#416 - 🏖️ [COOL TOPICS] - Can Statewide Collaboration Transform Neonatal Care? (ft. Dr. Denise Suttner)

Recorded live at the Cool Topics in Neonatology conference, this episode features Dr. Denise Suttner, Clinical Director of the Rady Children's Hospital NICU, professor of pediatrics at UC San Diego, and director of the San Diego Regional ECMO Program. Dr. Suttner discusses the California Perinatal Quality Care Collaborative (CPQCC) as a model for statewide neonatal quality improvement, the importance of family centered communication in the NICU, and the value of state level professional organizations in advancing advocacy for neonatal healthcare funding and pediatric subspecialty reimbursement.

Transcript

Ben Courchia MD (00:10.062) Hello, everybody. Welcome back to the Incubator Podcast. We're live today at the Cool Topics in Neonatology Conference. Daphna, good morning.

Daphna Yasova Barbeau MD (00:17.08) Good morning. We've had a whirlwind of a morning, but we are ready to go.

Ben Courchia MD (00:22.072) We had to set up our production here — it's always an ordeal, and we're learning as we go. And we're joined by Denise Suttner. Denise, welcome back to the show. We keep track — you've been on the podcast before, and it's a pleasure to have you on. You're one of the main organizers of the conference. Beautiful place, beautiful weather — congratulations. It seems like whenever these first few hours go by and everything goes well...

Daphna Yasova Barbeau MD (00:26.581) ...we're learning as we go.

Daphna Yasova Barbeau MD (00:31.416) Thank you.

Daphna Yasova Barbeau MD (00:47.938) People have arrived.

Dr. Denise Suttner (00:49.043) There's no parking, but that's problem number one.

Daphna Yasova Barbeau MD (00:52.056) Well, that's probably always a problem around here. We struggle with that in South Florida — parking.

Ben Courchia MD (00:57.454) We struggled with weather the last time, so parking, I feel like, can be sorted a bit more easily.

Daphna Yasova Barbeau MD (01:05.006) Well, wonderful. We wanted to highlight all of the amazing things that you're doing — this is really a collaboration across a number of organizations: the California Association of Neonatologists and the CPQCC — the California Perinatal Quality Care Collaborative — which has really served as a model of statewide collaboration. And you're a big state! If you guys can do it, the rest of us have no excuse. We should all be collaborating.

And you're trying to do a lot this week at the meeting. Today, on your first day, you're starting with parallel tracks — the Improvement Palooza and Life After Fellowship. So tell us a little bit about the thoughts for the meeting.

Dr. Denise Suttner (01:52.76) Very excited — we have record attendance. It might have something to do with the invitation of our star Incubator podcasters. Thank you for being here. I think it is a special meeting. So let's speak a little bit about Life After Fellowship. This was the brainchild of Dr. Ramanathan and a couple of others many years ago who thought, why don't we add on an opportunity for second-year fellows in California to have a paid opportunity to come and hear from others? And they cover all the topics: clinical FTE, how do you evaluate a job, what are the appropriate questions to ask, how do you think about your salary, how does it compare to others, how do you manage a family? So it's a great, full day. And then —

Dr. Denise Suttner (02:15 — continued) Simultaneously, right now, we have what we call Improvement Palooza, which brings together families, providers, neonatologists, APPs, nurses, and respiratory therapists to really think about how we partner and tackle the biggest challenges we're facing as a team. The CPQCC started in 1997 as an offshoot of the California Association of Neonatology — also the action arm of those who came before me and said, "This is great — we have this association. We're meeting, socializing, and we have some education, but we really need to figure out how to improve the care of families and neonates in California. Let's come together and think about quality. Let's use quality methodology to tackle problems. Let's support smaller programs with bigger problems." And CPQCC invites teams to participate.

And each year they pick one or two collaboratives and really think about how to improve outcomes. They've tackled racism. They've tackled the struggles with treating babies with mom's milk — what are the hurdles? We're all facing things differently. Some of our units don't even have a lactation expert in their NICU. So how do you empower your team to help those moms?

Dr. Denise Suttner (04:12.598) It's really remarkable when you look at it — we have a huge database, so you can go in and see how your NICU compares to another regional NICU, and reach out to those programs that are doing better in areas where maybe your unit is struggling. So that's what we're doing today, and we're going to hear a lot from parents. This afternoon, we're going to have a session on family communication — empowering our voices and theirs — and trying to understand this dynamic.

I've been in this as an attending for 28 years, and I feel like the culture is a bit different now when it comes to working with some families. They come to the unit with clear expectations of perhaps how things are going to go. And they have opinions — as we know, vitamin K has been a long-standing challenge, but also antibiotics and pain medication.

And we're being challenged, which can be good, but it can also set us up for a relationship that isn't necessarily as fruitful or positive as would be best for everybody. So we talk about the harm it does — to us and to them. Some experts this afternoon are going to address: How are we communicating? What are parents hearing when we give them news?

Why are we seeing more antagonistic relationships? And how do we help those situations? Because some of us, when we find ourselves there, we withdraw. We shut down — nobody wants to be the primary. All the attendings are like, "Thank goodness I'm going off service." And that obviously adds to the chaos. So having some tools to understand what's happening and what we can do to recover — or help the team acknowledge what's going on with families — is really valuable.

And then our keynote this afternoon — you two are going to be hosting — which we're super excited about. We'll hear from Susan Hintz, who has been just an extraordinary leader in California for improvement in neonatal care.

Ben Courchia MD (06:22.006) And beyond California — I think she's had an impact both nationally and internationally with her work. You were mentioning before we came on air about having this philosophy and intention of making sure people step out of their comfort zone. Can you tell us a little bit about that — why we have to do this to ourselves, and what kind of benefits we might reap from forcing ourselves to do the things we're a little bit skittish about?

Dr. Denise Suttner (06:50.742) Thanks for that question. For me — I'm going to be 60 in June —

Daphna Yasova Barbeau MD (06:55.65) People can check us out on video. They won't know that.

Dr. Denise Suttner (06:58.142) Reflecting on my career, I think we would all agree that some things we would do exactly the same, and some things we would do differently. But one thing I would encourage junior faculty, junior attendings, and mid-career folks: opportunities are going to come your way. Some of them — be true to yourself and say, "That's really not for me."

But when I stepped into this role as president of the California Association of Neonatology, I immediately thought, "Really? I'm just too busy." And then I thought about how important it is to serve, and also about what it might add to my professional development and my leadership. And I can tell you that I am so happy I've done this role. It's been important to serve.

That alone is great, but for me personally, I now have so many stronger relationships. I would encourage people — when things come your way, think about it. But don't immediately say, "No, thank you." Think about what it might do for others. Think about what it might do for you. And if there's an opportunity to make stronger connections or meet new people around the country or within your state, I would go for it. The relationships I've built through this organization are so special to me.

Daphna Yasova Barbeau MD (08:19.552) I love that. You are the president of the California Association of Neonatology, and you mentioned you were a little hesitant initially about taking on the role. What was the deciding factor for you?

Dr. Denise Suttner (08:34.094) I think I had some time to reflect and honor John Cleary — a neonatologist known to many of us, a very strong leader in California, and passionate about state legislation to improve healthcare for neonates. He served tirelessly for this organization, and unfortunately we lost him way too early. John and I became friends. He trained in San Diego, but by the time I arrived, he had already moved on to Orange County. Because of the similar work we do, we were aware of each other — but it was really only with his diagnosis that I became more involved in his life, just to say, "We're here for you." And as it became clear that he was going to have a shortened life, I thought, here is an opportunity to serve in his name and honor what he's done.

The reason I initially said no was that I felt I was already doing too many things in my organization, and I was afraid of letting people down — it's a big job. But then I didn't sleep well, and I thought, "Okay, I'm going to do this." And I'm just so happy I did.

Daphna Yasova Barbeau MD (09:42.05) What a lovely way to honor his legacy. That's so valuable when you've had a mentor who means something to you. But I want to go back to some of the things you've highlighted — collaboration, community. There's something so special about having a state-level body. National collaboratives are very important, obviously, but this is the United States — every state has different legislation, different policies, different socioeconomic situations, different educational landscapes. And to me, there's so much value in meeting with our local teams — even in a state as large as California — because there are so many shared experiences. The population is extremely diverse, but what a lovely way to support other neonatologists, to really get to know one another year after year, and to share experience around common state policies and politics.

When we're trying to accomplish what you're doing, we may not be able to replicate all of it in Florida, even when we look at high achievers in the neonatal community.

Dr. Denise Suttner (11:03.554) That's a great point, because last night we had our CAN board meeting and we talked about specific things California is facing — reimbursement, for one. The CAN has a seat on the board of the Children's Special Needs Care Coalition, which is a legislative body at the state level. So we could hear from our partners about what the governor is thinking and what his plans are around the budget. The national collaboratives are important, but it really is ideal for states facing the same challenges around reimbursement and how we fund our APPs.

And it's nice to be a bit smaller, because then you can work on things more efficiently and effectively.

Daphna Yasova Barbeau MD (11:59.47) I love that. In our state of Florida, there are a number of decisions on the docket where I think the voices of neonatologists, pediatricians, and neonatal healthcare professionals would be incredibly valuable. We talk about this all the time — advocacy feels like part of the DNA of the pediatrician. But it's tough to do it on your own. A united voice, though, could be super powerful.

Dr. Denise Suttner (12:28.694) We still have our frustrations, don't get me wrong. Last night we spent time speaking with our legislative partners and said, "How are we still in a situation where pediatric subspecialists are being paid substantially less than adult subspecialists?" They brought this forward to the state, and the state doesn't seem to be very excited about hearing the problem. And this is just a tragedy.

Ben Courchia MD (12:55.414) And we know that Dr. Satyan and Robin Steinhorn are going to address that at this conference. Very excited about that one. Denise, thank you so much for dropping by and congratulations on all this work. We're looking forward to speaking with many of the attendees and speakers at this conference and sharing their voices with our audience.

Daphna Yasova Barbeau MD (13:00.833) A highly anticipated talk.

Dr. Denise Suttner (13:14.904) Great, thanks for being here. 

Daphna Yasova Barbeau MD (13:18.833) Our pleasure.