Advancing Health Podcast: Generational Health – A Blueprint for Systemwide Care Transformation for Older Adults

Podcast: Advancing Health (American Hospital Association)
Episode: Generational Health: A Blueprint for Systemwide Care Transformation for Older Adults
Date: October 20, 2025
Host: Marie Clary Fishman, VP of Clinical Quality, HRET
Guests:

• Dr. John Zifferblatt, Chief Strategy Officer, West Health
• Dr. Diane Wince, Trauma Program Director and Critical Care Specialist, Sharp Memorial Hospital

Overview

This episode explores how West Health Institute and Sharp Healthcare are transforming older adult care through a comprehensive, systemwide approach. The conversation centers on their collaborative efforts to create sustainable, patient-centered models—focusing on the principle of “what matters to you?”—to improve outcomes for older Americans. The speakers discuss their innovative Generational Health program at Sharp Memorial Hospital, the importance of care tailored to the individual, the value of cross-disciplinary collaboration, and how scalable change is possible with existing resources and strong leadership.

Key Discussion Points & Insights

1. Origins and Mission of West Health (01:00 – 02:50)

• West Health is dedicated to advancing affordable healthcare models that promote independence, high quality of life, and dignity for older adults.
• The organization has three components:
  • West Health Foundation (funding arm)
  • West Health Policy Center (policy advocacy, D.C.)
  • West Health Institute (collaboration with health systems, San Diego).
• West Health positions itself as a catalyst, given its size and scope.

Quote:

“We are here in San Diego...to advance affordability and models of healthcare that promote independence, high quality of life, and dignity for older adults, and ultimately for us all.” – Dr. John Zifferblatt (01:11)

2. West Health and Sharp Collaboration (02:29 – 03:29)

• Collaboration began after successful work accrediting all health systems in San Diego (except military) as geriatric emergency departments.
• Praise for Sharp’s readiness, leadership, staff buy-in, and metric-driven mindset.

Quote:

“They had buy-in, they had metrics that they wanted to advance. They had a passionate and capable champion and really support from the clinical staff all the way up to the carpeted part of the hospital.” – Dr. John Zifferblatt (03:04)

3. Sharp Memorial’s Journey to Generational Health (03:51 – 06:21)

• Program began during the COVID pandemic as a trauma-focused pilot for patients aged 65+.
• Emphasized aggressive functional and cognitive rehabilitation; significant improvements noted:
  • Delirium mitigation
  • Sleep/wake hygiene
  • Out-of-bed mobility
  • Discharge rates back home
• Success prompted expansion to medical and surgical pathways—including community partnerships.
• National-level milestones achieved for sustainability and transferability.

Quote:

“We targeted patients who were 65 and older for very aggressive functional and cognitive rehabilitation after injury…which is what people want. They don’t necessarily want to be out of their homes to recover.” – Dr. Diane Wince (04:17)

4. Generational Health Program Scope (06:21 – 08:25)

• Generational Health is now hospital-wide, touching emergency, inpatient, surgical, and community sectors.
• Components include:
  • Advanced Illness Management: Goal-of-care discussions, advance care planning.
  • Appropriate Care Committee: Mediates misunderstandings around care levels.
  • Geriatric Surgery Program: American College of Surgeons verified; targets patients 75+ with high vulnerability/social determinants.
  • Community outreach: Education and resources for local partners.
  • Healthy Aging (Inpatient): Based on the John A. Hartford Foundation and IHI's “Age-Friendly Health Systems 4Ms” (Mobility, Medication, Mentation, What Matters Most).

Quote:

“…really prioritizes what we call 4M’s: mobility, medication management, mentation...and then what matters most. What are we doing in this hospitalization? What’s important to you?” – Dr. Diane Wince (07:51)

5. The Medical Inflection Point: Redefining What Matters (09:33 – 10:50)

• “Medical inflection” refers to recognizing when hospital care doesn’t improve quality or quantity of life, focusing care on patient goals rather than only medical interventions.
• Emphasized patient autonomy and individual definitions of “what matters.”

Quote:

“Medical inflection is the time...where the hospital doesn’t offer a therapeutic or diagnostic solution, that the needs or...interests of that person are to remain in place, to age in place, and the hospital doesn’t really enhance that quality or quantity of life.” – Dr. Diane Wince (09:39)

6. Concordance of Patient, Provider, and System Goals (10:50 – 12:06)

• There is significant overlap in what’s important to patients, practitioners, and health systems: independence, expeditious safe discharge, and satisfaction.
• Aligning length of stay and discharge outcomes benefits both individuals and institutions.

Quote:

“What matters to patients and practitioners...greatly overlaps with what matters to health systems...getting that right...gets [patients] out and back in an independent life in their community sooner and happier.” – Dr. John Zifferblatt (11:14)

7. Building Systemwide Culture Change (12:43 – 15:16)

• Culture change starts with supportive leadership; administrators at Sharp are accessible and personable.
• Effective change involves storytelling: using personal patient outcomes to motivate staff and leadership.
• Example: An elderly man’s negative cycle post-injury leading to programmatic changes in pain management and rehabilitation.
• The approach must be practical, not burdensome – “a shift of mindset.”

Quote:

“It starts at the top...we engaged frontline staff who had interest...and we welcomed them onto the team...One of the examples...is the gentleman who fell in his garden...he got into this cycle...Based on his outcomes, we took that back to the group and we said, we have to do better.” – Dr. Diane Wince (12:44; 13:15)

8. Sustaining and Scaling the Model (16:08 – 19:06)

• The Sharp approach: operational innovation over new technology—building with existing tools, modest training, and mindset change.
• West Health’s role: Amplifying success stories, catalyzing spread via policy and marketplace incentives.
• Importance of showcasing real-world success to inform policy, improve tech vendor solutions, and support business-friendly healthcare.

Quote:

“There wasn’t a new drug...This is about operational innovation, right? This is about bringing together pieces that already exist, putting it together in new ways...It’s helpful to provide to the market: what does success look like?” – Dr. John Zifferblatt (16:23; 18:30)

Notable Quotes – At a Glance

• “We are here...to advance affordability and models of healthcare that promote independence, high quality of life, and dignity for older adults...” – Dr. John Zifferblatt (01:11)
• “We targeted patients who were 65 and older for very aggressive functional and cognitive rehabilitation after injury...They don’t necessarily want to be out of their homes to recover.” – Dr. Diane Wince (04:17)
• “What matters to patients and practitioners...greatly overlaps with what matters to health systems.” – Dr. John Zifferblatt (11:14)
• “It’s just really a shift of mindset.” – Dr. Diane Wince (14:54)
• “There wasn’t a new drug that they needed to have been discovered. There wasn’t some new miraculous technology that didn’t exist a year ago. This is about operational innovation.” – Dr. John Zifferblatt (16:23)

Timestamps for Key Segments

• West Health Mission & Structure: 01:00 – 02:11
• San Diego Geriatric ED Work & Sharp Partnership: 02:11 – 03:29
• Sharp’s Generational Health—Origins & Expansion: 03:51 – 06:21
• Program Components & 4Ms Model: 06:21 – 08:25
• Medical Inflection Point Explained: 09:33 – 10:19
• Alignment of Stakeholder Goals: 10:50 – 12:06
• Culture Change at Sharp: 12:43 – 15:16
• Sustainability & Scaling Insights: 16:08 – 19:06

Memorable Moments

• The story of the patient who fell in his garden—an example of using real cases to drive systemic change (13:15)
• The emphasis on practical, sustainable change: “It doesn’t take a ton of extra time, doesn’t need a lot of extra training...it’s just really a shift of mindset." (14:53)
• West Health’s business-friendly view on scaling innovation through policy and marketplace guidance (18:30)

Takeaways

• Innovation in older adult care is possible by realigning existing resources and focusing on what matters most to the individual.
• Culture and leadership are crucial for enabling change, with patient stories as powerful motivators.
• Scalability comes from operational innovation—not just from new technology—and requires cross-sector collaboration and sharing of best practices.
• Patient-centered approaches such as the “what matters” question can lead to better alignment of outcomes for patients, providers, and health systems alike.