Season One: Rhonda Anderson: Connected Careers Transcript

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Robert Groves, MD:

Welcome, I’m Dr. Robert Groves you host for the Groves Connection Podcasts.

The Groves Connection brings you intimate conversations with pundits, providers, patients, leaders and lay people. All to help us understand the contradictions. How can our health care system be both magnificent and yet, so deeply flawed. We’re going inside healthcare to talk candidly with those who know. What they have to say may delight, surprise, frustrate or at times even anger you. But, I invite you to get curious and listen to the truth about health care and those who want to fix it. Maybe the answers have been there all along. We just need to make the connection.

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Robert Groves, MD:

My next guest is another storied healthcare leader. Her name is Rhonda Anderson and she would have you know that the one career high light of which she is most proud is that she is a nurse. Now there isn’t time to cover all she has done in this brief introduction because this nurse seems almost superhuman. She is a healthcare consultant for RNA Consulting of Arizona a surveyor for Global Healthcare Accreditation, president, no less, of the American Nurses Credentialing Center and that's in retirement. Her storied career includes seven years as the chief executive officer of Harden Children’s Medical Center now Banner Children’s Center, until her retirement from Banner in 2016. She has served as the joint commissioner as a trustee of the American Hospital Association Board as well as the joint commission internationally and as the Association of Nurse Executive president. Are you getting the idea that many in healthcare trust Rhonda’s leadership and her wisdom? She also has too many awards to count including the distinguished achievement award from Arizona State University College of Nursing. She was named the 2012 hospital executive of the year by Arizona Business Magazine and was also named one of the 50 most influential women in Arizona business and the list goes on. Now weaving through all of her accolades, awards and leadership positions you will find three clear things: a strong commitment to the nursing profession, a commitment to the care and education of our children, and a passion for innovation and the transformation of our fragmented system to one of which we can all be proud. I am honored to sit down with Rhonda for a candid conversation that ranges from delivering babies on the south side of Chicago to being the sole practitioner at night on a busy orthopedics unit. Truly Rhonda has blazed a trail, a trail for leaders in healthcare for nursing and for caring enough to show up. I am so proud to present this episode of the Groves Connection Connected Careers with Rhonda Anderson. Ready?   

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Robert Groves, MD:

Welcome, Rhonda Anderson. It’s good to have you on the Groves Connection. Thanks for coming by. 

Rhonda Anderson:

Thank you for inviting me.

Robert Groves, MD:

Yes, absolutely and it’s been a long time. We worked together indirectly for years, but it’s been awhile since we’ve been face to face and it’s nice that things are settling down enough so we can do that now. 

Rhonda Anderson:

That’s for sure. It’s been fun to be able to do things virtually and learn new things but boy, it’s much nicer in person.

Robert Groves, MD:

Yes it is. Rhonda, I’m fascinated by you career journey and how it is that you came to be where you are. When did you decide, growing up, that nursing was the thing that you wanted to do?  

Rhonda Anderson:

When I was in actually grade school and high school. My grandmother was the superintendent of a TB sanitarium.

Robert Groves, MD:

Wow!

Rhonda Anderson:

And so as a young girl I went down there. Worked in the kitchen obviously not out with patients but it was fascinating for me and that began my journey. And then became a candy striper and did all of those types of things that most people do if they are interested in a health career.

 Robert Groves, MD:

Where did you grow up?

Rhonda Anderson:

In Illinois. I actually was born in Idaho but my dad was killed in World War 2 when I was just a couple months old, so mother went back to Illinois because she came from a large family with a mother who was one of nineteen children so we had a lot of love surrounding us and helping as mom was trying to take care of me. So I grew up there and really learned about how to take care of each other because everybody in that family took care of each other. Big farming family and just you knew that it was your responsibility to help each other.

 Robert Groves, MD:

I’m almost getting nostalgic for that style of life. It is not as much present as it used to be. But I guess the next thing that I’m going to want to hear about is what about the formative years? Let’s say you are graduating from high school and how did you think about higher education? Was that a big deal in your family?

Rhonda Anderson:

 No, it was not. I was the oldest. My mother remarried and I was the oldest of the group.

Robert Groves, MD:

I bet that means you had lots of responsibilities for the younger ones.

Rhonda Anderson:

Especially the two youngest ones because I was seventeen when the first of the two youngest was born and then they had another one right after, so yes. The responsibility was what really taught me what I wanted to do. I did all kinds of things in high school from the science clubs to working as a candy striper. My dad, stepdad owned a lot of businesses, working in the businesses and working with my grandmother.  But I think one of the most formative things is when my grandmother was 88 she called me and asked me to come over. I thought something was wrong. And she shared with me, she pulls out a piece of paper, she had received her GED at 88. It was a goal because in the large family the women had to work the farm and cook and do all of those kinds of things. They were never able to complete anything and she was determined that she was going to do that. And even without that education, she was the superintendent of that TB sanitarium and then like a CEO, she was called the senior administrator of a long term care facility talking about all those old people when she was 90. We just know responsibility.

Robert Groves, MD:

That is so impressive. In her 80’s. Well I’ll be darn, so there is a lot of motivation. By the way, I have to say that you have one speed and that is full speed ahead. It sounds like it started at a very young age.

 Rhonda Anderson:

It did.

Robert Groves, MD:

You’re involved in so many things now that it’s hard to keep track of and some key and important rolls and obviously key and important rolls at Banner Health over the years but where did you go to college?

Rhonda Anderson:

So I was a student in a diploma program at Evanston Hospital and then we received some additional education at Northwestern. Roosevelt University, was where I was, which is in Chicago, I received my master’s in public administration.

Robert Groves, MD:

And did you always know that you wanted to be an administrator when you started this journey, to be an executive in a large healthcare company is that something that you aspired to?

Rhonda Anderson:

Not really. I had a mentor when I was working at Evanston Hospital who made me the associate chairman of the department of nursing and she kept saying you need to do this, you need to do this. I loved what I was doing so I did keep a practice also of oncology patients of my own and in that had a lot of fun because we created primary nursing which was not in any

Robert Groves, MD:

A new concept.

Rhonda Anderson:

It was a very new concept and we, with Beth Israel, developed the model with Marie Manthey

And that was my primary responsibility as the associate chairman and then clinical ladders which again were new at that time for nursing professionals, so just a lot of opportunities for those and taught. I taught at the same time.

Robert Groves, MD:

Very nice. Now what was your first job, what was your first independent nursing job?

Rhonda Anderson:

Delivering babies in the projects of south Chicago with the Chicago Maternity Center. 

Robert Groves, MD:

Wow. Baptism by fire.

Rhonda Anderson:

I loved it. It was great. Gangs would come and surround us, because anytime of the day or night you were going out, they’d protect us because we were helping. What we did was after delivery boiled water let it cool off dripped it in the mouths of the babies to make sure they could swallow, stayed for three hours and then left or sent the babies someplace. Like we delivered triplets on a kitchen table one time so.  

Robert Groves, MD:

Oh my goodness. You work with what you have.

Rhonda Anderson:

You do. You do. You figure it out.

Robert Groves, MD:

When was this? What year were you

Rhonda Anderson:

Back in 65.

Robert Groves, MD:

Wow. Okay yah, yah that’s a very different medical world then the one we live in today.

Rhonda Anderson:

Oh very much so, absolutely.

Robert Groves, MD:

And we’ll talk about those differences and your insights on that but take us though now your journey from delivering babies on the south side of Chicago to CEO of Cardon Children’s Hospital. That’s quite a journey but I’m interested in how you think about that career. Now how did it unfold? And do you have any advice for aspiring leaders?

Rhonda Anderson:

Well it was interesting because Jean Warner was my mentor that mentor I talked about. And I knew I could do that work, but I was also under her shadow and so a position came available at Samaritan out here and I thought hum are my wings going to grow by themselves or do I still need Jean to carry me and so I applied for it and received the position which was a senior administrator, so it was a combination of the nursing responsibilities of the nursing department as well as some other departments and programs. And then after I left that roll I went to Connecticut.

Robert Groves, MD:

Oh, okay.

Rhonda Anderson:

And I was in Connecticut with Hartford Healthcare Corporation as the executive vice president of Hartford Healthcare and did a lot of different things purchased properties, purchased the institute of Living which was the first psychiatric facility out on the east coast and we it was adjacent to our properties so did that. Also helped design and build a children’s hospital on the campus and consolidated children’s programs from the university etcetera. Taught at the university at the same time and just really enjoyed the east coast. My husband however didn’t move.

Robert Groves, MD:

He’s not an east coast guy?

Rhonda Anderson:

Well he’s a teacher and so he would come in the summers or on vacation time and things like that so he’d commute.

Robert Groves, MD:

Was that hard?

Rhonda Anderson:

It was somewhat hard. Our daughter we thought she was going to UCLA and she went to U Mass instead and so she was close by.

Robert Groves, MD:

I’m struck by something else you know when I asked what was your first job and what was the next one you very rapidly were promoted to positions of responsibilities. I mean that’s a rocket ship.  

Rhonda Anderson:

Well there was a little bit of a difference in between. Okay. I didn’t tell you about one and that was down in Decatur, Illinois. My husband was teaching down there and so after we got married I went down there obviously and worked with Decatur Memorial and I, this was a fascinating job. I was the only RN at night on a 72 bed orthopedic unit with a couple helping hands and aids and nobody was in the emergency department at night so they would ring the doorbell and I would run down the stairs and deal with emergency patients and then come back up and take care of the 72.

Robert Groves, MD:

Yah after all that fire, once again, you are on your own to figure it out.   

Rhonda Anderson:

But had great staff that I was working with and a wonderful leader on that unit so it was really nice and in that roll I also worked during the day for them teaching LPNs at the hospital. 

Robert Groves, MD:

Wow, you know something else strikes me as you’re helping us unfold this story and that is we talk a lot today about innovation and doing new things that are more effective, more efficient, more cost effective, more quality. It sounds like you have been doing that you whole career too, although you may not have called it innovation at the time. I’ve heard you mentioned several programs that you either conceived of and initiated or initiated and has that been part of you DNA are you always?

Rhonda Anderson:

Yah. Absolutely. While I was there in Decatur they didn’t have a cardiac care unit and so they asked if I would be willing to go to Chicago and work at Weiss Memorial with a Doctor Fessinger and them come back and establish a cardiac care unit in Decatur which I did. And so yes and I love nursing because you can do all those different ortho, you know cardiac, kids whatever it’s just great. And orthopedic especially was wonderful because most of those ortho patients had some other disease process and chronic illness and so you didn’t just have that surgical procedure you had a variety of options to really learn from and work with and teach so I loved ortho.      

Robert Groves, MD:

I have to ask you now do you ever say no to an opportunity?

Rhonda Anderson:

No it’s funny you say that because when I left Banner quote for retirement I called it preferment I said you can say yes or no but my husband says I don’t say no.

Robert Groves, MD:

Yah I get that sense that if you see something that has potential you can’t help yourself you’re going to be

Rhonda Anderson:

That’s true.

Robert Groves, MD:

Talk to us about your career at Banner. How did you wind up at Banner and what did that look like?

Rhonda Anderson:

So I was with Samaritan and then I left but I knew a lot of the people and Bruce Pierson was one of those. He was an intern at that time and John Harrison. Bruce called and asked if I would be interested in coming back and working with him at Desert. He needed a CNO but he also wanted to do something with pediatrics he had one floor that was peds. 

Robert Groves, MD:

Now give us an idea of what year this is.

Rhonda Anderson:

2000. So started working with Bruce out at Desert. We then really worked through what did we really need to do for pediatrics? And then there were a lot of changes at Banner, the top level, not Peter, but others. And each time someone would tap me out and say well maybe we should have a pediatric service line or maybe we should do this. 

Robert Groves, MD:

And you said yes.

Rhonda Anderson:

I did and then it would change because the leadership up there would change. And so we navigated all of that but we never lost sight of the need and I still say if you are going to manage patients through a managed care division why would you give your pediatrics away when you birth so many babies in the system? That makes no sense to me and that was really the reason I wanted to take that position. It never really came to fruition the way I thought it might. Not the position, but the Idea, well the idea that in our managed care division it isn’t just about adults or newborns. You had the whole lifecycle. Why not own it.

Robert Groves, MD:

Yah. And you still don’t see that happening the way you’d like to.

Rhonda Anderson:

No, no way and it’s sad because it really could and should and as I vision what’s happening in health care and in managed care and in pay for performance why wouldn’t you? And really be purposeful about it. Why would you pay some other place to take those kids? You know, it just doesn’t make any sense to me. 

Robert Groves, MD:

And there is so much opportunity to influence behavior at a young age.

Rhonda Anderson:

Absolutely, with the chronic illnesses, with everything you have such an opportunity and even the brain development kids. You know we started the music therapy for brain development and so important but then just think about that because then in memory care unit at the age of whatever, 90 music for that brain to sooth and peaceful etcetera, it’s just there’s so many opportunities. I think what I see most organizations are looking at things in pieces not in the continuum of life and that’s so sad.    

Robert Groves, MD:

Yes. That’s sort of the characteristic of our entire health care system, it’s fragmented.

Rhonda Anderson:

Exactly.

Robert Groves, MD:

Bolt on this or that and no interoperability. That is the nature of our health care system. I think of that kind of like a [clughe?] it is a mess that we built piece by piece and never really connected all the dots. 

Rhonda Anderson:

I always use the example of a jigsaw puzzle. You know what it looks like on the front of the box but the pieces are all scattered all over. At least put the corners in place you know.

Robert Groves, MD:

That’s kind of a scary concept but it rings true, it really does. So, I’ve discovered, or at least I think I hear two passions and probably a third and one is nursing, clearly, a second is kids and taking care of kids and then the third is more of an orientation responsibility.

Rhonda Anderson:

I would say making a difference, trying to make a difference in public policy and those types of things. I was on the joint commission for nine years and the AHH board also and all of those and AONL all of those boards on which I was sitting but also some of them I still do, the research that we are trying to do is that space that you and I were just talking about. I hope that we will be able to just make a little bit of a difference.

Robert Groves, MD:

Do you think we’re making progress?

Rhonda Anderson:

Sometimes. And then I think we have setbacks. What I see is with COVID and even though it’s been horrific there’s a lot of opportunity. Things that we learned during COVID that we shouldn’t get rid and actually I’m working with a group of nurses called Nurses Everywhere. I’m one of the founding members and we are identifying the things that happened in COVID that should not be let go of and that we should really keep and move forward and try to get into public policy.

Robert Groves, MD:

Walk us though some of those things.

Rhonda Anderson:

Well one of those is Telehealth, but I call it Tele professional management because it could be nursing, it could be physicians, it could be physical therapists, speech therapists, everybody. So with the Tele professional management of patients we should all be able to do that. If we have a license, why not in our space? And yet, there are so many restrictions in so many places and obviously payment. We’re all working through that as well. But when you think of, and I’ll use speech therapy as an example. I have a niece who is a speech therapist and for years she has been, she kept her clients all of the world, but she can’t get paid for it. Now she’s not doing it for the money. She’s doing it because that client needed the help so why not? Why not? The difference and the outcomes are great and yet not able to be reimbursed. So, just things like that are the things that we’re working on through this group.   

Robert Groves, MD:

Very Good. Do you see any opportunities that we’re likely to miss?

Rhonda Anderson:

Yes. I think hospital at home during the pandemic. Some places are keeping it. Many are discarding it. The question is why? You know years ago I said a hospital for our future will be one intensive care unit and that’s it and I think this hospital at home could help us get there.

Robert Groves, MD:

You know I’ve been thinking about this too and one of the things that give me a little bit of hope is I think we discovered during the pandemic is that we don’t have surge capacity or a stable supply chain and we have to address that. It’s a matter of national security we’ve learned in a global pandemic and one of the things that gives me a little bit of hope I mean we have so much malaise in the middle part of the spectrum in terms of income and a lot of those manufacturing jobs when away. I’m hopeful that we’ll do some on shoring for production ventilators and VE and medication, things that are critical to our survival in the setting of a pandemic. Do you see that as something that is likely to occur?

Rhonda Anderson:

Yes and it’s interesting that a company that I work with, I’m on their board, all venture capitalists, but it is an orthopedic company and many of the parts of our product were from China and we changed it all and moved it to North Dakota. So yes, I absolutely see that. 

Robert Groves, MD:

And that could really be a boon for folks that haven’t had opportunity.

Rhonda Anderson:

Exactly.

Robert Groves, MD:

I’m optimistic about that part of it at least. I can’t help but say that since we’ve been talking here I think you’ve mentioned, I don’t know, eight or nine boards. I don’t know how many you’re on.

Rhonda Anderson:

Fourteen.

Robert Groves, MD:

There’s that inability to say no right. Do they have a theme? Is there, are they aligned with you passions and how so? 

Rhonda Anderson:

Three buckets I would say. So one is like the venture capitalist one. I have three besides the one that I talked about that are in that bucket and they’re exciting because they are innovative companies and I like to work on those types of things anyway and they will help in the future, so that‘s one.

The second one is my professional boards. So AONL Foundation, Arizona Nurses Foundation and then president of the American Nurses Credentialing Association and all of those are in the profession.

And then the third is volunteer boards on which I both reside and preside in a couple of them and all of those are around children, at the national level, Healing the Children. At the local level Ryan House, Make a Wish and Feeding Matters and all of those. 

Robert Groves, MD:

That frames you passions pretty nicely doesn’t it? Children, Nursing and Innovation. That’s so cool and a few minutes ago you said the word retirement. It doesn’t sound like retirement to me.

Rhonda Anderson:

I call it preferment.

Robert Groves, MD:

So you get to do what you want.

Rhonda Anderson:

Exactly.

Robert Groves, MD:

That’s good. What I’m really interested in is your perspective on health care. What’s been the barrier to progress? Why do we see costs go up, exceeding inflation every single year in spite of all these efforts in value based care? And CMMI and driving our variation and the adoption of all of these strategies has been relatively weak overall and what’s the barrier to that? What’s standing in our way of really transforming the health care system to something we can be extremely proud of?

Rhonda Anderson:

There are quite a few things. I would say the first thing is the lack of commitment to innovating new models. Can’t get to value based care doing things the way we used to do it. And yes we’ve had some slight evolution I guess but the focus is not on the whole patient. It’s on getting that outcome so I get paid. So the second thing I would say is our primary care system is not in good shape. If, in fact, we were really managing connexity we would be in a whole different place I believe and we’re not. I mean I went into my primary care and this isn’t a plan it’s what they get paid for fifteen minutes, didn’t even look at my chart, I was in a car accident two years ago and my leg is still not good and no conversation unless I brought it up. So, who’s managing the whole person? The person has to but who is making the partnership with them?

Robert Groves, MD:

Right. Right.

Rhonda Anderson:

So I think those two things are foundational to a real change. So what I, what my observations are we change things either according to the regulatory standard or to the most recent payment mechanism but we don’t change the entire system to manage it.

Robert Groves, MD:

Do you see that happening anytime in the near future?

Rhonda Anderson:

I think there are a couple of places out there that possibly would do this. You know I’ve talked to a friend of mine at Cedars and they are really working on more of a holistic approach like we were talking about. So I think there are people thinking about it. I don’t know if they have the stamina to transition because you take a loss during the transition time but in the long term you are way ahead.  

Robert Groves, MD:

Yah. You know it strikes me that eighteen percent of GDP we spend enough money on health care but we’re not getting the value that I was in a conversation with a physician executive not too long ago that’s engaged internationally and the point that he made is that problems with quality waste are not unique to the USA and that every health care system in the world is thinking about how are we going to take care of the next generation but They’re starting from a very different place. Singapore is already at three percent of GDP I’m told and so we have plenty of money it’s so misallocated. What do you think of incentives? How might incentives play a role in transforming the system?  What do we need to do? Is it time for universal coverage, single payer, capitation, how do you think about all of those issues?  

Rhonda Anderson:

I don’t know that that makes a difference. It makes a small difference at the time but they have to want to and what concerns me most is I just don’t see a lot of individuals who not just want to but have the vision of the how it can happen. People seen to spring to whatever the new payment mechanism is like I was saying before versus let’s take two steps backwards and really create what’s new and what should be our future.

Robert Groves, MD:

Talk to me a little about what that ideal system looks like in your mind.

Rhonda Anderson:

Well, I would say it starts with a primary care working with their patient population to partner toward health, whatever that means for each person, and have a real plan for it. Then we have our community issues but our heavily qualified health centers could fill that space and some of our profitable organizations even though they’re not nonprofit could help fill that space. I really was hopeful when originally we had to do the community health needs assessment. I though oh, wow, here’s the beginning. This is the foundation. We’ve found out about this community wherever you were. Now we can build on that with partnerships between the healthcare organizations and community agencies and whatever, doctor’s groups etcetera. It hasn’t happened.   

Robert Groves, MD:

It hasn’t materialized has it? Talk a little about health care disparities in particular and also the widening gap between haves and have nots. How do you think about those things? What can we do to begin to address that? Is there any hope in your mind for coming to grips with that issue?  

Rhonda Anderson:

I belong to a couple book clubs and one of the book clubs is all on diversity and inclusion, equity and inclusion. One of the books we read was White Fragility. I don’t know if you’ve read it or not.

Robert Groves, MD:

I have not.

Rhonda Anderson:

It’s a fascinating book. It really speaks to what you are talking about. We will have a terrible time closing that gap if those who think they are superior can’t step up to the plate and understand the issue. It’s interesting because after reading that and having the discussion I was part of a community somewhere in the US that they asked me to come and consult. They were trying to look and deal with diversity, inclusion and equity. And look at their city council documents of how they were going to do it and so they talked about in the documents inclusion except in country clubs. 

Robert Groves, MD:

Interesting.

Rhonda Anderson:

Exactly. That’s the point and that’s the point the book was making.

Robert Groves, MD:

And I laugh. It’s not funny.

Rhonda Anderson:

No it isn’t.

Robert Groves, MD:

But it is ironic.

Rhonda Anderson:

It was crazy. I looked at it and I couldn’t believe that they would even put a document like that out if they really meant what they said. And so I thought, we have a long ways to go.

Robert Groves, MD:

What was the conversation like?

Rhonda Anderson:

I said you should not have that as an exclusion. Well they might not like those people. And I said you know what

Robert Groves, MD:

Clearly not ready.

Rhonda Anderson:

You are not ready and you shouldn’t put out any documents. You need a lot of work and education before you are going to just make something public that you think will say, oh now we include people. It was pretty discouraging.

Robert Groves, MD:

And what’s been discouraging to me in particular is that groundswell of ignorance that is apparent in our political system and I say that as gently as I can because the willingness to adopt false news, the willingness to get behind ideas that are nonscientific the willingness to, all of that in part is related to that sense of superiority and the need to make sure I stay in this position on top and that drives a lot of the behaviors out there. It’s not really about belief. It’s almost an instinctual survival strategy it seems like.   

Rhonda Anderson:

In White Fragility they call it the structural foundation that we’ve all grown up with and they go through a lot of the history that brought us to that but they said unless we essentially demolish the structural foundation and build something new we’re going to continue to have what you just described.

Robert Groves, MD:

Hence the longing in some circles to go back to the way it was before which was more structured and less open. That is a comfort zone for certain groups and it’s really taken a toll on us politically. My biggest fear, frankly, is that the political paralysis that we see has no end in sight. And policy now drives so much of the behaviors in health care. The federal government foots so much of the bill that it matters what CMS says and does, what CMMI says and does and everything else kind of follows on the heels of that. In the current environment it’s have to understand how we can get transformational bills through congress. It’s just going to be a real challenge. I’ll tell you why I retain a little bit of hope and you may not see it this way and I believe and I believe very strongly that most people if you go back to their commitment to get in to health care it’s because the wanted to help people. It’s because they have good hearts and they’re good people. And bad systems can trump good people at times and then there’s the need to have the courage to break out of the system and try something new and commit to doing that with both feet and that is a really difficult thing to do particularly if you’ve got family you’ve got to worry about etcetera. You’ve been able to do that. You are one of those people that I have always admired because you speak you mind. It doesn’t matter who’s on board or who’s not on board, you are going to call them as you see them. Is that something you got from being the eldest child in a large family? Where did that come from?

Rhonda Anderson:

I think that’s part of it definitely. I watched my mom, who was widowed at a very young age, and before she remarried had to really figure out how to navigate this whole world with a little one. And I watched her mother, my grandmother and my great-grandparents because there were five generations all living through all of these times including our grandkids and they taught us that. They taught us that. Now grandpa would sit at a table like this with all of us for dinner and you couldn’t speak until he spoke to you but he would ask everybody the answer to the question he was asking. So you were encouraged to speak up just not over somebody else.

Robert Groves, MD:

Yes. Interesting. I want to move now to what are you working on today? Where are you having an impact today? What are you trying to drive right now?

Rhonda Anderson:

So I talked about Nurses Everywhere. We’re trying very hard to drive the things that were good from the pandemic and to keep those in practice. The other thing is with a couple of the nursing organizations that I’m with we’re working on research projects for new models of care that we will fund those. We’ve developed a criteria and we’re going to be asking for individuals or groups who would like to do that research. The other thing is, I don’t know if you knew Dr. Melnyk, she was the dean of nursing here at ASU. She’s now at Ohio State. One of the things we’re all concerned about the suicides and depression and things that have occurred and we don’t know what’s going to occur with all the online school, not in person and all those things. So she developed a tool COPE, which is an online tool for different age groups and the kids love going online and taking these little fun tests but it gives an idea of their level of depression and not happiness etcetera and suicidal tendencies. She’s worked with 40 pediatricians across the country and now we’re going to be doing research and sharing it in children’s hospitals so through one of the organizations that I chair we’re going to give grants so we can use it in emergency departments in PICUs and see how we help those children as they progress.   

Robert Groves, MD:

Right. Right.

Rhonda Anderson:

So that’s a really exciting one. And then of course I told you about global healthcare accreditation.

Robert Groves, MD:

Yes. Yes.

Rhonda Anderson:

Oh my gosh, so we had to pivot obviously. I had four days of twelve hours for two surveys, so two different surveys, four days each, twelve hours each day virtually internationally.

Robert Groves, MD:

That was a new experience I’m sure.

Rhonda Anderson:

That was a great new experience. They carried me around on a cart to patients

Robert Groves, MD:

Where they pushing you around?

Rhonda Anderson:

To patients so I could interview patients and do all the things I normally would have done in person. So yes that’s kind of fun in a new way. Hopefully not going to stay that way, but you never know.

Robert Groves, MD:

So previously you would have been traveling a lot to do those.

Rhonda Anderson:

Yes.

 Robert Groves, MD:

Now tell us this is another interesting perspective that you’ve gained is a comparison of our health care system. I mean we hear all the time that in some ways we have the best health care system in the world. You talk about rescue medicine, time to balloon, major trauma we do that pretty darn well. Compare us to other health systems that you’ve seen. What’s your favorite that you’ve seen so far?

Rhonda Anderson:

Maybe Thailand.

Robert Groves, MD:

What ‘s the. . .

Rhonda Anderson:

Well I think the

Robert Groves, MD:

There’s a collectivism that we don’t share here.

Rhonda Anderson:

There is and that’s a part of it. There is a pride that we don’t see. As surveyors, they want to show you everything. They don’t want to hide anything and there is a pride in what they do and when you talk with the patients, they’re grateful, I guess is the word I would use for everything that they’ve got. We complain all the time. So it’s just that sense of pride and I’m doing something good for somebody else and the other person recognizes that. 

Robert Groves, MD:

You know it’s interesting you remind me of the reason that I started my practice in Greely, Colorado because it’s a fairly busy referral center full of complemental services but the patients come from eastern Colorado and Nebraska and Wyoming and they are so grateful for the care that they receive these are the kinds of guys you know, the farmer that comes in with his arm on ice and says well, yah, I put a tourniquet on and I brought the arm in and I had to finish getting the crops in. I don’t know if you can save it. Just that, this is what happened and this is how I deal with it and I’m grateful that somebody is paying attention to me and caring about it. So there is that, there are pockets of that. 

Rhonda Anderson:

Oh there are. We have friends up in Wyoming and we go up there periodically and they are really grateful for the care that they are able to receive. That’s what I grew up with. Great grandpa and grandma had literally thousands of acres of farmland and that’s how you were, you were grateful that somebody was able to help you.

Robert Groves, MD:

I learn every time I do one of these interviews. I’m learning so much from you, but I’m going to share something that I learned from Brent James and he reminded us that for most of the history of medicine showing up at a doctor meant you were not going to live as long and that in spite of that it was an integral part of society and that correlates with surveys of patients who rank caring above anything else. I think that’s a message that needs to be reiterated as much as possible. Patients don’t expect miracles but what they expect is somebody to care about their situation and to do the very best they can. They understand that we’re human and not everything works out the way that we plan. Those things, if we can get back to that, if we can get docs and nurses time to create the relationships to engage with individuals that’s what’s missing is the opportunity for those connections for those relationships. Somehow we’ve got to get that back because that’s the foundation I think of health care. 

Rhonda Anderson:

You know I would add a word to that and that’s listening. I’m working with four friends, three who have cancer and one who is wheelchair bound from a neurological disease and what they all have said, and I say you have the right you just go right back there and ask is they don’t listen to them. And they know what changes their body has had, I don’t. You don’t.

Robert Groves, MD:

Right. Right.

Rhonda Anderson:

But if they would just ask that question first and then listen and then be able to talk about how we together can you know go to the next steps whether that’s radiation or there’s nothing we can do or all those answers that people got recently. That would make a huge difference.

Robert Groves, MD:

Yes absolutely. Do you think that we can change that? And if so, how do we go about doing that?

Rhonda Anderson:

Well I think we can change it in our education system and I’m a trustee for Chamberlin University.

Robert Groves, MD:

I’m not surprised. Another obligation alright go ahead.

Rhonda Anderson:

But we have developed a program to support our students called Chamberlin Care because we take students that maybe weren’t able to get into other places. We have a 97% pass rate in the N class because of Chamberlin Care. But my point is and your question was teaching them. We care about you, you care about your patients and that makes a huge difference.

Robert Groves, MD:

Wow. So it starts with education.

Rhonda Anderson:

It starts with education.

Robert Groves, MD:

You know another interesting tidbit that I’ve learned along the way is that dollar for dollar investments in general education do more to prolong life than investments in health care. And of course you know what we call health care and spend three point whatever trillion dollars on now accounts for maybe fifteen percent of mortality outcomes. Some of its genetics hard to, although we’re getting there I guess, mess with that. Some of its environment, whether you are exposed to bad aid etcetera, but a huge part, 40% is behaviors and on the one hand there’s a faction that has taken the stance that well it’s your personal responsibility and if you can’t quit smoking or lose weight, whatever it is then we’ll charge you more for insurance and in my mind that is exactly the wrong approach. The approach should be education health literacy and it has to start in children. You know what’s fascinating to me to is how much influence kids can have over their parents.

Rhonda Anderson:

Amazing. It is absolutely amazing or their grandparents.

Robert Groves, MD:

Yes. Laughter. No but they learn stuff and it’s so fresh and new to them that you can’t ignore it and they can really influence behaviors as you mentioned parents and grandparents when they learn those things.

Rhonda Anderson:

You know that‘s why when I was at Carden I really just talking about and I really wanted to start and then obviously but,

Robert Groves, MD:

And you were the CEO.

Rhonda Anderson:

Right. But I wanted us to do games for the kids that would teach them health and nutrition etcetera but it would be a game. It would be a fun thing. And we had get will network and they were just ready to partner with us to develop some of those. I don’t think they pursued it the Carden people did, they’re not called Carden anymore but the Banner Children’s people didn’t anymore. I just think they’re all learning remotely, they are all on the computer. My grandson the other day he, well this was around Christmas time, was telling me what he had learned about Hanukah and all the different religions and I said you know we went to Jamaica when your mom was little and they celebrated Botkin day. Well, what’s bodkin day? I said, you know, I honestly don’t know they just had a big celebration. He runs in the house, gets on the computer and comes out and tells me. So why wouldn’t we do health education that way? They would have fun with it, have a game.      

Robert Groves, MD:

There is a natural curiosity at that age that we should be taking advantage of as best we can.

Rhonda Anderson:

And I think we will. The flip side of that is there is a book, a different book, that I read I Gen.  I don’t know if you read that book. Interesting.

Robert Groves, MD:

Go ahead and say the name.

Rhonda Anderson:

i Gen. Like internet generation but a small I and  then gen. There’s two things in there that, one that’s relevant to this that this is the way they want to learn but the other thing is relevant to a previous conversation you and I just had and that is they don’t want any conflict. So many of them don’t want to learn to drive. They don’t want to have a professor or person, some of they don’t want to go to college because they are afraid they will be put in like a debate discussion and they don’t want that, nothing that causes them to feel uncomfortable. So after reading that I thought wow, we have been focusing on millennials but we shouldn’t. We need to focus on the new couple younger generations because this psychologist, if she’s right, we’ve got an issue before us that we’re really going to struggle with in everything, in healthcare and everything. I was just talking with a friend the other day who was struggling with a teenager who does not want to learn to drive. She fits the exact description of what the psychologist wrote. So if that’s the case, I mean I think about who’s coming into healthcare?

Robert Groves, MD:

Yah. You know the way I think about that is that when I was younger whatever the latest book was about behavior health was everything. Everything fits into that little bucket and I’m gung-ho, and they’re really just variable perspectives and you put it in the mix and you say, that’s interesting, there’s a component of that here and how do we address that? 

Rhonda Anderson:

Well and that’s the question. There is a component of it. So how do we address it if we really are looking at the workforce of the future? And whether it’s physicians, nurses, repertory therapists how do we early on talk to them, work with them? We had a program here that when I was teaching at Grand Canyon one of my students, he was in a graduate program.

Robert Groves, MD:

For those of you keeping score I think that is number seventeen or eighteen.

Rhonda Anderson:

And he was a school nurse and so Randy and I conceived of something. Let’s start, and he did it as a project, start a healthcare program in their freshman year they could become nurse aids. They could become LPNs if they were the right age before they graduated and then they also had a matriculation into a baccalaureate program. They stopped that after Randy left and that’s so sad because that’s what we need to be doing to get at what you and I were just talking about. Helping our young enthusiastic kids.

Robert Groves, MD:

You know one of the things that I think that gets lost particularly in maybe all of us when we were younger is how much the benefit accrues to us when we care about others. You know it is such a rewarding thing to do. Some of my most proud moments have been when I was present, truly present for a patient with maybe an insurmountable problem and I benefited from that. I don’t want to call it self-esteem because that’s not what it is, but my feeling that I’m fulfilling a purpose that I’m here to fulfill. And that sense, that sense of being not externally, but internally rewarded for putting oneself out there and really caring about another person enough to listen carefully and enough to even take risks to make sure that they get what they need. There is no greater reward that I’m aware of anyway. I haven’t found one and I wish that everyone could experience that because I think it would be a different world. 

Rhonda Anderson:

It really would be.

Robert Groves, MD:

So we probably should be wrapping up here. We’ve been going for over an hour. I know you have a busy schedule.

Rhonda Anderson:

It’s been enjoyable.

Robert Groves, MD:

It’s been a great hour but I guess to wrap up I want to ask you a couple of questions. One, you are a nurse what advice would you give to young people, and this is kind of selfish because my son is going into nursing. What advice would you give to young people who are just embarking on a career in nursing?

Rhonda Anderson:

I would say find a mentor. That’s also something that I love to do and I was just over the last week on the phone with two different new nursing students. It’s hard. They can talk with their faculty. They can talk with their piers but I think sometimes the grounding comes from a mentor who’s been though all of those different stages. So I would say find a mentor.

Robert Groves, MD:

There is such a thing as wisdom and it is hard won. There was a Gary McMann quote, a cowboy poet, who said “Good judgement comes from experience and experience comes from poor judgement.” 

Rhonda Anderson:

That’s true. I always say failure is positive not negative.

Robert Groves, MD:

But by golly, if I can learn that from somebody else without having to go through that I’m open to that.

Rhonda Anderson:

Exactly.

Robert Groves, MD:

That’s a great way to spend time again we go back to not children but young adults. There is a window of opportunity that you can really have an impact on somebody’s life. When you do that the benefit accrues to the person mentoring just as much. It’s kind of like the old adage that if you want to learn something teach it. Taking advantage of that wisdom and helping young people discover what they need. I think that is great advice. So, find a mentor.

Now, here’s the harder question. What do you think that one thing we could do that would bring us closer to that ideal health care system that we all dream about? What’s the one thing that individuals, first, and second organizations can do to forward that effort?

Rhonda Anderson:

I think, and I’m going to put them in the same bucket because the individuals have to want to do a think tank but I do think that some of the larger systems could be the catalyst for a think tank and not just with their own staff but outside people as well from maybe even different systems and from the community so it isn’t just health care providers.

Robert Groves, MD:

Right.

Rhonda Anderson:

When we were with the children’s hospital we always had our advisory committee of different age groups of children and parents.

Robert Groves, MD:

Oh nice.

Rhonda Anderson:

Because if you didn’t, that’s how we designed it, because if you didn’t you’d do something that they didn’t want or feel.

Robert Groves, MD:

What a simple, and obvious, brilliant idea.

Rhonda Anderson:

So, there was a futurist, Russ Coil, years ago, and Russ brought 25 of us together from across the country and envisioned what would health care look like in 2025.  And it was 50 systems anchored by universities, either owned or contracted and wasn’t the design of the health system or care system it wasn’t a design of a health system to provide their workforce etcetera that’s why they were anchored by their owned university  or contracted university. It’s almost 2025 we see that Banner has done we see what Dignity has done with Creighton we see think tank like that with a futurist leading it that could loosen up the thought processes of individuals and bring dispirit individuals together not just the health care providers. I think we create the system.

Robert Groves, MD:

That is awesome. That’s probably a great place for us to stop today. I’ve got to tell you though that this is one of the joys of my life now is getting to talk to people like you who have done so much and who’s perspectives vary from mine but I learn every time I do this and the whole point of the Groves Connection is just that to make connections to understand a variety of perspectives. I think we get too entrenched in our thought patterns and we have tunnel vision and then we have confirmation by us and being shaken out of that by someone who has clearly had a successful career and may have a different perspective than we do. I think that is so valuable and I hope you’ll agree to come back to us and talk to us again and it has been such a great pleasure Rhonda. Thank you for agreeing to be on the show.

Rhonda Anderson:

Your welcome and it was fun and great to get to talk to you again. Thank you for having me.

Robert Groves, MD:

Thanks. Goodbye.

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Robert Groves, MD:

You’ve been listening to the Grove’s Connection your connection to the inside story on health care featuring in-depth interview with those who know you can find us on Apple podcast, Spotify, and anywhere else you get your podcasts. If you like what you hear give us a five star review to keep the connection going and hit the subscribe button to make sure you never miss a beat. 

The Groves Connection is produced by Dr. Robert Groves. Original music and editing and creative direction provided by Alden Brothers. Production support, content guidance courtesy of Janae Sharp and Elizabeth Barrett.

Thank you for listening.   

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