Latest / Becker’s Healthcare - Clinical Leadership Podcast / Tyler Hill, Chief Medical Officer at Sierra Nevada Memorial Hospital

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Tyler Hill, Chief Medical Officer at Sierra Nevada Memorial Hospital · Becker’s Healthcare - Clinical Leadership Podcast

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  Thanks for listening. Now here's the episode.
• 0:31
  This is Laura Dear with the Becker's Healthcare podcast.
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  I'm thrilled today to be joined by Dr. Tyler Hill,
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  chief Medical Officer at Sierra Nevada Memorial Hospital. Dr. Hill,
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  it's a pleasure to have you on the podcast today.
• 0:42
  Hey, good morning, and thank you for having me.
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  Now, I'm really looking forward to our discussion.
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  I know there's so much happening in healthcare and I'm really excited to learn,
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  you know,
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  what you're doing at Sierra Nevada Memorial Hospital and how you're working with
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  the community. But before we dive into my questions,
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  can you tell me a little bit more about yourself and your background?
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  Yeah, so, um, as you mentioned, I'm the,
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  the C M O currently in a hospital in northern California.
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  I'm an ed physician, emergency medicine physician in training,
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  and I work a few shifts a month,
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  about three to four shifts a month in our emergency department here.
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  I went to medical school in Missouri and then did my residency in emergency
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  medicine in Ohio and stayed in that area for about 10 years.
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  Uh,
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  was a medical director over several emergency departments and urgent cares and,
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  and even a telemedicine platform,
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  and then was also a physician executive over medical specialties
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  while I was there in Ohio.
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  And then last year I became the,
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  the C M O out here in California.
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  So loving what I get to do each and every day. And, um,
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  looking forward to chatting a little bit more about our, um,
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  our priorities and what's going on here at Sierra Nevada.
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  Absolutely. And what was that transition like going from Ohio to, uh,
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  California?
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  Uh, so, you know, Northern California is,
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  is unique in and of itself. Definitely nothing like Southern California,
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  uh, in regards to the, the weather, the culture, the pace,
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  things along those lines.
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  So where we were in southeastern Ohio and,
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  and West Virginia area, not all that different. So it wasn't complete,
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  uh, shock coming out here. Um, so overall it was a, uh,
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  it was an easy transition for the family and me and everyone here at the
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  hospital has treated me so well and hit the ground running is really what it
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  felt like picked up from one busy system came out here and, and literally,
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  uh, set the wheels in motion and took off and haven't looked back. So it's been.
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  That's amazing to hear. And you know,
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  I I think it's awesome that you were able to fit right into the hospital and,
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  and, and then as you mentioned,
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  just kind of get the wheels in motion and get going.
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  So when you look at where you're at today,
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  what are some of your top priorities whatcha spending most of your time on?
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  So for any Chief Medical Officer,
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  I feel it always starts and should start with quality and safety.
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  I have a very strong quality and safety team, um,
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  several members that comprise that, uh, team that I,
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  that I get to partner with to, um, champion certain,
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  certain aspects of, um, of projects and improvement opportunities. Um,
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  one of our, one of our newest, uh,
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  goals here at the hospital and in common spirit as a whole
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  is, um, heart failure mortality. You know,
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  a lot of evidence-based practices have emerged over the last five
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  years with the most recent heart failure kind of priorities changing last
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  year in 2022 or being updated in 2022.
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  So we've put together a committee specifically focusing on heart failure,
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  uh, treatment, the evidence-based guidelines, and really focusing on, on that,
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  uh, that goal of heart failure mortality. So that's, um, that's been one of the,
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  the biggest priorities here over the last few months.
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  And that's engaged all aspects of our,
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  of our hospital team and even focusing on the outpatient realm too. So,
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  you know, looking at our cardiology partners, our hospitalist partners,
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  our emergency medicine partners, palliative care, ensuring we, um,
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  we can meet the needs of our patients from the palliative care standpoint, um,
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  care coordination, nursing. So it really has taken the entire team,
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  uh, to focus on, on that goal. And, you know, sepsis is no different.
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  Um, that's another one of our big goals. And, uh,
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  we've had a sepsis committee for quite some time, as most hospitals have,
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  but we're also highly focused and remain focused on sepsis mortality,
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  uh, sepsis bundle compliance, um, all of the, the,
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  the key ingredients for a successful sepsis program,
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  sepsis is our top D r G here at the hospital.
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  And then heart failure is number two. So it,
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  it makes sense to have those kind of rise to the top as far as how much time and
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  energy and how much, um, involvement from the rest of the team is,
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  is required. Uh, patient experience is another big focus of ours.
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  We've been, um, heavily, uh, looking at our evidence-based strategies,
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  things like, it takes three rounding,
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  which is simply the physician that's taking care of the patient,
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  the hospitalist, uh,
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  going into the room with the nurse that's taking care of the patient and
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  rounding together with the patient in front of the patient involving the
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  patient.
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  And we've found that whenever we do that consistently on our,
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  all of our patients, uh, and we do it effectively, meaning we're in, uh, enga,
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  the physicians engaging the nurse, uh, and the patient,
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  it really makes a difference in our overall patient experience. The patient, uh,
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  better understands the plan for the day and so does the nurse taking care of
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  them. And so they're able to continue to communicate throughout the day. And it,
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  it also better sets up for family members that come in.
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  They see the whiteboard that's updated, the nurse, um,
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  has communicated with the doctor, the patient knows the plan,
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  so family members feel, uh, better kept in the loop.
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  Some of those other evidence-based strategies,
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  strategies I was talking about include bedside shift report, hourly rounding,
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  and leader rounding. So those four, um,
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  key ingredients we've really seen our patient experience, boom,
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  over the last five to six months. Um,
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  our hospitalists have been heavily engaged with this.
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  They're talking about it on a daily basis, um, and, and really, um,
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  have been transparent with the results, uh, even down to the individual level.
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  So that has, that has helped, uh, lead to that increase over the last, uh,
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  five to six months. Um, and efficiency for any, uh,
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  physician is a big area of focus, especially an ED physician like myself.
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  Um,
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  so we have a flow committee to optimize our efficiency
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  throughout the hospital.
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  And so that starts from the minute patients hit the emergency department all the
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  way till, uh, their, their discharged leaving the hospital. So again,
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  that involves a multidisciplinary team, uh,
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  including e v s or environmental services, care coordination,
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  nursing, cardiology team, physical therapy, um,
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  all of the components of nursing. So it's been, uh, it's,
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  it's been a great work in progress over the last couple of months,
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  identifying things like, how do we better space out our discharges, uh,
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  throughout the day instead of just having them all bundled in the early to
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  mid-afternoon, further bottlenecking, uh, a lot of other resources.
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  So that's, that's definitely been fun. And then kind of the last area of,
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  of one of our top priorities is our financial stewardship. You know,
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  I think every hospital in the country right now is really looking over the
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  next five to 10 years wondering how are we going to not just survive,
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  but be viable for our community?
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  How do we ensure that we can not only keep our doors open,
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  but be able to recruit and obtain, um, the,
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  the best equipment and staff for our community to best serve 'em,
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  not just, Hey, let's do everything we can, uh, to keep our doors open,
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  but to thrive for our community,
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  because our communities need us to continue to advance as, um,
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  as the evidence-based shows us, uh, the technology advances,
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  the needs advance of our community,
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  we have to have to be able to pivot and be able to serve those needs.
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  So it's very important that we not just survive,
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  but we thrive from a financial stewardship, uh, standpoint.
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  So there's a lot of ways in which we're, uh, looking to remain creative in that,
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  in that regard. So those would be my top four, uh, uh, priorities that,
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  um, as chief medical officer remain, uh, at the,
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  at the forefront in my mind each and every day that I come to work.
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  That's quality and safety, patient experience,
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  efficiency and financial stewardship.
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  Absolutely. That's really amazing to hear,
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  and especially impressive to think about the different structures and committees
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  that you've been working on and, and improvements that you've made, um,
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  since coming to Sierra Nevada.
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  I think it's definitely a lot of accountabilities. Like you said,
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  quality obviously, and patient safety is so important, but then too,
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  the patient experience and elevating that. Um,
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  and then the financial stewardship piece of it, um, certainly is something that,
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  as you mentioned,
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  a lot of health systems and hospitals are really needing to double down on this
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  year in particular, um, to make sure that they can thrive in the future.
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  And along those lines, you know,
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  when you take all of this into consideration and then look ahead,
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  how do you see the hospital evolving over the next two to three years?
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  What do you see as really being possible given some of the limitations,
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  but also opportunities with technology and everything else that's involving with
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  healthcare?
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  Yeah, I, I think my,
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  my answer to that question really will involve several of
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  those aspects that we were just talking about with priorities and doubling down
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  as, as you mentioned. I like that, I like that phrasing,
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  doubling down on those opportunities. Um, for me, in the,
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  in the physician side of things, recruiting is a must have.
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  We have to get creative, we have to be more effective with our recruiting, um,
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  for our, for our various service lines here, uh,
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  to ensure that we have the robust service lines that our community needs most
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  in Nevada County. Here in northern California, we have one of the oldest,
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  if not the oldest populations in California,
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  so a lot of Medicare, um, a lot of cardiology, orthopedics,
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  oncology needs.
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  So really that's a big part of our focus over the next several years,
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  is ensuring that those service lines are, are,
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  are robust and strong and able to meet the needs of our community. Um,
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  also reputation. Reputation is a huge part,
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  and that goes back to patient experience. That goes back to, uh,
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  optimizing your flow, your efficiency so that patients say,
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  I don't wanna come anywhere else. I will not drive out of the county.
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  I will actually, you know, drive a few additional miles to go to that hospital,
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  uh, you know, Sierra Nevada because their reputation.
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  Um, and along with your patient experience,
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  but you have the ability to start gaining market share as well.
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  And so that's what we envision through great patient experience,
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  through excellent quality and safety, um,
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  being able to gain market share and, and,
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  and ensure that we're keeping our county home here, uh, at, at their,
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  at their, uh, home-based hospital. Um, so, so that's a,
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  that's a large part of how I see our hospital, our system evolving, uh,
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  over the next several years.
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  Absolutely. That makes a lot of sense. And certainly it seems like, you know, a,
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  a really amazing vision to have for the community, a great resource as well.
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  You know, when you look at some of the different projects you talked about,
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  and you were talking about your priorities as well as moving forward and, and,
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  um, just really having this, um,
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  feeling of being able to stay in the community for healthcare in choose Sierra,
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  Nevada. Um,
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  what does that take on a people and workforce level to make that happen?
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  I can imagine, you know,
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  it's no easy task to have people thinking in that way, in,
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  in potentially changing some of the habits that they've been used to for years
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  and years.
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  How do you manage some of that change and especially get people excited and
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  motivated for this vision that you're laying?
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  Oh man, that that is, that is the leadership golden question right there.
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  Um, engagement, you know, I think, I think you mentioned that.
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  How do you get people engaged? Um,
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  because change is hard for all of us. Um,
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  we're not necessarily all that excited to know that, um,
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  that when we come into work tomorrow or for the next couple of weeks,
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  it's gonna be different. We're gonna do this a little bit differently.
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  We're gonna be challenged to think differently, to act differently,
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  work differently. And so that can be hard,
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  but I think first and first and foremost, um,
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  being passionate as a leader about what journey we're about to embark
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  on. And, and most significantly, I think, uh,
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  ensuring you are explaining the why and creating buy-in from those
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  immediately around you. Because as the,
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  as the C M O I can be passionate or excited about a project,
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  project, um, project,
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  but unless those around me also feel that excitement and are engaged and
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  believe in the why, the mission, whatever it's, we're, we're, uh,
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  being asked to accomplish, it's really hard to permeate throughout the rest of,
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  uh, those teams. So, you know, me being just one person,
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  it's impossible for me to go out there and have those one-on-one touches with
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  all of the employees and be able to explain the why or what my vision is.
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  But it's really about creating that team around you that's really able to, uh,
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  help, help get out and, and expand upon that, uh, that passion,
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  that engagement. And so, you know, from the physician side,
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  we've done several things over the last year, which I've been excited about, um,
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  creating, uh, you know, some, some enhanced physician engagement.
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  And we have an annual survey that we look at to kind of benchmark where we are.
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  And this year we were very much improved, uh,
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  compared to last year leading our division here in the Sacramento area, and, uh,
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  uh, significantly compared to the rest of California. And really, um,
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  really a a confident engaged group of physicians,
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  even compared on the national level. And so having events, uh,
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  helping the physicians feel that their voices are heard,
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  getting out there and doing, uh, social events, uh,
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  having physician mixers, um, you know, an annual Christmas party,
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  we're bringing back journal club,
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  so we're doing several different engagement events so the physicians can really,
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  um, be able to rally around each other, understand, uh,
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  the mission. And I have that,
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  that ability during those meetings as well to kind of, uh, talk about the why,
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  where we're going, uh, and so forth. So I,
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  I feel like that's been a really positive impact over the last year. Um,
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  also having one-on-one meetings with the key, uh, service line leaders,
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  the medical directors, the, uh, the medical staff leadership,
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  like the chief of staff, vice chief of staff, um, those have been, uh,
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  very impactful as well as we've built those relationships.
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  And then you can really start to, uh, expand upon upon that. Um,
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  once those relationships are built. Uh, I'd, I'd also say what I'm,
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  one of the things that I'm most proud of is our creativity with
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  recruiting. We understand we're in a more rural environment,
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  and anywhere in rural America, you're gonna have challenges with recruiting,
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  uh, especially on the physician front. So we've, um,
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  done a few things such as hosting an annual senior
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  resident recruiting weekend where we bring senior residents in family
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  medicine here to, uh, Nevada County for a weekend, we host them.
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  And last year we had, uh, 10,
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  about 10 senior residents and they were able to come and tour the area,
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  meet with the hospital leadership, take a hospital tour.
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  We had a large number of our primary care providers in their various model
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  of, of clinics and employment, uh,
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  come and speak at the events and meet with the various individuals. And so that,
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  that was actually a successful event. And we're gonna host that again, um,
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  this year.
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  And then we've also started a rural family medicine residency program.
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  It just started in July of this year. And so, as we know,
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  the data speaks in saying that where physicians train,
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  wherever they do their residency,
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  they end up staying with a very high likelihood in that area within a certain
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  proximity. So we're confident that those two strategies, um,
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  serve both short term need for large primary care deficit
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  and a longer term pipeline for, uh,
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  stabilizing our primary care workforce here. So those are, those are two big,
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  uh,
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  recruiting creative strategies that we've been able to employ that I'm really
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  proud of. I.
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  Love it. I think that, you know, definitely something to be proud of and,
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  and excellent to see the results there. Now, before we wrap up our conversation,
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  I was wondering, is there any other projects or initiatives that you've done,
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  have done in the last year that you wanted to outline with some great results?
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  I know you've had some really clear and amazing, um, examples of,
• 18:23
  of ways that you've been, um,
• 18:25
  things that you've been doing differently and things have gone well.
• 18:28
  So I just wanted to see if there's anything else you wanted to share with us
• 18:31
  that would be beneficial for our listeners to know about and hear about.
• 18:36
  Yeah, I, I think the other one that, um,
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  I would mention is kind of our marketing strategy and
• 18:45
  connecting with the community. Um, you know, a lot of times in,
• 18:49
  in communities it's just, um, you know, the hospital in a silo,
• 18:54
  but we've hired a, um, a director of mission over,
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  uh, within the last several months,
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  and he has done a phenomenal job at just getting out and connecting with the
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  community, and it starts to put a face, um,
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  uh, to the hospital.
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  And it's not just a brick and mortar or those people up on the hill,
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  that kind of thing, but it starts to really, um, uh,
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  bring a closer connection with the community. I have a, uh,
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  a radio show that I get to do once a month,
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  and I usually bring on a guest from the hospital,
• 19:29
  one of the physicians or one of the nurse leaders. Um, and,
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  and we just talk about what the community wants to hear what and,
• 19:36
  and provide updates about the hospital. We have a,
• 19:40
  a short radio segment every Thursday,
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  and we're able to provide the community with updates about how the hospital is
• 19:47
  doing. Um, and our, our director of mission is getting out and,
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  and doing various, um, events with the community involved with various cultures.
• 19:56
  Had a latino night the other night that he attended, and, um,
• 19:59
  gave us an update about that event.
• 20:01
  We represented at the county fair this year with a booth several of
• 20:06
  us rode in, uh, in our 4th of July parade. Um,
• 20:12
  and,
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  and so I think it's things like that that really start to change the way
• 20:17
  a community sees its hospital, because without a hospital,
• 20:21
  there is not, um, the same level of a community. I mean,
• 20:26
  we're the largest employer in the county. Um, we have a, uh,
• 20:30
  a large community benefit as far as financial impact. Um, so,
• 20:35
  you know, the, a community needs its hospital.
• 20:39
  And so when you start connecting on a deeper level between the community and the
• 20:43
  hospital,
• 20:43
  I think that really sets potential for the no,
• 20:49
  you know, no ceiling, uh, potential there for, for a hospital's, um,
• 20:53
  you know, potential growth and success going forward. But, uh,
• 20:58
  but I would say from a marketing and engagement standpoint with the community,
• 21:01
  that's kind of the biggest project and biggest area focus that, um,
• 21:05
  that I would add to, to our other,
• 21:08
  other opportunities that we've been focused on.
• 21:11
  Absolutely. Dr. Hill, thank you so much for joining us on the podcast today.
• 21:14
  This has been such a fun and interesting discussion,
• 21:16
  and I look forward to connecting with you again soon.
• 21:18
  Thank you very much. I enjoyed it.
• 21:23
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