WellSpan CEO on Addressing Vaccine Hesitancy and Expanding Care Access in PA

Roxanna Gapstur, PhD, RN, CEO of WellSpan Health, highlights two recently launched initiatives to expand access to quality women's health, mental health, and substance use disorder care.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Women in Healthcare Leadership Podcast. Audio of the full interview can be found here.

Roxanna Gapstur, PhD, RN, began leading WellSpan Health, a non-profit integrated healthcare system headquartered in York, Pennsylvania, in January 2019.

She has more than 25 years of experience in healthcare leadership, having worked in group practices, academic health systems, and integrated healthcare systems. Prior to serving as WellSpan's president and CEO, she served as president and senior vice president at HealthPartners System in Bloomington, Minnesota.

WellSpan serves diverse communities across five counties in Pennsylvania and one in Maryland. Among the populations served include the Amish and Plain communities, Latinx populations, as well as migrant and homeless communities.

One year ago, Gapstur spoke with HealthLeaders about the health system's strategies on caring for its rural and underserved communities during COVID and how the health system worked to serve the unique needs of its patient population.

In a recent conversation, Gapstur highlighted two recently launched initiatives to expand access to quality women's health, mental health, and substance use disorder care.

This transcript has been edited for clarity and brevity.

HealthLeaders: What has been your strategy to vaccinate the diverse communities WellSpan serves? Are you seeing vaccine hesitancy, and if so, what is the health system doing to address it?

Roxanna Gapstur: As the vaccine moved through clinical trials, and conversations took place both nationally and locally, WellSpan anticipated that there would be some vaccine hesitancy among several of our populations and communities across south central Pennsylvania. We asked ourselves, ‘Who will be hesitant to receive the vaccine, and what might be the contributing factors to this hesitancy?’

To understand more deeply about vaccine hesitancy with our at-risk populations, our community health team and medical group leadership embarked with our diversity and inclusion committee on a community listening campaign. The purpose of that campaign was to learn more about the opinions, thoughts, and barriers that lead to vaccine hesitancy within our communities, and to demonstrate cultural humility and respect for all while building relationships and trust. [We then used] those learnings to inform WellSpan's vaccination strategy.

The listening campaign ran for about four months and we heard from more than 220 community members. This included [members] from our Latinx community, the Black community, faith-based organizations, and some of our local physicians from the federally qualified health centers. [We also] collaborated with more than a dozen grassroots groups, schools, and local churches across our geography.

We found that few people mentioned their healthcare provider as a source of information and that the participation of physicians in these conversations with us was well received, especially physicians from the communities that we were connecting with, as well as physicians who are bilingual. They seem to make a critical difference in understanding the participants' acceptance of the information that we shared about the vaccine. We also learned that community members wanted to hear from someone who looked like them and had their shared lived experiences.

We uncovered many factors from fear of side effects to misinformation. But one of the main reasons we saw for vaccine hesitancy was simply lack of trust, and it often related to that populations’ history with vaccines and medical experimentation, but also individual lived experiences with healthcare and vaccines. We did see some mistrust of government, how privacy and data are collected, and some concern about pharmaceutical companies and whether they were acting in the interest of public health versus profit.

HealthLeaders: Recently, WellSpan has announced two initiatives to expand access to quality care for women's health, mental health, and addiction. In early May, Women's Health Center of Lebanon joined WellSpan. What does the health system hope to accomplish with this addition?

Gapstur: WellSpan has a strong commitment to women's health, and what we have found during the pandemic that [women’s health] has become more important than ever. In some of our rural communities, we believe that providing state-of-the-art, evidence-based women's healthcare is important for good outcomes, as well as for families overall.

The Women's Health Center of Lebanon has been an embedded group in that community, with a significant number of providers for rural practice. They have more than eight physicians and APPs working in that practice, and they've worked closely with us over the years. What we hope to accomplish now is to be able to use our long-term, trusting relationship to build on the services we've been able to provide in that community and work together to understand the various populations.

That is a community that has both Plain Community and Latinx populations, so we believe that by working together with some of our federally qualified healthcare centers and Women's Health Group, we can make a big difference in women's health in that community.

HealthLeaders: Another program launched in May was the opening of the Specialized Treatment and Recovery Team (START) to offer help to patients with mental health and substance use disorders. What does Wellspan aim to accomplish with this new program?

Gapstur: We're excited about the START clinic. It is a new and innovative certified community behavioral health clinic that works to increase access to mental health and substance use screenings and services. We also provide referrals to support services and work closely with community partners.

The focus of the program is to get people the care they need in the right place at the right time. At the same time, [we want] to reduce the use of emergency departments by providing those community-based alternatives for the treatment of mental health or addiction. The center itself has a diverse team of clinicians and staff that have been intentionally recruited to operate the clinic as an inclusive environment for the treatment of complex patients that have diverse backgrounds.

The START clinic uses a combination of in-person appointments and telehealth, and it can surround patients with all the resources they need for both mental health and substance use disorders. [START] also addresses issues of chronic disease, housing, social status, and other factors that impact health.

This was a $4 million community grant from WellSpan. The clinic itself has been in operation since December 2020, but it opened its doors for in-person care on May 3; more than 400 unique patients have been treated so far through the program.

[We're] excited about the community partnerships as well. One of those partners is called the Community Action for Recovery and Diversion Initiative, which is focused on individuals who have substance use mental health needs, and who are involved in the York County justice system. The goal of that partnership is to increase access to treatment rather than incarcerating individuals who are charged with minor crimes that are related to mental health or addiction.

HealthLeaders: You've served in multiple executive roles during your career, including COO, CNO, and now CEO. What has been your experience as a woman working in healthcare leadership?

Gapstur: Healthcare is a female-dominated field in terms of people who are working in the field, but females aren't generally represented in leadership at the same level. My own career has taken interesting twists and turns here and there.

I would say one of the biggest differences for me has been the sponsorship and mentorship opportunities that I've had over the years. [I’ve had] women leaders who have stepped up to help me learn more about how I can stretch myself and achieve the goals that I've set for myself in my career. I think there are some barriers to women in healthcare, just in terms of the acceptance in certain roles, as well as the ability of women to step up and be assertive in communicative settings like the boardroom.

I have worked hard to make sure that I am mentoring and sponsoring other women in healthcare to lead, improve, and achieve the goals that they'd like to do in their careers. We've done a number of things here at WellSpan, our governance and organizational structures have transformed over the past three years. Of our 13 senior vice presidents, six of them are female, three of them leading our regions.

We're committed to creating career paths for both women and other diverse talents throughout our system. We've increased the number of people of color who are executives at our organization by more than 7% in the past couple of years. We're holding ourselves to a higher standard of making sure that we're looking toward gender equity and also people of color in leadership here at WellSpan.

HealthLeaders: What advice do you have for women who want to serve in leadership roles in healthcare?

Gapstur: Be conscious of your own ability to speak up and be confident in yourself and in your leadership. Don't be afraid to take calculated risks and step outside of your comfort zone. Especially if there's a stretch project or something that you feel that you would be good at, but it seems like a scary thing to do.

I like to encourage people to stretch themselves; even the idea of speaking up with new ideas and getting some growth out of those stretch projects. I would also say build trusting relationships with other colleagues, both men and women, to get feedback on your performance, and to help yourself become more self-aware.

WellSpan hospitals (clockwise, from top left): WellSpan Good Samaritan Hospital in Lebanon, WellSpan Philhaven behavioral health hospital in Mt. Gretna, WellSpan Ephrata Community Hospital, WellSpan York Hospital, WellSpan Chambersburg Hospital, WellSpan Surgery and Rehabilitation Hospital in York, WellSpan Gettysburg Hospital and WellSpan Waynesboro Hospital. Photo courtesy of WellSpan Health.