1 00:00:00,240 --> 00:00:03,060 Imagine this. You're at the Hyatt Regency Chicago 2 00:00:03,439 --> 00:00:06,000 immersed in insightful discussions with the health care 3 00:00:06,000 --> 00:00:07,459 industry's top leaders. 4 00:00:07,854 --> 00:00:10,594 Welcome to Becker's 12th annual CEO 5 00:00:10,974 --> 00:00:14,834 and CFO roundtable from November 11th to 14th, 6 00:00:14,974 --> 00:00:15,474 2024. 7 00:00:16,289 --> 00:00:19,349 Picture yourself networking with over a 1000 executive 8 00:00:19,410 --> 00:00:20,309 level attendees, 9 00:00:20,689 --> 00:00:23,750 collecting business cards, and forging valuable connections. 10 00:00:24,295 --> 00:00:26,695 Feel the excitement as you engage in 4 11 00:00:26,695 --> 00:00:28,795 days of sessions featuring 400 12 00:00:29,175 --> 00:00:30,954 elite health system speakers. 13 00:00:31,429 --> 00:00:34,969 Envision yourself diving deep into critical topics like 14 00:00:35,030 --> 00:00:37,450 rural health care, digital transformation, 15 00:00:38,070 --> 00:00:40,409 health equity, and c suite diversity. 16 00:00:41,335 --> 00:00:44,715 Now imagine being inspired by our celebrity keynotes, 17 00:00:45,174 --> 00:00:48,215 pro football hall of famers Troy Aikman and 18 00:00:48,215 --> 00:00:52,079 Emmett Smith, 43rd president George w Bush, and 19 00:00:52,079 --> 00:00:55,439 author and journalist Jenna Bush Hager. Their stories 20 00:00:55,439 --> 00:00:57,564 will leave you motivated and energized. 21 00:00:58,204 --> 00:01:00,465 Don't miss this unparalleled opportunity. 22 00:01:00,844 --> 00:01:03,265 Get registered today. Visit beckershospitalreviewdot 23 00:01:04,579 --> 00:01:06,819 com and click on the events page to 24 00:01:06,819 --> 00:01:09,560 find the conference website. That's the beckershospitalreview.com 25 00:01:11,700 --> 00:01:13,719 events page. See you in Chicago. 26 00:01:15,135 --> 00:01:17,375 This is Laura Dierda with the Becker's Healthcare 27 00:01:17,375 --> 00:01:17,875 Podcast. 28 00:01:18,255 --> 00:01:19,935 I'm thrilled today to be joined by doctor 29 00:01:19,935 --> 00:01:22,629 Todd Smith, chief physician executive at Sutter Health. 30 00:01:22,709 --> 00:01:24,069 Doctor Smith, it's a pleasure to have you 31 00:01:24,069 --> 00:01:25,209 on the podcast today. 32 00:01:25,829 --> 00:01:27,269 Pleasure to be here, Laura. Thank you for 33 00:01:27,269 --> 00:01:28,009 having me. 34 00:01:28,310 --> 00:01:29,509 Now I know we've got a lot to 35 00:01:29,509 --> 00:01:31,114 talk about. There's so much happening in the 36 00:01:31,114 --> 00:01:33,114 health care space, and, certainly, Sutter has really 37 00:01:33,114 --> 00:01:35,515 been busy over the last few years and 38 00:01:35,515 --> 00:01:37,194 a lot going on with the organization as 39 00:01:37,194 --> 00:01:38,634 well. But before we dive in, I was 40 00:01:38,634 --> 00:01:39,915 wondering if you could tell us a little 41 00:01:39,915 --> 00:01:41,579 bit more yourself and your background? 42 00:01:42,600 --> 00:01:44,520 Yeah. I'd be happy to. So I'm an 43 00:01:44,520 --> 00:01:47,400 orthopedic hand surgeon by training, and I practiced 44 00:01:47,400 --> 00:01:48,055 here in, 45 00:01:48,534 --> 00:01:51,834 with Sutter for about 27 years 1997. 46 00:01:52,855 --> 00:01:55,415 Approximately 5 years ago, after doing a lot 47 00:01:55,415 --> 00:01:57,709 of medical group leadership, I took over as 48 00:01:57,709 --> 00:02:00,209 one of the foundation chief executive officers 49 00:02:00,670 --> 00:02:02,590 in one of our regions called the Central 50 00:02:02,590 --> 00:02:03,090 Valley. 51 00:02:03,629 --> 00:02:04,930 And about a year ago, 52 00:02:05,734 --> 00:02:08,134 right after Warner Thomas got here, the position 53 00:02:08,134 --> 00:02:10,474 for Chief Position Executive was created 54 00:02:11,014 --> 00:02:13,659 as a dyad for operations with the Chief 55 00:02:13,740 --> 00:02:15,360 Operating Officer, Mark Sevko. 56 00:02:15,740 --> 00:02:17,340 And so, for the last year, I've been 57 00:02:17,340 --> 00:02:19,760 working in that position at a system level, 58 00:02:20,540 --> 00:02:21,760 working with them particularly 59 00:02:22,300 --> 00:02:24,034 on a lot of our priorities like growth 60 00:02:24,034 --> 00:02:24,775 and access. 61 00:02:25,794 --> 00:02:27,235 That's great to hear. And, you know, I 62 00:02:27,235 --> 00:02:27,895 can imagine, 63 00:02:28,275 --> 00:02:30,449 there's always a lot happening within the growth 64 00:02:30,449 --> 00:02:32,289 access to care and a really cool model 65 00:02:32,289 --> 00:02:33,750 you have with the dyad 66 00:02:34,050 --> 00:02:36,709 partnering the clinical leader with the operational leader. 67 00:02:36,849 --> 00:02:38,849 Based on our previous conversations, it seems like 68 00:02:38,849 --> 00:02:41,444 you've had some great successes in in being 69 00:02:41,444 --> 00:02:42,185 able to, 70 00:02:43,044 --> 00:02:45,444 design and develop some models of care and 71 00:02:45,444 --> 00:02:47,305 operations that are really gonna be impactful, 72 00:02:47,685 --> 00:02:49,064 for health care in the future. 73 00:02:50,629 --> 00:02:52,469 Absolutely. It's been a real pleasure to work 74 00:02:52,469 --> 00:02:54,789 with someone like Mark. And because we both 75 00:02:54,789 --> 00:02:57,430 got the same values as far as, really 76 00:02:57,430 --> 00:02:59,435 trying to promote our people, and 77 00:03:00,455 --> 00:03:01,995 really put our patients first. 78 00:03:02,375 --> 00:03:04,614 That's really allowed us to really look at 79 00:03:04,614 --> 00:03:06,395 our priorities, which have been around 80 00:03:07,334 --> 00:03:08,680 growth of the organization 81 00:03:09,300 --> 00:03:10,039 as well 82 00:03:10,419 --> 00:03:12,419 as growth of our services and access to 83 00:03:12,419 --> 00:03:13,080 our patients. 84 00:03:13,699 --> 00:03:15,800 Access has been one of our biggest challenges 85 00:03:16,205 --> 00:03:18,125 across the organization as well as just in 86 00:03:18,125 --> 00:03:19,185 the industry itself. 87 00:03:19,564 --> 00:03:21,644 And partnering with somebody like Mark allows us 88 00:03:21,644 --> 00:03:24,319 to bring the administrative plus the clinical views 89 00:03:24,459 --> 00:03:25,259 to attempt to, 90 00:03:25,659 --> 00:03:27,580 address some of the very difficult challenges we've 91 00:03:27,580 --> 00:03:28,080 had. 92 00:03:28,939 --> 00:03:30,459 That makes a lot of sense. And, you 93 00:03:30,459 --> 00:03:30,959 know, 94 00:03:31,419 --> 00:03:33,504 spring boarding from there, are some of your 95 00:03:33,504 --> 00:03:35,025 top priorities for the rest of the year? 96 00:03:35,025 --> 00:03:36,645 What are you really focused on? 97 00:03:37,745 --> 00:03:40,305 Really focused we're focused on several things, obviously, 98 00:03:40,305 --> 00:03:41,689 Laura. But if I had to boil it 99 00:03:41,689 --> 00:03:44,189 down to 2 or 3, really it's around 100 00:03:45,129 --> 00:03:46,989 clinician and clinical growth, 101 00:03:47,769 --> 00:03:48,254 really 102 00:03:48,655 --> 00:03:50,575 to focus on a couple of things, to 103 00:03:50,575 --> 00:03:52,814 bring in top quality individuals who can provide 104 00:03:52,814 --> 00:03:55,294 the best quality care for our patients and 105 00:03:55,294 --> 00:03:57,680 create the centers and destination of excellence, but 106 00:03:57,680 --> 00:03:59,219 also really about access, 107 00:04:00,000 --> 00:04:02,479 improving our access. We know that the just 108 00:04:02,479 --> 00:04:04,694 access to healthcare, whether it's primary care, whether 109 00:04:04,694 --> 00:04:07,495 it's behavioral health, whether it's surgical care really 110 00:04:07,495 --> 00:04:08,794 is a challenge across 111 00:04:09,254 --> 00:04:10,004 the environment. 112 00:04:10,520 --> 00:04:12,439 And so we're moving forward and trying to 113 00:04:12,439 --> 00:04:13,800 do that in a way that actually makes 114 00:04:13,800 --> 00:04:15,180 it easier for the patients. 115 00:04:15,560 --> 00:04:18,360 And in so doing, we're actually focusing on 116 00:04:18,360 --> 00:04:18,860 developing 117 00:04:19,454 --> 00:04:22,414 service lines, so that as people move through 118 00:04:22,414 --> 00:04:24,574 the system and receive their care, it becomes 119 00:04:24,574 --> 00:04:25,074 seamless 120 00:04:25,535 --> 00:04:26,354 and it becomes 121 00:04:26,680 --> 00:04:28,279 a journey that we are on with them 122 00:04:28,279 --> 00:04:29,879 in the process. But if I had to 123 00:04:29,879 --> 00:04:32,439 boil it down, it's around service lines, it's 124 00:04:32,439 --> 00:04:35,339 around access, it's around, clinician growth. 125 00:04:36,764 --> 00:04:38,524 That's really fascinating to hear. And, you know, 126 00:04:38,524 --> 00:04:40,064 in particular, you mentioned 127 00:04:40,524 --> 00:04:42,285 that access a few times already in our 128 00:04:42,285 --> 00:04:42,785 conversation. 129 00:04:43,639 --> 00:04:45,079 Is there anything you can share with us 130 00:04:45,079 --> 00:04:47,160 that you've done in particular around expanding that 131 00:04:47,160 --> 00:04:50,439 access to care that has, been beneficial or 132 00:04:50,439 --> 00:04:50,939 really, 133 00:04:51,399 --> 00:04:53,180 shown some great results for the system? 134 00:04:54,584 --> 00:04:56,264 It's interesting. I wish I could tell you 135 00:04:56,264 --> 00:04:58,185 that there were things that we've really decreased 136 00:04:58,185 --> 00:04:59,084 the wait times. 137 00:04:59,625 --> 00:05:01,705 And right now, the demand is so high 138 00:05:01,705 --> 00:05:03,449 that as we add clinicians, 139 00:05:04,069 --> 00:05:06,569 so we've had a record year in 2023 140 00:05:06,590 --> 00:05:07,850 and even in 141 00:05:08,230 --> 00:05:08,730 2024, 142 00:05:09,110 --> 00:05:12,714 we've added another 500 physicians and APCs across 143 00:05:12,714 --> 00:05:13,935 the organization, which 144 00:05:14,555 --> 00:05:16,414 is up from approximately 4,500. 145 00:05:16,714 --> 00:05:19,194 So really almost about a 10% increase in 146 00:05:19,194 --> 00:05:22,269 number of clinicians over time. We're still seeing 147 00:05:22,649 --> 00:05:23,870 challenges in 148 00:05:24,329 --> 00:05:26,329 people being able to get in. However, one 149 00:05:26,329 --> 00:05:27,689 of the things that we've been able to 150 00:05:27,689 --> 00:05:29,469 do is really work on our referrals 151 00:05:30,394 --> 00:05:32,475 and really decrease the time to referral, 152 00:05:32,795 --> 00:05:34,555 so that the patients, when they do need 153 00:05:34,555 --> 00:05:36,314 a referral, they know they've been heard, they 154 00:05:36,314 --> 00:05:38,009 know there's a spot for them, and they 155 00:05:38,009 --> 00:05:39,930 at least know they're they're being taken care 156 00:05:39,930 --> 00:05:41,930 of. The other thing we're doing a lot 157 00:05:41,930 --> 00:05:43,790 is really working toward implementing 158 00:05:45,235 --> 00:05:48,274 virtual care, in a way that everybody's doing 159 00:05:48,274 --> 00:05:50,115 some virtual care, but how do we actually 160 00:05:50,115 --> 00:05:52,295 improve this? How do we increase the accessibility 161 00:05:52,595 --> 00:05:55,050 to it such that there is a mechanism 162 00:05:55,050 --> 00:05:57,289 for somebody to get care when they need 163 00:05:57,289 --> 00:05:58,729 it and when they want it in the 164 00:05:58,729 --> 00:06:00,625 process. All of those are in flight. 165 00:06:01,024 --> 00:06:03,745 And we also hope to kind of see 166 00:06:03,745 --> 00:06:06,545 improvements in that. We've seen increases in the 167 00:06:06,545 --> 00:06:09,824 number of digital online appointments as well, which 168 00:06:09,824 --> 00:06:12,620 really helps to decrease that barrier to care, 169 00:06:12,920 --> 00:06:15,079 so that people can really connect with us 170 00:06:15,079 --> 00:06:16,519 in a way that makes more sense for 171 00:06:16,519 --> 00:06:17,019 them. 172 00:06:17,935 --> 00:06:19,935 That is really helpful to know and understand 173 00:06:19,935 --> 00:06:21,694 and, you know, wow. That that's a lot 174 00:06:21,694 --> 00:06:23,775 of, clinicians to bring in between the physicians 175 00:06:23,775 --> 00:06:25,500 and APP is adding 500 176 00:06:25,879 --> 00:06:27,879 over the last, you know, 12 to 18 177 00:06:27,879 --> 00:06:30,040 months or so. I can imagine that has 178 00:06:30,040 --> 00:06:32,439 been a huge undertaking for the organization, but 179 00:06:32,439 --> 00:06:34,595 good to hear that, you know, that coupled 180 00:06:34,595 --> 00:06:37,175 with some of the other strategies around referrals 181 00:06:37,194 --> 00:06:39,875 and and potentially virtual care coming as well, 182 00:06:40,800 --> 00:06:42,579 could make a difference for accessibility, 183 00:06:43,120 --> 00:06:44,019 within the community. 184 00:06:45,279 --> 00:06:48,295 Yeah. Absolutely. It really, and we are partnering 185 00:06:48,295 --> 00:06:48,795 with 186 00:06:49,415 --> 00:06:51,095 our clinicians in the community as well to 187 00:06:51,095 --> 00:06:53,435 try and improve that as well. We've got 188 00:06:53,574 --> 00:06:55,250 programs that are working with them to help 189 00:06:55,329 --> 00:06:57,029 them with some of the digital access 190 00:06:57,370 --> 00:06:57,870 pieces, 191 00:06:58,290 --> 00:07:01,569 too. And so it's an and strategy, not 192 00:07:01,569 --> 00:07:02,949 an either or strategy. 193 00:07:04,634 --> 00:07:06,314 Got it. And that's really living in that 194 00:07:06,314 --> 00:07:08,154 and is such an important place to be. 195 00:07:08,154 --> 00:07:10,794 Now what other programs or initiatives have been 196 00:07:10,794 --> 00:07:12,875 the most needle moving for your you over 197 00:07:12,875 --> 00:07:13,209 the last 198 00:07:21,769 --> 00:07:22,002 our mission, vision, values. And really when you 199 00:07:22,002 --> 00:07:23,955 think about, you know, that our mission, vision, 200 00:07:23,955 --> 00:07:25,975 values and really when you think about 201 00:07:26,435 --> 00:07:28,694 that sort of mission statement, it became 202 00:07:29,074 --> 00:07:30,855 patients first and people always. 203 00:07:31,235 --> 00:07:33,069 And really what that speaks to is the 204 00:07:33,069 --> 00:07:34,670 fact that we're all here to serve the 205 00:07:34,670 --> 00:07:36,750 patients and we have to take care of 206 00:07:36,750 --> 00:07:38,350 our people in the process. And so it's 207 00:07:38,350 --> 00:07:40,455 really about taking care of our people so 208 00:07:40,455 --> 00:07:42,074 that they can take care of our patients. 209 00:07:42,535 --> 00:07:44,935 That's been needle moving and that we've been 210 00:07:44,935 --> 00:07:46,314 investing in our people, 211 00:07:46,935 --> 00:07:49,850 investing in creating a culture of working together, 212 00:07:49,990 --> 00:07:51,050 working as a team, 213 00:07:51,350 --> 00:07:53,050 getting to a culture of yes. 214 00:07:53,430 --> 00:07:55,350 And so what that's allowed us to do 215 00:07:55,350 --> 00:07:58,490 is to increase the transfers into our system, 216 00:07:59,805 --> 00:08:02,365 with approximately 10% more transfer we've been able 217 00:08:02,365 --> 00:08:05,345 to accept. We've been working very hard on 218 00:08:05,485 --> 00:08:07,509 how do we actually improve our length of 219 00:08:07,509 --> 00:08:10,410 stay and so doing utilize our resources better 220 00:08:10,870 --> 00:08:13,509 and really improve our overall volume. So we're 221 00:08:13,509 --> 00:08:15,289 able to take care of more patients 222 00:08:15,664 --> 00:08:17,764 and have more patients come into the system. 223 00:08:18,064 --> 00:08:20,324 And all of those really have helped us 224 00:08:20,625 --> 00:08:23,264 serve our patients better, but also take care 225 00:08:23,264 --> 00:08:24,964 of our people while we're doing it. 226 00:08:26,160 --> 00:08:27,520 That makes a lot of sense. And, you 227 00:08:27,520 --> 00:08:29,199 know, I I love that idea of being 228 00:08:29,199 --> 00:08:29,939 able to, 229 00:08:30,560 --> 00:08:32,960 have the clinicians and caregivers be in a 230 00:08:32,960 --> 00:08:35,225 great spot to take care of patients. I 231 00:08:35,225 --> 00:08:37,544 know physician wellness is something that's on top 232 00:08:37,544 --> 00:08:38,605 of so many different, 233 00:08:39,225 --> 00:08:42,504 people's minds and health systems and organizations across 234 00:08:42,504 --> 00:08:43,164 the nation. 235 00:08:43,759 --> 00:08:45,279 And, you know, when you look at Sutter, 236 00:08:45,279 --> 00:08:47,279 being able to invest in that and invest 237 00:08:47,279 --> 00:08:48,660 in having a great culture, 238 00:08:49,440 --> 00:08:51,519 you know, it it seems easy, but I 239 00:08:51,519 --> 00:08:54,185 can imagine it's a lot harder, to actually 240 00:08:54,185 --> 00:08:55,705 do and implement and live out on a 241 00:08:55,705 --> 00:08:56,524 daily basis. 242 00:08:57,305 --> 00:09:00,024 What makes Sutter unique? I you know, especially 243 00:09:00,024 --> 00:09:00,764 in given, 244 00:09:01,785 --> 00:09:03,279 like like I said, a lot of organizations 245 00:09:03,279 --> 00:09:04,960 are trying to do this. So what actually 246 00:09:04,960 --> 00:09:07,600 makes you your culture and your, programs around 247 00:09:07,600 --> 00:09:09,759 physician wellness different from what everybody else is 248 00:09:09,759 --> 00:09:10,259 doing? 249 00:09:11,414 --> 00:09:13,174 You know, I I I think it I 250 00:09:13,174 --> 00:09:15,414 don't I'm not sure it's unique as much 251 00:09:15,414 --> 00:09:17,115 as it is it's a focus. 252 00:09:17,894 --> 00:09:20,590 And so from the corner office from when 253 00:09:20,590 --> 00:09:23,870 Warner started to the elevation of the physician 254 00:09:23,870 --> 00:09:24,370 presence 255 00:09:24,830 --> 00:09:27,654 at the executive leadership team to focus 256 00:09:28,855 --> 00:09:32,134 on engaging the clinicians in decision making both 257 00:09:32,134 --> 00:09:34,394 on a strategic and operational front. 258 00:09:34,855 --> 00:09:36,579 I think what that's done is that's 259 00:09:36,879 --> 00:09:38,259 elevated and reengaged 260 00:09:38,559 --> 00:09:39,059 them 261 00:09:39,440 --> 00:09:41,379 in a way that we have not seen 262 00:09:42,159 --> 00:09:45,254 in other areas. What this has resulted in 263 00:09:45,815 --> 00:09:47,335 at the end of the day is not 264 00:09:47,335 --> 00:09:50,294 only excellent hiring from that standpoint, but our 265 00:09:50,294 --> 00:09:52,375 retention has actually been pretty good as well. 266 00:09:52,375 --> 00:09:53,995 Currently our projected 267 00:09:54,730 --> 00:09:56,750 turnover for this year for 2024 268 00:09:57,129 --> 00:09:58,909 is going to be around 3%, 269 00:09:59,529 --> 00:10:01,690 which is down from 5% the year before 270 00:10:01,690 --> 00:10:03,709 and 7% the year before that. 271 00:10:04,089 --> 00:10:05,454 That coupled with 272 00:10:06,074 --> 00:10:06,975 the increased 273 00:10:07,514 --> 00:10:10,235 retention on the staff side has really made 274 00:10:10,235 --> 00:10:11,054 for stabilization 275 00:10:12,169 --> 00:10:13,629 of the workforce itself 276 00:10:14,089 --> 00:10:16,250 that actually has allowed us to move forward 277 00:10:16,250 --> 00:10:17,069 in the process. 278 00:10:17,610 --> 00:10:20,250 We also just started a program with the 279 00:10:20,250 --> 00:10:21,549 American Medical Association, 280 00:10:22,815 --> 00:10:25,134 looking at joy of work and how do 281 00:10:25,134 --> 00:10:27,134 we engage better. And so we've got a 282 00:10:27,134 --> 00:10:28,754 lot of opportunities there 283 00:10:29,209 --> 00:10:31,289 and it really is top of mind. But 284 00:10:31,289 --> 00:10:34,649 I think engaging the medical groups we work 285 00:10:34,649 --> 00:10:37,529 closely within this, has really been very helpful 286 00:10:37,529 --> 00:10:38,189 for that. 287 00:10:39,225 --> 00:10:41,144 That's great to hear. Now before we wrap 288 00:10:41,144 --> 00:10:43,144 up, I'm wondering how are you thinking about 289 00:10:43,144 --> 00:10:45,404 growth and patient experience going forward? 290 00:10:46,759 --> 00:10:49,240 So, I really appreciate the question, really. If 291 00:10:49,240 --> 00:10:51,399 we think about growth, it's really gonna be 292 00:10:51,399 --> 00:10:54,200 about supporting and expanding the workforce. We've talked 293 00:10:54,200 --> 00:10:55,855 about the physicians and the APCs, 294 00:10:56,475 --> 00:10:58,554 but it's also about expanding where we provide 295 00:10:58,554 --> 00:11:01,434 the care in both ambulatory surgery centers as 296 00:11:01,434 --> 00:11:02,654 well as urgent cares, 297 00:11:03,049 --> 00:11:04,649 and then really looking at how do we 298 00:11:04,649 --> 00:11:07,769 organize around service lines, so that provides that 299 00:11:07,769 --> 00:11:10,669 growth vehicle and that growth opportunity for us 300 00:11:10,754 --> 00:11:13,475 and making the work that the clinicians do 301 00:11:13,475 --> 00:11:14,855 for the patients easier 302 00:11:15,394 --> 00:11:18,054 as opposed to harder and allowing them to 303 00:11:18,434 --> 00:11:19,414 connect with them. 304 00:11:20,049 --> 00:11:22,529 If you think about patient experience, it's a 305 00:11:22,529 --> 00:11:24,449 lot of it we're thinking about meeting the 306 00:11:24,449 --> 00:11:25,750 patients where they are, 307 00:11:26,449 --> 00:11:26,949 redesigning 308 00:11:27,250 --> 00:11:30,485 our online presence, redesigning the way that we 309 00:11:30,485 --> 00:11:33,365 interact with them and that digital engagement is 310 00:11:33,365 --> 00:11:34,184 so important. 311 00:11:34,940 --> 00:11:38,080 Looking at things like online appointments, virtual care, 312 00:11:38,460 --> 00:11:39,759 continuous home monitoring, 313 00:11:40,060 --> 00:11:42,000 if you look year over year, 314 00:11:42,764 --> 00:11:43,264 we 315 00:11:43,965 --> 00:11:46,865 increased our online appointments by approximately 316 00:11:47,325 --> 00:11:47,825 250,000 317 00:11:48,284 --> 00:11:49,184 year over year, 318 00:11:50,029 --> 00:11:52,190 which is really pretty important because that is 319 00:11:52,190 --> 00:11:53,970 that's the way that a lot of people 320 00:11:54,190 --> 00:11:56,429 want to interact with us. And so creating 321 00:11:56,429 --> 00:11:58,754 an opportunity for them really I think will 322 00:11:58,754 --> 00:12:00,455 be helpful for us moving forward. 323 00:12:00,835 --> 00:12:03,654 And then creating that consistency across the organization, 324 00:12:03,795 --> 00:12:05,259 I mean, how do we ensure that the 325 00:12:05,259 --> 00:12:07,200 patients when they are with us, 326 00:12:07,899 --> 00:12:09,820 they get a warm welcome. They know that 327 00:12:09,820 --> 00:12:11,899 we're happy that they've chosen us for their 328 00:12:11,899 --> 00:12:14,024 care. We can narrate their care. We can 329 00:12:14,024 --> 00:12:15,784 let them know what is going on and 330 00:12:15,784 --> 00:12:18,105 what will be there and take some of 331 00:12:18,105 --> 00:12:20,860 the unknown out of it. And then fond 332 00:12:20,860 --> 00:12:22,700 farewell. Let them know that we're happy they 333 00:12:22,700 --> 00:12:25,339 chose us. We appreciate the honor and the 334 00:12:25,339 --> 00:12:27,261 ability to be able to take care of 335 00:12:27,261 --> 00:12:28,134 them and create 336 00:12:28,514 --> 00:12:31,715 that constant and lasting relationship. So as we 337 00:12:31,715 --> 00:12:33,794 move forward, that's sort of how we're thinking 338 00:12:33,794 --> 00:12:35,899 about both growth as well well as patient 339 00:12:36,439 --> 00:12:36,939 experience. 340 00:12:37,480 --> 00:12:39,639 That's amazing to hear. Doctor Smith, thank thank 341 00:12:39,639 --> 00:12:40,919 you so much for joining us on the 342 00:12:40,919 --> 00:12:42,924 podcast today. This has been such a fun 343 00:12:43,004 --> 00:12:44,445 conversation, and I look forward to connecting with 344 00:12:44,445 --> 00:12:45,345 you again soon. 345 00:12:45,964 --> 00:12:47,745 Absolutely. Thank you for having me, Laura.