Welcome to Charting with Doctor. McNeil.

Greetings everyone. It is time for Charting with Doctor McNeil, our Adventist HealthCare podcast that talks through clinical issues, physician issues, and today, a topic about leadership under pressure. Today, we have great guests with us, people who work very hard behalf of community to make sure everybody's safe, well taken care of with high quality care at Adventist HealthCare. We have a guest, Doctor Andrew Catanzaro, infectious disease specialist extraordinaire, somebody who led us at Adventist HealthCare through the COVID pandemic and who has a long history of being at the side of the bed during a lot of infectious disease crises over time, including HIV crisis. We also have Charity Dorazio.

She is our CIO, who helps us with all of our IT needs. She's always there, always present, always wanting to conquer everything to make sure we have all the processes in place that are needed for us to give good care, including being protective about cyber attacks and things which can be very high pressure. Also, am pleased to say we have Joan Vincent, the person who in the room who's had the most healthcare experience as far as years. It's true, Joan.

It is true.

It is true. A Chief Nursing Officer at Shady Grove Medical Center, but also she represents the system and takes all the great ideas and thoughts for our nurses and our CNOs around the system. She represents at the senior executive level as well.

So welcome everyone. We're gonna have a good conversation today.

Thank you. You.

Thank you. So I wanted to cover this topic because, you know, it's funny. Television and Hollywood always cover different things, and you they cover legal cases, and they cover dramas they have to do with legal and suspense and detective and police work. When they cover hospitals, it really is more worthy to me because we have pressure and we have things happen in the hospitals and in healthcare that are truly high pressure situations that you have to on the spot make decisions about.

And so every leader in healthcare has been in a situation that is very high pressure. And so we're going to talk about this a little bit. We have the best experts in the room, I think, to talk about this. So let's start with how it shapes you.

Right?

How do you all, anybody can answer this question, do you believe that being a leader in healthcare, thinking about everything you've been through in your careers, really shapes you? Think about where you started. You know, you're you're getting out of college and you're like, I'm gonna be a doctor or a nurse, or I'm going go into tech.

And then you land in healthcare and you're like, wait a minute, wait, wait a minute. This is a little different. So how has it shaped you? Let's start with you, Doctor Catanzaro.

It's a broad question occurring a lot of years, I'm afraid to admit.

You know, I think one of the ways it shaped me is it really gives me a lot of gratitude at this point, you know, as a leader and some humility as well. You know, we all will be on the other side of the stethoscope at some point. And that's a humbling experience.

Having seen patients go through some pretty tough times and colleagues go through some tough times, you know, it's, it's great to have people there in your corner with you. You know, this is, I think this is one of the things that I kind of learned around pandemic time was, well, actually before that, I guess, nobody wants to go through this alone.

And just by somebody saying, you got this, I'm with you, we're with you. It's a huge boost. And I think throughout all of my training, except for maybe one instance, I never felt completely alone.

And when I did, I wasn't really alone. I just thought I was. I was a fool to think I was alone.

I could take on all of this. Right. That's a good way because you know, healthcare is a team sport. There's people around all the time trying to make sure that everybody does well. How about anybody else?

So I just wanna remember that the most beautiful diamonds are shaped under pressure.

And that's a really good thing because I think that's what happened to us during COVID.

It's easy to be confident and decisive when things are going great.

But when they're not, you're challenged. I think what shaped me through that was the need for perseverance and the continuing to do what we knew we had to do to support our mission and at the same time, take care of some really challenging situations.

And Joan, I have to echo that. You and I were both at Shady Grove as leaders, high leaders during the pandemic. I have to say you really were an example for me because I would be like, you know, in my mind, not out loud, the sky is falling. All my friends are gonna die.

And you would be like, no. We're just gonna keep on going. And you'd be your normal self just coming in and doing the work. You were there before I got there and thereafter I left.

And it was consistent on a daily basis. You were like, we were just gonna solve these problems and go through. And so it was an example. You have had the gift of time to test you.

And when the biggest test came, you were like, this is nothing. And I remember witnessing that. It was it was nice to see.

But it was something.

It it it was something unpleasant on a level I don't wanna do again to be to be clear. These cyber attacks. You're seeing them hit like bombs At different health systems behind us, in front of us, west north, you know, it's like we don't want any more here. Talk about that because you have a lot of your your job is a lot of pressure actually.

People don't really understand because it's not only the cyber attacks that are in the background that you always have to be compensating for, But if you're in IT and in healthcare, everybody wants more. And I have to say, I've seen you be in situations when people have been quite insistent. You kept your smile on your face and just keep on working. So tell me about your pressure you have and what you think about.

Yeah, think that's a really interesting question because healthcare is very demanding as we know. And there's a lot of priorities. And I think the pressure can bring out differences in people. It can bring out the best in people. It can bring out the worst in people.

And I think how you respond as a leader and how you even look back on those experiences to see how you responded, it shapes you going forward.

I think just understanding where other people are coming from, listening to them, trying to understand their pressures and trying to support them. I think those are really, really important key elements. And pressure situations tend to strip away the performative side of what we do in our kind of normal everyday environment, whether you're at home or at work. And it really gets to those kind of raw emotions. And so trying to manage that and succinctly telling people, you know, this is where we're going, kind of like what Joan said, like, okay, there's chaos around you, but we're going in this direction.

And articulating that. I think that brings some amount of comfort to people, even though inside you might be feeling like, oh my goodness, you still, you know, just bring everybody forward and really be succinct. That and plus I think I have ADHD and I think that those types of people do well in a crisis situation.

Yes, I agree. I'm not gonna say why I agree. I agree. Let's just for a minute go back.

Let's talk about the pandemic because that was a very difficult time for everyone. And I joke a little bit about the panic, but it was it was hard. It was very difficult. I'm gonna talk to you, doctor Catanzaro. At the beginning of the pandemic, what people don't understand is the resource of infectious disease across the country was profoundly low. Eighty percent of counties in the United States did not have an ID specialist. Eighty percent.

That's right.

Okay. And so we were blessed to have you.

But then, you know, I don't know what stage of your career you were when the HIV hit, when AIDS came into the picture. But this was something that was equally mysterious at the beginning and very intimidating. And so tell us about your mindset when you saw this coming to our door and your approach to keeping everybody together. Right. Making sure that you were available, which was amazing because we're not a tiny system.

Talk about that time a little bit in your mindset, as far as the pressure of it all on your shoulders, it must've felt as if it was all on your shoulders.

At times, at times, you know, I think, you know, first of all, when it was first starting, it kind of had this, like you said, I thought, Oh, there's an answer somewhere. And the harder I looked, the less I found, you know, and, Oh, someone's got to have a protocol. No. Oh, someone's got to have an understanding. No. Oh, there's gotta be medications. No.

You know, so you kind of go down that list mentally and got a lot of like, well now what?

And, it's a scary place. Very scary. There were times I remember distinctly when Robert Redfield came before Congress and said, you know, we're going to face a hundred thousand people who died in America. I cried.

Yeah. I just because I could feel like all these people are going to die and there's not a thing that I could do to stop it. I knew that, right? It's a virus.

Like what can you really do? You can support people through it. You can, you know, be with them, but it was clear.

Then of course that was sat on very quickly, but it became apparent. There was also some fascination. I'm not going to lie. You know, it's like, wow, this is something cool.

This is a thing new, something different. You know, it was feeding from a fire hose all over again. Like we were in, you know, in medical school, like suddenly there's just this flood of information and understanding and digesting it and being able to articulate it has always been fun, you know? So there was a lot of emotions that were running through.

Fortunately, I had some training with Ebola and ******* that could help me to kind of manage my own emotions, like you said, like what you said, you know, a charity about emotions to kind of manage them. Certainly couldn't manifest them.

Well, I'm sure they were manifest at some points on some of those calls, but couldn't really manifest them regularly.

So I don't know if you want to go in that direction. I developed something I was reviewing and actually went back on my notes because of this conversation called the fear protocol.

Did I tell you about this?

I don't think you did.

Oh yeah. So the fear protocol kind of came out of the Ebola experience and it kind of summarized how I tried to take care of myself and tried to be. First was to admit, you know, I have fear.

It was, I'll just personalize it for second. You know, I'm afraid. It's not a great feeling, but it's a natural and normal feeling.

Second part for me of the Pure Freeer Program was to learn something about what I was afraid of, you know, whether it was Ebola, whether it was COVID, whatever it was, learn, learn about HIV transmission, blah, blah, blah. And so I could kind of like obsess about, you know, going as much information I could do. And then the third, particularly with Ebola and COVID was train, train, train, train, train and train again, you know, going through the PPE, going through the product, the PPE mostly for myself, you know, and have a systematic way of doing it. Then I have to think about it.

I don't be afraid. Oh, did I adjust this right now? Just train. And then it just becomes reflexive.

Like the military, you know, they do train a lot. And that was a big part of the fear report protocol and then repeat. So those steps really got me through a lot of it and I stole it. I was from the military and I stole it now.

It's kind of adapted in COVID and other situations. And that really went a long way to kind of helping me manage my emotions.

That's something to remember. Was that apply, I can apply to me.

Oh, I left out the last part.

Oh, what's last part?

How can I leave out the last part?

Was going to say it.

The last part, processing those emotions in a safe place. So having a space, safe place, whether it's with a spouse or a friend or a pastor or a therapist, you know, somewhere where you can take those emotions apart, whether it's joy or fear, excitement, whatever it is, somewhere you can digest them and process them, became vital for me.

I think it's important for the public to understand because a lot of people from the public, when I speak with them during that time, if they had a desk job, they just moved it to their home. If they, you know, it it the the impact of what the hospitals and health care were going through, there's a lot of cheering for us, but understanding how dark it got and how fearful it really was. You know, I remember ordering refrigerated truck because our morgues were overwhelmed. I that wasn't something that was in my plans.

Right? And so in modern medicine, we've progressed to the point that we're used to saving people's lives. There's not these large amounts of deaths like this, and it took a very high emotional toll on everyone. Now I'm gonna turn to you, Joan, thinking from the nursing point of view.

Always had such great admiration for nurses. You know, I'm a doctor, I'm an ER doctor trained. When I look at nurses' activity, I'm like, I could not do that.

I'm gonna be quite clear. It's it's a lot of coordination to to do it well. It's a lot of coordination. It's a lot of emotional patient heft that you have to put on your back and shoulders throughout the day.

It's a lot of technical skills. It's it's a lot of critical thinking as well all at the same time. And we do a lot of that as a doctor, but then we move on and don't have to do some of that emotional heavy lifting for patients. I remember having people in my office crying, surgeons, nurses.

And I know that you were leading a large swath of the nursing workforce and a lot of young nurses as well. So talk a little bit about how you manage large teams when they are terrified. Because that was a lot there's a lot of terror, you know, a lot of fright and like extreme fear at that time.

There was. And I think that was the first thing was to know that everybody was afraid to be vulnerable to them.

And they knew I was afraid.

And to know that we didn't truly know how we were going to take care of patients. We just didn't have anything in place yet. So we came together, our senior leadership team in nursing, and we tried to make sure that we had processes for everything that changed, because keeping the routines clean and easy made it easier for people to accept than what was going around with them.

With the control.

And the teams at the system level supported us every day something was changing. But getting that communication out to the staff, making sure they knew every day what we were going to change, why we're doing that kept them at least calm. The hardest part, I think, were the closed COVID units. Those folks felt isolated and there were many staff from other departments that didn't really want to go on those units.

And so the nurses on the COVID units ended up doing a lot of treatments or even just activities like delivering trays that they weren't used to doing and they were just overwhelmed. So those were the nurses that really had the hardest time. We tried to go visit them, make sure that they got breaks from the unit, make sure that we listened to even the tiniest thing that might make their job easier and change that. Because that was all we could do at the time.

There was just there was no big plan. So that's what we had to do. And I think the directors spent a lot of time together doing just what Doctor said, talking about our own fear so that we could then be supportive to the staff.

It was awesome to see the level of bravery from all of the clinicians because you're seeing so many people die and you're walking toward that flame instead of running from it. And so I think, it was remarkable to see because it is what we're called to do. We all know that, but this is new. This was brand new and it was, this was a time when there's always protocols and things that are known, we know, but it was an unusual disease. It's a virus, respiratory virus, but why are we getting clots? Why are people having strokes? Why it was very it was a mess.

The nurses, you know, often were holding the hand in one room of a patient that was dying because their family couldn't come.

Exactly.

And at the next step, going to a room where a patient was recovering. And so that played a big part in them trying to be resilient and figure out how to manage those situations because they happened at the same time. A hundred percent.

I was gonna jump in and say, when you talked about the plan and we didn't know, my favorite analogy is we're building the plane as we're flying it.

Yes.

Because we have, and we have no idea what we're doing. We're like you say, we're taking off the wheel and then we're going try another wheel and we're flying and how are we going to land? We don't exactly know.

Admitting that, that we didn't know exactly what we're doing.

Some people hated that. I'm not gonna lie. But some people were like, yeah, I get it.

The staff appreciated that.

They appreciated hearing that.

Hearing that.

Yes. Sometimes. That's And Sometimes.

The thing that kept the staff, I think, going was the fact that we had support from all of you at the support center and we had materials management. We didn't have to worry about PPE. We didn't have to worry about pharmacy. We didn't have to worry about something we weren't supposed to do because Doctor. Catanzaro kept us up to date. Infectious disease was there. Infection prevention was there.

Absolutely.

We had support for all the fundamental things that we needed. And I think that was the thing that really kept the staff together.

Charity, during this time you were here working as well. At the time you weren't CIO, but you were number two essentially. Tell us about what was going on. Because you know, it's one thing to do the clinical care, but healthcare now is very, very, very dependent on IT resource. And so if anything had gone down, what was already a heightened fear would have gone through the roof and talk about pressure.

Tell us a little bit more about that time from behind the scenes a little bit.

So great question. And we appreciated the frontline staff so much and getting on those calls. We could hear the struggles that everybody was going through.

You know, we had some individuals in the hospitals that were our field teams that needed to still get in and fix computers and have computers working. So they were kind of, you know, in lockstep with you all in terms of the fear that they had. And, so there was that component that we were trying to manage from that staff. But we also had some activity behind the scenes with regards to the vaccine distribution.

And that was probably the most challenging technological piece that we had to deal with because our systems were not set up for mass scheduling. And when I say mass scheduling, I'm talking about, you know, tens of thousands of people trying to get in to schedule a vaccine appointment at one time. You know, we would know which how much vaccine we were getting and we would put that number of appointments on the calendar and we would say it's going to open up at midnight and literally you'd watch it at twelve zero five and the server would keel over and die. And then you'd get the four zero four error and we had people calling and saying, you know, I can't get into schedule.

Unfortunately, it happened more than we wanted it to happen because we just didn't have the technology. And we tried to work with our vendors to tell them what was happening, but everyone was having the same problem. So there was this frustration that, you know, there's this pressure that you want to give the service that you know you can and should, but you just can't because you're being prevented for so many factors are preventing you from being able to give that support that you really want to. So that was, I think that was probably the most challenging is, you know, these rapid cycles of improvement, I think is what we all went through without even really knowing that that's, you know, naming it like, hey, we're all learning as we go here.

These are truly rapid cycles of improvement.

And I think it was just trying to understand how we were gonna get through it and just seeing, you know, this, like you said, Joan, this didn't work today. So let's do this tomorrow and let's see if something else works the next day.

And just trying to keep that attitude where, you know, the exit sign will appear at some point here. Like this can't go on for eternity, right? It's got to, at some point we have to start coming out of this. I think it lasted longer than we had all had hoped.

Most longer. Would say so. I remember telling my wife this will be over, was like in June. January. Said, Oh, it'll be over by July.

And then obviously it wasn't. And we kept seeing the numbers increase, increase, increase.

But yeah, and then when's it gonna come down?

And I was like, it does.

It'll come down when it's done.

My husband said it was never gonna end.

It felt like I was a system CMO, I am now too, at the time. And I remember there's large swaths of twenty twenty. I can't remember at all. I just don't remember why. I don't remember. I don't remember the summer at all. I don't remember it's gone.

Will say, this as we reflect back in that time, a couple of things for the public to know. Number one, know, an emergency medicine doc. We're gonna talk about our darkest hours during that. My darkest time was I could see all the docs come in from the physician parking lot because that's where my office was.

And I wasn't at the clinical front any longer. I was having to manage all these other things. And I would see them come in. I would see them walk up to the steps.

I would see them progressively grayer over just a twelve month amount of time. Grayer, thinner, lined. And I would see them take these deep breaths and bend over and then get keep going. Keep because I could see almost see them say, I'm gonna keep going into this place because this is what I'm supposed to do.

Those are some dark times. I will say this though about Adventist HealthCare and the team and everybody working together because we did a magnificent job as a health system during that time. I want to make sure the public knows we did an exhibition.

If you were a nationally, if you were a patient who came into a hospital with COVID at the height of the pandemic pre vaccine, the mortality rate was twenty percent on average across the country. Twenty percent, which is really, that's a really high for you just being admitted for respiratory illness. At Adventist HealthCare, the average mortality, if you came into our hospital with COVID was six percent.

I will ever be very proud of us for being able to. That gives me chills every time I say it. Look at what we were able to do for the communities that we serve. We were able to save many more lives on average than the national rate by the work that everybody in this room and beyond were able to do.

A lot of personal costs there. A lot of I'm sure there are years off of my life because of those few years. But it was worth it because we saved a lot of lives. So just one more dark thing, and then we're gonna go towards light.

Tell us, you know, think about your times, Joan and Andy and Chad or T too during that time. What was what was dark? What was like the time of your office, the door closed, like, what am I going to do about this? I have my own, but I wanna hear yours.

How about you, Jo?

I think the darkest time for me was I had staff out there reporting to me when patient, I knew the patients that were really critically ill. And there just wasn't anything we could do for them.

And to see that truck pull up where we were going to have to put more bodies in, that probably was one of the darkest times. And to see these patients laying and us doing every respiratory treatment we knew. The brightest day, however, was when we learned that proning was the thing to do and our patients started getting better.

Tell people what proning is, just so they know.

So most of the time with respiratory illnesses, you think you can't breathe. So you have breathing equipment perhaps, but then you're sitting up or you're laying with your head raised, but you're usually on your back. We learned with COVID that by turning them over on their stomach with their breathing equipment, they really did better. And they had to spend several hours that way. And so we had teams in the hospital of nurses who really weren't that busy, like the OR, the ED, all of the busy part was in the inpatient part of the hospital. So we had teams that would come in the ICU and prone our patients, turn them on their stomachs and make sure that their equipment and make sure they were padded so that they didn't get a pressure injury from their equipment.

But it was the best day when we found out that that worked.

That's when my dark side turned to we can do something here.

Something you can control. How about you other two here, Andy and Jerodie, what are you thinking?

Like I said, most of us were not on the front lines, but I do remember having to reopen the Tacoma Park sites that we had to revive that. So going down there and oh no, we've got to put equipment back into this place where, you know, at least people were going to receive care at the alternative site. But really it was like, this is where we are now. We're in the field hospital realm of things. That was like, wow, this is, we're in a different area right now. We're in a different, you know, timeframe.

Fortunately for the community, Adventist HealthCare had most recently closed Washington Adventist Hospital and moved that hospital's operations to White Oak New Hospital, which is still of course in operation and doing very well.

We're told there was a freestanding building there that we were blessed enough to coordinate with the state to open it back up because there needed to be more inpatient beds. And so the lift on that, you have a dark building that's old, but, you know, we did what we needed to do as we needed to do it to to help people. And we were able to save a lot of people's lives throughout the entire state because of that place.

People were transferred in when places were It was, there was a bright side.

It was dark.

But it was an alternative to, you know.

To what could have been.

To not having space.

Yeah. So how about you, Andy?

So the one that comes to my mind the most is, you know, at a certain point I hit the wall pretty hard. I think it was like maybe April.

Twenty one or twenty.

Twenty.

I think that's right. Again, kind of a blur. I'd have to go back, you know, but I'm going to say sometime early pandemic, way before vaccines, and I hit the wall pretty hard. When I say hit the wall, I was burned out.

Just, you know, going through the motions and people were becoming numbers on a list and I could feel, and I was kind of looking for, it must've been, it was pretty early. I was looking for answers, quote unquote, about, how are people running this? There's gotta be an answer somewhere, right? This is the world.

There's eight billion people. There's gotta be an answer. So I signed on to a call about the pandemic from international kind of leaders. And I was like, Oh, there's this person from Britain.

They must be doing it better than we are. Anyway, what came out of that conversation was we were all burned out. There was no way around it. And so I walked into Jim Ross office and he, graciously said, Yeah, of course, you know, what do you need?

And I said, Well, I think I need to talk to this guy, Jim McKenna. So I got a coach and he sat down with me and said, what is what is bringing you joy right now? And I came up with a goose egg, like nothing.

Family, friends, you know, watching TV. I had zero, you know, and just by coincidence, like the day before I had made a walk, not in the neighborhood on the roads, but there's a little path behind our house. And, I just kind of blurred out walks in nature and piece by piece, because there was no joy, there was no excitement, there was no interest. There was just going through the motions at that point.

And, piece by piece, I felt like I was kind of brick by brick rebuilding myself and coming back to myself from a very dark place. Right. You know, so like you said, high mortality, nothing to do. People were dying.

We were trying stuff. We're opening up a hospital. So yeah, through that was the darkest time. But prior to that, I was, we jokingly referred to the command center.

Like there's a bedroom in my office, in my house that came in the office and I slept there. I woke up there. I read and went through my, this and that there. Like I didn't leave that room at all, like for twenty four hours, run down, get something to eat and run back up.

It was insane. It was insane. It was insane. So that was the darkest place. I think that it was.

I think it's important for folks to know who, you know, were at home during that time, or even if there were patients, they must realize that there's a study that shows that emergency medicine docs post pandemic, a little bit over thirty percent of them had signs of PTSD. I think that's very needed to understand. That was a hard time for clinicians. I don't know what the number is for nurses, but I can't imagine it's smaller, know? And so I think it's something to be said that that levels of personal sacrifice that were done by everyone were high.

Unbelievable.

Extremely high, but once again, six percent. And that makes it a little bit more worth the sacrifices that were made.

I was going to say too, when you said personal sacrifice, I remember reading, you know, the Washington Post at one point, they did like these profiles on different people who were frontline, you know, ER docs, ER nurses, respiratory technicians, and they would talk about what they're feeling, you know? And I was like, oh my God, that's me. That's me. That's me. I'm not the only one.

That's me too. And I turned to my wife. I was like, this is me. And she's she read it and she goes, oh.

And I was like, no, you don't get it. And that's also part of the darkest moment. Like nobody else understood what I was going through. Like it was basically, oh, I'm different than you and you just don't get it.

But once I started reading that, was like, oh my gosh, yeah, everyone is feeling this. And we were not quite talking about it until some things from nursing came through.

Ignite the flame.

Oh, right. Right.

You that, do you want to talk about that? Because I thought that was a brilliant stroke.

Ignite flame something that the education department designed that they would go around with to the staff and make sure that they usually had some statement or some point that they were trying to make that was happy, that lifted them up. And they would do that on a regular basis. And it just made the staff feel good. And they listened to them and it wasn't very long, but it was something that they paid attention to, usually brought them a little treat, and it was something that they could look forward to. And we did lots of those things. But that one is still going on at Shady I find it on my desk with a little piece of candy or whatever. And it's just something that reminds us that there are some really good things that we do and that we know and that we teach each other.

So that was really good.

It brought all of us closer too. I remember there was a lot more siloing, meaning that nurses are doing their thing, IT is doing its thing.

Infection prevention, which I was familiar with, but I became extraordinarily familiar with infection prevention during COVID. So do you all think that COVID has changed healthcare forever?

Definitely think it has.

I mean, I don't think we could have gone through this without it changing Changing us.

We are faster, more adaptive.

We can adapt a lot More flexible.

More flexible.

Have more process, More processes. How many did we do? A hundred and Process maps?

A hundred eighty.

So we have a specific way of working at Adventist HealthCare. We have an Adventist HealthCare way in which we have a very rigorous way of how we process map everything that we do.

It's a framework that was introduced by NIST that we've been on a journey for over a decade. It was definitely one of our saving graces as far as me. No. Everybody knew and had walked through developing a process, whether it's a person who comes in, who's pregnant and in labor, how do you get that person from the front door to labor and delivery if they've got COVID?

Still gotta have a baby. Can't do it the hallway. So we have to figure this out. And so that was there was a million a million of those.

What do you think? I found like a lot of change in IT. Oh, there was a lot.

Yeah.

There was I mean, everything from data when you think about I remember when we would talk about data we'd send the state and they'd, you know, say, oh, if there's ever a pandemic and we'd all go, that's not going to happen.

And then it happens and it's like, Oh my goodness, they need all this information now. They need all this data quickly. And they, you know, it can't lag now because we've got to figure out what the numbers are on a regular basis. We'd have to understand what's going on in the ED very quickly.

We have to capture this information and we have to produce these real time dashboards so that we know what's going on so that we can pivot in whatever way possible. So, you know, I think there's there's there's a lot of changes, a lot of things that have happened. We had new systems, we had new equipment. Teams.

Teams. Yeah. That's right.

Zoom calls.

Yeah. We went we went from Skype to Teams. You were also like, yeah, does Zoom work? Everything was remote. Do we have enough bandwidth?

You know, do the computers have enough power to handle these telesystems? And how do we do telehealth? Right? We were also thinking about telehealth. We should have been really full forward with telehealth. But that became an issue for consultations for physicians, for families to try to talk to their loved ones' behavioral health.

Even monitoring patients.

Monitoring patients.

And even in the outpatient space. Right? How could we give outpatient care when the offices are closed? It's like we had to pivot all those systems and processes.

And how do you check-in? How do you take a payment? How do you see the patient? How do you get vitals?

You know, remote monitoring, like just just so many systems that came to the forefront. And the, you know, the government said, oh, we'll we'll kind of pay you for this. Whereas before they were saying everything remote, it's not gonna we're not paying you for it. So I think that that helped kind of fast forward some of the technology. Yeah.

I think the other piece I was going to add in too, is that we developed, you know, we had to pivot from this big conference call, a lot of us were talking about the numbers and what's going on to the situation call, you know, which basically was a very structured way of doing it. And I can remember we had this one call, it was a complete catastrophe. Like physicians were getting online. You could the anxiety of what palpable like, oh, we need this.

We need that. And so Susan came on and said, we are not going to do this this way. And then the next day, cleaned everything up, had a very structured way of doing it. And then Deborah Illig and myself, and I think Bonnie would preplan it and say, here's what we're going to say, you know, and then we're going to go through it in a very structured way.

And so, you know, I think that also changed healthcare, at least from my perspective, like, you know, sure, if there was a nationwide catastrophe, I had not lived through it. But the situation call then became part of our standard operating procedures. And then people could turn to that and say, okay, I may not be on that call, but there's going to be a representative for my team who will be.

And, and then before those calls, I kind of had my battle buddy, Deborah Ilik being the key one who's like, okay, Andy, you're not going to do what you want to do, which is process your thoughts. You're going to just give just the facts and then we're going to go. So you kind of, what it changed my view of healthcare was, you're not Andy, I'll say, I'm not processing verbally with you during a call like that. No. There's pre processing and then there's the message. For sure. Know, but every time, because every time I started processing, people were like, he doesn't really know what's going on.

Yeah. That doesn't really lead well to the people who are already anxious, right? I will say this, healthcare is better now post pandemic than it was before. It is this.

At least I know that Adventist HealthCare and colleagues I have that are not Adventist HealthCare, things are better in that we have a different way of looking at things, different way of preparing for the future, as well and being aware. You know, there's no time now where there's a little illness that's happening in China or happening in Africa that we're like, yeah. It's not gonna be. We are very much so attentive to what's going on worldwide and making sure that it's not going to to land on our shores.

Really briefly, let's step out of the pandemic space. We're all I don't know about our belts, I'm getting a little sweaty.

Yeah. I can feel that in my stomach coming Exactly.

It's like, let's let's get off of this. Let's talk about talk about cyber. Yes. And talk about the attacks that are coming and and how we're preparing.

Because of course, I'm sure if I were you in my head, I'd be thinking if we have a cyber attack at Adventist HealthCare, I'm gonna think it's my fault.

Will not it will not be your fault. Of course. Yes. It's not gonna be your fault. But talk about that and the pressure of of that ever present thing. We're gonna wrap up soon, but talk about that.

No. It's it is ever present. Like you said, it's you know, health care is the third largest sector. It gets attacked the most often Right behind, I think it's banking and manufacturing, we are we are attacked the most often twenty two percent of attacks occur in healthcare. There's been a thirty six percent increase that's going into twenty twenty six.

In ransomware attacks, we have a large surface attack area, we have a lot of aging equipment takes a long time to get FDA approval for some of our biomedical equipment that makes it at risk. You know, go down the list of applications that you use. And so the risk is very, very real. There are groups trying to get at us and get at other health systems on a regular basis.

And, you know, when you talked about the darkest moment, I think COVID, there were some dark moments, but my darkest moment always comes when we have a network outage or some kind of outage that happens. I have that brief dark moment of this is it. You know, my team hops on a call, the IT team, and we try to figure out what's going on. We work with our external security operations center vendor, they tell us, you know, what's happening, what's not happening, but it's an ever vigilant process.

And AI is now fast forwarding, making that so much more real. Like, it's always been real, but it's just there's just more of it. And there's more kind of unknowns. And I think that's the other pressure side to this is, you know, with AI, anything is possible, really.

And so things we haven't even thought of, attacks that we haven't even thought of, ways to attack us that we haven't even thought of are possible. So it's scary. And, you know, it is it is something that I think about regularly. We have a good team.

We're lucky here at Adventist. We have, like probably a lot of other health systems out there, we have layers. So you never rely on just one tool. You have to rely on the layers and you have to hope that the layers kind of hold up to the different attacks that happen.

But it's very real and everything's electronic.

I will say that I've always been really admiring the intentionality and carefulness though that we take that is not at all health systems as far as preventing the possibility.

So many pings at our door that you're just spinning off like like a superhero. So I like to see that happen.

Is it true? Can I ask, is it true that we play insurance?

Like there's an insurance policy for cyber?

That blew my mind.

Like that when we have to have an insurance policy for that, that tells you like Health systems lose not only one or two million, hundreds of millions of dollars.

On Hundreds of millions of dollars. You have to have some kind of insurance. It's really important. Wow.

We're gonna close-up now and we're gonna reflect a little bit. I believe that in life in general, and specifically as a leader, but in life in general, every crisis that comes to you, you learn something from. If you're not learning, you're not paying attention. Right?

It all comes ups and downs with life. If you live long enough and are fortunate enough, there's going to be something. And sometimes there's more than one something. You think about your leadership, each of you, think through what do you feel like is the biggest learning, let's just say the last ten years even, or of your entire career of being a leader, having a lot of pressure.

I can give mine, but I wanna hear you guys as well.

I think for me, over the years, I've learned, especially in nursing, when young nurses come into the practice, they're worried about their clinical skills and the skills of taking care of patients.

But what I've really learned is that teams are important.

Trust is important from leaders. And if you don't have that, if you're not open and transparent with your staff, if you're not present, then you will not have success. And I think I learned through COVID with so many agency nurses that we had, that rebuilding those teams and helping the leaders understand the importance of supporting staff, listening to staff, understanding what they needed so that they could transfer that to our patients was the most important thing.

That's great. How many years in healthcare, Joan?

I would say fifty five.

Worth listening to. Charity, your turn.

I mean, I think there's with experience, you know, you get you get experience going through different pressure situations and you start to learn how to pivot and handle different things. And I think trying just to keep that kind of steady approach, and keeping your values in line with that approach. So, you know, when we're looking at things like a cyber situation, we are saying our patients come first, right? If we're going to take something down, we need to understand, is that going to affect care?

How is that going to affect care? How's that going to affect our physicians, our nurses? Kind of asking those questions, and also relying on the team to help. You know, I don't know everything, and I need perspective from others.

But you know, getting that in kind of a systematic way, and being able to try to make decisions, and also supporting the team, as you said, Joan, I think that's really important. It's important for other people to feel supported through that whole process.

That's good. I definitely agree. Andy?

I mean, there's so many, so I'm glad you're kind of wrapping up because I could go for a while. But the one thing I think is that science matters for me. So I'm a data guy. I'm a numbers guy.

And, you know, I have learned over the years, whether it was back in HIV, that there's a lot of really, really smart people working on really, really tough problems. And they'll write down their thoughts. They'll sometimes, you know, they'll put out graphs and information and that really makes a difference. And I can normally trust those numbers, And that's part of my fear protocol actually is to go into the, to learn about the subject, is to go do a deep, deep dive.

And that's true with any of these things that come up really. I'll do a deep, deep dive, whether it's hunter virus or Ebola, and then come out of it and say, okay, got something out of this. Know, got some numbers and then we'll go to the next step.

My learning is that with a lot of smart people who are well intended, we will figure it out.

That's right.

No matter how hard it is or how bad it is, we will figure it out because that's what humans do. And especially, I'm a little patriotic at this moment, Americans, we will figure it out. We got the gumption, we got the maverick style of approach to things.

You can't throw anything at us that we're not going figure out. I do believe that.

All right. And we never have to go through our first pandemic again.

Please. Right. Don't have to talk about it in a theoretical sense like we did.

Glass half full.

All right. That wraps us up for your day. Thank you for coming to this discussion. I think it was a good one to talk about leading through crisis.

You all are my heroes and so hopefully And you as well.

Thank you very much. I'm hoping we don't do that ever again, though. And so we'll see. Till the next thing. Alright. That's a wrap.

Charting with doctor McNeil.