1 00:00:02,240 --> 00:00:05,120 The most important health care decisions don't happen 2 00:00:05,120 --> 00:00:05,779 in isolation. 3 00:00:06,240 --> 00:00:08,179 They happen when leaders come together. 4 00:00:08,800 --> 00:00:11,519 Becker's sixteenth annual meeting brings together more than 5 00:00:11,519 --> 00:00:12,559 3,500 6 00:00:12,559 --> 00:00:15,525 hospital and health system executives this April in 7 00:00:15,525 --> 00:00:16,024 Chicago. 8 00:00:16,565 --> 00:00:18,664 With 800 speakers from Ascension, 9 00:00:18,964 --> 00:00:22,164 Cleveland Clinic, CommonSpirit and more, the conversations get 10 00:00:22,164 --> 00:00:24,964 real. Leaders will share how their scenario planning 11 00:00:24,964 --> 00:00:27,605 for policy shifts, breaking through value based care 12 00:00:27,605 --> 00:00:30,000 barriers, and building clinical teams that translate 13 00:00:46,054 --> 00:00:48,375 This is Laura Dierda with the Becker's Healthcare 14 00:00:48,375 --> 00:00:50,454 podcast. I'm thrilled today to be joined by 15 00:00:50,454 --> 00:00:53,015 doctor Matt Boles, chief medical officer at Salem 16 00:00:53,015 --> 00:00:55,174 Health Hospitals and Clinics. Doctor Boles, it's a 17 00:00:55,174 --> 00:00:56,954 pleasure to have you on the podcast today. 18 00:00:57,494 --> 00:01:00,630 Great. Thanks, Laura, for having me. Absolutely. Now 19 00:01:00,630 --> 00:01:03,109 I'm excited for our conversation because I know 20 00:01:03,109 --> 00:01:04,870 health care is changing so much right now. 21 00:01:04,870 --> 00:01:06,630 And so I'm looking forward to learning more 22 00:01:06,630 --> 00:01:08,549 about what you're doing at Salem Health and 23 00:01:08,549 --> 00:01:10,469 how you've been successful over the last couple 24 00:01:10,469 --> 00:01:12,194 years and how you're thinking about the future 25 00:01:12,194 --> 00:01:13,954 too. But before we dive in, can you 26 00:01:13,954 --> 00:01:15,875 tell me a little bit more about yourself 27 00:01:15,875 --> 00:01:17,094 and Salem Health? 28 00:01:17,394 --> 00:01:19,015 Sure. Absolutely. So, 29 00:01:19,554 --> 00:01:20,454 I'm an anesthesiologist, 30 00:01:20,834 --> 00:01:22,774 and I'm also the chief medical officer 31 00:01:23,075 --> 00:01:26,114 at Salem Health hospitals and clinics. And so 32 00:01:26,114 --> 00:01:27,334 I've been in my executive 33 00:01:28,219 --> 00:01:31,200 leadership role since about 2018, 34 00:01:31,740 --> 00:01:34,620 but recently stepped into that CMO role when 35 00:01:34,620 --> 00:01:35,520 my dear friend, 36 00:01:35,820 --> 00:01:37,359 doctor Ralph Yates retired. 37 00:01:38,219 --> 00:01:40,564 But fun fact, I've actually been at Salem 38 00:01:40,564 --> 00:01:42,885 Health for thirty five years. Started my career 39 00:01:42,885 --> 00:01:44,185 here when I was 18, 40 00:01:45,045 --> 00:01:47,924 only leaving for medical school and residency. So 41 00:01:47,924 --> 00:01:49,944 it truly is an honor and a privilege 42 00:01:50,085 --> 00:01:51,305 to serve in this role. 43 00:01:51,605 --> 00:01:53,385 A little bit about Salem Health. 44 00:01:54,439 --> 00:01:55,799 We, a lot of people don't know this. 45 00:01:56,040 --> 00:01:57,640 You know, we're in the capital city of 46 00:01:57,640 --> 00:01:59,959 Oregon, but we're actually the largest acute care 47 00:01:59,959 --> 00:02:00,459 hospital 48 00:02:01,079 --> 00:02:02,060 in the state. 49 00:02:02,680 --> 00:02:04,840 And Salem Health is a level two trauma 50 00:02:04,840 --> 00:02:07,415 center. We have over 600 51 00:02:07,555 --> 00:02:09,814 licensed beds, almost 650. 52 00:02:10,354 --> 00:02:12,354 A really large catchment area. We go all 53 00:02:12,354 --> 00:02:13,955 the way to the coast to the west 54 00:02:13,955 --> 00:02:15,895 of us, up the canyon towards 55 00:02:16,275 --> 00:02:17,414 the middle of Oregon, 56 00:02:17,794 --> 00:02:19,990 to our East. So maybe about half a 57 00:02:19,990 --> 00:02:22,010 million or so in our catchment area. 58 00:02:22,389 --> 00:02:23,909 And I've been told that we're one of 59 00:02:23,909 --> 00:02:26,230 the largest cities in The US with only 60 00:02:26,230 --> 00:02:27,210 one health system. 61 00:02:27,669 --> 00:02:29,909 And another fun fact about Salem Health is 62 00:02:29,909 --> 00:02:32,889 that we have one of the busiest EDs 63 00:02:33,224 --> 00:02:34,205 on the West Coast. 64 00:02:35,145 --> 00:02:37,305 We saw over a 115,000 65 00:02:37,305 --> 00:02:38,525 patients last year, 66 00:02:38,825 --> 00:02:41,224 and so a very, very busy level two 67 00:02:41,224 --> 00:02:44,504 trauma center. We do have a small critical 68 00:02:44,504 --> 00:02:47,724 access hospital to our west about 20 miles. 69 00:02:48,150 --> 00:02:49,050 And then also, 70 00:02:49,349 --> 00:02:50,949 I think it's important to point out that 71 00:02:50,949 --> 00:02:51,849 we are not 72 00:02:52,150 --> 00:02:54,230 a teaching hospital. So we have no residents 73 00:02:54,230 --> 00:02:54,889 or fellows, 74 00:02:55,750 --> 00:02:57,689 at our at our in our health system. 75 00:03:00,564 --> 00:03:02,884 That's helpful to understand. You know, great context. 76 00:03:02,884 --> 00:03:04,805 I mean, I think it's just so, 77 00:03:05,125 --> 00:03:08,025 impressive to see how many different folks that, 78 00:03:08,405 --> 00:03:08,905 you 79 00:03:09,364 --> 00:03:10,724 you you do serve within, 80 00:03:11,125 --> 00:03:13,204 your community and then too, like, to to 81 00:03:13,204 --> 00:03:15,710 hear how your career has evolved, you know, 82 00:03:15,710 --> 00:03:18,349 from stopping in the hospital in in when 83 00:03:18,349 --> 00:03:20,270 you're 18 and now being a physician and 84 00:03:20,270 --> 00:03:23,310 then chief medical officer is, truly, truly an 85 00:03:23,310 --> 00:03:24,770 amazing journey I can imagine. 86 00:03:25,469 --> 00:03:28,215 Yeah. No. Like I said, it's I never 87 00:03:28,215 --> 00:03:29,735 thought in a million years I would be 88 00:03:29,735 --> 00:03:30,794 in the role I am. 89 00:03:31,334 --> 00:03:33,414 I still practice one day a week, so 90 00:03:33,414 --> 00:03:35,574 it's great to be on the front lines 91 00:03:35,574 --> 00:03:36,074 with, 92 00:03:36,854 --> 00:03:39,014 you know, with all our caregivers caring for 93 00:03:39,014 --> 00:03:40,689 patients. So but, no, it is. It's It's 94 00:03:40,689 --> 00:03:42,770 great to be in the community I was 95 00:03:42,770 --> 00:03:44,209 born and raised in. I was born in 96 00:03:44,209 --> 00:03:45,349 this hospital system. 97 00:03:45,810 --> 00:03:48,530 Both my kids were. So, no. It is 98 00:03:48,530 --> 00:03:49,590 an honor and a privilege. 99 00:03:50,610 --> 00:03:52,689 Fantastic. And, you know, when you look at 100 00:03:52,689 --> 00:03:54,289 the last year or so, what was the 101 00:03:54,289 --> 00:03:55,685 most important initiative initiative 102 00:03:56,305 --> 00:03:57,284 you led? 103 00:03:57,664 --> 00:03:58,905 What did you do, and what were the 104 00:03:58,905 --> 00:04:00,145 results? Yeah. No. I think that's a that's 105 00:04:00,145 --> 00:04:02,224 a great question. And so let me begin 106 00:04:02,224 --> 00:04:03,685 by saying I have an amazing 107 00:04:03,985 --> 00:04:05,125 executive team 108 00:04:05,425 --> 00:04:07,125 that I work with. And so we 109 00:04:07,480 --> 00:04:09,580 we often co lead these initiatives, 110 00:04:10,040 --> 00:04:12,599 together, and I would not be successful without 111 00:04:12,599 --> 00:04:13,099 them. 112 00:04:13,560 --> 00:04:14,860 And, so, 113 00:04:15,960 --> 00:04:18,199 looking back on this past year, I I 114 00:04:18,199 --> 00:04:19,660 I probably would would, 115 00:04:20,574 --> 00:04:23,375 like to reflect on the work we did 116 00:04:23,375 --> 00:04:24,115 to employ 117 00:04:24,814 --> 00:04:27,375 our anesthesia group. Right? And so when I 118 00:04:27,375 --> 00:04:29,455 started my executive journey, I was part of 119 00:04:29,455 --> 00:04:30,194 an independent 120 00:04:31,055 --> 00:04:33,055 anesthesia group, but I also worked for the 121 00:04:33,055 --> 00:04:34,754 hospital in my executive role. 122 00:04:36,139 --> 00:04:38,779 And I'd say back in 2022, 123 00:04:38,779 --> 00:04:40,959 that's when this work started of moving, 124 00:04:41,980 --> 00:04:44,319 our anesthesia group to the employed model. 125 00:04:45,339 --> 00:04:46,800 Just to give you some context, 126 00:04:48,264 --> 00:04:49,785 the the group I worked for was out 127 00:04:49,785 --> 00:04:51,384 of Portland. Great group. 128 00:04:51,865 --> 00:04:53,625 Amazing group. One of the largest in the 129 00:04:53,625 --> 00:04:56,105 country. But, again, they were struggling just like 130 00:04:56,105 --> 00:04:57,485 everyone else's with recruitment 131 00:04:58,264 --> 00:04:58,764 and, 132 00:04:59,305 --> 00:05:01,464 trying to keep up with the demands of 133 00:05:01,464 --> 00:05:03,569 the contract that they had with our health 134 00:05:03,569 --> 00:05:05,029 system. And so 135 00:05:05,490 --> 00:05:07,110 they let us know, OAG, 136 00:05:07,730 --> 00:05:09,649 Oregon Anesthesiology Group, let us know that they 137 00:05:09,649 --> 00:05:11,810 were no longer able to honor the contract. 138 00:05:11,810 --> 00:05:13,189 And so I was led, 139 00:05:14,209 --> 00:05:15,970 to bring our employed 140 00:05:16,675 --> 00:05:18,675 excuse me, our our our private group to 141 00:05:18,675 --> 00:05:19,655 the employed model. 142 00:05:20,435 --> 00:05:22,275 And that was a three year three year 143 00:05:22,275 --> 00:05:23,655 journey that just concluded 144 00:05:24,275 --> 00:05:27,314 this last, this last fall. And so I 145 00:05:27,314 --> 00:05:28,775 learned so much culturally, 146 00:05:29,634 --> 00:05:30,855 professionally, personally, 147 00:05:32,269 --> 00:05:34,750 just to bring all of them from this, 148 00:05:34,750 --> 00:05:36,370 you know, fiercely independent, 149 00:05:36,670 --> 00:05:39,149 autonomous model. And what does it look like 150 00:05:39,149 --> 00:05:41,089 to be employed in a large health system? 151 00:05:41,629 --> 00:05:44,269 And so this was vital, right, to the, 152 00:05:45,544 --> 00:05:47,144 just for the care that we provide for 153 00:05:47,144 --> 00:05:49,464 our patients. We could not, we meaning Salem 154 00:05:49,464 --> 00:05:52,444 Health, could not lose this vital service line. 155 00:05:52,904 --> 00:05:54,504 And so it was an honor and a 156 00:05:54,504 --> 00:05:56,745 privilege to to bring them over. And as 157 00:05:56,745 --> 00:05:57,725 far as results, 158 00:05:58,419 --> 00:06:00,339 I think it really speaks well to our 159 00:06:00,339 --> 00:06:03,379 culture and to just what we've really, 160 00:06:03,860 --> 00:06:06,579 grown here at Salem Health. We had pretty 161 00:06:06,579 --> 00:06:08,979 much had everyone except for two of my 162 00:06:08,979 --> 00:06:10,680 partners decide to stay. 163 00:06:11,464 --> 00:06:14,104 That just really showcases their commitment to our 164 00:06:14,104 --> 00:06:15,564 community, to our health system. 165 00:06:16,664 --> 00:06:19,305 And also this work just really showcases that, 166 00:06:19,305 --> 00:06:21,704 yes, we have metrics, we have goals, we 167 00:06:21,704 --> 00:06:22,444 have targets. 168 00:06:23,305 --> 00:06:25,004 But this took a lot of 169 00:06:25,305 --> 00:06:27,910 those soft skills of, you know, talking 170 00:06:28,529 --> 00:06:29,029 these, 171 00:06:29,729 --> 00:06:30,229 providers 172 00:06:30,610 --> 00:06:33,029 through that journey of becoming employed. 173 00:06:33,649 --> 00:06:36,850 So there was hours spent on the on 174 00:06:36,850 --> 00:06:38,389 the, you know, the back end 175 00:06:38,824 --> 00:06:41,865 of, reassuring them about, what does it look 176 00:06:41,865 --> 00:06:42,845 like to be employed. 177 00:06:43,705 --> 00:06:45,245 Yes. You you are losing 178 00:06:45,545 --> 00:06:46,285 some of those, 179 00:06:46,745 --> 00:06:49,225 factors that were in an independent practice, but 180 00:06:49,225 --> 00:06:50,605 you're gaining so much more. 181 00:06:51,019 --> 00:06:53,259 And so, again, that was probably one of 182 00:06:53,259 --> 00:06:53,920 the most, 183 00:06:55,180 --> 00:06:56,959 professionally and personal fulfilling, 184 00:06:58,139 --> 00:07:00,860 projects that I've led over this past year, 185 00:07:00,860 --> 00:07:01,600 which concluded, 186 00:07:02,699 --> 00:07:04,240 basically this last summer. 187 00:07:04,574 --> 00:07:06,095 And then if I could just talk about 188 00:07:06,095 --> 00:07:06,835 one more, 189 00:07:07,535 --> 00:07:10,095 strategic initiative that I helped lead or co 190 00:07:10,095 --> 00:07:11,955 lead with other executives, 191 00:07:12,415 --> 00:07:15,154 was all about procedural capacity. And so, 192 00:07:16,415 --> 00:07:18,115 let me give you a little more context. 193 00:07:18,779 --> 00:07:21,019 We we have had surgeons over the last 194 00:07:21,019 --> 00:07:23,899 several years and other proceduralists say, hey. I 195 00:07:23,899 --> 00:07:26,220 cannot get more OR time. I can't get 196 00:07:26,220 --> 00:07:27,919 my patients into the OR. 197 00:07:28,939 --> 00:07:31,360 And so we did some research and data, 198 00:07:31,925 --> 00:07:34,404 and, you know, our baseline data did show 199 00:07:34,404 --> 00:07:37,125 that we probably had a backlog of several 200 00:07:37,125 --> 00:07:39,225 thousand patients waiting for their surgery. 201 00:07:39,685 --> 00:07:40,504 And so, 202 00:07:41,365 --> 00:07:43,525 when we first approached this problem, you know, 203 00:07:43,525 --> 00:07:46,085 the the easy solution or the solution that 204 00:07:46,085 --> 00:07:48,100 we thought was the right answer was just 205 00:07:48,100 --> 00:07:48,759 to build 206 00:07:49,139 --> 00:07:51,779 more ORs. And as we all know in 207 00:07:51,779 --> 00:07:52,600 the financial 208 00:07:53,300 --> 00:07:55,959 landscape that we're in, that's hugely expensive. 209 00:07:56,660 --> 00:07:57,480 And so, 210 00:07:58,339 --> 00:07:59,480 we're a lean organization, 211 00:08:00,034 --> 00:08:02,514 and so we use data to drive our 212 00:08:02,514 --> 00:08:03,414 problem solving. 213 00:08:03,875 --> 00:08:06,435 And so we were able to show that 214 00:08:06,435 --> 00:08:07,735 we are actually underutilizing 215 00:08:08,274 --> 00:08:10,514 all of our procedural space across the health 216 00:08:10,514 --> 00:08:11,014 system. 217 00:08:11,555 --> 00:08:14,294 So that started us on a journey of 218 00:08:14,960 --> 00:08:17,620 reimagining how we use this procedural space. 219 00:08:18,400 --> 00:08:20,100 And so for years, 220 00:08:20,480 --> 00:08:23,040 I'd say problem solving in the surgical space 221 00:08:23,040 --> 00:08:26,180 really centered on the day of surgery. Meaning, 222 00:08:26,240 --> 00:08:28,580 what can we do for, on time starts, 223 00:08:28,915 --> 00:08:29,735 turnover times, 224 00:08:30,274 --> 00:08:34,595 maximizing our sterile processing or prep, recovery areas, 225 00:08:34,595 --> 00:08:35,095 etcetera. 226 00:08:36,355 --> 00:08:39,794 But we really just stretched that value stream 227 00:08:39,794 --> 00:08:42,375 out for the patient, meaning we went upstream 228 00:08:43,250 --> 00:08:44,929 all the way to where that patient was 229 00:08:44,929 --> 00:08:46,870 referred into the clinics. 230 00:08:47,409 --> 00:08:49,909 And so because we have the luxury of 231 00:08:50,049 --> 00:08:51,990 having a lot of our surgical clinics, 232 00:08:52,450 --> 00:08:53,269 being employed, 233 00:08:53,649 --> 00:08:55,730 we were able to take that problem solving 234 00:08:55,730 --> 00:08:56,870 up way upstream, 235 00:08:57,495 --> 00:08:58,235 work with, 236 00:08:59,095 --> 00:08:59,914 our clinics, 237 00:09:00,294 --> 00:09:01,674 and to just really 238 00:09:02,215 --> 00:09:04,315 maximize the flow of that patient 239 00:09:04,774 --> 00:09:05,754 to our ORs. 240 00:09:06,294 --> 00:09:08,475 And here's where we leaned into technology. 241 00:09:09,670 --> 00:09:12,870 Epic traditionally had some great metrics around on 242 00:09:12,870 --> 00:09:15,509 time starts, turnover times, etcetera, just like I 243 00:09:15,509 --> 00:09:16,009 mentioned. 244 00:09:16,629 --> 00:09:19,670 But we were able to basically build a 245 00:09:19,670 --> 00:09:20,170 procedural 246 00:09:20,550 --> 00:09:23,050 traffic control system in Epic. 247 00:09:23,404 --> 00:09:25,725 And so we could see wherever that patient 248 00:09:25,725 --> 00:09:27,884 was on that value stream, meaning all the 249 00:09:27,884 --> 00:09:29,264 way back up in the clinic, 250 00:09:29,965 --> 00:09:31,644 the time they were waiting to see the 251 00:09:31,644 --> 00:09:32,144 specialist, 252 00:09:33,004 --> 00:09:35,485 the time that was needed to optimize the 253 00:09:35,485 --> 00:09:37,825 patient for surgery, the time that was needed, 254 00:09:38,850 --> 00:09:42,210 for authorizations and referrals. And so we were 255 00:09:42,210 --> 00:09:44,929 able to, look at data, how many patients 256 00:09:44,929 --> 00:09:46,230 were in each of those buckets, 257 00:09:47,090 --> 00:09:50,389 and, also, that helped focus our problem solving. 258 00:09:50,615 --> 00:09:53,115 And so we've had some really good results. 259 00:09:53,254 --> 00:09:55,495 We haven't built any more ORs. I think 260 00:09:55,495 --> 00:09:58,054 that's the that's the number one result to 261 00:09:58,054 --> 00:09:59,975 really celebrate because, like I said, they're so 262 00:09:59,975 --> 00:10:00,475 expensive. 263 00:10:01,334 --> 00:10:02,394 But we've maximized 264 00:10:02,934 --> 00:10:03,414 our, 265 00:10:03,894 --> 00:10:05,754 block time with these surgeons. 266 00:10:06,269 --> 00:10:08,509 We've been able to create a new system 267 00:10:08,509 --> 00:10:08,990 called, 268 00:10:09,389 --> 00:10:13,090 patient case classification window. We call it CCW. 269 00:10:13,790 --> 00:10:15,790 So we put targets on all of our 270 00:10:15,790 --> 00:10:16,290 electively 271 00:10:16,830 --> 00:10:17,889 scheduled patients. 272 00:10:18,524 --> 00:10:19,245 And so, 273 00:10:19,964 --> 00:10:22,125 we had an ambitious goal. We we we 274 00:10:22,125 --> 00:10:23,504 wanted all of our 275 00:10:24,044 --> 00:10:26,144 patients seen in the clinic to be scheduled 276 00:10:26,605 --> 00:10:29,105 in surgery in forty five days or less. 277 00:10:29,245 --> 00:10:30,779 And there were there, I won't get into 278 00:10:30,779 --> 00:10:32,799 all the details, but there are many classifications 279 00:10:33,019 --> 00:10:34,320 we can use under that. 280 00:10:34,860 --> 00:10:35,600 So globally, 281 00:10:36,299 --> 00:10:39,100 we are at about 67, 68% 282 00:10:39,100 --> 00:10:40,320 of meeting that target, 283 00:10:40,779 --> 00:10:42,779 which is a huge improvement from when we 284 00:10:42,779 --> 00:10:43,664 started this work. 285 00:10:44,144 --> 00:10:46,464 And, again, we are now starting to see 286 00:10:46,464 --> 00:10:48,644 that backlog that I spoke about, 287 00:10:49,504 --> 00:10:52,404 being addressed. And so those patients are getting 288 00:10:52,784 --> 00:10:54,164 the care that they need, 289 00:10:54,704 --> 00:10:57,090 in our procedural system. So, again, those are 290 00:10:57,090 --> 00:10:58,149 just a couple of, 291 00:10:58,769 --> 00:11:01,169 projects that I can recall, again, that I 292 00:11:01,169 --> 00:11:03,090 had the honor and privilege to to leave 293 00:11:03,090 --> 00:11:04,230 with my co executives. 294 00:11:06,210 --> 00:11:07,570 I love that. I think all of those 295 00:11:07,570 --> 00:11:09,830 things you mentioned are are so critical, especially, 296 00:11:10,529 --> 00:11:13,845 being able to improve that efficiency, reimagine the 297 00:11:13,845 --> 00:11:15,764 way that you're looking at the space, some 298 00:11:15,764 --> 00:11:16,985 processes, procedures, 299 00:11:17,365 --> 00:11:19,465 and then the data and having the information 300 00:11:19,524 --> 00:11:22,404 that can inform whether you're making improvements and 301 00:11:22,404 --> 00:11:24,485 and how it impacts quality and outcomes and 302 00:11:24,485 --> 00:11:25,350 everything else, 303 00:11:25,829 --> 00:11:28,389 you know, is so critical. I'm curious as 304 00:11:28,389 --> 00:11:29,850 you were making this transformation 305 00:11:30,230 --> 00:11:31,669 and putting all of this in place and 306 00:11:31,669 --> 00:11:34,629 integrating it into the the daily functioning at 307 00:11:34,629 --> 00:11:35,370 the hospitals, 308 00:11:36,309 --> 00:11:38,230 how did you, at the same time, go 309 00:11:38,230 --> 00:11:41,325 through the cultural transformation for folks to really, 310 00:11:41,884 --> 00:11:43,965 embrace all of these things and then make 311 00:11:43,965 --> 00:11:46,445 sure that, you're getting the outcomes that you 312 00:11:46,445 --> 00:11:46,945 wanted. 313 00:11:47,565 --> 00:11:49,965 Yeah. No. That's great. Right? It's part of 314 00:11:49,965 --> 00:11:52,445 that change curve. Right? When we had some 315 00:11:52,605 --> 00:11:54,465 you know, surgeons can be, 316 00:11:55,325 --> 00:11:56,144 let's say, 317 00:11:57,029 --> 00:11:57,930 you know, very, 318 00:11:59,029 --> 00:12:00,570 emotional and passionate 319 00:12:00,870 --> 00:12:02,950 about, their patients. And so we had to 320 00:12:02,950 --> 00:12:04,790 bring them along and it took some time. 321 00:12:04,790 --> 00:12:05,290 Absolutely. 322 00:12:05,910 --> 00:12:08,649 Like I said, we use our lean management 323 00:12:08,710 --> 00:12:11,769 system. And so everything is visible either electronically 324 00:12:12,284 --> 00:12:12,784 or, 325 00:12:13,404 --> 00:12:15,404 in our what we call our war rooms. 326 00:12:15,404 --> 00:12:18,365 And so we would bring our surgeons right 327 00:12:18,365 --> 00:12:19,824 along, and they would see, 328 00:12:20,284 --> 00:12:21,504 all the problem solving. 329 00:12:21,884 --> 00:12:22,365 And, 330 00:12:23,084 --> 00:12:25,404 and and also an important element is that 331 00:12:25,404 --> 00:12:28,839 we would include them in on the problem 332 00:12:28,839 --> 00:12:29,339 solving. 333 00:12:29,720 --> 00:12:32,059 And so, again, using our lean fundamentals 334 00:12:32,519 --> 00:12:34,379 of taking the work to our frontline, 335 00:12:34,679 --> 00:12:36,459 asking them to be a part of 336 00:12:36,839 --> 00:12:39,659 the problem solving, helping us set up targets, 337 00:12:40,625 --> 00:12:42,945 our process and outcome metrics. I think that 338 00:12:42,945 --> 00:12:43,684 was key. 339 00:12:44,225 --> 00:12:44,705 And, 340 00:12:45,184 --> 00:12:47,044 having several identified 341 00:12:47,345 --> 00:12:47,845 anesthesiologists 342 00:12:48,225 --> 00:12:48,884 and surgeons 343 00:12:49,424 --> 00:12:51,985 kinda champion this work. So it wasn't so 344 00:12:51,985 --> 00:12:54,759 much the executive team selling it. It really 345 00:12:54,759 --> 00:12:57,320 was the those that are impacted by this 346 00:12:57,320 --> 00:12:57,820 work. 347 00:12:58,279 --> 00:13:00,600 And so, again, that that to me really 348 00:13:00,600 --> 00:13:01,100 helped, 349 00:13:02,600 --> 00:13:05,399 you know, help help make this change easier 350 00:13:05,399 --> 00:13:08,054 and and also showing them results. Right? 351 00:13:08,534 --> 00:13:10,534 Showing them that, yes, you're getting this case 352 00:13:10,534 --> 00:13:12,695 in or we heard you. So we opened 353 00:13:12,695 --> 00:13:14,934 up this service line. We had a a 354 00:13:14,934 --> 00:13:17,335 big bottleneck in robotics, and so we had 355 00:13:17,335 --> 00:13:18,475 to, reimagine 356 00:13:19,254 --> 00:13:21,575 where we were going to do those surgeries. 357 00:13:21,575 --> 00:13:23,730 And so we put put the robot in 358 00:13:23,730 --> 00:13:25,649 a in a room, in an OR that 359 00:13:25,649 --> 00:13:26,870 may not have been, 360 00:13:27,410 --> 00:13:29,990 everyone's first choice, but we did simulations. 361 00:13:30,529 --> 00:13:32,850 We did mock ups. And so when we 362 00:13:32,850 --> 00:13:33,910 did all those, 363 00:13:35,024 --> 00:13:37,345 test of change, we included our surgeons in 364 00:13:37,345 --> 00:13:39,184 on that so that they could own it. 365 00:13:39,184 --> 00:13:40,404 They could give their feedback, 366 00:13:40,784 --> 00:13:42,865 and then they could also turn around and 367 00:13:42,865 --> 00:13:45,584 sell it to their section members and practice 368 00:13:45,584 --> 00:13:46,565 partners. So 369 00:13:47,105 --> 00:13:49,024 it just was critical to get them involved, 370 00:13:49,424 --> 00:13:50,245 early on. 371 00:13:52,649 --> 00:13:54,730 That's so helpful to understand. Thank you for 372 00:13:54,730 --> 00:13:57,629 sharing, and talking through that. Now looking ahead, 373 00:13:57,690 --> 00:13:59,289 what are some of your big priorities and 374 00:13:59,289 --> 00:14:00,990 headwinds for 2026? 375 00:14:01,529 --> 00:14:02,029 Gosh. 376 00:14:02,649 --> 00:14:04,750 Where do I begin? Lots of headwinds. 377 00:14:05,884 --> 00:14:08,285 I'd say, you know, we're not alone. I 378 00:14:08,285 --> 00:14:10,924 think everywhere and everywhere is struggling with the 379 00:14:10,924 --> 00:14:12,144 payer mix and reimbursements, 380 00:14:13,004 --> 00:14:15,165 and those issues that are coming, especially from 381 00:14:15,165 --> 00:14:15,665 our, 382 00:14:16,044 --> 00:14:16,544 government, 383 00:14:17,565 --> 00:14:19,024 programs such as Medicaid. 384 00:14:19,629 --> 00:14:22,829 And so, you know, it's it's just, the 385 00:14:22,829 --> 00:14:25,649 shrinking dollar. Right? Especially from the, 386 00:14:27,070 --> 00:14:29,230 the Medicaid program. And I know that in 387 00:14:29,230 --> 00:14:29,889 our community, 388 00:14:31,149 --> 00:14:33,889 you know, we're just not seeing those rates, 389 00:14:34,875 --> 00:14:36,334 increase year over year, 390 00:14:36,954 --> 00:14:39,195 like they need to to match inflation and 391 00:14:39,195 --> 00:14:42,254 match labor, to match all the other costs 392 00:14:42,475 --> 00:14:43,375 that are, 393 00:14:44,235 --> 00:14:46,174 you know, not just the hospital. 394 00:14:46,500 --> 00:14:48,179 You know, we're so big. We can kind 395 00:14:48,179 --> 00:14:50,019 of weather some of this a little bit 396 00:14:50,019 --> 00:14:50,519 better, 397 00:14:50,899 --> 00:14:53,720 but our private group's in town. And so, 398 00:14:54,500 --> 00:14:57,779 it is really impacting our private practices. And 399 00:14:57,779 --> 00:14:59,299 so to give you a little bit of 400 00:14:59,299 --> 00:14:59,799 perspective, 401 00:15:00,715 --> 00:15:03,274 we have had several large practices over the 402 00:15:03,274 --> 00:15:04,654 last couple of years 403 00:15:05,355 --> 00:15:06,095 that simply 404 00:15:06,475 --> 00:15:07,534 couldn't make, 405 00:15:08,315 --> 00:15:09,534 their books balance, 406 00:15:09,914 --> 00:15:11,995 so to speak, and and their businesses were 407 00:15:11,995 --> 00:15:12,495 failing. 408 00:15:12,875 --> 00:15:15,980 And so despite, you know, very smart people 409 00:15:15,980 --> 00:15:18,399 that were running these businesses, they could not 410 00:15:18,460 --> 00:15:20,299 keep up with all of those factors I 411 00:15:20,299 --> 00:15:23,419 just mentioned, like inflation and especially labor. That 412 00:15:23,419 --> 00:15:24,399 has been a huge 413 00:15:24,940 --> 00:15:25,440 huge, 414 00:15:26,220 --> 00:15:28,639 driver of cost for these practices. 415 00:15:29,404 --> 00:15:32,304 And when you couple that with, shrinking reimbursements, 416 00:15:33,325 --> 00:15:36,684 it really just made it almost impossible to 417 00:15:36,684 --> 00:15:38,304 function. And so we've had, 418 00:15:38,924 --> 00:15:41,184 a couple of large groups in our community 419 00:15:41,540 --> 00:15:44,259 come to us for employment. And again, that's 420 00:15:44,259 --> 00:15:47,379 not Salem Health strategy is to compete in 421 00:15:47,379 --> 00:15:48,519 these service lines. 422 00:15:49,220 --> 00:15:50,120 But our strategy 423 00:15:50,660 --> 00:15:51,160 absolutely 424 00:15:51,620 --> 00:15:52,759 is to make sure 425 00:15:53,139 --> 00:15:53,639 that 426 00:15:54,004 --> 00:15:56,664 these service lines are available to our patients, 427 00:15:56,725 --> 00:15:58,965 if that makes sense. We know we need 428 00:15:58,965 --> 00:15:59,465 orthopedics 429 00:16:00,085 --> 00:16:02,485 in our community. And so when that group 430 00:16:02,485 --> 00:16:04,965 approached us for employment, we absolutely worked with 431 00:16:04,965 --> 00:16:06,424 them, brought them in board. 432 00:16:06,884 --> 00:16:09,284 And, but the, I guess the concerning or 433 00:16:09,284 --> 00:16:11,250 the big challenges we're we're seeing more and 434 00:16:11,250 --> 00:16:13,090 more groups do this too. We just did 435 00:16:13,090 --> 00:16:14,710 this with our urology group. 436 00:16:15,330 --> 00:16:18,370 And so, it's not going away, but we're 437 00:16:18,370 --> 00:16:20,450 here to, you know, to help the best 438 00:16:20,450 --> 00:16:21,190 we can, 439 00:16:22,129 --> 00:16:24,674 to, you know, bolster these headwinds like you 440 00:16:24,754 --> 00:16:26,514 described in the question. But I really think 441 00:16:26,514 --> 00:16:28,214 that's that's our big challenge, 442 00:16:29,075 --> 00:16:30,855 facing all of us in our community. 443 00:16:32,355 --> 00:16:34,195 I think that's such an excellent point. And, 444 00:16:34,195 --> 00:16:35,714 you know, especially looking at how, 445 00:16:37,450 --> 00:16:39,709 physicians and physician shortages are impacting 446 00:16:40,169 --> 00:16:42,730 communities and hospitals and systems across the country 447 00:16:42,730 --> 00:16:44,269 in, you know, bringing 448 00:16:44,570 --> 00:16:46,970 those physician groups into employment. I know it's 449 00:16:46,970 --> 00:16:50,089 no small task and and then, you know, 450 00:16:50,089 --> 00:16:50,589 integrating 451 00:16:51,495 --> 00:16:52,394 them financially, 452 00:16:52,934 --> 00:16:55,735 culturally, everything else. And so when you're looking 453 00:16:55,735 --> 00:16:57,495 at, you know, how you've been able to 454 00:16:57,495 --> 00:16:59,414 do this successfully now a couple of different 455 00:16:59,414 --> 00:16:59,914 times, 456 00:17:00,455 --> 00:17:01,035 you know, 457 00:17:01,654 --> 00:17:04,154 what are your kind of, like, business considerations 458 00:17:04,295 --> 00:17:05,095 for your your, 459 00:17:05,734 --> 00:17:07,950 deciding to do that? And how do you, 460 00:17:08,250 --> 00:17:10,330 make sure that, you know, you have everything 461 00:17:10,330 --> 00:17:11,769 in place? Or what lessons have you learned, 462 00:17:11,769 --> 00:17:12,590 I guess, in, 463 00:17:12,970 --> 00:17:14,730 bringing in those types of groups and and 464 00:17:14,730 --> 00:17:16,650 making them employed to make sure things go 465 00:17:16,650 --> 00:17:17,869 as smoothly as possible? 466 00:17:18,330 --> 00:17:20,170 Yeah. No. We've learned a lot. Right? I 467 00:17:20,170 --> 00:17:21,309 talked about the anesthesia, 468 00:17:22,515 --> 00:17:24,055 model that became employed, 469 00:17:24,434 --> 00:17:26,295 several years ago. And so, 470 00:17:26,914 --> 00:17:28,455 again, we learn through, 471 00:17:28,835 --> 00:17:30,595 all of our problem solving. Like I said, 472 00:17:30,595 --> 00:17:31,654 we're a lean organization. 473 00:17:33,154 --> 00:17:35,494 But, yes, assimilating into our culture, 474 00:17:36,250 --> 00:17:38,269 You know, again, I just wanna make sure, 475 00:17:38,329 --> 00:17:40,490 you know, our strategy is not to compete 476 00:17:40,490 --> 00:17:42,569 or go after these groups, but we really 477 00:17:42,569 --> 00:17:44,410 try to put the patient in the middle 478 00:17:44,410 --> 00:17:45,230 of all this. 479 00:17:45,690 --> 00:17:48,585 What services do our patients need in our 480 00:17:48,744 --> 00:17:49,244 community? 481 00:17:49,865 --> 00:17:52,204 And so that's that's really been our approach. 482 00:17:52,265 --> 00:17:53,565 They need urology. 483 00:17:53,865 --> 00:17:55,804 They absolutely need orthopedics. 484 00:17:56,345 --> 00:17:58,744 And so when we take that approach, it 485 00:17:58,744 --> 00:18:01,224 makes that work, you know, focused on a 486 00:18:01,224 --> 00:18:03,164 a solitary mission or vision. 487 00:18:04,180 --> 00:18:05,960 But getting them culturally, 488 00:18:06,820 --> 00:18:07,400 you know, 489 00:18:07,779 --> 00:18:09,880 into our health system, that's been a challenge. 490 00:18:10,660 --> 00:18:12,580 But again, it just takes lots of, 491 00:18:13,140 --> 00:18:13,640 conversation, 492 00:18:14,019 --> 00:18:16,420 lots of time. Sometimes you have to slow 493 00:18:16,420 --> 00:18:17,474 down to go fast. 494 00:18:18,275 --> 00:18:20,835 And, just walking through these, 495 00:18:21,234 --> 00:18:23,714 numbers, sometimes it's just individually with all of 496 00:18:23,714 --> 00:18:27,075 them, keeping everything visible, good communication, follow through, 497 00:18:27,075 --> 00:18:27,575 etcetera. 498 00:18:28,595 --> 00:18:29,875 Like I said, a lot of those soft 499 00:18:29,875 --> 00:18:31,634 skills that you may not have learned so 500 00:18:31,634 --> 00:18:33,750 much in in medical school, but, 501 00:18:34,230 --> 00:18:36,470 it's just it speaks to that relational side 502 00:18:36,470 --> 00:18:37,130 of leadership. 503 00:18:39,349 --> 00:18:41,430 Absolutely. Easier said than done, I know, in 504 00:18:41,430 --> 00:18:44,070 many ways, but, seems like something that comes 505 00:18:44,070 --> 00:18:45,830 naturally to you, or did you have to 506 00:18:45,830 --> 00:18:47,535 to acquire skills there too? 507 00:18:48,095 --> 00:18:49,955 Oh, I'm always learning. Absolutely. 508 00:18:50,734 --> 00:18:51,955 Asking for feedback. 509 00:18:52,815 --> 00:18:54,894 But, yes, you know, there there really is 510 00:18:54,974 --> 00:18:57,154 there there there are people. There are humans, 511 00:18:58,095 --> 00:18:59,555 behind all of these, 512 00:19:00,335 --> 00:19:02,990 decisions that we make. And so again, 513 00:19:03,289 --> 00:19:05,450 I keep talking about lean. One of our 514 00:19:05,450 --> 00:19:08,650 fundamental pillars is respect for people. And so 515 00:19:08,650 --> 00:19:10,250 we really do honor that in all that 516 00:19:10,250 --> 00:19:10,990 we do. 517 00:19:11,289 --> 00:19:14,565 And walking, these people through these changes is 518 00:19:14,565 --> 00:19:17,125 is not easy, but it's essential to get 519 00:19:17,125 --> 00:19:18,664 them to where they need to be. 520 00:19:19,845 --> 00:19:22,105 Absolutely. I I I definitely agree. 521 00:19:22,404 --> 00:19:24,164 Now, when you're looking ahead to, what do 522 00:19:24,164 --> 00:19:25,605 you think the hardest thing you'll have to 523 00:19:25,605 --> 00:19:27,144 do in the coming year will be? 524 00:19:27,750 --> 00:19:29,430 Great. Well, I don't wanna be doom and 525 00:19:29,430 --> 00:19:31,349 gloom. I do think a lot of health 526 00:19:31,349 --> 00:19:33,369 care is is really hard right now. 527 00:19:34,230 --> 00:19:36,549 So, you know, there's there's pressures and challenges 528 00:19:36,549 --> 00:19:38,150 on all fronts. So I'd say, 529 00:19:40,015 --> 00:19:42,414 maybe the hardest thing that we we have 530 00:19:42,414 --> 00:19:43,775 in front of us is just to make 531 00:19:43,775 --> 00:19:45,634 sure that we stay true to our mission 532 00:19:45,775 --> 00:19:47,075 and serving patients 533 00:19:47,775 --> 00:19:48,595 and really, 534 00:19:49,454 --> 00:19:50,914 kinda getting back to, 535 00:19:51,375 --> 00:19:54,174 why we're why we are all doing this. 536 00:19:54,174 --> 00:19:55,075 And so, 537 00:19:55,440 --> 00:19:57,539 for instance, I love when, 538 00:19:58,399 --> 00:20:00,880 young people come and shadow me, in the 539 00:20:00,880 --> 00:20:03,200 OR or ask me about my profession. It 540 00:20:03,200 --> 00:20:05,119 kinda reminds me of why I even stepped 541 00:20:05,119 --> 00:20:06,500 into all of this. So, 542 00:20:07,279 --> 00:20:08,799 so I just you know, I think our 543 00:20:08,799 --> 00:20:11,085 challenge is, you know, how do we keep 544 00:20:11,085 --> 00:20:12,865 this fresh? How do we make this, 545 00:20:13,484 --> 00:20:13,984 rewarding? 546 00:20:14,845 --> 00:20:17,565 How do we just remind ourselves that our 547 00:20:17,565 --> 00:20:19,904 patients are benefiting from what we do? 548 00:20:20,845 --> 00:20:23,744 Just earlier today, I was at the nephrology 549 00:20:23,964 --> 00:20:24,865 section meeting. 550 00:20:25,289 --> 00:20:27,529 And so they're such a great amazing group 551 00:20:27,529 --> 00:20:29,630 of individuals. And so it was refreshing 552 00:20:30,170 --> 00:20:30,830 to see, 553 00:20:31,289 --> 00:20:33,769 them not jaded by all of those challenges 554 00:20:33,769 --> 00:20:35,950 I just mentioned. And they were, 555 00:20:36,330 --> 00:20:39,134 excited to share with me some innovative and 556 00:20:39,295 --> 00:20:41,154 creative ideas they had about 557 00:20:41,615 --> 00:20:44,595 certain barriers and problems that they were experiencing. 558 00:20:44,894 --> 00:20:45,394 So, 559 00:20:45,855 --> 00:20:47,695 so I guess, you know, some of the 560 00:20:47,695 --> 00:20:49,615 challenges that I think that we face as 561 00:20:49,615 --> 00:20:50,755 leaders is, 562 00:20:51,375 --> 00:20:53,160 let's not lose sight of, 563 00:20:53,759 --> 00:20:55,640 you know, why we're doing this, and it's 564 00:20:55,640 --> 00:20:56,380 for the patient. 565 00:20:56,920 --> 00:20:58,680 And so if we kinda keep that in 566 00:20:58,680 --> 00:21:00,519 mind, then I think all those other things 567 00:21:00,519 --> 00:21:02,599 will follow. And so, you know, how do 568 00:21:02,599 --> 00:21:04,920 we care for those who care for the 569 00:21:04,920 --> 00:21:07,080 patient? And so it just kind of expands 570 00:21:07,080 --> 00:21:07,634 from there. 571 00:21:08,115 --> 00:21:10,195 So that that's a challenge. We do get 572 00:21:10,195 --> 00:21:11,654 kind of focused on our problems. 573 00:21:12,115 --> 00:21:13,494 So how can we keep that, 574 00:21:14,035 --> 00:21:15,974 that true north, that positive, 575 00:21:16,434 --> 00:21:18,934 mission statement of caring for our our patients? 576 00:21:20,130 --> 00:21:22,390 That is such a helpful reminder and especially, 577 00:21:23,089 --> 00:21:25,170 you know, today in thinking about all the 578 00:21:25,170 --> 00:21:27,970 different pressures and, things that are going on 579 00:21:27,970 --> 00:21:29,589 for health care providers, 580 00:21:30,049 --> 00:21:32,609 being able to really craft that type of 581 00:21:32,609 --> 00:21:35,625 environment, atmosphere, atmosphere, and culture where they feel 582 00:21:35,625 --> 00:21:36,125 supported, 583 00:21:36,505 --> 00:21:38,585 can be so critical. And I I think 584 00:21:38,585 --> 00:21:39,944 when you're looking at, you know, 585 00:21:41,464 --> 00:21:43,784 some of those innovations that you've been hearing 586 00:21:43,784 --> 00:21:46,025 about, creative ideas and other ways to problem 587 00:21:46,025 --> 00:21:47,549 solve, Does anything, 588 00:21:47,930 --> 00:21:49,210 rise to the top or come to mind 589 00:21:49,210 --> 00:21:51,609 as something that was a particularly unique way 590 00:21:51,609 --> 00:21:52,750 that you've been tackling 591 00:21:53,210 --> 00:21:56,330 some of these, you know, more physician bonus 592 00:21:56,330 --> 00:21:57,150 or or clinician, 593 00:21:57,930 --> 00:21:59,549 you know, resilience issues? 594 00:22:00,255 --> 00:22:03,055 We are actually learning a lot. And if 595 00:22:03,055 --> 00:22:05,454 you wanna talk about innovation and creativity, we're 596 00:22:05,454 --> 00:22:07,075 learning so much about virtual 597 00:22:07,454 --> 00:22:07,954 care. 598 00:22:09,055 --> 00:22:11,134 I know we we did round one of 599 00:22:11,134 --> 00:22:12,355 that, right, with COVID. 600 00:22:13,160 --> 00:22:15,980 I'd say round two is kinda reimagining 601 00:22:16,279 --> 00:22:18,359 virtual care in a new way. And so 602 00:22:18,359 --> 00:22:19,099 we launched, 603 00:22:19,640 --> 00:22:21,720 I think it was about a year ago, 604 00:22:21,720 --> 00:22:24,779 maybe a little longer than that, virtual nursing. 605 00:22:25,240 --> 00:22:27,240 And so we have actually seen a lot 606 00:22:27,240 --> 00:22:28,365 of success there. 607 00:22:29,005 --> 00:22:31,424 Our nurses like it. Our patients like it. 608 00:22:32,285 --> 00:22:34,704 Our patient experience scores have grown. 609 00:22:35,164 --> 00:22:35,984 And so, 610 00:22:37,005 --> 00:22:39,265 I would say from a provider perspective, 611 00:22:40,045 --> 00:22:43,005 we are taking a deep lean into that 612 00:22:43,005 --> 00:22:45,660 work, and we're looking at what our nurses 613 00:22:45,660 --> 00:22:47,039 did to make that successful. 614 00:22:47,740 --> 00:22:48,700 And so we're, 615 00:22:49,099 --> 00:22:51,500 just scratching the surface on how can we 616 00:22:51,500 --> 00:22:52,799 apply that to, 617 00:22:53,420 --> 00:22:55,980 provider practices. You know, what does virtual care 618 00:22:55,980 --> 00:22:57,424 look like? And 619 00:22:57,725 --> 00:22:59,765 again, not necessarily in the way we saw 620 00:22:59,765 --> 00:23:01,725 it during COVID, but how do we do 621 00:23:01,725 --> 00:23:03,424 it in the acute care setting? 622 00:23:03,725 --> 00:23:06,205 So, I'm really excited for that. I think 623 00:23:06,205 --> 00:23:07,985 there's some great potential 624 00:23:08,605 --> 00:23:09,585 which will, 625 00:23:10,125 --> 00:23:10,625 perhaps 626 00:23:11,085 --> 00:23:12,840 make care better, more efficient. 627 00:23:13,299 --> 00:23:15,320 It might address the financial questions. 628 00:23:15,940 --> 00:23:17,700 And so it could be, you know, the 629 00:23:17,700 --> 00:23:20,119 triple or quadruple aim type of 630 00:23:20,580 --> 00:23:22,820 innovation that we're looking for. So, yeah, more 631 00:23:22,820 --> 00:23:24,740 to come on that. I'm really excited about 632 00:23:24,740 --> 00:23:25,640 virtual care. 633 00:23:28,015 --> 00:23:29,934 I love it. I I think there's so 634 00:23:29,934 --> 00:23:32,414 many opportunities there, and, really, it just seems 635 00:23:32,414 --> 00:23:34,575 like amazing way to expand access to care 636 00:23:34,575 --> 00:23:36,894 and and get you, in the system, you 637 00:23:36,894 --> 00:23:38,910 know, into the position it wants to be. 638 00:23:39,630 --> 00:23:40,910 Before we wrap up here, are there any 639 00:23:40,910 --> 00:23:42,590 other areas that you see as being really 640 00:23:42,590 --> 00:23:44,210 primed for organizational growth? 641 00:23:45,070 --> 00:23:45,890 I'd say, 642 00:23:46,430 --> 00:23:48,269 you know, this is a very small subset 643 00:23:48,269 --> 00:23:50,670 of our organization, but an important one is 644 00:23:50,670 --> 00:23:52,289 our medical executive committee. 645 00:23:52,955 --> 00:23:55,035 And we had a retreat this last fall. 646 00:23:55,275 --> 00:23:57,695 It was great to get us all together 647 00:23:57,755 --> 00:23:59,055 to have some time off-site, 648 00:23:59,994 --> 00:24:01,775 to really have some protected, 649 00:24:02,714 --> 00:24:03,214 conversation 650 00:24:03,595 --> 00:24:06,654 about the challenges that our medical executive committee, 651 00:24:07,099 --> 00:24:09,440 kinda kinda is seeing or experiencing. 652 00:24:10,380 --> 00:24:12,400 You know, we talked a lot about APPs, 653 00:24:13,820 --> 00:24:15,900 just how grateful we are for them, but 654 00:24:15,900 --> 00:24:16,400 also, 655 00:24:17,340 --> 00:24:19,820 just recognizing that their presence here in Oregon 656 00:24:19,820 --> 00:24:22,640 has exploded. It really has over the last 657 00:24:22,835 --> 00:24:25,315 several years and even here at Salem Health. 658 00:24:25,315 --> 00:24:27,154 So how can we honor them? How can 659 00:24:27,154 --> 00:24:28,375 we support them? 660 00:24:28,914 --> 00:24:30,615 How do we balance that independence 661 00:24:30,914 --> 00:24:32,694 versus where they fit in the healthcare, 662 00:24:33,634 --> 00:24:34,134 continuum? 663 00:24:35,075 --> 00:24:37,075 How do we help support them with quality 664 00:24:37,075 --> 00:24:39,319 of care, etcetera. So that's been exciting. 665 00:24:39,779 --> 00:24:42,420 And then, it was great to hear from 666 00:24:42,420 --> 00:24:44,680 my MEC leaders about how 667 00:24:45,220 --> 00:24:46,759 they can impact 668 00:24:47,140 --> 00:24:49,400 quality, not so much in the 669 00:24:50,325 --> 00:24:53,284 traditional sense of, you know, problem solving, all 670 00:24:53,284 --> 00:24:53,784 those, 671 00:24:54,644 --> 00:24:57,044 you know, important measures such as CAUTIs and 672 00:24:57,044 --> 00:24:59,684 CLABSIs, etcetera. But to hear from that that 673 00:24:59,684 --> 00:25:02,024 they want to drive the culture 674 00:25:02,849 --> 00:25:05,429 of quality. How do they improve that 675 00:25:05,809 --> 00:25:07,890 among our medical staff and care team? That 676 00:25:07,890 --> 00:25:10,150 was really exciting. So that was refreshing. 677 00:25:10,609 --> 00:25:13,009 It was great to have that, opportunity with 678 00:25:13,009 --> 00:25:15,009 them. And and so our next step now 679 00:25:15,009 --> 00:25:17,825 is just trying to apply that to some 680 00:25:17,825 --> 00:25:18,325 tactical, 681 00:25:19,345 --> 00:25:22,085 strategy to execute those those goals. 682 00:25:24,784 --> 00:25:26,625 I love that. Thank you so much, doctor 683 00:25:26,625 --> 00:25:28,065 Boles, for your time today. This has been 684 00:25:28,065 --> 00:25:30,144 such a fascinating interview. I think you've shared 685 00:25:30,144 --> 00:25:30,660 so many, 686 00:25:31,220 --> 00:25:32,039 different ideas 687 00:25:32,340 --> 00:25:34,660 in creative ways that you're problem solving today. 688 00:25:34,900 --> 00:25:37,140 It's just been very inspiring, and I look 689 00:25:37,140 --> 00:25:38,580 forward to seeing you as well at our 690 00:25:38,580 --> 00:25:40,500 annual meeting in April. I know you'll be 691 00:25:40,500 --> 00:25:42,340 speaking on a panel and covering a lot 692 00:25:42,340 --> 00:25:43,859 of these same same themes, and so it'll 693 00:25:43,859 --> 00:25:45,320 be great to continue the conversation. 694 00:25:46,394 --> 00:25:48,394 Great. Thanks, Laura. Well, like I said, it's 695 00:25:48,394 --> 00:25:50,234 an honor and privilege to be here. I'm 696 00:25:50,234 --> 00:25:50,975 very grateful.