Heroes of Healthcare
Heroes of Healthcare

Episode · 2 weeks ago

An Open Empathetic Approach to Managing Mental Fatigue in Healthcare

ABOUT THIS EPISODE

Dr. Hany Y. Atallah, Chief Medical Officer at Jackson Memorial Hospital , never wanted to go into administration. The last thing he wanted to do was wear a suit every day.

But over time, he recognized the transformational power of being in a position to identify a problem and to bring together the people who can fix it.

In his administrative career, he has confronted many problems from massive water leaks inside Grady Hospital that shut down a third of inpatient beds to COVID and the mental fatigue that accompanied civil unrest.

Through it all, he has kept one priority in focus: Providing exceptional patient care.

We discuss:

  • Making operational adjustments during an internal flood at Grady Hospital
  • How leadership at his hospital managed rising mental fatigue
  • Transitioning from departmental head to a healthcare system head at Jackson Memorial 
  • Inherent frustrations that come with healthcare administration

To hear this interview and more like it, subscribe to Heroes of Healthcare on Apple Podcasts, Spotify, or wherever you listen to podcasts.

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You are listening to heroes of healthcare. The podcast that highlights bold selfless professionals in the healthcare industry focused on transforming lives in their communities. Let's getinto the show, welcome to the heroes of health carepodcast, I'm your host Ted Wayne, I'm excited today to be joined by Dr HanniAtala Dor Tal is the chief medical officer at Jackson, Memorial Hospital.His previous positions include the chief and medical director of forEmergency Medicine of greate health system and the vice president ofclinical operations and associate professor in the Department ofEmergency Medicine at Emery University School of Medicine. His primaryresponsibilities is physician services and clinical operations at Jackson,Memorial, hospital, inclusive of clinical outcomes, physicianperformance and professionalism. Dr Tyle holds a degree from WashingtonUniversity in Saint Louis and a medical degree from the New York MedicalCollege, he's a member of the Eastern Association for surgery of Trauma andthe American Association of Physician Leadership and is a fellow of theAmerican College of emergency physicians. Doctor Tyler receivedseveral awards for his role as administrator educator and an advocatefor learners. We are honored to be joined to day by Doctor ANNITA LAwelcome to the hero's health care podcast, Dr Atala, thanks for joiningus. Thank you tod. Well, we want to jump right in and you've had such agreat background and experience that, but I thought will stay a littlechronological here and let's go back and talk about your time and grady willcome back to your current role and Jackson Memorial in a while, butobviously greedy was a big part of your career and a big part of yourdevelopment and in terms of medicine and and medicine administration. But ifyou don't mind tell the before we go there, please tell them the listeners alittle bit about yourself where you come from how you got into this crazyworld of medicine. What makes you passionate about medicine and thenwe'll step right into your experience at Grady. Oh sounds good, so I grew upin the suppers of Chicago my family's Egyptian. I was actually born inAlgeria, but we moved here to the US. You know before I I don't rememberanything about living abroad and both my parents, my father, is a PhD inTexola, my mother, a master's degree, so grew up. You know a sort of ascience oriented background, as you can imagine, with parents like that haveseveral cousins who are physicians in a lot of my father's friends werephysicians. You know through our church growing up, and you know I realizedshot to. I guess, on the earlier side, like definitely had this people part ofme and sort of my ability to talk to people and and things like that, Iinitially started in high school kind of wanted to be an electricalengineer as because certainly have a math oriented mind as well, which isactually helped me fairly well in health care, and then you know oversome time. My father said you know you should consider something a little bitels, something else, because you know you want to utilize that go. You haveof being able to talk to people, and things like that. So before I was outof high school, I was pretty sure you know that I wanted to be a physicianand I just thought from what I knew of medicine. At the time it suited myselffairly well went to college at Washington University in St Louis. Iactually I played football there for four years and certainly help you knowhow my development is a person I think as well and then went to med school atNew York. Medical College in in Balhalla New York, which is just justnorther of the city in Westchester. Co, met a lovely woman there who was myclassmate mat and is not my wife, Louis Chang, she's internal medicine,physician and she did this advanced program that was going to keep her inNew York after that school, and I thought well what better place to learnemergency medicine than in New York. So I ended up getting my first choice forresence, which was a chicoma medical center in the Bronx in New York, and Iwas right. I learned great emergency medicine. There really had theprivilege in honor, working with the physicians at Chacoli and Montapehospitals up there when she was finished and I was finished, we bothwere off for jobs where we trained and and we didn't really have any family upthere and obviously cost of living was rather high up there. So we look sortof mid Atlantic southeast and wound up getting a job down at emery and Atlanta.For me, it was about you know. I recognized the fact that Iwould be a new faculty member. I definitely wanted to stay in academics,but I wanted some place to be able to develop me in terms of whatever I wasinterested in funny thing. Is I never wanted to go to administration hm? Isaid. The last thing I ever want to do is have to wear soon every day and beone of those guys. You said that you said that word. Never never once you dothat, that's it! That's it so really was focused on on teachingearly on and like bedside teaching. To this day I love it still, and you knowobviously didactic teaching and things like that. Emery, I think, did a greatjob sort of allowing me to develop that...

...part of my skill set and sent me toprograms and things and- and I think I'd like to think that it paid off forthe department as well, but over time, you're at work and, like you see howthings are going, and you say you know, I that's frustrating to me. I think Iknow the right answer to that, and one thing leads to another and next thingyou know you Werna so sitting in an office. So you don't have some greatleaders along the way which helped me sort of develop that aspect of myinterest again. I think it suits itself. Well, I think, to the person that I amand then over the course of years became the chief of emergency medicinethere, a greedy in Atlanta, so that's kind of how I got to that point. Sowhat part of the administrative peace that you said never to, or what madeyou change, what made you say? Well, maybe or yes, I all start to look atthat, what what it, what it, what enticed you to the to the dark side asa yeah. You know it started out when I was working at one of the emeryhospitals and I was having some issues getting my labs back for patients. Iwas taking care of until we had a great medical director there at the time,because I the name of pet capes, and so I called them- and I said on my email-and I said you know, I got some issues with the lab he's like what's wrong andI said well, I didn't get my libres alt, so he's like. What can you give me someexamples and I said well no, and he said well you to give me some examplesM, and so I gave him some examples to send them some medical record numbers-and you know we talked about what some of the issues were and he followed up,which led to a meeting that I was invited to which led to things getting better. Thelab was obviously very engaged in making sure that they were. You know,helping us with the service to our patients, and I said well, that's kindof neat. You know, like you, identify a problem. You bring together the peoplewho can fix it, and then you fix it. You know- and I said you know- maybethis- that man stuff isn't so bad after all, and so I you know there was there's thoseworking in two hospitals at the time on emery hospitals and then and then thatgrady and obviously grades was a much bigger emergency department and a lotmore complexities and stuff, and so there's a leader there. I got by thename of Leon Hale, who really was almost an ICA and not almost he was an.I got there, and so I started getting engaged with some stuff on him aroundthe trauma program and being able to work more with the trauma surgeons, tohelp him prove processes. And- and you know, I found the same thing like you:sit down to get the people together, fix a problem and you address it and aslong as possis are in case on it, you'll fix it, and I think we made alot of improvements that way, and so that's kind of what got me along thatpath. You know process improvement, collaboration with other departments atthe end of the day, all for the benefit of the patient, which is something Ireally love. So that's that's kind of a what got me needing to do it yeah youhave you, have an ability to impact and fix things on a broader scale as wellyeah. You still can help patience one at a time, but you can also do somesystem wide improvements, which is great. So if you don't mind, tellpeople a little bit about grady, because I think ready people don'texcuse me people outside of Atlanta. Don't really know you know gravyhospital, but it is a very big Ospin, a very big city, which has very bigimpact, unlike some other cities that have a lot of hospitals which Atlantadoes have. But you got this big Behem at sitting right in the middle of theeven there's a part of the road when you're cutting to when you're cuttingthrough the city called the gray curve, which slows everything down. Nobodylikes the grate current, but it is, but it gives you kind of an idea of theiconic. You know thing that is Greaty Hospital, so just share in terms oftheir trauma level and the size and and give the listener some magnitude of GroGreat. He is yeah, so big inner city hospital, the biggest in Atlanta countyyou to run by it and not run any more, but we had been run by the county andnow under a non profit board. That runs the the hospital. Truly, you knowiconic in Atlanta. You know it's the the largest level on trauma center inAtlanta for a long time. It was the only level on trauma center in Atlanta,and you know in order a lot of people don't know, but in order to have bigevents in your town, you have to have a trauma center. So you know for a longtime you know, and today still it serves a very vital purpose to the tothe citzens of the Atlanta Metro area, as well as in some in some services tosome of the surrounding states like Alabama and Tennessee as well. You knowit's it's what you would think. I think you know the hospital struggled for awhile back a long time ago there was some change that happened in thegovernance of the hospital, which was for the better there's. The saying inAtlanta is Atlanta can't live without gravy. It's absolutely true. Everyonein the town knows it. You know the administration was right enough tobring along the right leaders. As far as the hospital goes. You know fromthis Brouin a great CEO to build a great team and has really turned thingsaround sort of financially culturally for e the hospital and again alter thebenefit of the patient population. So...

...learned a lot from those leaderswithout them. I wouldn't be sitting where I am today had not fortuno workvery closely with them, but it is a level one trauma center. It's a burncenter, it's a comprehensive stroke center and there's a lot of otherservices that I'm that I'm not doing justice to then just met some trulytalented committee people there and was able to learn from them and I hopeterrible earn for me. So that's the kind of hospital I've always wanted towork at right to help people who doesn't matter. You know if you're othe CEO, some you know, fourtene five hundred company or, if you're ahomeless person who lives under a bridge. In my book you know I don'tnecessarily care what insurance you have. I just want to be a doctor andhelp you out. So that's one of the things I love about that I was won. IsOne of th things? I love about the hospital where it wore now. YeahQuality of care comes first yeah. I think the number I have a hundred fiftyfive thousand visits per year at Grady for the emergency department, Jes P,just the emergency deferment, right, yeah, yeah and- and that was you knowthe administration believing US enough to invest in a humorin departments tokind of bring us into the twenty per century. I really help transform thecare where will provide to our patients from the trauma per perspective,behavioral health perspective, and we really, you know again put our put ourheads together and improve processes to the point where the patients would getthe very best care and it would rin timely and everything. So so so hereyou are your anti administration, but you find yourself in it and now you're.Now your your believer and your you're, the head of the emergency department atGrady, arguably one of the largest in the country- and it comes with certainunforeseen things like Ovid, like racial unrest, and I think you're eventelling me prior to covie. You guys had a little bit of a little bit of a flood,but let's walk through a little bit of those those times from grady and fromthe pre Covin to the Ovid, and you know what were some of the challenges as thehead of the M that you were dealing with, and how were you also trying to? I know this a part. That's reallyimportant to you and important us on the show. But how are you trying tohelp get all your colleagues through this time right? How did you you knowwe keep calling a doctor. You know physician, burn out a D, a D and anclinical, not just physician, but clinical burn out to the team kind ofthing. How did you take them through these times? Yeah, you know I wouldn't be remissio. I didn't mentionthat without the mentorship that I had from Detulerat, I don't know that Icould have done it. You know and certainly sort of woes instilled for mefrom both my parents. You know it all it all started. Thinis in Decembermight have been December third, or something like that in two thousand andtwenty, where we had a flood on a Saturday, so a two foot pipethat carry water, clean water, fortunately to the chillers for the AirConiton in the hospital broke on a Saturday dumped about a Olympics, Iswimming coin, a half worth of water down one of our towers and in one dayshut down a third of our beds or in tation beds, so truly an internaldisaster. Well, I know I was lucky enough to be skilled to work overnight,ship that night in the emergency apartment, but that's the kind of thingwhere it's all hands on deck. You know packed up my stuff for the night andheaded in the work, the obviously senior hospal administration was thereand involved. You know we did what we needed to do operationally to make surethat first of all, we can get a handle in the flood, our facilities team, at afantastic job, kind of getting quick control of the little leak that we hada d, and then it was okay. Well, what do we do now? We all of a sudden aredown two hundred and twenty two beds and how do we manage and that's when Ithink that the leadership of the hospital and the leadership of my teamreally stepped forward and said? Okay, here's what happened all right, it's noone's fault! These things happen. It is what it is. How are we going to manageso it required everyone to change their practice in the hospital. So what doesthat mean for the operating r? What does it mean for the EmergencyDepartment? What does it mean for the clinic? So you know we worked reallyhard to with our clinic colleagues to say: Okay, I could admit this guy tothe hospital. At the same time, if I can get them followed up daily or thenext day in the clinic, then maybe I feel more comfortable, letting them gohome. So we worked with Kelly Carol Up. There ran the clinics and she said Yeah,let's make it happen, and so we made it opin. We utilize more of ourobservation unit as much as we could for patients we held on the patientslonger and Amorata nt to see if we can turn them around and avoid inating him.So you know we work together and really, I think, got it done nice and I assumethose hundred and would say fifty five beds or or we have a hundred and fiftyfive thousand business about about a hundred as any mercer. So you lostthose beds and I assume they weren't from the flood, I'm assuming theyweren't unoccupied. So where did you move those patients that were in t thataffected area yeah? So I mean obviously,...

...if patients could go home, we sent themhome if they couldn't go home. You know we made adjustments in other areas ofthe hospital. We call our our our sister, our colleague hospitals in thecity, to see if we could transfer some patients over there. You know that itwas two hundred and twenty two beds an I tiny to yeah that work closes on theimpatient side. So yeah I just that's a assuming I'm assuming they weren't allempty. Not I mean in some cases people just ranupstairs with water pouring from the ceiling, unlike to patient stretchesand just push these patients out of the hallway to get them up from underneaththe water wow. So it was really. You know there. I say some heroic stuffgoing on that day, but no one expected anything less. You know, that's that'sthe thing is it's just how how we work, what we expect giving the roll at thehospital and the people playing in the city? So it's just what you do it yeah,so the flood is settled and you're getting them things fixed and put backtogether, and you know January. I guess now two years ago comes around and youstart hearing about this thing called Ovid. How did you in the hospital beginto pay begin to prepare and what we you specifically challenged with, arestarting to see in the EM yeah so for emergency car in general? You know wepractice. What's called a split law model where patients would come in andwe would, you know, rely on our great nurses to determine their their acuityand then we would, you know if they were high cute. Obviously they gostraight back to a bed. If there were a little acuity, we would have themdestined to go to our fast track carrier and if they were sort of thatmiddle of the road acuity, we would, you know, get them into the nextavailable bet to have that seen most emergency de farmers. Now thatreally have a focus on on through put in, and you know that kind of thing usethat sort of model. Now you have to take that and recreate it for a whole,separate group of patients. So you have this flitful model for the Monico vepatients, and now you have this other model t same the same model forpatients who could have cold and you really sort of have to do your best tokeep these two populations in the department separate, obviously prettycoved when we were at a hundred fifty five thousand visits. That's achallenge and it's simply a challenge because of a space thing. Obviously oneof our big, probably our biggest prober, is how to keep. How do we keep oursteps safe and keep helping our patients at the same time, you know hadhad great help from our infectus disease. Colleagues in the hospital tosay like okay, what should we be wearing? There's a shortage on masks?How should we property, talise man yeah is going to ask you how how was grading,because I've heard across the board and people we've talked to I've heardsystems who were you know, desperate and literally, had people coming involunteers to sew gown so that they could have things to replace? And thenI had heard some people who said I don't know how our supply chain teamdid it, but we never really had a chance. I was that were things on thePPP side with grady. You know I'm more from the latter group, our supply chainpeople, you know. Of course I was getting emails from people. Saying Hey,you can get your masks, you know or we can bring you hand sanitizer or youknow, and so I was sending all that stuff to our supply chain. People and Isaid, look if I'm. If you think these are a waste of time or I'm botheringyou tell me I'll, stop sending him. He said it's not a waste, we fall uponevery one of them and from a lot of them we get stuff right. We were tightthat we always had what we needed and and fortunate for that, and you knowwhether everyone again working together we're able to keep everyone safe. Sothey worked. It worked well, not to say we weren't stretched in for a while,but but the supply can people really did a great job, and when you werefirst told about ovid and it's coming and we're starting to see increases inthere did it did you ever? Could you ever have thought it was going to be asbig as it was? Or did you guys think this? Is We better strap in? This? IsWe're going for a ride? You know you know if my son asked me he was a seniorin high school at the time he's like so so now what- and I said you know- Idon't know- and he said, have you ever been through this in your lifetime andI said definitely not, and he said so. You know what what's going to happenand I said I have no idea and there's nobody. I can even call who has beenthrough this I er lifetime. You can tell me what to expect less. They werelie. One thousand nine hunded, a d eighteen yeah exactly right, so youknow to great associate medical directors. One of them has a particularhead of PENDA particular focus on emergency management, and he was in hiselement when this happened. So, let's put together a plan for this, you know put something online wherewhen people have questions, what's our standard upbrading procedure for thisand did a great job once we sort of realized that this was going to be withus for a while, you know the focus really was on again the safety of ourstaff and making sure everyone knows. Okay, we had to get created with theschedule because you know across the country: emergency apartment volumesdipped like crazy during their early early times of cove, because peoplewere terrified to come to the hospital right, and so you know how do we adjustour staffing to that like there's, no sense in having a whole bunch of peoplewho are sitting around doing nothing at the Sametime, the complexity ofmanaging a really sick patient who...

...comes in the door where you have noidea? Why they're there or what their you know, infection status is was verycomplicated. You know! So how do you secure someone's air way with thembreathing in your face if they could have coved? And how do we keep us tohave safe? So really you saw the creativity come through. You know whenthat all happened, and you know knock on wood. We were able to keep peoplesafe, not to say people didn't get infected, but it was really. You knoweveryone playing together that Brooks more was the associate Michael or do astalking about sedatest when he said you know we're flying this plane as webuild it yeah and there's really not, I think, a better phrase for it and thatwasn't unique to greedy that was sort of across the country. How it was iswhat safest, let's not save it so right yeah and that and you're right in termsof the interviews we've done on the show. That is a consistent theme wasthat early days we didn't know we got smarter. We went along, we tried things,some things work, some things didn't work, but that was that was. That wasall that was all anybody knew, so that was all the best we could do. So, let'stalk a little bit about some of the mental fatigue you were seeing and thenalso simultaneously is a lot of people. We've talked to you know being in a bigurban setting in the south like Atlanta, we have a George Floyd situation and awhole lot of civil and rest starts to happen. How did that impact your teamand what things did you notice in terms of just the mental fatigue, and how didyou in the staff try to treat that yeah? I think one one area- and this was sortof pre all this stuff was our department up. There really pridesitself on being able to openly talk about race and and how it affects thecare, a patients receipt and how it affects the interaction between people who worked in the same hospital.Then that goes for greedy and Emery, and so we have been having theseconversations you know for years. You know it was you always felt like atleast for my perspective, if it was always a safe place to bring up thesethings and have these conversations. So when it, you know, when things reallystarted to to get worse or to be publicly worse, because it was alreadybeen to begin with. You know we talked about it as an apartment, and we all weall said you know. We know this stuff has been going on for a while. It'sjust now much more in the public spotlight so being able to be open and talk aboutit. You know and to understand the perspective of our colleagues of color.The really, I think, is one of the strengths of the hospital as well asour department. You know you don't know what you go through until you'veactually been in that person's shoes and not a lot of people can say what wewere when you add Covin to that you know, and you had the limitation we hadon beds. I mean it's a perfect time bomb if you will for really just cryingpeople right and so again you know how do we do this? You know the leadershipteam steps up and says you know we developed a consistent message amongstus, which is yes, it's hard, it's very hard, and you know your in health care andthere's patients who come in every day. We rely on us to save their livesliterally, and so we have to make it happen for their sake. At the same time,we need to be conscious of you taking care of yourself. So obviously theoutpouring of love from the community in terms of food we had to initially wewere sort of managing the offers of food internally as a department, andthen we had to hand it over to our public relations team because we justcouldn't keep up with the scheduling of the Food and you know which departmentsare going to get to food. Certainly it's not only the emergency departmentthat deserves the food, but everyone in the hospital deserves it. So how do wemake sure that everyone gets started their first share? You know we had achoir group comment sing outside the hospital which you know is reallytouching us. So you know we told people yeah you're, going to have to wear amask during your shift, which you know if your physician is eight hours, ifyou're a nurse twelve hours, you have to take a break like you cannot youcannot do that, so we're going to make sure that you take a break right, butthe only thing we ask is while you're working for your own safety and thesafe to have our patience, you keep your mask and goggles on when you needa break, go take a break. Unfortunately, you'll probably have to take that breakall alone again for safety reasons, but you have to go. Take a break yeah, youknow most every dock and nurse was, you know, changing their clothes in thehospital before they went home or changing their clothes in the garagewhen they got home. That was unusual and then heading straight to the showeronce they got in the door or showering at work. You know we made adjustmentsto our schedule based on some people who worked with us, who wethought may be more at risk. You know, because of other underlying medicalconditions they have, or things like that. It's not always easy for peopleto share that information with their with their possit out leaders. So youknow, at the end of the day, we did the things we thought we had to do, to keepeveryone safe and to support everyone. We told everyone. This is hard and onemassage we kept going to is think about...

...how much stronger you'll be. After all,this is over, and so we really told people like you know it's challengingright and and adversity builds character, but you know we're going totake care of you best, as we can you'll be better for this and you'll be stronger in the future. When someone twenty five years down theline, ask you you have to go through Covin. How did you do it right and youcan kind of hold your head up and say: here's how we did it, so it was hardand it was. It was endless and the phone calls and being their sidedecided with the people to show them that your there is a leader supportingthem was absolutely necessary and can really accomplish our goal. Right yeah,it becomes almost a sense of a badge of honor right in terms of that thing,yeah, and so let's just talk a little bit more andthen I want to start moving into a little bit more about your yourtransition from ahead of a department to ahead of a hospital. But how did yousee the did? The did the civilem rest compounded, some of the things againwe've heard on the show. Is People felt stressed about the ovid wave and tryingto figure it out, and the George Floyd thing like almost became the breakingpoint like it almost became the thing like. Okay, I can handle this. I don'tknow if I can handle this and that, like that almost became too much. Youknow I, like the. I love the way that you guys addressed it and just continueto be open to communicate about it when it was going. But did you see it almost?An H highing of that stress when that happened, a hundred percent. We did ahundred percent and I think again you know rather and brushing itunder the rug and sort of saying this is happening in the community. You knowwe brought it to the forefront an we had groups and we talked about it andsimply getting out there and understanding what your colleagues ofcolor go through on a daily basis and truly a daily basis. I think helped us,I don't want to say deal with it because you can never really deal withit, but at least help us talk about it and move it out in the open and to letto let everyone in the department. Now like look we're we're allies, you knowwe're here for you. We can't you can't honestly say that you understand how itis for someone, but you can say you know, I'm going to do my best to learnhaving to be conscious of my own unconscious biases, and you know Isupport you as a colleague and as a friend. You know that wasn't only forthe physician and the provider side of the house, but for nurses and reallyfor our entire department. At the same time, the hospital did the same sort ofthing, and so there was this consistent message of we know this is going on. Weknow it's an issue, you know across the country and we're going to you knowwe're going to keep doing what we have to do to support everyone who workshere in provides Caro or patiens, so it did make it that much tougher. Butagain the message was consistent. Yeah think the acknowledgment of what wetalk about here is it's okay. To be to not be okay, you know was a big, was abig relief for people in a sense to say: Don't don't you don't have to put onthe armor? You don't have to put on the facade that I'm good everything's. Okay-and you know that was the expression we should say- is hey it's okay to not beokay, and please, let's talk about that and let's continue to get through thatand what we heard out of Mount Sinai hospital was they found when theystarted asking people. Are you having mental burn out stress? Everybody saidno, I'm fine, but when they said Hey, would you? How would you like someresiliency training that people would say I'd, love some resilience, trainingright, so sometimes it's just how your packaging yeah, I mean you know in somecultures or in some families, like you know, saying I'm tired or in brokenis, you know, may be considered a sign, a weakness. We made sure that peopleknew it was okay to say when they needed help and we're not only talkingabout help in the hospital or with a patient, we're talking about help withchild care right with with making sure you get toilet paper at your house. Youknow food like simple things. You know you know it's, okay, for you to saythat you're scared. You know we're all scared, you know, and and when you hearthat from everyone, and especially from the leadership group and as aconsistent message- and everyone can say you know we're here for you, youknow I just have to tell us if you need something or we're going to tell youyou if we think you need something you know being able to do those thingsreally helped to state, of course, when it came to making sure that thefundamental reason we were there is to take care of patients, and we werestill consistently able to do that on a day and day basis. Yes, keep keeping aeye on the mission right a lot of times that helps to let's remember why we'rehere and all that so well. Well, that that's awesome. I appreciate I'm surethat was a great great bad experience, but you know, as you said, those thingsthat are difficult is what we grow from and those are the things that make usstronger and better. So, let's talk about this you've now been you get. Iguess obviously got an opportunity to take on the chief medical officer, rollat Jackson, Memorial Hospital in Miami- and you say: Okay, I'm I'm now in thisadministrative world I kind of laugh about you saying I don't want to bethere now, I'm in it and I'm go even...

...going bigger. So tell me: How did thatopportunity come to you and what's been the transition to go from a department,the department head to now a full health care system had yeah? I mean onething: I've learned over the years from you know two people who being a lot tome, is sort of the power of perspective right, so I think to be a goodemergency department leader and the way that big emergency departments interactwith hospitals. You also have to take in a perspective the what's going oninside the hospital, so you can't say what we need this or we need to add, oryou have to do this or you have to do that without also understanding whatyour colleges are going through on the impasioned. I think I did a good jobwith that when I was a grating. I think it helped me a lot when I came totransitioning to this role. You know for me I was extremely happy where Iwas my family was happy. I was happy and you know I was looking for anopportunity to grow even more. You know. Jackson has such a great name reallyacross the country of the Rider Trauma Center, which is probablyinternationally renowned Ye the Miami transplantation, which is the largesttransplant center in the country, and- and this is my kind of hospital right,so we want to take care of people and that's really probably the most simplyto say it when the opportunity came up to take a leadership role here. Youknow I obviously asked a lot of people who knew me. Do you think I could do it,and that means the seem a like great the CE or grady. You know my my nursingpartner, who har and I go way back up there. You know, isn't something likedo you think, I'm ready, because I want t tell on to keep growing and they saidwell you're ready, but you can't go and you know- and I said well, they can'thave you right right. You know I had not going to lose an interviewing here.I had a great job and if it didn't work out, I was happy to keep it at the sametime. It's something I definitely wanted to sort of push myself to see.If I could do and so came down here, had a visit with the obviously thehospital leadership had to look around Mima in the midst of Covirid you sothat made the interview process kind of interesting but yeah. I said you knowthis is this: is the kind of hospital that I love and so- and this is these-are the patients that I love to take care of? And so you know was Hortaenough to be offered the position very fortunate and you know, had theopportunity to come down here and work with. You know just another fantasticteam, the similarities. You know thecommitment to the population, the commitment of getting the job done, thecommitment to leading the people in the right direction, despite challenges,which are always going to come up for hospitals and have just been absolutelyamazing, impressed with the commitment that everyone has here to the missionof the hospital and the level of expertise in the hospital when it comesto trauma carberry, stroke care, you know, medical care in general, surgicalcare. You know it's sort of what I thought it would be a bit more and soincredibly lucky to come down here and work with the leadership team in the Csweet here that that is in my mind, you know in something I learn from the seagravy. Probably the most important thing is how well you work with yourteammates, you know, and I we have other issuesand finding housing down here and some other stuff. But it's it's been theeasiest part of a transition which is the the leadership team. I have thechance to work here with so that's great, so so you're now so you've takenthe opportunity you're now there, and what do you see are some of the biggerdifferences. What did you have to focus on more as an as an EM leader as adepartment leader versus now, a full system yeah? You know so I'll say thatthe different departments and the physicians ore have been Nice enough toeducate me on and some of the challenges that are specific to theirdepartment. You know I've learned a lot about. You know a lot more aboutsurgical care, her critical care- and you know it's it's it's sort of similar,but you realize how much you don't know and if you realize how much you rely onon the people you work with and when I see the people you work with, I'm nottalking about the people who are here in this office, but the people who youwork with, who are you know, providing the direction care to kind of bring itup to speed on on how things are going and what the opportunities are andbasically how I can help and to me my message again as a chierement medicinein here as well is I look at my job is to make your job easier and that's it.So you don't work for me. You know figuratively, of course, but I work foryou and if you need help way, the patient we've had two great examplesthis past week then- and you need my help to provide that great patient care.Then then, that is a priority to M, and so you know I want to be the type ofleader where people reach out to me when they get stuck and there's apatient at the end of it. I don't care what time of day or night it is. Youknow I'm available and if I can't figure it out myself, then I'll. Asksomeone tell me okay, so that's what's great about this office is when Onee ofus has an issue. We need help with her...

...on jumps in an helps and and at the endof the day same as it was before, the patient is always the line to benefiton it. So so, when you were, and when you show when you were greeting, youwere ahead of the EM and now, as c Mo did you did you haveas well ma? Let me start this way as head to bem: Did you still have patientinteraction, or did your job really become full time? Administrative Time?No, I don't ever want to have only administrative time when I was a chiefo mercy, Manson still work shifts. I think I told you the day that typebroke. I was schedule for an overnight ship on a Saturday right night thatthat didn't change. You know you can't lead a department without working inthat department. You can't people can tell you what the promise when untilyou see it for yourself and think about it, you just I mean it- doesn't won'tmake you an effective Imese. It's been more challenging to get clinical timehere because of my other administrative responsibilities, but I still try andhead over the emergency apartment. You know I'll schedule a half a day. Youknow a couple O weeks beforehand to make sure it's blocked off, and youknow my my assistant again. His invaluable keeps me on try and won'twant plug things in there, but you know you build your credibility with thepeople when you're actually doing the work and it allows you to see thingsand hear about challenges that you might not otherwise her about, and Ithink ultimately makes your better administrator. That's great yeah,because I'm going to ask you miss you know: Do you miss the patient care?Obviously you got to take care of patients and do that you were, you, know, hesitant on the Admin side,but here you are in it. So I just you know: Do you miss that side of it yeah?I mean I definitely do. Yesterday evening we had a the con I and had ameeting with Espectin er and one of our transplant surgeons from the transmandepartment. This this particular surgeon transplants, livers, HM and you know we're focused to some degreeon meeting our key performance indicators. But until you can reallyunderstand what are going through, then then you know: How can you? How can yousay anything so after we finished meeting he said you know: Do you want to goaround any time? Any time, you're free and I said well, I'm free right now,and so we went up stair to fifteen for we walked around and he kind of shared.You know what was going on with a couple of his patients and, first ofall, it gives you a whole new appreciation for the level skill thatthese people have tingas and surgeons, and then it also gives you much more ofa perspective for the for the complexity of the patients. They'retaking care of you know, obviously, to do what our transparent surgence hereto as an example of the rest of the hospital. You know you're going to windup with some pretty sick people and they're, not always going to bestraightforward, and so they may need to stay in the hospital for a littlebit longer, but again, my job, the job of the rest of our team here is okay.Well, what can we do to help? You facilitate that care? No matter howcomplex the patient is, and that's where that really good relationshipbetween administration and the and the physicians during the work comes in soso what are some of the administrative things that are inherent probablywithin every hospital, not necessarily just to Jackson, that are for lack of aMidwerd, the most frustrating for you and and how do we? And how do weaddress them? You know we hear about a lot and a lot of high hospital systems.Some bureaucracy, things the insurance region, things the quality of careregulations that all of those things that are outside influences, sometimesthat get in the way of a doctor saying I just want to do my job. I just wantto go. I just want to practice medicine. Can You ye? Can you get all that? Ithink it's very similar in the world of teaching. Today you hear about teachers,saying I'm frustrated with the teacher, because here's so much bureaucracy andpaperwork I just want to. I just want to teach the kids and I've hurt thesame for doctors. Sometimes they say I just want to treat the patients yeah.You know it's, I think, a great question ten. I think I think part ofMedical Education is getting people to understand that stuff, ultimately ing.It makes you understand where the pressures arecoming from and allows you to better find a way to manage the care of thepatient. There's a lot more managed carater in Miami than there was anAtlanta. That's been a sharp learning curve for me to kind of understand howthose things go. Interesting. Okay, I've worked very closely. I think herewith our case managers and social workers, much more than I did inAtlanta on the hospital side who to understand the challenges that theyhave in terms of getting patients the services that they need. You know Iworked closely with our physicians in terms of what is needed from our casemanagers and social workers in terms of communication and timing, to be able tosend a vision home when you're ready to send the patient home right. So whatwhat hoops did they have to jump through to get insurance authorization?You know approve for the patient to go to reave facility or a nursing facilityso that they have a hard job and I think the communication behind okay,here's the plan for the patient really helps them do better. That, for me, hasbeen a big learning point since I got...

...here, and you know again, you don'thave to be at the bedside to be committed to the care of these patients.I think you know our case. Managers and social workers here have been veryimpressed with, and they really are part of the team. So that's been alearning cur. For me, it's been a point of frustration because you know themorency apartment, someone rolls in and they're sick and you take care of themand that's sort of the end of it. For me, that was one of the appeals ofemergency medicine. When I was trying to decide a specialty to going to M mymom was like: Don't you want to have your own office and staff and stuff,and I said no- I don't- I really don't know I just want to take care of people.You know again this in my mind, goes back to it's my job to make their jobeasier and if I can take care of something or take something off yourplate that I could deal with, it allows you declination and the nurse to focuson taking care of the patient. So you know I'm I'm much more need deep thanthe bureaucracy. If you will mount if, at the end of the day, it helps thepatient, I'm okay with that right yeah. So so that's you know. For me, I meanit's challenging, especially when you have the type of facial population thatI want to take care of, that that has often social issues, medical literacyissues, and so you sort of have to go above and beyond the altos patients andI'm totally okay with that great. So as we're kind of wrapping up on coming inthe home stretch of our time here, I just wanted did want to touch on alittle bit about staff shortages and things. I continue to hear, but we knowthere's a shortage of provide our physicians, nurses, not just physicians,but we know there's a shortage in the medical field to get all together andthere's a lot of people who are saying that the shortage isn't really beinginfelt yet because Delta kept people engaged longer o that sense of duty. Ihave to stay and continue to do, but there's a lot of speculation that oneDelta really does continue to ram down and let's hope that soon and we getback to a little bit more a normalcy with it that a lot of the providers whohave stuck it out for now two tours or three tours of duty as they say, aregoing to go on Sabatical are going to leave, are going to say I don't want towork in a big system or things like that. How are you guys planning forthat potential shortage? I mean you're dealing with shortages. Now today, buthow are you planning with an additional this this might this might not getbetter before it gets? This might not get. This might get worse before itgets better exces I mean the health care. A landscape and staffing. It isis an interesting time for it. You know. Ultimately, it's put. I mean it coveitself, as obviously put such a huge financial strain on health systems,that people have enticin ways to become more efficient with the care at thesame time bringing in providers from outside the system and paying thatpremium for doing that again has put a huge financial strain that systems youknow how we're going to manage to be honest, we're going to sit down at atable, we're going to get ourselves together and we're going to think itthrough. You know how much can we spend on this all right? How do we, how do webalance us with our volume in our patient care demands? At the end of theday, safety of the patients is the most important thing, and so how do we makesure we're maintaining that you know? Do we have to find what new andnovelties can we find to do things? You know to support our nurses, who areultimately the ones who are spending most of the time at the bed side? Youknow it's not only nursing, but you mention physicians and nurses, itsrespiratory therapists, it's physical, therapist yeah, it's all the members ofthe health care cost or sure, and so you know what are we going to do tomake sure we maintain operations? You know it's obviously, on constantlychanging, depending upon a sort of where we are and in whenever the changehappens, we sit down at the table. We fire it out figure out what we can payfor. We figure out what we can do to make sure that we're that we show ourcommitment to that facient safety in patient care that we think is horfulyeah. He I think it will be continue, a challenge, one of the one one la kindof last question I had I'm not sure you may not have the answer. So it's okay,but I just said I heard an article recently or up thing. I think it was onNPR and they were talking about how there's thirty six, that roughly thirtysix thousand residencies that are awarded who are assigned each year butyet there's about I don't know what the number was, but forty thousand or fortyfive sand. Physicians Graduating Medical School. So here you are you'vegone through. It was to me it was a shocking thought, because here I do Iget out of medical school. I finish, I'm ready to go on my residency and inthe and theoretically you may get bypast and they had a gentlemaninterviewed on there and he said I didn't get my letter. I called- and Isaid, Hey I didn't get my letter and they said you're not getting a letterand he you know he said my world started spiral, and what do I do nownow? I have to wait a year and how do I keep my my saw sharp so to speak andpractice and keep myself on this, so it did shortage and we have this w. WHYAREN'T WE GETTING? Why are we creating...

...more residency program so that we canget more, provide more doctors into the market to meet this growing demand? Soagain, I think it's a real good question. I think something to considerabout about. You know resident education. Is it's not as simple as just adding some spots or starting aprogram? You know you shouldn't, educate someone. If you can't do a goodjob, it educating the amount of infrastructure, the faculty time andthe dollars that that cost is not certainly inconsequential. Now, there'smoney that comes for the training of those residents, but you got to get theright people in place right. It's not simple enough to say, Oh, send me a fewmore residents were on it, so you know, there's, there's you know is ouropportunity out there will give in the sere numbers. Apparently there is Iagain it becomes a commitment thing, and so you know do we want to you knowif you're at a a community house but which can certainly have resenceprograms as well is: Do we want to introduce learners into thisenvironment that we have here? You know what is the cost to us in terms of notonly dollars but but people power in terms of me, making sure that we'redoing an adequate job. You know training these residents. There arelearners at the end of the day right, and so yes, you can rely on them andpart of their training is to see patients but they're there to learnright. So they're, not a solution to manpower issues right, and I think thathas that's interesting. You say that I didn't think about that, but you're butyou're right right, because they need supervision right right, they're, notflying solo, yet brand, and they need to be taught right and I think you knowsometimes what's underestimated, having been on sort of both sides of the table,the amount of time it takes to train, you know to train traineeright and- and you know, should they have some? You know family issue orother interpersonal issue, like those things have to be inpressed, so youknow you're, adding more people. You know, hospitals are you generallyincredibly complex, you know systems and so now you're adding another layerof complexity. So it requires really a commitment. You know, that's probably to some degree what maybe shying people away. We don't what's the solution now is it? Is it toincrease the dollars you know dedicated to training? Perhaps it depends how we,as a country, are sort of looking at medical education and we're always herour sort of physician supply going in the coming years, which I know is short,so you know how do we, how do we, as a country and as a health care system, support making sure that we have anadequate number of physicians to care for our growing and aging population?Yeah yeah well great that insightful. So thank you for your and your answeron that. Well, say it's hard to believe: We've been talking as long as we're betalking, it goes fast and I always have lots more questions and I usually havetime, but I want to thank you for your time. Thank you for your service. Youknow we here just continue, want to shout out the people, not only yourservice and your commitment to it, but obviously all the team at Jackson,Memorial Hospital and just thank you guys for serving self as selflessly,but as we wrap up, I always like to close the episode with asking the guest,who was your hero currently growing up, as I say, there's no wrong answer, butI'd love you to share who your hero was yeah, I mean there's, there's twopeople who've really had you know a profound kind of impact on who I am and-and you know, I'm just certain wouldn't be here without them. One obviously ismy father growing up, and you know he like I mentioned before he had a PhD intoxicology. I was a director at a large chemical company and sort of wouldoccasionally bring home those leadership lessons you know andcertainly led with a different style than I lead, but at the same time youknow there are things that polar that you learn from hearing the stories. Atthe same time, and most importantly, he taught me how to be a good father and a good husband, and youknow that's something. Obviously that's all so you know you can you can't haveone without the other you can't be. I think you can't be great your job andnot have a solid home life, and you know, support the people at home andhave them support you, so he certainly one of Em the other one certainly is. Imentioned him before Dor Lean Haley. He gave me the chance to start anadministration in the meres apartment at Grady and and the learning car wasextremely sharp. When, when I joined the team learn you know, you think whenyou start administration like okay. Now you have this title right, so you cango on your going, the Ro and San or ham on the table and tell people it's goingto be, and that's what's going to happen and day, one he's like. Well,that's no, how it works. I say that doesn't happen that no so you know from him, I learned a lotabout the power of perspective and sort of the emotional intelligence pieces.Put yourself in the shoes of the person you're talking to find out what'simportant to them, then it will help inform a conversation and thenegotiation that drelated to have with them, and so...

...you know learning that from him youknow learning her, how to effectively communicate learning one to to say youknow what I can't handle you know. I don't have the band with tobe able to deal with this right now and, quite frankly, it's not as important assome of the other things I got on the burner at the moment, so I'll write itdown and I'll keep it and I'll address it. When I am the chance so learning toprioritize what's important and what's you know what the things you have todrop everything for to make sure that you take care of so so learn that fromhim. So really those are my two heroes. You know unfortunately I'll say a los,both of them on the same weekend. In July in so he sorry which was reallydifficult for me, as as I can imagine, but you know every day, I think abouthow the impact and the influence that those you guys had on me- and you knowI know they're looking down and I'm just trying to make them proud of whatwhat we're doing here at Jackson so well. I have no doubt that they are I'mdoing some great work and- and we are appreciate all your effort and energy-and we appreciate your time to and to give us some of your insights and tellus a little bit of the story there. I just want to thank you again for yourtime and your service and thanks for being part of the show, thanks that Ireally appreciate you having me on appreciate it we'll talk again soon,I'm sure very good. Thank you. You've been listening to heroes ofhealth care for more subscribe to the show in your favorite podcast player,or visit us at heroes of health care. PODCAST T.

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