At athenahealth,
we know your ambulatory practice wants healthier, a
healthier business, healthier care teams, and healthier patients.
But the complexities of modern health care tech
make it hard for you and your care
teams to focus on what matters
most? That's where athenahealth can help. Our AI
native all in one solutions reduce administrative burdens,
streamline billing and payments, and deliver critical insights
when clinicians need it most. That means fewer
clicks, more time for patients, and stronger bottom
lines.
Practicing medicine is complex, but running a practice
can be that much simpler with athenahealth.
See how simpler is healthier@athenahealth.com.
Hi, everyone. And thank you so much for
tuning into this episode of the Becker's healthcare
podcast.
I'm Erica Carbajal, an editor with Becker's hospital
review. And today, I'm joined by doctor Todd
Smith, senior vice president and chief physician executive
at Sutter Health in California.
We're gonna be discussing his top priorities through
the end of the year, ambulatory
growth strategy,
and clinical standardization.
Doctor Smith, thank you so much for being
on today. Happy to have you.
Thank you for having me.
Yeah.
Well, as we enter the final stretch of
the year here, can you start by telling
us a little bit about what your top
clinical
or operational priorities are,
what are you personally spending the most energy
on right now, etcetera?
Well, thank you, Erica.
As as probably mentioned in previous podcasts as
well, we have been really growing our physician
and clinician base
significantly over the past, really, two years or
so, adding,
over 1,500 to 2,000 new clinicians.
And so
once you hire them now, you need to
actually get them onboarded operationally and up to
speed.
At the same time, we have been expanding
our ambulatory presence. So one of the biggest
issues that we've run into is obviously access
to health care, which is a which is
a national issue. We have the same problem
as well. So the two big things that
we've been focused on over the past really
eighteen months or better is really improving our
ambulatory footprint and improving and increasing our physician
and clinician base.
The 2025,
we've opened approximately
17
ambulatory sites so far, and we have another
probably five or six to go. And so
most of my time right now has been
spent
around how do we get these new sites
open,
how do we make sure they're staffed appropriately,
how do we make sure we've onboarded all
the clinicians and the staff
so that we can provide that access the
patients are really needing from that standpoint? And
focusing on providing that access and that experience
as we're sort of moving into the last
half of '25
to try to create, you know, a better
a better place not only for the patient
to receive care but also for the clinicians
to work.
And so the other part of my day
is spent really thinking about and supporting our
clinicians,
and what does that look like to practice
at Sutter Health with the advent of new
clinical technologies, with the advent of some of
the support structures we have as we move
forward. So a lot of work really around
that that that clinical base to try and
improve our access and experience,
for the patients.
Yeah. Thanks, doctor Smith. And I know you
mentioned,
just the onboarding piece. And, obviously, onboarding 2,000,
no physicians, and and,
you know, only a couple of years, no
small feat. And I think onboarding continues to
come up in conversations with physician leaders as
as a challenge of sorts right now. So
can you expand a little bit just on
how the onboarding piece is structured and organized
across the system, and who is really in
charge of
having that process be streamlined and organized?
It it's a great question, Erica, because as
you can imagine, with
eight different medical groups across 26
counties on in Northern California,
you can imagine that there's a lot of,
variation
that can occur in that process. So what
we've really been trying to do is
each of the medical groups partners with our
physician services and our operations people
to create an onboarding process that that begins
well before they actually start with, you know,
creating their accounts and creating their schedules and
opening them up
and trying to create that sort of welcoming,
feeling for when they actually start.
It's still a work in progress. I would,
I would not say it's done. I think
onboarding
is a journey, and it doesn't it doesn't
start the day they start. It doesn't stop
the day they start. And so part of
that process is creating something that makes them
feel welcome in the organization, something that helps
them to understand it. So there are orientations
for the physicians themselves and the clinicians with
the medical group, so they understand what it
means to be part of the medical group.
There's another orientation piece which is actually part
of the system, so they understand what it
means be part of the system.
And we partner with the medical groups to
provide that. And then orienting them to the
clinic they're gonna be working in and the
people they're gonna be working with,
and how do we support that particular piece.
So it's an ongoing process that is jointly
owned by the the medical groups themselves who
are the hiring entity here in California
as well as our foundation counterparts to provide
that support for them.
Yeah. Thanks, doctor Smith.
Well, I know you mentioned
ambulatory expansion and an access there as well.
I know Sutter is in the middle of
a $1,000,000,000
expansion there. So with rapid ambulatory
growth,
how are you ensuring clinical integration
and continuity of care across sites? What sorts
of measures or practices are you putting in
place to try to maintain that care quality
as more services start to shift outside of
the hospital walls?
It's it's a great question because you're right.
There is this this steady but constant shift
of things in from the from the acute
session to the ambulatory session. So one of
the biggest things that we've done over the
past couple of years is to really create
an operating rhythm,
which creates a way of communicating both at
the individual
clinic level,
the facility level, the division level, which encompasses
both foundation and hospital based, and then the
system
level. And creating that in such a way
that there's a clarity of conversation and a
clarity of metrics that we we are going
to actually be looking at as we move
forward. And those are some of the standard
metrics around quality, around whether they're in the
ambulatory world, around, you know, your infection rates
and around, you know, things of that nature.
You've got the acute ones as well.
But one of the pieces that, as I
was talking to one of my quality directors
about this the other day,
what we're learning is the onboarding in the
ambulatory
environment. We've got to be very careful about
that Because typically in the acute environment,
you've got, you know, nurses training nurses, and
so there is a definite procedural bend that
you you understand that. As you get into
the ambulatory environment, you may not have that
like training like in the process. And so
making sure that we've onboarded our people in
the clinic setting to understand what it means
to do some of these procedures
in that particular arena,
is it's a different skill set for them,
and it is something that we're realizing and
we are actually implementing as we as we
move forward from that bigger piece.
Yeah. That's a great point. Thanks, doctor Smith.
I think too, one of the things that,
you know, as we continue to
cover more on and hear about,
you know, the health care's ambulatory boom, if
you will, and the shift
of that care,
just questions and and implications
of what it might mean for
care in inpatient setting. So as this trend
does accelerate,
what considerations
does it raise for hospital leaders? What are
you thinking about, especially in terms of staffing
or
care model changes,
to ensure that inpatient teams are equipped for
a new new reality in the years ahead
in terms of patient acuity?
I think it's it's a good point because
we are beginning to see changes in our
case mix index in the inpatient world,
implying that we are treating sicker patients in
the process.
And part of that is the recognition of
how do we actually
provide our teams with the capabilities,
capacities to provide that care in a safe,
effective,
and consistent manner.
Some of that is going to be ensuring
that we've got regular training for them.
Some of it is going to be how
do we leverage technology? How do we actually
employ technology so that individuals can be doing
things that only individuals can do, and you
can utilize some of the technology to help
give you information that you might not have
had at your fingertips? So things like,
some of the predictive modeling that we are
beginning to start to see in some of
the environments around
who might be deteriorating a little bit faster
than you actually think they are. So instead
of the teams
responding
once the crisis has occurred, which obviously is
less efficient and not as good for the
patient, how do we sort of incorporate some
of that information a little earlier such that
we can identify these people? These are this
is emerging technologies in certain places, but certainly
something that we're keeping our eye on, we're
looking at, we're incorporating
in such a way as to really equip
our people
with what they what they need.
Other other ways
are understanding, you know, if you think about,
you know, observation or sitting or or patient
or sitters that need to observe patients,
really can we employ and have we employed
electronic or visual virtual means of sitting. So
that way, you can free up the individual
from doing this. You can provide more real
time information and allow the the nurses and
the aids to be more attentive from that
standpoint. So really trying to help them from
a care model standpoint
and give them the information when they need
at the time they need it
to be able to actually,
do their jobs better in a safer manner,
for for them and the patients.
Yeah. Definitely will be interesting too to see
what the predictive modeling and and what that
might look like, you know, just a few
years down the line.
I wanna talk now about care standardization.
I think it comes up increasingly
not just as a way to improve care
outcomes, of course, but also as a way
to improve operational efficiency is is something we
hear a lot about nowadays. So
I think it's also one of those things
across a large system, like many things in
health care that might sound simple on the
surface, but is incredibly
tough to execute is what I hear, particularly
when you think about the nuances and local
settings and clinical autonomy of clinicians. So can
you tell us a little bit about
Sutter's approach here? What has the system done
to try to make clinical standardization
and evidence based pathways
work in practice? And are there any lessons
that have emerged about making this work at
scale?
That that's great insight, Erica. One of the
things that we have learned is
scale is helpful at times, and other times
actually can get in the way.
One of the pieces that
we have been, working with over time is
exactly what you talked about, which is identifying
those clinical best practices
in such a way that they can be
available and they can be spread and adopted
across the organization.
We've learned that it requires,
clinician leadership and involvement in development of those
stricter pathways,
both at the local level as well as
at the system level. And then we've learned
that there's a communication
that has to take place on a very
consistent basis
so that there is the ability to learn.
At the end of the day,
being a learning organization allows you to adopt
the technologies, adopt the pathways, and then iterate
and improve them as they actually go.
And one of the things that we've learned
is we we put an operating calendar into
place that I talked about before, which was
the, you know, part of it is the
local part of it's daily, weekly, and monthly
check ins. But the other thing that we've
actually started to do quite a bit now
is we're we're celebrating
successes. So we'll we will have system level
meetings where we'll actually celebrate best practices, whether
they're around
infection,
prevention, whether they're around,
length of stay reductions, whether they're around discharge
lounges, whether they're around,
improvements in,
throughputs in operating rooms or in emergency rooms.
And what we're doing is we're highlighting the
work that's being done,
in various places in the organization.
And then we've also developed, in a couple
of places, we've developed the ability to send
teams
out to other places that are actually having
challenges
so that we can accelerate that sharing of
best practices
and measuring to the same outputs
as we continue to kind of go go
down this road. So it is a,
it it is a journey.
It is one that's never ending, but it
is one that we believe that we can
actually accelerate that,
if we shine a light on the work
that's being done in those place or doing
it well.
Yeah. Great point about sharing out those those
best practices.
Well, lastly here, just wanna talk about the
chief physician, chief medical officer role. How do
you see that role evolving in the next
two to five years, let's say? What new
skills or leadership qualities do you think will
define the most successful CMOs of the future?
That's a great question because I even I
just have to look back two years because
I've been in this role about two, two
and a half years at this point.
And just the skill sets I've had to
develop at this point to to be successful.
I think one of the things that is
true is as you talk to chief physician
executives,
they are
they there's there's a wider breadth of what
we're responsible for now than the standard chief
medical officer was. And most of the chief
medical officers were responsible for just
pretty much the quality. They were the clinical
transformation throughput,
in in interacting with the medical staffs, both
the ambulatory as well as the acute.
As we move forward,
you notice that when at the outset,
you know, what were we really working around
the operations pieces,
I'm much more involved in the operational
day to day pieces as far as, you
know, what drives the clinic
referrals, what drives the clinic throughput, what does
our staffing model actually look like.
In the in the hospital,
how does our emergency room throughput actually work?
How is the operating room actually work? What's
our supply chain, cost look like? When we've
had challenges
across the country around
the the
the IV fluid issues.
We found that we were involved in what
that looked like and that was a very
operational issue.
So I think that, you know, as we
as we move forward, and then
as we begin to think about what does,
you know, hiring look like, what does acquisition
of other organizations look like, how do we
integrate,
systems into ours,
and having a,
a medical viewpoint around an operational issue and
being at the table for that. I think
that's actually different
than it was two or three years ago.
I expect to see that continue. So I
expect to see the successful chief physician executive,
have a be well grounded in all the
clinical pieces, be well grounded in the the,
you know, the quality pieces, but also,
becoming much more well versed in the operational
pieces so they can
be a thought partner
with in my case, I'm a thought partner
with the chief operating officer for the system.
And I think that's a different skill set
than many physician leaders,
have had over the years.
Yeah. Absolutely. I think it's a theme I've
I've heard in, in a few recent conversations,
as well.
Well, doctor Smith, thank you so much for
taking the time to join the podcast today.
It's a pleasure having you on, talking about
a lot of relevant topics that come come
up and so often in conversations with clinical
leaders. And,
hopefully,
we foster some some peer learnings here and
hope to welcome you back to the podcast
again soon.
Very good. Thank you for having me today.
Yeah. Thanks so much. Take care.
At athena Health, we know your ambulatory practice
wants healthier,
a healthier business, healthier care teams, and healthier
patients.
But the complexities of modern health care tech
make it hard for you and your care
teams to focus on what matters most.
That's where athenahealth can help.
Our AI native all in one solutions reduce
administrative burdens,
streamline billing and payments, and deliver critical insights
when clinicians need it most. That means fewer
clicks, more time for patients, and stronger bottom
lines.
Practicing medicine is complex, but running a practice
can be that much simpler with athenahealth.
See how simpler is healthier at athenahealth.com.