1 00:00:00,365 --> 00:00:02,735 - This is Laura Dedo with the Becker's Healthcare Podcast. 2 00:00:03,355 --> 00:00:05,615 I'm thrilled today to be joined by Dr. Ralph Yates, 3 00:00:05,785 --> 00:00:08,695 chief Medical Officer at Salem Health Hospitals and Clinics. 4 00:00:08,835 --> 00:00:11,095 Dr. Yates, it's a pleasure to have you on the podcast today. 5 00:00:11,835 --> 00:00:13,255 - My pleasure as well. Thank you. 6 00:00:14,285 --> 00:00:15,705 - Now, I know we've got a lot to talk about, 7 00:00:15,765 --> 00:00:19,065 and I'm looking forward to catching up with you, uh, um, on 8 00:00:19,065 --> 00:00:21,625 what you're doing at Salem Health Hospitals and clinics. 9 00:00:21,625 --> 00:00:23,345 But before we dive into my questions, 10 00:00:23,405 --> 00:00:24,425 can you tell us a little bit more 11 00:00:24,425 --> 00:00:25,625 about yourself and your background? 12 00:00:26,305 --> 00:00:30,435 - Certainly. I'm a family doc by training 13 00:00:30,535 --> 00:00:31,715 and board certification, 14 00:00:31,775 --> 00:00:33,435 and I still practice one day a week. 15 00:00:34,265 --> 00:00:36,995 I've been, I've been doing this for 44 years, 16 00:00:37,935 --> 00:00:42,555 and I oversee a medical staff of just under a thousand 17 00:00:43,165 --> 00:00:45,435 physicians and advanced practitioners. 18 00:00:46,235 --> 00:00:50,315 Our health system, our largest hospital, we have two, 19 00:00:50,335 --> 00:00:52,715 our largest hospital is 644 beds, 20 00:00:52,975 --> 00:00:57,155 and we are the major sole provider for veterinary 21 00:00:57,785 --> 00:01:00,355 five, 500,000 patients in mid 22 00:01:00,355 --> 00:01:01,835 Willamette Valley here in Oregon. 23 00:01:03,825 --> 00:01:04,995 - Well, that's great to hear. 24 00:01:05,135 --> 00:01:07,195 And you know, I'm wondering if we could start off with, 25 00:01:07,285 --> 00:01:09,595 could you tell me about, um, one change 26 00:01:09,595 --> 00:01:10,995 that you've made in the last year 27 00:01:10,995 --> 00:01:12,675 or so that's really yielded some great results? 28 00:01:13,335 --> 00:01:14,335 Yes, 29 00:01:14,565 --> 00:01:15,865 - We happy to. 30 00:01:16,125 --> 00:01:17,225 We, we are, 31 00:01:18,435 --> 00:01:22,615 I believe it's 13 years into our lean experience. 32 00:01:22,955 --> 00:01:26,495 We are seriously dedicated 33 00:01:27,995 --> 00:01:30,045 lean hospital system and, 34 00:01:30,945 --> 00:01:35,685 and we have been, we pivoted over a year ago to 35 00:01:36,805 --> 00:01:41,645 recovery, which includes financial recovery coming out of, 36 00:01:41,945 --> 00:01:46,055 of Covid, and one part of that work 37 00:01:46,725 --> 00:01:50,055 that has directly involved medical staff and medical group. 38 00:01:50,115 --> 00:01:53,365 Our medical group is right around 300 individuals 39 00:01:53,385 --> 00:01:57,415 and includes our adult ISTs team, 40 00:01:57,545 --> 00:02:01,135 which is six five physicians and advanced practitioners. 41 00:02:01,715 --> 00:02:05,575 The major piece of work that has taken place over the, 42 00:02:05,715 --> 00:02:08,855 the last year has been length of stay work, 43 00:02:09,635 --> 00:02:12,455 and the team's been 44 00:02:13,585 --> 00:02:17,415 successful in bringing it down almost one 45 00:02:17,415 --> 00:02:21,915 and a half days from the about 6.4, 6.5 days 46 00:02:22,665 --> 00:02:25,675 that where it stood at the time 47 00:02:25,675 --> 00:02:26,915 they started doing their work. 48 00:02:28,005 --> 00:02:30,455 That work is continuing, it's ongoing, 49 00:02:31,395 --> 00:02:36,385 and we expect the continued improvement. 50 00:02:37,575 --> 00:02:40,975 A lot of this now for us involves patients 51 00:02:40,995 --> 00:02:44,655 and all health systems are dealing with this that are 52 00:02:45,325 --> 00:02:47,455 just have long stays by 53 00:02:49,675 --> 00:02:53,065 their condition and in their situations, sometimes social. 54 00:02:54,165 --> 00:02:58,625 So we're working on that in, in our usual method 55 00:02:58,725 --> 00:03:02,765 of approaching problems from a, a lean standpoint. 56 00:03:03,185 --> 00:03:07,085 And I would would just add that the big takeaway that 57 00:03:07,855 --> 00:03:08,965 we've discovered in, 58 00:03:09,145 --> 00:03:12,645 and I've been in active conversation with friends 59 00:03:12,665 --> 00:03:14,525 and other systems who are doing the same thing, 60 00:03:16,205 --> 00:03:19,865 is it fundamentally, this comes down to a cultural piece as 61 00:03:19,885 --> 00:03:23,225 so many things do, and we had to understand that 62 00:03:23,525 --> 00:03:27,505 and then address that in terms of how we do our work, 63 00:03:27,805 --> 00:03:30,865 how the hospitalists round, how they communicate 64 00:03:30,895 --> 00:03:35,225 with the nursing staff and, and discharge planners 65 00:03:35,445 --> 00:03:37,625 and how this coordination takes place. 66 00:03:38,325 --> 00:03:42,265 It was fundamentally a, a cultural shift that had in place. 67 00:03:43,915 --> 00:03:45,365 - Well, that's fascinating to hear about 68 00:03:45,425 --> 00:03:49,525 and you know, certainly awesome results in, in, um, dropping 69 00:03:49,525 --> 00:03:51,605 that length of stay by 1.5 days. 70 00:03:51,825 --> 00:03:53,685 You know, uh, a ton of credit to you 71 00:03:53,685 --> 00:03:55,405 and your team for achieving that, 72 00:03:55,405 --> 00:03:56,565 because I know it's not easy. 73 00:03:57,065 --> 00:03:59,405 And when you think about, as you were mentioning something 74 00:03:59,405 --> 00:04:01,965 like a cultural change, I, I know, um, 75 00:04:02,395 --> 00:04:05,845 that certainly doesn't, you know, doesn't always, 76 00:04:06,025 --> 00:04:07,885 um, come smoothly or naturally. 77 00:04:07,985 --> 00:04:10,885 So, you know, when you're approaching, um, having to make 78 00:04:10,955 --> 00:04:13,165 that kind of shift or make a change in the culture, 79 00:04:13,345 --> 00:04:14,365 what's important to do 80 00:04:14,445 --> 00:04:17,085 or what groundwork as a leader do you need to lay, um, 81 00:04:17,145 --> 00:04:20,445 to make sure that, you know, uh, everyone else, uh, is able 82 00:04:20,445 --> 00:04:23,525 to buy in and really achieve, um, what you're set out to do? 83 00:04:24,965 --> 00:04:26,535 - Well, well, culture drives everything. 84 00:04:27,555 --> 00:04:31,865 We, we all say that, but it really does. 85 00:04:32,485 --> 00:04:37,465 And crux of, of most cultural problems 86 00:04:38,205 --> 00:04:40,185 are, are communication 87 00:04:41,245 --> 00:04:45,825 and how, how people conduct their work, either individually 88 00:04:45,845 --> 00:04:49,215 or collectively in terms of solving problems. 89 00:04:49,275 --> 00:04:52,175 The most difficult problems are almost 90 00:04:52,195 --> 00:04:53,655 always people problems. 91 00:04:54,355 --> 00:04:55,735 And, and they are 92 00:04:55,925 --> 00:04:59,775 what Ron correctly identified no long ago at 93 00:04:59,775 --> 00:05:01,855 Harvard Adaptive problems. 94 00:05:02,115 --> 00:05:03,375 And they require adaptive. 95 00:05:04,445 --> 00:05:09,385 And an adaptive solution, by definition is one where a team 96 00:05:10,125 --> 00:05:14,545 of of committed, dedicated individuals sit down 97 00:05:14,545 --> 00:05:16,065 and solve the problem collectively. 98 00:05:16,675 --> 00:05:17,695 That's how you do it, 99 00:05:18,555 --> 00:05:21,695 and frankly, how you address the cultural piece 100 00:05:21,925 --> 00:05:25,855 because by definition, teams will bring others with them. 101 00:05:26,275 --> 00:05:29,895 That's not one person, someone like me saying, 102 00:05:30,435 --> 00:05:31,455 here's what you're gonna do. 103 00:05:32,635 --> 00:05:35,945 Rarely does that work, if it does 104 00:05:36,365 --> 00:05:39,865 or work well, if it does, it's not gonna work as well as 105 00:05:39,935 --> 00:05:42,705 what, what a team working together will solve. 106 00:05:44,075 --> 00:05:45,245 - That makes a lot of sense, you know, 107 00:05:45,245 --> 00:05:46,725 and it is really inspiring to hear. 108 00:05:47,345 --> 00:05:50,045 Now, broadening out just a bit, what are some 109 00:05:50,045 --> 00:05:51,725 of the top trends that you're following in the 110 00:05:51,725 --> 00:05:52,765 healthcare space right now? 111 00:05:52,875 --> 00:05:55,125 What is really top of mind for you and, 112 00:05:55,185 --> 00:05:56,725 and what are you trying to solve for right now? 113 00:05:57,225 --> 00:05:59,805 Um, you know, within your strategic changes, 114 00:06:01,715 --> 00:06:03,405 - What, what's going on right now is, 115 00:06:03,505 --> 00:06:05,365 is rapid change, right? 116 00:06:05,845 --> 00:06:09,925 I mean, we all see it, it, it gets changed in terms of 117 00:06:10,645 --> 00:06:14,485 turnover of personnel and our need to retain 118 00:06:15,015 --> 00:06:17,645 these great people that we work with. 119 00:06:18,985 --> 00:06:22,725 My, my emphasis is, is really on retention 120 00:06:23,265 --> 00:06:27,575 and in particular supporting the medical staff. 121 00:06:27,865 --> 00:06:32,055 Every way I can ensure that these individuals with 122 00:06:32,195 --> 00:06:36,645 so much wisdom and experience, they in this business 123 00:06:37,475 --> 00:06:40,175 and, and don't decide to do something else. 124 00:06:41,575 --> 00:06:45,415 I would say the top of the list for me 125 00:06:46,275 --> 00:06:47,735 is, is retention. 126 00:06:48,295 --> 00:06:50,735 I would just add, we've seen a dramatic 127 00:06:53,525 --> 00:06:56,245 turnover in in our nursing staff, 128 00:06:56,265 --> 00:06:57,645 and I know we're not alone. 129 00:06:58,685 --> 00:07:00,645 Everyone else is experiencing the same thing. 130 00:07:01,625 --> 00:07:03,085 And it, it is been quite dramatic. 131 00:07:04,155 --> 00:07:06,735 We came out of finished and came out of Covid. 132 00:07:08,405 --> 00:07:12,415 My daily emphasis, my 133 00:07:13,025 --> 00:07:15,775 North star for me is to ensure 134 00:07:15,775 --> 00:07:19,135 that we don't see the same thing with the medical staff. 135 00:07:19,825 --> 00:07:23,175 So far we haven't, but it's a work in progress 136 00:07:24,485 --> 00:07:25,505 as we come out of covid 137 00:07:25,885 --> 00:07:29,705 and everyone is looking at this new world that we're in 138 00:07:30,055 --> 00:07:33,665 with 100% hospital census eds 139 00:07:33,665 --> 00:07:37,945 with patients backed up care that's been delayed 140 00:07:39,275 --> 00:07:43,145 is all, this is the new normal for all of us. 141 00:07:43,605 --> 00:07:46,865 And, and how we adapt to that 142 00:07:46,965 --> 00:07:49,105 and how we support one another, getting 143 00:07:49,105 --> 00:07:53,195 through it is really gonna define where we end up. 144 00:07:55,325 --> 00:07:56,725 - I, I think that makes a lot of sense 145 00:07:57,025 --> 00:07:58,845 and certainly, you know, hearing from 146 00:07:59,305 --> 00:08:01,565 so many executives across the healthcare space 147 00:08:01,905 --> 00:08:06,245 and speaking to, you know, trying to have the, those results 148 00:08:06,245 --> 00:08:10,005 with the retention in combating the nurse turnover as well 149 00:08:10,005 --> 00:08:12,765 as, um, just building within the teams, the culture 150 00:08:12,765 --> 00:08:15,045 that you described earlier in our conversation of 151 00:08:15,465 --> 00:08:16,885 how people can do things together 152 00:08:17,075 --> 00:08:18,405 with each other and for each other. 153 00:08:18,625 --> 00:08:21,805 So, um, you know, I I think it's definitely a hard piece 154 00:08:21,805 --> 00:08:23,485 of the puzzle right now in healthcare to solve, 155 00:08:23,585 --> 00:08:26,125 but, um, you know, it, it, it's great to hear 156 00:08:26,125 --> 00:08:27,245 that you're focused on that 157 00:08:27,305 --> 00:08:30,765 and it sounds like, um, you know, have really, um, 158 00:08:31,075 --> 00:08:34,085 started on the journey at the very least to, to kind of, um, 159 00:08:34,785 --> 00:08:36,485 get into a space where you're able 160 00:08:36,485 --> 00:08:37,565 to solve some of those issues. 161 00:08:39,115 --> 00:08:41,405 - Well, we are, and, 162 00:08:41,745 --> 00:08:45,245 and I believe fundamentally people need to know that 163 00:08:45,755 --> 00:08:49,935 they're appreciated as professionals, as as individuals, 164 00:08:50,845 --> 00:08:53,475 that we respect them, we appreciate them, 165 00:08:53,935 --> 00:08:57,045 and we will do everything we can support them 166 00:08:57,665 --> 00:08:59,165 professionally and personally. 167 00:09:01,425 --> 00:09:03,545 - Absolutely. Know that you're spot on and, 168 00:09:03,545 --> 00:09:06,785 and I, I really, um, think that's so, so important as well. 169 00:09:07,485 --> 00:09:09,345 Now, you know, looking ahead into the future, 170 00:09:09,565 --> 00:09:10,785 how are you thinking about growth 171 00:09:10,845 --> 00:09:13,585 and development, um, over the next two to three years or so? 172 00:09:15,925 --> 00:09:18,455 - Well, we're seeing the same thing everyone else has seen, 173 00:09:19,255 --> 00:09:23,615 I believe, and there's really been a dramatic shift 174 00:09:24,365 --> 00:09:28,935 independent practice to other, other forms of, 175 00:09:29,235 --> 00:09:33,375 of employment in, in particular, uh, 176 00:09:33,375 --> 00:09:37,455 hostile based employment of previously independent groups. 177 00:09:38,695 --> 00:09:39,915 And we're aware of this. 178 00:09:40,495 --> 00:09:42,235 We we're doing what we can 179 00:09:42,975 --> 00:09:47,755 to support in independent practices in, in our area 180 00:09:47,785 --> 00:09:50,595 that we have such close relationships with, 181 00:09:51,835 --> 00:09:55,715 but the landscapes really changing dramatically, 182 00:09:56,135 --> 00:10:00,645 and it is a, obviously it's a reflection of 183 00:10:01,265 --> 00:10:05,325 the new math that's out there regarding reimbursement 184 00:10:05,865 --> 00:10:09,845 and the percentage of your patients that are 185 00:10:10,535 --> 00:10:15,195 commercial versus Medicare Medicaid. 186 00:10:16,805 --> 00:10:19,445 I think that's, for me is, is one of the biggest changes. 187 00:10:20,465 --> 00:10:21,465 That's, 188 00:10:23,635 --> 00:10:24,725 - That makes a lot of sense. 189 00:10:25,385 --> 00:10:27,845 Um, you know, in in, in seeing the evolution 190 00:10:27,845 --> 00:10:29,645 and seeing that shift, I know as you mentioned, trying 191 00:10:29,645 --> 00:10:32,325 to support the independent physicians whenever possible. 192 00:10:32,425 --> 00:10:35,245 But as time goes on, um, and, 193 00:10:35,305 --> 00:10:38,605 and you see that that kind of shift in how physicians are, 194 00:10:38,705 --> 00:10:42,525 um, you know, private practice to employed in other types 195 00:10:42,525 --> 00:10:45,965 of situations, um, what does that mean, do you think, 196 00:10:45,985 --> 00:10:49,405 for healthcare and healthcare delivery overall? Well, 197 00:10:50,165 --> 00:10:54,425 - One is we, we, we need to stay in touch with it 198 00:10:55,125 --> 00:10:59,135 and, and ensure ahead of what's going on 199 00:10:59,755 --> 00:11:02,135 and anticipating the changes that take place. 200 00:11:03,635 --> 00:11:07,675 I I saw a statistic recently that 75% 201 00:11:07,675 --> 00:11:09,115 of physicians are now employed. 202 00:11:10,235 --> 00:11:14,485 I came from, I've been at Salem for 10 years 203 00:11:15,385 --> 00:11:19,445 and I, I came from a multispecialty independent 204 00:11:19,445 --> 00:11:23,525 multispecialty group up in Portland, Portland Clinic 205 00:11:24,155 --> 00:11:28,775 that the math involved with operating 206 00:11:29,465 --> 00:11:31,935 these complex clinics 207 00:11:32,975 --> 00:11:35,315 has just become more and more difficult. 208 00:11:36,485 --> 00:11:40,045 I think from the standpoint of hospitals 209 00:11:40,385 --> 00:11:45,325 and hospital systems, it means that we have a lot of 210 00:11:46,535 --> 00:11:48,585 evolution to do regarding 211 00:11:49,375 --> 00:11:53,895 what the employment model looks like and, 212 00:11:54,195 --> 00:11:58,055 and things, for example, like the medical staff model been 213 00:11:58,055 --> 00:12:02,395 around forever, how do those two models, 214 00:12:04,235 --> 00:12:06,935 how do they, how do they relate to one another? 215 00:12:07,355 --> 00:12:08,695 How do they work with one another? 216 00:12:09,765 --> 00:12:14,345 And this is an evolutionary process, one that we're going 217 00:12:14,345 --> 00:12:17,465 through right now, particularly as our medical group 218 00:12:18,225 --> 00:12:21,105 continues to increase in size as it is with, 219 00:12:21,135 --> 00:12:22,425 with others around the country. 220 00:12:23,685 --> 00:12:25,935 - Fantastic. Well, Dr. Yates, thank you so much 221 00:12:25,955 --> 00:12:27,735 for joining us on the podcast today. 222 00:12:27,855 --> 00:12:29,935 I really appreciate your perspective, perspective. 223 00:12:30,355 --> 00:12:32,575 Um, you raised some excellent points here as well 224 00:12:32,575 --> 00:12:35,015 as you know, I appreciate you sharing some of the things 225 00:12:35,015 --> 00:12:37,375 that you're doing at CM Health Hospitals and clinics. 226 00:12:37,715 --> 00:12:38,935 Um, thank you for your time today 227 00:12:38,935 --> 00:12:40,575 and I look forward to connecting with you again soon. 228 00:12:41,515 --> 00:12:42,685 - It's been a pleasure. Thank you.