Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Lewis Marshall, Chief Medical Officer at NYC Health + Hospitals/Lincoln Hospital

Transcript

Dr. Lewis Marshall, Chief Medical Officer at NYC Health + Hospitals/Lincoln Hospital · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. Lewis Marshall,
• 0:06
  chief Medical Officer at NYC Health Plus
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  Hospital's Lincoln Hospital.
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  Dr. Marshall, it's a pleasure
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  to have you on the podcast today.
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  - Thank you. Happy to be here.
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  - Now, I know we've got a lot to talk about,
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  and I'm really looking forward to learning more about
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  what you're doing at Lincoln Hospital
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  and how you're thinking about the future.
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  But before we dive into my broader questions,
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  can you tell us a little bit more
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  about yourself and your background?
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  - Um, sure. So, um, uh, I'm a physician attorney,
• 0:34
  which means that everybody hates me, but that's okay.
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  Uh, I came here to, again, at, um, at the height
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  of the pandemic in 2020
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  as the Chief Medical Officer.
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  Uh, prior to this I was at NYU in a different role,
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  but I wanted to get back into healthcare in an
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  underserved community.
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  So Lincoln Hospital is a 360 bed, uh,
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  level one trauma center with, uh, probably the third
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  or fourth busiest emergency department in the country with,
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  uh, over 140,000 visits a year.
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  We also have ambulatory care visits over 400,000 annually.
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  Uh, and some of the services that we offer to this community
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  are, um, trauma services, medical services.
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  Uh, we have pediatric services.
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  We have a level three, uh, neonatal ICU as well
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  as a pediatric ICU and, and other support services.
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  Um, we also recently included robotic surgery,
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  uh, in our lineup.
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  And so that's been great for this community.
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  The community that we serve is really an
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  underserved community.
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  We are in the South Bronx,
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  and the Bronx is pro is one of the forest health
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  counties in New York State.
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  Uh, so we have a lot of challenges, uh, with our population.
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  We also have a very mixed population in terms of, you know,
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  where people are from.
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  About 60% of our patients are Hispanic
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  and speak Spanish at home is the primary language.
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  Uh, one of the, um, issues that's come up recently with the,
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  uh, immigration is
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  that our third most common language is now an African
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  language called Wolof, uh, which I had not heard of.
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  Um, and so now we have translation in moola
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  'cause of the increased number of immigrants from,
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  from the African diaspora.
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  And so the other major
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  population we serve in this area is patients
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  with substance use disorder.
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  We have a very large population
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  of patients in the South Bronx that are using substances,
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  and it has affected their health.
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  So we have lots of programs, uh, in that area as well.
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  And that's a quick snapshot of,
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  of Lincoln in the South Bronx.
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  - Wow, that's amazing to hear.
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  And certainly helpful to understand
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  that pa patient population that you're serving
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  and how I can imagine it's always
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  evolving in the South Bronx.
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  And so thank you for that background.
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  Now, what are some of the biggest issues
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  that you're following in healthcare right now?
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  - Well, I think for, uh, Lincoln
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  and for me, uh, one of the biggest things we're
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  that I'm following is, is the advancement
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  and the rapid deployment of
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  artificial intelligence in healthcare, right?
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  So we've seen it in the past.
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  It's been around for a while in terms of looking at
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  high repetition and low risk use cases, uh,
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  information gathering, post-treatment monitoring,
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  and now population health,
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  but also looking at the use of AI intelligently
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  and ethically, right?
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  Uh, I think that anybody in the same position that
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  as I am in, you know, is being bombarded with, you know,
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  startups that have new AI that, you know, they want
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  to implement and deploy in the healthcare sector.
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  And so we just have to be cognizant of
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  what this AI can
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  and cannot do if there are any risk factors.
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  Um, you know, is there any trust issues?
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  I think that, you know, making sure that patients understand
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  that we're using AI as well is another issue that
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  I'm following, uh, today.
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  I think that, uh, making sure that we're transparent and,
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  and sharing our information as as appropriate.
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  Uh, one of the other things, uh, with AI that we're doing
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  as a system, and I'm pretty sure other health systems are
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  doing the same thing, is that we've implemented a
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  artificial intelligence council,
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  and this council is made up of providers and administrators
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  and technical people from across the system.
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  And what we're, what we're doing is we're looking at ai,
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  and I'll give you a specific example in a minute.
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  We're looking at AI
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  and making sure that we can, one, understand
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  what it does and doesn't do.
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  We can use it intelligently
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  and we can integrate it into our we health system.
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  We can learn from it as well.
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  Um, so for a specific example, uh,
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  and this is related to another issue
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  that I'm following also here at Lincoln is,
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  is provider burnout.
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  And I think that's a national issue
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  that we've all been talking about,
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  but, uh, one of the AI tools is, um,
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  ambient dictation in the exam room.
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  So where they have the ability to have AI
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  listen, if you will, to the conversation
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  between the provider and the patient in the exam room,
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  and actually create the note for the provider.
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  And at the end of the exam, the provider can just go in
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  and review the note, correct any errors, and then sign it.
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  And that will really help, uh,
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  providers reduce the burden of some of their documentation
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  and the time that they spend outside
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  of taking care of patients.
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  Documenting. Uh, we have, um, uh, a big issue
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  with, um, providers spending lots
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  of their own time in completing documentation.
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  And that kind of goes to my second issue, which is
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  that I'm following is, is provider burnout.
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  Um, you know, as we ask more and more of our providers
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  and we need to provide them with the resources to make their
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  their lives better,
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  and one of the things with, um,
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  that I look at in my institution is, is
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  what we call pajama time, right?
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  It's how much, how much of
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  that at home time do my providers spend
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  documenting in the medical record?
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  Is that something that is affecting their life outside?
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  Is it adding to their burnout?
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  And that's where I think some, something like the program
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  that I just talked about in terms of ambient dictation, uh,
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  would help providers in reducing some of the burdens
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  that we have in terms of documentation.
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  Uh, so I'm really excited about that
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  and I think that that's, um, something
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  that's gonna develop very rapidly, uh, over the next, uh,
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  couple of years as more and more AI is being used
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  and implemented in the healthcare setting.
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  Um, and provider burnout is something
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  that we're all working on.
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  Uh, we implemented a program here, uh,
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  called Helping Healers Heal, or H three.
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  And what that is, is we have peer,
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  I don't wanna say peer counselors,
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  but peers that people can go to
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  and talk to when they have an issue.
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  And if they have a, an issue where the peer thinks they need
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  to speak to somebody in a more official capacity,
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  then we put in, uh, roads and,
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  and ways that they can do that without feeling
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  that somebody's watching them or it's a bad thing
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  because they're having a mental issue or stress.
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  Uh, so the a three program has been very beneficial
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  in helping our providers, not, not just, you know,
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  helping all of our staff really, um, that are having,
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  uh, stress issues.
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  Uh, so that's something else that,
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  that we've implemented here over the years,
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  and I think that that's working out very well.
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  - That's amazing to hear. And you know, I,
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  I love those specific examples of the different, um, kind
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  of committees
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  or groups you put together in order to, um,
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  dive into these different issues,
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  whether it's the AI council
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  or, you know, focused in on provider burnout and stress.
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  Um, when you look at those two areas in particular
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  where you're zeroing in, how do you develop, um, you know,
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  those councils, uh, who is, I guess, leading them and,
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  and what do they really, um, do in order to,
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  to have an effective impact on the organization as a whole?
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  - Yeah. So, um, for, for the, uh,
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  artificial intelligence council, it's really led
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  by our system, uh, CMIO and CIO,
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  and they brought together this group of, uh, technicians
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  or people in the tech field within our organization as well
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  as, uh, clinical providers like myself, uh,
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  in leadership roles and also frontline clinical providers.
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  So that what we do is we actually look at,
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  uh, a product, right?
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  An AI product. We look at its function, we demo it,
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  we figure out where it might work within our system,
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  and if it's something that can be deployed, uh,
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  across the system, uh,
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  and we usually will pilot it at one of our facilities.
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  So the backup health
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  and hospitals in New York City has
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  11 acute care hospitals.
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  Um, so it's huge health system as well
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  as we have a huge ambulatory network as well.
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  Uh, so we wanna make sure that, you know, we
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  pilot these programs before we implement them system wide,
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  and we also look at six of, of the AI
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  and making sure that we're using it in an ethical manner.
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  And that, you know, one of the things that we're
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  everybody's talking about now is health equity.
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  And so we want to make sure that the AI is not adding to
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  or worsening our equity efforts, right?
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  Uh, 'cause a lot of current data may not be based upon the
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  broad population of patients that we see,
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  and some of the results of the AI might not pertain
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  to a particular group.
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  So that's something that we also look at,
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  which I think is really important
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  as we look at health equity issues across our system and,
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  and across the health system in general at large.
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  It's a challenge, but I, I think that looking at that
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  as well as, you know, at what point do we need
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  to inform patients that we're using ai?
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  Do we share the data with, uh, systems outside of our own,
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  uh, and how do we do that?
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  You know, making sure that we're compliant
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  with rules and regulations.
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  - That's so helpful to know and understand.
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  Thank you for, um, talking us through that a bit more now.
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  When you look ahead, what are you most excited
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  about and what makes you nervous?
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  - So I think I'm really excited about, you know,
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  where, where AI is going to take us in terms of
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  if we use it, you know, the right way.
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  And, you know, even the, even the Vatican has a,
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  an ethical advisor
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  to the Pope who's looking at AI for the Vatican.
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  So, you know, if they're doing it, we also need to make sure
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  that we're using it ethically.
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  And I think the use of ai, I think it's gonna be tremendous
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  for our patients, right?
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  So whether it's, um, home health monitoring,
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  monitoring blood pressure from, you know,
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  the patient's home, using some of the technology
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  that's available to help us get that information
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  and then allowing AI to help us interpret it,
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  I think is going to be very exciting.
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  Uh, one of the, uh, items that I saw recently
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  was this thing called a smart mirror.
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  And the smart mirror would, could be in your bathroom
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  and, you know, while you're getting ready in the morning, it
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  uses infrared lights
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  and some other high technology that I can't explain,
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  and it can check your pulse, your blood pressure,
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  your body temperature,
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  and send all that information to the doctor like right away.
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  Uh, so things like that I think are,
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  are, are gonna be great.
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  We are as a system looking into, uh, implementing
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  and modeling, uh, the home blood pressure
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  and weight monitoring for a particular cohort of patients.
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  Like, say those with congestive heart failure, who you want
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  to make sure to measure their weight
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  and keep their weight in the right place
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  and make sure their blood pressure's under control.
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  So these are really things that will help connect us
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  providers to the patients more often, right?
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  And not just wait on, you know, the annual visit
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  or the sick visit, but really allow us much more time
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  and helping the patient manage their,
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  their chronic conditions
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  and work through, you know, their diet.
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  Um, I think those are some of the things
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  that I'm excited about.
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  Another thing I'm really excited about
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  is we have started a new program called Lifestyle Medicine.
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  And what this is, is this a program
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  that involves physician providers, nutritionists,
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  dieticians, and we really work with patients to
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  change their diet, uh, as, as use their diet as medication.
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  So that's very exciting.
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  That just kicked off like last month.
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  Um, and we already have patients with, you know,
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  like diabetes that are really excited about this, uh,
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  prospect in terms of, you know, using food
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  and diet as medication to help,
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  help control their chronic medical condition.
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  So it's really exciting. I wanna sign up myself.
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  - It sounds like a, such a, a really great opportunity
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  and a really cool service you're able
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  to offer the community, um,
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  and something unique too, um,
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  that you've kind of are, are diving into.
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  So, um, that's really interesting to hear about.
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  Is there, um, anything that makes you a little bit nervous?
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  - Yeah, so what makes me nervous is the potential AI
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  makes me nervous as well.
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  It makes me nervous 'cause I, I think that there's,
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  you know, there's a lot of potential risks involved
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  and not only risks to the patient,
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  but also, you know, what's the liability that a physician
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  or a provider has who uses
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  and relies on AI to help make a diagnosis
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  and that diagnosis is wrong, right?
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  Uh, so I think that that that has a potential
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  to make me very nervous.
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  Also, you know, we have to be able to trust the ai
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  and I think that's just gonna take some time, uh,
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  which is why I think our, our AI council is really going
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  to help us in, in that arena.
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  Uh, other things that make me nervous now in this
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  environment is, uh, is
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  is provider burnout, which I mentioned.
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  I think that, you know, um, you know, how do we recruit
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  and retain good providers?
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  How do we keep them from feeling
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  that they're overworked all the time?
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  Uh, and overstressed.
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  And, you know, one of the challenges
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  that we have in a public health system
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  and whether it's New York
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  or anywhere else, is really, you know, how can we recruit,
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  you know, specialists
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  and, you know, what can we offer them, you know, um,
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  especially young, young doctors coming out that, you know,
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  are spending or thinking more about their lifestyle than
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  necessarily, uh,
• 16:55
  providers from the past had had done right.
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  Making sure that they have work life,
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  well work life balance,
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  but I think it's really, uh, mean work life synergy, right?
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  It's like how do we balance our work life
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  and our regular life so that we're, we're content,
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  we're happy, we do a good job, you know?
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  And I think burnout can affect all of that,
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  uh, in the future.
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  So helping healers heal is one program,
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  and I'm sure that there are others, you know,
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  that do the same thing, uh, in providing, um,
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  aid to providers or,
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  or workers in healthcare that may need assistance.
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  We also had another program that we created here.
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  Uh, we, it's probably from somewhere else,
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  but it's called, uh, we have a Battle Buddy program.
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  And so what that is, is that senior leaders
• 17:53
  are get, um, a battle buddy,
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  so somebody from the front lines, um, who has challenges,
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  and then battle buddy.
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  We help them talk through issues.
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  And so my battle buddy is the, their surgery here,
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  uh, who runs a very busy trauma center as well
• 18:12
  as all the surgical subspecialties.
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  So, uh, I'm her battle buddy.
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  Uh, so that, that works out very well as well in,
• 18:20
  in addressing some of the issues that I'm concerned about
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  and make me nervous.
• 18:25
  - Absolutely. That sounds like a really cool solution.
• 18:28
  Um, you know, especially, um, just the battle buddy concept
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  and being able to pair the senior leadership
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  with somebody on the front lines
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  or who really is, uh, in the thick of things day in
• 18:38
  and day out to understand those challenges and issues
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  and really work through them together.
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  Um, I just think that's really cool
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  and your idea along work life synergy as well, um, can be
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  so, uh, informative
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  and instructive for people really,
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  no matter their profession.
• 18:54
  - Yep. - Agreed. So, absolutely.
• 18:57
  So before we wrap up here, I'm wondering
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  what will the most effective healthcare leaders need in
• 19:02
  order to be successful over the next
• 19:03
  two to three years or so?
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  Especially thinking through how much healthcare is changing
• 19:07
  and we'll continue to do so.
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  - I think there are a couple of things
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  that healthcare leaders will need.
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  Um, one is we need to show
• 19:16
  that we care about our staff, right?
• 19:18
  We can't be sitting in the office.
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  We have to get out there with the, with our staff
• 19:23
  and communicate with them.
• 19:25
  Uh, we will need a tremendous amount of patients, uh, to do
• 19:30
  that as we, you know, we talk about meeting the patient
• 19:34
  where they are in healthcare.
• 19:36
  We also need to meet our staff where they are, right?
• 19:39
  You know, are there ways that we can create, um,
• 19:44
  work environments
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  or work schedules that allow people, you know,
• 19:48
  to have appropriate time away and and disconnect?
• 19:53
  I think one of the, there was an article I read, uh,
• 19:56
  not too long ago that said when we were going
• 19:59
  to remote work, uh, just offering
• 20:03
  employees the opportunity
• 20:04
  to do remote work made them feel better.
• 20:07
  Uh, so we're gonna have to come up with ways to
• 20:11
  meet our workforce where they are
• 20:13
  and still be able to get the, the job done.
• 20:16
  Um, to trust honesty and integrity I think are gonna be key.
• 20:21
  If you don't trust your leader, uh,
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  or if they don't have integrity, um,
• 20:27
  then you're not gonna be able to lead.
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  Uh, um, also leaders, you know, we,
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  we can't hold grudges.
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  It's not personal, you know, it's not about the leader,
• 20:38
  it's about patient, it's about the system, uh,
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  and we just have to really understand that.
• 20:45
  Um, I think the other thing we need to
• 20:49
  look at is how are we gonna recruit, you know,
• 20:53
  over the next, let's say three to five years
• 20:56
  anticipating the needs of the community
• 20:59
  and making sure that we can recruit providers, um,
• 21:03
  that we need to provide that care.
• 21:05
  And I think as a leader, we need to think about that
• 21:08
  because as, as the healthcare workforce ages
• 21:13
  and people start to retire, uh, especially
• 21:16
  after Covid, um, you know,
• 21:18
  it gets very challenging sometimes to,
• 21:20
  to find the right people
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  or any people for that matter, uh,
• 21:26
  that can come in and, and do the job.
• 21:28
  And I, I think the last thing, uh, is that, you know,
• 21:32
  as healthcare leaders, we need to walk the talk
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  as they say, right?
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  Um, we need to be out there
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  and show people that we're authentic
• 21:41
  and that we, uh, listen, I tell my, my staff,
• 21:46
  I said, uh, you know, I may not be able
• 21:49
  to solve your problem, but I'm a really good listener
• 21:53
  and I can listen to you, so let's talk.
• 21:56
  And so I think we're gonna need to be able to do that
• 21:59
  as well as we move forward over the next two to three,
• 22:03
  five years, uh, as healthcare leaders.
• 22:06
  Um, the other thing we need to do,
• 22:07
  and the last thing I'll mention is we really need to
• 22:10
  develop our healthcare leader bench, right?
• 22:13
  So I'm not gonna be in this role forever, so I need
• 22:16
  to have somebody who's gonna step up.
• 22:18
  Um, and so how do we make sure that those people
• 22:23
  who are gonna step up into our positions have the right
• 22:27
  core competencies that we need them to have, whether it's,
• 22:32
  you know, communication skills, financial skills, um, how
• 22:37
  to run a hospital, even I think that these are some
• 22:39
  of the things that, that as healthcare leaders, we need
• 22:42
  to make sure that we're doing to bring up the next group of,
• 22:45
  of leaders that are coming up behind this.
• 22:48
  - Absolutely. I think that makes a lot of sense.
• 22:50
  And, you know, really appreciate you walking us
• 22:52
  through all those different areas.
• 22:54
  Um, just in terms of making sure
• 22:56
  that you are meeting the staff where you are,
• 22:58
  you can figure out what it takes in order for them
• 23:00
  to feel comfortable and be able to do their jobs well.
• 23:03
  And, and then leaning into, um, you know,
• 23:05
  that listening side of things and,
• 23:07
  and, um, continuing to build out that leadership bench.
• 23:10
  Um, definitely crucial all the way across the board.
• 23:12
  So thank you so much Dr. Marshall
• 23:14
  for joining us on the podcast today.
• 23:16
  This has been such a fascinating discussion
• 23:18
  and I look forward to connecting with you again soon.
• 23:21
  - Oh, thank you very much. It's been a wonderful time
• 23:23
  and, uh, look forward to doing it again someday.