Smilow Cancer Hospital Town Hall | October 25, 2023

Transcript

• 00:00Good evening everybody.
• 00:02Welcome to the monthly Smile
• 00:04Yale Cancer Center Town Hall.
• 00:07We are joined by just a small
• 00:10number of us this evening and in
• 00:13fact Eric Weiner sends his regards.
• 00:15He is all the way over
• 00:18in Australia right now.
• 00:19So I'm solo with Kim and Kevin
• 00:22this evening and we've got a
• 00:25special guest looking forward
• 00:26to introducing her in a minute.
• 00:29But before we do that,
• 00:31I would like to ask Kevin and Kim to
• 00:33provide whatever updates or messages
• 00:35they would like to share and then
• 00:38we will move on to our presentation.
• 00:43Sure. I think I guess I'll start Kevin,
• 00:47I'll go through the agenda
• 00:48and I think I might have.
• 00:50I just looked real quickly the first slide.
• 00:52So welcome everyone.
• 00:54It's good to virtually be
• 00:57together as usual every month.
• 00:59As Lori said,
• 01:00Eric is not with us today,
• 01:03but we just have a couple quick
• 01:05slides because we really do want
• 01:07to get to our main agenda item,
• 01:09which is really to discuss our
• 01:11work ahead over the next year for
• 01:14our fiscal year 24 and the work
• 01:16that the health system is doing.
• 01:18And we are very involved in that
• 01:19work as part of the health system
• 01:21with strengthening the core.
• 01:22And we should have a lot
• 01:24of time for Q&A this month,
• 01:26which I know sometimes we don't
• 01:28get to do and sometimes we do.
• 01:30So please start thinking of
• 01:32your questions as as we are
• 01:35presenting and you can either put,
• 01:37I probably prefer for you to
• 01:40put your questions in the Q&A
• 01:42section on the chat's a little
• 01:44bit more difficult to manage,
• 01:46but either way we will be monitoring both.
• 01:49I think we can go to the next slide.
• 01:52So we always like to recognize our
• 01:54teams and we have a really great
• 01:56announcement in our Nursing department.
• 01:59Elizabeth Wright who is our Director
• 02:02of Patient Services for many of our
• 02:05sites in the greater in like North Haven,
• 02:09Waterbury, Torrington, Guilford,
• 02:12Orange.
• 02:13Liz has been selected as one of the
• 02:172024 American Organization for Nursing
• 02:20Leadership Nurse Director Fellowship.
• 02:22So our AOL that many of you are a part of.
• 02:26So we really want to congratulate Liz
• 02:29for this accomplishment and she will
• 02:31be also as part of her fellowship,
• 02:34not only will she get to network
• 02:36with many people across the country
• 02:38and really dedicate some time to
• 02:41her own professional development,
• 02:42she will also be leading a project that
• 02:44will really help us move our nursing
• 02:46care forward through the next year.
• 02:48So she will be sharing that that
• 02:50initiative as time goes on and
• 02:53we're very excited to support
• 02:54her in this fellowship.
• 02:56So congratulations,
• 02:57Liz
• 03:00and Kevin. I think I'm going
• 03:01to turn it over to you.
• 03:02Thanks, Kim. Well, you know,
• 03:04I think honoring Liz's developing
• 03:09leadership and her accomplishments is a
• 03:12great transition into this next topic,
• 03:15which is a little tough and
• 03:17a little bittersweet for me.
• 03:19And the slide is nursing excellence,
• 03:21which is very appropriate.
• 03:24But the bittersweet part is that I need
• 03:28to both recognize and deeply thank Kim.
• 03:32I think our community is aware,
• 03:34I think communications have gone
• 03:37out that Kim will be leaving Smilo
• 03:40in the Yale Cancer Center later
• 03:43next month to head to MD Anderson
• 03:47where she will be leading their
• 03:50inpatient cancer nursing programs.
• 03:52And this is,
• 03:54this is a tough announcement for me.
• 03:58Kim has been an incredible partner for me.
• 04:02We both arrived within a relatively
• 04:05short time of each other and you
• 04:07know we were kind of tossed into the
• 04:11the whirlwind of COVID together and
• 04:14it has been exciting and rewarding.
• 04:18And I I think one of the things that
• 04:22I have learned from Kim is just
• 04:24how rich and valuable and important
• 04:27physician diet partnerships are.
• 04:29And it has been a true growing and
• 04:32learning experience for me as it
• 04:34as it has been I think for many
• 04:36across the organization.
• 04:37So you know thank you Kim and I
• 04:41know you were going to be terribly
• 04:43missed but I do I want to take
• 04:45this opportunity to to actually
• 04:47put some context on this and and
• 04:50help our teams think about this.
• 04:51One of the things that great
• 04:54organizations do and we are a great
• 04:57organization is we develop leaders
• 04:59through our ranks and we're you know
• 05:02Kim just recognized Liz Wright.
• 05:05We have a number of incredible nursing
• 05:08leaders across our enterprise that I
• 05:11am really looking forward to working
• 05:13closely with in coming months and years.
• 05:16And I have no doubt that they are going
• 05:20to continue to grow and and blossom.
• 05:22And we,
• 05:24although we're going to miss Kim,
• 05:26I know that the transition will be
• 05:29seamless and we have incredible people.
• 05:34And you know this is another thing great
• 05:37organizations do is when other leading
• 05:40cancer centers come looking for leaders,
• 05:43this is where they come knocking.
• 05:46And I think it is a tribute not only
• 05:48to Kim and some of our other leaders
• 05:51who've moved on to other organizations
• 05:53in recent months, but it's a it.
• 05:55It is a tribute to all of you and
• 05:59all of us that we are recognized as
• 06:01a center of excellence that not only
• 06:04provides incredible care for patients,
• 06:06moves the field forward,
• 06:08but develops people who can go on and
• 06:12lead and contribute another organization.
• 06:14So I think we should all be
• 06:17be enormously proud.
• 06:18So please join me in when you see Kim,
• 06:21wish her well and thank her.
• 06:23We will miss her,
• 06:24but we will also share her success
• 06:26and and be happy for the contributions
• 06:29that she's going to make it another
• 06:32really incredible institution.
• 06:33So with that,
• 06:35I think I'll kick it back to you,
• 06:37Lori.
• 06:38Well, I can't just leave that alone.
• 06:43And obviously you know and Pam,
• 06:46how perfect the timing is for you to
• 06:49be joining us on this because both
• 06:52Pam and I have known Kim since 2009.
• 06:55Kim went, came to Duke in 2009
• 06:58and she was a bedside nurse
• 07:00manager in the inpatient area.
• 07:03Right. Kim, when you first.
• 07:05Uh, oh, she's going to correct me on me.
• 07:06No, close enough.
• 07:07I'm not going to correct you.
• 07:08It's not, it's not important.
• 07:10But yeah, I can tell you bittersweet.
• 07:13I mean, like I'm finally sleeping at night.
• 07:16So Kim and I worked
• 07:20together really since 2009.
• 07:22I remember when Kim was leading a lot of
• 07:25work in the inpatient setting at Duke.
• 07:27She was just amazing.
• 07:29And we asked Kim if she would
• 07:31please take on the women's,
• 07:33all of the women's disease areas
• 07:36in the Cancer Center at Duke,
• 07:38which was all of breast GYN,
• 07:40oncology and then included
• 07:42our endocrine program.
• 07:43And it was her first foray
• 07:46into the ambulatory world.
• 07:47And she was
• 07:48a director and she
• 07:50just rolled up her sleeves.
• 07:51She said whatever you need me
• 07:53to do and she was remarkable.
• 07:54And I can tell you that the faculty
• 07:57there were unbelievably grateful for the
• 07:59partnership that she provided to them.
• 08:02And this was her first body of work
• 08:05in the ambulatory environment.
• 08:07She then made a decision to go to
• 08:12Emory because it was her opportunity
• 08:14to advance to the next level of her
• 08:17career as a vice president for cancer
• 08:20services at that fine institution.
• 08:22But then I ended up taking on the senior
• 08:24leadership role at Duke for cancer
• 08:26and I thought and then and then our
• 08:29Chief Nursing Officer for Duke, Pam,
• 08:31you'll remember Tracy Gosselin moved
• 08:34into the Chief Chief Nursing Officer
• 08:36role for Duke University Hospital.
• 08:38And I thought we got to get Kim back.
• 08:41So between Tracy and I, we worked very,
• 08:43very hard and we got her back to Duke.
• 08:47So Fast forward and then I come
• 08:49here and guess what?
• 08:52I got to get Kim here with us.
• 08:54So I don't know if I can keep
• 08:56this going. I don't know if we will.
• 08:59Maybe we'll see what we can do in
• 09:00the future years to get her back.
• 09:02But I I have watched the contributions
• 09:06that Kim has made for many years
• 09:09now and it is it is awe inspiring.
• 09:12It's amazing. She is a great leader,
• 09:15a great nurturer.
• 09:17She has oncology nursing running
• 09:20through her veins and this is is
• 09:24truly an amazing opportunity for her
• 09:26to advance her career in oncology.
• 09:29And I couldn't be more proud.
• 09:31I am sad to see her go,
• 09:34but I am just so happy for all of
• 09:37the things that she will continue to
• 09:39contribute to the field of oncology nursing.
• 09:41So thank you very much Kim for
• 09:44all the years of amazing work
• 09:47that I have been the beneficiary,
• 09:50beneficiary of in our leadership partnership,
• 09:53but more importantly what the
• 09:56field of nursing and and oncology
• 09:59patient care has gained from your
• 10:01commitment to this body of work.
• 10:04So thank you.
• 10:06Thanks Lori. And all I'll say is
• 10:08I think you gave a great story
• 10:10of how cancer is a very small
• 10:12world and nursing is oncology,
• 10:14nursing is an even smaller world.
• 10:17And so I know that many of our paths
• 10:19will cross again and frequently and
• 10:21we are very generous at sharing with
• 10:24one another and lifting each other
• 10:26up no matter where we're working.
• 10:28So I hope that will continue.
• 10:30And I just feel blessed to have
• 10:32learned from so many wonderful
• 10:33people and gotten the chance to
• 10:35work with so many wonderful people
• 10:38here and just have felt privileged
• 10:40every minute that I've been here.
• 10:42So thank you so much.
• 10:45Thank you, Kim, very much.
• 10:46All right. Well, with that,
• 10:48I am going to introduce Pam, Stephen Walls.
• 10:50I'm sure she doesn't need any introduction,
• 10:52but I'm going to anyway.
• 10:53Pam is our Chief Operating Officer
• 10:55and Executive Vice President for
• 10:57Yale New Haven Health System.
• 10:58And as you probably have figured out,
• 11:02Kim and Pam and I did work
• 11:03together in a past life.
• 11:05And I was, I was delighted when
• 11:07I heard the Pam was coming here.
• 11:09And she has already just done so many
• 11:12amazing things since her arrival.
• 11:14What a little over a year ago, Pam.
• 11:17That's right.
• 11:18And tonight we've asked her to
• 11:21share with everybody the work
• 11:23that has begun that is under way.
• 11:25That is a long time body of work,
• 11:29but that it is under way and
• 11:30that is something referred to
• 11:32as strengthening the core.
• 11:34And Pam will talk a little bit
• 11:35about what what that involves.
• 11:37And I I think Pam you'll probably
• 11:39share a few examples of some of
• 11:41the groups that are are working on
• 11:43things And then you know other things
• 11:45that that are priorities not only
• 11:47for the health system but our work
• 11:49in collaboration with the School of
• 11:51Medicine for fiscal year 24 and beyond.
• 11:54So Pam,
• 11:55take it away.
• 11:57Well, thank you,
• 11:58Lori and congratulations Kim.
• 12:00I'm delighted to see this for you.
• 12:01I always believe in leaders,
• 12:03develop great leaders and it's
• 12:05such a wonderful opportunity.
• 12:06And Liz, I don't know you,
• 12:08but congratulations to you as well.
• 12:10It's lovely to see the continued
• 12:12leadership development of others.
• 12:13So I'm thrilled to be here and I'm
• 12:15thank you so much for the invitation
• 12:17and I want to be mindful and leave
• 12:19plenty of time for questions.
• 12:21I actually think that's the richness
• 12:22of our conversations together
• 12:24than me just sitting here talking
• 12:25to you probably about things,
• 12:27things that you've heard.
• 12:28So just to give you by way of background
• 12:31as Lori give you a little bit of insight.
• 12:34But I've been in healthcare now
• 12:37for I guess 27 years, almost 30.
• 12:40It's a little scary to say that out loud.
• 12:42And I've always been in academic medicine.
• 12:45I just feel it a tremendous honor
• 12:47to work in academic medicine.
• 12:48I believe in the academic health system,
• 12:51vision and mission and values,
• 12:54and the translation of discoveries into
• 12:57clinical care and the way it changes lives.
• 13:00I don't know about you,
• 13:01but I've been the beneficiary
• 13:02of some of that care.
• 13:03And I just think it's a way
• 13:05to pay it forward and to see,
• 13:07to to contribute to people's
• 13:08livelihood and to be able to thrive
• 13:11and be healthy and restored back
• 13:13to health is pretty incredible.
• 13:15And I think you see it no more more
• 13:17relevant than in cancer and cancer care.
• 13:18So I I hope you see the connections
• 13:21to the work that that you do.
• 13:23Prior to coming back to Yale,
• 13:24I was at New York Presbyterian.
• 13:27Prior to that I was at University of
• 13:29Virginia and prior to that I was at
• 13:31Duke University Health System where I
• 13:33spent them 20 years of my 27 plus years.
• 13:35So I've seen a lot of different models
• 13:37and it's actually proving really helpful,
• 13:39right,
• 13:39because I can tap into those different
• 13:42models that I've seen to help think
• 13:45about how can we propel ourselves
• 13:47forward to even greater excellence.
• 13:49So I have a few slides I I will
• 13:53skip through them pretty quickly.
• 13:55So again we can leave time for questions.
• 13:57You'll see here I'm talking
• 13:59about strengthening the core,
• 13:59but I I really if you go to the
• 14:01next slide please. Thank you, Renee.
• 14:03I appreciate that.
• 14:04I really want to kind of re share
• 14:09our health system strategic pillars
• 14:10and I know you all know this,
• 14:12but I often get asked,
• 14:14well what's the strategic vision
• 14:16for our health system.
• 14:17And I'd like to remind people
• 14:19it remains the strategic pillars
• 14:21that we're all grounded in.
• 14:23But it's undergirded by a fierce
• 14:25commitment to alignment between
• 14:27the school and the health system.
• 14:29And again,
• 14:30I think Smilo and the Yale Cancer
• 14:32Center are wonderful examples of
• 14:34how that work can really advance
• 14:36care in a different direction
• 14:38across our enterprise.
• 14:39But basically we have these four pillars
• 14:42and I won't go into every
• 14:44item under the list here,
• 14:45but all of the work that we're doing
• 14:47that are priorities for us over the next
• 14:50year are encapsulated in these four pillars.
• 14:52Obviously the one that's most important
• 14:54is core to who we are and what we do
• 14:56is around quality, safety and service
• 14:58and that's delivering world class care.
• 15:01And contrary to what people may
• 15:04feel or think or hear. When I speak,
• 15:05I'm actually more interested in our quality,
• 15:07safety and service agenda than I am in the
• 15:10financial performance and turn around agenda.
• 15:13However, we've had to deal with our
• 15:16financial circumstances pretty urgently
• 15:17since my arrival about a year ago.
• 15:20But you'll see in the next fiscal
• 15:22year there will be a relentless focus
• 15:24on our quality and safety journey.
• 15:26When we look at our our quality
• 15:28and safety performance,
• 15:29what we see is while the way we are
• 15:33currently measuring ourselves in
• 15:34success and the system objectives,
• 15:35we have opportunities to improve
• 15:38significantly in our in in several
• 15:40of our quality and safety measures.
• 15:42And still there'll be a reigniting
• 15:45of our HRO principles, our practices,
• 15:50including rounding, whiteboarding,
• 15:53teared huddles in a very different way.
• 15:55I'm really going to Gemba.
• 15:56I'm a, I'm a real lean junkie.
• 15:58I believe in the power of lean principles
• 16:01because it's about engaging the
• 16:02frontline staff around the work that we do.
• 16:05It is not about leadership.
• 16:06Dictating down leadership's
• 16:08responsibility is to move remove the
• 16:11barriers to success of the frontline.
• 16:13And so it's a reigniting of those principles.
• 16:15So I'm really excited about that.
• 16:18Tethered to that is our work
• 16:19around the HealthEquity space.
• 16:21And again,
• 16:21I think we are uniquely positioned
• 16:24to really change the trajectory of
• 16:27health disparities in this country.
• 16:29And if there's any place you can do it,
• 16:30you can actually do it in Connecticut.
• 16:32I said the same in Virginia because
• 16:35Virginia has fewer people than
• 16:36the whole city of New York.
• 16:39As I mentioned,
• 16:39I worked in both of those places
• 16:41and they're just very different.
• 16:42Connecticut,
• 16:43we too can change the well-being across
• 16:46multiple domains in in healthcare
• 16:48and of course most of you know,
• 16:5180% of health outcomes are associated
• 16:53with the social determinants of health.
• 16:54So we have to consider these things as
• 16:57we eliminate disparities and I believe
• 16:59we can do that through our care signature.
• 17:01I know this is a huge passion of both
• 17:04Eric Weiner and Lori's and I know it's
• 17:07permeating how we think about cancer care.
• 17:10So I'm excited to see that work
• 17:12where we have a lot of opportunities
• 17:14around our service level, right.
• 17:16When we look at our patient experience,
• 17:18I don't think any of us would be
• 17:19very proud of where we're situated,
• 17:21whether we're looking at H caps or Prescani,
• 17:25which looks at not just inpatient based care,
• 17:27but outpatient based care.
• 17:29And in H caps,
• 17:31we are unfortunately in the 21st percentile,
• 17:34right.
• 17:35I don't think we deliver 21st
• 17:37percentile service to
• 17:38our patients,
• 17:39but that's what they're telling us.
• 17:40So we have an opportunity and similarly
• 17:42in the press gainey likelihood to
• 17:45recommend we're at the 60 some percentile,
• 17:48but it again you know we should
• 17:49be in the top quartile,
• 17:50top defile performance given
• 17:52who we are and what we do.
• 17:54So I went on a little long there,
• 17:56but I just want you to know that that's
• 17:59an area of real focus for us in 2024.
• 18:01And just a reminder,
• 18:03our fiscal year runs October to September.
• 18:05So we're starting, we're in fiscal year 24.
• 18:08Second pillar here is around our workforce.
• 18:11Obviously we can only deliver superlative
• 18:13care when we have outstanding talent And
• 18:16one of the things that we know is that we
• 18:19have a huge number of vacancies, right.
• 18:21And that's a real challenge for us,
• 18:24particularly in our
• 18:25frontline caregiving staff.
• 18:26So a lot of effort around recruitment and
• 18:29retention of our clinical caregiving teams,
• 18:32our front patient facing teams,
• 18:35including our environmental services,
• 18:37transport,
• 18:37food services.
• 18:38It's a tough labor market.
• 18:40We've done really important strategic
• 18:42market adjustments and we'll continue
• 18:44to do those market adjustments.
• 18:46But you know it impacts our ability
• 18:48to recruit and retain people.
• 18:50But I'm thrilled to say our turnover has
• 18:53declined significantly over the last year.
• 18:55I was encouraged by our recent employee
• 18:58engagement survey that demonstrated
• 19:00our teams are feeling good about
• 19:02where we are and when we address
• 19:05issues they are feeling supported.
• 19:07Of course we have opportunity.
• 19:09I will just say two of those big
• 19:11buckets of opportunity around
• 19:13security and safety of our workforce.
• 19:15And you'll see recommendations
• 19:17coming forward soon to improve
• 19:19our security and safety,
• 19:21which I think is also linked to
• 19:24some of the experiences our staff
• 19:26are having when patients are
• 19:28inflicting harm or visitors are
• 19:30inflicting harm to our caregivers.
• 19:31So we we're going to be addressing that.
• 19:34We're launching and or in some cases
• 19:37launching our affinity groups,
• 19:39meaning looking at our people who are
• 19:42especially interested in being allies
• 19:44and supportive of different demographics,
• 19:46whether it's our veterans,
• 19:48women, people of color,
• 19:51really launching affinity groups to
• 19:53strengthen our bonds here of allies.
• 19:55Ship at Yale, New Haven Health System,
• 19:57so excited about that too.
• 20:00Going into the next quadrant of looking at
• 20:04growth and agile and accelerated growth here,
• 20:08probably the one I want to call
• 20:09out the most is access, right.
• 20:11How many times do you hear that word a day?
• 20:14Clearly we have opportunity
• 20:16to improve access,
• 20:18Access across multiple specialties.
• 20:20None of us are satisfied with that.
• 20:23Someone recently asked how will we
• 20:25know we've we're successful and I
• 20:27said when you no longer have to call
• 20:29somebody to get an appointment right
• 20:30all of us probably have to phone a
• 20:32friend or ask or friends or family
• 20:34ask can you get me in kind of thing.
• 20:37So a heightened level work there
• 20:40access 365 and I hope you've
• 20:41been hearing about it if
• 20:43not you will soon.
• 20:44And just we we're doing a lot of
• 20:47work around strategic planning.
• 20:49If you look at the map of where
• 20:51Yale New Haven Hospital and Health
• 20:54System where we're located,
• 20:56we are heavily populated
• 20:58all across the shoreline,
• 21:00the Connecticut shoreline in particular.
• 21:03So we know there's opportunity
• 21:05to grow into the inside part of
• 21:07the state to the north of us.
• 21:09I guess if you call it,
• 21:10I'm not sure some people call it E,
• 21:11some people call it NI,
• 21:12call it N into.
• 21:13You know we have a hospital in
• 21:15Rhode Island and expanding that
• 21:16way especially as we think about
• 21:18some of our tertiary services and
• 21:20then opportunity to go South or
• 21:22West depending on on what you think
• 21:24into markets where we have a little
• 21:25bit of a foothold but not enough.
• 21:28So a lot of work happening as we
• 21:31think about that strategic plan and
• 21:34you see here multi channel care
• 21:36that's just probably a little too
• 21:38cute for the term just care continuum.
• 21:41All of us know that care is shifting
• 21:43from inpatient to outpatient.
• 21:44That happened a long time ago in cancer care,
• 21:47but it's happening across the
• 21:49health system and across services.
• 21:51And so we have to shore up our
• 21:53ambulatory services and and honestly,
• 21:55people now are getting care in
• 21:56their home or through telehealth.
• 21:58And so how do we think about
• 22:00using those resources?
• 22:01We have home health services
• 22:02in our health system.
• 22:04We need to optimize how we utilize that.
• 22:06Patients want to stay closer to home,
• 22:08if not at home,
• 22:09they don't want to be admitted
• 22:11and that's a good thing.
• 22:12But we have to leverage our current
• 22:15platforms to better suit that.
• 22:18And then finally of course financial
• 22:20sustainability and and and stewardship here.
• 22:23And I'm going to spend time because that
• 22:25really is the crux of strengthening the core.
• 22:27It's not the only part of
• 22:29strengthening the core,
• 22:30but figured you'll you'll get
• 22:31a good sense of that pillar.
• 22:33When I talk about that,
• 22:35undergirding all of this work,
• 22:36as I said earlier,
• 22:37is the expectation that we are
• 22:40more closely aligned with our
• 22:42School of Medicine partners.
• 22:44And you know,
• 22:45there's been a long history
• 22:47of of relationship,
• 22:49but not necessarily partnership, right?
• 22:52And so now, as Doctor Billingsley said,
• 22:55he's fiercely committed to the DYAD model.
• 22:57That's what this is on steroids, right?
• 22:59There needs to be this DYAD partnership
• 23:01between the school and the health system.
• 23:03As we execute on all of this hard work.
• 23:06We are inextricably linked and to think
• 23:09that we can't operate one without the
• 23:11other is a mistake to to think that way.
• 23:15Our greatness lies in us
• 23:17working Better Together.
• 23:18So we're whether it's creating a new
• 23:21funds flow model which has launched
• 23:23this year as well as as I said the
• 23:25first joint strategic plan that's
• 23:27been done in a very long time,
• 23:29which is critical, right.
• 23:30We can't all be rowing in
• 23:32different directions and then also looking
• 23:34at our clinically integrated network that
• 23:37Peg McGovern is leading that tightens the
• 23:40relationship between Yale Medicine and
• 23:42EMG and our community based providers.
• 23:45So lots of exciting work, but that's
• 23:47what we're working on in fiscal year 24.
• 23:49So at least I understand why I'm tired,
• 23:51right? When I think about all of this effort
• 23:54and probably why you're tired too is,
• 23:56you know, we have a lot going on.
• 23:58And I hope this gives a little bit of
• 24:01an overview. Next slide, please. Renee,
• 24:06Again, I think I talked about this,
• 24:08you know, why strengthening the
• 24:09core has been so important.
• 24:11It's just there's just lots of market forces
• 24:13impacting us and it's not here just at Yale,
• 24:15New Haven, but it's across the country.
• 24:18As I said earlier, we're seeing the
• 24:20shift more to ambulatory home based,
• 24:22community based care.
• 24:25Our expenses have far are starting
• 24:28to far exceed our revenue.
• 24:31You know salary amounts,
• 24:33labor force expenses are growing up,
• 24:35going up as are other things
• 24:38like our supplies.
• 24:39IT, you know the amount of money
• 24:41we now have to pay for software,
• 24:42hardware just to keep the lights on,
• 24:45pretty significant increases in
• 24:47drug expenses and supply expenses.
• 24:50All those things that are going up
• 24:51and cost at home are going up in
• 24:53cost Tier 2 and yet the reimbursement
• 24:55is declining as things push to
• 24:57the outpatient environment,
• 24:58good for patients but harder for us.
• 25:02In addition inpatient rates are
• 25:04also declining and and that's
• 25:05has historically went then where
• 25:07our bread and butter comes from.
• 25:09So it's creating this pressure on
• 25:10us and it's not going away right.
• 25:13These are not one time changes
• 25:15we have to change for the future.
• 25:17So strengthening the core is really
• 25:19about a multi year approach to that
• 25:21change and of course you know we
• 25:24don't do this work to turn a profit.
• 25:26We're not-for-profit institution.
• 25:27We we do this work because we
• 25:30believe in the mission.
• 25:31However,
• 25:31we have to return back to profitability
• 25:34in order to reinvest back in
• 25:37our workforce and reinvest back
• 25:39in things like our capital.
• 25:42I think,
• 25:42you know I spent a lot of time
• 25:44talking about radiation therapy
• 25:45with Lori and and Eric and you know
• 25:48to to change out one of our lunar
• 25:50accelerators is no small feat, right.
• 25:52That alone I think one machine is 3,000,000,
• 25:55is that right, Lori?
• 25:57Something like that.
• 25:59And when you have the construction cost,
• 26:00yeah, just for the machine.
• 26:02And I think actually I think
• 26:03Doctor Glaze was on here too.
• 26:04So he could I definitely
• 26:05fill you in on all that.
• 26:06But yeah, so yeah,
• 26:08it's about 3 million for the
• 26:10machine and then probably another
• 26:12few million just to to reconstruct
• 26:14and do all the work that needs. So
• 26:17that's just for one machine, right.
• 26:19When you look at something like SRC, the SRC,
• 26:23the Neurosciences Tower in the HVCIR,
• 26:27that building is $800 million
• 26:29to do that whole project,
• 26:31including the parking garage,
• 26:32800 million do you like,
• 26:34that's almost a billion dollars for
• 26:36one project and it's a big project.
• 26:37However, you can see why the criticality
• 26:40of returning or reinvesting back
• 26:42in ourselves and I talked again
• 26:45about those community models.
• 26:47Next slide.
• 26:49So again, won't go into all this detail,
• 26:52but this is the framework of
• 26:53strengthening the core and we called
• 26:55it strengthening the core because we
• 26:57created this framework because we were
• 26:58at one point had all these different
• 27:00ideas coming from us left and right.
• 27:02And we know we needed to encapsulate
• 27:05the work into one coordinated activity.
• 27:07And I am leading that coordinated
• 27:09activity on behalf of the health system.
• 27:11But you can see many,
• 27:12many people are involved.
• 27:13Right now,
• 27:14we have 41 plus work streams that are
• 27:17addressing different parts of the
• 27:19organization and what we can improve.
• 27:21We're we're bundling those into 5 focus
• 27:23areas and you can see them listed here.
• 27:26And we have executive leaders support
• 27:28from our Office of Strategic Management.
• 27:31Our finance colleagues are helping
• 27:33to support each of these work
• 27:35streams together with local leaders
• 27:38and local staff who who understand
• 27:41the details of our operations.
• 27:44This is not about just what I call
• 27:46nipping around the edges of savings.
• 27:48This is really about how can we redesign
• 27:51the care that we're providing to be
• 27:54more efficient to facilitate access
• 27:57and therefore generate opportunities
• 27:59for incremental revenue so that we have
• 28:03a more sustainable financial model.
• 28:05I won't you know some of these are obvious
• 28:07and we've been working on for years.
• 28:10If you look right in the middle of
• 28:11the page there under high value care
• 28:13delivery you'll see length of stay.
• 28:14We have shown tremendous improvement
• 28:16in our length of stay.
• 28:18We still have opportunity,
• 28:19but we've been improving over this
• 28:21past year in particular there's
• 28:23huge savings when we reduce length
• 28:25of stay and it's actually better
• 28:26for our patients and also enables
• 28:28us to get more patients back in.
• 28:30Other projects are a little are new to us.
• 28:34So for example,
• 28:35as we think about as the group,
• 28:37as the organization think about the
• 28:39scope of practice of our AP PS, right.
• 28:41AP PS really want to function at the
• 28:43top of their license where they're
• 28:45able to see their own panel of
• 28:48patients or really support direct
• 28:50patient independent caregiving.
• 28:51So we're evaluating that model
• 28:53across the health system,
• 28:54across departments and divisions and
• 28:56how we can optimize that and ensure
• 28:59that our local clinic and operations
• 29:01have the support they need so that AP
• 29:04PS can really function at the type
• 29:06of license that is just launching.
• 29:08And again, some areas do this perfectly well.
• 29:10Some other areas have real opportunities.
• 29:13We want to learn from each other.
• 29:15And so that that team is really
• 29:17just launching this year and there's
• 29:19a lot of wonderful opportunity.
• 29:21Next slide please.
• 29:24So if you we look to see for fiscal year 24,
• 29:28as I said this is a multi year approach
• 29:31with the goal of breaking even meaning
• 29:34to generate a margin this year.
• 29:37The these work streams,
• 29:38these work group made-up made-up of hundreds
• 29:42of people participating have identified
• 29:44more than $388 million in opportunity.
• 29:48Half of that opportunity is associated
• 29:50with generating more revenue and half of
• 29:52it is associated with expense reductions or
• 29:55expense improvements and you can see here,
• 29:58this is the revenue slide slide.
• 30:00So these are our targeted
• 30:02performance or pickups.
• 30:04For fiscal year 24,
• 30:06we're expecting about $284,000,000
• 30:08in incremental revenue associated
• 30:10with this work stream and you can
• 30:12see them listed here, right, A A,
• 30:15a huge amount highly leveraged
• 30:18and especially in retail pharmacy.
• 30:20And again I know it's an important
• 30:23space for oncology and non chemo
• 30:25infusion in particular.
• 30:26So you know the work teams have
• 30:27really worked very hard to not
• 30:29overestimate here and to really
• 30:31put onto paper what we think we can
• 30:33deliver in this year with the hopes
• 30:35of delivering more in fiscal 25.
• 30:37Next slide please.
• 30:40In terms of reducing expenses,
• 30:43you can see that in right in
• 30:45the middle of the page that we
• 30:48identified $243,000,000 in expense
• 30:50savings reduction opportunities.
• 30:52But some of those require investments
• 30:54which once you take out the investments
• 30:57yields about $107 million in expense savings.
• 31:01And I think that's a good thing sometimes
• 31:03you got to spend money to save money.
• 31:04So I want you to hear that we're
• 31:06being smart about this and really
• 31:07thinking about where do we have to
• 31:09make strategic investments so that
• 31:10we have a longer term efficiency.
• 31:12The biggest bucket here that may
• 31:15draw people's eyes is $95 million
• 31:18in premium labor.
• 31:19We think it's really important to
• 31:21as I said earlier recruit our staff
• 31:23who are permanent staff fiercely
• 31:25committed to being here with us,
• 31:27not that temporary labor is not
• 31:31or traveler resources are not,
• 31:33but we rather have you here full time,
• 31:35right and be part of our team that
• 31:38premium labor really goes to paving
• 31:41the traveler company and so we instead
• 31:43rather invest in our own workforce.
• 31:46And again you can see the examples here,
• 31:48happy to talk about any and or
• 31:50all of them as you see fit.
• 31:51But I actually think that's my last slide
• 31:56just to make sure. Yep. Good.
• 31:59So I know I spoke really quickly,
• 32:01but again, I wanted to hopefully
• 32:03give you a little bit of foundation
• 32:05and groundwork of of where
• 32:06we are and what we're doing.
• 32:08Thank you, Pam and everyone.
• 32:11Please don't be shy.
• 32:13Let's ask questions and we can start.
• 32:16But I would really love to hear
• 32:19from folks that are out there.
• 32:21I was looking at the list of
• 32:24attendees and we have a real mix Pam.
• 32:27We have of course our our Smilo
• 32:31Yale New Haven Health system
• 32:33staff and managers nursing,
• 32:35non nursing from across the whole system.
• 32:38So I'm seeing folks from Greenwich,
• 32:39I'm seeing folks from Bridgeport, L&M,
• 32:42I'm seeing folks obviously from Yale,
• 32:44New Haven on here.
• 32:46I'm also seeing,
• 32:47I'd say close to 3040% of the
• 32:50folks here are physician leaders,
• 32:53physicians from surgery, from medicine,
• 32:56from radiation oncology.
• 33:00You know,
• 33:01I I wonder if you could first of all,
• 33:03I want them to ask questions.
• 33:04I see one, I see one Good.
• 33:06Well, I'll let me ask and then we'll we'll,
• 33:08we'll we'll take that one.
• 33:10The partnerships,
• 33:11you've talked a little bit about the
• 33:13DYAD relationships and the partnerships,
• 33:15we talk a lot about that in our leadership
• 33:18forums and in the work that we do.
• 33:20But I I wanna emphasize the fact that
• 33:23you know we have worked pretty hard
• 33:26within our cancer world to cascade
• 33:30that throughout the organization as
• 33:32it occurs in the inpatient units,
• 33:34that occurs in the clinics,
• 33:35that occurs in our strategic
• 33:37work that we do in the different
• 33:40delivery network areas engaging
• 33:43with our multidisciplinary you know
• 33:45physician colleagues and I I just,
• 33:48I wonder if you wouldn't mind
• 33:50just sort of emphasizing just how
• 33:52important that is for us to continue
• 33:56to invest and those relationships
• 33:59especially I mean anytime.
• 34:01But right now as we are all trying to
• 34:04swim in the same direction with the
• 34:06challenges we have around financials,
• 34:08with our,
• 34:09with our,
• 34:09our our complete commitment to quality
• 34:12and safety and our our new renewed
• 34:15journey around the high reliability
• 34:17organization and all of that.
• 34:19Could you just maybe,
• 34:20you know,
• 34:20emphasize that more to the teams in
• 34:23ways in which you've seen that work
• 34:27effectively or ineffectively in other areas?
• 34:30Absolutely. And you know,
• 34:32as I said earlier,
• 34:34we are inextricably linked, right?
• 34:37We no one can do their job or
• 34:38none of us are on an island.
• 34:40And my experience has been the best
• 34:43leadership models in the healthcare
• 34:46landscape is all the way from
• 34:48the the top of the organization
• 34:51throughout cascaded throughout
• 34:53our leadership structures having
• 34:55Dyad and I would dare say Triad
• 34:59partnerships are absolutely essential.
• 35:00And so you will see and I think
• 35:03we have that in the service line
• 35:06structure particularly where you
• 35:07generally have a physician leader
• 35:09and an administrative leader.
• 35:11I would add into that mix
• 35:13a nursing leader as well.
• 35:15And those are the models honestly that
• 35:17I have grown up in my entire career.
• 35:19I don't really know any other
• 35:21models to live by,
• 35:22but those become really important
• 35:24that those three are staying in
• 35:27lockstep as we advance whatever
• 35:29mission it is that we're advancing,
• 35:31so that we have a comprehensive
• 35:34perspective of the clinical care
• 35:36landscape as we forge ahead,
• 35:38whether it's a cost savings opportunity,
• 35:41as you said,
• 35:42whether it's quality or safety that
• 35:43we're moving in tandem with one another.
• 35:45So if you think about it,
• 35:47Chris and Nancy Brown are
• 35:49functioning as Dyad partners.
• 35:50I consider Peg McGovern, my Dyad partner.
• 35:55Lisa and Lee Schwab in the IT landscape
• 35:58are functioning as Dyad partners,
• 36:00you and Eric, Dyad partners,
• 36:02Kim and Kevin Dyad partners,
• 36:04right.
• 36:04Those are the best shaped structures
• 36:09because you stay in balance and
• 36:11quite frankly it stops a little
• 36:13bit of this us and them so that we
• 36:16can learn and have appreciation for
• 36:18some of the challenges that we're
• 36:20each experiencing and some of the
• 36:22real opportunities to optimize.
• 36:23And I tell you work gets a lot
• 36:25easier when you're in a relationship
• 36:27versus being antagonistic.
• 36:28So I think it's critical.
• 36:30Yeah. Thank you Pam.
• 36:31And I'll just say we mix and match a lot
• 36:34in oncology and in the cancer arena.
• 36:36Kim and and I'll just by example you
• 36:39know Kim and Kevin Die add routinely
• 36:42and we try Add all the time you
• 36:45know in some strategic initiatives
• 36:47or in some operational initiatives.
• 36:49It may be say Kevin and Liz Herbert
• 36:52or Jeremy Kortmanski who's on and
• 36:54you know Kim and it it's there's a
• 36:57lot of mixing and matching and it
• 36:59takes a little while to really get
• 37:01that rhythm and making sure that
• 37:03everyone is aligned and knows who's
• 37:05on on on you know on task for what.
• 37:08But I think over time with a lot
• 37:10of work and a lot of experience,
• 37:12we I think we've,
• 37:14we've you know been trying to refine
• 37:16that more and more but we see it playing
• 37:19out in the on the frontline across
• 37:21the system and across the hospital.
• 37:23So thank you. Appreciate that.
• 37:25All right.
• 37:26We
• 37:26have some yeah, we have some questions.
• 37:28Go ahead, Kim. All right.
• 37:31Maybe we can we'll start with the first,
• 37:33we'll just go down and you know
• 37:35there I know that we've had some
• 37:37positions held through vacancy review.
• 37:39I know it's there's been a lot
• 37:41going on through the budget process.
• 37:43And Pam, I don't know if you have any
• 37:45details that you'd like to share about that.
• 37:47I know there's various pathways for
• 37:50you know I I don't know exactly which
• 37:55pathway this is but there's been a
• 37:58few pathways where it it has been
• 38:00a you know we have paused on some
• 38:02positions there's some positions we've
• 38:04delayed while we take the while we
• 38:06wait for the budget finalization.
• 38:09So maybe you could just give
• 38:10some comments to that.
• 38:12Absolutely and it is true we,
• 38:16so we during the budget period in order
• 38:20to you know the budget is a fixed get
• 38:23started in March at a fixed period of time.
• 38:25And what we were finding is that
• 38:28as we plan for the fiscal year 24,
• 38:31we were filling positions certain
• 38:34positions faster than what we
• 38:35were planning for our budget.
• 38:37So we put a hold on recruitments
• 38:40of select positions.
• 38:42At no point did we stop
• 38:45filling frontline positions.
• 38:46We were allowing those going forward if
• 38:49they were within the budget expectations.
• 38:51We did press pause because we
• 38:54wanted to make sure we had enough
• 38:56budget FT ES before we started
• 38:58recruiting into all of the seats.
• 39:00And so we are finishing up the
• 39:02closing out the budget now.
• 39:04The FT ES have been loaded into
• 39:07the into the appropriate system,
• 39:09I guess N 4 and then we're cleaning up.
• 39:13There's had some reconciliation
• 39:15that needed to be done and then we
• 39:18will release those positions for
• 39:20recruitment for those which we held.
• 39:23Again there was not a a house wide hold,
• 39:25there was a hold on a select number
• 39:28of positions and those were generally
• 39:30positions that were non clinical,
• 39:33non patient facing positions.
• 39:35So think management positions,
• 39:37think some of the not to say these
• 39:40positions weren't important,
• 39:41we know they're important to you,
• 39:43but those were the ones we felt
• 39:44like we could press pause on while
• 39:46we got the budget cleaned up and
• 39:48then we will release them if they
• 39:50were in the fiscal year 24 budget.
• 39:53So I know that was hard for everybody.
• 39:55It was a tough decision to make,
• 39:57but we really did not want to risk
• 39:59filling positions and not having the
• 40:01budget to support it for fiscal year 24.
• 40:03Great.
• 40:06Thanks.
• 40:08We have another question around
• 40:09have there has there been any
• 40:12discussion around initiatives aimed
• 40:14at improving provider Wellness?
• 40:16Yes. Well, thank you.
• 40:17And it's such a critical topic,
• 40:19especially right now as I mentioned earlier,
• 40:23Peg McGovern is leading the work
• 40:26around what's called the aligned
• 40:28clinician enterprise and that is the
• 40:31combination of Yale Medicine and NEMG
• 40:33physician providers and APP providers,
• 40:36which will again will be a structure
• 40:38to help support the objectives
• 40:40of that practice management.
• 40:42And as part of that,
• 40:43PEG has an intense focus on the
• 40:46physician well-being not just
• 40:48physician but provider well-being
• 40:51clinician well-being in that space.
• 40:53The 1st order of business
• 40:54that they've launched,
• 40:56and I just heard her give
• 40:57a very long presentation,
• 40:58is around the optimization of Epic,
• 41:01recognizing that our provider partners are
• 41:04spending far too much time documenting,
• 41:07you know, pajama time,
• 41:08which is basically people having to
• 41:10go home and do their documentation.
• 41:12So there's a special kind of
• 41:15firefighting team being brought together
• 41:18to help support health providers.
• 41:21We can facilitate the use of Epic.
• 41:23That's just one example.
• 41:25I think another piece where we're
• 41:27really focusing in on is understanding
• 41:30why we're having so much turnover
• 41:32in certain areas and really working
• 41:35together to identify the root causes
• 41:37of those turnover challenges.
• 41:39Then as we're recruiting new providers
• 41:40in and and it's beautiful to watch,
• 41:42we recruit an extraordinary number
• 41:44of providers here.
• 41:45So we're actually a place where
• 41:47people want to come and work to make
• 41:49sure they get on boarded quickly,
• 41:51efficiently,
• 41:52effectively and that quite that we
• 41:57create systems that once they get
• 41:59here they can do their best work.
• 42:02It's you know and I don't know if
• 42:03you have this trouble as much as in
• 42:05SMILO as I've heard in other areas.
• 42:06But you know we don't have consistent
• 42:10models of care in every ambulatory
• 42:13space where we provide services.
• 42:15So it's very frustrating for a provider.
• 42:17They go to one clinic location
• 42:19where they see patients and and
• 42:21they have you know ACMA or RN to
• 42:24support them or or whatever.
• 42:26And then they go to another
• 42:28location and have no resource.
• 42:30And so you will hear us rolling out
• 42:32more and more creating that ambulatory
• 42:35operations where there's consistency
• 42:36from clinic to clinic to clinic.
• 42:39Of course it has to be informed by
• 42:41the specialty that you're in, right.
• 42:42So what we put in a cardiology clinic,
• 42:44it may not be what's in an oncology
• 42:46clinic or pediatric clinic,
• 42:47but once that's informed and
• 42:49and developed by the providers,
• 42:51we should be able to stand up
• 42:53some consistency and it may mean
• 42:54we have to bring more resource to
• 42:56bear in certain locations.
• 42:58So I I think that it's starting
• 43:00to give some insight into
• 43:01the work that we have to do,
• 43:03but it's you know,
• 43:04it's pretty local it but has our attention.
• 43:10Yeah, there was a specific
• 43:12financial question.
• 43:12We talk a lot about the operating
• 43:15revenue and expense and there was a
• 43:17question about how we're doing from a non
• 43:20operating revenue perspective and how
• 43:22that feeds into our overall, you know,
• 43:24performance and financial health. Yeah,
• 43:26thank you for that question.
• 43:27That means somebody is pretty
• 43:28savvy at reading balance sheets
• 43:30and income statements. So.
• 43:32So we had a really tough year I guess
• 43:35was it when the market really tanked,
• 43:37not 20, I guess 22,
• 43:39right going into 22 and there were
• 43:42pretty significant investment losses,
• 43:44non operating losses,
• 43:45those are since recovering and it's
• 43:49really good because it's replenishing our,
• 43:52our assets or what was I trying to
• 43:55say replenishing our balance sheet
• 43:57so to speak and replenishing our
• 43:59cash on hand because it dropped
• 44:02precipitously during COVID, right,
• 44:03because we had trouble getting cash in
• 44:06the door and we saw volume declines
• 44:08and we can't live off stimulus funds.
• 44:11And so that number is rebuilding.
• 44:12Our cash on hand is now back up,
• 44:14I believe it's to two O 3.
• 44:16It had dipped down into one 70s or
• 44:20so and that is never a good place
• 44:21for a health system of our size.
• 44:23We are a $6 billion organization and
• 44:27it costs $25 million a day to run our,
• 44:31our, our, our, our system.
• 44:33And so that's not a lot of cash
• 44:34on hand when you're trying to run
• 44:36that $25 million a day.
• 44:38So thank you for the question.
• 44:39It's getting better,
• 44:39but not where it needs to be.
• 44:41That's great. I definitely would not
• 44:42have been able to answer that one. So
• 44:45and I hope I answered it right,
• 44:47if somebody from finance is on it, I'm
• 44:48wrong. Please. Just
• 44:49to clarify, when you gave the numbers,
• 44:51that's the number of days that
• 44:53we have cash on hand and I'm sure
• 44:56most folks realize that. But it's
• 44:58a really important performance metric
• 45:00from a financial landscape, right.
• 45:02And because if God forbid
• 45:03something happens like COVID,
• 45:05you want to have enough cash
• 45:06where we can pay people,
• 45:07we can pay our vendors, you've got to have.
• 45:10And then our when you hold debt,
• 45:12our bond rating agencies have a
• 45:15expectation you have a certain amount
• 45:16of cash on hand because your debt is
• 45:18a certain is the interest rate is
• 45:20at a certain price or the interest
• 45:22rate is set at a certain level
• 45:23depending on how many days of cash.
• 45:26So Pam, maybe I'll pick
• 45:27up the next questions.
• 45:28These are some of these are
• 45:30near and dear to my heart,
• 45:31particularly question from Doctor Taraga,
• 45:33one of my partners in our division
• 45:36Chief of Surgical Oncology. You know,
• 45:39Karen's been here a little over a year.
• 45:40And one of the things that he's
• 45:43pointed out is that we do,
• 45:45we're an open culture,
• 45:46we're inclusive,
• 45:47but we have a mixed medical staff
• 45:50across enterprise and that has,
• 45:55it does present certain
• 45:57challenges in a variety of ways.
• 46:01And I think he kind of is asking
• 46:04maybe for your general perspective
• 46:06on where we're going with that and
• 46:10are there opportunities for us to
• 46:12think about creating more coherent
• 46:15alignment among our specialists?
• 46:18Yeah. Thank you both. Yeah.
• 46:21I will speak this from a general perspective.
• 46:23I can't speak exactly to
• 46:24what's happening in cancer.
• 46:26But again at the turn of the year in January,
• 46:31we are hoping to launch a
• 46:34clinically integrated network.
• 46:35And that is really an important strategy at
• 46:37a place like Yale where you have faculty,
• 46:40employee providers and independent
• 46:42community providers who are practicing
• 46:45across the enterprise, right.
• 46:47It's a really critical vehicle to
• 46:51drive alignment in a legal compliant
• 46:55way around quality and safety,
• 46:57around how we think about our work
• 47:00together as we consider referral patterns
• 47:02and mechanisms, strategic growth.
• 47:04It creates the stickiness.
• 47:07Everybody hears me talk about that all the
• 47:09time that you want among those providers.
• 47:15But ideally you want people who are
• 47:17fiercely committed to the work and
• 47:19mission and vision of Yale New Haven
• 47:21Health System and committed to the
• 47:23patients that we're serving so that we
• 47:25can create this network where we can
• 47:28stay tethered together through Epic.
• 47:30Usually you can, everybody gets on Epic,
• 47:33you can have a common quality and
• 47:35safety platform so that you're looking
• 47:37at the same measures you can share
• 47:39at times in risk based contracts.
• 47:41So you can together contract with
• 47:44the same managed care companies
• 47:47so that you can go at risk for
• 47:50certain patient populations.
• 47:51And as we know more and more of
• 47:53our contracts are moving in that
• 47:55direction and you can together set
• 47:58goals about opportunities for cost
• 48:01containment or product standardization,
• 48:04things that you can't do together when
• 48:06you don't have a clinically integrated
• 48:08network because it violates stark
• 48:09and anti kickback you can do within
• 48:12a clinically integrated network.
• 48:14So again PEG,
• 48:16McGovern is launching that along with
• 48:19that you have a population health
• 48:21coordinated population health program
• 48:23underneath it so that you can start
• 48:26stratifying your patients and looking
• 48:28and provide data to that whole group
• 48:30so that they can see you know how
• 48:32are we caring for our patients,
• 48:33what are opportunities for
• 48:35improvement and the like.
• 48:36So that's this really,
• 48:37really big part of our strategy for fiscal
• 48:41year 24 and starting in the calendar year.
• 48:45I will say my understanding is we
• 48:48attempted this twice before at Yale,
• 48:51so third time's a charm and Peg
• 48:54has LED this in her career at
• 48:57Stony Brook and Mount Sinai.
• 48:59Believe she launched these and she
• 49:01is incredibly gifted in this work.
• 49:04So I have no doubt that we'll be
• 49:06launching this with rigor and vigor
• 49:08starting the come of the year.
• 49:10I would recommend you invite her or an
• 49:12opportunity to speak to it at some point.
• 49:14Yeah, absolutely. Pam, thank you.
• 49:16And and just to add, I was,
• 49:18I was not here for the first go at it,
• 49:21but I was here for the second go at it.
• 49:23And I'll just say from my
• 49:26perspective it feels different.
• 49:27I'm very encouraged that we
• 49:28are going to make this happen,
• 49:30that Peg and her leadership
• 49:31is going to make this happen.
• 49:33It is a heavy lift,
• 49:34but it's so critically important.
• 49:37Before we go on to the next question,
• 49:38if I can just sort of add a
• 49:40little addendum question.
• 49:42Can you talk a little bit because
• 49:44I'm not sure everybody that's in the
• 49:46town hall has heard about the work
• 49:48that's occurring around the alignment
• 49:49of yell medicine and NMG as well.
• 49:53Sure. So that is under the auspices
• 49:55of the Align Clinician enterprise
• 49:57and it's very related to the
• 50:00clinically integrated networks.
• 50:02I know there's a lot of acronyms here and
• 50:04it is kind of complex and a little fussy,
• 50:06but that Align Clinician Enterprise
• 50:10is the bringing together of Yale
• 50:12Medicine and the Northeast Medical
• 50:14Group to more formally work together.
• 50:17It's not a new legal entity.
• 50:19It's, it's, you know,
• 50:21there's still separate legal entities,
• 50:22but it's the coming,
• 50:24the informal coming together so that
• 50:29there is a focus on those things that
• 50:32can be shared between those groups,
• 50:35including not competing against one another,
• 50:38right.
• 50:38Because there are times that
• 50:40in EMG was recruiting,
• 50:42YM is recruiting and never did the two know.
• 50:45So it creates some of that alignment
• 50:47opportunities to share and some services,
• 50:50for example,
• 50:51a shared compliance program,
• 50:53having a shared ambulatory
• 50:55quality and safety program.
• 50:57I'm really looking at the physician
• 50:58practice management and I say physician,
• 51:00but I really mean provider clinician
• 51:03APPS are included in that.
• 51:05So that's the best I can explain it.
• 51:08It's really bringing some focus and
• 51:13collaboration between the the two practices.
• 51:18Yeah. And I would just say from my
• 51:21perspective what I see is that prior to
• 51:24this move they were very separate there.
• 51:27There were I'm sure attempts at trying
• 51:29to and I know in cancer we made
• 51:32attempts to try to make sure that we
• 51:34were creating sort of collaborative
• 51:35opportunities there because we did have,
• 51:37there are providers in any M&G
• 51:39that are very important to us that
• 51:41are in the cancer realm.
• 51:43But what what I see right now is
• 51:45that even though it's they're not
• 51:48one organization and it's informal,
• 51:50I see more structure around that
• 51:53and I see more alignment in terms
• 51:56of the desires across the board to
• 51:59do something very different than
• 52:01what we've done in the past.
• 52:02So I'll just add my observation to that
• 52:06and again I think it's very encouraging
• 52:09and I think you know I'm
• 52:10channelling peg a little bit here.
• 52:12But you know some of the desire
• 52:14is for the physician groups to
• 52:16socialize with one another and to
• 52:18understand how their shared success
• 52:20and getting to know one another.
• 52:23And you know doing a little bit of myth
• 52:26busting and interestingly many of the
• 52:28NEMG providers are former Yale grads,
• 52:30right, medical school or residency,
• 52:33fellowship trained physicians and clinicians.
• 52:36So it's kind of reconnecting those groups
• 52:40back together and again we'll be ongoing.
• 52:43It's not a project,
• 52:44it is a new way of doing our work.
• 52:47So we have a, we have a Anne Chang,
• 52:49I don't think Anne is is with us this
• 52:51evening, but Anne has been working with
• 52:54Karen Brown who is the physician leader
• 52:57at NEMG around the primary care body of
• 53:01work and they have for several months been
• 53:04doing something called Smile of Shares.
• 53:06We've been doing this across the
• 53:07state and and various communities.
• 53:10Oh hi Ann, Ann's here.
• 53:12And so Ann, correct me if I get this wrong,
• 53:15but anyway they have been doing these great.
• 53:19It's been through virtual mechanisms,
• 53:22but Ann and Karen have been putting
• 53:24these programs together for the
• 53:26primary care physicians in NMG,
• 53:27bringing the disease specialists
• 53:31multidisciplinary together to talk
• 53:34about how to work together in managing
• 53:38the cancer patient population.
• 53:39So you know,
• 53:40I think that we are continuing to try
• 53:43to be very creative and innovative
• 53:45in how we we would collaborate.
• 53:48It's so important,
• 53:49It is so important with our patients
• 53:52who need to also be taken care
• 53:53of by primary care physicians,
• 53:55not exclusively by oncologists.
• 53:57Yet the primary care,
• 53:58I mean the patients get very nervous
• 54:01and comfortable with their oncologists
• 54:02and we really need to bridge that gap.
• 54:05So Ann shout out to Ann and Karen
• 54:08you guys really impressive work.
• 54:10Yeah
• 54:11that's actually coming up
• 54:12in other services as well.
• 54:13So I'll thank you for shouting out the team.
• 54:16It's nice to know it's, it's happening.
• 54:17We have a example in in Smilo in
• 54:20primary care and you know we know we're
• 54:23under resourced in our primary care
• 54:25network and part of our strategic plan
• 54:27clearly calls that out that minimally
• 54:29it's likely we have to recruit 200
• 54:32plus primary care providers in our
• 54:34network in some form or fashion.
• 54:36They don't necessarily have
• 54:36to be employed by us,
• 54:38but maybe we have have a tighter
• 54:40relationship with community providers
• 54:42and and have this connection between
• 54:45specialties and primary care so that
• 54:48there can be effective handoffs
• 54:50back and forth as appropriate and
• 54:53as determined by those providers.
• 54:56And we heard it today in in our strategic
• 54:58planning around cardiology as well,
• 55:01absolutely. So there is one one
• 55:02more question and if we have a a
• 55:04few more minutes is the question.
• 55:06First of all, Michelle Kelvey,
• 55:07Albert thanks you for your presentation.
• 55:10She asked if you can comment on work
• 55:12that's being done around centralization
• 55:13of some areas and how this fits into
• 55:16the strategic vision and why it's so
• 55:18important for as we move this forward.
• 55:19And I may be adding things that
• 55:23Michelle doesn't intend for me to add,
• 55:25but Michelle is our Director for
• 55:27quality and I think a lot of the
• 55:29work Deb Rhodes is doing and she's
• 55:31working with our teams and with
• 55:32Michelle and and Scott Huntington
• 55:34and who I also Doctor Huntington,
• 55:35I think is on with us tonight around the
• 55:38work that's going on in the quality space.
• 55:40So perhaps you could just speak
• 55:41to that a little bit.
• 55:42Michelle,
• 55:43I hope I am representing you appropriately.
• 55:47Thanks, Lori for giving that
• 55:48a little bit more context.
• 55:49For me, I I think that's right that
• 55:54there's a desire to centralized some of
• 55:57that activity and and let me be clear,
• 55:59it's not for centralization's sake, right?
• 56:02The desire is to create uniform
• 56:06processes and approaches to how
• 56:08we manage quality and safety so
• 56:11that we establish common language,
• 56:14common approaches, common metrics,
• 56:17common performance expectations
• 56:20around quality and safety.
• 56:23Not to take away in any way,
• 56:24shape or form from the service line,
• 56:27specific definitions of quality and safety,
• 56:30which are absolutely part of that.
• 56:33How we think about and use language
• 56:35around quality and safety really
• 56:37has to be consistent regardless of
• 56:39what specialty we're talking about,
• 56:42regardless of which DN or hospital or
• 56:44ambulatory location we're talking about.
• 56:47So it's very hard to move the needle
• 56:49on quality if I'm using language
• 56:52of lean principles.
• 56:53And the person over here has no idea
• 56:55what lean principles mean, right?
• 56:56When I'm talking about standard
• 56:58work and someone over here is like,
• 57:00what do you mean by standard work
• 57:02and what do I have to do with that?
• 57:04Because you know when you,
• 57:06you make change in one space you you,
• 57:09you inextricably make a,
• 57:11it makes changes,
• 57:12It ripples throughout the organization.
• 57:15We have to understand those ripples.
• 57:17We have to work together so that
• 57:19we're looking at not just the
• 57:21impacts of within our bubble,
• 57:23but the impacts to the larger
• 57:25organization as changes are made.
• 57:27And that's what the intention of
• 57:29that centralization is doing.
• 57:31It also elevates the attention of this work.
• 57:36You know, 1000 Points of Light are great,
• 57:38but when you bring all those
• 57:39thousand Points of Light together,
• 57:41the impact of that is much
• 57:43greater than you know,
• 57:44the sum of our parts.
• 57:45So I this is really important work and I
• 57:50know it will feel like to people a little
• 57:52bit of cheese moving like you know I'm
• 57:54not I I've worked here all the time.
• 57:56I've always done it like this.
• 57:58We've got to think more globally and
• 58:00more as a system and create those
• 58:03efficiencies associated with being a system.
• 58:06There are a lot of benefits
• 58:09to creating standard work,
• 58:10for lack of a better word,
• 58:11or or common processes because a
• 58:13lot of what we're doing is rework
• 58:15and that's not helpful for anybody.
• 58:18Absolutely. Thank you, Pam.
• 58:19I appreciate that.
• 58:20All both tries. All, both tries.
• 58:22All, both tries. All right.
• 58:24So I think that all the questions
• 58:26are out just in time at 6:00.
• 58:28Good timing. Pam, thank you so much.
• 58:31It's been wonderful to have you with
• 58:34us tonight and we will invite PEG
• 58:36because I and and others as well.
• 58:39And Cynthia came not too long ago
• 58:41before we launched the official Access
• 58:44365 and a lot about Access and we knew
• 58:47that we talked about Guide House and
• 58:48that all of that work was coming about.
• 58:50So we will do a refresh on some
• 58:52Access work as well because I
• 58:54think there's just some wonderful
• 58:56information coming out right now
• 58:58that has a lot more detail and meat
• 59:00to it around that body of work.
• 59:02So really appreciate it, Kim.
• 59:05Kevin
• 59:08I the only thing I would say is thank
• 59:10you Pam is first and then I think it
• 59:13was somebody just put in the chat,
• 59:14very informative.
• 59:15I think everyone really appreciates
• 59:17you being here and taking time out.
• 59:19And then the second piece,
• 59:20I just want to thank everyone who's
• 59:24on the call that's involved in
• 59:25our Commission on Cancer survey.
• 59:26Tomorrow we have our site survey.
• 59:29A lot of people have been working
• 59:31very hard to prepare for that.
• 59:32I know it really actually every single
• 59:34person that works in Smilo or the Yale
• 59:37Cancer Center touches our accreditation.
• 59:39But we have a big day tomorrow
• 59:41with our site visit and I just
• 59:44know we'll do really well.
• 59:45I'll be at a few of the sessions and just
• 59:48real excited to see the team display our our,
• 59:52our high quality cancer care for
• 59:54the surveyor and then Kevin,
• 59:56I'll just turn it over to you
• 59:57to for final words.
• 60:00No, I have, I have very little to add.
• 01:00:02Pam, it's been a delight for you to be with
• 01:00:06us and you know I think you're listening.
• 01:00:09Your empathy and your forward-looking
• 01:00:11vision is affirming for all of us.
• 01:00:13So much gratitude and we're in
• 01:00:15the work together. So thank you.
• 01:00:18Thank you. I appreciate that.
• 01:00:19I do want to call out someone mentioned
• 01:00:22about leadership coming locally.
• 01:00:24I I couldn't agree more.
• 01:00:26I, you know the lean language is go to gimba,
• 01:00:28there's nothing better to than
• 01:00:30going to where the work is done.
• 01:00:32And I've had the joy of meeting quite a
• 01:00:35few oncology team members in the infusion
• 01:00:37center and several of your clinic locations.
• 01:00:40So thank you for that.
• 01:00:41I agree with you wholeheartedly
• 01:00:42and it makes all the difference.
• 01:00:43And thank you, Kevin,
• 01:00:44Kim and Laurie.
• 01:00:45I appreciated the time.
• 01:00:47Thank you. Thank you everyone for
• 01:00:49coming this evening and we will see
• 01:00:51you soon. Good night. Good night.