:08:57:27 - 00:09:21:06
Marie Cleary-Fishman
It really is important so that that care that we give to those older Americans really is focused on what's important to them and what matters in their life. And it helps us, as caregivers provide care that is something that advances and helps their life and makes them feel better. So, kudos to that broad perspective that you're bringing. That's really amazing.

00:09:21:13 - 00:09:33:12
Marie Cleary-Fishman
Maybe Dr. Wintz, you can talk to this just a little bit. And it's the idea of the medical inflection point of care. If you can give us a little bit of your insight and thought around that concept and what that might mean.

00:09:33:14 - 00:10:04:05
Diane Wintz, M.D.
Yeah. Well, I think you made a great point. You know, it comes down to what's important to someone. So medical inflection is the time on the health care journey where the hospital doesn't offer a therapeutic or diagnostic solution. That the needs or the interests of that person are to remain in place, to age in place. And the hospital doesn't really enhance that quality or quantity of life.

00:10:04:05 - 00:10:17:20
Diane Wintz, M.D.
And it's different for everybody. It's not based on age. It's not even based on frailty. It's based really on what matters to you and what can be accomplished in your current environment.

00:10:17:22 - 00:10:41:08
Marie Cleary-Fishman
That is so important. And I have used that. I can't even begin to tell you all of my dad's stories, but, we have used that to make care decisions, to help him make his care decisions because he is cognitively intact and capable of making those decisions himself. But I think that's a concept we really do need to focus on in health care, and that is through that lens of what matters.

00:10:41:11 - 00:10:50:20
Marie Cleary-Fishman
John, can you give us a little of your thoughts on that concept? Because, as the what matters comes so important and I know it's important to West Health as well.

00:10:50:22 - 00:11:16:06
Jon Zifferblatt, M.D.
Absolutely. And I think, you know, I'll take the perspective that it's kind of a beautiful thing. Because what matters to patients and practitioners, I daresay, is really also greatly overlaps with what matters to health systems, right? You know, older adults and all of us want to walk into the hospital if we have to walk in and we want to walk out. And we'd like to do that in an expeditious manner. And we'd like to do it as healthy as possible.

00:11:16:08 - 00:11:37:28
Jon Zifferblatt, M.D.
That's what health systems want. I mean, when we think about what's on the minds of those that run health systems and health systems leadership, it's to think about things like length of stay. Especially these days where you see the how many systems lines out the door in the ED. People waiting for beds, transfers, scheduled procedures having to be rescheduled or delayed.

00:11:38:01 - 00:12:03:08
Jon Zifferblatt, M.D.
Everybody would love to see beds being used in the optimal manner. And part of getting that right, part of getting a good case mix index and really tuning length of stay is allowing older adults the ability to really have that stay be optimized for them, and that gets them out and back in an independent life, in their community sooner and happier with greater satisfaction.

00:12:03:08 - 00:12:05:28
Jon Zifferblatt, M.D.
So wonderful to see the concordance of what matters.

00:12:06:00 - 00:12:30:23
Marie Cleary-Fishman
I love what you just said, the concordance of what matters. That's just perfect wording for that concept. And really, I've been in the position of having those conversations with caregivers. So Diane, help me think about or understand how you at Sharp Memorial, how you create the environment, how you create the culture within a system.

00:12:30:23 - 00:12:43:19
Marie Cleary-Fishman
And you clearly have a system, a continuum of care that you're working for. So how do you look at building systems that make it easier for those that are providing care to really understand the what matters?

00:12:43:25 - 00:13:15:23
Diane Wintz, M.D.
Well, it starts at the top, but we have a very receptive administration. We have an administration that's very accessible and also goes on a first name basis. So it's very comfortable to voice a concern or to be interested in something. And I think this collaboration with West Health is one of the best examples of how administrations really drive ships by stepping back and allowing leaders to take the reins.

00:13:15:29 - 00:13:44:11
Diane Wintz, M.D.
This is what happens, is that, you know, we had stories, we had patient examples that were really critical where we could have done better, and we shared those stories. And then we engaged frontline staff who had interest in what we were doing, self-identified, and we welcomed them onto their team to start that planning process. So that we could move forward with a bigger picture.

00:13:44:13 - 00:14:10:27
Diane Wintz, M.D.
One of the examples that I give is the gentleman who fell in his garden, and he was the family patriarch. And he came in with a few rib fractures, a minor injury and in most cases. And for him, unfortunately, he got into this cycle where he needed pain medication and then he was too groggy to participate. And then because he didn't participate, he was in bed.

00:14:10:27 - 00:14:31:08
Diane Wintz, M.D.
And because he was in bed, he lost strength. And this just- it was a cat chasing its tail, trying to get on top of the problem so that we could get him better. And based on his outcomes, you know, we took that back to the group and we said, we have to do better. We have to already be prepared for what's going to happen.

00:14:31:08 - 00:15:12:28
Diane Wintz, M.D.
We have to be ready to manage pain in such a way that we don't get into this cycle, that this doesn't happen to someone. It's a lot of things that we talked about on this call. It's bringing those personal examples and making that impact. And someone saying, you know, that resonates with me because I took care of someone and they have this story and, and really using those stories to build that impact, to build that need to build the interest and then to come up with a product that is really doable, doesn't take a ton of extra time, doesn't need a lot of extra training to do it.

00:15:13:00 - 00:15:16:15
Diane Wintz, M.D.
It's just really a shift of mindset.

00:15:16:17 - 00:15:38:03
Marie Cleary-Fishman
I think you're so right. And I think we have opportunities to bring the family caregivers, whoever that might be, and the clinicians and the clinical teams sort of together looking through that what matter lens, right? Because, you know, one thing might matter to the caregiver, one thing might matter to the clinicians. Well, do they - is that checkpoint of what matters-

00:15:38:03 - 00:16:06:00
Marie Cleary-Fishman
do they align with what that patient person who's in the bed wants? And I think that's something that's really important. John, West Health is really committed to this and really believers. We had another panel with you and we talked about the C-suite, the board involvement, and how important that is to going forward. Can you talk a bit about the sustainability of this model or the spread of it?

00:16:06:00 - 00:16:08:19
Marie Cleary-Fishman
And how does West Health look at that?

00:16:08:21 - 00:16:30:12
Jon Zifferblatt, M.D.
Sure. Happy to share. And I'll also add an observation about the wonderful work going on in Charlotte. When you heard Diane talking about the things that they've brought to bear and the multifaceted components they put into that product, if you will, there wasn't a new drug that they needed to have been discovered. There wasn't some new miraculous technology that didn't exist a year ago.

00:16:30:14 - 00:16:53:22
Jon Zifferblatt, M.D.
This is about operational innovation, right? This is about bringing together pieces that already exist, putting it together in new ways, doing some, you know, staff training. There's you know, and culture change, as you said. But all of these things are there. They need to be catalyzed. The incentives have to be in the right place. But this is not net new technology, new innovation.

00:16:53:22 - 00:17:12:18
Jon Zifferblatt, M.D.
We have the pieces now and we can do them. And that's part of how we think about catalyzing the scale and spread of this. There's multiple ways we can do it. One of the, you know, more simple and straightforward ways is we amplify the work. We take beacons of success and houses of excellence like Sharp Memorial and Sharp Health

00:17:12:18 - 00:17:39:07
Jon Zifferblatt, M.D.
that are doing it well. And share and spread that, break it down into the components that allowed for that success and enable those that are leading that success to share that as well. So obviously there's vectors to do that. And then there's other ways that we can try to catalyze that success. We can do it at a policy level, but we also can create the right environment where things like this can take root and spread.

00:17:39:09 - 00:18:03:12
Jon Zifferblatt, M.D.
And we're big believers in the marketplace. So how are the things that we're discussing here business friendly? How do they support hospitals as they move forward with their missions? How is there a marketplace of vendors? We were recently at a meeting and you were there, Marie, where we were talking about things like this and we had participation from technology vendors, large and small.

00:18:03:14 - 00:18:24:18
Jon Zifferblatt, M.D.
And not, you know, it wasn't a sales platform for them, but it was really a way for them to understand what is necessary. How does technology enable these things? Some of the things that Diane's been talking about have been greatly enabled by EHR builds and configurations. Other technologies, algorithms that identify the right patients to select for these interventions.

00:18:24:20 - 00:18:47:27
Jon Zifferblatt, M.D.
All of these things require a robust and healthy marketplace of technology. No philanthropy is going to come up with the right puzzle pieces, or even a single health system won't. The market will create them. But I think it's helpful to provide to the market: what does success look like? What are the guardrails? How are we who are delivering care of those who are delivering care, doing it?

00:18:47:27 - 00:19:06:05
Jon Zifferblatt, M.D.
And how are we who are enabling them thinking about this? And so for West Health, I think we're, you know, an honest broker, a neutral party, you know, we're nonpartisan, we're not a vendor. And so we try to showcase all of these things to allow both policy and the marketplace to come together to move these things forward.

00:19:06:08 - 00:19:25:06
Marie Cleary-Fishman
Well that's great, John, I love that. And yes, that was an amazing conference, an opportunity to see all of this in action. So that was really great.
Diane, thank you so much. And John, thank you for all of the things West Health does and the opportunity that we get to work with both of you.

00:19:25:08 - 00:19:33:19
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 - 00:00:28:25
Tom Haederle
Welcome to Advancing Health. Changes and challenges. That pretty well sums up the state of American health care in the last quarter of 2025. In this month's Leadership Dialog podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the American Hospital Association, we get a briefing from Stacey Hughes, AHA’s executive vice president of government relations and public policy, on the outlook for ending the government shutdown that began October 1st...

00:00:28:27 - 00:00:40:19
Tom Haederle
insights on what's expected on the legislative front for the remainder of the year...and an update on a host of issues important to the field.

00:00:40:22 - 00:00:59:26
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 for the American Hospital Association. I did my first leadership dialogue with Stacey Hughes, and there have been so many new changes and challenges, opportunities, developments since January that I felt that it was the right time to bring Stacey back for an update.

00:00:59:29 - 00:01:21:17
Tina Freese Decker
I can't wait to hear your insights, Stacey, on all that is playing out in Washington, D.C. and how the American Hospital Association is continuing to advance this work on behalf of our field. So, you and I have had lots of conversations over the past year. I am so grateful for your expertise. And just understanding what it feels like, what it's about, and what we should be doing as we go forward.

00:01:21:19 - 00:01:35:22
Tina Freese Decker
So let's start with what is top of mind for many of us, the current federal government shutdown. Can you give us a sense of how this government shutdown is the same or different from previous times? What do you think's going to happen?

00:01:35:24 - 00:01:55:22
Stacey Hughes
I'm so grateful that you invited me, and it's so fun to talk to you always and appreciate your leadership through all these different this this year for sure and heading into Q4, which is nice, but still a lot of challenges. So yeah, to your point, the shutdown, what is different? One, it's a full shutdown. The last shutdown in 2018 and 19, Tina, was a partial. And HHS was funded.

00:01:55:23 - 00:02:19:23
Stacey Hughes
Department of Defense was funded. This is a 100% shutdown of full government. And so that's really different.  I think second, one of the reasons a government shutdown, which I know we'll talk more about, is the concern Democrats have and want to use this opportunity to have leverage to get Republicans to support extending the EPTCs. I say that's a second difference in that this is going to play out in real time.

00:02:19:24 - 00:02:39:18
Stacey Hughes
You know, as we're speaking now and 21 days from now during this shutdown, or maybe it reopens, people are going to get their notices about their premium subsidies and those that have gone away during this time. So you've got sort of this dramatic dynamic that Democrats are kind of banking on so that people, everyday Americans, understand what a shutdown is.

00:02:39:18 - 00:02:57:13
Stacey Hughes
So for those two reasons it's very different. I will say in a lot of people ask me, how will it end? And, really nobody knows. I'll just add a few more facts about kind of this particular shutdown. You know, in terms of where we are, they've got about five payroll periods that are going to be coming up that are important.

00:02:57:13 - 00:03:20:17
Stacey Hughes
One I think it's been highly reported, which is the active military paycheck stops on October 15th. The second full government federal government employee paychecks stops between the 20th and 31st. Senate employees stop the 20th. You know, go down the line.  October 31st, the House employees stop receiving their paycheck. So that's kind of a an important mash up right there in terms of will that be impactful?

00:03:20:24 - 00:03:40:25
Stacey Hughes
They are moving money around to try to protect the WIC program. That funding is also expired. So there could be some action forcing events. I will say the president is going to be in Israel this weekend, rightly so, for an important ceasefire. And that's going to really occupy the news cycle till Tuesday. So I think we get back here Tuesday and we're kind of still stymied, Tina.

00:03:40:28 - 00:03:53:13
Stacey Hughes
So I don't know how this ends, but both sides feel like they're doing well. And I think frankly starting Tuesday it's a test of political stamina. You know, which party can withstand the things we just talked about.

00:03:53:15 - 00:03:56:24
Tina Freese Decker
Right. And it's challenging because all of those impact people.

00:03:56:26 - 00:03:57:09
Stacey Hughes
That's right.

00:03:57:16 - 00:04:01:25
Tina Freese Decker
The people, the federal workers. So on. And so what's a way to get unstuck from that?

00:04:02:01 - 00:04:27:08
Stacey Hughes
For sure. And I think for us, you know, because it is the Department of HHS, we also have some things that are affecting rural patients, in particular the telehealth pieces. As you know, that program expired September 30th when the CR was unsuccessful. And so did hospital at home. And, you know, that does affect real lives. According to CMS, there are about 1200 patients that were in the system during that month, between about 419 hospitals.

00:04:27:08 - 00:04:39:26
Stacey Hughes
And those patients, almost all had to be moved under the fact that the program was no longer authorized. So we feel it a little bit more than we normally would acutely. And with some of these programs not on the mandatory side, but it is real life implications.

00:04:39:28 - 00:04:56:11
Tina Freese Decker
True. So you mentioned this before. One of the sticking points is the enhanced premium tax credits, which, you know, expire at the end of the year. Why is extending those tax credits so important for hospitals and our members people? And what do you think is going to happen with those?

00:04:56:13 - 00:05:23:01
Stacey Hughes
Yeah. Boy, that's there's a great question. A couple things. Certainly we just came off the OBBA debate, right? And that already includes scoring estimates that up to 10 million people will be displaced from coverage over the next ten years. If you were to lose the enhanced subsidies which were part of President Biden's Inflation Reduction Act, as well as his American Rescue Plan, if those were to expire, you would see at least another 5 million individuals that would go from insured to uninsured status.

00:05:23:03 - 00:05:46:03
Stacey Hughes
But in addition, you know, under the four years of these enhanced subsidies, about 10 million people have come on the rolls and it's a substantial part of their ability to afford their care. 19 or 20 million people will see some reduction in their actual subsidy to pay for their premiums. And even if you get some of it, some people say a $12 differential to be the choice of staying covered or not covered.

00:05:46:06 - 00:06:06:19
Stacey Hughes
So that's number one was to create more people who are uninsured that would come through our doors. But importantly, also in terms of our own fiscal health, you know, we would estimate that's about a $28 billion loss of our ability to continue to provide services over the next ten years. So it's very real to hospitals in terms of what it would mean to our overall day-to-day ability to serve patients.

00:06:06:21 - 00:06:31:29
Tina Freese Decker
Right. And it is impacting in communities where we have payers offering the products and some not offering the products. So it's a very dynamic time happening on the ground. But then also what will happen in D.C. So thanks for that update. There are some more things from a comprehensive health care package that come together, such as structural changes to how pharmacy benefit managers operate or changes to Medicare Advantage.

00:06:32:02 - 00:06:36:24
Tina Freese Decker
What do you think is going to be put together in that sort of comprehensive package?

00:06:36:27 - 00:06:56:13
Stacey Hughes
Let's talk about the health part first. I guess I'll say that's where the PBM reform really does lie, and there's probably a combination of MA with regulatory and Hill. But right now is so acrimonious, Tina, I think while there was a lot of bipartisan support for both of those, I think that until they resolve this issue, it is going to be very difficult to restart those bipartisan conversations.

00:06:56:13 - 00:07:19:13
Stacey Hughes
And frankly, the longer this goes on, I think the more it will, you know, spoil the waters for those kind of conversations. In terms of, you know, is there an opportunity in December, you know, we would hope so. As you know, there was some significant proposals, ones that you mentioned, that were left on the cutting room floor last December when we had the health care, you know, end of year package and some other priorities on community health centers in May, as you mentioned.

00:07:19:13 - 00:07:43:15
Stacey Hughes
And so I think there's an opportunity, but it may actually bleed into next year. It's going to be solely dependent on the appropriations process. And once we open the government back up and there's a bipartisan solution for that, the question is how long, right? Is it a bipartisan solution just till next March? And normally our priorities and those types of priorities tend to travel just the length of the amount of time of the continuing resolution.

00:07:43:15 - 00:07:58:07
Stacey Hughes
So I'm not so sure when we'll be at that point of having more permanent PBM reform or MA reform. But the good news is I think the commitment to those are high. So we'll see if they revisit it. But I think they'll pick up where they left off once we can get the appropriations settled.

00:07:58:09 - 00:08:17:15
Tina Freese Decker
Okay. So you talked a little bit about December. I know the American Hospital Association has a full end of the year list of priority items. What are some of those other key issues that your team is tracking? And, you know, immigration, H-1B visa exemptions, maybe some of those. What are you thinking about that that we should be mindful of?

00:08:17:22 - 00:08:41:12
Stacey Hughes
There's no shortage of issues and it's real diverse. You know, I'll start with immigration. You know, I think everyone saw tension around the president's proclamation a couple weeks ago around adding a $100,000 fee going forward, the companies who are sponsoring H-1B visa applicants. And so on that one, we're looking and working very hard with the administration to try to seek exemption for health care workers. And that would be every clinical aspect, right?

00:08:41:12 - 00:09:02:26
Stacey Hughes
It would be lab technicians, physicians, nurses. You know, we are probably only 4.2% or 5% of the total of H-1B visas. So we're hopeful with the demonstrated workforce shortages that exist that we can have a good chance of leaning on the administration to be thoughtful about the exemption process for health care workers, that's number one. Tariffs,

00:09:02:26 - 00:09:29:05
Stacey Hughes
I think you mentioned to me that continues to be an area of concern. You know, we've engaged very significantly with some of the other stakeholders, obviously  AbbeMed and some of the other organizations. But for us, you know, a significant part of our PPE, which the president has now threatened a tariff on. Medical devices, which he's just renewed, a threat that an investigation about foreign and national security around tariffs, all of those really impact our domestic supply chain, our ability to access products.

00:09:29:05 - 00:09:48:07
Stacey Hughes
So those two are, you know, I wouldn't say left field, but they continue to occupy a lot of our bandwidth in trying to get some remedies for those two issues. Not to mention we're in that statutory rulemaking season. You know, we're in the part of this of the rule-making process. Our comments have been submitted but the government shut down. But the statutory rules still need to be addressed and worked on.

00:09:48:07 - 00:10:06:27
Stacey Hughes
This is when we spend our time with all the agency leaders, both political and career, and make our case coming off of our submitted comments and the field's comments. So a lot of challenges there, including some proposals on price transparency, obviously 340B, 340B obviously separate from the rule. There's the rebate model.

00:10:06:27 - 00:10:13:05
Stacey Hughes
So a lot is going to occupy our time and trying to influence these next 2 or 3 months for the year , Tina.

00:10:13:07 - 00:10:36:06
Tina Freese Decker
So, Stacy, my final question for you is, you know, you've been in this field for a long time. You know the players, you know the process. What advice can you give to our members as we're hearing about it, navigating through it, trying to be active with our government relations teams and legislative leaders and administrative leaders. What advice can you give to us that we should be doing?

00:10:36:09 - 00:10:53:02
Stacey Hughes
I just think it's engage. Engage, engage, engage. And I think that, you know, while it's a new, you know, group of single party leaders that are in town, I think everyone appreciates being able to hear our story and telling it well and telling it well with data, with real life consequences. And so I think just don't take your foot off the pedal on that.

00:10:53:02 - 00:11:09:12
Stacey Hughes
You know, the whole field really rose up in a way to tell Congress and the executive branch about the impact of the Medicaid cuts that were being considered. And I think we've got to continue to do that as we try to mitigate some of these issues and also make sure we're telling our story where we're innovating. Where we're creating efficiencies.

00:11:09:15 - 00:11:19:11
Stacey Hughes
What we're doing that is helpful in chronic disease. You know, we have a positive story to tell as well. And I think you'll find some, some people are really interested in what we can be doing to help improve health care.

00:11:19:14 - 00:11:38:26
Tina Freese Decker
I think that's a great reminder, Stacy. Of all the positive stories that we have, I was just rounding in one of our hospitals and I'm so impressed by what is happening. There's so many things that are happening to improve patient care that many people, including our legislative leaders, need to understand and recognize and know that they impact that our ability to provide that.

00:11:38:29 - 00:11:51:16
Tina Freese Decker
So thank you so much, Stacy, for your time today, for all of the work you and your team do on behalf of our field. And thank you so much for finding the time to listen to us. We'll be back next month for another Leadership Dialog conversation.

00:11:51:18 - 00:11:53:18
Stacey Hughes
Thank you Tina, appreciate your time.

00:11:53:21 - 00:12:02:03
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.

00:00:01:02 - 00:00:23:18
Tom Haederle
Welcome to Advancing Health. The impact of philanthropy can be a difference maker for a hospital or health system's mission of great patient care. In this episode of a four part podcast series, two experts from a leading health system share how philanthropy empowers clinical excellence and improves patient outcomes.

00:00:23:21 - 00:00:50:19
Sue Ellen Wagner
Hi everyone. Welcome to Advancing Health. I'm Sue Ellen Wagner, vice president of trustee engagement and strategy with the American Hospital Association. I'm happy to be joined by the leadership of Inova Health today. I'm happy to introduce Toni Ardabell, chief of clinical enterprise operations at Inova Health System and Sage Bolte, chief philanthropy officer and president of the Inova Health Foundation.

00:00:50:21 - 00:01:14:14
Sue Ellen Wagner
My first question: philanthropy can have a huge impact in helping a hospital or a health system achieve its mission and caring for our patients of our community while also supporting our operations. Can you talk about the role that philanthropy is playing right now on health care, and can you also talk about some of that broad, high level role that philanthropy is playing in Inova?

00:01:14:16 - 00:01:16:17
Sue Ellen Wagner
Toni, let's start with you.

00:01:16:19 - 00:01:52:01
Toni Ardabell
Philanthropy is extremely important to health care, and what it helps us do is provide services that we could not provide otherwise. And at Inova in particular, it works with our mission and it works with our priorities. We have three year priorities and annual priorities, and Sage makes sure that the fundraising is actually meeting those priorities. It helps us develop our service lines and our service lines, our specialty, for instance, neurosciences, pediatrics.

00:01:52:04 - 00:02:07:13
Toni Ardabell
And it really helps program development in those service lines so that we can offer extremely high acuity care and care that the community just wouldn't have without the help of philanthropy.

00:02:07:15 - 00:02:10:05
Sue Ellen Wagner
Thanks, Toni. Sage?

00:02:10:07 - 00:02:37:26
Sage Bolte, Ph.D.
Yeah. I think, you know, philanthropy across the nation right now is critical. We know that we are facing headwinds that some of us have really never faced before, and the opportunity for philanthropy to come forward - our community to come forward and support their local health system or hospital is critical. Right now, philanthropy is going to help keep the lights on for some health systems.

00:02:37:28 - 00:03:03:28
Sage Bolte, Ph.D.
Philanthropy in many systems are going to help extend care to areas where care might be minimized currently. The other aspect that philanthropy helps, at least at Inova, it really helps accelerate the things that we want to do but may not be able to do today, tomorrow, or five years from now, but with the support of philanthropy, allows us to accelerate on the work that we're committed to doing.

00:03:04:00 - 00:03:24:19
Sage Bolte, Ph.D.
The other aspect I think of philanthropy, at least at Inova, is, as Tony alluded, philanthropy follows strategy. And that's really critical because we don't want philanthropy starting and stopping. We don't want it to start something that then can't be sustained. We really want the investment of our community to be a legacy of the investment of the community.

00:03:24:19 - 00:03:42:28
Sage Bolte, Ph.D.
And that's really where I think currently and in the past and the future, philanthropy has such an opportunity to make an impact on the health of our communities and really connect people's hearts to the health and health outcomes of our community.

00:03:43:00 - 00:04:03:10
Sue Ellen Wagner
Thank you both. I think it's really important that connection to community because that really connects to the mission. Next question, I'm sure you've heard a lot about this before. Why is cancer and heart getting all of the support and the dollars? How do you begin to approach answering that question when folks ask you that from the community?

00:04:03:12 - 00:04:40:06
Toni Ardabell
They're getting all of the dollars because many people use those services. Many families have people who've had heart issues or who've had cancer, and so people's hearts are already tied to those two service lines. The other thing about those service lines is they are sort of image makers for health care systems. People think if you can do heart transplants or you can do the most sophisticated oncology like Car-T, then everything you do must be really good

00:04:40:06 - 00:05:07:01
Toni Ardabell
and you have a very high level of care in your organization. I also think a certain type of physician is attracted to those two specialties, and they are not shy about going out and working for philanthropic dollars. They will work with the foundation, they will show up at events. They will go to national meetings. And so they're very involved in that fundraising as well.

00:05:07:01 - 00:05:33:12
Toni Ardabell
It helps support their research. It helps support, special programs like We Have a Wonderful Life with cancer program that was started by philanthropy and continues to get supported by not 100%, but does get supported by it every year. And so they actually are two service lines that understand the importance of philanthropy to what they're able to do for their patients.

00:05:33:15 - 00:05:39:00
Sue Ellen Wagner
Yeah, I think the physician point is a really critical one that most of us probably don't think of.

00:05:39:01 - 00:06:06:23
Sage Bolte, Ph.D.
We have to remember that more than 85% of philanthropic support comes from grateful patients. And that is an important statistic, because when you think about the gratitude of patients and where the highest volume of patients live, it often is in those two areas in cancer and in heart. And beyond that, the relationships that they establish - because these are not short term

00:06:06:26 - 00:06:40:23
Sage Bolte, Ph.D.
you know, two visit relationships - these are relationships that they build over months, over years, sometimes over decades. And so the gratitude that these patients feel and their families feel for the care in which they receive, it shows up in the way that they provide philanthropic dollars. And to Tony's point, because many of these physicians, nurses, APPs, social workers like myself, I'm an oncology social worker, went into the field with the intention of those longer term relationships.

00:06:40:28 - 00:07:00:18
Sage Bolte, Ph.D.
I think they understand that, and they are capable and more willing to connect when they hear, "Thank you so much. Thank you for saving my mom's life. What can I do for you?" They're not shy to say, would you be willing to talk to one of my colleagues on the foundation team, right? Would you tell your story?

00:07:00:23 - 00:07:29:23
Sage Bolte, Ph.D.
Would you be willing to support the research that saved your mom's life, right? Those kinds of conversations they don't shy away from. The other piece of that, though, that I think it took me a while to understand, is when cancer is supported, at least at Inova, when cancer is supported, our musculoskeletal team is supported because what happens when a philanthropic dollar comes is it does offset the operational investment.

00:07:29:23 - 00:08:00:23
Sage Bolte, Ph.D.
So it frees up additional operational investments to be able to support something that might not have had philanthropic support or might not have had the operational dollars. And that's something that Tony and myself and the rest of cabinet are really working on creating that culture and that mindset of: we all win when a philanthropic gift comes in. We all win when a philanthropic gift comes in to any service line because it does support something that otherwise would have either had operational dollar support or wouldn't have happened.

00:08:00:23 - 00:08:04:25
Sage Bolte, Ph.D.
And would have waited for, you know, months to years. So we all win.

00:08:04:27 - 00:08:30:23
Sue Ellen Wagner
Yeah, very important points. Thanks so much. And that leads to my next question. You know, when people think of philanthropy and donations, they tend to focus on those large donors from the community. But there's really, you know, so much more than that. Can you both talk a little bit about the successes that you've had when creating philanthropic initiatives, and then the balanced donor audience?

00:08:30:26 - 00:08:41:10
Sue Ellen Wagner
We talked a little bit about that. You both did with the physicians, and then, you know, the community members who have that heart and cancer connection. But can you elaborate a little bit more on that?

00:08:41:12 - 00:09:14:28
Sage Bolte, Ph.D.
You know, again, I think what's really important in order to be successful in fundraising for a health system is that you have clear focus on your mission and you have clear alignment with the strategic priorities of the organization. That is critical. And when you do that, and when everyone in leadership is able to articulate what your mission is, what your strategic priorities are, and where the philanthropic alignment is with those strategic priorities, you're able to tell a really powerful story to the community.

00:09:15:00 - 00:09:41:24
Sage Bolte, Ph.D.
And that story in many what we call segments in philanthropy is critical. So, yes, a lot of health care right now is winning with the larger donors who are coming and giving substantial what we would call transformational gifts, right? Multimillion dollar gifts. And those are truly transformational and life giving to an organization. And there's only so many of those.

00:09:41:24 - 00:10:07:10
Sage Bolte, Ph.D.
So to be successful in philanthropy, you really have to look at a wider scope of donor opportunities. So those we call those mid-level giving donors, those annual donors, the people that are willing to give you $100 a month or $100 a year, those opportunities to keep them connected, that $100 is so valuable to them, and they're giving it to you.

00:10:07:13 - 00:10:14:25
Sage Bolte, Ph.D.
And our opportunity as an organization is to ensure that they feel that $100 matters.

00:10:14:28 - 00:10:46:02
Toni Ardabell
So what I would say from an operations perspective, I've learned over the years how important it is to take every gift seriously. I would also say we need to role model giving to our own organizations. If we believe in the work we're doing as executives, then we need to step up and donate ourselves. I also know, I tell Sage this, I have the experience of one family

00:10:46:05 - 00:11:08:13
Toni Ardabell
when I was in charge of women's and children's services, sent me a check out of the clear blue sky because their baby was in the NICU, had never really been involved with Inova. It was maybe a $10,000 check and I called them to thank them and asked if they would like to be recognized in some way. They're like, no, no, we don't want to get involved,

00:11:08:13 - 00:11:34:18
Toni Ardabell
we just want to give you money. And every year that increased. For the 6 or 7 years I was in that job, the check kept getting more every year. And I've learned it's important to let people give to where their hearts are. And if you've been a patient of ours, maybe it was the NICU, or maybe it was the pediatric floor or maybe it was the cardiac ICU.

00:11:34:21 - 00:11:54:21
Toni Ardabell
Whatever you give is meaningful. And folks need to know that their giving makes a difference. And when you believe that and your heart's in it already, then you're willing to give the larger and larger gifts that you can afford to give and know that it's appreciated.

00:11:54:23 - 00:12:21:26
Sue Ellen Wagner
Thank you both. A lot of really great important points. I really like the fact that no matter of the dollar amount of the gifts that you need to make everyone feel important, that they're contributing to their local hospital. So I think that's a really important takeaway. And that leads to my last question. Do you both want to share any final thoughts with our members on the philanthropy strategy that they should be looking at today?

00:12:21:28 - 00:12:55:03
Toni Ardabell
Hire a Sage Bolte! No, actually your leader is very important. It helps if you're a clinical leader in health care for fundraising because Sage understands the organization and what we do here in a way that a non-clinical leader may not understand. There are good non-clinical leaders in philanthropy but I think it is even better for the team to have a clinical leader there.

00:12:55:06 - 00:13:04:19
Toni Ardabell
And there needs to be total integration between philanthropy, strategy and operations. I think that's the secret.

00:13:04:22 - 00:13:44:13
Sage Bolte, Ph.D.
Where health systems have an opportunity is just to reinforce what Tony said. Your chief philanthropy officer should be at the table with the executives, issued a report to the CEO. And I'm fairly biased on that because I've seen the success that can be had when your CEO is highly integrated into the philanthropic strategy and opportunities. When you see your CEO giving others gifts, creating a culture of philanthropy, not just externally, where people around the health system have the opportunity to give, but those inside the health system, those who are caring for patients. When they give

00:13:44:17 - 00:14:17:15
Sage Bolte, Ph.D.
they also are, more connected to how the gifts have impact. They're more connected to the work of philanthropy, and they're more willing to tell their own story of gratitude, of where they've had impact. So giving, as Tony said, at the highest level, down to our frontline staff. And again, that could be $5 a year. But knowing that they're giving to the organization,  that culture of philanthropy, of both giving but also connecting people to the opportunity to give is really, really important.

00:14:17:18 - 00:14:35:26
Sue Ellen Wagner
Toni and Sage, thank you so much for joining me on this podcast today to discuss the impacts that philanthropy has had on your community and your employees. We really can't wait to hear what's next for Inova and appreciate all that you're doing for your community.

00:14:35:29 - 00:14:44:11
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.