Latest / Becker’s Healthcare Podcast / Why Play Matters in Pediatric Recovery with Dr. Nick Holekamp

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Why Play Matters in Pediatric Recovery with Dr. Nick Holekamp · Becker’s Healthcare Podcast

• 0:01
  - When the CEO of behavioral health services at
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  - a large health system sits down with the
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  - CEO of a small community mental health organization,
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  - Welcome to the Becker's Healthcare podcast. I'm Chris
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  - Sosa, your host. I'm thrilled to be joined
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  - today by doctor Nick Holkamp. He's chief health
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  - transformation officer at Ranken Jordan Pediatric Bridge Hospital
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  - in Missouri.
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  - Nick, thank you for joining us today. Thank
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  - you for having me. Wonderful. So, Nick, you're
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  - here to discuss how to improve care for
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  - children with medically complex conditions.
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  - But before we dive into that, could you
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  - please just tell us about yourself and about
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  - your career?
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  - Well, I'm, trained as a pediatrician,
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  - spent nine years at a a general hospital
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  - here in Saint Louis as a pediatrician hospital
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  - based.
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  - And then in 2000 came to be the
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  - medical director of a then
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  - small,
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  - pediatric
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  - nursing home actually, Ranken Jordan at the time,
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  - and,
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  - have been here twenty six years during which
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  - time the hospital has
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  - become a hospital and evolved into really a
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  - leading provider of transitional care services for children
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  - with medical complexity of all ages, really bridging
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  - the gap between hospital and home for those
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  - kids and their families.
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  - Thank you for laying that out for us,
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  - Nick. So
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  - as we dive into the crux of our
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  - conversation today, so you are adamant that play
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  - is critical for children's recovery.
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  - You've been saying that for years. This is
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  - not something that's new at all in terms
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  - of your approach to care for for children
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  - in general. So first question I have for
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  - you is simply, what should leaders understand about
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  - that approach?
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  - Well, for me, it's as simple as
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  - play is an essential part of childhood. Play
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  - is the work of childhood,
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  - and childhood is critical in becoming a high
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  - functioning adult. The absence of play means
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  - these kids would not be getting
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  - the all the important developmental
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  - and social and emotional
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  - building blocks that,
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  - they depend on when they continue to grow
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  - and evolve as adult humans.
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  - So play has to be the central feature,
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  - especially for children
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  - challenged by the added insult of having complex
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  - medical conditions and,
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  - being confined in, let's just be frank, not
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  - developmentally ideal settings,
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  - I e hospital rooms and hospital beds.
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  - Nick, I love that turn of phrase. It
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  - plays the work of childhood.
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  - Is that something that that you've been hammering
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  - home as far as,
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  - how we should think about it? How, more
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  - importantly, how health care leaders should think about
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  - that?
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  - I think so. Although it's well understood and
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  - recognized and reinforced daily by the American
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  - Academy of Pediatrics, for example, who says play
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  - is essential. Get more play into a child's
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  - life,
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  - deviate away from screens and isolation
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  - and get kids playing. So it's well understood.
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  - It's just sort of,
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  - forgotten a little bit in hospitals, and these
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  - are the kids who spend
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  - lots of time in hospitals,
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  - sometimes the majority of their childhood if it's
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  - the first year or two or three.
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  - So make sure that
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  - play
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  - is present because that's I I say it's
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  - work of childhood. It's the central therapeutic
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  - element for a recovering child too. If you
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  - are playing, you are getting better. You are
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  - healing. You are getting stronger,
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  - socializing,
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  - reengaging
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  - with your community.
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  - If not, you're not able to do those
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  - things optimally.
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  - Well, Nick,
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  - as you and Rankin Jordan at Rankin Jordan
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  - and other health care leaders
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  - try to to expand this approach, I understand
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  - there's a new research department,
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  - that's been developed to study, you know, the
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  - care model. So what would you say are
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  - its goals?
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  - Well, the first major goal was to assess
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  - our own
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  - environment,
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  - because,
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  - obviously, that's one of the things we have
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  - in our control is the environment in which
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  - children are unfortunately stuck for medical reasons.
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  - And when we looked, nobody had ever
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  - assessed
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  - the,
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  - environment in terms of where kids are, who
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  - they're with, what they're doing, what impact that
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  - was having on their
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  - recovery.
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  - And so,
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  - that was sort of
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  - the starting point. How are we doing on
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  - giving kids,
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  - helping enhance their environment to give them those
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  - developmental opportunities alongside the intensive medical support
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  - that they're getting to recover from whatever insult,
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  - prematurity, or a terrible accident.
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  - So,
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  - really,
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  - that was the starting point. We've made a
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  - lot of enhancements to our care environment. As
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  - a result of that, we're remeasuring that. And
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  - along the
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  - way, we've
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  - then,
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  - taken the next step to try and assess
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  - what impact does improving a child's environment have
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  - on their outcomes, and what outcomes are we
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  - interested in, how well they're healing, how well
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  - small children are developing.
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  - Small children stuck in hospitals for extended periods
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  - have
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  - a very high incidence of severe developmental delay.
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  - Might we have an impact on that? That's
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  - our real focus at the moment and probably
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  - for a number of years to come is,
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  - can we improve
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  - the course
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  - of what is commonly not a great track
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  - record on developmental outcomes for, high medical needs
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  - kids stuck in hospitals for extended periods.
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  - Nick, as you mentioned enhancements, I also wanna
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  - touch on some of the innovations and even
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  - potential innovations that may be farther down the
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  - road,
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  - that you're
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  - developing,
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  - you know, down at Rankin Jordan.
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  - So
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  - what would you say are are the top
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  - two or maybe three innovations that are really
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  - exciting you right now? Well, the one that's
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  - been there really since Mary Reinking Jordan's time
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  - in 1941
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  - is what we now call care beyond the
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  - bedside, just to focus on getting kids up
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  - and out of bed and out of their
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  - rooms, enhancing their environment. That's step number one.
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  - When we did our study and found we
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  - could improve on that, we looked at what's
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  - missing even in our environment that is normal
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  - and accepted and expected for every other child
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  - is
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  - engagement with other kids and learning. That's what
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  - happens in preschool or day care. That doesn't
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  - happen in hospitals. That's when we developed the
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  - Oz program,
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  - short for the optimization
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  - zone, because we're trying to optimize every child's
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  - neurodevelopmental
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  - recovery, which
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  - is going to school and playing with other
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  - kids. This can't happen for these kids,
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  - stuck in hospitals.
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  - And and the more general one since that
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  - first study
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  - are enhancing play opportunities
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  - in addition to us,
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  - organized play spaces
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  - on the,
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  - inpatient units
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  - and the hiring of new group of employees
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  - called patient play associates whose job it is
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  - to engage with kids when they're not getting
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  - the medical care that they need intermittently throughout
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  - the day.
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  - Nick, do you find yourself,
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  - at Rankin Jordan getting an overwhelming amount of
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  - applications
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  - for her patient play associates? It sounds like
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  - a pretty good job to have in health
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  - care.
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  - We
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  - we don't have a shortage of folks who
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  - think like you. That's a great job. And
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  - who wouldn't want that? Unfortunately, for the hospital,
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  - it's not a high skilled job. It's,
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  - something that
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  - students on the way to a career in
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  - health care might like, and, boy, how rewarding
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  - it is to see
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  - a child with tubes in the neck and
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  - the stomach and,
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  - monitors attached,
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  - get them up and out of their bed,
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  - even just to the play area adjacent to
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  - their hospital room or out of the room
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  - into bigger
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  - play and therapy areas or outside
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  - so that they can have experiences kids not
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  - stuck in hospitals would have. So it it
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  - it's a it is a popular,
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  - position to be applied for.
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  - That's wonderful to hear.
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  - As you think about
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  - how the department is evolving
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  - and all the efforts that are going on
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  - as far as
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  - using play to
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  - treat children with complex care conditions
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  - or complex medical conditions, I should say. What
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  - do you think other hospitals can learn? And,
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  - obviously, you're constantly learning this whole part of
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  - this process. Right? But in this moment in
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  - time, what can other hospitals learn from Michael
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  - Jordan? It's a great question, and it'll be
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  - the focus or one of the main
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  - focus points of a talk we're giving to
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  - a group of pediatric,
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  - hospital,
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  - medicine specialists
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  - at a national conference in Kansas City early
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  - next month where we're gonna say, this is
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  - possible at Ranken Jordan. It's really hard to
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  - do upstream in the acute care environment, but
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  - here's a few things you can do. You
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  - can take notice.
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  - Instead of ignore, take notice of that child
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  - sitting in bed by themselves doing nothing but
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  - staring at a screen and say, we need
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  - to do better and encourage your colleagues and
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  - administrators
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  - to find ways instead of excuses for leaving
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  - kids in beds too long. And then,
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  - little things,
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  - getting a mat in the room or outside
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  - the room and getting his up and out
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  - of bed and out. Getting kids with other
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  - kids is really hard because there's such a
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  - high bar for infection prevention purposes.
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  - We have to go to extra lengths to
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  - overcome that concern.
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  - I will tell you that it's not only
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  - possible. We do it really well and don't
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  - increase a child's risk of of infection.
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  - So,
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  - test
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  - but more generally,
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  - test and sort of push on the conventional
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  - hospital norms that require kids to be stuck
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  - in their room. They're not all as valid
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  - and,
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  - well,
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  - well seated in science as you might have
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  - been taught.
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  - Nick, is there anything else you would like
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  - our audience to know about,
• 11:02
  - your program or Rankin Jordan in general?
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  - I think it's, again, just a matter of
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  - paying attention to common sense. I often say
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  - these kids are,
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  - sometimes
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  - missing in plain sight. They sort of disappear,
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  - and yet they're,
• 11:19
  - a third
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  - they're they're they're only 1% of kids generally,
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  - you know, children with medical complexity, but they,
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  - account for over a third of health care
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  - resource use and
• 11:31
  - the majority of hospital days, acute care hospital
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  - days.
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  - Pay attention to this population and
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  - do what we ought to to really optimize
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  - their outcomes, not just medically, but,
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  - holistically for the whole child, especially their their
• 11:47
  - development in their future life.
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  - Well, Nick, here's hoping this approach catches on
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  - and very quickly. Thank you so much for,
• 11:55
  - joining us on the Doctors podcast today, and
• 11:58
  - we can't wait till the next time our
• 11:59
  - pass goes. I really sincerely appreciate you having
• 12:02
  - me today. Thank you so much.