Advancing Health Podcast

00:00:00:06 - 00:00:16:02
Tom Haederle
Welcome to Advancing Health. In this episode, we hear from a father-daughter physician team who are delivering babies in their hometown, keeping care in the family, and exploring what it means to care for families across generations.

00:00:16:04 - 00:00:45:18
Julia Resnick
It's not every day you get to practice medicine alongside your family, let alone deliver babies together. Today's guests are doing just that. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. Today, I'm joined by a father-daughter duo from Southwest Health in Platteville, Wisconsin. Dr. Kevin Carr is a family medicine physician who also provides obstetric care, and his daughter, Melissa Carr, has returned to her hometown to practice as an obstetrician and gynecologist.

00:00:45:25 - 00:00:56:00
Julia Resnick
We'll talk about what it's like to work and even deliver babies together, and what it takes to provide high quality maternal care in a rural community. Drs. Carr, welcome to the podcast.

00:00:56:04 - 00:00:56:26
Kevin Carr, M.D.
Thank you.

00:00:56:27 - 00:00:58:00
Melissa Carr, M.D.
Thanks for having us.

00:00:58:01 - 00:01:13:24
Julia Resnick
So this episode feels especially meaningful as we think about Father's Day. And the two of you are not only colleagues, but father and daughter working side by side. What has it been like to build a professional relationship alongside your personal one? Kevin, I'll start with you.

00:01:14:00 - 00:01:38:06
Kevin Carr, M.D.
Well it's awesome. It's obviously very exciting to see your daughter do well and be well liked in the community. She's actually now starting to deliver people that I actually delivered. So I think fair amount of those has happened. It's also very nice to have somebody very knowledgeable that I can walk down the hallway and ask questions to that I think knows more than I do right now.

00:01:38:07 - 00:01:40:22
Kevin Carr, M.D.
So it's pretty it's pretty awesome all the way around.

00:01:40:26 - 00:01:43:03
Julia Resnick
Amazing. Melissa, what's it been like for you?

00:01:43:06 - 00:02:03:06
Melissa Carr, M.D.
Yeah, kinda just to reiterate that, I think it's just it's really an amazing experience. I mean, he's such a great role model and just an overall mentor. I mean, he's been practicing medicine here at this location for 35 plus years. So, you know, with that, he brings a wealth of knowledge and all the experience that comes with it.

00:02:03:06 - 00:02:23:28
Melissa Carr, M.D.
And he's just so willing to offer that advice both clinically and, you know, from a personal standpoint as well. So, you know, there's just so insightful. And it's like you said, his office is down the hall. So, you know, you can just pop in and, you know, ask questions and bounce ideas off of him. And it's just it's so such a nice resource to have, you know, readily available to me.

00:02:24:00 - 00:02:28:04
Melissa Carr, M.D.
So I take advantage of it as much as I possibly can.

00:02:28:06 - 00:02:36:12
Julia Resnick
That's amazing. And my dad used to work in the building next to us, so we'd have lunch all the time. But that's different than being in the same profession and actually working together.

00:02:36:14 - 00:02:54:27
Kevin Carr, M.D.
And I'll have one more little anecdote. My dad was a veterinarian, and so for many years when I heard Doc Carr, I was looking around because it was my dad they were talking to. And I think Melissa will share that same anecdote that it's we're used to having that in the background.

00:02:55:02 - 00:03:01:01
Melissa Carr, M.D.
Yes. In fact, I had a patient this morning bringing up Doc Carr, who is Grandpa Carr, the veterinarian.

00:03:01:01 - 00:03:07:08
Julia Resnick
I love that. And I imagine that your dad being in this field influenced your decision to go into it as well.

00:03:07:10 - 00:03:14:22
Kevin Carr, M.D.
I was not sure if I was going to do veterinary medicine or people medicine, so obviously I made what I think is a very good choice.

00:03:14:25 - 00:03:18:07
Julia Resnick
And Melissa, you stuck with delivering babies.

00:03:18:09 - 00:03:46:15
Melissa Carr, M.D.
Yeah, same thing. I mean, I had a front row seat to, you know, to healthcare from a very early age. Growing up, I just remember seeing, you know, number one, seeing, you know, get up in the middle of the night to go deliver a baby or, you know, that side of things. But then, you know, you'd walk into the grocery store or to a ball game and there would be a patient that would track him down and telling stories about their family members or their loved ones that he took care of, and just or just being thankful and expressing their gratitude for the care he provided them, you know,

00:03:46:16 - 00:03:59:26
Melissa Carr, M.D.
so I saw from a very early age kind of how meaningful that was. And I feel like that's kind of a perspective that not a lot of people get going into healthcare. If you haven't been exposed to that, especially in more rural type setting.

00:03:59:28 - 00:04:08:16
Julia Resnick
Absolutely. So as you've been working together, what have you learned from each other, both as clinicians and his family members? How does that shape how you're caring for patients?

00:04:08:20 - 00:04:29:10
Melissa Carr, M.D.
Well, again, to kind of just like as I mentioned, you know, I saw the relationships that he developed with patients, both in the clinical setting and outside. You know, how patients just felt so grateful for their care. And I just I got to see how, you know, how you played that role in their lives. And I would just, you know, thought that was really pretty amazing.

00:04:29:11 - 00:04:36:07
Melissa Carr, M.D.
And so that really kind of impacted, number one, me to go into medicine. And then, you know, continuing to build those types of relationships with my own patients.

00:04:36:09 - 00:04:37:06
Julia Resnick
And Kevin.

00:04:37:12 - 00:04:54:12
Kevin Carr, M.D.
Well, again, I kind of go back to my parents again, I think kind of I was always taught you show up, be there and care for people and the rest will take care of itself. We're small town of 10,000, and it's just different care out here than using the big city because of that. And I think the patients see that.

00:04:54:13 - 00:04:59:14
Julia Resnick
Say more about that. What makes providing maternal care in rural communities special?

00:04:59:16 - 00:05:22:25
Melissa Carr, M.D.
So our model for maternal health care here is a little bit different than what you're going to get in some of the bigger health care systems. And we tend to have one provider that follows their patients through their prenatal care from the first visit through delivery and then postpartum. And so because of that, we really start to build these relationships with patients.

00:05:23:00 - 00:05:38:09
Melissa Carr, M.D.
You get to know them at a much more personal level. And I just think that that brings a whole other level of care to these moms and babies. So it is a little bit more of a unique experience here. And I think that that's part of what makes us special.

00:05:38:15 - 00:05:40:18
Julia Resnick
Kevin, anything you want to add to that?

00:05:40:20 - 00:05:55:27
Kevin Carr, M.D.
Yeah, I think especially with OB, once you take care of somebody and see them 12, 13, 15 times, they kind of remember you forever because it's one of the biggest days of their life that they're going to remember for every single day. And you're a big part of it.

00:05:55:28 - 00:06:15:06
Julia Resnick
Absolutely. And it's one of those few times in healthcare where you're getting care for a happy reason, and it's amazing that you get to be there for them throughout that entire journey. So, Kevin, I know you're an FM who does OB and Melissa, you're an obstetrician/gynecologist. And you know, how does that work together, working as a care team?

00:06:15:12 - 00:06:19:26
Julia Resnick
And how can those kind of collaborations help improve care for patients?

00:06:19:28 - 00:06:42:26
Kevin Carr, M.D.
Yeah, it works amazingly well. We have five family practice docs that deliver OB patients, and one of the family practice docs actually does C-sections, along with three of the OB doctors here. We still take care of our own patients. Obviously, they're very available for any consult, anything that happens, and if a C-section happens on their patient, we're also there first assisting.

00:06:42:26 - 00:06:58:19
Kevin Carr, M.D.
We're helping out and taking care of the baby. So it absolutely works very seamlessly. There's no turf battles. There's a lot of helping each other out and very willingness to answer questions if there's any problems or concerns about any kind of care.

00:06:58:24 - 00:07:15:24
Melissa Carr, M.D.
And we are located in the same building. We're two separate clinics or two different offices, but we're separated by hallway. So people will pop into my office all the time just to bounce ideas or ask questions, and vice versa. I'll do the same thing. I'll put my head in and say, okay, I got this patient. What do you think of this?

00:07:15:25 - 00:07:28:09
Melissa Carr, M.D.
And everybody is always so willing to, you know, to help out and provide advice and, you know, just kind of help coverage. And like you said, it's, you know, we're a pretty well oiled machine and it works really well for us.

00:07:28:12 - 00:07:43:24
Julia Resnick
That's amazing. And in a lot of rural communities these days, we're hearing about hospital closures or hospitals that are having to retract their OB services. But it sounds like you all are doing the opposite of that. So what do you think has been driving that growth and how are how are you adapting to meet that need?

00:07:43:26 - 00:08:14:28
Melissa Carr, M.D.
So we've seen that firsthand. We had a hospital in a neighboring county closed their maternal health services probably about ten years ago, give or take. And so those patients now had to travel further for their obstetrical care. Many of them do come our direction now. Another hospital, neighboring hospital, has also lost some of their OB providers and their gynecologist for whether it was from those providers relocating or retiring.

00:08:15:01 - 00:08:36:08
Melissa Carr, M.D.
So there's just less access to care. And so we have seen more patients coming our direction because of just there isn't as many options available to them. And they're now having to travel further. So to kind of combat that, number one, we've increased our OB providers since I've been here. We have more physicians that are providing OB care, whether it's family medicine, physicians and OBGYNs.

00:08:36:10 - 00:08:56:00
Melissa Carr, M.D.
And we've also opened outreach clinics through our organization. So that's where OB care is available. So people aren't having to drive as far for their prenatal care visits. They still come to our main hospital campus for deliveries, but at least for their visits, they're not having to travel as far.

00:08:56:07 - 00:08:58:20
Julia Resnick
Fantastic. Kevin, anything you want to add?

00:08:58:26 - 00:09:19:26
Kevin Carr, M.D.
Just to show you the numbers, in 2010, we were about 140 deliveries, and I believe this year we're going to be at 240 delivery. And some of it's the culture of the hospital. The whole hospital has exploded over this period of time. Going back to the American Hospital Association meeting a few years ago, quite a few years ago, we started a Journey to Excellence program

00:09:19:26 - 00:09:40:27
Kevin Carr, M.D.
after one of the meetings, we learned at the Rural Health Leadership Conference. And our hospital does that, and patients that walk in the door from the outside can tell the difference in every single employee the attitudes, the smiles, the willingness to help out everybody from the janitor to the CEO, every single step along the way. Every person is important.

00:09:40:27 - 00:09:57:07
Kevin Carr, M.D.
And it shows in how we take care of patients and how patients respond to what we do. And it's every single one of our sort of different programs, you know, OB, ortho, everything has literally exploded because of some of the things we've done.

00:09:57:09 - 00:10:05:22
Julia Resnick
That's fantastic and really just speaks to, you know, your organizational culture and how that exudes between providers and also to the people you care for.

00:10:05:25 - 00:10:31:02
Melissa Carr, M.D.
And I think there's a lot of word of mouth that spreads too, you know, people are very grateful for their care here. And they really enjoy their experience. And they spread that to their friends, their family members. And, you know, so that catches on. And we're starting to see patients that are willing to travel further for their OB care, even if they have options that are closer to home, because they're choosing to come to our facility to come to deliver and coming to see us for their prenatal care.

00:10:31:04 - 00:10:44:28
Julia Resnick
That is great. And so you've both really been talking about like, the human piece of this. And I know a lot of hospitals, including yours, are using technology to help extend care. Can you talk about how you're thinking about incorporating technology into your work?

00:10:45:01 - 00:11:03:15
Kevin Carr, M.D.
They are starting to do AI to help with notes here. We just started six months ago. So we're learning from many of the providers. There's some very good things about it. There's some things they got to learn. But it sounds like so far so, so good that it's saving some time so they can spend more time with the patient and do those things.

00:11:03:15 - 00:11:05:19
Kevin Carr, M.D.
So that's one of the things they're doing.

00:11:05:24 - 00:11:10:00
Julia Resnick
And wasn't there a piece about a telemedicine program for neonatology.

00:11:10:02 - 00:11:42:02
Kevin Carr, M.D.
Oh yes. We were the first - and it might still be the only program in the state - that has a telemedicine NICU program, neonatal intensive care unit program associated with University of Wisconsin-Madison. And it's been going on for a couple of years. It took us a while to tweak and fine tune some things, and it's really nice in the sense of in our newborn nursery, we have computer set up, we have cameras set up, and we basically call a number and usually within minutes we have a neonatologist on the phone.

00:11:42:02 - 00:12:01:03
Kevin Carr, M.D.
We can see them, they can see us. There's a video on us, there's a video on the baby. And back in the day where we take care of lots of babies who need a little bit of oxygen, need a little bit of help, a little CPAP to help them get through the breathing, and you kind of sit there and try to decide, okay, is this baby sick enough to be transferred?

00:12:01:03 - 00:12:20:06
Kevin Carr, M.D.
Can I watch for another two hours? Well, now we make that call right away and we talk to them and we go, hey, I'm pretty comfortable with this, but I just want to make sure that I'm doing the right thing. And you have them on the phone, they assess the baby, they help you sometimes in making the decision, do we order a few tests and then, hey, we'll keep an eye on things and get back to us an hour.

00:12:20:07 - 00:12:29:20
Kevin Carr, M.D.
And if the baby transitions and looks great, wonderful. If the baby doesn't do well, then we already have the numbers in and they're ready to send the transport team.

00:12:29:25 - 00:12:34:28
Julia Resnick
That sounds incredibly helpful for rural hospitals that probably don't see a ton of cases like that.

00:12:35:00 - 00:12:57:27
Melissa Carr, M.D.
We also have a new SIM lab here as well, so we can run different types of simulations for both physicians and the rest of the hospital staff that are on the OB unit. And that's been really helpful, especially in a rural setting, because, you know, our volumes are lower, which also means that our types of high risk clinical scenarios are also going to be lower.

00:12:57:27 - 00:13:18:09
Melissa Carr, M.D.
So you may have a nurse that might not experience a postpartum hemorrhage or a shoulder dystocia or those types of situations, but have only heard about it. So this allows people to, you know, get that training and doing that repetition through simulation, even if we don't necessarily see it very often to keep those skills up.

00:13:18:12 - 00:13:33:00
Julia Resnick
Absolutely. And to close, I just want to bring this back to Father's Day, since that's when we're releasing this. And you are a father-daughter duo, so can you just share a moment or a story that reminds you why this work is so important to your community?

00:13:33:02 - 00:13:54:16
Kevin Carr, M.D.
I called a patient this morning to ask if I could share this story without saying her name. Obviously, I've delivered a lot of patients and this specific family, I delivered all four of the girls. Several of them, I believe they're all going into nursing school. And so back in the start of Covid in 2021, she was in nursing school and came to me with symptoms.

00:13:54:24 - 00:14:13:18
Kevin Carr, M.D.
You just get gut feelings if something isn't right. And I basically did a chest X-ray and she had an apple sized lesion by her heart. And I immediately had my nurse call her mom, said I want her mom here now. I want to talk. I want to get her here before I get my CAT scan. I did a CAT scan. The next day

00:14:13:18 - 00:14:42:18
Kevin Carr, M.D.
I got her in with the hospitals at UW hospital to get a biopsy, and she ultimately had lymphoma. She did take six months in nursing school off and is now cured. Now, to add to that story, three years later she came, wanted to see me and she was somewhat tearful, so I wasn't sure what was going on until she got here and found out she was pregnant. And she was somewhat tearful because she just is finishing school.

00:14:42:20 - 00:15:07:19
Kevin Carr, M.D.
She's not married yet and she's worried, how are my parents going to take this? And we had a long discussion, and I kind of used some old quotes from my former nurse who was outstanding and said, this won't define who you are as a human and won't define who you will be in your lifetime. And she asked if she could give me a big hug and two days later told her parents and her dad was in tears,

00:15:07:19 - 00:15:23:09
Kevin Carr, M.D.
he was so excited. Because three years before that, they're worried they're going to lose their daughter. And now their daughter is bringing a life into this world. And so there's a huge turnaround. And that's why we go into medicine. Now I'm going to add to one step further to that I know this, I know her very, very well.

00:15:23:09 - 00:15:36:01
Kevin Carr, M.D.
I know this family very well. She told me there is nobody else that's going to deliver her baby except for me. Except unfortunately, that few days I was in Canada fishing. So guess who delivered my baby?

00:15:36:02 - 00:15:37:24
Julia Resnick
The other Doc Carr?

00:15:37:26 - 00:15:57:06
Kevin Carr, M.D.
The other Dr. Carr. And so she got to experience the best of both worlds. And now she had her second baby about eight months ago. And so I did deliver that one. So she was thrilled that both of us had an opportunity to care for her. And to be blunt, when I called her and asked if I could use her story today, I could tell she was in tears on the phone.

00:15:57:06 - 00:16:02:27
Kevin Carr, M.D.
She's an outstanding family, just core the earth people from southwest Wisconsin.

00:16:02:28 - 00:16:05:27
Julia Resnick
Amazing. And Melissa, on your end.

00:16:06:00 - 00:16:27:14
Melissa Carr, M.D.
One that comes to my mind is so my very first delivery that I did as a brand new grad or fresh out of residency was a C-section that I did with my dad. It was his patient and she needed a C-section. And so I was the primary surgeon. And then he was my first assist.

00:16:27:14 - 00:16:48:06
Melissa Carr, M.D.
So, you know, looking back, you know, you're just you're eager to do the delivery and, you know, be there for your patients. But at the same time, you know, looking back, it was just such a special cool moment. And now the other really neat thing is that particular patient, she takes care of my kids at daycare. So, you know, I see her every single day when I drop my kids off and, you know, so it's just it comes full circle.

00:16:48:08 - 00:17:07:01
Kevin Carr, M.D.
And to add to that story, the grandmother of that patient was an OB nurse here that I have delivered 500 babies with. And so she was in the operating room. And this is one in the morning, we're doing the C-section. And she thought it was the coolest thing ever, that her granddaughter was in there in the room with both of us.

00:17:07:03 - 00:17:22:00
Julia Resnick
That's amazing. And it's keeping in the family, both your blood family and your community family. So, Doc Carr, Doc Carr, thank you both for the work you do for your communities, for sharing your stories. And Happy Father's Day to all of our listeners out there.

00:17:22:02 - 00:17:24:19
Kevin Carr, M.D.
Thank you. Thank you very much.

00:17:24:21 - 00:17:33:14
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:14:50:03 - 00:14:58:26
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:28:00
Tom Haederle
Welcome to Advancing Health. June 8th through 12 is Community Health Improvement Week, a perfect time to recognize Denver Health's award winning approach to the stubborn and difficult problem of homelessness. Hello, friends, I'm Tom Haederle, senior communication specialist with the American Hospital Association. Homelessness is complicated by the reality that many unhoused people also deal with complex medical, behavioral health and social challenges.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:15:01:16 - 00:15:10:12
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

00:10:46:10 - 00:10:55:04
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.