Shining Light for Children


East Tennessee Children’s Hospital CEO Matt Schaefer leads the charge with passion, drive, and a desire to make an impact

It’s 6:30 a.m. and East Tennessee Children’s Hospital CEO Matthew Schaefer—just the third in the hospital’s history—is more than ready for his day to begin. The work never stops in the medical industry, and today is no exception. Matt is typically at work by this time. And as we sit down in his office to talk about his leap into pediatric healthcare and some exciting updates at the hospital this summer, it’s obvious just how passionate he is for what he does every day.

The smell of coffee penetrates our space as the sun’s rays dance into the room. It’s calm and serene, but we both know that in a few short hours, I will be back to the ENT surgical suite across the street prepping for a patient and Matt will be diving into the plethora of administrative duties to keep the hospital running smoothly.

John Little: We’re approaching two years now, Matt, and you’ve scripted the start of your tenure with just regular boring type days not much happening. Other than…

Matt Schaefer: COVID, COVID, and pause, COVID. Also, labor shortages, information technology challenges, all kinds of fun things.

JL: Cyber tech being our latest hiccup. Has that been a challenge as a leader of our institution trying to navigate all of us through that?

MS: The world’s a tricky place.

Nathan Sparks John Little, left, and Matt Schaefer, right at a 6:30 a.m. interview at East Tennessee Children’s Hospital.

JL: Well, let’s start at the beginning. Was pediatric healthcare always the plan for you?

MS: I was an engineer by background and transitioned into pediatric healthcare through an experience with my brother’s son, my nephew, who was a childhood cancer patient at Texas Children’s Hospital. I got to see that interaction, the impact on him, the impact on my family, what a pediatric institution can do, even in circumstances that no family wants. And when Malachi unfortunately lost his life due to cancer, I changed careers, and that career change actually led me to a start in pediatric healthcare on the administrative leadership side at Texas Children’s Hospital where Malachi was treated for five months. After about a decade there, I had a good friend and mentor, who had moved on to become president and CEO at Children’s Hospital in New Orleans. And he asked me to come and join him there. I eventually said yes. It was a great decision for me and for my family, a good opportunity to see there’s good people everywhere and there’s great work to do everywhere.

JL: Did you ever envision Knoxville would be your next step?

MS: When Keith Goodwin, who had served here for almost 15 years in a highly effective way, was looking to retire, I got a call about East Tennessee Children’s Hospital and this job. And I remember telling my wife, ‘You know, I don’t think this is very real, but I’m gonna call him back. You never know what’s gonna happen.’ I was fortunate enough to be in a position to succeed, to meet a lot of good people, meet a great organization that was in a good place to serve the community in the future, just like it had done in the past. And so since August of 2020, I’ve been able to be here serving in this role, working with lots of great people, including great medical staff like yourself and many others.

JL: After almost two years, what still gets you excited about this work?

MS: I think in any part of any role you do, the things that should get you most excited are the people you get to work with. Because when you peel everything back, you want to be surrounded by a group of people who care about what they’re doing, and ultimately care about the people who they’re doing it with. I think that’s been the case here for many, many years. And it’s hard to be unhappy in a place that has that type of energy. There are a number of individuals here who have served for many years and others who are newer to the organization, all who care about what our future looks like and are not just satisfied with the status quo.

JL: Do you think this has contributed to Children’s success over its history?

MS: One of the things I’ve said over and over is that in 85 years, we’ve never been okay just being who we are. If we were, we’d still be the Knox County Crippled Children’s Home 85 years later. We need to be able to look and reinvent ourselves and add services, not because they allow us to beat our chests or brag, but because the community needs it. Anytime a child or a family has to leave this area—their home—to get care, that’s an additional hardship, and we should be looking for ways not to have that hardship be any greater than it has to be. Children’s Hospital is different. Because everyone can walk down the hall, they can see their son, their daughter, their niece, their nephew, their grandson, their granddaughter, and they get it. And they understand that what we do here is not about them anymore. It’s about those children. It’s about those families. And that’s special. That’s unique.

JL: Recently, there’s been a focus on behavioral health at Children’s. Is this one of those reinvention of services you’re talking about?

MS: If you were to ask me, ‘What’s the number one thing I’m most worried about for the next generation of kids?’ It’s not COVID—not that it hasn’t been a danger. It is mental and behavioral crisis care. Over the last year, we’ve seen a 60-plus percent increase in children who arrive to our ER with no underlying medical condition, no underlying surgical condition that requires medical treatment. But they’re simply having a crisis moment: self-harm, inflicted self-harm, talk of self-harm, isolation, struggling with their own self-worth. That’s not a Knoxville thing. It’s not a Tennessee thing. It’s a United States thing. And unfortunately, what was already a challenge pre-pandemic has exacerbated over the pandemic in ways that we couldn’t have anticipated.

Thirty percent of those kids who’ve arrived at our ER over the last couple of years have ended up in an inpatient facility, and we shouldn’t be okay with that. We have to change that equation. And hopefully this is a step. It won’t be the only step, but it is a step along that continuum to start to bring about some healing where it’s needed.Matt Schaefer, East Tennessee Children’s Hospital CEO

JL: How is Children’s addressing this?

MS: This is not an environment that is linear. It’s not well understood. The resources that exist are in short supply in this community and elsewhere. So we’ve been looking for ways to find partners who can help us in that. [We are opening] the crisis stabilization unit. It’s a partnership with the [Helen Ross] McNabb Center, which is a mental health provider in this region for both adults and children. And the purpose of that—and a broader crisis continuum of care—is to keep children away from crisis moments. And when they’re in a crisis moment, keep children away from an inpatient psychiatric stay. That’s ultimately what the crisis stabilization can help us accomplish: from arrival in the ER, quickly stabilized in intensive therapy over a 72-hour period or less, transitioning that child—their family—to an outpatient care environment for ongoing therapeutic intervention, without having to send them to Kingsport to be an inpatient at a psychiatric facility or to Chattanooga or somewhere here locally. Because 30 percent of those kids who’ve arrived at our ER over the last couple of years have ended up in an inpatient facility, and we shouldn’t be okay with that. We have to change that equation. And hopefully this is a step. It won’t be the only step, but it is a step along that continuum to start to bring about some healing where it’s needed.

JL: How pervasive is this problem?

MS: Two years ago, a little bit more than 800 kids or so arrived at our ER in crisis. This past year, more than 1,500 children. So four children a day, on any given day, if you averaged it out, are coming here because they’re in a unique crisis of self-harm or potentially harm of others. Those are the ones who make it to us. That’s the tip of the spear.

JL: As a surgeon, I’m used to seeing a problem, identifying it, taking them to surgery, and my patient being better. Behavioral health is different in that you have a problem, but it’s not one that frequently lends itself to immediate correction.

MS: A child comes in with appendicitis, there’s a pretty predictable pathway to be able to solve that issue. And once it’s solved, it’s solved. This is not that environment. And these kids are different than we expect them to be. Oftentimes, we talk about social determinants of health. What does the household look like? What are the resources in that household? What’s the access to care? If you look at the zip codes in this area, for children who are suffering most from mental and behavioral health crises, many of them are in West Knoxville. These are children who have access to resources. These are children who live in a median household income advantage, relative to many of their peers. These are your next-door neighbors in some places, and it’s silent and it’s not seen but it’s there. These are girls that my daughters go to school with. And I think what that says is that somewhere along the chain, we’re missing—not as Children’s Hospital necessarily, although it could be, but as a community—signals that these children are struggling and suffering. And when we miss enough of them, that’s when they end up here in crisis. So the question is, how do we better solve the crisis equation, and then how do we concurrently get further towards what the underlying signals are, so we never have to get to crisis?

JL: My children are just a step ahead of yours. You have middle school and high school; we have college and graduate school, and it makes me wonder how many are suffering in silence that don’t ever make it to us. How do we help create an environment that addresses those needs, but also catches them before they become problems?

MS: It’s a tough equation. We’ve done one thing really well as a society. And we’ve done one thing really poorly on this dimension. We’ve made it safe and normal for people to talk about these issues, that we’ve normalized in a lot of ways, the ability to have a conversation about mental health and behavioral health. That’s a good thing. But what we haven’t done is added to the infrastructure of a system to be able to address it. So now we have more people who are willing to identify that they’re struggling, but there’s not enough providers, there’s not enough outlets for care. So it’s great to be able to talk about it, but if I can talk about it and can’t get help, that’s not so helpful. And I think that’s what, as a community, we’re facing and probably a lot of the reason why we’re seeing this exacerbation because it is more normalized. Even in moments of crisis, people will seek care. But even when they seek care, can they get where they need to get the best intervention as soon as possible to stabilize, treat, and resolve?

JL: When you think about that impact a children’s hospital can have, are there moments from throughout your own life and career that illustrate that?

MS: I can’t go any further without talking about Malachi. He was diagnosed at about 15 months old with an aggressive form of leukemia. He spent 150 days as an inpatient at Texas Children’s Hospital, and out of 150 days, he spent 10 days outside of the hospital. He was 19 months old when he passed. He was poked, prodded, five rounds of chemotherapy, I mean every unpleasant, unspeakable experience that anyone can imagine, he experienced in that time frame. But man, he was happy almost the whole time, with the exception of three days. He trusted, trusted his mom and dad, trusted the caregivers, even though he didn’t understand what was going on. He showed what resilience looks like even when he wasn’t feeling great. When the nurses would leave, likely after some poke or prod that wasn’t so fun, he’d say thank you and he meant it. And he made friends with everybody. His favorite person was not a nurse, not a physician, not a patient care assistant—all of whom he saw frequently—it was a gentleman named Mr. Peter who did the floor care. He would come and burnish the floor, and Malachi was 100 percent boy. Mr. Peter had a machine, and the machine shook, and it made noises and it did cool things. And that was part of the attraction between Peter and Malachi. Peter always took a moment. Even when Malachi couldn’t come out of his room, he had just gone through a round a chemotherapy and had no ability to fight infection and needed to stay in his room, Peter would come to the window of the room and interact with Malachi from the hallway. I don’t know how I’d deal with what Malachi dealt with. But it’s pretty inspiring, pretty humbling, and a great example of just what being a shining light looks like, even when you have every reason to be a dark cloud.

JL: Is this why you get up every day and do this work?

MS: He’s why I changed careers, and why I’m here today. I’ve got a big picture of him above my desk so that every day I walk in, and I can see him on his first day when he was at Texas Children’s Hospital and remember what he endured and remind me why I’m here.   

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