The most important health care decisions don't happen
in isolation.
They happen when leaders come together.
Becker's sixteenth annual meeting brings together more than
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hospital and health system executives this April in
Chicago.
With 800 speakers from Ascension,
Cleveland Clinic, CommonSpirit and more, the conversations get
real. Leaders will share how their scenario planning
for policy shifts, breaking through value based care
barriers, and building clinical teams that translate
This is Laura Dierda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
doctor Matt Boles, chief medical officer at Salem
Health Hospitals and Clinics. Doctor Boles, it's a
pleasure to have you on the podcast today.
Great. Thanks, Laura, for having me. Absolutely. Now
I'm excited for our conversation because I know
health care is changing so much right now.
And so I'm looking forward to learning more
about what you're doing at Salem Health and
how you've been successful over the last couple
years and how you're thinking about the future
too. But before we dive in, can you
tell me a little bit more about yourself
and Salem Health?
Sure. Absolutely. So,
I'm an anesthesiologist,
and I'm also the chief medical officer
at Salem Health hospitals and clinics. And so
I've been in my executive
leadership role since about 2018,
but recently stepped into that CMO role when
my dear friend,
doctor Ralph Yates retired.
But fun fact, I've actually been at Salem
Health for thirty five years. Started my career
here when I was 18,
only leaving for medical school and residency. So
it truly is an honor and a privilege
to serve in this role.
A little bit about Salem Health.
We, a lot of people don't know this.
You know, we're in the capital city of
Oregon, but we're actually the largest acute care
hospital
in the state.
And Salem Health is a level two trauma
center. We have over 600
licensed beds, almost 650.
A really large catchment area. We go all
the way to the coast to the west
of us, up the canyon towards
the middle of Oregon,
to our East. So maybe about half a
million or so in our catchment area.
And I've been told that we're one of
the largest cities in The US with only
one health system.
And another fun fact about Salem Health is
that we have one of the busiest EDs
on the West Coast.
We saw over a 115,000
patients last year,
and so a very, very busy level two
trauma center. We do have a small critical
access hospital to our west about 20 miles.
And then also,
I think it's important to point out that
we are not
a teaching hospital. So we have no residents
or fellows,
at our at our in our health system.
That's helpful to understand. You know, great context.
I mean, I think it's just so,
impressive to see how many different folks that,
you
you you do serve within,
your community and then too, like, to to
hear how your career has evolved, you know,
from stopping in the hospital in in when
you're 18 and now being a physician and
then chief medical officer is, truly, truly an
amazing journey I can imagine.
Yeah. No. Like I said, it's I never
thought in a million years I would be
in the role I am.
I still practice one day a week, so
it's great to be on the front lines
with,
you know, with all our caregivers caring for
patients. So but, no, it is. It's It's
great to be in the community I was
born and raised in. I was born in
this hospital system.
Both my kids were. So, no. It is
an honor and a privilege.
Fantastic. And, you know, when you look at
the last year or so, what was the
most important initiative initiative
you led?
What did you do, and what were the
results? Yeah. No. I think that's a that's
a great question. And so let me begin
by saying I have an amazing
executive team
that I work with. And so we
we often co lead these initiatives,
together, and I would not be successful without
them.
And, so,
looking back on this past year, I I
I probably would would,
like to reflect on the work we did
to employ
our anesthesia group. Right? And so when I
started my executive journey, I was part of
an independent
anesthesia group, but I also worked for the
hospital in my executive role.
And I'd say back in 2022,
that's when this work started of moving,
our anesthesia group to the employed model.
Just to give you some context,
the the group I worked for was out
of Portland. Great group.
Amazing group. One of the largest in the
country. But, again, they were struggling just like
everyone else's with recruitment
and,
trying to keep up with the demands of
the contract that they had with our health
system. And so
they let us know, OAG,
Oregon Anesthesiology Group, let us know that they
were no longer able to honor the contract.
And so I was led,
to bring our employed
excuse me, our our our private group to
the employed model.
And that was a three year three year
journey that just concluded
this last, this last fall. And so I
learned so much culturally,
professionally, personally,
just to bring all of them from this,
you know, fiercely independent,
autonomous model. And what does it look like
to be employed in a large health system?
And so this was vital, right, to the,
just for the care that we provide for
our patients. We could not, we meaning Salem
Health, could not lose this vital service line.
And so it was an honor and a
privilege to to bring them over. And as
far as results,
I think it really speaks well to our
culture and to just what we've really,
grown here at Salem Health. We had pretty
much had everyone except for two of my
partners decide to stay.
That just really showcases their commitment to our
community, to our health system.
And also this work just really showcases that,
yes, we have metrics, we have goals, we
have targets.
But this took a lot of
those soft skills of, you know, talking
these,
providers
through that journey of becoming employed.
So there was hours spent on the on
the, you know, the back end
of, reassuring them about, what does it look
like to be employed.
Yes. You you are losing
some of those,
factors that were in an independent practice, but
you're gaining so much more.
And so, again, that was probably one of
the most,
professionally and personal fulfilling,
projects that I've led over this past year,
which concluded,
basically this last summer.
And then if I could just talk about
one more,
strategic initiative that I helped lead or co
lead with other executives,
was all about procedural capacity. And so,
let me give you a little more context.
We we have had surgeons over the last
several years and other proceduralists say, hey. I
cannot get more OR time. I can't get
my patients into the OR.
And so we did some research and data,
and, you know, our baseline data did show
that we probably had a backlog of several
thousand patients waiting for their surgery.
And so,
when we first approached this problem, you know,
the the easy solution or the solution that
we thought was the right answer was just
to build
more ORs. And as we all know in
the financial
landscape that we're in, that's hugely expensive.
And so,
we're a lean organization,
and so we use data to drive our
problem solving.
And so we were able to show that
we are actually underutilizing
all of our procedural space across the health
system.
So that started us on a journey of
reimagining how we use this procedural space.
And so for years,
I'd say problem solving in the surgical space
really centered on the day of surgery. Meaning,
what can we do for, on time starts,
turnover times,
maximizing our sterile processing or prep, recovery areas,
etcetera.
But we really just stretched that value stream
out for the patient, meaning we went upstream
all the way to where that patient was
referred into the clinics.
And so because we have the luxury of
having a lot of our surgical clinics,
being employed,
we were able to take that problem solving
up way upstream,
work with,
our clinics,
and to just really
maximize the flow of that patient
to our ORs.
And here's where we leaned into technology.
Epic traditionally had some great metrics around on
time starts, turnover times, etcetera, just like I
mentioned.
But we were able to basically build a
procedural
traffic control system in Epic.
And so we could see wherever that patient
was on that value stream, meaning all the
way back up in the clinic,
the time they were waiting to see the
specialist,
the time that was needed to optimize the
patient for surgery, the time that was needed,
for authorizations and referrals. And so we were
able to, look at data, how many patients
were in each of those buckets,
and, also, that helped focus our problem solving.
And so we've had some really good results.
We haven't built any more ORs. I think
that's the that's the number one result to
really celebrate because, like I said, they're so
expensive.
But we've maximized
our,
block time with these surgeons.
We've been able to create a new system
called,
patient case classification window. We call it CCW.
So we put targets on all of our
electively
scheduled patients.
And so,
we had an ambitious goal. We we we
wanted all of our
patients seen in the clinic to be scheduled
in surgery in forty five days or less.
And there were there, I won't get into
all the details, but there are many classifications
we can use under that.
So globally,
we are at about 67, 68%
of meeting that target,
which is a huge improvement from when we
started this work.
And, again, we are now starting to see
that backlog that I spoke about,
being addressed. And so those patients are getting
the care that they need,
in our procedural system. So, again, those are
just a couple of,
projects that I can recall, again, that I
had the honor and privilege to to leave
with my co executives.
I love that. I think all of those
things you mentioned are are so critical, especially,
being able to improve that efficiency, reimagine the
way that you're looking at the space, some
processes, procedures,
and then the data and having the information
that can inform whether you're making improvements and
and how it impacts quality and outcomes and
everything else,
you know, is so critical. I'm curious as
you were making this transformation
and putting all of this in place and
integrating it into the the daily functioning at
the hospitals,
how did you, at the same time, go
through the cultural transformation for folks to really,
embrace all of these things and then make
sure that, you're getting the outcomes that you
wanted.
Yeah. No. That's great. Right? It's part of
that change curve. Right? When we had some
you know, surgeons can be,
let's say,
you know, very,
emotional and passionate
about, their patients. And so we had to
bring them along and it took some time.
Absolutely.
Like I said, we use our lean management
system. And so everything is visible either electronically
or,
in our what we call our war rooms.
And so we would bring our surgeons right
along, and they would see,
all the problem solving.
And,
and and also an important element is that
we would include them in on the problem
solving.
And so, again, using our lean fundamentals
of taking the work to our frontline,
asking them to be a part of
the problem solving, helping us set up targets,
our process and outcome metrics. I think that
was key.
And,
having several identified
anesthesiologists
and surgeons
kinda champion this work. So it wasn't so
much the executive team selling it. It really
was the those that are impacted by this
work.
And so, again, that that to me really
helped,
you know, help help make this change easier
and and also showing them results. Right?
Showing them that, yes, you're getting this case
in or we heard you. So we opened
up this service line. We had a a
big bottleneck in robotics, and so we had
to, reimagine
where we were going to do those surgeries.
And so we put put the robot in
a in a room, in an OR that
may not have been,
everyone's first choice, but we did simulations.
We did mock ups. And so when we
did all those,
test of change, we included our surgeons in
on that so that they could own it.
They could give their feedback,
and then they could also turn around and
sell it to their section members and practice
partners. So
it just was critical to get them involved,
early on.
That's so helpful to understand. Thank you for
sharing, and talking through that. Now looking ahead,
what are some of your big priorities and
headwinds for 2026?
Gosh.
Where do I begin? Lots of headwinds.
I'd say, you know, we're not alone. I
think everywhere and everywhere is struggling with the
payer mix and reimbursements,
and those issues that are coming, especially from
our,
government,
programs such as Medicaid.
And so, you know, it's it's just, the
shrinking dollar. Right? Especially from the,
the Medicaid program. And I know that in
our community,
you know, we're just not seeing those rates,
increase year over year,
like they need to to match inflation and
match labor, to match all the other costs
that are,
you know, not just the hospital.
You know, we're so big. We can kind
of weather some of this a little bit
better,
but our private group's in town. And so,
it is really impacting our private practices. And
so to give you a little bit of
perspective,
we have had several large practices over the
last couple of years
that simply
couldn't make,
their books balance,
so to speak, and and their businesses were
failing.
And so despite, you know, very smart people
that were running these businesses, they could not
keep up with all of those factors I
just mentioned, like inflation and especially labor. That
has been a huge
huge,
driver of cost for these practices.
And when you couple that with, shrinking reimbursements,
it really just made it almost impossible to
function. And so we've had,
a couple of large groups in our community
come to us for employment. And again, that's
not Salem Health strategy is to compete in
these service lines.
But our strategy
absolutely
is to make sure
that
these service lines are available to our patients,
if that makes sense. We know we need
orthopedics
in our community. And so when that group
approached us for employment, we absolutely worked with
them, brought them in board.
And, but the, I guess the concerning or
the big challenges we're we're seeing more and
more groups do this too. We just did
this with our urology group.
And so, it's not going away, but we're
here to, you know, to help the best
we can,
to, you know, bolster these headwinds like you
described in the question. But I really think
that's that's our big challenge,
facing all of us in our community.
I think that's such an excellent point. And,
you know, especially looking at how,
physicians and physician shortages are impacting
communities and hospitals and systems across the country
in, you know, bringing
those physician groups into employment. I know it's
no small task and and then, you know,
integrating
them financially,
culturally, everything else. And so when you're looking
at, you know, how you've been able to
do this successfully now a couple of different
times,
you know,
what are your kind of, like, business considerations
for your your,
deciding to do that? And how do you,
make sure that, you know, you have everything
in place? Or what lessons have you learned,
I guess, in,
bringing in those types of groups and and
making them employed to make sure things go
as smoothly as possible?
Yeah. No. We've learned a lot. Right? I
talked about the anesthesia,
model that became employed,
several years ago. And so,
again, we learn through,
all of our problem solving. Like I said,
we're a lean organization.
But, yes, assimilating into our culture,
You know, again, I just wanna make sure,
you know, our strategy is not to compete
or go after these groups, but we really
try to put the patient in the middle
of all this.
What services do our patients need in our
community?
And so that's that's really been our approach.
They need urology.
They absolutely need orthopedics.
And so when we take that approach, it
makes that work, you know, focused on a
a solitary mission or vision.
But getting them culturally,
you know,
into our health system, that's been a challenge.
But again, it just takes lots of,
conversation,
lots of time. Sometimes you have to slow
down to go fast.
And, just walking through these,
numbers, sometimes it's just individually with all of
them, keeping everything visible, good communication, follow through,
etcetera.
Like I said, a lot of those soft
skills that you may not have learned so
much in in medical school, but,
it's just it speaks to that relational side
of leadership.
Absolutely. Easier said than done, I know, in
many ways, but, seems like something that comes
naturally to you, or did you have to
to acquire skills there too?
Oh, I'm always learning. Absolutely.
Asking for feedback.
But, yes, you know, there there really is
there there there are people. There are humans,
behind all of these,
decisions that we make. And so again,
I keep talking about lean. One of our
fundamental pillars is respect for people. And so
we really do honor that in all that
we do.
And walking, these people through these changes is
is not easy, but it's essential to get
them to where they need to be.
Absolutely. I I I definitely agree.
Now, when you're looking ahead to, what do
you think the hardest thing you'll have to
do in the coming year will be?
Great. Well, I don't wanna be doom and
gloom. I do think a lot of health
care is is really hard right now.
So, you know, there's there's pressures and challenges
on all fronts. So I'd say,
maybe the hardest thing that we we have
in front of us is just to make
sure that we stay true to our mission
and serving patients
and really,
kinda getting back to,
why we're why we are all doing this.
And so,
for instance, I love when,
young people come and shadow me, in the
OR or ask me about my profession. It
kinda reminds me of why I even stepped
into all of this. So,
so I just you know, I think our
challenge is, you know, how do we keep
this fresh? How do we make this,
rewarding?
How do we just remind ourselves that our
patients are benefiting from what we do?
Just earlier today, I was at the nephrology
section meeting.
And so they're such a great amazing group
of individuals. And so it was refreshing
to see,
them not jaded by all of those challenges
I just mentioned. And they were,
excited to share with me some innovative and
creative ideas they had about
certain barriers and problems that they were experiencing.
So,
so I guess, you know, some of the
challenges that I think that we face as
leaders is,
let's not lose sight of,
you know, why we're doing this, and it's
for the patient.
And so if we kinda keep that in
mind, then I think all those other things
will follow. And so, you know, how do
we care for those who care for the
patient? And so it just kind of expands
from there.
So that that's a challenge. We do get
kind of focused on our problems.
So how can we keep that,
that true north, that positive,
mission statement of caring for our our patients?
That is such a helpful reminder and especially,
you know, today in thinking about all the
different pressures and, things that are going on
for health care providers,
being able to really craft that type of
environment, atmosphere, atmosphere, and culture where they feel
supported,
can be so critical. And I I think
when you're looking at, you know,
some of those innovations that you've been hearing
about, creative ideas and other ways to problem
solve, Does anything,
rise to the top or come to mind
as something that was a particularly unique way
that you've been tackling
some of these, you know, more physician bonus
or or clinician,
you know, resilience issues?
We are actually learning a lot. And if
you wanna talk about innovation and creativity, we're
learning so much about virtual
care.
I know we we did round one of
that, right, with COVID.
I'd say round two is kinda reimagining
virtual care in a new way. And so
we launched,
I think it was about a year ago,
maybe a little longer than that, virtual nursing.
And so we have actually seen a lot
of success there.
Our nurses like it. Our patients like it.
Our patient experience scores have grown.
And so,
I would say from a provider perspective,
we are taking a deep lean into that
work, and we're looking at what our nurses
did to make that successful.
And so we're,
just scratching the surface on how can we
apply that to,
provider practices. You know, what does virtual care
look like? And
again, not necessarily in the way we saw
it during COVID, but how do we do
it in the acute care setting?
So, I'm really excited for that. I think
there's some great potential
which will,
perhaps
make care better, more efficient.
It might address the financial questions.
And so it could be, you know, the
triple or quadruple aim type of
innovation that we're looking for. So, yeah, more
to come on that. I'm really excited about
virtual care.
I love it. I I think there's so
many opportunities there, and, really, it just seems
like amazing way to expand access to care
and and get you, in the system, you
know, into the position it wants to be.
Before we wrap up here, are there any
other areas that you see as being really
primed for organizational growth?
I'd say,
you know, this is a very small subset
of our organization, but an important one is
our medical executive committee.
And we had a retreat this last fall.
It was great to get us all together
to have some time off-site,
to really have some protected,
conversation
about the challenges that our medical executive committee,
kinda kinda is seeing or experiencing.
You know, we talked a lot about APPs,
just how grateful we are for them, but
also,
just recognizing that their presence here in Oregon
has exploded. It really has over the last
several years and even here at Salem Health.
So how can we honor them? How can
we support them?
How do we balance that independence
versus where they fit in the healthcare,
continuum?
How do we help support them with quality
of care, etcetera. So that's been exciting.
And then, it was great to hear from
my MEC leaders about how
they can impact
quality, not so much in the
traditional sense of, you know, problem solving, all
those,
you know, important measures such as CAUTIs and
CLABSIs, etcetera. But to hear from that that
they want to drive the culture
of quality. How do they improve that
among our medical staff and care team? That
was really exciting. So that was refreshing.
It was great to have that, opportunity with
them. And and so our next step now
is just trying to apply that to some
tactical,
strategy to execute those those goals.
I love that. Thank you so much, doctor
Boles, for your time today. This has been
such a fascinating interview. I think you've shared
so many,
different ideas
in creative ways that you're problem solving today.
It's just been very inspiring, and I look
forward to seeing you as well at our
annual meeting in April. I know you'll be
speaking on a panel and covering a lot
of these same same themes, and so it'll
be great to continue the conversation.
Great. Thanks, Laura. Well, like I said, it's
an honor and privilege to be here. I'm
very grateful.