In the ninth podcast in this series with general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Dan Peters, Senior Vice President and General Counsel, The University of Kansas Health System, and Stacy Rummel Bratcher, Vice President and Managing General Counsel, University of Southern California, about how the pandemic has affected their jobs and lives. The speakers discuss how their hospitals are managing the pandemic response, including how they are dealing with the relaxed regulations and patient volume and handling medical students. From AHLA's In-House Counsel Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
In the ninth podcast in this series with general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Dan Peters, Senior Vice President and General Counsel, The University of Kansas Health System, and Stacy Rummel Bratcher, Vice President and Managing General Counsel, University of Southern California, about how the pandemic has affected their jobs and lives. The speakers discuss how their hospitals are managing the pandemic response, including how they are dealing with the relaxed regulations and patient volume and handling medical students. From AHLA's In-House Counsel Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Welcome everyone to today's, uh, GC Roundtable podcast. Uh, this is Sarah Swank from the Law Firm of Mix and Peabody, and I have two guests with me today. Um, Dan, do you wanna introduce yourself?
Speaker 2:Sure. Uh, my name is Dan Peters and I am, uh, senior Vice President, uh, and general counsel for the University of Kansas Health System in Kansas City, uh, and have, have been, uh, uh, here for around nine and a half years. Uh, and, and really glad to be able to join.
Speaker 1:Thanks, Dan and Stacy, why don't you introduce yourself.
Speaker 3:Hello, I'm Stacy Bratcher. I'm currently vice president and managing general counsel of the University of Southern California and our health system, Keck Medicine of usc, um, in Los Angeles, California. Um, but in a couple weeks I will be moving to Santa Barbara, California, where I'll be general counsel of Cottage Health.
Speaker 1:Congratulations. Um, this is wonderful. So we can, we can talk a little bit about, I, I have another friend who changed, um, in-house jobs during a pandemic, so we can talk a little bit about what that, what that feels like, um, as well. So what's, let's start off with, um, a little bit about what it's been like to be in house and practicing law during the time of Covid. So we know, like we've talked a lot on this podcast about what March and April felt like. We started talking a little bit about what the summer has felt like, but we know we're heading into fall and, um, fall and winter, and I know a lot of organizations are starting to think about that. So why don't I start with you, Dan. You know how, you know, we used to say it was like covid matters now it just feels like covid is part of our, our daily lives. Um, you know, what do you, what does it feel, what has it felt like and what do you think going into the, to the fall, what it felt like to be in house right now?
Speaker 2:Yeah, good question. Um, let me start with, um, just a minute about what, what our health system, how it's structured, because that also frames some of, um, of what, uh, what the summer looks like and what the fall looks like. We, um, uh, our main hospital is, um, uh, at, uh, an academic medical center. Um, we're the, uh, pri principal teaching hospital, uh, for the University of Kansas Medical Center. And, um, we have about a thousand beds in our main hospital, um, about a thousand, uh, faculty members. And, um, on an everyday basis, um, among our biggest challenges is capacity and, um, and, and length of stay and, and where can we find that next bed. Um, and, um, our health system includes five, um, hospitals. Um, and, and they include both our inner city hospital, but also, um, several rural facilities and, um, that have different challenges during, um, this, uh, whole process. And so, um, while different parts of the country have experienced, um, uh, the, uh, either surges or not surges, um, we've seen that probably like many of the, of our health systems that have, um, some, uh, diverse, uh, settings where, um, either there's not many, uh, cases and then there are, and, and so we've had different solutions for, for different campuses, uh, and, and different hospitals and, and, and that also equates to preparedness and how, um, how ready are each of the hospitals, um, for, uh, surges and issues that have come up throughout to include, um, things like, um, supplies and, and, uh, surges.
Speaker 1:So Dan, you know, so watching, you know, we've been in health law for a while, right? And we've, we've actually had an interesting viewpoint. Like we look at where we are in our career of watching like health laws change and being, being there during those changes, right? Instead of some of the newer attorneys who were like coming out and trying to, trying to learn all these laws that we had, like this, I guess the luxury to wa you know, to to live through all through them, like stark changes, hipaa, things like that. So, but then we just saw a bunch of laws change and then all of a sudden, you know, we're health lawyers looking at like governor's executive orders and things like that where we hadn't looked at that. What does that, what does that feel like? And, and, and how did you keep up with the changes? And then do you, do you feel like it's at the same pace as it was?
Speaker 2:Well, yeah, that's, um, that was one of the interesting parts of the beginning of, uh, March and April is, um, we were all trying to evolve at a super fast pace. And, um, there were, there were tremendous responses from the government to help us be flexible, um, and again, in all different areas while we had to change. I, I think of the notion of everyone working from home, um, as an example where we didn't have a super robust, uh, okay now implement the work from home, uh, plan that we've been working on for, for years. It was, okay, everybody go home and work and, um, and yet still do what we're doing. And, and so from the legal side, um, we had to pay really close attention to these enormous, um, changes that were happening to allow us flexibility like telehealth and, and license waivers and, and building capacity issues. Um, where we had a two year work plan, um, to roll out, um, our telehealth, uh, platform. And it turns out we did it in two weeks. And, um, and so you take those flexibilities and, and, and, and dive head first into'em. And then I think probably Stacy will say some of the same thing as the lawyers were thinking, okay, but let's not forget what the rules might go back to so that we can plan for that too once we get towards the edge of, of getting our arms around this. And so we all probably have this running list of what things we changed in order to have flexibility but not lose track of, uh, remember, uh, guys, there's still some regulation around, um, whether it's telehealth or whether it's building out a, uh, you know, a floor plan, uh, temporarily or how we bill for, um, different things. So, yeah.
Speaker 1:So Stacy, so<laugh>, so I'm gonna ask you what it was like, and then, um, since you know, you are changing jobs to go in, um, into a general counsel position in a new, a new place, ha you know, what are your, what are some of your thoughts on, on that as well? So let's start with what was, what was it like, and do you agree with Dan around, um, some of the, the changes and adaptations and I guess nimbleness and fastness in which things had to ha like happen?
Speaker 3:Yeah, absolutely. And, um, I, I, what Dan referred to, I ca I call the covid hangover that we're all gonna have, um, you know, probably six to nine months from now, uh, if God willing, you know, we go back to more kind of business as usual. I think that we've all been really, uh, grateful and, um, appreciative that the government has relaxed so many of these regulatory requirements. But I think we're all, I, I'm certainly, I'm expecting that once life gets back to normal, that they're, they're gonna maybe forget about their generosity and we're all gonna be facing, you know, a lot of, uh, scrutiny about how we did things or, and also I think, you know, our, our, um, business business teams may have lost some of that rigor in how they were approaching, uh, operations because we all have been in this, you know, catches catch can and, and do whatever you need to do to, um, to meet the needs of, of patients and the community. So, um, I'm really curious to see what happens. And, you know, all all of us are, of course, crossing fingers and hoping that the virus gets under control sooner. But, um, anyway, um, and just, just backing up a little bit, I appreciate Dan giving an overview of his organization. I wanna give you just a little sense of tech medicine and also, uh, USC and how we're, uh, in the healthcare community in Los Angeles. So we are a three hospital system, um, primarily focused in East Los Angeles, uh, which is a very, um, you know, uh, localized community where there's, you know, a lot of, um, you know, under, uh, underserved folks. Our hospital, our main hospital is an academic medical center, but it does not have an emergency room. So Dan and I probably have some different, um, different, uh, challenges. And I'll, I'm really looking forward to talking about the elective cases because for us, we don't really see, we have a lot of electives. We have a cancer hospital on that campus also, which is a 60 bed, um, cancer hospital. And then we have a community hospital, um, a little bit about nine miles north of, um, the main hospital. In addition, our faculty are the medical staff of the largest public hospital west of the Mississippi. It's L a C U S C medical center, um, operated by the county of Los Angeles. And they are seeing, uh, much like what Dan was talking about earlier, um, with, you know, really strained on capacity, very difficult to get patients out of icu. Um, they've brought in, um, medical staff from Department of Defense, um, because we are just really, really thread bear with, um, you know, critical care doctors in particular. So, um, I kind of have the tail of two cities, um, just across the street on our campus. Um, so it's been, it's been interesting, you know, it's, um, it's, it's never dull, which is why I've stayed at USC for almost 15 years now,
Speaker 1:Right? I mean, this is like, we could see when you go into how long the personality type is not wanting things to always do the same and wanting things to be different. And, and, um, but it's interesting cause this was like a, a different level. And, and Stacy, I really do agree when I, and I mean I, I'm one removed cause I'm not in house right now, but I, I I, I was seeing, you know, we're talking life or death, we're talking preparedness, we're talking about something that's so historic and unprecedented, and we had to turn resources and attention to those things. But at the same time, we call it, like, we always say, oh, there's a patchwork to the laws. I mean, this was like the biggest quilt ever that kept changing patches as you're trying to like do whatever, right? And so as we're trying to, like, implement, um, but I do, I do wonder if we, when there's this look back there or, or this time of the hangover, you know, if you were do an audit over those, like, things change in those months and the standards change. And, um, I, you know, and I don't know if people will get the will, the will, we will hospitals and healthcare providers who are really trying to do their best, will they get the benefit of doubt around audits and enforcement. And, and so, you know, and, and trying to get people to sit and focus on that when they're really trying to prepare for a pandemic. I mean, it's, it's, I don't know, I think we should get the benefit of doubt, but we know ultimately those audits come down of documentation intent and all that. And, and I, and I, so I put that out there, you know, for those people that are in the government or others to think about is, is, um, you know, what the level that, you know, hospitals may have done in the past, it was hard to do during that time and even now. Um, so Stacy, let's, let's just talk for a moment about, um, going into a new position because there, there's a lot of people here that are maybe either are in house, wanna go in house, right? Um, what, um, and now you're, you know, taking a new job right now and people are like, oh, should I change jobs during a pandemic? But, um,
Speaker 3:Uh,<laugh>,
Speaker 1:And you're not the only person I know either, right? Um, should I move during a pandemic? What should I do? Yeah, well, I'll let you
Speaker 3:Know. I'll, I'll let you know six months from now if that was a good move. Um,<laugh>, you know, uh, you know, I, I don't know about all of you, but I feel like I, I really am someone that is kind of always looks at the silver lining. And I think one of the things, one of the gifts actually of Covid is that it's caused, it's given an opportunity for all of us to spend a lot more time with our families at home. Um, and to really, I think, have a, a chance to think about what's important to us. And, you know, I was, I was like many of you working in my dining room for 12 hours a day every day. And, um, you know, just this opportunity came across my desk to go do that up in Santa Barbara, which, um, I don't know if you've been before, but it's kind of one of the most amazing places in the world. And I, uh, you know, talked to my husband and we decided that it was, it was worth checking out. Um, it's gonna be, you know, as compared to Los Angeles, which I've lived, I've lived here for 20 years, um, have great friends, um, great, amazing colleagues on the healthcare bar. Um, just, it's been a really awesome experience, uh, being here. But, you know, I think we're looking, looking for something a little slower paced. Um, and, you know, looking for an opportunity where I can really dig in and focus on a, a, a medical center that is so, uh, ingrained in the community. Um, so, you know, we'll see if it was a good, if it was a good bet that I made, uh, in moving. But, you know, like I said, I I, I took the time during, during the quarantine to really kind of turn inward and see what was important to me. And, um, thankfully the universe, uh, presented something, uh, that was worth checking out. So I,
Speaker 1:I'm, I'm optimistic
Speaker 3:About it,
Speaker 1:<laugh>. That's great. I, I appreciate you sharing that with us because I think that, um, I, you know, I've, I've tried to think about this myself cuz I am somebody who tries to think of the positive and the silver lining, and maybe some of these changes could like stick and maybe things will get better. Um, and also like what, yeah, like, I don't think I'm on a plane and I'm spending more time with my family. And, um, but I appreciate you talking about that because, you know, there's this, there was a push in the beginning it felt like, of like, now you can do all the things you've never done before. And you're like, wait a second, we're in a pandemic and I'm working 12 hours a day. Like, this is not the time to get to like the reading list. I hadn't gotten, you know,<laugh> the books I wanna read, right? Um, but there is a level of like this higher level of, um, reflection. And, um, so, so Dan, why don't you tell us a little bit about, I'm not gonna make you reveal some deep dark secret, I promise. Um, but like, why don't you<laugh>, but like, why don't you tell us a little bit about what, like this, this, the, the working at, at home and how often you went into the office and like your staff and, you know, because this is even across like, not even just hospitals and health systems, this idea of like, how do you keep morale up and how do you keep your staff connected or even onboard new employees Yeah. During, during this time. So that's,
Speaker 2:Yeah, that's been a, um, one of the things that, um, we as, as hospitals and as as physician practices, um, we're, we're all care providers and we're, and we're businesses and, um, you know, and in many cases we're, um, economic engines for our communities. And, and so all of those, um, and, and frankly, when we're out in the community, people are looking at us in the way that we behave, um, from, you know, from, uh, are are we wearing masks? Are we, um, practicing what we preach? And so, um, uh, we, um, early on we tried to, even on our executive team, um, tried to just say, okay, how do we, um, uh, separate ourselves, have, like everyone did, um, everybody can't be in conference rooms the way they used to be. And, and we don't have, uh, this giant executive, uh, suite space and, and is pretty crowded. And so we've tried to be very, um, diligent about, um, asking people to work from home if you can. And, and, um, and even if you can't then find out how you can spend two days a week at home or one day or three days or something like that. And we've tried to continue that throughout, um, this process. Um, but an important part of that is how do we stay connected to the teams that we're helping, um, uh, lead. Because I think what all of us know and recognize is, um, it's the, it's the casual encounters that we're all missing, um, where I might pass somebody in the hall and we're able to solve that one thing that's been outstanding. Um, and one of us hasn't gotten an email or a meeting scheduled. And then just the ability to, to, um, be collegial with, with people. Um, and then lastly, you mentioned onboarding. Um, to me, uh, that's one of the things I I worry most about are we, um, are we able to, um, effectively ingrain culture in new people that we bring on so that, um, not only can they learn that essential functions of what they're supposed to do, but also, um, how do we make sure our new employees know who we are, um, that you can't necessarily capture by joining, uh, zoom calls all day, or teams calls all day. Um, so we've tried to be really thoughtful through, um, HR in our, in our, in our culture, uh, groups that help, uh, make sure that remains effective. And we as always, we try and make good hires, but then nurture that as well.
Speaker 3:I, I, I have to say, Dan, I absolutely agree with you that those are the big concerns of this time. And I, I mean, personally and through our team, I've noticed, you know, one of the things that we're all missing is that, um, impromptu, you know, water cooler or hallway conversation. Um, and it is really hard to feel connected. Um, you know, I, I don't know how you all feel, but I feel like I'm almost working harder than I was, uh, before. Um, and, but I don't know what I'm doing and I don't necessarily feel as connected to the team, even though I, I actually see them more, I mean, I don't know about you, but we're doing more like, uh, zoom meetings than we are conference calls. Um, so you see people, but you see'em on a screen and you don't necessarily have that kind of before meeting chit chat and, um, kind of those, those informal conversations that build relationships and, um, can help you, you resolve longstanding, uh, issues.
Speaker 1:Yeah, I, I think it's gonna be, it's interesting cause there's a lot of positives that came out of, of the technology and the ability to do this. Cause I, I think back of like pandemic planning back, um, with H one N one and the idea like, again, like thinking that like the DC was going to, like if DC were to shut down or like a city or area was to shut down and like, you know, the, you look at 2000 like that Yeah, that time period. Like the technology wasn't there. Like, it was really like, what are, you could bring a laptop home. It was gonna be hard. It was hard losing hard to be productive. Um, so the idea of Stacy that you're like, feel wildly productive, um, without the like, personal interaction that we need as humans, right? Um, and like talking to a screen, it's, it's funny how we adapt, though is, and I would love to hear what you guys think about this, but like, to go from like, like taping a virtual conference that I would've normally been on like a platform with a bunch of people and I could gauge whether people are interested or not interested to, to actually taping something and then having to sit and watch myself back or sit in a meeting and it's like my picture's in the corner and like, or I'm trying to figure out who to look at. I feel like I've gotten better at, at that and like how to use the technology, how to, whatever. But I don't know if I'll ever fully get used to it. And I'm glad that's introduced into our lives. Cause I think there's some efficiencies that can come out of it, but it, it would seem like just to be like this, like if this was permanent, which we, we hope it's not right, it's not permanent. What would you, what would that be like?
Speaker 2:Well,
Speaker 1:So
Speaker 2:Sure. That kind, that kind of leads to one of the things I was gonna mention about what do we learn out of this? What do we improve out of this? Um, there there are a couple of things that, um, three kind of themes that stick in my head. Um, one is, uh, and maybe most fundamentally, um, we've all had to gain efficiency. Um, whether that's cost cutting, whether it's, um, being purposeful about, um, about spending and, and growth and all those things. I think second, um, resilience and how do we, um, make sure that that is a, something we spend, um, the time on, purposeful time both for our faculty and physicians, for our, our clinical leaders and for, um, everyone up and down the, the line. And then third is communication. Because when the, when the normal lines of communication get interrupted, like those hallway interaction, how do we make sure that we're continuing to communicate with our, all of our teams and, and from leadership, uh, executive leadership on down one of the thing and, and frankly, um, that role we play in the community, um, communicating one of the things that we did very early on, um, and, and in some respects, I think we're kind of all surprised how well it has evolved. But we, we did probably like Penny, um, we created two key communication platforms. One of them is a daily take 10 that is our, um, our, our, uh, CEO and then hospital president. We actually have a media studio in our hospital. And so they go down and film a 10 minute discussion about what's going on, what issues do we need to know about today, and, and then bring in different parts over the course of the last hundred days to, to be communicating about what's going on. And that sent out to the entire health system. And then the second thing that we did is we created a live, um, Facebook, um, video media session that has happened every day since, well, except lately it's not been weekends. Um, but they've done it about 105 hundred and 10 se sessions now since the middle of March. And it's had over a billion views, um, through Facebook and YouTube where we have our chief medical officer and then our, um, the head of our, um, infection prevention practice who have been tagged teaming on kind of our covid response questions. And it's, it's providing information to the community and then answering questions in as open a way as we can. Cause one of the things that we've all found out is the most common answer to everything is, let me get back to you in two weeks,<laugh>. Um, let me fill, let me, uh, see how we're doing in two weeks or in another week. And then we'll be more informed. And we've learned so much through this, um, over time. So that, that's kind of rambling, um, uh, handful ram things, but especially that communication.
Speaker 1:Yeah. Yeah. I think it's a rambling set of really good suggestions that people should write down is a good checklist. So, um, so, so Stacy, I wanna ask you something. Um, so you're, I I have been to Santa Barbara and it is absolutely beautiful. And, um, I also know that there were fires that were there, and I know we're looking at, um, heat waves and fires, um, and areas. And so we're have this overlapping impact. I've been thinking, I was thinking about this this week, so I'm glad we, I get to talk to you about it. Um, the overlapping impact of covid plus whatever, like, we're thinking about covid plus flu, right? Going into, um, officially in some northeastern or other cold climates. Um, but, and even not cold climates, cause we're, we might be more inside, but how about like covid plus like natural disasters and fires and, um, was talking to one of the OSHA attorneys, which I've now like befriended, didn't never think I would need that before, but, but the idea like, you know, there's like requirements around math because of the, you know, the, the, the, the clouds of smoke and the pollution that's going into the air and, and, um, you know, some of the disaster rudeness that happened had to happen in California because of some of the wildfires. And so we, you have like these, um, these overlapping things that were already happening, plus we've now had covid. I mean, what, how do we think about those and what do you do about that?
Speaker 3:Oh, that's a, that's a softball, Sarah. That's an e I got that figured out.<laugh>.
Speaker 1:Um, and then you're gonna be the president of the United States, and then you're gonna go on softball piece. I I totally get it right,<laugh>. Um,
Speaker 3:What I'll say though is like that it's, life goes on, even with this virus, what has to happen is that you have to think about whatever it is you're doing, firefighting, um, uh, protesting. I mean that, it just is another variable as you're thinking through, you know, oh, um, you know, how are we gonna deal with these patients? Or how, what about our workforce and are they in impacted by, you know, uh, you know, unrest in their neighborhood or a fire in their neighborhood? So kind of a, what I would say, you know, I don't have any magic answers. Um, I will, I will agree with you that you do, we have sort of relied on certain, um, niche experts, OSHA included, but as a, as a leader in the organization, I think what I've tried to bring, bring in with me to my zooms or to the office is just overall compassion for people. And, um, we just don't know what somebody is dealing with at home in terms of, you know, are they affected by a protest? Are they, um, do they have family members affected by Covid? Um, we haven't, thank God we haven't had to evacuate yet for any fires, but that is certainly something that happens quite a bit here in California. So just trying to be, um, even though though there's a lot of pressure and there's a lot of work, just, I try to, as a leader, come, come in with a feeling of compassion for whomever I'm, I'm working with.
Speaker 1:I think Stacy, that's, I mean, that's a great, I think there's been a common theme around that, which I, I mean, if we can keep that, that that would be, that would be a nice thing that to have to have go past this pandemic, this idea of compassion and working together. Um, one of the things we, I really wanna talk about too, and I think Stacy, you, you mentioned this is, is, you know, when the, we had elective procedures canceled and, and you guys, no one can see me, but I'm air quoting elective procedures. Cause I know that that can, that can be political, that can have a lot of definitions, but I'm gonna stick with this elective procedures. They were canceled and, um, because of, uh, for various reasons, like not having p p e, um, sure to be prepared and responded. People were actually in surge areas and, and needed, needed to convert their hospitals and other spaces to ICUs. Um, how, how did, how did, why don't we start with you, Stacy, how did your ho how did your hospitals and your, how did you, how did they react and, and what was that like?
Speaker 3:Well, I'll first say again, we don't have an emergency room and, um, or at least at the, the big hospital. And so in our, so our cases are mostly transfers, and our case mix index, for those of you who follow that kind of thing is like 3.7 or something like that. We have, again, the highest case mix, uh, west of the Mississippi and potentially in the country. So we, our view is that most of our patients aren't coming to us because of an elective issue. Um, you know, certainly also at the cancer hospital, you know, people that are needing to get a diag diagnosis or a treatment that doesn't feel very elective. You know, however, um, the California Department of Public Health did ask us, or did ask all hospitals to, um, you know, be prepared for surge and, you know, we, we did that, but we, to the extent possible, continued seeing, you know, unscheduled patients and, um, really trying to accommodate as many as we could. Um, it's, it's ramped up, you know, as soon as the, I'm trying to think, this must must have been early June when, uh, when they sort of took us off the surge protocol. I mean, it was like a flood back in sort of a, they, we, they graph out our, um, our admissions and it was a, a sharp spike upward. Um, but you know, the faculty and I, I'm sure Dan will, will, uh, this will ring true for him. Our faculty don't think most people are elective. You know, they're, they're, if, if you're an academic physician, you're on the frontline fighting really complex disease. Um, and so they were very eager to get started, restarted as much as possible.
Speaker 1:So, Dan, what was your, what was the experience like there? Um, yeah, yeah,
Speaker 2:For us, um, in, in March and April, that change, um, was profound. Um, we, we, we typically would average a daily census of, um, between seven 50 and 800. And, and, um, when we closed a lot of our operating rooms, um, we do a substantial volume, um, of, of, uh, or work, um, both again, yeah, air quote elective, um, some of it maybe you'd call elective. Um, we, we tend to think of it not as elective, but can it wait? Um, uh, and, and so both on a, on a, um, revenue basis, it had a profound effect on, on patient's ability to get timely care and, um, you know, what their outlook was at the time about going into the healthcare setting and in our, in our clinics. Um, so all of that was, was a profound operational and financial effect that has taken a while to, uh, to get, uh, back. We, we sort of feel like right now we're, um, back in the neighborhood of a hundred percent of our, um, our volume, but even that, we, we still have 40, um, semi-private, uh, rooms, unfortunately, um, we've not been able to, um, undo those. And we've not, um, we've not, uh, those remain, um, private rooms right now. We're not putting, um, two patients back in a single hospital room at the moment. So, um, as a result of covid, we still have some, um, capacity. We can't get back fully to normal, but, um, we, we, of course, we contacted every single patient to try and make sure we got them back scheduled and, um, and could, uh, could get everyone back on schedules and calendars and make sure we don't lose, uh, people with healthcare needs.
Speaker 1:So Dan, the other thing that, and you and I chatted about this cuz we're, we're at back, there's back to school time and there's a lot of back to school discussion going on, um, at all levels. So I, it would nice to hear a little bit about, um, especially since both of you, you and Stacy are at academic medical centers that are attached to universities that, um, are mission driven towards education. Yeah. How has that changed based on the students and, and how are you, how have you adapted?
Speaker 2:Yeah, that's one of the things about, um, even going back to March and April, um, e everyone left, uh, I mean, um, students could not come in, um, and, and, uh, medical students couldn't come in. We're geographically, our hospital is in Kansas City and, and the main campus, university of Kansas, um, main campus is in Lawrence about 30, uh, 30 miles away. Um, but the medical center is attached to our hospital. And so that was a, um, a starting over with nursing students, with medical students, with radiology, stu, you know, the whole spectrum. And all of you guys that spend much time in, in, uh, AMCs know that it is just a big busy place with tons and tons of people, and all of a sudden, um, we had to start over. And so now over the summer, as both medical students, um, a new class of medical students start coming in, we have to re-envision how can we do that safely? How can we start putting more and more people in our, um, in our hospital and, and manage it safely with patients and the staff and with the students themselves. And a connected part of that, that, um, probably Stacy's even a lot closer to than I am, but we've been partnering with the University of Kansas on their reopening plans and spending just enormous amount of time and and resource to help them plan, right? And, and, um, allow a, a safe environment of when can students come back? Can they come back? Well, what happens when people test positive and how do we react? And we all have heard, um, all kinds of information about the different schools trying to struggle with the right timing and right que uh, you know, questions and solutions to, um, reopening campuses.
Speaker 1:So, Stacy, do you wanna talk a little bit about that? I'll first say, Dan, I do, I have been on campuses at AMCs and the things that, the thing that hit me the most, um, the difference was the energy level. Just you feel that I, you agree, you feel the energy level at an ammc in a way that, I'm not saying it's a bad or good, I'm just saying there's a different energy of having all the students there. Um, so Stacy, what, what, what, what was it like and what are some of the plans at at at U S C?
Speaker 3:Well, I have to say this is probably one of the most, um, an issue where there was the most passion around from our faculty, our deans, uh, and our university administration. So, you know, it toward, you know, when the, when the pandemic first hit, you know, it wasn't completely clear whether, um, the med students, um, and other, uh, allied health students could be in, in the hospital. So they were able to pretty much finish out their semester or they went, you know, did Zoom for, you know, several couple weeks. And then over the summer there was a lot of, uh, dialogue with the, um, Los Angeles, uh, county Department of Public Health about when we could bring them back because, um, for, uh, our public health order talked about, you know, higher ed needed to be closed except for, um, basically health sciences students. So that was, that was good. And we were, um, you know, excited about that. But, and Dan may know this as well, so med students don't just like show up and like go into a clinic and start, you know, doing whatever, uh, you know, the residents or attending physician, you know, don't, they don't start, you know, patient care type stuff. They train in what's many times called a sim simulation lab or on animals, cadavers, all that sort of, um, kind of classroom type, um, instruction. And, uh, for several, I think it was mostly, uh, end of May and end of June, um, the, the public health department wasn't going to let our students do that, wasn't gonna let us do that. And, you know, our dean partnered with the dean at UCLA and was able to finally prevail on them that this, you know, simulated learning had to happen because that was kind of the pipeline for medical students being able to come into a clinical environment. But those are the kind of things that aren't, you know, obvious. And certainly I, you know, I've been in academic medicine 15 years now and that wasn't obvious to me either, you know, that, um, wow. Well, the med students don't just show up and start their clinical rotations. So, um, you know, we had a, a really robust dialogue with our public health officials, you know, that had kind of got ahead of me a little bit. Um, I don't know, Dan, but sometimes, um, you can take a, you know, better to ask forgiveness than permission approach, but we had a real, we had a real close relationship with the public health department. And so once you start asking questions, then they start coming up with rules. Um, and, and that's kind of how we landed with a little bit of a pause in our, uh, our simulation lab, uh, learning. But, um, yeah, it did get resolved.
Speaker 2:Yes, Stacy, one of the things I would add to that, that's maybe one of the key takeaways that I've thought about ever since, um, March as it relates to the students, especially the medical students, but nursing students equally as important. Because part of the learning that's going on is there will be another, um, unfortunately someday, sometime another pandemic, another um, system of chaos that our students have to learn how to, uh, manage. And, and so while we're actively managing patient safety and employee safety, we're also teaching and, and the process of learning how to be safe and how to be calm and how to, um, be a, a community leader inside our organization, that's also something they're observing and learning, and we don't want to lose out on this opportunity to teach
Speaker 1:Dan. I don't know, can you learn that on Zoom? Um, and I wanna put an exclamation point on what Stacy, what you said. We're talking about the exact people that we need more of to help fight what's happening now. And like you said, Dan, prepare for future, whatever, whether it's another exact one of these or something else. Um, but this idea, yeah, and I would go back this idea, Dan, you said, of like, resilience, right? Um, uh, of the students, of, of all, of all of us. Um, and actually on that, on that note of resilience, um, one of the things that people have appreciated from these podcasts, and, um, it is the idea, you know, and, and this is, I I, I've struggled with this and too, which is like, I'm so focused on the clinicians, the housekeepers, the people that are there that we sometimes have to remember, we have to do stuff for ourselves. Like we are not robots.<laugh>, we are, I know we're lawyers, but we are also people. And, and how do we, how do we stay strong and how do we stay, uh, as leaders? Um, so that we, cuz this is a long haul, this isn't a few week thing. Um, people have said everything from, I go to a run in the morning now, or I'm set this sort of schedule. I like eat dinner with my family every day. Dan, what's something that you Yeah, some people say, I, I was at one of my friends who's probably will end up listening to this, well, says, I listened to podcasts and I now even listen to yours, Sarah. Um, so what do you, um, what are some of the, what are some, what are, what are something that you've done that you, that you could share with the audience that, that someone might go, that's a really good idea and I need, I need to think about that.
Speaker 2:Yeah, I don't know that I've got, um, any genius, um, ideas in, in this area. It is, it is just being very purposeful and, and knowing there are other things we have to do. And, and for me it's kind of simple, uh, stuff that, um, you know, going out of the way to talk about, um, not covid,<laugh>. Um, and, um, I, I like to golf and, um, so, you know, whether it's reed or golf or, uh, you know, in my own neighborhood we see more people out walking and, um, doing the things that you can do. Um, I mentioned our, our take 10 programs and our media sessions, um, over the course of the last five months, we've been very purposeful in, um, we actually take Friday in, in that session to talk about some resilience, uh, um, issues and whether it's, it's actual counseling resources and, you know, employee kinds of, um, help. Um, but, but also just, um, take, get away kinds of things. And, um, it, um, fortunately we had been working on our campus on physician resilience and, um, and, uh, engagement and you, you guys all know that that's been, um, kind of on our minds over the last, um, year to two as, as we hear things about, um, physician suicide or clinician um, suicide or, um, or, or other, uh, types of harm. And so we've tried to be, um, really thoughtful about putting groups together that can help each other. Um, and that that's really what we've tried to just stay purposeful about, um, that, that is a health need just as much as, um, you know, getting vaccines and, um, you know, regular checkups.
Speaker 1:Yeah, it's interesting, like we, yeah, we talk, work, a lot of work around physician burnout out and then even in our profession, realizing that the suicide rate was going up. And so there was like, obviously even before there's something happening, um, I don't know if it's culturally or whatever, but we were, we were burning ourselves out and now we, now we have this. And so I, it is a chance to look and say like, I, I like to read a book, for example, you know, like, like you said, Dan, or I like to do this, and it's okay to say that<laugh>, that's like part of my asking's. Like, it's okay to say that. And other people that are listening are gonna say, you know, I, I was talking to an attorney and they were like, I really, really love to play the guitar, and so I've now carved out time in my day because I don't have a commute anymore and we work weird hours now, um, to play the guitar. And it seems like so simple, but it wa what, yet we weren't doing it right. So, I dunno. Stacy, do you have something like that that you'd wanna share or something, you know, that, that you've to keep, keep us resilient?<laugh>? I'm, Yeah, I'm all making it. I gave you all the hard questions, right,
Speaker 3:<laugh>. I know, I know, right? Like, oh yeah. How do you, how do you survive a pandemic? Um,<laugh> I'll say that I, you know, um, you know, over the last couple years I've had a really, um, intense, uh, experience at work. Um, and so I had kind of been working on self-care for a while. Um, what I would say about the pandemic, again as this disruption, you, you mentioned it with the, the guitar example that it really, again, for me, it, it, it was an, it was, I see it as an opportunity. Like I'm not driving, you know, 40 minutes to work every day. Um, and you know, I I, I do some of my work now, um, you know, I check in with the team or do calls on walks and I, I'm very open actually with the team about, you know, hey, I'm, I'm on a walk right now, you know, I do, I do like, like a walk and talk. So that's very important. Um, I, we, uh, because gyms are closed, uh, my husband and I have started having a trainer come to the house and work out with us, uh, outside a couple days a week. Um, but just, you know, doing, figuring out things that you like to do and doing them, I mean, it is really, I think for many of us, you're so devoted to your job and you give everything to it, and you kind of work the rest of life around the edges. And with, uh, life being disrupted, I think it's, it's, um, caused a lot of us to, to try to explore new things. I have someone on my team who's now into bird watching because she's at her home and she's realized that she's got all kinds of birds in her backyard. I mean, that would've never happened. So, um, so yeah, it's a work in progress, but I I, I see that as another one of the, the covid positives.
Speaker 1:Excellent, though, I think that's great, and I appreciate you both being candid and sharing that because I do think, I think it helps people, if we say it out loud, um, we're actually allowed, we are humans and we are allowed to, to figure out how to balance all the, I don't even know if balance is the right word, but, uh, how to like integrate our lives, um, and our jobs together and the system, us that opportunity. So I guess with that, I would like to, I'm gonna ask both of you to, to give me like rapid fire, what something you'd wanna leave the audience with, um, something that you think would really be helpful for them to hear. And I'm gonna start with you, Dan.
Speaker 2:Well, um, I think everyone is is super weary and, and tired of, of covid not just impacting, but taking over, um, our lives. But, um, there, there just simply are some positives, um, amid all the, the grief and challenges, um, that, that we've been able to do. And, and, and I point to one of them as this evolution to, um, telehealth. Um, and it's just one of many, um, uh, some of our efficiencies that we've, we've gained. Um, and, and I think we've found ways to, um, force ourselves to be efficient and to, to, um, wade, wade through the, um, whether it's our own personal red tape or our systematic red tape because we had to make decisions and we had to move on, um, to, uh, answers. And, and I think there is some real healthy, um, organizational dynamic going on in that. And then figuring out that patients, figuring out, um, how to, um, how to be comfortable receiving their care and, you know, whether it's getting, getting comfortable with, we used to have patients packed in waiting rooms, right? And reception rooms and how that ever made any sense, um, to build systems where that's the way it works. And we've thought about different ways. So ingenuity maybe is just a key buzzword I would, um, take away from, um, what I think many or most or all of us have, have gotten on the positive side out of this, this big mess.
Speaker 1:Great. Thank you Jan. And I agree, I completely agree. There's a lot of things we knew didn't make a lot of sense and, um, we could do better, but it was like, how do we stop the system and reset, and we have that moment right now. Um, Stacy, how about you? What would you like to leave the audience with?
Speaker 3:Well, uh, you know, I, I think again, i I just try to be a very positive, have a positive outlook, and, um, I agree with Dan that the, you know, we're all sort of worn out by pandemic and covid, but, um, just always trying to look for the opportunities, um, to make things more efficient, to reinvent your life, um, to look at, look at the way you approach work and see, you know, what's working, what's not. Um, so I, I, again, I I view the disruption as a, as a what can be a very positive, um, thing, and would just encourage the audience to just think about what you're focusing on. If you're focusing on, you know, everything's hard and, um, it's uncertain and I, I don't know what I'm gonna, you know, fly again or whatever, then you're gonna feel like everything's hard and uncertain. But if you start focusing on, wow, now I have time to play the guitar and I'm not stuck in traffic all the time, and I finally have got it in time to clean out my closets, you know, um, and woohoo stark waivers, you know, like<laugh>,
Speaker 1:I know that's, we're that nerdy, right? That we're that nerdy.
Speaker 3:We're like
Speaker 1:Excited about shark waves,
Speaker 3:<laugh>, we're, we're, but I mean, you know, and telehealth, I mean, they're really, life is what you focus on. So that would be my, my parting words.
Speaker 1:Thank Stacy, that's a great way to, to end this podcast, and I really thank you both for, for joining, um, me and having this really great candid conversation. And I, um, tell the audience, you know, go onto the American Health Law Association website, um, check out, there's a lot more podcasts. This is nine in this series. There's other really awesome podcasts to listen to. There's a lot of good programming and, and webinars and on other covid and non covid topics. Like Dan said, sometimes we need to take a, not a covid break. Um, thinking about it. Uh, and, and, uh, you know, as join, join, if you're not a member, join, there's so many resources, there's so many connections to make. And, and so I really thank everyone and the audience for joining us.