Advancing Health Podcast

00:00:01:04 - 00:00:45:24
Tom Haederle
Health care tops the list of critical infrastructure targeted by cybercriminals. These threat to life crimes hit every hospital hard, but rural providers even harder due to fewer resources and generally smaller IT staff. The average recovery cost from a ransomware attack is $11 million, a vast sum that leaves many rural hospitals one cyberattack away from closure. In today's podcast, we hear from John Riggi, the American Hospital Association's national advisor for Cybersecurity and Risk, and Justin Spelhaug, corporate vice president of tech for Social Impact, Microsoft Philanthropies, about the steps rural providers can take to reduce the risk and impact of a ransomware attack.

00:00:45:27 - 00:01:13:18
Justin Spelhaug
I'm Justin Spelhaug the corporate vice president of tech for Social Impact here at Microsoft Philanthropies, and I'm joined by my co-host John Riggi, the national advisor for Cybersecurity and Risk at the American Hospital Association. And we're here today to discuss critical issues of cybersecurity in rural hospitals, and how our partnership is coming together to tackle the challenges that so many rural hospitals are facing across America.

00:01:13:19 - 00:01:17:09
Justin Spelhaug
So thank you for joining us. And John, thank you for joining us. Good to see you here today.

00:01:17:12 - 00:01:20:24
John Riggi
Good to see you too, Justin. It's always great to partner with you.

00:01:20:26 - 00:01:30:09
Justin Spelhaug
Well, John, you know, as the expert in hospital cybersecurity, can you tell us why rural hospitals are particularly vulnerable to cyber attacks?

00:01:30:11 - 00:01:58:19
John Riggi
Justin, great question. There's really a number of factors about that. First, the impact of the physical distance on patient care and mortality when a hospital is shut down by a ransomware attack. For example, rural hospitals provide critical health services to about 60 million Americans, or nearly 20% of the US population. Rural residents already must travel more than twice as far as urban residents to reach the nearest hospital.

00:01:58:22 - 00:02:30:22
John Riggi
So when you have this increased travel distances, they are directly associated with higher mortality rates for time sensitive conditions like heart attack, stroke or trauma. And then you're diverting these patients during a ransomware attack, again just magnifying that risk. Then there are the resource challenges, financial constraints and skill shortages. Low operating margins due to patient volumes, high fixed costs relative to urban hospitals. And rural hospitals are more likely to have older technology and smaller IT support staff.

00:02:30:27 - 00:02:59:06
John Riggi
This impacts the resources to implement key cybersecurity measures, creating really, unfortunately, an ideal opportunity for exploitation for cyber criminals. The average cost of addressing cyber attacks - now this is the cost after you've been attacked - the cost to recover is almost $11 million. I mean, just an enormous, staggering amount for the average rural hospital. Thirty percent of all rural hospitals are already at risk of closing,

00:02:59:08 - 00:03:22:09
John Riggi
so they can be only one cyber attack away from closure. And then, of course, as I indicated, there's a skill shortage. Very difficult to get your best cyber security professionals to work in rural areas. The salaries are generally not as competitive as urban areas or even other industries, so you compile that...it's extremely challenging to get good experienced

00:03:22:10 - 00:03:53:22
John Riggi
IT staff to work in rural America. And then we have geopolitical factors making rural hospitals kind of unique targets. So over the past 12 months, cyber attacks against hospitals have increased about 130%, making them the top critical infrastructure that's targeted by cybercriminals. And make no mistake, they know when they target a hospital, lives are threatened. In fact there's now even evidence that nation-states are collaborating with criminal groups.

00:03:53:24 - 00:04:04:21
John Riggi
Justin, I know Microsoft keeps a very close eye on the evolving threat landscape. Can you talk to us a bit about the trends you're watching that might affect health care organizations?

00:04:04:24 - 00:04:27:13
Justin Spelhaug
I can and John, thanks. I mean, your feedback that hospitals are only, you know, one cyberattack away from closing, especially the rural hospitals that are very stretched, is just really eye opening. And when we look at the challenge facing hospitals, but frankly, many different kinds of organizations, one of the reports that we produced is a Microsoft Digital Defense report.

00:04:27:18 - 00:04:51:13
Justin Spelhaug
Now, we use about 78 trillion security signals a day from Windows and Cloud endpoint devices to inform this report. We've got security engineers and intelligence analysts tracking about 1500 unique threat groups all around the world. And the trends I'll talk about here are relevant for every industry. But as you said, John, it's impacting health care and it's impacting rural health care in particular.

00:04:51:17 - 00:05:32:03
Justin Spelhaug
So let's talk about a couple of the trends. The first one is that we're continuing to see a massive escalating intensity on password based attacks. When we look at our Microsoft entry data, we see organizations being barraged by about 600 million identity attacks per day, and 99% of those are password based. Now, advances such as zero trust architecture, conditional access policy, MFA have helped defend against this. But we're seeing hackers work around MFA, targeting infrastructure and applications and bypassing authentication altogether.

00:05:32:03 - 00:05:59:15
Justin Spelhaug
And that's why advanced monitoring and threat detection capabilities inside of an environment are so critical. So that's the first theme. The second theme that we see is nearly a 3X increase in year-over-year human operated ransomware attacks. They're attacking health care. They're attacking rural hospitals. They're attacking nonprofit. They're attacking schools, they're attacking sensitive government infrastructure. Now, on the good news

00:05:59:15 - 00:06:27:25
Justin Spelhaug
if there is any good news anywhere in this story, is we see a significant decline year-over-year in attacks reaching the encryption stage and locking up resources. And that's because of the deployment of automated attack disruption tool. It is also endpoint protection deployment 92%, 92% of all successful ransomware attacks involve the attacker going through unmanaged device on the network.

00:06:27:27 - 00:06:50:08
Justin Spelhaug
And it's also about increased training and awareness across the employee base in every organization. But we need to keep making progress because as you know, John, you said the average recovery was about an $11 million investment when they break through. It's devastating, for a rural hospital in particular it's devastating. We're also seeing a third theme and that's the ingenuity of fraud

00:06:50:08 - 00:07:20:26
Justin Spelhaug
tactics are quickly evolving. We saw growing sophistication of investment scams, tech support scams are particularly impacting hospitals and more. At the same time, we're seeing impersonation getting more sophisticated, in fact, and detection more difficult because of the access to deepfake technologies that cybercriminals are using. And globally, the World Economic Forum reports that scammers stole over 1 trillion in U.S. dollars from the global economy in 2023.

00:07:20:26 - 00:07:54:11
Justin Spelhaug
So the massive, massive impact. Then finally, John, something that you mentioned, nation-states. We're seeing actually blurred lines between nation-state threat actors and cybercriminals. They're partnering together to advance each other's objectives and in particular monitoring and see Iran, who appears to be the most active nation-state actor targeting health care organizations specifically. Perhaps the most acute impacts and the biggest headlines have been in the health sector, certainly over the last 12 months.

00:07:54:13 - 00:08:13:15
Justin Spelhaug
And when you talk about a small rural organization or a rural hospital, John, as you just did with less resources as you just talked about to protect themselves and respond. We know why, you know, hackers are targeting these organizations and why it is such a huge challenge for us here in the United States. So big challenges all around.

00:08:13:17 - 00:08:25:04
Justin Spelhaug
Now, John, those are the challenges. Can you talk a little bit about the impacts you're seeing these cyber attacks actually have on hospitals and maybe even more importantly, the communities that they serve?

00:08:25:06 - 00:08:56:17
John Riggi
As you know, the AHA has been a very loud voice signaling what the impact is of these ransomware attacks on hospitals. Unfortunately, this isn't just about the protection and privacy of data. It's very important, but most importantly is the disruption to patient care. These attacks have caused significant disruption and delay to health care delivery when hospitals are attacked directly or through some third party attack that results in a disruptive effect.

00:08:56:24 - 00:09:31:09
John Riggi
And we all know that when there is disruption and delay to health care delivery, patient safety is placed at risk. Lives are threatened. The bottom line: these attacks are not just data theft crimes. These are threat to life crimes. And again, they're not only going after hospitals, but after our mission critical third party providers. For instance, the Change Healthcare attack: the largest, most consequential cyberattack against health care in history, compromised the health care records of 100 million patients, 100 million Americans, costing the sector $100 million a day.

00:09:31:12 - 00:09:57:23
John Riggi
And then ultimately disrupting health care delivery. But it's not just the big organizations that are attacked. And of course, when a rural hospital is attacked, there's an outsized impact to the community they serve. Because these attacks, as we have seen, are not just attacks on the hospital as an organization. It's an attack against the patients inside the hospital and against the entire community

00:09:57:23 - 00:10:26:11
John Riggi
that depends on the availability of that hospital. A couple of years ago, we had an attack on Sky Lakes Medical Center in southern Oregon. Their 90 bed hospital serve about 120,000 people across 10,000 square miles. Their next nearest hospital, 72 miles away. And when this attack occurred and encrypted their systems forcing them to shut down many of their services, it was very, very significant disruption.

00:10:26:11 - 00:10:54:01
John Riggi
And that disruption lasted about 28 days. They had to use 60,000 sheets of paper for clinical documentation. Fortunately, they did not have to pay the ransom. They had the capability to recover and restore independently. But again, significant impact to patient care delivery. And even after it hired extra staff, it took some six months to input all the paper records into the system.

00:10:54:03 - 00:11:23:00
John Riggi
So the organization spent about $10 million, a huge expense that was not covered by insurance to overcome this attack. And we have to thank Skylights Medical Center for coming forward to share best practices and lessons learned so we can all help prepare for the impact of these attacks. Unfortunately, I have many examples of how these attacks affect the patients in these rural hospitals, but also threaten the safety of the entire community.

00:11:23:03 - 00:11:45:10
John Riggi
A couple years back, I got a call from a hospital in the Pacific Northwest, and they were talking about an attack that they were experiencing, but there were two other hospitals that were also under attack. And so their natural diversion points no longer existed. And they said, John, we are very, very concerned because our next nearest emergency department is 125 miles away.

00:11:45:16 - 00:12:02:21
John Riggi
Said John, we've got a medevac parked in the parking lot, but we already are in the state. It actually snows in the winter quite a bit, and we're expecting a storm to come in. If that happens, our medevac can't fly. And if we get a stroke, heart attack or trauma patient, that patient's going to have to go ground transport if it's even safe.

00:12:02:23 - 00:12:21:20
John Riggi
And unfortunately, we don't think that patient would make it under those conditions. That's how deadly serious these attacks are. And that's why we always say and tell the federal government that these attacks - make no mistake - the bad guys know what they're doing in the hospital. They're threatening lives. These are threat to life crimes.

00:12:21:22 - 00:12:39:29
Tom Haederle
Thanks for listening to part one of this podcast. Please join us on Wednesday for part two as we continue this important conversation on cybersecurity for rural hospitals. Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcast.

00:00:01:05 - 00:00:29:17
Tom Haederle
Welcome to advancing Health. Every hospital, every day and everywhere is striving to improve its quality of patient care. As the winner of the American Hospital Association's prestigious 2024 quest for quality prize, WellSpan health serving 12 counties in Pennsylvania, is among the best at advancing health for those who depend on it. In today's podcast, we learn more about how the efficiencies WellSpan adopted during the pandemic are still in place and still paying dividends today.

00:00:29:20 - 00:00:43:05
Tom Haederle
Your host is Doctor Mindy Estes, former president and CEO of Saint Luke's Health System and former chair of the Board of trustees.

00:00:43:07 - 00:01:19:27
Mindy Estes, M.D.
I'm Dr. Mindy Estes, and today we have the privilege of speaking with Dr. Roxanna Gapstur, the president chief executive officer of WellSpan health, a position she has held since January 2019. Doctor gaster brings over 25 years of extensive health care leadership experience, having worked across various settings including practices, academic institutions and integrated health systems. Her background in strategic planning, business development and operational leadership, both at ambulatory and hospital settings, has been instrumental in her success at, well, speed.

00:01:20:00 - 00:01:36:03
Mindy Estes, M.D.
So let's just dive right in. To begin, can you provide our listeners with an overview of WellSpan health and its mission? Understanding the foundation of the health system gives context to the strategic discussions we'll be talking about today.

00:01:36:06 - 00:02:04:24
Roxanna Gapstur, Ph.D., R.N.
Yes, absolutely. WellSpan health is an integrated care delivery system in central Pennsylvania. We serve 12 counties and about a million and a half people have nine hospitals, 23,000 team members and about 2500 providers in our system. We are the largest provider of behavioral health in our region, and we also have a clinically integrated network which provides a basis for our value based care strategy.

00:02:04:26 - 00:02:07:27
Mindy Estes, M.D.
So your geographic footprint is quite large.

00:02:07:29 - 00:02:16:00
Roxanna Gapstur, Ph.D., R.N.
It's about 12 counties now in the center of the state. Yeah. We've been growing and serving more patients each and every year.

00:02:16:05 - 00:02:44:12
Mindy Estes, M.D.
Were you in WellSpan in 2019? And soon after a small event happened, the world was confronted with the Covid 19 pandemic. And despite these challenges, WellSpan was noted for maintaining high quality care and extensive community support. Could you share 3 or 4 critical factors that enabled your leadership team to be successful during this period, and what you've taken from it since?

00:02:44:14 - 00:03:11:23
Roxanna Gapstur, Ph.D., R.N.
Yeah, absolutely. One of our values here at WellSpan is working as one. And I think this was a moment for us to really live that value. And throughout the pandemic, we were able to rapidly adapt to changes. We practiced agility, and we practiced one of our other values to find a better way. We have a significant focus in a pretty big community health team that works across central Pennsylvania.

00:03:11:25 - 00:03:40:22
Roxanna Gapstur, Ph.D., R.N.
And little did we know that the pandemic was going to highlight some of the challenges. And that team really helped us respond quickly to some of those challenges. We focused significantly on the well-being of our team. Again, I think we all found at the beginning of the pandemic, perhaps this wouldn't last a long time. But as the pandemic went on, we needed to make sure that our team was taking care of and being one of the largest providers of behavioral health services.

00:03:40:22 - 00:04:03:24
Roxanna Gapstur, Ph.D., R.N.
We had pretty significant internal resources that we were able to bring to that issue. And then finally, we really empowered our teams to think differently. And at one point during the pandemic, even had developed our own N95 mask. So I think those were were some of the pieces that were most important because we unleashed the innovation within our own teams.

00:04:03:27 - 00:04:21:26
Roxanna Gapstur, Ph.D., R.N.
We were able to move pretty quickly on things like the outdoor testing, things like out-of-pocket costs. We were one of the first in the nation to say that we would provide things without charge. Really proud of the team for embracing agility and making sure that the well-being of our teams were front and center.

00:04:21:28 - 00:04:49:18
Mindy Estes, M.D.
You know, I want to pick up on something that you said, most of us in health care study things, and we study things for a long time, and then we pilot things, and sometimes we're pilot things. And I think the Covid crisis, if you think about making lemonade out of lemons, really told us that we could be agile, that we could make decisions quickly and in TAC one way or the other if we needed to.

00:04:49:21 - 00:04:55:13
Mindy Estes, M.D.
And the question I have for you, have you been able to maintain that agility?

00:04:55:15 - 00:05:23:13
Roxanna Gapstur, Ph.D., R.N.
We have actually, so was one of the things that we said to ourselves during our after action reviews that what were some of the silver linings of Covid, and how might we continue to capitalize on those? And one of those was being agile and making decisions quickly. I think because we are locally governed and one of the only health systems in our area that is locally governed, it helps us make decisions quickly because our headquarters are here and our family, friends and neighbors are here.

00:05:23:13 - 00:05:40:27
Roxanna Gapstur, Ph.D., R.N.
And so that is something we've been able to maintain. One of the things that I did with my team during Covid was we split into two teams. We had one team really focused on our long term strategy and another team that just focused on operations and taking care of patients each and every day. We've used that as well.

00:05:40:28 - 00:05:49:02
Roxanna Gapstur, Ph.D., R.N.
Since the pandemic ended, it was a great way for us to still make progress on some things, even though, you know, we had a lot on our plates.

00:05:49:05 - 00:06:06:24
Mindy Estes, M.D.
Well, you make an important point. The work of health care and the future of health care and what what we as organizations were going to do once the immediacy of the pandemic was over, it was tempting to put that on the back shelf and get back to it. But, you know, once you let it go, it's very difficult to restart.

00:06:06:25 - 00:06:28:21
Mindy Estes, M.D.
One of the things I was impressed by that I think goes into this long term thought, is that you had low nursing staff turnover during the pandemic. What strategies did you implement to have such a successful retention of nursing staff during, admittedly, an incredibly stressful and unknown time?

00:06:28:24 - 00:06:51:04
Roxanna Gapstur, Ph.D., R.N.
Yeah, that's a great question. I think one of the biggest areas was just the focus on the well-being of the team. We had a lot of peer to peer support going on, as well as our psychologists and psychiatrists across the system, working with our frontline care teams every single day. So we had real time coaching and support on all of our units.

00:06:51:07 - 00:07:12:26
Roxanna Gapstur, Ph.D., R.N.
We also did a lot of state interviews and a lot of work on understanding what people needed now because as you know, you know, things evolve during Covid and lots of changes happened over those 2 or 3 years. I would say a benefit to us is that generally, our region tends to lag a little bit on things that occur.

00:07:12:26 - 00:07:31:27
Roxanna Gapstur, Ph.D., R.N.
So we saw surges in new Jersey and New York prior to central Pennsylvania getting those same surges. And so we were working to try and learn from our colleagues and maybe what was coming. Our way, and how we could do a better job with our teams and with our nurses. So those were some of the things we did.

00:07:31:29 - 00:07:40:13
Roxanna Gapstur, Ph.D., R.N.
I think later when you ask about innovation, if you do, I can talk a little bit about some of the innovations we've done in nursing that I think also made a difference.

00:07:40:15 - 00:07:46:00
Mindy Estes, M.D.
Well, how about we just speak a little bit about innovation right now, particularly in nursing?

00:07:46:02 - 00:08:11:23
Roxanna Gapstur, Ph.D., R.N.
Well, certainly virtual nursing is something that we have rolled out across our system, which has made a really big difference in the satisfaction of our nurses, both in the time they spend and documentation. But the amount of time they're able to spend with their patients. So that's one area. We've also have tiered huddles in our system. So each day, seven days a week actually we start with tiered huddles around seven in the morning.

00:08:11:23 - 00:08:33:23
Roxanna Gapstur, Ph.D., R.N.
And those go until nine. At 9:00 is my huddle. So every day I know by 9:00 exactly what's happening in the system, and we're able to solve problems at the right level. So we have sort of tiers one through six. A lot of things are still at tier three and below or tier four and below, but those things that can't be are elevated to the senior leaders.

00:08:33:23 - 00:08:50:24
Roxanna Gapstur, Ph.D., R.N.
And we put a team on it right then and there. So I would say compared to when I first arrived at WellSpan, that we solve our problems more in real time. We're more situationally aware and we're able to prevent problems from happening because we have that focus.

00:08:50:26 - 00:09:21:03
Mindy Estes, M.D.
Well in solving problems where they're best solved. You know, is helpful for everyone. And you go away from that huddle knowing what you need to do and how you need to go forward. I think a lot of people perceive central Pennsylvania yet as a relatively homogeneous area, but WellSpan serves a diverse community. Can you discuss how you engage these diverse groups and provide resources while respecting their cultures and their autonomy?

00:09:21:05 - 00:09:53:15
Roxanna Gapstur, Ph.D., R.N.
Yeah, absolutely. I think a lot of Not-for-profit health systems feel very connected to their community and have different strategies. And certainly in my other roles in other states, even, I felt that connection. WellSpan has maybe a deeper connection than any I've ever experienced. And we have different ways of showing that. So each of our counties and our regions has a healthy county coalition, and WellSpan actually leads most of those coalitions.

00:09:53:18 - 00:10:23:18
Roxanna Gapstur, Ph.D., R.N.
But we don't try to do the work of the experts in our nonprofit organizations. Rather, we might be a convener, we might be a partner, we might be a funder. In some instances, we're working together alongside and with and the population across central Pennsylvania, as you mentioned, are more diverse. And I realized when I first arrived here, certainly the plan community is one of our largest stakeholders, and we serve a significant number of people from that population.

00:10:23:24 - 00:10:52:27
Roxanna Gapstur, Ph.D., R.N.
We have special cultural liaison individuals who work with our planning community. It's really important to have those relationships, and we've done that for more than 20 years. We also have special bundle payment programs and other types of programs that fit culturally for that particular action. And I will say during Covid that Covid was difficult for that population because of the amount of family interaction they prefer to have in their health care experiences.

00:10:52:29 - 00:11:24:06
Mindy Estes, M.D.
I want to skip to the notion of gun violence in workplace violence, workplace safety, community safety. You know, gun violence is a growing concern for all of us. And you've really taken an active role in addressing this issue in New York, Pennsylvania. And I really and I know our listeners would be interested in having you elaborate on when your efforts to reduce gun violence, the partners involved, the progress made thus far.

00:11:24:12 - 00:11:34:19
Mindy Estes, M.D.
And my sense is that this is one of these issues, that the minute you take your foot off the gas, it comes back. So talk a little bit about what you've been doing.

00:11:34:22 - 00:12:01:00
Roxanna Gapstur, Ph.D., R.N.
Well, I, I can't say enough about what the teams have done in this region on gun violence. It's an issue across all of our communities, but I would say probably more acute in New York County. And that's where we've done a significant amount of the work over the past three years. Probably the biggest piece of this has been understanding both our role and then what the role of others might be in helping prevent gun violence.

00:12:01:02 - 00:12:28:26
Roxanna Gapstur, Ph.D., R.N.
I did feel when I first came to WellSpan that there was more we could be doing as a health system in prevention, but also that we can't do it all. And so we needed the right partners. I will say that that strong partners right now have been our local police departments, certainly our judges. We have a really robust treatment court here that works very hard to prevent incarceration and to get people to the right kinds of treatment.

00:12:28:28 - 00:12:52:01
Roxanna Gapstur, Ph.D., R.N.
And we also have, in the last two years, a credible messenger program. This program first started on a grant and was a business partnership agreement between one of our local nonprofits and our WellSpan York Hospital, which is a level one trauma center. And the credible messengers are highly engaged individuals who support victims and families who enter York Hospital because of gun violence.

00:12:52:04 - 00:13:20:01
Roxanna Gapstur, Ph.D., R.N.
They work to solve some of the deeper causes of violence in the community. And so they're they're very connected outside of the hospital setting. And so far in the last three years, we've seen a 43% reduction in gunshot wound patients at our hospital and a 71% reduction in homicides in our community, which is just gives you goose bumps to think about because it's such a problem for some of the younger individuals in our community.

00:13:20:02 - 00:13:30:12
Roxanna Gapstur, Ph.D., R.N.
So I would say the credible messenger program in these partnerships with local non-profits have been the most impactful in addressing really root causes of gun violence.

00:13:30:14 - 00:13:33:16
Mindy Estes, M.D.
Question or the credible messengers? Volunteers.

00:13:33:18 - 00:13:56:02
Roxanna Gapstur, Ph.D., R.N.
Not the credible messengers, are paid on the grants that we received with the not for profit. But it has been so impactful that we've continued that payment, you know, after the grant. And so all of us in New York County are very invested in that program, both emotionally and financially, because we've seen such great results with it.

00:13:56:04 - 00:14:16:27
Mindy Estes, M.D.
Well, the success rate has it's really been extraordinary in the numbers of live saved in families saved, you know, has to be a positive for the entire community. I want to look ahead. And when we look ahead, what do you see as your biggest goal for WellSpan health and what challenges do you anticipate in achieving it?

00:14:16:29 - 00:14:39:27
Roxanna Gapstur, Ph.D., R.N.
Boy, that's a great question. I would say innovation is probably one of our biggest priorities. We really believe that the health care system, as great a job as we do in many things, needs some transformation and needs to meet the needs of the future. So we've worked really hard to think about people, process, and technology differently than we did in the past.

00:14:39:27 - 00:15:09:22
Roxanna Gapstur, Ph.D., R.N.
And we've spent the last two years setting up for our next strategic plan, which is WellSpan 2030. An innovation and transformation will continue to be a big part of learning how we can use people, process and technology differently together. And, you know, I think all of us were a little taken by surprise a couple of years ago with the, generative AI changes, the Pandora's box that can kind of open as we think about how we might have safer care, more efficient care, etc..

00:15:09:27 - 00:15:38:05
Roxanna Gapstur, Ph.D., R.N.
And I would probably call out to that we've been heavily involved in. One is using artificial intelligence to improve the speed and accuracy of our radiology exams. WellSpan has deployed over 14 different applications for the last five years in radiology. I think we're leading the pack, and in terms of how we've deployed and how engaged our radiologists are with artificial intelligence.

00:15:38:07 - 00:16:06:11
Roxanna Gapstur, Ph.D., R.N.
And as you know, Mindy, artificial intelligence requires a lot of work and effort and process in order to make it the most useful for care teams. Our teams have done that work, and we've seen 81% faster traditional review of our exams with our radiologists using using AI. And our physicians who read scans are 98% engaged with the applications.

00:16:06:13 - 00:16:30:25
Mindy Estes, M.D.
That's very exciting. And I think you've you've enabled your radiologists to be part of the process because, you know, I think ultimately will help us make smarter decisions, faster decisions, but does not replace the physician. I think once we understand how to use that, and we're still learning and the technology is evolving, you know, we'll see more and more of it.

00:16:30:27 - 00:16:46:29
Mindy Estes, M.D.
We are just about out of time, believe it or not. And I want to thank you for sharing your insights. Your leadership at WellSpan health clearly demonstrates how engagement can drive meaningful change and sustainable change.

00:16:47:02 - 00:16:55:11
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:20 - 00:00:33:17
Tom Haederle
Welcome to Advancing Health. South Dakota-based Sanford Health is America's largest rural health care system. But even with its hundreds of locations, some patients still face voyages of hundreds of miles to access the care they need. In today's podcast, recorded at one of the world's largest digital health conferences, we hear how Sanford is innovating with both telehealth and artificial intelligence - AI - to shrink those vast distances and deliver quality medical care to all who need it, regardless of where they are.

00:00:33:19 - 00:01:00:21
Chris DeRienzo, M.D.
Hi again everyone, this is Dr. Chris DeRienzo, AHA’s chief physician executive and I am super excited to be here on the sidelines of one of the world's largest digital health conferences with Dr. Dave Newman. Dave and I have known each other for a while now. He is an endocrinologist up at Sanford Health in the Dakotas, and he is the chief medical officer of virtual care for a health system that knows a little bit something about how to serve rural and frontier populations.

00:01:00:24 - 00:01:11:20
Chris DeRienzo, M.D.
And you can hear in the background, we are on the sidelines of this, this large conference, and both of us happen to be talking innovation. We got you to agree to jump on the podcast with us and talk a little bit more about it.

00:01:11:20 - 00:01:12:26
Dave Newman, M.D.
Yeah, thanks for having me, I appreciate it.

00:01:13:03 - 00:01:27:22
Chris DeRienzo, M.D.
So for you all, innovation is really grounded in your need to serve your population. So remind our listeners a little bit about Sanford Health and the populations you serve and why innovation has been so core to what you do from the beginning.

00:01:27:25 - 00:01:47:25
Dave Newman, M.D.
Yeah. So at Sanford Health, we're the nation's largest rural health care system. We range all the way from Wyoming to Michigan. We have lots of hospitals. We have got big hospitals. You got small hospitals, we've got critical access hospitals. You've got clinics. We've got a health network. We've got a nursing home. One thing that we don't have, though, is a problem that a lot of rural America has is enough providers.

00:01:47:28 - 00:01:53:03
Dave Newman, M.D.
We realize that we have to jump to innovative care models to survive because our patients really need it.

00:01:53:03 - 00:02:11:09
Chris DeRienzo, M.D.
Well, it's innovative care models and you need providers, but you also have patients who are spread far and wide. I mean, you all were incredibly generous with your time. We spent some time together, in the fall and you showed me what it really is like in parts of rural North Dakota where your patients live.

00:02:11:10 - 00:02:24:00
Chris DeRienzo, M.D.
Talk to us about that. And then you will return to given that this is who you all serve, and it really is a sacred mission that you have, the kinds of innovative approaches that you're taking, both with virtual care and with AI.

00:02:24:03 - 00:02:45:21
Dave Newman, M.D.
Yeah. So when I say rural, I mean really rural. So in, North Dakota, I live in Fargo, North Dakota. I'm the only andrologist for the state of North Dakota. And Fargo is in on the eastern part of the state. And, a lot of my patients come from western North Dakota or even Montana. It is a 400 mile drive one way to get to see me.

00:02:45:23 - 00:02:46:25
Chris DeRienzo, M.D.
Whoa.

00:02:46:27 - 00:02:49:16
Dave Newman, M.D.
And oftentimes it's for a 15 minute appointment.

00:02:49:19 - 00:02:50:10
Chris DeRienzo, M.D.
Oh my goodness.

00:02:50:10 - 00:03:10:22
Dave Newman, M.D.
And so if they're coming to see me for their hypogonadism or infertility or another thing, I'm the only option in town. You can imagine how frustrating it is if there is a blizzard, or even if there's not a blizzard for them to have to drive that far, take a day off of work, have multiple tanks of gas, to missed time away from their loved ones, to do something that can be easily done virtually.

00:03:10:24 - 00:03:25:27
Chris DeRienzo, M.D.
And that might even be two days, because I could imagine, you know, if that's an appointment you've been waiting on and you described a little bit about what you do, but remind our listeners what an andrologist is in just a moment. Yeah, yeah. You know, I mean, I would drive 400 miles and spend the night just so I don't, I don't miss that.

00:03:25:28 - 00:03:28:24
Chris DeRienzo, M.D.
That can be such a key conversation in in a family's life.

00:03:29:01 - 00:03:36:20
Dave Newman, M.D.
Right. Absolutely. Yeah. So andrology is sex hormone. So it's a lot of, if your testosterone is low or if you're having troubles, reproducing. Yeah.

00:03:36:20 - 00:04:00:26
Chris DeRienzo, M.D.
From a health perspective, even having one provider like that in that part of North Dakota is great, but you need to reach a massively spread out population. So, obviously you're the CMO of virtual care. Let's talk a little bit about how Sanford and you think about the kinds of virtual care options that allow a provider with your experience to reach people who are hundreds, if not a thousand miles away.

00:04:00:27 - 00:04:17:11
Dave Newman, M.D.
Yeah. So we've really been listening to patients and what they want. So one of the big things we heard is that they don't want to be transferred to our flagship hospitals. So we've got lots and smaller hospitals that feed the larger hospitals. One of the big issues is the lack of some of the pediatric subspecialties in the smaller hospitals.

00:04:17:15 - 00:04:26:19
Dave Newman, M.D.
So, for example, pediatric infectious disease. If a patient needs a pediatric infectious disease consult, they often had to be transferred to Fargo or Sioux Falls for the higher level of care.

00:04:26:20 - 00:04:27:11
Chris DeRienzo, M.D.
Wow.

00:04:27:13 - 00:04:56:06
Dave Newman, M.D.
You can think about as a parent, if your child is transferred, you're missing work. You have other children that you can't attend to. It's a big burden. So now leveraging technology and leveraging virtual care, we can beam our own providers, our own pediatric infectious disease doctors into their hospitals. We can keep the patients there. Sometimes you can just see how relieved the patients are knowing that they're not going to be transferred, and knowing that they still get the same high quality specialty care in their hometown hospital.

00:04:56:11 - 00:05:21:13
Chris DeRienzo, M.D.
Let's talk a little bit about follow up, because it's not just in-hospital care. And we got to visit Dickinson, North Dakota. And one reason that that you all took me there is that it made national news. The virtual care setup that you had in Dickinson was such that patients who had, pediatric patients actually, who had, you know, chronic conditions that were requiring them to drive a 1100 miles roundtrip to see subspecialists, you could now set them up in that building

00:05:21:13 - 00:05:33:27
Chris DeRienzo, M.D.
so now maybe it's an hour's drive from the ranch that they live to Dickinson rather than seven hours each way. That doesn't happen accidentally. You've got to be very intentional about designing a system to work like that. How do you do it?

00:05:33:29 - 00:05:50:02
Dave Newman, M.D.
Yeah. So a lot of it is, is what the patient wants, and from provider buy-in. And so we've had some champions that have driven this. And we have failed fast on a lot of these models that didn't work. For our hub and spoke model, it's the easy button for the patient. So if they're not tech savvy they can go to the clinic.

00:05:50:04 - 00:06:07:17
Dave Newman, M.D.
They can have a nurse, room them in a regular exam room, and then the provider beams into the room. So it's just like a normal visit. One of the great things about that is they're already there for labs. So if a patient needs an X-ray, they're there. Yeah. If they need blood test, they're there. And it is their trusted provider.

00:06:07:19 - 00:06:12:18
Dave Newman, M.D.
Those labs are going to go straight to their in-basket and they're going to have follow up there. So it's defragmented care.

00:06:12:18 - 00:06:32:09
Chris DeRienzo, M.D.
I love this example because that medicine is always a spectrum. I'm a neonatologist, you're an endocrinologist. You know I see babies at the super, you know, critical hyper-acute end of the spectrum and you know, out in follow up care. And telemedicine is no different, right? There are telemedicine visits you can do in a patient's home with the technology that just exists on their phone.

00:06:32:09 - 00:06:50:15
Chris DeRienzo, M.D.
But these kinds of visits that we're describing here, you need really special setup so that, for example, a pediatric pulmonologist can know what they need to know about, you know, a child who has a chronic condition, to say, no, you're good. You don't have to make the thousand mile round trip drive this month. That's sort of one part of an innovation.

00:06:50:21 - 00:07:04:11
Chris DeRienzo, M.D.
We're both here at this conference and innovation takes lots of forms. I know you all are early users of any number of AI enabled solutions. Where are you seeing an impact today? Either for your physicians and APPs or for patients?

00:07:04:14 - 00:07:22:25
Dave Newman, M.D.
Yes. So one of the best use cases of AI that I've seen in my career has been artificial intelligence for diabetes. In my previous career, I treated a lot of type 1 diabetes. And patients had an insulin pump, which you can imagine is like a cell phone that they wear in their belt that talks to a sensor, which is a sticker on your skin that continuously checks your blood glucose.

00:07:22:27 - 00:07:39:06
Dave Newman, M.D.
There is an artificial intelligence algorithm that tells you when you need more insulin and when you need less insulin, and it will do it for you. Wow. It's the easy button. So that was really cool technology that came out several years ago, but the software was clunky, so they had to come to a major diabetes center to download it.

00:07:39:06 - 00:07:55:06
Dave Newman, M.D.
Okay. With our feedback, a lot of the companies have been able to bring this into the patient's home. So there's an app or a program on their home computer that they can use, and we can do all their work virtually. So for a condition like type 1 diabetes, it is like a part time job.

00:07:55:13 - 00:07:56:02
Chris DeRienzo, M.D.
Yeah.

00:07:56:03 - 00:08:15:00
Dave Newman, M.D.
That it is four hours a day. We have completely revolutionized it. So sometimes I see a patient once a year for their type 1 diabetes. Once a year. Yeah. So it's partnering with the technology. We firmly believe that artificial intelligence is going to be a tool that we use. It's not going to replace doctors, but it's going to be absolutely kind of the stethoscope of 2025.

00:08:15:02 - 00:08:36:27
Chris DeRienzo, M.D.
I mean, for those, you know, listening to the podcast, that's the type of diabetes that you're typically are diagnosed with when you're young. And for generations that meant, you know, throughout childhood and your adolescent years, your blood sugars were way off. And so that that changed the trajectory of sort of the health band that you could live in for the rest of your life.

00:08:36:29 - 00:08:47:13
Chris DeRienzo, M.D.
Getting to press this easy button for patients with type 1 diabetes who are much younger, I mean, help me understand, you're talking about generational shifts in health outcomes.

00:08:47:13 - 00:09:03:26
Dave Newman, M.D.
Absolutely. So these patients are now not dying from their diabetes. It is giving them their life back, that they're no longer in the road for appointments, that they're able to go on cruises, they're able to go to on family trips, they're able to do those things, and they're able to be normal kids and normal adults. You use the term easy button.

00:09:03:26 - 00:09:18:27
Dave Newman, M.D.
So we are fully committed to not just our patients but our providers, leveraging technology to make things easier. Yeah. That if the solution is to add something more to our patients or my providers, I'm not interested in it. I'm interested in taking things away. I'm interested in making life simpler.

00:09:19:03 - 00:09:40:24
Chris DeRienzo, M.D.
And it doesn't have to be in cities with 8 million people. You're making life simpler for patients who get to stay where they want to live with their families for more of the time now. I don't think we think about this burden enough in health care. But we have patients who  - it's days, it's weeks. It's months of their life, you know, to be able to access our services.

00:09:40:24 - 00:10:01:26
Chris DeRienzo, M.D.
And we are we are experts in lots of different things. You're almost turning that around, by being able to project care into people's homes using technology. But let's talk about the providers for a minute, because I've been there right with you as a CMO of a health system before joining AHA. You don't want every new innovation to workflow to be an addition.

00:10:01:28 - 00:10:14:27
Chris DeRienzo, M.D.
And I, frankly, is one of the technological revolutions I'm seeing that actually is beginning to deliver a little bit on what you said, which is we can actually take some things away that have been layered on. Got any examples of those?

00:10:14:27 - 00:10:32:06
Dave Newman, M.D.
Oh yeah. So the best example is one that's really hot right now is ambient listening. Yeah. So we rolled this out recently and I cannot believe how well it works. So for the listeners, this is an AI program that the provider, during your clinic visit with them will turn on their phone and it'll listen to you and it will write their note for them.

00:10:32:09 - 00:10:53:09
Dave Newman, M.D.
One of my buddies is a pediatric oncologist. Really a good guy, he was really bad at writing his notes. So he was always on the naughty list, is what he called it. So he was getting messages from the CMO saying, you need to close your charts. And he did this for 12 years. We opened ambient listening to him, and he texted me the other day and he said, Dave, I didn't miss my daughter's recital.

00:10:53:12 - 00:10:57:01
Dave Newman, M.D.
I'm not on the naughty list. Like, this is giving me my life back.

00:10:57:01 - 00:11:20:00
Chris DeRienzo, M.D.
A little bit depressing, frankly. The baseline it's just an expectation that, yeah, I'm going to miss the recital. That's what you and I, that's the that's the culture that we've grew up. It doesn't have to be that way anymore. And I'm hearing the same things. I've now heard from multiple systems in multiple states on multiple different platforms that, on average, ambient listening seems to be decreasing in EMR time by double digits.

00:11:20:01 - 00:11:21:26
Chris DeRienzo, M.D.
Some sort of high double digits.

00:11:21:26 - 00:11:22:13
Dave Newman, M.D.
Absolutely.

00:11:22:13 - 00:11:28:06
Chris DeRienzo, M.D.
And that time is being returned to us to do the things that the human part of health care.

00:11:28:06 - 00:11:46:10
Dave Newman, M.D.
Yeah. So it was interesting. I was talking with a patient the other day, who was in a clinic visit with one of their providers that was using this. And they had a real conversation. Because now being a provider, it's harder. You're always ordering things on a computer. You're looking at labs, you're trying to type your note as you go, and it's lost the human element.

00:11:46:10 - 00:11:49:05
Dave Newman, M.D.
Ambient listening has given that human element a chance.

00:11:49:07 - 00:12:07:26
Chris DeRienzo, M.D.
I mean, we shifted to electronic technologies for all of the right reasons, you know, and it certainly led to some positive outcomes, for sure. But you're exactly right. Health care is and always has been and always will be a uniquely human experience. And we need to keep threading that thread of humanity through the needle of technology.

00:12:07:26 - 00:12:31:01
Chris DeRienzo, M.D.
If we're going to be able to experience the stuff that brings us joy as doctors, right? Getting to spend time with our patients, getting home and getting to our kids recitals. You know, as long as we've got folks like you, Dave, out there, leading the innovation, I tell you what, I am incredibly optimistic, about the current generation of trainees walking into a practice of medicine and of nursing, respiratory therapy and lab techs and all of the professions.

00:12:31:04 - 00:12:36:16
Chris DeRienzo, M.D.
That is only going to keep getting better. Thank you so much for joining the podcast. It's been a total privilege.

00:12:36:21 - 00:12:38:03
Dave Newman, M.D.
Thank you, Chris.

00:12:38:05 - 00:12:46:16
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:01:03 - 00:00:22:12
Tom Haederle
Welcome to Advancing Health. Coming up, a look at the role of leaders, including hospital boards, in ensuring patient safety and connecting with the communities they serve. How can leaders prepare to meet these important goals? Where do we find the right people to help lead the way? And what investments can care providers make to address disparities in care? These are among the questions you'll hear more about.

00:00:22:17 - 00:00:40:08
Tom Haederle
Dr. Mindy Estes, former CEO of Saint Luke's Health System and former AHA board chair, is your host today. Her guest is Tori Bayless, CEO of Luminis Health and a member of a board of trustees. Now over to Doctor Estes.

00:00:40:10 - 00:01:13:11
Mindy Estes, M.D.
I'm Mindy Estes, and joining me is Tori Bayless, CEO of Luminis Health and a member of the board of trustees. Under Tori's leadership, Luminous Health has made significant investments to advance patient safety, improve quality of care, and address disparities in behavioral health. And let's just dive right in. You've spoken about the strength of your board and the passion and insights they bring to Luminis work to improve patient safety and connect with the communities your hospitals serve.

00:01:13:13 - 00:01:26:12
Mindy Estes, M.D.
What are the keys to selecting and preparing board members for this vital work? And then could you share an example of how a board member from outside health care has brought new insight to quality and patient safety?

00:01:26:16 - 00:01:50:15
Tori Bayless
Sure. Thank you so much for that question. So clearly we're governed by a board of trustees. They are all volunteers. They are incredibly passionate about the work that we do. And it's a self-perpetuating board. And then we do a lot of the heavy lifting in our committees. So one of those key committees is the board quality, Patient Safety and Workforce Committee.

00:01:50:17 - 00:02:11:24
Tori Bayless
Over the years, we've debated whether workforce should be broken out separately. And we really came to the conclusion that how we take care of our teams, how we staff, how we do the work every day with our team members is going to impact the patient experience, the clinical outcomes. So we couple quality and patient safety with workforce at a governing level.

00:02:11:26 - 00:02:34:16
Tori Bayless
And in terms of our trustees, they really are incredibly committed. They need to be passionate. They need to be committed to our values. When we think about trustees and who and where they hail from. Some of them have deep expertise in health care, but many of them do not. And we look to different sectors. We looked at education, the public school system, higher ed.

00:02:34:24 - 00:03:06:01
Tori Bayless
We've looked at military leaders and had trustees commit to us and bringing that expertise to us. We have people from the technology sector, from pharma, and dare I even say the payer community has engaged with us, whether that's at a governance committee level, board of trustees or one of our community advisory councils. So we've been very, very fortunate to have the level of engagement and expertise and we have a tempo of meeting with the Board of Trustees and the committees on a quarterly basis.

00:03:06:03 - 00:03:11:09
Tori Bayless
But we have a lot of points for interaction in between those formal quarterly meetings as well.

00:03:11:12 - 00:03:39:26
Mindy Estes, M.D.
Let's pivot to another question. You know, I think a few years ago, luminous noticed rising behavioral health issues in your community. And a lack of resources, which is something we see all across our nation. As a result, there were disparities in care, and you chose to invest in addressing these problems. Can you describe your approach to the issue and what has worked best?

00:03:39:28 - 00:04:01:27
Tori Bayless
So clearly, Mindy, as you well know, a top health care priority. And in so many of our communities across the country. So if you look at our community health needs assessment for the various counties we're serving, you know, we've got number one on that list has been mental health. The rise in the need. And we've made a pretty significant investment over the past five years.

00:04:01:28 - 00:04:25:21
Tori Bayless
Now, if you think about that time horizon, that was also the horizon of the global pandemic. And economic adversity and difficulty for hospitals and health systems. And when it's the top priority in your community health needs assessment, we had to find a way to move forward. And we did that with support and cooperation from the counties we're serving in terms of resources they could bring to bear as well.

00:04:25:24 - 00:04:48:22
Tori Bayless
So over the past five years, we opened a new mental health hospital in Annapolis. We built out a new behavioral health pavilion on our Lanham campus. We have also built upon three decades of experience in substance use disorders. But as we think about behavioral health, it's not enough to have, you know, just the intake unit in the E.R. or just the inpatient beds.

00:04:48:22 - 00:05:12:13
Tori Bayless
We've really tried to build a continuum. And when we looked in particular in the Prince George's County area, which is wraps around the DC Beltway, if you will, there were Signifi can gaps and not enough services. So we partnered with the county, and they were able to bring forward capital dollars that could accelerate our investment. We married up of course, our resources as well.

00:05:12:14 - 00:05:38:04
Tori Bayless
We basically renovated what had been a former nursing home building on our campus, basically gutted it, took it down to the studs and built it back up as a behavioral health comprehensive program where we have walk in services, urgent care services. And, you know, it was a screaming need. And, you know, you know, well, sometimes the reimbursement for behavioral health services is not where it needs to be.

00:05:38:04 - 00:06:00:20
Tori Bayless
It's not always valued the same way some other health care services are, whether that's by commercial payers or even our government payers. So we continue to have that dialog to say, let's really put the dollars behind where the greatest need is in the community. So it's a work in progress for sure. We're certainly proud of the work that we've done to open up these additional resources.

00:06:00:22 - 00:06:11:13
Tori Bayless
And it's a journey, but very, very proud of the team and having that full continuum of services rather than just one slice of the behavioral health continuum.

00:06:11:15 - 00:06:31:28
Mindy Estes, M.D.
Where you point out that the continuum is important, and also that behavioral health is a part of all, if not all, many of the chronic diseases that we deal with. So addressing behavioral health issues not only is good in its own right, but really helps in our mission to provide the highest quality, safest care that we possibly can.

00:06:32:01 - 00:06:57:18
Mindy Estes, M.D.
You've made significant investments in developing analytics to guide decisions and track improvement, and we all know that what we measure is where we see improvement and accountability. What types of analytics have been most useful? How do you leverage the information? And can you give an example of where data analytics really has provided what was perhaps an unexpected opportunity?

00:06:57:25 - 00:07:17:26
Tori Bayless
That's a great question, Mindy. You know, I think organizations around the issues of quality and safety, you have to have enough courage to ask the questions, and you've got to be able to back it up with the data. So we've built a central data analytics team. And they are really we've been working in partnership with our clinical leaders across all of the different service lines.

00:07:17:26 - 00:07:43:00
Tori Bayless
So if I look to my lead for maternal and child health services, she has done an incredible job of delving into the data and recognizing disparities in our C-section rates, for example. And you have to study the data to know where to potentially put your interventions. Similarly, our orthopedic team has looked very carefully at surgical outcomes. They've looked at pain management.

00:07:43:03 - 00:08:07:29
Tori Bayless
Our opioid task force has looked at the data in great detail on the primary care side, we're really looking at not just the outcomes that we see, but how do we really get upstream to the issues of prevention and detection and screenings? So we looked at the data on our diabetic populations and how are we meeting the thresholds defined by ourselves defined by payers, defined by NCUA.

00:08:08:02 - 00:08:32:21
Tori Bayless
We also look at our colorectal cancer screening, breast cancer screening, lung cancer screening. And there are times where we've seen disparities we're finding and this shouldn't surprise us given the broad literature that's out there nationally. But some of our detection rates among some populations, more vulnerable population, underserved communities, their cancers are more advanced at the time they're detected.

00:08:32:23 - 00:08:56:06
Tori Bayless
We looked at data across patient experience. We looked at data across ID, wait times. So there are so many ways that we're delving into this. But I started with the example in maternal child health, and we looked at the data again in C-section disparities. And that multi-discipline generic team, through a number of different interventions, were able to reduce the disparity over a five year period.

00:08:56:13 - 00:09:10:18
Tori Bayless
It was from a 12% down to 7%. So more work to go. But it was a very focused work. And over many months and years, time to try to get those results demonstrated.

00:09:10:20 - 00:09:43:25
Mindy Estes, M.D.
You know, just a couple of thoughts come to mind. You know, the courage to ask the question is step one. And I think all of us have been surprised when we'd ask a question. Our answer would have been, absolutely not. This doesn't happen in my organization. But then when you find out that it does, then the multidistrict linear nature of a team that both has leadership but also grassroots folks where the work actually is occurring, I think is a key to really making forward progress and progress quickly.

00:09:44:01 - 00:10:07:12
Mindy Estes, M.D.
And you point out it was a five year journey, you know, and that journey continues. It's one of those things that strikes me the minute you take your foot off the gas, it slows down. So congratulations to you all. We appreciate the examples and the structure that you've shared. I wanted to just pivot a touch and talk about mentorship.

00:10:07:15 - 00:10:21:04
Mindy Estes, M.D.
What advice do you have for seasoned leaders considering a mentorship role for recent graduates? How does all of this come about? Do you identify people? Do mentors fall in your lap? Is it is it deliberate?

00:10:21:07 - 00:10:41:19
Tori Bayless
And I think think for all of us, you know, if we can have mentors, we're going to grow and develop. And that's at every stage of our careers. Even if you're sitting in a role as a chief executive or president of an organization. So to have mentors has always been impactful for my career, but also to be a mentor and mentor and can occur at so many different levels.

00:10:41:25 - 00:11:20:01
Tori Bayless
We've had programs within Luminous Health where we've identified what we'll call our hypo luminary leaders, our high potential leaders, and we've invested in them. But then we also expect them to give back and serve as mentors for others in the organization. At the administrative fellowship level. That's actually how I began my career 30 ish years ago, where I did an administrative fellowship coming out of graduate school, and I found it to be an incredible way to jumpstart a career, get broad exposure to an organization at a very senior level so that through the rest of your career, as you're progressing and growing, you always have that broad view of an organization.

00:11:20:02 - 00:11:46:04
Tori Bayless
So I think I'm in my 14th year of sponsoring administrative fellowships. I'm not the only mentor or preceptor. We have our hospital presidents and other members of executive leadership. We spend considerable time with our fellows. And I think about the generations in the workforce today. And you think about at least four generations in the workforce. And I do firmly believe that the greatest talent exists in every generation.

00:11:46:10 - 00:12:06:13
Tori Bayless
And it's not like the knowledge I can impart to you only, and that it's a one way street there. But to be open and candid and available to any questions these fellows want to ask. And believe me, I'm learning from them. And I don't mean just, you know, how do I save a PDF file or work figure out how to do a zoom poll or things like that?

00:12:06:16 - 00:12:08:04
Mindy Estes, M.D.
What's useful?

00:12:08:06 - 00:12:29:03
Tori Bayless
It's very useful. But they're coming out of these incredible programs, up programs across the country. They've got the latest and greatest research and the professors, what they're hearing and learning in their didactic training, and try to help them translate that in where they can have an impact. And they're not just sitting back as a sponge, observing and learning.

00:12:29:03 - 00:12:49:21
Tori Bayless
They can jump into projects and contribute in a pretty significant way in that fellowship. Yea, and selfishly, I do like to retain them. That's not a guarantee after the fellowship, but we have retained several throughout their careers and those who move on to other organizations. We follow them and track their career progress and remain accessible to them.

00:12:49:24 - 00:13:09:05
Mindy Estes, M.D.
You know, I think we are in health care, lifelong learners and mentorship and having mentees is part of that because you certainly are learning, and it is a two way stream. And something you said, I think is really important as we wrap up this thought in conversation is that, you know, I think we have an obligation to give back.

00:13:09:08 - 00:13:46:20
Mindy Estes, M.D.
Many of us have been very fortunate to have mentors throughout our career, sometimes unlikely mentors, but mentors who have made a great impact. And as you move into senior leadership and later in your career, I really do think it is a given or a privilege to be able to give back and to serve as a mentor. So thank you for sharing how that program works and how you expand to all of your leadership team, because, you know, half of what we do is being able to pick up the phone and talk to somebody and say, how have you tackled this?

00:13:46:23 - 00:13:55:27
Mindy Estes, M.D.
Or this is what I'm thinking. Help me think about the unintended consequences of an action. So thank you for sharing that.

00:13:56:00 - 00:14:18:12
Tori Bayless
Two things. One, that Mindy mentioned, I really value in all of our leaders and particularly young leaders and early careers is their curiosity and inquisitiveness. And I've tried to keep that with me through my career as well. But you're always learning, right? But that and it made me think of your other remark about the data question that we were talking about earlier.

00:14:18:14 - 00:14:42:14
Tori Bayless
And to have the courage to try to get to the right answer and understand where you're starting from. It's that curiosity that comes in and, you know, it's the Ted Lasso video where he talks about be curious, not judgmental. It's a great video clip that I've used in some training, but you can be curious. And even if it's in data that's telling a story that may not be that flattering.

00:14:42:17 - 00:14:57:24
Tori Bayless
We want to be able to really be honest with ourselves and have enough humility to dig in. But that curiosity, I think it's an important thing for all of us. Like as talented and sophisticated as our team members are, there's always room to learn and willing to grow.

00:14:57:27 - 00:15:21:26
Mindy Estes, M.D.
Well said. You know, on that note, I'm going to thank you for sharing your valuable insights and experiences today. You know, our discussion really has not only emphasized the importance of leadership and driving patients safety and equitable care, but just highlighted how innovative strategies and board leadership can transform health care delivery.

00:15:21:28 - 00:15:30:09
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:06 - 00:00:29:09
Tom Haederle
Welcome to Advancing Health. In this month's Leadership Dialogue, hosted by the American Hospital Association's 2025 board Chair, Tina Freese Decker, president and CEO of Corewell Health, we delve into the critical importance of trust - not only in the health care system, but across our society in general. Joining Tina are two distinguished experts who share their insights on what trust really means, why it seems to have eroded in many aspects of American life, and what we can do to restore it.

00:00:29:11 - 00:00:35:20
Tom Haederle
Trust us. This is a discussion you don't want to miss.

00:00:35:22 - 00:00:59:00
Tina Freese Decker
Thank you, everyone, for joining us today. I'm Tina Freese Decker, the president and CEO of Corewell Health and the board chair for the American Hospital Association. In 2025, the AHA is all in on tackling the challenges facing health care today. And these Leadership Dialogue conversations are diving deep into issues for inspiration and action as we continue to make health better together.

00:00:59:02 - 00:01:21:18
Tina Freese Decker
So today, I want to talk about an issue that seems timelier than ever. Trust. Trust in one another. Trust in our field. Trust in our communities and our government is so important to what we do every day. And everyone should know that our hospitals, our health systems are a place for healing no matter what. And that trust is critical.

00:01:21:21 - 00:01:44:03
Tina Freese Decker
Yet we see over the past several years, public trust has been decreasing, not just in health care but across the board. So with me today to give us some insights into why this might be happening is Lynn Hanessian who just completed a 28-year tenure as chief health strategist for Edelman, a global communications firm, and has worked directly with a number of hospitals and health systems during her career.

00:01:44:06 - 00:02:04:17
Tina Freese Decker
And we had the opportunity to meet last month, and I was just fascinated by her presentation and what she's seen. And then we also have Dr. Robert Trestman, who I call Bob, who is the chair of psychiatry and behavioral medicine at Carilion Clinic, based in Roanoke, Virginia. And he also serves as professor of behavioral medicine at the Virginia Tech Carilion School of Medicine.

00:02:04:20 - 00:02:25:29
Tina Freese Decker
And he's also on the American Hospital Association board. He is passionate about helping health care professionals and emphasizes the importance of remembering that we are human beings. It's a great reminder, with limits, and it's okay to ask for help. So before we get started, I would just love to hear from each of you about what you trust in today and why.

00:02:26:01 - 00:02:49:03
Lynn Hanessian
Well, I'll go first if you don't mind. So for me, trust is about this sort of sense of confidence. Do I rely on that person, that organization, that institution? Can I count on them to do what's right? And so having that, connection is really important and influences how I operate professionally and certainly how I operate personally and how I take care of my family.

00:02:49:08 - 00:02:50:03
Tina Freese Decker
That's great. Thank you. Bob?

00:02:50:07 - 00:03:20:23
Robert Trestman, M.D., Ph.D.
In same way as physicians, we are in a unique situation to bond with a patient and they need to believe that we have their interests at heart, even above our own. That's core to what we're all about. And for hospitals and health systems to be seen as extensions of the physicians, the nurses, the other clinicians who are dedicated to caring for our patients.

00:03:20:26 - 00:03:34:17
Robert Trestman, M.D., Ph.D.
So their belief in us is paramount because frankly, unless they trust in us, they won't be willing to follow our recommendations and we won't be able to help them heal.

00:03:34:20 - 00:03:54:04
Tina Freese Decker
Yeah, it's so important why I am so focused on our mission, because it is really about what we do and what we say we do in those values that are aligned there. And that's what gives me that confidence and trust that we're going to continue to focus on the mission. So, Lynn, let's start with you and the Trust Institute and the trust barometer.

00:03:54:06 - 00:03:59:21
Tina Freese Decker
Can you give us some just general background on the work and the research that has been conducted?

00:03:59:24 - 00:04:22:23
Lynn Hanessian
Thanks so much. To give you some framing around it, for about 25 years Edelman has been studying trust. And we originally sort of wanted to get a handle on what does the public think? How did they perceive sort of the pillars of society? How do they think about government, business, not for profits, the media? And what does that mean in relation to their behaviors?

00:04:22:24 - 00:04:42:18
Lynn Hanessian
And I think, Dr. Trestman, you bring up a really good point. If people don't trust they're not going to follow their doctor's recommendations. And we found that if they don't have trust in their health, what we defined as the health ecosystem that includes the doctor, the hospital, all of those factors that help them get into the health care,

00:04:42:20 - 00:05:05:24
Lynn Hanessian
they're not going to get their regular appointments. They're not going to get the kind of care that's recommended. And I deeply worried that that means they're going to turn somewhere else. As we've studied trust over the years, we've looked very closely at trust in different sectors of business, of industry. Health care is among the areas that we looked at, but we also want to understand how do we build trust?

00:05:05:27 - 00:05:17:03
Lynn Hanessian
How do we think about the implications of that and how do we sort of, frankly, help to forge a more trusting society? So that's really been quite a journey that Edelman has been on.

00:05:17:05 - 00:05:26:13
Tina Freese Decker
And so this conversation is particularly timely because Edelman just released the latest Trust Barometer data last month. What are some of the key trends that you can share with us?

00:05:26:16 - 00:05:55:03
Lynn Hanessian
Absolutely. And I think, I'm going to share some global trends because it's important to know that we're not alone. We're in a really interesting time, a difficult time because what we've seen is really a rise in distrust, distrust in government, in business, across society. And even as employers, we've seen a decline in the last year, a decline in my trust in my employer, which is, you know, if you think about your daily activities, you know, your employer relationship is among the strongest.

00:05:55:05 - 00:06:16:04
Lynn Hanessian
If we asked about spouses and loved ones, we'd probably find similar numbers. But what we know is, there's fear. There's fear of globalization, fear of economic pressures, fear of change that's really set upon us. And one of the things that the key concluding point that we saw this year, and again, this influence is what's coming into your health systems,

00:06:16:04 - 00:06:39:07
Lynn Hanessian
that dialogue with the doctor, the dialogue with the nurse, the whole communities in which you operate. There is a lack of optimism about the future. There is also a real fear of being discriminated against across all of the demographics we look at. And there's a belief that the government and business has their self-interest in that it's not including me, and that our leaders aren't telling us the truth.

00:06:39:07 - 00:06:58:22
Lynn Hanessian
So there's a real sort of intense worry, and we called it grievance this year that we're not going to get a fair shake. And so that's really the finding that we happened upon. And you can see there's forces in the world in which we live that want to shake our confidence in one sector so that they can have an advantage somewhere else.

00:06:58:22 - 00:07:01:12
Lynn Hanessian
And we're seeing it play out in the general public.

00:07:01:14 - 00:07:21:01
Tina Freese Decker
That word grievance, really hit me when you presented that to us and we talked about it. And it really does sum up where we are. And it's hard to be optimistic, but those are the things we need to be focused on and moving forward. So, Bob, as you're listening to this, what do you see are the implications of this distrust as it relates to health care?

00:07:21:04 - 00:07:48:11
Robert Trestman, M.D., Ph.D.
Well, I think it's really important for us to be aware that there is this level of distrust in the community and to think through very consciously how we can mitigate it. The words that come up grievance, fear, trust, all are woven together. So we need to think through what is it our patients fear? Yeah. There's the fear of pain.

00:07:48:11 - 00:08:11:02
Robert Trestman, M.D., Ph.D.
The fear of death. The fear of different kinds of morbidity. That's what we as clinicians are trained to focus on. But we now need to talk even more broadly about a range of other fears, because, frankly, people can be afraid that they even if we give them a recommendation, they may not be able to afford to follow it.

00:08:11:04 - 00:08:51:09
Robert Trestman, M.D., Ph.D.
So we need to think through with our patients the financial implications of our recommendations, what it means for their families. So we as clinicians, as providers of care and as systems of care need to be very, very thoughtful about how to support our patients so they can trust that we are thinking through the implications of how we recommend they deal with their illnesses in ways that actually will benefit them globally, and not that we're just focusing on one issue that may compromise something else.

00:08:51:11 - 00:09:00:10
Tina Freese Decker
So for both of you, how do we as hospitals and health systems help build that trust with our patients and with our communities and the people that we serve?

00:09:00:13 - 00:09:24:14
Lynn Hanessian
So I have some good news. While trust in these powers outside of us has really declined, one of the few places where we still have trust is local. My doctor, my institutions, my media. And so that gives us some hope. And I think, Dr. Trestman, when you talked about things so beautifully, it's not just, you know, Lynn, you have a diagnosis, here's your medication.

00:09:24:15 - 00:10:02:12
Lynn Hanessian
The things you're taking into account reassure me that you're concerned about all of me, that it is your understanding the context in which I live. And this is one of the few places where we have some defense, some opportunity to build trust, because that expertise of my doctor, more so than my CEO, is trusted. And so I think those places where we can lean into helping people to really understand all of those things, that we're seeing them not just as a diagnosis in a particular space, but we understand how that plays out in their whole lives, gives us an opportunity.

00:10:02:12 - 00:10:28:27
Lynn Hanessian
And I think, you know, the way you described it is so much a reflection of, I'm concerned about you, how you live, those hurdles that may prevent you from achieving all you want to achieve. And so helping the people in the communities that we serve to understand that that's so central. I think you mentioned mission earlier, so central to how we serve, that we have an opportunity to build that trust.

00:10:28:28 - 00:10:50:19
Lynn Hanessian
Now, one of the big challenges is when your patients are coming in, they're not getting a reliable source of information. They're not getting the news. We're not hearing the kinds of things and we don't trust public authority. So we have to think a little bit more about not only our individual patient, the role of our institutions in serving our communities and filling a little bit of that void.

00:10:50:27 - 00:10:52:11
Tina Freese Decker
What would you suggest related to that?

00:10:52:15 - 00:11:20:15
Lynn Hanessian
Well, I think, frankly, for health systems and hospitals, particularly hospital CEOs, take a look at your operations, your communications, your marketing, your public policy. All of your external and internal engagement activities have to be aligned. They have to be communicating. You can't just assume that we're in silos anymore where you've got your marketing team that's going out to bring in your patients, but your public policy folks are out there talking to your elected officials.

00:11:20:15 - 00:11:41:06
Lynn Hanessian
We need to make sure that there's a an integration, a communication, and, frankly, a little bit of a willingness to share the occasional vulnerability. We have our authority and our expertise because we're doctors and we're anchored in science. On the other hand, having that opportunity to be human together with the people we serve can make a big difference.

00:11:41:09 - 00:11:55:24
Tina Freese Decker
That goes back to your quote. So I'm curious to know what you think, Bob, we can do to build trust. And I know you're also very passionate about all of our teams that work in health care. And so how do we not only build trust with our community, but build it with our team members?

00:11:55:27 - 00:12:21:22
Robert Trestman, M.D., Ph.D.
There is an aphorism that at least is true today, as it was when it was first uttered, that people don't care how much we know until they know that we care. And how is it that they know that we care? It's by what we do, what we say, how we interact. And so I think hospitals and health systems are uniquely positioned to be an integral part of the community.

00:12:21:24 - 00:12:55:06
Robert Trestman, M.D., Ph.D.
In many of our communities, we are the financial driver, we are the main employer. And that gives us an enormous opportunity to think globally about the impact of care delivery to our patients. But also our clinicians need to feel supported and safe so that they can do their best to provide care to those in their charge. So, as Lynn just said, we need to think in a coordinated fashion.

00:12:55:09 - 00:13:40:08
Robert Trestman, M.D., Ph.D.
Silos can no longer exist if we want to thrive as a health care system, we really need to work in a coordinated fashion so that all of the information is shared. And it's really, really hard to overcommunicate these days. We really need as long as we're on message, and our message is driven by our mission to improve health and health care for the people we care for, that our internal folks, our employees, our colleagues know that we are doing everything we can to support them, to provide them the infrastructure they need to deliver the care they want to do and to deliver.

00:13:40:11 - 00:13:46:27
Robert Trestman, M.D., Ph.D.
Because so many of the people they're caring for are their neighbors in the communities in which we serve.

00:13:47:00 - 00:14:27:25
Lynn Hanessian
I have to say, the one other real benefit from that is trust is built. When we look at a business or an institution, trust is built by how you treat your colleagues, your workforce. And seeing those folks, appreciating that - and I think that gets back to sort of this really integrated communication model when I know when your teams, everyone from the person I see as I'm walking into the institution who may be at the information desk all the way to the clinician, to the nurse, to every touchpoint - when I know that they have the confidence because their institution trust them, engages with them, that radiates and rebuilds my sense of trust and my confidence.

00:14:27:25 - 00:14:47:29
Lynn Hanessian
So it's a nice virtuous cycle. And I would not underestimate the power of being a little bit more public sometimes with your internal communications, whether it's using your spokespeople or knowing that, as you said, so well, Dr. Trestman, that the people who are your employees are also part of your community, but that that then radiates out to their neighbors as well.

00:14:47:29 - 00:15:07:23
Lynn Hanessian
And so I think that's a that's an important place to be in it. It's a little bit challenging when we think with respect and deference to our, our patients, but letting our hair down just a little bit helps people to understand. And that's sort of that a little bit of the genuine and authentic kind of engagement that people look for these days.

00:15:07:25 - 00:15:16:07
Robert Trestman, M.D., Ph.D.
And if I may, as someone who serves on AHA the board with me, what do you think are some of the things that AHA members can be focusing on?

00:15:16:10 - 00:15:39:06
Tina Freese Decker
Well, we've talked a little bit about it. I have this view of a kind of paradox. We have to overcommunicate and we have to over-listen, and we have to show both of those in an authentic, vulnerable way to make sure we know we're really connecting with people. We're hearing where their fears are or where they are anxious, or where they want to go in places and really understand that and then communicate it back and forth.

00:15:39:09 - 00:16:00:11
Tina Freese Decker
So I think this power of communication is really critical. Also accepting grace. We're going to make mistakes and we need to make sure we continue move forward, and we have the best interests of people at heart. And how do we do that? Always focusing on the mission. And then lastly from the American Hospital Association, sharing and communicating stories are so important for us.

00:16:00:18 - 00:16:31:26
Tina Freese Decker
Talking about stories in the local community about what you can do to help patients, to help people live a healthier life. Those are really helpful as we drive those forward. As Lynn said, that local piece is critical. And then thinking about how do we represent ourselves well that delivers the trust and reinforces the trust in everyday actions. So I think we have to connect all of those dots and recognize that what we do is, is who we are, and we need to make sure we're delivering on that trust every single day.

00:16:31:29 - 00:16:51:05
Tina Freese Decker
So thank you so much, Lynn and Bob, for your time today, for sharing your expertise. Every one of our hospitals, our health systems is here for their communities. Despite the challenges that we all face, making sure that everyone has access to the care that they need and trying to build that trust every single day, trying to build that trust with our teams, with one another, with our communities.

00:16:51:07 - 00:17:13:02
Tina Freese Decker
And I think that the lessons that we've learned here about storytelling and over-communication and over-listening and connecting on a human level and really addressing it back to how we're serving everybody, and not assuming that people know that our mission is at the forefront of everything that we're doing, I think it's really great feedback for us. So thank you all for taking the time to listen to this Leadership Dialogue

00:17:13:02 - 00:17:16:17
Tina Freese Decker
and we'll be back next month for another good conversation.

00:17:16:20 - 00:17:25:01
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.