Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr Mara Nitu, VP and Chief Medical Officer at Riley Children's Health

Transcript

Dr Mara Nitu, VP and Chief Medical Officer at Riley Children's Health · Becker’s Healthcare - Clinical Leadership Podcast

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  Thanks for listening. Now here's the episode.
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  This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. Mara Mitu,
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  the Vice President and Chief Medical Officer at Riley Children's Health. Dr.
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  Nitti, it's a pleasure to have you on the podcast today.
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  Uh, thank you very much for inviting me.
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  It's a pleasure to be here with you and, uh, talk about our priorities at, uh,
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  Riley Children's Health.
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  Fantastic. Well, I'm really looking forward to what you have to say.
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  I know you've got some fascinating things happening there, you know,
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  and really it's such an important time right now for children's health and
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  pediatric care, a lot happening in that space and,
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  and definitely a very important, uh, patient population to care for.
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  But before we dive into my questions,
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  can you tell us a little bit more about yourself and your background?
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  I, um, am originally from Romania.
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  I graduated the medical school at Carol Davila in Bucharest, um,
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  and then subsequently, uh, completed pediatric, uh,
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  residency at SUNY at Stony Brook, and spent one year, uh, in critical care at,
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  um, Cincinnati children, and then, uh, joined Riley,
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  uh, children's Health immediately after training and spent here my, uh,
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  last 22 years of career.
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  Oh, wow. That's, you know, definitely a, a very, um, fantastic kind of like,
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  um, journey that you've had in healthcare. And then two,
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  to be in one place for 22 years and really grow and develop in the space.
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  I can imagine things are much different now than they were when you first joined
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  Riley Children's.
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  You are very, very right about that. .
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  Um, well, absolutely, and, and, you know, considering where we're at today,
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  I know we've been through some challenging years, um,
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  with the pandemic and then just, you know, other, um,
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  areas that have have been hard both for children as well as, um,
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  the hospital and health system at large. So I was wondering, you know,
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  could you talk a little bit about some of your top priorities today?
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  What do you really see as being areas where you're spending most of your time?
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  Uh, while, um, the, this year,
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  the top two priorities have been, uh,
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  culture and team building and, um,
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  specifically around team member retention and team member satisfaction.
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  So that's one of the priority. Uh, the other priorities is, um,
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  patient satis, patient and family satisfaction.
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  The consumerism has made its way into medicine and,
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  uh, we are learning how to better, uh,
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  support the needs of our families and our patients.
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  Absolutely. I think both areas are definitely spaces where, you know,
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  hospitals and health systems across the country are,
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  are looking deep into those areas and trying to figure out what's gonna work
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  best for them, um, in support their growth and development in the future.
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  When you look at the culture and team building aspect and especially that, um,
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  retention piece,
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  is there anything that you've tried over the last year or two that's, um,
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  you know, has gone well or,
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  or would just love to hear how you're thinking about retention and what you're
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  doing differently?
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  There are so many layers and so many different interventions. We are. Um,
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  it, it is a very, uh, complex problem and therefore the interventions are,
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  um, multi-facets and the different levels.
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  The one intervention that we, um,
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  founded to be most successful in terms of team member retention is to
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  work with each to, to devote a lot of time in, uh,
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  leadership development, both for our directors and our managers,
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  and, um, provide feedback from our team member,
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  real time feedback from our team members to,
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  to the managers and to the directors to
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  support them in, um, co connecting with their team members,
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  um,
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  effectively and making sure that we hear their needs and we support their needs
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  real time. Uh, that has been, um,
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  I would say probably the one intervention with, uh,
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  biggest return on the investment from a physician standpoint,
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  what we are trying to, uh, to do, um,
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  in terms of better building the team with various important members
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  on our clinical team is we have, um,
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  an appreciation program in which you,
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  you are able to go online and drop a very quick, um,
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  appreciation note to any team member that you are working with.
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  And we are encouraging every single one of the physicians to take the time to
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  recognize not just their peer physicians,
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  but more importantly different team members that have, um, done something,
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  um, great that day. Also,
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  part of our leadership development program, we spend a lot of time on com, uh,
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  compassion encouraging our team members to show
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  compassion, not just for our patients and families,
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  but for each other and helping them to think about
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  how that is impacting their own personal life and as well as the
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  team members. It's, um, very clear that one, uh,
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  who comes to work with a, um, compassionate attitude, uh,
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  tries from that themselves is not just that you support the people around you
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  but your own personal development, um, and wellbeing. It's,
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  it's enhanced by that. So that is where we spend a lot of the time.
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  And then specifically in the unit at the bedside,
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  one intervention that has helped,
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  and it's not an innovation people have tried that before,
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  is, um, with, with good results it's heart debriefing.
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  So when there is a patient related event, whether, whether it is, um,
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  unexpected outcome or whether it is, um,
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  unexpected complaint, um, we,
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  we try to use the hot debrief debriefing methodology and encourage the
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  team to,
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  to get together in the moment and talk about the event as a team and learn from
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  it. And, um,
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  many times that results in a better communication with the family.
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  I love that.
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  I think all the things you mentioned there from the leadership and professional
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  development and really investing in the team, uh, to grow and build, um,
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  the next generation of leaders as well as them looking at providing compassion
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  and support for each other in addition to families and then the debriefings as
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  well. It seems like there's just a lot happening, um,
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  that really I'll point to what you summarized in the beginning of,
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  of better culture and team building and then focus on the patient satisfaction
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  and consumerism and, you know,
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  looking at healthcare obviously will continue to evolve over the next two to
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  three years.
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  How do you see your organization changing and growing with the times.
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  That There are two things that we are trying to evolve over the next two to
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  three years, and one of it, one of our biggest strategic, uh,
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  priorities are, um, expanding on our statewide promise.
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  Um, we, um,
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  are committed to meet patient needs closer to home and to,
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  to develop the mechanism, the,
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  the infrastructure that is necessary to be able to provide, uh,
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  permanent aspects of care, uh, closer to the, to the home.
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  So basically at this point in time, we are spending a lot of time in, uh,
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  looking to, uh, ideal footprint, uh,
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  throughout the state and trying to develop the
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  mechanism that we need to have in place to be able to, to be present there for,
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  for, as I said, for pertinent aspects of care. Sure,
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  there will be high-end procedures that will have,
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  will have to occur in the academic medical center,
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  and that is why we are here as a central location to be able to provide that.
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  But there are, uh, many, many, many,
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  many aspects of the clinical care that can be, can happen closer to home.
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  So that is one of the evolution we are, uh,
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  interested in supporting and devoting a lot of time to.
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  Um,
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  the second is to devote more time to
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  understanding the social, um,
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  determinants of health aspects of healthcare and partnering with community,
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  uh,
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  resources to be able to support the families on that level such that we provide
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  more of a holistic patient care,
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  more focused on wellbeing rather than just disease resolution,
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  uh, disease management. And, um,
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  of course a big problem in pediatric, uh,
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  healthcare has been and probably will continue to be behavioral
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  health. So we have our strategy team's working, um,
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  a lot on, um, developing a statewide behavioral health strategy,
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  um, focused on prevention, uh,
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  not just acute event management.
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  Absolutely. I think that's so important, especially given all the, um,
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  challenges that, uh, the nation's children have been having, as you mentioned,
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  with mental health care and behavioral health, you know,
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  being able to really dig deep and, and have a program that's beneficial, um,
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  certainly, you know, seems like it would be, um, very helpful for the community.
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  When you look at that program in particular, um,
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  what are you doing different in order to really find the solutions and,
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  and work with the, um, patients and their families, uh, to,
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  to bring them to a place where, um,
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  they're able to receive treatment and then continue on with a,
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  a stronger and healthier life?
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  Well, for the behavioral health strategy,
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  the team that's working on, uh,
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  that has tried to partner with every single possible resource available
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  in the state, including schools, including primary care networking,
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  including family practice physicians, and, um,
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  the strategy, the vision is that together we are going to,
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  we are the academic medical center will,
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  will spend a lot of time and resources to develop that, uh,
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  best practice knowledge among all our partners throughout the state
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  and, um,
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  to enhance the prevention aspect of behavioral health and
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  or to provide necessary support in the earlier
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  stages of the, um, uh,
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  challenges that the patient experiences such that we prevent evolution to the
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  more severe, uh, stages.
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  And that's not to say that it's not important,
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  also focus on acute care management and we have strategy,
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  um, solutions that are devoted to that,
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  but we believe that we will get better return on our investment if we
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  partner across the,
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  the state with all potential links that are going to play a role in patient
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  care.
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  I love that. I, I think that it's just a great strategy and,
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  and definitely thank you for outlining it for us. And,
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  and that will be helpful for other listeners as well to think through those
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  different factors, um, and understand what a, a,
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  a very significant program like that looks like. Um,
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  before we wrap up our conversation,
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  I'm wondering if you could share what is one change that you or your team has
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  made, um, recently that's yielded some great results?
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  Well, on that one,
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  I think I will talk about the harm the hospital acquired events
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  and the harm coming out of covid.
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  So at the end of the epidemics, we've noticed,
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  um, an increase in our harm events, uh,
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  specific ecsi and, um, pressure injuries,
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  hospital acquired, pressure injuries, multifactorial,
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  probably enhanced by the challenges and the migration that we've all
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  have experienced in terms of our workforce throughout healthcare, uh,
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  but not solely linked to that.
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  So to get a hold of this problem and to be able to
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  get in top of of it, we've LAN launched two main,
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  uh, interventions that I felt had a huge impact on the outcome. Uh,
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  one is, um, uh, something that we call timeout,
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  which is every time we have an event,
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  the whole entire team gets together to talk specifically about that
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  event and then to identify missed, uh, opportunities,
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  how did we deviate from the standard of care that may have led to that
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  particular event. And, uh,
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  what is different from the traditional way we did this timeouts.
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  The in historically the timeouts was something that occurred at the unit
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  level, and we had the specific people who were devoted to,
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  to this, to preventing harm met and talked about this at this moment in time,
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  what we changed, we made sure that we have, um,
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  strong executive presence for this timeout.
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  They always happened with the division chief present and with CMO
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  and um, uh, ACQ associate Chief Quality Officer.
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  And we've had amazing learner learnings that have derived from
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  there with very,
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  very specific gaps that were identified that we would not have
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  discovered or,
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  or figured out had we not been present throughout all this,
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  all this timeouts.
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  And I'm happy to say that within a month actually we saw a,
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  a positive impact and the impact has been sustained
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  throughout the last nine months, and it's,
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  it's very rewarding to see where we are now from a harm standpoint and
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  preventing harm.
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  It's hard work and it takes perseverance and
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  it's, it takes attention to preoccupation with failure every day,
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  and the team has grown and been able to, to,
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  to provide that with this particular support. I'm very,
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  very proud about the result of this. And meanwhile, in parallel,
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  we are trying to also develop a predictive model to anticipate who are the
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  patients who could be at higher risk to develop harm such that
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  we are trying to, uh, get ahead of the problem,
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  not just assess the, uh,
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  impact on a patient that has already been harmed but actually preventing it
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  from happening. And this predictive model has been, uh,
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  rewarding in the sense of, uh, has been able to teach us several,
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  uh, effective ways that we can prevent harm.
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  Well, that's fascinating, Dr. Nito and, and certainly, you know,
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  seems like it's a very advanced way to implement technology, um, and, and,
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  um, do a lot of good in terms of finding those harms and connecting and have the
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  leadership involved and certainly, um,
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  works wonders in terms of getting those rates down and,
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  and having better patient care.
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  Thank you so much for joining us on the podcast today.
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  This has been really fun and interesting discussion and I look forward to
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  connecting with you again soon.
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  Thank you for inviting me.
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