Taking Healthcare by Storm: Industry Insights with Dr. Carrie Sue Shaver

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Carrie Sue Shaver, DHA, IHC, FACHE, Assistant Professor of Health Management and Leadership at Texas Tech University Health Sciences Center.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-091324-GK

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.

In each episode, Quality Insights Medical director, Dr.

Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West virginia, Pennsylvania, and the nation.

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Hello, everyone, and welcome to Taking Healthcare by Storm.

I am Dr.

Jean Storm.

Thanking you so much for joining us today.

We are joined by Dr.

Carrie Sue Shaver.

And I am really excited about this conversation, as we're going to be talking about public health in a different way than I am used to, and maybe in a different way than you are used to.

Dr.

Shaver is an assistant professor with the Department of Public Health Sciences at New Mexico State University.

So she has a really unique perspective and some interests that we're going to be talking about that are kind of regional, but maybe some that are not so much regional in the New Mexico area.

And I really feel like we can really learn from each other if we share best practices and tips and tricks across regions.

There's certain challenges that may be unique to a region, but certain challenges like COVID and opioid use disorder are not unique to a certain region.

So I think we can really learn a lot before looking at what regions are doing to solve certain problems.

So Carrie, thank you so much for joining us today.

It's my absolute pleasure.

Thank you, Jean.

Great.

So I'm excited to dive in and get this conversation started.

So tell us how you came to do what you do.

So it was a long, varied journey as I'm sure most people can relate with in the healthcare industry.

I started in the social service sector, administering health and wellness programs for at-risk populations.

And this is when I became acutely aware of the need for system syncing and application of evidence-based practice, although we weren't quite using that language in the 90s and early aughts.

I worked primarily with folks at risk of contracting HIV-AIDS, and then also worked with patients who had HIV-AIDS in terms of wellness and treatment.

From there, I worked in some social service programs around general health and wellness for girls and adolescents and young women around health and wellness.

Yeah, sorry, but just a pause.

And then, so that's my background in health care administration.

I then moved into administrative faculty roles with a number of universities, where I worked to align rural and frontier health care workforce needs with higher education offerings.

And I did that for around 13 years.

Wow, I mean, such a great wealth of experience.

So you talked about that you've managed networks of social service employees.

And I think I maybe I just want to get your feedback on recruitment and retention.

I know that's something that we're all focused on in the health care industry.

So any secrets that you have for recruitment and retention?

Yeah, first of all, it is extraordinarily hard work and requires a lot of dedication and resources.

And I know that the dedication is there, but resources may not be.

Again, my focus is in rural and frontier areas.

So you have a limited number of folks at high risk of burnout, engaged in a wide variety of tasks.

And it requires a lot of time and effort.

But you really need to first and foremost have very close relationships with the institutions of higher education that are providing the training for the health care professionals that are in roles that are critical and hard to fill for your organization.

And the other piece I would say from that is that hospitals, critical access hospitals, hospitals in urban areas, other health care organizations absolutely have to be involved in the education of health care professionals and engaged in recruitment from, I would say, middle school forward, bringing in students who have capacity and interest in the health care professions and then supporting them as they move forward in their education.

I love that, engaging students in middle school forward.

I mean, that's fantastic.

And I think they would be very interested.

I mean, I think I would prefer to get some involvement in any health care environment versus spending an entire day in the classroom.

For sure, for sure.

That experiential learning is so important, especially in this field.

The other thing I would add that we were very successful with in Southern Indiana in pre-licensure nursing education in particular was prioritizing applications.

And again, this is rural, prioritizing applications from students within the counties that we were working in with those critical access hospitals.

And we also did something called a clinical homes model, where we place those students in a particular county.

And the critical access hospital was the primary location for clinical training.

But it also included the rest of the community.

So in those three years of baccalaureate pre-licensure nursing education, they spent those in that county.

And by the end of that experience, both the student and the potential employer, the clinical placement, knew whether or not this would be a good fit.

We had a 95 percent placement rate of these students in those rural critical access hospitals after licensure and graduation.

So it really, you have to back way up into the education process, and everyone has to be involved.

I love that.

And what a fantastic model.

I mean, just that is fantastic.

So let's talk a little bit about public health.

What are your interests in public health?

Sure.

So I'm really interested in moving evidence-based practice around crises in our healthcare system, taking the evidence-based information and translating that for administrators for application in their organizational setting.

So I've done work, as you mentioned, with opioid use disorder and around COVID-19.

And what that involves is a team of interdisciplinary academics who look at the problem, look at the literature that's available holistically from a systems perspective, and then create a tool that then administrators can use to assess their performance within various domains around whatever crisis we're looking at.

So for opioid use disorder, for example, the tool that I created and can help folks use, you know, you're going to look at medical and behavioral health care treatment access.

And there are domains within there.

It involves pulling together a high-level team to do that assessment.

But it will give you the places where you need to engage your system in creating improvements and then also engage with perhaps your community who may or may not be ready for risk reduction strategies in trying to improve outcomes for opioid use disorder in your particular region.

I love that, that it kind of crosses, you're looking at organizations and then you're also cross-cutting into the community.

I think that's essential.

We're very siloed, I think, in just healthcare in general.

Yeah, that approach is what is needed, definitely.

So tell us a little bit about your work in disease prevention, treatment, health and wellness programs, especially for target populations, including those at high risk for contracting HIV AIDS.

Sure.

So the environment that we were in in the late 90s, early aughts was a lot different than today.

As your listeners know, we are exceptionally fortunate to be in a time when medications are available for folks that keep the disease treated and undetectable and unable to pass between folks, right?

It's an extraordinary time for HIV AIDS.

When I was doing that work, it really, we had much more limited treatment options, and the focus was on very heavily on prevention.

And I would say that that prevention model from HIV is something that can be applied in a lot of different communicable diseases, infectious diseases that we're seeing.

Prevention, for example, is one of the domains in the opioid use disorder tool.

It's really important that as administrators, we look at how we're performing in a particular area of concern.

So, you know, when you do that community health needs assessment, if you're a non-profit organization, and you see or you understand the trends that are happening in your area of responsibility, in your region, knowing how to back up and involve outside entities in that prevention piece, your Department of Health, you know, primary care providers, the EDs who may be seeing symptoms in your spaces, coming into that prevention space, and then looking to the evidence to see what is it that works best.

As we are all individually familiar with, health education is not the only thing that we should do to try to have healthy behaviors, right?

So many of us, for example, I'll use myself as an example, have issues with healthy eating and exercising.

And even though I have extensive higher education, changing poor health behaviors is really very difficult.

So I think lessons from the prevention and HIV AIDS around effective communication and now the effective medications for prevention of transmission, I think taking those lessons and moving them into whatever your primary areas of concern are for your population, for your community is really important.

Yeah, I love that lesson that we think about changing behaviors.

I think we only kind of focus on the lever of education.

Let's just educate individuals and ourselves into better behaviors, but that's only one part, right?

Absolutely, and I would refer, and we're talking about public health, of course, I would refer your folks to those social drivers of health.

So there are many, many issues that require our immediate attention that don't feel like healthcare provision initially.

So adverse childhood experiences, for example, are heavily correlated with opioid use, right?

Yes.

So there's a fantastic hospital system in southern Indiana, that Critical Access Hospital, that pulled together an advisory board to look at adverse childhood experiences in their community.

And they were experiencing very unusual and significant rates of suicide, of opioid use disorder and other substance use disorders, and pulling together a team to address that prevention issue from the very beginning, along with the school system, the criminal justice system, the Department of Health, everyone in that community who interacted with children to reduce those exposures to adverse childhood experiences.

So adverse childhood experiences like poverty or low educational attainment don't feel like healthcare provision, especially for administrators who are inevitably very busy with other immediate acute issues.

Right?

Yeah, putting out fires.

That's right.

So it really requires, again, systems thinking and the ability to back up from the immediate demands of the day and set aside and prioritize time and resources to these issues that are upstream and upstream by a whole lot.

So if we're going to talk about opioid use disorder, I want you to think about those mothers who are physiologically dependent on opioids, who then have a neonate who is physiologically dependent.

That if we're talking about prevention, that's at the very beginning.

And then when you know that this mother is more likely to have had adverse childhood experiences, that is more likely to have multiple poor social drivers of health, and you now have a newborn who's in the same situation, and they're in your space, they're in your labor and delivery unit.

It takes a very comprehensive team approach and a commitment to looking outside of the immediate care needs for both patients.

Yeah, I agree, a very holistic approach.

So you were selected as the National Rural Health Association Fellowship in 2023.

So tell us about the fellowship.

Sure.

So the National Rural Health Association is an extraordinary organization that advocates for rural and frontier health care organizations and providers.

So if you're in the space, I think it's probably unlikely that you don't know of these folks.

But I just want to take a moment to encourage your listeners to if you are in rural and frontier health, you have a passion for health care provision in these spaces.

Please, please join the National Rural Health Association and your state organization.

It was an extraordinary experience where they brought a cohort of us together and we were able to network.

We were also tasked with research and developing policies around issues that heavily impacted rural and frontier health.

So I was on a team, for example, that wrote the NRHA's policy for Medicare Advantage, which is a completely different topic, but also very important to funding for critical access hospitals.

And of course, you know, funding is the number one issue for a lot of administrators, especially those using CMS.

So we were able to do that.

We went to, they have a Hill Day, where we went and met with our federal representatives from Congress and the Senate or met with their staff and advocated for particular issues, especially those in the Farm Bill that relate to health.

So it was an extraordinary experience.

And I would really encourage those who are looking at developing their leadership in the space to apply for the fellowship.

And that application is open now.

It's a year commitment.

It wasn't too heavy of a lift.

And the time that I spent was heavily rewarded.

So they, you know, asked me and another colleague to set up a state affiliate in New Mexico, which did not have one.

So I was very pleased to be part of that work.

And we've been we've been in in existence now for a little over a year.

So very important work and a really impactful way to continue to develop your leadership and network with others.

Yeah, it's a great opportunity.

So I know you have interest in the One Health Systems Framework.

So tell us a little bit about that.

So this will be if you haven't heard of One Health already, this is another opportunity to stretch outside of our discipline.

So One Health is the idea that the health of humans, the health of animals and the health of the environment are inextricably linked.

So if you want more information, the CDC has an excellent framework that that you can look at.

But it involves bringing experts and practitioners from those very disciplines together in one space to look at a particular issue.

So let me give you an example.

A lot of my research is done on the US-Mexico borderland, specifically in New Mexico and in Texas.

And as you are aware, there have been significant wildfires in the Southwest.

So if you were to use a One Health systems thinking framework to pull together a team to look at what should be done about wildfire and its health impacts, you would want to first find folks who are from varied disciplines and bring them in together in one space to talk about their perspectives.

So you would bring in the environmental scientists, for example, who is going to have that information that I as a health care administrator and professional would not have, right?

So how do these start?

What conditions are there?

How does human interaction play into wildfires from the animal science piece?

How do wild animals, how do domesticated animals, how do our livestock impact wildfires and the spread of wildfires in the Southwest?

And then from human health, you're going to look at those increases in poor health outcomes.

So initially, mortality and health impact like respiratory and cardiovascular disease from the wildfire, but also longer term issues.

Including mental health issues.

So it really is about bringing folks together who have these varied viewpoints and then allowing all of us the space to work together to apply what each of us knows to, you know, address emerging crises in the best way that we can.

I mean, it makes sense.

It's not really how we do things.

I think, but it makes sense.

We're all here together, right?

That's definitely right.

So, you know, in rural spaces, right?

This is, you know, if you look at soil quality, water quality, initially, it doesn't feel like health care, especially health care administrators, right?

Have any connection to this at all.

But if you move into the fiscal sense that prevention makes, right?

In a limited, low resource environment, then it starts to make sense fiscally and for those public health outcomes we're all looking for.

Yeah.

So you talked a little bit about opioid use disorder.

So tell us how you became interested in OUD and tell us a little bit about your research in opioid use disorder.

Sure.

So I am very passionate about health equity and social justice.

For me, it became an issue I was really interested in.

I was working in southern Indiana and Scott County, and it's rate of HIV and Hep C infections brought the attention of the CDC.

It was an epidemic in one small rural county in Indiana.

And it was because of opioid use disorder and the sharing of needles for injecting opioids.

And it was a very difficult environment to engage in prevention.

And what I will say from this experience in Indiana, Indiana as a state is now at the forefront of evidence-based practice when it comes to prevention and treatment of opioid use disorders, especially in rural spaces.

And it's because the governor and the legislature realized that not only did this impact individual people, it impacted entire communities, including the business community.

So our primary industries, including advanced manufacturing, agriculture, and construction, were unable to meet the demands of consumers in the state of Indiana because of workforce shortages due in some part to opioid use disorder and other substance use disorders.

So the legislature and the governor took a very proactive, well, it was reactive in that it took Scott County and the issue there.

But in the time since, the state has really aligned itself with evidence-based practice.

So that's how I became interested, was because of that health equity and social justice piece.

And then at the onset of the creation of the opioid crisis, the involvement of clinicians and the pharmaceutical company in creating this problem.

Now, that has been addressed in many ways, but now it is different in its presentation due to fentanyl and the inclusion of other drugs in the illicit opioid mix.

We have far, far fewer problems with inappropriate prescribing, which of course clinicians were advised, ill-advised by the pharmaceutical industry.

Yeah, it was multifactorial, most definitely.

Absolutely.

So I would never put this at the feet of clinicians.

Clinicians absolutely do the best job they can with the information that they have and have done an exceptional job in responding to this crisis with the resources that they have.

And our understanding of the issue has certainly grown since that time.

So my primary interest in this work is just making sure that the information that we have in academia translates to those who are practicing in the field, specifically from an administrative standpoint.

You know, I have time, I'm paid to read and write and teach.

I and I have the interests, so I really view it as my responsibility to bring forward to those who are interested the information that they need to function at the highest levels that they can in their organizations.

And that's how it should work, right?

Yeah, absolutely.

I am lucky to do this job that I love so very much.

And if folks are interested in learning more, please reach out.

I am very willing to help them listen and share what I know.

Great.

So we talked a little bit about COVID-19, and maybe that's something that everybody is kind of tired of.

But I think there's definitely unique perspectives about the pandemic, things that we can learn.

So you have many publications around COVID-19 and its impact on many different populations, which I find very interesting.

So any consistent trends that you've discovered in your work?

Right.

So I would just take this back again, which to the overall theme of what we've been talking about, which is we absolutely need to be in the same spaces as each other, public health, health care administration, folks of epidemiology, environmentalists, all of us need to be in the same spaces sharing data.

A huge issue was around silos in the data that was available and having access to that and being able to, I think the second largest issue was communicate findings clearly in a way that the public understood.

And so what we found from COVID-19 was that public health officials and others that work in that space, including myself, were not as publicly present and available in communities that would create trust and understanding in communities.

So that was a huge issue in COVID-19 and communicating information, especially as that information changed over time.

When we go back to talk about the data, we also need to know what is culturally appropriate for different folks, right?

So the issues, for example, around bodily autonomy, I think were very important and not prioritized in a way that they should have been from the public health side.

We absolutely need to take community values and individual values into consideration when we're developing large scale implementation of things like vaccines or other measures for prevention.

Those have to be culturally appropriate for the community.

And we need to have established trusting relationships in those communities prior to the emergency so that those relationships are there in order to communicate effectively.

And I will say that our clinicians did that well.

Clinicians have those relationships in the community.

Clinicians by far were much more effective with communicating with patients directly one-on-one or administrators with their staff around these issues because those relationships were developed prior to the pandemic.

I will say two things.

You said that I completely, I mean, it kind of stuck out of my mind.

Things that we need to prioritize trust and understanding.

Yes.

Big lessons from the pandemic.

Absolutely.

I think too, respect.

When folks come to us and they have concerns, they shouldn't be dismissed.

We need to prioritize regions, communities, concerns and if you don't have that understanding and that trustful relationship beforehand, which is certainly where clinicians outperform public health in every way during this pandemic, you just cannot communicate effectively.

Yeah.

Great.

Go ahead.

I was just thinking one more thing about data.

So what we learned about Americans is by and large, we need to invest in passive data collection.

And that has really happened, right?

So folks do not want you, it is an American value to be left alone, I think, from mental interference.

So that's a value that I would say lots and lots of Americans hold, the individualism and the high need for privacy.

So you'll see now that when we're talking about rates of COVID increasing, and then right now we're at rates as high as this time of year in 2022, right this moment.

But we only know that from wastewater collection data.

We're not going and, for example, the university I was with at the time, we had weekly random screens.

And if you didn't do it, you wouldn't be employed and or you wouldn't be a student.

So we have moved away from that very intrusive data collection into what I think is much more appropriate for the American values that are broadly shared.

And that's with the wastewater data collection or passive collection of data from things like other regular screenings like blood tests or urine analysis or any number of other ways that we're collecting data around COVID-19 that isn't intrusive on the individual.

Yeah, I would agree.

100% needs to be less intrusive.

I think people are tired of sticking swabs up their noses.

Yes, sure, for sure.

So you teach.

So do you feel like it is difficult to get students to be excited about public health issues?

I don't actually.

I find and I know that there's a lot of chatter in popular culture and among professionals that aren't young, right?

I would include myself in that definition, not young.

I'm very heartened by the level of engagement and interest in these students who want to become future health care administrators.

So I teach in the Baccalaureate program and in the Master's program, and I have students who are clinicians and students who are not in the same space together, talking about their professional experiences.

And I'm very, very heartened by their level of critical thinking, of their understanding of the importance of public health, and then working through the issues around application of public health and systems thinking, you know, concepts into the practical application in their day-to-day professional lives.

I am very hopeful about the folks who are coming behind us and who will be leading our grandchildren and great-grandchildren.

That's exciting.

I'm really happy they have that.

I am, I love these folks.

These students want to make a difference.

They want to improve our health care system.

They want to improve population health and individual patient health.

And they're coming into administration because they know how important leadership is in attaining these goals that we have for our, you know, for our small little critical access hospital, the state or the entire nation or internationally.

So they have a keen understanding of the importance of their role as a leader and manager.

That's great.

So what big challenges in public health do you see coming in the near or far future?

So we're going to, so prevention, I think we've talked a lot about today.

We absolutely don't have the resources to continue to simply react to chronic health conditions.

We can't afford it.

We absolutely have to look at our funding mechanisms for healthcare in the US and back up our health care provision and focus in the space of prevention so that we can reduce cost.

I love that.

It's simple, easy, and it would be highly effective.

It would.

And if we look to, so I do some international health research as well, again, rural and frontier, primarily Latin American and Caribbean countries.

So, you know, if we look to other countries that are performing better than we are in the preventative health care space, especially those who are low resource, who have fewer resources than we do, we can take lessons that they've learned, especially in low resource countries, because we do, we are wealthy and we do have funds.

It's just how are we allocating those funds and how are we reimbursing those who are providing care?

Yeah, that just makes sense.

So last question, I try to ask almost everyone, if you were in charge of health care in the United States, what is the first thing you would do?

The first thing I would do is I would work on getting everyone access to health care.

If we think to prevention, and we have lots and lots of folks who wait to access until it's an acute situation, we could have a much higher functioning health care system if we were engaged in prevention.

Yeah, that's what I would do.

Again, it makes sense.

Well, I think where we get into a difficulty, of course, is when we get into the specifics.

So you're not going to find anyone who says, I don't think everybody deserves access to health care.

Where the issues are and where the disagreement is, is in how do we provide access?

And I think that if we move into innovative models around funding for prevention and reimbursement models around prevention, I think that we could realize cost savings that are really important.

And I would say also that providers and organizations should be adequately reimbursed for the work that they do.

And I think with CMS right now in particular, those reimbursements aren't adequate, especially for rural and frontier spaces for the provision of healthcare.

It's just not adequate.

So that absolutely has to be fixed.

Yeah, absolutely.

This was a fantastic conversation.

Dr.

Shaver, thank you so much for joining us today.

I am pleased to have been here and would encourage folks who are interested to reach out.

Great.

So where can they reach you?

Should they reach you via email?

Email is best.

It's my first name and last name, Carrie.Shaver at ttuhsc.edu.

That's Texas Tech University Health Sciences Center.

Great.

So we will link that in the podcast.

Again, thank you so much for joining us.

Thank you, Jean.

Thank you for tuning in to Taking Healthcare by Storm, Industry Insights with Quality Insights Medical director, Dr.

Jean Storm.

We hope that you enjoyed this episode.

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If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website.

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So until next time, stay curious, stay compassionate, and keep taking healthcare by storm.