AHA in the Field: Innovations Across America's Health Care System

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Tom Haederle

Novelist and humorist Mark Twain once observed, if we were meant to talk more than listen, we'd have two mouths and one ear. True in his lifetime and just as true today. In order for the American Hospital Association to be the most effective voice it can be for members, it needs to listen to their concerns. That means personal visits and face to face conversations with the leaders of hospitals and health systems across America,

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Tom Haederle

hearing firsthand how they are addressing the challenges and opportunities in our rapidly changing field. It's incredibly important work and a big part of the job for Dr. Chris DeRienzo, the AHA's chief physician executive.

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Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. As a neonatalogist who has cared for some of the tiniest patients in a hospital, Dr. Chris DeRienzo learned early on there is no substitute for spending time with the patient first hand. In 16 months with the AHA he's traveled to 27 states and racked up 400,000 sky miles

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Tom Haederle

putting that principle into action. In this podcast, Dr. DeRienzo shares with the AHA's Elisa Arespacochaga, vice president for clinical affairs and workforce, what he has heard and learned from spending a significant amount of time visiting with members. One key takeaway? It's clear there will never be a one size fits all solution that works for everyone to solve the challenges we face in health care.

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Tom Haederle

Let's join them.

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Elisa Arespacochaga

Thanks, Tom. I'm Elisa Arespacochaga, AHA vice president of clinical affairs and workforce. And today I'm really excited to talk with AHA's chief physician executive, Chris DeRienzo, who spends a good amount of his time around the country meeting with many of our members and understanding both the challenges and the opportunities that they're presented with. So I'm really excited to hear about his work.

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Elisa Arespacochaga

So, Chris, I know you came to this from one of our member hospitals. Can you give just the thumbnail sketch of how you got from there to here?

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Chris DeRienzo, M.D.

You bet, Elisa. And always a pleasure to get to join our podcast. And this I'm hoping will be the first in a series of conversations that we get to have with members and listeners about, what, frankly, is the best part of my job. And that is getting to, to travel this country and to be with our hospitals and the people who work within them.

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Chris DeRienzo, M.D.

So I'm a neonatologist clinically. I spent the last ten years working in chief physician roles in health systems in North Carolina. In the western part of the state and middle of the state, in urban and rural community, academic, investor owned and nonprofit. And so I really, really got, how to run health systems in North Carolina.

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Chris DeRienzo, M.D.

But back when I was interviewing for this role, I made sure to, to be really clear about the fact that that doesn't mean that I understood what it was like to lead in health care all over the country. and so that's what led me to, the kind of conversation we get to have today.

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Chris DeRienzo, M.D.

I've been lucky now to be part of the AHA team for about 16 months. And as you know, in the 16 months, so far, I've been to 27 states that and, have earned something like 400,000 frequent flier miles on American Airlines. And so that's a lot of travel. We get to see a lot of the country.

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Chris DeRienzo, M.D.

So really excited to get to spend some time with you today talking about the kind of things that we learned while out visiting with our members.

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Elisa Arespacochaga

Absolutely. And I agree, it definitely is one of my favorite parts of my job is getting to see the both the impact we can have and then how our members are doing so many amazing, innovative things. So you've gone from the very micro environment of care delivery and taking care of some of our tiniest patients to a very macro view of what's the operational policy?

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Elisa Arespacochaga

The organizational needs? And now a national agenda looking at care delivery and patient safety. What are the things you carry with you that are key lessons, even from those days of taking care of those tiny infants too, that help you do your work?

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Chris DeRienzo, M.D.

Yeah, Elisa. There are many but I'll just share one for the context of this podcast. One thing that you learn really quickly as a pediatric resident and frankly, as a neonatologist, is when the nurse at the bedside gives you a call and says, there's something going on, you go and see the patient.

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Chris DeRienzo, M.D.

And that in part is, is because, you know, the level of experience in those team members who spends you know, every hour at a bedside, they really get to know what's going on there. And one thing I learned in clinical practice is... There's a lot you can manage by phone, don't get me wrong.

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Chris DeRienzo, M.D.

But in order to really get a feel for the situation as your partner is seeing it firsthand, you gotta go and see the patient. And sometimes when you go and see the patient you can be reassuring. And sometimes your level of energy very rapidly escalates. Frankly, the same is true in leadership. And the same is true for understanding what health care looks like all over this country.

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Chris DeRienzo, M.D.

So as it relates to what we're doing here at AHA, we are incredibly lucky to get to speak for our members, in the halls of Congress, the White House, other members of the administration, and also to a variety of national media outlets. And as I've learned in the time I've spent at the association, in order to do that job really well, it also means we have to spend a significant amount of time visiting with our members.

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Chris DeRienzo, M.D.

And they thankfully invite us into their professional homes. So we get to go to their hospitals, and really see what it is like to live their lives and to serve their communities firsthand.

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Elisa Arespacochaga

Absolutely. I completely agree. I think getting to not only hear their stories, but then make them part of what you get to share on a national level is, is really important. As part of your travels, you're really learning a lot about some of the approaches organizations are taking to address the tsunami of change that's coming towards them, whether it's the changing demographics of their communities, the workforce shortages they may be plagued by, or some of the challenges related to how they support technology.

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Elisa Arespacochaga

How are you finding leaders staying hopeful and then what are some of the approaches they're taking to really bring their teams along and help support them as they go through this change?

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Chris DeRienzo, M.D.

Yeah, I think one thing that's become incredibly clear to me is that there is never going to be one solution that will work to solve the challenges we face in health care all over this country. And I'll give you a couple of examples. We know that today we're experiencing a real challenge when it comes to labor and delivery around the country.

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Chris DeRienzo, M.D.

We know that there are shifting demographics in America today that's leading to changes in birth rates. We know that our workforce kind of recruitment and retention perspective is incredibly challenged, especially in labor and delivery. And we know that the financing system is problematic with nearly 50% of deliveries in this country covered by Medicaid, and Medicaid being a provider that rarely even covers the cost of the services we provide. That has frankly led to a perfect storm of challenges.

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Chris DeRienzo, M.D.

And when I've gone to visit different parts of the country, the ways the folks are solving them look very different. There are some places in, for example, northeastern part of Kansas, where the medical staff consists of four full spectrum family medicine physicians. And preserving, access to labor and delivery in that community looks wildly different than in, say, other parts of incredibly rural parts of the Dakotas or in some of the urban core centers, where workforce is still a really problematic challenge.

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Chris DeRienzo, M.D.

But what I see from a hopeful perspective are the innovations that are happening within those local centers, and being able to innovate around what is the right resources to serve our community. In Iowa, for example, I was able to see some events, that innovation at work. As there's some grants funded by state government that have allowed for centers of excellence to pop up in certain communities.

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Chris DeRienzo, M.D.

And that that is the kind of spark that educates us at a national level, around what are the kind of things that we can we can help solve for nationally? And where do we need to help lift up stories of what's working within local communities so that our health systems, who really are embedded in and integrated with the communities they serve, can look to apply those lessons, as best as they can, within their unique circumstances.

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Elisa Arespacochaga

Agree that the ability to share those stories of what different organizations have brought together to make this work, no one is going to pick it up and do it exactly the same, but it's going to inspire a thought, an idea: hey, maybe we could...that I love to see. I love to see where people can take this.

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Elisa Arespacochaga

Because if nothing else that I've learned in my own travels is that there's no one in health care who doesn't pretty much want to be there, because they have just a burning desire to help.

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Chris DeRienzo, M.D.

Elisa, that's exactly right. And I think that we're challenged by the experiences through which we've lived. I've been fortunate to live in North Carolina, in communities large enough to have multiple pediatricians, because there are so many children in the counties that I've lived in. But I've gotten to visit counties who when you combine the populations of four counties together, you still don't have enough children just to be able to have one pediatrician there.

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Chris DeRienzo, M.D.

and I think it's challenging when, you know, at a national level, a lot of the folks who engage in those conversations about what is health care look like, they've never seen that environment, much less, you know, lived through it. And so it's easier for me as a double board certified pediatric and neonatologist, to have one definition of what I think access looks like.

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Chris DeRienzo, M.D.

But when you get out into other parts of the country and you get that sense for this community is different, that the nature of access to care here is different. We have to think differently about projecting subspecialty expertise from other centers in order to get it here. It really does reframe the way you think about the conversation.

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Elisa Arespacochaga

I still will never forget the day I learned from one of our members in a very rural area that helicopters only fly about 150 miles before they need to refuel.

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Chris DeRienzo, M.D.

That's right.

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Elisa Arespacochaga

That's why he used a fixed wing air ambulance to transport patients who needed more care than he could provide. It was a very humbling moment for someone who grew up in the middle of a city. So let's dig into that a little bit, because you've clearly seen organizations where you can have sub-subspecialties, you know, right there at the bedside in minutes to

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Elisa Arespacochaga

the hospital you just mentioned with a medical staff of four people. How do you see some of the field evolving to address this challenge?

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Chris DeRienzo, M.D.

Yeah, I think there are a lot of different ways that I've seen hospitals and health systems approach that, in part because in some cases, one of the great values of an integrated delivery system, means that you can have sort of centralized subspecialty expertise within your own health system and project it, either via telepresence or via physical presence into those communities.

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Chris DeRienzo, M.D.

So some systems approach this by having rotating specialists, you know, who are spending perhaps most of their time within a tertiary center in a larger community. But then or taking clinics, one day a week or two days a month or one day a month, even, within a more rural site than maybe a couple hours away.

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Chris DeRienzo, M.D.

require their family to drive: 1100

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Chris DeRienzo, M.D.

And then I got to see this in one critical access hospital, again, staffed by family medicine, physicians, terrific doctors in the emergency department. But they're not trained in trauma to the level of, say, a Level One trauma center is as though they had in their emergency department rooms. There were two rooms, and on the walls of each room was a massive television. And a partnership, I would say at the press of a button they could bring in the EM boarded physicians who have recent trauma experience for the incredibly rare time at that emergency department sees, you know, a very significant trauma patient.

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Chris DeRienzo, M.D.

And while they can drill on it and they can practice, you know, having that partner, that subspecialty partner, be able to look in and and walk through that case with you, that's an enormous benefit. And again, goes back to the kinds of local innovation that we see all across the country within AHA's members. And I know you've seen some examples of this firsthand as well.

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Elisa Arespacochaga

Absolutely. The one that comes to mind was at the Children's Hospital in Colorado, where they created a multi-specialty clinic series so that they could bring for patients who in many cases, were driving from 1 or 2 states away. They could come and see all of the clinicians they needed to see for their child's care without having to spend, you know, a week going from appointment to appointment.

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Elisa Arespacochaga

Everybody was together and it was focused on what that child needed. I just love that they centered it on the child.

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Chris DeRienzo, M.D.

And to be able to do that in that children's hospital required and significant amount of resource. And we know that health systems rely on many different sources of funding streams in order to make that happen. And that hospital - I remember that visit vividly, because I was envious of that clinic space that they had so many resources that they could pull together in that one space.

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Chris DeRienzo, M.D.

And you're right. Put the patient at the center and be able to serve these kids who really, really needed that subspecialty help.

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Elisa Arespacochaga

So as you think about this and now, you know, think through sort of your own training and how you went through and learned how to care for the kids that were in your care, how do you think the training of our future clinicians and I mean that broadly, not just physicians, needs to start to shift so that they're ready to go not only to an academic center down the street to practice where they can call and have 20 people come consult to practicing in those locations where they may not have that physical presence, but they may have another way to interact with, the subspecialties they need.

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Chris DeRienzo, M.D.

I think the training needs to evolve right along with the practice, as it has for generations. But the kind of evolution that's empowered by technology today is really important. I remember eons ago when I was a NICU fellow and we would fly out to some of the rural places where preemies would be born, and we would join the helicopter team on the flight, because sometimes you would need someone who is skilled in intubating a really tiny baby or managing pulmonary hypertension.

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Chris DeRienzo, M.D.

But that the phone calls that we would get, we would be managing via phone. Now, much of that management can happen via telemedicine. And so, figuring out how to expose trainees to those kinds of tele-consults, especially within, you know, an integrated system. I remember the first time as a neonatologist I was requested to have tele-privileges, which was within one integrated health system that had a remote labor and delivery service up in the mountains.

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Chris DeRienzo, M.D.

And for the first time, we had the technical capability to not just get on the phone with the team who was there in the delivery, but also beam in and be able to get visual on the resuscitation as well. That was a huge leap. And that was you know, almost ten years ago now.

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Chris DeRienzo, M.D.

And so today's trainees are growing up in an environment where that's increasingly becoming a kind of part of the expected table stakes - is being able to not only manage in person, but support via some kind of telepresence. We're seeing it in the physician world - and absolutely, I know our partners at AONL - are seeing that in the nursing role, too.

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Elisa Arespacochaga

Was really, excited to hear about some of the work that, Providence in particular had done and actually, through their virtual nursing were able to catch a patient who was exhibiting signs of a stroke.

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Chris DeRienzo, M.D.

Wow.

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Elisa Arespacochaga

That's how good their cameras and their interactions are, virtually to be able to call the bedside team, bring them in, and address that patient's needs immediately. Something that might not have been caught as fast had the virtual nurse not been having a conversation.

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Chris DeRienzo, M.D.

It's this kind of innovation. And I know we share this opinion that it's both - when you're approaching it from both a patient centered perspective and from the notion that, we know we're in the middle of a workforce crisis, one that we cannot recruit our way out of, and that we must be able to innovate around how to project workforce experience in different ways.

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Chris DeRienzo, M.D.

It's just such a great example of ways that our members are innovating. And I love the chance here to get to lift them up.

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Elisa Arespacochaga

Well, Chris, I really enjoyed getting a chance to hear about some of the places that you've been, some of the things you've seen, and I look forward to where your travels take you next.

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Chris DeRienzo, M.D.

It's a lot of fun, Elisa. And I say it all the time, I'm frankly the luckiest doctor in America to get to do this work. I cannot count the number of states that I get to visit over the coming months. But I'm really excited every time that that I do. Again, because when we see what's going on at the frontlines, it helps us not only connect hospitals with each other because there's so much learning that we can we can do across the field and but also informs the work that we do, on their behalf as an association in so many ways.

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Chris DeRienzo, M.D.

I'm so grateful to them, so grateful to you, and to the folks who've been listening.

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Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.