Janice Nevin 0:03
When you see an opportunity and you wonder if it’s an opportunity, it probably is and allow yourself to go through that door. Even if you think, “Well maybe I don’t have all of the accomplishments that I need.” But if it looks like an opportunity, take that risk, because you will learn and grow.
Gary Bisbee 0:22
That was Dr. Janice Nevin, President and CEO of Christiana Care Health System, sharing her thinking about opportunities for women in leadership. I’m Gary Bisbee. And this is Fireside Chat. Dr. Nevin described her evolution as a leader and the rewards of helping employees exceed expectations. She shared her experiences and thoughts about women in medicine, need for women to have a well-rounded portfolio of accomplishments and learning and what she terms work-life well being. We discussed social determinants of health, how Christiana Care is investing in its community and the public-private partnerships that contribute to a country comprehensive approach for delivery and financing. Let’s listen to Dr. Nevin’s comments and how the healthcare system needs to be organized to have a full and complete approach to social determinants and public health.
Janice Nevin 1:12
Fundamentally, I believe we need to move away from fee for service payment and move firmly and briskly towards value-based payment. As long as we continue to only get paid for the volume of services that we provide, it’s going to be very difficult to incorporate these other elements and ultimately results in health.
Gary Bisbee 1:36
Dr. Nevin spoke about how data and technology will drive telemedicine examples of innovation and changing the delivery model and how to hyper personalize the patient experience. I’m delighted to welcome Dr. Janice Nevin to the microphone. Good afternoon, Janice, and welcome.
Janice Nevin 1:58
Thank you, Gary. It’s great to be here with you.
Gary Bisbee 2:01
We’re pleased to have you at the microphone. Let’s start in by learning more about your background and interests, then move to Christiana Care, and then on to COVID. When did you first become interested in medicine, Janice?
Janice Nevin 2:13
I was one of those children that was inspired by the father of a close friend. I have wanted to be a physician for as long as I can remember. I took a little bit of a detour in my thinking, as I sat in the middle of my college physics class because what really drew me to medicine was the opportunity to work with people and help people and sort of got back on the path of becoming a physician and trained in family medicine.
Gary Bisbee 2:44
What was your first leadership position after being a practicing physician for a number of years?
Janice Nevin 2:50
So I spent the first part of my career at Jefferson in academic family medicine. I was the Residency Program Director. It was a great job and I learned so much from being in that leadership role. I really think that it prepared me for what was to come afterwards. And I got an opportunity as the Residency Program Director to serve on a national board. And I really enjoyed that and learned so much. It was really inspiring to be exposed to other Residency Program Director from all over the country. People who were leading programs in very rural areas, in the military, and across all of the states in this country. And so I think the combination of being a Residency Program Director and then having that national experience, exposed me to leadership in a way that has impacted me and continues to impact me.
Gary Bisbee 3:50
What did you enjoy the most about leadership?
Janice Nevin 3:53
I think for me, it’s always been about the people. As I said, it started with being a program director. It was one the reasons that I wanted to be the CEO here at Christiana Care. I think helping people exceed their own expectations is one of those things that brings me great joy. If I can do anything to help someone else aspire to be a leader to accomplish their goals. It’s incredibly rewarding.
Gary Bisbee 4:21
So your husband Charlie’s also a physician and you have two accomplished daughters. How have you thought about work-life balance through your career, Janice?
Janice Nevin 4:30
I don’t think about work-life balance. I sort of crossed that word out.
Gary Bisbee 4:37
Janice Nevin 4:38
And the phrase that we’re using here at Christiana Care is work-life well being. I like that phrase because clearly, you know, in a two physician, household, things are frequently out of balance. But you have to have a sense of humor. You have to be flexible. You have to trust your partner. I think if you can do that you can achieve well being.
Gary Bisbee 5:00
Makes good sense. When did you first think about becoming a CEO?
Janice Nevin 5:04
I am a very proud graduate of the Health Management Academy/GE CMO Fellowship Program. And as you know, when I came to that program, I had been at Christiana Care just for a few years as the chair of Family Medicine. And I was really just learning about the C-suite. And participating in that fellowship program really opened my eyes and showed me what was possible. And as a result of participating in that program, I got the chance to have several leadership roles here at Christiana Care. I ran our Wilmington campus during a period of growth and transformation in terms of what we were building. I had the chance to be the chief medical officer for the system and then when my predecessor who was a wonderful mentor, Bob Laskowski, was leaving the board began a national search for the next CEO. And I decided that I wanted to be a CEO and I want it to be the CEO here. So I put my hat in the ring and was successful.
Gary Bisbee 6:18
Well, the board made the right decision. You’ve done a terrific job as CEO. Onto this issue. Only about 20% of the new CEOs of our large health systems are women. Did that discourage you at all? Or did you think about that as you were pursuing a CEO role at Christiana?
Janice Nevin 6:36
As a woman in medicine, being sort of in the minority from a gender perspective is not new. In fact, when I was a teenager, I attended St. Andrews School in Middletown, Delaware, and I was part of the very first cohort of girls. There were 26 girls and 180 boys. And I always say that prepared me for the rest of my career. And in fact, I remember as a new faculty member at Jefferson, I was pregnant. And it was really very difficult to find a woman who had that experience that I could talk to about. What do I do as an attending physician and a new mother? I think the good news is there’s been a tremendous amount of change. And I know that women of my generation are entirely supportive of each other. And also committed to making sure that we continue to diversify the workplace, particularly the C suite, and fundamentally the CEO role. I know it’s something I’m personally committed to.
Gary Bisbee 7:42
So what advice do you have for a woman who might be aspiring to a CEO role?
Janice Nevin 7:48
I would say a couple of things. One is when you see an opportunity and you wonder if it’s an opportunity, it probably is, and allow yourself to go through that door. Even if you think, “Maybe I don’t have all of the accomplishments that I need.” But if it looks like an opportunity, take that risk, because you will learn and grow. I think also, it’s really important to do that self-reflection and look at what I call the portfolio of experiences that you have. And is it a well-rounded portfolio. So make sure you have some opportunity for P&L responsibility. You’ve got to be able to talk to talk, know the numbers, allow yourself to do something, take a leadership role that’s maybe completely outside your comfort zone outside the department in which you typically work. So assemble that portfolio, look at where you have strengths, and then intentionally fill in some of those gaps.
Gary Bisbee 8:46
Well, that’s terrific advice. And we all need to keep pushing on this one for sure. Let’s move on to Christiana Care Health System. Will you please describe Christiana Care for us, Janice?
Janice Nevin 8:57
Absolutely. Christiana is a large regional community based academic health system. We take care of people throughout the state of Delaware. We are a statewide health system. We also care for people in counties of Maryland, Pennsylvania and New Jersey that are contiguous to Delaware. We have three acute care hospitals, two in Delaware and most recently, Christiana Care Cecil County became part of the Christiana Care family. Cecil County is right next to Newcastle County. There’s one provider of health care in that county. And for us, this was really an opportunity to help serve our neighbors improve their health in partnership with a union hospital. And also I was intrigued by the Maryland model Christiana Care, we are committed to value, we’re committed to population health. And by partnering with a hospital system in Maryland, we’re doing a lot of learning about how that payment model works.
Gary Bisbee 10:03
You may have mentioned this earlier, but when did you first arrive at Christiana Care? What was your first position?
Janice Nevin 10:08
I started in 2002 as the Chair of Family Medicine, and I’ve been the CEO now for five and a half years.
Gary Bisbee 10:18
So how would you characterize the ChristianaCare culture?
Janice Nevin 10:22
Culture is absolutely critical and at ChristianaCare, and I believe we have a very special culture. And it’s the culture that we’ve cultivated here that has enabled our success. And it really starts with our values. Shortly after I became the CEO after spending a couple of years, creating a vision and developing a strategic plan, I felt that it was important that we redefine our core values. Organizations that not only survive but thrive in times of great uncertainty are filled with people who are resilient. But people who are also connected to their values, and I wanted to do the work in a way that we had not done before, which was to engage all of our people in helping us to find those values. So I remember saying to the leadership team, at the beginning of the year, the end of the year, I want to walk around, I want to talk to any one of our 12,000 plus people, and ask them how they participated in this work, and we did that and it was extraordinary and what surface and it truly came from the bottom up, obviously, with some guidance and support from leadership, but what emerged was the value statement. We serve together, guided by our values of excellence and love, and “We serve together” was a new framing of teamwork. Everyone loves to be on a great team. But we know that to be successful, our teams have to work together across the organization. Excellent excellence, again, not a surprise. It’s in our DNA. We talk about the Exceptional today and even better tomorrow. But you can imagine when the word love surfaced, there was some controversy and a lot of discussion about was it appropriate to talk about love and health care? And my feeling is absolutely. And if you look at the literature, if you look at what Donabedian wrote, what Don Berwick has written, love is essential to excellence. And we know that when we make patients feel loved, we’ve created an extraordinary experience when our caregivers say, I love my job. That’s exactly what we want. So we lived with these values now for about three years. We call all of our employees caregivers, whether they’re directly caring for a patient or caring for someone who is, and what we have learned is that when you lead with love, excellence is inevitable. Because love requires that you do hard things. You have to have hard conversations, make hard decisions. As I think about what we’ve gone through in the last several months, I’m so grateful that we had these values in place. Because as you can imagine, we have had to rely on serving together with love and excellence in ways that we couldn’t have imagined. And now that we have also seen the unrest around racism, something that we were already very much invested in talking about and taking action on. What we say now is, we truly lead with love. Excellence is inevitable and equity is achievable.
Gary Bisbee 13:41
This whole discussion just shows what a terrific leader you are, and the board made the right decision. For sure. Let’s turn to social determinants of health, which also is related to your past comments. How do you think about social determinants of health? What kind of programming is Christiana pursuing?
Janice Nevin 13:59
Our vision At Christiana Care is to improve the health of all the people who live in all the communities that we serve. Not just the people that come to us as patients, but all the people that they live with their neighbors because we know that fundamentally you can’t achieve health unless the whole community is healthy. And we know Delaware is very much like other communities, three miles can mean a 20-year difference in life expectancy. So unless we’re paying attention to the bio, the psycho and the social, we’re not going to be able to achieve health. I wrote my medical school entrance essay on the biopsychosocial model of care. And so at Christiana Care, we are implementing the 21st-century version of that. Our investments in medical care have been around expanding primary care, investing in virtual care. We know that health isn’t achievable unless we’re paying attention to mental health. I think we’ve got more work to do there, but certainly focused on that and making investments. And we won’t be successful unless we’re paying attention to social care, the social determinants of health. So we’ve taken a few new approaches to the social determinants work. Like all nonprofit health systems, we have always provided community benefit. Now we talk about community investment. So we have taken funds, and purposefully intentionally invested in community organizations that are doing great work, addressing some of those social determinants of health. It’s an investment we have an investment portfolio that’s made up of these community organizations because we believe that if we can create that network of social care in communities it will improve health and ultimately reduce health care costs and make care more affordable at the same time, improving people’s health. We use “Unite Us” as our platform. It’s called unite Delaware. We’re also an investor. And what’s wonderful about that technology is it really helps to close the loop. So that a provider, a patient, and a community organization, are all on the same page in terms of knowing what is needed and ensuring that those needs are met. So really rethinking social determinants. We also understand that many people who work here at Christiana Care now have 13,500 plus caregivers live in the communities that may be most at risk. And so we have increased our minimum wage to $15 an hour, that is the entry wage. We implemented paid parental leave this year against supporting people so that they can Meet a healthier life. And we also have food banks in each of our institutions. And as COVID hit and people lost their jobs, we saw that those food banks were really important to families in order for them to be able to continue to keep food on the table. And we have a whole host of other programs where we’re deeply connected to the community. One of the partnerships that I’m most proud of is a partnership with a purpose-built community called Reach Riverside. It’s a community center in the poorest neighborhood in Wilmington, and we helped fund some of the work that they’re doing, including building what’s called the “Teen Warehouse”, which is this extraordinary set of programs in a building for teens and the teens helped design the space design the programs. It makes me smile. I’m so optimistic for that community because of the investments that they’re making, and it’s a privilege to be able to be a partner in that work.
Gary Bisbee 18:07
one of the things that COVID has done is to lead to this thought that public health is actually part of the national security. How do social determinants of health program fit into that thought, Janice?
Janice Nevin 18:22
When I finished my residency, I did a faculty development fellowship and did a Master’s of Public Health. It really was public health that drew me to the field of medicine in many ways and cemented my decision to go to medical school. I felt that I could do more from a public health perspective if I was a physician. This pandemic has taught us many things. And one of the things that is taught us is that the inequities that we knew existed are real. COVID has shined a light on them, made them more visible to us, and I think we have a moral imperative at this point to address those. We can’t be a safe country, unless the people who live here also feel safe and are healthy. And fundamental to that is a place to live, to have education, to eliminate racism, and eliminate poverty. And we will not be a strong country, a successful country unless we work together to address these inequities.
Gary Bisbee 19:32
Well, what do you hear from your peer CEOs about this? Is their general interest in this point of view?
Janice Nevin 19:38
I believe more and more people are realizing that in order to impact health, particularly as we move more towards value-based payment, a failure to address mental health and a failure to address social care, really means a failure to achieve health and to make care affordable. It’s been really interesting to see the conversation that has really taken hold over the last two to three years. It makes me again, I’m an optimistic person by nature. But it’s been very rewarding to see these meaningful conversations about how we can care differently and have an impact for all people who live in all the communities that we serve.
Gary Bisbee 20:22
I agree with that. The problem has been with social determinants of health through the years is how is it financed. And you’re talking about Christiana Care playing a leadership role in investing in it, but that’s probably not going to be sufficient. So how do you see a broader coalition of financing for social determinants of health, Janice?
Janice Nevin 20:45
Fundamentally, I believe we need to move away from fee for service payment and move firmly briskly towards value-based payment, as long as we continue to only get paid for the volume of services that we provide. It’s going to be very difficult to incorporate these other elements that ultimately results in health Christiana Care. Certainly, we have embraced population health taking risk for the health outcomes and the cost of care for a population. And as I mentioned, we are investing in primary care, mental health, social care, but we’re also aggressively looking for partners that are willing to pay for care differently, to pay us for the outcome, to be flexible in terms of how those dollars get used, so they can be applied in a way that produces the outcome that’s important to that person. One of the reasons that we invested in the community organizations is that we know we can’t do this alone. And there are nonprofit community organizations out there that do exceptional work, and by partnering and bringing them together in one network. We’ve got an opportunity for all of us to be elevated and to have a bigger impact.
Gary Bisbee 22:05
So in effect, the public-private partnership would underlie the financing for social determinants. Moving on to COVID. If we’ve learned anything, we’ve learned that the surge is highly variable by region. So what was the profile of the COVID outbreak in Delaware and your associated markets, Janice?
Janice Nevin 22:25
We had our first case of COVID in Delaware that we knew about a reported case on March the 11th. At that point, we already had an incident command structure. We’ve really been getting ready for this ever since we heard about the virus in China. And on March the 12th, we made a decision to do the first regional drive through testing events. The following day, in 14 hours, we went from concept to execution. We tested 586 people over the course of three hours and as a result of that testing we were able to demonstrate that there was community spread. It was also really important because it gave us a messaging platform to help people understand what they should do if they were worried, where to go, where to get information. And we also demonstrated that we can do sort of a mass event very quickly and very effectively. So it was really an important moment in our timeline and also for the state of Delaware. It allowed us then to fairly quickly get into a conversation with the governor with the Department of Public Health, about what was the best course of action for the state. The following week, our governor issued essentially a stay at home order. So we were doing that work at the same time that it was happening in New York, so we got the chance to get ahead of the curve. And as a result, yes. Did we have an increase in disease? Yes, but we plateaued. We stayed at that plateau number for about three or four weeks. And then we started to come down. It meant that we were able to manage our PPE, our ventilators, our staffing in a way that allowed us to care for our community and also care for each other. And today, we’re at our lowest number since the beginning of all of this.
Gary Bisbee 24:17
That’s really good news. How are your expectations then for further spread over the course of this year or next year?
Janice Nevin 24:24
I fully expect that we’re going to be living with the virus for the next 12 to 18 months at least. I think I personally started to feel maybe a little bit too comfortable in mid-June, as we were seeing those numbers come down and starting to turn the dimmer switch up on bringing some of our services back and we did that really well. And I started to think I think we’re gonna be okay, we’ve got this if this is what it’s going to look like for the next 12 to 18 months. I think things are going to be all right. And I realized now seeing what’s happening in the sundial, frankly, what’s happening Delaware beaches, I realized that we have to stay vigilant. And it really is paying attention to the data and understanding what might happen a week, two weeks from now. I’m part of the governor’s pandemic resurgence Advisory Committee. We meet every couple of weeks and we talk about what did we learn as a state? And how do we take that learning and start to apply it to the future, particularly if there is a resurgence in the fall? Or if we have a particularly bad flu season and we’re managing flu and COVID-19 at the same time, so did you see the incredible increase in telemedicine that most of the other health systems have? We did our mantra right before COVID-19 really, for the last year has been “everything that can be digital will be, everything that can be done in the home will be” and we’d already been making investments in that. And when COVID hit, we had a virtual first primary care practice already in place, we expected that we would grow over the next two to three years. Instead, in two to three weeks, we went from one virtual first practice to 170 virtual first practices, not only primary care, but also specialty care of every ilk. It was fascinating. And it was an all hands on deck effort for us. It wasn’t using the phone or using an iPad to FaceTime. It really was how do we best enable providers to care for people using the best technology that we have available. And so we did that and it was just extraordinary. Our IT department did incredible work, making sure people had the tools that they needed. We did training videos, and like many places, our number of visits that We’re done virtually skyrocketed by several hundred thousand percent. It’s one of those learnings from COVID that I do believe needs to be pulled through. I do worry that it becomes another way to simply continue the current delivery model. I think the real value and opportunity in virtual care is to change the delivery model. Now that we know physicians like it, and patients like it, let’s start using it in a way that really creates value. Some of the examples that I heard that make me think we’re onto something where for example, a patient who had the opportunity to be on a teams visit with their neurosurgeon, their neurologist and their primary care physician, so all four on the same platform, making decisions together, the power of that model, I think is just extraordinary. And that’s how we should be using virtual care. The other piece that has to be different because we really got to move away from everything is done by visit. We need to be able to use data and technology synchronously and asynchronously. We have a platform. It’s called VO Care. We’ve been using it for about eight years now started with CMMI funds, sort of more traditional care coordination. It is now the platform for virtual care. We were able to stand up a COVID-19 monitoring practice immediately. So anyone that was tested, tested positive, anyone that was discharged from the hospital following COVID and we made it available for all of our caregivers could download the app. They were risk scored, and every day got one to four secure techs. Based on their symptoms, their reported symptoms. If they flipped from green to red, they were then escalated to a virtual visit. With a provider, who was then able to either support them more fully at home, sending equipment to the home, or get them to the right place of care, we literally cared for thousands of people on this platform. And now we are in the process of selling it to employers who want to be able to bring their workers back and know that there’s a layer of safety and protection. for them. We think we’ve got 20 plus contracts at this point for employers in the region.
Gary Bisbee 29:32
That’s just terrific. Let’s turn to governance. ChristianaCare had a rather unique governing structure that you inherited. Could you briefly describe that for us?
Janice Nevin 29:42
Absolutely. The governance structure that we had in place was very elegant when it came into being in the 1960s. Christiana Care was originally four different hospitals in Wilmington. And so the way that they manage that merger was to make all of the board members trustees and have them a left from that group, a smaller board of directors. And that’s the structure that remained and remained through the decades through Christiana Cares growth. And it became clear, particularly over the last couple of years, given that the trustee group had grown to 285, electing a board of directors of 18 to 20, that that really wasn’t reflective of what we were doing as an organization and our current needs given the current healthcare environment. So we started across us and really, I give credit to Doneen Damon, our board chair who stepped up and said, “We need to get this done.” She was particularly inspired at an HMA trustees meeting. We need to get this done and now is the time and so we work together on this for about a year and what had to do was essentially a member substitution, the trustees had to essentially remove themselves as members of the corporation and designate the board of directors as the sole members of the corporation. So we were successful. And on June the 24th, 2020 at our virtual trustee meeting with about 150 plus people on a zoom platform, the trustees voted to make the change. It was overwhelming – their support. And so we now have a modern governance structure at Christiana Care. We’ve got some more work to do. But I’m confident as we head into 2021, we will have the governance structure that we need, particularly in the times in which we live. It’s another one of those bodies of work. I’m so glad that we did it. I’m so glad that we continued it through COVID because as we coexist with COVID and then emerge. I believe it’s the governance structure we need for success moving forward.
Gary Bisbee 32:07
Well, congratulations. That was a huge effort. I know you worked long and hard on this. This has just been a great interview. Thank you, Janice. Could we turn to the final question, which is what we’re all referring to as the quote-unquote, new normal. What changes do you expect to happen as a result of COVID?
Janice Nevin 32:31
I really don’t like the term new normal, because normal feels so boring.
Gary Bisbee 32:37
Janice Nevin 32:37
We’ve got such an opportunity in this mode. And it’s just been an extraordinary challenge. We have the opportunity now, I believe, to build the health system, the delivery model that we’ve imagined. Nobody thought that what we were doing was necessarily the best way to care for people. It’s why we have so many people sort of investing in technology to try to improve, care and improve the experience and everybody believes it’s too expensive. So let’s use this opportunity to design something brand new. Let’s make sure that care delivery model is about hyper personalizing experience, getting people what they need when they need it in the way that they choose, ideally doing it in the home in the community. As we start to sort of turn that dimmer switch back on and bring services backup. Let’s become more efficient. Let’s eliminate waste. Let’s figure out how we’re going to make the numbers work as more and more of our patients will have government insurance. Let’s not wait 10 to 15 years to do that. Let’s do that now. Let’s take all those learnings around virtual and digital care and apply them in a way that creates value. Let’s move more quickly and wholly toward risk-based payments so we can use the resources that we have to make a difference. And let’s solve the issues of inequity. Let’s eliminate health disparities.
Gary Bisbee 34:16
Well said and I think you should join your fellow Delaware resident Joe Biden and run as Vice President, Janice. Maybe secretary of HHS would do it. This has been a terrific interview, Janice, as expected. Thank you very much. You’re doing just a terrific job there. Much appreciated.
Janice Nevin 34:36
Thank you, Gary. Always a pleasure. Take care.
Gary Bisbee 34:39
This episode of Fireside Chat is produced by Strafire. Please subscribe to Fireside Chat on Apple Podcasts or wherever you’re listening right now. Be sure to rate and review fireside chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating, we have found that podcasts are known through word of mouth. We appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capital in Washington DC, where we explore the intersection of healthcare politics, financing, and delivery. For additional perspectives on health policy and leadership. Read my weekly blog Bisbee’s Brief. For questions and suggestions about Fireside Chat, contact me through our website, firesidechatpodcast.com, or email@example.com. Thanks for listening.