1 00:00:00,235 --> 00:00:02,205 - Prepare to dive into the forefront 2 00:00:02,225 --> 00:00:05,525 of healthcare innovation at our 14th annual meeting coming 3 00:00:05,545 --> 00:00:06,645 up on April 8th 4 00:00:06,645 --> 00:00:10,765 through 11th at the Hyatt Regency in Chicago, with thousands 5 00:00:10,765 --> 00:00:13,965 of industry leaders converging over four dynamic days 6 00:00:13,985 --> 00:00:16,805 of discussions on crucial topics from health IT 7 00:00:17,185 --> 00:00:18,685 to executive leadership. 8 00:00:18,995 --> 00:00:21,325 It's where the future of healthcare takes shape. 9 00:00:21,865 --> 00:00:24,085 We can't wait to connect with you in person 10 00:00:24,305 --> 00:00:26,725 and engage in these important conversations. 11 00:00:27,485 --> 00:00:29,735 - Welcome to the Becker's Healthcare Podcast, made 12 00:00:29,735 --> 00:00:31,455 for the people who power US healthcare. 13 00:00:31,795 --> 00:00:33,055 I'm Molly Gamble at Becker's, 14 00:00:33,055 --> 00:00:35,455 and today I'm sitting down with Dr. James Keller, CMO 15 00:00:35,455 --> 00:00:37,615 of Advocate, Lutheran General Hospital. 16 00:00:38,435 --> 00:00:39,775 Dr. Keller, welcome to the podcast. 17 00:00:39,915 --> 00:00:42,415 Thanks for being my guest today. How are you? 18 00:00:42,435 --> 00:00:43,935 And where does the podcast find you? 19 00:00:45,545 --> 00:00:47,105 - I am great, and thanks for having me. 20 00:00:47,345 --> 00:00:50,345 I am at Lutheran General Hospital in Park Ridge, Illinois. 21 00:00:50,995 --> 00:00:53,065 - Great. For listeners, Dr. Keller, 22 00:00:53,065 --> 00:00:55,745 who might be less familiar with Advocate Lutheran General, 23 00:00:56,045 --> 00:00:59,905 can you share a few key facts about the organization just 24 00:00:59,905 --> 00:01:01,385 so we can better reacquaint ourselves? 25 00:01:03,045 --> 00:01:05,025 - Oh, absolutely. And thanks for the opportunity. 26 00:01:05,605 --> 00:01:06,625 Uh, you know, I came 27 00:01:06,625 --> 00:01:10,145 to Lutheran General Hospital about 33 years ago when it was 28 00:01:10,345 --> 00:01:11,425 a freestanding hospital. 29 00:01:11,605 --> 00:01:13,745 And at that time I thought it was quite large. 30 00:01:13,925 --> 00:01:17,345 And since that time, first there was an initial merger 31 00:01:17,445 --> 00:01:21,945 to create Advocate Healthcare, um, which was a 10 hospital 32 00:01:22,005 --> 00:01:24,825 or so system in the Chicagoland area. 33 00:01:25,565 --> 00:01:27,625 Um, subsequent to that, there was a merger 34 00:01:27,775 --> 00:01:30,865 with Aurora Healthcare to form Advocate Aurora. 35 00:01:31,445 --> 00:01:33,225 And then just recently there was a merger 36 00:01:33,335 --> 00:01:36,865 with Atrium Healthcare to form Advocate Health, 37 00:01:37,315 --> 00:01:41,905 which is really a, uh, involves Atrium Healthcare, 38 00:01:42,015 --> 00:01:45,345 wake Forest, um, Aurora, 39 00:01:45,805 --> 00:01:47,145 and Advocate Healthcare 40 00:01:47,685 --> 00:01:48,785 and creating one of the largest, 41 00:01:48,785 --> 00:01:50,905 not-for-profit healthcare systems in the country. 42 00:01:51,685 --> 00:01:55,145 Um, and Lutheran General is probably one of the five largest 43 00:01:55,945 --> 00:01:57,225 hospitals in the healthcare system. 44 00:01:57,845 --> 00:01:59,905 And, um, I'd like to think of it, 45 00:01:59,905 --> 00:02:03,385 and I guess I'm biased being Chief Medical Officer as one 46 00:02:03,385 --> 00:02:07,225 of the flagship hospitals, it's, um, one of the things 47 00:02:07,225 --> 00:02:09,385 that makes it a great hospital, um, 48 00:02:09,645 --> 00:02:12,825 and also makes it a challenging hospital is, uh, 49 00:02:12,925 --> 00:02:15,185 our characteristics shared by a lot of large 50 00:02:15,865 --> 00:02:17,225 hospitals and healthcare systems. 51 00:02:17,365 --> 00:02:20,585 And that's that we have a responsibility 52 00:02:20,685 --> 00:02:22,145 to serve our community. 53 00:02:22,685 --> 00:02:25,345 Um, and our community here is aging 54 00:02:25,345 --> 00:02:26,625 and becoming more complex. 55 00:02:27,165 --> 00:02:30,465 Yet as a quaternary care hospital, we're also charged 56 00:02:30,655 --> 00:02:33,425 with providing higher levels of care, not only 57 00:02:33,425 --> 00:02:35,985 for other hospitals within the Advocate Health system, 58 00:02:36,485 --> 00:02:38,705 but also other hospitals in our community. 59 00:02:38,845 --> 00:02:41,905 So we have to be focused sort of on all levels of care, 60 00:02:41,955 --> 00:02:43,785 which creates unique challenges. 61 00:02:44,565 --> 00:02:46,905 - Mm-Hmm. and 33 years. 62 00:02:47,125 --> 00:02:48,865 Uh, and I should make mention too, that 63 00:02:49,575 --> 00:02:52,225 Park Ridge is right on the cusp of Cook County, 64 00:02:52,275 --> 00:02:53,705 which contains Chicago. 65 00:02:54,285 --> 00:02:55,385 So Dr. Keller, I mean, 66 00:02:55,385 --> 00:02:58,265 you've really seen the Chicagoland area evolve 67 00:02:58,285 --> 00:03:00,565 and shift as it relates to hospitals 68 00:03:00,625 --> 00:03:02,445 and those relationships between them. 69 00:03:03,025 --> 00:03:06,085 Um, can you share a bit too about your clinical background? 70 00:03:08,095 --> 00:03:09,275 - Uh, yeah, I'd be glad to. 71 00:03:09,495 --> 00:03:12,395 Um, I'm a maternal fetal medicine specialist, which, um, 72 00:03:12,715 --> 00:03:14,795 I think in late terms is high risk obstetrics. 73 00:03:14,795 --> 00:03:17,875 So after completing a residency in obstetrics 74 00:03:17,875 --> 00:03:20,635 and gynecology, I did a couple years of extra training 75 00:03:20,735 --> 00:03:23,915 of fellowship at Northwestern University here in Chicago 76 00:03:24,615 --> 00:03:25,995 in maternal fetal medicine. 77 00:03:26,415 --> 00:03:29,595 And I think that my journey is probably pretty 78 00:03:30,335 --> 00:03:31,595 characteristic of people 79 00:03:31,595 --> 00:03:33,795 that are in healthcare leadership of my generation. 80 00:03:33,895 --> 00:03:36,835 And that's that we maybe start out thinking 81 00:03:36,835 --> 00:03:39,235 that it's just going to be a clinical journey, 82 00:03:39,495 --> 00:03:41,795 and you're asked to do something in a, 83 00:03:41,855 --> 00:03:44,595 in a center like this, maybe it gets involved 84 00:03:44,595 --> 00:03:46,955 with undergraduate or graduate medical education, 85 00:03:47,095 --> 00:03:50,235 and then leading a division and then leading a department. 86 00:03:50,235 --> 00:03:53,035 And then as the healthcare system grows, um, 87 00:03:53,465 --> 00:03:56,675 getting involved more at the healthcare system level 88 00:03:56,985 --> 00:03:58,035 service lines. 89 00:03:59,095 --> 00:04:02,275 Um, and then you, you just, 90 00:04:02,305 --> 00:04:04,355 it's an organic journey. 91 00:04:05,095 --> 00:04:06,675 And along the line, I went 92 00:04:06,735 --> 00:04:08,955 and, uh, received advanced training. 93 00:04:09,035 --> 00:04:12,395 I got, uh, a degree in health management policy from, uh, 94 00:04:12,395 --> 00:04:13,395 university of Michigan, 95 00:04:14,175 --> 00:04:19,115 and then started about, um, eight years ago, uh, 96 00:04:19,735 --> 00:04:21,235 in hospital administration, 97 00:04:21,335 --> 00:04:23,115 but have never given up my clinical role, 98 00:04:23,485 --> 00:04:27,915 which I think is pretty important for, um, physician leaders 99 00:04:28,095 --> 00:04:32,515 for credibility is as well as to give us insight into sort 100 00:04:32,515 --> 00:04:34,795 of the challenges the physicians are facing. 101 00:04:35,015 --> 00:04:37,275 So I still practice, but, um, 102 00:04:37,375 --> 00:04:40,955 and the chief medical Officer at Lutheran General as well. 103 00:04:41,645 --> 00:04:42,795 - Great. And, 104 00:04:42,795 --> 00:04:45,115 and Dr. Keller, I mean, you said a really interesting 105 00:04:45,115 --> 00:04:46,955 intersection given your specialty 106 00:04:47,255 --> 00:04:49,235 and the CMO role you find yourself in. 107 00:04:49,695 --> 00:04:51,275 And I was hoping you could spend a a bit 108 00:04:51,275 --> 00:04:53,395 of time today talking about your specialty. 109 00:04:53,855 --> 00:04:56,835 Um, you know, the US is facing such a pressing national 110 00:04:57,155 --> 00:04:59,755 shortage of obstetrician gynecologists. 111 00:04:59,855 --> 00:05:04,035 You have over half of US counties lacking an OB 112 00:05:04,035 --> 00:05:06,035 or gyne, which is a staggering finding. 113 00:05:06,375 --> 00:05:10,995 Um, I, I was curious, what considerations should those of us 114 00:05:11,055 --> 00:05:13,395 who are outside the specialty we're not nearly as close 115 00:05:13,395 --> 00:05:16,035 to it as you are, but concerned about this issue? 116 00:05:16,345 --> 00:05:17,915 What, what should we be aware of right now? 117 00:05:17,915 --> 00:05:18,915 Are we keeping in mind? 118 00:05:20,635 --> 00:05:22,255 - So those who know, uh, those 119 00:05:22,435 --> 00:05:25,095 who know me would not describe me as an optimistic person. 120 00:05:25,235 --> 00:05:27,335 I'm gonna start this, the answer with sort 121 00:05:27,335 --> 00:05:31,175 of an optimistic observation is that, um, people may 122 00:05:31,175 --> 00:05:33,775 or may not be aware, but, um, last week, 123 00:05:33,885 --> 00:05:35,655 last Friday was just the match 124 00:05:35,665 --> 00:05:38,175 where medical students get matched into specialties 125 00:05:38,235 --> 00:05:42,215 and obstetrics and gynecology was very competitive and had, 126 00:05:42,315 --> 00:05:45,135 and actually filled most of their places nationally. 127 00:05:45,195 --> 00:05:48,935 So we should be seeing a, uh, a great crop 128 00:05:48,935 --> 00:05:51,095 of young people going into obstetrics 129 00:05:51,095 --> 00:05:55,215 and gynecology, which should hopefully help the issues 130 00:05:55,215 --> 00:05:57,645 that we see in obstetrics and gynecology and I, 131 00:05:57,705 --> 00:06:01,165 and I'd like to come back to this, are, are not unique to 132 00:06:01,165 --> 00:06:05,325 that field, um, as we have resource issues, you know, 133 00:06:05,385 --> 00:06:07,885 in many rural and urban areas throughout the 134 00:06:07,885 --> 00:06:09,085 country in many of our fields. 135 00:06:09,265 --> 00:06:11,325 But there's something about obstetrics 136 00:06:11,325 --> 00:06:15,365 and gynecology, which, which creates even more stressors. 137 00:06:15,945 --> 00:06:20,805 Um, you know, first of all, the, it's the, you know, it's a, 138 00:06:21,445 --> 00:06:25,205 a field where in addition to getting the, the clinician 139 00:06:25,875 --> 00:06:27,005 into a rural area 140 00:06:27,265 --> 00:06:30,925 or into an urban area, the, the impact 141 00:06:30,945 --> 00:06:34,805 of an obstetric service on a hospital financially, um, 142 00:06:34,965 --> 00:06:36,565 presents some unique challenges. 143 00:06:36,785 --> 00:06:38,365 So first of all, you can't, 144 00:06:38,365 --> 00:06:39,765 you can never predict the volume. 145 00:06:40,505 --> 00:06:44,365 Um, it's not like you can staff, you know, we have, um, 146 00:06:44,715 --> 00:06:47,525 several areas of the hospital that are staffed up 147 00:06:47,525 --> 00:06:49,405 during the day and staffed less at night 148 00:06:49,405 --> 00:06:50,685 or staffed less on weekends. 149 00:06:50,985 --> 00:06:53,165 And you can't do that in obstetrics. 150 00:06:53,265 --> 00:06:57,085 So you're left with a fairly high fixed cost and a, 151 00:06:57,505 --> 00:07:01,885 and an unpredictable volume, um, which, which makes, 152 00:07:02,305 --> 00:07:04,485 um, financial planning difficult. 153 00:07:04,785 --> 00:07:06,645 You're also, um, left 154 00:07:06,675 --> 00:07:11,445 with a high resource utilization area if you want to, um, 155 00:07:11,515 --> 00:07:13,645 provide these services in a safe manner. 156 00:07:14,025 --> 00:07:16,765 So having the appropriate pediatric support for the baby 157 00:07:16,765 --> 00:07:17,925 after the baby's born, 158 00:07:18,185 --> 00:07:20,325 having the appropriate anesthesia support, 159 00:07:20,625 --> 00:07:24,525 having the appropriate, um, blood bank facilities, um, 160 00:07:24,525 --> 00:07:25,525 because a lot 161 00:07:25,525 --> 00:07:27,805 of our obstetric emergencies are really difficult 162 00:07:27,805 --> 00:07:29,085 to, to manage. 163 00:07:30,145 --> 00:07:33,405 So it's, we throughout the country and I, 164 00:07:33,905 --> 00:07:37,925 and again, would like to, um, I think it's something we need 165 00:07:37,925 --> 00:07:42,725 to recognize that our, that we have a sort of a re resource 166 00:07:43,405 --> 00:07:44,725 shortage when it comes to healthcare. 167 00:07:45,305 --> 00:07:49,965 But again, obstetrics is made worse when we look at sort of, 168 00:07:49,965 --> 00:07:52,685 how can we dig ourselves out of, out of this, 169 00:07:52,705 --> 00:07:53,925 or how can we address it. 170 00:07:54,585 --> 00:07:56,205 You know, there's a couple things to think of. 171 00:07:56,385 --> 00:07:59,845 One is you have to incentivize physicians to go 172 00:07:59,865 --> 00:08:00,885 to these rural 173 00:08:01,145 --> 00:08:04,285 or challenged urban areas, um, to, you know, 174 00:08:04,285 --> 00:08:05,605 to become providers. 175 00:08:05,785 --> 00:08:07,005 And, um, 176 00:08:07,625 --> 00:08:10,685 and you can do that, you know, by, you know, selection, 177 00:08:10,745 --> 00:08:12,885 you know, the people will return to their neighborhoods. 178 00:08:12,945 --> 00:08:15,085 So if you have, if you have people 179 00:08:15,345 --> 00:08:17,765 who come from the challenged urban areas 180 00:08:17,945 --> 00:08:20,485 or the rural areas starting medical school, 181 00:08:20,485 --> 00:08:23,445 there's a better chance that they will return, um, 182 00:08:24,175 --> 00:08:25,885 especially if you make it, uh, 183 00:08:26,005 --> 00:08:27,725 fin financially attractive for them. 184 00:08:28,505 --> 00:08:33,205 Um, the other thing is that we have to do, we have 185 00:08:33,205 --> 00:08:36,845 to rely also on our advanced practice clinicians. 186 00:08:37,345 --> 00:08:38,725 So making sure that everybody is 187 00:08:38,725 --> 00:08:39,925 working to the top of their license. 188 00:08:40,225 --> 00:08:44,005 So having more collaboration with, you know, when it comes 189 00:08:44,065 --> 00:08:46,525 to obstetrics with nurse midwives 190 00:08:46,745 --> 00:08:49,565 or, um, in the hospital setting 191 00:08:49,585 --> 00:08:50,885 or even in the outpatient setting, 192 00:08:51,025 --> 00:08:52,965 and physician, physician assistants 193 00:08:52,965 --> 00:08:55,525 and, um, advanced practice nurses in the outpatient 194 00:08:55,565 --> 00:08:58,245 settings, allowing a physician to be able 195 00:08:58,245 --> 00:09:00,085 to care safely for more patients. 196 00:09:00,665 --> 00:09:03,765 And then, um, a lot of the things that, you know, have just, 197 00:09:03,985 --> 00:09:07,565 uh, that we've learned during, um, through covid 198 00:09:08,105 --> 00:09:09,645 is strategic use of telehealth. 199 00:09:10,225 --> 00:09:14,205 So to be able to bring the expertise that we have, um, 200 00:09:14,305 --> 00:09:16,445 in places that are well served, some 201 00:09:16,445 --> 00:09:17,805 of our university settings, 202 00:09:18,105 --> 00:09:20,925 and take that expertise remotely into the, 203 00:09:21,315 --> 00:09:24,365 into the more challenged communities via telehealth. 204 00:09:24,865 --> 00:09:27,565 And although we can't have, we're not at the point 205 00:09:27,565 --> 00:09:30,765 of a robot delivering a baby, you know, managing somebody 206 00:09:30,765 --> 00:09:33,885 with cri critical levels of hypertension or bleeding. 207 00:09:34,385 --> 00:09:35,845 Um, we're starting to see more 208 00:09:35,845 --> 00:09:39,725 and more use of electronic intensive care resources. 209 00:09:40,345 --> 00:09:43,685 And then just like, um, you know, looking down the road, 210 00:09:43,685 --> 00:09:45,605 getting better at stratifying risk 211 00:09:45,605 --> 00:09:48,365 or identifying people that should be moved out 212 00:09:48,365 --> 00:09:51,445 of those communities into higher levels of care early. 213 00:09:51,985 --> 00:09:53,805 So via the use of, you know, modeling 214 00:09:53,985 --> 00:09:55,365 and artificial intelligence. 215 00:09:55,505 --> 00:09:57,645 So I think there's things that we can do, 216 00:09:57,785 --> 00:10:02,605 but it's, again, obstetrics is probably, you know, probably, 217 00:10:03,145 --> 00:10:07,645 um, the, the poster child of, of a service 218 00:10:07,665 --> 00:10:09,925 that's going to be challenged in low resource 219 00:10:09,925 --> 00:10:11,245 areas. Mm-Hmm. 220 00:10:11,285 --> 00:10:12,595 - . And, 221 00:10:12,655 --> 00:10:14,195 and I've noticed Dr. Keller, 222 00:10:14,195 --> 00:10:16,635 that sometimes when hospitals will either consolidate 223 00:10:16,635 --> 00:10:19,755 or close or restrict labor and delivery care 224 00:10:19,895 --> 00:10:23,115 or obstetrics, they'll make sometimes make a footnote in the 225 00:10:23,235 --> 00:10:26,195 announcement somewhere that there are fewer chil fewer 226 00:10:26,195 --> 00:10:29,275 babies being born, and there's a lower birth rate, uh, 227 00:10:29,275 --> 00:10:31,955 women are having and starting families later in life. 228 00:10:32,575 --> 00:10:35,555 Ha. Have you seen any of these demographic shifts come home 229 00:10:35,655 --> 00:10:37,995 to affect your volumes at Advocate Lutheran? 230 00:10:38,055 --> 00:10:40,155 Or even at a broader level, um, 231 00:10:40,455 --> 00:10:42,235 how those are playing out to affect hospitals? 232 00:10:42,295 --> 00:10:43,915 Is is that a credible reason for, 233 00:10:44,055 --> 00:10:46,035 for changes we're seeing in patterns? 234 00:10:47,535 --> 00:10:49,975 - I, I wouldn't, I would, I would say that it's a, 235 00:10:50,165 --> 00:10:51,295 it's a credible reason, 236 00:10:51,795 --> 00:10:54,495 but it doesn't account for all of the closures. 237 00:10:54,515 --> 00:10:56,375 Mm-Hmm. . So we know the birth rate is down, 238 00:10:56,435 --> 00:10:58,335 and it's certainly in certain states, Illinois, 239 00:10:58,335 --> 00:10:59,415 the birth rate is down. 240 00:10:59,955 --> 00:11:02,895 Um, it, at Lutheran General, we've maintained our, 241 00:11:03,155 --> 00:11:05,655 our volume and even increased our volume. 242 00:11:06,195 --> 00:11:09,895 Um, I don't know if it relates to closures around us, um, 243 00:11:10,475 --> 00:11:15,175 but, um, it, again, it, the number 244 00:11:15,315 --> 00:11:19,895 of facilities that are closing probably exceed the, 245 00:11:20,155 --> 00:11:22,135 the impact of the population changes 246 00:11:22,795 --> 00:11:27,095 and are probably likely related to, um, financial and VI 247 00:11:27,155 --> 00:11:29,695 and viability, um, considerations. 248 00:11:29,915 --> 00:11:33,415 And it's, you know, it's a zero sum game. 249 00:11:33,635 --> 00:11:35,855 And, you know, the hospitals 250 00:11:35,855 --> 00:11:37,535 and healthcare systems that are very, 251 00:11:37,685 --> 00:11:41,015 that are healthy financially are still not all that healthy. 252 00:11:41,875 --> 00:11:45,815 And then it, the decision has to be made of 253 00:11:45,815 --> 00:11:47,295 what services can we maintain 254 00:11:47,295 --> 00:11:49,135 and what services can we not maintain? 255 00:11:49,275 --> 00:11:54,085 And, um, when you're in a situation where you're not doing 256 00:11:54,085 --> 00:11:56,325 that many deliveries, it becomes harder 257 00:11:56,385 --> 00:11:58,125 and harder not only to, 258 00:11:58,825 --> 00:12:01,765 to rationalize continuing the service from a financial point 259 00:12:01,765 --> 00:12:02,765 of view, but it becomes harder 260 00:12:02,765 --> 00:12:05,365 and harder to maintain the competency that's necessary 261 00:12:05,545 --> 00:12:07,285 to provide high quality care. 262 00:12:07,905 --> 00:12:09,125 - Mm-Hmm. . Mm-Hmm. . 263 00:12:09,705 --> 00:12:11,045 Oh, thanks for weighing in on that. 264 00:12:11,345 --> 00:12:13,445 And, and thanks for taking some of my questions 265 00:12:13,445 --> 00:12:16,205 and my curiosity about the specialty in particular. 266 00:12:16,745 --> 00:12:18,525 Uh, if, if we zoom out a little bit more, 267 00:12:18,825 --> 00:12:20,485 can you tell us about some of the initiatives 268 00:12:20,485 --> 00:12:23,325 or areas at the hospital that have been commanding most 269 00:12:23,325 --> 00:12:26,405 of your energy or attention as of late at A CMO? 270 00:12:28,295 --> 00:12:31,355 - So, you know, I, I think that first of all, every, 271 00:12:31,375 --> 00:12:33,915 almost every, I have to come to work every day thinking 272 00:12:33,915 --> 00:12:37,475 of everything through a, a lens of quality and safety. 273 00:12:38,295 --> 00:12:41,155 Um, and then when we think about quality 274 00:12:41,215 --> 00:12:43,595 and safety, we think about efficiencies and value. 275 00:12:44,215 --> 00:12:45,955 So a lot of it is that, are the things 276 00:12:45,955 --> 00:12:48,675 that I talked about are the, the resources. 277 00:12:48,675 --> 00:12:50,955 And even at a place like Lutheran General, 278 00:12:51,095 --> 00:12:54,115 how do we maintain the, um, the resources 279 00:12:54,115 --> 00:12:57,715 and the specialties to be able to, to serve our community? 280 00:12:58,255 --> 00:13:02,115 So, um, it, it's a national phenomenon that, um, 281 00:13:02,695 --> 00:13:04,355 the hospitals are boarding more 282 00:13:04,355 --> 00:13:05,795 and more patients in the emergency room. 283 00:13:05,855 --> 00:13:09,395 So one of our large focuses is on, on throughput. 284 00:13:09,525 --> 00:13:12,195 Throughput is one of the, one of the areas that covers, 285 00:13:13,015 --> 00:13:14,475 you know, when we look at what are we trying 286 00:13:14,475 --> 00:13:18,435 to accomplish here, um, our throughput initiatives, um, 287 00:13:18,605 --> 00:13:22,555 focus on not only patient engagement and financial reasons, 288 00:13:22,615 --> 00:13:25,275 but for safety as well, making sure that everybody can get 289 00:13:25,335 --> 00:13:29,235 to the right level and the right, the right, um, area 290 00:13:29,295 --> 00:13:31,355 of care in a timely manner 291 00:13:31,375 --> 00:13:33,475 and get their care delivered in a timely manner. 292 00:13:33,815 --> 00:13:36,155 And that involves not only having the right number 293 00:13:36,175 --> 00:13:37,955 of physicians, but also the right number 294 00:13:37,955 --> 00:13:39,235 of teammates at every level. 295 00:13:39,935 --> 00:13:44,435 And, um, so I, I think that, um, when we look at resources 296 00:13:44,535 --> 00:13:45,795 and people resources 297 00:13:45,975 --> 00:13:49,275 and physical resources, I think those are the things that, 298 00:13:49,385 --> 00:13:52,555 that keep us, keep, uh, a lot of us up at night. 299 00:13:53,255 --> 00:13:56,475 Um, and again, it, it comes down to being able 300 00:13:56,475 --> 00:13:58,635 to deliver our, our care safely. 301 00:13:59,355 --> 00:14:02,515 I always, uh, can, one thing that I've noticed, 302 00:14:02,815 --> 00:14:06,955 and even in the past on eight years, is that the level 303 00:14:07,015 --> 00:14:10,315 of care that we deal with is becoming more and more complex. 304 00:14:10,415 --> 00:14:13,075 And the more and more complex the, the delivery 305 00:14:13,095 --> 00:14:16,635 of care gets, the greater, there is a potential for, 306 00:14:17,375 --> 00:14:20,635 for an error and it advocate as I'm sure at most, 307 00:14:20,975 --> 00:14:23,035 at most places, but I really think it's part 308 00:14:23,035 --> 00:14:26,555 of our DNA is our, our intense focus on safety. 309 00:14:26,775 --> 00:14:28,835 But as our population gets sicker 310 00:14:28,835 --> 00:14:32,955 and the amount of chronic disease increases, um, again, 311 00:14:33,025 --> 00:14:37,195 it's, it's providing what, um, highly integrated care, 312 00:14:37,575 --> 00:14:40,035 making sure that the handoffs are appropriate. 313 00:14:40,535 --> 00:14:42,555 So I think it's, again, just making sure 314 00:14:42,555 --> 00:14:43,755 that we have the resources 315 00:14:43,755 --> 00:14:46,475 and making sure that we have our systems in place 316 00:14:46,495 --> 00:14:48,875 to provide, um, the type of care 317 00:14:48,875 --> 00:14:50,555 that our complex patients need. 318 00:14:51,105 --> 00:14:52,935 - Mm-Hmm. , - And the, 319 00:14:52,935 --> 00:14:56,175 the boarding issue is such a intricate one 320 00:14:56,175 --> 00:14:58,535 because there's a number of contributing factors there, 321 00:14:58,675 --> 00:15:00,175 and even city by city 322 00:15:00,175 --> 00:15:02,655 or market by market, it can be a little different in terms 323 00:15:02,675 --> 00:15:04,935 of what contributing factors are more weighted. 324 00:15:05,315 --> 00:15:06,815 You, you just highlighted this as an issue. 325 00:15:06,815 --> 00:15:08,935 You're keeping top of mind as CMO. 326 00:15:09,125 --> 00:15:11,575 What do you see as the, the largest contributing factors? 327 00:15:11,755 --> 00:15:14,415 You just, you touched on greater patient acuity. 328 00:15:14,675 --> 00:15:16,655 Is that longer length of stay? 329 00:15:16,995 --> 00:15:21,415 Is there post acute capacity issues in the Chicagoland area? 330 00:15:21,685 --> 00:15:22,935 What, what are you seeing that's kind 331 00:15:22,935 --> 00:15:24,615 of tipping the scales when it comes to boarding? 332 00:15:26,365 --> 00:15:29,065 - So the, the one thing that we have to, that we have 333 00:15:29,065 --> 00:15:31,625 to recognize, and people have spoken about it 334 00:15:31,625 --> 00:15:34,305 before, is that although the patients are boarded in the 335 00:15:34,305 --> 00:15:38,865 emergency room, and that's where, um, you know, that 336 00:15:39,165 --> 00:15:42,345 that's where the, the issue is, is visual. 337 00:15:43,045 --> 00:15:45,945 The boarding issue comes from downstream, 338 00:15:45,945 --> 00:15:49,665 meaning moving the patients through the hospital, again, 339 00:15:49,665 --> 00:15:53,705 in a safe, in a safe and well orchestrated manner, 340 00:15:53,965 --> 00:15:56,145 and then moving them to the next level of care. 341 00:15:56,765 --> 00:16:01,545 So improving our access to, um, home healthcare so 342 00:16:01,545 --> 00:16:03,305 that we can get patients outta the hospital, 343 00:16:03,315 --> 00:16:06,425 which is not always the best place for them to be, so 344 00:16:06,425 --> 00:16:07,505 that we can free up a bed 345 00:16:07,505 --> 00:16:09,105 for the people in the emergency room. 346 00:16:09,605 --> 00:16:12,945 But it's also the reason that, um, that a lot 347 00:16:12,945 --> 00:16:16,465 of hospitals have boarding issues is, again, the, the fact 348 00:16:16,465 --> 00:16:19,905 that they were dealing with an aging population. 349 00:16:20,185 --> 00:16:23,785 I, I think that, and again, maybe I'm hypersensitive to it, 350 00:16:23,885 --> 00:16:26,145 but I think that, um, 351 00:16:26,245 --> 00:16:30,145 we were probably way wrong when we predicted, 352 00:16:30,885 --> 00:16:32,025 um, a couple of things. 353 00:16:32,205 --> 00:16:34,625 One is the number of hospital beds 354 00:16:34,625 --> 00:16:36,105 that we would need in certain areas, 355 00:16:37,005 --> 00:16:39,625 and there was so much talk about empty hospital beds 356 00:16:39,725 --> 00:16:43,025 and, um, in too many hospital beds. 357 00:16:43,205 --> 00:16:45,305 But that's not a phenomenon that we've seen, 358 00:16:45,325 --> 00:16:46,385 at least in this area. 359 00:16:47,245 --> 00:16:50,895 Um, and then, um, 360 00:16:51,885 --> 00:16:55,215 it's also the, again, the complexity of care that, 361 00:16:55,325 --> 00:16:58,775 that we're, that we're delivering, those are the things 362 00:16:58,775 --> 00:17:00,495 that I think are contributing to the borders. 363 00:17:00,515 --> 00:17:05,055 And then we also have hospitals such as ours that are, um, 364 00:17:05,785 --> 00:17:07,815 again, we use the term higher level of care. 365 00:17:08,115 --> 00:17:12,215 So dealing with the orthopedic trauma, the strokes, the 366 00:17:12,825 --> 00:17:15,535 myocardial infarctions that need interventions right away, 367 00:17:15,845 --> 00:17:19,055 when you become a destination site for those patients, then 368 00:17:19,705 --> 00:17:22,055 again, you have the community that you're serving 369 00:17:22,155 --> 00:17:26,295 for the basic needs, and you have, um, the higher level of, 370 00:17:26,475 --> 00:17:28,495 of care that that's needed as well. 371 00:17:29,355 --> 00:17:32,525 - Mm-Hmm. . - Well, Dr. Keller, I, I, 372 00:17:32,685 --> 00:17:34,765 I haven't been in the field nearly as long as you, 373 00:17:34,905 --> 00:17:38,645 but I do all I, 10 years ago, I remember seeing stories 374 00:17:38,745 --> 00:17:41,045 and think pieces, questioning over bedding 375 00:17:41,045 --> 00:17:43,245 and the relevance of brick and mortar hospitals. 376 00:17:43,345 --> 00:17:45,205 And I, I, I agree with you. 377 00:17:45,325 --> 00:17:48,245 I think what we're seeing today around the, the us uh, that, 378 00:17:48,245 --> 00:17:51,845 that hypothesis has not young yet rung very true. 379 00:17:52,145 --> 00:17:53,925 So I, I wanna thank you today 380 00:17:53,925 --> 00:17:56,925 for sharing your thoughts on Obste Obstetrics 381 00:17:56,925 --> 00:17:59,805 and gynecology also as CMO, what you're seeing, 382 00:17:59,835 --> 00:18:01,765 what you're most invested in right now. 383 00:18:02,485 --> 00:18:04,125 Anything I didn't ask you that you wanna make sure 384 00:18:04,125 --> 00:18:05,245 our listeners hear from you today? 385 00:18:07,195 --> 00:18:10,575 - No, I, I just think overall it's, it, um, you know, 386 00:18:10,575 --> 00:18:12,855 as I come to work every day, I, I use the term 387 00:18:12,925 --> 00:18:16,215 that I'm cautiously optimistic about, um, 388 00:18:16,785 --> 00:18:18,535 about the direction health here is going. 389 00:18:18,595 --> 00:18:22,295 We certainly face the challenges of an aging, uh, 390 00:18:23,185 --> 00:18:24,735 population with more chronic 391 00:18:24,735 --> 00:18:26,255 diseases, which need to be managed. 392 00:18:26,635 --> 00:18:30,295 But we also have, um, just, uh, an abundance 393 00:18:30,435 --> 00:18:33,455 of really bright people both in the clinical 394 00:18:33,635 --> 00:18:38,455 and the, um, policy, um, area, um, many 395 00:18:38,455 --> 00:18:41,055 of our operational leaders that are really focused on, 396 00:18:41,675 --> 00:18:43,655 on providing great healthcare. 397 00:18:43,995 --> 00:18:47,615 So although we have, we have great challenges ahead, 398 00:18:47,975 --> 00:18:49,655 I think we have great minds working on 399 00:18:49,655 --> 00:18:50,895 dealing with those challenges. 400 00:18:51,555 --> 00:18:52,975 - That's a great note to end on. 401 00:18:53,165 --> 00:18:55,735 Listeners, this has been Dr. James Keller, CMO, 402 00:18:55,735 --> 00:18:58,575 with Advocate Lutheran General Hospital, Dr. Keller, 403 00:18:58,575 --> 00:18:59,535 thank you so much for your time 404 00:18:59,535 --> 00:19:00,695 today, and thanks for being my guest. 405 00:19:01,685 --> 00:19:02,745 - It was my pleasure. Thank you.