full
WellSpan Health: A Commitment to Quality and Community
WellSpan Health's commitment to health care innovation and quality earned it the American Hospital Association’s Quest for Quality Prize in 2024. In this conversation, Mindy Estes, M.D., former CEO of Saint Luke's Health System and former AHA board chair, and Roxanna Gapstur, Ph.D., R.N., CEO of WellSpan Health, discuss the strategies that enabled WellSpan to maintain high-quality care during and after the pandemic, solutions for nursing retention, and how WellSpan is addressing critical community health challenges.
Transcript
Tom Haederle
tal Association's prestigious: ::Tom Haederle
Your host is Dr. Mindy Estes, former president and CEO of Saint Luke's Health System and former chair of the AHA Board of trustees.
::Mindy Estes, M.D.
on she has held since January: ::Mindy Estes, M.D.
So let's just dive right in. To begin, can you provide our listeners with an overview of WellSpan Health and its mission? Understanding the foundation of the health system gives context to the strategic discussions we'll be talking about today.
::Roxanna Gapstur, Ph.D., R.N.
team members and about: ::Mindy Estes, M.D.
So your geographic footprint is quite large.
::Roxanna Gapstur, Ph.D., R.N.
It's about 12 counties now in the center of the state. Yeah. We've been growing and serving more patients each and every year.
::Mindy Estes, M.D.
Were you joined WellSpan in: ::Roxanna Gapstur, Ph.D., R.N.
Yeah, absolutely. One of our values here at WellSpan is called Working as One. And I think this was a moment for us to really live that value. And throughout the pandemic, we were able to rapidly adapt to changes. We practiced agility, and we practiced one of our other values to find a better way. We have a significant focus in a pretty big community health team that works across central Pennsylvania.
::Roxanna Gapstur, Ph.D., R.N.
And little did we know that the pandemic was going to highlight some of the challenges. And that team really helped us respond quickly to some of those challenges. We focused significantly on the well-being of our team. Again, I think we all found at the beginning of the pandemic, perhaps this wouldn't last a long time. But as the pandemic went on, we needed to make sure that our team was taking care of. And being one of the largest providers of behavioral health services
::Roxanna Gapstur, Ph.D., R.N.
we had pretty significant internal resources that we were able to bring to that issue. And then finally, we really empowered our teams to think differently. And at one point during the pandemic, even had developed our own N95 mask. So I think those were some of the pieces that were most important because we unleashed the innovation within our own teams,
::Roxanna Gapstur, Ph.D., R.N.
we were able to move pretty quickly on things like the outdoor testing, things like out-of-pocket costs. We were one of the first in the nation to say that we would provide things without charge. Really proud of the team for embracing agility and making sure that the well-being of our teams were front and center.
::Mindy Estes, M.D.
You know, I want to pick up on something that you said. Most of us in health care study things, and we study things for a long time, and then we pilot things, and sometimes we're re-pilot things. And I think the Covid crisis, if you think about making lemonade out of lemons, really told us that we could be agile, that we could make decisions quickly and in tack one way or the other if we needed to.
::Mindy Estes, M.D.
And the question I have for you, have you been able to maintain that agility?
::Roxanna Gapstur, Ph.D., R.N.
We have actually, so was one of the things that we said to ourselves during our after action reviews that what were some of the silver linings of Covid, and how might we continue to capitalize on those? And one of those was being agile and making decisions quickly. I think because we are locally governed and one of the only health systems in our area that is locally governed, it helps us make decisions quickly because our headquarters are here and our family, friends and neighbors are here.
::Roxanna Gapstur, Ph.D., R.N.
And so that is something we've been able to maintain. One of the things that I did with my team during Covid was we split into two teams. We had one team really focused on our long term strategy and another team that just focused on operations and taking care of patients each and every day. We've used that as well
::Roxanna Gapstur, Ph.D., R.N.
since the pandemic ended. It was a great way for us to still make progress on some things, even though, you know, we had a lot on our plates.
::Mindy Estes, M.D.
Well, you make an important point. The work of health care and the future of health care and what we as organizations were going to do once the immediacy of the pandemic was over, it was tempting to put that on the back shelf and get back to it. But, you know, once you let it go, it's very difficult to restart.
::Mindy Estes, M.D.
One of the things I was impressed by that I think goes into this long term thought, is that you had low nursing staff turnover during the pandemic. What strategies did you implement to have such a successful retention of nursing staff during, admittedly, an incredibly stressful and unknown time?
::Roxanna Gapstur, Ph.D., R.N.
Yeah, that's a great question. I think one of the biggest areas was just the focus on the well-being of the team. We had a lot of peer-to-peer support going on, as well as our psychologists and psychiatrists across the system, working with our frontline care teams every single day. So we had real time coaching and support on all of our units.
::Roxanna Gapstur, Ph.D., R.N.
We also did a lot of state interviews and a lot of work on understanding what people needed now. Because as you know, Mindy, things evolve during Covid and lots of changes happened over those 2 or 3 years. I would say a benefit to us is that generally, our region tends to lag a little bit on things that occur.
::Roxanna Gapstur, Ph.D., R.N.
So we saw surges in New Jersey and New York prior to central Pennsylvania getting those same surges. And so we were working to try and learn from our colleagues and maybe what was coming our way, and how we could do a better job with our teams and with our nurses. So those were some of the things we did.
::Roxanna Gapstur, Ph.D., R.N.
I think later when you ask about innovation, if you do, I can talk a little bit about some of the innovations we've done in nursing that I think also made a difference.
::Mindy Estes, M.D.
Well, how about we just speak a little bit about innovation right now, particularly in nursing?
::Roxanna Gapstur, Ph.D., R.N.
Well, certainly virtual nursing is something that we have rolled out across our system, which has made a really big difference in the satisfaction of our nurses, both in the time they spend in documentation, but the amount of time they're able to spend with their patients. So that's one area. We've also have tiered huddles in our system. So each day, seven days a week actually, we start with tiered huddles around seven in the morning
::Roxanna Gapstur, Ph.D., R.N.
and those go until nine. At 9:00 is my huddle. So every day I know by 9:00 exactly what's happening in the system, and we're able to solve problems at the right level. So we have sort of tiers one through six. A lot of things are solved at tier three and below or tier four and below, but those things that can't be are elevated to the senior leaders.
::Roxanna Gapstur, Ph.D., R.N.
And we put a team on it right then and there. So I would say compared to when I first arrived at WellSpan, that we solve our problems more in real time. We're more situationally aware and we're able to prevent problems from happening because we have that focus.
::Mindy Estes, M.D.
Well, in solving problems where they're best solved, you know, is helpful for everyone. And you go away from that huddle knowing what you need to do and how you need to go forward. I think a lot of people perceive central Pennsylvania as a relatively homogeneous area, but WellSpan serves a diverse community. Can you discuss how you engage these diverse groups and provide resources while respecting their cultures and their autonomy?
::Roxanna Gapstur, Ph.D., R.N.
Yeah, absolutely. I think a lot of not-for-profit health systems feel very connected to their community and have different strategies. And certainly in my other roles in other states, even, I felt that connection. WellSpan has maybe a deeper connection than any I've ever experienced. And we have different ways of showing that. So each of our counties and our regions has a healthy county coalition, and WellSpan actually leads most of those coalitions.
::Roxanna Gapstur, Ph.D., R.N.
But we don't try to do the work of the experts in our nonprofit organizations. Rather, we might be a convener, we might be a partner, we might be a funder in some instances. We're working together alongside and with and the population across central Pennsylvania, as you mentioned, are more diverse than I realized when I first arrived here. Certainly the plan community is one of our largest stakeholders, and we serve a significant number of people from that population.
::Roxanna Gapstur, Ph.D., R.N.
We have special cultural liaison individuals who work with our planning community. It's really important to have those relationships, and we've done that for more than 20 years. We also have special bundle payment programs and other types of programs that fit culturally for that population. And I will say during Covid that Covid was difficult for that population because of the amount of family interaction they prefer to have in their health care experiences.
::Mindy Estes, M.D.
I want to skip to the notion of gun violence and workplace violence, workplace safety, community safety. You know, gun violence is a growing concern for all of us. And you've really taken an active role in addressing this issue in York, Pennsylvania. And I really - and I know our listeners would be interested in having you elaborate on when your efforts to reduce gun violence, the partners involved, the progress made thus far.
::Mindy Estes, M.D.
And my sense is that this is one of these issues that the minute you take your foot off the gas, it comes back. So talk a little bit about what you've been doing.
::Roxanna Gapstur, Ph.D., R.N.
Well, I, I can't say enough about what the teams have done in this region on gun violence. It's an issue across all of our communities, but I would say probably more acute in York County. And that's where we've done a significant amount of the work over the past three years. Probably the biggest piece of this has been understanding both our role and then what the role of others might be in helping prevent gun violence.
::Roxanna Gapstur, Ph.D., R.N.
I did feel when I first came to WellSpan that there was more we could be doing as a health system in prevention, but also that we can't do it all. And so we needed the right partners. I will say that that strong partners right now have been our local police departments, certainly our judges. We have a really robust treatment court here that works very hard to prevent incarceration and to get people to the right kinds of treatment.
::Roxanna Gapstur, Ph.D., R.N.
And we also have, in the last two years, a credible messenger program. This program first started on a grant and was a business partnership agreement between one of our local nonprofits and our WellSpan York Hospital, which is a level one trauma center. And the credible messengers are highly engaged individuals who support victims and families who enter York Hospital because of gun violence.
::Roxanna Gapstur, Ph.D., R.N.
They work to solve some of the deeper causes of violence in the community. And so they're very connected outside of the hospital setting. And so far in the last three years, we've seen a 43% reduction in gunshot wound patients at our hospital and a 71% reduction in homicides in our community, which is just gives you goose bumps to think about because it's such a problem for some of the younger individuals in our community.
::Roxanna Gapstur, Ph.D., R.N.
So I would say the credible messenger program in these partnerships with local non-profits have been the most impactful in addressing really root causes of gun violence.
::Mindy Estes, M.D.
Question, are the credible messengers volunteers?
::Roxanna Gapstur, Ph.D., R.N.
No. The credible messengers are paid on the grant that we received with the not for profit. But it has been so impactful that we've continued that payment, you know, after the grant. And so all of us in York County are very invested in that program, both emotionally and financially, because we've seen such great results with it.
::Mindy Estes, M.D.
Well, the success rate has it's really been extraordinary in the numbers of live saved and families saved, you know, has to be a positive for the entire community. I want to look ahead. And when we look ahead, what do you see as your biggest goal for WellSpan Health and what challenges do you anticipate in achieving it?
::Roxanna Gapstur, Ph.D., R.N.
Boy, that's a great question. I would say innovation is probably one of our biggest priorities. We really believe that the health care system, as great a job as we do in many things, needs some transformation and needs to meet the needs of the future. So we've worked really hard to think about people, process, and technology differently than we did in the past.
::Roxanna Gapstur, Ph.D., R.N.
tegic plan, which is WellSpan: ::Roxanna Gapstur, Ph.D., R.N.
And I would probably call out two that we've been heavily involved in. One is using artificial intelligence to improve the speed and accuracy of our radiology exams. WellSpan has deployed over 14 different applications for the last five years in radiology. I think we're leading the pack, and in terms of how we've deployed and how engaged our radiologists are with artificial intelligence.
::Roxanna Gapstur, Ph.D., R.N.
And as you know, Mindy, artificial intelligence requires a lot of work and effort and process in order to make it the most useful for care teams. Our teams have done that work, and we've seen 81% faster traditional review of our exams with our radiologists using AI. And our physicians who read scans are 98% engaged with the applications.
::Mindy Estes, M.D.
That's very exciting. And I think you've enabled your radiologists to be part of the process because, you know, I think ultimately will help us make smarter decisions, faster decisions, but does not replace the physician. I think once we understand how to use that, and we're still learning and the technology is evolving, you know, we'll see more and more of it.
::Mindy Estes, M.D.
We are just about out of time, believe it or not. And I want to thank you for sharing your insights. Your leadership at WellSpan Health clearly demonstrates how engagement can drive meaningful change and sustainable change.
::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.
