Scott Webb (Host): 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 patients and the entire community benefit 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 Medical Director. And I'm also joined by Keziah Jusseaume. 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. It's nice to have you both here today. We're going to talk about non-profits versus for-profits, and what does that mean exactly for providers, patients, families, and everybody involved. But before we get there,

Dr. Sweeney, I just want to 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 an 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 an 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 forward surgical team.

Host: Awesome. And, yeah, I always like when I had the opportunity to talk to sort of management, but as you say, you're also at the bedside as well, which is great. Keziah, 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 patients 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.

Host: Sure. Yeah. And of course, as we're saying with Dr. Sweeney, you can kind of see things from both sides, which is great. And today, as I said, we're going to talk about some of the essential differences between for-profit and non-profit. So, staying with Keziah, what does it mean to be a non-profit healthcare system? And why is that distinction so important for communities like Nashua?

Keziah Jusseaume: For me, working within a non-profit 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 non-profit 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 the end game is a shareholder; where, for a non-profit 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.

Host: Doctor, I know that freestanding EDs are becoming so common; I'm seeing them seemingly everywhere. What should patients 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 are a few on the Seacoast, but there are none within the Nashua surrounding community. I think there are three important things to understand about freestanding EDs.

The biggest one is that they don't have a hospital at the same location to support them. So, if you're having a heart attack or a stroke, or you need surgery, you're going to 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. A 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. They're billed as 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 patients.

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 a lack of staffing within the EMS system. And now, with the freestanding ED, you're asking them to pick patients 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.

Host: And Kehziah, 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 patients, 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 non-profit systems do.

Dr. Brett Sweeney: So, I think most of us in healthcare, when we take care of patients, whether it's nursing or physicians or anybody, we think about if it were my family member, how would their care 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 a 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.

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

Dr. Brett Sweeney: 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 are admitted as an inpatient, everything that the organization is doing is for the patient. And anything that comes out of that, you know, patient encounter is going to be put back into the community, which allows me to care for future generations of patients.

And I always think Southern New Hampshire Health has been around for 133 years. It started as Memorial Hospital. And I often have elderly patients-- You know, in emergency care, we often ask patients, you know, tell us where they are, what they're doing, just so we have a gauge on their mental status. I often have patients 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. Being a non-profit community-centered organization allows us to take care of generations of patients.

Host: Right.

Keziah Jusseaume: So, I think there are a few things from a nurse's perspective that seem to stand out to me working for a non-profit. The first one is a stronger alignment with patient-centered values. Oftentimes, non-profits are built around service rather than shareholder returns. So, that means that 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. And 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 them 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.

Host: Yeah. You really do see and get a sense from you guys today that the non-profit approach, if you will, the benefits for providers, patients, families, and 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 non-profit community-based care remains essential to ensuring equitable and accessible healthcare for everyone?

Dr. Brett Sweeney: Thanks. That's a great question. I think it boils down to two of the words within that question. One is nonprofit, and the other is community. Being a nonprofit organization, we can continue to use all of our resources to bring back to the community. We're not worried about outside investments. Everything we do goes right back into the community.

And then I think the second is community. You know, everything we do is focused on giving back to the community, and I think there are two great examples of that. The first being that we provide medical control to some of the local EMS agencies that are bringing us patients. We do that at no cost because we understand that it's a valuable asset to the community.

And I think the last, one of the greatest examples, is our sexual assault nurse examiner program. We're one of two programs in the state that offers 24 7, 365-day-a-year dedicated SANE coverage. And that's not a program that's going to bring a lot of money back to the hospital, but we understand. It is a valuable community resource, so we dedicate our time and efforts to providing it.

Host: 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.