COLLEAGUE INTERVIEW

Colleague Interview: A Conversation with Jennifer DeCubellis

Jennifer DeCubellis is the Chief Executive Officer (CEO) for Hennepin Healthcare

System (HHS), a 484-bed academic acute care hospital, as well as a clinic and specialty care system located in Minneapolis and across Hennepin County. Prior to this role, Jennifer was the Deputy County Administrator for Hennepin County, responsible for Health and Human Service operations, which included over 4,000 employees and a budget of over $1 billion. In addition, she oversaw business alignment with Hennepin Healthcare System. Jennifer has a master’s degree in Clinical Psychology from the Illinois School of Clinical Psychology and a bachelor’s degree in Special Education (emotional and behavioral disorders) from the University of Wisconsin, Madison. She has more than 25 years in public program administration working across all areas of Health and Human Services with an emphasis on program redesign, system transformations, and quality improvements to ensure positive resident outcomes alongside prudent financial management.

Hennepin Healthcare System (HHS) is a statewide resource for many things—particularly trauma care, hyperbaric treatment, poison control, and medical education. What kind of support does HHS receive from the state for these services?

Our system is an incredible resource for the whole state. We operate like other hospitals in that we get paid for the services we provide based on insurance contracts. This includes our specialization in trauma and hyperbaric treatment, which serves patients from across the state and region. We are also a specialized state resource, for instance with the poison control duties we take on for the State of Minnesota—a service operated under grant funding from the state. Graduate Medical Education gets paid through State and Federal programs, and graduates of our programs work in hospitals and clinics across the state today. In 2021, the State legislature recognized Hennepin Healthcare as a state safety net resource and authorized specialized funding through directed payments to support the care we provide, regardless of payer source, to all Minnesotans. Hennepin County also augments funding to ensure access to health care is available to all of its residents.

HHS was one of nine organizations to receive NCQA accreditation for health equity. The application process is arduous. Briefly explain the process and why this program is important for your organization.

Like all accreditations, this takes time and commitment to demonstrate that core requirements are built into our health system and standardized in how we do our work. HHS was one of only two provider systems in the nation to receive this accreditation. The other seven are payers. It is easy to say we are working on health equity but it’s critical to truly demonstrate it in all the work we do and to embed it into the core of our organization as demonstrated with this accreditation. Health care won’t change at the root of systemic racism unless those very roots change. We

believe this is a start. Embedding health equity into our policies, procedures, and practice means it will have staying power beyond any one leader or initiative. Our intent is to truly transform how we show up and how we provide care, and we knew that would take a deeper commitment.

HHS has received some negative news coverage related to its use of medications for “excited delirium” and for the relationship between EMS and police. How have you responded to the issues raised?

We used the opportunity to take a close look at our values and our core functions and we made a couple of critical decisions in response to conversations with our community. First, to clarify our role, we ended the practice of allowing dual employment with law enforcement. We had a couple of physicians who were also law enforcement officers and we asked them to choose one or the other. Most chose to be physicians only and one left to work in law enforcement. We also had conversations about the use of the term “excited delirium” as a condition description and made the decision to stop using it. It was being misused by others, so now we use more precise language about specific symptoms. We also made it clear that the evidence-based use of medications for specific conditions would continue. We trust our caregivers and provide the education and information they need to make treatment decisions and then we support them. They are trained to respond to some of the most difficult medical emergencies and they do so every day. Shift after shift, they provide lifesaving care. We also leverage research to ensure we stay at the forefront of best practices and deploy emerging treatments that benefit our patients.

Since HHS is the major trauma center in Minnesota, victims of violence and others associated with the violence frequently show up in the Emergency Department (ED). What are you doing to keep your ED staff physically safe and how are you addressing the staff mental health issues that are often associated with these kinds of stressful situations?

There is nothing more important than keeping our team members well. They cannot perform the lifesaving care we rely on them for if they themselves are not feeling safe and well. This has proven an increased challenge over the last three years as trauma care demand has drastically increased. We focus on safety and well-being every day across the organization. This includes our daily tiered huddles that recognize team members within departments and across the organization to acknowledge their efforts, their teamwork, and their commitment. We have on-demand supports for team members’ own mental health. Whether it is following an EMS response or a stabilization event, our team members see trauma every day and they feel it too. They would not be the incredible healers that they are if every case did not demand their very best—and that can be exhausting, emotional, and heart-breaking. No matter how many lives are saved, when any one is not, they feel it. We have created response teams internally, we have outside resources available, and we have peer supports. Everyone is on alert to look out for team members who may need to tap out for a bit or need additional support, and our goal is to make that not just ok but encouraged. We moved from “healthcare hero” language to the “Humans of Hennepin”—recognizing our team members in their humanity, their reality, their incredible gifts and emphasize that it cannot come at the price of self-sacrifice, that their health matters and that healers also must have a chance to heal. This will be on-going work. It is exciting to see the culture our residents are bringing in right now—a culture of support, of mental health, and of normalizing self-care.

As the only public hospital in Minnesota, HHS serves many people who are uninsured, homeless/ housing insecure, in mental health crises, and experiencing substance use issues. These factors put these individuals at risk for numerous safety-related problems. What are you doing to go beyond the classic “treat and street” approach to one that addresses some of the core societal issues that underlie many of these problems?

We know all too well that safe housing, mental health, chemical health, and health care in general are a significant part of well-being. And if we are not well, it makes everything else we need to function that much harder. We are working with many community partners to create a true ecosystem of care in an effort to create access to supports and pathways to stability for those we serve. One example of this is at our new East Lake clinic where we are working to bridge social services and health care in a single setting, so there is seamless access to medical benefits, mental health, work and education supports at one site. It ensures that wellness is not just physical but takes into account spiritual care, financial health, cognitive health, and builds a system of support when people need it most.

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Poverty affects not only the individuals who cannot work for diverse reasons, but it also affects those who work full time for very low wages—the working poor. How can you and your organization assist in improving the quality of life of the working poor? Joining the movement of increasing the wages for workers?

We all need to do our part, whether it is helping individuals get healthy enough to work, or as an employer making sure we pay livable wages with benefits and provide career pathways for our team members so they can afford to live in the communities they serve, afford benefits to keep themselves well, and have the supports they need to maintain employment. We have created many of our own training programs to assist people in moving into health care, gaining the training they need while being paid. There are examples of this in our paramedic academy, in our medical assistant/healthcare assistant programs, etc.

What relationships and partnerships does HHS have with state, county, and local agencies who are also focused on enhancing public safety, e.g., Metro Transit, BCA, MPD, DOJ, DOC, Legal Aid, etc.?

As first responders we work closely with other agencies. Whether it is providing medical training for the National Guard responding in Minnesota, covering immunization and vaccination events for the County, or training local fire depts in medical response—we all have a role to play to ensure readiness to respond to what our communities need. We partner with the State to meet health needs and make sure we are ready as a state to respond in case of a state emergency—such as a natural disaster, a pandemic, or other mass accidents/traumas. We work with local responders (police/fire) on emergencies that have a medical need—such as water rescues, acts of violence, or accidents. We train many local departments on specialized rescues to ensure capabilities exist in the community.

With all your past healthcare experience, what advice would you give medical students and residents as they complete their training in relation to the intersection of public safety and poverty? How can student doctors help now?

Understanding what trauma does to your physical health, your interpersonal interactions, and your response system is important. The worst thing we can do as healers is respond to only a presenting symptom or issue without seeing the whole person, identifying underlying concerns, and helping create response plans that reduce the many barriers people face in accessing care and provide the supports they need to truly realize optimal health. We will get better outcomes for lower costs by being more comprehensive. This is smart government in action.

What excites you the most as the leader of HHS?

What is possible when we work together as a community. The mission of Hennepin Healthcare inspires me. It is not about a business model, it is about doing right for and with others so we realize health and wellness together. And I see that in action every day—team members working on transforming health care and providing exceptional care without exception. They inspire me, they motivate me because they dream big, see no limitations, and are committed to being the change that health care needs to see right now!

What are the greatest challenges for the future of HHS?

Creating new care models to meet the needs of our community in new ways, whether it is on-demand care, new staffing models to address workforce changes, or technologies to elevate wellness for everyone. We also are looking at our downtown inpatient facilities and will be making big decisions about the future of our facilities in the coming years as we reinvest in downtown Minneapolis. There is a lot of positive movement and opportunity, and I believe we are well positioned to transform health care. It will be a heavy lift and we need to move fast. I have no doubt we will get there together!

What didn’t we ask that you would like our readers to know about you and/or HHS?

People work at Hennepin Healthcare for the right reasons: they are here for the mission and the community we serve. That passion for this work has carried us through the pandemic, through civil unrest, and into dreaming for the future. It is what creates our “team” here. That will carry us through changing times as we invest in the wellness of our community.