September 22, 2022
[00:01:00] Dr. Gary Bisbee: Good afternoon, Joanne and welcome.
[00:01:02] Dr. Joanne Conroy: Thanks, Gary. It’s great to be here.
[00:01:03] Dr. Gary Bisbee: Congratulations on being chair elected of the American hospital association. Very cool.
[00:01:09] Dr. Joanne Conroy: Thank you. It’s really an honor to serve an organization that does so much for American healthcare and through my three years that I’ve been serving thus far, you really appreciate the complexity of the issues that they’re dealing with and how effective they’re.
[00:01:25] Dr. Gary Bisbee: What are the several key issues that the American hospital association is dealing with?
[00:01:30] Dr. Joanne Conroy: There are five pillars of their strategic plan, but I would say two of them right now are super important. Number one, ensuring the financial stability of hospitals and health systems. I don’t think people appreciate that if we get backed up with either a COVID surge or patients that we can’t place in post-acute care facilities because of staffing issues, et cetera. If we start backing up, what happens is that people, when they present to our institutions cannot be cared for. That’s actually what you saw in rhode Island in the beginning of COVID. Remember their emergency rooms were just overwhelmed. It wasn’t because their emergency rooms were overwhelmed. It was that they couldn’t move people through their facilities and they were backing up into their emergency rooms. Imagine if that happened to hospitals across the country, what challenges that would present. American patients. And then the second thing is workforce, cuz they’re interconnected. We have had significant decreases in the number of nurses actually practicing in the workforce. And considering that we have an aging population across the us we need more nurses rather than fewer. Everything we wanna do requires people. And they’re just not enough people. And I live in a state where the unemployment. Rate is the lowest in the country. And we’ve just gotta be super creative now about how do we create a pipeline for our workforce? How do we retain them? And then if you can’t find people to do those jobs, how do you replace those jobs with technology?
[00:03:01] Dr. Gary Bisbee: Let’s move to Dartmouth health, if we could. You’ve been the president CEO there for now over five years. Can you describe Dartmouth health for us, Joanne?
[00:03:10] Dr. Joanne Conroy: Sure. We’re the most rural academic medical center in the country. And we have the Lebanon Campus, which is the well known Dartmouth Hitchcock medical center. We also have three critical access hospitals. We have a PBS hospital in Keene, New Hampshire. We have a visiting nurse and hospice association, which is probably as the largest geography in New Hampshire and Vermont. We deliver care to a very rural population, but the real powerhouse of Dartmouth health are these five gigantic multi-specialty group practices in Nashua, Concord, and Manchester, which is in the Southeastern part of New Hampshire, Putnam practice, which is in Bennington, Vermont, the practice in Keen New Hampshire. And also of course, the large academic practice up here in Lebanon. We have over 2200 providers in those practices, and let’s be honest, our providers, both our APRNs, which are not included in the 2200 and our physicians are really the reasons why patients are attracted to a health system like ours. It’s really knowing that they get world class care, wherever they touch the system. But all of these providers actually are connected and work together. We’re a truly integrated system. Everything can be cared for without you ever leading being the borders of Dartmouth health, number one, and your record, your pharmaceuticals, everything is all integrated into one patient portal. So it makes it incredibly easy for patients to advocate for themselves and get their care.
[00:04:46] Dr. Gary Bisbee: Yeah that leads to the rebranding that you recently led. Why did you rebrand to Dartmouth health and how was that received by the community and your medical staff and your employees?
[00:04:57] Dr. Joanne Conroy: We had not changed our brand. Ugh. Since I don’t know how long, maybe 25 years. And it was funny. I said, are those like trees or mountains, or you forget that when you develop the brand every symbol has a meaning 25 years later, nobody remembers what you really started out with. But we really needed to reintroduce ourselves to the community, because we changed, we’ve changed since that brand was developed. We actually spent three years doing it. Now COVID added a couple years onto it. We could have done it a little bit faster if there wast a pandemic going on, but it was really deliberate to figure out who we were, which was really fascinating. They spent a lot of time talking to a lot of stakeholder groups and decided that the term we are really embedded in the community. We’re not an academic medical center without any connections to the community and we’re actually woven into the fabric of our community. So we talk about world class care just where you need it most, which is in your community. And we are really embedded in our communities. That’s the beauty of rural healthcare. You can solve world problems in aisle three of the local grocery store. Everybody knows everybody people will stop me and ask me questions, not just about their care, but about where the health system is going, et cetera. You don’t have the anonymity that you maybe have in more urban settings. So I think that’s the beauty of delivering care in rural America.
[00:06:26] Dr. Gary Bisbee: Dartmouth health is the most rural of the medical centers, for those that may not be aware. What specific issues does Dartmouth health need to address? Because it’s in a rural area?
[00:06:37] Dr. Joanne Conroy: People who live in rural communities actually have poor health outcomes. Believe it or not, they have less access to care. A lot of that is because of transportation. We don’t have great transportation networks in rural America. The distances that they have to travel sometimes the geographies that they have to travel through. I would say at the same time the issues around broadband and internet and all the things you wanna deploy in order to deliver care in people’s homes, become a big struggle. Especially our home health teams often have to drive down a gravel road for four to six miles and they come upon a dwelling that they’re trying to care for. Somebody in that dwelling who may have iffy electricity and no internet. And very little in terms of public services out in these incorporated rural areas of our community. It just creates those challenges to deliver care. I’ve actually gone out with our home healthcare people to go to some of their new patient evaluations and check up on existing patients. And it’s a little bit of a journey. They gave me a pair of yak tracks. It was in the winter. We were climbing over Hills of snow and ice in order to get to these homes. And you have to have a pretty good sense of direction cuz you know, not all the roads are really well labeled the people were so grateful and thankful for that type of care. We would love to do a hospital at home. Hospital home is gonna be really different in rural America than it is in like Boston. We’ll figure it out. Now, I have to say we have an incredibly robust telehealth program. Even though we do a lot to patients, it’s actually provider to provider. So we are helping the rural hospital stay afloat by providing them with tele ED, telepsych, tele ICU tele specialty care. So those patients that can be cared for in the, those communities can stay there. And that has continued to grow. I had a recent report. I think we added another 25 programs over the last six months across New Hampshire, Maine, and Vermont and even a little bit into Massachusetts. The services we provide are really important for rural hospitals to actually stay afloat. And hospitals that we don’t own that are just members of our kind of community network.
[00:08:50] Dr. Gary Bisbee: The pandemic obviously took a toll on health systems. What have you found that by way of new initiatives that you’re taking because of COVID?
[00:09:00] Dr. Joanne Conroy: So they’re two great things about COVID. Number one, we realized that we could do telehealth. As I’ve said before one small strand of RNA has actually done more for the telehealth industry than billions of dollars of venture capital. Until we had to do it, people were reluctant to change, but once they knew that they had to change, they changed. And the second thing is remote work. We are full in, on remote work. We look through all of our job descriptions and here at the academic medical center. Over a third of the people that work on this campus are working remotely, permanently, remotely. That means we employ people in over 35 states across the country. And what it does for us though, is allow us to recruit nationally so we can recruit you from any state in the country. And you can work from your home. That gives us huge recruiting advantage versus having people have to come here to the upper valley because spouses have other jobs that may not be as movable. And it really allows us to access all that talent. And for two years running, we have determined that those people that are working remotely are our most engaged employees. They have just enough autonomy. They have enough responsibility and connection that they feel part of the team. But there is something about their ability to do their job in their own home that they appreciate. And it comes out on your engagement survey.
[00:10:26] Dr. Gary Bisbee: Joanne, as you know, some health systems are trying to work out arrangements with the health insurers to see if they can get into the financing stream a bit. Is that something that is part of Dartmouth health strategy?
[00:10:40] Dr. Joanne Conroy: We would love to do more of that, but frankly, a lot of the insurers are not interested and our market’s too small, Gary. We have. 1.6 million people in New Hampshire and probably 700,000, 800,000 people in Vermont. It’s just not a big enough market for them to think about doing something here in New Hampshire, Vermont. And that’s the reluctance we run into.
[00:11:02] Dr. Gary Bisbee: But have you been able to pursue consolidation, Joanne?
[00:11:06] Dr. Joanne Conroy: So we spent three and a half years trying to bring granite one into our network. It was very disappointing that we weren’t able to get it over the finish line and some of the expectations from the attorney general just were undoable. They wouldn’t have made us successful. And it was very disappointing cuz both organizations had spent a lot of time focusing on that. And I called the attorney general and still thanked him for all the effort. I said it was, we’re all disappointed that we couldn’t make it happen. And you still have to work with people. And we tried to really focus on not assigning blame just appreciating that we weren’t gonna be able to move forward. Having said that, however, we work with the university of Vermont and Maine health, very closely. We meet three times a year. Our executive teams meet. We try to figure out the things we can do together. And in the height of COVID, we worked with the university of Vermont to bring in a plane full of PPE from China. There are so many things that we can still do together. We are constantly looking at opportunities and I think as it gets harder and harder to make your margin in the market where your costs are going up and your revenues not covering that, we will find other opportunities to work together across larger region.
[00:12:19] Dr. Gary Bisbee: How concerned are you with these large wealth finance companies? CVS, Walgreens, Walmart now, Amazon Optum elbowing their way into ambulatory care and primary care. How big a problem do you see that becoming over time?
[00:12:35] Dr. Joanne Conroy: Yeah, we’ve talked about it a lot. You know what people need access to primary care and if they can improve that access to primary care. That’s good for our patients. It’s good for everybody. I think our patients, when they get fragmented care from Amazon here one medical there, if it’s not all coordinated, they’re gonna get a little bit frustrated. We’ve got some of our patients pretty spoiled that it’s so integrated. When you need to have a prescription renewal from your doctor’s office, you don’t even have to do that. We take care of that for you, our pharmacists call them and it shows up in your doorstep two days later. That’s pretty high level of service.
[00:13:12] Dr. Gary Bisbee: Yeah, you’re really making a point that you have the opportunity to build on integrated care and do even more I’m sure than you’re doing as opposed to the one off, more fragmented care. And that may be the answer to the question of how you compete with those big well finance companies. Let’s turn to women’s leadership. You’ve been active in that for a number of years. You co-founded women of impact. Why did you do that, Joanne?. And how has that worked out over the, I think last 10 years or so?
[00:13:42] Dr. Joanne Conroy: I’ve been pretty focused on at least gender equity around compensation and around access to. Opportunities that create leadership. So women of impact, I went to a leadership development session and I was like, Ugh, I don’t really know if I wanna go. And I went and I’m so glad I did. I was the only woman in healthcare. There, there were women from Microsoft, Shell and it’s fascinating. They let us through this process, not giving us skills or just doing networking, but basically saying you’re at a point where you have incredible influence, what are you doing with it? What are you doing with it to actually make a difference in the world? That’s a very different construct than most leadership development programs. Like it throws it right back on you. And after I went through that, I said, There’s a lot broken in healthcare that needs to be fixed and I can’t do it alone. And so I said I’m gonna grab a group of women and we’re gonna figure out what we can do about it. And I wrote a grant to the Robert Wood Johnson foundation and they gave me like $95,000 and I convened the first group called women of impact. And I think we’re up to eight cohorts now. It’s invitation only. We don’t necessarily wanna be really big, but. We wanna number one, identify own personal impacts. And everybody has this kind of personal goal when they finish a two day session and everybody goes through a two day session when they come into the organization, but we also wanna do things together. So we’ve helped establish Carol Emmett foundation. Which actually has a leadership development program for women. We help sponsor the equity collaborative, which is where HR and leaders from across the country look at our hiring practices. And we send our data to McKinsey that actually. Compares it with organizations that are not involved in the collaborative and does the collaborative actually make organizations move faster along that equity timeline? And frankly, it’s so energizing to be around women that are actually committed to a lot of the same things. And out of it I’ve got Karen Feinstein talking about creating a national patient safety board, like the NTSB. You have people that are actually championing diversity and equity causes within their own organizations and then taking them nationally. And a number of our members actually are serving in the current administration. It’s great. They are actually getting to the point where they are decision makers nationally. And it’s just creating that pipeline. So number one, these women know each other and number two, they figure out how can we leverage each other’s strengths? And they’ve done that very effectively.
[00:16:18] Dr. Gary Bisbee: well done on that. We’ve made pretty good progress in medical school admissions. Think it’s 50% women, 50% men, but as you mentioned earlier if you look at, for example, chief medical officers in the largest health systems, it’s. Not good. It’s substantially less than 20%. If you look at CEOs, your peers, the last numbers I saw were around 20%. What can we do to try to move this along, Joanne?.
[00:16:45] Dr. Joanne Conroy: Yeah, there are a couple things. Number one, you know, it’s gonna take us a hundred years if we go at the pace for moving right now, so we need to accelerate it. I think people understand that they’ve gotta invest in creating a pipeline for women leaders. People are very focused on having diverse pools with any leadership. It’s not about merit. There are lots of people out there that are incredibly talented, but you have to work harder to find them and get them in your pools. I would say it’s also creating opportunities and also the awareness of a lot of young leaders about the risks and responsibilities of moving into leadership roles. And I tell every woman that asks about leadership trajectory, I say there are two things. I say, you need to have a appetite for personal and professional risk because you will be in a position where they may say, thank you for your service. Here’s your severance. And it feels crappy, but that comes with the job when, especially in healthcare, when you know, reorganizing a health system or a regional unit is not uncommon. would say that second thing is that they have to be willing to move. And unfortunately, when you get two professional families that becomes a little bit more difficult. And that’s where the conversation begins within their family unit about whose career comes first at what time. And I know a number of couples that figure out how to balance that. It’s hard, but that’s one of the important, transparent conversations that professional couples have to have early.
[00:18:16] Dr. Gary Bisbee: Yeah, that’s pretty interesting. You’re talking about men personally, in terms of the family being support ive of a woman having to pay the price, so to speak of becoming a leader, whether it’s moving. More time and a job or whatever. But in terms of the workplace, a professional workplace, you talked about sponsoring men can sponsor. Seems to me, there’s also a recruiting aspect of that where men can actually approach women and recruit them into leadership positions and then support the development. Are there other obvious things that men could be doing to be supportive here?
[00:18:51] Dr. Joanne Conroy: I would say part of it is really developing the right leadership programs to identify people internally and externally. And also creating the opportunities for them to demonstrate their leadership in your organization. It doesn’t matter how much training you give somebody, they’ve gotta be able to apply it. So you need to be intentional about that within your institution. I get it that we have an affinity for people that are like us, but I know that my best leadership teams are teams that have all different backgrounds. Actually I’m in a minority, like I’m an extrovert. And most of my team is an introvert. They process very differently. And if I had a team just filled with people like me, I’m sure we would make a lot of really bad decisions. So, so, diverse teams actually make better decisions. We know that we’ve known that for 15 years and this is a pathway to creating those kind of diverse teams that can really steer a health system as an organiz.
[00:19:48] Dr. Gary Bisbee: Joanne, this has been a terrific interview. We really appreciate your time. I’d like to ask one last question if I could, and you’ve actually addressed this a bit, but let me ask it directly. What advice would you have for young women who are thinking about leadership? Not sure whether they want to actually go in that direction. What kind of advice do you have for them?
[00:20:09] Dr. Joanne Conroy: They need to do things with, and for a purpose. They need to think about the roles and responsibilities that they take on and what impact do they wanna have in that role in the organization. Be purposeful about it. Achieve your goal. And don’t be shy about telling people about it. There is nothing wrong about tooting your own horn when you’ve done a good job. In fact, my first husband used to tell me, don’t break your arm, pat yourself on the back. But I learned to do that very quickly because sometimes people are not running around patting you on the back. You have to do a good job because you know that you wanna do that job. You do it well. And then you congratulate yourself for doing it. You can tell everybody you want to, but you actually have to be centered around the reasons why you’re doing it. And don’t look to other people for approval or accolades. You should be able to give it to yourself.
[00:21:00] Dr. Gary Bisbee: Well, I’m gonna give you a great big pat on a back, Joanne. You’re just terrific. And you have been throughout your career congratulations, again, on your post at the American Hospital Association. And please call us if we can be at all helpful during your time there. Thank you again for being with us.
[00:21:17] Dr. Joanne Conroy: Well, Thank you, Gary. It’s always a pleasure.