00:00 Renee DeSilva
Welcome back to the table. I’m Renee DeSilva, CEO of the Health Management Academy and your host. This week, I had the pleasure of speaking with longtime friend of the Health Management Academy, Dr. Janice Nevin, President and CEO of ChristianaCare. Janice has led a remarkable career at ChristianaCare joining the system more than 21 years ago, she embodies their mission of service. In her own words, she came for the mission, and she stays for the mission. We continued our conversations around the next generation of leaders discussing culture at scale, and how to activate for the love of health, which is a core part of the mission and values of the system defined as having the courage to do the hard work that most might shy away from. As you’ll hear through our conversation today, Janice views culture as core to her role as CEO, here are a few of my takeaways. First, the investment in building culture and mission was evident from day one and her role as CEO. She prioritized time to understand the core values going on to share that organizations that survived turbulent times as a result of their team’s resilience and connection to those values. This stayed with me how we act as leaders communicate and engage throughout the organization ultimately creates the culture that drives success, a concept that we can all take back to our day to day work. Next, we covered ChristianaCare’s commitment to care delivery, innovation, and how care should be deeply personalized, highly accessible and centered around a continuous relationship. To quote Janice healthcare is human care. But innovation still plays its part, their approach to care delivery, innovation has a dual focus. First, how does innovation make the experience for the provider more efficient, more filled with joy? And secondly, how does innovation affect the patient experience? Finally, our conversation came full circle back to Mission, as we discussed their aspirational goals for zero disparities. This is not only embedded in their five year strategic plan in organizational goals, but it’s integrated into all the work they do as a system. So with that, let’s head to the table. Good morning, Janice. Welcome to the table.

Good morning, Renee, it’s great to be here with you. It is always nice to chat with you. I want to just before we dive into the substance, I just want to talk about you. As a leader, I have had the pleasure of getting to know you across the last five years. And so want to maybe bring some of that to life. But let’s start with your earliest days. One of the things that strikes me is that you always knew that you wanted to be a doctor, how did you get that clarity so early in life? You’re absolutely correct. I can’t remember anything other than wanting to be a physician. And the inspiration was as a young child, my best friend’s dad was the local doctor. And I used to sort of hang out with the family a fair bit. But I think fundamentally, it was, you know, my parents, there’s a great quote by Nelson Mandela, what counts in life is not the mere fact that we have lived. It’s what difference we have made to the lives of others, that will determine the significance of the life we lead. And it was made very clear to me early on that we and I say we because I have two sisters were put on this earth, to impact others to serve others, and to make a meaningful difference. What did your parents do as a vocation for that to be so crystallized for you? Out of my Yes, so my, my father was an Episcopal priest, which happens to be the family business. My sister’s an Episcopal priest, although she started as a nurse, and midwife. And my niece is an Episcopal priest, my youngest sister is a social worker. And my mother was an executive assistant extraordinaire, that’s amazing in terms of the grounded in service and grounded in something bigger than ourselves, which I can see how that animates, how you have how I observed you show up as a CEO. Yeah, and I think also,

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again, you know, the the service was always for those people in those communities that were vulnerable. And, you know, I have I got into health care, because I really did want to impact the health of communities and particularly communities that were challenged. So issues of poverty, issues of access, issues of racism, gender inequity, really, again, I think, sort of influenced by my family, but again, also influenced by some of the studies that I did, in college in particular really have sort of framed my career on, you know, how, what can I do to make a difference for those people who are most vulnerable in society? And so then over time you went from taking care of patients on a day to day basis to pursuing a more administrative role. Did you purposefully seek the CEO position? Or did it just find you along the way? When it came, when I was ready, I purposefully sought the CEO role. I had a number of experiences along the way, that led me to that, certainly, as a medical student resident, or earlier, in my career as a residency director, I was not thinking about becoming the CEO of a health system. But I sought opportunities to grow and develop, sought opportunities to evolve my leadership. And, you know, frankly, through the Health Management Academy, GE fellowship, and I was one of the the first leaders to go through that program, I was introduced to, I would say, almost a new world opportunities to have the kind of impact that I wanted to have in my career, but to do it in a different way. And so I, you know, I made a choice in that moment to pursue physician executive leadership, and stepped away from the more traditional clinical physician leadership track. Yeah, and it’s been interesting, as we’ve looked at, where current CEOs are tracking from, you know, what was the previous role that they served the last few years, we’ve definitely seen a increase in the number of physicians who, who really become, you know, sort of pursue a more administrative track and ultimately take the CEO spot. So I think you were a little bit ahead of your time in that capacity.

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Well, thanks, I have, you know, I feel felt very privileged to lead this particular organization, I’ve been at Christiana Care now for 21 years, came for the mission stayed for the mission. And to be part of this extraordinary group of caregivers that is so focused on living our mission, I’ve never once been disappointed. And as I said, I’ve had multiple roles here. But certainly, it’s a great privilege to be the CEO. So you’ve now been in the CEO role for almost 10 years, maybe reflect a bit on what what what has evolved over that 10 year period, both as a reflection of just time and seat and just the external forces that have been taking shape. And in this environment, when I started in the role, I had the benefit of knowing the organization and as importantly, knowing the community, and, you know, was able to hit the ground running in terms of really doing the work that we needed to do as an organization to sort of move outside the four walls, you have long held the belief that, you know, we we are here to create health.

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inside the four walls, we do a remarkable job of addressing sickness. But if we are truly going to achieve the goals of making people, families, communities healthier, it has to happen, you know, in the communities, in homes up more upstream. And so, you know, like many CEOs did the work initially of creating a new strategic plan. That was a firm commitment to moving towards population health, being accountable for population outcomes, both clinical outcomes, and financial outcomes, and starting to shape the organization in a way to deliver on those goals. The most important work I believe I have done as the CEO was about three years in when we had, you know, sort of firmly embraced our strategic plan. And I looked around the organization, and I realized that it was time to invest in doing the work to better understand our core values. It’s well known that organizations that survived turbulent times are not only successful because the people in them are resilient, but they’re connected to those core values. And they consistently demonstrate behaviors that allow that organization, not only to succeed, not only to survive, but frankly, to thrive in difficult times. Now, when we did this work, I was thinking turbulence was, you know, sort of payment change, policy reform. I wasn’t anticipating, you know, the pandemic,

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the greatest health issue that we’ve dealt with and dealt with in our lifetime.

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And I wanted to do the work differently. Because I’ve always believed we learn the most from the people who are doing the work, and the people who are receiving care from us. And so we did this values work across the entire organization. I said, I want to go to any part of our organization, talk to any person, and have them tell me how they contributed to this work. And we did that. And what emerged from the work was the value statement we serve together guided by our values of excellence and love, serving together being an expression of the importance of not only being on a successful team, but knowing that teams are going to work across the organization. Excellence, I always say it’s in our DNA. It’s about being exceptional today and even better tomorrow. And a lot was a surprise. And I was a little bit controversial initially. You know, I was in some conversations with folks who say you can’t talk about love and health care. But when you think about some of the great leaders Donabedian Don Berwick Peter Pronovost who are so focused on quality and safety, they talk about love, and that it is not possible to achieve those goals that are so important to those we serve without love. And so as an organization, I think we certainly know that love is about being generous with compassion, anticipating the needs of others. But more importantly, love is having the courage to do the really hard work that most people in organizations may shy away from. And so it is committing to diversity, showing respect to everyone, it is speaking the truth with courage and empathy, even though it may be difficult, it’s seeing those problems and being willing to walk towards them, and not sort of walk away from them. And so as you can imagine, when you know, march 2020, arrived, I was so grateful that as an organization, we had explored our values and the behaviors that support support them, we have lived those values and behaviors for a couple of years. And frankly, I attribute that to our ability to successfully manage through the first couple of years of the pandemic. And frankly, you know, this last year, it’s it may be the hardest work that we’re doing. But again, those values we draw on all the time, because we know we have to do the hard work, solve the difficult problems that we’re dealing with in healthcare, that resonated with me, for the love of health, I think is the short, sort of the tagline on that. And in the definition, I just want to play back something that you just said that I just think is worth repeating the definition of love, which is having the courage to do what’s hard. And often what you are doing every day and leading large integrated health systems is the hard gravel road. Right. And so I think that that is a beautiful way to encapsulate that. Thank you. And And absolutely, it’s hard work. So let me ask you one more question related to values, which is culture. And this is a topic that I know that you really animate on. It’s it’s an I think, in our view, it’s the work of leaders is to create culture. How do you do that at scale with the breadth and scope and reach of an organization? Like, like, Christianna? How do you think about doing that, and really ingraining that at scale, culture is so important. And I do see that as a core to my core to my role as CEO. And as I said, it, I believe it starts with our values and behaviors and creating opportunities for authentic discussion within the organization, engaging people, no matter where they sit in those in those conversations. And so, you know, I make myself available. I want you one of those specific things that I do is I do a monthly townhall for all of our caregivers, they can call in and I usually share some information about what’s going on in the system. I bring some of my leadership team into the discussion. And then I open it up and they can ask whatever they want, you know, whether it’s a, you know, a, a concern that they have about something on our benefits, or it’s a big strategic initiative that they had that they see us embarking on, like our expansion into Southeast Pennsylvania. And but I have found that particularly over the last couple of years to be of real value. I learned so much from the questions that I get asked, is still around and talked to frontline staff directly. And again, it’s talking to the frontline staff talking to those four

15:00
First line leaders and hearing from them what’s working, what’s not working, what their challenges are, how they’re responding really, really important. Because I, it’s, you know, it’s a way to better understand what’s happening throughout the organization, and to help create that culture. I think the other thing is we’re very transparent about everything we do. You know, it’s we’re transparent about our strategic plan our annual operating goals, we’re transparent about what we’re doing well, we’re transparent about what we need to improve and work on. So we have a culture here, I believe that is focus on excellence and love, and we, you know, we’re never satisfied with with where we are, we’re continually working to improve. And at the same time, you know, we, when we do work really well, you know, or sorry, when we do work that, you know, when we don’t get the results that we thought we should, and we acknowledge that and we learn from that, and then we build on, you know, what we need to do next. So I, I think fundamentally, culture starts with those values and behaviors. But then how we act as leaders, and particularly how we communicate and engage all the way through the organization, especially down to the frontline ultimately creates the culture that drives success. Agree and that that drumbeat is really important in terms of the consistency and how that gets modeled, and how the time spent is allocated accordingly. So those are all really good reminders for all of us in our own organizations. I want to switch gears a bit and talk about, you know, as we look at the the issues facing healthcare, one of the topics that often comes up is the need to continue to innovate on care delivery. And so can we talk a little bit about how you think about that, at Christiana Care? Absolutely, we have long had the mantra, all care that can be delivered in the home will be all care that can be digital will be an increasingly we talk about, and a technology will be accessed easily through voice. And that’s a phrase that we’ve been using, I think since I started as CEO, and we’ve done a lot of work. And fundamentally, you know, I believe that care should be deeply personalized, it should be highly accessible, and that access needs to be equitable. It should be based on a continuous relationship, rather than on transaction and episode, it should be enabled by technology, and as importantly, supported by people. Healthcare is a human care and the technology that we use can create so much potential. But fundamentally, it comes back to we do need people and people who feel supported and can do the work that connects to their purpose, their why in terms of coming into health care, we could probably spend, you know, the rest of the day talking about some of the specifics of the work that we have done. But you know, I think again, how can we sort of create an environment for what I’ve just described to occur? And so as you can imagine, like most CEOs, a lot of focus, particularly over the last year or two on workforce, and as I always say, you know, we will, we need more people, but we’ll never have enough people, so we have to rethink work. So some of the innovations in the acute care space have to do with launching Moxie. Moxie is a collaborative robotic co bot. We have a generous grant for the American from the American Nurses foundation to really explore how we can integrate Moxie into our electronic health record. Moxie is an extension of our human caregivers. Moxie does deliveries does some of the fetching and gathering on the units that makes makes sort of this makes careful list the work that our caregivers are doing feel sort of have less value. Ultimately, you know, when we are able to integrate Moxie into the electronic health record. Moxie will also be able to support some clinical tasks and we’re really excited about that. We’re also using Alexa in our women’s and children’s area right now. We did the work to integrate Alexa and Vocera and again, patients can connect with their caregiver without ringing a bell and having to wait for the caregiver to come into the room. So really enhancing the relationship between the patient and their caregiver

20:00
so they can both get their their needs met. We’ve also launched Alexa in the home, we developed Alexa home health coach, and the first HIPAA compliant Home Health app with Amazon. So Alexa is working with our home health patients, helping support them in their their health journey. And we just launched a couple of little robots into homes that have even more capability. This is at the early stages, we’re piloting it. But these little robots can support patients who are discharged from the hospital by doing even more than Alexa. So I’m really excited to see how that turns out. But I also think, you know, we talked about innovation, we immediately go to technology, I think there are innovations also that we can do around how we work, that maybe don’t involve technology. You know, one of we are using paramedics now, employing paramedics, to help us do some of the care that we’re delivering in the home. But we’ve got to think differently about, you know, how we do our work, challenge those assumptions that we’ve had for years about how care is delivered, where care is delivered, and who’s delivering it. Yeah, you know, one reflection I would have, as you’re stating, that is, when we think about care delivery innovation, it’s really through two different but important connected lens, which is how does it make the experience for the provider or the caregiver more efficient, and that has value. And then certainly from the patient lens, you know, that that is that is the other piece, but it really is a dual focus on innovation, both both through serving those, those two really important stakeholders and partners in care. Just to add, one of the innovations that we did this year was to solve the problem that we were having, I think everyone across the country is having with patients who really didn’t need acute care anymore, but had nowhere to go, couldn’t find a skilled nursing facility or weren’t able to go home even with home care. And so we rented a floor in the Hope Center, the Hope Center was a recently remodeled, Sheraton acquired by the county and turned into transitional housing for individuals and families who are homeless, but a lot of services around those families, including health care, we provide the health care, but we rented this floor for those patients who met discharge criteria, but just needed, maybe a few more days of someone checking in on them, making sure that they were taking their medications, making sure that they were getting fat and so forth. And it’s been great because it’s a source of revenue for the Help Center. And it helped us with some of our throughput issues. On the acute care side, a great example of an innovation that didn’t require technology, just some really smart people rethinking partnerships in the community. Yeah, that’s a great example. And also just the the way that health systems can catalyze support outside of the four walls of the of the health system. I think that’s another great way to illustrate that. Yes. All right. Well, let me go to one final topic. And I’m going to sort of play back what I’ve heard you talk about in the past, which is around that. Health Systems, in particular Christiana Care should aim for zero disparities, much like the medical community would say, zero harm. How do you how do you think about that? And what does it look like to just maybe Aspire or work towards that outcome, we will never achieve our goals of creating health together so every person can flourish unless we eliminate disparities and the healthcare embrace the concept of zero harm and focused effort efforts on reducing preventable harm. And it has had an impact and I believe we can do the same when it comes to disparities. So we have a strategic goal in our five year plan to end disparities,

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we know if we solve for disparity, we will get it right for everyone and we will achieve outcomes that are important to each individual important to a community. And so it is part of our strategic plan, as I mentioned, and it is it is integrated health equity, ending disparities is integrated into all of the work that we do as a health system. It took us a while but we use data. So we are not we are able to look and ask the question, you know, is there a disparate does a disparity exist in a particular outcome?

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If the answer is yes, what is driving that disparity? Is it race? Is it a type of insurance? Is it gender? Is it age, so we can understand, you know, what’s really driving that disparity. And then we can put solutions and start to see the impact. So when we have done that, and we’ve done that, particularly with a focus on maternal child health, we have seen significant improvements in, for example, postpartum hypertension, morbidity and mortality, we’ve significantly reduced the health disparity that was driven by race that existed in that population. And we’re also measuring not only the health outcome, but what’s the financial benefits. So we’re seeing when we do this work with that kind of intention, and focus, then we achieve the outcomes that we intend, we’re improving health, and making the business case for why it’s so important to do that. And we’re seeing some early work on very low birth weight, infants, and we think we’ll achieve the same, the same goals. That’s a great example. And I know that you are always very clear that there’s certainly a role that that caregivers can can play in creating an environment of wellness, but you also need to invest with communities and partnerships in the community to really get to a good place. And all of these things, maybe just bring to life a bit, how you approach the community investment to maybe be a catalyzer, a facilitator convener of solutions, not necessarily always being able to control the actual solution? Absolutely. The minute we start thinking we can solve problems on our own is the minute that, you know, we’re going to find ourselves in a whole whole lot of trouble. Partnership is absolutely essential. And partnership with communities is one of the most important ways that we will achieve our health outcomes. And just a couple of examples, you know, where we have had some great success, we are partnered with unite us and created unite Delaware, although it now includes part of Maryland, this is a statewide closed loop referral system. So a provider on the health system side who identifies a social care need can do a smooth hand off to an organization that does at best a community organization, we’ve got hundreds of organizations now on this platform, the other partnerships that we have done just to give a few more examples have been around substance use and behavioral health. We have long had a behavioral health unit embedded in the Newcastle county police, and just recently launched a new program with the Wilmington, city police, as you know, so many of the calls that the police respond to start because there’s a substance use issue or a mental health issue. And it gives the police a partner who can identify it as such, and then then then sort of be there to help resolve whatever that not only what that sort of crisis is in the moment then but to ensure that that person gets connected to the care that they need afterwards. We’re also very intentional about making the investments in our community partners. We’ve had a Community Investment Fund for several years now. And we specifically called it an investment fund. And we’re getting to the point where I think fairly shortly, we will be able to share with you that return on that investment in terms of how the partnership is truly impacting health. That’s That’s fantastic. And, you know, certainly there’s there’s financial matters there. But the community impact the getting community organizations to be more solvent, really being able to expand the reach are all really good, powerful examples from that story. All right. Final question for you, Janice, although I could I could go on would be. We’ve covered a lot of ground today. And this is a question that I ask all of my guests. So if you’ve listened to an episode, you’ve had a cheat here, but if you could invite any two people

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to a table that you convened for really any conversation that you’d like to have, who would they be and why? Well, this one is going to be very meaningful to you because I think we both miss him and that would be Gary Bisbee. You know, one of the things that I loved about Gary was his ability, really to connect with each of us in a very personal, meaningful way. He lived the value of love, and he would speak the truth with courage and empathy. He also had this uncanny ability to see into the future. I recently found a note card I had been at a meeting in 20

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17 and he had sort of shared the most important sort of themes in healthcare in 2017. And I looked at it, I said, that could be the same themes that we’re now dealing with in 2023. We didn’t know what they meant, in 2018. We’re living them now. And given all of the challenges that we face in health care, you know, I would, I would dearly love to be able to sit and get his perspective. And then I think the other person I’m really interested in hearing from is Mandy Cohen. She’s just been named the new CDC director of physician, she has had a really interesting experience, I think, in taking those themes that Gary identified and implementing them at scale, whether it’s CMS or North Carolina, and now, the CDC. So I think the three of us would have a pretty interesting time. I agree. And I will just, I will just end with when I when I joined.

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And in my sort of tutelage under Gary, he just always spoke so fondly of you. And so I know that, that your sentiment would really mean a lot to him. I don’t want to say he had favorites, but if he did, you were definitely one of them. So I appreciate you sharing that sentiment with us today. Thanks, Renee. Well, always good to connect. Look forward to chatting with you soon. And thank you for joining us. Thank you. Take care. Bye bye. Thanks for joining me at the table with Rene de Silva, a podcast brought to you by the Health Management Academy. I hope you enjoyed this episode. And if you did, subscribe, and drop us a review on Apple podcast, Spotify, or wherever you’re listening to this podcast now for all of our episodes, including show notes and transcripts and more information about how you might join me at the table in the future, please head to hmacademy.com/podcast. I look forward to having you back at my table next time. Talk to you again soon.