Beyond Shiny Amenities: Markers of Quality in Essential Hospitals

Welcome to the Barrel Institutes to Care Is Human podcast series.
You're listening to Humans in Healthcare, where we spotlight powerful stories from the
people who provide and receive care. By sharing the experiences of those on the
front lines, we are transforming the human experience in healthcare. - Hello,
and welcome to another To Care is Human Podcast. I'm Terri Ipsen,
Director of Content at the Barrel Institute. For this edition of Humans in
Healthcare, I'm delighted to have the opportunity to talk with our friends from
Denver Health, Sharif Abdel Hamid, and Amy Friedman. Denver Health is an essential
hospital, otherwise known as a safety net hospital.
Both Sharif and Amy hold roles in patient experience and they will be sharing with
us today what their organization as an essential hospital is doing to improve the
care experiences of their patients. So Sharif and Amy, welcome.
Thank you so much for being here. Just going to take a minute and have you both
Say hello and introduce yourself and I'll start with you, Amy. - Great, thank you,
Teri. I'm Amy Friedman, I'm the Chief Experience Officer at Denver Health and you
may ask, what does Chief Experience Officer mean? And it really is a role designed
to be there for both our patients as well as our staff because what we have
learned over time is our staff really need to be supported, be able to deliver that
healthcare to our patients. So it is a dual role in that we're serving both our
patients and our staff. And an important role, I must say as well. Thank you,
Amy. Sharif, say hello and introduce yourself. Hello, my name is Sharif Abdelhamid.
As you mentioned, I'm the Senior Director of Patient Experience and Language Services
here at Denver Health. I have gotten I've had the privilege of working here for 10
years, and in my role, I get to work with our patient advocates, the patient
information team, volunteer services, and also our language services, our medical
interpreter team. So it's a great place to be, and I'm proud to be here today.
- So Amy, I'm gonna start with you. We're here today to talk about essential
hospitals. Can you tell our listeners what an essential hospital is?
- Yeah, it's a great question. And it's changed over time. So you had mentioned
earlier safety net and it really has changed to essential hospital because that's
what we are in the community. A hospital that's termed as an essential hospital is
really one that's there serving those that are challenged by financial resources,
inability to get care. They're the marginalized underrepresented populations in our
community. And not only are we serving those populations, but we're there for the
public health of the community. Or if there is an emergency situation, it's often
the essential hospitals that are there in the middle of a crisis. We were the first
level one trauma center in the region. our role and we've been this hospital has
been here 164 years and we're critical to the city not only for all these services
but also to be able to help out these populations. Truly you are a pillar in your
community so thank you for that great definition of what an essential hospital is.
It lends itself for the questions that are going to follow today on today's podcast.
So, given that essential hospitals operate with limited resources is providing a good
care experience harder to achieve in a safety net hospital. And secondly,
how do limited resources impact your ability to deliver clinical excellence? And I'll
ask Amy to answer that as well. It is challenging. We are subsidized by federal
dollars, by donor dollars, and it is challenging to be able to give that same high
-quality clinical experience that you would expect at any hospital. You know, I
compare it to taking an airplane ride. You get on an airplane with full expectation
that you're going to get to your destination, you wouldn't think otherwise, and the
same thing for our patients when they come into the hospital. No matter what
hospital it is they're expecting a high quality experience and so we do have
challenges of how do we make that happen given that we don't have all the resources
that another system has and we can't offer maybe some of those shiny amenities such
as a big fancy waterfall fountain in our lobbies and sometimes those are considered
markers of quality but we know it that that's not what represents high quality and
so we're here to share with our patients that we can deliver it. We will deliver
it. We'll work with our community partners to make sure that it happens. And we do
that by creating partnerships with others in the community to really be able to
deliver those high -quality experiences for our patients. Amy, how does having to do
more with less impact your mission of serving Denver's most vulnerable populations and
those with those complex multiple medical needs. As I mentioned earlier,
I think it really is being able to rely on our community partners to make that
happen, to deliver on that mission. I'll give you an example. A few years before
COVID, we found that our patients were struggling with transportation. They couldn't
get to their appointments. They couldn't get home from the hospital, either because
they didn't have transportation or couldn't afford transportation and reached out to
Lyft which was a fledgling company at the time and said what can we do how can we
partner together and we were one of the first hospitals to deliver a system where
we could order rides for our patients in a very cost -effective and efficient way to
get them home from the hospital or to an appointment and that partnership continues
today. Another example of that is oftentimes we have our patients who haven't who
are homeless and have no resources they'll come to the hospital they'll be medically
clear to go home but home is not an option for them and they need somewhere where
they can rest recover heal and so we have a recent partnership with the Denver
Housing Authority and just right next door we have a building where we have 14
transitional units. So when they're medically clear to go, they can go to these
transitional units to further the healing process. So it just takes some creativity,
innovation, and partnering to really be able to deliver on our mission. Yes,
absolutely. Thank you, Amy. Let's shift gears now and talk a little bit about the
most recent paper released by the Barrel Institute. Sharif was a major contributor to
that paper. So thank you again, Sharif, for that. The paper was entitled
"Transforming the Human Experience in Essential Hospitals." And the paper was based on
the eight strategic lenses of the experience framework. And in this section in the
paper about culture and leadership. Sharif, you pointed out that essential hospitals
are values -based organizations. And you made a very interesting quote,
and I'd like to share that here. If we don't feel that sense of purpose and the
connection to organizational values, it's hard to achieve our mission.
So Tell us about your role and why you feel connecting staff to the values and
mission is a key driver at Denver Health to ensure a culture of excellence.
- Thank you for the question, Teri. You know, I was listening to Amy talk about our
partnerships with Lyft and the Denver Housing Authority and I just had the biggest
smile on my face. And I think that's the great example of the ways that we,
there's such a sense of pride to get to be a part of the work that we do. I do
a presentation for our new employees every two weeks and you can, the pride is
palpable in the room, you know? You can feel it in the hallways each day and you
see it in the interactions between staff members and their patients between staff
members and other folks that they're working with, you know, so I think that
connection to purpose is really important. And for us to have that connection to
purpose, I think we all have to align to a similar vision. And so we recently have
put out a new strategic plan where our vision is to be the most trusted healthcare
provider in Colorado. And so that requires a sense of purpose and connection to our
values. And it's really important to have that connection because as we strive to
deliver on those high quality services that Amy spoke to with those limited
resources, you have to have that connection to feel resilient. And I always say,
if your heart isn't in it, then you can't be effective. And I think there's a lot
of folks here whose hearts are in it and in it for the right reasons. - I'm glad
you brought up the strategic plan, Sharif, because during our focus groups, you
pointed to experience strategy being part of your strategic plan multiple times.
You said that in the strategic plan, it's being called out intentionally and
specifically in language. Can you tell our audience what your strategic plan is
addressing and how it influences your experience strategy? - Yeah, we're very excited
about our 2024 to 2026 strategic plan that we launched earlier this year.
Again, the vision of being the most trusted at its core means that patients and
staff and their community feel safe and confident to choose us for their care.
It means that Denver Health is a place that people want to work at. It means that
the community feels like entrust us with playing such an essential role for the
entire city and county of Denver. So we trust in our values first and foremost to
guide us and create that experience for everyone. and they really serve as those
building blocks of trust for us. And, you know, our values include things like
respect and belonging and accountability and transparency. And we know that those are
the backbone to trusting relationships. Specifically,
our strategic plan starts with our mission, which includes providing all in the
community with access to care, regardless of their ability to pay. And then from
there, we've identified three key strategies. First, we wanna be a collaborative and
transparent apart partner. Second, we wanna be financially sustainable. And thirdly,
we wanna advance accessible, high quality and equitable care and services.
So with those strategies in mind, we created nine strategic initiatives across the
three year plan. And truly, the humanized experience is embedded within all of these
initiatives and includes things like improving access to care for our patients,
improving our employee and provider engagement and retention, and making sure that our
net revenue processes and our air mix can keep our doors open. So lastly,
with our strategic plan, I would just share that our success in these areas are
measured using an org -wide scorecard and embedded in that scorecard are very specific
metrics like our inpatient and outpatient patient experience measures which are used
to determine are we attaining our goals. So we know that attaining our vision is
going to take everyone's involvement and dedication to be successful. Yeah, I love
that, Sharif, you guys have been busy, it sounds like. And congratulations on what
you've accomplished so far with that strategic plan and all your action plans within
it, so that's awesome. - Thank you. It's a really exciting time for essential
hospitals to think about how we can critically address all these challenges that are
out there. - And I hear the passion in your voice too, Sharif. So you're correct in
pinpointing to the compassion that folks at essential hospitals have, especially at
Denver Health. Thank you for sharing that with us. Gonna turn back to Amy for a
minute. And at the Institute, our mission is to transform the human experience in
healthcare. The patient is always at the center of experience as we know,
but from a human experience lens, we include the workforce and community as well.
And Amy, you touched on this a little bit earlier, but maybe we can take a little
bit deeper dive. You know, our paper mentions that Denver Health is very involved
with the community. How does the community fit into your human experience strategy?
And maybe you can give us some examples of changes that you've made based on
community feedback? Yes, it's so important. You bring up a great point of involving
our community. And it's something that's really critical to us, even for our
survival. And I think about the work that we've done around inviting different
cultural affinity groups to Denver Health to get their feedback, to hear their voice.
And we just don't do it one time. We do it on a consistent basis so that we're
hearing from various members, we're following up with them, sharing what we've done
based on the feedback that they've given to us. There is one particular program that
I thought was so effective is, you know, there's some challenges around being able
to get out health education. And we found in one of our communities that if we
showed up in barber shops that it was a highly effective way to talk to men about
preventative care and found this was an effective tool and we thought what other
places besides barber shops can we go do? Is it their place of worship? Is it
their celebrations in their communities? And so we have found various innovative ways
to be able to be in spaces with our patients other than our buildings and our
physical environment here on the campus and in our clinics. We've also found
important to get the feedback through focus groups and so we are a research center
and so we've conducted a variety of focus groups to be able to bring in the voice
of the patient and really work on diversity in our clinical trials. Throughout time
we have found that there's not a high level of diversity in clinical trials and
really have made an active effort and are now being recognized nationally for really
bringing in the voice of everyone into those spaces, being able to determine what is
the best type of care that we can offer and making sure that all voices are
included. And then we also have a patient and family advisory council that we meet
with frequently to get their feedback. So all these different spaces have been
created to learn from our patients and make changes. I remember one of our patients
who uses a wheelchair to be able to get around said to me, Amy, it's great that
you all have ramps to be able to get from the sidewalk across the street. But I
have to tell you about this one that is right in front of the clinic that I go
to. It's so steep that it's dangerous. And I just go right down the hill,
right into the street, and I'm not able to control the speed of it. And because of
their input, we went out and we changed the grade of the ramp. No one had actually
realized that it was too steep. And it was just those little things, but that makes
such a difference. And what a struggle it was for that patient to be able to be
able to get up and down that ramp. Another example that I think about is, and this
is a recent one, we have centers for OB and GYN services,
obstetrics and gynecological services, and we had called them women's care. And the
feedback from our patients is not all gynecological care is for women.
And so we have now changed the names of those centers to be more inclusive. And
it's something that our staff felt very passionately about, to be able to support
our patients and being able to hear them and make those changes so that they feel
heard in the spaces where they get care. Well, I applaud you for all that you're
doing. You're thinking outside the box to reach your patients and capturing their
feedback. So those are great examples and a great segue to talk a little bit more
with Sharif about his role in language services around the topic of diversity,
equity, inclusion. So we know that essential hospitals have a very diverse patient
population. And Sharif, we heard in our focus groups for that paper that diversity,
equity, inclusion are top strategic priorities for almost all essential hospitals.
Can you talk to us a little bit Sharif, share with us what your team is doing
from a language services perspective to address DEI? This is really one of my
favorite topics, access to language services and language justice providing services
such as oral interpreting or written translation services has been, it is critical to
enhancing patients' care and improving health outcomes, improving quality of care, all
of those things. So about 35 % of our encounters are with patients whose primary
language spoken is something other than English. So that means that year to date in
2024, we've had over a half a million visits with these communities. And even though
that's a very large number, that's an 18 % increase from the same period last year.
And we know, and we're very committed to providing access to language services
because that helps us to achieve language justice. And language justice we think
about as sort of a world where we're ensuring that we're providing equitable access
to our services and programs for these patients. So I'm really proud of our
commitment to language access and justice. What I've learned though and over the
years is that it takes everything to do it well. We have to pull every lever,
we have to push every button, we have to flip every switch. Things like making sure
that we have a bilingual proficiency testing program, making sure that we have an in
-house team of Spanish interpreters because 85 % of our non -English encounters are
with Spanish -speaking patients and having a strong network of third -party vendors to
provide services in all the other languages that we see. So when we do that,
we know that our patients, again, going back to trusting us when we provide care in
our patient's preferred language, not only is it the right thing to do, but it
helps our patients to feel like they're really in good hands. Sharif,
during our focus group conversation around policy, you had mentioned there are gaps
in reimbursement policies for interpreters and that you are hoping for change.
Can you expand on that for the policy makers out there listening?
Yeah, this is really and I appreciate you bringing this into our conversation today.
You know, there are many federal and state -based laws and regulations that require
making these services available to those with limited English proficiency or other
communication needs. And while every single care facility has an obligation to ensure
that those services are available, for the most part, they are not reimbursable. to
be blunt, it's quite expensive. And the same resource strapped essential hospitals
that we've been talking about are shouldering a big part of this. And so their
states do have the option of claiming Medicaid and ship reimbursement to reimburse
these agencies. And those funds can actually be matched at a federal level up to
90%. Currently, there are 18 states that are known to directly reimburse providers
for language services. So I would urge those who recognize the value and importance
of these services, including our policy makers, community advocates,
and especially our patient and family members in the states that don't provide this
reimbursement, which does include Colorado, to review our reimbursement structures and
to rethink how we prioritize the delivery of language services in the future. - Just
another big challenge on a plate of many challenges. So thank you for coming with
all those statistics. That's great for our listeners to hear and our policy makers
out there. Let's shift gears a little bit to look at the second lens of the
experience framework, staff and provider engagement. And I'm gonna shift over to Amy
now, another quote from a contributor to our paper said this,
"Essential hospitals' competitive advantage is compassion. It's in the DNA of most
people who work there." So Amy, my question to you is what steps are you taking to
ensure your staff is taking good care of themselves so they can care best for the
patients at Denver Health.
- Thanks, Teri. This is actually a subject I'm very passionate about. It is so
critical to be able to support our staff. One of the teams that I oversee are the
chaplains. And some years back, the head of our chaplain group came to me and said,
"Amy, I don't know how I can support everyone and I said share tell me what's
going on and he said well Oftentimes when we are on the floors or the units
visiting patients, we have staff Come to us and share the trials and tribulations of
what they're going through Whether it's a death of a patient a death of someone in
their family The maybe they can't pay rent But they are going through some of this
very same challenges our patients are and we need some way to be able to support
staff. So we started this group, it's now called Restore,
but it really provides psychological first aid, confidential psychological first aid.
It's available 24 /7 and it's delivered by peer responders. So these are Denver
health employees who volunteer their time to be able to provide the psychological
first aid. We were able to kick this off just a couple months before COVID and
little did we know how much it would really be needed. And so the program has
expanded exponentially. We now have a Restore Center where you can go and get
coffee, we have massage chairs, fish tanks, musical instruments.
You name it, there are a variety of resources for staff beyond the psychological
first aid so they can take a break from what they're doing and be able to recharge
and connect in whatever way is important to them. And we further expanded this to
be able to have what we call restore to you. So we have a mobile service that
goes out to our clinics. We oversee the Denver City Jail medical services.
And so this mobile service goes out to these areas whenever there is a crisis,
whenever maybe there's been a particular tragedy and be able to support our teams in
a way that can help them be able to continue to do their work for the remainder
of the day or situation. The second thing that we've really done to support staff
and I know those that might be listening in are facing the challenges that we have
around workplace safety and being able to feel safe in their environment and not be
concerned about either being assaulted at work or someone coming in with a weapon.
This is a national crisis, as you may know, it's been brought up by the in
general. And so we've had to be creative on how can we find ways to better de
-escalate situations other than bringing in security. So a year ago we developed this
team that we call DART, which is de -escalation of agitation response team. And when
there is a patient situation that's escalating, our team can call and have this DART
team come in. It is a multidisciplinary group and they have de -escalation techniques
and we've been able to de -escalate multiple situations and not only is it a create
a safe environment for our staff but also for our patients. So they're getting the
clinical expertise that they need in the time that they need it. So these are a
couple of the wet knees that we've developed to really able to to support our
staff. So those are great examples, Amy, and I applaud you again for taking care of
your workforce. I imagine this all helps with recruitment and retention of your staff
that you want to love and keep in your hospital. So congratulations on all those
wonderful examples that you've just shared. - As we wrap up our conversation today,
can each of you share that one thing that healthcare institutions can learn from an
essential hospital? And I'll start with you, Amy. - The thing that comes to mind
when I think about what's the one thing, and I know what the one thing for me has
been, is the lessons that we can learn from our patients. You know, I mentioned
earlier that we take care of the, you know, the marginalized, those individuals that
may not have financial resources, but that always wasn't the case for many of these
patients. Sometimes a tragedy will put you in a situation that you never expected to
be where you couldn't afford to live in the house that you're living in, that you
couldn't afford health care. And it is from these patients that I have learned about
resiliency, creativity, innovation, ability to get through the day and what gives you
that hope and inspiration to be able to move ahead. And it is from that,
I think many of us here at Denver Health, I've been here 16 years. It's what keeps
us going, it's our patients and what they go through and how we can be better and
do better based on what we see in them. - Thank you, Amy. Sharif, anything to add?
- For me, I think the thing that drives us and separates us as essential hospitals
is our focus on relationships and building trust and how important that human
connection is in health care.
At the end of the day, we're all just human beings trying to care for other human
beings and everything that comes with that. And I think as essential hospitals,
we recognize that inherent in all of our work is that shared humanity and the need
to be there for one another however we can be. and I think that's a great lesson
for not just healthcare organizations, but the whole world right now. Absolutely.
Thank you, Sharif. In our paper, we made a comment that other hospitals can learn
from essential hospitals. And we ended our paper highlighting that in essential
hospitals are innovators, trailblazers, and teachers.
How do you both feel about these labels and are they accurate? I love these labels.
It means that we're at the forefront of the healthcare industry as essential
hospitals. If you know, like Amy said, we need to innovate to be successful.
We need to create, you know, be creators and we need to be teachers to make sure
that folks are understanding How do you better participate in the community and
understand the voice of those that you serve? So I oftentimes will say that
essential hospitals are at the forefront of everything that happens in the healthcare
world. And if we can help share those practices that make us successful with others,
I think that's a great thing. - The beautiful answer, thank you. Amy, Amy, anything
to add? Absolutely. Those labels are perfect. I think that's what inspires a lot of
the people to be here and to work here is being trailblazers and teaching the next
generation of caregivers. And I think about all the things that Denver Health has
created and has put us on the map have been innovative, creative solutions to
situations. And it makes a difference in seeing how we have changed our community
and the health of our community by being those trailblazers. I take on those labels
and wear them proudly. - Thank you both, Amy and Sharif,
for sharing with our listeners today what you and your organization is doing to make
experience a strategic priority at Denver Health. Thank you for sharing all your
nuggets of wisdom with us, your action steps that you're taking. It sounds like you
have a solid backbone for moving experience forward and you're taking such a great
care of your of your patients and your and your population. So thank you for
sharing all of that with us today for this edition of To Care Is Human. Thank you
for tuning in. You've been to humans and health care, a part of the Beryl
Institutes to Care is Human podcast series where we strive to elevate the human
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