Advancing Health Podcast

00:00:00:18 - 00:00:10:16
Ashley Blake, D.O.
You have to love it. You have to love your job. You have to love your community. And really, it helps if you just think your feet in and embrace it.

00:00:10:19 - 00:00:32:28
Julia Resnick
Welcome back to Frontiers, a rural maternal health podcast series from the American Hospital Association. I'm your host, Julia Resnick. Voice you just heard was Dr. Ashley Blake, an OBGYN in Cynthiana, Kentucky. In our first episode, we heard from rural hospital leaders who made the choice to invest in maternal care and keep it close to home. But leadership alone isn't enough.

00:00:33:01 - 00:00:49:15
Julia Resnick
Even the most committed leaders can't sustain maternal care without the people to provide it. Today, we'll hear how rural hospitals are rethinking the maternal care workforce so that they are prepared to care for the next generation of rural families.

00:00:49:18 - 00:01:18:00
Julia Resnick
In rural communities, maternal care is deeply personal. Providers care for neighbors, coworkers, and oftentimes generations of the same families. Those relationships create a sense of purpose and connection. Many of the rural clinicians we spoke with chose rural medicine because of those relationships. At the top of this episode, you briefly heard from Dr. Ashley Blake, an OBGYN at Harrison Memorial, her hometown hospital.

00:01:18:02 - 00:01:20:09
Julia Resnick
Here's Dr. Blake.

00:01:20:12 - 00:01:43:02
Ashley Blake, D.O.
One of our labor nurses - I now see her sister, I see her mother in law, I see her cousins. They send pictures of me delivering her babies. They're three year-olds now that I delivered. Or color me pictures and bring me in gifts. You know, it's just like that is a reward and a benefit that no one like prepares you for how much of an impact it has.

00:01:43:07 - 00:01:54:21
Julia Resnick
In our first episode, you also heard from Jill White, chief nursing officer at Hutchinson Regional Medical Center in Kansas. She returned to her hometown to continue caring for the community that helped shape her.

00:01:54:24 - 00:02:19:13
Jill White
So I grew up here in Hutchinson, moved here at a very young age and spent my growing up years here through high school. I did move away, but quickly found that I missed it and wanted to move home and be back close to family. And as I've spent my adult years here, there's so much value in the size of the community that we are in raising a family here.

00:02:19:14 - 00:02:29:26
Jill White
I'm friends with people I work with, and we see each other, you know, outside of work, and there's so much to be said for that. It really is a big family.

00:02:29:28 - 00:02:40:13
Julia Resnick
If big families and relationships are what make rural medicine so rewarding, how do you help clinicians and training see the value of practicing in rural communities? Here's Dr. Blake again.

00:02:40:18 - 00:03:04:23
Ashley Blake, D.O.
I think that that is probably our biggest struggle, because all of the training takes place in these large cities that have targets, and they have Starbucks and they have malls and all the things that you need. And then you get your med school occurred there, your residency occurs there. And then the thought of going to somewhere without those things, I think, is sometimes hard for some physicians.

00:03:04:24 - 00:03:10:27
Ashley Blake, D.O.
The thing that makes it work the best is if you just plant your roots and, you know, embrace it and enjoy it.

00:03:11:00 - 00:03:26:10
Julia Resnick
But for rural hospitals to build a sustainable maternal health workforce, they have to create opportunities for students and trainees to experience rural practice firsthand. At Western Wisconsin Health, CEO Eilidh Peterson has made building that pipeline a strategic priority.

00:03:26:13 - 00:03:28:15
Eilidh Pederson
That pipeline starts at

00:03:28:15 - 00:03:57:27
Eilidh Pederson
different levels of training, so we do host rural residents. That's a wonderful opportunity to expose new physicians to rural medicine. We partner with all of our local colleges and universities to host midwifery students, to host medical students. And then recently, we've actually expanded the way in which we've hosted students to create that passion for rural medicine, namely obstetrical care.

00:03:57:27 - 00:04:22:10
Eilidh Pederson
So we do host high school students through our local scrub pumps. And then we started mentoring middle school students. We call it Mentored in Medicine. They are exposed to various careers in healthcare. And of course, we're going to talk to them about obstetrical care and the joys of entering into that practice. So we're starting early, but really through many channels and pipelines.

00:04:22:13 - 00:04:44:21
Julia Resnick
The future of rural maternal care is multidisciplinary teams where patients receive the right care from the right provider at the right time. For many rural hospitals, building that kind of team may be one of the most important strategies for sustaining maternal care into the future. Eilidh Peterson believes that diversity within the workforce has been one of the keys to strengthening maternal care at Western Wisconsin Health.

00:04:44:28 - 00:05:12:06
Eilidh Pederson
A diverse workforce has really been the number one solution for us. Not putting all of our eggs in one basket, but making sure that we have a number of different professionals for patients to choose from. To extend and expand our pipeline from where we can get qualified obstetrical providers has really been key. And a diverse workforce is really critical. For us

00:05:12:06 - 00:05:23:13
Eilidh Pederson
that looks like certified nurse midwives, obstetricians, family medicine with OB, and we'd love to hire our family medicine with OB and C-section.

00:05:23:15 - 00:05:51:07
Julia Resnick
One important member of that multidisciplinary team is the family physician with obstetrical training, often called an FMOB. In many rural communities, these physicians provide prenatal care, deliver babies including C-sections, and care for entire families, making them an important part of a sustainable workforce. Benjamin Anderson, CEO of Hutchinson Regional Medical Center, has become a strong advocate for expanding high quality training opportunities for FMOBs.

00:05:51:09 - 00:06:19:22
Benjamin Anderson
This is a passion point for me and I've seen the very best of full scope family medicine. There are a handful of residencies, maybe a dozen or two dozen residences in the United States that are consistently graduating board certified family physicians that are ready to do surgical OB. it's important to know the difference, and a lot of them are in training in what are called unopposed family medicine programs, where they're not competing against any other specialty for their numbers.

00:06:19:22 - 00:06:42:27
Benjamin Anderson
They're graduating with 200 deliveries and 101 hundred plus primary C-sections, where they are the surgeon, the primary surgeon on that. And so those are programs where there's a strong relationship between the OBGYN department and the family medicine residency. So they're getting that kind of exposure and that kind of direct, hands on experience. And so those are the ones from which we recruit.

00:06:42:27 - 00:07:02:21
Benjamin Anderson
And so there is a need to grow the number of unopposed family medicine slots in the United States. And there's some rural hospital transformation funds that are focusing on that to, to the program's credit. But those are the ones that it's really important to, to, to look at. We're looking for the Peyton Manning and Serena Williams of that. In Hutchinson

00:07:02:21 - 00:07:14:07
Benjamin Anderson
we're a larger community to accommodate full scope family medicine. But right on the right, right on the brink, we believe we have the capacity for and the volume to accommodate both.

00:07:14:09 - 00:07:38:25
Julia Resnick
Certified nurse midwives are another example of how rural hospitals are expanding the maternal care workforce. Working alongside physicians and nurses, certified nurse midwives provide prenatal, labor and delivery, post partum, and well woman care. Let's meet Samantha Crouch, a certified nurse midwife and director of the nurse midwifery program at University of Arkansas for Medical Sciences, also known as UAMS

00:07:38:27 - 00:07:40:16
Samantha Crouch, DNP
Midwifery care

00:07:40:19 - 00:07:42:01
Samantha Crouch, DNP
is, I mean, the

00:07:42:01 - 00:07:43:10
Samantha Crouch, DNP
reason that people are drawn

00:07:43:10 - 00:07:44:15
Samantha Crouch, DNP
To it,

00:07:44:15 - 00:08:14:26
Samantha Crouch, DNP
for a few different reasons. Really, the art of midwifery and the midwifery model of care, which places a really big emphasis on building trusting relationships within the health care provider and patient relationship. We spend a lot of time focusing on social determinants of health. And what's the holistic picture here for this patient? Not just checking in on mom and baby and what are the vital signs and what do the heart tones sound like.

00:08:14:27 - 00:08:51:26
Samantha Crouch, DNP
But really, how are you feeling about, you know, how is your partner feeling? What does your support system look like? What things are you nervous about? And really diving into some of the more emotional and psychological components of pregnancy. That really comes through for a lot of people and translates really well to rural health, because we do have a lot of specialized training in providing community based health care and providing continuity of care, which builds trust and builds partnerships and improves outcomes as well.

00:08:51:28 - 00:09:14:16
Julia Resnick
Recognizing the important role midwives can play, UAMS is investing in the next generation of the profession. This fall, they are launching the state's first publicly funded nurse midwifery education program to help address the growing need for maternal care providers and expand access to midwifery services across rural Arkansas, including many communities where midwifery services are not currently available.

00:09:14:19 - 00:09:57:27
Samantha Crouch, DNP
I have spent a lot of time looking into and kind of reflecting on as we've built is how to create better recruitment and better awareness about nurse midwifery as a career path in our areas across the state that don't currently have exposure to midwifery within the workforce. Trying to find ways where we can get certified nurse midwives practicing in some capacity, even just a day or two a week, so we can create exposure for the nurses and for the families of these rural communities, so that we can then recruit them into our program and send them back to their communities to practice.

00:09:58:00 - 00:10:11:22
Julia Resnick
The greatest impact comes when these professionals work together as a team. For Hutchinson Regional, building those connections across disciplines has transformed the way they deliver maternal care. Chief Nursing Officer Jill White shares more.

00:10:11:25 - 00:10:36:16
Jill White
OB itself can't sustain the health system. So how do we layer that to where you know someone who has that family med background, they can care for that entire life continuum, starting with OB and newborns, building that practice, building that relationship with their with their patients and families. And that really has had a huge impact in our delivery numbers as well.

00:10:36:19 - 00:10:41:02
(Dr. and Baby Background)
Okay. Next contraction. I think you're going to have a baby.

00:10:41:04 - 00:11:01:01
Jill White
We are on pace for over 100 more deliveries this year than we did even just last year, with onboarding of some new providers and working closely with the nurse midwives and getting them actual privileges to bring their patients on site. If they have that patient who, you know, can't deliver at the birth center, but they want their nurse midwife to follow them, great.

00:11:01:01 - 00:11:21:28
Jill White
We can do that here. The people that we serve are better the more that we serve. And so it's so important that we really maintain frequent touchpoints with patients like this, keeping those skills up, keeping our presence up. You know, it's so much about trust and relationship building in that patient population.

00:11:22:01 - 00:11:48:18
Julia Resnick
In low birth volume hospitals, providers may encounter obstetric emergencies less often than their colleagues in larger hospitals. That makes ongoing training, simulation, and peer learning especially important because every team needs opportunities to practice for the moments that matter most. Dartmouth Health partners with rural hospitals in northern New England to facilitate simulation drills. Emily Brayton, a perinatal outreach nurse, shares how that works.

00:11:48:20 - 00:11:52:15
Julia Resnick
You'll hear more about Dartmouth Health's work in the next episode.

00:11:52:18 - 00:12:28:27
Emily Brayton
Simulation and skills has been really beneficial to teams. We have one hospital in the North Country that has done a lot of work with a group at DHMC. We are teams that are kind of existing together, but we're not necessarily the same exact team. They are well supported, and so being able to go into that hospital and provide those teams with dedicated time with a neonatologist, and it really said it all with the people that showed up.

00:12:29:00 - 00:12:43:06
Emily Brayton
We didn't just have people who were there from their inpatient unit. We had all of the people who come and help when there's an emergency happening, regardless of whether it's happening on the OB side or with the baby.

00:12:43:08 - 00:13:09:21
Julia Resnick
Simulation is one way to maintain clinical skills. Another is creating opportunities for rural clinicians to spend time in higher volume settings, and then bring that experience back to their communities. At Banner Health that idea has become the rural OB pathways program. Here's Dr. Blake McLaughlin, an OBGYN and senior medical director of women's services at Banner Health. You'll also hear more from Dr. McLaughlin in the next episode.

00:13:09:24 - 00:13:36:27
Blake McLaughlin, D.O.
So something that we have done within Banner, we've created what's called the rural OB pathways program. And so what we do is we offer this program that folks can opt into where they will come from a rural facility like Paige, Arizona, or from Washakie, Wyoming, and they will come to one of our large volume facilities in Phoenix, and they'll spend seven, ten, 14 days embedded with that obstetrics team on labor and delivery.

00:13:36:27 - 00:14:06:06
Blake McLaughlin, D.O.
So they'll get high volume, high complexity of all of the things. But particularly they're focusing in on their optimization of their surgical skills and their obstetric skills. So we have had tremendous positive feedback from everyone involved in those experiences. Both for the physicians that are going and being embedded in that team, they're able to go back to their facilities and their communities that they came from, and they just have maintained that skill set and optimization.

00:14:06:08 - 00:14:17:14
Julia Resnick
Dr. McLaughlin believes that the same philosophy should begin during residency. Rather than asking clinicians to choose between urban and rural training, Banner is intentionally connecting the two.

00:14:17:16 - 00:14:38:12
Blake McLaughlin, D.O.
Those interns will spend their first year at the mothership there at the North Colorado Medical Center in Greeley, and they really get that foundational direction and education and training that they need. And then they'll go out to rural communities like our hospital in Sterling. So Sterling Regional Med Center, and they'll spend their last two years of their residency program embedded in that role community.

00:14:38:12 - 00:14:57:01
Blake McLaughlin, D.O.
And so they're really anchoring their heart, their mind, their attitude, their perspectives to rural medicine, but they're staying directly connected to that source program where they're getting that premier residency and fellowship equivalency training. Really ingrained them then, this connectedness.

00:14:57:03 - 00:15:27:08
Julia Resnick
Building a strong workforce is about creating a continuum of learning from early exposure and multidisciplinary teams to ongoing training and mentorship throughout a clinicians career. Together, these investments are helping ensure that role providers have the knowledge, skills and support they need to care for mothers and babies close to home. But no rural hospital can do it alone. Even the strongest workforce benefits from connection to colleagues to specialists, and to partners who can help expand what's possible.

00:15:27:10 - 00:15:52:03
Julia Resnick
That's where we'll go next. Join us for the final episode of Frontiers, as we explore how regional collaboration, digital tools, and new models of care are helping role communities strengthen maternal care for the future. This series is supported by the Commonwealth Fund, a national private foundation based in New York City that supports independent research on healthcare issues and makes grants to improve healthcare practice and policy.

00:15:52:10 - 00:15:59:10
Julia Resnick
The views presented here are those of the author and not necessarily those of the Commonwealth Fund, its directors, officers or staff.

00:00:19:07 - 00:00:44:25
Chris DeRienzo, M.D.
Hi, this is Dr. Chris DeRienzo, the chief physician executive of the American Hospital Association. Welcome back to Advancing Health. We've got a really interesting conversation today with a colleague of mine at Banner Health. Joining us on the podcast is Dr. Corey Casper. He's the senior vice president and chief research officer, the inaugural chief research officer at Banner Health and also a professor of medicine and clinical translational science.

00:00:44:25 - 00:01:02:21
Chris DeRienzo, M.D.
I had to try that one. I had to practice it a couple of times to get it right. Professor of medicine and clinical translational science at the University of Arizona. And we are very lucky to have him on the podcast today to talk about some of the interesting work they're doing to integrate research findings into a large community health system.

00:01:02:21 - 00:01:05:07
Chris DeRienzo, M.D.
Corey, thank you so much for being on the podcast.

00:01:05:13 - 00:01:10:14
Corey Casper, M.D.
What an incredible mouthful to begin with. But thank you for having me and I really look forward to our conversation.

00:01:10:19 - 00:01:28:21
Chris DeRienzo, M.D.
Well, you know, I think it would be helpful, for starters, to just help our listeners understand the arc that brought you out of what I might describe as a more traditional background in academic medicine into this unique partnership that Banner has with its academic partner at University of Arizona.

00:01:28:27 - 00:01:49:14
Corey Casper, M.D.
Yeah, thanks for asking that question. You know, there's a dirty secret, which is that every single healthcare worker working in the United States right now essentially has to come through an academic medical system to get to where they are. It's the way you become a health care worker. And so we all are very used to a very traditional academic medical system, and it works really well for lots of things.

00:01:49:15 - 00:02:23:27
Corey Casper, M.D.
I mean, it's incredibly the best in the world for training healthcare workers. It's exceptional at generating great research and often it's the source of amazing care. So when the model works well, it's incredible. I think what I was seeing in my career, after almost 25 years in a very traditional academic medical setting, is that there are increasing pressures and strains on that traditional model that make it more and more challenging to translate the incredible research that we're doing into teaching, and, more importantly, to every patient who needs to access care in this country.

00:02:23:28 - 00:02:38:13
Corey Casper, M.D.
You know, we're in such a golden age of research where research findings are accelerating and becoming so much more impactful, but getting them to every patient that needs them. And that's why I was so excited about the opportunity to join Banner as their first inaugural chief research officer.

00:02:38:14 - 00:02:52:07
Chris DeRienzo, M.D.
Let's build for a moment on what exactly does Banner look like? Many of our listeners might not be familiar with the reach of Banner as a health system, much less the nature of its partnership with your academic partner.

00:02:52:09 - 00:03:12:20
Corey Casper, M.D.
It's a great question. I wasn't familiar with all of the ins and outs of Banner either before joining about a year and a half ago. So Banner Health is an integrated healthcare delivery system, and we're one of the largest in the country. So we operate 33 hospitals, literally hundreds of clinics. We are the largest employer in the state of Arizona, employing over 65,000 individuals.

00:03:12:20 - 00:03:40:21
Corey Casper, M.D.
And we reinvest $1 billion a year back into our communities as a nonprofit healthcare delivery system. So it's a very large, very unique system that's run incredibly well. The way that we provide high quality care to so many people in so many areas, rural areas, urban areas, at our partner referral hospitals, you know, at our rural referral hospitals is through highly standardized, highly quality driven care.

00:03:40:24 - 00:04:05:09
Corey Casper, M.D.
You know, that is the hallmark of what we do at Banner, and that's all incredibly exciting. But what really attracted me as our chief research officer was kind of taking that next step. So, sure, we have 1.2 million patients under care. We have large health care system that is integrated with an insurance plan, as well as with ownership partly of Quest Labs in our region.

00:04:05:09 - 00:04:35:21
Corey Casper, M.D.
And so a truly integrated system of data that you could really begin to make some important observations using research about health outcomes and how to improve them. But what was really exciting too is some of the traditional partnerships that we've had for many years. So for over a decade, our academic partner has been the University of Arizona. So it's two colleges of medicine in Phoenix and Tucson are our partners in our delivery, and we oversee all of the clinical and translational research at the University of Arizona.

00:04:35:21 - 00:04:54:14
Corey Casper, M.D.
And we partner with them to deliver care and to train the next generation of healthcare workers. So it's an incredibly strong partnership. We're also, I think and I don't know this for sure, but I think we're one of the only, if not the only, large health care delivery system that's partnered with two NCI designated comprehensive cancer centers.

00:04:54:16 - 00:05:15:07
Corey Casper, M.D.
So the University of Arizona has a comprehensive cancer center in Tucson. And then we partner with MD Anderson in Houston to provide our cancer care in all regions other than Tucson. So it's an incredible embarrassment of riches that we have in terms of our partnerships. And that's really one of the things that hallmarks, you know, what makes us so successful.

00:05:15:09 - 00:05:48:04
Chris DeRienzo, M.D.
Well, let's build on those partnerships and to help our listeners understand, given the footprint that you've described, with a huge reach across 33 hospitals into the communities, but also this this fairly robust research pillar that you that you now lead. How are you bridging that gap from the discoveries that happen in labs, you know, at Banner. But all over the country, this bleeding edge of research with a community health system that is using your words, they're reaching 1.2 million patients a year.

00:05:48:04 - 00:05:55:03
Chris DeRienzo, M.D.
That is that is not a small gap. And my guess is the translational part of your title is exactly where that lives.

00:05:55:06 - 00:06:13:00
Corey Casper, M.D.
Yeah. Thanks so much. So there's three ways that I think we really try and address taking the research gains that we make and translating them to every single patient that we have. And I'll talk about these three ways and give you some examples because I think they're really quite exciting. So first and foremost our research is really focused or strategic.

00:06:13:00 - 00:06:37:18
Corey Casper, M.D.
So, you know, having been at the University of Washington, trained at the University of California, San Francisco, you know, went to medical school at Cornell, at New York Hospital. These are huge academic health systems that well, reputed and really do lots of things really well. I'm not saying that we don't, but for an organization that's primarily a healthcare delivery organization that also does some very good research, it's really important to focus.

00:06:37:18 - 00:06:57:04
Corey Casper, M.D.
So one of the first things that we really did was to think about where are those areas where we're making unique contributions and unique contributions within our region that really benefit our patients, but we can also learn from those patients. And so obviously, we operate our headquarters is in Phoenix, Arizona. We operate out of the southwest. Before coming to Phoenix

00:06:57:04 - 00:07:14:04
Corey Casper, M.D.
I often thought that, you know, Phoenix was sort of the home of some of the oldest people in the country, but that's actually not true. I learned that our median age is actually not that dissimilar from New York or other cities, but we do definitely have a bimodal distribution where we have many elderly people and many young people.

00:07:14:07 - 00:07:40:19
Corey Casper, M.D.
So a lot of our research is focused on diseases again in our patient population. So what are the diseases that are common that we focus on? We have a huge program in neurological diseases, especially memory and movement disorders because that's a huge problem in our region. As I mentioned, we have two large, you know, partnerships and a large research program in cancer because, you know, oncology is a critical portion of our part of the world. Cardiovascular disease,

00:07:40:19 - 00:08:04:22
Corey Casper, M.D.
so, you know, again, a disease that's often associated with aging, but structural heart disease, rhythm disorders and coronary heart disease. Fourth is our programs and orthopedics. Again, you know, our bones are what tend to fail us as we start to get older. And so we focus on how to keep them healthy and rehabilitate them when they're not. And then lastly, we have a very large program because of our breadth and transplantation.

00:08:04:22 - 00:08:22:21
Corey Casper, M.D.
And so how do we sort of make sure that these gains that we're making in transplantation are available to everyone? So first one way we just make sure that our research is getting to as many people as possible is we focus on the areas in our region and in those areas that we think can be applicable to the world.

00:08:22:25 - 00:08:43:18
Corey Casper, M.D.
The second way that we really do this is that we are laser focused, like our like, mission in the world right now is to think about the types of research that will change the practice of medicine. What we're really good at is protocolizing and standardizing the practice of medicine. So if we can define a best practice we can get that out there.

00:08:43:18 - 00:09:05:12
Corey Casper, M.D.
And so our research is laser focused on that. And I'll give you a couple of examples. So we have a preeminent Alzheimer's Institute, probably one of the best in the world. Scientists that are Alzheimer's Institute helped to develop one of the first blood tests to early detect Alzheimer's disease. We're very much, in part, developed and finalized or finished at Banner.

00:09:05:14 - 00:09:35:04
Corey Casper, M.D.
Terrific. Like wonderful that there's a blood test that's available. But what we then recognized is that still there's gaps in people's ability to get this test. So our researchers took it a step further. What if you could develop a device that would collect a small sample of blood at home and allow that blood to be shipped to a central laboratory where you can get a test for dementia that is as accurate right now as a spinal tap and as a, you know, MRIs that you used to need to get PET scans to diagnose Alzheimer's disease.

00:09:35:06 - 00:09:55:14
Corey Casper, M.D.
That test can now come to your home. So we've now allowed that test to go to people's homes in all sorts of rural parts of Arizona, and even a collaboration in rural parts in sub-Saharan Africa. So it's a great example of how we take technology, we develop new technology and make it fit for purpose. But more than that, we find a way to democratize it.

00:09:55:14 - 00:10:20:09
Corey Casper, M.D.
So we find a way to get that technology to every person who needs it. And I'll take that example one step further. We had a huge NIH grant to develop an imaging center where we actually developed some of the first ways PET scans to image people's brains, to look for dementia and other memory disorders. Fantastic. But very few people can travel to our quaternary care hospital, to our premier research clinic and get that test.

00:10:20:09 - 00:10:51:01
Corey Casper, M.D.
So what did we do? We worked with some other investigators in the Phoenix region from some of our collaborating institutions, and we came up with - it sounds crazy - but essentially behind a little RV, we were able to build this thing that kind of looks like a portable pizza oven, and it's a portable MRI machine. And this machine to rural communities throughout the southwest and offers people the ability to get scans, brain scans, to diagnose and to prevent deterioration in brain health.

00:10:51:01 - 00:11:00:15
Corey Casper, M.D.
So, again, a way that we're taking the research we've made at a sort of highly specialized referral center and making sure they're available to every person out there.

00:11:00:18 - 00:11:20:24
Chris DeRienzo, M.D.
And to me, these are examples that highlight exactly the connection we're trying to lift up. You know, there are only a handful of academic medical centers in America relative to the 6000, I think 51 at last count, total hospitals in the country. But I've seen this strength in community health systems of getting to execution. And in the communities they serve,

00:11:20:26 - 00:11:29:00
Chris DeRienzo, M.D.
what I'm hearing you describe is a model that really links the leading edge of research with the populations who can most need it.

00:11:29:01 - 00:11:30:08
Corey Casper, M.D.
That's exactly right.

00:11:30:09 - 00:11:33:26
Chris DeRienzo, M.D.
I want to make sure we get to your third. And so what's the third one?

00:11:34:02 - 00:11:55:25
Corey Casper, M.D.
Yeah. So the third thing that we're doing is we're trying to make sure that we can do this research as quickly and efficiently as possible. Now, why is that important? I mean, I'm sure, you know, with you doing the work that you do, you speak with a lot of people. And I'm sure you've heard a lot about all of the medical research now in the United States, funding cuts, changes in priorities, changes in the regulatory landscape.

00:11:55:26 - 00:12:18:07
Corey Casper, M.D.
It is not an easy road to navigate right now. But one thing that is really clear is that given all of those uncertainties and given the challenges, you need to have a laser like focus on the research that you do and you need to do it efficiently. What we've done is we've really established a new program to rapidly open clinical trials and have them available to our to our patients.

00:12:18:08 - 00:12:39:00
Corey Casper, M.D.
We are working towards a goal of getting new clinical trials open within 40 days of being approached by a sponsor. Like, that's incredible. Like, if we can do that, and we're making, you know, we've already reduced the time to activating a clinical trial at Banner fourfold. So we're making huge strides towards that. But it's such a simple example of something that we take for granted,

00:12:39:01 - 00:13:05:20
Corey Casper, M.D.
right? Like if, if our value proposition in the world as being a, you know, a health system with a strong academic partner and doing academic clinical research, if that's our value proposition, then we've got to get these studies to the patients who need them by doing them quickly and by doing them as distributably as possible. So right now, our research, we don't just do at our primary quaternary referral hospitals, we do them across our network.

00:13:05:20 - 00:13:22:14
Corey Casper, M.D.
So if you're in Northern Colorado and you're at one of our more rural sites, you have that same access that someone in downtown Phoenix has. And so to us, that's a model of research that we feel like truly will be able to bring the gains that we're making in medical research now to every patient and needs them.

00:13:22:16 - 00:13:45:06
Chris DeRienzo, M.D.
Corey, this has been a spectacular conversation. If I could read back what I'm hearing, I think your combination of focus, of depth and of reach is really what's driving this translation of research out into the 1.2 million patient community who you serve at Banner. Again, most folks on our podcast or listening to our podcast aren't going to be based in an AMC.

00:13:45:06 - 00:14:12:08
Chris DeRienzo, M.D.
So my last question for you. We've only got about a minute or two left, and I'd love to ask it of everybody who I get to interview for our show is if you had one thing that you would hope our listeners take away that they can bring back to possibly their rural hospital in Mississippi or in western Oregon and say, I want to help my home get better at translating this cutting edge research to reach my communities.

00:14:12:08 - 00:14:19:02
Chris DeRienzo, M.D.
What guidance would you give them? What first step should they take after they finish listening to our conversation?

00:14:19:04 - 00:14:43:24
Corey Casper, M.D.
Such a great question. I mean, I have an easy answer to that. I think we overcomplicate research, right? We think about it as a as a highly falutin academic exercise that is often frustrating and inaccessible to many. But research is simply the process of sitting at the bedside, recognizing a question that's important, and asking the question in a way that's answerable, measurable, and impactful.

00:14:43:26 - 00:15:08:10
Corey Casper, M.D.
If your eyes are open, if you see the problems that you're confronting at your health center, no matter how big or how small, single bed, clinic, hospital, tiny clinic, whatever it is, find a way to ask and answer those questions because it'll be to the benefit of your patients. And there's lots of people out there, whether they're at large academic medical centers or whether it community networks like ours that are there to partner with you.

00:15:08:10 - 00:15:22:13
Corey Casper, M.D.
So keep your eyes open. Look for those questions that present to us every day as clinicians. Ask those questions and find ways to answer them efficiently, impactfully. Because all of our patients and all the world will benefit from it.

00:15:22:15 - 00:15:28:28
Chris DeRienzo, M.D.
Corey, thank you so much for joining the podcast. Listeners, thank you for tuning in. This has been a lot of fun.

00:15:29:01 - 00:15:37:24
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.

00:00:20:09 - 00:00:26:08
Eilidh Pederson
There's one way we all come into this world.

00:00:26:10 - 00:00:46:18
Eilidh Pederson
And the safest and best way to do that is in hospital. And so it is so important that we preserve rural obstetrical care. For us, it's not just been about preserving, it's been about growing and thriving. And to do the right thing in the face of adversity.

00:00:46:20 - 00:01:13:14
Julia Resnick
You just heard from Eilidh Pederson, CEO of Western Wisconsin Health, a critical access hospital in Baldwin, Wisconsin. It's an agricultural community with three stoplights, where a traffic jam means you're waiting behind an Amish buggy. In just the past few years, six hospitals in her region have closed their labor and delivery departments. Workforce shortages, financial pressures and declining birth volumes have created extraordinary challenges for rural hospitals.

00:01:13:16 - 00:01:36:07
Julia Resnick
We set out to better understand how rural hospitals are sustaining maternal care in the face of these challenges. Again and again, we heard the same message. For rural hospital leaders, maternal care is more than a service line. It's a commitment to the families they serve and an investment in the future of their communities. Welcome to Frontiers, a new podcast series from the American Hospital Association.

00:01:36:08 - 00:02:00:09
Julia Resnick
I'm your host, Julia Resnick. Throughout this series, we'll explore how rural hospitals across the country are working to sustain maternal care in their communities through committed leadership, workforce innovation, and regional collaboration. Our story begins with the leaders who make the choice to invest in maternal care. Even when the path forward isn't easy.

00:02:00:12 - 00:02:28:08
Julia Resnick
When we talk about rural America, it's easy to picture a single kind of place. But rural communities are incredibly diverse. Some are surrounded by farmland, others by mountains, deserts, rivers, or forests. They vary in size, geography, and the opportunities and challenges they face. Before we explore the future of rural maternal care, let's take a moment to meet some of the communities at the heart of this story.

00:02:28:14 - 00:02:37:04
Julia Resnick
We'll start in upstate New York with Sinéad Ingersoll, chief operating officer of Canton Potsdam Hospital in the Saint Lawrence region of Rochester Regional health.

00:02:37:07 - 00:02:41:00
Sinéad Ingersoll
The Saint Lawrence County is the largest, most geographically

00:02:41:00 - 00:03:12:25
Sinéad Ingersoll
isolated county in New York State. We're 30 minutes from the border. We are by two to 2.5 hours away from the nearest highest level of care - tertiary care - that's either going into Vermont or south to Syracuse. We are the main provider of health care services in this broader community. There's about 110,000 people that live in this county, and they are scattered throughout this huge county, which also presents as you can imagine, unique challenges and very harsh winters, kind of want to throw that in there as well.

00:03:12:25 - 00:03:15:16
Sinéad Ingersoll
So we get a lot of snow up here.

00:03:15:19 - 00:03:29:09
Julia Resnick
Next, we'll head to the heart of the Sunflower State, Kansas. I spoke with two leaders from Smith County Memorial Hospital: Sarah Ragsdale, the CEO, and Laken Lyon, the chief nursing officer. Here's Lakin.

00:03:29:12 - 00:03:30:02
Lakin Lyon
We are

00:03:30:03 - 00:03:46:28
Lakin Lyon
in the middle of nowhere. We're 12 miles from the center of the contiguous 48 states. We're a rural community. We're out in the middle of an OB desert. We don't have a lot of facilities around us that deliver anymore.

00:03:47:04 - 00:03:47:13
Lakin Lyon
And

00:03:47:13 - 00:04:00:15
Lakin Lyon
some of that has been recent changes. So it's at least one hour of travel time to the nearest OB facility from us in any direction that you go.

00:04:00:18 - 00:04:04:16
Julia Resnick
Here's Sarah Ragsdale, CEO of Smith County Memorial Hospital.

00:04:04:19 - 00:04:08:12
Sarah Ragsdale
Critical Access Hospital here where we labor, deliver and

00:04:08:12 - 00:04:10:21
Sarah Ragsdale
do postpartum all in one room.

00:04:10:24 - 00:04:11:10
Sarah Ragsdale
We're very

00:04:11:10 - 00:04:22:04
Sarah Ragsdale
patient-centered here. You feel like if we didn't have that, those maternity services here, that we may lose the families coming to our rural health clinic.

00:04:22:07 - 00:04:34:03
Julia Resnick
One thing you'll hear from leaders across rural America is how deeply connected they are to the communities they serve. This is Dr. Ashley Blake, an ob/gyn at Harrison Memorial Hospital in Kentucky.

00:04:34:06 - 00:04:59:20
Ashley Blake, D.O.
I live in central Kentucky in a small community, Salvia, Kentucky. We do around 200 deliveries a year. Sometimes we get to the 250 mark, and sometimes we're right below the 200 mark. Salvia is a very small community. We all went to school together. We all know your grandmother and your children and your siblings. All of our children play ball together.

00:04:59:20 - 00:05:15:10
Ashley Blake, D.O.
So we work together, and we also go to the ballparks together and support our kids together. Our kids play on the same very small travel soccer or softball or baseball community. We all go to church together. It's a very, very small community.

00:05:15:13 - 00:05:37:08
Julia Resnick
While these communities may differ. One thing is remarkably consistent. In many places, the local hospital has cared for generations of the same families and is woven into the fabric of community life. That sense of connection shapes the decisions hospitals make. Across the country, leaders are committed to ensuring families can welcome a child into the world safely and close to home.

00:05:37:09 - 00:05:46:06
Julia Resnick
And that commitment starts at the top with hospital executives and governing boards. Here's Eilidh Pederson again from Western Wisconsin Health.

00:05:46:08 - 00:05:49:07
Eilidh Pederson
A hospital really has to make a decision

00:05:49:08 - 00:05:51:04
Eilidh Pederson
on where you're going to put

00:05:51:04 - 00:05:53:24
Eilidh Pederson
your funding and your priorities.

00:05:53:24 - 00:06:00:28
Eilidh Pederson
And at our hospital, we said, if we're going to be here for our community, truly from the start,

00:06:00:28 - 00:06:01:14
Eilidh Pederson
it

00:06:01:14 - 00:06:27:03
Eilidh Pederson
means we have to make obstetrical care a pillar and a foundational element in our hospital operations. And for us, that starts with our board of directors. They have helped us at the Foundation for we are going to provide obstetrical care. We're going to do it well. And to do that, we're going to put funding in place. We're going to ensure safe staffing.

00:06:27:10 - 00:06:49:15
Eilidh Pederson
We're going to ensure that we have all of the resources and equipment that we need to do this to the best of our ability. And so that's where it's really started, is at the board and indicating to everyone out there that obstetrical care is worth fighting for. And to do that well you must make it a priority.

00:06:49:18 - 00:07:11:20
Julia Resnick
For many rural hospital leaders, sustaining maternal care comes down to a choice. When Benjamin Anderson became CEO of Hutchinson Regional Medical Center, the organization was at a crossroads. Rather than scale back, he and his leadership team made the decision to invest in and strengthen maternal care. Here's Benjamin and Chief Nursing Officer Jill White describing why they chose that path.

00:07:11:24 - 00:07:15:19
Julia Resnick
You'll hear more of their story in our next episode.

00:07:15:21 - 00:07:33:14
Benjamin Anderson
At Hutchinson our obstetrics program...go from 800 plus deliveries a year down to 270 last year. We'd seen a lot of outmigration around OB. We had to decide, are we going to do this? Because if we're going to do it we need to do it well, and if we're going to do it well, we need to do it often. And we've got to double down and invest

00:07:33:14 - 00:07:54:24
Benjamin Anderson
and so rather than saying how much money can we make through this service line, we say, because we've already decided we're going to do it well, how do we sustain it? But the moral decision, ethical decision was already made and then we back in from there. And so it's important because birth rates are important. It's important because it's connected to community growth and health.

00:07:54:25 - 00:08:02:04
Benjamin Anderson
It's important because moms are important. We all have a mom. And it's important because through mothers we connect with everyone else in the community.

00:08:02:07 - 00:08:21:01
Jill White
If women don't have that place that they can start that healthcare journey for their families, they'll seek it elsewhere and they may lose it. You know, they're not going to return back for maybe family care or pediatrics or where are they going to refer their mom or their dad or sister or whoever it might be in their family that needs care.

00:08:21:01 - 00:08:35:07
Jill White
It's going to be wherever they've established and had that great interaction and relationship. And so it really is a very foundational stepping block for what you build an entire health care system and really community off of is those young families.

00:08:35:09 - 00:08:51:25
Julia Resnick
Sustaining maternal care takes more than financial investment or clinical expertise. It takes leaders who are willing to champion it. Not just within their own hospitals, but across the communities in rural America. Let's hear from Sinéad Ingersoll again. It's not just a service.

00:08:51:27 - 00:08:52:26
Sinéad Ingersoll
You know,

00:08:52:28 - 00:08:53:22
Sinéad Ingersoll
women's health

00:08:53:22 - 00:08:54:07
Sinéad Ingersoll
is really

00:08:54:07 - 00:09:00:02
Sinéad Ingersoll
essential to the survival of your community. If families don't feel safe delivering locally,

00:09:00:09 - 00:09:00:22
Sinéad Ingersoll
they may

00:09:00:22 - 00:09:01:16
Sinéad Ingersoll
not stay.

00:09:01:18 - 00:09:28:26
Sinéad Ingersoll
And, you know, it requires really intentional investment even when your volumes are low. Strong, team based care models, I think are really important. But it also means looking beyond maternal care like I just talked about and looking at that full women's health journey from preventative care to behavioral health to chronic disease management. You know, pregnancy is just one moment in that continuum.

00:09:28:28 - 00:09:40:01
Julia Resnick
Eilidh Pederson also speaks to how rural healthcare leaders can balance strategy with advocacy, making thoughtful decisions for their organizations while championing maternal care for their communities.

00:09:40:03 - 00:10:02:03
Eilidh Pederson
It's important that we think about obstetrical care in a different way. What does that mean for your region? What does that mean for care for the entire family? So often where you have your baby is where you will make your medical home. It's where you're seen for your prenatal care, where you'll have your lab work done, your imaging studies, surgeries down the road.

00:10:02:03 - 00:10:29:00
Eilidh Pederson
So it's truly a front door moment. So administrators to think about obstetrics care not just as a financial loss on the balance sheet, but what does it really mean for your region and for the hospital as a whole? Number two is advocacy work. As hospital administrators, I believe it is our duty to fight for the right things, to be the voice of those who don't have a voice.

00:10:29:00 - 00:10:55:03
Eilidh Pederson
And to do that in the space of obstetrical care, we must advocate. We must have conversations like this to bring awareness. We must speak with our lawmakers. We must speak with insurance companies and payers to bring about reimbursement reform. Because at the end of the day, that's what's needed. And then the third thing is to set up an infrastructure for obstetrical care, where the number one priority is quality.

00:10:55:06 - 00:11:19:07
Eilidh Pederson

This is a very risky specialty. There are deep clinical concerns that can come with having a baby, and it's our role as administrators to ensure that the team is as well prepared as they can be, that they can train where they fight, so to speak, and that they can practice as often as they can those maneuvers that bring about healthy outcomes.

00:11:19:09 - 00:11:39:04
Julia Resnick
After listening to these leaders, one thing becomes clear. The decision to sustain maternal care is about so much more than keeping a service open. It's about investing in families, strengthening communities, and ensuring that the next generation has the opportunity to grow and thrive close to home. Here's Sarah Ragsdale from Smith Center, Kansas.

00:11:39:07 - 00:12:02:03
Sarah Ragsdale
It shows thriving and growing communities, and it just shows sustainability across the system. You know, we're all here to take good care of people. We want to keep access local, and the more services we offer shows that we're a thriving facility and thriving community. All goes back to just giving back.

00:12:02:06 - 00:12:15:03
Julia Resnick
Which raises an important question what is at stake, not just for patients and families, for the future of rural communities if this care disappears? Here's Sinéad Ingersoll again.

00:12:15:06 - 00:12:34:18
Sinéad Ingersoll
So you know what would be lost? It's kind of hard to even articulate that. You know, when you think about women's health and I always think about people talk about, you know, OB services, maternal health, I think about women's health as  a continuum. It's a journey. And you know, it's not just access that will be lost, right?

00:12:34:19 - 00:13:01:24
Jill White
It's trust. It's safety. It's the ability for families to build their lives here. You know, we have four colleges that are within a ten mile radius of this little community. We need to have strong, high quality services to attract folks to move to this area, to want to stay in this area. And so, you know, this really our whole community hinges in my opinion on our ability to safely provide these services.

00:13:01:26 - 00:13:10:28
Julia Resnick
The challenges are real, but so are the opportunities. Here are Sinéad and Eilidh on why they are optimistic about the future of rural maternal care.

00:13:11:01 - 00:13:29:09
Sinéad Ingersoll
What gives me most hope is the people you know, rural teams are incredibly resilient. They're deeply committed to their communities. And rural health care has always been very resourceful. And I think now we're becoming resource enabled. And that's where I think you could really see real transformation happen.

00:13:29:12 - 00:13:54:03
Eilidh Pederson
It takes all of us fighting for the same thing, really working from the same playbook. And that's what the rural Wisconsin hospitals have done. We've seen great success to date, and I'm excited about what the future holds. There are about 50 rural hospitals in the state of Wisconsin, and we are all working together on quality outcomes, on reimbursement reform and workforce enhancement.

00:13:54:06 - 00:14:16:27
Julia Resnick
At the heart of these stories is a simple idea. Rural maternal care does not happen by accident. It happens because leaders choose to prioritize it. They make that choice because they understand what is at stake, not just for their hospitals, but for the families and communities they serve. The leadership commitment must be backed by the people who make maternal care possible -

00:14:17:02 - 00:14:43:12
Julia Resnick
skilled care teams who support patients throughout pregnancy, labor, delivery and postpartum. Join us for the next episode of Frontiers for a look at how rural hospitals are strengthening their workforce and creating new pathways to ensure maternal care is available for generations to come. This series is supported by the Commonwealth Fund, a national private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy.

00:14:43:19 - 00:14:50:18
Julia Resnick
The views presented here are those of the author and not necessarily those of the Commonwealth Fund; its directors, officers or staff.

00:00:00:07 - 00:00:17:07
Tom Haederle
Welcome to Advancing Health. Violence in the healthcare workspace may not always be preventable, but the chances of it happening can be greatly reduced with preparation and de-escalation training, as we hear today from Saint Louis Children's Hospital.

00:00:17:09 - 00:00:30:09
Jordan Steiger
Hi everyone, I'm Jordan Steiger, I'm the director of behavioral health and violence prevention at the AHA. And I'm really happy today to be joined by my friend and my colleague Tom Saggio. Tom, thank you so much for joining us today.

00:00:30:12 - 00:00:35:00
Tom Saggio, R.N.
Jordan. Great. I am so glad to be here and I really look forward to our discussion.

00:00:35:02 - 00:00:55:04
Jordan Steiger
Me too. So we are here today to talk about your Behavioral Assessment Response Team or your BART, which is a little bit different from the behavioral Emergency Response Team that I'm sure maybe many of our listeners are more familiar with. So just to get us started, can you just tell us what is a BART team and what does it do?

00:00:55:07 - 00:01:27:12
Tom Saggio, R.N.
The BART team essentially is that response team that people are familiar with. We took the tack to really focus in on the assessment. We wanted to have a more proactive approach to patient escalation situations. So our BART team consists of behavioral health RNs, and behavioral health associates. And the associates are a two year degree obtained with two years of behavioral health experience.

00:01:27:12 - 00:02:16:25
Tom Saggio, R.N.
And they are available 24/7. And we also have a close working relationship with our BCB, and that's our board certified behavioral analyst. So they not only present to emergent assistance but also do daily touchpoints with the patients. They do therapeutic interactions with them, and they provide educational support to the staff. Their primary responsibility is to respond to those code white events - or the escalation situations, but their daily expectation is to identify patients with behavioral needs, establish relationships with those kids, and connect with the staff to ensure that they understand the behavioral plans to maintain treatment integrity.

00:02:16:26 - 00:03:02:14
Tom Saggio, R.N.
So we've created standard work for each of these roles. At shift change we get report from the previous shift of any unusual activity at patient escalations or high needs patients. But then they utilize Epic to the run reports on the identified kids with 1 to 1 behavioral observation. They look at all the kids who have behavioral consults entered, and all the kids that have suicide precautions. So they prioritize the kids that have had escalated events round on all of the kids on the list and perform touchpoints, do engagement activities, and even therapeutic sessions under the guidance of our BCBA, and then additionally work with the nursing staff so that they are aware of the triggers,

00:03:02:18 - 00:03:06:26
Tom Saggio, R.N.
identify de-escalation techniques, and understand the behavioral plans.

00:03:07:00 - 00:03:16:19
Jordan Steiger
I love this approach for so many reasons, but before we get into that, I just want to make sure we all are on the same page with what a code white is at Saint Louis Children's Hospital.

00:03:16:21 - 00:03:41:07
Tom Saggio, R.N.
That is the escalated patient event where the staff in the moment need additional assistance. So we have personal activation devices. We have the emergent line that we can call from the desk. And they send out a page and that activates everybody's iPhones and notifies that this particular unit at this particular room needs some assistance.

00:03:41:09 - 00:04:09:01
Jordan Steiger
Perfect. Thank you. So what I love so much about this is that this incorporates, I mean, violence prevention techniques. It incorporates behavioral health, all of the things that we know really work to prevent violence. And its focus so much on that prevention aspect rather than being reactive to a situation. So can you tell me a little bit more about how you, at your organization, shifted the mindset to focus more on prevention, and why getting involved so early matter so much to your patients?

00:04:09:03 - 00:04:33:04
Tom Saggio, R.N.
Absolutely. Shifting the mindset - it really was a result of our executive leaders asking the question, well, what is the team going to do when they're not responding to an escalated event? And since we were asking for additional FTEs, we want to make sure the BART team had worked to actually do. I think often our hospital leaders think that a crisis response team can be delegated to frontline staff as part of their job,

00:04:33:04 - 00:04:58:26
Tom Saggio, R.N.
and in the event that a code white is called, they can just leave their assigned team and come to provide support. Well, we knew that that just wasn't optimal. So we were addressing the increase in the workplace violence injuries that were happening. So we got back to the basics. And what it comes down to is that it takes time and repeated encounters to build relationships with patients.

00:04:58:28 - 00:05:14:10
Tom Saggio, R.N.
We knew that building the relationship with the patient is so important, and is basically the fundamental practice in behavioral medicine, establishing the relationship with the patient not in crisis establishes trust and psychological safety.

00:05:14:10 - 00:05:22:10
Jordan Steiger
And so what changes for the patient when they have those relationships built with your staff already before something escalates?

00:05:22:16 - 00:05:45:26
Tom Saggio, R.N.
So when we have trust in psychological safety established with the patients, when that patient becomes escalated, they're more apt to accept verbal direction or even accept PRN medications from a non-staff, because the BART team has worked with that patient. Triggers may have already been identified, such as phrases, commands or even appearances, so they can avoid further escalation.

00:05:45:28 - 00:06:28:02
Tom Saggio, R.N.
They also may be aware of de-escalation techniques or coping mechanisms that the patient and family have already done. So because that relationship has been established, they can use the familiarity to de-escalate the patient. This has greatly shown to decrease the need for physical intervention, restraint, seclusion, all potentially resulting in workplace violence injuries. So over the last three years since the onset of our BART team, we have cut our OSHA recordable events in half. And we've also reduced our number of code whites and really shown a lot of support to the staff,

00:06:28:02 - 00:06:33:18
Tom Saggio, R.N.
so their whole staff engagement and safety in the workplace has been improved.

00:06:33:25 - 00:06:58:27
Jordan Steiger
I mean, we know workplace violence is on the minds of everybody that works in a hospital in every role. So I think showing this commitment that you have to your staff is incredible. And it sounds like you do a great job too of incorporating the family and the support system of the patient. I know you're at a children's hospital, but I do think that there is a way that our adult, you know, people who care for adults can kind of incorporate that into their approach as well.

00:06:58:27 - 00:07:00:08
Jordan Steiger
So it's a great example.

00:07:00:09 - 00:07:01:08
Tom Saggio, R.N.
Oh, absolutely.

00:07:01:09 - 00:07:26:15
Jordan Steiger
So one thing I wanted to touch on a little bit more to is you mentioned using evidence based assessments and, you know, using Epic and things to kind of track people's behaviors and triggers and things like that. But sometimes, you know, this kind of can feel disconnected and kind of clinical, you know, when you're talking about like, oh, they scored on, you know, this number on this assessment, it's not really translating to the behavior, if that makes sense all the time.

00:07:26:15 - 00:07:34:10
Jordan Steiger
So how do you take some of those evidence based tools that you're using and make them feel like meaningful and patient centered?

00:07:34:13 - 00:07:58:08
Tom Saggio, R.N.
Sure. We really use two assessment tools: the Violence Assessment Tool, otherwise known as the VAT and the Broset. Both of those tools really are highlighted in our ED space. We have created an electronic staffing assignment tool, and within that assignment sheet, we've incorporated an acuity rating that looks at the VAT and the Broset. So bear with me

00:07:58:08 - 00:07:59:18
Tom Saggio, R.N.
this is all complicated.

00:07:59:19 - 00:08:00:16
Jordan Steiger
That's okay.

00:08:00:18 - 00:08:26:10
Tom Saggio, R.N.
But every behavioral health patient presenting to the ED will get assessed using the VAT in triage. That score gets entered into Epic. And that alerts all staff what the initial acuity would be with that patient. We have a dedicated behavioral health space in our ED with five rooms, and for those five rooms we have a daily assignment tool.

00:08:26:13 - 00:08:50:18
Tom Saggio, R.N.
Now, in that tool there is a section for each room that VAT from triage gets put as a standard score in that room for that patient in those five rooms. And we assess the patient using the Broset on admission and any time there is an escalation. Behind the scenes there's a whole lot of formulas going on. And

00:08:50:21 - 00:09:28:01
Tom Saggio, R.N.
while the VAT is scored 0 to 3 and the Broset is scored 0 to 6, those numbers are totaled for the area, and it results in an overall acuity score. So we as a behavioral health leadership team, have identified numeric thresholds. And at each threshold, we have outlined clear action items as interventions for potential workplace violence avoidance. At the end of the day, when the charge nurse enters in all of that data, it will score green, yellow, orange or red and it will have associated interventions.

00:09:28:01 - 00:09:56:28
Tom Saggio, R.N.
It can be as simple as sending out a group text to our behavioral health leadership team and our Ed leadership, or it can be a simple awareness text, and I need the BART team to more frequently round. I need public safety here to more frequently round or I need somebody here consistently. Sounds very complicated, but at the very end of the day, you fill out the form, you follow the provided guidance, and you send out a text with your needs.

00:09:57:01 - 00:10:15:22
Jordan Steiger
I mean, that makes total sense to me. And what I really like about what you just said is that it really takes the opportunity for bias out of the situation and stigma and just, you know, keeping it very objective and saying, this is what this patient needs to be successful in their care, and this is what the care team needs to be successful in caring for that patient.

00:10:15:25 - 00:10:38:21
Jordan Steiger
And so I think that's a really great example for listeners to maybe take back to their own organizations. For leaders listening to this podcast, other behavioral health leaders, maybe violence prevention leaders - what do you think is your biggest lesson learned from using this BART approach? And if somebody wanted to kind of take this and adapt it to their own organization, what would you tell them to do?

00:10:38:24 - 00:11:05:04
Tom Saggio, R.N.
I think the biggest lesson that we've learned is be proactive in addressing the potential for workplace violence. I can't stress that enough. It's being prepared. It's getting the needed training to the staff, providing the care for that patient. And it isn't just the RNs and the texts, it is the therapist. It is anybody who may come in contact, even down to your dietary people.

00:11:05:07 - 00:11:29:00
Tom Saggio, R.N.
The other things that I would promote is that just being a responder isn't effective if you have a responsibility to another job. So you can't do it as a second job to be on that team. But for the organizations who are looking to create this type of a team, you don't need a huge team to establish a standalone response team.

00:11:29:02 - 00:11:52:22
Tom Saggio, R.N.
Four years ago, when I started this journey to establish the BART team, I was looking at a team of dedicated 4 to 5 people. And now three years later, we found it very effective to have two people dedicated to that rule, one RN and one support staff. They've been very effective not only in our ED, but the inpatient areas in all areas of our campus and even the outpatient areas.

00:11:52:22 - 00:12:15:27
Tom Saggio, R.N.
So we've found very good success in our wound care center and our same day surgery. So we're finding new and creative ways to use the BART team here on campus. And we're working with our partners every day to see how we can help them and avoid the next workplace violence. So I think the best place to start is always data gathering.

00:12:15:28 - 00:12:48:16
Tom Saggio, R.N.
Take a look at your number of code events, number of your restraint events, and really do a deep dive into your workplace violence injuries. You should be able to get a cost of those injuries - the OSHA recordable and what they call the "dart" rate, days away restricted and transferred. Organizations should evaluate how much workplace violence events and injuries are costing your facility due to not only injury, but absences or even turnover.

00:12:48:19 - 00:13:13:04
Tom Saggio, R.N.
Engage your employees through surveys and get their feedback on the culture of safety surveys. Over the last three years, we have found that the BART team has had not only a huge impact on reducing the workplace violence injuries, but also affecting our turnover. This was really apparent on our medical floors, where the kids had behavioral health needs but were admitted for medical reasons.

00:13:13:07 - 00:13:37:18
Tom Saggio, R.N.
The nursing staff on the unit didn't feel prepared to take care of high needs behavioral health kids, and we experienced a lot of turnover. But because they had a person in the moment that they could reach out to provide support and education, within a year, we cut down the turnover rate and improved our satisfaction from our nurses on the medical units.

00:13:37:20 - 00:13:57:19
Jordan Steiger
That's incredible. As I know many people are out there figuring out how they can decrease turnover and keep the staff that they have and, you know, make sure that they're supported. I think that this is just such a great example that more people need to be aware of. Again, really focusing in on that prevention piece instead of the reactivity.

00:13:57:21 - 00:14:02:25
Jordan Steiger
So thank you so much for being here today and for sharing some of the amazing work that you've done.

00:14:03:02 - 00:14:15:18
Tom Saggio, R.N.
Thank you so much for having me. And you know, I am an open book and willing to share anything that I've learned. So if you want to include my name and contact information, I am more than happy to do that.

00:14:15:19 - 00:14:27:28
Jordan Steiger
We will definitely do that. And we have a short case study coming out about this approach in a new de-escalation resource that we're coming out with in September, so please be sure to read that as well.

00:14:28:01 - 00:14:36:24
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.

00:00:00:03 - 00:00:23:22
Tom Haederle
Welcome to Advancing Health. Simulation is doing more than training clinicians. It's helping teams prepare for high risk moments, test new approaches and improve how care is delivered. In today's conversation with the head of Business Development and Hospital Strategy at Laerdal Medical, we explore what that shift means for quality, safety and the future of health care.

00:00:23:25 - 00:01:03:24
Kristin Preihs
Welcome to today's episode. I'm Kristin Preihs, vice president of American Hospital Association and Health Research and Educational Trust. Joining us today is Clint Pridgen and someone I would also consider a friend from Laerdal Medical, an organization that has built meaningful partnerships focused on advancing patient safety, workforce readiness and innovation across the health care continuum. This year at AHA's Leadership Summit, that partnership came to life in so many ways, from supporting our quality improvement initiatives and workforce developments to new simulation programs focused on rural maternal health, an immersive learning experience that showcases the future of healthcare and what education can look like.

00:01:03:25 - 00:01:36:15
Kristin Preihs
In today's conversation, we are going to discuss how simulation is evolving beyond traditional training, what health systems can learn from top performing organizations, and where there are the greatest opportunities for improving readiness, teamwork, and patient care in the years ahead. AHA and Laerdal have a long standing relationship in quality and patient safety, beginning with the AHA Patient Safety Initiative and evolving into the AHA Quest for Quality. Across our time together, Laerdal has developed a deep connection focused on quality, innovation, simulation, and rural readiness.

00:01:36:15 - 00:01:47:13
Kristin Preihs
And Clint, I'd love to connect a little bit with you and thank you so much for being here today. When you look across those areas, what do you see as common threads for where Laerdal's work with hospitals and health care systems?

00:01:47:15 - 00:02:11:02
Clint Pridgen
Great question, Kristin. And first of all, thank you for having us. We love the partnership and agree it's been very meaningful. I spent a lot of time thinking about that question over the last several months, which is the notion of change. And change is hard. I had a gentleman I worked with one time that said, you have to really treat change almost like the five stages of grief, because it's so hard to move through.

00:02:11:02 - 00:02:41:18
Clint Pridgen
And there's bargaining and denial. And the reality is, in the health care environment, the only concept we have right now is change. And what we have seen, whether it's the Quest for Quality, whether it's work with McDonough and Richland and Vernon, is those organizations that are willing to embrace change, to find ways to improve the patient experience are the ones that are really moving that needle and that find new and innovative ways of tackling challenges that, quite frankly, everyone is facing.

00:02:41:20 - 00:03:06:22
Kristin Preihs
One of the things you mentioned is the work that we're doing with rural hospitals, and it's a new frontier that we're engaging on. We know that rural hospitals focusing on maternal health are dealing with a myriad of challenges, from workforce to readiness to financial constraints. And we're really looking forward to this partnership where we're identifying a few hospitals for a pilot exercise on how to improve rural OB care.

00:03:06:24 - 00:03:10:25
Kristin Preihs
Can you talk a little bit about some of that pilot and what you're most excited about?

00:03:10:27 - 00:03:37:00
Clint Pridgen
Absolutely. Well, as you know, and as everyone on this listening to this podcast knows, we have not moved the needle on maternal care as much as we'd like to across the United States. And that really is for a myriad of reasons, right? Some of that reflects the closing of maternal services at locations. Some of it's also a function of workforce shortages and requiring individuals to work in departments that they're not really used to.

00:03:37:01 - 00:04:08:27
Clint Pridgen
At Laerdal, We really began our foundational work in resuscitation and cardiovascular events, and what we found through that work was the importance of repeated frequent training. And what does that mean to really put your hands on in a experience that replicates what you're going to see in real life? And as we work with McDonough, as we work with Richland, as we work with Vernon and partner with the AHA, I think we're really excited about bringing some of those principles into areas that, quite frankly, haven't had the opportunity to experience those as readily.

00:04:09:01 - 00:04:41:03
Clint Pridgen
I think the other thing that really excites us in particular is this notion of how do we use data in an actual, tangible way to create additional resourcing and efficiency in our efforts? We all know that time is one of the biggest limiters that we have as a resource, and so often training becomes a descriptive task where we've trained X number of people or the next number of hours, as opposed to a directive task that says, hey, here's where our biggest opportunity is to have the biggest impact.

00:04:41:03 - 00:04:47:22
Clint Pridgen
And so I think we're really excited about the work that we're doing together in that space and what it's going to mean ultimately for patient outcomes.

00:04:47:26 - 00:05:17:07
Kristin Preihs
You mentioned one thing I want to pull up for a moment, which is different experiences. And simulation is something that has evolved so much over time, especially integrating into quality and patient safety for practices and as an evolution in technology and how we're training the new workforce. I know when we were at AHA Leadership Summit, we were able to partner on a very specific experience, which was around a future healthcare system of tomorrow, and specifically integrated some surprises in an escape room along the way related to simulation.

00:05:17:08 - 00:05:19:08
Kristin Preihs
Can you talk a little bit about that?

00:05:19:10 - 00:05:49:08
Clint Pridgen
Absolutely, absolutely. You know, we have the opportunity to interact with a fair number of organizations and systems throughout the course of the week. And as we had different conversations about patient safety, not surprisingly, but unfortunately, the notion of workplace safety was on the top of everyone's list about how do we do that more effectively. And there is tremendous amount of positive conversation about incorporation of AI and how do we increase our digitization and our efficiency.

00:05:49:08 - 00:06:22:22
Clint Pridgen
But the reality is the end of the day, patients are human, and we're still going to be interacting with humans, which means we've got to be able to deal with them in an effective manner, regardless of their emotional state. And what we have seen over the last several years was the notion of changing the objective of what we're trying to achieve and taking it from necessarily a competency development exercise into how do we respond as a team, how do we look at our processes to protect our workers in a de-escalation situation?

00:06:22:22 - 00:06:41:16
Clint Pridgen
And that is an area in which we've barely begun to scratch the surface as we think about whether it's workplace safety, if we think about more broadly behavioral health and what that means also in the context of generational changes, where we know that the workforce that is coming in, they have different proclivities as it relates to interpersonal interactions.

00:06:41:16 - 00:06:50:10
Clint Pridgen
And how do we customize that to make sure that the workforce feels supported and safe? Because then the patients will feel supported and safe.

00:06:50:13 - 00:07:15:27
Kristin Preihs
And just focusing on safe, too. I was watching some folks after they after they were really experiencing the simulation and going through various exercises and from when they went in and were hesitant in this escape room to when they came out and were confident in having conversations about trust and exercises and the importance of fun, and really being able to fail quickly and learn from it and talk about the depth of their own experience was just something that was really meaningful.

00:07:15:27 - 00:07:37:07
Kristin Preihs
So I just want to say thank you as well for that partnership. Another area that I know we're working together very closely is on the AHA Quest for Quality, which recognizes hospitals and health care systems doing outstanding work in quality, patient safety and innovation. As part of our relationship together, Laerdal been a sponsor for now two years, offering simulation services to finalists and other honorees.

00:07:37:08 - 00:07:46:25
Kristin Preihs
What has it been like for you and your team to go across the country, visit different types of hospitals and health care systems, talk about simulation and the integration with quality and patient safety?

00:07:46:27 - 00:08:11:24
Clint Pridgen
Absolutely. In a word, it's been inspiring. It is so easy to get mired in the day to day challenges and sometimes lose sight of what we're really trying to do, right, which is improve that patient experience. And in the work we've done together in the quest for quality, being able to interact with these organizations in which quality is not just a buzzword, it's part of the organizational fabric, has been truly inspiring.

00:08:11:25 - 00:08:41:28
Clint Pridgen
I think what is interesting, as we reflect back on the commonalities, there are a couple of things that strike me. I think the first that strikes me is even though everyone believes that they're unique and have all of these different challenges, and certainly there's variability, at the end of the day 80% is very similar. And while that's sobering because it means everyone's facing similar challenges, it's also encouraging because it means if these organizations have been able to move the needle, theoretically everyone in healthcare should be able to move that needle.

00:08:41:28 - 00:09:14:13
Clint Pridgen
And I think that's really encouraging. And so then the question becomes, what do we see that really sets these two, these organizations apart. And it really is two things. It's innovation and it's not innovation for the sake of innovation. In fact, our one of our chairman for Laerdal says innovation without an impact is meaningless. But these are organizations that say we understand the challenge and we're willing to commit by taking actionable intelligence to figure out where we believe the biggest opportunity is, and then driving programs organizationally in a dedicated fashion.

00:09:14:19 - 00:09:43:13
Clint Pridgen
I think the other piece of it is these are organizations that have embedded this notion of quality and patient centered care into their culture. And we've heard it said that culture eats strategy for breakfast. And I think that is what we see repeatedly at these organizations. They're able to keep that 'why' of what they do front and center, and that enables them, I think, to move through some of the challenges, or at least be more willing to navigate them in the course of the innovation that they're trying to achieve.

00:09:43:14 - 00:10:03:03
Kristin Preihs
And thinking about that, too. I've seen a lot of different types of modules and experiences that you all put together. They have evolved considerably from what you've shared to ensure that it aligns with hospital health care providers general needs. What does the future look like for simulation? Because technology is moving so fast and its speed in all different types of areas.

00:10:03:03 - 00:10:08:18
Kristin Preihs
So what does the future look like? Are we going to see robots walking around? What does that look like from a Laerdal medical point of view?

00:10:08:22 - 00:10:32:00
Clint Pridgen
That's a great question. And if I take out my crystal ball, I think what we really see continuing to evolve is how do we get much more targeted on the objective we're trying to achieve? I think historically when people have mentioned the term simulation, oftentimes simulation becomes the objective. We're going to do simulation. And the reality, that's not the goal, right?

00:10:32:01 - 00:11:13:04
Clint Pridgen
We're either trying to improve individual competence or we're trying to improve team performance that we know impacts two thirds of all adverse events, right? Or we need to do system testing and provide some mechanism to detect latent patient safety threats in advance as opposed to retroactively. And simulation becomes part of the toolset in that kit. And I think what you've already seen, to your point about the optimization and the evolution of some of these modules are how do we continue to evolve those simulation methodologies to help organization achieve those competency goals or team performance goals, or quality goals from a patient safety threat? That's going to manifest in multiple ways.

00:11:13:04 - 00:11:48:06
Clint Pridgen
It's going to manifest in more sophisticated simulators, which we've already seen. It's going to manifest in much more digitized solutions. Conversational AI, as we think about behavioral health and looking at some of the soft skills that we even looked at the escape route. But more than anything, it's going to be how do we integrate analytic insight and data across all of those imperatives to really help organizations see the change that they have already experienced, and to really identify and zero in on what is it that we need to do to move the needle even further.

00:11:48:09 - 00:12:13:14
Kristin Preihs
And I love that Laerdal has really thought about how you're incorporating simulation into a hospital goal, because it doesn't sit separate. And sometimes we think of technology as one more thing we have to figure out. And in working with you and seeing your team work directly with hospitals, it's so well integrated to your point - what the goals are that teams are trying to achieve and help them to achieve it faster, smarter and with greater effectiveness.

00:12:13:16 - 00:12:34:14
Kristin Preihs
So thank you for everything that you've done. We've heard today, simulation is no longer viewed as simply a training exercise. It's becoming a powerful strategy for building safer systems, stronger teams and more resilient health care systems. So thank you, Clint, for sharing your insights. I know we'll be seeing a lot more from you in Q for Q and beyond, especially in the maternal and rural space.

00:12:34:16 - 00:12:40:04
Kristin Preihs
We really appreciate your partnership with Laerdal Medical, and thank you to all of our listeners today for joining us.

00:12:40:07 - 00:12:46:02
Clint Pridgen
Thank you so much for having us. Pleasure to be here. And we love the partnership.

00:12:46:04 - 00:12:54:27
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.