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