Latest / Becker’s Healthcare - Clinical Leadership Podcast / Advancing Patient Flow and Clinical Excellence at Atlantic Health System with Dr. Geralda Xavier

Transcript

Advancing Patient Flow and Clinical Excellence at Atlantic Health System with Dr. Geralda Xavier · Becker’s Healthcare - Clinical Leadership Podcast

0:02
The most important health care decisions don't happen
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in isolation.
0:06
They happen when leaders come together.
0:08
Becker's sixteenth annual meeting brings together more than
0:11
3,500
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hospital and health system executives this April in
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Chicago.
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With 800 speakers from Ascension, Cleveland Clinic, CommonSpirit
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and more, the conversations get real. Leaders will
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share how their scenario planning for policy shifts,
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breaking through value based care barriers and building
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clinical teams that translate new ideas into real
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world care.
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Join top decision makers in the room April
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13 through the sixteenth.
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For the agenda and event details, visit beckershospitalreview.com
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and click on the events tab in the
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upper right.
0:45
Hello, everyone, and welcome back to the Becker's
0:48
Healthcare podcast. I'm Mackenzie Bean, associate vice president
0:51
and managing editor of Becker's Hospital Review.
0:55
Today, I'm so thrilled to welcome back doctor
0:57
Geraldo
0:58
Xavier, who is a regional chief medical officer
1:01
with Atlantic Health System.
1:03
Doctor Xavier, welcome back to the podcast. Thanks
1:05
for joining us today.
1:07
Hey. Thanks, Mackenzie. Really appreciate you having me
1:10
on.
1:11
Hope all is well with you as well.
1:13
Looking forward to our conversation.
1:16
Yeah. I know we,
1:17
got to speak on the podcast
1:19
last spring. So here we are a year
1:21
later. So I'm excited to check-in and and
1:24
hear about some of the progress that you've
1:25
made and the efforts going on at Atlantic
1:27
Health System right now.
1:29
But I'm doing well. Thank you for asking.
1:33
Before we dive into the conversation, I'd love
1:35
to turn the floor over to you just
1:36
to briefly introduce yourself,
1:38
and tell us a little bit more about
1:40
your work at Atlantic Health System for anyone
1:42
who may not have caught your previous episode.
1:44
Sure. Absolutely.
1:46
Absolutely. So as you said, I'm a board
1:48
certified emergency medicine physician
1:51
and healthcare executive, currently serving as a regional
1:55
chief medical officer,
1:57
for Atlantic Health Hackettstown
1:59
and Newton Medical Centers. We are based in
2:02
New Jersey.
2:03
I've spent my career, leading large complex hospital
2:06
system,
2:07
through clinical, operational, and strategic transformation,
2:11
but always with a focus on quality patient
2:13
safety and health equity.
2:16
So a little bit about me. My background
2:18
combines both frontline clinical experience and executive leadership.
2:22
I began my career in emergency medicine and
2:25
progressively took
2:26
on additional leadership roles from medical director and
2:30
chair to,
2:31
chief quality officer to now my new, role
2:34
as the chief medical officer.
2:37
Those experiences have certainly helped shape my commitment
2:40
to serve in diverse and vulnerable populations while
2:43
driving measurable
2:45
system level improvements.
2:47
At Atlantic Health, I oversee clinical strategy and
2:50
operations for new in at Hackettstown Medical Centers,
2:54
two of our community,
2:55
medical centers within our network.
2:58
My responsibility,
3:00
while varied, includes
3:02
quality and patient safety,
3:04
regulatory
3:05
readiness,
3:06
clinical outcomes,
3:07
physician engagement, and care coordination.
3:11
I really work, it's a matrix organization, and
3:13
we work closely with our site based and
3:16
system leadership
3:17
as well as both employed and voluntary physician
3:20
to align with strategy and performance.
3:22
Really, with the key to ensure that we're
3:24
delivering high quality,
3:26
high reliable, strong value based care outcomes
3:29
with exceptional,
3:31
patient experience.
3:33
Yeah. Over my career, you have led,
3:36
significant challenges and work with transforming organization
3:41
to improve
3:42
their quality and reputation programs.
3:44
As we mentioned in the last
3:47
podcast, one of the work we did is
3:49
really focusing on how we improve readmissions
3:52
for these vulnerable cohorts,
3:55
pulmonary,
3:56
congestive heart failure, COPD, and acute myocardial infarction.
4:00
And that program has sustained some while undergoing
4:04
some challenges, has really sustained good improvements over
4:07
time,
4:08
really, which is something we're proud of.
4:10
Also,
4:11
really
4:13
looking forward to ensuring that we are,
4:16
continue to be a leapfrog aid at our
4:18
centers.
4:19
We do see hospital acquired conditions.
4:22
And really for me, really guiding emergency management
4:25
responses,
4:27
while what we did during the pandemic and
4:29
actually really post pandemic, really trying to strengthen
4:33
interdisciplinary
4:34
collaboration,
4:36
improve organizational
4:37
key performance indicators.
4:39
It really advanced for me personally working with
4:42
physician to advance
4:43
peer review transparency
4:45
and enhancing both workforce engagement and satisfaction.
4:49
So really,
4:50
I believe sustainable excellence in health care comes
4:53
from really aligning with physicians and aligning with
4:54
physicians and frontline teams
4:56
with executive leadership around a shared vision, delivering
5:00
safe, equitable, and high quality care for every
5:02
patient
5:04
every time.
5:05
So, really,
5:07
looking forward to this continued work that we're
5:09
doing within our health care space.
5:12
Yeah. I'm looking forward to hearing more about
5:14
it. I think you paint
5:16
such a clear strategic vision of this work
5:19
and and what needs to be done to
5:20
really move the needle for for
5:23
patients in your communities.
5:25
As you mentioned, the last time around the
5:26
podcast
5:28
laid out,
5:29
some information for us in terms of the
5:31
significant gains you've made in in readmissions, particularly
5:34
for those vulnerable groups.
5:35
I'm curious now speaking to you in early
5:38
twenty twenty six, as you reflect back on
5:40
the past twelve months, what would you say
5:42
is the most important initiative that you have
5:44
led? What did you do, and what were
5:46
some of the results that you've seen?
5:48
Yeah. Thanks.
5:50
As we said, so many different priorities, so
5:53
many things that are important to the organization
5:55
for many of the things you talk about.
5:58
But one of the, one of the important
6:00
initiative I'll share,
6:02
that I've
6:03
led and worked with the multidisciplinary
6:05
team over the past year is really
6:07
focusing on capacity management and patient flow,
6:11
specifically looking to reduce length of stay while
6:13
improving throughput, safety, and overall experience.
6:17
We are no different from many healthcare system.
6:19
We face rising volumes,
6:22
workforce constraints, and increasing
6:24
access challenges.
6:26
And, you know, patient flow is a passion
6:29
project as well for me because it's not
6:31
just an operational issue. It is fundamentally
6:34
a patient safety and quality imperative.
6:37
As we know that delays in,
6:39
patient flow or delays in movement creates,
6:42
risk and is a dissatisfier,
6:45
for patients.
6:47
They do affect care transition. It affects staff
6:50
workload,
6:51
and ultimately the care experience.
6:54
So,
6:55
with that in mind, I organized and led
6:57
a multidisciplinary capacity management
6:58
and capacity management and patient flow committee.
7:02
We brought together stakeholders from across the continuum,
7:05
such as nurse leadership, physicians,
7:08
transport, bed management, ancillary services.
7:12
Really, the key was ensuring that everyone who
7:15
touches the patient journey
7:17
had both a voice and a shared accountability,
7:20
because I believe that flow is not owned
7:22
by one department or one entity. It really
7:24
is a system responsibility.
7:27
With that premise,
7:28
we really approach this work using a multimodal
7:31
strategy.
7:33
We optimize
7:34
observational level of care management
7:37
by enhancing collaboration
7:38
between physicians,
7:40
physician advisors, case management, to ensure we have
7:43
the appropriate status designation
7:46
early in the hospitalization.
7:48
We partner with our clinical leaders to safely
7:51
shift appropriate
7:52
diagnostic testing from inpatient to outpatient setting.
7:56
This required
7:57
really meaningful
7:59
physician,
8:00
engagement and patient education,
8:02
but it significantly reduced avoidable inpatient days without
8:06
compromising quality.
8:07
As a result, we were able to reduce
8:10
our observation length of stay from an average
8:12
of thirty six to forty eight hours to
8:15
less than thirty hours and have been able
8:17
to sustain those gains.
8:19
That improvement alone created earlier, bed availability for
8:23
patients requiring inpatient level of care and significantly
8:26
improved our overall,
8:28
throughput efficiency.
8:30
One of the other key measures we took
8:32
on in this approach, in this multimodal
8:35
strategy is redesigning
8:37
daily interdisciplinary
8:39
bedside rounds
8:40
to improve real time communication
8:43
and identify discharge barriers early.
8:46
This helps us to align with the care
8:48
team around a clear daily plan and reduce
8:51
communication breakdown.
8:53
And I think more importantly, it helps us
8:55
to identify discharge barriers early, whether that be
8:59
clinical or logistical such as transportation needs so
9:02
we can address them more proactively
9:05
than reactively.
9:07
That focus on daily goals and expected discharge
9:10
dates
9:11
directly reduces length of stay and improves throughput.
9:14
It also supports discharge before noon and some
9:17
other key performance indicators and ensure beds available,
9:21
when patient needs it for the inpatient level
9:24
of care.
9:25
Equally, though, it does strengthen team engagement. Everyone
9:28
understands their role,
9:30
their shared accountability,
9:32
and everyone's working from the same plan.
9:35
And really when done right, interdisciplinary,
9:37
we call IDR rounds, can shift culture from
9:41
the fragmented care to really coordinated
9:43
high reliable care that benefits all, including patient
9:47
and staff.
9:48
And finally,
9:50
you know, we talked
9:51
about the way I really believe in robust
9:53
process improvement in our last episode. And this
9:57
is no different in this project where really
9:59
we use lean methodology
10:01
to help us streamline direct bedding from the
10:04
emergency department.
10:06
We started by just mapping out the process
10:08
to really understand where the delays in the
10:10
handoffs and rework occur.
10:12
And then we standardize that work,
10:15
therefore reducing unnecessary variation and then eliminating steps
10:18
that don't add value. The use of lean
10:21
help us to decrease the variation in workflow
10:23
between providers,
10:25
both ED providers and hospitalists
10:28
that that previously led to delays and redundant
10:30
handoff.
10:31
By standardizing the direct communication between those teams,
10:35
that helps to eliminate the non value added
10:38
steps and remove barriers to timely bed assignment.
10:42
We and this also helps us improve transparency
10:46
around throughput metrics and significantly reduce admission to
10:49
bedtime.
10:50
So this process really helped the team to
10:52
empower their frontline teams
10:54
to solve problems and shift the culture, again,
10:57
from just a reactive
10:59
firefighting to disciplined continuous improvement.
11:02
Overall, we achieved a measurable reduction in length
11:05
of stay from our baseline.
11:07
We improved admission to bedtime.
11:10
We shortened observation stays, as I mentioned,
11:13
to thirty hours and under,
11:15
and we improved some other KPIs such as
11:18
discharge before noon.
11:20
And that translated to really improve access and
11:23
decrease in ED boarding,
11:25
improving our financial performance, and higher patient and
11:29
staff satisfaction.
11:31
But I must say, from my perspective,
11:33
it really is not just about the metrics.
11:36
It really is about shifting the culture,
11:39
moving from reactive crisis management to proactive
11:42
capacity planning.
11:44
We really built a high functioning multidisciplinary
11:47
structure
11:48
that continues to drive improvement and resiliency across
11:51
the organization.
11:52
So that culture share from
11:55
creating a shared ownership of flow across the
11:57
different
11:58
multidisciplinary
11:59
teams that I mentioned
12:01
is what we know will sustain the results
12:03
long term.
12:04
So this is really exciting work that continues
12:07
a day to day, but it's really nice
12:08
to see how that structured approach
12:12
has allowed the teams to be empowered to
12:14
continue to ensure
12:16
that their processes are followed. And whenever there
12:18
is
12:19
opportunities where we may shift or,
12:22
there might be,
12:23
some, what I call,
12:26
metrics that may be not performing well is
12:28
to really look at it through the lens
12:30
of structural problem solving to say, what's not
12:32
working? How do we get back on board?
12:34
What do we need to do to engage?
12:36
What is it that we're learning from the
12:38
teams and do we need to pivot or
12:40
or any of those? So pretty exciting work
12:42
that, we continue to do.
12:46
Very exciting work with some significant
12:49
results, as you said.
12:51
And I I so appreciate your note about
12:54
the
12:55
the descriptive
12:56
structure being important, but also
12:59
the the culture really underpinning everything, as you
13:02
said, patient journey,
13:04
needing to be everyone's accountability.
13:06
I think that's such a key part of
13:08
it.
13:09
I'm curious now looking ahead and say over
13:11
the next,
13:13
you know, ten months of 2026,
13:16
what would you say are your biggest priorities
13:18
and headwinds that you're focused on now?
13:21
Yeah. Great question.
13:24
It feels like we just came out from
13:25
the,
13:26
these respiratory surges that we see across the
13:29
country. But,
13:31
really, looking ahead, our focus is centered on
13:34
events in our organizational
13:35
key strategic priorities,
13:38
while navigating some of these real headwinds in
13:40
health care.
13:42
A couple I, you know, a couple priorities
13:44
are is, you know, one is definitely our
13:46
clinical excellence.
13:47
It remains our foundational,
13:50
priority.
13:51
We are continuing to strengthen our, high reliability
13:54
practice, reduce preventable harm, and really leverage data
13:57
to drive consistent evidence based care across all
14:00
service lines.
14:02
I will be remiss to say one of
14:03
the one of the most important,
14:06
factors as well is really improving our consumer
14:09
experience.
14:10
Patient expect access, transparency, and seamless coordination.
14:14
So we're really working to simplify the care
14:16
journey,
14:18
while expanding digital capabilities and improving communication.
14:22
You know, leveraging workforce experience,
14:26
or and and elevating workforce experience is also
14:29
a top priority.
14:31
I mean, I'm sure in talking to other
14:32
leaders across the country as you do through
14:35
this,
14:36
podcast and other avenues of communicating with healthcare
14:39
leaders, I'm sure you hear about workforce fatigue,
14:43
recruitment pressures, and retention challenges.
14:46
And there remain headwinds across the industry.
14:49
We are focused on engagement,
14:51
leadership development, and create an environment where our
14:54
team members feel supported and heard and empowered
14:58
to do their best work.
15:00
And, again,
15:01
financial stewardship underpins everything
15:04
with ongoing reimbursement
15:06
pressures and rising costs. You know, we have
15:09
to stay disciplined. We have to use data
15:11
to drive
15:12
decisions
15:13
and operationally stay efficient
15:16
while continuing to invest strategically in quality and
15:19
innovation.
15:20
So, while, like I said, the headwinds are
15:22
definitely our workforce constraint,
15:24
regulatory complexity, and margin compression,
15:28
which are real. I believe, organizations
15:31
that stay anchored in quality, equity, and strong
15:34
physician alignment,
15:36
really is best positioned to, withstand 2026,
15:40
and to thrive beyond that.
15:43
Mhmm.
15:44
That focus is really core to everything. Right?
15:46
Yeah.
15:48
As you said, there are a variety
15:50
of headwinds that, not just you, but health
15:53
system executives across the country are facing right
15:55
now, obviously.
15:56
Acknowledging those, what do you think specifically is
15:59
gonna be the hardest thing that you have
16:00
to do over the coming year?
16:03
That's a great question, Mackenzie.
16:06
I think the hardest thing, in the coming
16:09
year will be balancing those financial discipline
16:12
with our commitment to clinical excellence and workforce
16:15
engagement.
16:17
As I said, we can healthcare continues to
16:19
face margin pressures,
16:21
reimbursement uncertainty, and rise in labor and supply
16:24
costs.
16:25
But at the same time, we're responsible
16:27
for our patients and our teams are having
16:29
changed. In fact, the expectations
16:32
are even higher than ever.
16:34
And so, the challenge is making thoughtful,
16:36
data driven decision about resource allocation
16:40
without compromising
16:41
safety and quality or or access, especially
16:44
if you're in community hospitals.
16:47
Access can definitely be sometimes a challenge.
16:50
Another difficult aspect,
16:52
in the coming year is leading through continued
16:55
workforce fatigue.
16:56
I know that several of my colleagues
16:59
within emergency medicine field, as well as in
17:01
leadership, have pivoted away from some of that
17:04
to other less grueling,
17:07
opportunities
17:08
due to, just fatigue.
17:10
Even as we move toward from the acute
17:13
phase of the pandemic,
17:15
I think we still see the emotional and
17:17
operational
17:18
toll,
17:19
that remains.
17:20
So supporting our teams
17:22
while also making sure
17:24
that they can adapt to change,
17:26
improve efficiency, and embrace innovation,
17:30
will require a different type of leadership that
17:33
includes
17:34
empathy,
17:35
transparency
17:37
and steadfast leadership.
17:39
So I think the ultimately,
17:41
you know, the hardest part is making sure
17:43
that we make these tough decisions,
17:45
but in a way that maintains trust trust
17:48
and trust with our frontline team, with our
17:50
physicians
17:51
teams,
17:52
with our nursing team and our community.
17:55
That means that we really have to have
17:57
really great communication,
17:59
shared accountability,
18:01
and really staying anchored in our mission.
18:04
And I think if we can do these
18:05
things,
18:07
while very difficult,
18:09
that will create opportunities to strengthen the organization.
18:13
Absolutely.
18:15
Doctor Xavier, I I'm always just,
18:18
so impressed that, you know, your your focused
18:21
approach, your dedication to quality and clinical excellence,
18:25
and it really shines through in in your
18:26
remarks today. So thank you so much for
18:29
rejoining us on the podcast to give us
18:31
a glance into some of your priorities and
18:33
focuses right now. We so appreciate it. Is
18:35
there anything else you'd like to add or
18:37
end on?
18:38
No. I think, again, thank you so much
18:40
for the opportunity for the conversation.
18:43
I really appreciate and enjoy,
18:46
you know, these these chats. I think that
18:48
as leaders, we are all trying to really
18:52
be supportive
18:53
and make sure that we are able to
18:56
provide what's needed for team members
18:58
in a really, in an environment that is
19:01
psychologically
19:01
safe, that empowers them to be their best,
19:04
that empowers them to work at the top
19:06
of their license.
19:07
And, you know, and, and making
19:10
the environment a great place to work. And
19:12
I think we, Atlantic Health System, as an
19:15
organization, have always prioritized
19:17
being a place that our team members can
19:19
find a great place to work because we
19:21
do provide some of these,
19:24
not just,
19:25
the ability to feel safe and to, have
19:27
joined in work, but also focusing really on,
19:32
succession building, workforce development engagement,
19:35
leadership support, and really providing the infrastructure
19:39
so that they can do their best work
19:41
and work, at the top of their license.
19:43
So,
19:44
you know, at this juncture where we are,
19:46
it really is
19:48
really enlightening to continue to journey,
19:51
with an organization that has such a great
19:53
priority on its workforce. So thank you so
19:56
much once again.
19:58
Hope to see you
19:59
one of these good days as,
20:01
Yes. I know.
20:03
We're excited to conferences.
20:05
Yes. We're excited to have you at our
20:06
annual meeting in April.
20:08
Looking forward to it. Wonderful. Well, thank you
20:10
again so much, doctor Xavier. And listeners, thank
20:12
you as well for tuning in. You can
20:15
find more podcast episodes by visiting the Becker's
20:17
podcast page at beckershospitalreview.com/podcasts.