Latest / Becker’s Healthcare - Clinical Leadership Podcast / Todd Smith, MD, Chief Physician Executive at Sutter Medical Center

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Todd Smith, MD, Chief Physician Executive at Sutter Medical Center · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
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• 0:44
  Hi, everyone. And thank you so much for
• 0:46
  tuning into this episode of the Becker's healthcare
• 0:50
  podcast.
• 0:51
  I'm Erica Carbajal, an editor with Becker's hospital
• 0:54
  review. And today, I'm joined by doctor Todd
• 0:57
  Smith, senior vice president and chief physician executive
• 1:00
  at Sutter Health in California.
• 1:03
  We're gonna be discussing his top priorities through
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  the end of the year, ambulatory
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  growth strategy,
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  and clinical standardization.
• 1:11
  Doctor Smith, thank you so much for being
• 1:13
  on today. Happy to have you.
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  Thank you for having me.
• 1:17
  Yeah.
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  Well, as we enter the final stretch of
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  the year here, can you start by telling
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  us a little bit about what your top
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  clinical
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  or operational priorities are,
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  what are you personally spending the most energy
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  on right now, etcetera?
• 1:33
  Well, thank you, Erica.
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  As as probably mentioned in previous podcasts as
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  well, we have been really growing our physician
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  and clinician base
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  significantly over the past, really, two years or
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  so, adding,
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  over 1,500 to 2,000 new clinicians.
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  And so
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  once you hire them now, you need to
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  actually get them onboarded operationally and up to
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  speed.
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  At the same time, we have been expanding
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  our ambulatory presence. So one of the biggest
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  issues that we've run into is obviously access
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  to health care, which is a which is
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  a national issue. We have the same problem
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  as well. So the two big things that
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  we've been focused on over the past really
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  eighteen months or better is really improving our
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  ambulatory footprint and improving and increasing our physician
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  and clinician base.
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  The 2025,
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  we've opened approximately
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  17
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  ambulatory sites so far, and we have another
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  probably five or six to go. And so
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  most of my time right now has been
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  spent
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  around how do we get these new sites
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  open,
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  how do we make sure they're staffed appropriately,
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  how do we make sure we've onboarded all
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  the clinicians and the staff
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  so that we can provide that access the
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  patients are really needing from that standpoint? And
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  focusing on providing that access and that experience
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  as we're sort of moving into the last
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  half of '25
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  to try to create, you know, a better
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  a better place not only for the patient
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  to receive care but also for the clinicians
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  to work.
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  And so the other part of my day
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  is spent really thinking about and supporting our
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  clinicians,
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  and what does that look like to practice
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  at Sutter Health with the advent of new
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  clinical technologies, with the advent of some of
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  the support structures we have as we move
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  forward. So a lot of work really around
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  that that that clinical base to try and
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  improve our access and experience,
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  for the patients.
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  Yeah. Thanks, doctor Smith. And I know you
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  mentioned,
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  just the onboarding piece. And, obviously, onboarding 2,000,
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  no physicians, and and,
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  you know, only a couple of years, no
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  small feat. And I think onboarding continues to
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  come up in conversations with physician leaders as
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  as a challenge of sorts right now. So
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  can you expand a little bit just on
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  how the onboarding piece is structured and organized
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  across the system, and who is really in
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  charge of
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  having that process be streamlined and organized?
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  It it's a great question, Erica, because as
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  you can imagine, with
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  eight different medical groups across 26
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  counties on in Northern California,
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  you can imagine that there's a lot of,
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  variation
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  that can occur in that process. So what
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  we've really been trying to do is
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  each of the medical groups partners with our
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  physician services and our operations people
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  to create an onboarding process that that begins
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  well before they actually start with, you know,
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  creating their accounts and creating their schedules and
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  opening them up
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  and trying to create that sort of welcoming,
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  feeling for when they actually start.
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  It's still a work in progress. I would,
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  I would not say it's done. I think
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  onboarding
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  is a journey, and it doesn't it doesn't
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  start the day they start. It doesn't stop
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  the day they start. And so part of
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  that process is creating something that makes them
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  feel welcome in the organization, something that helps
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  them to understand it. So there are orientations
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  for the physicians themselves and the clinicians with
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  the medical group, so they understand what it
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  means to be part of the medical group.
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  There's another orientation piece which is actually part
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  of the system, so they understand what it
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  means be part of the system.
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  And we partner with the medical groups to
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  provide that. And then orienting them to the
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  clinic they're gonna be working in and the
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  people they're gonna be working with,
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  and how do we support that particular piece.
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  So it's an ongoing process that is jointly
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  owned by the the medical groups themselves who
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  are the hiring entity here in California
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  as well as our foundation counterparts to provide
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  that support for them.
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  Yeah. Thanks, doctor Smith.
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  Well, I know you mentioned
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  ambulatory expansion and an access there as well.
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  I know Sutter is in the middle of
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  a $1,000,000,000
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  expansion there. So with rapid ambulatory
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  growth,
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  how are you ensuring clinical integration
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  and continuity of care across sites? What sorts
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  of measures or practices are you putting in
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  place to try to maintain that care quality
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  as more services start to shift outside of
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  the hospital walls?
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  It's it's a great question because you're right.
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  There is this this steady but constant shift
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  of things in from the from the acute
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  session to the ambulatory session. So one of
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  the biggest things that we've done over the
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  past couple of years is to really create
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  an operating rhythm,
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  which creates a way of communicating both at
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  the individual
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  clinic level,
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  the facility level, the division level, which encompasses
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  both foundation and hospital based, and then the
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  system
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  level. And creating that in such a way
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  that there's a clarity of conversation and a
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  clarity of metrics that we we are going
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  to actually be looking at as we move
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  forward. And those are some of the standard
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  metrics around quality, around whether they're in the
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  ambulatory world, around, you know, your infection rates
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  and around, you know, things of that nature.
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  You've got the acute ones as well.
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  But one of the pieces that, as I
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  was talking to one of my quality directors
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  about this the other day,
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  what we're learning is the onboarding in the
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  ambulatory
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  environment. We've got to be very careful about
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  that Because typically in the acute environment,
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  you've got, you know, nurses training nurses, and
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  so there is a definite procedural bend that
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  you you understand that. As you get into
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  the ambulatory environment, you may not have that
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  like training like in the process. And so
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  making sure that we've onboarded our people in
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  the clinic setting to understand what it means
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  to do some of these procedures
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  in that particular arena,
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  is it's a different skill set for them,
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  and it is something that we're realizing and
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  we are actually implementing as we as we
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  move forward from that bigger piece.
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  Yeah. That's a great point. Thanks, doctor Smith.
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  I think too, one of the things that,
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  you know, as we continue to
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  cover more on and hear about,
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  you know, the health care's ambulatory boom, if
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  you will, and the shift
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  of that care,
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  just questions and and implications
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  of what it might mean for
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  care in inpatient setting. So as this trend
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  does accelerate,
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  what considerations
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  does it raise for hospital leaders? What are
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  you thinking about, especially in terms of staffing
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  or
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  care model changes,
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  to ensure that inpatient teams are equipped for
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  a new new reality in the years ahead
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  in terms of patient acuity?
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  I think it's it's a good point because
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  we are beginning to see changes in our
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  case mix index in the inpatient world,
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  implying that we are treating sicker patients in
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  the process.
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  And part of that is the recognition of
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  how do we actually
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  provide our teams with the capabilities,
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  capacities to provide that care in a safe,
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  effective,
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  and consistent manner.
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  Some of that is going to be ensuring
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  that we've got regular training for them.
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  Some of it is going to be how
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  do we leverage technology? How do we actually
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  employ technology so that individuals can be doing
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  things that only individuals can do, and you
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  can utilize some of the technology to help
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  give you information that you might not have
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  had at your fingertips? So things like,
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  some of the predictive modeling that we are
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  beginning to start to see in some of
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  the environments around
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  who might be deteriorating a little bit faster
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  than you actually think they are. So instead
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  of the teams
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  responding
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  once the crisis has occurred, which obviously is
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  less efficient and not as good for the
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  patient, how do we sort of incorporate some
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  of that information a little earlier such that
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  we can identify these people? These are this
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  is emerging technologies in certain places, but certainly
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  something that we're keeping our eye on, we're
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  looking at, we're incorporating
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  in such a way as to really equip
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  our people
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  with what they what they need.
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  Other other ways
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  are understanding, you know, if you think about,
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  you know, observation or sitting or or patient
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  or sitters that need to observe patients,
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  really can we employ and have we employed
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  electronic or visual virtual means of sitting. So
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  that way, you can free up the individual
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  from doing this. You can provide more real
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  time information and allow the the nurses and
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  the aids to be more attentive from that
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  standpoint. So really trying to help them from
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  a care model standpoint
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  and give them the information when they need
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  at the time they need it
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  to be able to actually,
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  do their jobs better in a safer manner,
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  for for them and the patients.
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  Yeah. Definitely will be interesting too to see
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  what the predictive modeling and and what that
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  might look like, you know, just a few
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  years down the line.
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  I wanna talk now about care standardization.
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  I think it comes up increasingly
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  not just as a way to improve care
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  outcomes, of course, but also as a way
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  to improve operational efficiency is is something we
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  hear a lot about nowadays. So
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  I think it's also one of those things
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  across a large system, like many things in
• 10:52
  health care that might sound simple on the
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  surface, but is incredibly
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  tough to execute is what I hear, particularly
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  when you think about the nuances and local
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  settings and clinical autonomy of clinicians. So can
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  you tell us a little bit about
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  Sutter's approach here? What has the system done
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  to try to make clinical standardization
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  and evidence based pathways
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  work in practice? And are there any lessons
• 11:17
  that have emerged about making this work at
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  scale?
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  That that's great insight, Erica. One of the
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  things that we have learned is
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  scale is helpful at times, and other times
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  actually can get in the way.
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  One of the pieces that
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  we have been, working with over time is
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  exactly what you talked about, which is identifying
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  those clinical best practices
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  in such a way that they can be
• 11:42
  available and they can be spread and adopted
• 11:44
  across the organization.
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  We've learned that it requires,
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  clinician leadership and involvement in development of those
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  stricter pathways,
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  both at the local level as well as
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  at the system level. And then we've learned
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  that there's a communication
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  that has to take place on a very
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  consistent basis
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  so that there is the ability to learn.
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  At the end of the day,
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  being a learning organization allows you to adopt
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  the technologies, adopt the pathways, and then iterate
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  and improve them as they actually go.
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  And one of the things that we've learned
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  is we we put an operating calendar into
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  place that I talked about before, which was
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  the, you know, part of it is the
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  local part of it's daily, weekly, and monthly
• 12:27
  check ins. But the other thing that we've
• 12:29
  actually started to do quite a bit now
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  is we're we're celebrating
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  successes. So we'll we will have system level
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  meetings where we'll actually celebrate best practices, whether
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  they're around
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  infection,
• 12:40
  prevention, whether they're around,
• 12:43
  length of stay reductions, whether they're around discharge
• 12:46
  lounges, whether they're around,
• 12:48
  improvements in,
• 12:50
  throughputs in operating rooms or in emergency rooms.
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  And what we're doing is we're highlighting the
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  work that's being done,
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  in various places in the organization.
• 13:01
  And then we've also developed, in a couple
• 13:03
  of places, we've developed the ability to send
• 13:06
  teams
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  out to other places that are actually having
• 13:09
  challenges
• 13:10
  so that we can accelerate that sharing of
• 13:13
  best practices
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  and measuring to the same outputs
• 13:16
  as we continue to kind of go go
• 13:18
  down this road. So it is a,
• 13:20
  it it is a journey.
• 13:22
  It is one that's never ending, but it
• 13:24
  is one that we believe that we can
• 13:26
  actually accelerate that,
• 13:29
  if we shine a light on the work
• 13:30
  that's being done in those place or doing
• 13:32
  it well.
• 13:34
  Yeah. Great point about sharing out those those
• 13:37
  best practices.
• 13:39
  Well, lastly here, just wanna talk about the
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  chief physician, chief medical officer role. How do
• 13:45
  you see that role evolving in the next
• 13:48
  two to five years, let's say? What new
• 13:50
  skills or leadership qualities do you think will
• 13:53
  define the most successful CMOs of the future?
• 13:58
  That's a great question because I even I
• 14:00
  just have to look back two years because
• 14:02
  I've been in this role about two, two
• 14:03
  and a half years at this point.
• 14:06
  And just the skill sets I've had to
• 14:07
  develop at this point to to be successful.
• 14:11
  I think one of the things that is
• 14:12
  true is as you talk to chief physician
• 14:15
  executives,
• 14:16
  they are
• 14:18
  they there's there's a wider breadth of what
• 14:19
  we're responsible for now than the standard chief
• 14:22
  medical officer was. And most of the chief
• 14:24
  medical officers were responsible for just
• 14:27
  pretty much the quality. They were the clinical
• 14:30
  transformation throughput,
• 14:32
  in in interacting with the medical staffs, both
• 14:34
  the ambulatory as well as the acute.
• 14:37
  As we move forward,
• 14:39
  you notice that when at the outset,
• 14:42
  you know, what were we really working around
• 14:43
  the operations pieces,
• 14:45
  I'm much more involved in the operational
• 14:48
  day to day pieces as far as, you
• 14:50
  know, what drives the clinic
• 14:53
  referrals, what drives the clinic throughput, what does
• 14:55
  our staffing model actually look like.
• 14:58
  In the in the hospital,
• 15:00
  how does our emergency room throughput actually work?
• 15:03
  How is the operating room actually work? What's
• 15:05
  our supply chain, cost look like? When we've
• 15:08
  had challenges
• 15:09
  across the country around
• 15:11
  the the
• 15:13
  the IV fluid issues.
• 15:15
  We found that we were involved in what
• 15:16
  that looked like and that was a very
• 15:18
  operational issue.
• 15:19
  So I think that, you know, as we
• 15:21
  as we move forward, and then
• 15:24
  as we begin to think about what does,
• 15:27
  you know, hiring look like, what does acquisition
• 15:30
  of other organizations look like, how do we
• 15:32
  integrate,
• 15:34
  systems into ours,
• 15:36
  and having a,
• 15:37
  a medical viewpoint around an operational issue and
• 15:41
  being at the table for that. I think
• 15:43
  that's actually different
• 15:44
  than it was two or three years ago.
• 15:48
  I expect to see that continue. So I
• 15:51
  expect to see the successful chief physician executive,
• 15:55
  have a be well grounded in all the
• 15:57
  clinical pieces, be well grounded in the the,
• 16:00
  you know, the quality pieces, but also,
• 16:03
  becoming much more well versed in the operational
• 16:06
  pieces so they can
• 16:08
  be a thought partner
• 16:10
  with in my case, I'm a thought partner
• 16:12
  with the chief operating officer for the system.
• 16:15
  And I think that's a different skill set
• 16:18
  than many physician leaders,
• 16:21
  have had over the years.
• 16:24
  Yeah. Absolutely. I think it's a theme I've
• 16:26
  I've heard in, in a few recent conversations,
• 16:29
  as well.
• 16:31
  Well, doctor Smith, thank you so much for
• 16:33
  taking the time to join the podcast today.
• 16:36
  It's a pleasure having you on, talking about
• 16:38
  a lot of relevant topics that come come
• 16:40
  up and so often in conversations with clinical
• 16:43
  leaders. And,
• 16:44
  hopefully,
• 16:45
  we foster some some peer learnings here and
• 16:49
  hope to welcome you back to the podcast
• 16:51
  again soon.
• 16:52
  Very good. Thank you for having me today.
• 16:54
  Yeah. Thanks so much. Take care.
• 16:59
  At athena Health, we know your ambulatory practice
• 17:02
  wants healthier,
• 17:03
  a healthier business, healthier care teams, and healthier
• 17:06
  patients.
• 17:07
  But the complexities of modern health care tech
• 17:09
  make it hard for you and your care
• 17:11
  teams to focus on what matters most.
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  That's where athenahealth can help.
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  Our AI native all in one solutions reduce
• 17:18
  administrative burdens,
• 17:20
  streamline billing and payments, and deliver critical insights
• 17:22
  when clinicians need it most. That means fewer
• 17:25
  clicks, more time for patients, and stronger bottom
• 17:28
  lines.
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  Practicing medicine is complex, but running a practice
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  can be that much simpler with athenahealth.
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  See how simpler is healthier at athenahealth.com.