Podcast

PDV Talks With: LaRay Brown, President & CEO, One Brooklyn Health System

PDV Health Podcast Show Notes

Sponsor:

Welcome to Leadership, Transformation and the Healthcare CEO with Paul D. Vitale, a brand new podcast from PDV Health Consulting sponsored by One Brooklyn Health. With a special introduction in every show by LaRay Brown, CEO of One Brooklyn Health. We talk to New York’s top healthcare CEOs as they share their stories on how they managed to drive their organizations through tough times, and also hear about the transformations they’ve experienced firsthand. Here’s your host, Paul Vitale.

Paul D. Vitale:

Hello, I’m Paul Vitale, President and CEO of PDV Health Consulting. Welcome to Leadership, Transformation, and the Healthcare CEO. As a leader in healthcare policy and operation my career has encompassed acute, long term and outpatient care. I’ve had firsthand experience with homecare, business development strategies, and mergers and acquisitions. In this podcast series, I’ll be talking with some of the most extraordinary leaders in healthcare today. And the best part is, I get to share their insight and thoughts with you.

Paul D. Vitale:

I’m excited to have One Brooklyn’s CEO, LaRay Brown, introduce each of our guests on all of our shows. And to help kick off PDV’s brand new podcasts. Our first special guest is none other than LaRay Brown herself. Here she is.

LaRay Brown:

Thank you, Paul. I’m happy to be here. I think it’s so important that we talk about the entire spectrum of healthcare in this exciting and new podcast series. We’ve asked a select group of CEOs to take us behind the scenes of their organizations, and to share both their successes and their challenges during 2020. I know that all the episodes will provide our audiences with fresh insights on what were the successes and what were some of the difficulties in this past year. And thanks for moderating this podcast series. I’m looking forward to sharing with our audience more information about One Brooklyn Health and what we experienced in 2020. Thank you again.

Paul D. Vitale:

Thanks LaRay. Now let’s take a break to hear from our sponsor, One Brooklyn Health.

Sponsor:

PDV Health Consulting podcast Leadership, Transformation and the Healthcare CEO with Paul D. Vitale is made possible thanks to our sponsor, One Brooklyn Health. One Brooklyn Health is dedicated to providing high quality comprehensive health care to the communities they serve through a network of acute hospitals, community-based practices, long term care facilities, and partnerships with local health care providers. One Brooklyn Health’s patient-centered approach extends beyond medical care to enhance the health and wellness of their communities and their patients and families. Visit them online at OneBrooklynHealth.org today.

Paul D. Vitale:

Welcome back, everyone. We’re here with LaRay Brown, the Chief Executive Officer of One Brooklyn Health. And today I’m going to be interviewing LaRay and talking with her a little bit about 2020. A difficult year for all of us. I’ve heard a lot about different sectors of healthcare. One Brooklyn, I would say is a unique, beautiful healthcare system. And so many things have happened over 2020. And I know LaRay can share them.

Paul D. Vitale:

So LaRay, just to start out, can you tell everyone a little bit about yourself? Because so many people that are listening to this podcast, want to know how you became a CEO? There are a lot of, I’m sure, students listening and how do they go up through the ranks? If you could just tell us a little bit about yourself?

LaRay Brown:

Sure. I started my career actually working for the government. I was first a public high school teacher, believe it or not, and then got really interested in advocacy, community action work in the city of Newark. And through that effort, and with friends who had begun to work for the state of New Jersey, I was essentially inducted into working for the state government. And during that time, it was really exciting because the state was involved in making investments in community health, community mental health services. And so I got my feet wet in terms of public health issues. And interestingly, the intersection of healthcare, government and the community was what excited me most about that work. Then, as I said, I began to work for the state of New Jersey and became responsible for the state’s community mental health programs, working with all the counties in the state, including county psychiatric hospital systems. Then moved into the child welfare agency for the state of New Jersey, but during that time, continued to have great relationships with staff from the State Department of Health.

LaRay Brown:

And was essentially called by someone who knew someone who said, “We’re creating this new strategic planning office in New York City’s Health and Hospitals Corporation, the largest municipal hospital system in the country. We want to talk to you.” And in fact, the person who I was talking to was someone with whom I worked in New Jersey, within New Jersey in mental health. And when I interviewed with them, I said, “I don’t do strategic planning.” He says, “That’s exactly why we’re looking for you. But what you do is pull people together.”

LaRay Brown:

And so I essentially moved from being a deputy commissioner in the child welfare agency to actually taking the first level of the administrative position within this large municipal health and hospital system. And folks were like, “Well, how can you… It’s like a downgrade. You’re moving from being in charge of something to a staff position, essentially.” But what excited me most was you could be a big fish in a small pond, or you could be a small fish in a very large pond that has influence.

LaRay Brown:

And I tell that to young people, because many people are wanting to make sure they have titles and stature. And for me, it always has been on what is it that I’m doing? Why am I doing it? How can I have impact? And it doesn’t matter, the title, or frankly, even the salary, or how many people you’re in charge of. It really is the importance of the organization’s mission, and how you believe you can contribute. And so becoming the CEO of One Brooklyn Health is sort of a natural progression, I worked for nearly 30 years for Health and Hospitals, having a progressive number of positions at the senior level, again, starting at the bottom. And when I thought I was retiring… I literally retired for one week, before there was an outreach way to me to become the CEO of Interfaith Medical Center.

LaRay Brown:

Which is actually where I’m sitting today. And again, my son said, “I thought you were retiring, to have fun with your friends. But you’re jumping out of one large fire into the fire pit.” Because Interfaith had recently just come out of bankruptcy, there had been a lot of discussion about it closing, but what excited me most, A, was the fact that it’s a small community hospital. And that there was this groundswell of community support, local electeds, labor, patients who really came together to support the hospital and it’s not closing.

LaRay Brown:

And it having come through bankruptcy, we were really at a new beginning. And so I took that job, really not thinking about this thing called One Brooklyn Health. I was quite fine with being the CEO of Interfaith Medical Center and rolling up my sleeves and working with all of our partners and stakeholders to strengthen this, I think, very important community health resource. And then a couple of years later, a study came out that recommended that three of the safety net hospitals, there were really four in that study that served Central and North East Brooklyn, come together to form a system, to form an integrated system.

LaRay Brown:

With the premise being that as single hospitals, as sole community hospitals are, our future was very much in jeopardy. But creating a system of care would ensure the continued existence and viability of healthcare services in Central and Northeast Brooklyn. And so the recommendations were that this entity should be formed. A new governing body should be established. And that if this new entity was established, and the governing body agreed to restructuring, that there would be a significant investment of capital funds to help to gird, this new system and this new experiment. And so I was asked by the board members to take on the role of CEO of One Health system. And as they say, that’s where the story begins.

Paul D. Vitale:

Wow, wow. Thank you. It’s unbelievable, for some of you who don’t know, I have an affiliation with One Brooklyn, and I’m working with him right now. And I watch LaRay every day. And one thing I can tell you LaRay is your work ethic is unbelievable and people are proud of you. I want to start off backwards a little bit. Because yesterday, when I was sitting in an office, I read an email from you from the staff. And it really touched my heart. And it really was about what we’re going to talk about today, 2020. And you went back, can you tell everyone a little bit about what it was and why you decided to write that.

LaRay Brown:

Sure. I woke up to NPR, where the newscaster was basically remembering that yesterday was the day that the World Health Organization had essentially declared that this thing called COVID-19 was actually a world pandemic. And it really dawned on me that sometimes we are all so busy doing, and every day working really hard doing what we are supposed to do, which is to serve our patient that we somehow don’t pause, and just take a breath, and acknowledge that literally our lives changed a year ago, in many, many ways. And so I wrote the note to staff, and I wish I could do more of those notes.

LaRay Brown:

But I wrote a note to staff to remind folks that in fact, yesterday was that day when the WHO made that declaration, but also to share my thoughts about what we’d all gone through together. And including folks really not knowing what this thing was, how to respond. We were learning as we did. But also acknowledging so much of the compassionate, and professional responses of staff throughout the organization, not just our doctors and nurses, but everyone.

LaRay Brown:

And it was necessary during that time for everyone to be pulling together, and everyone to be doing the best they could to care for folks who were coming into the hospital, sometimes with symptoms that we didn’t even know that they were related to COVID-19. But I wanted to remind folks, not only of what we’ve been through in terms of just that uncertainty, but also what we’ve been through in terms of successes.

LaRay Brown:

The work we’ve done in these last couple of months, in providing vaccinations to our community. Interfaith has provided more than 7,000 people who live in our neighborhoods with COVID vaccine. As I speak, there are people lined up outside waiting to get the vaccinations, which to me is very heartwarming. Because, of course, early on when the vaccines came out, there was a lot of discussion about the hesitancy and the distrust of folks to be vaccinated, and that has actually and still I know exists.

LaRay Brown:

But on the flip side, there are so many, many people who are willing to trust and willing to come and get vaccinated. And I wanted to remind my staff at how grateful I was that they were now part of this battle. Last year, we were in the Battle of saving lives and just trying to figure out what this pandemic was all about. This year, we’re continuing to save lives, but with additional resources in terms of the vaccine. And I wanted to thank them. That was the most important thing. You have to have gratitude. You really must have gratitude and really just appreciate people.

Paul D. Vitale:

Yes, it was very moving. And speaking of the vaccine, you have been doing a lot of talking to staff and to people about how important the vaccine is. Tell me, what is the message that you give to people who say, “No, I don’t want it?” How do you deal with that? And how should people deal with that?

LaRay Brown:

Well, I think the first thing is to ask folks why? Why are they saying no? And to try them to respond to the issues that they raise. Very early on, I was talking to staff. Every time I saw someone in the hallways, coming in the morning, leaving out at night. And I would get the staff would say, “Well these things just came so quickly, how could they be safe when they just popped up? When there was such a quick development.” And so I would try to provide facts, the fact that these vaccines were being worked on when there was SARS, a decade ago, the development of, or at least a research had begun for the development of vaccines.

LaRay Brown:

Or folks would actually, and appropriately raise concerns and skepticism about and distrust of the government. And they would raise the Tuskegee Institute issues and other things that had occurred, particularly that had affected the African American community. And I would also say in that instance, that is absolutely… You have a reason, we all have a reason to distrust, but think about the alternatives. Think about the fact that you’ve lost friends, family members, to this virus. And the fact that this is all we have now to try to stem the death of people we care and love and yourself, and to protect yourself and your family.

LaRay Brown:

The other thing I would raise is, I understand that you may have hesitation. But by taking this vaccine, you help to protect the people you love. And also just providing written information to folks. We also hosted some town halls where we had a couple of physicians, one of whom had actually, as part of CDC, and it worked on the vaccine taskforce. We even featured our Chief Medical Officer, we had him talk about the vaccine, the science behind it, we put him on one of our mobile computers, which we rolled around. So we had a talking head, so to speak, where we were near the cafeteria. So staff who were coming into the cafeteria, could hear him talk about the vaccine and actually to go through commonly asked questions.

LaRay Brown:

Every town hall meeting, or every staff meeting, or every labor and management meeting, spent time talking about the vaccine and why it was important for folks to get it. To answer individuals’ questions. And I just have to really share a story and in my experience. On one day, we had many, many people lined up to get the vaccine and there was an elder, she was here with her husband. And I just stopped her and I said “I’m so happy to see you. And tell me, what do you think and why do you think there’s so many young people who are refusing…” For her young didn’t mean children. It just meant young adults, it meant adults, and particularly even healthcare professionals, I asked her who is saying they don’t want to take the vaccine.

LaRay Brown:

And she said to me, “Darling, I’m 90 some years old, and I’ve seen so many people, my neighbors, my friends die because of this. And I know about Tuskegee, I lived through that. But what I do know is this is what we got to stay healthy. And I and my husband, we want to live. So we’re here to get that vaccine.”

Paul D. Vitale:

Yeah. And families are so important during this time, and I know how our staff and how you really, really worked and tried to help the families. And I want to read a letter to you, to the audience, if I have your permission, LaRay.

LaRay Brown:

Sure.

Paul D. Vitale:

From a patient, family member who wrote to you today, which I thought was unbelievable. Because I think that One Brooklyn sometimes can be underrated and People don’t understand the kind of care that we give here. Because it’s not only the needles and the IVs that count, it’s what you’re talking about, the caring. And that’s what nurses and doctors do. This beautiful person wrote a letter to you today. And it says “This is a letter of commendation, to acknowledge my gratefulness to the medical team at Interfaith regarding the compassion and caring, shown to my family member, Barbara, while she received emergency and inpatient care at your hospital.”

Paul D. Vitale:

“During the months of January in February, Barbara was admitted to the ICU Four West nursing unit, respectively. While I don’t have the name of every practitioner who cares for her, I would like to express my gratitude.” And she names the number of doctors and many staff that she didn’t know, “For taking the initiative in contacting me to make me aware of Barbara’s medical condition and responding to my telephone calls. All staff, including nursing, treated Barbara and me with respect and dignity, exhibiting kindness, and patience. Even Barbara was at her worse. Although Barbara passed away while in care as a result of her stage four malignant lung cancer, I am truly confident in medical treatment she received at Interfaith, very truly yours.”

Paul D. Vitale:

When I read a letter like that, LaRay, I look at you because it all starts from the top. And I’ve heard you talk today. We’re not talking business, because you know what, a lot of times, these podcasts are all about, “Well, financially, we did this and the PPE and the supply chain,” and I had all those questions, and then I decided to ditch them all. Because that’s not what this is all about. This disease, being a deadly disease, was about caring, not only for the patient, but for the family members, which you did. And I know you’ve had a lot of interactions, and I’m sure you’ve had some tender moments. Can you talk about any of them?

LaRay Brown:

Well, I’ll give you another example of that. I am moved by every note, card, letter I get and I try to share as many of them as possible with the entire staff. Because as you said, Paul, it really reminds people of how important that people to people interaction. The technical skills, the medicine, the needles, the radiology, all those things are, of course, important. But for some people, they walk away with how they felt, and about how people treated them.

LaRay Brown:

So a few other moments. We had staff last year, who were personally affected by COVID, some folks got sick. And I actually had not seen one of our colleagues for a while and one evening, and she was standing near the front desk, and I said, “Oh, I’m so glad to see you.” And she says, “Oh, Ms. Brown. I’ve been out sick, I had COVID.” And I said, “Well, how are you doing?” She goes, “I had to come back to work. I’m clear, I’m fine. But I’m still having some of those symptoms they talked about. But I’m all fine. And I had to come back to work because I know how hard this was for my colleagues, my not being here.”

LaRay Brown:

So just that’s one example really, of the committed staff. Another member of our team, her sister passed away with COVID. And it was interesting because she and her sister had COVID at the same time. She was admitted to Interfaith and her sister was at one of our other hospitals here in Brooklyn, not part of One Brooklyn. And when she got discharged and she was home for a while but when she came back, she shared that she and her sister were very close, the loss of her sister.

LaRay Brown:

We had several other of our staff not just here to Interfaith but at Brookdale and Kingsbrook who lost colleagues and family. And so for each of the campuses, we had a memorial service. And you have to socially distance, but even the mourning process was so different. For families, but we had to acknowledge and show how much we cared about our staff. And understood that they had losses. And yet they were coming in every day.

LaRay Brown:

Even as they had sick family members or have lost a family member, they were still coming in to serve our patients. And so actually at Interfaith we were outside the Herkimer Street area, and we had folks who wanted to share who they lost. Just giving people a minute to say, “I lost my father, I lost my cousin.” And really, all of us just acknowledge how important it is for us to wrap our arms around folks, not literally because of the social distancing. But to be able to, just by virtue of being together, wrap our arms around people, who at the same time that they were really working hard and long hours, were also experiencing their own personal loss.

LaRay Brown:

Let me just say one more thing that we did, as for most of the year, all hospitals, nursing homes were not allowed for patients to have visitors. You know that Paul. And so when at some point, the Hospital Association, the state said, “Well, we’d like to have hospitals who would like to volunteer to test reopening up visitation?” Well, we were the first to raise our hands, because we knew how important it is for the patients, and the families and our staff, to know that a person who’s really very sick, has the opportunity to interact with their family.

LaRay Brown:

And although we had gotten iPads and gave folks, charges for their phone, to have the sort of telephonic and iPad connections, there is nothing like that family touch, seeing the faces of your family. And so we actually were one of the pilots. And could we open up visitation, of course, we had to make sure that people’s temperatures were taken, they have to have PPE, the visitor, we had a whole list of things they needed to do. But not one person, not one person complained of the need to wear the PPE, the gowns, the mass, the gloves, and the limits in terms of the time of the visits. Most family members came and thanked the staff to be allowed to come to visit their family or their friends. And again, something to touch your heart because again, we have to realize that part of the healing process is the humanity of it.

Paul D. Vitale:

Oh, I mean, that’s just so beautiful the humanity of it. I think this will, LaRay. But I ran a hospital that was a community hospital that became a public hospital in the Boston area. And I’m a cancer survivor. And I had to have surgery. And people said, “Well, you’re going to go to Mass General.” And I said, “No, I’m going to have it right here.” And they said, “Well, this is a smaller hospital. And it’s not that well known.” And I said, “I’m not worried about the technical skills. I’m worried about what’s going to happen to me. When I get in that bed after surgery. Do I have nurses that care about me? Do I have aids that care about me.”

Paul D. Vitale:

And when I see the caring at One Brooklyn, and I’ll give you one example of something I’ve observed. LaRay said there are long lines out there. She’s put, I would say, one of the nicest people on that line, that’s a staff member. I don’t want to mention her name because she’s one of my favorite people. And that person is on that line, talking to people, making them feel comfortable. These are people that are standing on their feet waiting on line, making them smile.

Paul D. Vitale:

And I passed her and I’ll just call her Miss H for now. And I said “Miss H, I can’t tell you what you’re doing for people. What you are doing for people here is making people who are afraid, happy. You’re turning fear into happiness.” And she just smiled at me because she doesn’t need to be the big kahuna. She just needs to help people. That’s what she does. And I’m just so proud of the organization. I wanted to talk to you a little bit about there was an article today in Cranes about the future of hospitals and where they’re going and what’s going to happen. After all of this, LaRay, where do you think healthcare and hospitals are going to go? How do you think it’s going to look? Is it going to look the same? Is it going to look different? How are we going to deal with the leftovers? And where’s our journey going?

LaRay Brown:

Well, even before this pandemic, hospitals and their role in the ecosystem of healthcare was changing. With all of the advances in healthcare, and all of the ways in which certain conditions can be treated outside of hospitals, outside of an inpatient bed, on an outpatient basis, with certain drugs the role of the hospital as a center of the universe was changing anyway. With COVID, it became very clear that many, many people were not wanting to come into hospitals, including into emergency rooms.

LaRay Brown:

And so I think we need to get it. Because I don’t know that it’s ever going to be the same. If you need to be admitted to a hospital, you need to be admitted to a hospital. But we need to be able to expand our capability of providing telemedicine and telepsychiatry so that individuals can still get the care they need and still have the interaction with the trained medical and psychiatric and other professional providers, but not have to come into a hospital. We need to be expanding our ambulatory care footprint. The marketplace shows that people want to go to centers. But expanding primary care, because the objective is really to keep people healthy and out of hospital, and only for folks to get go to a hospital when everything else has been tried.

LaRay Brown:

So I think that the footprint of hospitals will become increasingly smaller. That said, I think the communities, we need to have a hospital in a community. But again, it is part of an ecosystem. It should be part of a whole spectrum of services, including the community based off campus, outpatient services, including partnerships with community physician practices. Including working with, in the case of maternal health, working with doulas and other extenders to support women in their pre-pregnancy, prenatal and postnatal status.

LaRay Brown:

So, again, I think that what the pandemic has shown is the importance of having beds when people need critical care, but also the necessity to look to other ways of responding to the health needs of communities, and making sure that we also assure that there’s access to a full range of health care services for everyone in all communities. So I think also the healthcare delivery system in general, we had a rude awakening. I think a lot more evidence as to those who have and those who have not, and how the folks who depend on them have nots hospitals, like One Brooklyn, and the more well off hospitals and outcomes related to this pandemic. And so we’ll really have to be looking at resources, healthcare resources, not hospital resources, per se, but investments in healthcare in the communities that were most adversely impacted by COVID-19.

Paul D. Vitale:

So, LaRay, as we come to a close, I remember my son’s first grade teacher telling me something about my son who was having not great marks on his math tests. And I’m like “One and one is two in first grade.” And she looked at me, and she said, “Mr. Vitale, I’m going to teach you a lesson.” And I thought, “Okay, my son’s first grade teacher is going to be a lesson.” And she said, “Mistakes are opportunities to learn. So your son is learning.” And I know you’ve learned a lot. What would you have done differently?

LaRay Brown:

Well, I believe that we underestimated the competition that would exist in terms of staff. So very specifically, all hospitals in New York were mandated to increase our capacity, or to create what was called surge capacity, and literally, to nearly double our bed capacity. And of course, hospitals, like One Brooklyn’s hospitals, don’t have staff waiting in the wings, just in case we need to expand our bed capacity.

LaRay Brown:

And so we needed to rely on agencies, temporary nursing staff. And we didn’t act, I believe, as quickly enough to make sure that at least we were stemming the outflow of our own staff. Many of our staff, particularly nursing, work at multiple hospitals. They’ll work three days at the Interfaith and another three days at New York Crespi. And we realize that some of the hospitals were providing bonus pay or crisis pay. And so folks were like, “Well you know what, we’re going to use vacation time or leave time, not work those three days in Interfaith, we’re going to work six days at New York Crespi.”

LaRay Brown:

So we had to pivot really quickly, in spite of the fact that it was an expense that we really didn’t have the resources to provide for. But we had to create what we called recognition pay. And that also helped us to keep our staff working in our facilities. The other thing, and it’s related to staff, is that really quickly these agencies that provide nursing and respiratory therapists, et cetera, they doubled their prices. Because demand creates a market. And so we had to engage with those agencies, negotiate pricing. And we literally had nurses from Oklahoma and Iowa, and all parts of the country, coming to Brooklyn, and ultimately, we got a cadence. But I would say we started a little late in recognizing that there was going to be this steep, steep competition for the workforce.

Paul D. Vitale:

Yeah. Well, we learn by our things that we look back at.

LaRay Brown:

That’s right.

Paul D. Vitale:

And we have that opportunity. So I want to thank you. I’m trying to think of how to close this because of course, the first thing I want to say is to all of the people that are listening, the caregivers, the housekeepers, the nurses, to everyone that works in healthcare, I know LaRay by your letter yesterday that you feel as we all do, the only words to say are the two that we’ve said a million times is thank you, and we care about you. And we will continue to care about you as we go along.

Paul D. Vitale:

To you, LaRay, I guess this may be inappropriate to say, but I’m going to give you a virtual hug because, in today’s environment, but I’m just touched by your, by your words, and by your work ethic and your leadership. So today, we want to urge all of you to think about One Brooklyn Health to think about what they do, and how they educate and take care of people. And we also want you to think about helping support us because we deal with some of the sickest and poorest people in our community.

Paul D. Vitale:

I will be moving around the block from the hospital and you’re going to be my caregiver. I’m going to be going to one of the doctors at your hospital, and being taken care of there. And I’m putting myself, my care in your hospital’s hands, our hospital’s hands. Because it’s all of ours together. And so I guess I want to save you to you LaRay, take care of yourself. You know that and we want to tell that to everybody.

Paul D. Vitale:

And thank you for taking care of all of the folks there. It’s a privilege and an honor to know you, to work with you. And to just think about all the wonderful things that you have done. So thank you for being here with me today. I know all of you. Can you give us a website that if people are interested in finding out about One Brooklyn that they can come on and-

LaRay Brown:

Sure you can visit us online at oneBrooklyn health.O-R-G. OneBrooklynhealth.O-R-G. Find out more about our new health care system and find out how you can contribute to our system, so that we can make more investments in the health of our communities.

Paul D. Vitale:

Thank you, LaRay and have a wonderful evening. Bye bye, everyone.

LaRay Brown:

Bye.

Sponsor:

Thanks for listening to this episode of Leadership, Transformation and the Healthcare CEO with Paul D. Vitale. We hope you enjoyed it. Special thanks to One Brooklyn Health for supporting the show. And we hope you will too, by giving us a positive rating on Apple podcasts, Spotify, or wherever you listen to podcasts.

Sponsor:

If you want to learn more about the topic we discussed today, visit PDVhealth.com where you’ll find the show notes. The PDV Health Consulting executive team is proudly joined by world renowned psychiatrist Dr. Francine Cournos, along with top industry leading experts, Susan Flick, Joan Marin, Dr. Frank Kwakye-Berko, Dr. Allen Abrams, Sam Heller, Andrew Anello, Dr. Lisa DeRocher, and special projects manager Afua Kwakye-Berko.

PDV Talks With: Dr. Mitchell Katz, President and CEO, NYC Health + Hospitals

PDV Health Podcast Show Notes

Sponsor:

Welcome to Leadership, Transformation and the Healthcare CEO with Paul D. Vitale, a brand new podcast from PDV Health Consulting sponsored by One Brooklyn Health. With a special introduction in every show by LaRay Brown, CEO of One Brooklyn Health. We talk to New York’s top healthcare CEOs as they share their stories on how they managed to drive their organizations through tough times, and also hear about the transformations they’ve experienced firsthand. Here’s your host, Paul Vitale.

Paul D. Vitale:

Hello. I’m Paul Vitale, President and CEO of PDV Health Consulting. Welcome to Leadership, Transformation, and the Healthcare CEO. As a leader in healthcare policy and operation, my career has encompassed acute, long-term, and outpatient care. I’ve had firsthand experience with home care, business development strategies, and mergers and acquisitions. In this podcast series, I’ll be talking with some of the most extraordinary leaders in healthcare today. And the best part is I get to share their insight and thoughts with you.

LaRay Brown:

Today. You will be hearing from Dr. Mitchell Katz. Mitch is the President and CEO of Health + Hospitals, or H + H. H + H is our public healthcare system.,And H + H has played a major role in New York City’s response to the COVID-19 pandemic. I know a lot about H + H because I had the privilege of working for H + H for nearly 30 years. And so now I’ll turn the program over to Paul and my friend, Mitch.

Paul D. Vitale:

Okay. Welcome back. And we’re here today with our guest, Dr. Mitch Katz, who is the CEO of the Health + Hospitals Corporation in New York, a good friend, a good colleague, a well respected hospital executive. Welcome, Mitch. I’m glad to have you here.

Mitchell Katz:

Thank you. Thanks for inviting me.

Paul D. Vitale:

You’re welcome. You know, one of the first questions I’ve been asking the CEOs is how did you get to where you were because many of our listeners want to hear a little bit about your background. So if you can give us an overview of how you got to be a CEO of the largest hospital, public hospital system in the United States, I’m sure people would love to hear a little bit about it.

Mitchell Katz:

Well, thanks, Paul. If you woke me up out of a deep sleep and said, Mitch, what are you? I would say, I’m a primary care doctor. That’s how I identify, and I try very hard to run Health + Hospitals like a primary care doctor, meaning that I’m focused on what patients need. And they need many things, especially when they are low income, when they are uninsured, when they don’t speak the dominant language, when they’re dealing with family challenges, and they don’t have transportation to get to their appointments. And I want to create systems that take care of them in the best way possible.

Mitchell Katz:

I got involved as a public hospital doctor who wanted to make things better for my patients. I didn’t want to be someone who constantly whined and said, things were not good. I wanted to be someone who made care better. At the time that I began my career, it was the late eighties. I was an HIV AIDS physician in San Francisco, and I got very much involved in the services provided through the Ryan White Care Act, which were services beyond medical services. So we were providing housing, food, translation, childcare services, mental health and substance abuse services, because there was the recognition that without those services, medical care would not be useful to our patients.

Mitchell Katz:

And so that was my training ground for seeing that it’s not just about writing the prescription or giving the patient the appointment, it’s about getting them to the appointment. It’s about figuring out how they would have enough social support to take their medicines. It’s about making sure there is an interpreter so that the doctor understands what’s actually wrong with the person. And so I worked in San Francisco, ultimately running that two hospital system for 13 years. I then went to Los Angeles County and ran their four hospital system for seven years. And I left Los Angeles only because I always wanted to be a public hospital doctor. And this amazing opening came in New York City that enabled me to continue my career as a public hospital doctor. And at the same time, take care of my elderly parents who are long-time New York City residents are now 98 and almost 94.

Paul D. Vitale:

Thank you, Mitch. That was really something. I’m just thinking in my mind about the first time we met. I was so anxious to meet with you and find out about possibly even me working at Health + Hospitals, because my values are really to work with that kind of a population. I always have, and I always will continue to. That’s what I like to do the best. And so I met with you and I will never forget that day because it seems like I connected with you and I didn’t expect the caring that I heard from you, because I didn’t really know much about you. And it was pretty unbelievable to hear a doctor that wants to work with this population that has so many social disparities.

Paul D. Vitale:

And then we had our first dinner. Now my next question is going to be, we were out to dinner together and we were chatting about the world and all the problems in healthcare. And you said to me, I’m sorry, I have to leave right now. The car is coming. I said, Oh, you have an appointment. And you said, yes, I have to go meet a homeless man in a subway station. And I said, Oh my gosh. So could you tell me that story? Because I thought that was just a phenomenal story. Now let’s take a break to hear from our sponsor, One Brooklyn Health.

Sponsor:

PDV Health Consulting’s podcast, Leadership, Transformation, and the Healthcare CEO with Paul D. Vitale is made possible thanks to our sponsor, One Brooklyn Health. One Brooklyn Health is dedicated to providing high quality, comprehensive health care to the communities they serve through a network of acute hospitals, community-based practices, long-term care facilities, and partnerships with local healthcare providers. One Brooklyn Health’s patient centered approach extends beyond medical care to enhance the health and wellness of their communities and their patients and families. Visit them online at OneBrooklynHealth.org today.

Paul D. Vitale:

Could you tell me that story? Because I thought that was just a phenomenal story. Do you remember it?

Mitchell Katz:

Oh yes. Absolutely. Well, some of my best work in New York City, I think, was done in subway stations. So I’m very concerned about homeless, mentally ill people. If you look at the natural history of homeless people with mental illness living in the street, they have a mortality that I think would rival pancreatic cancer, although people don’t think of it that way. But if you look for those people six months later, a frightening proportion of them have passed. And so the work that I was doing at the time in the subway system was finding people who needed to be cared for, who were not getting the care that they needed and bringing them to the hospital. And that’s a scope of work that the city has continued. And I think it’s very important to reach out to those who are troubled and may not be able themselves to access care, may not realize that they need care. I feel we have a special responsibility to the mentally ill.

Paul D. Vitale:

Yeah. And you as a leader are just having your own employees understand what’s the most important thing, because if people’s lives aren’t in an order, how can their healthcare be in order? And that’s terrific. You know, we, to have just come through a very tough year, 2020, and we look back. And one of the things that I’d like to do with you today is to look back on some of the moments of 2020 that not only have you done a good job medically, but that have moved you in some way. And maybe it might even be a personal thing. Maybe it might be about your mom and dad or a patient or a family, but if you could just let us know how you, as the CEO, who probably have been under tremendous amount of pressure this last year, just thought about if you could think about some of the most moving and touching moments that you had.

Mitchell Katz:

Well, Paul, it was an incredible harrowing year. I still think that we’re still in the same year. I’m not going to say 2020 is over until the pandemic is behind us. To me, it’s like a dog year, it’s seven years because of all that has transpired. What happened to New York City last year at this time, it was something that none of us had ever seen before, nothing any of us had lived through, even through the AIDS epidemic, which was so difficult, and I lost so many friends and work colleagues. But it didn’t have the amazing pace, the speed, the devastation that COVID had. I mean, to give you some sense of what Health + Hospital did, on March 1, we had zero patients with COVID who were intubated. Six weeks later, on April 13th, we had 960 patients with COVID who were intubated.

Mitchell Katz:

We tripled the size of our ICU. And if you asked me, and Paul, you’re an incredibly capable and experienced hospital administrator. If you and I were sitting down two years ago and said, Hey, Paul, I want to triple the size of my ICUs, how long do you think that would take me to do?

Paul D. Vitale:

A long time.

Mitchell Katz:

You might have said, you know, well, okay. You need some planning, work you’ll have to figure out the space and variety of approvals. Maybe you could get that done in two or three years. Well, we got it done in six weeks. Every night at usually around 11, I was on the phone with my hospital CEOs plotting. Okay. So what unit are you opening tomorrow? How are we moving around patients so that we’re going to be able to accommodate them? I was moving ventilators with my supply team to be sure that there was always a ventilator and there always was, but it was harrowing.

Mitchell Katz:

There were times when it was very close, when we just got the ventilators to the hospitals because the hospitals were not evenly hit. And even during the period of time, it changed. So for example, there were very few COVID patients in South Brooklyn at Coney Island Hospital at the beginning, but then there were a lot towards the end of the first wave. So I was constantly moving equipment so that nobody would run out and always worried what if we do run out? What if we run out of N95 masks? What if we run out of ventilators? What if we run out of dialysis machines? And that sense that people’s lives were at stake, the patients that we care for, and also the lives of my own staff were at stake. People were working under incredible, incredible conditions of stress, under multiple masks, under multiple gowns, and also just watching the devastation to our patients.

Mitchell Katz:

As doctors, nurses, we accept, we know that sometimes medical care will not succeed. And in fact, death is part of life. It’s part of the life cycle. I think that most healthcare people can accept this, but we’re talking about multiple people dying on one night, people coming into the hospital who were in their thirties and forties coming half dead, as they entered through the hospital, needing to be ventilated, needing multiple medications to maintain their pressure. Nobody had ever seen this at this speed. Right? You could imagine one patient, two patients, but we were running into scenarios where 10, 15 patients would be intubated just in a few hours in an emergency room. We had never seen anything like that.

Paul D. Vitale:

Unbelievable. And you know, Mitch, you’ve talked about your staff and for a moment, I want to look back and talk about how you as a leader, had to deal with your staff. And what kind of approach did you take with people who were stressed and frustrated? I remember when I was walking with LaRay Brown, the CEO of One Brooklyn, we met a doctor in the hallway and the doctor was right in the middle of the whole pandemic, really was very upset about a small little issue. And after we left LaRay, I think, said to me, or I said it to her, this isn’t about the issue. This is about the stress that he’s under. How did you as a leader deal with the stress that the employees were going through?

Mitchell Katz:

Well, there’s both the direct concrete things. And then there are the deeper spiritual wounds. So on the direct concrete things, we had to provide food. All of the restaurants around our hospitals were closed because of the pandemic besides people couldn’t leave because they were working such long shifts, so we provided food for people. We needed to provide clothing and washing machines because people were afraid to go home in the same clothes that they had worked in for fear that they would infect their families. We provided hotel rooms because people were not wanting to even live with their families for fear that they would infect them. We had to provide transportation because the subways were not running at the same frequency and or people felt that it was too dangerous at that time to be able to take them, so we provided transportation for people.

Mitchell Katz:

So we worked hard to deal with the objective things. The deeper wounds, of course, were spiritual. They were from loss, you know, losing so many patients. They were from the sense of responsibility. I haven’t done enough for my patients because, of course, given the numbers of seriously ill patients, none of us could do enough for our patients. There were too many of them. It was much more about having to triage and figure out what were the most important things to do for each patient in order to keep them alive. We did provide rooms for patients, [inaudible 00:17:22] rooms for staff to meditate, to be able to find a safe place. We provided counselors to help them. On the administrative side, where I think it was equally important I always tell people, the people who report to me do what’s right. It’s in a pandemic that can be very important to advice because many of the things that we had to do didn’t fit with the rules. Right?

Mitchell Katz:

For example, there are rules on how many people should be in an emergency room. Right? There were rules about, you know, how far apart people should be in order to maintain confidentiality and privacy. Right? Things that we had no chance about being able to maintain. You know, rules about, you know, the approvals of space and where we’re patients can be and not be. And what I would tell people, of course, is try to follow the rules, but above else do what’s right. And if something goes wrong and you’ve done what’s right, then, you know, tell them that Mitch said to do it and I will take whatever blame comes from that. But what I didn’t want was people to, in addition to all the other things that they had to deal with, feel that they were responsible if we were not following the usual regulations about how to care for people.

Paul D. Vitale:

Yeah. That’s so true. That’s so true. You know, I always tell my clients, you know, you need to TOYF in some situations. And they say to me, what does TOYF mean? I never heard that word. And I say, it means, think on your feet, because there are certain situations. And that’s what I would tell my students too when I did teaching, that you just don’t know what’s going to happen, how quickly it’s going to happen, especially running a hospital, and how fast you have to react. So you do have to think on your feet, but the beautiful thing about what you just said, Mitch, was that they weren’t going to get in trouble, that you were going to take responsibility for it, and that was an act of trust.

Paul D. Vitale:

And you know and I know that, and all my clients know, high trust, high performance, high trust, high performance, low trust, low performance. By you saying that to them, their trust was high in you, and so that’s a bravo, but more than that, Mitch, how did you deal with this yourself emotionally? I’m sure you were right in the front lines. I mean, I could see you actually with a gown and mask on taking care of patients. How did you deal with it?

Mitchell Katz:

It certainly was a difficult time. And I mean, I think the biggest burdens that I felt were, you know, making the right decisions in times, as you were talking, Paul, in great uncertainty. I’ll tell you one sort of funny, sad moment. In order to deal with the uneven number of patients who came to our different hospitals, we had to transfer patients because especially the hospitals in Queens were hit very hard and there was only so much we could stretch. And at a certain point we needed to move the patients. So we did that. One week we had two articles in prominent New York City publications. In one article, we were criticized for the fact that we did not move patients quickly enough. And that because of that, hospitals became overwhelmed and patients did not do well. In the other article, they said that we moved too many patients because the patients, and this is absolutely true, were so sick. Right?

Mitchell Katz:

They were in respiratory distress and therefore many of them were not stable enough for transfer. And I felt, in some way, that perfectly captured the problem. Right? In some way, both articles were correct, but here I am with my staff trying to make the right decisions. Right? Trying to decide, aware of the risks, if I don’t transfer patients, aware of the risks, if I do transfer patients. Knowing both of those things, how do you make the best possible decision? And I feel like there were many moments throughout the crisis where the greatest stress was having to make a decision that you knew was high impact without having the information you would want, or even the time to think carefully about it. We made many decisions. I think at the end, most of them were right. Some of them were not right. And I will always carry that with me, just like every doctor or nurse carries with them the times that they didn’t make the right decision on behalf of the patient, and it’s a very painful and stressful thing.

Paul D. Vitale:

I can imagine. But my son’s first grade teacher always would tell me, because I’d always be called into school, about how it can help my son a little bit more in his learning experience. And I would get a little bit angry with him because he wasn’t really putting his all into it as a first grader. And the teacher really put me straight one day and she said to me, Mr. Vitale, let me tell you something, mistakes are one thing, an opportunity to learn. And so the one thing that you have behind some of those mistakes, whenever you’re feeling them are, maybe they were opportunities for you to learn something new that maybe the next time we would do differently. Can you just talk about one of those?

Mitchell Katz:

Yeah. Well, just a comment, and then we can talk more about the examples. I think, Paul, that part of the trauma that many of us fail from that first wave is that, yes, we learn from our experiences, but patients were harmed, and that’s hard to live with. And I think that’s what many of my doctors and nurses feel. Right? When you, as a doctor or a nurse or any kind of health professional, what you want to feel is that you gave the patient their best shot. Right? There are horrible illnesses, Alex Trebek and pancreatic cancer. Right?

Mitchell Katz:

The proof that even if you are able to access the best possible care, even if you have a great attitude, you still might die of late stage four pancreatic cancer in about nine months. It’s just a very horrible cancer. What you want to feel is that you’ve given people your best. The problem with how many of us came out of the pandemic is that wasn’t an option. We were past plan A. We were past plan B. We were how do we keep as many people alive as possible? How do we give everybody the best shot at it? It wasn’t the usual, what is every possible thing that I can do? And I think that’s the burden that people carry with them from those early times.

Paul D. Vitale:

Thank you for sharing from, what I call your heart, not your brain, Mitch, because that’s the best way to share. Let’s move on a little bit to what’s going on right now. We know we have Johnson & Johnson and Moderna and we have Pfizer and we have vaccines. How’s it going with the vaccines with H + H and where do you see the stumbling blocks, if there are any?

Mitchell Katz:

Well, let’s start, you know, with success. You know, the biggest success of the vaccines is their ability to prevent serious illness and death. And the best place to see that benefit is with nursing home patients. So in wave one, 45% of the deaths were attributed to nursing homes, either patients or staff. Deaths and serious illnesses are down now among nursing home patients by more than 80% because of the successful vaccination efforts. So I feel very confident that the vaccines prevent the serious implications of COVID, whether people will still continue to get sick may be something of our future depending upon how successful we are at vaccinating the entire population, depending on variants, and how sensitive the variants are to the vaccine. But I feel very optimistic that we have the right interventions for preventing serious hospitalizations and deaths and that our world can return to normal even if we recognize that there will still be a certain number of infections, still a certain number of cases.

Mitchell Katz:

At this point, our hospitals are quite full. Unlike the first wave, when other patients who didn’t have COVID were afraid to come to the hospital, we’ve been able to still take care of other patients in a safe way. And because patients know that, they’re continuing to come, so our hospitals are quite filled now even though in the second wave we don’t have nearly the high number of patients that we had in the first wave. Unlike the first wave, we still have large numbers of non-COVID patients. I look in the next few months, vaccine efforts are going well. We’re providing vaccines at all our hospitals, at our federally qualified health centers. New York City has a large number of other vaccination sites. Every day, more and more people are vaccinated which will over time change the dynamics and will result in us having a fewer patients ill.

Paul D. Vitale:

Mitch, there are a lot of people out there that I’ve spoken to, I would say it’s getting a little better now, that say I’m not taking the vaccine. What would you say to them?

Mitchell Katz:

Well, first, anytime, and you know this, Paul, from your spiritual work, anytime you want to help people to change their minds, you have to start where they are. Right? You cannot say, what do you mean you don’t want to take the vaccine? Haven’t you read the science? Right? Let me tell you what science says. You have to understand what it is. The first question that I ask my own patients who said they don’t want to take the vaccine is I say, well, tell me, is there anything that would make you more or less likely to take the vaccine? Right? Let me understand more about you. Right? Let me not first try to lecture you and what you learn when you have open nonjudgmental conversations is there’s a lot of concern about the speed at which the vaccines were developed. Right?

Mitchell Katz:

And even the naming, right, that the vaccines were developed under warp speed. Well, that kind of sounds like sci-fi like maybe, you know, that’s kind of dangerous. Right? I don’t know that I’d want to travel right now at warp speed. I don’t even think that’s a real thing. So what does this mean? And many people have fears about the previous federal administration that feel that they were hostile to people of color, to immigrants, and then they worry, well, if that administration developed this vaccine at warp speed, maybe it’s designed to hurt me. So I think going to, you know, well, tell me more about it, tell me what your feelings are, as opposed to first trying to change anyone’s feelings. I think that few people I’ve talked to have said no, never. Most people are thinking about it. And I think having others choose to take the vaccine, seeing that they’re okay, I think if we see disease continue to drop from COVID due to vaccines, over time more and more people will want to take it.

Paul D. Vitale:

You know, to all my listeners today, you’re listening to Mitch Katz, the President and Chief Executive Officer of the Health + Hospital system, who happens to be, after listening to him, I think I want to make an appointment for him to be my primary care doctor, because I’d love to get an answer like that if I were a patient. Mitch is the person who has a heart and running the public hospital system is not an easy job. It’s a job where there are a lot of financial challenges, a lot of patient challenges, a lot of medical challenges, and Mitch deals with them with grace and with a heart. And he’s got a very smart brain, as you will know by his background, but he also has a wonderful heart. So, Mitch, if there’s any last piece of advice you can give our listeners about anything that you’ve said today, people who maybe have had COVID, people who are long haulers, people who have lost a loved one, what is it that you’d like to say to them today?

Mitchell Katz:

Humans are social animals. We need company. We need connection. And part of what has made COVID so difficult is it’s put us in a position where we are dealing with a devastating illness without the ability to comfort each other in the ways that humans should, and that this comes at a tremendous harm to us. It’s the reason why overdose rates are up across our country. People are really suffering. And I think recognizing that enables us to be more compassionate and kinder to others. And whenever someone talks to me, whether it’s at work or in my personal life about someone who’s being difficult, my standard response, you know it’s COVID. You got to give people a little extra latitude. Right? You can’t judge them based on pre COVID standards. People are traumatized. You know, this is a moment where we need more compassion and more kindness. We have to give each other a little more room, and hopefully in a few more months, we’ll be able to all be together again. We’ll be able to hug one another. We’ll be able to shake hands. And that that return to human connection will heal us.

Paul D. Vitale:

That’s beautiful. So I want to say thank you to our guest today, Mitch Katz. And for any of you who want the website of H + H, you could look it up. It’s the Health + Hospitals of New York, and that’s Dr. Mitch Katz that you’re hearing today from us. And we’re so, so happy to have you. And we want to say thank you to you, to your leadership, to your staff, to your nurses, to your housekeepers, to everyone who has worked so tirelessly towards this, during this pandemic. So thank you, Mitch, very much. It was a pleasure to have you with us and listen to you, and I wish you well. And I hope to see you soon and give you a hug, but for right now I’ll give you a virtual one. Have a great day. Thank you.

Mitchell Katz:

Thank you, Paul. That was very sweet. I really appreciate you doing it.

Sponsor:

Thanks for listening to this episode of Leadership, Transformation, and the Healthcare CEO with Paul D. Vitale. We hope you enjoyed it. Special thanks to One Brooklyn Health for supporting the show. And we hope you will too by giving us a positive rating on Apple Podcasts, Spotify, or wherever you listen to podcasts. If you want to learn more about the topic we discussed today, visit PDVHealth.com where you’ll find the show notes. The PDV Health Consulting executive team is proudly joined by world renowned psychiatrist, Dr. Francine Cournos, along with top industry leading experts, Susan Flicks, Joan Marin, Dr. Frank Kwakye-Berko, Dr. Alan Abrams, Sam Heller, Andrew Anello, Dr. Lisa D. Roche and Special Projects Manager, Afua Kwakye-Berko.

PDV Talks With: Emma DeVito, President and CEO, VillageCare

PDV Health Podcast Show Notes

Sponsor:

Welcome to leadership, transformation and the healthcare CEO with Paul D. Vitale, a brand new podcast from PDV Health Consulting sponsored by One Brooklyn Health, with a special introduction in every show by LaRay Brown CEO of One Brooklyn Health. We talked to New York’s top healthcare CEOs as they share their stories on how they managed to drive their organizations through tough times. And also hear about the transformations they’ve experienced firsthand. Here’s your host, Paul Vitale.

Paul D. Vitale:

Hello, I’m Paul Vitale, president and CEO of PDV Health Consulting. Welcome to leadership, transformation and the healthcare CEO. As a leader in healthcare policy and operation, my career has encompassed acute long-term and outpatient care. I’ve had firsthand experience with home care, business development strategies and mergers and acquisitions. In this podcast series, I’ll be talking with some of the most extraordinary leaders in healthcare today. And the best part is I get to share their insight and thoughts with you.

LaRay Brown:

Today’s episode will be focused on long-term care. As you may know, One Brooklyn plays a significant role in providing long-term care services. We operate both the Rutland Nursing Home and the Schulman and Schachne Institute for nursing and rehabilitation. Our guest today is Emma DeVito. Emma is the CEO of VillageCare of New York. She will share a bit about her organization and the many challenges and many successes that they have experienced in the provision of long-term care. I’ll now turn the program over to Paul and Emma.

Paul D. Vitale:

Good afternoon, everyone I’d like to again, introduce our guest, Emma Devito, the President and Chief Executive Officer of VillageCare of New York. As I explained to you before, this podcast series is going to include a number of CEOs from the New York area, Mitch Katz, LaRay Brown, Karen Ignagni. We have a group of very smart, experienced people to talk about 2020, a little bit. And today we have a personal friend of mine and a great CEO. That’s handled by an organization called VillageCare of New York. And we’re going to talk about 2020, but before I do Emma, I want to say hello and thank you for joining us.

Emma Devito:

Hi, Paul. It’s so good to see you. I’m sorry we can’t be together in person, but this is as good as it gets.

Paul D. Vitale:

That’s right.

Emma Devito:

And I’m really happy to be here.

Paul D. Vitale:

Thank you.

Emma Devito:

So it’s great to see you.

Paul D. Vitale:

Thank you. So Emma, one of the first questions I’ve asked every CEO so far is because many different kinds of people listening to this is… Tell us a little bit about VillageCare of New York, and then tell us how you became a CEO, because a lot of people would be interested in knowing how to do that because they may want to do it themselves one day, or you may say, well, you may not want to do it. They may want to do it. So go ahead.

Emma Devito:

Sure, sure. Well, as you know, I have a background in finance. I have an MBA in finance, but I was always interested in health policy and really developing new programs and support services in particular for seniors, people with HIV and individuals that are underserved. And this was an opportunity that was offered to me at Village. I was able to participate in the creation of new programs. We develop a network of aid services for individuals with HIV, and then in 2010, I had the opportunity to move into the CEO role and truly it has been an amazing journey. It’s been exciting. It’s been challenging. I’ve learned a lot. And our organization has significantly transformed over the last 12 years. Many, many changes in policy which really required the organization to pivot.

Emma Devito:

We had to move quickly. We had to adapt to the changes and to respond to the needs of the individuals that we were serving. In 2012, we had the opportunity to apply and obtain a license to provide managed long-term care. And that really has been a significant change in our operations. We’re still continuing to serve people. We’re serving many, many more people that we were serving before as a provider. Currently we serve about 20,000 to 24,000 individuals on an annual basis. The opportunity to engage in managed care gave us the opportunity to serve people at home, which is where I think a lot of people would rather get their services, especially as they age in place. We also work with a wide range of providers to ensure that the services are provided and coordinated in an efficient and appropriate manner to our members.

Emma Devito:

We work very closely with the community services and we have been able to offer a number of products. We have Medicaid, MLTC, and managed long-term care, which is focused on the Medicaid population. And then we have two Medicare products. We have the Medicare advantage plus, which is a map product, which is an integrated product that brings both Medicare and Medicaid. And we’re able to coordinate not only personal care transportation, DME, but also hospitalization specialists in primary care. So it’s really a very robust product. And then also a Medicare decent product, which is primarily Medicare. So we really have been able to come together and have an amazing team of professionals who are really committed to providing excellent services to our members. And we very much value the work that we do with our provider partner. And we really try to foster collaboration in any way that we can, because that’s really important to be able to serve the members.

Paul D. Vitale:

That’s great. Now let’s take a break to hear from our sponsor One Brooklyn Health.

Sponsor:

PDV Health Consulting’s podcast, leadership, transformation and the healthcare CEO with Paul D. Vitale is made possible thanks to our sponsor One Brooklyn Health. One Brooklyn Health is dedicated to providing high quality, comprehensive health care to the communities they serve through a network of acute hospitals, community-based practices, long-term care facilities and partnerships with local healthcare providers, One Brooklyn Health’s patient centered approach extends beyond medical care to enhance the health and wellness of their communities and their patients and families. Visit them online at onebrooklynhealth.org today.

Paul D. Vitale:

You mentioned the word that’s in the title of this series and that’s transformation and you had to be nimble. One of the things that’s important to us is to be nimble. How with you running such a large organization, can you be nimble? And can you transform so quickly? And what advice would you give others about quick transformation? Because in this environment, we do need to do things. You’ve kind of reinvented VillageCare in so many ways yet still caring for people, but you’ve reinvented it so that you can sustain longevity. Could you comment on that?

Emma Devito:

Yeah. And I think that sometimes we complicate things more than we need to. I always say, let’s keep it simple. If we understand the direction and obviously the direction of policy is critical. I also think that we have to figure out where the funding is coming from, because without the funds we can’t provide the services. And I think you just kind of figure out what do you do best? How do you align your strengths and get the right people in the right positions to really help you move things forward and keep it simple, just really, really focus on the three things that you need to do. Get those done, go to the next three things. And I know it sounds easy, but it really is not easy. I think it could get a little complicated, but I do think keep it simple, don’t lose the focus of where do you need to get and how do you get there in the best possible way.

Emma Devito:

I think being agile, being able to turn on a dime, you have to take risks. That’s the other part of it. You have to be able to evaluate this is a risk that I can live with? What are the things that potentially could go wrong? And if you can figure that out, I think then you move forward and you have to move swiftly and really get as much information and support. I think the staff support, support of the team, the support of the board, I think those are critical things to really help you move forward and expedite it in an efficient manner.

Paul D. Vitale:

So today we’ve been talking to mostly hospital executives where we want to talk to you about a few things, but one is nursing homes because I know that you’ve been involved in that arena and we’re going behind the scenes a little bit. So some of these questions might be difficult, but I know you’re political enough to answer them the right way, but we know we’ve had a lot of issues with nursing homes in New York State. And we’ve had a lot of controversy. You run nursing homes. Could you tell us what your take on all of the controversy is and how this might’ve happened?

Emma Devito:

I think that as you said, this is a difficult topic and the decisions that were made when they were made, I think were decisions made with the information that was available at that time. I think that the nursing homes, the hospital, the state, we never experienced a pandemic before. I think too, we were not prepared. I think that’s the reality of it. And I would say that this is a great opportunity to really understand the stuff that worked and understand what didn’t work. And hopefully we don’t have to deal with another pandemic, but if there is another pandemic, what do we learn from the situation and how do we do it better? I think some decisions were made that were cleared a couple of months after the decisions made for nursing homes to take on COVID patients, those decisions were changed and I’m pretty sure that they wouldn’t be making those decisions again.

Emma Devito:

So it’s easy to kind of second guess, but at the time, the information that was available was the best information that everybody had. And I think the concern was that the hospitals would quickly become overwhelmed. There would be no capacity for patients. And I think that was the priority. And the decisions really supported that priority. We had a little bit of a different situation at Village. We’re a short-term rehab facility, people don’t stay for prolonged periods of time. We basically have an individual set state 12 days or 10 days or 20 days. So before we started to take COVID patients, we had the opportunity to empty out a floor and really isolate patients. Another thing that I think was a lesson for everyone we’ve really needed and we waited until we had PPE for at least two weeks. And that was very hard for everybody.

Emma Devito:

People did not have access to PPE, and that was a problem. And I think for us, we waited, we were able to access PPE, which by the way, was very difficult to obtain. It was extremely expensive. A mask that typically costs $1.50, $1.75, we were paying almost $10 per mask. So financially it was a significant output of dollars to try to get the equipment and the supplies that we needed. We were lucky. We were able to connect with a company in New Jersey and we were able to get PPE, but I think that it would be really important for everyone to learn from this experience, which we’re still learning from because the pandemic is not over. I think if we take lessons learned, things that we did well, let’s continue to do them and refine them and things that didn’t go so well, let’s learn from that. And I think for me, that would be the best way to move forward.

Paul D. Vitale:

What do you think is the thing you did really well, since we’re talking about well and challenges, successes, what do you think you did really well that made you so successful in this pandemic?

Emma Devito:

I think that there was a lot of pressure and I think what we did well is we came together as a team in particular, the clinical team at the facilities, the medical director. On the plan side, really talking to the providers, the licensed agencies and others, and really trying to identify what we could do for the members on the plan side. And that was to ensure that they had the support that they needed in terms of the personal care workers and some of the workers were not able to, because they either were sick or they were afraid. So we were able to enlist family members or other licensed providers that supported the members. We also, for the members, we started to, on a weekly basis bring, what we call, care packages. And over the year in 2020, we delivered probably an excess of 5,000 care packages to our members. Care packages included PPE included the little envelopes with the emergency to try to boost up the immune system.

Emma Devito:

We had information on their care managers. We provided information on hand washing and mask wearing and all of that stuff. And on a weekly basis, we deliver care packages to our members. Those that had COVID got care packages. And then the clinical team really did a risk assessment for members that were really at risk and they got care packages also. We really tried to maintain contact with our members, either telephonic or through the use of telemedicine. And I think that was extremely helpful. On the facility side, I think we strategize to make sure that we were able to designate a unit that was just for COVID patients. We wanted to make sure we had plenty of PPE on site and we kept replenishing the PPE on a very regular basis. We paid a lot of money for it, but we also maintain those supplies.

Emma Devito:

And then, there were staff that really volunteer to work in the COVID unit. And I think that was also helpful. So I really do think it was a team effort. I think that we really kind of took it slow and were really careful and thoughtful about what we were seeing and just prayed a lot I have to say, because there were a lot of nights that it was kind of concerning. It was really concerning, especially, when people were getting sick so quickly and not only the patients, but also the staff. So I think we just had a really good team effort and it was thoughtful to the extent that we could. I mean, infection control was really very, very high on our list. We provided and I think this was another thing for the facilities and yesterday was our one-year anniversary where on the plan side, we’re all on remote, which still incredible to me that we’ve been working remotely for a year, obviously on the facility side, people had to come on site.

Emma Devito:

So for those individuals, staff members that came to work every day, we provided transportation from March until June. At the end of June, when things started to ease up a lot. We kind of worked with a transportation company and we had locations where people were picked up, they were brought to work and they were taken home. We provided meals so that people didn’t have to go outside or bring meals into the facilities. So the staff was amazing and we tried our very best to really support them and in the best way that we could think of keeping them safe.

Paul D. Vitale:

It sounds like you did a lot of great things. Would you do anything differently?

Emma Devito:

Would I do anything differently? I don’t think so. I think the only different thing is that I didn’t think it was going to be this long. I didn’t think it was going to be a year plus. So I think I would have maybe gotten PPE a lot sooner, maybe kind of mobilized. I mean, I knew it was happening but I really, honest to God, I thought it was going to be a few months. I didn’t think it was going to be as long as it has and continues to be.

Paul D. Vitale:

Yeah. I’ve asked every CEO this question and it’s just three words. How are you? How are you dealing with this?

Emma Devito:

I think, okay. It’s been crazy, I think it’s been crazy for everyone. I must say, the support of the team, it’s been amazing. I don’t know what else to say. I think without the support of the team is part of the board. It’s been tough, but I think it’s been just knowing that there’s people there that are behind you a hundred percent. I think that’s been really, really amazing.

Paul D. Vitale:

And I could see that in your face, listeners who are listening to you, I can see Emma and you can’t. But I see besides a beautiful face, a face that has been through some pain and has been through some stress, and we just want you to take care of yourself because we know that it’s difficult. Because a lot of CEOs don’t take care of themselves. They try to take care of everyone else. And it’s lonely at the top, and we want you to take care of yourself. One of the things that we think listeners want to hear are some stories that you’ve seen in the nursing homes. We know visitors were not allowed until recently, which has been a difficult thing for patients. And we know that there are probably zillions of stories about these window visits and what [inaudible 00:20:54] people and et cetera. And actually, someone just told me about your nursing home, that someone turned a hundred years old. So you’re dealing with people that have families of generations that haven’t seen their relatives. Any stories, any touching things that have moved you during this period?

Emma Devito:

I think that the window visitation has been a godsend for people because it’s been a little tiny window where people have been able to see from the inside to the outside, from the outside to the inside, we’ve had a lot of FaceTime. We have a group of staff, our patient experience person and social workers that really work together to try to get that individual to have that little bit of face time with their family members. We also have a very, very popular and special staff member and it’s a dog and it’s Betty White and Betty White is an amazing team member. I think that she makes visits every day to people in the facility. And it’s such a ray of sunshine that it just brings so much joy to individuals.

Emma Devito:

And she’s also part of those window visits, which I think is also fun for the family members to see. As you said, we’ve had a couple of people that have turned 100 years of age or 100 years young. And I think that what has been amazing is we had a very popular Village individual, a parade just happened. It was a parade outside the window. The politicians participated, the community participated. There were balloons and cupcakes. And it’s just really amazing to see that human spirit, amongst all the pain, just to see that joy and celebration of life. And I think for me, that has been really special.

Paul D. Vitale:

Yeah. It looks like it has been. And I thank you for that. Are you back to regular visiting now?

Emma Devito:

Not yet. Because unfortunately any time that a staff member turns COVID positive, we have to go through the whole process again. So we’re keeping their fingers crossed. We have to be COVID free for 14 days. And that’s been also a very, very difficult time because when we thought we were going to be able to open the doors as you know, we’re testing constantly and we’re testing weekly and people turn positive, they may not have any symptoms, but then we’re not able to open our doors. So that has been a little bit of a challenge. And window visitations continue and a special staff member with our staff has made it very, very special for visitors and patients. Perhaps things will open up a little bit more. I think CMS is being a little less rigid. So we’re hoping. Fingers crossed.

Emma Devito:

The other thing is that at both facilities, we also have outdoor space. And that was something that when the weather was better, we used that. And we were very successful, April’s right around the corner, spring is right around the corner. So I think that once the weather gets a little bit warmer, people will be able to come into the outdoor space. And then we will have a little bit more of an in-person six feet apart mask wearing visitation. But we’re ready for that. We’re ready for that. Everybody’s ready for that.

Paul D. Vitale:

Yes. I’m sure you are. I think that you should write a letter to Betty White telling Betty-

Emma Devito:

About the dog?

Paul D. Vitale:

Yeah. About the dog. And telling Betty White, how much joy her name is given to people. She’s what? 90 something years old?

Emma Devito:

Yeah. Yeah. I mean, in this dog, I tell you has brought so much joy to people and she’s just a wonderful partner and a wonderful team member. She truly is part of that team.

Paul D. Vitale:

That’s really a story. That’s a story. I think that’s got to go on the news. I don’t know. I mean, I think people need to meet Betty White and we should put her on David Muir on ABC News 6:30. That should be the last story as it is all the time. I think that it would be great. Emma, we talk about staff and you have a lot of staff. And what did you do to continue to give them support, to deal with patient care, et cetera? I’m sure that you needed to do some special things for them.

Emma Devito:

Well, as I said, for the people that had to come on site, we did a lot of meals. We did a lot of celebrations. We provided transportation, we did some bonuses. We have this thing called BE Vital. And it’s kind of a way where we recognize people. And this was before COVID. Individuals that are really vital, that really are providing a service of value, not only to the organization, but to the people that we serve to each other and people are nominated and there’s criteria and people vote on it. To me, having your peers nominate you and vote for you is better than your supervisor or your boss because your peers really recognize the value and the support that you bring to the team. So during the pandemic, we did a couple of these BE Vital initiatives to recognize people.

Emma Devito:

We sent awards, we sent gift cards to their homes. We had a virtual celebration a couple of weeks ago for the very first time. And it was a little tricky because as you know, all this virtual stuff, you’ve got to figure it all out, but we hired a company and it was a lot of fun. People participated. You had games that you participated in. We had team games. And then we had individual games and people that won there were surprises and they were awards. And all of that, I think it was just a way to celebrate, to celebrate the team, to celebrate the work that people did. And just to show that this is all really appreciated. And we want to make sure that people know that they’re recognized and they’re valued and they are vital. They’re vital to the work that we do.

Paul D. Vitale:

I’ve asked this to everyone also and would love to hear an answer. And so what do you see the future looking like in healthcare after this pandemic?

Emma Devito:

Well, I think that if something’s going to come out of this and hopefully a lot of good things come out of it, but I think the opportunities to improve the way that healthcare is provided in this country a lot has been said about access to care. We all believe that healthcare is a right, that everybody should have access to healthcare entitled to healthcare. Certainly for me, I think in particular should be a focus on long-term care. I think it’s amazing to see the needs of seniors and think about all of us, people are living longer. People want to stay at home. People want to be able to access care and access services. People don’t necessarily want to go live in an institution if they don’t have to. So I think the opportunities are to improve the services that we offer to certainly make healthcare available to everyone.

Emma Devito:

I think that we need more funding. I think more of these services are needed to support people that want to stay home and want to remain independent for as long as possible. And I think we could learn from things that work one example is telemedicine. I think telemedicine could be used not only in urban areas, but also rural areas where you don’t have the access and distances are far apart. We did a lot with telemedicine. You could have your doctor or the NP or the pharmacist. I mean, you could really access care in ways that are more efficient and are more accessible to people. So I think it’s going to be a combination of technology, funding, more money. Hopefully the Biden administration sees that the needs are there and really make the process a lot more easy for people.

Emma Devito:

I think sometimes it’s difficult. It’s difficult. I mean, look at this whole vaccine situation, we’ve been helping people to get appointments. I mean, you think a 90 year old, you send them a link. I mean, they don’t even know what a link is. I mean, come on. People need to come and meet people where they’re at. So even though the effort is there and I think that the intent is there and it’s good intent. We have to make it available. We have to make it easy for people and accessibility, everybody should have access. Everybody’s entitled to have [inaudible 00:31:08].

Paul D. Vitale:

For those of you who don’t know. My company is a consulting company. And right now I’m working on merging three hospitals together in a very distressed area. And one of the reasons why the state is helping us financially with this by giving us a grant is to ensure just what you said to give good healthcare to everyone. Not just selected people, but to everyone. And we’re really making this work by bringing these three hospitals together. And it’s been a great thing to see because everybody’s on the same page saying what you’re saying, not just one person, but everyone should receive it. And that’s the journey that I’m taking. And I know that’s the journey that you’re taking. We’re talking today with Emma Devito, the president and CEO of VillageCare of New York who has been there for how many years now, Emma?

Emma Devito:

Oh my goodness. I keep losing track. I think it’s got to be about 28.

Paul D. Vitale:

28 years.

Emma Devito:

I think it’s got to be 28. I keep losing track and we’ve really changed to VillageCare because we wanted to keep it simple, Paul.

Paul D. Vitale:

Yeah. VillageCare. I’m sorry. Not in New York. It’s just VillageCare and it’s a privilege. And I’m humbled to talk with you about all the work that you’ve done throughout your career. And could you give people your website in case they want to check it out?

Emma Devito:

Villagecare.org

Paul D. Vitale:

VillageCare.org. She really does keep it simple.

Emma Devito:

Yeah. Keep it simple.

Paul D. Vitale:

Thank you for joining us today and thank you for all the good work that you’re doing. And I want to thank our audience for listening and for our sponsor, One Brooklyn Health System. Thanks very much and have a great day, Emma.

Emma Devito:

Thank you. Bye.

Sponsor:

Thanks for listening to this episode of Leadership, Transformation, and the Healthcare CEO with Paul D. Vitale. We hope you enjoyed it. Special thanks to One Brooklyn Health for supporting the show. And we hope you will too by giving us a positive rating on Apple Podcasts, Spotify, or wherever you listen to podcasts. If you want to learn more about the topic we discussed today, visit PDVHealth.com where you’ll find the show notes. The PDV Health Consulting executive team is proudly joined by world renowned psychiatrist, Dr. Francine Cournos, along with top industry leading experts, Susan Flics, Joan Marren, Dr. Frank Kwakye-Berko, Dr. Alan Abrams, Sam Heller, Andrew Anello, Dr. Lisa DeRoché and Special Projects Manager, Afua Kwakye-Berko.

PDV Talks With: Debbie Pantin, President and CEO, Outreach

PDV Health Podcast Show Notes

Sponsor:

Welcome to Leadership, Transformation and the Healthcare CEO with Paul D. Vitale, a brand new podcast from PDV Health Consulting sponsored by One Brooklyn Health, with a special introduction in every show by LaRay Brown, CEO of One Brooklyn Health. We talked to New York’s top healthcare CEOs as they share their stories on how they managed to drive their organizations through tough times and also hear about the transformations they’ve experienced firsthand. Here’s your host, Paul Vitale.

Paul D. Vitale:

Hello, I’m Paul Vitale, President and CEO of PDV Health Consulting. Welcome to Leadership, Transformation, and the Healthcare CEO.

LaRay Brown:

During today’s episode, you will hear about mental illness and substance use services. Our guest is the CEO of Outreach, Debbie Pantin. Outreach is an interesting organization caring for young people with substance abuse issues and adults who have substance abuse issues as well. This is also a service which One Brooklyn offers, and I cannot wait to hear about Outreach and its experiences last year. Now, I’ll turn the program over to Paul and Debbie.

Paul D. Vitale:

Thank you, LaRay, and welcome everyone to our podcast series on Leadership and Transformation and the CEO. Today, we are here with a great CEO from a very interesting organization that I’d like her to tell you about, her name is Debbie Pantin. Hi, Debbie. Welcome.

Debbie Pantin:

Hi, Paul. Thank you. I’m very happy to be here with you. Again, my name is Debbie Pantin and I’m the President and CEO here at Outreach. Folks might want to know what is Outreach and what does that Outreach do?

Paul D. Vitale:

Yes.

Debbie Pantin:

Well, we are an agency that has been around for over 40 years and we do a lot of work in the behavioral health space, that’s substance abuse and mental health services to adults, kids, and families. We actually started a lot of our work working with kids and doing outreach into the community, hence where our name was born. Since then, we pretty much have four residential sites, actually three up and running, and the fourth one is in the process of being built. We have several outpatient sites and our services run anywhere from out on Long Island, Suffolk and Nassau County, and also in Brooklyn and Queens.

Debbie Pantin:

The interesting thing about Outreach also is not only about the services we provide, it’s also about the workforce and the individuals that work with us and work in the field. We have a training institute where we work in terms of training our staff in this area and also training other folks in the field. A lot of our training is centered on trauma care training and also areas around professional development, and especially around certified substance abuse counselor training as well.

Paul D. Vitale:

Yeah. Let’s talk a little bit about the young younger folks that you have, because I think our audience would be interested in hearing about that-

Debbie Pantin:

Excellent.

Paul D. Vitale:

… before we go into 2020. We know there’s a drug problem in the United States, we know there’s an opioid epidemic, I would call it, in the United States and around the world. As you know, I sat on the world treatment communities of people around the whole world talking about the drug problem. Tell me about what happens and how a youngster would get admitted to one of your residential facilities, where they have to actually leave their home and go someplace else. Can the parents visit them? Especially during 2020, were they able to visit their child?

Debbie Pantin:

Absolutely. So, I’ll start by describing a little bit about how kids get to us. When we say kids, I think we are unique in that way. We’re probably one of five or one of seven programs across the State of New York, and there aren’t many in the country either that have residential services for kids. When we say kids, we’re talking about as young as 12, and as old as 17. We have two residential sites. One in Brooklyn, Queens border and also one out on Long Island. How the kids get to us is through a referral process with the schools or kids who come into behavioral health issues in the school setting.

Debbie Pantin:

So, they refer them in and they turn around also and they come to us through the criminal justice system sadly enough to say. Some of them do come to us through foster care placements and prevention situations where they are having some difficulty. Part of the foster care system will say to the parent, “Try to utilize the services at Outreach for residential services.” When they come to us, the family members are not only allowed to visit with their kids, more importantly, they’re in treatment with their kids.

Debbie Pantin:

So, family services, group therapy services for family groups, and also therapy sessions with their kids are also available. Pretty soon, we’ll get to talk about 2020 and beyond what could be normal.

Paul D. Vitale:

Tell me what happened in 2020. What happened with the visiting in 2020, were the parents allowed to visit their children?

Debbie Pantin:

No, they were not. What we did was telehealth. So, family members, we set up video rooms where family members were allowed to visit their kids via video and by conversation, telephonic, if they didn’t have the video capability. We were also able to continue our family services through that aspect as well. So, we just adjusted and found a way to keep going. But going back to 2020 and COVID, in the height of the COVID, we reached out to the families and we said to them, “Listen, this is the situation. Would you like your youngster to come home or to stay with us?”

Debbie Pantin:

I remember when we had our first, unfortunately, our first case was at our adolescent site and the family members said, “No.” They wanted us to keep the kids with us. They thought they were safer there, and it has worked out for the most part well. But kids are kids and it’s hard for them to keep on a mask and social distance. They didn’t get that. So, it was a constant piece with our staff having to remind them to keep the mask on and social distance and wash their hands.

Paul D. Vitale:

Well, just for the listeners, I’m very involved with Outreach. I’m a board member and I work with a terrific CEO here, Debbie, and I just wanted to ask you about your staff and how they dealt with it with the kids. Because I know there was a lot of pressure in the hospitals and a lot of pressures in nursing homes. Tell us about the substance use community and what the staff had gone through. Because we hear a lot about during COVID , there was a lot of depression with young people, and there were a lot of other issues. So, just maybe a story would tell the whole thing, if you could tell us a story.

Debbie Pantin:

Sure. So, as I mentioned, our first positive case that we had, I’ll never forget, that Friday night I’m laying down and I got this call from our COO that said, “Deb, sad news here. We got our first positive case.” It was really trying to figure out what we were going to do to keep the kids separated, which was hard, and reach out to the families, and what to say to the families not being able to panic. Make sure that they do not panic while we ourselves internally, we’re panicking, because we didn’t know what we needed to do, and just trying to figure all of this out.

Debbie Pantin:

The staff, oh my, wonderful staff, essential workers. I don’t know that a lot of folks realize that the same way that hospital staff were considered essential workers, all of our staff that worked in the substance abuse and the mental health arena were also considered essential workers, meaning that we had to continue to work throughout the pandemic. So, our residential staff could not go home, could not stay home. They had to come in to work and they had to continue to work with kids and with our clients knowing the situation.

Debbie Pantin:

Boy oh boy, did they step up to the plate? They are truly our heroes. They continue to come in knowing that going back home was … what the risks were. I have stories I can tell you where there are staff members who were so concerned about their family members. In order to keep working, they ended up taking a hotel room to not go home to their families. So, the thing for me with our staff, I’m just so proud of them that words cannot even explain how much we depended on them to get through this. Because without them I don’t know that we would have been as far as we are today.

Paul D. Vitale:

Yeah. Yeah. Well, I know many of your staff and they are what I would call heroes, dealing with what you’re dealing with here. I just want to ask you about the adults and how that went. I know we talked a little bit about the youngsters, but how did last year go with the adults in your residential facilities and also in your clinics? Did your clinics have to shut down for a while?

Debbie Pantin:

Yeah. I’ll start with that. Yeah. The clinics were not able to shut down. We kept going. We pivot our services during the height of the pandemic, where we were shut down to a telepractice and a telephonic service. So, we continue to provide assessment, individual, and group work through the telephones and also through video chats. That was very quick and difficult for our staff. But again, they hung in there and a lot of them, we had to quickly get them all laptops or computers, have them be able to access media services through these instruments, teach them how to use it, all of that stuff.

Debbie Pantin:

That had to happen all within a drop of a diamond and within a week. Boy, a boy, again, outpatient staff, they rock, they stood up. They did what they needed to do. Most of all, to service our clients, because our clients were significantly in need of services and did reach out for care. Our adult residential sites, similar to our adolescent residential site, the staff kept working, never missed a beat. They came in to work. We did also offer some of our residential clients, adult clients, to go home. Some of them did.

Debbie Pantin:

We had some very unfortunate stories, of course, folks who went home and unfortunately they did relapse, but they quickly connected with us and we connected with them and got them back into recovery. There were some instances for folks who were able to go home, help take care of family members and come back. Of course, there were some who left and did not come back, but those were very, very few. Paul, ultimately, and I don’t know if it’s important for our listeners to know this, in both our residential and outpatient settings, similar to hospital settings we had to provide these services with a mask, socially distance, and using all of the protocols.

Debbie Pantin:

So, we had to downsize our census because we had to leave rooms available for if folks came down with the virus or anything of the likes of being exposed, they have to be quarantined. So, very similar to how I would say hospitals or a skilled nursing home operated, we operate under those similar guidelines. Again, we had a lot of support from OMH and OASAS in really helping the agencies to pivot to do and accomplish a lot of these things that we needed to do overnight. So, I cannot go without saying that without the support, strong support of the commissioners at OASAS and OASAS and their staff we as a field could not have pulled this off.

Paul D. Vitale:

So, just for our listeners in healthcare, we use a lot of acronyms. So, OMH is the Office of Mental Health. OASAS is the Office of Addiction and Substance Abuse, and these are our New York State regulatory authorities that regulate the organizations and come out and visit them and do audits and audit checks, et cetera. Debbie, can you tell us a story that really moved you during this time or about one of your patients, about a staff member or a day where you yourself just thought, “Wow, I can’t believe we’re going through this.”

Debbie Pantin:

Yeah. I think the day that it really struck me was when there were staff members who, the first staff member who we got a call from, was positive. By all means, take the necessary precautions and stay away and be quarantined. But it was so admirable to see that the staff stayed on the phone and stayed engaged. She was a director and she’s continued to work and stay engaged with the site, making sure that the sites were okay. That day I was very much moved. I can tell you of another day when we had a lot of positivity rates at the sites.

Debbie Pantin:

There, I had my COO who I tell you I cannot stop during this process supporting her, really talking about the way she supported the staff. We continued to visit. She continued to visit all of our sites and touch base with the staff to make sure that they were okay. Another really chill day for me was the day that everything was moved to Zoom and Micro Teams and other platforms. The first day coming out of it, where we were able … It was June of last year as we were unpausing, and we were finally able to set up a Zoom meeting.

Debbie Pantin:

There it was, the Zoom thing came on and I saw all of the faces of the staff, over 200, over a hundred of them on that screen. I think that was the day that I was moved, because it had been almost months we had not seen each other in person, of course, as a group. Also, to see each other on the screen, I think, was also very moving at that time as well.

Paul D. Vitale:

Thank you. That’s a beautiful story.

Debbie Pantin:

So, those would be the times I can think of.

Paul D. Vitale:

Yeah, it gives you the chills a little bit when you said that, just not seeing people for a while and coming back.

Debbie Pantin:

Yes.

Paul D. Vitale:

So, Debbie I’ve asked every CEO this next question. So, you’re going to get it too and it’s just three words.

Debbie Pantin:

Okay.

Paul D. Vitale:

We’re going to ask you right after the break. So, if you can just hold on for a moment, we have a commercial break from our sponsor One Brooklyn Health System.

Sponsor:

PDV Health Consulting’s podcast Leadership, Transformation and the Healthcare CEO with Paul D. Vitale is made possible thanks to our sponsor One Brooklyn Health, One Brooklyn Health is dedicated to providing high quality, comprehensive health care to the communities they serve through a network of acute hospitals, community-based practices, long-term care facilities, and partnerships with local healthcare providers. One Brooklyn Health’s patient-centered approach extends beyond medical care to enhance the health and wellness of their communities and their patients and families. Visit them online at onebrooklynhealth.org today.

Paul D. Vitale:

Okay, welcome back. We’re here with Debbie Pantin, the President and Chief Executive Officer of a great organization called Outreach, for which I actually am a board member of and proud of it and very happy to be affiliated with this organization. They are an organization that deals with behavioral health and substance use, and they started with children and adolescents. I have done a lot of work in the substance use area and done a lot of speaking, actually, around the world regarding the opioid epidemic.

Paul D. Vitale:

One thing that always gets to me is that one person dies of an overdose every six hours in the United States. That’s pretty alarming when you hear that one person dies of an overdose. Before the break I sat down and I said to Debbie, I’ve been asking CEOs the same question and it has three words and they’ve been giving me an answer. Some of the answers had tears. Some of the answers started with a laugh, but I’m going to ask you this question. How are you? How are you? Well, you laughed?

Debbie Pantin:

That is a really good question.

Paul D. Vitale:

I told you some people cry and some people laugh.

Debbie Pantin:

Right. I think that laugh is a laugh of joy and hope because I’m a very hopeful person. I think that I am as good as my staff. I think that is the way I can sum it up. I think there are days that are better than others, but I think our staff is going through a lot in terms of their own personal stuff as well as at the same time adjusting to the new normal and also taking care of our patients. You have said it time and time again, and it’s worth repeating for the public to be aware, we have a serious opioid and fentanyl overdose problem in this country and it has skyrocketed.

Debbie Pantin:

We are recording anywhere around 40% increase in overdose deaths in the first quarter of 2020. The data only indicates it would look higher because the data is always several months shy of where we are. I think the ability for me to figure out how I am doing is very much based on knowing that my staff needs are met. I think the ability for me to communicate and be transparent with my staff, the more I’m able to do that, it makes me feel better. So, today, for example, and this week, is professional administrative day.

Debbie Pantin:

So, to me, watching this, we had a team putting together a rose with a little vase to send out to all of the administrative staff to recognize them. That gave me joy today. The ability to do something for social work month gives me joy. I did need to do something for nursing, anything, any opportunity to recognize the staff and to do something with them, brings joy to me because as much joy and my ability to take care of staff, they can take care of clients. Ultimately, that’s what I’m in this business for, is to take care of clients as much as I’m an administrator. So, how am I doing? I think I’m doing as well as I can do for my staff.

Paul D. Vitale:

That’s a good answer. Well, it wasn’t deep down, but maybe you’re not ready to go there because that’s a good CEO answer. I’m looking for a Debbie Pantin answer, because you know why I’m saying this? Because many CEOs, as I was a CEO, don’t want to admit their vulnerabilities. Don’t want to admit that they are not strong enough to deal with their staff. I coach some people who were CEOs and I work with CEOs all the time and I just finished training a CEO for a new position. He was a new CEO. What I said to him is what I’m going to say to you right now, and that is never be afraid to show your vulnerabilities.

Paul D. Vitale:

Never be afraid to do it in a way that makes people understand that you are human. I know people do understand that about you because you were a beautiful person inside and out. I’ve known you for a long time, but that’s an important trait. So, you don’t have to answer it again.

Debbie Pantin:

Absolutely.

Paul D. Vitale:

But if you think about it and you do want to say something during the rest of the interview, let me know.

Debbie Pantin:

Yeah. I do. I think the deeper part of that answer, I think, has come two ways. I think because I’m a very spiritual person I think for me, the question of how I am doing I think also rests in a lot of my ability to rely on my spiritual health as much as some of the other things that I depend on. But I can tell you that that Zoom meeting I mentioned to you, and you may have seen it on the screen, when I mentioned it I welled up because that was a joy for me to see the staff on the screen.

Debbie Pantin:

I cried that day when I was on the screen with them. So, I share my vulnerabilities. I’ve had days where I’ve said to my COO, this is not a good day for me. I’m having a hard time dealing with this COVID. I had a day, I think about a month ago, when I said to one of my staff, I couldn’t fight anymore. I couldn’t fight that day because I lost someone to an overdose. I lost a family member and I shared that with my staff, and I shared it with my peers in the field who know me. I readily reached out to them and I told them what was happening.

Debbie Pantin:

So, I think that you’re absolutely right. There are days that I can’t do it and I am upfront about that because this battle that we are in and this work that we do is real. It’s very real. I don’t think it’s as real to the public. They may not be aware of how real it is, but it’s a lot, because not only are we providing services, we as administrators and as CEO, we’re also advocating. As a board member, as you being a board member, I know you were one of the first people I reached out to that day when I told you what happened.

Debbie Pantin:

So, I think reaching out also, not only to peers and clients, but communicating with your board members and telling them what you’re going through. So, you and the board chair I reached out too and I shared with him what was going on. So, I think you’re raising a really good point in regard to admitting our vulnerabilities and where we are. Thanks for, I think, the permission to do that.

Paul D. Vitale:

Yeah. Well, those tears that I see, because people can’t see you right now, but I can on the screen, and those are tears of what I would call one of the strongest CEOs that I know. Because for you to put yourself out there gives everyone else the right to talk about their vulnerabilities. To me, in work doing that creates trust. I always say to people that I’m mentoring or talking to, high trust equals high performance. When people trust each other and show their vulnerabilities, it means that they can perform better because they were able to just let it go, and that’s it.

Debbie Pantin:

Let it go. Yeah.

Paul D. Vitale:

Debbie, what do you see for the future of healthcare and of substance use? Where do you see us going in the future?

Debbie Pantin:

Good question. Where do I see us going? I think COVID gives us a new normal that we have to adjust to. I think a very important part of it is really understanding a different way to work with our clients, with the use of telepractice. I see this hybrid of being able to provide in-service, in-person care, as well as the telepractice piece of it. I don’t see that going away. I also think integrated care is a big part of what we see for the future.

Debbie Pantin:

I think also we have to find a way, and I do believe we will, to address the workforce challenges that we have in this field, of which we have significant workforce challenges and really trying to figure out how we incentivize and get folks to work in this field. I think we will figure it out, but the thing is we have to think differently and we have to think, and Paul, you know this. I think you’re one of the first CEOs I heard this from, in that we have to really, in the CBO world, in the community based organization world, we have to really pivot our business, the work that we do more into a business.

Debbie Pantin:

I think COVID has really put us on a trajectory that we have to do that and do it in a different way, because a lot of other ways of doing this work is coming into the space we’re in with Talkspace and other things that we have to think and do things differently. So, that’s what I see for the future for us in this field, but a lot around integrated care between medical and also substance abuse and mental health.

Paul D. Vitale:

I have a little story for you that you might want to think about for the future to help your patients. I just interviewed Emma DeVito on long-term care since she manages some nursing homes. As you know, this series talks about substance use, acute care, or long-term care. There’s eight series where we’re talking to, eight episodes where we’re talking to CEOs. But I said to her, what do you see for the future of your patients? How do you see care being given? I forget how the question was asked and she said, well, what these window visits that we have, we have a dog, and the dog’s name is Betty White.

Paul D. Vitale:

Betty White is a beautiful dog that goes down with his owner, with her owner and visits with the patients in the window. I think that what I hear from that is that we have to think about business, but we also have to think about compassion and how do we bring those two together? How do we, as executives in this field, bring business and compassion together so that they can meld one another. I said to Emma, I said, I think we should put Betty White on channel seven or any of the other channels to meet an audience and show how healthcare can be delivered in many ways to this geriatric population.

Paul D. Vitale:

So, I think we all need to think about where we’re going from a business point of view. But I also think that we need to think about where we’re going from a patient care point of view, because patient care, I always say, it’s not always a bed and needle. It’s not always about an IV. It’s about compassion, and how do we show compassion yet run and try to get money to operate these businesses that are not funded as well as they could be. Any thoughts on that?

Debbie Pantin:

Yes. Absolutely. Yes, I do. I think you’re raising a really good point because I think with our workforce, so much about wellness for our staff, is so important. So, I think I mentioned to you that we have this quarterly virtual summit that we do with all staff where a hundred plus of us are on the screen. We pick a topic and we discuss it and we have a presenter. We just did that last week, last Tuesday, I believe. The focus was on wellness in terms of the ability for them to take care of themselves, recognizing what things may come up and how best to handle it.

Debbie Pantin:

Recognizing that they’re human and they’re going through things as well, and having at the same time to work with patients and how that may come across. The same thing working with colleagues, and how that might come across and ways of taking care of themselves and how to do it better. I agree with you. I think the other thing COVID has taught us is how important it is about care, to care for ourselves and to have, like you said, compassion in the work environment. Let me say this to you, Paul.

Debbie Pantin:

I think that we are going to be really challenged, because some of the things we don’t usually think about with regard to having someone work remotely and having someone be flexible around childcare, do we provide childcare in the workplace? Just some of these things that we just didn’t take into account. Some agencies may have and may have done it, not on a consistent basis. Well, I think moving forward most of us, if not all of us, as leaders, as CEOs, will have to sit down and think about what we are going to provide.

Debbie Pantin:

How are we going to demonstrate, like you said, that compassion for our workforce and ultimately for our patients? Because it’s going to be needed to move forward in this new normal.

Paul D. Vitale:

We’re speaking today with Debbie Pantin, who is the Chief Executive Officer for Outreach, a wonderful program that serves the New York area community and deals with behavioral health issues and substance use. Debbie, this is a question that I haven’t asked anybody because this is a question that I know you can answer best. But a lot of our listeners today may themselves or may have a family member that has addiction problems. What would you say that they should be doing now?

Debbie Pantin:

Love. I think just love them and give them the opportunity to know that the opportunity for them to receive help is always there. It’s never too late once they are willing. I think, yes, it’s very difficult having done it myself. As I mentioned before, having a family member that you know is addicted and trying to reach out to them and then I’m not responding to that help. Know that this is a disease, it’s a sickness, it’s an illness, very similar to any other illness that a person may have. It takes a process to get a person there.

Debbie Pantin:

I think, yes, there are realities that you have to lay down and just be firm, but try to do it in a loving, compassionate way because the situation out there for folks who are addicted today is, I think it’s more lethal than I have ever seen it in my time working in this field, and it is scary. I think for family members who are out there, don’t give up. Find other family members who are going through the same thing. There are resources you can turn to for help.

Paul D. Vitale:

Can you give them your website?

Debbie Pantin:

Yes, you can always go to www.opiny.org for information about Outreach. When you reach out to us, we can always lead you in a direction that you need to go. There are several 1-800 numbers out there, but definitely you can always … or call us. You can call our number (718)-847-9233, and you can always reach someone that can get you help.

Paul D. Vitale:

Well, once again, we talked today with Debbie Pantin, the President and Chief Executive Officer of Outreach. Debbie, we want to thank you very, very much. Today was really a moving podcast. Thank you for sharing your own personal struggles. Thank you for telling us more about substance use and about helping people, which is what you do. So, great to be with you, and I’ll see you at the next board meeting. Okay?

Debbie Pantin:

Absolutely. Thank you, Paul. This was great. Again, it’s always good, as a leader, to sit back and reflect on your thoughts and the work that you do. Thank you for the opportunity.

Paul D. Vitale:

You’re very welcome. Bye-bye. Thank you, ladies and gentlemen.

Debbie Pantin:

Bye-bye.

Paul D. Vitale:

We’ll see you soon.

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PDV Talks With: Dr. Neil Calman, MD, FAAFP, President and CEO, The Institute for Family Health

PDV Health Podcast Show Notes

Sponsor:

Welcome to Leadership, Transformation and the Healthcare CEO with Paul D. Vitale, a brand new podcast from PDV Health Consulting sponsored by One Brooklyn Health, with a special introduction in every show by LaRay Brown, CEO of One Brooklyn Health. We talk to New York’s top healthcare CEOs as they share their stories on how they managed to drive their organizations through tough times, and also hear about the transformations they’ve experienced firsthand. Here’s your host, Paul Vitale.

Paul D. Vitale:

I’m Paul Vitale, President and CEO of PDV Health Consulting. Welcome to Leadership, Transformation and the Healthcare CEO.

LaRay Brown:

During this episode, you will be hearing from Neil Calman. Neil is the CEO of The Institute for Family Health. Many of you may be aware that One Brooklyn Health is forming partnerships with community providers. Hospital systems need to go outside of their walls and work closely with family qualified health centers and other community-based organizations. Dr. Calman has grown the Institute and will talk to you today about working in the ambulatory care sector, and he will share some of their successes and challenges. And now I’ll turn the program over to Paul and Neil.

Paul D. Vitale:

Thank you, LaRay. And we’re here today with another very special guest. Thanks all for listening, Dr. Neil Calman from the Institute of Family Health. Dr. Calman has been there for a long time. Neil, welcome. I appreciate you coming today.

Dr. Neil Calman:

Hi Paul.

Paul D. Vitale:

Hi.

Dr. Neil Calman:

Great to be with you.

Paul D. Vitale:

Good. So the first question I usually ask folks is a little bit about their career because many of our listeners are looking to grow in their careers. You are a doctor, what’s your specialty, first of all, your area of specialty?

Dr. Neil Calman:

So I was trained in family medicine.

Paul D. Vitale:

Family medicine, and you are a CEO. So that’s a great combination and I’m sure everyone wants to know how you got there. Can you tell us a little bit about your background?

Dr. Neil Calman:

Yeah. When I was in training, I really started to take on some leadership positions. I was the chief resident. I was the president of the house staff at Montefiore. I’ve always been interested in leadership and always interested in policy and the things that make things run the way they do. And so my first job out, I took a job with New York Medical College, ended up working there. After a year, and I was a year out of residency, they made me the medical director of this small practice. I thought that was kind of cool. Then I got recruited to be the medical director of Soundview Health Center and opened a brand new health center in the Southeast Bronx. I did that for two or three years and just kind of outgrew it and thought if I really wanted to do what I wanted to do in life, which was to bring the personal nature of the way healthcare is done in private practices, but do that with people who were the most needy, that I should start my own non-profit.

Dr. Neil Calman:

So off I went and grabbed a hold of a couple of folks who I had worked with before and asked if they were interested in working with me. And four of us went off on our own, rented a little apartment in the Bronx and started the Institute for Family Health as a brand new nonprofit. And since it was my idea, I guess I always thought that I would be the CEO. They didn’t have any problem with that. And off we went, that was… I guess we started the project in ’83 incorporated and finally got our first grant in ’85, and I’ve been running it ever since.

Paul D. Vitale:

Wow. That’s terrific. We know you’re an FQHC, which people talk about, Federally Qualified Healthcare System, but can you tell everyone what an FQHC is?

Dr. Neil Calman:

Yeah, well, that’s part of our history. So in ’85 we started to do this work. We raised some money from foundations and we got some grants, but we knew that there was this process out there where you could become federally qualified, which means that at one point we had to turn over the leadership of this organization to a community governing board, and we did that in 1998. So we sort of ran for 13 years as a nonprofit healthcare provider, but then became a federally qualified health center and turned over our operation to a community governing board that was formed solely for that purpose.

Dr. Neil Calman:

So the FQHC is, the thing that stands them apart is that they’re run by community organizations, they’re run by a community governing board. That’s my boss and has been from the beginning, and we invited a group of people to get together and form a board. They were mostly patients of our health center and a couple of people who’d served as mentors to me personally, in my professional growth. And that was our first board, and I guess that was in the early 1990s. And then we got our first federal grant in 1998, which made us an FQHC.

Paul D. Vitale:

And for those of you who are out there, my background is also in FQHCs. FQHCs do receive grants to help them with operational funding and many other grants, and they also have benefits. But what an FQHC has to do is see anyone who needs healthcare. So anybody that knocks on that door insurance card or no insurance card or Medicaid or no Medicaid, we have to see them. So I know I was very proud of it, and I can tell you that I’ve known Neil for a long time, and he has an unbelievable reputation for taking care of the underserved and really even people who have insurance, because his care and the Institute for Family Health is such a great place to go. So you should be proud of what you’ve done, and I’m really privileged to be talking to you today.

Dr. Neil Calman:

Thanks, Paul. That’s very nice of you. Yeah, I mean, for us it wasn’t what somebody was forcing us to do. We found the vehicle to help fund it. I mean, it’s still only a small part of our budget, our budgets now about $145 million a year. And out of that only $10 million comes from the federal government, but that 10 million pays for a lot of care and does a lot of things that we wouldn’t be able to do, honestly, without it.

Paul D. Vitale:

So Neil, let’s talk a little bit about 2020, the famous year that we’ve all just lived. Tell me a little bit about how that affected your clinics, what happened, how it started and some of your successes and some of your challenges. I may stop you along the way and ask you something about one of your issues, but if you could just talk a little bit about 2020 in general.

Dr. Neil Calman:

Yeah, sure. I mean, challenging would be the term I would put to it, emotional, scary, heartbreaking ,eye opening. I mean, it was everything all rolled into one 15-month period, every emotion that you could feel. There were times where it was exhilarating and we were being successful. There were times I thought we were on the verge of dysfunction and just going down the tubes. There were a lot of things that were happening. I mean, in addition to all of that, all of us were concerned about our personal safety, about the safety of our families. I’m an older, I guess, exec at this point, hard to say that, but… and we were highest risk, and at the time we had 1400 employees and was worried about whether we would be able to sustain employment for them and what the future was going to look like for these folks, and many of whom I’d been working with for decades.

Dr. Neil Calman:

So I think the most critical thing was that we were functioning as leaders in an area that we had never been in before, and I think that was the scariest part. There weren’t any answers. You couldn’t look something up in a book, it says, here’s how you function in a pandemic when you’re down to your last 12 cents in the bank and trying to figure out what you’re going to do. I think that the financial risk when, all of a sudden, the state says nobody should go out unless they absolutely have to and you go from having thousands of visits a day to having 20 and wondering what that’s going to mean for revenue in the following months and whatever.

Dr. Neil Calman:

So that was all the scary part. The salvation was truly the pandemic funding that came from the federal government. I think without that, most of the FQHCs would have been insolvent, but we got funds and it was like nothing we had ever experienced before. I mean, literally, they would announce that there would be funding. The next morning when you woke up the money was in your bank account, you didn’t even know what it was for. And then a couple of days later, we would get a Notice of Grant Award that says, this is for testing, or this is for staffing, or this is for other things.

Dr. Neil Calman:

I have to say, the speed at which the stimulus dollars, the funding came through to the health centers, was extremely rewarding from two senses; one was the financial, but the other was there was just this incredible recognition of the importance of the work that we were doing and that people in the federal government knew that we needed to stay alive, to continue to do this work. And rather than getting all tangled up in all of the administrative craziness of how you apply for it and everything else, the funds came through in time to save most people’s jobs and to enable us to transition to tele-health and to stay alive and keep the mission going.

Paul D. Vitale:

Yeah, I want to go back to that word ‘scary’ a minute, because it’s an important word, and it’s not a word that many CEOs that I’ve interviewed so far used, and it shows the kind of person that you are because you need to be vulnerable. You need to show your true feelings and that, to me, makes any CEO a great leader. When was the first time, when this thing started, when was the first time where you started to get that tightness to know there’s really trouble. And what was the first thing you did as a leader? Did you have a meeting with your staff? Did you sit down and cry? Did you try to figure out something yourself? What does a leader do when they hear about that?

Dr. Neil Calman:

I mean, for me, leadership has always been a team sport. I mean, I always felt like the fun of being a leader is having people who you can lead and who you trust and who work with you, and that’s been… I’ve been so blessed that there’s probably a dozen people in my, to this day, in leadership positions in our organization who I’ve been working with for more than 25 years. And so that’s just, for me, that’s… I always say the thing that I’m proudest of is that people would give so much of their professional career and trust me enough to continue to work with me for all of that time, that that’s just, I don’t know, I never take that for granted. I always feel like it’s something you have to earn over and over again by doing right by the people who are with you.

Dr. Neil Calman:

So for… I think the first thing was I have this leadership team and we met every single day. We had our meeting, which we have, which is our Senior Administrative Management Team, used to meet for three hours once a month. And we met at 8:00 PM every single night, seven days a week for two months. And those meetings lasted between an hour and a half and three hours. And sometimes you could hear people starting to fall asleep on their calls, but there was such… everything had to change. It wasn’t just about tele-health. It was about micromanaging the economics and what we were buying and what we weren’t.

Dr. Neil Calman:

I mean, just give you a couple of examples, our purchasing department went through all 34 of our sites and inventoried every supply in every one of our cabinets, in every one of our sites, to bring together any surplus inventory that they could find. And as a result of that, we were able to combine in one location, enough supplies that. Literally, we didn’t order any supplies for over four months just by redistributing what we… and it wasn’t that people were hoarding them. It’s just that everybody, if you have 30 sites, every site’s got excess supplies in every area. And we closed a number of our sites and consolidated the patients and the staff into hub sites. So those sites didn’t need their supplies for that time. So just that process alone of who’s going through the stuff, who’s inventorying it, how’s it being transported, where’s it going to be held, how are people going to requisition it and the sites that need it? And that’s just one of 100 examples I could give you.

Dr. Neil Calman:

But that requires lots of people to be working on lots of things all at the same time and that was a challenge. But when I say scary and exhilarating, when you see people come together and think outside the box and try to really think about what you are in a crisis situation, I mean, the folks, just people just rise to the challenge. And it was amazing to be doing that. A lot of the time, I felt like a follower as well as a leader because some of the staff just took charge, like that whole thing that I talked about with purchasing, not one speck of that was my idea. It came strictly from the people who had been purchasing and whatever, and said, “I know that all the sites have supplies, why don’t we bring them together?” You also have to just learn to be a listener because the people who are on the front end of a lot of these, the apartments and things, are the people with the real knowledge about what to do in a crisis.

Paul D. Vitale:

Yeah. We’re talking today with Dr. Neil Calman, from the Institute of Family Health. Neil, one of the things you just said to me was that you felt like a follower. Well, I believe, and I think there are many books written about this, that followership makes great CEOs. People who follow, who listen, who do things like that, so I think those are really great words. We know that there are many stories out there about things that happen, and there are some we hear about. I heard about an interesting story when I interviewed a CEO about one of the things that they had, one of their employees had a service dog and the service dog was named Betty White. Betty White is the most beautiful little dog ever, and the patients in that nursing home, this was a nursing home executive that I spoke to, and the visitors loved it when they did the window visits. And it was a very touching, moving story. Do you have any stories from this past year that you remember vividly that you’d like to share with us?

Dr. Neil Calman:

Wow. The story that sits in my mind is an evening when I was on a one-to-one call with one of our junior faculty who was in the hospital and was trying to convey to me their frustration with some of the things they felt that we were doing wrong in managing the staffing. We also staff a whole floor at Mount Sinai through our Federally Qualified Health Center. I’ve always believed that doctors needed to follow their patients when they went into the hospital, because that’s when the people who you’ve been taking care of and who trust you need you the most. And somebody from our staff should be able to bring the information that’s needed and the continuity. So we have a whole staff in the hospital all the time with residents and faculty, and I was on the phone with her.

Dr. Neil Calman:

And she said, “I just have to tell you that I just went through an experience that I will never be able to forget.” She said, actually, she used the term ‘unsee’. She said, “I will never be able to unsee this.” And she was taking care of a woman. Our inpatient service at the time was 36 COVID patients out of 36 beds. Every single person we were taking care of had COVID. And she said she was taking care of a woman who was nine months pregnant, and she was part of the team that was trying to keep this woman alive long enough for the obstetrician to deliver the baby into the hands of the father, because the pregnant woman was dying. And she said, “How can I ever live through this experience and go on?” Like, she just… even just having experienced it.

Dr. Neil Calman:

And I realized at that point, and it changed my entire outlook for how I handled the rest of the pandemic, that the people that were truly our staff on the front lines were having experiences that I was being sheltered from by being the CEO and being in an office and being the puppeteer but not being in the emotional experiences that people were having. I felt that way throughout the entire pandemic, that, in a sense, that I was like the general sending the soldiers to the front lines and being back in the tent and giving the orders, but not putting myself in jeopardy. And that was a really hard thing to be thinking emotionally, sort of protecting yourself, but then I would talk about going in and people would say, “No, we need you doing what you’re doing.”

Dr. Neil Calman:

And I just… It was a very… In a leadership position, I was always used to being the hardest worker and the person out there demonstrating by my own actions what everybody else should be doing, and this was a time when I didn’t do that. And I felt detached from the people who were struggling. And then we lost one of our nurses in one of our ambulatory care facilities to COVID. And that was the second shockwave that just went through the entire organization. All of a sudden, every nurse felt vulnerable and every staff person felt vulnerable because one of us had died of this disease that we were working on fighting. And we held a memorial for her and did fundraising for her. And it was… It just brought home how serious the work was that you were doing in a very different, in a very real and vivid way.

Paul D. Vitale:

Yeah. We’re here today, as I said, with Dr. Neil Calman, the President and CEO of the Institute for Family Health. And Neil, when we come back from our break, which we’re going to take, I have a question that I’ve asked every CEO. I’m not going to tell you what it is yet. It’s only three words, so our listeners will come back after the break. But after this question, I’ve had some CEOs that have laughed. I’ve had some CEOs that have cried, and I have had some CEOs say to me, “What?” So for our listeners, we’re now going to take a bit of a break from our sponsor at One Brooklyn Health System and be back with Dr. Neil Calman. Thank you.

Sponsor:

PDV Health Consulting’s podcast, Leadership, Transformation and the Healthcare CEO with Paul D. Vitale is made possible thanks to our sponsor, One Brooklyn Health. One Brooklyn Health is dedicated to providing high quality, comprehensive health care to the communities they serve through a network of acute hospitals, community-based practices, long-term care facilities and partnerships with local health care providers. One Brooklyn Health’s patient-centered approach extends beyond medical care to enhance the health and wellness of their communities and their patients and families. Visit them online at onebrooklynhealth.org today.

Paul D. Vitale:

Welcome back everyone. We’re back with Dr. Neil Calman, the President and CEO of the Institute for Family Health. We’re so happy to have you here today. This discussion has been just extraordinary, Neil. Thank you for joining us.

Dr. Neil Calman:

Sure. It’s my pleasure, Paul. It’s always great to see you and to be with you.

Paul D. Vitale:

Yeah. So I have a three-word question, and I really want you to think about it before you answer it, because you’ve answered part of it a little bit, but the question is really this. How are you? How are you? Emotionally, physically after all of this?

Dr. Neil Calman:

I guess in one word I would say changed. Definitely feel more vulnerable than I had ever felt, I think, before as a CEO. I think when you’re forced into a situation where everything is unknown, the present, the future, where things are headed, will there be a vaccine? How long will the pandemic last? Will the funding hold out? Will my staff continue to believe in me as a leader? I think that all of that vulnerability changes you, that you, prior to that, I think, except for a couple of little flirtations with financial problems and things like that over the years, I think I felt like people had tremendous confidence in my ability as a leader, and I had a lot of confidence in myself. I was pretty cocky. Man, did that change. Not only the confidence in myself, but I think also, quite honestly, people, when they’re floating in an unknown sea, they know that I didn’t know what to do next.

Dr. Neil Calman:

There was no… They knew that… They know. I mean, they were listening, they were watching TV and they knew that nobody knew what to do next. We were changing our guidelines, changing everything from day to day, and I think part of that was reflected in people’s loss of confidence in my ability to get us out of this mess. And I think you saw that in relation to the government, you saw it in relationship to how people dealt with leaders in general, and I felt that in our organization. There was a month, I can’t remember exactly when, it might’ve been May or June, when we were so concerned about finances, we put productivity requirements in for our providers for the first time ever. And the providers and the residents, and people started an organization called the People’s IFH, to challenge my leadership.

Dr. Neil Calman:

And it was very painful. I have done a lot of soul searching and I said, “Look, the only way out of this is through total transparency and honesty.” And I said, yeah. I said, I can understand why people are questioning my ability to get us out of this mess, because we don’t really know what’s going to happen in this situation. It was the peak of the pandemic. The hospitals were overflowing, our staff was being pulled to staff the hospitals. We were short-staffed. We had no money. I mean, it was like… It was crazy. And overall, I have to say that we held some town hall meetings, I put together lots of information. We kept putting out bulletins about what we were doing and messages to the whole organization and communication, I think, is what saved the day, being totally open and honest with people about where we were at and what vulnerabilities we were facing. And that whole movement just faded away.

Dr. Neil Calman:

All the folks that were like… It just faded away, and I think what people really wanted was to have a lot more communication and a lot more honesty from, not just me, but all of the leadership folks, about the things that we were dealing with. They just wanted to know what was happening and to have some input into it. So we created some open forum for people to speak and to tell us what they thought was happening and what we were doing right and what we were doing wrong, and we made it out. But that really, when you say, how am I, I think that you can’t go through that stuff without having it shake your confidence a little bit and what the future holds. But right now, I feel like we’re in a really good place and I’m grateful for it.

Paul D. Vitale:

That’s what makes you so good, Neil. Neil, can we talk a little bit about vaccines? What are you doing with vaccines now and what do you think?

Dr. Neil Calman:

Giving them.

Dr. Neil Calman:

To as many people as possible. Oh my God, I spent so much time complaining in the beginning. I showed up at the first vaccination session that we had in one of our centers, because I wanted to see how it was running and I was volunteering to give some shots. And I walked into a place right in the middle of the South Bronx, and the waiting line was lined up down the halls, distanced six feet apart, and they were all White people from the suburbs.

Dr. Neil Calman:

And I was like, oh my God, what just happened? And we were putting our appointments online and that was the end of it. The people who were shopping around for appointments, they were coming in from everywhere, somebody from New Jersey, somebody from Connecticut. So, I mean, it was like… It was crazy. And that was the harbinger of what was to come right, was that people who were educated, who had computers, who could get online, who could surf for four hours for appointments, were getting vaccinated and the people in the community weren’t. So that was a big wake up call. I think we’ve done… We knew that that was a temporary situation, but the other thing that was really difficult about vaccines for primary care providers, we were giving it out to folks who weren’t on our patients, but we knew enough about who was at high risk. The folks in our centers who were 50 years old were at super high risk if they had diabetes, at risk of severe illness and death, and we couldn’t give them a vaccine, they didn’t fit into a category early on.

Dr. Neil Calman:

Meanwhile, we were seeing young teachers in their twenties, because teachers were unable to get vaccine and they were coming in and getting vaccinated when they had a very low risk, even if they got COVID, of getting desperately ill. So there were a lot of things, and I was trying to be constructively critical by getting my voice into the state and other places to say, look, this isn’t really what you want to be doing to save the most lives. But on the other hand, I think, because I’d been humbled by my own lack of knowing what to do next for a number of months, that it was… I was trying to do that without being critical, because I knew that everybody that was trying to make decisions was doing the best they could at the time.

Dr. Neil Calman:

It’s like nobody knew… nobody really had done this before. And so I think people were trying to do the best they could. And so I was like a microcosm of what people had been doing to me. I thought I had better ideas about what to do, and I was trying to figure out constructive ways to share that without being overly critical of the people who are making those ideas, because they were all… everybody was just trying to make the best ideas they could out of incomplete information.

Paul D. Vitale:

You know what I hear from you as a doctor all the time, which I hear from the Institute for Family Health, and I could just imagine you with patients, that’s like, I want to come to you as my doctor, by the way. I could just imagine you, instead of saying, “What’s the matter with you today,” saying, “What matters to you today?” And that’s the kind of person that you are. Just a little bit about the future, tell us where you think health care is going. Tell us where you think that we might be in trouble, or we’re doing well as the future moves on. Any advice you can give any of our listeners that are here, any good learnings, any points? Tell us all you know, Neil.

Dr. Neil Calman:

In three minutes… Look, the most important thing that’s going to come out of this entire event is the focus on healthcare equity and equity in society. That’s the most important and the most revolutionary… People are talking about telehealth and all this stuff. Those are just mechanics. The real learning that… And I don’t know why it took a pandemic to drive this home, but the real learning is the impact of a lack of health, equity and equity in all aspects of society, the impact that that has on all of us. And for some reason through the pandemic, because of who was getting, who had access to testing, who had access to vaccines early on, who was getting sick and dying disproportionately, because of all of those things were happening and they just kept driving home over and over again that you can’t solve these problems the way you want to solve them in a background of racism and inequality that exists in our society.

Dr. Neil Calman:

I just feel like, if anything good comes out of this, it’s all of the recognition of what happened. It’s kind of like the medical George Floyd. We saw what police… What impact police violence has on Black people. And we also saw the impact that pandemics have on Black people. And the fact that it didn’t take a genius to figure out who was getting diabetes, who had access only to unhealthy foods, who… Wow, and who was living in overcrowded housing and who were the homeless? You just went through it and said, oh my god, these are death sentences for these people. People are dying from this inequity. And they’re dying from a lack of being able to get tested and they’re dying because they’re not the ones getting vaccinated. And all of those things were like, I don’t know, just drove it home in a way.

Dr. Neil Calman:

I mean, I can tell you our organization, which has always been focused on equity and racial equity and diversity and trying our best in those areas, man, we’ve quadrupled the energy that’s going into that and looking at the way we work and who’s working and what kind of work people are doing.

Dr. Neil Calman:

So I think that that’s it. The big message is that’s what we have to… you got to look at the good in everything. The good that could come out of this is if we don’t let that be a blip and we really take it as a part of the charge of the healthcare system to make sure that at least the healthcare system is a refuge for people, and we can deal with the structural inequities in healthcare and make that a part of our society that’s built on a foundation of equity.

Paul D. Vitale:

Yeah, Neil, that is what I believe in. I’ve always worked in areas that need that kind of service.

Dr. Neil Calman:

You have. Yes, absolutely.

Paul D. Vitale:

And I’m very passionate about it. Right now, as you know, my company is doing work for One Brooklyn Health system who is sponsoring this, and this is really transforming. This is transformation at its best. This staff is working very hard and the state is giving them money to help the communities in North and Central Brooklyn really get better health care. LaRay Brown was one of our first guests and she really talked about that. And we, I believe in it so much, and it’s great.

Dr. Neil Calman:

She’s one of my heroes.

Paul D. Vitale:

Yeah, she’s one of my heroes too.

Dr. Neil Calman:

Heroines, I should say. Yeah, she’s just… she’s amazing.

Paul D. Vitale:

She is amazing.

Dr. Neil Calman:

They could not have picked a better person for that job.

Paul D. Vitale:

Yes. Yeah, she’s introduced you today. You probably don’t hear that now, but she’s taped your introduction, and I think she feels the same way about you. Neil, I want to thank you from the bottom of my heart for being with me today. It’s a privilege. I’m humbled and privileged to know you as a friend and as a colleague and keep doing the great work that you’re doing. And I know that we’ll be in touch very soon, have a great day, and everyone, we look forward to having you join us at our next podcast. Thank you for being with us today. Thank Neil Calman, the President and CEO of the Institute for Family Health, and before you go give us your website so that if people want to come in and use your services, they can. What is your website?

Dr. Neil Calman:

It’s www.institute.org.

Paul D. Vitale:

Thank you very much, everyone. Have a great day. Bye bye now.

Dr. Neil Calman:

Thank you, Paul.

Sponsor:

Thanks for listening to this episode of Leadership, Transformation and the Healthcare CEO with Paul D. Vitale. We hope you enjoyed it. Special thanks to One Brooklyn Health for supporting the show, and we hope you will too by giving us a positive rating on Apple Podcasts, Spotify, or wherever you listen to podcasts. If you want to learn more about the topic we discussed today, visit PDVhealth.com, where you’ll find the show notes. The PDV Health Consulting Executive Team is proudly joined by world renowned psychiatrist, Dr. Francine Cournos, along with top industry leading experts, Susan Flics, Joan Marren, Dr. Frank Kwakye-Berko, Dr. Alan Abrams, Sam Heller, Andrew Anello, Dr. Lisa DeRoché, and Special Projects Manager Afua Kwakye-Berko.

PDV Talks With: John MacIntosh, Managing Partner, SeaChange Capital Partners  *  Dr. Lisa DeRoché. Vice President, JCCA and PDV Executive Consultant, Human Resources/Organizational Development/Diversity & Inclusion  *  Dr. Francine Cournos, MD, Professor of Clinical Psychiatry, Columbia University | Author | Speaker | PDV Executive Consultant, Mental & Behavioral Health

PDV Health Podcast Show Notes

Announcer:

Welcome to Leadership, Transformation and the Health Care CEO, with Paul D. Vitale, a brand new podcast from PDV Health Consulting, sponsored by One Brooklyn Health. With a special introduction in every show by LaRay Brown, CEO of One Brooklyn Health, we talk to New York’s top healthcare CEOs as they share their stories on how they managed to drive their organizations through tough times, and also hear about the transformations they’ve experienced firsthand. Here’s your host, Paul Vitale.

Paul D. Vitale:

Hello. I’m Paul Vitale, President and CEO of PDV Health Consulting. Welcome to Leadership, Transformation and the Healthcare CEO.

LaRay Brown:

2020 brought many challenges and changes, not only in health care, but in the world of nonprofits and human resources. In this episode, we will speak with three special guests, John Macintosh, Managing Partner at SeaChange, and PDV Executive Consultants Dr. Lisa DeRoché and Dr. Francine Cournos. Dr. DeRoche is an expert in the field of human resources, organizational development and diversity and inclusion. And Dr. Cournos is a world-renowned psychiatrist. She’s a speaker and author as well. And now I’ll turn the program over to Paul, John, Lisa and Fran.

Paul D. Vitale:

Thank you, LaRay. Welcome everyone. My name is Paul Vitale from PDV Health Consultants. I’m happy to be here with all of you today. Today’s going to be a very special episode. We have a panel of three distinguished guests. The first guest is John Macintosh, who is the Managing Partner of an organization called SeaChange, which I’m very familiar with. That organization helps non-profits financially and operationally. So we thought we’d bring some different people on for you, and John can talk about what’s been happening in the nonprofit world, both in health care and not in health care.

Paul D. Vitale:

Our next guest is Dr. Francine Cournos. Dr. Cournos is a world-renowned psychiatrist who works at Columbia University. She has traveled world-wide to do speaking and training, and she’ll tell you a little bit more about herself. But when I was a CEO, Dr. Cournos hired me for the job as CEO, and I was so happy that she did, because I spent 10 years at Brightpoint Health as the CEO, and as a board member, I couldn’t have had a better person than her.

Paul D. Vitale:

Also on the panel is Dr. Lisa DeRoche, who works at JCCA as Vice President of Human Resources. Lisa and I also had the pleasure of working with each other. Lisa has a PhD and is an expert in human resources, and I wanted to have someone on the phone on one of these episodes that can really talk about human resources. So I’d like for each one of you, and I’ll call on you too, just talk a little bit about your background, and we’ll start with John. John, can you say hi to everybody?

John MacIintosh:

Hello, and Paul, thank you so much for having me. I spent my first career in private equity, so I was racing around looking for opportunities to make investments and make money for our investors, and also, quite frankly, for my firm and myself. But 14 years ago, I tried to put those skills to work in the non-profit sector. As you said, I lead a non-profit called SeaChange, and we work to help non-profits that are facing complex financial and organizational challenges, and we try to help them with loans, with grants, with consulting. Although we’re not exclusively focused in health and human services, and have been active in all sorts of sectors, health and human services is a lot of what we’ve done in New York over the years.

Paul D. Vitale:

And you know, John, I’m so happy that you do work in other sectors, because I think we in health care sometimes become very isolated, and I think we need to hear about what other nonprofits are doing in other areas. So I’m very happy to have you with us today. Our next guest, Dr. Cournos, can you tell the folks a little bit about yourself?

Francine Cournos:

Yes. Well, let me start out by saying that Lisa’s on this call, and she’s at the Jewish Child Care Association. I actually was a foster child at this association. I had the experience of my parents dying when I was a child, and living in foster care as an adolescent. It left me with a life-long passion for thinking about people who are receiving services in the public sector and who are disadvantaged. I’ve spent a lot of my adult career at the interface of HIV infection and mental illness, and that’s taking me to travel to many places, including in sub-Saharan Africa. So I feel I’m someone with an international understanding of how mental health is handled around the world.

Paul D. Vitale:

Wow. And for those of you, Dr. Cournos wrote a book, and I’m not pushing her book, but I’m just telling you that it was one of the best books that I’ve ever read, memoirs about her life, because she goes into her life in detail. It’s called City of One. I highly recommend you take a look at that, because it’s a great book. And we have Dr. Lisa DeRoché. Lisa, so nice to have you with us today. Could you tell our audience a little bit about yourself?

Lisa DeRoché:

I sure can, Paul. Thank you so much, and thanks for the opportunity to get back with you and work together on this fascinating opportunity. My initial career desire, and I’d love to hear Fran’s story. I can’t wait to pick up her book as well. My initial career desire was social work. I had interned at Planned Parenthood back in the days, but I pivoted into HR in the late ’90s after starting my own family. I spent 15 years managing HR for a global life insurance and annuity company by the name of AXA Equitable and also spent some time at a health plan, Fidelis Care, and as you know, Paul, long term five years as the head of HR and culture and the clinical operations call center for Brightpoint. But currently I’m excited to be the head of HR for JCCA. Many know it as Jewish Child Care Association. What we do is we help the abused, neglected and traumatized children heal physically and emotionally through compassionate and quality health care. So I look forward to talking more about that. And as you said, I did recently get my doctorate in business management, and of course with a specialization in human resources, because that’s what I love.

Paul D. Vitale:

Well, that’s great, and it’s wonderful to have you too. I want to start with Fran, because I think that’s really where it all starts. Fran, you have probably seen and heard a lot about how people in general have reacted, you’re a clinician, from a mental health point of view, during the COVID crisis. Can you talk about it a little bit, and let people know what you’ve seen and what you’re seeing now?

Francine Cournos:

I want to back up just to say that I’ve done work, as I mentioned, in sub-Saharan Africa, and there I’ve seen a lot of suffering. The suffering that is there is very widespread. I did some work in Rwanda, which was post-genocide. That occurred back in 1994, and I was in Rwanda in 2010. In that timeframe, the genocide was still very fresh in people’s minds. I had never been to a country where everyone had trauma. The whole country, as best I could tell, had PTSD. So it really made me think, what are you supposed to do when you’re working in a country where everyone has a mental health problem? The other thing about being there is that people minimized mental health problems because they were used to such a high level of suffering. People didn’t think of things that we would ordinarily call mental health disorders, like depression or post traumatic stress disorders, as real disorders, since everybody had them.

Francine Cournos:

So when COVID hit the U.S., for the first time ever, I actually saw something similar to my experience in Rwanda. All of a sudden we went from a country where we could go about our daily business, not all of us, but most of us, not give a lot of thought to what’s going on in the external world. I know that individual people worry about it. I know when I was in foster care I worried about it. But nonetheless, I think for the typical American person, we didn’t have to pay much attention to a pandemic or to genocide or to that kind of really systematic violence. So when COVID hit, all of a sudden everybody was distressed in the way that I had seen in sub-Saharan Africa.

Francine Cournos:

The interesting thing about it was it made me realize, first of all, how lucky we are here in this country that, for the most part, as circumstances usually are more favorable, how much we share in common with the rest of the world, because in fact we’re just as vulnerable. And the fact that when everybody is distressed, you really have to think about mental health differently. If you think about how COVID-19 has affected the general population, you see very high levels of distress, and you couldn’t possibly refer all of these people to a mental health professional. There aren’t enough people to serve them, and it’s not necessarily what’s needed.

Francine Cournos:

So it’s allowed me to really reflect on what’s mental health, what’s mental illness, and what’s distress? Distress is something that is very common. It’s very common under COVID, and what we do about distress is not to call on mental health professionals, particularly. As I said, there aren’t enough of them. We usually wait until people are ill. What we’ve seen in COVID is the many coping strategies that we’ve used at an organizational and individual level that don’t require going to someone trained in behavioral health care. And if you look at studies about what helped health care workers deal with COVID-19 in the U.S. and around the world, many of the interventions were structural. They weren’t about providing mental health services. They were about trying to make caseloads reasonable, about trying to help people stay connected to their families when they couldn’t go home because they might bring infection home. They were about trying to make sure that the hospital was safe and infection control procedures were in place, and that staff were fed, and that staff were appreciated, and people reminded staff members how grateful they were for all the service they were providing.

Francine Cournos:

All of those structural interventions went a huge way to keep health care workers well. Yes, there were some people who crossed over a line and had an illness, and then they really needed a referral. But I wanted to make this point, because if you are in the healthcare field, you are doing mental health no matter what you think you’re doing, because every interaction between the healthcare field and the patient is a chance to promote and support mental health. It’s a chance to be kind, it’s a chance to be thoughtful, it’s an opportunity to show that you care, it’s a way of checking in to let people know just because they can’t come in, you haven’t forgotten about them. There are so many things that we do that promote mental health where you don’t have to be trained in mental health services in order to be able to do.

Paul D. Vitale:

That’s a great overview. You know, John, I know that you’ve dealt with a lot of different companies this past year. What’s been happening? What’s been happening to the people, and have you seen any distress among people that you’ve dealt with?

John MacIntosh:

Oh, certainly. I think that those of us who have experience in the for profit and the not for profit realm know that even in the best of times, running a social service agency is a challenge. Even in the best of times, recruiting and retaining your staff, particularly your frontline staff, is difficult, and I think it was immensely, immensely difficult, particularly last year, when the needs that many not for profits exist to serve were going up just at the same moment that the cost of keeping staff in place and safe was going up. And as you know, but for people who don’t, the vast majority of human service nonprofits average margins half a percent. Probably a third of the organizations have less than a month of cash on hand at any given moment. Most are relatively small, and many of what I’ll call our battleship organizations like a JCCA, who are doing important work, from a financial standpoint, not from a philosophical standpoint, but from a financial standpoint are in effect outsource providers for government, financially. So just at the moment where their costs were up and their staff were struggling, the only place they could look to for the funds that they needed was the government, and there was that period last year where both city and state government was sort of in crisis.

John MacIntosh:

I think it was enormously difficult, not simply for the people being served and being supported, but for the people supporting them. I will say, and I hope we talk about this, that coming through this, the future’s going to be different. But I think that it’s been the most difficult year, I think that most non-profit leaders, even those who have Hurricane Sandy or 9/11 or the financial crisis or whatever it is, in their memories, really the most difficult that anybody has experienced.

Paul D. Vitale:

Yeah. Lisa?

Lisa DeRoché:

Yeah, yeah. I was listening to John’s comments on the difficulty in non-profits or what have you, and the biggest difficulty that I found and I can talk a little bit about, was the way in which we had to transform the workforce beyond the recruitment process, which I think tends to always be difficult, but from the transition from working on site to working from home, right? That was a big debate for us. It was an interesting debate that we took on in the environment with leadership on a regular basis. So since we have a residential campus where we house young people 24/7 with special needs, et cetera, we had various staff in positions such as our residential youth counselors and their supervisors and a cadre of social workers and case managers, the food workers that Fran mentioned, et cetera, who generally had to be on site all the time. Now, I don’t want to blame the fact that some workers, including myself, had to revert to working from home, since in the beginning it was not a choice. We didn’t ask for it, and in some cases, may have worked from home from time to time previously. It wasn’t necessarily new, but as a result of the pandemic, it was set up purposefully to ensure the safety of our staff, et cetera. So density in our office spaces was monitored very, very strictly and purposefully to ensure social distancing and safety.

Lisa DeRoché:

Unfortunately, those who worked on site versus those who worked from home, they became polarized, and in some cases when the remote work became a long-term decision, it turned into a bit of a race issue for my organization, since many of the frontline workers that were on site, I’ll say outside of the clinical roles, were those roles that pay less and have more black and brown folks engaged in them. So lots of issues there that were working on in reference to ensuring that all of our staff, every single person, recognizes the importance that they bring to the agency.

Lisa DeRoché:

So with that said, the work from home setup is not conducive to camaraderie in teamwork because I think we generally do miss that, and it doesn’t allow for that face-to-face partnership and social connection that we’re all used to. We’re going back on site now slowly, and it’s opening up. Obviously some organizations realize that they can do some jobs remotely, and in most cases, if not more productively. But there’s a lot of lost time in the commute, right, but companies are also saving on real estate and making decisions to re-think their entire landscape. So look how the world is transforming.

Paul D. Vitale:

Yeah. That’s so true. You know, I sent you all a list of questions, and as I’ve been doing these interviews, I decided to rip up the list because I think people, our audience, the people that are listening, know all about especially health care, the PPE and the financial crisis that people were in. It’s okay to talk about, but I’d like to talk about stories, stories that people had in the workplace, or that maybe John worked with someone, or Fran worked with someone. Talk about some stories. I was just wondering if any one of you had a story to tell us that was moving or that made a difference. Fran, I’m sure you do.

Francine Cournos:

Well, picking up on what Lisa said, we did have people who had to go into work and people who didn’t have to go into work, and that was a big divide. She’s absolutely right that it was also a color divide with who had to go in and who didn’t. But I would say maybe what was very humbling was that this didn’t apply to the physician level of people who have to really go in, work in the emergency department, work in the intensive care unit, work in the cardiac care unit, all of the intensive services that people provided. We were very sad … This is not an inspiring story, it’s a sad story, but early on in our pandemic, one of the physicians that we had running an emergency room department at the Pavilion, got COVID while she was there, came back, but appeared to be depressed, was sent back on leave, and ultimately suicided. So that was really shocking to the rest of us, that actually there were people on the front lines, I don’t know more about her background, that there were people on the front lines who actually were becoming ill enough to take their own lives.

Francine Cournos:

It made me more aware of how much we overlook the mental health care needs of our employees. We know that there’s a stigma to mental illness, and we know it’s very hard to go for help, and maybe even more so when you think that you’re a physician and you’re supposed to be invulnerable. So I would say that this pandemic, if you think about what we’ve needed most, aside from equipment, all of those things, but you think about what we needed most. We needed human to human contact. We needed to help people. And I do think that working remotely, even though there are some advantages to it, I’ve been working mostly remotely. Over time, I have found it less effective instead of more effective.

Francine Cournos:

I think what’s missing in this virtual world is that all of the informal day-to-day interactions that occurred in person don’t happen. We have to organize a meeting for every single thing we want to discuss. In the absence of all the little informal ways that we had of doing problem solving, what we’ve seen is people’s understanding of what’s going on drift further apart, people have more conflict, people don’t understand the head that the other person is in because they’ve been all by themselves in their house and this is what they’ve been thinking, and they haven’t told you. So I’m not at all convinced that we’re going to be living in a virtual world, because even though we may do more things virtually, we may save a lot of travel expenses, we may save pollution by not taking airplanes to conferences, I can tell you that the day-to-day interactions that normally keep people getting along with one another and operations running smoothly are really not there. And the longer we stay this way, the more of a burden I can see that has become.

Paul D. Vitale:

Yeah, yeah. You know, Fran, you used the word vulnerable, you used the word humble. I just finished a consulting commitment with a new CEO. The board called me, asked me if I was interested in the job, and they said, “Would you come in and train the new CEO?” He was a young man, this was his first CEO job, and it was a pretty substantial organization. The first question he asked me was, “What do you think the most important thing is that I need to do?” And I said, “The most important thing right now is to show people your vulnerabilities, show people your humility, show people they can trust you, show people that you are a person and not just a CEO. Once you’ve passed that gate, then you can worry about the finance and the quality and get your team on your side.”

Paul D. Vitale:

So what you’re saying about working at home … I have an article on my website about working at home. I got a lot of comments about it. It is true, it is true. Someone like him, who I’ve been coaching, and I just finished up with him … he’s [inaudible 00:24:43] because even with the Zoom meetings, it’s really [inaudible 00:24:48] to get that camaraderie. John, do you have any comments about that?

John Macintosh:

You know it’s so hard for us because we’re in the conference room or now on Zoom with the leaders of the organizations that we are working with, the chief executive, the executive director, maybe some of the board members. At least pre this crisis, we could get out into the field, we could see the actual work taking place, which I think is not only helpful for us to have a better understanding of what’s really going on, but it also makes the work more worthwhile. I was just reminded of that because one of my children, who was unable to go to freshman year of college in person this year, has been working for a large non-profit human service provider. To hear him describe, this group happens to work with adults who have developmental disabilities.

John MacIntosh:

To hear from him the life experience of the people who were working in the home, to hear from him how things like the Justice Center, things like difficulty in getting money for PPE, et cetera, how that actually feels to a frontline staff member was, for me, really sort of powerful and a reminder that those of us who lead these organizations, or like me, are even one step removed from that, need to find ways to be grounded in the actual work, and it’s been harder, again speaking personally, it’s been harder for us at SeaChange to do that because we’re not in the field at the center. And I look forward to getting back out there, because I think we’ll make better decisions and it’ll also be personally satisfying once again to not be stuck in the Zoom sphere.

Paul D. Vitale:

Yeah. Thank you. We’re talking today to John MacIntosh, Managing Partner of SeaChange, Dr. Fran Cournos, who works at Columbia University and is an internationally-renowned psychiatrist, and Dr. Lisa DeRoché, who is an executive for JCCA in human resources, and having a fascinating discussion. John, before we go to break, I have one question to ask you, because I know that you deal a lot with health care and non healthcare organizations. I have been curious to ask you this question. Did you see a difference in the stress level of the people or the work ethic of the people or any one of these things in the folks that you know in health care, as opposed to the folks that are in the arts or anything else?

John MacIntosh:

It’s hard to generalize. I think that the stress level in something like the arts is the stress of not being able to do anything, the stress of your theater being closed and running out of cash and wondering what that means, both for your mission or your livelihood. That’s a different kind of stress than if you were in a city harvest or something, distributing emergency meals, or you were, I think particularly in non-profits that were operating facilities like homeless facilities or congregate care of other kinds, where you had very vulnerable people that needed to be kept inside and safe, while also keeping your staff inside and safe. So I don’t know. I guess I feel, Paul, that stress and anxiety is more of an absolute concept rather than a relative concept. I think that the people in many, many organizations felt extremely uneasy, but it was qualitatively different because it was driven by different reasons.

Paul D. Vitale:

Lisa?

Lisa DeRoché:

Yeah, I think that’s a great way to put it. Depending on what circumstance you’re coming from, you would expect that you’re handling it a little differently. I’ll take my husband as an example, who was an executive chef and about to do a business deal to actually work with a catering firm in Long Island, and everything shut down at that moment. If he would have gone into that deal, his whole life would have changed, and he wouldn’t have been able to have any business on the table. So it all depends on the perspective that you’re coming from and how you’re looking at it.

Paul D. Vitale:

Well, you know, my son is in the theater industry as a director, and he’s done [inaudible 00:29:54] and Broadway work. When this happened to him, it was devastating, because everything shut down. He was working on a reprise, bringing back a Broadway show from a while ago, and he was working on it for one year and about to go into auditions when everything closed down. All the work he put into the show, everything else, and it was so disappointing. Luckily now he has another job, and he’s in a creative way. He works for a designer, but I know he misses it. We’re going to take a break in a few minutes, but before we take a break, I want you to think about the words vulnerability and humility.

Paul D. Vitale:

We’re talking to three experts today, John Macintosh, Dr. Fran Cournos and Dr. Lisa DeRoche. The question I’ve asked everyone has three words to it. I’m going to leave you hanging a little bit, but I can tell you that every CEO and every executive that I’ve interviewed, when I ask this question, the first thing they do is laugh and say, “What do you mean?” Then the second thing they do could either cry or tell a story. So we’ll be back in a few moments after this message from our sponsor.

Announcer:

PDV Health Consulting’s podcast, Leadership, Transformation, and the Health Care CEO, with Paul D. Vitale is made possible thanks to our sponsor, One Brooklyn Health. One Brooklyn Health is dedicated to providing high quality comprehensive health care to the communities they serve. Through a network of acute hospitals, community-based practices, long-term care facilities and partnerships with local health care providers, One Brooklyn Health’s patient-centered approach extends beyond medical care to enhance the health and wellness of their communities and their patients and families. Visit them online at onebrooklynhealth.org today.

Paul D. Vitale:

Welcome back. We’re back. I’m Paul Vitale from PDV Health Consultants, and I’m doing a series of podcasts on transformation and leadership and the CEO, and really talking about 2020, and about in a way that I would say a little more real than some of the interviews we’ve seen regarding how many people are getting vaccinated and how many people are really working from home. I think all that stuff is great, but I want to ask the three of you a question, and we’ll start off with Lisa answering it. The question has three words to it. It is this. How are you? How are you doing, Lisa?

Lisa DeRoché:

Wow. That’s a shocking question, Paul.

Paul D. Vitale:

Well, I know. I told you, some people laugh, and there you go.

Lisa DeRoché:

One that many, when you ask, you expect some of those similar answers. Oh, I’m doing okay, I’m doing well. I have to say, I feel, and I’ll use the word born again. And I’m going to use that word because 2020 was a lot about the safety of my family. Should I see my kids who don’t live with us? The safety of our parents. My daughter was pregnant at the time for 2020, and had her baby in the middle of the year, middle of the summer or what have you. I was worried for her completely out of my mind the whole time. What if she gets sick? All of these things. What if the baby gets sick? As a result of loving and wanting to see my family so badly, I was exposed to positive COVID cases at least four times, because of course everybody is trying to be as healthy and safe as they can be, but you just don’t know where it was coming from. This thing was like the devil in the middle of the night. You have no idea where it could be. Many people are asymptomatic, which was the case where I had been exposed. Luckily I didn’t get anything, but you still have to be super careful.

Lisa DeRoché:

Ultimately that year also was my son’s senior year in high school. Like John mentioned, what I’ll say is that you love to know how people come through for you, because I think a lot of that was shown in response to the pandemic. Even though he had no real senior year, everyone wanted to help. The entire school did as much as they could to get the young people to feel like it was a normal year, and it absolutely wasn’t. They established so many opportunities for them to have fun while being safe. So I always give it up for the people who look out for others in time of need. Our frontline workers, I would cry watching the commercials of hearing them getting the pots and pans banging for them in the evening and what have you. Every time I see the commercial, I’m in tears, Paul. So I would say born again and just crazy to see how this world is an easy target for terror in the form of disease, political unrest and race. We have to hold on to our families really, really tight. I think that’s what I would say.

Paul D. Vitale:

Yeah. You know, I answered this question myself, but I’m going to answer it right now, because your family brought up something interesting to me. I remember when that 7:00 hour happened. When people ask me how I am, well two things affected me very much in this [inaudible 00:35:54], where I would tear up. The one thing was 7:00 when everyone would do the pots and the pans. In my neighborhood, I live in Manhattan, everybody puts their head out the window. I would play, usually every night, Frank Sinatra’s New York, New York and we would all sing it together. A beautiful thing, and I would tear up.

Paul D. Vitale:

And the other thing that got me to tears during it, and really lasted a long time and I still remember today, is when we had somebody [inaudible 00:36:30]. We had so many deaths. I work in consulting right now for One Brooklyn, and there are three hospitals that are merging. So you can imagine how many deaths that we had in north and central Brooklyn, a very vulnerable area. When people went home, they played a song. They asked us all if we wanted to pick a song, and I was a consultant. I didn’t even think I would get asked that question. I picked It’s a Wonderful World. I heard that song so many times, along with other beautiful songs. And whenever I would hear it and the bells would chime, I would know that somebody was going home. And it would be so beautiful.

Paul D. Vitale:

On the other hand, my office was above the emergency room. I would see the ambulances pull up, back to back. It would bring me to a deep, deep feeling of fear. I wanted Fran to really talk about that, because I’m sure that she … Well, first of all, Fran, how are you? Let’s put it that way.

Francine Cournos:

Well, I would say I found this period, this past year, very bizarre. At times, I would think maybe this is a bad dream. It’s been one of the strangest years I’ve ever lived through. Aside from the social deprivations, worry about family, and all the other things that have been mentioned, I just want to also say that as someone who really thinks about public health, it was very sad to me to see how hampered we were from carrying out a sensible public health approach, how politicized a pandemic became, how it became a matter of opinion as to whether it existed or it didn’t exist, how somebody could be calling a relative and saying your patient is at our hospital dying of COVID-19, and the relative could say, “COVID-19 doesn’t exist.”

Francine Cournos:

I think of this period as a test of so many things. I think of it as a test of our democracy. I have to say I am very relieved. I don’t know if we’re allowed to get political in these conversations, but I think we were moving…

Paul D. Vitale:

You can say whatever you like, Fran.

Francine Cournos:

Thank you. I think that we were moving toward an authoritarian regime, and that even shocked me more. I just didn’t have any experience, and I’m 75 years old. I couldn’t think of any time where it ever seemed like there would be people who could follow a leader who was willing to say anything, like go get COVID, it’s not real and it won’t hurt you. And I feared for our democracy really falling apart. Yeah, a lot of my thoughts went to very global issues like that.

Paul D. Vitale:

That’s interesting.

Francine Cournos:

Thinking of the state of the world, thinking of whether democracy can survive, thinking of the vulnerabilities of people, thinking of how irrational we can become. You know, I once went on a safari in Africa, and I got a chance to see animals living in the wild, and I remember the thing that most struck me about it is animals in the safari settings, and a lot of them are just natural areas, they’re either anxious that they’re going to be killed, or anxious that they’re going to starve. It made me understand that we are probably animals too. It may seem like a bizarre thing to say. We’re animals as well. Living in a state of fear is the normal way animals live. You don’t know if you can get enough to eat, you don’t know if you’ll be eaten, you don’t know if you’ll survive.

Francine Cournos:

We try to get past that state, to create civilization. But civilization is vulnerable. So I came back from that safari, and living through this year, with a new appreciation, that to the extent that we can make the world more just and more civilized and treat everybody more fairly, we have overcome our animal nature to do something that elevates us. So it doesn’t really discourage me, it just makes me understand how hard it is for us to have a fair, just, humane society that doesn’t victimize people, doesn’t treat people like they don’t deserve anything, doesn’t racially profile people, doesn’t give some groups some and other groups nothing. This is so hard.

Paul D. Vitale:

Yeah, it is. John, where do you think health care or non-profits in general are going now that all this is starting to get leveled out? Where do you think they’re going to be?

John MacIntosh:

I was just going to tell you how I am, and you’ve skipped me. It’s all right.

Paul D. Vitale:

Oh, I forgot to ask you how you are. All right. Well, how are you?

John MacIntosh:

Thanks for asking, Paul.

Paul D. Vitale:

I got so caught up in Lisa’s story and Fran’s that I forgot. Tell me, how are you, John? You’re probably the best person to ask, because [inaudible 00:42:29] I did think you were going to respond to it. So go ahead and respond and let me see if my thoughts were right.

John MacIntosh:

I’ll be quick. I’ll be quick.

Paul D. Vitale:

No, you don’t have to be.

John MacIntosh:

I think it was a three word question, so here’s a three word answer. I think privileged, challenged and stuck in. I think on the privilege side, I believe on all relevant dimensions, the last year has exacerbated what already seemed to be unbelievable levels of inequality. I think as you said, the experience of this pandemic, depending on where you live and what your social network looks like and what your access to health care is, what your relationships are, where you stand financially, it’s just been extraordinary. So I think feeling like, wow, this is not terrible for me. I have resources in every sense of that word. It’s a strange feeling to have. I think guilt and just … or at least awareness. I think privilege is one.

John MacIntosh:

I think number two, not to politicize this conversation, but I naturalized last year. I became an American because I just felt, wow, who are the rest of us kidding? Even pre-COVID, you can’t go to New Zealand and hide out if America doesn’t get things together on all sorts of dimensions, from crumbling infrastructure to structural racism to health care to climate change. As goes America, so goes the world, so I think the feeling, particularly with COVID, of getting stuck in, whatever that means, make the most donations you can make, watch a poll, be nice to your neighbors, distribute food. I think that, which didn’t sort of come naturally to me, I haven’t always been stuck in person. I think that was [inaudible 00:44:32].

John MacIntosh:

And the third is I think I felt challenged. Work has always been my happy place, and so when we got really busy and it was crazy and it just seemed like waking up and work, work, work, work, work, my colleagues sort of took me aside, said, John, you’re killing us. Work is not everybody’s happy place, and it’s the place that I go for distraction. Just being forced to be a little bit more aware and empathetic as a manager, as a leader, I think is the other thing I would say. So privileged, stuck in, challenged. Now, you have asked another question.

Paul D. Vitale:

No, but I just want to comment on that.

Lisa DeRoché:

I love that point.

John MacIntosh:

So overall I’m good, Paul. Thanks for asking.

Paul D. Vitale:

I’m so happy to hear you say that, John, because I’ve always thought you were very bright and a smart person, but when I hear you talk that way about your own feelings, it makes me happy because you’ve really … I think some people know you as somebody that lends them money, goes through, talks to you about that at different times, gets the instructions saying you need to do this, you need to do that. And I think what you’re telling me is that you started to feel vulnerable in a way, and I think that’s a healthy thing. I don’t know about you.

John MacIntosh:

Yeah, I would say just that, I have four kids. Yeah, four girls.

Paul D. Vitale:

Four girls.

John MacIntosh:

Yeah. I think that we’ve had, without getting into the details, it has not always been an effortless ride. There have been challenges, challenges with individual kids, challenges between me and my wife. You know, life, and I think that when you think of how hard it is to deal with those things even pre-COVID and even when you have access to good health care and if you need out of pocket, you can pay out of pocket. It puts you in the mind of what if you didn’t have those things and you were relying on, to some degree, let’s call it the social safety net and the mental health and behavioral health that is available there. I mean it’s extraordinary. So I think if we’d had this conversation 10 years ago, you would have said, just as I suspected. John’s a bit of a Vulcan, he’s very smart, but he has a very sharp pencil and he doesn’t emote. But you can’t have four teenage daughters and live life that way, because reality intervenes.

Paul D. Vitale:

It does. Thank you, John.

Lisa DeRoché:

And John knows that girls run the world. I know John knows that.

John MacIntosh:

Yeah, I do my bit you know. Absolutely.

Paul D. Vitale:

Well, we’re talking today to John MacIntosh, the Managing Partner of SeaChange, Dr. Fran Cournos and Dr. Lisa DeRoché, and Lisa, you have started to say something.

Lisa DeRoché:

I was going to say that we were absolutely not prepared for this crisis. We didn’t act quickly enough, we politicized the issue, and if we had taken earlier precautions, we would not have lost so many lives, all of which mattered. I think we have done a lot now as we’re moving into 100 days of a new administration. But health care is going to continue to be a top priority. It will also continue to be scrutinized and probably continue to be politicized. I don’t think we’ll ever get away from that. The need for health care, I think, will always expand and grow, and hopefully if the Affordable Health Care Act does grow, we’ll have the ability to have lower prescriptions and more people can have equal access to affordable health care. I think that’s the direction that we should be going in, and assuming that we can all get to that place and put our heads behind doing that, we can turn this thing around. That’s what I’m hoping for.

Francine Cournos:

I just wanted to add that the statistics show that the U.S. spends more on health care than other high income countries, but gets poorer results. Whereas a lot of European countries are seeing an increased life span, we’re seeing a decreased life span. I think we really have to think through what we’re doing in our healthcare system to make it work better. You know, there may be too many incentives, for example, to run tests and do procedures that bring in good revenue, rather than have meaningful relationships with patients that allow them to monitor and take care of their own well-being, because behavior is the primary contributor to premature death. That’s been well documented. We need a different approach to health than the one we’re using.

Paul D. Vitale:

Yeah, well you know the whole thing about health care improvement is not what’s the matter with you, but what matters to you. John, you get the last word on that. Where do you think we’re going? Where do you think nonprofits and health care is going in the future?

John MacIntosh:

Look, I think if you look back at hospitals, hospice, nursing homes, and the list goes on a little bit, I think once private investors think that they can make money, they come. And it seems to me that the investment community has decided that managed care is here to stay. I think that attracts private capital. I think that COVID has probably accelerated the extent to which technology is going to be important in health care broadly defined, particularly behavioral mental health, which puts a privilege on technology and the financial and human capital needed to do that. I think the simple fact is I think you’re going to see a pretty challenging decade where the smaller non-profit providers are going to need to think about coming together in different ways, and that we’re going to end up with a system that’s got more for profit participation, and that the non-profits that are still doing work are considerably larger.

John MacIntosh:

I guess I would say I think it’s up to all of us to make sure that’s not a bad thing. If you look at higher education particularly, but I would say nursing homes as well, for profit provision is not covered in glory. So I think rather than resisting that, we need to work very hard in our advocacy work to make sure that that’s not a bad thing for the underlying people being served, but I do think it’s coming.

Paul D. Vitale:

Yeah. The interesting thing to all of you is during COVID, I consulted for another company called [inaudible 00:52:26] Peters, and they find experts in fields to talk to private equity, I don’t know if you ever heard of it, John, and they paid me to talk to these private equity companies about purchasing a non-profit, many of them nonprofits, some of them are a for profit company, like hospice. It surprised me. I think I had four or five of them during COVID, where I did that for Apex leaders, and that surprised me, because I thought they would be running away from that. But it seemed like they were running towards that a little bit. Now, whether they bought it or not, I don’t know. Yeah, go ahead.

John MacIntosh:

Welsh Carson hired a guy named Tom Scully, who I think was the head of CMS, and they’ve done a bunch of stuff, including building the largest PACE provider in the country. So I think the folks who maybe don’t know what they’re doing are good business for you, because they reach out to outside experts. Then if they get serious, they bring people onto the team. If they think they can make money, the money flows. And I just think we just need to make sure that if the for profits providers can use technology and deliver good services, terrific, but that we keep everybody honest so that vulnerable people, people who need good service at affordable prices aren’t left holding the bag.

Paul D. Vitale:

Thank you, John. Dr. Cournos and Dr. DeRoché also has another job. They work on my team as consultants, and they see what I’m doing, and are out there, I know, doing things that are great. So I want to thank you both for that. But I would like for you to give your contact information, your emails, in case anybody out there would like to write to you. Lisa, how can people contact you if they would like to?

Lisa DeRoché:

You can reach me at derochelisa@hotmail.com, D-E-R-O-C-H-E-L-I-S-A at hotmail.com.

Paul D. Vitale:

Fran, how can people reach you?

Francine Cournos:

They can reach me by emailing me at FC, my initials, C as in cat, fc15@cumc.columbia, C-O-L-U-M-B-I-A, dot EDU.

Paul D. Vitale:

Very good. And John?

John Macintosh:

People can email me at jmacintosh. That’s J-M-A-C-I-N-T-O-S-H at seachangecap.org.

Paul D. Vitale:

So all this will be on my website, which is PDV Health Consulting. Actually so will the recordings of the podcasts will be on there. If you have any other questions about the podcast, please contact me on our website. We want to thank One Brooklyn Health System for sponsoring this and for being a part of this. I want to thank all of the people. John, Fran and Lisa have so graciously taken their time out to talk to all of you out there. It’s been fascinating to talk with you today. John MacIntosh from SeaChange, Dr. Fran Cournos, Columbia, and Dr. Lisa DeRoché from JCCA. I want to thank you all very, very much. It was a fascinating discussion, and I hope that I see you all soon. Good-bye for now, and for those of you out there, please remember to check Spotify, Apple, any one of the social media platforms, or our website will give you more information about any of the speakers or any other information that you may need or any help that you need on anything at all. Thanks [inaudible 00:56:25], and have a wonderful day. Be safe, be healthy, be happy and be at peace. Bye-bye for now.

Announcer:

Thanks for listening to this episode of Leadership, Transformation, and the Health Care CEO with Paul D. Vitale. We hope you enjoyed it. Special thanks to One Brooklyn Health for supporting the show, and we hope you will too, by giving us a positive rating on Apple podcasts, Spotify, or wherever you listen to podcasts. If you want to learn more about the topic we discussed today, visit pdvhealth.com, where you’ll find the show notes. The PDV Health Consulting executive team is proudly joined by world-renowned psychiatrist, Dr. Francine Cournos, along with top industry leading experts Susan Flics, Joan Marren, Dr. Frank Kwakye-Berko, Dr. Alan Abrams, Sam Heller, Andrew Anello, Dr. Lisa DeRoché, and Special Projects Manager, Afua Kwakye-Berko.

PDV Talks With: Dan Savitt, President & CEO, Visiting Nurse Service of New York (VNSNY), with Dr. Ritchell Dignam, MD, CMO for Provider Services and Hospice Medical Director for VNSNY Hospice and Palliative Care, and Michelle Drayton, RN, MPH, Director for Hospice and Palliative Care Outreach and HOPE Program

PDV Health Podcast Show Notes

Announcer:

Welcome to Leadership, Transformation and the Healthcare CEO with Paul D. Vitale, a brand new podcast from PDV Health Consulting sponsored by One Brooklyn Health. With a special introduction in every show by LaRay Brown, CEO of One Brooklyn Health, we talk to New York’s top healthcare CEOs as they share their stories on how they managed to drive their organizations through tough times, and also hear about the transformations they’ve experienced firsthand. Here’s your host, Paul Vitale.

Paul D. Vitale:

Hello, I’m Paul Vitale, president and CEO of PDV Health Consulting. Welcome to Leadership, Transformation, and the Healthcare CEO.

LaRay Brown:

Home care and hospice care are vital parts of the healthcare ecosystem, and have had many challenges in these past years. Reimbursement continues to drop, and patients are coming home from the hospital sicker, and need their care at home. Here to talk about these important issues and their hospice care program, we have Dan Savitt, the new CEO of Visiting Nurse Services of New York, Dr. Ritchell Dignam, the CMO of Visiting Nurse Services of New York’s provider services, and also the hospice medical director for Visiting Nurse Services of New York’s hospice and palliative care, and Michelle Drayton, who’s the director of their HOPE program. The Visiting Nurse Services of New York is the largest home care company in the United States, and it has had national and international recognition. I’ll now turn the program over to Paul and his guest.

Paul D. Vitale:

Thank you, LaRay, and welcome, everyone. My name is Paul Vitale from PDV Health Consulting here in New York City. We want to welcome everyone today to this special episode of Transformation, Leadership and the CEO. And today we have a very, very special guest, and that is Dan Savitt from the Visiting Nurse Service of New York, who is the President and Chief Executive Officer. And we have Dr. Ritchell Dignam, who is the Chief Medical Officer of Provider Services and Hospice. And we have Michelle Drayton, who is the Director of Hospice and Palliative Care and Outreach.

Paul D. Vitale:

So, we have three special guests today from the Visiting Nurse Service of New York, which is actually an organization that means a great deal to me, not only because I used to work there, but because they took care of my mom and my dad in their last months at home. And both of them got care. When I say care, they got all the medicine they needed. They got everything else they needed, but they got care, which means that they got compassion. And they were there for my whole family and for me, and I am forever grateful to the Visiting Nurse Service of New York for what they have done for my family. They’ve also been there for me. I’m a cancer survivor, so while I was even working there, they took care of me. So, all I can say is Dan, welcome. And thank you, and congratulations on your new role as Chief Executive Officer for the Visiting Nurse Service of New York. It’s very nice to have you.

Dan Savitt:

Thank you, Paul. I’m really pleased to be here.

Paul D. Vitale:

And I want to welcome you, Michelle, very much. I’ve heard a lot of great things about you. And also you, Dr. Dignam. So, I’d like to actually start with you, Dan, if you could tell us a little bit about yourself and your career, because one of the things we’ve been doing at the beginning of the podcast with the CEOs is they’ve been telling us a little bit about how they got to that seat, because a lot of people want to know how you became chief executive officer and what your career has been like. So, if we can start there, that would be great.

Dan Savitt:

Sure. Well, thanks, Paul. Well, I’ve been in healthcare for over 20 years focused primarily on the space that we focus on at VNSNY. Really, the chronically ill, those most vulnerable. So, it’s been a journey for me. I spent my first 11 years at UnitedHealthcare and Optum, and really enjoyed that time and really spent time in each one of their businesses. So, for those folks listening, I came in in finance, I moved to operations, I went to business development, and over to acquisitions, and a lot of other things. And so, that afforded me the opportunity to get a number of different experiences, which has been really valuable in my leadership journey.

Dan Savitt:

From there, I spent time as a co-founder of Landmark Health, and that was a new experience for me moving from $100 billion organization to an organization of five people with no revenue and having a vision and building from there, and learned a significant amount about how to sell and build a business that lasts and is focused on a specific targeted population and a targeted care model. And then I went and had some opportunity at a private equity based firm doing emergency medicine from a provider group standpoint, and so, worked with a group of physicians, and went and grew that business to a group that sees over six million patients a year. And so, then came to Visiting Nurse Service of New York as their chief financial officer, and then ultimately, February, into this role.

Dan Savitt:

And what I would sum that up is a number of varied experiences within healthcare. So, not just one part of the industry, but payer, provider, and the pieces in between, as well as just having different model types of going from public to private and startup, and then to not-for-profit. So, all those varied experiences have been super helpful in preparing me for this role.

Paul D. Vitale:

Great, thank you very much. And, Michelle, can you tell us a little bit about what you do with the Visiting Nurse Service of New York?

Michelle Drayton:

Absolutely, Paul, and it’s wonderful to be here with you and my colleagues. I’m the director for hospice access in a program that addresses under utilization of hospice among communities of color. I direct a group of liaisons as well as a faith-based team. We focus on addressing the barriers and the systemic issues that many communities of color face in accessing hospice. I’ve been working at VNSNY for 10 years. In fact, actually, it’s nine years. I’ve just celebrated my anniversary on April 23rd. And I’ve been in public health for three decades. I’ve also worked in public policy. And this work that I do just aligns so well with my passion and my expertise. I’m also a registered nurse. And we’ve been doing a great deal of work in Harlem and in the Bronx, focusing on getting people access to this incredible service, and also just addressing the city wide issue related to hospice utilization. Unfortunately, although New York is quite a sophisticated city and medically advanced, our utilization rate of hospice is only 27%.

Paul D. Vitale:

And Dr. Dignam, nice to meet you. And can you tell us a little bit about what you do for the Visiting Nurse Service of New York?

Ritchell Dignam:

Thank you very much, Paul. And I also would like to tell everyone I’m very happy that I am included in today’s event. And for my role, I actually have two, a dual role in the Visiting Nurse Service of New York. I am the chief medical officer of the provider services, as well as the hospice medical director. And for my role as the chief medical officer of the provider services, it’s really offering medical oversight in multiple lines of business in the VNSNY that includes the home care, the hospice care. We have the community mental health services, also the chronic management organization, as well as the home health agency. And my background to become the chief medical officer, my background is internal medicine by training, as well as I’m fellowship trained in geriatric medicine, and I’m also certified in hospice and palliative medicine.

Ritchell Dignam:

So, I have been in practice as an internist and as a geriatrician, both in the academic setting, as well as in private practice, and I also worked in home care based organization as well as nursing homes, assisted living facilities. And as a hospice medical director, I’ve been doing hospice care over the last more than 20 years. And I was also both as a hospice medical director in a for-profit organization, and I joined this great not-for-profit organization five years ago. So, with hospice care, we’ve been around for 38 years, really providing hands-on care for end of life for the New Yorkers who are terminally ill, and I work with a great team to provide that end of life service. Thank you.

Paul D. Vitale:

Thank you very much. Dan, can you tell us how many patients that you serve each year?

Dan Savitt:

I can. So, we serve 44,000 patients a day, which is a better way to look at it. And what I would say is that it comes in different forms. And so, we are what I would call a truly integrated payer and provider. So, on the provider side, we have about 1,450 hospice patients in service. On any given day, we see roughly 80,000 admissions into our home health program. And then we’ve got a number of clients that we engage with in many programs on the community mental health side. And then in addition to that, we do about almost a million hours a month in home health aide services. And then finally, on the provider side, we have a care management organization that overlays many of those and provides value-based programs for complex patients.

Dan Savitt:

In addition to that, we have nearly 30,000 members of our health plan, and they range from Medicaid long-term care to the integrated Medicare Medicaid plan, which we call Medicaid Advantage Plus here in New York. And finally, an HIV special needs plan, which we brand SelectHealth. And so, all that together means we have about 44,000 patients, clients and plan members that we touch on any given day.

Paul D. Vitale:

Wow, you’re a tremendous organization, bigger than a lot of people think. Just for our listeners, Visiting Nurse Service of New York is the largest home health care agency in the United States. And they are quite a different kind of an organization. Our next episode, you’ll be hearing from the CEO of EmblemHealth, who also has a similar kind of business where we have a payer and a provider. And this is the Visiting Nurse Service of New York. They have a managed payer environment, and they also have a provider environment. So, let’s talk about that for a moment, Dan, if you could, because some people say, “How could you be a payer and a provider? Isn’t there a conflict there?” So, I’m wondering if you can comment on that for a moment. Because I asked Karen Ignagni the same thing, who is a good friend of mine, and I’m just curious to see what your answer would be.

Dan Savitt:

Well, it is a good question. And I would say 20 years ago, folks wrestled with that. But now, it’s so commonplace that it’s almost not even a question anymore. You have providers, hospital systems that have their own insurance company, and you have insurance companies like Humana and United, and pretty much every other one that’s in the provider space. And now you’ve seen the Aetna-CVS partnership, and that company coming together as one. So, I think it’s important to note that you have to have… There’s regulatory firewalls between the two, and so you have to be very careful on how you work together. But having both sides of the equation, having talent that can move across the organization helps us to build much more effective care models, which in the end is what we’re about. So, we’re about providing better care on a comprehensive basis across all the different components of their care, medical, social, psychological, and having both sides of that helps us to innovate and to do more and offer more to our population.

Paul D. Vitale:

Well, that’s great. That’s great. So, for a moment now, when you think about hospice, Michelle, and this past year, tell us what your challenges have been and what you think your successes were with the year 2020. I said to one of our speakers, “I had a whole list of questions that you may have seen.” And then I ripped up the paper and I said, “Our audiences want to hear about that. They want to hear stories. They want to hear what happened during 2020 inside your organization, and with our patients behind the scenes a little bit, because they want to get a flavor for maybe I did something that they didn’t do, and maybe they didn’t do something that I did do, and we can share each other’s information.” So, hospice is very near and dear to my heart, and that’s why we wanted to have you. Can you tell us a little bit about 2020 for you?

Michelle Drayton:

Well, I think 2020 for me, I mean, obviously, it was a transformative year. It changed everything. COVID changed everything. But it also elucidated a lot of the ongoing issues and disparities in healthcare access that pre-existed COVID. And we have an incredible, and I’m not saying it just because I’m part of the team, but we have such a committed team of healthcare providers. And we’re driven by increasing access. So, for the program that I direct, which is called HOPE, it’s a hospice outreach patient and provider engagement initiative. For many, we thought that perhaps it would be stymied in this environment. But the fact really was, it was needed more than ever.

Michelle Drayton:

As you probably know, many vulnerable communities, many communities of color were disproportionately impacted by COVID. There are systemic issues, access to testing. And really, the partnerships that the HOPE program has been forging with community stakeholders, from our physicians, hospitals, policymakers, religious leaders, we actually enhance those relationships. It’s very, very interesting, I think, when you’re out in the community, and Paul, you’re probably very familiar with this, working in a sort of a coalition based framework. It requires many, many different meetings with many people.

Michelle Drayton:

But the COVID pandemic, actually, because of Zoom, and because we started doing things differently, we transformed the way in which we worked. It actually helped to expedite and to actually strengthen relationships. So, we have done tremendous. I’m very, very proud of the team. We’ve done tremendous work in educating people and increasing awareness about hospice, but actually making sure that people in the community actually are admitted into hospice. Unfortunately, as I said earlier, on a national level, hospice utilization is very low among communities of color. Only 8.2% of the individuals who use hospice are African American or Black, 6% are Latino, 1.3% are Asian, Native American is even lower.

Michelle Drayton:

So, this pandemic, I think, illuminated… It leveled the playing field, if you will. Perhaps it made people a little bit more open and amenable to hearing about programs that are dedicated to people who have an advanced terminal illness. And people were ready to listen, and people were ready to mobilize. And so, my team, I have a team of liaisons, and I also had an incredible consultant who I was working with around faith-based issues. We were able to really increase admissions into hospice among African Americans, among Latinos. Particularly, we focus on Harlem and the Bronx right now. We would love to expand. But also, we were really able to engage faith-based leaders who are incredible influencers in the community to engage in the discussion. And so, COVID-

Paul D. Vitale:

Well, I’d like you to think about Brooklyn. I’d like you to think about Brooklyn. One of my clients is in Brooklyn, and it’s One Brooklyn Health who’s sponsoring this whole thing. And there are three distress hospitals that I’m trying to work with, not trying to, that we received a large grant, and we’re putting the hospitals together. And I think they could use your services. So, I am hoping that maybe I can see you over there and introduce you to someone if you haven’t been there yet. But there are three hospitals. And most of the communities are people of color, Latinos, et cetera, Black and Brown people. So, I would really, really like that. I’m sorry to interrupt you, but I always like to help my clients out if I can. And I think that they have a high need there. They really do.

Michelle Drayton:

I think you’re absolutely right. I think, I mean, we always know this, that collaboration is critical. No one entity can do it alone if we’re really going to impact people’s lives. And I think that that’s one of our key principles, and the values that we espouse at VNSNY is that we want to be in partnership. So, I’d love to meet your colleagues and talk about what we can do to increase hospice utilization in Brooklyn.

Paul D. Vitale:

And Dr. Dignam, I’m sure that you’ve seen it all this past year. And you’ve heard a lot. Can you tell us any stories about your patients, your challenges and your successes? We heard about Michelle’s successes, but I’m sure there was some challenges too with PPE and with people who-

Ritchell Dignam:

There were-

Paul D. Vitale:

Go ahead.

Ritchell Dignam:

Yes, there were so many challenges, in one word, I could say that that year of 2020 was unprecedented. With this COVID-19, so much was unknown in the beginning, and there was definitely the challenge of a global shortage of the PPE. But when we heard about COVID-19, this novel virus back in December, and even before it hit New York City, VNSNY was definitely proactive, as the leadership had put together a COVID-19 response structured in a way that there was executive leadership. And then from there, we created all the different sections of the organization. So, we have the emergency response planning team, we have the clinical infection control and leadership team. We also trained several nurses just to become the clinical expert response team to deal with the patients and families and even our staff. Because the main goal, really, with that year is to make sure that the patients and their families, as well our staff are all safe. So, we developed protocols, and they were all aligned with the guidance from the CDC, from the World Health Organization, as well as the state and local Department of Health.

Ritchell Dignam:

So, with that, right from the beginning, when there was a global shortage of the PPE, we had protocols of really how to in a way conserve our PPE without really compromising the safety of our staff. So, we develop screening protocols before we take care of the patients and their families. And we also develop our daily health assessment to make sure that our staff will not be the vectors of spreading the disease. So, those are the big challenges that we have. And the other challenge that I could say that I’d like to share is that there was constant new information that was coming out of this novel virus. And at the same time, the protocols and guidelines from the expert bodies kept changing. So, we had to keep up with that and make sure that the clinical team was really on top of looking at all the guidelines and advisories so we get our patients and families safe.

Paul D. Vitale:

You know, there are a lot of social determinants involved with our patients and with every patient. In my own family, my niece is a physician, and my other niece who’s a finance person. And I told the story in one of the other interviews, her husband got COVID, went into a hospital, then she got COVID went into the hospital, and they have two small children. And they were left. And it was a very, very difficult time for them. And all of this happened in the home. Did you have a lot of social work intervention, and did you have a lot of counseling in the home for situations like this? Because I know that this has happened, it happened to my own family. And I’m sure that you saw this in some of the families that your staff visited.

Ritchell Dignam:

Yes. So, actually, in 2020, with this pandemic, that is one of the things that was really highlighted, that there were such staggering lives that were lost. And the patients that were ending up in the hospital because they were COVID positive, there was definitely a physical distancing with their family, as well as the patients that were hospitalized. So, for example, in hospice, we’re really there to care for the patient’s family, hands-on care, but this pandemic changed the way we cared for the patient when the patients were dying in isolation. The patient, their families are not able to visit them either in the hospital or in the nursing homes, or assisted living because of the restrictions to mitigate the spread.

Ritchell Dignam:

So, our hospice team continued to support. We did not miss any beat to take care of the patients. We supported them by being the people… Our team became the source of information to update the patients and the family when they are not able to communicate with the hospital to see what’s going on with their loved ones. And there was also a memorial service that was hosted by the hospice bereavement team to really support the families, as well as our own staff with all the losses, both in their family.

Paul D. Vitale:

Thank you. Yeah, that’s beautiful. You guys are doing great things out there. And I think that it will be helpful to other organizations as they listen. Dan, you took over the Visiting Nurse Service of New York as chief executive officer in the middle of a pandemic, and came in, and had to transition. Was it a difficult transition for you, or how did you take over the middle of this whole thing?

Dan Savitt:

Well, what I would say to that is, it was… Since it was February, it wasn’t exactly in the middle, thank goodness. But what was nice is that I was named CEO in July, as Marki, my predecessor, chose to retire and we got a date. So, we had a long period of transition, which helped me to start my role much earlier than, say, if I was hired from the outside or it was a short notice transition. And so, the best part about the way we handled that, even though the timing wasn’t great, was that because we had a long transition, we were able to do that effectively. And we have a great leadership team. And so, if you have a strong leadership team, and we had a focus and a way of doing the work, and knew what work we needed to get done, with that longer transition, we were able to do that effectively. So, I felt pretty good about it.

Paul D. Vitale:

So, speaking of your leadership team, tell me, how did you motivate them? And how did you keep them positive during such a difficult, stressful time? How does a leader do that? Can you give some advice to some of our listeners out there?

Dan Savitt:

Sure. Well, the first thing is to provide focus, right? So, what are we going to do and what are we not going to do, right? And then that comes from vision, so you have vision and focus, and then when you have the right team, they can take that and run with it. And so, you don’t have to do a lot if you’ve provided those things and made sure that they have the resources they need. So, a lot of my role is making sure, one, we communicate to everybody, what is it that we want to get done, and who’s going to do it, and when are we going to get it done, and then making sure that everybody has what they need to be successful and course correct along the way. But when you have a strong leadership, if you point them in the right direction and they’re all rowing together, it makes the job a lot easier. And so, we had that, and we were able to come out as we started.

Dan Savitt:

The nice thing about it was, when you’re doing that, even in the midst of a pandemic, someone like me can be looking two, three, four years out and start planning for where we’re headed. And so, that’s where I spent a lot of my time because we had such a strong team focused on the right things with the resources that they needed, that we could still do our planning to get us ready for our next step.

Paul D. Vitale:

And what is your next step then?

Dan Savitt:

So, growth. So, we want to grow both within our current products, we want to grow outside of that, curate new products and services, and then grow geographically. And so, we have a number of ways we’re doing that. A simple example of that is we are adding to our Medicare Advantage portfolio. So, in 2021, we will be expanding into an MAPD and a dual snip product that gives us more reach in the Medicare community. And then we have a number of new provider programs like palliative care and other related programs, all focused against our mission, and especially on the most vulnerable in our community. So, we’ve got a good focus, especially around mental health, around taking care of complex populations, and then, like I talked about, with the new health plans coming out. And so, we think the combination of those puts us in a really strong place to, again, advance our mission in a way that’s also financially viable.

Paul D. Vitale:

Now, this question is for any one of the three of you. And that is, if you were to do one thing differently, one change… Now, a lot of people feel like, well, I wouldn’t do anything differently, and that’s fine if that’s true. But my son’s first grade teacher always told me when he did badly at his math test that mistakes are opportunities to learn. So, did you learn anything that you think you would do over again?

Dan Savitt:

Well, I think that’s a really good question. And that needs to be cultural within our organization. And the one thing I would say is we learned how to be agile. So, we were known as an organization that really struggled to pivot quickly. And I think what we did is we proved to ourselves, you know what, when focused on things that were energized around and that are aligned with our mission, we can do some pretty amazing things. And so, that doesn’t answer your question entirely about doing things, what would we do differently, but it certainly answers the question about the learning, which is we learned how to be much more agile, to move quickly, and to eliminate some of the hierarchical and bureaucratic ways that we were functioning in our silos and all that stuff. And then we could take that learning, and we have to keep it, we have to keep that, what we learn, and move that forward and not regress to the mean, so to speak, as we talked about [inaudible 00:31:05].

Paul D. Vitale:

I am so happy to hear that. I am so happy to hear that. Because when I worked there, I always learned, as I have spent many years in healthcare, in the for-profit and the non-for-profit world. And I would’ve been the CEO for 20 years, 10 in a hospital and 10 in a large, federally qualified health center. And the one thing that I learned in the for-profit industry was you need to have a sense of urgency about things. And if you don’t have a sense of urgency and are not nimble to make changes, you’re going to be behind the eight ball. And you seem to me, and I’ve just met you, Dan, you’re the first person that I’ve met for the first time, everyone else I knew very well that was on the episode, seemed a person that can make change and knows that you need to have a sense of urgency sometimes, especially in cases like the one that we just had in 2020. So, thank you, because I’ve always felt VNSNY needed to do that. And let’s put it this way, from working there for a few years, I could tell that it was a real tough needle to push. And you sound like you’re pushing it. And that’s a good thing.

Paul D. Vitale:

And it doesn’t mean anything bad about anyone else. It means that you’re trying to change the culture a little bit, and come with the times. And sometimes it takes something like a pandemic to do that. Because you know what happened in the pandemic everyone had to have a sense of urgency. And it showed them something that they never knew they had. And that way they could make change very quickly. I mean, when you look at the hospital system that’s one of my clients, did you ever think that, okay, you want to build an ICU? Might take you a year or two, or a new ED. Well, they built an ICU in two weeks in my hospital. I mean, that’s what we had to do. We had to make changes, move quickly, and do things in that way.

Paul D. Vitale:

I have another client who I trained as a CEO, it was a new CEO. They asked me to come in and work with him for six months. And he was the same way. And I think planning, and you use the word plan as a great thing to do. But it’s the execution that is important about planning. And you can plan all you want, but if you can’t execute, and you can’t execute with the focus, and I love that word focus that you used, Dan, then it’s not going to be a good thing. So, for those of you listeners out there, know that you can make changes. We all did healthcare. We all had to do that with COVID-19. Every one of my clients had to do that. And some of them struggled. And the ones that struggled, unfortunately, were behind the eight ball and had really tough times.

Paul D. Vitale:

I had a private equity gentleman from an organization called SeeChange, who all he does is deal with nonprofits. And he helps them out. And he knows how difficult it is for some nonprofits to move that needle of that focus and that sense of urgency. So, I congratulate all three of you. We’re going to take a break in a couple of minutes, but I want to get more on, I said this to someone I was interviewing, the softer side of 2020. And she said to me, “Was there a soft side to 2020?” And I said, “Well, what I mean by the soft side is, how did it affect you?”

Paul D. Vitale:

So after the break, I want you to think about this during the break, all three of you, if you could, how did COVID affect you as a leader? And how did COVID affect you, and how is it affecting you as a person? Because, Dan, this is just my thing, and for the two of you who are executives, I feel as though, I’ve always felt, and I’ve tried to do this my whole life, is that we, as executives in healthcare, need to show our vulnerability sometimes. If we don’t show our vulnerabilities, we don’t gain the trust of our employees. And what I say is high trust equals high performance, low trust equals low performance. So, I’m going to ask you when we come back from our break, how are you? And how are you as a leader, and how are you as a person after the year 2020?

Paul D. Vitale:

We’re talking today to Dan Savitt, and Dr. Dignam, and Michelle Drayton from the Visiting Nurse Service of New York. And for all of you out there, thank you for listening. And we’ll be back in a few moments while they think about this question. Thanks.

Speaker 1:

PDV Health Consulting’s podcast, Leadership, Transformation and the Healthcare CEO with Paul D. Vitale is made possible thanks to our sponsor, One Brooklyn Health. One Brooklyn Health is dedicated to providing high quality, comprehensive healthcare to the communities they serve through a network of acute hospitals, community-based practices, long-term care facilities, and partnerships with local healthcare providers. One Brooklyn Health’s patient centered approach extends beyond medical care to enhance the health and wellness of their communities, and their patients and families. Visit them online at onebrooklynhealth.org. today.

Paul D. Vitale:

Welcome back. Thank you. We’re here today with Dan Savitt from the Visiting Nurse Service of New York. He’s the new president and chief executive officer. And what I’ve learned about Dan so far is that he’s a man that’s focused, and that is trying to be a little bit more nimble, and has been really digging his heels into this organization. And for me, it’s great, because I love to see people like that. And we’re here with Dr. Dignam, who is the chief medical officer for the Visiting Nurse Service of New York, who’s talked a little bit about her challenges and about the great things that they’re doing. And lastly, we’re here with Michelle Drayton, who’s the director of hospice and palliative care and outreach for the Visiting Nurse Service of New York. And she talked about so many of the great things that they’re doing.

Paul D. Vitale:

Now, I ask you all a question, because I think that people need to know as leaders, and they look back, and they say, “Did I do this right in 2020? Did we make any mistakes? How do I feel as a leader? And then how do I feel as a person?” And that’s a very interesting question, because sometimes people say, “I feel the same way as a leader as they do as a person.” There’s no right or wrong answer. Or, “I feel different as a leader.” But as I said, if you really dig down deep, and that’s what I want you to do, I think it would be great. So, of course, we’re going to start with the CEO, Dan. Have you thought about that for a moment?

Dan Savitt:

Yeah, I think it’s interesting. Well, first, I don’t compartmentalize myself in any way. I just am incapable of doing that. So, even if I wanted to, I couldn’t. What I would say, throughout 2020, at the beginning of the pandemic, I was the chief financial officer of the organization. In addition to finance, I ran IT and analytics and those things. But I felt a little bit helpless, and didn’t know how to engage, to be honest. There are things I was doing and helping with, but I’m not a clinician and I wasn’t running the clinical side, I wasn’t running the operating side of the organization. So, the first month, I felt very uncomfortable. I’m an engineer by every part of me, by training and who I am as an individual. And so, I’m always wanting to fix things and make things better. And this was not a time for me to do that. And so, I learned a little bit more how to be patient, how to let go, how to stand back, and cheer, and engage in a way that I could be helpful, but not engage just because I felt left out. And that was a really, really valuable learning for me and a good preparation for the role I have today.

Paul D. Vitale:

Thank you for that answer, Dan, because you put yourself out there for a minute. And I think the greatest CEOs in the world are not afraid to put themselves out there. And that’s what I think. And I’m just a little older than you, maybe, by just a little. That’s what’s going to make you a great CEO. And I’m just so happy to hear you say that because comfort is important. And you are someone that is getting more comfortable in your role, and you’re not afraid to admit it. And as you move on and all these people hear that, especially the people that are new CEOs, they don’t know how to act sometimes. That’s why we want to talk about leadership and the CEO. Well, do I share this? Do I get vulnerable? And now I’m a consultant. And I’ve told this story once.

Paul D. Vitale:

And in the middle of COVID, we have three campuses. I was touring one campus because we need to make changes on that campus and close some beds and open up more outpatient facilities. And I was touring downstairs, and I’m there a few days a week. I have an office there. And took me downstairs, and I saw this room, a large room with boxes and names on it. And I said, “What is in that room?” And he said to me, “These are the valuables of all the people that had no families with them, or had families and they haven’t picked them up yet of people who have passed away of COVID.” And as a consultant, all I kept thinking about is, how am I going to bring these three hospitals together as one? How am I going to do this? We have 110 projects going on. I have other clients.

Paul D. Vitale:

And I just looked at those boxes. And I said, “Oh, my God, look at how many people here were alone.” And it was the first time in front of a client now, these are people that are paying customers, that I started to tear up. And I started to cry because I couldn’t believe how many people lost their lives and left their valuables, things that were important to them, pictures, clothing. It was one of the most emotional times that I went through.

Paul D. Vitale:

Someone said to me, “Well, how do you feel?” And I gave them that answer. And still, when I think of that, even right now, when I think of that right now, at this moment, I just tear up. I just can’t believe it. Because it’s like when patients were discharged, and it was supposed to be a happy time, we would play songs in the hospital. And they asked me, “What songs do you think we should play?” And I said, “What a Wonderful World.” And even though it was a horrible world, when somebody left, it was a wonderful world. So, by you being out there, putting yourself out there, Dan, I want to just say thank you. And so, Dr. Dignam, what about you?

Ritchell Dignam:

Well, for me, as one of the leaders in this very large organization, what I learned from last year is that there’s so many leaders in this organization. You’re never alone. You can always go to their expertise and work on their strengths and learn from them. At the same time, to be an effective leader is that you need to know what your group or your team or your staff really need. We have to be efficient with our communication, collaboration and coordination of care so we’ll be able to achieve caring for the patient and family, keeping them safe, as well as the employees safe.

Ritchell Dignam:

So, other than me being involved in some of the leadership teams to put the protocols together for the COVID-19 and our response team, is to really engage our employees and hear from them. What do they need? Are these protocols working? What else can we improve? So, as an effective leader, I think the communication should be both ways, communicating to them at the same time.

Paul D. Vitale:

I want you to tell me how you feel though.

Ritchell Dignam:

In the beginning, it was frustrating because of so many unknown things, like the COVID-19 and the rapid changes. So, that frustration turned into more of a challenge for me, that when you are hit with obstacles and challenges, you don’t shy away from them. You hit them head on and find solutions, be creative. But don’t do it alone, do it with other leaders, and also with the whole organization as well as the employees.

Paul D. Vitale:

I’m sorry to interrupt you, but I just had to ask you that question, because we’re on a timeline. But the interesting thing about this, doctor, is that I was walking in the hallway with our chief executive officer one day in the middle of this whole crisis at the beginning. And we met one of our intensivists, one of our intensive care doctors. And I had met him before, and he seemed like a very calm guy. And he stopped us, and he saw our CEO, and he started screaming at her, “This is crazy, this is nutty, we need more intensive care beds.” And he was going on and on and on. And you know what? This wasn’t about anything but his own emotions and stress level. It was about his stress level. And at the end, LaRay, who’s just a great CEO, turned around to me, and she said, “I know what this was about.” And we have to take care of our doctors. We have to make sure that our doctors are people that know that as they care about people, we care about them.

Paul D. Vitale:

I have a niece who is a doctor. She’s an emergency room doctor. And she’s my godchild. And I would say to her, “How are you?” And she would give me a doctor’s answer, and then I would say, “How are you?” Again. And then she would give me her answer. And she would cry. She’d say, “It’s very hard to be with people who are alone, who died. And it’s very hard for me to see that. I’m not used to that. I’ve never seen that before. I’ve seen people die, but I haven’t seen people die right in front of me every day, more than one, more than two.” And I’d give her a hug, and I’d tell her I loved her, and listen to her. And that’s what I heard you say. I listen to people because it is important, doctors, nurses, whoever, you have to listen to.

Paul D. Vitale:

So, I commend every nurse and every doctor, every aide, every housekeeper that works where I’ve worked, and I’ve worked in multiple places, and now I work at multiple places, because I feel that they see a lot and sometimes feel that they can’t show their emotions. And that was what I call the softer part of it. So, thank you for your answer. Thank you for your honesty. And last but not least, Michelle, can you give us a little bit on how you feel?

Michelle Drayton:

I think that the pandemic certainly caused me to stretch beyond the unknown and to embrace it. And I think that in that stretch, in that demand for us to go beyond what we understood in our work actually made things more actually successful. I think oftentimes, as Dan mentioned earlier, we get used to working in one way. And we don’t stretch beyond our own particular line of business. But I think that the pandemic demanded that we reach across tables, we reach across divisions, and that we rely on each other a little bit more. And it also demanded us to use technology in a more effective way where we could actually look at each other and make more connections, perhaps even more than we would do in a regular meeting when there were 10 people in the room. But I was able to connect with you because I saw the baby in the background, or the dog that jumped on your lap, or you were sitting in a place that seemed to be interesting. So, it did force us to connect to each other in ways that we had not connected before. And I think we need to hold on to that because that level of connection is the secret sauce for many things that we need to continue doing, and that is serving the most vulnerable populations with complex healthcare needs. We can’t do it alone. We have to do it together.

Paul D. Vitale:

Yeah. Yeah, I agree. I agree wholeheartedly. When I was first starting out, someone said to me during the AIDS crisis, when we had the AIDS crisis, the AIDS epidemic, they said, “You have to TOYF.” And I said, “What does that mean, TOYF?” And they said, “You have to think on your feet.” And I’ll never forget that because everybody had to think on their feet during this pandemic. And it was a quick change.

Paul D. Vitale:

We’re talking today with Dan Savitt from the Visiting Nurse Service of New York, who is the president and chief executive officer, Dr. Dignam, who is the chief medical officer, and Michelle Drayton. It’s been really a pleasure to speak to you. And, Dan, I want to ask you, what do you think the future of healthcare is after all this? Where do you think we’re going?

Dan Savitt:

I think we’re going where we were going, it’s just faster. So, we’re seeing a lot of consolidation in the industry. You’re seeing those with the money right now, which are the big payers, they’re consolidating vertically and investing significantly in technology. We see a lot of private equity and venture capital in the space too. And we were heading toward more care in the home, heading toward, of course, more value-based care to providers and other types of groups. And I think we’re just moving faster. I don’t know that we’ve changed our trajectory. What I do know is the needs are greater. And I think the disparity in health, right, those that have and those that have not is just widening. I think the case for increased mental health and social determinants of health resources is high, right? That’s just continuing to be a bigger part of what we do every day before we can even treat the medical side of the equation. So, I’m not sure we’re headed anywhere differently. We’re heading towards telehealth and remote patient monitoring, and more access to services in the home and in the community. I just think it’s happening faster.

Paul D. Vitale:

Yeah. Yeah, I agree. I agree. So, last question, Dan. And this is to your two fabulous lieutenants that are on this podcast with you, and to all of the caregivers out there, what advice would you give them? And what would you tell them now? And first to your two colleagues that are on this podcast with you.

Dan Savitt:

So, Paul, just to be clear, you’re asking what advice would you give caregivers out there today, and you would like maybe Michelle-

Paul D. Vitale:

Yeah, and then what would you like to say to your two colleagues that’s on the phone with you right now?

Dan Savitt:

Oh, my gosh. What I’d like to say to my colleagues, I am so thankful for them and the teams that they manage, and what they do every day. The two of them are really focused on an area of need for our communities. And I’m really proud to work with them, and frankly, all of our clinical and non-clinical team members. So, that’s what I would say.

Paul D. Vitale:

And what about everybody that’s listening today? What would you say to them, caregivers, administrators, healthcare workers, what advice would you give them?

Dan Savitt:

Spend time away from work. That’s what advice I would give them. You need to-

Paul D. Vitale:

What do you like to do out of work?

Dan Savitt:

Oh, me?

Paul D. Vitale:

What’s your hobby, Dan? Yeah.

Dan Savitt:

I love to do lots of things. I have lots of kids that are older now, so we can enjoy them in different ways. And I love spending time here in the city. I’m so glad it continues to open up. I have never stopped coming here and spending time in the city. Even eating outside in the cold. So, I’m just excited to be outdoors in the warm weather with my family and friends. And so, that’s what I do.

Dan Savitt:

But I mean that sincerely. Our caregivers are very, very stretched and stressed. And the best advice I can say is recognize that you are, and then do something about it. Get away from it, get away from it. You just need to get away from it, and then come back to it because it’s a little bit like a war out there, right? And if you don’t take a break, you’re going to melt down. And we saw a lot of that. A lot of that during the pandemic, and it’s really tough to watch. And that’s part of the feeling like you can’t do anything to help, right, and a little bit useless as a non-clinician. But yes, take time away, be with your family, do something you love to do that’s not clinical related. The work will always be there, but you gotta get away.

Paul D. Vitale:

You know what I did, Dan? I was supposed to go to Germany this summer. And I couldn’t go to Germany. And I said to my wife and my family, “What are we going to do?” Because we were going to go together, and we were going to go to Oberammergau. They have a passion to play every year there, and… Every 10 years, rather. And we were going to do that and go to the Italian Alps. We had this whole big thing planned, and it all fell apart. So, we rented a house on the Jersey Shore. And what I did was, I bought a house. It took me about the first visit, I rode my bike, I saw them building a house on the ocean, and I bought it. And I said, “I need to get away from things.” And when I get away, the ocean gives me peace. And I want peace in my life now. We all want peace in our life now. And we want peace in our country. And we want health, good health in our country.

Paul D. Vitale:

So, to our listeners out there, we’ve been talking with Dan Savitt, who is the president and chief executive officer of the Visiting Nurse Service of New York, Dr. Ritchell Dignam, who was the chief medical officer of the Visiting Nurse Service of New York, and Michelle Drayton. It was an absolute pleasure to speak to all of you today. And Dan, if you can please give us your website, so if people want to contact or need the Visiting Nurse Service of New York, or the hospice, or anything else, where would they go? On what website?

Dan Savitt:

Well, it’s very simple, www.vnsny.org. So, Visiting Nurse Service of New York .org. So, yep, thanks so much for having us, Paul. I appreciate it.

Paul D. Vitale:

Well, thank you all very much. And I want to thank One Brooklyn Health System, who sponsored this event. Kingsbrook, Brookdale and Interfaith hospitals have a special place in my heart. I hope, Michelle, that you can get over there and maybe help us develop patients to be interested in hospice because I know we have many that are in that particular area. Thank you all very, very much. Be safe, be healthy, be well, and have peace. Bye-bye now.

Michelle Drayton:

Thank you.

Dan Savitt:

Thank you, Paul.

Ritchell Dignam:

Thank you, Paul.

Announcer:

Thanks for listening to this episode of Leadership, Transformation and the Healthcare CEO with Paul D. Vitale. We hope you enjoyed it. Special thanks to One Brooklyn Health for supporting the show. And we hope you will too, by giving us a positive rating on Apple Podcasts, Spotify, or wherever you listen to podcasts. If you want to learn more about the topic we discussed today, visit pdvhealth.com, where you’ll find the show notes. The PDV Health Consulting executive team is proudly joined by world renowned psychiatrist, Dr. Francine Cournos, along with top industry leading experts, Susan Flics, Joan Marren, Dr. Frank Kwakye-Berko, Dr. Alan Abrams, Sam Heller, Andrew Anello, Dr. Lisa DeRoche, and special projects manager, Afua Kwakye-Berko.

PDV Talks With: Karen Ignagni, President and CEO, EmblemHealth

PDV Health Podcast Show Notes

Announcer:

Welcome to Leadership, Transformation and the Healthcare CEO with Paul D. Vitale, a brand new podcast from PDV Health Consulting, sponsored by One Brooklyn Health. With a special introduction in every show by LaRay Brown, CEO of One Brooklyn Health, we talk to New York’s top healthcare CEOs as they share their stories on how they managed to drive their organizations through tough times, and also hear about the transformations they’ve experienced firsthand. Here’s your host, Paul Vitale.

Paul D. Vitale:

Hello. I’m Paul Vitale, President and CEO of PDV Health Consulting. Welcome to Leadership, Transformation and the Healthcare CEO.

LaRay Brown:

Today’s episode will focus on managed care, and we have an exciting guest. Karen Ignagni is the President and CEO of EmblemHealth, which is a unique organization. In addition to being a managed care organization or payer, EmblemHealth is also an ambulatory care system. I’m sure Karen has a lot to say about being a payer provider organization and its challenges. So now, I’ll turn the program over to Paul and Karen.

Paul D. Vitale:

Thank you, LaRay. And welcome everyone to our series of Leadership, Transformation and the CEO. Happy to be here today. Today we have an unbelievable guest for you to listen to. She’s the President and Chief Executive Officer of EmblemHealth, Karen Ignagni. She’s someone that I think you need to hear from today. You’ve heard from people in long-term care, in acute care. You’ve heard from Mitch Katz, you’ve heard from LaRay Brown. Now it’s time to hear from a very interesting organization, EmblemHealth. So I want to welcome you, Karen. Happy to have you with us.

Karen Ignagni:

Thank you so much.

Paul D. Vitale:

Yeah.

Karen Ignagni:

It’s a pleasure to be here.

Paul D. Vitale:

Great. So Karen, the way we’ve started off a lot of these podcasts is really to talk a little bit about how you got to where you are. A lot of our listeners are listening to this because most of the guests are Chief Executive Officers and they’re wondering, how can I become a Chief Executive Officer one day? So, can you tell us how you got to where you are and a little bit about your background?

Karen Ignagni:

Yeah, of course.

Paul D. Vitale:

Thank you.

Karen Ignagni:

I started my career in Washington, D.C., and started working for the federal government at the department of health and human services, estimating healthcare expenditures. It was serendipitous. I never imagined that I wanted … I studied government, wanted to think about some job in that connection, but wasn’t really looking to estimate healthcare expenditures. But a professor of mine knew someone in the federal government and it just happened that they had a vacancy. So actually, it was probably one of the best places to start from a policy perspective because it taught you, how do you disaggregate healthcare expenditures? Where is the funding going? Who’s paying for it and how do you look holistically?

Karen Ignagni:

And then from there, I went to Capitol Hill and worked on what’s now the health committee, human resources and all of the labor issues. And then I was recruited to join the AFL-CIO, where I worked for a decade, helping unions negotiate contracts, preserve their benefits, and doing their healthcare pension domestic policy issue work. And then I was recruited to join the association that represented all of the health plans. And we did several mergers and grew that organization. And from there, I got a call one day, this was post-healthcare reform. We worked very closely with the Obama administration on health care reform in the beginning. And then of course, when things went off the rails in terms of the exchange, mobilize people all across the country to help with that.

Karen Ignagni:

And I feel very, very grateful to have had that experience. But I got a call from the CEO of EmblemHealth, about whether there is any interest in coming here, and had to think about it a little, but in a way, Emblem brings together all parts of my background because we are a union company, number one. We represent city workers and union members. We serve Medicare and Medicaid, commercial, ASO, administrative services only. And we have a very active wellness company too. So it joined together my policy experience, my unique personal experience in terms of I was a daughter of two union members, and the opportunity to rebuild a plan that has been a part of New York City and state for more than eight decades.

Paul D. Vitale:

Yeah. So for those of you who don’t know it, EmblemHealth is really an outcome of programs that … My dad was a police officer and all of our life, we had HIP, HIP. And we would go to the HIP building and we would see the doctor. And then if we needed a specialist, we would go to the specialists. And then we had GHI, which was another insurance that represented my father. So, a lot of these, how many of these programs actually came together to form EmblemHealth, Karen?

Karen Ignagni:

HIP and GHI came together with ConnectiCare, up in Connecticut. And what is now ACPNY, which you knew as the old HIP clinic, they’re very, very different today than they were 20 years ago, for example. We have a fabulous leader there, Dr. Rodriguez, who leads the whole team and its primary care specialty services. And now we have 40 centers throughout the five boroughs in Long Island. It’s definitely developed and grown.

Paul D. Vitale:

Yeah. Here’s something you don’t know about me, Karen. And I know it’s your interview, but I’ve always wanted to tell you this. When I was a child, when I was nine-years-old, I had very bad asthma. That’s what we thought it was, asthma. And I would get sick very often. And my father said, “I’m taking you to the …” We called it the HIP Center. “I’m taking you to the HIP Center now and I’m having you see Dr. Louis.” That’s what his name was. I was always afraid of him, but he was very nice. And he listened to my chest and he said, “You need to go to another doctor.” So we went to another HIP doctor, a specialist. And before you knew it … Actually, I remember that day pretty much, my parents were taking me out, I thought they would buy me a pair of shoes. They didn’t want to scare me. Instead, the next step was the hospital. North Shore Hospital at that point. And at nine-years-old, I needed surgery around my heart because there was a tumor that was growing, and actually-

Karen Ignagni:

Oh, my God.

Paul D. Vitale:

And this was 45 years ago, maybe 50 years ago, and it was a very serious operation. And it was all done by HIP. And after-

Karen Ignagni:

And that was impacting your breathing [crosstalk 00:07:48].

Paul D. Vitale:

Oh, yes, I couldn’t breathe anymore. I couldn’t breathe anymore.

Karen Ignagni:

Oh, God.

Paul D. Vitale:

It was becoming a terrible thing. And at that time, that kind of surgery was really very, very serious. Now it’s a bypass, where they cut into your chest and everything. But at nine-years-old, it was frightening. But I’ll never forget that. And I used to always think the HIP doctors were doctors that were scary. But HIP actually saved my life when I was a little boy. So I thought you should know that. That’s a little history about HIP.

Karen Ignagni:

There’s so much history with this plan and the physician group. And that is really just such a satisfying thing that makes all of us who work in this enterprise really proud. Because we’re not for-profit plan, a declining breed in the health market today across the country. We’re domesticated here in New York, this is where we’re located. We have a number of different centers. The people who work at the centers look like the communities they serve. We’re very proud of them. We have one of the largest non-invasive cardiology practices, a very, very large GI practice, endocrinology, podiatry, ophthalmology. Those are just some of the examples. But our specialists, they actually perform surgery, some do it in the office, some do it in ambulatory care centers or hospitals.

Karen Ignagni:

So, it is a very important part of the community. And the communities we serve are very, very underserved. So we’ve been very proud to actually partner with the city and state to be partners first on COVID testing during this pandemic, which has changed so many people’s lives, but also to partner on vaccines. So we were offering vaccines in early January in partnership with the state and city, for city workers, for members of the community, very, very hard hit by COVID because the people who have been the most underserved have the most disparities as we know, have a higher probability and did have higher probability of getting COVID. That’s our patient base. So we’re very focused on serving our patients and making sure we’re doing what people expect and what they need.

Paul D. Vitale:

And that’s one of the reasons why I invited you to do this today because that’s been my mission my whole life, to work in healthcare and serve the underserved because that is something … Your organization is very special. I remember one of my positions in my career was CEO of a large PACE organization. Now for those of you who don’t know what PACE is, PACE is called the Program for All-Inclusive Care for the Elderly. And it really is a program that some of you listeners may want for your own family because it is a nursing home without walls. It takes patients that are nursing home eligible and keeps him at home with a very, very close watch. Usually there, when I ran it, I mean, I think if we had 1,000 patients, that was a lot because you really have to do close, close case management.

Karen Ignagni:

And it’s so intensive.

Paul D. Vitale:

Oh, yeah, very intensive. And the objective, and the families know this, is to keep them out of the hospital and to provide what I call the triple aid because it really is to try to get the best outcomes that you possibly can at the lowest possible costs and give them good access. And we would send them to day centers. We had day centers every day, and we had beds there in case they needed IVs fluids or they had pneumonia. And for many things back then where people were going into the hospital, they just weren’t going anymore. So, I ran an organization much, much smaller, but it had the same idea of being a provider and a payer. So I want you to address that a little bit more because a lot of people say, “Well, how can somebody be a provider and a payer?” Now they have mixed emotions about what they do. Can you comment on that for a moment?

Karen Ignagni:

Yeah. Most people know Kaiser. We’re Kaiser without the hospital because we have the health plan and we have our physician groups. And our physicians are embedded in the community, very, very focused on what our neighborhood surrounding our centers need. And very focused on social disparities and issues relating to social determinants of care. And from a health plan perspective, I think there is a unique opportunity to have both pieces. We at ACPNY, our physician group, AdvantageCare Physicians, we serve Emblem patients, but we also serve other payers as well, to make sure that we are doing the job in our communities that individuals expect. There’s a complete firewall between the payer side of Emblem and the ACPNY side from the standpoint of how they connect with other payers.

Karen Ignagni:

But what they’re doing for us, they’re doing for other payers, and what they’re doing for other payers, they’re doing for us, which is focusing on quality. They have the highest certification. It’s called the primary care medical home, patient centered medical homes. We have the highest certification and all of our centers were Epic enabled. So we have a medical record that follows an individual across our 40 centers, wherever you might go. So if I go to Harlem, they can bring up my record, if I go to Flatiron later in the day or two weeks from now, or I go to Brooklyn, or I go to Staten Island, or I go to Long Island, they can see what was done in my record in Epic. So we’re very sophisticated from the standpoint of infrastructure, but really there’s a soul here to a not-for-profit organization like Emblem that I think is unique in the delivery system.

Paul D. Vitale:

Yes, I love the word soul.

Karen Ignagni:

There is. And it carries forth to our physician group. And we’ve now, we have a wellness company that is serving people across the country now. So, taking these concepts of how do you do chat therapy? How do you do coaching? How do you help people deal with difficult times? And COVID was quite a test for our wellness company. They’re also offering services to our city goal numbers, our HMO for city workers. And I can tell you, for city workers, our city goal plan and our coaches have made a significant difference during this time. And just the comments and the little notes we get, it’s just been so satisfying. When you go to bed at night, you think there’s a mission here. We’re very clear about what the mission is. And if you have the honor of being able to participate in a mission-driven organization, as far as I’m concerned, Paul, there’s nothing better.

Paul D. Vitale:

We’re talking today with Karen Ignagni, the President and Chief Executive Officer of EmblemHealth, a payer provider organization, as part of the advantage care clinics that you see all around New York City, which are beautifully done, I must say, Karen. So, can we talk a little bit about 2020?

Karen Ignagni:

Yeah.

Paul D. Vitale:

And just a little bit about your successes, your challenges, and any stories. I’m finding that our audiences want to hear the stories, that that helps them get through some of the emotional pain that they themselves have had. I know I’ve lost some friends and I’ve had some family members that, well, they didn’t die, but they are what we call long-haulers. And they have a 50-year-old nephew that had just so many things after COVID. So, can you chat a little bit about that, and you and your organization?

Karen Ignagni:

Sure. As I think about it and look back, one of the things that every leader had to do, wherever they were placed, in either the healthcare system or any other place, you had to think about how you operate in a system of pandemic. I can remember around Saint Patrick’s Day in ’20, thinking, well, this might be a month or two, who knew? I just didn’t have the ability to conceive that more than a year later, the economy would still not be back, and that people would still be at risk. So the first thing was, how do you create a digital service operation? And for us, we had to do it on the physician side, as you said, turn our ACP centers into digital operations. So people could still see their physicians. We treat people who have significant chronic illnesses, and to make sure we’ve continued that.

Karen Ignagni:

Our centers never closed, Paul, throughout the whole time COVID. So we had to make sure we were being responsible following CDC guidance. How do you space people? How do you make sure people coming in don’t have COVID, etc? Like every hospital and every other healthcare organization had to do, but we also had to go digital. We did that in a couple of weeks. Thank goodness, we were Epic enabled that helped that. On the health plan side, we had to take 5,000 people who used to work in offices, whether they are call center individuals, people who are doing various policy work, product work, what have you, you had to get them home. And that took about two and a half weeks, I’m pleased to say, because as part of our transformation and turnaround with Emblem, we started on the tech side.

Karen Ignagni:

So we went from a number of very old, creaky, held together with duct tape systems to a modern technology system. We couldn’t have gone digital if we didn’t have that. So we quickly had to get people home, ship notebooks to them, ship computers to them so they could continue to operate. And as a leader you think, “All right, what do I need to do to meet the moment?” So first are the rather procedural things of how do you get people up and running so they feel connected? And how do you do it fast? And thank God, we have a wonderful group of operations, individuals, IT people who just truly met the moment there, and I’m very grateful for what they did. Then as a leader, you think, “Well, how do you make sure that people are coming together, working together, and they don’t feel isolated?”

Karen Ignagni:

So we use Teams, Microsoft Teams, and I would find myself making sure that I always turned on my camera, set the tone, make it personal, make every interaction as personal as I could, as the leader, and to make sure that others were doing that too. So we talked a lot about that. I would reach out to people just to see how they were doing and listening to what they said. So just meeting the moment as a leader. And then for our members, we treat a number of people who we know are very vulnerable, and have a number of chronic illnesses. And so what we did was we ranked the people who we thought were the most vulnerable from the standpoint of disease and illness, and we reached out to them. We called them, we mobilized every part of our operation to make those calls. We call that our Peace of Mind initiative. Just to see, do you need anything? Can we help you?

Karen Ignagni:

Now one of the parts of our organization that’s also unique, which really came into play here, was our neighborhood care centers. We have 13 neighborhood care centers spread throughout New York City. They have always been open to the community free of charge, people could come in for wellness, a friendly face, hook up their laptop or their phone, get a charge, deal with, if they had social issues, housing, food insecurity, what have you. We had to take that, of course, digital, and that helped us create programming. So we created meditation programming. We created programming around behavioral health, so that we could offer additional support to our members. So what essentially happened during COVID, and I couldn’t have predicted this, but we opened the windows of our health plan. And we thought of our mission much broader than we had at the start of ’20.

Karen Ignagni:

And when the federal relief began coming, we made it our job to make sure customer service reps and others in our entity could help people with unemployment. Could help small businesses know where to apply for loans, and help, and support, because we thought it was part of our mission, not just to offer health insurance, but to help our customers in any way we could. So that’s meeting people where they are, that takes that concept and really blows it out. So we did a lot of that.

Paul D. Vitale:

Yeah. And for those of you who are listening right now, listen to the words. And when we talk about leadership, listen to the words that Karen just said. And that will tell you, I just finished a coaching gig, as we call them, a consulting business with a brand new CEO. And he asked me, “Gee, what do you think is the most important thing I should do as a first time CEO?” And the words that Karen use, for any of you out there, and I work in a great place right now and one of my major consulting engagements is with One Brooklyn Health, around doing a transformation of three hospitals, distressed hospitals, which has been a challenge, but because of our leadership, because of LaRay Brown, who’s sponsoring this whole thing, with One Brooklyn Health, we’ve managed to begin to say words like Karen just said.

Paul D. Vitale:

She used the word soul, she used the word humility. She used words that were open. We opened our doors, we were open every day, we gave access. We in the healthcare business know that access is extremely important, whether it be digital, whether it be person to person, whether it be by phone, she used all three. She just said she used all three. So to me, working with this population, we need to humble ourselves, as you hear one of the largest organizations in New York, managed care organizations. How many members do you have, Karen?

Karen Ignagni:

3 million.

Paul D. Vitale:

3 million. So we hear somebody with 3 million members talking with those words. That’s the most important thing. I was telling Karen before I started, I had some questions that I sent her and I said, “Karen, I think I’m going to drop the questions and talk about more of the softer issues of 2020.” And she said, “Were they really softer issues?” And yes, they were. And you just described them, Karen. You just described softer issues that were good, and were successful. But I want to ask you, what were the biggest challenges that you had?

Karen Ignagni:

Yeah. I was just thinking as you were talking about one of the most, I want to try to find the right word for it, but impactful just doesn’t cut it. Emotional maybe, experiences for me. I made it a point because I just thought it was the right thing to do, to phone every family member where one of our team members was lost to COVID. And that was just a very emotional experience for them. And one of them, of course … And one of the things that really made me feel just completely powerless, as a leader, you like to think as a leader, you can make things happen. And I’m really proud of that because I really work hard, our team does to make things happen and do it as quickly as possible, as effectively as possible. But here people would tell me at the beginning, particularly in the spring of COVID and the early summer, they don’t know where their parents or their spouse’s body is, because there were just so many individuals passing. They couldn’t get space in a funeral home.

Karen Ignagni:

And I just thought to myself, as we think about healthcare, we don’t normally think about … We think about death and we think about dying from the perspective of what can we do to ease a family and a patient’s pain? But you don’t think about the other issues that people were struggling with. And I think, Paul, as we think about public health going forward, we have to look at those kinds of issues. But just to be able to offer some empathy is so important. And as leaders, we need to always remember that. It’s kind of do unto others principle, but also it made me feel completely powerless that I couldn’t help with funeral homes and things like that. I wanted to but it was a time when this city was just reeling.

Paul D. Vitale:

Yeah, the burning.

Karen Ignagni:

With what we all went through. And we all went through it together. I mean, I remember feeling as nervous as everybody else about going to the grocery store. And should you go outside safely? And should you go in your elevator? All those things that we live in apartments in New York, and everybody had that experience.

Paul D. Vitale:

I remember one of the most emotional experiences I had, because of this client, but One Brooklyn Health system, I have an office here that I go into a few days a week. And I was working on one of the campuses that we are really transforming, the Kingsburg Campus, and I was downstairs touring. And I saw a huge, almost like caged area with tons of boxes and names on it. And I said to the person who was touring me, “What are all those boxes?” And they said to me, “These are people who have passed from COVID, who had no families and couldn’t find them, and these are their valuables. These are their treasures.” And at that moment, I started to tear up looking at those boxes.

Karen Ignagni:

Yeah, of course.

Paul D. Vitale:

I just couldn’t help myself. I said, “Here I am a new consultant tearing up and crying down in that base.”

Karen Ignagni:

It makes me tear up just listening to you tell the story. And we can’t forget that. And we can’t forget them. As we, from a policy perspective, think of mass, what is it going to take to rebuild public health?

Paul D. Vitale:

Yes.

Karen Ignagni:

And this is a decade.

Paul D. Vitale:

Oh, yeah.

Karen Ignagni:

Well, decades long process of unwinding public health. And now we have to rebuild it in a very significant way.

Paul D. Vitale:

We do. We do. After the break … We’re talking with Karen Ignagni, President and Chief Executive Officer of EmblemHealth, a wonderful organization, and a great CEO, who I admire very much. And I know that listening to her, and at the end we’re going to get her website. And you might want to just email her something. I’m sure the website will get the email to her because she’s a person that you can learn from and a person that runs a great organization. But after the break here, I’m going to ask you one question. And the question has three words in it. And the question is, how are you doing?

Paul D. Vitale:

And I want you to think about that for a moment because CEOs are vulnerable, but they don’t like to show it because they feel like they’re powerhouses and they can’t show it to anybody else because they have to be strong. I was a CEO of 20 years, 10 in a hospital and 10 for a federally qualified health center. And I sometimes felt that way, I can’t be vulnerable, I can’t show my emotion, I can’t do anything. Well, I’m Italian so I’m always showing emotion one way or another.

Karen Ignagni:

Me too.

Paul D. Vitale:

So after the break, we’re going to hear from our sponsor right now, and after the break, we’ll come back and see what Karen has to say about that. We’ll be back in a few moments.

Announcer:

PDV Health Consulting’s Podcast, Leadership, Transformation and the Healthcare CEO with Paul D. Vitale, is made possible. Thanks to our sponsor, One Brooklyn Health. One Brooklyn Health is dedicated to providing high quality comprehensive health care to the communities they serve, through a network of acute hospitals, community-based practices, long-term care facilities and partnerships with local healthcare providers. One Brooklyn Health, a patient centered approach, extends beyond medical care to enhance the health and wellness of their communities, and their patients and families. Visit them online at onebrooklynhealth.org today.

Paul D. Vitale:

Well, welcome back, everyone. We’re here today with Karen Ignagni, the President and Chief Executive Officer of EmblemHealth. We’ve had a fabulous discussion so far, about 2020, about being a good leader. And prior to the commercial break, I asked her, she could think about this question which has three words. And that is how are you now? And I must tell you that I’ve interviewed, you are one of the final interviews, but I’ve interviewed I think six, two CEOs of hospitals, a CEO of a large, long-term care division, a CEO of a substance use organization. And it’s funny because all of them either laughed, and then after they laughed, when they heard it like, “Haha, are you kidding me? How do I feel?” Or one of them cried because she lost her brother from a drug overdose, actually, in that COVID. So I asked you this question. How are you?

Karen Ignagni:

Yeah. I think everybody in the country, you don’t get a chance to use this word, but since you gave me a minute to think about it, the word gobsmacked, everybody in the country feels that way about this year. I made the point of really forcing myself to do something every day by way of exercise, because I thought I would just really not make it through unless I found a way to get some physical exercise, number one. Number two, I found that we have found a new voice in this period of such trauma, in terms of our physician group playing such an important role with the city and the state, and our health plan really serving our customers in a way that we just never expected. So I feel very grateful for that.

Karen Ignagni:

I feel that, I remember back when I was working on Capitol Hill, when I was just starting my career, and it’s so funny you should be asking this question. I can remember I was sitting in my office. I know exactly what the desk looks like and what I looked out on. And I remember worrying that as members were trying to reduce public health subsidies, I remembered worrying what would be the consequences of this. And until you asked the question, I hadn’t really thought, but now I can see myself. Some people have memories where they see themselves back in certain circumstances. I can’t say what I was wearing, but I see the desk and I see the little window. And I remember shaking my head, but I was young and I really didn’t have much by way of background, but I worried that we were beginning to take in on Capitol Hill, too much funding away from public health.

Karen Ignagni:

And I think as a result of all this, Paul, I think we all, anybody who’s working in the healthcare industry should be united and working together to campaign for a better, repaired public health infrastructure. That means enough public health workers to support whatever might come. And it also really hit me over the head as we were moving to digital, that there is such a digital divide, that I have the good fortune I’m sitting here, I have my cell phone, I have a computer and I have an iPad. Many families have one device, and they’ve had to share it for medical appointments, for educating their kids, for their own work, etc. So we have to do better as a society as we think about how to deal with inequity. This digital divide is a healthcare issue too.

Karen Ignagni:

So it’s made me think more broadly about all these issues. It made me remember where I started in my career and what had happened on Capitol Hill over decades, in terms of taking money away from public health. And the fact that we all have a role to play in building the system back, because it’s for all of us. And that’s the thing that we all should have learned. Public Health is for all of us. We have to have a number of public health workers that are adequate to do the job, they have to have proper training. And we have to have more social workers and people who are behavioral health specialists, because one of the major diseases now is isolation. People have been home so long, by themselves, and even if they have to occasionally get in an elevator, they still are feeling very, very isolated.

Paul D. Vitale:

Oh, yeah.

Karen Ignagni:

And you can see it every day. And I think that’s an important public health issue. So we have to think bigger about healthcare, deeper about public health, and more aggressively about rebuilding this infrastructure and supporting the people who are on the front lines.

Paul D. Vitale:

Yeah. The producer of the show said, “You can talk a little bit about yourself too while you’re on.” So, I have a little story, which people ask me, “How do you feel now?” I mean, working at One Brooklyn was a beautiful moment. I said this in the last interview, but I was listening to the music when a patient was discharged. And they asked us, LaRay asked me, “Pick a couple songs that you think people would like to hear.” And I said, “What a wonderful world.” And if we can make this a wonderful world together-

Karen Ignagni:

Yeah.

Paul D. Vitale:

You.

Karen Ignagni:

Yeah. Then we will have done something important.

Paul D. Vitale:

We would have done something to change things.

Karen Ignagni:

And endure [inaudible 00:37:19].

Paul D. Vitale:

Then I thought about the moment where I still have what I would call some post-traumatic stress, if you will, from this. This one, my niece, I have two nieces that live on Long Island. And one is a doctor in an emergency room, the other one’s an executive in finance, both have families. The one that’s in finance has two small children. Her husband came home and he’s the one that I told you was a long-hauler. Had to go into a hospital, he had [O2 stats 00:37:49], which for the folks out there don’t know, that is his breathing was very, very shallow and they were ready to put him on a ventilator after 10 days. In the meantime, his wife got COVID.

Karen Ignagni:

Oh, God.

Paul D. Vitale:

And she had to go to the hospital. So now we have two little children that are in a house with no parents. And it was frightening to me to know who is going to take care of those children and how are we going to do this together? And what’s going to happen? What’s going to happen to the both of them? And every once in a while, I just had them over for the Easter holiday. And they came and you can see they both are still very weak. And I said to them, “How are you doing?” And they said, “We’re glad to be here. We’re glad to be with our family,” which was a great ending. But I still think about that. I still think about the music that was played when patients were discharged. I would always be well up.

Paul D. Vitale:

I’d be in my office up there alone and I’d hear the music and I would well up. And every once in a while, I go back to those moments. And I don’t know that it’s a healthy thing to do, but I just do. And I feel very emotional about it. And it makes me want to work harder for what I’m doing right now, that’s the good part about it. It makes me say, “You know what? I need to take these three distressed hospitals and work with the CEO of this place, and get these three on target because the people in this community need these hospitals. They don’t need to get on a train and travel two hours to a place. They need a place to feel comfortable and to feel trusted.” And that’s a hard needle to move, as you all know. But going through that emotional stuff, and even afterwards, just makes me want to do more.

Paul D. Vitale:

I have a house that I, during COVID I just did this crazy thing and I bought a house on the shore, in New Jersey. I’ve always wanted the ocean in 130 minutes. We were there for the summer since we were supposed to go to Europe. So I was on my bicycle riding around and I saw this new house being built, three houses from the ocean, all ocean views, and I said, “I’m going to buy this house.” My wife said, “What?” And I said, “Yeah.” I said, “I want to be at peace. I need peace right now,” because I didn’t have peace at that time. So, it’s so great to talk to you. As I said to everyone, we’re talking to the wonderful Karen Ignagni from EmblemHealth, President and Chief Executive Officer. As we come to an end, Karen, I’d like your comments on where you see the future going in healthcare. What do you see the differences are going to be? What do you think we as leaders in healthcare need to do? What advice would you give us?

Karen Ignagni:

I think COVID shined a spotlight on what people knew intrinsically, but now they have seen the impact of disparities in care. So I think that is job one, to shrink disparities and deal with inequities. Two, I also think COVID shined a spotlight on how non-white individuals get treated in the healthcare system. One of my colleagues, a physician trained at Cornell, her sister was a vet in Harlem. And I say it was because she was being seen by a very important academic medical center who really didn’t pay attention to her, black woman, about what she was feeling, experiencing. She was treated for COVID, discharged and died of a blood clot two days later. And you talked about the trauma.

Karen Ignagni:

So my colleague, she lost her sister, but through her, I learned, and actually she wrote a wonderful piece in Salon Magazine about this and about, particularly black women interacting with the medical system, but we have to do better there. I think the third thing is everybody is so pleased with the wonders of digital health, but that doesn’t extend to everyone if they don’t have enough devices or they don’t have proper web service. And we know neither are true or both are true, they don’t have devices and access to great web service, even in the middle of a place like New York City. So we have to deal with that.

Karen Ignagni:

Fourth, we have to rebuild public health, and that has got to include the people, the training, the support for the nurses, the physicians that we are going to need to do the job for the next situation. And then fifth, I think that it’s going to be very, very important for the government to think about the broader issues of access, getting everybody into the system, dealing with the cost of healthcare so that we can sustain a system that works for everybody, and not just for one group, but works for everybody. I think that’s the agenda. It’s a challenging one-

Paul D. Vitale:

It is.

Karen Ignagni:

But we’ve got to start and you can’t afford to have anything drop off that list, I think.

Paul D. Vitale:

No, you can’t. And lastly, Karen, we’ve done a good job, I think with vaccinations, but what do you say to the folks out there that say, “I don’t really want to get vaccinated?” How do you respond to that?

Karen Ignagni:

It’s interesting. We have a great piece on our website.

Paul D. Vitale:

Really?

Karen Ignagni:

A recording about-

Paul D. Vitale:

Can you tell everyone about the website? Oh, so tell everybody-

Karen Ignagni:

Yes. Emblemhealth.com. We have a piece about COVID and vaccines recorded by Dr. Navarra Rodriguez, who’s our President of AdvantageCare Physicians, a wonderful physician, a woman. Dr. Wayne Rawlins, African-American leader, was on the health plan side of our enterprise. Now is the chief medical officer for Wells Fargo, our wellness company. And Dr. Julie Joseph, African-American woman, who is one of our medical officers at EmblemHealth. Talking from their perspective about what the research says? How do people reasonably come at this and be frightened? And how do they approach that? What should they know and why should they take a vaccine?

Karen Ignagni:

One of the other things that was such an honor for us, Paul, we partnered with Michael Mulgrew at the United Federation of Teachers to stand up some community vaccine spots for teachers who are so important in getting us all back, and families back and functioning. And worked with the teachers to actually educate their members about, what does the research say? Why should we all take a vaccine? My mom had polio and she was very disfigured from polio. And watching that my whole life and having, thank God, when I was young, like everyone else getting a polio vaccine, not having to live through that, but watching that does something to you.

Karen Ignagni:

So it makes an indelible impression about the importance of vaccines and public health, then do what we can do. So I wanted, as soon as my number came up, I wanted to be an early adopter so I could talk about it and make sure people know that I took it and my health is fine. And now I feel like I have a little peace of mind. Now we’re all going to have to take boosters. So that’ll be the next thing, but that’s okay. I took my flu shot too.

Paul D. Vitale:

There you go.

Karen Ignagni:

So it’s really important.

Paul D. Vitale:

Yeah. Well, Karen, I just, this is Karen Ignagni from EmblemHealth, that we’ve been talking to for the last 40 or 45 minutes, which flew by. And she is what I would call a leader that really is not a leader. She has what I call followership, which means that-

Karen Ignagni:

Thank you.

Paul D. Vitale:

People want to follow what she does because she does it with humanity, with humility, with pride, with good business skills and with a good understanding of the social determinants of health and many other things. So I urge you to go on emblemhealth.com, and I also urge you to go on onebrooklyn.com to see what we’ve been doing because we’ve been doing some exciting things there. I’m so proud of everyone there. It’s been a great transformation. And we are also going on Epic, where we’ve started and we’re in the middle of the transformation, which has been great. And it’s just been a pleasure to talk to you. I don’t see you enough any more. Nobody sees anyone now.

Karen Ignagni:

I know, exactly. I know. So it’s so nice to see you. Yeah.

Paul D. Vitale:

We have to have lunch one day when all this nonsense is finally over.

Karen Ignagni:

I would love that.

Paul D. Vitale:

Yeah. And then-

Karen Ignagni:

I was down at my office the other day and I said that I know people will be coming back to the city and we’ll be back to normal when I have to look both ways on water to cross the street. Sadly, it’s not quite that way.

Paul D. Vitale:

Yeah, yeah. And you’ll have to come down to my window on the shore of New Jersey and see that.

Karen Ignagni:

Yeah. Well, for a city girl, Paul, saying you have to cross the bridge or what have you, a river.

Paul D. Vitale:

Never in my life did I think I would do that. I never thought I’d be in New Jersey. I’m always in New York. I had an apartment in New York. I still have an apartment. Actually, I sold my apartment in Manhattan and moved to Brooklyn, but I love New York. And New York is going to come back. New Yorkers don’t be afraid.

Karen Ignagni:

Oh, no question. New York is going to come back.

Paul D. Vitale:

Yeah. And I will never leave New York.

Karen Ignagni:

It has after-

Paul D. Vitale:

I also love the ocean now.

Karen Ignagni:

Yeah, it’s beautiful. My husband grew up in Bay Ridge and has deep roots here [inaudible 00:48:45].

Paul D. Vitale:

Yeah, yeah.

Karen Ignagni:

It’s quite the place.

Paul D. Vitale:

So, I want to thank you from the bottom of my heart for doing this for us today. She did it graciously. At the minute that I called her, she said, “Yes, I’d be happy to do it.” And you’re lucky to hear her, everyone. So, thank you, Karen Ignagni. And thank you all. And please emblemhealth.com and check out what we’re doing at One Brooklyn. And my company is PDV Health Consulting. We have six consultants on staff. Check our website and all of this will be starting to air April 28th. We have eight episodes of different CEOs. So take a listen to them all and you might pick up some learning from them. And now that this is the last one that will be filmed, I do want to thank our producer, Lee from Content Monsta, and Alan Wiener from Hive Art Media, for helping put this on. It’s been a great opportunity. I’m grateful and I’m humbled. So for now, I say goodbye. Stay safe and in good health. Thank you.

Announcer:

Thanks for listening to this episode of Leadership, Transformation and the Healthcare CEO with Paul D. Vitale. We hope you enjoyed it. Special thanks to One Brooklyn Health for supporting the show. And we hope you will too by giving us a positive rating on Apple Podcasts, Spotify, or wherever you listen to podcasts. If you want to learn more about the topic we discussed today, visit pdvhealth.com, where you’ll find the show notes. The PDV Health Consulting executive team is proudly joined by world renowned psychiatrist, Dr. Francine Cournos, along with top industry leading experts, Susan Flicks, Joan Marren, Dr. Frank Kwakye-Berko, Dr. Alan Abrams, Sam Heller, Andrew Anello, Dr. Lisa D. Roche. And special projects manager, Afua Kwakye-Berko.