IFDHE Podcasts

These podcasts feature conversations with hospital and health system leaders on a variety of diversity and health equity issues that impact patients and communities. Look for new episodes directly from your mobile device by using SoundCloud. You can also listen to the podcasts directly by clicking below.

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The AHA's Carolyn Boone Lewis Equity of Care Award recognizes outstanding efforts among hospitals and health care systems to advance equity of care and reduce health disparities within their communities. 2023 Rural Winner, Monument Health, was honored for their journey in health equity progress that has spanned over eight years. In this conversation, Monument Health’s Paulette Davidson, president and CEO, and Sandra Ogunremi, DHA, vice president of diversity, inclusion and belonging, discuss how one incident made the rural health system vow to do better and commit to a strong path forward in health care equity.


 

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00:00:00:28 - 00:00:38:25
Tom Haederle
Sometimes it takes a controversy to light the way forward. In 2015, insensitive language used regarding a Native American patient triggered some soul searching at Monument Health, a rural system based in western South Dakota, serving patients in a five state region. Monument vowed to do better, and they made it stick. Eight years later, their progress in the health equity space has won a national award.

00:00:38:28 - 00:01:09:25
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Monument Health was recognized in the category of rural and small hospital excellence and equity to earn the American Hospital Association's 2023 Carolyn Boone Lewis Equity of Care Award. This award honors outstanding efforts among hospitals and health care systems to advance equity of care to all patients and spread lessons learned and progress towards diversity, inclusion and health equity.

00:01:09:27 - 00:01:35:11
Tom Haederle
In this podcast, hosted by Dr. Leon Caldwell, senior director of Health Equity Strategies and Innovation with AHA; Paulette Davidson, president and CEO of Monument Health, and Dr. Sandra Ogunremi, vice president of Diversity, Inclusion and Belonging with Monument, discuss the meaning and the journey of the commitment they made, the importance of a trusting relationship between leaders, and how it led the health system to where it is today.

00:01:35:13 - 00:02:06:05
Leon Caldwell
Hello, everyone. This is Dr. Leon Caldwell, senior director for Health Equity Strategy and Innovation at the American Hospital Association's Institute for Diversity and Health Equity. I am pleased beyond, I think, recognition right now to welcome to our podcast two stars of AHA's kind of award season. We are really excited to have two leaders from Monument Health and we'll get more into their work.

00:02:06:06 - 00:02:39:21
Leon Caldwell
We'll also get more into what makes the secret sauce for equity. I wanted to first open up by saying congratulations to you both and this is really a important thing for us to acknowledge that your hospital, Monument Health and your leadership is one of the first winners of the redesign of the Carolyn Boone Lewis Awards, Equity of Care. And this is exciting for us because we've expanded categories to include rural hospitals.

00:02:39:23 - 00:03:04:01
Leon Caldwell
And we think this is important to do, as many rural hospitals are doing the work and we wanted them to have a sense of inclusion in this conversation around equity and our work with making more hospitals and health systems equitable and transforming into more equitable opportunities to serve all. Well, you know, without further ado, I wanted to do an introduction.

00:03:04:04 - 00:03:23:10
Leon Caldwell
First, I'd like to introduce Paulette Davidson. She's the CEO of Monument Health and then Sandra Ogunremi, who is the vice president for Diversity, Inclusion and Belonging at Monument. Welcome to both of you. I'm excited to have you here in the podcast with me.

00:03:23:12 - 00:03:30:10
Paulette Davidson
Thank you, Leon. We appreciate being here with you and we're excited to have a conversation today.

00:03:30:12 - 00:03:31:22
Dr. Sandra Ogunremi
Thank you for having us.

00:03:31:24 - 00:03:56:29
Leon Caldwell
And let's be clear, this is a conversation. These podcasts are not only spreading the good word of your good work, but using these as learning platforms and really helping many of your colleagues around the country understand the work that needs to be done, the work they can get done, the possibilities, no matter what the setting you are, or whether urban academic setting, rural, small town, it doesn't make a difference.

00:03:57:00 - 00:04:18:03
Leon Caldwell
Equity is one of these things that we firmly believe will change health care for the good. So tell me a little bit about your work. I mean, what was the what was the thing that you propose that that your colleagues on AHA's panel award, what was the thing you did?

00:04:18:06 - 00:04:54:20
Paulette Davidson
I'll start. This Paulette. And I would say that we took diversity, inclusion and belonging very seriously several years ago. And it was a moment, I would say, that started with us in 2015. Monument Health is located in western South Dakota. We serve around 450,000 people in a five-state region. And within those areas we have three Indian reservations.

00:04:54:22 - 00:05:38:27
Paulette Davidson
And in 2015 and we had we had several points of friction, racial tension over the years. But in 2015 we had an event that took place. It was an event where a caregiver made an inappropriate comment via social media. She was a young person that worked within Monument Health and it was slanted toward a Native American patient. It was a wake up call in our in our community, especially within our internal community of the work we need to do to educate, to be more inclusive and to be an organization that is trusted in our region.

00:05:39:00 - 00:06:09:21
Paulette Davidson
And I think that was the initial stepping point. And Sandra and I were partners from the very beginning. And Sandra, I don't know if there's more you want to share about that, but it was it was a time of intention and a time of reflection for us. 
00:06:09:21 - 00:06:29:17

Paulette Davidson
Absolutely. And, you know, as we were thinking about making intentional decisions and reflecting upon it, Paulette asked me would I oversee a project and a plan that we had. And that was the American Hospital Association Institute for Diversity Health Equity goal to eliminate health care disparities, The 1, 2, 3 pledge goal in all of our five hospitals signed it. And we had four things that we had to do. We had to increase collection of race, ethnicity and language preference data. We had to increase cultural competency training.

00:06:29:17 - 00:06:50:14
Paulette Davidson
We had to increase diversity in governance and leadership. We had to strengthen and improve community partnerships. And so she gave me this very thick document that she had printed out that she had read, and she says, Let's do this. You can do this. And I'm right here. And that was the beginning of our journey together, working on this and getting the results we have.

00:06:50:16 - 00:07:18:21
Leon Caldwell
So it sounds like the, you know, the resource of the one, two, three, four equity pledge was at least allowed the framing for you all to to move through as you started to reflect and have intention, particularly after that catalytic incident in 2015. The interesting thing about pledges is, you know, people often say that, well, it's just a pledge.

00:07:18:26 - 00:07:36:11
Leon Caldwell
It's like kind of performative equity. It's not you know, you're not really doing it. This is, you know, what's next after the pledge. But it seems as if you all took the pledge seriously and started to actualize the thing you pledged to do. So can you tell me more about that?

00:07:36:13 - 00:08:07:15
Paulette Davidson
What I would tell you is that we took it as a pledge for all of our hospitals, all of our governing boards, all of the trustees for the organization. We took the pledge too and explained why we were signing the pledge and what it meant for our organization. And so it wasn't a step that we took that we kind of buried within our operations, within our hospitals that maybe would be successful, maybe wouldn't be.

00:08:07:15 - 00:08:36:00
Paulette Davidson
No one would really know. We were very forthright and we shared it with our boards and they took the commitment just as strongly as we did, and we made it part of our strategic plan for the organization. That transparency at the board level was necessary. If you're going to educate and improve your culture, it has to start at the board level, at our trustee level.

00:08:36:02 - 00:09:02:08
Leon Caldwell
Yeah, that's very powerful because, you know, our trustee services, led by Sue Ellen Wagner, would be really happy and pleased to hear like the role that boards play. We're now doing a lot of work in our health equity roadmap - its governance and leadership lever to really help boards see how vital they are in the creating culture right around equity.

00:09:02:13 - 00:09:25:09
Leon Caldwell
So it's really you know, Paulette, it's really fascinating to hear with a great example of how important boards are in shaping that. And I'm wondering, Sandra, like when you have a board and a CEO and a leader who is taking the work, right, and saying we're going beyond just a commitment, beyond a pledge, we're putting some some legs on this thing.

00:09:25:11 - 00:09:46:18
Leon Caldwell
And here's the person that's going to like shepherd us as we move forward. But I'm not leaving her. I'm just going to be by her side. And we'll shepard this together. What is that feeling like of knowing you had that level of commitment from not only the board, but your your top senior leader in the CEO?

00:09:46:21 - 00:10:27:06
Dr. Sandra Ogunremi
It's hard to describe the feelings I've had moments where I've gotten teary eyed saying, wow, I'm so blessed. I am so blessed because she's a text away. She is a huge encourager. When I became the vice president for Diversity, Inclusion and Belonging, she helped ensure that it reported to the Corporate Responsibility Committee, a committee that is a part of the board, and she was creating a structure that would last way longer than me or her, such that I report to a corporate responsibility committee while she's right there.

00:10:27:09 - 00:10:48:11
Dr. Sandra Ogunremi
And in that way - and I remember she said to me, I can't tell you what to do. And I looked at her, So you're reporting to a committee. That's how much you need to have the CEO believe in it, to support it, to be a partner with you, to be available such that you're not afraid. What if something goes wrong?

00:10:48:13 - 00:11:12:18
Dr. Sandra Ogunremi
One of the things that hinders people from making progress is the fear of failure. And sometimes the fear of success. If I do well, will more be required? I don't have either of those? Because I have someone who enables me to thrive. And so and to have psychological safety and to have a sense of belonging. So you can't talk about helping people have a sense of belonging

00:11:12:18 - 00:11:36:27
Dr. Sandra Ogunremi
if you don't have a sense of belonging. You have to have that. I would like to encourage anyone who listens to this. The CEO is important and not just important from the endorsement of stuff, but helping to create that psychological safety, diversity, work, inclusion, belonging - can be easy, but it can be hard. It's heart work, and heart work can be hard on occasion, and it can be easy on occasion.

00:11:36:27 - 00:11:42:03
Dr. Sandra Ogunremi
And you need someone who is right there who supports and encourages you.

00:11:42:06 - 00:12:13:07
Leon Caldwell
Your story and your passion, both of your passion around this work dispels a big myth that we're trying to also dispel. And that myth is that rural communities don't really care about equity, diversity, inclusion, belonging or justice. I think there's a a narrative that, you know, rural communities are, you know, this is all this is the conversation for urban spaces, right, where we see racial and ethnic diversity.

00:12:13:14 - 00:12:35:26
Leon Caldwell
But your story in the way you talk about it is not something I would expect to hear out of South Dakota. Right. Having lived in Nebraska, you know, I know there are places where we don't think of diversity in the way diversity is played out in some of these rural places. Right. It's not just race and ethnicity. It's ability, right?

00:12:35:26 - 00:13:05:08
Leon Caldwell
It's it's what we call sogi sexual orientation, gender identity. There's all kinds of human dimensions of human diversity that live everywhere. But when we think about, like rural communities and this is why I think that, you know, are really positioning the Equity of Care Award as also inclusive of and belonging, right for rural communities. These stories are really important for us to hear.

00:13:05:15 - 00:13:15:07
Leon Caldwell
So tell me more about what does it mean when you think about this award and your work in this area from a rural community?

00:13:15:09 - 00:14:02:05
Paulette Davidson
You know, we started this work early on with the data collection component. We wanted to make sure that the initial work was based on facts, was based on real data. And, you know, within a first few years we were collecting more than 90% of our patients real data, which then we were able to bring that information to our physicians and our clinicians, and we could actually look at where we had health disparities, where patients maybe we were discharged from one of our hospitals and potentially a certain group of patients were coming back sooner than other patients within a 30 day readmission rate.

00:14:02:07 - 00:14:31:00
Paulette Davidson
So it's really this data has helped us address quality as it pertains to outcomes. And specifically if we see a group that has a disparity in what we're seeing with other groups, we've been able to operationalize efforts to intervene and improve those outcomes. So I think for us, this work is our mission. Our mission is to make a difference every day.

00:14:31:03 - 00:14:58:10
Paulette Davidson
And by having the data and looking at the data carefully and understanding what is driving some of the challenges and creating those barriers, we can create those interventions. So for our patients and our families, I think it's been impactful. On any one day in one of our largest hospitals, which is our tertiary level hospital, it's licensed for 417 beds.

00:14:58:13 - 00:15:26:21
Paulette Davidson
Any one day, approximately 30% of the patients, adult patients in that hospital are Native American. And their backgrounds are different, their experiences are different. The historical trauma is different. We're better today at caring for those families and those patients than we were when we started this work. And our patient experience scores demonstrate that work. Our top scores have improved.

00:15:26:23 - 00:15:59:11
Paulette Davidson
Our ability to recruit and retain caregivers and physicians has improved. We start every new caregiver in our organization and they attend an orientation. And our orientation is like other health hospital and health system orientation. You learn about safety, you learn about the electronic health record. But we do something special, and they learn about diversity and inclusivity and belonging, and it is their favorite part of orientation.

00:15:59:17 - 00:16:22:03
Paulette Davidson
And every month they're invited to attend a culture diversity talk. And it's a different speaker from a different background with a different perspective. And it is a sharing opportunity. It's a culture where we want to hear about your differences, we want to hear about you and we want to respect those differences. And so part of that is also our daily huddles.

00:16:22:06 - 00:16:42:25
Paulette Davidson
Every caregiver in our organization participates in a daily huddle where they talk about what's happening, what are the safety issues and their voice is heard. And so I think for us, it's been this inclusive environment has really led to a culture where people feel like they can belong based on their differences.

00:16:42:27 - 00:16:44:04
Dr. Sandra Ogunremi
I want to add something to that.

00:16:44:04 - 00:17:05:15
Dr. Sandra Ogunremi
Paulette talked about our cultural diversity gatherings that we have. You know, we started those in 2017. And 2020 COVID happened. And we were having large gatherings and we would provide a lunch that people could spend the hour with those 12 to 1, have your lunch, learn and have a great time. And then COVID happened and we had to stop, right?

00:17:05:17 - 00:17:26:25
Dr. Sandra Ogunremi
I remember her saying to me right about May or June of 2020, what if we did this virtually? And I didn't want to. And that's the fear of failure. I was like, What if no one shows up? And I said, okay, great idea. And I kind of left it alone. And she came back several months later again and said, So what about the cultural diversity gathering?

00:17:26:28 - 00:17:45:03
Dr. Sandra Ogunremi
And I talk about this because sometimes that's what people need. You can be a successful leader and still say, what about what if this feels what if no one shows up? I mean, it's COVID, everyone's, you know, going through stuff. And she asked me several times and eventually we started a virtual cultural diversity gathering in the midst of COVID.

00:17:45:05 - 00:18:06:27
Dr. Sandra Ogunremi
And you know what? Now we have the virtual and in-person. If you can't make it in-person, you can join virtually.  People join. So we actually improved on what we already had in place. We're across our entire markets, people can watch our cultural diversity gatherings, we record them. So all of our five markets, they can look, they can go back and look at our archived records and watch a cultural diversity gathering.

00:18:07:04 - 00:18:27:29
Dr. Sandra Ogunremi
And those are the things that I want to really share, is you need that. I try to encourage all those who report to me. You need from the top down and with Paulette even sharing how many CEOs can actually talk about what's going on in their organization with their DIE efforts, VIP efforts, you know how many people can talk about it?

00:18:27:29 - 00:18:50:17
Dr. Sandra Ogunremi
How many people understand it? If you don't understand it, you cannot support it. You cannot advocate for it. You cannot speak up for it. You cannot provide the funding for it in the budget and the opportunities for it to succeed. So it is so important that the president and CEO and that the board of trustees that they understand this, the governing boards, whatever, or boards people have, they need to understand it so that they can support it.

00:18:50:20 - 00:19:07:01
Dr. Sandra Ogunremi
And as you mentioned before, you know, you think about diversity. There are so many aspects to it. And we're addressing the various aspects within Monument Health to ensure that all of our caregivers, 5000 plus have that sense of belonging and our patients have that sense of belonging.

00:19:07:04 - 00:19:47:19
Leon Caldwell
You know, when we think about transformation of systems, any system or particularly a hospital system, we know that there's policies that either have to be dismantled because they compromise the very thing we're going after equity or we know there's some that need to be proliferated because they help us to really anchor our climate culture on equity. Can you think of any policies that you all had to really look at and ask that question is, does it help us or does it hurt us?

00:19:47:21 - 00:19:50:29
Leon Caldwell
I see you both smiling. So there's a story in there I’m sure.

00:19:52:02 - 00:20:24:28
Paulette Davidson
I would say one of the first things we had to look at was our dress and appearance policy. I think it was a bit old school. In a rural setting and we're a growing health care organization, we have many open positions. And as everyone's recruiting, we are too. But we we also recognize that maybe our our dress and appearance policy was a bit old school, a bit outdated, and we had to take a hard look at it.

00:20:25:00 - 00:21:02:15
Paulette Davidson
We didn't allow tattoos or at least you couldn't you couldn't have them visible. And we actually brought focus groups of our patients and our caregivers together. And we asked them: what is professionalism in health care and how does our current policy not work anymore? And they gave us plenty of feedback. We listened and we adopted many of their recommendations, and I think that's allowed us to recruit more people than we had in the past.

00:21:02:21 - 00:21:23:23
Paulette Davidson
For example, where the second largest employer of Native Americans in our region, the first, the largest employer, is a Native American clinic in our community that we collaborate with, but we are the second largest employer. We're proud that we can attract our Native Americans to our organization to be part of our mission.

00:21:23:25 - 00:21:34:07
Dr. Sandra Ogunremi
So she talked about the tattoos and you can imagine that there's another aspect of our dress and appearance policy, which was the color of the hair.

00:21:34:09 - 00:22:02:04
Dr. Sandra Ogunremi
You know, can you have green hair? Can you have yellow hair? Can you have purple hair? Think about those colors. We determined that our caregivers can be their authentic self in the way that they deem it to be the best. So you might have someone who has some tattoos and may have a or a sleeve and they might not have what we consider the conventional hair color.

00:22:02:06 - 00:22:20:12
Dr. Sandra Ogunremi
Does that stop them from being an exceptional nurse? Does that stop them from being an exceptional physician? Does that stop them from being an exceptional respiratory therapist? Absolutely not. We have to look at body piercing. You know, how many piercings can you have on your face? You know, it used to be just one. Now you can have two.

00:22:20:12 - 00:22:49:02
Dr. Sandra Ogunremi
And again, we think about to protect the caregivers, two, right? When they're going into certain environments, you don't want to have too many facial piercings. What we're talking about on the face now. So we've come up with how do we help everyone have that sense of belonging that they don't have to put, you know, cover up, put some makeup over their hand or put makeup over their their arms because they have a shorter sleeve top on and it's summer.

00:22:49:05 - 00:23:03:28
Dr. Sandra Ogunremi
Those were huge. And it's been a huge win for our caregivers and even for our patients who have family members that have those piercings, can they see their family members working in our hospitals across our system, in our clinics? The answer is yes.

00:23:04:00 - 00:23:31:13
Leon Caldwell
Great. That's a really good example. The thing I like most about it is your really your openness to talk to and listen right to community members, to the end user, if you will, and get their feedback and then send you your last part of a belonging. Like really seeing can a community member or anyone see themselves as part of your community because it's all one kind of big community.

00:23:31:13 - 00:24:02:03
Leon Caldwell
When you think about the hospital system and where it anchors. So one of the things that arm's been really interesting, you know, as we talk about this work and really the strategy around it. From where you sit as a CEO, like what's kind of the message to other CEOs who are grappling with understanding equity, finding a place for it in the organization, maybe hearing about it, but not quite knowing what to do, how to accept it?

00:24:02:05 - 00:24:15:10
Leon Caldwell
Can you know, my VP have green hair if she wants to? Like like this is these are all things that I'm sure most CEOs are kind of wondering. What's with some words you have for the CEOs?

00:24:15:12 - 00:24:42:17
Paulette Davidson
Well, you know, I I'm fortunate. I have many CEO colleagues across the country where where we do talk about this issue. And sometimes the first thing you hear from others are we don't have the budget, we don't have the funding to really get into this work in a meaningful way. And margins are thin today. We're all in that same space.

00:24:42:17 - 00:25:10:09
Paulette Davidson
We share those challenges. But have a plan. Start with what is your data look like? Everyone's collecting data. What are how can you collect better data? Because that can at least tell you where you have some places to start. And it could be working with your cardiovascular team and saying, look at this certain group of patients. How can we connect with these patients to ensure they get their medications?

00:25:10:12 - 00:25:33:21
Paulette Davidson
And so you don't have to boil the ocean. This is just a process where you start identifying what are meaningful things for your organization, for your community. Every three years we do a community health assessment for all of our communities, and that work really informs us. What are those kind of low hanging fruit that you can partner with others in the community to address?

00:25:33:23 - 00:26:04:04
Paulette Davidson
This all doesn't have to be on you. We've partnered with probably dozens and dozens of organizations in our communities to help improve health and reduce disparities. Every time we begin a new relationship with either an opioid center or a the mission or a detox center, I think we just get more partnerships and more momentum so you don't feel like you're doing it yourself.

00:26:04:06 - 00:26:27:19
Paulette Davidson
And I would just say, don't be afraid. Just start doing some things and then you'll learn what you're good at and what you need more help with. I think I've learned when I think we've accomplished quite a bit, I realize we have a lot more to do and it does fuel me, but it at times it's a bit daunting and I think you just take it day by day.

00:26:27:21 - 00:26:56:03
Leon Caldwell
Thank you. That's very helpful. You know, one of the things you lead with is like data to help you chart your course and make your plan. So we designed the health equity roadmap, it was really important that we start with like a hospital's assessment of itself, right? Not benchmarking, no. Data is all your data. And those six levers can tell you something.

00:26:56:05 - 00:27:16:20
Leon Caldwell
Those six levers can give you at least a place to start. So even if it feels daunting, you know, you have a transformation action plan that can help you start to chart your course. So it's part of the journey I think we're all on. And that's one of our favorite words in IFDHE, is that we're all in this journey.

00:27:16:23 - 00:27:50:02
Leon Caldwell
We see everyone in this journey together. And I really can think of to greater leaders to actually be in this journey with. And I want to give you kind of a closing statement as we all go and still try to advance equity, even with its, you know, thin margins and and political climates and the agility that's needed, emotional agility that's needed to actually lead in some of the places where we just don't know the answers and we're moving forward really trying to figure it out.

00:27:50:03 - 00:27:59:02
Leon Caldwell
That's the beauty of the journey. So as you think of your other journey, folks, right, what kind of words of encouragement would you like to give them, Sandra?

00:27:59:02 - 00:28:26:09
Dr. Sandra Ogunremi
Everything that we do starts with heart, and that's part of our vision statement. It starts with heart. Our vision is to be one team, to be inclusive, to listen, to show that we care to do the right thing every single time. We have been on this journey, and when you think about the heart aspect, if something goes wrong or something needs improvement, if something needs to be adjusted, if new things need to be done, we do it, we do it.

00:28:26:09 - 00:28:54:18
Dr. Sandra Ogunremi
We check the pulse. When we had the situation where George Floyd was murdered and there was just this emotion, you know, you could feel the palpable emotions across the country. You could see the protests and everything. And I remember Paulette and I kind of looked at each other and said, we're going to do a lot recording for our caregivers, for them to be able to watch for us to talk about, check in on each other, because it wasn't about race anymore.

00:28:54:18 - 00:29:14:05
Dr. Sandra Ogunremi
It was about every single person who may have felt, you know, something going on in their soul with what they witnessed, with what they saw and all of that. And we said, let's check on each other. We did a 30 minute unedited recording, and we released it for our caregivers because it was a heart decision. And many people emailed saying, Thank you.

00:29:14:05 - 00:29:32:05
Dr. Sandra Ogunremi
We need it to hear. We need it to know that you knew how we were feeling. When you think about diversity, inclusion and belonging, there are things that happen that you have to say, am I going to ignore this or am I going to address it? Am I going to hope that it goes away or am I going to face it?

00:29:32:07 - 00:29:52:21
Dr. Sandra Ogunremi
Even if it did not happen in Rapid City, it affected people here. And we did that and we do that all the time where if something comes up, we do a heart check, is this what's the right thing to do? And that's what we do. We do the right thing all the time, and that's my encouragement to people is pause and say, what's the right thing to do and then do it.

00:29:52:24 - 00:30:24:15
Paulette Davidson
I would just encourage all the health care leaders out there. I've been a health care leader for over 35 years. This work is hard work, but the more you step in and lean into inclusivity, diversity and belonging, the more energized you will feel, the more joy you will find in your work and the more meaningful it will feel at the end of the day.

00:30:24:18 - 00:30:47:11
Paulette Davidson
Because you create a culture in your organization that you as a leader...it really takes a light, a good life of its own, and it just it raises the bar in your outcomes, in your patient experience, in your ability to recruit. It gives back and it gives back to you so you can continue to do the work that you do.

00:30:47:11 - 00:30:53:05
Paulette Davidson
So lean in. It just raises the bar for the organization.

00:30:53:07 - 00:31:30:03
Leon Caldwell
Awesome. So to two of our greatest leaders in this health equity space, I want to thank you both, Paulette Davidson, CEO of Monument Health, and Sandra Ogunremi, vice president of Diversity, Inclusion and Belonging. Congrats on being recognized as the Carolyn Boone Equity of Award winner for rural and small hospitals. It's quite a feat and we welcome more of your thoughts and your brilliance and your passion and your heart and your love for this work and for your community.

00:31:30:05 - 00:31:40:15
Leon Caldwell
And on behalf of the Institute for Diversity and Health Equity, congratulations again and we look forward to hearing more from you. Thank you so much.

00:31:40:17 - 00:31:41:11
Paulette Davidson
Thank you.

00:31:41:13 - 00:31:42:12
Dr. Sandra Ogunremi
Thank you so much.

The AHA's Carolyn Boone Lewis Equity of Care Award recognizes outstanding efforts among hospitals and health care systems to advance equity of care and reduce health disparities within their communities. 2023 Emerging Winner, Robert Wood Johnson University Hospital (RWJUH), was honored for its passion and progress in advancing health equity. In this conversation, Franck Nelson, RWJUH assistant vice president of health equity, discusses the big steps the organization has taken to dismantle equity barriers in its care delivery system and the community it serves.


 

View Transcript
 

00:00:00:27 - 00:00:39:21
Tom Haederle
Advancing health equity by expanding and improving access to care is a top priority for caregivers of every shape and size. No two paths on the journey are identical. But broad outlines have emerged pointing to some of the most effective ways hospitals and health systems can achieve progress. Please join us for today's podcast and hear from a health organization whose outstanding work in the health equity space has earned national recognition.

00:00:39:24 - 00:01:07:17
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Robert Wood Johnson University Hospital has been honored by AHA with the 2023 Carolyn Boone Lewis Equity of Care Award. The award recognizes outstanding efforts among hospitals and health systems to advance equity of care to all patients and to spread lessons learned and progress towards diversity, inclusion and health equity.

00:01:07:19 - 00:01:26:20
Tom Haederle
In this discussion, hosted by Dr. Leon Caldwell, senior director of Health Equity Strategies and Innovation for AHA’s Institute for Diversity in Health Equity, we learned how Robert Wood Johnson University Hospital took big steps forward towards dismantling structural barriers in its care delivery system and the community it serves.

00:01:26:22 - 00:01:55:20
Leon Caldwell
Good afternoon, everyone. I'm Dr. Leon Caldwell, senior director for Health Equity Strategies and Innovation at the American Hospital Association's Institute for Diversity in Health Equity. I am pleased to be joined by the Emerging Equity of Care Award winner, the Robert Wood Johnson University Hospital's Franck Nelson, the assistant vice president for equity or of equity, I should say.

00:01:55:23 - 00:02:24:20
Leon Caldwell
So, Franck, welcome. This is a big day for many of us as it culminates a process we go through to award this Carolyn Boone Equity of Care Award. I'll say this is the inaugural year of the three categories that we have for the award and the Robert Wood Johnson Foundation Hospital, University Hospital, was awarded the emerging category, if you will.

00:02:24:22 - 00:02:46:16
Leon Caldwell
And that emerging category recognizes a hospital that is leveraging the health equity roadmap - resources to dismantle structural barriers in their care delivery system and the communities they serve. So this is a great award to have. We're honored to have you representing your hospital and want to say again, welcome.

00:02:46:18 - 00:03:07:23
Franck Nelson
Great. Thanks so much, Leon. I truly am honored and quite delighted to have the opportunity to be here this evening. On behalf of our hospital, we are all thrilled. We have an incredible leadership team, starting with Bill Arnold, who is our CEO, along with Alan Lee, who's our president, and a number of incredible senior leaders who are truly committed to this work.

00:03:07:28 - 00:03:32:21
Franck Nelson
And we have team members of the corporate level, Dr. Alexander. We have our Angel Thomas, a number of many incredible team members who all take part of the work that we do each and every day. And I would certainly be remiss if I did not acknowledge Melissa Hernandez, along with Stephanie Soule, who are both here today. We have Angela as well as Ed House, who are all incredible team members, part of our team.

00:03:32:21 - 00:03:56:13
Franck Nelson
So truly it takes a village, as we all say, and we have worked on putting together a great infrastructure to really drive the work, build a strategy, work with other colleagues, and ensuring the full optimization of this work. And as we all know, it's a journey and we're absolutely thrilled that we have been selected as one of the winners this year.

00:03:56:13 - 00:04:03:05
Franck Nelson
And we understand that this is just part of the journey. We're certainly not where we want to be. But we were very, very thrilled that we're here today.

00:04:03:12 - 00:04:24:12
Leon Caldwell
Yeah, you know, we don't take it lightly that the way we design the redesign, the award, is to recognize the journeys that many of our hospitals are on. Some are have been doing this for a while and they still know there's more work to do. Some are just starting and they know there's work to do. But the important part for us is that we're all in this journey together.

00:04:24:15 - 00:04:47:04
Leon Caldwell
One thing I would say is that being on the journey, there's different kind of waypoints and stops, and we wanted to make sure that this award recognizes those who are in the journey and really leading a light during the journeys process. Right. So thank you for all your work in this. What's also really important that we recognize is . . . IFDHE . . .

00:04:47:09 - 00:05:12:04
Leon Caldwell
one of our indicators that this work is really taking hold. People are in the journey. They're okay to make mistakes. They're also taking a pause to celebrate because one thing that we want to make sure we recognize is that institutions, hospitals, health systems, in order to sustain this work, the infrastructure has to be in place, right? And that infrastructures with policies and practices.

00:05:12:07 - 00:05:40:24
Leon Caldwell
And we really want to make sure that there's a dismantling of those structural barriers before we can overlay what we call health equity or advancing health equity. And that's a really important piece. In Robert Wood Johnson Foundation here is the hospital has taken that on, right? And so I want you to tell me about, one, your health equity department, the work that it's been doing, and then what are some things you want us to know about that's really crystallize your award winning season, I should say?

00:05:40:26 - 00:06:11:07
Franck Nelson
Sure. I appreciate that. I'll make one quick distinction between our Robert Wood Johnson University Hospital, which is one of the main hospitals that are UJA Barnabas Health in New Jersey, and differentiating that from the RWJ Foundation. They're both in New Jersey, but they're not the same organization. I just want to quickly outline that. But for us, I think starting out with the infrastructure, one of the things that has been quite significant really begins with leadership by-in. We have a very committed leadership team

00:06:11:07 - 00:06:33:22
Franck Nelson
as I mentioned earlier, Bill Arnold, when he first started, Robert Wood Johnson University Hospital, made a commitment to the board to ensure that we were looking at how we can improve the care through the communities that we're serving, how can we be very well connected with our community, understanding that there's a lot of great work that was happening in our community from our director of community health and outreach.

00:06:33:25 - 00:06:51:16
Franck Nelson
But we also wanted to make sure that the access to care piece was fully embedded within what was happening. So I came on board. I had a corporate role as a health equity manager, and I had an opportunity to be now responsible for the one site and got an opportunity to work in my current role two years ago.

00:06:51:18 - 00:07:18:07
Franck Nelson
And my first responsibility was really to conduct an assessment to understand where we were as a team, what opportunities we had as a team, and how do we build a team that can help drive towards that journey. And of course, being the first person at the local level, meaning at RWJ University Hospital, my responsibility was to look at a strategic framework in which we could leverage workforce equity, which is diversity, equity and inclusion.

00:07:18:09 - 00:07:41:24
Franck Nelson
Identifying the health equity space as we traditionally know it and also looking at the community health and outreach piece. So the current framework is ultimately divided in those three areas. We had to look at how we can recruit all directors and all of those roles and make sure that those directors could fully operationalize the work and implement these initiatives.

00:07:41:27 - 00:08:17:07
Franck Nelson
The other piece that was particularly impactful for us was working in leveraging a navigation model. Historically, at Robert Wood Johnson University Hospital, we had a Chinese medical program which was developed in Monmouth County with one of our senior leaders, Shirley Wong, who did that work. So for us, what we wanted to do is make sure that as we're thinking about equity, as we thinking about health equity, in looking at access, we wanted to create a similar model and make sure that we're increasing navigation and we're connecting patients directly to our services and the care that was needed for our community.

00:08:17:10 - 00:08:44:17
Franck Nelson
As part of that, under the health equity framework, we looked at two processes and I'll make it very, very clear. The first one was improving the operational efficiencies within how we're collecting data, how we're analyzing data and some of the projects that were being implemented within the hospital. So operationally, we had to ensure that equity was fully embedded within the operational workflow.

00:08:44:20 - 00:09:12:05
Franck Nelson
Additionally, as we're doing that, the other part was making sure that patients were being connected with the right services. So we rolled out an African-American medical program. We rolled out of course, the Chinese medical program was already intact, in addition to a Souza blood medical program which focused on the Hispanic community. So in all, we had a robust and comprehensive community medical program, which really provided the framework to connect directly with the communities that we're serving.

00:09:12:08 - 00:09:39:26
Franck Nelson
Beyond that, we had the Access to Care initiative, which is ultimately a program that allows for anyone who does not have a primary care provider. For us, in collaboration with the Federally Qualified Health Center chamber, which is an entity of our partner Rutgers University. We wanted to make sure that those patients automatically had a referral to a primary care provider. That did two things. The first thing is,it allowed for the community

00:09:39:27 - 00:10:02:03
Franck Nelson
ultimately to be connected to a primary care provider, which in a sense helps the community become healthier in the long term. And the second aspect of that, it reduced emergency department readmissions. Because ultimately our community did not have to use the ED for primary care services. In a nutshell, there's been a number of other initiatives that took place.

00:10:02:03 - 00:10:38:22
Franck Nelson
So we have a number of navigators who are working directly. We have a breast care initiative which connects patients for early screening to make sure that we could identify early detection in the communities that we're serving. So if we think about the overall model, it really begins with, as I mentioned earlier, leadership engagement. And by end of the additional layer would be having the directors really owning each of their workflow and thirdly, having the frontline staff members who are working very closely with the patients as well as the communities that we're serving and connecting those with the care that was needed.

0:10:38:28 - 00:11:14:22
Leon Caldwell
Yeah, that's a great example of the equity roadmap and some of our six levers of transformation. I can see about three levers being leveraged there. One of the great things about this as well is if you listen to you in the way you all think about or have practiced equity, right, particularly cultural equity. And for those who may get that confused with equality, it sounds as if what you did was meet people where they needed and gave each cultural group what they needed, not give them all the same thing.

00:11:14:24 - 00:11:44:10
Leon Caldwell
And while for some that may sound like a bit of segregation, if you will, it's the necessity of being able to identify with language differences or cultural nuances. What are those things that this particular community needs to get access to care in a way that you actually define it? This is a great example of that work. The other piece to that I wanted to make sure we highlighted is that you're for hospitals work, right, and investment in equity policies and practices.

00:11:44:12 - 00:11:52:27
Leon Caldwell
It sounds like it actually avoided cost of ER visits, right? So there is a return, if you will, on your equity approach.

00:11:53:00 - 00:12:13:24
Franck Nelson
Most certainly. I can so appreciate your assertion here, particularly about the inclusion of the work itself. As we think about the community medical program, the practice behind that is to make sure that our communities that were face of it were serving particularly those that are of diverse backgrounds and those who may be underserved, that those patients were connected with the right services.

00:12:13:24 - 00:12:35:15
Franck Nelson
So I can totally appreciate your point about how that may be perceived by some. But ultimately, when we think about the level of the work, there is no one that's ever turned away from care. The goal is that we want to make sure that if someone has a language barrier, that they have access. If someone may have a lack of trust, that they're able to build trust with a navigator.

00:12:35:17 - 00:12:59:16
Franck Nelson
If someone has a particular issue that they're able to have someone directly that can help them with that. So absolutely, having community medical programs with navigation certainly has been really, really a winner for us. But the other point that you made about the investment or return on your investment, we also have a gender center that is focused on the LGBT plus community and providing care and services and navigation in that community as well.

00:12:59:19 - 00:13:22:19
Franck Nelson
And as we're thinking overall, when it comes to all of our community members and ensuring that communities remaining healthier, we know that all hospitals, for the most part, are facing all challenges as it relates to their emergency department. At our hospital in particular, at any given day we're really running at over 100% capacity and there's certainly a demand for our full volume and demand for space.

00:13:22:22 - 00:13:53:07
Franck Nelson
And more importantly, we just want to ensure that we are fully functioning as a quaternary place, such that the patients that could be seen by a primary care provider there, in fact, they have that opportunity. And so to your point, when you when we look at essentially how do we have a win-win model where the patients primarily is benefiting and two, we're also creating additional space such that the patients that really need the quaternary services and those that need the surgery, that need the bed, they can actually have that.

00:13:53:10 - 00:14:08:07
Franck Nelson
So ultimately, we're increasing capacity for others who are in fact in greater need of that care because of their acuity, if you will. So that's what that does for us by connecting those patients with the primary care. So I think you hit that right on the nail there.

00:14:08:07 - 00:14:25:24
Leon Caldwell
Awesome. And so, okay, we're here at the Leadership Summit. We're enjoying what this summit has to offer, learning from each other and having a kind of an experience, if you will, with many of our colleagues. Tell me why this equity work is important to you personally.

00:14:25:26 - 00:14:59:07
Franck Nelson
Yeah, that's a great question, Leon. I'll tell you that for me personally, I started in this work about ten years ago. In fact, I'm a nurse by training, and so I have been in different countries. I grew up in Haiti where lack of care and limited access was definitely a major barrier. So when I came here to the United States, having been exposed to various communities, having seen the difference in terms of those who could potentially be seen at the primary care level, and essentially they do not have the trust and they do not have any type of rapport with their providers.

00:14:59:10 - 00:15:19:24
Franck Nelson
And normally it's not until it's almost too late that those patients are really going for their services as others can attest, in different communities. So for me, it was really about having an opportunity to are really making make care accessible. I've had family members who are affected, whether it's from limited access to care or those who may...I had a sister

00:15:19:24 - 00:15:53:21
Franck Nelson
in fact, when I was younger who passed away from typhoid, malaria. And so to me, I've always made that a mission for me to really have purpose in the work that I do. And I found purpose in connecting patients and providing access and increasing access and really ensuring that we're creating healthier communities. So that really has been the driver for me and seeing...I can recall one time where we certainly in fact, this past October we had a screening event for men of color. Men in general, but particularly we know that there was a gap for men in color in terms of getting properly screening and getting a PSA to be able to get

00:15:53:21 - 00:16:14:27
Franck Nelson
their PSA lab values. So what we conducted was we had a Sunday football event at the hospital. We opened it up for the entire community to be a part of that. And just seeing the outcome, seeing the number of people that came to that and just how it was well-received by the community. To me, that that really was one of the things that really was significant.

00:16:15:00 - 00:16:36:02
Franck Nelson
And that's why it's all about. Making sure that the community understands health care as a necessity and understanding that there can be a mistrust. I can understand that. But we have to ensure that there is a level of familiarity, there's a level of comfort, and that we're building that trust with our communities because ultimately that's what we're here to do, essentially to serve those that are part of our community.

00:16:36:09 - 00:16:46:18
Leon Caldwell
Yeah, I'm pretty sure that the men's group...one way you built trust was to make sure that the Eagles game was playing.

00:16:46:21 - 00:16:51:10
Franck Nelson
We actually had the Giants versus the Jets playing.

00:16:51:12 - 00:17:14:21
Leon Caldwell
So thank you so much, Franck. It's been a pleasure. Its great to meet you hear about your awesome work before the fall your incredible career ahead of you. So on behalf of AHA, thank you for your organization, your leadership, your efforts to be in the journey with us. And for those who are listening, we welcome you to visit equity.aha.org

00:17:14:23 - 00:17:26:16
Leon Caldwell
Join Franck and many others around the country who are engaged with the health equity roadmap. So thank you so much and really do appreciate you being here and all you offer us.

0:17:26:17 - 00:17:46:04
Franck Nelson
Thank you. Thank you so much, Leon. I have to tell you that we could not be any more grateful for really the structure that the AHA has put together. When we think about that road map and how we've leverage every aspect of that, truly has been remarkable. So I'd like to commend you for your leadership, your team as well, and of course, as the president of AHA and along with all the members.

00:17:46:06 - 00:18:03:03
Franck Nelson
It's really significant work and we understand that the journey...it takes a village. And it begins with leadership, the structure and obviously all the hospitals essentially embarking upon that journey. So we're really excited and thank AHA for the selection and we're truly excited about celebrating for the next year or so.

00:18:03:05 - 00:18:08:24
Leon Caldwell
Yeah, I'm sure your community is going to be ready for you to bring home that award and you'll share it with your navigators.

00:18:08:24 - 00:18:21:27
Franck Nelson
Absolutely. Thank you so much, Leon. I greatly appreciate it.

 

The many pressures squeezing health care providers have all served to make the role of hospital trustees, or governing board members, more important than ever. These boards have been charged with making sure that quality metrics are met and that strategic priorities guide the missions. In this conversation, John Haupert, president and CEO of Grady Health System and the 2023 Chair of AHA’s Board, and Greg Bentz, board chair of Saint Luke's Health and chair of AHA's Committee on Governance, discuss the thin margin of error that hospitals and health systems are facing, and how Saint Luke's is focusing on governance to help achieve the highest levels of excellence in providing health care.


 

View Transcript
 

00;00;00;25 - 00;00;31;29
Tom Haederle
Hospitals and health systems have navigated some pretty choppy waters over the past several years. Most are not anchored in a safe harbor even now. The many pressures squeezing health care providers - finances, workforce retention, supply chain issues - have all served to make the role of hospital trustee or governing board member more challenging than ever. Hospital boards have accurately been described as the North Saintar in hospital operations, charged with making sure that quality metrics are met and that strategic priorities guide the mission.

00;00;32;02 - 00;01;11;25
Tom Haederle
Not an easy lift. But it is doable. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. On this leadership dialog series podcast, John Haupert, AHA’s board chair and president and CEO of Grady Health, is in dialog with Greg Bentz, board chair of Saint Luke's Health System in Kansas City, Missouri, and also the current chair of AHA’s Committee on Governance.

00;01;11;28 - 00;01;34;16
Tom Haederle
Saint Luke's Health System is big. It includes 14 hospitals and campuses across the Kansas City region and offers home care, hospice and behavioral health care, dozens of physician practices, a life care senior living community and more. Providing effective board oversight is a daily challenge and as Bentz says "it feels like the past three years have been a pretty intense time in the governance world.

00;01;34;23 - 00;01;42;07
Tom Haederle
The margin of error feels like it's pretty thin, so we focused our efforts very intently on governance."

00;01;42;09 - 00;02;30;26
John Haupert
Good afternoon and thank you everyone for joining me today for another leadership dialog session. I'm John Haupert, president and CEO of Grady Health System in Atlanta and board chair of the American Hospital Association. I am looking forward to our conversation today as we take a look at the important role of hospital and health system governance. Hospital trustees have been an important part and do an important job as they work to foster a positive and productive culture within their organization, ensure their hospitals are meeting high quality and patient focused performance metrics and act as a North Saintar in always ensuring that strategic priorities guide the mission by providing needed medical care, as well as supporting the broader

00;02;30;26 - 00;02;58;02
John Haupert
health and wellness of the communities they serve. Here at Grady, it's been fun to see the evolution of our board of directors. It's a 17-member board, so it's manageable. It meets quarterly, which I think is appropriate. But as many hospital boards experience, oftentimes the board members are already very familiar with things like financial acumen and the performance on customer service.

00;02;58;04 - 00;03;20;17
John Haupert
But sometimes they struggle to understand what is good quality and what does quality mean. So we've invested a lot of time in educating our board around where we are, where we're positioned and providing high quality care. But what should the goal be and what does that look like? And so for us, that's been a big focus. So today I want to introduce Greg Bentz.

00;03;20;18 - 00;04;01;22
John Haupert
Greg spent his days as a trial attorney with Wallace Saunders in Overland Park, Kansas, but he is here with us today in a different capacity, and that is as chair of Saint Luke's Health System, board of directors. The Saint Luke's Health System is a fully integrated regional health system with about 13,000 employees based in Missouri and Kansas. The health system has 13 hospitals ranging from a large tertiary hospital in the middle of Kansas City to metro hospitals outside the city to critical access hospitals, as well as a children's behavioral health hospital and a rehabilitation hospital.

00;04;01;27 - 00;04;30;04
John Haupert
I will say serving as the chair of that board really is extensive, given the broad range of types of facilities that are being served by Saint Luke's. Greg first started his service to Saint Luke's by serving on the board of one of their individual hospitals before being elected to the system Board and becoming chair in 2022. Additionally, Greg also serves as the chair of AHA's Committee on Governance.

00;04;30;07 - 00;04;34;26
John Haupert
So Greg, thank you for joining me today. And we're going to jump in with our first question.

00;04;34;29 - 00;04;36;19
Greg Bentz
Thank you, John.

00;04;36;22 - 00;04;55;04
John Haupert
It goes without saying that hospitals and health systems have faced some tremendous and I mean tremendous challenges these past few years with the pandemic and then grappling with the significant financial pressures that followed. What has that looked like from a governance perspective at Saint Luke's?

00;04;55;06 - 00;05;26;11
Greg Bentz
As we tried to move through COVID and past it, whether we'll ever really be past it remains to be seen. But we really focused everything we were doing on trying to invest in those things that would help us maintain the quality of our care and improve and reshape the efficiency with which we provided that care. It feels like the last three years have been a pretty intense time in the governance world.

00;05;26;14 - 00;06;04;03
Greg Bentz
The margin of error feels like it's pretty thin, and so we've really focused our efforts very intently on governance. Really we've invested primarily in our people and technology. You know, we've had a situation where health care's lost half a million workers in the last few years through burnout and retirement, illness and even sometimes death. And so it's really been critical that we focused on employee retention.

00;06;04;06 - 00;06;35;28
Greg Bentz
We made sure that we tried to keep our team together. We felt like if we could do that, we would be ahead of the game. We've invested a lot of time and effort in retention. We've listened carefully to what our team has been living through these past few years and tried to provide support for them, both technologically and with programs that would provide them both physical and mental support.

00;06;36;01 - 00;07;15;06
Greg Bentz
We've expanded our digital care as part of our investment in technology and that's been very well received by our patients. And so we've really tried to stay with our culture and be transparent with our patients and with the physicians as we try and govern during what the last few years has been a very challenging time. One thing we did change is we went a lot more virtual in our meetings with our boards, and we certainly needed to improve our technology related to that type of access for the board members.

00;07;15;09 - 00;07;36;08
Greg Bentz
As I mentioned, we made significant investments in digital care and also Hospital in Your Home, which is a program that is technologically intensive but has been very well received by the patients and more and more people are signing up for that type of program.

00;07;36;11 - 00;08;02;13
John Haupert
Great. Thank you. That was very good information and I appreciate that greatly. You're a great person to have answering these questions because you served on both a hospital specific board, but then on the broader health system. Which really I know is two different perspectives. In your experience so far and in both of those roles, have you seen changes in the structure or makeup of boards or focus of boards over time?

00;08;02;16 - 00;08;30;17
Greg Bentz
I sure have, John. I think there's been a big shift to the intentionality that it takes to develop a diverse board. I think that has become a higher and higher priority for boards and it's something we should all strive to do. The statistics, though, are still not fabulous. The AHA did a governance survey recently and the results of that are improving.

00;08;30;17 - 00;09;10;26
Greg Bentz
But we still have a situation where over 60% of the board members are over age 50. 80% of them are white and 65% of them are male. But those numbers are all better than they were five years ago. We have started using more out (?). At Saint Luke's we haven't done this, but nationally, more and more boards are reaching out to people from beyond their geographic region and bringing them on to boards to try and bring in diverse views and views that are not necessarily limited by parochial concerns.

00;09;10;29 - 00;09;42;00
Greg Bentz
One other area that is interesting to me is that nurses have been kind of overlooked as potential board members, and we found that having nurses who have their feet on the carpet of the hospital rooms are a great source of information for a board. As you mentioned, we've got a very diverse set of hospitals and delivery systems throughout a large geographic area.

00;09;42;03 - 00;10;11;27
Greg Bentz
And so trying to build a diverse board takes a lot of effort. It takes building relationships and sometimes you have to go out of your comfort zone to do that. But we think it's very important to kind of rebalance the table and make sure that all the communities we serve have a voice on the board so that we can be aware of their concerns and their needs so we can try and serve those as best we can.

00;10;11;29 - 00;10;41;13
Greg Bentz
There's been a effort to build a what we call leadership pipeline so that we can bring people in and educate them about the health system even prior to them being on the board. And then, of course, once they're on the board orientation is critical. There's been a big focus on diversity, equity and inclusion in governance recently, and that's something everybody needs to spend time thinking about.

00;10;41;20 - 00;11;14;23
Greg Bentz
And we do that. Workforce, as you mentioned, quality. I love the true North Saintar. That's a term I use a lot because I really believe that. But we've also been focused on workforce and trying to make sure that their needs are being met. And I actually noticed, or I've recently read some AHA Trustee Services board briefs that were very good on workforce, including physical safety, but also behavioral health support.

00;11;14;26 - 00;11;54;01
John Haupert
You brought up some really great points. And one of the ones that I have thought about often is bringing in someone from beyond your borders. And we did that here at Grady so that we could assure the board that the direction we were heading in from a quality and equity point of view was on target. And so we went outside our market and brought in a chief quality officer from another health system who's really well known to both support us and provide input, but also to assure the board from their position on our quality committee that we were headed in the right direction.

00;11;54;01 - 00;12;20;28
John Haupert
So I'm glad to hear that you see that as a priority. Now, this next one I know has received a little criticism, but we are increasingly hearing criticism of health systems or large health systems with multiple hospitals. And some of the naysayers are saying health systems are not in tune with the needs of the individual communities where they have all of these facilities.

00;12;21;00 - 00;12;39;05
John Haupert
So can you share your insights on how at Saint Luke's and as chair of that board, how are you all balance seeing that system oversight along with assuring that the voice of those very different communities that you serve are heard?

00;12;39;08 - 00;13;14;24
Greg Bentz
It's always a challenge. We've got a system board similar in size to yours with 15 members, but there are also 15 subsidiary boards that are at the entity level. I've been, as you mentioned, on several of those boards. I started on what we call the Plaza Board, which is our tertiary quaternary hospital in the center of Kansas City and served on that board for a while, was also during that time period on the South Board, which is a suburban hospital, and had the opportunity to serve as chair on that.

00;13;14;26 - 00;13;42;21
Greg Bentz
And now, of course, the system board. Five years ago we reorganized our system structure in a drive toward a higher level of systemization, and we've been successful with that and it's been a very strong and positive thing for us. But one of the decisions we made while we were doing that was to retain all of our subsidiary boards.

00;13;42;23 - 00;14;23;07
Greg Bentz
And we felt very strongly that those subsidiary boards provide a great amount of information and advocacy and potentially philanthropy that we really could not go without. So we retain those boards. We think it's important to get tuned in to them and to hear the voice of the communities that we serve. They play a critical role in that. But we also get an opportunity to educate them about what's going on at the national level through AHA information.

00;14;23;13 - 00;14;47;20
Greg Bentz
As you know, Mindy Estes, our CEO, was a chair as you are now, and it was a great source of information for all of us at the system and that the entity levels. We need to explain to them how Saint Luke's fits into the solutions that are necessary for the community and how each entity also fits into those solutions.

00;14;47;22 - 00;15;21;22
Greg Bentz
You know, local boards tend to focus on quality credentialing, financial, local issues, advocacy, those are all super important and they have to share that information with the system so we can build it in. The system boards are faced with a difficult task, and that is prioritization of decisions.And the system board has to take that all in and use it to make these hard allocation issues.

00;15;21;24 - 00;15;53;10
Greg Bentz
And, you know, being part of a system includes the possibility that a decision will not be the best one for an individual hospital, but it is the best one for the system overall. And those are hard decisions, but they're decisions that have to be made at the system level. And we think that it's important for the good of the entire system that they're made with the input from the individual hospitals.

00;15;53;13 - 00;16;15;07
John Haupert
Well, Greg, I really appreciate your answer to that question, because it sounds to me as if Saint Luke's and knowing Mindy and now having met you, you all have done this the right way by maintaining that open communication channel between all of the different entities that fold up under the Saint Luke's umbrella and getting that input from the communities.

00;16;15;07 - 00;16;46;27
John Haupert
And the reality is allocation of resources at a system level is one of the key roles that a system board plays. And so the way you describe that to me really sounds like you all have that one under control and doing well with that. Kind of tying into that, what role do you think board members can play in reputation management for a health system  - serving, as you said - as advocates, being a voice in the community, telling the hospital's story.

00;16;47;00 - 00;16;49;12
John Haupert
What does that look like at Saint Luke's?

00;16;49;14 - 00;17;19;13
Greg Bentz
Yeah, sure, John. We feel like our board members, not only at the system but at all of the entity levels, are our greatest advocates. They are a great source of credibility in the community. They have the ability to go out and explain the how and why of what's going on at the hospital to the community. They also internally provide information to our medical staff.

00;17;19;15 - 00;17;50;11
Greg Bentz
The medical staff is really almost like a community unto itself, and we certainly have doctors who are on our boards so that they can share and educate their colleagues about what's happening at the health system and the individual hospitals and why. They kind of act as educators. All of our board members act as educators in the community and a great source of feedback from the community, which we think is very important.

00;17;50;13 - 00;18;29;28
Greg Bentz
We need to arm our trustees with talking points to let them know what's going on, what information is important for us to share with the community, what information we're looking to get back from the community. The AHA's Seizing the Conversation process is a great example of that. Wonderful program. Actually, the trustee insight piece that goes out monthly in June had a very nice piece on board advocacy and the proper use of board members and advocacy in the community.

00;18;30;00 - 00;18;56;07
Greg Bentz
John, many hospitals are making significant community contributions, but their stories aren't always effectively being told or fully understood. And trustees can do a great job telling the story about what a hospital is doing in the community, its financial contribution, its health care contribution, its social contribution.

00;18;56;10 - 00;19;24;25
John Haupert
Well, that's music to my ears, by the way, because as you know, as chair of the AHA, one of our biggest priorities is getting the true and real story out into the community. As of late, there's been a little bit of hospital and health system bashing, and I think the AHA is doing an incredible job of arming hospitals and health system staff within our facilities with the right information then to go forth and share.

00;19;24;28 - 00;19;50;02
John Haupert
And I'm really pleased to hear you talk that you all are doing that throughout your system. That's just great work. So earlier on, you shared some pretty innovative things with us. Like Hospital at Home and expansion of your digital platform that's already happening at Saint Luke's. But when you look beyond that, are there some innovations or new care models or other things that Saint Luke's Board is focusing on?

00;19;50;05 - 00;20;20;20
Greg Bentz
We are, John. We actually have been working very diligently the last two years on reimagining and reinventing our care model. We realized that the care model was 30, 40, 50 years old and that it really needed a very strong analysis of the pros and cons of it. We worked hard to try and get nurses to be doing the work that they trained for, to be practicing at the top of their license.

00;20;20;23 - 00;20;47;13
Greg Bentz
We found, as we did an analysis of nursing at Saint Luke's, we found that nurses were spending what I would call it inordinate amount of time taking menu selections down, ordering food for patients. That's certainly something that you don't need a nursing degree to do. And so we've gone about hiring additional staff, which is a challenge right now.

00;20;47;13 - 00;21;30;25
Greg Bentz
But trying to remove the burdens that are unnecessarily placed on our nursing staff so that they can spend their time providing health care to the patient rather than doing what I would call more ministerial jobs. One interesting thing that we've tried and it's only been recently is we've actually purchased some robots and we have these robots and they're trained to travel back and forth from the nursing station to the pharmacy so they can go and get the medications and bring them back to the nursing station so the nurses don't have to leave the floor to do that.

00;21;30;28 - 00;21;59;01
Greg Bentz
And not only is it kind of fun to see a robot puttering around the halls, but it we found it's relieved our nurses of time that they can now spend with the patient in a meaningful way. So looking forward, we also are in the middle of the discussion with BJC Healthcare in Saint Louis about joining forces and becoming an integrated health system with them.

00;21;59;04 - 00;22;31;21
Greg Bentz
We have not received regulatory approval yet, but we hope that joinder can occur by the end of the year. And that would give us a large presence on both the west side and the east side of the state of Missouri and in Kansas and Illinois. So we're very excited about that and we hope that that'll go forward. And that will then, of course, cause us to spend a significant amount of time working on integrating the two health systems to become one efficient unit.

00;22;31;24 - 00;22;57;09
Greg Bentz
And then, as you know, I believe our fearless leader, Dr. Estes, is going to take a well-deserved retirement. That's a major issue for us. I mean, Mindy has done unbelievable things from Saint Luke's and as well for the AHA, and I know we're both going to miss her as far as her being retired from us. We're immensely grateful to her

00;22;57;09 - 00;23;14;22
Greg Bentz
and I think the AHA feels the same way. But we're going to have to come up with somebody that can try and fill her ample size shoes. And so those are kind of the biggest things that we're focused on for the coming year or so.

00;23;14;24 - 00;23;42;06
John Haupert
Yeah, Thanks, Greg. That's really great. The comments about looking at the care model and care model redesign is so critical and we have a committee on workforce that's doing some fantastic work and all throughout the pandemic was getting information out available to us in the field, even regionally, about workforce issues, best practices. They, too, are going to be moving into this

00;23;42;09 - 00;24;14;17
John Haupert
look at how do we redesign the care model to get nurses at the bedside and get them away from doing tasks they don't need to do like you have already brought up. So as you all work through that, I know with Mindy and you, you'll share that great work with us at the AHA and that can really become part of our research we're doing around defining what these models could be, because I know there'll be different models for different types of facilities, but I couldn't agree with you more about needing to revolutionize that model.

00;24;14;17 - 00;24;19;09
John Haupert
We are sitting on a 40 and 50 year old model and that has to be very different.

00;24;19;11 - 00;24;27;02
Greg Bentz
We'll be pleased, John, to share anything we've come up with or we've had some good findings and good results. So we'll be happy to bring that to the table.

00;24;27;04 - 00;24;51;22
John Haupert
Great. I really appreciate that. I appreciate you sharing the great work you're doing at Saint Luke's, as well as your insights into the important role that hospitals and health systems can play in both positioning organizations for success and also in helping to communicate the tremendous value that hospitals and health systems provide to their communities. Until next time, thank you to everyone for joining us today.

00;24;51;25 - 00;24;56;06
John Haupert
I hope you'll be back next month for our next Leadership Dialog. Thank you.

Ruby Kirby is a proud and accomplished member of a small club — African American women who are CEOs of rural hospitals. The 2022 recipient of the AHA’s Rural Hospital Leadership Team Award, Kirby is CEO of both Bolivar and Camden hospitals. In this episode, she discusses what has worked in improving quality and equity in rural health, and how her team is mentoring younger African American women for future leadership positions.



 

 

The LGBTQIA+ community often faces barriers to equitable health care. In this conversation, guest Dr. David Rosenthal of Northwell Health discusses bias, the specific needs of LGBTQ+ patients, education and training for health care workers, and the paths to creating competent and outstanding health care for all people.


 

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