Healthcare Voices podcast series: with Lisa Tank, Hackensack

Hello, and welcome to the Becker’s Healthcare Podcast. My name is Will Riley from R1. I’m joined today by Lisa Tank. Lisa is president and chief hospital executive at Hackensack University Medical Center, part of Hackensack Meridian Healthcare. Welcome to the podcast. Thank you so much. Thank you for being here. Thank you for having me. Alright, Lisa. Well, to start us off, tell us a little bit about your role, tell us a bit about Hackensack University Medical Center. Absolutely. Thank you. So once again, thank you for having me. I’m Lisa Tank. I am a geriatrician, a board certified internist, and a board certified geriatrician, and I’m the president and the chief hospital executive at Hackensack University Medical Center. Hackensack has been my home for about twenty five years. I trained there as a fellow, so I have grown in that institution. And the institution has become a large academic institution within the northern New Jersey market. It is the academic flagship for Hackensack Meridian Health. It is a robust tertiary quaternary center, and it continues to thrive within a community that is highly competitive and a market that is highly motivated to perform the highest level of clinical care and very competitive in the US news market too. Tell us a little bit about the community around you. You’re in Northern New Jersey. You said it’s competitive from a health care perspective. But what’s the demographic like? What what what’s the what’s the surrounding area? Absolutely. It is one of the you have the two largest airports, within that area. So you have the Newark Airport and, JFK within couple of miles. So there is a highly diverse community and highly populated community, pretty dense. But I think the most important thing I’ll tell you is it’s one of the most popular counties to retire in. So you have a large aging population with a high mix of patients living at home independently versus assisted living, independent living. So it has a quite diverse age group too. And that’s a critical part to remember as we deliver health care across the entire continuum. Fantastic. Okay. That’s great. And we’re going to come back and talk a little bit about patients and how you maintain patient centricity in that kind of environment later on. Let’s talk first about technology, if we can. So, I mean, historically, healthcare has moved fairly cautiously around new technologies and adopting new technologies. Right? Healthcare doesn’t seem to have necessarily been a leader in many waves of technology. But I’m curious whether you think that’s the same with AI because it feels like potentially it’s different. Can you talk about that a little? Yeah. I think you’re absolutely right. Health care has always been a bit cautious and, sometimes I think lagging in terms of technology, but AI has revolutionized that. So if you look at health care currently with AI adoption, the end end consumer is health care. Right? And it is going to double into billions. Absolutely. So I think I think AI is a critical piece, and health care has understood now that anything to do with safety, quality, seamless cost efficiency. So I always come back to the quadruple aim. So the quadruple aim is really focused on couple of things. Right? This was something that was introduced by IHI in the two thousands, and it focuses on patient experience. How are you going to deliver the best patient experience? Yeah. Second is how are you going to manage population health? That’s chronic disease management and focused on predictive analytics. Third part about that is how are you going to deliver cost efficient, you know, value based care. Right? And now the fourth component is how are you going to focus on the well-being of your entire team, your workforce? So if you look at that, AI is a critical part of that. AI is embedded within those, and it layers in your foundation. And what it tends to do is it, number one, streamlines administrative tasks, and it optimizes clinical models. So if you combine those two together, what you have is a great focus on patient outcomes. Yes. I think that’s why AI is taking on a whole different role. But I don’t know if we are gonna touch on this, but one of the critical pieces that we have seen at Hackensack Meridian Health is we were one of the early adopters in AI. And what we did is as we developed AI, we created a governance model. And that governance model is already set up initially as soon as there is any project intakes. So if I have a great idea, it might be a great idea for me, but how are you going to have those guardrails embedded? And what we’ve done is is the multi professional model. There’s ethics involved. There’s clinics clinicians involved. Legal is involved. Compliance, etcetera. So what you are able to do is really deliver the highest level of evidence based care with AI modules built in with the governance structure so you are always on point. And you are always, you have somebody watching that Yeah. You are not slipping or there is no what we call is a drift or variation. Sure. I want to yeah. It’s I’m glad you went there because has it been difficult to get that governance system set up? I’m curious about whether it’s required new skills or new ways of working or thinking, whether it’s been a challenge to implement in the c suite, for example, at the health system, or has it do you feel like it’s just evolved fairly fairly naturally as an extension of what people are already doing and were thinking about? Yeah. I think I think it boils down to the culture of the institution you are in. Again, it boils down to chain management. So if you are early early adopter and you are able to think through and be nimble and flexible enough to understand that if you are not going to have the guardrails, you’re probably going to land up in a lane that is probably not safe for your patient and not conducive for your clinic for your clinicians to deliver health care. So I think one of the things that we did upfront was we wanted to launch into AI, but we understood the risks with it. And we also wanted to take away the anxiety from all our team members that this is not here to replace you. This is absolutely something that’s going to be able to support you. And Yeah. I think that’s that’s how it all came about. Okay. Yeah. Excellent. Continuing on the theme of of innovation. So in in health care innovation, you often hear about two sort of archetypes: incumbents, like the large established health systems like you, or established payers, or established like legacy vendors, right, who kind of power the landscape and control the data and the infrastructure and so on. And then new entrants, insurgents. Right? People coming in and changing the game and rewriting the rules and so on. Do you have a a point of view on how you see that dynamic playing out around the adoption of AI? Yeah. I think one of the things that we focused on earlier on in Hackensack Meridian is we brought AI within our own infrastructure. So rather than working with vendors, we developed it within our infrastructure. So what we did is we took our EHR, which is Epic Yep. And built that AI platform within it. So for a great example is really thinking through a clinical workflow. We build the algorithms and decision making absolutely in real time and at point of care. So what that did is it allowed the clinicians to really be able to streamline their processes and engage with the patient. But what it also did is it actually made them change champions. And they started embedding the workflows much earlier on compared to other institutions. Right. So I think working with vendors is important, especially if you have a skills if you don’t have a skill set That they can bring to the table. But if you can develop it within your institution, which understands the culture, so our DTS team, that’s our digital transformation teams, have been able to do that. So we recruited highly skilled professionals that had the experience in AI. And we’re able to That’s interesting. And and you’re able to do that and and have them want to come and and work for you, a a large Yeah. Traditional, for want of a better word, health care provider. But I think the secret to that really is, and this is something I’ve learned in my journey as I have developed at Hackensack is how do you bridge the clinicians with the operational? So one of the things I tell my residents and my students and folks I work with my peers is if there is a patient in that lane, that’s your lane irrespective of if you are in the operational track or you’re on the clinical track. Okay. And what happened with AI and folks who came in were they were clinicians, and they have now developed a training or some form of specialization in AI. So what that really did is really brought those two areas together Yeah. And created a very high performing, workforce, that focused on outcomes. Right, I see. And you’ve talked a little bit about making things better from a clinical perspective and from an administrative perspective. Absolutely. So perhaps you feel that that way of doing it is allowing you to get at that. Absolutely. And I think I think they’re very connected. So if you look at you know, I get asked this question all the time. Where are you where are you applying AI? Are you applying AI? So if, clinically, if I’m applying AI, we are always applying AI. As clinicians, you want to know earlier on who is at risk for what. So if you already have the data, it’s it’s big data. So if you embed that AI in your EMR or EHR as we call it, you can understand who what we call is predictive analytics. Right? So you will know exactly who, at what age, which demographic is likelihood of developing. I’m just using an example for diabetes. Right? And that’s what you wanna know. And once you know earlier on, then you can develop the resource allocation towards that population. And the third part about that is you can have targeted therapies. Yep. Right? So you’ve already created a model and a macro environment that is cost efficient and sustainable rather than throwing everything at a patient and hoping something sticks. And administratively, what we’ve done is we’ve really created models. For example, Hackensack University Medical Center, we are the fifth busiest ED in the country, right, emergency room in the country. What’s the most important thing to me is throughput. How do we get patients through safely? So what AI has helped us administratively and taken the burden off the teams is create a model that has predictive analytics built in when we are going to have the maximum amount of patients coming through the ED. How do you triage them and then build a staffing model on top of it and really create a streamlined process so you are getting the maximum productivity and the highest efficiency and best outcomes. Fantastic. Staying on the administrative side a little bit. Maybe looking more at the finance aspects of administration, but not solely there. We’re used to thinking of healthcare administration being quite labour driven, labour centric, with sort of technology support and tools and aids and things like that. Right? But it but it feels like that is starting to shift and that with a a data centricity, for example, a focus on analytics and so on, that actually a lot of work can now be done through a technology first paradigm rather than a labor first paradigm. Do you see that playing out for you, and what are some of the implications of that? I think absolutely. I mean, one of the first places we saw it with data and AI again. I know you can’t use a say a sentence without AI anymore. But what it has done is in radiology. Right? K. It is tough to recruit radiologists. They are they are not as many radiologists that you would like. And radiologists have a lifestyle that they do quite a bit of work remotely. So what we did is give them those tools so that they can take large amount of data and process it with AI and with multiple data points and streamline it and create a module for them where they can have decision making in real time. Because in the past, what would happen is they would have to go back and do a second read and a third read and verification. Now you can do that together. So if you look at the labor costs versus the efficiencies with you have achieved with the data and analytics, they’ve been able to manage with not that large of a recruitment process. And they’ve been able to retain people because the work life balance has been better. Got it. So I think it’s a it’s a win win on both ends. Yeah. But I’ll come back to the same point I always tell the team. You have to make sure it is patient centric. It has validation built in. And as you just mentioned to me, it has quality. The QI piece, really embedded. Yeah. Okay. Constantly querying and doing quality, you know, evaluations and performance. So you’ve talked about providing, new new solutions that help clinicians and physicians do their job well, that reduce administrative burden. You bring it back to the patient. Like, what what does all this mean for the patient, for you? And and perhaps with an eye on the very competitive market that you’re in where you have to stay ahead. I think it boils down to one only one thing. It’s patient experience. Right? As they always say, everybody remembers how they were treated. And were you able to speak to the patient in their what we call is not in the medical speak Really simplify it for the patient. And I think I think the biggest advantage I’ll tell you through all this and the purpose we all do what we do is empowering the patient. Empowering the patient to be able to have insight and access, right, to their to their information and have a partnership with the providers because we are in for the long run. And as you know, health care is moving from four walls of a hospital going into a outpatient setting and a home setting. And our goal is to really make sure that that partnership it’s not a sprint for us. It’s a partnership through the entire continuum, and we wanna make sure that our patients trust us. So that’s the foremost thing that’s important to me. You’re a north star. Absolutely. Is there anything else, Lisa, that you want to to add before we before we close? Anything else on your mind as you think about next year, for example? Or I think I think it’s all going to be about access. It’s going to be about taking the care to the patient. All patients are not going to come to your come to the hospital. And really leveraging all the different technologies and access points like telehealth, tele ICU, and all institutions are not going to be able to do that high level of care because the key is how are you also going to have financial sustainability and continue to evolve and, transform. So I think I think it’s going to be a multifactorial way of providing health care in a different market. Lisip, thank you so much for sharing your thoughts today. I really appreciate it. It’s been fun talking to you. Much. Thank for having me. Thanks. Thank you.