Advancing Health Podcast

00:00:01:02 - 00:00:16:21
Tom Haederle
Welcome to Advancing Health. Coming up in today's podcast, we hear how SSM health is taking a whole team approach to combat workplace violence. And it's working.

00:00:16:24 - 00:00:39:29
Jordan Steiger
Hi everyone. My name is Jordan Steiger. I am a senior program manager on the Clinical Affairs and Workforce team at the American Hospital Association. I'm joined today by Todd Miller, who is the vice president of security, and Amy Wilson, who is a chief nurse executive at SSM Health, to talk about how they're making their hospitals safer for everyone, including patients, their families and the health care workforce.

00:00:40:01 - 00:00:50:21
Jordan Steiger
So to get us started, I'd love for all of our listeners to learn a little bit more about SSM health and also about the roles that you're playing within your organization. So, Amy why don't we start with you?

00:00:50:23 - 00:01:19:13
Amy Wilson, R.N.
So thank you, Jordan, and thank you for having us here today to talk about this really important topic. SSM Health is a fully integrated health care network, located in the Midwest. We’re across four states. We have 23 acute care facilities, a post acute network, and approximately 500 ambulatory care site settings across those states. My role at SSM Health as chief nurse executive, and also I'm responsible for our clinical workforce.

00:01:19:15 - 00:01:34:26
Todd Miller
And hi Jordan, I’ll introduce myself. Todd Miller, VP of security with SSM obviously. My role is really just overseeing the physical security program, security technology, as well as just all the programmatic elements that make up our department systemwide.

00:01:34:28 - 00:02:01:06
Jordan Steiger
That's great. So two really important perspectives here. I mean, somebody overseeing the clinical workforce and especially that nursing perspective, and then also the security perspective. And one thing as I was learning a little bit more about the work that you all do at a system health that I was just so impressed by is the way that you bring every single person in your workforce together to tackle the issue of workplace violence, because I think we all know on this call that it can't be just one person or one group.

00:02:01:08 - 00:02:07:11
Jordan Steiger
It can't just be security or nursing or administrators working on this. It has to be everyone together.

00:02:07:14 - 00:02:30:29
Amy Wilson, R.N.
Absolutely Jordan and I would tell you, I think that is the magic at SSM Health is the fact that we have taken a fully integrated approach to thinking about safety, security and workplace violence prevention. In many organizations and in organizations I've been in, in the past, this has really been the role of security or the role of facilities, and we don't actually have that perspective at SSM Health.

00:02:30:29 - 00:03:00:24
Amy Wilson, R.N.
And I think that is the reason, the number one reason actually, for why you're seeing some of our successful results is because we really think about the whole team, what the role is of that team and how they interact together. And one of the things that I'm most proud of, especially as as we think about the clinical work team, is that our clinical work team believes that our security team is an integral part of that team and helps us take great care of our patients and our families and our communities every single day.

00:03:00:27 - 00:03:22:17
Todd Miller
I want to add on to that, Amy. When Amy joined the organization, within two weeks or so, I said, Amy, I would love some time to sit down and go over the security program. You remember we met and it was it was awesome to see an executive at her level engaged. And what is security doing? How are you supporting our clinical staff?

00:03:22:19 - 00:03:54:27
Todd Miller
And probably the most important sentence that really rung with me was how can I support you and your team? And again, it was it was just that comforting feeling that there was understanding about what we do there. There's understanding we are part of the patient care team to some degree. And then again, that high level of support from the top down in the programs, what we're doing, in that ultimate goal of lowering workplace violence. Right from the start, it was a good, strong relationship, reinforced at the highest level, which we appreciated.

00:03:54:29 - 00:04:16:12
Jordan Steiger
That's great. That leadership by in piece is so, so important, as I think all of us know. Let's take a step back even because I'm hearing that there's this commitment across the organization to lowering the incidence of workplace violence. And I don't think we need to explain to anybody on this podcast that health care workers are far more likely at this point to experience violence than the everyman.

00:04:16:12 - 00:04:30:27
Jordan Steiger
right. And that trend seems to be increasing. That's not what we want to be seeing. So what were you seeing within your organization at SSM Health that led you to start developing some of these programs and, you know, getting that leadership buy in for it?

00:04:30:29 - 00:04:49:24
Todd Miller
When I first joined SSM which is actually ten years ago, I remember when there was a workplace violence incident, let's just say a nurse got assaulted. It was a big deal. It still is a big deal., but it would I would say it was more of a rare occurrence, that got of a lot of focus. And even within my first year, I was starting to notice that.

00:04:49:24 - 00:05:17:27
Todd Miller
So again, around 2015, you started to notice more incidents, higher volume, and the sentiment just from the nursing staff was something was changing. Whether it was at huddles or just informal conversations. Something was changing. And then you started to hear about it nationally. And the trend kept growing and growing. And then my peers in health care security industry, there was that conversation happening in forums through our trade organizations where something was changing.

00:05:18:00 - 00:05:37:17
Todd Miller
It was about, I would say, 2017, 2018 when really the focus started to grow and grow and grow, to say we have to be more proactive and not as reactive. So what are we doing to get ahead of that curve of just the the assault in general? How are we looking at our data? How are we working with our nursing staff?

00:05:37:19 - 00:05:57:16
Todd Miller
That was really for me. The start of it was around then, and I can probably speak for a lot of my health care security peers. That's about the point where the curve started going up almost exponentially, where we knew there was an epidemic across the US and then globally as well as far as health care workers.

00:05:57:18 - 00:06:23:09
Amy Wilson, R.N.
Yeah, and I would add to that, Jordan, I wasn't here during that time, but I would say that my frame of reference around the time frame is, is similar. About that same time, I was in a different organization, rounding in the ED one day and one of my most strong charge nurses was visibly upset about something. I was surprised to see this, pulled him off to the side, said, hey, tell me about what's going on.

00:06:23:09 - 00:06:55:27
Amy Wilson, R.N.
Seems like it might be a rough day. And it wasn't one thing that had happened that day. It was really the weight of the world on his shoulders with him saying, Amy, something's different than it used to be. We used to have all of our patients and families come into our emergency rooms, and no matter who they were or what they might have been involved in outside the walls of the hospital, once they walked over that threshold, there was this respect for the fact that the doctors and the nurses are caring for them in a very important time, in a very vulnerable time.

00:06:55:27 - 00:07:17:21
Amy Wilson, R.N.
And there was just total respect. And he said, we're seeing that change and we're seeing people come in and demand things or verbally escalate or be disrespectful. And it's it's really hard to see. And then I think if you fast forward to what we all experienced in the pandemic, we start to see this happening across the society.

00:07:17:23 - 00:07:51:12
Amy Wilson, R.N.
And unfortunately for us in health care, what's happening outside the walls of all of our facilities and our ambulatory care settings, as well as our hospitals and acute care settings, is being brought across the threshold now into that. And so all of the turmoil that we feel as a society, all of the kind of polarization that we feel, the lack of empathy and understanding other people's perspectives and just a little bit of respect for each other and humanity now gets brought into the facilities, into our hospitals, our health care settings.

00:07:51:14 - 00:08:15:14
Amy Wilson, R.N.
And now we are dealing with all of that burden at a very vulnerable time in people's lives, because in health care, we're dealing with everything from birth to death and everything in between. It's one of the most stressful times people ever have in their life. And so you couple that with what's been happening in our society, and we just see this escalating violence on the inside of our walls too.

00:08:15:17 - 00:08:24:02
Amy Wilson, R.N.
And so as leaders, we would be amiss if we did not address that differently than we thought about this a few years ago.

00:08:24:04 - 00:08:43:21
Todd Miller
I'll tack on that Amy. A common thread that we've noticed in our health care security teams is the external risk has now been brought internal. And that's the change. It used to be a sacred space and we're losing that. Churches, schools, hospitals. There's a change. And unfortunately we've had to adapt to that.

00:08:43:23 - 00:09:13:19
Jordan Steiger
It does seem like those places that seemed untouchable. Now we are seeing more violence, and it's not a trend that we certainly want to see. We know that, it's affecting, you know, the well-being of our our health care workforce, our patients, our families. This is something that's not beneficial to anybody right? So I'm hearing from both of you as you're starting to talk about what you're doing at SSM Health, that there isn't just one solution or set of activities that you can just implement and everything's going to be fine.

00:09:13:22 - 00:09:33:04
Jordan Steiger
It seems like you are using a lot of, just layered approaches, lots of different things. You know, it's not just physical security. It's not just de-escalation training. It's thinking about this problem holistically. So could you tell us a little bit about some of the activities you have that are helping your team members and your patients and families stay safe?

00:09:33:07 - 00:09:58:28
Amy Wilson, R.N.
One of the most important things we're doing around thinking about the entire team and thinking about security as part of a team member is team training, so those teams are trained together. They practice together. They're in simulation together, and they are simulating real live events so that when something happens, not if something happens, but when it happens that they know how to respond together as a team.

00:09:59:01 - 00:10:34:04
Amy Wilson, R.N.
And we've invested a lot of time and resources into finding the right tools to train with, the right settings to train with and providing the time and the space for training. And I think that has been instrumental in part of our success. We have a really wonderful partner right now and our de-escalation training, and we are seeing results that I've never seen before with our care teams and our security teams telling us that they feel 93% more capable of dealing with the violent situation than they have ever felt before.

00:10:34:04 - 00:11:06:21
Amy Wilson, R.N.
And I think those results are astronomical. And we're doing that by not just thinking about de-escalation training, which has been kind of the historical view of the world in the health care setting. It's what happens when de-escalation doesn't work. How do you stay safe? What do you do? What happens if this escalates to physical violence and is actually talking about protecting themselves and their team members and keeping themselves safe, and also integrating into that, this concept of trauma informed care.

00:11:06:24 - 00:11:29:25
Amy Wilson, R.N.
So the trauma that the person who is escalating might be experiencing and and if you're thinking about that, what could be happening and also your own trauma in the situation and thinking about what how that is impacting your reaction to the situation. And so that as well as a concept called heart math, is also an integral part and is really about self-regulation,

00:11:29:25 - 00:11:56:16
Amy Wilson, R.N.
in order to be able to hopefully de-escalate. But then also acknowledging that every situation will not be de-escalated and could turn into a violent situation. And what do you actually do if it if it does become violent? And I think for a long time we've been afraid as clinicians to have that conversation. You know, we always thought that we had a magic wand and we were going to de-escalate everything and everyone and everybody was going to be okay.

00:11:56:19 - 00:12:14:15
Amy Wilson, R.N.
And we now know that that may not happen. And in some circumstances it will not happen. And so we train for when that happens. What do you do as well. And what we're hearing from our team members is that makes them feel safer and well equipped. When the situation happens.

00:12:14:17 - 00:12:38:03
Todd Miller
If we back up even before we chose that, that the partner we have for our de-escalation program, really evaluating what was of value in the de-escalation programs and for us, even how it's delivered to me, was one of the more important aspects of that vetting process for all these de-escalation programs. They all have value and their you know, apples to gala apples, they're similar enough

00:12:38:03 - 00:12:58:09
Todd Miller
right. And I think when we were looking at that and saying, well, our old program that we were using really focused more on the intensity model, the idea that on January 1st you have an eight hour training, congratulations, you know, how to de-escalate somebody. Great. And then the incident happens on December 31st. Are you going to remember those physical intervention skills?

00:12:58:09 - 00:13:21:21
Todd Miller
Are you going to remember all those are of de-escalation skills. Maybe that's not realistic. And saying, okay, so what are we going to do to change? And moving more towards that consistency model of more training, smaller increments, more touch bases throughout the year. And even just that change to me is showing value because people are remembering it, instead of having to sit there and go, what did I do?

00:13:21:24 - 00:13:41:26
Todd Miller
And we all know in a time of panic and a time of crisis, actually dealing with somebody in crisis, you're kind of reverting back to fight, flight or freeze. And sometimes the think, the critical thinking, especially when dealing with our patients. So that to me was a big advantage in how we were moving forward with the program we have now.

00:13:41:29 - 00:13:45:12
Todd Miller
And really how we're delivering that education to be retained.

00:13:45:15 - 00:14:09:27
Jordan Steiger
So many things that you both just said resonate. I think this move of the month or, you know, remember this verbal de-escalation tactic. You know, having that repetitive kind of education I think is so important. You know, I'm a social worker by background. I've worked in the hospital, and I can say that that would have been very helpful to know and, you know, to train with the interdisciplinary team, because that's how you're responding to incidents when they happen.

00:14:09:27 - 00:14:21:24
Jordan Steiger
It's not just the nurses that are responding or just the social workers. It's everybody coming together and you have to know how to work together. So I think these are practices that I think a lot of different organizations could try to implement.

00:14:21:27 - 00:14:41:15
Amy Wilson, R.N.
And Jordan, you referenced earlier, kind of our multi-pronged approach. But then if you even start to peel back the layers of the onion more, you start to see in our system many other things that we're doing. And I think Todd's approach to physical security of our buildings and what that looks like has been instrumental.

00:14:41:17 - 00:15:05:20
Todd Miller
Yeah. New start. And you look at just historically and base like foundational level, no pun intended, but the construction of our buildings and how they were built, our hospitals are built for convenience, not security. We want to make sure the non ambulatory patients park close, walk directly in. So if you look and this isn't just a SSM issue, this is across the United States even globally.

00:15:05:22 - 00:15:30:13
Todd Miller
That's how we were building and designing our hospitals which made sense at the time. We're all now dealing with what we call sins of the architectural past and saying, well, now we have these open environments, these open campuses, numerous ingress points. How do we site harden these now while still making it convenient. You know, what are we doing to relook at how we're designing and reevaluating, how we are having people come into our buildings?

00:15:30:16 - 00:15:52:18
Todd Miller
And that has been one of the hardest challenges, just from a physical security perspective. If you think about even how a bank is designed and you walk into any bank across the United States, there's certain standards you see immediately. The desk height, the glass, how they talk to you. The way the doors and entrances are designed. Those standards have been in place for decades and decades, if not a century or more.

00:15:52:20 - 00:16:13:04
Todd Miller
Now hospitals are having to think the same way and saying, how are we designing our buildings? Or if we do a renovation, how are we incorporating what kind of a nerdy security term, crime prevention through environmental design? How are we designing our facilities to reduce crime, without even doing anything, other than just how it's built, and how that can lower the risk for violence?

00:16:13:04 - 00:16:36:01
Todd Miller
Because it does. Now we're looking at we're going to redesign it. And when that person enters, and what is the process now that we're going to employ to keep our staff safe. And we know through our trade organization, International Association of Security and Safety, they’re guidelines and standards. So when they say, those are management, weapons detection is now a standard to hold ourselves to,

00:16:36:03 - 00:17:05:11
Todd Miller
that's a big change from where it was ten years ago, 15 years ago. And so we're now we're having to rethink about how our patients and visitors are coming in, even our staff, how are they entering the building and what are those security controls, that can make our staff safer. I will say, when we started doing these renovations and redesigning some of our entrances, especially in the high risk departments and with our emergency departments especially. It’s staggering what we've turned up.

00:17:05:13 - 00:17:27:13
Todd Miller
And let's just be honest about it. Anybody that employs weapons detection, there's kind of a shock that happens when you say, oh my, look at all the things that we're preventing coming in, and it doesn't have to go straight to firearms or knives. It can be a screwdriver, it can be a can of mace, you name it, anything that can be used as a weapon against our staff.

00:17:27:16 - 00:17:34:08
Todd Miller
So some of those successes have been game changing for us as an organization. And again, in all transparency, we're not done.

00:17:34:10 - 00:17:53:00
Jordan Steiger
Absolutely. And, Todd, I won't be, totally surprised if you get some outreach after this podcast because you both just shared some incredible advice and insight. Thank you both so much for being here with us today. We really appreciate you sharing the work that you're doing, and we look forward to hearing about more of your success.

00:17:53:02 - 00:18:01:14
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.

00:00:01:04 - 00:00:30:12
Tom Haederle
Welcome to Advancing Health. Community health workers play a vital role in bridging the gap between health care systems and the communities they serve. As we celebrate the upcoming 2025’s Community Health Improvement Week, June 9th through June 13th, we learn more in today's podcast about how the team at Duke University's partnership with Community health workers led to stronger communities and measurable improvements in heart health outcomes.

00:00:30:14 - 00:00:55:24
Chris DeRienzo, M.D.
Hello again. I am Dr. Chris DeRienzo, the chief physician at the American Hospital Association. On this week's podcast, we are celebrating CHI week and that stands for Community Health Improvement Week. And we could not have two better guests joining our podcast today to celebrate CHI week and talk about the wonderful work that they do, right in my home of North Carolina around their community health needs assessment.

00:00:55:26 - 00:01:18:21
Chris DeRienzo, M.D.
Joining me today is Anna Tharakan. She is the lead project manager on the Closing the Gap on Hypertension Disparities work at Duke. And Bradi Granger, who is a professor in the Duke University School of Nursing and a co-pi for that same project. Thank you both for joining us on the podcast today. I am so excited to get to welcome you here.

00:01:18:24 - 00:01:19:19
Anna Tharakan
Hi. Happy to be here.

00:01:20:05 - 00:01:21:27
Bradi Granger, Ph.D.
Thanks for having us today.

00:01:21:29 - 00:01:45:09
Chris DeRienzo, M.D.
Well, let's jump right in. You know, the community health needs assessments is a really broad overview of both the assets and the needs within a community. I have known the community here in Durham, North Carolina, for nearly 25 years. When I started medical school in the early 2000’s. But I'm really curious, you know, Duke Health has excelled in doing its CHNAs for a long time.

00:01:45:14 - 00:01:52:17
Chris DeRienzo, M.D.
Talk to us about how do you approach this CHNA, and what kinds of things have you uncovered? Anna, we'll start with you.

00:01:52:19 - 00:02:21:20
Anna Tharakan
It's kind of kind of setting up what a hypertension is present within our community. We see that despite the proven interventions that are currently present, over 50% of patients that are diagnosed with hypertension kind of have their condition controlled. And kind of specifically within Durham, we see that there's a prevalence of hypertension of almost 42%. So I think for us, as are kind of really some baseline statistics of really motivating us to kind of get out into the neighborhood and communities and reduce these hypertension disparities and improve overall population health.

00:02:21:22 - 00:02:48:02
Anna Tharakan
So kind of our approach was taking a quality improvement intervention to target these hypertension disparities via a telephone outreach program. So we partnered with the local FQHC or Federally Qualified Health Center and students based out of Duke Health to kind of deliver this telephone outreach. We applied these functions essentially through student ambassadors, which were these students that conducted a structured telephone outreach to kind of help reach patients where they are.

00:02:48:03 - 00:03:11:06
Anna Tharakan
So over a series of three to four phone calls directly work with our patient cohort, which was around 300 patients, to help identify hypertension education. What are ways that we can help kind of work within their lifestyles to maybe attach hypertension care? We distributed free blood pressure cuffs. We helped them create Smart goals and accountability partners. And then lastly also conducted a social needs assessment.

00:03:11:08 - 00:03:16:24
Anna Tharakan
Which is really just trying to identify what are other things that are kind of getting in the way of your hypertension and health.

00:03:16:26 - 00:03:34:02
Chris DeRienzo, M.D.
Let's pause there for a second because wow! I mean, the level of depth that you all are able to go to, is, is truly impressive. But bring this up, you know, to the 30,000ft view level for a moment, because I don't know how many of our listeners are familiar with the Durham community and specifically the role that Duke plays in that community.

00:03:34:03 - 00:03:46:05
Chris DeRienzo, M.D.
So can you give the just sort of the brief snapshot of when you're talking about, you know, over 40% of the Durham population? How many people are we really talking about? And when you're saying going into the community, what does that look like?

00:03:46:07 - 00:04:24:03
Bradi Granger, Ph.D.
I can pitch in here. Durham has about 300,000 people and roughly, as Anna pointed out, we have a prevalence of hypertension of about 42 to 48% of the people in this county have, hypertension. About half of those are uncontrolled or unaware. And so the third issue, I would say in Durham County, is the disparity in care that we've seen and the prevalence. That the higher prevalence in the higher mortality and comorbidity that is associated with this, chronic illness in the black population, which that statistic is true throughout the South.

00:04:24:09 - 00:04:53:03
Bradi Granger, Ph.D.
And so we have a high proportion of minorities and underserved patients in Durham County. And we tend to focus on these first, as the risk in this group is much higher than the risk in the average population overall. So, given that we started there, the clinics and the specific areas in the community where we could be most effective in improving overall health for the community were those underserved, like safety net clinics.

00:04:53:03 - 00:05:25:25
Bradi Granger, Ph.D.
And so across the county, we have our Federally Qualified Health Center, which Anna mentioned and our, my co-pi, Dr. Holly Biola, is there leading the effort there. And we've also worked together with the Duke Safety Net Clinic, the Duke Outpatient Clinic, as well as our broader population health clinics in the county. So though the work began at Lincoln, our Federally Qualified Health Center, we have reached out to try and scale the project across other areas in the community that represent underserved populations.

00:05:25:27 - 00:05:48:07
Chris DeRienzo, M.D.
Thank you so much for sharing that. You know, I moved to North Carolina 25 years ago, and in the other places I've lived, I never really had the level of appreciation that I have now for just how different a place like Durham County can look when you drive like eight minutes from the downtown core, because Durham, you know, with 300,000 people, there's definitely a downtown core and there's some high rises.

00:05:48:07 - 00:06:12:23
Chris DeRienzo, M.D.
And I mean, it's not, you know, like New York City is downtown, but it's definitely an inner city environment. But eight minutes away, you are in farm country. And so when you're talking about reaching a community, that you are going from a very urban feel to a very rural feel quite quickly. And so I know that community health workers have played a huge role in how you all have addressed this work through the project around hypertension.

00:06:12:26 - 00:06:21:25
Chris DeRienzo, M.D.
Tell us a little bit more about the role that you all are finding community health workers playing and amplifying community outreach.

00:06:21:27 - 00:06:49:29
Bradi Granger, Ph.D.
We have a cohort of community health workers. The intent for that workforce is to really expand and extend the work that's done in a clinic, during a clinic visit, with a primary care provider. The fact is that many of our people in the underserved area, especially, have so many social determinants, which Anna can expand on. That it's hard to fit the care that's needed within that short window of time of the visit.

00:06:50:02 - 00:07:13:05
Bradi Granger, Ph.D.
So this project has served to really engage health professions students like Anna as patient navigators, to partner with these community health workers and literally give everyone more time to be able to provide the care, at the community level, that we want to do. So Anna can expand on exactly what that looks like.

00:07:13:07 - 00:07:34:09
Anna Tharakan
I think kind of as she pointed out, there was this huge, not gap that necessarily we realized, but kind of this, this system that patients weren't necessarily kind of getting the full time that they needed to just with the limitations of the system. And so I think what really community health workers, and in our case students, were able to really fill that gap was kind of being able to take that time with patients when they had it.

00:07:34:11 - 00:08:00:12
Anna Tharakan
Our first call with patients and students made was just sitting down with them being like, are you interested in kind of learning more about what hypertension means or how we can kind of implement some lifestyle changes, and can we do that on your time? I think that was just a really big portion of whether it was people that were working two to three jobs and only had availability at 8 p.m. or 9 p.m.. I think that was kind of the really great gap that students could kind of fill is kind of making sure outside clinic hours, where can we sit in and really impact and make a change?

00:08:00:15 - 00:08:27:26
Anna Tharakan
And then on top of that, really kind of making it really personalized with that education that we gave them,. Learning about the different things that they were kind of experiencing. What kind of struggles were specifically relevant to their lives, whether that was I'm struggling or trying to get groceries when I have to make sure to pick up my kids from preschool, or whether it's I'm taking care of two of my parents that are, kind of based in the hospital and kind of making sure that we were able to insert little pieces of advice where I was, hey, like how about we try to get 30 minutes, you know, walk to your parent's house instead

00:08:27:26 - 00:08:39:21
Anna Tharakan
of necessarily being able to drive there and really kind of instill small changes that they can make. And really be their personal cheerleader and kind of instill in these small changes that can really make such a big difference in their blood pressure and hypertension.

00:08:39:23 - 00:08:56:27
Chris DeRienzo, M.D.
I love that. Wouldn't we all benefit from having a personal cheerleader, especially when fighting, you know, a condition like hypertension, which is so seemingly innocuous because it's just a number on a machine. But we know that, that years and years and years of high blood pressure take its toll on nearly every organ system in the body.

00:08:57:00 - 00:09:14:28
Chris DeRienzo, M.D.
And again, being good project leads, I imagine you all are measuring countless kinds of metrics through this work. What is one measurable impact that you can tell us about through this engagement of a community health workers and really extending their reach, and not only into patients homes, but into community based settings as well.

00:09:15:00 - 00:09:34:05
Anna Tharakan
I think the big one was just the impact that we had on their blood pressure. And then also just self-management. I think within our intervention this past year, we saw a average drop in the systolic blood pressure of those that participated of over 15mg mercury, which is just a really huge kind of drop when considering, this intervention that took place.

00:09:34:08 - 00:09:53:13
Speaker 3
I think another big one was this idea of self-monitoring, kind of bringing the power to the patient, kind of being able to track with the free blood pressure cuffs that they were able to be provided, as well as the social needs assessment. Was kind of really putting that power of health back in their hands and showing that community health intervention lead can produce really meaningful clinical outcomes.

00:09:53:15 - 00:09:56:03
Chris DeRienzo, M.D.
Spectacular. Bradi, anything you would add?

00:09:56:05 - 00:10:29:04
Bradi Granger, Ph.D.
The one thing I would add to that is the idea of the system integration that this project brings. Whereby, to your point, hypertension really is a chronic illness, that the long term outcome is what we're after, reduction in stroke, reduction in chronic kidney disease and reduction in cardiovascular events. But those things happen so far from, you know, today's single measurement or even a couple of years worth of measurements of high blood pressure in an office visit, which is often mistakenly elevated anyway.

00:10:29:12 - 00:11:00:04
Bradi Granger, Ph.D.
So our real achievement, I feel like in addition to what Anna said about bringing the power to the patient to set their goals and really be able to be aware and to be responsible for changes and improvements in their health. We also really are trying to effectively connect a patient to the primary care provider team, including the community health worker and the community business organizations that help us serve patients outside of the formal system of health care delivery.

00:11:00:07 - 00:11:50:05
Bradi Granger, Ph.D.
These groups provide food, transportation, assistance with housing insecurity and all the things that are real barriers for patients managing long term, hypertension. So solving for those things and tracking it as we have, and making sure there's a closed loop on the referrals that happen, allows us to really measure the impact of this kind of project on some of our really important community outcomes, but also the policy implications for this project. Which we're working on now with our North Carolina Department of Health and Human Services, and trying to make sure that the opportunity for us to expand healthy opportunities. Pilots from our Medicaid expansion initiative, trying to make sure that we have the evidence and

00:11:50:05 - 00:11:56:27
Bradi Granger, Ph.D.
the measurable outcomes to support new policies for expansion of those kinds of efforts in the community.

00:11:57:00 - 00:12:29:11
Chris DeRienzo, M.D.
Well, you all have certainly covered the waterfront. I mean, clearly, it takes, it takes a team. And you've been able to connect not just the acute care clinical team, but the patient's family, community teams, all together in this web in supporting patients. I'm curious, we've only got a minute or two left. If you had to give one piece of advice for health care team members, in a community right now listening to this podcast who are just coming away from hearing your story and saying, I got to go do this tomorrow, what would your one piece of guidance be,

00:12:29:13 - 00:12:31:27
Chris DeRienzo, M.D.
as they're preparing to take their first step?

00:12:31:29 - 00:12:42:29
Bradi Granger, Ph.D.
Our guidance would be communicate with your primary health care provider and let them know you're interested in joining our team as a patient expert in the hypertension management program.

00:12:43:01 - 00:12:51:07
Chris DeRienzo, M.D.
Outstanding. Anna, what if you were giving advice to a hospital who was hearing the story and they said, I want to be just like this project that they're doing at Duke?

00:12:51:07 - 00:13:06:29
Anna Tharakan
I think it's just showing that it's possible to kind of get an intervention like this off the ground, and it really can can make a real big difference in patients lives. And so kind of putting a focus on community health workers and kind of connecting back that primary care doctor as Dr. Granger said is a really important component.

00:13:07:01 - 00:13:25:09
Chris DeRienzo, M.D.
You all have done tremendous work. Obviously connecting all the way back to the community health needs assessment. What it lifts it up, how you connect that to a project building in the the approach that brings community health workers into the fold and then obviously bringing patients and family members into the fold with you. We could not wish you more luck in the work that you're doing.

00:13:25:09 - 00:13:33:22
Chris DeRienzo, M.D.
And again, couldn't think of a better story to tell this week during CHI week in 2025. Any closing thoughts before we say goodbye?

00:13:33:25 - 00:13:41:14
Bradi Granger, Ph.D.
I think thanks for your support and for the dissemination of efforts like this and the impact it has on our community. Thank you.

00:13:41:16 - 00:13:45:04
Chris DeRienzo, M.D.
I couldn't say it better myself. Thank you both so much.

00:13:45:07 - 00:13:53:17
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.

00:00:01:06 - 00:00:22:12
Tom Haederle
Welcome to Advancing Health. In today's podcast, we learn how West Virginia University Medicine involves the entire clinical team: primary care physicians, virtual social workers and others to get children and young people the care they need before a psychiatrist is required.

00:00:22:15 - 00:00:53:12
Jordan Steiger
My name is Jordan Steiger, and I am senior program manager for clinical affairs and workforce at AHA. I'm really excited to be joined today by Dr. Adrienne Coopey from West Virginia University Medicine. Dr. Coopey is a child and adolescent psychiatrist who is extremely passionate about integrating physical and behavioral health services, which is, we know, something we love to talk about at AHA. And she is especially interested in doing this in areas of West Virginia where children and their families faced challenges in accessing behavioral health services.

00:00:53:14 - 00:01:14:17
Jordan Steiger
She and her team are doing lots of great work, not only to improve the outcomes for these children and their families, but also really trying to support the health care workforce, and clinicians who are developing behavioral health programs and delivering services maybe for whom behavioral health is not their specialty area. So, Dr. Coopey, thank you so much for being with us today.

00:01:14:20 - 00:01:15:29
Adrienne Coopey, D.O.
Thank you.

00:01:16:01 - 00:01:21:12
Jordan Steiger
So to get us started, please tell us just a little bit about you and your role at WVU.

00:01:21:14 - 00:01:52:13
Adrienne Coopey, D.O.
Thank you, Jordan, for that lovely introduction. I think the biggest thing is I'm really fortunate to have the support of West Virginia University to do this work, because I really enjoy it and it doesn't always pay well, right? Reimbursement can be an issue. So, I am currently a fully virtual faculty member in the Department of Behavioral Medicine and Psychiatry, and my role there at WVU is primarily in teaching psychiatry residents and the child and adolescent psychiatry fellows.

00:01:52:15 - 00:02:33:11
Adrienne Coopey, D.O.
So they can join the workforce, and help take care of our people. So teaching is a big role in my work, and it has been all along, which I didn't really catch on to. But, through integrated behavioral health, I've really done a lot of teaching all along. I think most of my, early career has been in-patient child and adolescent psychiatry, emergency departments,  doing consult liaison work in medicine and pediatrics, and then the integrated behavioral health work was just kind of like natural development that kind of happened, which is medical overlap, behavioral health

00:02:33:13 - 00:02:53:25
Adrienne Coopey, D.O.
in a lot of the work that I was doing. And I got really lucky. The hospital that I was working in supported me to implement, integrated behavioral health into primary care. Now, I've been at WVU for two years, and really I was hired to implement behavioral health integration.

00:02:53:28 - 00:03:12:21
Jordan Steiger
I love that WVU has made this investment in behavioral health integration. I think that speaks so, so much to the system and the priorities. And I love that you are completely virtual. I know we'll talk about that a little bit more later and how that helps you in your role. But I'd like to go back to, you know, you are a child and adolescent psychiatrist.

00:03:12:22 - 00:03:36:18
Jordan Steiger
You've practiced for a long time in this role. I know you're really passionate about the care that you provide. We know that there are not enough of you out there in the workforce right now. There are just not enough people going into psychiatry, and especially child and adolescent psychiatry. What does this mean for patients? What does this mean for the short term and long term outcomes for these kids when they can't see a psychiatrist?

00:03:36:20 - 00:04:02:19
Adrienne Coopey, D.O.
Right. So all of that is true. We are not able to produce enough child and adolescent psychiatrists to see every kid who needs help. But I would argue we don't need to. You know, our primary care providers are really seeing the kids who need behavioral health intervention. They're seeing them first, right? They're identifying their needs pretty early, right.

00:04:02:20 - 00:04:34:23
Adrienne Coopey, D.O.
We have made it important for screening tools to be implemented for depression and anxiety. So our primary care providers are seeing these kids right off the bat. If we can support our primary care providers to intervene early, we may not need as many child psychiatrists as we feel we do at this point. Treating behavioral health though, is so different than, say, treating strep throat, right?

00:04:34:25 - 00:04:57:04
Adrienne Coopey, D.O.
We don't have that one test that gives us that one answer and know that one antibiotic is going to be helpful. And so that can make it a little more difficult to just do. And that, is where I get to be a part of sort of distilling all the I've learned to support the primary care providers.

00:04:57:11 - 00:05:21:27
Jordan Steiger
So what I'm hearing you say, I think, is that we need to maybe shift our mindset around this a little bit. Not every child needs to be seeing a psychiatrist. And that early intervention piece is really important. And I know that that's something that WVU medicine is really investing a lot of time and resources in right now. So could you tell us a little bit about the work you're doing to empower that early intervention and get kids the care that they need?

00:05:21:29 - 00:05:46:12
Adrienne Coopey, D.O.
Yes. We have implemented three different programs already in behavioral health integration. That has been very exciting for me. One that I have continued today and it is a direct education with a primary care provider. I have a pediatrician that I work with in an area of West Virginia that has no behavioral health services as far as child and adolescent psychiatry is concerned.

00:05:46:15 - 00:06:12:13
Adrienne Coopey, D.O.
She primarily sees children with behavioral health needs. And I talk to her a couple times a week about patients. And we help implement those screening tools in a way that makes it easier for her to care for kids. I give her recommendations, but really, she's doing all the work. And often I am just saying, yeah, that sounds like a really good idea.

00:06:12:13 - 00:06:46:28
Adrienne Coopey, D.O.
And that has gotten a lot of children seen earlier and getting the care in their communities that they would otherwise have to travel pretty far for. Another program is primarily supported through our population health department. Really cool. It is a fully virtual collaborative care model. In general, the collaborative care model parks a social worker in a primary care office who then is the liaison between the patient, the primary care provider, and the specialist,

00:06:46:28 - 00:07:13:27
Adrienne Coopey, D.O.
the child and adolescent psychiatrist. I've worked in that model, it's super fun. It's great to have that collaboration with everybody in that team model. This model is completely virtual. The primary care provider can be in any setting. The social worker is calling the patient using the medical record to communicate. And I have direct conversations with the social worker.

00:07:13:29 - 00:07:45:06
Adrienne Coopey, D.O.
What that gives us is an opportunity to see patients in various practices that can be geographically quite separated. That was one of the difficulties with rural collaborative care is that the social worker may not have enough volume in one practice to really support their position. And so this really negates that issue. The third thing that we're doing that's super fun is, we call it E-consultation.

00:07:45:12 - 00:08:11:09
Adrienne Coopey, D.O.
It is an interprofessional consultation. So the primary care provider puts in an order and a question about a patient. It comes to me or one of our child psychiatrists electronically. We review the chart, review the question and send back an answer. This can be really great. Because we can give it an answer pretty quickly, and we can bill for it so it can support itself.

00:08:11:12 - 00:08:36:16
Adrienne Coopey, D.O.
The primary care provider and this child psychiatrist, are part of any kind of billings and review generation, so that can be helpful in supporting the program. That can give those patients who may not be appropriate for a collaborative care model, a more immediate answer before they can get to a child psychiatrist in specialty care.

00:08:36:18 - 00:09:07:01
Jordan Steiger
Wow, so many things you've mentioned I would love to just dive deeper and deeper into. I think that I mean, the thread I hear among all of these programs though, is the willingness to embrace that virtual care and the willingness to connect across a very large state with a lot of rural communities. You know, I think being a big anchor system in a state like West Virginia, there is such an opportunity maybe for other, you know, states similar to West Virginia, to kind of model off of the work that you are doing.

00:09:07:04 - 00:09:29:22
Jordan Steiger
One of the things you mentioned at the beginning, you know, talking about your different implementations is, you know, how you work one on one with this primary care physician in a rural community in West Virginia. I love this. I think this is such a smart way to just spread that knowledge and help - like you said - just bring that access to care to communities where it wouldn't maybe be.

00:09:29:24 - 00:09:51:18
Jordan Steiger
You alluded to this at the beginning too, but we know that behavioral health provision, you know, for services, is a little different sometimes than primary care. So how can other child and adolescent psychiatrists model kind of the work that you're doing and empower other primary care clinicians to be more confident in treating children with behavioral health needs?

00:09:51:20 - 00:10:23:15
Adrienne Coopey, D.O.
Great question. And this has taken time to develop for myself. Getting little bits of information about someone and formulating a diagnosis and plan can be really difficult and a little scary. So learning the ways that primary care providers can communicate with you in the same language. So sometimes our primary care providers and our psychiatrist are speaking different languages.

00:10:23:17 - 00:10:57:09
Adrienne Coopey, D.O.
One way that we can speak the same language and get the same information is if by using screening tools. And we are using screening tools in primary care a lot, right? We're using the PHQ. We're using the Gad seven and the scared for anxiety. We're using the Vanderbilt for ADHD. We're doing that. And that can be a great way to get the information that you need and communicate it with each other, primary care and psychiatry and follow the care. So we can use those to help support diagnosis.

00:10:57:11 - 00:11:17:18
Adrienne Coopey, D.O.
We can use those to help follow the care and see if we're getting better. Because one thing about psychiatry in general is that our responses aren't always immediate and they're not big. You don't go from sore throat to no sore throat, right? You have incremental improvement.

00:11:17:21 - 00:11:47:05
Jordan Steiger
Absolutely. And just making it objective, like you said, it's not like you have sore throat and no sore throat. It could be a lot of time, a lot of different interventions, a lot of different experimentation with lots of different things to get that person to that right care plan in psychiatry. So I think that that's a great takeaway message for our listeners is just figuring out what is that shared language and how can we come to kind of the middle and understanding each other between psychiatry and primary care

00:11:47:05 - 00:11:59:15
Jordan Steiger
so I love that. As we start to close, what advice would you have for other health systems who are looking to integrate behavioral health into their other models of care?

00:11:59:17 - 00:12:28:24
Adrienne Coopey, D.O.
Support it. I am super grateful to WVU for supporting my work. I am grateful to other hospitals that I've worked at for supporting behavioral health integration. It doesn't always pay upfront, but the improvements on the end in quality of life, hospital visits, hospitalizations and other needs are significant. So that prevention piece is really powerful.

00:12:28:26 - 00:12:34:16
Jordan Steiger
I absolutely agree. Thank you so much. Is there anything else you'd like to add?

00:12:34:18 - 00:12:57:24
Adrienne Coopey, D.O.
Thank you for having me. I really appreciate this. It is something I've been doing in the background for quite some time, and I know that individually, each primary care provider I work with is grateful their patients are getting what they need, and they are also grateful for this program. But I don't always get to talk about it.

00:12:57:27 - 00:13:06:12
Adrienne Coopey, D.O.
Because behavioral health can be something that we don't talk about a lot. So I really appreciate that you've given us this time and spotlight to do it.

00:13:06:15 - 00:13:17:23
Jordan Steiger
We are so happy to do so. I love talking about behavioral health and getting to help other people share their stories. So, we are really excited to keep following your work and see what comes next.

00:13:17:25 - 00:13:19:10
Adrienne Coopey, D.O.
Thank you.

00:13:19:13 - 00:13:27:24
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.

00:00:01:04 - 00:00:32:24
Tom Haederle
Welcome to Advancing Health. Most experts agree that less reliance on foreign made medical and pharmaceutical products would be a good thing for U.S. health care. But experts also agree it's going to take some time to increase control over our supply chain. In today's podcast hosted by Tina Freese Decker, president and CEO of Corewell Health and the 2025 Board Chair of the American Hospital Association, we hear from two experts about the potential impact of the Trump administration's trade tariffs on our supply chain and what they could mean for patients and providers.

00:00:32:27 - 00:00:39:28
Tom Haederle
This podcast was recorded on May 15th.

00:00:40:00 - 00:01:04:17
Tina Freese Decker
Hello, and thank you so much for joining us today. I'm Tina Freese Decker, president and CEO of Corewell Health and board chair for the American Hospital Association. This month, we are diving into a topic that is top of mind for all of our leaders, not just in health care. It's tariffs. As our nation watches the changing tariff policy play out for those in the hospital field, there are serious considerations as it relates to our supply chain.

00:01:04:19 - 00:01:31:00
Tina Freese Decker
Every day at Corewell Health and I'm sure at every hospital health system across our country, we use a wide array of products, devices and pharmaceuticals to deliver safe and effective care to our communities. The lives of the people we serve often depend on these items being readily available, making a robust health care supply chain critical. While the field shares the administration's long term goal of strengthening the domestic supply chain for essential medical and pharmaceutical products,

00:01:31:03 - 00:01:57:00
Tina Freese Decker
we know that achieving this goal will require significant time. In the short term, there is concern that tariffs could inadvertently disrupt that availability of these essential care delivery products, increase the complexity of delivering patient care, and significantly raise hospital costs. So today, I'm joined by two guests who will help us better understand the current environment as it relates to tariffs and the potential implications to health care supply chain.

00:01:57:02 - 00:02:06:12
Tina Freese Decker
Brian Pomper is a partner at Akin Gump Strauss Hauer and Feld, a D.C. based law firm, and he specializes in international trade policy. Welcome, Brian.

00:02:06:19 - 00:02:07:05
Brian Pomper, JD
Thanks for having me.

00:02:07:20 - 00:02:24:28
Tina Freese Decker
Before joining Akin Gump, Brian formerly served as the chief international trade counsel to the Senate Finance Committee, where he advised of all aspects of the committee's international trade and economic agenda. So we'll get into some of your expertise today. And we are also joined by Akin Demehin. Welcome, Akin.

00:02:25:05 - 00:02:26:03
Akin Demehin
Thank you Tina.

00:02:26:05 - 00:02:54:05
Tina Freese Decker
Akin is AHA's vice president for quality and safety policy. He leads public policy analysis, development and advocacy efforts related to quality, patient safety and workforce on behalf of the American Hospital Association. He also leads a regulatory policy development efforts related to the health care workforce. So thank you so much for joining us today. There's so many ups and downs, so many negotiations about what's happening with tariffs.

00:02:54:08 - 00:03:00:20
Tina Freese Decker
So Brian, I'm going to start with you. Can you tell us where we are today about what's happening for tariffs.

00:03:00:22 - 00:03:29:23
Brian Pomper, JD
Sure thing. Well there's a couple different avenues that the administration has taken on its trade and tariff plan, I'd say. The first I'd just talk about the giant reciprocal tariff regime that the president announced on Liberation Day, as he calls it, on April 2nd. On April 2nd, he announced that he would be imposing 10% tariffs on every country in the world and higher tariffs on 57 of those countries on April 9th.

00:03:29:23 - 00:03:53:27
Brian Pomper, JD
And so the 10% tariffs went into effect April 5th and then April 9th - for about a few hours - you had much higher tariffs on those 57 countries. The bond market and the stock market reacted quite negatively at the time. And so he decided he would pause those higher tariffs on the 57 countries for 90 days to allow for negotiations.

00:03:53:27 - 00:04:18:21
Brian Pomper, JD
He said at the time it was because the bond market had gotten, in his words, yippy. So they were watching what was happening in the broader market. Concerned about where the market was trending, decided to pause this enterprise to allow for these kind of bilateral negotiations over the course of 90 days. And so that's where we are now. Where there are, really, one hears 18 to 20 countries that are in active negotiations with the administration.

00:04:18:21 - 00:04:38:22
Brian Pomper, JD
There are many more that have proposed some degree of, measures they could take for their own economy. So there are really are dozens of countries that are engaged in negotiations with the United States during this 90 day period. There's been one announced agreement with the United Kingdom that was late last week or earlier this week.

00:04:38:24 - 00:04:58:07
Brian Pomper, JD
I would just note that that agreement with the U.K., it's much less of an operational agreement and much more really of a kind of a scoping exercise in agreement to agree sometime in the future on certain matters. And so it's really just a little bit of an appetizer for what maybe these agreements might look like in the future.

00:04:58:07 - 00:05:22:03
Brian Pomper, JD
And the hard part in even negotiating with the U.K. has yet to be done. There's a rumor that there's another agreement that should be announced here fairly soon, but I expect there will be a whole series of these kinds of announcements over the course of the next 90 days, until July 9th. I wouldn't expect the very high reciprocal tariffs on those 57 countries to snap back immediately into place on July 9th.

00:05:22:06 - 00:05:39:01
Brian Pomper, JD
My expectation is that countries that are able to negotiate, as the U.K. did, will end up with a 10% tariff. They won't get their higher tariff. But even for those countries that have expressed a willingness to negotiate with the United States, I don't think that the higher tariffs will go into place. I think the president will extend the pause there.

00:05:39:08 - 00:06:05:14
Brian Pomper, JD
So that's reciprocal tariffs. And then there are section 232 investigations. This is a mechanism whereby the president can ask the Department of Commerce to do an investigation into the national security impact of certain imports. And there has been, a variety of investigations that this president has, has undertaken and actually imposed tariffs on steel and aluminum and autos. All those tariffs are in place under the section 232 authority.

00:06:05:16 - 00:06:30:16
Brian Pomper, JD
But there's also investigations into pharmaceuticals, into semiconductors, trucks, timber, lumber, copper, aerospace, potentially more coming down the pike. And so we're expecting those investigations to be announced here in the coming months. But we don't know exactly where the president will land yet. The premise of those investigations is supposed to be the national security impacts of those imports.

00:06:30:18 - 00:06:52:20
Brian Pomper, JD
But really, the president seems to be using them as a cudgel to try to force companies to restore their manufacturing from overseas to the United States by tariffing the imports. He seems to like a tariff of 25%. That's the tariff that applies on steel, aluminum and autos. I think that's where we see him landing on some of these others.

00:06:52:23 - 00:07:26:13
Brian Pomper, JD
And unlike the reciprocal tariffs where there's a lot of negotiation that's ongoing, the section 232 tariffs feel a lot stickier. They'll be a lot harder to get out from underneath them. And then of course there are the China tariffs. When the president announced the 34% reciprocal tariff for China. China retaliated and we ended up in a tit for tat retaliation that ended up really with, 145% base tariff on imports into the United States from China and 125% tariff from US exports to China.

00:07:26:15 - 00:07:46:12
Brian Pomper, JD
That really was like an economic blockade. And both economies really needed to lower those and in fact, they did agree. The United States and China agreed to lower those tariffs. And so now the tariffs on products coming into China, the base tariff is 30% plus whatever additional tariffs might apply. And from the US side into China, it's 10%.

00:07:46:15 - 00:08:02:28
Tina Freese Decker
I was just recently reading a book, history book and talked about tariffs. So can you share how tariffs have been handled differently compared in the past, how they are different today than they were used in past administrations or past years and strategies?

00:08:03:00 - 00:08:26:03
Brian Pomper, JD
Yeah. Thank you. I love this question. Allows me to bring out my inner professor. So I would say for the first 150 years of American history, there was no topic that was more often and more frequently debated in Congress than what should be the level of the tariff. You had the incipient industrial industries in the North that wanted higher tariffs to protect their growing power up there.

0:08:26:05 - 00:08:49:15
Brian Pomper, JD
And then you had growers in the South who wanted open export markets, and so they wanted low tariffs so that other countries don't go there. So there was this just constant negotiation. We ended in 1930 with something called the Smoot-Hawley tariff, which people may remember from their high school history class, as blamed for having deepened the Great Depression, I think widely perceived as a negative economic outcome.

00:08:49:17 - 00:09:10:10
Brian Pomper, JD
And since 1930, what the Congress has really done is to delegate to the president quite a bit of authority over trade policy. This is why we have things like the section 232 investigation, where Congress has understood that well, you know, maybe it's not the best use of congressional time to negotiate on what the tariff on salmon imports should be.

00:09:10:13 - 00:09:33:18
Brian Pomper, JD
You know, we're going to let the president kind of deal with that stuff. So we have for the last almost 100 years, had this kind of joint authority between Congress and the president where they would share this, this sort of responsibility. And I think there are those who will argue that that President Trump is using this authority in ways that hadn't been contemplated.

00:09:33:20 - 00:09:56:17
Brian Pomper, JD
In particular, I would say, with a line of tariffs that I didn't talk about, which are these tariffs under the International Emergency Economic Powers Act that were imposed on Canada and Mexico, also on China. And actually, I should say IEEPA is the underlying authority the president used for this entire reciprocal tariff regime. It is a very aggressive use of this authority.

00:09:56:20 - 00:10:17:18
Brian Pomper, JD
That that's unusual. The president is much more willing to push legal boundaries, of course, not just in tariffs, but we certainly see it in tariffs here. So much so it is currently being challenged in the courts. And it's really anybody's guess whether the courts are going to decide that he may have exceeded his authority under the IEEPA statute to him to impose these tariffs.

00:10:17:21 - 00:10:19:28
Tina Freese Decker
And can you explain the IEEPA statute?

00:10:20:01 - 00:10:43:18
Brian Pomper, JD
Sure. I'm happy to. So IEEPA stands for the International Emergency Economic Powers Act. It was passed in 1977 to allow the president to act quickly in cases of some sort of economic emergency. It's actually the basis for our entire export controls regime. It has never been used before to impose tariffs. President Trump is the first president to use it to impose tariffs.

00:10:43:21 - 00:11:08:13
Brian Pomper, JD
There was a predecessor statute called the Trading With the Enemy Act, that President Nixon used to impose tariffs when we were in the process of going off of the gold standard, because there was a balance of payments crisis at the time. That was challenged in the courts, and the court at the time decided that was okay because the court decided, well, those tariffs that the president imposed were really in response to a true economic crisis.

00:11:08:13 - 00:11:32:19
Brian Pomper, JD
There wasn't enough gold in Fort Knox to cover the number of dollars that were in circulation at the time. And those tariffs were imposed for a relatively short period. It was only four months. And it wasn't every country and every product. If you fast forward now to the successor statute, the IEEPA statute, which was written largely because the Trading With the Enemy Act...it was an awkward fit for some of these actions that President Nixon took.

0:11:32:21 - 00:11:59:07
Brian Pomper, JD
Here you now have a president who has used IEEPA to impose tariffs on every country, every product, effectively forever. And so the question that the court in Yoshida, which is the case I'm talking about, the court in Yoshida decided the president in that case was not seeking to usurp the role of Congress, which is clearly given to Congress in the Constitution to control international economic relations, trade with foreign nations.

00:11:59:10 - 00:12:30:11
Brian Pomper, JD
The president wasn't seeking to stand in the role of Congress in resetting tariffs, because it was only time limited and, you know, limited in coverage. Here it's a much different circumstance where you really do have the entirety of the harmonized tariff code that covers all of our trade with every country being reset through executive order. I do think that there are very strong legal arguments that will be made and are being made in court, literally right now as we speak, that the president exceeded his authority under

00:12:30:14 - 00:12:40:06
Brian Pomper, JD
IEEPA. So it's not inconceivable in the next few weeks, you could see a court order that would invalidate the president's actions and really get rid of this entire reciprocal tariff regime.

00:12:40:08 - 00:13:04:03
Tina Freese Decker
Thank you very much. That was an excellent summary, we really appreciate that. I'm going to switch to Akin. Akin, can you share an overview of concerns specific to hospitals as how it relates to the tariffs may impact access to pharmaceuticals, medical supplies, other needed devices, and do you think that there is going to be a concern about exasperate some of the shortages that we have experienced to date?

00:13:04:06 - 00:13:27:02
Akin Demehin
Absolutely. I think the complexity that Brian was talking about in terms of how these tariffs are being rolled out is really needing the complexity of the health care supply chain. And the concern that we hear from members and that we really put front and center in our own advocacy efforts is what does this mean for the delivery of patient care?

00:13:27:04 - 00:13:54:21
Akin Demehin
What does it mean for our caregivers in health care facilities? Hospitals and health systems are constantly weaving together both domestic and international sources for their drugs, for their medical devices, and for other critical supplies. And we know that even temporary disruptions to the flows of those goods can have significant impacts to how hospitals deliver care. Great example are cancer drugs. 00:13:54:24 - 00:14:20:02
Akin Demehin
Many of those are manufactured in China or rely on a significant number of key starting materials that are manufactured in China or in other locations across the globe. The disruption from tariffs could potentially lead to disruptions in those carefully planned cancer treatments that really rely on careful scheduling. The same thing is true of things like cardiovascular medicines.

00:14:20:04 - 00:14:57:21
Akin Demehin
As you raised at the outset, Tina, we certainly support ongoing efforts to onshore production and really strengthen the domestic supply chain. At the same time, even those medical goods and devices that are manufactured here in the U.S. often draw in content from abroad. Great example is an infusion pump, where even those infusion pumps are manufactured here in the US might have parts from 20 or more different countries, ranging from the aluminum that goes into manufacturing the pole to the computer chips to the plastics.

00:14:57:24 - 00:15:12:17
Akin Demehin
All of that involves a considerable amount of complexity. And switching sourcing and offshoring production really is a long term effort. So we've really tried to elevate those concerns in our work around tariffs.

00:15:12:19 - 00:15:19:09
Tina Freese Decker
So can you tell us what the American Hospital Association is doing to secure exemptions for medical devices and pharmaceuticals?

00:15:19:11 - 00:15:56:23
Akin Demehin
Sure. So early in the rollout of the tariffs from the administration - going back to early February - we actually sent a letter to the president outlining our concerns about the potential impacts of tariffs to the delivery of patient care, to our ability to provide things like personal protective equipment to frontline providers. And we've continued to follow that up with ongoing proactive dialogue with the administration to really focus on advocating for exemptions for pharmaceutical products and for medical devices.

00:15:56:25 - 00:16:27:12
Akin Demehin
Bryan talked about the section 232 investigations. The administration has one ongoing for pharmaceutical products, and had an opportunity for the field to share feedback. And we share our concerns with the administration and continue to ask for exemptions. The other thing that we are trying to do is to really provide the hospital and health system perspective to policymakers, to the media, to the administration.

00:16:27:14 - 00:16:51:22
Akin Demehin
We're in a bit of a unique position versus other kinds of fields where we are large consumers of the goods within the supply chain. Our ability to stockpile any of these supplies is often constrained by just the sheer availability of the supplies. The shelf life for things like pharmaceuticals is finite, so it's not necessarily something that you can just have hanging out on a shelf.

00:16:51:25 - 00:17:20:12
Akin Demehin
There's space that you have to have in order to warehouse some of these materials. And the way that hospitals and health systems are reimbursed means that it's really our members that bear the costs of tariffs. Because our rates are set by government and by contracts in the private sector, the potential cost impacts of tariffs are ones that we really feel quite directly for our members.

00:17:20:14 - 00:17:33:17
Tina Freese Decker
Akin, you answered all of my questions coming through there. That was fantastic, because those are all of the concerns that we have as members and what's going on. Brian, do you think that exemptions are likely knowing this administration?

00:17:33:19 - 00:17:54:18
Brian Pomper, JD
An excellent question I get from many, many clients. And I would go back to what I mentioned earlier. My expectation is that the American economy is going to struggle a bit under the weight of all of the tariffs that the president has imposed in all these ways. And there are more tariffs coming under these section 232 investigations that are currently ongoing.

00:17:54:20 - 00:18:27:09
Brian Pomper, JD
I think that many in Congress, especially on the Republican side, have expressed privately but not publicly concern about the president's strategy with respect to tariffs and how it might impact their constituents. But I think over time, the political and economic pressure is going to force some kind of adjustment in the administration. And I think the most logical pressure valve to be released for the administration is for them to reimpose some type of exclusion process, as we did have in the first administration.

00:18:27:09 - 00:18:33:15
Brian Pomper, JD
So if I'm a betting person, yes, I think we will have some kind of exclusion process.

00:18:33:18 - 00:18:54:27
Tina Freese Decker
We'll come back to see if you're right. And so to close out our conversation today, this has been really helpful, a great history lesson and understanding of what's going on. Brian and Akin, can you share with us what your advice would be for our members? What should we be thinking about doing, planning for, as we think about these tariffs and the impact that they have?

00:18:54:29 - 00:19:13:08
Brian Pomper, JD
Yeah, I always tell clients if something is important to you, important to your bottom line, you need to be vocal about it, and you need to be telling people how these measures are going to impact you. It's hard to argue with the goal, or at least one of the goals the president has of increasing manufacturing employment in the United States.

00:19:13:08 - 00:19:34:21
Brian Pomper, JD
Who doesn't want that? I think where there's debate is how best to achieve that. But I do think it's important for organizations like AHA to go talk to your members, talk to the people who focus on the policy issues, the policy areas that you deal with. Let them know how these tariffs are going to impact you, and ask them to weigh in on your behalf.

00:19:34:21 - 00:19:46:01
Brian Pomper, JD
And just make sure that whatever the administration does, they try to maximize benefit while minimizing harm. So I would just say where there's an opportunity to engage, I encourage the AHA to do so.

00:19:46:04 - 00:19:50:13
Tina Freese Decker
Maximize benefit and minimize harm. Great statement. Akin?

00:19:50:15 - 00:20:20:02
Akin Demehin
You know, Brian's counsel here is extremely wise. I'll just build on it in a couple of ways. One of the things that I know hospitals and health systems are so good at doing is bridging that gap between data and story. And often it is those stories of what's happening on the ground, how the steps that you go through to access supplies to deliver care, how those are affected, and playing that out for what it means for patients.

00:20:20:04 - 00:20:49:15
Akin Demehin
Those are the kinds of stories that I know policymakers respond to. It really makes the issue even more real for them. And as Brian alluded to, raising some of those concerns with policymakers and certainly reaching out to us here at AHA, we can always be strong advocates on your behalf when we have intel and stories, and other information from all of you to help make the case as best we can.

00:20:49:16 - 00:20:58:17
Akin Demehin
So we want to stay connected as we possibly can with all of you going forward so that we can push for those exemptions for pharmaceuticals and medical devices.

00:20:58:19 - 00:21:23:02
Tina Freese Decker
That's wonderful. And your example about the cancer drugs or the smart pump or MRI and how all of those pieces come together is one of those stories that we can talk about and how it impacts us. So Brian and Akin, thank you so much for your time today and sharing in your expertise. I know this is an evolving issue and the AHA will continue to monitor closely and advocate on behalf of our field.

00:21:23:04 - 00:21:29:13
Tina Freese Decker
And thank you to everyone tuning in today. We'll be back next month for another Leadership Dialogue conversation.

00:21:29:15 - 00:21:37:26
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.

00:00:01:27 - 00:00:24:23
Tom Haederle
Welcome to Advancing Health. Tending to the overall well-being of a patient often has emotional and spiritual dimensions as well as medical. In today's podcast, we hear from two experts about how chaplains are helping people of all backgrounds in the health care setting as part of an interdisciplinary team, making sure care is focused on the whole person.

00:00:24:26 - 00:00:50:06
Elisa Arespacochaga
I'm Elisa Arespacochaga, vice president of clinical affairs and workforce at the AHA. Today, I'm joined by Jason Lesandrini, AVP of Ethics, Advanced Care Planning, Spiritual Health and Language Access Services at Wellstar Health System; and Kelsey White, assistant professor and chaplaincy faculty researcher in the Department of Patient Counseling at Virginia Commonwealth University. And this is a discussion I've been looking forward to for a little while.

00:00:50:06 - 00:01:09:27
Elisa Arespacochaga
We're here to really discuss how they have worked to integrate chaplains into well-being programs in health care, and really make those connections across both their research and their organization. So to start off, Kelsey, why don't you start, just tell us a little bit about the work that you do and who you are.

00:01:09:29 - 00:01:33:07
Kelsey White, Ph.D.
Yeah. Thanks for having me. I'm a professor primarily these days. But my career started out as a board certified chaplain working in outpatient, a very large outpatient center as well as oncology. Fell in love with chaplaincy to the extent that I wanted to figure out how to do research about it. And from there I went to do a Ph.D. and really focus on expanding the research and the integration of chaplains in my efforts.

00:01:33:09 - 00:01:37:27
Elisa Arespacochaga
And I'm guessing that's how you got to meet Jason. Jason, can you tell us a little bit about your work?

00:01:37:29 - 00:02:08:20
Jason Lesandrini. Ph.D.
Thank you. Thank you both for being with me today. So, like you said, I work at Wellstar Health System, which is a large integrated health care system in Georgia. I've been here for about ten years and really my focus on the work I was doing originally when I came was on ethics. That's where my background is. I'm a Ph.D. in healthcare ethics from Duquesne and spent a number of years at another local system doing ethics work and as I got here to Wellstar noticed there was a need, sort of in conversations with the executives to really take spiritual health as a team and have an executive representative.

00:02:08:20 - 00:02:12:23
Jason Lesandrini. Ph.D.
And so I've been doing that eight years now is what we're going on. So I'm really excited for it.

00:02:12:26 - 00:02:24:11
Elisa Arespacochaga
Kelsey, just to level set with our audience. Can you describe a little bit the role of a chaplain within a health care organization? I think everyone may have a little bit of an idea, but not fully understand what that role means today.

00:02:24:13 - 00:02:49:15
Kelsey White, Ph.D.
Yeah, absolutely. So to kind of step back, they aren't just the folks that go in and pray, but really they're members of the interdisciplinary team who really help make sure that the health care that we provide is focused on a whole person. So they typically have a graduate level of education, clinical training, over a year of clinical training typically, board certification or certified eligible.

00:02:49:17 - 00:03:28:08
Kelsey White, Ph.D.
And then they have this expertise to attend to individuals emotional, spiritual and that interpersonal well-being. So they are trained typically to talk to all people, whether it be staff or patients or family members, about spirituality, but not just what we think of as this like religious type of topic when it comes to spirituality. But spirituality really encompasses the way we make meaning of the world around us, how we find purpose and connection, and then to deal with kind of the tough things that happen in our life that make us ask why?

00:03:28:10 - 00:03:36:07
Kelsey White, Ph.D.
And so chaplains are trained to really have those tough questions, but also to really support folks in really difficult situations.

00:03:36:09 - 00:03:57:24
Elisa Arespacochaga
As I usually say, one of the challenges and opportunities in health care is that we are with people at what may be some of the most difficult moments in their lives, and so being able to not only support their physical health and their mental health, but their emotional health and their ability to connect with them and support them as they wrestle with some of those questions I think is key.

00:03:57:27 - 00:04:21:16
Kelsey White, Ph.D.
Yeah. And I also add like because of the extensive training they've had, they're equipped to work with people from all different backgrounds and regardless of faith tradition. And I think they're really touching on these like core existential topics that are just part of everyone's natural being and that when those things are out of whack, they can end up impacting one's health, too.

00:04:21:18 - 00:04:34:09
Elisa Arespacochaga
Jason, how are you actually incorporating this amazing set of skills and resources and humans in your organization into well-being initiatives? And, you know, Kelsey, I'm sure you have ideas as well.

00:04:34:11 - 00:04:59:13
Jason Lesandrini. Ph.D.
Yeah. So it's a great question. Kelsey definitely has a lot to share about this as being a chaplain, not being a chaplain, but leading chaplains. I get to see the great work that they do. And I think here in my own organization, we have a program called CARES. It's an acronym that basically it's a sort of a response system that when sort of some type of critical incident happens, our chaplains are available 24 hours a day, seven days a week, 365 days out of the year.

00:04:59:15 - 00:05:22:24
Jason Lesandrini. Ph.D.
No holidays, no breaks, no nothing. They are there to respond. The chaplain is the first person who gets that call. And the beautiful thing about our chaplaincy program is that our virtual care providers are on the ground, right? We're not in a telecenter responding to our team. We're actually on the ground and can be with another person, which we think is really important to, sort of, staff's overall well-being.

00:05:22:24 - 00:05:41:16
Jason Lesandrini. Ph.D.
Now, how you get in touch with them, of course, is electronically, but it's that physical presence that we think is important. You know, to Kelsey's point earlier about how do you care for this person? We care for them in the moment with them and to be by their side. And so our team, this is one big thing that we've been pushing as our team is there for others when they need them during those critical times.

00:05:41:19 - 00:06:18:02
Kelsey White, Ph.D.
At VCU we do a whole lot of different things. I like to think about them in kind of two buckets. So we've got like chaplain efforts that really focus on in real time reducing stress levels, helping manage distressing situations whether it be debriefing or giving them a moment of respite. So some people have heard of, like tea for the soul or cheek hearts, where chaplains will push them around and offer clinicians these moments to just breathe and to be reminded that they're cared for and that they're supported and that they're not alone.

00:06:18:04 - 00:06:46:12
Kelsey White, Ph.D.
And sometimes that can make a big difference in a busy day. And then there's this other group of ways in which, chaplains, I think can really impact well-being is thinking about a specific way that a chaplain can alter a workflow or a process that really shifts the burden off of other clinicians. So a really concrete example of this is, a program that was actually developed here at VCU called the Family Communication Coordinator.

00:06:46:15 - 00:07:17:23
Kelsey White, Ph.D.
And this intervention is really focused on those individuals that qualify to donate an organ. And so the chaplain comes in and to relieve some of the stress on the nurses and the physicians and the clinical team will facilitate the process between the family and the organ procurement organization. Which really can just, I mean, decrease the stress, decreases role ambiguity and helps kind of minimize all of the things that are that can be exacerbated in those moments.

00:07:17:25 - 00:07:44:01
Elisa Arespacochaga
I think that's so key. One of the challenges we keep seeing broadly in the workforce space is that need to unburden some of our team members from having to do all of the things, and how can we find those roles that and those activities that don't require a physician or a nurse to be doing it, but someone has to be part of the health system and, and be able to provide that support.

00:07:44:01 - 00:07:56:29
Elisa Arespacochaga
So I love the idea of taking advantage of that amazing set of skills and connections and really, bringing them to bear on what has got to be one of the those difficult times.

00:07:57:01 - 00:08:33:03
Kelsey White, Ph.D.
Yeah. And they're actually I talked to some chaplains recently who were part of their organizations efforts to assess for the social determinants of health. And that could be done by a lot of people. There's something about the way in which a chaplain is able to build that trusting relationship that not only helps with a specific process, but it's one less thing that the nurse has to screen for or attend to, but also those chaplains have the skills to get at really sensitive topics for patients and families.

00:08:33:06 - 00:08:47:23
Elisa Arespacochaga
Jason, talk to me a little bit about how you're connecting this great work not only to you make it available to your patients, but to the organization's mission and overall well-being for your team, for those who are doing the caring.

00:08:47:25 - 00:09:11:11
Jason Lesandrini. Ph.D.
Yeah. So here at WellStar, our mission is to enhance the health and well-being of every person we serve. And we're focused on something called People Care, which is about providing care that's unique to whoever. So it's Kelsey care, it's Jason care. It's all of our care. And look, I know this sounds silly, but I can't think of anything more people focused and thinking about how individuals deal with, mind, body and spirit.

00:09:11:13 - 00:09:29:16
Jason Lesandrini. Ph.D.
Right. And thinking about what are those individuals who have expertise in that space, and in some of the spaces that we often forget of to sort of attuned to that. And so while most of our work tends to focus on patients and their families at the bedside, there's also this other side of people care, which is about the people who care for the people care.

00:09:29:19 - 00:09:50:28
Jason Lesandrini. Ph.D.
And so, you know, we need to think a lot broader about this. Kelsey's earlier comments made me think of, you know, something that's really fascinating about working with chaplains. Sometimes it's just about being there. So, yes, the issue might be called up because of, you know, a family or a patient may be having some spiritual distress or something that's going on.

00:09:51:00 - 00:10:10:11
Jason Lesandrini. Ph.D.
But I'll tell you that the beautiful thing is when you just watch it happen, it doesn't have to be anything magical. It's Kelsey as a chaplain coming to my bedside or talking with a patient, a family. And then what do they do? They go out to the nurses station or they see the doctor who's documenting, you know, in the chart or whatever it may be, or the EDS worker and just being with them.

00:10:10:11 - 00:10:27:19
Jason Lesandrini. Ph.D.
I think that means a lot. And so when I think about how we focus on people care here and how we care for the people who care for the people that we care about, you know, that we're trying to tune to. I can't think of anything more connected than sort of the great work that our special care providers do across the entire enterprise.

00:10:27:21 - 00:10:48:22
Elisa Arespacochaga
It's just so heartwarming to see the taking that moment, because, I mean, health care is a hard place to be. It's a hard place to work, but it's one that is so rewarding. And so hearing the opportunity that the chaplains can take to really sort of reground everyone in that work. Kelsey, let me ask you, I've got, sort of two options here.

00:10:48:22 - 00:11:07:19
Elisa Arespacochaga
One share a story of something that surprised you as you've been involving chaplains in this work or -otherwise it may actually be both - advice you'd give to other organizations who are looking to tap into their chaplaincy programs to support well-being. And then, Jason, I'll ask you the same thing.

00:11:07:22 - 00:11:40:07
Kelsey White, Ph.D.
The thing that I think surprises me the most when I have conversations with folks across the country is this level of innovation that chaplains are really living into in these efforts. They recognize the highly specific nature of the stress and distress they see, and can adapt in a way that focuses on their localized contexts. So if there is a certain challenge that is very... perhaps it was a community shooting, right?

00:11:40:11 - 00:12:04:08
Kelsey White, Ph.D.
So the chaplain able to really adapt and address those tensions that are arising right there, and how that affected the clinicians because they're part of the community, too, right? They're not just there at the hospital, but they live there. And then I'd also add just the way in which chaplains care for the employees and the non, like at the outskirts of health care institutions.

00:12:04:08 - 00:12:33:21
Kelsey White, Ph.D.
So there's stories about chaplains caring for security workers, teaching them how to be resilient, teaching them how to cope with intense situations. Or teaching community health workers how to engage in authentic conversation. You know, Jason talked some about just being there. And I really, I would even take it a step further. And there's something about being both physically available and emotionally available that is not unique in our everyday relationships.

00:12:33:23 - 00:13:04:18
Jason Lesandrini. Ph.D.
I think the most surprising thing that I know in the work with chaplains is this misnomer about chaplains coming to pray. So Kelsey talked a lot about this. When I've asked my colleagues across the country about it that's what they tell me, that, you know, well, we call the chaplain to come in and pray. And I just think that selling them short, just really short of the work and scope, you know, we're all trying to work together every day to operate to the fullest extent of our capabilities because everyone in health care needs it.

00:13:04:21 - 00:13:21:24
Jason Lesandrini. Ph.D.
So I think just thinking about chaplains, as folks who come up and pray with people is just way too narrow. They can do that. But man, they can do so much more if we just open the door. You know, I live by this principle about being a helper. I think they're helpers. I think that's what they actually are.

00:13:21:24 - 00:13:44:21
Jason Lesandrini. Ph.D.
And they can help people across the spectrum: the religious, the non-religious, the spiritual, the non-spiritual. My experience has shown me that spiritual care providers are probably some of the best listeners and man, I can tell you this, I need an ear more frequently than I'd like to admit. It's not a judgment, it's not a religious context, it's just a really good listener.

00:13:44:23 - 00:14:04:22
Jason Lesandrini. Ph.D.
Your second point, Elisa, maybe I could just chime in here because I got lots to say. And if people who know me across the country know that I have a hard time being quiet. So I'll say this about advice to other organizations. You know, you'd mentioned that. I think the biggest piece of advice I'd give other folks is please just ask them, that's the biggest piece of advice, is ask them for help.

00:14:04:24 - 00:14:23:10
Jason Lesandrini. Ph.D.
I think that's the biggest problem we have across this country is that spiritual care providers, chaplains, all these folks who sit in this space are not being asked to assist with this work. And wow, if they are, the evidence is just not even you can't doubt it that they can help. But they got to ask. You got to ask them.

00:14:23:10 - 00:14:35:21
Jason Lesandrini. Ph.D.
And we have to, you know, we're doing work on this on the other side is we got to have the chaplains and folks speak up. That's the other piece. You got to speak up. So we need to ask, you got to ask them what's the work that they can do? What can they do? And then hold them accountable for it.

00:14:35:21 - 00:14:45:24
Jason Lesandrini. Ph.D.
Because I think that's part of the value that chaplains can do. The literature is clear, they can help. You got to ask them to do it and then just hold them to it because it will come out, I promise you.

00:14:45:27 - 00:15:10:00
Elisa Arespacochaga
Jason and Kelsey, thank you so much for joining me, sharing a little bit about your world, and hopefully through this podcast, we're sharing with others the opportunity both for chaplains to raise their hands and for those around them to say, hey, you got a moment? Can I bend your ear? Because I think that is something we all need very much to get through health care and to be able to help others.

00:15:10:02 - 00:15:12:01
Elisa Arespacochaga
So thank you again for joining me.

00:15:12:03 - 00:15:13:03
Kelsey White, Ph.D.
Thank you.

00:15:13:06 - 00:15:14:24
Jason Lesandrini. Ph.D.
Thank you.

00:15:14:26 - 00:15:23:07
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.