In this episode, Alexis Clark hosts a discussion with five current Master of Health Administration (MHA) students at the University of Iowa about their summer internship experiences in widely different positions around the country. What did they learn? How did their work in the classroom prepare them for these real-world experiences? What did they learn and how will they apply this new knowledge?

Alexis Clark:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Alexis Clark, and if this is your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health. Today, I will be hosting another group of Iowa College of Public Health students to talk about what they’ve been up to this summer. This episode features five Master of Health Administration students who have completed their internships in different sectors, or types of organizations. Today’s guests will be Arika Allen, Danny Bush, Quincy Markham, Olivia Moran, and Joe Promes. Welcome to the show, folks.

Speaker 2:

Great to be here.

Speaker 3:

Hello.

Alexis Clark:

Before we get started, if you would just provide a brief introduction about yourself, where you are from, your undergraduate degree, if you’re only studying Master of Health Administration, or if you have a dual program alongside that and lastly, what motivated you to pursue a degree at the College of Public Health. Arika, would you like to start us off?

Arika Allen:

Yeah. I’m Arika Allen. I am from Davenport, Iowa, and I actually did my undergraduate degree at the University of Iowa as a medical anthropology student. I’m just in the Master of Health Administration program, not a dual program and I would say something that motivated me to pursue a degree in the College of Public Health was I just had a lack of understanding when it comes to how health care systems work. I was a pre-med student undergrad and was really heavily based on the clinical side of medicine, but there’s much more to that. There is what CEOs do, what managers do, analytics that really drives the health care organization and without these entities, there would be no health care systems essentially. I just wanted to learn a little bit more about that.

Alexis Clark:

Awesome. Thank you for that. Danny, what about you?

Danny Bush:

Hey, I’m Danny Bush. I’m from the beautiful Pacific Northwest, Spokane, Washington, to be specific. I did my undergraduate degree at the University of Washington in Seattle, where I majored in economics. At Iowa, I am a law student and also a master of health administration student, pursuing both degrees in a 4-year time period. The reason why I decided to add the master of health administration to my law degree is twofold. One, to simply be a better lawyer in the health care industry.

Danny Bush:

I knew I wanted to practice law in the health care industry, and I figured that by learning how executives think and the problems that executives in the health care industry encounter on a day-to-day basis would help me better to serve them in the client service industry that I’ve chosen to work and also, pursuing an MHA expands my options from simply practicing law to practicing law, or going into hospital administration, or some other administrative role in the health care industry.

Alexis Clark:

Great. Thank you for that. Danny is one of six dual JD and MHA candidates at the University of Iowa College of Public Health. Moving on to Quincy.

Quincy Markham:

Hi, I’m Quincy Markham. I am from originally Sioux City, Iowa. I’ve been in this state for enough time, and then I did my undergrad at good old Coe College in Cedar Rapids. I graduated from there with business administration, neuroscience, and biology and then I went on to get my masters of health care administrator or am getting my Master’s of Health Care Administration and a master’s of public health and policy, so that’s going to be a dual degree. There’s enough electives between the two of them that instead of four years for both programs, you can condense it down to three or two and a half if you’re absolutely insane, but no one’s really done that.

Quincy Markham:

Given my experience coming back into health care administration after jumping through business administration and stuff, I have a family history of administrators, and then my dad was or is a health care administrator. I got that experience, and I wanted to go into the health care field at some point. I have obviously like many people wanted to become a doctor, and my dad was like, “Hey, you should take an accounting class as most kids do during one summer.” I felt like my summers were suddenly dying, but then ended up liking the class, only to find out that I was good at it, kept doing it, and then somehow wound up with business administration as my third bachelor’s degree.

Quincy Markham:

I was like, “Okay, maybe I can work this into a mix.” Health care administration was the light at the end of the tunnel for that solution, and I am interested also in health policy playing at a national, international level and bringing health care administration experience to that when making policies for health care and the patients that we serve.

Alexis Clark:

Very interesting, thanks Quincy. What about you, Olivia?

Olivia Moran:

Hi, I’m Olivia Moran. I’m originally from Lakeville, Minnesota and I got my undergraduate degree from the University of Iowa in Public Health with a leadership certificate and a fun fact, I was part of the first graduating class of the undergraduate public health degree at Iowa and just love the college, love the university, so decided to stay for my MHA degree. I really wanted to get that degree because through my public health undergrad and really discovered my passion for helping people on a larger scale, rather than individual like a nurse or a doctor helping them one-on-one.

Olivia Moran:

I wanted to make a bigger impact, and I saw all the problems that our health care system has and really want to be able to make an impact on that, even on a small level impacting the work and the care that’s provided in our communities really is what interested me in getting my MHA degree.

Alexis Clark:

Great, great. Joe, what about you, last, but not least.

Joe Promes:

All right, hello everyone. My name is Joe Promes, and I am from Jefferson Iowa, which is a small town in West Central Iowa, about an hour northwest of Des Moines. I got my undergrad degree in human physiology and pre-med from the University of Iowa, and what got me interested in public health was some experiences that I had, while volunteering at the Iowa city free medical. This experience really opened my eyes to the struggles that uninsured individuals in the US go through to receive health care, which is something that I consider to be a human right. This made me want to get more involved in working towards a solution for these individuals struggles, and that led me to the Iowa MHA Program.

Alexis Clark:

Thanks Joe. I think it’s really interesting how as we just saw, there’s five very unique stories here, and you never know with someone sitting behind a desk how they got behind that desk. Knowing why people decide to study such a broad degree is really interesting honestly, because everyone’s why is so different and it’s not just a cut and dry formulation to get an MHA degree. Going into that and going into the real breadth of our discussion today, I want to ask you all about your internship experience and what you’ve all been up to this summer because I didn’t just pull your names out of a hat.

Alexis Clark:

You guys have very distinct experiences and different experiences that I wanted to highlight on the podcast today because a lot of people don’t really know what an MHA degree can get you, or what you can do with it. If we just want to go in the same order that we introduced each other in, that would be great and just give us a rundown of where you’ve spent the summer and what you’ve been doing, and what impact you’ve felt that you gave the organization, and what impact the organization gave you. Arika.

Arika Allen:

I did my internship at UNC Health, which they will tell you is very different from University of North Carolina, but it’s still in Chapel Hill. They used to be one entity, and then they broke off into two separate entities. It is an academic medical center. However, they have acquired many community hospitals under their wing, just so that they can have that research as well in the community aspect of health care, so different hospitals across the state of North Carolina. When it came to my internship, I was actually very nervous about it because UNC is top for MHA programs, number one or something like that or number two. The amount of people that actually applied to the internship, but then got it is less than probably like 10% or 7%.

Arika Allen:

There’s only eight spots. We got to essentially choose where we want it to be. You could do quality projects, you can do analytics, you could do law. My summer was spent in the strategic planning department, and I was doing very heavily data analytics for that department. Something that is different from I guess most internships this summer is that mine was completely virtual. Even though I got the opportunity to meet my team in person occasionally, they are trying to decide who is supposed to be on campus and who can actually do work from home. We got a computer, got a laptop, all of those things, but no matter what, I was doing my work completely at home. That was very different from things in the past.

Arika Allen:

People always say, “Oh, you have to be in the office in order to be productive, in order to collaborate with people,” but it really showed how much we have come in terms of technology and how much integration I guess can do outside of the workplace, outside of the setting of the office. I just was really appreciative of the work that I did at the office. I would say some of the projects that I was a part of was facility planning. When it came to UNC, they are trying to decide which clinical program should be on the main campus, or should be pushed off of campus.

Arika Allen:

Just like any other academic medical center, if you have so many different clinical programs on the main campus, it can be congested, patients may not know where to go, it can be confusing. I was pulling data and whatnot to see which ones could be pushed off to different entities, and which ones could stay on campus. They are also going through a lot of construction and building a new surgical tower.

Arika Allen:

Things of that nature is trying to decide… as a leader trying to decide which program should be prioritized, versus which one should be put on the back corner, but also getting your team or getting your doctors and nurses to understand that we didn’t forget about you, but it’s just different things have to be put in place before we can either reach your clinical program, or adhere to what your wants and desires and needs are. I don’t know if I answered a lot of your questions or whatnot, but that was a little bit of my experience. I will say that in terms of like North Carolina versus Iowa, I was looking for something that was different from Iowa. I have lived in Iowa all my life. I did undergrad here.

Arika Allen:

I did my grad program here. Yes, it’s an academic medical center just like UNC. However, the things that they do are very different. In North Carolina, they’re a certificate of need state. Before they build any more beds, any more hospitals, get MRI, any equipment, they have to go through the government, and that is different from what Iowa does essentially, is that even though there’s Duke and UNC and WakeMed right here in this little small area, they’re fighting for beds essentially to reach the needs of the North Carolina patients. That was just a different perspective that I had when I was going to UNC versus Iowa, but I loved it. I love my experience, I love North Carolina, lots of outdoor things to do.

Arika Allen:

I will say I don’t know if we’ll talk about this later, but advice or anything to give later is just put yourself out there. I was scared at first to apply to UNC because I just psyched myself out and thought I wouldn’t get it, but you never know what might happen in the future, or who’s looking out for you, or seeing the things that you’re doing. Just put yourself out there and do what you need to do, and follow wherever you want to go. Yeah.

Alexis Clark:

That’s great Arika, and I think that’s a great and an important piece of advice you just gave. Transitioning to Danny.

Danny Bush:

Yeah. Well, so before I answer that, first I just want to say fun fact, North Carolina has actually one of the most strict certificate of need laws in the union. They need smart people like Arika to go down there and help them fix that, and get hospital beds for people who need it. Awesome experience Arika. Okay, me. My internship couldn’t be more different than what Arika did. I worked at a law firm in Chicago that is a full service law firm. Meaning, that they practice in pretty much every realm that you could imagine, but they also have a very sizable and robust health care practice group. I practiced mostly in that group with the health care attorneys out in Chicago, not to name drop and just say how great I am, but one of my co-workers was Scott Becker of Becker’s Healthcare.

Danny Bush:

Yeah, he’s a partner of the firm I was at and is definitely one of the foremost and leading experts on health care right now, and just a super excellent and down-to-earth guy.

Alexis Clark:

Scott, if you’re listening to this, Danny needs to put us in touch so I can get you on here. Anyway, sorry Danny for interrupting.

Danny Bush:

I’ll send this his way. All right, so what I did. What we practice at the Chicago office or the whole health care group at my law firm McGuireWoods is we practice mostly health care private equity. All right, everyone sit down, take a breather. Let’s unpack this because whenever I say health care private equity, no one has any idea what I’m talking about and that’s fine. Private equity is pretty self-explanatory. It’s money that comes from private sources. It can be anything from really wealthy people who invest in private equity firms. Whatever it may be, these private equity firms don’t get their money from public offerings. They get their money from private offerings, and they use that money to buy company.

Danny Bush:

Oftentimes, they’re in early stages of growth. Sometimes, they’ll buy big companies and make them bigger, but what a private equity firm does is they help those companies grow to a new revenue goal, and then they sell off the company. Private equity is booming right now in health care and if any physicians or any other medical providers are listening, they may end up in a physician’s group or some ambulatory surgery center that is operated by a private equity firm, because I mean frankly, there’s a lot of money to be had. That’s mostly why the private equity firms want to get into it, although there is certainly an altruistic angle to it. With that said, that is what I practiced this whole summer and what I’ll spend the large majority of my career practicing as well.

Danny Bush:

It’s a fascinating area and it’s growing rapidly. It affects everything from physicians to dentists to optometrists and every sort of a type of practice you can imagine. We have to use our skills and the law to get around things like the corporate practice of medicine doctrine, which means that only a licensed physician may own a corporation that practices medicine, which means that a private equity firm cannot own an entity that practices medicine. Lots of legal problems to get around, of course lots of privacy issues because of HIPAA, Stark and Anti-Kickback that we deal with. I spent my summer getting exposed to all sorts of different things that health care providers and the firms that control these providers have to deal with and navigate on a daily basis.

Alexis Clark:

That all sounded really interesting, and I am looking forward to taking this health care law class in the fall, so I hopefully will have a better understanding and hopefully I’m not saying… that was a great explanation Danny, and I know that your education with the MHA program will only accelerate you further with that law degree.

Danny Bush:

Oh, I did want to say one more thing. You asked to mention an impact I had on the organization. I just thought I’d point out that I made no impact on the organization, whatsoever as a summer intern, and I think that’s okay. That’s not really expected of you necessarily to make an impact on your organization, but rather to spend your internship and getting to know the people, and ensuring that you’re a good fit with what you want to be and narrowing down your own interests. No, I did not have an impact on the organization at all, but they impacted me quite a lot and taught me a whole bunch. It was great.

Alexis Clark:

I think I saw on LinkedIn, Danny, that you may or may not have accepted a job offer, so some impact had to have been made.

Danny Bush:

Yes, I’m a future permanent Chicagoan and will be working there, super excited about that.

Alexis Clark:

Congratulations, congratulations. Now moving on to Mr. Quincy.

Quincy Markham:

Yes. Let me take you down to the interesting land of Sedalia, Missouri, or a community-owned hospital. You wouldn’t find a lot of them, but one resides there called Bothwell Regional Health Center. I was placed down there for the summer to experience and work alongside the administration team down there. Something I picked up on real fast is that everyone knows everyone in the rural health care system. Rural health care politics plays a big part. I think through this internship that I was in, I think I’ve got a very good health care administration and plenty of experience for my public health and policy class. If you guys don’t know for whoever listening, we were two hours from and technically in the epicenter for the Delta variant.

Quincy Markham:

When I said two hours away, Springfield was basically the mega epicenter. If you guys didn’t see, the people of the town were literally saying, “Watch us, we’re going to be the canaries for the Delta variant,” because they didn’t want to get the vaccine. One of the greatest men who I will ever know, the CEO of CoxHealth, Steve Edwards, tweeted out to these people to shut up. He said, “If you don’t have a degree in public health and are spreading misinformation about vaccine, you need to shut up.” It’s amazing, but in my internship, I worked with actually a couple of interesting things. I got to participate in getting research for the community health needs assessment, a little easier in some areas and a little harder in other areas than I thought it would be.

Quincy Markham:

I worked alongside our vice president of clinical operations to find a new location for the pulmonary. That was interesting because I got to see a lot of politics playing between physicians. Really interesting stuff and have to figure out how to cut that out and look at purely numbers wise. Because as soon as you get anyone’s emotions mixed in there, the project goes sideways you’re never going to figure anything out. That led to my first realization of my internship, conflict of interest is going to be a massive barrier in any project, and you need to eliminate it. We started working with this company, and they have the first ever FDA approved objective concussion analysis tool.

Quincy Markham:

It’s called the [inaudible 00:19:48], company called [Oculogic 00:19:49]. Really fascinating stuff and they technically had just created the device. We were technically the only hospital in Missouri to have one. My CEO wouldn’t say it, but we’re the only other hospital besides Rush Copley to publicly disclose that we have one. Technically, one of two in the country to publicly disclose that we have them, and there was no real process to set it up. I had to set up the charges, the orders, the appointment types, how to get physician buy-in on a champion physician or nurse practitioner was going to be what my CEO dubbed as the concussion queen, and basically be the lead when I left.

Quincy Markham:

Then we had to get a nurse in on it as well to get buy-in from the nurses, and it was this really interesting process. It’s absolutely fascinating device. I made a whole Snapchat story over my summer and people supposedly loved it, but very different projects and a lot of common themes between them with conflict of interest, politics playing in. From there, you learned that with rural health care, things play down to a lot smaller level. One of the big things with rural health care is a shortage of staff. Bothwell for a couple… I don’t remember how long has only had one cardiologist, who’s been working basically around the clock.

Quincy Markham:

To give you that idea, if that cardiologist wanted to be lazy and go below his contract per patient number and then if the hospital was to say, “Hey, we’re going to lower your salary because you’re not working to the contract percent that we asked you to,” he could basically say, “Fine, I can leave. It’s either you let me work at the level that I want to and you have no say, or you’re just not going to get any revenue in this area, whatsoever.” That was one of the biggest things I experienced is the difference in the power shift between physicians and rural health care, the shortage because it’s hard to get nurses in rural health care. It wasn’t just nurses.

Quincy Markham:

I think the biggest issue that I saw was the kitchen actually. The director herself who was supposed to be playing scheduling and stuff, you could see her pushing food out of the kitchen doors and bringing them up to floors because she would have so little staff. She would have to do her work after her actual schedule. She was basically working 24 hours. She would do the schedule when she got home, and that was just something rough to see, yet very knowledgeable when going into health care administration health policy. Some of those key elements and yeah, definitely things to be brought up and addressed. You might not really experience them in a university or a larger hospital system, but definitely things that need to be addressed before they become too detrimental to the patient’s lives.

Quincy Markham:

The whole thing with the Delta variants, I could go on forever with that. The views and conflicts of interest with the vaccine alone are more complicated than I could ever get into. Being a rural hospital, already struggling with that and then going into a very politically viewed health care topic, it very hard to operate and not feel like you are just drowning under opposition just for whatever reason. Definitely came out of that a little scarred, but definitely a better person and wiser for it.

Olivia Moran:

That’s great, Quincy. Sounds like you had a great experience. I had a little bit of a different one. I was up in the Twin Cities in Minnesota, so more of city setting, a little bit different than your experience, but I interned at park. It’s a unique time for them as an organization right now because they merge with health partners and then a few other smaller rural hospitals actually throughout Minnesota and Western Wisconsin. A lot of their focus right now is trying to operate as a system standardized processes wherever they can. That’s where a lot of the work is going on across the organization and even within the service line that I was in. They’re fully integrated health system.

Olivia Moran:

They have a health insurance side and then the care delivery side. I was more so focused on the care delivery side and specifically, I was in the community based service, so that’s home care, hospice, palliative care, community senior care, and a few other programs. They have a growing through grief program that’s fully sponsored by their foundation, that helps teens or young adults that have lost a loved one. It provides them counseling in school, so very free counseling. It’s a really cool program. My experience was a little different as a lot of our services are provided in the community, in people’s homes. It was a totally different setting.

Olivia Moran:

It was also because of the population that we deal with, majority of our patients are 65 and older. It’s highly regulated by Medicare. A lot of our programs have a lot of requirements, a lot of regulations so that restricts a lot of what we do as a service line, and also makes us really think outside of the box in our solutions, and how we can make our processes more efficient. One of my main projects I worked on was a project called What Matters Most. Just asking patients what matters most to them, so we can get to know them outside of just their medical care. We can get to know them as a person. We can ask them what really matters most to them. For some of our hospice patients, maybe it was making it to a family reunion in three weeks.

Olivia Moran:

If that meant that we had to change a drug, so that they could make it there, that’s what our care team would do. It was really cool to be able to see that aspect of health care and work on. Two of our hospice programs already had it. Standardizing from two processes to one process across the service line, that could then be expanded across the organization. It was a huge learning component for me. Then one of my favorite parts of my internship was getting to do a ton of meet and greets with people across the organization and just understanding the organization itself and how it functions and how it’s structured, and then I also got to do a bunch of shadowing.

Olivia Moran:

I got to go out in the community and see patients in their home, in hospice and palliative care, in community senior care, and our home care infusion. I love being able to connect with patients and see the work that’s being done in the community and see how beneficial it is for our nurses, our doctors, be able to go into people’s home and see actually how their meds are set up, to see if they have their meds. It allows a whole different level of care to be actually in their home and to be able to see the fall risks, and different things like that was really cool and a unique experience, which I really appreciated. Then they also provide hospice and palliative care in the hospital and in a patient setting.

Olivia Moran:

I also got to shadow in the hospital. That was cool to see how they have those conversations with families, how you have conversations about transitioning to hospice when that’s a very difficult conversation to have with patients and families as everyone’s at different levels. To see how our providers were able to meet them at where they are and really educate them on hospice on the dying process was really interesting, and I took away a lot from those shadowing. I learned a lot this summer. It was definitely a different experience, and I got to sit in on a lot of cool meetings and shadow my preceptor who just had a great experience. She’s worked throughout the organization. She has a lot of different areas of knowledge.

Olivia Moran:

I really appreciated hearing her thoughts throughout my projects and just my whole summer internship. Also, just being in the Minnesota health care market, it’s very different than Iowa city. Just seeing the interactions and the relationships that the health care organizations have up here in the Twin Cities was really cool to see them work together. Even though they’re different organizations, they’re very collaborative and they’re always talking to each other. That was really interesting to see how those relationships play out as well, but I really enjoyed being back in Minnesota this summer and experiencing a new organization and learning a lot of different things.

Joe Promes:

Thanks for that, Olivia. My summer experience was a little bit different from everyone else’s in that I interned with a consulting firm, Deloitte Consulting. I was based out of the Chicago office, but as my internship was virtual, I was able to spend all my time in Iowa City. Unlike a norm hospital intern experience, Deloitte, you are staffed on a single project. While you can get involved with other projects, your main focus is on that one project. Mine was a project trying to implement a vendor care management platform at an eastern US health plan. For those listening who may not know, care management is a service that is provided by health care providers and health plans to help at-risk and chronically ill members better manage their health.

Joe Promes:

It involves a more comprehensive care plan than the majority of individuals who see a doctor only when needed, and it’s typically a one-off visit. In recent years, this has become something that’s been more digitalized, and my project was involved with improving the services provided by our health plan. Outside of my main project, I did get to experience what most would think of as the typical consulting experience with mainly travel. I got to travel a little bit, and mostly to the east coast to meet up with some of my project team members, and then to attend some in-person client meetings which was a great experience and definitely something I learned a lot from.

Joe Promes:

The main takeaway that I got from this summer is just the amount of the importance of networking. This is something that whether you’re doing consulting or not is going to be crucial, and it’s definitely something that I got to build more of during the summer and something that will be very valuable coming out of the summer.

Danny Bush:

Okay. I just wanted to say that totally agree about networking, and I think that the internship is largely for that purpose. I wish that I knew a little earlier in my career about networking and how to do it. I think it’s super important, super fun also that the MHA program comes with a pretty robust network of excellent people, who are both serving as hospital administrators, serving as consultants in unique roles, a number who are also lawyers and even lawyers at my firm McGuireWoods so network.

Alexis Clark:

That brings us to something, a question that we try to ask the students that we have on the podcast about their experience. With that being said, the question is what is, something that you have learned about the health care industry or public health that you have yet to learn from course?

Arika Allen:

I’ll go and start. Actually, what Joe was doing, consulting, was a big part of my project for the summer. In terms of strategic planning, they outsource to consultants to give a different perspective and a different viewpoint on what they should do with their clinical programs. I think that in our classes, I never really understood what consultants did, or how they were implemented into the health care system. That was something that I really was fascinated by was the work that the consultants do, and the ability to travel is always nice to do. I thought that was pretty cool. Also in my internship, something that we don’t really talk about is the support staff of the hospital in terms of food and nutrition or laundry services, housekeeping.

Arika Allen:

We got to tour different parts of the hospital. The bed repair and all those services, they’re essential. They make the hospital run on a daily basis, and something that we got to experience was actually in terms of the food for the hospital, if you know me, I’m a big foodie person. The UNC Rex hospital, they try to make their food be like a restaurant essentially. We got to taste the food and when I tell you that who was some of the best hospital food I ever had is awesome and amazing, because what they do is they try to I guess make patients feel at home and make patients feel like, “Hey, like you’re here and the situation may suck, but like we’re going to still treat you like a 5-star like experience essentially.”

Arika Allen:

All of the people there and all the support staff are really very humbling and have done their due diligence in terms of COVID and whatnot to keep these hospitals running, keep the hospitals maintaining. We may talk about the doctors and the nurses and the CEOs of the hospitals, but the support staff are really truly the people that run the hospital essentially.

Danny Bush:

I feel largely the same as Arika, but from a different angle and that’s that in the MHA program, you tend to have a pretty narrow scope, which is how do you run a hospital? Specifically, how do you manage provider, physicians, physician assistants, nurse practitioners, nurses, et cetera on down the list of providers, when in reality there is a whole wide world to health care and how to be an administrator within that. I mean Joe is a consultant going around across the country, using his skills as a health care administrator doing different things. I’m going to be a lawyer, but I mean there’s so many different ways to utilize the skillset of a health care administrator, other than being the CEO of a hospital or a health system.

Danny Bush:

I think that it’s a great thing that the MHA program teaches you how to do that because number one, that’s what most people want to do and number two, that’s I guess in a way of the pinnacle achievement of having an administrator, but there are so many other ways to successfully and fulfillingly assume a role as an administrator, and whether it be in my industry where I got to McGuireWoods who focuses on health care private equity. It blew my mind the amount of private equity operating in the health care space, because my study is focused on especially on the law side, health care system’s emerging, the privacy issues that health care systems face.

Danny Bush:

Then I go and I see these other things, like physician’s groups and how they operate independent from hospitals and it’s certainly a whole wide world. Arika’s point about the support staff, all these other key elements these, things that are of equal or greater value than just managing providers is something that was really excellent to learn over the course of the interview.

Quincy Markham:

I guess I can go next, but more of what I was learning was how do you retain those. Sure, managing providers is one, but how do you retain them? In the world of COVID and this second wave that turned out to be worse, how do you keep the staff motivated and feel like this is worth it, because they started seeing so many walkouts Even with increased pay, nurses would be responding, it’s like, “You can’t pay me to go back into it,” and their frustration and feelings of failure because they see all these people going against the vaccine and stuff. It’s basically how do you maintain moral support in a situation that is by and large extremely difficult and disheartening to watch.

Quincy Markham:

Then on top of that, mandating the vaccine I think was one of the biggest arguments. At University of Iowa, I think its vaccination rate is 95% around there. Yeah, Bothwells was 60 or is currently 60, and that is very common for hospitals in Southwest Missouri. The biggest fear is if you mandate the vaccine, you can have up to 40% of those employees that you’re already short staffed. You can’t tell them to walk out because you’ll have some easily take out their job. You need them desperately. There’s the fear that 40% could walk out because you’re telling them to get the vaccine and like I mentioned earlier, rural health care, there’s a shift in power.

Quincy Markham:

Since there’s a shortage, the employee has almost more power than the employer. It was basically you’re fighting a couple of different fronts throughout the vaccine and COVID, and basically just trying to… sometimes, it feels like you’re just trying to keep your head above the water and other times, it feels like you’re more strongly united and things are getting better, but yeah, interesting.

Olivia Moran:

Quincy, that makes me think of back up here in the Twin Cities. All the health care organizations came together to mandate the vaccine at the organization. Employees even if they maybe want to leave, all the health care organizations really band together to come up with that. I thought that was interesting, but one of the things that I learned this summer that we really don’t touch on in coursework is a few things. We talk a lot about mergers and how all these health care organizations are coming together, and they’re getting and bigger, but I think seeing how that plays out in real life and how it’s a slow process to merge to organizations and all the cultural issues and employee satisfaction, and how that takes time and how it’s very relationship based was really interesting.

Olivia Moran:

I think expanding on both of what Danny and Quincy said to just staffing and really understanding those relationships with the front line staff, I think that’s something that we talk about in coursework is how important the relationships are and talking with people that do the work, talking with the nurses and the doctors, but I think seeing that play out in the real world is very interesting, something that I really learned this summer, the importance of making sure people feel heard and not just going in and changing a process, but really including them throughout the whole process.

Joe Promes:

For me, the biggest learning experience was being able to actually step outside of that health care provider point of view and work with a health plan, and see the health care industry from their point of view. Like Danny said earlier, much of our coursework is focused primarily on that health care provider administration, but this was an opportunity for me to view the operations and strategy from the health plan point of view, particularly focusing on strategy of the next five to 10 years, where you’re looking at improving the customer experience with better member engagement, and then also with interoperability which has become a big one over due to recent legislation forcing interoperability among health plans.

Joe Promes:

Even if I end up working with a health care provider later on in my career as consultant, it will still be a huge benefit to have that experience of viewing the health care industry from the health plan point.

Alexis Clark:

Yeah, thank you all for those great answers. We’re running low on time, but I want to make sure we ask this question because it’s a traditional question that we like to ask every episode, but just being mindful of time when you are giving your answer. The question is, what is something you thought you knew, but were later wrong about? Arika.

Arika Allen:

We took an analytics class with Dan, Shane and I thought I knew Excel very well after that class. However, I knew absolutely nothing when going into my internship. I was very data analytic heavy. I would say that’s something, even though we go through this program, we get two years of literally dip and dabbing of different entities of how to be a health care administrator, you truly don’t know until you are in your role, or you are in that organization because every organization might do things differently. I think you don’t know what you don’t know honestly in those sit situations.

Arika Allen:

Yeah, I would just say another piece of advice if you were to go into an internship or into a career, or anything after this is that asking questions and understanding that you might have gone through a year of an MHA program, but truly you start at ground zero when you get to your internship. Yeah.

Danny Bush:

Well, Arika because I was going to say I thought I knew how to do my job, but turns out I was wrong. No, it’s so true though. I mean from the perspective of a lawyer as well, law school does not prepare you at all to be a lawyer. I think the master of health administration prepares you a little bit better to be a health administrator, but what it really takes is getting experience, finding a mentor who is willing to take you under her or his wing, and really latching on to that and being open-minded and learning the rest of your career. I imagine I will probably always think that I don’t know how to do my job because there’s always more things to learn.

Quincy Markham:

I think mine probably would like through my projects and stuff, I think the world of hospital charges and clinical charges is a nightmare. That was a big thing that my CFO dumped on me. Means nothing, it means everything that only makes sense when you actually get some experience in it, and the insane world of EMRs and the organizations that produce them such as Epic and Cerner, very complicated, so many third parties and almost all of the time, you feel like it’s either bugged or unreliable. Thought I knew some about it and well, we’re trying to make a switch from our EMR system over to a Cerner one, and a third party somehow completely forgot to do something.

Quincy Markham:

We had to wait for a full month for something to happen and never did. It’s a very complicated process, and I went in thinking I knew somewhat about it. I was like, “Oh yeah, we’re going to do data validation with Cerner.” Then over the next course a couple weeks, I felt like I was losing hairs from pulling them out and trying to figure things out. Yeah, definitely, definitely will have to need more experience to speak or understand it better.

Olivia Moran:

I would say my thing is so I had a lot of projects through my graduate assistantship with the University of Iowa physicians, and I learned so much from leading that my first big project. I think this summer going into leading another project, I thought that I was going to know a lot more things, be able to add those learnings from my last project, but there were still so many things that I learned from leaving this project, things that I would do differently. Going off what Danny said too, you’re always learning, you’re never going to know everything. Finding someone that can really coach you through that and provide you with resources to help you grow and learn I think is something that I learned this summer and will always take with.

Joe Promes:

For me, I thought I knew how to stay effectively organized, but I learned that I was wrong. I was given a project manager role within my project. Not only are you responsible for keeping yourself organized, you’re also responsible for keeping the rest of the project team organized. It was something I definitely struggled with early on, but like Olivia and Danny mentioned, there’s people you rely on to help you learn the tools and tricks, and I eventually showed progress throughout the summer.

Alexis Clark:

Very good. Well, that’s the end of our questions everyone. Thank you all so much for joining me. I have learned a lot about your experiences this summer, and I’m sure everyone listening has learned a lot about your vast experiences.

Olivia Moran:

Thanks Lexi.

Alexis Clark:

That’s it for our episode this week. Big thanks to Arika, Danny, Quincy, Olivia, and Joe for coming on with us today. This episode was hosted, written, edited ,and produced by Alexis Clark. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify Apple Podcasts and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Stay happy, stay healthy, and keep learning.