Jason Dana Costa 0:00

Hi, everybody. Welcome to Worth to Work with Jason Dana Costa. Today we have Dr. Brooke Tillman, who is a behavioral health executive in hospitals and healthcare, and they transfer our growth in some incredible challenging seasons. Her career has been on improving access, strengthening operations, building systems that deliver better outcomes for both patients and the people they serve. Ms. Tillman, welcome to the show.

Yonzetta Brook Tillman 0:23

Thank you for having me.

Jason Dana Costa 0:25

Excellent. We really appreciate you. How's things out in New Jersey today?

Yonzetta Brook Tillman 0:28

Things are great weather right now. It's been a little hot and now it's calming down. So that that is a big benefit.

Jason Dana Costa 0:36

Oh, I know having been down in New Jersey a few times, it can get to be a bit muggy. So I'm always happy for the fall season. So here at Worth the Work, I try really hard to connect your family of origin and things that you learned when you grew up to how you're a professional today. So I'd love to learn from you. What do you learn when you grow up that still sort of shapes how you lead today?

Yonzetta Brook Tillman 0:57

Sure. One of the first things that comes to mind is community. It's funny that you asked me that because I just expressed this in a meeting yesterday. An introduction to our board. But nevertheless, our community in the era that I grew up with, it wasn't just my parents that looked after us. It was also the neighbors. So they felt as though they needed to tell us go in a house and put on a jacket is too cold or any kind of corrective thing. They all contributed to rearing us in a very positive direction. From those origins came into the interest of community work, collective, collaborative teamwork, also working to better the community that you're part of and at large. So those are some of my fundamental growing up experiences that transitioned into me as a professional.

Jason Dana Costa 1:47

Wow, that's fantastic. I agree that it takes a village, as they say. It does take a village to sort of get you where you need to go. So someone in that community may have seen leadership in you there. Is there someone there that you could tell us a story about that saw your potential leadership, maybe before you even saw it in yourself?

Yonzetta Brook Tillman 2:06

Yes. So I started at in behavioral health per se, and Belmont Behavior Center in Philadelphia. And I had a VP, Diane Buchter. And it seems as if my new onboarding as a supervisor, everyone kind of disseminated to other positions. So it was okay, Brooke, you're it. You're in around looking over the department. And she was very supportive, but she gave me the best of compliments by saying, you're very detail-oriented, your organizational mindset. It helps us with strategic planning. You're really good at strategic planning. And that piqued my interest to not only more so be more collaborative, but think for the future. Think of what can be and what can't be, and how to try to prevent that. What catapults it the interest in public health? What can we do preventively? And when we can't, how do we respond proactively to minimize the damage?

Jason Dana Costa 3:06

Huh. So it sounds like you inherited something literally in that job and you sort of stood up to the challenge, for lack of a better phrase. Is that reasonable? So when you did that, I'm sure you may have gone through an evaluation process. So what helped you decide what to preserve or what necessarily needed to be rebuilt when you sort of, for lack of a better phrase, got handed this thing?

Yonzetta Brook Tillman 3:27

Well, the very strange timing of this is 9-11. I was at that facility during 9-11. And we had to brace ourselves for any calls we were going to receive, being only two hours away from New York, and what that would look like. And so all of the news outlets had given us a small glimpse of you're going to be flooded with calls. The city had tried to prepare every facility. You're going to have a lot of trauma coming in. And more so, not just the physical health, but the behavioral mental health. So our lines did uptick, our evaluations upticked, and it just again fortified how you need to prepare for the worst while hoping for the best. And it gave, again, another format of strategic planning. You have to prepare for what can be the worst possible scenario and how you can best meet that need of the community.

Jason Dana Costa 4:24

Wow. So that's twice now. You've mentioned strategic planning. So tell me what some of those major tenants are that you sort of look at when you think how to strategically plan about some initiative you want to do. Walk me through the Dr. Filmment process.

Yonzetta Brook Tillman 4:41

Well, if in forecasting, which is much of a component of strategic planning, you're looking at that historical data. You're looking at the events that occurred, and you're trying to predict in your best form of utilizing and analyzing this data, what can happen. If we know in the past five years, around a certain season or a certain time of the year, we had an uptick. The most prevalent thing I can tell you is the flu. We know flu season. So we know that in the past five years, we hit this number of this population and this region, this age bracket, whatever demographic, you can try to prepare for what you're going to support those kinds of ailments. And we're talking about flu, the flu shots. All of those things become a big factor of history, the data, the present time, and what we have as far as resources and what we need to collect additionally for resources and time that out over time. Resources is not just money, it is also the people, our systems, especially EHR or EMR, electronic medical or health record, that has become a big part of decision making, data analytics and of course AI, being able to predict something for the future in order to prepare to handle whatever comes your way.

Jason Dana Costa 6:00

So a key tenant for you is historical data, you know, looking at the past. So what tools do you use when you're looking at that historical data to sort of create that forecasting for yourself?

Yonzetta Brook Tillman 6:12

Well, we're looking at the trend. We're looking at the impact, how people were impacted, what level of impact it was, and that will help us determine how many resources or support we need to sustain in order to meet that need. We're looking at how many were in any kind of element from a triage standpoint to hospitalize to any morbidity or mortality. And we then look at if we had a 10% mortality, what do we do to prevent? What are the steps we need to put in place and what contributed to that level of mortality or morbidity? And those are the factors that you look at when you're trying to plan resources for the future, to have them at a on a standby level, but be able to put them in play as soon as you need them. And part of that strategic plan, when we're talking about resources in particular, you have to look at what still works. Now, if we have a five-year timeline and in year two, something completely changes, we have need to come back into the future. A very good example of that is when we went through our COVID period. And going through COVID, it morphed into a different variant and a different yet a different variant. And so that first vaccination wasn't the end all and be all. You had to keep and keep researching to what can happen in the future and how we need to make our vaccinations more potent for ever-changing viruses.

Jason Dana Costa 7:41

So I hear is the second tenant there. So first look at your historical data. The second one that you there, it sounds like you created multiple scenarios. What if 10% of X here's what it might be, or what other sort of situation, and then you decided on what was reasonably well prepared based on the historical data and a couple of your assumptions. Is there anything else you think of in that strategic planning for yourself?

Yonzetta Brook Tillman 8:05

We do. We look at present time and we look at who else has done it. Sometimes you really don't need to reinvent the wheel. So having colleagues and doing your research to see who else, not nationally, but also internationally, has come upon these concerns that you have or these problems and see what, again, collaboration you can come up with to mitigate those. I can tell you the World Health Organization is a perfect example of helping all of healthcare landscape mitigate some national and international concerns that are in common.

Jason Dana Costa 8:38

Great point. So the third point there is sort of look to your peers, see if somebody's already figured out how to solve the problem and can you adapt it. Is that reasonable? So a couple of times there, you've mentioned COVID, which was something I was going to ask you because I saw in your professional background, you were leading a state psychiatric hospital during COVID. That is a challenging season to say the least. And recently we're at the work, we were talking to somebody about sort of how COVID sort of not only impacted the employees, because we started out from an HR standpoint, but they were in the behavioral health space. So, of course, there was an explosion of attention for behavioral health at that particular point. In their organization, they were in the community experience. In a psychiatric hospital, for lack of a better phrase, you're already dealing with the people that are already seriously impacted. This is an inpatient situation, and I'm going to assume that's a lot of pressure. So, what did that sort of season teach you about leading under that kind of pressure?

Yonzetta Brook Tillman 9:39

Strangely enough, and leading during that time, and it was very tumultuous. It's not only the patients that we serve, but it was the employees as well. And those dynamics were very, very heavy. Everyone thought that they were going to die. So there is no worse scenario than I'm dying. I'm dying, I'm going to die. And the one thing that held us together was having a cadence and something that can relate to the norm of our normal life before March 20th in our hospital had hit. So we had regularly scheduled meetings, we had regularly scheduled check-ins, and we really looked at all of the data that we were looking for from day to day, from our PPE levels for our hospitalizations. We tried to provide surge for the state, and we were unable to become a hybrid for any new COVID in the community. But nevertheless, going over all of this information, this data up to date to the moment, keeping a timeline and a very tight communication with the staff within the hospital, it led to some level of normalcy. Some of us, of course, were there 24 hours around the clock. And how can that ever feel normal? But if you know at eight o'clock we're convening and we're going to discuss, and then we're going to follow up with an action plan. And then we may have to revise our action plan. But where we're currently moving in a certain direction and looking for those outcomes in small increments, it gives you you're working towards nothing, something. You're not just sitting there stagnant, and it's working towards something that's going to have a positive outcome. The goal is always to stress and emphasize this is going to bring us out of it. This is going to bring us at a better level, therefore. And that helped us along the way.

Jason Dana Costa 11:30

Was there any difficult thing that you had to figure out how to communicate to make sure you were keeping and/or earning the trust of these frontline workers? Because this is a major change. I mean, you said it yourself. I'm worried I was going to die. So creating that trust and safety must have been almost a constant job.

Yonzetta Brook Tillman 11:47

It really was. In the beginning, of course, everyone didn't have the number of PPE they needed. So it was almost as if who's going to communicate to the staff that please keep your masks. And it was that little level was of a higher stressor. But more importantly, the population that we both served and employed were of minorities. And the biggest factor was the COVID vaccine. No one wanted to take it. It was too new. We don't know about it. It was a major concern. And I really did think it was our job as leadership to say, how do we convince them this is the best practice for not just them and their families, but also our patients. And so I solicited the help of Dr. Miller and Dr. Watson, who were psychiatrists, medical doctors, and nurses that really came to the forefront and said, Me being a person of color, I have received the vaccine and I received it because I take care of my mom and I have a family. So it gave the message of right now, the world needs us as healthcare professionals. And the last thing you want to do is take us out. So if we are comfortable with taking the vaccination, we employ that we should hope that you would take be comfortable with taking it as well. And amazingly, that changed around. And we had more participants than before.

Jason Dana Costa 13:13

Wow. So a truly lead by example moment. You found people that are going to engender trust and get them to be upfront and lead for as examples.

Yonzetta Brook Tillman 13:22

Yes. Yes.

Jason Dana Costa 13:24

Wow.

Yonzetta Brook Tillman 13:24

Very great. Anything else you think that helped earn the trust during that period? Being present. Definitely being present. All of leadership was there day in and day out. We provided a lot of complimentary things for the staff in order for them to embrace this very overwhelming challenge from finances to food to shelter to being in the trenches with them at any given time, facing patient care directly with them. That really did build trust.

Jason Dana Costa 13:54

I agree with you. I worked at a community mental health center during the time of COVID and was both amazed at accredited organizations' planning skills. At the time, so I'd worked for nonprofits for 30 plus years, but literally having four totes that said pandemic on it with the instructions inside the box. Here's what we were going to do. J. Cos said to do this. It was a testament to that strategic planning. And I just wanted to share this is not always on the fly. Healthcare organizations have to be prepared to do this and do spend the energy and the time to prepare for it. I was so blessed to literally have three totes, pandemic. I had my mask on and went open the door. Hey, there's the four pandemic boxes. And to boot, even the masks weren't spoiled yet, which was amazing. Everything else we had replaced at an appropriate time. So I don't know if this happened to you and your hospitals, but I can say this happened to the community mental health centers. Sort of all this money poured into COVID and we did all the things and we got on the other side of the disease by and large, which is fantastic. But then came the reckoning, for lack of a better phrase, and some of those cost of revenue streams were no longer there and costs had to be cut. It's very clear looking at your history that you've been able to improve patient safety while cutting operating costs. So I was curious to find out how you found those efficiencies without losing the, frankly, the humanity of the care you were trying to provide. What's Dr. Brooke Tillman's secret sauce of maintaining that?

Yonzetta Brook Tillman 15:22

Well, we are always in healthcare, especially in community health, we are always in the realm of do more with less. It's not a great phrase, but it is the truth of what we do. So we are always looking for what are we using that is called that gap or waste? What is it that we can cut down on? I can tell you that electronics cost more upfront, but they do pay off the cost of these high expenses of what we know now to be labor costs, time off costs, supplies plummeted to the top cost of anything from sheetrock to food. So in order to manage that, it really was to diversify our workforce, to look at how we are maximizing the top of our licensed professionals and doing basic clinical and focus on the clinical and take the clerical tasks off of them. And that's where some of our electronic medical record and implementation did help with that. And then our support staff for them not to have to be overburdened with anything outside of their scope and have them really concentrated on their tasks and drawing out that workflow that the time that they're doing it is used efficiently and effectively, and that we're getting the most production that we can. In addition, the supplies that we need to pay for. We really did look at who is the best vendor and not just a cost-cutting measure, but the quality. Are these types of galls or any medical supplies going to last longer versus getting the cheapest route? And how does that phase out? And looking at all components of your budget and where you can minimize and maximize and offset those costs. It is a very micromanagement type of function that you're doing when you're looking at resource management, but it takes a deli emphasis on what we're using from equipment, from our workforce, any type of supplies and those costs at our risk. When we're looking at, we call it a nice word, but it's more of anything that is taken away from us in the regards of theft or overusage. Looking at that as well. What is it that we are not seeing that we can capture? And that is all for us having an optimum bottom line to not only care for our patients, but also our employees.

Jason Dana Costa 17:47

Wow. So clearly you're a consummate healthcare professional here, particularly in hospitals. So I'm sure you must have experienced at some point where the mission and the financial reality are on opposite directions. So what's one of the toughest decisions that you've had to make when they're really pulling in opposite directions?

Yonzetta Brook Tillman 18:06

Well, right when the time you're talking about when COVID did die down and costs went up, everyone was paying overtime because our workforce had depleted. And we were paying overtime out the roof. And so the company just was really on all of us, we can't sustain this way. And they were right. So in taking the team and looking at, let's do our strategic plan, we had implemented internal type of programs for incentives versus just a flat overtime rate. So if you did 10 weeks at a time, you would receive this amount of bonus, but it carried you through the 10 weeks. In order to do that, we aligned with our recruitment and retention planning. So we were really micromanaging as we developed five new employees. We knew this was taking five overtime costs off of the table. We were making sure that we had insulated our new employees with another education and a mentor so that we wouldn't lose them and we would retain them. And looking at that one process helped with costs immediately. So while overtime did go down in a gradual basis, we were able to not go right back into having people leave out of the company and then having to pay enormous overtime costs. Because it wasn't just about the money of overtime, it was more of overburdening our staff with working more hours than necessary and draining them to where they would quit or didn't want to come back into work. So really working with the nursing team and the clinical team on how we really phase that in and really just instilling what the overall objective was, which was patient care.

Jason Dana Costa 19:48

Wow. So truly being intentional and taking it each individual step, particularly from a human resource standpoint, is what I'm hearing. Get that correct?

Yonzetta Brook Tillman 19:58

Yes. Yes, you did.

Jason Dana Costa 19:59

Sounds like a great story, really does. So this podcast is called Worth the Work. So after everything that you've experienced, that you build teams, you build organizations, what helps you truly identify something's worth continuing to invest in, even when you know the road is difficult ahead? Because clearly, Dr. Sillman, you've navigated 9-11, COVID. You work in a psychiatric hospital, you do difficult work, but clearly you're staying in there. Something's got to be worth the work. How are you identifying it that it's still worth that investment?

Yonzetta Brook Tillman 20:31

Well, this may seem cliche or may sound cliche or mundane, but really when you get a call from a parent or a loved one and they thank you for what the organization or the doctor or the nurse or any social worker, any team under you or you yourself have accomplished in helping their loved one, that resonates. It resonates because we all have families. We have parents, we have siblings, we have children, we have spouses. And when we are in need of some help, and the help that we get, we're looking at the lens of what people are looking at us in our profession. And when someone says, I made it through, I felt better when your team or you helped me with this. There is no amount of money that goes with that. That is an internal gratification that says, We did something good here. We helped someone. I used to have a coworker that would always say, Let's go save a life. And I was like, You're being so extreme with save a life. But on the flip side, that is what those who come into our front doors for access to care. That is what they're thinking. I need help for you to save my life, rather be medical or mental health. It is really the auspices of why they're coming to you. We need help because evidently we can't go on another day if we don't get any help from you. And that is overwhelmingly. I just had a story in the community visiting residences, and one of the frontline workers expressed to me they had a morbidly obese consumer, and their blood sugar levels were just out of the roof. They were not even able to be really mobile. And in a three-year turnaround time, they are under 200 pounds when they were over 300, and their blood sugar levels are regulated, and they are now working part-time in the community. And that one person is like, that's all it takes. That's that one turnaround is all it takes to say we can do more. And that is again so internally gratifying that you can help someone in their time of need, that now they'll pass it on and they can share their experience. This is what I went through. So if I could do it, I know you can. And these are the steps that took, and these are the folk who helped me. Very great referral to say, what we do works. What we do works here.

Jason Dana Costa 22:50

Wow. So a real story of paying it forward in the community.

Yonzetta Brook Tillman 22:54

Definitely, yes. Yes.

Jason Dana Costa 22:57

Well, that's a fantastic place, and on Dr. Brooke Tillman, thank you for joining us here at Worth the Work. I appreciate all that you're doing out there, helping the community in New Jersey. Thank you so much for joining us.

Yonzetta Brook Tillman 23:08

Thank you for having me.