Becker's asked C-suite executives from hospitals and health systems across the U.S. to share their organization's areas of growth for the next few years.
The 45 executives featured in this article are all speaking at the Becker's Healthcare 12th Annual CEO+CFO Roundtable on Nov. 11-14, 2024 at the Hyatt Regency in Chicago.
To learn more about this event, click here.
If you would like to join as a speaker or a reviewer, contact Mariah Muhammad at mmuhammad@beckershealthcare.com or agendateam@beckershealthcare.com.
For more information on sponsorship opportunities, contact Jessica Cole at jcole@beckershealthcare.com.
As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our conference. The following are answers from our speakers at the event.
Question: What was your most effective project or initiative in the last year that yielded great results?
Terry Shaw. President and CEO of AdventHealth: Workforce retention continues to challenge our industry, which is why we continue to be relentlessly focused on team member retention and recruitment. Our multi-pronged strategy includes upskilling and training our current workforce of 95,000 team members through leadership and training programs within our Leadership Institute, education assistance and clinical ladder initiatives; home-growing our own talent pool through AdventHealth University and innovative partnerships with secondary and post-secondary institutions; and continuously refining our team member benefits and compensation packages based on their feedback and market and equity pay analyses. As a result, we're seeing our workforce turnover rates continue to decrease and top decile performance in employee engagement.
K. Craig Kent, MD. CEO of UVA Health and Executive Vice President of Health Affairs at University of Virginia (Charlottesville): As part of UVA Health's 10-year One Future Together strategic plan, ambulatory operations is in the midst of transformational change focused on providing a unified, best in class experience to patients at every step of their care journey and equipping providers and team members with the tools and infrastructure needed to attain our goal. Related, a key transformational initiative – One Team: United on Access (“One Team”) — is designed to increase patient access and is grounded in consistent progress measurement across core quantitative metrics.
UVA Health has seen tremendous progress since the One Team launch, creating up to a 30% increase in available patient appointments — which, when this work is complete, will mean tens of thousands of new patient visits annually for UVA Health. This growth in patient visits will occur without the expansion of staff or facilities and with some increase in the number of providers.
In addition, our patient experience survey data validates that we have improved satisfaction from the 83rd to the 88th percentile, further confirmed by our access team: over 80% say they are able to schedule appointments during the first patient call — a significant change from prior to the One Team launch.
We expect the transformational One Team work will continue to pay dividends for patients and team members alike as it continues to roll out across our remaining clinics.
Peter Banko. President and CEO of Baystate Health (Springfield, Mass.): The healthcare system all over our country has traditionally built its processes around those that provide the care. That doesn't work anymore for our consumers in what has become a consumer- and digital-centric world. As my oldest son said to me about one of his recent healthcare experiences, “It is not good to be a Banko in a non-Banko-led health system.” If you want to win in any market, be the first to tackle (and start fixing) consumer access. Over the last year, we started a transformational journey to become a more consumer-driven system.
With our emergency department teams redesigning processes, we produced some extraordinary results in reducing left without being seen throughout the system to less than 1%. We built LinkED to support our caregivers in building a one call system to connect ED patients with appointments before they left the ED for physician visits, imaging, and other important follow-up care. Surgeons crafted policies and systems to impact OR throughput, start times, turnover times, block scheduling, and overall efficiency. Multidisciplinary care teams – spearheaded by hospitalists – designed standardized work for care management to improve quality, safety, service, length of stay, and transitions outside of acute care. There was great work around scheduling in the physician enterprise and in the transfer center for access to tertiary centers.
Paul Hinchey, MD, MBA. Chief Operating Officer, University Hospitals (Cleveland): We embarked on a multi-year journey to implement our Systems of Care operational model, and we already have some good results to report from the past year. The new approach shifts the view of the delivery model from a site of delivery focus to that of the service line provider to better reflect how the patient experiences the care journey. Changing the operational model allows us to think differently about how we deploy our resources. This includes expanding our virtual footprint, redesigning what care we deliver at home in our Healthy at Home program, or making better use of brick and mortar assets to better consolidate interdependent services in care and volume hubs. With the focus shifting to the patient journey, we meet their needs first but find efficiency in better use of space, reduced cost of care delivery, higher quality and better outcomes.
Two service lines that are well on the way to achieving this are heart and vascular and cancer. For example, UH Lake West Medical Center now has high-level cardiovascular services that had not previously been available there. More cardiovascular subspecialists, a new suite for patients with vascular disease, a new diagnostic testing facility, and more complex interventional, electrophysiology and surgical procedures performed onsite. We've also established three main hubs for cancer care among our 17 sites, in addition to our main campus – UH Minoff, UH Mentor and UH Avon health centers. As a result of this system optimization, the number of participants in clinical trials is on the rise. Participation in smaller-scale trials at community sites has increased by 12% over the same metric in 2022. At the same time, participation in rigorous trials of new drugs or therapies, conducted at the three hubs, is up by 24%.
Ultimately, this Systems of Care strategy is designed to bring the highest-quality care to our local communities, with patients' needs and preferences always top of mind.
Elizabeth Wako, MD. President and CEO of Swedish Health Services (Seattle): One initiative making an impact is the Justice Unity Support Trust (JUST) Birth Network. The program provides our Black and Native patients with culturally connected care from the start of pregnancy through the postpartum experience. The network includes dedicated birth and postpartum doulas, childbirth educators and inpatient cultural navigators. Data has shown a reduced number of C-sections and an increased number of unmedicated births among Black parents who had the support of a Black doula during childbirth. In addition, government officials met last summer with JUST Birth leaders to learn more about the program.
Bradley C. Bond. CFO of University Hospitals (Cleveland): UH experienced tremendous success clinically when it went live on Epic across its system on October 1, 2023. As a result, stabilizing revenue cycle, cash collection and ensuring adequate cash flow was a high priority. We established a system of daily reporting and forecasting of patient cash deposits into the bank and predictive up-stream metrics. This system helped to identify areas of concern that needed immediate intervention.
We re-energized our various impacted departments to overcome some of the most challenging hurdles to clear claim submission, reduce denials, and address workflow challenges. In addition, we aggressively managed working capital in the fourth quarter to preserve our liquidity.
In addition, the Epic implementation created new work-flows, new ways of measuring utilization statistics, and new revenue recognition principles for our Strata costing system. This required tremendous collaboration across various departments to identify gaps in financial reporting and utilization measurement together with reconciling reported activity to actual cash received. I am extremely proud of our UH teams for the incredible success in standing up one of the largest and most complex Epic go-live events without harm to patients or operations and quickly resolving various issues after the go-live event.
Michael C. Backus. President and CEO of Oswego Health (N.Y.): The most effective project Oswego Health took on this past year was re-evaluating our nursing cohorts on our medical/surgical floors. Due to the workforce shortage, we chose to move away from a primary care style and into pod-centric nursing. This allowed us to onboard and welcome back LPNs into our care delivery model at a lower cost. Coupled in the pod with RNs and Nurse Aides, this team helped us open beds at a time when our community needed it most. This approach has helped us stabilize our service and with the help of a very talented hospitalist service led by Dr. Nicholas Runeare, our hospitalist medical director, we have been able to flex up beds to meet our community's needs.
Lynne Fiscus, MD. President and CEO of UNC Physicians Network (Durham, N.C.): Our most effective initiative in the last year was investment in our Onboarding and Optimization (O2) Team. They help focus on both onboarding of clinicians and their care teams and optimizing the experience of care for our clinicians and care teams, ultimately allowing clinicians to work to the top of license. Through focusing on care team workflows, centralized electronic health record inbasket support, and limiting the number of messages that require handling by the onsite care team, we have reduced clinician pajama time, improved quality, reduced time to fully ramp up for new providers and are getting patients answers to their electronic messages faster.
David Berger. CEO of University Hospital at Downstate (Brooklyn, N.Y.): Over the past three years University Hospital at Downstate has been engaged with Press Ganey on a high reliability journey. When I took over as CEO at UHD in September of 2020 we were emerging from the first wave of the COVID-19 pandemic. Central Brooklyn was ground zero during the first wave with a very high incidence rate and a high mortality rate. UHD was designated a COVID-19 only facility by the Governor of New York State. This devastated our clinical programs and clinical volumes. As an incoming leader I felt it was crucial to rebuild our culture.
We decided to partner with Press Ganey in an effort to elevate our culture by focusing on patient safety and quality, things everyone in the institution were supportive of. In three years we have returned our volumes to pre-COVID levels, improved our Vizient Safety score from the 2nd percentile, to the 54th percentile, had our kidney transplant program designated a center of excellence, and passed a Joint Commission triennial survey with no condition of participation findings. Additionally, we have seen an 84% reduction in our annual operating deficit.
Peggy Duggan. Executive Vice President, Chief Physician Executive and Chief Medical Officer of Tampa (Fla.) General Hospital: The most important initiative that I have worked on this year is regionalizing our physicians and providers to limited units within Tampa General's academic health system. Our team began by staffing advanced practice providers, doctors and trainees in intensive care units so that they would remain in the unit and continue to develop as a synergetic and cohesive team. This practice has accelerated our quality of work as well as the patient experience and has decreased patient days spent in the ICU, which has improved efficiency and decreased cost.
Additionally, we have included our hospital medicine teams in this initiative. This has allowed them to spend more time with their patients and the nursing and ancillary teams as opposed to when they previously saw patients on multiple units.
Overall, we are seeing true benefits from this effort regarding physician engagement and patient satisfaction. This is a shining example of Tampa General's continuous pursuit of becoming the safest and most innovative academic health system in America.
Mayank K. Shah, MD. Vice President and Chief Medical Officer of Advocate Condell Medical Center (Libertyville, Ill.): As a CMO I hold primary accountability for safety and quality outcomes at our hospital. When it comes to safety, our primary opportunity has been around hospital acquired infections.
The foundational strategy to reduce HAI's revolved around our hand hygiene compliance. Our processes previously yielded 80% performance in compliance with hand hygiene. Our goal was above 90%. We quickly implemented several steps to improve performance: monthly recognition of departments with highest performance by the executive team, regular sharing of the data on performance with all groups including providers, highlighting the importance of hand hygiene with our teams and leaders, creating accountability for performance through policies and procedures, and finally connecting hand hygiene performance with HAI outcomes.
This has led to a significant success in increasing our compliance. I am happy to report that the hospital has achieved more than 95% compliance with hand hygiene for six months in a row, and it continues to be sustained through this year as well. This seems like an insignificant process improvement; however, it has led to a significant cultural shift in our organization around safety and quality.
Matthew Painter, PhD. Director of Leadership Development at the University of Alabama Birmingham Health System and School of Medicine: Our most effective initiative in the last year was the High Performing Care Collaborative. The purpose of this collaborative is to submerge intact, interdisciplinary teams with the key management and leadership principles that drive outcomes while forming tailored action plans. This two-day intensive leadership development boot camp has served as a wonderful model to help leverage synergy between specialties and serves to promote a team-based culture.
Kevin Andryc. DO. Chief Medical Officer of UH Geneva and Conneaut Medical Centers (Conneaut, Ohio): Discharges by 14:00 — An essential metric for patient flow. Discharges by 14:00, multiple disciplinary teams approached (Daily huddle/meeting to discuss barriers). Emphasis on discharge orders are placed before 0900. Place transport (EMS) requests the day before potential discharges. Last month, 64% of discharges were before 14:00.
Ashley Arey. Vice President of Care Access at UNC Health (Chapel Hill, N.C.): With access being a key priority at UNC Health, I led a team that was responsible for 'blueprinting' initiatives that would revolutionize the access experience for our patients and care teams. The engagement was successful, yielding several robust initiatives including expanding and integrating access centers for a unified, consistent scheduling experience, and expanding online scheduling across specialties, putting more self-service options into the hands of our patients. Equally important to our 'front door' access experience was to develop strategies that support improved capacity management. Initiatives included improvements to our referral pathways and tools, analytics that elevate capacity gaps, and a bolstering of virtual strategies that support timely and convenient care.
Ashwani Bhatia, MD. CEO of BayCare Clinic (Green Bay, Wis.): The most impactful initiative recently undertaken by our clinic under my leadership involved addressing a capacity challenge at our main hospital campus. By appropriating certain surgeries to our outpatient ASC in Kaukauna, we not only enhanced capacity for more complex surgeries at our hospital, we also effectively reduced costs for the institution as well as for our patients.
Greg Jackson. Market Vice President and Finance Officer of Virginia Mason Franciscan Health (Tacoma, Wash.): One of our most effective projects was redistributing where our surgical cases were being performed. We looked at lower acuity procedures to see if we could move out of our tertiary center and filling capacity at a smaller nearby sister facility. This gave the volume push needed for the smaller site and increased capacity at the larger site to accept more higher acuity cases with favorable financial results.
K. Sarah Hoehn, MD, MBe. Chief Medical Officer of La Rabida Children's Hospital (Chicago): Our most effective project this year was establishing a hospital based food pantry for our families, based on the Feed First model. At the inception, we were not sure if families would be comfortable using it, but what we learned was that 'if you build it they will come.' Our pantry now gets high volume use and we stock daily. We have seen such gratitude from our families that we are continuing to expand and grow this initiative. Hunger IS a healthcare issue, and hospitals need to ensure they have a plan to mitigate food insecurity.
Stephanie Weatherly, DNP. Chief Clinical Officer of Psychiatric Medical Care (Brentwood, Tenn.): Psychiatric Medical Care provides behavioral health services to hospitals and health systems across the country, including a hospital-based, outpatient program for older adults called Senior Life Solutions. This past year, we created an outcomes measurement application that allows us to see patient and program outcomes at the press of a button. While we've measured patient improvement through evidence-based testing for the last 10 years, this new data application helps us make macro and micro changes to enhance the patient experience through enhanced reporting and graphing of the outcomes data.
We share this information with other members of the patient's care team, such as their primary care provider. When behavioral health providers can easily show an accurate snapshot of a patient's progress in a way that can be understood by all members of the care team, the patient wins!
Marie Langley. CEO of Desert Valley Hospital & Medical Group (Victorville, Calif.): Desert Valley Medical Group, a prominent multispecialty organization affiliated with Desert Valley Hospital and aligned with Prime Healthcare, directed its efforts predominantly towards operational growth and profitability throughout 2023. By fostering new collaborations with physicians and extending established service offerings, we significantly enhanced community access to healthcare while yielding notable outcomes. However, the expansion exerted pressures on existing personnel and resources. Consequently, our strategic focus for 2024 revolves around augmenting system workflows and fortifying our IT infrastructure to ensure sustained operational excellence and seamless service delivery.
Olusegun A. Ishmael, MD. COO and President of Hospital Division at MetroHealth (Cleveland): Over the past year we aggressively worked on the length of stay because of the increased risk of hospital acquired conditions, the added workload on nursing and the financial impact.
First, I like to break things down to something anyone can understand and relate with. For the decrease in LOS, I used the analogy that the inpatient service and the LOS is like being in a hotel. You check in to the hotel, you've booked a certain number of days, you expect a certain service, and you have a specific checkout date and time.
Secondly, I look at the impact on how it affects quality of patient care and outcome, as well as the impact on our caregivers' wellbeing.
A few of the things we did were:
- Estimated day of discharge – starts on the day of admission, the inpatient service determines the EDD based on diagnoses and SDoH factors. This is the number of days you are booked to stay.
- This EDD is posted in the patient room, the patient and caregivers are all aware of the EDD.
- Multidisciplinary rounds – we meet to discuss patient progress and identify any delays in care, this includes physicians, nurses, etc.
- Identification of long stay patients – patients who have spent four days or longer are reviewed with case management to identify any delays.
- Discharge Lounge – this serves as a holding area for patients who are waiting for their rides, medications, or any other delays in discharge.
- Hospitalist visibility of their data – every hospitalist gets a monthly report that compares them to their peers on multiple factors like LOS and their case mix index.
- LTACH partnership – early identification and transfer of these specific patients
This is an ongoing process and we are looking to partner with a payer on improving LOS that is impacted by prior authorizations.
Adam Breslow, MD. President and CEO of Children's Primary Care Medical Group (San Diego): For the better part of the past decade (and before post-COVID staffing concerns), the singular source of frustration for clinicians has been the overwhelming volume of EMR in basket messages and tasks. In 2023 after two years of planning and with coordination from our management and population health teams, we were able to hire 14 RNs and Clinical Coordinators to not only be the first point of contact for all in basket messages but also have the clinical practice guidelines in place to resolve the majority without needed clinician input. This has led to approximately an 80% reduction of individual clinician time with this portion of their workday. The quality of the resolutions is superior and the relief from clinician work outside of work has been met with exceptional positivity.
Valerie Mattison Brown. Chief Strategy Officer of Veterans Health Administration (Washington, D.C.): Realizing that Veterans get the best care and prefer to receive their care from the VA direct care system, we refocused our strategic planning efforts to ensure a laser focus on sustaining the system while creating pathways for better coordinated and integrated healthcare delivery with our partners including academic affiliates, Department of Defense, and community providers.
To maintain that laser focus we developed strategic goals, objectives and priorities that are aligned and integrated across our healthcare systems. We undertook a two-year process of ensuring, for the first time, true integrated strategic plan management where at any time from the headquarters, regional and facility level we can have an accounting of actions that the enterprise is taking to accomplish the goals and objectives.
Lynn Simon. President of Healthcare Innovation and Chief Medical Officer at Community Health Systems (Franklin, Tenn.): CHS is implementing technologies that advance patient safety, including tele-sitting for hospitalized patients at high risk for falls. In the second half of 2023, we moved from a decentralized model with four hub centers monitoring patients in 17 hospitals to a centralized model. We now have just one monitoring site, but we have expanded to provide tele-sitting services for 29 CHS hospitals. Since centralization of this service we have seen an additional 10% reduction in fall rates and to date only one confirmed fall with serious injury. CHS has a longstanding commitment to patient safety and has reduced the Serious Safety Event Rate in our hospitals by nearly 90% over the past decade.
Pooja Vyas, DO. Vice President and Chief Medical Officer of BJC Christian Hospital (St. Louis): One of our most effective projects in 2023 was the new implementation of our case management and social work model which helped to decrease our length of stay.
We created the contemporary care model, and helped to align our case manager and social worker roles to their education and expertise. We improved our ratios, and we also helped our teams develop leadership skills to be accountable to their roles from progressing the patient, managing cost of care, and planning safe discharge transitions.
Tom Vasko. CEO of Newman Memorial Hospital (Shattuck, Okla.): Newman Memorial Hospital has grown its volume by 73% over the fiscal year. Service line advancement in outpatient services and surgeries, revenue integrity initiatives, clinic expansion and women's health services commencing have been substantial contributors. However, the emphasis on culture, physician relationships and cultivating a community ownership mentality of our hospital has catapulted its growth and stability for the years to come. It is my job to ensure our team of physicians, clinical and administrative staff have the tools to accomplish their goals. Provide care to our community passionately, effectively, autonomously and without the burden of stress. While we focus on expansion of access and quality; we equally focus on our culture and partnering physician relationships.
Ryan Calhoun. Vice President and Chief Strategy Officer of Connecticut (Ohio) Children's: Our most effective initiatives in the past year that have yielded great results are our expansions of our regional locations in our secondary service areas, which are helping us continue to advance as a regional destination of pediatric care. These expansions coupled with our investments in expanding our capacity for surgery and inpatient care have allowed us to see large growth in the care we're providing to patients outside of our primary service area. The greatest impacts are being realized by our neonatology, otolaryngology, neurosciences, heart and critical care programs.
David Krajewski. Senior Vice President and CFO of LifeBridge Health (Baltimore): From a consumer's perspective, healthcare is simply too expensive – we know this – but the provider and system side of the equation isn't much better. Labor costs, despite recent normalization, continue to be a big issue while lagging reimbursement rates and capitated volumes here in Maryland (read more here: MHA / Global Budget Revenue) limit our opportunity to drive volume and revenue.
With these constraints, it's imperative we deliver care as efficiently as possible to remain viable, able to invest in priorities and be proactive vs reactive to our financial context. In the fall of 2022, we launched a systemwide performance improvement initiative dubbed 'Optimize It!' internally which reviewed every business unit, every purchase and every asset – from ORs to cleaning supplies – for opportunities to 'work smarter' without wholesale layoffs or reductions to the care we deliver across our 120-plus sites.
With this kind of all-hands-on-deck attention, together with partnership from other areas of the organization who understood the need, we were able to deliver in excess of $120 million in annualized OPEX savings to the organization. While not everyone's favorite activity, people bought-in, understanding the reality and that caring about the communities we serve was the mission.
Siri Nelson. President and CEO of Marshall Medical Center (Placerville, Calif.): Reducing and managing length of stay has had significant focus at Marshall, and making this a key initiative for coordinated action between providers, nursing, case management and administrative staff has enabled us to make significant improvements.
Our target LOS for 2023 was < 4.0 days and we achieved under goal at 3.99 days. In FY 2024 our LOS has increased to 4.4 days year to date, illustrating the impact that delays in authorization for DME or SNF placement can have.
Our success has been driven through a combination of training, education, and workflow improvements to ensure timely action on care management decision making and further details of specific initiatives are provided below. Underpinning all of this has been a strong emphasis on the importance of team-based care.
How our performance measures against target
- Our Target LOS for 2023 was < 4.0
- FYTD we ended under goal at 3.99
- CMI trended appropriately with LOS month to month
- Over 2023, our most consistent issues delaying discharge were difficulty obtaining DME and SNF placements due to payer delays.
- For non-Medicare patients, our most difficult discharge delays were long-term placement patients needing conservatorships and lack of funding.
- Our target LOS for 2024 is < 4.0
- FYTD we are at 4.2
- This is driven by an increased number of patient for whom we have faced challenges with authorizations from health plans for access to DME and / or SNF
- The situation has recently improved after direct action with these plans and we anticipate our LOS performance is again improving
Theresa Dawson, DNP, MSN, RN. Chief Nursing Officer of Oaklawn Hospital (Marshall, Mich.): As the CNO, I am responsible for the surgical services area at our small rural hospital. As with many challenges faced by smaller organizations, it was important to assure that our surgical volumes were optimized thus producing a better financial yield. One of our previous challenges had been with surgical blocks not being utilized efficiently or effectively. About 18 months ago, we started utilizing LeanTaas as our AI solution. This has allowed us to get real time block utilization data, open up release time from the offices and given us data on 'first case on time starts.' All of these tools have allowed our surgical team to optimize our resources, filling the blocks rather than having gaping holes in the middle of the day and realizing increased surgical volumes as a whole. This equates into additional revenue, improved patient satisfaction and block time availability for our new surgeons.
Alquietta Brown, PhD, MHSA, BSN, RN, NEA-BC. Chief Nursing Officer of Inova Mount Vernon Hospital (Fairfax County, Va.); Vice President of Nursing of Inova Neuroscience & Behavioral Health Service Lines: The critical need for behavioral health services has never been more apparent than it is today. I was proud to help lead the opening of a new 20-bed behavioral health unit at Inova Mount Vernon Hospital, increasing our capacity from 30 to 50 beds and filling a much-needed gap in the community. It's one step closer to ensuring those who are suffering from mental health challenges have access to compassionate, quality care when they need it.
Janet Bennett. Vice President of Cardiology Services, Clinical Cardiology at Deborah Heart and Lung Center (Browns Mills, N.J.): One project that my team worked on at Deborah Heart and Lung Center that yielded great results was related to efficiency. Our program leaders led an interdisciplinary work group who focused on ensuring that our procedural cases started on time. This group included team members from every department who touched our patient from scheduling to discharge on the day of the procedure.
We collected data on delay reasons and created a pareto graph so that we knew which delays we should work on first to yield us the greatest and quickest results. At the start of our project our 'on time' case start was 55%; within 6 months we reached 90% and have maintained that over the last year. The key to our success was engaging front line team members with regularly scheduled meetings, which helped hardwire their solutions. We celebrated our successes along the way.
Dave Dunkle, MD. President and CEO of Johnson Memorial Health (Franklin, Ind.): Improving patient access to a primary care provider is always important to us at Johnson Memorial Health. In the last year, JMH piloted a project where a more standardized scheduling template was applied to our Family Medicine practices. The intent of this project was to create more opportunities for same-day acute need visits as well as visits for new patients to the organization. This standardization has resulted in a 20% increase in visits scheduled the same day the patient was seen by a clinician, and a 15% increase in new patient visits to our Family Medicine practices.
Elham Yousef, MD. Vice President and Chief Medical Officer of Bayshore Medical Center Hackensack Meridian Health (Holmdel, N.J.): Leading the efforts to reduce avoidable readmissions across the system. The project yielded great results because of 3 critical factors: First, organization of an interdisciplinary team that was clear on rules, accountability structure, communication and most importantly, goals of maximizing value to patients across the continuum of care.
Second, mapping out the patient's journeys across different healthcare settings within the system ( inpatient, ambulatory, speciality, home, skilled nursing facilities, ED), in order to identify the system's infrastructure gaps.
Third, utilization of real time data and data analytics both retrospective and predictive. This comprehensive approach enabled us to ensure team alignment, system's integration and care coordination. We applied resources effectively and implemented patient centered, data driven initiatives across the continuum of care.
Zachary Lenert. MSN, RN. Vice President of Integrated Care Management at Sharp HealthCare (San Diego): One of our most impactful initiatives has been the optimization of our system's utilization review functions. We achieved this by creating a comprehensive system model and implementing standardized practices that support Sharp HealthCare's acute care hospitals and women and children's hospitals. This model aimed to unify UR core functions under a centralized model, expand our physician advisor program, and implement standardized operations. The introduction of a system-wide physician advisor has been crucial in creating system standards around minimizing payer denials through early physician advisor engagement.
While unifying our acute care UR team under a centralized model we have enhanced payer collaboration to ensure accurate and timely communication regarding medical necessity of patient care services. Applying a centralized model of utilization review and physician advisory has allowed us to provide high-quality patient care, denial risk mitigation, standard UR practices, apply new technologies, and build an agile team that can pivot to meet the demands of this ever-evolving work.
William Morice, MD, PhD. President and CEO of Mayo Clinic Laboratories/Mayo Collaborative Services: The most effective initiative over the last year has been our strategic push towards the digitalization of our business and pathology practice. From the Mayo Clinic Laboratories perspective, we are using these tools to provide our customers with both clinical and operational insights that can improve care delivery and optimize performance.
In our practice, the transition to paperless workflows and digital pathology slide review has reduced waste and introduced new efficiencies, making tasks less burdensome for our staff. Through these efforts, we are introducing new tools for our staff to not only adapt to the evolving landscape but also set ourselves up for success in the coming years. Ultimately, this helps us continuously innovate, scale those innovations to reach more patients, and serve them better.
Kathy Parrinello. Executive Vice President and COO at University of Rochester (N.Y.) Medical Center, Strong Memorial Hospital: One of the major initiatives I supported with my chief pharmacy officer was the reimagining of our outpatient pharmacy program as a critical part of our clinical integration program to keep all patient care and referrals within our health system. Typically under value based contracts, clinicians understand the importance of keeping all medical referrals in the system, but they don't realize the advantages of keeping pharmacy services such as outpatient medications, infusion therapy (home or in clinic), oxygen and other DME services in the system.
We have developed a robust outpatient pharmacy program including all of these ancillary services. Through education and providing strong clinical support to providers ordering these services, we have achieved tremendous growth in our ancillary service lines. We are now generating revenues of over $500 million in these services and achieving a 'closed-loop,' coordinated continuum of care for patients that they need and deserve.
Jodi Fincher, RN, BSN. CEO of St. Joseph Medical Center: Like most hospitals during the pandemic, we were forced to offer unprecedented pay incentives in efforts to maintain safe staffing levels in nursing, respiratory therapy, and radiology departments to just to name a few.
These incentives included:
- Expansion of our regional and internal float pools
- Utilization of traveling/agency staff
- Expansion of PRN positions
- Expansion of international nursing staff
- Utilization of overtime
- Offering critical pay incentives
While this was a necessary and successful staffing strategy, it became a “new normal” pay rate for staff. Thus, it was difficult to pull back and unwind these unsustainable pay practices post pandemic.
In collaboration with our CFO, CNO and local/corporate HR teams we created a cost matrix to identify by job category and class where we could achieve the quickest cost savings in a tiered approach.
Our clinical leadership teams utilized this matrix to assure we were utilizing the lowest cost staff while maintaining the loyalty and trust of our own internal staff. This project yielded tremendous cost savings and, with the emphasis on our internal staff, we were able to retain our tenured staff while still providing the highest quality of care.
Shlomit Schaal, MD, PhD. President and CEO of Houston Methodist Physician Organization; Executive Vice President and Chief Physician Executive of Houston Methodist: I joined Houston Methodist last year and kicked off a major initiative: the System Quality and Patient Safety Listening and Learning Tour. My goal was simple: get to know our team and find out what works and what needs improvement.
Over two months, my team and I visited all seven of our hospitals, talking to everyone from frontline workers to department heads. We collected a lot of face to face feedback about what was important to our staff—like better communication and more training. Using this information, we developed our 2024 Strategic Plan. We introduced three main strategies:
- SQPS Strategy: We hired a new senior leader, System Chief Quality Officer, Dr. Shawn Tittle, and created a quality and patient safety 'diamond' structure to keep all hospitals connected and informed, helping everyone work better together. We committed to go together on a path to become a high reliability organization.
- Communication Strategy: We started a monthly newsletter and a podcast called 'Quality Time' to keep everyone updated and involved.
- Joy in Medicine Strategy: We formed a new department in our physician organization dedicated to professional fulfillment and physician engagement.
These changes have made a big difference. Our meetings are now more about sharing best practices and our communication efforts have seen high engagement, with many staff actively participating.
This project wasn't just about gathering feedback; it was about creating a movement that brought us closer together and made our system stronger.
Arianne D. Dowdell, JD. Vice President and Chief Diversity, Equity and Inclusion Officer, Houston Methodist: Some of our biggest wins this year involve looking for ways to diversify our workforce now and in the future to meet the evolving needs of the healthcare landscape. Some of the ways we're doing this include exploring partnerships with outside organizations in our local community like Best Buddies, The Center for Pursuit, and Alexander Jewish Family Services, to support potential candidates with disabilities and expanding collaboration across departments like HR.
At Houston Methodist, we value the perspectives and skillsets of our employees and potential employees, and we believe sourcing candidates of all backgrounds is critical to meet the future needs of healthcare. Another way we're supporting future leaders is through our summer scholars program, administered by the Office of Diversity, Equity & Inclusion, which is now going into year three. Scholars have the opportunity to explore healthcare leadership in various non-clinical departments across Houston Methodist, which has helped to increase engagement across our community hospitals and even resulted in full time job opportunities for the scholars.
Dana McQuaide Begley. Vice President of Wellness and Recovery at Lee Health (Fort Myers, Fla.): Over the past 18 months, we have developed a multi-disciplinary team to focus systemwide on optimizing length of stay by reducing excess days in acute care. The team has concentrated on three primary areas: recognizing opportunities to create efficiencies in bedside care delivery, early identification and planning for post-acute needs and creating alternative care delivery options such as remote monitoring and telehealth.
Early discharge planning by cross-disciplinary teams has been key. By deploying utilization technology and standardized progression of care rounding to determine discharge options, care coordination and communication about transition to next levels of care are greatly improved. Post-acute services and community agencies are heavily integrated to pull patients into the next care setting. Feedback and collaboration throughout the continuum are essential to successfully meeting the patient's clinical needs at all levels of care at the right time.
Arshad K. Rahim, MD. Chief Medical Officer and Senior Vice President of Population Health at Mount Sinai Health System (New York City): We have consistently lowered acute utilization and cost of care over 8 years in our value based contracts but our medical loss ratio has suffered due to lack of accurate risk adjustment of our complex population consistent with a large academic medical center. We implemented a process via our EMR and best practice alerts to incorporate into the physician workflow better to drive accurate risk adjustment. We have also increased transparency and regular reporting on accurate risk adjustment at a provider level and targeted education. We have also recently rolled out these processes beyond primary care and into large volume specialists groups such as Cardiology. The result has been a substantial increase in accurate risk adjustment compared 12 months prior.
Niobis Queiro. Interim Chief Strategy Officer of Nashville (Tenn.) General Hospital: Creating a no wait ER, using technology to streamline communication across all providers, nursing, ancillary services to provide a high performance experience to our patients. Average time from entry to care is 2 minutes. This was created by innovating the triage process and handoffs across care and revenue cycle. The patient experience is heightened and it is wonderful to know we are delivering quality, time sensitive service that gets a patient home to recover. Where the need is urgent care or emergency we deliver a patient centered experience.
Pradeep Kadambi, MD. President and CEO of University of Florida Jacksonville Physicians; Senior Associate Dean for Clinical Affairs at UF College of Medicine – Jacksonville: One of the most effective projects we did was retaining patients seeking imaging studies within our organization. Our 'leakage' rate for radiology was nearly 23%. We identified the reasons for it and acted accordingly. The two top factors were lack of a convenient location, and higher cost for patients and payers. We created 2 full-service freestanding imaging centers, in convenient locations for our patients. The cost is lower and the service is exceptional. Our current 'leakage' rate is 1.4%.
Richard J. Gray, MD. CEO of Mayo Clinic Arizona (Phoenix); Vice President of Mayo Clinic: A recent, highly successful initiative at Mayo Clinic in Arizona was our Arizona. Bold. Forward. capital expansion. It created 1.6 million square feet of additional space on our Phoenix campus, most of which became operational in 2023. This expansion addressed the pressing demand for clinical care, research, and education growth and brought to life innovative care concepts and digital technologies that enhance collaboration across specialties, improve patient satisfaction and experience, and help transform specialty and complex care at Mayo Clinic.
It yielded exceptional results for our patients and staff as we were able to attract and retain top, values-based talent with nearly 5,000 new staff and a turnover rate of just 1.2%; increased access to care, enabling a U.S. record number of life-saving transplant procedures in 2023; ensuring consistent excellence in quality care and research. Mayo Clinic Hospital in Phoenix was ranked #1 in Arizona for the 11th consecutive year in 2023, and Mayo Clinic Comprehensive Cancer Center in Arizona was ranked #1 in the U.S. for quality clinical outcomes.
Even with rapid growth, our patient satisfaction stayed consistently high, including 'likelihood to recommend' top-box scores in the 99th percentile as we stayed focused on our primary value throughout -- the needs of the patient come first.
Cynthia Dold. COO of UW Medicine (Seattle); Associate Vice President for Medical Affairs at University of Washington: In January 2023, I launched Mission Forward, a systemwide initiative to ensure a future for UW Medicine that is financially stable, operationally efficient, and promotes the well-being of our staff, faculty and trainees. The goal is to ensure UW Medicine can continue to provide high-quality, equitable patient care to our community.
We launched more than 21 workstreams focused on immediate and long-term operational improvements and strategic opportunities. To date, we have realized more than $160 million in system-wide savings from the initiative, reduced voluntary staff turnover by 3.7%, improved RN retention by 9.1%, decreased length of stay across our hospitals by an average of 3.6%, and increased monthly cash on hand by 8.6%. Over a three-year period we expect to realize between $470 million - $650 million in savings from this initiative.