Effective healthcare leadership requires decisive action, collaboration and a commitment to patient safety. In this episode, Dr. Chu discusses leading a health system through Hurricane Helene, responding to nationwide IV fluid shortages and coordinating emergency management. Then, Dr. Chu shares lessons on hospital quality improvement, strengthening clinical outcomes, and empowering healthcare teams to deliver safer care.

Tom Haederle

Welcome to Advancing Health. It's been two years since Hurricane Helene unleashed deadly flooding and catastrophic destruction across the southeastern United States, while also disrupting a critical medical supply chain that impacted the rest of the country. In today's podcast, hear how Advocate Health stepped up to meet a moment that no one saw coming.

Chris DeRienzo, M.D.

Hi again, everyone, this is Dr. Chris DeRienzo. I serve as the American Hospital Association's chief physician executive. Welcome back to the podcast, where I get to have conversations with chief physicians from across America and ask them more or less five questions. Today, I am really excited because we get to talk with someone who's just down the road from me in North Carolina, Dr. Betty Chu, who serves as the chief medical officer of Advocate Health.

Chris DeRienzo, M.D.

Dr. Chu, thank you so much for joining the podcast.

Betty Chu, M.D.

Thank you so much for having me. It's great to be here.

Chris DeRienzo, M.D.

Well, instead of starting with telling us a little bit about you or about Advocate Health, I just want to jump right in because you were about a year into your role when disaster struck in western North Carolina. I was at the AHA when Hurricane Helene rolled through the country. It led to disruptions nationwide on things like IV fluids and whatnot.

Chris DeRienzo, M.D.

Take us into that moment. One year into the role of serving all the communities that you serve. What was it like?

Betty Chu, M.D.

I think, like most executives at a company, when something that catastrophic had happen, happens in an area that's you're serving for a patient perspective, the first thing you consider is what is my role as leader? You know, what is my what does my team need? What do our, you know, 170,000 team members need in that moment? And what can I uniquely contribute in that moment?

Betty Chu, M.D.

And so, because I had experience in my last organization from a command perspective during Covid, and then in my current role, work closely with emergency management, that seemed like an opportune time to utilize skills that I had learned in my past role, but also really take into consideration that partnership with supply chain, which was very, very critical in managing the crisis. But also the partnership with operations. At that time too,

Betty Chu, M.D.

we were not very old as a company, as an enterprise, having come together. So Advocate Aurora Wake Forest Atrium is one entity. So really thinking through at an enterprise level, what does the organization need in order to be successful? And some of that is just getting that situational awareness of what's happening on the ground.

Chris DeRienzo, M.D.

You brought two things up there that anyone who is trying to operate through the disaster that was that hurricane, who wasn't based in western North Carolina, or that part of Appalachia where it was just total decimation. And we've heard lots of stories about the folks who were who were directly in it. But the second and third order effects reverberated throughout healthcare. Perhaps the biggest of which was right at that intersection of the supply chain and emergency management.

Chris DeRienzo, M.D.

And as folks know, there was an IV fluid factory that was more or less wiped out. And it produced something like 60 to 70% of the IV fluids used in certain kinds of IV fluid and certain kinds of procedures throughout the country. And so how did you lead the team through responding to that, that dual crisis?

Betty Chu, M.D.

Well, I'll say a few things. One, our leadership in North Carolina, in particular, some of our leaders, like Dr. McElwee and others who had been very actively involved historically in hurricanes, as you know, Chris, because you're from North Carolina. This is not an uncommon activity to prepare for a hurricane, to deal with the aftermath of hurricane. So, of course, on the ground, because that area where the Baxter plant is not far from our facilities, there was a lot of interest and desire in going out there to help - physically going out there to help - that plant, to help

Betty Chu, M.D.

of course the citizens that were impacted in North Carolina. And so there was a community structure for North Carolina in particular that was helping on that effort. Of course, your comment about the supply relating packs of the plant impacted every health system in the country, ours no differently. And we had a very heavy dependance on Baxter. And I think it was a more like 70-80% dependance on Baxter.

Betty Chu, M.D.

And so that IV fluid shortage was simply from an enterprise level, because that was going to impact the safety, the care delivery for all of our patients. And we had an opportunity to really work collaboratively together as a company to solve for that. And that was where an enterprise wide incident command really came into place. So we were running an operational command in North Carolina, really to help from a hurricane response perspective and to help those facilities, not only our own, but is, you know, the state initiates a pretty robust response.

Betty Chu, M.D.

And then added to that, we had an enterprise command, as you mentioned, that I led that helped really deal with the conservation efforts and all the activity that you put into play to make sure that we had enough IV fluids at all of our facilities in all of our states because of the shortage.

Chris DeRienzo, M.D.

Chris DeRienzo, M.D.

And you've referenced a couple of times now, this enterprise wide approach. Let's take a step back and just help our listeners understand when you say enterprise at Advocate, what does that look like? How many communities do you serve? How many states are you covering and what are the logistics that you're trying to manage over the enterprises footprint here?

Betty Chu, M.D.

Sure. So Advocate Health, we are in six states. We have 170,000 teammates. We're divided now - at that time you were divided into two regions - now we're divided into three divisions that are state based divisions. And the impact of that in terms of our 6 million patients that we serve. So whether it's ambulatory inpatient visits. I think to your point, that was what was the most remarkable thing about this incident

Betty Chu, M.D.

or, if we project forward to some of the things that are happening with supplied related challenges across the across the country, even in current day, is, is that it doesn't impact us in one facility. Again, like a tornado or hurricane or one in or midnight, or even an infectious disease outbreak that might often happen in one geographic area.

Betty Chu, M.D.

But these supply chain impacts, especially as we go to more dependance on single source vendors, as we go towards more standardization, it can have a pretty profound impact on our ability to deliver care. So, you know, I always think about a command center is fundamental. Its primary goal is, of course, to patient safe. And as a result of that, how quickly can we communicate an action plan and our activities in a large organization to solve problems all the way down to the user level, to the front line?

Betty Chu, M.D.

How quickly can a nurse or physician change their practices? In this circumstance, how do we go from a three liter IV bag that urology case to one liter IV bag a rocket case? How do we go from immediate IV hydration to a patient university department to oral hydration first, and do that at scale so that everybody can understand what the message is and what understand what we're supposed to do.

Betty Chu, M.D.

That's the value of an organized command structure is really our ability to come up with a design, you know, the new design, the innovation, and then funnel that down into the operational units as quickly as we can so that we can achieve the value of that change.

Chris DeRienzo, M.D.

You all responded to, to Hurricane Helene in such a terrific way, but that is not the only opportunity that you've had to leverage this kind of enterprise wide approach to solving challenges. Advocate Health was recognized as a finalist this past year in the AHA's Quest for Quality Award. That award program is really quite prestigious.

Chris DeRienzo, M.D.

It was, I think, one previous winner's congressperson referenced it as the Stanley Cup for hospitals. And you joined us there to help tell the story about that same enterprise wide approach to driving improvements in quality and safety. Take us back to the beginning of that journey when you joined Advocate, and how you begin to bring those pieces together and drive the same kind of change from the enterprise level all the way down to the pointy end of the stick in healthcare, where we're delivering care to patients.

Betty Chu, M.D.

Well, I think it starts with probably, like you and many other folks, a desire to use your skills to serve the most to none people. And when I came from Henry Ford Healthcare, amazing career, an amazing culture, I really thought the opportunity to join this newly formed entity, six states. And as you know, Chris, a lot of the conversation in healthcare is that we get bigger, but our quality doesn't improve, our safety doesn't improve.

Betty Chu, M.D.

A lot of my desire was to disprove that construct. Because if we can spread innovation improvement at scale, we should theoretically be able to improve more lives, decrease mortality. And so but we also have to measure that. So I think that's one of the challenges. And what I loved about the AHA Quest for Quality Prize and the award and the process, whether we won or we didn't win, although we were very proud to be a finalist, was that it forced us to tell those narratives and stories and then take some, you know, hard looks at ourselves on what we have or have not pulled together as an organization to create one advocate on behalf of our

Betty Chu, M.D.

patients. And what it leads to is, again, internal discipline around creating that standardization, creating one framework, creating standardized wiring and plumbing. Because in our health systems, we have a lot of solos. We have a silo of patient experience, we might have a silo that's doing work in the community. If we are all communicating with each other inside of our own organization, we can really move the needle on outcomes and health outcomes.

Betty Chu, M.D.

So that actually application too, it wasn't just about safety, it wasn't just about quality. It was really this holistic view. And I feel like we were just getting started in the journey. But it was a good, disciplined approach to thinking about how far we've come.

Chris DeRienzo, M.D.

I'll say two things, Betty. First, I was part of a health system several years ago that that also applied for that process, for the quest for Quality Prize and was also recognized as a finalist. So be really proud of that, because there are something like 5,000 hospitals and health system members of the AHA in the country. And I think this year there was one winner and three finalists, and you all knocked it out of the park.

Chris DeRienzo, M.D.

And I would expect nothing less than you to say, but of course, we're still at the beginning of their journey. Because every great leader I know who drives improvement and who drives change is never satisfied with where they are. Yes, we celebrate success and we absolutely need to do that. But one of my favorite quotes comes from Sister Catherine McAuley, who founded the Sisters of Mercy movement in Ireland like 200 years ago.

Chris DeRienzo, M.D.

And when asked how she did it, her answer was the simplest and most practical lesson I know is to resolve to be good today and better tomorrow. And you are leading the way at Advocate to better tomorrow. Share some of the outcomes, the stuff that that knocked our socks off in the application that you've led. There are many of them.

Chris DeRienzo, M.D.

But just sepsis, hypertension, diabetes or a few that come to mind for me.

Betty Chu, M.D.

You know, since we've come together as an organization we've had a 14% reduction in mortality. We had started with five Leapfrogging hospitals. We have 27, and that's just in three years. So what I'm proud about with that is we have our internal measures, mortality compared to ourselves. And we have our external measures that are benchmarked, of course, to other organizations or CMS

Betty Chu, M.D.

number of stars. Four or five stars hospitals is going up. If we look at our U.S. News and World Report recognitions, we're increasing that number as well to not only again, internally, but externally. We're seeing that improvement. We've had a reduction in hospital infections. We've had a significant improvement in sepsis mortality through sepsis compliance. It's not, you know, it's not magic right?

Betty Chu, M.D.

It's that higher liability principle of design implementation and sustainability. You don't need to redesign the sepsis, we just need to do it every single time. And that's really, really, really hard. Huge kudos to our people. And alongside of that we've had some great team engagement. We continue to have tremendous team engagement, which to me is the secret sauce,

Betty Chu, M.D.

right? Behind any improvement activity is how do our teammates feel? Do they feel heard? Can they contribute? Do they have capacity for improvement? So I'm really thrilled to be partner with my nursing executives and the chief physician executive, who are working on a lot of those things to help free up that capacity for our clinicians.

Chris DeRienzo, M.D.

And there's pretty strong data that that when those measures rise around our team member engagement, that our patients feel it, too. And so kudos to you. And again, I just want to thank you so much for being willing to share your experiences leading your career and especially at Advocate. Congratulations on all of the outcomes that you've reached to date.

Chris DeRienzo, M.D.

I know they will be not the last time that we are hearing celebrations about the great work happening at Advocate under your leadership, but to listeners who are tuning in, and we have folks every week who tune in to the podcast from every conceivable kind of role in healthcare: small, independent, critical access hospitals in rural parts of America, frontier parts of America, folks in big academics, early career folks who maybe are clinicians who want to work in leadership but aren't exactly sure where to start.

Chris DeRienzo, M.D.

So the question I'd like to end with is, given all that you know and all the experience you have had as the chief medical officer for one of America's largest health systems, for those listening today who are perhaps closer to the beginning of their journey, what one piece of advice would you give them? Looking through the aperture that you see now that that is the best chance they have to get started on the right foot?

Betty Chu, M.D.

What I have learned is that there is a lot of pain in the world, and all of our responsibility is to understand other people's pain and try to work to solve for it. And that requires active listening, that requires deeply listening to other people and reacting and responding to what it is that they need. I think that's, you know, you've heard it called the servant leader or selfless leader.

Betty Chu, M.D.

I will say it's as simple as that. It's as simple as deeply listening to others and not listening to respond, listening to really understand what it is that people need. And as you figure that out and if you can solve for that, you will be successful, because that need is constantly changing. But it is something that I believe has served me well.

Betty Chu, M.D.

I've really tried to understand what is needed in society, what is needed from our patients, what is needed from our communities, what is needed from our nurses and our doctors. And I've tried to respond.

Chris DeRienzo, M.D.

I've spoken to a lot of people on this podcast, Dr. Chew, and that I think is one of the most profound answers I've ever gotten to that question. What you spoke to really cuts deep to who we are as people. And, you know, as folks, I think I would describe us as kindred spirits in the world of quality and safety, focusing on data.

Chris DeRienzo, M.D.

Yes, we have to focus on data. But man, you know, we can only move numbers so far if folks aren't feeling part of that process. So I just congratulate you so much. Thank you so much for spending time with us today. You're an amazing guest. And thank you listeners for joining in. Once again, this is Dr. Chris DeRienzo.

Chris DeRienzo, M.D.

We'll see you next time.

Tom Haederle

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