Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Ralph Yates, Chief Medical Officer at Salem Health Hospitals and Clinics

Transcript

Dr. Ralph Yates, Chief Medical Officer at Salem Health Hospitals and Clinics · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Dr. Ralph Yates,
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  chief Medical Officer at Salem Health Hospitals and Clinics.
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  Dr. Yates, it's a pleasure to have you on the podcast today.
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  - My pleasure as well. Thank you.
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  - Now, I know we've got a lot to talk about,
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  and I'm looking forward to catching up with you, uh, um, on
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  what you're doing at Salem Health Hospitals and clinics.
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  But before we dive into my questions,
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  can you tell us a little bit more
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  about yourself and your background?
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  - Certainly. I'm a family doc by training
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  and board certification,
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  and I still practice one day a week.
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  I've been, I've been doing this for 44 years,
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  and I oversee a medical staff of just under a thousand
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  physicians and advanced practitioners.
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  Our health system, our largest hospital, we have two,
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  our largest hospital is 644 beds,
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  and we are the major sole provider for veterinary
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  five, 500,000 patients in mid
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  Willamette Valley here in Oregon.
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  - Well, that's great to hear.
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  And you know, I'm wondering if we could start off with,
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  could you tell me about, um, one change
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  that you've made in the last year
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  or so that's really yielded some great results?
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  Yes,
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  - We happy to.
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  We, we are,
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  I believe it's 13 years into our lean experience.
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  We are seriously dedicated
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  lean hospital system and,
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  and we have been, we pivoted over a year ago to
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  recovery, which includes financial recovery coming out of,
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  of Covid, and one part of that work
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  that has directly involved medical staff and medical group.
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  Our medical group is right around 300 individuals
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  and includes our adult ISTs team,
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  which is six five physicians and advanced practitioners.
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  The major piece of work that has taken place over the,
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  the last year has been length of stay work,
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  and the team's been
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  successful in bringing it down almost one
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  and a half days from the about 6.4, 6.5 days
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  that where it stood at the time
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  they started doing their work.
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  That work is continuing, it's ongoing,
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  and we expect the continued improvement.
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  A lot of this now for us involves patients
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  and all health systems are dealing with this that are
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  just have long stays by
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  their condition and in their situations, sometimes social.
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  So we're working on that in, in our usual method
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  of approaching problems from a, a lean standpoint.
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  And I would would just add that the big takeaway that
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  we've discovered in,
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  and I've been in active conversation with friends
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  and other systems who are doing the same thing,
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  is it fundamentally, this comes down to a cultural piece as
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  so many things do, and we had to understand that
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  and then address that in terms of how we do our work,
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  how the hospitalists round, how they communicate
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  with the nursing staff and, and discharge planners
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  and how this coordination takes place.
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  It was fundamentally a, a cultural shift that had in place.
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  - Well, that's fascinating to hear about
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  and you know, certainly awesome results in, in, um, dropping
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  that length of stay by 1.5 days.
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  You know, uh, a ton of credit to you
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  and your team for achieving that,
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  because I know it's not easy.
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  And when you think about, as you were mentioning something
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  like a cultural change, I, I know, um,
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  that certainly doesn't, you know, doesn't always,
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  um, come smoothly or naturally.
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  So, you know, when you're approaching, um, having to make
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  that kind of shift or make a change in the culture,
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  what's important to do
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  or what groundwork as a leader do you need to lay, um,
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  to make sure that, you know, uh, everyone else, uh, is able
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  to buy in and really achieve, um, what you're set out to do?
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  - Well, well, culture drives everything.
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  We, we all say that, but it really does.
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  And crux of, of most cultural problems
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  are, are communication
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  and how, how people conduct their work, either individually
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  or collectively in terms of solving problems.
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  The most difficult problems are almost
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  always people problems.
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  And, and they are
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  what Ron correctly identified no long ago at
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  Harvard Adaptive problems.
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  And they require adaptive.
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  And an adaptive solution, by definition is one where a team
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  of of committed, dedicated individuals sit down
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  and solve the problem collectively.
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  That's how you do it,
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  and frankly, how you address the cultural piece
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  because by definition, teams will bring others with them.
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  That's not one person, someone like me saying,
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  here's what you're gonna do.
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  Rarely does that work, if it does
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  or work well, if it does, it's not gonna work as well as
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  what, what a team working together will solve.
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  - That makes a lot of sense, you know,
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  and it is really inspiring to hear.
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  Now, broadening out just a bit, what are some
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  of the top trends that you're following in the
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  healthcare space right now?
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  What is really top of mind for you and,
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  and what are you trying to solve for right now?
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  Um, you know, within your strategic changes,
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  - What, what's going on right now is,
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  is rapid change, right?
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  I mean, we all see it, it, it gets changed in terms of
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  turnover of personnel and our need to retain
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  these great people that we work with.
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  My, my emphasis is, is really on retention
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  and in particular supporting the medical staff.
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  Every way I can ensure that these individuals with
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  so much wisdom and experience, they in this business
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  and, and don't decide to do something else.
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  I would say the top of the list for me
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  is, is retention.
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  I would just add, we've seen a dramatic
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  turnover in in our nursing staff,
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  and I know we're not alone.
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  Everyone else is experiencing the same thing.
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  And it, it is been quite dramatic.
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  We came out of finished and came out of Covid.
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  My daily emphasis, my
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  North star for me is to ensure
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  that we don't see the same thing with the medical staff.
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  So far we haven't, but it's a work in progress
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  as we come out of covid
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  and everyone is looking at this new world that we're in
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  with 100% hospital census eds
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  with patients backed up care that's been delayed
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  is all, this is the new normal for all of us.
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  And, and how we adapt to that
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  and how we support one another, getting
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  through it is really gonna define where we end up.
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  - I, I think that makes a lot of sense
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  and certainly, you know, hearing from
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  so many executives across the healthcare space
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  and speaking to, you know, trying to have the, those results
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  with the retention in combating the nurse turnover as well
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  as, um, just building within the teams, the culture
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  that you described earlier in our conversation of
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  how people can do things together
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  with each other and for each other.
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  So, um, you know, I I think it's definitely a hard piece
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  of the puzzle right now in healthcare to solve,
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  but, um, you know, it, it, it's great to hear
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  that you're focused on that
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  and it sounds like, um, you know, have really, um,
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  started on the journey at the very least to, to kind of, um,
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  get into a space where you're able
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  to solve some of those issues.
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  - Well, we are, and,
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  and I believe fundamentally people need to know that
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  they're appreciated as professionals, as as individuals,
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  that we respect them, we appreciate them,
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  and we will do everything we can support them
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  professionally and personally.
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  - Absolutely. Know that you're spot on and,
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  and I, I really, um, think that's so, so important as well.
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  Now, you know, looking ahead into the future,
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  how are you thinking about growth
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  and development, um, over the next two to three years or so?
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  - Well, we're seeing the same thing everyone else has seen,
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  I believe, and there's really been a dramatic shift
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  independent practice to other, other forms of,
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  of employment in, in particular, uh,
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  hostile based employment of previously independent groups.
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  And we're aware of this.
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  We we're doing what we can
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  to support in independent practices in, in our area
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  that we have such close relationships with,
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  but the landscapes really changing dramatically,
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  and it is a, obviously it's a reflection of
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  the new math that's out there regarding reimbursement
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  and the percentage of your patients that are
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  commercial versus Medicare Medicaid.
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  I think that's, for me is, is one of the biggest changes.
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  That's,
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  - That makes a lot of sense.
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  Um, you know, in in, in seeing the evolution
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  and seeing that shift, I know as you mentioned, trying
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  to support the independent physicians whenever possible.
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  But as time goes on, um, and,
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  and you see that that kind of shift in how physicians are,
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  um, you know, private practice to employed in other types
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  of situations, um, what does that mean, do you think,
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  for healthcare and healthcare delivery overall? Well,
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  - One is we, we, we need to stay in touch with it
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  and, and ensure ahead of what's going on
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  and anticipating the changes that take place.
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  I I saw a statistic recently that 75%
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  of physicians are now employed.
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  I came from, I've been at Salem for 10 years
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  and I, I came from a multispecialty independent
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  multispecialty group up in Portland, Portland Clinic
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  that the math involved with operating
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  these complex clinics
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  has just become more and more difficult.
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  I think from the standpoint of hospitals
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  and hospital systems, it means that we have a lot of
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  evolution to do regarding
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  what the employment model looks like and,
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  and things, for example, like the medical staff model been
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  around forever, how do those two models,
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  how do they, how do they relate to one another?
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  How do they work with one another?
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  And this is an evolutionary process, one that we're going
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  through right now, particularly as our medical group
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  continues to increase in size as it is with,
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  with others around the country.
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  - Fantastic. Well, Dr. Yates, thank you so much
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  for joining us on the podcast today.
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  I really appreciate your perspective, perspective.
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  Um, you raised some excellent points here as well
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  as you know, I appreciate you sharing some of the things
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  that you're doing at CM Health Hospitals and clinics.
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  Um, thank you for your time today
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  and I look forward to connecting with you again soon.
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  - It's been a pleasure. Thank you.