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This is Laura Dirda with the Becker's Healthcare

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podcast. I'm thrilled today to be joined by

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doctor James Matera,

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senior vice president of medical affairs and chief

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medical officer at Central State Medical Center in

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New Jersey. Doctor Matera, it's a pleasure to

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have you on the podcast today. Thank you.

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It's my, pleasure to be here.

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Absolutely. Well, I'm excited for our conversation because

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I know we'll go through some of the

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cool things that you've been doing, over the

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last year or so and then how you're

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thinking about the future as well. But before

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we dive in, could you tell us a

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little bit more about Central

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State Medical Center and what makes it unique?

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Sure. Central State has been, for years, an

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independent hospital right in the heart of Central

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Jersey in, Freehold, New Jersey. And as the

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landscape has changed over time, and I've been

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on staff there thirty two years,

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we've realized that we couldn't remain isolated. So

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we began a unique co membership alignment with

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a larger New Jersey health care system,

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Atlantic Health.

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That's located primarily up in the Morristown area.

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That's a a legacy system of five hospitals,

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and Central State as a co member is

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the sixth hospital. And I think that really

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opens up our ability

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to survive

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down where we are, but yet keep our

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community hospital

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mentality as well as our

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personality, which I think is very important. I

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I think,

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as a 285

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bed acute care hospital,

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serving multiple counties right in the middle of

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the state, it's an essential role for us

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to remain here.

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Absolutely. And, you know, such an important population

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that you're serving, within the state of New

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Jersey. So I I'm curious,

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looking back on the last year or so,

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what's the accomplishment

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or initiative that you're most proud of?

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So one one of the things was being

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a unique,

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independent hospital, we have a large independent medical

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staff.

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And with that comes a lot of variability,

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when you have multiple docs doing things, sometimes

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variability is there. And I truly believe

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that variation,

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and variability in medicine is the archenemy of

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quality.

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So one of the things that we were

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able to do is to real roll out

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a full hospitalist system, which we never had

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before.

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We had,

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some hospitalist groups that were independent,

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that were taking some patients,

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but we really rolled that out. And we

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started in June of twenty twenty four where

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they cover all of our

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non assigned admissions and also cover a lot

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of our community doctors.

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And what we've seen is a decrease in

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our length of stay by almost a half

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a day,

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and, again, a reduction in that variability

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where we're seeing things,

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play out a little better

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so that people are treating things likewise. And

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that's all focused exactly

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around the, evidence based medicine

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and the need to, strictly adhere to guidelines

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to help drive quality and care. That's so

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important.

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Absolutely. I I know that is a huge

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transition to make to be able to standardize

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things a bit more and,

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seeing those results as you mentioned of the

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decreased length of stay as well as, better

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outcomes

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is really truly amazing. I'm curious, digging into

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that process of bringing the groups together and

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creating

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some of the standards, reducing that variability. What

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was that like? How did you set things

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up, to for productive conversations and then moving

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forward with the right policies in place, to

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implement some of these evidence based practices?

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Yeah. That's a great question. And it comes

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to, we were able to,

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undertake EPIC as our EMR,

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when we did our affiliation with Atlantic. And

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EPIC has a wealth of,

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good and bad things, but one of the

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things is the reporting that's available in Epic

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really opened my eyes to what was going

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on on a a variability level. So when

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we looked at things, we were able to

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really drill down. I'll give you an example.

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We noticed that our hip fractures, our acute

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hip fractures that were coming in, if they

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were admitted to a hospitalist group, their length

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of stay was

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significantly

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lower than if they were admitted to a

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community doctor.

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So what you have to do is you

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have to find the correct data, make sure

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that it's actionable,

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and then you look at that and say,

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well, in the interest of patient care, in

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the interest of quality and patient experience,

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it makes sense to move these things. So

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you start with the conversations,

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and people will start to buy in on

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that when you can prove it with data

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showing that there is improved outcomes. And that's

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what we all want, ultimately.

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You know, every doctor wants to be the

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best doctor that they can be. And, sometimes

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as things change and are you know, we're

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being pulled in different directions as clinicians,

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you know, the workload, of course, physician burnout,

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all of these things play a role. And

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if we're not careful, it can affect quality.

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So I think that's really a good starting

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point. And then you have to look at

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those evidence based protocols

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to ensure that you have buy in. And

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if not, or you think there's something

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that should be done otherwise, well, that's when

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you look at those and,

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start to tweak them as much as possible.

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But all it takes is buy in from

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the physicians.

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Do it, or practitioners.

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Do it with their in mind. Have them

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drive the process.

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Administrators

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like myself, I think we have a

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a advantage,

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particularly

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in the clinical setting where I can speak

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the same language. I could do the operational

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language, and I could do the clinician language.

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That is such a a strong characteristics to

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have to kinda bridge the gap between both

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and, make a difference both on the clinical

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side as well as the operational and administrative

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side. Now looking ahead, where do you see

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some of the biggest growth opportunities for the

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next twelve months or so?

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Yeah. For us, it's gonna be about service

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line building. We have also, done a lot

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of things. For instance, within the last two

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years, we became a full service cardiac cath

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lab, and we've recruited some top notch surgical

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oncologists into my program,

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to help supplement

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an already strong,

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medical oncology base. And we know that people

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wanna get their cancer care locally. And where

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we are in Central Jersey, I'm equidistant from

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New York City and Philadelphia,

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both mega centers, that are available.

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But if we have a strong program, I

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think we can get people to stay within

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their own communities.

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And you have to drive that again

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by,

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proving that you're up to the task and

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able to provide those outcomes.

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So that's that. We also have to have

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gone away of bolstering our OBGYN programs.

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We're trying to expand it to neurosciences.

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I'll be instituting a telestroke program.

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Some things that a lot of other facilities

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have already gone to,

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we're looking to do. And as we do

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that, we're gonna try to look at I

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I truly believe that when you look at

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it, especially community medical center, you don't wanna

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do everything. You wanna do what's best suited

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for your community.

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And I always ask myself a very simple

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question if I'm looking at a service line.

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The first question is, do I think we

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need

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this service line at central state?

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And I gotta be honest, sometimes the answer

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for me is no. We probably don't. But

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then I ask the more important question, does

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my community need it? And then I may

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come up with a different answer and say,

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you know what? Our community really does need

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this.

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One of the one of the things that

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I'll bring to light is, you know, in

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New Jersey, I I was very proud to

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be asked by first lady Tammy Murphy,

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to sit on a panel a couple of

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weeks ago, a roundtable,

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discussing maternal and fetal mortality in New Jersey,

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which, has a lot to be desired.

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And when we look at that, in my

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particular community, we have the borough of Freehold,

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which is a large indigent population,

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and we see a lot of, maternity cases

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there that come in without the proper prenatal

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care.

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We have to be advocates for our community

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to be able to provide these things, and

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it goes well beyond just being able to

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do the medicine. It has to do with

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the social determinants of health. Do you have

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access to care?

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We used to have our clinic on our

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site, which is a little bit away from

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the borough, about two miles,

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and transportation

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wasn't very good for patients to get there.

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Couple of years ago, we went and we

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put the clinic right in the middle of

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the Borough. So now

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the care at our FQHC in center

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of of Freehold

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has allowed that access to care.

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We also have the benefit of being in

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a very large farm area. So why not

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get farmers to donate good food? And at

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at the FQHC

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during the summer, we have food markets where

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you can come and pick up foods. We'll

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show you how to eat better. You know,

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diabetics,

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more fruits and vegetables.

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All these things are so important, and I

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think that's where we have to grow. Service

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line,

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according to community needs.

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That makes a lot of sense. And, you

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know, I really appreciate you digging into some

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of the specific examples of where the service

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lines are growing, why it's so important, and

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how you're will be able to better serve

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the community once you have those resources available.

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And now I'm curious, lots of opportunities for

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growth, development, and, continuing to expand access to

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care, but what are the challenges that you're

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anticipating as you go across this journey? Uh-huh.

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Challenges. Yes. So we always have challenges.

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I really think the challenges in medicine

275
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boil down to four buckets at this point

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in time. I've already spoken about variability in

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care. We have to get that under a

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little bit better control. Use our evidence based

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guidelines,

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hit our frontline to be able to do

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that so that we can say that we're

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effectively

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changing

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the way we provide care. Look at your

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metrics and your key performance indicators.

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And if people aren't up to that task,

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develop a a performance improvement plan to get

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them up to that task or rely on

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people who you know can meet that. I

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think that's number one. Number two is artificial

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intelligence, which to me is a double edged

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sword. We all know that it's in our

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daily lives. Who doesn't know that their phone

294
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is listening to them?

295
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But AI is also gonna be a huge

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factor in medicine, and we have to make

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sure that we have some some guardrails around

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it.

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You know, not everything that goes in comes

300
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out, and there's been some studies are in

301
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what are called

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AI biases or AI cancers

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where

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wrong information comes out, and you have to

305
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be careful to to know what to discern

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and what's good with AI. But just think

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about ambient voice technology in the office now.

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There are some studies that have shown that

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it does improve,

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clinician satisfaction.

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So I think that that's a big boom.

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I think, although we use the term burnout,

313
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I think a better term that we see

314
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among physicians is disengagement.

315
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I think most physicians, most clinicians, most practitioners

316
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get burned out on on a regular basis,

317
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but we recharge our batteries and we go

318
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back at it. Disengagement,

319
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I think, is a little bit deeper.

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That's when you're disengaging from your mission as

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a physician or your mission as a healthcare

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center,

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and I think that that exceeds past burnout,

324
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and that's something we really have to look

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at. We have to be better at keeping

326
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our clinicians

327
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and our administrators and our hospitals

328
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going along with the same thought the with

329
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the same thoughts. You know, we all take

330
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an oath to first do no harm. We

331
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may have to transcend

332
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what we normally look as traditional models. We

333
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have to develop our physician leaders to be

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sensitive to that.

335
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And, any way we can make our docs

336
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and practitioners more efficient, I think, is a

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is a win win for everybody.

338
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And then the fourth is around the finances.

339
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There's so many different physician models out there

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now, whether it be employment models, which continue

341
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to go up. The the the guy hanging

342
00:12:34,480 --> 00:12:35,379
out his shingle,

343
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or the girl hanging out their shingle right

344
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now is is less,

345
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popular and certainly not as lucrative

346
00:12:41,904 --> 00:12:43,845
or as rampant as it used to be.

347
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And you've got the entry of private equity

348
00:12:46,464 --> 00:12:47,605
firms into medicine.

349
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All of these things bring a new

350
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slant

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towards how medicine is practiced, and it has

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effects on things like call coverage. It has

353
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effect on the availability

354
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of specialists in your hospital. I know right

355
00:13:00,950 --> 00:13:02,889
now, I struggle with ophthalmology.

356
00:13:03,830 --> 00:13:06,514
We can't get ophthalmologists to come in. We

357
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have to be ready for all these things,

358
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and we have to charge at them head

359
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on to make sure that we don't interrupt

360
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patient care.

361
00:13:16,514 --> 00:13:18,115
That's a really good point. You know, a

362
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lot as you mentioned to think about and

363
00:13:19,875 --> 00:13:22,730
consider as you're transforming health care and understand,

364
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you know, the clinical workforce,

365
00:13:25,350 --> 00:13:27,509
and then the technology too. And talking about

366
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AI, I know this is a huge topic

367
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of conversation for so many health care leaders.

368
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And so I appreciate your perspective here, again,

369
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from both the clinical side as well as

370
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the operational and administrative, because I I think

371
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having

372
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the the ability to see across both and

373
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then,

374
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bridge together the needs, really,

375
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is crucial in in developing

376
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the transformation that, you know, I know you

377
00:13:50,919 --> 00:13:53,559
are looking at throughout the hospital. Yeah. It

378
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really is.

379
00:13:54,759 --> 00:13:55,660
Yeah. Absolutely.

380
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Before we wrap up here, I'm wondering, what

381
00:13:58,919 --> 00:14:00,759
is the number one thing that you're doing

382
00:14:00,759 --> 00:14:03,535
right now to set a central state up

383
00:14:03,535 --> 00:14:05,154
for success in the future?

384
00:14:05,535 --> 00:14:06,975
Well, I think I have to practice what

385
00:14:06,975 --> 00:14:09,215
I preach here. And, one of the things

386
00:14:09,215 --> 00:14:10,735
that I've done is I'm getting more,

387
00:14:11,215 --> 00:14:14,014
involvement. We just embarked, and today, I had

388
00:14:14,014 --> 00:14:15,794
my last kickoff meeting,

389
00:14:16,440 --> 00:14:19,019
on what I'm calling nurse physician dyads.

390
00:14:19,399 --> 00:14:22,440
So our medical directors, our department chairs are

391
00:14:22,440 --> 00:14:24,779
all gonna be, in a dyad model

392
00:14:25,240 --> 00:14:26,860
with me as an administrator

393
00:14:27,240 --> 00:14:28,460
kinda being the overlooks,

394
00:14:28,920 --> 00:14:29,580
of everything.

395
00:14:30,105 --> 00:14:32,904
But I'm setting them up to, move their

396
00:14:32,904 --> 00:14:34,605
service lines or their departments

397
00:14:35,225 --> 00:14:36,524
into a better direction.

398
00:14:36,825 --> 00:14:39,544
And that's all focused about improving quality and

399
00:14:39,544 --> 00:14:40,924
improving patient experience.

400
00:14:41,464 --> 00:14:43,784
So what we do is the clinicians may

401
00:14:43,784 --> 00:14:44,284
often

402
00:14:44,730 --> 00:14:46,649
they may know the clinical ins and outs

403
00:14:46,649 --> 00:14:49,769
of something, but they're not very good sometimes

404
00:14:49,769 --> 00:14:52,009
on the operational side. What is it how

405
00:14:52,009 --> 00:14:53,709
do you form a budget for this?

406
00:14:54,009 --> 00:14:56,330
What about service line, or,

407
00:14:56,730 --> 00:14:58,110
supply chain issues?

408
00:14:58,455 --> 00:15:00,055
How do we do this, and how do

409
00:15:00,055 --> 00:15:01,035
we monitor

410
00:15:01,495 --> 00:15:03,434
whether we're doing the right thing or not?

411
00:15:04,134 --> 00:15:07,014
So I've, now empowered them to join together

412
00:15:07,014 --> 00:15:08,955
with a a nurse or administrator

413
00:15:09,975 --> 00:15:12,934
or a clinical lead an operational leader to

414
00:15:12,934 --> 00:15:15,039
form these dyads. And each one is gonna

415
00:15:15,039 --> 00:15:16,740
come up with two to three key performance

416
00:15:16,799 --> 00:15:18,820
metrics that have to be actionable.

417
00:15:19,600 --> 00:15:21,220
They have to be able to pivot,

418
00:15:21,679 --> 00:15:23,600
on you know, for anything that might be

419
00:15:23,600 --> 00:15:26,000
there and really come down to I want

420
00:15:26,000 --> 00:15:28,684
them to perform a a SWOT analysis. What

421
00:15:28,684 --> 00:15:30,445
are the strengths of this program, the service

422
00:15:30,445 --> 00:15:31,584
line? What are the weaknesses?

423
00:15:31,964 --> 00:15:33,985
What are our opportunities? What are our threats?

424
00:15:34,284 --> 00:15:35,904
So we can be better planned

425
00:15:36,284 --> 00:15:37,264
for the future.

426
00:15:37,565 --> 00:15:39,324
I think that really takes us into the

427
00:15:39,324 --> 00:15:41,899
next level because it helps us to identify

428
00:15:42,040 --> 00:15:44,919
future operational and clinical leaders. You know, the

429
00:15:44,919 --> 00:15:46,460
old saying in medicine,

430
00:15:47,080 --> 00:15:48,919
is that you became the chair of the

431
00:15:48,919 --> 00:15:51,660
department of medicine because you missed the meeting.

432
00:15:52,120 --> 00:15:53,799
You're in the wrong place at the right

433
00:15:53,799 --> 00:15:55,240
time or the right place at the wrong

434
00:15:55,240 --> 00:15:57,684
time, and you became elected. We gotta do

435
00:15:57,684 --> 00:15:59,365
better at that, and we have to train

436
00:15:59,365 --> 00:16:01,605
our leaders to carry the torch forward for

437
00:16:01,605 --> 00:16:02,105
us.

438
00:16:03,924 --> 00:16:06,084
Alright. That's such an excellent point. And, you

439
00:16:06,084 --> 00:16:08,004
know, really cool that you're able to restructure

440
00:16:08,004 --> 00:16:09,924
in this way where you're creating that dyad

441
00:16:09,924 --> 00:16:13,100
model for the broader organization pairing the clinical

442
00:16:13,100 --> 00:16:14,559
and and operational leaders.

443
00:16:15,019 --> 00:16:17,339
In creating that type of bond and,

444
00:16:17,899 --> 00:16:20,079
you know, looking at that structure and restructuring

445
00:16:20,139 --> 00:16:21,179
things here and there,

446
00:16:21,740 --> 00:16:23,419
what has, you know, worked well as you're

447
00:16:23,419 --> 00:16:25,664
starting to launch this? Is there anything that,

448
00:16:25,904 --> 00:16:27,524
you've learned throughout this process?

449
00:16:28,304 --> 00:16:30,784
Yeah. I learned that, the people really wanna

450
00:16:30,784 --> 00:16:31,345
do this.

451
00:16:31,904 --> 00:16:32,884
You know, oftentimes,

452
00:16:33,345 --> 00:16:36,004
the two, the clinical and the operational work

453
00:16:36,225 --> 00:16:37,764
out of sync with each other.

454
00:16:38,649 --> 00:16:41,529
You know, sometimes someone will bring up, oh,

455
00:16:41,529 --> 00:16:43,149
I want the next best widget,

456
00:16:43,690 --> 00:16:46,009
to be able to do something. And, well,

457
00:16:46,009 --> 00:16:47,769
there's a lot that goes behind whether or

458
00:16:47,769 --> 00:16:50,190
not, you know, that widget should be employed.

459
00:16:50,754 --> 00:16:53,235
So I think when we blend those two

460
00:16:53,235 --> 00:16:55,314
and we get a better understanding of what

461
00:16:55,314 --> 00:16:58,034
everybody wants, I think you complete that. And

462
00:16:58,034 --> 00:17:00,034
then you add the administrative, though, or the

463
00:17:00,034 --> 00:17:00,774
c suite,

464
00:17:01,235 --> 00:17:02,375
component of that

465
00:17:03,059 --> 00:17:05,240
truly forming a triad model, actually,

466
00:17:05,779 --> 00:17:07,000
that's what you'll do.

467
00:17:07,380 --> 00:17:07,700
And,

468
00:17:08,180 --> 00:17:09,859
I think I'm gonna act as that for

469
00:17:09,859 --> 00:17:11,460
now, but as we get a little bit

470
00:17:11,460 --> 00:17:13,299
more robust in this and a little bit

471
00:17:13,299 --> 00:17:14,039
more seasoned,

472
00:17:14,660 --> 00:17:17,140
I think other c suite members will, be

473
00:17:17,140 --> 00:17:20,224
involved. And then you have the synergy from

474
00:17:20,224 --> 00:17:21,204
top down,

475
00:17:21,505 --> 00:17:23,105
and that's what we need in a health

476
00:17:23,105 --> 00:17:25,505
care facility or a health care system to

477
00:17:25,505 --> 00:17:27,265
be able to do that. They have to

478
00:17:27,265 --> 00:17:29,105
know out on the floors that I'm there.

479
00:17:29,105 --> 00:17:31,184
I'm I'm there for them. I got their

480
00:17:31,184 --> 00:17:31,684
back,

481
00:17:32,170 --> 00:17:32,910
high reliability,

482
00:17:33,369 --> 00:17:35,049
all of that, and it has to be

483
00:17:35,049 --> 00:17:36,730
shown from the top down. We gotta walk

484
00:17:36,730 --> 00:17:39,309
the walk because we can talk the talk.

485
00:17:41,769 --> 00:17:44,089
Fascinating. Well, doctor Montero, thank you so much

486
00:17:44,089 --> 00:17:45,644
for joining us on the podcast podcast today.

487
00:17:45,644 --> 00:17:48,365
This has been a really inspiring conversation. I

488
00:17:48,365 --> 00:17:50,285
love the passion for what you're doing, and,

489
00:17:50,285 --> 00:17:51,265
you know, it really,

490
00:17:51,725 --> 00:17:53,805
comes through how transformation can make a big

491
00:17:53,805 --> 00:17:56,445
difference, overall. So thank you for your time,

492
00:17:56,445 --> 00:17:57,884
and I look forward to connecting with you

493
00:17:57,884 --> 00:18:00,065
again soon. Thank you. It's been my pleasure.