- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Lewis Marshall,
chief Medical Officer at NYC Health Plus
Hospital's Lincoln Hospital.
Dr. Marshall, it's a pleasure
to have you on the podcast today.
- Thank you. Happy to be here.
- Now, I know we've got a lot to talk about,
and I'm really looking forward to learning more about
what you're doing at Lincoln Hospital
and how you're thinking about the future.
But before we dive into my broader questions,
can you tell us a little bit more
about yourself and your background?
- Um, sure. So, um, uh, I'm a physician attorney,
which means that everybody hates me, but that's okay.
Uh, I came here to, again, at, um, at the height
of the pandemic in 2020
as the Chief Medical Officer.
Uh, prior to this I was at NYU in a different role,
but I wanted to get back into healthcare in an
underserved community.
So Lincoln Hospital is a 360 bed, uh,
level one trauma center with, uh, probably the third
or fourth busiest emergency department in the country with,
uh, over 140,000 visits a year.
We also have ambulatory care visits over 400,000 annually.
Uh, and some of the services that we offer to this community
are, um, trauma services, medical services.
Uh, we have pediatric services.
We have a level three, uh, neonatal ICU as well
as a pediatric ICU and, and other support services.
Um, we also recently included robotic surgery,
uh, in our lineup.
And so that's been great for this community.
The community that we serve is really an
underserved community.
We are in the South Bronx,
and the Bronx is pro is one of the forest health
counties in New York State.
Uh, so we have a lot of challenges, uh, with our population.
We also have a very mixed population in terms of, you know,
where people are from.
About 60% of our patients are Hispanic
and speak Spanish at home is the primary language.
Uh, one of the, um, issues that's come up recently with the,
uh, immigration is
that our third most common language is now an African
language called Wolof, uh, which I had not heard of.
Um, and so now we have translation in moola
'cause of the increased number of immigrants from,
from the African diaspora.
And so the other major
population we serve in this area is patients
with substance use disorder.
We have a very large population
of patients in the South Bronx that are using substances,
and it has affected their health.
So we have lots of programs, uh, in that area as well.
And that's a quick snapshot of,
of Lincoln in the South Bronx.
- Wow, that's amazing to hear.
And certainly helpful to understand
that pa patient population that you're serving
and how I can imagine it's always
evolving in the South Bronx.
And so thank you for that background.
Now, what are some of the biggest issues
that you're following in healthcare right now?
- Well, I think for, uh, Lincoln
and for me, uh, one of the biggest things we're
that I'm following is, is the advancement
and the rapid deployment of
artificial intelligence in healthcare, right?
So we've seen it in the past.
It's been around for a while in terms of looking at
high repetition and low risk use cases, uh,
information gathering, post-treatment monitoring,
and now population health,
but also looking at the use of AI intelligently
and ethically, right?
Uh, I think that anybody in the same position that
as I am in, you know, is being bombarded with, you know,
startups that have new AI that, you know, they want
to implement and deploy in the healthcare sector.
And so we just have to be cognizant of
what this AI can
and cannot do if there are any risk factors.
Um, you know, is there any trust issues?
I think that, you know, making sure that patients understand
that we're using AI as well is another issue that
I'm following, uh, today.
I think that, uh, making sure that we're transparent and,
and sharing our information as as appropriate.
Uh, one of the other things, uh, with AI that we're doing
as a system, and I'm pretty sure other health systems are
doing the same thing, is that we've implemented a
artificial intelligence council,
and this council is made up of providers and administrators
and technical people from across the system.
And what we're, what we're doing is we're looking at ai,
and I'll give you a specific example in a minute.
We're looking at AI
and making sure that we can, one, understand
what it does and doesn't do.
We can use it intelligently
and we can integrate it into our we health system.
We can learn from it as well.
Um, so for a specific example, uh,
and this is related to another issue
that I'm following also here at Lincoln is,
is provider burnout.
And I think that's a national issue
that we've all been talking about,
but, uh, one of the AI tools is, um,
ambient dictation in the exam room.
So where they have the ability to have AI
listen, if you will, to the conversation
between the provider and the patient in the exam room,
and actually create the note for the provider.
And at the end of the exam, the provider can just go in
and review the note, correct any errors, and then sign it.
And that will really help, uh,
providers reduce the burden of some of their documentation
and the time that they spend outside
of taking care of patients.
Documenting. Uh, we have, um, uh, a big issue
with, um, providers spending lots
of their own time in completing documentation.
And that kind of goes to my second issue, which is
that I'm following is, is provider burnout.
Um, you know, as we ask more and more of our providers
and we need to provide them with the resources to make their
their lives better,
and one of the things with, um,
that I look at in my institution is, is
what we call pajama time, right?
It's how much, how much of
that at home time do my providers spend
documenting in the medical record?
Is that something that is affecting their life outside?
Is it adding to their burnout?
And that's where I think some, something like the program
that I just talked about in terms of ambient dictation, uh,
would help providers in reducing some of the burdens
that we have in terms of documentation.
Uh, so I'm really excited about that
and I think that that's, um, something
that's gonna develop very rapidly, uh, over the next, uh,
couple of years as more and more AI is being used
and implemented in the healthcare setting.
Um, and provider burnout is something
that we're all working on.
Uh, we implemented a program here, uh,
called Helping Healers Heal, or H three.
And what that is, is we have peer,
I don't wanna say peer counselors,
but peers that people can go to
and talk to when they have an issue.
And if they have a, an issue where the peer thinks they need
to speak to somebody in a more official capacity,
then we put in, uh, roads and,
and ways that they can do that without feeling
that somebody's watching them or it's a bad thing
because they're having a mental issue or stress.
Uh, so the a three program has been very beneficial
in helping our providers, not, not just, you know,
helping all of our staff really, um, that are having,
uh, stress issues.
Uh, so that's something else that,
that we've implemented here over the years,
and I think that that's working out very well.
- That's amazing to hear. And you know, I,
I love those specific examples of the different, um, kind
of committees
or groups you put together in order to, um,
dive into these different issues,
whether it's the AI council
or, you know, focused in on provider burnout and stress.
Um, when you look at those two areas in particular
where you're zeroing in, how do you develop, um, you know,
those councils, uh, who is, I guess, leading them and,
and what do they really, um, do in order to,
to have an effective impact on the organization as a whole?
- Yeah. So, um, for, for the, uh,
artificial intelligence council, it's really led
by our system, uh, CMIO and CIO,
and they brought together this group of, uh, technicians
or people in the tech field within our organization as well
as, uh, clinical providers like myself, uh,
in leadership roles and also frontline clinical providers.
So that what we do is we actually look at,
uh, a product, right?
An AI product. We look at its function, we demo it,
we figure out where it might work within our system,
and if it's something that can be deployed, uh,
across the system, uh,
and we usually will pilot it at one of our facilities.
So the backup health
and hospitals in New York City has
11 acute care hospitals.
Um, so it's huge health system as well
as we have a huge ambulatory network as well.
Uh, so we wanna make sure that, you know, we
pilot these programs before we implement them system wide,
and we also look at six of, of the AI
and making sure that we're using it in an ethical manner.
And that, you know, one of the things that we're
everybody's talking about now is health equity.
And so we want to make sure that the AI is not adding to
or worsening our equity efforts, right?
Uh, 'cause a lot of current data may not be based upon the
broad population of patients that we see,
and some of the results of the AI might not pertain
to a particular group.
So that's something that we also look at,
which I think is really important
as we look at health equity issues across our system and,
and across the health system in general at large.
It's a challenge, but I, I think that looking at that
as well as, you know, at what point do we need
to inform patients that we're using ai?
Do we share the data with, uh, systems outside of our own,
uh, and how do we do that?
You know, making sure that we're compliant
with rules and regulations.
- That's so helpful to know and understand.
Thank you for, um, talking us through that a bit more now.
When you look ahead, what are you most excited
about and what makes you nervous?
- So I think I'm really excited about, you know,
where, where AI is going to take us in terms of
if we use it, you know, the right way.
And, you know, even the, even the Vatican has a,
an ethical advisor
to the Pope who's looking at AI for the Vatican.
So, you know, if they're doing it, we also need to make sure
that we're using it ethically.
And I think the use of ai, I think it's gonna be tremendous
for our patients, right?
So whether it's, um, home health monitoring,
monitoring blood pressure from, you know,
the patient's home, using some of the technology
that's available to help us get that information
and then allowing AI to help us interpret it,
I think is going to be very exciting.
Uh, one of the, uh, items that I saw recently
was this thing called a smart mirror.
And the smart mirror would, could be in your bathroom
and, you know, while you're getting ready in the morning, it
uses infrared lights
and some other high technology that I can't explain,
and it can check your pulse, your blood pressure,
your body temperature,
and send all that information to the doctor like right away.
Uh, so things like that I think are,
are, are gonna be great.
We are as a system looking into, uh, implementing
and modeling, uh, the home blood pressure
and weight monitoring for a particular cohort of patients.
Like, say those with congestive heart failure, who you want
to make sure to measure their weight
and keep their weight in the right place
and make sure their blood pressure's under control.
So these are really things that will help connect us
providers to the patients more often, right?
And not just wait on, you know, the annual visit
or the sick visit, but really allow us much more time
and helping the patient manage their,
their chronic conditions
and work through, you know, their diet.
Um, I think those are some of the things
that I'm excited about.
Another thing I'm really excited about
is we have started a new program called Lifestyle Medicine.
And what this is, is this a program
that involves physician providers, nutritionists,
dieticians, and we really work with patients to
change their diet, uh, as, as use their diet as medication.
So that's very exciting.
That just kicked off like last month.
Um, and we already have patients with, you know,
like diabetes that are really excited about this, uh,
prospect in terms of, you know, using food
and diet as medication to help,
help control their chronic medical condition.
So it's really exciting. I wanna sign up myself.
- It sounds like a, such a, a really great opportunity
and a really cool service you're able
to offer the community, um,
and something unique too, um,
that you've kind of are, are diving into.
So, um, that's really interesting to hear about.
Is there, um, anything that makes you a little bit nervous?
- Yeah, so what makes me nervous is the potential AI
makes me nervous as well.
It makes me nervous 'cause I, I think that there's,
you know, there's a lot of potential risks involved
and not only risks to the patient,
but also, you know, what's the liability that a physician
or a provider has who uses
and relies on AI to help make a diagnosis
and that diagnosis is wrong, right?
Uh, so I think that that that has a potential
to make me very nervous.
Also, you know, we have to be able to trust the ai
and I think that's just gonna take some time, uh,
which is why I think our, our AI council is really going
to help us in, in that arena.
Uh, other things that make me nervous now in this
environment is, uh, is
is provider burnout, which I mentioned.
I think that, you know, um, you know, how do we recruit
and retain good providers?
How do we keep them from feeling
that they're overworked all the time?
Uh, and overstressed.
And, you know, one of the challenges
that we have in a public health system
and whether it's New York
or anywhere else, is really, you know, how can we recruit,
you know, specialists
and, you know, what can we offer them, you know, um,
especially young, young doctors coming out that, you know,
are spending or thinking more about their lifestyle than
necessarily, uh,
providers from the past had had done right.
Making sure that they have work life,
well work life balance,
but I think it's really, uh, mean work life synergy, right?
It's like how do we balance our work life
and our regular life so that we're, we're content,
we're happy, we do a good job, you know?
And I think burnout can affect all of that,
uh, in the future.
So helping healers heal is one program,
and I'm sure that there are others, you know,
that do the same thing, uh, in providing, um,
aid to providers or,
or workers in healthcare that may need assistance.
We also had another program that we created here.
Uh, we, it's probably from somewhere else,
but it's called, uh, we have a Battle Buddy program.
And so what that is, is that senior leaders
are get, um, a battle buddy,
so somebody from the front lines, um, who has challenges,
and then battle buddy.
We help them talk through issues.
And so my battle buddy is the, their surgery here,
uh, who runs a very busy trauma center as well
as all the surgical subspecialties.
So, uh, I'm her battle buddy.
Uh, so that, that works out very well as well in,
in addressing some of the issues that I'm concerned about
and make me nervous.
- Absolutely. That sounds like a really cool solution.
Um, you know, especially, um, just the battle buddy concept
and being able to pair the senior leadership
with somebody on the front lines
or who really is, uh, in the thick of things day in
and day out to understand those challenges and issues
and really work through them together.
Um, I just think that's really cool
and your idea along work life synergy as well, um, can be
so, uh, informative
and instructive for people really,
no matter their profession.
- Yep. - Agreed. So, absolutely.
So before we wrap up here, I'm wondering
what will the most effective healthcare leaders need in
order to be successful over the next
two to three years or so?
Especially thinking through how much healthcare is changing
and we'll continue to do so.
- I think there are a couple of things
that healthcare leaders will need.
Um, one is we need to show
that we care about our staff, right?
We can't be sitting in the office.
We have to get out there with the, with our staff
and communicate with them.
Uh, we will need a tremendous amount of patients, uh, to do
that as we, you know, we talk about meeting the patient
where they are in healthcare.
We also need to meet our staff where they are, right?
You know, are there ways that we can create, um,
work environments
or work schedules that allow people, you know,
to have appropriate time away and and disconnect?
I think one of the, there was an article I read, uh,
not too long ago that said when we were going
to remote work, uh, just offering
employees the opportunity
to do remote work made them feel better.
Uh, so we're gonna have to come up with ways to
meet our workforce where they are
and still be able to get the, the job done.
Um, to trust honesty and integrity I think are gonna be key.
If you don't trust your leader, uh,
or if they don't have integrity, um,
then you're not gonna be able to lead.
Uh, um, also leaders, you know, we,
we can't hold grudges.
It's not personal, you know, it's not about the leader,
it's about patient, it's about the system, uh,
and we just have to really understand that.
Um, I think the other thing we need to
look at is how are we gonna recruit, you know,
over the next, let's say three to five years
anticipating the needs of the community
and making sure that we can recruit providers, um,
that we need to provide that care.
And I think as a leader, we need to think about that
because as, as the healthcare workforce ages
and people start to retire, uh, especially
after Covid, um, you know,
it gets very challenging sometimes to,
to find the right people
or any people for that matter, uh,
that can come in and, and do the job.
And I, I think the last thing, uh, is that, you know,
as healthcare leaders, we need to walk the talk
as they say, right?
Um, we need to be out there
and show people that we're authentic
and that we, uh, listen, I tell my, my staff,
I said, uh, you know, I may not be able
to solve your problem, but I'm a really good listener
and I can listen to you, so let's talk.
And so I think we're gonna need to be able to do that
as well as we move forward over the next two to three,
five years, uh, as healthcare leaders.
Um, the other thing we need to do,
and the last thing I'll mention is we really need to
develop our healthcare leader bench, right?
So I'm not gonna be in this role forever, so I need
to have somebody who's gonna step up.
Um, and so how do we make sure that those people
who are gonna step up into our positions have the right
core competencies that we need them to have, whether it's,
you know, communication skills, financial skills, um, how
to run a hospital, even I think that these are some
of the things that, that as healthcare leaders, we need
to make sure that we're doing to bring up the next group of,
of leaders that are coming up behind this.
- Absolutely. I think that makes a lot of sense.
And, you know, really appreciate you walking us
through all those different areas.
Um, just in terms of making sure
that you are meeting the staff where you are,
you can figure out what it takes in order for them
to feel comfortable and be able to do their jobs well.
And, and then leaning into, um, you know,
that listening side of things and,
and, um, continuing to build out that leadership bench.
Um, definitely crucial all the way across the board.
So thank you so much Dr. Marshall
for joining us on the podcast today.
This has been such a fascinating discussion
and I look forward to connecting with you again soon.
- Oh, thank you very much. It's been a wonderful time
and, uh, look forward to doing it again someday.