Latest / Becker’s Healthcare Podcast / Leading Through Change in Community Healthcare with Dr. Matt Boles

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Leading Through Change in Community Healthcare with Dr. Matt Boles · Becker’s Healthcare Podcast

0:02
- There's a small circle of people who truly
0:04
- understand what it takes to lead a health
0:05
- system right now. The decisions are enormous.
0:08
- The variables are constantly shifting, and the stakes
0:11
- of getting a call wrong don't stay contained.
0:14
- That's not a complaint. It's a structural reality.
0:17
- And it's why the most effective c suite
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- leaders are deliberate about where they go to
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- pressure test their thinking.
0:22
- Becker's fourteenth annual CEO and CFO roundtable
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- brings together more than 1,500
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- executive level attendees
0:30
- and nearly 400 speakers for four days built
0:32
- around growth, financial sustainability,
0:35
- workforce strategy, and the leadership questions that don't
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- have easy answers.
0:39
- Join us November second through the fifth in
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- Chicago.
0:42
- For the agenda and event details,
0:45
- visit beckershospitalreview.com
0:47
- and click on the events tab in the
0:49
- upper right.
0:50
- Welcome to the Becker's Healthcare Clinical Leadership podcast.
0:53
- I'm Mariah Taylor, assistant editor, and I'm thrilled
0:56
- to be speaking with Matt Bowles, chief medical
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- officer at Salem Health Hospitals and Clinics.
1:01
- Thank you so much for joining me today.
1:03
- I'm really excited to learn more about the
1:05
- future of the CMO role. But before we
1:08
- dive into that, I'd love you to introduce
1:10
- yourself and tell us a little bit about
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- your background.
1:12
- Great. Well, thank you, and thanks for having
1:14
- me back.
1:15
- And, again, my name is Matt Bowles. I'm
1:17
- an anesthesiologist,
1:18
- and I'm the chief medical officer
1:20
- here at Salem Health hospitals and clinics.
1:23
- I've been in a medical leadership role now
1:27
- for, gosh, over nine years.
1:29
- Started as the VPMA,
1:32
- in 2018
1:33
- and took over as the CMO
1:36
- last summer. And, just a little bit about
1:38
- Salem Health.
1:39
- I may have said this at the last
1:41
- podcast, but
1:43
- we are,
1:44
- one of the largest acute care hospitals here
1:46
- in Oregon with over 600 licensed beds.
1:49
- We have an acute care hospital about 20
1:52
- miles to our west.
1:54
- Another fun fact about Salem Health is we
1:56
- have one of the busiest EDs on the
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- West Coast,
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- at least North Of Los Angeles all the
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- way to the Canadian border. And we had
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- over a 115,000
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- visits in our ED.
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- We have about 900 folks on our medical
2:11
- staff
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- so quite a large,
2:15
- medical staff here at sim health and again,
2:17
- it's my pleasure to be here today
2:19
- Yes, and we're so excited to have you
2:21
- back and to really chat about where the
2:23
- chief medical officer role is is headed.
2:25
- So as everyone probably expects, by 2030, the
2:29
- role will likely look a little bit different
2:31
- than what it does today.
2:32
- What competencies or capabilities do you think current
2:35
- and future CMOs will need to develop in
2:37
- the coming years?
2:39
- Yeah. That's a great question.
2:41
- And, just kind of looking over my notes
2:43
- preparing for today,
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- I think the best way to approach this
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- is,
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- looking back,
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- maybe five, ten, or even fifteen years ago
2:52
- when I started this, leadership journey.
2:55
- So much has changed.
2:57
- And like the mix,
2:59
- physicians and APPs and also the shift
3:02
- in the number of providers that have sought
3:05
- employment.
3:06
- And so, again, the numbers I'm gonna tell
3:08
- you are are are pretty rough estimates.
3:11
- But at Salem Health, when I started in
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- this role about ten years ago or so,
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- we had about 40%
3:19
- of our medical staff that was employed
3:22
- and about 60% or more were either in
3:25
- private practice or in in an independent group
3:28
- type of practice. And
3:30
- as of today, that has completely
3:32
- reversed,
3:33
- with majority of our medical staff that are
3:35
- now employed
3:37
- and probably right around 60%
3:39
- or more.
3:40
- And,
3:41
- just speaking to my CMO colleagues around the
3:43
- country, I know that we're not alone.
3:46
- They're also telling a similar story. And, again,
3:49
- I don't think private practice is dead by
3:51
- any means, but it's it's sure very hard
3:54
- for our practices to survive in this economic
3:57
- and regulatory climate, and we sure don't really
4:01
- make it that easy for them. So,
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- with things like rising
4:06
- non labor
4:07
- costs and and decreasing reimbursement,
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- especially for those government
4:12
- pay type of patients,
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- and you combine this, at least what we're
4:17
- experiencing here in Oregon,
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- just a really difficult recruiting
4:21
- landscape.
4:23
- It's really no wonder that these practices
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- aren't struggling
4:27
- and that regulatory piece,
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- I know it's different for each state,
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- but it really is it just makes it
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- so hard to stay ahead.
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- And, again, it's not easy for hospitals
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- either. And I know I spoke a little
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- bit about app's.
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- That mix has also dramatically changed, and the
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- scope of practice
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- for APPs has also changed over the course
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- of these years.
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- We have more PAs and MPs
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- than we did when I started in this
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- role.
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- And I think nationally,
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- that's the same trend. I've even seen numbers
5:01
- that have said that their growth has almost
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- been exponential.
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- And so we've had to do quite a
5:07
- bit of change management,
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- across our whole system just to keep up.
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- This includes looking at their scope of practice,
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- the types of oversight,
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- bylaws, rules and regs updates.
5:20
- So we had to do this,
5:22
- actually in a in a short amount of
5:24
- time.
5:25
- And when you compare this to the changes
5:27
- that the physicians, the MDs, DOs,
5:31
- have had, it's been it's it's actually quite
5:33
- stagnant. So
5:35
- looking into the future, kind of getting back
5:37
- to your original question,
5:38
- I think these changes and challenges
5:41
- are just gonna continue
5:43
- and in some cases get,
5:45
- even tougher and and more difficult to navigate,
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- especially
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- some of those economic
5:51
- and regulatory constraints I spoke about.
5:54
- CMOs will need to have a good understanding
5:58
- of these upcoming changes like h r one.
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- Of course, we don't know about that
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- and anticipate
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- how this is gonna impact your medical staff
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- and maybe your makeup of your medical staff.
6:10
- Will this cause more shortages or
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- Shift more patients to a different payer system?
6:17
- In Oregon, I I feel like our again,
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- I would say this to my friends in
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- state government I'm I'm just not sure if
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- we're quite ready for these changes.
6:26
- And but, again, this may be unique to
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- Oregon. So CMOs,
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- my advice to to all of you CMOs
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- out there is just to really lean in,
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- understand as best you can, what these impacts
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- are and how they may reach the front
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- lines,
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- of the health system.
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- My advice is to surround yourself with these
6:45
- experts. I'm so blessed in my world.
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- I have a very competent
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- and wise director of government relations. Her name
6:53
- is Ruth Miles. She's amazing.
6:55
- She regularly updates me with,
6:58
- legislative happenings,
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- upcoming bills. She translates them for me. They're
7:02
- very they're actually quite complicated and complex.
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- And she just tries to give me a
7:07
- heads up as as best she can how
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- this may impact
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- providers,
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- and how we,
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- deliver care here at Salem Health.
7:16
- I also would advise
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- UCMOs to get involved with your state hospital
7:21
- association in Oregon. I've had the pleasure of
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- working with the
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- the Oregon Hospital Association, and they actually host
7:30
- a monthly CMO call. And oftentimes on that
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- agenda,
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- there are federal and and state legislative updates
7:39
- so we can hear firsthand,
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- what is, you know, up and coming, what
7:43
- is imminent,
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- what may impact the health systems
7:47
- and,
7:48
- our providers
7:49
- and ultimately our patients.
7:51
- And so, again, my advice just kinda looking
7:53
- to the future is how can you best
7:56
- position yourself to be prepared for these impacts?
7:59
- If you want to take this to the
8:00
- next level again in full transparency, I haven't
8:03
- quite done this yet. I'm always looking at
8:04
- ways to improve,
8:06
- but how can you be actually proactive?
8:09
- How can you advocate
8:11
- and,
8:12
- partner with your your legislators
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- to to take a more proactive
8:17
- approach
8:18
- and help come up with better legislation that
8:21
- will positively
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- impact,
8:24
- our providers and our patients? So
8:27
- again,
8:28
- just to kind of wrap this up, I
8:29
- think it's just important to consider all these
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- things looking to the future the
8:34
- legislative piece your app mix,
8:37
- and how can you, position yourself for success?
8:41
- Excellent. I love that because all c suite
8:44
- leaders are facing so many complex avenues, right,
8:47
- especially in health care so many different
8:50
- legislative and regulatory things going on. And I
8:53
- love what you were saying there about that
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- partnership you have with some of your other
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- c suite leaders to help keep you informed
8:59
- and on top of some of these things
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- that don't fit necessarily into your job description.
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- How do you see relationships like that and
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- other relationships between CMOs and c suite leaders
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- evolving in the next few years? And are
9:12
- today's organizational structures actually built to support that
9:15
- collaboration?
9:17
- Yeah. I again, that's another great question. And
9:19
- let me begin by saying that, here at
9:21
- Salem Health, I truly am blessed
9:25
- to work alongside the most amazing,
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- competent, brilliant executives.
9:30
- Many of us have a long tenure.
9:32
- I didn't share this at the beginning, but,
9:35
- I actually started here at Salem Health right
9:37
- outside of high school,
9:40
- since I was 18. So I've been at
9:42
- Salem Health for,
9:43
- gosh,
9:44
- thirty five years or so, leaving only for
9:48
- medical school and residency.
9:50
- But I've but I've been here a long
9:52
- tenure and that's that's true for all of
9:55
- not all, but most of my executive partners,
9:57
- our CNO. She also started here right outside
10:00
- of high school.
10:01
- And so,
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- we have this long standing,
10:06
- understanding of our culture
10:08
- and how to work here at Salem Health.
10:10
- And so, again, we just have an incredible
10:13
- team,
10:14
- our c suite team. We have a amazing
10:17
- CEO,
10:18
- Cheryl Nester Wolf, and she has created such
10:21
- a great team. And we're actually really diverse,
10:24
- and, we're so different
10:26
- from one another,
10:28
- but we really work well together. And,
10:31
- Again, I'm sure everyone listening to this podcast
10:34
- Has had their their their trials and tribulations
10:37
- and challenges. We sure have covid
10:40
- financial challenges. We actually had a building fire
10:43
- One of those never events and so we
10:46
- have been tried and true with our challenges
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- of working well together So this team is
10:51
- is really well seasoned
10:53
- but beyond all that I think the true
10:56
- reason that we work so well together
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- is,
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- we all are
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- speaking the same language as far as how
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- we approach our problems and and our management
11:07
- strategy, and that's lean.
11:09
- And so we adopted the lean management system.
11:13
- I think it was right around 2009,
11:15
- 2010.
11:17
- So over fifteen years ago, and I was
11:19
- so fortunate. I was on,
11:21
- kind of the forefront with that group,
11:23
- when lean came to Salem Health. And I
11:26
- was lucky enough,
11:27
- to
11:28
- have traveled to Japan with our consultants.
11:31
- I went with our CEO.
11:33
- Cheryl was probably c and o or or
11:35
- maybe COO at the time,
11:38
- just for that hands on training and lead.
11:40
- And we've actually never looked back. And,
11:43
- so our org structure, you talked about that
11:45
- org structure with the c suite. It's really
11:47
- built around the system, so it's not really
11:50
- dependent on people.
11:52
- It's really dependent on our lean management, and
11:54
- we're all involved in strategy.
11:56
- We've all the c suite, leaders has been
11:59
- strategy deployment leaders,
12:01
- and we work together on our a threes.
12:04
- And we've just gotten better and better at
12:06
- it over the years.
12:08
- And so,
12:09
- you know,
12:10
- for the CMOs listening out there, how do
12:12
- how do I fit in to all of
12:14
- this?
12:15
- As CMO, I've really helped bring our strategy,
12:19
- to our frontline providers,
12:21
- especially those who aren't employed.
12:23
- And I really helped translate lean and high
12:26
- reliability,
12:27
- principles to their work and how they care
12:29
- for their patients
12:31
- In full transparency. It wasn't easy I think
12:33
- when we started this journey in 2009 or
12:35
- '10, I think our our docs our providers
12:38
- thought this was just the Flavor of the
12:40
- month
12:41
- another management saying that that's a fad, etc.
12:45
- But but now, you know fifteen years later
12:47
- They can speak to it. They know the
12:49
- language. They know the approach
12:51
- they they've really embraced it.
12:54
- In fact,
12:55
- some of them have even led lean projects,
12:58
- which is which is amazing.
13:00
- We regularly
13:01
- update our providers at at various forums, our
13:05
- section chief meetings, m e c meetings,
13:08
- etcetera. So that's been, just a a great,
13:11
- way for me to,
13:13
- partner with my c suite colleagues and
13:16
- bring the strategy to our providers.
13:18
- And, again, just thinking about advice,
13:22
- you know, keep those c suite connections strong,
13:26
- with your c suite colleagues.
13:28
- If you
13:29
- don't see many of your c suite
13:32
- partners very often, you know, reach out to
13:34
- them, be proactive, round with them. I often
13:37
- invite,
13:38
- some of my fellow executives
13:40
- to come to MEC meetings, section meetings,
13:44
- especially if they have anything
13:46
- to do with, a provider,
13:48
- a project or an initiatives.
13:51
- I help kind of translate them into provider
13:54
- language.
13:55
- They we will ask often consult me on
13:58
- how to best communicate this to them.
14:01
- So again, that's just, you know, be proactive,
14:03
- reach out,
14:05
- and,
14:05
- partner with your your c suite executives as
14:08
- as best you can. So again,
14:10
- you know, if nothing else, just kinda getting
14:12
- back to your your your original question,
14:15
- just spend time with them regularly just for
14:18
- for if nothing else build up that relational
14:20
- capital,
14:22
- with your colleagues in case you, for instance
14:24
- need need to make that withdraw and ask
14:27
- a favor or a partnership on something down
14:29
- the road
14:31
- That's such great advice.
14:32
- Now I know I've been asking a lot
14:34
- about, you know, skill sets and those relationships,
14:37
- and I have just one more question kind
14:39
- of on this topic. But I wanna look
14:41
- at it from the angle of a regional
14:42
- or a community hospital or health system.
14:45
- These kinds of facilities are often navigating the
14:47
- same complexities as the large academic medical centers,
14:51
- but with far fewer resources.
14:53
- So what skills or advice do you have
14:55
- for CMOs at community hospitals and systems?
14:59
- What skills do they need to really develop
15:02
- and stay on top of industry changes?
15:05
- Yeah.
15:06
- We are big. Right? And, again, I sometimes
15:09
- I take that for granted,
15:11
- probably because,
15:12
- you know, I've really been here
15:15
- my entire career. I started,
15:17
- like I said, out of high school when
15:19
- we were just one building,
15:21
- and now we span several city blocks. I
15:24
- think we have
15:26
- five sky bridges or more.
15:28
- So again, we are we are quite large.
15:30
- I think at one time,
15:32
- actually up until recently, we were the largest
15:35
- acute care hospital
15:36
- in Oregon.
15:38
- I think OHSU has now,
15:40
- taken back that honor.
15:42
- So again,
15:43
- when I compare us to these large academic
15:46
- centers like OHSU for instance,
15:49
- my mind goes to resources like residents and
15:52
- fellows
15:53
- and the gain that has to our workforce
15:56
- capacity. So so so I think as CMOs,
15:58
- we really just need to be empathetic
16:00
- and sympathetic to our providers,
16:03
- because we don't have that. We we're not
16:05
- a a teaching institution.
16:07
- And so our medical staff, you know, they
16:09
- see every consult. They do every HMP. They
16:12
- do every procedure.
16:14
- So just being really mindful
16:16
- of that and what it's like for them
16:18
- to go just through their workday.
16:21
- And, again, I know I'm speaking to the
16:23
- choir, but just get out and round,
16:25
- do the best you can. We have 32
16:27
- sections
16:28
- here at Salem Health, so I make it
16:31
- a point to try to be at the
16:32
- elbow,
16:34
- at least once a quarter across all those
16:36
- sections just to see what life is like
16:39
- for our medical staff,
16:41
- here at Salem Health.
16:42
- So, again, kind of getting back to,
16:45
- you know, what else might be a gap
16:47
- that you need to be mindful of,
16:50
- large academic centers may have,
16:52
- you know, a more broad,
16:55
- support structure as far as service lines they
16:58
- may have all the pediatric subspecialties
17:00
- or
17:01
- Maybe there's a transplant center. So just be
17:03
- really mindful
17:05
- of the service lines that you're lacking
17:07
- and then be, supportive as you can when
17:10
- we need to do those transfers
17:12
- up to a different,
17:13
- health system.
17:15
- When I came into this role, I really
17:17
- did my best to
17:19
- just develop those relationships with those CMOs up
17:21
- in Portland. I had some dinners, lunches,
17:25
- Zoom meetings,
17:26
- as best I can just to put a
17:27
- name at the face.
17:29
- That way, if there was a difficult transfer,
17:31
- if we needed to utilize
17:33
- a service that that we didn't have,
17:36
- I could help navigate that if there was
17:38
- any difficulty
17:39
- or or barriers that needed to be,
17:42
- overcome.
17:43
- So
17:44
- you also mentioned industry, I think as well.
17:47
- So I do feel like our medical staff,
17:50
- even though we're not an academic center, they're
17:52
- pretty well connected to
17:55
- you know to the up and coming technology
17:57
- So to speak.
17:59
- I really appreciate that our medical staff tends
18:01
- to not really follow trends
18:03
- or fads.
18:05
- But, again, they really do bring technology to
18:08
- our community when it when it you know,
18:10
- there's a significant impact to patient care.
18:13
- Robotic surgery, for instance,
18:15
- it was, gosh, I think it was about
18:17
- twenty years ago,
18:19
- when we
18:21
- brought, our first robot on campus, it's probably
18:23
- 2007
18:24
- or eight, but only recently I'd say in
18:27
- the last five years have we expanded this
18:29
- to
18:30
- multiple service lines like pulmonology,
18:32
- bariatric, thoracic surgery, etcetera. So, again, great question.
18:36
- But, again, just be mindful
18:39
- of just what your limitations are in a
18:41
- community setting and how to address those
18:44
- and You know again, my advice is just
18:46
- making sure you have those relationships,
18:49
- solidified with with those health systems where you
18:52
- may need some help in the future
18:54
- That's such great advice
18:56
- Now my last question for you is focused
18:59
- on advising CEOs. We here at Becker's have
19:01
- covered a lot of stories recently about CEO
19:04
- turnover,
19:05
- new people coming in, sometimes from other industries,
19:07
- sometimes they're health care professionals.
19:09
- But regardless, a new CEO, right, is trying
19:11
- to look forward to the future and figuring
19:13
- out how to keep their c suite stable
19:16
- and strong to meet the headwinds that are
19:18
- coming. So what advice do you have for
19:20
- those newer CEOs on one structural or cultural
19:24
- change that they should make now?
19:26
- Well, that's a great question. And again, we
19:28
- are I know we've talked about cheryl, in
19:30
- a prior question, but
19:32
- she too is long standing and she has
19:34
- been here for
19:36
- Just about twenty years and talk about
19:39
- forward thinking
19:41
- she's had some incredible foresight
19:43
- on,
19:44
- how to future proof many areas in the
19:46
- industry and
19:48
- like would expand on bed capacity, etcetera.
19:51
- We, we're so blessed. We broke ground on
19:55
- our latest patient or
19:57
- just a couple of months before kovat and
19:59
- yet that might have been a little bit
20:00
- of luck
20:01
- but again, she was just very
20:04
- forward and future thinking
20:06
- About bed capacity cetera where a lot of
20:08
- hospitals,
20:09
- you know really weren't
20:11
- taking that risk
20:12
- But for clinical leadership and how to future
20:15
- proof
20:15
- this bench so to speak
20:18
- You know, I guess my advice is you
20:20
- know, how do you really utilize your physicians
20:23
- your providers?
20:25
- In front of the community?
20:27
- Use them as a voice to communicate about
20:29
- the world class care
20:30
- that you're giving at your institution.
20:34
- You know, speak about all the accolades, the
20:36
- awards, the designations,
20:39
- The the cms star ratings, etcetera
20:42
- that would be my advice is just to
20:44
- really partner with your provider
20:47
- Clinical leaders
20:48
- to to have that forward face to the
20:50
- community
20:51
- and that's not just for physicians but also
20:54
- for you know, the amazing nurses
20:57
- that work in our hospitals again just to
20:59
- brag about our own
21:02
- we we've been on a magnet journey for
21:04
- twenty years
21:06
- we are four time,
21:07
- magnet designated hospital.
21:09
- And so again that just puts us into,
21:12
- I think it's upper 2% of hospitals nationwide
21:15
- So
21:16
- how can you use that care team to
21:18
- tell that story?
21:20
- To the community?
21:22
- It really helps, I think, with your brand
21:24
- and just
21:25
- establishes
21:26
- yourself as a pillar of, you know, great
21:29
- top quality care
21:30
- right here in Salem, Oregon. So again, that
21:32
- would be my advice,
21:34
- you know, really
21:35
- coming from a CMO perspective,
21:38
- how can you partner with your clinical leadership
21:40
- team,
21:41
- just to really brag and and,
21:44
- celebrate the great care that your institution
21:47
- gives to patients.
21:49
- Excellent.
21:50
- Well, thank you so much for joining us
21:52
- again on the podcast today. We really appreciate
21:54
- your thought leadership and taking the time. Great.
21:57
- Always glad to be here. Thanks for having
21:58
- me.