Advancing Health Podcast

00;00;00;04 - 00;00;16;07
Tom Haederle
Welcome to Advancing Health. Coming up in part one of this special two part conversation with FBI leaders, we learn about Operation Winter Shield, the FBI's new 60 day nationwide effort to protect against cybercrime.

00;00;16;10 - 00;00;43;24
John Riggi
Hello, everybody. I'm John Riggi, your national advisor for Cybersecurity and Risk at the American Hospital Association. What a great conversation we have lined up for you today. So proud and privileged to have two of my very good friends from the FBI here with me today to talk about the latest cyber threats and what we can do to help defend against the threats and how we share information with the FBI for the greater good.

00;00;43;27 - 00;01;03;26
John Riggi
So here with me today is my good friend, longtime friend, FBI Assistant Director Brett Leatherman, who leads the FBI's cyber division. We also have my longtime and good friend, FBI Assistant Director Gretchen Burrier who leads the Office of Private Sector. Thank you both for being here today.

00;01;03;28 - 00;01;05;15
Brett Leatherman
Thanks, John. Happy to be here.

00;01;05;18 - 00;01;09;16
Gretchen Burrier
Yeah. John, thank you so much for having us. It's really great to be here today.

00;01;09;18 - 00;01;19;23
John Riggi
Great to have you, Gretchen and Brett. Brett and I actually worked together in cyber division over ten years ago. Seems like a lifetime ago, right, Brett? So much has changed. Yeah.

00;01;19;26 - 00;01;22;01
Brett Leatherman
A lot changes in cyber in ten years.

00;01;22;03 - 00;01;45;00
John Riggi
Right! Sometimes it seems like in ten minutes, it changes. Brett, if I could start off with you - again, thank you for being here. And, coincidentally, at the time of this recording, you and the FBI have announced the launch of Operation Winter shield. Could you tell us a little bit about that and why it's relevant for the nation's hospitals?

00;01;45;02 - 00;02;15;06
Brett Leatherman
Thanks, John, and thanks for the invite to participate in the podcast. Operation Winter shield launched February 1st and it's a 60 day campaign to defend the homeland against malicious cyber activity. What's unique about Operation Winter shield is most FBI enforcement action or operations involves federal, state and local partners in support of, you know, reducing violent crime or some sort of enforcement action that the FBI has jurisdiction in.

00;02;15;08 - 00;02;55;21
Brett Leatherman
Operation Winter Shield is different in that it requires all of us, everybody listening to this podcast, to come together and work together to reduce risks to critical infrastructure, to health care and to the homeland from both state  and criminal cyber actors. So what it does is it distills the FBI's visibility in this space, pursuant to our law enforcement and intelligence community mission, into the top ten controls that we recommend organizations apply to their environments. Based on that work that we do,  today 95% of the breaches continue to exploit one of these controls, at least one of these controls.

00;02;55;23 - 00;03;26;23
Brett Leatherman
And so we believe that really spending the next 60 days firming up the ability to defend against these attacks by advertising these controls to Fortune 100 organizations, down to small mom and pop businesses, and especially in health care, can measurably move the needle and increasing resilience against these cyber attacks. The one thing I would add is that we know that nation states in general who target us now use a whole of society approach to target the homeland through these cyber operations.

00;03;26;23 - 00;03;37;14
Brett Leatherman
And this requires a whole of society approach to defending it. And this is meant to pull all of us together in support of that national defense and national security mission.

00;03;37;17 - 00;03;59;21
John Riggi
You and I have chatted many, many times - and Gretchen, over the years - of the value of private sector cooperation. I love this expression whole of society. We used to talk about a whole of government approach. But you're absolutely right. Private sector must be a partner with the government on these task forces to help defend the nation. Whole of nation, whole of society approach.

00;03;59;23 - 00;04;10;07
John Riggi
Brett, getting back to Operation Winter shield just briefly, could you give us a sampling of let's say, maybe the top five controls that you think all critical infrastructure should implement?

00;04;10;10 - 00;04;39;23
Brett Leatherman
Yeah. And none of these are going to come to a surprise to many folks, right? The issue is we continue to see the actors exploiting these. So things like adopting phish resistant authentication - incredibly important. Implementing a risk based vulnerability management program. Incredibly important. We continue to see nation state actors targeting end of life edge devices. So one of the controls is understanding how to track and retire end of life technology on a defined schedule.

00;04;39;23 - 00;05;03;22
Brett Leatherman
And for health care, that's incredibly important. Health care continues to be, you know, according to a lot of reporting out there, the number one targeted entity within critical infrastructure, I saw one report that showed the average cost of a data breach within health care is $7.42 million. And so there's a low tolerance for downtime because there is patient and life safety implications.

00;05;03;22 - 00;05;21;02
Brett Leatherman
So, for example, control number six within Winter Shield is maintain offline in immutable backups. That is incredibly important for health care when it comes to resiliency in being able to get, you know, health and safety data in systems back online during a breach.

00;05;21;04 - 00;05;46;00
John Riggi
Totally agreed, Brett. In fact, when the AHA, myself worked with the previous administration to help develop the cybersecurity performance goals version 1.0, what we did is we looked at the threat reporting coming from the FBI. And so as I said, let's look at how we are getting beat. And it's the same controls that, that you just described as the best mitigating practices. Challenge for us in health care for all our listeners,

00;05;46;00 - 00;06;10;05
John Riggi
you all know this better than I, is the financial constraints that we are faced with as well. We know what to do. This reinforcement from the FBI really gives validation to that, but within an operating environment under severe financial pressure. Brett, you just mentioned the nation-states. Talk to us a little bit about China and their typhoon campaigns targeting critical infrastructure.

00;06;10;07 - 00;06;30;16
Brett Leatherman
Yeah, we talked about these end of life devices. And if you look at Vault Typhoon, Flax Typhoon, both campaigns between 2024 and 2025 that are PRC sponsored campaigns, they target those end of life devices. The reason they do that is those devices sit here in the United States. They're global botnets, but the ones that are have real impact

00;06;30;16 - 00;06;57;25
Brett Leatherman
here are devices that sit here in the US. They sit on trusted IP space within the United States, meaning the actors can quickly pivot from that space to target other organizations like health care. So the PRC understands that the path of least resistance is the way to go. They don't want to deploy their most sophisticated capabilities when they can start to target things that these controls are meant to address.

00;06;58;01 - 00;07;10;18
Brett Leatherman
You know, it's incredibly important that we come together and really understand how we plug those gaps in our exposed infrastructure to reduce the likelihood of compromise.

00;07;10;20 - 00;07;31;06
John Riggi
Really key point you made. China and Russia around North Korea as sophisticated as they may be, they're not using highly sophisticated zero days to attack us. That's why these basic controls are so important to help mitigate the threat. Getting back to nation-states a little bit, we talked about China. What about Russia, Iran and North Korea?

00;07;31;09 - 00;07;57;14
Brett Leatherman
Yeah. Critical infrastructure is a target for each of those entities for a variety of different reasons. Number one, for organizations who want to pre-place capability in the United States, health care is a key area to do that, right. And so the electric grid, the financial services sector, health care, all of those areas would have real impact should a nation-state decide to launch some sort of cyber attack against the homeland.

00;07;57;14 - 00;08;23;09
Brett Leatherman
And so each of these nation-states possess different capabilities in this space, but each of them will also follow the model of that path of least resistance. And it doesn't matter if these are actors sitting in Iran, if they're actors sitting in North Korea, in Russia or China, they're going to continue to target credentials, stolen credentials, for example, to get into environments where there's no multi-factor authentication.

00;08;23;09 - 00;08;41;03
Brett Leatherman
So if there is remote access to your environment, every one of these state actors on top of criminal actors are going to target that. Same with the end of life devices. They're going to target those because they're easy to get into. And so each of these actors are sophisticated, but often they won't take the sophisticated way

00;08;41;03 - 00;08;43;09
Brett Leatherman
in if they can target one of these controls.

00;08;43;11 - 00;09;10;14
John Riggi
Great points. And again, pointing out to everyone at this time of the really increased geopolitical tensions, with all of these nations China, Russia, Iran, North Korea. Understanding that they do possess first world, highly sophisticated cyber capabilities. And the question is, will they use that against us or some proxy at their direction to launch some type of un-attributable attack, things we're all concerned about.

00;09;10;21 - 00;09;44;28
John Riggi
But I appreciated your advisory in early December, talking about pro-Russian hacktivists being directed by the Russian military intelligence service, the GRU. We in health care and hospitals need to understand the geopolitical risk environment because it directly translates to cyber risk. Brett, last question for you at this moment. We talked about the disruption to health care delivery by particularly these Russian-based or Russian speaking ransomware groups that disrupt and delay healthcare delivery, posing a direct risk to patient and community safety.

00;09;45;01 - 00;09;53;08
John Riggi
Can you talk to us a little bit about the most significant Russian groups or ransomware groups that the FBI's tracking at the moment?

00;09;53;10 - 00;10;19;06
Brett Leatherman
I appreciate that question because the, ransomware groups operating globally, continue to target the underlying ecosystem of health care. Meaning, where they can identify points of targeting that is not just one hospital, but has cascading impact across health care, hospitals, pharmaceuticals, they'll target that. And so we've seen attacks in the past. Change Healthcare as an example.

00;10;19;12 - 00;10;41;26
Brett Leatherman
So these supply chain breaches are incredibly important. And that goes back to one of our Winter Shield advisory statements, which is to analyze third party risk, to understand the third party's web access to your data in your systems and your networks and work with them to build resilience there. It's incredibly important that we also assess detection capability.

00;10;41;26 - 00;11;05;28
Brett Leatherman
We're so focused sometimes on prevention, and we do want to prevent cyber attacks from happening. But we've also got to detect the adversary when they get in. We can't stop them 100% of the time. And these groups are very good at in some cases, for example, scattered spider socially engineering their way into our helpdesk, getting legitimate credentials and getting into our environments.

00;11;06;00 - 00;11;26;18
Brett Leatherman
So if we can focus on detecting them earlier, it's incredibly impactful to reducing that blast radius. In health care, I think it's over 270 days on average it takes right now to detect an actor in a health care environment. And so we've got to reduce that dwell time significantly.

00;11;26;21 - 00;11;51;22
John Riggi
Totally agreed, Brett. And this again, the continuing threats that we face wholesale here, third party risk is a major area of risk exposure we talk about constantly. We can do the best we can to defend our own systems and networks. Then we get exposed to these third party technology and service providers and supply chain. Gretchen, turning to you, given all these threats that Brett just described,

00;11;51;23 - 00;12;00;16
John Riggi
can you tell us about your division's extremely important mission in helping carry these threats and the value of information sharing with the private sector?

00;12;00;18 - 00;12;24;23
Gretchen Burrier
Absolutely. And first, John, it's a privilege to be on your podcast. I love listening to it regularly. So to be on your show, it's very exciting. But to answer your question, you know, the reality today is that the front lines of national security, they're increasingly running through the private sector, whether it's cyber intrusions, ransomware, intellectual property or, you know, foreign malign influence.

00;12;24;25 - 00;12;51;17
Gretchen Burrier
U.S. companies are often the first to see these threats and sometimes the first to feel the impact. So the mission and focus of my team and the FBI's Office of Private Sector is to make sure these companies don't face those threats alone. We serve as the connecting bridge between the FBI's operational divisions and the businesses that own and operate, you know, the systems, the data and infrastructure our country relies on.

00;12;51;19 - 00;13;11;20
Gretchen Burrier
And if you don't know who to connect within the FBI, you can reach out to our team and we'll make sure you get the help you need. We also have in the FBI private sector coordinators, at least one in every field office across the country. You can pick up the phone, call the field office and ask to speak to the private sector coordinator for help and assistance.

00;13;11;23 - 00;13;43;28
Gretchen Burrier
They're the best at what they do, and they fully believe in partnering with industry. And just to touch on your comments about, you know, information sharing. It's at the heart of what we do and it's at the heart of our work. When companies share what they're seeing with the FBI, whether that's a suspicious cyber incident or unusual activity on their networks, Brett's team can connect the dots across sectors and across investigations, and that allows the FBI to provide contacts to warn others, disrupt adversaries, and in many cases, prevent the next victim.

00;13;44;00 - 00;14;11;19
Gretchen Burrier
And at the same time, you know, OPS is dedicated to giving value back through threat briefings, various engagements, webinars, other tailored information so that companies can make better risk decisions in real time. And we do this, of course, in coordination with our operational divisions. Just to give a quick plug too, we have two key partnership programs to the Office of Private Sector, the Domestic Security Alliance Council and Infoguard.

00;14;11;22 - 00;14;32;10
Gretchen Burrier
And those wishing to learn more can visit dsac.gov and info guard.org. Brett and I really do see this is a two way partnership. And John, I know you do as well. And when the private sector and the FBI work together, we're faster, we're more resilient, and we make it harder for criminals and foreign adversaries to succeed.

00;14;32;12 - 00;14;57;21
John Riggi
Thank you Gretchen. Appreciate your continued support. And for all of the private sector coordinators in the field, everywhere we go and we go a lot of places to help hospitals, we invite the FBI, we invite CISA, we invite Secret Service. The Office of Private Sector coordinators have been outstanding. Just recently, I did a four hour exercise for the leadership of one of the largest health systems in the country.

00;14;57;21 - 00;15;22;11
John Riggi
Over 100 C-suite executives there. Two FBI agents from the local field office stayed the entire time and really contributed significantly. So you talk about the partnership. It is real world, side-by-side. And the reality is a lot of the expertise and experience and evidence and Intel lies with the private sector on our networks. So it really is a tremendous partnership.

00;15;22;13 - 00;15;45;04
John Riggi
Brett and Gretchen, thanks for an amazing conversation. We have so much more to discuss. I think what we're going to do is part two of this amazing conversation. So for our listeners, stay tuned for part two. Until then, Brett and Gretchen, thank you and all the men and women of the FBI for what you do every day to secure our nation and health care. And to all our frontline health care heroes

00;15;45;04 - 00;15;54;03
John Riggi
thank you for what you do every day to defend our networks, care for our patients, and serve our communities. Stay safe everyone.

00;15;54;05 - 00;16;02;17
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.

00:00:00:06 - 00:00:16:14
Tom Haederle
Welcome to Advancing Health. CommonSpirit Health is a 2025 finalist for the American Hospital Association's prestigious Quest for Quality Prize. Stay with us and learn more about its winning formula for advancing health.

00:00:16:16 - 00:00:54:13
Kristin Preihs
Hi everyone, I'm Kristin Preihs and welcome to our Quest for Quality episode, where we highlight leaders in health care who are transforming the field through innovation, quality, and patient centered care. Today, we are shining a spotlight on an organization making a big impact at scale. CommonSpirit health, the 2025 finalist of the AHA's Quest for Quality Prize. The prize itself is a prestigious award that highlights hospitals and health care systems doing incredible work in leadership and innovation for others to learn from. And most importantly, they are delivering safe, patient centered and family centered care, partnering with communities to improve patient and safety outcomes.

00:00:54:16 - 00:01:22:29
Kristin Preihs
So today joining us is Dr. Thomas McGinn, a senior executive vice president and chief physician executive at CommonSpirit Health. Tom oversees clinical activities across the system, leads clinical service lines including population health, quality based programings, and supports academic partnerships and research, and is a practicing internal medicine physician and nationally recognized researcher. He's advanced evidence based care across the spectrum, and we are so honored to have him here today.

00:01:23:03 - 00:01:24:00
Kristin Preihs
Welcome.

00:01:24:02 - 00:01:36:05
Thomas McGinn, M.D., MPH
Thank you so much for having me. It's just a real thrill to talk about, you know, the efforts of our team across all of CommonSpirit. We're very proud of the work that we do. So thank you for giving me the opportunity to talk about those efforts and having me here.

00:01:36:08 - 00:01:51:17
Kristin Preihs
Well, you are certainly a leader who I think many can learn from with what you've done at CommonSpirit. So let's start there. I know when I was fortunate to be able to see a little bit of what CommonSpirit has done on our Quest for Quality site visit, you demonstrated some significant leadership with you and your team.

00:01:51:22 - 00:01:56:22
Kristin Preihs
Can you talk a little bit about leadership and quality and patient safety and what that means for the realm of today?

00:01:56:24 - 00:02:16:01
Thomas McGinn, M.D., MPH
So we're a large distributed health system. We're in multiple states, just continuously. So it's a little bit interesting to do this, but I think at each level of our organization, whether it's in our markets or our hospitals, in our regions - at the national level, you know, quality, safety and highest standards have been adopted and are constantly talked about at

00:02:16:01 - 00:02:41:00
Thomas McGinn, M.D., MPH
every executive meeting, every local meeting. And I think when you visited us, you know, from the AHA - which by the way, was an amazing opportunity for us to really, you know, look at what we were doing, think about that thoroughly and actually have experts come in and reflect on our work. Just the process itself was so beneficial and our teams were just excited that they were being looked at, seen and recognized whether we won or not.

00:02:41:00 - 00:02:59:09
Thomas McGinn, M.D., MPH
So the process itself is amazing. I really want to thank the AHA for actually giving us that opportunity. But what was fun for us at that visit was we had our board members there. We were in a local hospital and we could see very clearly what the board was thinking and what the community level people were doing. It was connected.

00:02:59:12 - 00:03:16:06
Thomas McGinn, M.D., MPH
And when you were at a system of this size, that doesn't always happen. You know, we didn't rehearse. It was just the culture from A to Z, from national to market was talking about quality, safety and high standards, reducing variability. And it was it was very evident. It was very exciting for me to see.

00:03:16:14 - 00:03:35:24
Kristin Preihs
Well, I think that's an important piece to talk about and really lean into it at such a large system, how leadership is aligned and scaffolded across all of your different locations and sites. It's something that certainly came across loud and clear at our site visit. And one of the things that we were fortunate to talk about with you and your team was also the evolution of technology, including AI.

00:03:35:24 - 00:04:00:06
Kristin Preihs
But certainly beyond that and how the field has shifted and predictive analytics and technology enabled solutions that improve patient safety. And how, as a leader, you have to identify and lean into areas to engage in that work to improve the broader support of patients, but certainly also engage with the workforce as well. So can you talk a little bit about the evolution of CommonSpirit's technology and how that's had an impact on patient safety and quality?

00:04:00:09 - 00:04:19:05
Thomas McGinn, M.D., MPH
You know, you said all the right things. I think that technology is a double-edged sword. You could jump too quick, the new shiny item, you know what's happening. And when you're this large, you have to be a little bit cautious what you're going to adopt and then disseminate. So we have a very, well-organized governance structure that has everything from legal to finance to clinical.

00:04:19:07 - 00:04:42:07
Thomas McGinn, M.D., MPH
As we adopt, particularly the AI space, it's happening so rapidly. We have weekly meetings as we look at different things coming at us. And of course, as you can imagine, everybody approaches us to say, hey, we've got the best solution for you. And having that ability to do that rapid cycle is critically important. We think about this in the lens of is this back office, front office, is this clinical decision making?

00:04:42:07 - 00:05:01:06
Thomas McGinn, M.D., MPH
Is it prognostic indicators? And depending on what pocket we put it in, we have a different level of scrutiny or evidence that we demand before we actually start even piloting something. So you've got to be eager but cautious at the same time. And that's kind of the trick. So I'm happy to meet people, hear their ideas. But then we do quick notes,

00:05:01:06 - 00:05:02:12
Thomas McGinn, M.D., MPH
we call them.

00:05:02:14 - 00:05:25:22
Kristin Preihs
I love your note on eager but cautious. And I think that's incredibly important for technology and equally for innovation, as I think patenting work is looking differently across the field as, of course, technology, but also really thinking about how you in a culture that continues to evolve so quickly, also allow for a culture of innovation, of spreading of ideas from the front line, from the board to the bedside.

00:05:25:29 - 00:05:55:19
Kristin Preihs
So can you also - you're kind of using and leaning into that phrase, just think about how you create an infrastructure of innovation and how then you scaffold that across the data, resources and technology that you guys all have in place. Because I believe when I was on site, I notated that there was 17 different EHRs feeding into your central quality measure repository, which is significant from a management and an incredibly impressive based on the clinical results that we all seen.

00:05:55:24 - 00:06:04:04
Kristin Preihs
Because you guys have a strong system, I think for others to learn from, for how you idiate and also lean into opportunities to innovate.

00:06:04:06 - 00:06:19:25
Thomas McGinn, M.D., MPH
We have a little bit of a mantra where we're all going to do the same process, we're going to adopt the same technology and we're going to use the same KPIs. So if you think about that process, technology, KPIs, if you're all thinking now, it takes a while to get there. But as we move forward, that's our goal.

00:06:19:27 - 00:06:42:18
Thomas McGinn, M.D., MPH
And if you're on the same process, the same technology, measuring the same KPIs, you can quickly and efficiently adopt new best practices and disseminate those. But if you're on different processes and have different technologies and you're all measuring things in different ways, that is a very difficult position to be in. So that is sort of our North Star. You know, this issue of the EHRs

00:06:42:18 - 00:07:01:20
Thomas McGinn, M.D., MPH
and we have 17 and I really thank my IT colleagues because we are rolling out one EHR. Every six months, we're kind of reducing that variability and the fragmentation of our data. However, at the same time, we have to win today and be excellent today, even though it's going to be 2 to 3 year roadmap. And that's all the hard work that you just talked about.

00:07:01:20 - 00:07:27:15
Thomas McGinn, M.D., MPH
The data normalization, the proper use of dashboards, which really to me means clinicians are in the moment thinking about what that dashboard should look like to help them. We often get dashboards, we're like, this doesn't help me. So how are the clinicians iterating on those dashboards? I've never had a dashboard that was done. I mean, if you're really working with a dashboard, there's a back and forth with the clinical frontlines about how it's being used, what's not being used.

00:07:27:18 - 00:07:41:11
Thomas McGinn, M.D., MPH
So it's a lot of hard work. The first win makes the second win easier and the third one even easier. You know, that normalization process gets a little bit easier every time you do it. And then hopefully on the back end we're reducing the amount of EMRs we're doing so it even gets easier.

00:07:41:13 - 00:08:04:11
Kristin Preihs
And I think what you're describing also really lends into the broader environment you've all built around creating a culture of continuous improvement. That you identify something, you try it, you iterate, you learn what happened, and you continue the cycle from there. And we all certainly felt that while we were on site that folks were interested able, based on data to try new things and to identify different solutions.

00:08:04:14 - 00:08:21:12
Kristin Preihs
Can you also talk about, again, based on your size, how that culture of continuous improvement, in addition to identifying and making improvements across dashboards, really went to the culture that is very evident at CommonSpirit of continuous quality improvement and using data to inform improvements for culture.

00:08:21:15 - 00:08:45:00
Thomas McGinn, M.D., MPH
One good example that pops to mind is the RPA process that we have on screening for cancer. And this again, same process, same technology, same KPIs. A group in the Pacific Northwest. We have five regions. We're looking at the big three cancers: breast, colon and lung cancer screening and how constant changes were happening in the screening guidelines.

00:08:45:05 - 00:09:12:19
Thomas McGinn, M.D., MPH
So some were age, genetics, family history, all these things were changing. And a busy, you know, primary care provider was having a hard time. These bots actually scrub the charts pre-visit and look for the different risk factors and hand up to the primary care provider. Would you like to send this screening colonoscopy, this mammogram? And we just saw a huge lift in our calling, particularly in colonoscopy which is one of the more difficult areas to kind of break into.

00:09:12:21 - 00:09:34:01
Thomas McGinn, M.D., MPH
So we got together and we decided, okay, this is best practice. How do we now take that from...actually, it was an Epic environment to a Cerner environment to other environments. And now we're rolling that out across the entire health system and that just gets all of our people so excited, right? Because we're sharing best practices, we're learning from each other and we're saving lives, you know, in a real, real, concrete, measurable way.

00:09:34:04 - 00:09:44:09
Thomas McGinn, M.D., MPH
And once you get a win like that, the next one is like, okay, let's do it again. The hard work of data normalization, technology shifts, people kind of push through those things and get excited.

00:09:44:12 - 00:10:02:02
Kristin Preihs
Certainly agree. And it's such a good example for the field to learn from. Technically process and people where to start and how to continue to scale up your quality management system from there. Your organization is so incredible, and I think there's so many facets that the realm of quality can learn from in the field.

00:10:02:03 - 00:10:19:07
Kristin Preihs
And as you went through the site visit, as you mentioned, and prepared for the Quest for Quality award, I'd love to hear from you advice you have for future leaders in the field, future organizations, as they consider or are just beginning their own quest towards excellence on what you might recommend as they continue that journey.

00:10:19:09 - 00:10:44:23
Thomas McGinn, M.D., MPH
I would strongly encourage, no matter where you are in your journey, to think about participating in this process, because I think the process onto itself is a learning curve for everybody. And it enables you to get feedback from AHA and from other experts around the country. And actually some of the feedback is like, honestly, some of our feedback, I was like, wow, I don't know, were that good, which is really nice to have, right?

00:10:44:23 - 00:11:02:02
Thomas McGinn, M.D., MPH
Someone said, you know, you're pretty good. And we're like, oh, I didn't know we were that good. And obviously then you get feedback on where you could you can make some improvements and some changes. And I think that process is invaluable. Because how often do you get an objective. And what's the downside of participating? It's very little,

00:11:02:02 - 00:11:11:19
Thomas McGinn, M.D., MPH
right? It's not like a rating agency or you know, it's not US news, but it's really looking at you and trying to trying to help you get better and smarter.

00:11:11:21 - 00:11:42:18
Kristin Preihs
Thank you so much, Tom. It's been fantastic having you and hearing your perspective on leading quality and safety, and certainly on innovation at CommonSpirit. The work you and your teams are doing from improving patient safety outcomes to implementing system wide solutions is nothing short of remarkable. Truly, it's been energizing to hear how from leadership to technology to data to continuous quality improvement, you all are a good point to reference as excellence and for others to pick up the phone and learn a little bit more.

00:11:42:20 - 00:12:01:04
Kristin Preihs
And if the quest for quality prize is on your radar, check out the AHA website or the show notes to learn how your organization could be recognized for its impact. On behalf of AHA, I just want to say thank you for taking the time on this podcast. Thank you for applying for and being awarded the Quest for Quality as a runner up, and we can't wait to hear more from you in the future.

00:12:01:06 - 00:12:18:23
Thomas McGinn, M.D., MPH
Again, I want to thank you for, you know, letting me have the opportunity to talk about my amazing team and all the frontline workers, our nurses, all the staff across all of CommonSpirit, you know, hats off to them for jumping on board and really tackling this as one CommonSpirit, as one big health system.

00:12:18:26 - 00:12:27:06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:00 - 00:00:13:14
Tom Haederle
Welcome to Advancing Health. Coming up on today's episode, a look at the immense value that peer support specialists provide in many health care settings.

00:00:13:16 - 00:00:39:16
Rebecca Chickey
I'm Rebecca Chickey, the vice president of Behavioral Health and Trustee Services at the American Hospital Association, and it is my honor today to be joined by Zelia Baugh, the senior vice president of behavioral health at JPS Health Network, and Melanie Cooper, a peer support specialist at JPS Health Network. We are going to speak today about the incredible value and role of peer support specialists.

00:00:39:18 - 00:00:56:13
Rebecca Chickey
And so, Zelia, I'm going to turn to you first. I want the listeners to have an understanding of what JPS Health is. What's your footprint? What type of organization hospital health system are you? Give them a little bit of background so they'll have some context.

00:00:56:15 - 00:01:30:18
Zelia Baugh
Thank you Rebecca, and we appreciate you having this on this podcast to share the great works that peer support specialists do for us. JPS Health Network is a safety net hospital located in Fort Worth, Texas. And we are in Tarrant County, which is one of the fastest growing counties in the country. We are a Level One trauma center, a Level Four maternal care center, and we have a large community health presence as well as large residency programs.

00:01:30:18 - 00:01:36:08
Zelia Baugh
We are a learning institution. And then we have a very large behavioral health division.

00:01:36:10 - 00:01:57:01
Rebecca Chickey
So JPS Health, as you and I have talked about, has made a strategic investment in hiring peer support specialists. For the listeners, can you first of all tell them what a peer support specialist is, you know, from the broad perspective, and then also, what was your plan and actually why you went down this journey.

00:01:57:01 - 00:02:01:12
Rebecca Chickey
And then we'll hear from Melanie, who's going to bring all of that to life.

00:02:01:15 - 00:02:33:09
Zelia Baugh
Absolutely. So in JPS we do employ peer support specialist. We, have 14 peer support specialists here in behavioral health. And a peer support specialist is a person that has lived experience with either mental illness or substance use disorders or both. And we utilize our peer support specialists in all areas of our division. So we have peer support specialists in our inpatient psych units.

00:02:33:11 - 00:03:09:12
Zelia Baugh
We have peer support specialists in our outpatient clinics. And we have peer support specialists in our psychiatric emergency center. And they provide different functions in each area. They do groups. They do individuals. They meet with all new patients that are admitted to our inpatient units to help answer their questions about what's going on. The group routines, the unit routines, also to get to know the patients so that they can help them navigate once they are discharged from our inpatient program.

00:03:09:15 - 00:03:39:04
Zelia Baugh
They also provide navigation for resources out in the community beyond what JPS has to offer. They help our patients get access to social determinants of health like housing, food, medicine, transportation. All those typical barriers are patients face in trying to get help. They help direct our patients towards those resources to be able to be successful once they discharge.

00:03:39:06 - 00:04:12:26
Zelia Baugh
They also are a huge part of our transition coordinator program. And that program is where we have licensed, as well as peer support specialists contacting all patients discharged from our psych emergency center and our inpatient program in order to help them navigate once they're out in the community and help get them to treatment. So if they have an outpatient appointment with us or someone else and they don't have a RA, we will help get them a RA if they can't pay for their medications.

00:04:12:28 - 00:04:42:12
Zelia Baugh
Our peer support specialists are able to set up for them to get a medication voucher, to have their medicines paid for, and if they need help with job force training. Our peer support specialists know how to set them up for that with resources here in our county. And that program, as a result of our peer support specialists and licensed clinicians, is very intensive with specific touch points throughout a six month to a one year time frame with all of those patients.

00:04:42:15 - 00:05:17:20
Zelia Baugh
Last year, our behavioral health inpatient readmission rate was 5.03%. It is primarily due to the wonderful navigation work and touchpoints and supportive services once our patients leave the inpatient setting. Because the one thing our peer support specialists do with our patients that just I love, the first thing they see is hope when they come in because there's someone right in front of them with lived experience that's in recovery now, and they're helping people.

00:05:17:22 - 00:05:41:18
Rebecca Chickey
That is just such a breadth and depth of offerings that the peer support specialists can do. And so I'm wondering, does the state of Texas, I realize you're in Texas and probably they're 50 different flavors of what peer support specialists are required to do in terms of training, in terms of certification. But what are the specifics for the state of Texas in terms of certification

00:05:41:18 - 00:05:46:22
Rebecca Chickey
and what does JPS look for when you're hiring a peer support specialist?

00:05:46:24 - 00:06:26:28
Zelia Baugh
So the state of Texas has a certified, peer support recovery certification. We love to hire folks that are already certified as a peer support specialist, but if they don't have that certification, we help pay for their training to end to get to that certification. And what we look for in a peer support specialist is someone that has a track record of their recovery, so to speak, and someone that has a great personality. Because you can teach the task to anybody, but you can't teach the people stuff.

00:06:27:00 - 00:06:42:00
Zelia Baugh
The people stuff, really in the personality and attitude is the first thing we look for. And the second thing is their depth of recovery. And the third thing would be certification. And if they don't have it, we get it for them.

00:06:42:02 - 00:07:06:12
Rebecca Chickey
Well, since I had the honor of meeting Melanie before we started recording this podcast, that's a nice transition because she definitely has the heart and the personality. So Melanie, I'm going to turn to you now. Zelia mentioned some of the tasks and the work that you do, which is quite broad. Just kind of describe the life of a peer support specialist as you've lived it at JPS.

00:07:06:14 - 00:07:30:19
Melanie Cooper
Sure. Thank you, Rebecca, and thank you, Zelia for the wonderful introduction. So life as a peer support specialist - we stay pretty busy here. We have as Zelia mentioned, four of our inpatient units, as well as our local commitment alternative unit, which is our long term. They have state beds. We have peer support specialists on every unit.

00:07:30:24 - 00:07:51:24
Melanie Cooper
There's sometimes there's two of us. It just kind of depends on the units. We meet the patients where they're at. So we have what's called an interdisciplinary interview. And we go in and we find out not necessarily what may be brought them here, but challenges they have. What barriers do they have? What are their goals? Learning about them

00:07:51:24 - 00:08:23:06
Melanie Cooper
as a person that they are. Who they are, what they love to do. And we also help with the risk of readmission. Like Zelia also stated, we also do a readmission survey. And this is when a patient comes in within 30 days or less of their last inpatient stay here at JPS. And we find out, you know, what's something differently that they like to work on? How can they stay out of the hospital? Making sure they have those wellness tools, setting up that crisis planning.

00:08:23:08 - 00:08:51:02
Melanie Cooper
You know, it's basically what they want in their own recovery. We also share our recovery stories. We have peer support specialists in our wonderful psychiatric emergency center here at JPS. And I love we share our stories there. We share our stories on all the inpatient units, and we rotate so all the patients get to hear our wonderful recovery stories, how we walk a life in wellness, what we do to stay well.

00:08:51:09 - 00:09:19:03
Melanie Cooper
Challenges. Barriers. Things that we're still going through because we know recovery is ongoing. It's a journey. It's something that you just don't get to forget about one day. It's something that you have to work on every single day is working on that self. In our psychiatric emergency center, we have peer support specialists that work with the discharges. Those are the discharges that are going home as well as discharges that may be coming to our inpatient unit.

00:09:19:06 - 00:09:41:09
Melanie Cooper
With that being said, the discharges going home, we make sure they're equipped with those resources, those things like Zelia mentioned in the community, making sure if they're discharging to a shelter, making sure, you know, they have, a ride for that, making sure there's some sort of warm handoff for that, making sure they have a safe discharge plan, a place to go. For those coming inpatient,

00:09:41:09 - 00:10:00:12
Melanie Cooper
we talk a little bit about the experience of what to expect next. What's it going to be like? We talked a little bit about their treatment team. They're going to have a peer support specialist. They're going to have a social worker assigned to them. They're going to have groups during the day. We do lead the groups on the inpatient units as well.

00:10:00:12 - 00:10:25:12
Melanie Cooper
They're all recovery focused, recovery driven. And that's what I love about it. And this gives patients the idea of maybe to try some own ideas of what they might want to do for their own wellness, their own recovery. We also meet with the discharges, people that come in to the hospital right before they discharge. We usually meet with them 24 to 40 hours prior to their discharge date.

00:10:25:18 - 00:10:48:02
Melanie Cooper
We make sure we're working. We're collaborating with the social worker, the doctor, making sure they have all the tools they need in their wellness toolbox to make sure they're well equipped to go home, making sure they have that crisis planning set. Not only our contact numbers, but our 988 numbers, 911, making sure they know they can come back to the psychiatric emergency center.

00:10:48:02 - 00:11:13:10
Melanie Cooper
This is what we're here for. So we do as well treatment team. So this is where we collectively work as a team. This is where the peer support specialist is involved. The social worker, the doctor, the residents, the psychiatrist, the nurse, and of course, their lovely peer support specialists. And we meet with them to basically find out how they feel like they're progressing in treatment.

00:11:13:13 - 00:11:43:09
Melanie Cooper
If there's any type of medication management, you know, how are the medications working for you if they're taking medications. Because everybody's journey is different. We don't push recovery on anyone. It's what they want. We don't talk about you should take medications. It's what works best for you because we believe that person individually knows what's best for them. We also help build that bridge where there's sometimes that gap between the social worker and the doctor and the nurse.

00:11:43:09 - 00:11:50:22
Melanie Cooper
So we are constantly rebuilding that and making sure we're all meeting at that one place, and that's meeting the patient's needs.

00:11:50:24 - 00:12:10:25
Rebecca Chickey
You just summarized what was in my head. Sometimes I think organizations are concerned that if they bring peer support specialists on, it may compete with some of the work the existing staff have. And you said the word more than once, and that is collaboration. And another way to say collaboration is we work in a team.

00:12:10:27 - 00:12:34:01
Rebecca Chickey
Thank you. Melanie, first of all, for the work that you do and the joy and the hope that you bring to individuals lives. Zelia, I'm going to ask you for the people that are listening, that are on the fence, that are thinking about, should we go on this journey to hire a peer support specialist or at least begin looking into is that right for our organization?

00:12:34:04 - 00:12:39:03
Rebecca Chickey
What sort of call to action would you have or what guidance would you provide them?

00:12:39:05 - 00:13:02:00
Zelia Baugh
Every institution needs to look at meeting your patients where they are. And whether you have behavioral health in your health system or not, you can still utilize peer support specialists in your medical emergency center. You can utilize them in your case management office and doing follow up phone calls and navigation for those patients that are going to come to your health system.

00:13:02:03 - 00:13:36:22
Zelia Baugh
You may not have behavioral health officially in your health system, but you have behavioral health patients in your health system. And many times, those are the patients that are coming back in less than 30 days. And what can be done to try to stop that revolving door, to give a patient the best chance for recovery? Peer support specialists are an untapped resource that I think is well overdue in all hospital settings, whether it's somebody that is a cancer survivor, heart attack survivor or whatever.

00:13:36:25 - 00:13:43:25
Zelia Baugh
These people have life experience and hope to share to help people where they are.

00:13:43:27 - 00:14:11:14
Rebecca Chickey
That's beautiful, inspirational, and I hope just by listening to this podcast, it will become actionable for our hospitals and health systems. So thanks to both of you today, again for the work you do day in, day out at JPS. And thank you so much for your willingness to, share your time and expertise with us and inspire others and also teach others about this valuable role on the behavioral health team.

00:14:11:16 - 00:14:13:03
Zelia Baugh
Thank you for having us.

00:14:13:06 - 00:14:14:17
Melanie Cooper
Thank you.

00:14:14:20 - 00:14:23:00
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:15:03
Tom Haederle
Welcome to Advancing Health. In today's podcast, a discussion with CommonSpirit Health about creating a care delivery system that is responsive to the needs of patients and communities.

00:00:15:05 - 00:00:37:06
Julia Resnick
Hi everyone. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association, and welcome to Advancing Health. I'm really excited to be here with my friend and colleague, Ji Im. She's the system's senior director of community and population health for Common Spirit Health. And she's really an incredible champion in this space. And just really excited to jump into this conversation.

00:00:37:10 - 00:00:38:27
Julia Resnick
So Ji, thanks for being here.

00:00:39:02 - 00:00:40:10
Ji Im
Of course.

00:00:40:13 - 00:00:49:09
Julia Resnick
So to get started, I would love some background on the work that you do about your health care system and the communities that you serve. Can you talk a little bit about that?

00:00:49:12 - 00:01:11:13
Ji Im
Absolutely. And thanks for having me here. So at CommonSpirit, my role lives between the clinical world and the community. And it's about seeing beyond the hospital walls and collaborating with an array of partners who have the mission and aligned values to improve health and well-being. To give a little bit of a background about CommonSpirit:

00:01:11:15 - 00:01:42:09
Ji Im
I've been here at this organization for 11 years. And I believe that our organization exists to heal, not just treat, especially in moments of hardship and vulnerability. And we have around more or less 140 hospitals, more than 2,300 care sites across 24 states and deliver more than 20 million patient encounters annually. And so I'm one of the 160,000 employees.

00:01:42:11 - 00:02:10:18
Ji Im
And collectively as a hospital, nonprofit hospital system, we provide more than $5 billion in community benefit. It's something that I'm extremely proud of. You know my role here, Julia, you know that it's been about co-creating solutions centered in community. We have initiatives that connect people to the services that they need, not just medical care, but could be housing support, food, transportation, family resources.

00:02:10:20 - 00:02:47:24
Ji Im
And these are the things that drive as much as 80% of health outcomes. So if we want to improve health, we can't ignore them. And I also want to mention not just the work that we do, the what we do, building community networks or leveraging community health workers, or supporting the transition to community via navigation that I know we're going to talk a lot about, but how we do the work, the how really alongside community building trust, recognizing that we play a role, but we are not the solvers of everything.

00:02:47:26 - 00:02:59:06
Ji Im
We do not have the solutions for everything. We do that in partnerships with others. I think that we're going to have a little bit of fun talking about, you know, digging deep into some of these issues that I just talked about.

00:02:59:09 - 00:03:20:26
Julia Resnick
And I think that connectivity piece is so important and is really going to be a thread throughout our conversation that health isn't just what happens in the clinic or in hospitals or an inpatient spaces. It's not just what happens in the community, but it's how all of those pieces connect together to make it more seamless for people as they navigate these really vulnerable times in their life.

00:03:20:28 - 00:03:38:08
Julia Resnick
I want to hear more of your thoughts about, you know, that whole health care ecosystem. That we all know it's complex and it's hard to navigate. So when you're working with patients and communities, how are you thinking about that ecosystem and how to simplify it and make it more fluid?

00:03:38:11 - 00:04:16:18
Ji Im
So when we're thinking about designing or building or redesigning an ecosystem, it really shouldn't feel like a system to the person. Whatever we're designing and building, people should feel a whole lot less of the cognitive and emotional load. The mental burden of having to figure things out, figuring out the next step, figuring out the options, figuring out what to covered, what's not, where to go, who to go to, who's who, what's in network, what's out in that work, how to override denials?

00:04:16:18 - 00:04:46:05
Ji Im
What is a denial? Why did it get denied? So much to figure out. It's not just for the patient, for the person, for the caregivers. It's not just about figuring out the medical burden. Right? It's about figuring out life. So much can change because of that. So we have to remember that this is also when people have the least energy and the least mental bandwidth to spare.

00:04:46:07 - 00:05:21:07
Ji Im
And having a system that just seamlessly works for them. You know, the concept, the topic of navigation. It's not just about helping people get to an appointment or coordinating care. Navigation is really about removing that invisible cognitive tax that people feel in the moment, and the moment that they start engaging with the health care system. We have to recognize that navigators, they absorb some of that.

00:05:21:09 - 00:06:12:08
Ji Im
You know, personally, I felt so much friction in this health care system as a patient. And the goal of designing or building a navigation system that really works, an ecosystem that really works. It's not just about adding and building things and doing more. It's really about removing that friction that people feel and that people experience. And because when friction is removed, I have to believe that people get more of that mental bandwidth back to actually care for themselves, to do what's important for them, their families, their loved ones, and it gives them something back that matters most to them so that they're not expending that energy figuring things out.

00:06:12:10 - 00:06:34:26
Julia Resnick
Yeah, I think that like that person centeredness of it - just it really resonates with me and that, you know, when you become a patient, it's the scariest time in your life, whether it's for yourself or a loved one. So to have a more fluid support system around you that's not just your family and friends, but the medical system that you're working in, would be invaluable.

00:06:34:28 - 00:06:46:03
Julia Resnick
And you mentioned in there your personal experience as a patient. Can you talk more about that and how it's influenced your perspective on how to navigate the health care system and advocacy for patients?

00:06:46:06 - 00:07:19:12
Ji Im
Two years ago, I was diagnosed with lung cancer. And, a total shock, disbelief, numbness, fear for the unknown when it meant for my family what it meant, especially my husband and two daughters. And even though I spent almost 20 years working in hospitals and health systems, trained in public health, pursuing a doctorate in public health, I felt completely lost.

00:07:19:15 - 00:07:58:00
Ji Im
I mean, Julia, I've studied the system, but I felt like I was dropped into a foreign world and what I experience and quite frankly, still experience are those cracks. You know, one hoop after another, another hurdle. And it doesn't surprise me when it's hard. But I will say all those things, all these feelings that I have, every person I've met from doctors and nurses, from call center people, pharmacists, adjudication people...they want to genuinely help.

00:07:58:03 - 00:08:06:17
Ji Im
They really do. People want to help. Everyone in this health care system, they go into it because they want to help people.

00:08:06:19 - 00:08:27:24
Julia Resnick
Yeah. I think what you're speaking to over and over again is like that power of human connection. And you know this about me and that I had cancer 20 years ago. And you're talking about this, and I'm thinking back to my list of heroes. Those people that made the worst six months of my life made me feel cared for and brought joy and laughter and helped hold my hand through.

00:08:27:24 - 00:08:49:18
Julia Resnick
And that when we're in this, we all need someone to hold our hand and help us. So as you're thinking about that care delivery ecosystem and care navigation, like what would a truly patient centered model look like and how can we start forging that path to have better coordinated care for patients?

00:08:49:21 - 00:09:16:21
Ji Im
So much of and it will be a constant message when I talk about, which is we have to consistently work hard around removing that friction. How do we all, each of us, do our jobs so that we're extending ourselves to the next space? Our extension goes until somebody else is there to extend back and build that connection.

00:09:16:24 - 00:09:47:17
Ji Im
We need people to feel and experience, not just having written in a paper, written in a protocol. How do we incorporate as we're designing the system, incorporate the expertise of the community, expertise of those with lived experiences. And, you know, I think about, like for me, I love to message my doctors. I tell them all my symptoms, all my side effects, everything through a message.

00:09:47:20 - 00:09:55:09
Ji Im
But I know that for my parents, they want to be there in person. They want to talk to a human.

00:09:55:12 - 00:10:01:24
Julia Resnick
The system as it is now. Do you see it? What mechanisms do you think we have in place already that we can build upon?

00:10:01:26 - 00:10:26:00
Ji Im
Oh, we have so much. We have people who realize that, hey, I know this is my job, but I'm going to do more because I know that my job isn't enough. Yes, I can make a referral, but I know that you could get lost. So I'm going to follow up. I know that medical care isn't the only thing that you're navigating.

00:10:26:03 - 00:11:06:03
Ji Im
So I'm going to make a connection, a warm transition to somebody in the community who understands and who can guide you and who can accompany you in that journey after you leave these clinical settings. So these are things where it's not just doing the job, it's to say, well, is this enough? Is this what's going to achieve the greater outcome that we all want, which is for people to access and afford quality care the way they want?

00:11:06:05 - 00:11:34:18
Ji Im
Because there's a bit of like respect for humans in that. It's to say that it's not you who can't figure out how to access the care. It's not because you don't know. It's because the system isn't working for you. And we have to do better. We have to do more than just what is written in protocols and procedures and processes, and to say, actually, let me think.

00:11:34:20 - 00:12:11:22
Ji Im
Let me not just read my script, but let me think if you're going to get what you need. And I think that that's really important. And we have so much of that already. I see hospitals and health systems and many health care actors putting more thought, money and resources into not just navigation, but creating more of a seamless experience where people feel cared for, where people feel that kindness, where people feel respected and dignified.

00:12:11:24 - 00:12:33:02
Ji Im
And I know that we're putting a lot more into it. The big thing here, Julia, I think, you know, again, we talk a lot about this is that we can't do that alone. This is not for a hospital to solve. This is about the entire health care industry and other sectors to help solve.

00:12:33:04 - 00:13:02:03
Julia Resnick
Absolutely. And I think what you've so beautifully illustrated is that within this ecosystem, the players are all there. They care deeply about their jobs and their patients. We just need to make for make progress in stitching it all together to make it more cohesive. So as we close out, is there anything else that you'd like to share with hospitals or any piece of advice that can help others who are in this space and are thinking about how to better meet the needs of their patients?

00:13:02:05 - 00:13:51:28
Ji Im
I do want the designers and the creators and the catalysts and the collaborators to just always keep in mind that, when we think about navigation, we need to make sure that success for navigation is not measure too narrowly. And that we're not saying, oh, navigator, you need to track appointments, you need to make sure that XYZ services resources was attained, but that they do so much more. They build trust.

00:13:52:00 - 00:14:40:08
Ji Im
They build confidence. They build agency for patients and their caregivers. And so there's so much more value that success cannot be just defined by did you do this appointment or not? The second piece is the navigation itself is so undervalued. I know we say it's important, but we have to look where resources are going. And we need to make sure that we're shifting the resources to make navigation support, whether they are community health workers or anyone else that their roles are stable, that they're defined, and that they're valued as part of the care that is being provided.

00:14:40:10 - 00:15:11:29
Ji Im
I think that that goes to my last point that I want to make, which is: navigators, they probably see so much more of the nuance that a 15 minute visit may miss, that people might not feel comfortable divulging certain things to certain people, let's say, in a medical setting. Right? In a clinical setting. But they see so much more the nuances, the small gestures.

00:15:11:29 - 00:15:23:13
Ji Im
And how do we really maximize on that information that navigators have about people to help them, to truly help them and what matters most to them?

00:15:23:15 - 00:15:47:03
Julia Resnick
Absolutely. So, Ji, just thank you so much for sharing your story with us and your insights. It's been really powerful, and I'm certain that this will give people new ideas about how they can design care to better support their patients throughout their health journey. So thank you so much. We appreciate the work that you do and wish you all the best in everything that you're going through right now.

00:15:47:05 - 00:15:49:00
Ji Im
Thank you.

00:15:49:02 - 00:15:57:12
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:03 - 00:00:23:09
Tom Haederle
Welcome to Advancing Health. In this first leadership dialogue podcast of the year, Dr. Marc Boom, president and CEO of Houston Methodist and the 2026 Board Chair of the American Hospital Association, speaks with a top leader at the Joint Commission about the factors that drive organizational innovation.

00:00:23:12 - 00:00:51:28
Marc Boom, M.D.
Well, greetings, everybody, and thank you so much for joining me today. I'm Dr. Marc Boom. I'm here with you today as I am privileged to start serving my term as the board chair of the American Hospital Association for 2026. This is a great honor, great privilege, and it's something I take very seriously. And I can't think of a more interesting time and an opportunity with more promise than leading the American Hospital Association's members, who work every single day to make health care better for all Americans.

00:00:52:00 - 00:01:12:03
Marc Boom, M.D.
Part of this new role is making sure we are continuously learning, and I believe these leadership dialog series are a great way to listen to and learn from others as a strategy to always seek to be better and better informed. To give a little background on me and my experience leading a hospital system since this is our first podcast.

00:01:12:06 - 00:01:36:27
Marc Boom, M.D.
I've been very fortunate to be at Houston Methodist now for 28 years, almost 29 years. I've been privileged to be CEO for the last 14 years or so. We're a very large organization, 35,000 employees, flagship Academic Medical center, the Texas Medical Center, and seven network hospitals that span throughout the greater Houston area. We have an active research institute, GME programs, etc..

00:01:36:29 - 00:01:57:27
Marc Boom, M.D.
And today, as we start this series and really wanted to focus on a foundational element, which is innovation. Because I believe this is a critical skill set for hospital leaders today. And so we're going to weave that theme throughout the year, along with a lot of other things. At Houston Methodist, innovation has been part of our DNA for a long time.

00:01:57:27 - 00:02:19:03
Marc Boom, M.D.
And we've really pushed it very hard, rethinking how we do things, being more agile in what we do, and trying technologies like virtual nursing, ambient listening in the operating rooms, wearable technologies. We have a saying at Houston Methodist when we try new technologies: we will succeed fast or we will fail fast. We also have two guiding principles for innovation.

00:02:19:06 - 00:02:41:23
Marc Boom, M.D.
The first is to obsessively focus on the needs of our patients, families and communities. That's why we are innovating. But a very close second is to make the lives of our clinicians and employees easier, so we can free them up to do what humans do best, which is actually the personal interaction in health care and what really connects them to the people we serve.

00:02:41:25 - 00:03:11:12
Marc Boom, M.D.
And I know that trying new and innovative solutions is nothing new for my guest today. I'm very pleased today to be joined by Dr. Jim Merlino, who was recently appointed a couple of months ago to serve as the chief operating officer of the Joint Commission. Prior to stepping into that new role, he served as the organization's chief innovation officer. And before that, he was the chief clinical transformation officer at the Cleveland Clinic, where he oversaw strategy, business development, safety, quality, patient experience, and continuous improvement.

00:03:11:14 - 00:03:21:04
Marc Boom, M.D.
So his experience and expertise make him a perfect guest for today's discussion. So let's welcome Dr. Jim Merlino, and let's jump on into our discussion. Jim, welcome.

00:03:21:07 - 00:03:31:25
James Merlino, M.D.
Thank you. Marc. Honored to be here. And congratulations becoming the chair of the American Hospital Association. Can't think of a better person. To be leading that organization in times like this.

00:03:31:27 - 00:03:51:16
Marc Boom, M.D.
Well, thank you very much. It's great to see here. Now, if my memory serves correctly, it's been a while, but the very first time we actually met was regarding institutional culture. So I know you think a lot about culture and you know the importance of culture, so I'd love to get your thoughts around that. How important is it when you're tackling innovation?

00:03:51:16 - 00:03:58:04
Marc Boom, M.D.
How do you use culture to drive quality safety, service, innovation. How do you do that?

00:03:58:06 - 00:04:23:00
James Merlino, M.D.
Yeah, well it is absolutely essential. And you know, when you first asked me to participate in this conversation, my initial thought was you know, I'm being questioned by a person that understands this better than I do because, you know, we first met when I was the chief experience officer for Cleveland Clinic under Toby Cosgrove, and we came to Houston Methodist to talk to you and talk to the team to learn about how you leverage culture to really build an incredible organization.

00:04:23:00 - 00:04:45:27
James Merlino, M.D.
And I remember we were touring the basement, and you showed me the floodgates and told me a story about how the hospital flooded after the hurricane and how you use that as a as a rallying point to really start to rebuild the organization. You know, I think in my career and I think you see it across the country, certainly within your organization, if you don't tackle the culture of an organization, particularly in health care, you're never going to achieve any of your goals.

00:04:46:05 - 00:05:01:29
James Merlino, M.D.
It is really foundational. You still have a saying, the clinic has a saying that, you know, if you don't, it's kind of like, how do you drive safe, high quality, patient centered care? You tackle your people and you make sure that they have the tools they need, that they are coming to work engaged, they love their job,

00:05:01:29 - 00:05:22:06
James Merlino, M.D.
they're feeling satisfied. You're meeting their needs. If you don't focus on that - organizations don't focus on that - you're never going to achieve your goals. That's essential for not only the basic elements, the table stakes and health care, but if you want to create an organization, particularly in health care, that's focused on trying to do new things and innovate, you need to harvest those ideas from your people, right?

00:05:22:06 - 00:05:29:15
James Merlino, M.D.
That's where the best ideas come from. The people that work in your organization, working closely with the people you serve, your patients and families.

00:05:29:18 - 00:05:33:27
Marc Boom, M.D.
That's great. So what do you do specifically to build that culture of innovation?

00:05:33:29 - 00:05:55:26
James Merlino, M.D.
Number one, I think we have to get leaders to recognize that culture is actually something you can develop. It's not something that just exists. You can invest in your culture. You can shape your culture. You can have your leaders help to define it and to grow it and to transform it. So investing in your people and your people development is a really critical component of it. Including measuring engagement, right?

00:05:55:26 - 00:06:19:25
James Merlino, M.D.
Are you ensuring that you're understanding what's important your people's minds? The second thing is giving them opportunities. And you talked about this at Houston Methodist, right? It's not the or, it's the and. It's like we need you to deliver great care, and we want to make sure that we're listening to you to harvest the information that we need to be able to build the organization that we want to deliver that great care.

00:06:19:28 - 00:06:39:23
James Merlino, M.D.
So I think it's a component of investing in your people, recognizing that culture is something that can be shaped, it can be molded, it can be developed, it can be improved. And giving your people the tools and the opportunities to speak up, to engage in that innovative culture, to share their ideas, to share their thoughts, to provide feedback.

00:06:39:23 - 00:06:46:03
James Merlino, M.D.
Those are two essential elements that I think health care leaders across the industry need to recognize.

00:06:46:06 - 00:07:03:29
James Merlino, M.D.
I think that's spot on. I always talk about intentionality. It is intentional. Culture is something, whether you're talking about any aspect of a culture, when you are intentional about what you do, you get the culture you want. When you don't have that intentionality, you don't get the culture you want. Unless you're lucky. And so that's critically important.

00:07:03:29 - 00:07:22:02
James Merlino, M.D.
So, okay, you've got the culture and you work on the culture, you build that, you work with your people. Now, you really talking about some of the technologies and how those intersect. And some of those technologies are so exciting. Some of these are kind of scary at the same time, right? What do you see as the opportunities at the intersection between technology and health care for our future?

00:07:22:08 - 00:07:27:15
Marc Boom, M.D.
I'd love to hear the thoughts about, you know, how that interplays with the Joint Commission as well.

00:07:27:18 - 00:07:57:23
James Merlino, M.D.
Well, you know, it's interesting because I think technology has always been with us in health care in some form. If you look at the innovations of the last 100 years in medicine alone, right? There's been tremendous advances. And now in the last few decades, those advances have just been accelerating where the curve is nearly straight up. But when you think about what we have with us today in terms of artificial intelligence, machine learning, etc., the opportunity to take new technology, new ideas and apply that to what we do is really unlimited.

00:07:57:23 - 00:08:16:04
James Merlino, M.D.
I mean, you are doing it now at Houston Methodist as well as others. I recently had the opportunity to visit your flagship and look at some of the things you're doing. And I think the exciting thing about technology today is that we really have an opportunity to use those new technologies to help liberate our people. Exactly what you said, right?

00:08:16:04 - 00:08:42:28
James Merlino, M.D.
We want to get people back to the personal touch of caregiving, AI. Machine learning, I don't think I hope will never replace the human touch, the human component, but it should be able to help the human component to be able to deliver that personalized care that people need in their healing process. I think from a Joint Commission standpoint, from the perspective of AI, you and I cannot imagine what AI is going to do for health care in ten years.

00:08:42:28 - 00:09:01:00
James Merlino, M.D.
I mean, when I was in college, right, my cell phone was, you know, it's five times the size of my current computer that I'm on, right? And now think about it, right. We are walking around with very sophisticated, very powerful computers in our palms. We could have never imagined that back when we were in college or high school.

00:09:01:02 - 00:09:30:21
James Merlino, M.D.
So I don't think we can really imagine how AI is going to transform, how technology is going to transform what we have in front of us for an opportunity. Our perspective is we can't regulate AI, right? We want to unleash the power that AI and technology can bring to benefit patients, and also to benefit caregivers. Our perspective is, you know, let's provide guidance on what you should be thinking about, because, as you know, in health care, particularly in your role at the AHA, is there's the haves and the have nots.

00:09:30:21 - 00:09:49:17
James Merlino, M.D.
There are big organizations that can invest in technology and resources, like yours. And then there's small organizations. We want to make sure that we're providing guidance on what people should be thinking about. We don't want to be saying, here's what you need to do, because the last thing we want to do is stifle the innovation that people can have with this technology.

00:09:49:23 - 00:09:57:03
James Merlino, M.D.
We just want to make sure that people are thinking about what's important for their organization and to protect patients. That's kind of our thinking about this.

00:09:57:05 - 00:10:14:09
Marc Boom, M.D.
So we talked about that foundation of culture and innovation within, but some innovation comes from outside, and is how we implement and how we move quickly with it. Talk about the partnerships that need to be part of the equation when we're thinking about innovation in health care.

00:10:14:12 - 00:10:34:08
James Merlino, M.D.
I think that sometimes organizations look at what they're doing and think that the best things happen here, right? And one of the things that I learned in the various roles that I've been fortunate to have in my career is that there's a lot of great things happening out in the market, and we should take advantage of learning from others and seeing what others are doing.

00:10:34:15 - 00:11:08:27
James Merlino, M.D.
To understand whether I could apply for what we're doing, apply to what we're doing or not, right? Learn from each other, share information. That's what our opportunity is. I think that if we look too much internally only and that look to partners, then we're going to be blinded by what the potential is. And I think about organizations like ours, like the American Hospital Association, the ability for us to lever these platforms to ensure that organizations have access to information, to have access to best practices, to be able to see what others are doing is really unlimited.

00:11:08:27 - 00:11:18:12
James Merlino, M.D.
And that's our opportunity is to help those organizations get exposure to that and get access to that so that they can judge for themselves whether the think is something they can use.

00:11:18:14 - 00:11:37:03
Marc Boom, M.D.
When you're judging those, what are you really jazzed up about? What makes you excited about the future of technology and what how big do you think this impact is? Put that in, I guess in in the scope of other big innovations within health care, how what's the potential opportunity here? What are the big exciting things coming down the pike?

00:11:37:06 - 00:12:06:10
James Merlino, M.D.
I think it's unlimited. I mean, again, going back to my comment earlier about what's our imagination to be able to say what it looks like in ten years, I don't think we can imagine that. Right? I think that it is limited by only our imagination, what we think we can bring to it. When you consider the advances in technology and the advances in disease treatment, just in my medical career alone. When I was a medical student, right, think about it - half the medicine wards were filled with people dying of AIDS.

00:12:06:12 - 00:12:29:16
James Merlino, M.D.
Today, HIV is a chronic medical condition and people are treating it with basically no detectable virus in their blood. And AIDS is nearly nonexistent in the United States. I mean, that's an amazing technological leap in terms of treatment in medicine. And I think the limit for what technology, whether it's science or AI or other things, can bring to medicine?

00:12:29:19 - 00:12:35:19
James Merlino, M.D.
There's no limit, right? I can't imagine the ability of what it's going to bring to the field.

00:12:35:21 - 00:12:52:02
Marc Boom, M.D.
Is there any particular challenge problem that you come across with the Joint Commission? You look into so many hospitals, as you mentioned, from really the entire spectrum of size that you wish technology could be brought to bear to fix first?

00:12:52:05 - 00:13:21:08
James Merlino, M.D.
For me, and this is a personal perspective, it's a little bit about what you touched on earlier, right? It's how you lift the burden from caregivers? You know, in some ways, technology has created a burden. I think about the electronic medical record. My wife is the chief medical informatics officer for the Cleveland Clinic. And her and the team spent a lot of effort helping physicians understand how to use the EMR as a tool in their workflow to deliver better care and reduce burden.

00:13:21:15 - 00:13:47:11
James Merlino, M.D.
Right. But if you look at the rollout of the electronic health record across the United States, across the world, when it started, what we did was we took the technology and we put it on top of bad processes. And now you had two things that weren't working well together. It was only after you think about how you get it to work more closely, how you evolve your workflows to get it to work more efficiently, to get it to work in a way that benefits caregivers and patients.

00:13:47:13 - 00:14:15:25
James Merlino, M.D.
I think that as we roll out new technologies, we look at new opportunities, we have to be mindful of how is it going to impact the caregivers, right? Ensuring that the promise of reduction of burden is reality and is going to impact them in a way that benefits their delivery of care and ultimately benefits patients. But I think that is what's really most important for me is how do you get to lift the burden for caregivers and ultimately improve the delivery of the care that they're doing.

00:14:15:27 - 00:14:39:14
Marc Boom, M.D.
I think that's spot on. That's why that was the second of our sort of philosophical aims with technology, because we all know burnout is a very real thing. We all know many of the things that cause burnout are - as our chief physician executive calls it - the pebbles in the shoe, they're the irritating things that just kind of get at you and over time just even get worse and worse, as if it was a pebble in a shoe.

00:14:39:15 - 00:15:01:00
Marc Boom, M.D.
Yet technology can take so much of that away. And when you put the patient at the center and you think about that one on one relationship or those close personal relationships, I'm a primary care physician, so that's important to me as well. I think technology has the dramatic potential that enable it. The other thing I'd probably throw in there, and I'd love to hear your thoughts about that.

00:15:01:03 - 00:15:19:08
Marc Boom, M.D.
I think one of the big challenges we face in health care, if not maybe the biggest existential question is affordability. For me, it's the big A right now. To be honest, I'm not sure much of technology has ever really improved affordability and health care, but I think we're on the cusp where that could happen. Do you agree with that?

00:15:19:09 - 00:15:27:28
Marc Boom, M.D.
Is that something plausible that we could actually help end some of the cost curve, make health care more affordable by implementing technology appropriately?

00:15:28:00 - 00:15:50:00
James Merlino, M.D.
I agree, and I think it's true. And particularly if you consider access issues. When you look across the country, you know, you have tremendous opportunities to improve access in rural health, for instance. And I think technology is a way to extend that delivery of care into communities, into areas that don't have the resources that you see in the big cities and urban areas with big systems.

00:15:50:03 - 00:16:03:27
James Merlino, M.D.
And, you know, we should be thinking about how we use technology to extend in those areas. Coming back to the issue of adoption, you know, I think that the pebble in the shoe analogy is a great line. I'm going to steal that.

00:16:03:27 - 00:16:07:15
Marc Boom, M.D.
Steal away. I stole it from our chief physician executive. So it's just breaking down the chain here.

00:16:07:17 - 00:16:28:26
James Merlino, M.D.
But think about it. If we're going to be successful at implementing technology, we should look to the challenges we've had in the past with technology implementation, right? and ensure that as we're leveraging new technologies, particularly AI, we're using our people, our physicians, our nurses, other professionals and health care to really help us understand how to apply it appropriately.

00:16:29:02 - 00:16:49:06
James Merlino, M.D.
Right? Because I think sometimes we lose track of that. Right? People are sitting in the ivory tower. They want to implement something that seems really exciting and really new, but we have to remember that we're giving this to the people that are delivering the care. We want to make sure that we're levering them to help us understand not only the best uses for it, but actually how to implement it.

00:16:49:08 - 00:17:08:04
Marc Boom, M.D.
Well, that's great. Thank you, Joe. I mean, this is exactly why I asked you and I'm so thankful that you agreed to be the first guest this year on this series is because I know you understand the inner workings of this and obviously have had a huge impact in your career at the Cleveland Clinic and now a huge impact across so many hospitals with the Joint Commission.

00:17:08:04 - 00:17:17:22
Marc Boom, M.D.
So thank you very much. Very insightful conversation. I enjoyed it a great deal, and thank you for everything you do in service of humanity through your through your roles.

00:17:17:24 - 00:17:25:18
James Merlino, M.D.
Well, thank you very much for having me. And I appreciate the conversation and look forward to the great things you're going to do at the American Hospital Association.

00:17:25:20 - 00:17:36:05
Marc Boom, M.D.
Thanks so much. Well, everybody, thank you so much. I hope you enjoyed this as much as I did. And thanks for taking your time to listen. We'll be back next month for another Leadership Dialog conversation.

00:17:36:08 - 00:17:43:14
Tom Haederle
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00:17:43:14 - 00:17:44:18
Tom Haederle
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