Advancing Health Podcast

Advancing Health Podcast / en Fri, 02 May 2025 19:15:48 -0500 Mon, 28 Apr 25 11:08:26 -0500 Leadership Dialogue Series: Cybersecurity and the Fight to Safeguard Health Care /advancing-health-podcast/2025-04-28-leadership-dialogue-series-cybersecurity-and-fight-safeguard-health-care From ransomware attacks to data breaches, the stakes for hospitals and health systems to protect their patients have never been higher. In this Leadership Dialogue conversation,&nbsp;Tina Freese Decker, president and CEO of Corewell Health and 2025 AHA board chair, talks with John Riggi, national advisor for cybersecurity and risk at the 黑料正能量 Association, about how health care leaders are planning to mitigate cyberattacks, the need to build resilience to these threat-to-life crimes, and why forging partnerships with the government and the private sector is crucial for defense.This podcast has been modified for time. To view the entire Leadership Dialogue, please visit <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fyoutu.be%2FfHgCZJFQa60&amp;data=05%7C02%7Cdsamuels%40aha.org%7Cf8bf1343f184401f206708dd866f9398%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C638814536022345698%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=BRGMWCo2BCIUx3%2B25Wb4Eax0qRNgJOK%2Bzc1tpZWzLzg%3D&amp;reserved=0">https://youtu.be/fHgCZJFQa60</a>.<hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript </h2> </summary> 00:00:01:01 - 00:00:26:02 Tom Haederle Welcome to Advancing Health. Cybersecurity is a risk. And because of that, a priority for all hospitals and health systems. In this Leadership Dialogue, Tina Freese Decker, chair of the 黑料正能量 Association, and John Riggi, AHA鈥檚 national advisor for Cybersecurity and Risk, discuss planning for cyber attacks, putting protections in place, navigating cyber threats, and rebuilding trust and confidence in the system 00:00:26:04 - 00:00:31:01 Tom Haederle when cyber attacks do occur. 00:00:31:04 - 00:01:00:23 Tina Freese Decker Hello, and thank you so much for joining us today. I'm Tina Freese Decker, president CEO of Corewell Health and the board chair for the 黑料正能量 Association. From data breaches to ransomware attacks to outages, cybersecurity affects patient safety and enterprise risk and is increasingly a strategic priority for hospitals and health systems. Planning for cyber attacks and putting the proper protections in place is key to ensuring sustainability, patient privacy and clinical outcomes. 00:01:00:26 - 00:01:34:22 Tina Freese Decker So I am so pleased to have the 黑料正能量 Association's John Riggi joining me for today's conversation. John is an expert in this field, and he serves as the AHA's first national advisor for cybersecurity and risk. He joined AHA in 2018 after a long, distinguished 30-year career with the FBI. He brings with him tremendous experience in the investigation and disruption of cyber threats, as well as the unique ability to provide informed risk advisory services to hospitals and health systems. 00:01:34:24 - 00:01:41:26 Tina Freese Decker So before we jump into the conversation, John, can you just tell me a bit about yourself so that our audience can get to know you a little bit better? 00:01:41:29 - 00:02:08:13 John Riggi Thank you, Tina, so much for inviting me here today to discuss these topics, which unfortunately, as you said, top of mind for everyone. So when I ended my 30-year career at the FBI, I still wanted to be in a position to serve. I spent a lifetime doing that, and in my last role at the FBI, my job was to establish mission critical relationships with private sector, with critical infrastructure in the health care sector in particular. 00:02:08:15 - 00:02:29:22 John Riggi That's when I had the privilege and honor to be introduced to AHA and Rick Pollack in talking about cyber threats. And that's when I really learned how critical a role that the 黑料正能量 Association served for the entire health care sector. I could send over, you know, an immediate urgent alert to the and with a single press of a button 00:02:29:29 - 00:02:56:16 John Riggi 5000 plus hospitals received that alert. 50,000 executives received it. So I understood at that point we needed to engage in that continuing relationship. And when I retired, fortunately for me, Rick Pollack in the team said, John, you know, we've been listening to you and we think cyber will be an emerging threat, going forward. Unfortunately, none of us realized how significant a threat it would be. 00:02:56:19 - 00:03:00:12 John Riggi And so, again, my privilege and honor to be here with you today. 00:03:00:14 - 00:03:22:21 Tina Freese Decker Well, we are privileged and blessed that you are part of the 黑料正能量 Association team, and you're helping us navigate so many of these issues that come forward. Let's start with kind of one of the underlying questions that I have. We've seen all these cyber and physical threats that have targeted hospitals and health systems. How have they evolved over the last, let's say, 7 to 8 years? 00:03:22:24 - 00:03:58:21 John Riggi Yeah, unfortunately they've increased pretty dramatically. So not only are they increased in frequency, but also in complexity and severity of impact. So on the cyber front, we have seen a, for instance, in hacking of patient health information. In 2020, it was about 450 hacks impacting 27 million individuals, not inconsequential. Last year, last year with the Change Healthcare attack, we had 259 million Americans had their health care records stolen or compromised by foreign bad guys, by foreign bad guys. 00:03:58:27 - 00:04:24:17 John Riggi If we add up the numbers, just since 2020, over 500 million Americans have had their health care records compromised or stolen. So, John, wait a minute. There's only 330 million Americans. That's the population. Meaning that every American in this country has had their health care records compromised more than once. But what really concerns us are the dramatic increase in ransomware attacks, which are often accompanied by data theft attacks. 00:04:24:19 - 00:04:51:12 John Riggi So these bad guys, primarily Russian speaking, believed to be provided safe harbor by the Russian government primarily but not exclusively Russian, have increased these attacks so that the impact really is not only disablement of technology, internal networks get shut down, data gets encrypted, organizations are forced to disconnect from the internet has a very, very dramatic impact on care delivery. 00:04:51:15 - 00:05:18:21 John Riggi So this resulting disruption, delay to care delivery and ultimately posing a serious risk to patient care and safety, not only for the patients in the hospital, but for the entire communities that depend on the availability of their nearest emergency department for life saving care, radiation oncology, so forth. So we've seen that evolve again very significantly, and one of the reasons I think it's evolved so dramatically. 00:05:18:23 - 00:05:30:21 John Riggi Geopolitics is part of that. But I think on a very base level, we as a sector depend more and more on network and internet connected technology and data. 00:05:30:24 - 00:05:56:13 Tina Freese Decker Very true. You know, I did a podcast earlier this year about trust and rebuilding confidence and trust and having that public trust in health care systems and hospitals. And when you have a cyber attack or an act of violence that targets hospitals, health systems, it impacts patients, like you said, it impacts staff and our communities. How can we go about building that trust and regaining that confidence when we have these instances occur? 00:05:56:15 - 00:06:06:23 Tina Freese Decker And do you have some examples of stories or insights organizations have used that have helped them navigate those cyber threats and build that public trust? 00:06:06:26 - 00:06:32:07 John Riggi Great question, Tina. And also on the on the violence side, unfortunately, as I wanted to mention as well, that's increased pretty dramatically to set the stage there. I was shocked, as a former law enforcement officer, to find out nurses are the second most assaulted profession outside of law enforcement. And, you know, we expect it as law enforcement officers to be engaged, confrontational engagements. 00:06:32:07 - 00:06:37:09 John Riggi You're making arrests, but nurses who just want to deliver care to help people? Shocking. 00:06:37:09 - 00:06:38:19 Tina Freese Decker It's sad and unacceptable. 00:06:38:23 - 00:06:58:27 John Riggi Agree, totally. So I think how do we how do we get that trust in the community? I think one - and I think we've done a fantastic job with your leadership and the AHA - acknowledge the risk, acknowledge the threat. Let's not hide it. Let's not pretend it's not there. But then to take real steps to prepare and help mitigate the impact of these threats. 00:06:59:00 - 00:07:25:01 John Riggi So now we see, on the cyber side, hospitals are actively working to develop better downtime procedures, better backup systems to help shorten the length of the impact and help recover more quickly. And work with the federal government. Exchange threat information across the sector with our partners in other sectors. And really understand if we're attacked, this isn't a stigma. 00:07:25:02 - 00:07:51:18 John Riggi This isn't something that an organization failed to do. We're all in this together. And on the physical side, we're working very closely with the FBI to help develop resources to help identify and mitigate targeted acts of violence directed toward health care organizations. But most importantly, our frontline health care heroes, our frontline health care workers. And again, working with the community, this is all partnership with the community as well. 00:07:51:20 - 00:08:08:05 Tina Freese Decker So I'm sure you have a top ten list of things that we could do to prevent these attacks. But if you could share the top three things that we should do to prevent these attacks and how we can be resilient. And when I say attacks, I'm talking cyber and physical. We have limited time, we have limited resources. 00:08:08:05 - 00:08:10:19 Tina Freese Decker But what is the most important things that we should be doing? 00:08:10:22 - 00:08:36:21 John Riggi I think the overarching umbrella that all the others follow under is leadership. And really looking at these risks, acknowledging them and ensuring that both cyber and physical risks are treated as an enterprise risk issue. And then within that, on the cyber side, making sure on the defensive side that you're following well known, well-established, recognized cyber frameworks, making sure you start there. 00:08:36:24 - 00:09:03:08 John Riggi Second, really thinking about third party risk. What we have seen is that a majority, the vast majority of cyber risk, cyber attacks we face come to us through insecure third party service providers. Insecure third party technology and insecure supply chain. Doesn't negate us from our responsibility to do what we can, but we have to understand that. And then the third thing is ultimately prepare. 00:09:03:10 - 00:09:24:08 John Riggi We must prepare for the attack. There's an often, I would say, overused expression in the cyber security world. It's not a matter of if, but when. It's true. But I would also change that a little bit about it's not a matter of if you will be attacked. The question is are you prepared? So focusing on resiliency and so forth. 00:09:24:10 - 00:09:55:13 John Riggi And then with on the physical side, education of staff, leadership priority, and working with the FBI and local law enforcement to potentially identify ahead of an incident acts of targeted violence directed towards the hospital. And then working together as a community help mitigate and prevent that act. The police always want to respond, can respond after the FBI. But I can tell you from personal experience, we'd rather prevent a crime, prevent an act of violence than respond after the fact. 00:09:55:15 - 00:10:19:15 Tina Freese Decker Agree. And I think that developing those relationships with local FBI, with local law enforcement is critical because you to your point, it's not if, but when. But we'd like to be able to prevent all of it. Having those relationships is key. So I know that the AHA has been working very closely with the FBI and some health care systems to exchange that threat intelligence and enhance collaboration across our sector 00:10:19:15 - 00:10:28:21 Tina Freese Decker and with federal agencies. Can you share more about that partnership and how it has helped us in identifying and mitigating both physical and cyber threats? 00:10:28:24 - 00:10:51:26 John Riggi Great question again, Tina, and thank you for highlighting what we're doing with the FBI. So on the cyber front, we've been actively engaged in cyber threat, information threat intelligence exchange. Both on a very technical level, exchanging what - without getting too technical - threat indicators, malware signatures and so forth, but also identifying big strategic threats that we may face as a sector. 00:10:51:28 - 00:11:19:23 John Riggi So, for instance, working with the FBI, we helped identify last year a threat to the blood supply before it was on the government's radar. We helped the government understand that cyber attacks on hospitals are not just data theft crimes. These are truly threat to life crimes. So the federal government actually previously raised the investigative priority level of ransomware attacks on hospitals to equal that of a terrorist attack once they understood what the impact was. 00:11:19:24 - 00:12:00:17 John Riggi We are working very closely with the famed Behavioral Analysis Unit of the FBI, the profilers that many books and TV shows and movies have been written about to develop resources to help hospitals identify targeted acts of violence, threats that are pending against hospitals, and again, help intercede, intervene and help prevent those attacks. We have a whole series of resources available on the first ever joint FBI and Joint Health Care Sector webpage. We're about to issue a manual coming out here within the next month or so, based upon, joint work with the FBI in the field on best practices and lessons learned to prevent these acts of violence. 00:12:00:17 - 00:12:06:08 John Riggi So we have a robust, almost daily interaction with the FBI and other federal agencies. 00:12:06:10 - 00:12:25:15 Tina Freese Decker It's so helpful to know that we have those robust partnerships at the national level, and then we can create it at the local level, and to make sure that we're all in this together to, help protect our patients and the people that we care for in our community. So that's wonderful. My last question for you is just one about how we look forward. 00:12:25:17 - 00:12:38:26 Tina Freese Decker Can you tell us what you think about is going to happen in the threat environment for 2025 and maybe into 2026? What are those things we should be watching, looking out for? And is there anything positive that you can see? 00:12:38:29 - 00:13:11:18 John Riggi I will let you know there is some hope. Talk about the realistic environment. Then we'll talk about where I see the hope. So first of all, I do believe that the frequency of the attacks may decrease, but I think the bad guys are looking to make a greater impact. We have seen them go after systemically important organizations that serves health care. Change Healthcare, for example. Last year, attacks against the blood supply. The year before they attacked - found vulnerabilities in a commonly used technology and software known as Move It. 00:13:11:21 - 00:13:41:03 John Riggi By attacking that software, it gave the bad guys, a Russian ransomware group, were able to gain access to millions and millions of patient records. I do believe geopolitics will have a very significant influence, for better or worse, on the level of cyber threat we face. Depending on how we deal in the outcomes of our negotiations, of our diplomatic efforts with Russia, China, North Korea and Iran has the potential to mitigate or increase the cyber threats that we face. 00:13:41:05 - 00:14:08:19 John Riggi And ultimately, again, third party risk, major, major issue. Where do I see the signs of hope? And there are signs of hope, folks. Honestly, I have never seen the sector come together to share threat information to prepare for attacks, best practices, lessons learned not only amongst the sector. We see channels of threat information sharing and best practice across with other critical and sectors, with the federal government. 00:14:08:21 - 00:14:45:26 John Riggi We've had victim organizations, CEOs come out publicly. Dr. Leffler from University of Vermont, Chris Van Gorder from Scripps. We've had Eduardo Conrado from the recent attack against Ascension not only come out publicly, but testify before the UN Security Council last November about the impact of this Russian ransomware attack against Ascension. So what I see is hope. The fact we are banding together and with the government and I hope, as we did in the great fight against terror, international terrorism, we will come together in a whole of nation approach to help mitigate that risk. 00:14:46:01 - 00:15:09:17 John Riggi Now, Tina, I know I've done a lot of speaking here, and if I may, and with all due respect, I'd like to ask you a question if I could. Tina, in your role, you have very unique dual role. You're CEO of a large health system, and you're also the chair of the 黑料正能量 Association board. So how do you think about cyber and physical threats for your own organization 00:15:09:19 - 00:15:11:20 John Riggi but on a national level? 00:15:11:22 - 00:15:33:26 Tina Freese Decker Well, I believe that cyber and physical threats must be prioritized. It's a strategic risk. We have to understand how we focus on it, and we have to significantly prioritize it and emphasize what we're doing there. Previously, maybe 5 or 10 years ago, it was just thought of as a technical issue. It's not that. It's how we operate. Because like you said, we're so connected, 00:15:33:26 - 00:16:01:07 Tina Freese Decker it's critical infrastructure and we must make sure that we are coming together. So for us as an organization, we prioritize our efforts, our investments, our work on it, but also prioritize business assurance. So how do we operate and make sure that everyone understands all the key components and the lessons that you shared on this discussion today, but also when we've had conversations before, how are we making sure that we know those and our teams know those? 00:16:01:09 - 00:16:25:19 Tina Freese Decker I think the importance of safeguarding sensitive patient data and ensuring the integrity of our systems cannot be overstated. And that applies for my organization, and that applies for all of our members throughout the 黑料正能量 Association. And so I think those are some critical points. As we think about this it is making sure that we are safeguarding sensitive patient data and ensuring the integrity of our systems, as we go forward. 00:16:25:19 - 00:16:59:14 Tina Freese Decker That cannot be overstated. And as we do that, I think we all uphold that level of commitment to excellence that our patients and the people in our community want. So, John, thank you so much for your time today, for sharing your expertise. While we may not be able to prevent or mitigate everything, you have given us such great advice and we should make sure we take that down, but also listen to many of your podcasts that you put out or the Action Alerts that you sent through because they are helpful and direct and provide that great advice to move forward. 00:16:59:16 - 00:17:17:11 Tina Freese Decker And I know that you are available to connect with all of our members if there is a specific situation, or they just want to learn more to make sure that we're better. So thank you, John, for being here. And thank you to all of those that have tuned in to this conversation. We will be back next month for another Leadership Dialogue. 00:17:17:13 - 00:17:25:24 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. </details></div> Mon, 28 Apr 2025 11:08:26 -0500 Advancing Health Podcast Quality 101: How University of Utah Health Strengthens Board Culture for Better Patient Outcomes /advancing-health-podcast/2025-04-21-quality-101-how-university-utah-health-strengthens-board-culture-better-patient-outcomes Developing a strong board culture of quality and safety is a heavy but necessary lift for any health system. In this conversation, University of Utah Health's Kencee Graves, M.D., hospitalist and palliative medicine physician, and David Colling, vice chair, Community Board of Directors, discuss how a 鈥淨uality 101鈥� approach helped bridge knowledge gaps between clinicians and board members, and why making this transformation interactive leads to stronger strategic alignment and better patient outcomes.<hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript </h2> </summary> 00:00:01:01 - 00:00:30:06 Tom Haederle Welcome to Advancing Health. Quality and patient safety are the twin engines driving the mission of every hospital and health system, and both clinicians and board members have an important role to play in achieving these goals. Coming up in today's podcast, we hear from two experts from University of Utah Health about some of the best ways to help board members understand the critical role they play in making sure that quality and safety are always foremost in the patient experience. 00:00:30:09 - 00:00:53:15 Nikhil Baviskar Hi, I'm Nikhil Baviskar program manager, trustee services here at the 黑料正能量 Association. Today I'll be discussing the critical role the board plays in quality and safety. With me are Dr. Kencee Graves, who is the interim chief medical quality officer at University of Utah Health and is an associate professor of internal medicine, where she practices as a hospitalist and palliative medicine physician. 00:00:53:18 - 00:01:16:24 Nikhil Baviskar Also with us today is David Calling, who has served on the University of Utah Hospitals and Clinics Board since 2016 and is currently vice chair and co-chair of the board Quality and Safety Committee. Dr. Graves, I'd like to start with you. You recently presented to the board at University of Utah Health on quality and patient safety, an extremely important topic now and always for board members. 00:01:16:29 - 00:01:19:18 Nikhil Baviskar Can you give us an outline of that presentation? 00:01:19:20 - 00:01:51:22 Kencee K. Graves, M.D. Thanks for having us. And I think this is a really important topic. So when I gave this presentation to our board, I was new in this role. And what I learned was people around me, our board, our staff, people did not really understand the nuts and bolts of quality and the details. And so one of the things I offered to do was a quality 101 session. And my intent in doing that was to make sure that the group I would be working with and I were starting on the same page, so we both knew kind of what was going on in the landscape of quality. 00:01:51:25 - 00:02:10:18 Kencee K. Graves, M.D. So the content of my presentation really came from the questions I was being asked in my first few months in this role. And that is, what is quality? What is safety? How they are different. So what sets those apart? What are these ranking systems all about? Why do we do that? What are accreditation bodies, why do we do that? 00:02:10:20 - 00:02:22:05 Kencee K. Graves, M.D. And then, what is a quality structure? So what are you responsible [for]? Who works for you, that kind of stuff. And so really that's what my outline was, was just the basics, what I consider the basics in quality. 00:02:22:07 - 00:02:38:29 Nikhil Baviskar I think it's great that you, you did something where everyone starts at a level playing field. That sounds like a really wonderful way. I know that not everyone has the opportunity to do so, but definitely a good way to get everyone on the same page. Can you give us the response that you received from the board members to that presentation? 00:02:39:01 - 00:02:57:20 Kencee K. Graves, M.D. Yeah, I do want to call out - when I started, I actually had really good support from our board members. And they told me that this is something that they wanted. And so I felt like I had an open invitation because Dave and our CEO said, hey, we really think people could use something like this. Would you be open for it? 00:02:57:20 - 00:03:15:20 Kencee K. Graves, M.D. So they gave me the time. Many of them had been to the AHA and we used an AHA podcast by Jamie Orlikoff to kind of set the tone for that session. And so people went in with a really curious mindset. I actually did a Google survey after I gave the talk to make sure people learned and felt like it was valuable. 00:03:15:22 - 00:03:35:21 Kencee K. Graves, M.D. The feedback I got were that people felt like they knew more about quality after this session than they did before. They loved hearing about what we did at the U. They really felt strongly about supporting quality and supporting our leadership and driving toward high quality care, and they wanted to know how they could be more involved. 00:03:35:23 - 00:03:44:27 Nikhil Baviskar So, David, question for you as one of the University of Utah Health board members, what was your reaction to this presentation? 00:03:45:00 - 00:04:03:12 David Colling Yeah, Nikhil, what I would say is a couple of things, a few things that Kencee mentioned. But also remember, community board members typically are not clinicians, they're not health care employees, so this is a bit of a foreign environment for them. And that's part of the point, right. To have community board members get, you know, to offer a different perspective. 00:04:03:14 - 00:04:22:09 David Colling But what can happen is, as a board member, you can get pretty overwhelmed pretty quickly with whether it's the acronyms, the accreditation, you know, all the different things Kencee trained on can be pretty overwhelming for community board members. So, I thought it was excellent. And once again, I want to reiterate, it was really a 101. Kencee 00:04:22:09 - 00:04:40:02 David Colling didn't take any for granted, whether it was an acronym or a word, something need to be defined. It was really quite effective in the way that she approached it. You know, the other thing I think is it helped us continue to elevate quality and safety, you know, as a really important topic for the board. Right? So this is not a sideline. 00:04:40:09 - 00:04:55:17 David Colling This is a really, really important really the driving force behind the board. You know, maybe besides finance and some other things, you know, a really important piece of piece of the work that we do. So I think there's a couple of things, that I reacted to. And frankly, I've been a board member for, as you mentioned, almost ten years. 00:04:55:19 - 00:05:03:13 David Colling And I learned a lot. So what does that tell you? Right. So I think it's good for existing board members and new board members. 00:05:03:16 - 00:05:14:01 Kencee K. Graves, M.D. I think it was a really important launching point for the CMS structural measure that requires patient safety to be part of board meetings. That would have been difficult if we had not done already the Quality 101 session. 00:05:14:03 - 00:05:35:29 Nikhil Baviskar Thank you for mentioning that. What you're referring to as quapi, we're seeing a lot of folks, other boards that are realizing this is something that has to be integral to the planning process and the strategic planning process. David, I wanted to ask you, a follow up on that. So as the co-chair of the Board Quality and Safety Committee, you said you learned a lot. 00:05:36:01 - 00:05:46:01 Nikhil Baviskar Do you do you feel like Kencee's presentation sort of set maybe an agenda or help you and your other co-chair plan going forward? 00:05:46:04 - 00:06:02:13 David Colling Yeah. I mean, again, it gave such a good foundation, and I liked what Kencee said about us all being on the same page. So I do, I think it's set an excellent foundation for the committee moving forward. Got us all kind of in the same spot, whether you'd been there for ten years like myself or whether you're a brand new community board member. 00:06:02:15 - 00:06:19:22 David Colling You know, the other thing I thought it was nice to, you know, we had it wasn't just board members. It was the clinical and health care staff there as well. I think it's important for them to listen to the dialog, understand that should help them understand kind of that knowledge gap, whether it's quality and safety or whether it's other, you know, board activities. 00:06:19:22 - 00:06:32:15 David Colling You know, the community board members do need to be constantly reminded of definitions and things that come naturally to clinicians and health care workers, that that we need to continue to, to bridge that knowledge gap. So, yeah, absolutely. 00:06:32:17 - 00:06:43:01 Nikhil Baviskar So as you know, this podcast will be listened to, by other board members. David, can you give some nuggets of wisdom or some advice to other board members that may be listening? 00:06:43:04 - 00:07:04:06 David Colling Yeah for sure. So again, going to reiterate 101 basics. You know, don't take anything for granted. Don't make any assumptions. Assume that you're starting with everyone that knows very little about, you know, not necessary quality and safety, but certainly quality and safety in the context of the health care environment. I'd highly recommend making it interactive, almost a Q&amp;A ongoing, right? 00:07:04:06 - 00:07:23:12 David Colling So in other words, and I think we did that, you know, we never have enough time in our board activities. We probably could even have allotted more time. But as opposed to a report out on a presentation with Q&amp;A at the end, and we did some of this, I would argue we could have even done more with this kind of back and forth discussion with the community board members asking further questions. 00:07:23:16 - 00:07:41:15 David Colling Kencee being able to elaborate a little bit more, potentially even the health care folks and clinicians in the room adding a little bit of color. And we did some of that but I would encourage that. And once again, I would make sure that you include all certainly all community board members, regardless of tenure. You know, there might be the occasional one that feels like they know it. 00:07:41:15 - 00:08:01:11 David Colling I'd be amazed if, if a community board member, no matter how long you've been serving didn't learn something from the presentation. And once again, I would say the entire board should be included, that dialog is healthy and I think creates good understanding amongst all parties. And you know, Kencee, you mentioned the podcast that that we kind of did a pre-work. 00:08:01:12 - 00:08:20:28 David Colling You know, we asked everybody to listen to Jamie's podcast, and I want to say that was about a 30 minute give or take podcast, excellent foundation to reinforce the importance of quality and safety, right? So before we go into the 101 and the teaching piece, get everybody on the same page of the importance of it and the role it plays with the board. 00:08:20:28 - 00:08:29:10 David Colling So I thought that was excellent. You know, I'll call it pre-work and everyone should kind of be required to listen to that I think prior to the actual presentation itself. 00:08:29:12 - 00:08:46:16 Kencee K. Graves, M.D. I'm really glad you called out some of the interactive stuff and the keep it fun. I don't know if there's any chief quality officers listening, I do think that's an important piece. And so a couple things that I did that I thought worked really, really well. Survey questions after sections of my presentation. So I would talk about patient safety. 00:08:46:16 - 00:09:04:11 Kencee K. Graves, M.D. And then I would ask people what it is. And then I would give them four multiple choice questions. Put one in there that was funny. And that kind of thing kept people really engaged. I also put together a laminated front-and-back about what ranking system that we use at the University of Utah, and explained every section of that. 00:09:04:14 - 00:09:23:11 Kencee K. Graves, M.D. I went through my office and introduced people and talk about what they did, and that's the kind of stuff that people loved. They loved getting to know who their leaders are, and they really liked the human part. And I think that's critical because we're here for humans, right? Like quality care is for humans. And so that was kind of my undertone. 00:09:23:11 - 00:09:24:29 Kencee K. Graves, M.D. I'm glad David picked up on it. 00:09:25:01 - 00:09:42:16 David Colling And Nikhil, I'll just add one more comment to that. Yeah, the structure within the organization where quality and safety fits, the different roles. Again, something I kind of knew but didn't know in that level of detail. There's quite a bit more to the quality and safety than many would imagine. So I thought that was know really well done. 00:09:42:16 - 00:09:58:17 David Colling You know, Kencee, I don't know if I've mentioned it to you, but I think that presentation it's interesting is I went back and reviewed it. That almost needs to be kind of a continuous piece of reference material. I almost feel like I want to make it a little less of a PowerPoint and more of a reference piece. So there's an assignment for you. 00:09:58:17 - 00:10:16:07 David Colling But, you know, because it is so well done. It should be a continuous reference, you know, that's almost in your little in your toolbox as a community board member, because this is how busy we as committee board members are. You know, we've got our day jobs and we get so focused. So that presentation, which was extremely effective was only a few months ago. 00:10:16:09 - 00:10:30:20 David Colling But when I reviewed it, you know, even prior to this, discussion, I was like, oh yeah, I need to, you know, keep remembering this kind of thing. So I'm going to be referring back to that pretty regularly. So that might be another piece of advice, you know, use it as an ongoing resource for the for the board. 00:10:30:22 - 00:10:48:28 Kencee K. Graves, M.D. That's really good advice. And I want to go back to a point you made earlier where our accreditation partner is, that Det Norske Veritas or DNV. They were on site at the end of January. And so I reported that out to the board in February, and I included what DNV stands for and what it means and what they gave us citations on. 00:10:48:28 - 00:11:07:27 Kencee K. Graves, M.D. And I used graphics to demonstrate kind of each bucket. And I did have people that have worked at the University of Utah in leadership for more than a decade come up and tell me, thank you for doing that, because I think quality is such an alphabet soup that for those of us who work in it, it's easy to forget that it doesn't mean a lot to anybody else. 00:11:07:27 - 00:11:16:23 Kencee K. Graves, M.D. And so I would just say, I think it's really, really important to continue to revisit those abbreviations that may not land well without an introduction. 00:11:16:25 - 00:11:35:05 David Colling And Kencee, I would say that the entire clinical or healthcare environment, health care environment is a big alphabet soup. If I had one advice for, you know, the clinical and health care staff, beyond quality and safety, there are acronyms and short you know, wordings used for things that just don't come natural to community board members. 00:11:35:05 - 00:11:38:06 David Colling So I think that's a good reminder beyond quality and safety as well. 00:11:38:08 - 00:11:59:03 Kencee K. Graves, M.D. Yeah, I've spent a lot of time talking about what I think chief quality officers should do. But I'll tell you what I think has been valuable to me as interim chief quality officer with a board. The board members ask really good questions. And for me, that is my check on. Am I explaining something well? What does an average patient hear and think and see? 00:11:59:03 - 00:12:17:24 Kencee K. Graves, M.D. And how do they perceive us through the media? And what does the community say? And that is incredibly valuable because there are not a lot of spaces in my life where I hear that because I work in health care, I work around other doctors and nurses and the community board is my window to what the rest of the world sees when they see our health system. 00:12:17:27 - 00:12:37:28 Nikhil Baviskar That's very helpful. As you said, the board should reflect the community and that's really important. You know, Kencee or Doctor Graves, I'll ask you just one more thing. For the board members listening, I already asked this to David, but what do you think that the board member should take away when it comes to, you know, working on quality, understanding it and learning about it? 00:12:38:01 - 00:13:01:02 Kencee K. Graves, M.D. Part of that is, is what I said in that ask questions, stay engaged. And so if you see something or hear something that doesn't make sense, ask about it. The other thing that our board has asked me to do, which I found very, very helpful, is if I bring them a problem they've also asked me to report on who is responsible for it, what is the fix and when do I report back? 00:13:01:05 - 00:13:23:29 Kencee K. Graves, M.D. And that cadence has kept me giving them information that is meaningful. And then also they've learned to trust the information I bring them. It keeps me honest and keeps a closed loop communication. So I think that's been really good. I do think it's possible to skim over things, and I would just say, I think board members can and should ask really really good questions. 00:13:24:01 - 00:13:35:08 Nikhil Baviskar Well, thank you both so much for your time. This has been an awesome discussion and we really do hope that you know, your quality journey just continues getting better from here on out. So thank you again. 00:13:35:11 - 00:13:36:04 David Colling Thank you. 00:13:36:07 - 00:13:38:16 Kencee K. Graves, M.D. Thank you for having us. 00:13:38:19 - 00:13:47:00 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. </details></div> Mon, 21 Apr 2025 08:18:45 -0500 Advancing Health Podcast Ambient AI Technology at Cleveland Clinic: Reducing Physician Burnout and Enhancing Patient Care /advancing-health-podcast/2025-04-14-ambient-ai-technology-cleveland-clinic-reducing-physician-burnout-and-enhancing-patient <div class="raw-html-embed"></div>AI voice-enabled solutions are reducing physician burnout, enhancing patient interactions and transforming workflows across health care. In this conversation, Cleveland Clinic's Eric Boose, M.D., family medicine physician and associate chief medical information officer, and Rohit Chandra, Ph.D., executive vice president and chief digital officer, discuss the Clinic's initial pilot of ambient listening technology, lessons learned from implementation and what's on the horizon for AI in health care.<hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript </h2> </summary> 00:00:01:01 - 00:00:26:19 Tom Haederle Welcome to Advancing Health. Ambient listening technology is coming into wider use as a way to keep accurate records of the conversations between doctors and their patients. In today's podcast, we hear from two senior executives with the Cleveland Clinic about how their integration of this new application of artificial intelligence makes for better clinical notes and leads to a better experience for everyone. 00:00:26:21 - 00:00:55:20 Chris DeRienzo, M.D. Hi, this is Dr. Chris DeRienzo, AHA鈥檚 chief physician executive, and I am very excited for today's podcast. We get to have a conversation about AI enabled solutions in health care, and we get to have that conversation with two individuals who are leading the way at the Cleveland Clinic. We have both Rohit Chandra, PhD, executive vice president and chief digital officer for the clinic, as well as Dr. Eric Boose, he's a family medicine physician and the associate CMIO for Cleveland Clinic. 00:00:55:23 - 00:01:14:12 Chris DeRienzo, M.D. We're going to have a broad ranging conversation today. But, folks, just before we get started, I've been out on the road a lot. And I have heard from health system after health system who is implementing this ambient listening technology about the kinds of transformative outcomes that they're experiencing. And now we get to talk to folks who are seeing that firsthand. 00:01:14:12 - 00:01:31:20 Chris DeRienzo, M.D. And so, Rohit, perhaps the first question is to you, as the clinic begin to think about this universe of AI enabled solutions and ambient technology, what drew you to that as an offering that you wanted to get integrated into practice, you know, as quickly as possible? 00:01:31:23 - 00:01:46:27 Rohit Chandra, Ph.D. So thanks, Chris, for the question. I think that our belief is that over time, AI has the potential to impact multiple aspects of health care all the way from clinical to back office and everything in between. 00:01:47:00 - 00:02:18:16 Rohit Chandra, Ph.D. The thing that is particularly intriguing about ambient solutions is that they hit a critical pain point for physicians, and they have the potential to do it in a way that is safe. So ambient listening hits a pain point where physicians often spend multiple hours a day in documentation tasks. Those are obviously necessary from a regulatory and patient care perspective, but they take a lot of time. And the technology is almost perfectly suited at streamlining that burden. 00:02:18:18 - 00:02:27:00 Rohit Chandra, Ph.D. The second part of it is it can be done safely and make sure that there is human oversight so that there is no risk of any patient harm. 00:02:27:02 - 00:02:38:21 Chris DeRienzo, M.D. Let's talk about implementing this kind of a solution a little bit, because I couldn't agree more of the potential for safe, and better experience is huge. But this isn't the kind of thing that you can just turn on. 00:02:38:21 - 00:02:50:15 Chris DeRienzo, M.D. And so, Eric, perhaps this one to you. When you made the decision, yes, we want to pursue this technology, we want to get it into the documentation arms of our clinicians. How did you begin that evaluation process? 00:02:50:17 - 00:03:07:03 Eric Boose, M.D. Yeah, we know that there's quite a few of these software companies that are out there on the marketplace now. And so we want to make sure we found the right one for us. Isro had said we want to make sure it's safe, the content is appropriate. It's really helping the physicians and not being a hindrance to their day or some new technology that's being imposed on them. 00:03:07:06 - 00:03:27:18 Eric Boose, M.D. So we actually took the route of doing several pilots. We actually worked with five different ambient vendors to see which one would work well for us. We had about 50 physicians in each of those. We kind of jokingly called it like a "British Bake Off," because we were kind of having comparisons going on between five different softwares, but we thought it was important to make sure that we chose the right one for us. 00:03:27:20 - 00:03:41:28 Eric Boose, M.D. And just like choosing a car, you could go with that first one. It seems to work pretty good and you'll take it. Or you want to look at a variety and really make sure that the choice you're making is a good one, because it's going to be a major decision going forward. So we actually had a lot of fun with that. 00:03:41:28 - 00:04:05:15 Eric Boose, M.D. We saw a lot of different aspects of ambient software. What's available out there on the marketplace, which ones worked well? And got a lot of feedback from our pilot users. And everybody was just so excited about this technology. The idea of going from being a lot of data entry, which was a big disruptor when the HRs came on the marketplace, to having something actually doing the work for you and doing it well was super exciting. 00:04:05:17 - 00:04:13:04 Eric Boose, M.D. And to your point, you know, thinking about the idea of not having to spend the extra hours and all this documentation and focusing on other patient care we'd like to do. 00:04:13:06 - 00:04:22:24 Chris DeRienzo, M.D. Amen. I imagine so five different solutions, 50-ish clinicians per solution. How did you pick where to go and who to work with and which sites to do? 00:04:22:26 - 00:04:49:09 Eric Boose, M.D. Yeah, I mean, we had a whole evaluation process. A lot of the things you might think of when you're trying to determine if a tool like this would be appropriate for your organization. And one of them is, you know, around documentation, we want to make sure, first of all, they're not having to spend as much time documenting or getting that documentation done in a more timely fashion, getting home better, you know, in the sense of like less time after work hours or spending more time with our family or things that you want to do rather than doing all this extra work after hours. 00:04:49:11 - 00:05:06:03 Eric Boose, M.D. But we want to make sure the quality was there. So we worked with our, you know, audit folks to make sure that the notes were looking good. We were tracking what the physicians were doing, how often they were using it, what they recommended. We did some surveys around, before and after, you know, do you feel like your cognitive load is less? 00:05:06:03 - 00:05:25:08 Eric Boose, M.D. Do you feel a little less burnout? Basically, do you feel more comfortable and kind of enjoying medicine again, being able to sit there, not be worried about taking notes through the whole visit, but just having that face to face conversation that we all enjoy, including the patient. The patient certainly &nbsp;notices, too. Everybody seems more relaxed and it's just been going so much more smoothly. 00:05:25:10 - 00:05:42:14 Chris DeRienzo, M.D. That really hits home. I remember I had this spectacular family practice physician when I was, in western North Carolina, and he could, stay totally engaged in the entire visit while continually typing away at structure documentation. And he's sort of a unicorn. There are obviously other doctors who can do that, but most of us can't do that. 00:05:42:17 - 00:05:56:28 Chris DeRienzo, M.D. And so, you know, hearing that you walk through this very purposeful and intentional evaluation process. Rohit, I'm curious. How did you ultimately decide on which solution to implement? And then, what approach are you taking the implemented? 00:05:57:00 - 00:06:08:08 Rohit Chandra, Ph.D. So, a couple of comments. One, I think that traditionally humans have to overextend themselves to adapt to technology and that was sort of the journey with the EHR. 00:06:08:11 - 00:06:40:14 Rohit Chandra, Ph.D. The thing that's intriguing about these ambient solutions is that the technology increasingly adapts to the human interaction, and that's the appeal. So just wanted to sort of get that out there. In terms of actually piloting and then deciding what technology to go forward with, we feel that this capability is the start of a transformation journey, and we hope that this is a big decision that if you make a good decision will be transformative over time. 00:06:40:16 - 00:07:02:28 Rohit Chandra, Ph.D. What that translated into was a little bit of an approach that I have in bringing technology into the organization is "try before you buy." So that's what led us to say, hey, it's important for us to pilot something as opposed to just pick a partner based on sort of a superficial assessment. So I look back and say, I'm glad we did the pilot. 00:07:02:28 - 00:07:23:29 Rohit Chandra, Ph.D. We got a chance to test drive multiple technologies by hand and there's no substitute for that. And at the end of it, then you're far more confident in your solution and the capability and the potential that it has. In terms of actually piloting five vendors, we piloted with what we thought were sort of key players in the space. 00:07:24:01 - 00:07:44:23 Rohit Chandra, Ph.D. I am told that there are more than 100 different companies doing it, so. Goodness! Exactly. How many survive? How many find different variations? Time will tell. But at least we try to apply some judgment on which are the prominent ones that we should test drive. Like Eric alluded to, we looked at a few different criteria. 00:07:44:25 - 00:08:13:06 Rohit Chandra, Ph.D. First and foremost is the product capabilities, the quality of the transcriptions, the ability to deal with multiple languages, the ability to attribute the right conversation to the right person in the room. All of that is technology capability that needs to be done right. The second part of it is the quality of the summaries that are generated, whether for the patient, whether for the physician, all of those. You need revisions... 00:08:13:06 - 00:08:23:14 Rohit Chandra, Ph.D. how accurate and how complete is it? is a second consideration. Integration with the EMR so that the workflows are relatively smooth and not cumbersome is essential. 00:08:23:21 - 00:08:33:16 Chris DeRienzo, M.D. Let's pause there for a second, because I know there are many different possible solutions. But as we get into sort of the next part of our conversation, which solution did you ultimately go with? 00:08:33:16 - 00:08:40:15 Chris DeRienzo, M.D. And then what is the EMR platform that sits on top of just so listeners can have sort of a sense of, okay, this is what their environment looks like. 00:08:40:17 - 00:08:55:25 Rohit Chandra, Ph.D. I can get some of the basics, and then I'll defer to Eric to speak to the experience. So we're an EPIC house. Our EMR is EPIC. And it was obviously essential for us that the workflows that the physicians encounter are as seamless as possible. 00:08:56:01 - 00:09:01:15 Rohit Chandra, Ph.D. And I'll defer to Eric to speak to that part of it. But that was obviously an important part of our assessment. 00:09:01:17 - 00:09:19:00 Eric Boose, M.D. Yeah. So in the end, when we went through our different assessments, we ended up with ambiance as our solution for our ambient AI software. I do think there's something about ease of use for the user, right? Just like any other technology, if you throw in too many barriers or make it too complicated the uptake is much lower. 00:09:19:02 - 00:09:42:17 Eric Boose, M.D. All of these softwares in general are pretty elegant in their solutions in the sense that the listening of the visit all tends to occur on a phone that's listening through an app. But how it gets into the EPIC or whatever your EHR might be, the ease of use of having it there as a draft so that at that point can be reviewed, edited, added, subtracted before it's obviously accepted in the medical record was very important to us. 00:09:42:19 - 00:09:55:25 Eric Boose, M.D. And so ease of use in the integration doesn't have to be fully, deeply integrated. I wouldn't say, but it has to be nice and elegant so that things go through so quickly and smoothly that the uptake is done. And it's very easy to use. 00:09:55:27 - 00:10:03:06 Chris DeRienzo, M.D. And from the integration perspective, it's not just free text getting ported in. There are structured components to it that also have to get completed. Is that right? 00:10:03:09 - 00:10:23:04 Eric Boose, M.D. Correct. I mean, as the recording is in the AI software is working, it will bring back the note and all the different sections that you would need. So the HPI, API and results and erroneous systems is also as patient instructions, which actually turned out to be one of the surprises that we found very valuable was that as soon as the AI was done, it created the note. 00:10:23:10 - 00:10:34:20 Eric Boose, M.D. You could have the patient structures ready for them before they even left the exam room. Wow. And to have kind of like that written record of all the things I asked them to do, it was so nice for them as they left, having those instructions with them. 00:10:34:22 - 00:10:46:09 Chris DeRienzo, M.D. You're about a month since announcing partnership in the move forward. How's it going? What kind of outcomes are you seeing? Well, you know, what do you what are you focusing on now that it's going live across the clinic? 00:10:46:12 - 00:11:03:25 Eric Boose, M.D. I mean, it's been very exciting. We just started the implementation on March 10th. We did listen to our vendor ambiance a little bit, guiding us the way, you know, what's been successful for implementation across a large enterprise to start. And we work together also with our Cleveland Clinic culture to make sure how was accepted and brought forth to all of our providers. 00:11:03:27 - 00:11:20:10 Eric Boose, M.D. There are several thousand in scope to be using the product, and so we decided to do things in waves. Ambiance gave us some advice about which they felt which specialty models were ready to go out of the box, which ones they might need about, you know, 4 to 6 weeks to get really tuned up and some other ones that took about 12 weeks. 00:11:20:12 - 00:11:40:07 Eric Boose, M.D. So we're like, that's fine, we'll spread out the waves, so we'll launch as many as we can in wave one. And then move on from there. And we've actually within two weeks have about 1500 trained and almost a thousand using it already. We're getting feedback, you know, it's life changing. I love this product. I don't know how I survived without it. 00:11:40:09 - 00:11:41:00 Chris DeRienzo, M.D. Oh my goodness. 00:11:41:00 - 00:11:57:09 Eric Boose, M.D. We can all attest that it's been a struggle these days, right? We have a lot of information coming to us. We have a lot of patient expectations about getting back to them as quickly as possible. All this electronic health record and patient portals and just, you know, it's expected to be very quickly going through information and getting back to them. 00:11:57:11 - 00:12:15:16 Eric Boose, M.D. So this really helps us in our day in the sense of things happened so quickly with it that it's really unloading the other processes that we have to do during the day. And we're feeling that relief and we're seeing some of the docs saying, you know, I don't know if I'm going to cut back my time like I thought it was going to, or I may postpone retirement for a couple more years. 00:12:15:16 - 00:12:31:00 Eric Boose, M.D. I mean, things you would never think you would hear from physicians, right? This is like a technology they're asking for and begging for. Like, it was so interesting during the pilots. If there was a person that was in the office using it, yet three others weren't, they're all like, I want it. When can I get it? So that kind of energy has been building. 00:12:31:00 - 00:12:37:03 Eric Boose, M.D. And so when we launched it and advertised it, everybody was very, very excited about it. So it's been it's been going very well. 00:12:37:06 - 00:13:01:20 Rohit Chandra, Ph.D. Chris, I'll add a quick comment, which is most times technology is a little bit clunky to adopt and integrate, and understandably so. That's true for all of us as consumers. The nice thing was this technology's the integration and the ability to use it is pretty seamless. And the appetite and the enthusiasm for adopting it is unprecedented. 00:13:01:22 - 00:13:06:27 Chris DeRienzo, M.D. It's pretty rare for me to hear a positive, life changing story from a technology implementation. 00:13:06:27 - 00:13:27:26 Chris DeRienzo, M.D. But you've got it. And to be clear, like, this is the story I'm hearing everywhere. Health care is and will always be a uniquely human experience. And the more opportunities we have to thread our humanity back into the practice of medicine using this needle of technology, the better. We are just about out of time. As expected, this has been a fantastic conversation. 00:13:27:28 - 00:13:46:18 Chris DeRienzo, M.D. I am curious, though, as your ambient rollout continues through its the thousands of providers who are pulling to try to get to use it. What else do you see on the horizon with this kind of potential impact? And where are you sort of looking down the road towards other potential AI enabled use cases? 00:13:46:20 - 00:14:04:10 Rohit Chandra, Ph.D. I'll touch on a couple of things, which is we are currently rolling out ambient listening in outpatient settings. I think there's an opportunity to look at other scenarios and use cases in different settings where ambient technology can help streamline the documentation burden. 00:14:04:13 - 00:14:22:04 Rohit Chandra, Ph.D. I think the second part of it is while today we are leading with transcription and summarization, I think there's an opportunity to bring greater clinical knowledge to bear that can perhaps serve as a physician's assistant at their elbow, helping streamline more and more mundane tasks as we go forward. 00:14:22:06 - 00:14:38:10 Eric Boose, M.D. Yeah. And I think just to echo that, I kind of picture that as well - as sort of having this kind of copilot, you know, with you. Again, we have so much information we're trying to gather before we see a patient and deal with after we see a patient with testing, that I almost see it as like, could the AI bring everything together, like do a chart review? 00:14:38:10 - 00:14:58:16 Eric Boose, M.D. What care gaps do they have? What are actionable findings that may need to be promoted to make sure they follow up on? Almost like a patient briefing that when I open that record, tell me what I really need to know going into this visit to make sure that I take care of that patient very well. It's personalized to their care, and we make sure that the proper follow up and everything is sort of set up before they even leave the office. 00:14:58:16 - 00:15:09:12 Eric Boose, M.D. So I feel like there's a lot of those tasks that I think that as the AI products get better and they do a little more deep dive into the charts and help us with all that context is where I see this going next. 00:15:09:15 - 00:15:32:06 Chris DeRienzo, M.D. Well, if that is where we are going, then to all of the young folks out there who are studying medicine and nursing and respiratory therapy at an APP school, the future that awaits you is much better than the present that the folks on this call have lived through. We've gone through the challenging ages of early stage implementation and hopefully through the work that you all are doing leading the way at Cleveland Clinic, 00:15:32:08 - 00:15:43:08 Chris DeRienzo, M.D. we will help bring some humanity back into the practice of medicine for all those who get to follow us. It has been a real privilege to get to speak with both of you. Thank you so much for joining us today. 00:15:43:10 - 00:15:44:17 Eric Boose, M.D. Thank you for having us. 00:15:44:20 - 00:15:46:22 Rohit Chandra, Ph.D. Thanks, Chris. 00:15:46:24 - 00:15:55:06 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. </details></div> Mon, 14 Apr 2025 22:55:40 -0500 Advancing Health Podcast A Stronger Workforce: Strategies from the 2025 AHA Health Care Workforce Scan /advancing-health-podcast/2025-04-09-stronger-workforce-strategies-2025-aha-health-care-workforce-scan The 黑料正能量 Association鈥檚 2025 Health Care Workforce Scan offers important insights into the current state of the health care workforce and outlines potential approaches to address both present and future staffing challenges. In this conversation, Claire Zangerle, DNP, R.N., chief executive officer of the American Organization for Nursing Leadership (AONL), and senior vice president and chief nurse executive of the 黑料正能量 Association, and Joel Moore, DNP, R.N., chief nursing officer of MercyOne Genesis, and chair of the AONL Workforce Committee, discuss the strategies the Workforce Scan has identified, including how organizations can rethink culture, improve workforce pipelines, and leverage partnerships to rebuild a stronger health care workforce.To learn more about The 黑料正能量 Association鈥檚 2025 Health Care Workforce Scan, please visit <a href="http://www.aha.org/aha-workforce-scan">www.aha.org/aha-workforce-scan</a>.<hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript </h2> </summary> 00:00:01:05 - 00:00:26:29 Tom Haederle Welcome to Advancing Health. There aren't enough people working in health care to meet demand, either current or projected. In today's podcast, we learn more about how the 黑料正能量 Association's 2025 Health Care Workforce Scan has identified ways to enhance the overall workforce experience and help employers refresh, retain and recruit health care workers for the future. 00:00:27:01 - 00:00:51:14 Elisa Arespacochaga Hello, I'm Elisa Arespacochaga, vice president for clinical affairs and workforce with the 黑料正能量 Association. Joining me today are Joel Moore, chief nursing officer with MercyOne Genesis and chair of the AONL Workforce Committee, and Claire Zangerle, chief executive officer of AONL, the American Organization for Nursing Leadership and senior vice president and chief nursing officer with the 黑料正能量 Association. 00:00:51:17 - 00:01:10:06 Elisa Arespacochaga So today, we're here to talk about workforce, and we're here to talk about the 2025 Health Care Workforce Scan, which focuses on four opportunities hospitals and health systems have to really support their workforce. Because, as I have been known to say many, many times, there are no more people who are going to come work in health care. 00:01:10:06 - 00:01:29:07 Elisa Arespacochaga We've got to keep the ones we have, and we really have to do more to encourage them to want to be in health care because there is probably a reason they started in health care. They were called to be there. Those four areas are embracing technologically integrated care models and innovation. Let's use technology as best we can. 00:01:29:10 - 00:01:53:12 Elisa Arespacochaga The second is engaging the clinical teams in the design of those innovations. We've got to get them involved in all of those details. Third, boosting access by increasing that workforce through some innovative partnerships, encouraging more people to come into health care, who might not have thought of health care as a career and rethinking how we can engage with our workforce. 00:01:53:12 - 00:02:12:21 Elisa Arespacochaga And I know most of the world is rethinking how they engage with their workforce in a more remote era. But we're going to talk a lot about how do we work on all four of those at the same time, while continuing to take care of the patients that come to our doors every day. Joel and Claire and I'll ask Joel - for you to start. 00:02:12:23 - 00:02:34:00 Elisa Arespacochaga How are you seeing in your roles the field really connect these ideas together - from everything from how do we use technology? How do we bring the clinicians in to encourage more people to join health care and also really engage those we have? How do you see those threading together as you're trying to address workforce challenges? 00:02:34:02 - 00:03:04:28 Joel Moore Yeah, it's a great question. I really appreciate what you said at the beginning about us being called into nursing. And I think that starts with the person at the bedside. And so as I've seen models of care and workforce wrap around and through these four top-of-mind ideas from the Workforce Scan, we have to really focus on the person providing care and engage them at every level of the work. 00:03:05:01 - 00:03:39:03 Joel Moore I think some of the work from our history and from our past, how things unfolded, it was very much top down. At this era we need bedside nurses to be a part of technology innovation, redesigning the model of care, helping us establish what a healthy work environment is about. So I think we can tackle all four of these, but I think we have to have it driven by the nurse at the bedside, or from those frontline staff who are providing direct care to our communities. 00:03:39:05 - 00:03:42:17 Elisa Arespacochaga Claire, from your perspective at AONL, how do you see this? 00:03:42:19 - 00:04:13:27 Claire Zangerle, DNP, R.N. I think all four of these tenants for the Workforce Scan fit together very well to make a bigger picture of what needs to happen with the workforce. Embracing technology is so important because that in and of itself reduces the workload of those who are delivering care, whether they're in acute care setting, an outpatient setting, an ambulatory surgery center, post-acute care - wherever they are. Bringing those clinicians in to help make the decisions around the solution is essential to success. 00:04:14:00 - 00:04:39:22 Claire Zangerle, DNP, R.N. There's really no way that anything technologically around the workforce can be successful without that clinician voice. Making sure that we take down some of those barriers that many are seeing as access to getting into health care so that they can become part of the health care ecosystem, I think is important, too, and it's really incumbent upon us as leaders in health care to take those barriers down. 00:04:39:25 - 00:05:01:28 Claire Zangerle, DNP, R.N. And again, let's not forget about the people who are already here, who are already doing the hard work so that we can reengage them so that we can, you know, court them again, have them fall back in love with their jobs because we're losing them. And that's the hard part, is all of that knowledge capital and that dedication is leaving. 00:05:02:04 - 00:05:09:10 Claire Zangerle, DNP, R.N. And those are let's solve the problems that we can solve because there's a lot of problems we can't. And that's a problem we can solve. 00:05:09:12 - 00:05:28:18 Elisa Arespacochaga I completely agree with that. Joel, from your perspective, I know we've gotten to work together on the AHA and AONL care model learning community. What are you seeing organizations embrace in that technology space into their care models? And what do you think is really had the most impact? 00:05:28:21 - 00:05:57:21 Joel Moore I am going to be cautious to say what's had the most impact, because I think we're still in development. We're still in the middle of the PDSA cycle. One of the first things that we stood up as a nursing profession in the pandemic and post pandemic was virtual nursing. And that's a model that does work for some. But I am unsure about the sustainability and if it really is having impact on patient outcomes. 00:05:57:24 - 00:06:40:15 Joel Moore I think this is our era of really thinking outside the box. I'm getting goosebumps thinking about ambient listening and the forward thinking that's being done with that. Some people are labeling it AI and how that supports the lift of the workforce load. But, you know, I think about the little devices that we have in our homes and that we've had for years that we're bossing around. What can we do to develop technology with these really brilliant people that are at the bedside now to help support and engage and attract future workforce clinicians that won't ever even touch a keyboard? 00:06:40:17 - 00:06:58:00 Joel Moore So, you know, there's so much technology &nbsp;- from help that's moving pharmaceuticals from, you know, one level to another in the hospital to ambient listening to virtual nursing. There's just a long stream of technology that's helping us at this point. 00:06:58:03 - 00:07:20:04 Elisa Arespacochaga Absolutely. And I think you are, you hit it on the head. We are very much in a phase of trying all of these different technologies to see which really, truly hit value for our organizations. And, you know, really help at the end of the day, that bedside nurse, that bedside clinician provide the best possible care for their patient. 00:07:20:06 - 00:07:30:15 Joel Moore What's driving the outcomes? I don't think we have enough to say what has been the most successful to help drive outcomes, which is what we need to be looking at. 00:07:30:18 - 00:07:51:11 Claire Zangerle, DNP, R.N. I think we also have to recognize the maturity of organizations around adopting technology. All organizations are on a different maturity model. Some are just thinking about it and what does it look like? And they're very scared of it. And I get that. And they're also asking themselves, do I have the money to invest in this? Because what if it doesn't work? 00:07:51:13 - 00:08:17:18 Claire Zangerle, DNP, R.N. I'm taking a big chance. We're seeing a lot of people do pilots, and this is okay to do a pilot, to say, does this work for me and if not, I'm going to either scale fast or fail fast. And I think it's important that people realize that when they think about technology. But there's also a human side to this technology that's being adopted and that I think will come out loud and clear in the Workforce Scan. 00:08:17:21 - 00:08:51:24 Claire Zangerle, DNP, R.N. Because just because you put technology in does not mean that you eliminate the human touch and the human aspect of caregiving. There's a lot of ways to do new models of care, including that human touch. Maybe you're using new disciplines to deliver that care, and they're infusing new technologies into using those new disciplines. We're inviting LPNs back into the acute care space when before we had somewhat dismissed LPNs to other care sites because we didn't have a place for them in acute care. Now we're rethinking that, 00:08:52:01 - 00:09:04:07 Claire Zangerle, DNP, R.N. and that's the beauty of our being nimble in health care is to be able to rethink and reapproach for what works today and what is going to work for the future. 00:09:04:09 - 00:09:25:01 Joel Moore Claire, I love that. I love that part too, perhaps even the people part of nursing. Perhaps we need to challenge, you know, what's our scope? We haven't revisited that for a while. You know, the scope of the RN, the scope of the LPN. It's, you know, it could be something. I've seen studies over in Europe, and we have opportunity to think about people. 00:09:25:06 - 00:09:31:07 Joel Moore And I love the thread of people that is woven through the four core challenges brought forward in the Workforce Scan. 00:09:31:09 - 00:10:01:04 Elisa Arespacochaga Joel, let me pick up on that. We all know that, you know, to some extent, the math doesn't work. With the retirement and aging of the baby boomers, the next generation, the staffing shortages, all of those things, they're just not going to go away. What are some of the pathways and partnerships you're seeing locally to really encourage people to not only get into health care, but now get into this, this new version of health care, this one that has the technology that is connecting to its frontline teams. 00:10:01:06 - 00:10:25:12 Joel Moore Yeah, it's taking the message out early. You know, we have to engage what we've done here is engage in our community, even at the elementary school age level and talked about the brand image or what is a nurse now? What does that look like? We're still pretty close to the pandemic. So there's this frightening view of what it may appear to be if you were to practice nursing. 00:10:25:15 - 00:10:56:04 Joel Moore And so taking the image of nursing and talking about the flexibility and engagement in the community that you can develop when you go into a profession like nursing, or many other professions at the bedside. So it's cultivating relationships early. I have a lot of energy focused on my partnerships with my colleges and universities that are within a 60 mile radius of the buildings. The colleges and universities know 00:10:56:04 - 00:11:21:19 Joel Moore I'm going to say yes to every nursing student, once they get into studies to come and do their clinicals in my building. Because that's the future workforce. And there isn't enough of them. So engaging with our colleges and universities and taking the message out in places where we hadn't been before, I think there's still opportunity to perhaps persuade some people in other vocations. 00:11:21:19 - 00:11:32:20 Joel Moore I'm a second vocation nurse, so I think we could persuade others to join the health care work environment if they really knew what fulfillment they would get practicing. 00:11:32:22 - 00:11:56:09 Elisa Arespacochaga I always say that there are a lot of places I could earn a living with my MBA, but health care is the only place that feeds my soul. Claire, from a national perspective, we know health care works workers are...they're tired. Health care is hard. It's never not been hard. But we've been able to continue to attract a great, amazing group of people to work in health care and be connected to health care. 00:11:56:15 - 00:12:02:25 Elisa Arespacochaga What are some of the strategies to now, given the challenges we're seeing, to keep them in health care? 00:12:02:28 - 00:12:24:03 Claire Zangerle, DNP, R.N. The first thing we need to recognize is that the workforce is evolving. We have new generations of workers that are here in our midst, and we have to recognize that. We have to recognize the opportunity to embrace those ways of thinking. Back in the day, you would work 24/7 and not think anything about it. That's not healthy. 00:12:24:05 - 00:12:44:24 Claire Zangerle, DNP, R.N. We have to recognize that people want to have harmony. They want to have a little bit of balance in their life. And health care is open 24/7, so we have to recognize that. And make sure that we're meeting the needs of a workforce that is before us. If we don't do that, we're not doing ourselves any favors. We're not going to grow our workforce. 00:12:44:24 - 00:13:03:00 Claire Zangerle, DNP, R.N. We're not going to retain the people that want to work in this profession. You hear all the time, I love what I do, but I can't maintain the pace. And I think we will attract more people if we become more realistic about what people want in their work life. 00:13:03:02 - 00:13:11:15 Elisa Arespacochaga Joel, on the ground at your organization, what some of the ways that you are really building that engagement and connection to your frontline teams? 00:13:11:18 - 00:13:39:15 Joel Moore One of the ways is that we are building a culture of trust. You know, my visibility as CNO is really important. So our leaders are with our frontline, our executive level leaders are rounding, being with the frontline as much. So building that culture of trust, picking up on one thing that Claire had said, you know, at my organization, we are really trying to cultivate our workforce to look like our community. 00:13:39:18 - 00:13:57:25 Joel Moore So we have a variety of cultures within our community. So we are recruiting from different neighborhoods that we hadn't recruited before. Which, you know, engages us in new ways as we're learning more about the people who may not be exactly like us. 00:13:57:27 - 00:13:59:10 Elisa Arespacochaga That's awesome. 00:13:59:12 - 00:14:28:28 Elisa Arespacochaga Joel and Claire, thank you so much for joining me today and sharing your views and how you're addressing this work, which are, among just some of the stories that are included in the 2025 AHA Health Care Workforce Scan, which is based on a review of reports and studies and leaders like Joel and Claire providing their input and insights and recommendations of what they are trying to really, support and retain our health care workforce 00:14:28:28 - 00:14:31:09 Elisa Arespacochaga staff. So thank you both for joining me. 00:14:31:12 - 00:14:51:08 Tom Haederle Thank you for joining us. If you'd like to learn more about the latest health care workforce trends and real world approaches to guide your workforce strategies, be sure to check out the 2025 Health Care Workforce scan at www.aha.org/aha-workforce-scan. </details></div> Wed, 09 Apr 2025 09:54:13 -0500 Advancing Health Podcast Leadership Dialogue Series: The Importance of Advocacy and Storytelling in Rural Health /advancing-health-podcast/2025-03-31-leadership-dialogue-series-importance-advocacy-and-storytelling-rural-health In this Leadership Dialogue conversation, Tina Freese Decker, president and CEO of Corewell Health and 2025 AHA board chair, talks with Lori Wightman, R.N., CEO of Bothwell Regional Health Center, about the challenges that rural hospitals and health systems face, including razor-thin operating margins and workforce staffing, before pivoting to discuss the importance of advocacy in telling the hospital story.<hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript </h2> </summary> 00:00:01:05 - 00:00:23:09 Tom Haederle Welcome to Advancing Health. In the face of today's multiple challenges, every hospital needs support and buy in for its mission of great care. Storytelling - sharing the right kinds of stories with the right audience at the right time - is a great way to build and maintain that support. This is particularly important for rural hospitals and health systems, most of which have razor-thin operating margins. 00:00:23:12 - 00:00:40:10 Tom Haederle In this month's Leadership Dialogue, hosted by the 黑料正能量 Association's 2025 Board Chair Tina Freese Decker, we hear more about the importance of advocacy and of all team members participating in telling the hospital story. 00:00:40:13 - 00:01:07:25 Tina Freese Decker Thank you so much for joining us today. I'm Tina Freese Decker, president CEO for Corewell Health, and I'm also the board chair for the 黑料正能量 Association. Last month we talked about trust and how our hospitals and our health systems can strengthen that trust with our communities and the people that we serve. Our rural hospitals are uniquely positioned to do this, as they are often the largest employers in their towns and communities, and frequently the only local source of care. 00:01:07:27 - 00:01:28:07 Tina Freese Decker Rural health care is about being a family. We take care of each other in our communities as best as possible, and we're here to provide that care close to home, no matter what headwinds that we all face. I recently had the opportunity to attend the 黑料正能量 Association's Rural Conference and you could really feel that sense of family and community in the room. 00:01:28:09 - 00:01:59:15 Tina Freese Decker We work in hospitals in red states and blue states all across the country, but we are all focused on the same thing: helping our neighbors in our communities to be healthier. There are some big challenges that are facing real health care, but together with a unified voice, we can get what we need. As I have traveled around our country meeting with the 黑料正能量 Association's regional policy boards and visiting the rural hospitals and my health system and others, the number one concern that I have heard from our hospitals, our communities, is access. 00:01:59:18 - 00:02:22:28 Tina Freese Decker And that is why it is so integral to the 黑料正能量 Association strategy and it is why it is so important that we come together as a field and that we're united as a field, because these challenges that we are facing are real. So today, I am pleased to have a distinguished leader in rural health care with us to talk about how we can all work together to advocate for the needs of our hospitals. 00:02:23:01 - 00:02:45:09 Tina Freese Decker I'd like to welcome Lori Wightman. She is the CEO of Bothwell Regional Health Center, a 108 bed acute care hospital in Sedalia, Missouri. Laura has served in this role since 2019, but even prior to Bothwell, she worked in real health care as the president of Mercy Hospital Ada in Ada, Oklahoma. So, Lori, welcome. Glad you were able to join us today. 00:02:45:15 - 00:02:46:17 Lori Wightman, R.N. Thank you, Tina. 00:02:46:19 - 00:03:03:20 Tina Freese Decker And I wanted to start out with just telling us a little bit about yourself. I know you started your health care career as a nurse and then you made the shift to administration. Can you tell us about yourself and how you see that family aspect in the hospital and the community in our rural areas? 00:03:03:22 - 00:03:30:01 Lori Wightman, R.N. Sure. Well, my father was a hospital administrator and my mother was a nurse, so I did both. And so it was a natural progression. And I think the foundation that nursing lays gives you all kinds of transferable skills that have been very helpful as I went into hospital administration. My career and dating advice has always been, you can't go wrong with a nurse. 00:03:30:03 - 00:03:57:14 Lori Wightman, R.N. And there's certainly served me well. And you talk about that family atmosphere. That is why I continue to choose rural health care. I've done the CEO position in a suburban hospital, and I sat at our senior leadership team meeting and thinking I was the only one on our senior leadership team that even lived in the area that we served. 00:03:57:17 - 00:04:23:24 Lori Wightman, R.N. Everyone else lived in a different suburb, and I just thought that was strange and disconnected. And, so I returned again then to rural health care because it is like a family. And it's ironic because we just finished revisiting our mission, vision and values. And our new mission statement talks about together we work to provide compassionate and safe care to family, friends, and neighbors. 00:04:23:27 - 00:04:37:07 Lori Wightman, R.N. Invariably, when I met new employee orientation, a significant number of people were born at the hospital. That's why I love rural. It's like that "Cheers" phenomenon where everyone knows your name. 00:04:37:09 - 00:05:01:02 Tina Freese Decker Very true. I used to lead a couple of rural hospitals as well. And like you said, even just walking into a rural hospital it feels like family where everyone there knows your name and of course, protect things from a confidentiality and a privacy perspective, but that feeling that we're all in this together. So I love that your mission statement is about together, that you can make an impact on people's health. 00:05:01:05 - 00:05:13:28 Tina Freese Decker I described a little bit about what it's like to walk into a rural hospital. Can you share a little bit about what is like to be a rural hospital, what it means in today's environment and why it's such a great place to work? 00:05:14:01 - 00:05:47:06 Lori Wightman, R.N. Well, in many ways, rural hospitals are uniquely the same as our suburban or urban counterparts. Forty six million people depend on a rural hospital for their care. So we struggle with the same labor shortages, the cost of labor supplies and drugs is rising faster than our reimbursement. We have all of those same struggles. Unique is that family atmosphere, I think. 00:05:47:06 - 00:06:13:26 Lori Wightman, R.N. And we have multiple generations working at the hospital. Now, you can't say anything bad about anyone because invariably they're somehow related. Or they were best friends in high school, or they used to be married to each other. So I mean, it's unique in that way. We have the same types of struggles that &nbsp;our counterparts do. 00:06:13:28 - 00:06:18:03 Tina Freese Decker What pressures are you feeling the most acutely right now? 00:06:18:06 - 00:06:47:09 Lori Wightman, R.N. Well, you take all of those common challenges that I talked about, and you turn up the volume a little bit. Because for us, 78% of our patients and our volume is governmental payers, so 78% of our business, we're getting reimbursed below cost. You can't make that up in volume. So we rely on all of the governmental programs, you know, disproportionate share all of those things. 00:06:47:09 - 00:06:54:22 Lori Wightman, R.N. And, 340B is doing exactly for us what it was designed to do, save rural hospitals. 00:06:54:25 - 00:07:11:22 Tina Freese Decker Those areas are critical that they remain. And so that we can continue to provide that sustainable, high quality care in our communities and all of our communities. 78% being governmental. It's a huge portion of what we do and what we rely on for access and caring for people. 00:07:11:29 - 00:07:23:15 Lori Wightman, R.N. Right. We are the typical rural hospital. We have razor-thin margins and aging plant of 18 years. 00:07:23:18 - 00:07:31:10 Tina Freese Decker So those are challenges that you're trying to navigate right now with all of the other things that happen. And how is your staffing levels going? Are those going okay? 00:07:31:13 - 00:07:55:12 Lori Wightman, R.N. Have the same labor shortage issues. We still have 22 traveling nurses here, but we have started being very aggressive in a grow your own program. And so as soon as the next month we're going to cut that number in half and then, within six months, we're hoping to have all of contract staff out. 00:07:55:15 - 00:08:02:04 Tina Freese Decker Is that something that you're most proud of, or is there something else that you want to share that you're most proud of from a rural hospital perspective? 00:08:02:06 - 00:08:29:24 Lori Wightman, R.N. I think what I'm most proud of is you get to personally view the impact of your decisions on people. I'm very proud of our all the talented people that we have here, from clinicians to community health workers. All of our physicians get to use all of the things they learned in medical school and residency, because there isn't a lot of subspecialists, so they are working at the top of their license. 00:08:29:26 - 00:08:50:21 Lori Wightman, R.N. Just several months ago, one of our critical care physicians diagnosed a case of botulism. Now as an old infection control nurse I get very excited about that because I never thought in my career I would see botulism. But it was diagnosed and treated here and the person's doing well. 00:08:50:23 - 00:09:25:27 Tina Freese Decker Oh, that's wonderful to hear. When you talk about all the different people that are part of health care in rural settings, or also another settings, it's quite amazing to see how many different areas we need to come together to take care of our community. When you think about an even larger scale, from rural hospitals to urban and teaching hospitals and others, how do you think about the whole ecosystem of our field and how we, you know, do we need all of us or and is there a way to form that greater fabric and social connection, or is there something else that we should be doing? 00:09:25:29 - 00:09:50:21 Lori Wightman, R.N. We are all very interconnected and I believe we are all needed. And I especially feel that as an independent hospital, not part of a health system, this is my first independent hospital. I rely on my hospital association more than I ever did when I was working for a health system, because it all comes down to relationships. 00:09:50:21 - 00:10:18:13 Lori Wightman, R.N. And so how do you develop, how do you get yourself in situations where you are meeting and now working with your partners around the state or the region? Because it comes down to relationships, you really need to know who your neighbors are in terms of other hospitals, who you're referring your patients to and develop that working relationship because it is all interconnected. 00:10:18:13 - 00:10:25:06 Lori Wightman, R.N. And we rely on our partners that we refer to, and they rely on us, too. 00:10:25:08 - 00:10:43:23 Tina Freese Decker One of the things I heard you say about the Rural Health Conference that the 黑料正能量 Association just put on, and the value of the 黑料正能量 Association is that we're not alone. And those values of relationships are really critical. So I appreciate that. The 黑料正能量 Association also talks a lot about how do we tell the hospital story. 00:10:43:25 - 00:10:55:15 Tina Freese Decker So how do you engage in advocacy to make sure we're telling that hospital story so that our legislative leaders and others know the value that we're bringing to the community? 00:10:55:17 - 00:11:22:11 Lori Wightman, R.N. Well, we are surrounded by stories. And so the first thing is to always be picking up on what is the story that is surrounding us, and how can we capture that? Because the most effective way is to bring that patient or nurse or physician to the legislator to testify, because they are the most effective way of communicating a message. 00:11:22:18 - 00:11:49:07 Lori Wightman, R.N. You know, the suits can go and talk about data, but nothing is more effective than what I call a real person telling their story and how a decision or a potential decision is going to impact them and how it feels. The other thing we do is every October, it's become tradition. We have Advocacy Day with our board, at our board meeting. 00:11:49:09 - 00:12:21:12 Lori Wightman, R.N. We invite our state elected officials &nbsp;- so people representing us at the state capitol - to come to our board meetings. On election years their challengers also come and I invite the hospital association and they all answer two questions: What do you hope to accomplish in the next legislative session, and what do you think might get in the way? That sets the scene for my board to understand that part of their role in governance is advocacy. 00:12:21:14 - 00:12:29:19 Lori Wightman, R.N. And so I've had two of my board members...almost every legislative session I go and testify on on some bill. 00:12:29:21 - 00:12:50:01 Tina Freese Decker That is really a good idea. Thank you so much for sharing that. Do you have any other final suggestions for us as AHA members, as other hospitals, whether it's rural or urban, that we should think about or do as we think about advocacy and access or also field unity? 00:12:50:03 - 00:13:22:11 Lori Wightman, R.N. You know, having been on the board of two different state hospital associations, I get it. You know, sometimes members can be at odds with each other on a given issue. And my advice to AHA would be to play the role of convener, facilitating conversations between members to better understand each other's position. And if a middle ground can't be reached, then that might be an issue that AHA remains neutral on. 00:13:22:14 - 00:13:34:07 Lori Wightman, R.N. But there are so many issues where we can agree on and that is very much the role and what all of us depend on AHA to play in advocating. 00:13:34:09 - 00:14:02:15 Tina Freese Decker There's a lot that binds us together. Like you said, we're all caring for our neighbors and our communities, and that's the most critical piece of it. And we have to keep that front and center with every decision that we make and every action that we do. Well, Lori, thank you so much for being with us today on this AHA podcast, for sharing your expertise in rural health care and for talking about some new ideas that all of us can take forward to ensure that we're telling the hospital story in the best way possible. 00:14:02:18 - 00:14:21:09 Tina Freese Decker So while I know that we have our work ahead of us, I know that I continue to be energized every time I speak with committed and passionate hospital leaders like Lori. Again, appreciate your work that you do every single day for the neighbors and for the people in your community that you serve. We'll be back next month for another Leadership Dialogue conversation. 00:14:21:13 - 00:14:23:01 Tina Freese Decker Have a great day. 00:14:23:03 - 00:14:31:13 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. </details></div> Mon, 31 Mar 2025 01:41:00 -0500 Advancing Health Podcast A Great Catch: Strategies for Building a Culture of Safety Reporting /advancing-health-podcast/2025-03-26-great-catch-strategies-building-culture-safety-reporting In this conversation, Mindy Estes, M.D., former CEO of Saint Luke鈥檚 Health System and former AHA board chair, and Nancy Howell Agee, CEO emeritus of Carilion Clinic and former AHA board chair, discuss the importance of bringing a culture of safety reporting to an organization, and how technology can鈥檛 replace the human factor in a successful patient safety strategy.<hr><div></div><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript </h2> </summary> 00:00:01:03 - 00:00:26:14 Tom Haederle Welcome to Advancing Health. Hospitals and health systems never stop working to advance patient safety and quality. It has been and always will be our field's top priority. In today's conversation, two former 黑料正能量 Association board chairs discuss the importance of bringing a culture of safety reporting to an organization, and how technology can't replace the human factor in a successful patient safety strategy. 00:00:26:16 - 00:00:41:04 Tom Haederle Dr. Mindy Estes is the former CEO of Saint Luke's Health System in Kansas City and her guest, Nancy Howell Agee, is CEO emeritus of Carilion Clinic in Roanoke, Virginia. 00:00:41:06 - 00:01:06:23 Mindy Estes, M.D. I'm Dr. Mindy Estes, and today we have the privilege of speaking with Nancy Howell Agee, CEO of Carilion Clinic. Nancy's remarkable journey began as a nurse when her commitment to patient care laid the foundation for an extraordinary leadership career. So let's just jump right in. You've had a remarkable career from nurse to CEO and long service in the field for AHA and other organizations 00:01:06:23 - 00:01:24:22 Mindy Estes, M.D. and so, I think it really gives you a unique perspective on health care quality, safety, equity, workforce, all facets that go into a quality organization. So thinking back, what have been the most important actions you've taken as a leader to drive quality and patient safety? 00:01:24:25 - 00:02:09:21 Nancy Howell Agee Well, you know, I'm glad you mentioned that I began my career as a nurse. And I treasure the fact that I am a nurse still. And, as one-on-one patient encounters are what have always driven me - the notion that you're caring for one person after another, and how you do that the very best of all. As I became a leader in health care about the time that I was moving as a chief operating officer and then the CEO, I was a representative from the 黑料正能量 Association to the Joint Commission, and I was on the Joint Commission Board. 00:02:09:24 - 00:02:34:07 Nancy Howell Agee And at that time, you know, we were beginning to talk about zero harm. And so I was hearing from the AHA in one ear: patient safety, quality; and in the other ear from the Joint Commission, patient safety and quality. So in stereo, what's really important. And I pondered that quite a lot as a leader to look at our own organization, 00:02:34:07 - 00:03:00:07 Nancy Howell Agee what could we do differently? Not just check the box, not just meet the regulations, but really understand fundamentally what it meant to improve health care, improve patient safety, and improve quality. It seemed to me that it needed to start with the board. And so sort of a bottom up, top down conversation of education about our highest priority and what that meant. 00:03:00:07 - 00:03:31:07 Nancy Howell Agee And when we talk about statistics, it's really important to measure quality, of course. But a statistic represents a patient. And so we began to frame how we think about quality with the patient in mind. Not the patients, but a patient. And it seemed to make a difference. At that time we reorganized the board and the board committees. And while we had a quality committee, it wasn't perhaps as robust as the finance committee. 00:03:31:07 - 00:04:00:15 Nancy Howell Agee And it seemed like the committee that got the most airtime at board meetings was the finance committee. And educating the board about what it meant to be an integral, high integrity, zero harm organization. So we renamed the Quality Committee for the board CAPS: Clinical Advancement and Patient Safety. And now the two most important board committees are CAPS and finance. 00:04:00:17 - 00:04:27:09 Nancy Howell Agee And our board chair sits on both. In hindsight, it was really important that our board chair began to [see] patient safety and quality is the single most important thing. I'll tell you something else we've done, Mindy. We celebrate what we call the great catch. And so the more event reporting that we do, we think that's fantastic. And so we, you know, any little thing, any big thing. Was funny, 00:04:27:09 - 00:04:51:07 Nancy Howell Agee I was waiting on the elevator, a gurney went by and it went a little too fast around the curve. And there was a resident standing there and he said, hey, I think we need to put that in the event report. And it was, you know, just kind of an everyday encounter, but it was a great focus. The other thing we did was create a new set of values. 00:04:51:09 - 00:05:25:17 Nancy Howell Agee Our mission is to improve the health of the communities we serve. We focused on our values and our values include courage, compassion, curiosity, commitment. And by focusing on those values, &nbsp;we use those to talk and to educate regularly for new employees, as well as every year the required education for all staff include focus on our values and what that means to patient safety and quality. 00:05:25:19 - 00:06:02:13 Nancy Howell Agee And the last thing I'd mention is that we organized everything under one umbrella. So everything from risk management to honor reporting to all the sort of things we do for preparation, for Joint Commission, for surveys from our state, patient safety, patient advocacy and our human factors team and our sim lab are all under one umbrella. And creating that real focus that's both education metrics and celebrate the good work that we do. 00:06:02:15 - 00:06:37:27 Mindy Estes, M.D. It's remarkable. There are a couple of things that have, that have struck me. One is your point about so much time spent in board meetings on finance. And one of the things that, we did at Saint Luke's was to reorder our board agenda and have a quality close, if you will, just like we have the financial close where we are presenting the quality metrics not only on a monthly basis, but year to date basis, so that we have time on the front end of the board meeting to talk about quality as opposed to whatever time we had left. 00:06:38:00 - 00:07:06:15 Mindy Estes, M.D. The other thing I would mention is, as you know, I'm currently on the Joint Commission Board, and we talk about innovation and quality and patient safety. And the conversations when you were on the board beginning to talk about Do No Harm. You know, today Joint Commission is innovating and innovating rapidly. So I think it really is, organizations in the Joint Commission, in this instance, marching together from a foundation that's been created over a number of years. 00:07:06:18 - 00:07:31:02 Mindy Estes, M.D. You helped develop Carilion's innovative care model. Undoubtedly - and I've heard you speak on how that evolved - and I know you have a lot of insights for other leaders. So if you were advising a new system leader and there certainly as we've seen, movement in health care, there are a lot of new system leaders in our field. What would you tell them to do first, to set the tone for an effective culture in the organization? 00:07:31:02 - 00:07:34:04 Mindy Estes, M.D. I think you've already touched on that, but I know there's more. 00:07:34:06 - 00:08:19:07 Nancy Howell Agee I think creating an environment of this is our highest priority means you're using every single meeting, every memo, your social media, we have an internal social activity. We focus on that with every single communication that we have. And I think that that's critically important. But I'm glad you mentioned technology because both existing technology and new technologies, again, we focus on why we're doing this for patient safety and how it improves quality and by having that as our key priority, I think it begins to permeate the organization. 00:08:19:15 - 00:08:45:00 Nancy Howell Agee Technology is important. If you ask me, what doesn't work as well as you thought it would when you first started? You know, I'll say introducing an electronic health record. I remember when we did that and we did it big bang approach. And I remember these words probably came out of my mouth as much as anybody. We're going to eliminate medication errors by having this technology. 00:08:45:04 - 00:09:15:24 Nancy Howell Agee And of course that's ridiculous in hindsight. There's nothing that can completely alter the human nature of our business, thank goodness. But because we are humans, mistakes can happen. And so doing everything you can to have a safe environment, to create a culture that's a permissive culture that encompasses patients taking quality and everything that you do, I think that makes all the difference. 00:09:15:27 - 00:09:43:27 Nancy Howell Agee You know, Mindy, you and I go back a long time. We used to think about things like central line infections and catheter infections and I don't know. It wasn't that we were cavalier about those things. I think we were just as concerned about patient safety and quality. We didn't recognize the whole milieu that it took to care for every single patient, every time, in the way that a patient should be cared for. 00:09:43:29 - 00:10:02:28 Nancy Howell Agee And when I look back and I think about some of the things that we perhaps took for granted or didn't realize that we could change, and now I look where we are as an industry. Our whole field has improved patient safety culture, and I think there's even more that we can do. 00:10:03:00 - 00:10:26:20 Mindy Estes, M.D. You know, to your point of change. And, you know, I think organizations like ours, we test, we pilot, we retest, and, you know, we want consensus. And if we don't like the first pilot, we do another one. And I think Covid taught us very quickly that, you know, we can innovate and we can innovate quickly. And we can learn from that innovation 00:10:26:20 - 00:10:39:12 Mindy Estes, M.D. and if we fail, we need to fail quickly. And you touched on the electronic record and my next question, it was just going to be, what did you learn from something that wasn't as effective as you might have hoped? 00:10:39:15 - 00:11:03:10 Nancy Howell Agee Well, I'll just echo first of all that you're right. During Covid, we learned, and I hope we continue to learn that lesson - and that is innovate, innovate quickly. You know, I think we can be accused of being way too slow and thinking through things, which is important. We have a saying here. Take risks without being reckless. After all, you are talking about a patient's life. 00:11:03:12 - 00:11:44:00 Nancy Howell Agee The notion that we can innovate, that we can recognize and do something about that and take ownership at multiple levels. So I think one of the real lessons that began before Covid, but what really came home during Covid was a necessity for focusing on the resilience of our staff and all the things that we can do, because, you know, as a CEO, you and I are not really important to that patient interaction, that precious moment between a caregiver and a patient. 00:11:44:03 - 00:11:54:07 Nancy Howell Agee And so all the things that we can do to support our staff so that they can give the kind of high quality, safe care that we would expect. 00:11:54:09 - 00:12:17:21 Mindy Estes, M.D. You know, resilience continues to be important. And I think in this day and age is something that we used to take for granted as well, that the mission and the privilege to do what we do would fuel internal resilience. And I think part of this whole patient safety, quality and quality of our workforce and our workforces experience as well - 00:12:17:27 - 00:12:57:04 Mindy Estes, M.D. that resilience and how we take care of that has become increasingly important. And Nancy, I want to thank you as always for your time, for your sharing your insights and experiences and your journey from being a nurse to an award winning CEO and your successful transformation of Carilion Clinic. It really provides powerful lessons for all health care leaders at all levels, and your commitment to quality and safety innovation, combined with your dedication to mentoring future leaders, especially women in health care, truly exemplifies exceptional leadership. 00:12:57:04 - 00:13:25:04 Mindy Estes, M.D. And, you know, we've seen through your examples, how health care organizations can navigate while maintaining an unwavering focus on quality and safety, Because at the end of the day, that is what we do to provide the highest quality patient care and safety to our patients, first and foremost. And I really think it's important for our listeners to realize that underlying all of the success you've had is the heart of a nurse. 00:13:25:06 - 00:13:27:11 Nancy Howell Agee Thank you Mindy. 00:13:27:13 - 00:13:35:23 Tom Haederle Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </details></div> Wed, 26 Mar 2025 02:25:11 -0500 Advancing Health Podcast Architecting Care: A Cancer Journey Intersects with a Breast Center鈥檚 Design /advancing-health-podcast/2025-03-17-architecting-care-cancer-journey-intersects-breast-centers-design How do you design a health care space that truly prioritizes patient experience? In this conversation, Sara Robinson, senior associate healthcare architect at McMillan Pazdan Smith Architecture, and Jamie Feinour, vice president of operations at Novant Health Presbyterian Medical Center and president of Novant Health Charlotte Orthopedic Hospital, discuss how patient-centered design and innovative architecture come together to create spaces of healing for patients and providers, and how Sara's personal cancer journey impacted the design for Novant Health's Breast Center.<hr><div></div>&nbsp; Mon, 17 Mar 2025 00:44:00 -0500 Advancing Health Podcast Critical Condition: Cybersecurity in Rural Hospitals with Microsoft Part 2 /advancing-health-podcast/2025-03-12-critical-condition-cybersecurity-rural-hospitals-microsoft-part-2 A cyberattack on a rural hospital or health system can have devastating impacts, leaving in its wake patient harm and financial distress. In part two of this conversation, John Riggi, national advisor for cybersecurity and risk at the 黑料正能量 Association, and Justin Spelhaug, corporate vice president and global head of Tech for Social Impact at Microsoft Philanthropies, discuss the urgent need for stronger defenses, the role of technology leaders to combat these attacks, and Microsoft鈥檚 strategies for long-term resilience.<hr><div></div><hr><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript &nbsp; </h2> </summary> 00:00:01:04 - 00:00:36:12 Tom Haederle Welcome to Advancing Health and part two of the conversation on cybersecurity attacks against rural hospitals, and what can be done to protect against them. In this conversation between John Riggi, the 黑料正能量 Association's national advisor for Cybersecurity and Risk, and Justin Spelhaug, corporate vice president of tech for Social Impact, Microsoft Philanthropies, we learn more about the role tech leaders can play in helping rural health care providers cope with cyber attacks and preserve their ability to care for the nearly 60 million Americans who depend on them. 00:00:36:14 - 00:00:45:02 Justin Spelhaug So the impact is clearly disruptive on these hospitals, clearly disruptive. Now, John, what can these hospitals do to protect themselves? 00:00:45:04 - 00:01:04:21 John Riggi So there's many things that they can do. There's many things they need to do. But again, it generally comes down to a resource issue. So we generally say start with the basics. Look at your tools and policies. We know that there are certain cybersecurity practices, basic practices that can help mitigate the risk of the majority of cyberattack. 00:01:04:27 - 00:01:33:13 John Riggi So example: multi-factor authentication, unified identity management, cybersecurity training for staff. We know that most of the attacks still start with those phishing emails, a psychological technique versus technological. Another step: join the Microsoft cybersecurity program. You all have been very generous in offering free cybersecurityassessments, curated learning pass product discounts to all rural hospitals in the U.S. 00:01:33:16 - 00:01:53:03 John Riggi And I mean, these are the type of things that we need to do together to help shore up the defenses of rural hospitals. Now, Justin, can you tell us more about the Microsoft cybersecurity program for rural hospitals in the role you see technology leaders having in addressing these challenges? 00:01:53:05 - 00:02:17:22 Justin Spelhaug Yeah, for sure, John. And of course, the technology leaders in these hospitals are on the frontline of driving change, and they're managing everything end to end with really limited resources. And so we wanted to pull together a program that would provide them more capacity, more capability to respond to the threats that you've just highlighted. And really, there are three big buckets. New offers that help make our technology more affordable. 00:02:17:24 - 00:02:41:18 Justin Spelhaug That's bucket one. Bucket two is capacity building services to help organizations respond. And then bucket three is new innovation to help rural hospitals have more impact, particularly with AI. So let me click into those just really specifically for just a moment. In bucket one, in terms of new affordable offers, we're providing those hospitals that typically have the least resources. 00:02:41:18 - 00:03:28:10 Justin Spelhaug And so that's independent critical access hospitals and rural emergency hospitals, those that are not in a health system, they can access Microsoft nonprofit pricing, which can provide up to a 75% discount for things like Microsoft 365 off of commercial pricing. So that goes a big way in helping some organizations really get access to affordable technology. Now, all other rural hospitals in the U.S. that are using Office 365 or M365 can get access to one year free of our most advanced security suite, Microsoft 365, E5 security and EMS E3 for one year to ensure that they can take action on their infrastructure immediately. 00:03:28:13 - 00:03:55:22 Justin Spelhaug We've also for everybody, we've extended one year of Windows 10 Extended Security update at no cost. So that's on the technology side. On the capacity building side, we're providing every rural hospital in America, over 2000 hospitals, free security assessments, through a pre-vetted Microsoft security partner to help them evaluate their risks and identify strategies to mitigate those risks. 00:03:55:24 - 00:04:19:08 Justin Spelhaug We've also, in this bucket, put together curated learning pathways for both technical staff and non-technical staff. And then the third area is AI innovation. Now, John, you were highlighting how stretched the finances of rural hospitals are, and CHQPR reports - and you said, John, that 30% of all rural hospitals are at risk of closure - that's a real statistic. 00:04:19:10 - 00:04:46:20 Justin Spelhaug And that means that funding is limited and funding is limited for security expertise and the services that they need. So to help tackle this challenge, we've launched a Microsoft Rural Health AI lab, which we affectionately call RAIL, that is developing tools to help improve both financial and health outcomes. The first tool we built, which is in testing now with a number of hospitals, is an AI tool to support managing denied insurance claims. 00:04:46:27 - 00:05:08:15 Justin Spelhaug We know that's a massively manual process for many hospitals. We know that if we can manage that more effectively, we can improve hospital revenue, which improves all outcomes. We've also been working to deploy nuance to improve patient and physician nurse experience through AI. And we continue to look at how we can use AI to support hospitals for a number of other scenarios. 00:05:08:18 - 00:05:40:22 Justin Spelhaug Since we launched it, nearly 500 hospitals have registered for the program. That's about 24% of all the hospitals in the country. And that's in about the last four months. Over 335 hospitals are participating in a cybersecurity assessment, and many are getting access to the offers as well. And this is, John, part of a broader commitment to rural communities. We've been investing for years, actually, in rural communities, both tackling the broadband divide in America, as well as investing in innovation in rural communities through our Tech Spark initiatives. 00:05:40:22 - 00:05:46:26 Justin Spelhaug So this is just the next step that we're taking for this acute challenge that we're dealing with at the moment. 00:05:46:28 - 00:05:54:12 John Riggi Since launching the cybersecurity program for rural hospitals. Let me ask you, Justin, what has Microsoft learned? 00:05:54:15 - 00:06:15:25 Justin Spelhaug Yeah. You know, John, we've learned a lot. And, you know, as I mentioned before, we've engaged just about 500 hospitals. And our learnings really break into two categories. So if you're watching this and you are a cybersecurity professional, pay attention to this next section because I want to tell you what we're learning from the hospitals that we're engaging with directly. 00:06:15:27 - 00:06:42:06 Justin Spelhaug Four key technical learnings that we're having. Number one, privileged account management is the top liability that we're seeing in many rural hospitals. Only 25% of rural hospitals adequately separate end user and privileged accounts, i.e. those accounts that have broader access to systems and data. Getting that segmentation is critical in terms of protecting your footprint. That's probably learning 00:06:42:09 - 00:07:11:20 Justin Spelhaug number one. Learning number two is mitigating known vulnerabilities, running basic vulnerability scanning, doing timely patching, establishing processes to remediate those issues. Only 49% of hospitals that we're working with right now receive passing scores on being able to mitigate vulnerabilities quickly. That's because they're stretched. They're doing everything. They've got a limited amount of resource. That's really the truth. But it's a challenge nevertheless. 00:07:11:22 - 00:07:45:22 Justin Spelhaug Number three, less than 65% of rural hospitals have implemented some of those basic cybersecurity best practices that you were highlighting, John. So email security, about 63% of hospitals. NFA, probably the number one thing we need to implement right now to protect against some of these threat vectors, about 64% of hospitals. Network segmentation, about 62% of hospitals. So A, it's good that we've got 60 something percent implementing these technologies, but we have 35-40% of hospitals that remain exposed and uncovered. 00:07:45:22 - 00:08:24:02 Justin Spelhaug So that's what our program is trying to get at and get across. And then number four, while most rural hospitals scored well across the category of asset management, one subcategory, which is super critical, endpoint management is a substantial risk for rural hospitals. Less than 35% of assessed hospitals met the expert informed passing score for endpoint management. And if you remember what I said about ransomware, the ransomware is coming through those devices that do not yet have endpoint management comprehensively, you know, securing them. 00:08:24:02 - 00:08:46:26 Justin Spelhaug So that's a real challenge as well. So there's a lot of work to do, a lot of work to do across the community. Now, the second category is that this challenge is enormous. And we're talking about over 2000 hospitals here in the United States. And it is going to take strong public private partnership with, I think, a real shared spirit both of collaboration 00:08:46:26 - 00:09:07:07 Justin Spelhaug but John, like you have, urgency. Because this is a life and safety issue as you mentioned. This is people's lives at stake and livelihoods of communities at stake. And this relates to technology. Certainly we need to get the technology out there, but it also relates to funding, developing long term cyber skills, job pathways in these communities, broadband access, 00:09:07:08 - 00:09:25:22 Justin Spelhaug there's a lot of different things that we need to get done. And, you know, Microsoft is all in. I know AHA is all in. And we're going to need more partnerships to tackle the size of this challenge. Another question here for you, John. You know, how can we collectively address the near-term risks of cyberattacks for rural hospitals? 00:09:25:22 - 00:09:29:07 Justin Spelhaug Some of those issues that I just talked about from your vantage point. 00:09:29:10 - 00:10:07:10 John Riggi First, I absolutely agree with all of those basic cybersecurity hygiene controls, procedures, policies that you've discussed. In fact, if hospitals are in fact looking for kind of a clear and concise list of these practices, starting with that multifactor authentication, unified identity management privilege accounts, you can go to, HHS' website - Health and Human Services website - where they have a list of ten essential cybersecurity practices and ten enhanced cybersecurity practices. 00:10:07:10 - 00:10:27:01 John Riggi These are voluntary at the moment. They may become minimum mandatory at some point, but that's a good place to get that concise list, which includes all those recommendations that you made. And then ultimately, hospitals have to have the resources, not just a list to help implement these measures effectively. 00:10:27:03 - 00:10:56:13 Justin Spelhaug Yeah they do, John. You know, we've also learned to remediate many of the risks that we're seeing to bring partner services in. If a hospital wanted to fund that, let's say they didn't have the staff, maybe between $30,000 or $40,000 per hospital to get those immediate issues addressed. You multiply that by 2000 hospitals. That's $60-$80 million, which in the grand scheme of things, and we're talking about rural America and rural communities, is a big number 00:10:56:13 - 00:11:16:03 Justin Spelhaug but it's not that big of a number. And we need to be mobilizing all of the resources we can to tackle that. Now, of course, there's more systemic challenges, such as the skills in the community and ongoing challenges to maintain the environments and to upgrade the software and the hardware over time. That's going to require systemic, capacity building, systemic sources of funding. 00:11:16:03 - 00:11:37:05 Justin Spelhaug But that has certainly been a learning we've had as well. So, John, as we kind of conclude the discussion, how are you thinking really about insuring rural hospital resilience long into the future? Sure, we're facing these challenges right now, but how do we create resilience over time? 00:11:37:07 - 00:12:23:28 John Riggi Again, great question, Justin, because that's really what this is about. It's about the long game. If we just address the near-term tactical threat that will not secure our future against these threats, nor will it secure our rural communities in the future. So really, what we do need is this sustained support from both public and private sectors to kind of help bolster these resources and really this continuing partnership in innovation across the rural areas, these public private partnerships, and we need to continue to invest in innovative solutions, workforce development, collaborative efforts to address these both systemic challenges, these international challenges, the strategic threat and then ultimately which translates down to the patient care and safety 00:12:24:00 - 00:12:32:07 John Riggi risk. Again, what good is needed this continued whole-of-nation approach, and we're proud to have Microsoft as a partner in that effort. 00:12:32:10 - 00:13:12:15 Justin Spelhaug Now we're proud to partner with you, John. AHA has been just such a staunch supporter, first of the rural hospital community and really advocating for that community broadly, getting partners like Microsoft to the table, helping us formulate effective strategies that provide as much capability to as many hospitals as we possibly can. And, we remain super committed to this effort and look forward to working both with you, other public and private sector partners that want to come together, that are of like mind, that want to collaborate, that are feeling the urgency like we're feeling and seeing the urgency and support these essential hospitals and these essential communities all across America. 00:13:12:18 - 00:13:25:18 John Riggi Thank you, Justin, and thank you Microsoft. It's been a great pleasure discussing this important topic with you today, and look forward to our continued partnership to help defend America's hospitals against these cyberthreats. 00:13:25:20 - 00:13:34:02 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. </details> </div> Wed, 12 Mar 2025 07:59:33 -0500 Advancing Health Podcast Critical Condition: Cybersecurity in Rural Hospitals with Microsoft Part 1 /advancing-health-podcast/2025-03-10-critical-condition-cybersecurity-rural-hospitals-microsoft-part-1 Rural hospitals are facing escalating cyberthreats, with ransomware attacks putting patient lives and entire communities at risk. In part one of this conversation, John Riggi, national advisor for cybersecurity and risk at the 黑料正能量 Association, and Justin Spelhaug, corporate vice president and global head of Tech for Social Impact at Microsoft Philanthropies, discuss the unique vulnerabilities rural hospitals face, the latest cyberthreats, and actionable strategies to strengthen defenses.<hr><div></div><hr><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript &nbsp; </h2> </summary> 00:00:01:04 - 00:00:45:24 Tom Haederle Health care tops the list of critical infrastructure targeted by cybercriminals. These threat to life crimes hit every hospital hard, but rural providers even harder due to fewer resources and generally smaller IT staff. The average recovery cost from a ransomware attack is $11 million, a vast sum that leaves many rural hospitals one cyberattack away from closure. In today's podcast, we hear from John Riggi, the 黑料正能量 Association's national advisor for Cybersecurity and Risk, and Justin Spelhaug, corporate vice president of tech for Social Impact, Microsoft Philanthropies, about the steps rural providers can take to reduce the risk and impact of a ransomware attack. 00:00:45:27 - 00:01:13:18 Justin Spelhaug I'm Justin Spelhaug the corporate vice president of tech for Social Impact here at Microsoft Philanthropies, and I'm joined by my co-host John Riggi, the national advisor for Cybersecurity and Risk at the 黑料正能量 Association. And we're here today to discuss critical issues of cybersecurity in rural hospitals, and how our partnership is coming together to tackle the challenges that so many rural hospitals are facing across America. 00:01:13:19 - 00:01:17:09 Justin Spelhaug So thank you for joining us. And John, thank you for joining us. Good to see you here today. 00:01:17:12 - 00:01:20:24 John Riggi Good to see you too, Justin. It's always great to partner with you. 00:01:20:26 - 00:01:30:09 Justin Spelhaug Well, John, you know, as the expert in hospital cybersecurity, can you tell us why rural hospitals are particularly vulnerable to cyber attacks? 00:01:30:11 - 00:01:58:19 John Riggi Justin, great question. There's really a number of factors about that. First, the impact of the physical distance on patient care and mortality when a hospital is shut down by a ransomware attack. For example, rural hospitals provide critical health services to about 60 million Americans, or nearly 20% of the US population. Rural residents already must travel more than twice as far as urban residents to reach the nearest hospital. 00:01:58:22 - 00:02:30:22 John Riggi So when you have this increased travel distances, they are directly associated with higher mortality rates for time sensitive conditions like heart attack, stroke or trauma. And then you're diverting these patients during a ransomware attack, again just magnifying that risk. Then there are the resource challenges, financial constraints and skill shortages. Low operating margins due to patient volumes, high fixed costs relative to urban hospitals. And rural hospitals are more likely to have older technology and smaller IT support staff. 00:02:30:27 - 00:02:59:06 John Riggi This impacts the resources to implement key cybersecurity measures, creating really, unfortunately, an ideal opportunity for exploitation for cyber criminals. The average cost of addressing cyber attacks - now this is the cost after you've been attacked - the cost to recover is almost $11 million. I mean, just an enormous, staggering amount for the average rural hospital. Thirty percent of all rural hospitals are already at risk of closing, 00:02:59:08 - 00:03:22:09 John Riggi so they can be only one cyber attack away from closure. And then, of course, as I indicated, there's a skill shortage. Very difficult to get your best cyber security professionals to work in rural areas. The salaries are generally not as competitive as urban areas or even other industries, so you compile that...it's extremely challenging to get good experienced 00:03:22:10 - 00:03:53:22 John Riggi IT staff to work in rural America. And then we have geopolitical factors making rural hospitals kind of unique targets. So over the past 12 months, cyber attacks against hospitals have increased about 130%, making them the top critical infrastructure that's targeted by cybercriminals. And make no mistake, they know when they target a hospital, lives are threatened. In fact there's now even evidence that nation-states are collaborating with criminal groups. 00:03:53:24 - 00:04:04:21 John Riggi Justin, I know Microsoft keeps a very close eye on the evolving threat landscape. Can you talk to us a bit about the trends you're watching that might affect health care organizations? 00:04:04:24 - 00:04:27:13 Justin Spelhaug I can and John, thanks. I mean, your feedback that hospitals are only, you know, one cyberattack away from closing, especially the rural hospitals that are very stretched, is just really eye opening. And when we look at the challenge facing hospitals, but frankly, many different kinds of organizations, one of the reports that we produced is a Microsoft Digital Defense report. 00:04:27:18 - 00:04:51:13 Justin Spelhaug Now, we use about 78 trillion security signals a day from Windows and Cloud endpoint devices to inform this report. We've got security engineers and intelligence analysts tracking about 1500 unique threat groups all around the world. And the trends I'll talk about here are relevant for every industry. But as you said, John, it's impacting health care and it's impacting rural health care in particular. 00:04:51:17 - 00:05:32:03 Justin Spelhaug So let's talk about a couple of the trends. The first one is that we're continuing to see a massive escalating intensity on password based attacks. When we look at our Microsoft entry data, we see organizations being barraged by about 600 million identity attacks per day, and 99% of those are password based. Now, advances such as zero trust architecture, conditional access policy, MFA have helped defend against this. But we're seeing hackers work around MFA, targeting infrastructure and applications and bypassing authentication altogether. 00:05:32:03 - 00:05:59:15 Justin Spelhaug And that's why advanced monitoring and threat detection capabilities inside of an environment are so critical. So that's the first theme. The second theme that we see is nearly a 3X increase in year-over-year human operated ransomware attacks. They're attacking health care. They're attacking rural hospitals. They're attacking nonprofit. They're attacking schools, they're attacking sensitive government infrastructure. Now, on the good news 00:05:59:15 - 00:06:27:25 Justin Spelhaug if there is any good news anywhere in this story, is we see a significant decline year-over-year in attacks reaching the encryption stage and locking up resources. And that's because of the deployment of automated attack disruption tool. It is also endpoint protection deployment 92%, 92% of all successful ransomware attacks involve the attacker going through unmanaged device on the network. 00:06:27:27 - 00:06:50:08 Justin Spelhaug And it's also about increased training and awareness across the employee base in every organization. But we need to keep making progress because as you know, John, you said the average recovery was about an $11 million investment when they break through. It's devastating, for a rural hospital in particular it's devastating. We're also seeing a third theme and that's the ingenuity of fraud 00:06:50:08 - 00:07:20:26 Justin Spelhaug tactics are quickly evolving. We saw growing sophistication of investment scams, tech support scams are particularly impacting hospitals and more. At the same time, we're seeing impersonation getting more sophisticated, in fact, and detection more difficult because of the access to deepfake technologies that cybercriminals are using. And globally, the World Economic Forum reports that scammers stole over 1 trillion in U.S. dollars from the global economy in 2023. 00:07:20:26 - 00:07:54:11 Justin Spelhaug So the massive, massive impact. Then finally, John, something that you mentioned, nation-states. We're seeing actually blurred lines between nation-state threat actors and cybercriminals. They're partnering together to advance each other's objectives and in particular monitoring and see Iran, who appears to be the most active nation-state actor targeting health care organizations specifically. Perhaps the most acute impacts and the biggest headlines have been in the health sector, certainly over the last 12 months. 00:07:54:13 - 00:08:13:15 Justin Spelhaug And when you talk about a small rural organization or a rural hospital, John, as you just did with less resources as you just talked about to protect themselves and respond. We know why, you know, hackers are targeting these organizations and why it is such a huge challenge for us here in the United States. So big challenges all around. 00:08:13:17 - 00:08:25:04 Justin Spelhaug Now, John, those are the challenges. Can you talk a little bit about the impacts you're seeing these cyber attacks actually have on hospitals and maybe even more importantly, the communities that they serve? 00:08:25:06 - 00:08:56:17 John Riggi As you know, the AHA has been a very loud voice signaling what the impact is of these ransomware attacks on hospitals. Unfortunately, this isn't just about the protection and privacy of data. It's very important, but most importantly is the disruption to patient care. These attacks have caused significant disruption and delay to health care delivery when hospitals are attacked directly or through some third party attack that results in a disruptive effect. 00:08:56:24 - 00:09:31:09 John Riggi And we all know that when there is disruption and delay to health care delivery, patient safety is placed at risk. Lives are threatened. The bottom line: these attacks are not just data theft crimes. These are threat to life crimes. And again, they're not only going after hospitals, but after our mission critical third party providers. For instance, the Change Healthcare attack: the largest, most consequential cyberattack against health care in history, compromised the health care records of 100 million patients, 100 million Americans, costing the sector $100 million a day. 00:09:31:12 - 00:09:57:23 John Riggi And then ultimately disrupting health care delivery. But it's not just the big organizations that are attacked. And of course, when a rural hospital is attacked, there's an outsized impact to the community they serve. Because these attacks, as we have seen, are not just attacks on the hospital as an organization. It's an attack against the patients inside the hospital and against the entire community 00:09:57:23 - 00:10:26:11 John Riggi that depends on the availability of that hospital. A couple of years ago, we had an attack on Sky Lakes Medical Center in southern Oregon. Their 90 bed hospital serve about 120,000 people across 10,000 square miles. Their next nearest hospital, 72 miles away. And when this attack occurred and encrypted their systems forcing them to shut down many of their services, it was very, very significant disruption. 00:10:26:11 - 00:10:54:01 John Riggi And that disruption lasted about 28 days. They had to use 60,000 sheets of paper for clinical documentation. Fortunately, they did not have to pay the ransom. They had the capability to recover and restore independently. But again, significant impact to patient care delivery. And even after it hired extra staff, it took some six months to input all the paper records into the system. 00:10:54:03 - 00:11:23:00 John Riggi So the organization spent about $10 million, a huge expense that was not covered by insurance to overcome this attack. And we have to thank Skylights Medical Center for coming forward to share best practices and lessons learned so we can all help prepare for the impact of these attacks. Unfortunately, I have many examples of how these attacks affect the patients in these rural hospitals, but also threaten the safety of the entire community. 00:11:23:03 - 00:11:45:10 John Riggi A couple years back, I got a call from a hospital in the Pacific Northwest, and they were talking about an attack that they were experiencing, but there were two other hospitals that were also under attack. And so their natural diversion points no longer existed. And they said, John, we are very, very concerned because our next nearest emergency department is 125 miles away. 00:11:45:16 - 00:12:02:21 John Riggi Said John, we've got a medevac parked in the parking lot, but we already are in the state. It actually snows in the winter quite a bit, and we're expecting a storm to come in. If that happens, our medevac can't fly. And if we get a stroke, heart attack or trauma patient, that patient's going to have to go ground transport if it's even safe. 00:12:02:23 - 00:12:21:20 John Riggi And unfortunately, we don't think that patient would make it under those conditions. That's how deadly serious these attacks are. And that's why we always say and tell the federal government that these attacks - make no mistake - the bad guys know what they're doing in the hospital. They're threatening lives. These are threat to life crimes. 00:12:21:22 - 00:12:39:29 Tom Haederle Thanks for listening to part one of this podcast. Please join us on Wednesday for part two as we continue this important conversation on cybersecurity for rural hospitals. Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcast. </details> </div> Mon, 10 Mar 2025 08:00:30 -0500 Advancing Health Podcast WellSpan Health: A Commitment to Quality and Community /advancing-health-podcast/2025-03-05-wellspan-health-commitment-quality-and-community WellSpan Health's commitment to health care innovation and quality earned it the 黑料正能量 Association鈥檚 Quest for Quality Prize in 2024. In this conversation, Mindy Estes, M.D., former CEO of Saint Luke's Health System and former AHA board chair, and Roxanna Gapstur, Ph.D., R.N., CEO of WellSpan Health, discuss the strategies that enabled WellSpan to maintain high-quality care during and after the pandemic,&nbsp;solutions for nursing retention, and how WellSpan is addressing critical community health challenges.<hr><div class="raw-html-embed"><details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript </h2> </summary> 00:00:01:05 - 00:00:29:17 Tom Haederle Welcome to advancing Health. Every hospital, every day and everywhere is striving to improve its quality of patient care. As the winner of the 黑料正能量 Association's prestigious 2024 quest for quality prize, WellSpan health serving 12 counties in Pennsylvania, is among the best at advancing health for those who depend on it. In today's podcast, we learn more about how the efficiencies WellSpan adopted during the pandemic are still in place and still paying dividends today. 00:00:29:20 - 00:00:43:05 Tom Haederle Your host is Doctor Mindy Estes, former president and CEO of Saint Luke's Health System and former chair of the Board of trustees. 00:00:43:07 - 00:01:19:27 Mindy Estes, M.D. I'm Dr. Mindy Estes, and today we have the privilege of speaking with Dr. Roxanna Gapstur, the president chief executive officer of WellSpan health, a position she has held since January 2019. Doctor gaster brings over 25 years of extensive health care leadership experience, having worked across various settings including practices, academic institutions and integrated health systems. Her background in strategic planning, business development and operational leadership, both at ambulatory and hospital settings, has been instrumental in her success at, well, speed. 00:01:20:00 - 00:01:36:03 Mindy Estes, M.D. So let's just dive right in. To begin, can you provide our listeners with an overview of WellSpan health and its mission? Understanding the foundation of the health system gives context to the strategic discussions we'll be talking about today. 00:01:36:06 - 00:02:04:24 Roxanna Gapstur, Ph.D., R.N. Yes, absolutely. WellSpan health is an integrated care delivery system in central Pennsylvania. We serve 12 counties and about a million and a half people have nine hospitals, 23,000 team members and about 2500 providers in our system. We are the largest provider of behavioral health in our region, and we also have a clinically integrated network which provides a basis for our value based care strategy. 00:02:04:26 - 00:02:07:27 Mindy Estes, M.D. So your geographic footprint is quite large. 00:02:07:29 - 00:02:16:00 Roxanna Gapstur, Ph.D., R.N. It's about 12 counties now in the center of the state. Yeah. We've been growing and serving more patients each and every year. 00:02:16:05 - 00:02:44:12 Mindy Estes, M.D. Were you in WellSpan in 2019? And soon after a small event happened, the world was confronted with the Covid 19 pandemic. And despite these challenges, WellSpan was noted for maintaining high quality care and extensive community support. Could you share 3 or 4 critical factors that enabled your leadership team to be successful during this period, and what you've taken from it since? 00:02:44:14 - 00:03:11:23 Roxanna Gapstur, Ph.D., R.N. Yeah, absolutely. One of our values here at WellSpan is working as one. And I think this was a moment for us to really live that value. And throughout the pandemic, we were able to rapidly adapt to changes. We practiced agility, and we practiced one of our other values to find a better way. We have a significant focus in a pretty big community health team that works across central Pennsylvania. 00:03:11:25 - 00:03:40:22 Roxanna Gapstur, Ph.D., R.N. And little did we know that the pandemic was going to highlight some of the challenges. And that team really helped us respond quickly to some of those challenges. We focused significantly on the well-being of our team. Again, I think we all found at the beginning of the pandemic, perhaps this wouldn't last a long time. But as the pandemic went on, we needed to make sure that our team was taking care of and being one of the largest providers of behavioral health services. 00:03:40:22 - 00:04:03:24 Roxanna Gapstur, Ph.D., R.N. We had pretty significant internal resources that we were able to bring to that issue. And then finally, we really empowered our teams to think differently. And at one point during the pandemic, even had developed our own N95 mask. So I think those were were some of the pieces that were most important because we unleashed the innovation within our own teams. 00:04:03:27 - 00:04:21:26 Roxanna Gapstur, Ph.D., R.N. We were able to move pretty quickly on things like the outdoor testing, things like out-of-pocket costs. We were one of the first in the nation to say that we would provide things without charge. Really proud of the team for embracing agility and making sure that the well-being of our teams were front and center. 00:04:21:28 - 00:04:49:18 Mindy Estes, M.D. You know, I want to pick up on something that you said, most of us in health care study things, and we study things for a long time, and then we pilot things, and sometimes we're pilot things. And I think the Covid crisis, if you think about making lemonade out of lemons, really told us that we could be agile, that we could make decisions quickly and in TAC one way or the other if we needed to. 00:04:49:21 - 00:04:55:13 Mindy Estes, M.D. And the question I have for you, have you been able to maintain that agility? 00:04:55:15 - 00:05:23:13 Roxanna Gapstur, Ph.D., R.N. We have actually, so was one of the things that we said to ourselves during our after action reviews that what were some of the silver linings of Covid, and how might we continue to capitalize on those? And one of those was being agile and making decisions quickly. I think because we are locally governed and one of the only health systems in our area that is locally governed, it helps us make decisions quickly because our headquarters are here and our family, friends and neighbors are here. 00:05:23:13 - 00:05:40:27 Roxanna Gapstur, Ph.D., R.N. And so that is something we've been able to maintain. One of the things that I did with my team during Covid was we split into two teams. We had one team really focused on our long term strategy and another team that just focused on operations and taking care of patients each and every day. We've used that as well. 00:05:40:28 - 00:05:49:02 Roxanna Gapstur, Ph.D., R.N. Since the pandemic ended, it was a great way for us to still make progress on some things, even though, you know, we had a lot on our plates. 00:05:49:05 - 00:06:06:24 Mindy Estes, M.D. Well, you make an important point. The work of health care and the future of health care and what what we as organizations were going to do once the immediacy of the pandemic was over, it was tempting to put that on the back shelf and get back to it. But, you know, once you let it go, it's very difficult to restart. 00:06:06:25 - 00:06:28:21 Mindy Estes, M.D. One of the things I was impressed by that I think goes into this long term thought, is that you had low nursing staff turnover during the pandemic. What strategies did you implement to have such a successful retention of nursing staff during, admittedly, an incredibly stressful and unknown time? 00:06:28:24 - 00:06:51:04 Roxanna Gapstur, Ph.D., R.N. Yeah, that's a great question. I think one of the biggest areas was just the focus on the well-being of the team. We had a lot of peer to peer support going on, as well as our psychologists and psychiatrists across the system, working with our frontline care teams every single day. So we had real time coaching and support on all of our units. 00:06:51:07 - 00:07:12:26 Roxanna Gapstur, Ph.D., R.N. We also did a lot of state interviews and a lot of work on understanding what people needed now because as you know, you know, things evolve during Covid and lots of changes happened over those 2 or 3 years. I would say a benefit to us is that generally, our region tends to lag a little bit on things that occur. 00:07:12:26 - 00:07:31:27 Roxanna Gapstur, Ph.D., R.N. So we saw surges in new Jersey and New York prior to central Pennsylvania getting those same surges. And so we were working to try and learn from our colleagues and maybe what was coming. Our way, and how we could do a better job with our teams and with our nurses. So those were some of the things we did. 00:07:31:29 - 00:07:40:13 Roxanna Gapstur, Ph.D., R.N. I think later when you ask about innovation, if you do, I can talk a little bit about some of the innovations we've done in nursing that I think also made a difference. 00:07:40:15 - 00:07:46:00 Mindy Estes, M.D. Well, how about we just speak a little bit about innovation right now, particularly in nursing? 00:07:46:02 - 00:08:11:23 Roxanna Gapstur, Ph.D., R.N. Well, certainly virtual nursing is something that we have rolled out across our system, which has made a really big difference in the satisfaction of our nurses, both in the time they spend and documentation. But the amount of time they're able to spend with their patients. So that's one area. We've also have tiered huddles in our system. So each day, seven days a week actually we start with tiered huddles around seven in the morning. 00:08:11:23 - 00:08:33:23 Roxanna Gapstur, Ph.D., R.N. And those go until nine. At 9:00 is my huddle. So every day I know by 9:00 exactly what's happening in the system, and we're able to solve problems at the right level. So we have sort of tiers one through six. A lot of things are still at tier three and below or tier four and below, but those things that can't be are elevated to the senior leaders. 00:08:33:23 - 00:08:50:24 Roxanna Gapstur, Ph.D., R.N. And we put a team on it right then and there. So I would say compared to when I first arrived at WellSpan, that we solve our problems more in real time. We're more situationally aware and we're able to prevent problems from happening because we have that focus. 00:08:50:26 - 00:09:21:03 Mindy Estes, M.D. Well in solving problems where they're best solved. You know, is helpful for everyone. And you go away from that huddle knowing what you need to do and how you need to go forward. I think a lot of people perceive central Pennsylvania yet as a relatively homogeneous area, but WellSpan serves a diverse community. Can you discuss how you engage these diverse groups and provide resources while respecting their cultures and their autonomy? 00:09:21:05 - 00:09:53:15 Roxanna Gapstur, Ph.D., R.N. Yeah, absolutely. I think a lot of Not-for-profit health systems feel very connected to their community and have different strategies. And certainly in my other roles in other states, even, I felt that connection. WellSpan has maybe a deeper connection than any I've ever experienced. And we have different ways of showing that. So each of our counties and our regions has a healthy county coalition, and WellSpan actually leads most of those coalitions. 00:09:53:18 - 00:10:23:18 Roxanna Gapstur, Ph.D., R.N. But we don't try to do the work of the experts in our nonprofit organizations. Rather, we might be a convener, we might be a partner, we might be a funder. In some instances, we're working together alongside and with and the population across central Pennsylvania, as you mentioned, are more diverse. And I realized when I first arrived here, certainly the plan community is one of our largest stakeholders, and we serve a significant number of people from that population. 00:10:23:24 - 00:10:52:27 Roxanna Gapstur, Ph.D., R.N. We have special cultural liaison individuals who work with our planning community. It's really important to have those relationships, and we've done that for more than 20 years. We also have special bundle payment programs and other types of programs that fit culturally for that particular action. And I will say during Covid that Covid was difficult for that population because of the amount of family interaction they prefer to have in their health care experiences. 00:10:52:29 - 00:11:24:06 Mindy Estes, M.D. I want to skip to the notion of gun violence in workplace violence, workplace safety, community safety. You know, gun violence is a growing concern for all of us. And you've really taken an active role in addressing this issue in New York, Pennsylvania. And I really and I know our listeners would be interested in having you elaborate on when your efforts to reduce gun violence, the partners involved, the progress made thus far. 00:11:24:12 - 00:11:34:19 Mindy Estes, M.D. And my sense is that this is one of these issues, that the minute you take your foot off the gas, it comes back. So talk a little bit about what you've been doing. 00:11:34:22 - 00:12:01:00 Roxanna Gapstur, Ph.D., R.N. Well, I, I can't say enough about what the teams have done in this region on gun violence. It's an issue across all of our communities, but I would say probably more acute in New York County. And that's where we've done a significant amount of the work over the past three years. Probably the biggest piece of this has been understanding both our role and then what the role of others might be in helping prevent gun violence. 00:12:01:02 - 00:12:28:26 Roxanna Gapstur, Ph.D., R.N. I did feel when I first came to WellSpan that there was more we could be doing as a health system in prevention, but also that we can't do it all. And so we needed the right partners. I will say that that strong partners right now have been our local police departments, certainly our judges. We have a really robust treatment court here that works very hard to prevent incarceration and to get people to the right kinds of treatment. 00:12:28:28 - 00:12:52:01 Roxanna Gapstur, Ph.D., R.N. And we also have, in the last two years, a credible messenger program. This program first started on a grant and was a business partnership agreement between one of our local nonprofits and our WellSpan York Hospital, which is a level one trauma center. And the credible messengers are highly engaged individuals who support victims and families who enter York Hospital because of gun violence. 00:12:52:04 - 00:13:20:01 Roxanna Gapstur, Ph.D., R.N. They work to solve some of the deeper causes of violence in the community. And so they're they're very connected outside of the hospital setting. And so far in the last three years, we've seen a 43% reduction in gunshot wound patients at our hospital and a 71% reduction in homicides in our community, which is just gives you goose bumps to think about because it's such a problem for some of the younger individuals in our community. 00:13:20:02 - 00:13:30:12 Roxanna Gapstur, Ph.D., R.N. So I would say the credible messenger program in these partnerships with local non-profits have been the most impactful in addressing really root causes of gun violence. 00:13:30:14 - 00:13:33:16 Mindy Estes, M.D. Question or the credible messengers? Volunteers. 00:13:33:18 - 00:13:56:02 Roxanna Gapstur, Ph.D., R.N. Not the credible messengers, are paid on the grants that we received with the not for profit. But it has been so impactful that we've continued that payment, you know, after the grant. And so all of us in New York County are very invested in that program, both emotionally and financially, because we've seen such great results with it. 00:13:56:04 - 00:14:16:27 Mindy Estes, M.D. Well, the success rate has it's really been extraordinary in the numbers of live saved in families saved, you know, has to be a positive for the entire community. I want to look ahead. And when we look ahead, what do you see as your biggest goal for WellSpan health and what challenges do you anticipate in achieving it? 00:14:16:29 - 00:14:39:27 Roxanna Gapstur, Ph.D., R.N. Boy, that's a great question. I would say innovation is probably one of our biggest priorities. We really believe that the health care system, as great a job as we do in many things, needs some transformation and needs to meet the needs of the future. So we've worked really hard to think about people, process, and technology differently than we did in the past. 00:14:39:27 - 00:15:09:22 Roxanna Gapstur, Ph.D., R.N. And we've spent the last two years setting up for our next strategic plan, which is WellSpan 2030. An innovation and transformation will continue to be a big part of learning how we can use people, process and technology differently together. And, you know, I think all of us were a little taken by surprise a couple of years ago with the, generative AI changes, the Pandora's box that can kind of open as we think about how we might have safer care, more efficient care, etc.. 00:15:09:27 - 00:15:38:05 Roxanna Gapstur, Ph.D., R.N. And I would probably call out to that we've been heavily involved in. One is using artificial intelligence to improve the speed and accuracy of our radiology exams. WellSpan has deployed over 14 different applications for the last five years in radiology. I think we're leading the pack, and in terms of how we've deployed and how engaged our radiologists are with artificial intelligence. 00:15:38:07 - 00:16:06:11 Roxanna Gapstur, Ph.D., R.N. And as you know, Mindy, artificial intelligence requires a lot of work and effort and process in order to make it the most useful for care teams. Our teams have done that work, and we've seen 81% faster traditional review of our exams with our radiologists using using AI. And our physicians who read scans are 98% engaged with the applications. 00:16:06:13 - 00:16:30:25 Mindy Estes, M.D. That's very exciting. And I think you've you've enabled your radiologists to be part of the process because, you know, I think ultimately will help us make smarter decisions, faster decisions, but does not replace the physician. I think once we understand how to use that, and we're still learning and the technology is evolving, you know, we'll see more and more of it. 00:16:30:27 - 00:16:46:29 Mindy Estes, M.D. We are just about out of time, believe it or not. And I want to thank you for sharing your insights. Your leadership at WellSpan health clearly demonstrates how engagement can drive meaningful change and sustainable change. 00:16:47:02 - 00:16:55:11 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. </details></div> Wed, 05 Mar 2025 00:36:47 -0600 Advancing Health Podcast