Scott Webb: There are some essential differences between non-profit and for-profit healthcare systems, and my guests today are here to help us to understand how patient's And the entire community benefits from the non-profit status and approach of Southern New Hampshire Health. I'm joined today by Dr. Brett Sweeney. He's the Emergency Department of Medical Director, and I'm also joined by Kei Joso.

She's a registered nurse And the director of the emergency department.

Scott Webb (Host): This is On Call with Southern New Hampshire Health. I'm Scott Webb.

Scott Webb: It's nice to have you both here today we're gonna talk about nonprofits versus for-profits, And what does that mean exactly for providers, patient's, families, everybody involved. But before we get there, Dr. Sweeney, I just wanna get a little bit of sense from you. Like, tell us about yourself, your healthcare journey, how you got involved in healthcare.

You know, what drives you.

Dr. Brett Sweeney: I've been a emergency medicine physician for 13 years now. I've been, here at Southern New Hampshire Medical Center for. The last 10 years. I currently, serve as the medical director of the emergency department, which, is a administrative role, but I also spend a fair amount of time at the bedside.

I also serve as a, physician in the United States Army Reserve on a four surgical team.

Scott Webb: Awesome. And, yeah, I always like, when I had the opportunity to talk to sort of management, but you're also, as you say, you're also at the bedside as well, which is great IIA opportunity here for you. Like, how'd you get involved, what drives you?

Keziah Jusseaume: So I entered healthcare about 20 years ago. I have always believed that caring for people in their most vulnerable moments is one of my greatest responsibilities as a nurse. So working in the ED has kind of shaped me in profound ways. It teaches me how to care for the whole person behind the crisis, and it demands that you show up with skill, compassion, and clarity no matter what the circumstances are.

For the past five years, I have been in healthcare leadership. So that has expanded my purpose and I've realized that the best way to care for my patient's is to just deeply care for the people who care for them. So supporting my staff, advocating for my staff, and creating an environment where they feel valued and empowered has become an extension of that same mission that brought me into nursing to begin with.

Scott Webb: Sure. Yeah. And of course you can, as we're saying with Doctor, you can kind of see things from both sides, which is great. And today, as I said, we're gonna talk about some of the essential differences between for-profit and nonprofits. So staying with uia, what does it mean to be a nonprofit healthcare system?

And why is that distinction so important for communities like Nashua?

Keziah Jusseaume: for me, working within a nonprofit has strengthened my commitment to nursing. The mission-driven focus of community health, equity and access aligns naturally with my values that I've developed at the bedside. Over the past five years in leadership, I've carried that same patient-centered philosophy forward by supporting the teams who deliver the care.

When staff feel respected, empowered, and supported, they're able to provide the kind of compassionate, thoughtful care that nonprofit systems strive for.

Dr. Brett Sweeney: I think for me, the other important thing to realize is that, you know, for-profit healthcare companies are essentially responsible to the shareholder. Right. So their ultimate goal is to provide back to the shareholder, you know, not that they don't provide compassionate care, but their, the end game is a shareholder.

Where for a nonprofit organization like ours, our end game is to give back to the community. So everything that, you know, comes out of our organization, goes back into the community and back into the healthcare mission of the community.

Scott Webb: doctor, I know that freestanding eds are becoming so common, I'm seeing them seemingly everywhere. What should patient's understand about the limitations of these facilities, especially in emergencies where, you know, every minute matters.

Dr. Brett Sweeney: I think that's an excellent question. So freestanding eds are relatively new to the Nashua area as of right now. There's a few on the Seacoast, but there's none within the Nashua surrounding community. I think there's three important things to understand about freestanding eds. The biggest one being that they don't have a hospital on the same location to support them.

So if you're having a heart attack. Or a stroke or you need surgery, you're gonna have to go to that freestanding emergency department And then be transferred to another hospital. And that's time. There's time in there. These are time critical illnesses, and you will have to be transferred on the other side to receive that definitive care.

Freestanding emergency department cannot offer that care. I think the second thing that people don't realize is that there's a higher associated cost. A lot of people see freestanding emergency departments in the same light. They see urgent cares, or in our case, we call them immediate care and that's not the case.

Their bill, like if you were to go to the emergency department, so if you go to a freestanding ed for a minor illness, you're going to. Get the same bill that you would get if you walked through the door of the emergency department. there's a little bit of sticker shock there for for patient's.

And I think the third is that there's an additional strain on the EMS system. You know, currently in 2026, we have significant delays due to lack of staffing within the EMS system and now with the freestanding ed, you're asking them to pick patient's up at a freestanding ED And then transport them to.

You know, a definitive care area, more than likely a hospital. So that creates additional delays within the EMS system.

Scott Webb: And Keysia, does the community hospital's ability to provide continuous. Fully integrated emergency care from arrival through recovery, really shape patient outcomes.

Keziah Jusseaume: So I think a big component to That is the shared electronic medical record system that's used for different departments and services. So that allows seamless integration and sharing of information about patient's, and it allows that transition throughout their continuum of care to be seamless. Details aren't missed, time isn't wasted.

I think another important component to That is it ensures access to the comprehensive coordinated emergency care close to home and prevents unnecessary transfers, for convenience. And another big piece that people may not realize is that privately funded health systems see about seven times more patient deaths per 10,000 emergency department visits than nonprofit systems do.

Dr. Brett Sweeney: So I think most of us in healthcare, when we take care of patient's, whether it's nursing or physicians or anybody. We think about if it was my family member, how would their care wanna go? And when you come to the emergency department, often it's the worst day of your life.

And do you want that to then be a process where you have to go one place And then to a next place And then to sometimes at third place and you have different nursing, different technicians, different physicians. You know when you go to a hospital that has full wraparound services.

It often is a much smoother experience for the patient And the families, for people who are, like I said, often experiencing the worst, you know, day of their life.

Scott Webb: Yeah. It makes so much sense to me, to this sort of one stop shopping, if you will, everything is there full wraparound services as you put it. And from your perspective, doctor a, as an emergency care provider, how does being a part of a nonprofit mission-driven system affect your ability to care for patient's?

Dr. Brett Sweeney: know, it's interesting, you know, being at the bedside, I know that everything that my organization is doing is for the patient, You know, whether it's their care in the emergency department, whether it's they go upstairs or admitted as an inpatient. Everything that the organization is doing is for the patient, and anything that comes out of that, you.

You know, patient encounter is gonna be put back into the community, which allows me to care for future generations of patient's. And I always think Southern New Hampshire Health has been around for 133 years. It started off as Memorial Hospital, and I often have elderly patient's, you know, in emergency care.

We often ask patient's, you know, tell us where they are, what they're doing, just so we have a gauge on their mental status. Now I often have patient's say to me that they're at Memorial Hospital, and it just shows you that continuum of care Through generations, they'll tell me that their children were born here and their grandchildren were born here.

And being that nonprofit community centered organization allows us to take care of generations of patient's.

Scott Webb: Right.

Keziah Jusseaume: So I think there's a few things from a nurse's perspective that, seem to stand out to me working for a nonprofit. The first one is a stronger alignment with patient-centered values. Oftentimes, nonprofits are built around service rather than shareholder returns. So that means that this, the decisions that are made at a nursing level are guided by community need and not profit margins.

There's a larger emphasis on equity access and caring for vulnerable populations. And then nurses often feel that their personal ethics align more naturally with the organization's mission. Another theme that I tend to see is a focus on holistic care And then a culture that supports compassionate practice. Staff development is another large one, we have a phenomenal staff development program at the med center.

And then a sense of purpose that fuels resilience. So especially in emergency room nursing, resilience is something that we teach all our staff And we support their ability to be resilient in the work that they do because it reinforces the why they become nurses. It helps 'em stay grounded during those stressful shifts, and it creates a sense of belonging and shared purpose so that when they come to work every day, they're a hundred percent.

Scott Webb: Yeah. Yeah. You really do see, and get a sense from you guys today that, the nonprofit approach, if you will, the benefits for providers, patient's, families, the entire community. It all makes sense to me in my head anyway Dr. Sweeney, As we wrap up here, You know, as healthcare evolves, what gives you confidence that nonprofit community-based care remains essential to ensuring equitable and accessible healthcare for everyone.

Dr. Brett Sweeney: Yeah, I would just say the we're ingrained in our community, right? When you take that question at face value, there's two words that stick out to me. It's nonprofit and community. I think those go hand in hand. We're not worried about profit, so we can focus on our community.

And I think here at Southern New Hampshire Medical Center, we are deeply ingrained in our community. You know, a couple of examples are we provide medical direction as physicians for most of the local EMS services. So everybody who's bringing us patient's, you know, we provide medical direction for those EMS services.

And that's a service that we offer at no cost. We just. Understand the importance of EMS services, having medical direction. I think there's countless other examples that prove how ingrained we are in the community. The other big example there I would say, is that Southern Hampshire Medical Center offers, I think one of, only two, sexual assault nurse examiner programs in the state.

So we offer. 24 hour, 365 day a year service to potential victims of sexual assault. And that's not a program that by any means generates a profit, but we understand the importance of it to the community, so it's a service that we offer.

Scott Webb: It's been nice to have you both here today and kind of get a sense of the essential differences between for-profit and non-profit. Good stuff. Thank you so much.

Keziah Jusseaume: Thank you.

Dr. Brett Sweeney: Thank you for the opportunity. Appreciate it.

Host: And for more information, go to snhhealth.org. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is On call with Southern New Hampshire Health. I'm Scott Webb. Stay well, and we'll talk again next time.