Latest / Becker’s Healthcare Podcast / Brooke A. Schweitzer, DMSc, MSPA, PA-C, FACHE, Chief Advanced Practice Officer at UChicago Medicine

Transcript

Brooke A. Schweitzer, DMSc, MSPA, PA-C, FACHE, Chief Advanced Practice Officer at UChicago Medicine · Becker’s Healthcare Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where do they go
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  - to pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - Welcome to the Becker's Clinical Leadership podcast. I'm
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  - Mariah Taylor, assistant editor, and I'm thrilled to
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  - be speaking with Brooke Schweitzer,
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  - chief advanced practice officer at UChicago Medicine. Thank
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  - you so much for joining me today. I'm
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  - really excited to learn more about your work
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  - to become the gold standard for APPs.
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  - But before we dive into that, I'd love
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  - for you to introduce yourself and tell us
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  - a little bit about your background.
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  - Thank you. I'm Brooke Switzer. I'm proud to
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  - be in this inaugural position of the chief
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  - advanced practice officer here at UChicago Medicine,
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  - leading the strategy and structure of how to
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  - support our advanced practice providers.
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  - I'm a clinical PA by background and feel
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  - that my forte is really at the intersection
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  - of that knowledge from my work as a
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  - clinical PA and then merging that with kind
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  - of the language of medicine and the business
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  - side that,
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  - is important for hospital systems and practices to
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  - thrive to better help patients. So thank you
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  - for, featuring our work.
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  - Of course. Now many of our listeners might
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  - know that we did an article together not
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  - that long ago highlighting some of the work
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  - that you're doing there at UChicago.
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  - And one of the things that stood out
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  - to me that we talked about in that
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  - interview was you said UChicago is on a
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  - journey to become the gold standard for APPs.
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  - So can you tell us what inspired this
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  - goal and what it means?
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  - Yeah. You know, that's just kind of a
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  - phrase that we like to use where
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  - our strategic goal is really to become the
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  - premier place for APPs
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  - to practice.
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  - I feel like the jury is still out
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  - where there's no one clear place where when
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  - every PA or nurse practitioner graduates from school,
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  - they think, oh, that's the place that I
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  - wanna go to. And we want UChicago
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  - to become that place. We know that, it
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  - is a competitive field where there is quite
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  - a few opportunities for both PAs and nurse
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  - practitioners.
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  - And many times they're moving across the country
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  - to find the the perfect job that fits
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  - their interests. And so we wanna make sure
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  - that we're setting up a platform where our
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  - APPs can thrive,
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  - where they feel that professional identity
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  - because we know that that translates into better
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  - patient care. So that's our goal, is to
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  - create an architecture and a framework where our
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  - APPs can really thrive.
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  - We don't want this to be in a
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  - silo. We wanna figure out how do we
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  - fit it in with the culture of our
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  - organization
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  - to better help patients. And so we've been
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  - on quite the journey
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  - of, our APP transformation,
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  - which really isn't specific to APPs. It is
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  - a health system strategy.
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  - The APP landscape has changed quite a bit
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  - over the last ten years where it used
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  - to be that APPs may have served in
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  - roles where they were kind of helpers or
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  - support staff
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  - to the rest of the care model. And
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  - that's changed drastically with some,
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  - kind of billing changes through CMS
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  - and really just APPs being able to exercise
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  - their full skills, everything that they were trained
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  - to do.
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  - And so we're excited to figure out how
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  - APPs can better fit into our system,
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  - to enhance the patient care that we provide.
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  - Amazing.
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  - Now what kind of changes have you already
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  - made, and what have the results of those
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  - changes been so far?
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  - Our first,
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  - kind of the aspect of this APP transformation
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  - that we were wanting to,
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  - better define was role clarity.
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  - We found after kind of doing a listening
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  - tour tour that there's quite a bit of
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  - role ambiguity, and we know that that translates
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  - into dissatisfaction.
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  - Clarity creates confidence and trust, and ambiguity really
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  - creates friction. And so we wanted to make
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  - sure to make it as easy as possible
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  - for our APPs to understand what their expectations
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  - are because people thrive when those expectations are
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  - clear.
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  - We want this clarity to be empowering.
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  - And so we went on a journey to
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  - better understand and define what does it mean
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  - to be an advanced practice provider
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  - here at UChicago Medicine,
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  - creating some of the skills that are important
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  - for APPs to be kind of the the
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  - lead on, and others finding some of those
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  - responsibilities where perhaps another member of the care
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  - team may be better positioned to provide.
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  - So we were very clear about setting role
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  - clarity and role expectations.
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  - And after we set that standard,
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  - we developed a big project to implement what
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  - that new definition means. Because in order to
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  - make that change, we wanted to make sure
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  - that our APPs had the support and the
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  - infrastructure
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  - in order to meet what that new definition
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  - was.
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  - So we spent,
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  - countless hours
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  - going through an individualized look at each of
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  - the APPs
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  - throughout our system to ensure that,
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  - they had the capability and the support structure
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  - to be able to practice at that advanced
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  - practice level.
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  - One of the most important things that we
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  - did was provide data transparency in the form
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  - of individualized
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  - scorecards so that every APP in our system
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  - could see where they were in comparison to
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  - their peers and in comparison to what our
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  - system level goals were.
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  - After,
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  - we went through that, we knew that that
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  - was only one piece of the puzzle. We
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  - wanted to create some professional visibility and recognition
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  - because we knew that that was another important,
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  - piece of our transfer transformation.
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  - Unfortunately, we had really high turnover
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  - numbers,
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  - within the last three years.
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  - And so we knew that this was something
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  - that we needed to to work on. We
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  - wanted to provide
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  - a retention framework or a retention architecture
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  - where our APPs could feel like this is
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  - more than just a job, that they had
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  - a career here. And so we did that
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  - by establishing the center for advanced practice,
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  - kind of a professional hub to support all
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  - things advanced practice providers.
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  - We also developed a framework or a scaffolding
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  - of APP leaders.
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  - We know that we work in an important
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  - academic system, but sometimes APPs are left out
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  - of that academia framework. And so we created
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  - processes where we can accept PA and NP
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  - students and where,
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  - our existing APPs can be preceptors.
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  - We wanted to get APPs on all relevant
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  - committees from safety to patient experience to compliance,
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  - even to food safety and ethics. We wanted
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  - our APPs to feel that they were embedded
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  - in our system and had an important,
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  - an an important,
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  - area to speak up and be a part
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  - of the decisions that were being made. We
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  - also have, a very strong APP executive council
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  - and even formed many committees of our own,
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  - starting with APP orientation
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  - and creating APP transition to practice programs.
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  - And so with this
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  - role clarity and creating some professional visibility and
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  - recognition,
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  - we've seen pretty dramatic results.
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  - We've seen our turnover
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  - decrease by 10%
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  - within about a three fiscal year period.
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  - And so we knew that the work that
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  - we were doing was something that was also,
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  - resonating with our APPs. They were voting with
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  - their feet saying, this is the place where
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  - I want to stay, and it had been
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  - different
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  - than the structure that they were practicing in
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  - in years past.
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  - And with that role clarity came improved independent
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  - practice for our APPs
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  - in the form of increased
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  - productivity.
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  - We saw a dramatic increase in productivity
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  - by more than 27%
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  - over the last two years, but that's just
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  - the outcome. The real work was creating the
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  - conditions
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  - to allow that to happen.
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  - Our access also dramatically improved. There was a
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  - 200%
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  - increase in the number of clinics,
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  - that were hosted by APPs,
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  - and that was associated with an additional 200%
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  - increase in the number of appointments that were
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  - available to our patients that APPs were be
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  - were able to to serve. So pretty dramatic
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  - increase in access. And, of course, paired with
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  - that is also revenue. There was significant cost
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  - savings
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  - since we weren't constantly dealing with turnover,
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  - and then also, the contribution margin for the
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  - additional patients.
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  - We also are working to improve our provider
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  - engagement scores, and I've seen them go up.
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  - And I think that that's the piece that
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  - I'm most proud of. It's fun to talk
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  - about, you know, some of the financial and
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  - productivity wins that we've had. But at the
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  - end of the day, this was something that
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  - was endorsed and supported and felt bar by
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  - our APPs,
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  - not only in their engagement scores, but also,
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  - through our retention outcomes. And it's something that
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  - we're really proud of.
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  - Absolutely.
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  - You've done some really amazing work so far,
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  - but I'm curious, what are you tackling next?
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  - You know, we, are really proud of the
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  - work that we've done and,
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  - you know, are happy to talk about how
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  - successful we've been. We certainly haven't gotten it
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  - all right, and so we wanna learn from
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  - what other systems are doing. But we also
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  - wanna share our work to support and influence
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  - other systems that perhaps are going through the
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  - same transformation.
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  - We're gonna continue to double down on our
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  - efforts,
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  - of creating,
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  - a professional home for our APPs.
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  - We started our first fellowship last year in
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  - GI,
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  - and IBD, and we're hoping to start more.
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  - We know that there's a lot of growth
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  - going on with our system.
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  - We're building
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  - a gigantic new cancer center here on our
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  - flagship campus,
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  - and many APPs will be a part of
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  - that cancer,
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  - network and a part of that a part
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  - of that growth. We hope to, expound upon
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  - our growth by using our APPs and some
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  - creative models,
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  - and we wanna continue to drive the the
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  - culture change of utilizing APPs to their fullest
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  - extent.
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  - We also know that being a provider isn't
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  - easy within health care. There are many demands
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  - that are placed upon us, and so we
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  - wanna make sure that not only are we
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  - doing this work to support the role clarity,
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  - but that we're also doing it in conjunction
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  - with well-being initiatives.
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  - We've partnered with our, chief wellness and vitality
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  - officer to plug in APPs,
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  - and really start our own journey of, well-being,
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  - as an advanced practice provider here.
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  - And we hope to be able to continue
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  - to,
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  - build upon the results that we've already achieved.
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  - Amazing.
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  - Now as you said a little bit earlier,
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  - a lot of systems across the nation and
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  - a lot of hospitals are kind of figuring
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  - out where APPs fit in the modern day
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  - because there have been so many changes.
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  - And I'd love kind of your last piece
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  - of advice on what changes do you think
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  - are the most important for every hospital to
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  - make in order to improve practice for APPs?
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  - Yeah. It definitely is something that all systems
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  - are looking at.
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  - We know that there's, quite a bit of
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  - a physician shortage, and APPs are really positioned
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  - to help with that and to create that
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  - wrapper and that scaffolding
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  - to support all of the different pieces that,
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  - patients are on their journey,
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  - where we do not have physicians to fill
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  - those roles.
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  - I think that it's important for other organizations
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  - to do a deep dive of their own
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  - current practice.
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  - Is there a role clarity issue?
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  - And how do we better define
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  - what are the best skills that APP should
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  - be performing in our systems? And how do
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  - we redesign our care models,
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  - in alignment with those efforts?
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  - Another important piece for us has been building
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  - the center for advanced practice as well as
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  - a scaffolding of leaders.
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  - A data point that we're proud of is
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  - that over 70%
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  - of our APPs in our system report directly
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  - to an APP leader, where they have someone
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  - that they can go to to have kind
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  - of that peer influence. They kind of they
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  - have that psychological safety of going to someone
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  - that intimately understands their role and can advocate
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  - for them for the highest scope of practice.
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  - And so we're gonna continue to work on
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  - those efforts here, but it's been part of,
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  - our success
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  - of having that network of leaders to rely
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  - on.
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  - Incredible. Well, that has been some great advice,
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  - and I just really appreciate you sharing everything
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  - that you're doing. So thank you for being
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  - on the podcast today. Thank you, Mariah.