Smilow Cancer Hospital Town Hall | October 25, 2023

October 27, 2023

Information

Hosted by: Lori Pickens

Clinical Announcements and News

Kevin Billingsley, MD, MBAKim Slusser, RN, MSN

Strengthening the CORE and Goals for FY24

Pamela M. Sutton-Wallace, MPHExecutive Vice President and Chief Operating Officer, Yale New Haven Health

ID10915

To CiteDCA Citation Guide

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&amp;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&amp;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&amp;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&amp;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.