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Illustrated image of Sara Bolton

NORSE DECODE with Sara Bolton

Sara Bolton, Senior Vice President, Programs & Services at The Health Collaborative

July 2020

Interview with Emily Geiger, IHI Innovation Fellow

Connecting dots, empowering people, and stewarding health improvement projects. That was Sara Bolton’s day job at The Health Collaborative before COVID-19 put the boldface type and blinding spotlight on public health this spring. Now she’s a part of a 24/7, high-stakes team whose mission critical role is coordinating our region’s COVID-19 response. 

In our next Norse DeCode series, we ask Sara frankly about the toughest moments of the COVID-19 response and glimpse into her Magic 8 Ball to predict the key tenets of a sustainable public health system built for more equity and better outcomes.

2020 has been nearly a perfect storm for you and your team at the Health Collaborative: a global health pandemic, the social movement in Black Lives Matter and an economic crisis, to boot. Are we done yet?

Right? I think we could all go for a few uneventful months. Regarding the work: there is so much more to do. The Health Collaborative is positioned to help push our region toward a more equitable community, where all members have the opportunity to thrive. Calling out structural racism as a public health crisis is step one. Now we need to act. COVID-19 has only shined a brighter light on the immense health disparities that exist here in our region and across our country. We must do better. 

What were some of the toughest moments for you personally and professionally in the COVID-19 crisis? Most inspiring?

Home schooling small ones, with both parents working crazy long hours was… interesting. On the upside, my kids are much more self-sufficient these days! Professionally, this has been extremely rewarding. To help coordinate our region’s response to COVID-19, bringing together the hospitals, local health departments, nursing facilities, and other leaders to work together is truly humbling. I’d be remiss if I didn’t acknowledge those on the frontlines who are doing the real work.

I've noticed you've partnered with unexpected partners like P&G for their consumer expertise and messaging prowess for the "Masks On" public health campaign. How did that come about?

Cincinnati is so fortunate to have companies like P&G and Kroger who have been ready to help from day one. The Health Collaborative partnered with the Cincinnati Regional Chamber to create the Regional COVID Communication Center (RC3) to align messaging and create a source of truth for information. As we watched the
cases rise and hospitalizations creeping back up, we knew we needed to get a message out before the July 4th holiday, and P&G was there to make it happen.

Prediction time: how does the rest of the pandemic response look for the rest of 2020, going into 2021?

My magic ball is in the shop, but my educated guess is that we are in for a bumpy fall. Kids will be heading back to school soon and we anticipate increasing cases. If we can do what we know works: masking, hand washing, and social distancing when possible, we can keep numbers manageable. But, we need everyone on board. Unfortunately, public health has become political.

Recently, public health leaders like yourself have had their shining moment in the limelight. (And some, unfortunately, have received their fair share of public grief.) Who do you look up to and reach out to for mentorship? 

Dr. Acton was such a calm during the storm, and she certainly taught me a lot about leadership and working under pressure. She wasn’t afraid to make the unpopular choices. But, I learn something everyday from our local leaders like Commissioner Melba Moore, Dr. Evie Alessandrini, and Dr. Steve Davis. I could go on and on. We have excellent leadership in our region.

How will public health evolve? What will be the practices in 20 years?

Public health has been grossly underfunded for decades, and we are seeing the consequences of that unfold in real time. The US has created a best in class “sick care” system. We need to invest upstream, in public health and education, if we expect a healthier, more equitable country.

You're a Mommy of two boisterous young boys. How does this affect your work-life balance and perspective in your career?

Work-life balance is a daily struggle, especially when you have children. The guilt can be all consuming. Now that I work from home, the lines are even blurrier. My colleagues know that at 7 p.m. I check out for family time, no exceptions. That has been a helpful boundary.

How will your boys' describe what you do on a daily basis?

Talk a lot on the phone? Ha! They now ask if I’m on a “listening call” or a “talking call” upon entering my home office workspace.

Rewind 20 years: if you weren't doing what you do now, what would you be doing instead?

I was 100% positive I’d be a physician.

Dogs or cats?

Dogs!  We adopted a pit bull recently and she’s made our family complete.



Illustrated image of Doug Flora

NORSE DECODE with Doug Flora

St. Elizabeth’s Executive Medical Director, Oncology Services Doug Flora on cancer care during COVID-19, the evolution of a holistic patient experience and why his favorite superheroes’ nerdy alter-egos may be the perfect match for smarter medicine in the future.

Interview with Emily Geiger, IHI Innovation Fellow

You've been busy this year - breaking ground on a brand-new greenfield cancer center at St. Elizabeth, fielding community conversations about COVID-19 and more. What's been your biggest challenge?

The building process for the cancer center obviously remains a huge priority, especially as we need space more than ever post-COVID-19. The new building will allow us to spread out staff and patients, especially if a fall surge in cases materializes as expected. More so, the challenge of maintaining our associates and patients safety keeps most of us up at night for the last few months. I feel blessed that our community pulled together to significantly reduce the impact of the virus on our region when other regions were struggling.

What do you expect will be the biggest challenges in your role for the duration of 2020?

For us, it is all hands on deck to keep our hospitals, physician offices and cancer center meticulously clean and open for cancer care. Cancer patients don’t have the luxury of taking this pandemic lightly, nor can many of them tolerate delays in screening or treatment. We are alongside them fighting every day to provide our best, cutting-edge care.

Do you like being a face of the community? Why?

I understand the role I play here as a visible member of this medical community, along with the larger role that St. Elizabeth plays as a community partner, and I take this responsibility seriously. This region deserves the best we can offer, and I’ve tried to represent us well arguing for important advances in cancer prevention, screening and early detection. While I might be the guy with the megaphone right now, cancer is a team sport.

You helped set up a center of excellence for precision medicine and genomics. What does the future of cancer care look like?

Much smarter. Over the last few years, we were able to finally solve puzzles in cancer that had eluded us for decades. Good science is catching up to cancer. Now, our cancer medicines are more targeted, less toxic and changing the paradigm in cancer care. We can screen you for genes that place you at risk, choose drugs that exploit weaknesses in your individual cancer, and are seeing survivals now even in rough diseases like lung cancer we’d previously prayed for.

Patient experience has been a big investment for your cancer center and St. Elizabeth. (I hear there's a spa!)

Our patients are at the center of everything we’ve built in the new center. We call it “Whole Person Care” and believe that offering local access to cutting edge clinical trials while also being able to nourish the soul with massage, yoga or meditation makes perfect sense for our patients. Who says we can’t treat the tumor AND the person both well at the same time?  We want to support our patients in their journeys however we can, and that means being right here for them no matter what they may need. 

How does this holistic cancer care experience translate to outcomes?

Emerging evidence is speaking to the importance of addressing stress, anxiety, insomnia and other symptoms related to either having cancer or the treatment itself. For example, we know that things like mindful meditation or exercise have been shown (especially in breast cancer patients) to reduce anxiety or insomnia, and exercise actually seems to reduce the risk of recurrence of some types of breast cancer.

How are patients' expectations different from when you first started to practice medicine?

I think today, physicians and patients work more in concert, as a team, and this is a great thing. Search engines and the rise of social media have allowed patients access to mountains of information, chat rooms with other patients, etc., which has helped build a much more engaged and curious patient. We are having more detailed and informed discussions now, and I think, as a result, patients benefit by maintaining a bit more control in the chaos of their daily lives.  

What's missing in medicine today?

Time. Everything is so rushed. This makes being both a physician and patient much harder. It is such a treat these days to have 45 minutes to sit down and get to know the person entrusting you with their care, and this seems harder and harder as the number and complexity of ill patients only continues to climb. We need more people to seek careers in nursing or medicine. 

What is your one wish for a disruptive change in the way you practice medicine?

We are well behind the regular world in real-time communication. I want to see us work harder in the next few years to better leverage technology in order to free up time for us to sit with our patients again. Artificial Intelligence and voice recognition should help us record our visits and replace antiquated data entry within our electronic medical records platform. So much time is lost to charting. 

Does it get exhausting picking out bow ties every morning?

Absolutely lol. I started wearing them instead of regular ties a few years ago to reduce the spread of infections from bed-to-bed on hospital rounds –never dreaming that this would be a thing I’d be asked about today. Now if I DON’T have one on, people look worried about me. I think it’s taken on a life of its own with me serving as the unofficial mascot of our cancer program over the last few years. Most of these bow ties are actually pretty relaxed and my patients laugh when the tie has rubber duckies, dragons or puppies. I guess it’s become a form of self-expression and lets me relax a bit and laugh with the people in my care.

Who's your favorite superhero?

Lately ALL nurses, but I assume you mean the comic book kind of superhero. In that case I must admit that growing up reading comic books the ones that resonated most with me were the superheroes with the nerdy alter-egos, trying hard to save the world. I have a lot more in common with the Peter Parkers of the world than I do Thor or Wolverine.

Good-hearted guys using science to make the world a better place. Yep. Those are my people.