Mara Nitu, Vice President and Chief Medical Officer at Indiana University School of Medicine and Riley Hospital for Children, IU Health

Summary

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Podcast Summary

Episode Overview

Podcast: Becker’s Healthcare Podcast
Guest: Dr. Mara Nitu, Vice President and Chief Medical Officer, Indiana University School of Medicine & Riley Hospital for Children, IU Health
Date: March 3, 2026
Host: Laura Deardle

In this episode, Dr. Mara Nitu discusses leadership initiatives at Riley Children's Health, with a focus on reducing hospital-acquired harm, adapting to Medicaid reform, improving care access, and developing innovative solutions for behavioral health. The conversation also explores operational efficiencies, preparation for systemic changes, and opportunities for growth and collaboration in pediatric healthcare.

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Key Discussion Points and Insights

Dr. Nitu’s Background and Role

• Tenure and Experience: Dr. Mara Nitu has served Riley Children's Health for 25 years, three as Chief Medical Officer.
  "I have been a physician here in this institution for 25 years... and have enjoyed every single moment."
  — Dr. Mara Nitu [01:23]

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Hospital-Acquired Harm Reduction

Major Initiative: Focused efforts on care coordination, improving access, and, most notably, reducing hospital-acquired conditions (HACs).

• Success Story - CLABSI Reduction:

  • Achieved a standardized infection rate of 0.51 for central line-associated bloodstream infections — the best since 2019.

    "We were able to decrease the infections to a standardized infection rate of 0.51, which has been the best we've been able to perform for ever since 2019."
    — Dr. Mara Nitu [02:16]

• Systematic Approach:

  • Created a HAC committee structure.
  • Each hospital-acquired condition got its own multidisciplinary (physician-nurse dyad) leadership and dedicated team.
  • Focused on high-reliability standards, standard of care, and moving from a reactive to a predictive safety culture.

    "Preoccupation with failure and moving from reactive to predictive has been probably the biggest accomplishment that led to those outcomes."
    — Dr. Mara Nitu [04:37]

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Key Success Factors and Workflow Changes

• Committee Model: Each HAC (e.g., CLABSI, CAUTI, unplanned extubation, medication errors) receives focused leadership.
• Team Formation & Accountability: Teams sourced from high-risk units, ensuring those closest to care delivery drive improvement.
• High-Reliability Focus: Adopted continual process improvement and stringent adherence to care bundles.

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Strategic Priorities for 2026

• Continued Harm Prevention
• Optimizing Access, Care Coordination, and Throughput
  • Preparing for Medicaid reform and the impending payment model changes.
  • Emphasizing efficiency without compromising quality (e.g., appropriate length of stay, avoiding preventable readmissions).

    "We are preparing, we are working very hard to adapt to the new model and to be able to become even more efficient in the way we move patients through the continuum."
    — Dr. Mara Nitu [05:52]

  • "Just in time" discharges to balance access with patient stability and safety.

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Improving Access: Models and Innovations

• Geographical Challenges: Many families travel hours for care; thus, care transitions and coordination require creative solutions.

• New Discharge Models:

  • Use of nearby hotels post-discharge for families traveling from afar.
  • Extensive parent training and coordination with home care services prior to discharge.

    "We've put together models in which sometimes we discharge the patient to a nearby hotel just for a night or so... Or we do a lot of patient care, parent care in the hospital prior to discharge..."
    — Dr. Mara Nitu [07:57]

• Care Coordination is Critical: Ensuring continuity and access post-hospitalization is complex but essential for outcomes.

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Biggest Challenge: Behavioral Health Integration

• Complexity: Growing demand, limited resources, especially for pediatric behavioral health patients with co-morbid medical issues.
• Need for Community Partnerships: Schools, social services, and broader networks are key.

  "How do we wrap our mind around supporting the patients who have an added layer of complexity that comes from behavioral health standpoint? It's one area in which we would need to partner with the entire community to be able to deliver that."
  — Dr. Mara Nitu [09:44]

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Innovative Solutions: Medical Behavioral Health Unit

• Upcoming Initiative: Launching a new medical-behavioral health unit by mid-2026.
• Current Gap: Patients with both medical and behavioral health needs are admitted to standard floors, missing robust behavioral programming.
• New Model: Integrated care on a dedicated unit—one of the few in the country—designed for simultaneous medical and behavioral health treatment.

  "A unit in which patients who have behavioral health needs are going to be admitted, but in addition to they would also have medical care needs... we are building a unit that is going to be able to deliver both aspects of care at the same time and would be one of the few such units in the country."
  — Dr. Mara Nitu [11:13]

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Growth Opportunities for Riley Children’s Health

• Access Optimization: Reducing outpatient wait times and enhancing prompt service is a key growth lever.

• Innovative Care Models & Destination Programs: Creating national centers of excellence and novel models to advise and handle complex or rare conditions.

  "The biggest growth opportunities... are in improving access... The other opportunities in the area of creating new models of care... programs of national excellence... brings innovation in the way we are treating the patient."
  — Dr. Mara Nitu [12:36]

• Innovation Culture: Emphasis on novel care delivery, especially for both common and orphan illnesses requiring complex coordination.

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Notable Quotes & Memorable Moments

• "Preoccupation with failure and moving from reactive to predictive has been probably the biggest accomplishment that led to those outcomes."
  — Dr. Mara Nitu [04:37]

• "We are preparing, we are working very hard to adapt to the new model and to be able to become even more efficient in the way we move patients through the continuum."
  — Dr. Mara Nitu [05:52]

• "Access, access, access is such a huge, it seems like theme of the year across the board."
  — Laura Deardle [14:11]

• "A unit in which patients who have behavioral health needs are going to be admitted, but in addition to they would also have medical care needs... would be one of the few such units in the country."
  — Dr. Mara Nitu [11:13]

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Timestamps for Key Segments

• [01:23] Dr. Nitu’s background and tenure
• [02:01] Major initiatives: hospital-acquired harm reduction example (CLABSI)
• [03:25] Systematic process change: HAC committees, dyad leadership, reliability culture
• [05:41] 2026 priorities: access, care coordination, throughput, Medicaid reform
• [07:30] Access solutions: models for rural/out-of-area patient discharges
• [09:26] Most difficult challenge: behavioral health care coordination
• [11:07] Medical behavioral health unit: innovation and integration
• [12:35] Growth opportunities: access optimization, new care models

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Conclusion

This episode highlights Riley Children's Health's focus on systematic process improvement, access optimization, preparedness for healthcare policy shifts, and a pioneering approach to integrated medical and behavioral health care. Dr. Mara Nitu underscores the value of multidisciplinary teamwork, community partnerships, and innovation in driving outcomes and growth, all while keeping patient and family needs at the center.

Transcript

[Becker's Healthcare Announcer]

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[Laura Deardle]

This is Laura Deardle with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Mara Nitsu, who is the Vice President and Chief Medical Officer at Indiana University School of Medicine and riley Children's Health. Dr. Nietzsche, it's a pleasure to have you on the podcast today. Fantastic. Well, I'm excited for our conversation because I know there's so much happening at IU Health and it'll be really, truly amazing to hear some of the cool things you've been doing over the last year as well as how you're thinking about the future. But before we dive in, can you tell us a little bit more about yourself and Riley Children's Health?

[Dr. Mara Nitsu]

Oh, absolutely. So I have been serving as a Chief Medical Officer at the Riley Children's Health for the last three years, but I have been a physician here in this institution for 25 years of my career and have enjoyed every single moment.

[Laura Deardle]

Fantastic. You know, that's an amazing career you've had there. And when you think about, especially the last year or so, could you tell us about initiative that you led? What did you do and what were the results?

[Dr. Mara Nitsu]

The biggest buckets of areas that we are focusing on at the moment are care coordination and access to care for all patients and improving quality, specifically by eliminating hospital acquired harm. If I am to focus on the latest one of the two projects, we've been very successful in reducing hospital acquired harm and specifically as an example for the clabsi for the central line associated Lyme infection, we were able to decrease the infections to a standardized infection rate of 0.51, which has been the best we've been able to perform for ever since 2019. So very, very happy to see that we are gaining those outcomes.

[Podcast Host/Interviewer]

That's amazing to hear. And you know, when you look at that type of outcome, that transition, and being able to really reduce that hospital acquired harm, what did you how did you change the mindset in Processes and workflows. What did you do on the clinician and clinical level to achieve those results?

[Dr. Mara Nitsu]

It takes a village as you, as you are suggesting with your question and really hard wiring. High reliable organization, high reliability mindset takes a number of interventions. So I would say the most successful first step was creating a HAC committee, which stand for Hospital acquired condition committee. And we have asked a leader, a dyad, a physician nurse dyad leader to lead each one of these hack committee. And we have one for central line associated infection, one for catheter associated urinary tract infection, one for accidental unplanned extubation and so in medication errors and so on and so forth. So every single one of the hospital acquired conditions harm get a hack committee. And then underneath those team leaders, we've built up teams from the participants from the main areas that would be at higher risk to acquire those infections. And this is systematic way to make sure that we are adhering to the standards of nursing practice that are the standard of care, that are well accepted, the bundle of care and then continue to improve the high reliability there. And really preoccupation with failure and moving from reactive to predictive has been probably the biggest accomplishment that led to those outcomes.

[Podcast Host/Interviewer]

That's helpful to understand and you know, definitely seems like that systematic process and then having the dyad leaders come together and really be accountable for those outcomes makes a big difference.

[Laura Deardle]

That's really cool to hear.

[Podcast Host/Interviewer]

Now looking ahead, what are some of the big priorities and headwinds that you're focused on for 2026?

[Dr. Mara Nitsu]

I think the biggest priority will be to continue to work on the harm prevention, but we are doubling down on optimizing access, care coordination and really throughput and length of stay. With the Medicaid reform, we are expecting that payment model is going to be restructured and with that we, we are preparing, we are working very hard to adapt to the new model and to be able to become even more efficient in the way we move patients through the continuum. We focus a lot on the length of stay and readmission. We definitely would not want to discharge patients sooner than they are ready such that we have more readmission, but just in time. It's what we are focusing through. So really access and throughput would be probably the biggest priority for this year.

[Podcast Host/Interviewer]

That's helpful to understand and I think especially through the lens of some of those changes that are coming down the pipe with insurance, Medicaid reform and other areas that could be challenging for folks to access care in the way they used to and so when you're thinking about access in general, and I know we touched on a little bit, obviously traditional access points as well as looking at digital and more. What does it take for the system, as well as clinicians on their level to really think differently and be ready to make the necessary adjustments so that patients can still have access to the care that they need?

[Dr. Mara Nitsu]

It's a very good question and it's a multifaceted effort that needs to be put in place. I think that biggest point for the physician is to be able to have to be certain that the patient has the ability to receive the care that they need outside of the hospital and specifically the follow up care. We've put together a number of different models that are looking to the most complex patient discharges, particularly for those who live very far away from our institution. Because obviously we serve the entire state of Indiana and beyond, and a lot of our patients travel two to three hours to come to our institution. So discharging one patient like that poses more challenges than one who would be right next door, located close by our facility. And just we've put together models in which sometimes we discharge the patient to a nearby hotel just for a night or so for the family to feel comfortable to do so. Or we do a lot of patient care, parent care in the hospital prior to discharge, working with a home care organizations to make sure that the family receives at home the help and the support that they need. So there is a lot of care coordination that gets packaged behind these discharges that is very, very important to get it right.

[Podcast Host/Interviewer]

That makes a lot of sense. Thank you for digging a little bit deeper there. Now what do you think the hardest thing you'll have to do in the coming year will be

[Dr. Mara Nitsu]

the hardest thing? I really think getting this done right is not easy. And then if I were to dive a little bit deeper in this is probably the behavioral health and the care coordination in that patient population. And I think that's difficult solely because of the increasing epidemic that we see with behavioral health and the fewer resources that are available within health care for those patients. So how do we wrap our mind around supporting the patients who have an added layer of complexity that comes from behavioral health standpoint. It's one area in which we would need to partner with the entire community to be able to deliver that. Because partnering with the schools, partnering with all resources is going to be crucial to be able to develop a model that's sustainable.

[Podcast Host/Interviewer]

That makes a lot of sense. I think it's so difficult to try to understand all the dynamics Coming into behavioral health and where it can actually make the biggest impact when you're looking at the population, when you're looking at how you want to not only improve outcomes, but also make sure that you're running the system efficiently on operational and financial side. So I think that's a huge challenge and question for so many leaders across the country. And you know, I can imagine from your seat too, in being focused very much on the patients and the outcomes, you know, it takes a lot of work and coordination and connection with your executive team to make this happen.

[Dr. Mara Nitsu]

Yeah. And if I may add to that particular point, one physical space we are developing as we speak, and hopefully we are going to go live with it by mid year 2026, is a medical behavior health unit. What that is is a unit in which patients who have behavioral health needs are going to be admitted, but in addition to they would also have medical care needs, because currently those patients are admitted in the regular medical floor and they don't have access while they receive medical care, they don't have access to the behavioral health programming. So we are building a unit that is going to be able to deliver both aspects of care in the same time and would be one of the few such units in the country. And we are partnering and learning from those who have one that's already established to see how to launch it, to make it safe and effective.

[Podcast Host/Interviewer]

Absolutely. I think being able to learn from others is always a really important aspect of healthcare. And partnering on a deeper level, especially now more than ever, is critical. Now, before we wrap up, I wanted to ask you about growth as well. Where do you see some of the best opportunities for organizational growth going forward?

[Dr. Mara Nitsu]

The biggest growth opportunities that we see are in improving access. We have a lot of patients who are hoping to receive care from our organization, but our access, meaning the time that one needs to wait to get an appointment in the outpatient space, sometimes doesn't meet the needs of the family. So. So trying to think of creative model to optimize that and then make sure that we are meeting the family needs in terms of providing fast and prompt and effective care for those families. It's one of the opportunity, the other opportunities in the area of creating new models of care. So a lot of work is being done in terms of programs of national excellence and creating those destination programs in which the entire team is focusing and thinking about that particular condition and brings innovation in the way we are treating the patient. So I think being able to be at the innovation side of things in terms of complex conditions and patients with orphan illnesses or even illnesses that are frequent enough but require more of a care. Coordination is one side of things and the other is just access for all and being able that we meet the needs of the patients and the families in terms of getting them in.

[Podcast Host/Interviewer]

Absolutely. Access, access, access is such a huge, it seems like theme of the year across the board. And so, you know, to understand in a better way how you're thinking about that and finding those creative models and in problem solving in real time is just really cool to hear. Thank you so much for joining us on the podcast today, Dr. Nietzsche. It's been such a fun conversation. I've learned a ton and look forward to continuing our conversation as well at the annual meeting. I know you'll be speaking on a panel there and it'll be truly fantastic to hear from you and thank you. Just continue to learn more.

[Dr. Mara Nitsu]

Thank you so much for your time, Laura, and I've enjoyed having this conversation with you as well.