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August 19, 2022: What was it like in the early stages of the pandemic through the eyes of a Secretary of Family and Social Services? Jen Sullivan who is now the Senior Vice President Strategic Operations at Atrium Health shares her thrilling and beautifully put story about handling the crisis, the vaccine rollout and other logistics at the state level through her fascinating lens. During the episode we ponder: What is the current status of the data infrastructure between states and health systems? How can we build behavioral health in an integrated way? How do we build novel delivery systems of care that go to people rather than our historic way where people have to come to us? What kind of magic happens when you combine an innovation hub and medical school all in one space? How can we best train our next generation of physicians? Are we seeing more virtual technology being used? How is that augmenting the training experience? 

Key Points:

  • When people looking at a health system, they're really looking for a partner in health
  • One of my favorite evolutions of public health is precision public health
  • How do you hire the right people and create an environment in which they can practice empathy?
  • Atrium Health

Sign up for our webinar: Challenges and Solutions to Unmanaged Devices in Healthcare - Thursday September 8, 2022: 1pm ET / 10am PT. If we had to troubleshoot just a few devices every once in a while, our hospital systems would run as smooth as butter, right? But when missing devices, security issues and friction caused by interoperability hits, we can’t expect a smooth operation. Our webinar will answer many questions surrounding the devices integral to keeping patients healthy. 


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Today on This Week Health.

How do we build novel delivery systems of care that really go to people rather than our historic way that we look at healthcare where people have to come to us. And so how do we expand home health and layer in things like community paramedicine and some of the novel delivery concepts that came out of the pandemic, like hospital at home systems, so that they become really the DNA of how we go to communities and link in a different way than we have.

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health πŸ“ leaders.

All right. Today, we are joined by Jen Sullivan, who is the SVP of strategic operations at atrium health. Jen, welcome to the show.

Thanks so much for having me.

strategic operations. I love that title. By the way, it says you could do strategy or you could do operate. It's like the world is wide open, wide open for things. Tell us what the role's about.

Well, so strategic operations was selected, I think specifically, because that's actually what I love to do. I call it whiteboard to the street. So you take the concept, you map it out, you know what you want and then you pull it off and you make it real.

And those, I think, as an emergency physician, that's the thrilling part of this work is taking a concept surrounding an. And then watching it grow and thrive and become real. So the work that I do in that role that as you've said is, is wonderfully undefined is really in three buckets right now.

I have the true honor of helping to lead seven service lines across our currently four state portfolio. So I have children's services, heart and vascular neurosciences. Cancer care, musculoskeletal, continuing care and long-term care. And so you can see that that is a huge continuum of services.

And it really goes very nicely with my philosophy around healthcare and that individuals don't come to see us one day to take care of their heart and the next day to take care of their brain and next week to take care of their grandbaby, they actually. Want us to take care of them. And so the connection between all of those different service lines and how we network them for increased access and, and efficiency and deliverables, I, I is really exciting.

So that's sort of bucket one. Bucket two is a huge passion and that is the development of an academic learning health system. So you may have heard just recently, about 18 months ago we merged with wake forest Baptist health and included in that is the wake forest. Of medicine. And part of that strategic portfolio is building a, a second campus for the school of medicine in Charlotte, which will really broaden our portfolio for training and education, but where sort of operations and academics have lived sort of in parallel, what atrium is doing, I think is really novel is that they will drive each other.

So that learning health system is that we're actually all academics. If you show up to work curious every day with a question and want to see the. You too, can be an academic and that learning health system drives. I think of it as a circle that operations drive research and research drives operations.

wake forest. Is that Winston-Salem? It is. It is. Okay. So they're gonna still have that campus. Yes, but you're gonna build another campus in Charlotte.

Absolutely. And that, work is actually underway. The groundbreaking for the innovation corridor in the Charlotte region is this week.

So really exciting work there. And then sort of the third bucket of my role is is really bringing things together. So connectivity. So a couple of examples, one behavioral health, as is the moment. Our defining moment, I think, as a society and as a healthcare delivery system of how we facilitate recovery we have a very fragmented system now.

And so behavioral health, as you noticed is not in my portfolio of seven service lines, but you can't extract it from any of those groups of individuals. You can't extract it from children, from individuals who have had a stroke from Folks that are wondering whether their chronic disease is going to get better.

They're all interlinked. And so building behavioral health in an integrated way, I think we unfortunately separated physical health and mental health a long time ago when we never should have they're not, they're not different. We're just people. And we need both of those things to be delivered in an effective way.

And then my passion really that drives a lot of this work across all three buckets is how do we build novel delivery systems of care that really go to people rather than our historic way that we look at healthcare where people have to come to us. And so how do we expand home health and layer in things like community paramedicine and some of the novel delivery concepts that came out of the pandemic, like hospital at home systems, so that they become really the, the DNA of how we go to communities and, and link in a, in a different way than we have.

You know what, Jen. I wasn't wrong. That's that's a lot. it's interesting, as you were talking there, I was thinking about some of the conversations I've had with other guests, just about this whole concept of what are people looking for from their health system. Mm-hmm and you sort of captured that.

I think pretty well in that. when people are looking at our health system, they're really looking for a partner for health, not, oh I need an endocrinologist. I need an oncologist. I need a, what? I, we don't speak that language. I remember when. First became a CIO in healthcare.

One of the things I had to do was take a list of all theologists and figure out what they were. And people were like, appalled. They're like, oh, how could you be the CIO of a health system? And you don't know all these things. I'm like, you know what? We need to understand that almost no one who walks in that door.

Knows what all of these things are. And so anyway, it's just, it's interesting that whole concept of being a partner in health with with the people in your community and really knitting all those things together.

Absolutely. Well and I think that partnership goes even beyond healthcare delivery. Healthcare is really just a tiny piece of health outcomes in general. And so I have to understand, and my teams have to understand that we can't make it all the way there without partners. And so our community partners help us be more effective partners to our patients because when they leave the office or someone leaves their home after a home health visit, they're not a patient anymore.

They're a person. And that that person still needs the other parts of health, food, safety, education, employment, transportation, housing all of those things that actually really are the drivers of health improvement for individuals and communities.

All right. So we're gonna take this conversation in a couple directions. One is you and I. At an event. I don't even remember the event. We happened to sit across from each other, didn't know each other, and then had a, really fun conversation. So we are gonna talk a little bit about your time in Indiana. Because I just think it's fascinating and I think it's a great story.

So you were secretary so we're gonna talk about that. We're gonna come back to atrium. So all the atrium people were like, no, no. Talk about atrium. We'll get back to it. Don't worry. But I do wanna hit on this story cuz the, it was fascinating. Secretary of family and social services. Is that the accurate title?

Yes. Okay. Walk us through, I mean, what's, what's the role and what did it look like in the early stages of the pandemic?

Well, so. There are a couple of things that I could not have engineered. And I just, I think back about the universe conspiring for good for the team that we had in Indiana and the work that we had done leading up to that moment in time that really Honestly, set us up to build a response that I am incredibly incredibly proud to have helped with.

First of all, we , we had more physicians in state government than any time in history. So the secretary of health and human services myself is generally not a physician. And in fact, at the time of the pandemic, there were only six in the country that had that unique background to think about things and human services in a little different way that clinical.

Really changes the way that you look at tools and and deployment being an emergency physician is a whole different layer of skills in order to respond to things with limited information and make decisions that are, that are really important. Our health commissioner, an OB GYN of 35 years, incredible wisdom and poise and connectivity trusted by the community in that space.

We had built a network of chief medical officers to advise each of our. Not for a pandemic, but for regular operations who were available to kind of become what we called Indiana general hospital and advise the governor on the work that he needed to build for policy changes and supports for the state.

Two other things that had been finished in 2019 that were really critical for our response. The first was that we had inked our contract for our state academic partner. And what that meant was that our statewide clinical and translational sciences Institute, our CTSI was on retainer to the state to be a policy analyst engine.

And I had intended to use that for things like childcare policy and Medicaid changes and aging supports and things like that. But they instead became our 24 7 COVID research engine, not just for our state response, but for the public as well. And so every day they published updates on the best practice for COVID response.

For the public for healthcare providers and for state policy makers. And then as we fielded questions, we could pitch them to this team of medical librarians and engineers and virologists across the state to help us make really evidence based and informed decisions for our teams. And then for our for our state and community as well. The second again, just incredibly,

you know, you're, you're going through this stuff and I'm sitting there going. It isn't every state set up this.

No. In fact that partnership was the first of its kind. We modeled it after some existing programs. There are state academic partnerships with Medicaid teams and there's actually a coalition of those that help advise and evaluate and do kind of nimble response to Medicaid policy and change.

What we did though, was for our entire health and human. Portfolio. So that CTSI would be again on, on retainer a, a team of experts that would be available to look at how human services policy, which is just as important as Medicaid policy for really improving health outcomes would be able to help us do the right thing for the right reason.

We made it mandatory to have a policy evaluation component to everything that we. And I think that really becomes data driven government, which is what we should be held to that standard.

πŸ“ πŸ“ We'll get back to our show in just a moment. I wanted to take this opportunity to invite you to our next webinar challenges and solutions to unmanaged devices in healthcare. This is where we're gonna take a look at the tools that are integral to keeping patients healthy in what we're doing to secure those tools and find them.

In some cases, guests will be leaders from children's hospital of Los Angeles Intermountain. And we're also gonna have representatives from mitigate by clarity on the call as well. And they're gonna share their experiences in maintaining these devices. And just some of the success stories, some of the challenges that they've had as well.

We're gonna do all that on September 8th at 1:00 PM. Eastern time, you could register on our website this week. top right hand corner has our, upcoming webinars. Just go ahead and click on that love to have you register for that. You could also give us your questions ahead of time.

I can give them to the guests and we can make sure that we talk about that. On the webinar. So your topics get addressed before the webinar, we're going to be having a briefing campaign, five short episodes on the channel about this important topic of securing your unmanaged devices in in the hospital setting. You wanna check those out as well. You can also check out those on this week, So look forward to having that conversation. Love to have you join us now back to our show. πŸ“ πŸ“

I'm glad you brought up that term data driven early on in the pandemic, we didn't have a lot of data. We didn't know what we were sort of operating from. No, so what did it look like? Where did you go for your data and I'll come back to, because a lot of the state to health system Data sharing and whatever was broken. So we weren't getting real time updates of information and those kinds of things. So talk, talk about the data and how it moved and good, bad or indifferent, how it worked.

Well, having this network of scientists who often would get information before anyone else. So even as we were waiting for public health information from the federal government, we would get really good early studies from other scientists across the globe.

As you can. You remember the entire global scientific community woke up, got outta bed. Poured a couple shots of espresso and got to work. And so with this network of scientists who had those connections, we could get evidence quickly. So when it turned out that that we started doing early intubation or airway management of COVID patients because they declined so quickly.

And then it turned out that that actually. Might not be the best way to do it. And we started doing what we call ping. So put people on their tummy like we do with kids, right. And we could avoid intubation, which has all kinds of complications associated with it, like pneumonia and long ICU stays and other infections.

And so making those pivots rapidly and disseminating that information to the healthcare community was just one of many examples of, of how we could get this done. And. It turns out there actually was some baseline data from previous coronavirus outbreak. So SARS and MERS, not the same coronavirus, but similar qualities that we could say, you know what doing temperature surveillance with drones.

In places where people gather is probably not the best use of our funding so cuz that had been studied in SARS at airports. And so we pivoted our funding toward really community based interventions that would help kind of simultaneous safety and economic reopening so that we were meeting people's unmet needs as well.

Some of the other things that were really interesting is that group helped us keep track. How many policy opportunities were available at the federal level. And we took advantage of all of them, every waiver , every Le every leniency, every regulatory thing we could wave, we waved them all.

And people really appreciated having that cataloged in a space where they could really make sure that they were still living by the. But taking advantage of, of flexibility. So just, just an incredible repository of information that, that lives to this day in, in the Mo on collaborative with our wise network,

we end up with a vaccine and the logistics of that at the state level had to be really fascinating. What did that look like?

so that gets actually to my second. Universe conspires for good moment. In the 2019 general assembly session the secretary's initiative. So my initiative with a ton of wonderful partners and with the support of the governor and what we unanimously passed, both house and Senate for two 11 to become part of the state.

So there at the time were two, three digit dialing codes that are national first is 9 1 1. Everyone knows that. And then there's 2 11, 2 11 is. Sort of social version of 9 1 1. So if you get your lights turned off, for example you can call 2, 1, 1, and they can help you find some emergency funds to help restore your, your power, or if you, if you can't make it to work, you need a transportation assistance.

You can call 2, 1, 1, and they can hook you up with a local network for transportation assistance. They're just incredible work of connecting people to unmet social. So two 11 is, is everywhere in the country and serves, I think 98% of, of the population of the United States. It is generally run at the county level and is philanthropy based.

So for an Indiana in particular the local United ways, both fund and operate two 11 up until 2019. When we realized that health and human services have to have a personal connection to people to not be so scary. when you realize that you are in a point in your life where you have such overwhelming food insecurity that you need to apply for snap or supplemental nutritional assistance program, that that may, that's a really bad day and it's daunting.

And it's also hard, the app, there's an application process. You have to find documents and you're already stressed. That Maslow's hierarchy of needs of, if you're hungry, it's. Or to do the next thing. So we decided to bring two 11 out of county by county and really centralize it and make it accessible at the state level.

And so we, we had gotten that past, really excited to make that work pandemic hits. And then vaccine becomes available. And so we decided as a state that we were going to run the entirety of the vaccine program. And so we built a centralized web based signup system and then backed it up with two one.

So at, at one point when we were at our highest demand of vaccine, we had sometimes over 1500 people Manning the phones. Getting folks scheduled through this centralized state based software system. We set up a network across the state. And so what we thought we were gonna use two on one four, we did, we in fact went from about 20,000 calls of a year for two, on one to one point where we had 20,000 calls a day because people had unmet needs that had never.

Interacted with our system before. And so now we had this way for them to call and we had something that we could do and then, okay, incredible.

So state of Indiana, how big.

About 6.7 million people.

Okay. So when it went from a county based to state based, still funded by the United way, or

no, we took it all. We took it all over and we said, Hey, United way partners. We would really like for you to take this funding that you've used. To fund 2, 1, 1, and use it to really drive down on the things that are most important in those communities. And it's really allowed our United ways to pivot, to meet unmet social needs in a different way.

And we could take that on now, the advisory board for 2, 1, 1 is made of all those awesome United way folks and other community leaders so that we could have the. Of the community and what I said when we started this process, cuz everyone was a little bit nervous about the state taken over two 11 is that I would actually, instead of two 11 to look more like the state that the state looks a little bit more like two 11.

Interesting and not to over overlook the politics. I mean, this is Indiana and we know the vote that just happened last week in Indiana. It's a very, very conservative place. So that, that move that you're describing was was, I would imagine not a small. Political move.

And it took a lot of collaboration, but I'll tell you what having conversations with our legislators, with our community partners about doing the right thing for people and elevating the human experience is really hard to argue with.

no, I, I could see that. Extremely rural. Right? So you, I mean, you have Indianapolis, you have Bloomington, I'm not even be able to name and then you have the Chicago suburbs essentially. But the rest of it's very rural. And so the specific needs of those communities are diverse, very diverse. I would think.

They are. So one of the other components of Fs S a that was novel during our team's time there was, we built something called the office of healthy opportunities. And that office really became the underpinning of everything that we did in connecting all of our programs to as an outcome. So everything from childcare to aging services to Medicaid, it didn't matter how disparate it might be, or how many steps away from improving health outcomes that became kind of our driver and that office of healthy opportunities really used the science of social drivers of health to kind of drive all of our policies and programs forward.

So one of the things that we built was an Atlas and it is, I, I think still the only. Comprehensive heat map of unmet social needs for an entire state. And so you can look it up and play with it and drill down by demographics and location and see really specifically, okay. This community is missing safe housing.

This community has a, has a transportation gap and even down to. It looks like food insecurity is the number one unmet need for the entire state of Indiana. That should be our number one priority. And so as you have that kind of data to drive programming, you can really do something that one of the, my favorite sort of evolutions of public health is precision public health.

When you think about precision medicine, getting the right medicine to the right person for the right condition to minimize harm and maximize efficiency and efficacy, we can do the same thing for human services and for public health. If we really know the needs of com of the community that we have partnered with, to understand, then we're not just coming in and saying that, that famous phrase, I'm the government I'm here to help. It becomes this really unique connection of, again, data driven, government, local connections and local solutions.

What would it take? I'm thinking about, I'm thinking about Indiana and I don't know, maybe I'm minimizing how difficult it was to put that together, but let's, let's take that to maybe not California. Let's take well, let's take it to North Carolina. How hard would it be to build that out in north?

Well what's really interesting is that there is a similar process in North Carolina. This will not be surprising to lots of folks who know me, but the network of physicians who were health and human services secretaries we really collaborated a lot during the pandemic.

Pre pandemic during and post and so Dr. Mandy Cohen, who up until recently was a health and human services secretary here in North Carolina built a similar network. So her program is called NC 360. And what it does is it uses a, a different platform than two 11, but still a, a database. And instead of connecting individuals through a 2, 1, 1 network or a human services delivery system, hers links in to the healthcare delivery system.

And so that helps again, connect healthcare, unmet social needs, and a referral platform for individuals to get. Access to those different services. So it's a, it's a different approach. But to tackle the same problem and there are, there are many different I'm relatively agnostic to the tool that's used, but there are lots of different vehicles and platforms to build something along those lines to be the connector between people and not just the emergent need that they.

Today, but really moving upstream to start identifying those needs more broadly and then preventing the emergency, which I think is what we all want.

All right. Last question on public health. And then we're gonna come back to to your work. I wanna talk about the innovation. Uh, I wanna talk about the Pearl is it called the Pearl? Is that what it is? Pearl? The, it is I'm come back to that. Not, not yet one last public health question. Yeah. One of the things that happened in the middle of the pandemic was we had information we were gonna send to the government the federal government and that completely broke in the middle and then they wanted to redo it and re re, but I heard that story over and over again, state after state, after state, what is, what is the current status of the data infrastructure between states and health systems? Do you feel in most states or across the.

Well, I can only speak to what you saw, right? The one I I know about I, I have got to tell you I was gifted to have probably the best informatics infrastructure of any state government. And I, I say that not to brag because I didn't build it. I inherited it and then harnessed it and grew it

But we had an award-winning CIO built out a team of data S. Had an incredible data warehouse that we could use. And so for, for us, if, if someone said pivot, we would pivot and you tell us to send information here. Okay. So let's tell us to send information here. Okay. And so we really did we really did function in a very isolated way as states in certainly in the beginning times of the pandemic with not a particularly coordinated response.

And it made us a little scrappy and all, and maybe a little stubborn too. So you may have been seeing some of that. Well, we've been doing this on our own for a while, so don't tell us what to do now. and that's, that's a. State's rights sort of way to behave. but really at the end of the day I think what we, what we learned about working together with our federal partners is that when you work together, everybody gets better.

And so if it means that we've got a report here and report there, okay, we'll do that because then you have our information and you federal government can make better decisions on behalf of your individual states as well.

Yep. Absolutely. The Pearl, what is it? And is that part of what you do at atrium?

Well, the Pearl one is just brilliantly named there is a historic neighborhood here in Charlotte. Pearl park and the Pearl neighborhood which has been steeped in history and tradition and in incredible groups of individuals and community leaders and the Pearl district will, will be in the Pearl neighborhood.

And so it's a, it's beautiful the way that it's a connection to the history of the city, and it is the innovation hub and the medical school all in one space. And so I'm really excited to see. What we do with this as it becomes a physical reality and sort of a magnet for innovation, both in the sort of the corporate realm.

So how do you build devices and test them and train surgeons? We have a, a really cool partnership with IRCAD which is based in France around how you do surgical training for. Highly specialized programs, all, all the way to having co-located medical students. So they have access to all of those training platforms as well.

So it really is a physical commitment to what we've said. We are going to be that academic learning health system. So the hospitals here the Pearl is here. We've got this connection to the both schools of medicine, all, all happening in this incredible.

yeah, I'm looking forward to seeing how that develops. Let me ask you this. we didn't get a lot of time to talk before this because I was out buying my daughter, her first car and just ran in and started this conversation, but With regard to training the next generation of physicians and whatnot. As you look at the academic medical center side and training these specialists and whatnot, how has training changed? Are we seeing more virtual and more technology being used or how is that augmenting the training experience?

Absolutely. It's so much more robust in the circumstances compared to 20 years ago when I trained, where you just got thrown in and figure it out so I think it is more comprehensive. But I'll tell you, in addition to the. The SIM lab and the technology that we use for even just doing things like every big IV that gets put in is we use an ultrasound to put that in. When we intubate folks, we always have a camera so that someone else can see what's happening and can, can help guide.

And I mean, just incredible, just things that make us better and safer in what we do, but I'll say the more even powerful thing. Changed about training is that we are teaching our physicians to care about their patients in a different way than we did before. And it's the training around what we've been talking about around thinking about the circumstances that surround your patient's life and how you have a little bit more empathy for the shoes that they may walk in that are different than your.

The equity lens that we need to apply as we're taking care of people who look different or have different backgrounds than we, how we make our physician and nurse and a P P workforce more representative of the communities that they care for so that we have. Connections and healing relationships.

I, I think that piece is really powerful. We've got a long way to go, but the fact that we've identified that as what will be the driver for recruiting and retaining the best and most compassionate folks to be in medicine is really what gives me incredible optimism to. An educator and training the next generation of physicians is that really building that culture and mission of why we do what we do. And it's about the people who, who trust us to do that work.

Yeah. The, the environment we have right now is really interesting. We hear of clinician shortages and I was just talking with a leader about empathy and one of the things that he was talking about was. the need to create margin.

People are so busy. We have to see so many patients and all that, all that thing. How do you look at a health system in our existing practices and say, all right, we're gonna create an not only are, we're gonna hire the right people. We're gonna create an environment where they can practice empathy.

Well, there's a couple of things. So first of all, and I'll, this is maybe a little bit more emergency medicine than, than, than most. But for me in the emergency department, it's a couple of things that are, that are just easy. Sit down. Write your note. When you leave the room, the conversation that you have with the patients, with our patients, their families, their kiddos, they want to see your face.

They want to know that you're listening and that additional. Look me in the eye. Let me finish my sentence. Let me tell my whole story. It may feel like a long time, but it's generally about 90 seconds longer than you would've taken in, in another situation. And it makes all the difference in the world that human connectivity it's not hard and it doesn't take very long.

Now the other more . Difficult spaces is how, how do we make sure that we build incentives to allow people to have relationships and have the time to spend with patients so that they are heard and we make less mistakes because we listen to the end and that's gonna require More robust partnerships with payers to value that in the way that we build the next 10 years, the next 20 years of healthcare delivery.

And that will, I think I'm hoping that that groundswell will come from our patients as well, because that's what they want.

So Jen, a lot going on at atrium, I'm not gonna talk to you about the M and a activity that's going on. I don't think that would be fair. That's above my pay grade. Yeah. But, but I do wanna, you have a, you have a significant area.

What are like one or two things that you are really excited that you're working on right now that that you feel is really gonna impact the communities that you.

Well, there's, there's quite a few and it goes EV all the way from that initial patient encounter in the how do you build a medical home? So the idea that we have four states that could have an integrated children's health network is really exciting. So it wouldn't matter where you live, where you're from, but you could have whatever need healthcare need met. From all the way from Charlotte to Macon, Georgia, that's really exciting to bring all of these systems together to do that work.

And that's, that's pretty simple. The telehealth platform that underlies some of that work, digital networks, bringing physicians together for one strategy for improving child health, I think is Achievable and very doable all the way to let's, we'll keep on the children's example all the way to the really complex process of building a congenital heart program across multiple sites so that those babies and families get what they need where they are and watch their kids grow and thrive.

Those things are really exciting bringing again, that, that whiteboard to reality of building those networks to scale is really the most exciting thing.

And you have a significant rural population. So how are you gonna take that expertise from Charlotte? To the rural locations. What does that look like?

Well, I'll, I'll shout out some teams that are already doing that incredibly well. our cancer team is way ahead of the game in providing rural care and already do extraordinary outreach and have built. It turns out that you can really. Deliver complex, high quality cancer care, wherever you decide to deliver it, if you, if you do it right.

And so those networks telehealth delivery with supports. So teaching folks how to use devices in their homes, making sure that they have good internet connectivity having home visits from nurses and community health workers, having infusion sites that are out in satellite areas so that we can.

Have a bigger catchment and really meet people's needs where they are. That cancer team in particular, I think, does that really, really well. And their example I think, is inspiring to all of our teams done, how we continue to replicate that work.

Well, it, it seems like you guys have a lot going on. I love the work that's going on at atrium. And I love the the innovation work, the work at the expanding the academic medical center opportunities across your entire network and doing the outreach into Into the rural areas. Let me ask you this, your public and last question, public, your public health experience.

How have you brought that across? And how does that help you to think about some of the challenges within the integrated delivery network?

Well the juxtaposition of being an emergency physician and responding to just in time problems. And then that public health brain and public health training is exactly how I look at every day.

So here's a problem. Let's fix that problem. And then let's take 10 steps back and look at this from a public health perspective so that we never have to solve this problem again. I think that's, that really is the underpinning of how those two things are, are connected. Public health is all about looking at big picture building systems and processes that.

Problems before they happen, rather than waiting for them to happen. And I think that infrastructure though it seems really simple to say it out loud, but if we really embraced that across multiple domains, a as a, an approach, I think we could find ourselves in a much better place from a health perspective in lots of different spaces.

Fantastic. Jen, thank you for your time. I really appreciate it. And look forward to catching up with you again.

Absolutely. Thanks so much.

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