1 00:00:02,240 --> 00:00:05,040 The most important health care decisions don't happen 2 00:00:05,040 --> 00:00:05,779 in isolation. 3 00:00:06,160 --> 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 --> 00:00:15,519 hospital and health system executives this April in 7 00:00:15,519 --> 00:00:15,914 Chicago. 8 00:00:16,635 --> 00:00:20,254 With 800 speakers from Ascension, Cleveland Clinic, CommonSpirit 9 00:00:20,394 --> 00:00:23,434 and more, the conversations get real. Leaders will 10 00:00:23,434 --> 00:00:26,094 share how their scenario planning for policy shifts, 11 00:00:26,234 --> 00:00:28,739 breaking through value based care barriers and building 12 00:00:28,739 --> 00:00:31,539 clinical teams that translate new ideas into real 13 00:00:31,539 --> 00:00:32,359 world care. 14 00:00:32,899 --> 00:00:35,429 Join top decision makers in the room April 15 00:00:35,429 --> 00:00:37,000 13 through the sixteenth. 16 00:00:37,460 --> 00:00:41,780 For the agenda and event details, visit beckershospitalreview.com 17 00:00:41,780 --> 00:00:43,460 and click on the events tab in the 18 00:00:43,460 --> 00:00:43,935 upper right. 19 00:00:45,615 --> 00:00:48,094 Hello, everyone, and welcome back to the Becker's 20 00:00:48,094 --> 00:00:51,875 Healthcare podcast. I'm Mackenzie Bean, associate vice president 21 00:00:51,935 --> 00:00:54,675 and managing editor of Becker's Hospital Review. 22 00:00:55,054 --> 00:00:57,570 Today, I'm so thrilled to welcome back doctor 23 00:00:57,570 --> 00:00:58,070 Geraldo 24 00:00:58,450 --> 00:01:01,009 Xavier, who is a regional chief medical officer 25 00:01:01,009 --> 00:01:02,549 with Atlantic Health System. 26 00:01:03,010 --> 00:01:05,569 Doctor Xavier, welcome back to the podcast. Thanks 27 00:01:05,569 --> 00:01:06,790 for joining us today. 28 00:01:07,329 --> 00:01:10,530 Hey. Thanks, Mackenzie. Really appreciate you having me 29 00:01:10,530 --> 00:01:11,030 on. 30 00:01:11,674 --> 00:01:13,515 Hope all is well with you as well. 31 00:01:13,515 --> 00:01:15,055 Looking forward to our conversation. 32 00:01:16,234 --> 00:01:17,355 Yeah. I know we, 33 00:01:17,674 --> 00:01:19,055 got to speak on the podcast 34 00:01:19,674 --> 00:01:21,515 last spring. So here we are a year 35 00:01:21,515 --> 00:01:24,075 later. So I'm excited to check-in and and 36 00:01:24,075 --> 00:01:25,674 hear about some of the progress that you've 37 00:01:25,674 --> 00:01:27,599 made and the efforts going on at Atlantic 38 00:01:27,599 --> 00:01:28,819 Health System right now. 39 00:01:29,439 --> 00:01:31,459 But I'm doing well. Thank you for asking. 40 00:01:33,120 --> 00:01:35,200 Before we dive into the conversation, I'd love 41 00:01:35,200 --> 00:01:36,640 to turn the floor over to you just 42 00:01:36,640 --> 00:01:38,099 to briefly introduce yourself, 43 00:01:38,655 --> 00:01:40,174 and tell us a little bit more about 44 00:01:40,174 --> 00:01:42,334 your work at Atlantic Health System for anyone 45 00:01:42,334 --> 00:01:44,194 who may not have caught your previous episode. 46 00:01:44,974 --> 00:01:45,875 Sure. Absolutely. 47 00:01:46,334 --> 00:01:48,814 Absolutely. So as you said, I'm a board 48 00:01:48,814 --> 00:01:51,234 certified emergency medicine physician 49 00:01:51,770 --> 00:01:54,750 and healthcare executive, currently serving as a regional 50 00:01:55,130 --> 00:01:56,430 chief medical officer, 51 00:01:57,290 --> 00:01:59,230 for Atlantic Health Hackettstown 52 00:01:59,930 --> 00:02:02,250 and Newton Medical Centers. We are based in 53 00:02:02,250 --> 00:02:02,909 New Jersey. 54 00:02:03,370 --> 00:02:06,409 I've spent my career, leading large complex hospital 55 00:02:06,409 --> 00:02:06,909 system, 56 00:02:07,724 --> 00:02:11,104 through clinical, operational, and strategic transformation, 57 00:02:11,724 --> 00:02:13,965 but always with a focus on quality patient 58 00:02:13,965 --> 00:02:15,664 safety and health equity. 59 00:02:16,205 --> 00:02:18,125 So a little bit about me. My background 60 00:02:18,125 --> 00:02:21,985 combines both frontline clinical experience and executive leadership. 61 00:02:22,750 --> 00:02:25,389 I began my career in emergency medicine and 62 00:02:25,389 --> 00:02:26,530 progressively took 63 00:02:26,909 --> 00:02:30,030 on additional leadership roles from medical director and 64 00:02:30,030 --> 00:02:31,090 chair to, 65 00:02:31,789 --> 00:02:34,669 chief quality officer to now my new, role 66 00:02:34,669 --> 00:02:36,449 as the chief medical officer. 67 00:02:37,265 --> 00:02:40,145 Those experiences have certainly helped shape my commitment 68 00:02:40,145 --> 00:02:43,685 to serve in diverse and vulnerable populations while 69 00:02:43,905 --> 00:02:44,965 driving measurable 70 00:02:45,265 --> 00:02:46,564 system level improvements. 71 00:02:47,745 --> 00:02:50,729 At Atlantic Health, I oversee clinical strategy and 72 00:02:50,889 --> 00:02:54,090 operations for new in at Hackettstown Medical Centers, 73 00:02:54,090 --> 00:02:55,150 two of our community, 74 00:02:55,849 --> 00:02:58,269 medical centers within our network. 75 00:02:58,889 --> 00:02:59,629 My responsibility, 76 00:03:00,009 --> 00:03:01,389 while varied, includes 77 00:03:02,090 --> 00:03:03,709 quality and patient safety, 78 00:03:04,090 --> 00:03:04,590 regulatory 79 00:03:05,049 --> 00:03:05,549 readiness, 80 00:03:06,344 --> 00:03:07,164 clinical outcomes, 81 00:03:07,784 --> 00:03:09,724 physician engagement, and care coordination. 82 00:03:11,064 --> 00:03:13,944 I really work, it's a matrix organization, and 83 00:03:13,944 --> 00:03:16,504 we work closely with our site based and 84 00:03:16,504 --> 00:03:17,405 system leadership 85 00:03:17,864 --> 00:03:20,424 as well as both employed and voluntary physician 86 00:03:20,424 --> 00:03:22,289 to align with strategy and performance. 87 00:03:22,989 --> 00:03:24,829 Really, with the key to ensure that we're 88 00:03:24,829 --> 00:03:26,129 delivering high quality, 89 00:03:26,669 --> 00:03:29,409 high reliable, strong value based care outcomes 90 00:03:29,949 --> 00:03:30,769 with exceptional, 91 00:03:31,310 --> 00:03:32,289 patient experience. 92 00:03:33,564 --> 00:03:35,985 Yeah. Over my career, you have led, 93 00:03:36,764 --> 00:03:40,864 significant challenges and work with transforming organization 94 00:03:41,164 --> 00:03:41,905 to improve 95 00:03:42,284 --> 00:03:44,305 their quality and reputation programs. 96 00:03:44,685 --> 00:03:46,384 As we mentioned in the last 97 00:03:47,280 --> 00:03:49,620 podcast, one of the work we did is 98 00:03:49,760 --> 00:03:52,419 really focusing on how we improve readmissions 99 00:03:52,800 --> 00:03:54,419 for these vulnerable cohorts, 100 00:03:55,040 --> 00:03:55,540 pulmonary, 101 00:03:56,000 --> 00:03:59,939 congestive heart failure, COPD, and acute myocardial infarction. 102 00:04:00,855 --> 00:04:04,555 And that program has sustained some while undergoing 103 00:04:04,615 --> 00:04:07,495 some challenges, has really sustained good improvements over 104 00:04:07,495 --> 00:04:07,995 time, 105 00:04:08,375 --> 00:04:10,474 really, which is something we're proud of. 106 00:04:10,855 --> 00:04:11,355 Also, 107 00:04:11,974 --> 00:04:12,474 really 108 00:04:13,289 --> 00:04:16,029 looking forward to ensuring that we are, 109 00:04:16,410 --> 00:04:18,089 continue to be a leapfrog aid at our 110 00:04:18,089 --> 00:04:18,589 centers. 111 00:04:19,209 --> 00:04:21,149 We do see hospital acquired conditions. 112 00:04:22,009 --> 00:04:25,310 And really for me, really guiding emergency management 113 00:04:25,370 --> 00:04:25,870 responses, 114 00:04:27,164 --> 00:04:29,404 while what we did during the pandemic and 115 00:04:29,404 --> 00:04:32,784 actually really post pandemic, really trying to strengthen 116 00:04:33,324 --> 00:04:33,824 interdisciplinary 117 00:04:34,365 --> 00:04:34,865 collaboration, 118 00:04:36,284 --> 00:04:37,344 improve organizational 119 00:04:37,644 --> 00:04:38,944 key performance indicators. 120 00:04:39,740 --> 00:04:42,459 It really advanced for me personally working with 121 00:04:42,459 --> 00:04:43,600 physician to advance 122 00:04:43,980 --> 00:04:45,120 peer review transparency 123 00:04:45,819 --> 00:04:48,639 and enhancing both workforce engagement and satisfaction. 124 00:04:49,660 --> 00:04:50,399 So really, 125 00:04:50,860 --> 00:04:53,259 I believe sustainable excellence in health care comes 126 00:04:53,259 --> 00:04:54,504 from really aligning with physicians and aligning with 127 00:04:54,504 --> 00:04:56,285 physicians and frontline teams 128 00:04:56,665 --> 00:04:59,725 with executive leadership around a shared vision, delivering 129 00:05:00,264 --> 00:05:02,985 safe, equitable, and high quality care for every 130 00:05:02,985 --> 00:05:03,485 patient 131 00:05:04,105 --> 00:05:04,925 every time. 132 00:05:05,944 --> 00:05:06,685 So, really, 133 00:05:07,310 --> 00:05:09,389 looking forward to this continued work that we're 134 00:05:09,389 --> 00:05:11,250 doing within our health care space. 135 00:05:12,350 --> 00:05:14,910 Yeah. I'm looking forward to hearing more about 136 00:05:14,910 --> 00:05:16,050 it. I think you paint 137 00:05:16,350 --> 00:05:19,149 such a clear strategic vision of this work 138 00:05:19,149 --> 00:05:20,829 and and what needs to be done to 139 00:05:20,829 --> 00:05:22,610 really move the needle for for 140 00:05:23,014 --> 00:05:24,634 patients in your communities. 141 00:05:25,175 --> 00:05:26,774 As you mentioned, the last time around the 142 00:05:26,774 --> 00:05:27,274 podcast 143 00:05:28,055 --> 00:05:28,795 laid out, 144 00:05:29,415 --> 00:05:31,335 some information for us in terms of the 145 00:05:31,335 --> 00:05:33,995 significant gains you've made in in readmissions, particularly 146 00:05:34,055 --> 00:05:35,459 for those vulnerable groups. 147 00:05:35,939 --> 00:05:38,259 I'm curious now speaking to you in early 148 00:05:38,259 --> 00:05:40,259 twenty twenty six, as you reflect back on 149 00:05:40,259 --> 00:05:42,339 the past twelve months, what would you say 150 00:05:42,339 --> 00:05:44,339 is the most important initiative that you have 151 00:05:44,339 --> 00:05:46,419 led? What did you do, and what were 152 00:05:46,419 --> 00:05:47,959 some of the results that you've seen? 153 00:05:48,899 --> 00:05:50,120 Yeah. Thanks. 154 00:05:50,435 --> 00:05:53,395 As we said, so many different priorities, so 155 00:05:53,395 --> 00:05:55,574 many things that are important to the organization 156 00:05:55,955 --> 00:05:58,115 for many of the things you talk about. 157 00:05:58,115 --> 00:06:00,214 But one of the, one of the important 158 00:06:00,355 --> 00:06:01,495 initiative I'll share, 159 00:06:02,115 --> 00:06:02,855 that I've 160 00:06:03,230 --> 00:06:04,930 led and worked with the multidisciplinary 161 00:06:05,230 --> 00:06:07,009 team over the past year is really 162 00:06:07,470 --> 00:06:10,610 focusing on capacity management and patient flow, 163 00:06:11,069 --> 00:06:13,629 specifically looking to reduce length of stay while 164 00:06:13,629 --> 00:06:16,689 improving throughput, safety, and overall experience. 165 00:06:17,735 --> 00:06:19,975 We are no different from many healthcare system. 166 00:06:19,975 --> 00:06:21,435 We face rising volumes, 167 00:06:22,134 --> 00:06:24,154 workforce constraints, and increasing 168 00:06:24,774 --> 00:06:25,995 access challenges. 169 00:06:26,855 --> 00:06:29,435 And, you know, patient flow is a passion 170 00:06:29,495 --> 00:06:31,769 project as well for me because it's not 171 00:06:31,769 --> 00:06:34,189 just an operational issue. It is fundamentally 172 00:06:34,569 --> 00:06:36,829 a patient safety and quality imperative. 173 00:06:37,370 --> 00:06:39,209 As we know that delays in, 174 00:06:39,610 --> 00:06:41,949 patient flow or delays in movement creates, 175 00:06:42,729 --> 00:06:44,605 risk and is a dissatisfier, 176 00:06:45,625 --> 00:06:46,605 for patients. 177 00:06:47,064 --> 00:06:50,105 They do affect care transition. It affects staff 178 00:06:50,105 --> 00:06:50,605 workload, 179 00:06:51,464 --> 00:06:53,725 and ultimately the care experience. 180 00:06:54,584 --> 00:06:55,064 So, 181 00:06:55,545 --> 00:06:57,369 with that in mind, I organized and led 182 00:06:57,369 --> 00:06:57,964 a multidisciplinary capacity management 183 00:06:58,584 --> 00:07:01,729 and capacity management and patient flow committee. 184 00:07:02,349 --> 00:07:05,169 We brought together stakeholders from across the continuum, 185 00:07:05,709 --> 00:07:07,729 such as nurse leadership, physicians, 186 00:07:08,829 --> 00:07:11,889 transport, bed management, ancillary services. 187 00:07:12,995 --> 00:07:15,475 Really, the key was ensuring that everyone who 188 00:07:15,475 --> 00:07:16,935 touches the patient journey 189 00:07:17,475 --> 00:07:19,495 had both a voice and a shared accountability, 190 00:07:20,435 --> 00:07:22,435 because I believe that flow is not owned 191 00:07:22,435 --> 00:07:24,915 by one department or one entity. It really 192 00:07:24,915 --> 00:07:26,295 is a system responsibility. 193 00:07:27,560 --> 00:07:28,539 With that premise, 194 00:07:28,839 --> 00:07:31,500 we really approach this work using a multimodal 195 00:07:31,720 --> 00:07:32,220 strategy. 196 00:07:33,240 --> 00:07:34,060 We optimize 197 00:07:34,439 --> 00:07:36,379 observational level of care management 198 00:07:37,079 --> 00:07:38,539 by enhancing collaboration 199 00:07:38,919 --> 00:07:40,060 between physicians, 200 00:07:40,985 --> 00:07:43,785 physician advisors, case management, to ensure we have 201 00:07:43,785 --> 00:07:45,485 the appropriate status designation 202 00:07:46,345 --> 00:07:47,485 early in the hospitalization. 203 00:07:48,345 --> 00:07:51,145 We partner with our clinical leaders to safely 204 00:07:51,145 --> 00:07:52,125 shift appropriate 205 00:07:52,985 --> 00:07:56,285 diagnostic testing from inpatient to outpatient setting. 206 00:07:56,720 --> 00:07:57,540 This required 207 00:07:57,840 --> 00:07:58,740 really meaningful 208 00:07:59,199 --> 00:07:59,699 physician, 209 00:08:00,319 --> 00:08:01,939 engagement and patient education, 210 00:08:02,480 --> 00:08:06,080 but it significantly reduced avoidable inpatient days without 211 00:08:06,080 --> 00:08:07,300 compromising quality. 212 00:08:07,920 --> 00:08:10,165 As a result, we were able to reduce 213 00:08:10,225 --> 00:08:12,384 our observation length of stay from an average 214 00:08:12,384 --> 00:08:15,025 of thirty six to forty eight hours to 215 00:08:15,025 --> 00:08:17,504 less than thirty hours and have been able 216 00:08:17,504 --> 00:08:18,964 to sustain those gains. 217 00:08:19,745 --> 00:08:23,025 That improvement alone created earlier, bed availability for 218 00:08:23,025 --> 00:08:26,600 patients requiring inpatient level of care and significantly 219 00:08:26,980 --> 00:08:28,199 improved our overall, 220 00:08:28,980 --> 00:08:29,959 throughput efficiency. 221 00:08:30,819 --> 00:08:32,980 One of the other key measures we took 222 00:08:32,980 --> 00:08:35,320 on in this approach, in this multimodal 223 00:08:35,700 --> 00:08:37,080 strategy is redesigning 224 00:08:37,940 --> 00:08:38,919 daily interdisciplinary 225 00:08:39,379 --> 00:08:40,279 bedside rounds 226 00:08:40,855 --> 00:08:42,634 to improve real time communication 227 00:08:43,014 --> 00:08:45,595 and identify discharge barriers early. 228 00:08:46,375 --> 00:08:48,375 This helps us to align with the care 229 00:08:48,375 --> 00:08:51,674 team around a clear daily plan and reduce 230 00:08:51,735 --> 00:08:53,035 communication breakdown. 231 00:08:53,840 --> 00:08:55,679 And I think more importantly, it helps us 232 00:08:55,679 --> 00:08:59,360 to identify discharge barriers early, whether that be 233 00:08:59,360 --> 00:09:02,960 clinical or logistical such as transportation needs so 234 00:09:02,960 --> 00:09:04,740 we can address them more proactively 235 00:09:05,040 --> 00:09:05,860 than reactively. 236 00:09:07,325 --> 00:09:10,065 That focus on daily goals and expected discharge 237 00:09:10,125 --> 00:09:10,625 dates 238 00:09:11,004 --> 00:09:13,904 directly reduces length of stay and improves throughput. 239 00:09:14,365 --> 00:09:17,004 It also supports discharge before noon and some 240 00:09:17,004 --> 00:09:20,945 other key performance indicators and ensure beds available, 241 00:09:21,629 --> 00:09:24,029 when patient needs it for the inpatient level 242 00:09:24,029 --> 00:09:24,690 of care. 243 00:09:25,549 --> 00:09:28,850 Equally, though, it does strengthen team engagement. Everyone 244 00:09:28,910 --> 00:09:30,370 understands their role, 245 00:09:30,670 --> 00:09:31,889 their shared accountability, 246 00:09:32,269 --> 00:09:34,529 and everyone's working from the same plan. 247 00:09:35,105 --> 00:09:37,205 And really when done right, interdisciplinary, 248 00:09:37,745 --> 00:09:41,205 we call IDR rounds, can shift culture from 249 00:09:41,345 --> 00:09:43,524 the fragmented care to really coordinated 250 00:09:43,985 --> 00:09:47,504 high reliable care that benefits all, including patient 251 00:09:47,504 --> 00:09:48,165 and staff. 252 00:09:48,850 --> 00:09:49,590 And finally, 253 00:09:50,049 --> 00:09:51,110 you know, we talked 254 00:09:51,730 --> 00:09:53,909 about the way I really believe in robust 255 00:09:53,970 --> 00:09:57,090 process improvement in our last episode. And this 256 00:09:57,090 --> 00:09:59,809 is no different in this project where really 257 00:09:59,809 --> 00:10:01,110 we use lean methodology 258 00:10:01,774 --> 00:10:04,174 to help us streamline direct bedding from the 259 00:10:04,174 --> 00:10:05,394 emergency department. 260 00:10:06,095 --> 00:10:08,174 We started by just mapping out the process 261 00:10:08,174 --> 00:10:10,815 to really understand where the delays in the 262 00:10:10,815 --> 00:10:12,434 handoffs and rework occur. 263 00:10:12,894 --> 00:10:14,835 And then we standardize that work, 264 00:10:15,190 --> 00:10:18,950 therefore reducing unnecessary variation and then eliminating steps 265 00:10:18,950 --> 00:10:21,190 that don't add value. The use of lean 266 00:10:21,190 --> 00:10:23,529 help us to decrease the variation in workflow 267 00:10:23,750 --> 00:10:24,810 between providers, 268 00:10:25,350 --> 00:10:27,290 both ED providers and hospitalists 269 00:10:28,174 --> 00:10:30,595 that that previously led to delays and redundant 270 00:10:30,654 --> 00:10:31,154 handoff. 271 00:10:31,694 --> 00:10:35,235 By standardizing the direct communication between those teams, 272 00:10:35,694 --> 00:10:38,095 that helps to eliminate the non value added 273 00:10:38,095 --> 00:10:41,074 steps and remove barriers to timely bed assignment. 274 00:10:42,269 --> 00:10:45,970 We and this also helps us improve transparency 275 00:10:46,190 --> 00:10:49,549 around throughput metrics and significantly reduce admission to 276 00:10:49,549 --> 00:10:50,049 bedtime. 277 00:10:50,750 --> 00:10:52,909 So this process really helped the team to 278 00:10:52,909 --> 00:10:54,529 empower their frontline teams 279 00:10:54,914 --> 00:10:57,554 to solve problems and shift the culture, again, 280 00:10:57,554 --> 00:10:58,695 from just a reactive 281 00:10:59,394 --> 00:11:02,054 firefighting to disciplined continuous improvement. 282 00:11:02,914 --> 00:11:05,714 Overall, we achieved a measurable reduction in length 283 00:11:05,714 --> 00:11:07,014 of stay from our baseline. 284 00:11:07,549 --> 00:11:09,569 We improved admission to bedtime. 285 00:11:10,110 --> 00:11:12,929 We shortened observation stays, as I mentioned, 286 00:11:13,389 --> 00:11:15,089 to thirty hours and under, 287 00:11:15,470 --> 00:11:18,350 and we improved some other KPIs such as 288 00:11:18,350 --> 00:11:19,730 discharge before noon. 289 00:11:20,615 --> 00:11:23,495 And that translated to really improve access and 290 00:11:23,495 --> 00:11:24,875 decrease in ED boarding, 291 00:11:25,495 --> 00:11:29,095 improving our financial performance, and higher patient and 292 00:11:29,095 --> 00:11:29,995 staff satisfaction. 293 00:11:31,335 --> 00:11:33,274 But I must say, from my perspective, 294 00:11:33,815 --> 00:11:35,914 it really is not just about the metrics. 295 00:11:36,509 --> 00:11:38,610 It really is about shifting the culture, 296 00:11:39,070 --> 00:11:42,050 moving from reactive crisis management to proactive 297 00:11:42,509 --> 00:11:43,649 capacity planning. 298 00:11:44,269 --> 00:11:46,610 We really built a high functioning multidisciplinary 299 00:11:47,149 --> 00:11:47,649 structure 300 00:11:48,204 --> 00:11:51,245 that continues to drive improvement and resiliency across 301 00:11:51,245 --> 00:11:51,904 the organization. 302 00:11:52,764 --> 00:11:54,544 So that culture share from 303 00:11:55,084 --> 00:11:57,725 creating a shared ownership of flow across the 304 00:11:57,725 --> 00:11:58,225 different 305 00:11:58,605 --> 00:11:59,105 multidisciplinary 306 00:11:59,644 --> 00:12:00,704 teams that I mentioned 307 00:12:01,110 --> 00:12:03,450 is what we know will sustain the results 308 00:12:03,509 --> 00:12:04,330 long term. 309 00:12:04,710 --> 00:12:06,889 So this is really exciting work that continues 310 00:12:07,110 --> 00:12:08,789 a day to day, but it's really nice 311 00:12:08,789 --> 00:12:11,769 to see how that structured approach 312 00:12:12,230 --> 00:12:14,389 has allowed the teams to be empowered to 313 00:12:14,389 --> 00:12:15,850 continue to ensure 314 00:12:16,264 --> 00:12:18,664 that their processes are followed. And whenever there 315 00:12:18,664 --> 00:12:19,164 is 316 00:12:19,465 --> 00:12:21,884 opportunities where we may shift or, 317 00:12:22,424 --> 00:12:23,384 there might be, 318 00:12:23,784 --> 00:12:25,404 some, what I call, 319 00:12:26,504 --> 00:12:28,424 metrics that may be not performing well is 320 00:12:28,424 --> 00:12:30,024 to really look at it through the lens 321 00:12:30,024 --> 00:12:32,339 of structural problem solving to say, what's not 322 00:12:32,339 --> 00:12:34,259 working? How do we get back on board? 323 00:12:34,259 --> 00:12:35,879 What do we need to do to engage? 324 00:12:36,579 --> 00:12:38,179 What is it that we're learning from the 325 00:12:38,179 --> 00:12:40,179 teams and do we need to pivot or 326 00:12:40,179 --> 00:12:42,579 or any of those? So pretty exciting work 327 00:12:42,579 --> 00:12:44,519 that, we continue to do. 328 00:12:46,845 --> 00:12:49,264 Very exciting work with some significant 329 00:12:49,644 --> 00:12:51,264 results, as you said. 330 00:12:51,804 --> 00:12:54,065 And I I so appreciate your note about 331 00:12:54,605 --> 00:12:55,105 the 332 00:12:55,725 --> 00:12:56,384 the descriptive 333 00:12:56,764 --> 00:12:58,865 structure being important, but also 334 00:12:59,529 --> 00:13:02,330 the the culture really underpinning everything, as you 335 00:13:02,330 --> 00:13:03,870 said, patient journey, 336 00:13:04,410 --> 00:13:06,190 needing to be everyone's accountability. 337 00:13:06,889 --> 00:13:08,250 I think that's such a key part of 338 00:13:08,250 --> 00:13:08,750 it. 339 00:13:09,210 --> 00:13:11,470 I'm curious now looking ahead and say over 340 00:13:11,769 --> 00:13:12,429 the next, 341 00:13:13,529 --> 00:13:16,105 you know, ten months of 2026, 342 00:13:16,644 --> 00:13:18,644 what would you say are your biggest priorities 343 00:13:18,644 --> 00:13:20,745 and headwinds that you're focused on now? 344 00:13:21,605 --> 00:13:22,825 Yeah. Great question. 345 00:13:24,004 --> 00:13:25,925 It feels like we just came out from 346 00:13:25,925 --> 00:13:26,085 the, 347 00:13:26,840 --> 00:13:29,720 these respiratory surges that we see across the 348 00:13:29,720 --> 00:13:30,779 country. But, 349 00:13:31,320 --> 00:13:34,279 really, looking ahead, our focus is centered on 350 00:13:34,279 --> 00:13:35,580 events in our organizational 351 00:13:35,960 --> 00:13:37,419 key strategic priorities, 352 00:13:38,279 --> 00:13:40,600 while navigating some of these real headwinds in 353 00:13:40,600 --> 00:13:41,419 health care. 354 00:13:42,154 --> 00:13:44,174 A couple I, you know, a couple priorities 355 00:13:44,235 --> 00:13:46,154 are is, you know, one is definitely our 356 00:13:46,154 --> 00:13:47,134 clinical excellence. 357 00:13:47,514 --> 00:13:48,894 It remains our foundational, 358 00:13:50,314 --> 00:13:50,814 priority. 359 00:13:51,194 --> 00:13:54,095 We are continuing to strengthen our, high reliability 360 00:13:54,235 --> 00:13:57,740 practice, reduce preventable harm, and really leverage data 361 00:13:57,740 --> 00:14:00,700 to drive consistent evidence based care across all 362 00:14:00,700 --> 00:14:01,600 service lines. 363 00:14:02,460 --> 00:14:03,899 I will be remiss to say one of 364 00:14:03,899 --> 00:14:05,440 the one of the most important, 365 00:14:06,620 --> 00:14:09,040 factors as well is really improving our consumer 366 00:14:09,100 --> 00:14:09,600 experience. 367 00:14:10,654 --> 00:14:14,274 Patient expect access, transparency, and seamless coordination. 368 00:14:14,735 --> 00:14:16,894 So we're really working to simplify the care 369 00:14:16,894 --> 00:14:17,394 journey, 370 00:14:18,095 --> 00:14:21,554 while expanding digital capabilities and improving communication. 371 00:14:22,659 --> 00:14:24,840 You know, leveraging workforce experience, 372 00:14:26,259 --> 00:14:29,379 or and and elevating workforce experience is also 373 00:14:29,379 --> 00:14:30,279 a top priority. 374 00:14:31,220 --> 00:14:32,980 I mean, I'm sure in talking to other 375 00:14:32,980 --> 00:14:35,220 leaders across the country as you do through 376 00:14:35,220 --> 00:14:35,565 this, 377 00:14:36,205 --> 00:14:39,725 podcast and other avenues of communicating with healthcare 378 00:14:39,725 --> 00:14:42,705 leaders, I'm sure you hear about workforce fatigue, 379 00:14:43,245 --> 00:14:45,664 recruitment pressures, and retention challenges. 380 00:14:46,125 --> 00:14:48,544 And there remain headwinds across the industry. 381 00:14:49,230 --> 00:14:50,769 We are focused on engagement, 382 00:14:51,870 --> 00:14:54,590 leadership development, and create an environment where our 383 00:14:54,590 --> 00:14:58,190 team members feel supported and heard and empowered 384 00:14:58,190 --> 00:14:59,490 to do their best work. 385 00:15:00,429 --> 00:15:01,250 And, again, 386 00:15:01,605 --> 00:15:04,024 financial stewardship underpins everything 387 00:15:04,325 --> 00:15:05,945 with ongoing reimbursement 388 00:15:06,404 --> 00:15:09,205 pressures and rising costs. You know, we have 389 00:15:09,205 --> 00:15:11,365 to stay disciplined. We have to use data 390 00:15:11,365 --> 00:15:12,024 to drive 391 00:15:12,485 --> 00:15:12,985 decisions 392 00:15:13,605 --> 00:15:15,464 and operationally stay efficient 393 00:15:16,029 --> 00:15:19,389 while continuing to invest strategically in quality and 394 00:15:19,389 --> 00:15:19,889 innovation. 395 00:15:20,669 --> 00:15:22,669 So, while, like I said, the headwinds are 396 00:15:22,669 --> 00:15:24,450 definitely our workforce constraint, 397 00:15:24,909 --> 00:15:27,330 regulatory complexity, and margin compression, 398 00:15:28,434 --> 00:15:31,014 which are real. I believe, organizations 399 00:15:31,634 --> 00:15:34,194 that stay anchored in quality, equity, and strong 400 00:15:34,194 --> 00:15:35,174 physician alignment, 401 00:15:36,034 --> 00:15:39,654 really is best positioned to, withstand 2026, 402 00:15:40,834 --> 00:15:42,694 and to thrive beyond that. 403 00:15:43,190 --> 00:15:43,690 Mhmm. 404 00:15:44,230 --> 00:15:46,730 That focus is really core to everything. Right? 405 00:15:46,870 --> 00:15:47,370 Yeah. 406 00:15:48,629 --> 00:15:50,250 As you said, there are a variety 407 00:15:50,629 --> 00:15:53,029 of headwinds that, not just you, but health 408 00:15:53,029 --> 00:15:55,110 system executives across the country are facing right 409 00:15:55,110 --> 00:15:55,850 now, obviously. 410 00:15:56,625 --> 00:15:59,345 Acknowledging those, what do you think specifically is 411 00:15:59,345 --> 00:16:00,785 gonna be the hardest thing that you have 412 00:16:00,785 --> 00:16:02,245 to do over the coming year? 413 00:16:03,345 --> 00:16:05,205 That's a great question, Mackenzie. 414 00:16:06,545 --> 00:16:09,105 I think the hardest thing, in the coming 415 00:16:09,105 --> 00:16:11,769 year will be balancing those financial discipline 416 00:16:12,389 --> 00:16:15,450 with our commitment to clinical excellence and workforce 417 00:16:15,509 --> 00:16:16,009 engagement. 418 00:16:17,110 --> 00:16:19,350 As I said, we can healthcare continues to 419 00:16:19,350 --> 00:16:20,570 face margin pressures, 420 00:16:21,350 --> 00:16:24,389 reimbursement uncertainty, and rise in labor and supply 421 00:16:24,389 --> 00:16:24,889 costs. 422 00:16:25,215 --> 00:16:27,075 But at the same time, we're responsible 423 00:16:27,774 --> 00:16:29,855 for our patients and our teams are having 424 00:16:29,855 --> 00:16:31,634 changed. In fact, the expectations 425 00:16:32,095 --> 00:16:33,955 are even higher than ever. 426 00:16:34,335 --> 00:16:36,355 And so, the challenge is making thoughtful, 427 00:16:36,894 --> 00:16:39,315 data driven decision about resource allocation 428 00:16:40,169 --> 00:16:40,909 without compromising 429 00:16:41,210 --> 00:16:44,110 safety and quality or or access, especially 430 00:16:44,490 --> 00:16:46,269 if you're in community hospitals. 431 00:16:47,370 --> 00:16:49,789 Access can definitely be sometimes a challenge. 432 00:16:50,409 --> 00:16:51,870 Another difficult aspect, 433 00:16:52,654 --> 00:16:54,995 in the coming year is leading through continued 434 00:16:55,054 --> 00:16:56,194 workforce fatigue. 435 00:16:56,894 --> 00:16:58,674 I know that several of my colleagues 436 00:16:59,054 --> 00:17:01,615 within emergency medicine field, as well as in 437 00:17:01,615 --> 00:17:04,595 leadership, have pivoted away from some of that 438 00:17:04,960 --> 00:17:06,500 to other less grueling, 439 00:17:07,039 --> 00:17:07,539 opportunities 440 00:17:08,000 --> 00:17:09,860 due to, just fatigue. 441 00:17:10,880 --> 00:17:13,440 Even as we move toward from the acute 442 00:17:13,440 --> 00:17:14,580 phase of the pandemic, 443 00:17:15,119 --> 00:17:17,279 I think we still see the emotional and 444 00:17:17,279 --> 00:17:17,779 operational 445 00:17:18,080 --> 00:17:18,580 toll, 446 00:17:19,279 --> 00:17:20,019 that remains. 447 00:17:20,434 --> 00:17:21,974 So supporting our teams 448 00:17:22,355 --> 00:17:24,054 while also making sure 449 00:17:24,355 --> 00:17:26,134 that they can adapt to change, 450 00:17:26,674 --> 00:17:29,174 improve efficiency, and embrace innovation, 451 00:17:30,355 --> 00:17:33,075 will require a different type of leadership that 452 00:17:33,075 --> 00:17:33,575 includes 453 00:17:34,194 --> 00:17:34,694 empathy, 454 00:17:35,870 --> 00:17:36,370 transparency 455 00:17:37,470 --> 00:17:39,009 and steadfast leadership. 456 00:17:39,710 --> 00:17:40,850 So I think the ultimately, 457 00:17:41,309 --> 00:17:43,309 you know, the hardest part is making sure 458 00:17:43,309 --> 00:17:45,170 that we make these tough decisions, 459 00:17:45,870 --> 00:17:48,184 but in a way that maintains trust trust 460 00:17:48,184 --> 00:17:50,865 and trust with our frontline team, with our 461 00:17:50,865 --> 00:17:51,365 physicians 462 00:17:51,664 --> 00:17:52,164 teams, 463 00:17:52,545 --> 00:17:54,484 with our nursing team and our community. 464 00:17:55,424 --> 00:17:57,525 That means that we really have to have 465 00:17:57,825 --> 00:17:58,884 really great communication, 466 00:17:59,904 --> 00:18:00,724 shared accountability, 467 00:18:01,184 --> 00:18:03,365 and really staying anchored in our mission. 468 00:18:04,279 --> 00:18:05,640 And I think if we can do these 469 00:18:05,640 --> 00:18:06,140 things, 470 00:18:07,079 --> 00:18:08,380 while very difficult, 471 00:18:09,240 --> 00:18:12,059 that will create opportunities to strengthen the organization. 472 00:18:13,559 --> 00:18:14,059 Absolutely. 473 00:18:15,159 --> 00:18:17,480 Doctor Xavier, I I'm always just, 474 00:18:18,119 --> 00:18:21,005 so impressed that, you know, your your focused 475 00:18:21,225 --> 00:18:24,525 approach, your dedication to quality and clinical excellence, 476 00:18:25,225 --> 00:18:26,985 and it really shines through in in your 477 00:18:26,985 --> 00:18:29,305 remarks today. So thank you so much for 478 00:18:29,305 --> 00:18:31,144 rejoining us on the podcast to give us 479 00:18:31,144 --> 00:18:33,305 a glance into some of your priorities and 480 00:18:33,305 --> 00:18:35,619 focuses right now. We so appreciate it. Is 481 00:18:35,619 --> 00:18:37,299 there anything else you'd like to add or 482 00:18:37,299 --> 00:18:37,960 end on? 483 00:18:38,579 --> 00:18:40,500 No. I think, again, thank you so much 484 00:18:40,500 --> 00:18:42,359 for the opportunity for the conversation. 485 00:18:43,619 --> 00:18:45,559 I really appreciate and enjoy, 486 00:18:46,099 --> 00:18:48,759 you know, these these chats. I think that 487 00:18:48,980 --> 00:18:52,244 as leaders, we are all trying to really 488 00:18:52,244 --> 00:18:53,304 be supportive 489 00:18:53,684 --> 00:18:56,184 and make sure that we are able to 490 00:18:56,404 --> 00:18:58,505 provide what's needed for team members 491 00:18:58,964 --> 00:19:01,044 in a really, in an environment that is 492 00:19:01,044 --> 00:19:01,544 psychologically 493 00:19:01,845 --> 00:19:04,184 safe, that empowers them to be their best, 494 00:19:04,369 --> 00:19:06,049 that empowers them to work at the top 495 00:19:06,049 --> 00:19:06,789 of their license. 496 00:19:07,650 --> 00:19:09,830 And, you know, and, and making 497 00:19:10,210 --> 00:19:12,369 the environment a great place to work. And 498 00:19:12,369 --> 00:19:15,250 I think we, Atlantic Health System, as an 499 00:19:15,250 --> 00:19:17,109 organization, have always prioritized 500 00:19:17,724 --> 00:19:19,964 being a place that our team members can 501 00:19:19,964 --> 00:19:21,964 find a great place to work because we 502 00:19:21,964 --> 00:19:23,505 do provide some of these, 503 00:19:24,284 --> 00:19:25,024 not just, 504 00:19:25,724 --> 00:19:27,964 the ability to feel safe and to, have 505 00:19:27,964 --> 00:19:31,585 joined in work, but also focusing really on, 506 00:19:32,160 --> 00:19:34,900 succession building, workforce development engagement, 507 00:19:35,600 --> 00:19:39,059 leadership support, and really providing the infrastructure 508 00:19:39,759 --> 00:19:41,440 so that they can do their best work 509 00:19:41,440 --> 00:19:43,519 and work, at the top of their license. 510 00:19:43,519 --> 00:19:44,019 So, 511 00:19:44,804 --> 00:19:46,964 you know, at this juncture where we are, 512 00:19:46,964 --> 00:19:47,944 it really is 513 00:19:48,325 --> 00:19:51,144 really enlightening to continue to journey, 514 00:19:51,605 --> 00:19:53,764 with an organization that has such a great 515 00:19:53,764 --> 00:19:56,404 priority on its workforce. So thank you so 516 00:19:56,404 --> 00:19:57,544 much once again. 517 00:19:58,085 --> 00:19:59,144 Hope to see you 518 00:19:59,750 --> 00:20:01,350 one of these good days as, 519 00:20:01,910 --> 00:20:02,890 Yes. I know. 520 00:20:03,190 --> 00:20:04,650 We're excited to conferences. 521 00:20:05,190 --> 00:20:06,630 Yes. We're excited to have you at our 522 00:20:06,630 --> 00:20:07,930 annual meeting in April. 523 00:20:08,309 --> 00:20:10,549 Looking forward to it. Wonderful. Well, thank you 524 00:20:10,549 --> 00:20:12,789 again so much, doctor Xavier. And listeners, thank 525 00:20:12,789 --> 00:20:15,075 you as well for tuning in. You can 526 00:20:15,075 --> 00:20:17,794 find more podcast episodes by visiting the Becker's 527 00:20:17,794 --> 00:20:22,054 podcast page at beckershospitalreview.com/podcasts.