1 00:00:05,075 --> 00:00:06,565 This is the Becker's Healthcare Podcast, 2 00:00:06,635 --> 00:00:08,245 created by the team of Becker's Healthcare, 3 00:00:08,405 --> 00:00:11,445 a multimedia company devoted to the people who power us healthcare. 4 00:00:11,755 --> 00:00:15,725 Four new 15 minute episodes are released daily containing industry news analysis 5 00:00:15,725 --> 00:00:19,405 and thought leadership from powerful healthcare decision makers Support our show 6 00:00:19,545 --> 00:00:23,485 by leaving it a five star rating and review on Apple Podcast or other platforms 7 00:00:23,485 --> 00:00:23,995 you use. 8 00:00:23,995 --> 00:00:27,085 It's a chance to tell us what you like about the show and act on your feedback. 9 00:00:27,085 --> 00:00:29,045 Thanks for listening. Now here's the episode. 10 00:00:31,395 --> 00:00:33,725 This is Laura Dedo with the Becker's Healthcare Podcast. 11 00:00:34,225 --> 00:00:36,405 I'm thrilled today to be joined by Dr. Mara Mitu, 12 00:00:36,985 --> 00:00:40,685 the Vice President and Chief Medical Officer at Riley Children's Health. Dr. 13 00:00:40,735 --> 00:00:42,725 Nitti, it's a pleasure to have you on the podcast today. 14 00:00:43,785 --> 00:00:45,685 Uh, thank you very much for inviting me. 15 00:00:45,755 --> 00:00:50,405 It's a pleasure to be here with you and, uh, talk about our priorities at, uh, 16 00:00:50,405 --> 00:00:51,485 Riley Children's Health. 17 00:00:52,435 --> 00:00:55,165 Fantastic. Well, I'm really looking forward to what you have to say. 18 00:00:55,325 --> 00:00:58,765 I know you've got some fascinating things happening there, you know, 19 00:00:58,825 --> 00:01:02,725 and really it's such an important time right now for children's health and 20 00:01:02,725 --> 00:01:05,485 pediatric care, a lot happening in that space and, 21 00:01:05,485 --> 00:01:09,085 and definitely a very important, uh, patient population to care for. 22 00:01:09,185 --> 00:01:11,405 But before we dive into my questions, 23 00:01:11,425 --> 00:01:13,765 can you tell us a little bit more about yourself and your background? 24 00:01:15,035 --> 00:01:17,195 I, um, am originally from Romania. 25 00:01:17,435 --> 00:01:21,555 I graduated the medical school at Carol Davila in Bucharest, um, 26 00:01:22,055 --> 00:01:26,155 and then subsequently, uh, completed pediatric, uh, 27 00:01:26,555 --> 00:01:30,915 residency at SUNY at Stony Brook, and spent one year, uh, in critical care at, 28 00:01:31,055 --> 00:01:35,795 um, Cincinnati children, and then, uh, joined Riley, 29 00:01:36,295 --> 00:01:40,795 uh, children's Health immediately after training and spent here my, uh, 30 00:01:41,385 --> 00:01:42,955 last 22 years of career. 31 00:01:44,825 --> 00:01:49,405 Oh, wow. That's, you know, definitely a, a very, um, fantastic kind of like, 32 00:01:49,745 --> 00:01:52,485 um, journey that you've had in healthcare. And then two, 33 00:01:52,505 --> 00:01:56,765 to be in one place for 22 years and really grow and develop in the space. 34 00:01:56,925 --> 00:01:59,645 I can imagine things are much different now than they were when you first joined 35 00:01:59,645 --> 00:02:00,565 Riley Children's. 36 00:02:01,305 --> 00:02:04,045 You are very, very right about that. . 37 00:02:05,105 --> 00:02:08,565 Um, well, absolutely, and, and, you know, considering where we're at today, 38 00:02:08,685 --> 00:02:11,045 I know we've been through some challenging years, um, 39 00:02:11,045 --> 00:02:14,405 with the pandemic and then just, you know, other, um, 40 00:02:14,655 --> 00:02:19,005 areas that have have been hard both for children as well as, um, 41 00:02:19,225 --> 00:02:23,085 the hospital and health system at large. So I was wondering, you know, 42 00:02:23,085 --> 00:02:25,565 could you talk a little bit about some of your top priorities today? 43 00:02:25,675 --> 00:02:28,645 What do you really see as being areas where you're spending most of your time? 44 00:02:29,865 --> 00:02:32,805 Uh, while, um, the, this year, 45 00:02:32,905 --> 00:02:36,725 the top two priorities have been, uh, 46 00:02:36,875 --> 00:02:40,005 culture and team building and, um, 47 00:02:40,925 --> 00:02:44,805 specifically around team member retention and team member satisfaction. 48 00:02:45,025 --> 00:02:49,285 So that's one of the priority. Uh, the other priorities is, um, 49 00:02:49,595 --> 00:02:52,565 patient satis, patient and family satisfaction. 50 00:02:53,185 --> 00:02:58,005 The consumerism has made its way into medicine and, 51 00:02:58,105 --> 00:03:01,045 uh, we are learning how to better, uh, 52 00:03:01,115 --> 00:03:03,965 support the needs of our families and our patients. 53 00:03:05,125 --> 00:03:08,645 Absolutely. I think both areas are definitely spaces where, you know, 54 00:03:08,965 --> 00:03:11,045 hospitals and health systems across the country are, 55 00:03:11,065 --> 00:03:14,365 are looking deep into those areas and trying to figure out what's gonna work 56 00:03:14,365 --> 00:03:18,685 best for them, um, in support their growth and development in the future. 57 00:03:19,355 --> 00:03:23,085 When you look at the culture and team building aspect and especially that, um, 58 00:03:23,325 --> 00:03:24,025 retention piece, 59 00:03:24,025 --> 00:03:27,565 is there anything that you've tried over the last year or two that's, um, 60 00:03:27,745 --> 00:03:29,765 you know, has gone well or, 61 00:03:29,765 --> 00:03:32,685 or would just love to hear how you're thinking about retention and what you're 62 00:03:32,685 --> 00:03:33,518 doing differently? 63 00:03:34,515 --> 00:03:39,265 There are so many layers and so many different interventions. We are. Um, 64 00:03:39,605 --> 00:03:44,585 it, it is a very, uh, complex problem and therefore the interventions are, 65 00:03:44,765 --> 00:03:48,425 um, multi-facets and the different levels. 66 00:03:49,365 --> 00:03:51,945 The one intervention that we, um, 67 00:03:52,415 --> 00:03:57,305 founded to be most successful in terms of team member retention is to 68 00:03:57,305 --> 00:04:00,865 work with each to, to devote a lot of time in, uh, 69 00:04:00,915 --> 00:04:05,265 leadership development, both for our directors and our managers, 70 00:04:06,325 --> 00:04:10,505 and, um, provide feedback from our team member, 71 00:04:10,655 --> 00:04:13,105 real time feedback from our team members to, 72 00:04:13,245 --> 00:04:16,545 to the managers and to the directors to 73 00:04:17,895 --> 00:04:22,345 support them in, um, co connecting with their team members, 74 00:04:23,125 --> 00:04:23,815 um, 75 00:04:23,815 --> 00:04:28,785 effectively and making sure that we hear their needs and we support their needs 76 00:04:28,895 --> 00:04:32,225 real time. Uh, that has been, um, 77 00:04:32,865 --> 00:04:36,505 I would say probably the one intervention with, uh, 78 00:04:36,775 --> 00:04:41,305 biggest return on the investment from a physician standpoint, 79 00:04:41,895 --> 00:04:45,185 what we are trying to, uh, to do, um, 80 00:04:45,885 --> 00:04:50,545 in terms of better building the team with various important members 81 00:04:50,765 --> 00:04:54,545 on our clinical team is we have, um, 82 00:04:54,885 --> 00:04:57,385 an appreciation program in which you, 83 00:04:58,725 --> 00:05:01,825 you are able to go online and drop a very quick, um, 84 00:05:01,865 --> 00:05:05,305 appreciation note to any team member that you are working with. 85 00:05:05,885 --> 00:05:10,825 And we are encouraging every single one of the physicians to take the time to 86 00:05:11,185 --> 00:05:13,425 recognize not just their peer physicians, 87 00:05:13,525 --> 00:05:18,265 but more importantly different team members that have, um, done something, 88 00:05:18,765 --> 00:05:21,545 um, great that day. Also, 89 00:05:21,895 --> 00:05:26,105 part of our leadership development program, we spend a lot of time on com, uh, 90 00:05:26,235 --> 00:05:30,585 compassion encouraging our team members to show 91 00:05:31,155 --> 00:05:34,385 compassion, not just for our patients and families, 92 00:05:34,645 --> 00:05:39,585 but for each other and helping them to think about 93 00:05:40,005 --> 00:05:44,945 how that is impacting their own personal life and as well as the 94 00:05:44,945 --> 00:05:49,825 team members. It's, um, very clear that one, uh, 95 00:05:49,965 --> 00:05:54,705 who comes to work with a, um, compassionate attitude, uh, 96 00:05:54,875 --> 00:05:59,365 tries from that themselves is not just that you support the people around you 97 00:05:59,465 --> 00:06:03,805 but your own personal development, um, and wellbeing. It's, 98 00:06:03,955 --> 00:06:08,525 it's enhanced by that. So that is where we spend a lot of the time. 99 00:06:09,625 --> 00:06:12,245 And then specifically in the unit at the bedside, 100 00:06:13,025 --> 00:06:14,965 one intervention that has helped, 101 00:06:15,265 --> 00:06:19,365 and it's not an innovation people have tried that before, 102 00:06:20,185 --> 00:06:23,885 is, um, with, with good results it's heart debriefing. 103 00:06:24,305 --> 00:06:28,805 So when there is a patient related event, whether, whether it is, um, 104 00:06:29,255 --> 00:06:31,805 unexpected outcome or whether it is, um, 105 00:06:32,695 --> 00:06:36,445 unexpected complaint, um, we, 106 00:06:36,745 --> 00:06:41,605 we try to use the hot debrief debriefing methodology and encourage the 107 00:06:41,605 --> 00:06:42,345 team to, 108 00:06:42,345 --> 00:06:47,125 to get together in the moment and talk about the event as a team and learn from 109 00:06:47,125 --> 00:06:48,365 it. And, um, 110 00:06:48,795 --> 00:06:52,845 many times that results in a better communication with the family. 111 00:06:55,545 --> 00:06:56,145 I love that. 112 00:06:56,145 --> 00:06:59,225 I think all the things you mentioned there from the leadership and professional 113 00:06:59,225 --> 00:07:03,825 development and really investing in the team, uh, to grow and build, um, 114 00:07:04,245 --> 00:07:07,825 the next generation of leaders as well as them looking at providing compassion 115 00:07:07,825 --> 00:07:11,625 and support for each other in addition to families and then the debriefings as 116 00:07:11,625 --> 00:07:14,425 well. It seems like there's just a lot happening, um, 117 00:07:14,425 --> 00:07:17,505 that really I'll point to what you summarized in the beginning of, 118 00:07:17,505 --> 00:07:20,985 of better culture and team building and then focus on the patient satisfaction 119 00:07:20,985 --> 00:07:22,505 and consumerism and, you know, 120 00:07:22,505 --> 00:07:26,345 looking at healthcare obviously will continue to evolve over the next two to 121 00:07:26,345 --> 00:07:26,885 three years. 122 00:07:26,885 --> 00:07:30,105 How do you see your organization changing and growing with the times. 123 00:07:31,615 --> 00:07:36,305 That There are two things that we are trying to evolve over the next two to 124 00:07:36,305 --> 00:07:40,665 three years, and one of it, one of our biggest strategic, uh, 125 00:07:40,715 --> 00:07:45,585 priorities are, um, expanding on our statewide promise. 126 00:07:46,285 --> 00:07:48,105 Um, we, um, 127 00:07:48,245 --> 00:07:52,985 are committed to meet patient needs closer to home and to, 128 00:07:53,485 --> 00:07:55,505 to develop the mechanism, the, 129 00:07:55,525 --> 00:08:00,465 the infrastructure that is necessary to be able to provide, uh, 130 00:08:00,905 --> 00:08:04,945 permanent aspects of care, uh, closer to the, to the home. 131 00:08:05,125 --> 00:08:09,385 So basically at this point in time, we are spending a lot of time in, uh, 132 00:08:09,385 --> 00:08:12,825 looking to, uh, ideal footprint, uh, 133 00:08:12,835 --> 00:08:16,465 throughout the state and trying to develop the 134 00:08:17,375 --> 00:08:21,905 mechanism that we need to have in place to be able to, to be present there for, 135 00:08:22,125 --> 00:08:25,945 for, as I said, for pertinent aspects of care. Sure, 136 00:08:26,195 --> 00:08:29,545 there will be high-end procedures that will have, 137 00:08:29,615 --> 00:08:32,625 will have to occur in the academic medical center, 138 00:08:32,805 --> 00:08:37,665 and that is why we are here as a central location to be able to provide that. 139 00:08:38,085 --> 00:08:40,505 But there are, uh, many, many, many, 140 00:08:40,505 --> 00:08:44,945 many aspects of the clinical care that can be, can happen closer to home. 141 00:08:45,045 --> 00:08:48,665 So that is one of the evolution we are, uh, 142 00:08:48,665 --> 00:08:53,185 interested in supporting and devoting a lot of time to. 143 00:08:53,605 --> 00:08:54,438 Um, 144 00:08:54,645 --> 00:08:59,285 the second is to devote more time to 145 00:08:59,285 --> 00:09:01,525 understanding the social, um, 146 00:09:01,965 --> 00:09:06,485 determinants of health aspects of healthcare and partnering with community, 147 00:09:07,025 --> 00:09:07,525 uh, 148 00:09:07,525 --> 00:09:12,045 resources to be able to support the families on that level such that we provide 149 00:09:12,115 --> 00:09:14,125 more of a holistic patient care, 150 00:09:15,395 --> 00:09:19,925 more focused on wellbeing rather than just disease resolution, 151 00:09:20,505 --> 00:09:23,005 uh, disease management. And, um, 152 00:09:25,025 --> 00:09:27,685 of course a big problem in pediatric, uh, 153 00:09:27,685 --> 00:09:32,245 healthcare has been and probably will continue to be behavioral 154 00:09:32,345 --> 00:09:37,045 health. So we have our strategy team's working, um, 155 00:09:37,605 --> 00:09:42,365 a lot on, um, developing a statewide behavioral health strategy, 156 00:09:42,985 --> 00:09:45,485 um, focused on prevention, uh, 157 00:09:45,745 --> 00:09:48,685 not just acute event management. 158 00:09:49,905 --> 00:09:53,425 Absolutely. I think that's so important, especially given all the, um, 159 00:09:53,865 --> 00:09:57,185 challenges that, uh, the nation's children have been having, as you mentioned, 160 00:09:57,185 --> 00:09:59,505 with mental health care and behavioral health, you know, 161 00:09:59,505 --> 00:10:04,305 being able to really dig deep and, and have a program that's beneficial, um, 162 00:10:04,305 --> 00:10:08,745 certainly, you know, seems like it would be, um, very helpful for the community. 163 00:10:09,015 --> 00:10:11,785 When you look at that program in particular, um, 164 00:10:12,415 --> 00:10:16,305 what are you doing different in order to really find the solutions and, 165 00:10:16,305 --> 00:10:19,745 and work with the, um, patients and their families, uh, to, 166 00:10:19,805 --> 00:10:21,985 to bring them to a place where, um, 167 00:10:22,095 --> 00:10:26,145 they're able to receive treatment and then continue on with a, 168 00:10:26,225 --> 00:10:27,425 a stronger and healthier life? 169 00:10:28,975 --> 00:10:31,185 Well, for the behavioral health strategy, 170 00:10:32,125 --> 00:10:34,385 the team that's working on, uh, 171 00:10:34,495 --> 00:10:39,145 that has tried to partner with every single possible resource available 172 00:10:39,285 --> 00:10:43,825 in the state, including schools, including primary care networking, 173 00:10:43,825 --> 00:10:47,905 including family practice physicians, and, um, 174 00:10:49,045 --> 00:10:53,425 the strategy, the vision is that together we are going to, 175 00:10:54,285 --> 00:10:56,945 we are the academic medical center will, 176 00:10:57,095 --> 00:11:01,905 will spend a lot of time and resources to develop that, uh, 177 00:11:02,015 --> 00:11:06,385 best practice knowledge among all our partners throughout the state 178 00:11:07,005 --> 00:11:07,838 and, um, 179 00:11:08,645 --> 00:11:13,345 to enhance the prevention aspect of behavioral health and 180 00:11:13,645 --> 00:11:18,305 or to provide necessary support in the earlier 181 00:11:18,565 --> 00:11:20,545 stages of the, um, uh, 182 00:11:20,905 --> 00:11:25,065 challenges that the patient experiences such that we prevent evolution to the 183 00:11:25,065 --> 00:11:26,585 more severe, uh, stages. 184 00:11:27,245 --> 00:11:30,265 And that's not to say that it's not important, 185 00:11:30,535 --> 00:11:35,385 also focus on acute care management and we have strategy, 186 00:11:35,885 --> 00:11:38,705 um, solutions that are devoted to that, 187 00:11:39,005 --> 00:11:43,945 but we believe that we will get better return on our investment if we 188 00:11:43,945 --> 00:11:45,105 partner across the, 189 00:11:45,805 --> 00:11:50,465 the state with all potential links that are going to play a role in patient 190 00:11:50,465 --> 00:11:51,298 care. 191 00:11:52,465 --> 00:11:55,625 I love that. I, I think that it's just a great strategy and, 192 00:11:55,625 --> 00:11:58,505 and definitely thank you for outlining it for us. And, 193 00:11:58,505 --> 00:12:02,305 and that will be helpful for other listeners as well to think through those 194 00:12:02,305 --> 00:12:05,025 different factors, um, and understand what a, a, 195 00:12:05,225 --> 00:12:08,545 a very significant program like that looks like. Um, 196 00:12:08,545 --> 00:12:10,105 before we wrap up our conversation, 197 00:12:10,365 --> 00:12:13,745 I'm wondering if you could share what is one change that you or your team has 198 00:12:13,745 --> 00:12:16,545 made, um, recently that's yielded some great results? 199 00:12:17,875 --> 00:12:18,805 Well, on that one, 200 00:12:18,885 --> 00:12:23,565 I think I will talk about the harm the hospital acquired events 201 00:12:23,905 --> 00:12:25,845 and the harm coming out of covid. 202 00:12:26,705 --> 00:12:31,005 So at the end of the epidemics, we've noticed, 203 00:12:31,545 --> 00:12:34,765 um, an increase in our harm events, uh, 204 00:12:35,205 --> 00:12:39,005 specific ecsi and, um, pressure injuries, 205 00:12:39,845 --> 00:12:42,885 hospital acquired, pressure injuries, multifactorial, 206 00:12:43,685 --> 00:12:48,565 probably enhanced by the challenges and the migration that we've all 207 00:12:48,595 --> 00:12:52,925 have experienced in terms of our workforce throughout healthcare, uh, 208 00:12:53,105 --> 00:12:55,485 but not solely linked to that. 209 00:12:56,185 --> 00:13:00,845 So to get a hold of this problem and to be able to 210 00:13:01,665 --> 00:13:06,245 get in top of of it, we've LAN launched two main, 211 00:13:06,665 --> 00:13:11,445 uh, interventions that I felt had a huge impact on the outcome. Uh, 212 00:13:11,745 --> 00:13:16,125 one is, um, uh, something that we call timeout, 213 00:13:16,375 --> 00:13:18,925 which is every time we have an event, 214 00:13:19,225 --> 00:13:24,205 the whole entire team gets together to talk specifically about that 215 00:13:24,295 --> 00:13:28,965 event and then to identify missed, uh, opportunities, 216 00:13:30,425 --> 00:13:35,205 how did we deviate from the standard of care that may have led to that 217 00:13:35,295 --> 00:13:37,685 particular event. And, uh, 218 00:13:38,155 --> 00:13:42,525 what is different from the traditional way we did this timeouts. 219 00:13:42,545 --> 00:13:47,245 The in historically the timeouts was something that occurred at the unit 220 00:13:47,295 --> 00:13:52,205 level, and we had the specific people who were devoted to, 221 00:13:52,305 --> 00:13:57,085 to this, to preventing harm met and talked about this at this moment in time, 222 00:13:57,085 --> 00:13:59,925 what we changed, we made sure that we have, um, 223 00:14:00,865 --> 00:14:04,365 strong executive presence for this timeout. 224 00:14:04,835 --> 00:14:09,525 They always happened with the division chief present and with CMO 225 00:14:09,665 --> 00:14:14,085 and um, uh, ACQ associate Chief Quality Officer. 226 00:14:14,905 --> 00:14:19,845 And we've had amazing learner learnings that have derived from 227 00:14:19,845 --> 00:14:21,605 there with very, 228 00:14:21,715 --> 00:14:25,725 very specific gaps that were identified that we would not have 229 00:14:26,605 --> 00:14:27,385 discovered or, 230 00:14:27,385 --> 00:14:32,005 or figured out had we not been present throughout all this, 231 00:14:32,785 --> 00:14:33,845 all this timeouts. 232 00:14:34,105 --> 00:14:38,285 And I'm happy to say that within a month actually we saw a, 233 00:14:38,525 --> 00:14:43,285 a positive impact and the impact has been sustained 234 00:14:43,285 --> 00:14:45,845 throughout the last nine months, and it's, 235 00:14:45,875 --> 00:14:50,245 it's very rewarding to see where we are now from a harm standpoint and 236 00:14:50,855 --> 00:14:51,805 preventing harm. 237 00:14:52,355 --> 00:14:56,845 It's hard work and it takes perseverance and 238 00:14:57,075 --> 00:15:02,045 it's, it takes attention to preoccupation with failure every day, 239 00:15:02,785 --> 00:15:05,725 and the team has grown and been able to, to, 240 00:15:05,985 --> 00:15:10,045 to provide that with this particular support. I'm very, 241 00:15:10,395 --> 00:15:14,445 very proud about the result of this. And meanwhile, in parallel, 242 00:15:14,465 --> 00:15:19,165 we are trying to also develop a predictive model to anticipate who are the 243 00:15:19,365 --> 00:15:24,165 patients who could be at higher risk to develop harm such that 244 00:15:24,225 --> 00:15:27,965 we are trying to, uh, get ahead of the problem, 245 00:15:28,745 --> 00:15:32,445 not just assess the, uh, 246 00:15:32,905 --> 00:15:37,725 impact on a patient that has already been harmed but actually preventing it 247 00:15:37,725 --> 00:15:41,525 from happening. And this predictive model has been, uh, 248 00:15:41,525 --> 00:15:46,165 rewarding in the sense of, uh, has been able to teach us several, 249 00:15:46,705 --> 00:15:49,325 uh, effective ways that we can prevent harm. 250 00:15:50,435 --> 00:15:53,565 Well, that's fascinating, Dr. Nito and, and certainly, you know, 251 00:15:53,565 --> 00:15:58,525 seems like it's a very advanced way to implement technology, um, and, and, 252 00:15:58,705 --> 00:16:02,645 um, do a lot of good in terms of finding those harms and connecting and have the 253 00:16:02,645 --> 00:16:05,045 leadership involved and certainly, um, 254 00:16:05,735 --> 00:16:08,805 works wonders in terms of getting those rates down and, 255 00:16:08,985 --> 00:16:10,365 and having better patient care. 256 00:16:10,775 --> 00:16:12,965 Thank you so much for joining us on the podcast today. 257 00:16:12,965 --> 00:16:16,125 This has been really fun and interesting discussion and I look forward to 258 00:16:16,125 --> 00:16:17,205 connecting with you again soon. 259 00:16:17,735 --> 00:16:18,965 Thank you for inviting me. 260 00:16:21,555 --> 00:16:25,005 It's so important for leaders at the top of organizations to keep learning, 261 00:16:25,195 --> 00:16:25,915 stay sharp, 262 00:16:25,915 --> 00:16:29,725 grow their networks to help our audience better do this in a more simplified, 263 00:16:29,725 --> 00:16:34,445 personalized, and meaningful way. 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