State of the System | Choosing Hope
Story 13

Joyce: Welcome everyone to State of the System. Thank you for joining us today. Scott, you've called us here for this moment, this place, this time, to have a conversation. And can you share with those who are joining us, why you decided that 2021 would be about choosing hope?

Scott: Thank you Joyce for asking that question. Hope is what is needed today. Hope is what we can count on when other things fail. Hope is what we need today to talk about, to celebrate, to understand, to appreciate where we've been over this last year and a half or so. You've heard from me over the last few years on many topics. Renew all, renewing the organization, one Adventist Health. And even in 2019, from success to significance, celebrating where we've come from. But who would have thought in 2020 and 2021, the topic would be hope? It's not about performance, it's not about metrics, it's not scorecards, it's not PowerPoints today, it's really looking at where we've come from and where we can go. So today I want to welcome you to the state of system. I want to welcome you to choosing hope.

Joyce: That's beautiful, Scott, thank you. So we have somebody waiting to come and offer some other thoughts. You want to invite him onto the set?

Scott: I would love to. I'd like to now bring on Alex Bryan. Alex Bryan is our Chief Mission Officer, to join us here this morning. Hey Alex.

Joyce: Hey there.

Alex: For you.

Joyce: Oh, gifts.

Scott: A little bump here.

Alex: Yeah, a little something for you.

Joyce: Okay, this could be interesting.

Scott: This is interesting. Okay, thank you Alex. So I suspect in a minute you're going to tell us the purpose of the ping pong paddle and the ball.

Alex: These objects are not accidental. They are here for a purpose and they are going to be symbols of hope. I'm going to tell you about that in a second.

Joyce: And just in case people are wondering, we really don't know why you gave us these, so this is a surprise for us too, so we'll see.

Alex: Well, a little ping pong never hurt anybody.

Scott: No it didn't, it's actually a good thing.

Alex: Well, most of us.

Scott: So, foundation. When you think about a foundation, and you're going to talk to us a moment about a foundation, you need a very broad and very deep foundation to actually climb further. When you think of the organization, where we're going, where we've been, the aspirations we have, we're climbing higher and higher and doing different things. And I suspect, the deeper the foundation the greater opportunity we have. So tell us about that.

Alex: Yeah. Can I stand up and talk a little foundation?

Scott: Yeah, please, you can talk foundation.

Alex: Because I think you're exactly right with that. I'll frame it up this way. I sometimes make a horrible mistake in competition with my 10-year-old son. Ping pong for example, everything is fine, I am beating him into submission, I am making sure that he has no opportunity to score enough points to ever threaten me. I have him on the brink of tears, I want to teach him a competitive spirit, and I'm just all over him. Then I make a mistake. I look with a little bit of compassion and I think I better give him a little bit more of a chance, and I back off. Instead of playing with my dominant hand, which is my right hand, I switch to my left hand. And he starts to score some points. And he has this new look in his eye, he acquires the most awful, horrible thing that you could ever give your son in competition, hope. He gets some hope.

And then that hope, I watch it in his face. That hope starts to develop a little confidence, a little cockiness, a little competitiveness of his own, and pretty soon that hope begins to fuel competency and then all is lost. Horrible decision on my part because now I can hardly keep up with him. Hope leads to incredible things. Just a tiny bit of hope, and pretty soon you're taking on much larger opponents, much stronger obstacles. Man, the power of hope to move big things.

There's a story in the first part of the scriptures, and there's these two armies fighting. And one army is totally psychologically dominating the other army because they have this huge giant by the name of Goliath. And everybody's terrified, "What are we going to do?" And then there's this one little boy, and he goes, "I'd like to go mano a mano with that giant." And everybody thinks he's crazy, but he's like, "Nope, I'm going to do it." Just one little one-on-one fight. And so they let him do it. And if you know the story, he prevails, he beats the big giant. And then the most amazing thing happens, this is just two soldiers, one beats another, little guy beats a giant. All of a sudden on the side of David who's this young guy, the whole army goes, "Wait a minute, we have hope." And they go and they chase the other army and they slaughter them and there's huge military victory. Just a little bit of hope and it turns everything around.

And so I wonder, do you play David? Do you show up in that one little meeting, that one decision, that one relationship, that turns the corner? Just a tiny bit of hope and everything changes.

Second part of the Bible, same thing. 10,000, 15, 20,000 people gathered, nothing to eat for lunch. Jesus says, "Does anybody have any food around here?" One little boy, "Yeah, I've got some fish, I've got some bread." All of a sudden, everybody has enough to eat by this shear miracle. One little boy says, "I'm going to put a little tiny bit of hope into the equation," and now you have the biggest feast ever and everyone can't believe it, there's even leftovers. Jesus says, "Just a tiny little seed of faith, a tiny little grain of hope, it can move mountains, it can build buildings, it can start revolutions." Don't underestimate your ability, wherever you are, wherever you work, to say, "Today, I'm going to instill just a tiny bit of hope," and then watch out. Because hope is so powerful.

And if each of us are sowing those little seeds, those tiny little bits of hope, pretty soon we're beating larger opponents, we're accomplishing great feats, hope sets the world on fire. So I want to challenge you today, wherever you are, from whatever seat you're sitting in, don't be afraid to say, "I'm going to be the voice of hope. I'm going to be that catalyst that does things that are so big it absolutely transforms our company, our enterprise, the movement that God has given us."

Will you pray with me? Father in heaven, thank you for giving us hope. Thank you for teaching us that it's not some big initiative hope that comes from someplace outside or some big group decides that there ought to be a big banner about hope. But no, here's the power of hope. Thank you for teaching us that it's the little things, one little fight, one little sandwich, one little seed. And we pray this in your name. Amen. Take care everybody.

Joyce: And now I'd like to invite Dr. Arby Nahapetian to come and join us on the stage. Hi, Arby. I'm going to hang onto this paddle just in case I need it here.

Scott: Just in case you get in trouble. Hey, Arby. Good to see you.

Arby: Hey Scott, good to see you.

Scott: You know, it is really great to see you. And I really mean that.

Arby: It is great to be here.

Scott: Yeah, I bet it is.

Arby: It's been a tough couple months, but we've managed as a hospital system, a health system, to really shine. And sharing with Joyce earlier, we've been blessed with the resources we've had, the people we've had and man, have they shined during this experience.

Joyce: They sure have.

Scott: Tell me a little bit ... We got this crazy pandemic, right? It's affected everybody's life. It's affected home life, our work life, our church life, everything that we do. And yet as a chief medical officer, you're kind of seen as someone that you need to make sure that we clinically are prepared, that we are safe. You have this responsibility with our physicians and our providers. Tell us how you've cared for that a little bit, how have you organized that and worked with it?

Arby: We've been very intentional. And I'll tell you, I could not be more proud of our medical staff and our nursing staff, and how they have pivoted, how they have adapted, how they have learned to deal with a lot of the adversity that COVID has brought on them. We had a lot of folks pinch-hitting in the hospital, even though they were ambulatory people. We've had a lot of folks from the emergency rooms do shifts as hospitalists and intensivists under the supervision of some of our folks. We've developed programs where we've shared physicians up and down our network. We took kind of a bold move in cross-credentialing all of our physicians at all of our sites, and all of our medical staff know what a difficult thing that was to do. And to be able to then share expertise up and down.

We've had sites develop best practice as the pandemic was ongoing about how to treat patients. We've shared those learnings across the enterprise, we've shared them with other enterprises. I'm proud to say that the esprit de corps has been one of unbelievable cooperation in the healthcare space. And working with other health systems, they've shared [crosstalk 00:11:46]-

Scott: So we've really had to innovate. We've had to really kind of blow it open and work collaboratively across many places.

Arby: Which kind of begs the question, "Why haven't we been doing that all along?"

Scott: Right, what could we have learned before?

Arby: Been learning.

Joyce: So all our plans, all of our preparation, and the most care we can take, and yet sometimes it still hits home, right?

Arby: And man, did it hit home.

Joyce: It did. So maybe you can set up the video for us by telling us just a little bit about how it hit home.

Arby: I'll start with a story. It's not often you get non-business related texts from the CEO of the company. And I got one, "I heard about what happened to you and I'm glad you're doing okay." So I will violate my own HIPAA freely, for the record.

Scott: You can do that, I think. You're allowed to do that.

Arby: And part of what I'll share is that I actually got COVID. And it was a long, drawn out episode of about 20 days. And at the 21st day, I ended up in one of our emergency rooms at Glendale. And I had a clot, from the hypercoagulative state that COVID caused, in my kidney and in my right coratid. And at one point the oxygen demand was so high that I actually stopped talking. Kind of an interesting experience, and we'll reference that in the video. But I'll tell you, it was both humbling and one of these opportunities to really appreciate the investments in our people, our skill set, that delivered the care. Where frankly, I'm sitting here, how many months after and talking to the both of you without a clot in my neck, without a clot in my kidney, and able to share the story.

But it really helps one reflect about what's truly important in life. When we talk about treating every patient the same way, whether it's me, whether it's you, and putting in the systems that even times of stress, and man was this a stress test for all of healthcare. And to be able to come through shining ... And it was very humbling, because part of the culture that took care of me, 60% of [inaudible 00:14:16], I did the dirty doctor math on the back of a napkin, 60% of the nurses had actually been on a medical mission trip at one of our sites. And 80% of the physicians that took care of me had been on a mission trip in one of our Adventist Health medical missions.

So I could not be more proud. You take the clinical skill, you take the do-gooder we're going to live our mission skill, and I can only thank the teams and be humbled by the experience.

Scott: Yeah. You probably couldn't have been anywhere better at that moment.

Arby: I'll tell you, there were many ... I have a fair number of colleagues in some ivy tower type institutions who called and asked for me to be transferred there. And I couldn't talk, so called my wife, and she's like, "Absolutely not. He is going to get the best care here within Adventist Health." And I'll tell you, knowing some of these other institutions, I know that I got much better care within our walls. Plus with that milieu of folks that I knew, who had been on trips with me, you can't describe the pride in that scenario, even though you can't talk.

Joyce: Well we're so thankful to have you here with us today. Let's watch the video and see more of the story.

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James Burke, MD: Arby's unresponsive. We've called the entire team. It doesn't look good.

Peter Shin, MD: My name is Dr. Peter Shin and I'm an Emergency Medicine Physician here at Glendale Adventist Medical Center. I remember it being January, even February. We had heard of coronavirus internationally.

James Burke, MD: We weren't sure if we all were going to get sick taking care of patients. I'm Dr. James Burke. I'm the Ambulatory Medical Officer.

Mikayel Grigoryan, MD: The main concept in pandemic is that you do not hide from a disease. There is no such thing as hiding from a disease. You need to fight that disease.

Mikayel Grigoryan, MD: My name is Mikayel Grigoryan. I'm a vascular and interventional neurologist. But I've known Dr. Arby since November 2016. Arby is, obviously apart from being within the Adventist Health System as an administrator, he's a very passionate doctor.

Peter Shin, MD: He's very personable. He's a good communicator. He's a very thoughtful person.

Arby Nahapetian, MD: I'm Dr. Arby Nahapetian, Chief Medical Officer for the Care Division of Adventist Health.

Elizabeth Maslow, MD: I used to think that as long as I do certain behaviors, I won't become a patient. COVID changed everything.

Arby Nahapetian, MD: We actually don't know where I got COVID. I was recovering and was no longer infectious and we decided to go get some takeout. I realized all of a sudden that I couldn't talk. My wife is an attorney by trade, and she immediately kind of started screaming that I was having a stroke, and I was thinking about it and I was like, "You know, she's right," but I just can't communicate that.

Mikayel Grigoryan, MD: It was Friday evening and I was not on call, but in our line of work, your phone is always on and you're always available. You never turn off a phone. I got a phone call from a dear friend and an excellent physician telling me that Arby's in the Emergency Department.

James Burke, MD: I got this phone call from one of my colleagues in the emergency room, and he was panicked. "Arby's unresponsive. We've called the entire time. It doesn't look good."

Mikayel Grigoryan, MD: We knew that he had COVID, but it's been already three weeks, but we know how tricky this disease is. So there he is, he understands what you tell him, he follows commands, and yet he's mute.

James Burke, MD: He could completely understand us, but he couldn't speak.

James Burke, MD: Here at Glendale, we are a comprehensive stroke center. And being a comprehensive stroke center, all of those protocols and pieces were in place. We had the advanced specialist, we had the interventionalist, we had the neurologist.

Mikayel Grigoryan, MD: COVID is known for forming blood clots, but unlike traditional stroke where the blood clot is in the brain, his clot was actually in the neck on the left side, but that clot was so big that it was impairing the flow to the left side of the brain that controls language. And language is the most oxygen-sensitive area of the brain.

James Burke, MD: We walked him up to the cath lab, and then he went into the surgical suite.

Mikayel Grigoryan, MD: There are no guidelines for this kind of treatment. Nobody will tell you exactly how to do. Are we going to treat that blood clot with blood thinners, or are we going to go and fetch that clot out? The danger of going to fetch that clot out is that you can push it further up, it can break into many pieces and then instead of having one big blood clot in the neck, you're going to have dozens of small blood clots in the brain, and that's game over, because it's very difficult to chase small clots.

Mikayel Grigoryan, MD: On the other hand, if we leave him on medications to thin the blood, that clot may not dissolve and obviously there is a person who is unable to speak at all.

Mikayel Grigoryan, MD: We made the decision to get the clot out, and I frankly told Arby, as much as he could comprehend at that time, and his wife, and the ER physician, "Look, I'm going with my gut feeling, but I believe that this is the right thing to do. And I'm going to own my decision, and if you agree with that, that's what we're going to do."

Arby Nahapetian, MD: Thankfully, Dr. Grigoryan had evacuated a fair bit of clot out of my left carotid. I remember the first question after that, him asking me, "Can you speak? Can you say anything?"

Mikayel Grigoryan, MD: And I ask him in Armenian, "Say something," and the first thing he said was, "What do you want me to say?" He said it in Armenian and we all started laughing.

Arby Nahapetian, MD: And I remember the entire cath lab sort of starting to laugh collectively with a couple of people in the control room kind of tearing up. I realized that most of the people taking care of me were folks that had come on a mission trip, or two or three, and that was actually a really comforting, nice feeling.

Peter Shin, MD: We are a stroke center, and there are processes in place for all patients who present in this manner.

Elizabeth Maslow, MD: I truly in my heart believe that we're all created equal. I see it as all of us helping each other.

James Burke, MD: If you're an executive here at our facility, or a patient in the community, you're going to receive the same expert care, same high-quality patient experience.

Mikayel Grigoryan, MD: I would take exactly the same care of you and anybody else who comes through the door. It doesn't really matter. This hospital epitomizes the center of care for the community.

Arby Nahapetian, MD: COVID, I think, has truly made the world a smaller place, and this is going to create a new focus on the public health of the world, and some of the prevention that we can put in place, which is frankly core to the mission of Adventist Health.

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Scott: I'd love to invite Jackie. Jackie, please join us.

Jackie: How are you?

Joyce: Good.

Jackie: Good to see you.

Joyce: Good to see you.

Scott: Good to see you. We're doing this, all right. Double, we're doing double. Jackie welcome.

Jackie: Thank you.

Scott: It's so good to have you. Last time I may have seen you was in our command center, just leading out doing that strong work you do across our system. I want to thank you for that.

Jackie: Thank you.

Scott: We just finished celebrating, just recently, I think even today may be the last day of our Nurses' Week.

Jackie: Yes.

Scott: So personally as a nurse, I couldn't be prouder of the profession. This last year has been an incredible testament to what nurses do, how compassionate they are, and what care they give, selfless care. Tell me a little bit about how you think about that and look at it. And what has this meant to you this last year?

Jackie: Well, last year was actually the year of the nurse. And because of the impact nurses have played during COVID, it's actually been changed to the month of the nurse, so it's actually been extended. I will tell you that our nurses and physicians were critical for us being able to provide the care that we did over the last year. And I was amazed, humbled, and awed by our nurses. They were so nimble.

We changed units. They would come in one day, it was a Med Surg unit, and then the next day it was a Telemetry unit. We changed PACU units into ICU units, and they rolled with that. We gave them new team members because we needed to bring agency on to meet that demand of all the volume and high acuity, and they embraced those people to work with them.

We changed nursing staffing models. We went from primary care to team nursing, haven't done that in over 30 years. But we did what we needed to do for the patients, and that is what they were concerned about. We were also concerned about them. So we wanted to make sure that they had the right personal protective equipment, and we couldn't always get the same brand of it, we were switching brands. And they were [inaudible 00:24:29] in learning it.

I will tell you, we were changing protocols. You do something this way this week and three weeks later, that's not what the evidence is showing.

Scott: Yup, change it again.

Jackie: And so we're changing it. We learned how to do as teams to prone position patients. I don't know about you, but I've worked ICU and it's pretty scary to take somebody who's intubated, has all these lines on, and put them on their belly.

Scott: Would not have expected that at the beginning, right?

Jackie: And not cut anything off. And it takes about five people to coordinate that, and we did it with lots. So our nurses were amazing, and I'm humbled by what they were able to do. They're just incredible.

Joyce: So Jackie, I know this global pandemic has affected us in countless ways, immeasurably. And yet it was the vaccine distribution that you found particularly meaningful. Tell us about that.

Jackie: We had gone through, I think, three waves of COVID, the last one being the most significant. And we had days where we were counting how many people died from COVID in the system, and it just kept climbing and climbing. And it was very ... When you talk about hope, this was the opposite of hope. And it was really soul-sucking in terms of the despair from it.

And we didn't have any medicine that was truly a cure for this, right? And when the vaccine came out, it was amazing. I've been in healthcare for more than 38 years, and I will tell you, to me, I've never experienced anything like this pandemic. I hope to never experience anything like this again. And for most people, this is something that happens once in every hundred plus years. It was a ray of hope, it was phenomenal. We saw light at the end of the tunnel, and it was just pure joy to know that we had something to offer against this awful disease, and that we were going to be able to do something.

I was elated over it, and I will tell you, so many nurses who had been working overtime to meet our patients' needs volunteered to go give vaccine administration because they felt how important that was and what a difference it was going to make. Everybody was just so overjoyed with the concept.

Scott: Maybe they just wanted to have their own personal experience of what that hope felt, very tangibly, right?

Jackie: Right.

Scott:It's probably the greatest example we can show about loving our communities and going out and reaching them on their turf. Not in our hospitals necessarily, in some cases they were, but just right in the communities.

Jackie: We actually have given vaccines to over 260,000 doses out. So talk about touching our community, in one of the largest waves that we've ever been able to reach out. That's pretty amazing.

Scott:

Yeah, that is absolutely amazing.

Jackie:

And I am just awed by how people have responded and wanted to do this. This wasn't we had to go looking for people, people were coming to us and saying, "How can I volunteer to do this?" It was so important. So people could get back to their family, their church, their community, their hair dresser, to go shopping, to be able to give somebody a hug, that made all the difference.

Joyce: So meaningful. Well we have a story, a video, that we can watch about one of the mass vaccination sites.

Scott: Oh good, this is fun.

Joyce: So let's watch the story.

Jackie: That's great.

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Jacalyn Liebowitz:

Adventist Health's mission is one of health, wholeness and hope, and this is really about the hope.

Kiyoshi Tomono:

We've taken on a calling of what God expects of us, which is to be his hands and feet. That's a pretty heavy burden.

Allison Fugitt:

We are standing at Cal State University, Bakersfield. We're right outside of their student resource center, now officially our COVID-19 mass vaccination center.

Kiyoshi Tomono:

The goal here is to have one location where we can bring thousands of people and vaccinate them efficiently and quickly, and end this pandemic as quickly as possible.

Fadi Abu Sneineh:

We started this journey a month ago in a race against time. We closed the basketball courts. We made them a vaccination hub.

Allison Fugitt:

Observation area was a functioning gym with all the exercise equipment.

Fadi Abu Sneineh:

We moved everything to the Icardo Center. So it was a lot of work.

Rebecca Malson:

The last few weeks have been very, very busy, a lot of hustle and bustle.

Jacalyn Liebowitz:

In order to bring up the mass vaccination center, it requires not just planning, but a lot of people to be able to manage it.

Fadi Abu Sneineh:

In every shift, I think that 70 to 80 employees.

Rebecca Malson:

Staffing, IT.

Kiyoshi Tomono:

Registration teams, the clinical teams.

Rebecca Malson:

Environmental services to make sure all the sharps containers are put away.

Kiyoshi Tomono:

The teams that had to come up and set everything up out here, it was a pretty large undertaking.

Rebecca Malson:

And now, it is a pharmacy prep area or an actual vaccination station. Every single little detail, basically, of a hospital has been placed at this site.

Jacalyn Liebowitz:

We have observation areas that we can bring people to if they are having more intense reactions. And then we have all of the lifesaving equipment to provide more than need should anyone have it. We actually have an ambulance onsite at all times. Hey sir.

Reynold Reynoso Hernandez:

How are you doing today?

Jacalyn Liebowitz:

Good. How are you?

Reynold Reynoso Hernandez:

Doing good. My role here on the mass vac site is to be a physician leader. By being the last voice of reason, what you try to do is to calm the people's fears, to be safe and efficient, and to coordinate any questions medically related.

Jacalyn Liebowitz:

Today is actually what I would call our soft opening. And so today we will run a very small number of people through the vaccination site so that we can test and understand if we have anything that isn't working, if we need to tweak any of our processes.

Rebecca Malson:

No one organization could accomplish this on their own.

Kiyoshi Tomono:

We were kind of running this operationally with three different groups. We've got Dignity Health, Kaiser Permanente, and Adventist Health all on site. So you have three different groups, but we're all operating as one cohesive team.

Fadi Abu Sneineh:

We all have common goal, which is one community, one entity trying to get rid of this virus.

Allison Fugitt:

So when you're all working for the same goal, it doesn't matter what organization you come from. You're all working together.

Reynold Reynoso Hernandez:

Everybody's excited, and we are volunteering to do this work because we know it's the right thing to do.

Jacalyn Liebowitz:

What we are doing today will impact more lives than I've ever touched throughout all of my decades in nursing. This is huge.

Kiyoshi Tomono:

This mass vaccination hub has the ability to bring in 5,400 people per day, which is roughly 38,000 people that we could vaccinate every single week, which is pretty astonishing when you think of those numbers. We're looking at being able to vaccinate everyone that wants to be vaccinated in Kern County by June.

Jacalyn Liebowitz:

We're probably going to be surpassing upwards of 3 million people that Adventist Health will be touching to be able to vaccinate.

Reynold Reynoso Hernandez:

The committee is part of you. I live here. So it's part of us. They are our friends, our family. We don't want to see them in the hospital. So we can prevent hospitalization and death by getting people vaccinated. It's really important.

Speaker 7:

Awesome.

Speaker 8:

Not too bad?

Speaker 7:

Nope.

Speaker 8:

All right.

Speaker 7:

And so where's the observation?

Speaker 9:

Within probably 60 seconds of walking in, I started crying. This is amazingly well-organized, and it was the easiest thing that I feel like I've done in 12 months, but it is also such a hopeful thing. We're going to get to move forward. This feels like the most positive, hopeful thing that I have done in 12 months is walking into this room. The way that it's laid out, the floor markings, the colors, the balloons, all of it feels like such a celebration. Kudos and thanks from the bottom of my heart as a human and as a mother and just citizen for putting this together and moving us forward.

Speaker 10:

I think folks are hoping we'll get enough vaccines administered to where we're getting toward that herd immunity, and it's a light at the end of the tunnel. We're getting close. And so I'm excited about it.

Rebecca Malson:

Anyone who works in healthcare knows the devastating effects of what COVID can be on some people. The thought that we can give a vaccine to someone and prevent that illness, it's really, really, really exciting.

Speaker 11:

Ready?

Speaker 10:

Yep. Painless. Didn’t feel a thing.

Speaker 11:

And here's some more information.

Rebecca Malson:

And so I'm really thankful to now embrace hope and joy and the end of this pandemic and getting my daughter to school full-time.

Speaker 12:

He's got an autoimmune disease. So it's important for us to stay healthy because he can't get this. So that's one of the reasons why it was so important for us to get vaccinated.

Speaker 13:

Get the vaccine. It will protect us.

Speaker 11:

This is just a major part of history that we're going to look back at on our textbooks. So to come here and be a part of the solution, it's humbling. It's definitely humbling, and I can't wait to tell my kids about it.

Allison Fugitt:

I've got a little girl at home. When she gets old enough, I'm really glad that I would be able to tell her that I helped in my small part in the pandemic.

Rebecca Malson:

It's going to be seven days a week, 12-hour days for everyone. So we're all going to be hustling and working really, really hard.

Kiyoshi Tomono:

We know it's a big job. It's a heavy burden, but being able to deliver happiness and hope to people is something that's giving people a lot of joy, too.

Fadi Abu Sneineh:

It wasn't a challenge. It was joy. To be honest with you, it was joy to work in this effort. It's part of our mission as Adventist Health living God's love by inspiring health, wholeness and hope, and that hope is what we're trying to promote here in our community.

Reynold Reynoso Hernandez:

Adventist Health is a force for good. I'm very joyful to work for Adventist and being able to be in this position that I can help.

Jacalyn Liebowitz:

It really has been a labor of love to be able to deliver on our mission. It is that level of hope that is inspiring.

 

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Joyce:

Wow, I keep thinking the word powerful as we watched these stories. I'd like to invite Jason Wells to come and join us. Good morning, Jason.

Jason:

It's not easy to follow Rebecca's story.

Joyce:

I know, right?

Scott:

Good seeing you, good to see you Jason.

Jason:

Good to be here.

Scott:

Jason, good to see you.

Jason:

Scott. Hi.

Scott:

Hey, listen, I want to say thank you, for someone who's really helping us and leading our experience, to actually share a story of your own family as ... your own patient experience. And I know we're going to have one on our story website.

Jason:

Yeah, we are.

Scott:

I've already had a chance to have a preview on it, which was amazing and very touching, so thank you for sharing that.

Jason:

You know, 10 years ago, it feels like yesterday telling that story. It's not easy to do, we feel so grateful.

Scott:

Yeah.

Jason:

So thank you.

Scott:

You bet. And your role, you're taking on an amazing opportunity to think about how we can envision an experience. We've seen incredible experiences with these videos and stories.

Jason:

Absolutely.

Scott:

Tell us a little bit about your vision on experience journey for Adventist Health.

Jason:

You bet. When you think of a patient's experience, a consumer's experience, a family member's experience, it's our brand. It's exactly what we deliver, and companies we fall in love with have incredible experiences. They deliver it with consistency. So I think of three things. First, we have to highlight the excellence we have. We've got five-star hospitals. We have people that are doing incredible work each and every day all across the system. Let's inspire, let's tell those stories. What have they done that's been so amazing.

Second, we've got to go here. Our patients and consumers are saying, "We want to lay in bed, we want to talk to a doctor, we want to be to do it 24 hours a day. Some of the old ways of healthcare aren't working for us anymore." And they're moving with their feet, and frankly, their fingers. So we've got to go digital.

And then third, we've got to go into the home. There is no question that consumers are saying the home is the future. We want to be in the home. Our packages go to the home, our cars are delivered to the home, our food's coming to our home. They want healthcare in the home.

Scott:

Absolutely.

Joyce:

So speaking of healthcare in the home, Hospital at Home.

Jason:

Hospital at Home.

Joyce:

Does this have a long-range future? Does it have legs? Tell us what you see in the future.

Jason:

Yeah, if we listen to our consumers it does. Right now, we've had over 520 patients to date. Today actually marks our first patient at Glendale a year ago.

Joyce:

Wow.

Scott:

Wow, today.

Jason:

So we were the first in the state of California. Mayo Clinic is leading in the Midwest and the East, we're leading on the West. But we have over 520 patients, and we have the number one HCAHPS scores for this population of all of our hospitals. They love the experience at home, and I do believe it has legs. I believe that we will deliver much more care than we do today in the home. You can imagine ED at home, primary care, specialty care at home. And we're seeing competitors move into this space where they bring the hospital to you, and like I said, we've led this in California.

Joyce:

Well we have a story here today about a hospital at home patient, so do you want to set that up for us?

Jason:

We do. She's also Glendale. So Gabriela, her family, COVID came into the house, it kind of went through, and she went to the emergency department thinking, "Hey, we'll test, I'll go back home." Sure enough, she had an inpatient admission. It broke her heart because she wanted to be there taking care of her family. And she shares her story. It's a beautiful story, and it shows the power of when we listen to our patients, when we listen to consumers, we take care to them.

Scott:

Well I'm looking forward to seeing Gabriela's story.

Joyce:

That's great, let's watch.

--

Gabriela Padilla:

We think we have a very typical house, certainly for our community. We have my mom and dad, my brother and his girlfriend, and one of my other younger brothers, and my son and I.

When the whole pandemic started, it's one of the main concerns was me getting sick because of my pre-existing conditions and my parents. My sister and I were watching as my dad started to get sick. Maybe four days after that, my son started complaining of a headache and a fever. And I'm like, "No, this isn't normal. He never gets sick." Immediately I took him to get tested. And then he came out positive. And so, by Wednesday or Thursday, he was already on the mend, which I'm like, "Oh, thank God," because that evening I started with a fever. I'm like, oh great. Here we go. Now it's my turn.” I'd have fevers at night. I told him, I said, "I think, I feel like a little dehydrated." So we just went to the ER. By that evening, they're like, "You have to stay." And I didn't know. I must've felt something because when I left and we were driving over I just broke down. I had to start crying because I told my son, "I'll be right back."

Just having to make that call of, "I'm sorry, but I'm not going to be home after all. And I'll just call you as soon as we get more information." And my mom says that ... I don't know. She doesn't know how I do it, but it seems like I'm the only one he talks to. I'm like, he is such a chatterbox. And she's like, "No, he's not. You're the only one he talks to."

You feel your body is not right. But in my mind, it's just like, so what are you looking for so that I can get back home? Maybe I can will my oxygen level higher or my fever lower or whatever it is to go home.

The fourth day that I was in the hospital and the morning doctor that gives you the rundown was like, "So we have this program and it's a hospital at home thing. And your oxygen level has improved some and we feel like we can recommend you for this program." And I'm like, “Yes, at home! Yes, me at home. That would be great.”

First thing I do is hug my son. And it was a moment where it's like, we definitely are not going to do this again for some time. And just holding him. And it's ... I'm home.

When I got home and I saw the setup, it definitely felt like, oh, this is interesting. I wonder how it will work. And then it starts working. You start getting the phone calls and the nurse all of a sudden pops up on the iPad.

One of the things that they send you home with is this watch. So what happens is that if you start to feel unwell, you press it. It just alerts that something has happened. They need to send someone out.

So the field nurses in the beginning would come about three times a day. I think Ryan was definitely one of the nurses that was very encouraging about the idea of, well, let's have a conversation. Let's ask these questions.

Ryan:

I've been a nurse for 18 years. So sometimes it gets so busy that I’m not able to talk to them about their life story, about their families. Here in a home we have the personal interactions. I was the one that discharged her the last day. Totally different person.

Gabriela Padilla:

And I think that's the best part of having it done virtually. It's that idea that at least your brain can turn it off for a moment. Even if physically you're still being ... You still have the bracelets, you still have all these different things that are 24/7 care. But then you get those moments where you get to turn it off. And my son masks up and he pokes his head in and he's like, hi. And I'm like, hi. And that moment of joy of seeing his face that you can't have at the hospitals because you're so completely isolated. And no matter how much it is for your well-being and your care and other people's care, that loneliness is so consuming and in a way that you don't register until you get to hear the idea that you get to go back home. I'm getting the best of both worlds.

I'm getting to receive this amazing care from people who genuinely make you feel like they want to provide this care for you. That they're happy to do it. And I'm getting my family.

And how could you not get better? It's that idea to come along, not only physically, but emotionally and mentally, and not have to put two aside. And kind of say, "Well, right now let's work on the medicine and physically getting you to some point, and then eventually you'll get to be back with your family. So you start to feel better." And if we can do it all together, all the better. And I think that's what this program made possible, is the idea of let's keep getting better.

 

--

Scott:
I'd like to introduce and welcome Andrew Jahn. Andrew is president of our Care Division. So, welcome Andrew.

Joyce:

Hello brother, how are you?

Scott:

Good to see you, sir.

Andrew:

Yeah. I was wondering what a CEO and Chief Culture Officer do, now we know.

Scott:

Now we know, we do this.

Andrew:

You guys are doing an amazing job.

Scott:

Well thank you. We're here telling stories, it's important.

Andrew:

I love it.

Scott:

And you guys are creating a lot of them.

Andrew:

Thanks for letting me be a part of it.

Scott:

So going into this week is our Hospital Week and Healthcare Week. And if you think about the footprint Adventist Health has, we have some incredible places across four states, three states, different communities, urban communities, rural communities, some communities are very poor, they're older. So tell us a little bit about how you think about expanding access, expanding care to actually some great populations, some difficult populations, and where they're located. Give us a little flavor on that Andrew.

Andrew:

Well Scott, really the center of that story is our caregivers. It's our frontline staff. And words like expansion and access and growth and market share, they just fall so short of capturing what these people are doing on a daily basis. And that's why I love the chance to celebrate our caregivers this week. We get to showcase and thank them for the extraordinary effort that they're putting in to taking care of our patients and our communities. And at the end of the day, that's our job.

Scott:

Yeah, absolutely.

Joyce:

So we're going to show a map of the clinic system throughout our company. And can you share with us a bit about your vision for the Care Division and how that fits in with our clinics, how the clinic fits in with that vision.

Andrew:

Certainly. That map of 300 clinics is just the starting point in terms of how we contribute to the communities we serve. That map represents our entry, if you will, into healthcare in the space. Over the next decade, we're going to double that footprint. But again, it's not about doubling market share, it's not about 300 more access points. The measures of our success are going to be measured in things like the health and well-being of the communities that we're in, the number of lives that we've transformed.

And rather than tell you about what these clinics do, I'd rather just showcase some frontline caregivers and some patients that we grabbed in this video.

Scott:

Let's do it.

Joyce:

Great, let's watch.

 

--

Kerry Cromwell:

If there were no community clinics, I think that a lot of our people would get lost in a confusing system.

Because medicine and being an advocate for yourself is a really hard thing, especially if you don't speak the language or you don't understand the system.

And I think having clinics offer a consistency to no matter where they are, they know what to expect.

Andrew Jahn:

Today, I'm blessed and excited to be in our Hanford rural health clinic. This clinic alone, is on pace to treat over a 100,000 individuals in this community, this year.

Raul Ayala:

This is one of the 39 rural health clinics, and one of the 60 clinical services within our ambulatory setting.

Andrew Jahn:

Adventist Health Hanford's rural health clinic is part of a network of clinics that Adventist Health operates that will treat over a million patients this year. To put that in context, we take care of about 200,000 individuals a year inside an acute care hospital. Our clinic structure has an opportunity to see five times as many individuals, which means we make five times the impact in the communities that we serve.

Kerry Cromwell:

So what we do here at the clinic is to the advantage of the patient, because we partner with them in their daily management of their illnesses, to where it doesn't become exacerbated so that they're not in the hospital, which can interrupt their entire life.

Stan Plooy:

I've been working with the complex care clinic for about four years. It is unique to have a chaplain at a clinic. And from the very beginning, some of the patients that I first met, I still get to see them even today. I just love learning about people, because everyone has a story.

Raul Ayala:

Where we are in this clinic, geographically, right behind this clinic is a school and right in front of this clinic to the west side, there's a park. We can see everyone. And again, it’s having the ability to see patients for their medical issues, whether that's walking into any of our clinics, whether it's a behavioral issue or a dental issue. We have services here from both primary care and specialty, and we open at 7:00 and we don't finish until 9:00 at night. And that's seven days a week.

Douglas Talk:

I think that the clinical setting is where we as physicians can have the greatest impact on patients. Like Hippocrates said, "It's much easier to prevent an illness than it is to treat it." And so, when patients come to see me, it gives me an opportunity to do what I think our primary job as a physician is, and that is to teach. It's a new day of medicine. Patients don't want to come to a doctor and have them tell them what's wrong with them. And then tell them, "This is what you do. You do A, B and C and follow back up in four weeks." Patients want to be informed.

Andrew Jahn:

Our clinic network gives Adventist Health a platform to leverage the power of the physician-patient relationship. That relationship gives us the opportunity to influence individuals in our community to live longer, healthier lives.

Raul Ayala:

Our clinics are somewhat sanctuaries, and they're sanctuaries of health, and they're sanctuaries of well-being, and a place where I know somebody is going to help me. And so that's what draws me here. That's why I am so happy to do what I do every day.

Douglas Talk:

They always say to physicians when you're in training, "Remember that you are part of a community. Remember to be part of a community." I think here we're more than that. I don't think we're just part of a community. Our clinic is the community. The providers, the MAs, the nurses, they go to church with these patients. They give us food at the grocery store and service in restaurants and fix our cars. They're family members and friends. They're patients we see on a daily basis. And so when those patients come in, it's not just somebody coming in for an OB appointment. It's someone who's coming in, who I want to know how their daughter Jessica is doing. I want to know how their husband who's been hospitalized with coronavirus, how he's doing. We are community. Adventist Health is not a part of the community. Adventist Health is the community. And because of that, I think we can provide a service, a closeness, a quality of care that you would not get somewhere else.

 

--

Joyce:

Adventist Health is the community, right?

Scott:

Absolutely.

Joyce:

That's the word that keeps coming to mind, it's powerful. I'd like to invite Shelly Trumbo, Melanie Cumbee, and John Beaman to come and join us.

Hi guys.

Shelly:

Hello.

Joyce:

Good to see you.

Shelly:

Good to see you.

Joyce:

Hi Melanie.

Scott:

Hello, good to see you. Hey Melanie, good. John, can we do across the table if you can reach?

Welcome. Look at the smiles across the faces here. You must be into the business of well-being. I can tell.

John:

You got it, we're all about well-being of people.

Joyce:

It's a happy crew.

Scott:

The healthy, smiling, happy, that's good. So hey, welcome again. Living our best life, what does that mean for our associates?

John:

I love that phrase, living our best life. I think for all of us, there are some unique things. We're going to define that our own way, but ultimately there are some commonalities. And I think those go toward the pieces of health, our social network, our community. Financial well-being, I think, is something we don't talk about enough that gets to our overall best life. But then ultimately, it's purpose, and I love the theme choosing hope, because ultimately that wraps it all together into one holistic picture. And I'm excited about this team and all we're doing because we're going to bring solutions that help us get there.

Scott:

I love it. Thank you, John. So this last year we've had some amazing things happen. Obviously, we've been talking about managing through the pandemic. But we're also doing some other things that I think were unbelievable timing during and post, as we start to look towards post. And that is looking at well-being, for not only our associates and our communities. So talk to us a little bit about what well-being is, and specifically the Blue Zone, which is a big opportunity for us to be that framework, if you will, for us to exercise the idea of well-being in our communities with our associates. So we're doing this in Adventist Health, so tell us a little bit about how that's going.

Shelly:

It is so exciting. If you look nationally or even internationally, there are very few strategies you can point to that actually have proven to be measurable and sustainably improve well-being. So I think as we're looking at the state of health in America, for our organization to invest in such a significant way in things that are proven. I think one of the reasons I'm so excited about this, it's best through a story, if I could just tell a super quick...

Scott:

Sure, please.

Shelly:

Before I came to healthcare a number of years ago, I had the chance to be inside the walls of a hospital for probably over 100 days in just a few months. My husband was very ill. And looking back at that today, I believe I could assess fairly accurately the well-being of every person who cared for us in that hospital.

Joyce:

Wow.

Scott:

Wow, interesting.

Shelly:

Because it impacts how we show up. When we have higher levels of well-being, we are more creative, it affects how we live as leaders, as parents, as community members. It affects how we give care. So in my mind, well-being, our Blue Zone strategy across individual, organizational, and community well-being is kind of that linchpin strategy that makes it possible to achieve our entire organization's goals across departments, across divisions. It lifts everything up to a new level. So I couldn't be more excited about this work.

Scott:

I can tell you're excited. And so am I, that's awesome. Thank you.

Melanie:

I would add to that, people always ask me, "What's different about Blue Zones, and is it just another wellness program?" And I think to Shelly's point, it operationalizes our mission in a way that nothing else can and really gives us that structure and framework for every single one of us to thrive. And it addresses our environment. Where we work, and where we live. So I'm excited about being able to co-create Blue Zones at Adventist Health in every market with every single associate.

Scott:

That's awesome.

Joyce:

So we came up with some creative ways to introduce people to the RealAge test.

Melanie:

We did.

Scott:

Uh-oh.

Shelly:

Very creative, yes.

Joyce:

So Shelly and John and I spent a couple of days of our life trying to create these stories, and oh my goodness, talk about pushing our comfort zones. We even pressed Scott into service on one of these videos. So I'm interested in what was your favorite of the videos, Shelly?

Shelly:

I think my favorite would have to be the celebrity sighting. Because honestly Joyce, it's not that far from the truth, that's kind of how I feel about you.

Joyce:

Oh right.

Scott:

Oh wow.

John:

Just natural, it was just natural.

Shelly:

Yes, I was able to be natural.

Joyce:

Hysterical.

Scott:

It was so easy.

Joyce:

Oh that was way out of my comfort zone, let me tell you. What about you Melanie?

Melanie:

Well I'm a Scott fan, so Scott's cameo on the table during open heart surgery, that was epic.

John:

We're still looking for the heart by the way.

Joyce:

I know, right? We lost the heart somehow.

Melanie:

Don't know where that went, yeah.

Joyce:

And what about you, John?

John:

The tower of terror, otherwise known as the bomb one, where literally we had to ride up this elevator accompanied by somebody uniquely trained to make sure we got up and down safely.

Scott:

Oh, one of those elevators.

Joyce:

That was a scary elevator.

John:

Yeah, I've seen a few of those.

Joyce:

Yeah, that was a good one. But I'll tell you what my favorite one was, Houston We Have a Problem.

Shelly:

That was a good one.

Joyce:

And trying to get a space shuttle back into Earth's atmosphere, and yeah, we're going to watch that. I will tell you all that I actually broke the headphones. We were supposed to be angry at Shelly being slow and being disengaged with us and doing the RealAge test instead. And I actually slammed the headphones down on the table and broke them. So sorry. Let's watch Houston We Have a Problem.

 

--

Speaker 1:

Copy that, Apollo 20. Astronauts are ready for reentry.

Speaker 2:

Okay, everybody. This is what we've been preparing for, for nine years.

Speaker 3:

Almost there. This is so exciting.

Speaker 2:

Stay focused, people.

Speaker 1:

Approaching the vortex. We only got one shot at this.

Speaker 2:

Everybody on your mark.

Speaker 3:

Standing by.

Speaker 1:

Standing by.

Speaker 2:

Approaching vector in three, two, one. Deploy primary...

Speaker 3:

Hang on.

Speaker 2:

What?

Speaker 1:

They're in the zone. We have to deploy.

Speaker 2:

What are you doing?

Speaker 3:

Yeah. One sec. I just registered on the Well-Being website and it's so cool. I just have to fill out the RealAge test real quick. It's all good. It's all good. It's only going to take me 15 minutes.

Speaker 4:

Don't miss your chance to live longer and better today. Visit us at adventisthealth.org/well-being.

Speaker 3:

This is so great. I am learning so much about myself. You guys should check this out.

--

Scott:

Wow, I didn't know we had such actors in our midst.

Joyce:

Oh my goodness, I loved when the director said that he wanted John to cry, and John's like, "You want me to what?"

Joyce:

That was funny.

Shelly:

I don't know if everybody knows, that is Melanie's vocal talents on the voiceovers of all of these as well.

Joyce:

Oh, so you were part of the videos, as well?

Melanie:

I was on the background.

Joyce:

Good to know.

John:

Good.

Joyce:

Well Scott, you've asked all of us as leaders to be inspired adopters of well-being. Can you maybe talk a little bit about what does that mean? What do you need from us on a daily basis to be inspired adopters?

Scott:

Inspired adopters of well-being. For me, it's been my constant practice, good or bad, as I am asking others to think about something and do something, what does it mean to me personally. You know, Joyce, it goes back to many years ago when we were looking at our mission statement.

Joyce:

Yup, I remember.

Scott:

You remember that. And you actually did the final penning of that, the last pieces. We were struggling with it. And at that moment, it turned from an organization mission statement to a personal mission statement. And I think that was the purpose, right? Is that we moved it from something you did at work to something you do in your life. And so we went down this path, and I personally have gone down this path of adopting it, living God's love by inspiring health, wholeness and hope. I can only ask the individuals in the organization to do something similar. It's a personal mission statement.

Living God's love, obviously, is a spiritual component for me, it's something we're called to do, it's something the foundation of this organization is built on. But this idea of expression of health, and Shelly mentioned it, you can tell when people are feeling healthy. Wholeness, which really is to me, it's that physical, mental, spiritual, social connectivity.

And then hope. Hope is something that we've seen. We've all had to dial it up this last year in our own personal lives and in our work setting. So for me, I would only ask what I try to do myself, and it's actually to live that mission personally and have your own unique expression of what it means. But I think that wasn't an accident that day that we came up with that statement that includes health, wholeness, and hope. Very powerful.

Joyce:

Absolutely. Well, thank you for choosing hope for State of the System this year. It's been a very powerful and inspiring way for us to tell our stories. So as we approach the rest of 2021 with hope, what's your last word here for this event about your hopes?

Scott:

Wow, my last words. There could be many, but I won't use many. I'm going to have you think about two words. Achieving and believing. If you think about what happened this last year, we've achieved much. We've also suffered a lot of losses, but we've had incredible innovation. We've achieved things we never thought we would have achieved. We've gone places we didn't think we would go, and difficult moments. But we're here, we are moving to the other side.

So I would say think about achieving. What we have achieved this last year as an organization, individually, has been nothing but amazing. So my next word then is belief. What do you believe about the future? If what we've done in the past is what we're achieving and seeing today, through videos, through stories, what could the future be? What could we believe about the future that we can't see today? So I would say, I would leave this with the organization. It's about appreciating what we have done and believing in what we can do next.

Joyce:

Beautiful.

Scott:

Thank you.

Joyce:

You want to take us out with a prayer?

Scott:

I would love to, thank you. Dear God, we just pray that you help us to live your love. And God, today, Adventist Health, among our 30,000 associates are 75 communities, 300 clinics, hospitals. All the things that we do every day, I just pray that we choose hope. In your name, amen.

Joyce:

Amen. Thank you all for joining us.

Scott:

Thank you, everybody