Heroes of Healthcare
Heroes of Healthcare

Episode · 5 months 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.

Listening on a desktop & can’t see the links? Just search for Heroes of Healthcare in your favorite podcast player.

You're 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 get into this show. Welcome to the heroes of healthcare podcast. I'm your host, Ted Wayne. I'm excited today to be joined by Dr Hanny Atala. Dr Tala is the chief medical officer at Jackson Memorial Hospital. His previous positions include the chief and medical director of for Emergency Medicine of Gradi health system and the vice president of clinical operations and associate professor in the Department of Emergency Medicine at Emery University School of Medicine. His primary responsibilities is physician services and clinical operations at Jackson Memorial Hospital, inclusive of clinical outcomes, physician performance and professionalism. Dr Talla holds a degree from Washington University in St Louis and a medical degree from the New York Medical College. He's a member of the Eastern Association for surgery of Trauma and the American Association of physician leadership and as a fellow of the American College of emergency physicians. Dr Toller received several awards for his role as administrator, educator and an advocate for learners. We're honored to be joined today by Dr Hanni Atala. Welcome to the Heroes Healthcare podcast, Dr Atala, thanks for Johning us. Thank you to well, we want to jump right in and you've had such a great background and experience that but I thought we'll stay a little chronological here and let's go back and talk about your time at Grady. We'll come back to the your current role in Jackson Memorial in a while, but obviously grady was a big part of your career and a big part of your development in terms of medicine and medicine administration. But if you don't mind telling the before we go there, please tell them, the listeners, a little bit about yourself, where you come from, how you got into this crazy world of medicine, what makes you passionate about medicine, and then we'll step right into your experience at Grady. So sounds good. So I grew up in the suppers of Chicago. My family's Egyptian. I was actually born in Algeria, but we moved here to the US. You know before I don't remember anything about living abroad and both my parents. My father has a PhD in Tuxt Coology, my mother and master's degree. So grew up, you know, it's sort of a science oriented background, as you can imagine with parents like that. have several cousins who are physicians. You know, a lot of my father's friends were physicians, you know, through our church growing up and you know, I realized sort of, I guess, on the earlier side, like definitely had this people part of me and sort of my ability to talk to people and and things like that. I initially, sort of in high school, kind of wanted to be an electrical engineer because certainly have a math oriented mind as well, which is actually helped me fairly well, and healthcare. And then, you know, over some time my father said, you know, you should consider something a little bit els, something else, because you know, you want to utilize that skill you have of being able to talk to people and things like that. So before I was had a high school I was pretty sure, you know, that I wanted to be a physician and I just thought from what I knew of medicine at the time it suited myself fairly well. Went to college at Washington University in St Louis. I actually played football there for four years and certainly hope you know how my development as a person I think as well. And then went to med school at New York Medical College in Valhalla, New York, which is just just north of the city in Westchester County. Metal Lovely woman there who was my classmate mat and is not my wife, Louise Chang. She's an internal medicine physician and she did this advanced program that was going to keep her in New York after med school and I thought, well, what better place to learn emergency medicine and then in New York? Huh? So I ended up getting my first choice for a residency, which was at Jacobian Medical Center in the Bronx in New York, and I was right. I learned great emergency medicine there. Really had the privilege and honor working with the physicians at Jacobi and Montefire hospitals up there. When she was finished and I was finished, we both were off for jobs were we trained and and we didn't really have any family up there and obviously cost of living was rather high up there, so we looked sort of mid Atlantic southeast and wound up getting a job down at emery and Atlanta. For me it was about you know, I recognize the fact that I would 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 was interested in. Funny thing is I never wanted to go into administration. HMM. I said, the last thing I ever want to do is have to wor suit every day and be one of those guys. You said that. You said that word never, never, once you do that. That said. That's it. So really was focused on teaching early on and like bedside teaching to this day. I love it still. And you know, obviously didactic teaching and things like that. Emory. I think that a great job sort of allowing me to develop that part of my my skill set and sent me to programs...

...and things and and I think, I'd like to think that it paid off for the department as well. But over time your work and like you see how things are going and you say you know, I that's frustrating to me. I think I know the right answer to that. And one thing leads to another and they you know, you're wearing a suit sitting in an office. So, you know, have some great leaders along the way which helped me sort of develop that aspect of my interest. Again, I think it suits itself well, I think, to the person that I am and then, over the course of years, became the chief of emergency medicine there a greedy in Atlanta. So that's kind of how I got to that point. So what part of the administrative piece that you said never to or what made you change? What made you say well, maybe or yes, I I'll start to look at that. What it wouldn't what entice you to the to the dark side? I say yeah, you know, it started out when I was working at one of the memory hospitals and I was having some issues getting my labs back for patients I was taking care of, and so we had a great medical director there at the time. We got by the name of Pat Capes, and so I called them, I said on my email and I said, you know, I got some issues with the lab. He's like, what's wrong, and I said well, I didn't get my labors all seems like what. Can you give me some examples? And I said well, no, and he said, well, you gotta give me some examples, hmm, and so I gave them some examples, I sent him 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. The lab 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 kind of neat, you know, like you've identified problem, you bring together the people who can fix it and then you fix it, you know, and I said, you know, maybe that that man stuff isn't so bad after all. And so I you know, there was there's those working in two hospitals at the time, when the emory hospitals and then and then that grady, and obviously gradi's a was a much bigger emergency department and a lot more complexities and stuff, and so there's a leader there I got by the name of Leon Haley, who really was almost an icon, and not almost, he wasn't. I got there and so started getting engaged with some stuff on him around the trauma program and being able to work more with the trauma surgeons to help improve processes and and you know, I found the same thing. Like you said, don't you get the people to get a fix a problem and you address it and as long as sposizes our engagement, you'll fix it. And I think we made a lot of improvements that way. And so that's kind of what got me along that path. You know, process improvement, collaboration with other departments, at the end of the day, all for the benefit of the patient, which is something I really love. So that's that's kind of what what got me needing to do it. Yeah, you haven't not you have an ability to impact and fix things on a broader scale as well. Yeah, you still can help patients one at a time, but you can also do some system wide improvements, which is great. So, if you don't mind, tell people a little bit about greedy, because I think greedy people don't. Excuse me, people outside of Atlanta don't really know. You Know Grady Hospital, but it is a very big hospital in a very big city which has very big impact, unlike some other cities that have a lot of hospitals, which Atlanta does have. But he got this big Behem at sitting right in the middle of the even there's a part of the road when you're cutting through the when you're cutting through the city, called the grady curve, which slows everything down. Nobody likes the grady curve, but it is but it gives you kind of an idea of the iconic, you know thing that is grady hospital. So just share in terms of their trauma level and the size and give the listeners some magnitude of grew who grady is? Yeah, so big inner city hospital, the biggest in Atlanta County, run by the not run anymore but had been run by the county and now under a a nonprofit board that runs the the hospital. Truly, you know, iconic in Atlanta. You know it's the largest level one trauma center in Atlanta. For a long time it was the only level one trauma center in Atlanta and you know, in order, a lot of people don't know, but in order to have big events in your town you have to have a trauma center. So you know, for a long time, you know, and today still it serves a very vital purpose to the to the citizens of the Atlanta Metro area, as well as, in some in some services to some of the surrounding states like Alabama. And Tennessee as well. You know, it's it's what you would think, I think. You know, the hospital struggled for a while back. A long time ago there was some change that happened in the the governance of the hospital, which was for the better. There's the saying in Atlanta is Atlanta can't live without grady. It's absolutely true. Everyone in the town knows it. You know, the administration was right enough to bring along the right leaders as far as the hospital goes. You know from this brought in a great CEO who built a great team and has really turned things around, sort of financially, culturally for the hospital...

...and again all to the benefit of the patient population. So learned a lot from those leaders. Without them I wouldn't be sitting R I am today. Had An opportunity to work very closely with them. But it is a level one trauma center, it's a burn center, it's a comprehensive stroke center and there's a lot of other services that I'm that I'm not doing justice to. Then just met some truly talented, committed people there and was able to learn from them and I hope there will learn from me. So that's the kind of hospital I always wanted to work at right to help people who didn't matter. You know, if you're the CEO some you know fortune five hundred company, or if you're a homeless person who lives under a bridge and my book, you know, I don't necessarily care on insurance you have. I just want to be a doctor and help you out. So that's one of the things I love about that hospital and that's one of the things I love about the hospital work. Now. Yeah, quality of care comes first. Yeah, I think the number. I have a hundred fifty five thousand visits per year at Grady for the emergency department. Just need just the emergency divine right. Yeah, and and that was, you know, the administration believing in US enough to invest in your emergency departments to kind of bring us into the twenty percentury. I really helped transform the care we're able to provide our patients from the trauma personal perspective, Behavioral Health Perspective, and we really, you know, again, put our put our heads together improve processes to the point where the patients would get the very best care and it would be timely and everything. So so here you are, your anti administration, but you find yourself in it and now you're now you're your believer and your you're the head of the emergency department at Grady, arguably one of the largest in the country, and it comes with certain unforeseen things like Covid, like racial unrest and I think you're even telling me prior to Covid, would 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 from the pre covid to the covid and you know what were some of the challenges as the head of the Em that you were dealing with and how you also trying to and I know this apart, that's really important to you and important us on the show, but how will you trying to help get all your colleagues through this time? Right? How did you know? We keep calling a doctor, you know, physician burnout, and and and in clinical not just physician but clinical burn out too, the team kind of thing. Did you take them through these times? Yeah, you know, I would be remissive I didn't mention that. Without the mentorship that I had from Dr Leon Haley, I don't know that I could have done it. You know, and certainly you sort of what was instilled for me from both my parents. You know it all. It all started. Think it was in December, might have been December third or something like that, in two thousand and twenty, where we had a flood on a Saturday. So a two foot pipe that carried water, clean water, fortunately, to the chillers for the organising in the hospital, broke on a Saturday, dumped about an Olympics ized swimming pool and a half worth of water down one of our towers and then one day shut down a third of our beds or in patient beds. So truly an internal disaster. Wow. I was lucky enough to be skilled to work over night shift that night in the emergency apartment, but that's the kind of thing where it's all hands on deck. You know, packed up my stuff for the night and headed into work. The obviously senior hospital administration was there and involved. You know, we did what we needed to do operationally to make sure that first of all we can get a handle on the flood. Our facilities team did a fantastic job kind of getting quick control of the little leak that we had and and then it was okay. Well, what do we do now? We all of a sudden are down two hundred and twenty two beds, and how do we manage? And that's when I think that the leadership of the hospital and leadership of my team really step forward and said, okay, here's what happened. All rights, no one's fault, these things happen. It is what it is. How are we going to manage? So it required everyone to change their practice in the hospital. So what does that mean for the operating or what does it mean for the Emergency Department? What does it mean for the clinics? So, you know, we worked really hard to with our clinic colleagues to say, okay, I could admit this guy to a hospital at the same time, if I can get them followed up daily or the next day in the clinic, then maybe I feel more comfortable letting them go home. So we worked with Kelly Carroll up there. We ran the clinics and she said Yeah, let's make it happen, and so we made it happen. We utilize more of our observation unit as much as we could for patients. We held on the patients longer in the emergency department to see if we can turn them around and avoid admitting him. So, you know, we work together and really, I think got it done nice and I assume those hundred and which fifty five beds or are we have a hundred fifty five thousand business about about a hundred beds in the emergency? So you lost those beds and I assume they weren't from the flood. I'm assuming they weren't unoccupied. So where did you move those patients that were in that affected area? Yeah, so, I mean obviously if patients could go home,...

...we sent them home. If they couldn't go home, you know, we made adjustments and other airs of the hospital. We called our our our sister or our colleague hospitals in the city to see if we could transfer some patients over there. You know that it was two hundred and twenty two beds. Hundred twenty two, yeah, that were closed on the inpatient side. So we had and I just that's right. I assuming. I'm assuming they weren't all empty. Another were. I mean in some cases people just ran upstairs with water pouring from a ceiling, unlike the patient stretchers, and just push these patients out of the Halliday to get them up from underneath the water. Wow. So it was really, you know, dare I say, some heroic stuff going on that day, but no one expected anything less, you know, that's that's the thing is. It's just how how we work, what we expect, given the role at the hospital and the people playing in the city. So it's just what you do. Is Yeah, so the flood is settled and you're getting things fixed and put back together and, you know, January, I guess now two years ago, comes around and do you start hearing about this thing called Covid? How did you in the hospital begin to pay, begin to prepare and what we use specifically challenge with our starting to see in them? Yeah, so for emergency care in general, you know, we practice what's called a splitflow model. Or patients would come in and we would, you know, rely on our great nurses to determine their their acuity, and then we would, you know, if they were high quity, obviously they go straight back to a bed. If there were low acuity, we would have them destined to go to our fast track area and if they were sort of that middle of the road acuity, we would, you get them into the next available butt to have them seen. Most emergency departments now that really have a focus on throughput and you know in that kind of thing use that sort of model. Now you have to take that and recreate it for a whole separate group of patients. So you have the splitflow model for the non covid patients and now you have this other model the same the same model for patients who could have cope, and you really sort of have to do your best to keep these two populations in the departments. Supper obviously pretty covid when we were at a hundred, fifty five thousand visits. That's a challenge and it's simply a challenge because of a space thing. Obviously, one of our big probably our biggest part of it, was how to how do we keep our steps safe and keep helping our patients at the same time. You know, had had great help from our infictious disease colleagues in the hospital to say like, okay, what should we be wearing? There's a shortage on masks. How should we proper utilize matter? Yeah, it's going to ask you. How how was grating, because I've heard across the board people we've talked to I've heard systems who were, you know, desperate and literally had people coming in volunteers to sow gown so that they could have things to replace. And then I had heard some people who said, I don't know how our supply chain team did it, but we never really had a challenge. I was that were things on the PPP side. With Grady, you know, I'm more from the latter group. Are Supply chain people. You know, of course I was getting emails from people saying, Hey, can get your masks, you know, or we can bring you hand sanitizer or you know. And so I was sending all that stuff to our supply chain people and I said, look, if I'm if you think these are a waste of time or I'm bothering, you tell me and I'll stop sending him. He said it's not a waste. We follow up on every one of them and from a lot of them we get stuff right. We were tight. We always had what we needed and and fortunate for that. And you know, with everyone to get working together, we're able to keep everyone saying so hm, they worked. It worked well. Not to say we weren't stretched in for a while, but but the supply chain people really did a great job. And when you were first told about covid and it's coming and we're starting to see increases in there, did it? Did you ever? Could you ever have thought it was going to be as big as it was, or did you guys think this is we better strap in, this is we're going for a ride, you know. You know, my son asked me. He was senior in high school at the time. He's like so, so now what? And I said, you know, I don't know, and he said, have you ever been through this in your lifetime? And I said definitely not, and he said, so you know what what's going to happen, and I said I have no idea and there's nobody I can even call who has been through this and a lifetime. We can tell me what to expect, right, unless they were live one thousand nine hundred and eight. Yeah, exactly right. So you know, it too great associated medical directors. One of them has a particular head of the particular focus in emergency management and he was in his element when this happened. So let's put together a plan for this. Lets, you know, put something online where when people have questions, what's our standard upbreating procedure for this and did a great job. Once we sort of realize that this was going to be with us for a while, you know, the focus really was on again the safety of our staff, making sure everyone knows okay with to get created with the schedule, because, you know, across the country emergency apartment volumes dipped like crazy during their early, early times of code because people were terrified to come to the hospital right and so, you know, how do we adjust our staffing for that? Like there's no sense in having a bunch of people he are sitting around doing nothing. At the same time, the complexity of managing a really sick patient who comes in the door where...

...you have no idea why they're they're or what their, you know, infection status is, was very complicated, you know. So how do you secure someone's hair way with them breathing in your face if they could have covid and how do we keep our staff safe? So really you saw the creativity come through, you know, when that all happened and, you know, knock on wood, we're able to keep people safe, not to see people didn't get infected, but it was really, you know, everyone pulling together that Brooks Moore, who's the associate medical director, was talking about, said at best when he said, you know, we're flying this plane as we build it. Yeah, and there's really not, I think, a better phrase for it. And and that wasn't unique to grady. That was sort of across the country. How it was what's safest? It's not safe. So right, yeah, and that in your right. In terms of the interviews we've done on the show, that is a consistent theme. Was that early days we didn't know. We got smarters, we were along, we tried things, some things work, some things didn't work, but that was that was, that was all. That was all anybody knew. So that was all the best we could do. So let's talk a little bit about some of the mental fatigue you were seeing and then also, simultaneously, as a lot of people we've talked to you know, being in a big urban setting in the south like Atlanta, we have a George Floyd situation and a whole lot of civil unrest starts to happen. How did that impact your team and what things did you notice in terms of just the mental fatigue and how did you and the staff try to treat that? Yeah, I think one one area, and this was sort of prey all this stuff, was our department up there really prides itself on being able to openly talk about race and and how it affects the the care patients received and how it affixed the interaction between people who worked in the same hospital. And that goes for greedy and emory. And so we had have been having these conversations, you know, for years. You know, it was you always felt like, at least from my perspective of it was always a safe place to bring up these things and have these conversations. So when it, you know, when things really started to to get worse, or to be publicly worse, because it was already bad to begin with, you know, we talked about it as a department and we all we all said, you know, we know the stuff has been going on for a while. It's just now much more in the public spotlight. So being able to be open and talk about it, you know, and to understand the perspective of our colleagues of Color Really, I think, is one of the strengths of the hospital as well as our department. You know, you don't know what you go through until you've actually been in that person's shoes and not a lot of people can say we are. When you add covid to that, you know, and you had the limitation we had on beds. I mean it's a perfect time bomb, if you will, for really just frying people right and so again. You know, how do we do this? You know, the leadership team steps up and says, you know, we developed a consistent message amongst us, which is yes, it's hard, it's very hard. And you know, you're in health care and there's patients to come in every day. We rely on us to save their lives a little really, 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 the outpouring of love from the community. In terms of food, we had to initially we were sort of managing the offers of food internally as a department, and then we had to hand it over to our public relations team because we just couldn't keep up with the scheduling of the food. And you know which departments are going to get to food. Certainly it's not only the emergency department that deserves the food but everyone in the hospital deserves and so how do we make sure that everyone gets sort of their fair share? You know, we had a choir group comment saying outside the hospital, which you know, is really touching us. So, you know, we told people, yeah, you're going to have to wear a mask during your shift, which, you know, if your physician is eight hours, if you're a nurse, twelve hours. You have to take a break, like you cannot. You cannot do that. So we're going to make sure that you take a break, right, but the only thing we ask is why you're working, for your own safety and the safety of our patients. You keep your mask and goggles on. When you need a break, will take a break. Unfortunately, you'll probably have to take that break all alone again for safety reasons, but you have to go take a break. Yeah, you know, most every dot and nurse was, you know, changing their clothes in the hospital before they went home or changing their clothes in the garage when they got home. That it was unusual, and then heading straight to the shower once they got in the door, or showering at work. You know, we made adjustments to our schedule based on some people who worked with us who we thought maybe more at risk, you know, because of other underlying medical conditions they had or things like that. It's not always easy for people to share that information with their with their Boston leaders. So, you know, at the end of the day, we did the things we thought we had to do to keep everyone safe in to support everyone. We told everyone this is hard and one message 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 challenging, right and and adversity builds character, but you know, we're going to take 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 the line, as you well, you have to go through covid how did you do it right, and you can kind of hold your head up and say here's how we did it. So it was hard and it was it was endless and the phone calls and being their side to side with the people to show them bigger there as a leader supporting them, was absolutely necessary and can really accomplished our goal right. Yeah, it becomes almost a sense of a badge of honor. Right in terms of that thing. Yeah, and so, and let's just talk a little bit more and then I want to start moving into a little bit more about your your transition from a head of a department too, ahead of a hospital. But how did you see the did the did the civil unrest compounded some of the things? Again, we've heard on the show, is people felt stressed about the covid wave and trying to figure it out, and the George Floyd thing like almost became the breaking point, like it almost became the thing like, okay, I can handle this, I don't know if I can handle this and that like that almost became too much. You know, I like the love the way that you guys addressed it and just continue to be open to communicate about it when's going but did you see it almost in heightening of that stress when that happened? A hundred percent. We did a hundred percent and I think I again, you know, rather and brushing it under the rug and sort of saying this is happening in the community. You know, we brought it to the forefront. We had groups and we talked about it and simply getting out there and understanding what your colleagues of color 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 with it, but at least help us talk about it and move it out in the open and to let to let everyone in the department know like look, we're we're allies. You know, we're here for you. We can't, you can't honestly say that you understand how it is for someone, but you can say, you know, I'm going to do my best to learn, I'm going to be conscious of my own unconscious biases and you know I support you as a colleague and as a friend. You know that wasn't only for the physician and the provider side of the house, but for our nurses and really for our entire department. At the same time the hospital did the same sort of thing, and so there was this consistent message we know this is going on, we know it's an issue you know across the country and we're going to you know, we're going to keep doing all we have to do to support that everyone who works here and provides care of our patients. So it did make it that much toffer, but again, the message was consistent. Yeah, I think the acknowledgement of what we talked about here is it's okay to beat, to not be okay, you know, was a big was a big relief for people in a sense to say don't, don't, you don't have to put on the armor, you don't put on the facade that I'm good, everything's okay. And you know, that was the expression. US Say, is, Hey, it's okay to not be okay and please let's talk about that and let's continue to get through that. And what we heard out of Mount Sinai hospital was they found when they started asking people, are you having mental burn out, stressed? Everybody said no, I'm fine. But when they said Hey, would you, how would you like some resiliency training, the people would say I'd love some resiliency training. Right. So sometimes it's just how you package it. Yeah, I mean, you know, in some cultures or in some families, like you know, saying I'm tired or I'm broken is, you know, maybe considered a sign a weakness. We made sure that people knew I was okay to say when they needed help. And we're not only talking about help in the hospital or where the patient. We're talking about help with childcare, right with with making sure you get toilet paper at your house, you know, food, like simple things. You know. You know it's okay for you to say that you're scared. You know, we're all scared, you know, and when you hear that from everyone, and especially from the leadership group, and it's a consistent message and everyone can say you know, we're here for you. You know, you just have to tell us if you need something, or we're going to tell you you if we think you need something. You know, being able to do those things really helped us stay the course when it came to making sure that the fundamental reason we were there is to take care of patients, and we were still consistently able to do that on a day and day basis. Yes, keep keeping an eye on the mission right. A lot of times that helps to let's remember why we're here and all that. So well, well, that's awesome. I appreciate. I'm sure that was a great, great, bad experience. But you know, if you just as you said, those things that are difficult is what we grow from and those are the things that make a stronger and better so let's talk about this. You've now been you you get, I guess obviously got an opportunity to take on the chief medical officer role at Jackson Moone Mortal Hospital in Miami, and you say, okay, I'm I'm now in this administrative world. That kind of laugh about you saying, I mean money there. Now I'm minute and I'm going even going bigger. So tell me.

How did that opportunity come to you and what's been the transition to go from a departmental department head to now a full health care system head? Yeah, I mean one thing I've learned over the years from you know, to people who being a lot to me, is sort of the power of perspective, right. So I think to be a good emergency department leader, in the way the big emergency departments interact with hospitals, you also have to take in a perspective the what's going on inside the hospital. So you can't say what, we need this or we need that, or you have to do this or you have to do that without also understanding what your colleagues are going through on the inpatient side. I think I did a good job with that when I was at creating I think it helped me a lot when it came to transitioning to this role. You know, for me, I was extremely happy where I was. My family was happy, I was happy and you know, I was looking for an opportunity to grow even more. You know, a Jackson has such a great name really across the country of the writer Trauma Center, which is probably internationally renound. You have the Miami Transplant Institute, which is the largest transplant center in the country and in this is my kind of hospital, right. So we want to take care of people, and that's really probably the most simple way to say it. When the opportunity came up to take a leadership role here, you know, I obviously asked a lot of people who knew me. Do you think I could do it? And that means the CMOA grady to see or grady, you know, my my nursing partner, who are and I go way back up there. You know, isn't something that you think I'm ready because I want I want to keep growing. And they said, well, you're ready, but you can't go. And you know, and I said why they can't have you right? You know, I have nothing 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 same time, 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 the hospital leadership had to look around meanwhile, in the midst of covid mind you. So that made the interview process kind of interesting. But yeah, I said, you know, this 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 what sports enough to be offered the position. Very fortunate and, you know, had the opportunity to come down here and work with, you know, just another fantastic team. The similarities, you know, the commitment to the population, the commitment to getting the job done, the commitment to leading the people in the right direction despite challenges which are always going to come up for hospitals. And have just been absolutely amazing impressed with the commitment that everyone has here to the mission of the hospital and the level of expertise in the hospital when it comes to trauma, are burn care, stroke care, you know, medical care in general, surgical care, you know, it's sort of what I thought it would be, but more and so incredibly lucky to come down here and work with the leadership team in the C suite here. That that is in my mind, you know, and something I learned from the Cemi Grady. Probably the most important thing is how well you work with your teammates, you know, and I we had other issues and finding housing down here and some other stuff, but it's it's been the easiest part of a transition, which is the the leadership team I have the chance to work here with. So that's great. So, so you're now. So you've taken the opportunity to you now they're and what do you see are some of the bigger differences? What did you have to focus on mores and as an EM leader, as a department leader, versus now a full system? Yeah, you know. So I'll say that the different departments in the physicians here have been Nice enough to educate me on some of the the the challenges that are specific to their department. You know, I've learned a lot about you know a lot more about surgical care here, critical care, and you know it it's it's it's sort of similar, but you realize how much you don't know and you realize how much you rely on the people you work with. And when I see the people you work with, I'm not talking about the people who are here in this office, but the people who you work with who are, you know, providing the direct patient care, to kind of bring you up to speed on how things are going and what the opportunities are and basically how I can help and to me, my message, again as a chieve emergency medicine in 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 for you and if you need help with a patient, we've had two great examples this past week, then and you need my help to provide that great patient care, then then that is a priority to and so, you know, I want to be the type of leader or people reach out to me when they get stuck and there's a patient at the end of it. I don't care what time of day or night it is. You know I'm available and if I can't figure it out myself, then I'll ask someone to tell me ket so that's what's great about this office is when one of us has an issue we need help with, everyone jumps in and helps and and at the end...

...of the day, same as it was before, the patient is always the one to benefit from it. So so when you were and when you show, when you're a greeting, you are head of them. And now, as Cmo, did you did you have as well? Let me it's let me start this way. As head of EM. Did you still have patient interaction, or did your job really become full time and in a strate of time? Now I don't ever want to have only administrative time. When I was a chief emergency medicine, I still workshifts. I think I've told you the day that pipe broke I was scheduled for an overnight shifted on a Saturday right that that didn't change. You know, you can't lead a department without working in that department. You just can't. People can tell you what the promise, but until you see it for yourself and think about it, you just I mean, it doesn't won't make you an effective administrator. It's been more challenging to get clinical time here because of my other administrative responsibilities, but I still try and head over the emergency apartment. I'll let you know. I'll schedule half a day, you know, a couple weeks beforehand to make sure it's blocked off and you know, my assistant again, who's invaluable, keeps me on try and won't plug things in there. But you know, you it builds your credibility with the people when you're actually doing the work and it allows you to see things and hear about challenges that you might not otherwise care about and I think ultimately makes you 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 do take care of patients and do that. You were, you know, hesitant on the Admin side, but here you are in it. So I mean, you know, do you miss that side of it? Yeah, I mean I definitely do. Yesterday evening we had a CFO and I had a meeting with nurse Pectitioner and one of our transplant surgeons from the transplant department. This this particular surgeon transplants livers, HMM. And you know, we're focused to some degree on meeting our key performance indicators, but until you can really understand what they're going through. Then then, you know, how can you cut? Can you say anything? So after we finished meeting he said, you know, do you want to go around any time? Anytime, you're free, and I said, well, I'm for you right now, and so we went upstairs to the fifteen four, we walked around and he kind of shared, you know, what was going on with a couple of his patients. And first of all it gives you a whole new appreciation for the level of skill that these people have, being that physicians and surgeons, and then it also gives you much more of a perspective for the for the complexity of the patients that are taking care of. You know, obviously to do what our transpant surgeons here do as an example of the rust of hospital, you know you're going to want up with some pretty sick people and they're not always going to be straightforward and so they may need to stay in the hospital for a little bit longer. But again, my job, the job of our the rest of our team here, is okay, well, what can we do to help you facilitate that care, no matter how complex the patient is? And that's where that really good relationship between administration and the physicians during the work comes. So so what are some of the administrative things that are inherent, probably within every hospital, not necessarily just to Jackson, that are, for lack of a better word, the most frustrating for you and and how do we and how do we address them? You know, we hear about a lot and a lot of high spe hospital systems, some bureaucracy, things, the insurance red union, things, the quality of care regulations, that all of those things that are outside influences. Sometimes I get in the way of a doctor saying I just want to do my job. You just want to go, I just want to practice medicine. Can you yeah, can you get all that? I think it's very similar in the world of teaching today year about teachers saying I'm frustrated with the teacher because there's so much bureaucracy and paperwork. I just want to I just want to teach the kids. And I've heard the same for doctors. Sometimes they say I just want to treat the patients. Yeah, you know, it's, I think, a great question to I think I think part of Medical Education is getting people to understand that stuff. Ultimately, I think it makes you understand where the pressures are coming from and allows you to better find a way to manage the care of a patient. There's a lot more managed care here in Miami than there wasn't Atlanta. That's been a sharp learning curve for me to kind of understand how those things go interesting. Okay, I've worked very closely, I think, here where our case managers and social workers much more than I did in Atlanta. On the hospital side, understand the challenge is that they have in terms of getting patients to services that they need. You know, I worked closely with our physicians in terms of what is needed from our case managers and social workers in terms of communication and timing to be able to send that patient home when you're ready to send the patient home right. So what? What hoops do they have to jump through to get insurance authorization, you know, approval for the patient to go to a Rehab Facility or nursing facility? So 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, has been a big learning point since I got here. And you know, again, you don't...

...have 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 very impressed with and they they really are part of the team. So that's been a learning curve for me. It's been a point of frustration because, you know the emergency department, someone rolls in and they're sick and you take care of them and that's sort of the end of it. For me, that was one of the appeals of emergency medicine. When I was trying to decide a specialty to going HMM, my mom was like, don't you want to have your own office and staff and stuff, and I said no, I don't, I really do know. It's just want to take care of people. You know again this and my mind goes back to it's my job to make their job easier and if I can take care of something or take something off your plate that I could deal with, it allows you, the clinician and the nurse, to focus on taking care of the patient. So you know, I'm I'm much more neat deep than the burecracy, if you will, but if, at the end of the day, it helps the patients, I'm okay with that. Right yeah, so so that's you know, for me. I mean it's challenging, especially when you have the type of patient population that I want to take care of that has often social issues, medical literacy issues, and so you sort of have to go above and beyond to help those patients and I'm totally okay with that right. So is we're kind of wrapping up on coming in the home stretch of our time here. I just wanted to did want to touch on a little bit about staff shortages and things. I continue to hear what we know. There's a shortage of provide, physicians, nurses, not just physicians, but we know there's a shortage in the medical field to get all together and there's a lot of people who are saying that the shortage isn't really being in felt yet because Delta kept people engaged longer that sense of duty. I have to stay and continue to do but there's a lot of speculation that one delta really does continue to ramp down on. Let's hope that soon and we get back to a little bit more normalcy with it, that a lot of the providers who have stuck it out for now two tours or three tours of duty as they say are gonna go on Sabbatical, are going to leave our going to say I I don't want to work in a big system, or things like that. How are you guys planning for that potential shortage? I mean you're dealing with shortages now today, but how are you planning with an additional this? This might this might not get better before it gets this might not get this might get worse before it gets better. Excuse. Yeah, I mean the healthcare and landscape and staffing is is an interesting time for it. You know, ultimately it's put, I mean it covid itself as obviously put such a huge financial strain on health systems that people have had to find ways to become more efficient with the care. At the same time, bringing and providers from outside the system and paying that premium for doing that again has put a huge financial strain on systems. You know how we're going to manage? To be honest, we're going to sit down at a table, we're going to get ourselves together and we're going to think it through. You know, how much can we spend on this? All right, how do we how do we balance this with our volume and our patient care demands? At the end of the day, safety of the patients is the most important thing. And so how do we make sure we're maintaining that? You know, do we have to find? What new and novel ways can we find to do things, you know, to support our nurses, who are ultimately the ones who are spending most of the time at the bedside. You know, it's not only nursing, but you mentioned physicians and nurses. It's respiratory therapists, it's physical therapists. Yeah, it's all the members of the healthcare cross the board. Sure, and so, you know, what are we going to do to make sure we maintain operations? You know, it's obviously constantly changing, opening on a sort of where we are, and whenever the change happens, we sit down at a table, we figure it out, we figure out what we can pay for, we figure out what we can do to make sure that were that we show our commitment to that patient safety and patient care. That we think is all. Yeah, Hey, I think it will be continue to be a challenge. One of the one last kind of 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 thing, I think it was on NPR, and they were talking about how there's thirty six, that roughly thirty six thousand residencies that are all awarded or assigned each year. But yet there's about, I don't know the number was, but fortyzero or forty five thousand physicians graduating medical school. So here you are, you've gone through I was to me it was shocking thought, because here I do, I get out of medical school, I finish, I'm ready to go my residency and in and theoretically you may get bypassed. And they had a gentleman interviewed on there and he said I didn't get my letter. I called and I said Hey, I didn't get my letter, and they said you're not getting a letter and he's you know, he said my world started spiraling. What do I do now? Now I have to wait a year, and how do I keep my my saw sharp, so to speak, and practice in keep myself on this? So it did shortage and we have this. Why aren't we getting why are we creating more residency programs so that we can...

...get more provide more doctors into the market to meet this growing demand? So again, I think it's a real good question. I think something to consider about about, you know, resident education is it's not as simple as just adding some spots or starting a program. You know, you shouldn't educate someone if you can't do a good job of educating. The amount of infrastructure, the faculty time and the dollars at the cost is not certainly in consequential another's money that comes for the training of those residents. But you got to get the right people in place right. It's not simple enough to say, Oh, send me a few more residents. We're right. So you know, there's there's you know, is our opportunity out there? Will given the shore numbers? Apparently there is. Again, it becomes a commitment thing in so, you know, do we want to you know, if you're at a community hospital, which can certainly have residency programs as well, because do we want to introduce learners into this environment that we have here? You know, what is the cost to us in terms of not only dollars but but people power, in terms of making sure that we're doing an adequate job, you know, training these residents? There are learners at the end of the day, right, and so yes, you can rely on them and part of their training is to see patients, but they're there to learn, right, so they're not a solution to manpower issues, right, and I think that that's that's interesting. You say that I didn't think about that, but you're yeah, but you're right, right, because they need supervision, right, right, they're not flying solo yet, right, and they need to be taught, right, and I think you know, sometimes it's underestimated, having been on sort of both sides of the table, as the amount of time it takes to train, you know, to train trainees, right. And and you know, should they have some family issue or other interpersonal issue like, those things have to be addressed. So you know you're adding more people. You know, hospitals, aren't you generally incredibly complex, you know systems, and so now you're adding another layer of complexity. So it requires really a commitment. You know, that's probably to some degree what maybe shining people away. We don't what's the solution is it? Is it the increase the dollars, you know, dedicated to training? Perhaps it depends how we as a country or sort of looking at medical education and where we see are our sort of physicians apply 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 an adequate number physicians to care for our growing and aging population? Yeah, yeah, well, great, that insightful. So thank you for your answer on that. Well, say, it's hard to believe we've been talking as long as we've been talking. It goes fast and I always have lots more questions than I usually have time. But I want to thank you for your time, thank you for your service. You know, we here just continue. Want to shout out the people, not only your service in your commitment to it, but obviously all the team at Jackson Memorial Hospital, and just thank you guys for serving selfless, selflessly. But as we wrap up, I always like to close the episode with asking a guest who was your hero currently growing up. There, as I say, there's no wrong answer, but I'd love for you to share who your hero was. Yeah, I mean there's there's two people who really had, you know, profound kind of impact on who I am, and and you know who. I'm certain wouldn't be here without them. One, obviously, is my father growing up and you know he, like I mentioned before, he had a PhD in toxicology and was a director at a large chemical company and sort of would occasionally bring home those leadership lessons, you know, and certainly led with a different style than I lead. But at the same time, you know, there are things that you know that you learn from hearing the stories. At the same time, and most importantly, he told me how to be a good father and a good husband, and you know that's something. Obviously that's also you know you can you can't have one without the other. You can't be I think, you can't be creating your job and not have a solid home life and, you know, support the people at home and have them support you. So he certainly one of them. The other one certainly is, I mentioned him before, Dr Leon Haley. He gave me the chance to start an administration in the emmerency apartment at Grady and and the learning care was extremely sharp when when I joined the team learn, you know, you think when you start administration like okay, now you have this title right, so you can go on, you're going there room and Simr Ham on the table and tell people it's going to be. And that's what's going to happen and day one he's like, well, that's not how it works. I say that doesn't happen. Doesn't know. So, you know, from him I learned a lot about 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's important to them, that it will help inform a conversation and the negotiation that drew them like trying to have with them. And so, you know, learning that...

...from him. You know, learning her how to effectively communicate. Learning one to you to say, you know what, I can't handle. You know, I don't have the bandwidth to be able to deal with this right now and, quite frankly, it's not as important to some of the other things I got on the burner at the moment. So I'll write it down and I'll keep it and I'll address it when I have the chance. So learning to prioritize what's important and what's you know, what the things you have to drop everything for it to make sure that you take care of. So so learned that from him. So really those are my two heroes. You know, unfortunately, I'll say I'llst both of them on the same weekend in July. I'm sorry to hear that. Sorry, which was really difficult for me wow, as you can imagine. But you know, every day I think about how the impact and the influence that those two guys had on me and you know, I know they're looking down and I'm just trying to make them proud of what we're doing here at Jackson. So well, I've no doubt that they are. I'm doing 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 you our insights and tell us a little bit of the story. there. I just want to thank you again for your time and your service and thanks for being part of the show. Thanks that. I really appreciate you having me. Appreciate it. We'll talk again soon, I'm sure. Very good. Thank you. You've been listening the heroes of healthcare. For more, subscribe to the show in your favorite podcast player or visit us at heroes of healthcare podcastcom.

In-Stream Audio Search

NEW

Search across all episodes within this podcast

Episodes (40)