Hello everyone and welcome to the Becker's Healthcare
Podcast.
I'm Mackenzie Bean, associate vice president and managing
editor of Becker's Hospital Review.
Today I'm so thrilled to be joined by
Doctor. Geraldo Xavier,
chief medical officer of Atlantic Health Systems, Hackettstown
and Newton Medical Centers.
Doctor Xavier, thank you for joining us today.
How are you doing?
I am doing really well, Mackenzie. Thank you
so much for having me. I am,
appreciate the opportunity to participate,
in the podcast and really looking forward to
the conversation.
Well, I'm looking forward to it just as
much.
I know I was reading,
your bio,
just before this, and
it it had a line that I really
loved, which is you have a strong reputation
for being a change management champion. And I
feel like that's probably gonna shine through today,
so I'm excited to,
learn more about that and some of the
work you're doing at Atlantic Health. But before
we dive into that specifically,
can you just share a little bit more
about yourself and your background?
Absolutely.
So yeah. You know, I was reflecting on,
what we're gonna talk about today, and I
thought to myself,
Jesus. I am a board certified
practicing emergency physician for now over twenty years,
and I thought Amazing. Time does fly.
But, yeah, I I completed my education
at
UMDNJ Robert Wood Johnson University Medical School, which
is now actually renamed Rutgers Robert Wood Johnson
Medical School where I got a dual degree.
I did a medical degree as well as
a master's in public health.
I then completed my emergency medicine residency training
in New York City,
my home state,
and, at the previously Columbia affiliated St. Luke's
Roosevelt Hospital System, which
has now also been renamed and is now
within the Mount Sinai family, and it's, Mount
Sinai
Morton Side and Mount Sinai West.
From there, I've I've had several years of
practice.
I went back to school and got my
master's in business administration
from Haslam College of Business at the University
of Tennessee,
in Knoxville.
Along my educational journey, I also completed a
safety quality informatics and leadership program at Harvard
School of Medicine
and the adviser program
at IHI, which is the Institute for Healthcare
Improvement.
Here is where you'll see a lot of
the training around change management,
that we'll talk about in terms of how
I,
incorporate that to do work,
at my facilities, and I'm also a certified
Lean Greenbelt Six Sigma.
So over the two decades, in addition to
clinical practice, I've had several leadership roles including
department chair,
chief quality officer
at both community,
hospitals and large level one trauma academic centers
leading multidisciplinary
cross functional teams.
As you stated in my current role at
Atlantic Health System, I serve as the chief
medical officer over
two of our, hospitals in the Western Region,
Hackettstown and Newton Medical Center.
And currently, some of my responsibilities,
include leadership oversight
of clinical operation, including care
coordination,
quality and patient safety initiatives,
obviously, our med staff functions and working to
ensure
we strengthen the relationship and,
and,
engagement and alignment with the or from the
with the organization
and the med staff, which
I have the privilege of working with both
employed,
physicians
and allied head workers as well as private,
physicians and allied head professionals.
I also served as a cochair of our
Atlantic Health System women leadership
business resource group.
I really continue to serve as a mentor
to many of our emerging leaders both within
the organization
and outside.
I thought about, wow.
That's a lot of documented accomplishment around education
and work, but maybe I should share a
little bit about me, which is
I couldn't do any of this without my
the support of my family.
I've been really fortunate
to have an extremely supportive spouse of twenty
five years
and three amazing kids who keep us busy
and grounded,
and really enjoy
traveling with our family.
Our last
trip,
we did was to South Africa, and that
was really,
eye opening in so many ways. I got
the opportunity
to visit Robben Island where
Nelson Mandela and other political
figures were held and just really sharing that
history with our children,
who are all school aged.
And, of course, we you cannot go to
South Africa without, going to the safari and
experiencing the diverse,
biodiversity
of the, not just the culture, but of
the environment. And, so that was really a
fun thing to do with with my family.
And then for me, balancing all of that,
I enjoy being outdoors. So I'm a long
distance runner,
and so
I love participating in short distances, five k's,
as well as half marathons.
So I that keeps me busy
with the current lifestyle that I live. So,
hopefully, that gives you a little bit of
flavor
as to who I am and what really
drives me in terms of the
the work that I do.
Absolutely.
Sounds like an extremely full life, full career,
and I think that paints a great picture
of,
you know, the type of leader you are
and the experiences that shape you.
I'd love to hone in now on some
of the work you're doing at Atlantic Health
that you, I know, started to allude to.
Can you tell us that maybe a a
successful project or initiative that you're particularly proud
of from the last year? What was it?
What results did you see?
Yeah. No. Thanks. That's a that's thanks for
that question. That's really a major part of
the work I do with any organization
is around really
aligning and organizing around our strategic,
enterprise strategic objectives,
which I am really,
really fortunate to be part of an organization
whose focus is demonstrating excellence at the highest
national level,
leading improvement
around patient access, experience, and affordability.
And so when we embark on initiatives, we
really strategize
our initiatives around our four main pillars.
And just to share, our main pillars of
how we do work is around performance,
population health, growth and stability,
innovation research, and education.
So under those,
four domain, we
focus on the performance domain,
that would align with our quality goals
as one of our priorities,
which was to reduce
thirty day readmission rates
on CMS hospital readmit reduction penalty program.
This program includes principal diagnoses
such as heart failure,
chronic obstructive pulmonary disease,
acute myocardial infarction, and pneumonia.
In my region, we in reviewing the data,
we saw opportunities to improve our outcomes
by decreasing the readmission rates across these cohorts.
So using data to guide our decisions,
we put together a multidisciplinary
team of key stakeholders
including
cardiologists,
hospital medicine,
pulmonologists,
pharmacy,
nursing,
transitions of care,
members that interacts with the patient and the
community to name a few.
We also embarked on using
robust,
performance improvement methodology and tools
to create a charter establishing
the process measures
that we seek to improve
the outcome measures and the balancing measures so
that we know,
what are the changes
that we're gonna make that may lead to
the improvement that we seek.
Additionally,
we work with frontline teams to streamline multiple
workflows,
creating education materials
for both
the team members as well as the patient,
to ensure that we are providing
the right amount of information and tools to
our patient including,
scales to make sure that they can weigh
themselves at home, etcetera.
We definitely collaborated with providers in the community
as well to ensure that we could have
a follow-up appointment scheduled for within one week
of discharge. And as I had indicated in
the past, in the community that I serve
and I work with, we do have, again,
employed physicians as well as independent practitioners of
the medical staff. So it was totally
being very inclusive,
of the way that we do provide care
for our patients in our community. And, of
course, making sure that we utilize our transitions
of care nurses to monitor the patients post
discharge.
Just really proud of. There's a lot of
work that went into that over several months.
We did celebrate the small wins as we
move along the project milestones.
And, really, at the end, we, we outperformed
the expected targets in all the cohorts.
Really proud to say that we took that
work, some of that work,
and,
submitted,
and it was and submitted the work, and
that was accepted for poster presentation at the
twenty twenty four
International Healthcare Institute, which is for short IHI
forum. So our team's
part of the celebration was going to IHI,
and presenting the work that we did and
sharing,
across the national's
forum
the things we did to see the improvements
that we saw.
Certainly, one of the challenges and I'm always
looking at what are the lessons learned. And
the lesson learned one of the lessons learned
is really about
what we find to be successful is really
the really,
intentional way we communicate it with the multidisciplinary
team
to share the reason for action. Why are
we doing this? Why does it matter? How
does it align with the organizational
priority? And how does it align in how
we care for our patients
so that they can receive the best care
and the best outcome possible,
within our system? And in and
when you talk about transition as well as
when they're in their communities
in the ambulatory setting.
The other thing we learned is that there
is sometimes challenges in follow ups of patients,
because many of them may have some social
determinants of health factors. So how do we
bake around using the resources in the community
to provide those,
those
patients with the things they need so that
they could get the medicine, so that they
can have transportation to go to the appointment
as such for for those,
what we call SDOH risk factors.
So, yeah, that that that was really, it
was a joy and and a pleasure, and
we continue to,
see sustained results even throughout this time where
the teams are just monitoring all the intervention
measures we put in place to ensure we
stay on track.
Wow. It sounds like extremely impressive results and
how meaningful for the team to be able
to present it at IHI and really share
that as a national example for other systems
to learn from as well. And I appreciate
you outlining those lessons. It sounds like that
intentional communication
and really explaining the purpose and why it
was, like, so crew so crucial to the
program success.
Absolutely.
Well, let's look ahead maybe to the next
year
for the in the sake of constant improvement.
What is the biggest challenge that you're thinking
about right now, or is there another specific
initiative,
or project that you're working on in 2025
that you'd like to know?
For for us and
clearly, as you know,
health care,
delivery is changing rapidly. It's constantly evolving. As
a CMO, you're constantly you have to stay
agile and really adjust to some of the
changes. However, I would suggest to you one
of our biggest challenge, and I'm sure it's
a challenge for some organization, is really access
to specialties.
I think that we were not immune to
the great resignation that we saw at the
at the somewhat towards the end of the
pandemic.
And I think that exacerbated an existing workforce
challenge that we were already having.
And so
how do we ensure
that we can maximize
what's what's on hand,
by potentially cross training our team more appropriate
and creating care models to include
the use of advanced practice providers,
to create those access.
But also one of the things we're doing
is how do we leverage
technology such as telehealth,
for certain specialties,
such as stroke care to to ensure that
we have timeliness,
of responses to some of these acute care
needs.
And another thing we saw,
you know, at the end of the pandemic
is just the
increase in behavioral health needs,
that enter in our, emergency department,
seeking care. So leveraging technology of virtual consults
to quickly provide access to patients in need,
because it's such a challenging resource
that we experience across the country in terms
of psychiatrists or mental health professionals.
Excuse me. So so certainly,
really recognizing
how we should be able to,
quickly organize about ensuring that we could get
those access to our patient. Because as we
know, at least those virtual consults are providing
the means to be able to do that
do help us to reduce wait times and
help us to increase,
access for patients that may not be able
to travel. We talk about, again, these risk
factors that may challenge or make it difficult
for patients to get to what they need,
but also allows specialists or just for us
to reach a broader, broader population
for sure. Another way,
we we have sort of
took on this challenge is looking for other
ways to create access. And recently,
we were able to,
in a collaborative,
have a collaborative joint venture with one of
our partners,
alongside a partner in a community who's a
multispecialty
physician group
across several location of our region, therefore, helping
us to expand and create more access to
services in the region so that we can
then
really ensure that we are providing
comprehensive,
care across the the continuum. So it's really
being smart about how do you then also,
create care models or work that will support
the ability
to provide the access along
the enterprise.
Because, again, as a system using systemness or,
capacity,
at one space may be able to be
shared
with another space and really creating those type
of loopholes
to really,
narrow the gaps to be able to provide
those access
and be able to provide that, high level
excellent care that we expect for our patients.
So that's one of the priorities we continue
to work in, really looking at using our
community needs assessment
as,
tools that we use to really also gauge,
which is an assessment we do every three
years, to gauge what else in the community,
we need to really prioritize
as we build, whether it's as we create
our budgets, as we as we look at
building new programs,
what is that what what is it informing
us that we need to do so that
we could continue to create those accesses and
provide those services
for our community?
Sounds like a a very multi pronged approach
to improving patient access, filling some of those
specialty care gaps like you mentioned, increasing reliance
on APPs,
thinking about technology in new ways, your new
joint venture.
I appreciate you outlining that.
For the last few minutes here, I wanted
to zoom in specifically on the chief medical
officer role. Right? We're seeing care delivery itself
involved just in response to various industry
factors.
How do you see the CMO role evolving
alongside all of that?
I think it's definitely,
changed. In the last twenty years that I
said I was practicing, I when I look
back and, you know, look at what the
CMO at the organization
that I may have been at is doing
compared to fast forward twenty years later. It's
so significantly different.
You know, back then, the focus was really
on just medical staff,
oversight,
and some clinical operation, ensuring quality of health,
and that is important.
But I think today,
with the with the evolving,
changes constant changing with health care delivery, technology
advancement,
and really the focus on population health, I
think this the chief medical officers have gotta
come along and be really a strategic partner
with the rest of the leadership in the
organization,
to be able to really meet those demands.
Some of the areas that I see us
expanded into
is really population health management. And the reason
why that's really important is because, as you
know, there's a shift from a fee for
service to value based care models.
So the chief medical officers have to play
a real key role in improving patient outcomes
and and across population,
not just
for individual
patients. I just shared
the reason why improving transitions of care so
that we can decrease or manage our readmission
is so important to how we ensure that
we can manage these chronic disease.
We can manage chronic disease condition, but also
make sure there's a handoff
at a different level of care, whether the
handoff is from the inpatient side
to the ambulatory side or the handoff is
from the inpatient side to the sniff or
post acute and vice versa. And how do
we
ensure those transitions are coerced seamlessly
so that we meet the patient demand?
We we also know that we are critically
important in ensuring that we have initiatives around,
again, the social determinants of health and managing
and the health care inequities that we may
see in our communities, in our surrounding,
populations, and how to address those by bringing
in the tools and the resources to do
that. So that overall, we can really be
part of the well-being of the community, not
just,
the well-being at one stage of the patient's
journey of their life. So really multipronged
in that way. Another
key, way that,
we are also involved in ensuring
organization success is workforce well-being and development.
We talk about, you know,
I mentioned we're not immune we were not
immune in health care, not just from the
nurses' perspective, but from physician and other
health care workers,
that burnout is a reality
and becoming a real growing concern.
And as CMOs, I think we're we're critically
important to taking on a larger role addressing
these clinician well-being issues
and promoting healthy workplace culture
with nerds by ensuring we have flexible work,
and, schedules,
ensuring that the EHR is such that we
can unload,
the burden of the clinician in terms of
documentations, facilitating tools to help make sure that
we can
documentations,
facilitating tools to help make sure that we
could manage that really well, promoting a healthy
workplace culture,
I think is also important,
so that we can foster,
that engagement.
But not just that. It's really important from
a retention perspective
to be able to have really good benefits
as well while ensuring that the clinicians
are able to work at the top of
their license
and making sure we can unburden
them with the regulatory,
not regulatory, but just unburden them with the
things that we can take over from them
by doing it in a much more smart
way.
So I think that those are some of
the ways
that CMOs are also involved in terms of
creating a positive workforce culture
to ensure that you're able to recruit the
best talent possible. And, ultimately, not ultimately, and
one one of the,
area I think that I see myself, especially,
and a lot of others as me is
financial oversight. We're in we're increasingly getting involved
in
strategic financial decision. I'm working much more closely
with chief financial officer and CEO,
CEO.
I know for sure I am involved in
all of our budget and annual budgeting processes,
participate in, and really influencing
cost control measures in terms of managing expenses,
also involving growth strategy. Right? When you look
at your revenue streams, where was that look
like? What are some of the things the
market is suggesting that we should focus on
or grow into
or implement implement new,
initiatives.
One of the things I did recently not
recently, but is our robotic program.
While robotic is not new, it is an
important tool to recruit the, physician nowadays because
that's a lot of the way that they're
that they're trained. So bringing that tool also
opens up the ability to have,
an ability to provide to provide more minimally
invasive surgeries for the for the community.
And so really ensuring that we continue that
revenue generation
and really aligning
our financial,
sustainability,
along our KPIs.
So really making sure that we are fiscally
doing that in a way
that, is aligned with the organizational,
organizational goals. Sorry.
So those are some of the ways
I think CMOs
have pivoted,
over the years to really be really much
definitely a huge value add and strategic partner
with the rest of the leadership
structure in the organization.
Mhmm.
It's clear the CMOs,
you know, strategic oversight has significantly expanded and
and will continue to, and I think you
are a living example of a clinical executive
who is,
so passionate and driven in, to do what's
best for their community, their patients, and their
staff members. So
thank you so much for your time today.
This has been such an enlightening discussion, and
I appreciate you sharing more about your work.
Yeah. I appreciate the opportunity to chat with
you a little bit.
I know I'm gonna see some of you
in different spaces. I'm gonna be at the
annual conference soon, and, really, it's been a
pleasure to, you know, work with some of
your teams in different spaces. So appreciate the
opportunity to share some of the the work
that I do and what keeps me, motivated.