Karen Wilding, Nemours Children’s Chief Value Officer, explains her role in the enterprise. She’ll also share her experience on 9/11, when she was a student in Washington, DC, where she watched the tragedy unfold. It was an event that shaped her life and put her on the path to becoming a Nemours associate.
Carol Vassar, producer
Karen M. Wilding, MHA, CHCIO, FHIMSS, Vice President, Enterprise Chief Value Officer
Carol Vassar, podcast host/producer (00:00):
Welcome to Well Beyond Medicine, the Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you’re here, let’s go.
Let’s go, Well Beyond Medicine.
Karen Wilding, Nemours Children’s Health (00:27):
I remember that day, the chaos that was in the streets and huddling together and watching the news, no telecommunication access, no way to contact my family to let them know that I was okay. Later that day, I remember going on to one of the taller buildings on campus, and we could see the smoke and smell the smoke in the air from what was at that time we now know, the Pentagon.
Carol Vassar, podcast host/producer (00:56):
Today I’m joined by Karen Wilding. That’s her voice you heard at the top of the podcast describing her experience on 9/11 when she was living in Washington, DC, just four blocks from the White House. It was a day that shaped her career, put her in a clinical role, and on the path to joining Nemours in January 2020 as Chief Value Officer. Before we get to her full 9/11 story, which is truly compelling, let’s explore her current Nemours role and what it means for patients, families, and associates.
Karen Wilding, Nemours Children’s Health (01:35):
The chief value role, I really believe, is a recognition that healthcare is changing in a big way and that organizations need a leader that’s focused on clinical and business transformation efforts that are focused on achieving that quadruple aim. And I think that the Chief Value Officer role is looking at how we can develop successful business models that put value into the core of the operations and how we function as an organization.
And in everything we do, the patient and family are at the center. And so we really are looking at how do we wrap around our services and support teams to achieve that quadruple aim. So I’m really excited for the opportunity to join this tremendous team of talent and to bring my enthusiasm and energy.
Carol Vassar, podcast host/producer (02:21):
And this is a brand new role here at Nemours. Tell us a little bit more about what you do day-to-day and week-to-week.
Karen Wilding, Nemours Children’s Health (02:27):
Sure. Well, it is a new role, and it’s a new role because I think that Nemours is being a trendsetter in this way. Nemours is leaning into where healthcare is going and recognized that they needed a leader that sat within operations and next to chief medical officers and chief nursing officers, and chief operating officers to guide value. And my day-to-day work, there’s some myth-busting, Carol, right? So it’s not just about running an ACO or leading a clinically integrated network. Value is so much more than just that.
And a lot of the work that I am doing, especially just as a joint to the team, is working with our leadership to define what we believe value is, right? It’s about high quality, cost containment, a great experience, and balancing the needs of our teams to be well. And so much of my day-to-day work is taking the current VBSO structure that Nemours has invested in and making sure that we have the leadership engaged and supportive. But also recognizing and identifying new opportunities for Nemours to really accelerate the work that we’re doing around value.
Carol Vassar, podcast host/producer (03:43):
I think you touched a little bit on this, but maybe you can give us a little clearer focus. It’s a new position. Where does it fit within the vision and strategy that Nemours is pursuing right now?
Karen Wilding, Nemours Children’s Health (03:54):
It’s funny. I think well beyond medicine is like my all day, every day. I wake up in the morning, and I think about how do we do well beyond medicine. So the opportunity is to take the work that we have in our hospitals and in our practices, so the acute and the ambulatory care, and connect it with the community. And the community could be community practices, it could be community partners, it could be strategic partners, it could be payers.
And so, really, I think that there’s an opportunity for me to think about Well Beyond Medicine in every day and the work that we are doing and try and connect back all of the connect-to-purpose work. It’s a bigger story, it’s a larger vision about where we want to go as an organization. And I think also a recognition of where we believe we should be.
As an anchor organization in the community, we deal with some of the most intimate moments in patient and family lives and we cannot just think about the health care that we are providing to people, that acute episode or that one practice visit. We have to think about the larger picture and what that means to that patient, to that family, and to the communities that we serve.
Carol Vassar, podcast host/producer (05:04):
Let’s get into some of the nuts and bolts of what you just said. You mentioned a couple of acronyms. I want to make sure that everyone who’s listening knows what those are. First is ACO, and then the other is VBSO.
Karen Wilding, Nemours Children’s Health (05:17):
So I am a victim of alphabet soup, so thank you for calling me out on that. An ACO is an Accountable Care Organization, and that’s effectively a group that comes together with some shared goals around managing cost and improving quality. VBSO is really the Nemours branded version of a group, the Value-Based Service Organization. The VBSO was started by Nemours back in 2017 and has grown over the years to support Delaware Valley and is now expanding to help support Florida, and we’re very excited about that.
And it’s a team of individuals and experts that have expertise in population health data and analytics. They help support the clinically integrated network that we have today, the Delaware Children’s Health Network. They help provide support and services around medical management so like nurses and social workers, and community health workers. We have medical directors. So we have really a multidisciplinary team that is focused on supporting all of the value work that the organization has.
Carol Vassar, podcast host/producer (06:31):
And I was going to ask the question, who works on your team? Is there anyone you want to call out and recognize? I know you’re rather new to the organization but who do you work with directly right now?
Karen Wilding, Nemours Children’s Health (06:40):
Oh, my goodness. There are so many people I would need the entire podcast to list the names. We’re so lucky to have such incredible talent. I think that there’s definitely some incredible leadership that are well known within the Nemours leadership. Lisa Adkins, who oversees our medical management division. She oversees our strategy around clinical delivery and how we actually support the patients that we’re taking care of.
We have Alex Koster who has been leading our data and analytics work and there’s just incredible work that’s going on in that space and really cutting edge about how we use the data that we have to drive change and provide insights to the organization about how we can improve. Kelli Thompson, who’s been with the organization for a very long time, is leading our population health work and helping drive some of the quality work that we have.
Dr. Miller is my partner in all of this around leading our medical director leadership and working through our medical director group. And there’s so many other members of our team that are leading this work.
Carol Vassar, podcast host/producer (07:45):
A lot of moving parts, a lot of things to consider. How do you plan and envision moving forward as the Chief Value Officer?
Karen Wilding, Nemours Children’s Health (07:54):
So right now, I’ve been largely focused on listening sessions and meet and greets, connecting in with the leaders across the organization, and really understanding what they believe our challenges and our opportunities are. And I’ve taken the last couple of months to go through and take a lot of notes about what we think our opportunities are.
And I’m now at a point where we’re starting to take what we’ve gathered from those one-on-one conversations and align it to what the vision and we know is industry-best practice and perform some gap assessments around where we are, what is our maturity and the tools, the team, the skillset sets that we have in the organization. Where do we need to consider investments? Where do we need to consider alignment?
And I’m hopeful and looking forward over the next couple of months to really work with the leadership teams of Delaware Valley and Florida on defining and refining our strategies for the health value and equity pillars.
Carol Vassar, podcast host/producer (08:54):
What are some of the gaps you have identified at this point, and what are some of the obstacles you face as you move forward?
Karen Wilding, Nemours Children’s Health (09:02):
Well, the foremost obstacle is making sure that there’s fluency in the organization about what value is. I think that there has been tremendous work that is going on, but it’s still common for me to be in a meeting and people ask about what is well beyond medicine. What does that really mean to me as a team member? What does that mean to the work that I’m doing? And I think we have an opportunity to give more concrete examples of this is well beyond medicine.
The work that you’re doing, in this example, in this practice, or in this facility, is well beyond medicine. And here’s how. I think that some of the teams are hungry for that kind of concrete example to understand how well beyond medicine impacts their jobs. Right now, it sounds kind of visionary, and it is, but I think that we have some opportunities to help with that. So to me, until we build a level of fluency and comfort in the organization on the work of what value means, it’s hard to get everyone rolling in the boat at the same time. But I think we’re there. I think we’re getting there. We have some work to do, though, around education.
Carol Vassar, podcast host/producer (10:12):
Do you happen to have a concrete example that you could share with us today?
Karen Wilding, Nemours Children’s Health (10:17):
Sure. One example that I think is so important, I was actually speaking with a coordinator. We have patients who are presenting to our hospitals, and as part of our assessment, we screen for social determinants of health and/or SDOH. And as we’re assessing for these, we’re looking at items around housing and food and the ability to connect in. And if we identify for someone who’s an inpatient that there is a challenge with planning for discharge, being able to leverage the clinical teams to connect those patients to resources in the community, that’s an example of Well Beyond Medicine.
That’s an example of when we are going beyond the medical care and recognizing that if a patient and their family have food insecurity or have housing challenges, maybe we need to help leverage a medical legal partnership. That is an example of going beyond a clinical regimen, a clinical pathway. It’s taking care of the whole child, the whole family. And that to me is something that maybe a lot of people don’t realize the value that they’re providing and the impact that it makes. And so I think we need to identify more examples like that and help illustrate them across the organization so that there’s a real sense of pride that everyone is delivering on the promise of well beyond medicine.
Carol Vassar, podcast host/producer (11:44):
And it sounds like at Nemours, that has always happened and this is really just a codification of that and really leveraging that to benefit the child and the children’s families.
Karen Wilding, Nemours Children’s Health (11:56):
It’s true. I think that well beyond medicine I’m finding is definitely cultural, that there’s always a recognition of going above and beyond and wanting to help and serve. I think that what we’ve not done is labeled it, maybe that way. But I also think that there’s opportunity for us to align some of the care delivery workflows and processes to make sure that we have people dedicated to doing that work.
So the greatest challenge has been that, the example I gave, that may be the same person that’s trying to call and get equipment to discharge this patient, the same person that may be calling the insurance company to get an authorization. That may be the same person that’s trying to do rounding on a unit or doing education with a family. And so we have to be able to balance those needs and to evaluate how do we make sure that we still deliver on our mission of care delivery and taking care of patients but also deliver on our vision around being well beyond medicine.
Carol Vassar, podcast host/producer (12:53):
So our guest today is Karen Wilding. She is the Chief Value Officer, a brand new position here at Nemours. I’d like to know a little bit about you. Where are you from? I understand at least one of your parents when you were growing up and maybe still is, as a nurse, and that experience helped shape your career path. Talk about you.
Karen Wilding, Nemours Children’s Health (13:12):
Well, I don’t like talking about me, but I’m happy to share a little bit of my story and what makes me tick and why I’m wired, maybe the way that I am. I grew up in Maine, so I came from a small town, a small community. The hospitals that we had in Maine, there was only one large hospital. Most of it was rural and community-based. And so that was kind of where I got my exposure growing up in small towns. And my dad was a nurse and so that was pretty rare to have a male nurse.
And I remember seeing, at a very early age, some of the challenges that he had with acceptance into the nursing profession and some of the challenges that he witnessed around stereotypes and expectations. And I think that as children, you think of your parents as pure and couldn’t understand why dad wasn’t accepted. Or why he loved the work that he was doing but sometimes he would have really hard days coming home from the hospital. I look back now and I realize that I had an early exposure to challenges that we see in diversity, inclusion and equity. And I didn’t even realize that I was having that.
But now I look back and go, “That makes sense.” So that’s one thing about me that having a nurse as a father was something. But I also was the little kid that would steal his nursing magazines that would come into the house and pour over journals of emergency medicine, nursing, and critical care nursing. And ask questions about what is this machine and why do they need that? And so I was always curious about medicine early on.
Carol Vassar, podcast host/producer (14:53):
So policy seemed to be, caught your fancy fairly early, it sounds like.
Karen Wilding, Nemours Children’s Health (14:58):
It did. It did, unknowingly. I was very intrigued in reading and wanting to just know more and question why.
Carol Vassar, podcast host/producer (15:07):
Now you attended George Washington University, which, of course, is in Washington DC, and you were in the district during the 9/11 attacks. Would you be willing to share with us some of your experiences that day?
Karen Wilding, Nemours Children’s Health (15:20):
Sure, I was. I actually lived four blocks from the White House at that time. And so, as you can imagine, being in the district was a profound time. It was profound for many reasons, specifically the impact that it had on the larger United States, and not really recognizing and realizing how profound that impact was at that moment. But I remember that day, the chaos that was in the streets and huddling together and watching the news.
No telecommunication access, no way to contact my family to let them know that I was okay. And being advised to leave buildings because we were concerned that there was going to be multiple threats on the locations and especially with the proximity to the White House. Later that day, I remember going on to one of the taller buildings on campus, and we could see the smoke and smell the smoke in the air from what was at that time, we now know, the Pentagon. That was a changing time, and I remember this immediate feeling of how do we help? What can we do?
And there were discussions of blood drives. The America Red Cross started to immediately get blood drives set up and ask for volunteers to help support. And that experience drove me to actually go get my EMT license. It was a great opportunity to get me to dip my toe in the water around care delivery. I was licensed for many years, and I’m grateful for that experience because I think that ground-floor exposure was so helpful for me to understand how hospitals operate and the impacts of care delivery and processes. And so I look back and reflect, and I’m grateful for that. It really taught me so much.
Carol Vassar, podcast host/producer (17:16):
So you went to George Washington University. You were an EMT. You did go on for a master’s. What’s the progression to getting to Nemours, and why did you choose to come to work at Nemours?
Karen Wilding, Nemours Children’s Health (17:28):
I feel like I’ve been blessed with so many opportunities that I never really sought but they just kind of landed in my lap. But I think that sometimes that’s been the story that I’ve learned from other leaders that I just really focused my head down on the work that I was doing and loved working on the teams. And I worked at the University of Maryland for many, many years. I was originally brought over there for some of the work around shock trauma and that acute medicine side that I talked about around my being an EMT and managed their IT shop and did a lot of really great data and analytics and EMR conversions.
And then several years ago, was asked to help develop their clinically integrated network in their population health areas. And it was an area that I truly loved, truly loved. And was able to achieve so much with this wonderful team that I was able to build and develop. And I think that I had this opportunity with Nemours that, to me, was very mission-focused. I loved the work that I was doing in population health, and in some ways, the work that I’m doing here at Nemours is very similar population health and value-based care work.
The difference is the goals around who we’re trying to change. And I’m a mom, and I have an obligation to think about my children and their future. And I really loved the idea of joining a children’s organization that was focused on health and the healthiest generations. And to me, I wanted to be part of that. And so I was very fortunate to be given the opportunity to join this team, and I really look forward to making an impact in that way.
Carol Vassar, podcast host/producer (19:12):
And you’ve been here since when?
Karen Wilding, Nemours Children’s Health (19:14):
Carol Vassar, podcast host/producer (19:15):
Since January. It might be too early to ask this question. But cultural differences between Nemours and previous employers, do you see any?
Karen Wilding, Nemours Children’s Health (19:24):
I will say there’s a big difference between just adult-focused and children-focused organizations. I think that, to me, that was marked differently. We talk differently in the way that we’re thinking about the family. Where in the adult space, they’re very focused on just the patient, right, or the clinician. And so I think there’s a recognition in children’s health organizations that you have to address mom and dad and caregiver, not just the patient. That it’s really a whole family experience when you have a sick child.
Culturally, people are very passionate here at Nemours and to me that’s really exciting that everyone I’ve encountered has been positive and passionate about the work that they do. And that’s not always the case in every organization, right? But I think that to me, it’s been a really enjoyable experience as I start to learn and meet more people across the organization. The new enthusiasm is exciting.
Carol Vassar, podcast host/producer (20:21):
Now, you’ve talked about Well Beyond Medicine. From your vantage point, being here since January, what is meant by Well Beyond Medicine?
Karen Wilding, Nemours Children’s Health (20:30):
I think that Well Beyond Medicine is really a commitment that Nemours is making to go beyond the brick and mortar and to think about whole child health. It’s a commitment that we acknowledge that we have an obligation to serve more than just the physical or mental health of a child and the corresponding family and caregiver. That we need to make sure that we are addressing all aspects of the environment and the psychological and some of those other social aspects that I mentioned earlier around social determinants of health.
And I think that’s a rarity. It’s starting to become more common in medicine that there is a recognition that social determinants of health play a larger role in the care that is being given but it’s not something that every organization has front and center. And it’s certainly not something that organizations have in a tagline and are bold enough to go out into large public forums and say, “This is what we’re focused on.”
Carol Vassar, podcast host/producer (21:37):
Where do you expect this work, the value work in particular, to be in a year, three years, maybe five years?
Karen Wilding, Nemours Children’s Health (21:45):
Well, there’s some key things that the organization has had in works before even my arrival. And I think that the opportunity that I have with our leadership team is to accelerate some of those areas. And so, in a year, I’d love to see more conversations about what value means into each of our team members’ work and the well-beyond examples that I mentioned. In a couple of years, I’d like to see some leading and progressive areas around value, whether it’s new alternative payment models that we’ve architected and put in place.
Or whether it’s industry-leading population health portfolio that people are asking us to give us the Nemours playbook. I think that we have an opportunity to go there, and we’re positioned to go there. It’s really about accelerating the work that we have. And so in a couple of years, I think that we can be trendsetters in some big ways. I know that every day there are so many activities that we are balancing as an organization.
And so having the willingness and the openness to accept a different way of thinking and to apply it into the work that you’re doing is really, to me, meaningful, and I’m grateful for that. I always say to my team, “I have an open door, and I would love to hear feedback from anyone in the organization about what they think value is or maybe what they think value isn’t.” Tell me, I’d like to hear that. I’d like to learn from the leaders in the organization and from all of the team members.
If anyone feels passionate and they can send along a note, I will absolutely take the time and energy to try and respond to them. I think that’s really important, and this is a system-wide effort. This is not a VBSO effort. This is not a Karen effort. This is a Nemours system enterprise effort and it requires everyone from our hospitals and our practices to come together and to row together.
Well Beyond Medicine.
Carol Vassar, podcast host/producer (23:53):
Thanks for listening to this episode of the podcast with me, Carol Vassar, and our fantastic guest, Karen Wilding. What are your thoughts? What does value mean to you? How does it relate to going Well Beyond Medicine? Visit nemourswellbeyond.org to submit a comment or leave us a voicemail.
While you’re there, check out our other episodes and subscribe to the podcast. Thanks to Che Parker, Cheryl Mahn, and Rachel Salis-Silverman for this week’s production assistance. Join us next week when we’ll discuss predictive analytics. Until then, remember, together, we can change children’s health for good, well beyond medicine.
Let’s go, Well Beyond Medicine.