<p>hello everyone this is Cole from the American Journal of healthcare strategy I'm joined this evening by a very special guest kadesia Ralston kadesia please introduce yourself hello everyone my name is kadisha Rolston I am an administrative fellow at northwell health I am just started my fourth rotation I have actually been with the organization for six years but started my fellowship last July I am a New York native born and raised and really excited to be here with you tonight I love my fellow northeasterners here that I get to have on and talk to everyone from the New York City and Philadelphia area so I appreciate being able to talk to you about the weather that we've been getting with that storm coming through and that earthquake that we had a couple been insane it's been wild so you know northwell very well-known institution known across the country competitive fellowship program as well so I want to go back to the beginning though where you were at a Boston University Y what led you to go to Boston from New York and why did you do the degree program that you did there yeah for sure I went to Boston because I wanted to get away but my parents wouldn't let me go too far so Boston is the first that they'd let me be I did a degree in behavior and health I knew that I wanted to be in the health care realm but didn't know what that looked like so I wanted a degree that would be broad enough that I could keep my options open but still focused in the healthcare space I thought I wanted to do medicine but chem 101 told me that that was was not my path but I still knew that I had a place in healthc care and behavior in health was the degree I chose to help me get there and I I think that's an excellent an excellent choice there Boston University I know has a really good health sciences and healthc Care career Explorations program chemistry also for me and many of the other fellows I found is what kind of killed that that dream of medical school at least for the time being I know one of them I was talking to recently went and did a post back and then went from health Administration to medical school which is wild amazing yeah so that'll be one that we're going to be coming out with soon I was shocked to hear that it's challenging when you're at that age too right because you need to support yourself in a few years there's all these things going on and then some of our grades tell us that our plans might not always work the way we expected but you went on to work at yaai after graduation what led you to work there and what was that experience like so if I'm being honest it was a happy acccident because I knew that I wanted to be in healthcare but I didn't know what that role was for me I love to tell people that I took odd jobs in healthcare like I worked in a Derm clinic for about 6 months understanding that outpatient side my little sister actually went to Stony Brook University and one day we were driving and she was like hey have you heard of this company called yai they were at my school recently and they sounded interesting and I was like nope I've never heard of it but I'll look into them that night I went home I Googled they sounded great so I sent in an application and within 2 weeks I had an an interview and a week after that I started working there I started off as a direct support professional so there were 11 individuals in my group home who had either schizophrenia autism oppositional Defiance disorder just a number of different disorders and my role was just to support them in their everyday living but because my interests were strong in health care I think that that came through so a year later I was promoted to being their health care specialist so focusing on everything healthcare related so that was their insurance their medications their appointments a lot of these individuals are seeing at least five or six Specialists on a a ridiculous amount of medication if I'm being honest so making sure all of that is being reconciled that nothing is interacting with one another it's like a very challenging role considering not only the amount of medications but also the population not always having the best circumstances oh 100% and it's actually what pushed me to my Master's Degree just under seeing how someone who is neuro ient interacts with Healthcare or should I say in healthcare interacts with someone who's neurod Divergent was very very depressing it was really hard to get even just basic Services sometimes something as simple as getting someone a driver's license took about six or seven trips to the DMV with all different kinds of documents it was really sad so that's what pushed me to get my degree in uh Public Health from City downstate impressive motivation there I know you were talking about that earlier that it was kind of depressing to see that struggle it's wild because it takes us one or two trips to the DMV and we think that's really frustrating some of us have anger when we encounter that I cannot imagine someone having to do that seven times maybe not being able to drive or having to rely on friends and family it's like that additional burden and then also having to do it that many times that's an incredible challenge what was your reason for going the M route instead of going that medicine route how did you see the M as being able to help you address these problems so when I think about pH versus medicine and this is no shame to our doctors at all but I think about the population being able to help one person at a time as opposed to being able to help a whole population of people at a time right so I knew that me and and Kim and the clinical aspect just were not going to get along but I also knew that I had a voice that could help that I had perspectives that could help and just being able to be at the table to be able to make a change and to be able to be a voice for people who are often voiceless was really what pushed me I wanted to understand okay well how did we come up with policies that are have such barriers to people to access care and how can we break them down what are the steps what are the routes that we can take to do that and knowing that I could be a partner to those in medicine to be able to do their jobs more effectively and to more effectively help those who who desperately need it and can't fight for themselves that makes a lot of sense so essentially you'd be able to help people like your sister do their jobs better remove those barriers I mean that's why I love Public Health as well is you know a lot of these policies they're they're too complicated they're not written by people who are in the situation they're outdated yeah it's it's wild so during grad school you mentioned earlier and this is something that I'm really interested in me and my wife have been talking about having kids in 5 to 10 years we'd like to have kids sooner but you had a tri during grad school from what I understand can you tell me what that experience was like and you mentioned earlier that that also propelled you on the path that you're in now yes so what does that look like for you can you maybe share a little bit of information as me as a potential father in the future yeah for sure it was a crazy time I will say because at this time I was actually working two jobs so I was working at Yi but at the same time I was working per DM for northwell health as well in their tele department at LJ Valley Stream while at the same time getting my degree in public health so my daughter actually was born at 24 weeks just station in 2021 so this was still during Co this was still during the thick of it where there a lot of restrictions around visitation a lot of restrictions around social distancing so at this time when my daughter was born she was 1 pound 7 ounces she was going to be in the NICU for the foreseeable future and as a first-time parent you are just confused I had a whirlwind of information thrown at me but one thing that I recognized immediately was that I could not go back into the group home because we were too concentrated there were 11 residents plus staff members and a lot of them were getting sick so immediately I knew that I could not go back into the group home so I took leave from there but at the same time I had actually been planning to and just had just started my internship at LJ Valley Stream in patient experience so at the time the niku had been saying hey so sorry but visitation is only 2 hours if your last name is this at this time it's only two hours at this it was insane you know so to keep myself from going stir crazy from not being at my daughter's bedside I decided okay I'm going to just continue my internship at LJ Valley Stream thankfully I was able to stay within the office social distance but I was able to you know interact with that patient experience team see patient experience during covid which like let me tell you was just heartbreaking it was a time in the hospital so I was actually able to spend 5 days a week at that hospital with the patient experience team understanding patient experience on the inpatient side and at the end of my internship with them they offered me a position I don't believe that if I hadn't spent as much time as I did at the time that I did that that opportunity would have been afforded to me so I always credit my daughter's early birth to okay well now I'm forced to Pivot immediately as opposed to 4 months later when I had anticipated as opposed to when that role wouldn't have been there anymore because they had been looking for someone else so it was The Perfect Storm of of a time that led me there and it was me being in patient experience that actually led to me discovering the fellowship so like I said just a whole bunch of craziness happening at one time that just landed me in the perfect place at the perfect time so there is definitely luck involved in a way but there's also that fortitude that you had to be able to take advantage of that yeah one thing I knew I did not want to stop my degree because one it would just be harder to try and finish with a newborn at home I only had one semester left and I knew that getting my degree and the doors that it would open for me would be the best way to provide for her in the future so as opposed to being like okay I'm just going to stop because my daughter was born I was just like I'm going to power through and we're going to make it to that finish line and that is really impressive and it's an impressive role model to myself and to others that is one thing I've noticed about a lot of the preds and I've said this in a few interviews is that preds are usually extremely determined because they hear about how hard it is to go to med school so they get very determined and when they don't go to med school usually they don't switch too many times after that usually they complete something but usually that determination and that fortitude I see in individuals like yourself is very clearly there I mean that's a tremendous amount of emotional challenges that you overcame probably a lot of anxiety that you were kind of going to work with every day right oh yeah for sure you know I had no clue what was going to happen especially in the early days the doctors were like you know they don't know what's going to happen they did say that girls Faire better than boys but there was still maybe like a 60% chance of survival she this is my first daughter first pregnancy it was really really trying but I had such a good support system and I always have to shout out my team at LJ Valley Stream they are to this day some of the best friends that I've ever had they just like Wrap Me In Their Love they welcome me to the team and my clinical leader was actually a nurse she would explain stuff to me that I would explain to her that was going on with my daughter so I would feel more comforted like okay this is actually more normal like this is okay your daughter went through this and and things like that so it was a trying time emotionally but I think that I was just blessed to be around such great people that it was easier than it could have been otherwise and then after that position your daughter is thankfully doing well today right two and and at going on 20 excellent that that's great to hear and so with this two and a half year- old or at the time I think it would be about one and a half years old you start the administrative Fellowship yep how did that come about because you were working there at the time you were getting ready to graduate your mph yep so how did that come about so I always tell people I actually had no clue what admin fellowships were in advance I had never heard of them I found out about admin fellowships literally through overhearing a conversation that one of my colleagues was having with somebody else she had also been applying she'd also been in grad school finishing up and she was like oh I'm applying to all these fellowships and looking into the I was like what's that that sounds kind of interesting so she explained what the programs were to me and I was like oh my goodness this sounds like something that I need to do because one thing that I had been saying at this point I was almost a year into being impatient experience and I was like what is my career TR what do I want to do is it do I just go up the uh patient experience ladder am I just a manager director senior director you know what else is out there and I didn't know where else my interest lied but to me when I found out about fellowships I'm like this sounds like the perfect sample platter of a bunch of different roles that I can test out people that I can meet and kind of figure out what that next step looks like for me so I actually found out less than a month before applications were due I think applications were due September 8th and I found out around like August 10th or something like that so I did like this Mad Dash I started reaching out to former North po fellows just asking them about the program just to get more information and I think it was like within that first week that I was like I just have to apply you know I'm just going to throw my hat in the ring so I actually only applied to northwell I didn't apply to any other program honestly because one I love I love northwell I love working for northwall the culture there is absolutely amazing so for me it was either I'm going to do the fellowship with northwall or I'm going to stay in patient EXP experi with northw with the friends and the team that I loved so much so there was no downside for me but also just having you know my daughter and my boyfriend it was hard for all of us to just like pick up and move to another city so I was like well I have to stay in New York and I want to stay with northwell so that's kind of how I ended up just applying to one and somehow tricked them into letting me into their program I so the thing is you know these are not uncompetitive programs in New York that you're applying to most competitive programs that you're apping to is northwell I think M SI also has one so you know you're in a very competitive City and you apply for a very competitive program in that City what was that like did you you know were you very anxious like you said either way you win you know you can stay with your excellent team or you can move up but was there some sense of still anxiety and excitement oh of course I when I found out about the program I said I had gone on this like information hunt and I was talking to a lot of former fellows and I'm talking to these people and I'm like you are so impressive you are so smart your journey sounds amazing how can I compete you know like I'm like will I be you know cut from that same cloth it was definitely still very nerve-wracking and the more I found out about the program the more I really really wanted it it was just it sounded so amazing and exactly what I wanted so it was very nerve-wracking and I remember in the final round of interviews it was on Zoom so there were points where you were kind of just like in the waiting room but you're in the waiting room with like everyone else that's applying and there was this one girl whose name is escaping me but she was so impressive you know like her degrees her experience everything that she was saying I was like well it's her she's got it she's got it she's a worthy competitor I can't even complain so there was a lot of anxiety around it but honestly like you said either way I was going to win so I wasn't too upset because I knew that I had a great backup plan just staying with my my previous team wow so definitely a very uh intense process as well going through that yeah so very impressive very imp and like I said you're an excellent role model so I appreciate you sharing all of this with us thank you when you started the fellowship you came from an mph a lot of people do come from an mha who go into fellowships I say the majority come from an mha yeah probably mph followed by MBA MBA I think is probably the least common I've heard how prepared were you for what got thrown at you at first do you feel like you were well prepared by your education or was it kind of like drinking from the fire hose per se um honestly it felt like a combination of both but one amazing thing that you know that northwalk tells you even in your interviews and holds true throughout your fellowship is that it's not about the tangible hard skills that you have when you go in it's really about your attitude it's really about the type of person that you are they will teach you the hard skills so when I first started northwell has a program called the management associate program they're called Maps it's a very similar to the fellowship but it's for uh people from undergrad so when I first started my my first rotation with L L Medical Center I was with a lot of the maps and I was like wow you guys are so impressive you do so much work I I how am I supposed to to to you know just hop in and get to work but you know they sat with me they show me everything that I needed to do honestly I think anybody who is just willing to do the work to learn put your pride aside and just be able to say hey I don't know what we're talking about can you explain it to me they do a wonderful job of teaching they will equip you with everything that you need like on the job no prerequisites really needed obviously you need to have the basic Foundation but they do a great job with even that so I think I was nervous about how prepared I'd be but the program just does a wonderful job of catching you up to where you need to be what are some of the projects that you worked on is it you know rotation based what are some of the rotations just tell us a bit about what that work has looked like for you yeah for sure so our program is one year um it is rotation based and Project based so we spend 12 weeks um at four different rotations three are preassigned but we did get to pick we were sent a list of um different opportunities with background information we picked three in advance and then we picked our fourth in January after having spent a good half a year running around the the system meeting people understanding some things and if anything had caught our eye we could spend our fourth rotation doing that so my all my rotations were were different and my project looked different so when I first started with L Medical Center I was on their clinical operations team looking at things to help our strategic growth you know there were certain areas that we were really focused on and helping to do things that would draw in that volume so for example I was helping out with our coloral program and seeing what that looked like we wanted to make a new web page for our vascular program just to draw people in help them understand the vascular landscape that northwell has and putting together what that web page might look like um then I went over to our emergency medicine service line so north wall has 22 hospitals 17 of which um have EDS and standardizing processes throughout um one one of the major things that I worked on with that uh service line was we have a a program called net it's the northwell emergency tell Health Service this is a tella health emergency medicine service where you can make a same day appointment to see an ER doctor as opposed to going into the clinic into our hospitals exposing yourself so we work with both internal and external partners for example a physician practice has closed for the night but someone needs to speak to a doctor we would onboard practices that way and we would take over overnight one of the main projects that I had with this service was onboarding an external partner which was a shelter out um in Bayshore Long Island um that was just opening and they didn't have a physician or a clinic on their campus at that time so they needed our services to make sure that at any point in the day if anything were to happen instead of having to drive someone to the Ed they had an ER doc to speak to and if they needed to go to the Ed they were at least seen by a clinician first they were then sent ahead with the hospital knowing that they were coming what was going on so I helped to onboard that practice and work with our patient access service team work with our Southshore University Hospital team getting that practice up and running which was really really cool being able to kind of see that see that through wow so you got incredible depth across the whole organization then oh yeah yeah and that was one thing that I was kind of intentional about because northw is large is very very large so it's very hard to the entire system but when you have service lines and we we also have regions you basically have hard onal bars and vertical bars and I wanted to make sure that I was able to see both horizontally and vertically so that I got a better grasp of what our entire Health System One how it operates but also what we have to offer was very intentional in that regard and I worked on so many other things with the emergency medicine service line that it's hard to list them all but from there I went on to our corporate arm in strategic planning this is the part of our health system that looks at our historical data to help us figure out what we want to do going um to the future I worked on a lot of projects looking at our market share market analysis um of our different service lines of our different services that we offer um I also helped we are doing a lot of C or Community sorry not Community certificate of needs for different projects that we're trying to put forth so helping out with the hea's Health Equity impact assessments as well as creating a website because there's new regulation H are brand new so there new regulations coming out all the time time but one of the new regulations is that once we submit a CO that has been approved or has been accepted we need to post our heia for that project online because this is new we didn't have a place to put it online so one project that I worked on from start to finish was setting up that website pulling up that template making sure that it had a place to go working with our marketing team working with our planning team to make sure that it was up appropriately that it was in the right place that the wording made sense because this is not for the government this is actually for the community because we wanted to make sure that people in the area knew what was going on in the hospital that affected them in plain language and that they were able to follow along so that was really nice also working on other Health Equity impact assessments looking at the data and putting that together for the co a whole plethora of projects with strategic planning some of those probably really used your mph training as well when especially when it comes to the Health Equity and the health policy measures exactly I want to ask you know one of the things people some sometimes like myself going into it I was like is this like an internship is this like a you know and so I've gotten a lot more knowledge conducting these interviews on what a fellowship is yeah but I want to ask you know let's look back at the parking garage example that one is really fascinating to me one of the things that we get told that reason startups are so good is because you get to have hands-on experience with everything in a startup you have to do all this stuff Y how Hands-On is it uh at northwell with the fellowship when it comes to like the parking garage needing signage what kind of tasks are you doing in something Niche like that I was quite literally walking the parking garage it's four levels three levels I'm walking through every lane and I so I had the schematic on my iPad and I was marking every single spot where there was a specific sign and we had at minimum 15 to 20 different signs I'm marking on this schematic where each sign is and the status of the sign is this a does the sign make sense is it still visible does it still apply is there graffiti on it does it need to be replaced we had maybe three different signs that were for the same thing but they all look different we're trying to standardize things like okay we have a hospital Arrow this way but this one is red this one is blue this one doesn't say hospital this one is just an arrow so you are very niche in the thick of it in that regard from there I made a PowerPoint depicting everything that I found in the parking garage the amount of signs that we need the amount of signs per level the signs that need to be tracked where signs where signage is missing you definitely get very into the weeds but then you have the opposite where some of your rotations are more observational where you may not be on a project but you may be in the boardroom with CEOs talking at about very high level things that you just get to be a fly on the wall and soak up information so it's both ends of the spectrum very cool and it sounds like you you've done an excellent job you know you clearly everyone at northwell thinks very highly of you I want to ask you know just I don't want to take up too much of your time here but I do want to ask real quick what is a tip or piece of advice you can give to individuals earlier in their career like myself oh that's a good so one thing that I have been working on is really pushing yourself outside of that box I think early on it's very easy to be like you know I want to go into Finance I want to go into operations and you kind of try and get experience in that as you should but also opening up yourself to things that may not interest you I just started my fourth rotation with our western region operations team I used to say before was that like I don't know anything about ambulatory and I'm not really interested in learning about ambulatory I spent my first day with the ambulatory team and I was hooked I'm like I want to learn all there is to learn about ambulatory so I would say in the very beginning think of it as your degree Works page you know when you first start college and you get that thing it's like you need to check off all these box in order to graduate in the beginning you should be open to everything see everything say yes to everything and then as you get experience in each thing you can check off that box and then look at the areas that you're still missing right so it's like you know I have a lot of experience in operations I understand this world but I really need to brush up on finance I'm not great at Finance throw yourself onto a finance project find a finance Mentor someone to teach you those skills because you do want to be very well-rounded before you start to specialize because it's easy to see the numbers and the data and just be like oh well this is what this means but you also want to be able to say well what story is the data telling right what can I glean from this information and I think you kind of get that from having a very well-rounded picture of what your organization offers of the healthcare landscape in general which is something that I've been pushing myself to do as well someone once compared being a healthcare administrator to Running a Restaurant right so like we are not the chefs we don't know how to filet the salmon we may not be giving out the food on the tables but we have to understand how everything in that restaurant works we need to know the menu uh forwards and backwards we need to know who the cooks are we need to know who we're serving so you want to make sure that you're taking in everything before you specialize in anything incredible advice and an incredible example as well very good insights I appreciate you giving us a snippet of the administrative Fellowship for free so very nice you're not paying me for this we have to talk about that after the recording no but on a serious note thank you so much for for coming on I know it's in the evening here on the East Coast so I do really appreciate it I hope you'll consider coming back on when you get your role certainly probably at northwell there I'm pretty sure so that's the goal I can't wait to hear what you do over the next few years hopefully you'll consider coming back on and talking with us oh for sure this was great it's very I've never done an interview before and you made this such a great experience so I definitely appreciate you and just for even reaching out oh thank you I'm happy to hear that we want to share as many people's in stories and and ideas as possible yours was incredible I I hope everyone enjoyed uh watching this as much as I enjoyed listening to you so thank you again so much thank you</p>