Latest / Becker’s Healthcare - Clinical Leadership Podcast / Geralda Xavier, MD, MPH, MBA, FACEP, Chief Medical Officer at Hackettstown and Newton Medical Centers, Atlantic Health System

Transcript

Geralda Xavier, MD, MPH, MBA, FACEP, Chief Medical Officer at Hackettstown and Newton Medical Centers, Atlantic Health System · Becker’s Healthcare - Clinical Leadership Podcast

0:00
Hello everyone and welcome to the Becker's Healthcare
0:03
Podcast.
0:04
I'm Mackenzie Bean, associate vice president and managing
0:07
editor of Becker's Hospital Review.
0:10
Today I'm so thrilled to be joined by
0:12
Doctor. Geraldo Xavier,
0:14
chief medical officer of Atlantic Health Systems, Hackettstown
0:18
and Newton Medical Centers.
0:19
Doctor Xavier, thank you for joining us today.
0:22
How are you doing?
0:23
I am doing really well, Mackenzie. Thank you
0:26
so much for having me. I am,
0:28
appreciate the opportunity to participate,
0:31
in the podcast and really looking forward to
0:33
the conversation.
0:34
Well, I'm looking forward to it just as
0:37
much.
0:38
I know I was reading,
0:40
your bio,
0:41
just before this, and
0:43
it it had a line that I really
0:44
loved, which is you have a strong reputation
0:46
for being a change management champion. And I
0:48
feel like that's probably gonna shine through today,
0:50
so I'm excited to,
0:52
learn more about that and some of the
0:54
work you're doing at Atlantic Health. But before
0:56
we dive into that specifically,
0:58
can you just share a little bit more
0:59
about yourself and your background?
1:02
Absolutely.
1:04
So yeah. You know, I was reflecting on,
1:07
what we're gonna talk about today, and I
1:09
thought to myself,
1:11
Jesus. I am a board certified
1:13
practicing emergency physician for now over twenty years,
1:16
and I thought Amazing. Time does fly.
1:20
But, yeah, I I completed my education
1:23
at
1:24
UMDNJ Robert Wood Johnson University Medical School, which
1:28
is now actually renamed Rutgers Robert Wood Johnson
1:30
Medical School where I got a dual degree.
1:33
I did a medical degree as well as
1:35
a master's in public health.
1:37
I then completed my emergency medicine residency training
1:40
in New York City,
1:42
my home state,
1:44
and, at the previously Columbia affiliated St. Luke's
1:47
Roosevelt Hospital System, which
1:49
has now also been renamed and is now
1:51
within the Mount Sinai family, and it's, Mount
1:54
Sinai
1:55
Morton Side and Mount Sinai West.
1:58
From there, I've I've had several years of
2:01
practice.
2:02
I went back to school and got my
2:04
master's in business administration
2:06
from Haslam College of Business at the University
2:09
of Tennessee,
2:10
in Knoxville.
2:12
Along my educational journey, I also completed a
2:15
safety quality informatics and leadership program at Harvard
2:18
School of Medicine
2:20
and the adviser program
2:22
at IHI, which is the Institute for Healthcare
2:24
Improvement.
2:26
Here is where you'll see a lot of
2:28
the training around change management,
2:30
that we'll talk about in terms of how
2:32
I,
2:33
incorporate that to do work,
2:35
at my facilities, and I'm also a certified
2:38
Lean Greenbelt Six Sigma.
2:41
So over the two decades, in addition to
2:43
clinical practice, I've had several leadership roles including
2:47
department chair,
2:48
chief quality officer
2:50
at both community,
2:52
hospitals and large level one trauma academic centers
2:55
leading multidisciplinary
2:57
cross functional teams.
2:59
As you stated in my current role at
3:01
Atlantic Health System, I serve as the chief
3:04
medical officer over
3:06
two of our, hospitals in the Western Region,
3:09
Hackettstown and Newton Medical Center.
3:12
And currently, some of my responsibilities,
3:15
include leadership oversight
3:17
of clinical operation, including care
3:20
coordination,
3:21
quality and patient safety initiatives,
3:24
obviously, our med staff functions and working to
3:27
ensure
3:28
we strengthen the relationship and,
3:30
and,
3:31
engagement and alignment with the or from the
3:33
with the organization
3:35
and the med staff, which
3:37
I have the privilege of working with both
3:39
employed,
3:40
physicians
3:41
and allied head workers as well as private,
3:45
physicians and allied head professionals.
3:48
I also served as a cochair of our
3:50
Atlantic Health System women leadership
3:53
business resource group.
3:55
I really continue to serve as a mentor
3:57
to many of our emerging leaders both within
4:00
the organization
4:01
and outside.
4:03
I thought about, wow.
4:05
That's a lot of documented accomplishment around education
4:09
and work, but maybe I should share a
4:10
little bit about me, which is
4:13
I couldn't do any of this without my
4:16
the support of my family.
4:18
I've been really fortunate
4:20
to have an extremely supportive spouse of twenty
4:23
five years
4:24
and three amazing kids who keep us busy
4:28
and grounded,
4:30
and really enjoy
4:32
traveling with our family.
4:35
Our last
4:36
trip,
4:37
we did was to South Africa, and that
4:40
was really,
4:41
eye opening in so many ways. I got
4:43
the opportunity
4:44
to visit Robben Island where
4:47
Nelson Mandela and other political
4:49
figures were held and just really sharing that
4:52
history with our children,
4:55
who are all school aged.
4:57
And, of course, we you cannot go to
4:59
South Africa without, going to the safari and
5:02
experiencing the diverse,
5:04
biodiversity
5:05
of the, not just the culture, but of
5:08
the environment. And, so that was really a
5:11
fun thing to do with with my family.
5:14
And then for me, balancing all of that,
5:17
I enjoy being outdoors. So I'm a long
5:19
distance runner,
5:20
and so
5:21
I love participating in short distances, five k's,
5:25
as well as half marathons.
5:27
So I that keeps me busy
5:29
with the current lifestyle that I live. So,
5:31
hopefully, that gives you a little bit of
5:33
flavor
5:33
as to who I am and what really
5:36
drives me in terms of the
5:38
the work that I do.
5:41
Absolutely.
5:42
Sounds like an extremely full life, full career,
5:46
and I think that paints a great picture
5:47
of,
5:48
you know, the type of leader you are
5:50
and the experiences that shape you.
5:53
I'd love to hone in now on some
5:54
of the work you're doing at Atlantic Health
5:56
that you, I know, started to allude to.
5:59
Can you tell us that maybe a a
6:01
successful project or initiative that you're particularly proud
6:04
of from the last year? What was it?
6:06
What results did you see?
6:08
Yeah. No. Thanks. That's a that's thanks for
6:10
that question. That's really a major part of
6:13
the work I do with any organization
6:15
is around really
6:17
aligning and organizing around our strategic,
6:21
enterprise strategic objectives,
6:24
which I am really,
6:26
really fortunate to be part of an organization
6:28
whose focus is demonstrating excellence at the highest
6:31
national level,
6:33
leading improvement
6:34
around patient access, experience, and affordability.
6:38
And so when we embark on initiatives, we
6:40
really strategize
6:42
our initiatives around our four main pillars.
6:45
And just to share, our main pillars of
6:47
how we do work is around performance,
6:49
population health, growth and stability,
6:52
innovation research, and education.
6:55
So under those,
6:57
four domain, we
7:00
focus on the performance domain,
7:03
that would align with our quality goals
7:06
as one of our priorities,
7:07
which was to reduce
7:09
thirty day readmission rates
7:12
on CMS hospital readmit reduction penalty program.
7:16
This program includes principal diagnoses
7:18
such as heart failure,
7:20
chronic obstructive pulmonary disease,
7:22
acute myocardial infarction, and pneumonia.
7:25
In my region, we in reviewing the data,
7:28
we saw opportunities to improve our outcomes
7:31
by decreasing the readmission rates across these cohorts.
7:36
So using data to guide our decisions,
7:39
we put together a multidisciplinary
7:41
team of key stakeholders
7:44
including
7:45
cardiologists,
7:47
hospital medicine,
7:48
pulmonologists,
7:49
pharmacy,
7:50
nursing,
7:51
transitions of care,
7:54
members that interacts with the patient and the
7:56
community to name a few.
7:59
We also embarked on using
8:01
robust,
8:02
performance improvement methodology and tools
8:05
to create a charter establishing
8:07
the process measures
8:09
that we seek to improve
8:12
the outcome measures and the balancing measures so
8:14
that we know,
8:16
what are the changes
8:17
that we're gonna make that may lead to
8:19
the improvement that we seek.
8:21
Additionally,
8:22
we work with frontline teams to streamline multiple
8:26
workflows,
8:28
creating education materials
8:30
for both
8:32
the team members as well as the patient,
8:34
to ensure that we are providing
8:37
the right amount of information and tools to
8:40
our patient including,
8:42
scales to make sure that they can weigh
8:44
themselves at home, etcetera.
8:46
We definitely collaborated with providers in the community
8:50
as well to ensure that we could have
8:52
a follow-up appointment scheduled for within one week
8:55
of discharge. And as I had indicated in
8:57
the past, in the community that I serve
9:00
and I work with, we do have, again,
9:02
employed physicians as well as independent practitioners of
9:06
the medical staff. So it was totally
9:08
being very inclusive,
9:10
of the way that we do provide care
9:12
for our patients in our community. And, of
9:14
course, making sure that we utilize our transitions
9:17
of care nurses to monitor the patients post
9:20
discharge.
9:21
Just really proud of. There's a lot of
9:23
work that went into that over several months.
9:25
We did celebrate the small wins as we
9:28
move along the project milestones.
9:31
And, really, at the end, we, we outperformed
9:33
the expected targets in all the cohorts.
9:37
Really proud to say that we took that
9:39
work, some of that work,
9:41
and,
9:42
submitted,
9:43
and it was and submitted the work, and
9:45
that was accepted for poster presentation at the
9:48
twenty twenty four
9:50
International Healthcare Institute, which is for short IHI
9:53
forum. So our team's
9:55
part of the celebration was going to IHI,
9:59
and presenting the work that we did and
10:01
sharing,
10:03
across the national's
10:04
forum
10:05
the things we did to see the improvements
10:07
that we saw.
10:09
Certainly, one of the challenges and I'm always
10:11
looking at what are the lessons learned. And
10:13
the lesson learned one of the lessons learned
10:15
is really about
10:18
what we find to be successful is really
10:21
the really,
10:23
intentional way we communicate it with the multidisciplinary
10:26
team
10:27
to share the reason for action. Why are
10:29
we doing this? Why does it matter? How
10:32
does it align with the organizational
10:34
priority? And how does it align in how
10:36
we care for our patients
10:38
so that they can receive the best care
10:40
and the best outcome possible,
10:42
within our system? And in and
10:45
when you talk about transition as well as
10:47
when they're in their communities
10:49
in the ambulatory setting.
10:51
The other thing we learned is that there
10:53
is sometimes challenges in follow ups of patients,
10:57
because many of them may have some social
10:59
determinants of health factors. So how do we
11:02
bake around using the resources in the community
11:05
to provide those,
11:08
those
11:09
patients with the things they need so that
11:12
they could get the medicine, so that they
11:13
can have transportation to go to the appointment
11:16
as such for for those,
11:18
what we call SDOH risk factors.
11:21
So, yeah, that that that was really, it
11:24
was a joy and and a pleasure, and
11:25
we continue to,
11:27
see sustained results even throughout this time where
11:31
the teams are just monitoring all the intervention
11:35
measures we put in place to ensure we
11:37
stay on track.
11:39
Wow. It sounds like extremely impressive results and
11:42
how meaningful for the team to be able
11:44
to present it at IHI and really share
11:46
that as a national example for other systems
11:49
to learn from as well. And I appreciate
11:50
you outlining those lessons. It sounds like that
11:53
intentional communication
11:54
and really explaining the purpose and why it
11:56
was, like, so crew so crucial to the
11:58
program success.
12:00
Absolutely.
12:01
Absolutely.
12:02
Well, let's look ahead maybe to the next
12:05
year
12:06
for the in the sake of constant improvement.
12:10
What is the biggest challenge that you're thinking
12:12
about right now, or is there another specific
12:14
initiative,
12:15
or project that you're working on in 2025
12:18
that you'd like to know?
12:20
For for us and
12:22
clearly, as you know,
12:24
health care,
12:25
delivery is changing rapidly. It's constantly evolving. As
12:28
a CMO, you're constantly you have to stay
12:30
agile and really adjust to some of the
12:32
changes. However, I would suggest to you one
12:34
of our biggest challenge, and I'm sure it's
12:36
a challenge for some organization, is really access
12:39
to specialties.
12:40
I think that we were not immune to
12:43
the great resignation that we saw at the
12:45
at the somewhat towards the end of the
12:47
pandemic.
12:48
And I think that exacerbated an existing workforce
12:51
challenge that we were already having.
12:54
And so
12:55
how do we ensure
12:57
that we can maximize
12:59
what's what's on hand,
13:01
by potentially cross training our team more appropriate
13:04
and creating care models to include
13:07
the use of advanced practice providers,
13:10
to create those access.
13:12
But also one of the things we're doing
13:15
is how do we leverage
13:16
technology such as telehealth,
13:18
for certain specialties,
13:20
such as stroke care to to ensure that
13:23
we have timeliness,
13:26
of responses to some of these acute care
13:29
needs.
13:30
And another thing we saw,
13:32
you know, at the end of the pandemic
13:35
is just the
13:36
increase in behavioral health needs,
13:39
that enter in our, emergency department,
13:43
seeking care. So leveraging technology of virtual consults
13:47
to quickly provide access to patients in need,
13:50
because it's such a challenging resource
13:53
that we experience across the country in terms
13:57
of psychiatrists or mental health professionals.
14:00
Excuse me. So so certainly,
14:03
really recognizing
14:04
how we should be able to,
14:06
quickly organize about ensuring that we could get
14:09
those access to our patient. Because as we
14:11
know, at least those virtual consults are providing
14:15
the means to be able to do that
14:16
do help us to reduce wait times and
14:19
help us to increase,
14:21
access for patients that may not be able
14:23
to travel. We talk about, again, these risk
14:25
factors that may challenge or make it difficult
14:28
for patients to get to what they need,
14:30
but also allows specialists or just for us
14:33
to reach a broader, broader population
14:36
for sure. Another way,
14:39
we we have sort of
14:41
took on this challenge is looking for other
14:43
ways to create access. And recently,
14:47
we were able to,
14:50
in a collaborative,
14:52
have a collaborative joint venture with one of
14:54
our partners,
14:56
alongside a partner in a community who's a
14:58
multispecialty
14:59
physician group
15:00
across several location of our region, therefore, helping
15:04
us to expand and create more access to
15:07
services in the region so that we can
15:09
then
15:10
really ensure that we are providing
15:12
comprehensive,
15:14
care across the the continuum. So it's really
15:18
being smart about how do you then also,
15:22
create care models or work that will support
15:26
the ability
15:27
to provide the access along
15:31
the enterprise.
15:33
Because, again, as a system using systemness or,
15:37
capacity,
15:39
at one space may be able to be
15:41
shared
15:42
with another space and really creating those type
15:44
of loopholes
15:45
to really,
15:47
narrow the gaps to be able to provide
15:49
those access
15:50
and be able to provide that, high level
15:53
excellent care that we expect for our patients.
15:55
So that's one of the priorities we continue
15:58
to work in, really looking at using our
16:01
community needs assessment
16:03
as,
16:05
tools that we use to really also gauge,
16:09
which is an assessment we do every three
16:11
years, to gauge what else in the community,
16:14
we need to really prioritize
16:16
as we build, whether it's as we create
16:19
our budgets, as we as we look at
16:21
building new programs,
16:23
what is that what what is it informing
16:25
us that we need to do so that
16:27
we could continue to create those accesses and
16:30
provide those services
16:31
for our community?
16:33
Sounds like a a very multi pronged approach
16:36
to improving patient access, filling some of those
16:38
specialty care gaps like you mentioned, increasing reliance
16:41
on APPs,
16:43
thinking about technology in new ways, your new
16:45
joint venture.
16:46
I appreciate you outlining that.
16:50
For the last few minutes here, I wanted
16:52
to zoom in specifically on the chief medical
16:54
officer role. Right? We're seeing care delivery itself
16:58
involved just in response to various industry
17:01
factors.
17:02
How do you see the CMO role evolving
17:04
alongside all of that?
17:07
I think it's definitely,
17:09
changed. In the last twenty years that I
17:12
said I was practicing, I when I look
17:14
back and, you know, look at what the
17:16
CMO at the organization
17:18
that I may have been at is doing
17:20
compared to fast forward twenty years later. It's
17:22
so significantly different.
17:24
You know, back then, the focus was really
17:27
on just medical staff,
17:30
oversight,
17:31
and some clinical operation, ensuring quality of health,
17:34
and that is important.
17:36
But I think today,
17:38
with the with the evolving,
17:41
changes constant changing with health care delivery, technology
17:45
advancement,
17:46
and really the focus on population health, I
17:49
think this the chief medical officers have gotta
17:51
come along and be really a strategic partner
17:54
with the rest of the leadership in the
17:55
organization,
17:57
to be able to really meet those demands.
18:00
Some of the areas that I see us
18:02
expanded into
18:04
is really population health management. And the reason
18:06
why that's really important is because, as you
18:09
know, there's a shift from a fee for
18:11
service to value based care models.
18:14
So the chief medical officers have to play
18:17
a real key role in improving patient outcomes
18:20
and and across population,
18:22
not just
18:23
for individual
18:24
patients. I just shared
18:26
the reason why improving transitions of care so
18:30
that we can decrease or manage our readmission
18:33
is so important to how we ensure that
18:36
we can manage these chronic disease.
18:39
We can manage chronic disease condition, but also
18:42
make sure there's a handoff
18:44
at a different level of care, whether the
18:45
handoff is from the inpatient side
18:48
to the ambulatory side or the handoff is
18:50
from the inpatient side to the sniff or
18:52
post acute and vice versa. And how do
18:55
we
18:56
ensure those transitions are coerced seamlessly
18:59
so that we meet the patient demand?
19:01
We we also know that we are critically
19:04
important in ensuring that we have initiatives around,
19:07
again, the social determinants of health and managing
19:11
and the health care inequities that we may
19:13
see in our communities, in our surrounding,
19:16
populations, and how to address those by bringing
19:19
in the tools and the resources to do
19:20
that. So that overall, we can really be
19:23
part of the well-being of the community, not
19:26
just,
19:27
the well-being at one stage of the patient's
19:30
journey of their life. So really multipronged
19:34
in that way. Another
19:36
key, way that,
19:38
we are also involved in ensuring
19:42
organization success is workforce well-being and development.
19:45
We talk about, you know,
19:48
I mentioned we're not immune we were not
19:50
immune in health care, not just from the
19:52
nurses' perspective, but from physician and other
19:55
health care workers,
19:56
that burnout is a reality
19:58
and becoming a real growing concern.
20:01
And as CMOs, I think we're we're critically
20:03
important to taking on a larger role addressing
20:06
these clinician well-being issues
20:08
and promoting healthy workplace culture
20:11
with nerds by ensuring we have flexible work,
20:15
and, schedules,
20:16
ensuring that the EHR is such that we
20:19
can unload,
20:21
the burden of the clinician in terms of
20:22
documentations, facilitating tools to help make sure that
20:22
we can
20:24
documentations,
20:25
facilitating tools to help make sure that we
20:27
could manage that really well, promoting a healthy
20:30
workplace culture,
20:32
I think is also important,
20:35
so that we can foster,
20:37
that engagement.
20:38
But not just that. It's really important from
20:40
a retention perspective
20:42
to be able to have really good benefits
20:44
as well while ensuring that the clinicians
20:47
are able to work at the top of
20:49
their license
20:50
and making sure we can unburden
20:52
them with the regulatory,
20:56
not regulatory, but just unburden them with the
20:58
things that we can take over from them
21:01
by doing it in a much more smart
21:03
way.
21:04
So I think that those are some of
21:06
the ways
21:07
that CMOs are also involved in terms of
21:09
creating a positive workforce culture
21:12
to ensure that you're able to recruit the
21:15
best talent possible. And, ultimately, not ultimately, and
21:19
one one of the,
21:20
area I think that I see myself, especially,
21:23
and a lot of others as me is
21:25
financial oversight. We're in we're increasingly getting involved
21:29
in
21:30
strategic financial decision. I'm working much more closely
21:33
with chief financial officer and CEO,
21:36
CEO.
21:37
I know for sure I am involved in
21:39
all of our budget and annual budgeting processes,
21:42
participate in, and really influencing
21:45
cost control measures in terms of managing expenses,
21:49
also involving growth strategy. Right? When you look
21:52
at your revenue streams, where was that look
21:54
like? What are some of the things the
21:56
market is suggesting that we should focus on
21:59
or grow into
22:01
or implement implement new,
22:04
initiatives.
22:06
One of the things I did recently not
22:08
recently, but is our robotic program.
22:11
While robotic is not new, it is an
22:13
important tool to recruit the, physician nowadays because
22:17
that's a lot of the way that they're
22:19
that they're trained. So bringing that tool also
22:22
opens up the ability to have,
22:24
an ability to provide to provide more minimally
22:26
invasive surgeries for the for the community.
22:30
And so really ensuring that we continue that
22:32
revenue generation
22:34
and really aligning
22:35
our financial,
22:37
sustainability,
22:39
along our KPIs.
22:41
So really making sure that we are fiscally
22:43
doing that in a way
22:45
that, is aligned with the organizational,
22:49
organizational goals. Sorry.
22:51
So those are some of the ways
22:53
I think CMOs
22:55
have pivoted,
22:57
over the years to really be really much
23:00
definitely a huge value add and strategic partner
23:03
with the rest of the leadership
23:05
structure in the organization.
23:07
Mhmm.
23:08
It's clear the CMOs,
23:11
you know, strategic oversight has significantly expanded and
23:14
and will continue to, and I think you
23:16
are a living example of a clinical executive
23:19
who is,
23:20
so passionate and driven in, to do what's
23:22
best for their community, their patients, and their
23:24
staff members. So
23:26
thank you so much for your time today.
23:27
This has been such an enlightening discussion, and
23:29
I appreciate you sharing more about your work.
23:32
Yeah. I appreciate the opportunity to chat with
23:35
you a little bit.
23:36
I know I'm gonna see some of you
23:38
in different spaces. I'm gonna be at the
23:40
annual conference soon, and, really, it's been a
23:43
pleasure to, you know, work with some of
23:45
your teams in different spaces. So appreciate the
23:48
opportunity to share some of the the work
23:51
that I do and what keeps me, motivated.