E40: From Bedside to Boardroom: The Future of Pediatric Care with Jamie Wiggins

In this episode, Dr. Timothy Chou speaks with Jamie Wiggins, COO of Arkansas Children’s, about his unconventional journey from nursing to executive leadership—and why clinical perspectives are critical in shaping healthcare systems. They explore the challenges of rural pediatric care, workforce shortages, and the growing role of AI in improving access, efficiency, and outcomes. Wiggins also shares a bold vision for the future of healthcare, centered on universal access, workforce sustainability, and smarter cost management.

This episode is brought to you by BevelCloud—powering distributed AI in healthcare and driving the Pediatric Moonshot forward. Learn more at BevelCloud.ai."

Transcript

SPEAKER_00 0:14

Good morning, good afternoon, good evening, everyone, uh, to another edition of the Pediatric Moonshot Podcast series. I'm really pleased to have Dr. Jamie Wiggins here today, who, as I have just recently discovered, is a fellow North Carolinian who knew we had that in common. Uh, by way of background, he has a Bachelor's of Science degree in nursing from USF, a Masters of Science in Nursing from UCSF, an MBA from Nichols State University, a PhD from Louisiana State. His career has spanned his tenure at UCSF, uh, Children's of Minnesota, Nicholas Children's Hospital. Uh he was Senior Vice President, Chief Clinical Officer, and Chief Nursing Officer at Children's Hospital of New Orleans. And let's see, about four or five years ago, became EVP and Chief Operating Officer at Arkansas Children's. Uh welcome, Jamie.

SPEAKER_01 1:21

Thank you. Thank you, Tim. Very glad to be here and uh look forward to our conversation.

SPEAKER_00 1:25

Yeah, um, I gotta start with, because obviously I just went through your background. I don't think there are very many EVPs or COOs of hospitals who children's hospitals who came through the nursing path. You know, how how did that happen? Um, you know, do you think that makes like you should tell nurses that ultimately this is a career path? Uh yeah, talk to me about that. I think it's a very unique place you've come from.

SPEAKER_01 1:58

Yeah, thanks, Tim. I would tell you that my entire career has probably developed uh from my ability to say yes when people brought me opportunities and uh not being so limited in how I looked at things. There are, uh while there aren't numerous, it is not uncommon for uh nurses to become COOs and CEOs. But my my trajectory really became uh I at first, when I was in high school, I thought I was going to be a math and science high school teacher. I was always really inspired by math and science. My mom was a nurse. Um she clearly was impactful to her children because my brother, my sister, and I are all nurses. Uh my nephew just started a CNA school for a pathway to become a nurse. So I would say nursing probably is in our is in our blood. Uh really at UCSF, I was given the opportunity to take over departments, pulmonary function lab, ancillary services, and greeters for kind of non-nursing oversight. And so a leader that saw something in me and invested in me really just kind of grew over time. Uh and then it really was in New Orleans as the chief nursing chief clinical officer, my boss at the time, really saw the value of nursing. I had what I would consider some very unique opportunities. I had human resources report to me for a couple of years, did a lot of deep cultural work together on establishing our values, and really kind of did some really transformational culture work. And again, slowly over time, got to take uh oversight of a bigger clinical enterprise. I think the nursing approach, the nursing lens, a clinical background is very helpful for executive leaders. I would say that you also have to have chief executives that see the value in a nurse in a role. So not every organization would perceive that a nurse could be a COO. I'm very fortunate that my boss here at Arkansas Children's really saw the value in that clinician lens in operations. And so I've been very fortunate to join Arkansas Children's, like you said, four and a half years ago. And I love my job. I I am very clear that I'm not the chief nursing officer, so I let the chief nursing officers do their work. But I think my clinical history, impeach critical care, neonatal critical care, and transport certainly reminds me that every decision I make from where the parking places are at the front door, what is our signage, uh, how do we operate our cafeteria, I'm always focused on how we can make sure our patients and families and team members are taken care of.

SPEAKER_00 4:34

Wow. Wow. Do you would you, if if you were standing in front of a bunch of nursing graduates uh at a commencement speech, I'll make up something. What would you recommend this path? Would you say you you should consider this?

SPEAKER_01 4:48

I absolutely do. As a matter of fact, I believe very strongly that nurses need to understand healthcare economics. They need to understand how healthcare is reimbursed. I think it is deep in our tradition. I mean, some of the earliest American hospitals were actually owned and operated by nurses and nuns and really kind of set the modern structure of a hospital up. I think over time, as healthcare has got complex, as organizations have gotten complex, uh, I think that we've often viewed our profession as the patient advocate and really thought that the finances and the way we got reimbursed for our work were someone else's thing to deal with. I would tell you, I think it's critical. When I was a director, I taught my charge nurses. When I was a senior director, I taught my managers and directors, and as a COO, I make sure to teach all of our nursing leaders uh the financial basics of health care and reimbursement because so much of what we do uh drives the cost of health care. And I think we have to understand those elements so that we can make smart decisions. So I I always encourage people uh to think about leadership and to think about um avenues outside of nursing that would allow them to improve patient care and be strong advocates.

SPEAKER_00 6:05

I'm curious, could you just give me an example of what you would have taught somebody that would change what they they did or will do?

SPEAKER_01 6:13

Yeah. I tell you the first thing I do for charge nurses, I think sometimes charge nurses don't realize that they manage the most expensive part of our healthcare system, which is our labor, every single shift of every single day. And I can tell you myself as a bedside nurse, if I had a period of time where we had been really, really busy, but then we got a period of time where maybe we were slower, I wouldn't send nurses home, I wouldn't change assignments, we would have what I referred to back then as a very nice shift. But those dollars are very important. And once you get out of budget compliance, it's really hard to get back into budget compliance. And so I think from a staff nurse level, that's very important information to have, especially understanding supply cost and supply chain and how do we educate our patients to take care of themselves at home so they don't have to come to the hospitals, are all really important for people to understand. For leaders, depending on where they are practicing, really understanding how we are reimbursed for our healthcare and how if we have unplanned admissions, if we have undesired outcomes like infections, uh, how do how does that impact our reimbursement as a healthcare system, which we turn around and reinvest back into our system? So I think those are kind of the two most read of the examples that I've used. Yeah.

SPEAKER_00 7:32

Yeah. Uh I mean I'm gonna state the obvious and ask you a question. Okay. Arkansas is not California. It is not. It is not. And you you obviously have some insight into California. So what are the unique challenges in Arkansas that you guys face?

SPEAKER_01 7:51

You know, we are uh 3.1 million population over about, I think, 53,000 square miles. So we're a medium-sized state. Um our population, we have what I would refer to as a bimodal population distribution. Little Rock and Northwest Arkansas are our biggest population centers in our state. And we have a lot of rural, a lot of rural um you know, counties in our state. So that actually is the biggest challenge. I don't I don't think that's necessarily unique to Arkansas, but I do think that we have a big population of our state that are living in rural areas, and so how do we build those connections? How do we make sure children have access to health care in counties or regions that don't have a pediatrician? How do we make sure that patients with chronic disease, diabetes, and asthma have access to health care monitoring processes and systems to keep them out of the hospital? I will tell you, I've worked, as you noted, in several children's hospitals. We are all dealing with the same issues. We are all trying to figure out how to optimize patient outcomes, how to take care of those that are at the most disadvantaged in our communities, and in how do we continue to try to improve the next generation of kids. So there's a lot more similarities with my colleagues that I have in the Bay Area and in Southern California. Uh the hospital size is different. Uh, the the colors on the walls might be a little different, but at the heart of what we do on the inside, there's a lot of commonality.

SPEAKER_00 9:27

Wow. Um talk to me. I mean, you know, obviously within the moonshot, we talk about how AI could make a difference in healthcare, reducing health care inequity, lowering cost, et cetera. So what what do you what do you see as the role of artificial intelligence in pediatric health care?

SPEAKER_01 9:47

You know, I've I've I heard somebody a few months ago talk about artificial intelligence and said he likes to refer to it as augmented intelligence. And so I actually like I like that term a little bit. You know, I think that there's a lot of potential. I think that for us, what we're really looking at at our healthcare system is one, administrative functions. There's a lot of bureaucracy in healthcare. And so can we put AI on top of systems to help uh streamline scheduling, to help streamline building processes, to streamline making sure that we're accessing our finite resources as good as possible. We've got a fair amount of AI that we are using in our workforce space. So, how do we retain and recruit talent? How do we review applications in our system and make sure that we are connecting much needed talent with the opportunities that we have across our health system? We've also done something really unique from a management tool. There's an artificial intelligence leadership coaching tool that's available where I, as a manager, can go and type in a question about an issue I'm having either with one of my employees or with another member of the multidisciplinary team, and it'll coach you through some step-by-step tactics that you might take to resolve that issue. So extremely fascinating. On the clinical care side, uh, I think the thing that we're all trying to figure out how to fully leverage ambient, ambient listening, creating of notes, uh, Epic, that which is the EMR that we use, I just know is going to be coming out soon, where it'll be able to generate provider orders based on that ambient listening from that clinical engagement. I think that's going to be extremely important. We have worked and are continuing to still try to understand how we can run predictive analytics. Right now, our big focus has been patients that are in our organization, in our hospital. How can we do some early detection of clinical deterioration? How can we really have machine learning notice things and pick up things before a human eye or a human would do that? We're still in the beginning stages of that. There's different organizations that have different types of models, and so we're still trying to make sure that we pick one that makes the most sense for us and our population. I know some organizations have already gotten there. We haven't yet, but we are very much interested in having an AI tool that sits on top of our system organizationally that's private, so that we can access and query things in our healthcare system. How many of a certain procedure are we doing? Where are we finding patients that are having uncontrolled asthma? So, like, how can we query our own data in our own system to help us drive solutions? So I say that we're not at the end of the pack, we're not running uh at the front of the pack, but I would say we are right there where many of our colleagues are across the country and trying to figure out how we balance uh cost, outcome, and where we want to put our resources. We have most recently uh started working on some ideas, thinking about how we might be able to leverage AI and technology in our rural communities so that we can really do some proactive disease management. Um, and so we're excited about that work. We're just kicking that off. I think uh, you know, as medicine and technology advances continue to grow over time, I'm amazed at uh how AI is spreading into our everyday world in life. And so it's how do we keep up with it? That's that's been our biggest challenge.

SPEAKER_00 13:36

Well, that might be a challenge for all of us. Yeah. Uh talk a little bit about, because as you point out, uh not that Arkansas is unique in rural communities, but talk a little about what does that look like out there and how do you, I'll call it, project expertise uh without them coming to Little Rock?

SPEAKER_01 13:56

Yeah. You know, we uh I think one of the ways that we are starting to do some of this work um over the past several years, uh we have a neonatal nursery, a nursery alliance connecting our intensive care unit with other nurseries across the state. So, how do we actually empower those communities to take care of infants that they can take care of in their community and close to their home? And how can we share some of our clinical pathways and protocols to help them stay in place? On the quality side, we are doing a lot of work on clinical protocols and decision trees, and we make sure that all of our clinical protocols that we use at Arkansas Children's are available to anybody in our community, and so there's really easy access to evidence-based clinical pathways that we check and follow up on a regular basis to make sure they align with the most current literature. And then I would say it's really trying to figure out the next iteration of telehealth and telemed. So, how do we create those components in areas of the state that don't have reliable broadband? How do we make sure that we have some technologies that are available that can do some connecting? And then, Tim, I think the one thing that we will start having to have more conversations about, as well as many of our other colleagues across the country, is as specifically our pediatric physician subspecialty populations continue to get small. Um, how are we gonna be able to leverage either learning model systems or technology connectivity so that we continue can continue to provide those highly specialized services in areas where we're not all gonna have a provider? I mean, I think the canary in the coal mine right now is a pediatric rheumatologist. Uh, a pediatric rheumatologist could likely work anywhere in the country they wanted to work right now. We just can't can't find them. Um, and increasingly we we know that more of our subspecialty uh fellowship programs aren't matching every year, and so we know that we're gonna have some some um country-wide issues with some of our advanced workforce.

SPEAKER_00 16:09

Just out of curiosity, why do you think that's happening?

SPEAKER_01 16:13

I think there's probably a number of reasons. I think one is I think you know, our um Medicaid, our medical education system is is a big time investment compared to maybe some of the other countries. For pediatrics specifically, we are one of the low, we are one of, if not the lowest uh medical specialty of all the physician specialties that um are available. And the work the work as currently structured, and I think we're doing our very best again from a national perspective, think about how we structure it differently. I think the the expectations of work and and always being on and always being available one or two generations ago isn't really what the current workforce is looking for. And so, how do we structure our healthcare delivery system in a way that we are um uh an interest point for them and also allows them to have balance in their life, which is a key focus and really key for people's mental health?

SPEAKER_00 17:15

Mm-hmm. I'm gonna uh gonna give you the magic wand at the end. We're at the beginning of the new year here. Uh, you know, uh I'll I'll grant you uh three wishes, one wish. What what do you if you had uh let's call it the American healthcare system at your beck and call, what what would you wish for? What would you want to see?

SPEAKER_01 17:39

Well, I wish it, I wish this one was real. Um, you know, our our system has a little over 60% Medicaid. My previous organization was over 70% Medicaid. Uh Medicaid covers a lot of children's lives across our country. Um, I would love to see every American, but especially or everybody in our country, especially children from my seat, have access to care and coverage so that when they had a health issue, there was never a hesitation or a question of can I afford it? Is it is it available? Can I have access? That would be uh number one. And then the number two thing I would do is I would make sure that we had an adequate pipeline of uh professionals to meet the demand. Um and and it's not just physicians or nurses, it's respiratory therapists, it's echocardiograms, it's ultrasonographers. Uh I also electricians, plumbers, uh, technical roles. You know, I tell people when you run a hospital or a healthcare system, you're running a small town or a small city. And so everything that you would need to run your home, we need to run a hospital. And so those um the workforce challenges continue to be a struggle. And then the third and the final thing is uh medication cost management, making sure that when people need medication, that there's a pathway that they can get it that doesn't require them to make really hard decisions uh between other requirements that they need in their life.

SPEAKER_00 19:09

Well, Jamie, I was I wish it was in my power to grant your three wishes. Me too. Maybe together we can figure out a way to make some inroads in some of them.

SPEAKER_01 19:19

Yeah, I absolutely agree. I think that uh all of these things are going to be uh surmountable. We just have to work on it together and and uh and work in collaboration.

SPEAKER_00 19:31

Yes, amen. So uh hey, thank you for taking time out of your busy schedule uh to do this, and uh we we look forward to continuing the conversation.

SPEAKER_01 19:43

It's been a real pleasure. I I appreciate the reach out and the opportunity to connect again, and uh I definitely look forward to following you and seeing how we might partner and continue to improve healthcare. I appreciate it.

SPEAKER_00 19:54

Amen.