What’s ahead for health care in Solano, Napa, Marin, Sonoma counties as COVID era shifts

A pandemic lingers, a virus mutates and a public frets. Through it all, health care workers push on as the foundations of the care system seemed to shift beneath them.

To gauge the status of that industry, the North Bay Business Journal posed several questions to local health leaders:

• Gabriela Bernal-Leroi, Santa Rosa Community Health
• Darian Harris, Healdsburg Hospital and Petaluma Valley Hospital (Providence)
• David Klein, MarinHealth
• Kathie Powell, Petaluma Health Center
• Alicia Hardy, OLE Health
• Kelley Jaeger-Jackson, Sutter Solano Medical Center
• Dan Peterson, Sutter Santa Rosa Regional Hospital
• John Hennelly, Sonoma Valley Hospital

Their answers have been edited.

We know that cybersecurity has been a threat to health care organizations. What steps should the industry take that it hasn’t?

Gabriela Bernal-Leroi: Organizations need to build a culture of security awareness, which starts with training staff, communicating frequently, and hiring dedicated resources who are focused on cybersecurity, like a director or CIO.

We’ve increased staff training and communications, and used technology to practice and reenforce awareness, for example sending out fake phishing campaigns and then following up with people who fail them. We also increase communication when there are known threats are around.

The biggest vulnerability of any organization in terms of cybersecurity is always its people. Everyone wants to make sure things are getting accomplished and to please their supervisors, and things are moving quickly. The attacks are so sophisticated now; it’s easy to fall for them.

Darian Harris: We have invested and continue to invest in sophisticated detection and prevention systems, including phishing alerts, proactive monitoring of firewalls and adaptive network updates, that harden our electronic infrastructure and securely protect the private health information of our patients.

The fact is that the considerable majority of focus as an industry continues to be on preventing cybersecurity attacks and given the increasingly connected world we live in, the unfortunate reality is that these attacks will continue to happen with greater frequency.

We in healthcare are very familiar with simulating response and recovery from unfortunate realities like this pandemic, mass trauma events, and many other potentialities, and we as an industry need to invest more into post-event / cybersecurity attack response and recovery simulations. This should include multi-organizational and multi-sector cybersecurity attack simulations where the difficult questions are wrestled, and worst-case scenarios considered.

For example, how do we keep patients safe who depend on technology-enabled equipment, what would be the federal (FBI) response, what would the cybersecurity experts advise in ransom-wear situations and what precedence would potential payments set for the industry?

David Klein: As new and exciting health technologies hit the market, we must demand that these products be built and maintained to industry security standards. It is extremely challenging for healthcare organizations to stay ahead of the cybersecurity risk curve.

Technology changes at a breathtaking pace and requires large investments in infrastructure and resources to minimize that risk. MarinHealth is equipped with the latest state of the art protection against cybersecurity and importantly train our staff regularly in recognizing phishing schemes and not opening emails or attachments from unknown senders.

In health care organizations where margins are thin and capital investments in clinical technologies is high, this is particularly challenging.

Additionally smaller hospital systems would be financially devastated with a cyberattack such as ransomware. We should also demand our state and federal government provide air cover for all industries but especially for healthcare, where our patient’s health is at stake.

Kathie Powell: Invest and Train: Invest in the best IT security systems possible, and continually train and remind employees with almost daily reminders to not “click” or respond to any emails that are in any way unusual.

Are you investing in technological advancements such as (artificial intelligence)? If so, how critical is this to your organization’s operations?

Bernal-Leroi: The pandemic definitely prioritized our investment in technology at Santa Rosa Community Health. A critical one was purchasing LUMA, a digital patient engagement platform, to reach out quickly to a very large number of people to schedule COVID-19 vaccine appointments when the vaccines became available in early 2021.

We had close to 25,000 patients who ultimately were eligible for vaccines. We were able to pull prioritized patient lists and send them a text through LUMA, enabling them to schedule their appointment.

In the first three months, over 5,200 appointments were self-scheduled and over 20,000 appointment reminders were sent, as well as over 300,000 other messages about care. There was no way we could have accomplished that so rapidly with our call center who was already fully utilized with regular care plus COVID! We were also surprised at how effective this was reaching our elderly population.

Now, we’ve fully invested in LUMA and are rolling out different components to manage our regular care. In addition to continuing our critical vaccine work, it’s been incredibly effective in terms of catching patients up on care that has been delayed due to COVID. We’re able to engage patients to come in for chronic health care issues like diabetes management and for preventative health screenings such as mammograms and cervical cancer screenings, and also for children’s regular immunizations.

Alicia Hardy: OLE Health has been upgrading our technology infrastructure to better serve our patients. We recently launched a new phone system that will allow for calls, texts, and online chat with our call center representatives. We have expanded our telehealth options to provide more capacity for virtual visits.

We also are leveraging technology for our patients with hypertension. We received a grant from HRSA to provide Bluetooth-enabled blood pressure monitors to patients diagnosed with hypertension, which allows them to monitor their blood pressure at home and have the readings upload directly to their health record. This information gives our providers a fuller picture of the patient’s blood pressure, which improves treatment decisions and helps patients play a more active role in managing their health.

Harris: We have begun introducing early and exciting applications of AI into key areas like our medical equipment that enhance the accuracy and precision of the care we can deliver our patients.

One example is our new patient fluid management system in our intensive care unit (ICU). That system leverages a technology-driven insights that support patient-specific clinical decisions about whether fluid may benefit or harm the patient in their recovery process.

Kelley Jaeger-Jackson: Sutter is always reimagining the ways we provide and deliver care across our integrated network. Sutter is advancing our digital capabilities in a way where in-person and virtual care are seamlessly integrated, supporting both patients and providers. Artificial intelligence is one example of those enhanced digital capabilities. It can complement the work of our clinicians—enhancing their ability to care for patients. Our work with Ferrum helps illustrate this approach.

Their AI-powered quality platform is designed to improve quality in medical imaging, like CT scans, via a “second read.” The goal is to help find important diagnoses like lung cancers in their early stages, so that care and treatment can be accessed quickly.

Klein: Artificial Intelligence has been around in health care for years in the form of clinical diagnosis, billing practices, treatment protocols and patient monitoring, and care. We have invested in and utilize A.I. across our healthcare platform.

Our new Electronic Medical Record system coming live this summer will greatly improve our access to integrated clinical information for our providers and our patients. These tools help us better diagnose diseases, provide more precise treatment options and monitor patients under our care.

We also use AI for predictive analytics in helping us improve safety and efficiency. MarinHealth is aggressively adopting other new technologies to provide outstanding care to our community.

Our new Oak Pavilion is equipped with state-of-the-art imaging equipment that provides visibility to our surgeons and other care providers. We have also added a new knee robot just in the past month.

Peterson: Sutter’s $170 million investment in a new three-story bed tower at Sutter Santa Rosa Regional Hospital will help keep us at the forefront as the newest, cleanest and most energy-efficient hospital in the area. Our expansion will also include a new high-tech operating room for our robotic surgery program, allowing for better visualization of vessels and anatomies, and new techniques. The expansion tower will open this May.

Powell: Clinical systems include decision support tools that assist providers in diagnosing and treating complex and co-existing disorders. Additionally, we are utilizing A.I. to assist in achieving ideal scheduling of patients.

Let’s assume telehealth is now the primary way to delivery patient care. What are the potential cost benefits and pitfalls in the long term?

Bernal-Leroi: First, that’s a big assumption. I’d say that telehealth remains another way to deliver care, but it cannot take the place of a face-to-face interaction with a trusted health care provider.

It’s difficult for patients to build relationships with their clinicians and be actively engaged in their care via telehealth, especially for our patient population. First, we have to remember or realize that for people with low socio-economic status, technology can be challenging, simply finding a private space to do a visit can be challenging, and there just may not be the same level of engagement because it’s not the traditional way of getting care.

It’s a little harder to adopt it readily. Second, people who are less resourced or who have been historically marginalized can find it difficult to speak up about what is bothering them or what they need. Trust and personal connection are absolutely critical and that is built with in-person care. Those are some of the pitfalls or barriers we work to address as we incorporate telehealth.

At the same time, it is convenient and can also be very effective - both from a cost and health outcome perspective. We definitely use it for patient convenience: if we don’t need to see them face-to-face, and if they have the ability to engage in a telehealth appointment, we do that.

Hardy: The pandemic accelerated the adoption of telehealth, and it’s a great tool for many types of primary care visits. It reduces the amount of time people have to take off for an appointment and alleviates transportation issues, which is the number one reason patients don’t show up for scheduled appointments at OLE Health.

It makes it more convenient for many to receive care or interact with a provider. It also offers providers additional flexibility and the opportunity to take advantage of remote work, which is a major plus for recruitment and retention of talent and employee morale.

However, we have found that many of our patients still want to see their provider face-to-face. And there are many services that cannot be accomplished via telehealth in the primary care realm – cancer screenings, dental cleanings and exams, and physicals.

On the behavioral health front, telehealth helps remove some of the stigma and shame or worry some patients may have that they will be judged for seeking help by someone they see or interact with. But, telehealth for behavioral health visits also has pitfalls as subtle nonverbals can be missed when you only see the patient from the shoulders up.

In terms of pitfalls more broadly, there are equity issues with telehealth, as many places still lack reliable broadband access. There are also concerns for patients who have low tech literacy.

Harris: Telehealth has the potential to support the democratization of healthcare, bridging the gaps between patients and communities lacking critical physician and provider resources to the broader medical expertise available across the industry.

The increased desire for virtual visits is also helping to drive changes in healthcare licensing practices that could allow providers to virtually and easily provide care across state lines, and as a result, lower the cost for both the patient and the physician.

This ‘shrinking’ and democratization of health care will be the catalyst for other healthcare innovations, as new market entrants drive the need for all health care delivery systems (local and further afield) to find new ways to conveniently meet the needs of our patients and elevate how our patients experience their care.

While telehealth is very effective and appropriate for many kinds of care needs, in some cases it is very important for patients and clinicians to form stronger relationships and trust that can be easier to do in person.

And some caregivers report feeling less connected with their patients when providing care only through virtual visits, and that can sometimes be less fulfilling and contribute to caregiver burnout. Another area of concern is the risk of leaving some socioeconomically disadvantaged and vulnerable communities behind due to the “digital divide.”

Hennelly: From a healthcare provider’s viewpoint, the ability to provide care via telehealth will enable us to provide more expedient care. Patients won’t have to dedicate hours to drive to see a provider, they’ll simply need 15 minutes on a screen. That means no need to take time off work, or find someone to drive them to the appointment, or needing to cancel due to other factors.

Many barriers simply disappear.

We do have some significant hurdles to address. Access to technology and comfort using it is significant, especially with seniors. We continue to be the great ‘melting pot,’ and language is a barrier. Our care teams don’t always mirror our communities.

There is also great value in face-to-face interactions. In a clinical care setting, a patient interacts with numerous people, each of whom has the potential to uncover relevant information that can assist in the provision of care. With telehealth, many of those interactions don’t happen. Everyone will need to adapt as the care delivery model evolves.

Jaeger-Jackson: Digital health is much more than the “video visits” that were used by so many during the early stages of the pandemic.

Digital health helps bring medical care closer to the patient and outside the walls of traditional care centers, which is part of the beauty and the value. It helps create greater access, which can help people stay more engaged with their health.

It also empowers them to adhere better to their care plans. That can mean many benefits for the patient, including lowering the incidence of readmission, better managing a chronic condition or avoiding a trip to the emergency department.

Klein: We launched our telehealth program in a matter of weeks at the beginning of COVID. This allowed MarinHealth to continue to see patients who were unable to safely come in for in-office visits.

We continue to offer telehealth visits for many immunocompromised patients and for others as warranted. We also effectively utilized telehealth in our hospital to keep our care providers safe and reduce our usage of critical PPE during the early stages of the pandemic.

Additionally our telehealth hardware has also facilitated patients to have video visits with their family, friends , and loved ones when hospital visitation was restricted due to the pandemic. As payers began to compensate providers for telehealth visits, it has opened the door for a more efficient and patient-friendly model of care delivery. The technology cost was not insignificant but that cost has already been borne.

Telehealth visits are a patient satisfier and we are excited to continue to provide this service to our community. Over time, we will see if this has a longer-term impact on the quality of care as a byproduct of providers not having as much direct hands-on contact with the patient. Additionally, we hope that payers will continue to reimburse for telehealth services.

Peterson: As a father of three children, it has already come in handy for me. Having the ability to speak with a clinician from the comfort of your own home not only gives you immediate peace of mind when you want it and where you want it but offers our patients real efficiencies in their own lives.

It saves on gas money and mileage for those who live a bit further away and saves a patient a significant amount of their own personal time spent in traffic or finding parking when making a trip to the doctor’s office, not to mention just getting yourself and your family ready and into the car. I believe this is the future of medicine, as it provides patients a lot of what they want, when they want it and where they want it.

Powell: The savings we are experiencing from telehealth, which comprises about 25% of our visits, supports the additional resources needed to provide the remaining 75% of our services in person, in a safe environment of care.

After the initial year of postponing in person visits for most patients, longer visits are needed when each person does come in for a physical visit. It is critical for us to balance the types of visits to ensure everyone who is best served in person receives the care needed.

If you were asked to give one piece of advice to your industry peers to ensure their own well-being, what would it be?

Bernal-Leroi: You’ve got to take care of yourself first. It’s the classic saying, you have to put on your own air mask first. It is just continuous; there is never a slow day. And with the pandemic, there are so many layers of new issues we are uncovering every day.

Take time off. Figure out what works for you as self-care and stress relief and do it. How do you continue to feed your soul so you can continue in this work? Take lunch away from the computer, take a walk, take two hours to build LEGO with your child. And let that be OK. Give yourself acceptance and forgiveness. We simply have to keep ourselves healthy and strong and vibrant because so many people depend on us.

Hardy: I would remind my peers to remember why they got into this profession to begin with. We work in health care because we care about people and the health of our communities.

When it gets tough, remember what your organization means to its patients and the larger community. Focus on the gratitude people have for your work and imagine the hardships those individuals would face without you. Let that ground and recharge you.

Harris: Give yourself the grace to pause, and in the midst of great uncertainty and change, take the time to consistently invest in those things that personally “fill your tank.”

For some, that looks like always getting to the kids’ soccer games. For others it may be a consistent and uninterrupted evening exercise routine, or maybe taking five minutes each morning to record your ‘moments of gratitude’ as you start the day

And I also encourage leaders to keep in mind that your team needs you at your best and they need to see that it is not only OK to take care of themselves, but it’s encouraged and exemplified by their leaders.

Hennelly: Exercise. There are so many benefits! From physical wellness, avoiding unnecessary healthcare and maintaining your mental health, exercise is a must...15-20 minutes each day can be a powerful recharge and keep you from visiting us!

Jaeger-Jackson: The reality is that even small rest breaks where you can close your eyes and take deep breaths help to lower blood pressure. That brief action can have a big impact. It lowers anxiety, which in turn boosts the immune system. In the age of COVID, anything you can do to improve your overall health will be of benefit.

There is some fascinating research being done on the effects of gratitude on improving individual mental well-being and increasing self-motivation through “changing” neural mechanisms and brain matter. Even small acts or thoughts of gratitude in a time of great fear, sorrow and anger can help to stave off feelings of hopelessness and sadness.

Klein: Keep front of mind the mission of your organization and why you are doing what you are doing and how fortunate we are to work in a profession where we make a difference in people’s lives every day! Build a team that you enjoy being around.

Equally important is to find time for self-care – whether that’s taking care of your mind, body, and soul or all three and most importantly - have fun!

Peterson: When you are at work, work hard. When you are with your family, take the time to really be present with them and get the most out of your time with them. If you are volunteering, do it for something that really means a lot to you and makes a real difference in your life.

Looking at the challenges of keeping health care staff, what would you say is the No. 1 retention strategy that has worked best at your organization?

Bernal-Leroi: Before the pandemic, we had issues with retention for some job classes, but never at the level and scope that we have now.

We’re still figuring this out, but we want to move in the direction of people finding a home at Santa Rosa Community Health. We do talk about and have a strong sense of being a work family, but with everything happening, even the strongest relationships are stressed.

We really need a whole-person approach to our employee’s just like we strive to offer to offer patients. Employees need to feel like, “I am an important piece of this organization’s future and success. My work matters and I am supported in doing it.”

Hardy: I find that our providers and staff are energized by our mission and reminding them of it helps keep them engaged and working at OLE Health. In addition to the mission, I find that showing appreciation and gratitude for an individual’s contributions makes a big difference. A simple thank you and finding ways to make people feel valued for the work they do can go a long way.

Harris: Two years into this pandemic, I can tell you the number one retention strategy for our caregivers is cultivating an environment where they feel connected with their personal “why” and the mission of our organization. They want to feel known and trusted by their leaders, compassionately cared for, and that they belong to a team in service of a bigger shared purpose. And they want to experience joy, fulfillment, and empowerment at work while providing exceptional quality care with compassion.

Hennelly: Engagement. Effective bi-directional communication outweighs everything else. Ensuring staff know what’s going on and giving them time to provide feedback is invaluable. It also helps insure you’re retaining the right people. There will be those who hear your communications and decide to leave. That’s ok. If they don’t embrace the game plan, they shouldn’t be on the team. I don’t want to diminish the importance of paying people, money talks, but engagement is the differentiator.

Jaeger-Jackson: I do know that when teams can rely on each other and have strong bonds, that helps individuals feel like a valued member of the team and choose to stay. I also hear from frontline teammates that some days they just need to be able to vent and feel like they are being heard. And as always, communicate, communicate, communicate. As leaders we simply cannot communicate enough with our teams.

As an employer, we realized early on that the pandemic was something we had never seen before, and it was affecting every aspect of our lives – childcare, education, everything. Sutter Health as an organization overall broadened its approach to addressing our teams’ mental, emotional and financial needs. This included investing heavily in mental health resources including anxiety and depression counseling, traumatic event recovery, grief response, stress relief, disaster coping and resilience trainings. We realize there isn’t one solution, but we continue to work hard to support and uphold our employees.

Klein: Klein: Like many other industries, we are feeling the impact of the volatile labor market. Building a strong culture and creating an environment where our staff feels connected to our mission, supported, and safe is of paramount importance.

To ensure we can attract and retain talent, we are staying competitive in the market with wages. Additionally, we are continuing to provide schedule flexibility and remote work for those positions that are able to be performed remotely or in a hybrid model.

Peterson: We have invested a lot this year in doing everything we can to honor staff wishes when it comes to desired position requests. For some staff this has meant reduced schedules. For others it has meant changing shifts.

For some it means training and moving over to a new department. While we have not been able to accommodate all staff at all times, we have certainly worked hard to do so wherever possible. A number of staff have remarked on what a difference this has made in keeping them refreshed and resilient.

Powell: Excellent, one-on-one communication between employees and their managers, ensuring people have everything they need to be successful, fulfilled, and have a solid career path is optimal, assuming their compensation is appropriate.

Please describe one or two changes you made to be more cost-efficient in your organization’s operations that you will keep in place going forward.

Bernal-Leroi: Expanding our workforce so it’s easier and more efficient and effective for patients to get ahold of us is huge.

Our dropped call rate is down in the single digits and wait time on hold has gone from an average of eight to 10 minutes during COVID (pre-COVID it was four to six minutes) to a wait of just 60 seconds. Patients are so used to the healthcare system being broken and fragmented. We are all genuinely so thrilled to be reducing their frustration level and offering an excellent experience, not just in the exam room but all around.

Jaeger-Jackson: One of the pillars to our approach is delivering the right care, at the right time and in the right place. This means focusing on access to primary preventative care so that chronic diseases are managed well, unnecessary emergency department visits are reduced and different access points to care are available through the region, like walk-in care and urgent care centers. Our focus is to keep patients healthy so that less care is needed, which can help lower the overall total cost of care.

We are also taking steps to preserve our ability to care for our communities in the future. Sutter is still recovering from the most difficult financial situation it has encountered in its history. Fortunately, thanks to the hard work of our employees and clinicians, as well as rebounding patient volumes, Sutter’s finances are improving.

Klein: We have taken a number of measures to adjust our cost structure to be more nimble, streamlining overhead, being more operationally efficient, and reducing spending not tied directly to patient care

Peterson: We have had a lot of success in replacing equipment rentals with long-term purchases, thereby reducing our overall purchased services expenses. Additionally, this year we asked each department in the hospital to come up with something we called a 0.5% initiative. We tasked managers to come up with a novel idea that would either reduce their department expenses or improve their revenue by a minimum of 0.5%.

Powell: We were forced to learn how to communicate very efficiently over the past two years. We now utilize communication technology quite nimbly, with patients, staff members, and outside organizations. As safety permits, we will begin to reduce excessive virtual communication to more appropriate levels yet continue to experience substantial savings in the areas of paid employee travel time and mileage reimbursement, not to mention the reduced carbon footprint benefit to the environment.