Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. David Marcozzi, Chief Clinical Officer at University of Maryland Medical Center and Associate Dean of Clinical Affairs at the School of Medicine

Transcript

Dr. David Marcozzi, Chief Clinical Officer at University of Maryland Medical Center and Associate Dean of Clinical Affairs at the School of Medicine · Becker’s Healthcare - Clinical Leadership Podcast

• 0:01
  Every year, Becker's annual meeting brings healthcare leaders
• 0:04
  together to unpack the most pressing issues facing
• 0:07
  the industry.
• 0:08
  And every year, those conversations shift in profound
• 0:11
  and unexpected ways.
• 0:12
  This April, more than 3,500
• 0:15
  health care executives will return to Chicago for
• 0:17
  Becker's sixteenth Annual Meeting.
• 0:19
  Seven ninety five elite speakers will offer new
• 0:22
  lessons, new case studies, and predictions about what
• 0:25
  comes next. Join us April 13 through the
• 0:28
  sixteenth.
• 0:29
  For the agenda and event details,
• 0:31
  visit beckershospitalreview.com
• 0:34
  and click on the events tab in the
• 0:35
  upper right.
• 0:38
  This is Laura Dirda with the Becker's Healthcare
• 0:40
  podcast. I'm thrilled today to be joined by
• 0:42
  doctor David Marcozzi,
• 0:44
  chief clinical officer of the University of Maryland
• 0:46
  Medical Center and associate dean of clinical affairs
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  at the University of Maryland School of Medicine.
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  Doctor Marcozzi, it's a pleasure to have you
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  on the podcast today. Laura, thanks for thanks
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  for asking me to be part of this.
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  Absolutely. Now I'm excited for our conversation because
• 0:59
  I know things are changing so quickly in
• 1:01
  the health care space, and I'm excited to
• 1:03
  learn more about some of the things you're
• 1:04
  doing at the University of Maryland. But before
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  we dive in, can you tell me a
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  little bit more about yourself and the health
• 1:09
  system?
• 1:11
  Sure. Well, as the chief clinical officer for
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  the flagship
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  academic medical center within our system,
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  I work in partnership
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  with our dyad my strongest dyad partner, our
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  CNO, doctor Karen Doyle, on many portfolios
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  that include clinical strategy,
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  operations,
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  quality, safety,
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  graduate medical education,
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  credentialing prefer of our providers,
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  and candidly, physician alignment and care transformations
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  across two campuses in our we have the
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  medical center comprises two campuses and two in
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  those campuses, there are two hospitals.
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  So the work that I do services,
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  for the for our flagship is one as
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  one of the largest and most complex academic
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  medical centers in the region. It delivers care
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  to some of the highest acuity patients in
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  the nation per Visient's q and a quality
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  and accountability ranking.
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  And my role
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  bridges strategy and execution, partnering with physicians, nurses,
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  operations, and analytics
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  to translate organizational priorities into reliable, high quality
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  care at the bedside.
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  The medical center includes about 800 beds downtown
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  and a 140 beds at Midtown. Those are
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  the two campuses with over 1,200 attending physicians
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  and close to 900 residents and fellows.
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  We deliver highly specialized high acuity care spanning
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  trauma, cancer, neurosciences,
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  transplant, and more,
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  and all of our physicians are faculty within
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  the University of Maryland School of Medicine,
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  tightly linking education discovery and care.
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  We've got a high some high rankings, including
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  our academic flagship scores very highly in the
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  Visiant quality and accountability ranking in comparison to
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  other academic medical centers.
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  We've scored some of our specialties high on
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  US News and World Report,
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  and we're also very proud of our four
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  time magnet designation,
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  which is really among some very small percentage
• 3:00
  of hospitals across our nation for nursing excellence.
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  So, Laura, a lot going on at the
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  medical center, and thrilled to talk to you
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  today.
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  Well, that's amazing to hear. And and what
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  a broad enterprise that, you have on Maryland.
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  It is amazing to see all the different
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  elements coming together and really truly serving the
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  community in a strong way. Now when you
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  think about the last year or so, could
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  you tell us about an initiative that you
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  led? What did you do, and what were
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  the results?
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  Yeah. You know, I'm gonna ask for some
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  latitude. I'm gonna speak on not just one,
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  but two. Our medical center is really focused
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  on the highest delivery and the highest quality
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  and the safest care, And we we started
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  to implement a conceptual framework called HRO, high
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  reliability
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  organization,
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  and really made it part of the fabric
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  of how we deliver care,
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  and made it essential to how we think
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  about day to day practice. And that meant
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  standardizing how leaders engage
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  with safety data,
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  responding to events rapidly,
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  and escalating risk in accordance with our protocols
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  and policies.
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  This the we embedded the five principles of
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  HRO into executive routines,
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  unit level governance,
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  and frontline workflows. So it went from the
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  bedside to the boardroom.
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  Practically, this included restructuring leadership safety reviews,
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  clarifying escalation cascades,
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  reinforcing just culture expectations, and holding dyads and
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  triads. The The triads
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  are nurse practitioners or PAs on units
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  accountable for consistent safety behaviors at the unit
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  and service levels.
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  And this really anchored was anchored in a
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  in a rollout that we were doing across
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  our system, something called continuous learning for improvement,
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  and that is education and applied
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  using
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  application strategies at the unit level and understanding
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  lean lean strategies
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  or,
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  or performance improvement,
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  educational training opportunities
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  to be applicable at the line at the
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  unit so we can have the greatest impact
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  of where the work is done.
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  The our results for HRO have been meaningful,
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  and but we all know HRO is a
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  never ending,
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  effort. So we saw improvement in our safety
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  reporting.
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  We have,
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  tangible examples of improved relationships between our dyads
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  and triads and understanding what their priorities are,
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  broader understanding of the data and more consistent
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  leadership at the unit level, and then finally,
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  very clear ownership of safety issues and faster
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  escalation and resolution of risks.
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  The la the second thing I'll talk to
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  is about the work around access to the
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  academic
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  health system.
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  This was a really major focus for our
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  system and is particularly relevant for patients requiring
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  highly specialized
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  time sensitive care.
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  As we are all experienced across our nation,
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  really a supply and demand mismatch
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  for health care demand,
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  versus the the the supply that we have
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  to provide that care. So we took that
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  challenge head on by innovating how we move
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  patients through the system
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  to provide earlier access to academic level care
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  with a specific focus on round trip transfers
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  that enabled greater access
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  to care
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  without the constraint of an inpatient bed.
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  And, really, over the past year, the medical
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  center has managed hundreds of round trip transfers
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  for a high acuity,
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  high acuity care across our system.
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  This was done through clear standards
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  engaged to our physicians
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  in how we're gonna do this. So there's
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  clear expectations set.
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  Really, we needed to improve our systemness, and
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  we have very disciplined
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  operational oversight.
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  And of the 70 of of all of
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  our requests that were that were made to
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  the medical center, 70% of those requests
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  for round trips were successfully completed. Some of
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  them, the other 30%, some of them were
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  not needed. Some of them we managed via
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  telehealth.
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  So we're really trying to think about a
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  systematic way to get access to high acuity
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  care that our medical center can provide, but
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  not limited
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  by bed capacity.
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  And this has improved flow across our University
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  of Maryland system
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  and region, and it puts what we feel
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  is that it puts care at the right
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  location at the right time for our patients.
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  So that's just two efforts that we've embarked
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  on. We've embarked on a lot of efforts,
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  but those are two I wanna highlight today,
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  Laura.
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  Well, that's amazing to hear. You know, both
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  are impressive in terms of looking at the
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  scale that it takes
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  to, really have some of the those changes
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  on the clinical workforce team, make sure they've
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  got the right,
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  structure in place for safety, reinforcing that culture,
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  and bringing them all together for high reliability
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  organization. And then secondly, looking at the things
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  that you were talking about in terms of
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  making sure expanding access to care, managing transfers,
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  and and doing things a little bit differently.
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  The results are impressive. I think in both
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  cases, it seems like it took some change
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  not only from the,
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  process and and procedure side, but also I'm
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  sure from the culture side and how, you
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  know, the the,
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  clinicians were approaching their work. So how do
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  you do some of that change management with
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  the broader teams and just make sure that
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  everyone is on the same page and and
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  doing the right things?
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  Yeah. Clarity of expectations and roles was really
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  one of those key fundamentals
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  of who owns this,
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  what is the work that needs to get
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  done, how do we support that work to
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  assure that the data is is understood,
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  and then drive
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  what I like the term I like to
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  use quite often in many meetings that we
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  have
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  is decisive collaboration.
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  So in academia and certainly academic medical centers,
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  we we sometimes wonder who's making the decision,
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  how is the decision made, and the process
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  for that decision.
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  And what we all have started to anchor
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  on is we we embrace a who is
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  the lead for this decision,
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  how are we collaborating to make that decision,
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  but we will make a decision to move
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  forward in a and and allow us to
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  continue to evolve, and we're not paralyzed by
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  indecision.
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  And that was really one of the things.
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  And then when we put on that the
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  priority of HRO,
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  it was much clear understood from a structure
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  standpoint
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  how we're gonna make decisions and who's making
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  them. From a process standpoint, a prioritization standpoint,
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  what the process and the priority was, HRO
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  and highest quality.
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  And then the outcomes we're seeing throughout our
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  hospital of folks understanding and escalating concerns,
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  and it's having really a broad impact to
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  patient care across our medical center.
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  That's amazing to hear. Thank you so much
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  for digging a bit deeper there. Now looking
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  ahead,
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  what are some of the big priorities and
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  headwinds you're focused on for 2026?
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  Yeah. Laura,
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  Maryland is quietly doing what the rest of
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  the country continues
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  to think about,
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  and we are using what's called the Maryland
• 9:52
  model, a waiver that was granted by the
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  federal government, CMS,
• 9:56
  to support a statewide health care global payment
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  and accountability
• 10:01
  system for our state's health care. And that
• 10:03
  has substantively
• 10:05
  shifted volume to value, and it has better
• 10:08
  aligned
• 10:09
  hospitals with physicians and communities.
• 10:11
  And the emphasis for this Maryland model has
• 10:14
  been around keeping people healthy,
• 10:16
  and assuring
• 10:17
  that our quality is the highest within our
• 10:19
  state. And lastly,
• 10:21
  our the Maryland model has demonstrated also it
• 10:24
  is starting to bend the cost curve, and
• 10:27
  Maryland continues to push that envelope forward. And
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  in partnership with our federal government,
• 10:31
  we are we're gonna be soon,
• 10:34
  to innovate further than what we've done historically
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  in the Maryland model and adopt
• 10:39
  the all pair evolution of the ahead model.
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  For more than a decade, our state has
• 10:44
  demonstrated it is possible to control health care
• 10:47
  costs
• 10:47
  while improving quality and addressing population health outcomes.
• 10:52
  And that's a result that we feel as
• 10:54
  though many states and federal partners now view
• 10:56
  as a blueprint
• 10:57
  for national reform.
• 10:59
  The upcoming ahead model, I'll just quickly speak
• 11:01
  to that because a lot a lot of
• 11:03
  folks know about it, but our state is
• 11:05
  certainly embedded,
• 11:06
  in executing this successfully. The upcoming ahead model
• 11:10
  builds on the foundation of that Maryland model
• 11:12
  that I spoke to around total cost of
• 11:13
  care
• 11:14
  by providing and expanding the accountability beyond hospitals
• 11:18
  to total cost of care,
• 11:20
  quality, and equity across defined populations.
• 11:23
  It now makes even greater emphasis on prevention,
• 11:27
  care coordination,
• 11:28
  and appropriate utilization where that utilization
• 11:31
  is best
• 11:32
  served by the patient and the care providers.
• 11:34
  And finally, it holds systems accountable for those
• 11:37
  outcomes
• 11:38
  that extend far beyond simply the hospital walls.
• 11:41
  So really, Maryland is innovating. We realize ahead
• 11:44
  is a new frontier for us. It our
• 11:47
  Maryland model continues to evolve, and we think
• 11:50
  we serve as a potential,
• 11:52
  beacon for how we can shape health care
• 11:54
  delivery across our nation. So what's that mean
• 11:57
  for our our medical center?
• 11:59
  We're continuing to evolve how we deliver care.
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  In fact, it's an imperative.
• 12:03
  Tighter clinical integration,
• 12:05
  stronger partnerships across
• 12:07
  the continuum of care from the outpatient side
• 12:09
  to the inpatient side and then back to
• 12:11
  our outpatient community.
• 12:13
  We really need to double down on how
• 12:15
  we're thinking through patient flow.
• 12:17
  And lastly,
• 12:19
  we have we we have to have a
• 12:20
  disciplined approach
• 12:22
  to limiting
• 12:23
  care variation, so standardizing care models, clinical practice
• 12:27
  guidelines, putting those in place. I'm not gonna
• 12:29
  didn't make any it's it's the the financial
• 12:31
  pressures are real. Workforce fatigue continues.
• 12:34
  Rising acuity, as I mentioned, the medical center
• 12:36
  is the second highest acuity,
• 12:39
  medical center academic medical center in the nation.
• 12:41
  But so we have our challenges. I'm not
• 12:43
  gonna say that we don't, but the challenge
• 12:45
  is executing at a high level locally while
• 12:48
  helping shape a model that could inform health
• 12:50
  care delivered nationally.
• 12:52
  So we feel as though we're really at
• 12:54
  the the tip of the spear with regard
• 12:56
  to where health care is going and really
• 12:58
  take that
• 12:59
  responsibility on
• 13:01
  with great excitement.
• 13:03
  That's great to hear. And I think, you
• 13:04
  know, super exciting, around both initiatives. I think,
• 13:07
  as you mentioned, it's something that so many
• 13:09
  different
• 13:10
  hospitals, health systems, and and states have been
• 13:12
  trying to figure out how to do smartly
• 13:14
  and in the right way. And so,
• 13:16
  it's fascinating to hear a little bit more
• 13:18
  about how you're doing things in Maryland and,
• 13:21
  you know, the outcomes for for patient care.
• 13:23
  It seems like it's been really beneficial. So,
• 13:27
  you know, when you were making these transitions,
• 13:29
  what did you have to do or what
• 13:31
  did you learn about going from the traditional
• 13:33
  fee for service to to more of these
• 13:35
  types of payment models and ways of thinking
• 13:38
  about care
• 13:39
  episodes?
• 13:40
  Well, I yeah. Thanks for asking that question.
• 13:42
  I think that one of the things that,
• 13:44
  you know, Maryland we when when folks interview
• 13:46
  for positions here, we are one of the
• 13:48
  questions we always ask is, do you know
• 13:49
  Maryland's different? And we always you know, the
• 13:51
  our our so our physician colleagues are nursing
• 13:53
  someone will ask,
• 13:55
  wow. And I said, well, the Maryland model
• 13:56
  really governs how we think about delivering health
• 13:59
  care about better outcomes, higher quality, but also
• 14:02
  around how that's linked to cost,
• 14:05
  and, and and how that cost curve can
• 14:08
  be bent by better outcomes, greater access into
• 14:10
  the ambulatory
• 14:12
  sector so the patient who receive care in
• 14:14
  the inpatient sector are the folks who really
• 14:16
  need that care, but supporting health overall outside
• 14:19
  the four walls of our hospital is really
• 14:22
  a mind shift,
• 14:24
  change for folks who might be coming in
• 14:25
  here in a typical fee for service model.
• 14:28
  One thing I'll just highlight is the emphasis
• 14:30
  around how our physicians and our hospitals work
• 14:34
  together to achieve what we're talking about now
• 14:36
  is improved outcomes.
• 14:38
  So our hospitals across our state are capitated,
• 14:41
  so we have a global budget for our
• 14:42
  hospitals.
• 14:43
  Our physicians are still fee for service. So
• 14:46
  it really emphasizes the importance of the work
• 14:48
  that we all do for physician leaders inside
• 14:51
  our state to align how our practices and
• 14:54
  our our physicians
• 14:55
  think about delivering care inside
• 14:58
  our hospital infrastructure that is that it has
• 15:00
  a global budget, and then aligning not only
• 15:03
  care quality, operations,
• 15:05
  and system design
• 15:07
  with how we our practices
• 15:09
  are delivering care inside their walls, and and
• 15:12
  that synergy
• 15:13
  has to be thought about with every decision
• 15:16
  we make with implementing, you know, the models
• 15:18
  like we have with the Maryland model and
• 15:20
  the head model upcoming.
• 15:21
  So it to me, the model helps
• 15:25
  importantly
• 15:25
  recognize the partnership
• 15:27
  between providers and hospitals moving forward. That's been
• 15:30
  one of the anchors that I found in
• 15:32
  this job that that is really essential
• 15:35
  to moving health care forward.
• 15:37
  That's helpful to understand. I mean, you know,
• 15:39
  really, really interesting context to think about how
• 15:42
  Maryland is doing things differently and and what
• 15:44
  it means for the patients. Now when you
• 15:46
  look at the next year too, what do
• 15:47
  you think the hardest thing that you'll have
• 15:48
  to do will be?
• 15:50
  Yeah. Well, I just mentioned we have got
• 15:52
  a lot of we got a lot of
• 15:53
  changes in health care coming, and I think
• 15:54
  health care one of the only thing I
• 15:56
  one of the things I quite often say
• 15:58
  is the only constant thing in health care
• 15:59
  is change.
• 16:01
  And that's where we're so this year upcoming,
• 16:03
  I think the hardest challenge will be continue
• 16:04
  to innovate at a time when everyone in
• 16:06
  health care is carrying some degree of fatigue.
• 16:09
  You know, the need to evolve, as I
• 16:10
  just spoke to clinically, operationally,
• 16:13
  technologically is unavoidable. It's
• 16:15
  all driven by the access pressures, workforce constraints,
• 16:19
  and new accounting but new accountability models just
• 16:21
  like ahead. But at the same time, we
• 16:23
  must be delivered about how we introduce change
• 16:27
  and how it's paced,
• 16:29
  And that balance is so critical.
• 16:31
  Our team members are our most vital strength,
• 16:34
  and sustained performance depends upon their well-being.
• 16:38
  The work ahead requires prioritization
• 16:41
  that truly matters, eliminating low value work,
• 16:44
  and ensuring that innovation makes care better
• 16:48
  and work more sustainable,
• 16:50
  not harder.
• 16:52
  Leading through that tension with clarity and empathy
• 16:55
  will be one of the most important responsibilities
• 16:57
  this upcoming year, Laura. So balancing
• 17:00
  innovation
• 17:01
  with assuring that we have workforce support and
• 17:04
  wellness
• 17:05
  is one of our one of the gauntlets
• 17:07
  that we make sure we carry is the
• 17:08
  medical center leadership team moving forward.
• 17:12
  That makes a lot of sense. You know,
• 17:13
  it is really a helpful foundation to think
• 17:16
  about,
• 17:17
  preparing your teams for any types of uncertainties
• 17:19
  or new things that
• 17:21
  come your way. So
• 17:23
  that's really, really helpful to to see. Now
• 17:25
  when you think about growth as well, where
• 17:27
  do you see some of the best opportunities
• 17:29
  for the health system in the next year
• 17:30
  or so to continue growing?
• 17:33
  Yeah. I think
• 17:34
  my perspective maybe I'll triangulate some of the
• 17:37
  things we've kinda talked about to previously in
• 17:39
  the conversation to for for for for this
• 17:41
  question. I think one of the strongest opportunities
• 17:44
  lies at that intersection of
• 17:46
  workforce sustainability,
• 17:48
  implementation of the AHEAD model,
• 17:50
  and an a concept around automation.
• 17:53
  You know, AHEAD is gonna require us to
• 17:55
  think about total cost of care, not only
• 17:57
  inside the hospital, but outside the hospital,
• 18:00
  assuring highest quality and ensuring we address a
• 18:03
  degree of workforce support to do that work
• 18:06
  moving forward and implement so we're able to
• 18:08
  have a successful implementation.
• 18:10
  Key to this will be,
• 18:12
  how we think about where the right work
• 18:14
  is done by the right person at the
• 18:16
  right time.
• 18:17
  Automation and responsible use of AI could allow
• 18:20
  us to redesign care so clinicians and staff
• 18:22
  can operate at the top of their skill
• 18:24
  set. I don't think we think we we
• 18:26
  are embracing that entirely as health care delivers
• 18:30
  care right now. You know, for patients, this
• 18:32
  means improved and easier access,
• 18:34
  smarter triage, navigation across our care continuum,
• 18:38
  and multimodal
• 18:39
  forms of communication.
• 18:41
  For care teams, it means decision support for
• 18:43
  triage,
• 18:44
  diagnosis,
• 18:45
  and management planning along with automation of low
• 18:48
  value administrative work that can that contributes to
• 18:52
  our staff's burnout.
• 18:54
  I think our efforts will directly support workforce
• 18:56
  retention if we're able to implement the things
• 18:58
  I'm speaking to, Because when team members spend
• 19:01
  more time delivering care and less time battling
• 19:04
  administrative systems, our engagement rises,
• 19:08
  turnover drops,
• 19:09
  and folks are just happier coming to work.
• 19:12
  And as we adopt the AHEAD model, triangulating
• 19:14
  that with the AHEAD model moving forward,
• 19:16
  changes like this in
• 19:18
  in concert will be essential to maintaining a
• 19:21
  stable and supported workforce, which is to me
• 19:23
  fundamental
• 19:24
  to our imperative for high quality care
• 19:27
  and our provider and staff wellness.
• 19:31
  Absolutely.
• 19:32
  Well, fantastic.
• 19:33
  I I think thank you so much, doctor
• 19:35
  Norcosi, for joining the podcast today. I really
• 19:38
  appreciate your time and effort, and I look
• 19:40
  forward to seeing you at our annual meeting
• 19:41
  in April. I know you'll be speaking at
• 19:43
  the event, and so,
• 19:44
  this will be a great opportunity for us
• 19:46
  to share and continue to learn more about
• 19:48
  everything that's going on in Maryland.
• 19:50
  Laura, appreciate you. Happy Wednesday. I look forward
• 19:52
  to seeing you at the conference.