1 00:00:00,435 --> 00:00:02,845 - This is Laura Dedo with the Becker's Healthcare Podcast. 2 00:00:03,505 --> 00:00:05,845 I'm thrilled today to be joined by Dr. Lewis Marshall, 3 00:00:06,015 --> 00:00:08,285 chief Medical Officer at NYC Health Plus 4 00:00:08,565 --> 00:00:09,605 Hospital's Lincoln Hospital. 5 00:00:10,025 --> 00:00:11,165 Dr. Marshall, it's a pleasure 6 00:00:11,165 --> 00:00:12,325 to have you on the podcast today. 7 00:00:13,605 --> 00:00:15,355 - Thank you. Happy to be here. 8 00:00:16,615 --> 00:00:18,515 - Now, I know we've got a lot to talk about, 9 00:00:18,655 --> 00:00:21,035 and I'm really looking forward to learning more about 10 00:00:21,035 --> 00:00:22,275 what you're doing at Lincoln Hospital 11 00:00:22,295 --> 00:00:24,275 and how you're thinking about the future. 12 00:00:24,455 --> 00:00:26,475 But before we dive into my broader questions, 13 00:00:26,535 --> 00:00:27,635 can you tell us a little bit more 14 00:00:27,635 --> 00:00:28,835 about yourself and your background? 15 00:00:30,325 --> 00:00:34,385 - Um, sure. So, um, uh, I'm a physician attorney, 16 00:00:34,755 --> 00:00:37,145 which means that everybody hates me, but that's okay. 17 00:00:37,925 --> 00:00:42,185 Uh, I came here to, again, at, um, at the height 18 00:00:42,185 --> 00:00:44,865 of the pandemic in 2020 19 00:00:46,045 --> 00:00:47,505 as the Chief Medical Officer. 20 00:00:48,285 --> 00:00:52,065 Uh, prior to this I was at NYU in a different role, 21 00:00:52,685 --> 00:00:55,745 but I wanted to get back into healthcare in an 22 00:00:55,745 --> 00:00:56,905 underserved community. 23 00:00:57,045 --> 00:01:01,585 So Lincoln Hospital is a 360 bed, uh, 24 00:01:01,585 --> 00:01:06,025 level one trauma center with, uh, probably the third 25 00:01:06,085 --> 00:01:09,185 or fourth busiest emergency department in the country with, 26 00:01:09,685 --> 00:01:12,305 uh, over 140,000 visits a year. 27 00:01:12,925 --> 00:01:17,865 We also have ambulatory care visits over 400,000 annually. 28 00:01:18,845 --> 00:01:22,025 Uh, and some of the services that we offer to this community 29 00:01:22,805 --> 00:01:26,105 are, um, trauma services, medical services. 30 00:01:27,005 --> 00:01:29,025 Uh, we have pediatric services. 31 00:01:29,245 --> 00:01:33,865 We have a level three, uh, neonatal ICU as well 32 00:01:33,865 --> 00:01:37,985 as a pediatric ICU and, and other support services. 33 00:01:38,365 --> 00:01:41,985 Um, we also recently included robotic surgery, 34 00:01:42,525 --> 00:01:43,825 uh, in our lineup. 35 00:01:44,245 --> 00:01:46,465 And so that's been great for this community. 36 00:01:47,045 --> 00:01:49,585 The community that we serve is really an 37 00:01:49,585 --> 00:01:51,025 underserved community. 38 00:01:51,045 --> 00:01:52,985 We are in the South Bronx, 39 00:01:53,765 --> 00:01:58,105 and the Bronx is pro is one of the forest health 40 00:01:58,625 --> 00:02:00,105 counties in New York State. 41 00:02:00,765 --> 00:02:04,345 Uh, so we have a lot of challenges, uh, with our population. 42 00:02:04,365 --> 00:02:09,185 We also have a very mixed population in terms of, you know, 43 00:02:09,185 --> 00:02:10,185 where people are from. 44 00:02:10,195 --> 00:02:14,385 About 60% of our patients are Hispanic 45 00:02:14,525 --> 00:02:17,185 and speak Spanish at home is the primary language. 46 00:02:17,805 --> 00:02:22,465 Uh, one of the, um, issues that's come up recently with the, 47 00:02:22,525 --> 00:02:23,865 uh, immigration is 48 00:02:23,895 --> 00:02:27,585 that our third most common language is now an African 49 00:02:27,985 --> 00:02:31,665 language called Wolof, uh, which I had not heard of. 50 00:02:31,885 --> 00:02:35,505 Um, and so now we have translation in moola 51 00:02:35,905 --> 00:02:38,345 'cause of the increased number of immigrants from, 52 00:02:38,735 --> 00:02:40,425 from the African diaspora. 53 00:02:40,925 --> 00:02:43,635 And so the other major 54 00:02:45,075 --> 00:02:48,385 population we serve in this area is patients 55 00:02:48,385 --> 00:02:50,105 with substance use disorder. 56 00:02:50,365 --> 00:02:52,945 We have a very large population 57 00:02:52,945 --> 00:02:57,425 of patients in the South Bronx that are using substances, 58 00:02:57,645 --> 00:02:59,205 and it has affected their health. 59 00:02:59,385 --> 00:03:03,365 So we have lots of programs, uh, in that area as well. 60 00:03:03,825 --> 00:03:05,885 And that's a quick snapshot of, 61 00:03:06,065 --> 00:03:07,685 of Lincoln in the South Bronx. 62 00:03:09,865 --> 00:03:11,245 - Wow, that's amazing to hear. 63 00:03:11,265 --> 00:03:12,885 And certainly helpful to understand 64 00:03:12,885 --> 00:03:14,885 that pa patient population that you're serving 65 00:03:14,945 --> 00:03:16,845 and how I can imagine it's always 66 00:03:17,165 --> 00:03:18,405 evolving in the South Bronx. 67 00:03:18,545 --> 00:03:20,165 And so thank you for that background. 68 00:03:20,705 --> 00:03:22,205 Now, what are some of the biggest issues 69 00:03:22,205 --> 00:03:24,045 that you're following in healthcare right now? 70 00:03:25,395 --> 00:03:27,205 - Well, I think for, uh, Lincoln 71 00:03:27,385 --> 00:03:30,485 and for me, uh, one of the biggest things we're 72 00:03:30,485 --> 00:03:32,645 that I'm following is, is the advancement 73 00:03:32,705 --> 00:03:34,285 and the rapid deployment of 74 00:03:34,805 --> 00:03:37,485 artificial intelligence in healthcare, right? 75 00:03:37,585 --> 00:03:39,325 So we've seen it in the past. 76 00:03:39,435 --> 00:03:42,005 It's been around for a while in terms of looking at 77 00:03:42,635 --> 00:03:46,325 high repetition and low risk use cases, uh, 78 00:03:46,395 --> 00:03:50,285 information gathering, post-treatment monitoring, 79 00:03:50,505 --> 00:03:52,245 and now population health, 80 00:03:52,345 --> 00:03:57,275 but also looking at the use of AI intelligently 81 00:03:58,095 --> 00:03:59,355 and ethically, right? 82 00:03:59,535 --> 00:04:03,595 Uh, I think that anybody in the same position that 83 00:04:03,695 --> 00:04:07,675 as I am in, you know, is being bombarded with, you know, 84 00:04:07,795 --> 00:04:12,075 startups that have new AI that, you know, they want 85 00:04:12,075 --> 00:04:15,275 to implement and deploy in the healthcare sector. 86 00:04:15,375 --> 00:04:19,105 And so we just have to be cognizant of 87 00:04:19,455 --> 00:04:20,905 what this AI can 88 00:04:20,925 --> 00:04:23,345 and cannot do if there are any risk factors. 89 00:04:24,325 --> 00:04:26,985 Um, you know, is there any trust issues? 90 00:04:27,945 --> 00:04:31,585 I think that, you know, making sure that patients understand 91 00:04:31,585 --> 00:04:34,905 that we're using AI as well is another issue that 92 00:04:35,485 --> 00:04:37,745 I'm following, uh, today. 93 00:04:38,585 --> 00:04:42,785 I think that, uh, making sure that we're transparent and, 94 00:04:43,205 --> 00:04:46,305 and sharing our information as as appropriate. 95 00:04:47,205 --> 00:04:50,265 Uh, one of the other things, uh, with AI that we're doing 96 00:04:50,485 --> 00:04:53,985 as a system, and I'm pretty sure other health systems are 97 00:04:53,985 --> 00:04:57,665 doing the same thing, is that we've implemented a 98 00:04:59,375 --> 00:05:00,895 artificial intelligence council, 99 00:05:01,115 --> 00:05:05,175 and this council is made up of providers and administrators 100 00:05:05,315 --> 00:05:07,695 and technical people from across the system. 101 00:05:08,555 --> 00:05:12,575 And what we're, what we're doing is we're looking at ai, 102 00:05:13,695 --> 00:05:15,675 and I'll give you a specific example in a minute. 103 00:05:16,125 --> 00:05:17,315 We're looking at AI 104 00:05:17,375 --> 00:05:21,355 and making sure that we can, one, understand 105 00:05:21,355 --> 00:05:22,995 what it does and doesn't do. 106 00:05:23,015 --> 00:05:24,435 We can use it intelligently 107 00:05:24,455 --> 00:05:28,275 and we can integrate it into our we health system. 108 00:05:29,535 --> 00:05:31,875 We can learn from it as well. 109 00:05:32,535 --> 00:05:36,115 Um, so for a specific example, uh, 110 00:05:36,295 --> 00:05:38,075 and this is related to another issue 111 00:05:38,665 --> 00:05:41,235 that I'm following also here at Lincoln is, 112 00:05:41,295 --> 00:05:42,355 is provider burnout. 113 00:05:42,655 --> 00:05:44,195 And I think that's a national issue 114 00:05:44,195 --> 00:05:45,315 that we've all been talking about, 115 00:05:45,335 --> 00:05:49,675 but, uh, one of the AI tools is, um, 116 00:05:51,065 --> 00:05:53,715 ambient dictation in the exam room. 117 00:05:53,895 --> 00:05:57,925 So where they have the ability to have AI 118 00:05:58,585 --> 00:06:01,405 listen, if you will, to the conversation 119 00:06:01,405 --> 00:06:04,365 between the provider and the patient in the exam room, 120 00:06:04,705 --> 00:06:09,205 and actually create the note for the provider. 121 00:06:09,825 --> 00:06:12,565 And at the end of the exam, the provider can just go in 122 00:06:12,565 --> 00:06:16,685 and review the note, correct any errors, and then sign it. 123 00:06:17,535 --> 00:06:20,675 And that will really help, uh, 124 00:06:21,235 --> 00:06:24,515 providers reduce the burden of some of their documentation 125 00:06:24,575 --> 00:06:27,545 and the time that they spend outside 126 00:06:27,545 --> 00:06:28,865 of taking care of patients. 127 00:06:29,425 --> 00:06:33,935 Documenting. Uh, we have, um, uh, a big issue 128 00:06:34,205 --> 00:06:37,535 with, um, providers spending lots 129 00:06:37,535 --> 00:06:40,815 of their own time in completing documentation. 130 00:06:41,275 --> 00:06:44,215 And that kind of goes to my second issue, which is 131 00:06:44,215 --> 00:06:46,335 that I'm following is, is provider burnout. 132 00:06:47,155 --> 00:06:50,095 Um, you know, as we ask more and more of our providers 133 00:06:50,095 --> 00:06:54,735 and we need to provide them with the resources to make their 134 00:06:55,345 --> 00:06:56,495 their lives better, 135 00:06:58,055 --> 00:07:00,195 and one of the things with, um, 136 00:07:00,625 --> 00:07:04,155 that I look at in my institution is, is 137 00:07:04,155 --> 00:07:06,075 what we call pajama time, right? 138 00:07:06,225 --> 00:07:07,755 It's how much, how much of 139 00:07:07,755 --> 00:07:10,275 that at home time do my providers spend 140 00:07:11,355 --> 00:07:12,675 documenting in the medical record? 141 00:07:13,215 --> 00:07:16,275 Is that something that is affecting their life outside? 142 00:07:17,095 --> 00:07:18,515 Is it adding to their burnout? 143 00:07:19,575 --> 00:07:23,675 And that's where I think some, something like the program 144 00:07:23,785 --> 00:07:27,635 that I just talked about in terms of ambient dictation, uh, 145 00:07:27,635 --> 00:07:31,355 would help providers in reducing some of the burdens 146 00:07:31,355 --> 00:07:33,635 that we have in terms of documentation. 147 00:07:34,215 --> 00:07:36,235 Uh, so I'm really excited about that 148 00:07:36,415 --> 00:07:39,035 and I think that that's, um, something 149 00:07:39,035 --> 00:07:43,155 that's gonna develop very rapidly, uh, over the next, uh, 150 00:07:43,155 --> 00:07:48,025 couple of years as more and more AI is being used 151 00:07:48,045 --> 00:07:50,105 and implemented in the healthcare setting. 152 00:07:50,765 --> 00:07:53,265 Um, and provider burnout is something 153 00:07:53,265 --> 00:07:54,745 that we're all working on. 154 00:07:55,775 --> 00:07:58,675 Uh, we implemented a program here, uh, 155 00:07:58,675 --> 00:08:01,315 called Helping Healers Heal, or H three. 156 00:08:02,055 --> 00:08:04,515 And what that is, is we have peer, 157 00:08:06,605 --> 00:08:07,845 I don't wanna say peer counselors, 158 00:08:07,985 --> 00:08:10,965 but peers that people can go to 159 00:08:11,025 --> 00:08:13,285 and talk to when they have an issue. 160 00:08:13,345 --> 00:08:16,405 And if they have a, an issue where the peer thinks they need 161 00:08:16,405 --> 00:08:19,285 to speak to somebody in a more official capacity, 162 00:08:19,285 --> 00:08:22,005 then we put in, uh, roads and, 163 00:08:22,105 --> 00:08:24,565 and ways that they can do that without feeling 164 00:08:24,565 --> 00:08:27,885 that somebody's watching them or it's a bad thing 165 00:08:27,885 --> 00:08:31,685 because they're having a mental issue or stress. 166 00:08:32,465 --> 00:08:36,245 Uh, so the a three program has been very beneficial 167 00:08:36,985 --> 00:08:39,925 in helping our providers, not, not just, you know, 168 00:08:39,925 --> 00:08:42,925 helping all of our staff really, um, that are having, 169 00:08:43,305 --> 00:08:44,525 uh, stress issues. 170 00:08:45,225 --> 00:08:46,885 Uh, so that's something else that, 171 00:08:46,885 --> 00:08:49,205 that we've implemented here over the years, 172 00:08:49,385 --> 00:08:51,285 and I think that that's working out very well. 173 00:08:52,725 --> 00:08:54,345 - That's amazing to hear. And you know, I, 174 00:08:54,465 --> 00:08:58,085 I love those specific examples of the different, um, kind 175 00:08:58,085 --> 00:08:59,365 of committees 176 00:08:59,465 --> 00:09:02,245 or groups you put together in order to, um, 177 00:09:02,795 --> 00:09:04,245 dive into these different issues, 178 00:09:04,245 --> 00:09:05,565 whether it's the AI council 179 00:09:05,745 --> 00:09:08,925 or, you know, focused in on provider burnout and stress. 180 00:09:09,345 --> 00:09:12,725 Um, when you look at those two areas in particular 181 00:09:12,725 --> 00:09:16,085 where you're zeroing in, how do you develop, um, you know, 182 00:09:16,085 --> 00:09:20,005 those councils, uh, who is, I guess, leading them and, 183 00:09:20,005 --> 00:09:22,805 and what do they really, um, do in order to, 184 00:09:22,905 --> 00:09:25,965 to have an effective impact on the organization as a whole? 185 00:09:27,775 --> 00:09:31,345 - Yeah. So, um, for, for the, uh, 186 00:09:31,665 --> 00:09:34,105 artificial intelligence council, it's really led 187 00:09:34,125 --> 00:09:38,705 by our system, uh, CMIO and CIO, 188 00:09:39,965 --> 00:09:44,145 and they brought together this group of, uh, technicians 189 00:09:44,285 --> 00:09:48,065 or people in the tech field within our organization as well 190 00:09:48,065 --> 00:09:52,225 as, uh, clinical providers like myself, uh, 191 00:09:52,325 --> 00:09:56,905 in leadership roles and also frontline clinical providers. 192 00:09:56,965 --> 00:10:00,065 So that what we do is we actually look at, 193 00:10:00,445 --> 00:10:01,825 uh, a product, right? 194 00:10:01,845 --> 00:10:05,265 An AI product. We look at its function, we demo it, 195 00:10:06,045 --> 00:10:09,065 we figure out where it might work within our system, 196 00:10:09,245 --> 00:10:12,505 and if it's something that can be deployed, uh, 197 00:10:12,645 --> 00:10:14,545 across the system, uh, 198 00:10:14,685 --> 00:10:17,985 and we usually will pilot it at one of our facilities. 199 00:10:18,125 --> 00:10:19,945 So the backup health 200 00:10:19,945 --> 00:10:22,965 and hospitals in New York City has 201 00:10:23,505 --> 00:10:25,365 11 acute care hospitals. 202 00:10:25,945 --> 00:10:28,805 Um, so it's huge health system as well 203 00:10:28,925 --> 00:10:31,245 as we have a huge ambulatory network as well. 204 00:10:31,825 --> 00:10:34,325 Uh, so we wanna make sure that, you know, we 205 00:10:35,215 --> 00:10:38,925 pilot these programs before we implement them system wide, 206 00:10:39,545 --> 00:10:43,485 and we also look at six of, of the AI 207 00:10:43,705 --> 00:10:47,325 and making sure that we're using it in an ethical manner. 208 00:10:47,625 --> 00:10:50,285 And that, you know, one of the things that we're 209 00:10:51,325 --> 00:10:53,895 everybody's talking about now is health equity. 210 00:10:54,395 --> 00:10:58,835 And so we want to make sure that the AI is not adding to 211 00:10:58,895 --> 00:11:01,675 or worsening our equity efforts, right? 212 00:11:02,215 --> 00:11:06,075 Uh, 'cause a lot of current data may not be based upon the 213 00:11:07,085 --> 00:11:09,555 broad population of patients that we see, 214 00:11:09,575 --> 00:11:14,275 and some of the results of the AI might not pertain 215 00:11:14,275 --> 00:11:15,515 to a particular group. 216 00:11:15,655 --> 00:11:17,555 So that's something that we also look at, 217 00:11:18,445 --> 00:11:19,955 which I think is really important 218 00:11:20,055 --> 00:11:23,515 as we look at health equity issues across our system and, 219 00:11:23,575 --> 00:11:26,555 and across the health system in general at large. 220 00:11:27,625 --> 00:11:32,195 It's a challenge, but I, I think that looking at that 221 00:11:32,615 --> 00:11:35,515 as well as, you know, at what point do we need 222 00:11:35,515 --> 00:11:37,995 to inform patients that we're using ai? 223 00:11:38,775 --> 00:11:43,555 Do we share the data with, uh, systems outside of our own, 224 00:11:44,375 --> 00:11:45,755 uh, and how do we do that? 225 00:11:46,055 --> 00:11:48,275 You know, making sure that we're compliant 226 00:11:48,275 --> 00:11:49,635 with rules and regulations. 227 00:11:51,755 --> 00:11:53,765 - That's so helpful to know and understand. 228 00:11:53,855 --> 00:11:57,205 Thank you for, um, talking us through that a bit more now. 229 00:11:57,395 --> 00:11:59,165 When you look ahead, what are you most excited 230 00:11:59,165 --> 00:12:00,325 about and what makes you nervous? 231 00:12:02,155 --> 00:12:06,945 - So I think I'm really excited about, you know, 232 00:12:06,945 --> 00:12:11,145 where, where AI is going to take us in terms of 233 00:12:12,045 --> 00:12:14,145 if we use it, you know, the right way. 234 00:12:14,765 --> 00:12:18,745 And, you know, even the, even the Vatican has a, 235 00:12:19,285 --> 00:12:20,425 an ethical advisor 236 00:12:20,605 --> 00:12:23,385 to the Pope who's looking at AI for the Vatican. 237 00:12:23,445 --> 00:12:26,505 So, you know, if they're doing it, we also need to make sure 238 00:12:26,505 --> 00:12:27,785 that we're using it ethically. 239 00:12:27,785 --> 00:12:32,025 And I think the use of ai, I think it's gonna be tremendous 240 00:12:32,045 --> 00:12:33,185 for our patients, right? 241 00:12:33,325 --> 00:12:37,065 So whether it's, um, home health monitoring, 242 00:12:37,755 --> 00:12:40,545 monitoring blood pressure from, you know, 243 00:12:40,565 --> 00:12:43,985 the patient's home, using some of the technology 244 00:12:44,085 --> 00:12:46,625 that's available to help us get that information 245 00:12:46,645 --> 00:12:50,065 and then allowing AI to help us interpret it, 246 00:12:51,145 --> 00:12:52,985 I think is going to be very exciting. 247 00:12:53,605 --> 00:12:57,905 Uh, one of the, uh, items that I saw recently 248 00:12:58,725 --> 00:13:00,745 was this thing called a smart mirror. 249 00:13:01,845 --> 00:13:04,745 And the smart mirror would, could be in your bathroom 250 00:13:04,885 --> 00:13:07,545 and, you know, while you're getting ready in the morning, it 251 00:13:08,295 --> 00:13:09,745 uses infrared lights 252 00:13:09,845 --> 00:13:12,705 and some other high technology that I can't explain, 253 00:13:13,445 --> 00:13:15,865 and it can check your pulse, your blood pressure, 254 00:13:16,095 --> 00:13:17,465 your body temperature, 255 00:13:17,605 --> 00:13:21,505 and send all that information to the doctor like right away. 256 00:13:21,965 --> 00:13:23,865 Uh, so things like that I think are, 257 00:13:24,605 --> 00:13:26,505 are, are gonna be great. 258 00:13:26,845 --> 00:13:30,705 We are as a system looking into, uh, implementing 259 00:13:30,725 --> 00:13:34,585 and modeling, uh, the home blood pressure 260 00:13:34,585 --> 00:13:37,985 and weight monitoring for a particular cohort of patients. 261 00:13:38,015 --> 00:13:40,745 Like, say those with congestive heart failure, who you want 262 00:13:40,745 --> 00:13:42,745 to make sure to measure their weight 263 00:13:43,005 --> 00:13:44,665 and keep their weight in the right place 264 00:13:44,765 --> 00:13:46,865 and make sure their blood pressure's under control. 265 00:13:47,005 --> 00:13:51,505 So these are really things that will help connect us 266 00:13:52,705 --> 00:13:55,585 providers to the patients more often, right? 267 00:13:55,685 --> 00:13:58,945 And not just wait on, you know, the annual visit 268 00:13:59,245 --> 00:14:03,305 or the sick visit, but really allow us much more time 269 00:14:03,445 --> 00:14:05,225 and helping the patient manage their, 270 00:14:05,555 --> 00:14:06,825 their chronic conditions 271 00:14:08,185 --> 00:14:11,205 and work through, you know, their diet. 272 00:14:11,505 --> 00:14:13,965 Um, I think those are some of the things 273 00:14:13,965 --> 00:14:15,165 that I'm excited about. 274 00:14:15,165 --> 00:14:16,965 Another thing I'm really excited about 275 00:14:17,625 --> 00:14:21,245 is we have started a new program called Lifestyle Medicine. 276 00:14:22,065 --> 00:14:24,125 And what this is, is this a program 277 00:14:24,235 --> 00:14:27,285 that involves physician providers, nutritionists, 278 00:14:27,535 --> 00:14:31,165 dieticians, and we really work with patients to 279 00:14:31,865 --> 00:14:36,485 change their diet, uh, as, as use their diet as medication. 280 00:14:36,625 --> 00:14:38,125 So that's very exciting. 281 00:14:38,155 --> 00:14:40,765 That just kicked off like last month. 282 00:14:41,465 --> 00:14:44,365 Um, and we already have patients with, you know, 283 00:14:44,365 --> 00:14:48,085 like diabetes that are really excited about this, uh, 284 00:14:48,565 --> 00:14:51,605 prospect in terms of, you know, using food 285 00:14:52,585 --> 00:14:54,565 and diet as medication to help, 286 00:14:54,995 --> 00:14:57,165 help control their chronic medical condition. 287 00:14:57,225 --> 00:15:00,805 So it's really exciting. I wanna sign up myself. 288 00:15:02,815 --> 00:15:05,395 - It sounds like a, such a, a really great opportunity 289 00:15:05,455 --> 00:15:06,755 and a really cool service you're able 290 00:15:06,755 --> 00:15:08,155 to offer the community, um, 291 00:15:08,155 --> 00:15:10,035 and something unique too, um, 292 00:15:10,505 --> 00:15:12,795 that you've kind of are, are diving into. 293 00:15:12,975 --> 00:15:15,195 So, um, that's really interesting to hear about. 294 00:15:16,055 --> 00:15:19,155 Is there, um, anything that makes you a little bit nervous? 295 00:15:20,815 --> 00:15:24,385 - Yeah, so what makes me nervous is the potential AI 296 00:15:24,475 --> 00:15:25,625 makes me nervous as well. 297 00:15:27,395 --> 00:15:30,135 It makes me nervous 'cause I, I think that there's, 298 00:15:31,125 --> 00:15:34,065 you know, there's a lot of potential risks involved 299 00:15:34,205 --> 00:15:35,905 and not only risks to the patient, 300 00:15:36,165 --> 00:15:40,265 but also, you know, what's the liability that a physician 301 00:15:40,365 --> 00:15:42,905 or a provider has who uses 302 00:15:42,925 --> 00:15:46,345 and relies on AI to help make a diagnosis 303 00:15:46,365 --> 00:15:49,145 and that diagnosis is wrong, right? 304 00:15:49,645 --> 00:15:53,635 Uh, so I think that that that has a potential 305 00:15:53,635 --> 00:15:54,995 to make me very nervous. 306 00:15:55,505 --> 00:15:59,555 Also, you know, we have to be able to trust the ai 307 00:15:59,615 --> 00:16:02,475 and I think that's just gonna take some time, uh, 308 00:16:02,475 --> 00:16:06,475 which is why I think our, our AI council is really going 309 00:16:06,475 --> 00:16:08,715 to help us in, in that arena. 310 00:16:09,855 --> 00:16:12,515 Uh, other things that make me nervous now in this 311 00:16:12,515 --> 00:16:14,595 environment is, uh, is 312 00:16:15,295 --> 00:16:17,275 is provider burnout, which I mentioned. 313 00:16:17,475 --> 00:16:22,005 I think that, you know, um, you know, how do we recruit 314 00:16:22,025 --> 00:16:23,765 and retain good providers? 315 00:16:23,865 --> 00:16:26,205 How do we keep them from feeling 316 00:16:26,235 --> 00:16:28,445 that they're overworked all the time? 317 00:16:29,145 --> 00:16:30,525 Uh, and overstressed. 318 00:16:30,905 --> 00:16:33,245 And, you know, one of the challenges 319 00:16:33,245 --> 00:16:35,005 that we have in a public health system 320 00:16:35,065 --> 00:16:36,205 and whether it's New York 321 00:16:36,265 --> 00:16:40,165 or anywhere else, is really, you know, how can we recruit, 322 00:16:40,505 --> 00:16:41,565 you know, specialists 323 00:16:41,785 --> 00:16:45,645 and, you know, what can we offer them, you know, um, 324 00:16:45,655 --> 00:16:49,205 especially young, young doctors coming out that, you know, 325 00:16:49,265 --> 00:16:53,205 are spending or thinking more about their lifestyle than 326 00:16:53,205 --> 00:16:55,085 necessarily, uh, 327 00:16:55,565 --> 00:16:58,525 providers from the past had had done right. 328 00:16:58,525 --> 00:17:01,645 Making sure that they have work life, 329 00:17:01,835 --> 00:17:03,085 well work life balance, 330 00:17:03,345 --> 00:17:07,685 but I think it's really, uh, mean work life synergy, right? 331 00:17:07,835 --> 00:17:10,845 It's like how do we balance our work life 332 00:17:10,865 --> 00:17:14,645 and our regular life so that we're, we're content, 333 00:17:14,815 --> 00:17:17,405 we're happy, we do a good job, you know? 334 00:17:17,545 --> 00:17:19,645 And I think burnout can affect all of that, 335 00:17:20,745 --> 00:17:21,765 uh, in the future. 336 00:17:22,025 --> 00:17:25,495 So helping healers heal is one program, 337 00:17:25,755 --> 00:17:28,015 and I'm sure that there are others, you know, 338 00:17:28,015 --> 00:17:32,055 that do the same thing, uh, in providing, um, 339 00:17:33,675 --> 00:17:35,135 aid to providers or, 340 00:17:35,195 --> 00:17:37,655 or workers in healthcare that may need assistance. 341 00:17:38,715 --> 00:17:42,015 We also had another program that we created here. 342 00:17:42,275 --> 00:17:44,335 Uh, we, it's probably from somewhere else, 343 00:17:44,435 --> 00:17:46,815 but it's called, uh, we have a Battle Buddy program. 344 00:17:47,955 --> 00:17:52,005 And so what that is, is that senior leaders 345 00:17:53,145 --> 00:17:55,525 are get, um, a battle buddy, 346 00:17:55,625 --> 00:17:59,405 so somebody from the front lines, um, who has challenges, 347 00:17:59,545 --> 00:18:01,085 and then battle buddy. 348 00:18:01,145 --> 00:18:02,765 We help them talk through issues. 349 00:18:02,945 --> 00:18:07,685 And so my battle buddy is the, their surgery here, 350 00:18:07,985 --> 00:18:11,885 uh, who runs a very busy trauma center as well 351 00:18:12,065 --> 00:18:14,005 as all the surgical subspecialties. 352 00:18:14,145 --> 00:18:16,645 So, uh, I'm her battle buddy. 353 00:18:17,145 --> 00:18:20,365 Uh, so that, that works out very well as well in, 354 00:18:20,365 --> 00:18:22,725 in addressing some of the issues that I'm concerned about 355 00:18:22,785 --> 00:18:23,885 and make me nervous. 356 00:18:25,715 --> 00:18:28,515 - Absolutely. That sounds like a really cool solution. 357 00:18:28,695 --> 00:18:32,755 Um, you know, especially, um, just the battle buddy concept 358 00:18:32,855 --> 00:18:34,675 and being able to pair the senior leadership 359 00:18:34,675 --> 00:18:35,915 with somebody on the front lines 360 00:18:36,015 --> 00:18:38,955 or who really is, uh, in the thick of things day in 361 00:18:38,955 --> 00:18:41,195 and day out to understand those challenges and issues 362 00:18:41,375 --> 00:18:43,035 and really work through them together. 363 00:18:43,455 --> 00:18:45,475 Um, I just think that's really cool 364 00:18:45,475 --> 00:18:48,715 and your idea along work life synergy as well, um, can be 365 00:18:48,735 --> 00:18:50,275 so, uh, informative 366 00:18:50,275 --> 00:18:52,395 and instructive for people really, 367 00:18:52,495 --> 00:18:53,555 no matter their profession. 368 00:18:54,255 --> 00:18:57,475 - Yep. - Agreed. So, absolutely. 369 00:18:57,535 --> 00:18:59,355 So before we wrap up here, I'm wondering 370 00:18:59,705 --> 00:19:02,115 what will the most effective healthcare leaders need in 371 00:19:02,115 --> 00:19:03,555 order to be successful over the next 372 00:19:03,575 --> 00:19:04,795 two to three years or so? 373 00:19:04,965 --> 00:19:07,435 Especially thinking through how much healthcare is changing 374 00:19:07,455 --> 00:19:08,595 and we'll continue to do so. 375 00:19:10,035 --> 00:19:11,155 - I think there are a couple of things 376 00:19:11,185 --> 00:19:13,395 that healthcare leaders will need. 377 00:19:14,055 --> 00:19:16,435 Um, one is we need to show 378 00:19:16,435 --> 00:19:18,675 that we care about our staff, right? 379 00:19:18,775 --> 00:19:20,275 We can't be sitting in the office. 380 00:19:20,375 --> 00:19:23,595 We have to get out there with the, with our staff 381 00:19:23,695 --> 00:19:24,915 and communicate with them. 382 00:19:25,575 --> 00:19:30,395 Uh, we will need a tremendous amount of patients, uh, to do 383 00:19:30,395 --> 00:19:33,995 that as we, you know, we talk about meeting the patient 384 00:19:34,045 --> 00:19:36,115 where they are in healthcare. 385 00:19:36,815 --> 00:19:39,395 We also need to meet our staff where they are, right? 386 00:19:39,935 --> 00:19:43,595 You know, are there ways that we can create, um, 387 00:19:44,145 --> 00:19:45,155 work environments 388 00:19:45,175 --> 00:19:48,475 or work schedules that allow people, you know, 389 00:19:48,495 --> 00:19:52,355 to have appropriate time away and and disconnect? 390 00:19:53,785 --> 00:19:56,425 I think one of the, there was an article I read, uh, 391 00:19:56,425 --> 00:19:58,945 not too long ago that said when we were going 392 00:19:59,085 --> 00:20:02,665 to remote work, uh, just offering 393 00:20:03,225 --> 00:20:04,745 employees the opportunity 394 00:20:04,845 --> 00:20:07,025 to do remote work made them feel better. 395 00:20:07,725 --> 00:20:10,785 Uh, so we're gonna have to come up with ways to 396 00:20:11,575 --> 00:20:13,225 meet our workforce where they are 397 00:20:13,725 --> 00:20:15,785 and still be able to get the, the job done. 398 00:20:16,525 --> 00:20:20,705 Um, to trust honesty and integrity I think are gonna be key. 399 00:20:21,325 --> 00:20:24,145 If you don't trust your leader, uh, 400 00:20:24,285 --> 00:20:26,785 or if they don't have integrity, um, 401 00:20:27,095 --> 00:20:29,305 then you're not gonna be able to lead. 402 00:20:29,645 --> 00:20:33,545 Uh, um, also leaders, you know, we, 403 00:20:33,605 --> 00:20:34,785 we can't hold grudges. 404 00:20:34,855 --> 00:20:38,825 It's not personal, you know, it's not about the leader, 405 00:20:38,935 --> 00:20:42,545 it's about patient, it's about the system, uh, 406 00:20:42,565 --> 00:20:44,945 and we just have to really understand that. 407 00:20:45,725 --> 00:20:48,205 Um, I think the other thing we need to 408 00:20:49,845 --> 00:20:53,415 look at is how are we gonna recruit, you know, 409 00:20:53,525 --> 00:20:55,975 over the next, let's say three to five years 410 00:20:56,855 --> 00:20:59,055 anticipating the needs of the community 411 00:20:59,115 --> 00:21:02,455 and making sure that we can recruit providers, um, 412 00:21:03,325 --> 00:21:05,375 that we need to provide that care. 413 00:21:05,635 --> 00:21:08,895 And I think as a leader, we need to think about that 414 00:21:08,895 --> 00:21:12,775 because as, as the healthcare workforce ages 415 00:21:13,435 --> 00:21:16,535 and people start to retire, uh, especially 416 00:21:16,535 --> 00:21:18,335 after Covid, um, you know, 417 00:21:18,335 --> 00:21:20,455 it gets very challenging sometimes to, 418 00:21:20,955 --> 00:21:22,375 to find the right people 419 00:21:23,515 --> 00:21:25,975 or any people for that matter, uh, 420 00:21:26,205 --> 00:21:28,215 that can come in and, and do the job. 421 00:21:28,475 --> 00:21:32,135 And I, I think the last thing, uh, is that, you know, 422 00:21:32,155 --> 00:21:34,895 as healthcare leaders, we need to walk the talk 423 00:21:34,995 --> 00:21:36,135 as they say, right? 424 00:21:36,755 --> 00:21:38,575 Um, we need to be out there 425 00:21:39,115 --> 00:21:40,775 and show people that we're authentic 426 00:21:41,915 --> 00:21:46,655 and that we, uh, listen, I tell my, my staff, 427 00:21:46,815 --> 00:21:49,495 I said, uh, you know, I may not be able 428 00:21:49,495 --> 00:21:52,895 to solve your problem, but I'm a really good listener 429 00:21:53,115 --> 00:21:56,255 and I can listen to you, so let's talk. 430 00:21:56,635 --> 00:21:58,975 And so I think we're gonna need to be able to do that 431 00:21:59,235 --> 00:22:03,175 as well as we move forward over the next two to three, 432 00:22:03,245 --> 00:22:05,335 five years, uh, as healthcare leaders. 433 00:22:06,035 --> 00:22:07,495 Um, the other thing we need to do, 434 00:22:07,495 --> 00:22:09,735 and the last thing I'll mention is we really need to 435 00:22:10,365 --> 00:22:13,095 develop our healthcare leader bench, right? 436 00:22:13,275 --> 00:22:16,215 So I'm not gonna be in this role forever, so I need 437 00:22:16,215 --> 00:22:17,815 to have somebody who's gonna step up. 438 00:22:18,675 --> 00:22:22,975 Um, and so how do we make sure that those people 439 00:22:23,155 --> 00:22:26,855 who are gonna step up into our positions have the right 440 00:22:27,485 --> 00:22:31,835 core competencies that we need them to have, whether it's, 441 00:22:32,215 --> 00:22:37,075 you know, communication skills, financial skills, um, how 442 00:22:37,075 --> 00:22:39,915 to run a hospital, even I think that these are some 443 00:22:39,915 --> 00:22:42,515 of the things that, that as healthcare leaders, we need 444 00:22:42,515 --> 00:22:45,035 to make sure that we're doing to bring up the next group of, 445 00:22:45,215 --> 00:22:47,075 of leaders that are coming up behind this. 446 00:22:48,935 --> 00:22:50,575 - Absolutely. I think that makes a lot of sense. 447 00:22:50,595 --> 00:22:52,615 And, you know, really appreciate you walking us 448 00:22:52,615 --> 00:22:53,615 through all those different areas. 449 00:22:54,115 --> 00:22:55,935 Um, just in terms of making sure 450 00:22:56,525 --> 00:22:58,455 that you are meeting the staff where you are, 451 00:22:58,595 --> 00:23:00,655 you can figure out what it takes in order for them 452 00:23:00,675 --> 00:23:03,135 to feel comfortable and be able to do their jobs well. 453 00:23:03,675 --> 00:23:05,935 And, and then leaning into, um, you know, 454 00:23:05,935 --> 00:23:07,535 that listening side of things and, 455 00:23:07,595 --> 00:23:10,415 and, um, continuing to build out that leadership bench. 456 00:23:10,515 --> 00:23:12,695 Um, definitely crucial all the way across the board. 457 00:23:12,795 --> 00:23:14,975 So thank you so much Dr. Marshall 458 00:23:14,975 --> 00:23:16,495 for joining us on the podcast today. 459 00:23:16,495 --> 00:23:18,575 This has been such a fascinating discussion 460 00:23:18,575 --> 00:23:20,455 and I look forward to connecting with you again soon. 461 00:23:21,155 --> 00:23:23,495 - Oh, thank you very much. It's been a wonderful time 462 00:23:23,675 --> 00:23:26,055 and, uh, look forward to doing it again someday.