David Cota: Welcome to the vault. I'm David Cota, your host, and I'm excited for this episode. We have Chanda Chacón, the President and CEO of Children's Nebraska with us here today, and we're going to talk through a variety of elements of the hospital, the work that they've been doing, the recent opening of the Behavioral Health and Wellness Center, along with Chanda's leadership style and the people first culture that she's been building at Children's Nebraska. Chanda, thanks for joining us,
Chanda Chacón: Thanks, David.
David Cota: You and I have had an opportunity to get to know each other over the past few years. Um, and I've always been impressed by what drives and motivates you to dedicate your career to pediatric healthcare. As we begin, would you mind telling a bit about your story?
Chanda Chacón: Yes, absolutely. It's one of the things that, for me, is, makes me the most proud about the work that I get to do, is that my why I do it is very strong. I was in middle school. I was in a car wreck. Taken to the hospital and it was sort of a journey that started there that wasn't awesome. We were shuttled around the medical system for about two years. I probably saw 20 physicians. And so I don't have a great experience with healthcare. I ended up having a spinal fusion with a non-pediatric physician. For me, what I remember is that there were great people we met. They were working in a system that didn't work.
David Cota: Right. You've been in Omaha and in this role for five years. What was the journey to get here? And then ultimately, what was it that drew you to this particular role?
Chanda Chacón: Sure. Um, so I graduated from graduate school with a Master of Public Health Management I didn't really know that I wanted to be in a pediatric hospital. I had actually still at that point in my life never been in one. I went to Houston, and I interviewed at almost all the health systems. And I remember walking into Texas Children's, and I thought, I'm meant to be here.
David Cota: Hmm.
Chanda Chacón: It looked different, the people were different. It felt different.
David Cota: Right.
Chanda Chacón: It just felt like this is where I was always supposed to be. So, I stayed at Texas Children's for 14 years and did a little bit of everything. I had an opportunity to go to Arkansas Children's. And I thought, you know, I'd bet in one of the biggest cities in the United States and Houston.
David Cota: Right.
Chanda Chacón: Could I take what I learned and help at Arkansas children's make a bigger impact? It was just an unbelievable experience to see how you scale pediatric healthcare across the state. I learned a ton.
The opportunity in Omaha came up, and a good friend who I'd worked with in Arkansas said, I think you need to look at this job. I have so many stories of when I interviewed here. And I remember going back to the hotel room on the first night and I said, if I get this job, we have to come here. There was just that potential was incredible.
David Cota: And you saw it right away.
Chanda Chacón: Immediately. And the reason I saw it, David, was because of the people.
David Cota: Right.
Chanda Chacón: I mean, we had infrastructure, we were building a new house. We had all these things. Those don't matter if you don't have great people and I could see the passion and commitment.
David Cota: Yeah.
Chanda Chacón: And so that, for me, was sort of the start of, can I execute as the CEO on implementing a people first culture and will it work?
David Cota: Yeah. What a great story. Well, and Omaha is fortunate to have you and what has transpired over the last five years has really been incredible.
I do want to come to the people first culture. But first, maybe a bit about the hospital. You mentioned it, that you had not been in a children's hospital until you had that fellowship. Um, what's important for people to know about pediatric medicine, children's hospitals, and then specifically Children's Nebraska?
Chanda Chacón: One of the reasons I came to Omaha was because of the mission of Children's Nebraska. Um, a lot of missions in healthcare tend to be the same. And Children's Nebraska mission was to improve the life of every child through care advocacy, research, and education. The last part is what's really consistent in academic, healthcare organizations.
David Cota: The how.
Chanda Chacón: The how, the front part of improving the life of every child, for me mattered. We weren't just improving the health.
David Cota: Right.
Chanda Chacón: We could actually change the trajectory of health, which changes the trajectory of kids' lives. I thought, like, what a bigger impact than that? So that for me was important. Children's Nebraska, started in 1948 by Henry Doorly, and Dr. Poynter. They raised in the city about $843,000 through a penny campaign. Knowing the passion behind the community to say this is the right thing to do to have a children's hospital, to me, says a lot about the community and the commitment to this type of work.
David Cota: You know, you talk about the origin story of Children's Nebraska, um, to Omaha leaders raising money, seeing the need, committing to an independent children's hospital. Last week was a pretty amazing week for Children's Nebraska. You had the grand opening of the Behavioral Health and Wellness Center. Talk a bit about that facility, the need that it is serving, and again, what makes it so unique in pediatric healthcare.
Chanda Chacón: So when I came here five years ago, I knew we needed to focus differently on mental and behavioral health. It had exacerbated during COVID. We saw one in five, one in four kids with a mental health issue. Anxiety, depression, suicidal ideation, and in Nebraska, we had the higher, higher than the national average of a rate for suicide in teens. And knowing what I'd seen about the people in this community and that worked at Children's, I thought, we can do better than that. Like we have the ability to do better and we should. And if not us who.
David Cota: Right.
Chanda Chacón: Right, who? This is too big of a challenge, too much of it happens outside of the walls of our organization. We needed partners. We needed the community. We needed to do it together.
David Cota: Yes
Chanda Chacón: In something that has a lot of stigma still, of like talking about behavioral and mental health and challenges people have had, the community was able to say, we're going to tackle that.
When I first spoke to Ken Stinson about this, he was one of the ones that said like, what do you need? How do we do this? He'd already been in this work trying to lift this idea in Omaha. And, um, he wanted to go faster. And I like to go fast, David.
David Cota: Yeah. I knew this about you.
Chanda Chacón: Yeah, I knew this was a challenge we couldn't wait on. It was already a problem. And the longer we waited the further behind we were going. We had not done inpatient behavioral health. We had never had a crisis assessment center. We had never done urgent care for mental health, and, um, like Ken, we gave deference to expertise and went to the national scene and said, who can help us do this in a different way.
David Cota: Right
Chanda Chacón: We want to, if we're going to do this and invest as a community. I want to do it the best way that we know now. I knew that if we were going to do it, two things were important to me, that we had an entire continuum of care in the facility. Families should not have to figure out where to go.
David Cota: Right.
Chanda Chacón: We don't make anyone figure out where to go for medical care, you go to the ED, right? You go to your primary care physician. And we were making families try to navigate a system that wasn't built in a continuum.
David Cota: Right.
Chanda Chacón: So we had to build it where it was one door. One door you walked in and we helped you. The other piece that was important to me is it felt like Children's when you walked in.
David Cota: Yes.
Chanda Chacón: The culture so important to me and ours is palpable when you're in our organization. I wanted families to feel safe. To feel like we were their trusted advisor, the one they have known for their pediatricians, right? I wanted them to feel that and to feel like it felt normal because this is probably one of the most challenging abnormal situations families are in.
David Cota: Yes.
Chanda Chacón: We've made it harder in healthcare to access mental healthcare. And so those two things for me were super important, and they were very important to Renee Rafferty, our executive for behavioral health and wellness.
You know, walking in, I thought to myself, this feels exactly like Children's. You wouldn't know what we did in that facility.
David Cota: Correct.
Chanda Chacón: If you didn't know what it was built for.
David Cota: At the ribbon cutting, you talked about how you wanted the facility to be known for access, compassion and hope. How do you ensure that that is what the experience will be for those that come and need the services?
Chanda Chacón: Yeah, 100 percent about the people we hired to work there. Like a 100 percent. Right? They all felt like they were doing this for a calling a reason. Um, and having been in the center, over the past week, watching how our team engages with families is, that's where the compassion comes. That's where the trust comes. Of there's no wrong door. You don't have to have the answer. You don't have to worry about, is this urgent enough? Should I be here for this? If it feels urgent for you as a family or a guardian, it is urgent.
David Cota: That's right.
Chanda Chacón: Right, and you need help and we're here to do that.
I was sitting in the lobby, and I watched a mom walk in. This mom was in a, was really nervous and in a crisis and didn't know if she could get her child out of the car. And I listened to this team member, very normally, as if this is just normal. Here's where you go, here's what happens, no matter how long it takes for your son to get out of the car, we're here. We got this. And I thought, that, like that interaction changed what that mom will remember.
David Cota: Absolutely.
Chanda Chacón: And that - like those little moments make such an impact for families. They change the whole experience.
David Cota: Absolutely. The continuum of care that was so important to you, you talked about that. It was important to you, important to Renee. How would you describe that continuum of care in that facility for those that may not know what to expect? And so that, um, we can ensure the community feels comfortable and welcome accessing it.
Chanda Chacón: Yes. So, um, it is interesting because some of the components we offer in the Behavioral Health and Wellness Center haven't existed in Nebraska before. And, that's been a real push for us is to help the community understand what this is and what this looks like. So, it starts with urgent care, and we have a crisis stabilization center, and that's really the no wrong front door, right? Your crisis is defined as how you're experiencing it
David Cota: And that's 24/7?
Chanda Chacón: 24/7, anyone, seven days a week to come in and for your child to be assessed. To say, where are they in their journey, where are you as a family, and what do you need? How do we help you? And how do we get you plugged into the system in the right place? Not dissimilarly to an emergency department where 85 percent of kids come to the emergency department for the medical side. Go home and get discharged from the ED.
What data shows is over time it will be about 75 percent of kids will discharge from there. That's really new for us as a community because we didn't have this step before, right? You would go to the ED and then you'd wait for an inpatient psych bed. Um, and so the power of that crisis stabilization center is pivotal. It's huge.
We also then sort of is the next step up from that, have a partial hospitalization unit, and that's where you're not ready for outpatient care, but you're not, you don't need inpatient care.
David Cota: Right.
Chanda Chacón: Right. And so, it's sort of the mid-step where after crisis stabilization, we might plug you into outpatient therapy or partial hospitalization, which is like eight to four, five or six days a week. You go to school and you have therapy, you're in a group, and do that work.
So, we have partial hospitalization for the majority of mental health conditions. We also have a specific one for eating disorders, we had prior to opening behavioral health. We moved that into the facility.
Then we have 40 inpatient psychiatric beds. They're set up in groups of eight. So, there's eight beds in a unit. And we had a young boy say it sort of feels like summer camp. Um, it's doesn't feel like a hospital unit.
There's private rooms, there's a lot of control for kids, music lighting. They lose a lot of control when they go into situations like this so we work really hard to give it back. Right? So that group of eight are getting better together. And that's really important rather than isolating kids, it's really showing them you're not alone. And um, so there's a lot of common space in each of these units.
We also have a primary care clinic in the facility that moved in, and that, for me, is important because a lot of the work that we do, in mental health happens at a local level. So all of our primary care clinics at Children's Nebraska have some type of mental health resource provider with them. And so, I wanted it to also feel normal for families. This is super normal. This is a part of health, and it's not separate, and that, for me, once we stop talking about it's mental health or physical health, we just say health. I mean, that's when will really have evolved. This still will never be something we solve ourselves. It will always be through partners and how we work together.
David Cota: Yeah. I'd imagine there is a lot of intention placed on the parents in the family unit or the guardians as well.
Chanda Chacón: Yes, huge because that's where that's where kids are going back to. You have to be prepared as a guardian and a parent to know, how do I help my child? How do I make the place, the environment safe in healing? And that, that for me, I think sometimes is a piece that's missed in mental health. We do it great in physical health, right? You send your kid home and they need oxygen or a trache or some medicine and we train you how to do that. This is not dissimilar to that.
David Cota: Yeah, absolutely. The way it looks and how you train people is a huge conveyance of the sentiment of caring.
Chanda Chacón: Yeah.
David Cota: I have to believe that, you know, many of those families as they step in, it's a host of emotions. One of them is, they feel cared for.
Chanda Chacón: Yes.
David Cota: And seen and validated.
Chanda Chacón: Unlike physical health, where you almost can't give up on it because it, it impacts you every day, right? You have a high blood pressure, a broken arm, you have to get it taken care of. Um, the stories we're hearing are, nothing I was doing was helping. No one could help me. I gave up. I stopped seeking care. It wasn't working.
And the stories now of how we meet families, how we meet individuals to say your journey is unique. And we're going to meet you wherever you are on that journey and we're going to figure it out together. It's what pediatric healthcare is built on.
David Cota: To your point around health is health. And the approach and the intentionality and the integration and the way that, um, you and your team are approaching it is just really impressive, and very needed across the community. We have to have that same dedication and commitment on mental health as well.
Chanda Chacón: Agreed
David Cota: Yeah, it's so important.
Chanda Chacón: We're doing some really intentional work that's sort of on the cutting edge of mental health work with technology to say, how do we help it power us to do better? I mean, people hear so often, the downsides of technology for mental health for kids. There's a lot of upside too if it's used correctly and how we can engage because we know kids are going to use technology, so how can we help it power that? And so that's the part, that innovation piece, it's one of our values. That's what I'm also really excited about is what's next in behavioral health and we're going to help set that course.
David Cota: Let's shift a little bit to people if you're okay with that.
Chanda Chacón: Yes!
David Cota: All right! I know it's a favorite topic of yours. The work that you do. You've mentioned it a couple of times, the work that the team does. It's hard. Um, often you are meeting families and children at a very vulnerable moment. How do you build an organization that is able to show up consistently for families in a way that exudes compassion and hope and caring?
Chanda Chacón: The first part of that is to show your team that you care about them and invest in them and their well-being and understand exactly what you said - that the work we do is hard, even if we have a strong why. You still need to take care of yourself.
David Cota: Right.
Chanda Chacón: And I tell people often, if you're not good outside of here, you won't be good here. So, you must take care of yourself. And we have to be committed to that as an organization, to say you matter, and we hear you and we see you, and here's the infrastructure tools we're going to provide.
I grew up in an age of leadership where being vulnerable, was seen as a weakness. That you didn't do that, especially as a female leader. If you cared that much about people, it was going to be exhausting to you, and how would you make tough decisions, if it was that exhausting? And I'm like, I mean, it should be exhausting. Like, we're, you know, these people are in our charge, right? We have to take care of them. So it, it should be hard.
I will never forget talking to you and the first questions you asked me were how my team was doing. How are the people doing at Children's Nebraska? There's a lot going on in healthcare. You understood who we were and the people first part of how we invested in our organization, and you were doing that at FNBO, and I thought, your insight and thought about how people matter is, is, who we are, right? It's it's what propels businesses and that was super important to me to see your lens of how you led. And that's much more important to me than what people do for their job is who are they? How do they lead? And that was, for me, very inspiring of, you know, these are the kind, this, he's the kind of person I want leading our organization and helping us govern children's Nebraska. So that was really powerful.
David Cota: Yeah. That approach, it does transcend all industries, right? I mean, at the end of the day, companies, regardless of industry, organizations, regardless of mission or focus, are a collection of people. And those that are great are the ones that have a healthy, trusting, vulnerable, authentic, driven, committed team.
Chanda Chacón: That focus on people and giving them resource and being authentic and real and knowing that's actually a strength.
David Cota: People don't care how much you know until they know how much you care. It's the basis of establishing trust and, um, it also comes with authenticity and a willingness to be vulnerable as a leader, which, as you said, um, isn't, a, always natural, and um, often for many, it's not the picture that they have in their mind of the persona that you need to put on when you lead. And my approach is don't put on the persona, be yourself.
Chanda Chacón: Be yourself, yeah
David Cota: Was there a moment as you were beginning to build that people first culture, which I know you now have identified it and labeled it as people first. Was there a moment where you saw the team kind of lock in to where you were able to kind of sit back and gain comfort knowing this is building. It's coming.
Chanda Chacón: We have an entire repertoire now of data that says we are better as an organization. We have better outcomes, We have better experience scores. We are phenomenally different than who we used to be, and we can show that the reason we are is because we invested in people. Every other metric you have should get better. Because people feel committed to the organization, to the leaders, to the team. You don't have to worry about all the other stuff.
David Cota: Yeah, absolutely. You know, you've talked as well about the fact that it's the people that are delivering the care. It's not the buildings. It's not the machines. They use those as tools to ensure that, um, they're providing good care. But at the end of the day, it's an organization of people, as all organizations are. And that's just so important then to place your intention there as a leader.
What's the approach that you take with your leadership team and then as you begin to ripple, change out to ensure that people understand why the change is necessary and what it is that we're going to get as a result of going this direction as opposed to the other?
Chanda Chacón: Yeah, for me, I don't find change to be scary because that's, it's the only way you get to the next phase. If we're trying to make it impact. You, you know, if you're not moving, if you're standing still, you're falling behind, right? Everyone is changing. And so I see it as a positive.
When you think about organizational change, individuals at the frontline of what we're doing is work aren't always the ones making the decision about what we're doing as an organization. And so it feels, it can feel a little bit out of control or I don't understand why. That's why you have to be intentional about investing and getting information from people. So at the same time, you're thinking of big organization or change, you have to actually be listening to the people that are doing the work. So it takes all levels of leadership being very aligned on what we're doing and where we're going, and you can't change for change sake, just to be like, well, we're going to be different. That also doesn't work because it's hard to explain the why behind it.
David Cota: And t's disorienting.
Chanda Chacón: It is. You know, the, and that for me is,being able to explain why we're doing it, even if people don't like it, if you can explain why, normally people go, okay. And that's a lot of what we did was being local and listening and empowering and training our leaders to do that. It's an investment and it's being consistent. It's communicating really clearly why we're doing it.
I also love to say during change that, um, the windshield is bigger for a reason. The rear-view mirror is small. Like you need to understand the past, but we're going forward.
We were in an executive retreat. A lot of the executive team had been there before my arrival, and you could feel the past. And I brought in this old ratty suitcase that literally probably weighed 25 pounds without anything in it. Like, why did people carry these? It was crazy. And it looked damaged, like it had been through a lot. And I set it on the table. And I said, what we are going to do now is I want you to write down on all these post-it notes all the things that you want to be different, just name it. Write it down. It was overwhelming. And we put them all in the suitcase.
After we did that, I said, okay, now write down who you want to be. Right. Who you want us to be? That was such a, like, release for people to say we could set it down because you can't grab onto something new if you're still holding on so tightly to the past. But you don't have a free hand.
David Cota: Right.
Chanda Chacón: Right. We remember what it felt like and look how far we've come. It wasn't me as the CEO. I was a part of a team of people who committed to make it different, to say we're going to be different, and who invested in that. So, it was us together. It certainly wasn't me by myself.
David Cota: So, a lot has happened in the five years that you've been here. Certainly, you talked quite a bit as well about the Behavioral Health and Wellness Center that just opened last week. I know you are someone - you mentioned it - who looks through the, uh, the front windshield and you scan the horizon constantly. What's next, Chanda? What are you thinking about? What are you focused on? Where does your mind go? with the next big thing?
Chanda Chacón: Yeah, I think the definitely the next big thing is establishing our new normal.
David Cota: Yes.
Chanda Chacón: With this type of facility opening, the Behavioral Health and Wellness Center, truly integrating it in, to who we are as an organization, and how we help change the language of our community, our region, to say, this is all health.
David Cota: Yes.
Chanda Chacón: That changes the impact of the work we're doing.
David Cota: I love that.
Chanda Chacón: And so that establishing that new normal is really important.
David Cota: Yeah. Because if you just build it and then it becomes its separate place and it isn't yet integrated, you haven't fully achieved what's possible.
Chanda Chacón: Correct. And it's, it is a continuum. The whole piece of health is a continuum and it isn't separate. I do think that you would be naïve in healthcare to not be scanning the environment and go, oh, this feels unsettling. Um, it is. There's a lot of unknown going forward. I, you know, it's not lost on me that 50 percent of children in the United States are covered by Medicaid, and that is not dissimilar to what we look like in Nebraska.
David Cota: Right.
Chanda Chacón: We see our volume is about 47, 48 percent Medicaid. And we see all kids. We don't um, determine the type of care we provide to you based off of your insurance coverage. We see you. We see your child, we take care of you. And the uncertainty that's happening in the landscape does cause us in healthcare to look at how efficient and effective are we in the work we do, how are we set up? And can we imagine a future where we look different?
David Cota: Right.
Chanda Chacón: And because I like change, um, I'm thoughtful about where we are in healthcare, but I'm not scared. We are resilient, we know how to solve problems, and we know we have to. That, for me, is probably the single most important thing. If I believe my people first culture, how are we devising a workforce in a leadership team to lead in not only uncertain times now, but in a future that - we work with such smart people when you ask the people you work with every day. Um, We've come up with some pretty transformational ideas of what we could be doing. Um, I tend to normally have the craziest idea because then anything anyone else says, they feel free to say it, it feels more normal than my idea. Um, And that's the kind of place I want to be, is setting the pace for where we're going to be. And so we're flexing those muscles now because it's, it's hard to sit in the gray and most of what you do as leaders. I mean, you're sit in that all the time.
David Cota: Right.
Chanda Chacón: And how do we prepare ourselves for being the kind of healthcare organization that's leading the pack and taking risks, learning from them and saying, we can we can withstand this. We can be shatterproof.
David Cota: Yeah, that's exactly what I was going to say is you're describing building a shatterproof organization. And so often I think there's an over fascination with trying to predict what that future is going to look like precisely. And, um, I subscribe to the approach that you're talking about, which is be mindful, be aware, but translate that back into what are the characteristics that we as a team, and we as an organization, need to be excellent at, to be shatterproof, regardless of how that future plays out so that we can be leading, opportunistic, innovative, and that will be a winning organization. And the work that is done, certainly at the Children's Hospital and across pediatric healthcare broadly is just so important that we need more organizations like exactly the one that you're building. Yeah.
Well, Chanda, thanks for being here with us today. I really appreciate your time, the honest conversation, your willingness to share a bit about not only Children's Nebraska, but also yourself and your leadership philosophy. I consider myself fortunate to consider you a friend and someone I get to work with as well. So appreciate you being here.
Chanda Chacón: Thank you.
David Cota: Thanks, all of you, for joining us on The Vault. Until next time, this is David Cota. Enjoy the rest of your day. Thank you.
