Advancing Health Podcast

00:00:00:09 - 00:00:17:02
Tom Haederle
Welcome to Advancing Health. New York City has long been considered one of the great food meccas of the world, and these days some of the best tasting and most nutritious meals in the Big Apple are served in hospitals.

00:00:17:04 - 00:00:41:16
Tom Haederle
Hello friends, I'm Tom Haederle, senior communication specialist with the American Hospital Association. And it's a pleasure today to talk about a vast improvement in patient care that is sometimes overlooked: the meals patients and families are served during their health care journey. I'm not just talking about taste and presentation, but significant upgrades in nutrition value, high quality ingredients, and the ability to tailor meals to patients and their needs.

00:00:41:16 - 00:00:50:04
Tom Haederle
I'm joined today by Dan Dilworth, senior director of food and nutrition services at NYU Langone Health. Dan, thanks so much for joining me on Advancing health today.

00:00:50:04 - 00:00:51:24
Dan Dilworth
Awesome. And thanks for having me.

00:00:51:26 - 00:01:01:27
Tom Haederle
Let's set things up. You and your team have invested enormous effort in the past several years radically overhauling, I guess, Langone's food system. Please give us a picture of what's been going on.

00:01:02:01 - 00:01:21:03
Dan Dilworth
So our journey actually began about 12 years ago after Hurricane Sandy. You know, NYU was decimated by that storm and they had to rebuild. So really we said, how do we want to do that? We have this opportunity to build new buildings and rebuild a program. And we really wanted to be the best in class in doing that.

00:01:21:04 - 00:01:39:10
Dan Dilworth
So, you know, the approach we took was actually very, very simple. It was let's focus on using really wonderful products, the best ingredients, and start making everything in-house. And that's sort of the base of how we did it. Of course, it's a lot more complicated and it's been a long, winding road. But you know, that's really what we prioritized.

00:01:39:12 - 00:01:46:21
Tom Haederle
What has the reaction been from patients and their families who are customers, so to speak, of Langone Health?

00:01:46:24 - 00:02:13:09
Dan Dilworth
Our changes have gone over very, very well. I must say that, you know, as part of our process, we removed all deep fryers from every kitchen within our organization. So the removal of French fries did upset some people. But aside from that, I think it's been overwhelmingly positive feedback. And, you know, funny enough, this morning in snail mail, which is a rare thing these days, I actually received a letter from a patient who was here at some point in the last several months thanking us.

00:02:13:09 - 00:02:29:07
Dan Dilworth
And she cited, you know, the salmon with the Salsa Verde and our sauteed kale, and was calling out these specific dishes, saying how wonderful it was to get this level of food at a hospital. And I think those are really the best moments when we can hear from a specific patient, you know, letting us know about their experience.

00:02:29:07 - 00:02:31:25
Dan Dilworth
But yeah, overall, it's gone over very well.

00:02:31:27 - 00:02:47:04
Tom Haederle
And nice to get that thumbs up, I imagine people are delighted. You come from a restaurant rather than a health care background. So how is that an advantage in looking at the menu and deciding what kinds of changes needed to be made? And did anything surprise you when you took this on as a project?

00:02:47:09 - 00:03:07:06
Dan Dilworth
So yes, you mentioned I come from restaurants, but it's a little bit more than that. I've worked in just about every area of food and beverage that you can imagine: catering, airlines, hotels, restaurants. And it's funny because I think hospitals are actually a conglomeration of all of those things. Each of those different areas has its own set of challenges that you have to navigate.

00:03:07:08 - 00:03:27:13
Dan Dilworth
You know, on an airplane, you're pre-making food and it has to get reheated in the air in a steel box. You know, in catering, you're doing kind of the same thing, but on the ground. You know, I've pulled a lot of sort of skills that I've learned in those areas over the years to help inform what we do here at NYU, knowing that, you know, we don't have a kitchen next to every patient bed.

00:03:27:14 - 00:03:47:27
Dan Dilworth
And that's something that's really interesting to me is the sort of logistics behind this. How do you make really fresh, amazing food and then transport it through hallways and up elevators and then get it distributed to a patient bed, which is decidedly not a restaurant table? I think just pulling from that background and different things I've learned over the years has been really helpful in this.

00:03:47:27 - 00:04:03:19
Dan Dilworth
But again, it just comes down to the same things. It's, you know, using great fresh ingredients, the best quality fish, the best quality vegetables and then delivering it with wonderful hospitality, I think is the key, no matter what happens with the logistics and behind the scenes.

00:04:03:21 - 00:04:21:28
Tom Haederle
I would think New York is probably...and correct me if I'm wrong, but maybe one of the easier places to source fresh ingredients. Is that an advantage just because so many ingredients coming to the city for so many different reasons, but you don't have any trouble getting your hands on the kinds of things that you want to be serving patients.

00:04:22:01 - 00:04:44:04
Dan Dilworth
100%. I mean, we're in probably the best place in the country to get amazing ingredients past maybe California. You know, our fish comes from the same purveyors that I've used for years in, you know, Michelin starred Manhattan restaurants. But having said that, we don't have the advantage of being able to run down to Union Square Green Market and pick up vegetables because of the sheer volume of the food that we're serving.

00:04:44:07 - 00:05:03:28
Dan Dilworth
So we're serving over 9000 people a day across all five of our campuses. And you know, that that does put some limitations on it. So we really focus on working with great purveyors to figure out how can we get local vegetables and the best quality items at that scale, and then knowing that in theory, this is an easy thing.

00:05:03:28 - 00:05:18:10
Dan Dilworth
But we do have campuses ranging from Manhattan all the way out to Suffolk on Long Island. There is a level of complexity there, but the number of amazing purveyors and vendors that we have to pull from make it, make it pretty, pretty straightforward and easy, which is a great, great asset.

00:05:18:15 - 00:05:33:22
Tom Haederle
Well, it's also remarkable, you just mentioned you're serving 9,000 patients a day. And I understand that Langone system puts a premium on tailored meals, when possible, that are aligned to a patient's personal taste and preferences. How do you pull that off?

00:05:33:25 - 00:05:57:12
Dan Dilworth
So that's really interesting. So just one caveat. So we're serving 9,000 people a day. So that's patients along with our coffee shops, our restaurants, our cafes, our catering. But when it comes to medically tailored meals, we have over 15 different special therapeutic diets. So that could be anything from a consistent carbohydrate diet to a low sodium diet.

00:05:57:13 - 00:06:18:26
Dan Dilworth
So depending on what a patient's condition is, the doctor can sort of flag them for that specific diet. And that tells us how much sodium can that patient have? What level of sugar can they have if somebody has diabetes? Any number of different conditions will fit into that. And we have essentially different menus, mini-menus that are put together that we will make available to that patient.

00:06:18:26 - 00:06:37:02
Dan Dilworth
But the best part about what we do here at NYU is we have a pretty expansive patient menu. We have daily specials, and every patient has the ability to pick what they want to eat. We're not telling you what you have to eat. We're not just sending something up to you, but you know, as long as you're not in surgery, when orders are being taken, patient can pick.

00:06:37:03 - 00:06:59:24
Dan Dilworth
Do they want pasta bolognese or do they want mac and cheese? Do they want chicken breast or do they want roasted salmon? And I think that level of choice is something that's really amazing. And that's something that's very personal to them. I think it really helps give a better experience as part of the overall stay at the hospital and being able to know, you know, pick what kind of tea one or what you want, what kind of cereal you want for breakfast.

00:06:59:25 - 00:07:07:04
Dan Dilworth
You know, that can be something that just gives a sense of sort of comfort and home when you're in a place that's definitely not your home.

00:07:07:10 - 00:07:23:21
Tom Haederle
That's a great point. And I was thinking it's probably also a big psychological advantage to feel like you have some control over the things you're picking to be brought to you to eat when, you know, depending on the nature of your of your stay in the hospital, you don't always have control about some other aspects of what's going on there.

00:07:23:21 - 00:07:41:05
Tom Haederle
But I was wondering if there's any -in addition to patient feedback, which I imagine is very positive - do you have any data that would indicate that this move to healthy food is actually making a medical difference? You know, sodium levels dropping or diabetes being treated just through food?

00:07:41:06 - 00:08:00:07
Dan Dilworth
So we're actually right now working on developing a number of different dashboards to start tracking data like this. It's not something that's one, very easily trackable, but it hasn't historically been tracked across the board. So we're really prioritizing right now, how do we gather more data? How do we turn that into something that you can see on a day to day basis?

00:08:00:07 - 00:08:18:06
Dan Dilworth
And that could be anything from, you know, things you're talking about to what utilization do we have of different menu items. What are patients ordering most frequently? How long does it take for a meal to get from our kitchen to different hospital units? And I think we're taking this holistic look at data, because NYU as a whole uses data as a tool to make decisions, right?

00:08:18:07 - 00:08:36:20
Dan Dilworth
We're not making decisions because Dan thinks it's good. We're making decisions because, you know, there's proven facts behind it. I'm really excited to see those dashboards come to life, and we're going to continue growing and refining them over the coming years, and hopefully be able to share some data that's really impactful to the world through the use of those.

00:08:36:22 - 00:08:55:19
Tom Haederle
That's exciting, and I'm looking forward to hearing more about that when that data becomes available. At the same time, you're also moving ahead on so many fronts at once, and I'm referring to carbon emission goals. Also trying to reduce the amount of single use plastics as part of part of the overhaul. What can you tell me about that?

00:08:55:20 - 00:08:57:03
Tom Haederle
How's that working out?

00:08:57:06 - 00:09:21:19
Dan Dilworth
So NYU has a goal of carbon neutral by 2050. In researching where the bulk of our carbon emissions come from, you know, one would think, oh, it's from the electric and the utilities that you use. A lot of it is from the products. And I say that because something made of plastic that's produced overseas has to go on a boat, in a box, in another box, get uncreated, repackaged, distributed, delivered.

00:09:21:21 - 00:09:40:28
Dan Dilworth
That whole process is incredibly impactful. We're sort of starting to focus in our department on things that we can make a big change with immediately. And for us, a lot of that has to do with removing plastics. It's not great for the world, it's not great for your body. And more and more on the market, there are better alternatives, especially for things like bottled beverages.

00:09:40:28 - 00:10:04:08
Dan Dilworth
There are a lot more bottled beverages out there right now that are packaged in glass or aluminum, which are endlessly recyclable and definitely ideal. So this last year, we reduced our plastic bottle beverages by 44%, and we're working pretty aggressively to turn that into a zero, hopefully by the end of the year. But that's a that's a loose goal.

00:10:04:10 - 00:10:26:14
Dan Dilworth
You know past that it's you know we're also looking at the health benefits of removing plastic from food service. So you know there's the benefit to our planet of using less plastic. But you know, more and more there's research saying that plastic, especially when it's heated, is really terrible for our health. So there are some really cool researchers here at NYU that are really focusing on this, so as a department

00:10:26:14 - 00:10:47:26
Dan Dilworth
we're partnering with them to figure out, as we get rid of plastic, which items are we bringing in and which have the least amount of risk to our bodies, our patients bodies, our staff and our guests. But overall, I think moving towards compostable is a huge goal. In the last couple of months, changed all of our cutlery over to being compostable in our retail cafes.

00:10:48:02 - 00:11:10:22
Dan Dilworth
Patient meals are next and I think alone that move saved us about 2.5 million pieces of single use plastic going into landfills a year. So a lot of good stuff. And, you know, it's amazing to work for an organization that puts resources behind this because it's not cheap to do these things. And NYU's dedication to this mission has really enabled us to make some moves here.

00:11:10:25 - 00:11:33:02
Tom Haederle
Congratulations. You're really making an important progress on so many fronts and advancing health at the same time. It's amazing. You're probably aware about a month ago, the Centers for Medicaid and Medicare Services announced a voluntary pledge hospital could sign related to their efforts on healthy food. The AHA has endorsed this. It seems like you guys have really been out ahead of the curve on this whole thing.

00:11:33:04 - 00:11:53:27
Dan Dilworth
Yeah. So that's the that's the great thing about this is for years, we've already been doing a lot of the things that are a part of that pledge. So using minimally processed foods, prioritizing from scratch, cooking simple vegetables and proteins, reducing the amount of added sugar. You'd love to reduce all added sugar. However, you can't get rid of ginger ale for patients, and that's always going to have added sugar.

00:11:53:27 - 00:12:15:00
Dan Dilworth
But even several years ago, we switched our ginger ale to a product that uses cane sugar instead of high fructose corn sirup. So even in those places where, you know, it's a sort of necessary evil, we're still trying to use the best thing possible. But at the end of the day, you know, like I said at the beginning, if we prioritize great, fresh, simple ingredients, where we're headed on the right track.

00:12:15:02 - 00:12:31:26
Tom Haederle
You're really, really setting the setting the standard for the field right now. And I congratulate you for that. I've got to ask, I've read that Langone's food is so excellent that some patients actually ask for recipes. So will we see a Langone Health cookbook coming out one of these days, or a show on the on the Food Channel?

00:12:31:28 - 00:12:55:21
Dan Dilworth
There's nothing I would love more, but funny you should ask about a cooking show. So we actually do shoot a cooking show right now. We've shot it for about six years. We've done 58 episodes so far. It's called Cooking for Wellness. It can be found on our YouTube channel. You know, historically, this this program has been sort of directed at our internal stakeholders, and it's featured all of the amazing clinicians and experts we have on our staff giving guidance on food.

00:12:55:24 - 00:13:28:19
Dan Dilworth
We're going through a bit of a relaunch on this right now, where we're redirecting this as a tool for our patients to provide them with, like real life, actionable guidance on cooking on nutrition surrounding specific diseases. We have this wealth of expertise from our doctors, from our nurses, from our researchers. So we love the fact that we're able to leverage that and then combine it with our culinary team and really create a program that's teaching everyone out there, sort of, how can you cook at home in a realistic way to solve for having a certain disease, to being on a certain medication.

00:13:28:21 - 00:13:38:26
Tom Haederle
Given your experience in redesigning the menu at Langone, what advice would you have for other organizations, health systems, or hospitals who are interested in doing the same thing?

00:13:38:28 - 00:13:59:10
Dan Dilworth
I think one big piece of advice I'd give other health systems is typically, you know, frozen food is a big part of the food and nutrition program in health care organizations. And, you know, everyone assumes that going to fresh vegetables is a sort of big mountain to tackle. You know, in my opinion, it's much easier. It's actually just that simple: buy fresh vegetables.

00:13:59:13 - 00:14:17:15
Dan Dilworth
When you buy a frozen vegetable, you have to store it. You have to thaw it. You have to process it more differently. You have to dry them out. It actually it's much easier and it ends up being a bit of a labor savings if you just go with straight vegetables. It's kind of counterintuitive. However, in the long run, you know it's going to give better nutrition, a better quality product.

00:14:17:16 - 00:14:33:08
Dan Dilworth
Many of the purveyors that sell these frozen or canned or processed ingredients also have fresh vegetables. And even if you start small, like you don't have to reinvent the wheel overnight, just switch from frozen carrots to fresh carrots. That's an amazing first step and pretty accessible.

00:14:33:10 - 00:14:47:10
Tom Haederle
Well, it may be an overused word, but I think what Langone Health is doing is truly awesome. And congratulations on the effort you're leading and the difference it's making in your patients lives and those are their families. So thanks again for your time and really appreciate you being on Advancing Health today, Dan.

00:14:47:16 - 00:14:50:01
Dan Dilworth
Awesome, thanks so much.

00:14:50:03 - 00:14:58:26
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 - 00:00:28:00
Tom Haederle
Welcome to Advancing Health. June 8th through 12 is Community Health Improvement Week, a perfect time to recognize Denver Health's award winning approach to the stubborn and difficult problem of homelessness. Hello, friends, I'm Tom Haederle, senior communication specialist with the American Hospital Association. Homelessness is complicated by the reality that many unhoused people also deal with complex medical, behavioral health and social challenges.

00:00:28:00 - 00:00:48:15
Tom Haederle
And as most will attest, it's all too easy to fall through the cracks. That's why it's a pleasure today to welcome someone who is driving real progress on a problem that defies easy solutions. Dr. Sarah Stella is the co-leader of Denver Health's Housing Outreach, Partnerships and Engagement, or HOPE program. Dr. Stella, thank you for joining me on Advancing Health today.

00:00:48:16 - 00:00:49:18
Sarah Stella, M.D.
Nice to be here.

00:00:49:22 - 00:01:08:21
Tom Haederle
First off, let me offer my congratulations on the HOPE program's recognition last month with the American Hospital Association's 2026 Dick Davidson NOVA Award, which is our award that honors outstanding collaboration by hospitals and health systems working to build healthier communities. It's quite an honor. So hats off to you.

00:01:08:26 - 00:01:13:15
Sarah Stella, M.D.
Thank you very much. It was a real honor to be in Dallas to receive the award.

00:01:13:18 - 00:01:23:09
Tom Haederle
Why don't we start at the beginning and please share with our listeners what HOPE is designed to do and the role that community partnerships play in helping Denver residents access the services they need.

00:01:23:16 - 00:01:51:00
Sarah Stella, M.D.
Well, I love that you mentioned seeing folks fall through the cracks. So I'm a hospitalist. I'm an internal medicine trained hospitalist physician. So I've worked at Denver Health for nearly the last two decades, and a lot of what I do is and what we do at Denver Health is catching people that are falling through the cracks, which sometimes are more like gaping holes in our systems.

00:01:51:04 - 00:02:24:04
Sarah Stella, M.D.
The HOPE program is really unique because it is an interdisciplinary team that lives at the intersection of the hospital system and the Metro Denver homelessness response system. And so I think sometimes what we see is, although hospitals like Denver Health are disproportionately caring for folks that are experiencing homelessness and other really significant social needs, that we're often separate from the response systems.

00:02:24:08 - 00:02:53:24
Sarah Stella, M.D.
And so a lot of what I've been doing - so I still practice hospital medicine with part of my time - but a big part of what I've spent the last decade doing is really building partnerships beyond the hospital walls to improve care for some of our most vulnerable and at risk folks experiencing homelessness at Denver Health. About 1 in 5 of the patients that I treat in the hospital is experiencing literal homelessness.

00:02:53:25 - 00:03:30:06
Sarah Stella, M.D.
So this is a significant challenge. We know that our folks experiencing homelessness have longer length of stay, really complicated discharge plans sometimes. And so working with a range of different partners is really important to improve the quality of care that we provide as well as our financial bottom line, because we know that if you don't have a safe place to go, you're likely to be in a hospital bed far longer sometimes than is needed.

00:03:30:07 - 00:03:37:04
Sarah Stella, M.D.
So having trusted partners on the other side of that transition is critical.

00:03:37:10 - 00:03:58:02
Tom Haederle
And what kind of options has that created working with these partnerships? If a patient comes into the hospital for a medical condition or reason, but you realize they're going to need a little bit more than that, you know, a stable housing situation, a roof over their head that they can count on -what are some of the options that that you can provide, and are they temporary or are they or try to be permanent?

00:03:58:09 - 00:04:39:19
Sarah Stella, M.D.
Yeah. Great question. So we do have a partnership with the Colorado Coalition for the homeless. They are a long existing provider of integrated housing and health care. And they operate a large recuperative care center in Denver. And so one of the ways that we partner is by investing in our partners. And so we help fund a portion of recuperative care beds in the John Parvensky Stout Street Recuperative Care Center to use as a discharge destination for many of our folks experiencing homelessness that have really complex medical needs.

00:04:39:19 - 00:05:09:21
Sarah Stella, M.D.
So things like wounds or needing IV antibiotics for a prolonged period of time, broken bones where people are unable to bear weight and they really need a safe place to rest and recuperate following that hospital stay. So that's a great partnership for us and that has helped us to reduce our length of stay. That is not housing. And so we still need to think about what is the next step for that, that patient.

00:05:09:21 - 00:05:38:16
Sarah Stella, M.D.
But it's a really great place to get medical care, to be able to heal and then get connected with housing and other supports that can help someone take the next step. We also had operated a transitional housing program at 655 Broadway. That's a partnership with the Denver Housing Authority, and that is specifically for elderly and or disabled patients who are experiencing homelessness.

00:05:38:19 - 00:06:09:08
Sarah Stella, M.D.
Again, to transition them out of the hospital, provide wraparound supports, and then try to get them connected with longer term housing in the community. And then we just work really closely with our city partners who can provide non congregate shelter, like motel rooms with some wraparound case management. We partner on the Denver Housing to Health program, which is a permanent supportive housing program that provides -

00:06:09:08 - 00:06:34:02
Sarah Stella, M.D.
not only do we have a very responsive partners on the end of that transition and a warm handoff to those partners during a hospital stay - but folks also are provided with a housing voucher and get connected with long term, permanent supportive housing. Really actually, how we learn to do a lot of the way that we work and we make connections and have these strategic partnerships.

00:06:34:03 - 00:07:06:20
Sarah Stella, M.D.
We learned how to do that through our Denver Housing to Health program. It's sort of proof of concept that when we have the right data to identify folks and outreach them, we have the right team on the ground to outreach them, and we have partnerships and resources on the back end, it is possible for someone to go from hospital into housing. And I think that's a great model for hospitals to think about in terms of what we can do to meaningfully partner to address homelessness.

00:07:06:22 - 00:07:29:01
Tom Haederle
That's wonderful, inspiring work. I'm really, really impressed. I would like to pull on that thread a little bit. You mentioned there is an issue of identification. Who needs these services? I read an article that you wrote that was published last October. I guess it was "the conversation.com" was the website about your frontline experiences as a care provider. And you made some, some excellent points.

00:07:29:01 - 00:07:47:00
Tom Haederle
You noted that Denver and I would say probably most cities tend to undercount the homeless, and I wanted to share one quote from that article that really struck me. You said "others are hard to spot, staying out of sight on couches or in creek beds, or hiding in plain sight while they serve our food and fix our roads."

00:07:47:04 - 00:07:51:14
Tom Haederle
So how do you reach that population and direct them to the available resources?

00:07:51:16 - 00:08:20:28
Sarah Stella, M.D.
Yeah, that's a great point. And I think, you know, a lot of times what we think of as a homogeneous population of people is actually a very diverse, heterogeneous population of people with very different pathways into homelessness, very different needs. And so one way that we do that is we use data to help us identify folks really early in their hospital course.

00:08:21:00 - 00:08:58:14
Sarah Stella, M.D.
And so that allows us to proactively identify people experiencing homelessness. To do that, we use Denver Health's homeless registry. And so that helps us kind of more inclusively and comprehensively identify people who may be experiencing homelessness. And that's sort of our starting point. And then we use the Homeless Management Information System or Colorado HMIS, and that really helps us better understand who this patient may be connected with in the community in terms of partners and resources.

00:08:58:16 - 00:09:22:12
Sarah Stella, M.D.
It helps us understand if they may be eligible for specific programs, and that is a good way to kind of see information that often hospitals are really blind to. Those data sources are really important for us to proactively identify folks and enable outreach to happen. And then we meet with the patient. So we have a consult based team,

00:09:22:12 - 00:09:49:15
Sarah Stella, M.D.
so an interdisciplinary team of social workers, care coordinators, myself and others who are on the ground, who really have a unique expertise and an understanding of the resources, which can often change. So they're not static. The team is really working closely on a day to day basis with a whole range of different community providers. When we're meeting with someone,

00:09:49:18 - 00:10:24:10
Sarah Stella, M.D.
we are really trying to meet them where they're at. We're really trying to understand what their unique story, what their specific barriers are, and we're really trying to make the best recommendation and connection for them based on not only their housing needs, but their health needs. And so we know that the patients that we care for in the hospital setting often have complex needs such as functional impairments, mobility impairments, difficulties sometimes completing their activities of daily living.

00:10:24:10 - 00:11:00:20
Sarah Stella, M.D.
And that's about 60% of our patients on the inpatient side. And so these are folks with really complex needs. And so we're really trying to understand those specific barriers and what their preferences are, what their medical needs are, and make the best recommendation and connection for them in that moment. We're often seeing patients at their some of their worst moments. And it is a privilege to walk beside them, to sit with them in those worst moments and to restore hope.

00:11:00:26 - 00:11:35:01
Sarah Stella, M.D.
So a lot of what I see as a hospitalist is loss of hope and what that can do to a person. And the last thing that people are expecting when they come to a hospital is a connection to housing or a partner, which ultimately could lead to more stability for them. That's often what they need most, because it's very hard to improve someone's health and well-being when their basic needs are not met and they're focused on survival.

00:11:35:04 - 00:12:14:04
Sarah Stella, M.D.
So it feels really good to be able to provide something that is unexpected and that is hopeful, because I think that, you know, myself as a physician who works in a hospital, I don't get to see the good outcomes. I see people during their worst times in times of crisis. And so to be able to provide these connections really helps us as health care providers, because witnessing the needless suffering that we see, especially in this group of patients that is preventable, it's hard.

00:12:14:04 - 00:12:46:22
Sarah Stella, M.D.
And it's really what I am passionate about. So I've seen sort of the, use case. I've seen all the negative impacts of homelessness on folks health. Preventable loss of life, loss of limb, lots of complications. And I've also seen the reverse, that when we are able to restore hope, make a meaningful connection and get someone to a place where they have more stability and their basic needs are met, it feels really good.

00:12:46:22 - 00:12:50:09
Sarah Stella, M.D.
And that's what really motivates me and drives me in my work.

00:12:50:12 - 00:13:11:01
Tom Haederle
It sounds immensely satisfying. I know there's no such thing as a foolproof system that's going to catch everybody and treat all of their needs and but, but it sounds like you've covering as many bases as you possibly can. And that's just it's just so impressive. As we wrap up, I just wanted to ask, you know, for anybody listening today who thinks, well, my hospital should be or could be doing something like that as well.

00:13:11:03 - 00:13:27:16
Tom Haederle
What advice would you have? And I'm thinking more in terms of the financial burden on a safety net hospital and how much all of this kind of thing costs. Is it within the reach of hospitals of similar size or serving similar size, metro areas or smaller markets for that matter?

00:13:27:19 - 00:13:56:13
Sarah Stella, M.D.
Yeah, I mean, I think this is a great case of, you know, not only is this the right thing, the best thing for my patients, but it also financially is the right thing as well. A good place to start is always going into community, being curious, not I think sometimes health care and hospitals go into community when there's a problem, when they want something, when they know how to fix it and they want to tell people how to do that.

00:13:56:13 - 00:14:23:19
Sarah Stella, M.D.
And I don't think that that's the right approach to community engagement. I think going with an open mind and curiosity and learning and understanding. Sometimes there are resources that exist and we're just not aware of them. Other times, we have significant challenges with scarcity of supportive housing. And so those are significant challenges that we cannot solve within the hospital system.

00:14:23:25 - 00:15:00:14
Sarah Stella, M.D.
We cannot solve unless we come together as a community. And think about this as an ecosystem where health systems can use our strengths, but we need partners. We can't solve all this on our own. But yeah, I think it's very important to think about our ability to provide care to people that that need us. I think that looking at the financial benefits and the reduction in length of stay and uncompensated costs are important, as well as seeing how stable housing can provide.

00:15:00:20 - 00:15:10:12
Sarah Stella, M.D.
It's really a platform for engagement in care and ultimately it's what's needed to improve someone's health and well-being.

00:15:10:14 - 00:15:25:16
Tom Haederle
Well, I think the work that the HOPE program is doing in Denver is I already said this, but I'll say it again, it's inspiring and I hope that people listening today will give some thought and think, you know, maybe there's something we can learn from here. Maybe there's something in this model we can duplicate and do in our own backyard.

00:15:25:16 - 00:15:35:16
Tom Haederle
And so I thank you for coming on Advancing Health today and for the fantastic work that you're doing on behalf of the people of Denver. So congratulations and keep it up.

00:15:35:20 - 00:15:37:22
Sarah Stella, M.D.
Thank you very much.

00:15:37:25 - 00:15:46:16
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:20:08
Tom Haederle
Welcome to Advancing Health. Food insecurity is more than the lack of enough to wheat. The lack of healthy, quality food is just as big a problem as Dr. Stormee Williams, senior vice president and chief health equity officer at Children's Health, explains in this Community Health Improvement Week podcast.

00:00:20:10 - 00:00:34:00
Nancy Myers
I'm Nancy Meyers from the American Hospital Association. Welcome to today's conversation. I want to start by saying welcome and thank you to Dr. Williams for sharing the work that you and your team are leading at Children's Health.

00:00:34:01 - 00:00:35:25
Stormee Williams, M.D.
Thank you so much for having me.

00:00:35:27 - 00:01:00:22
Nancy Myers
Today's topic, which is supporting health by identifying and tackling food insecurity for patients and community members, is one that I think is especially important as we think about how to better support children and their families. So, Dr. Williams, can you start off by telling us a little bit about Children's Health and how you came to focus on food insecurity in your community?

00:01:00:25 - 00:01:34:14
Stormee Williams, M.D.
Yes. So Children's Health is a leading pediatric health center in North Texas, and we're one of the largest pediatric health care providers in the nation. And with our academic partner at UT Southwestern, we're one of the leading pediatric care providers in the nation. Our mission is to make life better for children and we take that very seriously. So it's only natural that we decide to take care of the whole child, which is also including their families,

00:01:34:14 - 00:01:52:26
Stormee Williams, M.D.
right? So we can't do that by only considering their health care needs. We have to consider all of the needs that allows us to take care of both their health, as well as other needs and non-medical needs that impact their health outcomes, which includes food access and food quality.

00:01:53:00 - 00:02:04:16
Nancy Myers
So talk a little bit more about that. As a pediatrician yourself, can you tell us about how being food insecure impacts health, especially in children?

00:02:04:19 - 00:02:29:04
Stormee Williams, M.D.
Yeah. So let's talk a little bit about what is food insecurity. When we hear that term food insecurity, we think just having access to food, meaning you know, you just don't have enough food to last one day to the next. And that is definitely a part of it. But also food insecurity also looks at the quality of food that you have access to.

00:02:29:04 - 00:03:06:15
Stormee Williams, M.D.
And if you look at under resourced areas, sometimes some of our highest rates of obesity are in under-resourced areas. And so as a pediatrician, my early career started in an under-resourced area. And in fact, I worked in a federally qualified health center right in the Dallas-Fort Worth area. I saw firsthand what that looked like. A lot of my patients were overweight or obese in that very area, right, very close to downtown Dallas, actually, and they just didn't have access to healthy foods.

00:03:06:16 - 00:03:37:24
Stormee Williams, M.D.
I saw it for myself because if I forgot to bring my lunch, what was close by, and I had very limited time to run out and grab something to eat. My options were fried chicken, fried fish, you know, something that was not necessarily healthy. It was calorie dense, but not necessarily nutrient dense. And that's what we see for our patient families, is that they might have access to food, but is that necessarily healthy food?

00:03:37:24 - 00:03:47:04
Stormee Williams, M.D.
So we have a twofold approach to food insecurity. It is access to food, just purely food, but also access to healthy food.

00:03:47:04 - 00:04:08:20
Nancy Myers
And I would think that in addition to impacting our physical health outcomes, just being food insecure, especially in terms of access to just enough calories, has an impact on kids in terms of their mental health, too, and their sense of well-being. Do you see that in the work that you're leading?

00:04:08:22 - 00:04:33:14
Stormee Williams, M.D.
Oh, absolutely. There's been some studies out there that shows that kids who are food insecure, they're more likely to have mental and behavioral health issues. In fact, we've seen it firsthand. I have a very dear mentor of mine who's a pediatric emergency medicine physician, who told me about a story of a patient who came into our emergency room.

00:04:33:14 - 00:04:53:13
Stormee Williams, M.D.
She was seen, unfortunately, for trying to take her life, and she was only ten years old. And when she spoke to one of our counselors who asked her, did you really want to take your life? She said, no, but if I'm not here, they'll have enough food to feed my baby brother. And so that just is an extreme case.

00:04:53:13 - 00:05:23:09
Stormee Williams, M.D.
But when you think about children and the toll of what, you know, inadequate access to food and just financial resources and what that does to a family, we think as parents that we are keeping those needs away from the kids, but they hear it and they feel it. And also, food insecurity impacts kids ability to learn. We've all heard the term and we've used the term "hangry," right, when we're hungry.

00:05:23:10 - 00:05:44:26
Stormee Williams, M.D.
Remember that those ads like you need a snicker. But we've heard those terms. And we felt those terms to get a little irritable. Before a child that could look like behavioral issues, that could look like hyperactivity. But imagine trying to perform on a standardized test or to sit still. And so these are the types of things that children experience.

00:05:45:01 - 00:06:13:21
Stormee Williams, M.D.
But we see it in so many different forms in the health care system as well. So, it makes so much sense for health care providers, for hospitals to not necessarily say we want to take this on and tackle or solve food insecurity, but how can we partner with those organizations who are tackling these issues and say, we want to partner with you to see how we can stand in the gap for our patients and their families.

00:06:13:24 - 00:06:23:28
Nancy Myers
So you said that you have a two pronged approach within Children's Health. Tell us about what is the approach that you're taking to support children?

00:06:24:01 - 00:06:53:24
Stormee Williams, M.D.
Yeah. So first it all started with screening our patients for their non-medical drivers of health. We call it our social drivers of health screening. We started that back in 2022 as systematic digital screening for those needs where when they have a patient that's coming in for an appointment and if they're being seen in our emergency department or even as an inpatient, they received a digital screening tool through our electronic health record.

00:06:53:24 - 00:07:17:15
Stormee Williams, M.D.
And they can, within the privacy of their own device, just answer a few questions about those needs, whether or not they worry about food running out or food has actually run out. And of course, we ask them about other needs, including housing insecurity, financial strain as it relates to paying their utility bills or transportation issues, getting to and from appointments and things like that.

00:07:17:15 - 00:07:39:04
Stormee Williams, M.D.
And then if they do have a need, we can either just give them a list of resources or if they ask to speak to someone, we can connect them with one of our members of our care management team, which includes our social work team or our social work extenders. We call them our family resource coordinators. Based on that information,

00:07:39:06 - 00:08:10:04
Stormee Williams, M.D.
we've had the fortunate opportunity to screen over 250,000 families over the last few years, and we have access to a lot of information. And food insecurity remains in the top three needs of our patient families. And what do we do with that? We can't, you know, just sit on that information. And we're so thankful and grateful because our executive leaders of our hospital system, along with our board of directors, said that they want to do something about this.

00:08:10:04 - 00:08:40:04
Stormee Williams, M.D.
And so we have partnered with the community and said, like, there are some organizations out there who are already doing some really great work. So we partnered with a food bank here in the area and said, how can we support you to meet the needs of some of our patients? And so that's really the approach of screening families and then connecting them with resources that are already doing the great work and helping our families to get connected with those resources.

00:08:40:07 - 00:09:03:28
Nancy Myers
So I want to kind of dwell for a moment or two on that concept of partnership and collaboration. You know, health care and health is a team sport. And I think you said earlier hospitals can't do it all themselves. How has the act of partnering to better support the children and families in your community made your program stronger and more effective?

00:09:04:00 - 00:09:08:07
Nancy Myers
Talk about kind of the benefits of partnered approaches.

00:09:08:14 - 00:09:37:00
Stormee Williams, M.D.
Yes, I, I can't stress that enough. We pride ourselves on the work we do, of course, within the hospital, the walls of the hospital. But we pride ourselves as much on the work we do outside of the walls of the hospital as well. We are fortunate to have led a program known as our school based telemedicine program, that has been in existence since 2013, and what that is, is a program in schools.

00:09:37:00 - 00:10:11:10
Stormee Williams, M.D.
We're in over 260 schools in the Dallas-Fort worth area, in more than 30 school districts, actually in the area. And so we leverage that partnership with schools to say that we want to make sure that kids are benefiting from the partnership with the food bank. So we went and were able to leverage that relationship that we've already had and that we've built over a decade and had the food bank go to one of those schools and say, how can we leverage this relationship and put a food pantry right in one of these existing schools?

00:10:11:10 - 00:10:56:16
Stormee Williams, M.D.
So again, leveraging the data that we had, we knew exactly where some of the most needy areas were. So we looked at zip code data from our social needs screening or our non-medical driver screening, and could really drill into the top zip code that that was needed and put a food pantry right in one of the schools that we already had an existing partnership with. That relationship that we've built, like I said, for over a decade with schools, is really what helped us to get the ball rolling so quickly is because we already have that relationship, and because we've had these trusting relationships and collaborations with the North Texas Food Bank, it was really

00:10:56:18 - 00:11:30:03
Stormee Williams, M.D.
easy. But, you know, to be able to pick up a phone or send an email to someone you already have a relationship with, and to say that we want to expand, it was really not even difficult to do. Again, there's so many community based organizations who - that is their sole purpose - is to close those gaps. So to let them know that we want to right in line with what they're doing to help them expand their mission, it really just it's really like a no brainer for both of us to do that.

00:11:30:04 - 00:12:04:09
Nancy Myers
And, you know, the power of the data that you have, you've screened a quarter of a million children so that you can identify where those needs are highest. And that is then allowing those community partners to be more effective in targeting their delivery of services. I love that you've been able to use your data to bring food to where the children are, to make it easier for children and their families to access that food, and to probably decrease stigma too, I would imagine.

00:12:04:12 - 00:12:30:28
Stormee Williams, M.D.
Yeah. And, you know, and it's so great because we've been so intentional with all of our programing, right? One of the reasons we were in that particular school for the school based telemedicine program is because that is an under resourced area that needed access to primary care and acute care visits for kids. And that is why we were in that school for school based telemedicine

00:12:30:28 - 00:12:57:12
Stormee Williams, M.D.
so it made sense that that would also be an area that needed additional support for food, right? And again, it's kind of this this feedback loop of putting resources where those resources are needed. And the more we can kind of wrap our hands around that particular neighborhood, they kind of expect to see us. And what we've also seen is that now they look to us for so many other things.

00:12:57:12 - 00:13:15:03
Stormee Williams, M.D.
So we've done, you know, expanded career days in that school. And they now they know to pick up the phone for us and say, hey Dr. Williams, can you come? We're having this day and we're having that. We want you to come and read to the kids, because again, it's just expanding on an already fruitful relationship in that community.

00:13:15:06 - 00:13:31:27
Nancy Myers
Well, and that kind of reach back to you from the community certainly is a measure of success. What other ways are you looking at outcomes to understand what impact you're having with the food insecurity programing?

00:13:32:00 - 00:13:56:25
Stormee Williams, M.D.
Yeah. So that's the beauty of data. And this is actually the first year that we've had that particular program. So we're looking to see kind of what the impact of that work will be. We have another pilot that we've started inside the walls of the hospital, where we are connecting families who are food insecure with meal support, while their children are inpatient, where they are admitted into the hospital.

00:13:56:26 - 00:14:25:03
Stormee Williams, M.D.
So that'll be a little easier to track. With the data that we have is a little harder in the community, obviously, to track that information, but we're hoping to do that with the North Texas Food Bank. Another initiative that we do is with helping families to get enrolled with SNAP benefits. Once they're, you know, outside of our patient care, it's a little harder to track success and impact, but we hope to be able to do that.

00:14:25:06 - 00:14:41:07
Stormee Williams, M.D.
You know, there's so many different factors that are involved with food and financial security currently. We're tracking all of this. We see these numbers actually increasing over the last 2 or 3 years, so it's kind of hard to tell. But we definitely are looking at the data.

00:14:41:09 - 00:15:01:14
Nancy Myers
Dr. Williams, thanks so much for that insight and for all that you've shared today and for the work that you and your team are leading at Children's Health every day. To our audience, I want to say thank you for joining the conversation and for your commitment to improving health in the communities that you serve. Be well.

00:15:01:16 - 00:15:10:12
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.

00:00:00:06 - 00:00:18:22
Tom Haederle
Welcome to Advancing Health. Now in its 10th year, #HAVHope Friday is a national day of awareness to end violence, both in communities and in the hospital workplace. In this podcast, we get a progress report on how one health system is meeting that goal.

00:00:18:25 - 00:00:39:25
Jordan Steiger
Hi, my name is Jordan Steiger and I'm the director of Behavioral Health and Violence prevention at the AHA. We're here today to talk with Sarah Hunter, the president of Gottlieb Memorial Hospital, about AHA's #HAVHope day, which is happening this year on Friday, June 5th, and some of the work she and her team are doing at their organization to support workplace violence prevention.

00:00:39:26 - 00:00:41:21
Jordan Steiger
So, Sarah, welcome to the show.

00:00:41:24 - 00:00:43:18
Sarah Hunter
Yes. Thank you for having me. Excited to be here.

00:00:43:19 - 00:00:48:09
Jordan Steiger
So tell us a little bit just about who you are and where you come from.

00:00:48:12 - 00:01:04:16
Sarah Hunter
I am Sarah Hunter. I am the president at Gottlieb Memorial Hospital, which is a part of Loyola Medicine in the Chicagoland area. Our parent company is Trinity Health, based out of Michigan. So I've been here for just over six months, but have been in the area in healthcare administration for a long time.

00:01:04:17 - 00:01:10:10
Jordan Steiger
And I'll add, you are a member of AHA's Hospitals Against Violence Advisory Group.

00:01:10:10 - 00:01:15:08
Sarah Hunter
I am, it's a great honor to be a part of that advisory group. It's been a lot of fun and interesting so far.

00:01:15:12 - 00:01:32:18
Jordan Steiger
Yes, we love having you. So, and I mean to mention that you are so passionate about improving outcomes around workplace violence. And so we wanted to get you here today to just tell us a little bit about some of the work that you're doing at your own organization and how you're supporting your workforce.

00:01:32:25 - 00:02:00:03
Sarah Hunter
Yeah, I am very passionate about this topic. I find that supporting and building a safe environment for our healthcare workers is one of the top callings that we have in healthcare today. At Loyola Medicine, we've been really focused on building the environments that really care for our caregivers in all ways, and that includes avoiding workplace violence, supporting them if an incident happens, and really making sure that we build the right type of awareness around the issues that are facing our healthcare workers today.

00:02:00:03 - 00:02:03:09
Jordan Steiger
And tell us what you think some of those big issues are.

00:02:03:12 - 00:02:24:13
Sarah Hunter
So, you know, I think, you know, the world has changed. You know, and healthcare in particular, has really changed over the last decade or so. And the people that we are seeing in our within our walls are becoming more and more complex. And that lends itself to some situations that can sometimes get dangerous. There are a lot of different factors that influence how we care for a patient and their mental health.

00:02:24:13 - 00:02:49:09
Sarah Hunter
Their ability to escalate can really be something that takes its toll on our colleagues that are here within our system. So for me, you know, in leadership and administration, it is really our job to build good processes that support our colleagues, to make sure we're mitigating risk, to provide education, to build awareness both inside the hospital, outside the hospital, and to make sure that we're offering meaningful support and intervention when necessary.

00:02:49:12 - 00:02:52:02
Jordan Steiger
What does that look like, like in the day to day?

00:02:52:09 - 00:03:09:21
Sarah Hunter
Part of why I have so much hope, you know, for where we are going with reducing workplace violence is it's really about listening to the colleagues who do the work. Here at Loyola Medicine, we have really strong interdisciplinary support from our frontline colleagues about the things that make a difference to them day to day. I'll give you one example.

00:03:09:26 - 00:03:28:12
Sarah Hunter
Across our system at all three hospitals, we instituted what we call a buddy system, which is a really simplistic way of looking at a process that we've really used to improve the safety for our colleagues. It really involves starting at the front door of our hospital and making sure that we are assessing patients for their risk to escalate.

00:03:28:13 - 00:03:51:13
Sarah Hunter
We use a standardized tool, which is very common in healthcare, but we've applied it to behavior as well to know if a patient could possibly escalate to aggressive situation. From there, we mitigate the situation with a number of things, including, you know, making sure there's a visual cue for staff that this person could be somebody that would escalate, making sure that we're respectfully searching any belongings and being mindful of visitors that come into the space.

00:03:51:13 - 00:04:20:10
Sarah Hunter
And really, what's been the most impactful part of this process is that for these patients, in these situations where there might be a danger, our colleagues never enter those rooms alone. And so our public safety team, who's a great partner with us here for our clinicians, goes into those rooms with our clinicians, with our EDS personnel, with food and nutrition to make sure there's a second person in that room that could be a potentially, you know, bad situation for those moments that could escalate.

00:04:20:10 - 00:04:33:08
Sarah Hunter
And that has led to increased trust. It's safer for the patients, it's safer for our colleagues, and really, most drastically has reduced any sort of adverse outcome, any workplace violence towards our clinicians in the last year.

00:04:33:10 - 00:04:52:18
Jordan Steiger
I love that everything you just mentioned doesn't cost a ton of money. Building that trust through having support, you know, having a buddy person to come with you, you know, in a room or those visual cues. Those are all things that I think lots of different organizations could do. You mentioned some of those evidence based tools that you can use to assess risk.

00:04:52:20 - 00:05:03:20
Jordan Steiger
And those are out there. You know, those are out there for anybody to use. And I know a lot of our members are using those already, but I think there's still opportunity to kind of think about how we can use those resources that are available to us.

00:05:03:22 - 00:05:34:08
Sarah Hunter
Yeah, absolutely. And I think you hit on it just there to that trust is really the biggest part of this equation. It's amazing what people do when they start to have trust with one another across disciplines in a hospital setting, or every spoke of that will really matters for patient care. And when you introduce complex situations like a potentially aggressive or violent or dangerous situation that could result in harm, that trust becomes very, very critical and really is the cornerstone, I think, of healthcare and where we need to go.

00:05:34:15 - 00:05:51:10
Jordan Steiger
Absolutely. And you know, when you're talking about trust, too, I think about the community and, you know, the patients and families coming into your organization to get care that's going to enhance trust with them, too, if they know that they're going to be safe and get the care they need without having all of these kind of external factors.

00:05:51:12 - 00:06:18:03
Sarah Hunter
Absolutely. And I also just to add, the patients that come in that need our care sometimes are not at their best state, often are not in their best state, right. And so this gives our caregivers the latitude and the space to connect to their purpose of why they're here in the first place. They are here to take care of patients, to make sure they're giving that life saving care, whether it's an emergency room or a labor and delivery unit or an inpatient unit, wherever that might be, an ambulatory setting.

00:06:18:03 - 00:06:41:02
Sarah Hunter
And these types of factors are worrying about what could happen, really can get in the way of that good care. And so the processes like the ones that we've developed here, and we've seen great success in really help navigate that. So caregivers can do their jobs and feel like they can go home and stay safe and feel like they've done a good job that day, and they've cared for the people that they came to care for.

00:06:41:04 - 00:07:02:12
Jordan Steiger
Absolutely, absolutely. I think that's just so important for mental well-being, for, you know, feelings of psychological safety, for wanting to come to work and feeling good being at work. And like you said, just being able to deliver the care that they need to deliver, whether that's clinical care or, you know, providing care through administrative work or EDS or I mean, there's a million different ways.

00:07:02:18 - 00:07:20:24
Sarah Hunter
Yeah. So I think, you know, for us it is about continuing this good work. We want to make sure we continue to develop processes that we get the right people around the table to have conversations about workplace safety, continuing to really monitor and adapt and evolve to the communities that we serve into the situations that we might be in.

00:07:20:26 - 00:07:46:13
Sarah Hunter
You know, I think workplace safety really expands not only from the hospital setting, but to the larger community, to the ambulatory network, to home health and hospice, making sure that we're developing, again, the right processes, the protocols, the right training, the right education. There are a lot of really phenomenal tools out there that we can use to keep our workforce safe, and it is the future for us to be able to use those in a way that really makes a difference.

00:07:46:15 - 00:08:24:01
Sarah Hunter
I think beyond that, our community partnerships are becoming more and more critical. We partner very closely here at Loyola Medicine with our local public officials, with public safety officials, with our elected officials, to make sure that there's a mutual understanding of the priorities of both parties so we can align and work together. The critical partnership locally in each of our hospitals communities is our local police department, fire service, our local first responders. Police department in particular, has been really beneficial for us because we can partner on safety drills, on making sure that they understand the inner workings of places like our emergency room

00:08:24:01 - 00:09:03:08
Sarah Hunter
so if there is an incident, they can respond. I think getting to know our team, our leadership style also helps because when they come into a difficult situation, they already know how we operate and how we work, and it's much easier for them to support our teams if we've built up that relationship. I think the second really influential partnership that we have is with advocacy groups and organizations like the Illinois Hospital Association and the American Hospital Association, who gives us a plethora of resources to make sure that we are implementing best practices, that we're thinking really strategically about workplace safety, that we're looking meaningfully at trends in the industry.

00:09:03:08 - 00:09:09:08
Sarah Hunter
And that is something that we utilize often to help our conversations and our advocacy efforts.

00:09:09:10 - 00:09:27:08
Jordan Steiger
Absolutely. I'm glad you brought up the advocacy piece. That's such an important part of this conversation, and it's something that everybody can do, and AHA has a ton of resources to help you do that. But yeah, I'm glad you brought that up. I think the community partnership piece is also so important. Just acknowledging that we don't have to do this alone

00:09:27:08 - 00:09:34:18
Jordan Steiger
as hospital leaders. There are a lot of people in the community that we can work with and partner with to make our hospitals safer, but also our community safer.

00:09:34:22 - 00:09:48:25
Sarah Hunter
Safe hospitals, safe healthcare is a key part of safe communities, right? They go hand in hand. And so to think that we are in it alone would be foolish when the best thing that we can do is partner and find those partnerships that can make a lasting impact.

00:09:48:25 - 00:09:54:15
Jordan Steiger
And last question for you today. How are you spotlighting #HAVHope Day on June 5th?

00:09:54:18 - 00:10:11:14
Sarah Hunter
So we are going to spotlight it by really talking about it. So we want to talk to our colleagues about why they have hope, what they've seen change in their work environment, really talk about the processes that we've implemented that have kept them safer than they have before, than they've been before. That'll be a big part of what we do.

00:10:11:14 - 00:10:27:21
Sarah Hunter
And I think, you know, even beyond that, you know, we'll be partnering with the AHA. We also want to take part in having a strong presence on social media and public facing to talk about why we have hope in the organization and what we are doing about workplace violence and how what we are doing to address it.

00:10:27:24 - 00:10:43:20
Jordan Steiger
Sarah, thank you so much for being here today and sharing a little bit about the work you're doing. I think this really does spread great knowledge and great hope to our other members, and maybe gives them some ideas of things that they can do on Friday, June 5th for #HAVHope Day. So thank you for being here.

00:10:43:27 - 00:10:46:08
Sarah Hunter
Thank you again for having me.

00:10:46:10 - 00:10:55:04
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;10 - 00;00;19;03
Tom Haederle
Welcome to Advancing Health. The demand for behavioral health services continues to grow, and providing the necessary resources can be a challenge. In this Leadership Dialogue podcast, we learn how a New England health system is navigating these issues and delivering for its patients.

00;00;19;06 - 00;00;52;06
Marc Boom, M.D.
Greetings and thank you everyone for joining me today. I'm Marc Boom, the president and CEO of Houston Methodist and the board chair of the American Hospital Association. As we continue this set of discussions, we're going to focus today's conversation on the very critical issue of behavioral health. Behavioral health has long been, unfortunately, both stigmatized and underfunded. And yet, with the mental health crisis in our country worsening, the hospital field should innovate and advocate for solutions to help both patients and families, as well as our own caregivers, who have seen increased rates of anxiety and burnout.

00;00;52;07 - 00;01;16;11
Marc Boom, M.D.
I know at Houston Methodist, as with many other organizations, we are very dedicated to caring for our patients overall health, their physical and their emotional well-being. We've embraced a holistic, collaborative approach to incorporating behavioral health services into the organization and offer both inpatient and outpatient programs and services. Our caregivers work collaboratively in a team based structure that allows them to draw on clinical expertise and medical innovation.

00;01;16;13 - 00;01;38;16
Marc Boom, M.D.
So today, I am pleased to be joined by Dr. John Santopietro, an expert in the field. Dr. Santopietro is currently the senior vice president and physician- in-chief at Hartford Healthcare's Behavioral Health Network. Before that, he was president and medical director of Silver Hill Hospital and had served on the AHA's Committee on Behavioral Health and the Regional Policy Board.

00;01;38;17 - 00;01;46;18
Marc Boom, M.D.
So let's jump into our discussion. John, I look forward to learning from your expertise and hearing about the opportunities innovations you're seeing. Thanks for joining us today.

00;01;46;20 - 00;01;56;20
John Santopietro, M.D.
Well, thank you for having me. And thank you for centering behavioral health. And it sounds like you guys are doing amazing things in your system to make sure you're giving excellent care. So I'm honored to be here.

00;01;56;23 - 00;02;06;16
Marc Boom, M.D.
Well, fantastic. Well, I'd love to hear a little bit more about the Hartford Health Care Behavioral Health Network, what it encompasses, what's led to your current structure and approach?

00;02;06;19 - 00;02;30;21
John Santopietro, M.D.
Yeah, so not unlike your system, at Hartford Healthcare, we are very focused on behavioral health. So just briefly, I'm a psychiatrist. I took a course on Freud when I was a sophomore in college, and that was it. I loved doing the clinical work, but my first job was in an inner city hospital just outside of Boston about 26 years ago, and I saw how broken the system was, and I couldn't stay out of the fight to make things better.

00;02;30;21 - 00;02;55;28
John Santopietro, M.D.
So that's sort of my leadership journey. I've been in a number of systems, always focused on bringing the best care to the most people. I've been at Hartford Healthcare for going on seven and a half years now. So Hartford Healthcare is about a $7.5 billion integrated delivery system, not for profit in Connecticut. But even for a system that size, we have a almost an outsized engine of behavioral health.

00;02;55;28 - 00;03;24;19
John Santopietro, M.D.
So we have 4,000 people working in behavioral health in our system. We do about going on 700,000 outpatient visits a year, going on almost 200,000 inpatient days a year. We have education, we have three residencies, we have fellowships. We actually have a fair amount of research for an organization like ours. So since 2007, we're upwards of $100 million worth of behavioral health research just in this system.

00;03;24;19 - 00;03;33;14
John Santopietro, M.D.
So it's an incredible chassis, so to speak, for what I'm trying to do in my leadership and behavioral health, again, which is the best care to the most people.

00;03;33;20 - 00;03;38;19
Marc Boom, M.D.
That's amazing. So $100 million in research, where is that funded from?

00;03;38;19 - 00;04;09;09
John Santopietro, M.D.
Mostly places like NIH and NIMH, but also substance use agencies and local foundations. And we do also have some industry sponsored drug research going on from time to time. But primarily it's from NIH and NIMH. We actually just got an $8 million grant from NIH to enhance our research facilities. We're working in this one laboratory on what's called bio typing.

00;04;09;09 - 00;04;32;25
John Santopietro, M.D.
So, as you may know, in psychiatry, we're really good at what we do, but we're not precise. There's no blood tests that you can give somebody that says they've got PTSD or bipolar. But bio typing is a way of using a variety of different biomarkers to be able to identify populations outside of the normal way that we do it, to be able to classify them and figure out who's dealing with what.

00;04;32;27 - 00;04;49;28
John Santopietro, M.D.
Under the leadership of Godfrey Pearlson, who's been leading our neuroscience lab here for 20 years, he's one of the primary researchers in something called BESNET. And especially these days, to be getting that kind of funding from NIH is fantastic. So very, very proud of that.

00;04;50;02 - 00;05;11;21
Marc Boom, M.D.
That's quite amazing. Everything you've been able to accomplish and really the how robust the program is...really very multifaceted. So I know part of what you do then to build such a robust program is recruiting behavioral health care givers, which we know are in shortage across the country. So you must struggle with that even in an institution like yours.

00;05;11;23 - 00;05;16;14
Marc Boom, M.D.
I'd love to hear some advice and some steps you take to address those issues.

00;05;16;19 - 00;05;36;06
John Santopietro, M.D.
Yeah, it's a great question Marc. And we are not immune from, you know, having to deal with the job market. And there is an undersupply of the workforce in behavioral health, everything from psychiatrists, PRNs, to social workers to psychiatric nurses. You know, I have to say, first of all, being in a place where you're doing amazing, innovative things is very important, right?

00;05;36;09 - 00;06;00;15
John Santopietro, M.D.
That obviously helps. And we have a fantastic talent acquisition department, which we couldn't work without. Some of the other things that I've found in recent years that are very important and working for us. One is to recruit fantastic psychiatric leaders, because if you recruit great leaders, the people will come. And we've had an academic system, but we're not a medical school, so we're still community oriented.

00;06;00;16 - 00;06;28;03
John Santopietro, M.D.
This is a place where people can come and do what they want to do to make a difference and have impact, without necessarily having to jump through as many hoops as they would in an academic system. So we have this nice, sweet spot for recruiting psychiatric leaders. And that's one of the things that's been important. Another thing is that our HR department and talent acquisition have worked on some very innovative programing. For instance, social workers.

00;06;28;03 - 00;06;52;23
John Santopietro, M.D.
So these days, and you probably know for the work that you do and just the market, it's hard to compete with online virtual, you know, therapy organizations that, you know, I commend because they're getting out there, you know, needed treatment for people that have no treatment. But it's hard for folks like us working in systems to compete with some of the flexibility around, I can just work virtually and that sort of thing.

00;06;52;23 - 00;07;21;11
John Santopietro, M.D.
So one of the things that they have done is they've started a mentorship program for therapists and social workers. And they have events throughout the year, including now what's become a fairly sought after summit. There's like a summit for the interns that we have in social work and some of the trainees that we have, and we set aside a day and we invite people from the community, and it's become an incredible event.

00;07;21;12 - 00;07;47;16
John Santopietro, M.D.
Also, things like there's one called Coffee and Careers, and I think that's specifically focused on women who are in positions of leadership and inspirational, really making themselves accessible on a regular basis. So lots of things going on. I can't say enough about having your own training programs. In addition to we have internships for psychology and for social works, we now have three -

00;07;47;23 - 00;08;12;09
John Santopietro, M.D.
I may have mentioned - adult psychiatric residencies, and we have, you know, fellowship in addiction medicine and consult liaison psychiatry. So not only does that mean you'd be graduating young doctors who know your system, but you're also creating the kind of workforce that you're going to want in your system. So that's very helpful.

00;08;12;11 - 00;08;25;24
Marc Boom, M.D.
It's fantastic. I want to ask a question about innovating and transforming and says, I've heard a lot about that already, but one of your programs I know is a radical recovery program, which is something you all have done on a very innovative front. Tell me more about that.

00;08;25;25 - 00;08;47;26
John Santopietro, M.D.
Yeah, well, I'm so glad you found that. And you asked that question, and it's a catchy term and I wanted to catch on. Those listening who know about behavioral health know the term recovery. That term has been sort of an industry term for, you know, maybe 20 years for us. And that term itself came out of the movement of advocates for patients, basically.

00;08;47;27 - 00;09;12;22
John Santopietro, M.D.
And they stood up and said, when you build systems, we need to be at the table and we need to be part of this emerging movement of recovery. So radical recovery is a concept that was originated by one of these amazing psychiatric leaders that has come here named Dr. Javid Sukhera. And you can Google him and you can look for him on X and social media.

00;09;12;23 - 00;09;42;04
John Santopietro, M.D.
He's a thought leader that came out of he was in Canada, up in Toronto, and he's an educator. You know, some of the research that we're doing out of some of his research here at the Institute of Living - which is our flagship psychiatric hospital in the system, we have four behavioral health campuses, but that's the largest - is taking down the walls, so to speak, reaching into the community, co-designed programing and research with people with lived experience in the community.

00;09;42;06 - 00;10;11;16
John Santopietro, M.D.
One of the things that's falling under this umbrella of radical recovery is the notion of deprescribing. Again, that might be an industry term in behavioral health. What that means is an acknowledgment that even with all we know, we still over prescribe medications. We also under prescribe them, by the way. So it's not only that we over prescribe them, but the psychiatrists out there will be familiar with, you know, when you're picking up a patient and you see that they're on a list of 11 medications, and what is this about?

00;10;11;16 - 00;10;26;01
John Santopietro, M.D.
And this steps back and says, okay, wait a minute. Let's not just be reactive. Every time somebody has a symptom, we're going to put them on a medication. Let's try and understand what's going on with them and their families. Who is this human being within the patient, so to speak?

00;10;26;04 - 00;10;58;08
Marc Boom, M.D.
I'm actually geriatrics-trained. So we do a lot of deep prescribing in the geriatrics realm as well. Honing in and really focusing on medications, so that makes a lot of sense. In 2026, I can't ask a question without bringing AI into the mix, of course, right? So it seems to me AI has incredible promise. We heard a little bit about technology and virtual and things, but where's the promise of AI for both health care delivery in behavioral health, but also the operations part of that, and then also some of the treatment of the mental illness and addiction?

00;10;58;11 - 00;11;21;14
John Santopietro, M.D.
Yeah. And I imagine, you know, many are familiar or tracking formally or informally this idea about AI, you know, therapy. And so that's one thing it's probably worth touching on. But also even before that, you know, practically what we are using now with AI and many systems I think are thankfully is a way to transcribe, you know, notes.

00;11;21;14 - 00;11;44;20
John Santopietro, M.D.
We don't do a lot of procedures, we do some in psychiatry. But one of the things that slows us down in our day to day operations is doing notes. So we are currently engaged with a company that has a product that we use to transcribe notes. And so you can stay focused on the patient. Imagine in psychiatry and behavioral health and therapy to be on the computer and not making eye contact.

00;11;44;20 - 00;12;04;26
John Santopietro, M.D.
So that practically is something we are already using. To talk for a minute about the AI therapy, I think all of us in the field are tracking that very carefully. On the one hand, there's a part of us that has some healthy suspicion about some of the things that can go awry with having therapy with an AI agent.

00;12;04;29 - 00;12;25;14
John Santopietro, M.D.
People are seeing in the news reports with some regularity, but not every day about some kind of bad outcome. And these patients come to us opening up in their deepest moments of insecurity and suffering and doubt and thoughts of not being around. And sometimes it can be made worse. So I don't think anything is ready for mainstream there.

00;12;25;14 - 00;12;46;15
John Santopietro, M.D.
I will note though, and I do track it and have friends that are very involved in it. Some of the studies are showing that the AI relationship is tracking well as compared to human relationships, and when you measure things like therapeutic alliance, it's very interesting to follow that. I think first of all, we need to learn from that,

00;12;46;16 - 00;13;08;14
John Santopietro, M.D.
what does that mean? What does that mean about what we can do in our work better? And let's track it carefully. The system, however, is off and running outside of behavioral health. You know, with AI, including having recently launched our own, working with another company, basically like a chat GPT for patients. I think the name is Patient GPT, and it links even into the medical records.

00;13;08;14 - 00;13;31;01
John Santopietro, M.D.
So it's a personalized experience with agentic AI and the person who leads innovation for our system, Dr. Barry Stein, is just astonishing in what he has done in the last decade or more to build an ecosystem that is attracting incredibly innovative companies that want to do work with us. So we're very excited about a lot of those things going on.

00;13;31;01 - 00;13;49;23
John Santopietro, M.D.
But in behavioral health, outside of the dictation and of course, we should mention virtual. It's not AI, but it is technology. We were at least over the hump now after Covid and using that with much more regularity, which is fantastic for making our care more convenient to patients.

00;13;49;26 - 00;14;03;05
Marc Boom, M.D.
A lot of mind boggling things there. You know, I think there's a real role in loneliness and coaching and sort of longitudinal things that just are not achievable with a health care professional. What do you think about that comment?

00;14;03;07 - 00;14;28;11
John Santopietro, M.D.
Yeah, I agree, I remember hearing this term about the "white space" in between, right? You know, I'm still seeing patients and I luckily have some flexibility in my schedule where if I need to see somebody in a week, I can see you in a week. And sometimes I don't see somebody for three months. Their life happens in the white space in between appointments, and we don't effectively reach them in that space.

00;14;28;12 - 00;14;52;12
John Santopietro, M.D.
And that can be everything from, you know, wearables that track passive data and feed that into algorithms that might suggest some of the organizations we have been thinking with look at that. Is there some way that you could predict that somebody is headed toward a mood episode based on what time are they going to sleep, and what's their heart rate and maybe even galvanic skin stuff or tone of voice.

00;14;52;12 - 00;15;13;15
John Santopietro, M.D.
So there's a lot of really interesting stuff going on in that area. And I'm not the expert, but somebody within the system looking at this and seeing many organizations, companies and startups come in with great ideas that only sort of have an arc, and then it doesn't work out. I'm not sure that anyone's figured that out yet -

00;15;13;17 - 00;15;33;18
John Santopietro, M.D.
the white space problem in behavioral health. But I think we will. What they have figured out, the market has, is this virtual therapy, virtual psychiatry. Again, I think that is really filling a need in the community and the market and challenges us in systems to keep pace with the convenience of it.

00;15;33;23 - 00;15;53;26
Marc Boom, M.D.
Well, I want to thank you. It's been a fascinating conversation. I want to wrap up with one brief question, give you a chance to toot your horn a little bit, but also question that really gets right to the core mission as hospitals are delivering safe, high quality health care to the patients and human beings we serve. I know you all received the Quest for Quality award last year, and that's really about you

00;15;53;26 - 00;15;59;15
Marc Boom, M.D.
advancing high quality, evidence-based behavioral health programs. Could you give us just a little snippet about that.

00;15;59;16 - 00;16;24;09
John Santopietro, M.D.
Yes. And Jeffrey Flaks, our CEO, will be very glad that we've mentioned that. He's so proud of it. And Dr. Ajay Kumar, who was central to that in his physician leadership role in the organization. Yeah, very proud of that. And, you know, as you as you know, in behavioral health because it's not precise, one of the challenges for us is the quality measures that we have to work with right now that are reportable.

00;16;24;09 - 00;16;46;06
John Santopietro, M.D.
And all this tend to be more process measures at this point. Right? So if somebody comes in with a concurrent tobacco use disorder with their bipolar, did we offer them treatment for tobacco? Or what's your readmission rate and what's your seclusion and restraint rate? Those are all incredibly important by the way. And we work on them and we drive them in the forward direction.

00;16;46;06 - 00;17;12;15
John Santopietro, M.D.
Our teams are doing that. But at this point, because of the under utilization of behavioral health, because 1 in 4, 1 in 5 people have a behavioral health issue today in the country, less than half of them make it to treatment. First of all, access is quality. So getting people into care is quality. They're getting no care. And we really boy, in terms of pride, it is not easy to fill every bed in psychiatry.

00;17;12;15 - 00;17;43;20
John Santopietro, M.D.
In behavioral health we have limitations with physical plant. There's behavioral issues. Our teams have worked extraordinarily hard over last several years. Increased access by 20 to 30%. But one other thing I will mention is that we find this very effective quality tool that Dr. Kumar has used across the system. We call them clinical councils. So it's a group of experts and interested, passionate people within the system, different disciplines that get together to work on a clinical problem and drive it forward.

00;17;43;20 - 00;18;06;16
John Santopietro, M.D.
We have several in behavioral health. One of them is on psychosis. So we've been focusing on psychosis. Why psychosis? Well, among other things, it's more discreet than some of our other disorders, a little bit easier to identify. But more importantly you can have huge impact if you intervene early. If you detect it early, intervene early with evidence based practices.

00;18;06;16 - 00;18;32;23
John Santopietro, M.D.
And if you reduce what's called the duration of untreated psychosis - the DUP. Studies are very clear the impact on that human beings life is incredible. So we have Dr. Tobias Wasser, another one of these incredible leaders that's come here is leading that clinical council. And that's what they're focusing on. They have work groups working on early detection, early intervention, clinical pathways, drug dosing algorithms, wraparound services.

00;18;32;23 - 00;18;55;10
John Santopietro, M.D.
And they're beginning to put things into place and beginning to set the standards. And if we do this well, there is some possibility that we could reduce the incidence of schizophrenia, say, in our population. And so it's a bold, audacious goal and lots of energy going into it. Lots of pride. So very happy to be able to talk about it.

00;18;55;11 - 00;19;19;20
Marc Boom, M.D.
That's a very welcome big audacious goal. Wouldn't that be a fantastic thing? Well, thank you very, very much for your time today. It's been a fascinating conversation. I've learned a ton. I know our viewers will have learned a ton as well. So huge thanks for being here today. And thank you to all of you as viewers for taking the time to watch and listen, and we'll look forward to seeing you next month for another Leadership Dialogue conversation.

00;19;19;22 - 00;19;28;16
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.