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Advancing Health
Generational Health: A Blueprint for Systemwide Care Transformation for Older Adults
00:19:38
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- [00:01]
A
Welcome to Advancing Health. As America's population ages, hospitals and health systems are working to meet the evolving needs of older patients and provide care that enhances quality of life. Today, we highlight how West Health Institute and Sharp Healthcare are partnering to advance older adult care and the power of asking one simple what matters to you?
- [00:26]
B
Hi, everybody. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Marie Clary Fishman, the vice President of Clinical Quality for Health Research and Educational Trust, and I'm here today with Dr. John Zifferblatt, chief strategy officer at West Health, and Dr. Diane Wince, the trauma Program director, critical Care Specialist at Sharp Memorial Hospital in California. John, I'd like to start with you a little bit, and if you could tell me a little bit about your role at West Health and just a little bit of what West Health is all about.
- [01:01]
C
Sure. Thank you, too, Marie. Thank you for having me here. So I'm the Chief Strategy Officer at West Health. West Health, named for Gary and Mary west, our founders. We are here in San Diego, but it is named for our founders, Gary and Mary west, who have also given us our mission, which is to advance affordability and models of health care that promote independence, high quality of life and dignity for older adults, and ultimately for us all. My role is to overlook the portfolio work that we do and make sure it ladders up to create impact at scale. And when we say West Health, what we really mean is several organizations that all work together. There is the West Health foundation, but largely that foundation does its work through funding and Arms, legs and brains of the West Health Policy center in Washington, D.C. where we advance smart policy, and the West Health Institute here in San Diego, where we collaborate with health Systems. There's just 40 of us, so we can only be a catalyst and work with health systems to work together with them and try to affect change at scale.
- [02:12]
B
That's great, John. And that's really important information and very important to how we get work done in hospitals and health systems and in healthcare today. Share with me a little bit about your connection and tie to Sharp and what does that look like?
- [02:30]
C
Absolutely. We worked with Sharp and other systems here in San Diego. We originally did some work. We have a body of work in geriatric emergency departments, and we did some wonderful work with the county of San Diego, where every health system in San Diego, other than military, was accredited as a geriatric emergency department.
- [02:50]
B
So.
- [02:51]
C
And we obviously know Sharp by its reputation. And in the wake of that work, Sharp approached us. Diane approached us with some really exciting possibilities and she'll share more, I'm sure, about the details of that, but I just want to share at a high level. When we spoke with Sharp and Diane, it was clear that they had their ducks in a row. 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. So that's how we came to advance this work that we'll be talking about today.
- [03:29]
B
John, those are really important things to point out. And I think that the governing board, the C suite, and I like how you said the carpeted areas of the hospital. So thank you for pointing that out. Diane, I'm going to ask you to tell me just a little bit about the journey that Sharp Memorial has been on and how you got to where you are today.
- [03:51]
D
Like John said, we presented to west health back in 2021 and at the time the country was going through COVID pandemic as the entire world was going through. And we had a durable, sustainable program that we were running. It had started on trauma. I'm the trauma medical director at Sharp Memorial Hospital, which is a level 2 to ACS verified center. But what we had seen similar across the country is that the number of patients 65 and older is growing. And I think it's going to continue that way for some time. And we needed a way specifically on trauma to manage the acute process of injury and that potential threat to functional independence. And so we began a small pilot or soft launch program on a single unit in our hospital. It was the trauma unit. And we targeted patients who were 65 and older for very aggressive functional and cognitive rehabilitation after injury. And that program enrolled 83 patients and it had significant results with delirium mitigation, sleep, wake hygiene, out of bed mobility and discharge back to home, which is what people want. They don't necessarily want to be out of their homes to recover. Once we saw those results, we were able to take this and say, well, maybe there's a pathway for medical patients and maybe there's a pathway for surgical patients. And we begin to grow those things with our collaboration through West Health. And so for the past three years we've been completing national level milestones to complete these very aggressive but also very durable and sustainable processes that could be used anywhere.
- [05:56]
B
I've done some homework over the weekend and so I had a chance to go to your website and really look at some of the information and the materials that's there. So your generational Health program. Sharp Memorial has that in place. And I wonder if you could describe that a little bit and help our audience understand what is that cover, what is it involving?
- [06:22]
D
Yeah, it's really amazing at this point what we've been able to accomplish because where we started as just a little program on a trauma unit is now hospital wide and going system. Generational Health is an umbrella term. It encompasses all the pieces of the program that we do from the very beginning in the geriatric accredited emergency department that John mentioned all the way through community. It includes Advanced Illness management, which is a nursing team that comes in, talks about goals of care, advanced care, planning processes for future hospitalizations or how to prevent it, ensuring that your needs are met and that we really heard and understood what matters to you. We have an appropriate care committee that deals with families, patients where there might be a misunderstanding about the level of care or what's being offered. We have Geriatric surgery, which is another American College of Surgeons verified level one program. So this addresses surgical patients with vulnerability or social determinants of health who are going for operations and they're age 75 and older. We also have a community piece where we go out, we provide education resources to all of our community partners. And then most importantly is the Healthy aging, which is the inpatient program. This is an age friendly program. It was modeled after John a. Hartford Foundation IHI and it really prioritizes what we call 4M's mobility, medication management, mentation, which includes the aspiration precautions and the cognitive and the delirium mitigation. And then what matters most? What are we doing in this hospitalization? What's important to you? What goals are you trying to accomplish and how can we help you get there?
- [08:25]
B
That's amazing. I know that Sharp Memorial has a track record of coming up with innovations and for creating innovation that helps advance patient care. So I'm not surprised to hear you have such a comprehensive approach to the area of aging. And as you rightfully said, the number of aging in our country is growing significantly. And so things that our hospitals and health systems can put in place to help integrate these pieces and really look at things through that lens of what matters is it really is important so that that care that we give to those older Americans really is focused on what's important to them and what matters in their life. And it helps us as caregivers provide care that is something that advances and helps their life and makes them feel better. So kudos to that broad perspective that you're bringing. That's really amazing. Maybe Dr. Wince, you can talk to this just a little bit. And it's the idea of the medical inflection point of care. If you can give us a little bit of your insight and thought around that concept and what that might mean.
- [09:33]
D
Yeah, I think you made a great point. You know, it comes down to what's important to someone. So medical inflection is the time on the healthcare journey where the hospital doesn't offer a therapeutic or diagnostic solution, that the needs or the 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. And it's different for everybody. It's not based on age, it's not even based on frailty. It's based really on what matters to you and what can be accomplished in your current environment that is so important.
- [10:19]
B
And I have used that. I can't even begin to tell you all of my dad's stories, but we have used that to make care decisions, to help him make his care decisions, because he is cognitively intact and capable of making those decisions himself. But I think that's a concept we really do need to focus on in healthcare, and that is through that lens of what matters. John, can you give us a little of your thoughts on that concept? Because as the what matters comes so important, and I know it's important to West Health as well.
- [10:51]
C
Absolutely. And I think I'll take the perspective that it's kind of a beautiful thing, because what matters to patients and practitioners, I dare say, is really also greatly overlaps with what matters to health systems. Right. Older adults and all of us want to walk into the hospital if we have to walk in and we want to walk out, and we'd like to do that in an expeditious manner, and we'd like to do it as healthy as possible. That's what health systems want. I mean, when we think about what's on the minds of those that run health systems and health systems leadership, it's a thing about things like length of stay, especially these days where you see many systems lines out the door in the ed, people waiting for beds, transfers, scheduled procedures, having to be rescheduled or delayed. Everybody would love to see beds being used in the optimal manner. And part of getting that right, part of getting a good case mix index and really tuning length of stay is allowing older adults the ability to really have that stay be optimized for them. And that gets them out and back in an independent life in their community sooner and happier with Greater satisfaction. So wonderful to see the concordance of what matters.
- [12:06]
B
I love what you just said. The concordance of what matters. That's just perfect wording for that concept. And really, I've been in the position of having those conversations with caregivers. So, Diane, help me, help me think about or understand how you at Sharp Memorial, how you create the environment, how you create the culture within a system. And you clearly have a system, a continuum of care that you're working for. So how do you look at building systems that make it easier for those that are providing care to really understand the what matters?
- [12:44]
D
Well, it starts at the top. We have a very receptive administration. We have an administration that's very accessible and also goes on a first name basis. So it's very comfortable to voice a concern or to be interested in something. And I think this collaboration with West Health is one of the best examples of how administrations really drive ships by stepping back and allowing leaders to take the reins. This is what happens, is that we had so many stories. We had patient examples that were really critical where we could have done better. And we shared those stories and then we engaged frontline staff who had interest in what we were doing, self identified, and we welcomed them onto the team to start that planning process so that we could move forward with a bigger picture. One of the examples that I give is the gentleman who fell in his garden, and he was the family patriarch and he came in with a few rib fractures, a minor injury in most cases, and for him, unfortunately, he got into this cycle where he needed pain medication and then he was too groggy to participate. And then because he didn't participate, he was in bed. And because he was in bed, he lost strength. And this just. It was a cat chasing its tail, trying to get on top of the problems so that we could get him better. And based on his outcomes, we took that back to the group and we said, we have to do better. We have to already be prepared for what's going to happen. We have to be ready to manage pain in such a way that we don't get into this cycle, that this doesn't happen to someone. It's a lot of things that we talked about on this call. It's bringing those personal examples and making that impact. And someone saying, you know, that resonates with me because I took care of someone and they have this story and really using those stories to build that impact, to build that need, to build the interest, and then to come up with a product that is really doable doesn't take a ton of extra time, doesn't need a lot of extra training to do it. It's just really a shift of mindset.
- [15:17]
B
I think you're so right. And I think we have opportunities to bring the family caregivers, whoever that might be, and the clinicians and the clinical team sort of together looking through that what matter lens. Right. Because, you know, one thing might matter to the caregiver, one thing might matter to the clinicians. Well, do they? Is that checkpoint of what matters? Do they align with what that patient person who's in the bed wants? And I think that's something that's really important. John West Health is really committed to this and really believers. We had another panel with you and we talked about the C suite, the board involvement, and how important that is to going forward. Can you talk a bit about the sustainability of this model or the spread of it, and how does West Health look at that?
- [16:09]
C
Sure. Happy to share. And I'll also add an observation about the wonderful work going on at Sharp. When you heard Diane talking about the things that they've brought to bear and the multifaceted components they put into that product, if you will. 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, right? This is about bringing together pieces that already exist, putting it together in new ways, doing some, you know, staff training. There's, you know, these things and culture change, as you said. But all of these things are there. They need to be catalyzed. The incentives have to be in the right place. But this is not net new technology, new innovation. We have the pieces now and we can do them. And that's part of how we think about catalyzing the scale and spread of this. There's multiple ways we can do it. One of the more simple and straightforward ways is we amplify the work. We take beacons of success and houses of excellence like Sharp Memorial and Sharpe Health that are doing it well and share and spread that break it down into the components that allowed for that success and enable those that are leading that success to share that as well. So obviously, there's vectors to do that, and then there's other ways that we can try to catalyze that success. We can do it at a policy level, but we also can create the right environment where things like this can take root and spread. And we're big believers in the marketplace. So how are the things that we're Discussing here, business friendly, how do they support hospitals as they move forward with their missions? How is there a marketplace of vendors? We were recently at a meeting and you were there, Marie, where we were talking about things like this. And we had participation from technology vendors large and small, and not, you know, it wasn't a sales platform for them, but it was really a way for them to understand what is necessary. How does technology enable these things? Some of the things that Diane's been talking about have been greatly enabled by EHR builds and configurations, other technologies, algorithms that identify the right patients to select for these interventions. All of these things require a robust and healthy marketplace of technology. No philanthropy is going to come up with the right puzzle pieces or even a single health system won't. The market will create them. But I think it's helpful to provide to the market. What does success look like? What are the guardrails? How are we who are delivering care or those who are delivering care doing it? And how are we who are enabling them thinking about this? And so for West Health, I think we're an honest broker, a neutral party. We're nonpartisan, we're not a vendor. And so we try to showcase all of these things to allow both policy and the marketplace to come together to move these things forward.
- [19:06]
B
Well, that's great, John. I love that. And yes, that was an amazing conference and opportunity to see all of this in action. So it was really great. Diane, thank you so much. And John, thank you for all of the things West Health does and the opportunity that we get to work with both of you.
- [19:25]
A
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