Advancing Health Podcast

00:00:00:18 - 00:00:33:06
Tom Haederle
Integration - when a hospital joins a health system to benefit from enhanced economies of scale and pooled capabilities - is one of the many ways that hospitals meet the mission of advancing health. Bringing formerly independent hospitals together under a new administrative umbrella can be a delicate dance and must be done carefully for the arrangement to work and the integration to benefit all care providers and their patients.

00:00:33:08 - 00:00:58:05
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. In this month's Leadership Dialogue series podcast hosted by Dr. Joanne Conroy, president and CEO of Dartmouth Health and the 2024 board chair of the American Hospital Association, we glean some great insights on the value and challenges of running an integrated health system from one of the foremost experts.

00:00:58:07 - 00:01:13:18
Tom Haederle
Tom Priselac is president and CEO Emeritus of Cedars-Sinai, where he retired in September after more than 30 years of overseeing its growth from a regional hospital to one of the largest and most influential health systems in the country. And now, to Dr. Conroy.

00:01:13:21 - 00:01:38:24
Joanne Conroy, M.D.
It's great to be with you. I'm Joanne Conroy, CEO and president of Dartmouth Health and the current chair of the American Hospital Association Board of Trustees. I'm looking forward to our conversation today with my friend and colleague, Tom Priselac, who will share his insights on running an integrated health system. He's been at it for 30 years and he is an expert on this topic.

00:01:38:27 - 00:02:11:15
Joanne Conroy, M.D.
He knows his stuff. Tom is president and CEO emeritus of Cedars-Sinai Health System, and despite having just transitioned into retirement last month, he was kind enough to join us today. Tom led the transformation of Cedars-Sinai from a regional hospital into a renowned academic health system. He has spent much of his career championing the important role of health systems and, of course, advancing health for those patients and communities served by Cedars-Sinai.

00:02:11:18 - 00:02:28:22
Joanne Conroy, M.D.
So welcome Tom, who knows this topic better than anyone. And we'll start with a broad question to frame the discussion. How do you define what it means to be a health system, and what are the benefits and what are some of the challenges?

00:02:28:24 - 00:02:52:15
Tom Priselac
Well, I think for me, what it means to be a health system is essentially each of the institutions that become a part of the health system, asking themselves whether it's the founding institution as it was in our case, or affiliate organizations that have become part of the Cedars-Sinai Health System or the organizations with which we have joint ventures, which is another vehicle we've used to build our system.

00:02:52:17 - 00:03:30:16
Tom Priselac
I think it really comes down to each of the institutions asking that core question, what is the path forward for my institution that will allow that institution to best serve its community and carry out its mission? As we've gone through the development of the system in whatever structural form, we've always made that an important part of the consideration of, in the case of Cedars-Sinai, asking the question of given the mission of Cedars-Sinai as both a major academic medical center and a full service community hospital to about 3 million people in Los Angeles.

00:03:30:18 - 00:03:57:05
Tom Priselac
The whole purpose in creating the system, and this is literally embedded in the mission statement of the organization. The system exists to optimize the ability of the member institutions better serve their community. That aspect of what I just described applies whether the integration has been horizontal or whether it's been vertical, with integration of our physician network over the years.

00:03:57:08 - 00:04:27:26
Joanne Conroy, M.D.
I think that's incredibly important because health systems are there to really serve their members and their communities, because we don't always actually take care of patients at the health system. They're actually taken care of at the member sites. So when you talk about the commitment to quality and the commitment to excellence, when you bring in new members, that's a delicate balance between imposing something on a member versus creating it together.

00:04:27:26 - 00:04:31:15
Joanne Conroy, M.D.
So, you know, what's been your approach to really try to manage that?

00:04:31:17 - 00:04:53:28
Tom Priselac
That's a great question. And the characteristic you just described of what I guess I would call co-creating the vision of what it means to be part of a system and be a system. That philosophy of doing it in a co-creating way, as opposed to a kind of a top down. We know the answer in your local community way.

00:04:54:00 - 00:05:26:11
Tom Priselac
The former is very much the path that we have taken. And the same is true whether that's the development of partnerships and affiliations with hospitals or other health systems, or again, with the multiple physician organizations that have become part of our physician network. We do a lot of due diligence on the front end to number one, make sure there's a very much aligned set of core values that whether, again, whatever the entity is, that's becoming part of the system.

00:05:26:13 - 00:05:56:06
Tom Priselac
We really start there and spend a lot of time on that question. And we spend a lot of time talking through the philosophy of the institution, which is to take advantage of economies of scale and economies of capability. An important element, I think, that doesn't necessarily always get the same attention. And making sure that there's a common understanding between us and the incoming organization about what that means for them.

00:05:56:08 - 00:06:15:08
Tom Priselac
Back to the point I just made, how the approach that we take in that regard is going to allow that organization to better fulfill its mission, and how that affiliate becoming a part of the institution will allow Cedars-Sinai to better serve its mission.

00:06:15:10 - 00:06:38:23
Joanne Conroy, M.D.
Let's talk a little bit about recruiting clinicians, because I think there's been a little bit of a shift. I know that historically, when there was an academic medical center, you know, people didn't want to leave what was the comfortable academic medical center to actually provide services outside of that organization. I think over the last ten years that's become a little bit easier.

00:06:38:25 - 00:06:59:22
Joanne Conroy, M.D.
How do you actually use this concept of a health system to actually better recruit clinicians? I can tell you our parking is horrible here. So a number of our clinicians are happy to work at our other hospitals, where the operating room is a little bit more efficient, and the parking lot always has spaces. So how do you manage that with your health system?

00:06:59:24 - 00:07:24:28
Tom Priselac
Well, with regard to physicians being recruited here at Cedars-Sinai, first of all, it starts with what's the primary career interest of the physician being recruited? For those for whom their primary career interest is more research related. You know, the conversation there centers around things like access to diverse populations, which is now finally being recognized as how important that is on the on the research agenda.

00:07:24:28 - 00:08:09:01
Tom Priselac
And so, Los Angeles being one of the most diverse cities on the planet, we offer that kind of opportunity to academic physicians. And then secondly, with those physicians who have a more primary clinical orientation, the opportunity for the existence of the system, especially for the physicians who are providing the tertiary and quaternary services. The conversation really stems around how the existence of the system can facilitate the ability of Cedars-Sinai to be increasingly the place where more tertiary and quaternary services, which are of particular interest to that particular physician or surgeon, would be of most interest.

00:08:09:01 - 00:08:18:21
Tom Priselac
And so, there's an effort to try to align the purpose of the system with what the professional interest of the clinician or researcher involved.

00:08:18:23 - 00:08:47:02
Joanne Conroy, M.D.
How do you actually manage? And this is not uncommon for a new member hospital to actually look to the largest member of the organization to help them establish a new service or expand a service. Where are those decisions made in a health system? And there's got to be some investment because they're hard to stand up, and they're not always as maybe as efficient as it may be at a higher volume institution.

00:08:47:04 - 00:09:14:05
Tom Priselac
That process actually starts during the due diligence effort. And we try to take a very respectful approach with regard to clinical integration between Cedars-Sinai and the affiliates. We're very respectful of the capabilities and quality of the medical community and the local affiliate, and very consciously avoid trying to suggest that we're going to come in and fix a problem.

00:09:14:07 - 00:09:53:24
Tom Priselac
It's really a question of how can Cedars-Sinai and our clinical capability complement what already exists in the institution and builds on it for the benefit of that local community? By the way, you know, implementing that really gives emphasis to the importance of the individual who serves as the CEO of that affiliate organization, because that CEO has to have the kind of trusted and trusting relationship with their medical staff to be able to hopefully guide them through both an understanding and not just an acceptance, but a welcoming of the kind of relationship that I just described.

00:09:53:24 - 00:10:28:18
Tom Priselac
So, you know, and what we would typically do is our clinical leadership engaging with clinical leadership from the respective affiliate. And essentially, I guess you could call it going through an inventory. Before we actually proceed with the affiliation, there's a very clear understanding of where the priorities will be and how that would go about, how that might be executed via physicians that would be recruited here to Cedars-Sinai and then providing those services on some basis in the affiliate.

00:10:28:20 - 00:10:51:00
Tom Priselac
But in other situations, what we've done is we've taken the recruitment ability that an academic medical center has to be able to help those local communities be more successful in recruiting a more experienced and more capable physician or surgeon, depending on the specialty service involved.

00:10:51:02 - 00:11:21:29
Joanne Conroy, M.D.
You know, health systems, as we get larger, have a much broader community responsibility. And I know we are investing in transportation, housing, child care, really in a much broader footprint than necessarily one facility. What are the type of things that communities come to you and want your partnership on that actually benefit the broader health of the community?

00:11:22:01 - 00:12:03:12
Tom Priselac
One is the clinical capability. And so part of the strategic planning of the system is answering the question, how are we going to raise the clinical capability in each of the respective affiliates through whatever physician recruitment approach along the lines of what I just mentioned. So the clinical capability questions there, for some of the affiliates, being part of an organization that has the kind of balance sheet that the larger organization has, whether that's allowing the institution to be more cost effective and have better access to resources because borrowing costs might be lower, is maybe an example on that side.

00:12:03:14 - 00:12:50:11
Tom Priselac
In some of the relationships the research capability of the institution and how that can facilitate the availability of clinical trials, especially in an area like cancer, which may be of more interest and need in one community versus another. And then finally, each of our institutions as not for profits, all have community benefit missions. You know, over time, one of the things that that we carry out is the integration effort on the community benefit side as much as anything else, to just make sure that as each of the institutions approach their individual community benefit missions, we're doing it in an aligned way and looking for the commonalities of what kind of community benefit activities would be

00:12:50:11 - 00:13:22:04
Tom Priselac
most impactful over the geographic footprint of the system. And the example I would give in that regard in Los Angeles today, we're all familiar with the challenge of homelessness - in America in general and certainly here in Los Angeles. And so in the area of community benefit work related to homelessness, whether it's grantmaking or programming that might go on in each of the institutions, and sharing information, sharing knowledge about best practices and what we have found to be the most effective strategies in that regard.

00:13:22:06 - 00:13:49:15
Joanne Conroy, M.D.
Yeah, you're right. You know, every single community just seems to have their own specific challenges. Talk a little bit about quality and patient safety. How do you, you know, bring people together and have them kind of co-create a quality safety culture? You know, I've said that the system is there. Its role is to monitor, but the quality is really kind of owned by the combined organizations.

00:13:49:15 - 00:13:56:04
Joanne Conroy, M.D.
So how have you kind of structured bringing people together and what do you think has been the most effective?

00:13:56:06 - 00:14:29:18
Tom Priselac
Yeah. So I guess I'd begin by reflecting the overall philosophy we've taken, which is the purpose of the system, is to assure the optimal success of each of the individual members. We're very much interested in strengthening and not disempowering the local hospital or the affiliate hospital, especially issues like quality. When we bring organizations into the system, part of that due diligence is to make sure we're satisfied it's already a high quality institution.

00:14:29:21 - 00:14:51:21
Tom Priselac
And the question is, how can becoming part of that system help make it better? We've taken the approach of in certain areas to pursue a more what I would call a shared services approach. And in others, we're using what we call a collaborative approach. And with regard to how we approach managing for quality, we use the collaborative structure.

00:14:51:26 - 00:15:31:00
Tom Priselac
What does that mean? What that means is that we've gone through a process of, on the one hand, identifying a set of common measures of what quality means across the system and making sure that each of the institutions have focused work that is addressing what those commonly identified quality goals are for each of the institutions, but also leaving room for the local institution to continue to pursue quality priorities that are relevant and unique to that particular institution.

00:15:31:02 - 00:16:00:25
Tom Priselac
We establish what I'll call a common language, a common platform for measurement, agree on how that measurement is going to take place, and then essentially we use the collaborative model and the knowledge sharing that goes on in the collaborative discussions among each of the management teams from the respective institutions to be able to advance the individual and therefore the collective performance of the system.

00:16:00:27 - 00:16:34:19
Joanne Conroy, M.D.
You know, you bring up a good point that, you know, you can't actually run it centrally. But one thing that is very evident when there's an issue is the resources when you can pull everybody from across the system to address an issue are incredibly powerful. I think we had an organization once that was going through a very rough Joint Commission visit. And I think on day two, half the system swooped in there to actually assist the team that was there and say, how can we help you?

00:16:34:22 - 00:16:51:15
Joanne Conroy, M.D.
And, you know, it's interesting you don't appreciate the power of the system until you actually need to use it. And it's often just all of a sudden, instead of having two people on your team, all the sudden you look behind you and you have 100. It makes people both confident and much more effective.

00:16:51:18 - 00:17:16:24
Tom Priselac
That's an example of what I meant earlier about systems bringing economies of capability or scaling capability within the institution. In a lot of the public policy discussions there's really a lack of appreciation, I think, from people outside of health care delivery about what that means and how that can enhance the ability of an institution to provide high quality care.

00:17:16:26 - 00:17:41:24
Joanne Conroy, M.D.
Well, Tom, I want to thank you for giving us some of your time today. We really appreciate your valuable insights and your expertise, and we wish you the best in retirement. But I have a feeling your dance card is going to be pretty full. Probably already is with people that want you to give them advice about, you know, building a health system that serves the needs of the communities.

00:17:41:27 - 00:17:43:27
Joanne Conroy, M.D.
Thank you Tom, again.

00:17:43:29 - 00:17:45:09
Tom Priselac
Thanks, Joanne.

00:17:45:11 - 00:17:53:22
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:20 - 00:00:40:09
Tom Haederle
Even as Baxter strives to restart its production of IV fluids critical for patient care, in the wake of the damage caused by Hurricane Helene, hospitals and health systems nationwide are reviewing and reevaluating their response playbooks for dealing with supply chain disruption. For many caregivers, such as Ohio's Cleveland Clinic, this national shortage is just the most recent in a long line of shocks to essential supplies that preceded the Covid pandemic, dramatically escalated during the Covid years and still has yet to abate.

00:00:40:11 - 00:01:14:11
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Conservation, communication and cross-functional collaboration are the pillars of Cleveland Clinic's approach to leading through this IV fluid shortage and minimizing its impact on patient care to the extent possible. In this podcast hosted by Dr. Chris DeRienzo, AHA's chief physician executive, we get an overview of Cleveland Clinic's ongoing IV fluid conservation strategies from its surgical director for surgical operations, Dr. Mark Taylor.

00:01:14:13 - 00:01:30:24
Chris DeRienzo, M.D.
I am very lucky to be joined by Dr. Mark Taylor. He is the surgical director of surgical operations for the Cleveland Clinic, and to talk about the clinic's approach to how they've managed through this, frankly, national crisis. Dr. Taylor, thank you so much for joining us today.

00:01:30:27 - 00:01:32:15
Mark Taylor, M.D.
Well, thank you, Chris, for having me.

00:01:32:18 - 00:01:44:17
Chris DeRienzo, M.D.
Let's go back a few weeks. So, when did you first learn about the true level of this IV solution shortage? And what actions did you and your teams at the clinic put in place around conservation?

00:01:44:20 - 00:02:08:11
Mark Taylor, M.D.
So, we first heard the day following Hurricane Helene’s landfall, when reports of significant damage were sustained at the Baxter facility in North Cove, North Carolina area. We immediately stood up teams between supply chain and some operational leaders to start to assess the situation. And then as the next several days played out, it became apparent that the damage was significant.

00:02:08:11 - 00:02:27:06
Mark Taylor, M.D.
And that that Baxter facility was going to be in a compromised position for not just a number of days, but probably a number of months. That really sort of planned our response, if you will, in that first four days, which was critical to where we are today in terms of some sustainable cadence around our meetings and our multidisciplinary teams.

00:02:27:09 - 00:02:52:09
Mark Taylor, M.D.
What we did immediately was, as we looked internal to determine what our inventory looked like, what our usage patterns were, and where we had supply opportunities to centralize and then allocate appropriately. Respectful of the fact that this may be a much longer-term situation, that both the Cleveland Clinic, in Ohio and Florida were going to face, but also, health care systems across the U.S. market.

00:02:52:11 - 00:03:20:12
Chris DeRienzo, M.D.
I remember being on the phone with chief physicians in those first couple of days after the storm. And, you know, there was some real concern about what can we do short term, recognizing that all those images coming out of western North Carolina looked pretty scary. But I think one thing our listeners would really appreciate is from an operational standpoint, and we talk about conservation and there's some just assumption you flip a switch and magically, you know, conservation efforts are going on.

00:03:20:12 - 00:03:30:14
Chris DeRienzo, M.D.
But what was actually involved at Cleveland Clinic, what kind of teams were involved and what processes did you have to turn on in order for the impact of conservation to really be felt?

00:03:30:17 - 00:04:00:10
Mark Taylor, M.D.
Yeah, I think the first step was to really get a sense from Baxter and from some teams internal to the Clinic, what fluids were specifically going to become necessary for conservation? We quickly assessed that it was IV fluids, OR irrigation fluids and fluids specific to peritoneal dialysis. And once we knew that that was the platform, we could then create teams, if you will, that were subject matter experts in those areas to address some of the nuances that may exist.

00:04:00:12 - 00:04:21:19
Mark Taylor, M.D.
From an operational standpoint, this work is at the forefront of what a large team of professionals at the Cleveland Clinic is focused upon daily. We meet twice a day with these groups, but I know that there's a lot of work that goes on in between those twice-daily meetings to make sure that work is ongoing. Given the size and scope and the impact.

00:04:21:22 - 00:04:46:07
Mark Taylor, M.D.
These products are daily-use products. When one thinks about the amount of IV fluid that is moving through our organization, through all kinds of clinical areas, through the pharmacy, the emergency rooms, the ICUs, the ORs, the fact that we had a facility taken offline that was really sort of the standard part of what a patient would experience for either a simple procedure or a large procedure, or an inpatient or short outpatient admission —

00:04:46:09 - 00:04:53:03
Mark Taylor, M.D.
you could see how critical the response has to be so that flow of care continues.

00:04:53:05 - 00:05:05:24
Chris DeRienzo, M.D.
No question. It sounds like there's a pretty large team at Cleveland Clinic involved in the issue. Speak a little bit for our listeners about the importance of collaboration and what it takes to manage such a widely disparate group.

00:05:05:26 - 00:05:42:26
Mark Taylor, M.D.
Yeah, well I think it's important to recognize that the teams that we brought together represented operations, nursing, pharmacy, supply chain, anesthesia, ICU, nephrology, informatics, communications, infection prevention specialist, and several more that come and go as we manage through this crisis. You know, as we explore changes to our operations, we have to make sure that we reach out to other partners within the clinic to ensure that changes in workflows align with our policies, align with our regulatory affairs.

00:05:42:28 - 00:06:17:09
Mark Taylor, M.D.
Make sure that things are in alignment with how we want to deliver care. So I think what's really critical with these multidisciplinary teams is you have to have a forum where these teams can come together, obtain information, ask insightful questions, allow others to speak and offer suggestions about changes in strategy, changes in operations or, equally important, inclusion of others so that we don't make a step that may potentially create a different situation than we have to manage.

00:06:17:12 - 00:06:38:29
Chris DeRienzo, M.D.
Let's go deeper on that forum for a minute, because communication is absolutely crucial to successfully leading through these kinds of disruptions. And I remember past experience during Covid with other disruptions to our normal daily work. It is really hard to communicate quickly, efficiently and effectively, both internally and externally. So how are you doing it?

00:06:39:01 - 00:07:04:15
Mark Taylor, M.D.
Yeah, that's a great question. So, I like the term disruptions. And we learned during the pandemic to become comfortable, if you will, with disruptions. Many of us in operations and in clinical leadership roles, I think we're happy to think that the disruptions were behind us. But I think disruptions are going to be part of our operational work and leadership portfolio for the foreseeable future, because it's just the nature of the work that we are doing.

00:07:04:16 - 00:07:30:03
Mark Taylor, M.D.
And to focus specifically on communications, communication and leadership from communications was central to this. We have to reach our caregivers across a wide variety of different platforms. We have to reach them where they work. We have to reach them through a medium with which they continually engage with the organization. And so we have a variety of different tactics or techniques that we utilize.

00:07:30:05 - 00:07:55:00
Mark Taylor, M.D.
We have a daily huddle approach. Every unit has a huddle, that starts at the beginning of their shift. And we use the huddle to disseminate information in a daily fashion. And that huddle is scripted for some communications. And that huddle we then hope is one way to get it to sort of pass to the caregivers that are providing care in the clinical environments.

00:07:55:02 - 00:08:30:26
Mark Taylor, M.D.
We also have a very robust intranet page, and the source of a lot of communication for information, which is standard for most health care organization, is on that intranet page that you see when you go to log in to your computer before you log into Epic, or into your email. We have lots of bulletin boards or video Scala boards, and we like the Scala boards because that's another way when someone's passing through the hall or passing in a break room, or at a point where they're able to take in new information, they're able to sort of take a look at that board and hopefully get a snapshot.

00:08:30:28 - 00:08:54:06
Mark Taylor, M.D.
And then most importantly, we have one central source of resources. On our intranet we created a page where with one click you can see an icon of an IV fluid drip chamber. And once you click that icon, it then takes you to four or five intranet pages that are specific to your service line. So we have a page dedicated to OR irrigation.

00:08:54:08 - 00:09:25:29
Mark Taylor, M.D.
We have a page dedicated to peritoneal dialysis. We have a page dedicated to inpatient IV fluid management, which is slightly different than our ambulatory or procedural area or OR IV fluid conservation strategies. And with that form of communication, we're really trying to make our communication specific to our caregivers, respectful of time constraints, respectful of restrictions in terms of how they're able to interact with that information

00:09:26:02 - 00:09:47:15
Mark Taylor, M.D.
during a busy clinical day. And then finally, we really leverage our senior leadership team. Our CEO has been extremely interested in this situation. We utilize him frequently to send out important messages  that we want everybody to understand. Most importantly, the impact of conservation.

00:09:47:18 - 00:10:11:01
Chris DeRienzo, M.D.
I think it has been widely said, seven times seven ways is the way we've got to do it. And we're hearing that the impact of that conservation is pretty substantial. When hospitals are taking the kinds of steps that you've described, you know, taking at the Clinic. We're seeing up to 40% reductions in utilization of some of those products, which we know is having a dramatic effect on decreasing the impact to patients right now.

00:10:11:08 - 00:10:38:02
Chris DeRienzo, M.D.
Because that hole in the supply chain caused by the loss of this Baxter facility, that's a gaping hole. It's 60% of IV fluids in the country. As you indicated, though, this is not the first time and definitely won't be the last time that we we've experienced challenges in the resiliency of our supply chain. What kinds of lessons have you learned from past incidents at the Cleveland Clinic, Dr. Taylor, that you've actually been able to apply to this situation?

00:10:38:03 - 00:10:39:19
Chris DeRienzo, M.D.
I imagine there are several.

00:10:39:21 - 00:11:08:14
Mark Taylor, M.D.
Yeah, I think many would agree with me that, you know, the pandemic prepared us for supply chain interruptions. Obviously, the pandemic was on a global scale, but we learned during the pandemic to manage through supply chain interruptions and to accept changes in supplies or changes in the way we managed our supplies. We have worked post-pandemic to ensure that we have strong relationships with our supply chain partners.

00:11:08:16 - 00:11:37:16
Mark Taylor, M.D.
We have a better understanding of how they work, where they have facilities, where they have redundancy in their facilities, where there could be some potential challenges in that. We also have worked to build alternative avenues of supply chain connections so that if one avenue comes up insufficient, we're able to pivot or fully explore another avenue to continue to bring in the products we need to care for our patients.

00:11:37:18 - 00:12:08:26
Mark Taylor, M.D.
We also share information with our supply chain partners. We provide them forecast with number of lives to be treated. What's our daily census look like? What's our anticipated volume in the upcoming months or quarters? So our supply chain partner has a better understanding of our needs, and then we obviously hope that they'll share with us their resources. And if they have any operational challenges that may not align with what we're forecasting, we can work on that as a team and come up with solutions.

00:12:08:29 - 00:12:29:06
Chris DeRienzo, M.D.
Really is a continuous process. I mean, you said it well, if you turn off a hospital supply of IV fluid, it's like turning off the water to your house. You really don't last very long until you start increasing in intensity the challenges that you face. We've talked a lot about the way that you're approaching this, Dr. Taylor at Cleveland Clinic.

00:12:29:09 - 00:12:52:06
Chris DeRienzo, M.D.
What are some things that hospitals and health systems should think about doing, you know, throughout the year to both prepare for these kinds of potential supply disruptions? And be ready, you know, no matter the cause, be it, this kind of a natural disaster or other events. What are some leading practices that you would leave our listeners with, that hospitals could be taking action on today?

00:12:52:08 - 00:13:14:27
Mark Taylor, M.D.
We want patient safety to be the number one priority. And that's our driving mission here. We don't want to make operational changes to focus on one component of a supply chain interruption that would ever harm our patients, but many people know that it's probably, you know, easy to hang one liter bag on everybody, whether or not they're going to be on campus for 20 minutes or whether they're going to be undergoing a two hour-long surgical procedure.

00:13:14:27 - 00:13:50:17
Mark Taylor, M.D.
So we really focused on conservation. And we've been able to cut the indiscriminate use of large bags of fluid down to the appropriate size, including using IV push for short procedures that require one or two medications and a quick IV push or IV flush. In regards to supply chain, I really think it's having those supply chain experts understand their partnership with our vendors, understand their strengths, understand their potential opportunities or weaknesses, and really let them sort of explore a resiliency plan.

00:13:50:20 - 00:14:23:07
Mark Taylor, M.D.
This is not an area where any health care organization wants to cut corners or take a pathway that may put too many eggs in one basket, so to speak. You need to have backup plans because natural disasters will occur, supply chain interruptions will continue. And what, like you say, I mean, we have to continue to care for patients and we have to continue to embrace this idea that we have to have teams that can step up at a moment's notice and keep the supply of products coming into our health care facilities so that hopefully we don't have to interrupt care.

00:14:23:10 - 00:14:43:06
Chris DeRienzo, M.D.
Well said. As I talk to hospitals across the country, I think we understand the role that we play for our communities. Being ready to care 24-7, 365, and we are nothing if not always learning. Dr. Taylor, we've learned a lot from you today. Thank you so much for being willing to share the experience of the Cleveland Clinic walking through the shortage.

00:14:43:06 - 00:14:44:13
Chris DeRienzo, M.D.
It was a real privilege.

00:14:44:21 - 00:14:46:09
Mark Taylor, M.D.
Thank you for having me.

00:14:46:12 - 00:14:54:18
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us rate stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:19 - 00:00:33:14
Tom Haederle
Issues that continue to affect the entire health care field, such as cybersecurity, workforce and the lingering effects of the pandemic, are areas of vulnerability for most organizations. Their boards can help by asking the right questions and providing the guidance that helps hospitals and health systems develop effective plans to deal with these challenges. And now, boards themselves could get a little help with this important task.

00:00:33:17 - 00:01:00:18
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Today we hear from James Liggins, an experienced board member with Bronson Healthcare in Michigan. In this podcast hosted by Nikhil Baviskar, the AHA's program manager for trustee services, Liggins describes his work on a tool board members can use to help their organizations thrive in this complex and challenging era for health care.

00:01:00:20 - 00:01:19:04
Nikhil Baviskar
Hi James, great to see you here at the 2024 AHA Leadership Summit. Can you tell me a little bit about your organization as well as your board, specifically the composition, the history? And I would be remiss if I didn't ask about your involvement with our AHA Committee on Governance as well.

00:01:19:06 - 00:01:44:18
James Liggins, Jr.
Absolutely. So my name is James Liggins, I am the incoming board chair, actually, for my organization, which is Bronson Healthcare Group. It's located in Michigan. It is a four-hospital system, almost five hospitals now. We just brought in a behavioral health hospital as well. Maybe about 9000 employees, the largest employee in the area. So it's headquartered in Kalamazoo, Michigan.

00:01:44:21 - 00:02:04:00
James Liggins, Jr.
And then we pretty much are southwest Michigan as our region as a nine-region area. And I am the incoming chair, and I've been there for, I've been on the board there for about eight years now. I'm also a commercial litigator by trade, so I do business-to-business kind of litigation. The firm that I work for is called Warner Norcross + Judd.

00:02:04:02 - 00:02:33:11
James Liggins, Jr.
And then with respect to the American Hospital Association, I am a Committee on Governance member, and I've been a member for several years now. And the incoming chair for that committee as well. And that is really one of the highlights of my career with respect to board work, because it's a different type of committee and it's the flow is a little bit different than I'm used to, but I'm really enjoying the impact that it seems like it has over the entire health care industry and hospitals in general.

00:02:33:13 - 00:02:58:23
Nikhil Baviskar
Appreciate that and thank you for the shout out. We love having our COG members involved with so much of what we do. Specifically, you know, referring to the AHA, I wanted to next question ask you about the AHA Next Generation Leaders Fellow. So this is a program that you are expected to develop a project. And one of the reasons we have you here today is to explain that project as it is something that seems interesting for lots of people.

00:02:58:29 - 00:03:36:27
James Liggins, Jr.
Well, sure. So the Next Generation Leaders Fellowship is, I think I'm a little bit of a unicorn with it because it's normally for those who are kind of up and coming executives headed towards the C-suite kind of level in operations of hospitals. But since I'm actually a board member as opposed to operationally speaking, it's been very interesting. And the focus of what I really wanted to get out of it was the operational side of the health care industry as a whole, and the project that I've decided to focus on is actually kind of near and dear to my heart as a board member, because it really kind of stemmed from some of the dynamics that we

00:03:36:27 - 00:04:07:27
James Liggins, Jr.
received or experience as an industry from Covid, as well as now we're seeing some of the cybersecurity issues that, not some of them, a lot of them, and even CrowdStrike that just kind of impacted the airline industry and others. It really kind of started to concern me as a board member about those areas of vulnerability with organizations that, should they fail and we not have redundancies in those fields or in those areas, we could have catastrophic kind of impact for the organizations.

00:04:07:27 - 00:04:39:12
James Liggins, Jr.
And so my project was focused on the board side of this. How do we develop a tool that helps the board to ask the right questions, to make sure that our organizations are addressing areas of those types of vulnerabilities? They're called single points of failure, and it really comes from the technical side or technology side with the idea that if you have an app or you have a server that potentially if that's your only non-redundant system and it fails, then you're in trouble.

00:04:39:12 - 00:05:05:27
James Liggins, Jr.
And so, but that's organizationally-wise it can be applied throughout every industry. And so my thought was how do we apply that to the health care industry. And particularly from the board level. How do we develop a tool. And this is really interesting, how do you develop a tool that doesn't poke too far into operations as a board, but also allows you to do your due diligence to ask and inquire for the questions that the board members should be asking.

00:05:06:00 - 00:05:16:25
James Liggins, Jr.
And so that's been my project, is develop that type of tool, and it's been a wonderful process. And fortunately I have a organization that was really behind the idea of trying to help me to develop it as well.

00:05:16:27 - 00:05:35:11
Nikhil Baviskar
That is awesome. In a word. I think it's really great that you are looking at this from a board member’s perspective, because we don't usually see that. And I think calling yourself a unicorn is helpful as well, because it shows us that the board member does have a unique perspective on all of this. So the board tool sounds amazing.

00:05:35:11 - 00:05:38:27
Nikhil Baviskar
Can you tell me how it would work in practice and potentially give us an example?

00:05:38:28 - 00:05:58:21
James Liggins, Jr.
Sure. So in practice, the way it works is what you really want to do is work with your executive team. So to develop questions that kind of are focused on things like, so a single point of failure could be a person, you know, it could be a position, maybe a position that we don't have a succession plan for, we don't have.

00:05:58:25 - 00:06:19:27
James Liggins, Jr.
But if we lost that person, the system could come to a halt. It could be very catastrophic for us. It could be a vendor that is a single point of produce or production or service for the organization that we don't have backups for. It could be someone or a knowledge or a skillset, that if that skillset goes away, the organization as a whole is in trouble.

00:06:20:03 - 00:06:40:25
James Liggins, Jr.
And so what we develop was a, so you work with your team, and the reason why you have to work with your executives is because you really want to counteract and mitigate the defense, the automatic defensiveness that people might have when you start talking about areas within their responsibility, right? That at the end of the day, may look or reflect bad on them.

00:06:40:27 - 00:06:54:24
James Liggins, Jr.
So you really have to work to bring them into the process right from the beginning and help them to understand that this is going to be anonymous. The goal is not to single point anyone out. The goal is to make sure that the organization as a whole is as healthy as it can be.

00:06:54:27 - 00:06:57:08
Nikhil Baviskar
Have you been able to test this out as of yet?

00:06:57:13 - 00:07:19:23
James Liggins, Jr.
So I have the survey. We are working on implementation right now. And so the goal is by fourth quarter to implement it at Bronson. Yeah. And the cool thing is I'll just be moving into the board chair role. So I'll have some legitimacy and pushing this out to the organization as a whole. Because just as a regular board member, I'm not sure I'd be able to get it pushed.

00:07:19:23 - 00:07:29:18
Nikhil Baviskar
Well legitimacy matters, yeah, legitimacy matters. Well, James, thank you so much for your time today. I can't wait to follow up with you and find out how this works out.

00:07:29:18 - 00:07:46:08
James Liggins, Jr.
And one last thing I'll say, Nikhil, is on the Committee on Governance. You know, the goal is hopefully after I've had a year of implementation to talk to our committee about it as well and just let the committee members know what we're doing, they may decide that it's something that they may have interest in as well. And our members as well.

00:07:46:10 - 00:07:53:27
Nikhil Baviskar
We are at the Innovation Hub at the Leadership Summit. So perfect idea. So thank you again, James, for your time and we'll talk to you later.

00:07:53:27 - 00:07:56:02
James Liggins, Jr.
Nikhil, I appreciate the opportunity.

00:07:56:04 - 00:08:04:15
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:13 - 00:00:36:24
Tom Haederle
Every hospital and health system is motivated to find ever-better ways to deliver patient care. But driving improvement across 17 hospitals serving two states is a challenge that defies a one-size-fits-all approach. That's why Jefferson Health, serving patients in New Jersey and Pennsylvania, created a unified platform it calls the OnPoint Program to keep everyone on the same page when it comes to identifying and implementing needed changes.

00:00:36:27 - 00:01:12:03
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle, with AHA communications. Jefferson Health's innovative approach to system wide improvement made it a finalist for the AHA's 2024 Quest for Quality Prize, which celebrates hospitals and health systems that are committed to providing exceptional quality, safe and patient and family-centered care. In today's podcast, we hear more about how this large and growing health care system drives progress towards its goals for quality, safety and health equity across teams with very different skill sets.

00:01:12:06 - 00:01:31:18
Chris DeReinzo, M.D.
Hi everybody. This is Dr. Chris DeReinzo. I'm AHA’s chief physician executive and we are coming to you from the AHA Leadership Summit in San Diego. We are here in the Innovation Hub, which is a perfectly apropos place to be, because we're here today to talk with some of Jefferson Health's senior leaders. Joining us on the podcast, I have Dr. Cara Martino.

00:01:31:18 - 00:01:50:21
Chris DeReinzo, M.D.
She is a DNP and she's the vice president of clinical improvement and transformation across Jefferson Health. And Dr. Trish Henwood, who is an M.D., and she is the executive vice president and chief clinical officer for the system. And you all are here in part because Jefferson has been recognized as one of the finalists for AHA's Quest for Quality Award.

00:01:50:21 - 00:01:58:06
Chris DeReinzo, M.D.
Congratulations. That is a spectacular achievement. And our listeners want to know a little bit about how you do it. And so, Trish, why don't we start with you.

00:01:58:13 - 00:02:31:04
Trish Henwood, M.D.
Thanks, Chris. We're really glad to be here and really excited for the recognition and to be here with all of the innovation conversation that's happening. For us at Jefferson Health, we have taken a different approach on how we're focused on improvement. We have a unified platform across the system we call the OnPoint program and that really is to us, a clinical operating system that helps drive our goals in quality and safety, in health equity, in patient experience and in population health and really is sort of the foundation for us and how we think about how our teams come together to work on these improvement efforts.

00:02:31:06 - 00:02:43:09
Chris DeReinzo, M.D.
It's a spectacular system and one that you've spoken about internationally. I'm curious, Cara, perhaps tell us a little bit about how you start from that system and then actually make it tactically happen with your teams?

00:02:43:15 - 00:03:16:15
Cara Martino, DNP
Yeah, sure. No problem. A few pieces. We have a clinical improvement approach where we really start by looking at our data across the board and identifying opportunities, looking at that by our divisions, our region and across the enterprise to really try to understand the playing field. And then we look at our process, our people and our technology. Once we kind of identify what we want to improve, what are the resources that we have in place, what are the technologies that those resources are interacting with to drive that workflow, and what are the different processes or policies?

00:03:16:17 - 00:03:39:05
Cara Martino, DNP
And then I think it's really important because Jefferson Health has so much expertise at the frontline and with the clinicians. We work with them to identify what is evidence based practice to drive that opportunity? And then we take that and we kind of build it into a system to make it easy for the frontline staff to do the right thing, to get the outcome that we need.

00:03:39:08 - 00:04:01:17
Cara Martino, DNP
Many times we do that through technology, but through process also, and then we continuously monitor that to really understand is what we intended happening, right? Because a lot of times it's what we think is going to happen or we think happens on the front line isn't always the reality. And so we continuously monitor that through process measures and through outcome measures.

00:04:01:24 - 00:04:15:07
Cara Martino, DNP
And then we tweak it. And over time we continuously improve on that. And I think that's really important. The first time that you try to improve something, you're not going to get there 100%. And so it's really important to have that continuous process.

00:04:15:08 - 00:04:32:16
Chris DeReinzo, M.D.
One of my favorite favorite quotes of all time was from Sister Katherine McCauley, who was the founder of the mercy movement in Ireland that ultimately grew to be one of the most impactful social movements worldwide. And her guiding principle was in a letter that she wrote in like the 1840s, was to resolve to be "good today and better tomorrow."

00:04:32:19 - 00:04:52:18
Chris DeReinzo, M.D.
And in order to get better tomorrow, you got to measure it. But remind me, our listeners know you obviously as one of the premier academic systems in the northeast, but your footprint spreads pretty far beyond, you know, it's kind of our traditional closed medical staff, academic model. Remind our listeners, when you talk about driving that process improvement to the front line, what kind of front lines are you driving it to?

00:04:52:21 - 00:05:19:18
Trish Henwood, M.D.
We have quite a variety across our system. We're a 17-hospital system. We span two states, southeastern Pennsylvania and southern new Jersey, nine county areas serving a catchment area of over 5 million people. Wow. So it's quite a large system, growing system as well in the coming months. So for us, it's very important for us to think about how we interact across all those teams and how we bring our teams together to have the prioritized focus that we are establishing as we move year on year.

00:05:19:21 - 00:05:53:07
Trish Henwood, M.D.
To piggyback on what Cara was saying, part of what we try to do in the discovery phase for our improvement is to think, to use principles from human factors engineering and resilience engineering, to think about the difference between work as done versus work as imagined. We know that at times the enterprise approach may be the work as imagined, and it's very important that our process is informed by our frontline teams, by telling us going across our system and understanding how is work actually done, how do we ensure that we have representation from our clinicians and or our team members if they're not clinical, that are interacting on these workflows?

00:05:53:07 - 00:06:11:17
Trish Henwood, M.D.
As we think about designing something that's going to work across an entire system of our size, where we have complex academic medical centers, where we have smaller community hospitals. We have obviously a large ambulatory footprint in addition to urgent care. And so how we think about things in our different care settings and how we think about things across the continuum of care.

00:06:11:23 - 00:06:33:26
Chris DeReinzo, M.D.
I love that thinking, because I remember being at a health system in the western part of North Carolina, and the approach that we took to drive something like improvement in timed one-hour antibiotics in the emergency department could follow one pathway, and it's pretty classic pathway. But then once we brought that out into the region in the critical access hospitals, you just can't do that because their pharmacy isn't even open from like 11 p.m. to 7 a.m..

00:06:33:27 - 00:06:46:06
Chris DeReinzo, M.D.
This was ten years ago now, but I love the flexibility in that approach. But talk to me a little bit about the kinds of people who do that work are fundamentally some different skill sets than perhaps what we've seen in the quality and safety world in the past.

00:06:46:06 - 00:07:17:06
Cara Martino, DNP
Yeah, absolutely. As we were developing the team, what we really started to realize is that we needed to advance the skill sets of the people that are in quality and safety and in this improvement work. And I think that today we really look for people that understand informatics and analytics and can take that deeper dive into where the opportunities are for improvement and really drive those through with process improvement and project management and really get down to kind of tactical items that we can do to really change that.

00:07:17:06 - 00:07:43:14
Cara Martino, DNP
And I think to your point around what's going to work for our maybe Center City hospital, our academic hospital, may not work for the regions where there are community hospitals. And we try to have a standardized approach, but build in for those nuances and those complexities that are at the local regions and divisions. And we do that through our quality and safety folks, kind of as the glue between the groups that really help with that connection.

00:07:43:17 - 00:08:05:08
Chris DeReinzo, M.D.
Talk to me about how you make that bridge real, because you both, like me, have a clinical background. But we're talking about design thinkers and informatics folks that come from fundamentally different backgrounds sometimes. How do you make that bridge happen so that the folks who live exclusively in one, you know, our bedside clinicians who aren't going to go to design school, but how do they understand the challenges?

00:08:05:11 - 00:08:43:01
Trish Henwood, M.D.
I think we certainly take a matrixed approach, right, to how our teams interact. We work very closely in terms of the office of the chief quality and chief clinical officer with our office of the CIO, and thinking about how we interact with our ISNT teams, making sure that our teams are appropriately connected, and then again, bringing in our frontline caregivers, clinicians and patients and community member voices, again, depending on what the process is, so that we make sure that from the front of the process, we're thinking about all of the different stakeholders, making sure that we're thinking about the entire health care ecosystem. And we ensure that those voices are represented, but supported again

00:08:43:01 - 00:09:00:03
Trish Henwood, M.D.
by the clinical improvement design team that's helping to think about, okay, this is the perspective that we have from all of our key stakeholders. And how are we going to think about how we build that into the system? Where are there things that we can standardize across the board, and where are there areas where - to Cara's point - we know that we have to allow for some local adaptation?

00:09:00:04 - 00:09:26:06
Chris DeReinzo, M.D.
Bingo. I mean, it takes so much energy to do what you guys are describing. It sounds simple. We can cover it in a ten minute podcast, but the amount of time and effort you put in to making such a complex organism seem so simple. I know from firsthand experience it is a ton. And through AHA's Patient Safety Initiative, one thing we've heard from our members in this innovation engine is they want to hear not only the what folks are doing, but some of the really tactical hows.

00:09:26:06 - 00:09:48:21
Chris DeReinzo, M.D.
So I'm curious. In just the couple of minutes we have left, again, recognizing that you all span the entire spectrum from large academic inner city to rural community. What about our smaller, more independent members who are listening saying, wow, I wish I had OnPoint, or a stats team, or the kind of dashboards that I've gotten to see coming from Jefferson, but I just don't even know where to start.

00:09:48:23 - 00:10:14:22
Trish Henwood, M.D.
I think one of the key considerations is just thinking about that interdisciplinary collaboration. I think that's really been key for us in thinking about how different teams communicate and work together, and are clear on the prioritized goals and quality and safety. So that's part of the fundamental approach for us, is making sure that we are working with all of those different teams and stakeholders and that everyone knows what matters most in the organization, and everyone can work from their perspective in helping us drive that.

00:10:15:00 - 00:10:36:23
Trish Henwood, M.D.
So communication has been key as well as a real foundational focus that we've had in safety. We see safety as the bedrock. We can't focus on quality until we're ensuring that we can deliver safety. We obviously are moving as a learning organization continually in many areas at the same time, but that has been a fundamental area that we build our safety management system and build our quality management system on top of that.

00:10:36:29 - 00:10:39:27
Chris DeReinzo, M.D.
Outstanding. Cara, any final thoughts for our listeners?

00:10:39:28 - 00:11:02:14
Cara Martino, DNP
Yeah, I would say two things. Focus. You can't do 100 improvement projects. You have to focus. You have to prioritize. And that's when you're really going to see the outcomes. And the second thing I would say is brand your product because people can feel connected to it. And I think that's something we've found with OnPoint that people know what it is and they feel their work connects to something larger

00:11:02:16 - 00:11:06:02
Cara Martino, DNP
and that's been really helpful for us to drive it across such a large health system.

00:11:06:09 - 00:11:22:06
Chris DeReinzo, M.D.
You heard it here first, folks. This has been really one of the most fun podcasts I've ever had a chance to do. Trish, Cara, thank you for joining us. Thank you for being here onsite, sharing your stories here in the Innovation Hub at the AHA's Leadership Summit. Thank you, listeners for tuning in, and we hope that you'll tune in next time as well.

00:11:22:08 - 00:11:30:19
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.