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Tallwood: The inception and success of a Hartford HealthCare Institute
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In this episode of More Life, Hartford HealthCare’s Steve Coats talks with Jan Ruderman, vice president of the Tallwood Urology and Kidney Institute, and Dr. Steven Shichman, physician-in-chief of the Institute. They discuss the inception of Hartford HealthCare’s unique, system-wide Institute Model, and the remarkable progress made in the fields of robotic surgery and men’s health at large.
To learn more about the Tallwood Urology and Kindney Institute, check the links in this episode’s notes.
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At the Tallwood Institute you get world-class urology and kidney care from a team of local and national leaders in their fields. Learn more
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SPEAKER_05What Jan has done is driven the team to be able to provide this multidisciplinary care. There's tremendous opportunities for us to grow with that, and I see that getting better and better.
SPEAKER_00Welcome to More Life. In this episode, Hartford Healthcare's FD Coach talks with Jan Ruderman, Vice President of the Tollwood Urology and Kidney Institute, and Dr. Steven Chickman, physician-in-chief of the Institute. They discussed the inception of Hartford Healthcare's unique system-wide institute model and the remarkable progress made in the fields of robotic surgery and men's health at large. Here's Steve Coates.
SPEAKER_04Jane, if you had to pick one thing, I know it's difficult over the last decade that you're most proud of in terms of accomplishments for Tallwood, what would it be?
SPEAKER_01Yeah, I think in that partnership with Dr. Shickman, we've really created a framework by which we can standardize care across the system. Our vision when we started this was that anyone who saw our logo would get the same care at whatever entrance they were entering across the state. And so I think we've made headway into standardizing care that is provided across the system. And I think we've done that in part by recruiting people who have values that match the organizational values and allow us to create that standardization.
SPEAKER_04Dr. Shickman.
SPEAKER_05Yeah, I 100% completely aligned with Jan. What I want to add to that, as you know, hearing Jeff Black speak and other motivational speakers who really drive an organization, culture each strategy for breakfast. And Jan has been amazing in building the culture of this organization and the culture of our institute. And I think Jan's personality, the way she interacts with people, her curious nature, her analytical thinking, and her ability to execute has really made such a difference. But if I had to pick one thing, it's the impact that she's had on our culture. The culture of the administrative teams, the culture of the physicians and the two interacting and how it all comes together.
SPEAKER_04So Jane, you come from H3W, you were a facilitator before your leadership role here. How does that impact your leadership style?
SPEAKER_01I think it gives a framework and a background that everyone can fall back on. And so I think when there is a disconnect or when there's tension, it's likely because our values are rubbing up against something. And so if we can always go back to our values of doing the right thing, the kind thing, the safe thing, the best thing, and the equitable thing, that is really sort of the foundation of what creates our culture. And, you know, and then you sort of layer the leadership behaviors on on top of that. And um, I think one of the things our team is strongest for is discretionary effort. And I think that what Dr. Schickman has done in discretionary effort has set an expectation or framework combined with the values that have attracted people who want to work in that kind of an environment.
SPEAKER_04And let's talk about the name. You know, as I said, I work in marketing and I constantly am asked about the name, which is from a marketing standpoint, Talwood is fantastic. People remember it. Um, you guys have had some interesting and irreverent marketing that's really grabbed people's attention. But where does the name come from?
SPEAKER_05I'll tackle that one, Jan. Okay. I used to do all types of uh cancer surgery, and a patient that I operated on for prostate cancer surgery over a couple decades ago was a patient that I would see routinely, and he was very supportive of our there was an annual run walk for prostate cancer that we used to have, and he would always bring a check in, and um he wanted to do this anonymously. He didn't even want to bring the check into the office. He asked for my home address so I can drop he could drop it off with my wife, and he did this for a number of years, and he'd always give you know a few thousand dollars every year. And then one year at his follow-up appointment, he actually was in the next room and the doors were open, and he heard a phone call I was having with Steve Donnew when we were putting SESI together, the Center for Education, Simulation and Innovation, and he overheard the discussion about simulation training. So I came in the exam room and he goes, you know, I overheard you. I hope you don't think I was being uh nosy, but I'm really interested in what you were talking about, simulation training, because I'm a pilot and all my everyone in my family are pilots. So I really believe in simulation training. So I told him about it. He said, you know, I'd like to learn more about what you guys are doing. And we brought him down and to Hartford and and introduced him to Mr. Flex, and he ended up giving a million-dollar anonymous donation, his family did, to support the build out of SESI. So that was very successful. Um, that was uh he I think he made the donation about 2009, and then we would give him reports all the time what we're doing, or we grew rapidly. And he came to us, he goes, you know, you guys have done a great job. You keep giving me feedback. I've given a lot of money places, but no one ever tells me what has happened to the money, and you guys keep telling me all the things you're doing. If you ever if you have any other projects, tell me, and maybe I'd be interested in supporting them. And then we got them together with Mr. Flax and Mr. Joseph, who was the president of Hartford Hospital at the time. And uh this was just at the beginning of the institute evolution, and we pitched the urology and kidney institute to him, and they were very interested, both he and his wife, and they supported it with a five million dollar gift that was again given anonymously. All the gifts that his family give in a philanthropic nature, they affix the name Talwood to. Talwood is the name of their course farm down south. And Talwood goes that goes on the gift. They they want to remain anonymous. That's the background of the name. Now it just happens to generate interesting comments when it's fixed to a urology delivery of the care system. So I'll just leave it at that.
SPEAKER_04When you started this all those years ago, could you ever have imagined that you'd be here today in terms of just being known nationally, whether it's robotic surgery or the coordination of care, just the way things have come together. Could you have imagined this?
SPEAKER_05No, I we never envisioned the growth that we would have realized uh both on a local, regional, and national level. It's been hard work. It's not too often we sit back to think about it. We always look back. Jan is amazing in developing the organizational team that actually catalogs and records everything that we do, both in a prospective and retrospective fashion, uh looking forward, how we work as a team and how we work within the organization of Hartford Healthcare, and looking back and just to answer your question, we're really proud of the achievements we've made. We have amazing providers and administrative leaders. Uh, you know, you mentioned Dr. Wagner, who runs our research group and has been the leader in robotic surgery since uh 2003 when he came here. Um, and that's why we recruited him here because of that new technology, which was just in its infancy at that time, and how he's built an amazing program across the whole healthcare system.
SPEAKER_01But you've had a passion for and an interest in innovation in from a surgical standpoint. And if it wasn't for your advocacy and seeing what the robot could do, we probably wouldn't have had the robotics program we have at Hartford. So you really advocated for Hartford to get on the map and provide that service in this community.
SPEAKER_05Yeah, there's some interesting stories about that. I don't know if we'll go into sharing those today.
SPEAKER_04Oh, we have time. No, it's funny with robotics. When we talk about robotics, no matter what kind of robotics is it is, it all starts with Tallwood. And we talk about Dr. Wagner and being the first, you know, the first here and the first there.
SPEAKER_05Actually, it was in 2001, right after 9-11, I bumped into Pepe at a um, we were giving some talks at a meeting in New York, and um Pepe uh was doing some robotic surgery then. Uh it goes back to 1998, Vin Ledon and I. Vin Ledone, who was uh the busiest urologic oncology surgeon here, uh Vin and I went over to France together to learn how to do laparoscopic prostatectomies in 98. It was really difficult to do. Pepe called me after, who was he was practicing at Beth Israel in New York, and I said, you know, I'm not pursuing it, it's just too difficult. I don't think it's reproducible. And then if we bump into each other in 2001, he said he came up to me and goes, you know, I've got this robot at Beth Israel Hospital that cardiac surgeons bought bought. They're not using it, and we started doing prostates, it really makes a difference. It's the real deal. I said, You mind if I come down and watch you? So I went down a few months later to watch him and his partner do two robotic prostates, and this was early in 2002. And at the end of the day, you know, I realized after watching do the two cases that this was the real deal, this really made a difference. Joking that I said, um, you know, if you think if you guys want a job in Hartford, give me a call. Well, the next day both of them called me independently. But obviously, knowing Peppy, because Peppy was a med student here at UConn when I was a resident, so we knew each other. We talked more, and he says, I'll definitely want to come up there, but you got to get me a robot. So I went to John Meehan, who was the president at Hartford at that time, and I set up a meeting with John. I went in and talked to him, and he asked, How much is this robot? And I said, It's uh $1.75 million and then $250,000 a year for a service contract. And he basically he looked up and he said, meeting's over. And we're not buying it, they're not expensive. So I went back and then you know, I told Pappy, Peppy said, Listen, I'm not coming without a robot. So that was it. So six months went by, and I said, you know, and I heard more stuff about the robot, and then went back to Mr. Me and he said, Listen, I'm not I'm not sticking my neck out to to buy a two million dollar piece of equipment. And I've seen this happen before, and I and I was really passionate about it. And he said, Well, you can present to the board. So I presented to the board at Hartford Hospital, and uh fortunately at the end of the meeting, no one was really interested. But there was one guy sitting at the head of the table, a guy named Joe Sargent, who was the chairman of the board at that time. He looked up after no one said anything, he goes, he goes, I'd buy two of the damn things. And uh those were his words exactly. So Mr. Mean turned to him and goes, How about we start with one? So uh that's how Peppy ended up here. So I called up Peppy when we got out of that meeting, and he says, I he goes, Okay, I'll come. And so he ended up here at the end of 2000, I think at the end of 2002, beginning of 2003, and then we got the robot right after he came here. It finally was delivered, and and he has built an amazing program with that since then. So it's really an amazing story. And I and and he just presented at the our national meeting in May his 20-year experience, wasn't that Jan? Yes, which was uh um it was an amazing presentation, our national meeting, and many thousands of patients.
SPEAKER_04So one area of success for the institute has been men's health, not only a physical building in Farmington, but also a coordinated system of care for men who, to be honest, in that age group, that 45 and over, I was very skeptical. How do men take charge of their health when generally we go to the doctor or our provider when something is seriously wrong? Take us through what has made this a success.
SPEAKER_01You know, one of the things that I would say that, you know, Dr. Schickman did a really good job and in not just attracting people who have values that align with Harvard Healthcare, but also brought subspecialty expertise. And so in recruiting Dr. Beanick, who was you know fellowship trained in andrology, it was adding another dimension to the practice and to the services provided to this community that didn't exist before. He really presented a lot of data on how men really are an underserved population because of their ignoring going to the doctor, ignoring things that could be managed for chronic diseases with you know out acute exacerbation. But in current state, men wait for the acute exacerbation, and then it's very hard to manage. And so with that data, we began the idea of a men's health program and um did a focus group with a professional marketing team of looking at a group of women and a group of men and asking them, what gets the man in your life to go see a doctor? And then to the men, what would drive you to go to the doctor? And it was, you know, severe agonizing pain, which is that acute situation, frequency of going to the bathroom at night where you're either disrupting your own sleep or your partner's sleep, sexual dysfunction and fear of prostate cancer. And those were the things that would drive men to see a doctor. And they did admit that oftentimes it was the people who loved them that were driving them to the doctor, not physically driving them, but forcing them to go to the doctor. And so women said the same thing that if they nagged long enough, whether it was to their father, to their brother, to their spouse, that the person eventually caved because of the relationship that they had. And so that's sort of how we approached it, both going to men about the things that they identified as being most important, and also marketing to women to encourage them and continue to encourage them to support the men in their life that they love and care about to get preventative care. And so we decided with the men's health program that we would meet the man wherever they were, whether it was they were coming in for fear of prostate cancer, whether they were coming in for urinary frequency, whether they were coming in for sexual dysfunction, that we would try to capitalize on that and do an assessment to see while you're here, kind of, is there anything else we could do preventatively to help you cope with whatever is going on in your life and make sure that you're getting the screenings that you should be getting so that we can address things preventatively.
SPEAKER_04If men, their their spouses or partners haven't seen the advertising, haven't gone to the webpage, where does it start? How do they access these services?
SPEAKER_01So it starts wherever the man is. I mean, in if they come in for urology as a man into the men's health program for whatever they're being referred to, they're given a checklist based on their age of things that they should be having addressed. And if they haven't had it addressed, a nurse navigator refers them to the services that they may need. One of the biggest areas that we found in doing that is the need for behavioral health services, the need for emotional mental health support that men are often reluctant to ask for. But when questioned, the nurse navigator can really help them get to the support that they need.
SPEAKER_04So, what is next? What is on the horizon for Tollwood, say in the next decade or so as we work to try to increase access for people who are in need of urologic or or kidney care?
SPEAKER_05Going back to the basics of what Gian started with, of providing the best care to patients and this and the same care no matter where they enter the system. And if they end up in a tallwood urology and kidney institute, if it's in Rhode Island, if it's in Massachusetts, if it's in New York State, if those if that comes to happen, who knows? I don't know. But if it's in Fairfield County or if it's in Litchfield County or down in New London County or Hartford County, that they're going to get the best urologic care. And it's going to be very similar, if not almost identical, no matter which provider they see or which office they go to, and they will get state-of-the-art care in a multidisciplinary approach. What Jan has done is driven the team in an organized fashion to be able to provide this multidisciplinary care in a very, very organized fashion. There's tremendous opportunities for us to grow with that, and I see that getting better and better. Jan, I'll pass the time.
SPEAKER_01I'm going to go backwards actually, because I know that I have a little elevator speech that I give that sort of gives the history of how the institute was formed. I think it was 2011 when Jeff Flax was president and CEO of just Hartford Hospital, just the Hamilton retreat, which was a retreat intended to bring conversations between administrative leaders and physician leaders together on solving issues that were impacting Hartford Hospital. And at the time, our patient experience scores were in the 38th percentile, and our physician engagement scores were in the 44th percentile. And he used the retreat to facilitate a conversation around these are numbers that are not reflective of the talent that are in within the walls of Hartford Hospital. But clearly we're designed our the way we're our care delivery system is designed is it's designed to get the outcomes we're getting. How could we redesign care in a way that would get us better outcomes? And it would be less frustrating for physicians and less frustrating for patients. And the idea of organizing care around diseases really is what came out of that. And then the Cancer Institute was piloted using nine, what they were calling disease management teams, to bring any provider who touches a given disease together to help address what happens to the patient from the time they start care to the time they're under surveillance for care or they finish their care, what happens to them along the way, and what are the pain points. And those groups continue to meet monthly. And that was the sort of the foundation of our clinical councils, which are really intended to decrease variation, improve access, improve quality. And that's sort of how the institute model was born, which was really to organize care around diseases and bring the providers who touch that given disease together for regular conversations on improving that care. And that's the model that we used from when we piloted with cancer to when this grateful patient gave the anonymous donation, is to organize care around our clinical councils and around our what we called disease management teams at the time, and we now call clinical councils. And we continue that across the healthcare system of anyone who's interested in providing care to that population of patients comes together for regular conversations on how we can review what's new in the literature, what's coming down the pike, what can we do to improve handoffs, what can we do to decrease variation, what can we do to decrease cost in the delivery of care to this population of patients? And that's sort of been the foundation of our institute. And it makes a great vehicle so that wherever we geographically grow, we can just incorporate that geography into this structure that we have around our clinical councils. And I think that's sort of what has been our success. The impetus really was Jeff Flax raising the idea that we can do better than the way care is current was currently organized in 2012.
SPEAKER_04Thank you both so much.
SPEAKER_01Thank you. It was fun.
SPEAKER_05Thank you.
SPEAKER_00To learn more about the Tallwood Urology and Kidney Institute, check the links in this episode's notes. Follow More Life to be notified each time a new episode drops. Just search Hartford Healthcare on your favorite podcast platform. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to More Life.