← Becker’s Healthcare Podcast
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- [00:00]
A
MOLLY welcome to the Beckers Healthcare Podcast. I'm Molly Gamble with Beckers and today I'm honored to be joined by Dr. Ngozi Zike, President and CEO of Sinai Chicago, the largest private safety net health system in Illinois. A respected physician, public health leader, Dr. Ezike previously served as director of the Illinois Department of Public Health where she guided the state through the COVID 19 pandemic with utmost clarity and compassion. As a Chicago resident, I still remember watching her briefings every day now at Sinai. She is leading efforts to advance health equity, expand access to care and strengthen the communities the system serves. Dr. Thank you so much for being my guest today.
- [00:35]
B
Thank you so much for having me, Molly.
- [00:38]
A
I just shared a little bit of an overview of you, Dr. Zke, and your leadership, but is there more that you'd like our listeners to know about your background in Sinai?
- [00:46]
B
Yeah, you know, I will say my dad decided that I was going to be a doctor, but it was after I finished med school and started practicing that I realized that my calling was to serve underserved communities, marginalized communities. And so that's where all of my clinical work has been. All of my professional work did take a detour from direct clinical care to serve as the director of public health for the state of Illinois, but still with a keen focus on making sure that policies that we undertook. And again, my time was dominated a lot by Covid keeping a keen eye on those marginalized communities that I had always cared for and making sure that the policies would benefit them and not hurt them. And now at Sinai that we're a walking, talking, breathing, living health equity initiative. We take care of a majority minority population with over 90% of our population being Latino or African American. And so, you know, everything we do is to promote quality and safety and the best health outcomes for communities that often have been left behind.
- [02:13]
A
I mean, you call it detours. I think different paths taken on the road to leadership make one ultimately a more powerful and so, so much more an interesting leader. I think we're going to get into a lot of what's going on at Sinai. I encourage our listeners to skip can be just such a masterclass in what a small system can do for its community with health equity front and Center. But Dr. Ezike, let's talk about a recent initiative you took on that you're particularly proud of. I'm sure many come to mind, but can you walk us through one in greater detail and talk about the impact it's made on your organization so far?
- [02:48]
B
You know, we are Constantly working. You know, as a safety net leader, I am really butting heads against a system that was not designed to take, take care of the population that I feel blessed to serve. You know, I have people who are on the, you know, short stick of the, you know, economic resources, you know, ladder, people who are economically disadvantaged. Metrics for many health indices are on the, on the poor end and largely Medicaid population, which of course means that that is more poorly reimbursed. So for populations that need much more to get caught up because they're starting further behind the starting gates, we who are taking care of them are actually given less. And so it's a bit of a catch 22. But I am so grateful for the 3500 caregivers that call Sinai Chicago home, that are committed to narrowing those gaps and those inequities and those disparities. And so a lot of things are necessary, right? I mean, we can talk about how we provide transportation so that we can help people get to the appointment. We can talk about using our community health workers so that we can identify those specific needs, those social determinants and try to act upon them. We can talk about the basic infrastructure of having a well functioning electronic health record that allows us to get data better to see what is going on with our population, that allows us to communicate directly with our patients through the MyChart app, that allows us to better promulgate the use of order sets so that people will all get the same treatment, apart from any kind of conscious or unconscious biases, that with these order sets that helps standardize the care so that all of our patients can be treated similarly and equitably. That institution of the installment of the electronic health record. Being able to join EPIC is something that most safety nets never get because of the prohibitive cost. And so we have been able to launch that. We are about a year and a half in and are really still learning, but reaping many of the benefits that come with having the right architecture infrastructure. You can only get so far if you don't have just that right foundation. And so we're very excited to be on our way and continuing to evolve with this very important technology, probably the most important technology that the institution it's 106 years has ever invested in.
- [05:57]
A
That's huge. And when was the go live on Epic?
- [06:00]
B
So the go live was about 18 months ago. And so it's a very long process to really learn all the pieces and get all the benefits and continually getting our staff trained on all the, you know, all the pieces of it, but we are already seeing much improved provider. The physicians love it. We now can have a system where we can see where our patients have been in other places outside of our system, there are AI embedded tools that actually help us care for the patient better. With some of the AI tools, just something as simple as assessing the fall risk status of a patient. You might, when they first come in, you say, oh, you don't have a history of falls, you're a low fall risk. We don't have to worry about you. This system will say, will actually alert you that, oh, this patient since admission has been put on such and such a narcotic that now the fall risk status maybe is elevated. And so there from this static thing where you made this assessment when they first came in. But you know, having a little friend on your shoulder tapping you like, pay attention maybe, maybe all those pain meds that they're taking now might make them a little groggier that they might fall. Like those kinds of assistive devices that come with this technology are great for patient care and help us to better care for our, for our community.
- [07:29]
A
That's terrific. I remember you talking about the transition to Epic and I can't believe it's already been 18 months. But that's a huge investment. Also a huge undertaking though, a go live and all the change management around it. So that really is a big initiative that still is ongoing. I want to talk to you about challenges and you kind of wove a lot of challenges into your response just now facing healthcare industry, but I think particularly facing safety nets. I almost feel like this is a tough time for all health systems and hospitals in many ways. But safety nets to your point, I mean, they are entrenched in the community on thin resources and they make a lot of things work with relatively thinner resources than other institutions have. I do worry sometimes as institutions have fewer resources or their own financial challenges, it could detract from the attention we owe safety nets for what they do in good times and bad. Can you talk about a challenge that's been really weighing heavily on your mind, Dr. Ezike, recently that's coming home to affect Sinai?
- [08:29]
B
Yeah, definitely. There are some serious headwinds on the horizon. When we think about the cuts that may be coming to Medicaid, we know that in D.C. that we've agreed on this $880 billion cut. It's hard to imagine that $880 billion over the next 10 years, we know that's going to touch Medicaid So however that looks, you know, you know, six months ago the line from me was like, please, we need to increase these Medicaid dollars. It's not enough. And now we're saying like, please don't cut any part of it, you know, and so really thinking about what that would mean and it's not. It is. The first hit is to the safety nets. We're 70% Medicaid population. But if, if these significant cuts really materialize, not only will the safety net hospitals start to fall off like, like dominoes, but then you'll have all of these patients that were served by these safety net institutions now either recede and not get care until it's very late and then show up with advanced stage illness in the emergency rooms of the remaining hospitals, which we know is not the ideal place to get care and is not how you want to let, you know, disease, you know, progress. But the idea is that we need to really look at what is happening now and we should all be advocating for the same thing, that we can't afford to have the 3.5 million Illinoisans that count on Medicaid. We can't, we can't disrupt that. We can't have the, the 40% of births that happen in the state of Illinois that are Medicaid births. We can't create a situation where people are inhibited from getting their prenatal care because they don't have coverage or have to figure out how to pay for it when we know that the start of life is the, is the most important piece. So we have a lot of self reckoning that we need to do to make sure that we are aware of what is being threatened and that we are all talking to our legislators and trying to push back against these, against these cuts and actually get back to the conversation of saying this dichotomy of haves and have nots. And if you're poor, you get less and your hospitals get less and your doctors get less. That's not how we're going to create thriving communities, healthy communities, such that people can be part of this great ecosystem together. All hospitals, safety net, academic medical centers. We all need to lock arms and figure out how we're going to support our city's health by strengthening our safety net systems.
- [11:43]
A
I feel so lucky to be sitting across this table from you and just hearing you speak. I think your voice just shines through so much noise. And I really do value this time with you. I wanted to, based on what you just shared there and then also going back to One of your earlier remarks, you find yourself constantly butting heads against a system that is not designed to care for the people we serve is what you had said there. This is such a time where strong leadership is needed. Dr. Ezekiel, can you recall one of the biggest leadership lessons you've learned along the way that feels incredibly relevant to you right now?
- [12:17]
B
Again, I think as a leader, you actually, in the clinic, you might not want this, but. And as a leader, you want to hallucinate, you want to visually hallucinate. You want to see the reality that should be, even if it's not the reality that we have in front of us. And so being able to identify that vision of what it should be and be able to, you know, gather your team around that vision so that they're all working towards that same thing, I think that's one of the most important pieces. And then after that, obviously, you have to surround yourself with the talent and the people who are going to help execute on this vision. But another part that is hard, and I will say this specifically for me, is being able to. After the direction is set, the vision is set, the right team is in place, they're competent and able to execute. Being able to stand back and let them do the work and not feel that as the leader, you have to have all the answers or do all the work, but in fact, entrust the team to do what it is that they are called to do. I think sometimes leaders are afraid to step up. Would be. Leaders could be leaders are afraid to step up because they think, I don't have this, I don't have that. I'm not great at this, I'm not perfect at that. But. But the truth is, nobody is. And so it's not about one person. It's about one person setting the tone. But you have a team that will do the rest. And so being able to stand up and then have that team, lead the team and trust the team, I think that's how you get as far as possible. There's an African proverb that says, if you want to go fast, just. Just go, go by yourself, but if you want to go far, go with others. And I think that's the power of teamwork. And I've seen it be. Just have exponential results here at Sinai and previous roles and just understanding that the team will get you there. And you got to. Got to lean in and count on.
- [14:37]
A
That team and trust your team. Yeah, absolutely. I wrote down, you want to see the reality that should be and how at times that can feel pretty vulnerable, but your team is relying on you as a leader to be doing that consistently. Dr. Ozika, as we wind down, is there anything else you wanted to take note of or something I did not ask you that you want to leave our listeners with?
- [14:57]
B
Yeah, thanks so much. I just appreciate the opportunity to talk with you. This is something that I'm so passionate about, as are the thousands of caregivers that work at Sinai Chicago. And I'd love to have people direct to our podcast, the More Than medicine podcast with Dr. Ngazi Azike. Please find us at Apple, Spotify or your favorite podcast. Appreciate.