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  Today on Town Hall

I wish more hospitals were comfortable with partnering and collaborating with people that are complementary to the services that they provide.

I wish more hospitals realized that they didn't have to be experts at everything because those institutions that feel like they have to do it all themselves are just fooling themselves. You can't be good at everything. It's impossible.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare.

Today's episode is sponsored by Meditech and Doctor First .

Alright, let's jump right into today's episode.

Welcome to one more episode of This Week Health. My name is Carla Arzola, and I am the CIO of Rec and Occupant Services. Today's guests are Sam Nima, CEO at Traven Health, and John Curtis, CEO at Tampa General Hospital. And we will be talking about their successful partnership, and how together they have been able to create significant cost savings and improve patient outcomes.

Their efforts are specifically focused on recovery of ventilator dependent patients. Sam and John, welcome. Carla.

 thanks for having me.

Yeah, thank you, Carla.

Yeah, thank you for the time. Let's do some quick intros before we get started. John, why don't you start and then just tell us a little bit about your background. How long have you been in the organization? Just fill us

in. So, I'm the President and CEO of Florida Health Sciences Center, the parent company of Tampa General.

And Florida Health Sciences Center is an organization that's made up of a little over 30 companies. 000 team members we've got six hospitals, 150 outpatient centers and clinics across the state. And we're a big academic. and Research Center for the state of Florida.

Thank you for the intro.

Samhat, what about yourself?

Carla, I'm the CEO of Trivent Healthcare, and I will share with you that I was a hired gun in corporate America for a very long time, and after a long career in a couple Fortune 100 companies. I got this itch that corporate America really couldn't scratch but I also wanted to be in an organization that was mission driven, and so when I stumbled upon this company, I absolutely fell in love fell in love initially with the outcomes, but then when you start hearing the human stories, not just the patients, but the staff it's really, it's life changing and so, it's been life changing for me and I've been honored to be the CEO here for about 10 years.

Awesome. Congratulations. That's great to hear. And thank you for, to both of us for the time and I was reading about some of the outcomes that your organization have been able to accomplish using the TriVend care approach. So, therapy just in case of therapy, the average length of stay on triphant care units, it's 28 days, which there's a 32 percent reduction from the national average your ventilator liberation rate is 85%, which is more than 40 percent higher than the national average.

And then in terms of recovery, within 30 days of discharge, readmission rate is less than 7%, which is nearly 80 percent lower than the natural average. So those numbers are outstanding. So before we get into that, how do you start this partnership? John, can you tell us more about how all this started?

Yeah, I mean, the way the partnership started for us, strategically is it sort of goes back to our vision. So our vision as an institution for TGH is to be the safest and most innovative academic health system in America, that's our journey. And we have all sorts of ways we measure that.

And we have all sorts of programs and initiatives and teams that focus on that. We realized that we could do a better job with vented patients. Essentially, we knew that we were doing good work with before Sam, but we weren't doing world class work the way Sam and his organization performing. So we knew there was a better way to treat vented patients, to get vented patients off the vent.

And to get these people home to their families. And so, Sam and I have known each other a long time. I was very impressed with the company that Sam took over. I really liked the results that he was delivering for other clients. And he could get into that. And we came together internally as a team and said, We could do a better job with vented patients.

we believe we need a partner in this. Why recreate the wheel when you can partner with somebody who does a great job at this work in a really sustainable, reproducible way. We can learn from each other. We can collaborate and innovate with each other and we can deliver better results. And as I said, and get people home and that's exactly what's happening TGH and with TriVet.

It's absolutely. What's happening and it's been wonderful, but that's that was the genesis behind Getting connected with Sam and his organization, TriVent Health.

That's amazing. And that's a benefit of having long term partners and people that, you know, for a long time that understand your problems.

So let's talk about the challenge that you were trying to accomplish. And either Sam and John, can you tell us what are the major differences between the approach that most hospitals take and the TriVent approach? Care unit approach.

I think Sam is best equipped to answer this, in my opinion, but from my perspective, I really enjoy the culture that Sam's created.

It's a strong culture. The multidisciplinary team approach that Sam's created is something that is different. It may sound to the audience as like basic, but it's not. Very few people approach caring for patients like this in a multidisciplinary type of a way and Sam can get into the details around that, but I think that's very different.

His evidence based protocols and systems and clinical pathways is a differentiator, and when you put the culture, the multidisciplinary rounding and approach together with his evidence based protocols, it's my opinion that he's built something that's very different and very impactful. In our industry.

Yeah, John, I'd like to share a little bit more on that as well. and I appreciate the kind words, but the culture that we have. Fits with Tampa General's culture, and that's an important piece because what we always find is we're either right or we're learning. There's never right or wrong, right?

And so we review our results. Both organizations are very transparent. results regularly and we review all of the results, either the good results or the learning results. And so, both organizations are deeply intellectually curious and painfully honest with one another.

And that's part of what makes it really work. Well, John's right. We have a multidisciplinary high touch approach. Approach to care is very evidence based. We're always looking for new opportunities to get better. So when you have academic and research hospital, like Tampa General, well, they're all about getting better all the time.

And so, so really it's a great fit for us. We don't culturally fit with every hospital. This hospital is hand in glove.

So let's talk about I appreciate, obviously, understanding each other as a partner, understanding the problem of the culture fit the learning together, it's super important.

In terms of the model in the hospital itself, let's talk about the technology, the model, the changes that need to happen. Sam, can you talk about those things?

Certainly. So, most hospitals If they're being honest with themselves, we'll share that there is an opportunity to improve care for patients suffering from prolonged mechanical ventilation.

The reality is across the country lengths of stay are very high with this patient population. Outcomes are, frankly, less than they should be. Okay? Not that they're not good, but they can be better. And in some places, frankly, they're quite bad. Now, hospitals have used long-term acute care hospitals.

LTACs has an approach for caring for these patients, discharging them to the ltac, but I feel as though that model has failed this patient population specifically as well. But what's really failed the patient population is the regulatory and reimbursement model for these patients.

Frankly, an LTAC is not funded well enough to care for these patients properly. And what we've found is the best place is the acute hospital environment like ours, not in the ICU, because I think hospitals, again, if they're being honest with them, with everybody, including themselves, they'll say patients typically don't rehabilitate in the ICU.

Some are better than others. Tampa General does an exceptional job. But what they found was there was an opportunity to do even better. And so, they chose to partner with us. Now, the model itself, we take those patients out of all of their different ICUs. They have a commonality. They are all trached and on a ventilator for a long period of time.

However, the preliminary diagnoses could be stroke, congestive heart failure, trauma, whatever it is, right? It all resulted in respiratory failure. And so we bring those patients to our unit as soon as they're hemodynamically stable, and we attack aggressively that patient with care and rehabilitation. You can't just rehabilitate the lungs.

You have to rehabilitate the entire body. So, we use PT, OT, speech language pathology when a patient doesn't feel like they're ready to rehabilitate. We say, no problem, we'll be back in 15 minutes. Most hospitals, in fact, every significant hospital in the country, they have a respiratory therapy department and a physical therapy department or rehab department, those resources are taxed across the entire hospital.

Our unit is dedicated. So, if a patient in a traditional hospital setting, in an ICU setting, physical therapist comes to perform their services. Patients off getting a CT scan. Well, that rehab professional has 25 other patients they have to see today, and they don't have the time to wait around.

Not that we're waiting around, but what we've done is we've efficiently put these patients together in one place so that when we have our dedicated unit, we're always there ready for rehabilitation. Patient hits the nurse call button. I'd like to use the bedside commode. Fantastic. bring your occupational therapist in here.

We're going to make a rehab opportunity out of this. We try to make every patient interaction into a rehabilitation opportunity. That's a little bit of our secret sauce.

Okay. So, thank you for sharing a little bit of your secret sauce, which is consolidating your resources to optimize your processes and efficiencies and be able to respond to those needs immediately.

Let's talk about the technology. Can you brief us in what, what role does it play into this model?

Sure. We're an AI company. No, I'm just kidding. So, everybody wants to be an AI company these days. Look, we are an evidence based supported protocol company. However, I was joking, but I wasn't joking when I said we're an AI company because with the advent of machine learning and what we're calling artificial intelligence in today's world, we would be foolish if we didn't use every tool available to us to improve our decision making skills, right?

When we have a patient, and by the way, I mentioned all of the different diagnoses that result in respiratory failure. So there are no two patients for us. They're identical. Every single patient has their own course of treatment. And so we are looking at artificial intelligence and how it can help us improve the protocols that we provide in the clinical pathways.

So we are an AI company, it's just not in our name yet. We're going to change it next week. I'm kidding, again.

Awesome, thank you for sharing that. So, I have a question for John. I worked in a hospital before, and it's super dynamic, many initiatives, and when you come with an idea like this, that you know that it's going to improve outcomes, how did you start this journey? Like, walk us through your process.

And some of the challenges that you have to overcome. Because, I mean, you have to move units around. I mean, and I don't know. Walk us through your experience.

Well, it's a great question. Moving units around and finding 6, 8, 10, 12 beds is not really the problem.

Because you have the patients in the hospital anyway. You're just cohorting them together. Versus having them spread out over the four corners of your hospital. You're cohorting them. That's not the issue. The biggest challenge hospitals have is around change management, getting people to understand that we're not partnering with a company like TriVent Health because we're doing a poor job.

We're partnering with a company like TriVent Health. because they have figured out a better approach, a more reliable approach, a more comprehensive approach, and the approach is delivering very consistent results. So the toughest part of this is change management because immediately what people feel like is they feel like they failed.

Like, why are we going with a company like Drivehead? We can do it ourselves. And the truth of the matter is yes. We can do it ourselves, but we can't, in my opinion, do it as well as TriVent Health not just because of what Sam just articulated, which is spot on, but this is all TriVent Health does.

They don't do anything else. they have fine tuned, they've created an environment where they've become experts. Because it's what they eat, drink, and sleep every day. So to get people to understand that we're partnering with someone like TriVed, not because something's wrong, it's because we just want to make it better.

We just want to become more highly reliable. We just want to deliver better quality, better results, better outcomes for these types of patients. And the most difficult part is change management. So our approach is we, you spend lots of time with your team members explaining the why behind the decision.

What's the rationale? What's the thinking that went into it? What's the why that went that sort of behind the decision. And then you go about. You create a very transparent environment to work in, you create an environment that's authentic, so people can truly feel safe in expressing their opinions, their concerns, and their issues.

And you just work yourself through the project and it takes time. It takes energy. You have to be intentional about it and you have to be open minded. But the hardest part was the change management aspect of the work.

perfect segue to ask who was your champion for this project? Like, who were your main stakeholders who were driving this to make sure that it was successful?

typically in an organization, it's going to be the chief medical officer, the chief nursing officer. Different hospital systems have different titles, right? It can be the chief quality officer, the chief transformation officer, but it's really those executives who are intentioned to deliver quality at the hospital, and that is their main role, right?

at this hospital, it was the CNO and the and frankly, the Chief Transformation Officer. we had multiple champions.

Great, no, great to hear that. So how long was the process and then at what point you start seeing results?

So I like to say that hospitals make bad decisions very quickly, but it takes time for hospitals to make good decisions.

And our cycle is typically two years. from meeting a hospital to getting in the door. Tampa General was a little bit shorter than that, but it takes time. We want to make sure, again, we have to make sure it's a good partner for us, but the hospital needs to make sure that we're vetted quite adequately.

And then, there's all the compliance issues and everything you have to go through. But once we sign an agreement, we're four to six months, we're up and live and running. And frankly, Carla, the results are immediate. It's literally day one.

That's amazing. let me

add into this too for people.

Sam and his team, they are excellent partners. created a wonderful culture. He has trained his teams beautifully. And we're a really difficult customer. We can be. We are incredibly demanding. we really don't compromise around quality, clinical outcomes, safety. We're fanatical about that work.

We're maniacal when it comes to the focus around that. And that can be overwhelming and off putting to some partners we work with. And by the way, I'm not sharing this with you because I think we're perfect, we're far from that. But when it comes to this kind of work, clinical outcomes, safety, quality, we just hyper focus.

Sam and his team are a perfect match for us because it's exactly the way they think, it's the way they behave, it's the way they deliver on their results. it's, it really is excellent. it's important to share that because you want to partner with somebody who has similar values, similar culture and similar commitment to excellence when it comes to delivering patient care.

TriVend Health has all that. Very important to us. And I know we're no different than most organizations in our industry. He's a wonderful partner, and he's an excellent leader.

is John, and they hold us accountable, Carla, every single day.

I feel like we're all in this industry because we want to do the best.

And I don't feel like challenging your partners to provide with quality of service is being a difficult customer. I believe this is what we all need to do, be committed to do the best we can to provide amazing service to our patients. So, I applaud you for your commitment and trying to be the best.

And lastly, what are some of the lessons learned and recommendations that you will give other organizations that want to embark into this journey?

It would be simple and selfish for me to say to partner with us on such initiatives. However, we feel like we're good partners, but I would say that no matter what is to embark on such a mission and on such initiatives, because these patients are suffering from prolonged mechanical ventilation.

Okay, so if not partnering with us, find someone who fits your culture to partner with and. just embark, and if you don't, and if you're not a hospital whose culture is to partner with others, then take it on yourself, grab one of your leaders and give them the initiative, but take it on, embark on the mission because it's important and it's meaningful work.

No, I just, it's really well said. I mean, he said it beautifully. I usually don't give him these types of compliments very often. So, so, I usually it's the opposite. But it's really well deserved. Quite frankly, you know, I do a lot of work nationally and I do a lot of, I do a fair amount of healthcare policy work.

I wish more hospitals would embrace this. I mean, I actually had mixed emotions. It's a differentiator for us. So the competitive side of me says, Hey, great. If hospitals in my community don't want to embrace this kind of work, this is just another program, an initiative that differentiates us from our competitors in a really good way.

But then the public health policy side of me, which is the more important side, says I wish more hospitals embrace this. I wish more hospitals were more open minded, were comfortable with partnering and collaborating with people that are complementary to the services that they provide.

I wish more hospitals realized that they didn't have to be experts at everything because those institutions that feel like they have to do it all themselves are just fooling themselves. You can't be good at everything. It's impossible. And people that think that aren't very enlightened and really, I wish more people would partner with organizations like TriVend Health.

I really do. And by the way, this is no paid advertisement. We are a partner. I drive him nuts. My team drives him nuts. But he's committed, he's as committed to quality and clinical outcomes as we are. And together, we're making each other better, stronger, and more resilient. And that's what it's all about, because when you do that kind of work together, care with better results.

That's the journey that we're on, and this partnership is critical to that journey.

Well, I have to say that I really enjoyed this conversation and seeing you guys complement each other and work together on this initiative and the success of it. Thank you so much for the time. I really did enjoy the conversation, so.

I'd like to think that Sam is one of the luckiest people in the world because he gets to work with me and my team too.

That is undoubtedly true. Undoubtedly true.

Well, there you go. Thank you so much again. And we'll talk soon again.

Yeah. Thanks, Carla. It's been a pleasure.

Of course. It's been a pleasure. Thank you. Bye bye.

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