Smilow Cancer Hospital Town Hall | April 26, 2023

Transcript

• 00:00I am absolutely delighted to welcome our
• 00:03community to our Smilow Cancer Hospital
• 00:06Town Hall here on April 26th, 2023.
• 00:11We have an absolutely packed and
• 00:14exciting agenda this evening and
• 00:16it's really a pleasure for me as the
• 00:18Chief Medical Officer to feature a
• 00:21roster of our senior Cancer Center
• 00:24and cancer hospital leadership as
• 00:27well as our health system leadership.
• 00:29And you can see from just looking at
• 00:32the agenda, we are going to cover a
• 00:35number of very high priority topics
• 00:37that are going to be some of the
• 00:40strategic and tactical elements that
• 00:42will drive our growth and development
• 00:45as an organization into the next
• 00:47generation of of SMILO in the Cancer
• 00:50Center in terms of national prominence
• 00:54and clinical and academic excellence.
• 00:57I have a few brief clinical announcements
• 01:00which really focus on our evolution
• 01:03into what we hope is a post COVID world.
• 01:07I'm really delighted to share that
• 01:09as of May 1st,
• 01:11we will cease across the system
• 01:14doing routine COVID testing for
• 01:17asymptomatic patients admitted for
• 01:20surgery procedures and direct admits.
• 01:23As you can tell from this list,
• 01:25there will still be a few isolated
• 01:28incidences where we do admission testing,
• 01:30but for the most part,
• 01:32we will be returning to normal clinical
• 01:35operations without routine testing.
• 01:38I'm also absolutely thrilled to
• 01:41share that our mask,
• 01:44our masking policies will continue to
• 01:46be in place, but will be less restrictive.
• 01:50We will. We will.
• 01:52Essentially in the use of routine
• 01:55masking in public areas,
• 01:56but we will continue to ask that our
• 02:00clinicians and our staff use masks in
• 02:03inpatient areas such as patient rooms,
• 02:06diagnostic and procedural rooms and
• 02:09when providing direct individual
• 02:11patient care and contact.
• 02:15Of course,
• 02:16we ask that staff will continue
• 02:18to adhere to all policies related
• 02:20to transmission based precautions
• 02:22and staff and visitors with any
• 02:24signs or symptoms of COVID should
• 02:26be advised to remain at home.
• 02:29So without any further commentary,
• 02:32I'm really pleased to take the agenda over
• 02:36to our Cancer Center Director and
• 02:38Physician in Chief Doctor Weiner and our
• 02:40Senior Vice President, Lori Pickens.
• 02:44Great. Thanks, Kevin.
• 02:46So we're going to talk about
• 02:48a number of items today,
• 02:51including patient to access.
• 02:52And we're going to talk about patient
• 02:55access both across the whole Health
• 02:57system and very specifically in Smilo.
• 03:00And then we're going to be talking
• 03:02about clinical integration.
• 03:04So first just in terms of access
• 03:05and then I'm going to turn it
• 03:07over to Lori in just a second,
• 03:08I think from our standpoint in Smilo.
• 03:13Patient access is really key,
• 03:15and I'm just going to speak
• 03:16to this for a minute.
• 03:17From a patient's standpoint,
• 03:19which is that, you know,
• 03:20when a patient has a new diagnosis
• 03:23of cancer and those are by,
• 03:25you know,
• 03:26far and away the majority of the
• 03:28people who are coming to us who have
• 03:30already had a biopsy or someone
• 03:31telling them that they have cancer
• 03:33or a high suspicion of cancer,
• 03:36getting in quickly is really important and
• 03:39it is hugely reassuring to the patient.
• 03:42We need to make sure that we are
• 03:45answering calls quickly and even
• 03:47more importantly that there is not
• 03:49a long lag before the appointment.
• 03:51And the truth is if there is a long delay,
• 03:54they'll just go elsewhere And we don't
• 03:57want that because we want to grow,
• 03:59but we also don't want that
• 04:00because we want to serve our our,
• 04:02our patient population.
• 04:03So I just think it's,
• 04:05it's really important and as you know,
• 04:09we sent out some guidelines.
• 04:13In the past week or two
• 04:14about what we think is,
• 04:15is a reasonable amount of time and
• 04:17and we'll go over that further today.
• 04:19So without further ado, Lori,
• 04:22thank you, Eric and I echo absolutely
• 04:24everything Doctor Reiner just shared.
• 04:26And you know we've been working on patient
• 04:30access within Smilo for a number of
• 04:33years and this work has been largely led
• 04:36by Doctor Shellhorn and Lisa Chomsky.
• 04:39They have. An amazing team of people.
• 04:42Many of you are out there hearing this
• 04:44and have participated in this amazing
• 04:46work over the last couple of years and we
• 04:49are very fortunate that the Health System
• 04:52and Yale Medicine have been doing the same.
• 04:55And they in fact brought a consultant in
• 04:59some of you may have heard named Guide House.
• 05:01I sometimes make the mistake
• 05:03of calling it White House,
• 05:04but it's Guide House.
• 05:06I don't know what I'm thinking, but anyway.
• 05:10So you know our work is really
• 05:13aligning beautifully with what the
• 05:15the health system and Yale Medicine
• 05:17are are seeking to achieve.
• 05:19And so we are very fortunate this
• 05:21evening for to have Cynthia Sper
• 05:23joining us to share a little bit
• 05:26about where the system and where
• 05:28Yale Medicine are heading with that.
• 05:31Cynthia is the president for our
• 05:33ambulatory work across the entire
• 05:35health system and she Co leads
• 05:38this patient access work with.
• 05:40Peg McGovern,
• 05:41who is the CEO for Yale Medicine
• 05:44and Doctor Churchwell, as we know,
• 05:45is our president for Yale New Haven Hospital.
• 05:48So Cynthia,
• 05:49I'm going to ask you to go ahead
• 05:50and give a preview,
• 05:51and then we'll have Sarah and and Lisa
• 05:55talk about how that ties in nicely
• 05:57with the work we're preparing to launch.
• 06:00Thank
• 06:01you so much, Laurie, and thank you, Eric.
• 06:03You teed it up perfectly.
• 06:04And good evening, everyone.
• 06:06It's really a pleasure to be joining
• 06:08you tonight to talk about something.
• 06:10That frankly, I'm quite passionate
• 06:12about and as Eric and Laurie, you said,
• 06:15clearly is a top priority for you know,
• 06:18medicine and the only event health system.
• 06:21And I am as as Laurie mentioned,
• 06:23representing my colleagues
• 06:25in this in this work,
• 06:27Peg McGovern has had the distinct.
• 06:30Actually dubious pleasure of being up
• 06:33in Hartford all day today since early
• 06:36this morning still up there or she
• 06:38would have been joining me tonight
• 06:40at today is the day we presented at
• 06:43the certificate of need hearings for
• 06:45the Prospect hospitals transactions.
• 06:47So Peg has been spending her day up
• 06:50there in Hartford and so anyway I I
• 06:54am representing both of them tonight.
• 06:57I want to just start by saying I
• 07:00am confident that everyone in this
• 07:02town hall is an expert at some level
• 07:05in the challenges around access,
• 07:08whether it's for their own personal health,
• 07:11a family member, a friend,
• 07:12a neighbor colleague, whatever.
• 07:15I think everyone is touched by and is
• 07:19in some way engaged in what turns out
• 07:22to be the workarounds around access.
• 07:25Because the truth is that we needed
• 07:30to and we have stepped back and
• 07:33looked at systems,
• 07:34the processes etcetera that we are
• 07:37utilizing with both in the health
• 07:40system and with in Yale Medicine.
• 07:42And recognized going back to
• 07:45last fall that we can do better,
• 07:48that we need to do better,
• 07:49that we have to do better and
• 07:52that the IT was not.
• 07:54Any one person or any one function
• 07:57or any one area that was that
• 08:00was somehow complicit and why we
• 08:02weren't where we needed to be.
• 08:03But in fact that we have too much of what
• 08:07gets done on behalf of our patients,
• 08:10always on behalf of our patients
• 08:12that are not supported as well as
• 08:14they might be by the systems that
• 08:16we are currently utilizing.
• 08:18And it's not for lack of trying.
• 08:20It's simply the fact that.
• 08:22We wanted to take a fresh set of eyes
• 08:24to this and as part of that work we
• 08:28put out an RFP to leading consulting
• 08:31firms in the country who do this
• 08:33work to see who might be in the best
• 08:36position to come in and help us.
• 08:37And as Lori mentioned,
• 08:39after a national search,
• 08:41we did select Guide House to
• 08:43help us with that work.
• 08:45The other fact of life is
• 08:46that we are not alone.
• 08:48When we talked to colleagues around the
• 08:50country at leading academic health systems,
• 08:52at academic medical centers,
• 08:54everyone is working on access.
• 08:57So it's not that we that
• 09:00people have perfected this.
• 09:02Colleagues again are are working on this,
• 09:05but the fact is that when Guide House
• 09:08came in and took a look at what we
• 09:10were doing collectively and rated
• 09:12us on essentially A1 to four scale.
• 09:15Looking at different elements from
• 09:18clinical coordination to scheduling to
• 09:20other mechanisms, financial reviews,
• 09:22other things that we were doing
• 09:25on a scale of one to four,
• 09:27we were running between A1 and A2.
• 09:31So a lot of opportunity for improvement
• 09:35and it it it's really been and this is very
• 09:38much a part of other things that that we
• 09:41see as themes that it is the commitment.
• 09:44To work together across the health system,
• 09:47across your medicine in a unified enterprise
• 09:50wide way that is going to create some of
• 09:53our best opportunity for doing this better.
• 09:57Here's where I'm going to pledge
• 09:59that you will not hear the words
• 10:01handoff come out of my mouth.
• 10:03There will be no more handoffs.
• 10:04We're going to work.
• 10:06Go away from handoffs, no handoffs.
• 10:08And that we are doing this in a
• 10:11unified way and unified approach.
• 10:14And so when Guidehouse came in,
• 10:16the first thing they did was they
• 10:18went into the enterprise and they
• 10:21spoke to over 70 individuals.
• 10:24They did mystery shopping,
• 10:26they visited sites of service.
• 10:28Milo was a part of that.
• 10:31And they assessed what what
• 10:33they were seeing and hearing and
• 10:35learning and looking at the data.
• 10:37And it it was not shocking,
• 10:41not surprising,
• 10:42but it was affirming that as to
• 10:45where we had these opportunities and
• 10:48they took their time to do that and
• 10:50they came to us after several months
• 10:53and presented a cogent approach to
• 10:55how we could make this pivot and
• 10:58how we could approach this work.
• 11:01And so again, it was impressive.
• 11:03It was comprehensive.
• 11:05And it was directionally important
• 11:07for us to look at it this way.
• 11:10What they've now put together is
• 11:12the next phase of this work which
• 11:15which is now launching,
• 11:17it is launching this month to really
• 11:20get underway with the work itself.
• 11:22And it's the sobering part of
• 11:26this is to really fully optimize
• 11:29the opportunities that have been
• 11:31identified is a three-year journey.
• 11:34But what we've also worked on with
• 11:36Guidehouse is that we needed to front
• 11:38load as in the first year of that
• 11:41three-year journey work that was
• 11:42going to be most impactful to make a
• 11:46difference in the patients that Smilo
• 11:49was serving and also across the enterprise.
• 11:52And when I,
• 11:53you know I'll give an example that I'm sure
• 11:56everyone on this call will understand.
• 11:58Yes, as Eric said, it is the patients
• 12:01who just got a diagnosis of cancer.
• 12:04That need desperately need
• 12:06immediate access to care,
• 12:08but it's also important to look
• 12:10at the feeders, cardiology,
• 12:12GI, neuro,
• 12:13urology,
• 12:13all the programs that if they're
• 12:17having access challenges,
• 12:19it's going to affect the ability
• 12:21to identify who are those patients
• 12:23that need access to smile.
• 12:26So it it's it really is important that we
• 12:29look at this across all of our services.
• 12:32So that for the people who are seeking care,
• 12:35they really can get in and get into
• 12:37that queue and get identified as
• 12:39and diagnosed appropriately in a
• 12:42timely way and then get the access
• 12:44to the to the care that they need.
• 12:46So that's the approach that we're taking.
• 12:48If the no one is opting out,
• 12:50everyone is all in and it will
• 12:53affect all of
• 12:54the aspects of care no matter where
• 12:57that occurs across the health system.
• 13:00So we're, as I said,
• 13:01we're getting underway this month.
• 13:03We have some structural aspects to this
• 13:06that we're putting in place and then it's
• 13:09it's really getting into the deep dive.
• 13:12What we expect is that somewhere by
• 13:15this fall we will be able to have a good
• 13:20line of sight to drive the consistency,
• 13:24the standardization,
• 13:25the coordination and alignment.
• 13:27Of all of the elements that can
• 13:30produce the change that we are seeking.
• 13:32So no, it isn't going to be overnight,
• 13:34but it's not going to be 3 years
• 13:36from now either.
• 13:37And I would expect that by the
• 13:39time we are rolling into the fall,
• 13:41we're going to do this in coordinated waves.
• 13:44So there'll be waves of of implementation
• 13:47that will get underway this fall.
• 13:49And what we have committed to our
• 13:53leadership to the board, etcetera, is.
• 13:57That we are going to see real
• 14:00change within this one year time
• 14:03frame that we've gotten underway
• 14:05with with God as His help.
• 14:07So I'm happy to go through any specific
• 14:11questions that people have about this.
• 14:14But what we're doing here tonight with
• 14:17all of you is really as Lori said,
• 14:19previewing what's coming and it
• 14:23will require change and that.
• 14:27Isn't always easy.
• 14:28In fact it often is not very easy to to,
• 14:31but it's going to be essential 2
• 14:34platforms and I think this is another
• 14:36key piece that I want to convey tonight
• 14:39is that 2 platforms for all of this work.
• 14:43The first platform is communication.
• 14:46The commitment to all of you is that you're
• 14:49going to get tired of hearing about access,
• 14:51but that's a good thing because
• 14:54we really have to make sure.
• 14:56That we're walking in lockstep together.
• 14:59This isn't something that you're
• 15:00hearing about tonight and then six
• 15:02months from now you'll get an update.
• 15:04You will be hearing a lot about
• 15:06this and I am commit.
• 15:08I'm confident that that
• 15:09commitment will be seen through.
• 15:11So communication throughout
• 15:12is going to be essential.
• 15:15No surprises.
• 15:16The other platform will be IT.
• 15:20All of this work is going to need
• 15:23the support of and be informed by.
• 15:26Our IT capabilities,
• 15:28you all know that we adopted
• 15:31EPIC 10 years ago,
• 15:33but we haven't fully utilized
• 15:34or optimized it in support of
• 15:36what we need to be doing here.
• 15:38And we've had different pilot
• 15:40elements etcetera.
• 15:41So I T is being pushed up to the
• 15:44front because we can't the size that
• 15:46we are and we have over 5,000,000
• 15:49interchanges with patients a year,
• 15:52it is impossible.
• 15:53To be able to really have a
• 15:56meaningful organized,
• 15:57coordinated way of doing this work if
• 16:00we're not leveraging IT as part of this.
• 16:03So that's going to be another
• 16:06platform element of all of this work.
• 16:08So again,
• 16:09I'm going to pause there and happy Eric
• 16:12and Laurie to open it up to comments
• 16:14that and our questions everyone may have.
• 16:17But that is sort of the that's
• 16:19the overview of how we got here,
• 16:21where we're headed.
• 16:22And what we're committed
• 16:23to doing in the weeks,
• 16:25months and it will be in
• 16:26some cases years ahead.
• 16:28Cynthia, thank you very much.
• 16:29And and I think that smile is ready to jump
• 16:32right in and and get going on this work.
• 16:35And I think if you're able to stay,
• 16:37you'll hear how we are poised to do that.
• 16:41There is a question in the chat that
• 16:44I think is an important question.
• 16:46And the question is will this mean
• 16:48phase three or what does this,
• 16:50I think this is what does this mean
• 16:52for the phase three of SMILO moving
• 16:55to the Ill Medicine access center.
• 16:57It's probably good to try to reconcile you
• 17:00know that because we have spent so much
• 17:03time in that space over the last few years.
• 17:06Can you help us with that?
• 17:08Certainly. So let me just say this,
• 17:12first of all, we are not.
• 17:15If you will, blowing up anything that exists.
• 17:18What we have to do is connect the
• 17:21dots and we have been too siloed.
• 17:24That is crystal clear and we have not
• 17:27had some of the wraparound efforts.
• 17:29Let me take a very basic example.
• 17:33If you go to a website,
• 17:36depending upon what portal of entry
• 17:38we use and let's say we're going to
• 17:41want to look and see Doctor Eric
• 17:43Weiner and have he is represented.
• 17:45Depending upon what website you go into,
• 17:47whether it's a health system website,
• 17:48a departmental website,
• 17:50a young medicine website,
• 17:53you could get different information.
• 17:59We're talking about fundamental issues here.
• 18:03So no, the last thing we want
• 18:05to do is is is go backward.
• 18:09But we have to do this go
• 18:10forward in a coordinated way.
• 18:12And so that that's the commitment.
• 18:14And so I understand the question.
• 18:16We're going to leverage things
• 18:18that are in place, the people,
• 18:20the resources that have been
• 18:22already been worked on.
• 18:24What I'm sure the team will
• 18:26be talking about tonight.
• 18:28We want to take what's good
• 18:30about what's been done,
• 18:32but we also have to recognize
• 18:34that it is siloed.
• 18:35And so this,
• 18:37this work is really about making
• 18:39sure that we connect the dots.
• 18:42So that the point of view of
• 18:44the of the consumer and the
• 18:45consumer definition in this
• 18:47case is obviously the patient.
• 18:49It's also the referring physicians if
• 18:52you want to get an earful about access,
• 18:55talk to people out there who have
• 18:59patients that they want to send
• 19:01us and experience a lot of the
• 19:03same frustrations our patients do.
• 19:05So consumer in this case is obviously
• 19:08first and foremost it's the patient.
• 19:10Also the referring positions
• 19:13and is it safe to say Cynthia that you
• 19:15know going back to what we've all been
• 19:18accustomed to preparing for around you
• 19:20know becoming the next phase if you
• 19:22will that there are there are a lot of
• 19:26things to leverage in the existing?
• 19:28Work that's been done and the
• 19:31infrastructure that is there that what
• 19:34we would hope to do with the the now
• 19:37the great help from Guide House and all
• 19:40of the participation that occurred in
• 19:42that effort is to really most adequately
• 19:45and appropriately leverage what we have.
• 19:48And I will just share for for those of you
• 19:51on that are out there that we were very
• 19:54involved in providing input and sharing.
• 19:57In that guide house process.
• 19:58So our voices were a part of
• 20:01the 70 that Cynthia mentioned.
• 20:04So you know,
• 20:05I think that they have taken into account
• 20:08not only what we shared but what a lot
• 20:10of other folks have shared as well.
• 20:12So thank you. All right.
• 20:17That was the question.
• 20:18That's the one question that came up.
• 20:19I think if there's anything else we we will.
• 20:23We'll catch it along the way.
• 20:24If that's okay,
• 20:25Cynthia,
• 20:26this is just such a perfect preview
• 20:29and perfect setup for what Doctor
• 20:31Shellhorn and Lisa Chomsky will
• 20:33now share with the group.
• 20:35It just ties in very nicely and
• 20:37really appreciate you being able
• 20:39to come and help us tee this up.
• 20:45The opportunity to present this
• 20:47update on our access initiative,
• 20:49I think first Doctor Shelhorn and I
• 20:51just want to acknowledge our small but
• 20:56mighty core patient access group that
• 20:58includes Jen Watkins, La, the Sudakar,
• 21:00Paula Pike and Mike Strait who are
• 21:03currently running off our team.
• 21:06We tend to pass
• 21:07over this slide in a lot of
• 21:10presentations, but as a reminder.
• 21:12Access is addressed at the very top.
• 21:15Yale New Haven Health enhances
• 21:17the lives of the people we serve
• 21:19by providing access to high
• 21:21valued patient centered care,
• 21:25right. This slide really reinforces
• 21:28that improving access is a firmly
• 21:30established goal for the entire health
• 21:32system as well as Yale Medicine.
• 21:35Executing a patient access
• 21:37strategy is a strategic priority.
• 21:40Patient access and navigation
• 21:42represent a Yale New Haven Health
• 21:44System strategic pillar and the
• 21:47university and the hospital share an
• 21:49aspiration for unparalleled access.
• 21:52These all represent different ways of
• 21:54saying timely access to care represents
• 21:57care that's truly patient centric
• 21:59and that when we improve access,
• 22:00we not only provide more timely care,
• 22:02but we increase patient engagement
• 22:04and patient satisfaction.
• 22:08OK, so our access goals center,
• 22:10I'm putting center,
• 22:11I'm putting the patient first.
• 22:13Our SMILO standard is to offer an appointment
• 22:16to new patients when then within three days,
• 22:19one to two when subspecialties are
• 22:21required or within four days when a
• 22:25multidisciplinary appointment is indicated.
• 22:28And it's important to note that our
• 22:30standard is a bit more ambitious than
• 22:32the Yale Medicine goal of seven days.
• 22:35Another goal is to follow the established
• 22:37Yale Medicine template standards.
• 22:39By doing this,
• 22:40we hope to improve access,
• 22:41clinical operations as well as
• 22:44the patient experience.
• 22:46We do realize that implementation of
• 22:48these goals might be a significant
• 22:50practice change in some areas and by
• 22:53moving to a patient centric model,
• 22:55we are changing our culture
• 23:01so. How did we approach this work?
• 23:04First, we created what we're calling
• 23:06the SMILO Access Dashboard to assess
• 23:09wait times by sight and by disease.
• 23:11We held to focus groups with multiple
• 23:14stakeholders that included RN coordinators,
• 23:17intake staff and physicians so that
• 23:20we can understand best practices as
• 23:22well as challenges and scheduling.
• 23:25Then we looked at the work queues
• 23:27across the SMILO enterprise to
• 23:28determine the number of new patient
• 23:30referrals that we were receiving.
• 23:32On a weekly basis and for our sites that
• 23:36are participating in Next Day Access,
• 23:39we reviewed scheduling codes to understand
• 23:41the reasons for the appointment delays.
• 23:44And finally,
• 23:45we began to review templates to
• 23:47determine specific challenges with
• 23:49scheduling and this work is ongoing.
• 23:54So Lisa's given a a nice
• 23:56overview of our process overall,
• 23:58but first we wanted to introduce
• 24:00our new dashboard that we've that
• 24:02we're using as the first step.
• 24:03It's important that we be able to measure
• 24:05the time to the first appointment.
• 24:07And so this was a dashboard developed
• 24:11over several months that has the
• 24:13following features and I want to point
• 24:15out that none of this is real data,
• 24:17but just so that all of you could
• 24:20take a look at what we're capturing.
• 24:22The first column is what percent of patients,
• 24:26according to site,
• 24:27are seen within three days.
• 24:30The second is within seven days.
• 24:32To align with the Yale Medicine standard,
• 24:38I'll I'll point out that the colors that
• 24:40we use in this dashboard are arbitrary,
• 24:43but green is good, red is bad,
• 24:45or green is better and red is bad.
• 24:48Greater this column is the the percentage
• 24:51of patients that were seen within
• 24:53more than with outside of three days
• 24:56for reasons other than their choice.
• 24:58So reasons being we don't have an
• 25:01appointment available would be captured
• 25:04here then median days to the new
• 25:06patient visit appointments and the total
• 25:08number of patients seen within that
• 25:10site in whatever time frame we use.
• 25:14It's important to remember that the
• 25:16time from the appointment being given
• 25:19to the appointment actually occurring
• 25:21is certainly important and that's
• 25:24what's been captured routinely.
• 25:25But the patient actually
• 25:28experiences a longer period.
• 25:30There's a that kind of.
• 25:32Processing time between the point that
• 25:34the referral is entered or called in to
• 25:37the point that the appointment is made,
• 25:38and that's a high anxiety period as well.
• 25:40So we're capturing that in a separate
• 25:43dashboard looking at time from the
• 25:45referral entry to the appointment made.
• 25:47And rather than show you multiple
• 25:49views of all of our dashboards,
• 25:52we wanted to summarize what
• 25:54we found in our first.
• 25:56Pass through with this dashboard,
• 25:58more than half of our patients
• 26:00aren't being seen within seven
• 26:02calendar days within solid tumors.
• 26:05That number does improve when we
• 26:07look at our top four disease sites,
• 26:09breast, GIGU and thoracic.
• 26:12Those patients with hematologic
• 26:14malignancy experience much longer wait
• 26:17times than patients with solid tumors.
• 26:20And patients with classical hematologic
• 26:22diagnosis are experiencing significant
• 26:25delays at nearly all of our sites
• 26:30Okay. So we conducted a
• 26:31couple of focus groups and you can see
• 26:34the feedback that we got on the left.
• 26:37Smile of physicians are flexible
• 26:39and accommodating new patients with
• 26:41malignancies and they often schedule
• 26:44outside of their templated time.
• 26:45Nursing outreach to patients prior
• 26:47to their appointment is key to
• 26:50immediate patient engagement and
• 26:51our R and coordinators report the
• 26:54patients expressed appreciation
• 26:56and relief when they call them.
• 26:58The presence of the intake team on site
• 27:01facilitates communication and triaging.
• 27:03Those hallway conversations among staff
• 27:05and physicians are really important and
• 27:08patients are grateful for the opportunity
• 27:10to schedule a timely appointment.
• 27:13We also identified some
• 27:14opportunities in blue.
• 27:15We heard again and again that
• 27:17there aren't enough open new
• 27:19patient visit slots and there's not
• 27:21enough return patient visit slots.
• 27:23There's a large volume of
• 27:25classical hematology patients,
• 27:26new patients and next day access
• 27:29slots are being taken by return
• 27:31and classical hematology patients.
• 27:33There's not enough APP return patient
• 27:36slots for active and longterm patients.
• 27:39And patients with scheduled six month
• 27:41and one year followup appointments
• 27:43are often rescheduled to accommodate a
• 27:45new patient and this happens sometimes
• 27:48more than once to the same patient.
• 27:50Obtaining necessary information is
• 27:52also causing delays outside records,
• 27:54especially diagnostic imaging
• 27:56and outside pathology,
• 27:58including heme pathology.
• 28:00Classical heme patients often have
• 28:02limited information in the referral.
• 28:04And staff spend time obtaining
• 28:07additional information to triage
• 28:08the appointment correctly.
• 28:10Cancer subspecialization is
• 28:12leading to longer waits.
• 28:13Next day.
• 28:14Access can't be offered if a
• 28:16subspecialist is not available.
• 28:18There may be openings,
• 28:19but not with the required
• 28:21specialized provider,
• 28:22and we anticipate that regionalization
• 28:24may reduce these wait times,
• 28:26allowing onboarding staff
• 28:28at multiple locations.
• 28:30To schedule at multiple locations
• 28:32would streamline the scheduling
• 28:34process and we do see this with our
• 28:36thoracic and our head and neck teams.
• 28:43Next slide, Sarah.
• 28:48OK, so to summarize the our current state
• 28:53greater than 50% of patients are not
• 28:55being seen within seven calendar days.
• 29:00Focus groups and scheduling codes confirm
• 29:02that new patient visit slots are not
• 29:04available when scheduling new patients.
• 29:09Trend and scheduling codes unfortunately
• 29:11shows a lack of new patient visit
• 29:14availability is increasingly common
• 29:19and template management varies
• 29:21widely across the organization.
• 29:24New patient slots are not
• 29:26consistently filled by new patients.
• 29:28And we're not following the YM
• 29:30policies on clinic and patient
• 29:32cancellations consistently.
• 29:37So our approach in in addressing our
• 29:39access issue first of all is to to
• 29:42look at the different contributors
• 29:44and the key drivers of delayed access
• 29:46to care and we can bucket these into
• 29:49four very large areas looking first
• 29:53at patient demand, clinician supply.
• 29:56Scheduling practices and the administrative,
• 30:01administrative approach.
• 30:04So I realize here and I apologize
• 30:08to everyone, I am using an old
• 30:10version of our slides.
• 30:11But in terms of our
• 30:13template optimization goals,
• 30:18let me come. I apologize everyone.
• 30:21I think in terms of the four buckets of of.
• 30:27Things that contribute to access
• 30:30patient demands are we seeing the we
• 30:33need to look at our referral numbers.
• 30:34We need to look at the frequency
• 30:36that patients are being seen.
• 30:38We need to look at the numbers of clinicians.
• 30:42Do we have the right numbers?
• 30:44Do we have the right lengths of sessions,
• 30:46the right availability of clinicians,
• 30:48the numbers of sessions,
• 30:50the distribution of templates
• 30:52across the morning and the
• 30:54afternoon and days of the week.
• 30:55In terms of the scheduling practices,
• 30:58what are the templates?
• 31:00What are the standards across
• 31:02the the system and are we
• 31:05complying with those standards?
• 31:06How are templates managed And make sure
• 31:09that that our management of those of of
• 31:11each of the schedules is standardized.
• 31:14And then looking at staffing of our
• 31:16onboarding associates and ensuring
• 31:18that we have the right number of people
• 31:20to do all of the work in advance of
• 31:23that first new patient appointment.
• 31:28Our goals for template optimization are
• 31:31first to follow the YM template standards,
• 31:36which is, as many of you have seen,
• 31:39a 240 minute session per 240 minute session.
• 31:43We recommend that in accordance with
• 31:46YM standards that that eight weeks
• 31:49notice prior to time out from clinic
• 31:52with a clear process for exceptions.
• 31:54Be developed for our group and
• 31:57protected new patient slots.
• 31:59We need to match the supply of clinicians,
• 32:01the availability of clinicians with
• 32:04the demand that patients have and we
• 32:08need to make templates reflective
• 32:10of our daytoday life.
• 32:12We are hoping to harness the power
• 32:15of the electronic medical record to
• 32:18allow for more efficient scheduling
• 32:20and improve our data collection.
• 32:23And improve the this will lead to
• 32:28improved efficiency in the clinical
• 32:30operations and we're hoping to
• 32:32balance appointments across the days
• 32:34of the week as well as mornings and
• 32:36night to kind of even out flatten
• 32:38the curve as it were of patients
• 32:41appointments throughout the day.
• 32:43And our our ultimate goal is as we've
• 32:45mentioned to ensure appointment
• 32:46availability within three days
• 32:47for every referred patient.
• 32:54I think. I think overhaul is
• 32:58probably an excessive word here,
• 33:00but we want to make sure that
• 33:03this is that templates are.
• 33:06Evaluated on a sitebysite basis,
• 33:10we'll be looking at the templates across
• 33:12the enterprise and we'll be developing
• 33:13a road map for template optimization,
• 33:15standardization and alignment,
• 33:16which will pilot in specific sites.
• 33:21We're going to look at visit types,
• 33:23the numbers of news and
• 33:24followups in the duration,
• 33:25and we'll look by areas of specialty.
• 33:31And we'll be optimizing our
• 33:33administrative processes,
• 33:34standardizing our template management
• 33:36and rolling out new and scheduling code,
• 33:40new scheduling codes to under to understand
• 33:43those patients who are referred to us,
• 33:46why they might not actually be seen.
• 33:49And we'll be doing some training and
• 33:51in servicing of all of our staff.
• 33:53We'll be standardizing our new
• 33:55patients record collection and we're
• 33:58hoping to develop and implement.
• 34:00Scripting to offer an alternative provider.
• 34:04I do have another slide in
• 34:07a newer version of this.
• 34:09You can speak to it, but if you
• 34:11would like to speak to it Lisa, that
• 34:13would be 1 sure if I just want to
• 34:17speak about what happens next,
• 34:18so as Cynthia. Stated earlier,
• 34:21we're going to be communicating
• 34:23Smilo's access goals in multiple
• 34:24forums over the coming weeks to
• 34:26make sure that everybody's on the
• 34:28same page and will utilize existing
• 34:30meetings like our clinical council
• 34:32meeting and we'll use some of the
• 34:34Smilo communications that go out as
• 34:36well as hopefully getting in front
• 34:38of the chairs at their meeting.
• 34:40We are also going to contact
• 34:42pilot site leaders,
• 34:44including clinical and administrative
• 34:45leads to set up a time to meet.
• 34:48And we're just asking that everyone
• 34:50please be flexible with your schedule
• 34:52so we can continue this important work.
• 34:55Our goal is to understand site and
• 34:57or team specific challenges and
• 34:59make recommendations for solutions
• 35:01including template optimization.
• 35:03And we're going to schedule training
• 35:05sessions for staff on use of the
• 35:08scheduling code algorithms that we've
• 35:09developed as well as the young medicine
• 35:12standards for work to management.
• 35:14And then after piloting in
• 35:15a couple of locations,
• 35:16we'll make any necessary modifications
• 35:18and then begin to meet with
• 35:20additional sites and team leads.
• 35:22So thank you.
• 35:28If I can make one comment,
• 35:30Lisa and Sarah, please.
• 35:32I think one of the things that
• 35:34often comes up and and you may have
• 35:37addressed this is filling up new
• 35:39patient slots with follow up visits.
• 35:41And while I will never say always or never,
• 35:44I think that part of the plan
• 35:46is going to have to be that if
• 35:49that's something we just don't do.
• 35:50I mean there there are going to be
• 35:52very rare situations where it happens,
• 35:54but if you build templates within disease
• 35:57programs that are meant to accommodate the,
• 36:00you know a given number of new patients then.
• 36:03We're just shooting ourselves in the
• 36:06foot if we if we eliminate those new
• 36:08visits to fill them with follow up
• 36:11slots and we have to figure out another
• 36:13solution for those follow up visits.
• 36:15So you got your work ahead of you.
• 36:18Yeah. And and I just add Eric that
• 36:21you know that is all part of the
• 36:23all part of the work that we have
• 36:25to do in front of us and I think.
• 36:27You know when Jeremy and Liz present the
• 36:30work we're doing around regionalization
• 36:33and and and sub specialization
• 36:35and integration and all that,
• 36:38those are bodies of work that
• 36:40help address other
• 36:44variables to the access challenges and
• 36:46that none of this is mutually exclusive.
• 36:50And so we do recognize that we have to be
• 36:53able to accommodate all of our patients.
• 36:56Whether there are new patients or
• 36:58are new patients who then become
• 37:00our return patients because we know
• 37:02that these patients are with us
• 37:04until they don't need to be with us.
• 37:06And that's a very long time.
• 37:08And it's really important that we are
• 37:11able to provide all of the services
• 37:13that are needed to to continue to
• 37:16take care of our cancer patients.
• 37:19And and I saw a question in the Q&A.
• 37:22Around the staffing to support this,
• 37:24absolutely we have to make, we have to,
• 37:27we have to have everything aligned
• 37:30and and appropriately supported.
• 37:32But we need to understand that
• 37:34much better than we do right now.
• 37:36And I think that's the work that's
• 37:38in front of us and I think it's
• 37:39that's why it's so great that we
• 37:41have already started down this path.
• 37:43While the system and and Yale Medicine
• 37:45are prepared to roll out the the a lot of
• 37:48critical work that we're going to rely on.
• 37:51And so hopefully we will maybe be a
• 37:53little bit ahead of the game and we can
• 37:55take advantage of what's coming next
• 37:57from you know the health system in the
• 37:59school relative to to the broader efforts.
• 38:02But you know all of that's
• 38:04critically important.
• 38:04We have to make sure we have access
• 38:07for all of our patients and and and
• 38:10there was another question Eric in the.
• 38:13In the chat that maybe we can touch upon
• 38:15and anyone else who wants to jump in
• 38:17on this can and that was related to the
• 38:19the the lag time for breast cancer scans.
• 38:23I think that you know maybe we need a
• 38:26little bit more clarification on that.
• 38:28But we are aware that there there is,
• 38:32there is a delay sometimes in
• 38:34access within imaging.
• 38:36That aren't that support both our new
• 38:40patient and our existing patients and
• 38:43that is also work that is underway not
• 38:47just within Smilo that's obviously a a
• 38:50body of work that is you know for the
• 38:53entire health system and and School
• 38:55of Medicine and Yale Medicine to be
• 38:57working through and and Cynthia is probably.
• 39:02One of the most knowledgeable leaders
• 39:04in that work because she leads our
• 39:07ambulatory transformation work and
• 39:08radiology is a key part of that effort.
• 39:11And we are all at the table having
• 39:13those conversations and providing
• 39:15that input and helping I think
• 39:17to to address those issues,
• 39:19not just stay that it's a problem,
• 39:21but what can we all do.
• 39:23To help with that situation.
• 39:25So there is a lot of work that's being
• 39:27done and we all recognize that again
• 39:29none of this is mutually exclusive.
• 39:31Cynthia mentioned the importance
• 39:33of of this work touching on all of
• 39:36the other services that need to
• 39:38happen before we can even provide
• 39:41or even know that we have a cancer
• 39:43patient that needs our services
• 39:45and she referenced cardiology and.
• 39:47Other services where radiology is,
• 39:48is, is, is a big part of that.
• 39:50So you know I think that you know
• 39:52all of these are the important
• 39:54items that we need to understand is
• 39:56very complex but this is the work
• 39:58we're committed to and and we will
• 40:01be engaging everyone in this work.
• 40:04Well let me just say I'm hugely
• 40:06confident that we're going to fix
• 40:08this both system wide and and and
• 40:11and in smile up it'll be way better.
• 40:15612 months from now.
• 40:16And as Cynthia mentioned, I don't
• 40:18think we need to wait for three years.
• 40:21And if we if, if we do, all of us may
• 40:24not have as much hair as we do now.
• 40:27But Jeremy, you will.
• 40:29But but anyway,
• 40:33Lisa, Lisa and Sarah,
• 40:35really great work and you got
• 40:38all of our support.
• 40:39Yeah, great work.
• 40:40Yeah, great work. Thank you.
• 40:43Okay, should we transitioned,
• 40:46we should okay.
• 40:48So Eric, do you want to go
• 40:49ahead and introduce some?
• 40:51Sure. So yeah, so this is listen Jeremy
• 40:55I believe and and they're going to be
• 40:59speaking about two related topics and one
• 41:03has to do with regionalization within
• 41:06our broad system and the other is within.
• 41:12Medical oncology and hematology,
• 41:16the the need, the desire,
• 41:18the critical nature of moving
• 41:21toward a subspecialized care model.
• 41:25And by that we mean GI cancer doctors
• 41:28taking care of GI cancer patients,
• 41:31breast cancer doctors taking
• 41:32care of breast cancer patients.
• 41:33And the importance of it,
• 41:34I think is pretty obvious to most people,
• 41:36but cancer medicine has become
• 41:39so complicated that it is.
• 41:41Increasingly difficult for one person to
• 41:43be an expert across all disease subtypes.
• 41:46And so with that,
• 41:48I will turn this over to Liz and German,
• 41:52who have been working hard on this.
• 41:57Thank you, Eric.
• 41:58I'm going to share my screen.
• 42:02Whoops, and get it into the right mood here.
• 42:06Sorry guys, don't get dizzy.
• 42:08We're going to take a quick
• 42:09tour back through the the deck.
• 42:12So good evening everyone.
• 42:13I'm going to say a few words then hand
• 42:16the podium over to Jeremy Cortmanski.
• 42:18But we have been,
• 42:20Jeremy and I and many others listed
• 42:22on this slide have been working
• 42:24over the last year really on this
• 42:27notion of clinical integration,
• 42:29which we'll talk more about
• 42:30in the next few minutes.
• 42:32It really comes from the recognition
• 42:35that Smylo Cancer hospital so
• 42:38sorry is really quite an A very
• 42:40special place and we have you know
• 42:43clearly the clinical investigation
• 42:45and the Yale Cancer Center that
• 42:48whose home is in New Haven.
• 42:50But we actually have a very wide
• 42:52geographic reach throughout the state
• 42:56and what you what we're trying to
• 42:58actually work toward is to eliminate.
• 43:00Any distinction between New Haven
• 43:02and the rest of our enterprise.
• 43:05So you'll you'll notice tonight
• 43:07we're going to avoid using the
• 43:09word network or care centers or
• 43:10main campus that really what we
• 43:12have is the Smile Cancer Hospital,
• 43:14Yale,
• 43:15Yale Comprehensive Cancer Center that
• 43:17delivers academic the best in class
• 43:21cancer care access to clinical trials.
• 43:24But that we're able through
• 43:27our extensive sites,
• 43:28we have 16 sites across the state
• 43:31able to offer that care close to
• 43:33home which is very powerful from a
• 43:35population health and public health
• 43:37point of view and also tremendously
• 43:39extends the reach of our clinical trials.
• 43:45So before I hand it over to Jeremy to make
• 43:47the Segway here the the the a lot of the.
• 43:52Programs that are part of SMILO today were
• 43:54integrated and acquired over the last
• 43:5710 years and at the time that different
• 44:00practices were brought into SMILO,
• 44:02there was a lot of work done to integrate,
• 44:05to introduce care signature and to
• 44:09introduce an academic sub specialized.
• 44:12Mode for physicians.
• 44:14So really this work is intended to
• 44:16continue what was really kind of always a
• 44:19part of the DNA of the of the the smile.
• 44:21Oh, I'll use the word network,
• 44:23which you know Eric often says
• 44:27is actually pretty strong.
• 44:29Among cancer centers,
• 44:31there are very few.
• 44:32Eric often will say memorial.
• 44:34So Kettering is one that actually
• 44:36has achieved a high level of disease
• 44:39of specialization and academic.
• 44:41Faculty throughout their enterprise
• 44:42and we actually have a pretty
• 44:45strong basis and the work we want
• 44:47to do is to continue
• 44:48to evolve that. So
• 44:50Jeremy, I'm going to hand
• 44:51it over to you. Thank you.
• 44:55I'm hoping when all of this work is done,
• 44:57my hair does in fact grow back,
• 44:58but we'll see. So, you know, tonight's.
• 45:04Talk is not meant to deliver a
• 45:06finished product by any means.
• 45:08I think it is really meant to introduce
• 45:12the rationale for the the work that
• 45:15we're doing and also introduce the work
• 45:18that needs to be done and help our
• 45:23entire system to start the process of
• 45:26getting involved in that work I I think.
• 45:28Knowing the the size of our enterprise,
• 45:32it's important that there is
• 45:35involvement from everyone.
• 45:37But I think it's obvious that there has
• 45:40been some real transformative shifts
• 45:43in medicine and in cancer care in
• 45:47particular that have required some new
• 45:49new thinking about how we deliver that care.
• 45:52One is that there's this rapid increase
• 45:55in the complexity of the diseases and
• 45:57the treatments that we have for them
• 46:00with rapid emergence of immuno oncology,
• 46:03new drugs and therapeutics and multiple
• 46:06complicated clinical trial options,
• 46:08dependence on molecular profiling
• 46:11and targeted therapies,
• 46:13early introduction of genetic
• 46:15testing and genetic counseling,
• 46:18new technologies in radiation oncology.
• 46:22Interventional radiology, Thera gnostics.
• 46:26Increasing surgical specialization
• 46:28and expertise with robotic surgery,
• 46:31minimally invasive surgery,
• 46:33and then also the emergence of
• 46:36cellular therapeutics.
• 46:37And so the field has gotten very
• 46:40complicated in a very short period of time.
• 46:44On top of that, though,
• 46:46there is also a.
• 46:48A value imperative that the the
• 46:50payers for this care require that
• 46:53we don't just deliver a lot of it,
• 46:55but that we demonstrate the value
• 46:57in what we are doing that we try
• 47:01to reduce variability.
• 47:03And I think that that's also important
• 47:06that we try to reduce variability in
• 47:08what we deliver as a Cancer Center,
• 47:11so that there aren't great disparities
• 47:14depending on where within our
• 47:15system you're getting your care.
• 47:18And then making sure that
• 47:19people are still getting the
• 47:21right care at a location that is
• 47:24convenient and with a provider
• 47:26that is an expert in their field.
• 47:31And I think from the consumer side,
• 47:33from the patient side,
• 47:35patients and families really
• 47:38desire a research driven
• 47:41multidisciplinary expertise,
• 47:43but also want it to be close
• 47:45to home and convenience.
• 47:51And so when we think about
• 47:52the future of SMILO,
• 47:55it's really in these two areas,
• 47:57subspecialized care because the
• 47:59speed of change and complexity of
• 48:03care demands that and that it's
• 48:06offered with multidisciplinary
• 48:07expertise and integration.
• 48:09Because it does require a team.
• 48:11It's not just a hematologist
• 48:13or a medical oncologist.
• 48:14It is a surgeon and a radiation
• 48:17oncologist and imaging and pathology
• 48:19nursing and all of the supportive
• 48:22services that all have to be available
• 48:24to our patients wherever it is
• 48:25that they are getting their care.
• 48:32And so it really is at a point
• 48:35that achieving this state is
• 48:37critical and work that needs to
• 48:40be done now for the patients.
• 48:42It allows the the oncologists and
• 48:44hematologists that are treating
• 48:46them to be abreast and nuanced of
• 48:50the latest advances in their care.
• 48:53It allows the the physicians and clinicians.
• 49:00To have job satisfaction with that
• 49:03mastery of their area and getting
• 49:07stronger relationships with their
• 49:10partners in that care and better
• 49:13access and utilization of clinical
• 49:16trials and for our entire center,
• 49:19it allows us to reduce that
• 49:23variability and really create a
• 49:25distinctive signature of care.
• 49:27That not only separates us from
• 49:29our local competitors,
• 49:31but also on a national standpoint.
• 49:37So this is sort of the next
• 49:39two slides will sum up.
• 49:40But so the guiding principles that I think
• 49:43Jeremy has articulated are subspecialization.
• 49:46So the idea is that all
• 49:49physicians will progress towards
• 49:51subspecialty expertise such that.
• 49:54You know when we are kind of as we
• 49:57evolve a a the majority of patients
• 49:59will be taken care of by an expert in
• 50:02their tumor type and that access to
• 50:04clinical trials will be an emphasis
• 50:06and an important part of the program.
• 50:09One of the key ways that we see
• 50:12this subspecialization becoming
• 50:14manifest is through regionalization
• 50:17which we've alluded to.
• 50:19So one of the challenges in creating
• 50:22subspecialized practice is that.
• 50:24With the exception of breast cancer,
• 50:26they're really in small communities,
• 50:28there's not a large volume of cases and
• 50:31so it becomes hard to keep a Doctor Who's
• 50:35in practice 7 or 8 sessions a week busy.
• 50:37So we think that one of the ways we
• 50:40can mitigate that is to introduce
• 50:42the concept where physicians
• 50:44will practice in up to two sites.
• 50:47So I'll mention you know Waterbury
• 50:48and Torrington have already started
• 50:50down this path and are are working.
• 50:52On developing a model in which the
• 50:55physicians will practice at each site
• 50:57which will enable them more readily to
• 51:00become focused on a on a single disease.
• 51:04And that we know will take a lot
• 51:07of effort to mobilize changes in
• 51:09workflow and kind of rewiring how
• 51:11we do our business so that we can
• 51:14we can do that smoothly.
• 51:15And patient access,
• 51:16we just spent a lot of time
• 51:18on patient access.
• 51:19It continues obviously in
• 51:20this work to be a priority.
• 51:22And as Jeremy said,
• 51:24providing world class
• 51:25care very close to home.
• 51:28So just to wrap up the the general time frame
• 51:31is that between now and roughly July 2025,
• 51:34we will go through a process of retreats
• 51:37and engagement and organizing local
• 51:40work groups all kind of to manage
• 51:43the many changes and to get everyone
• 51:45engaged in making the changes that we
• 51:48required so that we wind up where.
• 51:51Each position is aligned with a
• 51:53subspecialty and is able to regularly
• 51:55attend tumor boards and other important
• 51:58center of excellence related meetings.
• 52:00Each has an academic portfolio of
• 52:02work and has access to mentorship that
• 52:05a PP's are a key part of the team
• 52:07and are optimally deployed in this.
• 52:09In this new model,
• 52:10the majority of patients are seen
• 52:12by a subspecialists,
• 52:13physicians working in up to two sites
• 52:15within a region we've redesigned workflows.
• 52:18And really importantly that we've
• 52:20engaged the referring community so that
• 52:23they understand the value proposition
• 52:25and are are comfortable with the way
• 52:27we will be functioning.
• 52:30So that ends our slides, we can pause
• 52:35and see what questions have been posed.
• 52:47So I will.
• 52:48I will take a step so that there's a
• 52:51question in the chat about how difficult
• 52:53that is to fit in patients currently
• 52:58and so and how that would be impacted if
• 53:01if a physician is in a different site.
• 53:04I I think that this the the ideas
• 53:08of sub specialization,
• 53:10regionalization and access all
• 53:12work hand in hand and to do that.
• 53:18It requires that we optimize
• 53:21how how everybody is used,
• 53:24how we utilize physicians APP's our
• 53:29nursing staff to to make that happen,
• 53:33how we right size the,
• 53:35the staffing that we need in
• 53:37certain places whether that's
• 53:39through additional hiring or better
• 53:42template management I think.
• 53:45That's why this work, you know,
• 53:48takes a couple of years to accomplish
• 53:50because it's not as simple as
• 53:53just moving someone from point A
• 53:55to point B for a session a week.
• 53:57It really involves all of the ways
• 54:00that patients are going to interface
• 54:02with the care that they're getting.
• 54:05And
• 54:05I would just add, Jeremy,
• 54:07that it also demonstrates the importance.
• 54:11Of recognizing that the work we do
• 54:13in the access efforts that was just
• 54:15presented and the work that you all
• 54:17just presented is really tied together.
• 54:20I mean we cannot work on these in
• 54:23silos And the timing for us to be
• 54:27doing both the patient access work
• 54:29and this work is not accidental.
• 54:34It it really needs to work
• 54:38together otherwise we will miss.
• 54:40Opportunities that we would
• 54:42not otherwise capture.
• 54:43And and I think in the chat around staffing,
• 54:47Lisa, you responded that you know
• 54:48this is this is important as well
• 54:50and it's part of work that we've
• 54:52done in in the analysis around
• 54:54what we call role harmonization.
• 54:57All of these have to be in place
• 54:59and have to be working together
• 55:01in concert and perhaps perhaps
• 55:04at a soon an upcoming town hall.
• 55:09We could do an update on the
• 55:11royal harmonization work as well.
• 55:13It's important for us to be able to
• 55:15keep everyone apprised of all of those
• 55:17moving parts and and making sure that
• 55:19everybody is is engaged in in that work.
• 55:26So look, it's it We,
• 55:28we we've sort of hit the hour and I
• 55:30think everyone's done a great job.
• 55:31I just want to say the, the goal here,
• 55:34the mission here is to provide absolutely
• 55:38outstanding multidisciplinary care
• 55:40in a research setting to patients
• 55:43with cancer and hemologic conditions
• 55:46in New Haven and around the state.
• 55:50We want to, we want people to feel like
• 55:53they have received the very best care.
• 55:56In all ways with a big hug and
• 56:00I think it's really,
• 56:01really important and I think you
• 56:04know we we have such potential
• 56:06and in many ways we're really,
• 56:09really close and we can do this.
• 56:12So everybody just you know bear with
• 56:14us as we as we take these steps
• 56:17and I I come as close as I can to
• 56:21promising that this is going to work.
• 56:25We have.
• 56:25Total support in this in this mission
• 56:29from both the CEO of the healthcare
• 56:33system and the Dean of the medical
• 56:35school and it's really going to be great,
• 56:38completely agree Eric And and
• 56:39actually there is one other
• 56:41question and I know we're at time,
• 56:42but I want to make sure we answer it.
• 56:45Will there be work on evaluation of
• 56:47frequency of provider slash patient visits,
• 56:49It seems to differ greatly between
• 56:51providers even for the same diseases
• 56:53and that is absolutely true.
• 56:55And we, yes, absolutely will
• 56:57be addressing that 100%.
• 56:59So yes, all right, this was great.
• 57:04I'm sorry the time is up.
• 57:06Sure that we could continue
• 57:07to talk about these topics.
• 57:09We will plan to bring I think this
• 57:12this back on a regular basis to
• 57:16keep everybody updated and we'll be
• 57:18adding more people to the panels,
• 57:20maybe some of you who are out there now.
• 57:23Will be on the screen helping to
• 57:26share some of the progress that
• 57:28is made that you are helping to
• 57:31to to lead and drive forward.
• 57:33So everyone have a great rest
• 57:37of your evening and we'll hope
• 57:39to see you all again very soon.
• 57:42Good night you.
• 57:43Bye bye.