Taking Healthcare by Storm: Industry Insights with Dr. Rosha McCoy

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Rosha McCoy, MD, Senior Director for Advancing Clinical Leadership & Quality at the Association of American Medical Colleges (AAMC), a Principal Investigator for the CDC Cooperative Agreement, a pediatrician, and the lead for VaccineVoices.org.

Dr. McCoy discusses initiatives aimed at improving physician leadership, healthcare quality, and combating vaccine misinformation post-COVID. She highlights AAMC's extensive programs in supporting medical education, fostering community collaborations, and promoting integrated behavioral healthcare to address emerging public health challenges.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

Publication number QI-041125-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello, everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the Medical Director of Quality Insights. And our guest today is Dr. Rosha McCoy, the Medical Director of Advancing Clinical and Operational Leadership at the Association of American Medical Colleges. AAMC  you may have seen Dr.

McCoy is a trained pediatrician, former chief medical officer, and leader in improving physician leadership, hospital quality, and clinical effectiveness. All things that are so very relevant right now as we really think about growing the healthcare.  Workforce and really growing leadership in health care.

She's also the principal investigator for the CDC cooperative agreement as, and is deeply involved in initiatives like the vaccine voices project. Again, something that is very relevant right now. This project is helping to combat vaccine hesitancy and misinformation and really getting at the truth. Of the science behind vaccines in this episode, we'll explore Dr.

McCoy's journey, the work AAMC is doing to shape the future of healthcare and how physician leadership and quality improvement are evolving in this post COVID era that we are still journeying through. So Dr. McCoy, Rocha, thank you very much for joining us today. Thank you so much for having me, Jean. So we're going to be calling each other by our first names today.

I always like to say that at the beginning if we have two physicians, so. So can you share a bit about your background and how you arrived at your current role as the Medical Director of Advancing Clinical and Operational Leadership at AAMC? And what has shaped your journey in healthcare and leadership?

Sure. I'm I like to say I'm a proud general pediatrician. I, am also proud of having trained at Cincinnati Children's Hospital many years ago, and I was in practice for 14 years in an academic setting in Northwest Ohio, teaching medical students and residents and seeing patients. And then I was a chief medical officer, as you said, at a hospital in South Florida Children's Hospital.

So my ears and both have really shaped my journey and have really prepared me for the role right now at the AAMC. I just really learned a lot really from patients and families and my colleagues in both those roles. I say I'm a proud general pediatrician because I think pediatricians have really been on the forefront of preventive care for decades, even centuries, maybe really thinking about caring for the whole person, right?

Thinking about a child's developmental progress their social background and how that impacts their health, behavioral and certainly have been strong advocates for vaccines that have really changed the face of vaccines. of pediatrics and the health of kids and with kids living longer and healthier lives.

Really partnering with patients and families some of my, my colleagues who are not in pediatrics will say, well, I don't want to go into pediatrics. I like kids, but I don't want to deal with parents. for me it's both of those are really a great part of what what's wonderful about pediatrics.

Parents really care about their kids and you can count on them. The vast majority of the time to give their kids the med   or  think about the things that you've shared with them about vaccines and really ask very good questions. And so I just, I've just found that to be such a wonderful part of my life and what has led me to where I am now.

you know, I will agree as a primary care physician, I'm an internist  an internal medicine doctor. You really need to see the whole individual and even I spend a lot of time in geriatrics. You're involving the entire family, the caretakers  and so I agree, you have to look at the whole person. And it makes.

sense. Yeah, absolutely. And I you know, my taking having to care for my parents and now my husband and I help care for my mother in law. You know, There is a lot of overlap in geriatrics as well. And I think there's a lot to be learned from each other.  And the other piece of this that I've learned a lot about is really coordination of care, right?

Because that just remains to be such a big opportunity in medicine.  And what do patients complain about? That we don't talk to each other enough. We don't coordinate across disciplines, across settings. And so there's really, that's been a really big focus of my career as well. Really trying to understand how we can coordinate better to help patients lead healthier lives.

Yes. So  the Association of American Medical Colleges, you said AAMC, I'm going to say that from now on, it has a vital role in advancing clinical leadership and healthcare quality. So can you elaborate on the mission of AAMC and how it supports the development of leaders within academic health systems and healthcare organizations?

 know, We were founded back in 1876. So we're, we have a long history. We're based in Washington, DC, and we're a not for profit association. And our mission is dedicated to transforming health through medical education, healthcare, medical research, and community collaborations. And the thing about the WMC is we just have such a broad reach, our members.

And our work is really done through our members and supporting our members. So  we represent 174 accredited U. S. and Canadian med schools, M. D. granting medical schools, M. D. degree, 490 teaching hospitals. And you know, over 200, 000 full time faculty physicians and similarly  around 200, 000 resident physicians and medical students.

So it's just such a broad reach. We also work with a number of academic societies.  And so that's how we, really work hard in supporting our leaders and faculty and learners within those member institutions and academic societies. I think the interesting thing about teaching hospitals is that even though we're only about, they're only about 5%.

Of the short term general non federal hospitals just have such a huge impact, right? 100 percent of national cancer institutes are academic and academic health part of academic health systems  61 percent of trauma centers, 63 percent of pediatric intensive care units. So  they're really major centers of discovery and innovation, transplants.

care was pioneered at teaching hospitals, immunotherapies for cancer. So really, really important. And really also working and collaborating with their communities in all of these areas and really having true authentic partnerships with their communities. So we're really, Committed to supporting our member institutions.

And the way we do that is we bring together leaders from different groups within our academic health system. So, for example, we have a council of academic health system executives called case. which supports CEOs and other senior executives with comparable roles and really important to have them network and share best practices.

 And think about what the future looks like and how to best provide care to their patients and communities and provide the education needed to residents and lawyers.  We have achieved medical officers groups. So similarly, we bring together clinical leaders. To talk together about probably many of the things your audience is interested in and safety and quality and thinking about how every day we are able to deliver safe, high quality care at our institutions.

We actually have a chief medical officer Leadership Academy. It's a 15 month program for those who are new in the role or are thinking about becoming chief medical officers and similarly, WMC has a wide array of leadership development programs at all levels for folks from junior faculty or even residents and medical students to think about leadership in the future, all the way to the CEO and Dean level.

So many opportunities.   If we think about the COVID pandemic, obviously it's been a major disruptor in healthcare. So what have you observed about the evolution of physician leadership in response to the pandemic and what shifts in leadership are most important in today's healthcare environment?

Yeah, I totally agree. The pandemic really changed things. But first of all, we're facing historic workforce shortages, right? So we're dealing with a very different hospital settings and health care setting where people are dealing with Shortages of nursing, shortages of other health professionals, and maybe people who are newer to their roles or temporary the travel, folks who are traveling, etc.

to provide care, they're not part of the usual staffing. So really need to think about continuing to partner as teams. And how do you do that when somebody's new? So really trying to think about teaching team training over and over again, right? And really developing how to, how do you figure, how do you try to develop a team um, um, And so that's so important. So physicians are the leads often for that and really appreciating their team, right? And understanding the roles and responsibilities  and being flexible and open, learning together. The shift to really collaborating with the community, authentically coming to the table humbly, not coming to tell a community what to do, but really listening and understanding what their needs are and learning from them and developing programs that really are meaningful developing partnerships that are meaningful so that People will trust what we say and what, what care we deliver.

 There's some other new, forces, just somewhat disruptive. There's private equity in the healthcare market now, trying to understand how we work through those issues. AI is a big issue.  It holds a lot of promise, but it also holds some potential challenges. So really trying to understand how these tools can be developed to support clinicians prevent burnout.

That's the other big problem we're facing of burnout among our clinicians and healthcare providers, and how do we support each other through very trying times. So  it's a lot of being flexible and open and authentic and trying to understand each other in our communities. Yeah, very trying times.

And  you talked a little bit about trust. So I'm going to shift to a subject that maybe is a little bit controversial currently. And I think it, it most likely came out of the pandemic. So there's ongoing challenges we all know about vaccine hesitancy and a lot of misinformation. So what strategies and initiatives has AAMC implemented to address these issues, especially through the Vaccine Voices Project?

I learned about this project and I'm really Curious  and I think it's wonderful. And so how is double a MC tackling this challenge now and moving forward. Yeah, it certainly is a challenge. I think I just saw something come through the news about a child in Texas who was unvaccinated and died from measles.

So again, I don't have a lot of detail, but I just saw that and it's just so tragic. The children in this country would be dying from vaccine preventable illnesses. So there's just definitely more to do. We launched a Vaccine Voices in 2021, right as the COVID vaccine was coming out  really to try to help our member institutions with practical tools and guidance to increase confidence in the COVID vaccines.

Really, initially our thinking was if we can help healthcare professionals feel confident in the vaccine, then they will feel confident. Providing that recommendation to their patients and communities. They themselves, obviously, were the first ones to get vaccinated. The vaccine became available. And so how do we  continue that?

And then, of course, there have been so many challenges. The way we've approached it is, like I said, through toolkits and best, highlighting best practices and videos. We did a number of media tours where we did television and TV and print interviews with our experts and member institution experts, really targeting communities with low vaccination rates, both, both COVID and pediatric vaccines, and really talking about what patients concerns may be and trying to address those concerns.

We did an interesting grant, a sub award program where we provided funding for a strategic initiative to address medical misinformation and mistrust. through health professions education. So  we funded a number of four different organizations to develop or institutions, academic institutions, health professions institutions to develop  competency based interprofessional strategies.

So these toolkits are a collection of resources. for curricula that can be used at other places.  So they're generalizable for medical nursing and pharmacy schools to really try to help learners understand how to communicate health information, dispel misinformation and myths. And so they use things like standardized patients to help learners.

 Think about how to approach patients who may have medical misinformation  how to deal with myths  they talked, they did motivational interviewing and really learning how to improve scientific communication and those tools are now available in our journal called MetaPortal.

And so we really heard that sometimes  when a learner encounters a patient who may have some misinformation they kind of shy away now having a conversation. So this is really about how do you engage? How do you do it authentically? And how do you do it effectively? And then sometimes it's with your own colleagues  there may be other physicians, there may be other.

Nurses  or others within your own institution who may have some medical misinformation. So really, how do you engage with colleagues as well? So it was really a fascinating program led by one of my colleagues after Lisa Howley. And we're very proud of that work. It's so very important. I think the messaging is as important as the message.

Absolutely. Absolutely. Yes.   And it really coming humbly  we don't know everything and we need to acknowledge that  and we want to hear authentically what people's concerns are not to just.  To make them feel like we don't understand or we think they don't understand.

It's really about understanding together and engaging. Absolutely. So given your leadership experience in academic health systems, how have teaching hospitals adjusted their leadership in clinical practices in recent years to better handle emerging challenges in healthcare quality and performance?

Yeah, I mean, I think it's some of what you and I just talked about health care quality and performance that really had to adjust this issue that they have a workforce turnover. Right? So this has been a big problem. We've trained a group of folks. Let's say it's central line infections.

We've trained folks how to do How to maintain a central line  the bundles and all of those things that we're so familiar with. And then a whole new group of folks come in, and so you have to retrain them. And so really thinking about how do you commit to that retraining? How do you get everybody on board with your culture of safety?

So  folks are using these culture surveys. They're using standardized bundles. I think one of the big, one of the big success stories is the Children's Hospital Solutions for Patient Safety. I'm not sure if you've heard of them. They've done some incredible work  of Children's Hospitals around the country coming together to work together on safety  and have really shown some great results.

 And it's really about saying we're not going to compete on safety. We are going to share. Everybody, we're going to lift all boats.  And so really being very transparent about their challenges and successes with the talking to each other about that, what has worked, what hasn't worked and the other thing is you just, you can't take your eye away from quality and safety, right?

You can't think it's done and you walk away. You have to keep doing it over and over again. Otherwise, it just doesn't work.  So, I mean, it sounds Transcribed It's not sometimes as interesting as some of the AI things that are coming along or other things is really the day to day work that's so important in quality and safety, but it's so impactful and I think that's what the solutions for.

Patient safety at children's hospitals have shown I resonate with that message so much because I agree. I think about you know, in a nursing home, just a very small oversight and non communication of a critical lab. Just that little error creates such a cascade of, really tragic events. And that isn't a bad thing.

That isn't AI. That isn't like the most  that it's not on the cutting edge, but that is such an impactful thing that can be fixed with processes that work  and you have to do that by really committing to a culture of safety and  making patient safety a priority  in your organization, most definitely.

Absolutely. And I think it's connecting that purpose for folks. you know, Just really helping everyone understand how important their role is.  There was something I learned as a chief medical officer  the environmental service folks are so important to your, culture of safety, right?

And trying to keep places clean and decreasing. infections, et cetera, and to have them understand how important their role is. And similarly the sterile processing folks who are often in the basement of hospitals, cleaning, cleaning instruments and tend to be some of the lower, lowest paid workers in a hospital, but really you know, speaking up for them and their importance and helping them feel important.

 Because they truly are.  I think those are some things we as leaders continue to learn as we move forward in this journey. Most definitely. So, so AAMC fosters collaboration as you've been talking about between academic medicine, public health and community partners, something that's very important.

How do you see interdisciplinary partnerships evolving in healthcare, especially when it comes to improving patient outcomes and addressing public health challenges, which I'm sure we are going to, we're, I will say we probably are in the midst of many currently. So what role do physician leaders play in driving these collaborations and are there specific programs or partnerships you are particularly proud of?

Yeah, I mean one of the programs that we did as part of the CDC work is called Building Trust and Confidence Through Partnerships, where we again provided funding For  stronger cross collaboration, cross sector collaboration between our member institutions, public health departments, social service agencies, community based organizations to really kind of respond to the pandemic.

 And then continue relationships, right? Knowing that, as you said, there may be another pandemic coming down the road. There may be some other health emergency coming down the road  which, you know, is not going to be unexpected. So we have five community partnerships that receive funding. Each was led by one of our member medical schools, and then they developed partnerships, and they were just really interesting programs that we learned about many of them really looked at what the local solutions, those who  who are closest to their own community health challenges and develop these programs a number of them trained health champions, Transcribed to extend the reach of quality vaccine and immunology information.

So really trying to train folks in the faith community.  Henry Ford, for example, trained kids and teenagers at schools to become health champions. University of Cincinnati trained a number of diverse Health champions within different communities, the Hispanic community, the African American community, and really try to reach folks that way.

And then really talk, thought about accessible ways to deliver the information. Albert Einstein, which has a large West African immigrant population really looked at how best to reach that population and did that through faith communities and then  used comic books and health fairs and other things like that to make this information more accessible.

University of Cincinnati's storybook had. Had different people in the storybook kind of delivering the information that were similar to people within their community. So really thinking about how to reach a particular community, not just going out with information, thinking this is one size fits all, or we know what to say.

 You listen to us as much as what are really the concerns. So a number of them used some methods to kind of get feedback from communities to really think about what their questions were, and therefore then tailored the communication to them. Now using different languages was really important, so many of these materials were translated to different languages.

Really being flexible because again, workforce challenges and public health and other places had turnover of staff. So you've had to really engage different groups of people throughout. And then really thinking about going to where people are and sort of may having people come to us as much.

So thinking about food programs and health fairs and community events to really go with the information and possibly go with the vaccines. So these were really important lessons for physicians to learn to walk as co equal partners in these collaborations. What I hear you saying is you're meeting people where they are.

So  exactly. Yeah. And sometimes we think of X it's vaccine hesitancy when it may actually be vaccine access, right? We think that if we are out there. We say we have vaccines available. Come get them. People don't have transportation. People don't have can't get off of work, etcetera. So we have to think about what challenges people may have and to make it as easy as possible for somebody to get the vaccine.

Yes. So, something that I'm very interested in, the Diagnostic Safety Toolkit, developed by AAMC. It's an important tool to improve transitions of care. Again, just a, such an important issue right now. So, can you tell us more about the toolkit and how it is helping healthcare providers reduce diagnostic errors?

Particularly, which at the discharge point in the hospital setting, a point that's really critical, a lot can go wrong at that point. Exactly. This came out of our chief medical officers group, actually, and they suggested that we work together to develop this. It was led by my colleague, Jennifer Fairberg,   you said it exactly right.

The issue of high risk transitions from acute to post acute care, especially and the volume and complexity of information. So our toolkit was really Developed.  Again, not for us to say these are the three things you should do, but really looking at helping to facilitate discussion among clinicians and leaders at teaching hospitals about practical approaches.

So really thinking about a journey of discovery and providing a stepwise approach. To key discussion questions, patient vignette. So it was interesting because some of the people who have used our toolkits tell us that they come to it thinking they don't have this particular issue. And then they listen to a patient vignette.

about a patient in the ER who had a pulmonary nodule, for example, just found on x ray  how would that be communicated to their, to somebody who's actually going to take action, right? And everyone, sometimes people think, well, we've got that issue figured out, but then when you really peel all the steps back, that there, there may be places where there are gaps.

So that's really what the toolkit is about, to bring interprofessional and multidisciplinary teams together. Bring your, lab team and your hospitalist team and your discharge nurse and the case manager potentially. And everybody's a little different, so we're not telling you.

Who it should be, but just giving examples of possibilities and really fostering conversation and thinking about what are the steps? What are the potential gaps? And it's really being valuable to tee up the right questions to have that conversation, the right people to have at the table. And they really, most folks have been really surprised by the opportunities for improvement that they've discovered.

It's allowed them to modify their processes, engage providers differently and so thereby being more efficient and follow up for effective follow up care.  So that's really what the toolkit is all about. Yeah, I would encourage everyone to take a look because, I mean, if you can have care that is more efficient.

And safer. I mean, that's amazing, right? It's a miracle. Yeah. Yeah. I mean, I think it's, scary sometimes because it's almost like you don't want to know what you don't know. But unless you ask the questions  there's potential for an issue. You can't like just kind of hide your head and think there's not a problem.

It's really important.  And I, just like you said, There's just so many opportunities for potential miscommunication from the acute setting to the post acute setting. And nobody wants that. Everybody wants to be able to provide the information. But  quite often there are labs pending or there's something that's come back on the last day.

And  who's really responsible for that?  And who's really responsible to make sure that there's action taken? Yeah. Infinite things can go wrong. I've seen many. Exactly. Exactly. So as we look to the future, how do you envision the role of physician leadership evolving in both academic health systems and hospitals?

And what qualities do you feel will be most important for physician leaders in the coming years? Yeah. I mean it's, becoming such a complex system and continually increasing in complexity. And physicians are really being called upon. You know, you're seeing more and more physician CEOs certainly a enhanced role for chief medical officers, chief clinical officers  the titles are growing and the rules are growing.

So physicians are really involved in so many aspects. of care. And then the outpatient setting is just  we used to have our chief medical officer leadership academy really focused on the inpatient setting. But now we have more and more chief medical officers and chief physician executives in the outpatient setting, which is where most of the care is delivered.

Right. And so really thinking about the really important safety and quality. And medical staff leadership in the outpatient setting. So I think that's what's happening. And it's really important for physicians to learn to work across. Disciplines. One of the things we do some training and thinking about dyad leadership, the importance of working with nursing leaders with your chief financial officer with your pharmacy team.

And how do you do that? And how do you come to the table as a true partner? And then really, like we just talked about, how do you connect and coordinate care? How do you do that in training? Uh, where our ERs are so backed up and lengths of, length of stay is increasing. How do you really make a difference to get people out of the hospital safely?

The post acute setting, just like you said, is also very challenged right now. So discharging patients is extremely difficult. How do you work with these post acute settings to make sure these discharges are safe? And then I think we're really learning about partnering with patients and families.

Really thinking about the patient experience from a true thinking about it through a true lens of safety and quality and how you partner with patients. And many institutions are having patient advisory councils, patient and family advisory councils, finding patient advocates to really help.

As part of the team. So I think it's really being open to all of these things.  And then really understanding the financial picture  how stressed many of our institutions are, and how do you make, how do you do more with less, right? Continue to focus on patient safety and quality. But know you're challenged with staffing and financial issues.

So  really challenging times and really need people to step up and physicians to provide that leadership and understand how to do that. Yeah, I will agree. Very challenging times. And I will say, I love that patient and family councils, individuals with lived experience, I think are just vital as we move forward in healthcare.

So very important. Yeah, when I, when we were at the Children's Hospital and our patient safety council, we had a patient, a family representative in pediatrics, obviously it's a family member, although we had a teen advisory council as well, which was really interesting. But, you know, it's often the patient, the family representative would ask very, Interesting and important questions that nobody else would have thought of and it was just really impactful to have that person in the room as we're talking about our safety incidents about medical errors, etc.

To really kind of peel back all the layers and think together about how to solve it. Yeah, very critical voice. So, finally, in your opinion, what do you see as the most impactful change or development in health care quality improvement that will emerge from your work at AAMC? And how do you see your efforts contributing to lasting change in the health care system?

Yeah, I mean, one area that we haven't discussed is mental and behavioral health as much, right? And, you know, our hospitals and health systems are dealing. with unprecedented numbers of patients presenting with mental health needs. I think our ERs are often backed up with people there for mental health emergencies, or at least what they feel is an emergency.

In our inpatient settings, many patients have Medical and mental health needs together, certainly in our outpatient settings. So we've been really working  on promoting a model of care called integrated behavioral health care as a way to improve access, reduce stigma, really try to coordinate care so people are working together and improve patient outcomes.

Somebody with diabetes who also has depression, you have to treat both if you're going to make an impact on their diabetes. Similarly with heart disease, and you know, we could go on and on so really trying to say and look at mental health as part of medical care, not separated and siloed. And so that's a big part of the work that we've been doing, and we're continuing to do to think about how to promote those models, how those models can be sustained, both in the primary care at primary and specialty settings.

And really the importance of breaking down those silos. So that we can really deliver whole person care. But I think that is an emerging, issue around safety and quality in our healthcare settings and really one that deserves a lot of attention. Absolutely. And breaking down silos and the whole person care, I mean, so like they seem like very common sense, but they're not right.

We see we're siloed in healthcare, but I agree. I mean, especially with mental health  behavioral health challenges. Important to do that. Very much so. Very much so. So last question, if individuals want to learn more about AAMC, how can they do that? Our website is double mc dot org.  There's a lot of information on there.

I think we talked about vaccine voices, which is also vaccine voices dot org. So we encourage you to visit both. If you go to the double mc website, you'll see more about our chief medical officers, Leadership Academy and our leadership, other leadership programs. You'll see more about the work we're doing in promoting vaccine voting.

Behavioral health access.  So you'll see a lot of information from all of our mission areas.  And during these challenging times, we're just trying to support our members and support patients, families and communities. I would encourage everyone to visit those websites. I will say I spent much time in them and I went down the rabbit hole and learned a lot.

So I would encourage you to do as well. Dr. Rosha McCoy, this was an inspiring conversation. I enjoyed it so very much. Thank you very much for joining us today. Thank you so much, Jane. I really appreciate it. 

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.