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

Transcript

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

• 0:02
  - There's a small circle of people who truly
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  - 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.
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  - 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.
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  - 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
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - 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.
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  - For the agenda and event details,
• 0:45
  - visit beckershospitalreview.com
• 0:47
  - and click on the events tab in the
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  - upper right.
• 0:50
  - Welcome to the Becker's Healthcare Clinical Leadership podcast.
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  - I'm Mariah Taylor, assistant editor, and I'm thrilled
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  - to be speaking with Matt Bowles, chief medical
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  - officer at Salem Health Hospitals and Clinics.
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  - Thank you so much for joining me today.
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  - I'm really excited to learn more about the
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  - future of the CMO role. But before we
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  - dive into that, I'd love you to introduce
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  - yourself and tell us a little bit about
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  - your background.
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  - Great. Well, thank you, and thanks for having
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  - me back.
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  - And, again, my name is Matt Bowles. I'm
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  - an anesthesiologist,
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  - and I'm the chief medical officer
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  - here at Salem Health hospitals and clinics.
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  - I've been in a medical leadership role now
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  - for, gosh, over nine years.
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  - Started as the VPMA,
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  - in 2018
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  - and took over as the CMO
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  - last summer. And, just a little bit about
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  - Salem Health.
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  - I may have said this at the last
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  - podcast, but
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  - we are,
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  - one of the largest acute care hospitals here
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  - in Oregon with over 600 licensed beds.
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  - We have an acute care hospital about 20
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  - miles to our west.
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  - Another fun fact about Salem Health is we
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  - 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
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  - staff
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  - so quite a large,
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  - medical staff here at sim health and again,
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  - it's my pleasure to be here today
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  - Yes, and we're so excited to have you
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  - back and to really chat about where the
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  - chief medical officer role is is headed.
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  - So as everyone probably expects, by 2030, the
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  - role will likely look a little bit different
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  - than what it does today.
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  - What competencies or capabilities do you think current
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  - and future CMOs will need to develop in
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  - the coming years?
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  - Yeah. That's a great question.
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  - And, just kind of looking over my notes
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  - 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
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  - when I started this, leadership journey.
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  - So much has changed.
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  - And like the mix,
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  - physicians and APPs and also the shift
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  - in the number of providers that have sought
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  - employment.
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  - And so, again, the numbers I'm gonna tell
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  - you are are are pretty rough estimates.
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  - 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%
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  - of our medical staff that was employed
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  - and about 60% or more were either in
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  - private practice or in in an independent group
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  - type of practice. And
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  - as of today, that has completely
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  - reversed,
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  - with majority of our medical staff that are
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  - now employed
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  - and probably right around 60%
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  - or more.
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  - And,
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  - just speaking to my CMO colleagues around the
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  - country, I know that we're not alone.
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  - They're also telling a similar story. And, again,
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  - I don't think private practice is dead by
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  - any means, but it's it's sure very hard
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  - for our practices to survive in this economic
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  - and regulatory climate, and we sure don't really
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  - make it that easy for them. So,
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  - with things like rising
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  - non labor
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  - costs and and decreasing reimbursement,
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  - especially for those government
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  - pay type of patients,
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  - and you combine this, at least what we're
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  - experiencing here in Oregon,
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  - just a really difficult recruiting
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  - landscape.
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  - It's really no wonder that these practices
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  - aren't struggling
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  - 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
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  - 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
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  - 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.
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  - So we had to do this,
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  - actually in a in a short amount of
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  - time.
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  - And when you compare this to the changes
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  - that the physicians, the MDs, DOs,
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  - have had, it's been it's it's actually quite
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  - stagnant. So
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  - looking into the future, kind of getting back
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  - to your original question,
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  - I think these changes and challenges
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  - are just gonna continue
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  - and in some cases get,
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  - even tougher and and more difficult to navigate,
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  - especially
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  - some of those economic
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  - and regulatory constraints I spoke about.
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  - CMOs will need to have a good understanding
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  - 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.
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  - Will this cause more shortages or
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  - Shift more patients to a different payer system?
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  - 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.
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  - 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
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  - 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
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  - is Ruth Miles. She's amazing.
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  - She regularly updates me with,
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  - legislative happenings,
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  - upcoming bills. She translates them for me. They're
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  - very they're actually quite complicated and complex.
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  - And she just tries to give me a
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  - 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.
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  - I also would advise
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  - UCMOs to get involved with your state hospital
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  - 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
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  - 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
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  - so we can hear firsthand,
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  - what is, you know, up and coming, what
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  - is imminent,
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  - what may impact the health systems
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  - and,
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  - our providers
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  - and ultimately our patients.
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  - And so, again, my advice just kinda looking
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  - to the future is how can you best
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  - position yourself to be prepared for these impacts?
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  - If you want to take this to the
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  - next level again in full transparency, I haven't
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  - quite done this yet. I'm always looking at
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  - ways to improve,
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  - but how can you be actually proactive?
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  - How can you advocate
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  - and,
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  - partner with your your legislators
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  - to to take a more proactive
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  - approach
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  - and help come up with better legislation that
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  - will positively
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  - impact,
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  - our providers and our patients? So
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  - again,
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  - just to kind of wrap this up, I
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  - think it's just important to consider all these
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  - things looking to the future the
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  - legislative piece your app mix,
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  - and how can you, position yourself for success?
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  - Excellent. I love that because all c suite
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  - leaders are facing so many complex avenues, right,
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  - especially in health care so many different
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  - legislative and regulatory things going on. And I
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  - 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
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  - 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
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  - today's organizational structures actually built to support that
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  - collaboration?
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  - Yeah. I again, that's another great question. And
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  - let me begin by saying that, here at
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  - Salem Health, I truly am blessed
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  - to work alongside the most amazing,
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  - competent, brilliant executives.
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  - Many of us have a long tenure.
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  - I didn't share this at the beginning, but,
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  - I actually started here at Salem Health right
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  - outside of high school,
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  - since I was 18. So I've been at
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  - Salem Health for,
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  - gosh,
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  - thirty five years or so, leaving only for
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  - medical school and residency.
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  - But I've but I've been here a long
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  - tenure and that's that's true for all of
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  - not all, but most of my executive partners,
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  - our CNO. She also started here right outside
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  - of high school.
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  - And so,
• 10:02
  - 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,
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  - 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
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  - 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
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  - 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
• 11:04
  - 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.
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  - I think it was right around 2009,
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  - 2010.
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  - So over fifteen years ago, and I was
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  - so fortunate. I was on,
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  - kind of the forefront with that group,
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  - when lean came to Salem Health. And I
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  - was lucky enough,
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  - to
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  - have traveled to Japan with our consultants.
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  - I went with our CEO.
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  - Cheryl was probably c and o or or
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  - maybe COO at the time,
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  - just for that hands on training and lead.
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  - And we've actually never looked back. And,
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  - 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
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  - we're all involved in strategy.
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  - We've all the c suite, leaders has been
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  - strategy deployment leaders,
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  - and we work together on our a threes.
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  - And we've just gotten better and better at
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  - it over the years.
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  - And so,
• 12:09
  - you know,
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  - for the CMOs listening out there, how do
• 12:12
  - how do I fit in to all of
• 12:14
  - this?
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  - As CMO, I've really helped bring our strategy,
• 12:19
  - to our frontline providers,
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  - especially those who aren't employed.
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  - 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.
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  - In fact,
• 12:55
  - some of them have even led lean projects,
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  - 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,
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  - 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.