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This is Laura Dear with the Becker's Healthcare podcast.
I'm thrilled today to be joined by Dr. Tyler Hill,
chief Medical Officer at Sierra Nevada Memorial Hospital. Dr. Hill,
it's a pleasure to have you on the podcast today.
Hey, good morning, and thank you for having me.
Now, I'm really looking forward to our discussion.
I know there's so much happening in healthcare and I'm really excited to learn,
you know,
what you're doing at Sierra Nevada Memorial Hospital and how you're working with
the community. But before we dive into my questions,
can you tell me a little bit more about yourself and your background?
Yeah, so, um, as you mentioned, I'm the,
the C M O currently in a hospital in northern California.
I'm an ed physician, emergency medicine physician in training,
and I work a few shifts a month,
about three to four shifts a month in our emergency department here.
I went to medical school in Missouri and then did my residency in emergency
medicine in Ohio and stayed in that area for about 10 years.
Uh,
was a medical director over several emergency departments and urgent cares and,
and even a telemedicine platform,
and then was also a physician executive over medical specialties
while I was there in Ohio.
And then last year I became the,
the C M O out here in California.
So loving what I get to do each and every day. And, um,
looking forward to chatting a little bit more about our, um,
our priorities and what's going on here at Sierra Nevada.
Absolutely. And what was that transition like going from Ohio to, uh,
California?
Uh, so, you know, Northern California is,
is unique in and of itself. Definitely nothing like Southern California,
uh, in regards to the, the weather, the culture, the pace,
things along those lines.
So where we were in southeastern Ohio and,
and West Virginia area, not all that different. So it wasn't complete,
uh, shock coming out here. Um, so overall it was a, uh,
it was an easy transition for the family and me and everyone here at the
hospital has treated me so well and hit the ground running is really what it
felt like picked up from one busy system came out here and, and literally,
uh, set the wheels in motion and took off and haven't looked back. So it's been.
That's amazing to hear. And you know,
I I think it's awesome that you were able to fit right into the hospital and,
and, and then as you mentioned,
just kind of get the wheels in motion and get going.
So when you look at where you're at today,
what are some of your top priorities whatcha spending most of your time on?
So for any Chief Medical Officer,
I feel it always starts and should start with quality and safety.
I have a very strong quality and safety team, um,
several members that comprise that, uh, team that I,
that I get to partner with to, um, champion certain,
certain aspects of, um, of projects and improvement opportunities. Um,
one of our, one of our newest, uh,
goals here at the hospital and in common spirit as a whole
is, um, heart failure mortality. You know,
a lot of evidence-based practices have emerged over the last five
years with the most recent heart failure kind of priorities changing last
year in 2022 or being updated in 2022.
So we've put together a committee specifically focusing on heart failure,
uh, treatment, the evidence-based guidelines, and really focusing on, on that,
uh, that goal of heart failure mortality. So that's, um, that's been one of the,
the biggest priorities here over the last few months.
And that's engaged all aspects of our,
of our hospital team and even focusing on the outpatient realm too. So,
you know, looking at our cardiology partners, our hospitalist partners,
our emergency medicine partners, palliative care, ensuring we, um,
we can meet the needs of our patients from the palliative care standpoint, um,
care coordination, nursing. So it really has taken the entire team,
uh, to focus on, on that goal. And, you know, sepsis is no different.
Um, that's another one of our big goals. And, uh,
we've had a sepsis committee for quite some time, as most hospitals have,
but we're also highly focused and remain focused on sepsis mortality,
uh, sepsis bundle compliance, um, all of the, the,
the key ingredients for a successful sepsis program,
sepsis is our top D r G here at the hospital.
And then heart failure is number two. So it,
it makes sense to have those kind of rise to the top as far as how much time and
energy and how much, um, involvement from the rest of the team is,
is required. Uh, patient experience is another big focus of ours.
We've been, um, heavily, uh, looking at our evidence-based strategies,
things like, it takes three rounding,
which is simply the physician that's taking care of the patient,
the hospitalist, uh,
going into the room with the nurse that's taking care of the patient and
rounding together with the patient in front of the patient involving the
patient.
And we've found that whenever we do that consistently on our,
all of our patients, uh, and we do it effectively, meaning we're in, uh, enga,
the physicians engaging the nurse, uh, and the patient,
it really makes a difference in our overall patient experience. The patient, uh,
better understands the plan for the day and so does the nurse taking care of
them. And so they're able to continue to communicate throughout the day. And it,
it also better sets up for family members that come in.
They see the whiteboard that's updated, the nurse, um,
has communicated with the doctor, the patient knows the plan,
so family members feel, uh, better kept in the loop.
Some of those other evidence-based strategies,
strategies I was talking about include bedside shift report, hourly rounding,
and leader rounding. So those four, um,
key ingredients we've really seen our patient experience, boom,
over the last five to six months. Um,
our hospitalists have been heavily engaged with this.
They're talking about it on a daily basis, um, and, and really, um,
have been transparent with the results, uh, even down to the individual level.
So that has, that has helped, uh, lead to that increase over the last, uh,
five to six months. Um, and efficiency for any, uh,
physician is a big area of focus, especially an ED physician like myself.
Um,
so we have a flow committee to optimize our efficiency
throughout the hospital.
And so that starts from the minute patients hit the emergency department all the
way till, uh, their, their discharged leaving the hospital. So again,
that involves a multidisciplinary team, uh,
including e v s or environmental services, care coordination,
nursing, cardiology team, physical therapy, um,
all of the components of nursing. So it's been, uh, it's,
it's been a great work in progress over the last couple of months,
identifying things like, how do we better space out our discharges, uh,
throughout the day instead of just having them all bundled in the early to
mid-afternoon, further bottlenecking, uh, a lot of other resources.
So that's, that's definitely been fun. And then kind of the last area of,
of one of our top priorities is our financial stewardship. You know,
I think every hospital in the country right now is really looking over the
next five to 10 years wondering how are we going to not just survive,
but be viable for our community?
How do we ensure that we can not only keep our doors open,
but be able to recruit and obtain, um, the,
the best equipment and staff for our community to best serve 'em,
not just, Hey, let's do everything we can, uh, to keep our doors open,
but to thrive for our community,
because our communities need us to continue to advance as, um,
as the evidence-based shows us, uh, the technology advances,
the needs advance of our community,
we have to have to be able to pivot and be able to serve those needs.
So it's very important that we not just survive,
but we thrive from a financial stewardship, uh, standpoint.
So there's a lot of ways in which we're, uh, looking to remain creative in that,
in that regard. So those would be my top four, uh, uh, priorities that,
um, as chief medical officer remain, uh, at the,
at the forefront in my mind each and every day that I come to work.
That's quality and safety, patient experience,
efficiency and financial stewardship.
Absolutely. That's really amazing to hear,
and especially impressive to think about the different structures and committees
that you've been working on and, and improvements that you've made, um,
since coming to Sierra Nevada.
I think it's definitely a lot of accountabilities. Like you said,
quality obviously, and patient safety is so important, but then too,
the patient experience and elevating that. Um,
and then the financial stewardship piece of it, um, certainly is something that,
as you mentioned,
a lot of health systems and hospitals are really needing to double down on this
year in particular, um, to make sure that they can thrive in the future.
And along those lines, you know,
when you take all of this into consideration and then look ahead,
how do you see the hospital evolving over the next two to three years?
What do you see as really being possible given some of the limitations,
but also opportunities with technology and everything else that's involving with
healthcare?
Yeah, I, I think my,
my answer to that question really will involve several of
those aspects that we were just talking about with priorities and doubling down
as, as you mentioned. I like that, I like that phrasing,
doubling down on those opportunities. Um, for me, in the,
in the physician side of things, recruiting is a must have.
We have to get creative, we have to be more effective with our recruiting, um,
for our, for our various service lines here, uh,
to ensure that we have the robust service lines that our community needs most
in Nevada County. Here in northern California, we have one of the oldest,
if not the oldest populations in California,
so a lot of Medicare, um, a lot of cardiology, orthopedics,
oncology needs.
So really that's a big part of our focus over the next several years,
is ensuring that those service lines are, are,
are robust and strong and able to meet the needs of our community. Um,
also reputation. Reputation is a huge part,
and that goes back to patient experience. That goes back to, uh,
optimizing your flow, your efficiency so that patients say,
I don't wanna come anywhere else. I will not drive out of the county.
I will actually, you know, drive a few additional miles to go to that hospital,
uh, you know, Sierra Nevada because their reputation.
Um, and along with your patient experience,
but you have the ability to start gaining market share as well.
And so that's what we envision through great patient experience,
through excellent quality and safety, um,
being able to gain market share and, and,
and ensure that we're keeping our county home here, uh, at, at their,
at their, uh, home-based hospital. Um, so, so that's a,
that's a large part of how I see our hospital, our system evolving, uh,
over the next several years.
Absolutely. That makes a lot of sense. And certainly it seems like, you know, a,
a really amazing vision to have for the community, a great resource as well.
You know, when you look at some of the different projects you talked about,
and you were talking about your priorities as well as moving forward and, and,
um, just really having this, um,
feeling of being able to stay in the community for healthcare in choose Sierra,
Nevada. Um,
what does that take on a people and workforce level to make that happen?
I can imagine, you know,
it's no easy task to have people thinking in that way, in,
in potentially changing some of the habits that they've been used to for years
and years.
How do you manage some of that change and especially get people excited and
motivated for this vision that you're laying?
Oh man, that that is, that is the leadership golden question right there.
Um, engagement, you know, I think, I think you mentioned that.
How do you get people engaged? Um,
because change is hard for all of us. Um,
we're not necessarily all that excited to know that, um,
that when we come into work tomorrow or for the next couple of weeks,
it's gonna be different. We're gonna do this a little bit differently.
We're gonna be challenged to think differently, to act differently,
work differently. And so that can be hard,
but I think first and first and foremost, um,
being passionate as a leader about what journey we're about to embark
on. And, and most significantly, I think, uh,
ensuring you are explaining the why and creating buy-in from those
immediately around you. Because as the,
as the C M O I can be passionate or excited about a project,
project, um, project,
but unless those around me also feel that excitement and are engaged and
believe in the why, the mission, whatever it's, we're, we're, uh,
being asked to accomplish, it's really hard to permeate throughout the rest of,
uh, those teams. So, you know, me being just one person,
it's impossible for me to go out there and have those one-on-one touches with
all of the employees and be able to explain the why or what my vision is.
But it's really about creating that team around you that's really able to, uh,
help, help get out and, and expand upon that, uh, that passion,
that engagement. And so, you know, from the physician side,
we've done several things over the last year, which I've been excited about, um,
creating, uh, you know, some, some enhanced physician engagement.
And we have an annual survey that we look at to kind of benchmark where we are.
And this year we were very much improved, uh,
compared to last year leading our division here in the Sacramento area, and, uh,
uh, significantly compared to the rest of California. And really, um,
really a a confident engaged group of physicians,
even compared on the national level. And so having events, uh,
helping the physicians feel that their voices are heard,
getting out there and doing, uh, social events, uh,
having physician mixers, um, you know, an annual Christmas party,
we're bringing back journal club,
so we're doing several different engagement events so the physicians can really,
um, be able to rally around each other, understand, uh,
the mission. And I have that,
that ability during those meetings as well to kind of, uh, talk about the why,
where we're going, uh, and so forth. So I,
I feel like that's been a really positive impact over the last year. Um,
also having one-on-one meetings with the key, uh, service line leaders,
the medical directors, the, uh, the medical staff leadership,
like the chief of staff, vice chief of staff, um, those have been, uh,
very impactful as well as we've built those relationships.
And then you can really start to, uh, expand upon upon that. Um,
once those relationships are built. Uh, I'd, I'd also say what I'm,
one of the things that I'm most proud of is our creativity with
recruiting. We understand we're in a more rural environment,
and anywhere in rural America, you're gonna have challenges with recruiting,
uh, especially on the physician front. So we've, um,
done a few things such as hosting an annual senior
resident recruiting weekend where we bring senior residents in family
medicine here to, uh, Nevada County for a weekend, we host them.
And last year we had, uh, 10,
about 10 senior residents and they were able to come and tour the area,
meet with the hospital leadership, take a hospital tour.
We had a large number of our primary care providers in their various model
of, of clinics and employment, uh,
come and speak at the events and meet with the various individuals. And so that,
that was actually a successful event. And we're gonna host that again, um,
this year.
And then we've also started a rural family medicine residency program.
It just started in July of this year. And so, as we know,
the data speaks in saying that where physicians train,
wherever they do their residency,
they end up staying with a very high likelihood in that area within a certain
proximity. So we're confident that those two strategies, um,
serve both short term need for large primary care deficit
and a longer term pipeline for, uh,
stabilizing our primary care workforce here. So those are, those are two big,
uh,
recruiting creative strategies that we've been able to employ that I'm really
proud of. I.
Love it. I think that, you know, definitely something to be proud of and,
and excellent to see the results there. Now, before we wrap up our conversation,
I was wondering, is there any other projects or initiatives that you've done,
have done in the last year that you wanted to outline with some great results?
I know you've had some really clear and amazing, um, examples of,
of ways that you've been, um,
things that you've been doing differently and things have gone well.
So I just wanted to see if there's anything else you wanted to share with us
that would be beneficial for our listeners to know about and hear about.
Yeah, I, I think the other one that, um,
I would mention is kind of our marketing strategy and
connecting with the community. Um, you know, a lot of times in,
in communities it's just, um, you know, the hospital in a silo,
but we've hired a, um, a director of mission over,
uh, within the last several months,
and he has done a phenomenal job at just getting out and connecting with the
community, and it starts to put a face, um,
uh, to the hospital.
And it's not just a brick and mortar or those people up on the hill,
that kind of thing, but it starts to really, um, uh,
bring a closer connection with the community. I have a, uh,
a radio show that I get to do once a month,
and I usually bring on a guest from the hospital,
one of the physicians or one of the nurse leaders. Um, and,
and we just talk about what the community wants to hear what and,
and provide updates about the hospital. We have a,
a short radio segment every Thursday,
and we're able to provide the community with updates about how the hospital is
doing. Um, and our, our director of mission is getting out and,
and doing various, um, events with the community involved with various cultures.
Had a latino night the other night that he attended, and, um,
gave us an update about that event.
We represented at the county fair this year with a booth several of
us rode in, uh, in our 4th of July parade. Um,
and,
and so I think it's things like that that really start to change the way
a community sees its hospital, because without a hospital,
there is not, um, the same level of a community. I mean,
we're the largest employer in the county. Um, we have a, uh,
a large community benefit as far as financial impact. Um, so,
you know, the, a community needs its hospital.
And so when you start connecting on a deeper level between the community and the
hospital,
I think that really sets potential for the no,
you know, no ceiling, uh, potential there for, for a hospital's, um,
you know, potential growth and success going forward. But, uh,
but I would say from a marketing and engagement standpoint with the community,
that's kind of the biggest project and biggest area focus that, um,
that I would add to, to our other,
other opportunities that we've been focused on.
Absolutely. Dr. Hill, thank you so much for joining us on the podcast today.
This has been such a fun and interesting discussion,
and I look forward to connecting with you again soon.
Thank you very much. I enjoyed it.
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