Latest / Becker’s Healthcare Podcast / Leading Rural Healthcare Innovation on Nantucket Island with Amy Lee

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Leading Rural Healthcare Innovation on Nantucket Island with Amy Lee · Becker’s Healthcare Podcast

• 0:02
  - Every health system executive right now is being
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  - asked to do something that has no useful
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  - precedent,
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  - make durable technology decisions in an environment that
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  - looks meaningfully different every six months.
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  - The pace isn't slowing,
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  - the vendor landscape isn't getting simpler, and the
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  - cost of missteps
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  - keeps rising.
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  - Becker's eleventh annual IT and Revenue Cycle Conference,
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  - The Future of AI and Digital Health, exists
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  - for exactly this challenge.
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  - Here, you'll find more than 2,500 executive level
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  - attendees,
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  - 600 plus speakers, and four days of sessions
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  - built around the questions leaders are actually wrestling
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  - with.
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  - How to scale AI responsibly,
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  - how to protect increasingly complex systems,
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  - how to wring more performance out of the
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  - revenue cycle, and how to make tech investments
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  - that hold up over time.
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  - Join us September fourteenth through the seventeenth at
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  - the Hilton Chicago.
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  - You can register on our events page at
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  - beckershospitalreview.com
• 0:57
  - by clicking on the events tab in the
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  - upper right.
• 1:01
  - Hi. My name is Paige Twenter. I'm an
• 1:03
  - editor at Becker's Hospital Review.
• 1:06
  - I'm so, so excited to be joined by
• 1:09
  - Amy Lee, president of Mass General Brigham's Nantucket
• 1:12
  - Cottage Hospital.
• 1:14
  - Amy, I'm I'll just go ahead and kick
• 1:16
  - it off to you. Can you please introduce
• 1:19
  - yourself and tell listeners a bit about,
• 1:21
  - Nantucket Cottage Hospital?
• 1:23
  - Hi. My name is Amy Lee, and I
• 1:25
  - serve as president and chief operating officer of
• 1:27
  - Nantucket Cottage Hospital. Nantucket
• 1:29
  - is the island's only acute care hospital. We're
• 1:32
  - a rural rural community hospital, and we are
• 1:34
  - 30 miles out to sea. So we have
• 1:36
  - a very unique geographic location.
• 1:39
  - We serve a population that goes from anywhere
• 1:41
  - from 16,000
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  - up to a 130,000.
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  - We have a surge population in the summer,
• 1:47
  - and we are a 14 bed hospital.
• 1:50
  - We have
• 1:51
  - over 38 specialties that we bring on island
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  - to care for our community.
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  - And with that, we can care for ninety
• 1:57
  - seven percent of the patients that walk through
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  - our doors. So only three percent are transported
• 2:01
  - off island to a higher level of care.
• 2:03
  - We're very proud of that number.
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  - How long have you been at Nantucket
• 2:07
  - College Hospital and seeing these seasonal fluctuations?
• 2:10
  - So I've been on Nantucket for four years.
• 2:12
  - In my past
• 2:14
  - roles,
• 2:15
  - I was actually in Vail, Colorado, so I'm
• 2:17
  - very comfortable with the resort,
• 2:20
  - seasonal populations, and that was part of the
• 2:22
  - draw to Nantucket.
• 2:24
  - I think, you know, this is an amazing
• 2:26
  - population. We have a very diverse population that
• 2:29
  - is on island. We have our very rich
• 2:31
  - and we have our very poor and we
• 2:33
  - have everything in between.
• 2:35
  - But the one thing that makes this island
• 2:36
  - incredible is that the passion
• 2:38
  - because people know they couldn't be here on
• 2:40
  - island if the hospital wasn't here. So they
• 2:43
  - they work very hard and they support the
• 2:45
  - hospital really well.
• 2:46
  - The newest version of this hospital, the new
• 2:49
  - building was built seven years ago, and it
• 2:51
  - was $120,000,000
• 2:52
  - that was raised by the community, the entire
• 2:55
  - community,
• 2:56
  - to build this hospital. So it is a
• 2:58
  - beautiful facility,
• 2:59
  - and we really have a unique opportunity to
• 3:02
  - care for our population.
• 3:04
  - That's amazing,
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  - like, community gift. It's I feel like most,
• 3:09
  - you know, multimillion dollar gifts or donations
• 3:12
  - to new hospital builds or buy one one
• 3:15
  - foundation, one trust. So it was a 120,000,000
• 3:19
  - from, like, several community
• 3:21
  - members. Yeah. Yeah. So it was across the
• 3:23
  - community. It was from lemonade stands to our
• 3:25
  - very rich. It was everyone chipped in and
• 3:28
  - because they really truly understand the importance of
• 3:30
  - the hospital and how it's so integrated into
• 3:33
  - our our community itself. One of the things
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  - I say all the time is the health
• 3:37
  - care we provide is so much more than
• 3:39
  - the four walls of this beautiful building. We
• 3:41
  - are in our communities. We are in the
• 3:43
  - schools. We are all the way around making
• 3:46
  - sure that it's a holistic viewpoint for health
• 3:48
  - care, not just that episode of care when
• 3:50
  - you come into the emergency department or primary
• 3:52
  - care. It's it's we are truly taking care
• 3:55
  - of people,
• 3:56
  - throughout the entire lifespan.
• 3:59
  - And so I understand you've been kinda convening
• 4:02
  - similar hospitals to
• 4:04
  - Nantucket that also have, you know, seasonal population
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  - swings.
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  - What does that collaboration
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  - look like in practice?
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  - Yep. So it's a little disjointed because, you
• 4:14
  - know, it's it's you don't necessarily always recognize
• 4:17
  - hospitals that are like yours. And so it's
• 4:20
  - by happenstance. For example, I worked in Colorado,
• 4:22
  - so I knew the the Colorado hospitals that
• 4:24
  - are up in the mountains and that kind
• 4:25
  - of thing. And we have a lot of
• 4:27
  - of community members that are seasonal, so they
• 4:29
  - are back other places. They're in Lake Tahoe,
• 4:31
  - they're in Florida. And so we built relationships
• 4:34
  - that way with other seasonal communities.
• 4:37
  - But the purpose of the summit that we're
• 4:39
  - having in October is to really bring together
• 4:41
  - the hospitals that are like ours, the rural
• 4:43
  - community hospitals or the seasonal hospitals,
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  - that we can create a collaboration and really
• 4:48
  - have
• 4:49
  - more of an effort to work together because
• 4:51
  - we're solving for a lot of the same
• 4:53
  - issues, housing, workforce development, seasonal surges, you know,
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  - taking care of patients that are only there
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  - part time,
• 5:00
  - emergency management. And because a lot of us
• 5:02
  - are in locations that make it very difficult.
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  - You know, you think of the mountains, you
• 5:06
  - think of the coastal cities, those kinds of
• 5:08
  - things. So,
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  - the whole intent of our summit is to
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  - bring people together. And when I was doing
• 5:12
  - that research, there's almost 300 hospitals that are
• 5:15
  - like ours. I never would have guessed that.
• 5:18
  - So it really gives us an opportunity
• 5:20
  - to collaborate
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  - and solve problems together as opposed to constantly
• 5:24
  - reinventing the wheel.
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  - What would you say has been the most,
• 5:29
  - like, eye opening
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  - lesson so far from
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  - I mean, I know you said, like, nearly
• 5:35
  - 300 was really surprising.
• 5:38
  - What
• 5:39
  - has anything changed at Nantucket because of collaboration
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  - with other hospitals?
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  - We do a lot with seasonal care coordination,
• 5:47
  - which means that when patients come on island,
• 5:50
  - we're creating a continuity of care plan so
• 5:52
  - that they go from wherever their home is
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  - to here and still get the care that
• 5:56
  - they need. So oncology patients, infusion patients,
• 6:00
  - diabetic, whatever it is, we really want to
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  - make sure that we are here to support
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  - them so that they can be on island.
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  - And then for our residents that are here,
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  - you know, it's very expensive to go off
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  - island for appointments. If they have to go
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  - to Boston, for example, the average cost is
• 6:14
  - about $400
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  - So the more that we can provide on
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  - island and learn from each other, you know,
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  - how are you doing this and and what
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  - does it do for your patient population, the
• 6:22
  - better that we can be.
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  - And I think
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  - even in starting this summit, talking to some
• 6:29
  - of the speakers or some of the hospitals
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  - that we work with, we've already solved some
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  - problems that, you know, we would have had
• 6:35
  - to do on our own. And I think
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  - that that's just a great way of making
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  - sure that we're doing the best things possible
• 6:40
  - for our patients.
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  - What were those problems?
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  - A lot of times it's, you know, we
• 6:45
  - have very medically complex patients, for example.
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  - And, you know, it's hard if you are,
• 6:51
  - you know, from an insurance perspective or from
• 6:53
  - just a care perspective, if you're going from
• 6:55
  - one system to another, making sure that your
• 6:57
  - information goes with you, that, you know, your
• 7:00
  - provider that's off island and your provider that's
• 7:02
  - on island are collaborating and talking so that
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  - you have a very seamless transition of care
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  - while you're here.
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  - You know, it's it's those different kinds of
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  - things that really help patients stay as healthy
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  - as they can be and and keep to
• 7:15
  - their treatment plans.
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  - You know, it's travel. All those things are
• 7:18
  - barriers to care. And the more that we
• 7:20
  - can take those barriers out, the better our
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  - patients are going to,
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  - to be.
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  - So far, we've talked a lot from, like,
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  - the patient
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  - perspective.
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  - I I'd like to shift a little bit
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  - to kind of workforce
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  - strategies and just staffing. You're already nodding your
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  - head. You know where I'm going with this.
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  - So, I mean, besides the, you know, nearly
• 7:39
  - 300 hospitals like yours, I mean, every
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  - hospital in The US has to deal with
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  - some kind of seasonal fluctuations, whether, you know,
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  - it's just, you know, natural
• 7:48
  - surges and flu and other infectious,
• 7:51
  - or viral
• 7:53
  - illnesses.
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  - So
• 7:55
  - at Nantucket,
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  - what is the kind of staffing
• 7:59
  - flow and strategy?
• 8:01
  - Yeah. So we will always have seasonal staff,
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  - and we staff up by about 60 people,
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  - which is a big number if you're, you
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  - know, just a very small island.
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  - One of the things that we've learned over
• 8:10
  - time, and again, it's those those relationships that
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  - we've built is that the hospitals that are
• 8:15
  - on opposite schedules of ours. So for example,
• 8:17
  - the mountain resort hospitals that have the winter
• 8:20
  - season and we have the summer season. Right?
• 8:22
  - We actually share some staff. So they're here
• 8:24
  - for six months and they're there for six
• 8:25
  - months. And for those staff that that's the
• 8:28
  - kind of lifestyle they want, it's pretty spectacular.
• 8:31
  - So just building that kind of pipeline rather
• 8:34
  - than having to use locums or whatnot.
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  - And then also learning on how we can
• 8:39
  - best support our seasonal staff so that they
• 8:41
  - come back year after year. So you're not
• 8:43
  - reteaching every single time, but you're really getting
• 8:46
  - a staff that
• 8:47
  - wants to be here during our busy time,
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  - has the knowledge base to understand we are
• 8:51
  - not very resource rich when it comes to,
• 8:54
  - you know, lots of specialties and whatnot. So
• 8:56
  - understanding what it means to take care of
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  - patients on an island or in the mountains
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  - or on the coast or wherever it is,
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  - is really important. And so we've shared education
• 9:05
  - programs. We've talked about, you know, how we
• 9:07
  - can do programs together or how we can
• 9:10
  - do trainings or even sharing policies
• 9:12
  - or education pieces. So that way we have
• 9:15
  - a lot of continuity
• 9:16
  - when it comes to our staffing, and that's
• 9:18
  - important.
• 9:19
  - And it's also a satisfier for the staff.
• 9:21
  - Right? Our retention is pretty high. The one
• 9:24
  - thing the one time we lose the most
• 9:26
  - staff is for housing.
• 9:28
  - The average home price on island is about
• 9:30
  - $4,000,000
• 9:31
  - and that's out of out of range for
• 9:33
  - almost everybody. And so we have to be
• 9:35
  - very, very creative about workforce housing
• 9:38
  - and working with others. We've learned, you know,
• 9:41
  - what are they doing? What are their best
• 9:42
  - practices and how are they empowering their staff?
• 9:44
  - So it's not a one size fits all
• 9:46
  - solution. You know, we have we have our
• 9:48
  - own housing for some, not enough.
• 9:50
  - We have programs in our town that have
• 9:52
  - been built, which are wonderful. Again, not enough.
• 9:55
  - And so we have to figure out what
• 9:57
  - works best for,
• 9:59
  - our, our staff. We have a role that
• 10:01
  - we put in two years ago called housing
• 10:04
  - coordinator
• 10:04
  - and his full time job is to work
• 10:07
  - on housing solutions for our staff. And last
• 10:09
  - year he worked with about 120
• 10:11
  - people. We do a housing survey every year
• 10:14
  - and about 70% of our employees experience some
• 10:16
  - type of housing insecurity
• 10:18
  - because of the, you know, just the cost
• 10:20
  - and,
• 10:21
  - and the fact that short term rentals have
• 10:23
  - impacted the market, all those things. And so
• 10:25
  - having the housing coordinator really
• 10:28
  - provides
• 10:29
  - support and solutions. And we've had staff buying
• 10:32
  - houses through lotteries and, you know, the programs
• 10:34
  - that are available
• 10:36
  - to provide funds.
• 10:37
  - He has really worked hard to work with
• 10:40
  - local homeowners to see how we can provide
• 10:43
  - leases and that type of thing. So it's
• 10:44
  - it's been a really incredible role and it
• 10:46
  - was working with other hospitals and figuring out
• 10:48
  - what worked for them and then bringing that
• 10:50
  - all in together into one role that made
• 10:52
  - it very successful for us.
• 10:55
  - It's just it's so many things that you
• 10:57
  - just said are just kinda crazy
• 10:59
  - to me because I, you know, I I
• 11:01
  - grew up in, like, a small,
• 11:03
  - suburb and Missouri warehouses are not $4,000,000
• 11:06
  - averages. And, also, the you said 70% of
• 11:10
  - staff,
• 11:11
  - said they're kinda housing insecure.
• 11:13
  - So, obviously, the housing coordinator has helped a
• 11:16
  - lot. I believe you said, that role started
• 11:19
  - about two years ago. What do you see
• 11:21
  - as kind of, like, a long term
• 11:23
  - mitigation
• 11:24
  - strategy?
• 11:26
  - Right. So we are right in the middle
• 11:28
  - of a capital campaign to build additional workforce
• 11:31
  - housing.
• 11:31
  - Again, we've asked the community to step up.
• 11:33
  - And it's a it's a almost a $70,000,000
• 11:36
  - project. It's very expensive. And that's to build
• 11:38
  - 45 units of housing and then some clinical
• 11:40
  - space. It's not, you know, these huge massive
• 11:43
  - projects, it's just very expensive to build. So
• 11:46
  - having 45 additional units,
• 11:49
  - then, working with our town for programs like
• 11:52
  - lease to locals and other things that, subsidize
• 11:55
  - housing, You know, there's it has to be
• 11:57
  - a multifaceted
• 11:58
  - approach. And so we have to work with
• 12:00
  - our community resources.
• 12:01
  - And then, you know, some of that solution
• 12:04
  - has to come from us.
• 12:06
  - In our last few minutes,
• 12:08
  - where do you see the greatest,
• 12:10
  - like, opportunity
• 12:12
  - for Nantucket
• 12:13
  - Hospital and, you know, other, like, kind of
• 12:15
  - destination community hospitals?
• 12:18
  - I think the collaborations are so incredibly important
• 12:20
  - because we've learned from each other and we
• 12:22
  - are, you know, building on what has worked
• 12:24
  - for other people rather than
• 12:26
  - reinventing that wheel and failing at times. And
• 12:29
  - not everything will work, but there's quite a
• 12:30
  - few solutions that will. I think one of
• 12:32
  - the things that we're looking forward to in
• 12:34
  - the future is really as we look at
• 12:36
  - workforce development and look at our community to
• 12:39
  - home grow a lot of talent, What programs
• 12:41
  - are working for others and how can we
• 12:43
  - incorporate that in our current practice? In our
• 12:46
  - hospital, even though we're a tiny little 14
• 12:48
  - bed hospital, you know, we have over 200
• 12:50
  - students,
• 12:51
  - throughout the year and we are very proud
• 12:52
  - of that. And the staff work really, really
• 12:55
  - hard and our providers work very hard to
• 12:57
  - make sure that those,
• 12:58
  - those students understand. And that's everything from pharmacy
• 13:02
  - tech and MA
• 13:03
  - to,
• 13:05
  - residents and nurse practitioner students and those types
• 13:08
  - of things. We want to make sure we
• 13:10
  - are an environment that really encourages that. And
• 13:12
  - the community has the chance to learn and
• 13:15
  - grow and advance through,
• 13:18
  - through the hospital too. We are the second
• 13:19
  - largest employer
• 13:21
  - on the island. And so it's incredibly important
• 13:23
  - that we have a workforce that can
• 13:26
  - support the hospital, but then we're also supporting
• 13:29
  - the community.
• 13:30
  - Well, I really, really enjoyed talking with you.
• 13:33
  - Amy, we're right at time, but I just
• 13:36
  - wanna say thank you again for joining us.
• 13:38
  - Thank you. I love talking about my my
• 13:40
  - hospital. I'm very proud of it, and I
• 13:41
  - think, you know, I I look forward to
• 13:44
  - what both the summit is going to to
• 13:46
  - bring to us, but also just what the
• 13:48
  - future looks like.