Advancing Health Podcast

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:14:28:01 - 00:14:36:24
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:00:00:06 - 00:00:22:06
Tom Hederal
Welcome to Advancing Health. Cyber attacks from criminal and nation-state hackers directed against health care continues to grow, leading to care delivery disruption and risks to patient safety. In this podcast, two AHA experts discuss today's healthcare cyber threats and what the field should know to defend against cyber attacks.

00:00:22:08 - 00:00:52:22
John Riggi
Welcome to Advancing Health. I'm John Riggi, national advisor for cybersecurity and risk at the American Hospital Association. Since 2020, there have been an enormous amount of cyber attacks against US healthcare. In the period from 2020 to 2025, there are over 3400 breaches reported to HHS Office of Civil Rights, impacting the health care records of 730 million Americans.

00:00:52:22 - 00:01:28:27
John Riggi
I know what you're thinking folks, there's only 330 million Americans. That's right. Statistically speaking, everyone in this country has had their healthcare records stolen or compromised in full or part, at least two times. We believe that at least one third of these reported attacks are actually ransomware attacks, which resulted in the encryption of data and networks, causing significant disruption and delay to health care delivery, posing a direct risk to patient care and safety. But also posing a direct threat to the entire community

00:01:28:27 - 00:01:53:08
John Riggi
that depends on the availability of their nearest hospital in the event of a life threatening emergency. Folks, let's be clear: these type of attacks are not data theft crimes. They are threat to life crimes. And we need to be ready. Joining me today, very pleased to have my colleague Scott Gee, deputy national advisor for Cyber and Risk at the American Hospital Association.

00:01:53:12 - 00:02:10:00
John Riggi
Scott, I spoke a lot about the trends from 2020 to 2025 in general, but there are really some specific patterns from that data about third parties and where the data is actually being stolen from. Can you talk to us a little bit about that, and what are you seeing for 2026?

00:02:10:07 - 00:02:41:10
Scott Gee
Sure, John. So over the 2020 to 2025 period, about 12% of the phi that was stolen was stolen from hospitals or health care systems. The rest was stolen from third party providers or non hospital health care providers. That trend is continuing today. So far in 2026, we're at 11%, roughly, actually about 10.7% of the reported phi has been stolen from hospitals and health care providers.

00:02:41:12 - 00:03:09:16
Scott Gee
The rest has been stolen from third parties. So 376 incidents reported and about 49.9 million people impacted this year alone. So that's on top of the numbers from 2020 through 2025, John. This is going to be a record setting year because we have a couple of major breaches that have been reported in the news, but haven't quite made the OCR statistics yet.

00:03:09:16 - 00:03:11:19
Scott Gee
And that's where this data comes from.

00:03:11:21 - 00:03:33:26
John Riggi
Yeah. Appreciate that, Scott. You know, when you and I chat and we present, as we do quite often and we say in 2026 there's only 50 million Americans who have had their healthcare records stolen. It's just really preposterous that we've become used to these massive data breaches targeting so many Americans. Scott, you and I have been doing this for a long time.

00:03:33:27 - 00:03:56:15
John Riggi
I will say perhaps even longer than we'd like to admit. Decades. We've witnessed the increase sophistication of cyber attacks and cyber threats. Each year in the field really needs to be aware of these key cyber threats so they can better prepare for an attack when their organization occurs. So let's talk about what we see as the three current and very real cyber threats to hospitals.

00:03:56:15 - 00:04:30:25
John Riggi
And really I always start the list with geopolitical tensions. The vast, vast majority of cyber attacks that we face in healthcare originate from foreign nations, specifically our adversarial nations Russia, China, North Korea and Iran. And they're either providing safe harbor for the bad guys, criminal organizations to attack us, to steal our data, to encrypt our networks, to extort us for stolen data, and/or working with nation states to plant potentially destructive malware on a critical infrastructure.

00:04:30:28 - 00:04:47:25
John Riggi
Scott, can you talk to us about really the number two - perhaps number one threat as well - as you talked about third parties? Talk to us a little bit about the cyber risk that originates from insecure third parties, or just our exposure and dependency on third parties.

00:04:47:27 - 00:05:11:13
Scott Gee
John, the thing about third party providers is they are absolutely critical to hospital operations. They're fantastic. They can do things at scale that a hospital couldn't afford to do for themselves necessarily, and they do it very well. The problem is, when we get dependent on those third party providers and they get attacked, it becomes a huge impact to health care delivery, right?

00:05:11:14 - 00:05:38:10
Scott Gee
We don't have to look any further than Change Healthcare or the attack on Stryker, which, by the way, ties into your number one, which was geopolitical tensions. That was Stryker was attacked by a proxy of the Iranian government. And those outages, those third party attacks had effects across the entire healthcare sector. So, you know, it's not just defending your own hospital, defending your own network.

00:05:38:10 - 00:06:00:12
Scott Gee
It's counting on those third parties to be able to defend their networks. And they are facing some incredibly sophisticated attacks. As you often say, the bad guys know where the critical points in our healthcare system are. They know where those weak links are and when they attack them they have significant impact across the sector.

00:06:00:14 - 00:06:35:06
John Riggi
Totally agreed Scott, and thanks for that perspective. You're absolutely right. These aren't happenstance type attacks when Change Healthcare is attacked. And unfortunately, the very significant number of attacks in the news right now as of this recording against mission critical third party providers, the bad guys have mapped our network and they understand our critical third party dependencies. You know, over the years in healthcare, we have moved to third party providers, cloud based providers for very good reasons, certainly improves business sufficiency.

00:06:35:06 - 00:07:04:10
John Riggi
The economics often are better, but it also improves the efficiency of patient care and patient outcomes. So we did this, established this dependency on third parties for very good and noble reasons and really, really not recognizing the potential risk we were creating. And again, the bad guys have mapped our sector. They know who we depend on for key services, supply chain and key technologies.

00:07:04:10 - 00:07:22:18
John Riggi
And speaking about key technologies, let's talk a little bit about what everybody is talking: about artificial intelligence. Scott, can you talk to us a little bit about the threats that we're seeing, the increased risk by the use of artificial intelligence in our networks?

00:07:22:20 - 00:07:49:14
Scott Gee
John, the biggest risk with friendly use of AI, if you will, hospitals and health care systems using AI for their purposes is understanding the data security piece, right? Where is that data actually being stored? Who actually has access to it? Are you contributing to a large language model that is accessible around the world, because you clearly don't want to add sensitive data to something like that.

00:07:49:15 - 00:08:18:10
Scott Gee
The other problem with AI is that the bad guys are using it incredibly well. A couple of months ago, Microsoft published an article about a particular Russian ransomware group, Medusa, using AI, and it was allowing them to develop exploits for published vulnerabilities within 24 hours of that vulnerability being published. That process used to take weeks. They're doing it in a day now.

00:08:18:10 - 00:08:48:13
Scott Gee
So the exponential increase in bad guy capability and what the adversary can do thanks to AI is a significant problem. AI is also being used to really enhance network and internet scanning, so they can scan systems, find those vulnerabilities, and exploit them at machine speed now. That is an adversarial evolution that is going to have some profound effects.

00:08:48:14 - 00:09:15:15
Scott Gee
We saw the article from the heads of cyber agencies across the Five Eyes, the friendly intelligence communities, saying that within months, AI had the potential to overwhelm cyber defenses. That's exactly what we're looking at here. AI is also doing wonders for phishing email crafting, for instance. Used to be easy to spot a phishing email because the person that wrote the email didn't necessarily speak English as a primary language.

00:09:15:22 - 00:09:39:04
Scott Gee
AI doesn't have that problem. It can craft some very effective phishing emails and other social engineering attacks, and they're working very well. So we have challenges on the good guys side of implementing AI safely, and then challenges from the adversarial side of defending against a weapon that is really expanded their capabilities.

00:09:39:12 - 00:10:02:00
John Riggi
Totally agreed, Scott, and it's pretty clear from your remarks and things that we talk about all the time. We are not at the beginning, but in the midst of a cyber arms race. Bad guys are using it to discover vulnerabilities and develop exploits in 24 hours. Believe me, I've never heard of a hospital, for good reason, being able to identify a vulnerability and patch within 24 hours.

00:10:02:01 - 00:10:27:15
John Riggi
Unless it's super, super critical because they have to test the patch. They have to make sure it doesn't cause a malfunction in a patient connected medical device. With all that, though, we really understand the need, despite all the threats in the risk to move to AI, improve patient outcomes, improve the economics of providing health care under this enormously intense financial pressure that hospitals are facing.

00:10:27:15 - 00:11:04:27
John Riggi
And of course, we do know the good guys us, the network defenders, are using AI to help detect and defend against these attacks. Really quickly here, Scott, one of the other emerging threats that we have seen and we talk about every day now, are threats to operational technology. The Iranians in particular, have a long history of demonstrating their intent and capability to attack operational technology that affects water treatment plants, as we just saw a couple of weeks ago, and really exploiting these, what we call vulnerable programable logic controllers.

00:11:05:00 - 00:11:31:26
John Riggi
Programable logic controllers are a piece of hardware that's generally internet connected that governs a mechanical function, like opening a water valve or controlling the water flow or level of chemicals in a water treatment or your HVAC system. So not only are these in present and critical infrastructure, they are present in our hospitals. And Scott, we just as of today, have warned the healthcare field about a particular threat.

00:11:31:27 - 00:11:39:02
John Riggi
Can you talk to us a little bit about PLCs in healthcare and what the threat in mitigation might be?

00:11:39:04 - 00:12:04:09
Scott Gee
The alert is very specific to one particular product, but it's important to understand that those PLCs, as you mentioned, are everywhere in healthcare. Not only are they in water treatment facilities and power facilities and things like that, they're running elevators, they're running HVAC systems, they're running pneumatic tube systems. They're everywhere in a hospital network that has devices that are connected technology.

00:12:04:15 - 00:12:38:24
Scott Gee
The way to defend those, first and foremost is having a cohesive, comprehensive inventory of what you actually have in your network. Sometimes we have run across disconnects between the facilities folks who are hanging technology on the network, and the IT folks who don't realize that that technology is on their network. And there needs to be a joining at the hip of those two teams and get cybersecurity involved to understand the threats that those devices may pose.

00:12:38:25 - 00:13:02:12
Scott Gee
It's not that they shouldn't be there. They're serving incredibly valuable purposes. They're entirely legitimate technology, but they have to be defended. And the best way to defend them, first and foremost, is not connecting them to the outside internet, if possible. If you can put them on a segregated Vlan or something along those lines, keep them away from the outside world.

00:13:02:12 - 00:13:30:13
Scott Gee
That's the first step in defending PLCs. There's really not much of a reason they need to be exposed to the internet in most cases, so that should be an easy, easy fix. But the first step is identified what they are in the network. Once you've identified them, isolated them, then you can talk about patching and maintaining those just like all of the other connected devices on the network.

00:13:30:13 - 00:13:40:03
Scott Gee
So it's a multi-stage problem, but it has to start with identifying those, those devices and where they are and what they're doing.

00:13:40:04 - 00:14:07:25
John Riggi
Yeah. Totally agreed. And you know, all the facility managers you and I speak to, they say but John, Scott, it's so much easier for us to view and control operational technology from our remote iPads and our phones. And it's not just convenience. It really does help quite a bit on the building management systems. But when we're talking fire and safety systems as well, really life critical systems. But they have to understand that the bad guys can see it often, just as they can see it.

00:14:07:25 - 00:14:31:24
John Riggi
And it has provided a pathway by the Iranians targeting hospitals. They have a history of this, so they have to understand it. I think, as we always say, for whatever the issue is, good governance starts with good governance. Setting those policies that operational technology visibility at least should be merged with cybersecurity folks. They should have good inventory visibility and network monitoring.

00:14:31:24 - 00:14:52:25
John Riggi
So we covered quite a bit here. I think in a relatively short time. We just want to thank our listeners really for tuning in today and again, continuing to do what they do every day to defend networks, care for their patients and serve their community. Scott, thanks again for joining me. Thanks for your assistance here to help defend the field.

00:14:52:26 - 00:15:03:09
John Riggi
This has been John Riggi, your national advisor for Cybersecurity and Risk with Scott Gee, deputy national advisor for Cybersecurity and Risk. Thanks, everybody. Stay safe.

00:15:03:12 - 00:15:12:04
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.

00:00:00:01 - 00:00:17:04
Tom Haederle
Welcome to Advancing Health. Over the past several years, the commitment to Age Friendly health care principles has been increasingly embedded across America's health care system. Now, its success is being recognized on the national level with a new award.

00:00:17:06 - 00:00:32:28
Kristin Preihs
Welcome, everyone, and welcome to the AHA Advancing Health podcast. I am Kristin Preihs, vice president with the American Hospital Association, and I am thrilled to be joined today by Rani Snyder, president of the John E. Hartford Foundation. Rani, it is always wonderful to be with you.

00:00:33:00 - 00:00:34:27
Rani E. Snyder
I'm so happy to be here.

00:00:35:00 - 00:01:01:21
Kristin Preihs
Fantastic. For nearly a decade, AHA and John E. Hartford have worked together through advancing Age Friendly care to help hospitals and health care systems put the 4Ms, what matters, medication, mentation and mobility into practice. And what is exciting about this moment is how far this work has come. We're no longer just talking about organizations being their Age Friendly journeys across the country, and hospitals and health care systems.

00:01:01:21 - 00:01:23:03
Kristin Preihs
We're seeing now, for the first time, are really embedding those principles so much more deeply into delivering care, to measuring measurable results and, most importantly, improving the experience of older adults and their families. And that evolution is why we're so excited to together launch the Age Friendly Health Care Impact Award. This is more than another recognition program.

00:01:23:05 - 00:01:41:27
Kristin Preihs
It's an opportunity to shine a national spotlight on organizations that are setting a new standard for what excellent care looks like across older adults. And Rani, before we talk about the award itself, which we're so excited to get into, I want to start a little bit about you and the foundation. For someone who may be newer to this work,

00:01:41:28 - 00:01:48:26
Kristin Preihs
can you tell us a little bit about Age Friendly care and how you have seen Age Friendly health systems and the movement evolve?

00:01:48:28 - 00:02:12:10
Rani E. Snyder
Thanks, Kristen. I could not be happier to be here talking about this today. Age Friendly care really comes from an initiative that we started called Age Friendly Health Systems, which is a national movement to improve both the quality and the safety of care for older people. We're really pleased to have the American Hospital Association as one of our lead partners in this whole movement.

00:02:12:12 - 00:02:33:11
Rani E. Snyder
In addition to the Institute for Health Care Improvement, I'll note that Age Friendly care is grounded in the 4 M's framework and you referenced those 4Ms already. They are what matters, medications, mentation and mobility. And I'll say a little bit more about those. But first I want to note that the four M's represent the biggest drivers of health outcomes for older patients.

00:02:33:13 - 00:03:00:03
Rani E. Snyder
They provide a streamlined evidence based way for health care teams to reduce harm, and also to align care with what matters most to older people and their family caregivers together. What matters I'll note, is certainly the most meaningful starting point. Understanding each older person's goals and preferences and making sure that the care plan itself reflects those are key.

00:03:00:06 - 00:03:29:24
Rani E. Snyder
All 4Ms are interrelated. They're designed to be a set, not a one, one by one. And that's a really important point. So I'm going to give a brief example. My colleague's 86 year old father badly needed a hip replacement. He was nervous to have the surgery and didn't want to do it. And it wasn't until the what matters conversations started happening with his care team and his family about getting back out to his garage, that he agreed to the procedure.

00:03:29:27 - 00:04:02:15
Rani E. Snyder
So the care team then realized that his medications were actually a big risk. He was on two of them that were no longer needed, and the hospital team ensured that his mentation, his cognitive status, was monitored, especially to prevent delirium, which is something that can happen, especially in hospitals, but in other settings as well. And the result was a successful surgery that restored his mobility so that he could do what mattered to him most, which was really getting out into his garage and being able to putter around.

00:04:02:17 - 00:04:34:08
Rani E. Snyder
And that's what we want, ideally for all patients everywhere, is it's that ability to get to what they care most about. And the really exciting thing is that it's starting to happen. Since the movement was launched in 2017, it has grown to now more than 6000 different sites of care. Those include hospitals, ambulatory practices, nursing homes and convenient care clinics, all of which are recognized for delivering Age Friendly, 4Ms-based care.

00:04:34:10 - 00:04:58:16
Rani E. Snyder
And we are particularly excited because the movement, as we call it, is now entering a new phase. So it's moving beyond just adoption of those 4Ms towards what we're referring to as reliable delivery across entire systems and demonstrating measurable improvements in outcomes, safety, and the overall experiences for older people and their care teams.

00:04:58:18 - 00:05:40:00
Kristin Preihs
I love that, Rani, particularly the emphasis on what matters, because when you strip down this work to its core, it's always about seeing a whole person care and an older adult to your exact example, and maybe managing several chronic conditions, taking multiple medications, and interacting with many different parts of the health care system. And when every member of the care team understands especially what matters to that person, and seeing that it has such a significant impact on health outcomes and is consistently considering medication and mentation availability alongside it, suddenly care becomes more coordinated, safer and personal, which is what everyone is looking for and to some degree expects when they roll into a hospital or

00:05:40:00 - 00:06:04:22
Kristin Preihs
health care system with a particular opportunity to improve their own health. We've seen tremendous growth in organizations adopting Age Friendly care. So the next question really logically becomes, how do we identify those organizations achieving extraordinary impact? How do we learn from them and use their successes to bring even more organizations along? Which really brings us to this new and very exciting award.

00:06:04:23 - 00:06:18:25
Kristin Preihs
I would love to hear from you. Why is this the right moment to create an Age Friendly Health Care Impact Award? What motivated and why do you feel like now is the time to recognize this work across the field?

00:06:18:27 - 00:06:44:12
Rani E. Snyder
It's a great question. Our vision at the John E. Hartford Foundation is for every older adult, in every setting, anywhere they go, to receive Age Friendly care. So we want evidence based practices that are, as we said, reliably delivered to see reductions in harm. And we want older people and their families and their health care teams to feel the satisfaction and the joy that comes when health care is focused on what really matters, the goals of the older patient.

00:06:44:12 - 00:07:15:00
Rani E. Snyder
So, as you've alluded to, as the movement has spread now, is the perfect time to create a national, prestigious award from one of the country's premier health care organizations, and that's the American Hospital Association. Why? Well, because we've seen widespread not just adoption, but also enthusiasm for adopting the 4Ms's framework. That's been spurred in part by the Centers for Medicare and Medicaid Services, which implemented an Age Friendly hospital measure this year.

00:07:15:02 - 00:07:47:20
Rani E. Snyder
And we've also seen really important outcomes being published in the literature. A recent study found that older people receiving 4Ms care had a 33% lower rate of the 30 day readmission compared with usual care, and another site reported a 34% reduction in falls and a 53% increase in de-prescribing of those potentially inappropriate medications. That same initiative also saw re-hospitalizations decrease and the 30 day ED utilization fall.

00:07:47:23 - 00:08:10:13
Rani E. Snyder
So we want to shine a light on the enthusiasm and those outcomes that we're seeing, so that other hospitals and other health systems can't help but to want to join in. We'd be very happy to see all the FOMO. We want friendly but fierce competition to be the best at Age Friendly care. And there's certainly moral incentive for this given our growing aging population.

00:08:10:15 - 00:08:21:01
Rani E. Snyder
But there's economic incentive too. And here's a sort of a metaphor for you. When a film receives an Oscar. Everybody wants to see it. So the same can happen in health care.

00:08:21:03 - 00:08:43:11
Kristin Preihs
I love that, and I completely agree that the FOMO is real. One of the things we see again and again and again at AHA or in Hollywood is that recognition can be an incredibly powerful tool for transformation, for thought leadership, and for thinking of different ways to to do things. And when an organization is doing something exceptionally well, we don't just want to applaud it.

00:08:43:12 - 00:09:07:15
Kristin Preihs
We want to understand it. We want to know how they did it. Who made the work successful? How did leadership support it? What barriers did they overcome? And perhaps most importantly, what can other hospitals and health care systems in this case take from that experience to adapt for their own unique community? And that's where I think this award is, enormously important for the time that we're in.

00:09:07:17 - 00:09:32:14
Kristin Preihs
The organizations that we recognize can become somewhat of, I think, our learning laboratories for the field, because health care leaders are hungry for practical examples. So as we think about an older adult who comes into a hospital after a fall, for example, maybe there are medication concerns or mobility has declined. And as you've said, we know that when teens consistently apply the 4M's, those pieces are handled as separate problems.

00:09:32:15 - 00:09:57:28
Kristin Preihs
They become a very well coordinated approach around what matters to the individual. And that's what this partnership, this award is really trying to recognize. So when running, folks are considering applying for this new award for the first time. Can you talk a little bit about what you expect the committee will look at? What will distinguish organizations that are truly leading this work and what you hope folks can learn from them?

00:09:58:00 - 00:10:22:19
Rani E. Snyder
Gladly. First of all, I want to say that the AHA has such expertise in creating rigorous awards that examine the critical dimensions that are needed, really, to drive true outcomes in quality and safety. So we are grateful to you and your team, and your team has worked hand-in-hand with us to determine the what are now five criteria, that fall into different domains.

00:10:22:19 - 00:10:51:14
Rani E. Snyder
And so the specifics of what we're looking for will include evaluating elements like, first of all, leadership engagement and organizational alignment. That includes being embedded in strategy and governance. It's seeing leaders champion the work. It's having accountability for Age Friendly care built into organizational operations. Second, of course, patient safety and clinical quality. Those are major pieces of this work.

00:10:51:19 - 00:11:16:00
Rani E. Snyder
And so it will be a significant domain. Are we seeing reliable delivery of 4Ms care and measurable improvements in health outcomes as well. Third, community and patient partnerships is another area that we're going to look at. Age Friendly care has got to extend beyond the walls of just a hospital or office. Patients, families and caregivers have got to be engaged.

00:11:16:02 - 00:11:46:24
Rani E. Snyder
Fourth, we talk a lot about technology in all of our work, and we are seeing innovation and technology playing a key role in supporting the sustainability and the scaling of Age Friendly care. So that's another domain. Last but not least, thinking about spread and sustainability itself is going to be a marker of a successful applicant. Patients are going to benefit most when Age Friendly principles become part of the organization's DNA, and not just isolated projects.

00:11:46:25 - 00:11:48:13
Rani E. Snyder
So that's an important piece.

00:11:48:16 - 00:11:55:18
Kristin Preihs
Rani, from your point of view, what does readiness look like and why would you encourage an eligible organization to apply right now?

00:11:55:20 - 00:12:25:06
Rani E. Snyder
So perfection is not required, but if organizations can demonstrate the following points, they should consider applying. So first of all, implementation of the 4MS across multiple settings. They really need to have achieved the highest level of recognition in the Age Friendly health systems movement. There are two levels of recognition. They need strong leadership engagement. It is useful to be able to show measurable improvements in care and outcomes.

00:12:25:06 - 00:12:55:11
Rani E. Snyder
And we're seeing this more and more all across the country. It will be helpful to demonstrate effective partnerships across the care continuum. And sustainable processes that have been maintained over time as well. But honestly, I highly encourage every Age Friendly health system out there to go through the application process. And the reason is the award criteria are structured in a way that can be very helpful in moving your Age Friendly journey forward.

00:12:55:14 - 00:13:21:23
Rani E. Snyder
So there are a whole host of benefits that go with winning, and there are some that go beyond winning, so it's definitely worth a shot. First of all, applying for the Age Friendly Health Care Impact Award itself offers an opportunity for organizational reflection. And that matters. Applying can lead to a greater leadership engagement for your Age Friendly work, because you got to really step into it and examine it.

00:13:21:26 - 00:13:45:12
Rani E. Snyder
And then you'll be able to very publicly recognize the team accomplishments internally. And then, of course, if you win, you will have tremendous visibility as a national leader. The accolades will be very public and well promoted as well. Pioneering this movement sets a powerful new standard for organizational excellence, and that's part of what we're so excited for.

00:13:45:15 - 00:14:07:25
Kristin Preihs
And I want to underscore, two things that you said. First, that organizations sometimes underestimate the value of the application process itself. I've had the privilege of sitting on a few AHA award committees, and I have seen time over time that when individual hospitals and health care systems apply, it's it's almost not about the application, but it's about the process.

00:14:07:25 - 00:14:29:06
Kristin Preihs
And that they're recognizing their team members incredible work. They're preparing and making space for celebrating that, something it doesn't always happen. And that can make a significant difference to really stopping and reflecting on the impact that an organization has had and how far they've come. And the second piece I want to underscore is don't talk yourself out of applying because everything isn't perfect.

00:14:29:08 - 00:14:54:08
Kristin Preihs
This award is about progress, about measurable results and sustained commitment. And so if your organization has done that work, tell that story. Lean into it. Celebrate. Because behind every data point, every piece of progress is an adult, a caregiver or family whose experience of health care was better because your teams chose to approach care differently. And those stories right now deserve to be told.

00:14:54:10 - 00:15:06:18
Kristin Preihs
So, Rani, before we close, I have two final questions for you. First, for the hospital health care system that's listening today who again might be considering applying. Is there one piece of advice you would give to them?

00:15:06:20 - 00:15:29:06
Rani E. Snyder
Well, you referenced stories, and I want to say not only tell your story, but tell your story with confidence. Focus on the impact you've achieved for your older patients, their families and caregivers, your full care teams and their communities. Share both your results and the lessons that you've learned. Because you're going to see benefits from sharing your work no matter what,

00:15:29:12 - 00:15:31:28
Rani E. Snyder
even if you aren't selected as a winner.

00:15:32:01 - 00:15:44:15
Kristin Preihs
I love that, so well said. One final question for you, and let's look a little farther into the future. When we come back several years from now and look at what this award has accomplished - what do you hope we'll see?

00:15:44:18 - 00:16:08:02
Rani E. Snyder
I'm going to have three points to respond to that. First of all, we want this award to celebrate the leaders in the Age Friendly field. This is about telling stories, but it's about so much more than telling stories of how best care for older people really looks. It is also illustrating how much this initiative really means to real people in real communities and health systems.

00:16:08:04 - 00:16:40:00
Rani E. Snyder
Second, I firmly believe that this award is going to continue to accelerate adoption of Age Friendly care nationwide by creating visibility, by inspiring innovation, and by helping organizations to learn from one another as well. And then finally, the award is going to be an important component of our larger strategy to use every lever available to make sure that care for all of us, every one of us as we age, is safe and patient centered and Age Friendly to the core.

00:16:40:03 - 00:17:04:24
Kristin Preihs
And that is a wonderful place to end, and I share that hope. This award will become so much more than something organizations aspire to win. Rani, thank you for your leadership, for the John E. Hartford's extraordinary partnership with AHA and for continuing to push this movement forward. And to everyone listening, we cannot wait to see the stories and impact represented in this first round of applicants.

00:17:04:26 - 00:17:07:24
Kristin Preihs
Thank you so much for joining us.

00:17:07:26 - 00:17:16:07
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:10 - 00:00:14:21
Tom Haederle
Welcome to Advancing Health. Improving maternal health takes more than one type of provider. Learn how multidisciplinary teams are breaking down silos to support healthier pregnancies and better outcomes.

00:00:14:24 - 00:00:32:19
Julia Resnick
Welcome to Advancing Health. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. I'm here with Kardie Tobb from Cone Health. She's a cardiologist and works in obstetrics. And we're going to talk about team based care so that women can have better pregnancy outcomes. Kardie, thank you so much for being here.

00:00:32:21 - 00:00:37:26
Kardie Tobb, DO
Thank you for having me. It's such an honor. I am looking forward to this conversation.

00:00:37:27 - 00:00:42:18
Julia Resnick
Same. Can you tell our listeners a little bit about who you are and your role at your hospital?

00:00:42:19 - 00:01:07:13
Kardie Tobb, DO
Sure. Of course. So I am a trained cardiologist. Preventive cardiologist. I focus in on women with cardiovascular disease in pregnancy. So a term that we call cardio obstetrics. And I am in Greensboro, North Carolina. I work with a health system here, and we have been able to be fortunate for me to lead our initiative to develop our cardio obstetrics program.

00:01:07:13 - 00:01:22:17
Kardie Tobb, DO
And it's exciting to be able to work across dimensions of health specialties with the OBs, the maternal fetal medicine specialist, anesthesiologist and our nurses, and take care of patients to make sure they're having better outcomes.

00:01:22:18 - 00:01:37:22
Julia Resnick
So cardio obstetrics, I think by nature is kind of a interdisciplinary model of care. So can you talk about how you're thinking about that, that level of team based care? And really what prompted you to redesign how pregnancy care works at your hospital?

00:01:37:24 - 00:02:14:05
Kardie Tobb, DO
So let me tell you, it is really everything stemmed from looking at what our national data is showing. Maternal mortality, we're in a crisis and in different pockets of where we are in the country. We have to be thinking along the lines of team based care. So when I started fellowship, initially, I thought I was going to be a interventional cardiologist, and I was feeling pretty good about that until I started to look at my mentor, who was in women's health and started to look at the burden of women with heart disease and pregnancy and thought that I was going to pivot.

00:02:14:05 - 00:02:45:26
Kardie Tobb, DO
And I'm so glad I did, because now I have a fulfilling career where I'm not only caring for these women, but I have colleagues that we think about it together. So at Cone Health, with our interdisciplinary cardiac obstetrics team, what we have is a team of people: OB, MFM, anesthesiologist, pharmacist, social worker, nurses that we really discuss what the outcome or what that delivery plan and what the care plan is doing in pregnancy of a woman who has high risk cardiovascular diseases.

00:02:45:26 - 00:03:09:06
Kardie Tobb, DO
By that I mean like women who've had a heart attack, who've had heart failure, who've had strokes, who actually have high chronic hypertension that's really not controlled during that time, diabetes. And you name it. And we really do a good job to talking to each other. I'm really intentional to say talking to each other because all health systems have cardiologists.

00:03:09:08 - 00:03:28:26
Kardie Tobb, DO
Most health systems, I should say, because some of our hospitals may or may not have OBs, have an anesthesiologist, but most of them work in silo. And that's why I'm so proud that wit our cardio-obstetrics program, we're able to have this interdisciplinary conversation that we can make sure our patients are well cared for.

00:03:28:28 - 00:03:38:15
Julia Resnick
That's fantastic. And especially, you know, knowing that cardiology issues are one of the major causes of maternal morbidity and mortality. Like it makes so much sense to start there.

00:03:38:16 - 00:03:58:21
Kardie Tobb, DO
It is, it is. For many years we've had the traditional care where we think reproductive care years and pregnancy years is for the OB. But what we're seeing now, the trend with women having babies in older years, some of them have developed heart disease, some of them have inheritable heart disease, some of them have congenital heart disease. It's a problem.

00:03:58:21 - 00:04:05:16
Kardie Tobb, DO
So cardiologists, we need to understand that this is our problem too, to help solve.

00:04:05:18 - 00:04:23:22
Julia Resnick
Right. And I think, like we've been hearing that so many women are sicker when they become pregnant, which just means that their pregnancies are higher risk for themselves, higher risk for their babies. So like, how can we think more holistically about like, preconception care to put women on a pathway to healthier pregnancies?

00:04:23:28 - 00:04:54:10
Kardie Tobb, DO
This is one of my advocacy, Julia, to be honest with you, because a lot of time we now think about the pregnancy care and we don't think about the mother before the pregnancy care. And we don't educate women enough for them to understand that they need to declare their intentions of wanting to give birth, because once that's known, and we don't also talk enough with the primary providers to help women declare their intentions of being pregnant.

00:04:54:10 - 00:05:13:09
Kardie Tobb, DO
Because once the intentions is known, the rest of it is easy, because then you start asking questions about family history, about the woman's own history. So imagine a 42 year old woman who desires to get pregnant, but was diagnosed with high blood pressure ten years ago and may or may not be treated. And she wants to have a baby.

00:05:13:10 - 00:05:31:18
Kardie Tobb, DO
She needs to know that we need to look at those blood pressures, needs to know that her blood pressure needs to be optimized as opposed to - she gets pregnant, she's very happy because she's planned her life, she planned her career and now she's starting her family. And then by her 12 weeks of pregnancy, her blood pressure is 160 over 90.

00:05:31:19 - 00:05:54:14
Kardie Tobb, DO
That is devastating because there is a risk that she could lose the baby. And there's also that problem that not only losing a baby, her complications that are associated with it, not just during that time of the loss or the potential loss or during that time, years later. So we need to - it should really become a part of how we care for reproductive women.

00:05:54:15 - 00:05:59:14
Kardie Tobb, DO
Asking them about declaring intentions because there are some women who don't want babies and its okay.

00:05:59:18 - 00:06:12:25
Julia Resnick
Absolutely. And I feel like we're going to become evangelists for this. Like, how can we how can we better educate women about their health before they get pregnant to set them up for a lifetime of health, whether or not they decide to have a baby.

00:06:12:25 - 00:06:39:19
Kardie Tobb, DO
And I will be there, there with you. Trust me, because the advocacy and I think that I have dedicated my career to just this one thing. Making sure that women understand their heart health, their overall wellness. And then when it comes to trying to have a baby, we need to, as a country, not just as where I practice Greensboro or not just as Chicago or Philadelphia or Alabama.

00:06:39:19 - 00:07:04:06
Kardie Tobb, DO
We need to, as a country, start thinking about the wellness of women health, period. There's been a huge transformation in the education of women across the country, but there are still a lot of work to do. Because when we see women, sometimes we think breast cancer number one killer. But that is not true. Heart disease number one killer. Reproductive years, heart disease number one killer leading causes.

00:07:04:10 - 00:07:11:20
Julia Resnick
Yeah. And when we think about young women, they usually think that they can't have heart disease because they're too young and they're too healthy. But that's not true.

00:07:11:20 - 00:07:34:01
Kardie Tobb, DO
That is not true. Young people in general feel that we're indispensable,  we're not. There are lots of ways that young people can have heart disease. Genetically, high cholesterol, thinking about heart disease or inherited genetically. So I think it should start from the younger years, because people are thinking that heart disease is not something for the young, especially in women.

00:07:34:01 - 00:07:46:26
Kardie Tobb, DO
We look at it in post-menopausal stages. That is not true. We start from a younger age, knowing the blood pressure, thinking about if you want to have a baby with that desire for your work and things like that.

00:07:46:27 - 00:08:02:28
Julia Resnick
I do want to go back to the pregnancy conversation. So from the patient's perspective, when they're part of this interdisciplinary model of care, who are they seeing as part of those, their care team? And how do the how does the flow work for them, and how does it differ from traditional pregnancy care?

00:08:03:02 - 00:08:27:18
Kardie Tobb, DO
So the OB is the driver of the care team. The OB is the one that's going to identify when cardiology coming, OB's going to identify when a behavior specialist coming. So it's almost OBs are captain of the ship. But being in that model where we're not siloed anymore and we're making sure that the patients know when they need to be referred, the patients are screened.

00:08:27:18 - 00:08:51:22
Kardie Tobb, DO
And I think the big part of that care model is not necessarily always seeing the patient, but always having a conversation during those roundtable, because we can't have a multidisciplinary clinic in all states or all places, because when you think about the payers and all, how that works, but we can have a roundtable where we can discuss every patient, every problem and come up with a joint solution.

00:08:51:23 - 00:08:55:18
Julia Resnick
And can you talk more about those roundtables and who's involved and how that guides care?

00:08:55:19 - 00:09:20:12
Kardie Tobb, DO
So what happens - we have patients based on our history, what they have. And a lot of times the identification comes from our OB team. And sometimes if they see a cardiologist first like myself, and we have a group of a list of those patients, and then who's on those roundtable discussions are the cardiologists. Sometimes our advanced heart failure team members, because we have women whose EFs are low and need (?) heart failure.

00:09:20:13 - 00:09:49:25
Kardie Tobb, DO
Our pharmacist, our obstetrician gynecologist, our maternal fetal medicine team member, our nurse and leadership's from the discharge areas to the labor wards. Our social workers, our pharmacist, and we pull people in as we need. And what we do, we look at the individual, we look at their chronic disease processes. We look at what is needed, what is needed in terms of clinical care and social needs, not as we think about it as providers, doctors.

00:09:49:25 - 00:10:07:14
Kardie Tobb, DO
And we say, oh, this is what we know. We'll look at it from my holistic standpoint. What they need to have a safe delivery in terms of treatment prenatally and what they need to have a postpartum stay and be very comfortable at home and making sure they're not leaving their baby to come back for a readmission.

00:10:07:14 - 00:10:22:21
Julia Resnick
That's incredible. And I just want to close with your words of advice. So if our listeners were to take one action to think about how they could improve pregnancy outcomes for women in their communities, what would be your one piece of advice for them?

00:10:22:24 - 00:10:43:28
Kardie Tobb, DO
So start from an enterprise level and talk to healthcare executives and say, from the care of a pregnant woman or a reproductive age woman is not based on the OB or the nurse. It starts from the CEO, who really pushes the initiative of making sure that we look at data on maternal health, not just from the race, ethnicity, language.

00:10:44:00 - 00:11:09:18
Kardie Tobb, DO
Make sure we understand the gaps and really build bridges to help close those gaps. And then I'll talk to the clinicians. It's not about us as physicians or providers, it's about the patient. So we need to align and have conversations with our other subspecialties to make sure that we're aligning on better outcomes and not work in silo. And then I would talk to the patients and say that, have a conversation with your provider.

00:11:09:18 - 00:11:32:07
Kardie Tobb, DO
If you're a reproductive age woman who wants to be have an intention of having a baby, who wants to be pregnant, understand your health because a healthy woman would carry a healthy baby. And once you can do that, push until you find a person is going to help you. And then optimize your health if you have chronic disease before you get pregnant, it makes for a much more healthier pregnancy.

00:11:32:14 - 00:11:44:06
Julia Resnick
Those are wise words for leaders, providers, and patients. So Kardie, thank you so much for joining me for this conversation. I am so inspired by the work you do, and look forward to seeing how it continues to develop and grow.

00:11:44:13 - 00:11:47:21
Kardie Tobb, DO
Thanks for having me. It's always a pleasure.

00:11:47:24 - 00:11:56:15
Tom Haederle
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