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.

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]

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]

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.

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.

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.

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]

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]

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.

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]

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

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.