Latest / The SHEA Podcast / Public Health Conversation: From Hospital to State with ASTHO

Transcript

Public Health Conversation: From Hospital to State with ASTHO · The SHEA Podcast

• 0:11
  SPEAKER_00: Welcome to the We're All In This Together COVID-19 Allies and Infection Prevention podcast series as part of the Society for Healthcare Epidemiology of America's Rapid Response Program.
• 0:22
  SPEAKER_00: I am Dr.
• 0:22
  SPEAKER_00: Gida Sood, hospital epidemiologist at Johns Hopkins Bayview Medical Center and assistant professor at Johns Hopkins University, and I will serve as your Shay moderator and speaker.
• 0:32
  SPEAKER_00: I'm happy to welcome Dr.
• 0:34
  SPEAKER_00: Nirav Shah, Director of the Maine Center for Disease Control and Prevention, who will serve as your association of state and territorial health officials, also known as ASDO, speaker for today's podcast.
• 0:45
  SPEAKER_00: Discussion on the podcast does not reflect Shay's or ASTO's perspective, but provides a forum to facilitate communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:56
  SPEAKER_00: Today's episodes will focus on collaboration between hospital epidemiologists and public health and how we can work together as a team to address the most important questions surrounding COVID-19 outbreak.
• 1:06
  SPEAKER_00: Let's get started with our first question.
• 1:09
  SPEAKER_00: Dr.
• 1:09
  SPEAKER_00: Shah, thank you for joining our podcast and sharing your expertise and experience.
• 1:13
  SPEAKER_00: Can you tell us a little bit about your history landing in public health?
• 1:18
  SPEAKER_00: How did you end up in public health?
• 1:20
  SPEAKER_01: Well, first of all, thank you so much for inviting me and having me join everyone today.
• 1:24
  SPEAKER_01: It's a real pleasure to be able to speak with you and everyone else who's listening.
• 1:30
  SPEAKER_01: My journey into public health was fairly atypical.
• 1:34
  SPEAKER_01: And I think one of the reasons I like public health so much is that virtually everyone's journey into public health is pretty atypical.
• 1:41
  SPEAKER_01: It's emblematic of the field overall.
• 1:44
  SPEAKER_01: In my situation, when I was in medical school many, many years ago, I had the opportunity to take a leave of absence from medical school and move to, of all places, Cambodia and work at the Ministry of Health of Cambodia, working as an epidemiologist and as an economist.
• 2:00
  SPEAKER_01: And that was where I learned a lot of the really critical skills of public health, both things like how to investigate an outbreak and some basic skills around mathematical epidemiology, but also really critical skills for governmental public health, things like how to navigate a budget process, how to evaluate the performance of hospitals.
• 2:20
  SPEAKER_01: Of course, that was Cambodia in the early 2000s.
• 2:24
  SPEAKER_01: But what's been striking is how much a lot of the skills that I learned now 20 years ago apply with equal force nowadays to contemporary US politics, as well as as we're dealing with COVID.
• 2:36
  SPEAKER_01: After I got back from Cambodia, I finished up medical school, happened to go to graduate school and other disciplines as well, worked in the private sector for many, many years.
• 2:45
  SPEAKER_01: And in late 2014, early 2015, at that point, the governor-elect of Illinois reached out to me and asked if I would be willing to leave my position in the private sector and serve as the director of Illinois' Department of Public Health, which I did for just over four years.
• 3:01
  SPEAKER_01: After he lost his re-election bid, I loved the job so much that I was interested in doing the same thing in another state.
• 3:09
  SPEAKER_01: Maine happened to be looking for somebody, and my family and I had always wanted to move somewhere where the outdoors were a big focus.
• 3:16
  SPEAKER_01: And so here I am now in Maine.
• 3:18
  SPEAKER_00: That's fascinating.
• 3:19
  SPEAKER_00: And it certainly sounds like skills beyond just simple medical skills and infectious disease skills are required for this job.
• 3:27
  SPEAKER_00: Can you tell us a little bit more about the kinds of skills people generally bring to these kinds of positions and what kinds of skills would make them successful?
• 3:36
  SPEAKER_01: That's a great question.
• 3:37
  SPEAKER_01: So, on one hand, the skill set you need to be really successful, at least in governmental public health, is vast.
• 3:45
  SPEAKER_01: I like to say, and I it's a joke, but it's really true, to really be successful in at least governmental public health, you need to have mastery of about two to three hundred skill sets.
• 3:57
  SPEAKER_01: On any given day, I think I've got my head around maybe four of them.
• 4:01
  SPEAKER_01: And so it's such a vast area that there's not one hallmark set of trades or skills you need to have.
• 4:08
  SPEAKER_01: But I think some of the basics apply across all sectors.
• 4:11
  SPEAKER_01: The first is a really good grounding in just quantitative analysis.
• 4:15
  SPEAKER_01: How good are you with manipulating data, understanding what data are telling you, and making sure that you understand what the implications are, the signal from the noise.
• 4:24
  SPEAKER_01: Another really critical skill set, at least in governmental public health, is the ability to navigate what is nowadays a very charged political atmosphere.
• 4:34
  SPEAKER_01: And being able to do so while understanding the needs and demands of stakeholders, very, very critical.
• 4:40
  SPEAKER_01: The third piece, at least as to governmental public health, that should not be overlooked, is the role of being a public communicator.
• 4:47
  SPEAKER_01: Many of my colleagues and I across the other states and territories are for their people and their states the voice and the face of a lot of COVID-19.
• 4:57
  SPEAKER_01: Being able to communicate with the public concisely, accurately, and clearly is a really essential skill.
• 5:04
  SPEAKER_00: Well said.
• 5:05
  SPEAKER_00: Can you tell us a little bit about what you specifically love about your job?
• 5:10
  SPEAKER_01: Well, there's a couple things, and I hope you can hear the enthusiasm in my voice when I talk about the work I do because I really truly love it.
• 5:18
  SPEAKER_01: And I want to be really honest with everybody about this.
• 5:21
  SPEAKER_01: There are up days and down days, but my worst days as a state health official are still preferable to me than my best days working in the private sector.
• 5:31
  SPEAKER_01: The things that I really love about it are a fewfold.
• 5:34
  SPEAKER_01: The first is the ability to affect immediate change on a population level.
• 5:40
  SPEAKER_01: When I was in medical school, for every patient who came in to the clinic, I was always the person saying, but what about those 500 other people out there who never even find their way to the clinic?
• 5:51
  SPEAKER_01: What are we doing to help them?
• 5:53
  SPEAKER_01: And so for me, population health, public health in this respect has the ability to affect the lives of so many more people.
• 6:01
  SPEAKER_01: That's one thing I like about it.
• 6:02
  SPEAKER_01: The other, though, is that it allows me to tap into a number of other disciplines and integrate and synthesize all of that information, whether it's about regulation, whether it's about navigating and negotiating with stakeholders, all of those disparate skill sets, it allows me to tap into all of them, weave them together, and actually make policy change.
• 6:27
  SPEAKER_01: For me, one of the most satisfying things about being a state health official is to take a crazy idea and then work that idea through the legislature with stakeholders, through the budgeting process, and actually make it come true.
• 6:42
  SPEAKER_01: For me, that's really one of the biggest payoffs of the job because that means that we've helped hundreds of thousands of people at one time.
• 6:50
  SPEAKER_00: Well, we can definitely hear the enthusiasm in your voice, and thank you for sharing some of the things that are really exciting and impactful about your job.
• 6:58
  SPEAKER_00: Can you tell us a little bit about some of the challenges that you face?
• 7:02
  SPEAKER_01: Well, in governmental public health, as in many fields, funding is a perennial challenge.
• 7:08
  SPEAKER_01: One wonders whether the recent experience with COVID-19 will change the funding landscape, at least as to state and local and municipal health departments.
• 7:18
  SPEAKER_01: For years, decades now, we've chronically underinvested in state and governmental public health.
• 7:24
  SPEAKER_01: And I think we see what some of the consequences of that underinvestment are.
• 7:27
  SPEAKER_01: But on top of those evergreen funding issues, one of the challenges right now that is top of mind, I think for everybody, is the role of good scientific literacy across the population in helping us do our jobs better.
• 7:44
  SPEAKER_01: A really essential piece of controlling a pandemic is making sure that we've got buy-in from the people that we're serving, our clients, our friends, our neighbors.
• 7:54
  SPEAKER_01: And that buy-in is impossible to have unless scientific literacy is at a threshold where the things that we talk about are resonating with folks.
• 8:03
  SPEAKER_01: So whether it's talking about face coverings, physical distancing, the importance of preventive health, the importance of getting your flu shot, all of those messages rely on a baseline level of scientific understanding.
• 8:17
  SPEAKER_01: And as the discussions get more nuanced and as science becomes something that is more debated, we have to wonder whether the role of scientific literacy or the lack of it might hamstring our efforts going forward.
• 8:30
  SPEAKER_00: Related to that, we've always wondered in the hospital epidemiology world, how does politics play into your role and your job, both with the public and just in your job itself?
• 8:43
  SPEAKER_01: Well, you know, politics matters.
• 8:45
  SPEAKER_01: Politics is the mechanism through which we as a country have decided to make collective decisions and get things done.
• 8:53
  SPEAKER_01: Indeed, that's one usable definition of politics is the means of collective decision making.
• 8:59
  SPEAKER_01: But when it comes to the intersection of politics with what is inherently a scientific endeavor, public health, disease control, things get interesting.
• 9:09
  SPEAKER_01: Fundamentally, the science tells us what should be done in a situation.
• 9:15
  SPEAKER_01: But politics helps us understand and decide the prioritization of those tasks.
• 9:22
  SPEAKER_01: So science helps us understand what we need to do, but the political process helps us understand in what order or with what priority or with what fervor we might approach getting them done.
• 9:33
  SPEAKER_01: I don't think you can go into a position like this, running a state health department, without appreciating the political nature of the position and the nuances that politics will introduce.
• 9:45
  SPEAKER_01: Every stakeholder group has a different set of prioritizations.
• 9:48
  SPEAKER_01: And of course, it's up to elected officials, not appointed officials like me, but elected officials to help navigate and prioritize those things.
• 9:57
  SPEAKER_00: That was so well articulated.
• 10:00
  SPEAKER_00: Can you talk a little bit more about the stakeholders?
• 10:03
  SPEAKER_00: Who are the stakeholders and how do you go about engaging your stakeholders?
• 10:07
  SPEAKER_01: Well, you know, that's a great question because as I mentioned a moment ago, one of the defining elements of working at a state health department, running a state health department, is making sure that all the stakeholder voices are heard.
• 10:20
  SPEAKER_01: In this situation, especially right now in a pandemic, the list of stakeholders that we engage with is as long as one you can imagine.
• 10:29
  SPEAKER_01: So right now, one of our principal stakeholders are the public writ large.
• 10:34
  SPEAKER_01: I try to make sure that I'm communicating with the public and getting their sense of whether we're on the right track or the wrong track through so many different mechanisms, press conferences several times a week, social media, interviews with local and national media, podcasts of this nature to share with them what we're doing and then making sure that we're on the same page.
• 10:53
  SPEAKER_01: So the public in and of themselves are a major set of stakeholders.
• 10:57
  SPEAKER_01: But given that this is a pandemic, there's many others.
• 11:00
  SPEAKER_01: So healthcare providers writ large are a major source of stakeholders for us.
• 11:05
  SPEAKER_01: Physicians, hospital management, long-term care facility owners, those are all folks that we have to work with, not against, in order to get our goals in place.
• 11:15
  SPEAKER_01: But there are other stakeholders across the spectrum.
• 11:18
  SPEAKER_01: So other elected leaders are individuals that we have to check in with to make sure we're on the same page with, to say nothing of my colleagues across state government.
• 11:28
  SPEAKER_01: If I make a rule that flies in the face of what the Department of Environmental Protection wants to do, then well, that's going to be an issue.
• 11:35
  SPEAKER_01: So we've got to navigate those things beforehand.
• 11:38
  SPEAKER_01: In a pandemic, the list of stakeholders grows tenfold.
• 11:43
  SPEAKER_00: Can you talk a little bit about hospitals specifically?
• 11:46
  SPEAKER_00: How do you engage hospitals and how do you see the role of hospitals and hospital epidemiologists in your world?
• 11:52
  SPEAKER_01: Well, hospitals are critical partners of ours, especially right now given the pandemic.
• 11:59
  SPEAKER_01: The bottom line is that hospitals right now are where all the action is happening.
• 12:05
  SPEAKER_01: So they are extremely, extremely important for us as a state in getting to where we want to go.
• 12:12
  SPEAKER_01: Early on in the COVID-19 pandemic, very, very early on, even before Maine had its first case, we had already reached out to two core groups within hospitals, the healthcare staff themselves, and then separately but relatedly, the management of the hospitals to make sure that we were all on the same page.
• 12:32
  SPEAKER_01: We knew that whether it was from a healthcare infection standpoint or from a reimbursement standpoint, being on the same page with hospitals was going to be critical.
• 12:42
  SPEAKER_01: An added element to that, I think in many states and certainly in Maine, is the distinction between large tertiary care urban hospitals and small primary or secondary care rural hospitals.
• 12:56
  SPEAKER_01: The needs of those hospitals are completely different.
• 12:59
  SPEAKER_01: For the most part, large academically affiliated tertiary care centers like the one where you're at, they pretty much had their house in order and didn't need a lot of assistance from the state.
• 13:10
  SPEAKER_01: So for us, it was more working with them to make sure we were sharing data, that we had a robust referral system in place for hospitals, other hospitals that needed to send patients, et cetera.
• 13:21
  SPEAKER_01: But for smaller hospitals, especially those in rural areas, the system was different.
• 13:26
  SPEAKER_01: For us, with working with them, it was making sure that they had all the resources and technical assistance on day one.
• 13:34
  SPEAKER_01: And so it was a different relationship, but just as critical of one to get right from the outset rather than trying to fix the plane while it was already in the air.
• 13:43
  SPEAKER_00: That makes a lot of sense.
• 13:45
  SPEAKER_00: Can you give us some examples of how public health has specifically provided support or healthy hospitals and the community?
• 13:54
  SPEAKER_01: I can talk about that on two different fronts.
• 13:56
  SPEAKER_01: The first is just very tactical.
• 13:59
  SPEAKER_01: On a very tactical level, one of the things that we've been working with hospitals very early on are things like supplies, materials, and PPE.
• 14:07
  SPEAKER_01: So again, even before the first case in Maine was detected, we were checking in with hospitals to get a sense of their PPE supplies and make sure that we were furnishing them what they felt that they needed to be at a gold standard to protect their own staff.
• 14:22
  SPEAKER_01: So that's something very tactical that we did from very early on in the epidemic.
• 14:27
  SPEAKER_01: But on a more strategic level, one of the ways that we have worked with hospitals is in a sense to view them as extensions of the public health department, to be local thought leaders and population health anchors within their own communities.
• 14:44
  SPEAKER_01: So we've involved them very early on from a strategic perspective to say, okay, within your community, within your casement area, what can we, the health department, and you, the hospital, do collectively to get a handle on COVID-19?
• 15:00
  SPEAKER_01: In some cases, that has entailed setting up testing sites in their parking lots.
• 15:04
  SPEAKER_01: In other cases, it's involved to having the hospital be the front for a lot of educational activities within the community and now with schools.
• 15:13
  SPEAKER_01: So those are those are on a strategic level where we've tapped into the expertise and the local relationships that hospitals have to be the public health thought leader in the community and make sure that we're aligned with them.
• 15:26
  SPEAKER_01: So our work with hospitals is both very tactical and as well as very strategic.
• 15:31
  SPEAKER_00: I can add from our perspective, the public health department in Maryland has been incredibly helpful in providing support for us as well as you have in Maine.
• 15:41
  SPEAKER_00: And we are very grateful for all the support that Maryland has provided.
• 15:47
  SPEAKER_00: From a hospital epidemiology point of view, to us, the disease comes from the community.
• 15:52
  SPEAKER_00: So all of your efforts and interventions related to population health helps us inform and mitigate those disease transmissions so that we don't see as much of it in the hospital.
• 16:04
  SPEAKER_00: For us in Maryland, the policies, of course, have been really beneficial from the governmental public health agencies.
• 16:12
  SPEAKER_00: Also, public health has offered opportunities to provide additional testing more than hospital capacity can manage, as well as resources like housing for patients and for community members that may not be able to isolate properly in underserved areas, as well as the robust data that the health department has provided, both in terms of testing results, but also in terms of the ICU capacity across multiple hospitals and, like you had mentioned, PPE and other supplies across the entire state that we wouldn't have access to.
• 16:48
  SPEAKER_00: From a hospital epidemiologist's point of view, we are very grateful for the support and guidance that you have been providing throughout this pandemic.
• 16:55
  SPEAKER_00: Can you share some of the resources that are available to other hospital epidemiologists beyond just our state health departments?
• 17:02
  SPEAKER_01: Sure.
• 17:03
  SPEAKER_01: You mentioned the first one I was going to recommend, which was your own state's health department.
• 17:07
  SPEAKER_01: If you're a hospital epidemiologist or affiliated in healthcare in any way in healthcare epidemiology, and you do not yet have a relationship with your state health department, I would urge you to forge one.
• 17:18
  SPEAKER_01: Whether it's on the HAI front, on the infectious disease epi front, chronic disease epidemiology, I would urge you to forge some sort of relationship with your state health department.
• 17:28
  SPEAKER_01: They can be a vital resource in terms of so many things that might be going on.
• 17:33
  SPEAKER_01: Another area that I would ask everyone to take a look at is the website for ASTO.
• 17:38
  SPEAKER_01: As Dr.
• 17:39
  SPEAKER_01: Sood mentioned, ASTO is the Association of State and Territorial Health Officers, the professional society for folks like me.
• 17:46
  SPEAKER_01: And our website has a wealth of resources on things like reports around COVID-19, best practices therein, HAI work, a lot of those issues that are front and center from an infectious disease, a healthcare epi perspective, are on the website.
• 18:02
  SPEAKER_01: The other area that I would recommend is to check out groups that are very active in this area.
• 18:08
  SPEAKER_01: The one that pops into mind immediately for me is Cora.
• 18:12
  SPEAKER_01: CORA is the Council for Outbreak Response for Healthcare Associated Infections and Antimicrobial Resistant Pathogens, C-O-R-H-A.
• 18:21
  SPEAKER_01: This is an organization, a group that works to strengthen partnerships, communication, as well as coordination between and among public health and healthcare to respond to HAI, antimicrobial resistance matters, as well as now, of course, things related to COVID.
• 18:38
  SPEAKER_01: Cora does this by bringing together groups of partners to improve practice, as well as policies that help really focus in on detection and investigation and control of things like HAI outbreaks.
• 18:51
  SPEAKER_01: I would really recommend taking a look at their website.
• 18:54
  SPEAKER_01: There is a wealth of information there.
• 18:57
  SPEAKER_00: Thank you.
• 18:57
  SPEAKER_00: These sound like terrific resources to help us in our collective response to the global pandemic.
• 19:03
  SPEAKER_00: Thank you so much for making time to speak with us today and for sharing your perspectives and experience.
• 19:08
  SPEAKER_00: This podcast can be accessed on SHA's online education center, Learning CE, under the Rapid Response Program.
• 19:16
  SPEAKER_00: You will find additional resources such as the recorded webinars, Healthcare Facility Outbreak Preparedness and SHA COVID-19 Town Halls, and the additional podcast series, COVID-19 update, What Do We Know?
• 19:27
  SPEAKER_00: which is released every Thursday.
• 19:29
  SPEAKER_00: SHAY has also been sending out weekly newsletters with the most up-to-date and relevant information to its membership and has been hosting online forums in addition to the spectacular town halls where anyone can ask questions as we learn together in this pandemic.
• 19:43
  SPEAKER_00: On a personal note, I've been very grateful for the support and leadership Shea has provided during this pandemic.
• 19:48
  SPEAKER_00: This concludes today's episode of Allies and Infection Prevention Podcast Series.
• 19:53
  SPEAKER_00: Thank you for tuning in.