This is the Becker's Healthcare Podcast,
created by the team of Becker's Healthcare,
a multimedia company devoted to the people who power us healthcare.
Four new 15 minute episodes are released daily containing industry news analysis
and thought leadership from powerful healthcare decision makers Support our show
by leaving it a five star rating and review on Apple Podcast or other platforms
you use.
It's a chance to tell us what you like about the show and act on your feedback.
Thanks for listening. Now here's the episode.
This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Mara Mitu,
the Vice President and Chief Medical Officer at Riley Children's Health. Dr.
Nitti, it's a pleasure to have you on the podcast today.
Uh, thank you very much for inviting me.
It's a pleasure to be here with you and, uh, talk about our priorities at, uh,
Riley Children's Health.
Fantastic. Well, I'm really looking forward to what you have to say.
I know you've got some fascinating things happening there, you know,
and really it's such an important time right now for children's health and
pediatric care, a lot happening in that space and,
and definitely a very important, uh, patient population to care for.
But before we dive into my questions,
can you tell us a little bit more about yourself and your background?
I, um, am originally from Romania.
I graduated the medical school at Carol Davila in Bucharest, um,
and then subsequently, uh, completed pediatric, uh,
residency at SUNY at Stony Brook, and spent one year, uh, in critical care at,
um, Cincinnati children, and then, uh, joined Riley,
uh, children's Health immediately after training and spent here my, uh,
last 22 years of career.
Oh, wow. That's, you know, definitely a, a very, um, fantastic kind of like,
um, journey that you've had in healthcare. And then two,
to be in one place for 22 years and really grow and develop in the space.
I can imagine things are much different now than they were when you first joined
Riley Children's.
You are very, very right about that. .
Um, well, absolutely, and, and, you know, considering where we're at today,
I know we've been through some challenging years, um,
with the pandemic and then just, you know, other, um,
areas that have have been hard both for children as well as, um,
the hospital and health system at large. So I was wondering, you know,
could you talk a little bit about some of your top priorities today?
What do you really see as being areas where you're spending most of your time?
Uh, while, um, the, this year,
the top two priorities have been, uh,
culture and team building and, um,
specifically around team member retention and team member satisfaction.
So that's one of the priority. Uh, the other priorities is, um,
patient satis, patient and family satisfaction.
The consumerism has made its way into medicine and,
uh, we are learning how to better, uh,
support the needs of our families and our patients.
Absolutely. I think both areas are definitely spaces where, you know,
hospitals and health systems across the country are,
are looking deep into those areas and trying to figure out what's gonna work
best for them, um, in support their growth and development in the future.
When you look at the culture and team building aspect and especially that, um,
retention piece,
is there anything that you've tried over the last year or two that's, um,
you know, has gone well or,
or would just love to hear how you're thinking about retention and what you're
doing differently?
There are so many layers and so many different interventions. We are. Um,
it, it is a very, uh, complex problem and therefore the interventions are,
um, multi-facets and the different levels.
The one intervention that we, um,
founded to be most successful in terms of team member retention is to
work with each to, to devote a lot of time in, uh,
leadership development, both for our directors and our managers,
and, um, provide feedback from our team member,
real time feedback from our team members to,
to the managers and to the directors to
support them in, um, co connecting with their team members,
um,
effectively and making sure that we hear their needs and we support their needs
real time. Uh, that has been, um,
I would say probably the one intervention with, uh,
biggest return on the investment from a physician standpoint,
what we are trying to, uh, to do, um,
in terms of better building the team with various important members
on our clinical team is we have, um,
an appreciation program in which you,
you are able to go online and drop a very quick, um,
appreciation note to any team member that you are working with.
And we are encouraging every single one of the physicians to take the time to
recognize not just their peer physicians,
but more importantly different team members that have, um, done something,
um, great that day. Also,
part of our leadership development program, we spend a lot of time on com, uh,
compassion encouraging our team members to show
compassion, not just for our patients and families,
but for each other and helping them to think about
how that is impacting their own personal life and as well as the
team members. It's, um, very clear that one, uh,
who comes to work with a, um, compassionate attitude, uh,
tries from that themselves is not just that you support the people around you
but your own personal development, um, and wellbeing. It's,
it's enhanced by that. So that is where we spend a lot of the time.
And then specifically in the unit at the bedside,
one intervention that has helped,
and it's not an innovation people have tried that before,
is, um, with, with good results it's heart debriefing.
So when there is a patient related event, whether, whether it is, um,
unexpected outcome or whether it is, um,
unexpected complaint, um, we,
we try to use the hot debrief debriefing methodology and encourage the
team to,
to get together in the moment and talk about the event as a team and learn from
it. And, um,
many times that results in a better communication with the family.
I love that.
I think all the things you mentioned there from the leadership and professional
development and really investing in the team, uh, to grow and build, um,
the next generation of leaders as well as them looking at providing compassion
and support for each other in addition to families and then the debriefings as
well. It seems like there's just a lot happening, um,
that really I'll point to what you summarized in the beginning of,
of better culture and team building and then focus on the patient satisfaction
and consumerism and, you know,
looking at healthcare obviously will continue to evolve over the next two to
three years.
How do you see your organization changing and growing with the times.
That There are two things that we are trying to evolve over the next two to
three years, and one of it, one of our biggest strategic, uh,
priorities are, um, expanding on our statewide promise.
Um, we, um,
are committed to meet patient needs closer to home and to,
to develop the mechanism, the,
the infrastructure that is necessary to be able to provide, uh,
permanent aspects of care, uh, closer to the, to the home.
So basically at this point in time, we are spending a lot of time in, uh,
looking to, uh, ideal footprint, uh,
throughout the state and trying to develop the
mechanism that we need to have in place to be able to, to be present there for,
for, as I said, for pertinent aspects of care. Sure,
there will be high-end procedures that will have,
will have to occur in the academic medical center,
and that is why we are here as a central location to be able to provide that.
But there are, uh, many, many, many,
many aspects of the clinical care that can be, can happen closer to home.
So that is one of the evolution we are, uh,
interested in supporting and devoting a lot of time to.
Um,
the second is to devote more time to
understanding the social, um,
determinants of health aspects of healthcare and partnering with community,
uh,
resources to be able to support the families on that level such that we provide
more of a holistic patient care,
more focused on wellbeing rather than just disease resolution,
uh, disease management. And, um,
of course a big problem in pediatric, uh,
healthcare has been and probably will continue to be behavioral
health. So we have our strategy team's working, um,
a lot on, um, developing a statewide behavioral health strategy,
um, focused on prevention, uh,
not just acute event management.
Absolutely. I think that's so important, especially given all the, um,
challenges that, uh, the nation's children have been having, as you mentioned,
with mental health care and behavioral health, you know,
being able to really dig deep and, and have a program that's beneficial, um,
certainly, you know, seems like it would be, um, very helpful for the community.
When you look at that program in particular, um,
what are you doing different in order to really find the solutions and,
and work with the, um, patients and their families, uh, to,
to bring them to a place where, um,
they're able to receive treatment and then continue on with a,
a stronger and healthier life?
Well, for the behavioral health strategy,
the team that's working on, uh,
that has tried to partner with every single possible resource available
in the state, including schools, including primary care networking,
including family practice physicians, and, um,
the strategy, the vision is that together we are going to,
we are the academic medical center will,
will spend a lot of time and resources to develop that, uh,
best practice knowledge among all our partners throughout the state
and, um,
to enhance the prevention aspect of behavioral health and
or to provide necessary support in the earlier
stages of the, um, uh,
challenges that the patient experiences such that we prevent evolution to the
more severe, uh, stages.
And that's not to say that it's not important,
also focus on acute care management and we have strategy,
um, solutions that are devoted to that,
but we believe that we will get better return on our investment if we
partner across the,
the state with all potential links that are going to play a role in patient
care.
I love that. I, I think that it's just a great strategy and,
and definitely thank you for outlining it for us. And,
and that will be helpful for other listeners as well to think through those
different factors, um, and understand what a, a,
a very significant program like that looks like. Um,
before we wrap up our conversation,
I'm wondering if you could share what is one change that you or your team has
made, um, recently that's yielded some great results?
Well, on that one,
I think I will talk about the harm the hospital acquired events
and the harm coming out of covid.
So at the end of the epidemics, we've noticed,
um, an increase in our harm events, uh,
specific ecsi and, um, pressure injuries,
hospital acquired, pressure injuries, multifactorial,
probably enhanced by the challenges and the migration that we've all
have experienced in terms of our workforce throughout healthcare, uh,
but not solely linked to that.
So to get a hold of this problem and to be able to
get in top of of it, we've LAN launched two main,
uh, interventions that I felt had a huge impact on the outcome. Uh,
one is, um, uh, something that we call timeout,
which is every time we have an event,
the whole entire team gets together to talk specifically about that
event and then to identify missed, uh, opportunities,
how did we deviate from the standard of care that may have led to that
particular event. And, uh,
what is different from the traditional way we did this timeouts.
The in historically the timeouts was something that occurred at the unit
level, and we had the specific people who were devoted to,
to this, to preventing harm met and talked about this at this moment in time,
what we changed, we made sure that we have, um,
strong executive presence for this timeout.
They always happened with the division chief present and with CMO
and um, uh, ACQ associate Chief Quality Officer.
And we've had amazing learner learnings that have derived from
there with very,
very specific gaps that were identified that we would not have
discovered or,
or figured out had we not been present throughout all this,
all this timeouts.
And I'm happy to say that within a month actually we saw a,
a positive impact and the impact has been sustained
throughout the last nine months, and it's,
it's very rewarding to see where we are now from a harm standpoint and
preventing harm.
It's hard work and it takes perseverance and
it's, it takes attention to preoccupation with failure every day,
and the team has grown and been able to, to,
to provide that with this particular support. I'm very,
very proud about the result of this. And meanwhile, in parallel,
we are trying to also develop a predictive model to anticipate who are the
patients who could be at higher risk to develop harm such that
we are trying to, uh, get ahead of the problem,
not just assess the, uh,
impact on a patient that has already been harmed but actually preventing it
from happening. And this predictive model has been, uh,
rewarding in the sense of, uh, has been able to teach us several,
uh, effective ways that we can prevent harm.
Well, that's fascinating, Dr. Nito and, and certainly, you know,
seems like it's a very advanced way to implement technology, um, and, and,
um, do a lot of good in terms of finding those harms and connecting and have the
leadership involved and certainly, um,
works wonders in terms of getting those rates down and,
and having better patient care.
Thank you so much for joining us on the podcast today.
This has been really fun and interesting discussion and I look forward to
connecting with you again soon.
Thank you for inviting me.
It's so important for leaders at the top of organizations to keep learning,
stay sharp,
grow their networks to help our audience better do this in a more simplified,
personalized, and meaningful way. Becker's Healthcare has launched my BHC,
it's your trusted Becker's healthcare experience and more with content,
connections, events and learning opportunities.
Join the community free of charge@www.my dot becker's
hospital review.com and we'll see you there.