Latest / Becker’s Healthcare Podcast / Rethinking Orthopedic Access Through Innovation and Collaboration with Dr. Leo T. Kroonen

Transcript

Rethinking Orthopedic Access Through Innovation and Collaboration with Dr. Leo T. Kroonen · Becker’s Healthcare Podcast

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  - Just five years ago, a big portion of
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  - what's now being done in ambulatory surgery centers
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  - wasn't considered outpatient work. The cases have changed,
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  - the tech has changed, the patient expectations have
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  - changed, and the leaders who are thriving are
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  - the ones who saw it coming.
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  - Becker's twenty third annual Spine Orthopedic and Pain
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  - Management Driven ASC Conference
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  - exists for exactly that kind of forward looking
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  - practitioner.
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  - Here, Becker's hosts more than 1,000 attendees, 275
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  - physician and ASC speakers, and three days of
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  - sessions that move between the clinical, the operational,
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  - and the strategic, and the CME credits to
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  - show for
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  - it. Join us June eleventh through the thirteenth
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  - at the Swiss Hotel in Chicago, and come
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  - ready to think about what's next. Register on
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  - our events page at beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
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  - This is Gracelyn Keller with the Buckers Healthcare
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  - podcast, and we are recording live at the
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  - twenty third annual Spine Orthopedic and Pain Management
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  - Driven ASC Conference.
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  - I'm joined now by doctor Leo t Cronin,
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  - who is the chief of orthopedic surgery at
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  - Kaiser Permanente San Diego. Doctor Cronin, thanks for
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  - being here. Let's have you start off by
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  - briefly introducing yourself, telling us a little bit
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  - more about your role at Kaiser and what's
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  - currently commanding most of your attention as leader.
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  - Okay. Thanks, Grace. I'm really appreciative of the
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  - opportunity to be here. Yeah. My name is
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  - Leo Cronin. I'm chief of orthopedic surgery at
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  - Kaiser Permanente in San Diego. So, we're part
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  - of the Southern California Permanente Medical Group, which
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  - is,
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  - the large largest physician group in Southern California.
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  - We cover basically the lower half of the
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  - state. We are one of 13 areas, but
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  - we are the largest. And so we have
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  - about 45 orthopedic surgeons, and we cover three
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  - hospitals, four surgery centers, five clinical sites, and
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  - about, between six hundred and fifteen and six
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  - hundred and thirty thousand,
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  - patients. So, so really, what focus what I
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  - focus most of my attention on is is
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  - access, and access comes in,
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  - really two main flavors. The first is getting
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  - people into our clinics,
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  - and the second is getting them into our
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  - ORs. And ever really ever since the pandemic,
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  - we had this has been a real challenge
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  - because we we had a significant backlog of
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  - especially total joints, but all surgeries in the
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  - pandemic. And so,
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  - while we have continued to try to work
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  - down that backlog, we have,
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  - also seen pent up demand from from the
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  - pandemic, so more patients coming in, which are
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  - furthering our backlog. And and
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  - and since we're trying to work down the
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  - backlog, we're spending more time in the operating
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  - room. So,
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  - it makes it a challenge to get them
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  - seen in clinic too. So it's always a
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  - balancing act, and and that's definitely where I
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  - spend most of my time.
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  - Absolutely.
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  - Well, let's start our conversation
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  - with in a year marked by rapid change,
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  - what recent decision or pivot required the most
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  - leadership conviction from you,
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  - particularly when it came to aligning people, resources,
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  - or capabilities?
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  - Yeah. That's that's a great question and,
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  - really directly relates to what I was just
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  - talking about, which was we needed to find
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  - a way to try to get more patients
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  - seen in a more thoughtful and efficient way.
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  - And, one of the things that we did,
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  - it was we started talking to our referring
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  - providers. So it was a lot of primary
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  - care physicians and emergency room physicians, urgent care
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  - physicians,
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  - and seeing what their challenges were and who
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  - they were referring.
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  - And there are a lot of systemic
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  - problems where they just they just need to
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  - get the patients to us because they don't
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  - have another way to deal with them, particularly
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  - the emergency rooms and urgent cares. They don't
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  - have a real follow-up plan for these, patients.
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  - And a lot of times, they don't even
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  - know what the actual diagnosis is by the
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  - time they let them go from the, emergency
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  - room or urgent care. You know, they they,
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  - they have a,
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  - a sore body part. The X rays might
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  - be equivocal. And so they just the default
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  - is to send them to orthopedics.
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  - And I think in a traditional orthopedic model,
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  - that was something where,
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  - either you would just get them seen or
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  - you would say, no. I looked at that.
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  - We don't really need to see that. But
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  - we
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  - worked with these referring providers to try to,
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  - figure out a way to
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  - kinda care for them together.
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  - So instead of this traditional model of they
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  - hand it off to us and then we
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  - take it from there, it was more a
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  - model of we have a team
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  - with the referring provider and us, and we're
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  - collectively
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  - taking care of the patient. So that could
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  - look a lot of different ways.
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  - So so mind set shift from the normal,
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  - like, everybody gets booked into a consult appointment
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  - of some sort to we can kind of
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  - make it on the fly and figure out
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  - what's more efficient.
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  - And so this change in mindset was really
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  - important because it, allowed us to think of
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  - new ways that hadn't been done before. So
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  - some of the stuff that's, like, really easy,
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  - maybe somebody had a toe fracture or a
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  - little finger fracture or something that has already
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  - been really well treated by the urgent care.
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  - And and the the patient oftentimes just wants
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  - to kinda hear it or have it validated
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  - by a specialist.
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  - And so we figured out new workflows to
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  - kinda expedite that with maybe a phone call
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  - or an email or something just saying, hey.
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  - I'm an orthopedic surgeon. I've been able to
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  - look at your studies. You've already gotten great
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  - treatment. Here's what you can expect after the
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  - next few weeks, and feel free to contact
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  - us if you, you have any questions or
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  - wanna get in for an in person visit.
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  - So that was one way. But the other
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  - other ways might be, you know, patients who
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  - are waiting for a total, joint replacement,
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  - and they have, a lot of medical comorbidities
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  - that still need to be worked on before
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  - they're medically optimized for surgery, but they really
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  - wanted to have that,
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  - that word from the orthopedic surgeon so we
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  - could figure out new ways to communicate that,
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  - to
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  - establish that dialogue, let the patient ask questions
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  - maybe through a virtual means instead of an
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  - in person appointment, which really was able to
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  - gain us a lot of capacity,
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  - to see the patients that we really needed
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  - to see in clinic.
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  - So it was a new way of thinking
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  - about it to say maybe every patient that
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  - comes in doesn't need to have the standard
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  - clinic appointment,
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  - but that we can still provide care that's
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  - kinda right size for what they need at
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  - that time.
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  - So it it it required a lot of
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  - getting other people on board, though,
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  - and we're still working on that. There's still
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  - some people who have a lot of questions
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  - about this and whether or not it might,
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  - you know, present some regulatory risk or something.
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  - But,
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  - the most important thing was that we were
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  - working with the referring providers, and we were
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  - able to kinda establish this relationship with them
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  - so that the primary care,
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  - and urgent care doctors really started to love
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  - this and recognize that this was a faster
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  - way to get their patients taken care of
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  - for a lot of these things that they
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  - needed our help on.
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  - Absolutely. And when you think about these issues,
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  - how did they challenge your assumptions,
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  - and what did they change about how you
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  - approach decision making, talent, or organizational readiness?
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  - Yeah. So I think it definitely changed
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  - the assumption about what care has to look
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  - like. And I think we get trapped in
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  - this traditional
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  - medical mindset of
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  - all patients need to be treated this way.
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  - I think in orthopedics in particular,
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  - it's something where we've traditionally had this this
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  - idea that it is a hands on
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  - sport. You know, we have to touch the
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  - patient. And I think that there's a lot
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  - of truth to the the the importance of
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  - that in the right patients, but there's also
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  - a lot of cases where maybe you don't
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  - need that. Maybe these are the things that,
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  - are very easy to us to identify and
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  - look at and and treat in a virtual
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  - manner,
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  - that is very, very satisfying for the patient.
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  - The other main assumption that I've totally flipped
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  - in my head is about triage.
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  - I think triage, you know, I spent my
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  - the early part of my career in the
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  - military where we learn a lot about triage
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  - on the battlefield, and you kinda put people
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  - into piles, and it was always relegated to
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  - somebody who,
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  - was a little bit lower on the totem
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  - pole in terms of medical expertise.
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  - I flipped my mindset on that so that
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  - now I think the most powerful triage can
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  - be done by the people who know the
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  - most.
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  - And when I get physicians who are enthusiastic
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  - about sorting this out and doing this virtual
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  - care, they can come up with some really
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  - innovative and creative ways to take care of
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  - patients quickly
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  - and with high quality without using as as
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  - much resources. But it requires
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  - the level of expertise that we've gained over
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  - the years,
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  - to make these nuanced decisions that can be
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  - very customized
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  - to titrate the actual amount of time that
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  - we need for a given patient to just
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  - the right amount so that we're giving them
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  - we're not missing the important things, but we're
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  - also,
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  - expediting care for these patients.
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  - And switching gears a little bit, when you
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  - think about the forces reshaping healthcare right now,
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  - where do you believe leaders need to be
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  - more decisive, especially when it comes to balancing
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  - speed risk and having the right teams in
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  - place? Yeah. I I think the most important
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  - thing is to recognize that a lot of
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  - the resources that we need
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  - are probably already there, that we are we
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  - we already have them, but we need to
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  - look at our system and say, are we
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  - using those resources in the best way possible?
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  - So so a lot of examples of this,
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  - like, you know, we might,
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  - need to do a bunch of hand surgery
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  - procedures, and we traditionally have put them through
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  - the operating room. But we recognize that the
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  - operating room is a coveted resource that is
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  - demanded by a lot of different people. And
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  - so if we can move those out of
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  - that operating room into a lower acuity
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  - setting like a procedure room, well, that's really
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  - effective.
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  - In that same way, when we're doing our
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  - virtual ortho program and we're looking and we're
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  - we're titrating, we might not need a clinic
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  - visit for that patient. So we we have
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  - to look at it through a a nontraditional
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  - mindset. We have to get rid of the
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  - assumptions that we have about how medical care
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  - is supposed to look
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  - and,
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  - think of new ways that are just as
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  - good that can provide just as high quality
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  - care,
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  - but using the resources in a much more
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  - thoughtful way.
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  - So I think we have to break the
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  - mindset of traditional medicine and relook at these
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  - processes and redesign our systems to to make
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  - the best use of the resources that we
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  - already have.
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  - Certainly. And as we wrap our conversation,
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  - I'd love to know that while uncertainty has
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  - become the norm, what leadership habit or mindset
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  - has been most critical in keeping your organization
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  - and your people moving forward?
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  - I think it's
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  - curiosity
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  - and openness to change.
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  - Right now, my biggest fear in medicine is
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  - that everybody is approaching this problem that we
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  - have of increased demand with thinking that we
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  - need to just do the same thing we've
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  - been doing, but we need to do more
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  - of it in the same amount of time.
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  - And, if we can have an open mind
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  - and maintain this curiousness as to, like, what
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  - other ways we can do things,
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  - be open to listening to our physicians who
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  - are on the front line because those people
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  - are really the people who understand what the
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  - challenges are, what the friction points are for
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  - the patient and the provider.
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  - And if we can be open to listening
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  - to them and
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  - finding new ways and and and being willing
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  - to try them, I think that that's gonna
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  - be the mindset that allows us to grow
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  - in the way that we need to grow.
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  - Absolutely. Well, thank you so much for joining
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  - me today on the Becker's Healthcare podcast to
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  - share these thoughts and insights. And, again, we
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  - are recording live at the twenty third annual
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  - Spine Orthopedic and Pain Management Driven ASC Conference.
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  - Thanks, Grace.